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.

Keywords: Healthcare workers; N95 respirator; Network meta-analysis; Surgical mask; Viral respiratory infectious diseases.

Fig. 1

PRISMA process. PRISMA, preferred reporting items for systematic reviews and meta-analyses.

Fig. 2

Risk of bias summary. IORV, without control arm.

Fig. 3

Network meta-analysis for laboratory-confirmed viral respiratory infection. (A) The network plot shows a comparison of the incidence of the laboratory-confirmed viral respiratory infection between nodes (blue circles). Each node represents a unique rPPE and wearing manner or control; the size of each node represents the included HCWs for the intervention. The width of each line represents the number of direct comparisons between interventions. The connecting line noted the number of trial-level comparisons between the two nodes. (B) The forest plot of the network meta-analysis comparing the VRID of each rPPE group against the control group. (C) Schematic detailing the most efficacious rPPE class in terms of reducing laboratory-confirmed viral respiratory infection according to the surface under the cumulative ranking curve analysis (SUCRA). HCWs, healthcare workers; OR, odds ratio; CrI, credibility interval; rPPE, respiratory personal protective equipment; VRID, viral respiratory infectious disease. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

Network meta-analysis for clinical respiratory illness. (A) Network plot showing comparisons of the incidence of clinical respiratory illness between nodes (blue circles), each representing a unique rPPE and wearing manner or control; the size of each node represents the included HCWs for the intervention. The width of each line represents the number of direct comparisons between interventions. The connecting line noted the number of trial-level comparisons between the two nodes. (B) Forest plot of the network meta-analysis comparing the CRI of each rPPE group against the control group. (C) Schematic detailing the most efficacious rPPE classes in terms of reducing CRI according to the surface under the cumulative ranking curve analysis (SUCRA). HCWs, healthcare workers; OR, odds ratio; CrI, credibility interval; rPPE, respiratory personal protective equipment; CRI, clinical respiratory illness. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)