Long-term Care Tool Kit


This project is a collaboration of the Michigan Antibiotic Resistance Reduction (MARR) Coalition, Michigan Department of Community Health, Michigan Society for Infection Prevention and Control (MSIPC), and the Centers for Disease Control and Prevention (CDC) Division of Healthcare Quality Promotion. It is designed to help LTC facilities implement the 12 Steps to Prevent Antimicrobial Resistance Among Long-Term Care Residents, a set of recommendations developed by the CDC as part of its Campaign to Prevent Antimicrobial Resistance in Healthcare Settings.

While the authors recognize that other prevention strategies exist, this tool kit follows the CDC 12-step framework; there are no alterations, additions or deletions to the CDC language. The user is encouraged to identify additional risks and to develop appropriate interventions accordingly.

What’s In the Tool Kit

The book is divided into twelve sections, one for each step in the CDC Campaign. Strategies on how to break a specific link(s) in the chain of infection are included in each step, along with practical information, protocols, policies and tools designed to be easily customized for your specific facility needs. Some steps include several documents; please review all documents associated with the step before implementing. The contents of each step are provided in Microsoft Word or Power Point format. Special tools, such as signage, are provided in PDF format.

Appreciation and Recognition

This project was made possible by a generous grant from Elan Biopharmaceuticals, Pfizer and the CDC Division of Healthcare Quality Promotion. The content is a product of many hours of research, development and discussion among infection prevention and control specialists, physicians, nurses and thought leaders in Michigan’s long-term care community. Thank you to the many individual contributors who made this project possible, especially Ruth Anne Rye, Judene Bartley and Russ Olmsted, whose tireless dedication and persistence made this project a reality.

Copyright Use

The MARR LTC Tool Kit exists for the benefit of healthcare providers in the LTC setting. These materials are available free of charge and, with the exception of journal articles, may be reproduced without permission. It is also acceptable to link to this Web site without express permission. If you decide to use these materials, we ask that you please credit the MARR Coalition.

How to Download Documents

The complete MARR Tool Kit may be downloaded in one file, or individually step by step. All of the materials and documents associated with each step are included in a Zip file folder. Click on the name of the step, i.e. Step 1: Vaccinate, and the files will automatically download to your computer's desktop. Click on the folder and it will automatically decompress if you have UnZip software. If you do not have UnZip software, you may download it here.

If you have any problems downloading, please contact us.


Download the complete MARR Tool Kit in one click . Each step and its contents are included in a separate folder by step number. File size 12 MB UPDATED November 11, 2010


Download the Introduction which includes: How to use the MARR LTC Tool Kit, key references, journal articles and understanding the infectious disease process. File size 752 KB


Download Step 1: Vaccinate (File size 2 MB) UPDATED June 16, 2008
Download Step 2: Prevent conditions that lead to infection (File size 620 KB)
Download Step 3: Get the unnecessary devices out (File size 252 KB)


Download Step 4: Use established criteria for diagnosis of infection (File size 2.1 MB)
Download Step 5: Use local resources (File size 920 KB)


Download Steps 6, 7, and 8 (includes introduction and files for all 3 steps) (File size 120 KB)
Step 6: Know when to say "no"
Step 7: Treat infection, not colonization or contamination
Step 8: Stop antimicrobial treatment


Download Step 9. Isolate the pathogen (UPDATED November 11, 2010 File size 836 KB)
Download Step 10. Break the chain of contagion (UPDATED November 11, 2010 File size 2.7 MB)
Download Step 11. Perform hand hygiene (File size 500 KB)
Download Step 12. Identify resident with multi-drug resistant organisms (MDROs) (File size 64 KB)