Welcome to visit Zhongnan Medical Journal Press Series journal website!
Zhongnan Medical Journal Press Series of Journals Center for Evidence-Based and Translational Medicine of Wuhan University

The title
  • The title
  • The keywords
  • The author
Submit中文版

HomeArticlesVol 30,2020 No.2Detail

Do medical staffs need to wear masks? - Arguments based on best evidence

Published on Mar. 19, 2020Total Views: 10969 timesTotal Downloads: 2871 timesDownloadMobile

Author: Yun-Yun WANG 1, 2 Ying-Juan CAO 3 Rong FU 4 Kan-Da FU 5 Zhong-Kai FAN 6 Wei-Jie GAO 7 Ying-Hui JIN 1, 2 Yu-Feng LIU 8 Zhi MAO 9 Bin PEI 10 Ping RONG 11 Yue-Xian SHI 12 Li-Ming TAN 13 Fen WANG 14 Ying WANG 15 Da-Guo XU 16 Qing-An XU 17, 18 Wen-Zhong XIE 19 Zheng XIAO 20 Jian YANG 21, 22 Qi-Wen YANG 23 Zhi-Ping YANG 24 Bo ZHOU 25 Xiao-Wen ZHAI 26 Yun ZHANG 27 Yan-Jun ZHONG 28 Xiao-Ping ZHU 29 Xing-Huan WANG 1, 2* Jin GU 30*

Affiliation: 1. Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China 2. Center for Evidence-Based and Translational Medicine, Wuhan University, Wuhan 430071, China 3. Nursing Department, Qilu Hospital of Shandong University, Jinan 250012, China 4. Department of Internal Medicine, Gulou Hospital Affiliated to Medical College of Nanjing University, Nanjing 210008, China 5. Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China 6. Department of Orthopedics, First Affiliated Hospital of Jinzhou Medical College, Jinzhou 121001, Liaoning Prov-ince, China 7. School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China 8. Department of Paediatric Internal Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China 9. Department of Critical Medicine, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China 10. Evidence-Based Medicine Center, the first People’ s Hospital of Xiangyang, Hubei University of Medicine, Xiang-yang 442000, Hubei Province, China 11. Department of Pediatrics, First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China 12. School of Nursing, Peking University, Beijing 100191, China 13. The Second People's Hospital of Huaihua, Huaihua 418200, Hunan Province, China 14. Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanchang University, Nanchang 330006, China 15. Department of pharmacy, China Japan Union Hospital of Jilin University, Changchun 130033, China 16. Department of Quality Management, Zhujiang Hospital Affiliated to South Medical University, Guangzhou 510282, China 17. Department of Stomatology, School of Medicine, Jianghan University, Wuhan 430056, China 18. Stomatological Hospital, Jianghan University, Wuhan 430022, China 19. Kaifeng Instituty of Medical Science, Kaifeng 475000, Henan Province, China 20. Evidence-Based Medicine Center, Affiliated Hospital of Zunyi Medical University, Zunyi 536000, Guizhou Province, China 21. Department of Cardiology, The People's Hospital of China Three Gorges University, Yichang 443000, Hubei Province, China 22. Institute of Evidence-based and Translational Medicine, China Three Gorges University, Yichang 443003, Hubei Province, China 23. Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing 100730, China 24. Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an 710032, China 25. Department of Clinical Epidemiology and Evidence-Based Medicine, The First Affiliated Hospital of China Medi-cal University, Shenyang 110001, China 26. Department of Hematology, Children's Hospital, Fudan University, Shanghai 201102, China 27. Stomatological Hospital of Lanzhou City, Lanzhou 730000, China 28. Department of Intensive Care Unit, Xiangya Second Hospital, Central South University, Changsha 410011, China 29. Hospital Quality and Safety Management Office, Zhongnan Hospital of Wuhan University, Wuhan 430071, China 30. Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing 100043, China

Keywords: Medical Institution Medical Worker Mask Best Evidence Clinical Evidence

DOI: 10.12173/j.issn.1004-5511.2020.02.09

Reference: Wang YY, Cao YJ, Fu R, Fu KD, Fan ZK, Gao WJ, Jin YH, Liu YF, Mao Z, Pei B, Rong P, Shi YX, Tan LM, Wang F, Wang Y, Xu DG, Xu AQ, Xie WZ, Xiao Z, Yang J, Yang QW, Yang ZP, Zhou B, Zhai XW, Zhang Y, Zhong YJ, Zhu XP, Wang XH, Gu J. Do medical staffs need to wear masks? - Arguments based on best evidence[J].Yixue Xinzhi Zazhi, 2020, 30(2): 124-138. DOI: 10.12173/j.issn.1004-5511.2020.02.09.[Article in Chinese]

  • Abstract
  • Full-text
  • References
Abstract

Objective  whether the medical staff need to wear masks or not is still controversial, the aim of this study is to evaluate and summarize the best evidence relevant to this topic in order to provide sugges-tions for the medical staff. 

Methods  PubMed, Cochrane Library, web of science, CINAHL, CNKI, Wan-fang, VIP, CBM, guideline databases and related professional societies were systematically searched from the inception of the database to 27 October 2019 in order to relevant guidelines, expert consensus and systematic reviews. The researchers assessed the quality of best evidence included using international recognized quality evaluation tools, and summarized the recommendations on whether the medical staff need to wear masks or not. 

Results  35 documents were included, including 6 guidelines, 27 expert consensus, 2 systematic reviews, and the overall quality of the evidence was higher. According to the ev-idence, masks were recommended as one of the personal protective measures, and wearing masks has obvious advantages in the prevention of nosocomial infection compared with the nonuse of respiratory protective equipment. The evidence also put forward a number of recommendations based on different clinical scenarios workplace such as operation area, laboratory area, obstetrics. 

Conclusion  Wearing masks is well recognized by the existing best evidence to prevent nosocomial infection. However, the quality of the evidence still has certain limitations. The medical staff should use masks reasonably consid-ering their experience, clinical settings, or other factors. 

Full-text
Please download the PDF version to read the full text: download
References

1. 中华人民共和国卫生部. 中华人民共和国卫生行业标准-医院隔离技术规范 [EB/OL]. (2019-04-01) [Access on 2019-10-27]. http://www.nhc.gov.cn/cmsresources/mohyzs/cmsrsdocument/doc5841.pdf. 

2. 王天阳. 院内高危科室工作人员医用口罩使用现状综述[C]. 中国医学装备大会暨第27届学术与技术交流年会论文汇编. 中国医学装备协会、《中国医学装备》杂志社, 2018: 147-149. [Wang TY. The use of medical masks by the staff of high-risk departments in the hospital: a review[C]. China medical equipment conference and the 27th annual meeting of academic and technical exchange. China medical Equipment As-sociation, Periodical Office of China Medical Equipment, 2018: 147-149.]

3. 杨京. 医护人员“摘口罩”，看清面容更要敞开内心[N]. 长江日报, 2019-10-31(007). [Yang J. Medical staffs "take off masks", see their faces clearly and open their hearts[N]. Changjiang Daily, 2019-10-31(007).]

4. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care[J]. CMAJ, 2010, 182(18): E839-42. DOI: 10.1503/cmaj.090449.

5. Dans AL, Dans LF. Appraising a tool for guideline appraisal (the AGREE II instrument)[J]. J Clin Epidemiol, 2010, 63(12): 1281-2. DOI: 10.1016/j.jclinepi.2010.06.005.

6. Ma LL, Wang YY, Yang ZH et al. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better?[J]. Mil Med Res, 2020, 7: 9. DOI: 10.1186/s40779-020-00238-8.

7. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both[J]. BMJ, 2017: j4008. DOI: 10.1136/bmj.j4008.

8. 张方圆, 沈傲梅, 曾宪涛, 等. 系统评价方法学质量评价工具AMSTAR 2解读[J]. 中国循证心血管医学杂志, 2018, 10(1): 14-18. DOI: 10.3969/j.issn.1674-4055.2018.01.03. [Zhang FY, Shen AM, Zeng XT, et al. An Introduction to AMSTAR 2: a critical appraisal tool for systematic reviews[J]. Chin J Evid Based Cardiovasc Med, 2018, 10(1): 14-18.]

9. Meerpohl JJ, Langer G, Perleth M, et al. GRADE guidelines: 4. Rating the quality of evidence - limitations of clinical trials (risk of bias)[J]. Z Evid Fortbild Qual Gesundhwes, 2012, 106(6): 457-69. DOI: 10.1016/j.zefq.2012.06.014.  

10.  Perleth M, Langer G, Meerpohl JJ, et al. GRADE guidelines: 7. Rating the quality of evidence - incon-sistency[J]. Z Evid Fortbild Qual Gesundhwes, 2012, 106(10): 733-44. DOI: 10.1016/j.zefq.2012.10.018. 

11.  Rasch A, Perleth M, Langer G, et al. GRADE guidelines: 8. Rating the quality of evidence - indirectness[J]. Z Evid Fortbild Qual Gesundhwes, 2012, 106(10): 745-53. DOI: 10.1016/j.zefq.2012.10.019. 

12.  Kulig M, Perleth M, Langer G, et al. GRADE guidelines: 6. Rating the quality of evidence: imprecision[J]. Z Evid Fortbild Qual Gesundhwes, 2012, 106(9): 677-88. DOI: 10.1016/j.zefq.2012.10.016. 

13.  Nolting A, Perleth M, Langer G, et al. GRADE guidelines: 5. Rating the quality of evidence: publication bias[J]. Z Evid Fortbild Qual Gesundhwes, 2012, 106(9): 670-6. DOI: 10.1016/j.zefq.2012.10.015.

14.  Guyatt GH, Oxman AD, Sultan S, et al. GRADE guidelines: 9. Rating up the quality of evidence[J]. J Clin Epidemiol, 2011, 64(12): 1311-6. DOI: 10.1016/j.jclinepi.2011.06.004.

15.  Guyatt GH, Oxman AD, Sultan S, et al. GRADE guidelines: 9. Rating up the quality of evidence[J]. J Clin Epidemiol, 2011, 64(12): 1311-6. DOI: 10.1016/j.jclinepi.2011.06.004. 

16.  National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment[EB/OL]. 2019. [Access on 2019-10-27]. https://www.nice.org.uk/guidance/ng125.

17.  Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm[EB/OL]. (2019-11-18) [Access on 2019-11-23]. https://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.html.

18.  Belinda Ostrowsky. Guide to infection control in the healthcare setting: Streptococcus pyogenes[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/pathogens/streptococcuspyogenes/.

19.  Roman Pallares, Imma Grau. Guide to infection control in the healthcare setting: Pneumococcus[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/pathogens/pneumococcus/.

20.  Morgan A. Pence. Guide to infection control in the healthcare setting: laboratory areas[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/infectionprevention/laboratory/.

21.  Ziad A. Memish. Guide to infection control in the healthcare setting: Middle East respiratory syndrome coronavirus[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/pathogens/mers/.

22.  Larry Lutwick, Gonzalo Bearman. Guide to infection control in the healthcare setting: Bloodstream infec-tions[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/hospital/bloodstreaminfections/.

23.  Ziad A Memish, Shaheen Mehtar, Gonzalo Bearman. Guide to infection control in the healthcare setting: Nipah virus[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/pathogens/nipah/.

24.  Zias A. Memish. Guide to infection control in the healthcare setting: SARS-associated coronavirus[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/pathogens/sars/.

25.  Véronique Y. Miendje Deyi. Guide to infection control in the healthcare setting: Helicobacter pylori[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/pathogens/hpylori/.

26.  Eric Nulens. Guide to infection control in the healthcare setting: Isolation of communicable diseases[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/infectionprevention/isolation/.

27.  Pawan Suri, Ravinera Gopaul. Guide to infection control in the healthcare setting: Emergency department and receiving areas[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/infectionprevention/emergency/.

28.  Peter N. Hoffman, T.D. Healing. Guide to infection control in the healthcare setting: The infection hazards of human cadavers[EB/OL]. 2018. [Access on 2020-10-27]. https://www.isid.org/guide/infectionprevention/humancadavers/.

29.  Marie-Claude Roy. Guide to infection control in the healthcare setting: The operating room[EB/OL]. 2018. [Access on 2019-10-27].https://www.isid.org/guide/infectionprevention/operatingroom/.

30.  Sean Wasserman, Angeliki Messina. Guide to infection control in the healthcare setting: Bundles in infection prevention and safety[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/infectionprevention/bundles/.

31.  Samuel Ponce de León-R. Guide to infection control in the healthcare setting: Reuse of disposable devic-es[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/infectionprevention/disposabledevices/.

32.  Paul R. Allyn, Timothy F. Brewer. Guide to infection control in the healthcare setting: Tuberculosis[EB/OL]. 2018.  [Access on 2019-10-27]. https://www.isid.org/guide/pathogens/tuberculosis/.

33.  Jan AJW Kluytmans, Jacobien Veenemans. Guide to infection control in the healthcare setting: Infection control in obstetrics[EB/OL]. 2018. [Access on 2019-10-27]. https://www.isid.org/guide/infectionprevention/obstetrics/.

34.  Centers for Disease Control and Prevention. 2018. Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons under Inves-tigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals, Including Procedures for Donning and Doffing PPE[EB/OL]. [Access on 2019-10-27]. https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html.

35.  Centers for Disease Control and Prevention. Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings[EB/OL]. (2018-03-28) [Access on 2019-10-27]. https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html.

36.  Center for Disease Control and Prevention : Prevention strategies for seasonal influenza in healthcare set-tings[EB/OL]. (2018-10-30) [Access on 2019-10-27]. https://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm. 

37.  Offeddu V, Yung CF, Low MSF, et al. Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis[J]. Clin Infect Dis, 2017, 65(11): 1934-1942. DOI: 10.1093/cid/cix681.

38.  Smith JD, MacDougall CC, Johnstone J, et al. Effectiveness of N95 respirators versus surgical masks in pro-tecting health care workers from acute respiratory infection: a systematic review and Meta-analysis[J]. CMAJ, 2016, 188(8): 567-574. DOI: 10.1503/cmaj.150835. 

39.  Kim JY, Song JY, Yoon YK, et al. Middle East Respiratory Syndrome Infection Control and Prevention Guideline for Healthcare Facilities[J] . Infect Chemother, 2015, 47(4): 278-302. DOI: 10.3947/ic.2015.47.4.278. 

40.  World Health Organization. Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in HealthCare Settings, with Focus on Ebola[EB/OL]. 2014. [Access on 2019-10-27]. http://www.euro.who.int/__data/assets/pdf_file/0005/268772/Interim-Infection-Prevention-and-Control-Guidance-for-Care-of-Patients-with-Suspected-or-Confirmed-Filovirus-Haemorrhagic-Fever-in-Health-Care-Settings,-with-Focus-on-Ebola-Eng.pdf.

41.  Healthcare Infection Society Working Group on Respiratory and Facial Protection. Guidance on the use of respiratory and facial protection equipment[J]. J Hosp Infect, 2013, 85(3): 170-182. DOI: 10.1016/j.jhin.2013.06.020.

42.  中华医学会呼吸病学分会感染学组. 甲氧西林耐药的金黄色葡萄球菌肺炎诊治与预防专家共识[J]. 中国医学前沿杂志(电子版), 2013, 5(1): 45-50. DOI: 10.3760/cma.j.issn.1001-0939.2012.10.007. [Infection group, Respiratory branch of Chinese Medical Association. Expert consensus on diagnosis, treatment and prevention of methicillin resistant Staphylococcus aureus pneumonia[J]. Chinese Journal of the Frontiers of Medical Sciences (Electronic Edition), 2013, 5(1): 45-50.] 

43.  Provincial Infectious Diseases Advisory Committee (PIDAC). Routine Practices and Additional Precautions In All Health Care Settings, 3rd edition[EB/OL]. 2012. [Access on 2019-10-27]. https://www.publichealthontario.ca/-/media/documents/bp-rpap-healthcare-settings.pdf?la=en.

44.  National Institute for Health and Clinical Excellence (NICE) UK: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control[EB/OL]. 2011. [Access on 2019-10-27]. https://www.nice.org.uk/Guidance/CG117.

45.  The European Network for Infectious Diseases (EUNID) Working Group. Infection control in the manage-ment of highly pathogenic infectious diseases: consensus of the European Network of Infectious Disease[J]. Lancet Infect Dis, 2009, 9(5): 301-11. DOI: 10.1016/S1473-3099(09)70070-2.

46.  Center for Disease Control and Prevention: Interim guidance on infection control measures for 2009 H1N1 influenza in healthcare settings, including protection of healthcare personnel[EB/OL]. (2010-07-15)[Access on 2019-10-27]. http://www.cdc.gov/h1n1flu/guidelines_infection control.htm.

47.  World Health Organization (WHO): Infection prevention and control during health care for confirmed, probable, or suspected cases of pandemic (H1N1) 2009 virus infection and influenza like illnesses[EB/OL]. (2009-12-16)[Access on 2019-12-23]. http://www.who.int/csr/resources/publications/cp150_2009_1612_ipc_interim_guidance_h1n1.pdf.

48.  Betsy Lehman Center for Patient Safety and Medical Error Reduction, JSI Research and Training Institute, Inc. Surgical attire and drapes [Internet]. In: Prevention and control of healthcare-associated infections in Mas-sachusetts. Part 1: final recommendations of the Expert Panel. Boston: Massachusetts Department of Health. 2008. p. 66-7. http://data.patientcarelink.org/uploadDocs/1/Betsy-Leham.pdf.

49.  Center for Disease Control and Prevention: Public health guidance for community-level preparedness and response to severe acute respiratory syndrome (SARS)[EB/OL]. (2005-05-03)[Access on 2019-10-27]. http://www.cdc.gov/sars/guidance.

50.  Center for Disease Control and Prevention. Guidelines for preventing the transmission of mycobacterium tuberculosis in health-care settings. morbidity and mortality weekly report[EB/OL]. (2005-12-30) [Access on 2019-10-27].https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm.

Popular Papers
© 2022 - 2024 Zhongnan Medical Journal Press of Zhongnan Hospital of Wuhan University|Support: Yufu Technology
About NM | Contact us