Preventing Antimicrobial Resistance in Long-Term Care
Preventing Antimicrobial Resistance in Long-Term Care | Practical Guidance for Safer Resident Care
Antimicrobial resistance is becoming a larger challenge across the entire healthcare system, and in long-term care it can have a direct and immediate impact on residents. Many of our residents are recovering from recent hospital care or are living with chronic conditions that make infections harder to fight. They depend on us to create an environment that protects them and gives them the best chance at staying well.
The Centers for Disease Control and Prevention recently shared an email update on antimicrobial resistance and the role healthcare organizations play in prevention. Much of it reinforces what long-term care professionals already know, but the reminder is timely. Infection prevention and careful antibiotic use can make a meaningful difference in quality of life and safety for the people living in our long-term care facilities. (CDC, 2024)
The goal of this post is to translate the CDC guidance into practical steps for long-term care administrators, directors of nursing, infection preventionists, and frontline nurse leaders.
Why Antimicrobial Resistance Is Critical For Long-Term Care Residents
Residents in skilled nursing settings often move between hospitals, emergency departments, rehab centers, and long-term care. Each transition increases the chance of being exposed to a resistant organism. Many residents also have catheters, wounds, or weakened immune systems, which naturally puts them at higher risk.
(CDC, Infection Prevention and Control in Nursing Homes)
Even small breakdowns in infection practices can turn into bigger problems. This is not about blame. It is about building systems that support safe, predictable, everyday actions.
What Long-Term Care Providers Can Do Right Now
Below is the CDC guidance, adapted for the realities of long-term care.
1. Strengthen Infection Prevention Practices and Screen At-Risk Residents, Families and Staff
Good infection prevention is still the most effective tool we have. This includes strong hand hygiene practices, correct PPE use, and consistent environmental cleaning. Screening new admissions for risk factors such as recent hospitalization, wound care, ventilator use, or past MDRO history helps staff take precautions early.
(CDC, Core Infection Prevention and Control Practices for Safe Healthcare Delivery)
Screenings should also include caregivers and family members of new admissions who will be visiting, as well as temporary/agency staff on an ongoing basis, and facility staff are encouraged to put appropriate voluntary protocols in place.
A quick daily safety huddle and clear signage near entryways and supplies go a long way. Staff respond well when expectations are simple and visible.
2. Improve Antibiotic and Antifungal Prescribing
Antibiotics are essential, but unnecessary use increases the risk of resistance and can cause future treatment failures. Long-term care facilities can reduce inappropriate use through:
• Clear clinical criteria for diagnosing UTIs, respiratory infections, and wounds
• Cultures before treatment when the resident is stable
• Antibiotic reviews within 48 to 72 hours
• A facility-specific antibiogram
• Limited antifungal use unless infection is confirmed
These steps follow the CDC’s Core Elements of Antibiotic Stewardship for Nursing Homes.
(CDC, Core Elements of Antibiotic Stewardship for Nursing Homes)
3. Teach Residents and Families How They Can Help
Families often want to help but are not sure how. Simple, friendly education at admission can make a big difference. Hand hygiene reminders, easy explanations for precautions, and reassurance that these steps protect the resident help reduce anxiety and encourage participation.
(APIC, Guide to Preventing Multidrug-Resistant Organisms)
4. Watch Trends Inside the Facility and in the Local Community
Facilities that monitor trends early tend to prevent larger problems later. Monthly snapshots of MDRO activity, hand hygiene compliance, and unit-level patterns help leaders respond quickly. Local hospitals and public health departments often share resistance patterns too, offering helpful context.
(SHEA, Compendium of Strategies to Prevent HAIs)
5. Communicate Promptly When a Resident Has an MDRO
Clear communication builds trust and prevents misunderstandings. Residents and families appreciate knowing what the organism is, what precautions mean, and how staff will ensure safety. Documentation is important, but empathy matters just as much.
(CMS, Infection Control Requirements for Long-Term Care Facilities)
6. Know When to Report to the Health Department
Certain resistant organisms require reporting to state or local public health departments. Reporting helps detect unusual patterns or clusters that may affect multiple facilities. Creating a simple internal protocol ensures reporting remains consistent even during staffing transitions.
(CDC, Antibiotic Resistance Threats Report)
Additional Strategies That Support Safer Environments
- Stabilizing staffing on clinically complex units
- Observing new hires closely during their first 30 days
- Screening agency/temporary staff as they often move from facility to facility
- Tracking cleaning of shared equipment like vitals machines and wheelchairs
- Including environmental services in all infection control education
- Staying connected with regional infection control collaboratives
Final Thoughts
Antimicrobial resistance will continue to challenge healthcare, but long-term care facilities have a powerful role in slowing its spread. Strong infection-prevention habits, thoughtful antibiotic use, early trend recognition, and open communication all contribute to safer, healthier environments.
Every handwash, every careful antibiotic review, every conversation with a resident or family makes a difference. These small moments are the foundation of resident safety and quality of life. Learn more about infection control in long-term care facilites here.
To get a clearer picture of how infection control trends influence long-term facility resident care in your state, you can review the statewide reports on our Reports page.
FAQ
Residents in long-term care often have chronic conditions, recent hospitalizations, or medical devices that increase their risk of infection. They also move between hospitals and skilled nursing settings, which increases exposure to resistant organisms. Strong infection prevention and careful antibiotic use help protect residents from serious complications
Daily habits matter. Consistent hand hygiene, correct PPE use, thoughtful antibiotic practices, and early screening for at-risk residents all help reduce spread. Supporting new staff during their first few weeks also improves consistency and safety.
Families can help by practicing hand hygiene during visits, understanding the purpose of precautions, and supporting their loved one’s care plan. Simple conversations and clear explanations reduce stress and help everyone feel more comfortable.
Communication should happen as soon as an antimicrobial-resistant infection or colonization is identified. This helps families understand what the organism is, what precautions mean, and how the care team will support the resident.
No. Only certain organisms must be reported, such as Candida auris, carbapenem-resistant Enterobacterales, and unusual resistance patterns. Each state has its own rules, and having a clear internal reporting procedure helps ensure nothing is missed.
A simple monthly snapshot of MDRO cases, hand hygiene compliance, and unit-level patterns can reveal early changes. Watching community trends from hospitals or public health departments also helps facilities prepare for what may enter the building.