CDC Updates Guidance on Well-Fitting Masks In Q&A Document

Posted on March 3, 2021 by Kari Everson

On February 10^th, the Centers for Disease Control and Prevention (CDC) published a MMWR article discussing well-fitting masks. The study shows the better a mask fits around the user’s face, the better the protection against contracting COVID-19. Methods to increase mask fitting include a mask fitter, tucking and looping a surgical or procedural mask, or wearing a cloth mask over the surgical or procedure mask.

Early in the pandemic, the Minnesota Department of Health (MDH) instructed long-term care communities not to use a cloth mask over the surgical or procedure mask as donning and doffing the double masks could increase the risk of contracting COVID. However, that is no longer the case.

Currently, MDH says they have not received direction from CMS or others to include the well-fitting mask information in a survey and would not issue a citation for failure to have a well-fitting mask process in your organizations. However, they could add it to another infection prevention and control citation. MDH is seeking clarification on whether or not to survey to the well-fitting mask standard but reminds us that CMS will usually follow CMS guidance.

It would be a good practice to review the MMWR information and create a well-fitting mask protocol. Based on MDH’s response it seems we could see this becoming something that is looked at during survey.

The CDC recently put new information regarding well-fitting masks into their Q&A document. Although a cloth mask can be used over a medical facemask to improve fit, there may be better alternatives such as framed “fitters” or using a knot-and-tuck approach to achieve a good fit. If a good fit is achieved using a single medical facemask, additional approaches like adding layers to achieve a better fit might not be necessary.

• Cloth masks are not personal protective equipment (PPE). They should not be used in place of medical facemasks or NIOSH-approved respirators as part of Standard or Transmission-based Precautions.
• Wearing a medical facemask or cloth mask over an N95 respirator is not recommended for healthcare personnel in healthcare settings except as a contingency or crisis strategy during extended use of N95 respirators to protect the respirator from contamination during aerosol-generating procedures or procedures that might generate splashes and sprays.
• Wearing a medical facemask or cloth mask under an N95 respirator is never recommended as it will interfere with the seal.

Survey citations are a consideration when determining whether a process should be implemented. It good clinical practice to review the well-fitting mask information and construct protocols to implement in your organization, and it seems likely this will turn out to be something survey will consider in the future.