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Healthcare Setting Specific FAQs
Surgical N95 filtering facepiece respirators are commonly used in healthcare settings. These respirators provide healthcare personnel protection from both airborne and fluid hazards (e.g., splashes, sprays). Therefore, use of these respirators outside of healthcare settings is not necessary. The NIOSH Science Blog describes how NIOSH works with the Food and Drug Association to approve/clear surgical N95 Respirators.
To find NIOSH-approved Surgical N95 respirators, use the Certified Equipment List or the NIOSH table of Surgical N95 Respirators.
Surgical masks are loose fitting and provide only barrier protection against droplets, including large respiratory particles. Surgical masks do not require fit testing. N95 FFRs are tight-fitting respirators and require fit testing. These respirators filter out at least 95% of particles in the air, including large and small particles.
For more information, see the NIOSH infographic, Understanding the Difference between Surgical Mask vs. N95.
No. Surgical masks do not have the same protection level as particulate respirators like NIOSH-approved N95 respirators. Surgical masks provide barrier protection against droplets including large respiratory particles.
For more information, see the NIOSH infographic, Understanding the Difference (Surgical Mask vs N95 Respirator). The NIOSH Science Blog, N95 Respirators and Surgical Masks, provides more information.
Studies on PAPRs are ongoing at this time. Professional judgement suggests PAPRs as an alternative for operating room staff who cannot pass a fit test with an N95 respirator. The PAPR should vent under the shroud in which exhalation gases vent underneath the gown. Ensure you can wear the PAPR shroud in this fashion (under the gown) by checking the manufacturer’s instructions. PAPRs venting to the rear of the PAPR wearer likely provide less contamination to the surgical field. PAPRs venting to the front may contaminate the surgical field.
For PAPRs used in operating rooms, we suggest the following approach:
- Identify a NIOSH-approved filtering facepiece respirator (e.g., N95) for which you successfully passed a fit test.
- If (1) is not possible, choose a PAPR model capable of venting under the gown. First check the PAPR manufacturer’s instructions to verify they permit such use for that particular model. In addition, direct the PAPR blower/exhaust away from the sterile field.
The Association for Peri-Operative Registered Nurses issued guidance on “3 Interventions When Using a Powered Air-Purifying Respirator in the OR.”
It depends on the type of respirator and the setting. Healthcare personnel (HCP) can use an FFR with an exhalation valve for source control. However, when it is important to maintain a sterile field, HCP cannot use an FFR with an exhalation valve. Source control refers to the ability to prevent disease transmission to others via the spread of respiratory secretions. A NIOSH technical report summarizes research on filtering facepiece respirators with an exhalation valve. Findings suggest FFRs with exhalation valves provide the same or better source control than surgical masks or procedure masks. This finding is the same even without covering the valve.
However, FFRs with exhalation valves are not fluid resistant. HCP should not use these types of respirators in situations requiring a sterile field. For example, during an invasive procedure in an operating or procedure room. The exhalation valve may allow unfiltered exhaled air to escape into the sterile field. In situations requiring a fluid resistant respirator (e.g., in surgical settings), HCP should wear a Surgical N95.
HCP should not use elastomeric respirators with unfiltered exhalation valves as source control in surgical and other healthcare settings. This is due to concerns that air coming out of the exhalation valve may contaminate the sterile field. The NIOSH Certified Equipment List identifies the elastomeric respirators without exhalation valves or with filtered exhalation valves. HCP can use both types in surgical settings.
Healthcare facilities may have their own policies regarding the use of respirators with exhalation valves. Check with your Occupational Health Clinic or Infection Control Staff to understand your facility’s policies.
Respirators can become contaminated after each use. Ideally, you should discard used respirators after each patient encounter. When worn during aerosol-generating procedures, discard disposable N95 respirators after the procedure.
Healthcare facilities can extend the use of disposable N95 respirators by training personnel on extended use of respirators. This includes training on wearing them during consecutive patient encounters without removing or re-donning between encounters.
Manufacturers provide guidance for cleaning, sanitizing, repairing, inspecting, and storing their respirators. Refer to the manufacturer’s guidance. Pack or store the respirators so that they do not become damaged or deformed. Never store disposable respirators in pockets, plastic bags, or other confined areas.
Yes, especially if you wear a respirator in a room with any type of aerosol-generating procedure. Or if your patient has a suspected or confirmed case of an infectious disease.
It depends on the type of cells and infectious agents contained in the smoke generated during the procedure. You should first incorporate control methods such as ventilation. Ventilation can reduce potential exposure of surgical smoke produced by the use of lasers. See the NIOSH publication, Control of Smoke From Laser/Electric Surgical Procedures for more information.
The Association of periOperative Registered Nurses has a resource on management of surgical smoke, including respiratory protection recommendations.
A NIOSH-approved N95 respirator has the minimum filtration performance required when treating patients with suspected or confirmed TB. When the potential for TB exposure is high (i.e., aerosol-generating procedures), healthcare personnel may need a more protective respirator. For more information, see the CDC’s guidelines for preventing the transmission of TB in healthcare settings.
It depends on the setting. You can use NIOSH-approved N95 respirators to reduce your exposures to hazardous particulates in a patient setting. However, you should wear NIOSH-approved surgical N95 respirators when working in a sterile field. If you’re exposed to high-velocity splashes, sprays, or splatters of blood or body fluids, wear a surgical N95 respirator.
NIOSH Reach II Study: Understanding and Selecting Respiratory Protection Devices (2014)
Respirator Use and Infection Control in Healthcare (2015)
Key Requirements of a Respiratory Protection Program (2015)
Considerations for Respirator Selection in Healthcare (2017)
Understanding the Difference (surgical mask vs N95 FFR) (2018)
Understanding the Difference (surgical masks, N95 FFRs, and Elastomerics) (2019)