Masking as source control is recommended during the times of increased positivity in the community and in the long-term care facility.”— Jane Siegel
Talbot then directed the town hall conversation to the issue of masking as a source control intervention.“ Thinking back to when we were in the midst of COVID when everyone in a healthcare facility was masking, I know there has been talk and approaches of how to handle and use that intervention. We did see during the pandemic a reduction in healthcare-associated respiratory viral infections; also, multiple papers have pronounced the lack of pertussis exposures because everyone was masking and so we did see that benefit. While that loosened up for a while, some facilities have put that in place again, so I’ d like to ask the panelists for their thoughts on universal masking.”
Drees noted,“ Ever since we stopped universal masking, we’ ve been following our internal respiratory viral positivity rate. So, it’ s everything from rhinovirus to COVID, to flu, and we follow that data weekly and usually it’ s been around 20 percent. I think this year it seemed like the data’ s always about a week old. I shared the data on a Thursday and leadership decided to start masking the next Monday, so that happened pretty quickly. It’ s now been a month and we still don’ t have all of our signage up, we don’ t have our respiratory hygiene stations up, and all the things that used to happen automatically during flu season. I don’ t know where we’ ll go with our policies next year but we definitely have to plan for operationalizing it in advance, regardless of what we use as a trigger.”
Talbot reported that his institution implements a tiered approach.“ The first tier is in our protective environment units, so positive pressure in key units,” he said.“ We use our positivity rate and we use the acute respiratory infection circulation, but that’ s a little delayed. We actually started masking a little later than I think we should have based on anecdotal reports, honestly. So, we’ ve talked about do we just turn it on and turn it off? As we’ ve vetted that with different groups, some feel just turn it on November 1 to March 1, while others say not to, and even some populations you think would be desirous of a mask are pretty resistant to it.”
In the pediatric setting, Nyquist said her institution“ conducts year-round visitation evaluation of people who are coming in as visitors either to outpatient or to inpatient where they go through a screening process,” she said.“ When they check in at the front desk, if they have any symptoms, they are turned away. If they’ re inpatient, or a parent, we ask them to wear a mask. I think people have done a pretty good job of wearing masks, at least here in Colorado, but it is not popular to have mandatory masking anywhere. We’ ve also had a measles outbreak here, so in areas where we have a significant congregation of people, we are offering masks to everyone. It’ s multimodal. We do this year round and haven’ t done a seasonal restriction. Our focus
is on family-centered care and we really haven’ t had increased HAIs.”
From the long-term care perspective, Siegel commented,“ We need to have respiratory hygiene / cough stations set up, with advance planning,” she said.“ Masking as source control is recommended during the times of increased positivity in the community and in the long-term care facility. I think it’ s important to track in the longterm care facility the results of microbiological testing and during respiratory season to perform active surveillance for respiratory symptoms among residents.”
Talbot mentioned that healthcare-acquired viral respiratory infection may not be on practitioners’ radar and institutions may not formally track that.
“ We unified a definition for hospital-acquired( HA) respiratory viruses,” Passaretti noted.“ Three days is tricky because we felt it over called present-on-admission infection, so we have a more nuanced definition based on the incubation period for the different viruses. We focus on flu, COVID, RSV, which are the most impactful, and maybe there are interventions that we might do, whether it’ s testing, Tamiflu prophylaxis, and enhanced masking on the unit. We consider two healthcare-acquired cases to be a cluster. We do masking and visitor restrictions during respiratory viral season, and that’ s also our trigger for performing healthcare-acquired viral surveillance, so we marry those up and do them during the same times when we’ re seeing the height of activity.”
Drees says her institution tries to keep it simple.“ I didn’ t want my IPs to have to investigate every case so we use the lab-identification definition where if it’ s after three days, we call it hospital-acquired,” she said.“ Ultimately it relies on someone sending the test though and so clinicians have to be thinking,‘ Oh, this could be a viral infection’ to even send it. I think we probably miss some with milder symptoms who never get tested, but it’ s kind of a loose metric that we follow.”
Siegel noted that in long-term care,“ Active surveillance during the respiratory season for symptomatic individuals is important as well as clinical laboratory surveillance. It’ s also important to remember that it is recommended that there be a full-time infection preventionist in long-term care facilities that have more than 100 beds or have ventilated patients or patients on hemodialysis in smaller facilities. A half-time person may be more practical, but the idea is that the infection preventionist would be dedicated to doing these tasks to prevent transmission within long-term care. The state of California actually requires LTCFs to have an FTE who is well trained in infection prevention, and I think New Jersey may also require that.”
Panelists then turned to what should be done in long-term care if there is an exposure, as well as what to do in hospitals with shared rooms and flu or COVID exposure.
“ For influenza, if there are two or more cases within onset, within 72 hours and at least one case is documented influenza, we would recommend chemoprophylaxis for those who have been exposed but are not symptomatic.,” Siegel said.“ The group to receive this chemoprophylaxis is dependent on how the facility is structured, so there are some recommendations that the entire facility or the entire wing, and dedicating healthcare workers to care only for patients with influenza. It’ s also important to keep those who may have been exposed but aren’ t symptomatic before we know the testing results to keep, not have them move their rooms to be with other people who are confirmed.”
Talbot addressed exposure in the acute-care setting when private or semi-private rooms may or may not be available.“ We have criteria for placement into those areas, particularly symptomatic syndromic, not just confirmed infections, but if you have suspected which would require that suspicion, you cannot be placed in those locations. Now, that doesn’ t mean you don’ t have a suspicion, you don’ t think
march-april 2026 • www. healthcarehygienemagazine. com •
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