Summary of Mask Recommendations for Hygiene Promotion Staff
N95 respirators should be prioritised for health workers and hospital staff.
Surgical masks should be prioritised for symptomatic individuals, those caring for or in close proximity COVID-19 cases, and high risk individuals who may be more vulnerable to COVID-19 (people older than 60 years, people with pre-existing medical conditions).
Hygiene promoters do not fit into either of the above categories but are at higher risk than the general population and could put others at risk, especially in settings where physical distancing may be difficult.
Hygiene promoters should be encouraged to wear fabric masks if the hygienic use conditions described below can be met and maintained. If these hygienic use conditions cannot be maintained then fabric masks should not be used by hygiene promoters.
Below we describe the rationale behind each of these recommendations.
In some countries it is still safe for hygiene promotion staff to be going from household to household to share information about COVID-19 and promote hygiene behaviors. Hygiene promoters have a critical role to play in terms of interrupting transmission but this type of hygiene promotion is also a risk. As hygiene promoters move around communities they are putting themselves at a higher risk of getting infected. We also know that people infected with COVID-19 may be infectious (able to spread the virus) but not symptomatic (Study 1, Study 2, Study 3). This means that hygiene promoters who feel healthy may themselves be infected and at risk of spreading this to other people in the community.
Due to the potential risks of transmission during community hygiene promotion activities, we recommend hygiene promoters wear fabric masks if the conditions outlined below can be met and maintained. The purpose of wearing these masks is to prevent hygiene promoters from spreading the disease to others in the community (‘source protection’). Organisations should provide fabric masks to their staff (rather than relying on staff to make or purchase them), train them on their safe use, and provide zip-lock plastic bags for storing used masks prior to washing. Due to limited supplies, we do not currently recommend the use of N95 respirators or surgical masks, even though they may offer a higher level of protection, as these masks must be reserved for healthcare workers, caretakers of COVID-19 patients, vulnerable populations, and those with symptoms.
Hygienic use conditions for fabric mask wearing among hygiene promoters:
Make masks out multiple layers of material. The WHO recommends masks be made of at least three layers. Choose materials and designs that balance breathability and filtration efficiency. Fabrics with tighter weaves are preferable over looser weaves (e.g. choose higher thread count cotton vs lower thread count) as they may offer better filtration. Consider combining layers of different fabric, including a water resistant outer layer (polyester blend, non-woven polypropylene) and a water absorbent inner layer (cotton). For more information see our section on What should be considered when making fabric masks.
Attach ties or elastic ear-loops at the top and base so that you can ensure a good fit.
Ensure a tight fit around the nose and mouth. Using a thin piece of wire at the top of the mask could aid in achieving this around the nose.
Wash your hands with soap and water or use alcohol-based hand rub prior to putting the mask on and after taking it off.
Ensure all hygiene promotion staff have multiple masks and that they can change them when damp, visibly soiled, or at least every day.
Do not touch masks during use. If accidental contact occurs, wash hands with soap and water or alcohol-based hand gel.
Remove masks from the back (ties or ear-loops) and avoid touching the front of the mask while removing (See the infographic below). Once removed, reusable fabric masks should be immediately washed or stored in a sealable plastic bag until they can be washed.
Machine or hand wash fabric masks in hot soapy water (water should be at least 60 degrees centigrade or as hot as permitted by the fabric) with standard laundry detergent and fully dry before reuse (a machine dryer is preferable). If a machine washer is not available, the WHO and CDC recommend soaking fabric masks in a dilute chlorine solution (0.1% chlorine, 1 part household bleach [typically 5% chlorine] to 49 parts water) for 1-5 minutes before rinsing and drying or boiling for 1 minute. Note that bleach may discolour some fabrics. We recommend demonstrating the cleaning process to hygiene promotion staff prior to recommending use.
Masks should not be shared among hygiene promoters.
Additional information on the safe and hygienic use of fabric masks is summarized in this section and this WHO video.
If your organisation decides to promote fabric masks among your hygiene promoters in a region where mask-wearing by the general public has not been recommended, you need to make sure that your staff are able to explain why they are wearing masks and why masks are not encouraged for the rest of the population. For tips on discussing COVID-19 transmission and mask-wearing without using stigmatizing language, see this Oxfam guidance.
Note: If supply systems of surgical masks are able to adapt to the current need and there is ample supply in your setting, then hygiene promoters should switch to these rather than fabric masks. Handwashing and safe use and disposal will still be key to practice. Please see this section for additional information on the safe disposal of personal protective equipment, including surgical masks.
Want to learn more about mask use for interrupting the spread of COVID-19?