Why hospitals won't keep universal masking around forever

Face masks have played a crucial role in reducing COVID-19 transmission in hospitals, but clinical and infection control experts are not convinced the pandemic has set a new precedent for widespread use of facial coverings in healthcare settings. 

"If it's going to set a precedent, it's probably going to set it for clinical areas … and maybe not all the time — maybe during the winter season or the flu season," Firas Zabaneh, director of system infection prevention and control for Houston Methodist, told Becker's

Early in the pandemic, respirators and other facial coverings emerged as crucial and highly coveted supplies for healthcare workers to protect themselves and others. Now, more than two years into the pandemic, some healthcare organizations are relaxing mask rules and looking to a future where masking is more strategic, versus comprehensive. The CDC also updated its infection control guidelines Sept. 23, dropping its universal masking guideline for healthcare workers in areas where community transmission levels are not high. 

The pandemic is not the first time an infectious disease threat has spurred sweeping changes to clinical practice. While disposable gloves were a norm for clinicians in operating rooms by 1966, they weren't used broadly across hospitals until prompted by the AIDS crisis in the 1980s, according to Baltimore-based Johns Hopkins Medicine. While widespread rubber glove use is still common in hospitals today, healthcare leaders are less confident that universal masking will solidify itself as a widely accepted infection control practice. 

"Masking is a tool and it's certainly become one we've leaned on more heavily than before the pandemic," Melanie Swift, MD, an occupational medicine physician at Rochester, Minn.-based Mayo Clinic, told Becker's. "I think that what we'll see is kind of this evolving from a universally applied tool in healthcare to a bit more targeted, and it will probably fluctuate."

Infection control leaders cited several reasons why universal masking may not stick around after the pandemic. For one, mortality rates for AIDS were much higher than the U.S. is seeing now for COVID-19 or flu, Mr. Zabaneh said. Masks can also hinder communication and connection between individuals, Dr. Swift added. Many health systems are also facing pressure from staff members to scale back masking. 

"Unlike wearing gloves, covering your face really challenges that human connection that's so important in healthcare. So much of communication is nonverbal," Dr. Swift said. "We're hungry for that human connection, so I think we'll continue to look for ways to unmask."

As of Sept. 26, Mayo Clinic still required universal masking in all of its patient care areas. The system did relax masking in nonpatient care settings where staff may gather for breaks or meals, which employees have really welcomed, Dr. Swift said. 

With high community transmission rates, Houston Methodist also still had universal source control in place for patient care areas as of Sept. 28. Mr. Zabaneh said leadership will closely monitor these rates, along with the upcoming flu season, to decide when mask rules can be loosened in clinical areas. 


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