Day-to-day COVID-19 mask protocol

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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.

This document needs review by medical professionals before it is adopted. If you are a medical professional, please use this form to provide feedback

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
This page is specific to the COVID-19 pandemic. Our covid protocol still focuses on somewhat older science relating to droplet transmission. We are currently reviewing this. It will be updated rapidly.

This is the protocol for the usage of masks for when you must go into public spaces during the COVID-19 pandemic. This covers activities such as:

  • Going to the shops
  • Using public transport.

If you need to enter a person's home to provide care, please see the close contact mask protocol for guidance.

In the current UK situation we encourage the use of cloth face coverings for day-to-day usage during the COVID-19 pandemic, to preserve limited medical supplies for higher risk scenarios. If there is no supply shortage of surgical masks in your area, these should be used instead.

When using masks it is esential to remember the following principles:

  • Masks are an addition to other infection control measures (hand hygiene, use of tissues, not touching the face, etc) not a substitute.
  • Maintain distance wherever possible. Masks give an additional layer of protection, but must not be used as an excuse to ignore social distancing.

When using cloth masks it is also essential to remember that they must be sterilised after every use.

When to wear cloth masks

  • Cloth masks should only be used when surgical masks are in limited supply. They are inferior to surgical masks, but several studies have concluded that they are better than nothing if no alternative options are available.[1][2][3]
  • During the pandemic, you should wear a surgical or cloth mask, if possible, in public or shared spaces where it will be difficult to maintain distancing. This is to prevent yourself from infecting others.
    • This is particularly important in enclosed spaces, which may carry a higher risk of infection.[4]
    • Remember that even if you have no symptoms, you may still be infected with COVID-19 and able to transmit it to others.
    • Respirator masks should not be prioritised for this purpose, as their main use is to protect the wearer from infection in high-risk situations. If you do use one, you must cover any valve in order to protect others from your exhaled breath.
  • You should also wear a mask when handling items which will then be handled by a person who is at high risk from the virus (e.g. when packing items for delivery, or leafleting).


  • If you are at high risk from the virus, but cannot avoid public spaces, you may also wish to wear a mask for your own protection.
    • Tightly woven cotton masks can filter some, though not all, particles, but the fit of the mask will further reduce the efficacy.[1][2]
    • See 'How to wear cloth masks' for a technique to improve the fit of a mask using a loop of nylon tights/stocking fabric as an overlay. However, this does *not* provide complete protection.
    • A surgical mask is always preferable when available; the fit of this can also be improved with a nylon band. See 'Close contact mask protocol' for more details on surgical mask usage.
    • If you are at particularly high risk, but cannot avoid confined spaces where there is a likelihood of infection, you may also wish to see 'High risk mask protocol'


When not to wear a mask

  • If you have a respiratory condition, do not wear a mask if this makes it more difficult for you to breathe.
  • Children under 2 should not wear masks.[5]

How to wear cloth masks

Using a nylon overlay

A recent study suggests that the fit of a cloth mask can be improved, thus enhancing its ability to protect the wearer, by adding a band of nylon tights/stocking fabric[6]

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

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.

Putting on a mask

Without a nylon overlay

  1. Check there are no defects, such as holes or tears.
  2. Wash your hands.
  3. Make sure the mask is the right way round.
  4. Put on the mask ensuring it covers your mouth and nose.
    • Depending on the style of mask, tie it on or adjust the straps.
  5. If wearing gloves, you should:
    • Put on the mask first, then the gloves, to avoid transferring virus from your face to your gloved hands.
    • Wash your hands again before putting on the gloves.

With a nylon overlay

  1. Check there are no defects in the mask, such as holes or tears.
  2. Wash your hands.
  3. Make sure the mask is the right way round.
  4. Put on the mask ensuring a snug fit covering your mouth and nose.
    • Depending on the style of mask, tie it on or adjust the straps.
  5. Put on the nylon overlay, but before putting on gloves.
  6. Pull the nylon over your head so that it forms a horizontal band over the mask and around the back of your neck.
  7. Arrange it so that it extends over the top and bottom of the mask, pressing the edge of the mask to your face.
  8. Wash your hands.
  9. If wearing gloves, you should put these on as the last step.

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 for a maximum of two hours, but be aware that its effectiveness will decrease over this period.[7]
    • If you have multiple masks and access to handwashing facilities, change your mask more frequently - after 30 minutes if possible.

Taking off a mask

Without 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 mask.
  2. Remove the mask by unfastening the ties/unhooking the ear loops, without touching the face of the mask.
  3. Place in a sealed bag until it can be safely washed.

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 that 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
  6. Place in a sealed bag until it can be safely washed.
    • This can be the same bag as the overlay.
  7. Wash your hands and face.

Sterilising masks

Cloth masks must be sterilised after every use

  • This can be done by:
    • Washing in a machine at a minimum temperature of 60°C, or
    • Boiling for at least 10 minutes, or
    • Steaming over a pan of boiling water for at least 10 minutes.
  • Handle unsterilised masks by the straps only, and wash your hands very thoroughly after handling.
  • Be very careful that you do not contaminate any surfaces with the unsterilised masks, and disinfect any surfaces (e.g. taps, washing machine door) which you may have touched.
  • Do not use bleach to sterilise masks.
  • Do not use a microwave, as this may be a fire hazard.
  • They must be completely dry before reuse.
  • If you are using a nylon overlay this should be treated as single use and disposed of in a sealed bag after use.

Selecting or making a cloth mask

When selecting which mask to buy or make, you should consider the following:

Material

  • Use a tightly woven cotton fabric, e.g. a thick t-shirt or a high-thread-count pillowcase
  • Fabric should be flexible, not stiff, to allow a better fit.[1]
  • Material must be washable at 60C.
  • If sewing your own, the material should be washed at a high temperature first, to allow for shrinkage.
  • A filter layer of lightweight cotton interfacing or batting will improve the efficacy, especially if you are using the mask to protect yourself from infection.[6]
  • A nylon overlay can be used to improve the fit of a mask, but the nylon does not itself have any ability to filter particles.[8]

Design

  • Two layers of cotton should be used, in addition to a filter layer if possible.
  • If using a rectangular mask, it should cover the cheeks and tuck underneath the chin.
  • Pleats also improve the fit of a rectangular mask.[9]
  • Use head ties, as well as ear loops, to achieve a better fit.[10]
  • Avoid patterns with a seam in the mouth or nose area.


If you can't sew, options include:

  • Folding a bandana and fastening with elastic bands [11]. Use a nylon overlay to improve the fit.
  • For a better-fitting result, see our No-Sew Mask protocol, which demonstrates a technique for making a simple mask from a t-shirt or fabric rectangle.
  1. ↑ 1.0 1.1 1.2 Davies et al, 'Testing the Efficacy of Homemade Masks'; Accessed:2020-04-27
  2. ↑ 2.0 2.1 van der Sande et al, 'Professional and home-made face masks reduce exposure to respiratory infections among the general population'; Accessed: 2020-04-27
  3. ↑ MacIntrye et al 'A cluster randomised trial of cloth masks compared with medical masks in healthcare workers'[1] is often cited as evidence against cloth masks; it showed poor performance of cloth masks compared to surgical masks, but since the control arm also wore masks of either kind as they chose, it did not determine whether cloth masks were better than nothing. It tested the ability of the mask to protect the wearer from infection (primarily by rhinoviruses, which are airbourne, not coronaviruses), but did not consider whether cloth masks can prevent the wearer from infecting others. Moreover, the surgical mask users were provided with two masks per day, whereas it is not clear whether the cloth mask users wore the same mask all day - if so, this would be an additional factor contributing to poor performance.
  4. ↑ Qian et al, Indoor transmission of SARS-CoV-2; Accessed:2020-04-27
  5. ↑ US Centre for Disease Control; Accessed: 2020-04-27
  6. ↑ 6.0 6.1 Mueller et al 'Assessment of Fabric Masks as Alternatives to Standard Surgical Masks in Terms of Particle Filtration Efficiency'; Accessed: 2020-04-27
  7. ↑ Kelkar et al, 'How effective are face masks in operation theatre'; Accessed: 2020-04-27
  8. ↑ Cooper et al, 'Common Materials for Emergency Respiratory Protection: Leakage Tests With a Manikin'; Accessed: 2020-04-27
  9. ↑ Quesnel, 'The efficiency of surgical masks of varying design and composition'; Accessed: 2020-04-27
  10. ↑ Cherrie et al, 'Effectiveness of face masks used to protect Beijing residents against particulate air pollution'; Accessed: 2020-04-27
  11. ↑ Use of Cloth Face Coverings to Help Slow the Spread of COVID-19; Accessed: 2020-04-28
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