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Surgical Masks Non-Inferior to N95 Respirators for Preventing Influenza Among Health Care Workers CHICAGO -- October 1, 2009 -- Surgical masks appear to be no worse than, and nearly as effective as N95 respirators in preventing influenza in healthcare workers, according to a study released early online today by JAMA. The study was posted online ahead of print because of its public health implications and will be published in the November 4 issue. “Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting healthcare workers against influenza are sparse,” the authors wrote. “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.” Mark Loeb, MD, McMaster University, Hamilton, Ontario, and colleagues conducted a randomised controlled trial of 446 nurses in 8 Ontario hospitals to compare the surgical mask with the N95 respirator in protecting healthcare workers against influenza. Nurses were randomised to receive surgical masks (n = 225) or the fitted N95 respirator (n = 221) which they were to wear when caring for patients with febrile respiratory illness. The primary outcome of the study was laboratory-confirmed influenza. Effectiveness of the surgical mask was assessed as non-inferiority of the surgical mask compared with the N95 respirator. Between September 23, 2008 and December 8, 2008, “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%),” indicating non-inferiority of the surgical mask. Even among those nurses who had an increased level of the novel influenza A(H1N1), non-inferiority was demonstrated between the surgical mask group and the N95 respirator group for H1N1. “Our data show that the incidence of laboratory-confirmed influenza was similar in nurses wearing the surgical mask and those wearing the N95 respirator,” the authors wrote. “Surgical masks had an estimated efficacy within 1% of N95 respirators. That is, surgical masks appeared to be no worse, within a prespecified margin, than N95 respirators in preventing influenza.” “Our findings apply to routine care in the healthcare setting,” they concluded. “They should not be generalised to settings where there is a high risk for aerosolisation, such as intubation or bronchoscopy, where use of an N95 respirator would be prudent. In routine healthcare settings, particularly where the availability of N95 respirators is limited, surgical masks appear to be non-inferior to N95 respirators for protecting health care workers against influenza.” In an accompanying editorial, Arjun Srinivasan, MD, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and Trish M. Perl, MD, School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland wrote: “The 2009 influenza A(H1N1) pandemic has revived debate about the role of respiratory protection in preventing the transmission of influenza to healthcare personnel.” The “N95 particulate respirators protect wearers from small particles when appropriately designed and worn.” The World Health Organization and Society for Healthcare Epidemiology of America recommend the use of medical masks for most patient care. The CDC and Institute of Medicine recommend the use of N95 respirators during care of patients infected with the H1N1 influenza. “That this study is, to our knowledge, the first and only published randomised trial assessing respiratory protection for preventing influenza transmission is a sad commentary on the state of research in this area. Uncovering the truth and identifying the most appropriate way to protect healthcare personnel will require that other investigators build on this study …,” they wrote. “Ultimately, accumulating a body of evidence on this topic will provide much-needed answers.” SOURCE: JAMA E-mail this page to a friend or colleague! To print, use this version