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Requiring masks for healthcare workers

The feature article in the November issue of Briefings on Infection Control [1] 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 [2].