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. 2019 Jul 1;2019(7):CD011621. doi: 10.1002/14651858.CD011621.pub3

Strauch 2016.

Methods Simulation study, randomised controlled cross‐over trial
How was the simulation performed?
Two different simulations of contamination of the Filtering Facepiece Respirator (FFR) were performed: one in which the FFR was contaminated but not the hands and another one in which the hands were contaminated but not the FFR 1. Contamination of the FFR and clean hands: 20 subjects performed 3 trials of FFR with removal tabs (tab+) and tab‐ masks each in random order 2. Clean FFR and Contamination of hands: 20 subjects performed one tab+ trial and one tab‐ trial
How was the exposure simulated?
To contaminate the FFR, 7 mL of fluorescent tracer was brushed onto the entire outer surface of the test FFRs. As only the outer surface of the FFR was contaminated with the fluorescent tracer, transfer from the FFR to the hands would only occur if the FFR was doffed improperly by grasping the contaminated surface. 2. For the hand contamination test, 1 mL of fluorescent tracer was applied and rubbed into the hands of the test subject before removal of a clean FFR with or without tabs.The fluorescent tracer was prepared by suspending 1 g of GloGerm (GloGerm Company;Moab,UT) powder suspended in 25 mL of mineral oil.
Participants N = 20 aged 18‐60 HCW
 Volunteers employed as HCW, that were enrolled in a respiratory protection program and experienced in wearing filtering face‐piece respirators (FFRs) were preferred, but a potential subject was not excluded if all of the qualities were not met.
Volunteers were excluded if they had a history of skin cancer, sensitivity to Ultra Violet (UV) light, or burns from a black light
 Country: USA
Interventions Intervention: Mask with tabs; N‐95 mask with four red foam tabs attached to straps to assist in mask removal.
Control: Mask with out tabs
Outcomes Contamination of the hands resulting from exposure to a contaminated mask.
Contamination of the head resulting from exposure to contaminated hands: The subject’s head, face and hair were photographed under UVA light for contamination with fluorescent tracer.
Notes Location:USA; Funding source and conflict of interest were not published; reported on Lumens as a measure of contaminate but the written results did not match those presented in figure.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk "each subject doffed one randomly assigned FFR" Unclear how randomisation was performed
Allocation concealment (selection bias) Unclear risk Unclear if allocation was irrevocable
Blinding of participants and personnel (performance bias) 
 All outcomes Low risk not reported but unlikely to have influenced the outcome that was assessed by observers
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk not reported
Incomplete outcome data (attrition bias) 
 All outcomes Unclear risk Unclear if there were missing data
Selective reporting (reporting bias) Unclear risk no protocol available
Other bias Low risk No other biases detected