Is your facemask really protecting you?

by Mary Govoni, CDA, RDA, RDH, MBA

Facemasks, referred to by OSHA as respiratory protection, are the dental professional's first line of defense against airborne pathogens and respiratory irritants such as dust, chemicals, or smoke from lasers.

In the Bloodborne Pathogens Standard, OSHA requires the use of respiratory protection whenever "splashes, sprays, splatters, or droplets of blood or OPIM pose a hazard." This is also included in the CDC guidelines because the mucous membranes of the nose and mouth can serve as portals of entry for microorganisms into the body.

After more than 20 years of dealing with OSHA compliance, I believe that the majority of dental professionals have embraced this concept of safety. But I am not convinced that the majority of dental professionals have embraced the concepts of the appropriate use of facemasks or respiratory protection.

It concerns me that I frequently see dental team members wearing their facemasks over their mouths, but not over their noses. This just begs the question, "Why bother?"

Respiratory protection is meant to protect both portals to the respiratory system – the mouth and the nose. Inhalation of airborne droplets can lead to many types of respiratory infections, including colds, influenza, tuberculosis, and others.

In addition, lack of appropriate respiratory protection and spraying of disinfecting solutions has been linked to asthma in dental professionals. Behavior modification – developing appropriate habits for wearing respiratory protection – is the solution. But old habits are sometimes hard to break.

Another common misuse of facemasks is reusing them for multiple patients or for an entire day. Facemasks are disposable, single-use items. This means they should be changed, at minimum, after every patient.

OSHA standards and CDC guidelines also state that a facemask should be changed immediately during a procedure if it becomes wet. A wet facemask can cause a wicking action, drawing microbes into the facemask, and putting the wearer at increased risk.

A common practice in dentistry is to remove the mask from the face after a procedure and place it around the neck or under the chin. This can cause any contaminants on the mask to be in contact with the skin on the neck or chin of the dental team member.

In addition, when the team member repositions the facemask for use with the next patient, they have to touch the outside of the contaminated mask with either their bare hands (which must be washed) or gloves (which must then be replaced). The mask should be removed and discarded after each patient, along with exam gloves.

Selecting the appropriate type of facemask is also important for dental professionals. Facemasks are rated and certified by the American National Standards Institute. As such, ANSI classifies masks by safety characteristics: bacterial filtration efficiency, particle filtration efficiency, and body fluid penetration (splash repellence, splash resistance, and fluid resistance).

In addition, the National Institute for Occupational Safety and Health has criteria for respirators that must be worn when treating patients at risk for tuberculosis. This is referred to as the N95 particulate respirator.

Masks are available in several styles. The most common are earloop and molded masks. Masks available to dental professionals also have additional features, such as anti-fogging and dye-free for sensitive skin.

One of the best resources available to dental professionals regarding facemasks and their characteristics is Crosstex® Maskenomics at http://www.crosstex.com/products/masks/maskenomics.pdf. All the types of facemasks and their various ratings are listed, along with important information about selection of the most appropriate mask for specific types of procedures.

I challenge you to find the most appropriate facemask for the types of procedures that you perform in your practice or facility and to wear those masks correctly so that your facemask is really protecting you.

Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Mary Govoni & Associates, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected] or www.marygovoni.com.