JournalWise: N95 respirator and surgical mask effectiveness against respiratory viral illnesses in the healthcare setting: A systematic review and meta-analysis.

Review: In health care settings, effectiveness of N95 respirators vs surgical masks for preventing respiratory viral illness was assessed.

Collins AP, Service BC, Gupta S, et al. N95 respirator and surgical mask effectiveness against respiratory viral illnesses in the healthcare setting: A systematic review and meta-analysis. J Am Coll Emerg Physicians Open. 2021 Oct 28;2(5):e12582. doi: 10.1002/emp2.12582. eCollection 2021 Oct.

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.

Ratings

Specialty Area	Relevance to Practice	Is this News?	Score
Emergency Medicine
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Respirology/Pulmonology

Comments from MORE raters

Infectious Disease

Considering a high risk of biases, generated evidence should be taken with great care. Despite this, it is already generally perceived by the public that N95 respirators are superior to surgical masks in preventing respiratory viral infections, leave alone discomforts. This aggravates biases and it is difficult to control for these.

Respirology/Pulmonology

The meta-analysis is limited by relative small sample size. The study design confirms need for N95 mask to decrease risk of health care workers contracting Covid-19 and other viruses. However, for influenza, there is no apparent advantage to N95 vs paper surgical mask. Ideally, we would need better randomized trials to get to the full truth. This study does not impact current infection prevention strategies.

Infectionists predict the next outbreak of viral diseases in a few years. The results of such studies will help guide the right policy regarding the use of PPE from the outset of a pandemic.

Comments from JournalWise subscribers

Kenneth Wilson on 2021-11-26

This article is helpful. IDSAs lack of strong support for N95s despite the very strong rationale that has focused on a lack of "evidence base". Given the strength of the rationale to use N95s and the stakes, one would have thought that the lack of evidence one way or the other would favor N95s. This article may help to shift the group think on this issue.

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