Cleaning and Disinfection Essentials for Long-Term Care Settings
Author: Doe Kley, RN, MPH, T-CHEST, LTC-CIP, CIC
Behind every infection statistic is a person who matters deeply to someone. For long-term care professionals, that reality gives environmental cleaning and disinfection a purpose far beyond maintaining appearances or preparing for a survey: protecting the people who call these facilities home. As past Director for the Centers for Disease Control & Prevention Dr. Julie Gerberding used to say, “We shouldn’t strive for a benchmark – rather we should strive to protect the “n” of one.”
Residents depend on staff to create an environment that supports both safety and quality of life. Meeting that responsibility requires a coordinated cleaning and disinfection program with clear ownership, appropriate products, effective training, and ongoing feedback [1]. Infection preventionists play an essential role in connecting those elements and working with environmental services teams to make good practices consistent.
Why the environment matters
Long-term care residents often face overlapping infection risks, including chronic conditions, weakened immune defenses, invasive devices, and antibiotic exposure [2]. Shared rooms and communal living create additional opportunities for pathogens to move between people and their surroundings [2].
Environmental surfaces and medical equipment can harbor organisms that healthcare workers transfer on their hands during care. Pathogens of concern include Clostridioides difficile, norovirus, and multidrug-resistant organisms such as Candida auris [3]. Their ability to persist on surfaces makes regular cleaning and disinfection an important part of interrupting transmission [4,5].
Contamination can spread surprisingly quickly [6]. In a study conducted in a 67-bed nursing home, researchers placed a viral tracer on volunteers’ hands and detected it on 49% of sampled surfaces within four hours [6]. Hygiene interventions subsequently reduced the tracer by 99%, demonstrating the potential value of coordinated prevention practices [6]. Although tracer findings do not measure infections directly, they help illustrate how contamination can travel through a facility.
Cleaning a place people call home
Long-term care facilities present challenges that differ from those of acute care hospitals. Residents may stay for months or years, bringing personal belongings and familiar furnishings into their living spaces. They also gather for meals, recreation, and social interaction, making shared spaces an important focus for environmental hygiene.
Research across eight long-term care facilities in six states found an average of 12 resident contacts and 26 staff contacts with environmental surfaces per hour in common areas [7]. Dining rooms, rehabilitation spaces, and recreation areas therefore deserve sustained attention alongside resident rooms.
Portable equipment introduces another challenge because devices travel between residents [8]. Vital signs machines, thermometers, pulse oximeters, and other shared items need clearly assigned cleaning responsibilities and staff who understand how to disinfect them correctly [8]. Clinical staff need this training just as environmental services personnel do [8].
Written policies must translate into daily practice
The Centers for Medicare & Medicaid Services, public health agencies, the Environmental Protection Agency, and the Occupational Safety and Health Administration all influence cleaning and disinfection practices. Their responsibilities span care quality, public health, disinfectant registration, and worker safety.
According to the Centers for Medicare and Medicaid Services, facility policies should address common areas and resident rooms, high-touch surfaces, shared medical equipment, privacy curtains, and staff education and competency [9]. Worker protections also belong in the program, including appropriate personal protective equipment, safe chemical handling, access to safety data sheets, and procedures for cleaning blood or body fluid spills [10].
Requirements and guidance can change, so facilities should confirm current federal, state, and local expectations when reviewing policies. A gap analysis offers a practical starting point by comparing applicable requirements with written procedures and what staff actually do.
Training should build and demonstrate competence
An effective cleaning program includes five connected components: education and training, product selection, standardized protocols, quality monitoring, and feedback [1]. Training establishes the foundation by helping staff understand how pathogens spread and how their work protects residents [1].
Education should cover facility policies, safe work practices, and correct product use [1]. Provide training at hire and annually, whenever products or procedures change, and when observations identify gaps that require additional coaching [1].
Competency assessment should examine both knowledge and practical skills [1]. Someone may understand why disinfection matters yet still need support applying a product correctly or maintaining the required contact time [1]. Asking staff to demonstrate the procedure can make coaching specific and useful [1]. It also creates an opportunity to identify confusing instructions or workflow barriers before they become routine shortcuts [1].
Product selection deserves careful consideration
Choosing a disinfectant involves more than comparing purchase prices [1]. Products should have appropriate claims for pathogens relevant to the setting and the facility’s particular concerns [1]. Other considerations include speed of action, surface compatibility, safety, odor, and ease of use [11].
Contact time deserves particular attention because surfaces must remain wet for the required duration [1]. Staff need to understand the directions that apply to the product and task, including the equipment manufacturer’s instructions [1].
Dilutable products introduce additional responsibilities, such as ensuring correct concentrations and maintaining dispensing systems and containers [12]. Ready-to-use products avoid the dilution step, although they still require careful adherence to label directions.
Product decisions should include the infection preventionist, environmental services leadership, frontline users, purchasing personnel, and financial stakeholders. Their combined perspectives help identify options that meet infection prevention needs and work within daily operations.
Every task needs a clear owner
A cleaning responsibility grid helps prevent important tasks from falling between departments. It should identify what needs cleaning, when cleaning occurs, who performs it, and how to complete the task, including the approved product and contact time.
Develop the grid collaboratively so teams agree on responsibilities. Include shared equipment and resident belongings and clarify whether staff have permission to move personal items to clean around them.
Cleaning schedules should reflect the likelihood of contamination, residents’ vulnerability, and opportunities for exposure [13]. Shared medical equipment needs cleaning and disinfection after each use, while common areas and frequently touched surfaces require schedules appropriate to their use and risk [14].
Supplies should be readily accessible where staff need them. In memory care, placement requires additional judgment to balance convenient access with resident safety, using a case-by-case approach and input from the quality improvement team.
Monitoring makes improvement possible
Quality monitoring helps teams understand whether cleaning practices match expectations [1]. A monitoring plan should identify who conducts assessments, which rooms and surfaces they examine, what methods they use, and how often assessments occur [1]. Options include direct observation, fluorescent markers, and adenosine triphosphate testing [14].
Process surveillance should also examine product selection, adherence to facility procedures, and compliance with disinfectant instructions, including contact time [14]. Share results promptly with frontline staff in a way that encourages learning and shared accountability [1]. Reporting findings to the Quality Assurance and Performance Improvement committee gives leaders an opportunity to address barriers and support corrective action [9].
A practical next step is to assess the current program, identify gaps, and use those findings to guide improvements. The reason for doing so remains personal: every reliably cleaned surface contributes to the effort to protect someone’s loved one.
References
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Frank JN, Bodily-Bartrum M, editors. Infection Prevention Guide to Long-Term Care. 2nd ed. Arlington (VA): Association for Professionals in Infection Control & Epidemiology (APIC); 2019.
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Fekety R, Kim KH, Brown D, Batts DH, Cudmore M, Silva J. Jr. Epidemiology of antibiotic-associated colitis; isolation of Clostridium difficile from the hospital environment. Am. J. Med. 1981; 70:906–908.
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Pineles L, Perencevich E, Roghmann M, Gupta K, Cadena, J, Barocco G, et al. Frequency of Nursing Home Resident Contact with Staff, other Residents, and the Environment outside Resident Rooms. ICHE. 2019;1-3. https://doi.org/10.1017/ice.2019.117.
Donskey C. Beyond high-touch surfaces: Portable equipment and floors as potential sources of transmission of HAIs. AM J Infect Contrl. 2019; 47: A90-95.
Centers for Medicare & Medicaid Services (CMS). State Operations Manual Appendix PP, 2024 [Internet]. [cited 2026 Oct 24]. Available from https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/downloads/appendix-pp-state-operations-manual.pdf
Occupational Safety and Health Administration (OSHA). eTools-Hospital-Housekeeping. [Internet]. [Cited 2026 Oct 24]. Available from https://www.osha.gov/etools/hospitals/housekeeping
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Cadnum JL, Kaple CE, Eckstein EC, Saade EA, Ray AJ, Zabarsky TF, Guerrero BJ, et al. Dilution dysfunction: evaluation of automated disinfectant dispenser systems in 10 hospitals demonstrates a need for improved monitoring to ensure that correct disinfectant concentrations are delivered. ICHE. 2024; doi:10.1017/ice.2024.148
Centers for Disease Control and Prevention (CDC). Healthcare-Associated Infections Appendix A: Risk assessment for determining environmental cleaning method and frequency, Mar 19 2024 [Internet]. [cited 2026 Oct 24]. Available at https://www.cdc.gov/hai/prevent/resource-limited/risk-assessment.html
Centers for Disease Control & Prevention. Healthcare-Associated Infections: Environmental Cleaning Procedures, Mar 19, 2024 [Internet]. [Cite 2026 Oct 24]. Available from https://www.cdc.gov/healthcare-associated-infections/hcp/cleaning-global/procedures.html
