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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 in Healthcare Settings1 recommends practices known to reduce the risk of HAIs. These
practices include hand hygiene, gloves 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 rates2.
Participation in NHSN Prevention Process Measures Surveillance is open to all types of long
term care facilities (LTCF) including Nursing Homes/Skilled Nursing Facilities
(LTC:SKILLNURS); intermediate/chronic care facilities for the developmentally disabled
(LTC:DEVDIS; Assisted Living Facilities and Residential Care Facilities (LTC:ASSIST).
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
(HH) 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). For the purposes of monitoring, HCP include all staff members providing direct care
for residents (for example, physicians, nurses, certified nursing assistants, therapists), as well as
staff members who perform services in resident care areas (for example, environmental
services, and meal delivery). Research studies report data suggesting that improved aftercontact HH is associated with reduced HAI transmission. While there are multiple opportunities
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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: Facilities must indicate their reporting for the calendar month in the Monthly
Reporting Plan for LTCF (CDC 57.141). Surveillance for hand hygiene adherence in the LTCF
must be reported for at least 6 consecutive months to provide meaningful measures.
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.
Hand hygiene process measure data are reported using the Prevention Process Measures
Monthly Monitoring for LTCF form (CDC 57. 143). (See Tables of Instructions for
instruction on how to complete this form.)
Definitions:
Antiseptic hand wash: 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 organisms present.
Hand hygiene: A general term that applies to either: hand washing, antiseptic hand wash,
antiseptic hand rub, or surgical hand antisepsis.
Hand washing: Washing hands with water and plain (i.e., non-antimicrobial) soap.
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 a resident or objects/surfaces in the immediate vicinity of the resident and
therefore, appropriate hand hygiene was indicated.
Data Analysis: Data are stratified by time (e.g., month, quarter, etc.).
Hand Hygiene Percent Adherence = Number of contacts for which hand hygiene was performed
/ Number of contacts for which hand hygiene was indicated X 100.

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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 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: Facilities must indicate their reporting for the calendar month in the Monthly
Reporting Plan for LTCF (CDC 57.141). Surveillance for gown and gloves use adherence in the
LTCF must be reported for at least 6 consecutive months to provide meaningful measures.
Perform at least 30 different unannounced observations for as many individual HCP as
possible. An observable contact would be the entry of a HCP into a room to interact with a
resident on Transmission-based Contact Precautions. Try to observe all types of HCPs
(physicians, nurses, therapists, aides, etc.) performing a variety of resident care tasks during the
course of the month (e.g., 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.
Gown and gloves use process measure data are reported using the Prevention Process
Measures Monthly Monitoring for LTCF form (CDC 57. 143). (See Tables of Instructions for
instruction on how to complete this form.)
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, when that resident is on Transmissionbased Contact Precautions, for which gown and gloves were donned prior to the contact.
Denominator: Gown and Gloves Indicated = Total number of observed contacts between a
HCP and a resident or objects/surfaces within the resident’s room on Transmission-based
Contact Precautions, gown and gloves were indicated.
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.
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