Guidelines & Recommendations

Selecting the appropriate mask for a particular procedure is a critical component of your Personal Protective Equipment (PPE) protocol. Although masks may look similar, each mask has notable differences affecting the performance and level of fluid resistance and particle filtration. Understanding the ASTM performance level of each surgical mask or procedural mask can help make the selection process easier and ensure your mask will provide the appropriate protection to minimize the spread of potentially infectious diseases.

Medical Surgical Mask or Procedural Mask Standards and Regulations

Specifications developed by the American Society of Testing and Materials (ASTM) are referenced by the FDA as the required standard in the USA. The current standard ASTM F2100-11 specifies the performance requirements for medical surgical masks or procedural masks with five basic criteria:

• FLUID RESISTANCE represents the mask's resistance to penetration by synthetic blood under pressure (mmHg). It measures the ability of a mask's material construction to minimize fluids from traveling through the material and potentially coming into contact with the wearer. The higher the fluid resistance (filtration), the better the protection.
• BFE (Bacterial Filtration Efficiency) represents the percentage of aerosol particulates filtered at a size of 3 microns. It is the measure of the efficiency of the mask in filtering bacteria passing through it.
• PFE (sub-micron Particulate Filtration Efficiency) represents the percentage of submicron particulates filtered at 0.1 microns. PFE is the measure of the efficiency of the mask in filtering particles passing through it. The size of the particles filtered is critical.
• DELTA P (Differential Pressure) represents the pressure drop across the mask or resistance to air flow in mmH2O/cm2 . This determines breathing resistance — the higher the Delta P, the less the breathability, but the better the filtration.
• FLAME SPREAD is a ranking derived by laboratory standard test methodology of a material's propensity to burn rapidly and spread flames.

PPE for Standard Precautions: Determining What to Wear

Decisions about what PPE to use should be determined by the type and level of contact you will have with the patient.

Ask yourself:

• Will I be touching the patient or potentially contaminated objects in their environment?
• Is there a likelihood of blood or body fluids spraying or splashing?
• Is the patient coughing, sneezing, or vomiting?
• Do they have diarrhea?

Decisions about PPE can also be made with the following in mind: the diagnosis or suspected diagnosis of the patient, the patient's symptoms, and the type of infectious agent or illness you may encounter.

To determine what PPE to wear, ask yourself:

• What is the patient's diagnosis or suspected diagnosis?
• Is the patient infectious?
• What is the infectious agent or illness that I may encounter?
• What is the mode of transmission of this agent or illness?
• Does the patient have symptoms which lead to increased likelihood of transmission?

Consider the use of the following PPE:

• Gloves: Use when you will have to touch a patient in a way that might lead to exposure to blood or body fluids or touch objects in their environment that may be contaminated
• Gowns: Use when there is a risk of your clothing or exposed skin coming in contact with anything wet or weeping
• Mask and goggles or a face shield: Use when there is a risk of being splashed or sprayed with blood or body fluids

When in doubt, applying the most conservative level of PPE is the best protection.