VII. MethodsThis guideline was based on a targeted systematic review of the best available evidence on<strong>CAUTI</strong> prevention. We used the Grading of Recommendations Assessment, Development <strong>and</strong>Evaluation (GRADE) approach 32-34 to provide explicit links between the available evidence <strong>and</strong>the resulting recommendations. Our guideline development process is outlined in Figure 1.Figure 1. The Guideline Development ProcessGUIDELINE SEARCHDEVELOPMENT OF KEY QUESTIONSReview of relevant <strong>guidelines</strong> to in<strong>for</strong>m key questionsLITERATURE SEARCHDatabases identified; search strategy developed;references stored; duplicates resolvedABSTRACT AND FULL-TEXT SCREENINGTo identify studies which were a) relevant to one or morekey questions b) primary analytic research, systematicreview or meta-analysis <strong>and</strong> c) written in EnglishDATA EXTRACTION AND SYNTHESISData abstracted into evidence tables; study qualityassessedDRAFT RECOMMENDATIONSStrength of evidence graded; summaries <strong>and</strong>recommendations draftedFINALIZE RECOMMENDATIONSRecommendations finalized; guideline published26
Development of Key QuestionsWe first conducted an electronic search of the National Guideline Clearinghouse® (Agency <strong>for</strong>Healthcare Research <strong>and</strong> Quality), Medline® (National Library of Medicine) using the Ovid®Plat<strong>for</strong>m (Ovid Technologies, Wolters Kluwer, New York, NY), the Cochrane® HealthTechnology Assessment Database (Cochrane Collaboration, Ox<strong>for</strong>d, UK), the NIH ConsensusDevelopment Program, <strong>and</strong> the United States Preventive Services Task Force database <strong>for</strong>existing national <strong>and</strong> international <strong>guidelines</strong> relevant to <strong>CAUTI</strong>. The strategy used <strong>for</strong> theguideline search <strong>and</strong> the search results can be found in Appendix 1A. A preliminary list of keyquestions was developed from a review of the relevant <strong>guidelines</strong> identified in the search. 1,35,36Key questions were finalized after vetting them with a panel of content experts <strong>and</strong> HICPACmembers.Literature SearchFollowing the development of the key questions, search terms were developed <strong>for</strong> identifyingliterature relevant to the key questions. For the purposes of quality assurance, we comparedthese terms to those used in relevant seminal studies <strong>and</strong> <strong>guidelines</strong>. These search terms werethen incorporated into search strategies <strong>for</strong> the relevant electronic databases. Searches wereper<strong>for</strong>med in Medline® (National Library of Medicine) using the Ovid® Plat<strong>for</strong>m (OvidTechnologies, Wolters Kluwer, New York, NY), EMBASE® (Elsevier BV, Amsterdam,Netherl<strong>and</strong>s), CINAHL® (Ebsco Publishing, Ipswich, MA) <strong>and</strong> Cochrane® (CochraneCollaboration, Ox<strong>for</strong>d, UK) (all databases were searched in July 2007), <strong>and</strong> the resultingreferences were imported into a reference manager, where duplicates were resolved. ForCochrane reviews ultimately included in our guideline, we checked <strong>for</strong> updates in July 2008.The detailed search strategy used <strong>for</strong> identifying primary literature <strong>and</strong> the results of the searchcan be found in Appendix 1B.Study SelectionTitles <strong>and</strong> abstracts from references were screened by a single author (C.V.G, R.K.A., orD.A.P.) <strong>and</strong> the full text articles were retrieved if they were 1) relevant to one or more keyquestions, 2) primary analytic research, systematic reviews or meta-analyses, <strong>and</strong> 3) written inEnglish. Likewise, the full-text articles were screened by a single author (C.V.G. or D.A.P.) usingthe same criteria, <strong>and</strong> included studies underwent a second review <strong>for</strong> inclusion by anotherauthor (R.K.A.). Disagreements were resolved by the remaining authors. The results of thisprocess are depicted in Figure 2.27
- Page 4 and 5: AcknowledgementHICPAC thanks the fo
- Page 6 and 7: AbbreviationsADLAPACHE IIASAASBBUNC
- Page 8 and 9: I. Executive SummaryThis guideline
- Page 10 and 11: II. Summary of RecommendationsTable
- Page 12 and 13: II. Proper Techniques for Urinary C
- Page 14 and 15: 1. If obstruction is anticipated, c
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- Page 18 and 19: III. Implementation and AuditPriori
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- Page 22 and 23: V. BackgroundUrinary tract infectio
- Page 24 and 25: acteriuria inevitably occurs over t
- Page 28 and 29: Figure 2: Results of the Study Sele
- Page 30 and 31: After determining the GRADE of the
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- Page 34 and 35: VIII. Evidence ReviewQ1. Who should
- Page 36 and 37: Evidence Review Table 1B. What are
- Page 38 and 39: Very low-quality evidence suggested
- Page 40 and 41: Q2B.2. Hydrophilic catheters vs. st
- Page 42 and 43: For all comparisons, we considered
- Page 44 and 45: a. Clamping vs. free drainage prior
- Page 46 and 47: studies. 3,25,260-276 The findings
- Page 48 and 49: 2D.5. Maintain unobstructed urine f
- Page 50 and 51: 15. Jain P, Parada JP, David A, Smi
- Page 52 and 53: 44. Chaudhuri P, Vengadasalam D. Ur
- Page 54 and 55: 71. Kelleher RE, Meeropol E, Parks
- Page 56 and 57: 101. Hirsh DD, Fainstein V, Musher
- Page 58 and 59: 132. Van Nagell, JR, Penny RM, Rodd
- Page 60 and 61: 163. Lai KK, Fontecchio SA, Lai KK,
- Page 62 and 63: 193. Waites KB, Canupp KC, Armstron
- Page 64 and 65: 222. Cohen A. A microbiological com
- Page 66 and 67: 253. Chavigny KH. The use of polymi
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