Fooled into masking follow-up. Do Surgeons Need Masks?

If masks don't work why do surgeons wear them?  I've received this comment a lot on every single   video I've made about masking. I'm going to tell  you the history about why surgeons started wearing   masks, what the research actually tells us  about mask wearing in the operating room.   There have been studies done with masked  and unmasked operating room staff. Some   of you made interesting comments on my last  video about the Cochrane review of 15 masking   studies and I'll answer those questions as well  in this video. Now the reasons why surgeons have   historically worn masks have been twofold.  Masks have been worn in the operating room   ostensibly to reduce bacteria and saliva from  the mouth from contaminating the surgical field   and they possibly would provide some protection  to the Physicians and nurses who are wearing them   from inadvertent splashes of bodily fluids. Now  bacteria which we all carry in our mouths are   much larger than viruses and are contained in  the mask and can be cultured within the mask if   you've been wearing them for a length of time.  Surgeons talk during the operations of course   some even sing along to the music that can get  played in the OR. We've all had the experience   of someone talking to us and unfortunately  receiving some of their saliva on her own face.   This is what masks are designed to prevent.  The other reason is that masks would prevent   patient's bodily fluids or blood splashing on  the surgeon's face. In many operating rooms all   of the staff in the room have to wear masks. There  are obviously different risks between the surgeon   and the surgical assistant who stand beside the  patient and others in the room. The surgeon and   surgical assistant are scrubbed in other words  they've washed their arms and hands and they   have sterile gowns as well as sterile gloves on.  The scrub nurse handing the surgical instruments   is also scrubbed and is also gowned and gloved and  stands near the patient. Now the remaining people   in the room are not scrubbed and would include the  circulating nurses, the anesthesiologists, porters   who might assist transferring the patient in and  out of the room, as well as housekeeping staff.   The question is who in the operating  room if any needs to be wearing masks?   Now the interesting thing is that do we truly know  that the scrub staff again the surgeon, surgical   assistant, and scrub nurse, need to wear masks  like many of my commenters mentioned. The answer   is we just don't know. People assume that they do.  You must remember that people make assumptions in   life that just because we do things a certain way  means there's definite evidence that that way is   helpful. Sometimes things are done because it's  practical or it makes some sense to do it that   way and that's essentially what I'm talking about  in this situation but what is the actual evidence?   Well Cochrane actually has published a systematic  review of masks in the operating room. For those   that don't know the Cochrane reviews they're  considered the gold standard of evidence-based   medicine where they only look at the best studies  and review those to formulate the best medical   practices. They're heavily peer reviewed. This is  their review and it was published back in 2016.   There have been some newer reviews from other  authors including this one in 2021, but there have   not been any good quality randomized trials in the  last seven years. Face masks in the operating room   actually date back to 19th century Germany.  There have been some observational studies   which have cast doubts on whether face masks are  actually needed in the operating room. There was   an observational study back in 1981 in England  where no one in the operating room wore masks   for six months. There's a link to the study in  the description. Now this was their results and   what they did was they compared the 6 months in  the preceding 4 years in a row and you can see   when masks were worn there were about 16 to 19  infections over that time span but during the 6   months of where no masks were worn there were only  8 infections which was a statistically significant   difference. In addition the infections that were  cultured during the 6 months with no masks or no   relationship to the bacteria cultured from the  surgical staff's nose and throat and while this is   an interesting observational study what we really  need is randomized studies where one operating   theater is randomized to mask wearing and to  compare it to another operating room theater   where the staff is actually masked. Now there  have been three randomized studies that were   reported in the 2016 Cochrane review there were  2,106 participants in the three trials Tunevall   in 1991 reported 13 out of 706 which is 1.8% of  post-operative wound infections in the masked   group and 10 out of 723 or 1.4% in the non-masked  group and that was not statistically different.   Chamberlain in 1984 had a very small study of only  9 patients in gynecological surgery that reported   no post-op wound infections in the masked group  and 3 out of 10 in the non-masked group which had   no statistically significant difference due  to a very small sample size. Webster in 2010   randomized the non-scrub staff to masks versus  no masking they reported 33 out of 313 patients   or 10.5% in the mass group got infected and 31  out of 340 or 9.1% in the non-masked group. That   was not statistically significant. The Cochrane's  conclusion were that from the limited data that   I've just presented it's unclear whether wearing  surgical face masks by either surgical team either   increased or reduced the risk of surgical site  infection in patients undergoing clean surgery. So   essentially we don't truly know who if any needed  to be masked for this surgery in the OR. Better   randomized studies would need to be done and this  needs to include a large sample size to detect   clinically important differences in infection  rates as well as of course to discriminate between   those who were scrubbed in the room and close  to the patient and those who were not scrubbed.   Future research should have clear definitions  of the kind of surgery as well as who in the   operating room actually needs face masks.  The randomization needs to be done per   operating room list and not per case to avoid  contamination of the surgical environment   and guard against bias and follow-up of  course needs to extend post-operatively   into the outpatient sphere after the operation  to pick up infections that might develop late.   Of course the outcome assessment needs to  be blinded to the allocation of masking.   Economic evaluations need to be incorporated.  Some hospitals including the world-renowned   Karolinska institute in Sweden have looked at  the Cochrane evidence specifically the Webster   study I reported at the end and they've  chosen to allow non-scrubbed people such   as anesthesiologists to not wear masks in the  operating review given the lack of evidence.   This is approved by their surgeons. It's important  to be skeptical of how we all do things in life   whether it's medicine or otherwise ask yourself  whether what you're doing is based on evidence   or whether we're simply doing something one  way because we've always done it that way.   There's nothing wrong with questioning what we  do even things that might intuitively make sense.   Remember that medical reversals happen commonly.  It's estimated that about 10 to even 50% of what   we do in medicine will subsequently be reversed.  One of my former teachers Dr David Sackett who is   known as one if not the pioneer of evidence-based  medicine used to say that 50% of what you learn   in medicine will subsequently found out to be not  true but the problem is you don't know which 50%   it is. In the case of masking in the operating  room it would be helpful to know whether the   non-scrubbed personnel benefit from masking as  well as whether the scrubed personnel need to   be masked. There would be significant costs that  could be saved by not masking even time saved from   the staff putting on their masks and tying up  their masks. Operating room costs are typically   on the order of ten dollars a minute. Reducing  garbage would have significant implications as   well. Next my recent video on the use of masks  to prevent Covid generated a lot of comments. As   I mentioned in the video the topic of community  masking is extremely polarized with many people   putting forth their opinion on both sides of the  spectrum. The key word there is opinion. My video   was based on the Cochrane systematic review of  physical interventions to prevent Covid-19. Now   to briefly summarize proper hand washing was found  to be helpful in randomized trials as you might   expect but there was low to moderate certainty  of evidence that masking was not of any benefit.   Now as expected there was a lot of dissent on the  results and the pro masking people made some poor   arguments that it was an example of cherry-picking  studies. The systematic reviews by Cochrane are   specifically designed to address the issue of  cherry picking. Their process is rigid where every   inclusion exclusion and evaluation is accounted  for which is why the actual document is over 300   pages long. Cochrane reviews informed the World  Health Organization and government guidelines   because of how thorough their evaluations  are. Their system is heavily peer reviewed.   Many of the criticisms of the Cochrane review  were that Cochrane did not include poor quality   observational studies showing that masks worked.  As I mentioned in my video you can't rely on   heavily confounded observational studies for  medical interventions. There were many heavily   confounded observational studies reported  in the last three years but unfortunately   the limitations of the studies made the results  highly suspect and really completely unhelpful. I   reviewed this study reported by the CDC to show  these profound limitations that reported that   even basic cloth masks were very helpful in an  observational review but a randomized Bangladesh   study looking at three-Ply cloth masks with a  metal nose piece was found to have no benefit.   Now the Cochrane reviewers they only looked  at well done randomized studies and that's the   important thing. They concluded as I've mentioned  that there was load of moderate confidence in the   results primarily because masting was just not  studied in the depth that was clearly needed.   Many governments and organization just assumed  that it was going to work even though it's   not been helpful for influenza and we have  many randomized studies that look at that.   Despite that mandates were made  without hard evidence of benefit.   One of the interesting and frequent comments  that I saw was the assumption that the virus   could only be transmitted through the air and that  robot or human models using masks was a hundred   percent evidence that masks can be helpful. Now  unfortunately respiratory viruses are transmitted   in different ways and we know that. We can find  live virus which can subsequently replicate in   humans on surfaces such as people's hands that's  why hand washing is helpful the outside of masks   and so on. A lot of the people commented that  the reason why masks weren't helpful in studies   is that people weren't using them properly.  Although there was teaching in the randomized   studies as to how to wear masks and there's no  question that most people don't wear the mask   properly but that's unfortunately real life. Some  commenters mentioned that masks would have worked   if people wore them all the time. Now this is  obviously impractical and as I mentioned in the   video even health care workers at the hospital  take their masks off from time to time and even   in places where there were mandates such as on  public transportation masks were allowed to be   removed to eat or drink and this is real life. I  hope you found my video today to be informative.   I appreciate you watching until the very end  and remember get healthy and stay healthy.

Channel: Medicine with Dr. Moran

Views: 112,549

Keywords: Should surgeons wear masks, do surgeons need to wear masks, surgical masks, masks, COVID 2023, Dr. John Campbell, do surgeons need masks, why do surgeons wear masks, surgical mask, Masks in the operating room, mwdrm, kwvm, masking, OR masking, Nurse mask, surgeon mask, surgical masking, surgical infection, anaesthesiologist, anaesthetist, anaesthesiologist masking, COVID masking, Cochrane, Cochrane collaboration, COVID masks, COVID mask, masks don't work, mask fitting tips, covid

Id: 2S4VEIgFrgs

Length: 13min 9sec (789 seconds)

Published: Sun Mar 12 2023