| Methods |
Controlled before and after study designed to evaluate the efficacy of infection‐control procedures with the use of masks and gowns compared with procedures not using mask and gowns on the rate of nosocomial RSV infection in both infants and staff. The study, conducted at Strong Memorial Hospital in Rochester, NY, USA, in 1979, was begun 12 days after the hospital admission of the first infant infected by RSV, and was continued for the next 2 months. All patients and staff on the ward for children less than 3 years of age were included. During the first 4 weeks (period 1) of the study the infection‐control procedures for infants with respiratory illness included handwashing and the use of mask and gowns by the staff on entering the room, with a change of gowns between contacts with each infant. After 4 weeks the wearing of gowns and masks was discontinued and handwashing alone was used for the final 5 weeks of the study. Throughout the study handwashing, cohorting and isolation were employed and emphasised. The number of nosocomial infections in patients and staff for period 1 were compared with the period 2 (last 4 weeks of the study). Infections that occurred in the interval week were not counted |
| Participants |
162 patients suspected with RSV infections from infected infants; 78 admitted in the period 1 and 84 in period 2. The age range was 2 weeks to 3 years. 55% were male. Of 78 (period 1), 24 were admitted for RSV infections and the remaining 24 became the contacts. (Due to lack of comparability of children and an unclear text children data were not extracted)
39 ward personnel were included, 30 in the period 1 and 27 of these were also studied during period 2 along with 9 other personnel. Thus a total of 36 staff members were studied during period 2 |
| Interventions |
Use of gowns and masks and standard infection‐control procedures (handwashing, cohorting, isolation) versus standard infection‐control procedures only to prevent transmission of RSV infections from infected infants |
| Outcomes |
Laboratory: serological evidence
Effectiveness: RSV infection demonstrated by symptoms, viral isolation and serology
Safety: n/a |
| Notes |
Risk of bias: high
Notes: the authors concluded that the use of masks and gowns as additional infection‐control procedures for RSV infection shows no appreciable benefit in preventing nosocomial spread of RSV to infants or to the ward personnel. The nosocomial infection rate in the 2 periods was not significantly different in either the infants or staff (32% infection versus 41%). Both of the study periods appeared to be equal in terms of potential for transmission or exposure to RSV. The number of infants admitted during both periods was similar. Furthermore these 2 groups of contacts were alike in age and types of underlying diseases. The routine use of masks and gowns does not seem warranted in view of the considerable cost. A very poorly reported study with an unclear eligibility procedure and a lack of description of denominators. Why not use randomisation? |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
Unclear risk |
N/A |
| Allocation concealment (selection bias) |
Unclear risk |
N/A |
| Blinding (performance bias and detection bias)
All outcomes |
Unclear risk |
N/A |
| Incomplete outcome data (attrition bias)
All outcomes |
Unclear risk |
N/A |
| Selective reporting (reporting bias) |
Unclear risk |
N/A |
