Nursing practice often involves undertaking procedures about which there is debate or uncertainty. In Practice Questions, we ask experts to determine how nurses should approach these procedures
A. Masks were introduced into clinical practice at the beginning of the 20th century to protect patients from microorganisms being expelled from healthcare workers’ respiratory tracts during clinical procedures (Wilson, 2006).
Interest in the effectiveness of masks has been raised by the swine flu pandemic.
In discussing effectiveness of masks, it is important to differentiate between standard surgical face masks and respirators.
When are surgical face masks required?
In general there are two reasons for using surgical face masks:
- To prevent respiratory droplets being expelled from the mouth and nose into the environment. They may be used for this purpose by healthcare workers or patients;
- In conjunction with eye protection to prevent exposure of the wearer’s mucous membranes to blood or body fluids due to splashing (Pratt et al, 2007).
If a mask is required, important practice points need to be followed. These are listed in Box 1.
Box 1. Practice points
- Masks should cover the mouth and nose and be tied in a way that minimises any gaps between the face and mask;
- Avoid touching the mask while it is worn;
- Replace the mask with a clean, dry one when it becomes damp/humid;
- Masks are single-use items and should be discarded and disposed of as clinical waste as soon as the task for which they were needed is complete;
- Decontaminate hands by washing with soap and water or using an alcohol-based handrub after mask disposal (WHO, 2007).
When is a respirator mask required?
A respirator mask is required to protect the wearer from inhaling harmful respiratory particles, for example multiple-drug resistant tuberculosis bacteria.
The European Standard EN149 describes the filtration efficiency of respirator masks, the highest of which is FFP3 (98% efficiency) (British Standards Institution, 2001). The next highest category is FFP2 (N95) which has a 95% efficiency.
It is important for staff to undergo face-fit testing and training before using respirator masks as they must seal tightly to the face or air will enter around the sides. The advice given for surgical masks also applies to respirators; both types are single-use items (see Box 1).
Swine flu pandemic
The Health Protection Agency (2009) advises people with flu to use face masks when they are in contact with other people and healthy people to wear a face mask when they are caring for a person with flu in non-clinical situations.
Where healthcare staff are involved in caring for a patient with a probable/confirmed diagnosis, they should wear a face mask, plastic apron and gloves as a standard precaution, with the addition of eye protection if splashing is likely to occur. Where aerosol-generating procedures such as physiotherapy are being undertaken, an FFP3 respirator is required in addition to a gown, gloves and eye protection.
The same precautions also apply to caring for patients with severe respiratory illness as a result of swine flu as they are likely to be shedding high quantities of virus.
Carol Pellowe, EdD, MA Ed, BA, RNT, RN, is deputy director, Richard Wells Research Centre, Joanna Briggs Institute Collaborating Centre, Faculty of Health & Human Sciences, Thames Valley University, Brentford.
British Standards Institution (2001) European Standard. Specification for Filtering Half Masks to ProtectAgainst Particles. BS EN149. London: British Standards Institution.
Health Protection Agency (2009) The Use of Personal Protective Equipment (PPE) by Healthcare Workers inClose Contact with Possible, Probable and Confirmed Cases of Swine Flu During the Pre and Pandemic Phases. Version 1.1 15.05.09. London: HPA.
Pratt, R.J. et al (2007) epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection; 65 (supplement 1): S1–S69.
Wilson, J. (2006) Infection Control in Clinical Practice. London: Ballière Tindall.
World Health Organization (2007) Infection Prevention and Control of Epidemic- And Pandemic-Prone AcuteRespiratory Diseases in Health Care. WHO Interim Guidelines.