Clostridioides difficile Module 3 Risk-of-bias-tabel

Was selection of exposed and non-exposed cohorts drawn from the same population?

Definitely yes,
probably yes,
probably no,
definitely no

Can we be confident in the assessment of exposure?

Definitely yes,
probably yes,
probably no,
definitely no

Can we be confident that the outcome of interest was not present at start of study?

Definitely yes,
probably yes,
probably no,
definitely no

Can we be confident in the assessment of confounding factors?

Definitely yes,
probably yes,
probably no,
definitely no

Did the study match exposed and unexposed for all variables that are associated with the outcome of interest or did the statistical analysis adjust for these confounding variables?

Definitely yes,
probably yes,
probably no,
definitely no

Can we be confident in the assessment of outcome?

Definitely yes,
probably yes,
probably no,
definitely no

Was the follow up of cohorts adequate? In particular, was outcome data complete or imputed?

Definitely yes,
probably yes,
probably no,
definitely no

Were co-interventions similar between groups?

Definitely yes,
probably yes,
probably no,
definitely no

Low,
some concerns,
high

Hacek, 2010

Definitely no

Reason: Before-after study. Case-mix and referral patterns may have differed over time. Comparability not reported.

Probably no

Reason: Compliance for terminal sporicidal cleaning/disinfection measured but no compliance data reported.

Definitely no

Reason: Prevalent cases; unclear whether prevalent cases at the time of implementation of the intervention were excluded from the population after implementation. Potential underestimation of the effect of the intervention.

Definitely no

Reason: No assessment of confounding factors.

Definitely no

Reason: No matching or adjustment for confounding factors.

Probably no

Reason: Indication for C. difficile toxin stool test not reported, nor whether this was comparable for both study periods.

Probably yes

Reason: Missing data not reported, but outcome data extracted from automated surveillance interface.

Definitely no

Reason: Concurrent changes in EVS notification of CDI Clostridioides difficile-infectie (Clostridioides difficile-infectie) discharges, EVS reminders of terminal cleaning procedures and cleaning observations.

High