Infection preventionists need to be able to identify any increase in disease frequency and unusual infectious disease occurrences, report the incident to their local health department (LHD) and CDPH Licensing & Certification District office, and implement appropriate infection control measures to protect residents and healthcare workers.
An outbreak is defined by the occurrence of cases of a disease above the expected or baseline level, over a given period of time, in a geographic area or facility. The number of cases indicating the presence of an outbreak will vary according to the disease agent, size and type of population exposed, previous exposure to the agent, and the time and place of occurrence. For example, a single case of a communicable disease long absent from a population or the first invasion by a disease not previously recognized may warrant additional investigation as a possible outbreak.
Outbreaks can result from lapses in infection control practices such as hand hygiene (HH), use of personal protective equipment (PPE), and environmental cleaning and disinfection. Occasionally, outbreaks occur as a result of a contaminated medical product or device.
SNF should ensure consistent implementation and adherence monitoring of evidence-based infection prevention strategies to help prevent outbreaks. See the
Establishing an Effective IP Program webpage for additional information on infection prevention strategies in SNF.
SNF infection preventionists should have policies and procedures in place for what to do as soon as an outbreak is suspected. SNF must report suspected or confirmed outbreaks and unusual infectious disease occurrences to their LHD and CDPH Licensing & Certification District office; see
AFL 19-18 (PDF). In consultation with the LHD, SNF infection prevention staff should gather pertinent information, identify gaps in infection prevention, and implement control measures as recommended by the LHD.
Influenza - Refer to
Recommendations for the Prevention and Control of Influenza in California Skilled Nursing Facilities (SNF) during the COVID-19 Pandemic (PDF)
Appendix A: Sample Surveillance Case Log of Residents with Acute Respiratory Illness and/or Pnuemonia (PDF) Last Reviewed October 25, 2021
Appendix B: Sample Surveillance Case Log of Health Care Personnel with Acute Respiratory Illness and/or Pnuemonia (PDF)- Last Reviewed October 25, 2021
Appendix C: Guidance for POC Diagnostic Testing for Influenza and COVID-19 (PDF) - Last Reviewed November 2022
Influenza Vaccination Resources (PDF)
Legionnaires’ Disease - See
Carbapenem-resistant Enterobacteriaceae (CRE) - See the
CRE for Public Health and Healthcare Providers guidance
See Recommendations for the Prevention and Control of Viral Gastroenteritis Outbreaks in California Long-Term Care Facilities guidance (PDF)
C. difficile infection -
See CDI Prevention for Public Health and Healthcare Providers guidance
Prevention and Control of Scabies in California Healthcare Settings (August 2020) (PDF)
CDPH Scabies Information for Healthcare Professionals and Educational Materials & Resources
NEW! Line List for SNF COVID-19 Outbreaks (Excel)Information collected in the line list will help the SNF organize and present information to leadership on staff and on the facility outbreak.