Face mask use is currently a global topic of conversation. It is a well-known fact that social connections are a crucial factor in the transmission of bacteria and viruses. As the coronavirus pandemic continues, many people are thinking of things they never used to think about at all. Can you go outside? What if you are walking downwind of another person? What if you are stuck waiting at a train station, and someone else is there? What if your family is at risk if you work in a residential aged care facility? 

The history of face masks use from the medieval period to today

1600–1700

In 17th-century Europe, the doctors during the black plague covered themselves head to toe and wore a mask with a long bird-like beak filled with herbs and oils. The doctors believed that they protected themself from the disease. Now we know that the beaked plague masks were a misconception about the nature of the dangerous illness.

1800–1900

In 1867, the British surgeon Joseph Lister suggested that the germs caused wound infection. Later, the bacteriologist Carl Flügge confirmed that respiratory droplets carried bacteria. In response to these discoveries, Johann Mikulicz-Radecki, the head of the surgery department of the University of Breslau (now Wroclaw, Poland), started to wear a face mask in 1897. By 1923, over two-thirds of surgeons in operating rooms in US and European hospitals wore face masks.

Spanish Flu Pandemic 1918–19

During the 1918–19 influenza pandemic, wearing a face mask became compulsory for law enforcement officers, healthcare workers, and even citizens in some US cities.

PD-US: A family portrait during the Spanish Flu. Even the cat is wearing a mask!

The face mask will be a symbol of these times

Since January 2020, many public conversations have argued that face masks are ineffective during the COVID-19 pandemic crisis. However, since April 27, face masks have become mandatory for shopping and public transportation in Germany. In the Netherlands, it became compulsory only for public transit from June 1, 2020. On August 2, face masks became mandatory for Victorians whenever leaving the home. Nevertheless, in Asian countries people have been wearing masks in public for many years. 

The new growth in community transmission of COVID-19 in Australia means some states and territories now recommend or mandate the use of masks in aged care settings. The correct use of personal protective equipment (PPE) is a significant concern among aged care workers caring for residents. Australian health authorities must prioritise the needs of aged care workers, who provide daily care for residents who are more susceptible to infection and mortality if infected. 

What are the latest recommendations? Should aged care workers wear a face mask at work?

For aged care workers, the answer is yes. 

However, a risk-based approach to undertaken focusing on: 

  • The purpose of mask use
  • Settings where workers are unable to keep a physical distance of at least 1.5 metres 
  • Risk of exposure to the COVID-19 virus. 

The World Health Organization (WHO) recommends that masks use for:

  1. The protection of healthy persons (worn to protect oneself when in contact with an infected individual), or
  2. For source control (worn by an infected individual to prevent onward transmission). 

On July 30, 2020, the Australian Infection Control Expert Group (ICEG) released guidelines on the precautions that healthcare workers in areas with significant community transmission should take to protect themselves against COVID-19.

The ICEG advises us that the new coronavirus, SARS-CoV-2, could only be transmitted:

  1. Directly, through close contact with an infected person, or
  2. Indirectly by contact with contaminated surfaces or objects. 
  3. Also, there is little clinical or epidemiological evidence of regular airborne transmission of SARS-CoV-2. These data suggest that airborne transmission of COVID-19 is infrequent, and the routine use of airborne precautions not justified.

“The use of surgical masks may be indicated “for … residential aged care facility, where COVID-19 case(s) have occurred or are suspected, and close contact cannot be avoided…”

Which masks should aged care workers wear? 

The WHO advises that health professionals can use:

  • Surgical masks when caring suspected or confirmed COVID-19 patients, or
  • N95 respirators when performing interventions that might create aerosols. 

On August 18, 2020, the Australian Government recommended the use of a surgical mask in areas with significant community transmission, as minimum requirements in preventing SARS-CoV-2 transmission during routine care of residents as:

  1. Standard precautions: eye protection AND a surgical mask in all clinical settings
  2. Contact and droplet precautions: Gown, gloves, protective eyewear, and a surgical mask forroutine care of residents with suspected or confirmed COVID-19, those with acute respiratory symptoms, or who are in quarantine. 

Are there potential risks from continuous face mask use?

The constant wearing of face masks by aged care workers during their full shift should be implemented along with other measures as:

  • Frequent hand hygiene, and 
  • Physical distancing among workers in shared and crowded places where mask use may be impractical, such as staff rooms. 

The WHO revises several potential harms and risks of mask wearing, which include:

  • Self-contamination from the mask by contaminated hands or not being changed when wet, soiled or damaged
  • Possible development of facial skin lesions, irritant dermatitis or worsening acne, when used frequently for long hours 
  • That masks may be uncomfortable to wear
  • A false sense of security, leading to a breach of well-recognised preventive measures such as physical distancing and hand hygiene
  • Risk of droplet transmission and splashes to the eyes if mask wearing is not combined with eye protection
  • The complexity of wearing them in hot and humid environments (shower rooms).

When would a mask be considered contaminated? 

According to SafeWork Australia, a mask would be contaminated if it:

  • Has been worn by a person with respiratory symptoms, or
  • Has been worn by close contact of a confirmed COVID case, or, 
  • Is visibly soiled or damp.  

How many face masks does an aged care worker need to use?

It is a wise approach to consider having a few more clean masks in your handbag. An aged care worker will need a different mask when going someplace in the community where maintaining physical distancing (at least 1.5 m away from others) might be a challenge, including:

  • A trip to the local supermarket
  • A ride on public transport
  • A visit to a doctor.

It is essential to protect and support aged care workers and residents to minimise the risk of transmission from the community. Aged care workers are doing vital work in challenging times. When there is a lack of therapeutic interventions, the use of face masks seems to be essential to prevent the transmission of SARS-CoV-2. Research on the duration of face mask protection, the measures to prolong the life of disposable masks, and the invention of reusable face masks should be encouraged.

Are you worried about COVID-19 in your facility? Why not download our COVID-19 management checklist for free? Alternatively, if you have any questions about infection prevention and control, please feel free to contact us for an obligation-free conversation. Our goal is to stop infections in aged care, so please let us share our expertise and experience with you.