Among the following, which is the safest mask for the ICU nurse during endotracheal suctioning in a mechanically ventilated patient having COVID infection?

1. A

   FFP-1 mask

2. B

   N95 mask

3. C

   Triple layered surgical mask.

4. D

   Surgical mask placed over a cloth mask

Appeared in: Haryana CHO - 2022

Explanation

• Endotracheal suctioning is classified as an aerosol-generating procedure (AGP), which creates fine, airborne infectious particles.
• For AGPs on patients with airborne diseases like COVID-19, a high-filtration respirator is mandatory to protect the healthcare worker.
• The N95 mask is a NIOSH-approved respirator that filters at least 95% of airborne particles and provides a tight facial seal, making it the standard of care for this situation.
• Surgical masks are not designed to protect against inhaling small aerosolized particles.

Why Other Options Were Wrong

• Option A: An FFP-1 mask offers a filtration efficiency of only about 80%, which is insufficient protection against the high concentration of viral aerosols generated during suctioning.
• Option C: A triple-layered surgical mask is designed to block large droplets and splashes but does not provide a tight seal around the face, allowing smaller airborne particles (aerosols) to be inhaled.
• Option D: This combination is not a recognized or approved form of PPE for healthcare workers during high-risk clinical procedures. It does not provide the certified filtration and seal of a respirator.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Personal Protective Equipment (PPE) for Aerosol-Generating Procedures (AGPs) in acute care settings.
• Performing an AGP like endotracheal suctioning without an N95 respirator places the nurse at a very high risk of contracting airborne infections such as COVID-19 or tuberculosis.
• A crucial nursing responsibility before any AGP is to don the complete PPE kit: N95 respirator (after a seal check), eye protection (face shield or goggles), gown, and gloves.
• Healthcare facilities must have a respiratory protection program that includes fit-testing for all staff required to wear N95 respirators to ensure a proper seal.

How to Approach the Question

• First, identify the clinical procedure mentioned in the stem: 'endotracheal suctioning'.
• Recognize that this is an aerosol-generating procedure (AGP), which carries the highest risk of transmission for respiratory pathogens.
• Next, identify the patient's condition: 'COVID infection', a disease transmitted via airborne routes, especially during AGPs.
• Recall the different levels of respiratory protection. For AGPs and airborne precautions, a high-filtration, tight-sealing respirator is mandatory.
• Evaluate the options based on this requirement. An FFP-1 and surgical masks do not provide adequate filtration or seal for aerosols.
• Conclude that the N95 mask is the only option that meets the standard of care for this high-risk procedure.

Concept Tested & Keywords

• Concept Tested: Personal Protective Equipment (PPE) for Aerosol-Generating Procedures (AGPs)
• Stem keywords: safest mask, ICU nurse, endotracheal suctioning, mechanically ventilated, COVID infection
• Lead-in keywords: which is
• Clinical cues: The procedure 'endotracheal suctioning' is a key clinical cue, as it is a known aerosol-generating procedure (AGP).
• Clinical cues: The diagnosis 'COVID infection' indicates the need for airborne precautions.

Question ID

Q8Npu7CcomxhMCmRl8ct6l

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 2 p. 237-239

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1621-1623