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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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., Case-control study in Odds ratio of staff with specific protection 2003 five Hong Kong not getting infected: • Masks: OR= 13 (95% CI 3 to 60, p = hospitals of 13 SARS-infected staff 0.0001) and 241 non-infected • Gloves: OR = 2 (95% CI 0.6 to 7, p = staff 0.364) • Gowns: OR not calculated • Handwashing: OR = 5 (95% CI 1 to 19, p = 0.047) • Risk of SARS infection in those report- Lau et al., 2004 Case-control study in Hong Kong of 72 ing problems with mask fit: OR = 1.00 hospital workers (95% CI 0.51 to 1.95, p = 1.0000) with SARS and 144 • Risk of SARS infection in those who had matched controls problems with fogging of goggles: OR = 0.61 (95% CI 0.31 to 1.17) Continued 173

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174 PERSONAL PROTECTIVE EQUIPMENT FOR HEALTHCARE PERSONNEL Reference Description Results Loeb et al., Retrospective cohort Risk of acquiring SARS based on use of 2004 study of 43 nurses PPE: • Gown: RR = 0.36 (95% CI 0.10 to 1.24, working with SARS patients in Toronto p = 0.12) critical care units • 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 Case-control study in Adjusted odds ratio (multivariate analysis) al., 2004 Singapore of 36 associated with transmission of SARS: • Wearing of N95 mask: 0.1 (95% CI 0.02 healthcare workers with probable SARS to 0.9, p = 0.04) and 50 healthcare • Wearing of gloves: 1.5 (95% CI 0.3 to workers in the same 7.2, p = 0.6) ward with history of • Wearing of gowns: 0.5 (95% CI 0.4 to exposure 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) • Proportion of infants acquiring RSV: Hall and Comparison of use Douglas, and nonuse of gowns o When masks and gowns were used by 1981 and masks by staff staff: 32% members on a pedia- o When masks and gowns were not tric ward with child- used by staff: 41% ren < 3 years old • Proportion of staff acquiring RSV: o During the time masks and gowns were used by staff: 33% o During the time masks and gowns were not used by staff: 42% • Measurable benefit not found in control- ling spread of RSV • Number of RSV or other respiratory Murphy et al., Prospective study of 1981 use and nonuse of infections did not differ significantly masks and gowns by between the two groups of staff (hand- staff members caring washing only; and handwashing, gown- for infants with res- ing, and masking) piratory disease

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175 APPENDIX C Reference Description Results • Frequency of RSV infection in hospital Gala et al., Comparison of use 1986 and nonuse of eye– personnel: nose goggles by staff o Three weeks during goggle use: 8% members on an infant (p = 0.003) ward o Three weeks with no goggle use: 34% (p = 0.003) • RSV illness rate in healthcare workers Agah et al., Comparison of use 1987 and nonuse of mask or caring for children with RSV infections: goggles by staff mem- o Wore masks or goggles: 5% (p < 0.01 bers caring for child- compared to no masks or goggles cat- ren with RSV egory) infections on a pedia- o Did not wear masks or goggles: 61% tric inpatient service • Combination of cohort nursing with use Madge et al., Prospective study of 1992 four infection control of gowns and gloves significantly re- strategies in prevent- duced RSV infection ing RSV in four • Use of gowns and gloves alone did not pediatric wards result in a significant reduction of infection • Various combinations of requirements Langley et al., Prospective cohort 1997 study comparing for use of gowns, gloves, and masks did isolation policies and not result in decreased nosocomial rates RSV infections in in patients; gowning for any entry to the pediatric patients in patient’s room was associated with in- nine hospitals creased 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. a Comparator is use of no mask. b Consistent 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 syncy- tial virus (RSV) infection rate in personnel caring for children with RSV in- fections. 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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176 PERSONAL PROTECTIVE EQUIPMENT FOR HEALTHCARE PERSONNEL 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 gog- gles 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: Per- sonal protective equipment for healthcare workers. Washington, DC: The Na- tional 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 hospit- als: 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 con- trolled study of four infection-control procedures to prevent nosocomial infec- tion 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 con- tact in prevention of nosocomial transmission of severe acute respiratory syn- drome (SARS). Lancet 361(9368):1519-1520. Teleman, M. D., I. C. Boudville, B. H. Heng, D. Zhu, and Y. S. Leo. 2004. Fac- tors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. Epidemiology and Infection 132(5):797- 803.