Objectives To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types.
Design Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare.
Data sources Websites of international standards organisations, Medline and Embase, hand-searching of references and citations.
Study selection Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use.
Results We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators.
Conclusion A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.
- occupational health
- health personnel
- international health regulations
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Contributors The article was collaboratively developed as part of a wider series of evidence reviews on personal protective equipment edited by TG and overseen by the Oxford Covid-19 Evidence Review Service. SS conceptualised the review and undertook extensive background desk research on respirator standards. CB led the shaping of the methodology to align with formal systematic review guidance, led the synthesis and wrote the first draft of the paper, to which all authors made contributions. CB and SS undertook searches. CB and BC contributed to data extraction. AA provided specialist occupational medicine expertise. XHSC and LR provided specialist infection control expertise. All authors approved the final manuscript. CB is corresponding author and guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests SS recently retired from a scientific research position at a major manufacturer of respiratory protective equipment.
Provenance and peer review Not commissioned; externally peer reviewed.
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