Efficacy of face masks and respirators in preventing upper respiratory tract bacterial colonization and co-infection in hospital healthcare workers.
OBJECTIVE
We compared the efficacy of medical masks (MM) and N95 respirators (N95) in preventing bacterial colonization/infection in healthcare workers (HCWs).


METHODS
A cluster randomized clinical trial (RCT) of 1441 hospital HCWs randomized to medical masks or N95 respirators, and compared to 481 control HCWs, was performed in Beijing, China, during the winter season of 2008-2009. Participants were followed for development of clinical respiratory illness (CRI). Symptomatic subjects were tested for Streptococcus pneumoniae, Bordetella pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae or Haemophilus influenza type B by multiplex polymerase chain reaction (PCR).


RESULTS
The rate of bacterial colonization was 2.8% in the N95 group (p=0.02), 5.3% among medical mask users (p<0.01) and 7.5% among the controls (p=0.16). N95 respirators were significantly protective (adjusted RR 0.34, 95% CI: 0.21-0.56) against bacterial colonization. Co-infections of two bacteria or a virus and bacteria occurred in up to 3.7% of HCWs, and were significantly lower in the N95 arm.


CONCLUSIONS
N95 respirators were significantly protective against bacterial colonization, co-colonization and viral-bacterial co-infection. We showed that dual respiratory virus or bacterial-viral co-infections can be reduced by the use of N95 respirators. This study has occupational health and safety implications for health workers.
School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia; National Centre for Immunization Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia.
C Raina
CR
MacIntyre
The Beijing Center for Disease Prevention and Control, Beijing, China.
Quanyi
Q
Wang
School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia.
Bayzidur
B
Rahman
School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia.
Holly
H
Seale
School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia; National Centre for Immunization Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia.
Iman
I
Ridda
School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia.
Zhanhai
Z
Gao
The Beijing Center for Disease Prevention and Control, Beijing, China.
Peng
P
Yang
The Beijing Center for Disease Prevention and Control, Beijing, China.
Weixian
W
Shi
The Beijing Center for Disease Prevention and Control, Beijing, China.
Xinghuo
X
Pang
The Beijing Center for Disease Prevention and Control, Beijing, China.
Yi
Y
Zhang
School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Australia. Electronic address: a.moa@unsw.edu.au.
Aye
A
Moa
Centre for Infectious Diseases and Microbiology Laboratory Services, Institute for Clinical Pathology and Medical Research, Westmead Hospital and University of Sydney, Australia.
Dominic E
DE
Dwyer
D000328:Adult; D002681:China; D019411:Clinical Laboratory Techniques / Q000379:methods; D016000:Cluster Analysis; D060085:Coinfection / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016273:Occupational Exposure / Q000517:prevention & control / Q000706:statistics & numerical data; D011446:Prospective Studies; D012134:Respiratory Protective Devices / Q000592:standards* / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires
Bacterial colonization; Healthcare workers; Hospitals; N95 respirators and medical masks