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.


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. TAttempts 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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