Comparative efficacy of respiratory personal protective equipment against viral respiratory infectious diseases in healthcare workers: a network meta-analysis

Abstract

Objective With the epidemic of coronavirus disease 2019 (COVID-19), the healthcare workers (HCWs) require proper respiratory personal protective equipment (rPPE) against viral respiratory infectious diseases (VRIDs). It is necessary to evaluate which type of mask and manner of wearing is the best suitable rPPE for preventing the VRID. Study design A Bayesian network meta-analysis was performed to comprehensively analyze the protective efficacy of various rPPE. Methods This network meta-analysis protocol was registered in an international prospective register of systematic reviews (CRD42020179489). Electronic databases were searched for cluster randomized control trials (RCTs) of comparing the effectiveness of rPPE and wearing manner in preventing HCWs from VRID. The primary outcome was the incidence of laboratory-confirmed viral respiratory infection reported as an odds ratio (OR) with the associated 95% credibility interval (CrI). The secondary outcome was the incidence of clinical respiratory illness (CRI) reported as an OR with the associated 95% CrI. Surface under the cumulative ranking curve analysis (SUCRA) provided a ranking of each rPPE according to the primary outcome and the secondary outcome as data supplement. Results Six studies encompassing 12,265 HCWs were included. In terms of the incidence of laboratory-confirmed viral respiratory infection, the continuous wearing of N95 respirators (network OR, 0.48; 95% CrI: 0.27 to 0.86; SUCRA score, 85.4) showed more effective than the control group. However, in terms of reducing the incidence of CRI, there was no rPPE showing superior protective effectiveness. Conclusions There are significant differences in preventive efficacy among current rPPE. Our result suggests that continuous wearing of N95 respirators on the whole shift can serve as the best preventive rPPE for HCWs from the VRID.

The Well-Being of Healthcare Workers During the COVID-19 Pandemic: A Narrative Review

“…There is a unanimous consensus that the use of N95 decreases the chances of contracting viral respiratory illnesses [15]. Studies suggest that better protection is obtained with coveralls and long gowns, but it made donning and doffing difficult, leading to low user satisfaction and overall greater contamination [16].…”

Respirators in Healthcare: Material, Design, Regulatory, Environmental, and Economic Considerations for Clinical Efficacy

“…However, for the greatest degree of protection from viral respiratory illnesses, it was found that continuous use was necessary. [ 87 ] This is particularly important during respiratory viral seasons and viral pandemics.…”

Rapid review and meta-analysis of the effectiveness of personal protective equipment for healthcare workers during the COVID-19 pandemic

“…This past year, several reviews have been published on the effectiveness of PPE in the clinical setting. Due to a lack of studies on COVID-19, these reviews included studies on different kind of respiratory infectious diseases like influenza [ [9] , [10] , [11] , [12] , [13] ]. However, these infectious diseases differ from COVID-19 with respect to the transmissibility of the virus, viral reproductive number and viral loads in the days of infection as well as in their signs and symptoms [ 14 ].…”