This AAOS and ADA-led guideline replaces the 2009 information statement "Antibiotic Prophylaxis in Bacteremia in Patients With Joint Replacement" and contains recommendations to guide clinical practice in the prevention of orthopaedic implant infections in patients undergoing dental procedures. 

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SHEA endorsement statement: 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 SHEA 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.


Reviewed January 2019.

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.

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.

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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.

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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.

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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.

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This consensus document presents background data and evidence‐based recommendations for practices that are intended to decrease the risk of transmission of respiratory pathogens among CF patients from contaminated respiratory therapy equipment or the contaminated environment and thereby reduce the burden of respiratory illness. Included are recommendations applicable in the acute care hospital, ambulatory, home care, and selected non‐healthcare settings. The target audience includes all healthcare workers who provide care to CF patients. Antimicrobial management is beyond the scope of this document.

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This document provides healthcare workers with a review of data regarding handwashing and hand antisepsis in healthcare settings, as well as specific recommendations to promote improved hand‐hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.

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Antimicrobial agents are among the most frequently prescribed medications in long‐term care facilities (LTCFs). Therefore, it is not surprising that C. difficile colonization and C. difficile-associated diarrhea (CDAD) occur commonly in elderly LTCF residents. C. difficile has been identified as the most common cause of non‐epidemic acute diarrheal illness in nursing homes, and outbreaks of CDAD in LTCFs have also been recognized. This position paper reviews the epidemiology and clinical features of CDAD in elderly residents of LTCFs and, using available evidence, provides recommendations for the management of C. difficile in this setting.

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Urinary tract infection is the most common bacterial infection occurring in residents of long‐term–care facilities. It is a frequent reason for antimicrobial administration, but antimicrobial use for treating UTIs is often inappropriate. Achieving optimal management of UTI in this population is problematic because of the very high prevalence of bacteriuria, evidence that the treatment of asymptomatic bacteriuria is not beneficial, and the clinical and microbiological imprecision in diagnosing symptomatic UTI. This position paper has been developed using available evidence to assist facilities and healthcare professionals in managing this common problem.

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Antimicrobial resistance results in increased morbidity, mortality, and costs of healthcare. Prevention of the emergence of resistance and the dissemination of resistant microorganisms will reduce these adverse effects and their attendant costs. Appropriate antimicrobial stewardship that includes optimal selection, dose, and duration of treatment, as well as control of antibiotic use, will prevent or slow the emergence of resistance among microorganisms. A comprehensively applied infection control program will interdict the dissemination of resistant strains.

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More than 1.5 million residents reside in U.S. nursing homes. In recent years, the acuity of illness of nursing home residents has increased. LTCF residents have a risk of developing HAI that approaches that seen in acute care hospital patients. This position paper reviews the literature on infections and infection control programs in the LTCF. Recommendations are developed for long-term care infection control programs based on interpretation of currently available evidence. The recommendations cover the structure and function of the infection control program, including surveillance, isolation precautions, outbreak control, resident care, and employee health. Infection control resources are also presented.

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There is intense antimicrobial use in long-term-care facilities, and studies repeatedly document that much of this use is inappropriate. Attempts to improve antimicrobial use in the LTCF are complicated by characteristics of the patient population, limited availability of diagnostic tests, and virtual absence of relevant clinical trials. This article recommends approaches to management of common LTCF infections and proposes minimal standards for an antimicrobial review program. In developing these recommendations, the article acknowledges the unique aspects of provision of care in the LTCF.

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During the last quarter century, numerous reports have indicated that antimicrobial resistance commonly is encountered in long-term-care facilities. Once present, resistant strains tend to persist and become endemic. Rapid dissemination also has been documented in some facilities. Person-to-person transmission via the hands of healthcare workers appears to be the most important means of spread. The LTCF patients most commonly affected are those with serious underlying disease, poor functional status, wounds such as pressure sores, invasive devices such as urinary catheters, and prior antimicrobial therapy. The presence of antimicrobial-resistant pathogens in LTCFs has serious consequences not only for residents but also for LTCFs and hospitals. Experience with control strategies for antimicrobial-resistant pathogens in LTCFs is limited; however, strategies used in hospitals often are inapplicable. Six recommendations for controlling antimicrobial resistance in LTCFs are offered, and four priorities for future research are identified.

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The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic‐impregnated short‐term central venous catheters if the rate of infection is high despite adherence to other strategies.

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Fueling fears of the public about medical waste are such concerns as the hypothetical risk of medical waste for transmitting HIV, HBV, and other agents associated with bloodborne diseases. The public is also concerned about emissions from incinerators that burn medical waste and whether these emissions may contain microorganisms or toxic substances. Thus, a lack of understanding of the modes of transmission of agents associated with bloodborne diseases, the fear of fatal diseases such as AIDS, and a distrust of healthcare facilities accentuated by media coverage has led to intense public pressure on federal, state, and local politicians to regulate medical waste.

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