Masks: More Use Equals Better Comfort Level

Two of the hurdles in trying to get health care personnel (HCP) to properly use medical masks and N95 respirators involve a lack of training on how to use the masks, and the notion that using them might interfere with the HCP communication. Those two obstacles were addressed head-on in a pragmatic, cluster randomized clinical trial that took place over four consecutive influenza seasons, between 2011 and 2015.

That trial, the Respiratory Protection Effectiveness Clinical Trial (ResPECT), shows that attitudes among HCP can be improved concerning the need for wearing masks, and also the proper way to do so.

“The proportion of HCP who correctly identified the infection control precautions needed for clinical scenarios was low, but it improved over successive years of participation…,” states the study in the American Journal of Infection Control (AJIC). HCP participants included in the ResPECT study worked at 7 sites in 5 geographic regions (Children’s Hospital Colorado metropolitan Denver, CO; Denver Health Medical Center, Johns Hopkins Health System in Baltimore, MD; and the Department of Veterans Affairs sites in Denver, CO; Houston, TX; New York, NY; and Washington, DC).

ResPECT grew out of the response to the 2009 H1N1 influenza pandemic, and investigators of the AJIC study argue that its findings are relevant to the current COVID-19 pandemic.

“Participant survey data from ResPECT showed that HCP knowledge was lacking about the proper PPE and infection prevention measures required to diminish exposure to respiratory pathogens,” the study states. “Moving forward, it will be critical to increase infection control literacy among HCP. The COVID-19 pandemic has drawn increased attention to expanding the knowledge required for HCP to safely navigate the use of PPE.”

At the beginning of each flu season, participants were asked to follow guidelines from the Centers for Disease Control and Prevention in terms of mask use whenever they came into contact with patients with severe respiratory problems. In the preseason survey, participants were asked to identify what of the 7 possible infection and control measures that they would use when caring for those patients. Those methods were hand hygiene, gown, gloves, eye protection/face shield, medical mask, and N95 respirator.

Among 5180 participant-seasons, a pre-study and post-study survey pair was available for 4560 (88.1%). Attitudes toward using medical masks and N95 respirators “improved significantly” between the beginning and end of each season.

“The proportion of participants assigned to medical masks who reported a reason to avoid wearing a medical mask fell from 88.5% in the pre-study survey to 39.6% in the post-study survey (OR 0.11, 95% CI 0.10-0.14),” the study states. “The proportion of participants assigned to N95 respirators who reported a reason to avoid N95 respirators fell from 87.9% in the pre-study survey to 53.6% in the post-study survey (OR 0.24, 95% CI 0.21-0.28).”

The number of participants who reported discomfort wearing the masks or that the masks made communication more difficult also decreased significantly; from 44.2% to 18.5% for those worried about discomfort, and from 33.5% to 11.6% for those concerned that the masks would hinder communication.

“Prior to the COVID-19 pandemic, medical masks and respirators were often seen as a nuisance, whereas during the COVID-19 pandemic, they are recognized as essential measures for protection of HCP,” the study states. “Our study shows that many HCPs believed that masks and respirators would interfere with performing their duties; however, their attitudes improved with time and experience with the masks and respirators in the study.”

The study also states that “it is a question not of if, but when, the next pandemic will occur and thus it is essential to learn the lessons of COVID-19 to be better prepared for the next pandemic.”