SHEA Guidelines and Expert Guidance Documents

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

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

https://doi.org/10.1017/ice.2016.189

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

https://doi.org/10.1017/ice.2016.118

This complete update in Infection Control and Healthcare Epidemiology to the 2008 Compendium. Published in July 2014 with evidence-based, practical recommendations for acute care hospitals for the prevention of common HAIs.

• Synthesizes evidence and expert consensus
• Highlights basic HAI prevention strategies
• Provides special approaches for outbreak management
• Describes implementation strategies and frameworks

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

Reviewed: 8/1/2014

https://doi.org/10.1086/676882

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

https://doi.org/10.1017/ice.2016.93

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

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

The scope of a healthcare institution’s infection prevention and control/healthcare epidemiology program (IPC/HE) should be driven by the size and complexity of the patient population served, that population’s risk for healthcare-associated infection (HAI), and local, state, and national regulatory and accreditation requirements. Essential activities of all IPC/HE programs are reviewed in this white paper.

Authors: Kristina A. Bryant, Anthony D. Harris, Carolyn V. Gould, Eve Humphreys, Tammy Lundstrom, Denise M. Murphy, Russell Olmsted, Shannon Oriola and Danielle Zerr

Reviewed: November 2018

https://doi.org/10.1017/ice.2015.333

This manuscript was created to provide general recommendations for isolation precautions among visitors based on the literature and a survey of the Society for Healthcare Epidemiology of America (SHEA) membership and SHEA Research Network (SRN). For endemic situations with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), we recommend not using contact isolation precautions, although visitors interacting with multiple patients should use isolation practices similar to those of HCWs. Utilization of contact precautions should be considered for visitors to patients with extensively drug-resistant Gram-negative organisms (eg, Klebsiella pneumoniae carbapenemase (KPC) or enteric pathogens with diarrhea, such as Clostridium difficile and norovirus). Visitors with extensive documented exposure to the symptomatic patient prior to hospitalization such as parents/guardians/family members may be excluded from isolation precautions. These recommendations should be adapted to patient populations and individual hospital needs.

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

Reviewed: April 2019

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

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