Herpes zoster virus

No clinical practice guideline exists for herpes zoster immunization in nursing home residents. Immunization decisions should include an assessment of life expectancy, immune competency, burden of illness, and nutritional status.32

The CDC recommends herpes zoster virus vaccine (Zostavax) for all adults 60 years and older without contraindications; booster is not necessary.33

Influenza

Influenza vaccine should be administered to all staff and residents annually.34,35

A meta-analysis demonstrated fewer influenza complications in nursing home residents, compared with community-dwelling older adults.36

If an influenza outbreak occurs, treatment and chemoprophylaxis with antivirals should be initiated, and droplet precautions established. Cohorts of residents should be identified, and contact restricted among ill staff, residents, and visitors.35

MRSA

All staff, visitors, and residents should use strict handwashing practices, and barrier precautions for wounds and medical devices should be initiated.

Surveillance cultures are not warranted.

Aggressive housekeeping practices play little, if any, role in prevention.

Cohorting and isolating residents are not practical or cost-effective.31

Pneumococcal virus

Nursing homes are permitted to have standing orders to administer the pneumococcal polysaccharide vaccine (Pneumovax).

The CDC recommends the pneumococcal polysaccharide vaccine for all adults 65 years and older, with repeat vaccination in five years if immunocompromised.37

Tuberculosis

Frail older adults residing in nursing homes have a greater risk of tuberculosis than those in the community setting. Two-step testing is recommended for nursing home residents to prevent false-negative results, which often occur in older adults.38

All new residents and staff should receive a TST, unless a prior positive result is documented. Chest radiography and clinical diagnostic evaluation should be performed for those with a positive TST result.

Residents with known prior positive TST results who have normal findings on chest radiography or stable prior findings should be reevaluated periodically for change in symptoms. Repeat chest radiography is needed only if clinically indicated.

Residents with symptoms suggestive of tuberculosis, sputum smears positive for acid-fast bacilli, or radiography changes should be placed in airborne infection isolation.

When caring for residents with confirmed or suspected infectious pulmonary tuberculosis, staff must use respiratory protection devices approved by the National Institute for Occupational Safety and Health.38