Time for a new mask model specifically for health care

Current situation 'frankly quite inadequate'

It's time for a new mask. Neither surgical masks nor industrial respirators were ever designed to prevent airborne occupational infections in health care workers, though that is the role they have haphazardly evolved to fill, laments Michael Bell, MD, medical epidemiologist in the Centers for Disease Control and Prevention's division of healthcare quality promotion.

"We have a need for improvement in protective equipment," he said. "One of my chronic pet peeves is that really neither surgical masks nor respirators were ever designed with the intent of protecting us — the health care workers. These were things that were industrial devices in the case of respirators, which are supposed to protect people who are grinding metal or digging coal. Likewise surgical masks were intended to keep the wound clean while individuals are performing procedures — so they wouldn't spit on the wound."

Speaking recently in San Jose at the annual meeting of the Association for Professionals in Infection Control and Epidemiology, Bell said the CDC is using pandemic influenza research funds to conduct experiments on various masks and respirators. However, he has issued a broader challenge to industry and respirator manufacturers, asking them to design something — finally — specifically for the health care setting.

"I think it's about time that we take the next step," he said. "The health care setting is different from industry in general. The way we use respirators is different, the type and number of individuals who use respirators are different, and the requirements for the job are very different."

First and foremost, the mask/respirator should be designed to prevent infection of bacterial, viral and fungal etiology. "This is something that needs to be designed and tested with regard to preventing infection, not just excluding latex beads," he said.

The respirator should provide effective fit for more than 90% of users without fit-testing, he stressed. "[We need] something that is comfortable to wear for an hour of patient care if necessary and it allows you to speak clearly to a patient," he said. "I'm sure you have all had the experience where you have a 77-year-old person who is a little hard of hearing, you have a respirator on your face, and you are in an airborne isolation room with a whirring noise. That poor patient can't hear a darn thing your saying, and this is a problem."

The shelf life for the ideal mask/respirator should be at least several years, particularly since there is an emphasis on stockpiling in influenza pandemic planning. "Lastly, something that was reasonably priced and maybe even reusable," Bell said. "I could certainly foresee sending a textile-type mask back down to central processing to be repackaged and sent back up. There are many things that need to be looked at, but this is an opportunity to go beyond what we have now, which is frankly quite inadequate."