Face Masks: Which One to Wear in What Clinical Situations

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Face Masks: Which One to Wear in What Clinical Situations

When should pharmacists and other healthcare professionals wear N96 respirators and when should they wear surgical masks? That is a common question during the COVID-19 pandemic. Find out how a new review from the American College of Physicians answers those questions.

PHILADELPHIA – With the shortage of personal protective equipment and sometimes conflicting guidance from a number of specialty groups and public health officials, pharmacists might be confused by what face mask to wear when.

Physician and pharmacist authors working for the American College of Physicians (ACP) recently provided new Practice Points on the effectiveness of N95 respirators, surgical masks, and cloth masks for the prevention of COVID-19 disease. The guidance also discusses the use of standard precautions – including hand washing and gloves -- in both healthcare settings and community settings.

The Annals of Internal Medicine article seeks to answer three 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 (gloves + handwashing) in community settings?
  • What is the effectiveness of N95 respirators versus surgical masks versus cloth masks for the prevention of COVID-19 in addition to standard precautions (gowns + gloves + handwashing) in health care settings?
  • What is the effectiveness for reuse or extended use of N95 respirators for prevention of COVID-19?

https://www.acpjournals.org/doi/10.7326/M20-3234

The ACP advises that, in the healthcare setting, clinicians should wear N95 respirators when in close contact with suspected or known COVID-19 patients. Surgical masks, on the other hand, should be worn by all healthcare personnel, patients and visitors who are not in close contact with those with suspected or known COVID-19; that practice reduces the risk of transmission of SARS-CoV-2 infection.

ACP says asymptomatic or symptomatic persons in community settings should follow community and statewide public health guidelines for mask use. Those should take into account factors such as local demographics, including high risk population, as well as ), epidemiologic data, including reproduction rate, daily case counts, hospitalizations, and deaths, according to the report. The physician group suggests that exposure context also be considered, including the number of people in a setting, whether it is indoors or outdoors and the quality of ventilation.

“Health care personnel should not be exposed to patients suspected or known to have COVID-19 without proper PPE,” the authors write. “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) in health care settings.”

One issue, according to the report, is that data on SARS-CoV-2 are limited. The ACP says it based the practice points on the best available evidence on the effectiveness of N95 respirators, surgical masks, and cloth masks in reducing transmission of infection with SARS-CoV-1, Middle East respiratory syndrome coronavirus (MERS-CoV), and influenza-like or other respiratory viruses in community and health care settings. Guidance was developed by the ACP based on a rapid systematic evidence review conducted by the Pacific Northwest Evidence-based Practice Center and funded by the U.S. Agency for Healthcare Research and Quality

“The use of respiratory personal protective equipment (PPE) may decrease the risk for respiratory infection, although controversy exists around the appropriate types of masks and the situations in which they should be used in community and health care settings for the prevention of SARS-CoV-2 infection,” the authors emphasize.

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