Veille documentaire MTPH

Médecine du travail du personnel hospitalier

A randomized clinical trial of three options for N95 respirators and medical masks in health workers

Auteur     C Raina MacIntyre
Auteur     Quanyi Wang
Auteur     Holly Seale
Auteur     Peng Yang
Auteur     Weixian Shi
Auteur     Zhanhai Gao
Auteur     Bayzid Rahman
Auteur     Yi Zhang
Auteur     Xiaoli Wang
Auteur     Anthony T Newall
Auteur     Anita Heywood
Auteur     Dominic E Dwyer
Volume     187
Numéro     9
Pages     960-966
Publication     American journal of respiratory and critical care medicine
ISSN     1535-4970
Date     May 1, 2013
Résumé     RATIONALE: We compared three policy options for the use of medical masks and N95 respirators in healthcare workers (HCWs). OBJECTIVES: A cluster randomized clinical trial of 1,669 hospital-based HCWs in Beijing, China in the winter of 2009-2010. METHODS: Participants were randomized to medical masks, N95 respirators, or targeted use of N95 respirators while doing high-risk procedures or barrier nursing. Outcomes included clinical respiratory illness (CRI) and laboratory-confirmed respiratory pathogens in symptomatic subjects. MEASUREMENTS AND MAIN RESULTS: The rate of CRI was highest in the medical mask arm (98 of 572; 17%), followed by the targeted N95 arm (61 of 516; 11.8%), and the N95 arm (42 of 581; 7.2%) (P < 0.05). Bacterial respiratory tract colonization in subjects with CRI was highest in the medical mask arm (14.7%; 84 of 572), followed by the targeted N95 arm (10.1%; 52 of 516), and lowest in the N95 arm (6.2%; 36 of 581) (P = 0.02). After adjusting for confounders, only continuous use of N95 remained significant against CRI and bacterial colonization, and for just CRI compared with targeted N95 use. Targeted N95 use was not superior to medical masks. CONCLUSIONS: Continuous use of N95 respirators was more efficacious against CRI than intermittent use of N95 or medical masks. Most policies for HCWs recommend use of medical masks alone or targeted N95 respirator use. Continuous use of N95s resulted in significantly lower rates of bacterial colonization, a novel finding that points to more research on the clinical significance of bacterial infection in symptomatic HCWs. This study provides further data to inform occupational policy options for HCWs.

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