shea expert guidance Duration of Contact Precautions for Acute-Care Settings David B. Banach, MD, MPH; 1,a Gonzalo Bearman, MD, MPH; 2,a Marsha Barnden, RNC, MSN, CIC; 3 Jennifer A. Hanrahan, DO, MSc; 4 Surbhi Leekha, MBBS, MPH; 5 Daniel J. Morgan, MD, MS; 5 Rekha Murthy, MD; 6 L. Silvia Munoz-Price, MD, PhD; 7 Kaede V. Sullivan, MD, MSc; 8 Kyle J. Popovich, MD, MS; 9 Timothy L. Wiemken, PhD 10 purpose This expert guidance document (EG) provides recommendations regarding discontinuation of contact precautions (CP) at the individual patient level in acute-care hospitals employing CP for 1 or more of the following organisms: methicillin-resistant Sta- phylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant Enterobacter- iaceae (MDR-E), including carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum β-lactamase (ESBL)–producing organisms. This document also provides a review of the role of molecular testing in guiding decisions pertaining to duration of CP for patients with these organisms. The guidance does not address decisions regarding the initiation of CP for any specific organism. Previously published guidelines describe components of CP and identify situations in which CP should be used; currently, however, few publications address the issue of how long CP should be maintained. At the time of publication, decisions related to implementation of CP for select, endemic organisms are made by individual facilities based on factors such as insti- tutional epidemiology, resources, organizational priorities, and previously published guidance, and these vary widely. The SHEA Guidelines Committee (GLC) selected this topic to address when CP should be discontinued for individual patients in acute-care settings that employ CP for the aforementioned organisms. Although the organisms addressed are frequently encountered in other settings (eg, nursing homes, long-term acute-care facilities, rehabilitation centers, outpatient medical care settings), additional considerations may affect the application of these recommendations outside the acute-care hospital environment. authors The authors consist of current and past members of the SHEA Guidelines Committee (GLC), who serve as volunteers. All authors are involved at their respective institutions in the development of policies pertaining to CP, either directly or in an advisory role. intended use Special-topic EG documents are developed to address areas of relatively narrow scope that lack the level of evidence required for a formal guideline but are important for the provision of safe and effective healthcare. As such, systematic grading of evidence level is not provided for individual recommenda- tions. Each EG is based on a synthesis of limited evidence, theoretical rationale, current practices, practical considera- tions, the opinion of the writing group, and consideration of potential harms where applicable. Within the EG, a summary list of recommendations is provided, along with their respec- tive rationales. We also conducted a survey of the SHEA Research Network (SRN). No EG can anticipate all situations and this EG is not meant to be a substitute for individual judgment by qualified professionals. methods Expert Guidance Development This EG follows the process outlined in the Handbook for SHEA-Sponsored Guidelines and Expert Guidance Documents. 10 The topic of duration of CP was among those proposed and ranked highest by the GLC. A manuscript proposal was approved by the SHEA Publications Committee and the SHEA Board of Trustees. We developed PICO-style (ie, population, intervention, control, and outcomes) questions based on agreed-upon themes. These questions were used to define the scope of the EG and the development of search terms, which were voted on until unan- imous approval was achieved. We identified the period during which articles would be collected as January 1, 1990, to April 1, 2016. Only English-language articles were included. The lists of articles generated by the searches were reviewed for inclusion by a primary reviewer and a secondary reviewer. The EG was also informed by a survey of the SHEA Research Network (SRN). Affiliations: 1. University of Connecticut, Farmington, Connecticut; 2. Virginia Commonwealth University, Richmond, Virginia; 3. Adventist Health, Roseville, California; 4. MetroHealth Medical Center, Cleveland, Ohio; 5. University of Maryland, Baltimore, Maryland; 6. Cedars-Sinai Medical Center, Los Angeles, California; 7. Medical College of Wisconsin, Milwaukee, Wisconsin; 8. Temple University School of Medicine, Philadelphia, Pennsylvania; 9. Rush University Medical Center, Chicago, Illinois; 10. University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky. a Co-chairs. © 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2018/3902-0001. DOI: 10.1017/ice.2017.245 Received October 10, 2017; accepted October 26, 2017; electronically published January 11, 2018 infection control & hospital epidemiology february 2018, vol. 39, no. 2