Herd protection effect of N95 respirators in healthcare workers

OBJECTIVE: To determine if there was herd protection conferred to unprotected healthcare workers (HCWs) by N95 respirators worn by colleagues. METHODS: Data were analysed from a prospective cluster randomized clinical trial conducted in Beijing, China between 1 December 2008 and 15 January 2009. A minimum compliance level (MCL) of N95 respirators for prevention of clinical respiratory illness (CRI) was set based on various compliance cut-offs. The CRI rates were compared between compliant (≥MCL) and non-compliant (<MCL) N95 wearers by ward, and between non-compliant wearers and control subjects who did not wear masks. RESULTS: Data were analysed from 949 HCWs who wore N95 respirators and 125 HCWs who did not wear masks. At 50% MCL there were no significant differences in the CRI rates between compliant and non-compliant N95 wearers by ward. In multivariate analysis, the CRI rate in non-compliant HCWs was significantly lower compared with controls (relative risk 0.26; 95% confidence interval 0.08, 0.82). CONCLUSION: This study suggests herd protection from use of N95 respirators by colleagues within a hospital ward.