Understanding the Factors Involved in Determining the Bioburdens of Surgical Masks

Overview

Journal Ann Transl Med

Publisher AME Publishing Company

Date 2020 Feb 12

PMID 32042770

Citations 14

Authors

Zhiqing Liu

Degang Yu

Yuwei Ge

Liao Wang

Jingwei Zhang

Huiwu Li

Fengxiang Liu

Zanjing Zhai

Affiliations

Soon will be listed here.

Abstract

Background: Surgical site infection (SSI) continues to be one of the most common postoperative complications. In our previous study, surgical mask (SM) bioburden was identified to be a potential source of SSI. In the present study, we investigated the factors involved in SM bioburden.

Methods: Bioburdens of the disposable SM (A: medical mask; B: medical surgical mask) and newly laundered cloth SM (C) were tested by immediately making an impression of the external surface of the mask on sterile culture media. SM microstructure was observed using a scanning electron microscope (SEM). Filtering efficiency and airflow resistance were evaluated with TSI Automated Filter Tester 8130 (TSI Incorporated) according to GB/19083-2010. Whether speaking during operation and washing the face pre-operatively affect SM bioburdens was also evaluated. Surgical procedures were performed in a dynamic operation room. Fifty cases of mask use were enrolled in this study.

Results: The bioburden of mask A was the highest. The bioburden of mask B was the lowest. Mask C possessed the lowest filtering efficiency and the highest airflow resistance. SM bioburden was higher in the speaking group. SM bioburden showed no significant difference after washing the face, despite the finding that washing could significantly reduce facial bioburden.

Conclusions: Multiple factors influence SM bioburdens. Mask B showed the lowest bioburden and best protection effects. Mask C is not recommended to be used, especially considering that surgeons do not wash the cloth masks daily. Unnecessary talking during operation is not recommended, and washing the face before surgery is not strictly necessary.

Citing Articles

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Reuse of N95/PFF2 masks in clinical practice: morphological and structural analysis.

Vimieiro V, Vimieiro C, Oliveira A Rev Lat Am Enfermagem. 2024; 32:e4209.

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Advancement of Nonwoven Fabrics in Personal Protective Equipment.

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A Review of Filtration Performance of Protective Masks.

Wang A, Zhang X, Gao L, Zhang T, Xu H, Bi Y Int J Environ Res Public Health. 2023; 20(3).

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Checchi V, Montevecchi M, Valeriani L, Checchi L Materials (Basel). 2022; 15(24).

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References

Sellden E . Is routine use of a face mask necessary in the operating room?. Anesthesiology. 2010; 113(6):1447. DOI: 10.1097/ALN.0b013e3181fcf122. View

Salassa T, Swiontkowski M . Surgical attire and the operating room: role in infection prevention. J Bone Joint Surg Am. 2014; 96(17):1485-92. DOI: 10.2106/JBJS.M.01133. View

McLure H, Talboys C, Yentis S, Azadian B . Surgical face masks and downward dispersal of bacteria. Anaesthesia. 1998; 53(7):624-6. DOI: 10.1046/j.1365-2044.1998.435-az0528.x. View

Eisen D . Surgeon's garb and infection control: what's the evidence?. J Am Acad Dermatol. 2010; 64(5):960.e1-20. DOI: 10.1016/j.jaad.2010.04.037. View

Ritter M, Eitzen H, French M, Hart J . The operating room environment as affected by people and the surgical face mask. Clin Orthop Relat Res. 1975; (111):147-50. DOI: 10.1097/00003086-197509000-00020. View

Zhiqing L, Yongyun C, Wenxiang C, Mengning Y, Yuanqing M, Zhenan Z . Surgical masks as source of bacterial contamination during operative procedures. J Orthop Translat. 2018; 14:57-62. PMC: 6037910. DOI: 10.1016/j.jot.2018.06.002. View

Mitchell N, Hunt S . Surgical face masks in modern operating rooms--a costly and unnecessary ritual?. J Hosp Infect. 1991; 18(3):239-42. DOI: 10.1016/0195-6701(91)90148-2. View

Tunevall T . Postoperative wound infections and surgical face masks: a controlled study. World J Surg. 1991; 15(3):383-7; discussion 387-8. DOI: 10.1007/BF01658736. View

Hare R, Thomas C . The transmission of Staphylococcus aureus. Br Med J. 1956; 2(4997):840-4. PMC: 2035620. DOI: 10.1136/bmj.2.4997.840. View

10.

Doshi R, Leng T, Fung A . Reducing oral flora contamination of intravitreal injections with face mask or silence. Retina. 2012; 32(3):473-6. DOI: 10.1097/IAE.0B013E31822C2958. View

11.

Shooter R, Smith M, Hunter C . A study of surgical masks. Br J Surg. 1959; 47:246-9. DOI: 10.1002/bjs.18004720312. View

12.

Tanner J, Dumville J, Norman G, Fortnam M . Surgical hand antisepsis to reduce surgical site infection. Cochrane Database Syst Rev. 2016; (1):CD004288. PMC: 8647968. DOI: 10.1002/14651858.CD004288.pub3. View

13.

Li X, Li M, Li J, Gong W, Sun Y, Tang J . Glove perforation and contamination in fracture fixation surgeries. Am J Infect Control. 2016; 45(4):458-460. DOI: 10.1016/j.ajic.2016.07.024. View

14.

Datta R . Use of Surgical Facemasks in the Operation Theatre: Effective or Habit?. Med J Armed Forces India. 2016; 66(2):163-5. PMC: 4920922. DOI: 10.1016/S0377-1237(10)80133-9. View

15.

Allegranzi B, Bischoff P, de Jonge S, Kubilay N, Zayed B, Gomes S . New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016; 16(12):e276-e287. DOI: 10.1016/S1473-3099(16)30398-X. View

16.

Tammelin A, Ljungqvist B, Reinmuller B . Single-use surgical clothing system for reduction of airborne bacteria in the operating room. J Hosp Infect. 2013; 84(3):245-7. DOI: 10.1016/j.jhin.2013.03.007. View

17.

Markel T, Gormley T, Greeley D, Ostojic J, Wise A, Rajala J . Hats Off: A Study of Different Operating Room Headgear Assessed by Environmental Quality Indicators. J Am Coll Surg. 2017; 225(5):573-581. DOI: 10.1016/j.jamcollsurg.2017.08.014. View

18.

Chauveaux D . Preventing surgical-site infections: measures other than antibiotics. Orthop Traumatol Surg Res. 2015; 101(1 Suppl):S77-83. DOI: 10.1016/j.otsr.2014.07.028. View

19.

McHugh S, Corrigan M, Hill A, Humphreys H . Surgical attire, practices and their perception in the prevention of surgical site infection. Surgeon. 2013; 12(1):47-52. DOI: 10.1016/j.surge.2013.10.006. View