IPC PROs Helping Each Other: When to Unmask a Long-term Care Facility

IP Pros Helping Each Other

Infection Control Today^® introduces a new series, IPC PROs Helping Each Other which features infection prevention and control professionals at all levels speaking with each other, giving best practices, and telling stories of what has worked—and not worked—for them in their facilities.

Do you have a best practice to share? A question you need answering? Or have an answer to the weekly question? If so, please send them to tmartonicz@mjhlifesciences.com and help out those in the IPC community.

Next week: Do you have an answer to "How do you help others in your facility to remember infection prevention and control requirements that they consistently seem to forget?"

“We are never getting rid of these masks, are we?” a nurse on the rehab wing asked me as I passed through the nurse’s station. I had heard the question numerous times and still did not know the answer. The staff—and patients—wanted our facility to go back to normal.

A few weeks later, the conversation on unmasking finally happened. Our Director of Nursing broached the subject of unmasking. She discussed that all counties in the state had been in moderate community transmission for a few weeks, and the numbers in the state had been good. She questioned if this was the time to do it. As the infection preventionist, my initial gut response was ‘NO! We need our masks.' The reality of the situation said if we are ever going to try it, now is the time to do it.

Once the decision was made to unmask, the question became, how do we do it? I knew that doing it wrong could lead to chaos! What I learned is that the key to successfully unmasking is staff education.

The Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic in the Sept. 27, 2022, update lays out the guidelines for when masks can be removed in health care settings. That is the easy part. Once the masks are off, the risk increases for COVID-19 outbreaks, so we must ensure we are taking all possible precautions. This is where staff education comes into play.

The staff needs to understand that not wearing masks is a privilege. As with all privileges, this one comes with great responsibility. The responsibilities that come along with no masks in a long-term care facility are self-reporting exposures to COVID-19, self-reporting illness, and masking during periods of illness and exposure.

Education should include what situations would require the facility to return to mandatory masking and how that will be communicated to staff and visitors. Ensure the team understands that you, as the IP, will expect 100% compliance when such situations occur. A reminder that in the future, when they are asked to mask it, it will be for a reason (ie outbreak, high COVID-19 levels, etc.) can be helpful.

When educating staff, I recommend taking the time to speak to staff one on one or in small groups. This allows you to make sure they understand what you expect from them.

My facility was unmasked on March 16, 2023. It has been several weeks, and things have been going great. The staff is happy, and the residents are pleased to see their caregivers' faces. When we had an exposure that required one floor to be put back in masks during exposure testing. The staff was adherent with no pushback. The reality of no masks is that, eventually, there will be an outbreak. But we had outbreaks with our masks on too. So, in the end, it was worth taking the chance to get back to this little bit of normal.