OBJECTIVES: Primary focused question for this systematic review (SR) was: "Which is the evidence about surfaces decontamination and protection masks for SARS-Cov-2 in dental practice?". Secondary question was: "Which is the evidence about surfaces decontamination and protection masks against airborne pathogens and directly transmitted viral pathogens causing respiratory infections?"
MATERIALS AND METHODS: PRISMA guidelines were used. Studies on surfaces decontamination and protective masks for SARS-Cov-2 in dental practice were considered. Studies on other respiratory viruses were considered for the secondary question.
RESULTS: No studies are available for SARS-Cov-2. Four studies on surfaces disinfection against respiratory viruses were included. Ethanol 70% and sodium hypochlorite 0,5% seems to be effective in reducing infectivity by >3log TCID. Four RCTs compared different types of masks on HCW. The single studies reported no difference for laboratory-diagnosed influenza, laboratory-diagnosed respiratory infection and influenza like illness. A meta-analysis was not considered appropriate.
CONCLUSIONS: There is lack of evidence on the efficacy of surfaces disinfection and protective masks to reduce the spread of SARS-CoV-2 or other respiratory viruses in dentistry. However, the consistent use of respirator and routine surfaces disinfection is strongly suggested. There is urgent need of data on the efficacy of specific protection protocols for dental HCW against viral infections.
OBJECTIVE: With the epidemic of coronavirus disease 2019 (COVID-19), the healthcare workers (HCWs) require proper respiratory personal protective equipment (rPPE) against viral respiratory infectious diseases (VRIDs). It is necessary to evaluate which type of mask and manner of wearing is the best suitable rPPE for preventing the VRID.
STUDY DESIGN: A Bayesian network meta-analysis was performed to comprehensively analyze the protective efficacy of various rPPE.
METHODS: This network meta-analysis protocol was registered in an international prospective register of systematic reviews (CRD42020179489). Electronic databases were searched for cluster randomized control trials (RCTs) of comparing the effectiveness of rPPE and wearing manner in preventing HCWs from VRID. The primary outcome was the incidence of laboratory-confirmed viral respiratory infection reported as an odds ratio (OR) with the associated 95% credibility interval (CrI). The secondary outcome was the incidence of clinical respiratory illness (CRI) reported as an OR with the associated 95% CrI. Surface under the cumulative ranking curve analysis (SUCRA) provided a ranking of each rPPE according to the primary outcome and the secondary outcome as data supplement.
RESULTS: Six studies encompassing 12,265 HCWs were included. In terms of the incidence of laboratory-confirmed viral respiratory infection, the continuous wearing of N95 respirators (network OR, 0.48; 95% CrI: 0.27 to 0.86; SUCRA score, 85.4) showed more effective than the control group. However, in terms of reducing the incidence of CRI, there was no rPPE showing superior protective effectiveness.
CONCLUSIONS: There are significant differences in preventive efficacy among current rPPE. Our result suggests that continuous wearing of N95 respirators on the whole shift can serve as the best preventive rPPE for HCWs from the VRID.
OBJECTIVE: To identify, appraise and synthesise studies evaluating the downsides of wearing face masks in any setting. We also discuss potential strategies to mitigate these downsides.
DESIGN: Systematic review and meta-analysis.
DATA SOURCES: PubMed, Embase, CENTRAL and EuropePMC were searched (inception-18 May 2020), and clinical registries were searched via CENTRAL. We also did a forward-backward citation search of the included studies.
INCLUSION CRITERIA: We included randomised controlled trials and observational studies comparing face mask use to any active intervention or to control.
DATA EXTRACTION AND ANALYSIS: Two author pairs independently screened articles for inclusion, extracted data and assessed the quality of included studies. The primary outcomes were compliance, discomforts, harms and adverse events of wearing face masks.
RESULTS: We screened 5471 articles, including 37 (40 references); 11 were meta-analysed. For mask wear adherence, 47% (95% CI 25% to 68%, p<0.0001), more people wore face masks in the face mask group compared with control; adherence was significantly higher (26%, 95% CI 8% to 46%, p<0.01) in the surgical/medical mask group than in N95/P2 group. The largest number of studies reported on the discomfort and irritation outcome (20 studies); fewest reported on the misuse of masks, and none reported on mask contamination or risk compensation behaviour. Risk of bias was generally high for blinding of participants and personnel and low for attrition and reporting biases.
CONCLUSIONS: There are insufficient data to quantify all of the adverse effects that might reduce the acceptability, adherence and effectiveness of face masks. New research on face masks should assess and report the harms and downsides. Urgent research is also needed on methods and designs to mitigate the downsides of face mask wearing, particularly the assessment of possible alternatives.
SYSTEMATIC REVIEW REGISTRATION: Open Science Framework website https://osf.io/sa6kf/ (timestamp 20-05-2020).
Protecting Health Care Workers (HCWs) during routine care of suspected or confirmed COVID-19 patients is of paramount importance to halt the SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) pandemic. The WHO, ECDC and CDC have issued conflicting guidelines on the use of respiratory filters (N95) by HCWs. We searched PubMed, Embase and The Cochrane Library from the inception to March 21, 2020 to identify randomized controlled trials (RCTs) comparing N95 respirators versus surgical masks for prevention of COVID-19 or any other respiratory infection among HCWs. The grading of recommendations, assessment, development, and evaluation (GRADE) was used to evaluate the quality of evidence. Four RCTs involving 8736 HCWs were included. We did not find any trial specifically on prevention of COVID-19. However, wearing N95 respirators can prevent 73 more (95% CI 46-91) clinical respiratory infections per 1000 HCWs compared to surgical masks (2 RCTs; 2594 patients; low quality of evidence). A protective effect of N95 respirators in laboratory-confirmed bacterial colonization (RR= 0.41; 95%CI 0.28-0.61) was also found. A trend in favour of N95 respirators was observed in preventing laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza like illness. We found no direct high quality evidence on whether N95 respirators are better than surgical masks for HCWs protection from SARS-CoV-2. However, low quality evidence suggests that N95 respirators protect HCWs from clinical respiratory infections. This finding should be contemplated to decide the best strategy to support the resilience of healthcare systems facing the potentially catastrophic SARS-CoV-2 pandemic.
BackgroundConflicting recommendations exist related to whether masks have a protective effect on the spread of respiratory viruses.
MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was consulted to report this systematic review. Relevant articles were retrieved from PubMed, Web of Science, ScienceDirect, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI), VIP (Chinese) database.
ResultsA total of 21 studies met our inclusion criteria. Meta-analyses suggest that mask use provided a significant protective effect (OR=0.35 and 95% CI=0.24-0.51). Use of masks by healthcare workers (HCWs) and non-healthcare workers (Non-HCWs) can reduce the risk of respiratory virus infection by 80% (OR=0.20, 95% CI=0.11-0.37) and 47% (OR=0.53, 95% CI=0.36-0.79). The protective effect of wearing masks in Asia (OR=0.31) appeared to be higher than that of Western countries (OR=0.45). Masks had a protective effect against influenza viruses (OR=0.55), SARS (OR=0.26), and SARS-CoV-2 (OR=0.04). In the subgroups based on different study designs, protective effects of wearing mask were significant in cluster randomized trials and observational studies.
ConclusionsThis study adds additional evidence of the enhanced protective value of masks, we stress that the use masks serve as an adjunctive method regarding the COVID-19 outbreak.
Report»Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I). AHRQ Publication No. 20-EHC016. Rockville, MD: Agency for Healthcare Research and Quality (Posted final reports are located on the Effective Health Care Program search page)
OBJECTIVETo examine the effectiveness of eye protection, face masks, or person distancing on interrupting or reducing the spread of respiratory viruses.
DESIGNUpdate of a Cochrane review that included a meta-analysis of observational studies during the SARS outbreak of 2003.
DATA SOURCESEligible trials from the previous review; search of Cochrane Central Register of Controlled Trials, PubMed, Embase and CINAHL from October 2010 up to 1 April 2020; and forwardand backward citation analysis.
DATA SELECTIONRandomised and cluster-randomised trials of people of any age, testing the use ofeye protection, face masks, or person distancing against standard practice, or a similar physical barrier. Outcomes included any acute respiratory illness and its related consequences.
DATA EXTRACTION AND ANALYSISSix authors independently assessed risk of bias using the Cochrane tool and extracted data. We used a generalised inverse variance method for pooling using a random-effects model and reported results with risk ratios and 95% Confidence Intervals (CI).
RESULTSWe included 15 randomised trials investigating the effect of masks (14 trials) in healthcare workers and the general population and of quarantine (1 trial). We found no trials testing eye protection. Compared to no masks there was no reduction of influenza-like illness (ILI) cases (Risk Ratio 0.93, 95%CI 0.83 to 1.05) or influenza (Risk Ratio 0.84, 95%CI 0.61-1.17) for masks in the general population, nor in healthcare workers (Risk Ratio 0.37, 95%CI 0.05 to 2.50). There was no difference between surgical masks and N95 respirators: for ILI (Risk Ratio 0.83, 95%CI 0.63 to 1.08), for influenza (Risk Ratio 1.02, 95%CI 0.73 to 1.43). Harms were poorly reported and limited to discomfort with lower compliance. The only trial testing quarantining workers with household ILI contacts found a reduction in ILI cases, but increased risk of quarantined workers contracting influenza. All trials were conducted during seasonal ILI activity.
CONCLUSIONSMost included trials had poor design, reporting and sparse events. There was insufficient evidence to provide a recommendation on the use of facial barriers without other measures. We found insufficient evidence for a difference between surgical masks and N95 respirators and limited evidence to support effectiveness of quarantine. Based on observational evidence from the previous SARS epidemic included in the previous version of our Cochrane review we recommend the use of masks combined with other measures.
To evaluate the efficacy of N95 respirators and medical masks for protection against respiratory infectious diseases, including COVID-19. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating the use of N95 respirators and medical masks for protection against respiratory infectious diseases. We retrieved relevant articles published from January 1994 to January 2020 by searching the PubMed, EMBASE, Cochrane CENTRAL, and Web of Science databases. The study quality was evaluated using the Cochrane Risk of Bias tool with RevMan 5.3 software. Eleven RCTs adjusted for clustering were included in the meta-analysis. Compared with the control group, N95 respirators or medical masks conferred significant protection against respiratory infectious diseases (odds ratio (OR) = 0.50; 95% CI: 0.29–0.84). Compared to medical masks, N95 respirators conferred significant protection against respiratory infectious diseases (OR = 0.75; 95% confidence interval (CI): 0.57–0.99). Meta-analysis of 10 observational studies adjusting for clustering also suggested that N95 respirators and medical masks are effective for protection against respiratory infectious diseases (OR = 0.59; 95% CI: 0.42–0.82). However, only one case report showed the effectiveness of medical masks for preventing COVID-19. Although medical masks and N95 respirators may confer significant protection against respiratory infectious diseases, there is insufficient evidence to conclude that these types of personal protective equipment offer similar protection against COVID-19. Therefore, in the absence of sufficient resources during an epidemic, medical masks and N95 respirators should be reserved for high-risk, aerosol-generating producing procedures.
Protecting Health Care Workers (HCWs) during routine care of suspected or confirmed COVID-19 patients is of paramount importance to halt the SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) pandemic. The WHO, ECDC and CDC have issued conflicting guidelines on the use of respiratory filters (N95) by HCWs. We searched PubMed, Embase and The Cochrane Library from the inception to March 21, 2020 to identify randomized controlled trials (RCTs) comparing N95 respirators versus surgical masks for prevention of COVID-19 or any other respiratory infection among HCWs. The grading of recommendations, assessment, development, and evaluation (GRADE) was used to evaluate the quality of evidence. Four RCTs involving 8736 HCWs were included. We did not find any trial specifically on prevention of COVID-19. However, wearing N95 respirators can prevent 73 more (95% CI 46-91) clinical respiratory infections per 1000 HCWs compared to surgical masks (2 RCTs; 2594 patients; low quality of evidence). A protective effect of N95 respirators in laboratory-confirmed bacterial colonization (RR = 0.41; 95%CI 0.28-0.61) was also found. A trend in favour of N95 respirators was observed in preventing laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza like illness. We found no direct high quality evidence on whether N95 respirators are better than surgical masks for HCWs protection from SARS-CoV-2. However, low quality evidence suggests that N95 respirators protect HCWs from clinical respiratory infections. This finding should be contemplated to decide the best strategy to support the resilience of healthcare systems facing the potentially catastrophic SARS-CoV-2 pandemic.
BACKGROUND: Conflicting recommendations exist related to whether masks have a protective effect on the spread of respiratory viruses.
METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was consulted to report this systematic review. Relevant articles were retrieved from PubMed, Web of Science, ScienceDirect, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI), VIP (Chinese) database.
RESULTS: A total of 21 studies met our inclusion criteria. Meta-analyses suggest that mask use provided a significant protective effect (OR = 0.35 and 95% CI = 0.24-0.51). Use of masks by healthcare workers (HCWs) and non-healthcare workers (Non-HCWs) can reduce the risk of respiratory virus infection by 80% (OR = 0.20, 95% CI = 0.11-0.37) and 47% (OR = 0.53, 95% CI = 0.36-0.79). The protective effect of wearing masks in Asia (OR = 0.31) appeared to be higher than that of Western countries (OR = 0.45). Masks had a protective effect against influenza viruses (OR = 0.55), SARS (OR = 0.26), and SARS-CoV-2 (OR = 0.04). In the subgroups based on different study designs, protective effects of wearing mask were significant in cluster randomized trials and observational studies.
CONCLUSIONS: This study adds additional evidence of the enhanced protective value of masks, we stress that the use masks serve as an adjunctive method regarding the COVID-19 outbreak.
Primary focused question for this systematic review (SR) was: "Which is the evidence about surfaces decontamination and protection masks for SARS-Cov-2 in dental practice?". Secondary question was: "Which is the evidence about surfaces decontamination and protection masks against airborne pathogens and directly transmitted viral pathogens causing respiratory infections?"
MATERIALS AND METHODS:
PRISMA guidelines were used. Studies on surfaces decontamination and protective masks for SARS-Cov-2 in dental practice were considered. Studies on other respiratory viruses were considered for the secondary question.
RESULTS:
No studies are available for SARS-Cov-2. Four studies on surfaces disinfection against respiratory viruses were included. Ethanol 70% and sodium hypochlorite 0,5% seems to be effective in reducing infectivity by >3log TCID. Four RCTs compared different types of masks on HCW. The single studies reported no difference for laboratory-diagnosed influenza, laboratory-diagnosed respiratory infection and influenza like illness. A meta-analysis was not considered appropriate.
CONCLUSIONS:
There is lack of evidence on the efficacy of surfaces disinfection and protective masks to reduce the spread of SARS-CoV-2 or other respiratory viruses in dentistry. However, the consistent use of respirator and routine surfaces disinfection is strongly suggested. There is urgent need of data on the efficacy of specific protection protocols for dental HCW against viral infections.
