Universal Mask Usage for Reduction of Respiratory Viral Infections After Stem Cell Transplant: A Prospective Trial

Abstract

Background. Respiratory viral infections (RVIs) are frequent complications of hematopoietic stem cell transplant (HSCT). Surgical masks are a simple and inexpensive intervention that may reduce nosocomial spread.Methods. In this prospective single-center study, we instituted a universal surgical mask policy requiring all individuals with direct contact with HSCT patients to wear a surgical mask, regardless of symptoms or season. The primary endpoint was the incidence of RVIs in the mask period (2010-2014) compared with the premask period (2003)(2004)(2005)(2006)(2007)(2008)(2009).Results. RVIs decreased from 10.3% (95/920 patients) in the premask period to 4.4% (40/911) in the mask period (P < .001). Significant decreases occurred after both allogeneic (64/378 [16.9%] to 24/289 [8.3%], P = .001) and autologous (31/542 [5.7%] to 16/622 [2.6%], P = .007) transplants. After adjusting for multiple covariates including season and year in a segmented longitudinal analysis, the decrease in RVIs remained significant, with risk of RVI of 0.4 in patients in the mask group compared with the premask group (0.19-0.85, P = .02). In contrast, no decrease was observed during this same period in an adjacent hematologic malignancy unit, which followed the same infection control practices except for the mask policy. The majority of this decrease was in parainfluenza virus 3 (PIV3) (8.3% to 2.2%, P < .001).Conclusions. Requiring all individuals with direct patient contact to wear a surgical mask is associated with a reduction in RVIs, particularly PIV3, during the most vulnerable period following HSCT.

Efficacy of face mask in preventing respiratory virus transmission: a systematic review and meta-analysis

“…A flow diagram of the literature search and related screening process is shown in Figure 1. A total of 21 studies met our inclusion criteria [4, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35], including 12 case-control studies, 6 cluster randomized trials, 2 retrospective studies, and 1 cohort study (Table 1)…”

Consecutive yearly outbreaks of respiratory syncytial virus in a haemato-oncology ward and efficacy of infection control measures

“…When caring for RSVpositive patients our staff wore surgical masks. Implementation of a universal surgical mask policy, whereby all staff in direct contact with patients wore a mask, led to a significant reduction in respiratory viral illness in a haemopoeitic stem cell unit [14].…”

“…Prophylaxis in paediatric outbreaks of RSV is well described; however, studies into its use in adults are lacking [14]. Prophylactic administration of palivizumab was administered during a nosocomial outbreak involving five stem cell transplant patients in 2010.…”

The role of next generation sequencing in infection prevention in human parainfluenza virus 3 infections in immunocompromised patients

“…A recent large single center study had reported a reduction of RVIs in their HSCT unit from 10.3% to 4.4% by mandating universal surgical masks for all individuals in direct contact with HSCT patients in addition to standard infection control precautions (7). Of note, almost all the reduction in RVIs came from reduced incidence of HPIV3 infections with no significant reductions in the incidence of influenza A, B and respiratory syncytial virus (RSV) infections.…”