How long should a mask be worn when caring for a patient with hand‑foot‑mouth disease?

Mask Use for Hand-Foot-Mouth Disease

Masks should be changed between each patient encounter when caring for someone with hand-foot-mouth disease, and should be worn only during direct patient care when splashing or spattering of saliva or respiratory secretions is anticipated.

Duration and Context of Mask Use

The available infection control guidelines address mask use in healthcare settings but focus on procedure-based rather than disease-specific or time-based protocols. For hand-foot-mouth disease (HFMD) specifically:

During Direct Patient Care

• Wear a surgical mask when examining patients with suspected HFMD or other respiratory tract pathogens, particularly when the patient has new onset of cough or increased respiratory secretions 1
• Masks should be worn when procedures are likely to generate splashing or spattering of saliva or other body fluids 2
• Change the mask between patients or during patient treatment if it becomes wet or moist 3, 2

After Patient Care

• Remove all barrier protection (including masks, gloves, and gowns) before departing the patient care area 2
• Masks are not intended for continuous wear throughout the day, but rather for individual patient encounters

Key Considerations for HFMD

Transmission Routes

HFMD spreads through:

• Fecal-oral contact
• Oral-oral contact
• Respiratory droplet transmission 4

Viral Shedding Duration

The virus can be shed for extended periods:

• Viral positive rates remain around 50% at 3 weeks post-onset for CVA16 and CVA6, and at 4 weeks for EV71 5
• This prolonged shedding occurs primarily through fecal and oral routes rather than respiratory droplets

Practical Application

The mask is not worn for a specific duration related to the disease itself, but rather:

1. During each direct patient encounter where respiratory droplet or saliva exposure is anticipated
2. Changed between each patient to prevent cross-contamination
3. Removed immediately after completing patient care before leaving the clinical area

Common Pitfalls

• Do not wear the same mask for multiple patient encounters - this defeats the purpose of infection control 3, 2
• Do not rely solely on masks - hand hygiene is equally critical, as HFMD spreads primarily through fecal-oral and direct contact routes 4
• Remember that respiratory precautions alone are insufficient - standard precautions with emphasis on hand hygiene and environmental disinfection are essential 6, 4

Additional Infection Control Measures

Beyond mask use:

• Maintain at least 3 feet separation between symptomatic patients and others in waiting areas 1
• Implement respiratory hygiene/cough etiquette for patients and families 1
• Focus on handwashing and disinfection of contaminated surfaces, as these are the most effective prevention methods 4