Table 2. Details of review design, characteristics of interventions, comparisons, participants, main results and certainty of evidence, assessed by means of GRADE.
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Interventions | Comparisons | Participants | Main Results | GRADE |
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Different types and quarantine locations for individuals. They included studies combining isolation and quarantine. |
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• Quarantine of people exposed to confirmed or suspected cases prevented 44% to 81% of incident cases and 31% to 63% of deaths, compared with no measures (incident cases: four modelling studies on COVID-19 and SARS; mortality: two modelling studies on COVID-19 and SARS). | • Low certainty |
• The earlier the quarantine measures are implemented, the greater the cost savings (two modelling studies on SARS). | • Low certainty | ||||
• The effect of quarantining travelers from a country with a reported outbreak was small with regard to reducing the incidence of illness and deaths (two modelling studies on SARS). | • Low certainty | ||||
• When the models combined quarantine with other prevention and control measures, including school closures, travel restrictions and social distancing, modelling studies demonstrated a greater effect with regard to reducing new cases, transmissions and deaths than individual measures alone (incident cases: four modelling studies on COVID-19; subsequent transmission: two modelling studies on COVID-19; mortality: two modelling studies on COVID-19). | • Low certainty | ||||
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Control group is not evident from the nature of the review. | Most of the studies included involved nurses (14 studies) or doctors (9 studies). Other types of healthcare professionals included in the studies were occupational therapists, respiratory therapists and physical therapists; auxiliary personnel responsible for patient care, such as porters and domestic workers; laboratory technicians; infection control professionals; and managers. | • Healthcare professionals felt insecure about how to follow local guidelines when they were lengthy and ambiguous or did not reflect national or international guidelines. | • Moderate confidence |
• Clear communication about ICP guidelines was considered vital for its implementation. | • High confidence | ||||
• Sufficient space to isolate patients was also considered essential for the implementation of the guidelines. | • Moderate confidence | ||||
• The lack of PPE and poor quality equipment were serious concerns for healthcare workers and managers. | • Moderate confidence | ||||
• Healthcare professionals believed that they followed ICP guidelines more closely when they saw their value. | • Moderate confidence | ||||
• Healthcare professionals pointed out the importance of including all employees (cleaning, doormen, kitchen and other support staff) when implementing ICP guidelines. | • Low confidence | ||||
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Comparisons were grouped according to similarity. Studies without a comparator group were not included. |
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• Using a respirator and energized air purifier with overalls can protect against the risk of contamination better than an N95 mask and gown (RR 0.27; 95% CI 0.17 to 0.43), but it was more difficult dressing (non-conformity: RR 7.5; 95% CI 1.81 to 31.1). | • Very low certainty |
• In an RCT (59 participants), people with a long gown had less contamination than those with a coverall, and the coverall was more difficult to wear | • Low certainty | ||||
• The following modifications to the PPE design can lead to less contamination, compared with the standard PPE: combination of sealed gown and glove (RR 0.27; 95% CI 0.09 to 0.78), a more suitable fit around the neck, wrists and hands (RR 0.08; 95% CI 0.01 to 0.55), additional tags to grip, to facilitate the use of masks (RR 0.33; 95% CI 0.14 0.80) or gloves (RR 0.22; 95% CI 0.15 to 0.31). | • Very low certainty | ||||
• better coverage of the wrist-cuff interface can lead to less contamination, compared with standard PPE (RR 0.45; 95% CI 0.26 to 0.78) | • Low certainty | ||||
• Using the CDC recommendations can lead to less contamination, compared with no guidance (small spots: MD -5.44; 95% CI -7.43 to -3.45). | • Very low certainty | ||||
• The use of additional computer simulation can lead to fewer errors in the process (MD -1.2; 95% CI -1.6 to -0.7). | • Very low certainty |
GRADE: Grading of Recommendations, Assessment, Development and Evaluation; RCT = randomized controlled trial; PPE = personal protective equipment; KQ1 = key question 1; KQ2 = key question 2; SARS = severe acute respiratory syndrome; MERS = Middle East respiratory syndrome; WHO = World Health Organization; IPC = infection control and prevention; RR = relative risk; CI = confidence interval; CDC = Centers for Disease Control and Prevention; MD = mean difference.