Mask FAQ

Mask FAQ

What are the differences in masks and their virus protection?

Level 1
Level 2
Level 3
Mask/Respirator Levels

Mask protection is based on a total of 3 ASTM levels.  ASTM stands for the American Standard for Testing Materials.  This group has 30,000 members and represents over 12,000 operating standards to ensure global adherence and protection for citizens around the globe.

ASTM Level 1 – “Low Barrier” – General standard for procedural and surgical use.  These masks are most appropriate for exams, cleanings, 

ASTM Level 2 – “Moderate Barrier” – Low to moderate protection against fluids, aerosols, and sprays.  Think blood, saliva, surgical smoke, etc.

ASTM Level 3 – “Maximum Barrier” -Heavy protection against fluids, aerosols, and sprays.  Think blood, saliva, surgical smoke, etc.

The 4 F's of Mask Fit*
  1. Filtration – Each mask has it’s own level of filtration minimum (N95, for example) and this is critical to understand your needs, especially in times of viruses, infections, etc.  Considerations include COVID-19 and TB in regards to saliva spray and surgical smoke.

  2. Fluid Resistance – This is most important in emergency rooms, operating rooms, and similar “high-risk” environments.  Level 2 & 3 masks have some level of protection, but both must be replaced after soiled.  

  3. Features – These include base materials, metal and plastic nose wires, ear or head loops (OR’s generally do not recommend ear loops/ties), additional shields, etc.

  4. Fit – This is critical for protection.  Masks must fit snugly all the way around and form a seal.  Ear loops/ties must be tight and nose wires must conform to the nose.  While Level 1 masks don’t allow for tight seals, Level 2 and 3 allow for increased seal depending on level.

For more information, download a PDF from Cardinal Health here


NIOSH – National Institute for Occupational Safety and Health.  All NIOSH masks are designated as respirators, must have tight seals (non-ear loop), be heavily resistant to particulates, have “air-purifying” properties, be resistant to dust particles, infectious agents, (other non-mask NIOSH devices also include protection against gases and vapors) and include 3 levels of protection:

  • N95 (also R95 & P95) – Minimum efficiency of 95%

  • N99 (also R99 & P99) – Minimum efficiency of 99%

  • N100 (also R100 & P100) – Minimum efficiency of 99.97%

The letter designates a respirator’s resistance to oil. 

  • N – Not resistant to oil

  • R – Somewhat Resistant to oil

  • P – Strongly resistant or Proof to oil

FDA – United States, Food and Drug Administration.  The FDA designates that masks at this level are known as a Filtering Facepiece Respirator (FFR).  According to the FDA website,

“An N95 FFR is a type of respirator which removes particles from the air that are breathed through it. These respirators filter out at least 95% of very small (0.3 micron) particles. N95 FFRs are capable of filtering out all types of particles, including bacteria and viruses.”

CE – CE marked masks are disposable respirators approved by the European Economic Area for safety, health and environmental protection standards. CE stands for Conformité Européenne, which closely translated means, conforms with European regulations.  CE grades their masks as either FFP1, FFP2, or FFP3.  FDA and CE are roughly equivalent certifications from different global regions.

Mask FAQs

“What is the difference between a medical mask and a respirator?”

The fit.  A true medical mask fits loosely and a respirator has a tight fit to protect against particulates.

“How do I ensure a good fit with my mask/respirator?”

Any respirator that requires a snug fit should have a seal all the way around the nose and mouth.  This means that nose wire and loops or ties must cause a complete seal..  Both nose and mouth must always be covered to ensure safety.

“Is it safe to wear a Non-NIOSH certified respirator in the OR during COVID-19 risk?”

It is not recommended.  You are putting yourself, the patient, and other in the OR at risk.  Many operating rooms will not allow respirators without a NIOSH designation in the OR.  This is not only an issue with the hospital, but also not allowed by many insurance providers.

“How long can I use my PPE?”

Any mask/respirator is compromised when it is torn, wet, dislodged, et al.  The higher the certification and protection value, the more likely it will hold up for longer periods of time.  If you are in an OR, it is not recommended for use, again, for the safety of all those around you.  Largest impacts are respiration rate (how long you wear and breathe), nasal discharge, environmental humidity, etc.

“Can these pieces expire?”

Yes.  Like anything else, items that haven’t been stored properly will break down.  While NIOSH, for example, doesn’t require an expiration date, any PPE that hasn’t been stored in a clean, dry environment, will lose its ability to protect.  Again, non-NIOSH PPE will more likely break down more quickly and put you and your colleagues at risk.  Expiration is currently a large problem and many NIOSH masks in current circulation are many years old and would not be recommended for use.

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