Strategies for Conserving the Supply of Medical Masks

Conventional capacity strategies

Use Food and Drug Administration (FDA)-cleared medical masks according to product labeling and local, state, and federal requirements

FDA-cleared medical masks (shortened to medical masks) include surgical masks, medical procedure masks, and isolation masks. In healthcare settings, medical masks are used by healthcare personnel (HCP) for two general purposes:

1. As personal protective equipment (PPE) to protect their nose and mouth from exposure to splashes, sprays, splatter, and respiratory secretions. When used for this purpose, medical masks should be removed and discarded after each patient encounter.
2. As a source control device in the healthcare facility, to cover one's mouth and nose to prevent spread of respiratory secretions when they are talking, sneezing, or coughing. When used for this purpose, medical masks should be discarded after removal but may be used until they become soiled, damaged, or hard to breathe through.

Medical masks are designed to protect against splashes and sprays and are prioritized for use when such exposures are anticipated. Some disposable face masks that are not regulated by FDA may look similar to medical masks, which are typically used for source control, and may not provide protection against splashes and sprays.

Use NIOSH Approved® respirators

Use NIOSH Approved respirators in place of medical masks if supplies of respirators are not compromised. NIOSH maintains a searchable, online version of the Certified Equipment List identifying all NIOSH Approved respirators.

Contingency capacity strategies

Remove medical masks from facility entrances and other public areas

Healthcare facilities can consider removing all medical masks from public areas (e.g., entrances, near elevators) and instead keep them in a secure and monitored site where they are distributed at check-in only to patients who do not have their own respirator or mask. This is especially important in high-traffic areas like emergency departments.

Restrict medical masks for use only by HCP when needed as PPE

HCP who only require the use of a source control device may use a cloth mask or disposable face mask that is not FDA cleared. Patients may use a cloth mask or disposable face mask as a source control device.

Use Enhanced Performance and Enhanced Performance Plus Barrier Face Coverings (BFC)

Enhanced Performance and Enhanced Performance Plus BFCs are disposable or reusable BFCs that achieve a minimum of 50% filtration efficiency against particulates. They are intended to cover the nose and mouth. These BFCs meet the ASTM F3502-21 consensus standard and are tested by a laboratory. The manufacturer must specify how to wear it properly to reduce gaps and, if reusable, the number of times you can wash the BFC. They are intended primarily for source control and to provide a degree of particulate filtration to reduce the amount of inhaled particulate matter. However, they may not offer fluid resistance.

Implement extended use of medical masks as PPE

Extended use of medical masks is the practice of HCP wearing the same medical mask as PPE (e.g., for patients on Droplet Precautions) during encounters with several different patients, without removing the medical mask between encounters.

• The medical masks should be discarded whenever the mask is removed, and always at the end of each workday.
• The medical masks should also be removed and discarded if soiled, damaged, or hard to breathe through.
• HCP must take care not to touch their medical mask. If they touch or adjust their mask, they must immediately perform hand hygiene.
• HCP should leave the patient care area if they need to remove the medical mask.

Crisis capacity strategies

Use medical masks beyond the designated shelf life during patient care activities

If there is no date available on the medical masks label or packaging, facilities should contact the manufacturer. The user should visually inspect the product prior to use and, if there are concerns (such as degraded materials or visible tears), discard the product.

Implement limited re-use of medical masks with extended use

Pairing limited re-use of medical masks with extended use is the practice of using the same medical mask by one HCP for multiple patient encounters but removing it after several encounters and redonning it for further patient encounters. It is unknown what the potential contribution of contact transmission is for many respiratory infectious agents. Ensure that HCP do not touch outer surfaces of the mask during care and that mask removal and replacement is done in a careful and deliberate manner.

• There is not a known maximum number of uses (donnings) for the same medical mask to be re-used.
• The medical mask should be removed and discarded if soiled, damaged, or hard to breathe through.
• Not all medical masks can be re-used.
  • Medical masks that fasten to the provider via ties (surgical masks) may not be able to be undone without tearing and should be considered only for extended use, rather than re-use.
  • Medical masks with elastic ear hooks may be more suitable for re-use.
• HCP should leave patient care area if they need to remove the mask. Medical masks should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage. The folded mask can be stored between uses in a clean sealable paper bag or breathable container.

Prioritize medical masks for selected activities such as:

• For provision of essential surgeries and procedures
• During care activities where splashes and sprays are anticipated
• During unavoidable activities that require prolonged face-to-face or close contact with a potentially infectious patient for whom medical mask use is recommended
• If respirators are no longer available, during the care of patients for which a respirator is recommended