Decorative homemade surgical mask and different patterned cloths behind

COVID-19 hit our world unexpectedly, and a national PPE shortage came along with it.

Nurses and other healthcare workers have suddenly been put in the position to ignore what they have been taught all along, and start reusing and cutting down on their PPE usage. In certain hospitals where N95 respirators and surgical masks have completely run out, some nurses have no other option than to wear cloth masks.

As a nurse, it's very frightening to have our protection disappear - especially in the middle of a global pandemic. Nurses who work in hospitals with COVID-19 patients and only a cloth mask are understandably concerned about just how protected they are.

If you're a nurse who has wondered whether your cloth mask is protecting you sufficiently, keep reading to find out. Be sure to share this information with fellow nurses or healthcare workers who may have the same concerns.

What Does Research Say?

As nurses, we are taught to go straight to evidenced-based research for answers. The COVID-19 pandemic is no different, and many nurses have spent hours scanning articles from leading health organizations for clarity to guide their practice as healthcare workers. Unfortunately, the answers have not always been clear.

Due to the ever-changing nature of the pandemic, guidelines from the CDC and WHO shift regularly too. While these changes can be frustrating, the best we can do is stay up-to-date with the latest guidelines.

So what does the research say about the effectiveness of cloth masks? Because COVID-19 is a newly detected virus, there are no studies that specifically address the protection a cloth mask provides against the virus.

And because cloth masks have never been recommended for healthcare workers, very little research exists around their safety. However, there was one study published in 2015 that compares the safety of cloth masks to medical masks for healthcare workers. The study's conclusion discourages the use of cloth masks due to the increased risk of infection from moisture retention, reuse, and poor filtration. Interestingly enough, this group of researchers wrote a response to their earlier work in light of the current COVID-19 pandemic and a worldwide shortage of PPE. Although their previous study showed a higher rate of infection for healthcare workers who used cloth masks, they do not advise healthcare workers to work unprotected. A cloth mask may provide a certain level of protection over no mask at all.

RELATED: How Do Nurses Protect Themselves from Highly Infectious Patients?

How to Safely Use a Cloth Mask

Cloth masks should be used as a last resort for nurses, and definitely do not provide the same level of protection as a medical-grade mask. However, if you are put in the position to wear one, here are some factors to keep in mind.

  • Material of mask
  • Hygiene practices when donning and doffing the mask
  • Reuse of mask
  • Cleaning mask

Cloth masks can be made with a variety of materials, and no clinical trial has indicated a specific recommendation or determined a gold standard. In their public statement regarding cloth masks, the CDC recommends that cloth masks have multiple layers of fabric like cotton. Adding some kind of filter, such as a coffee filter, between the fabric may be beneficial as well.

When donning and doffing your cloth mask, follow the same hand hygiene practices that you would with a regular mask. Thoroughly wash your hands before touching the mask, and refrain from touching your face or mask when your hands are not clean.

If possible, aim to have several cloth masks on-hand so that you can switch them out after each shift and wash them. To clean your mask, wash it in your washing machine on a regular cycle.

When Should Cloth Masks Be Used?

The Washington State Nurses Association states that homemade masks should not be consid­ered PPE since their ability to protect HCP is unknown. Therefore, cloth masks should only be used by healthcare workers when medical-grade masks are not available.

When considering using a cloth mask, remember that this approach should be used as a last resort. Since there are no conclusive findings around COVID-19 and cloth masks, they should simply serve as one more barrier between you and potential germs in the air.

The quality of cloth masks vary, so make sure to prioritize those made with multiple layers of quality fabric and ideally a filter inside. The same hygiene principles apply to donning and doffing, and the mask should never be touched during use. Reuse should be minimized, nurses should aim to use a clean cloth mask for every shift if possible.

As nurses, we are all in this together. Always remember that the best way to get through this challenging time is to continually support and uplift each other.


Janine Kelbach, RNC-OB
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