Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff

Cochrane Database of Systematic Reviews

Volumn 2019, Issue 7, 2019, Pages

  Verbeek, Jos H ^a   Rajamaki, Blair ^a   Ijaz, Sharea ^b   Tikka, Christina ^c   Ruotsalainen, Jani H ^a   Edmond, Michael B ^d   Sauni, Riitta ^c   Balci, F Selcen Kilinc ^e  

^a UNIVERSITY OF EASTERN FINLAND   (Finland)

^b UNIVERSITY HOSPITALS BRISTOL NHS FOUNDATION TRUST   (United Kingdom)

^c FINNISH INSTITUTE OF OCCUPATIONAL HEALTH   (Finland)

^d UNIVERSITY OF IOWA HOSPITALS AND CLINICS   (United States)

^e NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ALCOHOL; HYPOCHLORITE;

BACTERIOPHAGE; BODY FLUID; CLINICAL OUTCOME; COMPARATIVE STUDY; COMPUTER SIMULATION; DOFFING PERSONAL PROTECTIVE EQUIPMENT; DONNING PERSONAL PROTECTIVE EQUIPMENT; EBOLA HEMORRHAGIC FEVER; FLUORESCENCE ANALYSIS; HEALTH CARE PERSONNEL; HEALTH EDUCATION; HUMAN; INFECTION PREVENTION; INFECTION RISK; LEARNING STYLE; MEDICAL ERROR; MICROBIAL CONTAMINATION; OCCUPATIONAL EXPOSURE; OUTCOME ASSESSMENT; PRIORITY JOURNAL; PROTOCOL COMPLIANCE; REVIEW; SCORING SYSTEM; SEVERE ACUTE RESPIRATORY SYNDROME; SKILL; SYSTEMATIC REVIEW; VIDEORECORDING; VIRAL CONTAMINATION; DISEASE TRANSMISSION; PREVENTION AND CONTROL; PROTECTIVE CLOTHING; PROTECTIVE EQUIPMENT; PROTECTIVE GLOVE; RANDOMIZED CONTROLLED TRIAL (TOPIC);

BODY FLUIDS; GLOVES, PROTECTIVE; HEALTH PERSONNEL; HEMORRHAGIC FEVER, EBOLA; HUMANS; INFECTIOUS DISEASE TRANSMISSION, PATIENT-TO-PROFESSIONAL; PERSONAL PROTECTIVE EQUIPMENT; PROTECTIVE CLOTHING; RANDOMIZED CONTROLLED TRIALS AS TOPIC; SEVERE ACUTE RESPIRATORY SYNDROME;

EID: 85068234855     PISSN: None     EISSN: 1469493X     Source Type: Journal    
DOI: 10.1002/14651858.CD011621.pub3     Document Type: Review

References (198)

1. Bell T, Smoot J, Patterson JE, Smalligan R, Jordan R. Ebola virus disease: The use of fluorescents as markers of contamination for personal protective equipment. ID Cases 2015;2:27–30.
2. Buianov VV, Kolesnikov NV, Malyshev NA, Suprun IP. [Use of new individual protection substances in Mel’tser boxes]. Vestnik Rossi sko Akademii Meditsinskikh Nauk 2004;1:30–5.
3. Casalino E, Astocondor E, Sanchez JC, Diaz-Santana DE, Del Aquila C, Carrillo JP. Personal protective equipment for the Ebola virus disease: A comparison of 2 training programs. American Journal of Infection Control 2015;43 (12):1281–7.
4. Casanova LM, Rutala WA, Weber DJ, Sobsey MD. Effect of single-versus double-gloving on virus transfer to health care workers’ skin and clothing during removal of personal protective equipment. American Journal of Infection Control 2012;40(4):369–74.
5. Casanova LM, Teal LJ, Sickbert-Bennett EE, Anderson DJ, Sexton DJ, Rutala WA, Weber DJ. Assessment of self-contamination during removal of personal protective equipment for Ebola patient care. Infection Control and Hospital Epidemiology Oct 2016;37(10):1156–61.
6. Curtis HA, Trang K, Chason KW, Biddinger PD. Video-based learning vs traditional lecture for instructing emergency medicine residents in disaster medicine principles of mass triage, decontamination, and personal protective equipment. Prehospital and Disaster Medicine Feb 2018;33(1):7–12.
7. Gleser M, Schwab F, Solbach P, Vonberg RP. Modified gloves: A chance for the prevention of nosocomial infections. American Journal of Infection Control Mar 2018; 46(3):266–269.
8. Guo YP, Li Y, Wong PLH. Environment and body contamination: a comparison of two different removal methods in three types of personal protective clothing. American Journal of Infection Control 2014;42(4):e39–e45.
9. Hall S, Poller, B, Bailey C, Gregory S, Clark R, Roberts P, et al. Use of ultraviolet-fluorescence-based simulation in evaluation of personal protective equipment worn for first assessment and care of a patient with suspected high-consequence infectious disease. Journal of Hospital Infection 2018;99(2):218–28.
10. Houlihan CF, McGowan CR, Dicks S, Baguelin M, Moore DAJ, Mabey D, et al. Ebola exposure, illness experience and Ebola antibody prevelence in international responders to the West African Ebola epidemic 2014-2016: A cross sectional study. PLOS Med May 2017;14(4):e1002300.
11. Hung PP, Choi KS, Chiang VC. Using interactive computer simulation for teaching the proper use of personal protective equipment. CIN: Computers, Informatics, Nursing 2015;33 (2):49–57.
12. Mana TSC, Tomas ME, Cadnum JL, Jencson AL, Piedrahita CT, Donskey CJ. A Randomized trial of two cover gowns comparing contamination of healthcare personnel during removal of personal protective equipment. Infection Control & Hospital Epidemiology Jan 2018;39(1):97–100.
13. Shigayeva A, Green K, Raboud JM, Henry B, Simor AE, Vearncombe M, et al. Factors associated with critical-care healthcare workers’ adherence to recommended barrier precautions during the Toronto severe acute respiratory syndrome outbreak. Infection Control 2007;28(11): 1275–83.
14. Strauch AL, Brady TM, Niezgoda G, Almaguer CM, Shaffer RE, Fisher EM. Assessing the efficacy of tabs on filtering facepiece respirator straps to increase proper doffing techniques while reducing contact transmission of pathogens. Journal of Occupational and Environmental Hygiene Oct 2016;13(10):794–801.
15. Tomas ME, Cadnum JL, Mana TSC, Jencson AL, Donskey CJ. Seamless suits: reducing personnel contamination through improved personal protective equipment design. Infection Control & Hospital Epidemiology Jun 2016;37(6): 742–744.
16. Wong TK, Chung JW, Li Y, Chan WF, Ching PT, Lam CH, et al. Effective personal protective clothing for health care workers attending patients with severe acute respiratory syndrome. American Journal of Infection Control 2004;32 (2):90–6.
17. Zamora JE, Murdoch J, Simchison B, Day AG. Contamination: a comparison of 2 personal protective systems. Canadian Medical Association Journal 2006;175 (3):249–54.
18. Abrahamson SD, Canzian S, Brunet F. Using simulation for training and to change protocol during the outbreak of severe acute respiratory syndrome. Critical Care 2006;10 (1):1–6.
19. Alraddadi BM, Al-Salmi HS, Jacobs-Slifka K, Slayton RB, Estivariz CF, Geller AI, et al. Risk factors for Middle East Respiratory Syndrome coronavirus infection among healthcare personnel. Emerging Infectious Diseases 2016;22 (11):1915–20.
20. Beam EL, Gibbs SG, Boulter KC, Beckerdite ME, Smith PW. A method for evaluating health care workers’ personal protective equipment technique. American Journal of Infection Control 2011;39(5):415–20.
21. Beam EL, Gibbs SG, Hewlett AL, Iwen PC, Nuss SL, Smith PW. Method for investigating nursing behaviors related to isolation care. American Journal of Infection Control 2014; 42(11):1152–6.
22. Beam EL, Schwedhelm S, Boulter K, Kratochvil C, Lowe J, Hewlett A, et al. Personal protective equipment processes and rationale for the Nebraska Biocontainment Unit during the 2014 activations for Ebola virus disease. American journal of infection control 2016;44(3):340–2.
23. Beam EL. Call for improvement in personal protective equipment guidance and research. American journal of infection control 2016;44(11):1428–.
24. Bearman GM, Marra AR, Sessler CN, Smith WR, Rosato A, Laplante JK, et al. A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms. American Journal of Infection Control 2007;35(10):650–5.
25. Belkin NL. The protectiveness of protective clothing. Infection Control and Hospital Epidemiology 1991;12(8): 464–468.
26. Belkin NL. Selecting protective apparel for the degree of exposure anticipated. Infection Control and Hospital Epidemiology 2000;21(7):436.
27. Belkin NL. “False faith in the surgeon’s gown” revisited. Bulletin of the American College of Surgeons 2005;90(4): 19–23,56.
28. Biddell EA, Vandersall BL, Bailes SA, Estephan SA, Ferrara LA, Nagy KM, et al. Use of simulation to gauge preparedness for Ebola at a free-standing children’s hospital. Simulation in Healthcare 2016;11(2):94–9.
29. Borchert M, Mulangu S, Lefevre P, Tshomba A, Libande ML, Kulidri A, et al. Use of protective gear and the occurrence of occupational Marburg hemorrhagic fever in health workers from Watsa health zone, Democratic Republic of the Congo. Journal of Infectious Diseases 2007; 196 Suppl 2:S168–75.
30. Bosc J, Sanchez O, Carrie C, Revel P, Tentillier E, Biais M, et al. Impact of the personal protective equipment for Ebola virus disease on vascular access skills and the performance of airway: A manikin study. Annales Francaises de Medecine d’Urgence 2016;6(3):172–8.
31. Buianov VV, Elkin EN, Kolmykov VG, Kaplunov IuV, Malyshev NA, Kelli EI, et al. [Use of personal protective equipment by pathologists and legal physicians working with particularly dangerous infectious diseases]. Arkhiv Patologii 1991;53(3):59–61.
32. Bunyan D, Ritchie L, Jenkins D, Coia JE. Respiratory and facial protection: a critical review of recent literature. The Journal of Hospital Infection 2013;85(3):165–9.
33. Butt TS, Koutlakis-Barron I, AlJumaah S, AlThawadi S, AlMofada S. Infection control and prevention practices implemented to reduce transmission risk of Middle East respiratory syndrome-coronavirus in a tertiary care institution in Saudi Arabia. American Journal of Infection Control 2016;44(5):605–11.
34. Casanova L, Alfano-Sobsey E, Rutala WA, Weber DJ, Sobsey M. Virus transfer from personal protective equipment to healthcare employees’ skin and clothing. Emerging Infectious Diseases 2008 2008;14(8):1291–3. DOI: 10.3201/eid1408.080085
35. Castle N, Owen R, Hann M, Clark S, Reeves D, Gurney I. Impact of chemical, biological, radiation, and nuclear personal protective equipment on the performance of low-and high-dexterity airway and vascular access skills. Resuscitation 2009;80(11):1290–5.
36. Christian MD, Loutfy M, McDonald LC, Martinez KF, Ofner M, Wong T, et al. Possible SARS coronavirus transmission during cardiopulmonary resuscitation. Emerging Infectious Diseases 2004;10(2):287–93.
37. Chu M, Bausch D, Velazquez-Berumen A, Vallenas C, Committees A. Report from the world health organization’s advisory committees on innovative personal protective equipment for front line health workers. American Journal of Tropical Medicine and Hygiene 2017;97(5):283–.
38. Chughtai AA, Seale H, MacIntyre CR. Availability, consistency and evidence-base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis. BMC Research Notes 2013;6 (216):1.
39. Clay KA, O’Shea MK, Fletcher T, Moore AJ, Burns DS, Craig D, et al. Use of an ultraviolet tracer in simulation training for the clinical management of Ebola virus disease. The Journal of Hospital Infection 2015;91(3):275–7. PUBMED: 26319591]
40. Coates MJ, Jundi AS, James MR. Chemical protective clothing; a study into the ability of staff to perform lifesaving procedures. Journal of Accident and Emergency Medicine 2000;17(2):115–8.
41. Coca A, DiLeo T, Kim JH, Roberge R, Shaffer R. Baseline evaluation with a sweating thermal manikin of personal protective ensembles recommended for use in West Africa. Disaster Medicine and Public Health Preparedness 2015;9(5): 536–42. PUBMED: 26314211]
42. Colebunders R, Sleurs H, Pirard P, Borchert M, Libande M, Mustin JP, et al. Organisation of health care during an outbreak of Marburg haemorrhagic fever in the Democratic Republic of Congo, 1999. Journal of Infection 2004;48(4): 347–53.
43. Cooper DM, Charles D, Durnell AJ, Anderson JM, Kern T, Self T. Assessment of personal protective equipment used for facial mucocutaneous exposure protection in nonhuman primate areas. Lab Animal (NY) 2005;34(5): 49–53. PUBMED: 15861159]
44. Delaney HM, Lucero PF, Maves RC, Lawler JV, Maddry JK, Biever KA, et al. Ebola virus disease simulation case series: Patient with Ebola virus disease in the prodromal phase of illness (scenario 1), the “wet” gastrointestinal phase of illness (scenario 2), and the late, critically ill phase of disease (scenario 3). Simulation in Healthcare 2016;11(2):106–16.
45. Doll M, Feldman M, Hartigan S, Sanogo K, Stevens M, McReynolds M, et al. Acceptability and necessity of training for optimal personal protective equipment use. Infection Control and Hospital Epidemiology 2017;38(2):226–9.
46. Doshi R H, Hoff N A, Mukadi P, Mwanza A, Mukadi D, Wasiswa J, et al. Seroprevalence of Ebola virus among health care workers in the Tshuapa district, Democratic Republic of the Congo. American Journal of Tropical Medicine and Hygiene 2016;95(5):50–.
47. Drew JL, Turner J, Mugele J, Hasty G, Duncan T, Zaiser R, et al. Beating the spread: Developing a simulation analog for contagious body fluids. Simulation in Healthcare 2016; 11(2):100–5.
48. Dunn AC, Walker TA, Redd J, Sugerman D, McFadden J, Singh T, et al. Nosocomial transmission of Ebola virus disease on pediatric and maternity wards: Bombali and Tonkolili, Sierra Leone, 2014. American Journal of Infection Control 2015;43:[Epub ahead of print]. DOI: 10.1016/j.ajic.2015.09.016; PUBMED: 26521701
49. Elcin M, Onan A, Odabasi O, Saylam M, Ilhan H, Daylan Kockaya P, et al. Developing a simulation-based training program for the prehospital professionals and students on the management of Middle East respiratory syndrome. Simulation in Healthcare 2016;11(6):394–403.
50. Fischer WA 2nd, Weber DJ, Wohl DA. Personal protective equipment: Protecting health care providers in an Ebola outbreak. Clinical Therapeutics 2015;37(11):2402–10. PUBMED: 26452427]
51. Fogel I, David O, Balik CH, Eisenkraft A, Poles L, Shental O, et al. The association between self-perceived proficiency of personal protective equipment and objective performance: An observational study during a bioterrorism simulation drill. American Journal of Infection Control 2017; 45(11):1238–42.
52. Foote MMK, Styles TS, Quinn CL. Assessment of hospital emergency department response to potentially infectious diseases using unannounced mystery patient drills-New York city, 2016. MMWR. Morbidity and Mortality Weekly Report 2017;66(36):945–9.
53. Franklin SM. A comparison of personal protective standards: Caring for patients with Ebola virus. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice 2016;30(2):E1–8.
54. Gozel MG, Dokmetas I, Oztop AY, Engin A, Elaldi N, Bakir M. Recommended precaution procedures protect healthcare workers from Crimean-Congo hemorrhagic fever virus. International Journal of Infectious Diseases 2013;17 (11):e1046–50.
55. Grélot L, Koulibaly F, Maugey N, Janvier F, Foissaud V, Aletti M, et al. Moderate thermal strain in healthcare workers wearing personal protective equipment during treatment and care activities in the context of the 2014 Ebola virus disease outbreak. Journal of Infectious Diseases 2015 Dec 9;212:[Epub ahead of print]. PUBMED: 26655297]
56. Grélot L, Koulibaly F, Maugey N, Janvier F, Foissaud V, Aletti M, et al. Moderate thermal strain in healthcare workers wearing personal protective equipment during treatment and care activities in the context of the 2014 Ebola Virus Disease outbreak. The Journal of Infectious Diseases May 2016;213(9):1462–5.
57. Hendler I, Nahtomi O, Segal E, Perel A, Wiener M, Meyerovitch J. The effect of full protective gear on intubation performance by hospital medical personnel. Association of Military Surgeons of the United States 2000;165 (4):272–4.
58. Herlihey TA, Gelmi S, Flewwelling CJ, Hall TN, Bañez C, Morita PP, et al. Personal protective equipment for infectious disease preparedness: A human factors evaluation. Infection Control and Hospital Epidemiology 2016;37(9): 1022–8.
59. Herlihey TA, Gelmi S, Cafazzo JA, Hall TNT. The impact of environmental design on doffing personal protective equipment in a healthcare environment: A formative human factors trial. Infection Control and Hospital Epidemiology 2017;38(6):712–7.
60. Hersi M, Stevens A, Quach P, Hamel C, Thavorn K, Garritty C, et al. Effectiveness of personal protective equipment for healthcare workers caring for patients with filovirus disease: a rapid review. PloS one 2015;10(10): e0140290. PUBMED: 26451847]
61. Hildwine F. Breathable PPE. New fabric blocks virus transmission. JEMS: a Journal of Emergency Medical Services 2006;31(9):100.
62. Ho AS, Sung JJ, Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong. Annals of Internal Medicine 2003;139(7):564–7.
63. Ho KY, Singh KS, Habib AG, Ong BK, Lim TK, Ooi EE, et al. Mild illness associated with severe acute respiratory syndrome coronavirus infection: lessons from a prospective seroepidemiologic study of health-care workers in a teaching hospital in Singapore. Journal of Infectious Diseases 2004; 189(4):642–7.
64. Hon CY, Gamage B, Bryce EA, LoChang J, Yassi A, Maultsaid D, et al. Personal protective equipment in health care: Can online infection control courses transfer knowledge and improve proper selection and use?. American Journal of Infection Control 2008;36(10):e33–7.
65. Hormbrey PJ, Moore F, Skinner DV. Protective clothing in accident and emergency departments: Cost versus risk benefit. Journal of Accident and Emergency Medicine 1996; 13(1):70.
66. Jaques PA, Gao P, Kilinc-Balci S, Portnoff L, Weible R, Horvatin M, et al. Evaluation of gowns and coveralls used by medical personnel working with Ebola patients against simulated bodily fluids using an Elbow Lean Test. Journal of occupational and environmental hygiene 2016;13(11): 881–93.
67. Jeffs B, Roddy P, Weatherill D, de la Rosa O, Dorion C, Iscla M, et al. The Medecins Sans Frontieres intervention in the Marburg hemorrhagic fever epidemic, Uige, Angola, 2005. I. Lessons learned in the hospital. Journal of Infectious Diseases 2007;196 Suppl 2:S154–61.
68. Jinadatha C, Simmons S, Dale C, Ganachari-Mallappa N, Villamaria FC, Goulding N, et al. Disinfecting personal protective equipment with pulsed xenon ultraviolet as a risk mitigation strategy for health care workers. American Journal of Infection Control 2015;43(4):412–4. PUBMED: 25726129]
69. Kang J, Kim EJ, Choi JH, Hong HK, Han SH, Choi IS, et al. Difficulties in using personal protective equipment: Training experiences with the 2015 outbreak of Middle East respiratory syndrome in Korea. Antimicrobial Resistance and Infection Control 2017;6:53.
70. Kang J, O’Donnell J, Colaianne B, Bircher N, Ren D, Smith KJ. Use of personal protective equipment among health care personnel: Results of clinical observations and simulations. American Journal of Infection Control 2017;45 (1):17–23.
71. Keane E, Gilles HM. Lassa fever in Panguma Hospital, Sierra Leone, 1973-6. British Medical Journal 1977;1 (6073):1399–402.
72. Kerstiens B, Matthys F. Interventions to control virus transmission during an outbreak of Ebola hemorrhagic fever: experience from Kikwit, Democratic Republic of the Congo, 1995. Journal of Infectious Diseases 1999;179(suppl. 1):s263–7.
73. Kilinc-Balci FS, Nwoko J, Hillam T. Evaluation of the performance of isolation gowns. American Journal of Infection Control 2015;43(6):S44–.
74. Kilinc Balci FS. Isolation gowns in health care settings: Laboratory studies, regulations and standards, and potential barriers of gown selection and use. American Journal of Infection Control 2016;44(1):104–11.
75. Kim SG. Healthcare workers infected with Middle East respiratory syndrome coronavirus and infection control. Journal of the Korean Medical Association 2015;58(7): 647–54.
76. Ko PC, Chen WJ, Ma MH, Chiang WC, Su CP, Huang CH, et al. Emergency medical services utilization during an outbreak of severe acute respiratory syndrome (SARS) and the incidence of SARS-associated coronavirus infection among emergency medical technicians. Academic Emergency Medicine 2004;11(9):903–11.
77. Kratz T, Verbeek L. Discussion of two infection prevention and control training approaches to enhance biosafety in primary healthcare facilities during an outbreak of Ebola virus disease. Tropical Medicine and International Health 2017;22:167–.
78. Kwon JH, Burnham CD, Reske KA, Liang SY, Hink T, Wallace MA, et al. Assessment of healthcare worker protocol deviations and self-contamination during personal protective equipment donning and doffing. Infection Control and Hospital Epidemiology 2017;38(9):1077–83.
79. Lai TS, Keung Ng T, Seto WH, Yam L, Law KI, Chan J. Low prevalence of subclinical severe acute respiratory syndrome-associated coronavirus infection among hospital healthcare workers in Hong Kong. Scandinavian Journal of Infectious Diseases 2005;37(6/7):500/3.
80. Lai J, Guo Y, Or P, Li Y. Comparison of hand contamination rates and environmental contamination levels between two different glove removal methods and distances. American Journal of Infection Control 2011;39(2):104–11.
81. Lange JH. SARS, emerging diseases, healthcare workers and respirators. Journal of Hospital Infection 2005;60(3):293.
82. Lau JT, Fung KS, Wong TW, Kim JH, Wong E, Chung S, et al. SARS transmission among hospital workers in Hong Kong. Emerging Infectious Diseases 2004;10(2):280–6.
83. Le DH, Bloom SA, Nguyen QH, Maloney SA, Le QM, Leitmeyer KC, et al. Lack of SARS transmission among public hospital workers, Vietnam. Emerging Infectious Diseases 2004;10(2):265–8.
84. Lee MH, Meerbach A, Straub J, Neidhardt I, Gresser N, Gies S, et al. Which personal protective equipment to provide? Challenges during the Ebola outbreak and lessons learned. Tropical Medicine and International Health 2017; 22:29–.
85. Lindsley WG, King WP, Thewlis RE, Reynolds JS, Panday K, Cao G, et al. Dispersion and exposure to a cough-generated aerosol in a simulated medical examination room. Journal of Occupational and Environmental Hygiene 2012;9 (12):681–90.
86. Lindsley WG, Noti JD, Blachere FM, Szalajda JV, Beezhold DH. Efficacy of face shields against cough aerosol droplets from a cough simulator. Journal of Occupational and Environmental Hygiene 2014;11(8):509–18.
87. Liu W, Tang F, Fang LQ, de Vlas SJ, Ma HJ, Zhou JP, et al. Risk factors for SARS infection among hospital healthcare workers in Beijing: A case control study. Tropical Medicine and International Health 2009; Vol. 14, issue supplement 1:52–9.
88. Loeb M, McGeer A, Henry B, Ofner M, Rose D, Hlywka T, et al. SARS among critical care nurses, Toronto. Tropical Medicine and International Health 2004;10(2):251–5.
89. Low JG, Wilder-Smith A. Infectious respiratory illnesses and their impact on healthcare workers: a review. Annals of Academic Medicine Singapore 2005;34(1):105–10.
90. Lowe JJ, Jelden KC, Schenarts PJ, Rupp LE, Hawes KJ, Tysor BM, et al. Considerations for safe EMS transport of patients infected with Ebola virus. Prehospital Emergency Care 2015;19(2):179–83.
91. Lu YT, Chen PJ, Sheu CY, Liu CL. Viral load and outcome in SARS infection: The role of personal protective equipment in the emergency department. Journal of Emergency Medicine 2006;30(1):7–15.
92. Luo CH, Yang S, Wen CY, Syu MY, Lin KH, Chiu SH, et al. Fluorescent aerosol leakage quantification for protective clothing with an entropy-based image processor for industrial and medical workers. Journal of Aerosol Science 2011;42(7):491–6.
93. Ma HJ, Wang HW, Fang LQ, Jiang JF, Wei MT, Liu W, et al. [A case-control study on the risk factors of severe acute respiratory syndromes among health care workers]. Zhonghua Liu Xing Bing Xue Za Zhi 2004;25(9):741–4.
94. Malik MH, Handford E, Staniford E, Gambhir AK, Kay PR. Comfort assessment of personal protection systems during total joint arthroplasty using a novel multidimensional evaluation tool. Annals of the Royal College of Surgeons England 2006;88(5):465–9.
95. Marklund LA. Transporting patients with lethal contagious infections. International Journal of Trauma Nursing 2002;8 (2):51–3.
96. Matanock A, Arwady MA, Ayscue P, Forrester JD, Gaddis B, Hunter JC, et al. Ebola virus disease cases among health care workers not working in Ebola treatment units-Liberia, June-August, 2014. Morbidity and Mortality Weekly Report 2014;63(46):1077–81.
97. McLaws ML, Chughtai AA, Salmon S, MacIntyre CR. A highly precautionary doffing sequence for health care workers after caring for wet Ebola patients to further reduce occupational acquisition of Ebola. American journal of infection control 2016;44(7):740–4.
98. Mehtar S, Hakizimana B, Infection Control Africa Network Education and Training Working Group. IPC training in Sierra Leone-ICAN’s role in fighting Ebola. Antimicrobial Resistance and Infection Control 16 June 2015;4(Suppl 1):12.
99. Minnich G. A clean ride. Building EMS vehicles for easier cleaning & decontamination. JEMS: a journal of emergency medical services 2003;28(5):104–15.
100. Mollura DJ, Palmore TN, Folio LR, Bluemke DA. Radiology preparedness in Ebola virus disease: guidelines and challenges for disinfection of medical imaging equipment for the protection of staff and patients. Radiology 2015;275(2):538–44. PUBMED: 25654616]
101. Moore D, Gamage B, Bryce E, Copes R, Yassi A. Protecting health care workers from SARS and other respiratory pathogens: organizational and individual factors that affect adherence to infection control guidelines. American Journal of Infection Control 2005;33(2):114–21.
102. Morgan DJ, Diekema DJ, Sepkowitz K, Perencevich EN. Adverse outcomes associated with contact precautions: A review of the literature. American Journal of Infection Control 2009;37(2):85–93.
103. Mumma JM, Durso FT, Ferguson AN, Gipson CL, Casanova L, Erukunuakpor K, et al. Human factors risk analyses of a doffing protocol for Ebola-level personal protective equipment: Mapping errors to contamination. Clinical Infectious Diseases 2018;66(6):950–8.
104. Muyembe-Tamfum JJ, Kipasa M, Kiyungu C, Colebunders R. Ebola outbreak in Kikwit, Democratic Republic of the Congo: discovery and control measures. Journal of Infectious Diseases 1999;179(Suppl 1):S259–62.
105. Nikiforuk AM, Cutts TA, Theriault SS, Cook BWM. Challenge of liquid stressed protective materials and environmental persistence of Ebola virus. Scientific Reports 2017;7(1):4388–.
106. Nishiura H, Kuratsuji T, Quy T, Phi NC, Van Ban V, Ha LE, et al. Rapid awareness and transmission of severe acute respiratory syndrome in Hanoi French Hospital, Vietnam. American Journal of Tropical Medicine and Hygiene 2005;73 (1):17–25.
107. Northington WE, Mahoney GM, Hahn ME, Suyama J, Hostler D. Training retention of level C personal protective equipment use by emergency medical services personnel. Academic Emergency Medicine 2007;14(10):846–9.
108. Nyenswah T, Fallah M, Sieh S, Kollie K, Badio M, Gray A, et al. Controlling the last known cluster of Ebola virus disease-Liberia, January-February 2015. MMWR Morbidity and Mortality Weekly Report 2015;64(18):500–4. PUBMED: 25974635]
109. Ofner M, Lem M, Sarwal S, Vearncombe M, Simor A. Cluster of severe acute respiratory syndrome cases among protected health care workers-Toronto, April 2003. Canada Communicable Disease Report 2003;29(11):93–7.
110. Ofner-Agostini M, Gravel D, McDonald LC, Lem M, Sarwal S, McGeer A, et al. Cluster of cases of severe acute respiratory syndrome among Toronto healthcare workers after implementation of infection control precautions: A case series. Infection Control 2006;27(5):473–8.
111. Ogendo SW, Awori MN, Omondi MA, Mulatya EM, Mugo PW. Risk of conjunctival contamination from blood splashes during surgery at the Kenyatta National Hospital, Nairobi. East African Medical Journal 2008;85(9):432–7.
112. Ong MS, Magrabi F, Post J, Morris S, Westbrook J, Wobcke W, et al. Communication interventions to improve adherence to infection control precautions: A randomised crossover trial. BMC Infectious Diseases 2013;13:72.
113. Park BJ, Peck AJ, Kuehnert MJ, Newbern C, Smelser C, Comer JA, et al. Lack of SARS transmission among healthcare workers, United States. Emerging Infectious Diseases 2004;10(2):244–8.
114. Pei LY, Gao ZC, Yang Z, Wei DG, Wang SX, Ji JM, et al. Investigation of the influencing factors on severe acute respiratory syndrome among health care workers. Journal of Peking University (Health Sciences) 2006;38(3):271–5.
115. Phan L, Su YM, Weber R, Fritzen-Pedicini C, Edomwande O, Jones R M, et al. Environmental and body contamination from cleaning vomitus in a health care setting: A simulation study. American Journal of Infection Control 2018;46(4): 397–401.
116. Phrampus PE, O’Donnell JM, Farkas D, Abernethy D, Brownlee K, Dongilli T, et al. Rapid development and deployment of Ebola readiness training across an academic health system: The critical role of simulation education, consulting, and systems integration. Simulation in Healthcare 2016;11(2):82–8.
117. Quinn T, Kim JH, Seo Y, Coca A. Comparison of thermal manikin modeling and human subjects’ response during use of cooling devices under personal protective ensembles in the heat. Prehospital and Disaster Medicine 2018;33(4):1–9.
118. Ragazzoni L, Ingrassia PL, Echeverri L, Maccapani F, Berryman L, Burkle FM, et al. Virtual reality simulation training for Ebola deployment. Disaster Medicine and Public Health Preparedness 2015;9(5):543–6. PUBMED: 25782591]
119. Ransjo U. Attempts to control clothes-borne infection in a burn unit, 3. An open-roofed plastic isolator or plastic aprons to prevent contact transfer of bacteria. Journal of Hygiene (London) 1979;82(3):385–95.
120. Reynolds MG, Anh BH, Thu VH, Montgomery JM, Bausch DG, Shah JJ, et al. Factors associated with nosocomial SARS-CoV transmission among healthcare workers in Hanoi, Vietnam, 2003. BMC Public Health 2006;6:207. PUBMED: 16907978]
121. Rosenberg K, Zolot JPA. A simple intervention reduces contamination risk in health care personnel. AJN American Journal of Nursing 2016;116(1):64–5.
122. Russell CD, Young I, Leung V, Morris K. Healthcare workers’ decision-making about transmission-based infection control precautions is improved by a guidance summary card. The Journal of Hospital Infection 2015;90 (3):235–9. PUBMED: 25986167]
123. Scales DC, Green K, Chan AK, Poutanen SM, Foster D, Nowak K, et al. Illness in intensive care staff after brief exposure to severe acute respiratory syndrome. Emerging Infectious Diseases 2003;9(10):1205–10.
124. Schumacher J, Gray SA, Michel S, Alcock R, Brinker A. Respiratory protection during paediatric cardiopulmonary resuscitation. European Journal of Anaesthesiology 2011;28: 150.
125. Scott Taylor R, Pitzer M, Goldman G, Czysz A, Simunich T, Ashurst J. Comparison of intubation devices in level C personal protective equipment: A cadaveric study. The American Journal of Emergency Medicine 2017;36:922–5.
126. Seto WH, Tsang D, Yung RW, Ching TY, Ng TK, Ho M, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003;361(9368): 1519–20.
127. Shao X-p, Zhou Q, Ju J-t, Xin H-g, Chen J, Wan C-l, et al. Evaluation of anti-Ebola training system in the PLA Medical Team to Liberia and some suggestion. Academic Journal Of Second Military Medical University 2015;36(8): 822–7.
128. Sorensen P, Ejlertsen T, Aaen D, Poulsen K. Bacterial contamination of surgeons gloves during shunt insertion: a pilot study. British Journal of Neurosurgery 2008;22(5): 675–7.
129. Su YM, Phan L, Edomwande O, Weber R, Bleasdale SC, Brosseau LM, Fritzen-Pedicini C, Sikka M, Jones RM, CDC Prevention Epicenters Program. Contact patterns during cleaning of vomitus: a simulation study. Am J Infect Control 2017;45(12):1312–1317.
130. Tartari E, Allegranzi B, Ang B, Calleja N, Collignon P, Hopman J, et al. Preparedness of institutions around the world for managing patients with Ebola virus disease: An infection control readiness checklist. Antimicrobial Resistance and Infection Control 2015;4:22. PUBMED: 26056563]
131. Tartari E, Falzon Parascandalo AR, Borg MA. Ensuring healthcare workers’ safety in the management of Ebola virus disease: A novel competency assessment checklist for proper PPE use. Antimicrobial Resistance and Infection Control 2015;4:Suppl 1.
132. Teleman MD, Boudville IC, Heng BH, Zhu D, Leo YS. Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. Epidemiology and Infection 2004;132(5): 797–803.
133. Tomas ME, Kundrapu S, Thota P, Sunkesula VC, Cadnum JL, Mana TS, et al. Contamination of health care personnel during removal of personal protective equipment. JAMA Internal Medicine 2015;175(12):1904–10. PUBMED: 26457544]
134. Tomas ME, Cadnum JL, Mana TSC, Jencson AL, Koganti S, Alhmidi H. Utility of a novel reflective marker visualized by flash photography for assessment of personnel contamination during removal of personal protective equipment. Infection Control and Hospital Epidemiology 2016;37(6):711–3.
135. Torres M, Hansen KN, Jerrard D. Ebola: A review for emergency providers. Emergency Medicine Clinics of North America 2015;33(2):e1–18. PUBMED: 26065304]
136. West K. Ebola outbreak 2014. Why we don’t need moon suits. JEMS: a Journal of Emergency Medical Services 2014; 39(11):28–30.
137. Xi H, Cao J, Liu J, Li Z, Kong X, Wang Y, et al. Improving health care workers’ protection against infection of Ebola hemorrhagic fever through video surveillance. American Journal of Infection Control 2016;44(8):922–4.
138. Yin WW, Gao LD, Lin WS, Gao LD, Lin WS, Du L, et al. [Effectiveness of personal protective measures in prevention of nosocomial transmission of severe acute respiratory syndrome]. Zhonghua Liu Xing Bing Xue Za Zhi 2004;25 (1):18–22.
139. Zellmer C, Van Hoof S, Safdar N. Variation in health care worker removal of personal protective equipment. American Journal of Infection Control 2015;43(7):750–1. PUBMED: 26138659]
140. Zhou G, Qi Y, Li L. [Investigation report on the SARS infection rate of the second medical team of Peking University First Hospital]. Beijing Da Xue Xue Bao 2003;35 Suppl:59–61.
141. Chughtai AA, Chen X, Macintyre CR. Risk of self-contamination during doffing of personal protective equipment. Am J Infect Control 2018;46(12):1329–1334. DOI: 10.1016/j.ajic.2018.06.003; PUBMED: PMID: 30029796
142. Suen LKP, Guo YP, Tong DWK, Leung PHM, Lung D, Ng MSP, Lai TKH, Lo KYK, Au-Yeung CH, Yu W. Self-contamination during doffing of personal protective equipment by healthcare workers to prevent Ebola transmission. Antimicrob Resist Infect Control 2018;7:1.
143. ANSI/AAMI. PB70: Liquid barrier performance and classification of protective apparel and drapes in health care facilities. Association for the Advancement of Medical Instrumentation 2012.
144. Australian National Health and Medical Research Council. Australian guidelines for the prevention and control of infection in healthcare. http://www.nhmrc.gov.au/book/html-australian-guidelines-prevention-and-control-infection-healthcare-2010 (accessed 8 December 2014).
145. Campbell MK, Mollison J, Grimshaw JM. Cluster trials in implementation research: Estimation of intracluster correlation coefficients and sample size. Statistics in Medicine 2001;20(3):391–9.
146. Centers for Disease Control and Prevention (CDC). Outbreak of severe acute respiratory syndrome-worldwide, 2003. Morbidity and Mortality Weekly Report 2003;52(11): 226–8.
147. Center for Disease Control. Guidance on personal protective equipment to be used by healthcare workers during management of patients with Ebola virus disease in U.S. Hospitals, including procedures for putting on (donning) and removing (doffing). http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html (accessed 8 December 2014).
148. Cherrie JW, Semple S, Christopher Y, Saleem A, Hughson GW, Philips A. How important is inadvertent ingestion of hazardous substances at work?. Annals of Occupational Hygiene 2006;50(7):693–704. [PUBMED: 16840437]
149. Coia JE, Ritchie L, Adisesh A, Makison Booth C, Bradley C, Bunyan D, et al. Guidance on the use of respiratory and facial protection equipment. The Journal of Hospital Infection 2013;85(3):170–82.
150. Veritas Health Innovation. Covidence Systematic Review Software. Melbourne, Australia: Veritas Health Innovation, 2016.
151. De Iaco G, Puro V, Fusco FM, Schilling S, Maltezou HC, Brouqui P, et al. European network for highly infectious diseases working group. Personal protective equipment management and policies: European network for highly infectious diseases data from 48 isolation facilities in 16 European countries. Infection Control and Hospital Epidemiology 2012;33(10):1008–16.
152. [no authors listed]. Ebola: Protection of health workers on the front line. Lancet 2014; Vol. 384, issue 9942:470.
153. European Center for Disease Prevention and Control. Safe use of personal protective equipment in the treatment of infectious diseases of high consequence. ECDC. Stockholm, Sweden: ECDC. DOI: 10.2900/339505; ISBN 978–92–9193–612–0
154. CEN (European Committee for Standardization). EN 13795-2 Surgical drapes, gowns, clean air suits used as medical devices for patients, clinical staff and equipment. CEN (European Committee for Standardization) 2005.
155. CEN (European Committee for Standardization). CSN EN 14126 Protective clothing-Performance requirements and tests methods for protective clothing against infective agents. CEN (European Committee for Standardization) 2003.
156. European Commission. Council Directive 2010/32/EU of 10 May 2010 implementing the Framework Agreement on prevention from sharp injuries in the hospital and healthcare sector concluded by HOSPEEM and EPSU. http://eur-lex.europa.eu/legal-content/EN/TXT/?uri= CELEX:32010L0032 (accessed 30 March 2015).
157. Fischer WA 2nd, Hynes NA, Perl TM. Protecting health care workers from ebola: personal protective equipment is critical but is not enough. Annals of Internal Medicine 2014; 161(10):753–4.
158. Forrester JD, Hunter JC, Pillai SK, Arwady MA, Ayscue P, Matanock A, et al: Centers for Disease Control and Prevention (CDC). Cluster of Ebola cases among Liberian and U.S. health care workers in an Ebola treatment unit and adjacent hospital-Liberia, 2014. Morbidity and Mortality Weekly Report 2014; Vol. 63, issue 41:925–9.
159. Gershon RR, Vandelinde N, Magda LA, Pearson JM, Werner A, Prezant D. Evaluation of a pandemic preparedness training intervention of emergency medical services personnel. Prehospital and Disaster Medicine 2009; 24(6):508–11.
160. Gould DJ, Moralejo D, Drey N, Chudleigh JH. Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews 2010, Issue 9. DOI: 10.1002/14651858.CD005186.pub3
161. Brozek J, Oxman A, Schünemann H. GRADEpro. Version 3.2 for Windows. GRADE working group, 2008.
162. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org. Available from www.cochrane–handbook.org.
163. Howie RM. Respiratory protection use. Occupational Environmental Medicine 2005;62(6):423–8.
164. International Organization for Standardization (ISO). Clothing for protection against contact with blood and body fluids-Determination of resistance of protective clothing materials to penetration by blood-borne pathogens-Test method using Phi-X 174 bacteriophage ISO 166604: 2004. International Organization for Standardization 2004.
165. International Organization for Standardization (ISO). Clothing for protection against contact with blood and body fluids-Determination of the resistance of protective clothing materials to penetration by blood and body fluids-Test method using synthetic blood, ISO 16603:2004. International Organization for Standardization (ISO) 2004.
166. International Organization for Standardization (ISO). Protective clothing-Protection against chemicals-Determination of resistance of protective clothing materials to permeation by liquids and gases ISO 6529:2013. International Organization for Standardization (ISO) 2013.
167. Jefferson T, Foxlee R, Del Mar C, Dooley L, Ferroni E, Hewak B, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: Systematic review. BMJ 2008;12(7635):77–80.
168. Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database of Systematic Reviews 2011, Issue 7. DOI: 10.1002/14651858.CD006207.pub4; PUBMED: 21735402
169. Kilmarx PH, Clarke KR, Dietz PM, Hamel MJ, Husain F, McFadden JD, et al: Centers for Disease Control and Prevention (CDC). Ebola virus disease in health care workers-Sierra Leone, 2014. Morbidity and Mortality Weekly Report 2014;63(49):1168–71. [PUBMED: 25503921]
170. Kuklane K, Lundgren K, Gao C, Löndahl J, Hornyanszky ED, Östergren PO, et al. Ebola: Improving the design of protective clothing for emergency workers allows them to better cope with heat stress and help to contain the epidemic. Annals of Occupational Hygiene 2015;59(2): 258–61.
171. Landers T, McWalters J, Behta M, Bufe G, Ross B, Vawdrey DK, et al. Terms used for isolation practices by nurses at an academic medical center. Journal of Advanced Nursing 2010;66(10):2309–19. DOI: 10.1111/j.1365-2648.2010.05398.x; PUBMED: 20722801
172. Levy B, Rao CY, Miller L, Kennedy N, Adams M, Davis R, et al. Ebola infection control in Sierra Leonean health clinics: A large cross-agency cooperative project. American Journal of Infection Control 2015;43(7):752–5. DOI: 10.1016/j.ajic.2015.03.011; PUBMED: 25891979.
173. Luong Thanh BY, Laopaiboon M, Koh D, Sakunkoo P, Moe H. Behavioural interventions to promote workers’ use of respiratory protective equipment. Cochrane Database of Systematic Reviews 2016, Issue 12. DOI: 10.1002/14651858.CD010157.pub2
174. Makison Booth C. Vomiting Larry: A simulated vomiting system for assessing environmental contamination from projectile vomiting related to norovirus infection. Journal of Infection Prevention 2014;15(5):176–80.
175. Missair A, Marino MJ, Vu CN, Gutierrez J, Missair A, Osman B, et al. Anesthetic implications of Ebola patient management: A review of the literature and policies. Anesthesia and Analgesia 2014;121(3):810–21. DOI: 10.1213/ANE.0000000000000573; PUBMED: 25551317
176. Moon S, Sridhar D, Pate MA, Jha AK, Clinton C, Delaunay S, et al. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM independent panel on the global response to Ebola. Lancet 2015;386:2204–21. DOI: 10.1016/S0140-6736 (15)00946-0; PUBMED: 26615326
177. Mäkelä E, Mäkinen H. Protective clothing against chemical and biological hazards. http://oshwiki.eu/wiki/Protec-tive clothing against chemical and biological hazards# cite note-EN14126-11 (accessed 12 November 2014).
178. National Fire Protection Association. Standard on protective clothing for emergency medical operations. National Fire Protection Association 2013.
179. Nichol K, Bigelow P, O’Brien-Pallas L, McGeer A, Manno M, Holness DL. The individual, environmental, and organizational factors that influence nurses’ use of facial protection to prevent occupational transmission of communicable respiratory illness in acute care hospitals. American Journal of Infection Control 2008;36(7):481–7.
180. The National Institute for Occupational Safety and Health (NIOSH). Considerations for selecting protective clothing used in health care for protection against microorganisms in blood and body fluids. http://www.cdc.gov/niosh/npptl/topics/ProtectiveClothing/default.html (accessed 2 January 2015).
181. Occupational Safety & Health Administration (OSHA). Bloodborne pathogens. 1910.1030(d)(3) Personal Protective Equipment https://www.osha.gov/law–regs.html (accessed 10 December 2014).
182. Poller B, Hall S, Bailey C, Gregory S, Clark R, Roberts P, et al. ‘VIOLET’: A fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment. Journal of Hospital Infection 2018;99 (2):229–35.
183. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
184. Roberge RJ. Evaluation of the rationale for concurrent use of N95 filtering face piece respirators with loose-fitting powered air-purifying respirators during aerosol-generating medical procedures. American Journal of Infection Control 2008;36(2):135–41.
185. Roberge RJ. Effect of surgical masks worn concurrently over N95 filtering face piece respirators: extended service life versus increased user burden. Journal of Public Health Management and Practice 2008;14(2):E19–26.
186. Sterne JAC, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:e4919.
187. Verbeek JH, Mihalache RC. More PPE protects better against Ebola. American Journal of Infection Control 2016; Jun 1;44(6):731. DOI: 10.1016/j.ajic.2015.12.024; PUBMED: 26944010
188. Ward DJ. The role of education in the prevention and control of infection: A review of the literature. Nurse Education Today 2011;31(1):9–17.
189. World Health Organization (WHO). Health workers: a global profile. World Health Organization (WHO), Geneva 2006.
190. World Health Organization. WHO guidelines on hand hygiene in health care: A summary. http://www.who.int/gpsc/5may/tools/who guidelines-handhygiene summary.pdf (accessed 8 December 2014).
191. World Health Organization. Health worker Ebola infections in Guinea, Liberia and Sierra Leone. file:/ //C:/Users/jver/Desktop/Ebola%20update%202017/ WHO EVD SDS REPORT 2015.1 eng.pdf 21 May 2015:1–15.
192. WHO regional office for Africa. Overview of Ebola virus disease epidemic in West Africa. WHO regional office for Africa Outbreak Bulletin 2015; Vol. 5, issue 5:2–3.
193. World Health Organization. Personal protective equipment for use in a filovirus disease outbreak. Rapid advice guideline. WHO. Geneva, Switzerland: World Health Organization, 2016:1–53. [ISBN 978 92 4 154972 1 ]
194. WHO. Preferred Product Characteristics for Personal Protective Equipment for the Health Worker on the Frontline Responding to Viral Hemorrhagic Fevers in Tropical Climates. http://apps.who.int/medicinedocs/documents/s23448en/s23448en.pdf 2018:1–31. [ISBN 978–92–4–151415–6]
195. Yassi A, Moore D, Fitzgerald JM, Bigelow P, Hon CY, Bryce E: BC Interdisciplinary Respiratory Protection Study Group. Research gaps in protecting healthcare workers from SARS and other respiratory pathogens: An interdisciplinary, multi-stakeholder, evidence-based approach. Journal of Occupational and Environmental Medicine 2005;47(1): 41–50.
196. Zelnick JR, Gibbs A, Loveday M, Padayatchi N, O’Donnell MR. Health-care workers’ perspectives on workplace safety, infection control, and drug-resistant tuberculosis in a high-burden HIV setting. Journal of Public Health Policy 2013; 34(3):388–402.
197. Verbeek JH, Ijaz S, Mischke C, Ruotsalainen JH, Mäkelä E, Neuvonen K, Edmond MB, Sauni R, Kilinc Balci FS, Mihalache RC. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database of Systematic Reviews 2016, Issue 4. DOI: 10.1002/14651858.CD011621.pub2
198. Verbeek JH, Ijaz S, Mischke C, Ruotsalainen JH, Mäkelä E, Neuvonen K, Edmond MB, Garner P, Sauni R, Hopping K. Personal protective equipment for preventing highly infectious diseases due to contact with contaminated body fluids in health care staff. Cochrane Database of Systematic Reviews 2015, Issue 4. DOI: 10.1002/14651858.CD011621