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healthcare-associated infections (HAI) program

​  Infectious Disease bookEstablishing an Effective Infection 
  Prevention and Control Program


A SNF infection prevention (IP) program includes evidence-based practices to prevent healthcare-associated infections (HAI) and provide safe, quality resident care.

What makes an effective SNF IP program?

An effective IP program must be managed by a trained infection preventionist who ensures that written infection prevention policies and procedures are adhered to by healthcare providers (HCP). Active administrative support and an engaged staff are essential to an effective IP program.

What elements should be included in a SNF IP program?

A SNF IP program includes but is not limited to:  



​Visible, tangible leadership support for IP

  • ​Leadership accountable for the success of infection prevention activities
  • Sufficient resources allocated so that infection prevention practice adherence is feasible
  • Individual with infection prevention training assigned to manage the program is given support and authority

​A written annual risk assessment

  • ​Numbers of HAI in the facility over the past year
  • Gaps in infection prevention care practices such as hand hygiene, Standard and Transmission-based precautions, environmental cleaning and disinfection
  • Community rates of infectious disease such as tuberculosis (TB) and influenza
    • Review local public health reports for these data

                                                                                                                         Sample annual risk assessment (EXCEL)

​A written IP plan based on the annual risk assessment

  • ​The role of the Infection Preventionist
  • Infection prevention goals for the year
  • HAI surveillance to be conducted, such as incidence of C. difficile infections (CDI), urinary tract infections (UTI), pneumonia, scabies, etc.
  • How infections will be recorded and reported
  • Policies and procedures to prevent transmission of infection
  • How and where adherence monitoring will be performed
  • How feedback will be given to HCP

                                                                                                                           Sample annual IP program plan (PDF)

IP policies and procedures based on current, evidence-based recommendations

  • ​Standard and Transmission-based precautions
  • Respiratory hygiene/cough etiquette
  • Cleaning and disinfection of the environment and resident care equipment, including “who cleans what”
  • Use of Environmental Protection Agency (EPA)-approved cleaning agents according to manufacturer instructions
  • Evidence-based methods to prevent infection for residents with invasive devices such as urinary catheters, ventilators or intravascular devices
  • Vaccination for residents and HCP
  • Screening and work restrictions to prevent HCP with a communicable illness from  working with residents while ill or infected

​Adherence monitoring and feedback

  • ​Standardized tools and definitions to monitor HCP adherence to infection prevention practices
  • Prompt, regular performance feedback to HCP and leadership

                                                                                                                             CDPH Adherence Monitoring Tools and References for SNF

​HCP education

  • ​Job-specific infection prevention training
  • New hire and annual training on hand hygiene, Standard and Transmission-based precautions, bloodborne pathogen exposure, environmental cleaning, linen handling, and hazardous waste disposal
  • Additional training when gaps in care practice adherence or increased infection rates noted

Patient, family, caregiver education

  • ​Appropriate infection prevention education to patients, family members, visitors, and others included in the caregiving network
  • Include:
    • How infections are spread
    • How they can be prevented
    • What signs and symptoms should prompt evaluation
    • Instructional materials that address varied levels of education, language, comprehension, and cultural diversity

Occupational health

Antibiotic Stewardship Program

  • Element 1: Leadership commitment
  • Element 2: Accountability of leader for ASP outcomes
  • Element 3: Drug expertise access
  • Element 4: Action to implement at lease one intervention to improve antibiotic use
  • Element 5: Tracking antibiotic use practices and outcomes
  • Element 6: Reporting antibiotic use to physicians, nurses and relevant staff
  • Element 7: Education for clinical providers and nursing staff on rationale and goals


What makes an IP program effective throughout the facility?

An effective IP program must engage participation from multiple disciplines facility wide, including Administration, Nursing, Environmental Services, Pharmacy, Dietary, Engineering, and other ancillary departments.

What practices must all HCP follow for every care encounter?

Use Standard Precautions to care for all patients in all settings.



​Standard Precautions

  • Hand hygiene
    • Alcohol hand rub is acceptable for hand hygiene unless hands are visible soiled, or during a C. difficile or norovirus outbreak
    • Use soap and water when hands are visible soiled
  • Environmental cleaning and disinfection
  • Injection and medication safety
  • Assess the risk of transmission in task to be performed to select appropriate personal protective equipment (PPE) including gloves, gowns, face masks
  • Minimize potential exposures through respiratory hygiene and cough etiquette
  • Reprocessing reusable medical equipment between each patient and when soiled

Transmission-based Precautions, as necessary (PDF)

  • ​Additional precautions needed for patients with documented or suspected diagnoses where contact with the patient, their body fluids, or their environment presents a transmission risk despite adherence to Standard Precautions
  • Include the use of appropriate PPE specific to the mode of pathogen transmission:
    • Contact, Droplet, and Airborne precautions

​Early, prompt removal of invasive devices

  • ​During each healthcare encounter, assess the medical necessity of any invasive device to identify the earliest opportunity for safe removal
    • Vascular catheter
    • Indwelling urinary catheter
    • Feeding tube
    • Ventilator
    • Surgical drain

What are Enhanced Standard Precautions?

Enhanced Standard precautions (AFL 22-21) (PDF) is a resident-centered and activity-based approach for preventing MDRO transmission in SNF.  The use of gowns and gloves by HCP during specific care activities is based on periodic assessments of a resident's risk for being colonized and transmitting MDRO, whether or not the resident is known to be MDRO colonized or infected.

Use this tool to determine if staff members are correctly adhering to Enhanced Standard Precautions practices. Feedback of results to staff has been shown to increase adherence to these practices.

Six Moments of Enhanced Standard Precautions Sign (PDF)

Six Moments for Enhanced Standard Precautions Trifold Pamphlet (PDF) 

Visit the ESP webpage​ for additional information on ESP and educational resources.

What is interfacility communication?

Interfacility communication between healthcare facilities, such as SNF, hospitals, and outpatient clinics, provides critical patient information to inform the receiving facility of appropriate infection prevention precautions upon arrival. All healthcare facilities may use or adapt the CDPH Healthcare Facility Transfer Form (PDF) and learn more about interfacility communication on the Interfacility Transfer Communications Guide webpage.

What are the education requirements for the SNF Infection Preventionist, and what educational courses are available?  

The SNF infection preventionist requires additional education to understand her/his unique function and role. In addition, the Centers for Medicare and Medicaid Services (CMS) requires (§483.95(e) PDF) the SNF IP to complete an infection prevention course (PDF).

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