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Surgical Mask vs Non-surgical Mask

If you think that all masks are made equal, then you are definitely wrong! Not all masks provide the same level of protection that you need with today’s health crisis. While all masks offer some level of protection, understanding what separates medical masks from non-medical masks is a vital consideration, especially when you want to protect you and your family. 

(Source: Pexels.com/photo/photo-of-man-and-woman-wearing-face-masks-4148971/)

While both may be referred to as face masks, these two protective devices are actually utilized for different functions and different settings. Surgical masks and non-surgical masks are very different kinds of masks from the material used to the intended uses. Below is a breakdown of what separates surgical masks from non-surgical masks and the levels of protection that they provide. 


What are Surgical and Non-Surgical Masks?

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Surgical masks are considered as medical masks. These masks are a form of disposable covers that are usually worn by medical professionals as personal protective equipment (PPE) during surgeries or other medical procedures. Furthermore, when indicated, surgical masks are typically worn in conjunction with other types of PPE in order to protect the wearer from exposure to the potentially infectious respiratory droplets of infected patients.  Surgical or medical masks are frequently made of a combination of paper and plastics, and are commonly manufactured to have a light blue color.  Studies have shown that surgical masks have the ability to protect wearers from large respiratory droplets but do not have as strong protection against smaller droplets. However, it must be noted that when worn correctly, medical masks can serve as a form of source control, protecting those around the wearer from potential exposure to their respiratory droplets, especially when the wearer is a carrier of a virus. Lastly, unlike non-surgical masks or cloth masks, medical masks cannot be washed or reused, hence it is intended to be worn only once before being discarded.

(Source: Pexels.com/photo/business-people-wearing-face-masks-and-talking-4427957/)

Non-medical masks are cloth masks or masks not certified as medical grade by Health Canada.  Just like surgical masks, a cloth face mask or non-medical masks fits against the face using either ear loops or ties around the head. Several layers of fabric creates a protection between your nose and mouth and the external environment, aiding in containing any respiratory droplets that you may breathe out. Hence, the sole purpose of wearing non-medical masks is for source control. With that, non-medical masks have the capacity to protect those around the wearer from possible exposure to the wearer’s respiratory droplets, especially when worn properly. However, it must be noted that non-medical masks are not considered as personal protective equipment and are not recommended to be used in scenarios where the use of PPE is indicated, such as when attending direct care to or within 2 meters of an individual suspected or confirmed to be infected with COVID-19. 

What makes Surgical Mask different from Non-surgical mask?

It is understood that surgical and non-surgical masks offer a degree of protection against respiratory droplets that may contain infectious viruses. Furthermore, it has been shown that both can actually work as a source of control, protecting others from the wearer’s potential infective muco-salivary secretions. However, it must be noted that surgical masks are far way better than non-surgical masks.

The American Society for Testing and Materials  (ASTM) is an international standards organization that develops and publishes voluntary consensus technical standards for a wide array of materials, products, systems, and services, including those that are utilized in the healthcare field. Furthermore, the ASTM is responsible for setting the standards for surgical masks. Their ratings provide the criteria to which surgical masks should meet to have an adequate protection and performance. With that, ASTM F2100, the current standard, reviews 5 basic criteria. These include Bacterial Filtration Efficiency (BFE) or the ability to filter bacteria; the Particulate Filtration Efficiency (PFE) or the ability to filter sub-micron particles; Fluid Resistance or the ability to prevent fluid penetration through the mask to the wearer; Delta P (Pressure Differential) or the measurement of how light and breathable a mask feels; and Flame Spread or the ability to withstand exposure from flame. Unlike Cloth masks, surgical masks undergo the scrutiny of the ASTM. In addition to that, ISO (International Organization for Standardization) 10993-5 and ISO 10993-10 also provide certifications for  skin sensitivity and cytotoxic testing for surgical masks. This ensures optimal comfort and minimizes the risk of adverse reaction from surgical mask materials and surgical mask usage.

(Source: Pexels.com/photo/photo-of-woman-wearing-protective-mask-4270078/)

Cloth masks do not have ASTM ratings. Surgical masks, on the other hand, have ASTM ratings that span from Level 1 to Level 3, in which each level offers an increased level of protection across the range of criteria:

  • ASTM Level 1 - these surgical masks are utilized for general procedures, minimally invasive surgery, ophthalmology, and respiratory etiquette. Surgical masks under ASTM Level 1 has a BFE at 3.0 micron of  ≥ 95%, PFE at 0.1 micron of  ≥ 95%, Delta P of < 5.0 mm H2O/cm2, Fluid Resistance to synthetic blood at 80 mm Hg, Flame Spread Class 1 per 16 CFR part 1610.
  • ASTM Level 2 - these surgical masks are utilized for procedures such as general surgery and endoscopy while providing greater breathability than high barrier (Level 3) masks. These surgical masks were designed to resist a splash or spray at arterial pressure. Surgical masks under ASTM Level 2 has  BFE at 3.0 micron of  ≥ 98%, PFE at 0.1 micron of  ≥ 98%, Delta P of < 6.0 mm H2O/cm2, Fluid Resistance to synthetic blood at 120 mm Hg, and Flame Spread Class 1 per 16 CFR part 1610.
  • ASTM Level 3 -  these surgical masks are utilized in order to have the highest fluid resistance. These surgical masks were designed to resist a splash or spray during tasks like orthopedic surgery or trauma. Surgical masks under ASTM Level 3 has BFE at 3.0 micron of ≥ 98%, PFE at 0.1 micron of  ≥ 98%, Delta P of < 6.0 mm H2O/cm2, Fluid Resistance to synthetic blood at 160 mm Hg, and Flame Spread Class 1 per 16 CFR part 1610.
  • With that, surgical masks greatly differ from cloth masks because it has reached the standards and criteria set by the ASTM. It must be noted that if surgical masks are not available in a particular area, cloth masks can be utilized. However, particular guidance for wearing cloth masks was set by the Centers for Disease Control and Prevention (CDC). These include the following: 

    1. Wearers should ensure that the cloth masks cover the nose and mouth and are secured with ties or ear loops, fitting snugly but comfortably, without gaps.
    2. It is important that wearers do not touch their cloth masks while wearing it. If it has been touched, wearers should sanitize and wash hands immediately. 
    3. When removing cloth masks, one should not touch his or her face - especially the nose, eyes, and mouth - or the front of the mask.
    4. After removing the cloth mask, washing of hands should be done immediately
    5. Per manufacturer's instructions, cloth masks should be regularly cleaned in a washing machine.
    6. One should make or look for cloth masks that have more than one layer of fabric. To wear a gaiter as a mask, choose one with two layers, or fold it to make two layers.
    7. In order to aid in preventing fogging when wearing glasses with a face covering, choose a cloth mask with a nose wire or tight-fitting nose area.
    8. It is important to remember that while wearing a cloth mask is an important precaution, washing of hands frequently and following social distancing guidelines are still vital measures. 
    9. It is vital to remember that cloth face masks are not a substitute for required respiratory protection.

    Bottomline:

    Face masks are an important protection against viruses that may cause illness such as COVID-19. With that, it is vital that you should always choose the kind of masks that are scientifically proven and tested by a verified and certified body, so that you can make sure that you get the right protection that you need. At the end of the day, whether it may be a surgical mask or a non-surgical mask, the effectiveness of masks can be improved by ensuring that the masks are well fitted to the contours of your face to prevent leakage of air around the masks' edges. Make sure that your mask is snug over the nose, mouth and chin, with no gaps. Together with proper handwashing and social distancing, wearing your mask properly and at all times is an effective strategy in reducing the transmission of the deadly COVID-19 virus - hopefully ending this global health crisis. 

    References: 

    1. Canadian For Centre Occupational Health and Safety. Respirators, Surgical Masks, and Non-Medical Masks. 2020. Retrieved from: https://www.ccohs.ca/images/products/pandemiccovid19/pdf/masks.pdf. Retrieved on 29 March 2021. 
    2. Esposito S, Principi N, Leung CC, Migliori GB. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Eur Respir J. 2020;55(6):2001260. Published 2020 Jun 18. doi:10.1183/13993003.01260-2020
    3. MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud. 2020;108:103629. doi:10.1016/j.ijnurstu.2020.103629
    4. Mayo Foundation for Medical Education and Research (MFMER). 2020. How well do face masks protect against coronavirus?. Retrieved from: https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-mask/art-20485449. Retrieved on 29 March 2021. 
    5. PRIMED Medical Products. 2020. Medical vs Non-Medical Masks: Considerations to Optimize Protection. Retrieved from: https://www.primed.ca/medical-vs-non-medical-masks/. Retrieved on 29 March 2021. 
    6. Public Health Ontario. 2020. COVID-19: Non-Medical Masks. Retrieved from: https://www.publichealthontario.ca/-/media/documents/ncov/factsheet/2020/11/covid-19-non-medical-masks-qa.pdf?la=en. Retrieved on 29 March 2021. 

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