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A guideline is a set of recommendations for clinical practice accompanied by an explanation of how the recommendations were derived. The explanation will usually link to research evidence relevant to the clinical topic area as well as incorporating knowledge and expertise contributed by healthcare workers and patients or their carers or representatives.
Guideline production processes typically include the following stages:
As part of the development process, systematic literature searches will be conducted to identify research studies meeting criteria related to the guideline topic and scope. The guideline group will seek evidence that is related directly to their clinical questions of interest, and how closely the available evidence meets the pre-specified criteria will have a bearing on how useful it is in guiding the group to answer their questions. For example, the group may be interested in a particular healthcare setting or patients with a specific condition (e.g. a healthcare-acquired infection). If the available evidence turns out to be somewhat removed from the pre-specified criteria, then the group may feel less confident in drawing conclusions relevant to the guideline population and this could be reflected in the phrasing of their recommendations.
Another aspect to be considered is the underlying design of each study identified via the literature searches and implications in terms of susceptibility to bias, for example. One needs only to explore the most recent issues of the Journal of Hospital Infection (JHI) and Infection Prevention in Practice (IPIP) to recognise examples of contrasting study designs used to investigate issues in the field of infection prevention and control. For example, a randomised controlled trial was used to compare approaches for inserting central venous access devices in terms of outcomes related to catheter-associated bloodstream infections. A different quantitative study design is a cohort study, as illustrated by an investigation of the incidence of healthcare-associated infections in a tertiary care hospital. Qualitative study designs are also reflected in HIS journals, for example, to explore perceptions and experiences of patients and healthcare workers in relation to cohort isolation units. While particular study designs are appropriate for specific research questions, their strengths and limitations will be taken into account as part of the guideline development process.
If a guideline group finds that literature searches yield no relevant evidence, then various approaches to reaching a consensus on recommendations for practice can be used. In such cases, the collective knowledge and experience of the group ensure that it is still possible to formulate recommendations. Equally, the group can propose areas for future research to fill identified gaps in the evidence.
Guidelines produced by HIS are accredited by the National Institute for Health and Care Excellence (NICE), meaning that the processes used adhere to high standards set by NICE. The steps outlined above are central to ensuring that a guideline is of high quality.
If the route from evidence to guideline recommendations sounds interesting to you, why not attend the HIS online training course to be held in January 2021? An outline programme will be available on the HIS website soon. If in the meantime you have any questions you can contact Moira via firstname.lastname@example.org.