Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 26, Number 10—October 2020
Online Report

Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2

Abrar A. ChughtaiComments to Author , Holly Seale, and C. Raina Macintyre
Author affiliations: University of New South Wales, Kensington, New South Wales, Australia (A. Chughtai, H. Seale, C.R. Macintyre); Arizona State University, Tempe, Arizona, USA (C.R. Macintyre)

Main Article

Table

Recommendations with regard to cloth masks

Activity Details
Making cloth masks
 •Select a fabric with high thread count and fine weave.
•If using t-shirt material, cotton blend (10) may be better than pure cotton.
•Hybrid fabrics such as cotton–silk, cotton–chiffon, or cotton–flannel may be good choices (10).
•Select a fabric that is water resistant.
•Use a minimum of 2–3 layers, preferably with batting between the layers.
•Design a mask that fits and seals around the face.
•Use ties rather than ear loops because ties provide better fit.
Putting on a cloth mask
 •Wash your hands with soap and water or alcohol-based hand sanitizers.
•Take a clean and dry cloth mask.
•Place and hold the mask over your nose and mouth. Tie upper strings first at the back of your head and then the lower set at the base of your neck. If cloth mask has loops, hold the mask over your nose and mouth and tie ear loops.
•If mask has pleats, unfold the mask from top and bottom so it covers your nose, mouth, and chin.
•Do not touch the outer layer of face masks during use.
Taking off a cloth mask
 •Wash your hands
•Do not touch the outer surface of the face mask while removing.
•Untie the lower strings first and then upper strings. In case of ear loops, remove ear loops first and then remove the mask.
•Place the mask in a plastic zipper-sealed bag until it can be decontaminated.
•Wash your hands again after removing the mask.
Caring for masks •Have at least 2 masks per person, and wash masks with soap and water daily.
•Cloth masks can be used for an extended period as long as they are not wet or soiled, but do not reuse them unless washed and cleaned.

Main Article

References
  1. Centers for Disease Control and Prevention. Strategies for optimizing the supply of facemasks [cited 2020 Mar 25]. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
  2. Chughtai  AA, Seale  H, Islam  MS, Owais  M, Macintyre  CR. Policies on the use of respiratory protection for hospital health workers to protect from coronavirus disease (COVID-19). Int J Nurs Stud. 2020;105:103567. DOIPubMedGoogle Scholar
  3. Chughtai  AA, Seale  H, MacIntyre  CR. Use of cloth masks in the practice of infection control—evidence and policy gaps. Int J Infect Control. 2013;9:1–12. DOIGoogle Scholar
  4. MacIntyre  CR, Seale  H, Dung  TC, Hien  NT, Nga  PT, Chughtai  AA, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open. 2015;5:e006577. DOIPubMedGoogle Scholar
  5. Weaver  GH. Droplet infection and its prevention by the face mask. J Infect Dis. 1919;24:218–30. DOIGoogle Scholar
  6. Viseltear  AJ. The pneumonic plague epidemic of 1924 in Los Angeles. Yale J Biol Med. 1974;47:40–54.
  7. McNett  EH. The face mask in tuberculosis. Am J Nurs. 1949;49:32–6.
  8. Yang  P, Seale  H, MacIntyre  CR, Zhang  H, Zhang  Z, Zhang  Y, et al. Mask-wearing and respiratory infection in healthcare workers in Beijing, China. Braz J Infect Dis. 2011;15:102–8. DOIPubMedGoogle Scholar
  9. Rengasamy  S, Eimer  B, Shaffer  RE. Simple respiratory protection—evaluation of the filtration performance of cloth masks and common fabric materials against 20–1000 nm size particles. Ann Occup Hyg. 2010;54:789–98.
  10. Konda  A, Prakash  A, Moss  GA, Schmoldt  M, Grant  GD, Guha  S. Aerosol filtration efficiency of common fabrics used in respiratory cloth masks. ACS Nano. 2020;14:6339–47. DOIPubMedGoogle Scholar
  11. Davies  A, Thompson  KA, Giri  K, Kafatos  G, Walker  J, Bennett  A. Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med Public Health Prep. 2013;7:413–8. DOIPubMedGoogle Scholar
  12. van der Sande  M, Teunis  P, Sabel  R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One. 2008;3:e2618. DOIPubMedGoogle Scholar
  13. Chughtai  AA, Seale  H, MacIntyre  CR. Availability, consistency and evidence-base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis. BMC Res Notes. 2013;6:216. DOIPubMedGoogle Scholar
  14. World Health Organization. Infection control for viral haemorrhagic fevers in the African health care setting [cited 2020 Mar 20]. https://www.who.int/csr/resources/publications/ebola/whoemcesr982sec1-4.pdf
  15. World Health Organization. Advice on the use of masks in the community setting in influenza A (H1N1) outbreaks [cited 2020 Mar 25]. http://www.who.int/csr/resources/publications/swineflu/masks_community/en/index.html
  16. Institute of Medicine. Reusability of facemasks during an influenza pandemic: facing the flu. Washington (DC): The National Academies Press; 2006.
  17. World Health Organization. Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. [cited 2020 Mar 25]. https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected
  18. Guo  ZD, Wang  ZY, Zhang  SF, Li  X, Li  L, Li  C, et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg Infect Dis. 2020;26:1583–91. DOIPubMedGoogle Scholar
  19. Liu  Y, Ning  Z, Chen  Y, Guo  M, Liu  Y, Gali  NK, et al. Aerodynamic characteristics and RNA concentration of SARS-CoV-2 aerosol in Wuhan hospitals during COVID-19 outbreak. Nature. 2020;582:557–560.
  20. Ong  SWX, Tan  YK, Chia  PY, Lee  TH, Ng  OT, Wong  MSY, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020;323:1610. DOIPubMedGoogle Scholar
  21. van Doremalen  N, Bushmaker  T, Morris  DH, Holbrook  MG, Gamble  A, Williamson  BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382:1564–7. DOIPubMedGoogle Scholar
  22. Bahl  P, Doolan  C, de Silva  C, Chughtai  AA, Bourouiba  L, MacIntyre  CR. Airborne or droplet precautions for health workers treating COVID-19? J Infect Dis. 2020;jiaa189.
  23. Chughtai  AA, MacIntyre  CR, Ashraf  MO, Zheng  Y, Yang  P, Wang  Q, et al. Practices around the use of masks and respirators among hospital health care workers in 3 diverse populations. Am J Infect Control. 2015;43:1116–8. DOIPubMedGoogle Scholar
  24. Beckman  S, Materna  B, Goldmacher  S, Zipprich  J, D’Alessandro  M, Novak  D, et al. Evaluation of respiratory protection programs and practices in California hospitals during the 2009–2010 H1N1 influenza pandemic. Am J Infect Control. 2013;41:1024–31. DOIPubMedGoogle Scholar
  25. Lautenbach  E, Saint  S, Henderson  DK, Harris  AD. Initial response of health care institutions to emergence of H1N1 influenza: experiences, obstacles, and perceived future needs. Clin Infect Dis. 2010;50:523–7. DOIPubMedGoogle Scholar
  26. Rebmann  T, Wagner  W. Infection preventionists’ experience during the first months of the 2009 novel H1N1 influenza A pandemic. Am J Infect Control. 2009;37:e5–16. DOIPubMedGoogle Scholar
  27. Centers for Disease Control and Prevention. Coronavirus disease (COVID-19): infection control guidance [cited 2020 Jul 1]. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
  28. European Centre for Disease Prevention and Control. Infection prevention and control for the care of patients with 2019-nCoV in healthcare settings [cited 2020 Mar 25]. https://www.ecdc.europa.eu/sites/default/files/documents/nove-coronavirus-infection-prevention-control-patients-healthcare-settings.pdf
  29. Narla  S, Lyons  AB, Kohli  I, Torres  AE, Parks-Miller  A, Ozog  DM, et al. The importance of the minimum dosage necessary for UVC decontamination of N95 respirators during the COVID-19 pandemic. Photodermatol Photoimmunol Photomed. 2020;phpp.12562; Epub ahead of print. DOIPubMedGoogle Scholar
  30. Macintyre  R, Chughtai  A, Tham  CD, Seale  H. COVID-19: should cloth masks be used by healthcare workers as a last resort? BMJ. 2020 Apr 9 [cited 2020 May 20]. https://blogs.bmj.com/bmj/2020/04/09/covid-19-should-cloth-masks-be-used-by-healthcare-workers-as-a-last-resort/
  31. 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;19:491. DOIPubMedGoogle Scholar
  32. He  X, Lau  EHY, Wu  P, Deng  X, Wang  J, Hao  X, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020;26:672–5. DOIPubMedGoogle Scholar
  33. MacIntyre  CR, Chughtai  AA. Facemasks for the prevention of infection in healthcare and community settings. BMJ. 2015;350(apr09 1):h694.
  34. Chughtai  AA, Chen  X, Macintyre  CR. Risk of self-contamination during doffing of personal protective equipment. Am J Infect Control. 2018;46:1329–34. DOIPubMedGoogle Scholar

Main Article

Page created: July 08, 2020
Page updated: September 17, 2020
Page reviewed: September 17, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external