UPMC Presbyterian to assess utility of surgical mask use
when caring for MRSA patients
UPMC Presbyterian will begin a six-month study to determine if eliminating mask use for routine care of patients with known or suspected methicillin-resitant Staphylococcus aureus (MRSA) will affect MRSA hospital-acquired infections and conversion rates.
During the recent H1N1 epidemic, mask inventory was depleted severely and a mask-sparing protocol (mask reuse) was launched. It was recommended that a used mask could be stored in a pocket after placing it in a plastic bag. At the time, UPMC Presbyterian experienced an increase in MRSA conversion rates (patients not colonized on admission but determined to be colonized with follow-up active surveillance). This increase may have been caused by provider hands becoming contaminated after touching the used mask.
MRSA transmission has been assumed to occur primarily via direct or indirect contact with MRSA colonized patients, making contact precautions warranted. Because MRSA colonizes the nose and respiratory tract, some older studies suggested a role for airborne/droplet transmission. These studies supported mask use to prevent MRSA nasal acquisition among health care workers and subsequent transmission to patients.
During the last decade, investigators at various facilities, including the Veterans Affairs in Pittsburgh, have introduced an MRSA control bundle that did not include use of a mask and have successfully reduced MRSA colonization/infection. The associated increased MRSA converters with mask reuse and the success of the mask-free programs prompted this evaluation of mask use.
As of July 1, masks are no longer required for the routine care of MRSA patients.
Health care workers still will be required to adhere to contact precautions, in addition to standard precautions. Standard precautions are designed to protect providers from exposure to blood and body fluids and should be used to care for all patients.
MRSA and many other pathogens (for example, extended-spectrum beta lactamase (ESBL)/Klebsiella pneumoniae carbapenemase (KPC) gram-negative rod (GNR) bacteria, Acinetobacter, Pseudomonas, and Stenotrophomonas) commonly are found in the respiratory tract and can be aerosolized under certain conditions. As a reminder, a mask should be worn routinely as part of the standard precautions when caring for all patients undergoing treatments/procedures that increase potential for splashing or aerosolization of respiratory secretions. Examples include suctioning, performing bronchoscopy, and sputum induction. For more information, call Infection Control at 412-692-2566.