Reiniging en desinfectie van ruimten Module 3 Risk-of-bias-tabellen
Risk of bias table diagnostic accuracy studies (QUADAS II, 2011)
Subquestion 1 – Diagnostic performance of monitoring methods
| Study reference | Surface selection | Index test | Reference standard | Flow and timing | Comments with respect to applicability |
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Amodio (2014) |
Was a consecutive or random sample of surfaces enrolled? Unclear (random selection, but method not described; low risk of bias considering the comparison of adjacent areas) Was a case-control design avoided? Yes (cross-sectional design; both tests applied to the same surface) Did the study avoid inappropriate exclusions? Unclear (not reported) |
Were the index test results interpreted without knowledge of the results of the reference standard? Yes (automatic reading, directly after sampling; microbiological results available after 48 h) If a threshold was used, was it pre-specified? No threshold used
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Is the reference standard likely to correctly classify the target condition? No (size of area sampled 25% of that sampled for index test) Were the reference standard results interpreted without knowledge of the results of the index test? Unclear (not reported)
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Was there an appropriate interval between index test and reference standard? Yes (simultaneously) Did all surfaces receive a reference standard? Yes (adjacent sampling) Did surfaces receive the same reference standard? Yes Were all surfaces included in the analysis? Unclear (no incomplete data reported, but unlikely that there were none)
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Are there concerns that the included surfaces do not match the review question? No (surfaces in healthcare facilities) Are there concerns that the index test, its conduct, or interpretation differ from the review question? No (Lumicontrol II is a known ATP (Adenosinetrifosfaat) bioluminescence assay; conduct and interpretation according to the manufacturer’s instruction) Are there concerns that the target condition as defined by the reference standard does not match the review question? No |
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CONCLUSION: Could the selection of surfaces have introduced bias? RISK: UNCLEAR |
CONCLUSION: Could the conduct or interpretation of the index test have introduced bias? RISK: LOW |
CONCLUSION: Could the reference standard, its conduct, or its interpretation have introduced bias? RISK: HIGH |
CONCLUSION Could the surface flow have introduced bias? RISK: UNCLEAR |
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Trsan (2019) |
Was a consecutive or random sample of surfaces enrolled? Unclear (random selection, but method not described; low risk of bias considering the comparison of adjacent areas) Was a case-control design avoided? Yes (cross-sectional design; both tests applied to the same surface) Did the study avoid inappropriate exclusions? Unclear (not reported)
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Were the index test results interpreted without knowledge of the results of the reference standard? Yes (automatic reading, directly after sampling; microbiological results available after 48 h) If a threshold was used, was it pre-specified? Yes (based on previous measurements)
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Is the reference standard likely to correctly classify the target condition? Yes (standard practice) Were the reference standard results interpreted without knowledge of the results of the index test? Unclear (not reported)
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Was there an appropriate interval between index test and reference standard? Yes (simultaneously) Did all surfaces receive a reference standard? Yes (adjacent sampling) Did surfaces receive the same reference standard? No (different thresholds for different surfaces) Were all surfaces included in the analysis? Unclear (no incomplete data reported, but unlikely that there were none) |
Are there concerns that the included surfaces do not match the review question? No (surfaces in healthcare facility)
Are there concerns that the index test, its conduct, or interpretation differ from the review question? No (Lumitester PD-30 is a known ATP bioluminescence assay; conduct and interpretation according to the manufacturer’s instruction) Are there concerns that the target condition as defined by the reference standard does not match the review question? No |
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CONCLUSION: Could the selection of surfaces have introduced bias? RISK: UNCLEAR |
CONCLUSION: Could the conduct or interpretation of the index test have introduced bias? RISK: LOW |
CONCLUSION: Could the reference standard, its conduct, or its interpretation have introduced bias? RISK: UNCLEAR |
CONCLUSION Could the surface flow have introduced bias? RISK: HIGH |
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Risk of bias table for cohort studies (CLARITY Group at McMaster University)
Subquestion 2 – Role of monitoring in infection control
| 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 |
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
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Co-interventions Were co-interventions similar between groups? |
Overall risk of bias |
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Ziegler (2022) |
Definitely no Reason: |
Definitely yes Reason:
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Definitely yes Reason: |
Probably no Reason: |
Probably no Reason: Adjustment for (limited number of) confounding factors. |
Probably yes Reason: |
Probably yes Reason: |
Definitely no Reason: Feedback of monitoring results only performed for ATP and UV/F, not for VI.
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High |
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