|Other names||Procedure mask, medical mask, isolation mask, laser mask, fluid-resistant masks, face mask|
A surgical mask, also known as a medical face mask, is a personal protective equipment worn by health professionals during medical procedures. It prevents airborne transmission of infections between patients and/or treating personnel by blocking the movement of pathogens (primarily bacteria and viruses) shed in respiratory droplets and aerosols into and from the wearer's mouth and nose.
Typically quite impermeable to moisture, the mask act as an additional barrier for the airway and are not usually designed (unless N95-rated) to completely prevent the wearer from inhaling smaller airborne pathogens, but could be still protective by filtering out and trapping most of the droplets that carry them. There is a predominance of evidence that surgical masks protect both the wearer (by filtering the inhaled air) and bystanders (by blocking down forceful exhalations from the wearer that can spread pathogens afar).
Surgical masks were originally designed to protect medical personnel from accidentally breathing or swallowing in splashes or sprays of bodily fluids, but the effectiveness of surgical masks against influenza-like infections has not been confirmed by high-quality randomized controlled trials. Commonly seen surgical masks vary greatly by quality and levels of protection. Despite their name, not all surgical masks are appropriate to be used during surgery. Surgical masks may be labeled as surgical, isolation, dental or medical procedure masks. Chinese health officials distinguish between medical (non-surgical) and surgical masks.
Surgical masks are made of a nonwoven fabric created using a melt blowing process. They came into use in the 1960s and largely replaced cloth facemasks in developed countries. The dark blue (or green) side of the mask (the fluid-repellant layer) is to be worn outward, with the white (absorbent) layer on the inside. With respect to some infections like influenza surgical masks could be as effective (or ineffective) as respirators, such as N95 or FFP masks; though the latter provide better protection in laboratory experiments due to their material, shape and tight seal.
The use of surgical masks during the COVID-19 pandemic has been a subject of debate, as mask shortage is a central issue. Surgical masks are popularly worn by the general public all year round in East Asian countries like China, Japan and South Korea, especially during allergy and flu seasons, to reduce the chance of spreading airborne diseases to others, and to prevent the breathing in of airborne irritants such as pollens or dust particles created by air pollution (though dust masks are more effective against pollution.) Additionally, surgical masks have become a fashion statement, particularly in contemporary East Asian culture bolstered by its popularity in Japanese and Korean pop culture which have a big impact on East Asian youth culture.
A surgical mask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain aerosol-generating medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the often loose fit between the surface of the face mask and the face.
A surgical mask is a disposable device that creates a physical barrier between the respiratory tract openings (nose and mouth) of the wearer and potentially pathogenic contaminants in the immediate environment. If worn properly, surgical masks are meant to help blocking out most (if not all) large-particle droplets, splashes, sprays, or splatter that may contain viruses and bacteria, keeping them from entering the wearer's nose and mouth., and conversely ere also effective barriers for retaining large droplets released from the wearer's the mouth and nose. Surgical masks help reduce exposure of the wearer's saliva and respiratory secretions to others that could otherwise travel up to 7.9 metres (26 ft). Surgical mask also remind wearers not to touch their mouth or nose, which could otherwise transfer viruses and bacteria after having touched a contaminated surface.
A surgical mask is not to be confused with a respirator (which is specifically rated for sub-micron particles) and is not certified as such. Surgical masks are not designed to protect the wearer from inhaling airborne bacteria or virus particles and are less effective than respirators, which are designed for this purpose. Collection efficiency of surgical mask filters can range from less than 10% to nearly 90% for different manufacturers’ masks when measured using the test parameters for NIOSH certification. However, a study found that even for surgical masks with "good" filters, 80–100% of subjects failed an OSHA-accepted qualitative fit test, and a quantitative test showed 12–25% leakage.
The design of the surgical masks depends on the mode; usually, the masks are three-ply (three layers). This three-ply material is made up of a melt-blown polymer, most commonly polypropylene, placed between non-woven fabric. The melt-blown material acts as the filter that stops microbes from entering or exiting the mask. Pleats are commonly used to allow the user to expand the mask such that it covers the area from the nose to the chin. The masks are secured to the head with ear loops, head ties, or elastic straps.
|Pressure differential, ∆P||cm of H2O / cm2|
|Filtration and exposure||%|
|Liquid penetration resistance||mbar|
|Air permeability||ml/s⋅cm2 at 100 Pa|
|Water vapor permeability||g/24 hr⋅cm2|
Filter material in the middle layer may be made of microfibers with an electrostatic charge; that is, the fibers are electrets. An electret filter increases the chances that smaller particles will veer and hit a fiber, rather than going straight through (electrostatic capture).[better source needed][medical citation needed] While there is some development work on making electret filtering materials that can stand being washed and reused, current commercially produced electret filters are ruined by many forms of disinfection, including washing with soap and water or alcohol, which destroys the electric charge. During the COVID-19 pandemic, public health authorities issued guidelines on how to save, disinfect and reuse electret-filter masks without damaging the filtration efficiency. Standard disposible surgical masks are not designed to be washed.
Physical properties and quality
Performance of surgical masks is evaluated based on such parameters as filtration (mask capture of exhaled aerosols), exposure (transfer of aerosols from outside), mask airflow resistance (pressure difference during breathing, ΔP, also known as breathability), liquid penetration resistance, air and water vapor permeability, water repellency (for outer and inner surfaces).
Filtration and exposure is typically measured in bacterial filtration efficiency (BFE) using particles of size 3.0 μm. Particulate filtration efficiency (PFE) using particles of size 0.3 μm is only measured in China.
Face masks for use in surgery were developed in Europe by several physicians, including Johann Mikulicz at the University of Breslau and Paul Berger in Paris, in the late nineteenth century, as a result of increasing awareness of germ theory and the importance of antiseptic procedures in medicine. In response to a pneumonic plague in Manchuria and Mongolia in 1910, Chinese-Malaysian epidemiologist Dr. Wu Lien-teh greatly improved on the designs he had seen in Europe to develop a face mask of layers of gauze and cotton that would protect both the wearer and others.
Modern surgical masks began to be used in the 1960s. Their adoption caused cloth facemasks, which had been used since the late 19th century, to completely fall out of use in the developed world. However, cloth masks and surgical masks both continued to be used in developing countries.
A surgical mask is intended to be worn by health professionals during surgery and certain health care procedures to catch microorganisms shed in liquid droplets and aerosols from the wearer's mouth and nose. Evidence supports the effectiveness of surgical masks in reducing the risk of infection among other healthcare workers and in the community. However, a Cochrane review found that there is no clear evidence that disposable face masks worn by members of the surgical team would reduce the risk of wound infections after clean surgical procedures.
Healthcare workers are trained in how to put on, handle, remove, and dispose of surgical masks.For healthcare workers, safety guidelines recommend the wearing of a face-fit tested N95 or FFP3 respirator mask instead of a surgical mask in the vicinity of pandemic-flu patients, to reduce the exposure of the wearer to potentially infectious aerosols and airborne liquid droplets.
In community and home settings, the use of facemasks and respirators generally are not recommended, with other measures preferred such as avoiding close contact, maintaining good hand hygiene, and wearing cloth face coverings.
Surgical masks are popularly worn by the general public all year round in East Asian countries like China, Japan, South Korea and Taiwan to reduce the chance of spreading airborne diseases to others, and to prevent the breathing in of airborne dust particles created by air pollution.
In Japan and Taiwan, it is common to see these masks worn during the flu season, as a show of consideration for others and social responsibility. Surgical masks provide some protection against the spread of diseases, and improvised masks provide about half as much protection.
More recently, due to the rising issue of smog in South and Southeast Asia, surgical masks and air filtering face masks are now frequently used in major cities in India, Nepal and Thailand when air quality deteriorates to toxic levels. Additionally, face masks are used in Indonesia, Malaysia and Singapore during the Southeast Asian haze season. Air filtering surgical-style masks are quite popular across Asia and as a result, many companies have released masks that not only prevent the breathing in of airborne dust particles but are also fashionable.
Additionally, surgical masks have become a fashion statement, particularly in contemporary East Asian culture bolstered by its popularity in Japanese and Korean pop culture which have a big impact on East Asian youth culture.
Surgical masks may also be worn to conceal identity. In the United States banks, convenience stores, etc. have banned their use as a result of criminals repeatedly doing so. In the 2019–20 Hong Kong protests, some protestors wore surgical masks amongst other types of mask to avoid recognition, and the government tried to ban such use.
In the United States, surgical masks are cleared for marketing by the U.S. Food and Drug Administration. As of 2009, manufacturers of surgical masks must demonstrate that their product is at least as good as a mask already on the market to obtain "clearance" for marketing. Manufacturers may choose from filter tests using a biological organism aerosol, or an aerosol of 0.1 µm latex spheres.
In the European Economic Area (EEA), surgical masks have to be certified through the CE marking process in order to be commercialized. CE marking of surgical masks involves the respect of many obligations indicated in the Medical Device Regulation (Council Regulation 2017/745 of 5 April 2017 concerning medical devices, OJ No L 117/1 of 2017-05-05).
Surgical masks for use in the US and the EEA conform to ASTM F2100 and EN 14683 respectively. In both standards, a mask must have a Bacterial Filtration Efficiency (BFE) of more than 95%, simulated with particles of size 3.0 μm.
In China, two types of masks are common: surgical masks that conform to YY 0469 standard (BFE ≥ 95%, PFE ≥ 30%, splash resistance) and single-use medical masks that conform to YY/T 0969 standard (BFE ≥ 95%). Daily protective masks conforming to GB/T 32610 standard is yet another type of masks that can have similar appearance to surgical masks.
- Smith, Jeffrey D.; MacDougall, Colin C.; Johnstone, Jennie; Copes, Ray A.; Schwartz, Brian; Garber, Gary E. (17 May 2016). "Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis". Canadian Medical Association Journal. 188 (8): 567–574. doi:10.1503/cmaj.150835. ISSN 0820-3946. PMC 4868605. PMID 26952529.
- "Advice on the use of masks the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak" (PDF). www.who.int. Retrieved 4 February 2020.
- "Transmission-Based Precautions". U.S. Centers for Disease Control and Prevention. 7 January 2016. Retrieved 31 March 2020.
- "Prevention of hospital-acquired infections" (PDF). World Health Organization (WHO). p. 45. Archived (PDF) from the original on 26 March 2020.
- "Clinical Educators Guide: Australian Guidelines for the Prevention and Control of Infection in Healthcare". Australian National Health and Medical Research Council. December 2019. p. 20. Retrieved 30 March 2020.
- Sommerstein R, Fux CA, Widmer A (6 July 2020). "Risk of SARS-CoV-2 transmission by aerosols, the rational use of masks, and protection of healthcare workers from COVID-19". Antimicrobial Resistance & Infection Control. 9 (1): 100. doi:10.1186/s13756-020-00763-0. PMC 7336106. PMID 32631450.
- Peeples L (2020). "Face masks: what the data say". Nature. 586 (7828): 186–189. Bibcode:2020Natur.586..186P. doi:10.1038/d41586-020-02801-8. PMID 33024333. S2CID 222183103.
- Xiao J, Shiu EY, Cowling BJ (2020). "Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-Personal Protective and Environmental Measures". Emerging Infectious Diseases. 26 (5): 967–975. doi:10.3201/eid2605.190994. PMC 7181938. PMID 32027586.
- "N95 Respirators and Surgical Masks (Face Masks)". FDA. Retrieved 12 April 2020.
- "For different groups of people: how to choose masks". NHC.gov.cn. National Health Commission of the People's Republic of China. 7 February 2020. Archived from the original on 5 April 2020. Retrieved 22 March 2020.
- Strasser, Bruno J; Schlich, Thomas (2020). "A history of the medical mask and the rise of throwaway culture". Lancet. The Lancet. 396 (10243): 19–20. doi:10.1016/S0140-6736(20)31207-1. PMC 7255306. PMID 32450110.
- Chua MH, Cheng W, Tan H, Li Z, Tan BH, Loh XJ (2020). "Face Masks in the New COVID-19 Normal: Materials, Testing, and Perspectives". Research. 2020: 7286735. doi:10.34133/2020/7286735. PMC 7429109. PMID 32832908.
- Johnmin (1 June 2020). "Which Way Round Should a Surgical Face Mask Go?". SmartAirFilters.com. Retrieved 8 October 2020.
- Johnmin (1 June 2020). "Does Wearing Surgical Masks With the Wrong Side Out Affect Their Ability to Capture Viruses?". SmartAirFilters.com. Retrieved 8 October 2020.
- Long, Y; Hu, T; Liu, L; Chen, R; Guo, Q; Yang, L; Cheng, Y; Huang, J; Du, L (13 March 2020). "Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis". Journal of Evidence-based Medicine. 13 (2): 93–101. doi:10.1111/jebm.12381. PMC 7228345. PMID 32167245.
- Long Y, Hu T, Du L (2020). "Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis". Journal of Evidence-Based Medicine. 13 (2): 93–101. doi:10.1111/jebm.12381. PMC 7228345. PMID 32167245.
- Chu DK, Akl EA, Schünemann HJ (2020). "Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis". The Lancet. 395 (10242): 1973–1987. doi:10.1016/S0140-6736(20)31142-9. PMC 7263814. PMID 32497510.
- "N95 Respirators and Surgical Masks - Blogs - CDC". CDC Blogs. 14 October 2009. Retrieved 29 April 2020.
- Smith, JD; MacDougall, CC; Johnstone, J; Copes, RA; Schwartz, B; Garber, GE (17 May 2016). "Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis". Canadian Medical Association Journal. 188 (8): 567–574. doi:10.1503/cmaj.150835. PMC 4868605. PMID 26952529.
- Ting V (4 April 2020). "To mask or not to mask: WHO makes U-turn while US, Singapore abandon pandemic advice and tell citizens to start wearing masks". South China Morning Post.
- "Not Enough Face Masks Are Made In America To Deal With Coronavirus". NPR.org. 5 March 2020. Retrieved 10 April 2020.
- "Chinese mask makers use loopholes to speed up regulatory approval". Financial Times. 1 April 2020. Retrieved 10 April 2020.
- Yang, Jeff. "A quick history of why Asians wear surgical masks in public". Quartz. Retrieved 28 March 2020.
- Dazed (24 December 2015). "How surgical masks became a fashion statement". Dazed. Retrieved 28 March 2020.
- "How K-Pop Revived Black Sickness Masks In Japan". Kotaku Australia. February 7, 2019.
- "Respiratory Protection Against Airborne Infectious Agents for Health Care Workers: Do surgical masks protect workers?" (OSH Answers Fact Sheets). Canadian Centre for Occupational Health and Safety. 28 February 2017. Retrieved 28 February 2017.
- Tang, Julian W.; Nicolle, Andre D. G.; Pantelic, Jovan; Jiang, Mingxiu; Sekhr, Chandra; Cheong, David K. W.; Tham, Kwok Wai (22 June 2011). "Qualitative Real-Time Schlieren and Shadowgraph Imaging of Human Exhaled Airflows: An Aid to Aerosol Infection Control". PLOS ONE. 6 (6): e21392. Bibcode:2011PLoSO...621392T. doi:10.1371/journal.pone.0021392. ISSN 1932-6203. PMC 3120871. PMID 21731730.
- "N95 Respirators and Surgical Masks (Face Masks)". U.S. Food and Drug Administration. 11 March 2020. Retrieved 28 March 2020. This article incorporates text from this source, which is in the public domain.
- Padilla, Ramon; Zarracina, Javier (3 April 2020). "Coronavirus might spread much farther than 6 feet in the air. CDC says wear a mask in public". USATODAY.com. Retrieved 4 April 2020.
- Brosseau, Lisa; Ann, Roland Berry (14 October 2009). "N95 Respirators and Surgical Masks". NIOSH Science Blog. Retrieved 28 March 2020. This article incorporates text from this source, which is in the public domain.
- "Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission". Centers for Disease Control and Prevention. 27 May 2009.
Unless otherwise specified, the term "facemasks" refers to disposable facemasks cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. This includes facemasks labeled as surgical, dental, medical procedure, isolation, or laser masks... Facemasks should be used once and then thrown away in the trash.
- "How Surgical Masks are Made, Tested and Used". ThomasNet. Retrieved 5 April 2020.
- Reusability of Facemasks During an Influenza Pandemic: Facing the Flu. The National Academies Press. 17 March 2006. doi:10.17226/11637. ISBN 978-0-309-10182-0. Retrieved 5 April 2020.
- Wei, Neo Kang (6 May 2019). "What is PM0.3 and Why Is It Important?". Smart Air Filters.
- , "US 5496507 A – Method Of Charging Electret Filter Media The Lens – Free & Open Patent and Scholarly Search"
- "PROPERTIES OF DIFFERENT TYPES OF MASKS" (PDF). Government of New South Wales Clinical Excellence Commission. February 2020.
- Jung, James (17 March 2020). "KAIST Researchers Develop Highly Reusable Mask Filter". KoreaTechToday.
- "Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings". cdc.gov. NIOSH Workplace Safety and Health Topic. CDC. 27 March 2020.
- "Coronavirus Disease 2019 (COVID-19)". Centers for Disease Control and Prevention. 11 February 2020.
- Skaria, S.; Smaldone, G. (2014). "Respiratory Source Control Using Surgical Masks With Nanofiber Media". Annals of Occupational Hygiene. 6 (58): 771–781.
- Wong, Chung; Guo, Hu; Guan, Yao; Song, Newton; Newton, E. (2006). "In Vivo Protective Performance of N95 Respirator and Surgical Facemask". American Journal of Industrial Medicine. 12 (49): 1056–10065. doi:10.1002/ajim.20395. PMID 17096360.
- 中华人民共和国医药行业标准：YY 0469–2011 医用外科口罩（Surgical mask） (in Chinese)
- Reusability of Facemasks During an Influenza Pandemic: Facing the Flu. Washington, D.C.: National Academies Press. 24 July 2006. pp. 6, 36–38. doi:10.17226/11637. ISBN 978-0-309-10182-0.
- Chughtai, Abrar Ahmad; Seale, Holly; MacIntyre, Chandini Raina (19 June 2013). "Use of cloth masks in the practice of infection control – evidence and policy gaps". International Journal of Infection Control. 9 (3). doi:10.3396/IJIC.v9i3.020.13. ISSN 1996-9783.
- MacIntyre, C. R.; Chughtai, A. A. (9 April 2015). "Facemasks for the prevention of infection in healthcare and community settings" (PDF). BMJ. 350 (apr09 1): h694. doi:10.1136/bmj.h694. ISSN 1756-1833. PMID 25858901. S2CID 46366687.
- Procedure mask. nursingcenter.com
- MacIntyre, CR; Chughtai, AA (9 April 2015). "Facemasks for the prevention of infection in healthcare and community settings". BMJ (Clinical Research Ed.). 350: h694. doi:10.1136/bmj.h694. PMID 25858901. S2CID 46366687.
- Vincent, Marina; Edwards, Peggy (26 April 2016). "Disposable surgical face masks for preventing surgical wound infection in clean surgery" (PDF). Cochrane Database of Systematic Reviews. 4: CD002929. doi:10.1002/14651858.cd002929.pub3. PMC 7138271. PMID 27115326.
- "Interim guidance on planning for the use of surgical masks and respirators in health care settings during an influenza pandemic" (PDF). U.S. Department of Health & Human Services. October 2006. Archived from the original (PDF) on 4 March 2016.
- "Working with highly pathogenic avian influenza virus". UK Health and Safety Executive. Retrieved 2 August 2014.
- "N95 Factsheet". Centers for Disease Control and Prevention. Archived from the original on 11 November 2009.
- FDA clears first single-use face mask for children; URL accessed 18 October 2020.
- CDC (11 February 2020). "Coronavirus Disease 2019 (COVID-19)". Centers for Disease Control and Prevention. Retrieved 5 July 2020.
- Juliet Hindell (30 May 1999). "Japan's war on germs and smells". BBC Online.
- Negrin, Matt (26 April 2009). "For allergy and flu season, the Japanese turn to surgical masks". Winnipeg Free Press. Retrieved 29 September 2017.
- "CJCU Student Handbook" (PDF). 2016. Retrieved 4 April 2020.
In Taiwan, it is considered courteous to wear a face mask if you have a cold and cough and plan to be in close proximity with others
- Davies, Anna; Thompson, Katy-Anne; Giri, Karthika; Kafatos, George; Walker, Jimmy; Bennett, Allan (August 2013). "Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?". Disaster Medicine and Public Health Preparedness. 7 (4): 413–418. doi:10.1017/dmp.2013.43. ISSN 1935-7893. PMC 7108646. PMID 24229526.
- "Why are face masks selling out in Bangkok?". BBC News. Retrieved 28 March 2020.
- Punit, Maria Thomas, Itika Sharma. "Delhi's rich and beautiful are breathing clean air stylishly, with help from the Nevada desert". Quartz India. Retrieved 28 March 2020.
- "Keeping Kathmandu Out". kathmandupost.com. Retrieved 28 March 2020.
- "How to choose the right mask to protect yourself from the haze". AsiaOne. Retrieved 28 March 2020.
- Holliday, Katie (20 June 2013). "Face Masks, Anyone? Singapore Struggles With Haze". www.cnbc.com. Retrieved 28 March 2020.
- Delhi residents brave the smog in style
- "New mask against air pollution offers six times more protection". South China Morning Post. December 1, 2016.
- "Hong Kong protesters defy face mask ban — with humor". DW.COM.
- Robertson, Paddy (15 March 2020). "Comparison of Mask Standards, Ratings, and Filtration Effectiveness". Smart Air Filters.
- 中华人民共和国医药行业标准：YY/T 0969–2013 一次性使用医用口罩（Single-use medical face mask） (in Chinese)
- "GB/T 32610–2016 Technical specification of daily protective mask" (PDF).
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