An Overview of Medical PPE Masks for Orthopaedic Surgery - As published in AAOS Now
Orthopaedic surgery mask requirements may be more specialized due to the physical nature of many of the specialty’s procedures. This article provides a general overview of different medical mask options. As there are regional and case-specific requirements, no assertions are made about best practices.
No mask works well without proper fit and donning technique. Fit testing is especially important to achieve particle blockage with respirators. Be aware that industrial and healthcare-approved respirators have different standards, and it is important to use the Centers for Disease Control and Prevention’s website to ensure that a respirator has been cleared by the Food and Drug Administration (FDA) for surgical use.
N95 masks: The name correlates with the mask’s ability to block at least 95 percent of very small test particles (< 0.3 microns). The mask is built to form a tight seal around the nose and mouth. This forces air exchange through the filter and increases the labor of breathing for surgeons. Surgeons with preexisting respiratory, cardiac, or other medical conditions should consult with their physicians. It is also important to check whether the mask is fluid-resistant, as some N95 respirators are not FDA-cleared for use in surgery.
N99 and P100 masks: These masks offer even higher filtration (99.0 percent and 99.7 percent, respectively) but, as anticipated, may lead to an even harder respiratory effort.
Both N95 and N99 masks have options that incorporate a one-way exhalation valve. The valve may decrease moisture inside the mask and decrease the labor of breathing. It is important to understand that breath is exhaled through the one-way filter, so the mask wearer is protected, but because the air is being expelled, everyone else in the vicinity is not protected. This is especially important for surgical procedures. It is not recommended that the one-way valve technology is employed during surgery, as the surgical wound would be exposed to the surgeon’s exhalation.
Reusable respirators: These are heavier-duty and more cumbersome to wear, especially during surgical procedures. The biggest challenge with this technology is ensuring proper donning and doffing techniques (taking on and off), as well as sterilization of the product between uses.
The duckbill-style respirator, N95 rated: This technology utilizes a pleated design, which allows for a larger air chamber. This has the potential advantage of easier air exchange and decreased labor of breathing. Specific designs are fluid-resistant, which makes them FDA-approved for surgery.
Nitin Khanna, MD, FAAOS, is the founder of spinecarespecialists.com in Munster, Ind., where he has been in practice for the past 18 years.
Recently published: https://www.aaos.org/aaosnow/2020/jun/early-release/covid-19-ppe3/