This is the first systematic review on the efficacy of N95 respirators versus surgical masks among HCWs accounting for possible bias derived from cluster trials and evaluating the findings from a public health policy perspective. We found evidence that N95 respirators halve the risk of any respiratory infection compared to surgical masks. Considering that the absenteeism from work due to healthcare related infections hampers heavily the resilience of healthcare systems facing an infectious pandemic, the protective effect of N95 respirators for this primary outcome could produce large benefits in the current context. Furthermore, the immediate implementation of the intervention, rather than deferring it until more studies will be available, seems justified on a sound quantitative basis. The evidence from the current study could be used to inform the production of trustworthy GRADE based guidelines for the prevention of SARS-CoV-2 infection among HCWs.

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