Sterile field contamination from powered air-purifying respirators (PAPRs) versus contamination from surgical masks

Currently, powered air-purifying respirators (PAPRs) are not recommended for usage in close proximity to sterile fields owing to concerns that exhaled, unfiltered air potentially may cause contamination; however, this has not been confirmed by experimental study.

After establishing background levels of airborne contamination, our team placed settling plates in a sterile field and collected contamination from participants who were performing particulate-generating actions. Participants performed the actions while wearing various forms of respiratory protection, including: (1) a full facepiece PAPR, (2) a full facepiece PAPR with a shoulder-length hood, (3) a surgical mask, and (4) no facial covering (as a positive control to determine contamination-reduction effectiveness). Specimens were collected at the end of a 10-minute sampling time frame. After incubation at 36.5˚C for 72 hours, we tabulated colony forming units as a marker of contamination.

Surgical masks and the 2 PAPR configurations all drastically reduced aerosolized droplet contamination. Surgical masks reduced contamination by 98.48%, and both PAPRs reduced contamination by 100% (compared with the usage of no facial covering). There was no statistical difference between their effectiveness (surgical mask vs both PAPRs, P value = .588 and no hood PAPR vs hood PAPR, P value >.999).

Based on these findings, the tested PAPR configurations are effective at reducing aerosolized droplet contamination into a sterile field, and further testing is warranted to assess other PAPR configurations as well as PAPR suitability in an operating room.