Chughtai Abrar Ahmad, Seale Holly, MacIntyre Chandini Raina
School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney 2052, Australia.
BMC Res Notes. 2013 May 31;6:216. doi: 10.1186/1756-0500-6-216.
Currently there is an ongoing debate and limited evidence on the use of masks and respirators for the prevention of respiratory infections in health care workers (HCWs). This study aimed to examine available policies and guidelines around the use of masks and respirators in HCWs and to describe areas of consistency between guidelines, as well as gaps in the recommendations, with reference to the WHO and the CDC guidelines.
Policies and guidelines related to mask and respirator use for the prevention of influenza, SARS and TB were examined. Guidelines from the World Health Organization (WHO), the Center for Disease Control and Prevention (CDC), three high-income countries and six low/middle-income countries were selected.
Uniform recommendations are made by the WHO and the CDC in regards to protecting HCWs against seasonal influenza (a mask for low risk situations and a respirator for high risk situations) and TB (use of a respirator). However, for pandemic influenza and SARS, the WHO recommends mask use in low risk and respirators in high risk situations, whereas, the CDC recommends respirators in both low and high risk situations. Amongst the nine countries reviewed, there are variations in the recommendations for all three diseases. While, some countries align with the WHO recommendations, others align with those made by the CDC. The choice of respirator and the level of filtering ability vary amongst the guidelines and the different diseases. Lastly, none of the policies discuss reuse, extended use or the use of cloth masks.
Currently, there are significant variations in the policies and recommendations around mask and respirator use for protection against influenza, SARS and TB. These differences may reflect the scarcity of level-one evidence available to inform policy development. The lack of any guidelines on the use of cloth masks, despite widespread use in many low and middle-income countries, remains a policy gap. Health organizations and countries should jointly evaluate the available evidence, prioritize research to inform evidence gaps, and develop consistent policy on masks and respirator use in the health care setting.
目前，关于医护人员使用口罩和呼吸器预防呼吸道感染存在持续的争论且证据有限。本研究旨在审查有关医护人员使用口罩和呼吸器的现有政策和指南，并参照世界卫生组织（WHO）和美国疾病控制与预防中心（CDC）的指南，描述指南之间的一致性领域以及建议中的差距。
审查了与使用口罩和呼吸器预防流感、严重急性呼吸综合征（SARS）和结核病相关的政策和指南。选取了世界卫生组织（WHO）、美国疾病控制与预防中心（CDC）、三个高收入国家和六个低/中等收入国家的指南。
WHO和CDC就保护医护人员免受季节性流感（低风险情况使用口罩，高风险情况使用呼吸器）和结核病（使用呼吸器）提出了统一建议。然而，对于大流行性流感和SARS，WHO建议在低风险情况下使用口罩，高风险情况下使用呼吸器，而CDC建议在低风险和高风险情况下均使用呼吸器。在所审查的九个国家中，针对这三种疾病的建议存在差异。虽然一些国家与WHO的建议一致，但其他国家与CDC的建议一致。呼吸器的选择和过滤能力水平在不同指南和不同疾病之间有所不同。最后，没有一项政策讨论重复使用、延长使用或使用布口罩的问题。
目前，关于使用口罩和呼吸器预防流感、SARS和结核病的政策和建议存在显著差异。这些差异可能反映了用于为政策制定提供信息的一级证据的稀缺性。尽管布口罩在许多低/中等收入国家广泛使用，但缺乏关于其使用的任何指南仍然是一个政策空白。卫生组织和各国应共同评估现有证据，优先开展研究以填补证据空白，并制定关于在医疗环境中使用口罩和呼吸器的一致政策。
