Respiratory viruses have not gone anywhere. Just ask any clinician in the nursing home space, which continues to see infection prevention and control deficiencies as a challenge. Nursing experts inside and outside facilities attest to the need for continued vigilance to prevent airborne outbreaks of respiratory, stomach-related, and other viruses, notably RSV.

Easier said than done, say some of these voices from the nursing field, framing the problem as one exacerbated by staff fatigue after the COVID years, turnover rates that prevent consistent care protocols at times, and the decrease in vaccinations among the most vulnerable and the general population that come into contact with residents.

“While COVID-19 increased awareness of infection prevention, it did not eliminate the underlying challenges that exist in long-term care,” said Lauren Stenson, curriculum development specialist, American Association of Post-Acute Care Nursing (AAPACN).

“Residents today are often more medically complex and at greater risk for serious illness. Staffing shortages and turnover continue to affect the ability to consistently implement infection prevention measures. In addition, vaccine hesitancy among some residents, families, and staff can impact overall protection within the facility.”

Highly contagious and dangerous pathogens on the rise as infection threats are Candida auris, or C. auris, a fungal infection, and CRE infections caused by Carbapenem-resistant Enterobacterales, nursing sources said.

CRE are a group of bacteria normally found in the human gut, such as Escherichia coli (E. coli) and Klebsiella pneumoniae, which have developed resistance to carbapenem antibiotics and are often used as a last resort for severe infections, according to the Centers for Disease Control and Prevention.

Fatigue Comes After Crisis

What about people just being tired? The experts said there is the seemingly natural pullback after a crisis acting as another challenge to controlling infections.

“During and after the pandemic, healthcare workers were required to maintain a heightened focus on infection prevention practices for extended periods of time. Consistently adhering to screening protocols, PPE requirements, isolation precautions, and enhanced cleaning procedures can be challenging, particularly when staffing levels are strained,” Stenson said.

Over time, maintaining that level of vigilance becomes more difficult, which can contribute to lapses in infection prevention practices.

“The emergence of new infectious threats and antibiotic-resistant organisms further complicates prevention efforts. Ultimately, effective infection prevention and control requires ongoing vigilance and consistent adherence to best practices, which can be challenging to sustain in a complex and demanding healthcare environment,” she added.

Acuity and Vaccines

Jodi O’Mara, chief nursing officer for Journey Skilled Nursing, said it is no surprise to see a rise in airborne infections as a leading concern. “We are taking care of more compromised medically complex individuals with combined living spaces. Respiratory droplets linger in the air and can be transmitted without direct contact,” she said.

“Older communities were not designed to avoid tight or crowded spaces. In some cases, residents may share a room with two to three other individuals.”

And those vaccines are not being tapped like they were a few years ago.

O’Mara said there has been a significant decline in vaccination rates in recent seasons due to vaccine fatigue and federal guideline revisions. “Retail pharmacy reported a drop of 1.3 million less doses given in 2025-2026 than the previous year. Improving vaccination rates will continue to be a primary focus for prevention regarding airborne infections, along with hand hygiene, and proper PPE usage,” she said.

Back to Basics

On the issue of education and steps to take to prevent infection, Sarah Braceland, Prevail (by First Quality) US clinical leader, said the basics to achieving success are clear.

“Hand hygiene remains one of the most effective tools in preventing the spread of infection. Equally important is ensuring individuals living with incontinence receive appropriate continence care, including prompt product changes, gentle cleansing, and skin health support,” she said.

“By combining quality products with caregiver education and clinical resources, organizations can help promote dignity, comfort, and a healthier care environment.”

She added that through Prevail incontinent products and First Quality eNurse clinical support program, caregivers have access to product education and continence care guidance that help reinforce best practices and promote a cleaner, more supportive care environment.

Total Spectrum Care

Stenson said preventing the spread of respiratory viruses requires a comprehensive, multi-layered approach. Vaccination remains one of the most effective strategies available, particularly for influenza, COVID-19, RSV, and pneumococcal disease when indicated.

“Equally important are robust infection prevention and control practices, including early recognition of symptoms, timely testing, appropriate transmission-based precautions, hand hygiene, proper use of PPE, and ongoing staff education and competency validation,” she said.

Environmental cleaning and disinfection using approved products, attention to ventilation and indoor air quality, and adequate staffing levels are also critical components of an effective infection prevention program.

“Together, these measures help reduce transmission risk and support consistent adherence to infection control practices throughout the facility,” Stenson said.

Privacy Rights

One area that deserves attention, she added, is the balance between infection prevention and resident rights. Residents have the right to make their own healthcare decisions, including whether to receive vaccinations or participate in certain precautions, which can create challenges during outbreaks.

“Another consideration is the role of visitors and family members in introducing respiratory illnesses into facilities,” she said.

While facilities have made significant progress since COVID-19, the ongoing struggle is maintaining consistent execution amid staffing pressures, resident complexity, vaccine hesitancy, and the emergence of new infectious threats, Stenson said.

Questions or comments on this article? Contact Patrick Connole at pconnole@parkplacelove.com.