We all know by now that masks play an important role in not only protecting our healthcare workers, but now evidence is showing it will also play an important role in protecting our families and our communities.
The long debate this year has been to mask or not to mask throughout this pandemic, but as data emerges about the transmission of Sars-Cov-2 and how people can minimize their own risk of not just catching COVID but also transmitting COVID to others, it seems all public health officials around the world, including Canada have now mandated masks in public areas to help slow the spread and minimize transmission from person to person.
Masks are one of our best defences in personal protection against COVID (and part of a bigger infection prevention program that also involves cleaning and disinfection, other PPE (personal protective equipment), and social distancing).
How do we choose the right mask?
First we need to understand that not all masks are made equally - similar to disinfectants we need to choose the right product for the right tasks. A nurse working in a COVID unit has a very different need than the person going to buy groceries at the store.
Knowing not all masks are created equal... how do we ensure we are not only getting the right mask but a good quality mask that does what it says it is supposed to do?
That is where ASTM rated masks come in.
ASTM International is a globally recognized organization that is responsible for setting technical standards of products, materials, systems and services. In 2012, ASTM established a standard for medical face masks the ASTM F2100-11. This is important because not all masks are designed using ASTM standards and therefore if it does not have an ASTM rating, you cannot be assured of its quality and effectiveness.
ASTM has 4 main performance criteria:
Fluid Resistance - How resistant is the mask to penetration from blood and bodily fluids under pressure? The higher the fluid resistance the higher the score and that means more protection for the user.
Differential Pressure / Breathability - What is the resistance to air flow in the mask? The greater the resistance the better the filtration of the mask, however this reduces breathability for the user.
Filter Efficiency (includes both Bacterial Filtration Efficiency and Submicron Particle Filtration Efficiency) - What is the percentage of particles filtered at a size of 3 microns (bacterial filtration efficiency) and what is the percentage of Submicron particles filtered at 0.1 microns (Submicron filtration efficiency).
Flammability - How fast is the flame spread of the mask material?
SOURCE: American Society for Testing and Materials Standard specification for performance of materials used in medical face masks. F2100-11 Standard.
When evaluating which mask you need for your specific needs, there are 3 Levels of Masks from ASTM Standards you can choose from.
Level 1:
Low barrier masks. These masks are offered for general use when you have short exposure and DO NOT involve exposure to aerosols, spray or fluids. They have low fluid resistance and low protection against particles and bacteria filtration.
Filtration: > 95%
Level 2:
Medium or moderate barrier masks. Offer increased protection to particles and bacteria, and low to moderate levels of aerosols, spray or fluids. These masks are typically recommended for use when low amounts of aerosols, spray or fluids are present.
Filtration: > 98%
Level 3:
High barrier masks. These masks have high aerosols, spray or fluid resistance. They are ideal when exposure to aerosols, spray or fluids is moderate to high. They offer the best level of protection of the 3 levels.
Filtration: > 98%
Another option is the N95 Respirator.
This option has the highest protection against pathogens, aerosols, sprays, or fluids. N95 Masks are recommended when dealing with patients who have suspected or aerosols transmittable diseases such as Tuberculosis, Varicella, Rubeola2, Influenza, and now Sars-CoV-2.
In addition to ASTM Standards of Filter, Breathability, Fluid Resistance, and Flammability when selecting a mask there are also other considerations to choose the right mask for your needs.
What features are you looking for in a mask?
Do you need or want a mask that has loops? Ties?
Do you wear glasses and require an anti-fog film, foam strip, or tape strip to help reduce your glasses fogging up when wearing a mask?
How important is comfort and breathability?
What kind of fit are you wanting or needing? Gaps are bad - a gap allows particles (and potentially germs) to enter and exit the mask. This may put you and others at risk of infection. Your mask should have a tight seal around your face and not allow for gaps or openings against the face. Your nose and mouth SHOULD ALWAYS BE COVERED!
Are you looking for a disposable mask that is worn once and discarded after each use? Or looking for a solution that can be reused a few times with confidence?
The deal with face shields.
Face shields are a topic of interest and often we are asked - can I wear a shield instead of a mask?
The simple answer is NO.
Why?
Face Shields are meant to be worn to protect your face and MASK against blood and bodily fluid splatter. This may help to prolong your mask life and in certain occupations, situations, are required or needed.
But if you are not a dentist, nurse, or someone who will be exposed to splatters (perhaps daycare workers and teachers should be included since we know little kids do not always cover their sneezes well and this may result in an unwanted "splatter") then you do not NEED a face shield.
Wearing only a face shield will not help to protect yourself or others. The particles and pathogens can easily escape (or enter) the shield - there is no protection.
Think about if you walked into a smokey room - would the shield help prevent the smoke from entering your airways? Nope. The same is true for germs.
We are all in this together. So please mask up - even if you still want to wear the shield, please put a mask on underneath for all of our safety - including yours.
The other area of masks that is not as widely discussed is how to safely put on and remove your mask to minimize your exposure to infection.
How to safely put on and take off your mask
How you put on your mask and remove your mask is AS IMPORTANT as wearing one to protect yourself.
Germs are invisible but that doesn't mean they are not there. Assume your hands are dirty when putting a mask on and off and use the ties or loops to safely put on and take off your mask.
Remembering to change your mask frequently is also important.
So Remember:
Choose a mask that matches your needs. If in doubt about exposure - level up and choose a mask that provides you with more - not less - protection than you need.
Do not assume all masks are made equally. Now more than ever it is important to challenge your supplier and ask them to provide proof (ASTM approved or Quality reports/standards) that gives you confidence that the mask you are buying is going to do what it needs to do to keep you and other safe.
Do not pull your mask up or down to expose your nose or mouth.
Do not touch your mask and repeatedly adjust it - the more you touch it the more likely you are to contaminate the mask and risk spreading your germs (from the mask) onto surfaces you are going to touch.
Do not reuse disposable masks! There is a reason they are disposable. If you want to reuse a mask - invest in the ones that can be reused OR use a cloth mask that can be laundered after EVERY SINGLE USE.
Do not share masks - yuck. This is one of those few moments in life where it is socially acceptable - in fact preferred - you do not share.
Do not litter you mask on the ground. Put it in the garbage where it belongs.
You don't know what you don't know - but that is why we believe in educating and sharing our expertise as much as possible. The more we can help educate each other, the faster we will beat this awful virus and get back to a life we all miss.
Where we can hug each other without fear of infection.
Where we can let our kids be kids and run free and enjoy the company of other kids without screaming after them to not touch their face, or get too close to other kids.
Where we can go to a grocery store without a mask and lineups outside.
We've got this Canada. We can beat COVID-19 together - with the proper tools, community education, and working together to keep each other - especially our most vulnerable - safe.