The Respiratory Protection Effectiveness Clinical Trial (ResPECT)

• ClinicalTrials.gov Identifier: NCT01249625
• Recruitment Status: Completed
• First Posted: November 30, 2010
• Results First Posted: April 25, 2019
• Last Update Posted: April 25, 2019
• Sponsor: Johns Hopkins University
• Collaborators: Centers for Disease Control and Prevention; US Department of Veterans Affairs; University of Massachusetts, Amherst; Denver Health and Hospital Authority; Children's Hospital Colorado; VA Eastern Colorado Health Care System; VA New York Harbor Healthcare System; Michael E. DeBakey VA Medical Center; Washington D.C. Veterans Affairs Medical Center; VA St. Louis Health Care System
• Information provided by (Responsible Party): Johns Hopkins University

• Study Type: Interventional
• Study Design: Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: Double (Investigator, Outcomes Assessor); Primary Purpose: Prevention
• Conditions: Influenza; Respiratory Syncytial Viruses; Paramyxoviridae Infections; Coronavirus; Rhinovirus
• Interventions: Device: N95 Respirator; Device: Medical/surgical mask
• Enrollment: 2862

Participant Flow

Recruitment Details	participants were recruited from outpatient settings considered at high risk for respiratory illnesses (emergency rooms, internal medicine and pediatric clinics) and had to work at least 24 hours per week in a given setting. They had to have face to face exposure to patients and be willing and able to participate, sign informed consent.
Pre-assignment Details

Arm/Group Title	N95 Respirator	Medical/Surgical Mask
Arm/Group Description	The investigators are comparing the selected N95 respirators against the selected medical mask. N95 Respirator: Participants in this arm will be asked to wear an N95 respirator for the extent of the 12 week study period.	The investigators are comparing the selected medical/surgical mask against the N95 respirator. Medical/surgical mask: Participants in this arm will be asked to wear a medical/surgical mask for the extent of the 12 week study period.
Period Title: Overall Study
Started	1374	1488
Completed	1374	1488
Not Completed	0	0

Baseline Characteristics

Arm/Group Title		N95 Respirator	Medical/Surgical Mask	Total
Arm/Group Description		The investigators are comparing the selected N95 respirators against the selected medical mask. N95 Respirator: Participants in this arm will be asked to wear an N95 respirator for the extent of the 12 week study period.	The investigators are comparing the selected medical/surgical mask against the N95 respirator. Medical/surgical mask: Participants in this arm will be asked to wear a medical/surgical mask for the extent of the 12 week study period.	Total of all reporting groups
Overall Number of Baseline Participants		1374	1488	2862
Baseline Analysis Population Description		[Not Specified]
Age, Categorical; Measure Type: Count of Participants; Unit of measure: Participants
	Number Analyzed	1374 participants	1488 participants	2862 participants
	<=18 years	0 0.0%	0 0.0%	0 0.0%
	Between 18 and 65 years	1347 98.0%	1451 97.5%	2798 97.8%
	>=65 years	27 2.0%	37 2.5%	64 2.2%
Age, Continuous; Mean (Standard Deviation); Unit of measure: Years
	Number Analyzed	1374 participants	1488 participants	2862 participants
		43 (0.6)	43 (0.5)	43 (0.55)
Sex: Female, Male; Measure Type: Count of Participants; Unit of measure: Participants
	Number Analyzed	1374 participants	1488 participants	2862 participants
	Female	1149 83.6%	1220 82.0%	2369 82.8%
	Male	225 16.4%	268 18.0%	493 17.2%
Ethnicity (NIH/OMB); Measure Type: Count of Participants; Unit of measure: Participants
	Number Analyzed	1374 participants	1488 participants	2862 participants
	Hispanic or Latino	212 15.4%	227 15.3%	439 15.3%
	Not Hispanic or Latino	1151 83.8%	1245 83.7%	2396 83.7%
	Unknown or Not Reported	11 0.8%	16 1.1%	27 0.9%
Race (NIH/OMB); Measure Type: Count of Participants; Unit of measure: Participants
	Number Analyzed	1374 participants	1488 participants	2862 participants
	American Indian or Alaska Native	9 0.7%	7 0.5%	16 0.6%
	Asian	103 7.5%	108 7.3%	211 7.4%
	Native Hawaiian or Other Pacific Islander	2 0.1%	6 0.4%	8 0.3%
	Black or African American	371 27.0%	431 29.0%	802 28.0%
	White	731 53.2%	761 51.1%	1492 52.1%
	More than one race	50 3.6%	57 3.8%	107 3.7%
	Unknown or Not Reported	108 7.9%	118 7.9%	226 7.9%
Region of Enrollment; Measure Type: Count of Participants; Unit of measure: Participants
United States	Number Analyzed	1374 participants	1488 participants	2862 participants
		1374 100.0%	1488 100.0%	2862 100.0%

Outcome Measures

1. Primary Outcome

Title	Protective Effects of N95 Respirators vs Medical Masks (MM) as Assessed by Number of Influenza A and B Events
Description	Number of influenza A and B events in healthcare practitioners wearing N95 respirators compared to medical masks.
Time Frame	60 weeks

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	N95 Respirator	Medical/Surgical Mask
Arm/Group Description:	The investigators are comparing the selected N95 respirators against the selected medical mask. N95 Respirator: Participants in this arm will be asked to wear an N95 respirator for the extent of the 12 week study period.	The investigators are comparing the selected medical/surgical mask against the N95 respirator. Medical/surgical mask: Participants in this arm will be asked to wear a medical/surgical mask for the extent of the 12 week study period.
Overall Number of Participants Analyzed	1374	1488
Measure Type: Number; Unit of Measure: number of influenza A and B events
	222	204

2. Secondary Outcome

Title	Protective Effects of N95 Respirators vs Medical Masks as Assessed by Number of Influenza-like Illnesses
Description	Number of influenza-like illnesses in healthcare practitioners wearing N95 respirators compared to medical masks.
Time Frame	60 weeks

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	N95 Respirator	Medical/Surgical Mask
Arm/Group Description:	The investigators are comparing the selected N95 respirators against the selected medical mask. N95 Respirator: Participants in this arm will be asked to wear an N95 respirator for the extent of the 12 week study period.	The investigators are comparing the selected medical/surgical mask against the N95 respirator. Medical/surgical mask: Participants in this arm will be asked to wear a medical/surgical mask for the extent of the 12 week study period.
Overall Number of Participants Analyzed	1374	1488
Measure Type: Number; Unit of Measure: number of influenza-like illnesses
	128	166

3. Secondary Outcome

Title	Protective Effects of N95 Respirators vs Medical Masks as Assessed by Number of Lab Confirmed Respiratory Illnesses
Description	Number of lab confirmed respiratory illnesses in healthcare practitioners wearing N95 respirators compared to medical masks.
Time Frame	60 weeks

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	N95 Respirator	Medical/Surgical Mask
Arm/Group Description:	The investigators are comparing the selected N95 respirators against the selected medical mask. N95 Respirator: Participants in this arm will be asked to wear an N95 respirator for the extent of the 12 week study period.	The investigators are comparing the selected medical/surgical mask against the N95 respirator. Medical/surgical mask: Participants in this arm will be asked to wear a medical/surgical mask for the extent of the 12 week study period.
Overall Number of Participants Analyzed	1374	1488
Measure Type: Number; Unit of Measure: number of respiratory illnesses
	371	417

4. Secondary Outcome

Title	Protective Effects of N95 Respirators vs Medical Masks as Assessed by Number of Lab Detected Respiratory Infections
Description	Number of lab detected respiratory infections in healthcare practitioners wearing N95 respirators compared to medical masks.
Time Frame	60 weeks

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	N95 Respirator	Medical/Surgical Mask
Arm/Group Description:	The investigators are comparing the selected N95 respirators against the selected medical mask. N95 Respirator: Participants in this arm will be asked to wear an N95 respirator for the extent of the 12 week study period.	The investigators are comparing the selected medical/surgical mask against the N95 respirator. Medical/surgical mask: Participants in this arm will be asked to wear a medical/surgical mask for the extent of the 12 week study period.
Overall Number of Participants Analyzed	1374	1488
Measure Type: Number; Unit of Measure: number of respiratory infections
	679	745

5. Secondary Outcome

Title	Protective Effects of N95 Respirators vs Medical Masks as Assessed by Number of Acute Respiratory Illnesses
Description	Number of acute respiratory illnesses in healthcare practitioners wearing N95 respirators compared to medical masks.
Time Frame	60 weeks

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	N95 Respirator	Medical/Surgical Mask
Arm/Group Description:	The investigators are comparing the selected N95 respirators against the selected medical mask. N95 Respirator: Participants in this arm will be asked to wear an N95 respirator for the extent of the 12 week study period.	The investigators are comparing the selected medical/surgical mask against the N95 respirator. Medical/surgical mask: Participants in this arm will be asked to wear a medical/surgical mask for the extent of the 12 week study period.
Overall Number of Participants Analyzed	1374	1488
Measure Type: Number; Unit of Measure: number of acute respiratory illnesses
	1556	1711

6. Secondary Outcome

Title	Protective Effects of N95 Respirators vs Medical Masks as Assessed by Number of Laboratory Confirmed Illness
Description	Number of laboratory confirmed influenza illnesses in healthcare practitioners wearing N95 respirators compared to medical masks.
Time Frame	60 weeks

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	N95 Respirator	Medical/Surgical Mask
Arm/Group Description:	The investigators are comparing the selected N95 respirators against the selected medical mask. N95 Respirator: Participants in this arm will be asked to wear an N95 respirator for the extent of the 12 week study period.	The investigators are comparing the selected medical/surgical mask against the N95 respirator. Medical/surgical mask: Participants in this arm will be asked to wear a medical/surgical mask for the extent of the 12 week study period.
Overall Number of Participants Analyzed	1374	1488
Measure Type: Number; Unit of Measure: Number of laboratory confirmed illnesses
	207	193

Adverse Events

Time Frame	We collected adverse events (AEs) for each 12-week respiratory season (total of 4 seasons) while participants were actively wearing masks or respirators.
Adverse Event Reporting Description	An AE is any adverse change from patient's baseline (pre-study) condition, which occurs during the course of the study, whether the event is considered to be related to the study intervention or not and documented in REDCap. Researchers assessed if the reported event meets the definition of an AE. Patients will be monitored until resolution. AEs were submitted to local Institutional Review Board according to their reporting policy. Participants reported symptoms in daily and weekly diaries.
Arm/Group Title	N95 Respirator		Medical/Surgical Mask
Arm/Group Description	The investigators are comparing specific N95 respirator against specific medical masks. Participants in this arm will be asked to wear an N95 respirator for the extent of the 12 week study period.		The investigators are comparing medical/surgical masks against the N95 respirator. Participants in this arm will be asked to wear a medical/surgical mask for the extent of the 12 week study period.
All-Cause Mortality
	N95 Respirator		Medical/Surgical Mask
	Affected / at Risk (%)		Affected / at Risk (%)
Total	0/1374 (0.00%)		0/1488 (0.00%)
Serious Adverse Events
	N95 Respirator		Medical/Surgical Mask
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/1374 (0.00%)		0/1488 (0.00%)
Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events	0%
	N95 Respirator		Medical/Surgical Mask
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	19/1374 (1.38%)		0/1488 (0.00%)
Skin and subcutaneous tissue disorders
rash † [1]	19/1374 (1.38%)	19	0/1488 (0.00%)	0
† Indicates events were collected by systematic assessment; [1] skin irritation and worsening acne reported -- all events reported at one site in one respiratory virus season

Limitations and Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

Results Point of Contact

• Name/Title: Dr. Trish Perl
• Organization: University of Texas Southwestern
• Phone: 214-648-9022
• EMail: Trish.Perl@UTSouthwestern.edu

Publications:

Anzueto A, Niederman MS. Diagnosis and treatment of rhinovirus respiratory infections. Chest. 2003 May;123(5):1664-72. doi: 10.1378/chest.123.5.1664.

Askarian M, Mirzaei K, Honarvar B, Etminan M, Araujo MW. Knowledge, attitude and practice towards droplet and airborne isolation precautions among dental health care professionals in Shiraz, Iran. J Public Health Dent. 2005 Winter;65(1):43-7. doi: 10.1111/j.1752-7325.2005.tb02785.x.

Askarian M, Mirzaei K, Mundy LM, McLaws ML. Assessment of knowledge, attitudes, and practices regarding isolation precautions among Iranian healthcare workers. Infect Control Hosp Epidemiol. 2005 Jan;26(1):105-8. doi: 10.1086/502495.

Bettinardi O, Argentero P, Giorgi I. [Assessment of occupational stress among workers in rehabilitation medicine]. G Ital Med Lav Ergon. 2007 Jul-Sep;29(3 Suppl):693-5. Italian.

Blachere FM, Lindsley WG, Pearce TA, Anderson SE, Fisher M, Khakoo R, Meade BJ, Lander O, Davis S, Thewlis RE, Celik I, Chen BT, Beezhold DH. Measurement of airborne influenza virus in a hospital emergency department. Clin Infect Dis. 2009 Feb 15;48(4):438-40. doi: 10.1086/596478.

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Brankston G, Gitterman L, Hirji Z, Lemieux C, Gardam M. Transmission of influenza A in human beings. Lancet Infect Dis. 2007 Apr;7(4):257-65. doi: 10.1016/S1473-3099(07)70029-4.

Bridges CB, Kuehnert MJ, Hall CB. Transmission of influenza: implications for control in health care settings. Clin Infect Dis. 2003 Oct 15;37(8):1094-101. doi: 10.1086/378292. Epub 2003 Sep 19.

Burke JP. Infection control - a problem for patient safety. N Engl J Med. 2003 Feb 13;348(7):651-6. doi: 10.1056/NEJMhpr020557. No abstract available.

Cadena J, Thompson GR 3rd, Patterson JE, Nakashima B, Owens A, Echevarria K, Mortensen EM. Clinical predictors and risk factors for relapsing Clostridium difficile infection. Am J Med Sci. 2010 Apr;339(4):350-5. doi: 10.1097/MAJ.0b013e3181d3cdaa.

Chia SE, Koh D, Fones C, Qian F, Ng V, Tan BH, Wong KS, Chew WM, Tang HK, Ng W, Muttakin Z, Emmanuel S, Fong NP, Koh G, Lim MK. Appropriate use of personal protective equipment among healthcare workers in public sector hospitals and primary healthcare polyclinics during the SARS outbreak in Singapore. Occup Environ Med. 2005 Jul;62(7):473-7. doi: 10.1136/oem.2004.015024.

Chor JS, Ngai KL, Goggins WB, Wong MC, Wong SY, Lee N, Leung TF, Rainer TH, Griffiths S, Chan PK. Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys. BMJ. 2009 Aug 25;339:b3391. doi: 10.1136/bmj.b3391.

Christini AB, Shutt KA, Byers KE. Influenza vaccination rates and motivators among healthcare worker groups. Infect Control Hosp Epidemiol. 2007 Feb;28(2):171-7. doi: 10.1086/511796. Epub 2007 Jan 17.

Daley P, Castriciano S, Chernesky M, Smieja M. Comparison of flocked and rayon swabs for collection of respiratory epithelial cells from uninfected volunteers and symptomatic patients. J Clin Microbiol. 2006 Jun;44(6):2265-7. doi: 10.1128/JCM.02055-05.

Daugherty EL, Perl TM, Needham DM, Rubinson L, Bilderback A, Rand CS. The use of personal protective equipment for control of influenza among critical care clinicians: A survey study. Crit Care Med. 2009 Apr;37(4):1210-6. doi: 10.1097/CCM.0b013e31819d67b5.

Daugherty EL, Perl TM, Rubinson L, Bilderback A, Rand CS. Survey study of the knowledge, attitudes, and expected behaviors of critical care clinicians regarding an influenza pandemic. Infect Control Hosp Epidemiol. 2009 Dec;30(12):1143-9. doi: 10.1086/648085.

de Gentile A, Rivas N, Sinkowitz-Cochran RL, Momesso T, Iriart EM, Lopez E, Beck-Sague CM, Jarvis WR. Nosocomial infections in a children's hospital in Argentina: impact of a unique infection control intervention program. Infect Control Hosp Epidemiol. 2001 Dec;22(12):762-6. doi: 10.1086/501859.

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Dudukgian H, Sie E, Gonzalez-Ruiz C, Etzioni DA, Kaiser AM. C. difficile colitis--predictors of fatal outcome. J Gastrointest Surg. 2010 Feb;14(2):315-22. doi: 10.1007/s11605-009-1093-2.

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Fendrick AM, Monto AS, Nightengale B, Sarnes M. The economic burden of non-influenza-related viral respiratory tract infection in the United States. Arch Intern Med. 2003 Feb 24;163(4):487-94. doi: 10.1001/archinte.163.4.487.

Ferguson NM, Cummings DA, Fraser C, Cajka JC, Cooley PC, Burke DS. Strategies for mitigating an influenza pandemic. Nature. 2006 Jul 27;442(7101):448-52. doi: 10.1038/nature04795. Epub 2006 Apr 26.

Fisher E, Rengasamy S, Viscusi D, Vo E, Shaffer R. Development of a test system to apply virus-containing particles to filtering facepiece respirators for the evaluation of decontamination procedures. Appl Environ Microbiol. 2009 Mar;75(6):1500-7. doi: 10.1128/AEM.01653-08. Epub 2009 Jan 9.

Gammon J, Morgan-Samuel H, Gould D. A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions. J Clin Nurs. 2008 Jan;17(2):157-67. doi: 10.1111/j.1365-2702.2006.01852.x. Epub 2007 Mar 1.

Gershon RR, Karkashian CD, Vlahov D, Kummer L, Kasting C, Green-McKenzie J, Escamilla-Cejudo JA, Kendig N, Swetz A, Martin L. Compliance with universal precautions in correctional health care facilities. J Occup Environ Med. 1999 Mar;41(3):181-9. doi: 10.1097/00043764-199903000-00007.

Ginocchio CC. Detection of respiratory viruses using non-molecular based methods. J Clin Virol. 2007 Nov;40 Suppl 1:S11-4. doi: 10.1016/S1386-6532(07)70004-5.

Grinshpun SA, Haruta H, Eninger RM, Reponen T, McKay RT, Lee SA. Performance of an N95 filtering facepiece particulate respirator and a surgical mask during human breathing: two pathways for particle penetration. J Occup Environ Hyg. 2009 Oct;6(10):593-603. doi: 10.1080/15459620903120086.

Jarvis WR. Infection control and changing health-care delivery systems. Emerg Infect Dis. 2001 Mar-Apr;7(2):170-3. doi: 10.3201/eid0702.010202.

Jefferson T, Foxlee R, Del Mar C, Dooley L, Ferroni E, Hewak B, Prabhala A, Nair S, Rivetti A. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ. 2008 Jan 12;336(7635):77-80. doi: 10.1136/bmj.39393.510347.BE. Epub 2007 Nov 27.

Johnson DF, Druce JD, Birch C, Grayson ML. A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. Clin Infect Dis. 2009 Jul 15;49(2):275-7. doi: 10.1086/600041.

Loeb M, Dafoe N, Mahony J, John M, Sarabia A, Glavin V, Webby R, Smieja M, Earn DJ, Chong S, Webb A, Walter SD. Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. JAMA. 2009 Nov 4;302(17):1865-71. doi: 10.1001/jama.2009.1466. Epub 2009 Oct 1.

Radonovich LJ Jr, Cheng J, Shenal BV, Hodgson M, Bender BS. Respirator tolerance in health care workers. JAMA. 2009 Jan 7;301(1):36-8. doi: 10.1001/jama.2008.894. No abstract available.

Radonovich LJ Jr, Hodgson MJ, Cohen HJ. Do respirators protect health-care workers from airborne infectious diseases? Respir Care. 2008 Dec;53(12):1660-4. No abstract available.

Radonovich LJ Jr, Perl TM, Davey V, Cohen H. Preventing the soldiers of health care from becoming victims on the pandemic battlefield: respirators or surgical masks as the armor of choice. Disaster Med Public Health Prep. 2009 Dec;3 Suppl 2:S203-10. doi: 10.1097/DMP.0b013e3181be830c.

Rengasamy S, Eimer BC, Shaffer RE. Comparison of nanoparticle filtration performance of NIOSH-approved and CE-marked particulate filtering facepiece respirators. Ann Occup Hyg. 2009 Mar;53(2):117-28. doi: 10.1093/annhyg/men086.

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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Los J, Gaydos CA, Gibert CL, Gorse GJ, Lykken J, Nyquist AC, Price CS, Radonovich LJ Jr, Rattigan S, Reich N, Rodriguez-Barradas M, Simberkoff M, Bessesen M, Brown A, Cummings DAT, Perl TM; ResPECT Study Team. Take-home kits to detect respiratory viruses among healthcare personnel: Lessons learned from a cluster randomized clinical trial. Am J Infect Control. 2021 Jul;49(7):893-899. doi: 10.1016/j.ajic.2021.02.001. Epub 2021 Feb 10.

Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Jones MA, Thorning S, Beller EM, Clark J, Hoffmann TC, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2020 Nov 20;11(11):CD006207. doi: 10.1002/14651858.CD006207.pub5.

Cummings DAT, Radonovich LJ, Gorse GJ, Gaydos CA, Bessesen MT, Brown AC, Gibert CL, Hitchings MDT, Lessler J, Nyquist AC, Rattigan SM, Rodriguez-Barradas MC, Price CS, Reich NG, Simberkoff MS, Perl TM. Risk Factors for Healthcare Personnel Infection With Endemic Coronaviruses (HKU1, OC43, NL63, 229E): Results from the Respiratory Protection Effectiveness Clinical Trial (ResPECT). Clin Infect Dis. 2021 Dec 6;73(11):e4428-e4432. doi: 10.1093/cid/ciaa900.

Radonovich LJ Jr, Simberkoff MS, Bessesen MT, Brown AC, Cummings DAT, Gaydos CA, Los JG, Krosche AE, Gibert CL, Gorse GJ, Nyquist AC, Reich NG, Rodriguez-Barradas MC, Price CS, Perl TM; ResPECT investigators. N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial. JAMA. 2019 Sep 3;322(9):824-833. doi: 10.1001/jama.2019.11645.

Lauer SA, Kleinman KP, Reich NG. The effect of cluster size variability on statistical power in cluster-randomized trials. PLoS One. 2015 Apr 1;10(4):e0119074. doi: 10.1371/journal.pone.0119074. eCollection 2015.

Reich NG, Myers JA, Obeng D, Milstone AM, Perl TM. Empirical power and sample size calculations for cluster-randomized and cluster-randomized crossover studies. PLoS One. 2012;7(4):e35564. doi: 10.1371/journal.pone.0035564. Epub 2012 Apr 27.

• Responsible Party: Johns Hopkins University
• ClinicalTrials.gov Identifier: NCT01249625
• Other Study ID Numbers: NA_00031266
• First Submitted: November 29, 2010
• First Posted: November 30, 2010
• Results First Submitted: April 3, 2019
• Results First Posted: April 25, 2019
• Last Update Posted: April 25, 2019