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

BMC Research Notes

Chandini Raina MacIntyre²  Holly Seale¹  Abrar Ahmad Chughtai¹ 

[1] School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney2052, Australia;National Centre for Immunization Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children’s Hospital, Westmead, Australia

关键词: Respirators;    Masks;    Tuberculosis (TB);    Sever Acute Respiratory Syndrome (SARS);    Pandemic influenza;    Seasonal influenza;    Infectious diseases;   

Others  :  1142590
DOI  :  10.1186/1756-0500-6-216

 received in 2013-03-05, accepted in 2013-05-21,  发布年份 2013

【 摘 要 】

Background

Currently 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.

Methods

Policies 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.

Results

Uniform 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.

Conclusion

Currently, 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.

【 授权许可】

   
2013 Chughtai et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Siegel JD, Rhinehart E, Jackson M, Chiarello L: Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control [Guideline] 2007, 35(10 Suppl 2):S65-S164.
• [2]Safety O, Administration H: Pandemic influenza preparedness and response guidance for. U.S. Department of Labor: Healthcare Workers and Healthcare Employers; 2009.
• [3]Institute of Medicine (IOM) National Academy of Sciences: Preventing transmission of pandemic influenza and other viral respiratory diseases: personal protective equipment for healthcare personnel update 201. Washington D.C: The National Academies Pres; 2010.
• [4]Department of Health and Aging Australia: Australian health management plan for pandemic influenza. 2009. http://www.health.gov.au/internet/panflu/publishing.nsf/Content/B11402BB723E0B78CA25781E000F7FBB/$File/ahmppi-2009.pdf webcite
• [5]Shine K, Rogers B, Goldfrank L: Novel H1N1 influenza and respiratory protection for health care workers. Massachusetts Medical Society: The New England Hournal of Medicine; 2009.
• [6]Balazy A, Toivola M, Adhikari A, Sivasubramani SK, Reponen T, Grinshpun SA: Do N95 respirators provide 95% protection level against airborne viruses, and how adequate are surgical masks? Am J Infect Control 2006, 34(2):51-57.
• [7]Lawrence RB, Duling MG, Calvert CA, Coffey CC, Lawrence RB, Duling MG, et al.: Comparison of performance of three different types of respiratory protection devices. Journal of occupational & environmental hygiene. [Comparative Study Evaluation Studies] 2006, 3(9):465-474.
• [8]Weber A, Willeke K, Marchioni R, Myojo T, McKay R, Donnelly J, et al.: Aerosol penetration and leakage characteristics of masks used in the health care industry. Am J Infect Control 1993, 21(4):167-173.
• [9]Derrik J, Gomersall C: Protecting healthcare staff from severe acute respiratory syndrome: filtration capacity of multiple surgical masks. J Hosp Infect 2004, 59:365-368.
• [10]Ministry of Health PR China: The guiding principles to protect HCWS from atypical pneumonia. 2005.
• [11] : Chinese center for disease control and prevention. Type a H1N1 influenza nosocomial infection control guideline. 2009.
• [12]Ministry of Health. Socialist Republic of Vietnam: Guidelines on the issuance of diagnosis and treatment of flu season. 2011.
• [13]World Health Organization (WHO): Infection prevention and control during health care for confirmed, probable, or suspected cases of pandemic (H1N1) 2009 virus infection and influenza like illnesses. Available from: http://www.who.int/csr/resources/publications/cp150_2009_1612_ipc_interim_guidance_h1n1.pdf webcite
• [14]World Health Organization (WHO): Epidemic-prone & pandemic-prone acute respiratory diseases: Infection prevention and control in health-care facilities. http://www.who.int/csr/resources/publications/WHO_CDS_EPR_2007_8/en/ webcite. 2007
• [15]Center for Disease Control and Prevention (CDC): Prevention strategies for seasonal influenza in healthcare settings. [cited 2012 15 May]; Available from: http://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm#settings webcite
• [16]Health Protection Agency UK: Infection control precautions to minimise transmission of respiratory tract infections (RTIs) in the healthcare setting. http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1317131892566 webcite. 2012
• [17]National Health and Medical Research Council (NHMRC): Australian guideline for the prevention and control of infection in healthcare. Australian Government; 2010. http://www.nhmrc.gov.au/node/30290 webcite
• [18]Ministry of Health and Family Welfare. Government of India: Pandemic influenza a H1N1. Guidelines on use of masks for health care workers, patients and members of public. http://mohfw-h1n1.nic.in/Guidelines.html webcite
• [19]Ministry of Health Pakistan: National guidelines of influenza A/H1N1 pandemic for health care providers. 2009. http://www.nih.org.pk/files/national_guidelines_of_influenza_a-_h1n1_-_22.12.pdf webcite
• [20]The Public Health Agency of Canada: Seasonal influenza: guidance: infection prevention and control measures for healthcare workers in acute care and long-term care settings. 2010. Available from: http://www.phac-aspc.gc.ca/nois-sinp/guide/ac-sa-eng.php webcite
• [21]Center for Disease Control and Prevention: Interim guidance on infection control measures for 2009 H1N1 influenza in healthcare settings, including protection of healthcare personnel. [cited 2012 3 May]; Available from: http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm webcite
• [22]Department of Health UK: The use of face masks during an influenza pandemic. 2007. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147387/dh_125425.pdf.pdf webcite
• [23]Public Health Agency of Canada: Prevention and control of influenza during a pandemic for All healthcare settings. 2011. cited 2012 25 May; Available from: http://www.phac-aspc.gc.ca/cpip-pclcpi/annf/assets/pdf/ann-f-eng.pdf webcite
• [24]Center for Disease Control and Prevention: Public health guidance for community-level preparedness and response to severe acute respiratory syndrome (SARS). 2004. http://www.cdc.gov/sars/guidance webcite
• [25]Health Protection Agency UK: SARS - hospital infection control guidance. 2005. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947350823 webcite
• [26]Health Canada: Infection control guidance for health care workers in health care facilities and other institutional settings–severe acute respiratory syndrome (SARS). 2003. http://www.opseu.org/hands/sars-respiratormasks-0526_e.pdf webcite and http://www.phac-aspc.gc.ca/sars-sras/pdf/sarsfactsheetinstitutions06-03-03_e.pdf webcite
• [27]Department of Health and Ageing and the Communicable Disease Network of Australia: Interim australian infection control guidelines for severe acute respiratory syndrome (SARS). 2004. http://www.health.gov.au/internet/main/publishing.nsf/content/health-sars-guidelines-index.htm webcite
• [28]Ministry of Health Pakistan: The national infection control guidelines. 2006. [cited 2012 12 September]; Available from: http://www.nacp.gov.pk/policies_and_guidelines/treatment_and_care/Guideline%20for%20Infection%20Control.pdf webcite
• [29]Ministry of Health. Socialist Republic of Vietnam: Interim guidance: diagnosis, management and prevention of infection respiratory syndrome severe acute (SARS). 2003.
• [30]World Health Organization (WHO): WHO policy on TB infection control in health-care facilities, congregate settings and households. http://whqlibdoc.who.int/publications/2009/9789241598323_eng.pdf webcite
• [31]Center for Disease Control and Prevention: Guidelines for preventing the transmission of mycobacterium tuberculosis in health-care settings, 2005 morbidity and mortality weekly report. Volume 14. No. RR-17. 2005. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm webcite
• [32]Public Health Agency of Canada: Tuberculosis prevention and control. The lung association canada. Canadian tuberculosis standards. 6th edition. 2007. http://www.phac-aspc.gc.ca/tbpc-latb/pubs/tbstand07-eng.php webcite
• [33]Chinese Center for Disease Control and Prevention: Chinese tuberculosis control program implementation work guide. 2008.
• [34]National Institute for Health and Clinical Excellence (NICE) UK: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control. 2011. http://publications.nice.org.uk/tuberculosis-cg117/guidance webcite
• [35]Directorate General of Health Services Ministry of Health & Family Welfare: Guidelines on airborne infection control in healthcare and other settings. 2010. cited 2012 12 May]; Available from: http://www.tbcindia.nic.in/pdfs/Guidelines_on_Airborne_Infection_Control_April2010Provisional.pdf webcite
• [36]Ministry of Health. Govt. of Pakistan: National guidelines for mycobacterium tuberculosis infection control. 2010. http://ntp.gov.pk/resource.php webcite
• [37]Ministry of Health and Family Welfare. Dhaka Bangladesh: National guidelines for tuberculosis infection control. 1st edition. 2011. http://tbcare2.org/sites/tbcare2.org/files/BAN_TB%20CARE%20II_IC%20Guidelines_1.pdf webcite
• [38]Ministry of Health. Socialist Republic of Vietnam: Diagnosis, treatment and prevention of tuberculosis. 2009.
• [39]Department of Health. Republic of Indonesia. N: National strategic plan for avian influenza control and pandemic influenza preparedness. 2006. http://www.un-influenza.org/regions/asia/national_pandemic_preparedness_plans webcite
• [40]Ministry of Health and Family Welfare. Government of Bangladesh: National avian influenza and human pandemic influenza preparedness and response plan bangladesh 2006–2008. 2006. http://un-influenza.org/files/National_Avian_Influenza_And_Human_Pandemic_Influenza_Preparedness_and_Response_Plan_2006-2008.pdf webcite
• [41]Ministry of Health Socialist Republic of Vietnam: On the issue guidance Monitoring and prevention Influenza A (H1N1). Vietnam: MoHSRo; 2009.
• [42]Occupational Safety and Health Administration: Healthcare workplaces classified as very high or high exposure risk for pandemic influenza what to do to protect workers. [cited 2012 May 19]; Available from: http://www.osha.gov/Publications/exposure-risk-classification-factsheet.html webcite
• [43]Occupational Safety and Health Administration (OSHA): Respiratory protection, 29 CFR 1910.134. Fed Regist 1998, 63:1152-1300.
• [44]Occupational Safety and Health Administration: Information regarding severe acute respiratory syndrome (SARS). [cited 2012 12 June]; Available from: http://www.osha.gov/dep/sars/index.html#SARS-III webcite
• [45]World Health Organization (WHO): Comparative analysis of national pandemic influenza preparedness plans. 2011.
• [46]Bell D, Nicoll A, Fukuda K, Horby P, Monto A, Arbor A: Nonpharmaceutical interventions for pandemic influenza, international measures, world health organization writing group. Emerg Infect Dis 2006, 12(1):81-87.
• [47]Milton DK, Fabian MP, Cowling BJ, Grantham ML, McDevitt JJ: Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathog 2013, 9(3):e1003205.
• [48]Institute of Medicine (IOM) National Academy of Sciences: Preventing transmission of pandemic influenza and other viral respiratory diseases: personal protective equipment for healthcare personnel. Update 2010. 2011 [cited 2012 1 March]; Available from: http://iom.edu/ webcite~/media/Files/Report%20Files/2011/Preventing-Transmission-of-Pandemic-Influenza-and-Other-Viral-Respiratory-Diseases/Pandemic%20Influenza%202010%20Report%20Brief.pdf
• [49]Bridges CB, Kuehnert MJ, Hall CB: Transmission of influenza: implications for control in health care settings. Clin Infect Dis 2003, 37:1094-1101.
• [50]Cowling BJ: Airborne transmission of influenza: implications for control in healthcare and community settings. Clin Infect Dis 2012, 54(11):1570-1580.
• [51]Brankston G, Gitterman L, Hirji Z, Lemieux C, Gardam M: Transmission of infuenza a in human beings. Lancet Infect Dis 2007, 7:257-265.
• [52]Center for Disease Control and Prevention (CDC): Interim guidance for the Use of masks to control influenza transmission. [cited 2012 24 March]; Available from: http://www.cdc.gov/flu/professionals/infectioncontrol/maskguidance.htm webcite
• [53]World Health Organization (WHO): Influenza (seasonal). [cited 2012 29 March]; Available from: http://www.who.int/mediacentre/factsheets/fs211/en/index.html webcite
• [54]Tellier R: Review of aerosol transmission of influenza a virus. Emerg Infect Dis 2006, 12(11):1657-1662.
• [55]Tellier R: Aerosol transmission of influenza a virus: a review of new studies. J R Soc Interface 2009, 6:S783-S790.
• [56]Blachere FM, Lindsley WG, Pearce TA, Anderson SE, Fisher M, Khakoo R, et al.: Measurement of airborne influenza virus in a hospital emergency department. Clin Infect Dis 2009, 48(4):438-440.
• [57]Lindsley WG, Blachere FM, Thewlis RE, Vishnu A, Davis KA, Cao G, et al.: Measurements of airborne influenza virus in aerosol particles from human coughs. PLoS One 2010, 5(11):e15100.
• [58]Bischoff WE, Swett K, Leng I, Peters TR: Exposure to influenza virus aerosols during routine patient care. J Infect Dis 2013, 207(7):1037-1046.
• [59]Schulman JL: Experimental transmission of infl uenza virus infection in mice. IV. Relationship of transmissibility of dierent strains of virus and recovery of airborne virus in the environment of infector mice. J Exp Med 1967, 125:479-488.
• [60]Schulman JLKE: Airborne transmission of influenza virus infection in mice. Nature 1962, 195:1129-1130.
• [61]Andrewes CHGR: Spread of infection from the respiratory tract of the ferret: transmission of infl uenza a virus. Br J Exp Pathol 1941, 22:91-97.
• [62]Munster VJ, Wit E, Brand JMA, Herfst S, Schrauwen EJA, Bestebroer TM, et al.: Pathogenesis and transmission of swine-origin 2009 a(H1N1) influenza virus in ferrets. Science 2009, 325(5939):481-483.
• [63]Webera TP, Stilianakisa NI: Inactivation of influenza a viruses in the environment and modes of transmission: a critical review. J Infect 2008, 57(5):361-373.
• [64]Noti JD, Lindsley WG, Blachere FM, Cao G, Kashon ML, Thewlis RE, et al.: Detection of infectious influenza virus in cough aerosols generated in a simulated patient examination room. Clin Infect Dis 2012, 54(11):1569-1577.
• [65]Ling ML, Ching TY, Seto WH: A handbook of infection control for asian healthcare workers. 3rd edition. 2011.
• [66]World Health Organization (WHO): Hospital infection control guidance for severe acute respiratory syndrome (SARS). 2003. [cited 2012 12 April]; Available from: http://www.who.int/ihr/lyon/surveillance/infectioncontrol/en/index.html webcite
• [67]Yu ITS, Li Y, Wong TW, Tam W, Chan AT, Lee JHW, et al.: Evidence of airborne transmission of the severe acute respiratory syndrome virus. N Engl J Med 2004, 350:1731-1739.
• [68]Joint Tuberculosis Committee of the British Thoracic Society: Control and prevention of tuberculosis in the united kingdom: code of practice 1994. Thorax 1994, 49:1193-1200.
• [69]Thompson KA, Pappachan JV, Bennett AM, Mittal H, Macken S, Dove BK, et al.: Influenza aerosols in UK hospitals during the H1N1 (2009) pandemic–the risk of aerosol generation during medical procedures. PLoS One 2013, 8(2):e56278.
• [70]Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J: Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012, 7(4):e35797.
• [71]Davies A, Thomson G, Walker J, Bennett A: A review of the risks and disease transmission associated with aerosol generating medical procedures. J Infection Prevention 2009, 10:122-126.
• [72]Institute of Medicine (IOM) National Academy of Sciences: Reusability of facemasks during an influenza pandemic: facing the Flu - committee on the development of reusable facemasks for Use during an influenza pandemic. 2006. cited 2012 25 September; Available from: http://www.iom.edu/Reports/2006/Reusability-of-Facemasks-During-an-Influenza-Pandemic-Facing-the-Flu.aspx webcite
• [73]National Institute of Occupational Safety and Health (NIOSH). US Department of Health and Human Services: NIOSH guide to industrial respiratory protection. 1987. cited 2012 15 May; Available from: http://www.cdc.gov/niosh/docs/87-116/pdfs/87-116.pdf webcite
• [74]Coffey CC, Campbell DL, Zhuang Z: Simulated workplace performance of N95 respirators. Am Ind Hyg Assoc J 1999, 60:618-624.
• [75]Lawrencea RB, Dulinga MG, Calverta CA, Coffeya CC: Comparison of performance of three different types of respiratory protection devices. J Occup Environ Hyg 2006, 3(9):465-474.
• [76]Yang P, Seale H, MacIntyre C, Zhang H, Zhang Z, Zhang Y, et al.: Mask-wearing and respiratory infection in healthcare workers in beijing china. Braz J Infect Dis 2011, 15(2):102-108.
• [77]Dũng TC, Hiển NT, Ngà PT, Đính PN, Seale H, MacIntyre CR, et al.: Use of cloth masks amongst healthcare workers in hospitals in Hanoi, Vietnam.Journal of Preventive Medicine. Published by the Vietnam Association of Preventive Medicine (VAPM) 2012, 2(129):104-110.
• [78]Seale H, MacIntyre R, McLaws M-L, Maher L, Newall A, Kaur R, et al.: Health care worker practices around face mask use in hospitals in hanoi, vietnam. 15th ICID abstracts. Int J Infect Dis 2012, 16S(e317–e4732012):e384.
• [79]Paine CG: The aetiology of puerperal infection. BMJ 1935, 1:243-246.
• [80]Shooter RA, Smith MA, Hunter CJW: A study of surgical masks. Br J Surg 1959, 47(203):246-249.
• [81]Guyton HG, Decker HM, Anton GT: Emergency respiratory protection against radiological and biological aerosols. AMA Arch Ind Health 1959, 20:9-13.
• [82]Greene VW, Vesley D: Method for evaluating effectiveness of surgical masks. J Bacteriol 1962, 83(3):663-667.
• [83]Quesnel LB: The efficiency of surgical masks of varying design and composition. Br J Surg 1975, 62(12):936-940.
• [84]Dato V, Hostler D, Hahn M: Simple respiratory mask. Emerg Infect Dis 2006, 12(6):1033-1034.
• [85]Sande MVD, Teunis P, Sabel R: Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One 2008, 3(7):e2618.
• [86]Rengasamy S, Eimer B, Shaffer R: Simple respiratory protection—evaluation of the filtration performance of cloth masks and common fabric materials against 20–1000 nm size particles. Ann Occup Hyg 2010, 54(7):789-798.
• [87]European Center for Disease Control and Prevention: Interim ECDC public health guidance on case and contact management for the new influenza a(H1N1) virus infection. 2009. cited 2012 1 March; Available from: http://ecdc.europa.eu/en/publications/publications/0905_gui_influenza_ah1n1_public_health_guidance_on_case_and_contact_management.pdf webcite