Becker's Clinical Quality & Infection Control

5 INFECTION CONTROL Hospitals enter uncharted territory on masking By Mackenzie Bean T his fall will mark the first virus season since COVID-19 emerged in which hospitals and health systems must independently determine when and how to implement universal masking, if at all. e CDC dropped its universal masking guideline in September 2022, saying that healthcare facilities in areas without high transmission can decide whether to require patients, visitors and staff to wear face coverings. is May, the agency further loosened mask guidelines in accordance with the public health emergency's end, putting masking decisions in the hands of hospital leaders, versus national health officials. e updated guidance says healthcare facilities should take a risk- based approach that considers various factors when determining when to implement universal masking, including local virus transmission, the types of patients cared for and stakeholder input. Universal masking should still be used when a unit or facility is experiencing a COVID-19 outbreak. e hands-off approach from federal health officials means hospital and health system leaders nationwide are now strategizing on the best approach to masking this fall as COVID-19 admissions tick up and new variants emerge. e U.S. saw 12,613 new COVID-19 admissions in the week ending Aug. 12, marking a 21.6 percent jump from the week prior and the fourth consecutive week of significant increase, CDC data shows. At least three hospitals in New York state reinstated mask mandates in August amid an uptick in positive cases and staff out sick with the virus. Auburn (N.Y.) Community Hospital restored its universal mask mandate Aug. 19 only a month aer officially ending the policy. is trend is not isolated to the East Coast. Oakland, Calif.-based Kaiser Permanente also reintroduced universal masking at Santa Rosa (Calif.) Medical Center and its affiliated medical buildings. Houston Methodist has not implemented universal masking, but still recommends it throughout its facilities and requires it for interactions with immunocompromised and highly at-risk patients. e organization is looking at numerous factors to inform decisions about universal masking, including data from its robust wastewater surveillance program, positivity rates for patients and employees, and COVID-19 variant activity. e system is also monitoring COVID-19 patient levels in the hospital and intensive care unit, along with the severity of these cases. "If we saw a variant that showed increased virulence or a big shi in immune escape from immunity from prior infection and from immunization, those are all things we look at that would give us more reason to recommend universal masking," Ashley Drews, MD, system epidemiologist and medical director of infection prevention and control at Houston Methodist Hospital, told Becker's. Conversations about masking's role in healthcare is not limited to this immediate fall. e industry as a whole is navigating what masking policies may look like coming virus seasons. Dr. Drews pointed to numerous studies, which found universal masking during COVID-19 was linked to a decrease in other respiratory viruses, including flu and respiratory syncytial virus. However, masks can also hinder the patient-provider experience or impede communication. Dr. Drews said there are ongoing efforts among leaders across the Texas Medical Center, which includes Houston Methodist, to decide what parameters to set for universal masking in the future. She predicts masks won't disappear from healthcare for good but acknowledged that blanket mandates may not be necessary every fall and winter. Instead, healthcare organizations are likely to embrace a more situational approach that allows for nuanced and tailored responses. "We really want to be cautious and make sure that we're recommending it in the right place at the right time," Dr. Drews said. n US physicians worried about enterovirus flare-ups By Paige Twenter A s bundles of severe echovirus infections pop up in at least three countries, U.S. infectious diseases experts are seeing a small increase in enterovirus cases, especially among children, NBC News reported July 6. In May, the World Health Organization said nine babies in France developed organ failure and sepsis from the infection, and seven died. The WHO pointed to an unusual increase in severe myocarditis and coxsackievirus, a type of enterovirus, in 10 babies in the United Kingdom. One died. A month prior, an echovirus-11 strain infected twin baby boys in Italy, and required them to be admitted to intensive care, according to a publication in Eurosurveillance. Physicians in the U.S., which lacks a national surveillance system, are watching more than 100 types of enteroviruses, NBC News reported. "We're hearing reports from around the country of all of our children's hospitals having some degree of significant enterovirus this summer," Buddy Creech, MD, a pediatric infectious disease physician at Nashville, Tenn.-based Vanderbilt University Medical Center, told the news outlet. Enteroviruses are common and most inflict a mild disease in infected patients, but with the higher severity in enterovirus cases around the world, health experts are concerned about a spike this summer. There are no treatments approved for such young children, the report said. n

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