The Respiratory Protection Information Trusted Source

A surgical N95 filtering facepiece respiratorexternal icon (also referred as a medical respirator) is recommended only for use by healthcare personnel (HCP) who need protection from both airborne and fluid hazards (e.g., splashes, sprays). These respirators are not used and are not needed outside of healthcare settings. To understand how NIOSH works with the Food and Drug Association (FDA) to approve/clear surgical N95 Respirators for healthcare, see the NIOSH Science Blog, Who Does What? The Roles of NIOSH, OSHA, and the FDA in Respiratory Protection in the Workplace

For more information, see the NIOSH table,  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 that filter out at least 95% of particles in the air, including large and small particles and require fit testing.

For more information, see the NIOSH infographic, Understanding the Difference between Surgical Mask vs. N95pdf icon.

No. Surgical masks are not designed for use as particulate respirators and do not provide as much respiratory protection as a NIOSH-approved N95 respirator. 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)pdf icon, and the NIOSH Science Blog, N95 Respirators and Surgical Masks.

Studies on PAPRs are ongoing at this time. However, professional judgement suggests that for operating room staff who cannot be fitted with an N95 respirator, the next best alternative is a PAPR that can be vented under the shroud in which exhalation gases are vented underneath the gown, as long as the PAPR manufacturer’s instructions allow for the shroud to worn in this fashion (under the gown). PAPRs that vent to the rear of the PAPR wearer are expected to provide less contamination to the surgical field. PAPRs that vent to the front (anteriorly) may contaminate the surgical field.

For PAPRs used in operating rooms, the following approach is suggested:

• Identify a NIOSH-approved filtering facepiece respirator (e.g., N95) for which you have been successfully fit tested.
• If (1) is not possible, choose a PAPR model that can be vented under the gown, as long as the PAPR manufacturer’s instructions permit such use.  In addition, the PAPR blower/exhaust should be directed away from the sterile field.

In addition, the Association for Peri-Operative Registered Nurses (AORN) has issued guidance on “3 Interventions When Using a Powered Air-Purifying Respirator in the ORexternal icon.”

It depends on the type of respirator and the setting. An FFR with an exhalation valve can be used for source control but cannot be used when it is important to maintain a sterile field. Source control refers to the ability to prevent disease transmission to others via the spread of respiratory secretions. A NIOSH technical report, Filtering Facepiece Respirators with an Exhalation Valve, suggests that, even without covering the valve, FFRs with exhalation valves provide the same or better source control than surgical masks or procedure masks.

However, FFRs with exhalation valves are not fluid resistant. They should not be used in situations where a sterile field is required (e.g., during an invasive procedure in an operating or procedure room) because the exhalation valve may allow unfiltered exhaled air to escape into the sterile field. In situations where a fluid resistant respirator is indicated (e.g., in surgical settings), healthcare personnel should wear a Surgical N95.

Elastomeric respirators with unfiltered exhalation valves should not be used as source control in surgical and other healthcare settings 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 that may be used 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.

Used respirators are considered contaminated and ideally should be discarded after each patient encounter. Disposable N95 respirators worn during aerosol-generating procedures should be discarded after the procedure.

Healthcare facilities can extend the use of disposable N95 respirators by training personnel on extended use of respirators—that is, wearing them during consecutive patient encounters without removing or re-donning between encounters.

For information about FFR extended use and limited reuse in healthcare settings in emergency or crisis circumstances, such as during an influenza pandemic when supplies are depleted, please consult the Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings.

Manufacturers provide instructions for cleaning, sanitizing, repairing, inspecting, and storing their respirators. The respirators should be packed or stored 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 the patient is suspected of or confirmed to have an infectious disease.

The type of respiratory protection needed is dependent on the type of cells and whether any infectious agents are contained in the smoke generated during the procedure. Control methods such as ventilation should be used first to reduce potential exposure of surgical smoke produced by the use of lasers (See the NIOSH publication, Control of Smoke From Laser/Electric Surgical Procedures).

The Association of periOperative Registered Nurses has a resource on management of surgical smokeexternal icon that includes the use of respiratory protection (N95 respirators).

A NIOSH-approved N95 filtering facepiece respirator has the minimum filtration performance required when treating patients with suspected or confirmed TB. For situations in which the potential for TB exposure is high (i.e., aerosol-generating procedures), a more protective respirator might be needed. See the CDC’s guidelines for preventing the transmission of TB in healthcare settingspdf icon for additional information.

NIOSH-approved N95 respirators that have not been cleared by NIOSH as a surgical N95 can be used for respiratory protection to reduce your exposures to hazardous particulates in a patient setting. If you are working in a sterile field or may be exposed to high-velocity splashes, sprays, or splatters of blood or body fluids, you should wear a NIOSH-approved surgical N95 respirator.