In another new normal of the COVID-19 pandemic, all healthcare personnel (HCP) should wear surgical masks throughout their entire shift, the Centers for Disease Control and Prevention (CDC) recommends.1

Moreover, patients should be actively screened for fever before entering the facility and wear their own mask or be provided one to receive care. The recommendations come amid a shortage of personal protective equipment (PPE), but these are voluntary measures for hospitals to meet as their local situation warrants. Sometimes called “universal masking,” the practice was used in some hospitals during the 2003 sudden acute respiratory syndrome (SARS) outbreak. As opposed to that predecessor coronavirus, SARS-CoV-2 can spread with apparent ease from asymptomatic people.

“To address asymptomatic and presymptomatic transmission, implement source control for everyone entering a healthcare facility (e.g., healthcare personnel, patients, visitors), regardless of symptoms,” the CDC recommended.

Medical face masks should be reserved for healthcare personnel, but visitors and patients can wear cloth face coverings. If they arrive without one, they can be provided a mask if supplies are available, the CDC noted.

“As community transmission intensifies within a region, healthcare facilities could consider forgoing contact tracing for exposures in a healthcare setting in favor of universal source control for healthcare personnel and screening for fever and symptoms before every shift,” the CDC stated.

HCP should receive job-specific training on PPE and demonstrate competency with selection and proper use, including donning and doffing the equipment. Universal masking may be as much about addressing fear in the healthcare workforce as science, Ann Marie Pettis, RN, BSN, CIC, FAPIC, president-elect of Association for Professionals in Infection Control and Epidemiology (APIC), said at a recent press conference.

“As this ramps up, our staff is getting understandably more and more fearful,” said Pettis, director of infection prevention at the University of Rochester in NY. “We’re probably going to institute universal masking. In other words, every time staff come into work, we are going to offer them a new mask each day whether they are taking care of COVID patients or not. Again, it’s not scientific, but we have to give them the feeling that they are safe because their families are so worried about them coming to work.”

While acknowledging the ongoing PPE shortage, CDC guidelines still call for N95 respirators when treating suspected or confirmed COVID-19 patients.

“Facilities that do not have sufficient supplies of N95s and other respirators for all patient care should prioritize their use for activities and procedures that pose high risks of generating infectious aerosols and use facemasks for care that does not involve those activities or procedures,” the CDC recommended. “Once availability of supplies is reestablished, the guidance states that the use of N95 and higher-level respirators should resume.”2

“What is this really about? It is about the almost unconscionable U.S. national shortage of N95 respirators,” says Daniel Lucey, MD, MPH, FIDSA, FACP, an infectious diseases physician at Georgetown University Medical Center in Washington, DC.

Although the universal masking policy has been adopted at his facility, an emergency physician tells Hospital Employee Health the rationale behind it is questionable.

“A surgical mask is a false sense of security,” says Hamad Husainy, DO, FACEP, of Helen Keller Hospital in Sheffield, AL. “It blocks large particles, but studies have been done showing the longevity of this virus in the air and on surfaces. Also, the [small] size of this virus. I understand there is a PPE shortage and that is one of the issues that goes into this, but it should be an N95 mask.”

Because asymptomatic cases are probably driving transmission, Husainy wears an N95 respirator while on duty.

“New York, New Orleans, New Jersey, Italy — those places went ‘boom,’” he says. “That didn’t just happen. The way that so many people got sick so quick in all these places was the asymptomatic carriers.”

REFERENCES

  1. Centers for Disease Control and Prevention. Interim infection prevention and control recommendations for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) in healthcare settings. April 13, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
  2. Centers for Disease Control and Prevention. Healthcare infection prevention and control FAQs for COVID-19. April 23, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-faq.html