November 11, 2025
4 min read
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Key takeaways:
- The updated guidance highlights best practices for infection prevention and control staffing and preparedness in nursing homes.
- The guidance serves as an update to APIC and SHEA’s 2008 guidance.
For the first time in 17 years, physicians and researchers have published updated guidance for infection prevention and control practices and programs in U.S. nursing homes.
The new document serves as an update to the 2008 guidance released by the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC).
While the 2008 guidelines provided the framework and main points for a nursing home infection prevention and control (IPC) program, the new guidance also offers recommendations for leadership and staffing, personnel and resident adherence to IPC practices and hand hygiene, outbreak preparedness and more.
In addition to SHEA and APIC, the guidance is endorsed by the American Geriatrics Society, the Infectious Diseases Society of America and the Post-Acute and Long-Term Care Medical Association.
“While the basic principles for implementing a nursing home IPC program remain the same, facilities are challenged by the tasks of ensuring their IPC program’s infrastructure and practices evolve to meet the changing care needs of their resident population and responding to the emergence of antimicrobial resistance and novel pathogens,” Lona Mody, MD, MSc, professor of epidemiology and Amanda Sanford Hickey Professor of Internal Medicine at the University of Michigan’s School of Public Health, and colleagues wrote.
We spoke with Mody about the updated guidance and what the authors hope it accomplishes.
Healio: The guidance has not been updated in 17 years. What prompted this update?
Mody: First, with a plethora of literature published every year, it is important to update our guidance with new evidence. Since the last update, several new studies have been published to inform practice in this sector. So, it was first and foremost important to summarize all the knowledge that was gained by some incredible work.
Second, the nursing home industry has gone through many changes — the population has evolved monumentally. Who we serve today in these facilities is very different than back in 2008. Patients admitted for short stays are sicker, have more wounds, devices and are more likely to be on antibiotics.
Third, we suffered a historic pandemic that disproportionately affected nursing homes. All of a sudden, what we feared for a long time became a painful reality. Although the pandemic slowed down our timeline to put this guidance together, it heavily informed the seriousness of our task and our recommendations.
It is no longer possible to not invest time and resources in control, prevention and safety.
Healio: What are the key changes and new recommendations?
Mody: The scope of the guidance has expanded monumentally. We have carefully and thoughtfully outlined resources that are needed to meet the goals of an IPC program, outlined studies and interventions that have shown to be effective in reducing infections and antimicrobial resistance, described stepwise approach to outbreak management and control including respiratory pathogens.
All of this is done by keeping in mind the environment of care that is provided in nursing homes, where we have short-stay but sicker recently hospitalized older adults who will be discharged in 2 to 3 weeks and a long-stay population that will consider these facilities their home. Furthermore, we have characterized ways in which nursing homes can be part of the entire health care eco-system and not operate in silos. All in all, we address 42 different IPC scenarios backed up with evidence and experience.
Healio: Is there anything the new guidance does not address that might be included in a future update?
Mody: Evidence is constantly growing. There were some specific studies that had shown promise but needed more evidence before recommending them into practice. We describe them as supplemental practices. I am certain we will be updating those in the next update — these include specific decolonization strategies, and use of universal vs. targeted surveillance to understand transmission of drug-resistant organisms.
Healio: What are you hoping this new guidance will accomplish?
Mody: We hope that these new guidance can serve as a key reference when revamping the current framework of IPC in nursing homes. We hope that nursing home administrators can take a look at this and allocate adequate resources and support to these programs. Infection prevention in a team sport.
First, we hope that this document serves as a guiding document for infection preventionists to refer to for a myriad of challenges they face in their daily work. Second, we also hope that the infection prevention leader within each nursing home sees a role each and every provider can play and is empowered to serve as their guide and mentor in helping them adopt these practices consistently. We also hope that this document shows how to approach antimicrobial stewardship and reduce antibiotic use in nursing homes. This has direct impact on resident safety and reducing drug-resistant pathogens. Finally, we hope to convey that nursing homes do not need to feel alone in this. We have outlined several ways in which they can engage other health care systems and seek support and guidance.
Healio: What is the clinical take-home message of the updated guidance?
Mody: Since the last update, we have come a long way in terms of building evidence to inform the practice of IPC in nursing homes. This paper outlines these advances. We have a long way to go to address many key questions using strong study designs, however difficult they may be to conduct.
For more information:
Lona Mody, MD, MSc, can be reached at infectiousdisease@healio.com.
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Sources/Disclosures
Source:
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References:
Disclosures:
Mody reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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