maybe i should 🤔

Lipp A, Edwards P. **Surgical face masks to reduce bacterial contamination of the surgical field: effectiveness and harms.** Cochrane Database Syst Rev. 2016;(2):CD006087. PubMed PMID: 26819913.

[2] Tunevall TG. **Postoperative wound infections and the use of an occlusive face mask by the surgical team.** Infect Control Hosp Epidemiol. 1991 Mar;12(3):155-9. PubMed PMID: 1906247.

[3] Webster J, Croger S, Lister C, Doidge M, Terry MJ, Jones I. **Use of face masks by non-scrubbed personnel in the operating room during clean surgery: a randomised controlled trial.** ANZ J Surg. 2010 Apr;80(4):243-9. PubMed PMID: 20546154.

[4] Orr NW. **Is a mask necessary in the operating theatre?** Ann R Coll Surg Engl. 1981 Sep;63(5):390-2. PubMed PMID: 7025465; PMCID: PMC2493966.

Tunevall et al., 1991

- Single-center RCT in Varberg, Sweden, 1984–1989.

- Population: 4,087 “clean” or “clean-contaminated” elective general-surgery cases.

- Mask group:Staff used masks (control).

- No-mask group: Staff used **no masks (intervention).

- Outcome: Surgical-site infection (SSI) rate within 30 days.

- Results: Infection rate 3.5 % with masks vs. 3.5 % without masks (p = 0.95).

- Interpretation: The trial had only 50 % power to detect the 20 % relative difference the authors pre-specified as clinically important. A post-hoc power analysis showed it could have missed a true difference.

- Limitations: Single center, no blinding, outdated aseptic techniques.

Webster et al., 1978

- Design: 3-week crossover RCT in London teaching hospitals.

- Population: 3,088 gynaecologic surgery patients over three years.

- Mask group vs. no-mask group**: Same surgical teams alternated every week.

- Results: No statistically significant difference in SSI rates (≈ 2 % in each group).

- Limitations:

- Short follow-up;

- Masking was not double-blinded;

- No sample-size calculation;

- Modern prophylaxis not used (no single-dose antibiotics).

Orr, 1981 (non-RCT)

- Design: Retrospective chart review before/after policy change.

- Population: 1,308 clean hernia repairs.

- Findings: SSI rates dropped after masks were abandoned, but the change coincided with simultaneous improvements in ventilation and prophylactic antibiotics, so causation cannot be inferred.

- The 2016 Cochrane Review “Surgical face masks to reduce bacterial contamination of the surgical field: effectiveness and harms” identified only the two small RCTs above. Their conclusion was:

“The small number of trials, together with … low methodological quality and the heterogeneity of interventions, means that there is no reliable evidenceon the effectiveness of wearing … masks to reduce SSI rates