Development and validation of a tool to appraise guidelines on SARS-CoV-2 infection control strategies in healthcare workers

Subramaniam, Ashwin; Reddy, Mallikarjuna; Kadam, Umesh; Zubarev, Alexander; Lim, Zheng; Anstey, Chris; Bihari, Shailesh; Haji, Jumana; Luo, Jinghang; Mitra, Saikat; Ramanathan, Kollengode; Rajamani, Arvind; Rubulotta, Francesca; Svensk, Erik; Shekar, Kiran

BACKGROUND: Clinical guidelines on infection control strategies in healthcare workers (HCWs) play an important role in protecting them during the SARS-CoV-2 pandemic. Poorly constructed guidelines that are incomprehensive and/or ambiguous may compromise HCWs’ safety. OBJECTIVE: To develop and validate a tool to appraise guidelines on infection control strategies in HCWs based on the guidelines published early in the COVID-19 pandemic. DESIGN, SETTING, AND OUTCOMES: A three-stage, web-based, Delphi consensus-building process among a panel of diverse HCWs and healthcare managers was performed. The tool was validated by appraising 40 international, specialty-specific, and procedure-specific guidelines along with national guidelines from countries with a wide range of gross national income. RESULTS: Overall consensus (≥75%) was reached at the end of three rounds for all six domains included in the tool. The Delphi panel recommended an ideal infection control guideline should encompass six domains: general characteristics (domain-1), engineering recommendations (domain-2), personal protection equipment (PPE) use (domain-3), and administrative aspects (domain 4-6) of infection control. The appraisal tool performed well across the six domains and the inter-rater agreement was excellent for the 40 guidelines. All included guidelines performed relatively better in domains 1-3 compared with domains 4-6 and this was more evident in guidelines originating from lower-income countries. CONCLUSION: The guideline appraisal tool was robust and easy to use. Engineering recommendations aspects of infection control, administrative measures that promote optimal PPE use, and HCW wellbeing were generally lacking in assessed guidelines. This tool may enable health systems to adopt high-quality HCW infection control guidelines during the SARS-CoV-2 pandemic and may also provide a framework for future guideline development.