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OBRA 87 Infection Control Requirements
OBRA 87 at 42 CFR § 483.80 requires nursing homes to establish and maintain an infection prevention and control program (IPCP) designed to prevent, identify, and respond to the development and transmission of communicable diseases and infections. The IPCP must include surveillance protocols, hand hygiene policies, isolation procedures, antibiotic stewardship, and staff education. The 2016 CMS reform rule strengthened these requirements and mandated that each facility employ an infection preventionist — a dedicated staff member trained in infection control. Failure to maintain a compliant IPCP, or to implement outbreak response protocols during an active infection event, constitutes an F-tag F880 deficiency and creates civil liability when residents are harmed.
COVID-19 and the Catastrophic Failure of Nursing Home Infection Control
Nursing homes were the epicenter of COVID-19 mortality in the United States, with long-term care residents accounting for more than 25% of all COVID deaths despite representing a small fraction of the population. While the pandemic posed unprecedented challenges, facilities that failed to implement CDC and CMS infection control guidance — including PPE requirements, cohort isolation of confirmed and suspected cases, staff cohorting, visitor restrictions during active outbreaks, and testing protocols — are potentially liable when their negligent failure to follow published guidance caused resident deaths. Several states have enacted COVID-19 liability shields for healthcare facilities that raise complex legal issues but do not uniformly bar these claims.
C. Diff, Legionella, and Other Facility-Acquired Infections
Clostridium difficile (C. diff) colitis — a severe intestinal infection often occurring after antibiotic use — spreads readily in nursing home environments when contact precautions and environmental cleaning protocols are not properly implemented. Legionella pneumophila (Legionnaires' disease) is transmitted through contaminated water systems (showerheads, cooling towers) and has caused multiple deadly nursing home outbreaks attributable to failures in water management plans. Facilities that fail to properly maintain water systems, implement C. diff contact precautions, or respond to known infection clusters may be held liable under negligence and OBRA 87 regulatory violation theories.
Key data
Data & Statistics
Nursing home residents accounted for more than 25% of all U.S. COVID-19 deaths
Kaiser Family Foundation Analysis of CMS COVID Data, 2021
C. difficile causes an estimated 15,000-30,000 deaths annually, with nursing home residents among the highest-risk populations
CDC Clostridioides difficile Infection Data, 2023
FAQ
Frequently Asked Questions
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