A Randomized Clinical Trial of Three Options for N95 Respirators and Medical Masks in Health Workers

MacIntyre, C. Raina; Wang, Quanyi; Seale, Holly; Yang, Peng; Shi, Weixian; Gao, Zeyu; Rahman, Bayzid; Zhang, Yi; Wang, Xiaoli; Newall, Anthony T.; Heywood, Anita E.; Dwyer, Dominic E.

doi:10.1164/rccm.201207-1164oc

Cited by 178 publications

(256 citation statements)

References 40 publications

(58 reference statements)

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“…3 82 needs to be worn throughout the shift to be protective. 10 None of the four RCTs showed that medical masks were efficacious, although efficacy might have been at a lower level than the trials were able to detect. 9 10 Bacterial colonisation An analysis published in 2014 showed that laboratory confirmed bacterial colonisation (mainly Streptococcus pneumoniae and Haemophilus influenzae) is common in healthcare workers with symptoms of respiratory illness.…”

Section: Stat E O F T H E a Rt R Ev I E Wmentioning

confidence: 93%

“…We identified only four RCTs of the clinical efficacy of facemasks or respirators in healthcare workers, which studied a diverse range of interventions and outcomes ( fig 1). [7][8][9][10] The updated 2014 WHO guidelines on personal protective equipment (PPE) cite two of these four trials, 44 but exclude the larger two. 9 10 The first trial, which was carried out in healthcare workers in Japan, randomised 32 workers to a medical mask group or a control arm.…”

Section: Stat E O F T H E a Rt R Ev I E Wmentioning

confidence: 99%

“…The threat of pandemic A/H5N1 influenza and resultant pandemic planning drove the first RCTs of facemasks in various settings. [7][8][9][10][11][12][13][14][15][16][17][18][19] The aim of this review is to inform policy makers and stakeholders by examining and summarising the available evidence related to the efficacy of facemasks and respirators, current practice, and guidelines, as well as highlighting the gaps in evidence.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Facemasks for the prevention of infection in healthcare and community settings

MacIntyre

Chughtai

2015

BMJ

281

304

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Facemasks are recommended for diseases transmitted through droplets and respirators for respiratory aerosols, yet recommendations and terminology vary between guidelines. The concepts of droplet and airborne transmission that are entrenched in clinical practice have recently been shown to be more complex than previously thought. Several randomised clinical trials of facemasks have been conducted in community and healthcare settings, using widely varying interventions, including mixed interventions (such as masks and handwashing), and diverse outcomes. Of the nine trials of facemasks identified in community settings, in all but one, facemasks were used for respiratory protection of well people. They found that facemasks and facemasks plus hand hygiene may prevent infection in community settings, subject to early use and compliance. Two trials in healthcare workers favoured respirators for clinical respiratory illness. The use of reusable cloth masks is widespread globally, particularly in Asia, which is an important region for emerging infections, but there is no clinical research to inform their use and most policies offer no guidance on them. Health economic analyses of facemasks are scarce and the few published cost effectiveness models do not use clinical efficacy data. The lack of research on facemasks and respirators is reflected in varied and sometimes conflicting policies and guidelines. Further research should focus on examining the efficacy of facemasks against specific infectious threats such as influenza and tuberculosis, assessing the efficacy of cloth masks, investigating common practices such as reuse of masks, assessing compliance, filling in policy gaps, and obtaining cost effectiveness data using clinical efficacy estimates.

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Section: Stat E O F T H E a Rt R Ev I E Wmentioning

confidence: 93%

Section: Stat E O F T H E a Rt R Ev I E Wmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Facemasks for the prevention of infection in healthcare and community settings

MacIntyre

Chughtai

2015

BMJ

281

304

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“…However, no significant difference in confirmed viral infections (de-fined as a positive test from a symptomatic patient using a multiplex PCR to detect a group of respiratory pathogens including influenza) was found between the study arms. 17 This may reflect a true lack of difference between the 2 groups, or it may reflect an underpowering of the study to detect a difference. In the face of current uncertainties, CDC recommends the precautionary approach of using N95 respirators for influenza outbreaks that are greater in severity than seasonal strains to prevent severe cases of influenza among healthcare personnel.…”

Section: Discussionmentioning

confidence: 99%

Clinician Beliefs and Attitudes Regarding Use of Respiratory Protective Devices and Surgical Masks for Influenza

Pillai¹,

Beekmann²,

Babcock

et al. 2015

Health Security

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While influenza transmission is thought to occur primarily by droplet spread, the role of airborne spread remains uncertain. Understanding the beliefs and attitudes of infectious disease physicians regarding influenza transmission and respiratory and barrier protection preferences can provide insights into workplace decisions regarding respiratory protection planning. Physicians participating in the Infectious Diseases Society of America’s Emerging Infections Network were queried in November 2013 to determine beliefs and attitudes on influenza transmission. A subset of physicians involved in their facility’s respiratory protection decision making were queried about respirator and surgical mask choices under various pandemic scenarios; availability of, and challenges associated with, respirators in their facility; and protective strategies during disposable N95 shortages. The majority of 686 respondents (98%) believed influenza transmission occurs frequently or occasionally via droplets; 44% of respondents believed transmission occurs via small particles frequently (12%) or occasionally (32%). Among the subset of respondents involved in respiratory protection planning at their facility, over 90% preferred surgical masks during provision of non-aerosol-generating patient care for seasonal influenza. However, for the same type of care during an influenza pandemic, two-thirds of respondents opted for disposable N95 filtering facepiece respirators. In settings where filtering facepiece (disposable) N95 respirators were in short supply, preferred conservation strategies included extended use and reuse of disposable N95s. Use of reusable (elastomeric facepiece) respirator types was viewed less favorably. While respondents identified droplets as the primary mode of influenza transmission, during a high-severity pandemic scenario there was increased support for devices that reduced aerosol-based transmission. Use of potentially less familiar respirator types may partially relieve shortages of disposable N95s but also may require significant education efforts so that clinicians are aware of the characteristics of alternative personal protective equipment.

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“…Research shows that respirators provide better protection than masks for health workers, even when most of the pathogens identified are not spread by the airborne route (MacIntyre et al 2011;MacIntyre et al 2013), yet many bloggers positioned themselves as authoritative experts despite lacking any relevant expertise in the area. One blogger with a large following trivialized the need for respirators for health workers, even going as far as to say respirators were a "bad idea."…”

mentioning

confidence: 99%