A study affirms that wearing a mask is still as necessary in health establishments

A recent study published in the Annals of Internal Medicine Journal argued that now is not the (right) time to stop using masks in healthcare settings.

Study: For patient safety, it is not time to remove masks in healthcare settings. Image Credit: GroundPicture/Shutterstock.com

Background

Hospitals must decide whether to de-escalate certain mitigation strategies as the public health emergency related to coronavirus disease 2019 (COVID-19) lifts. Decisions to change institutional infection control and prevention policies are complex and depend on a variety of institutional and regional factors.

Masking in community settings has been controversial during the COVID-19 pandemic, in part due to the lack of high-quality evidence endorsing efficiency and the politicization of mask-wearing.

So far, most studies investigating the effectiveness of masks have methodological limitations, with suboptimal adherence to mask use in nearly all studies. It is difficult to demonstrate that masks work when the use of masks is inconsistent.

The authors suggest that masking should continue during interactions between healthcare professionals and patients for patient safety despite the lack of clinical trials of effectiveness.

Masks limit the spread of particles

Laboratory studies have shown that mask respirators and surgical masks can effectively limit the spread of droplets and aerosols from people infected with coronavirus and the flu.

Although masks are not 100% effective, they reduce the number of virus particles released during coughing or communication and mitigate risk. Additionally, transmission from healthcare personnel to patient and vice versa can occur even when both are using masks, but this is not common.

Presenteeism makes it necessary to continue to wear masks in health establishments, because health personnel continue to work even when they are sick.

In several studies, up to two-thirds of healthcare professionals admitted to working with respiratory symptoms. Presenteeism is well documented during healthcare-associated respiratory viral outbreaks.

Through interviews, the authors examined presenteeism at one of their hospitals during the COVID-19 pandemic.

More than 50% of staff who preferred asymptomatic testing and later tested positive for SARS-CoV-2 admitted to exhibiting COVID-19-related symptoms during testing, highlighting presenteeism issues. Nevertheless, transmission to patients did not occur despite the proximity when providing care.

Masking in healthcare facilities

People vaccinated against COVID-19 or the flu may develop mild symptoms that could be mistaken for non-infectious symptoms. Additionally, a third of SARS-CoV-2 Omicron infections are asymptomatic but could be serious and life-threatening if transmitted to susceptible individuals.

Hospitals caring for immunocompromised and elderly patients will face challenges when measures are stopped.

The universal masking approach may not be the only option; other approaches may be applied depending on the clinical context. For example, masking in season for viral respiratory infections, at the beginning of autumn, and in departments with patients at risk of respiratory sequelae, among others.

Masks should continue to be examined in clinical settings for unintended benefits and outcomes, and key limitations of masking, for example communication impedance, should be addressed by improving or redesigning masks.

Despite the pitfalls of masks, health facilities have functioned well during the COVID-19 pandemic. Some argue that universal masking is impractical for patient care.

During the Acquired Immune Deficiency Syndrome (AIDS) epidemic, doctors advised that they could not use gloves even when they were likely to be exposed.

Nevertheless, healthcare professionals have adapted and gloves are accepted as standard precautions and have become the standard of care.

Final remarks

Of note, masking reduced healthcare-related transmission of almost all respiratory viruses, not just SARS-CoV-2, in several settings. Additionally, a recent survey of epidemiologists across the United States (US) suggested that most (97%) were not keen on removing masking in their facilities.

Although this sentiment may have changed in recent months, many experts support the use of masks to prevent the spread of respiratory viruses. Therefore, the authors advocate that masking should not be discontinued in healthcare settings for patient safety.