What Are McGeer's Criteria?
McGeer's criteria are a standardized set of definitions used to identify and classify infections in long-term care residents. Developed in the early 1990s by Dr. Allison McGeer and colleagues at Mount Sinai Hospital in Toronto, these criteria give infection preventionists a consistent framework for determining whether a resident's signs and symptoms meet the threshold for a reportable infection case.
For anyone working in long-term care infection prevention, McGeer's criteria are the foundation of surveillance. They're the difference between reliably tracking infections over time and making subjective, inconsistent case-by-case decisions that produce unreliable data.
Why Standardized Case Definitions Matter
Without a shared definition of what counts as an infection, facilities end up with surveillance data that can't be compared across units, across time, or against benchmarks. A respiratory infection case reported on one floor might meet a completely different threshold than one reported on another — creating blind spots that allow outbreaks to develop undetected.
McGeer's criteria solve this by establishing specific, observable criteria for each infection type. When every staff member and every system is working from the same definitions, your infection data becomes meaningful — and actionable.
Which Infection Types Do McGeer's Criteria Cover?
McGeer's criteria have been updated over the years to reflect evolving evidence and clinical practice. The most widely used version (updated in 2012) includes criteria for:
- Urinary tract infections (UTI) — with specific criteria for catheterized and non-catheterized residents
- Respiratory tract infections — including pneumonia, influenza-like illness, and other upper and lower respiratory infections
- Skin and soft tissue infections — including cellulitis, wound infections, and fungal infections
- Gastrointestinal infections — including norovirus and C. difficile
- Eye, ear, and oral infections
- Bloodstream infections
- Other systemic infections
Each category includes specific minimum criteria — combinations of signs, symptoms, and laboratory findings — that must be met before a case is recorded.
How McGeer's Criteria Are Applied in Practice
In practice, applying McGeer's criteria requires clinical judgment and careful documentation. Here's how the process typically works:
- A resident develops signs or symptoms that may indicate an infection — fever, increased confusion, dysuria, productive cough, etc.
- The nurse or care provider assesses the resident and documents the specific signs and symptoms present, including onset date and time.
- The infection preventionist (or designate) reviews the case against the relevant McGeer's criteria to determine whether the case meets the case definition.
- If the criteria are met, the case is recorded in the facility's surveillance system with the date of onset, infection type, and relevant clinical details.
- The case is monitored for progression, treatment, and resolution — and added to the line list for ongoing outbreak monitoring.
The challenge in many facilities is that this process happens manually — often in spreadsheets or paper logs — which introduces delays and errors, particularly during high-volume periods or potential outbreaks.
Common Pitfalls When Applying McGeer's Criteria
Even experienced infection preventionists encounter challenges with McGeer's criteria. The most common pitfalls include:
- Over-reporting UTIs: Asymptomatic bacteriuria is frequently treated as a UTI in long-term care, but McGeer's criteria require specific symptoms beyond a positive urine culture. Over-reporting distorts data and can drive inappropriate antibiotic use.
- Missing the onset date: Accurately determining the date of symptom onset is critical for outbreak detection. Incomplete documentation makes it difficult to identify clusters.
- Inconsistent application across staff: When criteria are applied differently by different nurses or on different shifts, data quality suffers. Training and standardized tools help.
- Not updating to current criteria: The 2012 revision made meaningful changes to several definitions. Facilities still using the original 1991 criteria may be under- or over-reporting for certain infection types.
McGeer's Criteria and Antibiotic Stewardship
One of the most important applications of McGeer's criteria is in antimicrobial stewardship. When criteria are applied consistently, facilities can identify patterns of antibiotic prescribing relative to confirmed infection cases — helping to reduce unnecessary antibiotic use and the risk of resistant organisms like MRSA and C. difficile.
This is why CMS F-Tag 880 and IPAC Canada guidelines both emphasize the importance of standardized surveillance using validated case definitions like McGeer's criteria.
How HealthConnex Automates McGeer's Criteria
Manually checking cases against McGeer's criteria is time-consuming and prone to inconsistency. HealthConnex automates this process: when a new infection case is created in the platform, the system automatically evaluates the documented signs and symptoms against the relevant McGeer's criteria and flags whether the case meets the definition.
This means your surveillance data is consistent, your staff spend less time on documentation, and your infection preventionist can focus on analysis and action rather than paperwork.
Want to see how it works? Book a demo with the HealthConnex team.
