Evidence-Based Nursing Practice

Introduction to Air-Borne Illness Infections

Respiratory or air-borne illness infections are very harmful that pose a great threat to a healthy society; but with the use of masks, the risk of spread of infections can be greatly reduced (Flaskerud, 2020). According to Tan(2014)&Flaskerud (2020), wearing masks prevents the droplets from the infected person to spread into the surrounding environment, and the infectious droplets if present in the environment does not enter the body of the individual. The air-borne illness is majorly caused by the droplets that are released by the infected individual through talking, sneezing, or coughing. These are mainly bacteria or viruses that cause health problems such as influenza, pox, tuberculosis, COVID-19, and many others. Therefore, in this essay, the following sections will discuss the literature evidence for the research question “In adults, is wearing a mask effective for preventing human-to-human transmission of airborne illnesses”?, implications for public health recommendations, and gaps in the evidence for future research.

Methods for Literature Retrieval

For this essay, 3 databases were used for searching the literature such as CINAHL, EMBASE, and PubMed. The search was successful with the use of key terms such as masks, air-borne infection, illness, and a few others. The use of an effective search strategy helps in the retrieval of data that is relevant to the research question. For example, the use of Boolean operators helps the ineffective selection of the literature by using a combination of key terms (Grewal et al., 2016). The use of Boolean operators with key terms helped in the retrieval of high-quality articles such as masks AND air-borne infection, masks OR air-borne infection, air-borne illness AND face masks. Only the articles that were in the range of 2015 to 2020 were selected rest were excluded from the search. After successful retrieval of the literature again a cross-check was performed as per the selection criteria. The relevant articles that were in the English language were selected and the rest of the selected papers that did not meet the criteria were excluded.

Analysis of Air-Borne Illness Infections

The selected articles include data that was collected by experimental studies of literature available, a systematic review of a qualitative study, and meta-analysis. (Article 1)According to Matuschek et al. (2020), the study conducted experimental studies (level of evidence 3) and showed that while coughing and sneezing the mucous or pathogenic droplets are released that stay in the air for some time and then drop on the ground. If in the air they are inhaled by any healthy individual then he can develop air-borne infections. The masks cover the face, mouth, and nose of the individual and protect him/her from the infectious agents in the air. The FFP masks (filtering facepiece) are found to restrict the entry of the pathogen to the body through the air and protect the wearer and the surrounding people. Although, these masks do not provide high-quality protection as the air can pass through them. The masks that are made from fabric do not prevent the spread of air-borne infection in public places due to sneezing or coughing (Omura et al., 2020). With the use of N95-mask/FFP2-masks, it is found that almost 95 % of the pathogen in the air that causes illness or infection is trapped in the masks and nit inhaled inside the body during inhalation not spread in the outer environment during exhalation.

(Article 2) According to Li et al. (2020), the study conducted a systematic review of a qualitative study (level of evidence 5) and showed that the population who wear masks showed a flattened curve for the air-borne infection spread than the population who did not wear masks. The masks have the potential to restrict and block the jets that are generated due to coughing and sneezing thereby preventing the air-borne spreading of the infection. They filter air containing aerosols and pathogens to prevent human-to-human air-borne infection transmission. These masks can prevent the spread of human coronaviruses or influenza pathogens from one symptomatic person to another healthy person in a public place. A mask-wearing attitude can significantly reduce the virus spread and viral reproduction in the general public population.

(Article 3) According to Verma et al. (2020), the study conducted a systematic review of a qualitative study (level of evidence 5) and stated that masks are found to mitigate the chances of the spread of air-borne infections in public places. A mask curtails the speed of the respiratory jets and a well-fitted mask help in limiting the transmission of pathogens via coughing or droplets. It is found that 35% of the individual with respiratory or air-borne infections do not exhibit symptoms so it becomes a serious issue to consider so that virus does not spread to others in public places. It showed that if a high-quality well-fit mask is used then the rate of the respiratory jet can be highly controlled and the droplets get trapped in the masks preventing the transmission.

(Article 4) According to Kähler et al. (2020), this meta-analysis study (level of evidence 1) showed that masks protect the surrounding, effectively resists the airflow during coughing, sneezing or talking, or singing. However, it is also required that public places should also maintain an appropriate distance so that the spread of transmission is effectively limited. If infected individual releases the pathogenic droplets in the air then a healthy individual without a mask will get the infection at a high rate and an individual with a mask is at low risk to get affected with the infection via transmission. If the infected person and the healthy person both wear masks in a public place then the prevention and protection will be more. 

Implications for Public Health Recommendations and Evidence Gaps

From the studies and literature access, the recommended implications for public health are the masks should be appropriately worn; they should be frequently changed; wearing low-quality masks do not guarantee any protection to the wearer and the surrounding people; use high-quality masks in public places to ensure self-protection and prevent the spreading of the pathogens in the air; the nurses and the medical staff should encourage the patients and their family members to use masks in public places so that the spread of air-borne infection is reduced from one human to the other (Chughtai et al., 2015; Lee et al., 2020). Moreover, if the masks are not frequently exchanged and are improperly used then the risk of spread of infection can increase; due to breathing the masks may become moistened resulting in the entry and the exit of the air through the edges which will increase the risk of infection spread. Hence, the individual should be informed by the health care members about the appropriate use of masks and the benefits associated with it.

The research gap includes the following: the quality of the mask material can be researched more so that it is cost-effective; the mask should be made in such a way that even a child or an old can wear it for longer durations in public places; more future research is required to ensure that if mask material is improved then the guidelines for social distance will decrease or not; it is also found that from the edges of the mask the air can get exchanged so research can be performed for the new design of mask for public use; facemask may hurt the feelings of the people as they might appear unfriendly; discomfort; the sense of embarrassment (Martin et al., 2020; Fischer et al., 2020). Researchers can research more for a material that is not opaque so that communication is clear with children and old and people feel friendly or comfortable even after wearing it for a longer duration in public areas.

Conclusion on Air-Borne Illness Infections

It is concluded that a mask helps in various ways such as it prevents the spreading of infection of the droplets released by the wearer to the outside environment and it also protects the wearer from the air-borne pathogens that might be inhaled by the individual if a nearby person sneezes or coughs. The air-borne infection is caused when the infectious droplets enter the body of a healthy person from an asymptomatic person. A mask should be appropriately worn by the individuals in a public place to prevent the spread and multiplication of the viruses. If a person wears a high-quality mask then he/she gets protection at a high rate than a person who wears a low-quality mask. Although, it is found that ethics might get hurt in some cases such as the development of feelings of unfriendliness, ineffective communication with others in a public place, or with health care professionals, discomfort, and others.

References for Air-Borne Illness Infections

Chughtai, A. A., Seale, H., Chi Dung, T., Maher, L., Nga, P. T., &MacIntyre, C. R. (2015). Current practices and barriers to the use of facemasks and respirators among hospital-based health care workers. Journal of Infection Control43(1), 72–77.https://doi.org/10.1016/j.ajic.2014.10.009

Fischer, E. P., Fischer, M. C., Grass, D., Henrion, I., Warren, W. S., &Westman, E. (2020). Low-cost measurement of face mask efficacy for filtering expelled droplets during speech. Science Advances6(36), eabd3083. https://doi.org/10.1126/sciadv.abd3083

Flaskerud, J. H. (2020). Masks, politics, culture and health. Issues in Mental Health Nursing41(9), 846-849.https://doi.org/10.1080/01612840.2020.1779883

Grewal, A., Kataria, H., &Dhawan, I. (2016).Literature search for research planning and identification of research problem.Journal of Anaesthesia60(9), 635.https://dx.doi.org/10.4103%2F0019-5049.190618

Kähler, C. J., &Hain, R. (2020).Fundamental protective mechanisms of face masks against droplet infections. Journal of Aerosol Science148, 105617. https://doi.org/10.1016/j.jaerosci.2020.105617

Lee, L. Y. K., Lam, E. P. W., Chan, C. K., Chan, S. Y., Chiu, M. K., Chong, W. H., &Tsoi, S. L. (2020). Practice and technique of using face mask amongst adults in the community: A cross-sectional descriptive study. BMC Public Health20(1), 1-11.https://doi.org/10.1186/s12889-020-09087-5

Li, T., Liu, Y., Li, M., Qian, X., & Dai, S. Y. (2020). Mask or no mask for COVID-19: A public health and market study. PloS One15(8), e0237691.https://doi.org/10.1371/journal.pone.0237691

Martin, G. P., Hanna, E., McCartney, M., &Dingwall, R. (2020). Science, society, and policy in the face of uncertainty: Reflections on the debate around face coverings for the public during COVID-19. Critical Public Health, 1-8.https://doi.org/10.1080/09581596.2020.1797997

Matuschek, C., Moll, F., Fangerau, H., Fischer, J. C., Zänker, K., van Griensven, M., &Tamaskovics, B. (2020). Face masks: Benefits and risks during the COVID-19 crisis. European Journal of Medical Research25(1), 1-8.https://doi.org/10.1186/s40001-020-00430-5

Omura, M., Stone, T. E., Petrini, M. A., & Cao, R. (2020). Nurses’ health beliefs about paper face masks in Japan, Australia and China: A qualitative descriptive study. International Nursing Review67(3), 341-351. https://doi.org/10.1111/inr.12607

Sim, S. W., Moey, K. S., & Tan, N. C. (2014). The use of facemasks to prevent respiratory infection: A literature review in the context of the Health Belief Model. Singapore Medical Journal55(3), 160–167. https://doi.org/10.11622/smedj.2014037

Verma, S., Dhanak, M., &Frankenfield, J. (2020).Visualizing the effectiveness of face masks in obstructing respiratory jets. Physics of Fluids32(6), 061708. https://doi.org/10.1063/5.0016018

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