The need of health policy perspective to protect Healthcare Workers during COVID-19 pandemic. A GRADE rapid review on the N95 respirators effectiveness
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Abstract
Protecting Health Care Workers (HCWs) during routine care of suspected or confirmed COVID-19 patients is of paramount importance to halt the SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) pandemic. The WHO, ECDC and CDC have issued conflicting guidelines on the use of respiratory filters (N95) by HCWs. We searched PubMed, Embase and The Cochrane Library from the inception to March 21, 2020 to identify randomized controlled trials (RCTs) comparing N95 respirators versus surgical masks for prevention of COVID-19 or any other respiratory infection among HCWs. The grading of recommendations, assessment, development, and evaluation (GRADE) was used to evaluate the quality of evidence. Four RCTs involving 8736 HCWs were included. We did not find any trial specifically on prevention of COVID-19. However, wearing N95 respirators can prevent 73 more (95% CI 46-91) clinical respiratory infections per 1000 HCWs compared to surgical masks (2 RCTs; 2594 patients; low quality of evidence). A protective effect of N95 respirators in laboratory-confirmed bacterial colonization (RR = 0.41; 95%CI 0.28-0.61) was also found. A trend in favour of N95 respirators was observed in preventing laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza like illness. We found no direct high quality evidence on whether N95 respirators are better than surgical masks for HCWs protection from SARS-CoV-2. However, low quality evidence suggests that N95 respirators protect HCWs from clinical respiratory infections. This finding should be contemplated to decide the best strategy to support the resilience of healthcare systems facing the potentially catastrophic SARS-CoV-2 pandemic.
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Several published examples exist of GRADE being used in rapid reviews.
“Several examples have been published where the GRADE approach has been used for rapid reviews.[61][62][63]”
From Updated recommendations for the Cochrane rapid review methods guidance for rapid reviews of effectiveness (2024) · cites this paper as [61]
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- Authors
- Iannone, P., Castellini, G., Coclite, D., Napoletano, A., Fauci, A. J., Iacorossi, L., D’Angelo, D., Renzi, C., La Torre, G., Mastroianni, C. M., & Gianola, S.
- Affiliations
- Istituto Superiore di Sanità (IT)
- IRCCS Ospedale Galeazzi - Sant'Ambrogio (IT)
- University College London (GB)
- Sapienza University of Rome (IT)
- Corresponding author
- Castellini, Greta
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-06-03
- Volume
- 15
- Issue
- 6
- Pages
- e0234025
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7269249
- OpenAlex
- W3031052409
- Cited by
- 52
- References
- 38
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 14 · 2021: 23 · 2020: 8
- FWCI
- 6.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by-nd)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Safety in Workplaces
- Keywords
- N95 respirators, healthcare workers, COVID-19 pandemic, SARS-CoV-2, surgical masks, respiratory infection prevention, personal protective equipment, bacterial colonization, respiratory viral infections, influenza-like illness, health policy, healthcare worker safety
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Health Personnel, Humans, Masks, Pneumonia, Viral, Respiratory Protective Devices, Randomized Controlled Trials as Topic, Infection Control, Coronavirus Infections, Pandemics
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