Patients would not accept a surgeon who doesn't wear a mask because they are so ingrained as a symbol of a safe surgical environment, Bartlett said. And since the masks are fairly inexpensive and easy to wear, it hasn't been worth challenging the status quo, he declared.
Nor are there likely to be more studies to decide the issue one way or the other, added Rupp. So the impact of wearing a surgical mask is difficult to demonstrate," he said. Unlike the operating room, where it would be impossible to stop people from wearing masks, there are few places outside the hospital where it hasn't been hard to persuade people to put them on. One of the exceptions is Asia, which has developed has a strong culture of mask use, both in medical settings and in public venues, largely as a result of the SARS epidemic in , Bartlett said.
The CDC recommends that people who are ill with suspected or confirmed H1N1 flu wear face masks when at home around family members, in healthcare settings, at school until they can be taken home, and when it's necessary for them to be out and about. However, the only high-level evidence for efficacy of masks in the community was a trial from Hong Kong -- published online last month in the Annals of Internal Medicine -- involving flu patients who were randomized to hand hygiene alone or in combination with surgical masks.
Compared with controls, employing hand hygiene alone or with face masks tended to reduce transmission of the flu to those living in the same house, but not significantly so. Although the entire benefit can't be attributed to face masks, the results suggest masks may make a difference, MacIntyre said. Because exposure to pathogens is typically much lower for the general public than for healthcare workers, "surgical masks may be enough in the community," she said.
Rupp agreed, saying he takes a "better safe than sorry" approach. His medical center asks patients with potentially droplet-mediated infections to put on a surgical mask. N95 masks would likely provide even more protection, MacIntyre said, but there's is fairly clear consensus that they would be intolerable for someone with a respiratory illness.
Practical issues such as compliance and supply have been part of the argument for use of surgical masks rather than N95 respirators in most clinical settings. In a New England Journal of Medicine perspective piece last week, several IOM committee members acknowledged that N95 respirators are currently in short supply.
They suggested that healthcare institutions place priority on N95 respirators in the highest-risk areas, "such as enclosed spaces in the respiratory care unit, patients' rooms, and ambulances.
While the IOM was instructed to not take these issues into consideration in its guidelines, a CDC spokesperson said that agency is making them a large factor in revision of its interim guidelines for healthcare worker respiratory protection.
Debate over the role of respiratory protection in preventing influenza transmission doesn't "excuse anyone from failing to implement other measures that are known to protect patients and healthcare professionals from influenza," Srinivasan's JAMA editorial concluded.
Get Permissions. View large Download slide. Lipp A, Edwards P: Disposable surgical face masks for preventing surgical wound infection in clean surgery. Tunevall TG: Postoperative wound infections and surgical face masks: A controlled study. World J Surg ; —8. View Metrics. Citing articles via Web Of Science 5. Uptake of Halothane by the Human Body.
Email alerts Article Activity Alert. Online First Alert. Anesthesiology Featured Articles Alert. Social Media Twitter. Anesthesiology ASA Monitor. Close Modal. The findings from this review cannot be generalised for several reasons: the studies included only looked at clean surgery, some of the studies did not specify what type of face mask was used and one of the studies did not involve many participants therefore making the findings less credible.
The quality of the studies we found was low overall. The way in which participants were selected for the studies was not always completely random, which means the authors' judgements could have influenced the results.
More research in this field is needed before making further conclusions about the use of face masks in surgery. From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery. Surgical face masks were originally developed to contain and filter droplets containing microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient.
However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound, e.
To determine whether the wearing of disposable surgical face masks by the surgical team during clean surgery reduces postoperative surgical wound infection. We also searched the bibliographies of all retrieved and relevant publications. There were no restrictions with respect to language, date of publication or study setting.
Randomised controlled trials RCTs and quasi-randomised controlled trials comparing the use of disposable surgical masks with the use of no mask. We included three trials, involving a total of participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials.
We identified no new trials for this latest update. Background Surgeons and nurses performing clean surgery wear disposable face masks.
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