"Infection control training" in a skilled nursing facility is really two obligations wearing one name. One is the program — the written system and the specially-trained person who runs it. The other is staff training — making sure everyone who touches care actually knows and follows it. Federal law requires both, and in California a Cal/OSHA standard adds a third layer with a hard annual deadline. This guide sets out each, with the citation attached.
Level 1 — the program and the Infection Preventionist (§ 483.80)
42 CFR § 483.80 requires every facility to establish an Infection Prevention and Control Program (IPCP). Under § 483.80(a) that program must include a surveillance system to identify infections, written standards, policies and procedures (standard and transmission-based precautions, and when to isolate a resident), an antibiotic stewardship program, and documentation of incidents and the corrective actions taken. The program is reviewed and updated at least annually (§ 483.80(f)).
The program has to have an owner. § 483.80(b) requires the facility to designate one or more individuals as the infection preventionist(s) (IP), who must:
- be qualified by education, training, experience or certification — with professional training in a field such as nursing, medical technology, microbiology or epidemiology;
- have completed specialized training in infection prevention and control (§ 483.80(b)(3)); and
- work at least part-time at the facility.
The IP is also a member of the facility’s quality assessment and assurance (QAA) committee (§ 483.80(c)), so the infection program is not run in a corner — it feeds the facility’s wider quality work.
Level 2 — training the staff (§ 483.95(e))
A program on paper protects no one until the staff are trained on it. The federal training rule, 42 CFR § 483.95, lists infection control at paragraph (e) as a required subject the facility must train its staff on. In practice this is delivered as recurring in-services — hand hygiene, precautions, PPE — inside the same in-service program that carries every other required topic. (Nurse-aide in-service also carries a no-less-than-12-hours-a-year floor under § 483.95(g).)
The California layer — Cal/OSHA’s ATD standard (§ 5199)
California adds an occupational-safety layer that federal SNF rules do not. Cal/OSHA’s Aerosol Transmissible Diseases (ATD) standard, 8 CCR § 5199, applies to skilled nursing facilities. It requires the employer to:
| Requirement | Citation |
|---|---|
| Maintain a written ATD Exposure Control Plan specific to the workplace | 8 CCR § 5199(d)(1) |
| Train exposed staff at initial assignment | 8 CCR § 5199(i)(2)(A) |
| Re-train at least annually — not to exceed 12 months from the previous training | 8 CCR § 5199(i)(2)(B) |
| Provide respirators, PPE, training and medical services at no cost to the employee | 8 CCR § 5199 |
That annual, documented ATD training is the piece facilities most often let slip, because it has a hard 12-month clock the federal in-service rule does not. Put it on the training calendar with a date, not a vague "annually."
What an infection-control in-service should cover
- Hand hygiene — the single highest-yield topic, taught to competence, not just shown
- Standard and transmission-based precautions, and when each applies
- Selecting, donning and doffing PPE, and respirator use under the ATD plan
- Isolation set-up and communication
- Recognizing a possible outbreak and who to tell
Documenting it so it survives survey
As with every in-service, the credit is in the documentation: a lesson plan (CDPH-278 format), a sign-in sheet, a competency check, and a place in the training file — plus, for the ATD piece, dated records that show training happened within the last 12 months. Attendance is not competence, and an undocumented in-service, to a surveyor, did not happen.
Putting it together
- Run a written IPCP under a qualified, specially-trained Infection Preventionist who works at least part-time (42 CFR § 483.80).
- Train every staff member on the program, as a recurring in-service (§ 483.95(e)).
- In California, keep a written ATD plan and train staff at hire and at least annually (8 CCR § 5199).
- Document all of it — lesson plan, sign-in, competency, dates.
Owning that program is a core part of the Director of Staff Development’s job. Our DSD certification course teaches you how to build and document an in-service program from the regulation up; see also what a DSD does.
Frequently asked questions
Is infection control training required in nursing homes?
Yes, at two levels. Every staff member must be trained on the facility’s infection prevention and control program under 42 CFR § 483.95(e), and the facility must run that program under a qualified Infection Preventionist (§ 483.80(b)). In California, Cal/OSHA’s Aerosol Transmissible Diseases standard adds its own training rule (8 CCR § 5199).
Does a nursing home have to have an Infection Preventionist?
Yes. 42 CFR § 483.80(b) requires the facility to designate one or more individuals as the infection preventionist(s) — qualified by education, training, experience or certification, having completed specialized training in infection prevention and control, and working at least part-time at the facility.
Can the Infection Preventionist be part-time?
The current federal text requires the IP to "work at least part-time at the facility" (§ 483.80(b)(3)). CMS has revisited how much IP time it expects, so confirm the current requirement and any state expectation rather than relying on a figure you read once.
What must the infection prevention and control program include?
Under § 483.80(a): a surveillance system to identify infections, written standards, policies and procedures (including standard and transmission-based precautions and when to isolate), an antibiotic stewardship program, and documentation of incidents and corrective actions. The program is reviewed at least annually (§ 483.80(f)).
How often must infection-control training happen?
Staff training is part of the facility’s ongoing in-service program (42 CFR § 483.95(e)). In California, Cal/OSHA’s ATD standard requires training at the time of initial assignment and "at least annually thereafter, not to exceed 12 months from the previous training" (8 CCR § 5199(i)).
What does California add on top of the federal rule?
Cal/OSHA’s Aerosol Transmissible Diseases standard, 8 CCR § 5199, applies to skilled nursing facilities. It requires a written ATD Exposure Control Plan (§ 5199(d)), employer-provided respirators and PPE at no cost, and documented training at hire and at least annually (§ 5199(i)).
What should an infection-control in-service cover?
Commonly: hand hygiene, standard and transmission-based precautions, selecting and using PPE, isolation, respiratory and injection safety, and outbreak recognition and response. The facility’s risk assessment and antibiotic stewardship program shape the specifics.
Where can I get infection-control training materials?
Our In-Service Lesson-Plan Library includes ready-to-teach infection-control in-services (hand hygiene, precautions and PPE), and our Infection Prevention & Control in Long-Term Care reference manual covers the Infection Preventionist role and the written program in depth.
