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A key part of infection prevention standard precautions, healthcare workers use personal protective equipment (PPE) to help minimize exposure to hazardous and infectious materials. PPE can include anything from face masks and shields to gowns and gloves.
Medical face coverings fall into three groups: surgical masks, procedure masks – also known as isolation masks – and N95 respirator masks. The CDC refers to them all as “medical masks,” but there are important differences.
The easiest way to tell them apart is that procedure masks affix with stretch loops behind the ears, while masks intended for use in surgery have two sets of ties for a more secure fit to the face. N95 respirator masks usually have over-the-head elastic bands to hold them firmly in place.
Both surgical and procedure masks for use in a medical setting are made with non-woven fabrics designed to protect the wearer and the patient from the transfer of microorganisms and large droplets and splashes of blood and other body fluids. They are disposable and only intended for single use.
Industry-standard “ASTM” test methods are used to measure mask performance. To carry an “ASTM Rating,” the FDA requires that masks be tested for:
A mask may be rated “ASTM Level 1, 2 or 3,” with the highest performance rated Level 3. But note that not all masks in the marketplace are ASTM-rated.
Used for performing patient procedures, or when patients are in isolation, to protect them from potential contaminants. Procedure masks are used to protect both patients and staff from the transfer of respiratory secretions or other fluids or debris. They are used for “respiratory etiquette” to prevent people from spreading germs via talking, coughing or sneezing. Procedure masks have ear loops for quick donning and can be worn without a surgical cap.
Used inside the operating room or during other sterile procedure areas, these types of masks help protect the patient environment from contamination. They also help protect the clinician from contaminated fluid or debris generated during the procedure. Surgical masks have ties so they can be adjusted for fit, and are tied over top of a surgical or bouffant cap.
These masks cover the user’s nose and mouth and provide a physical barrier to fluids and particulate materials (ASTM Level 1, 2, 3). The mask meets certain fluid barrier protection standards and FDA Class I or Class II flammability tests.
A disposable half-face-piece, non-powered, air-purifying particulate respirator intended for use to cover the nose and mouth of the wearer to help reduce wearer exposure to pathogenic biological airborne particulates. They are certified by NIOSH, an agency of the CDC, to filter out at least 95% of particulates .3 microns in size; thus, an N95 FFR filters 95% of .3 micron particulates (the N stands for NIOSH).
There are seven classes of filters for NIOSH-approved filtering face-piece respirators available. Ninety-five percent is the minimal level of filtration that will be approved by NIOSH. The N, R and P designations describe the filter’s oil resistance:
|N95||Filters at least 95% of airborne particles; not resistant to oil|
|N99||Filters at least 99% of airborne particles; not resistant to oil|
|N100||Filters at least 99.97% of airborne particles; not resistant to oil|
|R95||Filters at least 95% of airborne particles; somewhat resistant to oil|
|P95||Filters at least 95% of airborne particles; strongly resistant to oil|
|P99||Filters at least 99% of airborne particles; strongly resistant to oil|
|P100||Filters at least 99.7% of airborne particles; strongly resistant to oil|
An FFR offers protection from particulate materials at an N95 filtration efficiency level; also called a medical respirator.
A NIOSH-approved N95 respirator has also been cleared by the Food and Drug Administration (FDA) as a surgical mask.
This type of air-purifying respirator protects by filtering particles out of the air the user is breathing.
Hand hygiene is an important part of infection prevention, including during COVID-19. Practicing hand hygiene, which includes the use of alcohol-based hand rub or hand-washing, is a simple yet effective way to help prevent the spread of pathogens and infections in healthcare settings.
The Center for Disease Control & Prevention (CDC) recommends alcohol-based hand sanitizer at 60% ethanol or 70% isopropyl to kill COVID-19. Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. Hand rubs are generally less irritating to hands and are effective in the absence of a sink.
There are various types of protective gowns, including surgical and isolation – or procedure – gowns. Gowns are rated according to their AAMI level, which indicates how a gown performs against a series of barrier performance criteria and ranges from one to four, with level 4 providing the highest barrier to fluids and microorganisms.
To aid in choosing the right gown for each use, AAMI-rated surgical and isolation gowns should all be clearly marked on the gown –not just on the packaging.
The highest barrier protection is in the primary “critical zones” of the gown, in the front and on the sleeves, where direct contact with blood, body fluids and other infectious material is likely to occur. Higher-level gowns have larger critical zones and the sleeves and seams are fully sealed, not sewn, to prevent fluid penetration.
AAMI level 2 isolation or procedure gowns may be appropriate for minimally-invasive or in-office procedures where fluid impact is expected to be low; whereas level 3 gowns are used for a wide range of surgeries where the risk is moderate and level 4 gowns are best for high-fluid and lengthy procedures when the risk is higher.
In general medical gloves consist of exam gloves, surgical gloves and chemotherapy cloves.
Exam gloves are generally less tight-fitting for easy donning and removal, come in fewer sizes, and can be worn on either hand.
Typically, surgical gloves are sterile, packaged in pairs and “handed” with left and right gloves in each pair. They can be made of many materials, including nitrile, neoprene, polyisoprene and latex. They come in many sizes and surgeons sometimes double-glove for extra protection from viral contamination or in procedures that involve heavy instruments, like orthopedics.
Chemotherapy gloves must be tested to resist a range of highly toxic hazardous drugs, according to ASTM testing. As users are often required to double-glove to prevent cross-contamination, chemo gloves come in under-glove and outer-glove combinations.
To learn more about how to help stop the spread of infection, check out our infection prevention resources, including training courses, webinars & videos.
“Mobile surfaces” such as medical uniforms, scrubs, white coats and footwear can serve as a feeding ground for hungry microbes looking for nutrition and are often overlooked in a facility’s infection prevention practices. The Society for Healthcare Epidemiology of America (SHEA) provides recommendations to prevent transmission of potential infections through healthcare personnel (HCP) clothing in non-operating room settings.
Surgical site infections (SSI) are on the rise – by 2030, the cost of knee and should surgical site infections is expected to exceed $1.6 billion.2, 3 Whether you’re doing total joint procedures today or plan to, it’s important for your staff to have the tools and knowledge to help prevent, diagnose and treat surgical site infections. What’s your plan to reduce SSI at your facility? We offer four tips for you to consider before you operate.
Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.