Patient safety implications of wearing a face mask for prevention in the era of COVID-19 pandemic: a systematic review and consensus recommendations

Abstract

In the past, the use of face masks in western countries was essentially limited to occupational health. Now, because of the COVID-19 pandemic, mask-wearing has been recommended as a public health intervention. As potential side effects and some contraindications are emerging, we reviewed the literature to assess the impact of them in daily life on patient safety and to provide appropriate guidelines and recommendations. We performed a systematic review of studies investigating physiological impact, safety, and risk of masks in predefined categories of patients, which have been published in peer-reviewed journals with no time and language restrictions. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. Wearing a N95 respirator is more associated with worse side effects than wearing a surgical mask with the following complications: breathing difficulties (reduced FiO 2 , SpO 2 , PaO 2 increased ETCO 2 , PaCO 2 ), psychiatric symptoms (panic attacks, anxiety) and skin reactions. These complications are related to the duration of use and/or disease severity. Difficulties in communication is another issue to be considered especially with young children, older person and people with hearing impairments. Even if benefits of wearing face masks exceed the discomfort, it is recommended to take an “air break” after 1–2 h consecutively of mask-wearing. However, well-designed prospective studies are needed. The COVID-19 pandemic could represent a unique opportunity for collecting large amount of real-world data. Supplementary Information The online version contains supplementary material available at 10.1007/s11739-022-03083-w.

Negative impact of face masks in patients with interstitial lung disease: A prospective study

“…According to the questionnaire valved FFP3 masks were rarely used by participants of our studythis might be due to accessibility and price (furthermore this mask type was not recommended/allowed by public authorities). Effects of FFP3 masks in healthy volunteers and patients have not been studied widely before [2].…”

“…Masks, however, might reduce breathing comfort and increase airway resistance, but data on the quantity of this effect are scarce, especially in patients with lung disease [2].…”

Riboflavin based setup as an alternative method for a preliminary screening of face mask filtration efficiency

“…Face masks can be defined as protective equipment with the primary function of reducing the transmission of airborne particles or droplets 1 . The use of face masks to prevent the transmission of respiratory infectious agents was limited to healthcare worker or to individuals to reduce the impact of air pollution, allergies, and risk of infection in immunosuppressed people 2 . More recently, with the COVID-19 pandemic, face masks have become widely used to limit the spread Sars-CoV-2 virus because airborne transmission was demonstrated as the main person-to-person transmission way in poorly ventilated indoor environments 3 , 4 .…”