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Review
. 2015 Oct 9;10(10):e0140290.
doi: 10.1371/journal.pone.0140290. eCollection 2015.

Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review

Mona Hersi  1 , Adrienne Stevens  2 , Pauline Quach  1 , Candyce Hamel  1 , Kednapa Thavorn  3 , Chantelle Garritty  2 , Becky Skidmore  4 , Constanza Vallenas  5 , Susan L Norris  5 , Matthias Egger  6 , Sergey Eremin  5 , Mauricio Ferri  7 , Nahoko Shindo  5 , David Moher  3
Affiliations
Review

Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review

Mona Hersi et al. PLoS One. .

Abstract

Background: A rapid review, guided by a protocol, was conducted to inform development of the World Health Organization's guideline on personal protective equipment in the context of the ongoing (2013-present) Western African filovirus disease outbreak, with a focus on health care workers directly caring for patients with Ebola or Marburg virus diseases.

Methods: Electronic databases and grey literature sources were searched. Eligibility criteria initially included comparative studies on Ebola and Marburg virus diseases reported in English or French, but criteria were expanded to studies on other viral hemorrhagic fevers and non-comparative designs due to the paucity of studies. After title and abstract screening (two people to exclude), full-text reports of potentially relevant articles were assessed in duplicate. Fifty-seven percent of extraction information was verified. The Grading of Recommendations Assessment, Development and Evaluation framework was used to inform the quality of evidence assessments.

Results: Thirty non-comparative studies (8 related to Ebola virus disease) were located, and 27 provided data on viral transmission. Reporting of personal protective equipment components and infection prevention and control protocols was generally poor.

Conclusions: Insufficient evidence exists to draw conclusions regarding the comparative effectiveness of various types of personal protective equipment. Additional research is urgently needed to determine optimal PPE for health care workers caring for patients with filovirus.

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Conflict of interest statement

Competing Interests: The authors have the following interests: MF reports other financial support from World Health Organization – GOARN (Global Outbreak Alert and Response Network) and personal fees from World Health Organization outside the submitted work. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials as detailed online in the guide for authors.

Figures

Fig 1
Fig 1. Comparisons of personal protective equipment to prevent transmission of ebolavirus to health care workers.
Fig 2
Fig 2. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of the study selection process.
Fig 3
Fig 3. Non-comparative studies of healthcare workers wearing gloves, masks, gowns, and glasses/goggles.
Abbreviations: ELISA = enzyme-linked immunosorbent assay; HCW = healthcare worker; IgG = immunoglobulin G; IgM = immunoglobulin M; NA = not applicable; NR = not reported; PPE = personal protective equipment.
Fig 4
Fig 4. Virus transmission in non-comparative studies of healthcare workers wearing personal protective equipment.
Abbreviations: CI = confidence interval; n = number of events; N = number of HCWs at risk for whom we knew the PPE worn; NR = not reported; WHO = World Health Organization. aMost studies did not provide data on all healthcare workers; only workers with available data were included. bCase reports: One report on filovirus (Martini 1969) and one on Crimean-Congo hemorrhagic fever (Naderi 2011) were identified. cOne case report on Crimean-Congo hemorrhagic fever (Tutuncu 2009) was identified. dOne case report on Crimean-Congo hemorrhagic fever (Naderi 2011) was identified. ePPE protocol was altered during process of care; unclear whether events occurred before or after the enhanced PPE protocol was implemented.
Fig 5
Fig 5. Needle stick injury in non-comparative studies of healthcare workers wearing personal protective equipment.
Abbreviations: CI = confidence interval; n = number of events; N = number of HCWs at risk for whom we knew the PPE worn. aMost studies did not provide data on all healthcare workers; only workers with available data were included. bOne case report on filovirus (Martini 1969) was also identified. cOne case report on Crimean-Congo hemorrhagic fever (Tutuncu 2009) was also identified.
Fig 6
Fig 6. Other adverse events in non-comparative studies of healthcare workers wearing personal protective equipment.
Abbreviations: CI = confidence interval; n = number of events; N = number of HCWs at risk for whom we knew the PPE worn; NR = not reported; WHO = World Health Organization. aMost studies did not provide data on all healthcare workers; only workers with available data were included.
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