外科口罩與N95口罩於臨床健康照護者流感防護成效的文獻綜整

Comprehensive literature on the effectiveness of surgical masks and N95 masks in influenza protection among clinical health care workers

歐淑伊(Su Yi Ou) ； 陳亮晨(Chen Liang Chen) ； 施皇任(Huang Jen Shih) ； 唐心如(Hsin Ju Tang)

《台灣實證醫學學會會刊》 11卷1期 (2020/07) Pp. 38-52

https://doi.org/10.6864/EC.202007_11(1).0011

摘要

背景：近年流感及具抗藥性的呼吸道疾病增加，使健康照護者暴露於高風險的感染危機。衛生福利部疾病管制署（2019）指出，醫護人員與病人接觸時需配戴外科口罩，並建議執行會產生飛沫微粒等特殊處置時，應配戴N95口罩。目前臨床照護時配戴外科口罩為標準防護配備，但照護流感及呼吸道疾病族群，或執行可能暴露於飛沫或空氣傳染源的照護行為時，並無一致規範與建議需配戴N95口罩。目的：本文目的為藉由實證步驟整理配戴外科口罩與N95口罩兩者在隨機對照試驗（RCT）、系統性文獻回顧及統合分析等研究中，在預防流感之防護成效。方法：依據中英文關鍵字「健康照護人員；health care personnel, hospital health care worker, healthcare provider、healthcare worker, ＂health personnel＂[MeSH]」、「N95 mask*、N95 respirators」、「外科口罩；medical mask*、surgical mask*、mask*[MeSH]」和「流感；＂Influenza＂ influenza, human[MeSH]」搜索選用Airiti Library華藝線上圖書館、Cochrane Library、PubMed、CINAHL Plus with Full Text四個資料庫，限制文獻類別於隨機對照試驗、系統性文獻回顧或統合分析，搜索日至2019年12月29日。共納入三篇文獻，各篇依英國牛津實證醫學中心隨機對照試驗、系統性文獻回顧評讀內容為基礎評讀，結果再進一步以Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence調整證據等級。結果：MacIntyre等（2017）顯示持續配戴N95口罩對流感的RR=0.34（95% CI，0.10-1.11，P=0.074），高風險時配戴N95口罩的RR=0.46（95% CI，0.06-3.40，P=0.445），配戴外科口罩的RR=0.55（95% CI，0.16-1.91，P=0.350），三者感染風險皆低，但無顯著差異。Radonovich等（2019）結果顯示於laboratory-confirmed influenza（difference, [95% CI，-0.5% to 2.5%]；P= .18）（adjustedOR, 1.18 [95% CI,0.95-1.45]）無顯著差異。Vittoria等（2017）對五篇RCT統合分析比較：MacIntyre等（2011, 2015）顯示，在整個工作班次期間配戴外科口罩或N95口罩，對實驗室確診的病毒感染（VRI）有保護性但非統計學意義的作用（RR=0.70；95% CI：0.47-1.03）。三篇在整個工作班次中使用指定的rPPEN95口罩相對於外科口罩在流感（RR=0.84；95% CI，0.36-1.99）及病毒性呼吸道感染（VRI）（RR=0.78；95% CI：0.54-1.14）並無優勢。（MacIntyre et al., 2011; MacIntyre et al., 2013; Leob, 2009）。結論：納入三篇文獻進行文獻評讀結果，顯示醫療機構中的健康照護者配戴N95口罩及外科口罩的流感的防禦力相當（MacIntyre et al., 2017; Vittoria et al., 2017; Radonovich et al., 2019），兩篇隨機對照試驗及一篇統合分析研究結果顯示配戴N95口罩及外科口罩的流感感染風險低，但無統計上的差異。

關鍵字

流感 ； 外科口罩 ； N95口罩

並列摘要

Background: Recently, clinical health care workers got higher risk of infection crisis due to the increasing of influenza and drug-resistant respiratory diseases. The Ministry of Health and Welfare's (2019) pointed out that clinical health care workers needed to wear surgical masks, but they also suggested the healthcare workers required to wear N95 masks when performing special treatments which could produce droplets. Currently, wearing surgical masks as standard protective equipment in clinical care, but there is no consistent standard or recommendation to wear N95 masks when caring for groups of patients with influenza and respiratory diseases or performing care activities that may expose to droplets or airborne sources. Purpose: The purpose of this article is to organize the effects of wearing surgical masks and N95 masks in preventing influenza through empirical steps in the research of randomized controlled trials (RCT), systematic literature reviews, and meta-analysis. Method: We searched some keywords without language restriction from four database which are Airiti Library, Cochrane Library, PubMed, and CINAHL Plus with Full Text until December 30, 2019. These keywords contain of the following words: health care personnel, hospital health care worker, healthcare provider, healthcare worker, ＂health personnel＂[MeSH], N95 respirators, N95 mask*, medical mask*, surgical mask*, mask*[MeSH] and ＂Influenza＂ influenza, human [MeSH]. A total of three articles were included, and each article was evaluated on the basis of randomized controlled trials and systematic reviews of the Oxford Positive Medical Center, and the results were further adjusted based on the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. Results: MacIntyre et al. (2017) showed that RR = 0.34 (95% CI, 0.10-1.11, P = 0.074) for continuous wearing N95 masks to prevent influenza, and RR = 0.46 (95% CI, 0.06-3.40, P = 0.445) for wearing N95 masks at high risk groups, RR = 0.55 (95% CI, 0.16-1.91, P = 0.350) for wearing surgical masks, all the risks of infection are low, but there is no statistical significant difference. Radonovich et al. (2019) showed that laboratory-confirmed influenza (difference, [95% CI, 0.5% to2.5%]; P = .18) (adjusted OR, 1.18 [95% CI, 0.95-1.45]) No statistical significant difference. Vittoria et al. (2017) From five RCT integrated analysis and comparisons: MacIntyr et al. (2011, 2015) showed that wearing surgical masks or N95 masks during the entire work shift was protective but no statistical significant difference for the laboratory-confirmed virus infection (VRI) (RR = 0.70; 95% CI: 0.47-1.03). 3 articles using designated rPPE N95 masks throughout the work shift compared to surgical masks in influenza (RR = 0.84; 95% CI, 0.36-1.99) and viral respiratory infections (VRI) (RR = 0.78; 95% CI: 0.54- 1.14). There is no advantage. (MacIntyre et al, 2011; MacIntyre et al, 2013; Leob, 2009). Results: MacIntyre et al. (2017) showed that RR = 0.34 (95% CI, 0.10-1.11, P = 0.074) for continuous wearing N95 masks to prevent influenza, and RR = 0.46 (95% CI, 0.06-3.40, P = 0.445) for wearing N95 masks at high risk groups, RR = 0.55 (95% CI, 0.16-1.91, P = 0.350) for wearing surgical masks, all the risks of infection are low, but there is no statistical significant difference. Radonovich et al. (2019) showed that laboratory-confirmed influenza (difference, [95% CI, -0.5% to2.5%]; P = .18) (adjusted OR, 1.18 [95% CI, 0.95-1.45]) No statistical significant difference. Vittoria et al. (2017) From five RCT integrated analysis and comparisons: MacIntyr et al. (2011, 2015) showed that wearing surgical masks or N95 masks during the entire work shift was protective but no statistical significant difference for the laboratory-confirmed virus infection (VRI) (RR = 0.70; 95% CI: 0.47-1.03). 3 articles using designated rPPE N95 masks throughout the work shift compared to surgical masks in influenza (RR = 0.84; 95% CI, 0.36-1.99) and viral respiratory infections (VRI) (RR = 0.78; 95% CI: 0.54- 1.14). There is no advantage. (MacIntyre et al., 2011; MacIntyre et al., 2013; Leob, 2009). Conclusion: Three literatures were included, which showed that health care workers in medical institutions wear N95 masks and surgical masks are equally resistant to influenza (MacIntyre et al., 2017; Vittoria et al., 2017; Radonovich et al., 2019) .A randomized controlled trial and a meta-analysis study showed that wearing N95 masks and surgical masks had a low risk of influenza infection, but there was no statistical difference. (Radonovich et al., 2019; MacIntyre et al., 2017).

並列關鍵字

Influenza ； surgical masks ； N95 respirators