Buianov 2004.

Methods	Controlled simulation study, not randomised; probably cross‐over study
Participants	N = 9 volunteers that carried out a 4‐hour step test of average workload at a temperature of 20º C and 60% relative humidity, no further details provided.
Interventions	Intervention: Positive pressure suit (special biological suit, СКБ‐I) consisting of a rubber hood connected to a powered air‐purifying respirator and a 'dust‐proof' coverall in one piece with different rates of air supply: initially 250 L/min, then 50, 100, 150, 200, 250, 300 L/min. No information about the filtering piece. PPE was especially developed for highly infectious diseases such as Ebola, Marburg and Lassa fever intended for use by health care staff, such as doctors, nurses and orderlies Comparison: Two different types of positive pressure hoods (ЛИЗ‐4 and ПШБ‐3) together with a coverall type Biotekhnolog ‐1. Procedure: Tests are carried out in a so‐called Meltserovsky room (individual room with quarantine). The pressure suit or hood and coverall is put on before entering and checked whether it functions by attaching the connecting pipe to the air supply system. Then the worker enters the buffer zone (gateway with entrance and exit) and proceeds to the individual measurement room. After the step test in the individual room the worker goes to the buffer zone in order to treat the outside surface of the pressure suit. The worker attaches the suit to the connecting pipe of the air supply system and treats the suit with the help of aerosol disinfectant, usually 3‐6% hydrogen peroxide (2‐3 aerosol generators are situated at different heights). After the aerosol rests are pumped out of the buffer zone the worker leaves through the gateway, takes off the pressure suit and places it in the special container for final disinfection.
Outcomes	Contamination exposure: Participants were exposed to a microbial aerosol with a concentration of 108 colony forming units(cfu)/m3. No further details on the spray aerosol provided. Contamination outcome measured aerosol particles on different parts of the body (neck, shoulder, forearm, chest, loin, thigh, shin) and the suit with “washouts” and triple agar prints. Only data from triple agar prints is presented since the “washouts” resulted in unreliable data (because the textile materials used in the pressure suit were impregnated with hydrophobic materials). Triple agar prints were taken from the outside surface of the pressure suit, inside surface of the pressure suit, clothes and skin areas at different parts of the body (neck, shoulder and forearm, chest, loin, thigh and shin). The outcome was both expressed as cfu/m³ and as penetration rate as a percentage of the outside that has leaked inside the PPE. It was unclear if these outcomes were expressed as an average across the participants and what the variation was. The authors conclude that "despite the significant concentration of microbial aerosol in the experimental room (107‐105 cfu/m3) no microbial aerosol was measured on skin areas with air supply speeds of 250 L/min and higher". Additionally, the authors assessed skin temperature, heart rate, breath rate, and moisture loss
Notes	Article in Russian, data retrieved with help of a native speaker (AP) Article difficult to judge due to cultural differences in style and translation
Risk of bias
Bias	Authors' judgement	Support for judgement
Confounding NRS	High risk	No confounders reported
Selection Bias NRS	Low risk	Selection of volunteers unrelated to intervention or to outcome. Start follow‐up and intervention coincide for all participants.
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	Unclear risk	Unclear if data reported for all nine participants
Selective reporting (reporting bias)	Unclear risk	All data announced in methods reported in results
Other bias	Low risk	No other biases assessed