Mask Hacks

Ear guards, hair clips, hats and headbands with buttons

Scrub cap with level 1 medical mask

In a peer-reviewed publication (Clapp), hooking a disposable earloop mask onto an ear guard improved filtration in the inward direction. Experiments were conducted on one person. Findings were reproduced by Blachere, using 4 volunteers; source control (protection of the environment) was also improved. We think that ear guards, and buttons or hooks attached to a hat, head-band or head-covering are all ways of increasing the tension in the straps. Some methods also change the angle of the straps. We think that both these effects are likely improving filtration because they are reducing edge leak and improving fit to the sides of the face. We think that this idea can be applied to wearing cloth masks in the community.

​Ear guards are strips of material with buttons or hooks at either end. They can be elastic or fixed length. They are widely commercially available, or can be made or improvised.

​This may also be a useful modification for people wearing religious head-coverings or head-coverings for work.

​Anecdotally, some people who wear earloop masks for extended periods find the use of ear guards improves comfort and reduces the need for adjustment. Others prefer to have nothing that interferes with their hair or head covering.

Ear guards can be purchased commercially or hand-made from crochet, knits or fabric.




Mask fitter or mask brace

Example of mask fitter over lvl 1 medical mask

Mask fitter/brace over a level 1 medical mask

A mask fitter or mask brace is a washable outer structure that:

  1. Compresses the mask around its edges

  2. Provides two-to- four additional fixation points around the edge, which likely also improves fit

​Mask braces made of rubber bands (elastic bands), or custom-made, improved fitted filtration in three peer-reviewed studies (Clapp, Runde, Blachere).

​A template for a DIY mask brace to be made from a rubber sheet, and a link to a video tutorial, are available at Fix the Mask. Commercial products in a variety of different designs are also available.

​The CDC recommends mask fitters or braces as a method of improving the filtration properties of masks by reducing leak.



The mask should fit snugly, without gaping, at the sides: consider knot-and-tuck for medical masks with earloops

Many designs naturally lie flat or in a curved shape over the cheeks. In the Health Canada design, material is gathered onto the elastic at either side: anecdotally, we have found that it is important, as recommended by Health Canada, to stitch the material to the elastic to maintain the gathering, which is what gives curvature to the mask in this design.

​In experiments performed only with disposable masks, tying the earloops in a knot close to the mask and folding in the excess material results in better filtration, presumably because of less edge leak. A short video explaining how to do this has been produced by the authors. They emphasize that it is important to make the knot as close to the mask as possible. Using this modification was associated with increased filtration, likely because of better fit, in two peer-reviewed publications (Clapp, Blachere) using human volunteers, and in work conducted by the CDC on manikins, showing increased inward and outward protection. Both studies used disposable masks.

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Knot and tuck method using lvl 1 medical mask

Knot-and-tuck using a level 1 medical mask

It is unlikely that knot-and-tuck applies to cloth masks.  Cloth masks are thicker than disposables, particularly at the edges, because of seams. If the knot-and-tuck method results in a lot of bulk at the edge of the mask, it may worsen, rather than improve, the fit.

​If you are a mask maker designing a mask, consider that you do not have to attach the earloops to the corners of the mask, they can be closer together if that produces a better, flatter, fit.

​Knot-and-tuck is recommended by the CDC for community use of disposable masks.

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Nylon hosiery (stockings, tights, pantyhose)

In peer-reviewed publications, a nylon sleeve was shown to reduce leak and improve filtration for cloth masks and for disposable masks. This modification tends to push mask material into the mouth (see below), unless the mask is quite strongly structured. However, it is further evidence of the value of over masking as a method of improving the fit of disposable masks.

 

Taping masks to the face

Using medical tape to tape the mask to the face has been shown to reduce leak. Anecdotally, some people who wear masks for extended periods have taped the top of mask to reduce glasses fogging or to reduce the need for adjustment. However, using tape on the face can cause bruising and skin damage when removed.



Glasses fog

The area on either side of the nose is the hardest to fit. Fitted respirators (N95-type masks) seal perfectly by using a combination of mask shape, a nose wire, and sometimes a cushion or pad. Some respirators, though sealing perfectly, do not eliminate glasses fog: if the portion of mask under the glasses is permeable, water vapour moving through this area can create fogging.

Eliminating glasses fog in other masks is challenging. The first step is a good nose wire. Anecdotally, we have found that the 3D design may be good for reducing fogging. Finally, consider a mask brace - a silicone or rubber device that fits over the mask to improve the seal, reduce edge leak and improve the overall filtration efficiency of a mask (see mask hacks). Mask braces are not designed to be worn over structured masks, such as the 3D mask; they are designed to work with pleated or Olson masks or disposable masks, including certified Level 1 and 3 masks issued to health care workers.

Anecdotally, this tip to reduce glasses fog using a folded tissue (kleenex) attracted a large number of positive comments.

If you are a health care worker who needs to wear glasses, and you work in a high-risk setting and have the resources, prescription goggles worn above a mask will also afford eye protection and eliminate glasses fog. Eye protection has been found to be protective in a study that summarized previous studies (a meta-analysis). Most of the included studies were of health care workers. They were observations of what happened in those who did and didn't wear eye protection, rather than true experiments, but the effect was consistent and large.

Taping the top of the mask to the face with paper tape completely eliminates glasses fog, in anecdotal experience, and is very likely to improve fit. However, bruising and skin damage can occur when the tape is removed.