title: Choosing Wisely in Healthcare Epidemiology and Antimicrobial Stewardship.
abstract: OBJECTIVE To identify Choosing Wisely items for the American Board of Internal Medicine Foundation. METHODS The Society for Healthcare Epidemiology of America (SHEA) elicited potential items from a hospital epidemiology listserv, SHEA committee members, and a SHEA-Infectious Diseases Society of America compendium with SHEA Research Network members ranking items by Delphi method voting. The SHEA Guidelines Committee reviewed the top 10 items for appropriateness for Choosing Wisely. Five final recommendations were approved via individual member vote by committees and the SHEA Board. RESULTS Ninety-six items were proposed by 87 listserv members and 99 SHEA committee members. Top 40 items were ranked by 24 committee members and 64 of 226 SHEA Research Network members. The 5 final recommendations follow: 1. Don't continue antibiotics beyond 72 hours in hospitalized patients unless patient has clear evidence of infection. 2. Avoid invasive devices (including central venous catheters, endotracheal tubes, and urinary catheters)and, if required, use no longer than necessary. They pose a major risk for infections. 3. Don't perform urinalysis, urine culture, blood culture, or Clostridium difficile testing unless patients have signs or symptoms of infection. Tests can be falsely positive leading to overdiagnosis and overtreatment. 4. Do not use antibiotics in patients with recent C. difficile without convincing evidence of need. Antibiotics pose a high risk of C. difficile recurrence. 5. Don't continue surgical prophylactic antibiotics after the patient has left the operating room. Five runner-up recommendations are included. CONCLUSIONS These 5 SHEA Choosing Wisely and 5 runner-up items limit medical overuse. Infect Control Hosp Epidemiol 2016;37:755-760.
authors.affiliation: 1Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Morgan
authors.affiliation: 1Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Croft
authors.affiliation: 4The Society for Healthcare Epidemiology of America,Arlington,Virginia.
authors.forename: Valerie
authors.initials: V
authors.lastname: Deloney
authors.affiliation: 5Division of Infectious Diseases,Department of Medicine,Rush University Medical Center,Chicago,Illinois.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Popovich
authors.affiliation: 7Division of Infectious Diseases,Department of Medicine,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin.
authors.forename: Chris
authors.initials: C
authors.lastname: Crnich
authors.affiliation: 9Division of Healthcare Quality Promotion,National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.affiliation: 10Department of Medicine,University of Pennsylvania Health System,Philadelphia,Pennsylvania.
authors.forename: Neil O
authors.initials: NO
authors.lastname: Fishman
authors.affiliation: 11University of Louisville,Louisville,Kentucky.
authors.forename: Kristina
authors.initials: K
authors.lastname: Bryant
authors.affiliation: 12Johns Hopkins University,Baltimore,Maryland.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.affiliation: 1Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Surbhi
authors.initials: S
authors.lastname: Leekha
mesh_terms: D000073602:Antimicrobial Stewardship / Q000379:methods / Q000458:organization & administration*; D003697:Delphi Technique; D004812:Epidemiologic Methods; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D017410:Practice Guidelines as Topic; D014481:United States; D019564:Unnecessary Procedures / Q000706:statistics & numerical data