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 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 toward 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 were identified . Further pragmatic studies are needed in order to delineate actual effectiveness and provider satisfaction with PAPR technology. Please note: Protocol for this review was prospectively registered with the International Register of Systematic Reviews identification number CRD42020184724.

Personal protective equipment for reducing the risk of COVID-19 infection among healthcare workers involved in emergency trauma surgery during the pandemic: an umbrella review

“…66,67 This left 19 studies for appraisal, extraction, and synthesis. 4,[68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83] . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

“…Overall, the quality of the 19 included studies was assessed as moderate to high by JBI appraisal standards, and no disagreements occurred between the reviewers. Of the 17 included systematic reviews, nine fulfilled all 11 indicators of the critical appraisal tool, 69,70,72,[75][76][77]79,81,82 one fulfilled ten indicators, 68 choosing not to perform risk of bias assessment given the rapid publication of the review; four fulfilled nine indicators, 4,80,83,84 failing to report a risk of bias assessment and choosing not to combine studies for meta-analysis owing to study limitations and heterogeneity in study designs, comparisons, and analyses. Two fulfilled six indicators, 71,78 having no method of study appraisal, no method of minimising errors in data extraction, failing to report a risk of bias assessment, and choosing not to combine studies for meta-analysis owing to study limitations and heterogeneity in study designs, comparisons, and analyses; and one fulfilled four indicators, 73 for not reporting the indicators aforementioned in the previous studies in addition to a lack of future directives and recommendations for policy and clinical practice.…”

“…The 17 included studies were systematic reviews, 4,[68][69][70][71][72][73]75,76,[79][80][81][82][83][84] . Appendix II provides details of the characteristics of the included studies.…”

“…Ten of 17 systematic reviews evaluated the risk of contagion for respiratory viral infections, 4,35,[69][70][71][72]77,82 which six included outcome data for COVID-19 infection. 4,69,72,75,77,78,82 Four systematic reviews, 70,75,79,81 evaluate other respiratory pathogens such as seasonal influenza, SARS, H1N1, and MERS. A rapid systematic review that also addressed the effect of masks to prevent COVID-19 infection considered evidence from the current pandemic in addition to the SARS and MERS epidemics.…”

“…75 Among the included studies, one reported on the use of Powered Air Purifier Respirators (PAPR). 69 Based on observational studies, the authors report they did not found a difference in risk of contagion in HCWs when comparing PAPR devices with other, more compliant protective elements (N95, FFP2). They found that PAPR users reported higher heat tolerance but limited mobility and reduced audibility.…”