When it comes to protecting patients from infection, all operating room staff wear masks during certain procedures. This includes neurosurgical, vascular, and orthopedic operations involving implants and regional anesthesia. The Cochrane12 review searched six established databases for randomized control trials and quasi-randomized control trials that investigated surgical outcomes, comparing the use of disposable surgical masks with the use of masks without the use of masks. According to the National Institute for Excellence in Health and Care guidelines, there is “limited evidence” on the use of non-sterile operating room clothing, such as surgical masks, when attempting to minimize the risk of surgical site infection.
The face mask has been used in surgical settings for more than a century; first described in 1897, it was initially just a single layer of gauze to cover the mouth3 and its primary purpose was to protect the patient from contamination and infection of the surgical site. However, there are several ways in which surgical masks could potentially contribute to surgical wound contamination. Published literature suggests that it may be reasonable to further examine the need for masks in contemporary surgical practice given the interests of comfort, budget, limitations, and possible ease of communication. In fact, three large randomized controlled trials were conducted in the 1980s to determine whether surgical masks actually prevented surgical wound infection.
Until recently, it was unclear whether bacterial colony growth on an agar plate was a direct correlation of surgical site infections and also if the purpose of the surgical mask had been replaced by more modern infection control strategies. It is possible that if surgical masks were introduced today, without the historical impetus currently associated with their use, the experimental evidence would not be compelling enough to incorporate masks into surgical practice.
