Considerations for implementing broader use of masking in healthcare settings
By Patti Cullen, CAE | May 12, 2023 | All members
On May 8, 2023, the Centers for Disease Control & Prevention (CDC) issued an update to their guidance: “Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic” in advance of the ending of the Public Health Emergency (PHE) on May 11, 2023 (see related story).
With the end of the public health emergency on May 11, 2023, the CDC will no longer receive data needed to publish community transmission levels for SARS-CoV-2. This metric informed CDC’s recommendations for broader use of source control in healthcare facilities to allow for earlier intervention, to avoid strain on a healthcare system, and to better protect individuals seeking care in these settings.
As described in CDC’s Core IPC Practices, source control remains an important intervention during periods of higher respiratory virus transmission. Without the community transmission metric, healthcare facilities should identify local metrics that could reflect increasing community respiratory viral activity to determine when broader use of source control in the facility might be warranted. The following information is an excerpt from that guidance specifically related to source control.
Introduction When to Implement Broader Use of Masking
Use of well-fitting masks in healthcare settings are an important strategy to prevent the spread of respiratory viruses. Well-fitting masks can help block virus particles from reaching the nose and mouth of the wearer (wearer protection) and, if someone is ill, help block virus particles coming out of their nose and mouth from reaching others (source control). Masking by healthcare personnel as part of Standard and Transmission-Based Precautions and by ill individuals as part of respiratory hygiene and cough etiquette (i.e., for people with symptoms) are already well-described. This appendix describes considerations for implementing broader use of masking in healthcare settings. However, even when masking is not required by the facility, individuals should continue using a mask or respirator based on personal preference, informed by their perceived level of risk for infection based on their recent activities (e.g., attending crowded indoor gatherings with poor ventilation) and their potential for developing severe disease if they are exposed.
The overall benefit of broader masking is likely to be the greatest for patients at higher risk for severe outcomes from respiratory virus infection and during periods of high respiratory virus transmission in the community.
Facilities should consider several factors when determining how and when to implement broader mask use:
- The types of patients cared for in their facility.
- Facilities might tier their interventions based on the population they serve. For example, facilities might consider a lower threshold for action in areas of the facility primarily caring for patients at highest risk for severe outcomes (e.g., cancer clinics, transplant units) or in areas more likely to provide care for patients with a respiratory infection (e.g., urgent care, emergency department). Except when experiencing an outbreak within the facility, facilities with residents or patients that generally do not leave the facility might consider implementing masking only for staff and visitors
- Input from stakeholders.
- Reviewing plans with stakeholders including patient and family groups and healthcare personnel can help a facility determine practices that will be more broadly supported.
- Plans from other facilities in the jurisdiction with whom the facility shares patients.
- Some jurisdictions might consider a coordinated approach for all facilities in the jurisdiction.
- What data are available to make decisions.
- Facilities and jurisdictions might have access to more granular data for their jurisdiction to help guide efforts locally
Some facilities might consider recommending masking during the typical respiratory virus season (approximately October-April). Facilities could also follow national data on trends of several respiratory viruses.
Metrics for Community Respiratory Virus Transmission
CDC is in the early stages of developing metrics that could be used to guide when to implement select infection prevention and control practices for multiple respiratory viruses. However, at this time there are some general metrics that could be used to help facilities make decisions about community respiratory virus incidence. Data on the exact metric thresholds that correspond with a higher risk for transmission are lacking. In addition, data from these systems are generally not available for all jurisdictions.
SARS-CoV-2 Specific Metrics CDC will also continue to collect and report SARS-CoV-2 hospital admissions data on the CDC COVID Data Tracker. These data continue to be available at the county level and are used by CDC to help the public decide when masking in the community should be considered. Based on CDC analyses from data from late 2022 and early 2023, these levels might be less useful to inform masking recommendations in healthcare facilities. CDC continues to recommend that healthcare facilities institute facility-wide masking when masks are recommended in the community. Metrics Encompassing Other Respiratory Viruses
During the COVID-19 pandemic one of the strongest indicators of increasing cases in nursing homes was increasing community incidence. If a jurisdiction still has access to SARS-CoV-2- community incidence, using these data to guide local recommendations at the levels previously described (community incidence > or = to 100/100,000) could be considered.
The RESP-NET interactive dashboard or data from the National Emergency Department Visits for COVID-19, Influenza, and Respiratory Syncytial Virus can be used to inform when respiratory virus season is beginning or ending, as described above.
Patti Cullen, CAE | President/CEO | [emailprotected] | 952-851-2487