Since the onset of the COVID-19 pandemic in late 2019, it’s no longer just health care workers wearing masks daily. A significant part of the infection control messaging aimed at the general public has been on the importance of masks, including cloth face coverings, to help stop the spread of respiratory droplets.
In combination with social distancing, mask wearing has been the primary way of managing the pandemic response in the United States and other countries worldwide. But as new research on COVID-19 becomes available, evidence is mounting that the virus is spread through small respiratory droplets rather than the large droplets that initially led experts to recommend that distancing yourself from 6 feet from others would prevent the spread of infection.
As more nations change their messaging to reflect airborne particles’ presence, the types of masks people are wearing for protection become increasingly critical. Both 3-ply surgical masks and N95 respirators are useful forms of personal protective equipment (PPE) to combat COVID-19, but a 3-ply cloth mask is an alternative when they’re unavailable.
CDC Masking Guidelines
The Center for Disease Control and Prevention (CDC) has stated that masking is essential to stopping the novel coronavirus spread. Its website suggests wearing masks should:
- Cover both your nose and mouth
- Have two or more layers
- Fit snugly with no gaps
- Have a nose wire to prevent airflow out of the top
They advise against choosing N95 masks, which are in short supply and should be left for health care and other frontline workers. Many people may feel more comfortable wearing an N95 mask, knowing it does a better job than cloth masks at filtering out small respiratory droplets. However, 3-ply face masks and surgical masks can also offer sufficient protection when worn correctly.
What is the Difference Between Surgical and Non-Medical 3-Ply Masks?
There are critical differences between non-medical and surgical masks worth noting for anyone considering an alternative to N95 respirators. On a basic level, non-medical masks are designed for the public to wear in low-risk situations where the chance of exposure to infectious diseases is minimal.
Surgical masks provide protection in a medical environment where the exposure to harmful pathogens is higher. Surgical, or medical masks, come in many forms based on a rating system from the American Society for Testing and Materials (ASTM).
While both can be useful alternatives to an N95 respirator, there are significant differences between medical and non-medical masks:
Medical masks are intended for single use and should be disposed of immediately after removal. However, many non-medical cloth masks are washable. You must wash your masks in hot water on the same cycle as the rest of your clothes and ensure you clean them after every single use for maximum safety.
Surgical masks are meant for the operating room, while standard medical masks are designed for clinicians who still operate in high-risk environments but not close to hazards. Non-medical masks are for the public who are not regularly inside medical facilities.
The actual design of a surgical mask differs from a medical and non-medical mask. Surgical masks have tie up straps designed to fit over a scrub cap, while medical and non-medical masks typically offer a loop for either ear that may or may not be adjustable.
None of these masks has a tight enough fit to filter out airborne particles; they protect the wearer from spreading large respiratory droplets to surfaces and other people.
Medical and non-medical masks are most helpful for combatting COVID-19 when worn in combination with practicing other public health measures.
Key Differences Between a Surgical Mask and an N95
While they both qualify as forms of PPE and are FDA regulated, there are significant differences between surgical masks and N95 respirators.
N95 respirators are designed to provide a close fit to the face, sealing it from air around the edges, covering the nose and mouth. This provides effective filtration of airborne particles. A surgical mask is much looser fitting, simply creating a barrier from large particles in the surrounding environment. Surgical masks do not form a seal around the mouth and nose, making them less effective against airborne particles.
Both N95 respirators and surgical masks undergo testing for PFE, BFE, and fluid resistance. You must not wash, share, or reuse either mask type. An N95 offers superior protection against airborne infection, but when one isn’t available, a surgical mask can help lower your chances of spreading or contracting COVID-19.
The Difference Between KN95 and N95 Masks
ICU Productions offers both KN95 and N95 masks for frontline worker protection, but what is the difference between the two?
While both mask types offer 95% protection against small airborne particles, the difference is their certification. The CDC has already approved N95 masks before you receive them, so you can simply open the box, put it on, and you’re achieving 95% protection.
However, KN95 masks need to pass a human fit testing process and receive a leakage amount of less than 8% to become certified. N95 masks are also slightly more breathable because of increased inhalation pressure regulations. Both are incredibly effective options for protection from airborne bacteria, viruses, or other particles.
Fit Testing For Workplace Masks
If an employee must wear a KN95 mask to perform their job safely, they undergo fit testing before donning the PPE. The Federal OSHA (Occupational Safety and Health Administration) requires fit testing to evaluate how the mask fits the employee’s face. It should be performed anytime you use a new size or model of mask or respirator.
Testing agents are used to determine if the seal on the mask fits properly to the wearer’s face. These tests are performed on surgical masks and KN95 masks.
ASTM Surgical Mask Ratings
The similarity between medical masks and N95 respirators is that they are both regulated by the FDA and must adhere to strict testing guidelines. The ASTM develops and enforces the rating system for medical masks.
This tiered system rates a mask on a scale of level 1 to 3 by reviewing these criteria:
- Bacteria Filtration Efficiency (BFE)
- Particle Filtration Efficiency (PFE)
- Pressure Differential (breathability)
- Flammability (how does it withstand exposure to a flame)
- Fluid Resistance
Level 1 ASTM-rated medical masks offer the lowest protection level with minimal BFE and PFE and resistance to synthetic blood. These masks are suitable for general procedures, ophthalmology, or respiratory etiquette.
A Level 2 ASTM-rated medical mask can be used in general surgery and is easier to breathe through than the Level 3 mask. It offers much better BFE and PFE protection and can resist splash or spray.
Level 3 ASTM medical masks can be used for trauma centers or orthopedic surgery because they offer a high protection level, including fluid resistance to protect from blood and other bodily fluids.
Knowing that medical masks provide sufficient protection for these environments can seem comforting when thinking about surgical masks as N95 alternatives. However, studies suggest that wearing a surgical mask is better protection for others in the room rather than the person wearing the mask.
Through this logic, surgical masks offer COVID-19 protection only if the community wears them to protect one another. However, surgical masks are a valuable option for some form of protection when N95 filtering facepiece respirators are not accessible, and a health care worker requires respiratory PPE.
Study Suggests Any Mask Can Reduce Virus Severity
A recent study on mask benefits shared by the National Institutes of Health suggests there may be additional benefits for mask wearers rather than just preventing the spread of their germs to others.
While it was previously thought that wearing a mask was more of an act to protect others than yourself, this latest evidence examines the possibility that the humidity created by wearing a mask lessens the severity of COVID-19 in the wearer.
The method behind this study is that virus transmission increases in seasons when air humidity is reduced. When you wear a mask, and your breath is contained within it, it creates a humid atmosphere that reduces the likelihood of viral transmission, protects the masked individual from contracting COVID-19, and reduces their chance of spreading it.
The humidity also encourages mucociliary clearance of pathogens which can delay and sometimes reduce infection in the lower respiratory tract, even if the virus is in the upper respiratory tract. When this happens, the infection’s severeness is lessened dramatically. This holds true for 3-play non-medical masks and medical-grade surgical masks.
Protection Offered By 3-Ply Masks
The respiratory protection offered by 3-ply non-medical masks depends on a few factors. 3-ply non-medical masks are not personal protective equipment (PPE) and cannot be used as a replacement for surgical masks or N95 masks in a workplace setting where PPE is required.
For the public, non-medical 3-ply masks with a filter layer can offer increased filtering efficiency against respiratory droplets, preventing the wearer from transmitting the virus and reducing contraction risk.
No epidemiological studies properly examine the value of a 3-ply non-medical mask over a 2-ply non-medical mask. The idea behind a filter layer between two cloth layers is that it prevents more of the aerosolized droplets from getting through to the second cloth layer and exposing the wearer.
The main indicator for effectiveness with non-medical masks doesn’t appear to be the mask itself, but how the person adheres to mask etiquette while wearing it. This means:
- Not removing the mask partially or fully in a public space
- Ensuring your nose and mouth are covered at all times
- Selecting a mask that fits snugly to the face
- Refraining from touching the mask while you’re wearing it
Adhering to these practices decreases the chances you’ll be exposed to harmful airborne particles while wearing your face mask or transferring droplets from the outside of the mask to other surfaces.
How to Safely Remove Your Mask
The efficacy of a mask partially depends on how you remove and handle it. Learning proper mask removal techniques is simple but something many people forget to employ daily.
Safe mask removal applies to all mask types to ensure you avoid contact with the mask’s exterior, which has been exposed to respiratory droplets. To remove a mask properly:
- Untie the fasteners or release the loops around your ears
- Touch only the strings or ear loops
- Fold the outer corners of the mask together
- Put the mask directly in the washing machine or laundry basket
- Do not touch your face until you’ve washed your hands thoroughly
By following these recommendations for removing a mask safely, you reduce your risk of exposure to large droplets that could contain a viral load. Washing your hands before touching your face (especially eyes, nose, and mouth) is good practice for preventing virus transmission through your mucus membranes.
Improving the Efficacy of 3-Ply and Surgical Masks Against COVID-19
The World Health Organization (WHO) advises that non-medical masks are most effective in combination with other methods of slowing the spread of infection. While they don’t offer the same protection as N95 masks, they can be a useful alternative when you also practice the following public health measures:
- Physical distancing
- Avoiding crowded places
- Ensuring adequate ventilation for indoor spaces
- Washing your hands
- Staying home when you’re sick
It is currently advised that you wear masks anytime you cannot maintain a distance of at least 3 feet from others and in poorly ventilated indoor areas. It’s critical to understand that wearing a mask does not mean it’s safe to have close contact with people; this is simply another layer of protection that works best when paired with physical distancing.
Until N95 masks are readily accessible to the public, it’s necessary to make do with alternatives like 3-ply non-medical masks and surgical masks. On their own they are less effective than an N95 respirator, but by practicing masking in combination with other public health measures, the efficacy of these masks improves dramatically.
Why Mask Fabric Matters
While a cloth mask cannot be a substitution for health care workers’ PPE until it is proven to be as effective as a surgical mask, a 3-ply non-medical mask can offer sufficient protection when worn correctly. This protection level improves further when the material the mask is made from meets certain criteria.
Choosing a cloth mask that is made of waterproof fabric with a tight weave can lower the chances of respiratory droplets penetrating the temporary barrier both ways. However, avoid vinyl masks because this material makes it difficult to breathe.
The World Health Organization (WHO) recommends that cloth masks comprise of 3 layers of fabric:
- Inner absorbent layer
- Middle barrier of non-woven non-absorbent material
- Outer layer of non-absorbent material
For the inner absorbent layer, the WHO recommends cotton as an effective cloth material. The middle layer acts as a filter and can be made of polypropylene. For the outer non-absorbent layer, the WHO suggests polyester.
The outer layer must be non-absorbent to prevent airborne particles and droplets from the wearer’s environment from being absorbed into the mask. The inner layer must be absorbent to decrease the likelihood that the wearer will spread their droplets into the surrounding environment.
Are Surgical Masks as Safe as N95 Masks?
N95 masks are proven to filter out 95% of airborne particles, making them the safest option for dealing with high-risk environments like a COVID-19 hospital ward. However, to conserve N95 masks for aerosol-generating procedures, many frontline healthcare workers are still using surgical masks instead when dealing with infectious patients.
The same fabric is used to create the filters in N95 masks and 3-ply surgical masks. The main difference is their fluid resistance, attachment method, and ability to provide an effective seal. Unfortunately, surgical masks do not provide an airtight seal, making them less effective at keeping air in and out.
All fluid-resistant masks pass the FDA approval process, including surgical masks. While medical masks (like surgical masks) are rated by the ASTM level 1-3 system, N95 masks are rated by the National Institute for Occupational Safety and Health (NIOSH). N95 respirators undergo additional testing like PAPR are secured tightly to the face with elastic straps.
Both surgical masks and N95 masks are thought to be equally effective at providing protection from large respiratory droplets, but when airborne particles come into play, N95s are still the better choice because of their secure fit and sealant.
Choose ICU Productions
ICU Productions has the best range of safety products for all your PPE needs. We offer various protection levels for the workplace, including gowns, coveralls, face shields, eye protection, 3-ply medical masks, KN95 masks and N95 masks.
By understanding which level of mask your workplace requires, you can protect yourself and your employees effectively. When N95 masks are desirable but unavailable, 3-ply surgical masks combined with face shields are useful alternatives.