An estimated 500,000 health care workers are exposed to electrosurgical, or laser smoke, annually1, also subjecting them to the toxic gases, vapors, bioaerosols and viruses that have been found within it.
Considering the hazards of surgical smoke, it is hard to ignore the importance of wearing proper facial protection. While there are no mandatory regulations in the U.S. requiring that surgical smoke be evacuated from operating rooms, there are control measures designed to reduce the inhalation of aerosols and particulate released into the air from surgical smoke.
Surgical masks are among those protection mechanisms. However, with an abundance of mask choices, clinicians need to understand how to select masks that provide the protection they need. Equally as important, they need to understand that an improper fit can actually compromise protection from the hazards of the OR.
Historically, health care workers have selected masks based on comfort. Other times, the choice has resulted from knowing which masks fog glasses or shields the least. It’s not unusual for clinicians to consider both comfort and performance factors before considering the level of protection a mask provides as they select their personal protective equipment.
As knowledge of the dangers of surgical smoke increases, the thinking around face masks has begun to change. Indeed, many health care workers are beginning to wear masks not only to protect themselves against blood and other potentially infectious materials but also to protect themselves from the dangers of surgical smoke in the operating room.
Before clinicians select a mask to protect against surgical smoke, it is important for them to understand the concept of Particulate Filtration Efficiency (PFE). PFE measures the ability of the mask’s materials to filter harmful particles, such as those found in surgical smoke.
PFE is expressed as the percentage of particulate that does not pass through the mask’s layers at a fixed aerosol flow rate. For instance, if a mask stops 95 percent of particles 0.1 microns in size or larger, the mask is given a PFE score of 95 percent at 0.1 micron.
According to the ASTM F2100 standards, a mask must receive a PFE score of 98 percent, 0.1 micron to be considered a high barrier mask2. In other words, for a mask to be considered high-barrier, it must filter out at least 98 percent of particles that are 0.1 microns in size or larger.
According to the Association of periOperative Registered Nurses (AORN), personnel working in the laser environment should avoid exposure to smoke plume generated during laser surgery. Furthermore, AORN advises that health care practitioners participating in these procedures should wear surgical masks designed to filter smoke plume3. Clearly it’s important to make sure that facial protection is able to filter the smallest particles found in surgical smoke.
Surgical smoke varies in size, with the smallest particles generated by electrocautery. These particles range in size between 0.1 and 1.0 microns. When choosing a mask for use during procedures that may generate smoke plume, clinicians should use a mask that filters at least 99 percent of particles 0.1 microns in size or larger (99 percent, 0.1 micron).
Though some masks may be labeled more precisely as “Laser Mask,” it is likely that many of the other masks that are available filter particles at this level. Users should be sure to check the fine print on the box.
Many manufacturers of facial protection products include testing scores on their packaging. If the information is not included, clinicians can contact a representative of the company and request the testing data in order to determine if protection levels are adequate for an environment with surgical smoke.
Though wearing a high barrier mask is an important step in protecting oneself from surgical smoke, the way clinicians wear their masks is an important consideration as well. Too often, health care workers sacrifice correct fit for comfort.
Often, health care workers tie masks loosely, leaving large gaps between the mask and the surface of the face, typically in an attempt to increase comfort. Clinicians should seek a secure fit for masks to ensure proper filtration, especially during procedures that generate surgical smoke. Masks that are improperly tied allow for large gaps around the sides or bottom of the mask, which presents opportunity for surgical smoke to enter the chamber of the mask without passing through the filtering layers.
To ensure the mask fits properly, the wearer should tie the top set of ties at the crown of the head and the lower set of ties around the back of the neck. The nose wire should be formed across the bridge of the nose. The mask should fit underneath the mouth and conform to the shape of the cheekbones. A proper fit will ensure there are no gaps around the edges that would allow dispersion or entry of microbes4.
Concerns about surgical smoke make it especially apparent that there is more to choosing a mask than selecting one that feels comfortable. Though comfort is an important consideration, the most critical consideration should be the level of protection the mask provides.
Today, most surgical masks use a traditional 4-tie structure that is easy to wear incorrectly. Although typical masks work if worn correctly, future mask designs should incorporate new ways to secure the mask to the face. Until manufactures improve on mask design, clinicians should consider tying their masks in a way that improves fit, rather than comfort.
1 OSHA. OSHA’s 30th anniversary. OSHA at 30: three decades of progress in occupational safety and health. Available at: http://www.osha.gov/as/opa/psha-at-30.html. Accessed Sept. 14, 2009.
2 ASTM. ASTM F2100-04 Standard Specification for Performance of Materials Used in Medical Face Masks. West Conshohocken, PAA; ASTM International; 2004.
3 AORN. Recommended practices for laser safety in practice settings Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2009; 367-372.
4 AORN. Recommended practices for surgical attire. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2009; 299-305
Scott Harrison is a product manager at Cardinal Health, where he concentrates on making it easier for clinicians to choose the right mask for the right procedure. The Cardinal Health portfolio of surgical masks provides product lines that maintain comfort and breathability without sacrificing protection. Clinicians interested in CE programs to help their teams select the right masks should visit www.cardinalhealth.com/education/ce