Skip directly to search Skip directly to A to Z list Skip directly to site content
CDC Home

Updating the Guideline Methodology of the Healthcare Infection Control Practices Advisory Committee (HICPAC)

Updating the Guideline Methodology of the Healthcare Infection Control Practices Advisory Committee (HICPAC) The complete guideline is available for download in PDF format (188 KB / 31 pages).

Table 1: Rating the Quality of Evidence for Therapy or Harm Studies Using the GRADE Approach

Type of Evidence Initial Grade Criteria to Decrease Grade Criteria to Increase Grade Overall Quality Grade
RCT High

Quality
Serious (-1 grade) or very serious (-2 grades) limitation to study quality

Consistency
Important inconsistency (-1 grade)

Directness
Some (-1 grade) or major
(-2 grades) uncertainty about directness

Precision
Imprecise or sparse data (-1 grade)

Publication bias

High risk of bias (-1 grade)
  High
   

Strong association
Strong (+1 grade) or very strong evidence of association (+2 grades)

Dose-response
Evidence of a dose-response gradient (+1 grade)

Unmeasured Confounders

Inclusion of unmeasured confounders increases the effect size  (+1 grade)
Moderate
Observational study Low Low
Any other evidence (e.g., expert opinion) Very Low Very Low

Abbreviations: Grading of Recommendations Assessment, Development and Evaluation (GRADE); Randomized Controlled Trial (RCT).

Top of Page

Table 2: Formulating Recommendations

HICPAC Recommendation Weighing Benefits and Harms for Critical Outcomes Quality of Evidence
STRONG (Category I) Interventions with net benefits or net harms Category IA – High to Moderate
Category IB – Low to Very Low (Established Practice)
Category IC – High to Very Low (Regulatory)
WEAK (Category II) Interventions with trade offs between benefits and harms High to Very Low
No recommendation/unresolved Issue Uncertain trade offs between benefits and harms Low to Very Low

Top of Page

Table 3. Updated HICPAC Categorization Scheme for Recommendations

Category IA A strong recommendation supported by high to moderate quality evidence suggesting net clinical benefits or harms.
A strong recommendation supported by low quality evidence suggesting net clinical benefits or harms, or an accepted practice (e.g., aseptic technique) supported by low to very low quality evidence.
A strong recommendation required by state or federal regulation.
Category IB
Category IC
Category II A weak recommendation supported by any quality evidence suggesting a trade off between clinical benefits and harms.
No Recommendation An unresolved issue for which there is low to very low quality evidence with uncertain trade offs between benefits and harms.

Top of Page

 
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #