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Nussbaumer-Streit et al.44. Nussbaumer-Streit B, Mayr V, Dobrescu AI, et al. Quarantine alone or in combination with other public health measures to control COVID‐19: a rapid review. Cochrane Database Syst Rev. 2020;4(4):CD013574. PMID: 32267544; doi: 10.1002/14651858.CD013574.
https://doi.org/10.1002/14651858.CD01357...
/rapid review
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• Cohort
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• Case-control
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• Time series
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• Interrupted time series
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• Case series
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• Mathematical modelling studies
|
Different types and quarantine locations for individuals. They included studies combining isolation and quarantine. |
-
• No quarantine.
-
• Different types and quarantine locations.
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• Public health measures without quarantine to reduce the spread of the virus (isolation, social distancing, personal protective equipment, hand hygiene and others).
|
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• (KQ1) contacts of a confirmed or suspected case of COVID-19 (SARS or MERS) or individuals living in areas with high rates of transmission;
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• (KQ2) individuals returning from countries with a declared outbreak of COVID-19 (SARS or MERS), defined by WHO as an ‘occurrence of cases of disease above normal expectations’.
|
• 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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Houghton et al.22. Houghton C, Meskell P, Delaney H, et al. Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database Syst Rev. 2020;4(4):CD013582. PMID: 32315451; doi: 10.1002/14651858.CD013582.
https://doi.org/10.1002/14651858.CD01358...
/rapid review (synthesis of evidence)
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• Mixed method designs (qualitative aspect)
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• Early recognition and source control (screening and breathing hygiene).
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• Administrative controls (isolation, spatial separation and cohort of patients).
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• Environmental and engineering controls (cleaning and disinfection; and ventilation).
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• PPE (dressing and undressing), aprons, gloves, masks and glasses).
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• Hand hygiene.
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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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Verbeek et al.33. Verbeek J, Rajamaki B, Ijaz S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020;4(4):CD011621. PMID: 32293717; doi: 10.1002/14651858.CD011621.pub4.
https://doi.org/10.1002/14651858.CD01162...
/traditional systematic review
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• RCT
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• Non-randomized controlled trial
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• Cohort
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• Case-control
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• Prospective and retrospective controlled field studies
|
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• Different types of full body protection (PPE), different compositions or amounts of PPE (body protection, such as aprons, overalls; eye and face protection in glasses, goggles, face mask visors or masks or hoods that cover the entire head; hand protection: gloves; and foot protection: boots).
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• Different parts of PPE or different procedures or protocols for placing and producing PPE.
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• Effectiveness of training to increase compliance with existing guidelines on the selection or use of PPE, including, but not limited to: education (courses); practical training; information only (such as posters, guidance leaflets, etc.); audit and feedback, or monetary or organizational incentives.
|
Comparisons were grouped according to similarity. Studies without a comparator group were not included. |
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• For simulation studies, any type of participant (volunteer or health professional) using PPE designed for Ebola virus disease or highly infectious diseases comparable with serious consequences was included.
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• For field studies, only studies carried out on healthcare professionals or auxiliaries exposed to patients’ body fluids in the form of splashes, droplets or aerosols contaminated with particles of highly infectious diseases that have serious health consequences, such as Ebola virus, SARS or COVID-19. Studies carried out on the laboratory team were excluded because the preventive measures in the laboratories are more detailed and easier to comply with.
|
• 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 |
