The Lowdown
Fall 2025

An Educational Resource for Long-Term Care

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​​​​​​​​​​Welcome to the fall issue of The Lowdown, an educational resource focused on promoting resident and healthcare worker health and safety. International Infection Prevention Week is being celebrated October 19–25. As infection prevention is everyone’s responsibility within a facility, this newsletter is dedicated to the ancillary departments ​that are important members of the infection prevention team! Happy reading!

It Takes the Village!

Good infection prevention practices prevent harm and increase resident safety. Techniques such as hand hygiene,cough and sneeze etiquette, and injection safety helpprovide a safe environment for residents, visitors, and staff.1

Everyone plays a vital role to stop the spread of germs.Staff must be educated on good infection preventionpractices and monitored for compliance. Teamworkand good communication also help build a culture ofsafety. Resident harm can occur if staff hesitate to reportpoor infection prevention practices. Staff should feelcomfortable reporting safety concerns without fear ofretribution. Residents and family members play a roleby practicing good infection prevention, including handhygiene, using personal protective equipment (PPE) appropriately, not visiting when sick, and being up to date on vaccinations.1-3

Practices staff can follow to decrease transmission of pathogens and reduce the risk of infection include:1-3
  • Practice good hand hygiene with alcohol-based hand rub or soap and water.
  • Wear appropriate PPE according to facility policies.
  • Clean and disinfect the environment and equipment.
  • Handle waste and biohazards safely.
  • Don’t touch your face; avoid the T-zone (eyes, nose, mouth).
  • Practice good cough and sneeze etiquette.
  • Stay home when sick.
  • Be current on all recommended vaccinations.
  • Practice standard precautions at all times for all residents.

​

​Unsung Heroes!

Environmental Services

Environmental services (EVS) are a critical part of the healthcare team to prevent and control the spread of infection! Practicing good environmental hygiene will help win the battle of infection control and promote a safe environment for residents, visitors, and healthcare personnel. The resident environment can facilitate transmission of bacteria and viruses. Enterococci and staphylococci can survive for days to months on surfaces!4

Environmental cleaning tips to consider:4,5
  • Make policies and procedures for routine cleaning and disinfection part of your facility’s infection prevention plan.
  • Emphasize high-touch surfaces.
  • Assign responsibility for cleaning to properly trained personnel.
  • Monitor cleaning practices to ensure they are performed correctly and consistently, and provide timely feedback.
  • Use an Environmental Protection Agency (EPA)–registered disinfectant labeled for use in healthcare and follow the manufacturer’s instructions for use (e.g., amount, dilution, contact time, safe use, disposal).
  • Label containers with date and time.
  • Document completion of terminal and scheduled cleanings using a standard checklist and/or log.
  • Spray bottles can aerosolize microorganisms and may not completely wet the surface well enough to have the appropriate contact time.
When using an EPA-registered disinfectant labeled for use in healthcare, look for the following information on the label:
  • Precautions to take when applying the product, such as wearing gloves
  • Whether the disinfectant is safe for the surface to be cleaned
  • Whether the disinfectant needs to be diluted with water before use
  • How to apply the disinfectant to a surface
  • How long the disinfectant must remain wet on the surface to be effective (contact time)
  • Whether the surface needs to be cleaned first and/or rinsed afterwards​
If using disinfectant ​wipes, remember “Keep It Wet!” The area being disinfected needs to remain wet for the stated contact time. Keep the top of the dispenser closed to prevent the wipes from drying out and use the right size wipe for the size of the surface being cleaned and disinfected. Small wipes are fine for bedside tables and use larger wipes for mattress covers. Proper use and storage of disinfectants is key.4,5

Additional environmental cleaning tools and resources are available from the Centers for Disease Control and Prevention (CDC) at cdc.gov/infection-control/php/ evaluating-environmental-cleaning/.

Certified Nursing Assistants

Certified nursing assistants (CNAs) play an important role in infection identification because they provide most of the hands-on care. CNAs typically have keen observational abilities, are attuned to the resident’s baseline status, and are likely to note subtle changes quickly. Educate CNAs on the signs and symptoms of infection as defined in the revised McGeer criteria to leverage their often unique and important perspective.6-8

Research shows good oral hygiene reduces the risk of cavities—and of developing an infection. Infections in the 
mouth can spread and lead to severe complications, such as endocarditis (inflammation of your heart’s inner lining), as well as sepsis.9 Providing residents with good personal hygiene, such as bathing, handwashing, and shampooing, helps to stop the spread of germs and illnesses, such as gastroenteritis (stomach infection) and the common cold.10

Encouraging and assisting your residents with their diet is important. Hydration and nutrition help the immune system function well. Water helps the body absorb nutrients and minerals, and assists in removing body waste.10,11

Facilities and Maintenance

The facilities/maintenance team is vital to resident safety by maintaining a secure, therapeutic environment. A safe, well-maintained facility impacts resident physical and mental health. The team accomplishes this by promoting safety and compliance with regulations, supporting infection prevention, and optimizing facility efficiency and operation.12-15

Laundry

Laundry in a facility includes a variety of items, such as sheets and blankets, towels, and a resident’s personal clothing. Contaminated linen often contains a high number of microorganisms from skin and body fluids and may transmit disease when handled inappropriately. Bacteria, viruses, fungi, and scabies can spread from contaminated linen to staff by direct contact or aerosolization of lint from shaking, sorting, or handling the linen inappropriately.15,16

Hygienically clean laundry, laundry considered free from pathogens that could cause illness, is processed with a combination of soil and pathogen removal and pathogen inactivation. It poses a minimal risk of transmitting pathogens to staff and residents if it is not contaminated before use.15,16

Properly transporting, processing, and storing linen is important to prevent transmission. Minimizing how much unclean linen is handled may help prevent generating lint aerosols in resident-care areas. Sorting or rinsing dirty laundry where contamination occurred is prohibited by the Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard [29 CFR 1910.1030(d)(4) (iv)(A)(1)]. Staff should use PPE when handling dirty linen. Never carry contaminated linen against your body or down the hallway. It should be placed in a laundry bag or hamper at the point of use. All linen (clean and dirty) should be covered during transport and when stored on the unit.16

Dietary

A healthy diet is essential to maintain a strong immune system. Poor nutrition can affect heart health and weaken bones, muscles, and the immune system.11 Communal dining provides several benefits for residents, including better nutrition and the opportunity for social interaction, but also poses infection control risks. Close contact with others while dining may lead to gastrointestinal infections, such as norovirus and Clostridioides difficile, and respiratory infections, such as influenza or RSV.17

Dietary staff play an essential role in preventing the spread of illness and promote safety before, during, and after meals.

References

  1. Centers for Disease Control and Prevention. Guidelines for Environmental Infection Control in Health-Care Facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm. Published June 6, 2003. Accessed August 27, 2025.
  2. Green D. Standard and Transmission-Based Precautions. In: Franck JN, Bodily-Bartrum M, eds. Infection Prevention Guide to Long-Term Care. 2nd ed. Association for Professionals in Infection Control and Epidemiology, Inc; 2019:66–78.
  3. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Centers for Disease Control and Prevention website. https:// www.cdc.gov/infection-control/hcp/isolation-precautions/. Updated 2023. Accessed August 27, 2025.
  4. Agency for Healthcare Research and Quality. Clean Equipment and Environment Promotes Safe Patient Care. AHRQ. www.ahrq.gov/hai/quality/ tools/cauti-ltc/modules/implementation/education-bundles/infection-prevention/environment-and-equipment/environ-equip-slides.html.  Published March 2017. Accessed August 27, 2025.
  5. Centers for Disease Control and Prevention. Healthcare Associated Infections: Prevention Toolkits - Options for Evaluating Environmental Cleaning. CDC. https://www.cdc.gov/infection-control/php/evaluating-environmental-cleaning/. Updated March 28, 2024. Accessed August 27.2025.
  6. Allemann H, Sund-Levander M. Nurses’ Actions in Response to Nursing Assistants’ Observations of Signs and Symptoms of Infections Among Nursing Home Residents. Nurs Open. 2015;2(3):97-104. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006863/
  7. Ball, W. (2020) Sweet Sixteen: Top Qualities of a Great CNA. https://cna.plus/certified-nurse-assistant-top-qualities/
  8. Tingström P, Milberg A, Sund-Levander M. Early Nonspecific Signs and Symptoms of Infection in Institutionalized Elderly Persons: Perceptions of Nursing Assistants. Scand J Caring Sci. 2010 Mar;24(1):24-31. doi: 10.1111/j.1471-6712.2008.00680.x; PMID: 19954493.
  9. Sepsis Alliance. Keeping Up Oral Hygiene Reduces Risk of Infection. Sepsis Alliance. https://www.sepsis.org/news/keeping-up-oral-hygiene-reduces-risk-of-infection/. Published October 9, 2018. Accessed August 27, 2025.
  10. Ames H. Why Is Personal Hygiene Important? Medical News Today. www.medicalnewstoday.com/articles/personal-hygiene. Updated July 8, 2025. Accessed August 27, 2025.
  11. Whitley M. How to Improve Immune System in Elderly: 10 Key Ways. A Place for Mom. https://www.aplaceformom.com/caregiver-resources/ articles/immune-system-boosters. Updated March 9, 2021. Accessed August 27, 2025.
  12. LTC News. Care Home Maintenance: 4 Key Things to Consider. LTC News. https://www.ltcnews.com/articles/care-home-maintenance-4-key-things-to-consider. Published November 20, 2023. Accessed 8/27/2025.
  13. DimoMaint. Ensuring Well-being in Nursing Homes: Maintenance and Management of Essential Assets. DimoMaint. https://www.dimomaint.com/ blog/nursing-home-essential-assets-maintenance/. Accessed 8/27/2025.
  14. Kensky C. Engineering Enables Upgrades to Support a Thriving Senior Living Community. McKnight’s Senior Living. https://www. mcknightsseniorliving.com/home/columns/guest-columns/engineering-enables-upgrades-to-support-a-thriving-senior-living-community/. Published December 2, 2024. Accessed 8/27/2025.
  15. American Healthcare Association, National Center for Assisted Living. Tips for Meeting the Linen Requirements in Skilled Nursing Facilities. AHCA/NCAL National Infection Prevention Forum. https://www.ahcancal.org/Quality/Clinical-Practice/Documents/Tips%20for%20Meeting%20 the%20Linen%20Requirements%20in%20SNF%20LTC.pdf. Accessed August 27, 2025.
  16. Centers for Disease Control and Prevention. Laundry and Bedding. https://www.cdc.gov/infection-control/hcp/environmental-control/laundry-bedding.html. Updated January 8, 2024. Accessed August 27, 2025.
  17. Lamphier I. Dining Recommendations for Long-Term Care Facilities. Infect Control Today. 2024;28(4):10-11. Available from: https://www. infectioncontroltoday.com/view/dining-recommendations-long-term-care-facilities