The Society for Healthcare Epidemiology of America (SHEA), in a pivotal collaboration with the Association for Professionals in Infection Control and Epidemiology (APIC), the Infectious Diseases Society of America (IDSA), the Post-Acute and Long-Term Care Medical Society (PALTmed), and the American Geriatrics Society (AGS), has unveiled a comprehensive and updated multisociety guidance aimed at revolutionizing infection prevention and control within nursing homes. This initiative responds directly to the escalating complexities and vulnerabilities observed in long-term care environments, reflecting advances in epidemiological science and a growing understanding of nursing home populations’ unique needs.
This updated directive supersedes the prior seminal SHEA/APIC guideline issued in July 2008, signaling a major advancement in infection control protocols tailored for long-term care facilities. The 2025 guidance not only addresses the biomedical and epidemiological challenges inherent to healthcare-associated infections in nursing homes but also integrates a holistic perspective that respects the social and rehabilitative dimensions critical to residential care. The document provides a sophisticated framework intended to safeguard the health of some of the most vulnerable members of society while maintaining the quality of life and dignity for both short-term and long-term residents.
An immediate catalyst for this guideline’s evolution was the catastrophic impact of the COVID-19 pandemic on nursing homes worldwide. The pandemic underscored the urgent imperative for robust, science-driven infection prevention measures. Nursing homes experienced devastating morbidity and mortality rates, exposing systemic deficiencies in infection control. The lessons learned have driven a reevaluation of traditional practices and a pressing need to develop adaptable, scalable strategies sensitive to unprecedented infectious threats.
In parallel, the demographic and clinical profiles of nursing home residents have shifted markedly over recent years. Increasingly complex medical conditions and the elevated prevalence of invasive devices, such as catheters and ventilators, significantly amplify the risk of both common and emerging infections. This epidemiological transition necessitates sophisticated, evidence-based interventions tailored explicitly to a population characterized by chronic comorbidities and immunological vulnerabilities.
Furthermore, the expansion of services within nursing homes—particularly the growth of ventilator-dependent units—introduces substantial complexities to infection control efforts. These units demand heightened vigilance and specialized protocols to manage the risks associated with respiratory pathogens, multidrug-resistant organisms, and device-associated infections. The updated guidance meticulously addresses these high-risk subpopulations, advocating for targeted strategies that encompass both preventive and outbreak management components.
Regulatory agencies, most notably the Centers for Medicare & Medicaid Services (CMS), have prioritized infection prevention as a national objective for nursing homes. This realignment of policy underscores the critical importance of structured infection control programs, backed by adequate resources and administrative commitment, to achieve sustainable improvements in patient safety. The new guidance aligns with and supports these regulatory frameworks by recommending measurable organizational standards and fostering accountability in leadership.
Central to the updated recommendations is the insistence on dedicated infection preventionists within each nursing home facility. Staffing models encourage full-time infection prevention professionals for larger institutions, with smaller facilities maintaining at least half-time infection control experts. This workforce commitment ensures that facilities possess the technical expertise necessary to oversee infection surveillance, education, and intervention implementation, thereby enabling real-time, data-driven responses to emerging threats.
Moreover, the guidance calls for a reinforced infrastructure of administrative and medical leadership, emphasizing their crucial role in endorsing and facilitating infection prevention measures. Leadership support is novelly framed not just as governance but as active accountability in fostering a culture of safety and compliance. This paradigm shift expects leaders to engage proactively with frontline staff, ensuring operationalization of best practices and resource allocation.
Vaccination emerges as a cornerstone in the strategy to fortify healthcare personnel against transmissible diseases, reducing workforce illness and associated infection risks to residents. The guidance presses for concerted efforts to enhance vaccination coverage among healthcare workers, recognizing immunization as an integral component of comprehensive infection control that helps maintain staffing stability and resident safety.
Effective outbreak management forms another keystone, with the guidance delineating clear protocols encompassing precautionary measures, the prudent use of personal protective equipment (PPE), and calibrated visitation policies. These interventions are designed to be evidence-informed and adaptable to the severity and scope of infectious threats faced, ensuring that response plans are both rigorous and context-sensitive.
Environmental considerations receive explicit attention, with infection prevention experts urged to collaborate closely on critical systems such as water quality, air handling, and cleaning practices. This multidisciplinary approach acknowledges that pathogen transmission pathways extend beyond direct person-to-person contact, necessitating a broad environmental strategy to interrupt infection chains comprehensively.
A transformative aspect of the guidance is the emphasis on ongoing collaboration with public health authorities and infectious diseases specialists. This integration ensures nursing homes remain connected to evolving epidemiologic data, emerging pathogen profiles, and novel therapeutic or preventive modalities, fostering a dynamic and informed approach to infection control that transcends isolated institutional efforts.
Dr. Lona Mody, MD, MSc, who led the development of this landmark guidance, highlights the uniquely dual nature of nursing homes as both healthcare settings and homelike environments. The updated directive respects this duality, offering pragmatic, evidence-based strategies that protect resident health without compromising the comfort and social engagement essential to their well-being.
The multisociety guidance document is the product of a multidisciplinary consortium of experts in geriatrics, infectious diseases, epidemiology, and infection prevention, ensuring that the recommendations are comprehensive, clinically relevant, and scientifically sound. Its peer-reviewed publication in SHEA’s flagship journal, Infection Control & Hospital Epidemiology (ICHE), affirms its significance and facilitates widespread dissemination within healthcare and academic communities.
By integrating advanced infection prevention science with practical, facility-specific interventions, this guidance represents a critical evolution in protecting nursing home residents. It holds promise for reducing the human and economic toll of healthcare-associated infections while preserving the rehabilitative mission and social fabric of these essential care environments.
For stakeholders engaged in nursing home care, this guidance offers a decisive resource combining technical expertise, regulatory alignment, and operational insight. It equips healthcare teams with the knowledge to anticipate infection risks proactively, implement robust protective measures, and respond with agility to outbreaks. Ultimately, it advances a safer, more resilient future for long-term care settings worldwide.
Subject of Research: Infection prevention and control strategies in nursing homes
Article Title: Multisociety guidance for infection prevention and control in nursing homes
News Publication Date: 28-Oct-2025
Web References: http://dx.doi.org/10.1017/ice.2025.10252
Keywords: Public health, Epidemiology
