Day-to-day COVID-19 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.

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. 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 vital to remember that they must be sterilised after every use.

See 'Principles and assumptions for using masks during the COVID-19 pandemic' for more discussion of our sources and reasoning on these issues.

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.

• During the pandemic, you should wear a surgical or cloth mask, if you can, 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.
  • 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, but 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 can filter some particles, but will let others through. Gaps round the edges of the mask will also reduce its ability to protect you.
  • See 'How to wear cloth masks' for a technique to improve the fit of a mask by using nylon tights/stockings. However, this does *not* provide complete protection.
  • A surgical mask is always preferable when available. See 'Close contact mask protocol' for more details on surgical mask usage.
  • If you are at very high risk, but cannot avoid confined spaces where you will be exposed to infection, you may also wish to see 'High risk mask protocol'

When not to wear a mask

• Children under 2 should not wear masks.

• If you have a respiratory condition, do not wear a mask if this makes it difficult for you to breathe.

Masks and breathing difficulties

• If you are concerned that a mask may trigger breathing problems (asthma, panic attacks, etc):
  • Use lightweight, flexible fabrics - see 'Selecting or making a mask' below
  • Trial the mask at home before you attempt to use it in public, to see if it affects your breathing.
  • If you decide to use it in public, practice the safe removal technique at home first, to ensure you will be able to take it off quickly and safely if you need to (see 'Taking off a mask' below)
  • Carry a disposable bag with you, so that you can safely store the mask if you need to take it off.
  • If possible, carry hand sanitiser with you, in case you need to remove the mask in a location where you don't have access to handwashing facilities.

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

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

Without a nylon overlay

1. Put on the mask before you put on gloves, if you are using them.
2. Check there are no defects, such as holes or tears.
3. Wash your hands.
4. Make sure the mask is the right way round.
5. 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.
6. Wash your hands.

With a nylon overlay

1. Put on the mask before you put on gloves, if you are using them.
2. Check there are no defects in the mask, such as holes or tears.
3. Wash your hands.
4. Make sure the mask is the right way round.
5. 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.
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.

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 crowded situation.
  • One study suggests cloth masks may become completely ineffective after two hours, but be aware that their effectiveness will decrease throughout this period.
  • If you have multiple masks and access to handwashing facilities, change your mask more frequently - after 30 minutes if possible.
• 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

Without a nylon overlay

1. If wearing gloves, remove them first.
2. Wash your hands
3. 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.
4. Place in a sealed bag until it can be safely washed.
5. Wash your hands.

With a nylon overlay

1. If wearing gloves, remove them first.
2. Wash your hands.
3. 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.
4. Place the overlay in a sealed bag until it can be safely disposed of.
5. Wash your hands again
6. 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.
7. Place in a sealed bag until it can be safely washed.
   • This can be the same bag as the overlay.
8. 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 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 wearing.

Selecting or making a cloth mask

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

Material

• Use a lightweight but tightly woven cotton fabric, e.g. a t-shirt or a high-thread-count pillowcase.
  • Thick cottons such as tea towel fabric are effective at filtering particles, but will make it more difficult to breathe.
• Fabric should be flexible, not stiff, to allow a better fit.
• 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 make it more effective, especially if you are using the mask to protect yourself from infection.
• 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.

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.
• Use head ties, as well as ear loops, to achieve a better fit.
• 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 . 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.