Long-term Care Toolkit


cover of long-term care toolkit 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.

Download Toolkit

Complete MARR Toolkit ZIP File

Download the complete MARR Tool Kit
Each step and its contents are included in a separate folder by step number.
File size 12 MB

Individual File Download


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

Prevent Infection

Download Step 1: Vaccinate (File size 2 MB)

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)

Diagnose and Treat Infection Effectively

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)

Use Antimicrobials Wisely

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

Prevent Transmission

Download Step 9. Isolate the pathogen (File size 836 KB)

Download Step 10. Break the chain of contagion (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)