SHEA Guidelines and Expert Guidance Documents

SHEA Expert Guidance Documents, Expert Consensus Statements, Guidelines, and White Papers are developed by panels of experts who review the available evidence, and apply their clinical experience and expertise to make practical recommendations. The process for development of the first three types of documents is described in the Handbook for SHEA-Sponsored Expert Guidance, Consensus, and Guideline Documents (pdf). The Handbook does not define the development process for white papers. The Handbook is reviewed and updated periodically by the SHEA Guidelines Committee, and updates are approved by the Board of Trustees.

  • Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update
    Current - Compendium, Healthcare-associated Infections, Infection Prevention, Ventilator-Associated Pneumonia
    Author:
    SHEA/IDSA/APIC
    Published:
    May 20, 2022
    Abstract:

    The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

  • Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update
    Current - CLABSI, Compendium, Healthcare-associated Infections, Infection Prevention
    Author:
    SHEA, IDSA & APIC
    Published:
    April 19, 2022
    Abstract:

    Previously published guidelines provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates the Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute-Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

  • SHEA NICU White Paper Series: Practical approaches for the prevention of central line-associated bloodstream infections
    Current - CLABSI, Clinical Practice, Guidelines, Immunocompromised Patients, Infection Prevention, NICU, NICU White Paper Series, Pediatrics
    Author:
    SHEA
    Published:
    March 4, 2022
    Abstract:

    This document is part of the “SHEA neonatal intensive care unit (NICU) white paper series.” It is intended to provide practical, expert opinion, and/or evidence-based answers to frequently asked questions about CLABSI detection and prevention in the NICU. This document serves as a companion to the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of Infections in Neonatal Intensive Care Unit Patients. Central line-associated bloodstream infections (CLABSIs) are among the most frequent invasive infections among infants in the NICU and contribute to substantial morbidity and mortality. Infants who survive CLABSIs have prolonged hospitalization resulting in increased healthcare costs and suffer greater comorbidities including worse neurodevelopmental and growth outcomes. A bundled approach to central line care practices in the NICU has reduced CLABSI rates, but challenges remain. This document was authored by pediatric infectious diseases specialists, neonatologists, advanced practice nurse practitioners, infection preventionists, members of the HICPAC guideline-writing panel, and members of the SHEA Pediatric Leadership Council. For the selected topic areas, the authors provide practical approaches in question-and-answer format, with answers based on consensus expert opinion within the context of the literature search conducted for the companion HICPAC document and supplemented by other published information retrieved by the authors. Two documents in the series precede this one: “Practical approaches to Clostridioides difficile prevention” published in August 2018 and “Practical approaches to Staphylococcus aureus prevention,” published in September 2020.

    Authors: Martha Muller, Kristina A. Bryant, Claudia Espinosa, Jill A. Jones, Caroline Quach, Jessica R. Rindels, Dan L. Stewart, Kenneth M. Zangwill, and Pablo J. Sánchez

  • Antimicrobial Stewardship: A Collaborative Partnership between Infection Preventionists and Healthcare Epidemiologists
    Current - Antimicrobial Stewardship, Guidelines, Knowledge & Skills
    Author:
    SHEA & APIC
    Published:
    April 1, 2012
    Abstract:

    Misuse and overuse of antimicrobials, primarily involving therapeutic agents used to treat infection in humans, is considered one of the world’s most pressing public health problems. Not only does such inappropriate use diminish the therapeutic benefit of essential medications, it also facilitates the development and spread of multidrug-resistant organisms (MDROs). Antimicrobial resistance and the rise in MDROs globally are associated with increased morbidity and mortality, cross-transmission within and between healthcare settings, and increased consumption of limited patient-care resources. Despite elevated awareness, publication of guidelines on antimicrobial stewardship, and several initiatives, the proportion of resistant strains causing both health care- and community-associated infections continues to increase and the number of new antimicrobials continues to decline.

    Authors: Julia Moody, Sara E. Cosgrove, Russell Olmsted, Edward Septimus, Kathy Aureden, Shannon Oriola, Gita Wasan Patel and, Kavita K. Trivedi

  • Guidance for the Knowledge and Skills Required for Antimicrobial Stewardship Leaders
    Current - Antimicrobial Stewardship, Guidelines, Knowledge & Skills
    Author:
    SHEA
    Published:
    December 1, 2014
    Abstract:

    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.

    Authors: Sara E. Cosgrove, Elizabeth D. Hermsen, Michael J. Rybak, Thomas M. File, Sarah K. Parker, and Tamar F. Barlam

  • Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship—Quasi-Experimental Designs
    Current - Antimicrobial Stewardship, Guidelines, Knowledge & Skills, Research
    Author:
    SHEA
    Published:
    October 1, 2016
    Abstract:

    Quasi-experimental studies evaluate the association between an intervention and an outcome using experiments in which the intervention is not randomly assigned. Quasi-experimental studies are often used to evaluate rapid responses to outbreaks or other patient safety problems requiring prompt, nonrandomized interventions. Quasi-experimental studies can be categorized into 3 major types: interrupted time-series designs, designs with control groups, and designs without control groups. This methods paper highlights key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship, including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies.

    Authors: Marin L. Schweizer, Barbara I. Braun, Aaron M. Milstone

  • Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship—Mathematical Modeling
    Current - Antimicrobial Stewardship, Guidelines, Knowledge & Skills, Research
    Author:
    SHEA
    Published:
    November 1, 2016
    Abstract:

    Mathematical modeling is a valuable methodology used to study healthcare epidemiology and antimicrobial stewardship, particularly when more traditional study approaches are infeasible, unethical, costly, or time-consuming. We focus on 2 of the most common types of mathematical modeling, namely compartmental modeling and agent-based modeling, which provide important advantages—such as shorter developmental timelines and opportunities for extensive experimentation—over observational and experimental approaches. We summarize these advantages and disadvantages via specific examples and highlight recent advances in the methodology. A checklist is provided to serve as a guideline in the development of mathematical models in healthcare epidemiology and antimicrobial stewardship.

    Authors: Sean L. Barnes, Parastu Kasaie, Deverick J. Anderson, Michael Rubin

  • Research Methods in Healthcare Epidemiology: Survey and Qualitative Research
    Current - Antimicrobial Stewardship, Guidelines, Knowledge & Skills, Research
    Author:
    SHEA
    Published:
    November 1, 2016
    Abstract:

    Surveys are one of the most frequently employed study designs in healthcare epidemiology research. Generally easier to undertake and less costly than many other study designs, surveys can be invaluable to gain insights into opinions and practices in large samples and may be descriptive and/or be used to test associations. In this context, qualitative research methods may complement this study design either at the survey development phase and/or at the interpretation/extension of results stage. This methods article focuses on key considerations for designing and deploying surveys in healthcare epidemiology and antibiotic stewardship, including identification of whether or not de novo survey development is necessary, ways to optimally lay out and display a survey, denominator measurement, discussion of biases to keep in mind particularly in research using surveys, and the role of qualitative research methods to complement surveys. We review examples of surveys in healthcare epidemiology and antimicrobial stewardship and review the pros and cons of methods used. A checklist is provided to help aid design and deployment of surveys in healthcare epidemiology and antimicrobial stewardship.

    Authors: Nasia Safdar, Lilian M. Abbo, Mary Jo Knobloch, Susan K. Seo

  • Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship: Use of Administrative and Surveillance Databases
    Current - Antimicrobial Stewardship, Guidelines, Knowledge & Skills, Research
    Author:
    SHEA
    Published:
    August 30, 2016
    Abstract:

    Administrative and surveillance data are used frequently in healthcare epidemiology and antimicrobial stewardship (HE&AS) research because of their wide availability and efficiency. However, data quality issues exist, requiring careful consideration and potential validation of data. This methods paper presents key considerations for using administrative and surveillance data in HE&AS, including types of data available and potential use, data limitations, and the importance of validation. After discussing these issues, we review examples of HE&AS research using administrative data with a focus on scenarios when their use may be advantageous. A checklist is provided to help aid study development in HE&AS using administrative data.

    Authors: Marci Drees, Jeffrey S. Gerber, Daniel J. Morgan, Grace M. Lee

  • Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship: Randomized Controlled Trials
    Current - Antimicrobial Stewardship, Guidelines, Knowledge & Skills, Research
    Author:
    SHEA
    Published:
    April 25, 2016
    Abstract:

    Randomized controlled trials (RCT) produce the strongest level of clinical evidence when comparing interventions. RCTs are technically difficult, costly, and require specific considerations including the use of patient- and cluster-level randomization and outcome selection. In this methods paper, we focus on key considerations for RCT methods in healthcare epidemiology and antimicrobial stewardship (HE&AS) research, including the need for cluster randomization, conduct at multiple sites, behavior modification interventions, and difficulty with identifying appropriate outcomes. We review key RCTs in HE&AS with a focus on advantages and disadvantages of methods used. A checklist is provided to aid in the development of RCTs in HE&AS.

    Authors: Deverick J. Anderson, Manisha Juthani-Mehta, and Daniel J. Morgan

  • Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship—Observational Studies
    Current - Antimicrobial Stewardship, Guidelines, Knowledge & Skills, Research
    Author:
    SHEA
    Published:
    June 20, 2016
    Abstract:

    Observational studies compare outcomes among subjects with and without an exposure of interest, without intervention from study investigators. Observational studies can be designed as a prospective or retrospective cohort study or as a case-control study. In healthcare epidemiology, these observational studies often take advantage of existing healthcare databases, making them more cost-effective than clinical trials and allowing analyses of rare outcomes. This paper addresses the importance of selecting a well-defined study population, highlights key considerations for study design, and offers potential solutions including biostatistical tools that are applicable to observational study designs.

    Authors: Graham M. Snyder, Heather Young, Meera Varman, Aaron M. Milstone, Anthony D. Harris, and Silvia Munoz-Price

  • Moving Toward Elimination of Healthcare-Associated Infections: A Call to Action
    Current - Infection Prevention, Public Health
    Author:
    CDC, SHEA, APIC, ASTHO, CSTE, IDSA, PIDS
    Published:
    September 30, 2010
    Abstract:

    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.

    Authors: Denise Cardo, Penelope H. Dennehy, Paul Halverson, Neil Fishman, Mel Kohn, Cathryn L. Murphy, Richard J. Whitley, and HAI Elimination White Paper Writing Group

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