Can the Mask and Gloves I am Wearing to Protect Myself and Others Actually Do Harm?: FACS Update #11

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While the primary way that COVID-19 is thought to spread is directly from person to person, it may be possible that a person can become infected by touching a surface or an object that has the virus on it and then touching their own mouth, nose or eyes. This person-to-surface-to-person cross-contamination and subsequent spread of COVID-19 is possible but is something we can prevent by following a few simple strategies.

Take steps to ensure everyone adheres to appropriate cough etiquette, routine cleaning and disinfection of frequently touched surfaces. Clean your hands well and often. Post visual alerts (e.g., signs, posters) at the entrance and in strategic places to provide instructions (in appropriate languages) regarding cleaning hands and protecting lungs and covering coughs. Wearing a cloth face covering or facemask for source control is recommended by many public health departments and required by others at this time. These instructional messages should include instructions on the proper use of face covers as well as and how and when to perform hand hygiene.

Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60-95% alcohol, tissues, and no-touch receptacles for disposal, at facility entrances and break rooms.

Consider implementing policies requiring everyone entering the facility to wear a cloth face covering (if tolerated) while in the building, regardless of symptoms. This approach is consistent with a recommendation from the CDC to the general public advising them to wear a cloth face-covering whenever they must leave their home. However, if you aren’t wearing, removing, and washing your mask correctly, you could be putting yourself (and others) at greater risk.

Some important thing to note when wearing face masks or coverings:

  • 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. To avoid the risk of cross-contamination, adjust your mask to fit your face as soon as you put it on.
  • 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. Care should be taken to prevent self-contamination of cloth face coverings because they may become saturated with respiratory droplets. They should be changed if they become soiled, damp, or hard to breathe through, laundered regularly (e.g., daily and when soiled), and hand hygiene should be performed immediately before and after any contact with the cloth face covering.
  • To remove the mask: remove it from behind (do not touch the front of mask), when removing your mask, minimize the touching of your face by only using the straps or ear hooks for removal and then pull the respirator away from the face without touching the front of the mask. Discard immediately in a closed bin.
  • Clean hands with alcohol-based hand rub or soap and water just as you would after touching any other surface.

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. A mask worn improperly may not only fail to provide protection but could increase the risk of exposure. Some commonly reported observations regarding mask usage include people pulling the mask down below their nose and only covering their mouth or people frequently adjusting their masks without first performing hand hygiene. Both of these could result in cross-contamination both to the wearer and to the surfaces that the wearer touches after touching his/her mask or exhales onto if the mask does not adequately cover the mouth and nose.

Hand hygiene is an important part of the response to COVID-19. Practicing hand hygiene, which includes the use of alcohol-based hand rub (ABHR) or handwashing, is a simple yet effective way to prevent the spread.

Hand Washing/Hygiene

CDC recommends using alcohol-based hand rub with greater than 60% ethanol or 70% isopropanol. Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water due to evidence of better compliance compared to soap and water. Hand rubs are generally less irritating to hands and are effective in the absence of a sink.

Hands should be washed with soap and water for at least 20 seconds when visibly soiled, before eating, and after using the restroom. Consider your actions and the environment. You may find yourself touching surfaces that are frequently touched by others but are not sure how effectively they have been cleaned. There are a lot of doorknobs and other similar touchpoints we may encounter daily. If you touch these, perform hand hygiene before eating or touching your face.

Gloves

Wearing gloves is often crucial to preventing the spread of COVID-19. Gloves are common in healthcare, but they change their gloves between possible contamination events. If not properly worn, removed, and disposed of, glove use could be a waste of time, effort and resources and may give you a false sense of security. Cross-contamination is possible while wearing gloves as anything you touch will be transferred from the surface of your gloves and then to any other surface you touch. For example, if you are wearing gloves and touch a shopping cart, a doorknob, or even a sink faucet and then touch your face or your phone, you may transfer any organism present from one surface to another. It is essential to be aware of everything you touch.

In order to stop the spread of viruses, you have to be cautious when touching surfaces and handling items. Look with your eyes, not with your hands. Be deliberate with items that you do touch and wash your hands (20 seconds in water, and routinely throughout your day).

Don’t wear gloves more than once. Since the main purpose of wearing gloves is to avoid direct contact with potentially contaminated objects, washing and disinfecting them after use in order to reuse them isn’t effective.

How you remove your gloves is every bit as important as how you wear them to ensure glove removal does not cause additional contamination of hands. Gloves should be inverted for removal by turning them into one another, but you can very easily contaminate your bare hands by doing this, so immediately washing your hands once you have removed your gloves is always the best practice: Grab one glove with the other gloved hand and remove (glove to glove), then with your un-gloved finger remove the second glove by sliding your finger under the glove and remove.

If you aren’t throwing away your gloves safely, you may not be safeguarding yourself from the coronavirus. Gloves should be disposed of in a closed lid trash can. If you are using gloves out in public, bring along a disposable bag to place the gloves in once you are done with them, so you do not contaminate any other surfaces in your vehicle or work area if needed.

Wash your hands. While wearing gloves correctly can help prevent the spread of viruses, it does not replace the need to actively washing your hands. Wash your hands often, especially when you’ve been in a more public place. Keeping hand sanitizer in your car or nearby for use once you’ve been out in public is also helpful, but nothing is safer and more effective than washing your hands.

Additional Tips

  • Clean and disinfect frequently touched surfaces and objects (e.g., tables, countertops, light switches, doorknobs, and cabinet handles). In the workplace, rather than relying on others, place a sign for people to clean the copy machine (and wash their hands) before and after each use.
  • Launder items, as appropriate and in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely.

Together We Can

Being armed with good information on how to protect yourself and those around you and taking action based on that knowledge is critically important to getting through this current public health challenge as safely and swiftly as possible.  And keep in mind those around you may not yet have the same information. So, while they may not have traveled the exact same road, they have been on this long, strange trip too.  Provide some encouragement and education so we can all help each other prepare, prevent and protect those that are important to us.