Infection Prevention in Dementia Care: Practical Strategies for Residents Living in Aged Care (AU & NZ)

Infection prevention in aged care for residents with dementia. Learn person-centred IPC strategies, practical approaches, and standards alignment for Australia and New Zealand.

Infection prevention and control (IPC) in aged care for residents with dementia requires adapted, person-centred strategies that balance infection risk with cognitive and behavioural needs.

Residents living with dementia often can't follow standard infection-prevention instructions: wash your hands, wear this mask, stay in your room. This blog is for IPC Leads, nurses, care workers, and facility managers who manage that gap every day. It explains why infection prevention and control (IPC) needs to be adapted for residents with dementia, what that looks like in practice, and how it aligns with person-centred care under Australia's Strengthened Aged Care Quality Standards and New Zealand's NZS 8134:2021 Ngā Paerewa Health and Disability Services Standard. You'll come away with strategies you can use on the floor this week.

Standard IPC measures assume a resident can understand and cooperate with them. Dementia changes that equation. A resident may not understand why a stranger in a mask is suddenly in their room, may resist hand hygiene as an unwanted intrusion, or may wander through shared spaces during an outbreak because the instruction to "stay put" has no meaning for them.
Evidence from the pandemic period bears this out; studies during the pandemic found that many residents with dementia were unable to consistently follow measures such as mask use or physical distancing, even when it was indicated, not because of non-compliance, but because the request itself couldn't land. Residents who wander with unwashed hands or soiled clothing can spread infection throughout a facility well before anyone identifies a cluster.

This isn't a reason to abandon IPC instruction. It's a reason to redesign how that instruction is 

The Strengthened Aged Care Quality Standards, effective 1 November 2025, place dementia care and continuous improvement among their central priorities. Standard 5 (Clinical Care) requires that health needs, including management needs, are identified, prioritised, and well managed. Outcome 4.2 (Infection Prevention and Control) requires providers to maintain an appropriate IPC system and ensure aged care workers use hygienic practices and appropriate precautions across all aspects of care.

Read together, these standards don't present infection control and person-centred care as competing obligations. For residents living with dementia, compliant IPC must be person centred, culturally safe, trauma-aware, and healing-informed. Even when the clinical technique is correct, it falls short if it overlooks the resident's cognitive needs.

Source: Strengthened Aged Care Quality Standards (Department of Health and Aged Care, 2025); Aged Care Quality and Safety Commission, Infection Prevention and Control guidance (2025)

The following approaches keep IPC effective without turning care into confrontation:

Each of these strategies should be documented in the resident's care plan, not left as informal staff knowledge. That documentation turns good practice into audit-ready evidence.

Source: A Unit Guide to Infection Prevention for Long-Term Care Staff (Agency for Healthcare Research and Quality)

New Zealand facilities work to a different standard, but the same principle holds. NZ8134:2021 Ngā Paerewa Health and Disability Services Standard, which superseded the 2008 version, requires service management to implement a planned infection prevention and antimicrobial stewardship program appropriate to the service's size and complexity, led by a trained and designated infection prevention and control professional appropriate to the service. Ngā Paerewa also shifted the whole standard towards more person- and whānau-centred services, where people are supported to make their own care decisions wherever possible. This reflects the same tension between autonomy and protection that sits at the heart of dementia-specific IPC.

Health New Zealand / Te Whatu Ora's aged residential care guidance reflects this in practice, recommending single rooms for unwell residents and PPE for staff during periods of respiratory illness. Its Dementia Mate Wareware initiative focuses on helping people living with dementia and their whānau live well day to day, not just on managing risk. Facilities operating across both countries can apply the same dementia-friendly strategies outlined above; the main difference is which standard and terminology to reference in documentation.

	Australia	New Zealand
Standard	Strengthened Aged Care Quality Standards	NZS8134:2021 Ngā Paerewa Health and Disability Services Standard
IPC Requirement	Outcome 4.2 - appropriate IPC system, hygienic practices, and precautions in every aspect of care	Planned infection prevention and antimicrobial stewardship program, led by a trained infection prevention nurse
Dementia Focus	Standard 5 (Clinical Care) dementia management prioritised as a health need	Whānau-centred care under Ngā Paerewa, supported by the Dementia Mate Wareware initiative
Regulator/Agency	Aged Care Quality and Safety Commission (ACQSC	Health New Zealand / Te Whatu Ora

Sources: Sector Guidance for Ngā Paerewa Health and Disability Services Standard, NZS 8134:2021 (Ministry of Health NZ); Aged-Residential Care Resources and Dementia Mate Wareware (Health New Zealand/Te Whatu Ora*

This is where the real tension lies. A resident with dementia has the same right to move through communal spaces, decline an intervention, or refuse to wear a mask as any other resident - dignity of risk doesn't disappear because of a diagnosis. But the facility still has a duty of care to every resident and worker exposed to infection risk.

The resolution isn't about choosing one value over the other. It's proactive planning: knowing in advance which residents are likely to resist which measures, and having a person-centred workaround ready before an outbreak forces a rushed decision. A facility that only thinks about this during an active outbreak is managing reactively, not proactively; and reactive IPC under pressure is where dignity and safety both suffer.

The IPC Lead's role here is less about policing hand hygiene compliance and more about equipping the team to adapt with confidence. That means embedding dementia-specific scenarios in IPC training, reviewing care plans for infection risk alongside behavioural support plans, and creating a feedback loop that allows care workers to flag what isn't working without it becoming a compliance black mark.

Facilities that treat this as ongoing coaching - not a once-a-year module - tend to see steadier compliance and fewer incidents in which a resident's distress escalates a routine IPC task into a crisis.

Take-Home Message:
Infection prevention for residents with dementia works best when it's person-centred, not applied over the top of them — plan for cognitive needs before an outbreak forces the decision, and document every adaptation so it holds up at accreditation.


Sources:

- Strengthened Aged Care Quality Standards, August 2025 (Department of Health and Aged Care)
 https://www.health.gov.au/sites/default/files/2025-08/strengthened-aged-care-quality standards-august-2025.pdf

- Infection Prevention and Control (Aged Care Quality and Safety Commission)
(https://www.agedcarequality.gov.au/strengthened-quality standards/environment/infection-prevention-and-control)

- The Care and Services Standard (Aged Care Quality and Safety Commission)(https://www.agedcarequality.gov.au/strengthened-quality-standards/care-and services)

- [Dementia and COVID-19 Infection Control in Assisted Living in Seven States (PMC,