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Guidelines and Information for Nursing Homes and Assisted Living Facilities (Long Term Care Facilities [LTCFs])


Nursing homes, skilled nursing facilities, and assisted living facilities (collectively known as long term care facilities [LTCFs]) are an important part of any healthy community. 
By providing necessary services and support to people who are unable to manage independently, LTCFs play an essential role in the health and well-being of the elderly in our community. 
Orange County is home to more than 75 LTCFs admit over 35,000 patients annually. 

Disease Outbreaks

LTCFs are at particular risk for infectious disease outbreaks.  There are a number of things LTCFs can do to prevent outbreaks from occurring and to control outbreaks if they do occur.  General measures include:

  • The easiest, and most effective prevention measure is proper hand hygiene
  • Long term care facility staff should stay home if they have symptoms of infectious illness, particularly flu-like or gastrointestinal symptoms.
  • Facility surveillance Is also critical in the fight to stop the spread of disease.  The CDC’s National Healthcare Safety Network provides long-term care facilities with a customized system to track infections and illness outbreaks.

Specific Pathogens:


Active daily surveillance (see CDC Guidelines) for influenza illness should be conducted among all new and current residents, staff, and visitors at all LTCFs year-round, and particularly during influenza season. Preventing the spread of the influenza virus requires preventive measures such as vaccination and testing, and control measures like enhanced surveillance and antiviral treatment.

An influenza outbreak is reportable from LTCFs when there is ONE confirmed case, and ONE additional individual who is exhibiting influenza like illness (ILI) symptoms. If an outbreak does occur, the CDC recommends that facilities administer influenza antiviral treatment to those ill, as well as chemoprophylaxis to all residents, and offer antiviral prophylaxis to all healthcare personnel.

Influenza Resources:

Legionnaire’s Disease

Legionnaire’s Disease (LD) is a respiratory bacterial pathogen that causes pneumonia, leading to hospitalization or even death.  LD is transmitted through inhalation or aspiration of water contaminated with Legionella.  In recent years, Orange County has seen an increasing number of healthcare-associated LD, including cases in LTCF residents.  If a patient in your facility is diagnosed with LD, it is required that you report the incident to the OCHCA. Facilities are also recommended to develop water system plans to reduce the risk of Legionella becoming established.

LD Resources:


Contained populations such as those in LTCFs are at particular risk of norovirus outbreaks, and the elderly are at particular risk of severe symptoms when infected with norovirus. Norovirus is extremely contagious and is primarily spread from contaminated hands to the mouth and ingested.  Facilities should enhance transmission prevention precautions whenever an outbreak of gastrointestinal illness occurs. Quick identification and response when early in an outbreak is critical to prevent the spread of norovirus.

Norovirus Resources:

Antimicrobial Resistance

Antibiotics have been used for over 70 years to help fight off illness and death from infectious diseases. However, because of widespread use, misuse, and over use of these drugs, the organisms they target have developed resistance, rendering many antibiotics ineffective.  Of particular concern are pathogens such as Methicillin-resistant Staphylococcus aures (MRSA), extended spectrum beta-lactamase producing Enterobacteriaceae (ESBL), Carbapenem-resistant Enterobacteriaceae (CRE), and Clostridium difficile (C. difficile).  The CDC’s Threat Report classifies these four pathogens as urgent and serious threats to public health.  Combined these pathogens cause over 350,000 serious infections per year.  The Orange County Healthcare Agency is dedicated to reducing the spread of these organisms through programs such as SHIELD, the C. diff Collaborative, and enhanced surveillance efforts (see MDRO Health Order).

General Antimicrobial Resistance Resources:


The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of Multidrug-resistant organisms (MRDOs) in Orange County (SHIELD) Project is a CDC-initiated collaborative among local, state, and national health departments.
Through the use of patient decolonization in Long Term Care Facilities and Hospitals, SHIELD aims to reduce multi-drug resistant pathogens in Orange County. 

SHIELD Resources:

Orange County C. difficile Infection Collaborative

The Orange County C. diff Collaborative is a combined effort between OCHCA, the California Department of Public Health, and County healthcare facilities to reduce the prevalence and spread of C. difficile in healthcare settings.  The collaborative aims to guide facilities on best practices for in and out transfer of infected patients, as well as the prevention of patients through eliminating the improper use of antibiotics.  It provides assistance for individual facility surveillance and antimicrobial stewardship programs, and encourages the use of a standardized patient transfer form when moving patients in or out of a LTCF.


Other Resources

Last reviewed January 30, 2019