[Table of Contents]
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Canada Communicable Disease Report
- Supplement
Volume: 23S8
December 1997
INFECTION CONTROL GUIDELINES
Preventing Infections Associated with Indwelling Intravascular
Access Devices
APPENDIX I
Guideline Rating System
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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(115,116).
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 adoptionMeasures 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.
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Current Rating System for Statements
A more elaborate system of rating has been recently proposed(117),
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(117) 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
"poor" in the original rating scheme. This system is outlined in Table
4.
TABLE 4
Strength and Quality of Evidence for Recommendations
|
Categories for strength of each
recommendation |
CATEGORY
|
DEFINITION |
A
|
Good evidence to support a recommendation
for use. |
B
|
Moderate evidence to support a recommendation
for use. |
C
|
Insufficient evidence to support
a recommendation for or against use. |
D
|
Moderate evidence to support a recommendation
against use. |
E
|
Good evidence to support a recommendation
against use. |
Categories for quality of evidence
on which recommendations are made |
GRADE
|
DEFINITION |
I
|
Evidence from at least one properly
randomized, controlled trial. |
II
|
Evidence from at least one well-designed
clinical trial without randomization, from cohort or case-controlled analytic studies,
preferably from more than one centre, from multiple time series, or from dramatic
results in uncontrolled experiments. |
III
|
Evidence from opinions of respected
authorities on the basis of clinical experience, descriptive studies, or reports
of expert committees. |
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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