Nursing home deficiency citations for infection control


      This study examined the deficiency citation for infection control (ie, F-Tag 441). This information represents potential problems in infection control as identified in the yearly certification process of almost all US nursing homes.


      The data used came primarily from the Online Survey, Certification, and Reporting data base, which contains information on both deficiency citations and characteristics of nursing homes. The data for each nursing home from 2000 through 2007 were combined, providing a panel of 100,000 observations. Multivariate analyses and generalized estimating equations with a logit link were used.


      An average of 15% of all nursing homes received a deficiency citation for infection control each year from 2000 to 2007. In the multivariate analyses, several staffing levels were robust in their significance. For all 3 types of caregiver examined (ie, nurse aides, Licensed Practical Nurses, and Registered Nurses), low staffing levels were associated with receipt of a deficiency citation for infection control.


      The high number of deficiency citations for infection control problems identified in this study suggests the need for increased emphasis on these programs in nursing homes to protect vulnerable elders.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Richards C.
        Infections in residents of long-term care facilities: an agenda for research report of an expert panel.
        J Am Geriatr Soc. 2002; 20: 570-576
        • Barker W.H.
        • Zimmer J.G.
        • Hall W.J.
        • Ruff B.C.
        • Freundlich C.B.
        • Eggert G.M.
        Rates, patterns, causes, and costs of hospitalization of nursing home residents: a population-based study.
        Am J Public Health. 1994; 84: 1615-1620
        • Hu T.-W.
        Impact of urinary incontinence on healthcare costs.
        J Am Geriatr Soc. 1990; 38: 292-295
        • Mody L.
        • Langa K.M.
        • Saint S.
        • Bradley S.F.
        Preventing infections in nursing homes: a survey of infection control practices in southeast Michigan.
        Am J Infect Control. 2005; 33: 489-492
        • Pan A.
        Adherence to hand hygiene in an Italian long-term care facility.
        Am J Infect Control. 2008; 36: 495-497
        • Huang T.T.
        • Wu S.C.
        Evaluation of a training programme on knowledge and compliance of nurse ’assistants’ hand hygiene in nursing homes.
        J Hosp Infect. 2008; 68: 164-170
        • Fendler E.J.
        The impact of alcohol hand sanitizer use on infection rates in an extended care facility.
        Am J Infect Control. 2002; 30: 226-233
        • Richards C.L.
        Infection control in long-term care facilities.
        J Am Med Dir Assoc. 2007; 8: S18-S25
        • Kash B.A.
        • Hawes C.
        • Phillips C.D.
        Comparing staffing levels in the Online Survey Certification and Reporting (OSCAR) system with the Medicaid Cost Report data: are differences systematic.
        Gerontologist. 2007; 47: 480-489
        • Grabowski D.C.
        • Feng Z.
        • Intrator O.
        • Mor V.
        Recent trends in state nursing home payment policies.
        Health Aff. 2004; W4: 363-373
        • Putnam M.
        • Fengyan T.
        • Brooks-Danso A.
        • Pickard J.
        • Morrow-Howell N.L.
        Professionals’ beliefs about nursing home regulations in Missouri.
        J Appl Gerontol. 2007; 26: 290-304
        • Allen J.E.
        Nursing home federal requirements: guidelines to surveyors and survey protocols.
        Springer, New York2006
        • Castle N.G.
        • Engberg J.
        • Lave J.
        • Fisher A.
        Factors associated with increasing nursing home closures.
        Health Serv Res. 2009; 44: 1088-1109
        • Comondore V.R.
        • Devereaux P.J.
        • Zhou Q.
        • Stone S.B.
        • Busse J.W.
        • Ravindran N.C.
        • et al.
        Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.
        BMJ. 2009; 4: 339
        • Zeger S.L.
        • Liang K.Y.
        An overview of methods for the analysis of longitudinal data.
        Stat Med. 1992; 11: 1825-1839
      1. SAS Institute. Multicollinearity in logistic regression, 1999. Available from: Accessed July 2, 2009.

        • Smith A.
        • Carusone S.C.
        • Loeb M.
        Hand hygiene practices of health care workers in long-term care facilities.
        Am J Infect Control. 2008; 36: 492-494
      2. Centers for Disease Control and Prevention. Healthcare-associated infections, 2009. Available from: Accessed November 7, 2010.

        • Goldrick B.A.
        Infection control programs in skilled nursing long-term care facilities: an assessment.
        Am J Infect Control. 1999; 27: 4-9
        • Ahlbrecht H.
        • Shearen C.
        • Degelau J.
        • Guay D.R.P.
        Team approach to infection prevention and control in the nursing home setting.
        Am J Infect Control. 1999; 27: 64-70
        • Castle N.G.
        Nursing home caregiver staffing levels and quality of care: a literature review.
        J Appl Gerontol. 2008; 27: 375-405
      3. Otero RB. Current approaches to infection control, 1993. Available from: Accessed January 14, 2010.

        • Rao G.G.
        • Jeanes A.
        • Russell H.
        • Wilson D.
        • Atere-Roberts E.
        • O'Sullivan D.
        • et al.
        Effectiveness of short-term, enhanced, infection control support in improving compliance with infection control guidelines and practice in nursing homes: a cluster randomized trial.
        Epidemiol Infect. 2009; 137: 1465-1471
        • Smyer M.
        • Brannon D.
        • Cohn M.
        Improving nursing home care through training and job redesign.
        Gerontologist. 1992; 32: 327-333
      4. National Nursing Aide Assessment Program. 2004 NNAAP nurse aide practice written exam packet. Available from: Accessed November 7, 2010.

        • Pittet D.
        • Donaldson L.
        Clean care is safer care: the first global challenge of the WHO World Alliance for Patient Safety.
        Am J Infect Control. 2005; 33: 476-479
        • World Health Organization
        First global patient safety challenge: clean care is safer care. WHO guidelines on hand hygiene in health care.
        World Health Organization, Geneva, Switzerland2009