Infection prevention and control deficiencies remain the most cited compliance violation for nursing homes in the first half of 2026, with respiratory viruses, gastrointestinal viruses and multidrug-resistant organisms (MDROs) among the top concerns. While many of these threats can be minimized through effective protocols and readily available vaccines, infection prevention efforts can also be complicated by resident attitudes and resistance to vaccination.
Among highly contagious – and potentially deadly pathogens – Candida auris, or C. auris, a fungal infection, and CRE infections caused by Carbapenem-resistant Enterobacterales, present some of the greatest risks, according to Jodi O’Mara, chief nursing officer for Journey Skilled Nursing.
Both classes of pathogens are on the rise nationally and require heightened vigilance from providers because of their resistance to treatment and potential for severe outcomes among medically complex residents, she said.
Last year the Centers for Disease Control and Prevention (CDC) reported over 7,000 deaths related to C. Auris. In 2026, more than 7,000 C. Auris cases alone have already been reported in half of the states, with Nevada, California and Illinois being the highest, O’Mara noted.
Meanwhile, CRE infections have been rising since 2019 and are resistant to the strongest antibiotics available, she said.
C. auris is of particular concern in nursing homes serving residents with respiratory compromise, ventilator dependence or in-dwelling medical devices. The fungal infection carries a high mortality risk and is difficult to treat because many available antimicrobial therapies are ineffective against it. The organism can survive for extended periods on bedrails, catheters and medical equipment, making environmental cleaning a critical component of infection prevention.
Residents diagnosed with C. auris typically require contact isolation, while facilities must implement rigorous cleaning protocols using EPA-approved hospital-grade disinfectants, including bleach- and hydrogen peroxide-based products.
Michelle Stuercke, chief clinical officer with TCM Management and Consulting, has seen a rise in Pneumonia and RSV, partly because there was nursing home resident resistance to vaccines related to pneumococcal and respiratory viruses.
“These were a bit harder to convince individuals to accept,” Stuercke told Skilled Nursing News. “However, as we are seeing a surge in RSV, families and residents are asking about [vaccination] more at this time.”
Aside from the respiratory viruses, GI issues, particularly due to Norovirus are spreading quickly through the facilities, Stuercke said.
Overall, vaccines can be highly effective in preventing infection spread. However, since the days of the COVID-19 pandemic, facilities have faced some opposition to vaccination.
In Journey’s facilities, O’Mara told SNN that the rates of vaccination have varied from state to state.
Meanwhile, vaccination rates for influenza and pneumococcal disease have improved across Journey’s facilities, O’Mara said, for which she credited strong collaboration among medical directors, nurse practitioners and facility leadership for helping drive vaccination rates above national averages.
“We have had some outbreaks in a few facilities [but] we developed a respiratory treatment protocol to avoid serious complications,” O’Mara said. “The medical director and facility nurse practitioners are crucial in assisting in getting vaccination rates above the national average.”
Journey operates 39 skilled nursing facilities across multiple states, primarily concentrated in Georgia, Indiana, Kentucky, Maryland, Ohio and West Virginia.
Compliance with CMS infection prevention requirements remains a priority for Journey, O’Mara said, noting that F880 – the tag for Infection Prevention and Control in nursing homes and long-term care facilities – remains one of the most frequently cited deficiencies.
Simple things like ongoing staff education on hand hygiene and monitoring it and proper use of personal protective equipment and adherence to isolation protocols, remain essential to reducing health care-associated infections and protecting vulnerable residents, O’Mara said.
Moreover, facilities need to be in touch with their local and state health departments to be aware of any new emerging organism and put into place training and education, Stuercke said.
“Prior to accepting an emerging organism it is important that the facility educate staff on how the organism is transmitted, and ensure the cleaning agents the facility has will kill the organism,” she said.
Staffing levels, ‘trusting’ relationship
Optimal staffing levels can also be key in implementing a sound infection prevention program, providers say.
“Staffing has become such a focus since COVID … the more staff we have in the buildings allows us better training,” said Laurel Lingle, Journey’s vice president of talent acquisition.
But maintaining these protocols isn’t always easy, even when a facility has all its ducks in a row.
Andrew McNamara, chief medical officer with Trilogy Health Services, told SNN last year that Trilogy had faced challenges creating solid vaccination policies as various states in the company’s footprint had taken different approaches to CDC vaccine and masking recommendations.
“Based on location, how they interpreted some of the vaccines and the stuff that happened during the pandemic, they’re a little jaded. It can be hard to say, ‘Hey, this RSV thing is really important now,’” he said.
For TCM’s Stuercke, the success of an infection prevention and control program often boils staff relationships with residents.
“We saw great acceptance of the flu vaccine this year,” Stuercke said. “The Infection Preventionists did a great job in educating both residents and families around the importance of these vaccines. If the IP has a good, trusting relationship with the residents, then they are more likely to be accepting.”
Preventing common MDROs
To help prevent the spread of common superbugs such as C. auris, skilled nursing facilities have had to turn away residents in some cases, according to Stuercke.
“In Metropolitan areas, C-auris continues to be a challenge. Facilities are reluctant to accept residents, as they are worried about the spread and it is often difficult in a building with a high census to be able to make a private room,” she said.
If a facility discovers an existing resident has developed a C.Auris infection, staff should promptly place the infected resident on contact precautions, particularly those who are ventilator-dependent or have indwelling medical devices and are at heightened risk for infection, O’Mara said.
Because the organism can survive for long periods on bedrails, catheters, medical equipment, and other surfaces, facilities should implement enhanced environmental cleaning and disinfection protocols, O’Mara recommends. This includes deep cleaning resident rooms and shared equipment using EPA-approved hospital-grade disinfectants, such as bleach- or hydrogen peroxide-based products effective against C. auris.
Also, given the organism’s resistance to many antimicrobial treatments, early identification, strict infection-control practices and diligent cleaning are critical to limiting transmission and protecting vulnerable residents, she said.
And, to prevent a resurgence of superbugs, nursing homes should continue monitoring and education activities for staff in 2026, O’Mara said.
“It is important for communities to educate and conduct surveillance and a root cause analysis on [health-care associated infections],” she said. “The education should involve the entire IDT Team, nursing, housekeeping, dietary, activities social services and rehab.”
At least one common issue preventing superbug control has an easy fix: using the right cleaning agent.
“What the facility is using to clean either does not kill the organism or the facility does not understand the required dwell time for the cleaner to ensure the organism is removed and therefore the organism stays on the surface,” Stuercke said. “Your environmental services/housekeeping staff [should] know which supplies to use when and what are the instructions for use for the different organisms.”
Companies featured in this article:
Journey Skilled Nursing, TCM Consulting & Management, Trilogy Health Services
