Considerations for de-escalating universal masking in healthcare centers

Area of Science:

• Infectious Diseases
• Public Health
• Epidemiology

Background:

• Universal masking in healthcare settings became widespread due to COVID-19 pandemic knowledge on respiratory viral infections (RVI) transmission, including asymptomatic cases.
• Evolving SARS-CoV-2 epidemiology and increased population immunity necessitate a review of current infection control masking strategies in healthcare.

Purpose of the Study:

• To review factors influencing the de-escalation of universal masking in healthcare centers.
• To propose refined recommendations for future masking strategies based on local RVI surveillance and epidemiological context.

Main Methods:

• Narrative review considering compliance, local epidemiology, mask protection, absenteeism/presenteeism, logistics, costs, and ecological impact.
• Analysis of current guidelines based on community transmission and proposal for tiered RVI surveillance and masking activation thresholds.

Main Results:

• Current guidelines often rely on community SARS-CoV-2 transmission levels.
• A tiered approach to masking is proposed: standard precautions, systematic masking during patient contact, and universal masking.
• Factors like local RVI surveillance, epidemiological context (e.g., winter season), and wastewater analysis can inform strategy activation.

Conclusions:

• Refining masking recommendations requires establishing relevant RVI lists, reliable surveillance, and defined activation thresholds.
• A gradual, context-dependent masking strategy is suggested, integrating with immunization and ventilation for comprehensive infection control.
• Cost-effectiveness analyses of different masking strategies are needed.