The question of the clinical evidence on the safety of different levels of wear compliance for respiratory protection remains unclear as no published studies or guidelines could be found. This is likely a result of the fact that in order to properly investigate this problem in a clinical situation there would be a need to recruit human volunteers who would then be at risk of severe illness. Alternatively investigation could use a retrospective analysis of HCW infections correlated to compliance for respirator use though no investigation of this type was identified for this review. The clinical evidence on the safety of repeated donning and doffing of respiratory protection is also limited. One study was found that investigated this problem and it was completed in a laboratory setting not in a working health care environment. This means that the results will have to be interpreted with caution when applied to real world settings. While the relevance of these results to actual healthcare environments is unclear, the authors demonstrated that extended donning and doffing practice resulted in an inability of the respirators to maintain full protective capability and that a maximum of 5 consecutive donning and doffing uses should be adhered to.

The evidence based guidelines that were found regarding wear compliance, donning and doffing, and reuse of respiratory protection were well written and contained step-by-step protocols. In addition they used pictorial representations for proper wear and methods for donning when it was appropriate. Along with this they provide recommendations on when it is appropriate to institute reuse or extended use practices and how these policies should be governed.