Universal Mask Usage for Reduction of Respiratory Viral Infections After Stem Cell Transplant: A Prospective Trial

• Published in: Clinical infectious diseases 2016-10, Vol.63 (8), p.999-1006
• Main Authors: Sung, Anthony D., Sung, Julia A. M., Thomas, Samantha, Hyslop, Terry, Gasparetto, Cristina, Long, Gwynn, Rizzieri, David, Sullivan, Keith M., Corbet, Kelly, Broadwater, Gloria, Chao, Nelson J., Horwitz, Mitchell E.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; and Commentaries; ARTICLES AND COMMENTARIES; Confounding Factors (Epidemiology); Female; Hematologic Neoplasms - complications; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Humans; Immunocompromised Host; Incidence; Infection Control - methods; Male; Masks; Middle Aged; Nosocomial infections; Paramyxoviridae; Respiratory Tract Infections - diagnosis; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - prevention & control; Respiratory Tract Infections - virology; Risk assessment; Seasons; Stem cells; Transplants & implants; Viral infections; Young Adult
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciw451

Background. Respiratory viral infections (RVIs) are frequent complications of hematopoietic stem cell transplant (HSCT). Surgical masks are a simple and inexpensive intervention that may reduce nosocomial spread. Methods. In this prospective single-center study, we instituted a universal surgical mask policy requiring all individuals with direct contact with HSCT patients to wear a surgical mask, regardless of symptoms or season. The primary endpoint was the incidence of RVIs in the mask period (2010–2014) compared with the premask period (2003–2009). Results. RVIs decreased from 10.3% (95/920 patients) in the premask period to 4.4% (40/911) in the mask period (P< .001). Significant decreases occurred after both allogeneic (64/378 [16.9%] to 24/289 [8.3%], P= .001) and autologous (31/542 [5.7%] to 16/622 [2.6%], P= .007) transplants. After adjusting for multiple covariates including season and year in a segmented longitudinal analysis, the decrease in RVIs remained significant, with risk of RVI of 0.4 in patients in the mask group compared with the premask group (0.19–0.85, P = .02). In contrast, no decrease was observed during this same period in an adjacent hematologic malignancy unit, which followed the same infection control practices except for the mask policy. The majority of this decrease was in parainfluenza virus 3 (PIV3) (8.3% to 2.2%, P < .001). Conclusions. Requiring all individuals with direct patient contact to wear a surgical mask is associated with a reduction in RVIs, particularly PIV3, during the most vulnerable period following HSCT.