Guidelines on the use of Non-medical masks and face coverings during COVID-19
The use of masks is part of a comprehensive package for Infection prevention and control measures, to reduce the spread of certain respiratory viral diseases, including COVID-19. Masks can be used either for the protection of healthy persons (worn to protect oneself when in contact with an infected individual) or for source control (worn by an infected individual to prevent onward transmission).
Face mask and face coverings do not replace hand hygiene, social distancing and other infection prevention and control (IPC) measures. Therefore, it is important to note that the use of a face mask or face covering alone is insufficient to provide an adequate level of protection or source control, and other personal and community level measures should also be adopted to suppress transmission of respiratory viruses. Whether or not face masks or face coverings are used, compliance with hand hygiene, physical distancing and other infection prevention and control (IPC) measures are critical to prevent human-to-human transmission of COVID-19.
This guidance provides information and guidance on the use of Non-medical masks and face coverings for the general public to help prevent potential exposure risk of the Coronavirus disease 2019 (COVID-19).
Use of non-medical cloth/ disposable masks or face coverings in community settings
COVID-19 is spread through contact with the respiratory droplets produced by infected individuals when they cough, sneeze, or even when they laugh or speak, including by individuals who have not yet or who may never develop symptoms.
Strategies to re-open sectors and societal activities need to take into account the role of both symptomatic and asymptomatic individuals in spreading COVID-19. This challenges us to consider additional strategies to reduce transmission by whatever means available.
Use of non-medical cloth/ disposable masks or face coverings in workplace settings
There may be some non-healthcare work settings for which medical masks may be more appropriate than non-medical masks. Masks may not be suitable for all types of occupations. Employers should consult with the local public health team before introducing mask-wearing policies to the workplace.
When establishing policies regarding use of non-medical masks or cloth face covering in the workplace, employers should consider carefully the occupational requirements of their workers and their specific workplace configuration to ensure mitigation against any possible physical injuries that might inadvertently be caused by wearing a face covering (e.g., interfering with the ability to see or speak clearly, or becoming accidentally lodged in equipment the wearer is operating).
The potential psychological impacts of the non-medical mask or cloth face covering on other employees or clients should also be considered (e.g. design/construction of the mask, messaging, etc.). Non-medical masks or cloth face coverings are not considered personal protective equipment (PPE).
Although all efforts should be made to preserve the supply of medical masks for healthcare settings, there may be some non-healthcare workplaces in which a medical mask may be a more appropriate choice for the protection of the worker. An f example of this would, providing services to a client who cannot wear a non-medical mask or face covering when the two-metre physical distance cannot be maintained, and measures such as plexiglass/transparent barriers are not possible or available.
Masks may not be suitable for all types of occupation. Employers should consult with their Occupational Health and Safety team and local public health personnel, before introducing mask-wearing policies to the workplace
How to protect others
The best thing you can do to prevent spreading COVID-19 is to wash your hands frequently with warm water and soap for at least 20 seconds. If none is available, use hand sanitizer with a minimum of 60 % ethanol or 70% isopropyl, regularly cleaning and disinfecting your surfaces and objects.
To protect others, you should also:
- Stay at home and away from others if ill.
- Protect those most at risk from the virus
- Maintain a 2-metre (6 feet) physical distance from others.
- When physical distancing cannot be maintained, consider wearing a non-medical mask or homemade face covering.
- Avoid touching your face, mouth, nose or eyes.
Wearing a homemade facial covering/non-medical mask or disposable non-medical mask in the community has not been proven to protect the person wearing it and is not a substitute for physical distancing and hand washing. However, it can be an additional measure taken to protect others around you, even if you have no symptoms.
Wearing a homemade non-medical mask/facial covering in the community is recommended for periods of time when it is not possible to consistently maintain a 2-metre physical distance from others, particularly in crowded public settings such as:
- shopping areas
- public transportation
Appropriate use of non-medical mask or face covering
When worn properly, a person wearing a non-medical mask or face covering can reduce the spread of his or her own infectious respiratory droplets.
Non-medical face masks or face coverings should:
- Allow for easy breathing.
- Fit securely to the head with ties or ear loops.
- Maintain their shape after washing and drying.
- Be changed as soon as possible if damp or dirty.
- Be comfortable and not require frequent adjustment.
- Be made of at least 2 layers of tightly woven material fabric (such as cotton or linen).
- Be large enough to completely and comfortably cover the nose and mouth without gaping.
Some masks also include a pocket to accommodate a paper towel or disposable coffee filter, for increased benefit.
Non-medical masks or face coverings should NOT
- Be shared with others.
- Impair vision or interfere with tasks.
- Be placed on children under the age of 2 years.
- Be made of plastic or other non-breathable materials.
- Be secured with tape or other inappropriate materials.
- Be made exclusively of materials that easily fall apart, such as tissues.
- Be placed on anyone unable to remove them without assistance or anyone who has trouble breathing.
- Be worn by persons who are unconscious or incapacitated.
Homemade masks are not medical devices and are not regulated like medical masks and respirators. Their use poses a number of limitations:
- They have not been tested to recognized standards.
- The fabrics are not the same as used in surgical masks or respirators.
- The edges are not designed to form a seal around the nose and mouth.
- They may not provide complete protection against virus-sized particles.
- They can be difficult to breathe through and can prevent you from getting the required amount of oxygen needed by your body.
These types of masks may not be effective in blocking virus particles that may be transmitted by
coughing, sneezing or certain medical procedures. They do not provide complete protection from virus particles because of a potential loose fit and the materials used (see table 1).
Medical masks, including surgical, medical procedure face masks and respirators (like N95 masks), must be kept for health care workers and others providing direct care to COVID-19 patients.
Alternatives to non-medical masks for the general public
In the context of non-medical mask shortage, face shields may be considered as an alternative noting that they are inferior to mask with respect to prevention of droplet transmission. If face shields are to be used, ensure proper design to cover the sides of the face and below the chin. In addition, they may be easier to wear for individuals with limited compliance with medical masks (such as those with mental health disorders, developmental disabilities, deaf and hard of hearing community and children).
Table 1: Summary guidance and practical considerations for non-medical mask production and management
Guidance and practical considerations
Choose materials that capture particles and droplets but remain easy to breathe through.
Avoid stretchy material for making masks as they provide lower filtration efficiency during use and are sensitive to washing at high temperatures.
Fabrics that can support high temperatures (60° or more) are preferable.
A minimum of three layers is required, depending on the fabric used: an inner layer touching the mouth and an outer layer that is exposed to the environment.
Choose water-absorbing (hydrophilic) materials or fabrics for the internal layers, to readily absorb droplets, combined with an external synthetic material that does not easily absorb liquid (hydrophobic).
Masks should only be used by one person and not shared with others
All masks should be changed if soiled or wet; a soiled or wet mask should not be worn for an extended period of time.
Non-medical masks should be washed frequently and handled carefully, so as not to contaminate other items.
Clothing fabrics used to make masks should be checked for the highest permitted washing temperature, which is indicated on the clothing label.
Non-woven polypropylene (PP) spunbond may be washed at high temperature, up to 140°C.
The combination of non-woven PP spunbond and cotton can tolerate high temperatures; masks made of these combinations may be steamed or boiled.
Where hot water is not available, wash mask with soap/detergent at room temperature water, followed by either i) boiling mask for one minute OR ii) soak mask in 0.1% chlorine for one minute then thoroughly rinse mask with room temperature water, to avoid any toxic residual of chlorine.
Advice on the use of masks in the context of COVID-19, Interim Guidance 5 June 2020, WHO
Note that as the COVID-19 situation continues to develop, the Ministry of Health will provide updates if any additional precautions are recommended.