Written by Narayana Health , Bangalore

Circulated by Society for Andaman Nicobar Ecology.

The world these days is gripped with the fear of Coronavirus and face masks are a very important component to save us from catching an infection. But due to the pandemic, the world is facing a shortage of these masks and hence judicious use of face masks is paramount. So, I am sharing tips not just on how to judiciously use face masks but how to reuse, disinfect and discard this essential but biohazard commodity.

Don’t forget it’s not just the use of a mask that is important but it’s equally important to use it properly. Also, the value of hand hygiene and sanitizing your hands with alcohol-based sanitizers or soap and water for at least 20 seconds can’t be underestimated. Don’t forget to disinfect frequently touched surfaces. Avoid touching eyes, face, nose and mouth as much as possible. Please discard used tissues also immediately in the biohazardous marked dustbin. Also, disinfect the surfaces frequently with alcohol. Please fit the mask snugly around the nose and it must be completely covering your nose and mouth and not just hanging loosely around the neck otherwise the purpose of using the mask is defeated. Don’t ever touch the front surface of the mask as that’s the contaminated portion. The masks commonly in use are cloth masks, 3 layered surgical masks, and N95 respirator. I will be discussing all of these, one by one.

1. A) Who should be using which face mask?

Please remember people in good health need not wear a face mask if they are staying at home and not taking care of any sick patient.

• Cloth mask – Not ideally recommended when taking care of infected patients as they do not provide adequate protection but they are still better for routine use than not covering your mouth and nose. However, using a HEPA filter with a face mask might increase its effectiveness but it leads to more difficulty in breathing. High-efficiency particulate air (HEPA) filter means a filter that is at least 99.97% efficient in removing mono-disperse particles of 0.3 micrometers in diameter. For the general public, if a face mask is not available at least a bandana or a scarf may be used to cover the face.
• Surgical mask – Loose-fitting, a disposable device made of polypropylene, may be effective in blocking particle droplets, splashes, sprays which may contain germs, keeping them from reaching mouth and nose – does not block small particles in the air that may be transmitted by nearby coughing or sneezing.

To be used by persons caring for sick persons with respiratory infections and symptoms as cough, sneezing and fever, and health care and frontline workers.

• N95 respirator – Not for routine use for the general public. It’s made of polypropylene material. These respirators filter out at least 95% of very small (0.3 microns) particles. These respirator masks are capable of trapping 95%, 99% and 99.9% of particles, smaller up to 0.3 microns in size.

N95 FFRs are capable of filtering out all types of particles, including bacteria and viruses. It should be used judiciously only. It should be worn by:

1. Healthcare and front line workers who are attending to patients with respiratory infections as cough, cold and patients under investigation.
2. While entering rooms of confirmed or suspected COVID patients.
3. While obtaining clinical specimens, soiled medical supplies and equipment or whosoever come in contact with potentially contaminated environmental surfaces.
4. B) How to dispose of a used mask? (Remember masks should be treated as medical waste)

Different germs can survive on a used mask for different durations. Experts feel that viruses, when left exposed, can survive between a few hours and a few days. My earnest request to all of you is not to throw the used mask indiscriminately in lifts, parks, workplaces, homes, open dust bins as it can pose a potential health hazard to people who come in contact with such masks. Also, some people are picking them up for re-use and hence putting their life in danger. The infected masks have respiratory secretions on them and can be dispersed and transmitted through the air. So, please be sensitive. Always wash your hands before and after taking off the mask.

• Cloth mask (Wash) – Should be washed properly and frequently and left to hang and air dry.
• Surgical mask (Fold, tie, wrap) – It should be removed chin upwards and please take care to remove it from the strings and be careful not to touch the front portion while taking off the mask. After taking the mask off, please fold it half inwards, such that droplets from mouth and nose are not exposed. Then, fold the mask into another half, until it looks like a roll. The mask can also be wrapped with its ear loops so that it will not unravel. Then wrap the mask in a tissue paper or polythene bag and immediately discard it in the yellow waste bag. Keep the things handy before disposing it off.
• N95 respirator – When removing the mask, hold the edge of the straps attached to take of the N95 mask. Don’t touch the inside part of the respirator. Wash hands before and after it. Gently remove the mask so as not to disseminate contaminants on the mask. Place the mask in a plastic bag or zip-lock bag. You can also store them in a breathable container such as a paper bag between uses. Secure the bag tightly. Place the plastic bag into garbage can or biomedical waste disposal unit. Never put on a new mask until you have properly washed your hands.

1. C) Can we reuse or sterilize the mask?

Most face masks are disposable and are for one-time use only. Ideally, face masks should not be used once they are soiled or the inner lining gets moist. Rarely they can be sterilized for limited reuse. If you want to reuse the mask, it should be kept dry so that it can last long. While taking out the mask please do not put it under the chin so that germs there will not attach to the mask. Please don’t leave used masks on any surface as it will be a source of infection. It should be properly stored so that it can be reused.

Reuse – refers to the practice of using the same N95 respirator for multiple encounters with patients but removing it after each encounter. It’s stored in between encounters to be put on again.

• Cloth mask – Can be properly washed, disinfected, dried and reused.
• Surgical mask – If it’s dry and the layers and shape are intact, put it in a zip lock pouch with a desiccated gel. The gel absorbs moisture and keeps the mask dry. If the mask is intact and not torn, it can be reused for 3 days. If it’s worn by an infected person, it should never be reused or shared.
• N95 respirator – When you are not using it, please store it in a closed plastic container and dispose of and regularly clean the storage containers. When reusing the N95 respirator, leave a used mask in the dry atmosphere for 3-4 days to dry it out. Polypropylene in N95 is hydrophobic and contains zero moisture. COVID-19 needs a host to survive – it can survive on a metal surface for up to 48 hours, on plastic for 72 hours and on cardboard for 72 hours. If the respirator is dry for 3-4 hours, the virus would not have survived. Best is to use four N95 masks and number them 1-4. On day 1 use mask 1, then let it dry for 3-4 days. On day 2 use mask 2 and then let it dry for 3-4 days. Same for Day 3 and Day 4. Another method is to sterilize the N95 mask by hanging it in the oven (without contacting metal) at 70 degrees C for 30 min. Or use a wooden clip to hang the respirator in the kitchen oven. N95 masks are degraded by UV light so keep them away from UV light or sunlight. Label the string of the mask with your name so that no one else uses it. Follow the guidelines provided by the manufacturer or use it maximum up to 5 times.

1. D) What are the recommendations for the extended use of N95 respirators?

If the supplies are limited as in a pandemic situation, the user can be extended to protect health care workers from the risk of infection. Extended use refers to the practice of wearing the same N95 respirator for repeated close contact encounters with several patients, without removing the respirator between patient encounters. Extended use may be implemented when multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms or hospital wards. Studies have shown that respirators can function within their design specifications for 8 hours of continuous or intermittent use.

1. E) When to discard the N95 respirator?
2. Discard N95 respirators following use during aerosol-generating procedures.
3. Discard masks contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients.
4. Following close contact with any patient co-infected with an infectious disease requiring contact precautions.
5. Consider the use of a cleanable face shield over N95 when feasible to reduce surface contamination of the respirator.
6. Use a pair of clean gloves when donning a used N95 respirator and performing a user seal check. Discard the gloves after use properly.

If the general public, as well as health care workers, take care of all these precautions we can prevent the spread of infection to ourselves as well as to people around and also prevent the depletion of supplies of masks during any pandemic. So stay safe, and don’t forget the importance of hand hygiene and the use of other personal protective equipment (PPE) at the time of need.

This is based on WHO and CDC (USA) Guidelines.

Narayana Health

For a COVID free world soon.

Narayana Health is headquartered in Bengaluru, India, and operates a network of hospitals across the country, with a particularly strong presence in the southern state of Karnataka and eastern India, as well as an emerging presence in northern, western and central India.