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December 06, 2018
Flu protection: Respirator or surgical mask?

The 2018–2019 flu season is fully upon us and, according the Centers for Disease Control and Prevention (CDC), may continue well beyond the beginning of spring 2019. February is typically the peak month (by a large margin) in the flu season. This can be a high-risk period for workers in healthcare facilities where sick people may be streaming in because of an extensive community outbreak. Healthcare employers are required to take actions to protect their employees from infection. But what those actions must be—whether in a healthcare facility or any facility where a worker may be exposed to a virus—are not specified by law.  “Your employer does have a duty to protect you from recognized hazards,” states OSHA. “However, there is no specific duty that details what an employer must do to protect you from an infectious disease.”

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Vaccinations do not guarantee protection

In fact, there are multiple ways an employee can be protected against the flu. The best known is the flu vaccination. But the effectiveness of vaccinations can vary significantly. The CDC states:
“At least two factors play an important role in determining the likelihood that flu vaccine will protect a person from flu illness: 1) characteristics of the person being vaccinated (such as their age and health), and 2) the similarity or ‘match’ between the flu viruses the flu vaccine is designed to protect against and the flu viruses spreading in the community. During years when the flu vaccine is not well matched to circulating influenza viruses, it is possible that little or no benefit from flu vaccination may be observed. During years when there is a good match between the flu vaccine and circulating viruses, it is possible to measure substantial benefits from flu vaccination in terms of preventing flu illness and complications. However, even during years when the flu vaccine match is good, the benefits of flu vaccination will vary, depending on various factors like the characteristics of the person being vaccinated, what influenza viruses are circulating that season and even, potentially, which type of flu vaccine was used.”

During the flu season or any infectious outbreak, healthcare employers may require that employees protect themselves by wearing either respirators or surgical masks. As OSHA points out in a fact sheet, there is a substantial difference in the level of protection afforded by these two types of personal protective equipment.


Respirators are designed to reduce a worker's exposure to airborne contaminants. Respirators come in various sizes and must be individually selected to fit the wearer's face and provide a tight seal. A proper seal between the user's face and the respirator forces inhaled air to be pulled through the respirator's filter material and not through gaps between the face and respirator.

“Respirators offer the best protection for workers who must work closely (either in contact with or within 6 feet) with people who have influenza-like symptoms,” states OSHA.

OSHA emphasizes that where workers are required by employers to wear respirators, they must be National Institute for Occupational Safety and Health (NIOSH)-certified, selected, and used in the context of a comprehensive respiratory protection program (see OSHA standard 29 CFR 1910.134). Also, it is important to medically evaluate workers to ensure that they can perform work tasks while wearing a respirator.

Surgical masks

Surgical masks are used for several different purposes, including the following:

  • Placed on sick people to limit the spread of infectious respiratory secretions to others;
  • Worn by healthcare providers to prevent accidental contamination of patients' wounds by the organisms normally present in mucus and saliva; and
  • Worn by workers to protect themselves from splashes or sprays of blood or bodily fluids; they may also keep contaminated fingers/hands away from the mouth and nose.

The message here is that surgical masks are not as effective as respirators in protecting the wearer from being infected by a virus.

“During inhalation, much of the potentially contaminated air can pass through gaps between the face and the surgical mask and not be pulled through the filter material of the mask,” states OSHA. “Their ability to filter small particles varies significantly based upon the type of material used to make the surgical mask, so they cannot be relied upon to protect workers against airborne infectious agents.”

Only surgical masks that are cleared by the U.S. Food and Drug Administration to be legally marketed in the United States have been tested for their ability to resist blood and bodily fluids.

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