Statement on universal masking of staff, patients, and visitors in health care settings
The Joint Commission supports the Centers for Disease Control and Prevention’s (CDC) revised infection prevention and control recommendations related to COVID-19.
Issued on April 13, the CDC stated that to address asymptomatic and pre-symptomatic transmission, health care facilities should “implement source control for everyone entering a healthcare facility (e.g., healthcare personnel, patients, visitors), regardless of symptoms.” Source control involves having people wear a cloth face covering or face mask over their mouth and nose to contain their respiratory secretions — reducing the dispersion of droplets from an infected individual. This will decrease the possibility that anyone with unrecognized COVID-19 infection will expose others and will allow organizations to forgo contact tracing if a case is identified. For source control to be effective, it requires that everyone wear a mask within health care buildings to prevent droplet and (to a lesser degree) aerosol spread of respiratory viruses, such as COVID-19.
The Joint Commission believes that universal masking within health care settings is a critical tool to protect staff and patients from being infected by asymptomatic and pre-symptomatic individuals and should be implemented in any community where coronavirus is occurring. Even a single case of community spread of COVID-19 means that health care facilities and staff are at risk because other asymptomatic and pre-symptomatic patients may come in for care and inadvertently infect staff.
Here are some key steps that may be helpful in implementing this recommendation:
Patients and visitors:
All patients and visitors should be instructed to wear a cloth mask when entering any health care building. If they arrive without a cloth mask, one should be provided. If there is a sufficient supply of medical grade face masks, one may be provided instead of a cloth mask.
In accordance with CDC recommendations, face masks and cloth face coverings should not be placed on:
- Young children under age 2.
- Anyone who has trouble breathing.
- Anyone who is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
Patients may remove their cloth face covering when in their rooms but should put them back on when leaving their room or when others (e.g., care providers, visitors) who are not wearing a mask enter the room. If available, organizations should consider switching patients with respiratory symptoms (e.g., cough or sneeze) — including patients with confirmed COVID-19 — to a medical grade face mask.
Health care personnel:
Facility workers should wear at least a cloth mask when leaving their home, per CDC recommendations. When providing direct patient care to any patient, they should don a “medical grade” (official personal protective equipment) face mask or respirator depending on the care provided.
The CDC states: “Cloth face coverings are not considered PPE because their capability to protect healthcare personnel (HCP) is unknown.”
Health care personnel who provide support services but do not provide direct patient care should also wear a face mask. But in order to conserve supplies, the face mask can be cloth. Outbreaks of COVID-19 have occurred among health care personnel who provide support services.
Masks may be removed when social distancing of at least 6 feet is possible (e.g., after entering a private office). In order to ensure staff can take off their masks for meals and breaks, scheduling and location for meals and breaks should ensure that at least a 6-foot distance can be maintained between staff when staff needs to remove their mask.
It is important for health care facilities to emphasize that hand hygiene is essential to maintaining employee safety, even if staff are wearing masks. If the face mask is touched, adjusted or removed, hand hygiene should be performed.
To assist with rapid implementation, The Joint Commission is providing two items that organizations may find helpful:
- Signage that can be posted at facility entrances in black and white and in color.
- An infographic on the do’s and don’ts for wearing face masks during the COVID-19 pandemic that can be used to educate staff and patients.
Organizations have done an excellent job communicating policies regarding prior interventions to stop the spread of coronavirus. The Joint Commission encourages organizations to use similar processes to remind patients and visitors that they should be wearing a face mask when they arrive and to provide links to CDC resources for making their own sewn or non-sewn masks with materials that are commonly available.