Q&A: Getting Healthcare Workers to Wear Masks

You’d think that healthcare workers would be the last ones to ignore proper masking guidelines, but sadly too many of them do, says Linda Spaulding, RN, BC, CIC, CHEC, CHOP. She tells Infection Control Today® that infection preventionists (IPs) need to constantly monitor and educate their fellow healthcare workers. IPs also need to keep an eye on patients, as well, because coronavirus disease 2019 (COVID-19) continues to surprise us in nasty ways. “For infection preventionists, know that if people have diarrhea, that is a huge sign that they may have COVID. We’re seeing a lot of people with only diarrhea, no fever, no respiratory tract infection. And we’re starting to see those people come back positive for COVID.”

Linda Spaulding, RN, BC, CIC, CHEC, CHOP: I think there’s a couple things. You know how COVID is changing almost by the hour. One of the most important things that I feel I didn’t stress enough in the last interview was masks. I think we’re getting so used to wearing masks all the time. As healthcare workers, we don’t even think of the word mask because we always have it on. And with the upcoming flu season and COVID not going away anytime soon…. There are a couple things that could happen during flu season. One, we may find that less people come down with the flu, because more people are wearing masks. Masks not only prevent COVID, but it also prevents the flu. And on the other hand, we might also find out that we do have more COVID cases detected because if people come down with flu symptoms, which are similar to COVID symptoms, then we may find out that they’re co-infected or that they don’t have flu, they have COVID. In the past week, I have been doing so many workups on COVID cases that it’s amazing the astronomical numbers of asymptomatic individuals that we’re finding with COVID. Now a lot of the CDC and the news media report it could be 40% to 50% of the people that have COVID are asymptomatic. And I’m seeing that a whole lot right now. Because we’re finding spouses of healthcare workers coming down with COVID. Only to find out that when we check the healthcare worker, the healthcare worker is positive, but they’re asymptomatic. We’re finding the same thing with kids. The kids may get admitted or see the ER physician because of symptoms. And we find out that there’s a parent that’s asymptomatic. Or the parent gets sick, we decided to test the whole family. And they have children in the house and the children are asymptomatic, but the parents are getting COVID. My hope at this point is we will see less flu because a mask will protect people from the flu. And we will identify more asymptomatic carriers so we can move them away from other people in order to prevent others from becoming symptomatic. I think that’s the key right here.

ICT®: You’re in Florida, correct?

Spaulding: Yes.

ICT®: And you’re seeing a big surge there?

Spaulding: Oh, definitely we are.

ICT®: And you’re seeing a big surge in asymptomatic carriers?

Spaulding: Yes.

ICT®: And asymptomatic healthcare workers who either gave it their spouse, or got it from their spouse or somebody else in their family?

Spaulding: Right.

ICT®: What’s the bottom line as far as what infection preventionists should do? Just basically just keep on pushing, pushing, pushing that everybody should wear a mask in the hospital?

Spaulding: Yes, definitely. I heard a study this morning. I can’t remember if it was out of Denmark or someplace else. But I’m going find the study. And I’ll try to share the information with Infection Control Today®. But it talked about they did a laser review of a lot of different types of masks that are out on the market. And one of the things they found, which makes mask testing so simple for people at home, is if you take a flashlight and shine it on the inside of the mask, if you can see the light on the outside of the mask, then that mask probably isn’t good enough to protect you from COVID. Now just that study alone tells us so much that we didn’t know yesterday. So, for infection preventionists in the hospital, it’s important to just get extremely good at contact tracing. If you have an employee that tests positive, find out who they’ve been around. If an employee calls you and tells you their family member’s positive, then keep that in mind as your employees are coming to work. But know that there are a lot of asymptomatic carriers around us, be it children, or a lot of young adults. And so those are the people we have to be monitoring when we’re having them come in to visit in the hospital, or if they’re admitted to the hospital and they have illnesses that we just don’t understand. And most importantly, for IPs, know that if people have diarrhea, that is a huge sign that they may have COVID. We’re seeing a lot of people with only diarrhea, no fever, no respiratory tract infection. And we’re starting to see those people come back positive for COVID. And most people look for respiratory tract infections and fever. Keep in mind GI is very important also to track especially during flu season, because if people get influenza B, usually you see GI upset. But this year, think about COVID.

ICT®: How closely should infection preventionists monitor the wearing of masks? Even up to the point where they say to someone wearing a neck gaiter that they have to get a different mask?

Spaulding: In the healthcare setting, we don’t let anyone…. Well, I’m speaking for the healthcare settings I’ve been in. We don’t let anybody wear anything other than the masks we provide because we know that those masks will protect them. Now, what they do once they leave work is anybody’s guess. That’s our biggest concern. We [infection preventionists] have listening sessions with staff and we talked to them about proper mask wearing 24/7. We can do a listening session and we still have people sitting there with a mask under their nose, while we’re telling them not to. You have to continuously stress this among healthcare workers, be it whatever department. All departments have to be wearing the mask correctly and everybody in the facility must be monitoring those people, not just the IPs.

ICT®: It’s shocking that you’re telling me that healthcare workers are not following guidelines. It’s shocking to me. Is it shocking to you?

Spaulding: No, not really because we have varying different cultures, varying different belief systems. And some people still believe COVID is a farce, it doesn't really exist, it’s made up.

ICT®: Even healthcare workers believe that?

Spaulding: Yes, you have some in healthcare that believe that. And you have to remember not all healthcare workers are being impacted by COVID. It’s mainly the ICUs and the COVID units that are set up in hospitals. Other regular medical surgical units and oncology units that aren’t dealing with COVID patients: they have to take the same precautions, but they’re not seeing the results of COVID. Because there are a whole lot of other situations out there other than COVID that some people are dealing with.

ICT®: Do infection preventionists educate about masks so that the healthcare workers when they leave work take the lessons with them?

Spaulding: We try to instill that in them. But it’s almost like with some individuals, once they walk out the door, they forget what they just did the last eight or 10 hours. We just keep reinforcing, reinforcing, reinforcing. But sometimes what it takes is those people that don’t want to follow the masking out in public and that kind of thing. If one of their family members get sick, sometimes that’s a wakeup call. If one of them get sick. There have been a few people that have been interviewed in the news media that, “Oh, I always thought this wasn’t any big deal until I got it.” People have to sometimes experience things firsthand. Because if they never see it, never experience it, it’s like, “Well, it really doesn’t exist. It has nothing to do with me.”

ICT®: Let me paraphrase. You’re stressing the use of masks, and the proper use of masks might help prevent the spread of flu as sort of a byproduct.

Spaulding: Right.

ICT®: Any final words for your fellow infection preventionists about the flu and COVID riding together in their area and how to deal with that?

Spaulding: Just keep doing the regular surveillance that we do on a daily basis. Follow up things closely. If you’re going to test for flu, you’re probably going to have to test for COVID. If we have the ability to test for COVID. There are still areas in the US that don’t have the ability to test as much as they need to. So just keep doing what you’re doing. Keep track of the CDC website, because we don’t know what’s going to happen if somebody’s co-infected with the flu and COVID. It’s never happened before. Are we going to be sitting here and talking about something that nobody expected to happen when these two met? We’re just going to have to monitor it closely and keep the staff informed and track everybody.

This interview has been edited for clarity and length.