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A randomized clinical trial of three options for N95 respirators and medical masks in health workers.
Am J Respir Crit Care Med. 2013 May 01; 187(9):960-6.AJ

Abstract

RATIONALE

We compared three policy options for the use of medical masks and N95 respirators in healthcare workers (HCWs).

OBJECTIVES

A cluster randomized clinical trial of 1,669 hospital-based HCWs in Beijing, China in the winter of 2009-2010.

METHODS

Participants were randomized to medical masks, N95 respirators, or targeted use of N95 respirators while doing high-risk procedures or barrier nursing. Outcomes included clinical respiratory illness (CRI) and laboratory-confirmed respiratory pathogens in symptomatic subjects.

MEASUREMENTS AND MAIN RESULTS

The rate of CRI was highest in the medical mask arm (98 of 572; 17%), followed by the targeted N95 arm (61 of 516; 11.8%), and the N95 arm (42 of 581; 7.2%) (P < 0.05). Bacterial respiratory tract colonization in subjects with CRI was highest in the medical mask arm (14.7%; 84 of 572), followed by the targeted N95 arm (10.1%; 52 of 516), and lowest in the N95 arm (6.2%; 36 of 581) (P = 0.02). After adjusting for confounders, only continuous use of N95 remained significant against CRI and bacterial colonization, and for just CRI compared with targeted N95 use. Targeted N95 use was not superior to medical masks.

CONCLUSIONS

Continuous use of N95 respirators was more efficacious against CRI than intermittent use of N95 or medical masks. Most policies for HCWs recommend use of medical masks alone or targeted N95 respirator use. Continuous use of N95s resulted in significantly lower rates of bacterial colonization, a novel finding that points to more research on the clinical significance of bacterial infection in symptomatic HCWs. This study provides further data to inform occupational policy options for HCWs. Clinical trial registered with Australian New Zealand Clinical Trials Registry http://www.anzctr.org.au (ACTRN 12609000778280).

Authors+Show Affiliations

School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia. r.macintyre@unsw.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23413265

Citation

MacIntyre, C Raina, et al. "A Randomized Clinical Trial of Three Options for N95 Respirators and Medical Masks in Health Workers." American Journal of Respiratory and Critical Care Medicine, vol. 187, no. 9, 2013, pp. 960-6.
MacIntyre CR, Wang Q, Seale H, et al. A randomized clinical trial of three options for N95 respirators and medical masks in health workers. Am J Respir Crit Care Med. 2013;187(9):960-6.
MacIntyre, C. R., Wang, Q., Seale, H., Yang, P., Shi, W., Gao, Z., Rahman, B., Zhang, Y., Wang, X., Newall, A. T., Heywood, A., & Dwyer, D. E. (2013). A randomized clinical trial of three options for N95 respirators and medical masks in health workers. American Journal of Respiratory and Critical Care Medicine, 187(9), 960-6. https://doi.org/10.1164/rccm.201207-1164OC
MacIntyre CR, et al. A Randomized Clinical Trial of Three Options for N95 Respirators and Medical Masks in Health Workers. Am J Respir Crit Care Med. 2013 May 1;187(9):960-6. PubMed PMID: 23413265.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized clinical trial of three options for N95 respirators and medical masks in health workers. AU - MacIntyre,C Raina, AU - Wang,Quanyi, AU - Seale,Holly, AU - Yang,Peng, AU - Shi,Weixian, AU - Gao,Zhanhai, AU - Rahman,Bayzid, AU - Zhang,Yi, AU - Wang,Xiaoli, AU - Newall,Anthony T, AU - Heywood,Anita, AU - Dwyer,Dominic E, PY - 2013/2/16/entrez PY - 2013/2/16/pubmed PY - 2013/6/29/medline SP - 960 EP - 6 JF - American journal of respiratory and critical care medicine JO - Am J Respir Crit Care Med VL - 187 IS - 9 N2 - RATIONALE: We compared three policy options for the use of medical masks and N95 respirators in healthcare workers (HCWs). OBJECTIVES: A cluster randomized clinical trial of 1,669 hospital-based HCWs in Beijing, China in the winter of 2009-2010. METHODS: Participants were randomized to medical masks, N95 respirators, or targeted use of N95 respirators while doing high-risk procedures or barrier nursing. Outcomes included clinical respiratory illness (CRI) and laboratory-confirmed respiratory pathogens in symptomatic subjects. MEASUREMENTS AND MAIN RESULTS: The rate of CRI was highest in the medical mask arm (98 of 572; 17%), followed by the targeted N95 arm (61 of 516; 11.8%), and the N95 arm (42 of 581; 7.2%) (P < 0.05). Bacterial respiratory tract colonization in subjects with CRI was highest in the medical mask arm (14.7%; 84 of 572), followed by the targeted N95 arm (10.1%; 52 of 516), and lowest in the N95 arm (6.2%; 36 of 581) (P = 0.02). After adjusting for confounders, only continuous use of N95 remained significant against CRI and bacterial colonization, and for just CRI compared with targeted N95 use. Targeted N95 use was not superior to medical masks. CONCLUSIONS: Continuous use of N95 respirators was more efficacious against CRI than intermittent use of N95 or medical masks. Most policies for HCWs recommend use of medical masks alone or targeted N95 respirator use. Continuous use of N95s resulted in significantly lower rates of bacterial colonization, a novel finding that points to more research on the clinical significance of bacterial infection in symptomatic HCWs. This study provides further data to inform occupational policy options for HCWs. Clinical trial registered with Australian New Zealand Clinical Trials Registry http://www.anzctr.org.au (ACTRN 12609000778280). SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/23413265/A_randomized_clinical_trial_of_three_options_for_N95_respirators_and_medical_masks_in_health_workers_ L2 - https://www.atsjournals.org/doi/10.1164/rccm.201207-1164OC?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -