This 2-arm cluster randomized trial tested whether portable HEPA filters (communal areas + bedrooms) reduced respiratory infection rates in older adults in English care homes over one winter season (September 2021–May 2024), compared to usual infection prevention measures alone.
No significant difference in respiratory infections per winter: 0.99 (intervention) vs 1.04 (control) episodes per bedroom resident (adjusted IRR 0.92; 95% CI 0.64–1.33; P = .67). Staff absenteeism was also unchanged (adjusted IRR 0.80; 95% CI 0.55–1.16; P = .24).
- Each care home participated for only one winter, limiting generalizability across seasons and pathogen variation. - The trial may have been underpowered to detect small but clinically meaningful effect sizes given the wide confidence intervals. - Infection ascertainment relied on care home reporting, which may introduce misclassification.
HEPA filters in care home communal areas and bedrooms did not reduce resident respiratory infections compared to standard precautions. Care homes should not substitute or supplement current recommended infection control measures with HEPA filters based on this evidence.
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