Centers for Medicare and Medicaid Services Long Term Care (LTC) Infection Control Worksheet LTC Facility Self-Assessment Tool

This is a 18 page worksheet/checklist that can be used by long term care facilities as a self-assessment tool. It comprises both regulatory requirements and best practices in infection prevention and control. A facility that uses this ICWS will identify gaps in practice and have a “roadmap” that can lead to an improved infection prevention and control program.

CMS

IPC Intermediate Level

English

Checklist

Downloadable

Nonclinical / Indirect Healthcare Personnel 

Clinical / Direct Healthcare Personnel 

Infection Preventionist 

Assisted Living Facility (ALF) 

Nursing Home / Skilled Nursing Facility (SNF) 

Surveillance

Antimicrobial & Diagnostic Stewardship

Hand Hygiene

Standard Precautions

Transmission-Based Precautions

Injection Safety

Central Line

Urinary Catheter

Wound Care

Cleaning & Disinfection

Employee / Occupational Health

Vaccination

Physical Environment / Environment of Care (EOC)

Inter-/Intra-Facility Patient Transfer

Water Management

Tuberculosis

Multidrug Resistant Organisms (MDRO)

Influenza