Clinical Review State of the Art Review

Facemasks for the prevention of infection in healthcare and community settings

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h694 (Published 09 April 2015) Cite this as: BMJ 2015;350:h694
  1. C Raina MacIntyre, professor of infectious diseases epidemiology and head of school1,
  2. Abrar Ahmad Chughtai, research assistant1
  1. 1School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, 2052, NSW, Australia
  1. Correspondence to: C R MacIntyre r.macintyre{at}unsw.edu.au

Abstract

Facemasks are recommended for diseases transmitted through droplets and respirators for respiratory aerosols, yet recommendations and terminology vary between guidelines. The concepts of droplet and airborne transmission that are entrenched in clinical practice have recently been shown to be more complex than previously thought. Several randomised clinical trials of facemasks have been conducted in community and healthcare settings, using widely varying interventions, including mixed interventions (such as masks and handwashing), and diverse outcomes. Of the nine trials of facemasks identified in community settings, in all but one, facemasks were used for respiratory protection of well people. They found that facemasks and facemasks plus hand hygiene may prevent infection in community settings, subject to early use and compliance. Two trials in healthcare workers favoured respirators for clinical respiratory illness. The use of reusable cloth masks is widespread globally, particularly in Asia, which is an important region for emerging infections, but there is no clinical research to inform their use and most policies offer no guidance on them. Health economic analyses of facemasks are scarce and the few published cost effectiveness models do not use clinical efficacy data. The lack of research on facemasks and respirators is reflected in varied and sometimes conflicting policies and guidelines. Further research should focus on examining the efficacy of facemasks against specific infectious threats such as influenza and tuberculosis, assessing the efficacy of cloth masks, investigating common practices such as reuse of masks, assessing compliance, filling in policy gaps, and obtaining cost effectiveness data using clinical efficacy estimates.

Footnotes

  • Contributors: Both authors contributed equally to the writing of this paper. CRM devised the structure and topic areas for the review, AAC did the literature review and first draft, and both contributed equally to the final manuscript.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: CRM has received funding for investigator driven research on facemasks from 3M in the form of an Australian Research Council Industry Linkage grant (where 3M was the industry partner) and supply of masks for clinical research. She also has received funding or in-kind support from GSK, Merck, BioCSL, and Pfizer for investigator driven research on infectious diseases. 3M Australia provided support to AAC for facemask testing as part of his PhD thesis.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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