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

Breanne Kunstler; Skye Newton; Hayley Hill; John Ferguson; Phillipa Hore; Brett G Mitchell; Kathy Dempsey; Andrew J Stewardson; Deborah Friedman; Kate Cole; Malcolm R Sim; Bridget Ferguson; Penelope Burns; Nicole King; Steven McGloughlin; Melanie Dicks; Sally McCarthy; Barry Tam; Briony Hazelton; Cherylynn McGurgan; Steve McDonald; Tari Turner

doi:10.1016/j.idh.2022.01.001

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

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

Authors

Breanne Kunstler¹, Skye Newton², Hayley Hill², John Ferguson³, Phillipa Hore⁴, Brett G Mitchell⁵, Kathy Dempsey⁶, Andrew J Stewardson⁷, Deborah Friedman⁸, Kate Cole⁹, Malcolm R Sim¹⁰, Bridget Ferguson¹¹, Penelope Burns¹², Nicole King¹³, Steven McGloughlin¹⁴, Melanie Dicks¹⁵, Sally McCarthy¹⁶, Barry Tam¹⁷, Briony Hazelton¹⁸, Cherylynn McGurgan¹⁹, Steve McDonald²⁰, Tari Turner²⁰

Affiliations

¹ BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton, Melbourne, VIC, 3800, Australia. Electronic address: Brea.kunstler@monash.edu.
² Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Australia.
³ Division of Medicine, John Hunter Hospital, Newcastle Regional Mail Centre, NSW, 2310, Australia.
⁴ Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Victoria Parade, Fitzroy, VIC, 3065, Australia.
⁵ The University of Newcastle, School of Nursing and Midwifery, Level 9, 77a Holden St, Gosford Hospital, Gosford, NSW, Australia, 2250.
⁶ The Clinical Excellence Commission, 1 Reserve Road, St Leonards, NSW, Australia, 2065.
⁷ Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, 85 Commercial Rd, Melbourne, VIC, Australia, 3004.
⁸ Deputy Chief Health Officer, Victorian Department of Health Melbourne, VIC, Australia, 3004.
⁹ Cole Health Pty Ltd, Balmain, NSW, Australia, 2041.
¹⁰ Monash Centre for Occupational & Environmental Health (MonCOEH), School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Rd, Melbourne, VIC, Australia, 3004.
¹¹ Central Queensland University, School of Nursing, Midwifery and Social Sciences; 554-700 Yaamba Rd, Norman Gardens, QLD, 4701, Australia.
¹² Academic Unit of General Practice, ANU Medical School, The Australian National University, Building 4, Hospital Road, Garran, ACT, 2605, Australia.
¹³ North Shore Private Hospital, 3 Westbourne St, St Leonard's, 2065, Australia.
¹⁴ Alfred Health and School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, Australia, 3004.
¹⁵ Ernst & Young, 121 Marcus Clarke Street, Canberra, ACT, Australia, 2601.
¹⁶ Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
¹⁷ Health Infrastructure NSW, 60 Day Road, Cheltenham, NSW, 2119, Australia.
¹⁸ PathWest Laboratory Medicine, QEII Medical Centre, Hospital Avenue, Nedlands, WA, Australia, 6009.
¹⁹ Royal Melbourne Hospital Emergency Department, 300 Grattan Street, Parkville, VIC, Australia, 3050.
²⁰ Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.

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.

Publication types

Meta-Analysis
Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / prevention & control
Humans
N95 Respirators / adverse effects
Pandemics / prevention & control
Personal Protective Equipment
SARS-CoV-2