SHEA Guidelines and Expert Guidance Documents

This SHEA expert guidance provides a framework to guide practitioners in when to evaluate nursing home residents for infection if they exhibit non-specific signs or symptoms, including: fever, hypothermia, low blood pressure, high blood sugar, delirium, behavioral changes, functional decline, falls, and anorexia.

Authors: Rowe TA, Jump RLP, Andersen BM, Banach DB, Bryant KA, Doernberg SB, Loeb M, Morgan DJ, Morris AM, Murthy RK, Nace DA, Crnich CJ

Full text: https://doi.org/10.1017/ice.2020.1282

Pocket card: https://www.guidelinecentral.com/shop/nursing-home-infections-guidelines/ 

This SHEA white paper updates the 2010 SHEA guideline, following advances in interventions that reduce risk for occupational exposures and injuries, antiretroviral therapy that can now fully suppress HIV, and evidence of very low risk for transmission from HCP to patients (only 5 occurrences worldwide since 2010). This white paper provides recommendations regarding Category III/exposure-prone procedures. It details factors that contribute to the pathogenesis and transmission risk for HBV, HCV, and HIV, viral load thresholds for any restrictions on HCP practice, categorization of healthcare-associated procedures according to level of risk for bloodborne pathogen transmission, and responsibilities of healthcare organizations, including academic institutions, professional schools, hospitals, and other healthcare facilities. 

Authors: Henderson DK, Dembry L-M, Sifri CD, Palmore TN, Dellinger EP, Yokoe DS, Grady C, Heller T, Weber D, del Rio C, Fishman NO, Deloney VM, Lundstrom T, Babcock HM

Full text: https://doi.org/10.1017/ice.2020.458 

β-Lactam antibiotics are among the safest and most effective antibiotics; however, many patients report allergies to these drugs despite few having clinically significant reactions, resulting in the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance and adverse events. This review provides recommendations for evaluation of penicillin allergies to support antimicrobial stewardship.

Authors: Shenoy ES, Macy E, Rowe T, Blumenthal KG

Full text: https://doi.org/10.1001/jama.2018.19283 

Resources:

• AAAAI Choosing Wisely
• JAMA Pediatrics: Is My Child Allergic to Penicillin?
• Toolkit
• Patient resources

This SHEA expert guidance gives infection prevention and control recommendations related to hand hygiene (activities, glove use, alcohol-based hand sanitizer), reusable versus single-use devices, environmental cleaning and management, use of injection ports, barrier precautions, and vials, syringes, and IV bags. 

Authors: Munoz-Price LS, Bowdle A, Johnston BL, Bearman G, Camins BC, Dellinger EP, Geisz-Everson MA, Holzmann-Pazgal G, Murthy R, Pegues D, Prielipp RC, Rubin ZA, Schaffzin J, Yokoe D, Birnbach DJ

Full text: https://doi.org/10.1017/ice.2018.303

Pocket card: https://www.guidelinecentral.com/shop/infection-prevention-operating-room-anesthesia-work-area-guidelines-pocket-guide 

Resources:

• Webinars:
  • New Guidance for OR Anesthesia – Recommendations for Preventing Infections
  • Infection Prevention in Anesthesia Q&A
  • Implementing Changes for Infection Prevention in Anesthesia
• ASA Statement 

These white papers serve as companion to CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) Recommendations for Prevention and Control of Infections in Neonatal Intensive Care Unit Patients and provide practical, expert opinion and/or evidence-based answers to frequently asked questions on infection detection and prevention in the NICU on S. aureus, C. difficile, CLABSI, and respiratory infections. 

Full text:

• Practical approaches to S. aureus disease prevention. Authors: Akinboyo IC, Zangwill KM, Berg WM, Cantey JB, Huizinga B, Milstone AM
• Practical approaches to C. difficile prevention. Authors: Sandora TJ, Bryant KK, Cantey JB, Elward AM, Yokoe DS, Bartlett AH

In development: 

• CLABSI
• Respiratory Infections

NICU Advisory Panel: Chairs (SHEA): Bryant K, Elward A, Yokoe D. Members: Zangwill K (AAP), Foster N (AHA), Rindels J (APIC), Huizinga B (NANN), Sanchez P (IDSA), Milstone A (PIDS), VanAmringe M (Joint Commission)

Pocket cards:

• NICU S. aureus
• NICU C. difficile 

IDSA and SHEA update to the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults, incorporating recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment) and significant changes in the management of CDI reflecting the evolving controversy over best methods for diagnosis. This evidence-based guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.

Authors: McDonald LC, Gerding D, Johnson S, Bakken J, Carroll K, Coffin S, Dubberke E, Garey K, Gould C, Kelly C, Loo V, Sammons JS, Sandora T, Wilcox M

Full text: https://doi.org/10.1093/cid/cix1085

Partial update January 2021.

This SHEA expert guidance advises hospitals in when they can safely discontinue contact precautions for patients with multidrug-resistant bacteria, addressing how long hospital staff should use these safety protocols to reduce the spread of pathogens within the hospital, in most cases ranging from one to three negative cultures prior to discontinuation. The guidance also outlines the use of molecular testing in care decisions.  

Authors: Banach DB, Bearman G, Barnden M, Hanrahan JA, Leekha S, Morgan DJ, Murthy R, Munoz-Price LS, Sullivan KV, Popovich KJ, Wiemken TL

Full text: https://doi.org/10.1017/ice.2017.245

Pocket card: https://www.guidelinecentral.com/shop/contact-precautions-guidelines-pocket-guide 

This SHEA expert guidance document, developed as part of the SHEA/CDC Outbreak Response Training Program (ORTP), provides recommendations for incident management during infectious diseases outbreaks and how to work within an emergency response framework. The guidance's recommendations are not pathogen-specific and are meant to apply to a range of potential infectious diseases outbreaks. 

Authors: Banach DB, Johnston BL, Al-Zubeidi D, Bartlett AH, Bleasdale SC, Deloney VM, Enfield KB, Guzman-Cottrill JA, Lowe C, Ostrosky-Zeichner L, Popovich KJ, Patel PK, Ravin K, Rowe T, Shenoy ES, Stienecker R, Tosh PK, Trivedi KK

Full text: https://doi.org/10.1017/ice.2017.212

Toolkits: https://ortp.guidelinecentral.com

ORTP Advisory Panel: Guzman-Cottrill J, Ashraf M, Furuya Y, Hota S, Iovine N, Jacob J, Kressel A, May L, Murthy R, Nyquist A, Ostrowsky B, Safdar N, Young H

IDSA and SHEA evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care, with recommendations that address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.

Authors: Barlam T, Cosgrove S, Abbo L, MacDougall C, Schuetz A, Septimus E, Srinivasan A, Dellit T, Falck-Ytter Y, Fishman N, Hamilton C, Jenkins T, Lipsett P, Malani P, May L, Moran G, Neuhauser M, Newland J, Ohl C, Samore M, Seo S, Trivedi K

Full text: https://doi.org/10.1093/cid/ciw118

Chinese translation: Part I, Part II, Part III, Part IV

This SHEA expert guidance provides recommendations to help healthcare facilities develop or modify policies related to the use of isolation precautions by visitors, pertaining predominantly to adult and pediatric acute care hospitals; however, personnel in other care settings may find the recommendations useful as they consider this issue.

Authors: Munoz-Price LS, Banach DB, Bearman G, Gould JM, Leekha S, Morgan DJ, Palmore TN, Rupp ME, Weber DJ, Wiemken TL

Full text: https://doi.org/10.1017/ice.2015.67 

This SHEA expert guidance provides general guidance to the medical community regarding the management of animals in healthcare based on analysis of the medical literature regarding risks and evidence for animal-to-human transmission of pathogens in the healthcare setting, along with the potential benefits of animal-assisted activities in healthcare, review of hospital policies related to animals in healthcare, and a SHEA Research Network survey assessing institutional policies. It offers specific guidance for acute care hospitals and ambulatory care facilities to develop or modify policies related to animals based on their role (i.e., animal-assisted activities, service animals, research animals, and personal pet visitation). It is not intended to guide the management of animals in other healthcare facilities such as assisted living, nursing homes, or extended care facilities.

Authors: Murthy R, Bearman G, Brown S, Bryant K, Chinn R, Hewlett A, George BG, Goldstein EJC, Holzmann-Pazgal G, Rupp ME, Wiemken T, Weese JS, Weber DJ

Full text: http://dx.doi.org/10.1017/ice.2015.15

Pocket card: https://www.guidelinecentral.com/shop/animals-in-healthcare-facilities-guidelines-pocket-card 

Medscape slide summary: http://www.medscape.com/features/slideshow/animals

Reviewed April 2019.

This CFF and SHEA guideline updates the 2003 Cystic Fibrosis Foundation recommendations for infection prevention and control to reduce the risk of acquisition and transmission of pathogens among people with CF.

Authors: Saiman L, Siegel JD, LiPuma JJ, Brown RF, Bryson EA, Chambers MJ, Downer VS, Fliege J, Hazle LA, Jain M, Marshall BC, O’Malley C, Pattee SR, Potter-Bynoe G, Reid S, Robinson KA, Sabadosa KA, Schmidt HJ, Tullis E, Webber J, Weber DJ

Full text: https://doi.org/10.1086/676882 

Reviewed August 2018.

Complete update to the 2008 SHEA/IDSA Compendium with evidence-based, practical recommendations for acute care hospitals for the prevention of common HAIs. Basic practices, special approaches, and implementation strategies. 

• Executive Summary
• Catheter-Associated Urinary Tract Infections (CAUTI)
  Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, Pegues DA, Pettis AM, Saint S, Yokoe DS
• Surgical Site Infections (SSI)
  Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, Nyquist A-C, Saiman L, Yokoe DS, Maragakis LL, Kaye KS
• C. difficile
  Dubberke ER, Carling P, Carrico R, Donskey CJ, Loo VG, McDonald LC, Maragakis LL, Sandora TJ, Weber DJ, Yokoe DS, Gerding DN
  
• Methicillin-Resistant Staphylococcus aureus (MRSA)
  Calfee DP, Salgado CD, Milstone AM, Harris AD, Kuhar DT, Moody J, Aureden K, Huang SS, Maragakis LL, Yokoe DS
• Central Line-Associated Bloodstream Infections (CLABSI)
  Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O’Grady NP, Pettis AM, Rupp ME, Sandora T, Maragakis LL, Yokoe DS
• Ventilator-Associated Pneumonia (VAP)
  Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, Magill SS, L. Maragakis L, P. Priebe G, Speck K, S. Yokoe D, M. Berenholtz S
• Hand Hygiene
  Ellingson K, Haas JP, Aiello AE, Kusek L, Maragakis LL, Olmsted RN, Perencevich E, Polgreen PM, Schweizer ML, Trexler P, VanAmringe M, Yokoe DS

This SHEA expert guidance gives general guidance to the medical community regarding HCP attire outside the operating room. In addition to the initial guidance statement, the article has 3 major components: review and interpretation of the medical literature regarding, review of hospital policies related to HCP attire, and a survey of the SHEA Research Network to assess institutional HCP attire policies and perceptions. Although the optimal choice of HCP attire for inpatient care remains undefined, the document provides recommendations on the use of white coats, neckties, footwear, the bare-below-the-elbows strategy, and laundering.

Authors: Bearman G, Bryant K, Leekha S, Mayer J, Munoz-Price LS, Murthy R, Palmore T, Rupp ME, White J

Full text: https://doi.org/10.1086/675066

Reviewed June 2018.

This SHEA guideline is the first infection prevention and control guideline to address preventing transmission of infectious agents in “home away from home” residential settings, of which the Ronald McDonald Houses (RMHs) serve as a prototype. Pediatric patients are frequent guests of the family-centered facilities while receiving or recovering from specialized medical therapy. Examples of high-risk populations served in these facilities include families of patients with cancer, recipients of stem cell or solid organ transplants, surgical and/or very-low-birthweight infants who receive care in neonatal intensive care units (NICUs), those with cystic fibrosis, and women with high-risk pregnancies awaiting.

Authors: Guzman-Cottrill JA, Ravin KA, Bryant KA, Zerr DM, Kociolek L, Siegel JD

Full text: https://doi.org/10.1086/673141 

Patient and family education guides: http://www.shea-online.org/index.php/practice-resources/patients 

Reviewed November 2018.

These ASHP, SHEA, IDSA, and SIS clinical practice guidelines provide practitioners with a standardized approach to the rational, safe, and effective use of antimicrobial agents for the prevention of surgical-site infections based on available clinical evidence and emerging issues.

Authors: Bratzler D, Dellinger EP, Olsen K, Perl T, Autwaerter P, Bolon M, Fish D, Napolitano L, Sawyer R, Slain D, Steinberg J, Weinstein R

Full text: https://www.ashp.org/surgical-guidelines 

Reviewed March 2018.

This SHEA guideline provides recommendations for disinfection and sterilization of medical instruments in order to prevent Creutzfeldt‐Jakob disease (CJD), a degenerative neurologic disorder 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.

Authors: Rutala WA, Weber DJ

Full text: https://doi.org/10.1086/650197 

Reviewed 2014.