Review Article

Face masks for respiratory viral illness prevention in healthcare settings: a concise systemic review and meta-analysis


Background and Objectives: There are conflicting views regarding face mask guidelines amongst healthcare staff to prevent transmission of coronavirus disease 2019 (COVID-19), influenza and other respiratory viral infections (RVIs). We conducted a thorough meta-analysis to statistically compare mask use versus no mask use efficacy for RVIs in healthcare settings.
Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used for selecting researches published between 2003 and June 2022 from different databases, including Publisher Medline (PubMed), Web of Science, etc.; 6 studies qualified for inclusion. Data was pooled from in vivo randomized control, case-control and observational studies dealing with the relationship between face mask use and no use by patients or health personnel and RVI prevention in healthcare setups.
Results: The fixed and random-effects model was carried out to determine pooled odds ratios (ORs) and their respective 95 percent confidence intervals (CIs). The results revealed that wearing a face mask significantly reduced the risk of contracting a respiratory viral illness in hospital settings, with pooled OR (95% CI) of 0.11 (0.04 to 0.33) (probability value (P) <0.08).
Conclusion: Masks largely succeeded in stopping respiratory virus transmission, as evidenced by the meta-analysis of 6 studies (a total of 927 individuals).

1. Wang CC, Prather KA, Sznitman J, Jimenez JL, Lakdawala SS, Tufekci Z, et al. Airborne transmission of respiratory viruses. Science 2021; 373(6558): eabd9149.
2. Shiu EYC, Leung NHL, Cowling BJ. Controversy around airborne versus droplet transmission of respiratory viruses: implication for infection prevention. Curr Opin Infect Dis 2019; 32: 372-379.
3. Tellier R, Li Y, Cowling BJ, Tang JW. Recognition of aerosol transmission of infectious agents: a commentary. BMC Infect Dis 2019; 19: 101.
4. Xiao J, Shiu EYC, Gao H, Wong JY, Fong MW, Ryu S, et al. Nonpharmaceutical measures for pandemic influenza in nonhealthcare settings—personal protective and environmental measures. Emerg Infect Dis 2020; 26: 967-975.
5. Kutter JS, Spronken MI, Fraaij PL, Fouchier RA, Herfst S. Transmission routes of respiratory viruses among humans. Curr Opin Virol 2018; 28: 142-151.
6. Cowling BJ, Leung GM. Epidemiological research priorities for public health control of the ongoing global novel coronavirus (2019-nCoV) outbreak. Euro Surveill 2020; 25: 2000110.
7. Han Q, Lin Q, Ni Z, You L. Uncertainties about the transmission routes of 2019 novel coronavirus. Influenza Other Respir Viruses 2020; 14: 470-471.
8. Peiris JSM, Guan Y, Yuen KY. Severe acute respiratory syndrome. Nat Med 2004; 10(12 Suppl): S88-97.
9. Peiris JS, Tu W-W, Yen H-L. A novel H1N1 virus causes the first pandemic of the 21st century. Eur J Immunol 2009; 39: 2946-2954.
10. Trajman A, Menzies D. Occupational respiratory infections. Curr Opin Pulm Med 2010; 16: 226-234.
11. Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2011; 2011: CD006207.
12. Johnson DF, Druce JD, Birch C, Grayson ML. A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. Clin Infect Dis 2009; 49: 275-277.
13. Guo X, Wang J, Hu D, Wu L, Gu L, Wang Y, et al. Survey of COVID-19 disease among orthopaedic surgeons in Wuhan, People’s Republic of China. J Bone Joint Surg Am 2020; 102: 847-854.
14. Leung NHL, Chu DKW, Shiu EYC, Chan K-H, McDevitt JJ, Hau BJP, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med 2020; 26: 676-680.
15. Choudhury A, Singh M, Khurana DK, Mustafi SM, Ganapathy U, Kumar A, et al. Physiological effects of N95 FFP and PPE in healthcare workers in COVID intensive care unit: a prospective cohort study. Indian J Crit Care Med 2020; 24: 1169-1173.
16. Lim ECH, Seet RCS, Lee K-H, Wilder-Smith EPV, Chuah BYS, Ong BKC. Headaches and the N95 face-mask amongst healthcare providers. Acta Neurol Scand 2006; 113: 199-202.
17. Chen X, Chughtai AA, MacIntyre CR. Herd protection effect of N95 respirators in healthcare workers. J Int Med Res 2017; 45: 1760-1767.
18. Lawrence RB, Duling MG, Calvert CA, Coffey CC. Comparison of performance of three different types of respiratory protection devices. J Occup Environ Hyg 2006; 3: 465-474.
19. Ueki H, Furusawa Y, Iwatsuki-Horimoto K, Imai M, Kabata H, Nishimura H, et al. Effectiveness of Face Masks in Preventing Airborne Transmission of SARS-CoV-2. mSphere 2020; 5(5): e00637-20.
20. Ng I, Kave B, Begg F, Bodas CR, Segal R, Williams D. N95 respirators: quantitative fit test pass rates and usability and comfort assessment by health care workers. Med J Aust 2022; 217: 88-93.
21. MacIntyre CR, Chughtai AA. Facemasks for the prevention of infection in healthcare and community settings. BMJ 2015; 350: h694.
22. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.
23. Peng W, Yang J, Wang Y, Wang W, Xu J, Wang L, et al. Systematic review and meta-analysis of randomized controlled trials of Xingnaojing treatment for stroke. Evid Based Complement Alternat Med 2014; 2014: 210851.
24. Deeks JJ, Dinnes J, D'Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technol Assess 2003; 7: iii-x, 1-173.
25. Wang X, Pan Z, Cheng Z. Association between 2019-nCoV transmission and N95 respirator use. J Hosp Infect 2020; 105: 104-105.
26. Kim M-C, Bae S, Kim JY, Park SY, Lim JS, Sung M, et al. Effectiveness of surgical, KF94, and N95 respirator masks in blocking SARS-CoV-2: a controlled comparison in 7 patients. Infect Dis (Lond) 2020; 52: 908-912.
27. Seto WH, Tsang D, Yung RWH, Ching TY, Ng TK, Ho M, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003; 361: 1519-1520.
28. Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, et al. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 36: 101751.
29. Offeddu V, Yung CF, Low MSF, Tam CC. Effectiveness of masks and respirators against respiratory infections in healthcare workers: a systematic review and meta-analysis. Clin Infect Dis 2017; 65: 1934-1942.
30. Teleman MD, Boudville IC, Heng BH, Zhu D, Leo YS. Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. Epidemiol Infect 2004; 132: 797-803.
31. Cowling BJ, Zhou Y, Ip DKM, Leung GM, Aiello AE. Face masks to prevent transmission of influenza virus: a systematic review. Epidemiol Infect 2010; 138: 449-456.
32. Oberg T, Brosseau LM. Surgical mask filter and fit performance. Am J Infect Control 2008; 36: 276-282.
33. Bischoff WE, McNall RJ, Blevins MW, Turner J, Lopareva EN, Rota PA, et al. Detection of measles virus RNA in air and surface specimens in a hospital setting. J Infect Dis 2016; 213: 600-603.
34. Myatt TA, Johnston SL, Rudnick S, Milton DK. Airborne rhinovirus detection and effect of ultraviolet irradiation on detection by a semi-nested RT-PCR assay. BMC Public Health 2003; 3: 5.
35. Leung NHL. Transmissibility and transmission of respiratory viruses. Nat Rev Microbiol 2021; 19: 528-545.
36. Yu ITS, Li Y, Wong TW, Tam W, Chan AT, Lee JHW, et al. Evidence of airborne transmission of the severe acute respiratory syndrome virus. N Engl J Med 2004; 350: 1731-1739.
37. Fischer EP, Fischer MC, Grass D, Henrion I, Warren WS, Westman E. Low-cost measurement of face mask efficacy for filtering expelled droplets during speech. Sci Adv 2020; 6(36): eabd3083.38. Tang JW, Liebner TJ, Craven BA, Settles GS. A
schlieren optical study of the human cough with and without wearing masks for aerosol infection control. J R Soc Interface 2009; 6 Suppl 6(Suppl 6): S727-36.
39. Fennelly KP. Particle sizes of infectious aerosols: implications for infection control. Lancet Respir Med 2020; 8: 914-924.
40. Cheng VCC, Wong S-C, Chuang VW-M, So SY-C, Chen JH-K, Sridhar S, et al. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J Infect 2020; 81: 107-114.
41. Amanat F, Krammer F. SARS-CoV-2 Vaccines: Status Report. Immunity 2020; 52: 583-589.
IssueVol 15 No 2 (2023) QRcode
SectionReview Article(s)
Mask; Coronavirus; Influenza; Respiratory; Healthcare settings; Health personnel

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How to Cite
Sami H, Firoze S, Khan P, Fatima N, Khan H. Face masks for respiratory viral illness prevention in healthcare settings: a concise systemic review and meta-analysis. Iran J Microbiol. 2023;15(2):181-188.