COVID-19 Response: Reuse of surgical or P2/N95 masks
Wednesday, 25 March 2020
Disposable surgical masks and P2/N95 masks are in short supply in veterinary and human health care organisations. Requests have been made to access unused medical stockpiles of surgical and P2/N95 masks for veterinary distribution, however surgical and P2/N95 masks may be in short supply for months as the COVID-19 pandemic continues.
Disclaimer - This is an evolving situation. The reuse of masks is not recommended so these guidelines are only recommended during circumstances of extreme need, such as during the COVID19 Pandemic. When you receive adequate stocks of PPE, please revert to recommended usage for your safety, as well as that of your staff, patients and clients.
What I need to know
Do I need to wear a mask during consultations?
No. Masks are NOT REQUIRED  during general consultations. If clients have a cough or cold, please ask them to leave the clinic immediately.
Ensure that you have signage on the clinic door advising people to CALL if they have a cough, cold or flu like symptoms, are in home quarantine, or may be infectious.
Are there disadvantages to wearing a mask?
A mask may act as a prompt to not touch your face. Be cautious, as the outside of the mask will be contaminated and should not be handled. You need to determine which is the safer option for you.
Do I need to wear a mask during surgery?
Yes, wearing a mask during surgery is preferable.
If performing surgery and you have limited or no masks available, operating without a mask may be necessary. In this instance make sure not to talk, sneeze or cough over the patient.
You may like to use a homemade mask to protect the patient from any respiratory secretions. More information below.
When do I need to wear a surgical mask?
When there is a risk of droplet infection. Droplets are heavy and travel about one metre .
Surgical masks can:
- Protect the wearer - when there is a risk of splashes or sprays from respiratory secretions from other people reaching the nose or mouth.
- Reduce spread - if worn by individuals likely to sneeze or cough, the mask will contain their respiratory droplets .
When do I need to wear a P2/N95 mask?
P2/N95 masks must be worn for:
- High risk equine consultations or procedures,
- Avian consultations, when there is a concern of Psittacosis,
- Performing caesareans on cats and dogs to reduce the risk of Q fever infection, and
- Investigations of abortions, for example of small ruminants or poultry mortality .
- The use of eye goggles or face masks should also be worn for additional protection .
How do I take my mask off?
- Perform hand hygiene.
- Masks should be removed by untying the straps or unhooking elastic ear pieces.
- DO NOT touch the front of the mask - this area is contaminated.
- Discard mask.
- Perform hand hygiene after removal .
https://covid-19training.com.au/res/ppe_sequence.pdf (simply register to gain access)
How can I best store my mask for reuse?
It is not recommended that single use masks (surgical or P2/N95) are reused.
- Many PPE consumables are in short supply as a result of the COVID19 pandemic so reusing masks may be required.
- Write your name on the side of the mask BEFORE you use it.
- Remove the mask by untying the ties or loosening the straps over the ears, taking care to not touch the front of the mask. Place the mask in a clean breathable container, such as a paper bag between use .
- Perform hand hygiene before and after touching or adjusting the respirator. Avoid touching the inside of the respirator .
You must perform a user seal check if reusing a P2/N95 mask . Discard the mask if you cannot maintain a seal.
When MUST I throw my surgical or P2/N95 mask out?
Masks MUST be discarded:
- When there is ANY blood or bodily fluids on them.
- After being used in an aerosol generating procedure,
- After close contact with a patient / individual with an infectious disease requiring contact precautions ,
- If the mask is damaged.
- If you cannot maintain a seal with a P2/N95 mask.
Can I make my own mask?
All masks can reduce aerosol exposure. Homemade masks will not be as efficient as surgical or P2/N95 masks, however they may provide some protection if masks cannot be accessed. One study found that homemade masks made from tea towels provided about half the level of protection as surgical masks . Another study testing varied materials such as T-shirts, towels and scarves, found that these may only provide minimal respiratory protection to aerosols .
While making your own mask is not recommended, they can provide some protection to patients undergoing surgery. Please make sure that you change your mask between every patient.
Using homemade masks during surgery will help reduce aerosol transmission and protect the patient. Use once and then wash with commercial laundry detergent in a hot wash (at least 71o Celsius for minimum 25 minutes) to help reduce pathogen load. Drying in a tumble dryer on high heat will help to further reduce pathogens [8, 9].
There are patterns for making your masks available on YouTube https://parade.com/1012729/jessicasager/how-to-sew-a-face-mask-to-overcome-the-shortage-during-coronavirus-pandemic/
What about ordering masks online from overseas?
Both surgical and P2/N95 masks are made to strict Australian requirements. Masks purchased from overseas may not offer the same level of protection and provide a false sense of security. Ensure that they satisfy PPE standards (see below).
Fit testing of P2/N95 masks
You must perform fit testing of P2/N95 masks before you wear a mask. This is important to ensure that you have a good seal. There are several types of P2/N95 masks available. A link for fit testing and instructions is provided below.
P2/N95 masks cannot be worn with beards as a proper seal cannot be attained.
What is nice to know
What are disposable surgical masks?
Surgical masks meeting Australian standards are fluid impervious and provide protection to the nasal and oral mucosa against droplet contamination .
What are P2 and N95 masks?
- P2 refers to European testing requirements.
- N95 refers to the NiOSH, the USA testing requirements.
- Australian requirements for P2 respirators are stated in Standard AS/NS 716:2012
- P2/N95 masks are worn during Airborne Precautions, in addition to Standard Precautions.
- P2 respirators minimise aerosol contamination by ensuring a firm fit and that there is a firm seal.
- They limit aerosol particles 0.3 to 0.6 microns .
What are airborne precautions?
Airborne precautions are used in addition to standard precautions (such as hand hygiene, gowns, gloves, protective eyewear).
They are used for infections that are known to be transmitted from person to person, such as COVID 19.
Aerosols are very small particles that can remain suspended in the air and travel for more than two metres . Aerosols may land on surfaces such as desks, floors, door handles.
A P2/N95 mask should be worn when airborne precautions are required.
What are droplet precautions?
Droplets are airborne and remain in the air for a short time. Droplets can travel about 1 metre because they are heavy . This is why a 1.5 metre separation is recommended for social distancing.
A surgical mask should be worn if droplets are a risk, for example, a coughing or sneezing dog or when performing pharyngeal suctioning .
- WHO: When to use a mask
- WHO: How to remove a mask
- Infection control in Pandemics, Royal Australian College of General Practitioners: Mask use and cleaning information
- Centers for Disease Control. Coronavirus Disease 2019 (COVID-19). 2020 18 March 2020 [cited 2020 17 March 2020]; Available from: https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fprevention.html.
- Health, D.o. Transmission of respiratory diseases and managing the risk. 2020 [cited 2020 19 March 2020]; Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/transmission-of-respiratory-diseases-and-managing-the-risk.
- Australian Commission on Safety and Quality in Health Care, Australian Guidelines for the Prevention and Control of Infection in Healthcare 2019, National Health and Medical Research Council,. p. 362.
- Australian Veterinary Association. Guidelines for veterinary personal biosecurity. 2017 May 2017; 3rd:[Available from: http://www.ava.com.au/sites/default/files/Guidelines-for-veterinary-personal-biosecurity-2017-FINAL.pdf.
- Centers for Disease Control. Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings. 2018 28 march 2018 [cited 2020 18 March 2020]; Available from: https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html.
- Sande, M.v.d., P. Teunis, and H.W.R. Sabel, Professional and home-made face masks reduce exposure to respiratory infections among the general population. 2008.
- Rengasamy, S., B. Eimer, and R.E. Shaffer, Simple Respiratory Protection—Evaluation of the Filtration Performance of Cloth Masks and Common Fabric Materials Against 20–1000 nm Size Particles. Annals of Occupational Hygiene, 2010. 54(7): p. 789-798.
- Anderson, M.E.C., M. Wimmers, and J.S. Weese, Infection prevention and control best practices for small animal veterinary clinics. 2019, Ontario Animal Health Network: Guelph.
- Caveney, L., B. Jones, and K. Ellis, Veterinary infection prevention and control. 2012: John Wiley & Sons, Chichester UK.