Casanova 2012.
| Methods | Controlled simulation study, non‐randomised, first intervention then control condition for all participants | |
| Participants | N = 18 volunteer healthcare providers over 18 years of age; Exclusion criteria:pregnant, latex allergy, skin disorder, previous fit‐testing for N95 respirator; 17/18 right handed, 18/18 previous experience with PPE Location: USA |
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| Interventions |
Intervention: Two pairs of latex gloves; inner glove under the cuff of the gown sleeve, the outer glove, one size larger worn over the gown cuff; in addition, full PPE consisted of contact isolation gown, N95 respirator and eye protection Control: One pair of latex gloves in addition to similar full PPE as in intervention group Doffing was performed according to CDC instructions: gloves, goggles, gown, mask or respirator in case of single gloves; in case of double gloves, outer pair of gloves first and inner pair last |
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| Outcomes | 1. Contamination of the hands, face, gloves and scrubs with bacteriophage MS2 virus;hands sampled with "glove juice method", face with a swab at the edge of the N95 respirator, shirt pants and gloves were immersed in beef extract. All eluants were assayed by 'most probable number enrichment infectivity assay' (MPN). Detection level 0.15 log 10 MPN; Used paired t‐test for the analysis of continuous data to take the cross‐over into account 2. Noncompliance with doffing guidelines. Contamination with bacteriophage MS2 was put on front shoulder of the gown, right side of respirator, right front of eye protection and palm of dominant hand by simulated droplet contamination; before doffing participants had to perform neck and wrist pulses on manikin. |
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| Notes | No funding or conflict of interest reported | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Confounding NRS | Low risk | No apparent confounders for this type of study and outcome |
| Selection Bias NRS | Low risk | No apparent selection of participants into the study |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | no blinding, but performance bias not likely because participants would not have an interest with either intervention |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Unclear risk | Some data only in figures and not in tables |
| Other bias | Low risk | no other biases anticipated |