Appendix A: Infection Prevention and Control Guideline for Flexible Gastrointestinal Endoscopy and Flexible Bronchoscopy – Guideline development process

APPENDIX A – PHAC IP&C Guideline Development Process

Literature Search – Inclusions/Exclusions

A thorough literature search was performed by the Public Health Agency of Canada reference librarian in collaboration with the nurse consultant and the writer. The search results were reviewed, and articles that did not meet the criteria for the guideline were eliminated. Abstracts of remaining articles were examined; those that were not appropriate study designs or that failed to meet specific methodological criteria were eliminated. As the essence of the guideline was further defined, additional searches were conducted to ensure all relevant literature was captured. All searches covered the period from 1996 onwards.

Formulation of Recommendations

This Guideline provides evidence-based recommendations. Guideline recommendations were graded to differentiate between those based on strong evidence and those based on weak evidence. Grading did not relate to the importance of the recommendation, but to the strength of the supporting evidence and, in particular, to the predictive power of the study designs from which that data were obtained. Assignment of a level of evidence and determination of the associated grade of recommendation was done by the writer and was reviewed and approved by the co-chairs and all Guideline Working Group members. When recommendations were not unanimous, difference of opinion was formally recorded and the reasons for disagreement noted for the information audit trail. It is important to note that no real divergence of opinion occurred for this guideline, however when a difference of opinion occurred, debate took place and a solution was found and accepted.

Where scientific evidence was lacking, the consensus of experts was used to formulate a recommendation. The grading system is outlined in Appendix I.

External Review by Stakeholders

This Guideline was reviewed by a group of societies and associations for feedback on the quality and content of the document and grading of recommendations for further validation before widespread implementation. The reviewers were:

• Association of Medical Microbiology and Infectious Disease Canada
• Canadian Association of Clinical Microbiology and Infectious Diseases
• Canadian Association of General Surgeons
• Canadian Association of Thoracic Surgeons
• Canadian Nurses Association
• Canadian Standards Association
• Canadian Thoracic Society
• Central Service Association of Ontario
• Community and Hospital Infection Control Association - Canada
• Healthcare Infection Control Practices Advisory Committee
• Network of Networks Interest Group, Community and Hospital Infection Control Association-Canada
• The Canadian Association of Gastroenterology
• The Canadian Society of Gastroenterology Nurses and Associates
• The Hospital for Sick Children

Editorial Independence

This guideline was funded by the Public Health Agency of Canada. Financial contribution was provided by the Canadian Association of Gastroenterology for travel and hospitality costs for non-public servants attending the expert working group meeting.

All Members of the Guideline Working Group have declared no competing interest in relation to the guideline. It was incumbent upon each member to declare any interests or connections with relevant pharmaceutical companies or other organizations if their personal situation changed.

The guidelines outlined herein are part of a series that has been developed over a period of years under the guidance of the 2008 Steering Committee on Infection Prevention and Control Guidelines. The following individuals formed the Steering Committee on Infection Prevention and Control Guidelines:

• Dr. Lynn Johnston, (Chair), Hospital Epidemiologist & Professor of Medicine, QEII Health Science Centre, Halifax, Nova Scotia
• Nan Cleator, National Practice Consultant, VON Canada, Huntsville, Ontario
• Brenda Dyck, Program Director, Infection Prevention and Control Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba
• Dr. John Embil, Director, Infection Control Unit, Health Sciences Centre, Winnipeg, Manitoba
• Karin Fluet, Director, Regional IPC&C Program, Capital Health Region, Edmonton, Alberta
• Dr. Bonnie Henry, Physician Epidemiologist & Assistant, Professor, School of Population & Public Health, UBC, BC Centre for Disease Control, Vancouver, British Columbia
• Dany Larivée, Infection Control Coordinator, Montfort Hospital, Ottawa, Ontario
• Mary LeBlanc, Carewest Infection Prevention & Control Coordinator, Tyne Valley, Prince Edward Island
• Dr. Anne Matlow, Director of Infection Control, Hospital for Sick Children, Toronto, Ontario
• Dr. Dorothy Moore, Infection Control, Division of Infectious Diseases, Montreal Children's Hospital, Montreal, Quebec
• Dr. Donna Moralejo, Associate Professor, Memorial University School of Nursing, St. John’s, Newfoundland
• Deborah Norton, Infection Prevention and Control Consultant, Regina, Saskatchewan
• Filomena Pietrangelo, Occupational Health and Safety Manager, McGill University Health Centre, Montreal, Quebec
• JoAnne Seglie, Occupational Health Nurse OC RN, University of Alberta Campus, Office of Environment Health/Safety, Edmonton, Alberta
• Dr. Pierre St-Antoine, Professor of Medicine, Centre Hospitalier de l’Université de Montréal, Campus Notre-Dame, Microbiology, Montreal, Quebec
• Dr. Geoff Taylor, Professor of Medicine, Department of Medicine, Division of Infectious Diseases, Edmonton, Alberta
• Dr. Mary Vearncombe, Medical Director, Infection Prevention & Control, Sunnybrook Health Sciences Centre, Toronto, Ontario