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BMJ. 2007 December 22; 335(7633): 1293.
PMCID: PMC2151165

Excuse me!

J Granville-Chapman and R L Dunn review the etiquette of sneezing in surgical masks

Sneezing etiquette and the efficacy of masks in the operating theatre remain a subject of debate.1 Standard teaching dictates that one must face the wound when sneezing, so that droplets escape backwards, via the sides of the mask. A literature search found no clear demonstration of this principle.

We therefore tested the hypothesis that one should face the wound when sneezing into a surgical mask in theatre.

Method

A surgeon wearing a surgical mask (Kimberley Clark Healthcare) was encouraged to sneeze by inhaling finely ground pepper. A small reservoir of water was held in the floor of the mouth to improve the appearance of the droplets on the photographs. All photographs were taken by the medical photography department in a dark room with a dark background, using a Kodak DCS Pro SLR camera (ISO 160, 13.5MP resolution, RAW format) and a Nikon Micro-Nikkor 55mm F2.8 lens. A Sony HVL56AM flashgun was strobed (1/32 power, 2 sec, 10Hz). Images were converted into TIFF files and then sharpened slightly on Adobe Photoshop.

Results

Fig 11 shows the droplet spray from a sneeze without a mask. Fig 22 shows slight droplet spray escaping from the sides of the mask. Fig 33 shows there is also little spray escaping anteriorly. On close inspection, however, a few droplets can be seen escaping inferiorly on to the surgeon’s upper chest. None of our photographs showed substantial numbers of droplets passing behind the head of the surgeon.

figure granj530147.f1
Fig 1 Sneeze without a surgical mask: lateral view
figure granj530147.f2
Fig 2 Sneeze with a surgical mask: posterior view
figure granj530147.f3
Fig 3 Sneeze with a surgical mask: lateral view

Discussion

The doctrine of facing the wound when sneezing seems logical. Our study does not, however, support this hypothesis. A few droplets of spray escaped sideways, but no substantial numbers passed behind the surgeon’s head. Our photographs show that the most important visible escape of spray comes from below the mask on to the surgeon’s chest. We therefore recommend that surgeons should follow their instincts when sneezing during operations.

Notes

Competing interests: None declared.

References

1. Romney MG. Surgical face masks in the operating theatre: re-examining the evidence. J Hosp Infect 2001;47:251-6. [PubMed]

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