Many clinical practice guidelines for preventing Clostridium difficile infections do not comply with the reporting standards outlined in the Appraisal of Guidelines for Research and Evaluation II instrument, according to a study in Infection Control & Hospital Epidemiology.
AGREE II is a tool used to gauge the methodological rigor and transparency related to how a guideline is developed and used internationally. In healthcare, the AGREE II instrument can help determine the validity and reliability of protocols, like those implemented to prevent healthcare-associated infections.
The authors of the research scoured medical databases for clinical practice guidelines for C. diff prevention that were published between January 2004 and January 2015. Then, they rated the quality of the guidelines they identified using the AGREE II instrument.
Here are eight things to know about the clinical practice guidelines for C. diff prevention, as outlined in the study.
1. The median AGREE II score for the clinical practice guideline's clarity of presentation was 75.9 percent.
2. For scope and purpose, the median score was 74.1 percent.
3. The median AGREE II score for editorial independence was 63.9 percent.
4. For applicability, the clinical practice guidelines achieved a median score of 43.1 percent.
5. For stakeholder involvement, the median score was 40.7 percent.
6. The median AGREE II score for rigor of development was a low 18.1 percent.
7. The guidelines frequently addressed four common C. diff prevention strategies — antibiotic stewardship, hypochlorite solutions, probiotic prophylaxis and bundle strategies.
8. Many recommendations included in the guidelines were based on low-level studies and were inconsistent with clinical evidence.
The authors concluded that current clinical practice guidelines do not adhere well to AGREE II reporting standards.
"Furthermore, there was limited transparency in moving from evidence to recommendations," according to the study. "[C. diff infection] prevention [guidelines] need to…be transparent in moving from evidence to recommendations, and recommendations need to be consistent with available evidence."
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