Universal Masking in Hospitals in the Covid-19 Era

Introduction 

As the SARS-CoV-2 pandemic continues to explode, MOH systems are scrambling to intensify their measures for protecting patients and health care workers from the virus. This effort should include universal use of masks by all healthcare workers. In health care settings, First and foremost, a mask is a core component of the personal protective equipment (PPE), HCWs need when caring for symptomatic patients with respiratory viral infections, in conjunction with gown, gloves, and eye protection.

Rationale for Universal Masking Guidance: 

All HCWs working in inpatient units, ambulatory unit, and procedural areas (all clinical units) will be expected to wear surgical face masks, at all times, while in their respective clinical care settings. This universal mask approach will serve to:

1. Protect patients and HCWs from exposure to infection from asymptomatic COVID-19 infected HCW (a mask achieves source control and decreases the risk of spreading infection)
2. Protect healthcare workers caring undiagnosed asymptomatic COVID-19 infected patients or patients have mild COVID-19 infection that have not yet been recognized.

Universal Masking Guidance:

• A single mask can be worn across different cases and between cares of different patients.
• When providing care to a patient with known or suspected COVID-19 the mask should be removed and wear new one after hand hygiene.
• Masks must be changed if they become wet or contaminated during a case.
• Surgical mask is not allowed to be worn outside the clinical care areas.
• Surgical mask is not allowed to be hanged around the neck or kept in the pocket.
• Personnel working in nonclinical areas where persons are reliably separated by more than 1.5 meter should not wear masks and when walking through common clinical areas where care is delivered, the mask policy applies. Stop at an entry point prior to entering the clinical area to use surgical masks .These employees should practice principles of social distancing, respiratory etiquette and frequent hand hygiene.

Process to Use and Discard Surgical Mask 

1. A surgical face mask will be used at the start of each shift, for those individuals working in clinical care units.
2. Masks will be available at each entrance to the unit, and will be used throughout the shift.
3. In the event that the mask becomes visibly soiled, wet or damaged, a new mask must be used.
4. At the end of shift, HCWs will be asked to doff their face masks as they exit the unit. 
5. Medical waste containers will be placed at each exit for the used masks to be discarded.

Implantation of This Guideline This guideline developed to be applied on the hospital/s that have COVID-19 or any other infectious respiratory disease outbreaks, implementation of this guideline should be under the authority of Regional Command and Control Centre (CCC) with guidance of General Directorate of Infection Prevention and Control (GDIPC).

References:

1. Universal Masking in Hospitals in the Covid-19 Era, the New England Journal of Medicine, April 3, 2020.
2. Rothe C, Schunk M, Sothmann P, et al.Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med 2020; 382: 970-1.
3. Bai Y, Yao L, Wei T, et al. Presumed asymptomatic carrier transmission of COVID 19. JAMA 2020 February 21 (Epub ahead of print).
4. Li R, Pei S, Chen B, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science 2020 March 16 (Epub ahead of print).
5. Hoehl S, Rabenau H, Berger A, et al. Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. N Engl J Med 2020; 382: 1278-80.
6. Ng O-T, Marimuthu K, Chia P-Y, et al. SARS-CoV-2 infection among travelers returning from Wuhan, China. N Engl J Med. DOI: 10.1056/NEJMc2003100.