Step 1. Vaccinate
- Give influenza and pneumococcal vaccinations to residents
- Promote vaccination among all staff

Step 2. Prevent conditions that lead to infection
- Prevent aspiration
- Prevent pressure ulcers
- Maintain hydration

Step 3. Get the unnecessary devices out
- Insert catheters and devices only when essential and minimize duration of exposure
- Use proper insertion and catheter-care protocols
- Reassess catheters regularly
- Remove catheters and other devices when no longer essential

Step 4. Use established criteria for diagnosis of infection
- Target empiric therapy to likely pathogens
- Target definitive therapy to known pathogens
- Obtain appropriate cultures and interpret results with care
- Consider C. difficile in patients with diarrhea and antibiotic exposure

Step 5. Use local resources
- Consult infectious disease experts for complicated infections and potential outbreaks
- Know your local and/or regional data
- Get previous microbiology data for transfer residents

Step 6. Know when to say “no”
- Minimize use of broad-spectrum antibiotics
- Avoid chronic or long-term antimicrobial prophylaxis
- Develop a system to monitor antibiotic use and provide feedback to appropriate personnel

Step 7. Treat infection, not colonization or contamination
- Perform proper antisepsis with culture collection
- Re-evaluate the need for continued therapy after 48-72 hours
- Do not treat asymptomatic bacteriuria

Step 8. Stop antimicrobial treatment
- When cultures are negative and infection is unlikely
- When infection has resolved

Step 9. Isolate the pathogen
- Use Standard Precautions
- Contain infectious body fluids (use approved Droplet and Contact isolation precautions)

Step 10. Break the chain of contagion
- Follow CDC recommendations for work restrictions and stay home when sick
- Cover your mouth when you cough or sneeze
- Educate staff, residents, and families
- Promote wellness in staff and residents

Step 11. Perform hand hygiene
- Use alcohol-based handrubs or wash your hands
- Encourage staff and visitors

Step 12. Identify residents with multi-drug resistant organisms (MDROs)
- Identify both new admissions and existing residents with MDROs
- Follow standard recommendations for MDRO case management