Does wearing a face mask reduce bacterial wound infection? A literature review.

Current practices of operating room management and sterile technique are direct descendants of the elaborate principles of antisepsis and asepsis set down by Lister. The surgical face mask has become an integral part of the uniform for theatre personnel since its introduction in an attempt to reduce the rate of clinical wound infections (von Mikulicz 1897). The Medical Research Council's (1968) recommendations on aseptic procedure advise donning a new mask for each patient and changing the mask part-way through long procedures (four hours or more). In most hospitals no one is allowed to enter an operating room without wearing a face mask. Anecdotal evidence in the author's own area of practice suggests that surgeons and other theatre personnel consider wearing face masks a nuisance but feel it is the "thing to do". Increasing costs of medical services is now a real problem. In one major teaching hospital in 1990, 10,000 pounds was spent on masks for theatre use (Leyland and McCloy 1993). Although the available clinical data suggests that the present generation of masks does not protect staff either from airborne bacteria or Hepatitis B virus (Ransjo 1986, Reingold 1988), theatre personnel may adopt self-protection as a reason for wearing a mask. It is not the intention of this literature review to examine self protection as a reason for wearing a face mask in theatre but to investigate whether masks do reduce bacterial infections in the postoperative patient.