Two Recent CDC Infection Control Updates
On February 10, CDC issued a few infection control-related updates to various COVID-19 web pages. These changes centered around two issues:
- Using well-fitting facemasks
- Using updated quarantine guidance for fully vaccinated health care facility staff, inpatients, and long-term care facility (LTCF) residents
As we enter the second year of the COVID-19 pandemic, more data and research will continue to emerge that may impact practice guidance and alter recommendations.
Well-Fitting Facemasks
The recent guidance from CDC on facemasks focuses on the fit and filtration of masks for protection of health care personnel and the general community. The guidance is based on a recent CDC Morbidity and Mortality Weekly Report, Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure.
Health care personnel (HCP)
CDC updated all mentions of HCP facemask use in various sections of COVID-19 infection control guidance to reference the use of “well-fitting facemasks” for source control and as an alternative to respirators for patient and resident care encounters. While the LTCF-specific infection control guidance has not yet been updated to include this term, CDC is in the process of updating that guidance and it is anticipated that it will change to match the guidance for other settings.
It is standard practice for HCP to wear medical-grade personal protective equipment (PPE), which already offers multiple-layer filtration. HCP should continue to ensure their medical-grade KN95, procedure, or surgical masks fit well and do not have any gaps between the mask and face. This should be something HCP are already familiar with and practice as part of their regular PPE regimen. This new CDC guidance simply reiterates the importance and safety of a well-fitting mask.
If staff have a mask that does not fit well, any of the options indicated in CDC’s updated guidance will help improve the fit. DHS advises starting with the knot and tuck approach or checking for other available models among in-house PPE supplies. While tie-back masks are good for fit purposes, they are not able to be reused, which may be needed based on facility PPE capacity practices.
Although a cloth face covering is listed as an acceptable method to enhance the fit of the medical-grade facemask for HCP, there are concerns associated with introducing a non-PPE mask into medical settings. Among these are concerns are how frequently the cloth face coverings are cleaned, method of cleaning, and options for replacement of the cloth face covering during the day. Layering multiple masks can also present a disease transmission opportunity through HCP self-contamination during the donning and doffing processes and is never part of a manufacturer’s product instructions for use.
Fit tested N95s remain the gold standard for a well-fitting, filtered face piece for HCP. They do not require another mask or method to ensure they meet the criteria of a well-fitting mask, as this is accomplished through the fit testing process and re-affirmed with the seal check for each donning. Facilities should not be using N95s for HCP universal source control if they are not in conventional capacity for respirators. In such circumstances, facilities should implement optimization and prioritization strategies to ensure supplies are available for activities that require respirator use.
Patients, residents, and visitors
Patients, residents of LTCFs, and visitors to any health care facility should utilize a well-fitting facemask in all situations where a facemask or cloth face covering was previously recommended. For LTCF residents, this includes when leaving the facility, when outside their rooms, and when HCP enter their rooms. Gaiters and bandanas do not meet the criteria for a well-fitting facemask.
Patients and residents should try different mask styles or the knot and tuck method if their mask has open gaps. Double masking can assist with meeting the goal of a well-fitting mask, by reducing gaps that allow respiratory droplets from moving around the mask edges, and forcing air through multiple layers of filtration to help contain more viral particles. This may also be a population that would benefit from the disposable mask layered with the cloth face covering, as CDC indicates for the general community.
Medical-grade PPE should continue to be reserved for HCP. The disposable masks indicated by CDC for use by the community are not intended to be medical-grade PPE. If a mask already has multiple layers and fits well, double masking may not be necessary.
Quarantine for Fully Vaccinated HCP, Inpatients, and LTCF Residents
As indicated in HAN 27, DHS is fully adopting CDC’s latest quarantine guidance for fully vaccinated individuals. This guidance indicates that fully vaccinated individuals meeting specific criteria are not required to quarantine after exposure to someone with COVID-19. However, these individuals should continue to self-monitor for symptoms during the full 14-day incubation period and be clinically evaluated and tested if they develop any symptoms of COVID-19.
Fully vaccinated HCP with exposure to COVID-19 may be considered exempt from quarantine requirements. This guidance for fully vaccinated HCP replaces the previous “early return-to-work from quarantine” guidance contained in HAN 18 and 22. Vaccinated HCP should continue to self-monitor for symptoms and be tested if any symptoms develop.
Patients receiving inpatient care in a health care setting and LTCF residents should continue to quarantine after exposure to COVID-19, even if fully vaccinated. Due to the higher risk of severe illness and death among these patients and residents, they should continue to follow prior guidance requiring 14-day quarantine after the date of last exposure. CDC’s updated guidance also does not change any recommended strategies for routine testing practices or new admission or readmission quarantine processes at this time.
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