Table 1. Characteristics of CPGs regarding SSI prevention.
| CDC 1999 & 2017 update | NICE 2008 & 2014 update | WHO 2016 | Strategies to Prevent SSI 2008 & 2014 update | Bulletin of the American College of Surgeons, 2016 | University of Toronto 2017 | |
|---|---|---|---|---|---|---|
| Original CPG title | Guideline for Prevention of Surgical Site Infection, 1999 | Surgical site infection prevention and treatment of surgical site infection | Global Guidelines for the Prevention of Surgical Site Infection | Strategies to prevent surgical site infections in acute care hospitals | Guideline for prevention of surgical site infection | Surgical Site Infection Prevention: A Clinical Practice Guidelines developed by the University of Toronto’s Best Practice in Surgery in collaboration with the Antimicrobial Stewardship Program |
| Date published | 1999/2017 | 2008/2014 | 2016 | 2008/2014 | 2016 | 2017 |
| Country of origin | US | UK | Switzerland | US | US | Canada |
| Objective of CPG | Provide recommendations for the detection and prevention of SSI. | Provide guidance on the patient’s journey through out the pre/intra, & postoperative phases of care | Provide comprehensive evidence-based recommendations for interventions, applied during the pre/intra, & postoperative phases of care | Provide comprehensive evidence-based recommendation for detecting HAI infections. | Not stated | To make recommendations for interventions which decrease the risk of surgical site infections in surgical patients. |
| Methods used to collect/select the evidence | 1999-not stated; 2017-targeted systematic review using 4 databases | 2008-systematic literature reviews using 7 databases; 2014-searches based on clinical questions | Identify critical priorities using PICO; Systematic reviews of topic areas |
Not stated | Not stated | Primary literature review; consideration of the WHO 2016 Global Guidelines for the Prevention of surgical Site Infection, American Society of Health-System Pharmacists (ASHP) recommendations, National Institute for Health and Care Excellence (NICE) guidelines and Canadian Patient Safety Institute (CPSI) Surgical Site Infection: Getting Started Kit. |
| Methods used to analyse the evidence | Hierarchical system used to grade levels of evidence | Hierarchical system used to grade levels of evidence | Assessment & synthesis of evidence; Formulate recommendations & dissemination | Not stated | Not stated | Not stated |
| Ranking scheme to determine strength of the evidence & recommendation | 1999: 1A, 1B, 2 & no recommendation; 2017: modified GRADE system | 1++, 1+, 1-, 2++, 2+, 2-, 3 & 4 | GRADE system: High, moderate, low & very low | 2008: Adapted from the Canadian Task Force; A I-III, B I-III & C I-III; 2014: GRADE System I-high, II-moderate & III-low | 1A, 1B, 2 & no recommendation | GRADE system: High, moderate, low & very low |
| Methods used to formulate the recommendations | Expert consensus | Expert consensus | Expert consensus | Not stated | Not stated | Recommendations were tailored for practice at the University of Toronto affiliated hospitals in collaboration with the Antimicrobial Stewardship Program. |
| Number of recommendations in each CPG | 72 44 |
59 20 |
33 | 26 28 |
44 | 21 |
| Method of CPG validation | External and internal peer review | External and internal peer review | External and internal peer review | Not stated | External and internal peer review | Externalb and internal peer review |
| Intended users | Surgeons, operating room nurses, postoperative inpatient and clinical nurses; infection control professionals; anaesthesiologists; healthcare epidemiologists; and other personnel directly responsible for the prevention of nosocomial infections. | 2008-health professionals involved in the care of surgical patients; 2014-decision makers, surgical patients, their families and caregivers | Surgical team including surgeons, nurses, technicians, anaesthetists & bedside clinicians; decision makers; senior managers & infection control professionals | Acute care hospitals | Not stated | Surgeons, surgical residents and fellows; anaesthesiologists; pharmacists; and nurses caring for surgical patients |
| Composition of CPG working group | 12 health professionals from infectious diseases, surgery & nursing, | 2 surgeons, tissue viability nurse, theatre nurse, 2 microbiologists, surveillance coordinator, infection control specialist, 2 patient/carer representatives | 4 groups: 1.Steering group 2. Guidelines development group 3. Systematic reviews group 4. External peer review group |
Not stated | Not stated | 7 members of the University of Toronto’s Best Practice in Surgery group in collaboration with the Antimicrobial Stewardship Program |
| Number of documents included in appraisal | 3 1999 CPG (38 pages); 2017 update (8 pages); 2017 supplementary online content (600 pages) |
2 2008 CPG (168 pages); 2014 update (28 pages) |
1 2016 CPG (168 pages) |
6 2008 CPG (11 pages); 2008 executive summary (10 pages); 2008 introduction (9 pages); 2014 CPG (23 pages); 2014 compendium (25 pages); 2014 introduction (5 pages) |
2 2017 CPG (16 pages); 2017 executive summary (4 pages) |
1 2017 CPG (27 pages) |
| Where primary CPG can be found | Available through CDC Stacks Public Health Publications Website: https://stacks.cdc.gov/view/cdc/7160 |
Available through NICE Website: https://www.nice.org.uk/guidance/cg74 | Available through WHO Website: http://www.who.int/gpsc/ssi-prevention-guidelines/en/ | a2014 update available through EMBASE Website: https://www.embase.com/search/results?subaction=viewrecord&from=export&id=L373762398 | Available through Mary Ann Liebert Online Website: http://online.liebertpub.com.libraryproxy.griffith.edu.au/doi/pdf/10.1089/sur.2016.214 | Available through Google search: http://bestpracticeinsurgery.ca/wp-content/uploads/2017/11/SSI-BPS-CPG-Nov20.pdf |
CPG, clinical practice guideline; NICE, National Institute for Clinical Excellence; WHO, World Health Organisation; US, United States; UK, United Kingdom; SSI, surgical site infection; PICO, population intervention comparison outcome; ASHP, American Society of Health-System Pharmacists; CPSI, Canadian Patient Safety Institute; GRADE, Grades of Recommendation Assessment, Development and Evaluation; CDC, Centre for Disease Control.
a2008 CPG not available online; was requested through Griffith University; refer to S3 Table for details of where to obtain all documents included in appraisal.
bExternal validation information is not publically available; multiple requests for this information by the authorial team were not responded to by the working group.