title: Performance of Facepiece Respirators and Surgical Masks Against Surgical Smoke: Simulated Workplace Protection Factor Study.
abstract: OBJECTIVE
  Surgical smoke generated during electrocautery contains toxins which may cause adverse health effects to operating room (OR) personnel. The objective of this study was to investigate the performance of surgical masks (SMs), which are routinely used in ORs, more efficient N95 surgical mask respirator (SMRs) and N100 filtering facepiece respirator (FFRs), against surgical smoke.
  
  
  METHODS
  Ten subjects were recruited to perform surgical dissections on animal tissue in a simulated OR chamber, using a standard electrocautery device, generating surgical smoke. Six respiratory protective devices (RPDs) were tested: two SMs, two SMRs, and two N100 FFRs [including a newly developed faceseal (FS) prototype]. Fit testing was conducted before the experiment. Each subject was then exposed to the surgical smoke while wearing an RPD under the tests. Concentrations inside (C in) and outside (C out) of the RPD were measured by a particle size spectrometer. The simulated workplace protection factor (SWPF) was determined by the ratio of C out and C in for each RPD-wearing subject.
  
  
  RESULTS
  For the SMs, the geometric means of SWPFtotal (based on the total aerosol concentration) were 1.49 and 1.76, indicating minimal protection. The SWPFtotal values of the SMRs and N100 FFRs were significantly higher than those of the SMs: for the two SMRs, the SWPFtotal were 208 and 263; for the two N100s, the SWPFtotal values were 1,089 and 2,199. No significant difference was observed between either the two SMs or the two SMRs. The SWPFtotal for the novel FS prototype N100 FFR was significantly higher than the conventional N100 FFR. The correlation between SWPFtotal and fit factor (FF) determined for two N95 SMRs was not significant.
  
  
  CONCLUSIONS
  SMs do not provide measurable protection against surgical smoke. SMRs offer considerably improved protection versus SMs, while the N100 FFRs showed significant improvement over the SMRs. The FS prototype offered a higher level of protection than the standard N100 FFR, due to a tighter seal. While we acknowledge that conventional N100 FFRs (equipped with exhalation valves) are not practical for human OR use, the results obtained with the FS prototype demonstrate the potential of the new FS technology for implementation on various types of respirators.
authors.affiliation: 1.Department of Environmental Health, Center for Health-Related Aerosol Studies, University of Cincinnati, PO Box 670056, Cincinnati, OH, USA;
authors.forename: Shuang
authors.initials: S
authors.lastname: Gao
authors.affiliation: 2.Department of Surgery, Martha's Vineyard Hospital, 1 Hospital Rd, Oak Bluffs, MA 02557, USA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Koehler
authors.affiliation: 1.Department of Environmental Health, Center for Health-Related Aerosol Studies, University of Cincinnati, PO Box 670056, Cincinnati, OH, USA;
authors.forename: Michael
authors.initials: M
authors.lastname: Yermakov
authors.affiliation: 1.Department of Environmental Health, Center for Health-Related Aerosol Studies, University of Cincinnati, PO Box 670056, Cincinnati, OH, USA; sergey.grinshpun@uc.edu.
authors.forename: Sergey A
authors.initials: SA
authors.lastname: Grinshpun
mesh_terms: D000395:Air Pollutants, Occupational / Q000032:analysis; D005260:Female; D006801:Humans; D019570:Inhalation Exposure / Q000517:prevention & control*; D008297:Male; D008397:Masks; D008422:Materials Testing; D016273:Occupational Exposure / Q000517:prevention & control*; D009873:Operating Rooms; D010316:Particle Size; D012134:Respiratory Protective Devices; D012906:Smoke; D017132:Workplace
chemical_list: D000395:Air Pollutants, Occupational; D012906:Smoke
keywords: filtering facepiece respirators; simulated workplace protection factor; surgical mask; surgical smoke