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Mask Level Research

So recently I took the infection control quiz that Kara posted & was concerned with my office’s mask levels. Both offices were using ASTM Level 1/Low Barrier. I addressed this with my first office & they bought level 3’s no problem.
Today, I talked to my other office about it- in response, they sent out a group email about how our masks are effective & they researched them & if we find any research otherwise to send it to them. This is part of the email:
“ Note that the higher level masks should have a PFE (particulate filtration efficiency) of 99.8%. The OSHA standard for all dental procedures is 98%. The masks we use are greater than 99%.” they also attached two articles to the email, which I’ll post here.

http://www.dimensionsofdentalhygiene.com/2010/03_March/Features/Maximizing_Protection.aspx
http://www.osap.org/?FAQ_PracticeSafety#wewereall

I am really confused, how can our masks keep out 99% but only be ASTM Level 1/Low barrier. Unfortunately I don’t have a picture of the box but I just looked at it yesterday. They also included that hey can have a level 3 box on hand for heavy ultrasonic use or chlorhexidine for pre-procedural rinses. Note: I Cavitron 97% of my patients, so I feel most comfortable using a high mask level.
Point is, I’m looking for help understanding the levels, verifying if our masks are useful for us or not & any research I can submit to my office if they are not.



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Author Note:
UPDATE: I checked our mask Levels this morning & the box says 95%, not 98%.

1 Answer

Good for you for addressing face mask ASTM levels at both of the offices you work at! However, it’s disappointing that one office is pushing back and not interested in providing its employees with the most appropriate masks for the treatment rendered.
 
The Dimensions of Dental Hygiene article they provided with the email actually backs up your argument entirely. It states, “The “one size fits all” mask approach where all procedures are completed with the same type of mask by all office staff should be revisited. Mask selection based on both proper fit and given application or exposure risk of the activity is a more contemporary approach.”
 
While OSHA requires at least an ASTM level 1 mask (>95% BFE), this level mask is most appropriate for procedures that don’t create any aerosols like taking radiographs, taking impressions, fluoride treatments, exams, etc. Clearly, if the box of the masks this office uses state on the box they are ASTM level 1 with a BFE of 95%, then whoever wrote the email is mistaken. The person who wrote the email is also inaccurate in the OSHA guidelines.
 
It’s important to remember that “standards,” as in “OSHA standards” or like the term “standard of care,” is the LOWEST level of conduct which practitioners or offices can operate. In other words, if the lowest grade to pass was a “C” then practicing at the standard of care would be getting an academic grade of a “C.”
 
As far as references, the Dimensions article has references/research at the bottom of the article, including the American Society for Testing and Material (ASTM): Standard Specification for Performance of Material used in Medical Face Masks (https://www.astm.org/Standards/F2100.htm). Unfortunately, to download the ASTM Standard costs $41. The Quiz from Today’s RDH has a reference from Dentistry Today: Translating the Science, which breaks down what the ASTM document states. Here’s the link: https://www.dentaladvisor.com/pdf-download/?pdf_url=wp-content/uploads/2015/02/face-masks-what-to-wear-and-when.pdf
 
I would suggest showing the box of the masks that are provided to the person who wrote the email and also pointing out what was written in the Dimensions article they provided along with the Dentistry Today: Translating the Science document. Best of luck, this has got to be frustrating!

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