Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers A Randomized Trial

被引:336
作者
Loeb, Mark [1 ,2 ,3 ,5 ]
Dafoe, Nancy [1 ]
Mahony, James [1 ,5 ,6 ]
John, Michael [7 ,8 ]
Sarabia, Alicia [9 ]
Glavin, Verne [10 ]
Webby, Richard [11 ]
Smieja, Marek [1 ,3 ,5 ]
Earn, David J. D. [3 ,4 ,5 ]
Chong, Sylvia [6 ]
Webb, Ashley [11 ]
Walter, Stephen D. [3 ]
机构
[1] McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON L8N 3Z5, Canada
[2] McMaster Univ, Dept Med, Hamilton, ON L8N 3Z5, Canada
[3] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada
[4] McMaster Univ, Dept Math & Stat, Hamilton, ON L8N 3Z5, Canada
[5] McMaster Univ, Michael G DeGroote Inst Infect Dis Res, Hamilton, ON L8N 3Z5, Canada
[6] St Josephs Hosp, Reg Virol Lab, Hamilton, ON, Canada
[7] Univ Western Ontario, Dept Pathol, London, ON N6A 3K7, Canada
[8] Univ Western Ontario, Dept Microbiol & Immunol, London, ON N6A 3K7, Canada
[9] Credit Valley Hosp, Dept Microbiol, Mississauga, ON, Canada
[10] Joseph Brant Mem Hosp, Burlington, ON, Canada
[11] St Jude Childrens Res Hosp, WHO, Collaborating Ctr Studies Ecol Influenza Anim & B, Memphis, TN USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2009年 / 302卷 / 17期
关键词
VIRUS; INFECTION; TRANSMISSION; NONINFERIORITY; PATHOGENESIS; EMERGENCE; LEAKAGE;
D O I
10.1001/jama.2009.1466
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse. Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing the effectiveness of the surgical mask is of public health importance. Objective To compare the surgical mask with the N95 respirator in protecting health care workers against influenza. Design, Setting, and Participants Noninferiority randomized controlled trial of 446 nurses in emergency departments, medical units, and pediatric units in 8 tertiary care Ontario hospitals. Intervention Assignment to either a fit-tested N95 respirator or a surgical mask when providing care to patients with febrile respiratory illness during the 2008-2009 influenza season. Main Outcome Measures The primary outcome was laboratory-confirmed influenza measured by polymerase chain reaction or a 4-fold rise in hemagglutinin titers. Effectiveness of the surgical mask was assessed as noninferiority of the surgical mask compared with the N95 respirator. The criterion for noninferiority was met if the lower limit of the 95% confidence interval (CI) for the reduction in incidence (N95 respirator minus surgical group) was greater than -9%. Results Between September 23, 2008, and December 8, 2008, 478 nurses were assessed for eligibility and 446 nurses were enrolled and randomly assigned the intervention; 225 were allocated to receive surgical masks and 221 to N95 respirators. Influenza infection occurred in 50 nurses (23.6%) in the surgical mask group and in 48 (22.9%) in the N95 respirator group (absolute risk difference, -0.73%; 95% CI, -8.8% to 7.3%; P=.86), the lower confidence limit being inside the noninferiority limit of -9%. Conclusion Among nurses in Ontario tertiary care hospitals, use of a surgical mask compared with an N95 respirator resulted in noninferior rates of laboratory-confirmed influenza. Trial Registration clinicaltrials.gov Identifier: NCT00756574 JAMA. 2009;302(17):1865-1871
引用
收藏
页码:1865 / 1871
页数:7
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