Effectiveness of using full personal protective equipment in reducing the transmission of SARS-CoV-2 in health care workers: A systematic review - 08/12/25

Doi : 10.1016/j.ajic.2025.11.013

Juliette Gagnon, MD ^a,^b, Myriam Naïmi, MD ^b,^c, Frederic Bergeron, MSI ^d, Yves Longtin, MD ^e, Judith Villeneuve, BSc ^b, Katia Boudaoud, MD ^b, Daphnée Jolicoeur-Ouellette, MD ^b, Hong Hao Xu, MD ^b, Émile Cormier, MD ^b, Jason R. Guertin, PhD ^b,^f,^g, Tania Marx, MD, PhD ^h, Judicaël Adadja, MD, MSc ^b, Ariane Bluteau, MSc ^b, Simon Berthelot, MD, MSc ^b,^i,^⁎

^a Département d′anesthésiologie et de soins intensifs, Université Laval, Québec, Quebec, Canada

^b Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Quebec, Canada

^c Département de médecine interne, Université de Montréal, Québec, Quebec, Canada

^d Bibliothèque-Direction des services-conseils, Université Laval, Québec, Quebec, Canada

^e Département d′infectiologie, Université McGill, Montréal, Quebec, Canada

^f Département de médecine sociale et préventive, Université Laval, Québec, Quebec, Canada

^g Centre de recherche en organogénèse expérimentale de l′Université Laval/LOEX, Québec, Quebec, Canada

^h Département de médecine d′urgence, Centre Hospitalier Universitaire de Besançon, Besançon, France

ⁱ Département de médecine de famille et de médecine d′urgence, Université Laval, Québec, Quebec, Canada

^⁎ Address correspondence to Simon Berthelot, MD, MSc, 2705 Boul. Laurier, Québec City, QC G1V 4G2, Canada. 2705 Boul. Laurier Québec City QC G1V 4G2 Canada

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Résumé

Background

This systematic review aimed to assess the effectiveness of full personal protective equipment (PPE) in preventing COVID-19 transmission among health care workers.

Methods

Studies published from December 2019 to August 2024 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, Epistemonikos, ClinicalTrials.gov, MedRxiv, and Web of Science. Full PPE was defined as the combination of respiratory protection (surgical mask, N95, or equivalents), eye protection (visor or goggles), gown, and gloves, as recommended by the World Health Organization (WHO). The comparator was partial PPE or no PPE. Two reviewers independently performed screening, data extraction, and risk of bias assessment. The review was registered on PROSPERO (CRD4202230259).

Results

Eight observational studies were included; 4 showed a significant reduction in transmission with full PPE. Seven studies compared full to partial PPE, and 1 compared full PPE to no protection. Among studies with significant results, odds ratios ranged from 0.03 to 0.6. Risk of bias was critical in 6 studies and serious in 2. No meta-analysis was performed due to study quality.

Conclusion

Full PPE appears protective for health care workers. The small number and low quality of studies limit the certainty of this conclusion. Further analyses are required to establish clear guideline for its use.

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Highlights

•	Full personal protective equipment reduces SARS-CoV-2 transmission among health care workers.
•	Included studies had a high risk of bias, limiting the strength of the conclusions.
•	This review will help strengthen personal protective equipment use guidelines.

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Key Words : SARS-CoV-2 infection, COVID-19 infection, Health care worker