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Preventing Transmission of Pandemic Influenza and other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel - Update 2010 C Studies of the Clinical Effectiveness of Personal Protective Equipment During Outbreaks of Severe Acute Respiratory Syndrome and Respiratory Syncytial Virus TABLE C-1 Studies of the Clinical Effectiveness of Personal Protective Equipment During Outbreaks of Severe Acute Respiratory Syndrome and Respiratory Syncytial Virus Reference Description Results Severe Acute Respiratory Syndrome (SARS) Seto et al., 2003 Case-control study in five Hong Kong hospitals of 13 SARS-infected staff and 241 non-infected staff Odds ratio of staff with specific protection not getting infected: Masks: OR= 13 (95% CI 3 to 60, p = 0.0001) Gloves: OR = 2 (95% CI 0.6 to 7, p = 0.364) Gowns: OR not calculated Handwashing: OR = 5 (95% CI 1 to 19, p = 0.047) Lau et al., 2004 Case-control study in Hong Kong of 72 hospital workers with SARS and 144 matched controls Risk of SARS infection in those reporting problems with mask fit: OR = 1.00 (95% CI 0.51 to 1.95, p = 1.0000) Risk of SARS infection in those who had problems with fogging of goggles: OR = 0.61 (95% CI 0.31 to 1.17)
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Preventing Transmission of Pandemic Influenza and other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel - Update 2010 Reference Description Results Loeb et al., 2004 Retrospective cohort study of 43 nurses working with SARS patients in Toronto critical care units Risk of acquiring SARS based on use of PPE: Gown: RR = 0.36 (95% CI 0.10 to 1.24, p = 0.12) Gloves: RR = 0.45 (95% CI 0.14 to 1.46, p = 0.22) N95 (respirator at least once) or surgical mask: RR = 0.23 (95% CI 0.07 to 0.78, p = .02) N95: RR = 0.22 (95% CI 0.05 to 0.93, p = 0.06) Surgical mask:a RR = 0.45 (95% CI 0.07 to 2.71, p = 0.56) N95 vs. surgical mask:b RR = 0.50 (95% CI 0.06 to 4.23, p = 0.51) Teleman et al., 2004 Case-control study in Singapore of 36 healthcare workers with probable SARS and 50 healthcare workers in the same ward with history of exposure Adjusted odds ratio (multivariate analysis) associated with transmission of SARS: Wearing of N95 mask: 0.1 (95% CI 0.02 to 0.9, p = 0.04) Wearing of gloves: 1.5 (95% CI 0.3 to 7.2, p = 0.6) Wearing of gowns: 0.5 (95% CI 0.4 to 6.9, p = 0.6) Handwashing after each patient: 0.07 (95% CI 0.008 to 0.7, p = 0.02) Respiratory Syncytial Virus (RSV) Hall and Douglas, 1981 Comparison of use and nonuse of gowns and masks by staff members on a pediatric ward with children < 3 years old Proportion of infants acquiring RSV: When masks and gowns were used by staff: 32% When masks and gowns were not used by staff: 41% Proportion of staff acquiring RSV: During the time masks and gowns were used by staff: 33% During the time masks and gowns were not used by staff: 42% Measurable benefit not found in controlling spread of RSV Murphy et al., 1981 Prospective study of use and nonuse of masks and gowns by staff members caring for infants with respiratory disease Number of RSV or other respiratory infections did not differ significantly between the two groups of staff (handwashing only; and handwashing, gowning, and masking)
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Preventing Transmission of Pandemic Influenza and other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel - Update 2010 Reference Description Results Gala et al., 1986 Comparison of use and nonuse of eye– nose goggles by staff members on an infant ward Frequency of RSV infection in hospital personnel: Three weeks during goggle use: 8% (p = 0.003) Three weeks with no goggle use: 34% (p = 0.003) Agah et al., 1987 Comparison of use and nonuse of mask or goggles by staff members caring for children with RSV infections on a pediatric inpatient service RSV illness rate in healthcare workers caring for children with RSV infections: Wore masks or goggles: 5% (p < 0.01 compared to no masks or goggles category) Did not wear masks or goggles: 61% Madge et al., 1992 Prospective study of four infection control strategies in preventing RSV in four pediatric wards Combination of cohort nursing with use of gowns and gloves significantly reduced RSV infection Use of gowns and gloves alone did not result in a significant reduction of infection Langley et al., 1997 Prospective cohort study comparing isolation policies and RSV infections in pediatric patients in nine hospitals Various combinations of requirements for use of gowns, gloves, and masks did not result in decreased nosocomial rates in patients; gowning for any entry to the patient’s room was associated with increased risk of RSV transmission NOTE: CI = confidence interval; OR = odds ratio; RR = relative risk. The terms (masks, surgical masks, and respirators) used in this table are those used by the investigators or authors of the cited journal article or report. In some cases, it is not possible to determine whether the authors’ use of the term masks refers to medical masks, respirators, or both. aComparator is use of no mask. bConsistent use of N95 versus consistent use of surgical mask. SOURCE: IOM (2008). REFERENCES Agah, R., J. D. Cherry, A. J. Garakian, and M. Chapin. 1987. Respiratory syncytial virus (RSV) infection rate in personnel caring for children with RSV infections. Routine isolation procedure vs routine procedure supplemented by use of masks and goggles. American Journal of Diseases of Children 141(6):695-697.
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Preventing Transmission of Pandemic Influenza and other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel - Update 2010 Gala, C. L., C. B. Hall, K. C. Schnabel, P. H. Pincus, P. Blossom, S. W. Hildreth, R. F. Betts, and R. G. Douglas, Jr. 1986. The use of eye-nose goggles to control nosocomial respiratory syncytial virus infection. Journal of the American Medical Association 256(19):2706-2708. Hall, C. B., and R. G. Douglas, Jr. 1981. Nosocomial respiratory syncytial viral infections. Should gowns and masks be used? American Journal of Diseases of Children 135(6):512-515. IOM (Institute of Medicine). 2008. Preparing for an influenza pandemic: Personal protective equipment for healthcare workers. Washington, DC: The National Academies Press. Langley, J. M., J. C. LeBlanc, E. E. Wang, B. J. Law, N. E. MacDonald, I. Mitchell, D. Stephens, J. McDonald, F. D. Boucher, and S. Dobson. 1997. Nosocomial respiratory syncytial virus infection in Canadian pediatric hospitals: A Pediatric Investigators Collaborative Network on Infections in Canada Study. Pediatrics 100(6):943-946. Lau, J. T., K. S. Fung, T. W. Wong, J. H. Kim, E. Wong, S. Chung, D. Ho, L. Y. Chan, S. F. Lui, and A. Cheng. 2004. SARS transmission among hospital workers in Hong Kong. Emerging Infectious Diseases 10(2):280-286. Loeb, M., A. McGeer, B. Henry, M. Ofner, D. Rose, T. Hlywka, J. Levie, J. McQueen, S. Smith, L. Moss, A. Smith, K. Green, and S. D. Walter. 2004. SARS among critical care nurses, Toronto. Emerging Infectious Diseases 10(2):251-255. Madge, P., J. Y. Paton, J. H. McColl, and P. L. Mackie. 1992. Prospective controlled study of four infection-control procedures to prevent nosocomial infection with respiratory syncytial virus. Lancet 340(8827):1079-1083. Murphy, D., J. K. Todd, R. K. Chao, I. Orr, and K. McIntosh. 1981. The use of gowns and masks to control respiratory illness in pediatric hospital personnel. Journal of Pediatrics 99(5):746-750. Seto, W. H., D. Tsang, R. W. Yung, T. Y. Ching, T. K. Ng, M. Ho, L. M. Ho, and J. S. Peiris. 2003. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 361(9368):1519-1520. Teleman, M. D., I. C. Boudville, B. H. Heng, D. Zhu, and Y. S. Leo. 2004. Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. Epidemiology and Infection 132(5):797-803.