Cochrane · systematic review · CD011621

Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff

Verbeek, JH, Rajamaki, B, Ijaz, S, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library

Work4 versionsAMSTAR 2: not assessed

SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.

Questions

current version

GRADE rated

No studies

Included studies

No studies 1 · 2.4%Ungraded 2 · 4.8%Very low 34 · 81%Low 5 · 11.9%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Questions and results

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Personal protective equipment (PPE) types: powered, air‐purifying respirator (PAPR) plus coverall versus N95 mask plus gown

Population: healthcare staff volunteers

3 questions

Outcome	Effect	Evidence	Status / GRADE
Any contamination: fluorescent marker Personal protective equipment (PPE) types: powered, air‐purifying respirator (PAPR) plus coverall vs N95 mask plus gown	RR 0.27 [0.17, 0.43]	50 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Compliance: noncompliance with donning guidance Personal protective equipment (PPE) types: powered, air‐purifying respirator (PAPR) plus coverall vs N95 mask plus gown	RR 7.5 [1.81, 31.1]	50 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Compliance: noncompliance with doffing guidance Personal protective equipment (PPE) types: powered, air‐purifying respirator (PAPR) plus coverall vs N95 mask plus gown	RR 0.5 [0.2, 1.23]	50 participants	Very low Downgraded: risk of bias, imprecision, indirectness

Personal protective equipment (PPE) types: more protective versus less protective

Population: healthcare worker volunteers

7 questions

Outcome	Effect	Evidence	Status / GRADE
Number of contaminated spots: trunk Fluorescent marker Personal protective equipment (PPE) types: more protective vs less protective	no estimate extracted	1 study · 50 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Number of contaminated spots: neck Fluorescent marker Personal protective equipment (PPE) types: more protective vs less protective	no estimate extracted	1 study · 50 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Number of contaminated spots: foot Fluorescent marker Personal protective equipment (PPE) types: more protective vs less protective	no estimate extracted	1 study · 50 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Number of contaminated spots: palm Fluorescent marker Personal protective equipment (PPE) types: more protective vs less protective	no estimate extracted	1 study · 50 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Number of contaminated spots: trunk or neck Fluorescent marker Personal protective equipment (PPE) types: more protective vs less protective	no estimate extracted	NR	No studies
Usability score Range 1 to 5, higher indicating better Personal protective equipment (PPE) types: more protective vs less protective	no estimate extracted	1 study · 50 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Compliance with guidance Personal protective equipment (PPE) types: more protective vs less protective	no estimate extracted	0 studies · 0 participants	Ungraded

Personal protective equipment (PPE) types: gowns versus aprons

Population: healthcare worker volunteers

3 questions

Outcome	Effect	Evidence	Status / GRADE
Contamination with marker: individual type of doffing Personal protective equipment (PPE) types: gowns vs aprons	no estimate extracted	1 study · 50 participants	Very low Downgraded: imprecision, indirectness
Contamination with marker: CDC‐recommended doffing Personal protective equipment (PPE) types: gowns vs aprons	no estimate extracted	1 study · 50 participants	Very low Downgraded: imprecision, indirectness
Compliance with guidance Personal protective equipment (PPE) types: gowns vs aprons	no estimate extracted	0 studies · 0 participants	Ungraded

Personal protective equipment (PPE) types: different types of PPE attire

Population: healthcare workers

2 questions

Outcome	Effect	Evidence	Status / GRADE
Any contamination	no estimate extracted	1 study · 59 participants	Very low Downgraded: risk of bias, imprecision
Compliance	no estimate extracted	1 study · 59 participants	Very low Downgraded: risk of bias, imprecision

Modified personal protective equipment (PPE): sealed gown‐glove interface versus standard gown

Population: healthcare workers

2 questions

Outcome	Effect	Evidence	Status / GRADE
Contamination: fluorescent lotion Modified personal protective equipment (PPE): sealed gown‐glove interface vs standard gown	RR 0.27 [0.09, 0.78]	1 study · 30 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Contamination: MS2 Modified personal protective equipment (PPE): sealed gown‐glove interface vs standard gown	RR 0.68 [0.47, 0.98]	1 study · 30 participants	Very low Downgraded: risk of bias, imprecision, indirectness

Modified personal protective equipment (PPE): gown ‐ easy to doff compared to standard gown

Population: healthcare workers

2 questions

Outcome	Effect	Evidence	Status / GRADE
Contamination: fluorescent marker Modified personal protective equipment (PPE): gown ‐ easy to doff vs standard gown	RR 0.08 [0.01, 0.55]	1 study · 62 participants	Low
Contamination: bacteriophage Modified personal protective equipment (PPE): gown ‐ easy to doff vs standard gown	RR 0.53 [0.29, 0.94]	1 study · 62 participants	Low

Modified personal protective equipment (PPE): gown with gown‐glove improvement compared to standard gown and gloves

Population: healthcare workers

1 question

Outcome	Effect	Evidence	Status / GRADE
People with contamination Modified personal protective equipment (PPE): gown with gown‐glove improvement vs standard gown and gloves	RR 0.45 [0.26, 0.78]	2 studies · 50 participants	Low Downgraded: risk of bias

Modified personal protective equipment (PPE): gloves with tab versus standard gloves

Population: healthcare workers

1 question

Outcome	Effect	Evidence	Status / GRADE
Any contamination of hands Modified personal protective equipment (PPE): gloves with tab vs standard gloves	RR 0.22 [0.15, 0.31]	1 study · 317 participants	Very low Downgraded: risk of bias, indirectness

Modified personal protective equipment (PPE): mask plus tabs versus standard masks

Population: healthcare workers

2 questions

Outcome	Effect	Evidence	Status / GRADE
Contamination of mask from hands Modified personal protective equipment (PPE): mask plus tabs vs standard masks	RR 0.33 [0.14, 0.8]	1 study · 20 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Contamination of head from hands Modified personal protective equipment (PPE): mask plus tabs vs standard masks	RR 0.96 [0.83, 1.12]	1 study · 20 participants	Very low Downgraded: risk of bias, imprecision, indirectness

Procedures: doffing according to Centers for Disease Control and Prevention method versus individual doffing

Population: healthcare worker volunteers

2 questions

Outcome	Effect	Evidence	Status / GRADE
Contamination with fluor marker when using gowns Procedures: doffing according to Centers for Disease Control and Prevention method vs individual doffing	no estimate extracted	1 study · 50 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Contamination with fluor marker when using aprons Procedures: doffing according to Centers for Disease Control and Prevention method vs individual doffing	no estimate extracted	1 study · 50 participants	Very low Downgraded: risk of bias, imprecision, indirectness

Procedures: single‐step doffing compared to Centers for Disease Control and Prevention standard

Population: preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare workers

2 questions

Outcome	Effect	Evidence	Status / GRADE
Fluorescent contamination Procedures: single‐step doffing vs Centers	RR 0.98 [0.75, 1.28]	1 study · 22 participants	Very low
Bacterial contamination Procedures: single‐step doffing vs Centers	RR 0.2 [0.05, 0.77]	1 study · 27 participants	Very low

Procedures: doffing with double gloves compared to doffing with single gloves

Population: healthcare workers

6 questions

Outcome	Effect	Evidence	Status / GRADE
Contamination: virus detected ‐ all body parts Procedures: doffing with double gloves vs doffing with single gloves	RR 0.34 [0.17, 0.66]	1 study · 58 participants	Very low
Contamination: virus detected ‐ face Procedures: doffing with double gloves vs doffing with single gloves	RR 4.39 [0.53, 36.37]	1 study · 58 participants	Very low
Contamination: virus detected ‐ shirt Procedures: doffing with double gloves vs doffing with single gloves	RR 1.01 [0.79, 1.29]	1 study · 58 participants	Very low
Contamination: virus detected ‐ pants Procedures: doffing with double gloves vs doffing with single gloves	RR 0.91 [0.52, 1.58]	1 study · 36 participants	Very low
Non‐compliance: any error Procedures: doffing with double gloves vs doffing with single gloves	RR 1.08 [0.7, 1.67]	1 study · 36 participants	Very low
Contamination with fluorescent Procedures: doffing with double gloves vs doffing with single gloves	RR 0.98 [0.75, 1.28]	1 study · 22 participants	Very low

Procedures: donning and doffing with instructions compared to without instruction

Population: healthcare workers

3 questions

Outcome	Effect	Evidence	Status / GRADE
People with one or more errors Procedures: donning and doffing with instructions vs without instruction	RR 0.31 [0.11, 0.93]	1 study · 120 participants	Very low
Mean errors Procedures: donning and doffing with instructions vs without instruction	no estimate extracted	1 study · 120 participants	Very low
Fluorescence contamination Procedures: donning and doffing with instructions vs without instruction	no estimate extracted	1 study · 24 participants	Low

Procedures: doffing with extra sanitation of gloves compared to standard no sanitation

Population: healthcare workers

3 questions

Outcome	Effect	Evidence	Status / GRADE
Bacterial contamination: alcohol‐based hand rub Procedures: doffing with extra sanitation of gloves vs standard no sanitation	RR 0.75 [0.39, 1.45]	1 study · 46 participants	Low
Bacterial contamination: quaternary ammonium Procedures: doffing with extra sanitation of gloves vs standard no sanitation	no estimate extracted	1 study · 20 participants	Very low Downgraded: risk of bias
Bacterial contamination: bleach Procedures: doffing with extra sanitation of gloves vs standard no sanitation	no estimate extracted	2 studies · 20 participants	Very low Downgraded: risk of bias

Procedures: doffing with hypochlorite versus doffing with alcohol‐based glove sanitiser

Population: healthcare workers

2 questions

Outcome	Effect	Evidence	Status / GRADE
Contamination: MS2 Procedures: doffing with hypochlorite vs doffing with alcohol‐based glove sanitiser	RR 4 [0.47, 34.24]	1 study · 15 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Contamination: Ph6 Procedures: doffing with hypochlorite vs doffing with alcohol‐based glove sanitiser	no estimate extracted	1 study · 15 participants	Very low Downgraded: risk of bias, imprecision, indirectness

Teaching: video‐based learning versus traditional lecture

Population: healthcare workers

1 question

Outcome	Effect	Evidence	Status / GRADE
Skills in PPE donning Teaching: video‐based learning vs traditional lecture	no estimate extracted	1 study · 26 participants	Very low Downgraded: risk of bias, imprecision, indirectness