Postoperative wound infections increase length of hospital stay, cost of care, and morbidity. Infections occurring in a wound created by an invasive surgical procedure are referred to as surgical site infections (SSIs). SSIs account for a significant fraction of health care associated infections, however since many of these infections occur after discharge from the hospital their frequency is likely underestimated. While many SSIs cause no additional complications, they can be associated with considerable morbidity, with estimates at over one third of postoperative deaths at least partly attributable to SSIs.

In the operating room (OR) there are procedures and practices in place intended to reduce the probability of infectious material transfer between OR staff and patients. Surgical face masks (SFMs) provide a physical barrier between bacteria of oropharyngeal and nasopharyngeal origin and an open patient wound. Wearing a SFM in the OR is one of many long standing preventative practices, yet controversy exists as to the clinical effectiveness of SFMs in reducing the frequency of SSIs. Additionally, SFMs potentially protect OR staff by providing a physical barrier to infectious bodily fluid splashes from the patient. General purpose disposable SFMs however, are not specifically designed to protect the wearer from airborne infectious particulates. A review of clinical effectiveness and evidence-based guidelines for mask use in the OR can inform practice decisions to minimize the occurrence of SSIs and OR staff infections.

The purpose of this report is to retrieve and review the existing evidence on the clinical effectiveness of wearing SFMs in the OR to prevent infections of patients and OR staff.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Strategy
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• List of Abbreviations
• APPENDIX 1 Selection of Included Studies
• APPENDIX 2 Summary of Characteristics Of Included Systematic Reviews
• APPENDIX 3 Summary of Characteristics of Included Guidelines
• APPENDIX 4 Guideline Grading of Recommendations and Levels of Evidence
• APPENDIX 5 Summary of Critical Appraisal of Systematic Reviews Using AMSTAR
• APPENDIX 6 Summary of Critical Appraisal of Guidelines Using AGREE
• Appendix 7 Summary of Systematic Review Findings
• APPENDIX 8 Summary of Recommendations by Source

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.