In Italy with the Law Decree approved by the Council of Ministers on 7 October 2020 “it is mandatory to wear the masks not only in closed places accessible to the public, but more generally in indoor places other than private homes e even in all outdoor places. Children under the age of six are excluded from the obligations, as well as those with pathologies or disabilities incompatible with the use of the mask and those who, in order to interact with the latter, are in the same incompatibility. "

Basically, masks anytime, anywhere. In this phase of coexistence with the Sars-Cov2 virus, in addition to the physical safety distancing and the sanitation of the hands, the masks, if used correctly, they are the tool capable of containing and reducing the contagion of the infection.

On the market there are community masks, surgical masks and personal protective medical devices. Let's see the differences, what to wear, how, how to dispose of or reuse them thanks to guidelines of the Ministry of Health and the contribution of dr. Fabrizio Facchini, pulmonologist in Dubai.

COMMUNITY MASKS

Eg community mask

They are not subject to particular certifications. They are not considered either medical devices or personal protective equipment, but a hygienic measure useful to reduce the spread of the SARS-COV-2 virus. They must ensure an adequate barrier for the nose and mouth adhering to the face while ensuring adequate breathing and comfort.

They are made of non-toxic and anti-allergic multilayer material that is resistant to washing up to 60 degrees. The masks of commercial communities are disposable or washable.

Washable masks: on the package usually includes the number of washes allowed without diminishing performance. After handling a mask, wash it. (source: Ministry of Health)

Disposable masks "Although not recommended as a rule - explains Dr. Fabrizio Facchini - if necessary, they can be reused by adopting adequate sterilization measures. The most studied are:

  • Ultraviolet Lamps (UV, usually UVC): Sterilize surfaces in direct contact with light, so both faces of the mask must be turned to achieve safe sterilization. Never expose yourself directly to the light of the lamps, the eyes are the most sensitive part to UV rays
  • Ozone generators: It is the most effective method in consideration of the fact that the gas is distributed and also reaches the parts hidden from UV light, it acts thanks to its highly oxidative properties. Ozone shields the earth from cosmic rays, but is highly reactive and therefore can damage the organic tissues of our body, especially the eyes and respiratory tract
  • Microwave oven: Readily available in our homes. Cannot be used if there are metal or rubber / plastic components (e.g. elastic)
  • Autoclave: This is the sterilization method for surgical instruments. In principle it can be considered as a pressure cooker. It works by transmitting heat through pressurized steam. Can be used with metal parts, it damages rubber / plastic parts

SURGICAL MASKS:

Eg surgical mask

The surgical masks are the masks for medical use, developed for use in a healthcare environment and certified according to their filtering capacity. They work by preventing transmission.

In the presence of symptoms of Sars-Cov2 infection it is necessary to use surgical masks, i.e. those certified as medical devices.

PERSONAL PROTECTIVE MEDICAL DEVICES (DIP)

ES. individual protection medical device

"Protective masks are real personal protective equipment (PPE = Personal Protective Equipment in Italian, PPE = Personal Protective Equipment in English) - specification dr. Fabrizio Facchini, pulmonologist in Dubai - These masks have a real filtering task and reduce the infectious risk corresponding to the value reported on the package. The N95 (American certification), KN95 (Chinese certification) or FP2 (European certification) masks, although with some differences, have quite similar protective capacity, as well as the N98, KN98 and FP3 for a higher protection value.

Some of these masks have a valve which favors exhalation (when we throw out the breathed air). In fact, although these masks do not reduce the ability to oxygenate, they can instead favor the retention of carbon dioxide which is partially re-breathed by the air we exhale (we throw out). Conversely, while retaining the protective capacity, valve masks are not designed to reduce the risk of transmitting infections, which is an additional property of those without valve. Finally, surgical and community masks in general do not limit the ability to oxygenate, nor do they significantly promote carbon dioxide retention ”.

What to do before wearing a mask or PPE?

  1. wash your hands with soap and water for at least 40-60 seconds or perform hand hygiene with alcohol solution for at least 20-30 seconds;
  2. wear the mask touching only the rubber bands or ties and taking care not to touch the inside;
  3. position the mask correctly by adhering the upper wire to the nose and bringing it under the chin;
  4. make sure you have worn it in the right direction (for example in surgical masks the colored part of blue is the external one)

R.imotion 

  1. always manipulate the mask using the rubber bands or ties;
  2. wash your hands with soap and water or perform hand hygiene with an alcohol solution;

How to dispose of the masks? 

Disposable mask: in unsorted waste;

Reusable mask: put it in an envelope and proceed with washing at 60 degrees with common detergent or according to the manufacturer's instructions. Sometimes the manufacturers also indicate the maximum number of washes possible without reducing the performance of the mask.

Dr. Facchini, how does the transmission take place?

Transmission occurs via droplets of vapor released during breathing or thrown into the air by a sneeze or cough. In general, wearing a mask has shown its effectiveness not only in the surgical field, but also in protecting people with diseases or therapies that reduce the immune defenses from infections transmitted unintentionally by friends and relatives. However, its effectiveness is not limited to this.

In fact, it has also been demonstrated an ability to reduce the transmission of diseases transmitted by others with a variable percentage between 60 and 70%. A value certainly far from the protection of 95 or 98% given by the protective masks N95 (FP2) and N98 (FP3) respectively.

Dr Facchini, qhen the correct use of masks is important and PPE?

Is critical. Bringing the mask under the nose, covering only the mouth, is an irresponsible act because the vapor droplets come out of the nose, transmitting the infection; conversely, the nose receives the droplets of others, increasing the possibility of being infected. Equally irresponsible is to lower the mask while talking on the phone or with others. Unfortunately, you see this all the time on TV even when there are no safe distances (not to mention what the microphones can transmit!).

In addition to increasing the risk of Sars-Cov-2 infection, can an incorrect use also cause the onset of other diseases?

Yes. With proper use, all types of masks limit infections, including seasonal infections such as the flu. If, on the other hand, masks are used incorrectly, not only do they not protect us, but they can favor the transmission of the Sars-CoV2 virus. For example, if you touch the surface of the mask after it has been exposed to SARS CoV2 or other microbes and don't wash your hands right away, we could then get infected with our own hands!

Furthermore, prolonged use of the mask without it being changed, washed or sterilized allows for the multiplication of microbes on the surface of the mask. In fact, the presence of filtered microbes on both the internal and external surface of the mask progressively produces a biofilm that compromises the filtering capabilities of the masks and favors the transmission of biofilm microbes in our respiratory tract, increasing the risk of infecting us. 

For people who have to wear them all day, what do you recommend?

Remember that touching the mask potentially causes transmission through direct contact. In fact, we unknowingly bring our hands to our face almost every 10 minutes. If this happens, remember to wash or disinfect your hands.

How often to “take a breath of fresh air" without mask and how?

The breath of air is not clinically necessary for surgical masks even though, we have all experienced it, it is more tiring to breathe with the mask. When we feel the need, we take the opportunity to hydrate and do it safely at a distance of at least 2 meters from other people

How many hours to change the masks?

Common sense rules are:

  1. change the mask when it is wet, therefore with impaired filtering capacity
  2. change the mask when it gives off a bad smell, in fact the perception of smell could indicate the presence of bacterial multiplication
  3. change the mask at least every 24 hours, in fact the exhaled microbes (on the inner surface of the mask) and filtered ones (on the outer surface of the mask) reproduce very quickly, producing a biofilm capable of infecting us

Myselfson the mask single-use community or the surgical community?

Both perform the function of reducing the emission of vapor droplets emitted with our breath. Those of communities, by definition, do not need certification and they vary a lot in terms of protective capacity. Sometimes they are more effective, other times less effective than surgical ones, nor do we know how their effectiveness changes with repeated washing. A handkerchief in front of the nose and mouth has a filtering capacity of about 20-30%, much lower than the 60-70% of a surgical mask.

In conclusion, what is meant by "Universal masking"?

It is a strategy that is adopted when the probabilities of transmission of a virus become more frequent and it is effective only if we all participate in it. A person with the mask lowered under the nose and less than 2 meters away does not only endanger themselves, but also us who keep the mask in the correct position.

The strategy is also adopted outdoors because opportunities for close encounters in everyday life are continually present, at the local market while we are choosing products, as in the street on the sidewalk when we meet strangers.

INFOGRAPHICS (MINISTRY OF HEALTH)

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