SHEA Guidelines and Expert Guidance Documents

This intersociety position statement addresses the issue of disinfection of transcutaneous ultrasound transducers used for percutaneous procedures or for monitoring other invasive procedures. Some organizations are not congruent in their recommendations for disinfection, with recommendations for high-level disinfection of sheathed probes for percutaneous procedures being not evidence-based and resulting in unwarranted and unnecessary use of resources, increase the possibility of safety events if procedures are performed without ultrasound guidance. This statement addresses several specific points for determining when to use high-level disinfection appropriately.

https://onlinelibrary.wiley.com/doi/epdf/10.1002/jum.15653

This ASGE-led multisociety guideline updates the 2016 version, to address gaps and variation in implementing infection prevention practices are common in endoscopy units across the United States. Given the rising concerns of endoscope-related infections, this guideline evaluates the current literature and standards for endoscope reprocessing and expands details related to the critical reprocessing steps of cleaning and drying and incorporates recent evidence as it pertains to improving the reprocessing of GI endoscopes.

https://doi.org/10.1016/j.gie.2020.09.048

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

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

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

SHEA/CDC Outbreak Response Training Program Tool Kits (multimodal tools covering incident management, communication, negotiation, implementation, IPC strategies, emerging pathogens, and COVID-19)