MASKS AND RESPIRATORY VIRUS PROTECTION

The importance of proper infection prevention and control is at the forefront for healthcare providers. This document is meant to be a guide for dental practices to consider the elements of a practice respiratory protection program to help prevent transmission in the dental practice environment, with a focus on masks as an element of respiratory virus protection for both Dental Health Care Personnel (DHCP) and patients.


 

COMPLIANCE: IS YOUR TIME UP?

• Face masks have a use-life; best practice dictates changing a mask if the fluid-resistant outer layer becomes wet or soiled with exposure to spatter and bioaerosols and/or the internal lining layer becomes moist from the DHCP’s breath condensation
• In an aerosol environment, masks should be changed every 20 minutes and in a non-aerosol environment every 60 minutes during lengthy procedures(6)

COMPLIANCE: CHECK YOURSELF OUT!

COMPLIANCE: ARE YOU FIT FOR SAFETY?

• Perform hand hygiene
• Inspect PPE prior to donning (e.g., not torn, punctured, ripped)
• Confirm the exterior side of the face mask (only side that is fluid resistant)
• Prior to placing the mask to the face, create a concave ‘divot’ with your thumb in the aluminium noseband to guide proper placement high on the bridge of the nose
• Slightly extend the face mask by pulling the chin-side edge down
• Pleat configuration should be open in a downward “waterfall” effect to prevent pooling of condensate or aerosols
• Holding mask by the ear loops, orient the noseband divot placement on the face and secure a loop around each ear
• Never ‘twist’ the earloop into a figure 8 to gain a closer fit as this will cause the inner lining of the mask material to be in close contact with the DHCP’s mucous membranes (lips/nose)
• Never ‘pinch’ the noseband with thumb and index finger as V-notch exposure will remain
• Mold the nosepiece with index and middle finger to secure fit across the bridge of the nose and along orbits of the eyes
• Fully extend the chin-edge of the mask to cover the mouth and chin
• If an additional malleable chin-strip is available, pinch snugly directly under the chin to create a 360° peripheral seal
• If using a face shield, put on over the face mask and eyewear
• Doffing (removing): With clean hands, on each side of the head grasp the ear-loops of the mask, pull down lifting back and away to remove the mask from the face. Dispose of properly and immediately perform hand hygiene.

REFERENCES

1. Veena, e al. “Dissemination of Aerosol and Splatter during Ultrasonic Scaling: A Pilot Study.” Journal of Infection and Public Health 8, no. 3 (2015): 260-65
2. Harrel, S. “Contaminated Dental Aerosols: Risks and Implications for Dental Hygienists”. Dimensions of Dental Hygiene. October 2003;1(6):16, 18, 20
3. Molinari J, Nelson P, Face Mask Performance: Are You Protected?; Oral Health, March 16, 2016; https://www.oralhealthgroup.com/features/face-mask-performance-protected/ 
4. Rosen S, Schmakel D, Schoener M. Incidence of respiratory disease in dental hygienists and dietitians. Clin Prevent Dent. 1985; 7:24 -25
5. Grinshpun, S. A., Haruta, H., Eninger, R. M., Reponen, T., McKay, R. T., and Lee, S.-A. (2009). Performance of an N95 Filtering Facepiece Particulate Respirator and a Surgical Mask During Human Breathing: Two Pathways for Particle Penetration. J. Occup. Environ. Hyg., 6:593–603
6. CDC Summary of Infection Prevention Practices in Dental Settings https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care2.pdf 
7. Jorgenson G, Palenik C. Selection and use of personal protective equipment. The Dental Assistant 2004; 73;16-19