New study evens the playing field for surgical masks and N95s

By: March 31st, 2010 Email This Post Print This Post

When it comes to respiratory protection against H1N1, the CDC says N95s should be used during close contact with possibly infected patients, a recommendation many healthcare experts have debated, but OSHA has enforced.

Now a new study out of Japan indicates that surgical masks provide just as much protection against H1N1.

The observational study, published in Clinical Infectious Diseases, was conducted in Tan Tock Seng Hospital in Singapore, and began by implementing recommendations similar to the CDC. From April 25th, when H1N1 first emerged, to June 18th fit tested N95 respirators, eye protection, gloves, and gowns were required in high‐risk areas, including the ED and isolation areas.

After local H1N1 transmission was detected on June 19, the hospital switched to surgical masks in all clinical areas, and continued using N95s in the ED and isolation areas.

By mid-July the facility had transitioned into surgical masks for all routine care, recommending N95s only for aerosol generating procedures. Having previously dealt with SARS outbreaks, the hospital already established web-based surveillance systems to monitor sick employees.

Results from that surveillance showed 33 employees had confirmed cases of H1N1, but none of these healthcare workers cared for infected patients. Five worked in the emergency departments, but did not participate in screening suspected patients. Investigations found that the majority of cases were linked to H1N1 transmission outside of the hospital.

“Although this is an observational study, nonetheless our findings show that surgical masks and N95 respirators do not appear to differ in efficacy in the prevention of the acquisition of pH1N1 by staff,” authors wrote in the conclusion of the study.


By Debby Rapp on March 31st, 2010 at 11:04 am

This study is very informative and so was the study done earlier in our own country. Unfortunately however, this does not help any of us in infection prevention and control programs until the CDC recognizes and recommendes it. Many of us have been asking why do we need to require the use of an N-95 when supplies are limited and it did not fit the droplet transmission of this disease.
Until CDC changes we are obligated to use N-95’s by our state health departments and OSHA who follow CDC’s recommendations.

For me it’s simple, how can I, as a healthcare provider who has direct patient contact/care, be assured that I am fully protected by the mask I am wearing if it was not tested on me first? I would like to be able to work without having to be concerned about that and knowing fully that I am protecting myself by following the proper recommended procedures and that my employer if supporting that requirement.

By Deborah Dutton on March 31st, 2010 at 12:44 pm

Until the CDC accepts that the study they based the use of N 95s for H1N1 was flawed and look at other studies (as the above)that show the use of surgical masks meet the need.

By Melissa McDiarmid on March 31st, 2010 at 3:04 pm

The letters to the editor regarding this study were published in the March 10 issue of JAMA and reiterate some of the same significant flaws of this study that were mentioned in the accompanying editiorial that appeared with the article in the Fall of last year. Importantly, the statistical power was noted to be inadequate to observe a difference between the types of masks used, there was a failure to count flu contacts of the study participants (thus ‘apples to apples’ comparisons could not be made) and inadequate documentation of mask compliance. This adds up to a deeply flawed study and certainly not useful in policy development.

And what about protecting self from other diseases/impending pandemics in the future? NOT only for the H1N1. Just thinking ahead.


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