MRSA Module 3 Risk-of-bias-tabel
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Author, year |
Was the allocation sequence adequately generated? Definitely yes |
Was the allocation adequately concealed? Definitely yes |
Blinding: Was knowledge of the allocatedinterventions adequately prevented? Were patients blinded? Definitely yes |
Was loss to follow-up (missing outcome data) infrequent? Definitely yes |
Are reports of the study free of selective outcome reporting? Definitely yes |
Was the study apparently free of other problems that could put it at a risk of bias? Definitely yes |
Overall risk of bias If applicable/necessary, per outcome measure LOW |
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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 data analysts blinded? |
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
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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 |
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Author, year |
Selection of participants Was selection of exposed and non-exposed cohorts drawn from the same population?
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Exposure Can we be confident in the assessment of exposure?
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Outcome of interest Can we be confident that the outcome of interest was not present at start of study?
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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?
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Follow up Was the follow up of cohorts adequate? In particular, was outcome data complete or imputed?
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Co-interventions Were co-interventions similar between groups?
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Overall Risk of bias
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Definitely yes |
Definitely yes |
Definitely yes |
Definitely yes |
Definitely yes |
Definitely yes |
Definitely yes |
Definitely yes |
Low |
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Lopez-Alcalde (2015) |
- |
- |
- |
- |
- |
- |
- |
- |
Low Cochrane review -no eligible studies were identified for this review, either completed or ongoing |
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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
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Probably no
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Probably yes Reason: not adequately documented |
Probably no Reason: not adequately documented |
High |
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Shahbaz (2020) |
Definitely yes Reason: data and samples were collected from infants who screened positive for either MRSA (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)
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Probably yes Reason: the outcome measures were defined according to the CDC (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 |
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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).
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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 |
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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
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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 |
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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
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Definitely yes Reason: quantitative and genotyped outcome measures were used. |
Not applicable
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Not applicable
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Low
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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
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Definitely yes Reason: quantitative and genotyped outcome measures were used. |
Not applicable
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Not applicable
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Low
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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
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Definitely yes Reason: quantitative and genotyped outcome measures were used. |
Not applicable
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Not applicable
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Low
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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
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Definitely yes Reason: quantitative and genotyped outcome measures were used. |
Not applicable
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Not applicable
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Low
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