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Face Masks as Protection From Laser Plume
SEPTEMBER 1989, VOL. 50, NO 3
AORN JOURNAL
Letters to the Editor
Response to ‘Nightingales’Editorial
T
he editorial in the May 1989 issue of the Journal regarding the “Nightingales” was excellent. Members of our local AORN chapter have written to Mr Tartikoff and the program sponsors. I agree with the entire editorial up to the last sentence. I am sure that your sentiment that Mr Tartikoff “does not require professional nursing care” in the near future is one shared by many nurses throughout the United States. My concern is that such a sentiment brings us down to his level of functioning. In the course of my career, I had to take care of an alcoholic who had run over and killed my next door neighbor’s child. My immediate response was that I hoped he died. But, my second response was that I am a professional nurse, and regardless of who my patient is or what he may have done, he is a human being who deserves the best nursing care that I can deliver. Mr Tartikoff also deserves the best of care. SANDRA J. FFAFF, RN, BSN, CIC INFECTION CONTROL NURSE UNIVERSlTY OF ROCHESTER (NY)
MEDICAL CENTER
issue of the Journal. In the section “Responses to surgery,” the author refers to a study by Cote et al, describing the effects of colored nail polish on pulse-oximetry readings. Cote concludes that nail polish should be removed before surgery to prevent false readings when oximetry is used. Although this was a minor part of the article, it caught my attention because I know of a similar study that was published in the April 1989 issue of Anesthesia and Analgesia, which contradicted Cote’s fmdings. Paul White, PhD, MD, and Walter Boyle, MD, of the Washington University School of Medicine, St Louis, performed a study in which fingernail polish was applied, and the oximeter probe was strategically placed to avoid the polished nail. The researchers found that it was possible to avoid erroneous readings by reorienting the probe in the lateral direction on the fingertip. They concluded that using this placement, nail polish and/or artificial nails did not have to be removed. These findings may be important to perioperative nurses who are responsible for placement of pulse-oximetry probes. LINDAWHITE,RN, MS, CNOR DIRECTOR, ORIPACU BARNESHOSPITAL ST LOUIS
Face Masks as Protection From Laser Plume
Use of Pulse Oximeter With Nail Polish
I
would like to comment on the article “Perioperative nursing research Part I V Intraoperative phase,” which appeared in the May 1989 520
I
n the April 1989 issue of the AORN Journal, the authors of the article “Perioperative nursing research: Part 111: Potential intraoperative
AORN JOURNAL
biological hazards to personnel,” summarized laser plume issues. I would like to comment on the authors’ discussion of the capability of surgical masks to provide “protection” from potentially hazardous agents in the laser plume. Surgical masks are not respirators. Respirators provide protection from defined respiratory hazards and are certified by the National Institute for Occupational Safety and Health (NIOSH). The potentially infectious hazard in laser plume has not been defined. As a result, there are no respirators certified by NIOSH for use in the presence of laser plume. Although the level of protection offered by a surgical mask is not known, surgical masks can reduce the amount of submicron particles to which a practitioner is exposed. The ability of a surgical mask to filter submicron particles can be determined by using the dioctyl phthalate (DOP) filtration efficiency test, which measures the ability of a material to filter a monodispersed aerosol of 0.3 micron diameter. Using the DOP filtration efficiency test, a Department of Energy Filter Test Facility recently tested three types of surgical masks. Promotional literature for two of the masks claimed 95% filtration efficiency for particles of 0.3 micron. In the test, one of these masks filtered less than 60% of those particles, and the other filtered less than 45%. The third mask, a standard surgical mask, filtered 56%of the particles. The face fit of a surgical mask also affects the amount of particles to which the practitioner might be exposed. A molded face mask with two head strips generally provides better face fit than a molded mask with one head strap or a traditional tie-on mask. Neither filtration efficiency nor face fit can guarantee protection from potentially infectious agents contained in laser plume. Until we can define a safe level of exposure to those agents, no one should claim that surgical masks provide that protection. Jo DICKES TECHNICAL SERVICE SPECIALIST INFECTION CONTROL PRODUCTS 3M CENTER ST PAUL 522
SEPTEMBER 1989, VOL. 50, NO 3
Authors’ response. The issue seems to be the use of a surgical mask as a protective device from laser plume. To reiterate, we have specifically stated that little research has been done to support the idea that laser plume contains viable cells that can be transferred to personnel. In addition, we did not state that a surgical mask of any type would serve as adequate protection. We did, however, encourage the use of a surgical mask on all procedures where laser plume was present as a protective measure, until adequate research is done. The issue surrounding masks seems to focus on their efficiency and ability to filter particulate matter of 0.3 micron diameter. Most discussion of laser plume takes into consideration virus size and carbon particles. It is believed that viruses are attached to the carbon particles, which increases the size of the particle being filtered. If this is true, we believe that some protection is better than none, and that a mask should be worn in the presence of any smoke or plume resulting from surgical procedures. JULIA A. KNEEDLER, RN, EDD OR CONSULTANT E D U C A ~ ODESIGN, N INC DENVER SUSANK. PURCELL, MA MEDICAL SCIENCE WRITER EDUCATION DESIGN,INC DENVER The Journal welcomes letters for its “Letters to the Editor” column. Letters must refer to Journal articles or columns published within the preceding two months. Each letter is subject to editing. Authors of articles or columns referenced in the letter to the editor will be given the opportuniw to respond Letters that are included in the ‘Zetters to the Editor” column must contain the readers name, credentials $ applicable (eg, RN, BSN, CNOR), position or title, employer, and employer’s address. Submit all correspondence to AORN Journal,Lettersto the Editor, 10170 East Mksksppi Ave, Denver, CO 80231.
AORN JOURNAL
Letters to the Editor
Response to ‘Nightingales’Editorial
T
he editorial in the May 1989 issue of the Journal regarding the “Nightingales” was excellent. Members of our local AORN chapter have written to Mr Tartikoff and the program sponsors. I agree with the entire editorial up to the last sentence. I am sure that your sentiment that Mr Tartikoff “does not require professional nursing care” in the near future is one shared by many nurses throughout the United States. My concern is that such a sentiment brings us down to his level of functioning. In the course of my career, I had to take care of an alcoholic who had run over and killed my next door neighbor’s child. My immediate response was that I hoped he died. But, my second response was that I am a professional nurse, and regardless of who my patient is or what he may have done, he is a human being who deserves the best nursing care that I can deliver. Mr Tartikoff also deserves the best of care. SANDRA J. FFAFF, RN, BSN, CIC INFECTION CONTROL NURSE UNIVERSlTY OF ROCHESTER (NY)
MEDICAL CENTER
issue of the Journal. In the section “Responses to surgery,” the author refers to a study by Cote et al, describing the effects of colored nail polish on pulse-oximetry readings. Cote concludes that nail polish should be removed before surgery to prevent false readings when oximetry is used. Although this was a minor part of the article, it caught my attention because I know of a similar study that was published in the April 1989 issue of Anesthesia and Analgesia, which contradicted Cote’s fmdings. Paul White, PhD, MD, and Walter Boyle, MD, of the Washington University School of Medicine, St Louis, performed a study in which fingernail polish was applied, and the oximeter probe was strategically placed to avoid the polished nail. The researchers found that it was possible to avoid erroneous readings by reorienting the probe in the lateral direction on the fingertip. They concluded that using this placement, nail polish and/or artificial nails did not have to be removed. These findings may be important to perioperative nurses who are responsible for placement of pulse-oximetry probes. LINDAWHITE,RN, MS, CNOR DIRECTOR, ORIPACU BARNESHOSPITAL ST LOUIS
Face Masks as Protection From Laser Plume
Use of Pulse Oximeter With Nail Polish
I
would like to comment on the article “Perioperative nursing research Part I V Intraoperative phase,” which appeared in the May 1989 520
I
n the April 1989 issue of the AORN Journal, the authors of the article “Perioperative nursing research: Part 111: Potential intraoperative
AORN JOURNAL
biological hazards to personnel,” summarized laser plume issues. I would like to comment on the authors’ discussion of the capability of surgical masks to provide “protection” from potentially hazardous agents in the laser plume. Surgical masks are not respirators. Respirators provide protection from defined respiratory hazards and are certified by the National Institute for Occupational Safety and Health (NIOSH). The potentially infectious hazard in laser plume has not been defined. As a result, there are no respirators certified by NIOSH for use in the presence of laser plume. Although the level of protection offered by a surgical mask is not known, surgical masks can reduce the amount of submicron particles to which a practitioner is exposed. The ability of a surgical mask to filter submicron particles can be determined by using the dioctyl phthalate (DOP) filtration efficiency test, which measures the ability of a material to filter a monodispersed aerosol of 0.3 micron diameter. Using the DOP filtration efficiency test, a Department of Energy Filter Test Facility recently tested three types of surgical masks. Promotional literature for two of the masks claimed 95% filtration efficiency for particles of 0.3 micron. In the test, one of these masks filtered less than 60% of those particles, and the other filtered less than 45%. The third mask, a standard surgical mask, filtered 56%of the particles. The face fit of a surgical mask also affects the amount of particles to which the practitioner might be exposed. A molded face mask with two head strips generally provides better face fit than a molded mask with one head strap or a traditional tie-on mask. Neither filtration efficiency nor face fit can guarantee protection from potentially infectious agents contained in laser plume. Until we can define a safe level of exposure to those agents, no one should claim that surgical masks provide that protection. Jo DICKES TECHNICAL SERVICE SPECIALIST INFECTION CONTROL PRODUCTS 3M CENTER ST PAUL 522
SEPTEMBER 1989, VOL. 50, NO 3
Authors’ response. The issue seems to be the use of a surgical mask as a protective device from laser plume. To reiterate, we have specifically stated that little research has been done to support the idea that laser plume contains viable cells that can be transferred to personnel. In addition, we did not state that a surgical mask of any type would serve as adequate protection. We did, however, encourage the use of a surgical mask on all procedures where laser plume was present as a protective measure, until adequate research is done. The issue surrounding masks seems to focus on their efficiency and ability to filter particulate matter of 0.3 micron diameter. Most discussion of laser plume takes into consideration virus size and carbon particles. It is believed that viruses are attached to the carbon particles, which increases the size of the particle being filtered. If this is true, we believe that some protection is better than none, and that a mask should be worn in the presence of any smoke or plume resulting from surgical procedures. JULIA A. KNEEDLER, RN, EDD OR CONSULTANT E D U C A ~ ODESIGN, N INC DENVER SUSANK. PURCELL, MA MEDICAL SCIENCE WRITER EDUCATION DESIGN,INC DENVER The Journal welcomes letters for its “Letters to the Editor” column. Letters must refer to Journal articles or columns published within the preceding two months. Each letter is subject to editing. Authors of articles or columns referenced in the letter to the editor will be given the opportuniw to respond Letters that are included in the ‘Zetters to the Editor” column must contain the readers name, credentials $ applicable (eg, RN, BSN, CNOR), position or title, employer, and employer’s address. Submit all correspondence to AORN Journal,Lettersto the Editor, 10170 East Mksksppi Ave, Denver, CO 80231.