In the hospital environment, global marketing manager at 3M Brigette Master looks at the use of masks and respirators, and the importance of knowing the difference between the two.
Historically, surgical masks were designed and used mainly to minimise the risk of contamination of the patient and wound from the spread of microorganisms expelled from the nose and mouth of healthcare professionals (HCP) in the operating room (OR). Today, we are faced with myriad challenges, including new and drug-resistant pathogens.
We do not need to only protect our patients from these threats but the HCP as well. Surgical masks and respirators are helping to protect HCP, in all areas of the healthcare facility, from certain contaminants. Appropriate selection and use of surgical masks and respirators is critical to implementing standard precautions in the OR and throughout the health care facility.1,2
Because certain disposable filtering facepiece respirators look similar in appearance to surgical and/or procedure masks, their differences are not always well understood. However, respirators and surgical masks are very different in several ways, including intended use, fit to the face, testing, and regulatory clearances and approvals.
The biggest difference between a respirator and a surgical mask is the intended use. Respirators are designed to help reduce the wearer's respiratory exposure to airborne contaminants such as particles, gases or vapours. Particulate respirators may be used to help reduce exposure to particles that are small enough to be inhaled - particles less than 100µ in size. This includes airborne particles that may contain biological material, such as mould, Bacillus anthracis, Mycobacterium tuberculosis, the virus that causes SARS and the Pandemic Novel Swine Origin Influenza A (H1N1) virus, etc.3,4
Surgical masks do not have either adequate filtering or fitting attributes to provide respiratory protection for the wearer, as they are designed to help prevent contamination of the work environment or sterile field from large particles generated by the wearer (such as spit and mucous). They may also be used to help reduce the risk of sprays or splashes of blood, bodily fluids, secretions and excretions from reaching the wearer's mouth and nose.3-5
The fit against the face is also an important differentiator. Respirators, such as N95 filtering face pieces, are designed to seal to the face of the wearer. Therefore, when properly fitted on the face, inhaled air is drawn through the filter media and not through gaps between the respirator and the wearer's face. To determine proper fit, wearers must be tested prior to first use to ensure the respirator forms an adequate seal to the face. The wearer must also perform a 'user seal check' each time the respirator is worn, prior to entering the contaminated environment, to check the respirator-to-face seal.
Surgical masks are not designed to seal against the face and are not fit-tested because the main purposes of the mask are to help capture large particles expelled by the wearer and help reduce the wearer's exposure to splashes. During inhalation, much of the air can pass through gaps between the face and the surgical mask.5 Respirators must be carefully donned, using the manufacturer's instructions, and worn properly the entire time the user is in the contaminated area. Surgical masks are frequently worn for specific procedures and then removed.6
In conclusion, surgical masks help put a barrier between the wearer and the work environment or sterile field. They may help keep saliva and mucous generated by the wearer from reaching a patient or medical equipment. They can also be used as a fluid barrier to help keep blood splatter from reaching the wearer's mouth and nose. Surgical masks do not provide respiratory protection unless they are designated, tested and National Institute for Occupational Safety and Health (NIOSH) approved as a respirator and then properly used in accordance with user instructions (with proper fit test and user seal checks, for example). Devices that are both NIOSH approved as an N95 respirator and cleared by the US Food and Drug Administration (FDA) as a surgical mask are available and often referred to as 'surgical respirators' or, more formally, Surgical N95 NIOSH-certified respirators.6
As healthcare workers consider the potential hazards faced in the variety of tasks they perform during the delivery of healthcare services, it is important they know some of the main differences between masks and respirators so that, when needed, the appropriate type of personal protective equipment can be selected.
1. Prust, Janet M. 'Surgical Masks: Current Issues and Update.' Surgical Services Management. 3.4 (1997): 33-39.
2. Siegel JD, Rhinehart E, Jackson M, Chiarello L, others. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. American Journal of Infection Control. 2007;35(2):65.
3. Brosseau LM, Berry Ann R. N-95 Respirators and Surgical Masks. CDC NIOSH Science Blog. 2009. Available at: http://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/. Accessed December 4, 2013.
4. Brosseau LM. Update on Respirators and Surgical Masks Review
of Literature (2007 - 2010). 2010. Available at: http://www.iom.edu/Activities/PublicHealth/PPECurrentResearch/2010-JUN-03.aspx.
5. Oberg T, Brosseau LM. Surgical mask filter and fit performance. American Journal of Infection Control. 2008;36(4):276-282.
6. Center for Devices and Radiological Health. Guidance Documents (Medical Devices and Radiation-Emitting Products) - Guidance for Industry and FDA Staff: Surgical Masks - Premarket Notification [510(k)] Submissions; Guidance for Industry and FDA. Available at: http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm072549.htm. Accessed December 4, 2013.