Daily Operations Manual

1Log into PointClickCare and check overnight alerts

• Review any new infection surveillance entries flagged overnight
• Check the "Alerts" bell icon for lab critical values or pending precaution flags
• Note any new admissions or readmissions from hospital — these require baseline assessment
• Check census for any transfers in that may bring in resistant organisms (MRSA, VRE, C. diff, CRE)

2Pull the Morning Report & Identify High-Risk Residents

• Cross-reference hospital transfers: confirm precautions are active in PCC before nurse receives resident
• Flag any resident with wound infection, foley catheter, central line, or tracheostomy for priority rounds
• Review the 24-hour nursing notes for reports of fever, diarrhea, respiratory symptoms
• Check if any isolation rooms are occupied and verify correct PPE carts are stocked outside doors

3Check and Restock Your IP Cart / Supplies

• Verify PPE stock at all isolation rooms: gloves (correct size), gowns, N95s (if applicable), surgical masks, face shields
• Confirm alcohol-based hand rub dispensers at every room entrance are not empty
• Check that contact precaution signage is intact and facing outward on all applicable doors
• Stock audit clipboard: Nurse audit forms, CNA audit forms, EVS audit forms

1Conduct Floor Rounds Using McGeer Surveillance Criteria

Apply McGeer Criteria 2012 to determine whether a resident meets the definition of infection before entering it in PCC. Do not count antibiotic starts alone — use clinical criteria.

2Enter New Infection Surveillance Cases in PCC

• Use onset date (not the date you entered it) — FL DOH and NHSN both require accurate onset
• Select all McGeer criteria that apply — do not leave criteria fields blank
• Enter culture source and organism if available (even preliminary results)
• Mark isolation type: Contact, Droplet, Airborne, or combination
• Link to antibiotic if one was started (ties into stewardship tracking)

3Verify Active Precautions Are Correctly Flagged

• Confirm the precaution type matches the organism/infection: MRSA = Contact; TB = Airborne; Flu = Droplet + Contact
• Verify the isolation status appears on the resident's face sheet and care plan
• Walk the unit: physical door sign must match PCC flag — discrepancy = immediate correction

1Review All Pending & New Lab Results

• Review all urinalysis results — do NOT treat a UA alone; apply McGeer criteria first
• Review all wound cultures: identify organism and susceptibility pattern
• Flag any C. diff PCR positives — immediately verify isolation is in place
• Flag any MRSA, VRE, CRE, ESBL, CRAB culture positives — update PCC precautions
• Review blood cultures: any positive blood culture = notify DON and attending immediately
• Review respiratory cultures for residents on antibiotics for pneumonia

2Antibiotic Stewardship Review

Per CDC 7 Core Elements of Antibiotic Stewardship for LTC (required by CMS F886):

3Document Antibiotic Review in PCC

• Write a note for every antibiotic reviewed — even if no action needed ("Reviewed: indication documented, culture pending, continue as prescribed")
• If you called prescriber: document call, time, prescriber response, and plan
• If antibiotic was de-escalated or discontinued: document rationale

1Update Infection Surveillance Log in PCC

• Close resolved cases: mark resolution date (when symptoms resolved, not when antibiotic ended)
• Update culture results on open cases as they return
• Confirm outcomes are documented: resolved, transferred, or deceased
• Verify all new cases from morning rounds are entered with complete criteria

2NHSN Reporting — Know Your Deadlines

3Resident Care Plan Updates

• Add isolation precaution as a care plan problem within 24h of onset
• Document interventions: PPE type, hand hygiene reminders, dedicated equipment
• Goal: "Resident will remain free from spread of [organism] to others as evidenced by no secondary cases in unit"
• Update care plan when precautions are lifted

1Conduct Unannounced Staff Observation Audits

Target minimum: 1 nurse audit, 1 CNA audit, and 1 EVS audit per week. Rotate units, shifts, and staff. Document all results.

2Answer Staff Questions & Provide Just-In-Time Education

• When staff asks "Do I need to gown for this?" — use it as a teaching moment, walk them through the precaution type
• Post updated isolation signage immediately when a new case is identified (do not wait for next shift)
• Review PPE doffing with any staff member you observe making an error — correct privately, document trend patterns
• Distribute written education when a new pathogen is circulating in the facility

3Attend or Facilitate Clinical Meetings

• Morning clinical meeting: report any active infections, new precautions, or outbreak status
• Weekly QAPI/IDT meeting: present infection data, audit scores, and stewardship report
• Monthly infection control committee: present surveillance summary, trend analysis, plan of correction if needed
• Coordinate with Director of Nursing (DON) on any staffing or PPE supply issues

1Declare Outbreak & Notify Required Parties

• Notify DON and Administrator immediately upon meeting outbreak threshold
• Report to County Health Department within 24 hours (FL Statute §381.0031)
• Notify Medical Director to coordinate testing and clinical management
• Contact FL DOH HAI Program if MDRO cluster: 1-800-342-3557
• Notify corporate/regional clinical leadership per facility policy

2Implement Outbreak Control Measures

3Maintain Outbreak Line List

• Line list: Resident name/ID, room, onset date, symptoms, specimen date, result, outcome, current status
• Update daily — send to DON and Medical Director each morning during active outbreak
• Track staff cases separately: name withheld from group reports per HIPAA — use staff ID or role
• Document when outbreak is declared over: 28 days (2 incubation periods) after last case resolves

4Outbreak Investigation & Root Cause Analysis

• Map cases by room and unit: look for geographic clustering
• Review dietary (common food source?), activities (common gathering?), shared staff
• Review environmental cleaning logs for affected area
• Interview charge nurses: when did first case appear? Who had contact?
• Document RCA findings and corrective actions in QAPI record

Annual Tasks

1Finalize PCC Documentation

• Ensure all infection surveillance entries are saved and complete — no draft entries left open
• Verify all antibiotic stewardship notes are completed
• Close any care plan items updated today
• Check your PCC task list: no outstanding notifications requiring your response

2Brief Oncoming Charge Nurse or Evening Supervisor

• Report any new isolation residents: room number, type of precaution, what PPE is required
• Report any residents being monitored (not yet meeting criteria but symptomatic)
• Alert to any pending culture results expected overnight
• Communicate any active outbreak status and current control measures
• Confirm PPE carts are stocked before leaving

3Before You Leave — Final Walkthrough

• Walk isolation rooms: door closed? Signage visible? PPE cart stocked? Dedicated equipment in room?
• Check hand sanitizer dispensers in hallways — refill or flag for housekeeping if empty
• Confirm any outstanding lab specimens were collected and sent
• Secure your IP forms and audit papers
• Set a PCC task reminder for any follow-up needed tomorrow