N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial

Details

• Personal Author:
  Bessesen MT ; Brown AC ; Cummings DAT ; Gaydos CA ; Gibert CL ; Gorse GJ ; Krosche AE ; Los JG ; Nyquist A-C ; Perl TM ; Radonovich LJ Jr. ; Reich NG ; Rodriguez-Barradas MC ; Savor Price C ; Simberkoff MS
• Description:
  IMPORTANCE: Clinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections. OBJECTIVE: To compare the effect of N95 respirators vs medical masks for prevention of influenza and other viral respiratory infections among HCP. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups. INTERVENTIONS: Overall, 1993 participants in 189 clusters were randomly assigned to wear N95 respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with respiratory illness. MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute respiratory illness, laboratory-detected respiratory infections, laboratory-confirmed respiratory illness, and influenza-like illness. Adherence to interventions was assessed. RESULTS: Among 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95%CI, -0.5%to 2.5%]; P = .18) (adjusted odds ratio [OR], 1.18 [95%CI, 0.95-1.45]). There were 1556 acute respiratory illness events in the respirator group vs 1711 in the mask group (difference, -21.9 per 1000 HCP-seasons [95%CI, -48.2 to 4.4]; P = .10); 679 laboratory-detected respiratory infections in the respirator group vs 745 in the mask group (difference, -8.9 per 1000 HCP-seasons, [95%CI, -33.3 to 15.4]; P = .47); 371 laboratory-confirmed respiratory illness events in the respirator group vs 417 in the mask group (difference, -8.6 per 1000 HCP-seasons [95%CI, -28.2 to 10.9]; P = .39); and 128 influenza-like illness events in the respirator group vs 166 in the mask group (difference, -11.3 per 1000 HCP-seasons [95%CI, -23.8 to 1.3]; P = .08). In the respirator group, 89.4%of participants reported "always" or "sometimes" wearing their assigned devices vs 90.2% in the mask group. CONCLUSIONS AND RELEVANCE: Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01249625 [Description provided by NIOSH]
• Subjects:
  Communicable Diseases Health Personnel Influenza, Human Occupational Health Personal Protective Equipment Respiratory Protective Devices Safety
• Keywords:
  Disease Prevention Health Care Personnel Influenza N95 Filtering Facepiece Respirators Respirators Respiratory Protective Equipment Surgical Masks
• ISSN:
  0098-7484
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Colorado ; District of Columbia ; Florida ; Maryland ; Massachusetts ; Missouri ; New York ; OSHA Region 1 ; OSHA Region 2 ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 6 ; OSHA Region 7 ; OSHA Region 8 ; Pennsylvania ; Texas
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  NPPTL - National Personal Protective Technology Laboratory
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  322
• Issue:
  9
• NIOSHTIC Number:
  nn:20057229
• Citation:
  JAMA 2019 Sep; 322(9):824-833
• Contact Point Address:
  Lewis J. Radonovich Jr, MD, National Personal Protective Technology Laboratory, Centers for Disease Control and Prevention, 626 Cochrans Mill Rd, B141, R108, Pittsburgh, PA 15236
• Email:
  mto5@cdc.gov
• Federal Fiscal Year:
  2019
• Peer Reviewed:
  True
• Source Full Name:
  Journal of the American Medical Association
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:31bd2e79a6b748d3f66a1702996590c91c360c5adc4b231fbf39bb242654f4a5af5d240652fa7574a0245f7c54a109ea9d4d7d81bdad9ff05334bdfd48febf76
• Download URL:
  https://stacks.cdc.gov/view/cdc/214648/cdc_214648_DS1.pdf
• File Type:
  [PDF - 428.07 KB ]