title: Compliance with the Use of Medical and Cloth Masks Among Healthcare Workers in Vietnam.
abstract: BACKGROUND
  Masks are often worn in healthcare settings to prevent the spread of infection from healthcare workers (HCWs) to patients. Masks are also used to protect the employee from patient-generated infectious organisms but poor compliance can reduce efficacy. The aim of this study was to examine the factors influencing compliance with the use of medical and cloth masks amongst hospital HCWs.
  
  
  METHODS
  HCWs compliance with the use of medical and cloth masks was measured over a 4-week period in a randomized controlled trial in Vietnam. HCWs were instructed to record their daily activities in diary cards. Demographic, clinical, and diary card data were used to determine the predictors of compliance and the relationship of compliance with infection outcomes.
  
  
  RESULTS
  Compliance rates for both medical and cloth masks decreased during the 4 weeks: medical mask use decreased from 77 to 68% (P < 0.001) and cloth masks from 78 to 69% (P < 0.001). The presence of adverse events (adjusted RR 0.90, 95% CI 0.85-0.95), and performing aerosol-generating procedures (adjusted RR 0.78, 95% CI 0.73-0.82) were negatively associated with compliance, while contact with febrile respiratory illness patients was positively associated (adjusted RR 1.14, 95% CI 1.07-1.20). Being compliant with medical or cloth masks use (average use ≥70% of working time) was not associated with clinical respiratory illness, influenza-like illness, and laboratory-confirmed viral infection.
  
  
  CONCLUSIONS
  Understanding the factors that affect compliance is important for the occupational health and safety of HCWs. New strategies and tools should be developed to increase compliance of HCWs. The presence of adverse events such as discomfort and breathing problems may be the main reasons for the low compliance with mask use and further studies should be conducted to improve the design/material of masks to improve comfort for the wearer.
authors.affiliation: 1.School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia; abrar.chughtai@unsw.edu.au.
authors.forename: Abrar Ahmad
authors.initials: AA
authors.lastname: Chughtai
authors.affiliation: 1.School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia;
authors.forename: Holly
authors.initials: H
authors.lastname: Seale
authors.affiliation: 2.National Institute of Hygiene and Epidemiology (NIHE), Hanoi, Vietnam.
authors.forename: Tham Chi
authors.initials: TC
authors.lastname: Dung
authors.affiliation: 1.School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia;
authors.forename: Andrew
authors.initials: A
authors.lastname: Hayen
authors.affiliation: 1.School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia;
authors.forename: Bayzidur
authors.initials: B
authors.lastname: Rahman
authors.affiliation: 1.School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia;
authors.forename: C
authors.initials: C
authors.lastname: Raina MacIntyre
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000379:methods; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D008297:Male; D008397:Masks / Q000706:statistics & numerical data*; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control*; D010564:Personnel, Hospital; D012141:Respiratory Tract Infections / Q000517:prevention & control; D013784:Textiles; D014744:Vietnam
keywords: cloth masks; compliance; healthcare workers; masks; medical masks; respiratory infections