Mask debate diverting attention from measures that work

In an editorial published in the Journal of the American Medical Association, Dr Trish Perl and Dr Arjun Srinivasan say findings of a new study comparing the value of two types of medical masks are likely to ignite still more debate at a time when more emphasis should be placed on vaccination, rigorous hand washing and other proven prevention measures.

The mask study, conducted by a team of Canadian researchers, found that nurses who wore high-tech N95 masks were infected by influenza only slightly less often than those who wore common surgical masks, Perl and Srinivasan say.

Perl, chief epidemiologist at The Johns Hopkins Hospital, says that the release of the mask study, to be published in an upcoming issue of JAMA, will further distract attention from other important prevention measures.

“Unfortunately, this intense discussion over respiratory protection has distracted attention from the critical importance of implementing other strategies known to prevent the transmission of influenza in health care settings,” Perl and Srinivasan write in the JAMA article.

Perl and Srinivasan say prevention measures are even more pressing in health care settings today, given the reemergence of H1N1 Influenza pandemic, which is widespread in much of the United States. A vaccine for H1N1 is expected to be publicly available in mid-October.

The chief prevention measure that should be employed more widely among health care personnel is flu vaccination, Perl and Srinivasan said in their editorial. Unfortunately only about 45 percent of health care workers get an annual flu shot each year, the two experts say, citing a 2008 CDC study.

Annual flu vaccination of health care workers “has been shown to protect both patients and health care personnel, decrease patient mortality, and minimize worker absenteeism,” the authors say.

Masking plays a role, the authors say, but a diverse approach — using such measures as keeping sick visitors from hospitals, rapidly moving patients with respiratory illness and high fever into isolation areas, and developing programs to encourage cough etiquette and regular hand washing — is better.

Health care workers’ “adherence with hand hygiene is also far from ideal,” said the authors. In addition, health care workers commonly work despite having a respiratory illness, thereby putting patients and co-workers at risk.

“Hence, a change in culture is needed; personnel must stay home when they are ill and employers must penalize them when they do [come to work sick],” they added.

The authors conclude in their editorial that, while more research and discussion are needed about which type of mask health care workers should wear when near sick patients, that should not “excuse anyone from failing to implement other measures that are known to protect patients and [health care personnel] from influenza.”

Johns Hopkins news releases can be found at


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