Article No.2. PPE; What if the 1st step out of lockdown is mandatory wearing of Face masks?

Disclaimer; Without prejudice the information above is and shall not hold the author liable to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by the information contained within this article.

As a textile product designer and ex-supplier of uniforms for over 18 years who understands the logistics of managing the supply, fitting and distribution of clothing I believe we need to get prepared and informed for this scenario. Primarily to ensure that we are building a strategy to ensure that Certified PPE Face masks is distributed only to those at the frontline; the NHS Medical and Nursing staff and members of the public most at risk. 

The Telegraph 19th April ” The German government is under pressure to make mask-wearing compulsory in public after the success of a city-wide trial. Several German regions and cities sent a clear signal to Angela Merkel’s government that they don’t see its advice on face masks as adequate, with two states announcing individual measures to enforce face mask usage. The eastern state of Saxony announced that everyone will have to wear a face mask as of Monday when entering shops or travelling on public transport. Wolfsburg, hometown of Volkswagen, and Mecklenburg-Western Pomerania soon followed suit, announcing mandatory masks in public starting the following week.”

In Austria it is compulsory to wear basic masks in supermarkets and other food and drug stores. Millions of face masks are being given to Spanish commuters to allow some non-essential staff to return to work. It is reported that in Portugal face-masks will be required in open spaces if and when the relaxations kick in.

My area of expertise is not in PPE but as textile product designer who has been currently prototyping non-certified reusable face masks I have a series of data that I believe others may find helpful on face masks. My compiled research offers resources on understanding different types of masks, how to wear, wash, dry and store face masks. (Please note always follow the NHS & Government guidance.)

Evaluated Pro’s & Con’s of certified & non-certified, homemade face masks:

Pro’s

  • Masks catch droplets of breath: ‘There is widespread evidence from the field of occupational health, the SARS epidemic, and other outbreaks that wearing masks protects us from germs and interrupts the transmission of disease from sick to healthy people. (See Article. 04. from Boston Globe 19th March 2020)
  • Reduces & stops us unconsciously touching our mouths & noses. “Unfortunately, we humans are relatively unique among mammals in that we continuously touch our eyes, noses, and mouths for seemingly no reason every 2.5 minutes” (See Article. 04. from Boston Globe 19th March 2020)
  • The production & distribution of non-certified masks to those with symptoms of the virus or the elderly could support a Government initiative to ensure that more stocks of Certified PPE Masks are distributed to frontline medical staff, the elderly and those most at risk in Hospital or Carehomes.
  • This is not the current reality but if stocks of masks run out for frontline staff; non-certified masks could be used and distributed to low risk workers in the hospital and caretakers of vulnerable people at home. Use as a protective cover for surgical masks which must be thrown away once they are soiled or wet.
  • For those untested may offer some form of marginal protection to the health of those you come in close contact with. 
  • With more face masks available we can limit the re-use of Masks. As we have limited facts on the potential contract transmission the goal is to reduce multiple encounters with different people/patients, reduce risk of wearer’s touching outer surface of masks during contact with others and ensuring removal and replacement of masks is done in a careful & deliberate manner.

Con’s

  • Non-certified face masks are not medical garments don’t falsely assume that they are all offering protection non-medical mask will not guarantee protection from a direct cough or sneeze from an infected person .
  • The wearing of Face masks must compliment social distancing not replace it: social distancing is necessary.
  • Homemade masks provide no reassurance to the source of materials used and what standards of hygiene have been used in their preparation, manufacturing and packaging (commercial clean room vs kitchen table). Doesn’t guarantee proper fit for e.g. adult, child sizing etc. or reliability of breathable fabrics, stitching, wash trials or sewing methods used. 
  • In the past week some immunologists have controversely stated that the overuse or unnecessary use of face masks could reduce our immune system long term (See .07.Article)

ESSENTIALS

1. Understanding Different masks- the difference between a Surgical mask and a Filter Face Piece mask (FFP3), Homemade masks.

Health & Safety Standards- Safety Acronyms Used: Respiratory protection in the form of disposable dust masks come in three respirator ratings: FFP1, FFP2, and FFP3 – FFP stands for “Filtering Face Piece” and the number denotes the level of protection.

Surgical masks are plain masks that cover the nose and mouth and are held in place by straps around the head. In healthcare settings, they are normally worn during medical procedures to protect not only the patient but also the healthcare worker from the transfer of microorganisms, body fluids and particulate matter generated from any splash and splatter. Whilst they will provide a physical barrier to large projected droplets, they do not provide full respiratory protection against smaller suspended droplets and aerosols. That is, they are not regarded as personal protective equipment (PPE) under the European Directive 89/686/EEC (PPE Regulation 2002 SI 2002 No. 1144).

A filtering face piece (FFP3) device is a mask which is certified to the PPE Directive. It provides a high level of filtering capabilIty and face fit. It can be supplied with an exhale valve so that it can be worn comfortably over a fairly long period of time. It will provide an effective barrier to both droplets and fine aerosols and is the type recommended particularly for people in the healthcare sector dealing with symptomatic patients undergoing treatment where aerosols are likely to be generated. There are also filtering face pieces FFP1 and FFP2 available but these provide less respiratory protection than a properly fitting FFP3 device. Source of reference: info: www.medtree.co.uk

Home made masks are not certified by any Health & Safety body. It provides no reassurance to the source of materials used and what standards of hygiene have been used in the preparation, manufacturing and packaging of items (commercial clean room vs kitchen table). Doesn’t guarantee proper fit for e.g. adult, child sizing etc. or reliability of stitching or sewing methods use.

2. Mask properties

Name Tag/ Label Each face mask should have a name tag label to easily distinguish who it belongs to whether in workplace or home. This will avoid wearers putting on wrongly fitting face masks and reduce cross contamination.

Fabrics Masks should be composed of both an outer breathable fabric and approved removable filter. External Fabric- preferably cotton, natural fibres are breathable, durable & withstand high temperature washing (traditional material used for medical masks). Avoid -wool & silk (wool shrinks at high temperatures). Light to medium weight cotton, brushed cotton/ muslin (not gauze). Tight thick weave fabric. Should be pre-washed before cutting patterns to avoid shrinkage.

Ties vs Elastic

Elastic Elastic ties have better re-use performance, easier removal and re-application after first fit test is completed. May require tightening after prolonged or repeated use (tighten by tying a knot in elastic to achieve tighter fit around wearer.)

Ties Fabric ties can be difficult to tie & untie with rubber gloves on. If using fabric ties, materials should be able to hold a firm knot (not slide loose) and not irritate skin or tangle with your hair. Multiple washes at high temperatures will eventually reduce effectiveness of elastic so fabric ties are a viable alternative if you don’t have access to elastic.

Design Options Face masks should cover the entire front extending to the chin or below the chin and sides of the face. Most common fabric face mask designs include the Olson & traditional pleated Surgical Mask. Face masks should fit as snuggly and tightly as possible to the skin with no gaping fabric at the cheek or below the eyes. Suggestions use Skin safe double sided adhesive tape to ensure no gaps between mask and skin.

3. Suggestions on Washing, Drying & Storing Face Masks: 

We currently don’t have all the information on how long the coronavirus lives on clothes. As COVID-19 is such a new disease, there aren’t many reputable sources for how long it lasts on different surfaces. However, coronaviruses are well known to be resilient. On clothing and fabrics, it’s not yet clear how long the virus can survive. Although one study (which has yet to be published in a scientific journal but is being quoted as a source across news organisations) found that it could survive in the air for a few hours, up to 24 hours on cardboard and up to 2-3 days on plastic and stainless-steel surfaces. Ref.02: Which Magazine. To verge on the side of caution see the following;

  1. Washing Face Masks: See article attached on laundering nurse uniforms (Article 01.)
  • A long wash cycle with a minimum temperature of 60°C should be used to wash face masks.
  • After removing your Face mask: Have a sealed box, disposable zip lock bag for storing used mask till you get round to laundering.  
  • Masks (pre-wash) should be stored and washed separately from all other items (launder as soon as possible- (Article 01.) Point1: Data showed that both bacteria were able to survive on polyester for up to seven days and on cotton for up to 21 days. This raises the question of the storage of dirty uniforms/ masks at home, especially with regard to potential cross-contamination with surfaces in the home environment. Point 2: To determine whether cross-contamination could occur in the wash, sterile samples were included. The 40˚C wash did remove most micro-organisms, but the cells that were left were in excess of 1,000, and similar numbers had been transferred to the sterile items (Fig 2). This highlights the risk that other items of clothing in the home could become contaminated, or that domestically laundered uniforms could re-contaminate the home and/or healthcare environment. 
  • Healthcare / Face masks should always be laundered after every shift/ or after each use.
  • A detergent should always be used- preferably powder detergent. Note- Killing germs-liquid detergent doesn’t contain any oxygen based bleaching agents (which is used in detergents for laundry disinfection) only powder detergents contain this (except colour care or eco versions of powder) so when you use a bio liquid detergent on a high temp, because there are no enzymes anymore you’re essentially using a detergent with a brightener and perfume. Ref 01: https://www.mumsnet.com/Talk/housekeeping/1832141-Please-clear-this-up-for-me-once-and-for-all-bio-washing-stuff

2. Drying Face Masks; The strongest practical argument for a washing line vs tumble dryer comes from the anti-bacterial effect of sunlight: UV light kills the bacteria that may survive a cool wash, both those that might have a health impact and those that cause clothes to smell. (Ref.03)

3. Dispose & Replace Face masks as regularly as possible, especially if- heavily soiled, damaged, burst or showing evidence of wear & tear.

4. Face masks should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the inner surface during storage. The folded mask can be stored between uses in a clean sealable paper bag or breathable container.

4.Understand how & when to use masks from The World Health Organisation- Videos:

How to use: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

When to use: https://youtu.be/Ded_AxFfJoQ 

If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.

  • Wear a mask if you are coughing or sneezing.
  • Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.
  • If you wear a mask, then you must know how to use it and dispose of it properly

When and how to wear medical masks to protect against coronavirus https://youtu.be/M4olt47pr_o

  • Before putting on a mask, clean hands with alcohol-based hand rub or soap and water.
  • Cover mouth and nose with mask and make sure there are no gaps between your face and the mask. ( Check fit every time, tighten if necessary to insure it doesn’t come loose.)
  • Avoid touching the mask while using it; if you do, clean your hands with alcohol-based hand rub or soap and water.
  • Replace the mask with a new one as soon as it is damp and do not re-use single-use masks.
  • To remove the mask: remove it from behind (do not touch the front of mask-outside surface); discard immediately in a closed bin; clean hands with alcohol-based hand rub or soap and water.

Other research sources recommend: Fit testing Face Mask: For best results you should be clean-shaven around the face to achieve an effective fit – if your mask has an anti-slip elastic like Stayt4sure elastic beards and stubble will reduce the effective seal to your face and protecting you properly.

References

01; Ref Mumsnet Washing powders : https://www.mumsnet.com/Talk/housekeeping/1832141-Please-clear-this-up-for-me-once-and-for-all-bio-washing-stuff

02. Which Magazine; https://www.which.co.uk/news/2020/03/coronavirus-how-to-wash-clothes-and-kill-germs/Articles

03. https://www.theguardian.com/commentisfree/2014/aug/07/ditch-tumble-dryer-use-washing-line-laundry

04. Dr Ryan Southworth https://youtu.be/W6d3twpHwis

05. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html?fbclid=IwAR1DLKJNxvCesoMn2IrdPh89f42Cg4pu5yf-XUO0CcVGUz3MABDqTgxE_us

06. Masks4Medicine. C/O Nicole Seminara, MD. 240 East 38th Street, 11th Floor New York, NY 10016

07. Dr Dan Erickson & Dr Artin Massihi (Controversial Youtube video Bakersfield Dr’s)

Articles : Further reading

Article 01. Washing Face Masks Taken from nursingtimes.nethttps://www.nursingtimes.net/clinical-archive/infection-control/domestic-laundering-of-nurses-uniforms-what-are-the-risks-29-01-2018/ How safe is the laundering of uniforms by staff at home? What can be done to reduce the risk of bacterial survival and contamination? 

Article 02. Fit testing face masks to avoid transmission: coronavirus (COVID-19) Ref: Health & Safety Executive hse.gov.uk

Article .03 Article on Linkedin from Australia https://www.linkedin.com/pulse/homemade-cloth-masks-covid-19-meriel-chamberlin/?trackingId=3KtRNcmCSHWEN0DXEF223Q%3D%3D

Article. 04 https://www.bostonglobe.com/2020/03/19/opinion/guidance-against-wearing-masks-coronavirus-is-wrong-you-should-cover-your-face/?outputType=amp&__twitter_impression=tr

Disclaimer; Without prejudice the information above is and shall not hold the author liable to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by the information contained within this article.

Interested in learning more see NEXT article No. 3 PPE : Will we see a review of Uniform & Dress code practices in the UK’s public sector in the coming months i.e NHS, Carehomes?

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