Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2

Chughtai, Abrar Ahmad; Seale, Holly; MacIntyre, C. Raina

doi:10.3201/eid2610.200948

Cited by 134 publications

(142 citation statements)

References 26 publications

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“…Shortages of personal protective equipment (PPE) have been described as a contributing risk factor for COVID-19 in HCW worldwide ( Lapolla et al, 2020 , Lai et al, 2020 , Australian Government Department of Health, 2020 ). Initial recommendations from the Centres for Disease Control and Prevention (CDC) were to use respirators, but following a shortage in supply of these, guidelines changed to the use of medical masks, or even cloth masks ( Chughtai et al, 2020 , Center for Disease Control and Prevention 2020 ). In China, HCW infections decreased with the increase in acquired PPE along with proper training and make-shift hospitals, where patients were categorized and separated according to symptoms ( Tang et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Estimating the burden of COVID-19 on the Australian healthcare workers and health system during the first six months of the pandemic

Quigley¹,

Stone

Nguyen

et al. 2021

International Journal of Nursing Studies

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Introduction There is no publicly available national data on healthcare worker infections in Australia. It has been documented in many countries that healthcare workers are at increased occupational risk of COVID-19. We aimed to estimate the burden of COVID-19 on Australia healthcare workers and the health system by obtaining and organizing data on HCW infections, analyzing national HCW cases in regards to occupational risk and analyzing healthcare outbreak. Methods We searched government reports and websites and media reports to create a comprehensive line listing of Australian healthcare worker infections and nosocomial outbreaks between January 25 th and July 8 th , 2020. A line list of healthcare worker related COVID-19 reported cases was created and enhanced by matching data extracted from media reports of healthcare related COVID-19 relevant outbreaks and reports, using matching criteria. Rates of infections and odds ratios (ORs) for healthcare workers were calculated per state, by comparing overall cases to healthcare worker cases. To investigate the sources of infection amongst healthcare workers, transmission data were collated and graphed to show distribution of sources. Results We identified 36 hospital outbreaks or outbreaks between January 25 th and July 8 th , 2020. According to our estimates, at least 536 healthcare workers in Australia have been infected with COVID-19, comprising 6.03% of all reported infections. The rate of healthcare worker infection was 72/100,000 and of community infection 34/100,000. healthcare workers were 2.76 times more likely to contract COVID-19 (95% CI 2.53 to 3.01; P <0.001). The timing of hospital outbreaks did not always correspond to community peaks. Where data were available, a total of 131 healthcare workers across 21 outbreaks, led to 1656 healthcare workers being furloughed for quarantine. One hospital was closed and had 1200 workers quarantined in one outbreak. Conclusion The study shows that HCWs were at nearly 3 times the risk of infection. Of concern, this nearly tripling of risk occurred during a period of low community prevalence suggesting failures at multiple hazard levels including PPE policies within the work environment. Even in a country with relatively good control of COVID-19, healthcare workers are at greater risk of infection than the general community and nosocomial outbreaks can have substantial effects on workforce capacity by the quarantine of numerous workers during an outbreak. The occurrence of hospital outbreaks even when community incidence was low, highlights the high risk setting that hospitals present. Australia faces a resurgence of COVID-19 since late June 2020, with multiple hospital outbreaks. We recommend formal reporting of healthcare worker infections, testing protocols for nosocomial outbrea...

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Section: Introductionmentioning

confidence: 99%

Estimating the burden of COVID-19 on the Australian healthcare workers and health system during the first six months of the pandemic

Quigley¹,

Stone

Nguyen

et al. 2021

International Journal of Nursing Studies

Self Cite

View full text Add to dashboard Cite

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“…Cotton is not a suitable fabric for the outer layer of a mask, as it is absorbent, can become damp and pose a risk of contamination if not washed daily or if washed inadequately. 7 The principles of a safer cloth mask would include at least three layers, water-resistant fabric for the outer layer, fine weave, high thread count, fit around the face and ties instead of ear loops, which the latter has been reported to reduce fit. 8 They should also be washed daily in soap and water, and the design should allow frequent washing without compromising the design features.…”

Section: Discussionmentioning

confidence: 99%

Contamination and washing of cloth masks and risk of infection among hospital health workers in Vietnam: a post hoc analysis of a randomised controlled trial

et al. 2020

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BackgroundIn a previous randomised controlled trial (RCT) in hospital healthcare workers (HCWs), cloth masks resulted in a higher risk of respiratory infections compared with medical masks. This was the only published RCT of cloth masks at the time of the COVID-19 pandemic.ObjectiveTo do a post hoc analysis of unpublished data on mask washing and mask contamination from the original RCT to further understand poor performance of the two-layered cotton cloth mask used by HCWs in that RCT.Setting14 secondary-level/tertiary-level hospitals in Hanoi, Vietnam.ParticipantsA subgroup of 607 HCWs aged ≥18 years working full time in selected high-risk wards, who used a two-layered cloth mask and were part of a randomised controlled clinical trial comparing medical masks and cloth masks.InterventionWashing method for cloth masks (self-washing or hospital laundry). A substudy of contamination of a sample of 15 cloth and medical masks was also conducted.Outcome measureInfection rate over 4 weeks of follow up and viral contamination of masks tested by multiplex PCR.ResultsViral contamination with rhinovirus was identified on both used medical and cloth masks. Most HCW (77% of daily washing) self-washed their masks by hand. The risk of infection was more than double among HCW self-washing their masks compared with the hospital laundry (HR 2.04 (95% CI 1.03 to 4.00); p=0.04). There was no significant difference in infection between HCW who wore cloth masks washed in the hospital laundry compared with medical masks (p=0.5).ConclusionsUsing self-reported method of washing, we showed double the risk of infection with seasonal respiratory viruses if masks were self-washed by hand by HCWs. The majority of HCWs in the study reported hand-washing their mask themselves. This could explain the poor performance of two layered cloth masks, if the self-washing was inadequate. Cloth masks washed in the hospital laundry were as protective as medical masks. Both cloth and medical masks were contaminated, but only cloth masks were reused in the study, reiterating the importance of daily washing of reusable cloth masks using proper method. A well-washed cloth mask can be as protective as a medical mask.Trial resgistration numberACTRN12610000887077.

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“…The copyright holder for this this version posted September 29, 2020. ; https://doi.org/10.1101/2020.09.28.20202952 doi: medRxiv preprint Also critical to note is that, not only did the outbreak of COVID-19 spark a major debate about the efficacy of face-masks in general but it also exposed the inadequacy of existing guidelines on the use of cloth face-masks, despite the wide spread use of these face-masks in majority of the low-and middle-income countries especially in Africa as reported in several studies (20,(24)(25)(26)(27). At the same time, the outbreak fashioned critical questions like whether or not there was an adequate alternative to commercially manufactured facemasks for example the N95, KN95 and surgical face-masks that could be made easily available for populations in low-and middle-income settings especially in Africa (28).…”

Section: Research Articlementioning

confidence: 99%

Efficacy of face-masks used in Uganda: a laboratory-based inquiry during the COVID-19 pandemic

Mboowa

Semugenze

Nakabuye

et al. 2020

Preprint

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Background With shortages of face-masks continuing to be reported worldwide, critical questions like whether or not there is an adequate alternative to commercially manufactured face-masks continue to linger especially in low- and middle- income settings. This study aimed at addressing this through testing and comparing various materials and forms of face-masks for filtration efficiency, breathability, microbial cleanliness, distance-dependent fitness, and re-usability of different face-masks procured from face-mask vendors in Kampala, Uganda. Methods This was a laboratory-based descriptive study that applied new protocols and already existing protocols with substantive modifications to ten different types of face-mask types each in quadruplicate to achieve each specified aim. Results Surgical face-masks had better filtration efficiency, distance-dependent fitness and breathability compared to other face-masks tested. Decontamination of these face-masks with 70% ethanol negatively affected their efficacy. Locally-made double layered face-masks had better: filtration efficiency, distance-dependent fitness and breathability compared to other locally-made cloth face-masks, and re-usability compared to all the face-mask types that had been tested. Discussion/conclusions Locally-made double layered cloth face-masks could serve as alternative face-masks especially for populations in low- and middle- income settings like Uganda while allowing restricted use of surgical face-masks and other respirators like the KN95 to high-risk groups only.

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Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2

Cited by 134 publications

References 26 publications

Estimating the burden of COVID-19 on the Australian healthcare workers and health system during the first six months of the pandemic

Estimating the burden of COVID-19 on the Australian healthcare workers and health system during the first six months of the pandemic

Contamination and washing of cloth masks and risk of infection among hospital health workers in Vietnam: a post hoc analysis of a randomised controlled trial

Efficacy of face-masks used in Uganda: a laboratory-based inquiry during the COVID-19 pandemic

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