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.
Facemasks for infection prevention explained
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.
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, http://dx.doi.org/10.1186/s12879-019-4109-x
Chughtai AA, Chen X, Macintyre CR, 2018, 'Risk of self-contamination during doffing of personal protective equipment', American Journal of Infection Control, http://dx.doi.org/10.1016/j.ajic.2018.06.003
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
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]
Chen X;Chughtai AA;MacIntyre CR, 2016, 'Herd protection effect of N95 respirators in healthcare workers.', J Int Med Res, http://dx.doi.org/10.1177/0300060516665491, 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, http://dx.doi.org/10.1136/bmjopen-2016-012330, 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.
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.
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.
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.