Ongoing monitoring

Three of the 54 categories are not walkthrough items. They describe the screening schedule that runs between visits — what is checked when a resident arrives, and what is repeated every month.

Category 10 of 54 · Ongoing Monitoring

The heading the two schedules below sit under. A walkthrough is a snapshot; residents change between snapshots, and most of what goes wrong in a facility develops quietly in the interval.

Category 11 of 54 · At intake

The source list reads: Intake STD, Quant TB, Urine Tox, RPR, Nasal PCR, Genetics Neurocognitive.

STD screening — sexually transmitted infection screening on admission.
Quant TB — a quantitative tuberculosis test rather than a skin test.
Urine Tox — urine toxicology, which establishes what a resident is actually taking on arrival rather than what the transfer paperwork says.
RPR — rapid plasma reagin, the screening serology for syphilis.
Nasal PCR — nasal polymerase chain reaction testing for respiratory pathogens.
Genetics Neurocognitive — neurocognitive genetic testing.

Category 12 of 54 · Monthly

The source list reads: Monthly Urine Tox, RTM, Nasal PCR.

Urine Tox — repeated monthly, which is how a medication that is being taken by someone other than the resident becomes visible.
RTM — remote therapeutic monitoring: device-reported data on a resident’s therapy and function between visits, rather than a point-in-time observation.
Nasal PCR — repeated monthly, for the respiratory infections that move through a congregate setting before anyone has symptoms worth charting.

The pathogen panels

Where the schedule says PCR, the practical content is a set of multiplex panels rather than a single test: urinary tract infection genomics, respiratory pathogen panels, COVID-19, gastrointestinal pathogen panels and sexually transmitted infection testing. In a congregate setting the argument for panels over single-target tests is speed — an outbreak in a building with shared air, shared bathrooms and shared staff is measured in days.

Why an arrival baseline matters

A resident who arrives on eleven medications and is assessed six months later has no baseline to be compared to. The intake panel exists so that later change is measurable — which is also the precondition for any serious deprescribing work. DWARAA.

The monthly physical check

Alongside the schedule above, CareGuard 360 is the monthly whole-person look at each resident: skin and wound checks, unexplained bruising, cuts and scrapes. CareGuard 360.

This is one of seven groups in the review. The safety review · all 54 categories.

The evidence on infection control in congregate settings

The outbreak burden

CDC surveillance across a decade found 13,092 norovirus outbreaks and 416,284 outbreak-associated cases in US long-term care facilities between 2009 and 2018. Most spread person to person (90.4%), and 75% occurred between December and March. Residents had higher attack rates than staff (median 29.0% versus 10.9%), and for every 1,000 cases there were 21.6 hospitalizations and 2.3 deaths.

A prospective study across 43 facilities found 47% of cases shed virus for 21 days or more — which is the number that determines how long an exclusion policy actually has to run, and is usually longer than facilities assume.

The capacity gap

A national survey of 990 US nursing homes found that most infection preventionists had at least two responsibilities besides infection control (54%) and that 61% had no specific infection prevention and control training. Approximately 36% of responding facilities had received an infection control deficiency citation. A 2024 mixed-methods study reported the same picture: in 36.7% of nursing homes the infection preventionist had no specific training.

That is a structural finding rather than a criticism of individuals, and it is one an owner can actually act on, because it is about a job description and a budget line.

What works, stated at the strength the evidence supports

Antimicrobial stewardship programs were associated with a 14% reduction in overall antimicrobial use in a meta-analysis of 11 studies (95% CI −8% to −20%) — with the authors’ own caveat that funnel plot analysis suggested publication bias.
Hand hygiene has weaker evidence in this setting than most people assume. A systematic review of 56 studies found 63% reported a benefit on at least one outcome, but “only 25% of randomized trials concluded that HH-related interventions led to a reduction in the infectious risk,” and noted that “the effectiveness of HH in these settings is not well documented, and HH compliance is low.”
Alcohol-based sanitizer is not a substitute for soap and water in a norovirus outbreak. A survey of long-term care facilities in northern New England found that facilities where staff were equally or more likely to use alcohol-based hand sanitizer than soap and water had higher odds of an outbreak, adjusted odds ratio 6.06 (95% CI 1.44 to 33.99).

Why it belongs on a safety review at all

A retrospective cohort of 20,698 nursing home residents aged 65 and over found that infection-related hospitalization was followed by an increase in the prevalence of severe cognitive impairment of 1.6 percentage points (95% CI 1.2 to 2.0), an 18% relative increase, persisting for six quarters or more. An outbreak is not only an outbreak; it leaves residents changed.

References

Calderwood LE, et al. 2022. Norovirus outbreaks in long-term care facilities in the United States, 2009-2018: a decade of surveillance. Clinical Infectious Diseases 74(1):113-119. [national surveillance] · PMID 34523674 · doi:10.1093/cid/ciab808
Costantini VP, et al. 2016. Epidemiologic, virologic, and host genetic factors of norovirus outbreaks in long-term care facilities. Clinical Infectious Diseases 62(1):1-10. [prospective outbreak cohort, 43 facilities] · PMID 26508509 · doi:10.1093/cid/civ747
Herzig CTA, et al. 2016. Infection prevention and control programs in US nursing homes: results of a national survey. Journal of the American Medical Directors Association 17(1):85-8. [national survey, 990 nursing homes] · PMID 26712489 · doi:10.1016/j.jamda.2015.10.017
Wu JH, Langford BJ, Daneman N, Friedrich JO, Garber G 2019. Antimicrobial stewardship programs in long-term care settings: a meta-analysis and systematic review. Journal of the American Geriatrics Society 67(2):392-399. [systematic review and meta-analysis, 18 studies] · PMID 30517765 · doi:10.1111/jgs.15675
Hocine MN, Temime L 2015. Impact of hand hygiene on the infectious risk in nursing home residents: a systematic review. American Journal of Infection Control 43(9):e47-52. [systematic review, 56 studies] · PMID 26184767 · doi:10.1016/j.ajic.2015.05.043
Gracner T, et al. 2021. Association of infection-related hospitalization with cognitive impairment among nursing home residents. JAMA Network Open 4(4):e217528. [retrospective cohort, 20,698 residents] · PMID 33890988 · doi:10.1001/jamanetworkopen.2021.7528
Mody L, et al. 2025. Multisociety guidance for infection prevention and control in nursing homes. Infection Control & Hospital Epidemiology 46(11):1069-1096. [practice guidance] · PMID 41146603 · doi:10.1017/ice.2025.10252

Ask for a safety review of your facility

A CareGuard safety review walks the building against 189 items in 54 categories and reports what it finds to you, not to your site manager. The registration form takes the facility and a contact for the ownership group; scope is settled in the conversation that follows.

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