Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review

  1. Christopher Burton
  2. Briana Coles
  3. Anil Adisesh
  4. Simon Smith
  5. Elaine Toomey
  6. Xin Hui S Chan
  7. Lawrence Ross
  8. Trisha Greenhalgh

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Abstract

To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types.

Design

Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare.

Data sources

Websites of international standards organisations, Medline and Embase, hand-searching of references and citations.

Study selection

Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use.

Results

We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators.

Conclusion

A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.

Article activity feed

  1. Version published to 10.1136/oemed-2020-107058
  2. ScreenIT

    SciScore for 10.1101/2020.05.21.20108233: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Review type: This rapid review was informed by the Cochrane Rapid Reviews Interim Guidance produced to guide the rapid generation of evidence syntheses in the Covid-19 pandemic.
    Cochrane Rapid Reviews
    suggested: None

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and weaknesses of the study: Strengths of the study was the highly interdisciplinary nature of the team, comprising individuals with expertise in Occupational Medicine (AA), infectious diseases and infection control (X-H C, LR), respirator design and performance (SS) and evidence synthesis (CB, BC, ET and TG); and adherence to Cochrane Rapid Review interim guidance.7 This study was a rapid review with a search of two databases, supplemented with hand-searching of references and citations from a sample of high-quality papers12,21,43,51 and the personal reference libraries of two of the authors with expertise in the topic (AA and SS). In light of the heterogeneity of studies and reported findings and the need to produce a timely review, we did not carry out a formal analysis of risk of bias. In the context of Covid-19 and related research activity, we recognise that new research is emerging daily and so some of the findings of this review may quickly be superseded. Meaning of the study: implications for clinicians and policymakers: Clinicians, particularly those who do not regularly use respiratory protective equipment outside of crises such as Covid-19, need to be aware of the importance of fitting and fit-testing. While the public discourse has mostly centred on the availability of protective equipment, our findings show that professionals’ use of respirators is frequently inadequate. Implementing respirator use requires a system-wide approach which includes availab...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.05.21.20108233v1 on medRxiv