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).

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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

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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.

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