Masks... why are we not using masks?

[BayPAC]

At this point we should assume everyone has covid-19 until proven not infected. My organization does not allow us to use masks unless we suspect the patient is + for it. In my opinion, we all should be wearing masks when treating patients. Am I wrong? Thoughts? 

[mgriffiths]

Regardless of whether you are wrong or right, we don't have enough PPE to wear when in contact with anyone and everyone.  So, the idea is conservation and using only when we know we need it.  Unfortunately the lack of PPE is a huge aspect of why cases are continuing to balloon.

[rev ronin]

There's a reason universal precautions are universal.  It is perhaps less offensive, but no less unjustified, to assess someone's likely Covid-19 status by their outward appearance than it is to fear and shun those we suspect to have HIV by their lifestyle markers.

[PACali]

At Some hospitals,  the nurse are required to wear mask when they are not vaccinated for flu. It is ridiculous they don't allow you to wear a mask at all time.  

[DarwinStarwin]

I saw something on Vice TV with a clinician complaining that his hospital had similar red tape: established (and already outdated) protocol requires providers to only wear masks around patients who screen positive.

He felt this protocol-driven flow was inadequate and already out of date.

He also felt that is rationalized the facade from some hospital systems stating that they had adequate PPE to protect their providers.

[DogLovingPA]

We are required to wear surgical mask, eye pro and gloves for all patient encounters.  For serious concern of respiratory illness, add gown and N95.  Most of us wear head covers too. We have PAPRs for the docs for intubating. All patients (no matter what their complaint) are also given surgical masks to wear.  Our ER is also partitioned into "hot" and "cold" zones to try to keep folks separate.  

Now granted, we use the same darn mask all shift.....  and are sanitizing disposable gowns?  And N95 masks....

[EMEDPA]

On 4/2/2020 at 9:04 PM, PACali said:

At Some hospitals,  the nurse are required to wear mask when they are not vaccinated for flu. It is ridiculous they don't allow you to wear a mask at all time.  

Agree. I would not work anywhere that would try to tell me when I can and can't wear PPE. We have plenty of PPE at present and all of the clinical staff have their own p-100s. For lower risk patients I am wearing an n95 mask with a regular mask on top. wearing a surgeon's cap all day. would gown up and use a papr for intubation/cpap/bipap. 

We check temps on hospital entry and exit and change into hospital scrubs before going to the dept and back into street clothes on exit. 

 

[charlottew]

Where I work anyone who works in any capacity in a building that contains patients, has to wear a surgical mask for their entire shift. Only to be removed for eating/drinking, preferably in a private space. We have been doing this since 3/25. 

I think it's a very very good idea, as asymptomatic transmission is a thing, as is community spread. We're protecting ourselves, from each other.

[SedRate]

On 4/2/2020 at 5:26 PM, BayPAC said:

At this point we should assume everyone has covid-19 until proven not infected. My organization does not allow us to use masks unless we suspect the patient is + for it. In my opinion, we all should be wearing masks when treating patients. Am I wrong? Thoughts? 

University of Nebraska pre-published a study on transmission via viral shedding. They had positive samples obtained from air not only inside but also outside the room of a positive pt, specifically in hallways and doorways. They also obtained positive samples from window sills, cell phones, bedrails, and toilet seats. Disclaimer was made that the study did not evaluate whether these samples contained active viruses that could be transferred. In light of this and considering that I'm mobilizing throughout the hospital past multiple personnel, pts mobilizing in hallway (PT rehab sessions), several airborne precaution rooms and one of two COVID units in our large, rural community hospital, I started wearing an N95 plus surgical mask all day. (Thankfully only working partial shifts to limit exposure so I'm able to tolerate 4 hours of consistent use.) To help with conservation of N95s to ensure that those at high exposure risk encountering positive or pending pts will have the masks they need, I will be alternating my N95s, using each for a total of three shifts and then disposing, storing them away when not in use. 

https://www.medrxiv.org/content/10.1101/2020.03.23.20039446v2.full.pdf+html

[SedRate]

https://www.sages.org/n-95-re-use-instructions/

https://www.facs.org/covid-19/ppe

"The extent of marginal benefit of universal masking over and above these foundational measures is debatable. It depends on the prevalence of health care workers with asymptomatic and minimally symptomatic infections as well as the relative contribution of this population to the spread of infection. It is informative, in this regard, that the prevalence of Covid-19 among asymptomatic evacuees from Wuhan during the height of the epidemic there was only 1 to 3%.4,5 Modelers assessing the spread of infection in Wuhan have noted the importance of undiagnosed infections in fueling the spread of Covid-19 while also acknowledging that the transmission risk from this population is likely to be lower than the risk of spread from symptomatic patients.3 And then the potential benefits of universal masking need to be balanced against the future risk of running out of masks and thereby exposing clinicians to the much greater risk of caring for symptomatic patients without a mask. Providing each health care worker with one mask per day for extended use, however, may paradoxically improve inventory control by reducing one-time uses and facilitating centralized workflows for allocating masks without risk assessments at the individual-employee level.

There may be additional benefits to broad masking policies that extend beyond their technical contribution to reducing pathogen transmission. Masks are visible reminders of an otherwise invisible yet widely prevalent pathogen and may remind people of the importance of social distancing and other infection-control measures.

It is also clear that masks serve symbolic roles. Masks are not only tools, they are also talismans that may help increase health care workers’ perceived sense of safety, well-being, and trust in their hospitals. Although such reactions may not be strictly logical, we are all subject to fear and anxiety, especially during times of crisis. One might argue that fear and anxiety are better countered with data and education than with a marginally beneficial mask, particularly in light of the worldwide mask shortage, but it is difficult to get clinicians to hear this message in the heat of the current crisis. Expanded masking protocols’ greatest contribution may be to reduce the transmission of anxiety, over and above whatever role they may play in reducing transmission of Covid-19. The potential value of universal masking in giving health care workers the confidence to absorb and implement the more foundational infection-prevention practices described above may be its greatest contribution."

https://www.nejm.org/doi/full/10.1056/NEJMp2006372

[SedRate]

Also from the above NEJM article for those who don't wish to read the entire article:

"What is clear, however, is that universal masking alone is not a panacea. A mask will not protect providers caring for a patient with active Covid-19 if it’s not accompanied by meticulous hand hygiene, eye protection, gloves, and a gown. A mask alone will not prevent health care workers with early Covid-19 from contaminating their hands and spreading the virus to patients and colleagues. Focusing on universal masking alone may, paradoxically, lead to more transmission of Covid-19 if it diverts attention from implementing more fundamental infection-control measures."

[Lucy199]

If all the nitrile and latex plants in the world burnt down, the new "recommendations" for rectal exams on cdiff positive patients with mrsa infected perianal abscess' would be as follows "we now recommend washing your finger before the procedure, wrap your hand with a napkin or tissue, perform procedure, and then good hand hygiene after" It's all bullshi** and we all know it. PPE preservation is obviously needed at this time but at what cost? I have to wear simple surgical mask in a non negative pressure room with covid + patients for 10 hours in a row..... but I don't "need" an n95.... what a joke. When we look back at this a couple years from now this will be the biggest blunder in recent healthcare history. The amount of us that will get sick because we were wearing paper masks and told that "it was fine". And gag ordered to not speak out about it or face the fear of being fired by execs who would legitimately die of a panic attack if they were in the room with myself and a patient with their cute little surgical mask. 

[Lexapro]

My organization now requires every single person wash their hands and put on a mask prior to entering (inpatient psych hospital).