Personal protective equipment is only as effective as the person wearing it. Here?s how to avoid cross-contamination.

Friday, the Centers for Disease Control and Prevention changed course and began recommending the use of cloth face masks in public places where maintaining social distancing may be difficult.

As Elemental previously reported, evidence supporting the use of cloth face masks isn?t great, but with studies showing that a large number of asymptomatic or presymptomatic people may be unknowingly transmitting the coronavirus, experts now believe cloth masks can help slow the spread. That?s because of the momentum of the air that comes out of your mouth when you?re coughing, sneezing, or breathing propels many of the infected particles into the mask or bandana.

?Some of what you exhale is going to get around the outside edges of the mask, but most of it is going to get caught right as it comes out,? says Thomas Fuller, ScD, CIH, CSP, associate professor of the Illinois State University Safety Program and an American Industrial Hygienist Association fellow. ?Particles that small don?t bounce once they stick to something, so masks are pretty protective in catching the agent if someone?s infected.?

But they?re not foolproof. ?If the person is infectious, and they breathe on a mask, the inside of that mask is going to be highly contaminated,? says Fuller. ?So you have to handle them with caution.? And the same goes for disposable gloves, should you choose to wear them (the CDC has not yet recommended it).

?I teach a course where I have the nurses get dressed from head to toe in all the [PPE] gear and then I sprinkle them with glow powder.?

As a certified industrial hygienist and certified safety professional, it?s Fuller?s job to train health care workers on the proper protocol for putting on and taking off personal protective equipment (PPE), like N95 respirators and gloves, without cross-contaminating themselves.

?I teach a course where I have the nurses get dressed from head to toe in all the [PPE] gear and then I sprinkle them with glow powder,? says Fuller. ?I tell them to go ahead and take off all of their protective clothing, and then I take a black light and I shine it on them. And you can see all the places that they?ve cross-contaminated themselves and gotten germs all over their body. After I have their attention, then I teach them how to do it properly and let them practice again.?

The risk of your mask and gloves becoming highly contaminated because you walked through the grocery store is much lower than that of a doctor working with a bunch of sick patients in an enclosed space, but it?s still a good idea to follow proper PPE protocol. Below, how to do exactly that.

How to put on a mask and gloves

1. Wash your hands with soap and water for at least 20 seconds or, if that?s not possible, apply hand sanitizer with at least 60% alcohol.

2. Make sure there are no holes or tears in your mask, bandana, or whatever fabric face covering you?re using.

3. If you wear glasses, take them off.

4. Determine which side of the face mask is the front. You should always wear your mask in the same orientation to avoid cross-contamination.

5. If you?re using a mask with ear loops, bring the mask to nose level and place the loops around your ears. If you?re using a mask with ties, bring the mask to nose level and secure the top set of ties into a bow around the crown of your head. If you?re using a mask with elastic bands, hold the mask in one hand at nose level. Stretch the top strap over your head so that it rests over the crown of your head. Then pull the bottom strap over your head so that it rests below the ears at the nape of your neck.

6. If your face mask has a moldable nose bridge, pinch the mask around your nose for a more secure fit.

7. If you?re using a mask with ties, secure the bottom set into a bow at the nape of your neck.

8. Pull the bottom of the mask over your mouth and chin and adjust the mask so that it?s snug, but not so tight that it?s painful or will move around. All straps should lay flat against your skin and not crisscross. Avoid having any large gaps ? or hair, if possible ? between your face and the mask.

9. Put your glasses back on.

10. If using gloves, pull them on and over the cuff of a long-sleeve shirt, if possible.

11. Avoid touching the front of the mask ? this includes resisting the urge to fiddle with the fit once it?s on your face. If you do, wash your hands or apply hand sanitizer again. Similarly, gloves should be changed or washed (see below) as often as you would normally wash your hands. Limit how many surfaces and items you touch to avoid cross-contamination.

How to remove gloves and a mask

1. Start with the gloves, if you?re wearing them. With a gloved hand, grasp the palm area of your other gloved hand just above the cuff and peel off the glove, turning it inside out.

2. Holding the removed glove tightly in your gloved fist (do not let it hang down), slide the fingers of your ungloved hand under the remaining glove?s cuff and peel that glove off so that it?s also inside out. The first glove you removed should be inside the second.

3. Place both gloves into a closed trash bin. (Disposable gloves are not meant to be reused, but if you absolutely must, you can wash them with soap and water, let them dry, then turn them inside out to use them once more. Just be sure there are no rips or tears.)

4. Wash your hands with soap and water for at least 20 seconds or, if that?s not possible, apply hand sanitizer with at least 60% alcohol.

5. If you?re wearing glasses, take them off.

6. If you?re wearing a mask with ear loops, tilt your head forward, grasp the mask by the loops, and remove them from your ears. If you?re wearing a mask with ties or elastic bands, tilt your head forward and grasp the mask by the ties or bands, removing the bottom ones before the top.

7. Machine wash and dry the mask, if possible, or hand wash the mask with soap and water and leave it in the sun to dry.

8. Repeat step four.

9. Put your glasses back on.

What about kids?

Preliminary CDC data on the first wave of coronavirus cases in the U.S. suggests that fewer children develop Covid-19 than adults, and when they do, they?re less likely to develop telltale signs like fever, cough, and shortness of breath. Instead, the disease appears to manifest in more mild ways ? or not all, meaning children, like adults, could be asymptomatic carriers.

Until more is known, if you?re going to be in a situation where you need to wear a mask, any child two years of age or older should, too. To increase your odds of success (we?re looking at you, parents of toddlers), Dr. Danelle Fisher, vice chair of pediatrics at Providence Saint John?s Health Center in Santa Monica, California, suggests practicing at home.

First, explain in simple, age-appropriate terms why you both need to wear the mask ? that is, ?We don?t want to spread germs.? ?Toddlers understand a lot more than we give them credit for,? says Fisher. ?When you use simple language like that, they?ll understand it more than if you just shoved a mask on them.?

Second, make it fun. ?A lot of times toddlers like to mimic whatever adults are doing, so if the parent puts on the mask, talks it up, laughs, makes it seem really fun, the kid?s going to want to try it,? says Fisher. ?You can even reward them for wearing the mask with a little toy or little something.?

If your kid?s not having it, that?s okay. Avoid taking them into stores and restaurants if you can. If you must, ?the next-best steps would be to try to make your visits to places like the grocery store incredibly quick ? in and out as much as possible,? says Fisher.

In the store, seat your kid in a cart so they?re not able to touch as many items, and wipe down their hands with an alcohol-based hand sanitizer or baby wipes as needed. And breathe. ?It can be very, very difficult to be in a situation and experience something you?ve not planned for,? says Fisher. ?So take a deep breath and try to be as calm and positive as possible. You don?t want to exhaust your kid?s patience and their ability to sit still. They have very little of that right now.?

Lastly, when it comes to kids and gloves, don?t worry about it. ?I?m strictly advising people to wear masks when they?re in grocery stores,? says Fisher. ?Gloves are not necessary and in fact can still spread germs.?

The bottom line

Regardless of who in your household is wearing a mask and/or gloves, remember: Cloth face masks only offer limited protection and should only be used when travel outside of self-isolation is unavoidable, writes cloth-mask researcher Anna Davies, BSc. ?Social isolation and distancing, as well as handwashing and avoidance of face touching, are by far the most effective way to protect yourself and limit the spread of the virus.?