Requiring masks for healthcare workers

By: November 22nd, 2011 Email This Post Print This Post

The feature article in the November issue of Briefings on Infection Control looks at AHA’s mandatory flu shot policy that requires either influenza vaccination or wearing a mask in the presence of patients across healthcare settings during flu season for healthcare workers. Here is an excerpt of the article that examines considerations such as comfort, enforcement, and communication with patients for choosing to wear a flu mask as alternative to immunization.

Healthcare workers either need to get an influenza vac­cination or wear a mask when working with patients during flu season, according to a new American Hospital Association (AHA) policy.

That’s a necessary step to protect the safety of patients, says Nancy Foster, AHA’s vice president of quality and ­patient safety.

While a flu shot is preferable, wearing a mask is a way to minimize the transmission of droplets that can cause ­influenza, she says.

An uncomfortable option
But is mask-wearing practical?

“I won’t say it’s the most comfortable option. But the risk to patients is too great [not to require it],” Foster says.

Hospitals often start vaccinating workers with flu vaccine in September, and flu season can run as late as through April.

“You’re looking at months of wearing a mask,” says Libby Chinnes, RN, BSN, CIC, an independent infection control consultant with IC Solutions, LLC, based in Mt. Pleasant, SC.

The requirement to wear a mask may be an incentive for some healthcare workers to get a flu vaccination, Chinnes says. “If you wear a mask for very long, it gets hot and uncomfortable,” she says.

Enforcement a challenge
If hospitals are going to require masks for healthcare workers who decline the flu vaccine, they need to make that part of their policy, Chinnes says.

The hard part will be enforcement, she says, since workers may need to wear a mask for five or six months.

“Masking is a hassle for employees and can be problematic for hospitals to enforce,” says Deborah L. Wexler, MD, executive director of the ­Immunization Action Coalition in Saint Paul, MN.

Monitoring healthcare workers who must wear a mask because they haven’t had a flu shot is a challenge, agrees Peggy Prinz Luebbert, MS, MS(ASCP), CIC, CHSP, a consultant and owner of ­Healthcare ­Interventions in ­Omaha, NE, who works with healthcare ­organizations across the country.

Luebbert has worked with a couple of hospitals that have required masks and it does provide some motivation for workers to get a flu shot.

Healthcare workers are required to wear a mask as soon as they enter the facility, from October 1 to March 1, she says.

The healthcare workers are required to indicate on their identification badge whether they have had a flu vaccination or must wear a mask, she says. For instance, a blue dot indicates the worker has had a flu shot, while a red dot indicates they have not had it.

Luebbert admits it is like wearing a scarlet letter for those who don’t get a flu shot.

The masks themselves are “awful,” she says. “The employees hate it. It’s uncomfortable and the patients can’t see your face. And the patients hate it because they can’t see the worker’s expression.”

It must be the responsibility of the employee’s manager to monitor workers to ensure they are wearing their mask, Luebbert says. Infection preventionists cannot be everywhere in a hospital to monitor all workers.

Communicate with patients
Hospitals should be prepared for questions from patients and family members who may wonder why a worker is wearing a mask when providing care, says Chinnes.

“I think hospitals should come up with some kind of script so a healthcare worker can say, ‘This is why I’m wearing a mask,’ ” she says. Hospitals don’t want patients to think they are allowing a worker who is sick to take care of them.

Luebbert agrees that hospitals need to communicate to patients and family members why workers are wearing a mask. One hospital put up a poster in its lobby advising people that both visitors and employees who had not been vaccinated against the flu must wear a mask during flu season, she says.

Briefings on Infection Control subscribers can read more from the November issue by clicking here.


I will probably find another profession after more than 25 years of nursing. I will not get the flu shot as I have had bad reactions in the past. I feel humiliated wearing a mask having to explain why to patients and visitors. It’s also hot and uncomfortable. The backs of my ears are sore from the ear loops. I came home from work today and broke into tears. What are we coming to?? Really look at the research on vaccines and effectiveness never mind the side effects.

The hospital where I work made flu vaccine mandatory three years ago. I was/am medically exempt. The first two years a drs excuse was sufficient, however this past year (flu season) they required an allergist determine vaccine reaction. Even if there was a positive skin test reaction protocol requires for the HCW to receive the vaccine, slowly, over a 6 to 8 hour period while under the care of the allergist. Now, mind you, I am a clerical employee and have limited contact with pts.
I work mainly at a desk.

Having had a hx of anaphylaxis with the flu vaccine, I was required to visit the allergist. (However I am NOT allergic to eggs) After administering the skin test the site of testing appeared to be negative. However ten minutes into testing I began having an anaphylactic reaction. My mouth inside and out begin to itch, as did the roof of my mouth and my throat, my lips began to swell and I became covered with hives and a rash. Plus my skin was beet red and warm all over.

I was administered meds to combat the reaction and observed for awhile before being released. The Dr said I was NOT to be vaccinated against flu this year nor in the future EVER!!

This all happened at the beginning of the flu season, now, in mid January, admin is going to require me to wear a mask. Wear it or else! All day long, 9+ hours.

Coworkers, visitors and pts are going to be fearful I’m sick. The above people are going to ask questions. So what do I tell them? Anything I tell them will reveal I have a medical condition which prevents me from getting the flu vaccine. Is this NOT a violation of MY privacy?

Several on here have stated, “Well get vaccinated wear a mask or get out!” None of these policies were in place when I started working at the hospital. It would be different if they were. I love my job and my coworkers. I need my job. But am I willing to break one of the cardinal rules of pt privacy, even though its MY privacy?

Becoming a hospital employee doesn’t make our privacy rights null and void.

I cant take the flu shot due to a bad reaction. I’m a receptionist at a family practice office and we are corporate owned so we are required to get the shot or wear a mask. I wear glasses the mask causes my glasses to fog upi cant see the computer screen patients cant hear me on the phone. I cant stand to have my face covered. I really feel that my rights are violated. Its not aboyr protecting patients its about federal funds to these corporations. Why do I have to have the flu shot show proof or wear a mask? I can go to a hospital walk in go visit a patient and I dont need to show proof of a flu shot or wear a mask. Why are my rights and HIPPA privacy violated? Wearing a mask says your sick or it says I didnt have my flu shot. Its no ones business and the risk is mine and anyone else who can’t take or chooses not to take the shot.

If a person, nurse or anyone, shows signs and symptoms of the flu, they are required to wear a mask while sick and infectious.
Nowhere in logic is a mask indicated for a person who is NOT sick.
Not getting vaccinated does not indicate infected.
We have complete idiots running things. It is a HIPAA violation to say the least. Nurses can sue the hospitals for violating their HIPAA. There is a fine for violating HIPAA as well. It is ILLEGAL to force people to wear masks for 8-12 hours a day 4-6 months out of the year.
Just because you are put in a position to make rules, does nto qualify you to make logical and ethical decisions that others will blindly follow like morons.
For all the places where the mask is mandatory because the vaccination is mandatory, sign the paper stating
HIPAA violation due to reasonable cause and not due to willful neglect is $1,000 per violation, with an annual maximum of $100,000 for repeat violations $50,000 per violation, with an annual maximum of $1.5 million.
THAT’S a lot of money hospitals will be fined just to bully and harass employees.

Is this true? If this is a HIPAA violation, how can it be madated by healthcare facilities?

To Marti and all the FLU vac pushers:
1. The FLU vaccine is only 59-61% effective at best.
2. Over 90% of the reported FLU cases that were reported were in fact people who had the FLU shot. via the CDC!
3. It is only in droplet form. Meaning when I am at my desk in the hospital I work at, I am in NO WAY a threat to any patient. Even if I cough and sneeze at my desk, the droplets do not stay airborne.
4. Poor hygiene will be more of a risk to patients.
5. If we are mandating that us employees wear the mask, than I want every single patient, family member, visitor, vendor, and anyone else that did not get the FLU shot to wear a mask.
6. People being forced to wear a mask every day for 8-12 hrs with no break are at risk to get ill by keeping their face moist. AKA a breeding ground for microbes.
7. To MANDATE that every health care worker get the FLU shot is lest you forget: UNCONSTITUTIONAL!!!
8. Again, FLU SHOT IS ONLY AROUND 60% effective. I know 10 staff members who got the vaccine and have been sick for 3 months straight since then.
9. People with allergies to the FLU Vaccine being forced to wear a mask? Laughable at best.
10. To force this upon us and brand us or black list us by putting stickers on our badges and than making those who CHOOSE not to get the vaccine, well in a word: Healthcare Communism!!!!!!!!!!!!!
There is so many facts on how the FLU vac works and does not work.
So get off your high horse Marti and all the others that think the FLU vac is a must and promise you won’t get sick. Its a choice. Oh wait, I don’t treat my honeybees either like a lot of others do. Damn, guess I am going against that policy to and should not be a beekeeper. Oh wait, I use only organics in my garden beds, dog gonnit, I guess I am a hippy and therefore am ignorant. This needs to stop.

You’ve got interesting articles here. Your site can go viral, you
need some initial traffic only. How to get initial traffic???
Search google for: marihhu’s tips

It’s impressive that you are getting ideas from this piece
of writing as well as from our dialogue made here.

Hi, I am a healthcare worker and right now have been asked to take the flu shot or wear a mask. Is there any way to fight this? I read about nurses in Canada fighting against this and they won. How do we get things started?

A few simple questions…..a lot above to sift through…..

I have tried to find confirmation that Medicare does require HCWs to get the flu shot..or wear a mask yes or no and where to find it. I am specifically referring to employees who work in a clinical outpatient setting’s offices where there is a lab and x-ray department, secretaries, nurses and administration …this refers to a provider based hospital clinic, if that makes a difference. Again, where does it say employers can make it mandatory or wear a mask for employment ?

Secondly, why not require that all patients coming into the facility show proof of having had the flu shot…Rhetorical question of course…

I do agree somewhere in all this money is going from the pharmaceutical industry to the hands of the people making these decisions in Washington….

By edline massey on November 5th, 2017 at 1:08 pm

Is’nt it a HIPAA violation that I would have to get the flu shot and a sticker on my badge stating if I took the flu shot or not?
What about other vaccines or contagious illnesses .Are those health care workers going to have it stated on their badge what they are positive for ?

I totally agree with David, people should not be forced to do anything and put anything into their body. It is a free country. And how about the people that had the flu vaccine and is getting the flu anyway, and walking around with it in the hospital.

Concerns raised
1. What about patients that don’t take the flu vaccine and are in our Hospital? Are we isolating them from the other patients…No.

2. What about visitors that come to our hospital we are not asking them for their vaccine status? Vendors?

3. What about Physicians that come to our hospital and meet face-to-face with their patients we are not asking them for their flu vaccine status

4. What about the side effects of mask-wearing to the healthcare worker for extended periods of time?

5. Isn’t the basis for the flu mandate for healthcare workers, found in Obamacare that states certain reimbursement will be made by percentage of healthcare workers that have the flu shot? . Once again the travesty called Obamacare has placed on healthcare workers demands that are ridiculous just as the premiums and you won’t lose your doctor was.

This is once again like Nazi Germany with the Jews I’m taking a religious exemption and I should not be singled out with something on my badge that says that.

I have researched the efficacy of the influenza vaccine and it is coming up with no actual proof the vaccine is effective. In fact if you average the effectiveness based on the CDC site, it is around 41%! In our healthcare system, staff who received the vaccine feel they are exempt from ever wearing a mask…one study demonstrated a nurse, who was vaccinated, giving all of her patients the flu. It is a form of bullying. In the meantime, I was just told I need to wear my mask even at my desk without anyone around me! Arrgh!!It is all based on money.

I know someone who at 38yrs old, works as a teacher, required to get a flu shot. Had no health issues. She died from the flu.

By Andy Crow on April 17th, 2018 at 1:27 pm

Even though I think that everyone should be immunized unless they have an actual medical reason to not receive one, I think that mandatory masking for individuals not exhibiting any signs of infection is absurd. It is simply a way to shame the ignorant or unfortunate. It tells the world about your “protected health information” against your will.

First of all, the AHA never mandated that employees wear masks everywhere inside a healthcare facility (except a dining room). They recommeded masking while in direct contact with patients.
Issues with mandatory masking everywhere:
1. Employee health has no safety montoring plan for those employees: ex did the masked employee suffer skin breakdown, exacerbation in allergies (masks release particles cant imagine what they release after 12hrs), experience headaches, dry/chapped lips, airway compromise due to lack of humidity in inspired air? Look back 10 years to identify how many reports your employee health department has filed federally regarding vaccine reactions. Is there a monitoring/reporting process whereby an employee can report a reaction to the vaccine. What is the safety in obstructing an employees airway for 12 hours? What if that employee has allergies, asthma or other airway related pre-existing illness?
2. Employee satisfaction and HR issues: is masking treated as a punishment or hard core bargaining chip to FORCE administration of a medication to an employee? What happens if the employee has a serious reaction–are they covered under the hospitals disability program or are they forced under a federal vaccine reaction program (who can afford to live if that is the case?)This should fall under the ADA protections?? Are masked employees mocked? Is there a health care privacy violation in requiring a mask (esp in an employee with rare or no patient contact?)? I think that an employee class action suit against all hospitals mandating a mask is warranted. Where is the Nurse’s advocate, ANA, standing on this?
3. The science is not there: viruses pass through masks, no evidence that vaccinated employees cannot transmit a flu virus either, the flu vaccine itself is not 100% effective, often less than 50% and sometimes not even that.
Nurses have been required to mask for YEARS lets get a research project going (while I get a law firm to take on the class action) Lets rise up and take the masks off!

Per my personal provider – the more one receives the flu shot, the more they are building up immunity to various strains of the flu shot. For many years, I have sat in small triage rooms with people coughing non-stop who are positive for the flu, and I have never gotten it. Perhaps there is some truth to the built up immunity.

Do you know who among those patients in those small triage rooms were immunized?

I have never had a flu shot. I have never had the flu, but for once when I was nine. I now have to wear a mask for six months and I have no direct contact with patients.

I work in the kitchen, so I understand that if I feel sick, I shouldn’t be in there or that I should at least mask up and wash up more frequently.

Last year, I had to cover the shifts of three workers in a kitchen of nine people due to influenza vaccination reactions. Since yesterday was the deadline, I anticipate having to work yet more double shifts with no days off for the same reason – all while having to explain to co-workers that I’m not sick, not a conspiracy kook and not a devil-may-care monster for refusing the shot.

Add peer pressure to the list of wonderful things I get to experience this flu season, even though I most likely won’t be getting the flu. If I do – I’ll call in! Logical, right?

I got a written verbal my mask slipped off few times. Never taken flu vaccine. New job new organization policy. I declined signing. Ridiculous to enforce your employees wanting to work to wear mask 12 HRs.

I am a nurse and I last got the flu shot in 2002 & 2003. I became ill both times, fever and body aches and missed 3 days of work both times. I am hardly ever ill or do I miss work for illness. I feel that getting the shot is just not worth the risk. I also think that making anyone who does not get the flu shot wear a mask is a violation of my rights. It lets everyone know that I did not get the flu shot. It is no one business whether I get it or not. I think I should have control over what I put in my body. Flu shots do not eradicate the flu, most times it is only a guess what what put in the vaccine and most of the time it is not correct. Last year almost every patient I saw in the ED that had influenza had had the flu shot

This is the first year my hospital has required the mask, within 6′ of patients only. Prior to this, it was enough to sign a declination. I am just incensed over having to discuss my personal health information with everyone, coworkers, patients and families, to explain I’m not sick but forced to mask in order to retain my job. It is wrong.

The problem is, that in this role I am not the patient and my information is not protected, evidently. Instead, I am an employee. My employer can impose these nonsensical requirements because if I do not agree or comply, they can just fire me. This is so much different than just requiring my presence at certain times, requiring me to follow dress code, other employee rules. This time they are inserting themselves into my private health decisions that I make myself with my doctor. My body.

I can only hope that evidence-based practice catches up with people and these rules can be changed. The flu vaccine is not as effective as they pretend it is. Also, wearing a mask as a means of containing droplets is ineffective.

It is about coercion, which is one of the last qualities you want to find in your employer, and reimbursement. Money money money.

By Judy Vincenty on December 5th, 2018 at 12:35 am


We are forced to wear masks. last year I had an allergic reaction and decided that the mask was far better choice than risking my life for a flu shot that doesn’t even work. I took the flu shot three years in an a row and each year I would become very sick numerous time through the year. This year I have not been sick once so far, and I attribute that for not taking the shot. However when we administered the flu shot to our patients almost half of them became very ill after administration, and the other half a few weeks later.

I hate the fact that I am forced to walk around with a mask, and everyone knowing that I didn’t get the flu shot. We are forced to wear the mask Nov-April. I have patients always asking me why I didn’t get the shot, or make some type of comment towards me. I am in compliance between 12 and 16 hours a day, but still get harassed and threatened by our management. Almost as if they are trying to bust me not wearing it. I feel harassed daily which makes coming to work unbearable at times.


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