I have put people on bypass at 54 hospitals. I have worked as a surgical first assistant in another 10 hospitals – and in the operating room theater of at least five military hospitals.
I won’t even begin to try to count the days, hours, or the number of operations that this implies, but I’m pretty sure it adds up to an incredible number of disposable surgical masks.
By my estimate, during routine day in the operating room involving a single uncomplicated open heart operation, I would say I go through at minimum 5 to 10 masks in roughly an eight hour period. Typically one for setting up, changing masks if I leave the OR to go to the cafeteria, changing masks if I have gone to the staff lounge for coffee, changing masks simply because they tore or didn’t feel/fit right, the occasional sneeze in the mask or cough, is definitely a mask change out event, because both situations are gross, your mask is wet thus compromised, and did I say it’s gross? Or tearing it off when I leave the OR- just because it feels good to be released from wearing it for a few minutes.
So when I showed up this morning to find no masks at the scrub sinks outside our room, I looked to the next operating room and noticed that there were no masks anywhere to be found. I had been in this same OR until 4 PM the day before, and every single scrub sink had boxes of at least eight different styles of masks to choose from. All masks had been removed sometime in the PM or during the night.
At approximately 7 o’clock in the morning, in a central area outside of the operating rooms, the director of perioperative services was handing out masks with very serious look of concern and worry on his face. He’s usually a stern man to begin with, but there was a look there that clearly implied that we were in uncharted waters. He was almost hesitant as he told me that I would only have one mask for the entire day, and if possible keep it in my locker for use on the next day. It was pretty clear from the way he presented this new mandate- that he in his heart-of-hearts (no pun) knew- that this was just NOT the right way to go about this.
So I wore that mask from 7 AM to 3:30 PM, during which we performed very complex combined open-heart procedure. Since I don’t have a locker at this hospital, as I am a locums here, I put that tired overused mask into a drawer in our office, on the off chance that I would be able to find one in the middle of the night for an emergency heart.
I was shocked we were so low on masks- because I cover 5 hospitals in this region- and there really wasn’t any surge or uptick in our surgical caseload at any of those hospitals- so that implies that increased demand was not the issue. Employee hording or theft? NOT A CHANCE. These are good people that are too strong willed and straight up to degrade themselves like that. Professional pride supersedes silly tunnel visioned panic.
I’m assuming there is a supply chain disruption closer to the manufacturing side of things- where either a delivery issue- or a materials shortage issue. It’s possible a portion of the manufactured masks were being siphoned off to other vendors- but not enough to so immediately and abruptly affect our availability so quickly.
I included a few articles below- the most significant is the study suggesting that:
after 150 minutes of wearing the same mask-
you might as well not be wearing one at all-
based on it effectiveness in subverting bacterial communication past the mask!
Let’s Get Past This 🙂
Pump Strong (bcf)
Bottom Line: After 150 minutes- Fabric Face Masks are useless in terms of containing bacteria.
Bottom Line: After 150 minutes- Disposable Face Masks are useless in terms of containing bacteria.
Click on Image Above to Read Source Article
This study was conducted to check the efficacy of face masks in limiting bacterial dispersal when worn continuously in Operation Theater. A comparison was done to find out difference between fabric and two ply disposable masks. The first sample was collected prior to wearing the mask, using cough plate method holding a blood agar plate approximately 10 -12 centimeters away from the mouth. the personnel were asked to produce “ahh” phonation. Participants were then asked to don the face mask, continue routine work and report to the study center located inside the theater for further sample collections at designated intervals of 30, 60, 90, 120 and 150 minutes after wearing the fabric mask made of cotton. the study was replicated on immediate next day using two ply disposable mask keeping all the other conditions and personnel exactly the same. Bacterial counts before wearing the mask were 5.36±4.38 and 5.7±2.99 on day 1 and day 2 of study. Bacterial counts were 0.96±1.06 (P<0.001) and 0.7±0.87 (P<0.001) at 30 min; 2.33±1.42 (P<0.001) and 2.36±1.03
(P<0.001) at 60 min; 3.23±1.54 (P=0.007) and 4.16±1.78 (P=0.011) at 90 min; 5.63±4.02 (P=0.67) and
4.9±1.98 (P=0.161) at 120 min and 7.03±4.45 (P=0.019) and 5.6±2.21 (P=0.951) at 150min respectively for fabric and two ply disposable mask. Counts were near pre-wear level in about two hours irrespective of the type of mask. There was no significant difference between cotton fabric and two ply disposable masks.
Face masks significantly decreased bacterial dispersal initially but became almost ineffective after two hours of use.
OSHA Issues Guidance for Stockpiling Masks and Respirators
By Eric Toner, M.D., May 30, 2008
The Occupational Safety and Health Administration (OSHA) recently proposed guidance for employers to use in determining the numbers of masks and respirators to stockpile for an influenza pandemic.1 OSHA’s guidance addresses the various levels of respiratory risk that employees may face and the type of protection needed at each level. The guidance also addresses methods for calculating the required numbers and costs to stockpile masks and respirators. While not obligatory, this guidance should prove useful to hospital pandemic planners in making informed decisions about stockpiling.
Respirators for High Exposure Risk Groups; Face Masks for Medium Exposure Risk Groups
OSHA’s proposed guidance describes the types of masks or respirators needed by various healthcare workers (HCW) based on their exposure risk. Most HCWs are at high or very high risk of exposure and should use a respirator instead of a mask for protection. Respirators should be rated N95 or higher and can be any one of several types, including a common disposable N95 filtering face piece, a surgical respirator, a reusable elastomeric (flexible rubber) respirator, or a powered air purifying respirator (PAPR). HCWs with limited exposure to patients may fall in the medium risk category; for this group, a surgical mask is appropriate protection. Also noted is the need to provide masks for essential visitors, such as parents of small children and patients with flu-like illnesses in the emergency department and waiting rooms. A comparison of the advantages, disadvantages, and relative costs of the various types of respirators and masks is included.
OSHA Provides Methods for Estimating Stockpile Numbers and Costs
The guidelines provide estimates of the number of respirators or masks needed per HCW, expressed as masks per shift. With these estimates, along with assumptions about the duration, attack rate, and severity of an epidemic, a planner can calculate the number and cost of masks and respirators needed to protect HCWs.
Interestingly, the analysis of the cost to protect one HCW at high risk of exposure reveals that it may be far less expensive in the long run to stockpile more expensive reusable elastomeric respirators than it would be to stockpile inexpensive disposable N95 filtering face pieces. And both of these options are less expensive than PAPRs. The calculation assumes two 12-week pandemic waves, during which time the HCW could be expected to use:
- 1 PAPR with spare hoods, batteries, and filters for $330 total;
- 480 N95 filtering face pieces @ $.50/each for $240 total; or
- 1 reusable elastomeric respirator every day with periodic filter changes for $40 total.
OSHA Guidelines and Hospital Data Will Support Informed Decisions about Stockpiling
Since re-supply during a pandemic may be difficult or impossible, stockpiling critical supplies such as masks and respirators is important. This guidance, used in conjunction with a hospital’s actual data on cost of respirators and masks and numbers of staff, along with credible assumptions about numbers of pandemic patients, will allow hospital pandemic planners to make informed decisions about stockpiling.
U.S. Department of Labor, OSHA. Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza. May 12, 2008. https://www.osha.gov/dsg/guidance/proposedGuidanceStockpilingRespirator.pdf. Accessed May 28, 2008.