BACKGROUND: behaviour change interventions were central in the COVID-19 response and are vital for strengthening pandemic preparedness and resilience. To be effective, interventions must target specific behavioural determinants, but determinants are complex and multifaceted and there is a gap in robust, theory driven evidence on which behavioural determinants are most effective at changing mask usage and hand hygiene behaviour.
OBJECTIVE: to map available evidence on the types of hand hygiene and mask usage behaviour change interventions conducted during the COVID-19 pandemic and assess their effectiveness, feasibility and acceptability.
METHODS: we conducted a systematic review, searching four peer-reviewed databases for terms related to COVID-19, targeted behaviours (hand hygiene and mask usage) and interventions. Eligible studies were those which focused on adults or children in naturalistic, non-experimental settings; reported on an intervention designed to change hand hygiene and or mask usage to reduce COVID-19 transmission; provided clear outcome measures, including through self-report, proxy indicators or observation. Studies were excluded if they were purely qualitative, opinion pieces or based on secondary data alone; focused on health workers; measured intended rather than enacted behaviour; were conducted in laboratory or health care-based settings; involved infants; were published before the 11th of March 2020 (when COVID-19 was declared a pandemic) and published in a language other than English. There were no geographical limits set. Descriptive summaries were produced and the quality of evidence and reporting was evaluated. Studies were divided into three sub-groups according to the behaviour targeted and behaviour change techniques (BCTs) were mapped. Effect estimates were summarised and the relationship between BCTs and effect was explored. Feasibility and acceptability was summarised where reported. Due to the heterogeneity of studies included, meta-analysis could not be conducted.
RESULTS: sixteen citations met the criteria, with sub-studies (two citations including multiple studies) totalling nineteen eligible studies. The majority were randomised controlled trials which targeted hand hygiene only and were conducted in high income nations, with none conducted in crisis settings. Due to the constraints of the pandemic, many interventions were delivered online. The quality of studies was low, with the majority demonstrating a medium risk of bias (Likert scale: low, medium, high). Whilst acceptability and feasibility was good, both were rarely evaluated. \'Natural consequences\' was the most commonly used BCT group. Fourteen of the studies elicited positive or potentially positive effects in at least one intervention arm and/or targeted behaviour. Effective interventions typically targeted multiple individual BCTs, including \'Instruction on how to perform a behaviour\', \'Information about health consequences\', and group \'Reward and threat\', through repeated engagement over a sustained period of time.
CONCLUSIONS: there is a substantial knowledge gap, particularly in low resource and crisis settings, and available evidence is of low quality. We must address these gaps to enable evidence-based practice and strengthen pandemic preparedness and resilience. Future research should include another systematic review which includes grey literature and different languages, as well as more robust evaluations which use implementation research to explore the impact of multiple BCTs in low resource and crisis settings. Evaluations should include assessments of acceptability, practicability, affordability and equity.

BACKGROUND: Pressure ulcers associated with the non-invasive ventilation mask can significantly reduce the quality of life of the patient who needs this therapy. This study aims to identify clinical interventions to prevent skin lesions associated with the use of non-invasive ventilation medical devices.
METHODS: The Scoping Review followed the methodology of the Joanna Briggs Institute. For this study the research was carried out, during the month of January 2022, in several databases, such as PubMed, Web of Science, Scopus, EBSCOhost, RCAAP and OpenGrey, and studies published between 2010 and 2022 were included.
RESULTS: Of the 33 articles identified, 11 articles were included in this review, in which we identified several interventions for the prevention of skin lesions associated with the use of medical devices for non-invasive ventilation. The interventions identified include skin assessment, optimal fixation of the device, and the use of interfaces, namely, hydrocolloid or foam dressing under the NIV mask, among others Conclusion: This scoping review demonstrates that there is some scientific evidence for prevention, however the methodological approaches are very different, which makes it difficult to clearly describe the referenced interventions. This study was not registered.

The COVID-19 pandemic had a devastating impact on the world, causing widespread illness and death. Focusing on prevention strategies to limit the spread of the disease remains essential. Despite the advent of vaccines, maintaining a vigilant approach to prevention remains paramount. We reviewed effective strategies to prevent COVID-19 transmission, including various prevention measures and interventions and both established practices and unresolved issues that have been addressed in meta-analyses, literature reviews, or in the health care context. Standard precautions are the cornerstone of infection control, with hand hygiene and mask use as key components. The use of surgical masks is recommended to prevent droplet transmission, while eye protection is recommended in combination with masks. In terms of room occupancy, ventilation is critical in reducing the risk of transmission in poorly ventilated environments. Chemical disinfection of indoor air with Triethylene glycol-based products can provide safe additional protection. Since viral RNA detection on surfaces does not necessarily indicate infectivity, the risk of transmission by surface contact remains low if surfaces are properly maintained and hand hygiene is practiced regularly. Thus, prevention of SARS-CoV-2 transmission requires a multifaceted approach, including reducing particle emissions from infected persons by wearing masks, eliminating aerosols by ventilation and air treatment, ensuring physical separation, and protecting exposed persons with masks and eye protection.

Sleep disordered breathing is commonly treated with positive airway pressure therapy. Positive airway pressure therapy is delivered via a tight-fitting mask with common side effects including: leak, ineffective treatment, residual sleep disordered breathing, eye irritation, nasal congestion, pressure ulcers and poor concordance with therapy. This systematic review and meta-analysis aimed to identify the effectiveness of current treatment strategies for managing side effects associated with positive airway pressure therapy. Five databases were searched and 10,809 articles were screened, with 36 articles included in the review. Studies investigated: dressings, nasal spray/douche, chin straps, heated humidification and interfaces. No intervention either improved or detrimentally affected: positive airway pressure concordance, Epworth Sleepiness Score, residual apnoea hypopnea index or interface leak. The review was limited by study heterogeneity, particularly for outcome measures. Additionally, patient demographics were not reported, making it difficult to apply the findings to a broad clinical population. This review highlights the paucity of evidence supporting treatment strategies to manage side effects of positive airway pressure therapy.

BACKGROUND: Since the beginning of the COVID-19 pandemic, face masks have been among the cornerstones of COVID-19 prevention. Therefore, evaluating their preventive effects against COVID-19 is crucial. This review aimed to systematically search for the systematic review articles that explored the role of various types of face masks in preventing COVID-19.
METHODS: We browsed the keywords of this study in the online databases of Scopus, Web of Science, PubMed, and Cochrane on 10th January 2023 and retrieved all the relevant systematic review articles. The records were downloaded into an Endnote file, and the duplicates were removed. A two-step screening process consisting of title/abstract and full-text screenings was conducted to select the most relevant articles. To ensure the validity and reliability of the results, this study adhered to the PRISMA protocol.
RESULTS: A total of 28 systematic reviews were included in this review. Most studies found that face masks are beneficial against viral respiratory infections, such as COVID-19. Different types of masks were evaluated in included studies. It appeared that mask efficacy depends on the material, layers, fitting on the face and user compliance. N 95 respirator had maximum efficacy, especially when used continuously.
CONCLUSIONS: Face masks have a beneficial effect against COVID-19. Home masks are less protective than surgical masks or N95 personal breathing masks. Besides, the use of masks may elicit a false sense of security in people, which may lead to poor hand hygiene and violation of social distancing. Therefore, the necessary training should be provided to the public to increase awareness and encourage the right practice of using the mask, emphasizing the preventive effects of washing hands, social distancing, and using a face mask against COVID-19.

UNASSIGNED: Coronavirus disease 2019 (COVID-19) has led to severe shortages of filtering facepiece respirators (FFRs). As a result, extended use, limited reuse, and FFR decontamination have been utilized to extend the life of single-use FFRs. Although some studies have raised concerns that reuse could affect the FFR\'s ability to form a seal, no comprehensive literature review of the effect of extended use or limited reuse on FFR seal exists.
UNASSIGNED: The goal of this review was to assess the effect of extended use and reuse on respirator fit, with and without decontamination.
UNASSIGNED: Searches of PubMed and Medrxiv yielded 24 papers that included assessment of fit after extended use or limited reuse on a human. One additional handpicked paper was added.
UNASSIGNED: Studies report a wide variation in the number of donnings and doffings before fit failure between different models of respirators. Additionally, while seal checks lack sufficient sensitivity to reliably detect fit failures, individuals who failed fit testing were often able to pass subsequent tests by re-positioning the respirator. Even with failure, respirators often maintained a substantially higher level of fit than a surgical mask, so they may still provide a level of protection in crisis settings.
UNASSIGNED: Based on currently available data, this literature review was unable to establish a consensus regarding the amount of time a respirator can be worn or the number of uses before fit failure will occur. Furthermore, variations in reuses before fit failure between different models of N95 respirators limit the ability to offer a comprehensive recommendation of greater than one reuse or a specific amount of wear time.

UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: Masks largely succeeded in stopping respiratory virus transmission, as evidenced by the meta-analysis of 6 studies (a total of 927 individuals).

As face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation.
A systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on n = 8,641, m = 2,482, f = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes.
We found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO2 (overall Standard Mean Difference, SMD = -0.24, 95% CI = -0.38 to -0.11, p < 0.001) and minute ventilation (SMD = -0.72, 95% CI = -0.99 to -0.46, p < 0.001), simultaneous increased in blood-CO2 (SMD = +0.64, 95% CI = 0.31-0.96, p < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03-0.41, p = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03-0.39, p = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23-1.38, p = 0.006) and humidity (SMD +2.24, 95% CI = 1.32-3.17, p < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in n = 373 with a robust relationship to mask wearing (p < 0.006 to p < 0.001). Pooled symptom prevalence (n = 8,128) was significant for: headache (62%, p < 0.001), acne (38%, p < 0.001), skin irritation (36%, p < 0.001), dyspnoea (33%, p < 0.001), heat (26%, p < 0.001), itching (26%, p < 0.001), voice disorder (23%, p < 0.03), and dizziness (5%, p = 0.01).
Masks interfered with O2-uptake and CO2-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health.
Face mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256694, identifier: PROSPERO 2021 CRD42021256694.

Filtering facepiece respirators (FFRs) were introduced to protect the wearer by removing small particles from inspired air. FFRs are now also used to reduce the spread of transmissible agents from the wearer and are worn outside traditional healthcare and other workplaces. The COVID-19 pandemic increased concerns about potential adverse effects on wearers. A PUBMED query retrieved articles through June 2022. Abstracts and selected full-text articles were systematically reviewed by the authors. This article focuses upon cardiopulmonary physiologic effects (e.g., ventilation, CO2 elimination, oxygen uptake, and respiratory control) with emphasis upon current and potential research methods as well as summarizing results. 1985 records were identified, of which only 26% were published before 2020. FFR effects on CO2 elimination appear more likely to be significant than effects on oxygenation or cardiovascular function. While FFRs appear well tolerated by healthy persons, more research is needed for those with pulmonary or cardiac disorders, and for children. Many traditional pulmonary exercise study methods require special care when applied to filtering facepiece respirators. Studying additional parameters may explain the paradox of many subjective discomfort reports despite very limited physiologic effects.

In early 2020, newborns were separated from their mothers who were diagnosed with COVID-19 infection. The purpose of this literature review is to examine the current evidence to determine if the transmission of COVID-19 infection to the neonate increases if newborns are directly breastfed by mothers who are positive for COVID-19 infection. There were 28 studies conducted in seven countries, with 10 of those studies conducted in the United States. In total, 5,123 neonates were born to mothers diagnosed with COVID-19, with 3,872 neonates determined to have been breastfed or provided mixed feeding including breast milk. Overall, 2.35% (91/3,872) of the newborns tested positive, and all recovered from COVID-19 infection. As frontline health care providers, nurses are instrumental in offering support and education on the risks and benefits of breastfeeding for individuals diagnosed with COVID-19.