Complete nose coverage to prevent airborne contamination via nostrils is unnecessary

Abstract

Besides an atraumatic procedure, aseptic techniques during surgery have been suggested to have a positive impact on the predictability of osseointegration. To avoid an infection of the surgical field, coverage of the face of the patient (drapes) and nose (surgical mask, drape and plastic film) were advocated in order to reduce airborne infections and to prevent a contact contamination of instruments and gloves. Such a coverage, however, increases the feeling of claustrophobia when local anaesthesia is used and can lead to hypoxemia. The aim of the present study was to investigate whether the expired air via the nostrils could contribute to the contamination of the oral surgical field. Test blood agar plates were installed for 30 min under the nose of volunteers lying on a surgical table; once with full coverage of their nostrils, as indicated above, and once without. Simultaneously, control plates were installed on a table besides the patient to measure the basic contamination from the environment. All plates were incubated both aerobically and anaerobically. The number of colony forming units (c.f.u.) recorded on test plates after aerobic and anaerobic incubation were surprisingly low, with a mean score of 2.7 and 5.0 c.f.u. for the uncovered situation, and 2.5 and 3.3 c.f.u. for the covered situation, respectively. The control plates were infected by a nearly comparable number of bacteria (means ranging from 2.2 to 3.2). These findings indicate that covering nostrils by a mask and sterile adhesive plastic film is not essential in avoiding airborne microbial contamination. However, the use of a meshed nose guard to prevent contact with the highly contaminated nasal skin is highly recommended.