Fast and economic cardboard cutout use to increase compliance of face mask wear during COVID-19 pandemic

Abstract

COVID-19 pandemic has infected millions of people and many more millions are at risk of getting infection. As no permanent treatment has been found, social distancing, hand hygiene and rational usage of personal protective equipment (PPE) have come as most effective means to contain the virus. Face masks as part of PPE form an effective barrier between pathogen and health care workers (HCW). The WHO has published specific guidelines on use of masks in the context of COVID-19.1World Health Organization Advice on the Use of Masks in the Context of COVID-19: Interim Guidance, 6 April 2020. World Health Organization, 2020Google Scholar These mask are put on with elastic cord, or ribbon ties (Fig. 1). They are meant to contain droplet infection and prevent it from spreading. In present scenario several governments across the world have made use of masks compulsory in public places2Christopher J. Tharyan P. Masks Are Mandatory for All Now. The Hindu [newspaper on the internet], 2020https://www.thehindu.com/news/cities/chennai/masks-are-mandatory-for-all-now/article31400601.eceGoogle Scholar and thus the need of masks is not restricted to HCW but too pertinent to general population. It demands these masks to be worn for long hours leading to a panorama of issues ranging from personal safety to health hazards. Literature suggests an appropriate modification of medical equipment for ease of use and safety. But, in demanding times like these in the pandemic, innovations bring in solutions which may find no place in print in good times. We propose an innovative use of cardboard cut-out to increase compliance and safety of masks. We believe this to be the first description of novel cardboard technique. Take a 5 ply rectangular cardboard of size 15 × 8 cm approximately, make four “V” shape grooves depending on size of head and mask (Fig. 2). Adjust the elastic cords in the cardboard grooves and put on the mask by placing it over the back of head (Fig. 3).Fig. 3Wearing technique.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 4Pressure changes after prolonged duration of mask wearing.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Face mask is worn as PPE to limit the transmission of droplet infection. Originally the masks were not devised to be worn all day, but now in wake of COVID-19 pandemic, duration of masks use has increased. Using mask has become both necessity and legal boundation.3Wearing Masks Made Mandatory in Delhi Order Vide No. F/02/07/2020/S.I/30 Dated 08/04/2020 Issued by Delhi Disaster Management Authority Government of Delhi.Google Scholar Because of a sudden surge in demand and low availability of masks, new standard operating procedure (SOP) regarding their use have been formulated.4Standard Operating Procedure (SOP) for Extended Use of N-95 Masks for Personal Safety of Health Care Workers (HCW) at AIIMS Order Vide No. F.79/COVID-19/2020-Extt.(H.)Google Scholar These guidelines recommend an increase in duration and reusing the masks. However, there are several issues experienced by the present style of putting on the masks which are1)Prolonged pressure over ears causing erythematous and painful changes (Fig. 4).2)Constant irritation at back of ear while wearing the mask.3)Decrease in compliance, thereby lowering the preventive measures.4)Inadvertent urge to touch the mask, face and ears to relieve the soreness and irritation. This increases the risk of acquiring and spreading virus. With cardboard cut-out as described, it distributes the pressure over the greater occipital region, reducing the irritation and friction over the ears and undue ear pull. This makes mask more convenient and lessen the risk of damage to ears and face (Fig. 5). It also makes the mask more snuggly fit with less air leak and offer better protection. Several setups are commercially producing similar devices made up of polythene or 3D printed material.5Iw Staff One Million 3D Printed Ear Savers Going to Front Line Workers. Industryweek. [newspaper on the internet], 2020https://www.industryweek.com/technology-trends/article/21128668/one-million-3d-printed-ear-savers-going-to-frontline-workersGoogle Scholar These designs are very expensive and not readily accessible to user-end. Our technique is simple to make, reproducible, ready to use, economical and flexible depending on user and mask size. Our novel technique will enhance the compliance of elastic worn masks. It will also improve the crisis of demand-supply gap and aid in preventing droplet infection. This small innovation will greatly help in the war against COVID-19 pandemic.