The scope of a healthcare institution’s infection prevention and control/healthcare epidemiology program (IPC/HE) should be driven by the size and complexity of the patient population served, that population’s risk for healthcare-associated infection (HAI), and local, state, and national regulatory and accreditation requirements. Essential activities of all IPC/HE programs are reviewed in this white paper.

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Since its inception in the 1960s, the specialty of infection prevention and control has grown considerably. The field took shape in the 1970s following the landmark Study on the Efficacy of Nosocomial Infection Control (SENIC) project and grew in importance with the emergence of employee safety and multidrug-resistant  organisms in the 1980s.1,2 In the 1990s and into the 2000s, the focus on hospital-acquired infection (HAI) prevention grew, so the field played a larger role in regulatory, patient safety, and quality improvement issues. In the present day, infection control data are frequently available to the public and impact hospital finances and healthcare insurance reimbursements.

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Antimicrobial stewardship (AS) refers to coordinated interventions to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy and route of administration. The objectives of antimicrobial stewardship are to achieve the best clinical outcomes related to antimicrobial use while minimizing emergence of antimicrobial resistant organisms, Clostridium difficile infection, and other adverse events and reducing excessive costs attributable to suboptimal antimicrobial use.

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A framework for achieving elimination of HAIs using successful preventive practices and public health strategies to achieve the goal of eliminating HAIs builds upon the basis of lessons from recent successes and require constant action and vigilance. These are: implement evidence-based practices that protect patients; align incentives to promote system-wide strategies for HAI prevention; address gaps in knowledge to push beyond the current medical knowledge; and collect data to target prevention efforts and to measure progress.

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In large part, the discussion about the rationale for influenza vaccination of healthcare personnel, the strategies designed to improve influenza vaccination rates in this population, and the recommendations made in the 2005 paper still stand. This position paper notes new evidence released since publication of the 2005 paper and strengthens SHEA’s position on the importance of influenza vaccination of HCP. This document does not discuss vaccine allocation during times of vaccine shortage, because the 2005 SHEA Position Paper still serves as the society’s official statement on that issue. SHEA views influenza vaccination of HCP as a core patient and HCP safety practice with which noncompliance should not be tolerated. Therefore, for the safety of both patients and HCP, SHEA endorses a policy in which annual influenza vaccination is a condition of both initial and continued HCP employment and/or professional privileges.

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Revised: August 2010, ICHE

The emergence of a novel H1N1 influenza A virus has dramatically impacted communities and healthcare institutions across the globe. In addition to potential exposure in the community, healthcare personnel are often called upon to care for individuals with suspected or confirmed novel H1N1 influenza A and may become exposed to the virus if appropriate infection control precautions are not implemented.

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The SHEA Board of Directors appointed a task force to draft this evidence‐based guideline to assist hospital epidemiologists in justifying and expanding their programs. Part 1 describes the basic steps needed to complete a business‐case analysis for an individual institution. A case study based on a representative infection control intervention is provided. Part 2 reviews important basic economic concepts and describes approaches that can be used to assess the financial impact of infection prevention, surveillance, and control interventions, as well as the attributable costs of specific healthcare‐associated infections. Both parts of the guideline aim to provide the hospital epidemiologist, infection control professional, administrator, and researcher with the tools necessary to complete a thorough business‐case analysis and to undertake an outcome study of a nosocomial infection or an infection control intervention.

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SHEA established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panel's best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by IDSA and HICPAC.

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Strain typing is an integral part of epidemiological investigations of nosocomial infections. Although not all molecular techniques are equally effective for typing all organisms, pulsed-field gel electrophoresis is the technique currently favored for most nosocomial pathogens. Nucleic acid amplification-based typing methods also are applicable to many organisms and can be completed within a single day, but interpretive criteria still are under debate. Strain typing cannot be used to replace a sound epidemiological investigation, but serves as a useful adjunct to such investigations.

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The Quality Indicator Study Group was created by the governing boards of three national professional organizations that have interest and experience in epidemiology, nosocomial infection control and prevention, and quality of care improvement. The Study Group has reviewed the existing literature concerning quality indicators, interviewed experts in the field, and focused on how best to evaluate such indicators, with an emphasis on nosocomial infection indicators as a paradigm for all QIs. In this report, we review pertinent issues and, where possible, provide specific advice on how to evaluate QIs and QI systems.

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New Edition! Best Practices in Infection Prevention and Control: An International Perspective, Second Edition

A copublication of Joint Commission International (JCI) and the Society for Healthcare Epidemiology of America (SHEA)

Best Practices in Infection Prevention and Control This fully updated second edition of Best Practices in Infection Prevention and Control: An International Perspective is an essential resource for health care organizations. It provides a thorough analysis of JCI’s and other IPC requirements, as well as case studies, tips, and tools for increasing IPC compliance and patient safety.  The second edition is edited by Barbara M. Soule, RN, MPA, CIC, FSHEA; Ziad A. Memish, MD, FRCPC, FACP, CIC, FIDSA; and Preeti N. Malani, MD, MSJ.

“Infection prevention and control is one of the most challenging issues facing health care organizations from a quality, safety and financial perspective.  This publication will help organizations address these issues and mitigate infection by providing strategies and tools for developing and sustaining an effective infection prevention and control program using evidence-based practice as a foundation and accreditation standards as a framework.”

Barbara M. Soule, RN, MPA, CIC, FSHEA
Practice Leader, Infection Prevention and Control Services, Joint Commission Resources and Joint Commission International

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877-223-6866 or +1-770-238-0454.

Joint Commission International

Practical Healthcare Epidemiology, 3rd Edition

Practical Healthcare Epidemiology, 3rd EditionEdited by Ebbing Lautenbach, Keith F. Woeltje, and Preeti N. Malani
© 2010

E-book $60.00

Practical Healthcare Epidemiology takes a practical, hands-on approach to these issues, addressing all aspects of infection surveillance, prevention, and infection control. This fully revised third edition brings together the expertise of more than fifty leaders in healthcare epidemiology and infection, who provide clear, sound guidance on infection control for the full range of patients in all types of healthcare facilities, including those in settings with limited resources.

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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.

SHEA Handbook for SHEA-Sponsored Guidelines and Expert Guidance Documents


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

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.