Personal protective equipment for protecting healthcare staff from highly infectious diseases

Citation: Verbeek JH, Rajamaki B, Ijaz S, Tikka C, Ruotsalainen JH, Edmond MB, Sauni R, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database of Systematic Reviews 2019; (7): CD011621.

What is this? The arrival of a new respiratory virus, such as COVID-19, is followed by a lead-time for the development of vaccines and treatments, and these may have a limited effect in containing or interrupting spread of the virus. Therefore, physical interventions to prevent the infection of healthcare staff are particularly important.

In this Cochrane systematic review, the authors searched for studies of the effects of different types of full body personal protective equipment (PPE), ways to remove it after use 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 June 2019. They identified 10 randomized, 1 quasi-randomized and 6 non-randomized trials (total: 1950 participants).

What works: Gowns may protect better against contamination than aprons. Removal of gowns with attached gloves led to less contamination than when gown and gloves were removed separately. Adding tabs to grab masks or gloves and a better fitting gown around the neck, wrists and hands may reduce contamination. The use of a powered air-purifying respirator may protect better than simpler PPE without a respirator.

What doesn’t work: Alcohol-based hand rub used during the doffing process may not reduce contamination any better than the use of a hypochlorite-based solution.

What’s uncertain: There were too few studies to determine the effects of goggles, face shields and  non-breathable PPE clothing on contamination. There is uncertainty about the best way to remove protective clothing after use or on training staff in the use of PPE over the long-term, but spoken instructions when PPE is being removed and face-to-face training (rather than video or folder-based training) might lead to less contamination.


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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