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Updated Recommendations on the Use of Chlorhexidine-Impregnated Dressings for Prevention of Intravascular Catheter-Related Infections (2017)

Appendix: 4.0 The GRADE Approach to Rating the Evidence

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Table 10. Rating the Evidence for Benefit or Harm Using the GRADE Approach9


Type of Evidence: Starting GRADE

  • RCT: High
  • Observational study: Low

Criteria to Decrease GRADE

  • Study quality limitations
    Serious (−1 GRADE) or very serious (−2 GRADE) study quality limitations determined by Risk of Bias Assessments
  • Inconsistency
    Important inconsistency (−1 GRADE)
  • Indirectness
    Some (−1 GRADE) or major (−2 GRADE) uncertainty about directness
  • Imprecision
    Imprecise or sparse data (−1 GRADE)
  • Publication bias
    High risk of bias (−1 GRADE)

Criteria to Increase GRADE

  • Strength of association
    Strong (+1 GRADE) or very strong evidence of association (+2 GRADE)
  • Dose-response
    Evidence of a dose-response gradient (+1 GRADE)
  • Confounding
    Inclusion of unmeasured confounders increases the magnitude of effect (+1 GRADE)

Resulting GRADE

  • High
  • Moderate
  • Low
  • Very Low

Reference

  1. Umscheid CA, Agarwal RK, Brennan PJ, Healthcare Infection Control Practices Advisory C. Updating the guideline development methodology of the Healthcare Infection Control Practices Advisory Committee (HICPAC). Am J Infect Control. 2010;38(4):264-273.
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