Infection Prevention and Control in Swiss Nursing Homes: From Pandemic Lessons to the NOSO Strategy

Infection prevention in a nursing home is fundamentally different from infection control in an acute hospital. Residents are not simply receiving treatment in a clinical environment. They are living in their home, sharing meals and communal spaces, maintaining relationships, receiving visitors and, where possible, exercising freedom over daily routines. Measures that reduce infection risk can therefore also affect autonomy, social contact and quality of life if they are applied without sufficient judgement.

This tension sits at the centre of Switzerland’s current reform direction. Within the Switzerland Ageing, Long-Term Care & Community Support Knowledge Hub, infection prevention needs to be understood as a governance and care-quality issue rather than a narrow hygiene function. The experience of COVID-19 exposed the vulnerability of nursing homes, but it also demonstrated the consequences of approaches that protect physical health while restricting ordinary life for prolonged periods.

Switzerland is now trying to build a more mature model. The National Strategy for the Monitoring, Prevention and Control of Healthcare-Associated Infections, known as the NOSO Strategy, has been extended into a dedicated 2025–2029 action plan for retirement and nursing homes. For the first time, Switzerland also has national point-prevalence data on healthcare-associated infections and antibiotic use in these settings.

The strategic challenge is no longer simply whether nursing homes recognise infection prevention as important. It is whether the Confederation, cantons, providers, professionals and training systems can turn that recognition into reliable everyday practice while preserving the character of nursing homes as places where people live.

The NOSO Strategy marks a shift from local practice towards national coordination

Switzerland’s federal structure has historically produced substantial variation in how nursing homes organise infection prevention and control. Cantons hold important responsibilities for health-system organisation and oversight, while individual institutions have developed their own procedures, staffing arrangements and professional links.

This decentralisation can support adaptation to local circumstances, but it also makes consistency more difficult. A large nursing home linked closely to a hospital infection-prevention team may have access to specialist expertise that is far harder to obtain in a smaller rural institution. Different cantons may also have different support structures, professional networks and operational expectations.

The NOSO Strategy provides a national framework intended to reduce healthcare-associated infections in hospitals and nursing homes and limit the spread of potentially dangerous pathogens. Its nursing-home action plan, published jointly by the Federal Office of Public Health, the Swiss Conference of the Cantonal Ministers of Public Health and CURAVIVA in June 2025, creates a clearer implementation structure for the residential long-term care sector.

The action plan runs from 2025 to 2029. It is designed to strengthen awareness, institutionalise infection prevention and control, improve consistency and close known gaps in implementation. Importantly, it also makes explicit that infection prevention should be compatible with residents’ independence, autonomy and quality of life.

That last point is more than a statement of values. It changes how infection-control measures should be designed. A technically effective measure may still be inappropriate if it is disproportionate, poorly reviewed or applied without considering the individual consequences for residents.

Six priority areas turn national strategy into operational work

The action plan is organised around six packages of measures. Together they move infection prevention from an activity dependent on individual enthusiasm towards a more structured system.

The first priority is stronger infection prevention and control structures at both cantonal and institutional level. This includes designated contact people for IPC and stronger networks so that nursing homes are not expected to solve complex infection-control questions in isolation.

Other priorities include the development of minimum structural requirements, national recommendations, specialist expertise, workforce education and the collection of reference data. The practical direction can be summarised as:

• clearer IPC responsibility within cantons and nursing homes;
• stronger professional networks and access to specialist advice;
• minimum expectations for institutional infection-prevention capability;
• practical national recommendations for issues relevant to nursing homes;
• more systematic staff education and training;
• national surveillance capable of showing infection and antibiotic-use patterns.

This approach is significant because it recognises that infection prevention cannot depend solely on written procedures. An organisation may possess technically correct policies while staff lack time, confidence, equipment or specialist support to implement them consistently.

The strategy therefore connects naturally with wider quality standards and assurance frameworks. Effective IPC requires structures, knowledge, practice monitoring, escalation and learning to operate together.

For organisations examining whether responsibilities are sufficiently clear, the Governance Maturity Assessment can provide a general framework for testing accountability, escalation and oversight. It does not replace Swiss requirements, but it can help leaders examine whether responsibility genuinely reaches from organisational governance into everyday practice.

Switzerland now has its first national picture of infection in nursing homes

A major development has been the first nationwide point-prevalence survey of healthcare-associated infections and systemic antibiotic use in Swiss retirement and nursing homes.

The survey was undertaken in September 2024 and involved 94 institutions and 7,244 residents, whose average age was 87. It created a national reference point that had previously been missing from Swiss long-term care.

On the survey date, 2.3% of residents had a healthcare-associated infection. Urinary tract infections represented 44% of identified infections, while respiratory infections and skin or soft tissue infections each accounted for 15%.

Systemic antibiotics were being used by 2.6% of residents on the reference date.

The data also identified important risk factors. Urinary catheterisation was associated with the highest risk, followed by factors including urinary incontinence, wounds and recent hospital admission.

These figures need careful interpretation. A point-prevalence survey captures a particular moment rather than every infection occurring across a year. It also cannot by itself establish whether one institution’s infection is preventable or whether its practice is weak.

Its value lies in creating a baseline. Switzerland can now begin to examine patterns, repeat measurement and relate infection prevalence to organisational characteristics, workforce practice and prevention activity.

This is the foundation of stronger quality data and performance measurement: not collecting numbers for their own sake, but creating enough visibility to target prevention intelligently.

Scenario: a nursing home moves from assumption to evidence

A nursing home has historically considered respiratory outbreaks its main infection-control risk because influenza and COVID-19 have generated the most visible disruption. Staff training, contingency plans and supplies have consequently focused heavily on respiratory infection.

When the institution compares its own incident records with the emerging national evidence, it notices that urinary tract infections account for a much larger share of resident infections than management had previously appreciated.

A targeted review follows. The home examines catheter use, continence support, hydration, recognition of symptoms and the thresholds at which staff seek medical advice. It also looks at whether urine testing and antibiotic treatment are being used consistently and appropriately.

The exercise does not produce one simple intervention. Some residents have complex clinical histories and recurrent infections that cannot realistically be eliminated. However, staff identify several catheter reviews that have been delayed and inconsistent documentation of hydration risk.

The home introduces clearer review responsibility and begins monitoring catheter prevalence alongside infection events rather than concentrating almost exclusively on respiratory outbreaks.

The significance of national surveillance is therefore practical. It changes the organisation’s perception of where risk sits and directs attention towards an issue that had been less visible precisely because it caused fewer dramatic outbreaks.

Survey evidence shows that nursing homes want practical, usable guidance

National data collection has been accompanied by work to understand how nursing homes experience infection prevention in everyday practice.

A separate Swiss survey of 209 retirement and nursing homes found that urinary tract infections and acute respiratory infections were among the most significant challenges reported by institutions.

Homes also expressed a strong need for clear, practice-oriented and nationally consistent guidance. Areas identified included infectious diseases, multi-resistant organisms, standard hygiene and the practical application of infection-prevention measures for residents with cognitive impairment.

The last issue deserves particular attention. Infection-control instructions may appear straightforward when written for a clinical environment: isolate, maintain distance, wear protective equipment or restrict movement. In dementia care, those measures may be difficult to implement without causing distress, confusion or increased restriction.

The survey also indicated that awareness and implementation were themselves challenges. Knowing that infection prevention matters does not guarantee reliable compliance in daily care.

Many nursing homes had adapted national respiratory-infection guidance into simpler or locally usable formats. That is an important operational lesson. Guidance becomes effective only when the workforce can understand and apply it under real working conditions.

Good national policy therefore needs translation rather than mere circulation.

Infection prevention has to work in a home, not turn the home into a hospital

Nursing homes occupy an unusual position. They provide healthcare to people with increasingly complex needs, but they remain residential environments.

This means infection prevention involves continuous trade-offs.

A hospital may isolate a patient for a defined clinical episode. A nursing-home resident may live in the same room for years and regard communal meals, visitors and shared activity as essential parts of life. Restrictive measures can therefore have psychological, cognitive and functional consequences that differ substantially from those in acute care.

This is especially important for people living with dementia. Extended isolation can increase distress, disorientation, reduced mobility and loss of social connection. Visitors may also be essential sources of communication and emotional security rather than optional social contact.

Strong practice therefore requires proportionate decision-making. Infection risk, transmissibility, vulnerability, available protective measures, residents’ understanding and the consequences of restriction all need to be considered.

This connects infection prevention directly with safeguarding, consent and human rights in older people’s services.

The goal is not weaker infection control. It is better infection control: measures that protect people effectively while recognising that safety includes emotional wellbeing, mobility, relationships and autonomy.

Scenario: respiratory infection spreads through a dementia unit

Several residents on a dementia unit develop symptoms of an acute respiratory infection over a short period. One resident repeatedly leaves her room because she does not understand why staff are asking her to remain inside. Another becomes distressed when workers enter wearing unfamiliar protective equipment.

A rigid response could treat non-compliance as the central problem. The stronger response treats the environment and communication strategy as part of the infection-control intervention.

The home groups affected residents where clinically and operationally appropriate, increases ventilation and cleaning, reinforces hand hygiene, reviews communal activity and adjusts staffing so familiar employees can support the most distressed residents. Families receive clear information about the situation and appropriate visiting precautions.

For the resident who repeatedly leaves her room, the team considers how to reduce close contact with vulnerable residents without relying on prolonged confinement. Staff use familiar explanations, supportive redirection and changes to communal-space use.

The outbreak is later reviewed not only in terms of infection numbers but also the restrictions imposed, staff sickness, resident distress and the effectiveness of communication.

The lesson becomes part of future planning. Infection control is judged by whether transmission was managed safely and proportionately, not simply by whether every resident remained behind a closed door.

The workforce determines whether infection-control policy becomes reliable practice

Infection prevention is often described through technical measures: hand hygiene, personal protective equipment, cleaning, vaccination, wound management, isolation and antimicrobial stewardship. In practice, every one of these depends on the workforce.

Nursing homes employ people with different qualifications, responsibilities and levels of clinical knowledge. Staff turnover, temporary workers, language diversity and workforce pressure can all affect consistency.

The NOSO action plan therefore gives workforce education an important role. Infection-prevention content is intended to become more visible within continuing education and sector events, while nursing homes should have access to training designed around their actual needs.

This matters because training must go beyond knowledge transfer.

A worker may know the correct sequence for using protective equipment yet skip part of the process because supplies are poorly located. A team may understand hand-hygiene expectations but find that workload and workflow repeatedly undermine compliance. Staff may know that a resident should be reviewed for possible infection but hesitate because escalation routes are unclear.

Strong workforce skill and practice competence therefore involves behaviour, environment and professional judgement as much as formal education.

Institutions should be able to see whether training changes practice. Observation, infection patterns, incident review and staff feedback can all help identify whether learning has transferred into everyday care.

The same principle applies to leadership. Infection-prevention leads need enough authority, time and access to expertise to influence practice. Simply naming an IPC contact without giving that person the capacity to act risks creating responsibility on paper rather than capability in reality.

Cantonal and institutional IPC networks can reduce professional isolation

One of the action plan’s most important structural ideas is the development of stronger networks between cantonal and institutional infection-prevention contacts.

This addresses a practical problem. Smaller nursing homes cannot realistically maintain the same level of specialist infection-control expertise as major hospitals.

They nevertheless face complex questions involving outbreaks, multi-resistant organisms, isolation, antibiotic use, staff exposure and resident vulnerability.

Networked expertise provides an alternative to expecting every institution to become self-sufficient.

A nursing home can maintain competent local responsibility while drawing on wider professional advice when complexity increases. Cantonal structures can support consistency, spread learning and identify recurring problems across several institutions.

This has a wider governance benefit. If multiple homes report similar problems with the implementation of a recommendation, the issue may not be individual compliance. It may indicate that national guidance needs clarification, training needs redesigning or system infrastructure is insufficient.

Organisations examining whether escalation routes and external dependencies are sufficiently clear can use the Quality Dashboard Builder to structure a broader view of infection indicators, workforce measures and improvement actions. It is a generic governance tool rather than a Swiss IPC instrument, but it can help translate multiple signals into one management view.

Scenario: a small rural home encounters a resistant organism

A relatively small nursing home in a rural area is informed that a resident returning from hospital is colonised with a multi-resistant organism. The home has competent nursing staff but no dedicated infection-control specialist.

The immediate concern is not simply what protective equipment to use. Staff need to understand how precautions apply in a residential environment, what information should be shared, how communal life can continue safely and whether additional measures are required for particular care tasks.

The institution’s IPC contact uses the cantonal support route to obtain specialist advice. A proportionate plan is agreed rather than the resident being subjected automatically to broad and indefinite restrictions.

Staff are briefed before the resident returns. Cleaning requirements, hand hygiene and task-specific precautions are clarified. The resident and family receive an explanation of why measures are needed and how they will affect daily life.

The case is later discussed through the regional IPC network because other nursing homes have asked similar questions.

The value of the network lies in both directions. The individual home gains expertise it could not efficiently maintain alone, while cantonal partners gain visibility of recurring operational uncertainty that may justify clearer guidance or targeted training.

Antibiotic stewardship belongs inside infection prevention

The SPOT survey measured antibiotic use alongside healthcare-associated infections for good reason.

Preventing infection and using antimicrobial medicines appropriately are connected. Unnecessary or poorly targeted antibiotic use contributes to antimicrobial resistance, while delayed or inappropriate treatment can expose frail residents to significant harm.

Nursing homes create particular diagnostic challenges. Older people may present atypically. Cognitive impairment can make symptoms difficult to describe. Chronic urinary problems or colonisation may complicate interpretation, and clinical decisions may involve nursing staff, attending physicians, laboratories and pharmacies.

This makes antibiotic stewardship an interdisciplinary issue rather than a prescribing issue alone.

Reliable practice requires good observation, appropriate diagnostic reasoning, communication and review. Staff need to recognise deterioration without treating every non-specific change as evidence of bacterial infection.

The coexistence of the NOSO Strategy and Switzerland’s Strategy on Antibiotic Resistance reinforces the need to treat infection prevention and antimicrobial stewardship as complementary responsibilities.

For providers, useful governance questions include whether recurrent antibiotic prescribing is reviewed, whether cultures or diagnostic information are used appropriately, whether recurring urinary infections lead to examination of catheter practice and whether treatment decisions are communicated effectively across care transitions.

Strong stewardship protects individual residents while also reducing wider system risk.

Hospital transfers create infection-control interfaces that nursing homes cannot manage alone

Residents move between nursing homes, hospitals, rehabilitation and outpatient services. Those movements create infection risks that cross organisational boundaries.

A resident may return from hospital with a wound, urinary catheter, new antibiotic, resistant organism or altered infection status. If information is incomplete, the nursing home may not know what precautions, monitoring or treatment follow-up are required.

Recent hospitalisation was one of the risk factors identified in Switzerland’s national prevalence study, reinforcing the importance of this interface.

The issue connects directly with care transitions and hospital interfaces, even though the receiving service in this context is residential rather than home care.

Information transfer should therefore be treated as part of infection prevention. Relevant microbiology, current antimicrobial treatment, invasive devices, wound status and necessary precautions need to accompany the resident in usable form.

The receiving home also needs a clear route for clarification. A technically detailed hospital discharge record does not guarantee safe implementation if key information is difficult to find or staff cannot obtain timely answers.

The reverse direction matters too. When a resident is transferred to hospital, accurate information about recent infections, antibiotics and known resistant organisms can influence hospital treatment and precautions.

This is one example of why infection prevention cannot be governed solely within institutional boundaries.

Cleaning, equipment and building design shape what staff can realistically achieve

Infection prevention is partly behavioural, but behaviour occurs within physical systems.

Hand hygiene is easier when suitable facilities and products are available where care is delivered. Cleaning is more reliable when responsibilities, products and frequencies are clear. Protective equipment is more likely to be used correctly when storage and access support workflow.

Nursing-home environments create specific challenges because they are not designed entirely around clinical separation. Residents share dining rooms, lifts, lounges and activity spaces. Bedrooms are personal spaces containing belongings and furniture. Some older buildings may offer limited possibilities for isolation or ventilation adaptation.

The action plan’s emphasis on minimum structural requirements is therefore important. The purpose is not to transform nursing homes into acute hospitals but to establish the infrastructure necessary for safe practice.

Institutions need to know what minimum capability should exist routinely and what additional capacity is required during outbreaks.

That can include access to protective equipment, cleaning materials, isolation arrangements, hand-hygiene resources, specialist advice and contingency staffing.

Environmental assurance should also examine whether infection-control measures create unintended hazards. Excessive clutter removal may affect familiarity for residents with dementia. Repeated room changes can increase disorientation. PPE storage should support safe practice without making living areas unnecessarily institutional.

The environment has to support both clinical safety and residential quality.

Outbreak management is also a business-continuity issue

Large outbreaks affect far more than clinical care.

They can increase staff absence, disrupt catering and housekeeping, restrict admissions, increase demand for protective equipment, intensify communication with relatives and create pressure on local healthcare services.

This makes infection preparedness part of wider emergency preparedness.

A nursing home should understand which functions become vulnerable when infection spreads simultaneously among residents and staff.

Plans need to address not only infection-control actions but also operational continuity. Questions include how minimum staffing will be maintained, how agency or replacement workers will be inducted safely, how supplies will be replenished, how families will receive updates and who holds decision-making authority if usual leaders are absent.

The pandemic demonstrated the risk of developing contingency arrangements only after services are already under pressure.

Scenario testing can therefore be valuable. Rather than assuming that a written outbreak plan is sufficient, institutions can examine what would happen if several nurses, kitchen employees and cleaners were absent at once.

The lesson is not that every home needs unlimited spare capacity. It is that critical dependencies should be understood before they become operational failures.

Scenario: infection creates a workforce problem before a clinical crisis

A seasonal respiratory outbreak begins in a nursing home with 70 residents. Within four days, several residents are symptomatic, but none initially requires hospital care.

The greatest immediate pressure comes from staff sickness. Two nurses and several care and housekeeping employees are absent at the same time.

The home activates its contingency arrangements. Non-essential meetings are paused, agency workers are brought in and induction is shortened to focus on essential resident information, infection-control procedures and escalation routes. Cleaning resources are concentrated on the most important areas, while management monitors staffing twice daily rather than waiting for the normal rota review.

The IPC lead and senior nurse work together so clinical decisions and staffing decisions remain aligned. If staffing drops below safe thresholds, the escalation route to organisational and external partners is already defined.

After the outbreak, management reviews not only transmission and resident outcomes but also which operational systems came closest to failure.

The most important finding is that the home's protective-equipment supply was adequate, but replacement housekeeping capacity was fragile. The continuity plan is revised accordingly.

The case demonstrates why infection resilience is organisational. An outbreak may become unsafe because care, cleaning or staffing systems fail even when the disease itself is clinically manageable.

Surveillance should support prevention rather than become an administrative burden

The national point-prevalence survey creates a baseline, but the longer-term value will depend on how surveillance develops.

Repeated measurement can show whether infection patterns change and whether interventions appear to be working. Comparable data can help identify unusual variation and generate research questions.

Yet more surveillance is not automatically better surveillance.

Long-term care staff already document substantial amounts of clinical and operational information. Adding separate datasets that are difficult to extract or rarely used can divert time from direct care.

The strongest approach is therefore to build surveillance around information that leads to decisions.

Useful measures may include infection prevalence, outbreak frequency, antibiotic use, catheter exposure, staff sickness, vaccination where relevant, hand-hygiene monitoring and implementation of improvement actions. These measures need interpretation rather than mechanical targets.

A higher recorded infection rate may sometimes reflect better recognition and reporting. A low figure can be misleading if infections are under-detected.

Data quality and professional context therefore matter.

Future digital infrastructure may make surveillance more efficient by reducing duplicate reporting and extracting information from existing systems. Organisations considering this type of change can use the Digital Transformation Readiness Assessment to examine data quality, interoperability, workforce capability and governance before relying more heavily on automated monitoring.

Digital tools can support infection prevention, but only if the underlying records are accurate and staff understand what the resulting signals mean.

Resident and family communication is part of infection control

Residents and relatives need to understand infection-control measures if those measures are to work and remain proportionate.

During an outbreak, families may be asked to change visiting behaviour. Residents may be encouraged to remain away from communal areas temporarily. Staff may use masks or other protective equipment that affects communication.

Without clear explanations, these changes can generate anxiety and mistrust.

Communication should therefore explain what is happening, why particular measures are being used, how long they are expected to continue and how decisions will be reviewed.

This is particularly important for people with sensory impairment, cognitive impairment or limited understanding of the language used by the institution.

Accessible communication should not be treated as an optional courtesy. It is part of safe implementation.

Family members can also contribute important information. They may notice deterioration, behavioural changes or reduced appetite before these become obvious clinically. At the same time, relatives may have different risk tolerances and may push either for tighter restrictions or faster relaxation of measures.

Staff therefore need a clear clinical and ethical framework rather than allowing the most vocal preference to determine practice.

The best approach keeps residents’ rights and preferences central while making infection-control reasoning understandable.

Learning from outbreaks needs to reach beyond the individual institution

Outbreak reviews are most useful when they examine systems rather than assign blame.

A nursing home can ask when the first symptoms were identified, whether escalation was timely, whether staffing was sufficient, how guidance was interpreted, whether equipment was available and whether communication worked.

But some lessons will extend beyond the provider.

If several institutions struggle with the same recommendation, the issue may require cantonal or national clarification. If repeated hospital transfers arrive with incomplete infection information, the interface needs wider attention. If institutions cannot access specialist support quickly enough, the problem sits partly within regional infrastructure.

This is where stronger IPC networks become particularly valuable.

The principle aligns with broader learning from incidents and continuous improvement. Local events should inform institutional action, but recurring patterns should travel upwards through the system.

Governance is effective when learning changes future conditions.

That might mean revised guidance, different training, stronger specialist support, changed data collection or better interfaces with hospitals.

A national strategy becomes credible only when it can absorb these local lessons rather than operating as a one-way flow of instructions from the centre.

The post-pandemic lesson is proportionality, not permanent restriction

COVID-19 changed long-term care across Switzerland and internationally. Nursing homes experienced outbreaks, staff pressure, visitor restrictions and difficult decisions about how to protect people who were particularly vulnerable to severe disease.

The enduring lesson should not be that residential life needs to remain more restricted.

It is that nursing homes need stronger preparedness before the next infectious threat arrives.

Preparedness allows proportionate responses because organisations have alternatives available. Good ventilation, reliable PPE, trained staff, clear escalation routes and rapid access to advice can reduce reliance on broad restrictions.

Better surveillance can identify threats earlier. Strong workforce arrangements can make cohorting or additional precautions more feasible. Clear communication can help residents and families participate in risk reduction.

This is why the NOSO action plan’s explicit commitment to quality of life and autonomy matters.

Protection and independence should not be treated as competing objectives until a crisis forces a choice. They should be designed together in advance.

Where restrictions are necessary, they should be targeted, proportionate and reviewed rather than allowed to continue automatically because they once appeared prudent.

International learning lies in adapting infection control to long-term care itself

Switzerland’s emerging approach offers several useful lessons for other decentralised care systems.

The first is that nursing homes need infection-prevention standards designed for nursing homes rather than hospital standards transplanted without adaptation.

The second is that specialist expertise can be networked. Every institution does not need to duplicate the full infrastructure of an acute hospital if local responsibility is supported by accessible regional or cantonal expertise.

The third is that national surveillance can coexist with decentralised delivery. Comparable data create visibility while cantons and providers retain responsibility for implementing improvements in context.

The fourth is that workforce implementation matters as much as technical guidance. A national recommendation that frontline staff cannot understand or apply consistently will have limited effect.

The fifth is that infection prevention and quality of life need to be governed together. Residential long-term care cannot measure success solely by reducing infection if the methods used unnecessarily diminish mobility, relationships, dignity or autonomy.

The institutional structure cannot simply be exported to another country. Switzerland’s model is shaped by federalism, cantonal responsibility and its own health and long-term care architecture.

The transferable principle is stronger: infection prevention in residential care works best when national evidence, local expertise, practical workforce capability and person-centred judgement reinforce each other.

By 2029, implementation will matter more than the existence of the strategy

The NOSO nursing-home action plan establishes a clear direction, but publication is only the beginning.

By 2029, progress should be visible in how institutions operate rather than simply in how many recommendations have been produced.

The most meaningful evidence would include clearer IPC accountability, stronger access to specialist support, improved workforce competence, routine use of national recommendations, better surveillance and stronger responses to recurring infection patterns.

The development of national minimum structural requirements will also be important because it can reduce the extent to which infection-prevention capability depends on local organisational resources alone.

However, national consistency should not become inflexibility. Cantons and providers will continue to operate in different geographic, workforce and service contexts.

The stronger opportunity lies in defining what capability must exist while allowing institutions to determine how that capability is delivered appropriately within their setting.

Future assurance should also connect infection prevention to broader nursing-home quality. Infection rates, antibiotic use, staffing, restraint, resident experience and continuity are not separate systems. They interact.

A mature governance model therefore asks not only whether the IPC policy was followed, but whether prevention is becoming more reliable without unnecessarily diminishing the life people are able to live.

Conclusion

Switzerland’s approach to infection prevention in nursing homes is entering a more structured phase. The NOSO Strategy and its 2025–2029 action plan provide a national direction that had previously been less developed across a highly varied cantonal and institutional landscape.

The first national point-prevalence survey has also changed the evidence base. Switzerland can now see more clearly where healthcare-associated infections occur, which infections are most common and how antibiotic use sits alongside them. That information creates an opportunity to move from assumption towards targeted prevention.

The central challenge is implementation. Effective infection prevention depends on local IPC responsibility, accessible specialist advice, workforce competence, practical guidance, reliable surveillance and learning across organisational boundaries. It also depends on understanding that nursing homes are homes.

The strongest future model will therefore avoid a false choice between infection control and quality of life. Residents need protection from preventable infection, but they also need relationships, mobility, dignity, familiar routines and autonomy.

By 2029, the success of the NOSO action plan should be judged not only by whether Switzerland has produced stronger guidance and better data, but by whether nursing homes can use those tools consistently in everyday care. That is where national strategy, cantonal coordination and frontline practice meet—and where safer long-term care becomes tangible for residents and families.