Protection of health care workers and surgeons are of paramount importance during COVID-19 pandemic. COVID-19 virus has the potential to infect surgeons and other health care workers in the OR through aerosolised droplets during aerosol generating procedures like intubation, endoscopy, use of cautery, use of pneumoperitoenum and high speed drilling procedures.
According to NIOSH - N95 mask (respirators) has got the ability to protect up to 95% of test particles of size of 300nm.The disposable surgical mask may be effective up to 80%.
So is there a case for routine use of N95 mask during all surgery? Both routine and emergency and irrespective of COVID status of the patients. Are there any evidences?
Dear colleague, the question is very interesting. as far as I know there is no strong evidence but this very reason should push us to use the utmost caution....
Medical masks and N95 respirators offer similar protection against COVID-19 in healthcare workers.
Article Medical Masks vs N95 Respirators for Preventing COVID‐19 in ...
Dear Prof. Kaman!
I found the following research articles that shed a new perspective on this important question
1) Kenneth K. W. Li et al. (2020). FFP3, FFP2, N95, surgical masks and respirators: what should we be wearing for ophthalmic surgery in the COVID-19 pandemic? Editorial, Graefe's Archive for Clinical and Experimental Ophthalmology 26 May 2020, Open Access;
Article FFP3, FFP2, N95, surgical masks and respirators: what should...
2)Jennifer F. Ha (2020). The COVID‐19 pandemic, personal protective equipment and respirator: A narrative review, The International Journal of Clinical Practice Volume 74, Issue 10, October 2020, Open Access:
Article The COVID-19 pandemic, personal protective equipment and res...
3) Ming Hui Chua, et al. "Face Masks in the New COVID-19 Normal: Materials, Testing, and Perspectives", Research, vol. 2020, Article ID 7286735, Open Access:
https://spj.sciencemag.org/journals/research/2020/7286735/?fbclid=IwAR3qb600nGz1kEa61LIBYWrkfTHsICEBFdsjsJR9NJVkZJew7MKH5epo6EQ
Yours sincerely, Bulcsu Szekely
Since 15 years we use FPP3 or FPP2 and additional a chirurgical mask over it and we wear a shield. Patienten with halitosis are a good reference. If you cannot smell the bad odor molecules the protection is good. The nose is a good sensor. Double masking gives more strength to the pression in the skin against leakage. Important is hand desinfection before putting on and after doffing.
In areas of community transmission may mean that also the atmpsheric air ( oxygen ) inhaling may be also contaminated with COVID 19, thus it is compulsory for all health servic eproviders to use N95 respirators while in the health facility and also when performing any medical procedure such as aurgery, autopsy and cs.
https://www.cdc.gov/niosh/npptl/pdfs/UnderstandDifferenceInfographic-508.pdf-
The N95 should be treated as disposable mask after each surcery .
Sir it is a very valid and important question pertaining to the current scenario. N95 respirators provide the maximum protection and should be worn by all health care personnel working in the OT. Surgical masks will not be as effective as the respirators.
If no aerosol generation- in the procedure- then surgical masks are equally good and frankly more tolerable than N95 thereby increasing long term compliance
N95 gives better protection compare to Surgical Masks. But till now their are no evidence on this topic.
The question warrants more investigation and research, and should not be merely answered subjectively.
When we are looking at the NIOSH study, it appears like N-95 masks are better for surgeons than the simple surgical masks. But it all depends on multiple factors that surrounds COVID-19 infectiousness. Surely, we will need more well conducted research to come to such conclusion. We do not want to give an impression that masks are all we need for protection.
Have to consider both the risk of COVID and the fit of the mask. In general, N95 masks have closer fit and thus should give more protection. Masks should be one-time use only, but current availability in the USA means that masks are often re-used. Surgical masks can be modified for a closer fit - check YOUTUBE for instructional videos.
Risk of COVID is also key. Any time aerosols may result during surgery, then N95 masks should be considered. However, if patient is tested for COVID and tests negative, then might consider surgical mask modified for closer fit.
Note: these are opinions, the research data is insufficient.
Dear @ Arvind Singh
There is definite difference between disposable surgical mask and N95 respirators. The efficacy of N95 is 95% filtrations and surgical mask is about 80%. This is NIOSH recommendations. Clinically In hospital settings N95 is preferable during this pandemic time.
Dear @ Dr Ross Pastel
You have very pertinent points. Reuse of N95 due to unavailability is a great concern amongst health workers all over the world. Is it compromising the safety? Another issue is the COVID negative on testing. The false negative may be up to 20% in RT-PCR test.
So I think surgeons should take all the precautions during surgery, including wearing N95 mask
Dear @ Jean Marc Matala Tshivuila
Your point is very valid. Mask is not only factor for infection. But this is one of the important factor. Because most of the time surgeons does not wear full PPEs. Many a time we wear N95 mask and operate. In that situation it is better than normal surgical mask.
Dear @ Dr Pranav Ish
Yes, disposable surgical masks are more comfortable than N 95s. Specially 3M N95 is very tight and uncomfortable for long duration use. But all surgical procedures are AGPs. So we are using N95 in all surgeries as a routine.
Dear @ Dr Isabelle Villard
Question is not of double masking, question is which one is better? Your point of smell as an indicator is good and very practical. I agree! Thanks!
You will find this interesting.
Please have a look.
Thank you.
Article Medical Masks vs N95 Respirators for Preventing COVID‐19 in ...
Dear@ Talha Bin Emran
That is interesting read. Low certainty factors are included in the analysis and the conclusion of surgical mask in non AGPs and N95 in AGPs are standard now. All surgical procedures should be considered as AGPS. If ethically correct, it will be interesting to conduct a study in AGPs and in COVID-19 positive patients. Thanks!
Message from Astrobiology: first global foci are linked geographically.
We have answer why.
In Italy, surgeons who used appropriate "PPE" had a lower incidence of fatalities than other categories.
Article COVID-19 and Italian Healthcare Workers From the Initial Sac...
Vaccines are currently the only way to limit the infection. But there are too many negative opinions against vaccines. Even people without primary education express opinions (negative), people who do not understand anything but are "against". False "facts" are written. This prevents all of humanity from solving this serious problem.
Dear@ Anton Georgiev
I agree with you. But the emergence of new mutant and variants of the virus is causing a real danger. The existing available vaccines were developed specifically against the original virus. So we do not know about the efficacy of the existing vaccine against the newer variants of the virus.
Another problem is the emerging reports of adverse effects including mortality after vaccination, especially from Europe and Astrazeneca vaccine. So it is discouraging people to go for the vaccine.
But I agree with you that widespread vaccinations is the way of limiting the danger of the virus along with wearing a mask, social distancing and hand hygiene!
aerosol-generating procedures need n95 like bronchoscopy and spirometry. I doubt if all surgeries can be called aerosol generating. Even before covid-19, surgeons in my country used surgical mask only (not n95)
