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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included RCTs.
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Figure 1

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included RCTs.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included RCT.
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Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included RCT.

Comparison 1 Case‐control studies, Outcome 1 Thorough disinfection of living quarters.
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Analysis 1.1

Comparison 1 Case‐control studies, Outcome 1 Thorough disinfection of living quarters.

Comparison 1 Case‐control studies, Outcome 2 Frequent handwashing.
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Analysis 1.2

Comparison 1 Case‐control studies, Outcome 2 Frequent handwashing.

Comparison 1 Case‐control studies, Outcome 3 Wearing mask.
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Analysis 1.3

Comparison 1 Case‐control studies, Outcome 3 Wearing mask.

Comparison 1 Case‐control studies, Outcome 4 Wearing N95 respirator.
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Analysis 1.4

Comparison 1 Case‐control studies, Outcome 4 Wearing N95 respirator.

Comparison 1 Case‐control studies, Outcome 5 Wearing gloves.
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Analysis 1.5

Comparison 1 Case‐control studies, Outcome 5 Wearing gloves.

Comparison 1 Case‐control studies, Outcome 6 Wearing gowns.
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Analysis 1.6

Comparison 1 Case‐control studies, Outcome 6 Wearing gowns.

Comparison 1 Case‐control studies, Outcome 7 All interventions.
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Analysis 1.7

Comparison 1 Case‐control studies, Outcome 7 All interventions.

Comparison 1 Case‐control studies, Outcome 8 Use of eye protection (mask/goggles).
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Analysis 1.8

Comparison 1 Case‐control studies, Outcome 8 Use of eye protection (mask/goggles).

Comparison 1 Case‐control studies, Outcome 9 Nose wash.
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Analysis 1.9

Comparison 1 Case‐control studies, Outcome 9 Nose wash.

Table 1. Significance in multivariable analysis of interventions to prevent SARS

Outcome or subgroup

Studies

How many statistically significant on multivariable analysis

1.1 Thorough disinfection of living quarters

1

1

1.2 Frequent handwashing

7

4

1.3 Wearing mask

7

6

1.4 Wearing N95 respirator

3

2

1.5 Wearing gloves

6

2

1.6 Wearing gowns

5

2

1.7 All interventions

2

1

1.8 Use of eye protection (mask/goggles)

3

1

1.9 Nose wash

2

1

Figuras y tablas -
Table 1. Significance in multivariable analysis of interventions to prevent SARS
Table 2. Summary of main results

 

RCT (N = 6)

C‐RCT (N = 17)

Case‐control (N = 9)

Prospective cohort (N = 16)

Retrospective cohort (N = 6)

Before‐after (N = 13)

Handwashing

3 trials in children effective
1 trial in households effective if implemented < 36 hours after onset

7 studies OR 0.54 (95% CI 0.44 to 0.67)

2 studies found effect, 2 no effect on ARIs

1 study in military recruits: > 5 times per day effective

Handwashing with antiseptic

3 trials in children: 2 antiseptic more effective
1 antiseptic = soap

2 studies added effect of antiseptic
1 study: no difference

Handwashing and surface disinfection

4 trials in children and families: 2 studies effective

1 study in school effective

Hand disinfection

3 trials effective

Gargling with iodine

1 trial effective

Nose wash

2 studies OR 0.30 (95% CI 0.16 to 0.57)

Virucidal tissues

1 trial: small effect
2 trials: non‐significant

1 study effective

Disinfection of living quarters

1 study OR 0.30 (95% CI 0.23 to 0.39)

Use of eye protection

3 studies OR 0.10 (95% CI 0.05 to 0.17)

Barriers (masks, gloves, gowns combined)

2 studies OR 0.09 (95% CI 0.02 to 0.35)

1 study: masks + gowns no added effect to handwashing

3 studies: combined with isolation effective
1 study: mask and gown added to isolation not effective
1 study: gowns and gloves effective in paediatric ward

Mask

1 trial: surgical masks no effect

1 trial: no effect added to handwashing
1 trial: no effect of P2 mask

1 trial: added to handwashing effective if implemented < 36 hours after onset of illness

1 trial: added to handwashing effective during weeks 4 to 6

1 trial: no effect added to handwashing

7 studies OR 0.32 (95% CI 0.26 to 0.39)

3 studies: masks effective (with air filter safer)

1 study: harm related to mask wearing

1 study in children’s hospital effective

N95 respirator

1 trial: surgical masks non‐inferior to N95 respirators

3 studies OR 0.17 (95% CI 0.07 to 0.43)

1 study: harm related to N95 respirator wearing

Gloves

6 studies OR 0.32 (95% CI 0.23 to 0.45)

1 study: harm related to gloves

Gowns

5 studies OR 0.33 (95% CI 0.24 to 0.45)

1 study: harm related to gown wearing

1 study: no added effect in neonatal ICU

Distancing

1 study: no effect in military recruits
2 studies: cohorting in hospitals effective

1 study: cohorting in paediatric wards effective
1 study in military hospital cohorting with handwashing and gowns effective

6 studies: early identification of cases and isolation effective

Quarantine

1 study: isolation of close contacts effective

1 study: isolation of close contacts effective

1 study: marginal non‐significant benefit of border entry screening

ARI: acute respiratory infection
C‐RCT: cluster‐randomised controlled trial
ICU: intensive care unit
OR: odds ratio
RCT: randomised controlled trial

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Table 2. Summary of main results
Comparison 1. Case‐control studies

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Thorough disinfection of living quarters Show forest plot

1

990

Odds Ratio (M‐H, Fixed, 95% CI)

0.30 [0.23, 0.39]

2 Frequent handwashing Show forest plot

7

2825

Odds Ratio (M‐H, Fixed, 95% CI)

0.54 [0.44, 0.67]

3 Wearing mask Show forest plot

7

3216

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.26, 0.39]

4 Wearing N95 respirator Show forest plot

3

817

Odds Ratio (M‐H, Fixed, 95% CI)

0.17 [0.07, 0.43]

5 Wearing gloves Show forest plot

6

1836

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.23, 0.45]

6 Wearing gowns Show forest plot

5

1460

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.24, 0.45]

7 All interventions Show forest plot

2

369

Odds Ratio (M‐H, Fixed, 95% CI)

0.09 [0.02, 0.35]

8 Use of eye protection (mask/goggles) Show forest plot

3

1482

Odds Ratio (M‐H, Fixed, 95% CI)

0.10 [0.05, 0.17]

9 Nose wash Show forest plot

2

1225

Odds Ratio (M‐H, Fixed, 95% CI)

0.30 [0.16, 0.57]

Figuras y tablas -
Comparison 1. Case‐control studies