School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
BMJ Glob Health. 2020 May;5(5). doi: 10.1136/bmjgh-2020-002553.
The coronavirus disease 2019 (COVID-19) pandemic has led to personal protective equipment (PPE) shortages, requiring mask reuse or improvisation. We provide a review of medical-grade facial protection (surgical masks, N95 respirators and face shields) for healthcare workers, the safety and efficacy of decontamination methods, and the utility of alternative strategies in emergency shortages or resource-scarce settings.
We conducted a scoping review of PubMed and grey literature related to facial protection and potential adaptation strategies in the setting of PPE shortages (January 2000 to March 2020). Limitations included few COVID-19-specific studies and exclusion of non-English language articles. We conducted a narrative synthesis of the evidence based on relevant healthcare settings to increase practical utility in decision-making.
We retrieved 5462 peer-reviewed articles and 41 grey literature records. In total, we included 67 records which met inclusion criteria. Compared with surgical masks, N95 respirators perform better in laboratory testing, may provide superior protection in inpatient settings and perform equivalently in outpatient settings. Surgical mask and N95 respirator conservation strategies include extended use, reuse or decontamination, but these strategies may result in inferior protection. Limited evidence suggests that reused and improvised masks should be used when medical-grade protection is unavailable.
The COVID-19 pandemic has led to critical shortages of medical-grade PPE. Alternative forms of facial protection offer inferior protection. More robust evidence is required on different types of medical-grade facial protection. As research on COVID-19 advances, investigators should continue to examine the impact on alternatives of medical-grade facial protection.
2019 年冠状病毒病（COVID-19）大流行导致个人防护设备（PPE）短缺，需要重复使用或临时制作口罩。我们提供了对医护人员使用的医用面部保护装置（外科口罩、N95 呼吸器和面罩）、消毒方法的安全性和有效性，以及在紧急短缺或资源匮乏情况下替代策略的实用性的审查。
我们对与 PPE 短缺情况下面部保护和潜在适应策略相关的 PubMed 和灰色文献进行了范围界定审查（2000 年 1 月至 2020 年 3 月）。局限性包括缺乏 COVID-19 特异性研究和排除非英语语言文章。我们根据相关医疗保健环境对证据进行了叙述性综合，以提高决策中的实际实用性。
我们检索到 5462 篇同行评议文章和 41 篇灰色文献记录。共有 67 篇记录符合纳入标准。与外科口罩相比，N95 呼吸器在实验室测试中表现更好，在住院环境中可能提供更好的保护，在门诊环境中表现相当。外科口罩和 N95 呼吸器的保存策略包括延长使用、重复使用或消毒，但这些策略可能导致保护效果下降。有限的证据表明，在无法获得医用级保护的情况下，应使用重复使用和临时制作的口罩。
COVID-19 大流行导致医用级 PPE 严重短缺。替代形式的面部保护提供的保护效果较差。需要更多关于不同类型医用面部保护的更可靠证据。随着对 COVID-19 的研究进展，研究人员应继续研究对医用级面部保护的替代方案的影响。
