Toggle navigation Load unfinished survey Resume later Exit and clear survey default Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters. [CNISP] Long-term care home (LTCH) profile Note: Responses should reflect information obtained during the first month of surveillance participation. For example, if surveillance began in July 2025, the responses should pertain to data collected or events that occurred within that initial month. There are 23 questions in this survey. Home Characteristics (This question is mandatory) What is the name of your LTCH? (This question is mandatory) What is the LTC-ID for this LTCH? Choose one of the following answers Please choose... LTC-1 (This question is mandatory) Please provide an e-mail address for data follow up and results dissemination (This question is mandatory) What is the total number of beds for this LTCH? (This question is mandatory) Of the total number of beds for this LTCH, how many are LTCH resident beds? (This question is mandatory) What is the ownership model? Choose one of the following answers Private, for profit Private, not for profit Public Mixed private public (This question is mandatory) Type of long-term care home? Choose one of the following answers Independent, free standing Part of a multi-home organization (chain), free standing Independent, free standing associated with a hospital or hospital network Part of a multi-home organization (chain), free-standing associated with a hospital or hospital network (This question is mandatory) Which of the following services does your long-term care home provide? (Check all that apply) Check all that apply General nursing Dementia Skilled nursing and/ or short-term (sub-acute) rehabilitation Psychiatric (non-dementia) Ventilator Bariatric Hospice/palliative Other: (This question is mandatory) Do you have an electronic health record? Choose one of the following answers Yes No (This question is mandatory) Please Indicate whether any of the following are available in an electronic health record (check all that apply): Check all that apply Microbiology lab culture and antimicrobial susceptibility results Medication orders Medication administration record Resident vital signs Resident admission notes Resident progress notes Resident transfer or discharge notes Infection Prevention and Control Practices (This question is mandatory) For what type(s) of infection do you conduct surveillance (check all that apply)? Surveillance is defined as the ongoing systematic collection, analysis, and reporting of data to plan, implement, and evaluate healthcare practices. Check all that apply Urinary tract infection (catheter & non-catheter-associated) Skin/soft tissue infection Pneumonia C. difficile infection Gastroenteritis Other respiratory infections (including COVID-19) (This question is mandatory) Do you conduct screening for the following AROs? Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant enterococcus; CPO, carbapenemase-producing organism; ESBL, extended spectrum beta-lactamase producer. All residents on admission High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents on transfer from another healthcare facility Current residents (e.g. periodic/prevalence screens, contact follow-up) No screening MRSA All residents on admission High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents on transfer from another healthcare facility Current residents (e.g. periodic/prevalence screens, contact follow-up) No screening VRE All residents on admission High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents on transfer from another healthcare facility Current residents (e.g. periodic/prevalence screens, contact follow-up) No screening CPO (eg. CPE, CPA) All residents on admission High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents on transfer from another healthcare facility Current residents (e.g. periodic/prevalence screens, contact follow-up) No screening ESBL All residents on admission High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents on transfer from another healthcare facility Current residents (e.g. periodic/prevalence screens, contact follow-up) No screening Candida auris All residents on admission High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents on transfer from another healthcare facility Current residents (e.g. periodic/prevalence screens, contact follow-up) No screening (This question is mandatory) Do you have a policy for additional precautions (i.e. gown, gloves, and/or mask) for patients infected or colonized with an ARO? Choose one of the following answers Yes No (This question is mandatory) If yes, please select the option that is applicable for each of the following AROs All infected or colonized residents High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents upon transfer from another healthcare facility No MRSA All infected or colonized residents High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents upon transfer from another healthcare facility No VRE All infected or colonized residents High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents upon transfer from another healthcare facility No CPO (e,g. CPE,CPA) All infected or colonized residents High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents upon transfer from another healthcare facility No ESBL All infected or colonized residents High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents upon transfer from another healthcare facility No Candida auris All infected or colonized residents High risk residents (e.g. uncooperative, wounds, presence of an indwelling device, uncontained drainage, etc.) Residents upon transfer from another healthcare facility No (This question is mandatory) What is your LTCH’s ability to send urine specimens on symptomatic residents to the microbiology laboratory? (excluding statutory holidays) Choose one of the following answers Any day of the week Weekdays only Select days of the week (This question is mandatory) If select days, please specify which days of the week: Check all that apply Monday Tuesday Wednesday Thursday Friday Saturday Sunday Antimicrobial Stewardship Programs (This question is mandatory) Do you currently have formal surveillance of quantitative antimicrobial use (AMU) for this LTCH? Choose one of the following answers Yes No (This question is mandatory) Is an annual antibiogram (cumulative antibiotic susceptibility report) produced for this LTCH? Choose one of the following answers Yes No (This question is mandatory) Does your LTCH perform prospective audit and feedback for antimicrobial agents? Prospective audit and feedback broadly refers to reviewing and discussing a patient’s antimicrobial therapy with the prescriber after the antimicrobial was prescribed, which if done in real time, may or may not lead to a change in therapy. Choose one of the following answers Yes No (This question is mandatory) Does your LTCH have an antimicrobial stewardship program (ASP)? Choose one of the following answers Yes No (This question is mandatory) Please specify who is on the ASP team/committee Check all that apply MD: Infectious diseases MD: Other Pharmacist Microbiologist LTCH Director Infection Control Professional Nursing staff representative Resident representative Other: (This question is mandatory) Does your ASP provide education to prescribers and other relevant staff (eg. optimal prescribing, adverse reactions from antibiotics, and antibiotic resistance)? Choose one of the following answers Yes No (This question is mandatory) Does your ASP provide education to residents and families (eg. duration of therapy, side effects, signs and symptoms, adverse reactions from antibiotics)? Choose one of the following answers Yes No Submit Load unfinished survey Resume later Please confirm you want to clear your response? Exit and clear survey ×
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