Our academic medical center has offered a cooperative education position in infection prevention and control (IPC) to undergraduate students since 2005. We describe the position and surveyed prior participants (n = 16)—all reported a valuable experience, and 6 of 16 (38%) reported subsequent employment in full-time IPC positions during their careers.

The Society for Healthcare Epidemiology of America, the Association of Professionals in Infection Control and Epidemiology, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society represent the core expertise regarding healthcare infection prevention and infectious diseases and have written multisociety statement for healthcare facility leaders, regulatory agencies, payors, and patients to strengthen requirements and expectations around facility infection prevention and control (IPC) programs. Based on a systematic literature search and formal consensus process, the authors advocate raising the expectations for facility IPC programs, moving to effective programs that are:• Foundational and influential parts of the facility's operational structure• Resourced with the correct expertise and leadership• Prioritized to address all potential infectious harmsThis document discusses the IPC program's leadership-a dyad model that includes both physician and infection preventionist leaders-its reporting structure, expertise, and competencies of its members, and the roles and accountability of partnering groups within the healthcare facility. The document outlines a process for identifying minimum IPC program medical director support. It applies to all types of healthcare settings except post-acute long-term care and focuses on resources for the IPC program. Long-term acute care hospital (LTACH) staffing and antimicrobial stewardship programs will be discussed in subsequent documents.

Objective:The importance of infection prevention and control and healthcare epidemiology (IPC/HE) in healthcare facilities was highlighted during the COVID-19 pandemic. Infectious disease (ID) clinicians often hold leadership positions in IPC/HE teams; however, there is no standard for training or certification of ID physicians specializing in IPC/HE. We evaluated the current state of IPC/HE training in ID fellowship programs.Design:A national survey of ID fellowship program directors was conducted to assess current IPC/HE training components in programs and plans for expanded offerings.Setting and participants:All ID fellowship program directors in the United States and Puerto Rico.Methods:Surveys were distributed using Research Electronic Data Capture (REDCap) to program directors in March 2023, with 2 reminder emails; the survey closed after 4 weeks.Results:Of 166 program directors, 54 (32.5%) responded to the survey. Among respondent programs, 49 (90.7%) of 54 programs reported didactic training in IPC/HE averaging 4.4 hours over the course of the fellowship. Also, 18 (33.3%) of 54 reported a dedicated IPC/HE training track. Furthermore, 23 programs (42.6%) reported barriers to expanding training. There was support (n = 47, 87.0%) for formal IPC/HE certification from a professional society within the standard fellowship.Conclusions:Despite the COVID-19 pandemic highlighting the need for ID medical doctors with IPC/HE expertise, formal training in ID fellowship remains limited. Most program directors support formalization of IPC/HE training by a professional organization. Creation of standardized advanced curriculums for ID fellowship training in IPC/HE could be considered by the Society of Healthcare Epidemiology of America (SHEA) to grow, retain, and enhance the IPC/HE physician workforce.

In this study, we examined the impact of the number and type of arterial grafts, and surgical dressing type, on deep and organ/space surgical site infection following coronary artery bypass graft procedures. Bilateral internal mammary artery grafts and negative pressure wound therapy were associated with higher odds of infection.

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The coronavirus disease 2019 (COVID-19) pandemic highlighted the lack of agreement regarding the definition of aerosol-generating procedures and potential risk to healthcare personnel. We convened a group of Massachusetts healthcare epidemiologists to develop consensus through expert opinion in an area where broader guidance was lacking at the time.

Executive summary Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, “asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope.

Abstract Background Advances in coronary artery bypass graft (CABG) surgery have improved graft patency and survival. Our prior work suggested a reduction in deep and organ/space surgical site infection (SSI) with single versus bilateral internal mammary arteries and a skeletonized approach. Even for the same number of arterial grafts used, specific artery type may impact SSI incidence. We aim to assess the effect of potentially modifiable risk factors on post-CABG deep and organ/space SSI, including number and type of vessel grafts, and closure method. Methods This was a single-center retrospective cohort study of post-CABG surgery patients from 01/01/19-12/31/22. SSIs were identified during routine surveillance using National Healthcare Safety Network criteria. Data on demographics, comorbidities, surgical technique and surgeon were obtained from hospital and cardiac surgery databases. A sub-analysis evaluated the risk of SSI in patients with two arterial grafts by type of artery used, specifically bilateral internal mammary (BIMA) graft versus single internal mammary artery plus radial graft (SIMA-R). We performed univariate analyses to determine association of risk factors with SSI. Results Of the 2050 included patients, 23 developed an SSI . In univariate analyses, diabetes mellitus (OR 5.6, p < 0.001) and negative pressure wound therapy (NPWT) versus surgical adhesive (OR 19.82, p< 0.001) were associated with SSI. There was no significant association between SSI and the total number of arteries or combination of vessel grafts used. In the sub-analysis, 281 patients underwent SIMA-R and 154 underwent BIMA. None of the SIMA-R, versus 4 of the BIMA developed SSI (p=0.02). There were other differences between the groups, including a greater proportion with a skeletonized (versus pedicled) arterial harvest (OR 2.19, p=0.003) and longer case duration (238 vs 217 minutes, p=0.003) in the BIMA group, which could confound this relationship. Conclusion In the overall cohort, NPWT was associated with SSI on univariate analysis, though notably this closure method is often used in patients with higher pre-operative risk. Amongst those patients who received two arterial grafts, there was a reduced SSI risk with SIMA-R approach. Future studies should explore the impacts of graft choice and wound care. Disclosures All Authors: No reported disclosures

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Abstract Background Infectious disease (ID) clinicians are often identified to lead infection prevention and control (IPC)/healthcare epidemiology (HE) programs, however, there is no standardized training in fellowship for this role. The most recent survey of ID fellows in 2001 found that only 51% of graduates reported adequate training in IPC/HE. Despite this, half of respondents had IPC/HE responsibilities and received compensation from those activities. We conducted a survey of Program Directors (PD) of United States ID fellowship programs to assess current IPC/HE training. Methods An electronic survey was distributed in March and April 2023 to all ID fellowship PD identified by the Infectious Disease Society of America using Research Electronic Data Capture (REDCap). Survey questions covered training program characteristics, current required and optional IPC/HE training components, barriers to IPC/HE training, interest among fellows in IPC/HE training, and support for formalization of IPC/HE training. Results Of 166 programs, 54 (32.5%) completed the survey, representing programs in 25 states (Figure 1) and size range from 1-10 fellowship positions (mean 4). The majority (49/54, 90.7%) offered didactics in IPC/HE (mean 4.4 hours, range 1-10), of which 45/49 (94%) and 4/49 (6%) were required and elective, respectively. 52/54 (96.3%) of programs reported a formalized curriculum in IPC/HE training for all fellows and 18/54 (33.3%) of the responding programs offered a specialized track in IPC/HE. Reported training components varied (Table 1). A minority of PDs 11/55 (20%) reported considering expanding their IPC/HE training, however, 23/54 (42.6%) reported barriers (Table 2). There was widespread PD support for a formal IPC/HE certification program through a professional society (52/54, 96.3%).Figure 1:Geographic distribution of survey respondents divided by FEMA regions (1-10) of the United States and Territories (N= 54). Conclusion ID fellowship programs with dedicated IPC/HE training remain limited and the majority of training in IPC/HE is restricted to a small number of hours of didactics. Among respondents, many barriers to increasing IPC/HE training were identified. Respondents supported creation of a formal IPC/HE training program through a professional society. Disclosures Molly L. Paras, MD, Angiodynamics: Honoraria|Angiodynamics: Honoraria

Ideas and Opinions18 April 2023Universal Masking in Health Care Settings: A Pandemic Strategy Whose Time Has Come and Gone, For NowFREEErica S. Shenoy, MD, PhD, Hilary M. Babcock, MD, MPH, Karen B. Brust, MD, Michael S. Calderwood, MD, MPH, Shira Doron, MD, Anurag N. Malani, MD, Sharon B. Wright, MD, MPH, and Westyn Branch-Elliman, MD, MMScErica S. Shenoy, MD, PhDHarvard Medical School, Infection Control Unit and Division of Infectious Diseases, Massachusetts General Hospital, and Infection Control, Mass General Brigham, Boston, Massachusetts (E.S.S.), Hilary M. Babcock, MD, MPHInfectious Disease Division, Washington University School of Medicine, and BJC HealthCare, St. Louis, Missouri (H.M.B.), Karen B. Brust, MDDivision of Infectious Diseases, Department of Internal Medicine, University of Iowa College of Medicine, and University of Iowa Hospitals, Iowa City, Iowa (K.B.B.), Michael S. Calderwood, MD, MPHSection of Infectious Diseases and International Health, Dartmouth Hitchcock Medical Center, and Value Institute, Dartmouth Health, Lebanon, New Hampshire (M.S.C.), Shira Doron, MDDivision of Geographic Medicine and Infectious Diseases, Tufts University School of Medicine, and Tufts Medicine, Boston, Massachusetts (S.D.), Anurag N. Malani, MDSection of Infectious Diseases, Department of Internal Medicine, Trinity Health Michigan, Ann Arbor, Michigan (A.N.M.), Sharon B. Wright, MD, MPHHarvard Medical School, and Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Beth Israel Lahey Health, Cambridge, Massachusetts (S.B.W.), and Westyn Branch-Elliman, MD, MMScHarvard Medical School, VA Boston Healthcare System, Department of Medicine, Section of Infectious Diseases, and VA Boston Center for Healthcare Organization and Implementation Research, Boston, Massachusetts (W.B.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-0793 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The use of facemasks for source control and as protection against exposure to infectious agents was well accepted in health care settings before the COVID-19 pandemic as part of both Standard Precautions and Transmission-Based Precautions. During the pandemic, expanded use of facemasks as part of "universal masking" for health care personnel (HCP), patients, and visitors in health care settings was implemented (as in most public settings) to reduce the risk for morbidity and mortality associated with the spread of a novel virulent pathogen. In the context of no population immunity, limited testing capacity, and no medical countermeasures (for example, vaccines, therapeutics), universal masking was a critical protective measure.Health care settings remain one of the last environments where widespread masking requirements continue despite the evolution of the pandemic and transition to endemicity. Some health care facilities have maintained these requirements even after state and local health authorities have lifted them. Masking requirements in health care have continued longer than in the community because these settings have a higher proportion of individuals at high risk for complications of infection. However, the context and conditions of the pandemic have changed dramatically and favorably since masking requirements in health care were initially adopted (Figure), and evidence-based public health policy should also adapt in response (1).Figure. Key milestones and contextual factors during the pandemic to endemic phases.Transitions during the pandemic to endemic stages and linkage of key milestones and contextual factors to masking recommendations in health care and community settings are illustrated. Download figure Download PowerPoint In this commentary, we review the utility of universal masking in health care settings during the COVID-19 pandemic, the potential downsides of maintaining such policies, and why universal masking should not, as some have argued, be incorporated as a required component of Standard Precautions for all direct patient care encounters, regardless of symptoms or diagnosis (2). We also address future circumstances that could prompt reconsideration for masking requirements, beyond what are included in Standard Precautions and Transmission-Based Precautions. We advocate for considering masking requirements as a tool in our arsenal that can be deployed as part of a dynamic approach to infection prevention policy that adapts to changing circumstances.Universal Masking in Response to the Pandemic: The Why?Throughout the pandemic, widespread use of universal masking in health care settings was justifiable for reducing the risk for transmission among HCP, patients, and visitors and preserving the health care workforce to maintain operations during surges. Universal masking was one element of a larger bundle of strategies to limit transmission, which included restricting access to facilities, use of remote work, symptom screening, asymptomatic testing, and expansion of telemedicine. The implementation of masking along with these interventions, as part of a framework often called the hierarchy of controls (3), were supported by public health guidelines and health care epidemiology experts (4). Although many of these interventions interfered with care delivery, they were appropriate and widely accepted during the early pandemic response given our limited knowledge about the pathogen and lack of preventive and therapeutic options.Universal Masking During Later Phases: The Why Not?The burden of SARS-CoV-2 has been mitigated over time through access to testing, substantial population-level immunity providing durable protection against severe disease, a series of less virulent variants, and widespread availability of medical countermeasures, which in combination have resulted in decreasing infection mortality rates. Both the World Health Organization and the U.S. federal government have announced an imminent end to the public health emergency. SARS-CoV-2 has transitioned to a more stable phase, during which the choice and intensity of mitigation efforts must be commensurate with the risk and align with management strategies for other endemic pathogens. Recognizing these changes, many pandemic interventions have been deimplemented. Masking requirements and other restrictions remain notable exceptions in health care settings.Maintaining masking requirements for HCP during all direct clinical encounters may marginally reduce the risk for transmission from HCP to patient or from patient to HCP. Those potential incremental benefits, however, need to be weighed against increasingly recognized costs. Masking impedes communication, a barrier that is distributed unequally across patient populations, such as those for whom English is not their preferred language and those who are hard-of-hearing and rely on lip reading and other nonverbal cues. The increase in listening effort required when masks are used in clinical encounters is associated with increased cognitive load for patients and clinicians (5). Masks obscure facial expression; contribute to feelings of isolation; and negatively impact human connection, trust, and perception of empathy (6, 7).Masking in Health Care: The What Now?The time has come to manage SARS-CoV-2 as we generally manage other endemic respiratory viruses in health care settings, which is through correct and consistent application of Standard Precautions and Transmission-Based Precautions (pathogen-specific). Under Standard Precautions, HCP use a mask (and eye protection) to protect themselves from exposure when they are engaging in activities that could generate splashes or sprays to the face, regardless of patient symptoms. Respiratory hygiene, a component of Standard Precautions, means individuals with respiratory symptoms should use a mask for source control in health care settings. Finally, when caring for patients with suspected or confirmed respiratory infection, HCP should implement Transmission-Based Precautions, which include specific personal protective equipment and other interventions. These practices in combination effectively limit and minimize the risk for transmission of pathogens in health care settings.Moving away from universal masking policies should be accompanied by reconsideration of other pandemic-era strategies (for example, asymptomatic testing, resource-intensive contact tracing), which similarly have experienced a shift in their risk–benefit balance over the course of the pandemic.Masking in the Future: The What Next?Masking policies remain an important infection prevention strategy. Educating HCP, our patients, and others in health care settings on the rationale for ongoing policy reconsideration and changes will be essential. Future pandemics or significant localized outbreaks may justify more widespread or targeted masking policies, respectively, as part of a bundled response. High-quality epidemiologic data with frequent updates and regular reevaluation are needed to inform scale-up or scale-down decisions. The health care community needs focused research to quantify the incremental value of interventions under various epidemiologic circumstances and to support the development of a learning health care system. This is essential to allow active and ongoing local reassessment of utility to ensure requirements are not maintained longer than necessary and are reinstated when needed (8). Consistent with the principles of continued assessment of infection prevention interventions, the Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee is currently reevaluating existing approaches to Transmission-Based Precautions, which is likely to inform future considerations for health care transmission mitigation strategies (9, 10). Additional investigation to understand the transmission risks from infected individuals across a range of respiratory viruses and intensity of exposures during asymptomatic, presymptomatic, and symptomatic stages will also inform future policy.ConclusionInteractions between humans and pathogens are inherently dynamic and are constantly evolving, and we have achieved major advancements in the prevention and management of SARS-CoV-2 since the pathogen was initially identified in 2019. In recognition of these achievements, the time has come to deimplement policies that are not appropriate for an endemic pathogen when the expected benefits of such policies are low. Universal masking in health care is a policy whose time has come and gone ... for now.References.1. Oh A, Abazeed A, Chambers DA. Policy implementation science to advance population health: the potential for learning health policy systems. Front Public Health. 2021;9:681602. [PMID: 34222180] doi:10.3389/fpubh.2021.681602 CrossrefMedlineGoogle Scholar2. Kalu IC, Henderson DK, Weber DJ, et al. Back to the future: Redefining "universal precautions" to include masking for all patient encounters. Infect Control Hosp Epidemiol. 2023:1-2. [PMID: 36762631] doi:10.1017/ice.2023.2 CrossrefMedlineGoogle Scholar3. National Institute for Occupational Safety and Health (NIOSH). Hierarchy of controls. Updated 17 January 2023. Accessed at www.cdc.gov/niosh/topics/hierarchy/default.html on 20 March 2023. Google Scholar4. Calderwood MS, Deloney VM, Anderson DJ, et al. Policies and practices of SHEA Research Network hospitals during the COVID-19 pandemic. Infect Control Hosp Epidemiol. 2020;41:1127-1135. [PMID: 32571447] doi:10.1017/ice.2020.303 CrossrefMedlineGoogle Scholar5. Lee E, Cormier K, Sharma A. Face mask use in healthcare settings: effects on communication, cognition, listening effort and strategies for amelioration. Cogn Res Princ Implic. 2022;7:2. [PMID: 35006342] doi:10.1186/s41235-021-00353-7 CrossrefMedlineGoogle Scholar6. Wong CK, Yip BH, Mercer S, et al. Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care. BMC Fam Pract. 2013;14:200. [PMID: 24364989] doi:10.1186/1471-2296-14-200 CrossrefMedlineGoogle Scholar7. Song YK, Mantri S, Lawson JM, et al. Morally injurious experiences and emotions of health care professionals during the COVID-19 pandemic before vaccine availability. JAMA Netw Open. 2021;4:e2136150. [PMID: 34817579] doi:10.1001/jamanetworkopen.2021.36150 CrossrefMedlineGoogle Scholar8. Chambers DA, Feero WG, Khoury MJ. Convergence of implementation science, precision medicine, and the learning health care system: a new model for biomedical research. JAMA. 2016;315:1941-2. [PMID: 27163980] doi:10.1001/jama.2016.3867 CrossrefMedlineGoogle Scholar9. Healthcare Infection Control Practices Advisory Committee. Healthcare Infection Control Practices Advisory Committee Meeting Minutes August 23, 2022. Accessed at www.cdc.gov/hicpac/pdf/2022-August-HICPAC-Summary-508.pdf on 20 March 2023. Google Scholar10. Healthcare Infection Control Practices Advisory Committee. Healthcare Infection Control Practices Advisory Committee Meeting Minutes November 3, 2022. Accessed at www.cdc.gov/hicpac/pdf/2022-November-HICPAC-Summary-508.pdf on 20 March 2023. Google Scholar Comments0 CommentsSign In to Submit A Comment Andrew WangPrivate Capacity18 April 2023 Equitable Opinions on a Sensitive and Important Topic This opinion piece was published with awareness of a very sensitive topic that requires a fair and equitable opportunity to others to provide an opposing view. Please invite or allow others to publish a view to ensure a proper discussion. I look forward to your action towards equity. Steven E Reznick MDPrivate Practice21 April 2023 universal masking in health care setting Much of the physician workforce is older than 65 years putting them in the "high risk" category for development of severe disease requiring hospitalization. Is the author advocating that these individuals not mask indoors in health care settings? I am all for restudying the issue and determining what value, if any, a properly fitted surgical mask or respirator mask has in protection against the spread of SARS-CoV-2 and other respirator pathogens, but in the interim there should be different suggestions for individuals with different risks such as seniors and the immunosuppressed. Dafer Al-HaddadinPortsmouth Regional Hospital, NH23 April 2023 Universal Masking in Hospitals As a practicing infectious disease physician figuring out how to "do no harm," I struggle with different published opinions over mask use coming from my colleagues. I was hoping for a collaborative position road map document applying "what we know" and outlining an approach to a "safe landing," that is universal with measurable outcomes. This is my personal view. Tyler S. Brown, Amir M. Mohareb, and Regina C. LaRocqueDivision of Infectious Diseases, Massachusetts General Hospital (TSB, AMM, RCL) and Department of Medicine, Harvard Medical School (TSB, AMM, RCL), both in Boston, USA.22 April 2023 Include diverse communities in decision-making that impacts them We read with interest the contribution from Shenoy et al. to the ongoing public conversation around infection control strategies, patient safety, and our collective path forward through an ever-evolving pandemic [1]. Certainly, alternative viewpoints on this issue exist, including those of physicians, scientists, patients, and advocates who have argued for continued universal masking in health care settings. A key concern, heard in this chorus of alternative voices, involves questions of health equity: Who among us will shoulder the foreseeable negative consequences of eliminating universal masking for patients and health care workers? All available evidence tells us that this burden will fall most squarely on socially disadvantaged communities and their most medically vulnerable members. These communities have experienced glaring, persistent disparities throughout the pandemic: markedly higher epidemic intensity in the early days of the US epidemic, lower vaccination coverage, less access to COVID-19 testing, less workplace protections, and ongoing challenges accessing antiviral therapies [2-5]. The priorities of these communities – including racial and ethnic minorities, lower income households, and people living with disabilities – were marginalized in public health discourse long before COVID-19. We strongly disagree with the viewpoint presented by Shenoy et al. precisely because it will further concentrate the risk and burden of COVID-19 disease among the most disadvantaged in society, which has the potential to further damage public trust in the healthcare system[5]. Conversely, a continued approach of universal masking in healthcare settings will maintain safety and trust among patients and healthcare workers alike. Most importantly, ensuring that these voices are heard and truly involved in highly consequential health policy decisions should be an essential priority in our collective journey forward. Stakeholders in medical and public health publishing can contribute to this critical mission by actively diversifying their contributors and amplifying a more diverse collection of voices. Likewise, hospitals and health systems should involve both their infection control professionals and members of the communities they serve in high stakes conversations like the one happening right now about mask requirements. References: 1. Shenoy ES, Babcock HM, Brust KB, et al. Universal masking in health care settings: a pandemic strategy whose time has come and gone, for now. Annals of internal medicine, 10.7326/M23-0793. Advance online publication. 2. Bor J, Assoumou SA, Lane K, et al. Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes after the emergence of Omicron: A population-based cross-sectional study. PLoS Med. 2023;20(1):e1004167. doi:10.1371/journal.pmed.1004167 3. Dryden-Peterson S, Kim A, Kim AY, et al. Nirmatrelvir Plus Ritonavir for Early COVID-19 in a Large U.S. Health System : A Population-Based Cohort Study. Ann Intern Med. 2023;176(1):77-84. doi:10.7326/M22-2141 4. Mackey K, Ayers CK, Kondo KK, et al. Racial and Ethnic Disparities in COVID-19-Related Infections, Hospitalizations, and Deaths : A Systematic Review. Ann Intern Med. 2021;174(3):362-373. doi:10.7326/M20-6306 5. Ojikutu BO, Bogart LM, Dong L. Mistrust, Empowerment, and Structural Change: Lessons We Should Be Learning From COVID-19. Am J Public Health. 2022;112(3):401-404. doi:10.2105/AJPH.2021.306604 Peter HillPrivate Capacity25 April 2023 Saving face This opinion piece -- published at a time when many health care institutions are following suit in their policies -- appears more rooted in a need to maintain control over pandemic narratives than in any honest reckoning with epidemiological data or hard-won insights from real-world practice. In other words, we cannot allow the Cochrane Review to be the final word on the matter, so universal masking must be set aside and placed on the shelf -- "for now." Based on in the included Figure, one wonders if "School Masking" was singled out for extra-long deployment for any reason whatsoever -- apart from a desire to make the practices for HCPs appear as part of something more systematic and less arbitrary. No explanation (much less justification) is even attempted. When it comes to shaping future responses, I sincerely hope we are able to learn some lessons from this whole experience (empirical and otherwise), rather than allow a litany of pandemic-era cognitive biases to become cemented (and then repeated) if only for our HCP to save face before the public. Mel W.Harvard University28 April 2023 Removing masks ignores impact of long Covid, will limit access to care, and increase ableism in healthcare Removing univeral masking in healthcare reinforces ableism and will discourage those who most need to safely access healthcare from doing so. The suggestion to remove masks is premature given that Long-Covid is continuing to cause lasting disability for a not insignificant portion of the population. At a minimum, waiting areas, Emergency departments, and emergency personel (including fire, police, and EMT), as well as post procedural recovery rooms-- times when people do not have a choice whether to be there and may not be able to mask, should maintain universal mask requirements. Of all places, people should be able to safely and comfortably access medical settings without fear of increased risk of catching covid in a waiting room. It seems like such a minimal ask to require people to wear masks the short times they're in patient settings. The reasons given to remove masks are in fact the reasons they should remain. For the disabled and at risk communities, removing masks would "contribute to feelings of isolation; and negatively impact human connection, trust, and perception of empathy." The greatest show of care and humanity medical professionals and hospital admiistration can make is to maintain masking in medical settings to make them accessible to all as safely as possible. If those in this article are are the only reasons to remove masking, the case is not particularly compelling and those issues could easily be resolved by maintaining universal masking in patient areas of healthcare settings, but adding an option to remove masks in exam rooms with mutual consent of all parties. The cost of people deferring healthcare to avoid potential exposure will be much greater to the healthcare system than the small costs of asking people to continue to mask in patient areas (with an added option to remove with consent in private exam rooms). Lara Z. Jirmanus, Eiryn Griest Schwartzmann, JD Davids, Margaret Morganroth Gullette, Colin KillickCambridge Health Alliance, Harvard Medical School, COVID Safe Campus, Strategies for High Impact and Long COVID Justice, Brandeis University, Dignity Alliance, Disability Policy Consortium1 May 2023 Health Facilities Must Ensure the Safety of All, Especially the Most Vulnerable A fundamental responsibility of health facilities is to ensure the safety of all patients and employees. Shenoy et al. argue that because COVID-19 has "transitioned to a more stable phase," masking requirements in healthcare have only "incremental benefits." The 26% of U.S. adults who are disabled (1), and the 17% over 65 (2) who suffer nearly 90% of COVID mortality, would likely disagree. Furthermore, everyone is potentially at risk for Long COVID, which affects 15.5% of U.S. residents (4). Since 2020, COVID-19 has stably remained the 3rd leading cause of death in the United States (3). While vaccines and treatments decrease mortality, a substantial proportion of patients still risk severe illness or death from COVID-19. The benefits of universal masking to prevent nosocomial COVID-19 far outweigh the costs. Because COVID-19 is airborne and the majority of transmission is asymptomatic or presymptomatic,5 standard respiratory precautions are insufficient to prevent transmission, particularly among patients in shared waiting areas. As disability advocates, we found the authors' assertion that unmasking would offer net benefit to deaf and hard-of-hearing (DHH) and limited-English-proficiency (LEP) patients to be disingenuous and ableist. DHH and LEP patients are at higher risk of serious illness from COVID-19 and have the right to safe and accessible healthcare. Nobody should have to expose themselves to COVID-19 to receive healthcare. Universal masking is more effective than one-way masking, infants and young children cannot wear masks, and patients cannot remain masked during surgery. When institutions downplay the risk of disease while removing protections against it, patients are denied true informed consent, violating their autonomy. Unless patients can trust that their health facility is safe, it is impossible to serve them effectively. The most vulnerable patients often require the most frequent medical care, which places them disproportionately at risk of nosocomial COVID-19 exposure. Even when COVID-19 prevalence is low, which is increasingly difficult to estimate due to decreased PCR testing, people visiting healthcare settings are among the most likely to be infected. Thus, community transmission data cannot guarantee that a vulnerable patient will not encounter a COVID-positive patient, and suffer a life-threatening or disabling outcome. Our organizations include many patients who will forgo necessary health care because of reasonable concern regarding serious health repercussions should they be exposed to COVID-19. Health systems should apply the precautionary principle, center the needs of the most vulnerable, and aim first to do no harm. References: Centers for Disease Control and Prevention. Disability and Health Data System (DHDS) [Internet]. updated 2022 May; Accessed April 27, 2023. Available from: http://dhds.cdc.gov Administration for Community Living. 2021 Profile of Older Americans. U.S. Department of Health and Human Services.; 2022. https://acl.gov/sites/default/files/Profile%20of%20OA/2021%20Profile%20of%20OA/2021ProfileOlderAmericans_508.pdf Ortaliza J, Krutika Amin, Cynthia Cox. COVID-19 leading cause of death ranking. Peterson-KFF Health System Tracker. Published November 10, 2022. Accessed November 25, 2022. https://www.healthsystemtracker.org/brief/covid-19-leading-cause-of-death-ranking/ Centers for Disease Control and Prevention. Long COVID - Household Pulse Survey. Published February 21, 2023. Accessed March 6, 2023. https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm Johansson MA, Quandelacy TM, Kada S, et al. SARS-CoV-2 Transmission From People Without COVID-19 Symptoms. JAMA Netw Open. 2021;4(1):e2035057. doi:10.1001/jamanetworkopen.2020.35057 Binh Ngo M.D., Marc Rendell MDKeck USC School of Medicine; The Rose Salter Medical Research Foundation29 April 2023 The Time For Meaningful Discourse and Contrasting Viewpoints on Masking Recommendations Dr. Wang's comment summarizes the current concern with the presentation by Shenoy et al. Decisions on any intervention require thoroughly weighing benefits against harms. Policies cannot rely on opinions alone. In the health care setting, wherein individuals are often exposed to pathogens, not by choice but by the need to seek medical care, there are clearly benefits to barriers to respiratory transmission. The comments by Drs Reznick, Al-Haddadin, and Brown et al point out several weaknesses in the position advocated by Shenoy et al. Conversely, the issue of patient doctor communication deserves a more comprehensive discussion. Author, Article, and Disclosure InformationAuthors: Erica S. Shenoy, MD, PhD; Hilary M. Babcock, MD, MPH; Karen B. Brust, MD; Michael S. Calderwood, MD, MPH; Shira Doron, MD; Anurag N. Malani, MD; Sharon B. Wright, MD, MPH; Westyn Branch-Elliman, MD, MMScAffiliations: Harvard Medical School, Infection Control Unit and Division of Infectious Diseases, Massachusetts General Hospital, and Infection Control, Mass General Brigham, Boston, Massachusetts (E.S.S.)Infectious Disease Division, Washington University School of Medicine, and BJC HealthCare, St. Louis, Missouri (H.M.B.)Division of Infectious Diseases, Department of Internal Medicine, University of Iowa College of Medicine, and University of Iowa Hospitals, Iowa City, Iowa (K.B.B.)Section of Infectious Diseases and International Health, Dartmouth Hitchcock Medical Center, and Value Institute, Dartmouth Health, Lebanon, New Hampshire (M.S.C.)Division of Geographic Medicine and Infectious Diseases, Tufts University School of Medicine, and Tufts Medicine, Boston, Massachusetts (S.D.)Section of Infectious Diseases, Department of Internal Medicine, Trinity Health Michigan, Ann Arbor, Michigan (A.N.M.)Harvard Medical School, and Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Beth Israel Lahey Health, Cambridge, Massachusetts (S.B.W.)Harvard Medical School, VA Boston Healthcare System, Department of Medicine, Section of Infectious Diseases, and VA Boston Center for Healthcare Organization and Implementation Research, Boston, Massachusetts (W.B.)Disclaimer: The views expressed are those of the authors and do not necessarily represent those of the U.S. Department of Veterans Affairs or the U.S. federal government.Acknowledgment: The authors acknowledge Paul D. Biddinger, MD, and David A. Chambers, DPhil, for thoughtful review of the manuscript.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-0793.Corresponding Author: Erica S. Shenoy, MD, PhD, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA, 02114; e-mail, [email protected]harvard.edu.Author Contributions: Conception and design: W. Branch-Elliman, M.S. Calderwood, S. Doron, E.S. Shenoy, S.B. Wright.Drafting of the article: H.M. Babcock, W. Branch-Elliman, M.S. Calderwood, S. Doron, A. Malani, E.S. Shenoy, S.B. Wright.Critical revision for important intellectual content: H.M. Babcock, W. Branch-Elliman, K. Brust, M.S. Calderwood, S. Doron, A. Malani, E.S. Shenoy, S.B. Wright.Final approval of the article: H.M. Babcock, W. Branch-Elliman, K. Brust, M.S. Calderwood, S. Doron, A. Malani, E.S. Shenoy, S.B. Wright.Administrative, technical, or logistic support: E.S. Shenoy.This article was published at Annals.org on 18 April 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoFor Patient Safety, It Is Not Time to Take Off Masks in Health Care Settings Tara N. Palmore , and David K. Henderson Metrics Cited byFor Patient Safety, It Is Not Time to Take Off Masks in Health Care SettingsTara N. Palmore, MD, and David K. Henderson, MD LatestKeywordsCOVID-19Health careHealth care policyHospital medicineInfection controlInfectious disease epidemiologyInfectious diseasesPathogensPrevention, policy, and public health ePublished: 18 April 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

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Hospitals are increasingly consolidating into health systems. Some systems have appointed healthcare epidemiologists to lead system-level infection prevention programs. Ideal program infrastructure and support resources have not been described. We informally surveyed 7 healthcare epidemiologists with recent experience building and leading system-level infection prevention programs. Key facilitators and barriers for program structure and implementation are described.

N95 respirators were reprocessed using vaporized hydrogen peroxide to supplement limited supplies during the COVID-19 pandemic. In this study, we found no statistically significant differences in qualitative and quantitative fit or filtration efficiency with reprocessing. Filtration efficiency remained above 95% even at 25 cycles of reprocessing without statistically significant change from cycle 20-25 compared to cycle 0 (P = .10, P = .05, respectively). Vaporous hydrogen peroxide is an effective option to augment N95 respirator supplies. (C) 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Background: In May 2022, the first case of monkeypox virus (MPXV) infection in the United States in the current global outbreak was identified. As part of the public health and health care facility response, a contact tracing and exposure investigation was done. Objective: To describe the contact tracing, exposure identification, risk stratification, administration of postexposure prophylaxis (PEP), and exposure period monitoring for contacts of the index patient, including evaluation of persons who developed symptoms possibly consistent with MPXV infection. Design: Contact tracing and exposure investigation. Setting: Multiple health care facilities and community settings in Massachusetts. Participants: Persons identified as contacts of the index patient. Intervention: Contact notification, risk stratification, and symptom monitoring; PEP administration in a subset of contacts. Measurements: Epidemiologic and clinical data collected through standard surveillance procedures at each facility and then aggregated and analyzed. Results: There were 37 community and 129 health care contacts identified, with 4 at high risk, 49 at intermediate risk, and 113 at low or uncertain risk. Fifteen health care contacts developed symptoms during the monitoring period. Three met criteria for MPXV testing, with negative results. Two community contacts developed symptoms. Neither met criteria for MPXV testing, and neither showed disease progression consistent with monkeypox. Among 4 persons with high-risk exposures offered PEP, 3 elected to receive PEP. Among 10 HCP with intermediate-risk exposures for which PEP was offered as part of informed clinical decision making, 2 elected to receive PEP. No transmissions were identified at the conclusion of the 21-day monitoring period, despite the delay in recognition of monkeypox in the index patient. Limitation: Descriptions of exposures are subject to recall bias, which affects risk stratification. Conclusion: In a contact tracing investigation involving 166 community and health care contacts of a patient with monkeypox, no secondary cases were identified. Primary Funding Source: None.

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A. Rekha Murthy MD1, Jennifer A. Hanrahan DO2 , Sonali D. Advani MBBS, MPH3 , Muhammad Salman Ashraf MBBS4 , John P. Mills MD5 , Lona Mody MD, MSc56 , David K. Henderson MD7, Mary K. Hayden MD8, David J. Weber MD, MPH9, Sharon B. Wright MD, MPH10, Hilary Babcock MD, MPH1112 , Judith Guzman-Cottrill DO13, Sarah D. Haessler MD, MS14 , Clare Rock MD, MS15 , Trevor Van Schooneveld MD16 , Corey Forde MBBS17, Latania K. Logan MD, MSPH8 and Anurag Malani MD18 1Division of Infectious Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, 2Division of Infectious Diseases, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, 3Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina, 4Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, 5Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, 6Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, 7Clinical Center, National Institutes of Health, Bethesda, Maryland, 8Rush University Medical Center, Chicago, Illinois, 9Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, 10Beth Israel Deaconess Medical Center, Boston, Massachusetts, 11Washington University School of Medicine, St Louis, Missouri, 12Infection Prevention and Epidemiology Consortium of BJC HealthCare, St Louis, Missouri, 13Oregon Health and Science University, Portland, Oregon, 14UMass Medical School-Baystate, Springfield, Massachusetts, 15Johns Hopkins University School of Medicine, Baltimore, Maryland, 16University of Nebraska Medical Center, Omaha, Nebraska, 17Queen Elizabeth Hospital, Christ Church, Barbados and 18St Joseph Mercy Health System, Ann Arbor, Michigan for the SHEA Board of Trustees

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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