Appendix 2: Methods

Overview

A Workgroup of the Healthcare Infection Control Practices Advisory Committee (HICPAC) was convened to update Part 2 of the Guideline for infection control in health care personnel, 1998 1 ("1998 Guideline"). The Workgroup consisted of current and former HICPAC members and non-HICPAC members who brought expertise including, but not limited to, infectious diseases, infection prevention and control, healthcare epidemiology, nursing, clinical and environmental microbiology, surgery, hospital medicine, internal medicine, epidemiology, health policy, health services research, public health, and related medical fields. Additional support and technical advice was provided by CDC subject matter experts, including experts at the National Institute of Occupational Safety and Health (NIOSH). This methods section for the update of the 1998 Guideline is developed according to the HICPAC guideline development (https://archive.cdc.gov/#/details?url=https://www.cdc.gov/hicpac/php/about/index.html) and workgroup (https://www.cdc.gov/hicpac/media/pdfs/HICPAC-Workgroup-Guidance-508.pdf) processes. The 1998 Guideline is being updated on a section-by-section basis, and sections will be added to the following list as they are updated:

• Cytomegalovirus
• Diphtheria
• Group A Streptococcus
• Measles
• Meningococcal Disease
• Mumps
• Parvovirus B19
• Pertussis
• Rabies
• Rubella
• Varicella-Zoster Virus
• Special Populations: Pregnant Healthcare Personnel

Update Strategy

The Workgroup reviewed each recommendation, its accompanying narrative, and the references from the 1998 Guideline. Landscape analyses were conducted to determine whether the existing recommendations would be adopted, adapted, or archived, and whether there was a gap that required the development of de novo recommendations according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE)-ADOLOPMENT approach. 23 Landscape analysis searches included the following steps: brief keyword searches in PubMed, internet scraping, and searches of relevant partner websites. Workgroup members reviewed the results of the landscape analysis searches and suggested additional references as necessary. Results from landscape analyses informed the Workgroup's decision on whether to adopt or adapt 1998 Guideline recommendations. Landscape analysis search strategies and results are in Tables 3-14 and Figures 1-12.

Guideline recommendations were adopted when the Workgroup determined the 1998 Guideline recommendation remained applicable when unchanged or where edits were minor and did not alter the meaning. Recommendations were adapted when the 1998 Guideline recommendation required alignment with current CDC resources or trusted partner organization recommendations, the incorporation of new evidence that may have resulted in a change in the recommendation, or if there were inconsistent existing recommendations. Recommendations were archived when the 1998 Guideline recommendation was maintained in a different infection prevention control guideline (e.g., Isolation Precautions Guideline) or by a different group at CDC [e.g., the Advisory Committee on Immunization Practices (ACIP)]. Recommendations were created de novo when the Workgroup identified a research question for which no current recommendation exists or for pathogens or healthcare issues that had emerged since 1998. When the Workgroup determined the 1998 Guideline recommendation required updating, systematic literature reviews or rapid reviews were conducted to support changes.

Literature Search Methods

Adapted and de novo recommendations were informed by the results of systematic literature reviews or rapid reviews as applicable. CDC methodologists reported these reviews in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) or the PRISMA scoping review extension (PRISMA ScR). 4 Research questions were developed by CDC methodologists and subject matter experts and reviewed by the workgroup and the full committee at public meetings. An information specialist developed research question-specific search strategies that were performed in MEDLINE, Embase, Cochrane Library, CINAHL, and Scopus. Results of literature searches were independently screened by two reviewers using screening criteria identified a priori,and disagreements were resolved by consensus among reviewers. For completeness, systematic reviews meeting inclusion criteria were mined for references not identified by search strategies. The final list of included references was reviewed by workgroup members who suggested additional relevant references. The results of the study selection process are depicted in accompanying tables and figures for each section. Data from studies meeting inclusion criteria was extracted by two reviewers using standardized extraction templates, and differences were reconciled by discussion. Risk of bias was assessed using a framework developed by the Division of Healthcare Quality Promotion (DHQP) at the CDC utilizing criteria found in established Risk of Bias tools. 56 The GRADE 7 approach was used to evaluate the certainty of evidence and to provide transparent links between available evidence and resulting recommendations.

Recommendation Development

For adopted recommendations, the Workgroup proposed minor edits for HICPAC review and discussion. Minor edits included updating wording to clarify the original intent and to explicitly state implied recommendations. For adapted and de novo recommendations, the Workgroup developed draft recommendation options for HICPAC review and discussion using GRADE Evidence to Decision frameworks. 8 Uniformity was sought across sections and guided the formatting of recommendations. Workgroup members recused themselves from decisions pertaining to the development of recommendations when there was a perceived or actual conflict of interest.

Reviewing and Finalizing the Guideline

Draft recommendations and accompanying narratives were presented at HICPAC meetings following the process for guideline development outlined here: https://archive.cdc.gov/#/details?url=https://www.cdc.gov/hicpac/php/about/index.html.

Previous meeting materials are available here: https://archive.cdc.gov/#/details?url=https://www.cdc.gov/hicpac/php/meeting-materials/index.html.

The dates when each recommendation was first presented to HICPAC, entered into a 60-day public comment period, presented to HICPAC again following revision, and approved by HICPAC are available in Table 1. If no substantive changes were made following the public comment period, the first HICPAC vote was considered the final vote. Completed recommendations that have already been posted are all considered Good Practice Statements that are either adapted from a pre-existing recommendation or based on indirect evidence.

The summary of evidence-to-decision making rationale can be found in Table 2. HICPAC was terminated on March 31, 2025. Any section-specific changes to this process can be found in the supplementary material to that section. Supplementary materials can be found here: https://www.cdc.gov/infection-control/hcp/healthcare-personnel-epidemiology-control/index.html.