Collaborative approaches to masking: statewide threshold development and performance across three respiratory seasons

Area of Science:

• Healthcare epidemiology
• Infection prevention and control
• Public health policy

Background:

• Respiratory illness transmission in healthcare settings presents risks to patients and staff.
• Inconsistent masking policies can lead to confusion and varied safety protocols.
• Standardized thresholds are needed to guide masking decisions in health care systems.

Purpose of the Study:

• To develop statewide consensus thresholds for guiding masking policies in Minnesota health care systems.
• To establish consistent and clear guidelines for masking over three respiratory seasons.
• To reduce confusion and improve adherence to masking protocols.

Main Methods:

• A multidisciplinary workgroup reviewed hospitalization rates, influenza-like illness levels, test positivity, and wastewater data.
• Masking thresholds were evaluated and updated annually based on performance and facility feedback.
• Data sources and threshold recommendations were refined over three respiratory seasons.

Main Results:

• Initial thresholds based on illness levels were revised to focus on hospitalization rates.
• Adjustments were made to COVID-19 masking thresholds and implementation timing based on season two analysis.
• Nine out of ten reporting health systems implemented universal masking, with strong support attributed to aligned metrics.

Conclusions:

• Standardized masking thresholds enhance staff support and decrease confusion for staff and patients.
• The use of basic epidemiology tools facilitates replication and communication of masking policies.
• Addressing data reporting lags is crucial for timely masking during rapid illness surges.