Unifying Concepts

Revised McGeer Criteria for Respiratory Tract Infection Surveillance (RTIs)

The criteria that define infections for surveillance purposes were selected to increase the likelihood that the events captured by application of the definitions are true infections. Presentations of infection in older residents of long-term care facilities (LTCFs), may be atypical, so failure to meet surveillance definitions may not fully exclude the presence of infection. For this reason, the surveillance definitions presented here may not be adequate for real-time case finding, diagnosis, or clinical decision making (eg, antibiotic initiation). Separate clinical guidelines address early identification of infections and appropriate initiation of antibiotic therapy in LTCF residents, which are both important for impacting resident outcomes.

Revised McGeer Criteria for Respiratory Tract Infection Surveillance (RTIs)

Common cold syndromes/pharyngitis
The resident must have at least two of the following signs or symptoms:

  • Runny nose or sneezing
  • Stuffy nose (i.e. congestion)
  • Sore throat or hoarseness or difficulty in swallowing
  • Dry cough
  • Swollen or tender glands in the neck (cervical lymphadenopathy)

(Note: Fever may or may not be present. Symptoms must be new and care must be taken to ensure symptoms are not caused by allergies)

Influenza-like illness

  • Acute onset of respiratory illness with cough and fever and one or more of the following symptoms: (Note: fever or feverishness with chills may not be prominent in the elderly)
  • Sore throat
  • Arthralgia
  • Myalgia
  • Prostration

Both of the following criteria must be met:

  • Interpretation of a chest radiograph as demonstrating pneumonia, probable pneumonia, or the presence of an infiltrate. If a previous radiograph exists for comparison, the infiltrate should be new.
  • The resident must have a least two of the signs and symptoms described under “other lower respiratory tract infections.”

Other lower respiratory tract infection (bronchitis, tracheobronchitis)
The resident must have at least three of the following signs or symptoms:

  • New or increased cough
  • New or increased sputum production
  • Fever (>38º C)
  • Pleuritic chest pain
  • New or increased physical findings on chest examination (rales, rhonchi, wheezes, bronchial breathing)
  • One of the following indications of change in status or breathing difficulty: new/increased shortness of breath or respiratory rate >25 per minute or worsening mental or functional status.



  1. Stone ND, Ashraf MS, Calder J, Crnich CJ, Crossley K, Drinka PJ, Gould CV, Juthani-Mehta M, Lautenbach E, Loeb M, Maccannell T, Malani PN, Mody L, Mylotte JM, Nicolle LE, Roghmann MC, Schweon SJ, Simor AE, Smith PW, Stevenson KB, Bradley SF; Society for Healthcare Epidemiology Long-Term Care Special Interest Group. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 2012 Oct;33(10):965-77. [Medline]
  2. Nicolle LE. Infection prevention issues in long-term care. Curr Opin Infect Dis. 2014 Aug;27(4):363-9. [Medline]
  3. Dowson L, Marshall C, Buising K, Friedman ND, Kong DCM, Stuart RL. Optimizing treatment of respiratory tract infections in nursing homes: Nurse-initiated polymerase chain reaction testing. Am J Infect Control. 2019 Aug;47(8):911-915. [Medline]


Created May 19, 2021.

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