Hospitals re-evaluate policies as state mask mandates end

After three years of strict federal and state policies, health systems are regaining the ability to make their own decisions on the use of masks and other personal protective equipment.

As a result of declining COVID-19 infection and mortality rates nationwide, most states have ended executive orders and emergency mandates requiring universal masking for patients, visitors and workers in healthcare settings. 

The lack of requirements has not greatly affected hospitals’ infection prevention practices, as individual facilities continue to follow guidance from the Centers for Disease Control and Prevention on when to mask, said Nancy Foster, vice president for quality and patient safety policy with the American Hospital Association. The CDC recommends health systems base the extent of their masking policies on community transmission data. 

Ahead of the declared end of the public health emergency on May 11, worries pdrsist that varying requirements will send mixed messages about the need for PPE and the severity of COVID-19.

With the exception of a bill passed in California in 2021, no state or federal laws require health systems to maintain a specific supply of protective equipment such as gloves, face shields and surgical gowns. That means hospitals are in charge of ensuring a sufficient amount exists, often at the insistence of healthcare workers and union members.

In December 2022, the California Nurses Association and National Nurses United ratified a contract with Kaiser Permanente requiring the health system to keep a three-month stockpile of PPE and screening for infectious disease.

While some in the industry enjoy the freedom health systems have to make their own rules, others are adamant about states maintaining high-level safety protocols. 

“Abandoning those standards will be very counterproductive, and it’s a bad approach to curb the spread and the evolution of COVID-19,” said Zenei Triunfo-Cortez, a registered nurse and president of the California Nurses Association and National Nurses United. “It only hurts the health and safety of nurses, other healthcare workers and the general public.”

Due to the posed risks, health systems should keep requiring precautionary measures like vaccinations and masking despite external guidelines, Triunfo-Cortez said. 

In California, Oregon and Washington, mask mandates enacted by the states’ public health departments are set to end April 3, meaning more hospitals will have to re-evaluate their policies surrounding the use of PPE. 

The last states where masking in healthcare facilities remains mandatory are Indiana, Colorado, Connecticut, Indiana and Rhode Island. 

Getting rid of requirements “allows local health departments and facilities to assess their current situation and develop their own plans, requirements and time for implementation regarding masking based on their patient populations and local COVID-19 exposure risk,” the California Department of Public Health said in an emailed statement.

In Seattle, Harborview Medical Center will continue to require masking in all public and patient care spaces after the state’s mandate ends, due to high community transmission rates and less testing by providers, said Dr. John Lynch, the center’s associate medical director. 

The hospital plans to take three months to reassess its masking policies and find new sources of data to inform its decisions amid fluctuating levels of COVID-19 transmission, Lynch said. 

“We have to figure out as health systems what is the best thing for patients and our healthcare workforce to keep them as safe as possible,” he said. “My concern with the end of the secretary of health order and the end of the public health emergency is that it’s going to be really challenging for healthcare workers, patients and visitors when they see a patchwork approach to PPE used in clinical spaces.” 

It is important that clinical staff are able to communicate with system management and have a voice in decision-making processes surrounding masking policies, said Scott Palmer, chief of staff with the Oregon Nurses Association.

Despite the statewide masking order ending in California, certain counties — including Los Angeles and San Francisco — will maintain more restrictive rules for healthcare workers and continue to require masking in patient care areas.

At the University of California, San Francisco Medical Center, staff will follow the county’s guidance and gradually reduce the requirements of who needs to wear a mask, said Dr. Peter Chin-Hong, professor of medicine and the center’s infectious disease specialist. The local public health department is also organizing a series of conversations with stakeholders to discuss the use of PPE, he said. 

“Values are different in different parts of the country and different parts of states,” Chin-Hong said. “Like with everything else, some places are going to be more conservative than others.”

Because Rush University Medical Center has been strict about universal masking to protect its workers and patients, the hospital will likely move away from requiring masks for staff and patients in patient-facing areas, said Dr. Brian Stein, chief quality officer of the Chicago-based center. The facility intends to continue masking in clinical areas with more vulnerable patients, like its bone marrow transplant unit.

Illinois Governor J.B. Pritzker (D) lifted the state’s face-covering order for healthcare settings in October. 

“With COVID-19 becoming less severe for the average person, we’re trying to restore some degree of normalcy to our clinical areas,” Stein said. “But we still have to understand that if we see a resurgence in COVID-19 or a different viral infection, we may put some of those universal masking mandates back in place.” 

Asante, a health system based in Medford, Oregon, will support staff who wish to continue wearing a mask, and is working on a pathway for patients to request clinicians they interact with wear a mask, said Holly Nickerson, the system’s vice president of quality and patient safety.

It will be good for the system to have control again and be able to support workers during the transition to lower levels of caution, Nickerson said.

“It’s a really exciting time that the science matches us to do something that is going to be good for the mental health of our caregivers, and allow them to see each other’s smiles again and be able to interact and connect with patients without a mask on their face,” she said. 


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