Due to the coronavirus outbreak, it appears we may experience a higher than normal demand for infection control products such as masks, goggles, and face shields among other items.  

However, this should not cause us to be more lax about how we use a mask or for saving them and using them on multiple patients.  A common misuse of facemasks, is after a procedure, placing it around the neck or under the chin and even taking it off and placing it into a gown pocket with the intention of reusing it again.  This act requires the health care worker to touch the outside of the contaminated mask with either their bare hands or gloves.  Now contaminates on the mask are in contact with the skin on the neck or chin of the dental team member.  Masks should be removed and discarded after each patient by only the ties, bands or loops, along with the exam gloves.  

Beginning with the initial 1978 American Dental Association published document, every series of ADA and Centers for Disease Control and Prevention infection control guidelines for dentistry has included recommendations for wearing face masks as  key components of personal protection against airborne pathogens.  The 1991 Occupational Health and Safety Administration Bloodborne Pathogens Standard also included a regulation stating:  “Masks in combination with eye protection devices, with solid side shields or a face shield, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated.”

Specific features should be evaluated when selecting a mask:

1. it should not come into contact with the wearer’s nostrils or lips

2. has a high bacterial filtration efficiency rate

3. fits snugly around the entire periphery

4. does not cause fogging of eyewear

5. is made of a fabric that does not irritate skin or induce an allergic reaction

6. is comprised of a material that does not collapse when worn or when wet

7. is easy to put on and remove

Wet masks should be changed every 20 minutes when challenged during procedures that generate heavy levels of spatter and aerosols, after 60 minutes in non-aerosol environments and certainly after each patient.  Keep in mind, no mask can filter out 100% of all aerosolized particles.

The American Society of Testing and Materials is the organization responsible for establishing criteria and testing methods to delineate performance specifications for face masks used in healthcare.  Masks are generally classified into 3 types:

• Level 1 masks are designed for procedures with low amounts of blood, fluid, spray and/or aerosol exposure.  Common clinical examples include patient exams, operatory cleaning, impressions, lab trimming and orthodontic work.

• Level 2 masks are ideal for procedures where moderate to light amounts of fluid, spray and/or aerosols are produced.  Restoratives, prophylaxis, sealants, limited oral surgery and endodontic treatment.  

• Level 3 masks are designed for procedures with moderate to heavy amounts of blood, fluid, spray and/or aerosol exposure.  High barrier protection is needed for procedures such as implant placement, crown preparation, and periodontal or complex oral surgery.

So lets all be safe – not sorry.

References:

• Defend blog

• Oral Health Group

• Dental Economics

• Dentistry IQ