Close contact mask protocol

This protocol is under review, and has not been accepted.

We are currently gathering feedback and editing this protocol, and there may be errors or bad wording. Please only use this protocol with caution, and if other organisations have definitive protocol, use that instead.

Please see #protocols on Slack to discuss this protocol further.

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More documents in need of medical review can be found here.

This page describes protocol for using PPE. Please read the PPE principles and remember that appropriate PPE, not simply the most PPE is the correct solution. PPE is not a magical talisman or substitute for good practice and a scene survey

Note regarding COVID: This page is not specifically relating to the COVID-19 pandemic pandemic, but includes information that will be useful for dealing with the pandemic.

This is the protocol for using masks during 'close contact' (within 2m of another person) in situations where there is a particular risk that an infectious disease will be transmitted. It applies to diseases such as COVID-19 that are transmitted by infectious droplets from the mouth and nose.

This protocol deals with surgical masks. They are designed to prevent the wearer from infecting others, but may also give some partial protection to the wearer,, especially if worn with modifications to improve the fit. For situations where there is a very high risk of infection (e.g. prolonged close-contact care) see 'High risk mask protocol' for discussion of how respirator masks, which are designed to protect the wearer from infection.

Photograph of a surgical mask

For use of masks to prevent the spread of infection in public spaces during the COVID-19 epidemic, see 'Day-to-day COVID-19 mask protocol'.

When to wear a surgical mask

Masks should be worn

• During close contact between someone who has (or is suspected to have) an infection such as COVID-19, and a person who is not known to be infected.
  • If possible, the infected person and the person caring for them should both wear masks.
  • However, if a person with COVID-19 finds it hard to breathe while wearing a mask, they should not wear one.

• During close contact between someone who would be at high risk if they developed COVID-19 and a person from outside their household who might transmit it to them. People without symptoms may still be infected and able to spread COVID-19.
  • If possible, both people should both wear masks.
  • If there is only one mask available, the person who may be infectious should wear it

For such situations, surgical masks should be used if available, but cloth can be used if there is no alternative. (See 'Day-to-day Covid-19 mask protocol' for information on cloth masks.)

When using masks, it is essential to remember the following principles:

• Masks are an addition to other infection control measures (hand hygiene, use of tissues, not touching the face), not a substitute.
• Maintain distancing whenever possible. Masks give an additional layer of protection, and should be used in situations where distancing is impossible, but must not be used as an reason to ignore social distancing.

How to wear a surgical mask

Putting on a mask

1. Put on the mask before putting on gloves, if using.
2. Wash your hands first.
3. Check there are no defects, such as holes or tears.
4. Make sure the mask is the right way round:
   • The coloured side faces outwards
   • The metallic strip is at the top, over your nose
5. Put the mask over your mouth and nose and fasten it on.
   • If there are small elastic loops at the sides, these go around your ears.
   • If there are straps, these are tied behind your head. Fasten the upper ties behind your head first, above your ears. Then tie the lower ties behind your neck.
   • If there are two large elastic loops at the top and bottom, these go behind your head. Pull the top band over your head so that it rests above your ears, then pull the bottom band over your head so that it goes behind your neck.
6. Press the metallic strip with your fingertips to mould it into shape over the bridge of your nose.
7. Make sure the mask is secure, with a tight seal around your nose, and covers your mouth, nose and chin.
   • If the mask has ties, you may need to tighten the lower ones behind your neck after adjusting the nose piece.
8. Wash your hands again

Wearing a mask

• The mask must cover your nose and mouth.
• Do not touch your face, or touch the face of the mask while wearing it.
  • If you do, you must sanitise or wash your hands before touching your surroundings.
• You should not take it off when talking, using the phone etc.
• Wear the mask for as short a time as possible
  • Put it on immediately before entering the situation.
• Wear the mask continuously. If you take it off and put it on again, you risk spreading virus from the exterior to the interior.

Taking off a mask

1. Wash your hands, or if wearing gloves
   • Take off the gloves first.
   • Wash your hands after removing gloves, before removing the mask.
2. Remove the mask by unhooking the ear loops/unfastening the ties, without touching the face of the mask.
   • If it has ties, unfasten the bottom tie first, then the top. If you undo the top tie first, the mask will fall down to hang around your neck, and may contaminate your clothes.
   • If there are elastic bands behind your head, remove the bottom one first, then the top.
3. Place in a sealed bag until it can be safely disposed of.

Using a nylon overlay

A recent study suggests that the fit of a surgical mask can be improved, thus enhancing its ability to protect the wearer, by adding a band of nylon tights/stocking fabric

This does not provide full protection and should never be treated as an alternative to social distancing.

The nylon improves the fit of the mask, but does not provide any protection if worn separately.

To make a nylon overlay:

• Cut the leg from a pair of lightweight nylon tights, then make another horizontal cut across the leg to give you a loop of fabric.
• This should be tall enough to cover the top and bottom of your mask
• When worn, it should be tight enough to hold the edges of the mask against your face, but you should still be able to stretch out some slack if you pull the loop at the back of your head
• You may need to trial several loops from different places on the leg of tights, in order to get a good fit.

If you use this technique, it is important to follow the removal instructions carefully to ensure that you do not spread the virus to your eyes when removing the band.

Putting on a mask with a nylon overlay

1. Put on the mask before putting on gloves if using.
2. Wash your hands.
3. Check there are no defects in the mask, such as holes or tears.
4. Make sure the mask is the right way round.
5. Put on the mask and adjust the nosepiece, as described above.
6. Put on the nylon overlay before putting on gloves.
7. Pull the nylon over your head so that it forms a horizontal band over the mask and around the back of your neck.
8. Arrange it so that it extends over the top and bottom of the mask, pressing the edge of the mask to your face.
9. Wash your hands again.
10. If wearing gloves, you should put these on as the last step.

Taking off a mask with a nylon overlay

1. Wash your hands, or if wearing gloves
   • Take off the gloves first.
   • Wash your hands after removing gloves, before removing the overlay.
2. Remove the nylon overlay, being careful that the area which was in contact with the mask face does not come into contact with your face, eyes or hair.
   • Pull the back of the overlay away from your neck.
   • Pass this over the top of your head, towards your face.
   • Keep the front of the overlay in contact with your mask until you have brought the back of the loop over your head. This is to reduce the chance of the overlay springing into your eyes.
3. Place the overlay in a sealed bag until it can be safely disposed of.
4. Wash your hands again
5. Remove the mask by unfastening the ties/unhooking the ear loops, without touching the face of the mask
   • If it has ties, unfasten the bottom tie first, then the top. If you undo the top tie first, the mask will fall down to hang around your neck, and may contaminate your clothes.
   • If there are elastic bands behind your head, remove the bottom one first, then the top
6. Place in a sealed bag until it can be safely disposed of.
   • This can be the same bag as the overlay.
7. Wash your hands and face.

Sterilising masks

• Surgical masks should be single-use, but in the current severe supply shortage, clean undamaged masks can be set aside in a breathable paper bag until the virus has expired before reuse.
  • Leave for 2 weeks before reuse. A recent study found that the COVID-19 virus survived longer on a surgical mask than on any other surface.
  • Label the bag with the date of last use
  • Don’t use a plastic bag, as this may prevent them from drying.

• Never share masks.

• Do not wash surgical masks or sterilise them with alcohol - this will damage their filtration abilities.

• Never use bleach to clean masks.