[Table of Contents]

Canada Communicable Disease Report - Supplement
Volume: 23S8
December 1997

INFECTION CONTROL GUIDELINES

Preventing the Spread of Vancomycin-Resistant Enterococci (VRE) in Canada

APPENDIX - Guideline Rating System

A. Previous Rating System for Statements

In the Laboratory Centre for Disease Control (LCDC) Infection Control Guidelines a system was previously used for rating guideline statements according to the strength of evidence^(88,89). Each statement was rated into one of three categories:

Category I: Strongly recommended for adoption

Measures in Category I are strongly supported by well-designed and controlled clinical studies that show effectiveness in reducing risk of nosocomial infections or are viewed as useful by the majority of experts in the field. Measures in this category are judged to be applicable to the majority of facilities regardless of size, patient population, or endemic nosocomial infection rate and are considered practical to implement.

Category II: Moderately recommended for adoption

Measures in Category II are supported by highly suggestive clinical studies or by definitive studies in specialized institutions that might not be representative of other facilities. Measures that have not been adequately studied, but have a strong theoretical rationale indicating that they might be very effective, are included in this category. Category II measures are judged to be practical to implement but not considered a standard of practice for every setting.

Category III: Weakly recommended for adoption

Measures in Category III have been proposed by some investigators, authorities or organizations, but, to date, lack both supporting data and strong theoretical rationale. Thus, they may be considered as important issues requiring further evaluation by those who wish to implement them.

B. Current Rating System for Statements

A more elaborate system of rating has been recently proposed⁽⁹⁰⁾, with five categories to rank the strength of evidence for (categories A-C) or against (D-E) a statement, and three grades to describe the quality of supportive studies. This system of rating follows the guidelines that have been recently published⁽⁹⁰⁾ for clinical practice guidelines. The format uses an evidence-based medicine approach, which stresses the examination of evidence from clinical research, especially randomized studies, and places less emphasis on intuition and recalled experiences. This new rating scheme, with one modification, is used in this document with appropriate clarification of evidence described in the text. The modification occurs in Category C with the word "insufficient" replacing "poors" in the original rating scheme. This system is outlined in the following table.

The information in these guidelines was current at the time of publication; it should be emphasized that areas of knowledge and aspects of medical technology advance with time. Guidelines, by definition, are directing principles and indications or outlines of policy or conduct, which should not be regarded as rigid standards. These guidelines should facilitate development of standards but respect the autonomy of organizations and recognize their governing body's authority and responsibility to ensure the quality of care provided to their patients.

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