N95 respirator and surgical mask effectiveness against respiratory viral illnesses in the healthcare setting: A systematic review and meta-analysis
- PMID: 34746923
- PMCID: PMC8552225
- DOI: 10.1002/emp2.12582
N95 respirator and surgical mask effectiveness against respiratory viral illnesses in the healthcare setting: A systematic review and meta-analysis
Abstract
Objective: To examine the results, level of evidence, and methodologic quality of original studies regarding surgical mask effectiveness in minimizing viral respiratory illness transmission, and, in particular, the performance of the N95 respirator versus surgical mask.
Methods: Meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with use of PubMed, MEDLINE, and the Cochrane Library databases.
Results: Eight studies (9164 participants) were included after screening 153 articles. Analyses showed statistically significant differences between N95 respirator versus surgical mask use to prevent influenza-like-illness (risk ratio [RR] = 0.81, 95% confidence interval [CI] = 0.68-0.94, P < 0.05), non-influenza respiratory viral infection (RR = 0.62, 95% CI = 0.52-0.74, P < 0.05), respiratory viral infection (RR = 0.73, 95% CI = 0.65-0.82, P < 0.05), severe acute respiratory syndrome coronavirus (SARS-CoV) 1 and 2 virus infection (RR = 0.17, 95% CI = 0.06-0.49, P < 0.05), and laboratory-confirmed respiratory viral infection (RR = 0.75, 95% CI = 0.66-0.84, P < 0.05). Analyses did not indicate statistically significant results against laboratory-confirmed influenza (RR = 0.87, CI = 0.74-1.03, P > 0.05).
Conclusions: N95 respirator use was associated with fewer viral infectious episodes for healthcare workers compared with surgical masks. The N95 respirator was most effective in reducing the risk of a viral infection in the hospital setting from the SARS-CoV 1 and 2 viruses compared to the other viruses included in this investigation. Methodologic quality, risk of biases, and small number of original studies indicate the necessity for further research to be performed, especially in front-line healthcare delivery settings.
Keywords: COVID‐19; N95 respirator; PPE; SARS‐CoV; influenza; mask; personal protective equipment; respiratory infection; respiratory viral infection; surgical mask.
© 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.
Conflict of interest statement
The authors report no conflicts of interest pertaining to this work. For full listing of conflicts of interest, please see American Academy of Orthopaedic Surgeons Conflicts of Interest disclosures.
Figures
Similar articles
-
Physical interventions to interrupt or reduce the spread of respiratory viruses.Cochrane Database Syst Rev. 2020 Nov 20;11(11):CD006207. doi: 10.1002/14651858.CD006207.pub5. Cochrane Database Syst Rev. 2020. PMID: 33215698 Free PMC article.
-
Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis.J Evid Based Med. 2020 May;13(2):93-101. doi: 10.1111/jebm.12381. Epub 2020 Mar 13. J Evid Based Med. 2020. PMID: 32167245 Free PMC article.
-
Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff.Cochrane Database Syst Rev. 2020 May 15;5(5):CD011621. doi: 10.1002/14651858.CD011621.pub5. Cochrane Database Syst Rev. 2020. PMID: 32412096 Free PMC article.
-
N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial.JAMA. 2019 Sep 3;322(9):824-833. doi: 10.1001/jama.2019.11645. JAMA. 2019. PMID: 31479137 Free PMC article. Clinical Trial.
-
Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial.JAMA. 2009 Nov 4;302(17):1865-71. doi: 10.1001/jama.2009.1466. Epub 2009 Oct 1. JAMA. 2009. PMID: 19797474 Clinical Trial.
Cited by
-
How the COVID-19 Pandemic Affects Risk Awareness in Dentists: A Scoping Review.Int J Environ Res Public Health. 2022 Apr 20;19(9):4971. doi: 10.3390/ijerph19094971. Int J Environ Res Public Health. 2022. PMID: 35564366 Free PMC article. Review.
References
-
- Therapeutic Options for COVID‐19 Patients . Centers for Disease Control and Prevention. www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html. Accessed May 1, 2021.
-
- Interim guidance for managing healthcare personnel with SARS‐COV‐2 infection or exposure to SARS‐COV‐2 . Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hc.... Accessed May 1, 2021.
-
- Qian Y, Willeke K, Grinshpun SA, Donnelly J, Coffey CC. Performance of N95 respirators: filtration efficiency for airborne microbial and inert particles. Am Ind Hyg Assoc J. 1998;59(2):128‐132. - PubMed
LinkOut - more resources
-
Full Text Sources
-
Miscellaneous