Att G.10 LTCF PPM

Prevention Process Measures Surveillance for Long Term Care
Facilities
Background: Healthcare-associated infections (HAIs) can be reduced by adherence to infection
prevention measures . The CDC’s Healthcare Infection Control Practices Advisory Committee
(CDC/HICPAC) Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents
1
in Healthcare Settings recommends practices known to reduce the risk of HAIs. These practices
include hand hygiene, glove use, and gown use. Despite evidence supporting these prevention
measures, adherence to these practices is sub-optimal. Several facilities have found it useful to
monitor adherence to these prevention practices as a method for identifying quality improvement
opportunities and strategically targeting interventions. Feedback of adherence data has been a
component of multifaceted interventions that have successfully reduced HAI rates.
Participation in NHSN Prevention Process Measures Surveillance is open to all types of long
term care facilities (LTCF) including Nursing Homes/Skilled Nursing Facilities;
intermediate/chronic care facilities for the developmentally disabled; Assisted Living Facilities
and Residential Care Facilities. Participation enables facilities and CDC to:
•
•

Monitor practices in facilities and provide aggregate adherence data for all participating facilities.
Facilitate quality improvement by identifying specific gaps in adherence to recommended
prevention practices, thereby helping to target intervention strategies for reducing HAI rates.

1: Healthcare Infection Control Practices Advisory Committee (HICPAC) Guidelines for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare Setting. Available at
www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf
2: Smith et al. SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care
Facility. Infection Control and Hospital Epidemiology 2008;29:785-814.
1. Monitoring Adherence to Hand Hygiene
Introduction: This surveillance option will allow LTCFs to monitor adherence to hand hygiene
after healthcare personnel (HCP) have contact with a resident or objects/surfaces in the
immediate vicinity of the resident (e.g. within resident’s room, equipment handled during
therapy). Research studies have reported data suggesting that improved after-contact hand
hygiene is associated with reduced HAI transmission. While there are multiple opportunities for
hand hygiene during resident care, the focus of this option, is to observe and report adherence to
hand hygiene opportunities only after contact with a resident or the objects/surfaces in the
immediate vicinity of the resident. (www.cdc.gov/handhygiene/ )
Requirements: Surveillance for adherence to hand hygiene in the LTCF for at least one
calendar month as indicated in the Monthly Reporting Plan for LTCF (CDC 57.141). Perform
at least 30 different unannounced observations after contact with residents for as many

individual HCPs as possible. For example, try to observe all types of HCPs (physicians, nurses,
technicians, aides, etc.) performing a variety of resident care tasks during the course of the
month. No personal identifiers will be collected or reported.
Definitions:
Antiseptic handwash: Washing hands with water and soap or other detergents containing an
antiseptic agent.
Antiseptic hand rub: Applying an antiseptic hand-rub product to all surfaces of the hands to
reduce the number of microorganisms present.
Hand hygiene: A general term that applies to either: handwashing, antiseptic hand wash,
antiseptic hand rub, or surgical hand antisepsis.
Handwashing: Washing hands with plain (i.e., non-antimicrobial) soap and water.
Numerator: Hand Hygiene Performed = Total number of observed contacts during which a
HCP touched either the resident or objects/surfaces in the immediate vicinity of the resident and
appropriate hand hygiene was performed.
Denominator: Hand Hygiene Indicated = Total number of observed contacts during which a
HCP touched either the resident or objects/ surfaces in the immediate vicinity of the resident and
therefore, appropriate hand hygiene was indicated.
Hand hygiene process measure data are reported using the Prevention Process Measures
Monthly Monitoring for LTCF form (CDC 57. 143). (See Tables of Instructions Table XX
for completion instructions.)
Data Analysis: Data are stratified by time (e.g., month, quarter, etc.) and resident care location.
Hand Hygiene Percent Adherence = Number of contacts for which hand hygiene was performed
/ Number of contacts for which hand hygiene was indicated X 100

II. Monitoring Adherence to Gown and Gloves Use as Part of Contact Precautions
Introduction: Transmission-based Contact Precautions are additional infection prevention
measures implemented to limit the transmission of pathogens which are spread by direct or
indirect contact with the resident or the resident’s environment. This option will allow facilities
to monitor adherence to gown and gloves use when a HCP has contact with a resident or
objects/surfaces within the resident’s room, only when that resident is on Transmission-based
Contact Precautions. While numerous aspects of adherence to Contact Precautions could be
monitored, this surveillance option is only focused on the use of gown and gloves.
(www.cdc.gov/hicpac/2007IP/2007ip_part1.html#2)

Requirements: Surveillance for adherence to gown and gloves use for at least one calendar
month as indicated in the Monthly Reporting Plan for LTCF (CDC 57.141). Among residents on
Transmission-based Contact Precautions, perform at least 30 unannounced observations. An
observable contact would be the entry of a HCP into the room to interact with a resident on
Transmission-based Contact Precautions. A total of thirty different contacts must be observed
monthly among HCP of varied occupation types. For example, try to observe all types of HCP
performing a variety of resident care tasks during the course of the month, not only nurses, or not
only during catheter or wound care. Both gown and gloves must be donned prior to contact for
compliance. No personal identifiers will be collected or reported.
Definitions:
Gown and gloves use: In the context of Transmission-based Contact Precautions, the donning of
both a gown and gloves prior to contact with a resident or objects /surfaces within the resident’s
room. Both a gown and gloves must be donned prior to contact for compliance.
Numerator: Gown and Gloves Used = Total number of observed contacts between a HCP and a
resident or objects/surfaces within the resident’s room for which gown and gloves had been
donned prior to the contact.
Denominator: Gown and Gloves Indicated = Total number of observed contacts between a
HCP and a resident on Transmission-based Contact Precautions or objects/surfaces in the
resident’s room and therefore, gown and gloves were indicated.
Gown and gloves use process measure data are reported using the Prevention Process
Measures Monthly Monitoring for LTCF form (CDC 57. 143). (See Instruction Table X for
completion instructions.)
Data Analysis: Data are stratified by time (e.g., month, quarter, etc.).
Gown and Glove Use Percent Adherence = Number of contacts for which gown and gloves were
used / Number of contacts for which gown and gloves were indicated X 100