Clinicians, administrators, and policy makers rely on evidence to make informed decisions. Systematic reviews (SRs) offer the most rigorous evidence, but typically take 6-18 months to complete. During the COVID-19 pandemic, Ontario hospitals were facing a shortage in personal protective equipment (PPE) and required answers within days. To address this need, we used our innovative web-based tool (insightScope), developed in partnership with the Social Innovation Lab at Algonquin College. insightScope is a systematic review platform designed to build a large online team, and crowdsource SR tasks. Between March-April 2020, we used insightScope to rapidly recruit a team from the >600 individuals on the platform. We then completed four SRs regarding the re-use of personal protective equipment (PPE), specifically the effectiveness of different sterilization techniques for surgical and N95 respirator masks. We completed each SR within ~7 days and shared them with key decision-makers.

Background:
Decision-makers rely on high-quality evidence. Systematic reviews (SR) synthesize all existing literature on a topic and are considered the highest level of evidence, but historically take 6-18 months to complete. During the COVID-19 pandemic, there was an urgent need to provide evidence to decision-makers within actionable timeframes. In 2018, our team launched insightScope: a web-based platform designed to accelerate SR completion by crowdsourcing SR tasks.
Objective:
With many Ontario hospitals facing shortages in personal protective equipment (PPE), our goal was to use insightScope to rapidly perform 4 comprehensive SR’s.
Results:
In March to April, 2020, our team used crowdsourcing and insightScope to complete four SRs related to PPE decontamination. We completed each SR within an average of 7 days. Together, these SRs involved screening 10,000 abstracts, retrieval and evaluation of hundreds of full-text articles, and extraction of thousands of data points. Despite the rapid pace, we maintained scientific rigor by developing SR protocols a priori and registering each review, using peer-reviewed search strategies developed by experienced information specialists, training the crowd, and reporting findings in alignment with current guidelines.
We have received numerous requests to share our findings with key decision makers (e.g. federal and provincial government) as well as several Canadian hospitals. We presented to NSERC, PHAC, CCCTG, and Children’s Healthcare Canada. There was also significant global interest (e.g. The UN, Cochrane Ireland, Oxford COVID Evidence Services). Based on the results of this work, we were able to secure $309,056 in subsequent grants to further develop and implement our novel SR methodology.
Conclusion:
Our innovative approach to SRs allowed us to rapidly generate evidence during the COVID-19 pandemic. This led to evidence-based policy recommendations related to PPE decontamination and re-use in Ontario.

Zorko et al Doi: doi: 10.1016/j.jhin.2020.07.007 (PMID: 32653432) https://pubmed.ncbi.nlm.nih.gov/32653432/

Gertsman S at al. Microwave- and heat-based decontamination of N95 filtering facepiece respirators: a systematic review. J Hosp Infect. 2020 Nov;106(3):536-553. doi: 10.1016/j.jhin.2020.08.016.

O’Hearn K at el. Efficacy and safety of disinfectants for decontamination of N95 and SN95 filtering facepiece respirators: a systematic review. J Hosp Infect. 2020 Nov;106(3):504-521. doi: 10.1016/j.jhin.2020.08.005.

O’Hearn K at al. Decontaminating N95 and SN95 masks with ultraviolet germicidal irradiation does not impair mask efficacy and safety. J Hosp Infect. 2020 Sep;106(1):163-175. doi: 10.1016/j.jhin.2020.07.014.

Zorko DJ et al. Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review. J Hosp Infect. 2020 Oct;106(2):283-294. doi: 10.1016/j.jhin.2020.07.007.