Information on face masks, surgical masks and respirators

Use of masks and mask types

Up-to-date information on the risk of coronavirus infection and the consequences of infections should be used when selecting a mask. The regulations and recommendations of the authorities must be observed. Here, a mask refers to a fibre mask, cloth face mask, surgical mask or a respirator of either FFP2 or FFP3 class.

The use of masks during free time is controlled by the Finnish Institute for Health and Welfare. The employer decides on the use of masks at a workplace. A risk assessment is performed at the workplace to decide if there are any situations in which masks should be used and what type of masks should be used in those situations. Regional recommendations and restrictions must be taken into account when performing a risk assessment.

The masks effectively reduce the amount of coronavirus in the vicinity of the virus carrier. Carriers may not be aware that they are infected, so everyone should always use the mask as instructed. According to current knowledge, also those who are vaccinated can become infected and infect others, albeit to a lesser extent. Below you will find information on the efficiency of masks in protecting the user.

More information:
Instructions for workplaces for assessing the risk of COVID-19 infections (Finnish Institute of Occupational Health)
Recommendation on the use of face masks for citizens (Finnish Institute for Health and Welfare, THL)
Transmission and protection – coronavirus (Finnish Institute for Health and Welfare, THL)
Coronavirus and safety of indoor air (Finnish Institute for Health and Welfare 
THL The COVID-19 epidemic: regional situation, recommendations and restrictions (Finnish Institute for Health and Welfare)

Protection in relation to coronavirus infections in social and health care services is guided by the Finnish Institute for Health and Welfare:
Instructions when suspecting an infection caused by coronavirus COVID-19.
THL’s classification of precautions (in Finnish)

Visors, masks and respirators

Face shield or face visor

A face visor is a piece of personal protective equipment that is meant to protect from splashes of liquid (figure 1). It protects the face, eyes, nose and mouth from any droplets that fly towards the face both from the user or from a person opposite to the user of the visor. The face visor makes the use of a face mask and a respirator more effective.  The face visor does not protect from aerosols and gives weak protection against covid-19.

The challenge related to using a visor for protection against the coronavirus is maintenance unless disposable visors are used. Keeping visors clean requires good motivation. The outer surface and edges must be always disinfected when removing the visor. The entire visor must be washed with water and soap, rinsed and dried at least once per day. The face shield must be CE marked and come with instructions for use.

Figure 1. Face shield or face visor

Cloth face masks

A face mask may protect others by reducing the spread of droplets when coughing and sneezing. Cloth face masks can typically be used several times. They must be washed after each use.

When buying face masks, notice that there must directions (käyttöohje) included and you need to be able to breathe well through the mask. Buy masks that fit well your face. If you buy a large amount of masks it is good if some of the users first try the masks.

There are no common quality standards for the clothe face masks and their quality varies a lot. They are not as good as surgical masks.

See Information on cloth face masks (FIOH)

Figure 2. A cloth mask

Fibre masks

Face masks that resemble surgical masks which are made out of a polymer material that is not produced by weaving or knitting. These are often called fibre masks. They may be called surgical masks only if they fulfil all the requirements set for surgical masks. Fibre masks have the same purpose as cloth face masks. The filtration efficiency of the material may be better and the breathing resistance lower than that of cloth face masks. However, this cannot be known unless the manufacturers report test results and methods. Fibre masks are intended to be disposable unless they have instructions for use include instructions for cleaning.

Requirements for fibre masks and cloth face masks available for sale

• They must not compromise the health and safety of the user.
• They must feature the name of the manufacturer, distributor or importer.
• They must include instructions for use.
• The packaging or instructions for use must mention the intended purpose of use, which cannot include any suggestion that the mask protects its wearer.
• No reference to surgical masks or respirators may be made. The product information may, for example, list the filtration capacity and breathing resistance and describe the method, but there must be no references to standards of personal protective equipment.
• The product must not be CE marked.

Please find further information from Tukes: Respiratory protective equipment

Figure 3. A fibre mask. Fibre masks look like surgical masks. The difference is in their filtration capacity, packaging labels and instructions for use.

Surgical masks

The original purpose of the surgical masks is to protect the patient and prevent the droplets of the nurses and doctors to spread. Surgical masks prevent the droplets both ways, out and in. However they do not protect their user very well against aerosols.

Surgical masks must fulfil the legal requirements set for medical devices and supplies. Surgical masks comply with requirements of the standard EN 14683 and the general requirements set for class I medical devices and supplies. A surgical mask must be registered as a medical device. Once the requirements have been fulfilled, the manufacturer puts a CE label on the surgical masks. 

Surgical masks can be purchased for use by consumers or employees. Surgical masks cannot be used if, based on a risk assessment, employees require respirators to protect against airborne aerosols. If surgical masks are sold for any use outside of healthcare they must include instructions for use.

In accordance with the standard EN 14683:

• A Type I surgical mask is placed on the face of a patient during, for example, an epidemic or pandemic so that they do not infect other people.
• A Type II surgical mask is used in operating rooms and other medical situations to protect the patient from the respiratory secretions of nursing staff.
• A Type IIR surgical mask also protects its user from blood splatter at blood pressure.

According to the Finnish Institute for Health and Welfare, surgical masks (type II and IIR) are used in so-called droplet precautions when respirators that protects from aerosols are not necessary.

Instructions for use of surgical masks

• Put on with clean hands. The nose clip, which is the stiff part in the upper edge of the mask, must be at the top edge when wearing the mask. The folds usually point downwards when looking from the outside (see instructions for use.) The upper strap is set on the back of the head and the lower one behind the neck or ear loops are placed around the ears. The lower edge is pulled under the chin (figures 2 and 3.) The nose clip is pressed with two fingers on both sides of the nose so that it adapts to the contours of the face.
• Should not be touched during use. If touching the mask is necessary, hands must be cleaned before and after touching.
• Take off with clean hands by grabbing the straps and wash/disinfect your hands. 

Figure 4. Type II surgical mask put on correctly: the lower edge pulled under the chin, folds downward on the outside surface and nose clip bent to fit the face.

FFP standard respirators or filtering half masks

When you need respirators at workplaces to protect workers against aerosols, you can only choose respirators which are manufactured according to the Personnel protection equipment (PPE) regulation VnA 427/2021. The FFP respirators need to full fill the requirements given in the EU regulation EU2016/425 and standard EN149.

An FFP standard respirator can be identified because it features

• identification of the equipment, the standard EN 149 (and the year of publication of the standard at the time of type approval) as well as the classification FFP1, FFP2 or FFP3.
• a CE label followed by four numbers, which correspond to the facility that regularly assesses the conformity of the manufacturing process.
• instructions for use that includes the contact information of the facility that conducted the EU type examination.
• the name, FFP class, end of storage period and storage conditions as well as the contact information of the manufacturer and EU importer printed on the packaging.

The user must read the instructions for use. They include information cleaning and disinfection methods if the equipment can be cleaned. Usually this information is not available which means the equipment cannot be cleaned. Once the storage period of the equipment has been exceeded, the manufacturer is no longer responsible for it being protective. The vendor of the equipment may not repackage the equipment in smaller batches in packaging that does not have the required labels.

You may file a report to the market surveillance authority of the Regional State Administrative Agency regarding any FFP respirator meant for the workplace that has, for example, inadequate labels or instructions of use. For consumer products the report is filed with the Finnish Safety and Chemicals Agency Tukes.

In protecting against COVID-19, FFP standard respirators are used disposably. The equipment features labels regarding uses other than the prevention of infectious disease:

• NR (non-reusable) – the equipment is intended to be used for the duration of one working day at most.
• R (re-usable) – the equipment can be reused for several days, unless in becomes clogged during use or becomes unhygienic for some reason.
• Equipment labelled with D has passed a clogging test conducted with dolomite.

The equipment may not cause its user adverse health effects, such as skin irritation or allergies. No testing is required, but the manufacturer must give their assurance that the product is designed to be safe as part of the EU type examination. However, skin irritation may still occur in continuous use due to chafing. Continuous use may also cause a headache or irritation of the respiratory tract.

Persons with respiratory, heart or cardiovascular diseases may find it difficult to use respirators or they need to have more breaks when using the FFPs. Use during work requires that ergonomics and the user’s health is taken into consideration when choosing the protective equipment.

An FFP respirator does not provide effective protection from airborne aerosols if it is not placed tightly on the face. The model must fit the face well and there may not be any hair under the edges.

Instructions for using FFP respirators for protection against the coronavirus

• Put on with clean hands. See the Finnish Institute of Occupational Health’s instructions or print them where the equipment is put on: Instructions (in Finnish) on putting on a filtering half mask (FFP3).
• Should not be touched during use. Wash your hands before and after if you touch the mask.

• Take off with clean hands by grabbing the straps and put into mixed wasted or a plastic bag followed by washing hands. The plastic bag with the used mask in it is put into mixed waste.

FFP respirator with no exhalation valve

• The FFP2 model pictured below in figure 5 does not have an exhalation valve. It can be used for a shorter time than a model with an exhalation valve. A model with no valve will become moist faster than a model with one. It protects both the user and other people from aerosols assuming that the mask is sealed tightly on the face.

Figure 5.  An FFP2 respirator with no exhalation valve.

An FFP respirator with an exhalation valve

Figure 6 below shows a FFP3 respirator equipped with an exhalation valve. The valve makes use easier as the warm and moist exhaled air can escape the mask with very little back pressure.

FFP respirators equipped with exhalation valves are not recommended for situations where others have to be protected from the user’s airborne respiratory secretions. There has not been sufficient research regarding the matter. There is only one reported research result that indicates that a mask with a valve protects people other than its wearer as well as a cloth face mask.

A person who, for health reasons, is not able to use a non-valved mask may use one that has a valve, for example, in public transportation. This requires that the person is able to use the model with a valve and that they do not have COVID-19 or symptoms related with it.

Models that do not have valves provide no extra benefit in situations where everyone wears well-fitting valved respirators. One such situation is when performing aerosol-generating procedures in the treatment of a COVID-19 patient. In these situations, the use of a valved model is essential for coping at work.

There are FFP respirators with a protective layer on top of the valve. These have shown to also fulfill the requirements set for surgical masks. Currently, such equipment is hard to come by due to the market situation. The Finnish Institute of Occupational Health does not recommend using a surgical mask on top of a FFP respirator in order to protect others from the user’s respiratory secretions.  According to research this kind of usage might cause leaks in the edges of FFP.

Figure 6.  An FFP3 respirator with an exhalation valve

Further information: Technical requirements of FFP standard respirators and surgical masks.

For more information, please contact: viestinta@ttl.fi.

The guidelines of the Finnish Institute of Occupational Health (FIOH) are drawn up together with the Ministry of Social Affairs and Health (SMAH) and the Finnish Institute for Health and Welfare. We also follow the publications of the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO).

European Centre for Disease Prevention and Control (ECDC), COVID-19

World Health Organization (WHO), coronavirus