How to Reduce the Risk of Infection in Nursing Homes

Infections are among the most frequent and most preventable causes of harm in long-term care. Residents live close together, share staff and equipment, and many have weakened immune systems, wounds or devices such as urinary catheters. For directors of nursing, administrators and infection preventionists, the question is rarely whether infections will occur, but how quickly they are detected and how far they spread. This guide looks at how to reduce the risk of infection in nursing homes in practical terms: the structure of a strong program, the daily behaviors that matter most, the clinical realities of older residents, and how to handle visitors and families without losing the warmth that makes a community feel like home.

Start with a real program, not a binder

In the United States, federal requirements for participation (42 CFR 483.80) ask every certified nursing home to maintain an infection prevention and control program, to designate at least one infection preventionist who works at least part time at the facility and has completed specialized training, and to run an antibiotic stewardship program with protocols and a system to monitor antibiotic use. Surveyors review this under tag F880 and related tags. Meeting the rule on paper is not the same as having a living program, though. An effective program has a yearly facility risk assessment, written policies that staff can actually find, a surveillance routine, regular rounds on every shift and a clear line from data to action. The infection preventionist needs protected time, not a role squeezed between other duties.

Hand hygiene and standard precautions every day

Most transmission in care settings travels on hands, gloves, gowns and shared equipment. Hand hygiene remains the foundation of how to reduce the risk of infection in nursing homes, and it depends far more on systems than on reminders. Alcohol-based hand rub should be within arm's reach at the point of care, including on medication carts and outside each room. Soap and water are still needed when hands are visibly soiled and when caring for residents with suspected Clostridioides difficile or norovirus, since alcohol is less effective against them. Standard precautions apply to every resident, every time: gloves for contact with body fluids, eye protection when splashes are possible, safe handling of sharps, and cleaning and disinfecting shared equipment such as blood pressure cuffs, glucometers and lifts between residents.

• Place hand rub dispensers where care happens, and check weekly that none are empty.
• Run short, frequent observations of hand hygiene on all shifts, and share the results with teams rather than individuals alone.
• Make glove removal followed by hand hygiene a coached habit, since gloves are not a substitute for clean hands.
• Assign clear responsibility for cleaning each piece of shared equipment, with a simple log.
• Help residents clean their hands before meals and after using the bathroom; they are part of the chain too.

Enhanced barrier precautions and targeted measures

Since April 2024, CMS surveyor guidance has incorporated the CDC's enhanced barrier precautions for nursing homes. They are designed to limit the spread of multidrug-resistant organisms without the isolation of traditional contact precautions. Staff wear a gown and gloves during high-contact care activities, such as dressing, bathing, toileting, transfers, changing linens, device care and wound care, for residents who are infected or colonized with a targeted organism and for residents with chronic wounds or indwelling devices, even if their status is unknown. Because these residents can still join meals and activities, the approach protects quality of life. Pair it with good catheter practice, careful wound care and an antibiotic stewardship program that avoids treating asymptomatic bacteriuria, a common driver of unnecessary antibiotics.

Geriatric realities: atypical presentation and immunosenescence

Older bodies respond to infection differently. Immunosenescence, the gradual decline of the immune system with age, makes residents more susceptible and can blunt the usual signals. Many frail older adults do not develop a high fever; an infection may instead appear as delirium, a fall, loss of appetite, new incontinence or a sudden decline in function. Geriatricians call this atypical presentation, and it is the reason front-line aides are your best early warning system. Teach staff to report any change from a resident's usual baseline, not only classic symptoms, and give nurses a structured tool for escalation. Tracking these early signals, together with lab results and antibiotic starts, is the core of surveillance that catches clusters before they become outbreaks.

The human side: presenteeism and the cost of isolation

Infection control is also a behavioral challenge. Organizational psychology describes presenteeism: working while unwell, often out of loyalty to colleagues, fear of losing income or worry about short staffing. In a nursing home, one aide with a respiratory or gastrointestinal illness can start an outbreak. Clear sick leave policies, a culture where calling in sick is respected, and contingency staffing plans are therefore infection prevention tools. Isolation has a human cost on the resident side as well. Loneliness and social isolation are linked to depression and to cognitive and physical decline, so the least restrictive measure that works should always be preferred. Our article on preventing loneliness in older adults explains why this matters so much.

Vaccination, visitors and communication with families

Federal rules require nursing homes to educate residents or their representatives about influenza and pneumococcal vaccines and to offer them, and current CDC guidance also covers COVID-19 and RSV vaccination for older adults. Keep a clear record of offers, acceptances and refusals, and encourage staff vaccination. Visitors are part of resident well-being, and CMS guidance expects visitation to remain open, with limits only when they are clinically justified. A good visitor policy relies on simple core practices: hand hygiene at entry, signage asking anyone with symptoms of a contagious illness to postpone their visit, and masks available during outbreaks. Explaining the reasons openly helps families see themselves as partners in how to reduce the risk of infection in nursing homes, rather than as people being kept out.

Clear communication is especially valuable during an outbreak, when families worry and phones ring constantly. Palermia gives your team one place to share updates: staff can post photos of residents' days, record meals and medication, and answer families through direct messages. When visits must be adapted for a few days, families can still see how their relative is eating and spending time, which reduces anxiety and calls to the front desk. It also supports the daily contact described in our piece on why daily communication improves well-being. See how it works

There is no single trick for how to reduce the risk of infection in nursing homes. Results come from a consistent program, reliable hand hygiene, targeted precautions, attentive aides who notice small changes, supportive staffing policies and honest communication with residents and families. Review your data regularly, celebrate improvements with your teams and stay up to date with guidance from the CDC, CMS and your state health department, which is updated as new evidence emerges. Clinical decisions about individual residents should always be made with the attending physician and your medical director.