Availability, consistency and evidence-base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis

Abstract

BackgroundCurrently there is an ongoing debate and limited evidence on the use of masks and respirators for the prevention of respiratory infections in health care workers (HCWs). This study aimed to examine available policies and guidelines around the use of masks and respirators in HCWs and to describe areas of consistency between guidelines, as well as gaps in the recommendations, with reference to the WHO and the CDC guidelines.MethodsPolicies and guidelines related to mask and respirator use for the prevention of influenza, SARS and TB were examined. Guidelines from the World Health Organization (WHO), the Center for Disease Control and Prevention (CDC), three high-income countries and six low/middle-income countries were selected.ResultsUniform recommendations are made by the WHO and the CDC in regards to protecting HCWs against seasonal influenza (a mask for low risk situations and a respirator for high risk situations) and TB (use of a respirator). However, for pandemic influenza and SARS, the WHO recommends mask use in low risk and respirators in high risk situations, whereas, the CDC recommends respirators in both low and high risk situations. Amongst the nine countries reviewed, there are variations in the recommendations for all three diseases. While, some countries align with the WHO recommendations, others align with those made by the CDC. The choice of respirator and the level of filtering ability vary amongst the guidelines and the different diseases. Lastly, none of the policies discuss reuse, extended use or the use of cloth masks.ConclusionCurrently, there are significant variations in the policies and recommendations around mask and respirator use for protection against influenza, SARS and TB. These differences may reflect the scarcity of level-one evidence available to inform policy development. The lack of any guidelines on the use of cloth masks, despite widespread use in many low and middle-income countries, remains a policy gap. Health organizations and countries should jointly evaluate the available evidence, prioritize research to inform evidence gaps, and develop consistent policy on masks and respirator use in the health care setting.

Facemasks for the prevention of infection in healthcare and community settings

“…Elastomeric respirators (reusable full face respirators with a changeable cartridge) and powered air purifying respirators are increasingly recommended in the healthcare setting but have not been tested in an RCT. 148 Another limitation of the available facemask studies is the mixing of interventions. In four trials in the community setting facemasks were combined with hand hygiene as an intervention, which makes it difficult to ascertain the efficacy of masks alone.…”

Current practices and barriers to the use of facemasks and respirators among hospital-based health care workers in Vietnam

“…4,5 But even though this practice is highly recommended, actual policies and practices regarding the use of facemasks and respirators vary. 6 For example, whereas the WHO and CDC have the same policy on the use of facemasks/respirators for seasonal influenza, tuberculosis, and ebola virus infection, 4,7-11 they have different recommendations for pandemic influenza and MERS-CoV. 4,12,13 Low-and middle-income countries generally adopt policies and guidelines of the WHO and/ or the CDC.…”

Practices around the use of masks and respirators among hospital health care workers in 3 diverse populations

“…The data suggest that hospitals generally do not follow national policies and guidelines regarding the types of masks and respirators that should be used. 1 Varying practices around the use of masks and respirators at the facility level might be caused by conflicting guidance from the World Health Organization and Centers for Disease Control and Prevention 1,2 and the availability of the certain type of masks and respirators in the hospitals. 4 Although respirators are reported to be more protective than medical masks, 2 few hospitals in this study reported using respirators; and among those that did, registered adherence with comprehensive respiratory protection programs (ie, regulations, medical evaluation, training, fit testing) appeared to be low.…”

“…Survey questions focused on policies and practices around mask and respirator use against influenza and tuberculosis (TB). 1 Clean samples of mask and respirators were also collected and examined for design, size, material manufactured from, and number of layers. After the gross examination, 25 different types of masks and respirators were identified as being used across the 3 countries and tested for particle filtration efficiency.…”

“…1,2 Although health agencies and governments may advocate for certain practices, in reality behaviors occurring in individual organizations may be very different. This study aimed to examine the clinical practices occurring in hospital departments from low-and middle-income countries around the use of masks and respirators.…”