2019 Novel Coronavirus (COVID-19)

 Facemasks - Healthcare Provider Guidance for the Use of Homemade Cloth Facemasks

Last Updated: April 25, 2020
Skip Navigation LinksAPHC Home / Topics / Campaigns / 2019 Novel Coronavirus (COVID-19) / Facemasks - Healthcare Provider Guidance for the Use of Homemade Cloth Facemasks

ADDITIONAL RESOURCES:

- Army PPE Guidance for Healthcare Providers (printable flyers) | APHC

- Face Coverings, Masks, & Respirators: Know the Difference & When to Use Them | APHC

- TIP 98-112-0420 Guidance for Do-it-Yourself Respiratory Fit-Testing During Increased Demand Conditions | APHC


_______________________________________________________________________________

​In the event the supply of disposable, commercially made facemasks is depleted, a homemade cloth facemask can be used, with the understanding that it is not a respirator and there is no scientific evidence that they offer adequate protection from transmission of infection (References 1 and 2). 

Homemade cloth facemasks are NOT to be considered Personal Protective Equipment and should only be considered as a last resort measure.  This information is intended for the healthcare provider (HCP) population, but if it is used outside of the HCP population, it must be understood that homemade cloth facemasks are never to be used in an industrial setting for protection against chemical contaminants, dusts, mists, fumes, or vapors.

​Cloth Facemasks

Specific to Health Care Providers (HCP), the CDC has issued an update to the use of homemade cloth facemasks.  They state "In settings where facemasks are not available, HCP might use homemade masks…for care of patients with COVID-19 as a last resort (Reference 3)."  Army Public Health Center guidance is targeted at HCPs, it is not recommended to be used outside of the healthcare setting. 

 The limited literature on the topic suggests homemade cloth facemasks made from common materials (e.g., cotton fabric) offer only marginal protection against the transmission of microorganisms and nanoparticles, including those in the size range of viruses. (References 1 and 2)


Homemade Cloth Facemask Restrictions and Limitations:

 Homemade cloth facemasks are not tested by any accrediting body to ensure their effectiveness.  Therefore there are restrictions and limitations to their use.

Restrictions:
  • Homemade cloth masks are only to be used as an option of last resort.
  • Use of a face shield that covers the entire front and sides of the face (extending to the chin or below) should be used with homemade cloth masks.
  • Proper hand hygiene is required.
  • Do not eat or drink while wearing a homemade cloth facemask.
  • Mask must cover the nose and mouth at all times. Do not wear below nose.
Limitations:
  • Due to the homemade nature of these masks, they will not be uniform, and have the potential not to have uniform cloth thickness.
  • Due to reuse, the homemade cloth facemask can become loose and not have a tight fit against the face.
  • Facial hair can interfere with the placement.
  • The protective factor of these masks are unknown.
  • May give a false sense of protection.
  • May become contaminated and thereby a source of transmission.


Use of Homemade Cloth Facemasks:

Based on the ear loop style shown in Figure 1.

Figure 1 Example of homemade cloth facemask - Lilley 2020

Donning Homemade Cloth Facemasks:
  • Properly wash hands with soap and water (minimum of 20 seconds of scrubbing hands fingers, between the fingers, back of hands and under nails), or use hand sanitizer with at least 60% alcohol.
  • Select a clean, unused mask.
  • Check the mask for any tears or holes.  Check to make sure the elastic is in good condition and will not break when stretched.
  • Hold the mask against the face, with the nose piece against the bridge of the nose and the bottom of the mask below your chin.
  • Secure facemask to head.
    • If using a facemask with elastic bands, pull the bands over and behind ears, one at a time.
    • If using a tied facemask, using a bow knot, tie lower bands around base of neck and upper bands around crown of head.
  • Make sure the mask is as tight as possible around your nose and cheeks, and the bottom is fully covering your mouth and chin.
  • Wear cloth facemasks in combination with a full face shield, when available.

Doffing Homemade Cloth Facemasks:
  • Consider the front of the mask to be contaminated – DO NOT TOUCH!
  • Remove facemask.
    • If using a facemask with elastic bands, grasp both of the elastic bands from behind the ears and move it slowly away from your face.
    • If using a tied facemask, unknot the top bands and pull mask away from face using top band.  Untie the lower knot and completely remove facemask from face.  If you cannot untie it, have another person cut the bands and discard facemask.
  • Put the mask in a bag or into laundry basket.
  • If mask is no longer being used, properly discard as regular waste.
  • Properly wash hands with soap and water (minimum of 20 seconds of scrubbing hands fingers, between the fingers, back of hands and under nails), or use hand sanitizer with at least 60% alcohol.

 

Cleaning and Reuse of Homemade Cloth Facemasks:

Cloth facemasks are inherently reusable.  After each use they must properly be cleaned and sterilized prior to reuse to prevent contamination.  Do not reuse homemade cloth facemasks without first cleaning and sterilizing.

Follow established medical treatment facility practice for transportation of used/soiled homemade cloth facemasks.  Sorting and cleaning of homemade cloth masks is prohibited in patient locations by the Occupational Safety and Health Administration (OSHA).

Due to the harsh nature of medical facilities cleaning and sterilizing procedures the homemade cloth facemask will deteriorate over time.  When tears become evident or elastic no longer rebounds after being stretched, discard mask into proper waste container.

 

Cleaning:

Cleaning helps to remove any soiling of the homemade cloth masks and reduces the total microbiological load on the article.  All articles must be sterilized after cleaning to completely eliminate the microbiological load. 

Ensure laundry facilities are capable of:

  • Hot water wash (160˚F/71.1˚C) with detergent following manufacturers' instructions for 25 minute cycle.
  • Warm water agitation (135-145˚F/57.2-62.7˚C) with 125ppm chlorine bleach. 
  • Multiple rinse cycles using mildly acidic (pH 5-6) clean warm water (71-77˚F/2.7-25.0˚C).
  • Dry using standard dryer.
Sterilization:

After homemade cloth masks are cleaned and dried, pack masks together into a bundle that can be autoclaved. 

​Type of AutoclaveExposure Time (minutes) ​Drying Time (minutes)
​Gravity Displacement 250˚F/121˚C​30​15
​Gravity Displacement 270˚F/132˚C​25​15
​Dynamic-air-removal 270˚F/132˚C​4

​5-20

Storage:

 

Store cleaned and sterilized homemade cloth procedure facemasks where facemasks are normally stored.  Upon receipt of standard procedure facemasks, remove homemade cloth procedure facemasks from distribution locations.

 

Instructions on Construction of Homemade Cloth Facemasks:

In order to have a standardized homemade cloth facemask, follow the following pattern (click here for the pattern), and instructions below. JoAnn Fabric (not to be considered an endorsement) has created a useful video on facemask construction. (Reference 4)

Materials Needed (Available at craft or fabric retailers):
  • Cotton fabric (tight weave)
  • Lightweight fusible interfacing
  • ¼" knit elastic
  • Florist wire
  • Cotton thread
  • Sewing machine
  • Straight pins

 

Procedure:

Note: ¼" seam allowance is used unless otherwise noted.

  1. Print the pattern (click here for the pattern).  Ensure printer print scale is set to 100%.
  2. Cut out the pattern.
  3. Place pattern on the fold of your fabric and cut out fabric.
  4. Utilizing the same pattern cut a same sized piece of interfacing (9"x12").
  5. Adhere the interfacing to the wrong side of fabric according to the interfacing instructions.
  6. Cut a piece of fabric that is 2"x9".  This can be the same fabric as used for the 9"x12" portion of the mask, or coordinating fabric.
  7. Press the 2"x9" piece of fabric, wrong sides together, lengthwise.  This will be used to hold the wire for the nosepiece.
  8. Open main fabric, and pin smaller piece to one of the 9" ends on the right side of the fabric.  Cut edges together.  Dew to secure using a 1/8" seam allowance.
  9. Fold fabric in half, right sides together, so the rectangle measures 9"x6".
  10. Cut two (2) pieces of elastic, each 7" long.
  11. Sew along the 9" length of fabric, leaving a 2-3" gap in order to turn the fabric.
  12. Place one end of the elastic inside the fabric tube, as close to the seam as possible on one side of the 6" opening, with a small tag hanging out the end of the tube.  Pin into place.
  13. Making sure the elastic is not twisted, pin other end of elastic to the other side of the 6" opening.
  14. Repeat for the other end of the tube.  Make sure the elastic at the sewn end is on the same side of the nosepiece fabric as the elastic on the other side of the mask.
  15. Sew across both sides of the fabric.  Backstitch well over elastic to ensure the elastic is secure.
  16. Turn right side out.
  17. Press, and tuck in the seam allowance of the 2-3" gap, folding the nose piece away from the elastic, pinning the nose piece in place.
  18. Cut a piece of florist wire 4" long.
  19. Insert floral wire under the nose piece, and pin down.
  20. Using the pattern, mark the center of each pleat with a pin, as well as the bottom of each pleat with a pin, aligning the seam allowance line at the top of the mask.
  21. Fold the fabric from the bottom pleat marker up, so that the center pleat pin is in a fold.  Secure this fold with a pin.
  22. Repeat up the side of the mask.  You will have a total of 3 pleats.  The pleats should be touching, but not overlapping, as to not create too much bulk.  Pleats may be pinned in place in the middle of the mask, especially the bottom pleat, so they do not get in the way in later steps.
  23. Repeat on the other side.
  24. Topstich around all sides of the mask, making sure to stitch closed the area where the mask was turned.  If needed, use the mattress stitch to close the hole.


References:

  1. Davies A, Thompson, K, Giri K, Kafatos G, Walker J, and Bennett A.  Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?. Disaster medicine and public health preparedness. 2013;(7):413-418.

  2. Rengasamy S, Eimer B, and Shaffer R. Simple respiratory protection-evaluation of the filtration performance of cloth masks and common fabric materials against 20-1000 nm size particles, Ann Occup Hyg. 2010;54(7):789-98.

  3. CDC.  Strategies for Optimizing the Supply of Facemasks. 17 March 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html

  4. JoAnn Fabric Video. https://youtu.be/VgHrnS6n4iA