Insufficient Evidence N95 Respirators Protect Health Care Workers From Respiratory Infections Better Than Face Masks Interview with:
Dr. Gary Garber MD
Chief of infection prevention and control
Public Health Ontario
Professor of medicine
University of Ottawa What is the background for this study? What are the main findings?

Dr. Garber: There are conflicting recommendations regarding the use of respirators vs face masks to protect healthcare workers against acute respiratory infections. Our systematic review and meta-analysis show that although N95 respirators have improved efficiency in reducing filter penetration under laboratory conditions, there is insufficient data to show a protective advantage compared to surgical mask in clinical settings. What should clinicians and patients take away from your report?

Dr. Garber: The choice of respiratory protection is usually decided at the local institutional or government level. However, the type of facial protection is just one small component in the overall strategy for healthcare worker protection. Environmental and administrative controls which include triage, isolation policies, proper air exchanges and meticulous hand hygiene are key first principles to protecting clinical personnel from acquiring an acute respiratory infection. When a patient has a respiratory infection, their wearing a face mask provides excellent control of respiratory secretions. Thus patients should not wear an N95 respirator.

Clinicians should recognize that N95 respirator efficiency requires fit testing to have a proper seal and their discomfort encourages adjustments by the healthcare worker which may inadvertently enable face exposure to infected droplets which are on the hands/gloves. What recommendations do you have for future research as a result of this study?

Dr. Garber: The weakness in this study is that we cannot assess the adherence to hand hygiene and use of personal protective equipment in any of the published reports. Auditing of compliance/adherence would strengthen the findings but is very complex to accomplish. Is there anything else you would like to add?

Dr. Garber: The use of respiratory protective equipment is just one component of an infection control program. Other components of an infection control program are necessary to adequately control risk to health care workers.

Our findings suggest there was insufficient data to show definitively that N95 respirators were better than surgical masks in protecting health care workers against acute respiratory infections in clinical settings. However, these findings do not apply to airborne infections such as measles and TB nor to the protection requirements for aerosol generating procedures. Thank you for your contribution to the community.


Jeffrey D. Smith, Colin C. MacDougall, Jennie Johnstone, Ray A. Copes, Brian Schwartz, Gary E. Garber.Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. CMAJ, March 2016 DOI: 10.1503/cmaj.150835

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Dr. Gary Garber MD (2016). Insufficient Evidence N95 Respirators Protect Health Care Workers From Respiratory Infections Better Than Face Masks

Last Updated on March 8, 2016 by Marie Benz MD FAAD