Health care standard bearer tells hospitals to let staff bring own face masks, use as desired

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Health care workers at Keck Hospital of USC near downtown Los Angeles in front of the hospital before their shifts on March 10, 2020, listening to representatives of the California Nurses Association, which is upset about the lack of preparation for COVID-19 outbreaks.

Health care workers at Keck Hospital of USC near downtown Los Angeles in front of the hospital before their shifts on March 10, 2020, listening to representatives of the California Nurses Association, which is upset about the lack of preparation for COVID-19 outbreaks. (Al Seib/Los Angeles Times/TNS)

The U.S. body that sets standards for and accredits 22,000 health care organizations recommended Tuesday that employers not only allow health care workers to bring face masks from home but also allow them to choose when to wear them.

Leaders of The Joint Commission stated: “We are receiving reports from across the country that some hospitals are prohibiting staff from bringing in their own N95 respirators, surgical masks, and home-made cloth masks. … In circumstances of PPE shortages, it is better to allow staff the opportunity to enhance their protection, even if the degree of that increased protection is uncertain.”

Health care workers told the commission that employers prohibited them from bringing their own personal protective equipment, justifying these edicts by saying that it was against policy, that the safety of the equipment was unknown or that it would cause divisiveness among staff and fear among patients.

Workers also complained that employers were imposing restrictions on where they could wear face masks, the joint commission stated. At Mercy San Juan in Carmichael, Calif., for instance, the hospital’s president Michael Korpiel, sent a memo to staff saying they could only wear face masks in hallways if they were transporting patients whose conditions merited it, according to a copy of the document sent to The Sacramento Bee. Otherwise, Korpiel stated, “you will be instructed to remove the mask” in hallways.

Dignity Health did not respond Tuesday to a query about the memo.

The Joint Commission pointed to research showing that there’s significant risk of transmission from people who have been infected with the coronavirus but are not yet showing any symptoms or showing only mild symptoms.

“Based on this, it is reasonable for health care workers who provide direct patient care to want to take universal precautions by wearing a surgical mask or even an N95 respirator with all patients,” leaders of the Joint Commission said. “Another factor that should be considered is the risk that health care workers may have asymptomatic COVID-19 and could transmit the disease to both patients and other health care workers.”

The commission recommended that health care workers be allowed to decide when it is safe to take off the mask. This also is especially important, the statement noted, in light of a study published March 17 in the New England Journal of Medicine that found that the coronavirus, formally known as SARS-CoV-2 could remain viable and infectious for hours in an aerosol form and for days on some types of surfaces, depending on how much of the virus was shed.

The commission said it recognized that protective equipment such as masks are in short supply and hospitals must conserve equipment for staff performing high-risk jobs. In situations such as this, the commission stated, privately held equipment can augment the hospital stock and provide additional protection for staff.

The commission classified homemade masks as an “extreme measure” that should be used only if personal protective equipment of proven value have been exhausted. The bottom line, the commission stated, is that workers will be better able to care for patients if they feel safe.

The American Medical Association supported The Joint Commission in a statement Tuesday advising hospitals and other health care employers to allow workers to use their own respirators and face masks at a time when critical resources are scarce.

“The people working ’round the clock to combat this virus should not be penalized or punished for taking precautions necessary to protect themselves, their patients, and their families from the spread of COVID-19,” AMA leaders said in a joint statement. “We are pleased that The Joint Commission updated its guidance today, and provided an evidence-based analysis, to clarify that its policy does not prohibit health care workers from bringing their own PPE from home.”

The virus that causes COVID-19 results in fever, coughing and shortness of breath, and it can lead to respiratory and organ failure in acute cases.

Several U.S. health care workers have died as a result of complications from the respiratory disease. In Spain, The Joint Commission noted, roughly 14% of people with confirmed cases of COVID-19, were health care workers.

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