Iowa’s most recent Respiratory Virus Surveillance Report shows increased spread of respiratory pathogens across the state, with influenza, RSV and COVID‑19 all demonstrating measurable activity heading into early 2026. Week 51 data (Dec. 14 – Dec. 20, 2025) indicates elevated levels of influenza positivity (with notable Flu A and Flu B activity), a rise in RSV positivity and ongoing COVID‑19 cases within long‑term care environments.
These trends signal that nursing homes should anticipate an increased likelihood of outbreaks and be prepared to respond rapidly using established infection prevention and control (IPC) protocols.
How leaders should respond: IPC priorities
The CDC’s Viral Respiratory Pathogens Toolkit for Nursing Homes (updated Jan. 9, 2026) provides a comprehensive roadmap for prevention and response.
Specifically, nursing homes are expected to comply with the Centers for Disease Prevention and Control’s Infection Control Guidance: SARS-CoV-2. To assist providers with implementation of this guidance, IHCA has made available the IHCA Clinical Guidance Summary, which is a comprehensive summary of COVID-19 practices and expectations set forth by relative regulatory bodies (CMS, DIAL, Iowa HHS and CDC).
Key leadership actions include:
1. Strengthen vaccination programs
- Ensure residents and healthcare personnel (HCP) receive recommended vaccines for influenza, COVID‑19 and RSV.
- Partner with pharmacies and public health entities to maintain adequate vaccine supply.
- Promote vaccine education for residents, staff, families and visitors.
2. Maintain adequate supplies and resource readiness
- Confirm availability of PPE, hand sanitizer, diagnostic tests and antiviral treatments.
- Prepare contingency plans for periods of increased symptomatic residents.
3. Enhance masking and surveillance based on community transmission
- Work closely with local health authorities to monitor regional spread.
- When community rates rise, consider masking recommendations for visitors, HCP and residents (especially when outside their rooms).
4. Educate residents, staff and visitors
- Display and distribute reminders about symptom reporting, masking, hand hygiene and visitation expectations.
- Encourage symptomatic visitors to postpone non‑urgent visits.
5. Improve ventilation and air quality
- Collaborate with facility engineers to optimize airflow in resident rooms and shared common areas.
Iowa‑specific reporting requirements for respiratory illness outbreaks
Nursing facilities must report outbreaks of influenza and other novel respiratory viruses to Iowa HHS. This infographic identifies when and how to report an outbreak.
Facilities should ensure:
- Clear internal processes for identifying clusters of respiratory illness.
- Prompt reporting to local public health as outlined in Iowa HHS guidance.
- Strong communication between nursing leadership, infection preventionists and local/state agencies.
Federal reporting requirements: National Healthcare Safety Network (NHSN)
CMS issued updated reporting requirements (QSO‑25‑11‑NH) for long‑term care respiratory reporting. As of Jan. 1, 2025, nursing homes have been required to electronically report standardized data on COVID‑19, influenza and RSV to the CDC’s National Healthcare Safety Network (NHSN).
Required NHSN long‑term care facility module data elements include:
- Census and occupancy
- Vaccination status for COVID‑19, influenza and RSV (residents and staff)
- Confirmed cases among residents (broken down by vaccination status)
- Hospitalizations associated with confirmed cases
- Laboratory‑confirmed influenza and RSV data
Members are reminded that COVID-19 response protocols have not significantly changed since March 2023. Although other states have drafted alternative, state-specific COVID-19 response expectations that may apply in nursing homes or other health care settings (for example, the duration of isolation for COVID-19 residents), CMS has reminded nursing facilities and state governments that the requirements (F880) found in federal regulation will serve as their minimum requirement.
Rising respiratory illness activity in nursing homes demands vigilant infection prevention, strong leadership oversight and adherence to both Iowa and federal reporting requirements. By implementing CDC‑recommended strategies, maintaining readiness and ensuring transparent reporting, nursing homes can significantly reduce the impact of respiratory outbreaks on residents and staff. Questions can be directed to IHCA’s Brenda Irlbeck, VP of Regulatory Affairs.