Personal protective equipment for protecting healthcare staff from highly infectious diseases

Citation: Verbeek JH, Rajamaki B, Ijaz S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database of Systematic Reviews 2020; (4): CD011621

What is this? A variety of types of personal protective equipment (PPE) are being used to try to protect healthcare workers from infection with COVID-19.

In this Cochrane systematic review, the authors searched for studies of the effects of different types of PPE, ways to put it on and remove it and how to train workers to comply with guidance on its use. They did not restrict by date, type or language of publication and did their searches in March 2020. They identified 14 randomized, 1 quasi-randomized and 9 non-randomized trials (total: 2278 participants).

What works: The use of a powered, air-purifying respirator may protect better than a N95 mask and gown but was more difficult to put on.

Long gowns may protect better against contamination than coveralls and were easier to take off; and gowns may protect better against contamination than aprons.

PPE made of more breathable material may lead to a similar number of spots on the trunk compared to more water‐repellent material but may have greater user satisfaction.

Other interventions that may reduce contamination include: sealed gown and glove combinations; a better fitting gown around the neck, wrists and hands; a better cover of the gown‐wrist interface; and tabs to grab to facilitate the removal of masks or gloves; using Centers for Disease Control and Prevention (CDC) recommendations for removing PPE; one‐step removal of gloves and gown; double‐gloving compared to single gloving; and spoken instructions and extra sanitation of gloves with quaternary ammonium or bleach when removing PPE.

For training: the use of additional computer simulation, a video lecture on putting PPE on and face‐to‐face instruction may be better than providing folders or videos only.

What doesn’t work: Nothing noted.

What’s uncertain: There is insufficient evidence on the long-term effects of training methods.

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Disclaimer: This summary has been written by staff and volunteers of Evidence Aid in order to make the content of the original document accessible to decision makers who are searching for the available evidence on the coronavirus (COVID-19) but may not have the time, initially, to read the original report in full. This summary is not intended as a substitute for the medical advice of physicians, other health workers, professional associations, guideline developers, or national governments and international agencies. If readers of this summary think that the evidence that is presented within it is relevant to their decision-making they should refer to the content and details of the original article, and the advice and guidelines offered by other sources of expertise, before making decisions. Evidence Aid cannot be held responsible for any decisions made about the coronavirus (COVID-19) on the basis of this summary alone.

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