Universal Masking Guidance Detail 04012020

Guidance on Masking in Clinical Areas
Effective April 1, 2020, all employees working in inpatient units, ambulatory clinic spaces, and procedural areas will
be allowed (but not required) to wear procedural/surgical or cloth face masks while in their respective clinical care
settings. We recognize this is a departure from standard infection prevention guidance and is not an intervention
currently recommended by the CDC, Tennessee Department of Health, or other health authorities; however, we
find ourselves in extraordinary times and given current circumstances, we believe this guidance is allowable. This
practice will be continually monitored and re-evaluated for extension with a tentative end date of May 1, 2020.
Rationale for Masking Guidance

Our knowledge regarding COVID-19 is rapidly expanding. This allows us the opportunity to update PPE policies to
incorporate the best evidence about issues like mask and respirator reuse and viral transmission.
Given what we have learned about COVID-19, this masking approach will serve to:
1. Act as a barrier to prevent touching of one’s face in the event one’s hands have become contaminated
2. Protect our patients and other staff members should the healthcare worker have early COVID-19 infection
or develop symptoms at work (a mask achieves source control and decreases the risk of spreading
infection)
To be successful, this approach will require support from all of us across the enterprise and require the following:
• Strict adherence to extended use/reuse of masks
• Meticulous adherence to hand hygiene (including before and after removing masks)
• Proper mask use and hygiene including wearing the mask as directed to cover the mouth and nose
• Strict avoidance of manipulation/touching the mask to reduce the risk of contamination and self-
inoculation
As our current N95 respirator supply must be reserved for approved high-risk procedures, respirators should
NOT be worn in general clinical areas or for non-approved indications.
Process to Obtain and Discard Procedure/Surgical and Cloth Masks to Preserve our Supply
Supply Chain will round and supply applicable units with the appropriate masks. Masks will be issued by the clinical
manager of your clinical work area, for those individuals working in one of the clinical care settings outlined above.
In order to conserve masks, these should be used throughout the shift (with the exceptions noted below) and
should be reused each day. Surgical masks should be replaced once they become visibly soiled, damp or damaged.
Cloth masks should be laundered each night at home. Stock will be securely stored in each clinical setting. Should
you need a replacement mask, you must request one from supervisory personnel in your clinical area. All personnel
should make every effort to help preserve the supply of PPE and reduce the need for replacement masks whenever
possible. Masks should not be diverted to persons outside VUMC.
04/01/2020 Department of Infection Prevention – Resource

Infection Prevention Guidance on Procedure/Surgical and Cloth Mask Use and Re-Use
To remove facemask with intent to reuse:
1. Perform hand hygiene
2. Remove mask
• Ear-Loop Mask Style: Remove mask by holding the ear loops. The front is contaminated, so remove
slowly and carefully.
• Tie Back: Remove mask by untying lower ties FIRST. Untie upper ties last. The front is contaminated, so
remove slowly and carefully. Ensure ties do not fall into clean interior side of mask.
3. After removing mask, visually inspect for contamination,
distortion in shape/form. If soiled, torn, or saturated the
mask should be discarded.
DO:
4. If the mask is NOT visibly soiled, torn, or saturated, • Wear masks in all clinical areas
• Follow guidance on reuse, donning and
carefully store in the provided brown paper bag (label
doffing
with your name, and “front” and “back” on the two sides.
• Conserve masks
Insert mask so that the front of the mask faces the side of
• Wear and store masks correctly
the bag labelled “front.”
5. Perform hand hygiene.
DO NOT:
To re-apply used mask: • Wear masks in non-clinical areas
1. Perform hand hygiene • Wear N95 respirators unless performing
2. Grasp mask an approved high-risk procedure
• Pinch mask at the ear loops or grasp upper ties • Use Cloth masks in isolation precaution
3. Place over face rooms
• For ear-loop style mask: Secure ear loops behind the • Wear or store masks incorrectly
ears. Secure mask.
• For tie back style mask: Secure upper ties first, behind head. End by securing lower ties behind head.
4. Perform hand hygiene
A single mask can be worn between different patients with the exception of care of patient on Droplet or COVID-
19 Precautions. For those cases, if you are wearing a surgical mask, you may wear the mask into the room as part
of the recommended PPE. It should be doffed with the other PPE after the visit, and a new mask should be
acquired. If you are wearing a cloth mask, it should be doffed and stored in a brown paper bag and a surgical
mask obtained as part of the expected PPE for the patient visit. Remember, N-95 respirators remain required for
patients on Airborne Precautions for infections such as TB.
Frequently Asked Questions

Why are we recommending a procedure/surgical or cloth mask and not an N95 respirator? Similar to
influenza and other respiratory viruses, COVID-19 appears to be transmitted primarily through large respiratory
droplets. Procedure masks provide protection against respiratory droplet spread. In contrast, N95 respirators
provide a higher level of filtration and are important in clinical situations where infectious droplets could become
aerosolized. This primarily occurs in specific clinical situations such as when a patient is intubated or undergoes
bronchoscopy. N95 respirators are difficult to wear for long periods of time and are impractical for generalized use.

Also, the supply of N95 respirators is smaller and our supply would not support such use. As our current N95
respirator supply must be reserved for approved high-risk procedures, N95 respirators should NOT be worn in general
clinical areas or for non-approved indications.
Does this guidance apply to every member of the workforce working anywhere at VUMC? No. This masking
applies to employees working in areas where clinical care is provided and is not mandatory. Personnel working in
nonclinical areas, should not wear surgical masks in order to conserve stock for patient care, but could wear a
fabric mask. Personnel who work in nonclinical buildings (e.g. research space in MCN) are excluded from this
process. These employees should practice principles of social distancing, respiratory etiquette and frequent hand
hygiene. If these individuals visit areas where clinical care is provided, they may wear a mask as instructed above.
Should visitors be wearing face masks? No. Visitors are limited on campus except for certain circumstances.
Visitors will not be instructed to wear face masks. If a visitor develops symptoms while on the premises, that
person should be provided a face mask and asked to leave.
Should all patients be wearing face masks? No. Patients with symptoms concerning for COVID-19 or other
respiratory illness should be provided a face mask and isolated per our existing policies. Once roomed, it is
recommended that symptomatic patients continue to wear their face mask to mitigate exposure risk. This is an
evolving situation and will be reevaluated as needed.
Can a single procedural mask be worn continuously, including across different cases? Yes, a single mask can be
worn between different patients with the exception of care of patient on Droplet or COVID-19 Precautions. For
those cases, if you are wearing a surgical mask, you may wear the mask into the room as part of the recommended
PPE. It should be doffed with the other PPE after the visit, and a new mask should be acquired. If you are wearing a
cloth mask, it should be doffed and stored in a brown paper bag and a surgical mask obtained as part of the
expected PPE.
I work in a clinical setting. How can I eat/drink when I am supposed to wear a mask? Masking is not mandatory.
For those who choose to wear a mask, perform hand hygiene, remove the mask, eat or drink in an approved
location, and then replace your procedure/surgical mask. Please follow the guidelines on appropriate doffing.
Should I wear the mask at home, and should my family members wear masks? You should store the mask in a
secure location when leaving the hospital and not wear them home. Unless you have otherwise been specifically
instructed, you or your family members should not wear masks at home. Social distancing and taking precautions
like washing your hands, using hand sanitizer, and cleaning surfaces frequently should be appropriate for home.
Can we gather in break rooms and other areas? You should adhere to the same principles of social distancing
when together in break rooms, conference rooms or other spaces. You should allow 6 feet distance from others
and should take the appropriate precautions involving hand hygiene and not touching your faces. To limit the
number of people in a break room, personnel should consider staggering their break times.

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Guidance on Masking in Clinical Areas

Rationale for Masking Guidance

04/01/2020 Department of Infection Prevention – Resource

Frequently Asked Questions

04/01/2020 Department of Infection Prevention – Resource

04/01/2020 Department of Infection Prevention – Resource

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