Bell 2015

Methods	Randomized two parallel groups; simulation study
Participants	N = 8, nurses (6), physicians 2; women 7/8 Intervention: 4 Control: 4 Volunteer healthcare providers, no further details provided Location: USA
Interventions	Intervention: Commercially available PPE: neck-to-ankle coverall (type not reported), water impermeable surgical gown, knee length impermeable leggings, Stryker hood, double gloves with outer arm-length surgical gloves, N95 masks; meeting CDC recommendations; each participant was assisted in PPE donning by an experienced trainer. Control: Local readily available attire: two plastic gowns worn over the front and the back of the torso, rain-suit pants and hood, spark-shield as face-cover, ankle length shoe covers, double gloves with outer arm-length surgical gloves, N95 masks; meeting CDC recommendations; each participant was assisted in PPE donning by an experienced trainer.
Outcomes	Contamination: measured in ml of fluorescent agent with LED black light after doffing. Random order of two types of exposure: high volume or standard. High volume meant 100 ml of fluorescent agent splashed on the torso. Standard meant working on a manikin contaminated with fluorescent agent. Fluorescent liquid mimicked body fluids and consisted of fluorescent powder, clothes detergent, fluorescent tablets
Notes	No funding or conflict of interest reported Apparently tape was used to put attire together; this resulted in more difficult doffing but no figures reported; costs of locally available equipment was 36 US dollars, that of commercial material not reported
Risk of bias
Bias	Authors’ judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	“randomized to one of two PPE ensembles”
Allocation concealment (selection bias)	Unclear risk	not reported
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	not reported
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	not reported
Incomplete outcome data (attrition bias) All outcomes	Low risk	no incomplete outcome data
Selective reporting (reporting bias)	High risk	Contamination outcomes reported but no separate outcomes for high or normal exposure, however small sample and no statistical analysis by study authors
Other bias	Low risk	No indication