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4137660-22860000safety measures and good practice for Cloth mask use in the presence of coronavirus or covid-19Updated 23 April 2020Cloth mask findingsHealth care workers caring for patients that are COVID-19 positive or suspected positive should always wear N95 (with eye protection) when available. Second best is a medical mask (with eye protection). If neither of those are available, a cloth mask is better than nothing Research shows that cloth masks were not as effective as medical masks or N95 masks in preventing wearers from inward or outward exposure; but cloth masks did decrease risk of exposure and are preferable to no mask if used properly21The fit of cloth masks needs to be as close as possible to airtight for protection from airborne dropletsCloth masks can offer up to 70% filtration efficiency, depending on cloth9.Cotton T-shirt: 70%Anti-microbial Pillowcase: 65%Linen: 60%Silk: 58%Adding an additional filtration insert significantly improves the protective factor of a cloth mask2,3,9Add a cut out from vacuum cleaner bag: 94%Medical mask, for comparison: 96%Other materials have been suggested to use for an insert in addition to cloth, including coffee filters and multiple layers (2-3) of folded paper towels.Cloth masks can statistically significantly reduce the number of microorganisms expelled by wearers12, 20, 21, and every individual with symptoms, or suspected or known COVID-19, should wear a mask of some kindCloth masks, even with an additional insert (folded paper towel, coffee filter or vacuum cleaner bag) do not filter microorganisms as effectively as medical masks and medical masks do not filter as effectively as N9516Making cloth masksThere are many easy patterns available and several are listed below1-3 Include a sewn-in?small gauge (1.0mm) copper or aluminum wire or similar material to create a 'pinchable' bridge over the nose to help create as close as possible to an airtight seal1Elastic can be sewn into seams to help snug the mask to the faceInclude at least 3 layers of material in the mask; consider adding a filtration screen such as a cut-up coffee filter or vacuum cleaner bag2,3Your mask should allow for breathing without restrictionDonning and Doffing masksDon’t continue to use a damp or soiled cloth or medical mask; or use either type for more than three hoursPlease see here for a WHO video on donning and doffing masks safely. After you have donned (put on) the mask and have adjusted it, do not touch the mask again until you doff (remove) it. The exterior of the mask may be contaminated with the coronavirus. Safe doffing means: take mask off from the back/strings; do not touch eyes, nose, or mouth when removing mask; do not shake the mask. Store used, un-sanitized masks in a designated bin or container with a lid, and do not remove until ready to launder. If you don’t have a bin, a large envelope can be used to store the mask until it can be sanitized. Always wash your hands after removing or handling un-sanitized masks. Safely cleaning cloth masksLimit handling of contaminated masks as much as possible. Ensure you practice thorough hand hygiene after handling used masks.Sanitize cloth masks by one of the following methods:6-8, 15, 22Machine washing with detergent on hottest settingORLaunder in very hot water (at least 60°C) with soap, and dry thoroughly. Iron on high heat if possibleAdditional safety considerations for cliniciansAll mask use protects us best when paired with hand washing with soapDon’t expect any mask to fully protect you from coronavirus.Even with a mask on, do not touch your face or readjust your mask. Some people have found that a mask can help remind you not to touch your face.Consider a cloth mask as?the last possible alternative if a supply of medical face masks is not available4,5,16 N95 respirator and medical masks are more protective than cloth masks and should be chosen if available.Consider wearing a cloth mask over an N95 respirator or medical mask, if these are being rationed4. Change cloth mask and don a clean one every time the mask is removed. Don’t put your cloth mask back on your face before you have sanitized it.Follow the CDC advice that masks be worn with eye protection4Use standard infection control measures when donning,?doffing and sterilizing cloth masks4,5?Resources about masks and airborne influenza-like illnesses:CDC Cloth mask instructions: No-sew patterns: mask with vacuum cleaner bag insert (avoid vacuum cleaner bag with fiberglass!): Advice on wearing N95, surgical and cloth masks: Advice:(2019-ncov)-outbreakSanitizing: studies:C. K. Lai, C. K. M. Poon?and A. C. T. Cheung 2011 Effectiveness of facemasks to reduce exposure hazards for airborne infections among general populations. J. R. Soc. Interface.9938–948, of cloth masks in the practice of infection control—evidence and policy gaps.?Int J Infect Control?2013;9:1–12.Chughtai, A.A., Seale, H. & MacIntyre, C.R. Availability, consistency and evidence-base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis.?BMC Res Notes?6,?216 (2013). BJ, Chan K, Fang VJ, et al. Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households:?A Cluster Randomized Trial. Ann Intern Med. 2009;151:437–446.?doi:?, Anna & Thompson, Katy-Anne & Giri, Karthika & Kafatos, George & Walker, James & Bennett, Allan. (2013). Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic? Disaster medicine and public health preparedness. 7. 413-418. 10.1017/dmp.2013.43.Del Valle, Sara, Tellier, Raymond, Settles, Gary, Tang, Julian, Can we reduce the spread of influenza in schools with face masks?, American Journal of Infection Control, Volume 38, Issue 9, 2010, Pages 676-677, ISSN 0196-6553, . Duan, Shu-Ming & Zhao, Xin-Sheng & Wen, Rui-Fu & Huang, Jing-Jing & Pi, Guo-Hua & Zhang, Su-Xiang & Han, Jun & Bi, Sheng-Li & Ruan, Li & Dong, Xiao-Ping. (2003). Stability of SARS Coronavirus in Human Specimens and Environment and Its Sensitivity to Heating and UV Irradiation. Biomedical and environmental sciences : BES. 16. 246-55.MacIntyre, C Raina et al. “A cluster randomised trial of cloth masks compared with medical masks in healthcare workers.”?BMJ open?vol. 5,4 e006577. 22 Apr. 2015, doi:10.1136/bmjopen-2014-006577Price, A and Chu LF, March 2020,COVID-19 Addressing COVID-19 Face Mask Shortages(v 1.3), Learnly Anesthesia/Stanford AIM Lab COVID-19 Evidence Service, Stanford, California USAQuesnel, L.B. (1975), The efficiency of surgical masks of varying design and composition. Br J Surg, 62: 936-940. doi:10.1002/bjs.1800621203Roberge, Raymond. "Facemask use by children during infectious disease outbreaks." Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, vol. 9, no. 3, 2011, p. 225+. Gale Academic OneFile, . Suess, T., Remschmidt, C., Schink, S.B.?et al.?The role of facemasks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomised trial; Berlin, Germany, 2009-2011.?BMC Infect Dis?12,?26 (2012). der Sande, Marianne et al. “Professional and home-made face masks reduce exposure to respiratory infections among the general population.”?PloS one?vol. 3,7 e2618. 9 Jul. 2008, doi:10.1371/journal.pone.0002618Viscusi, Dennis J et al. “Evaluation of five decontamination methods for filtering facepiece respirators.”?The Annals of occupational hygiene?vol. 53,8 (2009): 815-27. doi:10.1093/annhyg/mep070Mask templates*:*Notes:Fine gauge wire can be substituted for elastic in the sewn cloth face covering belowAdditional filtration such as from a coffee filter or paper towel can be inserted between layers of fabric in the first and second designs below:center-197100center43789600065021-330700right117607004115435317500FACE MASK SEWING PATTERN facemask pattern includes a) a slot or pocket to add a filter to make the mask more effective; and b) a nose clamp (aka nose wire) to provide a better seal at the nose bridge area c) due to shortages of elastic band and also for comfort the head tie can be made out of shoelace and t-shirt yarn MaterialsMain Fabric (cotton), 13" x 7", prewashLining Fabric (cotton or flannel), 12" x 7", prewashBias Tape, 2" wide 6" long (5" for young kids, 4" for small kids), prewash. (Optional, as nose wire sleeve)Wire, 6" (5" for young kids, 4" for small kids). (Optional, as nose wire), bent the ends inward so the won't poke through the fabric.Elastic cord: for ear loops, 8" x 2, or, for head tie, 18" x 1, (this is an approximate length, please measure with your own elastic band to judge; as everyone's head and sizes are different)or, shoelace/ribbon/cord/t-shirt yarn with at least 44" length for the head tieInstructionsleft825500Step 1. Get ready all the materials as stated in the material list above.Step 2.right692500Fold the fabric with the wrong side facing each other, place the paper template on it, pin.Cut the fabric out with ?” seam allowance (you can use ?" seam allowance), except the side of the face mask: 1″ for the outer layer (1.5" if you are using t-shirt yarn as the head tie), ?” for the inner layer.Trace the sewing lines with the tracing paper and tracing wheel.NOTE: If you are using templates that already have seam allowances included, you do not need to add any more seam allowance.2413005588000Step 3.Turn the pieces over and pin the pair together with the right side facing each other. Sew the curved lines as shown in the picture.Draw a line ?” from the original side sewing line of the inner layer, do the same to the other side of the inner layer.23242219520900Step 4.Clip the seam allowance about ?” apart. This will let the fabric’s raw edge to stretch without pulling the seam when you turn it right side out. Repeat this on both the outer layer and the inner layer.21532512957600Step 5.Turn the pieces right side out, press the seam allowance to one side, topstitch near the seam line. Repeat the same to the inner layer.19732910850100Step 6.Fold the side at the second line drawn next to the original sewing line of the inner layer. Fold the raw edge and hide inside the fold. Topstitch to sew it on. Repeat on both sides of the inner layer. HYPERLINK "" \t "_blank" ADD THESE STEPS IF INCLUDING A NOSE WIRE. IF NOT, JUMP TO STEP 13left5132700Step 7.Cut a bias strip of 2” wide and 6” long or use store-bought bias tape if you can find if from the shelf.How to cut bias strip:Fold the fabric diagonally, draw a line along the crease of the fold, measure 2” from the line and draw a line parallel to it. Cut the strip into 6” length.Step 8.3492520193000Fold ?” from the 2” ends.Step 9. Fold the strip into half, lengthwise.-2476512573000Step 10.Stitch up both ends.-635031432500Step 11.Align the bias tape along the front top edge of the stitch at the bottom edge of the bias tape.Do not remove the pins until you pin the main piece to this lining piece.829310254000left7696700Step 12.Continue to attach the main piece and sew them up into a face mask as shown above.left479200Step 13.Place the inner layer on top of the outer layer, with the right side facing each other.Sew the top and bottom seam lines.You may notice that the edge of the inner layer is now ?” away from the sewing line of the outer layer. If it is not the case, please check if you sewing it correctly in the previous step.left3739300Step 14.Clip curve on the seam allowance where the 2 layers meet. Leave about 1/2″ from the ends un-clip.Turn the face mask right side out. Press seam flat.left12890500Step 15.Double fold the top and bottom raw edges of the outer layer (both sides). Topstitch near the edge as shown in the picture. Repeat the same to the bottom seam line.To make the pocket for the elastic band, fold the side raw edge 1/4″ from the edge, then fold again so that the edge meets the edge of the inner layer.-6351167000Step stitch a vertical line to sew it on. The top and bottom have an opening for you to insert your elastic band.I added my label while sewing it.left1151400Step 17.This is the opening for the filter insert.1785620633800left2500500Step 18.Add elastic bands or shoelaces to the pocket face mask the way you like and it is really to be worn.left30543500IF YOU ARE USING A NOSE WIRECut a piece of pipe cleaner about 6” long, bend the ends in to make the pipe cleaner slightly shorter than the nose wire sleeve. Insert it into the sleeve. Remove the wire before washing the face mask.Other options of nose wire are twist tie, florist wire, garden bonsai wire, aluminum or other hardware wires as long as it can be bent and stays there. Wash the face mask with warm water of at least 60 °C or 140 °F, dry it properly before wearing. Add filter insert if required. ................
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