Facemasks in the protection of hospitals healthcare workers (HCW) in resource poor settings

Currently there is an ongoing debate and a dearth of evidence around the efficacy of facemasks and respirators. Most studies have been observational and there is a lack of trial data around use and re-use of facemasks in the healthcare setting. Due to the lack of high quality studies, I hypothesised that there would be huge variations in the policies and practices around the use of facemasks and respirators in the healthcare setting. This thesis therefore aims to examine the policies and practices around the use of these products in low resource countries.Five studies were conducted at varying administrative levels. In the first study, publicly available policies and guidelines around the use of facemasks/respirators were examined to describe areas of consistency, as well as gaps in the recommendations. In the second study, infection control stakeholders were interviewed from China, Pakistan and Vietnam to further explore the issues, which arose during the guideline review. Next, hospitals from the three countries were surveyed to examine practices around the use of facemasks/ respirators and to examine the translation of policies into practice. Samples of facemasks and respirators were also collected and tested. In the fourth study, focus groups were undertaken to examine the knowledge, attitudes and practices of Vietnamese hospital HCWs towards the use of masks/respirators. The fifth study examined the factors associated with compliance of Vietnamese HCWs with the use of various types of facemasks. In addition, the available evidence around the efficacy and use of cloth masks was reviewed. These studies provide new data around factors impacting on the use of facemasks and respirators in resource poor settings. Inconsistencies and gaps were identified in the reviewed polices, which highlight that there is a need to develop a comprehensive and uniform policy around the use of facemasks/respirators. Practices around the use of facemasks and respirators are influenced by organizational and personal factors and understanding these factors will assist with the development of strategies to improve staff compliance with respiratory protection. On the basis of these studies, recommendations have been developed around the use of facemasks and respirators in low resource settings