Best Practices for Reducing Bioburden in Longterm Care Facilities

Long-term care facilities have some unique characteristics that require special attention above and beyond standard hospital-grade infection control protocols. We can consider the appropriate prevention and control actions in the context of common infection transmission routes:

  • Direct contact — Physical contact with an infected person.
  • Indirect contact — From a contaminated object or person (uniforms, gowns, and other clothing; shared activity equipment is a common source).
  • Droplet — From an infected person’s respiratory tract during coughing, sneezing or talking. Zone of risk can be up to six feet.
  • Airborne — Small particles remain suspended in air and can be inhaled by susceptible people.
  • Environmental — Via construction dust, insects, pests and similar environmental sources.

The Centers for Disease Control (CDC) issues detailed infection control guidelines for long-term care facilities.
Here is a quick overview of precautions and considerations in those facilities. Some apply to only one of the infection transmission methods; others work against multiple transmission mechanisms.

Hand Hygiene

  • Use an alcohol-based hand rub when hands are not visibly soiled, after contact with objects near a resident, and after removing gloves and other personal protective equipment (PPE).
  • Wash hands with an antimicrobial soap and water when hands are visibly dirty or contaminated.
  • Follow CDC guidelines for hand hygiene.

Use of Personal Protective Equipment (PPE)

  • Gloves—disposable (latex or nitrile) medical examination gloves for direct care; reusable utility gloves for environmental or equipment cleaning.
  • Use mask, gown, face shield, and/or eye protection during patient care activities that may cause splashes or sprays.
  • Remove and dispose of PPE before leaving the resident’s room.

Respiratory Hygiene

  • Cover your mouth and nose with a tissue whenever you cough and promptly dispose of used tissues.
  • Perform hand hygiene after contact with respiratory secretions.
  • Offer masks to coughing residents, staff, or visitors and encourage them to maintain approximately three feet (one meter) distance from others. If zone is six feet, wouldn’t that be a better recommendation?

Equipment and Devices

  • Each facility should have a strategy for dealing with single-use medical devices and equipment.
  • A central area should be allocated for cleaning, disinfecting and/or sterilizing equipment and devices for use.
  • Written policies and staff training on treatment of devices and equipment are essential.
  • Cleaning and disinfecting processes should be consistently monitored to ensure quality and compliance.

Employee Personal Hygiene 

  • Daily showers or baths.
  • Clean, neatly trimmed, unpolished nails, no false nails.
  • Clean uniform every day. Change when leaving the facility.

Signage In the interest of preventing the spread of infection, it’s hard to post too many reminders. Respect for the resident’s privacy is an important concern as well. Signs should remind residents, visitors, and staff about:

  • hand hygiene,
  • maintaining safe distances,
  • disinfecting care equipment or dedicating it to a single resident
  • using PPE, and
  • checking with the nursing station before entering the room

Environmental Services

  • Cleaning and disinfecting should be continuously performed.
  • Clear standards for cleaning and disinfecting should be defined and it should be similarly clear who is accountable for compliance.
  • Continuing education of cleaning staff is essential.
  • Cleaning practices should be routinely monitored and audited.

Pets and Service Animals

  • Service animals, pets, pet therapy animals can harbor and pass germs or parasites to humans, or spread animal diseases to humans.
  • Follow all the same precautions after contact with pets as after contact with humans.
  • Maintain regular veterinary care.
  • Make sure the animal’s diet uses uncontaminated food and water.
  • Provide flea and tick control.


  • Use clean linen cart covers to protect clean linen from contamination.
  • If clean linen comes in contact with any contaminated object, it should be rewashed.
  • Keep clean linen carts separated from soiled linen carts or hampers.
  • Handle soiled linen carefully, using gloves to handle contaminated linens.
  • Never shake out dirty linen as it may cause germs or bacteria to become airborne.