nursing home infection control12 mins read

Review Nursing Home Infection Control

Use CMS inspection data, deficiency reports, and direct questions to assess a nursing home's infection control practices before admission.

Tiatun Tiatun

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Tiatun Tiatun

Founder of The Care Ratings

TCR Editorial Team

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TCR Editorial Team

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Nurse in protective equipment checking infection control protocols in a nursing home hallway

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How to Review a Nursing Home’s Infection Control Record

Key Takeaways

  • Infection control violations (F880) are tracked by CMS and appear in nursing home inspection reports and Five-Star ratings with a three-year lookback period.
  • You can access raw deficiency data through CMS’s Provider Data Catalog; look for patterns of repeated citations over multiple survey cycles.
  • Specific tour questions—about staffing, training, outbreak reporting, and the facility’s infection preventionist—reveal how seriously a home takes these standards.
  • Research on nursing homes from 2017 to 2019 found that facilities with lower profit margins and higher Medicaid reliance showed more persistent infection control deficiencies. [1]

Nursing home infection control is one of the most consistently cited categories of federal deficiency—and one of the most measurable. The data is public, updated regularly, and tied directly to the Five-Star ratings families already use. This guide explains what the records show, where to find them, and what questions yield comparable answers across facilities.

What Infection Control Violations Are and Why They Matter

The F880 deficiency tag

Every Medicare- and Medicaid-certified nursing home must maintain a comprehensive Infection Prevention and Control Program under 42 CFR §483.80. [2] When CMS surveyors find a facility has fallen short of that requirement, they cite it under deficiency tag F880. F880 is the primary federal tag for infection control; it covers everything from hand hygiene failures to inadequate isolation procedures during outbreaks.

The 2016 CMS final rule substantially raised the bar. Under 42 CFR §483.80(b)–(c), nursing homes are now required to designate a trained Infection Preventionist (IP)—a staff member with professional credentials in nursing, microbiology, epidemiology, or a related field—who must also sit on the facility’s Quality Assessment and Assurance committee. [2] They must also maintain an antibiotic stewardship program, per the same 2016 rule. [3] Starting April 2024, Enhanced Barrier Precautions for multidrug-resistant organisms were folded into F880 surveying as well, per CMS memo QSO-24-08-NH, referenced by LeadingAge (an industry-affiliated nonprofit). [4]

Why infection control shows up in Five-Star ratings

CMS’s Five-Star Health Inspection rating pulls from three inspection types: standard health surveys, complaint investigations, and focused infection control surveys. Deficiency findings from all three feed into the rating with a three-year lookback window, according to the CMS Five-Star Technical Users’ Guide. [5] Recency matters: for complaint and infection control inspections, findings from the most recent 12 months carry a weight of 3/4, while those from 13 to 36 months ago carry a weight of 1/4. That means a serious infection control citation from last year drags a facility’s Health Inspection score more than an older one does.

For a fuller explanation of how these components combine, see how CMS Five-Star ratings are calculated.

How Common Are Infection Control Violations?

Facilities cited at least once for F880 (2017–2019)

57%

Facilities cited more than once for F880 (2017–2019)

15%

Facilities cited in all 3 years — lowest profit margin quintile

13.7%

Facilities cited in all 3 years — highest profit margin quintile

7.6%

F880 Infection Control Deficiency Citation Rates Among U.S. Nursing Homes, 2017–2019

Source: PubMed Central / Infection Control & Hospital Epidemiology, 2021

These figures reflect pre-pandemic conditions, but the scale is instructive. Research published in Infection Control & Hospital Epidemiology found that in the two-year period from November 2017 to November 2019, approximately 57% of nursing homes—roughly 8,464 of 14,894 facilities studied in the continental U.S.—received at least one F880 deficiency citation, and about 15% were cited more than once. [6] A separate study published in the Journal of the American Medical Directors Association found that about three-fourths of all nursing facilities received an infection control deficiency in at least one of those three years, with roughly 10% cited in all three consecutive years. [7]

Those numbers predate COVID-19 and the subsequent wave of focused infection control surveys. Overall deficiency trends have moved sharply since then. According to KFF data from December 2025, the average certified nursing facility now receives 9.5 deficiency citations per survey cycle, up from 6.8 in 2015—a 40% increase. [8] The share of facilities receiving deficiencies rated at actual harm or immediate jeopardy rose from 17% in 2015 to 27% in 2025. [8]

Which facilities are cited more often

Research on the 2017–2019 period found that facilities receiving two or more F880 citations were more likely to be for-profit, more dependent on Medicaid reimbursement, and serving more acutely ill residents. [6] There is also a staffing connection: KFF’s analysis finds that facilities with lower staffing levels are more likely to receive deficiencies that cause serious harm or immediate jeopardy. [9]

For a broader overview of how violations are categorized and what they mean, see nursing home violations explained.

Reading Your Facility’s Infection Control Inspection Record

Where to find the data

The most direct public source is the CMS Provider Data Catalog. Two datasets are relevant:

Both are updated regularly and are searchable by the facility’s CMS Certification Number (CCN). You can also reach the same underlying data through Medicare’s Care Compare tool, which surfaces health inspection scores and deficiency summaries without requiring a data download.

According to KFF’s December 2025 analysis, there were 14,742 certified nursing facilities in the U.S. in 2025. [8] The records for any of them are publicly accessible.

What to look for in the report

When you pull a facility’s deficiency history, focus on three things:

  • F880 citation frequency. Was the facility cited once, or in multiple consecutive survey cycles? A pattern of repeat citations—especially in back-to-back years—is a clearer signal of systemic weakness than a single isolated finding.
  • Scope and severity. CMS rates each deficiency on a grid from A (isolated, no actual harm) to L (widespread immediate jeopardy). Infection control deficiencies at scope/severity G or higher are the most serious and carry mandatory enforcement consequences under current CMS guidance.
  • What the citation covered. The report text describes what surveyors observed. A KFF analysis drawing on GAO data documented common examples: staff failing to practice proper hand hygiene, or failing to isolate sick residents and use appropriate PPE during outbreaks. [11] These remain the core of what F880 covers.

Interpreting dates and severity levels

As of July 2025, CMS updated its Five-Star methodology (per the American Health Care Association, an industry trade group representing nursing homes) to use only the two most recent standard survey cycles for the standard health inspection component, while continuing to apply a three-year lookback for complaint and infection control inspections. [12] That means infection control findings from up to 36 months ago still affect a facility’s current Five-Star score—weighted less heavily, but still present.

When you’re reading a report, note the inspection date. A citation from 18 months ago carries 1/4 the scoring weight of one from 6 months ago. A recently corrected violation is different from one that appears repeatedly without resolution. The date-by-date pattern matters as much as the count.

For context on how to use CMS Five-Star ratings alongside inspection records, that guide covers the full methodology.

Questions to Ask During a Facility Tour

The questions below are grounded in the requirements of 42 CFR §483.80 and informed by the October 2025 multisociety infection prevention and control guidance endorsed by SHEA, APIC, IDSA, PALTmed, and AGS, published in Infection Control & Hospital Epidemiology. [13] They are not a validated clinical protocol. Use them to get comparable information from multiple facilities, then weigh the answers alongside the public data.

About staffing and training

  • Who is your designated Infection Preventionist? Federal regulations require every facility to employ one. Ask for their name, their professional background, and how many hours per week they dedicate to infection control duties. The 2025 multisociety guidance notes that IP turnover and insufficient time allocation are associated with weaker program outcomes. [13]
  • Is your IP certified in infection control (CIC)? Pre-2016 baseline data from a survey of 922 nursing homes found fewer than 3% of trained IPs held CIC certification. [3] The 2016 CMS rule raised training requirements, but certification remains voluntary. Facilities that invest in it are signaling a higher standard.
  • How are new staff trained on infection control procedures, and how often is that training refreshed? Ask specifically about hand hygiene, PPE use, and isolation protocols—the areas most commonly cited under F880.

About outbreak response and reporting

  • Does the facility report to the National Healthcare Safety Network (NHSN)? Since November 2024, long-term care facilities must report resident vaccination status and confirmed cases of COVID-19, influenza, and RSV under the CY2025 acute respiratory illness reporting requirements (CMS QSO-25-11-NH). [14] Compliance with this reporting requirement is itself a proxy for how systematically the facility tracks infectious disease data.
  • What is the protocol when a resident tests positive for a respiratory illness or gastrointestinal infection? You’re looking for a specific answer: isolation procedures, staff cohorting, family notification timelines, and how quickly the facility contacts the state health department.
  • Has the facility had any infection control-related complaint investigations in the past three years? This is public information—you can verify it in the Health Deficiencies dataset—but asking directly tells you how forthcoming the staff are.

About policies and practices

  • How does the facility implement Enhanced Barrier Precautions for residents with multidrug-resistant organisms? Since April 2024, Enhanced Barrier Precautions (EBP) for MDROs have been incorporated into F880 surveying. A facility that can’t explain its EBP protocol is operating behind current regulatory standards, per CMS memo QSO-24-08-NH. [4]
  • What does your antibiotic stewardship program look like? The 2016 CMS rule made this a required component of the infection control program. The answer should describe how the facility tracks antibiotic prescribing patterns and what criteria trigger a review.
  • Can I see the facility’s most recent Plan of Correction for any infection control deficiency? Plans of Correction are public documents. A facility that has addressed a past F880 citation with a substantive, implemented plan is in a different position than one that has not.

What the Data Reveals About Facility Type and Ownership

Profit margins and deficiency patterns

The pre-pandemic data shows a consistent pattern: lower profit margins correlate with higher rates of persistent infection control citations. Among facilities studied from 2017 to 2019, research found that 13.7% of facilities in the lowest profit margin quintile were cited for F880 in all three consecutive years, compared with 7.6% in the highest margin quintile. [7] That’s a nearly 2-to-1 difference in persistent, repeat citation rates.

This matters because facilities with thin margins are more likely to defer investment in IP training, staffing, and supplies—the exact inputs the 2025 multisociety guidance identifies as central to strong infection control programs. [13]

Staffing levels and compliance

Facilities that received two or more F880 deficiency citations during 2017–2019 were more likely to be for-profit and more dependent on Medicaid funding, according to published cohort research. [6] More broadly, KFF’s analysis finds that lower staffing levels are associated with a higher probability of serious-harm deficiencies overall. [9] Infection control is labor-intensive—consistent hand hygiene, proper PPE use, and resident isolation all require adequate staff to execute.

Ownership type and Medicaid mix are both visible in Care Compare data. They don’t predict outcomes for any individual facility, but they are context worth knowing when you’re comparing records.

Next Steps: Using This Information in Your Decision

Comparing facilities side-by-side

The CMS Provider Data Catalog lets you pull deficiency data for multiple facilities and compare F880 citation counts, dates, and severity levels directly. [10] When comparing, look at:

  • The number of infection control citations in the past three years
  • Whether citations recur across multiple survey cycles
  • The severity levels assigned (A–L), and whether any reached G or above
  • Whether associated Plans of Correction were accepted and closed

A facility with one older, lower-severity F880 citation that has since passed multiple clean inspections is in a meaningfully different position than one with repeated citations or an open Plan of Correction.

Red flags and when to ask for more detail

A few patterns in the public record warrant closer follow-up: repeated F880 citations in consecutive survey cycles; any deficiency rated at scope/severity G or above; complaint investigation findings related to infection control; or a facility that cannot clearly describe its IP’s role, its NHSN reporting, or its MDRO protocols during a tour.

If you are also evaluating post-acute care recovery options alongside long-term placement, the same CMS data applies—skilled nursing facilities operating under Medicare certification are subject to the same 42 CFR §483.80 requirements.

Infection control quality is not invisible. The data exists, the regulatory framework is specific, and the right questions yield comparable answers. Start with the public record, then use the tour to fill in what the numbers can’t tell you.

Important: This article describes general information about nursing home infection control and the care options available. It is not medical advice and is not a substitute for a diagnosis, treatment plan, or recommendation from a licensed healthcare provider. If you or a family member are experiencing a medical emergency, call 911. For non-emergency medical questions, consult your physician or a licensed care professional.

Sources cited in this article:

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