Back to Basics: Resuming Medical Mask Best Practices

In the first months of the COVID-19 pandemic, a shortage of medical masks forced many healthcare workers around the world to set aside respiratory protection best practices. Desperate times called for desperate measures and they had no choice but to wear the same mask even after it became damp or soiled and while treating multiple patients.

Thankfully, medical mask supply has stabilized and most hospitals and clinics can now return to following best practices. As medical mask experts, the team at Medicom would like to remind mask wearers of some of the most important ways to ensure optimal respiratory protection:

1. Choose a mask from a reliable manufacturer.

When demand for masks spiked due to the pandemic, many unqualified manufacturers rushed to turn a quick profit by producing masks in the fastest and cheapest way possible, on improvised machinery, using any materials they could find. Not only were most of the masks they produced uncomfortable to wear and hard to breathe through, but many failed to provide reliable respiratory protection.

This should not come as a surprise, since medical grade face masks are medical devices that are subject to stringent regulatory requirements that require specialized expertise to meet. Only highly specialized medical mask manufacturers have the knowledge, experience, premium raw materials, state-of-the art machinery, and tight quality controls necessary to produce reliable respiratory protection that doesn’t compromise breathability or comfort.

That’s why it’s so important to use only medical masks made by experienced mask manufacturing experts like Medicom.

2. Wear your mask correctly.

Even the most well-made mask can only protect if it is worn correctly. To ensure that you are protected, follow these mask donning instructions:

• Before putting on a mask, always wash your hands for at least 20 seconds or use hand sanitizer.
• Remove a mask from its package and inspect it for tears or holes; never use a damaged mask.
• Ensure that the nose piece is at the top and pleats face outwards and downwards (for shingle pleated masks).
• For colored masks, ensure that the white side is against your skin and the colored side is facing out, away from your skin.
• Place the mask over your nose and mouth and extend it under your chin.
• Adjust the nosepiece securely over the bridge of your nose.
• Adjust the mask so that it lies closely against the sides of your face to minimize gaps.
• Slip the earloops over each ear (for an earloop mask) or tie the ties behind your head (for a tie-on mask) to hold the mask securely in place.
• Once your mask is on, be sure not to touch it while you are wearing it.

Important: Remember not to pull your mask under your chin, even briefly to eat, drink or talk.

Watch this short video for simple step-by-step instructions for Wearing Your Mask Correctly.

3. Make sure your mask fits properly.

• To determine whether a mask fits properly, check that it fits snugly over the nose and mouth and under the chin and that there are no gaps at the sides of the face.
• When a mask is too big, it creates gaps that allow contaminants to enter and escape.
• A mask designed with an adjustable nose piece will create the best possible seal around your nose and cheeks.
• For children (or adults with smaller faces), a pediatric mask such as the Medicom SafeMask® Premier Pediatric earloop face mask is recommended. This mask, designed for children 4 to 12 years of age, offers ASTM Level 1 protection in a mask designed specifically to fit smaller faces.

Important: Children under 2 years of age should not wear a mask.

4. Choose the right level of ASTM protection.

Medical masks should be selected based on the level of protection required for their intended use.
ASTM (American Society of Testing and Materials) standard 2100 classifies the level of protection provided by medical masks as Level 1, Level 2 or Level 3, with Level 3 providing the highest level of protection, based on 5 criteria:

1. BFE (Bacterial Filtration Efficiency): The ability to filter bacteria.
2. PFE (Particulate Filtration Efficiency): The ability to filter sub-micron particles.
3. Fluid resistance: The ability to prevent fluid from penetrating the mask.
4. Delta P (differential pressure): The lightness and breathability of the mask for the wearer.
5. Flame spread: The mask’s ability to withstand exposure to open flame.

Level 1 masks offer low barrier protection and are suitable for general use for short procedures and exams that don’t involve aerosols, spray or fluids.

Level 2 masks provide moderate barrier protection for procedures that involve low to moderate levels of aerosols, spray and/or fluids.

Level 3 masks ensure maximum barrier protection for procedures that produce heavy levels of aerosols, spray and/or fluids.

Important: In certain situations, even a level 3 procedure or surgical mask is insufficient, and an N95-type respirator is required. For more information, please see the CDC’s most recent guidance.¹

5. Look for special features.

Whether you have sensitive skin, wear glasses or simply feel claustrophobic in ordinary masks, there is a specialty mask for you.

• If you wear glasses: Find a mask that fits closely over your nose or one that has a nose wire to limit fogging. Choosing a mask with an anti-fog film or strip also helps.
  • The Medicom SafeMask^® FreeFlow^™ earloop mask with Air Space™ technology has a unique fog-free strip integrated into the adjustable nosepiece to minimize fogging and ensure clear vision when wearing loupes or eyewear.
• If you feel claustrophobic in ordinary masks: Look for a mask that creates a larger breathing space between the mask and your face.
  • The Medicom SafeMask^® FreeFlow^™ earloop mask with Air Space™ technology also has innovative contoured pleats create a unique pocket that allows air to flow freely, making it ideal for those who feel claustrophobic in ordinary masks.
• If you have sensitive skin: Choose a mask with an inner layer made of materials that are gentle on skin.
  • The Medicom SafeMask^® SofSkin earloop mask is designed especially for those with sensitive skin. It is ultra-soft and lightweight with a breathable inner layer and unique wicking technology that keeps the face dry and comfortable.
• To prevent fluids or other substances from entering the eyes: Choose a mask with a protective shield or visor.
  • The Medicom Premier Elite^™ ProShield mask with visor combines a level 3 earloop face mask with an integrated visor to protect the eyes, making it a safe choice for treating high-risk patients and during procedures that may produce airborne particles, moisture, spray and spatter.
• Earloops versus ties: Outside the OR, the choice between earloop or ties can be based on personal preference; however, earloop masks are not recommended for use in the OR.

6. Know when to change your mask.

Now that medical mask supply has stabilized, you can now go back to changing your mask as follows:

• Between patients: Wear a new mask for every patient.
• As soon as it becomes wet: A mask that becomes wet, whether from sweat, breath or other substances, loses its ability to filter pathogens.
• If it becomes damaged or torn: A damaged or torn mask could allow pathogens enter or escape the mask. If you notice any tears or damages, change your mask immediately.
• If it becomes noticeably soiled or contaminated or hard to breathe through.²
• If you have been wearing it for an extended period: The longer a mask is worn, the greater the risk for infectious particles to become deposited on its surface.³

7. Remove your mask safely.

To minimize the risk of cross-contamination when removing a mask, handle it only by the earloops or ties and never touch the front.
To safely remove your mask:

• Begin by stretching the earloops up and over your ears (for an earloop mask) or untying the ties behind your head (for a tie-on mask).
• Next, bring the outside corners of the mask together so that the contaminated front of the mask is no longer exposed.
• Take care not to touch your eyes, nose or mouth while removing a mask and disinfect your hands with soap and water or hand sanitizer immediately after removing a mask.

8. Safely dispose of single-use masks.

Single-use facemasks should be used once and then discarded as follows:

• After safely removing the mask, immediately dispose of it, ideally in a receptacle designated for this purpose. (Note that your facility may be subject to certain regulatory requirements or have its own standard operating procedures in this respect).
• Perform hand hygiene immediately after discarding a mask.
• Do not carry a used mask around your arm or wrist or pull it down to rest under your chin or around your neck.
• Never share your mask with others.

References

1. Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, Centers for Disease Control and Prevention, updated Feb. 10, 2021. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
2. The Right Mask for the Task, Johns Hopkins Bloomberg School of Public Health, https://www.jhsph.edu/covid-19/articles/the-right-mask-for-the-task.html
3. Chughtai AA, Stelzer-Braid S, Rawlinson W, Pontivivo G, Wang Q, Pan Y, et al. Contamination by respiratory viruses on outer surface of medical masks used by hospital healthcare workers. BMC Infect Dis. 2019;19(1):491. Available from: https://doi.org/10.1186/s12879-019-4109-x.