Leung 2004.

Methods	Prospective cohort study conducted during 13 March to 29 June 2003 in the paediatric department of the Prince of Wales Hospital at the height of the SARS epidemic in Hong Kong, China. The aim of the study was to test the effectiveness of procedures to stop transmission of SARS from infected children to carers and visitors
Participants	26 HCWs in close contact with probable or suspected SARS and 88 HCWs in contact with patients in other study areas during the study period
Interventions	Triage and UHR‐S isolation and strict infection control procedures versus triage and UHR‐S isolation and less strict infection control procedures Healthcare workers were exposed to 9 children with probable SARS and 29 with suspected SARS admitted into the Ultra High Risk SARS (UHR‐S) areas with a mean age of 8.9 years, 88 children with pneumonia but no SARS contact with a mean age of 8.2 admitted to the isolation cubicle of the Ultra High Risk Infection (UHR‐I) area, 227 with febrile illness and normal chest radiograph aged 4.9 years treated in an open cubicle in the UHR‐I area and 274 non‐febrile children with a mean age of 7.5 years admitted into the High Risk (HR) area. The study tested the effectiveness of triage and UHR‐S isolation + strict infection control procedures versus triage and UHR‐S isolation + less strict infection control procedures Triage at admission aimed at identifying children aged less than 18 who: ‐ were febrile or afebrile with a known SARS contact who were admitted to the UHR‐S area ‐ with a positive CXR and a SARS contact who were admitted to the UHR‐S area ‐ with CXR changes but no SARS contact who were admitted to the UHR‐I area ‐ were febrile or afebrile but no SARS contact who were admitted to the HR area Very strict infection control measures were implemented on entry and exit from the UHR‐S area (handwashing, gown, caps, goggles, mask, upper and trousers of cloth operating theatre garments and N95 face respirator for HCWs, all measures but no goggles or undergarments for visitors and handwashing and mask for patients) Less strict infection control measures were implemented on entry and exit from the UHR‐I area (handwashing, gown, goggles, mask, upper and trousers of cloth operating theatre garments and N95 face respirator for HCWs, and handwashing and mask for visitors and patients), Even less strict infection control measures were implemented on entry and exit from the HR area (handwashing, gown, caps, goggles, mask, upper and trousers of cloth operating theatre garments and mask of N95 face respirator for HCWs and handwashing and paper mask for visitors and patients) Enforcement was directed by a police nurse in the UHR areas
Outcomes	Laboratory: laboratory confirmation of SARS Effectiveness: probable or suspected SARS according to WHO definitions Safety: N/A
Notes	Risk of bias: low Note: the authors conclude that the measures worked well as no HCW or visitor became ill. This is a remarkably well‐conducted and clearly reported study in the midst of a major infectious disease outbreak with a previously unknown agent. The Prince of Wales Hospital had previously witnessed an outbreak in which an index patient had infected 138 healthcare workers. All the more remarkable as the paediatric department had not been built as isolation facility and had to be rapidly reorganised
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