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For questions about the SNF Program, please contact the SNF team via the following email address: LACSNF@ph.lacounty.gov or LTC_NCoV19@ph.lacounty.gov (only COVID related inquiries)

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News and Updates

The new Honors Program recognizes SNFs for outstanding performance in IPC, public health engagement, and vaccination coverage.
Infection Prevention Webinar: Update on COVID-19 Vaccination Recommendations and LA County Uptake slides | recording (3-18-24)
IPC Policy Announcement: The following IPC Policy Templates are available for use (please see drop down #3 IPC Templates below)
- Hand Hygiene
- Enhanced Standard Precautions (ESP)
- Transmission-Based Precautions (TBP)
The Order of the Los Angeles County Health Officer on Immunization or Masking Requirement for Healthcare Personnel during the 2023-2024 Respiratory Virus Season was amended on February 2, 2024. Learn more from the following resources:
- Rationale for mandated influenza vaccination (12-29-23)
- Fact sheets for HCWs: Influenza vaccination and COVID-19 vaccination
- Vaccine Preventable Disease Control Program Provider website
SNF IP Monthly Feature April 2024 (4-26-24)
Infection Prevention webinar: Enrolling in My Turn and Using CAIR Quick Entry slides | recording | Q&A (1-19-24)
Infection Prevention webinar: Winter Vaccine Champions slides | recording (12-15-23)
Infection Prevention webinar: Building Trust and Effective Vaccination Programs in Nursing Homes slides | recording (10-20-23)

Increasing Uptake of the COVID-19 Vaccine Flyer

Increasing Uptake of the Updated COVID-19 Vaccine flyer (10-30-23)
Sign up for a preventative Infection Control Assessment & Response (ICAR) visit from LAC DPH to receive free expert consultation on how to improve your infection prevention & control program. To learn more, check out our SNF ICAR program page or sign up here.

Resources for Skilled Nursing Facilities

Click on the blue section headers below to expand and reveal the resources within each section.

California Department of Public Health (CDPH) requires that every facility has a full-time infection preventionist (IP). As per the CDPH AFL 20-85 “Effective January 1, 2021, AB 2644 requires a SNF to have a full-time IP, a role that may be shared by two staff members if the total time dedicated to the IP role is equivalent to one full-time staff member. The IP must be a registered nurse or licensed vocational nurse, and the IP hours cannot be included in the 3.5 direct care service hours per patient day required in a SNF. Please note that the IP role eligibility is expanded in CDPH AFL 20-51. “Effective January 1, 2022, AB 1585 expands existing eligibility and minimum qualifications for a SNF's IP. The IP must have primary professional training as a licensed nurse, medical technologist, microbiologist, epidemiologist, public health professional, or other health care related field. The IP must be qualified by education, training, clinical or health care experience, or certification, and must have completed specialized training in infection prevention and control."

The facility must ensure that the IP(s) meet the minimum qualifications outlined in CDPH AFLs 20-85 and 20-51. The facility should consider the IPs’ education, prior experiences, and clinical background. Additionally, having a team of at least two IPs is best practice regardless of the facility’s bed capacity given the significant amount of everyday work and the often urgent nature of infection control (e.g., outbreaks, respiratory viral illness season). Also, a team model of multiple IPs allows there to be back-up when one IP is not available which can also help with burnout and staff turnover. Finally, teamwork between the core IP team and other leadership (e.g., administrator, director of nursing, director of staff development, etc.) is crucial to the success of a SNF’s infection prevention and control program and for the safety of their residents.

As per CDPH AFL 20-84, the initial training for IPs should include the following topic areas and be a minimum of 14 hours:

Role of the Infection Preventionist
Infection Prevention Plan
Standard, Enhanced Standard, and Transmission-Based Precautions
Injection Safety
HAI Prevention (e.g., Respiratory, BSI, UTI, Scabies, CDI, MDRO)
Infection Surveillance
Cleaning, Disinfection, Sterilization, and Environmental Cleaning
Microbiology
Outbreaks
Antibiotic Stewardship
Laws and Regulations (e.g., reporting requirements)
Preventing Employee Infections
An additional 10 hours of continuing education in the field of IPC are also required as per CDPH AFL 20-84, on an annual basis. See the LAC DPH Recommended Infection Prevention and Control (IPC) Training for Skilled Nursing Facilities webpage for a list of IPC training resources.

In reference to CDPH AFL 20-84: “Facilities should provide encouragement and support for IP staff to stay abreast of current news and training sources through a nationally recognized infection prevention and control association.” Facilities should encourage their IP staff to get involved and attend meetings of their local Association for Professionals in Infection Control and Epidemiology (APIC) Chapter.

Greater Los Angeles (GLA) Chapter
Tri-Valley Chapter
Inland Empire Chapter
California APIC Coordinating Council

Facilities should also ensure their point-of-contact information is up to date with LAC DPH to receive the latest alerts including invitations to webinars for SNFs: https://tinyurl.com/LACSNFcontacts

Complete initial and annual IP training. See the LAC DPH Recommended Infection Prevention and Control (IPC) Training for Skilled Nursing Facilities webpage for a list of IPC training resources. Please note: CDPH allows the IP to repeat the initial course in following years to meet the IP CE annual requirement. However, check with the Board of Registered Nursing (BRN) as they may not allow an identical course to be repeated for BRN CE during the same licensure period.
Update LAC DPH with your name and email address as a new IP: https://tinyurl.com/LACSNFcontacts
Use an IP Orientation Checklist to standardize essential components of an IP Program and ensure consistency

The following are some tools to assess your facility's IP Program:

LAC DPH ICAR Program (recommended for SNFs)
CDC ICAR Tools

Once you assess your facility’s IP Program, you will want to prioritize improvement tasks. Use the Infection Prevention Post-Acute Risk Assessment Prioritization Worksheet to help your facility prioritize and determine where to start focusing your IP efforts.

Areas of concern identified through your ICAR and/or risk assessment in Step 3 will allow your team to next work to:

Identify strategies and best practices to be put into place
Determine who is responsible for that work
Establish a timeline for completion
Evaluate effectiveness of those efforts through surveillance
Gather feedback from frontline staff (RN, LVN, CNA) and DON/ADON, DSD Admin, Providers on your plan

See example Modifiable Plan templates: Generic 1-page Templates | COVID-19 Template

Keys to successfully implementing your action plan include:

Educating all stakeholders, including faculty leadership, regarding expectations
Empowering staff to speak up
Engaging staff members, providers, and residents in the process
Modifying your action plan as necessary

Continual improvement to your facility’s infection prevention and control program is key. Below is a brief preview to quality assurance and process improvement (QAPI), but it is strongly recommended for SNFs to use the slides and recording from LAC DPH’s Transforming Nursing Home Care Together (TNT) Unit 1 to learn how to incorporate QAPI into your infection prevention and control program.

Evaluate your plan by conducting surveillance—this allows your facility to analyze key data to determine effectiveness. There are two key components of surveillance: Process Measures and Outcome Measures

Process Measures

Process measures are important in quality improvement as they describe whether or not a strategy or intervention has been ‘properly performed’ or if we are ‘doing the things we say we should do’. From an improvement perspective, they make the important connection between behavioral changes and outcomes. Examples of process measures include adherence monitoring tools such as: HSAG Tool and the following CDPH tools:

Outcome Measures

Examples of outcome measures are the are the data that gets reported and reflect the impact or end result of the health care service, strategy, or intervention on the health status of patients. While outcome measures may be seen as a key method of measuring quality, an outcome is truly the result of numerous factors, many of which may be beyond providers’ control. Resources include:

Maryland Dept. of Health UTI Surveillance Checklist
Revised McGreer Criteria for Infection Surveillance Checklist

National Healthcare Safety Network (NHSH) Resources

NHSH Resources include:

SNF ICAR: Infection Control Assessment and Response

The Skilled Nursing Facility (SNF) Infection Control Assessment and Response (ICAR) Program is a collaboration between the Los Angeles County Department of Public Health (LAC DPH) and LAC SNFs to work towards the common goal of improving safety and quality of care for residents, staff, and visitors. The LAC DPH Acute Communicable Disease Control Program (ACDC) Long Term Care team assesses a facility’s Infection Prevention and Control (IPC) practices following a standardized gap assessment based off the Centers for Disease Control and Prevention (CDC)’s ICAR tool in order to provide feedback to the facility on how they can improve their IPC practices.

This program aims to assist facilities with implementing IPC best practices and improving IPC programs. Our purpose is to serve one of the most vulnerable populations (e.g., nursing home residents) by serving their providers – the SNFs.

Please note: We are not inspectors or surveyors, so this is not a licensing or certification visit, but an opportunity to share information and provide consultation.

All LAC SNFs (excluding Long Beach and Pasadena) are eligible to participate in the SNF ICAR Program. Follow this link to learn more about the SNF ICAR Program.

Infection prevention and control (IPC) policies are essential in skilled nursing facilities to minimize the risk of healthcare-associated infections, maintain high standard of care and prioritize the safety of patients, staff and visitors. LAC DPH has developed IPC policy templates based on best practices and relevant regulatory requirements. These templates are meant to serve as a structured framework for SNFs to use as they tailor their own policies to meet their facility needs and requirements.

Transmission Based Precautions: Infectious Disease Prevention Posters

These signs aim to help healthcare workers remember when certain precautions are necessary to help prevent infections and save lives. These Transmission Based Precautions are in addition to Standard Precautions as a part of a basic infection prevention and control program. They are used anytime there is a known potential for spreading infectious agents. The appropriate Transmission Based Precaution is determined by the type of organism and how it is usually transmitted.

For additional guidance on infection control in your facility, please contact the Healthcare Outreach Unit: HAI@ph.lacounty.gov

The following posters can be printed or downloaded.

Enhanced Standard Precautions
		These precautions should be used during high contact care for residents with high risk characteristics for MDRO colonization and transmission, even if MDRO status is unknown: Presence of indwelling devices (e.g. urinary catheter, feeding tube, endotracheal or tracheostomy tube, vascular catheters) Wounds, or pressure ulcer (unhealed) This would include all residents in a subacute unit.
Novel Respiratory Precautions
		These precautions should be used for patients known or suspected to be infected with novel respiratory pathogens such as, but not limited to: SARS-CoV-2 that causes COVID-19
Airborne Precautions
		These precautions should be used to prevent transmission of airborne infectious agents that remain infectious over long distances such as, but not limited to: Measles (Rubeola), Tuberculosis, Chickenpox (Varicella-Zoster virus). PLEASE NOTE: Facilities must isolate in an Airborne Infection Isolation Room (AIIR) that is engineered to be at a negative pressure at all times. Otherwise, the resident must be transferred to another facility with AIIR within 5 hours of identification per the Cal-OSHA Aerosol Transmissible Disease (ATD) Standard.
Droplet Precautions
		These precautions should be used to prevent transmission of pathogens spread through respiratory droplets or secretions such as, but not limited to: Influenza, Meningitis due to Haemophilus influenza type B whether known or suspected, Meningococcal disease (caused by Neisseria meningitidis) including meningitis.
Contact Precautions
		These precautions should be used to help prevent the spread of infectious agents that spread by direct or indirect contact with a resident or a resident’s environment such as, but not limited to: Hepatitis (Type A), scabies, skin abscesses with heavy drainage (until drainage stops), diarrhea (not C. diff), and certain multi-drug resistant organisms (MDROs).
Contact/Spore Precautions
		These precautions should be used to help prevent transmission of particular infectious agents which are spread by direct or indirect contact with the patient or the patient's environment that also produce spores and thus require soap and water hand hygiene, such as, but not limited to: Clostridium difficile (C. diff), Candida auris, Norovirus, Rotavirus

Ask an IP Learning and Communication Series

The Ask an IP is an educational series hosted by the Acute Communicable Disease and Control (ACDC) Infection Prevention Team at the Los Angeles County Department of Public Health (LAC DPH) to discuss the infection prevention practices in the Skilled Nursing Facility (SNF) setting. In 2023, the sessions will be held monthly in contrast to the weekly sessions held in 2021 and 2022.

With the goal of fostering discussion among LAC SNFs, this program includes the following:

Core infection prevention concepts
Open and guided Q&A
Case studies
IP resources
Subject matter experts: IPs, nurses, physicians, epidemiologists

To learn more and access recordings, click on this link to visit the Ask an IP webpage.

TNT Program

The TNT program was an all-inclusive, financially supported collaboration between the Los Angeles County Department of Public Health (LAC DPH) and LAC Skilled Nursing Facilities (SNFs) with the overall goal of improving safety and care for residents, staff, and visitors. This program aimed to empower SNF staff to initiate and maintain quality improvement projects within their facilities, leading to high quality care for their residents and family satisfaction. During the Live Program, participating LA County SNFs were trained in a variety of areas within quality assurance and performance improvement (QAPI) and infection prevention and control (IPC). SNFs were led through the foundations of QAPI and IPC, then bridged into developing their own sustainable QAPI and IPC projects.

While the program is no longer live, SNFs are welcome to review recorded sessions and utilize the resources shared within the TNT webpage.

Antimicrobial Stewardship Program

Updates for the Antimicrobial Stewardship Program are currently pending.

Title	Description
California Department of Public Health (CDPH) Antimicrobial Stewardship in Skilled Nursing Facilities Webinar Series and Examples of Implementation	The CDPH Healthcare-Associated Infections (HAI) Program collaborated with the California Association of Health Facilities to develop this six-part webinar series providing practical guidance for California skilled nursing facilities developing their antimicrobial stewardship policies.
2018 U.S. Antibiotics Awareness Week: Skilled Nursing Facility Educational Event Presentation Archive The Clinical Microbiology Laboratory: Our Role in Antimicrobial Stewardship Antibiotic Stewardship Updates and Resources for California Skilled Nursing Facilities A QAPI Approach to CDI Reduction Using the National Healthcare Safety Network (NHSN)
Resources and Handouts AHRQ Nursing Home Antimicrobial Stewardship Guide CDC Core Elements for Antimicrobial Stewardship for Nursing Homes NHSN Facility Enrollment Checklist For Long-Term Care Facilities Instructions For Long Term Care Facilities Reporting CRE In NHSN Infection Control Risk Assessment Guidelines for Long Term Care Facilities

CDC Appendix A: Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007)

Influenza and Other Respiratory Viral Infections
Influenza Main Page Flu Health Education Materials Flu Vaccination Influenza Outbreak Prevention and Control Guidelines for SNFs SNF Guidelines for Influenza Prevention and Control in the Context of COVID-19 Respiratory syncytial (RSV) Main Page RESP WATCH Viral Respiratory Surveillance for LA County (latest issue) Health Officer Order (HOO) Requiring Annual Influenza and Updated COVID-19 Immunization or Masking for Healthcare Personnel during the 2023–2024 Respiratory Virus Season Health Officer Order SNF Toolkit CDPH Resources: California Department of Public Health Recommendations for Prevention and Control of COVID-19, Influenza, and Other Respiratory Viral Infections in California Skilled Nursing Facilities – 2023-24 RSV (RESPIRATORY SYNCYTIAL VIRUS) CDC Resources Influenza (Flu) Respiratory syncytial (RSV) Viral Respiratory Pathogens Toolkit for Nursing Homes	Information on influenza and other respiratory viral infections including resources and guidance for outbreak mitigation and prevention. Respiratory Watch is a free electronic newsletter summarizing current respiratory illness surveillance data in LAC. and published during Respiratory Virus season. LAC DPH surveillance data excludes the cities of Long Beach and Pasadena. HOO-Los Angeles County mandates all healthcare personnel in a licensed healthcare facility to be vaccinated against influenza and updated Covid-19 immunizations every Respiratory Virus Season (Nov.1- April 30) or wear a respiratory mask while in contact with patients or working in Patient Care Areas.
Norovirus
LAC DPH Main Page for Norovirus LAC DPH: A Guide for Preventing Norovirus Outbreaks in Skilled Nursing Facilities LAC DPH Norovirus Presentation: Norovirus in Skilled Nursing Facilities CDC: Norovirus in Healthcare Settings	Norovirus information and resources; how-to-guide for norovirus outbreak prevention and control in SNFs.
Scabies
LAC DPH Main Page for Scabies LAC DPH: Scabies Toolkit for Healthcare Settings	Scabies information and resources; how-to-guide for scabies outbreak prevention and control in medical settings.

Infection Prevention Webinars

Update on COVID-19 Vaccination Recommendations and LA County Uptake slides | recording (3-18-24)
Enrolling in My Turn and Using CAIR Quick Entry slides | recording | Q&A (1-19-24)
Winter Vaccine Champions slides | recording (12-15-23)
Prevention and Control of Influenza and Other Respiratory Viruses in Skilled Nursing Facilities slides | recording (11-17-23)
Building Trust and Effective Vaccination Programs in Nursing Homes slides | recording (10-23-23)
COVID-19 Vaccine Updates and Preparing for the Virus Respiratory Season slides | recording (9-22-23)
Fall 2023 Immunizations: RSV, Influenza and Building Vaccine Confidence slides | recording (08-04-23)
Training for Los Angeles County Skilled Nursing Facilities: AB 1797 Requirements: California Immunization Registry (CAIR) slides | recording (08-04-23)
The Infection Preventionist as an Educator slides | recording | Webinar Q&A (03-01-23)
Preventing Legionellosis in Healthcare Facilities Through a Water-Management Program slides | recording | Webinar Q&A (02-08-23)
Prevention and Control of Influenza and RSV in LAC SNFs in the Context of COVID-19 slides | recording (12-16-22)
Monkeypox Guidance Update for Skilled Nursing Facilities recording (8-26-22)
Influenza Update for Skilled Nursing Facilities slides | recording (10-29-21)
Skilled Nursing Facilities Update: Infection Prevention and Control of MDRO's like Candida auris (4-30-21) slides | recording
Candida auris Update and Visitation/Guidance Q and A for SNF's (11-13-20) slides | recording
Influenza Management in SNF's in the Context of the COVID-19 Pandemic (10-30-20) slides | recording

COVID-19 Webinars

COVID-19 Guidance Update for LAC SNFs: Clarifying COVID-19 Guidelines and more (7-14-23) slides | recording
COVID-19 Guidance Update for LAC SNFs: Frequently Asked Questions (2-24-23) slides | recording
COVID-19 Guidance Update for LAC SNFs: Shifting the Approach Back to Basics Part 2 (1-6-23) slides | recording
COVID-19 Guidance Update for LAC SNFs: Shifting the Approach Back to Basics (12-23-22) slides | recording
COVID-19 Update for Skilled Nursing Facilities, Winter Surge Readiness: Improving COVID-19 Booster Coverage from the Field and Best Practices for Influenza Vaccination (11-18-22) slides
Data Hygiene: COVID 19 CDPH 123 Survey Reporting (11-4-22) Recording | Slides | Special Session Questions and Answers
COVID-19 Update for Skilled Nursing Facilities: Guidance Changes to Visitation, Testing, and More slides (9-23-22)
COVID-19 Update for Skilled Nursing Facilities: Updated (bivalent) Booster Recommendations and More (9-9-22) recording | slides
COVID-19 Updates to SNF Guidance and Therapeutics recording | slides (5-27-22)
COVID-19 Updates for Skilled Nursing Facilities slides (3-4-22) The correct method for figuring out which CDC level of transmission LA County is in with regard to implementing SNF guidance is by using this link. Per this tracker, LA County is still in "substantial" transmission. This is the tracker the SNF guidance has links to in multiple places, please make sure to read through the guidance fully for all restrictions.
COVID-19 Updates for Skilled Nursing Facilities: Vaccine Boosters, PPE, Testing Reporting, and More slides | recording (1-28-22)
COVID-19 Updates for Skilled Nursing Facilities: Boosters, Quarantine & Isolation, Visitation, Testing, and More slides | recording (1-07-22)
COVID-19 Updates for Skilled Nursing Facilities: The Omicron Variant, Boosters, Monoclonal Antibodies, Testing Updates, and More slides (12-10-21)
COVID-19 Update for Skilled Nursing Facilities: Monoclonal Antibodies, Holiday Guidance, and More slides recording (11-19-21)
COVID-19 Update for Skilled Nursing Facilities: Guidance Updates, Influenza Vaccination and More (9-24-21) slides | recording
COVID-19 Frequently Asked Questions on Visitation, Interfacility Transfers, Testing & More (7-16-21) slides | recording
COVID-19 Vaccine and Other Key Updates for SNFs (1-29-21) slides | recording
COVID-19 Vaccine Update for SNF's (12-23-20) slides | recording
COVID-19 Vaccine Introduction (12-17-20) slides | recording
Aerosol Transmissible Disease Standards and Update on N-95 Respirator Use (10-2-20) slides | recording

LAC DPH Past Training and Events

2023 Symposium on Infection Prevention and Control in Skilled Nursing Facilities (October 2023)
- Enhanced Standard Precautions Slides | Recording
- Community Field Services Presentation Slides | Recording
- Local MDRO Surveillance Slides | Recording
- Antimicrobial Stewardship Slides | Recording
2019 Skilled Nursing Facilities Symposium Presentation Archive (Full Recording/Video here)
2018 Skilled Nursing Facilities Symposium on Managing Legionnaires' Disease Presentation Archive (Full Recording/Video here)
2017 Skilled Nursing Facilities Symposium on Infection Control and Prevention Presentation Archive:

Click on the section headers below to expand and reveal the resources within each section.

Health alert networks (HANs) are public health communication systems that provide urgent health alerts, advisories, updates on prevention guidelines, coordination of disease mitigation efforts, updates on emergency preparedness planning, and more. SNF IPs and leadership are strongly recommended to subscribe to all three HANs for CDC, California, and Los Angeles County.

A few highlighted state laws and regulations related to infection prevention and control SNFs.

Title 17, California Code of Regulations
Senate Bill 361: Requires SNFs to establish an Antimicrobial Stewardship Program by January 1, 2017
Assembly Bill (AB) 2644: Requires at least one (1) dedicated full-time infection preventionist per SNF
Assembly Bill (AB) 1797: Requires all healthcare providers to report immunization doses to an immunization registry (CAIR2)

Related SNF Webpages

Content

Contact

Join LAC DPH's Email List for SNFs

News and Updates

Resources for Skilled Nursing Facilities

For the Facility:

Background - Infection Preventionist Requirement

Step 1. Identify the IPs and Form an IP Team

Step 2. Understand the IP Training Requirements

Step 3. Support Your IP to Stay Informed and Involved

For the IP:

Step 1. Become and Maintain Training as an IP

Step 2. Assess the Strengths and Areas for Improvement

Step 3. Develop an Action Plan

Step 4. Implement Your Action Plan

Step 5. Measures to Evaluate Your Action Plan

Enhanced Standard Precautions

Novel Respiratory Precautions

Airborne Precautions

Droplet Precautions

Contact Precautions

Contact/Spore Precautions

Title

Description

Influenza and Other Respiratory Viral Infections

Norovirus

Scabies