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The Effectiveness and Compliance of Surgical Face Mask Wearing in the Operating Suite Environment: an Integrated Review

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The Effectiveness and Compliance of Surgical Face Mask Wearing in the Operating Suite Environment: an Integrated Review Volume 33 Issue 4 Article 2 11-9-2020 The effectiveness and compliance of surgical face mask wearing in the operating suite environment: An integrated review Noriko Ogo [email protected] Paula Foran [email protected] Follow this and additional works at: https://www.journal.acorn.org.au/jpn This work is licensed under a Creative Commons Attribution 4.0 License. Recommended Citation Ogo, Noriko and Foran, Paula (2020) "The effectiveness and compliance of surgical face mask wearing in the operating suite environment: An integrated review," Journal of Perioperative Nursing: Vol. 33 : Iss. 4 , Article 2. Available at: https://doi.org/10.26550/2209-1092.1105 https://www.journal.acorn.org.au/jpn/vol33/iss4/2 This Article is brought to you for free and open access by Journal of Perioperative Nursing. It has been accepted for inclusion in Journal of Perioperative Nursing by an authorized editor of Journal of Perioperative Nursing. Emerging scholar article Authors Noriko Ogo The effectiveness and compliance MCN (Perioperative Nursing), BN, RN, MACORN of surgical face mask wearing in Dr Paula Foran PhD, RN, FACORN, FACPAN, MACN the operating suite environment: An integrated review Abstract Problem identification: Surgical face masks have been used for over a century in the operating room (OR); firstly, as it has been believed that they may reduce surgical site infections (SSIs) in patients and, secondly, as personal protective equipment (PPE) for staff. However, recent studies have reported disparities in the efficacy of wearing surgical face masks including inconsistency in their use. This integrative review aims to investigate the effects of surgical masks in the OR, in regard to maintaining both patient and staff safety, and will discuss compliance or lack thereof in face mask usage for the entire multidisciplinary team. Literature search: Four electronic health databases were used to identify the relevant research: CINAHL, Medline, EMCare and Cochrane Library. The reference lists of retrieved articles were also manually searched and appropriate literature retrieved. Data evaluation synthesis: Inclusion and exclusion criteria were used revealing that 15 articles fully met the criteria which were critiqued (see Table 2 in Supplemental material for the literature matrix). Implications for practice: SSIs are multifactorial and no reviewed studies looked at causative considerations such as comorbidities and other variables (such as hypothermia) which could all contribute to this post-operative complication. However, there is evidence to suggest that surgical face masks are useful in decreasing the biological load in the theatre environment. They are also a vital piece of PPE that should be worn to protect the perioperative team from blood and bodily fluid splatter that commonly occur. Keywords: surgical mask, surgical site infection, PPE, operation theatre, staff compliance Introduction length of hospitalisation, the cost of care, mortality and morbidity2. Since Traditionally there are two reasons surgical masks were introduced as for staff to wear surgical masks in the a preventive practice for SSIs, over a OR: firstly, to protect surgical sites hundred years ago, they have been from microorganisms transferred used to provide a physical barrier from the faces and respiratory tract between the mouth and nose of of scrubbed staff and, secondly, to health care personnel and surgical protect health care professionals wounds of patients3. from sprays and splashes of patients’ blood and body fluids during Problem identification surgery1. Surgical site infections (SSIs) contribute to the increase in Despite the long-standing use of the burden of both patients and surgical face masks to prevent wound health care systems by increasing the infection, a Cochrane systematic Journal of Perioperative Nursing Volume 33 Number 4 Summer 2020 acorn.org.au e-11 review conducted by Da Zhou, Personnel have a duty to: comprehensive understanding of Sivathondan and Handa4 in 2015 particular problems in health care • wear disposable, high filtration concluded there was no statistically settings7,8. It incorporates a five- masks: significant difference in the risk stage process comprising problem of SSIs between two cohorts, one • whenever a sterile/aseptic field is identification, literature search, masked and one non-masked. In the being prepared or maintained data evaluation and synthesis, data following year a second Cochrane integration, and results presentation • in the restricted areas during 7 systematic review by Vincent and surgical procedures and discussion . Edwards was published which investigated the same question; • whenever there is risk of blood or Literature search methods body fluid splash however, their research only included To identify research on the effect 5 ‘clean’ surgical procedures . The • wear masks that meet the of wearing surgical masks in the cohort (n= 653) included patients Australian standards perioperative environment and the who underwent ‘clean’ surgery – compliance and behaviour of theatre • select the appropriate mask for the where the respiratory, alimentary, staff, electronic health database surgical procedure or infectious genital or urinary tracts, that may searches of the literature were nature of the patient, and contain bacteria, were not surgically conducted using CINAHL, Medline, 5 treated . Armed with the knowledge • apply the mask securely to EMCare and Cochrane Library. The that there may be a lower risk of SSIs completely cover the nose and reference lists of retrieved articles when conducting ‘clean’ surgery, it mouth were also manually examined to was hypothesised that the formation • secure the mask according to identify additional research papers of a SSI in this cohort would make relevant to the topic. it more reasonable to attribute an manufacturer’s instructions and infection to other factors such as avoid touching the mask once it The initial search was limited to a higher airborne bacterial load is applied studies published between 2015 from the use or non-use of surgical • remove the mask completely and 2020 and written in English. face masks. However, results of this when it is no longer required, One salient paper from 2013 was research were inconclusive, and it touching only the tapes/elastic, subsequently retrieved. was unclear whether the use of a and discard into the appropriate surgical face mask impacted the receptacle Inclusion and exclusion occurrence of SSIs in clean surgery5. criteria • perform hand hygiene following Standards for Perioperative Nursing mask disposal Inclusion criteria included peer in Australia (the ACORN Standards) reviewed articles that reported the • avoid hanging masks around the states that surgical masks should be effects of the use of a surgical mask neck when not in use. worn in operating theatres during in the OR, those that investigated procedures, when proximal to open the efficacy of wearing surgical sterile or aseptic clinical supplies Figure 1: Criteria 6.1–6.3 from ACORN masks, and those that investigated and when there is a risk of blood standard ‘Perioperative attire’ the compliance and behaviour of or body fluid splash6. Although This integrative review aims to operating theatre staff towards there are detailed criteria about investigate the effects of wearing wearing surgical masks. the use of surgical masks in the surgical masks in the OR, and related Exclusion criteria included studies ACORN Standards (Figure 1), ACORN compliance and behaviours of the that focused on a surgical helmet acknowledges that using a surgical multidisciplinary perioperative team. system, theatre traffic and respiratory mask remains controversial in some infections. The terms used to conduct health care settings and conflicting Literature search the search in the databases were 6 evidence may exist . ACORN further based on the PICO (population, suggests that individual health care Design intervention, comparison, outcome) settings should make their decision This review follows an integrative acronym, and Boolean operators on best available evidence and approach which enables a ‘OR’ and ‘AND’ were used to combine clinician’s judgment6. broad review of the available synonyms and concepts of the PICO literature. It includes various respectively. Terms were surgical study methodologies to provide a mask OR surgical facemask AND e-12 Journal of Perioperative Nursing Volume 33 Number 4 Summer 2020 acorn.org.au Additional records identified through Records identified through database manual searching the reference lists of searching included articles (n =90) (n = 11) Identification Records screened Records excluded including duplicates (n = 101) (n = 65) Screening Full-text articles assessed for eligibility Full-text articles excluded, with reasons (n = 36) (n = 21) Eligibility Studies included in quantitative synthesis (meta-analysis) (n = 15) Included Figure 2: PRISMA flow diagram of search strategy surgical site infection OR surgical and critiquing process, 15 articles relevant critical appraisal skills wound contamination, with the remained for this review. programme (CASP) checklists10,11. RCTs article title, abstracts and body. provide the strongest evidence for a single study with minimal bias8. Articles that met the study inclusion Data evaluation and However, only one RCT was found criteria were summarised within synthesis as it is considered unethical, due the PRISMA (Preferred reporting to personal risk, for surgical staff items for systematic reviews and Data
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