We are proposing to hold an invitational roundtable meeting to convene a panel of experts to identify how high reliability practices can be applied in facility-based long term care settings to reduce transmission of infection. Results from the meeting will inform the development of multimedia educational materials in the form of a narrated power point presentation that will be disseminated to long term care facilities on a national level. Though healthcare-associated infections (HAIs) in hospitals have declined, HAI prevention in long term care facilities (LTCFs) has lagged behind. Structural and process characteristics of these organizations are contributing factors that have a major impact on adverse outcomes. In particular, LTC staff must have sufficient knowledge, training and availability to ensure appropriate adherence to recommended infection prevention and control practices. Facility leaders must prioritize infection prevention and promote an organizational culture that values safety for both residents and staff. Given increasing national attention on preventing infections, there is need to identify and share new effective strategies to address HAIs in LTCFs. Little is known about the application of high reliability principles to long term care settings. A broad-scale effort to apply high reliability organization practices would enhance quality improvement for HAI prevention in LTCFs. The target settings include nursing homes, assisted living facilities, and long term acute care hospitals. The specific aims for this project are: 1) Using a national call for effective practices, identify high reliability practices that canbe used to reduce infection transmission in long term care; 2) Convene a roundtable meeting comprising a panel of topic experts and leaders from long term care organizations to develop practical recommendations for implementation across a variety of long term care settings; and 3) Prepare professionally developed multimedia educational materials and actively disseminate the knowledge and information gathered from the conference to thousands of facilities. Because of its role in improving quality across settings and leadership in advancing high reliability, The Joint Commission can have a major impact on the field by implementing the proposed project.