All operating room staff wear masks when treating patients susceptible to infection, such as in neurosurgical, vascular, and orthopedic procedures involving implants and regional anesthesia procedures (for example, masks are also used to protect staff from contamination). The Cochrane12 review searched six established databases (Appendix) for randomized control trials and quasi-randomized control trials that investigated surgical outcomes, comparing the use of disposable surgical masks with the use of masks without the use of masks. Based on the findings of this review, the National Institute for Excellence in Health and Care guidelines state that there is “limited evidence on the use of non-sterile operating room clothing,” such as surgical masks, when attempting to minimize the risk of surgical site infection, although there was “general consensus.” that the use of non-sterile theatrical clothing is important to maintain theatrical discipline.” The face mask has been used in surgical settings for more than a hundred years; 2 first described in 1897, in its beginnings, it consisted simply of a single layer of gauze to cover the mouth3 and its main function was to protect the patient from contamination and infection of the surgical site. However, there are several ways in which surgical masks could potentially contribute to surgical wound contamination, e.
Published literature suggests that it may be reasonable to further examine the need for masks in contemporary surgical practice given the interests of comfort, budget, limitations, and possible ease of communication, although any such study would certainly need to be extensive and well-controlled to demonstrate causality given the low frequency of infection events at the surgical site. This would explain why there has been a lack of published literature examining the effectiveness of surgical masks despite their ubiquitous nature within the surgical profession. In fact, three large randomized controlled trials were conducted in the 1980s to determine once and for all whether surgical masks actually prevented surgical wound infection. Until recently, it was unclear whether bacterial colony growth on an agar plate was a direct correlation of surgical site infections and also if the purpose of the surgical mask had been replaced by more modern infection control strategies.
It is possible, if not likely, that if surgical masks were introduced today, without the historical impetus currently associated with their use, the experimental evidence would not be compelling enough to incorporate masks into surgical practice.