Evidence-based Nursing Practice

Introduction to Efficacy of Face Mask

When a bacteria, virus, or fungus-infected individual releases such pathogens in form of droplets or aerosols which are inhaled by a healthy individual then through transmission the pathogen will stead and multiply and illness will prevail in society. When an infected person releases droplets in the air through talking, coughing, or sneezing then these droplets are found to be suspended in the air for some time and then later they drop down to the ground (Haslam et al., 2020; Sun et al., 2020). To prevent this condition, the face-masks are used for the people in public areas but to explore more about the effect of these masks in limiting the transmission of air-borne infection from one human to another this essay will discuss the evidence retrieved from various literature available. The following sections will discuss how the literature of evidence is acquired, appraisal and assessment of evidence, the implication for public health recommendations, and evidence gaps for future research. 

Methods for Acquiring Literature for Evidence

For this essay, a particular selection criterion is made and all the articles are selected as per the criteria. If any of the articles does meet the requirements then it is excluded from the selected list. Various credible databases were used such as Pubmed, CINAHL, Cochrane Library, EMBASE, and ELSEVIER. The articles are acquired based on the time period of 2015 to 2020 and only English articles were selected and the rest were not selected for the final list. From a total of more than 200 articles, only 4 were selected by the essay for evidence-based study. The use of Boolean operators helps the researcher to find the required and relevant data with the help of a combination of specific and particular key terms related to the research topics (Pazhaniraja et al., 2020). With the use of key terms and Boolean operators such as air-borne infection AND masks, masks OR public place, air-borne infection AND public place, air-borne infection OR masks, masks, AND public place. After the retrieval of the literature, a recheck is performed to ensure that all the articles meet the criteria of selection.

Appraisal and Assessment of The Evidence

All 4 selected articles are of high quality with the first level of evidence, as all the 4 journal articles are systematic review articles.

According to Liang et al. (2020), the study stated that wearing a mask in the health care sector prevents the spread of infection through transmission, lower the risks of spread of disease, masks, and social distancing helps in limiting the transmission of respiratory illness, and washing of hands with the use of masks is found to decrease the chances of human-to-human transmission of air-borne illnesses. The study stated that the presence of a physical barrier prevents the droplets to enter the respiratory tracts of the surrounding people in public areas, thereby reducing risks of the spread of air-borne infections. The micropores of the masks that capable are enough to block the droplets, aerosols, and dust particles and are highly effective in preventing the transmission of airborne infections among humans via transmission if the people are wearing masks in public areas (Chiodini et al., 2020).

According to MacIntyre et al. (2020), the study result showed that wearing a mask is beneficial especially in times of covid-29 to prevent the virus from spreading and multiplication. The wearing of a mask is effective without or with hand hygiene, but with hand hygiene, the effectiveness is more. The masks prevent the spread of air-borne infections due to cough or sneezing in public places or health care institutions. The virus of covid-19 is more easily inhaled without masks but it is not inhaled with protective measures such as a mask applied on the face covering the mouth and nose.

According to Smith et al. (2016), the study stated that N95 masks are efficient in protecting the health workers and the public in ensuring protection from acute respiratory infections. A well-fitted mask ensures no leakage and the improper wearing of the masks infects the surrounding people. However, coughing, talking, and sneezing results in a respiratory jet of droplets, and those are pathogenic and infectious for the healthy individual. A mask helps in overcoming the risks of contracting infectious materials or particles in the air. Moreover, the increased use of masks during covid-19 resulted in the limited spread of the virus among the public and limited multiplication thereby, reduction in the transmission due to the efficiency of the masks.

According to Dugré et al. (2020), the study result showed that the individuals who wear masks are less infected with the disease whereas those who do not wear masks are more infected with the air-borne infection. Thus, the results showed that the use of masks for health care professionals as well as for the general public is effective in providing protection from respiratory illness. A person with no mask is at high risk of transmission and contraction with the respiratory illness. Moreover, the N95 masks are more effective in providing protection than various other fabric or cloth masks. The re-use or disposal of the masks should be as per the recommended guidelines to ensure safety and no transmission.

The Implication for Public Health Recommendations

From the information collected through the journal articles and literature evidence, it is concluded that the implication for the public health recommendations is as follows: the people should be asked to wear only high-quality N95 masks and use of cloth masks should be avoided; a well-fitted mask should be used; the masks should be worn in an appropriate manner; the masks should not be touched after use or during use; the disposal or washing of the masks should be as per the recommended guidelines so that chances of transmission are reduced; the health care staff should educate the encourage the patients and co-workers to wear the mask in public places and frequently change it and use the sterile mask for the next use; the patients should be educated about the importance of wearing a mask in public places to ensure the security of self and the surrounding people (Sun et al., 2020; Fang-Lin et al., 2020)

Evidence Gaps for Future Research

It is found that most of the studies are discussing the effectiveness of masks or no masks; therefore, more research is required to explore about the effectiveness among different mask types, different types of wearing methods, masks fabric, the relationship of masks, and social distancing in public areas or closed areas (Chu et al., 2020; Offeddu et al., 2017). More research is required to explore the effects of the frequency of short-term mask-wearing and the effects of long-term mask-wearing frequency. A well-fitted mask can be worn by a child or an old patient for longer durations due to discomfort so the researchers should come up with new solutions so that a patient or any individual of different age groups can easily wear a mask for longer duration either in hospitals or in public areas (Gierthmuehlen et al., 2020). No information is provided to the common public about the appropriate way to dispose or wash the masks after its first use; which type of masks can be reused after first use and which cannot be used or methods of washings or sterilization should be more researched upon so that cost-effective solution is obtained. Furthermore, more research is required to produce new designs of masks that are cost-effective and reduce the sense of unfriendliness or embarrassment among the common people. 

Conclusion on Efficacy of Face Mask

It is concluded that the spread of air-borne illness is due to the spread and transmission of droplets or respiratory aerosols. A mask is very effective in reducing the transmission of the virus from one human to the other. It acts as a barrier and its pores trap the droplets and aerosols thereby preventing the spread of air-borne infections in public places. If a mask is present then the pathogens after coughing or sneezing by an infected individual will not affect much on the healthy individual. Hand hygiene, social distancing, and masks are capable to limit the spread of the virus and their multiplications. A mask should be worn by every individual in public or open areas as it protects the infection spread from unhealthy to unhealthy, unhealthy to healthy, and other surrounding environments. It should be ensured that a mask is appropriately worn by the person so that the exchange of air does not impact the health of the person.

References for Efficacy of Face Mask

Chiodini, J. (2020). Maps, masks and media–Traveller and practitioner resources for 2019 novel coronavirus (2019-nCoV) acute respiratory virus. Travel Medicine and Infectious Disease33, 101574. https://dx.doi.org/10.1016%2Fj.tmaid.2020.101574

Chu, D. K., Akl, E. A., Duda, S., Solo, K., Yaacoub, S., Schünemann, H. J., & Hajizadeh, A. (2020). Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: A systematic review and meta-analysis. The Lancet. https://doi.org/10.1016/S0140-6736(20)31142-9

Dugré, N., Ton, J., Perry, D., Garrison, S., Falk, J., McCormack, J., & Thomas, B. (2020). Masks for prevention of viral respiratory infections among health care workers and the public: PEER umbrella systematic review. Canadian Family Physician66(7), 509-517. https://www.cfp.ca/content/66/7/509.full

Fang-Lin, C. (2020). Face mask designs following novel Coronavirus. Journal of Public Health Research9(1). https://doi.org/10.4081/jphr.2020.1770

Gierthmuehlen, M., Kuhlenkoetter, B., Parpaley, Y., Gierthmuehlen, S., Köhler, D., & Dellweg, D. (2020). Evaluation and discussion of handmade face-masks and commercial diving-equipment as personal protection in pandemic scenarios. Plos One15(8), e0237899. https://doi.org/10.1371/journal.pone.0237899

Haslam, A. (2020). Response to ‘MacIntyre et al., 2020: A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patient’. International Journal of Nursing Studies. https://dx.doi.org/10.1016%2Fj.ijnurstu.2020.103750

Liang, M., Gao, L., Cheng, C., Zhou, Q., Uy, J. P., Heiner, K., & Sun, C. (2020). Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Medicine and Infectious Disease, 101751. https://doi.org/10.1016/j.tmaid.2020.101751

MacIntyre, C. R., & Chughtai, A. A. (2020). A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. International Journal of Nursing Studies, 103629.https://doi.org/10.1016/j.ijnurstu.2020.103629

Offeddu, V., Yung, C. F., Low, M. S. F., & Tam, C. C. (2017). Effectiveness of masks and respirators against respiratory infections in healthcare workers: A systematic review and meta-analysis. Clinical Infectious Diseases65(11), 1934-1942. https://doi.org/10.1093/cid/cix681

Pazhaniraja, N., Sountharrajan, S., & Kumar, B. S. (2020). High utility itemset mining: A Boolean operators-based modified grey wolf optimization algorithm. Soft Computing, 1-14. https://doi.org/10.1007/s00500-020-05123-z

Smith, J. D., MacDougall, C. C., Johnstone, J., Copes, R. A., Schwartz, B., & Garber, G. E. (2016). Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: A systematic review and meta-analysis. Medical Association Journal188(8), 567-574. https://doi.org/10.1503/cmaj.150835

Sun, C. X., Bin, H. E., Di, M. U., Li, P. L., Zhao, H. T., Li, Z. L., & Ying, C. U. I. (2020). Public awareness and mask usage during the covid-19 epidemic: A survey by China cdc new media. Biomedical and Environmental Sciences33(8), 639-645. https://doi.org/10.3967/bes2020.085

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