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Meta-Analysis
. 2022 May;27(2):81-95.
doi: 10.1016/j.idh.2022.01.001. Epub 2022 Jan 20.

P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection: Effectiveness & adverse effects

Breanne Kunstler  1 , Skye Newton  2 , Hayley Hill  2 , John Ferguson  3 , Phillipa Hore  4 , Brett G Mitchell  5 , Kathy Dempsey  6 , Andrew J Stewardson  7 , Deborah Friedman  8 , Kate Cole  9 , Malcolm R Sim  10 , Bridget Ferguson  11 , Penelope Burns  12 , Nicole King  13 , Steven McGloughlin  14 , Melanie Dicks  15 , Sally McCarthy  16 , Barry Tam  17 , Briony Hazelton  18 , Cherylynn McGurgan  19 , Steve McDonald  20 , Tari Turner  20
Affiliations
Meta-Analysis

P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection: Effectiveness & adverse effects

Breanne Kunstler et al. Infect Dis Health. 2022 May.

Abstract

Background: Millions of people have acquired and died from SARS-CoV-2 infection during the COVID-19 pandemic. Healthcare workers (HCWs) are required to wear personal protective equipment (PPE), including surgical masks and P2/N95 respirators, to prevent infection while treating patients. However, the comparative effectiveness of respirators and masks in preventing SARS-CoV-2 infection and the likelihood of experiencing adverse events (AEs) with wear are unclear.

Methods: Searches were carried out in PubMed, Europe PMC and the Cochrane COVID-19 Study Register to 14 June 2021. A systematic review of comparative epidemiological studies examining SARS-CoV-2 infection or AE incidence in HCWs wearing P2/N95 (or equivalent) respirators and surgical masks was performed. Article screening, risk of bias assessment and data extraction were duplicated. Meta-analysis of extracted data was carried out in RevMan.

Results: Twenty-one studies were included, with most having high risk of bias. There was no statistically significant difference in respirator or surgical mask effectiveness in preventing SARS-CoV-2 infection (OR 0.85, [95%CI 0.72, 1.01]). Healthcare workers experienced significantly more headaches (OR 2.62, [95%CI 1.18, 5.81]), respiratory distress (OR 4.21, [95%CI 1.46, 12.13]), facial irritation (OR 1.80, [95%CI 1.03, 3.14]) and pressure-related injuries (OR 4.39, [95%CI 2.37, 8.15]) when wearing respirators compared to surgical masks.

Conclusion: The existing epidemiological evidence does not enable definitive assessment of the effectiveness of respirators compared to surgical masks in preventing infection. Healthcare workers wearing respirators may be more likely to experience AEs. Effective mitigation strategies are important to ensure the uptake and correct use of respirators by HCWs.

Keywords: COVID-19; Cross infection; Healthcare personnel; Personal protective equipment; SARS-CoV-2; Safety.

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Figures

Figure 1
Figure 1
PRISMA flow chart. Template adapted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372:n71. https://doi.org/10.1136/bmj.n71.
Figure 2
Figure 2
The odds of SARS-CoV-2 infection in healthcare workers who wore surgical masks compared to those who wore respirators in the clinical setting. Note: Fletcher et al., 2021, collected infection data at two time points (Fletcher 2021a: Aug 17-Sep 4 2020, Fletcher 2021b: Dec 2–23 2020). Those who tested positive at the first time point were excluded from analysis at the second time point.
Figure 3
Figure 3
The odds of healthcare workers experiencing adverse events from wearing surgical masks compared to respirators in the clinical setting.
See this image and copyright information in PMC

References

    1. Cucinotta D., Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157–160. doi: 10.23750/abm.v91i1.9397. - DOI - PMC - PubMed
    1. Li Q., Guan X., Wu P., Wang X., Zhou L., Tong Y., et al. Early transmission dynamics in wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199–1207. doi: 10.1056/NEJMoa2001316. - DOI - PMC - PubMed
    1. Liu Y., Ning Z., Chen Y., Guo M., Liu Y., Gali N., et al. Aerodynamic analysis of SARS-CoV-2 in two wuhan hospitals. Nature. 2020;582(7813):557–560. doi: 10.1038/s41586-020-2271-3. - DOI - PubMed
    1. Locke L., Dada O., Shedd J. Aerosol transmission of infectious disease and the efficacy of personal protective equipment (PPE): a systematic review. J Occup Environ Med. 2021 doi: 10.1097/JOM.0000000000002366. - DOI - PMC - PubMed
    1. National Health and Medical Research Council . 2019. Australian guidelines for the prevention and control of infection in healthcare Canberra: Commonwealth of Australia.https://files.magicapp.org/guideline/d4b5b8a9-4745-4f0f-b675-f6fcb41d01a... [Available from: Accessed.

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