Surgical Mask

The issue of infection control in the hospital is an everyday concern for all members
of the healthcare team and patients. In the surgical setting, surgeons, anesthetists,
nurses, and infection control practitioners have informed opinions and subjective
beliefs about causes and prevention of infection. What should be done to eliminate or
at least reduce the causative agents of infection is a concern for all.

Historically, surgical attire and the ritual of gloving, gowning and donning of masks
date back to the 1860s. It is known that live microorganisms are shed from the hair,
exposed skin and mucus membranes. Based on studies done in Great Britain by
Tuneval, it was concluded that the use of surgical masks during operations does not
influence the number of potential pathogenic bacteria in the air close to the operative
site and questioned the value of using surgical masks.1 Although there is no evidence
to suggest that masks are not necessary to decrease wound infections, the use of
surgical masks in protecting the surgical team from contaminated contacts is an
important principle to consider. The protection of the health care professional, as
well as the patient, has more recently become an issue of infection control and is
becoming more complex. Some of the issues related to the real need to wear a
surgical mask in the operating room (OR) are controlled by regulatory requirements.2

1. Bacterial Filtration Efficiency: Determines the bacterial filtration efficiency as

directed in Test Method F 2101.

2. Differential Pressure: Determines breathing resistance or differential pressure as

specified by a test method that provides a measurement of pressure per unit area of
material specimen tested.

3. Sub-Micron Particulate Filtration: Determines particulate filtration efficiency as

directed in Test method F 1215.

4. Resistance to Penetration by Synthetic Blood: Determines synthetic blood

penetration resistance as specified in Test Method F 1862.

5. Flammability: Determines flammability as specified in 16 CFR Part 1610.4.4

Recommendations

Healthcare professionals should wear a mask and eye protection or a face shield to
protect mucous membranes of the eyes, nose and mouth during procedures and
patient-care activities that are likely to generate splashes or sprays of blood, body
fluids, secretions or excretions.

Masks can be found in various shapes with different features and are selected by
personal protection need and personal preference of style and fit. Flat-fold tie-on,
duck bill, cone shaped, flat-fold with shields, and duckbill with shields are the most
common styles worn in the operating room. High fluid resistant earloop masks that
can be worn by circulating nurses in the OR are also available.

Masks are effective only if worn properly. Masks reduce the passage of bacterial
particles from the wearer into the environment and help protect the wearer from
blood and body fluid splash or spatter. Masks should be comfortable and cover both
the nose and mouth completely. A face shield or protective eyewear should be worn
by staff within the sterile field. The fit should assure that there is no tenting at the
sides of the mouth that would allow dispersion or entry of microbes. A small pliable
strip at the nose area should promote a close fit. Masks should be changed frequently
and anytime they become wet. When removing the mask, handle only by the strings
and promptly discard it into a waste receptacle. It is not uncommon to see masks
poorly fitted, placed below the nose, or wet with blood or body fluids. A mask should
never be allowed to hang or dangle around the neck, nor should it be folded and
placed in a pocket for later use; masks should be either on or off.
Medical gloves
are disposable gloves used during medical examinations and procedures to help
prevent cross-contamination between caregivers and patients.[1] Medical gloves are
made of different polymers including latex, nitrile rubber, polyvinyl
chloride and neoprene; they come unpowdered, or powdered with cornstarch to
lubricate the gloves, making them easier to put on the hands.[2]
Cornstarch replaced tissue-irritating Lycopodium powder and talc, but even
cornstarch can impede healing if it gets into tissues (as during surgery). As such,
unpowdered gloves are used more often during surgery and other sensitive
procedures. Special manufacturing processes are used to compensate for the lack of
powder.
There are two main types of medical gloves: examination and surgical. Surgical
gloves have more precise sizing with a better precision and sensitivity and are made
to a higher standard. Examination gloves are available as either sterile or non-sterile,
while surgical gloves are generally sterile.