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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


  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.