Personal protective equipment

Personal protective equipment

Raina MacIntyre has led the largest body of clinical research on face masks and respirators in front line health workers internationally. Research in this area includes complex cluster RCTs of efficacy of different PPE products, design of more efficient PPE, and modelling to inform policy options.The literature is abundant with RCTs on pharmaceutical interventions for infection prevention, but there is very little evidence on efficacy of non-pharmaceutical measures, of which facemasks, respirators and other personal protective equipment (PPE) are the most important.  Prior to 2009, there were no RCTs of any PPE published, yet PPE is among the few available interventions to protect frontline workers in an emergent epidemic or pandemic where drugs and vaccines may be unavailable, or delayed in development. Facemasks and respirators are widely used in the hospital setting to protect hospital healthcare workers (HCWs) from nosocomial infections. Facemasks are mostly used to avoid contact with splashes and sprays of body fluids or blood, and to prevent spread of infections from sick patients. Respirators are designed for respiratory protection widely accepted in healthcare setting to protect HCWs from acquiring respiratory infections. Respiratory Protection Standards of many countries (rich and lower income) are inconsistent and in some cases have not been updated for 20 years. One of the main reasons for this is the lack of research data on effectiveness of respiratory protection devices and HCW practices. Raina and her team set out to address this important evidence gap with this body of work, which includes 4 RCTs on facemasks and respirators (the largest published to date in HCWs) and numerous other studies. 





This video explains the large body of research conducted by Prof Raina MacIntyre and collaborators on face masks and respirators for prevention of infection. It covers surgical masks, respirators and cloth masks. See below for details of published research in respiratory protection.


Selected publications

Ma T; Heywood A; MacIntyre CR, 2021, 'Travel health seeking behaviours, masks, vaccines and outbreak awareness of Australian Chinese travellers visiting friends and relatives – Implications for control of COVID-19', Infection, Disease and Health, vol. 26, pp. 38 - 47,

Bahl P; Bhattacharjee S; De Silva C; Chughtai AA; Doolan C; Macintyre CR, 2020, 'Face coverings and mask to minimise droplet dispersion and aerosolisation: A video case study', Thorax, vol. 75, pp. 1024 - 1025,

MacIntyre CR; Chughtai AA, 2020, 'Masks in the community are an effective strategy: Author's response to Haslam et al (2020)', International Journal of Nursing Studies, vol. 111, pp. 103751,

Bhattacharjee S; MacIntyre R; Wen X; Bahl P; Kumar U; Aguey-Zinsou K-F; Chughtai A; Joshi R, 2020, 'Reduced Graphene Oxide and Nanoparticles Incorporated Durable Electro-Conductive Silk Fabrics', Advanced Materials Interfaces

Chughtai AA; Seale H; Rawlinson WD; Kunasekaran M; Macintyre CR, 2020, 'Selection and Use of Respiratory Protection by Healthcare Workers to Protect from Infectious Diseases in Hospital Settings', Annals of work exposures and health, vol. 64, pp. 368 - 377,

Bhattacharjee S; Macintyre CR; Wen X; Bahl P; Kumar U; Chughtai AA; Joshi R, 2020, 'Nanoparticles incorporated graphene-based durable cotton fabrics', Carbon,

Chughtaita AA; Seale H; MacIntyre CR, 2020, 'Effectiveness of Cloth Masks for Protection against Severe Acute Respiratory Syndrome Coronavirus 2', Emerging Infectious Diseases, vol. 26,

MacIntyre CR; Dung TC; Chughtai AA; Seale H; Rahman B, 2020, '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', BMJ open, vol. 10, pp. e042045,

Bhattacharjee S; Bahl P; Chughtai AA; MacIntyre CR, 2020, 'Last-resort strategies during mask shortages: Optimal design features of cloth masks and decontamination of disposable masks during the COVID-19 pandemic', BMJ Open Respiratory Research, vol. 7, pp. e000698 - e000698,

MacIntyre CR; Chughtai AA, 2020, 'A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients', International Journal of Nursing Studies, vol. 108, pp. 103629 - 103629,

MacIntyre CR; Chughtai AA; Seale H; Dwyer DE; Quanyi W, 2020, 'Human coronavirus data from four clinical trials of masks and respirators', International Journal of Infectious Diseases, vol. 96, pp. 631 - 633,

MacIntyre CR; Wang Q, 2020, 'Physical distancing, face masks, and eye protection for prevention of COVID-19', The Lancet, vol. 395, pp. 1950 - 1951,

MacIntyre CR; Heslop DJ, 2020, 'Public health, health systems and palliation planning for COVID-19 on an exponential timeline', Medical Journal of Australia, vol. 212, pp. 440 - 442.e1,

Wang Y; Tian H; Zhang L; Zhang M; Guo D; Wu W; Zhang X; Kan GL; Jia L; Huo D; Liu B; Wang X; Sun Y; Wang Q; Yang P; Macintyre CR, 2020, 'Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: a cohort study in Beijing, China', BMJ Global Health, vol. 5,

MacIntyre CR; Hasanain SJ, 2020, 'Community universal face mask use during the COVID 19 pandemic-from households to travellers and public spaces', Journal of Travel Medicine, vol. 27,

Chughtai AA; Stelzer-Braid S; Rawlinson W; Pontivivo G; Wang Q; Pan Y; Zhang D; Zhang Y; Li L; MacIntyre CR, 2019, 'Contamination by respiratory viruses on outer surface of medical masks used by hospital healthcare workers', BMC Infectious Diseases, vol. 19, pp. 491,

Chughtai AA, Chen X, Macintyre CR, 2018, 'Risk of self-contamination during doffing of personal protective equipment', American Journal of Infection Control,

MacIntyre CR, Chughtai AA, Rahman B, Peng Y, Zhang Y, Seale H, et al. The efficacy of medical masks and respirators against respiratory infection in health workers. Influenza and other respiratory viruses. 2017.

Shohini Mukerji, C. Raina MacIntyre, Holly Seale, Quanyi Wang, Peng Yang, Xiaoli Wang, and Anthony T. Newall Cost-effectiveness analysis of N95respirators and medical masks to protect healthcare workers in China from respiratory infections, BMC Infectious Diseases (2017) 17:464 [Full text]

MacIntyre CR, Chughtai AA. Facemasks for the prevention of infection in healthcare and community settings. BMJ (Clinical research ed). 2015;350:h694.

Chen X;Chughtai AA;MacIntyre CR, 2016, 'Herd protection effect of N95 respirators in healthcare workers.', J Int Med Res,, ROS ID: 853542

MacIntyre CR;Zhang Y;Chughtai AA;Seale H;Zhang D;Chu Y;Zhang H;Rahman B;Wang Q, 2016, 'Cluster randomised controlled trial to examine medical mask use as source control for people with respiratory illness', BMJ Open, vol. 6,, ROS ID: 866220

MacIntyre CR, Wang Q, Seale H, Yang P, Shi W, Gao Z, et al. A randomized clinical trial of three options for N95 respirators and medical masks in health workers. American journal of respiratory and critical care medicine. 2013;187(9):960-6.

MacIntyre CR, Wang Q, Cauchemez S, Seale H, Dwyer DE, Yang P, et al. A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza and other respiratory viruses. 2011;5(3):170-9.

MacIntyre CR, Seale H, Dung TC, Hien NT, Nga PT, Chughtai AA, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open 2015;22(5):1-10.

Chughtai AA, MacIntyre CR, Peng Y, Wang Q, Ashraf MO, Dung TC, et al. Practices around the use of masks and respirators among hospital health care workers in 3 diverse populations. . American journal of infection control. 2015;43:1116-8.

Chughtai AA, MacIntyre CR, Zheng Y, Wang Q, Toor ZI, Dung TC, et al. Examining the policies and guidelines around the use of masks and respirators by healthcare workers in China, Pakistan and Vietnam. J Infect Prev. 2015;16(2):68–74.

Chughtai AA, Seale H, Chi Dung T, Maher L, Nga PT, MacIntyre CR. Current practices and barriers to the use of facemasks and respirators among hospital-based health care workers in Vietnam. American journal of infection control. 2015;43(1):72-7.

Chughtai AA, Seale H, Dung TC, Hayen A, Rahman B, MacIntyre CR. Compliance with the use of medical and cloth masks among healthcare workers in Vietnam. Ann Occup Hyg. 2016:1-12.

Macintyre CR, Seale H, Yang P, Zhang Y, Shi W, Almatroudi A, et al. Quantifying the risk of respiratory infection in healthcare workers performing high-risk procedures. Epidemiology and infection. 2014;142(9):1802-8.

MacIntyre CR, Cauchemez S, Dwyer DE, Seale H, Cheung P, Browne G, et al. Face mask use and control of respiratory virus transmission in households. Emerging infectious diseases. 2009;15(2):233-41.

Seale H, Corbett S, Dwyer DE, MacIntyre CR. Feasibility exercise to evaluate the use of particulate respirators by emergency department staff during the 2007 influenza season. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 2009;30(7):710-2.

MacIntyre CR, Ridda I, Seale H, Gao Z, Ratnamohan VM, Donovan L, et al. Respiratory viruses transmission from children to adults within a household. Vaccine. 2012;30(19):3009-14.

MacIntyre CR, Wang Q, Rahman B, Seale H, Ridda I, Gao Z, et al. Efficacy of face masks and respirators in preventing upper respiratory tract bacterial colonization and co-infection in hospital healthcare workers. Preventive medicine. 2014;62:1-7.

Seale H, Leem J-S, Gallard J, Kaur R, Chughtai AA, Tashani M, et al. “The cookie monster muffler”: Perceptions and behaviours of hospital healthcare workers around the use of masks and respirators in the hospital setting. IJIC. 2014;1(i):1-8.

Yang P, Seale H, MacIntyre CR, Zhang H, Zhang Z, Zhang Y, et al. Mask-wearing and respiratory infection in healthcare workers in Beijing, China. Braz J Infect Dis. 2011;15(2):102-8.

Chughtai AA, Seale H, MacIntyre CR. Availability, consistency and evidence-base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis. BMC research notes. 2013;6:216.

MacIntyre CR, Chughtai AA, Seale H, Richards GA, Davidson PM. Respiratory protection for healthcare workers treating Ebola virus disease (EVD): Are facemasks sufficient to meet occupational health and safety obligations? Int J Nurs Stud. 2014;51(11):1421-6.

MacIntyre CR, Chughtai AA, Seale H, Richards GA, Davidson PM. Response to Martin-Moreno et al. (2014) Surgical mask or no mask for health workers not a defensible position for Ebola. Int J Nurs Stud. 2014;51(12):1694-5.

MacIntyre CR, Chughtai AA, Seale H, Richards GA, Davidson PM. Uncertainty, risk analysis and change for Ebola personal protective equipment guidelines. Int J Nurs Stud. 2014;52(5):899-903.

Mukerji S, MacIntyre CR, Newall AT. Review of economic evaluations of mask and respirator use for protection against respiratory infection transmission. BMC infectious diseases. 2015;15(1):1.

Seale H, Dwyer DE, Cowling BJ, Wang Q, Yang P, Macintyre CR. A review of medical masks and respirators for use during an influenza pandemic. Influenza and other respiratory viruses. 2009;3(5):205-6.

Chughtai AA, Seale H, MacIntyre CR. Use of cloth masks in the practice of infection control–evidence and policy gaps. IJIC. 2013;9(3):1-12.


Selected Media

I’ve always wondered: why many people in Asian countries wear masks, and whether they work

Flu facemask rule under review at Waikato DHB, Interview with Raina MacIntyre

Research Excellence in Epidemic Control

Team MacIntyre – Eureka Prize for Infectious Diseases Research

Lifesaving sepsis study wins MJA best research article

Designing a low cost, re-usable face mask to prevent infection

How are nurses becoming infected with Ebola?

Ebola: WHO guidelines risk healthcare workers’ lives, expert claims

The Ebola Gamble

Flu Scan for Apr 23, 2015

Texas Ebola Cases Prompt CDC to Adopt Stricter Guidelines

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