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Considerations for de-escalating universal masking in healthcare centers


Birgand, Gabriel; Landelle, Caroline; Price, James R; Mutters, Nico T; Morgan, Daniel J; Lucet, Jean-Christophe; Kerneis, Solen; Zingg, Walter (2023). Considerations for de-escalating universal masking in healthcare centers. Antimicrobial Stewardship & Healthcare Epidemiology, 3(1):e128.

Abstract

Three years after the beginning of the COVID-19 pandemic, better knowledge on the transmission of respiratory viral infections (RVI) including the contribution of asymptomatic infections encouraged most healthcare centers to implement universal masking. The evolution of the SARS-CoV-2 epidemiology and improved immunization of the population call for the infection and prevention control community to revisit the masking strategy in healthcare. In this narrative review, we consider factors for de-escalating universal masking in healthcare centers, addressing compliance with the mask policy, local epidemiology, the level of protection provided by medical face masks, the consequences of absenteeism and presenteeism, as well as logistics, costs, and ecological impact. Most current national and international guidelines for mask use are based on the level of community transmission of SARS-CoV-2. Actions are now required to refine future recommendations, such as establishing a list of the most relevant RVI to consider, implement reliable local RVI surveillance, and define thresholds for activating masking strategies. Considering the epidemiological context (measured via sentinel networks or wastewater analysis), and, if not available, considering a time period (winter season) may guide to three gradual levels of masking: (i) standard and transmission-based precautions and respiratory etiquette, (ii) systematic face mask wearing when in direct contact with patients, and (iii) universal masking. Cost-effectiveness analysis of the different strategies is warranted in the coming years. Masking is just one element to be considered along with other preventive measures such as staff and patient immunization, and efficient ventilation.

Abstract

Three years after the beginning of the COVID-19 pandemic, better knowledge on the transmission of respiratory viral infections (RVI) including the contribution of asymptomatic infections encouraged most healthcare centers to implement universal masking. The evolution of the SARS-CoV-2 epidemiology and improved immunization of the population call for the infection and prevention control community to revisit the masking strategy in healthcare. In this narrative review, we consider factors for de-escalating universal masking in healthcare centers, addressing compliance with the mask policy, local epidemiology, the level of protection provided by medical face masks, the consequences of absenteeism and presenteeism, as well as logistics, costs, and ecological impact. Most current national and international guidelines for mask use are based on the level of community transmission of SARS-CoV-2. Actions are now required to refine future recommendations, such as establishing a list of the most relevant RVI to consider, implement reliable local RVI surveillance, and define thresholds for activating masking strategies. Considering the epidemiological context (measured via sentinel networks or wastewater analysis), and, if not available, considering a time period (winter season) may guide to three gradual levels of masking: (i) standard and transmission-based precautions and respiratory etiquette, (ii) systematic face mask wearing when in direct contact with patients, and (iii) universal masking. Cost-effectiveness analysis of the different strategies is warranted in the coming years. Masking is just one element to be considered along with other preventive measures such as staff and patient immunization, and efficient ventilation.

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Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Epidemiology
Health Sciences > Microbiology (medical)
Health Sciences > Infectious Diseases
Uncontrolled Keywords:Infectious Diseases, Microbiology (medical), Epidemiology
Language:English
Date:1 January 2023
Deposited On:26 Mar 2024 08:13
Last Modified:30 Jun 2024 03:42
Publisher:Cambridge University Press
ISSN:2732-494X
Additional Information:CORRIGENDUM to this article: the authorship should appear as follows: Gabriel Birgand, Caroline Landelle, James R. Price, Nico T. Mutters, Daniel J. Morgan, Jean-Christophe Lucet, Solen Kerneis and Walter Zingg /// Birgand G, Landelle C, Price JR, et al. Considerations for de-escalating universal masking in healthcare centers – CORRIGENDUM. Antimicrobial Stewardship & Healthcare Epidemiology. 2023;3(1):e157. doi:10.1017/ash.2023.438
OA Status:Gold
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1017/ash.2023.200
Related URLs:https://doi.org/10.1017/ash.2023.438 (Publisher)
PubMed ID:37592969
  • Content: Published Version
  • Language: English
  • Description: Incorrect order of authorship (see CORRIGENDUM)
  • Licence: Creative Commons: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
  • Content: Published Version
  • Language: English
  • Description: CORRIGENDUM
  • Licence: Creative Commons: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)