***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Please cite this paper as : MacIntyre et al. ( 2011 ) A cluster r and omized clinical trial comparing fit‐tested and non‐fit‐tested  N95 respirators to medical masks to prevent respiratory virus infection in health care workers . Influenza and Other Respiratory Viruses DOI : 10.1111/j.1750‐2659.2010.00198.x . Background We compared the efficacy of medical masks , N95 respirators ( fit tested and non fit tested ) , in health care workers ( HCWs ) . Methods A cluster r and omized clinical trial ( RCT ) of 1441 HCWs in 15 Beijing hospitals was performed during the 2008/2009 winter . Participants wore masks or respirators  during the entire work shift for 4 weeks . Outcomes included clinical respiratory illness ( CRI ) , influenza‐like illness ( ILI ) , laboratory‐confirmed respiratory virus infection and influenza . A convenience no‐mask/respirator group of 481 health workers from nine hospitals was compared . Findings The rates of CRI ( 3·9 % versus 6·7 % ) , ILI ( 0·3 % versus 0·6 % ) , laboratory‐confirmed respiratory virus ( 1·4 % versus 2·6 % ) and influenza ( 0·3 % versus 1 % ) infection were consistently lower for the N95 group compared to medical masks . By intention‐to‐treat analysis , when P values were adjusted for clustering , non‐fit‐tested N95 respirators were significantly more protective than medical masks against CRI , but no other outcomes were significant . The rates of all outcomes were higher in the convenience no‐mask group compared to the intervention arms . There was no significant difference in outcomes between the N95 arms with and without fit testing . Rates of fit test failure were low . In a post hoc analysis adjusted for potential confounders , N95 masks and hospital level were significant , but medical masks , vaccination , h and washing and high‐risk procedures were not . Interpretation Rates of infection in the medical mask group were double that in the N95 group . A benefit of respirators is suggested but would need to be confirmed by a larger trial , as this study may have been underpowered . The finding on fit testing is specific to the type of respirator used in the study and can not be generalized to other respirators . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) , ACTRN : ACTRN12609000257268 ( http://www.anzctr.org.au ) BACKGROUND Certain emerging infections , such as severe acute respiratory syndrome and avian influenza , represent a great risk to healthcare workers ( HCWs ) . There are few data about the epidemiology of H1N1 influenza among HCWs . METHODS We conducted a prospect i ve surveillance study for all HCWs at King Abdulaziz Medical City ( Riyadh , Saudi Arabia ) who were confirmed positive for H1N1 influenza by polymerase chain reaction ( PCR ) from June 1 through November 30 , 2009 . RESULTS During 6 months of surveillance , 526 HCWs were confirmed positive for H1N1 influenza . The distribution of these cases showed 2 clear outbreaks : an initial outbreak ( peak at early August ) and a shorter second wave ( peak at end of October ) . Among all PCR-confirmed cases , the attack rate was significantly higher in clinical HCWs than in non clinical HCWs ( 6.0 % vs 4.3 % ; P < .001 ) and in HCWs in emergency departments than in HCWs in other hospital locations ( 17.4 % vs 5.0 % , P < .001 ) . The percentage of HCWs who received regular influenza vaccination  was greater for clinical HCWs than for non clinical HCWs ( 46.2 % vs 24.6 % ; P < .001 ) . The majority of HCWs with confirmed H1N1 influenza were young ( mean age + or - st and ard deviation , 34.5 + or - 9.5 years ) , not Saudi ( 58.4 % ) , female ( 55.1 % ) , and nurses ( 36.1 % ) . Approximately 4 % of women who were less than 50 years old were pregnant . Reported exposures included contact with a case ( 41.0 % ) , contact with a sick household member ( 23.8 % ) , and recent travel history ( 13.3 % ) . Respiratory symptoms ( 98.0 % ) , including cough ( 90.1 % ) , were the most frequently reported symptoms , followed by muscle aches ( 66.2 % ) , fever ( 62.5 % ) , headache ( 57.9 % ) , diarrhea ( 16.5 % ) , and vomiting ( 9.8 % ) . None of these HCWs died , and all recovered fully without hospital admission . CONCLUSIONS The results confirm the vulnerability of HCWs , whether clinical or non clinical , to emerging H1N1 influenza Abstract Purpose To explore factors relating to the practice of habitual and volitional health behaviors against the severe acute respiratory syndrome ( SARS ) among Chinese adolescents in Hong Kong . Methods A community telephone survey was conducted with 230 Chinese adolescents . R and om-digit dialing of the local residential telephone directory was used to select respondents , who were asked to provide information on their practice of SARS preventive health behaviors and associated factors as specified by the Health Belief Model . These factors included perceived threat of SARS , perceived benefits and barriers in practicing SARS preventive health behaviors , cues to action , knowledge of SARS , and self-efficacy . Hierarchical regression analyses were conducted to determine salient correlates of habitual and volitional health behaviors against SARS . Results About 54.8 % of respondents reported practicing all three recommended habitual health behaviors . Another 47.8 % indicated consistent practice of  volitional health behavior of facemask-wearing to prevent SARS . Results of hierarchical regression analyses showed that habitual health behaviors against SARS were related to perceived health threat and environmental cues . For facemask-wearing , salient correlates were environmental cues , rates of SARS habitual health behaviors , younger age , and perceived health threat . Conclusions The Health Belief Model is useful in underst and ing Chinese adolescents ’ practice of health behaviors , especially volitional health behaviors OBJECTIVE To evaluate healthcare worker ( HCW ) risk of self-contamination when donning and doffing personal protective equipment ( PPE ) using fluorescence and MS2 bacteriophage . DESIGN Prospect i ve pilot study . SETTING Tertiary-care hospital . PARTICIPANTS A total of 36 HCWs were included in this study : 18 donned/doffed contact pre caution ( CP ) PPE and 18 donned/doffed Ebola virus disease ( EVD ) PPE .  INTERVENTIONS HCWs donned PPE according to st and ard protocol s. Fluorescent liquid and MS2 bacteriophage were applied to HCWs . HCWs then doffed their PPE . After doffing , HCWs were scanned for fluorescence and swabbed for MS2 . MS2 detection was performed using reverse transcriptase PCR . The donning and doffing processes were videotaped , and protocol deviations were recorded . RESULTS Overall , 27 % of EVD PPE HCWs and 50 % of CP PPE HCWs made ≥1 protocol deviation while donning , and 100 % of EVD PPE HCWs and 67 % of CP PPE HCWs made ≥1 protocol deviation while doffing ( P=.02 ) . The median number of doffing protocol deviations among EVD PPE HCWs was 4 , versus 1 among CP PPE HCWs . Also , 15 EVD PPE protocol deviations were committed by doffing assistants and /or trained observers . Fluorescence was detected on 8 EVD PPE HCWs ( 44 % ) and 5 CP PPE HCWs ( 28 % ) , most commonly on h and s. MS2 was recovered from 2 EVD PPE HCWs ( 11 % ) and 3 CP PPE HCWs ( 17 % ) . CONCLUSIONS Protocol deviations were common during both EVD and CP PPE doffing , and some deviations during EVD PPE doffing were committed by the HCW doffing assistant and /or the trained observer . Self-contamination was common . PPE donning/doffing are complex and deserve additional study . Infect Control Hosp Epidemiol 2017;38:1077 - 1083 BACKGROUND Masks are often worn in healthcare setting s to prevent the spread of infection from healthcare workers ( HCWs ) to patients . Masks are also used to protect the employee from patient-generated infectious organisms but poor compliance can reduce efficacy . The aim of this study was to examine the factors influencing compliance with the use of medical and cloth masks  amongst hospital HCWs . METHODS HCWs compliance with the use of medical and cloth masks was measured over a 4-week period in a r and omized controlled trial in Vietnam . HCWs were instructed to record their daily activities in diary cards . Demographic , clinical , and diary card data were used to determine the predictors of compliance and the relationship of compliance with infection outcomes . RESULTS Compliance rates for both medical and cloth masks  decreased during the 4 weeks : medical mask use decreased from 77 to 68 % ( P < 0.001 ) and cloth masks from 78 to 69 % ( P < 0.001 ) . The presence of adverse events ( adjusted RR 0.90 , 95 % CI 0.85 - 0.95 ) , and performing aerosol-generating procedures ( adjusted RR 0.78 , 95 % CI 0.73 - 0.82 ) were negatively associated with compliance , while contact with febrile respiratory illness patients was positively associated ( adjusted RR 1.14 , 95 % CI 1.07 - 1.20 ) . Being compliant with medical or cloth masks use ( average use ≥70 % of working time ) was not associated with clinical respiratory illness , influenza-like illness , and laboratory-confirmed viral infection . CONCLUSION Underst and ing the factors that affect compliance is important for the occupational health and safety of HCWs . New strategies and tools should be developed to increase compliance of HCWs . The presence of adverse events such as discomfort and breathing problems may be the main reasons for the low compliance with mask use and further studies should be conducted to improve the design / material of masks to improve comfort for the wearer This study investigated provincial and territorial differences in dentists ' compliance with recommended infection control practice s in Canada ( 1995 ) .  Question naires were mailed to a stratified r and om sample of 6,444 dentists , of whom 66.4 % responded . Weighted analyses included Pearson 's chi-square test and multiple logistic regression . Significant provincial and territorial differences included testing for immune response after hepatitis B virus ( HBV ) vaccination , HBV vaccination for all clinical staff , use of infection control manuals and post-exposure protocol s , biological monitoring of heat sterilizers , h and washing before treating patients , using gloves and changing them after each patient , heat-sterilizing h and pieces between patients , and using masks and uniforms to protect against splatter of blood and saliva . Excellent compliance ( compliance with a combination of 18 recommended infection control procedures ) ranged from 0 % to 10 % ; the best predictors were more hours of continuing education on infection control in the last two years , practice location in larger cities ( > 500,000 ) and sex ( female ) . Clearly , improvements in infection control are desirable for dentists in all provinces and territories . Extending m and atory continuing education initiatives to include infection control may promote better compliance with current recommendations The nature of discomfort and level of exertion associated with wearing respiratory protection in the health care workplace are not well understood . Although a few studies have assessed these topics in a laboratory setting , little is known about the magnitude of discomfort and the level of exertion experienced by workers while they deliver health care to patients for prolonged periods . The purpose of this study was to determine the magnitude of discomfort and level of exertion experienced by health care workers while wearing respiratory protection for periods up to 8 hr when performing their typical occupational duties . This project was a multiple cross-over field trial of 27 health care workers , aged 24–65 , performing their typical , hospital-based occupational duties . Each participant served as his/her own control and wore one of seven respirators or a medical mask for 8 hr ( or as long as tolerable ) with interposed doffing periods every 2 hr . Self-perceived discomfort and exertion were quantified before each doffing : self-perceived level of discomfort using a visual analog scale , and self-perceived level of exertion using a Borg scale . Overall , and as would be expected , discomfort increased over time with continual respirator use over an 8-hr period . Interestingly , exertion increased only marginally over the same time period . The relatively low level of exertion associated with eight respiratory protective devices , including models commonly used in the U.S. health care workplace , is not likely to substantially influence workers ’ tolerability or occupational productivity . However , the magnitude of discomfort does appear to increase significantly over time with prolonged wear . These results suggest that respirator 
    Output:
    
The studies examined  PPE use in hospital ( n=7 ) , dental ( n=4 ) or laboratory ( n=2 ) setting s. Policies and practice s on PPE use were inconsistent .
Face masks and gloves were the most commonly used PPE to protect from respiratory and other infections .
PPE was not available in many facilities and its use was limited to high-risk situations .
Compliance with PPE use was low among healthcare workers , and reuse of PPE was reported .