Tackling COVID-19 in public settings – to mask or to shield is the question?
There are ongoing debates on various social media platforms on what the best approach to tackling COVID-19 should be like particularly in public settings. Face coverings or face masks are thought to be good at source control according to prominent researchers and are therefore now recommended for enclosed places. Of concern however, is the fact that many people aren’t wearing the masks properly despite there being guidance which defeats the whole purpose for which masks were designed for. Furthermore, face masks are thought to be an 'added barrier' to deaf and hard of hearing communities for example which makes face shields suggested by Perencevich and colleagues a preferred option. I support the current Twitter campaign #FaceShieldsForAll in community settings as I feel these are easier to manage from an infection prevention and control perspective i.e. can be cleaned easily with soap and water, there is added protection for eyes and dissuades people from touching their eyes, nose and mouth without proper #HandHygiene. People can also continue to see each other’s faces and smiles whilst protecting themselves from COVID-19 which is particularly important in non-verbal communication. Whether people choose to use face masks or face shields in public, they must remember to use good mask or shield hygiene.
With the face masks versus face shields debate continuing, there has been a worrying increase in the number of people wearing gloves in public. A friend informed me of the horror she witnessed when the COVID-19 pandemic was just gaining momentum at the beginning of March 2020. She saw someone entering a public toilet whilst wearing gloves. The individual then proceeded to using the facilities and to her shock, she saw the same person leaving the bathroom without washing hands or changing their gloves – Yuck! I knew from this time that we were going to face huge challenges around inappropriate glove use in public settings, a phenomenon that some top Infection Prevention & Control (IPC) experts were already trying to tackle in healthcare settings. Evidence suggests that healthcare staff may actually feel protected and think they’re saving time when they wear gloves. This, sadly is clear evidence of a false sense of security that people often get when wearing gloves and applies not only to healthcare but community settings alike. The fact is – using gloves inappropriately increases one’s risk of acquiring COVID-19 or other infections as it can hinder good #HandHygiene. Nevertheless, the fear of the COVID-19 pandemic has seen an increase in the use of gloves not only in community settings but also in critical care settings where staff may feel they have ‘a sense of added security with another pair of gloves which may be perceived as another skin layer that could protect them from COVID-19’. I certainly appreciated a video featuring IPS Vice President Jennie Wilson which has very clear IPC guidance for critical care areas. More work is still required locally to tackle inappropriate use of gloves and improve IPC in all settings. An exploration and understanding of some of the behaviours and attitudes linked to poor practices may help us devise practical ways of tackling some of the issues locally. Rose Gallagher and colleagues are already leading the way with campaigns like #GAW19 and #GAW20 which are not only IPC focused but also seek to address environment and climate change challenges that come with inappropriate glove use.
The bottom line may be that people need to understand why they do what they do and why they do what they are asked to do regardless of whether it’s a pandemic situation or not. This reminds me of the 5 whys in root cause analyses (albeit acknowledge it has some limitations) which I will use to focus on the 5 whys of wearing face masks or face shields in public in the next section.
Wearing face masks or face shields in public during COVID-19
The 5 Whys
Why do people wear face masks or face shields in public? – because they want to protect themselves from COVID-19 and also protect others in case they have the virus that causes COVID-19 but are asymptomatic.
Why do people want to protect themselves and others from COVID-19? – because the virus (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) that causes the deadly COVID-19 is a highly infectious virus that can enter through people’s nose, eyes and mouth.
Why does COVID-19 enter a person’s nose, eyes and mouth – because if someone coughs or sneezes or talks in your vicinity i.e. within 6 feet or 2 meters, generated small droplets or aerosols containing SARS-CoV-2 can potentially end up in your nose, eyes or mouth. Furthermore, people don’t always practice good hand hygiene after touching potentially contaminated surfaces such as bus or train rails, door handles, elevator buttons, shopping baskets or trolleys etc. and therefore risk transferring the virus from these surfaces to their eyes, nose and mouth.
Why do surfaces become contaminated with COVID-19? – because when people have poor cough etiquette and don’t catch it, bin it and kill it, and/or don’t practice good hand washing or hand hygiene regularly, the virus in droplets or aerosols can end up on hands and on various surfaces. Additionally, people can keep transferring the virus when they continue to touch various other surfaces or shake hands without washing or sanitising their hands.
Why do people touch things – because it is impossible for anyone to do anything without contact; be it at home, in shops, when travelling or at work etc. It is therefore important for people to be mindful of their behaviours and attitudes, particularly being aware of what they touch and remembering to decontaminate their hands and surfaces regularly to reduce the risk of them acquiring the virus or transmitting it to others.
So back to my original question – why do people wear face masks or face shields in public?
Wearing a face mask or face shield in public is one of several other recommended interventions (social distancing, hand hygiene, good environmental decontamination etc.) that can help to reduce SARS-CoV-2 (the virus that causes COVID-19) transmission. Transmission is usually from small particles or aerosols generated by those already infected particularly those carrying the virus without knowing it. Wearing a face mask or face shield without good mask / shield hygiene is however counterproductive. Therefore good hand hygiene should always be used when wearing masks or face shields together with all the other recommended strategies.
In summary:
Avoid touching the face mask or face shield and interfering with it after putting it on as you may contaminate your hands or contaminate your mask or shield with virus from touched contaminated surfaces (check mask Dos and Don’ts on Twitter)
Clean high touch surfaces regularly
Always practice good cough etiquette - #CatchItBinItKillIt
Always practice good hand washing with soap and water or hand hygiene with an approved hand sanitiser, especially before and after touching your face mask or face shield if you've one on
By doing the above, you minimise the risk of COVID-19 entering your mouth, nose and eyes thereby protecting you and others from the deadly COVID-19.
If you’re thinking of wearing gloves, a face mask or a face shields in public, think carefully about WHY you’re doing it and always practice GOOD HAND HYGIENE!
Image credit World Health Organisation (WHO)
References
Wilson J, Bak A, Loveday H (2019) Applying human factors and ergonomics to the misuse of nonsterile clinical gloves in acute care. Available at: https://www.ajicjournal.org/article/S0196-6553(17)30140-2/abstract. (Accessed on 24/05/2020)
Wilson J, Loveday H (2014) Does glove use increase the risk of infection? Nursing Times; 110: 39, 12-15 Available at: https://www.nursingtimes.net/clinical-archive/infection-control/does-glove-use-increase-the-risk-of-infection-19-09-2014/. (Accessed on 24/05/2020)
Perencevich EN, Diekema DJ, Edmond MB (2020) Moving Personal Protective Equipment Into the Community: Face Shields and Containment of COVID-19 Available at: https://jamanetwork.com/journals/jama/fullarticle/2765525. (Accessed on 24/05/2020)
My focus will soon be shifting to surgical site infection prevention but before then, I may be able explore the 5 whys of glove use in a future blog.