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

Journal article

Kunstler, Breanne, Newton, Skye, Hill, Hayley, Ferguson, John, Hore, Phillipa, Mitchell, Brett G., Dempsey, Kathy, Stewardson, Andrew J., Friedman, Deborah, Cole, Kate, Sim, Malcolm R., Ferguson, Bridget, Burns, Penelope, King, Nicole, McGloughlin, Steven, Dicks, Melanie, McCarthy, Sally, Tam, Barry, Hazelton, Briony, ... Turner, Tari. (2022). P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection : Effectiveness & adverse effects. Infection, Disease and Health. 27(2), pp. 81-95. https://doi.org/10.1016/j.idh.2022.01.001
AuthorsKunstler, Breanne, Newton, Skye, Hill, Hayley, Ferguson, John, Hore, Phillipa, Mitchell, Brett G., Dempsey, Kathy, Stewardson, Andrew J., Friedman, Deborah, Cole, Kate, Sim, Malcolm R., Ferguson, Bridget, Burns, Penelope, King, Nicole, McGloughlin, Steven, Dicks, Melanie, McCarthy, Sally, Tam, Barry, Hazelton, Briony, McGurgan, Cherylynn, McDonald, Steve and Turner, Tari
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.

KeywordsCOVID-19; healthcare personnel; SARS-CoV-2; personal protective equipment; safety; cross infection
Year2022
JournalInfection, Disease and Health
Journal citation27 (2), pp. 81-95
PublisherElsevier B.V.
ISSN2468-0451
Digital Object Identifier (DOI)https://doi.org/10.1016/j.idh.2022.01.001
PubMed ID35151628
Scopus EID2-s2.0-85124398422
PubMed Central IDPMC8769935
Open accessPublished as ‘gold’ (paid) open access
Page range81-95
FunderDepartment of Health, Australian Government
Department of Health and Human Services, Victoria
Ian Potter Foundation
Walter Cottman Endowment Fund
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online20 Jan 2022
Publication process dates
Accepted05 Jan 2022
Deposited26 May 2025
Additional information

© 2022 The Author(s). Published by Elsevier B.V. on behalf of Australasian College for Infection Prevention and Control. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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