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Open Access Correspondence

Availability, consistency and evidence-base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis

Abrar Ahmad Chughtai1*, Holly Seale1 and Chandini Raina MacIntyre12

Author Affiliations

1 School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney2052, Australia

2 National Centre for Immunization Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children’s Hospital, Westmead, Australia

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BMC Research Notes 2013, 6:216  doi:10.1186/1756-0500-6-216

Published: 31 May 2013

Abstract

Background

Currently there is an ongoing debate and limited evidence on the use of masks and respirators for the prevention of respiratory infections in health care workers (HCWs). This study aimed to examine available policies and guidelines around the use of masks and respirators in HCWs and to describe areas of consistency between guidelines, as well as gaps in the recommendations, with reference to the WHO and the CDC guidelines.

Methods

Policies and guidelines related to mask and respirator use for the prevention of influenza, SARS and TB were examined. Guidelines from the World Health Organization (WHO), the Center for Disease Control and Prevention (CDC), three high-income countries and six low/middle-income countries were selected.

Results

Uniform recommendations are made by the WHO and the CDC in regards to protecting HCWs against seasonal influenza (a mask for low risk situations and a respirator for high risk situations) and TB (use of a respirator). However, for pandemic influenza and SARS, the WHO recommends mask use in low risk and respirators in high risk situations, whereas, the CDC recommends respirators in both low and high risk situations. Amongst the nine countries reviewed, there are variations in the recommendations for all three diseases. While, some countries align with the WHO recommendations, others align with those made by the CDC. The choice of respirator and the level of filtering ability vary amongst the guidelines and the different diseases. Lastly, none of the policies discuss reuse, extended use or the use of cloth masks.

Conclusion

Currently, there are significant variations in the policies and recommendations around mask and respirator use for protection against influenza, SARS and TB. These differences may reflect the scarcity of level-one evidence available to inform policy development. The lack of any guidelines on the use of cloth masks, despite widespread use in many low and middle-income countries, remains a policy gap. Health organizations and countries should jointly evaluate the available evidence, prioritize research to inform evidence gaps, and develop consistent policy on masks and respirator use in the health care setting.

Keywords:
Infectious diseases; Seasonal influenza; Pandemic influenza; Sever Acute Respiratory Syndrome (SARS); Tuberculosis (TB); Masks; Respirators