infection prevention
infection prevention
By Shanina Knighton , PhD , RN , CIC
Are Masks Really Not Working or Do We Need to Focus on Community-level Masking Education Around Proper Handling and Indications for Use ?
As we reflect on being what some people would describe as being out of the “ eye of the storm ” as it relates to COVID-19 , there are many opinions and reflections about what worked well and what did not . One controversial scientific question that still exists is “ are masks effective ?” A few scientific reviews , including Cochrane 1 suggest the effectiveness of masks were inconclusive , whereas mainstream media outlets shared the message that “ masks do not work .”
As an infection preventionist , nurse and scientist , I understand that non-healthcare workers do not always understand how important proper wear and handling of masks are and the risks associated with mishandling and reuse 2 of disposable masks . In healthcare , it is established that if masks are mishandled or improperly used , they can increase the risk for infection transmission between patients . For example , in the pre-pandemic era it was standard for surgical masks to be one-time use when needed for precautions and or if you had a patient that required airborne precautions you would be told to use a N-95 mask for just that patient during your shift . These measures helped decrease the risks of transmission . During the pandemic , emergency reuse was emphasized due to limited supplies favoring the opinion that mask reuse provided more of an upside for protection than risks . However , data was scarce in determining that .
As attention turns more to public health and community-level infection prevention and control efforts it intreats the scientific community to pause and ask , “ Are we educating and measuring the effectiveness of basic infection prevention and control practices and in this example — mask use and handling including the practical uses that can keep everyday people safe ?” Furthermore , “ Do we educate the community on the benefits of proper mask use and handling and the potential consequences associated with misuse and mishandling ?”
Briefly , I summarize some examples of misuse and education tips often overlooked .
Dirty hands taking the mask on and off parallels to a dirty mask . Hand hygiene is the simple most important wat to prevent the spread of germs that lead to infections . During the pandemic people were told to put on masks . However , evaluating if people clean their hands at all , less known correctly before and after putting their masks on should be considered . Mouths and noses expel germs and are also entry for germs . The mask coming in direct contact with the mouth and nose means that people run the risk of unknowingly transmitting germs directly to and from their face by way of the mask .
Dirty cell phones inked to a dirty mask . Cell phones are seen as the “ third hand ” and are shown to be 10 times dirtier 3 than a toilet seat . Cell phones create a segway to germs being directly transmitted to the face . Imagine your face , cell phone and mask all coming in contact with each other as you place your phone against your mask while keeping it on or pulling it down to take a call instead of moving it from ear to ear . Cell phones can get contaminated just because we use them for almost everything . People who engage in bathroom scrolling are at risk , given many studies showing the splash effect from sinks 4 and toilets 5 thus justifying the transmission of some harmful germs . Mobile hygiene and touchscreen hygiene is important to avoiding germs that can travel to or from your “ third hand .”
Mishandling and mis-wearing of masks connect to microbes . Treading through the hallways in many walks of life from emergency departments where the highest foot traffic occurs , to COVID testing or vaccine clinics , many people -- including healthcare workers -- could be observed time and time again wearing masks as chin girdles or beneath their nose while some wore them correctly above the bridge of their nose with a snug fit . Incorrect masking wearing means that the protection against particulates is inaccurate compared to what the manufacturer ’ s protection standards might say . Many factors , such as not removing masks from ear to ear , sitting masks on unclean surfaces , wearing disposable masks multiple times because it is not “ visibly ” dirty and exposure of the mask under certain conditions , can alter the effectiveness of how well a mask will protect someone . Education around correct technique and understanding of how to handle and wear masks is needed for community use of masks .
We won ’ t be masked forever , but we should when it matters . It is not likely people will wear masks while sitting privately in their cars forever . It is also not likely that masking will go away . Geographical areas where transmission is high , working with high-risk populations or being considered a part of a high-risk population , warrants consideration for wearing masks according to the Centers for Disease Control and Prevention 6 . However , based on my expertise there are situations where transmission is at its highest that influences my personal masking habits . While I do not wear masks in every setting , I do wear them on public transportation 7 where cleaning practices have slowed , and high air exchange is no longer occurring . I wear masks in old buildings 8 where I know the heating , ventilation and air conditioning systems are not up to par . If I am in an elevator 9 with strangers , I wear my mask . Unfortunately , you cannot predict when someone will have to cough or sneeze in these types of closed environments therefore , I would rather take my chances on wearing a mask for that short duration of time than coming in contact with droplets that can make me sick . Many agree that wearing masks in healthcare settings should go away , but I disagree . We know that within healthcare settings people are likely to go to facilities because they are sick including a higher likelihood to carry transmissible germs such as respiratory illnesses .
Disposable masks are disposable and do expire . 10 It is understandable that resources at certain points during
10 • www . healthcarehygienemagazine . com • march 2024