Use of N95, Surgical, Cloth Masks to Prevent COVID-19

Quick Takes

  • Persons should seek guidance from the local community and statewide public health guidelines for mask use in light of the absence of evidence in the community setting to reduce the risk for transmission of SARS-CoV-2 infection.
  • In the health care setting, evidence showed that N95 respirators may reduce the risk for SARS-CoV-1 infection compared with surgical masks or no masks and regardless of use of masks, it is essential to strictly follow all other infection prevention and control measures.
  • Extended use of N95 respirators is preferable to reuse of N95 respirators because it involves less touching of the respirator, thus less risk for contact transmission.

Study Questions:

What is the effectiveness of N95 respirators versus surgical masks versus cloth masks for the prevention of coronavirus disease 2019 (COVID-19) in addition to standard precautions in community and health care settings?

Methods:

The Scientific Medical Policy Committee, in collaboration with staff from the American College of Physicians’ Department of Clinical Policy, developed these practice points on the basis of a rapid systematic evidence review conducted by the Pacific Northwest Evidence-Based Practice Center and funded by the Agency for Healthcare Research and Quality.

Results:

Low-certainty evidence showed that mask use may reduce the risk for severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) infection compared with no mask use in the community, but a major limitation of the studies is that they did not specify mask type. Moderate-certainty indirect evidence showed that surgical masks probably do not reduce the risk compared with no masks in the community. In the health care setting, low-certainty evidence showed that mask use and consistent mask use may reduce the risk for SARS-CoV-1 infection compared with no mask use and inconsistent mask use in health care settings, but studies did not specify mask type. Low-certainty indirect evidence showed that N95 respirators may reduce the risk for SARS-CoV-1 infection compared with surgical masks or no masks. Finally, currently, no evidence is available about the effectiveness of extended use or reuse of N95 respirators in health care settings.

Conclusions:

The authors concluded that regardless of use of masks, it is essential to strictly follow all other infection prevention and control measures (such as hand hygiene, physical distancing, and others) along with appropriate use of other personal protective equipment (PPE) (such as gowns, gloves, and goggles) in health care settings.

Perspective:

This Living Practice Points From the American College of Physicians suggests that persons should seek guidance from the local community and statewide public health guidelines for mask use in light of the absence of evidence in the community setting to reduce the risk for transmission of SARS-CoV-2 infection. In the health care setting, evidence showed that N95 respirators may reduce the risk for SARS-CoV-1 infection compared with surgical masks or no masks and regardless of use of masks, it is essential to strictly follow all other infection prevention and control measures (such as hand hygiene, physical distancing, and others) along with appropriate use of other PPE (such as gowns, gloves, and goggles). Finally, no evidence is available about the effectiveness of extended use or reuse of N95 respirators in health care settings, but extended use of N95 respirators is preferable to reuse of N95 respirators because it involves less touching of the respirator, thus less risk for contact transmission.

Clinical Topics: Prevention

Keywords: Coronavirus, COVID-19, Eye Protective Devices, Gloves, Protective, Hand Hygiene, Health Services Research, Infection Control, Masks, Personal Protective Equipment, Primary Prevention, Public Health, SARS Virus, Severe Acute Respiratory Syndrome, severe acute respiratory syndrome coronavirus 2


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