SHEA Guidelines and Expert Guidance Documents
SHEA and its collaborators work to provide guidance to put the science of healthcare epidemiology and infection prevention into practice through evidence-based guidelines, expert guidance papers (EGs), white papers, and other resources on infection prevention for hospitals, long-term care centers, and other healthcare facilities.
These papers are provided as a professional courtesy by SHEA and Cambridge University to be used for educational purposes only. They may not be reproduced or used for commercial purposes without written permission from SHEA.
SHEA guidelines and EGs are overseen by the SHEA Guidelines Committee. Current guidelines and EGs are reviewed periodically per the process described in the Handbook.
Guidelines and Expert Guidance Documents
Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America
Expert Guidance: Isolation Precautions for Visitors
Expert Guidance: Animals in Healthcare Facilities: Recommendations to Minimize Potential Risks
Expert Guidance in ICHE:
Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update
In 2003, the Cystic Fibrosis (CF) Foundation published recommendations for infection prevention and control (IP&C) in an effort to reduce the risk of acquisition and transmission of pathogens among people with CF.1 However, both IP&C and CF are dynamic disciplines, and during the past decade new knowledge and new challenges necessitated the development of updated IP&C strategies for this unique population.
Healthcare Personnel Attire in Non-Operating-Room Settings (SHEA Expert Guidance)
Healthcare personnel (HCP) attire is an aspect of the medical profession steeped in culture and tradition. From Hippocrates's admonition that physicians' dress is essential to their dignity, to the advent of nurses' uniforms under the leadership of Florence Nightingale, to the white coat ceremonies that continue to this day in medical schools, HCP apparel and appearance is associated with significant symbolism and professionalism. Recent years, however, have seen a rising awareness of the potential role of fomites in the hospital environment in the transmission of healthcare-associated microorganisms. Although studies have demonstrated contamination of HCP apparel with potential pathogens, the role of clothing in transmission of these microorganisms to patients has not been established. The paucity of evidence has stymied efforts to produce generalizable, evidence-based recommendations, resulting in widely disparate practices and requirements that vary by country, region, culture, facility, and discipline. This document is an effort to analyze the available data, issue reasonable recommendations, and describe the needs for future studies to close the gaps in knowledge on HCP attire.
Infection Prevention and Control in Residential Facilities for Pediatric Patients and Their Families
Three family education guides focusing on hand hygiene, respiratory etiquette, and safe handling of blood and body fluids were also created as part of this guideline but are not contained in this document. These guides are tools to educate families about how to help with minimizing the risk of pathogen transmission. These guides can be found at Patient Guides on Healthcare-Associated Infections
Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery
The guidelines are intended to provide practitioners with a standardized approach to the rational, safe, and effective use of antimicrobial agents for the prevention of surgical-site infections (SSIs) based on currently available clinical evidence and emerging issues.
Prevention Of Orthopaedic Implant Infection In Patients Undergoing Dental Procedures
In their recent Clinical Practice Guideline ‘Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures’, the American Academy of Orthopaedic Surgeons (AAOS) reversed their 2009 informational statement, which asserted that “given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia.” After a comprehensive literature review by the work group, this statement was replaced with a recommendation that acknowledges the lack of evidence to support this practice. In deciding whether to endorse the most recent AAOS guideline, the SHEA Board expressed concern about the potentially confusing language of the recommendation: “The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures;” however, the Board ultimately voted to endorse the guideline because it overrides the 2009 guideline. SHEA’s position on the use of antimicrobial prophylaxis before dental work in patients who have prosthetic joints is that the evidence does not support its routine use.
Guideline for Disinfection and Sterilization of Prion-Contaminated Medical Instruments
Creutzfeldt‐Jakob disease (CJD) is a degenerative neurologic disorder of humans. CJD is caused by a proteinaceous infectious agent. Prion diseases elicit no immune response, result in a noninflammatory pathologic process confined to the central nervous system, have an incubation period of years, and usually are fatal within 1 year after diagnosis.
Guideline for Management of Healthcare Workers Who Are Infected with Hepatitis B Virus, Hepatitis C Virus, and/or Human Immunodeficiency Virus
This guideline provides the updated recommendations of SHEA regarding the management of healthcare providers who are infected with HBV, HCV, and/or HIV. SHEA continues to recommend that, although some aspects of the approach to and administrative management of each of these infectious syndromes in healthcare providers are similar, separate management strategies for healthcare workers who are infected with these unrelated viruses remain appropriate. SHEA emphasizes the use of appropriate infection control procedures to minimize exposure of patients or providers to blood, emphasizes that transfers of blood from patients to providers and from providers to patients should be avoided, and recommends that infected healthcare providers should not be totally prohibited from participating in patient‐care activities solely on the basis of a bloodborne pathogen infection.
Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010
Since publication of the SHEA position paper on Clostridium difficile infection in 1995, significant changes have occurred in the epidemiology and treatment of this infection. C. difficile remains the most important cause of healthcare‐associated diarrhea and is increasingly important as a community pathogen. A more virulent strain of C. difficile has been identified and has been responsible for more‐severe cases of disease worldwide. Data reporting the decreased effectiveness of metronidazole in the treatment of severe disease have been published. Despite the increasing quantity of data available, areas of controversy still exist. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management.
SHEA retires guidelines based on new evidence or if revisions have occurred replacing the original document; however, they still may be accessed as a resource.
Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global Perspective
Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals
SHEA and IDSA, with partner organizations AHA, APIC, and the Joint Commission in 2008 published these science-based and practical recommendations for acute care hospitals for the prevention of common HAIs in Infection Control and Healthcare Epidemiology.
Recommendations for Surveillance of Clostridium difficile-Associated Disease
The epidemiology of C. difficile–associated disease (CDAD) is changing, with evidence of increased incidence and severity. However, the understanding of the magnitude of and reasons for this change is currently hampered by the lack of standardized surveillance methods. An ad hoc C. difficile surveillance working group was formed to develop interim surveillance definitions and recommendations based on existing literature and expert opinion that can help to improve CDAD surveillance and prevention efforts.
Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship
This document presents guidelines for developing institutional programs to enhance antimicrobial stewardship, an activity that includes appropriate selection, dosing, route, and duration of antimicrobial therapy. The combination of effective antimicrobial stewardship with a comprehensive infection control program has been shown to limit the emergence and transmission of antimicrobial‐resistant bacteria and reduce healthcare costs without adversely impacting quality-of-care. These guidelines focus on the development of effective hospital‐based stewardship programs and do not include specific outpatient recommendations. The population targeted includes all patients in acute care hospitals.
Antiviral Stockpiling for Influenza Preparedness
Guideline for Reprocessing Flexible Gastrointestinal Endoscopes
The beneficial role of gastrointestinal endoscopy for the prevention, diagnosis, and treatment of many digestive diseases and cancer is well established. Like many sophisticated medical devices, the endoscope is a complex, reusable instrument that requires reprocessing before being used on subsequent patients. The most commonly used methods for reprocessing endoscopes result in high‐level disinfection. To date, all published episodes of pathogen transmission related to gastrointestinal endoscopy have been associated with failure to follow established cleaning and disinfection/sterilization guidelines or use of defective equipment. Despite the strong published data regarding the safety of endoscope reprocessing, concern over the potential for pathogen transmission during endoscopy has raised questions about the best methods for disinfection or sterilization of these devices between patient uses. This document provides evidence-based guidelines for reprocessing gastrointestinal endoscopes.
Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus
Frequent antibiotic therapy in healthcare settings provides a selective advantage for resistant flora, but patients with MRSA or VRE usually acquire it via spread. CDC has long‐recommended contact precautions for patients colonized or infected with such pathogens. Most facilities have required this as policy, but have not actively identified colonized patients with surveillance cultures, leaving most colonized patients undetected and unisolated. Many studies have shown control of endemic and/or epidemic MRSA and VRE infections using surveillance cultures and contact precautions, demonstrating consistency of evidence, high strength of association, reversibility, a dose gradient, and specificity for control with this approach. Adjunctive control measures are also discussed.