Masking strategy to protect healthcare workers from COVID-19: An umbrella meta-analysis

IF 2.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Infection Disease & Health Pub Date : 2023-08-01 DOI:10.1016/j.idh.2023.01.004
Yijun Lu , Arnold Ikedichi Okpani , Christopher B. McLeod , Jennifer M. Grant , Annalee Yassi
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引用次数: 2

Abstract

Background

The burden of severe disease and death due to SARS-CoV-2 (COVID-19) pandemic among healthcare workers (HCWs) worldwide has been substantial. Masking is a critical control measure to effectively protect HCWs from respiratory infectious diseases, yet for COVID-19, masking policies have varied considerably across jurisdictions. As Omicron variants began to be predominant, the value of switching from a permissive approach based on a point of care risk assessment (PCRA) to a rigid masking policy needed to be assessed.

Methods

A literature search was conducted in MEDLINE (Ovid platform), Cochrane Library, Web of Science (Ovid platform), and PubMed to June 2022. An umbrella review of meta-analyses investigating protective effects of N95 or equivalent respirators and medical masks was then conducted. Data extraction, evidence synthesis and appraisal were duplicated.

Results

While the results of Forest plots slightly favoured N95 or equivalent respirators over medical masks, eight of the ten meta-analyses included in the umbrella review were appraised as having very low certainty and the other two as having low certainty.

Conclusion

The literature appraisal, in conjunction with risk assessment of the Omicron variant, side-effects and acceptability to HCWs, along with the precautionary principle, supported maintaining the current policy guided by PCRA rather than adopting a more rigid approach. Well-designed prospective multi-centre trials, with systematic attention to the diversity of healthcare settings, risk levels and equity concerns are needed to support future masking policies.

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保护医护人员免受COVID-19侵害的掩蔽策略:一项总括性荟萃分析
世界各地的卫生保健工作者(HCWs)因SARS-CoV-2 (COVID-19)大流行而造成的严重疾病和死亡负担非常沉重。掩蔽是有效保护卫生工作者免受呼吸道传染病侵害的一项关键控制措施,但对于COVID-19,不同司法管辖区的掩蔽政策差异很大。随着欧米克隆变异开始占主导地位,需要评估从基于护理点风险评估(PCRA)的宽松方法转向严格掩盖策略的价值。方法检索MEDLINE (Ovid平台)、Cochrane Library、Web of Science (Ovid平台)和PubMed至2022年6月的文献。然后对调查N95或同等呼吸器和医用口罩保护作用的荟萃分析进行了总括性回顾。数据提取、证据合成和评价是重复的。结果:虽然Forest图的结果略微倾向于N95或同等级别的呼吸器,而不是医用口罩,但总纲评价中包含的10项荟萃分析中有8项的确定性评价为非常低,另外2项的确定性评价为低。结论文献评价,结合对Omicron变异、副作用和对HCWs的可接受性的风险评估,以及预防原则,支持在PCRA指导下维持现行政策,而不是采取更严格的方法。需要设计良好的前瞻性多中心试验,系统地关注医疗环境的多样性、风险水平和公平性问题,以支持未来的掩盖政策。
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来源期刊
Infection Disease & Health
Infection Disease & Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
5.70
自引率
5.70%
发文量
40
审稿时长
20 days
期刊介绍: The journal aims to be a platform for the publication and dissemination of knowledge in the area of infection and disease causing infection in humans. The journal is quarterly and publishes research, reviews, concise communications, commentary and other articles concerned with infection and disease affecting the health of an individual, organisation or population. The original and important articles in the journal investigate, report or discuss infection prevention and control; clinical, social, epidemiological or public health aspects of infectious disease; policy and planning for the control of infections; zoonoses; and vaccination related to disease in human health. Infection, Disease & Health provides a platform for the publication and dissemination of original knowledge at the nexus of the areas infection, Disease and health in a One Health context. One Health recognizes that the health of people is connected to the health of animals and the environment. One Health encourages and advances the collaborative efforts of multiple disciplines-working locally, nationally, and globally-to achieve the best health for people, animals, and our environment. This approach is fundamental because 6 out of every 10 infectious diseases in humans are zoonotic, or spread from animals. We would be expected to report or discuss infection prevention and control; clinical, social, epidemiological or public health aspects of infectious disease; policy and planning for the control of infections; zoonosis; and vaccination related to disease in human health. The Journal seeks to bring together knowledge from all specialties involved in infection research and clinical practice, and present the best work in this ever-changing field. The audience of the journal includes researchers, clinicians, health workers and public policy professionals concerned with infection, disease and health.
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