The use of surgical facemasks during cataract surgery: is it necessary?

Abstract

Aim: To assess whether facemask utilisation by the surgeon during cataract surgery has any effect on the bacterial load falling onto the operative site. Method: Prospective randomised masked study. Consent was obtained from 221 patients. Cases were randomised to wearing a new mask or not wearing any mask throughout the procedure. Blood agar settle plates were placed adjacent to the patient's head in the operative field. Duration of procedure was noted. Plates were incubated and read at 48 hours. Colony forming bacteria were counted and identified. Results: There were significantly fewer organisms cultured when the surgeon used a facemask (p=0.0006). The majority of organisms were Staphylococcus epidermidis, Bacillus spp, and Diphtheroid spp; however Staphylococcus aureus and Pseudomonas aeruginosa were cultured on several occasions. There were no cases of infective complication. Conclusions:The main purpose of an operating mask is to prevent bacteria falling on to the operative site from the surgeon's oropharynx or nasopharynx with the concomitant theoretical risk of infective complication. Operating masks were shown to have a significant effect on the volume of bacterial organisms falling to the operative site; however, whether this is clinically significant is unknown.T he use of surgical face masks for prevention of contamination during surgical procedures was first advocated in 1897 by Mikulicz, 1 a German physician. Since then there have been numerous studies attempting to determine whether the use of face masks has a significant effect on reducing surgical wound infection.2-10 Unfortunately the evidence in the literature has often been conflicting with little definitive guidance offered.In the field of cataract surgery the major infective complication of concern is postoperative bacterial endophthalmitis. This study was designed to determine whether wearing a surgical facemask during cataract surgery reduces the volume of potentially infective organisms falling on to the operative site. METHODSConsecutive patients undergoing phacoemulsification cataract surgery were recruited. There were no patient exclusion criteria. If the surgeon had a symptomatic upper respiratory tract infection then that operating list was excluded from the study.Ethics committee approval was obtained and consent obtained from 221 patients. Cases were randomised to group A "with mask" or group B "without mask."All operations were carried out in ophthalmic theatres fitted with high efficiency particulate air (HEPA) filtering systems providing positive pressure airflow and a complete change in theatre atmosphere 20 times per hour. The scrub nurse wore a new surgical facemask throughout. None of the other theatre staff wore face masks.The eye was cleaned with aqueous Betadine and a surgical adhesive drape was placed. A drop of aqueous Betadine was placed in the conjunctival sac. Cataract surgery was carried out by phacoemulsification via a superior or temporal corneal section. Subconjunctival Betnesol (4 mg) and cefuroxime (125 mg) (gen...

A model for the management of an atypical endophthalmitis outbreak

“…Staff entering or leaving the surgical area did not always use a mask. It has been shown that facemasks reduce bacterial contamination of the perioperative area, 12 although their effect on endophthalmitis rates are unknown.…”

Risk factors for endophthalmitis: does non-wearing of face-masks increase relative risk?

“…5 When prescribing oral tetracycline for the treatment of blepharitis in adult patients, it is important to advise on oral hygiene measures and on avoidance of sunlight to minimize staining of teeth. Patients should also be reassured that the stain may be removed with abrasive cleansing by dental surgeon.…”

As surgeons, our view of postcataract surgery endophthalmitis prevention is still not clear

“…Wearing a surgical face mask for cataract surgery is recommended. 12 Wear a surgical mask that fully covers the mouth and nose when entering the operating room if an operation is about to begin or already under way, or if sterile instruments are exposed. The current article is a retrospective study, and as such is limited by the inherent problems of any retrospective study (eg, recall bias, reporting bias, etc).…”