Cloth Mask, Surgical Mask or N95 respirator?

Amidst PPE shortages and ongoing questions of how and when to provide staff with appropriate protective equipment, our legal panel recently addressed the issue of when (and whether) a fabric mask is enough.

According to Jeff Segal, M.D., J.D., Founder, Medical Justice Services, the main reason for wearing a mask is literally to keep your fingers out of your mouth.

“It's a way to avoid hand-to-mouth transmission of virus,” he says.

And cloth masks, surgical masks and N95 respirators all do that.

However, there are particular situations that require an N95 respirator, namely for aerosol-generating procedures, procedures that require intubation or procedures on patients who have been exposed to COVID exposure or have an active infection.

These are situations in which “…someone is either a quite sick and you're around them, or you're going to be doing a procedure on someone where there's intubation [or] if you're in a dentist office and there's a drill going and things are going flying all over the place. That's an aerosol-generating procedure, so in those types of circumstances the N95 mask would be the bare minimum that you would need for that,” says Dr. Segal. “But in, in general, and in real life, just doing a facial injection, for example, on someone who is not symptomatic, you can use a surgical mask and it makes a little easier to talk through a surgical mask compared to an N95 respirator mask.”

Randolph Waldman, M.D., Editorial Advisor, Aesthetic Authority, Founder and Director of the multi-specialty Global Aesthetics Conference in Miami Beach, Fla., agrees, but also adds that he will be taking additional precaution in his Lexington, Ky.-based practice.

“…in the state of Kentucky, they require us to use dental precautions when we're injecting around the mouth, particularly lips and… around the nose. So we're now into the territory where the virus does hide out, and I think that aerosolization there can be a possibility. So… in our practice, we're probably going to be using N95 masks if we're injecting the perioral region on someone.”

What about plume? Whether from bovie or CO2 laser use, “Is there any particular liability that we would have with plume in this COVID environment?” asks Dr. Waldman.

According to Dr. Segal, he doesn’t have a definitive answer, but he does have practical advice.

“That's the first time I've ever heard that brought up, so I don't know the answer to it. I think protect your eyes, protect your mouth. I'm going to take an educated guess because the coronavirus is a wimpy virus. It doesn't take much to destroy it. It's got a lipid bilayer. It's easy to use soap and water to get rid of it. And heat also apparently destroys it pretty quickly, so if the bovie is doing its job and generating some heat, there's a high likelihood that that is not the greatest risk for the procedure. But the truth is I don't, I don't know that anybody really knows.”

Dr. Segal also points out that compared with the general population, healthcare providers seem to be at higher risk.

“Most people think it's because of just the large amount of COVID. That they've been exposed to higher concentrations in the sickest patients in the hospital. But I can't say I know with certainty that plume plays a role more than just the intubation and the aerosolization during the coughing and everything else that goes on with either intubation or extubation.”

Amidst these unknowns, protect yourself the best way you can, says Dr. Segal. “I think all you can do is try and protect your airway, protect your eyes at the same time and you're likely not to have a problem. I do know surgeries have clearly been going on since COVID began.”