General background

With the rapid expansion of the Infection Prevention Control/Healthcare Epidemiology (IPC/HE) fields over recent decades, the pivotal roles of IPC/HE in hospital regulation, quality improvement, patient safety, and healthcare finances have become increasingly apparent. Consequently, the demand for effective IPC/HE leaders has surged.^{Reference Chiotos, Rock and Schweizer1,Reference Torriani and Taplitz2} Training in IPC/HE is essential for all infectious diseases (ID) fellows (both adult and pediatric), including those planning a career in hospital epidemiology as well as those planning to focus on general ID, transplant, HIV, etc. ID fellows, however, have historically felt ill-prepared in IPC/HE. Joiner et al’s survey highlighted this gap, revealing that only half of respondents felt adequately trained in infection control, despite half of them participating in infection control in their practice.^{Reference Joiner, Dismukes, Britigan, Cohen, Johnson, Karchmer, Mandell and Stamm3} IPC/HE fellow education is not currently standardized, and most IPC/HE training is led by individual mentors and healthcare facilities.

ID fellowship programs are expected to educate their fellows on infection prevention.⁴ ACGME Program Requirements for Infectious Diseases includes Core Competency IV.B.1.c.⁵: “Fellows must demonstrate knowledge of infection control and hospital epidemiology.”⁵ The ABIM Blueprint for the Infectious Disease Certification Exam indicates that “Infection Prevention and Control” accounts for 5% of the adult exam, and per the Pediatric Infectious Diseases Content Online, it accounts for 10% of the pediatrics exam.^6,7 However, in a 2023 national survey of ID fellowship program directors, less than half of programs (46.3%, n = 54) reported having a formal curriculum of IPC/HE.^{Reference Winkler, Paras, Wright and Shenoy8} Further, 43% of programs surveyed reported barriers to IPC/HE training, with 65% reporting that a lack of curriculum was the largest barrier to implementation. Most program directors were in favor of formal IPC/HE certification from a professional society within the standard fellowship timeframe.

We propose the Society for Healthcare Epidemiology of America (SHEA) Infection Prevention and Control/Healthcare Epidemiology (IPC/HE) Curricula to serve as a practical guide for ID training programs and fellows. Recognizing the pressing need for standardized IPC/HE fellow education, this structured curriculum is simultaneously adaptable to individual career paths and interests. The basic IPC/HE curriculum allows ID fellowship programs to ensure sufficient IPC/HE training for all fellows, regardless of career path. The advanced IPC/HE curriculum covers more advanced topics necessary for an ID physician to assume a leadership position with an IPC/HE program upon graduation. This curriculum is based on a SHEA white paper with recommended competencies for healthcare epidemiologists, current ID fellowship curricula from select institutions, expert opinion from the SHEA Education Committee, and the Infectious Diseases Society of America (IDSA) Training Program Directors’ Community of Practice.^{Reference Kaye, Anderson and Cook9–13}

Intended use

The SHEA IPC/HE Curriculum is divided into 9 categories, including (1) surveillance and reporting; (2) cluster detection, investigation, and resolution; (3) pathogen transmission and transmission interruption; (4) environment of care; (5) diagnostic stewardship; (6) occupational health; (7) emergency preparedness; (8) hospital leadership and operations; and (9) communicating infection prevention and control (IPC) work. Antimicrobial stewardship is largely excluded, since it falls outside the scope of this paper. Each category is organized into relevant topics, with each topic containing at least one learning objective (see Table 1). The objectives are categorized by pathway, either “Basic” or “Advanced” (see Table 2 for pathway requirements and a list of just the objectives in Supplementary Table 1). Twenty of the basic objectives are also marked as “core” objectives, and all fellows are expected to achieve these objectives. The basic objectives and activities are relevant for all ID fellows, regardless of long-term career path. Fellows planning a career in IPC/HE should meet a combination of basic and advanced objectives to achieve a more in-depth understanding of both IPC/HE and program leadership. Many of the objectives use introductory terms such as “recognize” or “understand,” since the goal for most fellows is to develop awareness of the objective rather than achieve proficiency. To achieve the objectives, fellows can engage in a variety of activities at their facility, such as reading and summarizing landmark articles, consulting with or shadowing local subject matter or IP experts, participating in their facility’s IPC/HE activities, and/or working on specific fellow projects. Activities are categorized only if they are advanced; otherwise, they are not labeled. Select activities are listed in Table 1, and additional ideas for activities are included in Supplementary Table 2. While these may be helpful suggestions, local adaptation based on local resources and fellow needs is recommended.

Table 1. The SHEA infectious diseases fellow infection prevention and control and healthcare epidemiology curriculum with objectives designated as core, basic, and advanced, including selected activities

CAUTI: catheter-associated urinary tract infection, CLABSI: central line–associated bloodstream infection, CDI: Clostridioides difficile infection, MRSA: Methicillin-resistant Staphylococcus aureus, VAE: Ventilator-associated event, SSI: Surgical site infection

Table 2. Required activities for completion and certificate for of both the basic and advanced pathways

Each ID fellowship program can incorporate the curriculum to meet its program’s needs. This document may supplement key areas of an existing basic curriculum, or it can be incorporated into programs without any existing structured IPC/HE training program. While this curriculum is meant to be relatively comprehensive, fellows and fellowship programs will have a variety of mechanisms by which to achieve the learning objectives. Ideally, program leadership and/or local IPC/HE leaders should guide each fellow in choosing one or more topics from each category of highest local priority, emphasizing meeting at least one objective through the suggested activities or local facility opportunities. Programs can use this list as a checklist to ensure a broad range of key IPC/HE topics are incorporated into each fellow’s training.

This education can also be supplemented by and combined with existing infection prevention education programs, such as the SHEA/Centers for Disease Control and Prevention Training Certification in Healthcare Epidemiology, the SHEA Primer on Healthcare Epidemiology, Infection Control, and Antimicrobial Stewardship (online ID fellows’ course), and the Annual Fellows’ Course in Healthcare Epidemiology, Infection Prevention, & Antimicrobial Stewardship (in-person course).^14–16 The curriculum in this paper is designed to offer a more comprehensive approach and serve as a framework for longitudinal training. It can be implemented either as a several-week rotation for all fellows or as an extended program during the second and/or third year of fellowship, particularly for those aspiring to careers in infection prevention and hospital epidemiology. While this curriculum reviews collaboration with public health, fellows interested in advanced public health training could consider further collaboration with their local public health department or the Epidemic Intelligence Service.¹⁷

To be considered to have received adequate training in IPC/HE, this committee recommends that a fellow aiming to complete basic training (those not pursuing a career in IPC/HE) should complete at least 50% of all basic objectives, including the 20 core objectives. Those interested in advanced training in IPC/HE should complete at least 80% of all basic objectives, 25% percent of all advanced objectives, and complete a scholarly project, such as a research project or quality improvement project in IPC, with the goal of sharing it locally or nationally at a scientific meeting or manuscript publication. Local ID programs should assist ID fellows with opportunities to meet the recommended training and track their progress/completion.

The SHEA Education Committee is currently working on a certificate program as part of the 2025 work plan.