Use of powered air-purifying respirator (PAPR) by healthcare workers for preventing highly infectious viral diseases—a systematic review of evidence

Abstract

Background Healthcare workers (HCWs) are at particular risk during pandemics and epidemics of highly virulent diseases with significant morbidity and case fatality rate. These diseases include severe acute respiratory syndrome coronaviruses, SARS-CoV-1 and SARS-CoV-2, Middle Eastern Respiratory Syndrome (MERS), and Ebola. With the current (SARS-CoV-2) global pandemic, it is critical to delineate appropriate contextual respiratory protection for HCWs. The aim of this systematic review was to evaluate the effect of powered air-purifying respirators (PAPRs) as part of respiratory protection versus another device (egN95/FFP2) on HCW infection rates and contamination. Methods Our primary outcomes included HCW infection rates with SARS-CoV-2, SARS-CoV-1, Ebola, or MERS when utilizing PAPR. We included randomized controlled trials, non-randomized controlled trials, and observational studies. We searched the following databases: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers independently screened all citations, full-text articles, and abstracted data. Due to clinical and methodological heterogeneity, we did not conduct a meta-analysis. Where applicable, we constructed evidence profile (EP) tables for each individual outcome. Confidence in cumulative evidence for each outcome was classified according to the GRADE system. Results We identified 689 studies during literature searches. We included 10 full-text studies. A narrative synthesis was provided. Two on-field studies reported no difference in the rates of healthcare workers performing airway procedures during the care of critical patients with SARS-CoV-2. A single simulation trial reported a lower level of cross-contamination of participants using PAPR compared to alternative respiratory protection. There is moderate quality evidence that PAPR use is associated with greater heat tolerance but lower scores for mobility and communication ability. We identified a trend towards greater self-reported wearer comfort with PAPR technology in low-quality observational simulation studies. Conclusion Field observational studies do not indicate a difference in healthcare worker infection utilizing PAPR devices versus other compliant respiratory equipment. Greater heat tolerance accompanied by lower scores of mobility and audibility in PAPR was identified. Further pragmatic studies are needed in order to delineate actual effectiveness and provider satisfaction with PAPR technology. Systematic review registration The protocol for this review was prospectively registered with the International Register of Systematic Reviews identification number CRD42020184724 .

Microbial contamination of powered air purifying respirators (PAPR) used by healthcare staff during the COVID-19 pandemic: an in situ microbiological study

“…PAPRs are an important component in the range of respiratory PPE available to healthcare staff in pandemics. 2 , 3 , 33 , 34 It is our opinion that, given the constraints outlined by both the manufacturer and the distributor, the hoods tested cannot be adequately disinfected for use in high risk healthcare environments and the systems may support fomite transmission; in the short-term this may be overcome by issuing HCWs with personal PAPR hoods and air supply hoses.…”

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

“…We used the revised AMSTAR-2 tool to assess the risk of bias in systematic reviews [ 42 ]. We used the GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) system to classify the evidence into one of four categories: high, moderate, low, and very low [ 43 , 44 ]. Evidence based on randomized controlled trials was considered as high quality unless confidence in the evidence was decreased due to study limitations, inconsistency of results, indirectness of evidence, imprecision, and reporting biases.…”

“…Evidence based on randomized controlled trials was considered as high quality unless confidence in the evidence was decreased due to study limitations, inconsistency of results, indirectness of evidence, imprecision, and reporting biases. Observational studies were considered low quality; however, they were graded higher if the treatment effect observed is very large or if there is evidence of a dose-response relationship [ 33 , 44 , 45 ].…”

Das erste Jahr der Pandemie mit SARS-CoV-2 – Auswirkungen auf die Hals-Nasen-Ohren-Heilkunde

“…Es fehlt allerdings bis heute Evidenz, dass diese Geräte auch zu einem erhöhten Schutz gegenüber SARS-CoV‑2 im Vergleich zu FFP3-Masken beitragen. Es wird deswegen weder für klinische Routinemaßnahmen noch für Hoch-Risiko-Prozeduren empfohlen, PAPR anstatt FFP3-Masken zu verwenden [ 2 , 26 ]. Auf der anderen Seite scheinen PAPR einen höheren Tragkomfort zu besitzen [ 25 ], und sie bieten sich bei stark Aerosol generierenden Eingriffen oder längerem Kontakt zu COVID-19-Patienten (z.…”