Is there sufficient evidence to inform personal protective equipment choices for healthcare workers caring for patients with viral hemorrhagic fevers?

Abstract

Background: Ugandan health authorities declared an outbreak of Ebola disease (EBOD), caused by the Sudan virus, in September 2022. A rapid review was conducted to update the Public Health Agency of Canada's guidelines for infection prevention and control measures for EBOD in healthcare settings to prepare for potential introduction of cases.

Objective: Summarize the available evidence on personal protective equipment (PPE) use by healthcare workers (HCWs) to prevent exposure to and transmission of viral hemorrhagic fevers (VHFs), including Ebola virus.

Methods: Electronic databases were searched to identify peer-reviewed evidence published from July 2014-October 2022. Peer-reviewed primary studies and literature reviews, in English or French, reporting on PPE for VHFs and filoviruses in the healthcare context were eligible for inclusion. Literature review processes were conducted by two reviewers using DistillerSR® systematic review software and the Public Health Agency of Canada's Infection Prevention and Control Critical Appraisal Toolkit. An environmental scan of grey literature was also conducted to inform the rapid review.

Results: The database search yielded 417 citations and 29 studies were considered eligible for critical appraisal. In total, 20 studies were included in the narrative synthesis of evidence. The evidence base was limited regarding comparative effectiveness of types of PPE for preventing exposure to and transmission of VHFs to HCWs. Four studies reported on exposure to and transmission of a VHF. Sixteen studies provided data on other relevant topics, such as simulated contamination and lab-based tests of PPE integrity.

Conclusion: There is limited evidence with which to draw conclusions on the comparative effectiveness of PPE to prevent exposure to and transmission of VHFs to HCWs. Additional research is required to determine the optimal PPE to protect HCWs from exposure to and transmission of VHFs.