Rapid Review on the Use of Personal Protective Equipment in the Wards, Intensive Care Unit and Emergency Room in the Prevention of COVID-19 Infection

Abstract

Objective. We investigated the effect of personal protective equipment (PPE) on prevention of COVID-19 on health care workers (HCW) assigned in the wards, intensive care (ICU) and emergency room (ER).

Methods. We searched MEDLINE, Cochrane CENTRAL as of 30 April 2021, as well as trial registers, preprint sites and COVID-19 living evidence sites. We included studies that compared use of PPE versus no use in the prevention of COVID-19. We screened studies, extracted data, assessed risk of bias and certainty of evidence using GRADE approach.

Results. Five observational studies (three cohort and two case control) were found. There was moderate certainty of evidence that the use of Level 2 PPE (OR 0.03 [95% CI 0, 0.19]; 1 study, n = 5542) was protective for HCW. Level 2 PPE used N95 or higher standard respirators, goggles/protective mask, medical protective clothing and disposable hats, gloves and shoe covers. We also confirmed with moderate certainty evidence the protective use of N95 respirators (OR 0.035 [95% CI 0.002, 0.603]; 1 study, n = 493). There was very low certainty of evidence that demonstrated the protective effect of face shield (OR 0.338 [95% CI 0.272, 0.420]; 2 studies, n = 6717, I2 = 45% P < 0.00001). Very low certainty of evidence showed no significance difference with use of face/surgical mask (OR 1.40 [95% CI 0.30, 6.42]; 1 study, n = 186), gowns (OR 0.768 [95% 0.314, 1.876]; 1 study, n = 179) and disposable gloves (OR 0.62 [95% CI 0.13, 2.90]; 1 study, n = 179) when attending to patients with COVID-19.

Conclusion. There was lower odds of COVID-19 infection in HCW assigned to the wards, ICU and ER with possible direct contact with COVID-19 patients who wear Level 2 PPE including N95 respirators and face shields.