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Original research
Facial protection for healthcare workers during pandemics: a scoping review
  1. Laura R Garcia Godoy1,
  2. Amy E Jones1,
  3. Taylor N Anderson1,
  4. Cameron L Fisher1,
  5. Kylie M L Seeley1,
  6. Erynn A Beeson1,
  7. Hannah K Zane1,
  8. Jaime W Peterson2,
  9. Peter D Sullivan3
  1. 1 School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
  2. 2 Department of Pediatrics, Oregon Health and Science University Hospital, Portland, Oregon, USA
  3. 3 Department of Internal Medicine, Oregon Health and Science University Hospital, Portland, Oregon, USA
  1. Correspondence to Ms Amy E Jones; jonesamy{at}ohsu.edu

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has led to personal protective equipment (PPE) shortages, requiring mask reuse or improvisation. We provide a review of medical-grade facial protection (surgical masks, N95 respirators and face shields) for healthcare workers, the safety and efficacy of decontamination methods, and the utility of alternative strategies in emergency shortages or resource-scarce settings.

Methods We conducted a scoping review of PubMed and grey literature related to facial protection and potential adaptation strategies in the setting of PPE shortages (January 2000 to March 2020). Limitations included few COVID-19-specific studies and exclusion of non-English language articles. We conducted a narrative synthesis of the evidence based on relevant healthcare settings to increase practical utility in decision-making.

Results We retrieved 5462 peer-reviewed articles and 41 grey literature records. In total, we included 67 records which met inclusion criteria. Compared with surgical masks, N95 respirators perform better in laboratory testing, may provide superior protection in inpatient settings and perform equivalently in outpatient settings. Surgical mask and N95 respirator conservation strategies include extended use, reuse or decontamination, but these strategies may result in inferior protection. Limited evidence suggests that reused and improvised masks should be used when medical-grade protection is unavailable.

Conclusion The COVID-19 pandemic has led to critical shortages of medical-grade PPE. Alternative forms of facial protection offer inferior protection. More robust evidence is required on different types of medical-grade facial protection. As research on COVID-19 advances, investigators should continue to examine the impact on alternatives of medical-grade facial protection.

  • review
  • respiratory infections
  • public health
  • prevention strategies
  • control strategies
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2020-002553

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    Footnotes

    • LRGG and AEJ are joint first authors.

    • Handling editor Soumyadeep Bhaumik

    • Twitter @LauraRGarciaG, @AmyJonesPDX, @tayloander, @kylie_seeley, @erynnbeeson, @jaimewildman, @PeteSullivanPDx

    • LRGG and AEJ contributed equally.

    • Contributors All authors contributed to the concept design and scope of this review. LRGG and AEJ wrote the first draft of the review. CLF, TNA, KMLS, HKZ and EAB equally contributed individual sections and additional writing. PDS and JWP reviewed and edited the paper and provided clinical insight and thematic guidance. All authors reviewed, edited and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • Data availability statement There are no data in this work.