title: Universal Mask Usage for Reduction of Respiratory Viral Infections After Stem Cell Transplant: A Prospective Trial.
abstract: Respiratory viral infections (RVIs) are frequent complications of hematopoietic stem cell transplant (HSCT). Surgical masks are a simple and inexpensive intervention that may reduce nosocomial spread.
  
  
  
  In this prospective single-center study, we instituted a universal surgical mask policy requiring all individuals with direct contact with HSCT patients to wear a surgical mask, regardless of symptoms or season. The primary endpoint was the incidence of RVIs in the mask period (2010-2014) compared with the premask period (2003-2009).
  
  
  
  RVIs decreased from 10.3% (95/920 patients) in the premask period to 4.4% (40/911) in the mask period (P < .001). Significant decreases occurred after both allogeneic (64/378 [16.9%] to 24/289 [8.3%], P = .001) and autologous (31/542 [5.7%] to 16/622 [2.6%], P = .007) transplants. After adjusting for multiple covariates including season and year in a segmented longitudinal analysis, the decrease in RVIs remained significant, with risk of RVI of 0.4 in patients in the mask group compared with the premask group (0.19-0.85, P = .02). In contrast, no decrease was observed during this same period in an adjacent hematologic malignancy unit, which followed the same infection control practices except for the mask policy. The majority of this decrease was in parainfluenza virus 3 (PIV3) (8.3% to 2.2%, P < .001).
  
  
  
  Requiring all individuals with direct patient contact to wear a surgical mask is associated with a reduction in RVIs, particularly PIV3, during the most vulnerable period following HSCT.
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Sung
authors.affiliation: Division of Infectious Diseases, University of North Carolina at Chapel Hill.
authors.forename: Julia A M
authors.initials: JAM
authors.lastname: Sung
authors.affiliation: Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Samantha
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Terry
authors.initials: T
authors.lastname: Hyslop
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gasparetto
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham.
authors.forename: Gwynn
authors.initials: G
authors.lastname: Long
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham.
authors.forename: David
authors.initials: D
authors.lastname: Rizzieri
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Sullivan
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham.
authors.forename: Kelly
authors.initials: K
authors.lastname: Corbet
authors.affiliation: Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Gloria
authors.initials: G
authors.lastname: Broadwater
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham.
authors.forename: Nelson J
authors.initials: NJ
authors.lastname: Chao
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham.
authors.forename: Mitchell E
authors.initials: ME
authors.lastname: Horwitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015986:Confounding Factors, Epidemiologic; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D017053:Infection Control / Q000379:methods; D008297:Male; D008397:Masks; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology*; D012621:Seasons; D055815:Young Adult
keywords: hematopoietic stem cell transplant; infection; parainfluenza virus; prevention; surgical mask