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A cluster randomised trial of cloth masks compared with medical masks in healthcare workers.
BMJ Open. 2015 Apr 22; 5(4):e006577.BO

Abstract

OBJECTIVE

The aim of this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs). The null hypothesis is that there is no difference between medical masks and cloth masks.

SETTING

14 secondary-level/tertiary-level hospitals in Hanoi, Vietnam.

PARTICIPANTS

1607 hospital HCWs aged ≥18 years working full-time in selected high-risk wards.

INTERVENTION

Hospital wards were randomised to: medical masks, cloth masks or a control group (usual practice, which included mask wearing). Participants used the mask on every shift for 4 consecutive weeks.

MAIN OUTCOME MEASURE

Clinical respiratory illness (CRI), influenza-like illness (ILI) and laboratory-confirmed respiratory virus infection.

RESULTS

The rates of all infection outcomes were highest in the cloth mask arm, with the rate of ILI statistically significantly higher in the cloth mask arm (relative risk (RR)=13.00, 95% CI 1.69 to 100.07) compared with the medical mask arm. Cloth masks also had significantly higher rates of ILI compared with the control arm. An analysis by mask use showed ILI (RR=6.64, 95% CI 1.45 to 28.65) and laboratory-confirmed virus (RR=1.72, 95% CI 1.01 to 2.94) were significantly higher in the cloth masks group compared with the medical masks group. Penetration of cloth masks by particles was almost 97% and medical masks 44%.

CONCLUSIONS

This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry: ACTRN12610000887077.

Authors+Show Affiliations

Faculty of Medicine, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.Faculty of Medicine, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.Faculty of Medicine, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.Faculty of Medicine, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.Institute for Clinical Pathology and Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia.Beijing Centers for Disease Control and Prevention, Beijing, China.

Pub Type(s)

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

Language

eng

PubMed ID

25903751

Citation

MacIntyre, C Raina, et al. "A Cluster Randomised Trial of Cloth Masks Compared With Medical Masks in Healthcare Workers." BMJ Open, vol. 5, no. 4, 2015, pp. e006577.
MacIntyre CR, Seale H, Dung TC, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open. 2015;5(4):e006577.
MacIntyre, C. R., Seale, H., Dung, T. C., Hien, N. T., Nga, P. T., Chughtai, A. A., Rahman, B., Dwyer, D. E., & Wang, Q. (2015). A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open, 5(4), e006577. https://doi.org/10.1136/bmjopen-2014-006577
MacIntyre CR, et al. A Cluster Randomised Trial of Cloth Masks Compared With Medical Masks in Healthcare Workers. BMJ Open. 2015 Apr 22;5(4):e006577. PubMed PMID: 25903751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. AU - MacIntyre,C Raina, AU - Seale,Holly, AU - Dung,Tham Chi, AU - Hien,Nguyen Tran, AU - Nga,Phan Thi, AU - Chughtai,Abrar Ahmad, AU - Rahman,Bayzidur, AU - Dwyer,Dominic E, AU - Wang,Quanyi, Y1 - 2015/04/22/ PY - 2015/4/24/entrez PY - 2015/4/24/pubmed PY - 2016/1/16/medline KW - Cloth mask KW - Influenza SP - e006577 EP - e006577 JF - BMJ open JO - BMJ Open VL - 5 IS - 4 N2 - OBJECTIVE: The aim of this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs). The null hypothesis is that there is no difference between medical masks and cloth masks. SETTING: 14 secondary-level/tertiary-level hospitals in Hanoi, Vietnam. PARTICIPANTS: 1607 hospital HCWs aged ≥18 years working full-time in selected high-risk wards. INTERVENTION: Hospital wards were randomised to: medical masks, cloth masks or a control group (usual practice, which included mask wearing). Participants used the mask on every shift for 4 consecutive weeks. MAIN OUTCOME MEASURE: Clinical respiratory illness (CRI), influenza-like illness (ILI) and laboratory-confirmed respiratory virus infection. RESULTS: The rates of all infection outcomes were highest in the cloth mask arm, with the rate of ILI statistically significantly higher in the cloth mask arm (relative risk (RR)=13.00, 95% CI 1.69 to 100.07) compared with the medical mask arm. Cloth masks also had significantly higher rates of ILI compared with the control arm. An analysis by mask use showed ILI (RR=6.64, 95% CI 1.45 to 28.65) and laboratory-confirmed virus (RR=1.72, 95% CI 1.01 to 2.94) were significantly higher in the cloth masks group compared with the medical masks group. Penetration of cloth masks by particles was almost 97% and medical masks 44%. CONCLUSIONS: This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry: ACTRN12610000887077. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/25903751/full_citation L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=25903751 DB - PRIME DP - Unbound Medicine ER -