Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: A randomized controlled trial

doi:10.1016/j.ajic.2008.11.002

American Journal of Infection Control

Volume 37, Issue 5, June 2009, Pages 417-419

https://doi.org/10.1016/j.ajic.2008.11.002 Get rights and content

Background

Health care workers outside surgical suites in Asia use surgical-type face masks commonly. Prevention of upper respiratory infection is one reason given, although evidence of effectiveness is lacking.

Methods

Health care workers in a tertiary care hospital in Japan were randomized into 2 groups: 1 that wore face masks and 1 that did not. They provided information about demographics, health habits, and quality of life. Participants recorded symptoms daily for 77 consecutive days, starting in January 2008. Presence of a cold was determined based on a previously validated measure of self-reported symptoms. The number of colds between groups was compared, as were risk factors for experiencing cold symptoms.

Results

Thirty-two health care workers completed the study, resulting in 2464 subject days. There were 2 colds during this time period, 1 in each group. Of the 8 symptoms recorded daily, subjects in the mask group were significantly more likely to experience headache during the study period (P < .05). Subjects living with children were more likely to have high cold severity scores over the course of the study.

Conclusion

Face mask use in health care workers has not been demonstrated to provide benefit in terms of cold symptoms or getting colds. A larger study is needed to definitively establish noninferiority of no mask use

Section snippets

Methods

The study was a 77-day prospective randomized controlled trial beginning in January 2008. Subjects were recruited from a population of health care providers at a 520-bed tertiary care hospital in Tokyo, Japan. Exclusion criteria were self-identification of conditions predisposing to URI or taking antibiotics. Participants were given ¥9000 (approximately 90 US dollars equivalent) each. All underwent informed consent. The hospital ethics board approved the study.

Mask and no mask groups were

Results

Thirty-three volunteers met inclusion criteria. One subject in the no mask group dropped out after 1 week of data collection. Intake survey questions' results and subject demographics are summarized in Table 1.

One participant in each group had a Jackson-verified URI (not significant). Analyses were performed following the principles of intention-to-treat. The mean (standard deviation [SD]) Jackson score over the length of the study was 43.3 (SD, 47.7), the range was 0 to 210, and the median was

Discussion

The low number of participants in the study limits the interpretations of the results. However, the findings do not support the utility of surgical face masks in protecting health care workers in Japan from URI. There were significantly fewer people experiencing days with “headache” in the group that did not wear masks and a trend for this group to report fewer days with the symptom labeled “feel bad.” This clearly does not suggest a protective effect of masks for common cold symptoms. Our

References (8)

L.A. Meyers et al.
Network theory and SARS: predicting outbreak diversity
J Theor Biol
(2005)
J. Resnick
Rationale for Chinese gauze masks?
N Engl J Med
(1973)
T. Jefferson et al.
Physical interventions to interrupt or reduce the spread of respiratory viruses: a systematic review
BMJ
(2008)
UCLA Asia Institute. Teaching about Japan: population density. Available at:...

There are more references available in the full text version of this article.

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: UMIN Clinical Trials Registration number: UMIN000000981.

: Conflicts of interest: None to report.

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Brief reportUse of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: A randomized controlled trial

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Theor Biol

Rationale for Chinese gauze masks?

N Engl J Med

Physical interventions to interrupt or reduce the spread of respiratory viruses: a systematic review

BMJ

Brief report
Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: A randomized controlled trial