MRSA Module 3 Risk-of-bias-tabel

Author, year

Was the allocation sequence adequately generated?

Definitely yes
Probably yes
Probably no
Definitely no

Was the allocation adequately concealed?

Definitely yes
Probably yes
Probably no
Definitely no

Blinding: Was knowledge of the allocatedinterventions adequately prevented?

Were patients blinded?
Were healthcare providers blinded?
Were data collectors blinded?
Were outcome assessors blinded?
Were data analysts blinded?

Definitely yes
Probably yes
Probably no
Definitely no

Was loss to follow-up (missing outcome data) infrequent?

Definitely yes
Probably yes
Probably no
Definitely no

Are reports of the study free of selective outcome reporting?

Definitely yes
Probably yes
Probably no
Definitely no

Was the study apparently free of other problems that could put it at a risk of bias?

Definitely yes
Probably yes
Probably no
Definitely no

Overall risk of bias

If applicable/necessary, per outcome measure

LOW
Some concerns
HIGH

 

Chuang (2015)

Definitely yes

Reason: Care homes were used as units of randomization. RCHE were randomly allocated to either intervention or control arm. The authors applied stratified block randomization where the stratum was the operation mode (run by non-governmental-organizations or run by the private section) with a block size of two.

Definitely yes

Reason: Randomization was done by centrally administered randomization. The randomization list was generated using the “rand” command in Microsoft Excel 2003

Probably yes

Reason: patients blinded: yes

Were healthcare providers blinded?
Probably no

Were data collectors blinded?:
Probably yes

Were outcome assessors blinded?Probably yes

Were data analysts blinded?
Probably yes

Definitely yes

Reason: The turnover rate was 33.1% in the intervention group while that was 30.1% in the control group. The number of participants with missing outcome data is sufficiently large that their outcomes could have made an important difference to the estimated effect of intervention.

Probably no

 

 

Probably no

Reason: The analysis accounted for participant characteristics that are likely to explain the relationship between missingness in the outcome and its true value. The difference between intervention groups in the proportions of missing outcome data is minimal (33.1% vs. 30.1%). Reported reasons for missing outcome data seems to be similar between groups

High

 

Author, year

Selection of participants

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

 

 

 

Exposure

Can we be confident in the assessment of exposure?

 

 

 

Outcome of interest

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

 

 

 

 

Confounding-assessment

Can we be confident in the assessment of confounding factors? 

Confounding-analysis

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?

Assessment of outcome

Can we be confident in the assessment of outcome?

 

 

Follow up

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

 

Co-interventions

Were co-interventions similar between groups?

 

 

 

 

Overall Risk of bias

 

 

 

 

 

 

Definitely yes
Probably yes
Probably no
Definitely no

Definitely yes
Probably yes
Probably no
Definitely no

Definitely yes
Probably yes
Probably no
Definitely no

Definitely yes 
Probably yes 
Probably no 
Definitely no

Definitely yes
Probably yes
Probably no
Definitely no

Definitely yes
Probably yes
Probably no
Definitely no

Definitely yes
Probably yes
Probably no
Definitely no

Definitely yes
Probably yes
Probably no
Definitely no

Low
Some concerns
 High

Lopez-Alcalde (2015)

-

 -

 -

 -

 -

 -

 -

 -

Low

Cochrane review -no eligible studies were identified for this review, either completed or ongoing

Furuya (2018)

Definitely yes

Reason: Data and samples were collected from for all 6 ICUs in an academic tertiary-care over 9 years: 2006–2014

Definitely yes

Reason: testing was performed similar in all experiments

Probably no

Reason:  because no active surveillance was conducted beyond the time of admission, the isolates represented results from clinically indicated cultures only.

Probably no

Reason: data not shown – they assessed major demo-graphics over time. They stated not found detectable change in average length of stay, Charlson co-morbidity scores, or age in these ICUs over the study period (data not shown).

Not applicable

 

 

Probably no

 

 

Probably yes

Reason: not adequately documented

Probably no

Reason: not adequately documented

High

Shahbaz (2020)

Definitely yes

Reason: data and samples were collected from infants who screened positive for either MRSA meticilline-resistente Staphylococcus aureus (meticilline-resistente Staphylococcus aureus) or MSSA at two level III–IV University of California, Los Angeles NICUs from August 2014 to November 2018.

Noncolonized patients were selected as controls with an attempt to match by gestational age during the same time period.

Definitely yes

Reason: Patient information gathered, including maternal and infant history, birth information, demographics, diagnoses, laboratory results and overall hospital course, was obtained by accessing the electronic medical record

Probably yes

Reason: selection criteria were used excluding participants with the outcome of interest at the start date

Probably yes

Reason: medical records were used

Probably no

Reason: although stated, some variables were not taken into account in the multivariate analysis (LOS)

 

 

Probably yes

Reason: the outcome measures were defined according to the CDC Centers for Disease Control and Prevention (Centers for Disease Control and Prevention)’s National Healthcare Safety Network. However, there were inconsistencies on how the surveillance cultures were collected due to ordering error.

Probably yes

Reason: not adequately documented

Probably no

Reason: not adequately documented

High

Morgan (2020)

Definitely yes

Reason: data and samples were collected from 74 individual LTCFs, representing 59 different VA health-care clusters across 39 states, as well as the District of Columbia and Puerto Rico

Definitely yes

Reason: exposure was defined by the facility’s MRSA prevention policy for residents colonized with MRSA (policies covered all LTCFs within a cluster).

 

Probably yes

Reason: the primary outcome was any positive culture or PCR test for MRSA in a patient previously negative for MRSA indicating the acquisition of MRSA. This was analyzed on an individual resident level and identified using VA laboratory and microbiology databases from the VA CDW.

Probably yes

Reason: the authors include variables that were potential risk factors for confounders based on the literature in the generalized estimating equations models.

Probably no

Reason: it is possible that the survival analysis did not fully account for unmeasured confounding.

Probably yes

Reason: policies were reviewed by a hospital epidemiology physician and categorized into standard pre-cautions or contact precautions, blinded to outcome.

Probably no

Reason: not adequately documented

Probably no

Reason: not adequately documented

High

Schrank (2020)

Probably no

Reason: Data and samples were collected from a tertiary, academic medical center in Boston 1 year prior to and after the intervention.

However the retrospective, quasi-experimental design did not include a contemporaneous control group, limiting the ability to infer causation in statistical associations.

Definitely yes

Reason: testing was performed similar in all experiments

Probably yes

Reason: Incidence of nosocomial MRSA, VRE and methicillin-susceptible Staphylococcus aureus (MSSA) clinical isolates and central line-associated bloodstream infections (CLABSIs) were collected as part of routine infection control surveillance.

Probably no

Reason: not adequately documented

Not applicable

 

 

Probably yes

Reason: Incidence of nosocomial MRSA, VRE and methicillin-susceptible Staphylococcus aureus (MSSA) clinical isolates and central line-associated bloodstream infections (CLABSIs) were collected as part of routine infection control surveillance.

Probably yes

Reason: not adequately documented

Probably no

Reason: not adequately documented

High

Hetem (2010)

Definitely yes

Reason: data and samples were collected among 62 hospitals spread across the Netherlands

Definitely yes

Reason: testing was performed similar in all experiments

Definitely yes

Reason: the outcome measure resulted from transmission of index patients

Definitely yes

Reason: testing was performed similar in all experiments

Not applicable

 

Definitely yes

Reason: quantitative and genotyped outcome measures were used.

Not applicable

 

Not applicable

 

Low

 

Omland (2012)

Definitely yes

Reason: all notified cases (from clinical samples, contact tracing, screening of risk groups, and clinical presentation) reported in the period January 2008 – December 2009 to the National Centre for Antimicrobial and Infectious Control, Statens Serum Institut, Copenhagen, from North Denmark Region were included

Definitely yes

Reason: testing was performed similar in all experiments

Definitely yes

Reason: the outcome measure resulted from transmission of index patients

Definitely yes

Reason: testing was performed similar in all experiments

Not applicable

 

Definitely yes

Reason: quantitative and genotyped outcome measures were used.

Not applicable

 

Not applicable

 

Low

 

Wassenberg (2011)

Definitely yes

Reason: index cases were collected from 52% of all general and academic hospitals in The Netherlands

Definitely yes

Reason: testing was performed similar in all experiments

Definitely yes

Reason: the outcome measure resulted from transmission of index patients

Definitely yes

Reason: testing was performed similar in all experiments

Not applicable

 

Definitely yes

Reason: quantitative and genotyped outcome measures were used.

Not applicable

 

Not applicable

 

Low

 

Wulf (2012)

Definitely yes

Reason: all MRSA positive cultures between July 2002 and December2008 were included

Definitely yes

Reason: testing was performed similar in all experiments

Definitely yes

Reason: the outcome measure resulted from transmission of index patients

Definitely yes

Reason: testing was performed similar in all experiments

Not applicable

 

Definitely yes

Reason: quantitative and genotyped outcome measures were used.

Not applicable

 

Not applicable

 

Low