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The efficacy of medical masks and respirators against respiratory infection in healthcare workers.
Influenza Other Respir Viruses. 2017 11; 11(6):511-517.IO

Abstract

OBJECTIVE

We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs).

METHODS

The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory-confirmed viral respiratory infection, influenza A or B, laboratory-confirmed bacterial colonisation and pathogens grouped by mode of transmission.

RESULTS

Rates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory-confirmed bacterial colonisation (RR 0.33, 95% CI 0.21-0.51), laboratory-confirmed viral infections (RR 0.46, 95% CI 0.23-0.91) and droplet-transmitted infections (RR 0.26, 95% CI 0.16-0.42) were significantly lower in the continuous N95 arm. Laboratory-confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10-1.11), but the difference was not statistically significant. Rates of laboratory-confirmed bacterial colonisation (RR 0.54, 95% CI 0.33-0.87) and droplet-transmitted infections (RR 0.43, 95% CI 0.25-0.72) were also lower in the targeted N95 arm, but not in medical mask arm.

CONCLUSION

The results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as "airborne precautions," provide superior protection for droplet-transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines.

Authors+Show Affiliations

School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia. College of Public Service & Community Solutions, and College of Health Solutions, Arizona State University, Phoenix, AZ, USA.School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.The Beijing Centre for Disease Prevention and Control, Beijing, China.The Beijing Centre for Disease Prevention and Control, Beijing, China.School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.The Beijing Centre for Disease Prevention and Control, Beijing, China.The Beijing Centre for Disease Prevention and Control, Beijing, China.

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28799710

Citation

MacIntyre, Chandini Raina, et al. "The Efficacy of Medical Masks and Respirators Against Respiratory Infection in Healthcare Workers." Influenza and Other Respiratory Viruses, vol. 11, no. 6, 2017, pp. 511-517.
MacIntyre CR, Chughtai AA, Rahman B, et al. The efficacy of medical masks and respirators against respiratory infection in healthcare workers. Influenza Other Respir Viruses. 2017;11(6):511-517.
MacIntyre, C. R., Chughtai, A. A., Rahman, B., Peng, Y., Zhang, Y., Seale, H., Wang, X., & Wang, Q. (2017). The efficacy of medical masks and respirators against respiratory infection in healthcare workers. Influenza and Other Respiratory Viruses, 11(6), 511-517. https://doi.org/10.1111/irv.12474
MacIntyre CR, et al. The Efficacy of Medical Masks and Respirators Against Respiratory Infection in Healthcare Workers. Influenza Other Respir Viruses. 2017;11(6):511-517. PubMed PMID: 28799710.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The efficacy of medical masks and respirators against respiratory infection in healthcare workers. AU - MacIntyre,Chandini Raina, AU - Chughtai,Abrar Ahmad, AU - Rahman,Bayzidur, AU - Peng,Yang, AU - Zhang,Yi, AU - Seale,Holly, AU - Wang,Xiaoli, AU - Wang,Quanyi, Y1 - 2017/08/30/ PY - 2017/07/22/accepted PY - 2017/8/12/pubmed PY - 2018/8/1/medline PY - 2017/8/12/entrez KW - droplet infections KW - healthcare workers KW - influenza KW - masks KW - medical masks KW - respirators SP - 511 EP - 517 JF - Influenza and other respiratory viruses JO - Influenza Other Respir Viruses VL - 11 IS - 6 N2 - OBJECTIVE: We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs). METHODS: The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory-confirmed viral respiratory infection, influenza A or B, laboratory-confirmed bacterial colonisation and pathogens grouped by mode of transmission. RESULTS: Rates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory-confirmed bacterial colonisation (RR 0.33, 95% CI 0.21-0.51), laboratory-confirmed viral infections (RR 0.46, 95% CI 0.23-0.91) and droplet-transmitted infections (RR 0.26, 95% CI 0.16-0.42) were significantly lower in the continuous N95 arm. Laboratory-confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10-1.11), but the difference was not statistically significant. Rates of laboratory-confirmed bacterial colonisation (RR 0.54, 95% CI 0.33-0.87) and droplet-transmitted infections (RR 0.43, 95% CI 0.25-0.72) were also lower in the targeted N95 arm, but not in medical mask arm. CONCLUSION: The results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as "airborne precautions," provide superior protection for droplet-transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines. SN - 1750-2659 UR - https://www.unboundmedicine.com/medline/citation/28799710/The_efficacy_of_medical_masks_and_respirators_against_respiratory_infection_in_healthcare_workers_ L2 - https://doi.org/10.1111/irv.12474 DB - PRIME DP - Unbound Medicine ER -