SHEA Guidelines and Expert Guidance Documents

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

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 the evaluation of penicillin allergies to support antimicrobial stewardship.

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

Patient Resources: https://jamanetwork.com/journals/jama/fullarticle/2720729 

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

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

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

The potential for clinically significant microbial cross transmission in the intraoperative environment poses a threat to patient safety. A growing body of literature has shown contamination in the anesthesia work area, including the anesthesia medical work cart, stopcocks, laryngeal masks and laryngoscope blades, touchscreens, and keyboards, as well as on providers’ hands, resulting in transmissions, healthcare-associated infections, and increased risk of patient mortality.

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

The “SHEA neonatal intensive care unit (NICU) white paper series” is intended to provide practical, expert opinion, and/or evidence-based answers to frequently asked questions about infection detection and prevention in the NICU. This document serves as a companion to the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) Guidelines for Prevention of Infections in Neonatal Intensive Care Unit Patients. 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.

Practical approaches for the prevention of central line-associated bloodstream infections
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
March 2022
READ MORE: https://doi.org/10.1017/ice.2022.53
CDC Companion Guideline: https://www.cdc.gov/infectioncontrol/guidelines/nicu-clabsi/index.html

Practical approaches for the prevention of viral respiratory infections
AUTHORS: Nisha Thampi, Judith Guzman-Cottrill, Allison H. Bartlett, Wendy Berg, Joseph B. Cantey, Eimear Kitt, Karen Ravin, Kenneth M. Zangwill, Alexis Elward
October 2023
READ MORE: https://doi.org/10.1017/ice.2023.120
CDC Systematic Review: https://www.cdc.gov/hicpac/reviews/prophylaxis-nicu/

Practical approaches to S. aureus prevention
AUTHORS: Ibukun Akinboyo, Kenneth Zangwill, Wendy Berg, JB Cantey, Beth Huizinga, Aaron Milstone
September 2020
READ MORE: https://doi.org/10.1017/ice.2020.51
CDC Companion Guideline: https://www.cdc.gov/infectioncontrol/guidelines/nicu-saureus/

Practical approaches to C. difficile prevention
AUTHORS: Thomas Sandora, Kristina Bryant, JB Cantey, Alexis Elward, Deborah Yokoe, Allison Bartlett
August 2018
READ MORE: https://doi.org/10.1017/ice.2018.209
CDC Systematic Review: https://www.cdc.gov/hicpac/reviews/cdiff-nicu/

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

Partial Update: January 2021

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

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

Reviewed: June 2018

https://doi.org/10.1086/675066

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

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

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

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

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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

https://doi.org/10.1017/ice.2016.160

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

https://doi.org/10.1017/ice.2016.171

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

https://doi.org/10.1017/ice.2016.117