The SHEA Position Paper discusses the importance of diagnostic stewardship in improving patient outcomes and healthcare-associated infection (HAI) metrics. Diagnostic stewardship involves optimizing the ordering, collection, performance, and reporting of diagnostic tests to enhance the accuracy of HAI diagnosis and treatment. The paper highlights the role of inappropriate testing in HAI rates and emphasizes the need to avoid strategies that solely aim to impact reportable metrics. It reviews specific examples of diagnostic strategies for CAUTI, HO-CDI, and CLABSI, focusing on patient-centered approaches that reduce misclassification of colonization or contamination events as HAIs. The paper also addresses the challenges and opportunities in adapting HAI definitions to new testing technologies and the potential consequences of metric-centered approaches that bypass diagnostic stewardship. It concludes by advocating for a patient-centered approach to diagnostic stewardship to align with quality and safety goals, ensuring that HAI definitions consider clinical criteria and that processes are in place to track inappropriate testing.The SHEA Position Paper discusses the importance of diagnostic stewardship in improving patient outcomes and healthcare-associated infection (HAI) metrics. Diagnostic stewardship involves optimizing the ordering, collection, performance, and reporting of diagnostic tests to enhance the accuracy of HAI diagnosis and treatment. The paper highlights the role of inappropriate testing in HAI rates and emphasizes the need to avoid strategies that solely aim to impact reportable metrics. It reviews specific examples of diagnostic strategies for CAUTI, HO-CDI, and CLABSI, focusing on patient-centered approaches that reduce misclassification of colonization or contamination events as HAIs. The paper also addresses the challenges and opportunities in adapting HAI definitions to new testing technologies and the potential consequences of metric-centered approaches that bypass diagnostic stewardship. It concludes by advocating for a patient-centered approach to diagnostic stewardship to align with quality and safety goals, ensuring that HAI definitions consider clinical criteria and that processes are in place to track inappropriate testing.