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The use of appropriate theatre attire has always been vital for providing effective

barriers that prevent the dissemination of microorganisms to patients and protect

personnel from blood and body substances of patients. One of which is the use of

the surgical face mask. Mask is worn to contain and filter droplets containing

microorganisms expelled from the mouth and nasopharynx during breathing, talking,

sneezing and coughing (Phillips, 2007).

The things I have noticed when I started my work in this country is that surgical mask

is not used very often. I have observed some staffs, anaesthesiologist and operating

room department practitioners (ODP) not using it during some surgical procedures,

surgeons not wearing the mask when doing some minor surgeries or wound care,

and some nurses preparing their instruments for some EENT surgeries without the

mask on.

I have asked one of my colleagues why they are not challenge for not having the

mask and answered that there are some cases when the mask is not used in the

theatre. It has surprised me a lot because in our practice the use of surgical mask

inside the theatre has always been essential. As long as all the sterile pack or

instruments are open everyone are required to wear the mask regardless of what

procedure is ongoing. I feel very indifferent and really awkward because of the

opposing views in our practice.

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The effectiveness of the surgical mask use has always been questioned there are

couple of researches pertaining to the necessity of wearing a mask in the theatre.

According to Orr (1981) wearing of a mask is a standard practice that could be

abandoned because it has very little relevance to the wellbeing of patients

undergoing routine general surgery. The study lacks some scientific rigidness but it

posts a significant influence in the abandonment of wearing a mask during some

surgical procedure. In addition Mitchell and Hunt (1991) as cited by Radford et al.

(2004) suggested that it is unnecessary for a non-scrubbed staff to wear a faced

mask in an operating room with forced ventilation. The latest evidence was

supported by Webster et al. (2010) concluding that surgical site infection rates did

not increase when non-scrubbed operating room personnel did not wear a face

mask.

However, according to AORN recommendations on wearing of a mask in the

operating theatre as cited by Radford et al. (2004) that all persons entering the

operating theatre should wear a mask when there are open items or instruments.

They also suggest that although the risk of contamination is dependent to so many

variables which include the airflow of the area, personnel practices and other factors

they should still continue to wear a mask until definitive answers are provided.

There may be evidences that question the efficacy of using the mask in the theatre

by all members of the healthcare team but we must still observe the principles of

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infection control practice by wearing the proper theatre attire. It has always been a

standard for minimising the transmission of infection and development of post

surgical site infection. The patient is still the forefront of our duties as a nurse. We

should provide them with the highest standard of practice and care at all times

(Nursing & Midwifery Council, 2008).

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REFERENCE LIST

AORN (2002b) Recommended practices for surgical attire. In: Standards, Recommended Practices
and Guidelines. Denver: AORN, 255-260. Cited in Radford, M., County, B. and Oakley, M. (2004)
Advancing Perioperative Practice. Cheltenham. Nelson: Thornes Ltd.

Mitchell, N. & Hunt, S. (1991) Surgical face masks in modern operating rooms—a costly and
unnecessary ritual? Journal of Hospital Infection. 18 (3), 239-242. Cited in Radford, M., County, B.
and Oakley, M. (2004) Advancing Perioperative Practice. Cheltenham. Nelson: Thornes Ltd.

Nursing and Midwifery Council (2008). The Code in Full. Available from: http://www.nmc-
uk.org/Nurses-and-midwives/The-code/The-code-in-full/ [Accessed 11 October 2010]

Orr, N. (1981) Is a mask necessary in the operating theatre? Annals of the Royal College of Surgeons
of England. 63(6): 390–392. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2493
952/?page=1 [Accessed 06 October 2010]

Phillips, N. (2007) Berry and Kohn’s Operating Room Technique. 11th Edition. Missouri: Mosby
Elsevier.

Radford, M., County, B. and Oakley, M. (2004) Advancing Perioperative Practice. Cheltenham.
Nelson: Thornes Ltd.

Webster, J., Croger, S., Lister, C., Doidge, M., Terry, M. And Jones, I. (2010) Use of face masks by non-
scrubbed operating room staff: a randomnized controlled trial. ANZ Journal of Surgery. 80 (3), 169-
173. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1445-2197.2009.05200.x/full
[Accessed 06 October 2010]