Use of powered air-purifying respirator(PAPR) as part of protective equipment against SARS-CoV-2-a narrative review and critical appraisal of evidence

Licina, Ana; Silvers, Andrew

doi:10.1016/j.ajic.2020.11.009

Cited by 33 publications

(28 citation statements)

References 83 publications

(119 reference statements)

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“…In cases of failed fit-test, clinical exposure may be limited to reduce exposure to the virus; however, in cases where this could not be achieved, alternative PPE may be offered including hoods and powered air-purifying respirators (PAPR). PAPRs use a high-efficiency particulate air (HEPA) filter which filters 99.97% particles measuring 0.3 μm [ 13 ]. However, a recent study by Chakladar et al identified that bacteria and fungi remain on the internal components of PAPRs despite disinfection following use.…”

Section: Discussionmentioning

confidence: 99%

Fit-testing of respiratory protective equipment in the UK during the initial response to the COVID-19 pandemic

Green

Gani

Bailey

et al. 2021

Journal of Hospital Infection

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Section: Discussionmentioning

confidence: 99%

Fit-testing of respiratory protective equipment in the UK during the initial response to the COVID-19 pandemic

Green

Gani

Bailey

et al. 2021

Journal of Hospital Infection

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“…Among PAPRs and N95 respirators to reduce viral respiratory infection, neither has demonstrated clinical effectiveness over the other in decreasing infection during aerosol generating procedures. 34 , 35 Additionally, there is limited evidence that in the healthcare setting, N95 respirators provide enhanced protection over aerosol viral transmission compared to surgical masks. 36 Like the PAPR recommendations, these are precautionary principles rather than evidence‐based protocols.…”

Section: Discussionmentioning

confidence: 99%

N95 respirator and surgical mask effectiveness against respiratory viral illnesses in the healthcare setting: A systematic review and meta‐analysis

et al. 2021

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Objective To examine the results, level of evidence, and methodologic quality of original studies regarding surgical mask effectiveness in minimizing viral respiratory illness transmission, and, in particular, the performance of the N95 respirator versus surgical mask. Methods Meta‐analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines with use of PubMed, MEDLINE, and the Cochrane Library databases. Results Eight studies (9164 participants) were included after screening 153 articles. Analyses showed statistically significant differences between N95 respirator versus surgical mask use to prevent influenza‐like‐illness (risk ratio [RR] = 0.81, 95% confidence interval [CI] = 0.68–0.94, P < 0.05), non‐influenza respiratory viral infection (RR = 0.62, 95% CI = 0.52–0.74, P < 0.05), respiratory viral infection (RR = 0.73, 95% CI = 0.65–0.82, P < 0.05), severe acute respiratory syndrome coronavirus (SARS‐CoV) 1 and 2 virus infection (RR = 0.17, 95% CI = 0.06–0.49, P < 0.05), and laboratory‐confirmed respiratory viral infection (RR = 0.75, 95% CI = 0.66–0.84, P < 0.05). Analyses did not indicate statistically significant results against laboratory‐confirmed influenza (RR = 0.87, CI = 0.74–1.03, P > 0.05). Conclusions N95 respirator use was associated with fewer viral infectious episodes for healthcare workers compared with surgical masks. The N95 respirator was most effective in reducing the risk of a viral infection in the hospital setting from the SARS‐CoV 1 and 2 viruses compared to the other viruses included in this investigation. Methodologic quality, risk of biases, and small number of original studies indicate the necessity for further research to be performed, especially in front‐line healthcare delivery settings.

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“…Respondents report lack of supply for elastomeric respirators and powered air-purifying respirators (PAPRs). (31,32) Correlation to larger DHBs or those with prior experience with COVID-19 did not appear significant due to low numbers reporting. About one in ten ED consultants (11%) had not been fit tested for N95 masks at the time of this survey.…”

Section: Resultsmentioning

confidence: 94%

New Zealand Emergency Department COVID-19 Preparedness Survey

Howard

Chambers

Mohr

2021

Preprint

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Objective This research sought to assess the level of COVID-19 preparedness of Emergency Departments (EDs) in Aotearoa New Zealand (NZ) through the views of Emergency Medicine specialists working in District Health Boards around the country. Given the limited experience NZ hospitals have had with SARS-CoV-2, a comparison of current local practice with recent literature from other countries identifying known weaknesses may help prevent future healthcare worker infections in NZ. Methods A cross-sectional survey by convenience sample of New Zealand Emergency Specialists in November 2020 to evaluate preparedness of engineering, administrative policy, and PPE use. Results A total of 137 surveys were completed (32% response rate), revealing heterogeneity in NZ ED clinical work environments in November 2020. More than 10% of emergency specialists surveyed reported no access to negative pressure rooms. N95 fit testing was not done on 15 (11%). Most specialists (86%) work in EDs that cohort patients, about one-third (34%) do not use spotters during PPE doffing, few have policy regarding breaches in PPE, and most do not have required space for physical distancing in non-clinical areas. Initial PPE training, simulations and segregating patients were widespread but appear to be waning with persistent low SARS-CoV-2 prevalence. PPE shortages were not identified in NZ EDs, yet 13% of consultants did not indicate they would use respirators during aerosol generating procedures on COVID-19 patients. Treatment interventions including non-invasive ventilation and high flow nasal cannula were common. Many respondents reported high levels of stress attributable to predicted inadequate staffing and the state of overall preparedness in event of a second wave. Conclusions New Zealand emergency specialists identified significant gaps in COVID-19 preparedness, and they have a unique opportunity to translate lessons from other locations into local action. Proactive identification of weaknesses in hospital engineering, policy, and PPE practice in advance of future SARS-CoV-2 endemic transmission would be prudent.

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Use of powered air-purifying respirator(PAPR) as part of protective equipment against SARS-CoV-2-a narrative review and critical appraisal of evidence

Cited by 33 publications

References 83 publications

Fit-testing of respiratory protective equipment in the UK during the initial response to the COVID-19 pandemic

Fit-testing of respiratory protective equipment in the UK during the initial response to the COVID-19 pandemic

N95 respirator and surgical mask effectiveness against respiratory viral illnesses in the healthcare setting: A systematic review and meta‐analysis

New Zealand Emergency Department COVID-19 Preparedness Survey

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