Characteristics of Included Studies Evaluating the Effectiveness of Personal Respiratory Protection (n = 9)
| First Author, Year Published . | Setting . | Study Design . | Population/s . | Intervention/s . | Comparator . | Primary Findings . | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| . | . | . | . | Personal Respiratory Protection . | Other . | . | No Intervention . | Respiratory Hygiene Intervention . | Absolute Risk Difference . | |
| High burden settings | ||||||||||
| Roth, 2005 [15] | Four hospitals, Brazil | Cohort | HCWs | N95 respirators worn by HCWs | Administrative controls used in Hospital A. Engineering controls (mechanical ventilation) also used in Hospital B | Hospitals where respirators were not worn routinely | 19.8 per 1000 person-years (hospital C). 12.2 per 1000 person-years (hospital D) | 7.4 per 1000 person years (hospital A). 8.1 per 1000 person-years (hospital B) | Reduction of between 4.1 and 12.4 conversions per 1000 person-years, depending upon comparison | |
| Yanai, 2003 [14] | TB hospital, Thailand | Before and after | HCWs | N95 respirator use encouraged, with fit testing, for HCWs | Administrative (an isolation room established in each ward, safety cabinet in TB laboratory), Engineering (local ventilation), Personal cough etiquette training | Prior to introduction of guidelines | 13/77 (16.9%) TST conversions 30/4357 TB cases (0.7/100 person years) | 2/96 TST conversions (2.1%) 19/4780 (0.4 TB cases /100 person years) | Reduction in TST conversions by 14.8%; Reduction in TB cases by 0.29 cases per 100 person-years | |
| Da Costa, 2009 [19] | General hospital, Brazil | Before and after | HCWs | HCW training to use N95 respirators | Administrative (rapid separation and diagnosis) | Prior to implementation | 25 cases / 4307 person months (5.8 / 1000 person-months) | 599 people retested. 15 cases / 3858 months (3.9 / 1000 person-months) | Reduction in conversions of 1.9 / 1000 person-months | |
| Low burden settings | ||||||||||
| Bangsberg, 1997 [17] | Urban hospital, USA | Before and after | HCWs | Particulate respirators with fit testing for medical staff | Administrative (isolation of high-risk patients, patient education) Engineering (negative pressure isolation rooms) | Prior to introduction of the policy | Period 1: 9/109 (10%) conversion Period 2: 2/101 (2%) conversion Period 3: 0/100 (0%) conversion | Period 4: 1/107 (1%) Period 5: 0/106 (0%) | No difference identified; conversion rate had already decreased prior to intervention | |
| Baussano, 2007 [13] | Urban health facilities, Italy | Before and after | HCWs | Particulate respirators during cough-inducing procedures | Administrative (risk evaluation and prompt isolation, appointment of TB control officials); Engineering (laboratory containment) | Prior to the introduction of the policy | 2182 participants: 106 infections in 4034 person-years (26.3/1000 person years) | 42 infections in 4463 person years (9.4/1000 person-years) | Reduction by 16.9 conversions per 1000 person-years | |
| Blumberg, 1995 [16] | Tertiary hospital, USA | Before and after | HCWs | Particulate respirator use | Administrative (patient isolation, infection control coordinator appointed), Respiratory hygiene. HCW education | Standard practice prior to intervention | 118/3579 (3.3%) conversions | 23/5153 (0.4%) conversions | Reduced TST conversion by 2.9% in intervention | |
| Maloney, 1995 [12] | MDR-TB wards, USA | Before and after | HCWs | Staff use of moulded masks (3M 1800 Aseptex) | Administrative (Improved isolation, routine smear testing to guide isolation), Engineering (exhaust fans in isolation rooms, portable chambers for cough-inducing procedures) | Standard practice prior to intervention | 15/90 (16.7%) conversions over 18 months | 4/78 (5.1%) conversions over 18 months in intervention period | Reduced TST conversion by 11.5% after intervention | |
| Fella, 1995 [11] | Urban AIDS center and prison hospital, USA | Before and after | HCW | Particulate respirators then dust mist fume respirators | Administrative (early isolation), Engineering (negative pressure rooms, and UVGI) | Staff use of technol shields / Staff use of particulate respirators | 41/303 (13.5%) conversions | 21/446 tests (4.7%) conversions | Reduction of 8.8% | |
| Welbel, 2009 [18] | Urban hospital, USA | Before and after | HCWs | Particulate respirators with a fit test | Use of HEPA filters in the Emergency Department, with daily checks for negative pressure in isolation rooms | No respirators, prior to the intervention | 98/2221, (4.4%) conversions | 6/2108 (0.28%) conversions | Reduced TST by 4.1% in the intervention group | |
| First Author, Year Published . | Setting . | Study Design . | Population/s . | Intervention/s . | Comparator . | Primary Findings . | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| . | . | . | . | Personal Respiratory Protection . | Other . | . | No Intervention . | Respiratory Hygiene Intervention . | Absolute Risk Difference . | |
| High burden settings | ||||||||||
| Roth, 2005 [15] | Four hospitals, Brazil | Cohort | HCWs | N95 respirators worn by HCWs | Administrative controls used in Hospital A. Engineering controls (mechanical ventilation) also used in Hospital B | Hospitals where respirators were not worn routinely | 19.8 per 1000 person-years (hospital C). 12.2 per 1000 person-years (hospital D) | 7.4 per 1000 person years (hospital A). 8.1 per 1000 person-years (hospital B) | Reduction of between 4.1 and 12.4 conversions per 1000 person-years, depending upon comparison | |
| Yanai, 2003 [14] | TB hospital, Thailand | Before and after | HCWs | N95 respirator use encouraged, with fit testing, for HCWs | Administrative (an isolation room established in each ward, safety cabinet in TB laboratory), Engineering (local ventilation), Personal cough etiquette training | Prior to introduction of guidelines | 13/77 (16.9%) TST conversions 30/4357 TB cases (0.7/100 person years) | 2/96 TST conversions (2.1%) 19/4780 (0.4 TB cases /100 person years) | Reduction in TST conversions by 14.8%; Reduction in TB cases by 0.29 cases per 100 person-years | |
| Da Costa, 2009 [19] | General hospital, Brazil | Before and after | HCWs | HCW training to use N95 respirators | Administrative (rapid separation and diagnosis) | Prior to implementation | 25 cases / 4307 person months (5.8 / 1000 person-months) | 599 people retested. 15 cases / 3858 months (3.9 / 1000 person-months) | Reduction in conversions of 1.9 / 1000 person-months | |
| Low burden settings | ||||||||||
| Bangsberg, 1997 [17] | Urban hospital, USA | Before and after | HCWs | Particulate respirators with fit testing for medical staff | Administrative (isolation of high-risk patients, patient education) Engineering (negative pressure isolation rooms) | Prior to introduction of the policy | Period 1: 9/109 (10%) conversion Period 2: 2/101 (2%) conversion Period 3: 0/100 (0%) conversion | Period 4: 1/107 (1%) Period 5: 0/106 (0%) | No difference identified; conversion rate had already decreased prior to intervention | |
| Baussano, 2007 [13] | Urban health facilities, Italy | Before and after | HCWs | Particulate respirators during cough-inducing procedures | Administrative (risk evaluation and prompt isolation, appointment of TB control officials); Engineering (laboratory containment) | Prior to the introduction of the policy | 2182 participants: 106 infections in 4034 person-years (26.3/1000 person years) | 42 infections in 4463 person years (9.4/1000 person-years) | Reduction by 16.9 conversions per 1000 person-years | |
| Blumberg, 1995 [16] | Tertiary hospital, USA | Before and after | HCWs | Particulate respirator use | Administrative (patient isolation, infection control coordinator appointed), Respiratory hygiene. HCW education | Standard practice prior to intervention | 118/3579 (3.3%) conversions | 23/5153 (0.4%) conversions | Reduced TST conversion by 2.9% in intervention | |
| Maloney, 1995 [12] | MDR-TB wards, USA | Before and after | HCWs | Staff use of moulded masks (3M 1800 Aseptex) | Administrative (Improved isolation, routine smear testing to guide isolation), Engineering (exhaust fans in isolation rooms, portable chambers for cough-inducing procedures) | Standard practice prior to intervention | 15/90 (16.7%) conversions over 18 months | 4/78 (5.1%) conversions over 18 months in intervention period | Reduced TST conversion by 11.5% after intervention | |
| Fella, 1995 [11] | Urban AIDS center and prison hospital, USA | Before and after | HCW | Particulate respirators then dust mist fume respirators | Administrative (early isolation), Engineering (negative pressure rooms, and UVGI) | Staff use of technol shields / Staff use of particulate respirators | 41/303 (13.5%) conversions | 21/446 tests (4.7%) conversions | Reduction of 8.8% | |
| Welbel, 2009 [18] | Urban hospital, USA | Before and after | HCWs | Particulate respirators with a fit test | Use of HEPA filters in the Emergency Department, with daily checks for negative pressure in isolation rooms | No respirators, prior to the intervention | 98/2221, (4.4%) conversions | 6/2108 (0.28%) conversions | Reduced TST by 4.1% in the intervention group | |
Abbreviations: HCW, health-care workers; HEPA, high efficiency particulate air; HIV, human immunodeficiency virus; LTBI, latent tuberculosis infection; MDR-TB, multidrug resistant tuberculosis; TB, tuberculosis; TST, tuberculin skin test; UVGI, ultraviolet germicidal irradiation.
Characteristics of Included Studies Evaluating the Effectiveness of Personal Respiratory Protection (n = 9)
| First Author, Year Published . | Setting . | Study Design . | Population/s . | Intervention/s . | Comparator . | Primary Findings . | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| . | . | . | . | Personal Respiratory Protection . | Other . | . | No Intervention . | Respiratory Hygiene Intervention . | Absolute Risk Difference . | |
| High burden settings | ||||||||||
| Roth, 2005 [15] | Four hospitals, Brazil | Cohort | HCWs | N95 respirators worn by HCWs | Administrative controls used in Hospital A. Engineering controls (mechanical ventilation) also used in Hospital B | Hospitals where respirators were not worn routinely | 19.8 per 1000 person-years (hospital C). 12.2 per 1000 person-years (hospital D) | 7.4 per 1000 person years (hospital A). 8.1 per 1000 person-years (hospital B) | Reduction of between 4.1 and 12.4 conversions per 1000 person-years, depending upon comparison | |
| Yanai, 2003 [14] | TB hospital, Thailand | Before and after | HCWs | N95 respirator use encouraged, with fit testing, for HCWs | Administrative (an isolation room established in each ward, safety cabinet in TB laboratory), Engineering (local ventilation), Personal cough etiquette training | Prior to introduction of guidelines | 13/77 (16.9%) TST conversions 30/4357 TB cases (0.7/100 person years) | 2/96 TST conversions (2.1%) 19/4780 (0.4 TB cases /100 person years) | Reduction in TST conversions by 14.8%; Reduction in TB cases by 0.29 cases per 100 person-years | |
| Da Costa, 2009 [19] | General hospital, Brazil | Before and after | HCWs | HCW training to use N95 respirators | Administrative (rapid separation and diagnosis) | Prior to implementation | 25 cases / 4307 person months (5.8 / 1000 person-months) | 599 people retested. 15 cases / 3858 months (3.9 / 1000 person-months) | Reduction in conversions of 1.9 / 1000 person-months | |
| Low burden settings | ||||||||||
| Bangsberg, 1997 [17] | Urban hospital, USA | Before and after | HCWs | Particulate respirators with fit testing for medical staff | Administrative (isolation of high-risk patients, patient education) Engineering (negative pressure isolation rooms) | Prior to introduction of the policy | Period 1: 9/109 (10%) conversion Period 2: 2/101 (2%) conversion Period 3: 0/100 (0%) conversion | Period 4: 1/107 (1%) Period 5: 0/106 (0%) | No difference identified; conversion rate had already decreased prior to intervention | |
| Baussano, 2007 [13] | Urban health facilities, Italy | Before and after | HCWs | Particulate respirators during cough-inducing procedures | Administrative (risk evaluation and prompt isolation, appointment of TB control officials); Engineering (laboratory containment) | Prior to the introduction of the policy | 2182 participants: 106 infections in 4034 person-years (26.3/1000 person years) | 42 infections in 4463 person years (9.4/1000 person-years) | Reduction by 16.9 conversions per 1000 person-years | |
| Blumberg, 1995 [16] | Tertiary hospital, USA | Before and after | HCWs | Particulate respirator use | Administrative (patient isolation, infection control coordinator appointed), Respiratory hygiene. HCW education | Standard practice prior to intervention | 118/3579 (3.3%) conversions | 23/5153 (0.4%) conversions | Reduced TST conversion by 2.9% in intervention | |
| Maloney, 1995 [12] | MDR-TB wards, USA | Before and after | HCWs | Staff use of moulded masks (3M 1800 Aseptex) | Administrative (Improved isolation, routine smear testing to guide isolation), Engineering (exhaust fans in isolation rooms, portable chambers for cough-inducing procedures) | Standard practice prior to intervention | 15/90 (16.7%) conversions over 18 months | 4/78 (5.1%) conversions over 18 months in intervention period | Reduced TST conversion by 11.5% after intervention | |
| Fella, 1995 [11] | Urban AIDS center and prison hospital, USA | Before and after | HCW | Particulate respirators then dust mist fume respirators | Administrative (early isolation), Engineering (negative pressure rooms, and UVGI) | Staff use of technol shields / Staff use of particulate respirators | 41/303 (13.5%) conversions | 21/446 tests (4.7%) conversions | Reduction of 8.8% | |
| Welbel, 2009 [18] | Urban hospital, USA | Before and after | HCWs | Particulate respirators with a fit test | Use of HEPA filters in the Emergency Department, with daily checks for negative pressure in isolation rooms | No respirators, prior to the intervention | 98/2221, (4.4%) conversions | 6/2108 (0.28%) conversions | Reduced TST by 4.1% in the intervention group | |
| First Author, Year Published . | Setting . | Study Design . | Population/s . | Intervention/s . | Comparator . | Primary Findings . | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| . | . | . | . | Personal Respiratory Protection . | Other . | . | No Intervention . | Respiratory Hygiene Intervention . | Absolute Risk Difference . | |
| High burden settings | ||||||||||
| Roth, 2005 [15] | Four hospitals, Brazil | Cohort | HCWs | N95 respirators worn by HCWs | Administrative controls used in Hospital A. Engineering controls (mechanical ventilation) also used in Hospital B | Hospitals where respirators were not worn routinely | 19.8 per 1000 person-years (hospital C). 12.2 per 1000 person-years (hospital D) | 7.4 per 1000 person years (hospital A). 8.1 per 1000 person-years (hospital B) | Reduction of between 4.1 and 12.4 conversions per 1000 person-years, depending upon comparison | |
| Yanai, 2003 [14] | TB hospital, Thailand | Before and after | HCWs | N95 respirator use encouraged, with fit testing, for HCWs | Administrative (an isolation room established in each ward, safety cabinet in TB laboratory), Engineering (local ventilation), Personal cough etiquette training | Prior to introduction of guidelines | 13/77 (16.9%) TST conversions 30/4357 TB cases (0.7/100 person years) | 2/96 TST conversions (2.1%) 19/4780 (0.4 TB cases /100 person years) | Reduction in TST conversions by 14.8%; Reduction in TB cases by 0.29 cases per 100 person-years | |
| Da Costa, 2009 [19] | General hospital, Brazil | Before and after | HCWs | HCW training to use N95 respirators | Administrative (rapid separation and diagnosis) | Prior to implementation | 25 cases / 4307 person months (5.8 / 1000 person-months) | 599 people retested. 15 cases / 3858 months (3.9 / 1000 person-months) | Reduction in conversions of 1.9 / 1000 person-months | |
| Low burden settings | ||||||||||
| Bangsberg, 1997 [17] | Urban hospital, USA | Before and after | HCWs | Particulate respirators with fit testing for medical staff | Administrative (isolation of high-risk patients, patient education) Engineering (negative pressure isolation rooms) | Prior to introduction of the policy | Period 1: 9/109 (10%) conversion Period 2: 2/101 (2%) conversion Period 3: 0/100 (0%) conversion | Period 4: 1/107 (1%) Period 5: 0/106 (0%) | No difference identified; conversion rate had already decreased prior to intervention | |
| Baussano, 2007 [13] | Urban health facilities, Italy | Before and after | HCWs | Particulate respirators during cough-inducing procedures | Administrative (risk evaluation and prompt isolation, appointment of TB control officials); Engineering (laboratory containment) | Prior to the introduction of the policy | 2182 participants: 106 infections in 4034 person-years (26.3/1000 person years) | 42 infections in 4463 person years (9.4/1000 person-years) | Reduction by 16.9 conversions per 1000 person-years | |
| Blumberg, 1995 [16] | Tertiary hospital, USA | Before and after | HCWs | Particulate respirator use | Administrative (patient isolation, infection control coordinator appointed), Respiratory hygiene. HCW education | Standard practice prior to intervention | 118/3579 (3.3%) conversions | 23/5153 (0.4%) conversions | Reduced TST conversion by 2.9% in intervention | |
| Maloney, 1995 [12] | MDR-TB wards, USA | Before and after | HCWs | Staff use of moulded masks (3M 1800 Aseptex) | Administrative (Improved isolation, routine smear testing to guide isolation), Engineering (exhaust fans in isolation rooms, portable chambers for cough-inducing procedures) | Standard practice prior to intervention | 15/90 (16.7%) conversions over 18 months | 4/78 (5.1%) conversions over 18 months in intervention period | Reduced TST conversion by 11.5% after intervention | |
| Fella, 1995 [11] | Urban AIDS center and prison hospital, USA | Before and after | HCW | Particulate respirators then dust mist fume respirators | Administrative (early isolation), Engineering (negative pressure rooms, and UVGI) | Staff use of technol shields / Staff use of particulate respirators | 41/303 (13.5%) conversions | 21/446 tests (4.7%) conversions | Reduction of 8.8% | |
| Welbel, 2009 [18] | Urban hospital, USA | Before and after | HCWs | Particulate respirators with a fit test | Use of HEPA filters in the Emergency Department, with daily checks for negative pressure in isolation rooms | No respirators, prior to the intervention | 98/2221, (4.4%) conversions | 6/2108 (0.28%) conversions | Reduced TST by 4.1% in the intervention group | |
Abbreviations: HCW, health-care workers; HEPA, high efficiency particulate air; HIV, human immunodeficiency virus; LTBI, latent tuberculosis infection; MDR-TB, multidrug resistant tuberculosis; TB, tuberculosis; TST, tuberculin skin test; UVGI, ultraviolet germicidal irradiation.
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