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A recent study published in JAMA Network Open highlights the critical role of masking and testing policies in curbing hospital-acquired respiratory viral infections, such as those caused by SARS-CoV-2, influenza, and respiratory syncytial virus (RSV). Conducted across 10 Massachusetts General Brigham hospitals, the research underscores the effectiveness of reinstating masking policies in reducing nosocomial infections.
Impact of Masking and Testing on Infections
Respiratory viruses pose a significant risk to hospitalized patients, particularly those with weakened immune systems. During the COVID-19 pandemic, universal masking and routine viral testing became standard practices, significantly reducing the spread of infections in healthcare settings. However, the relaxation of these policies coincided with a rise in hospital-acquired infections.
This study provides quantitative evidence showing how changes in masking and testing policies influence infection rates. Researchers emphasized the need for adaptive infection control strategies to protect vulnerable populations during periods of heightened viral transmission.
Study Design
The researchers analyzed data from November 2020 to March 2024, spanning four distinct policy phases:
- Universal masking and testing before the emergence of the Omicron variant.
- The continuation of these measures during the Omicron surge.
- The cessation of universal masking and testing.
- The reinstatement of masking for healthcare workers.
Hospital-onset infections were identified as positive cases detected more than four days after admission. Data analysis, adjusted for community infection rates and seasonal variations, aimed to isolate the impact of policy changes.
Key Findings
The study revealed a clear link between masking policies and infection rates:
- During universal masking and testing, hospital-acquired infections constituted 2.9% of the weekly ratio to community-acquired cases.
- After discontinuation, this ratio surged to 15.5%.
- Following the reintroduction of masking for healthcare workers, the ratio fell to 8%.
Hospital-acquired infections rose by 25% when masking and testing were halted but decreased by 33% after healthcare workers resumed masking.
Additionally, a significant portion (89%) of hospital-onset SARS-CoV-2 cases involved patients who developed new respiratory symptoms, with most cases associated with high viral loads (PCR cycle thresholds under 30). The study also noted a spike in influenza and RSV cases following the relaxation of testing protocols.
Conclusions and Implications
The findings underscore the importance of maintaining targeted masking and testing policies during periods of high community viral activity. Reinstating masking for healthcare workers proved effective in mitigating hospital-acquired infections, balancing patient safety with resource use.
The study’s authors advocate for adaptive infection control strategies to protect hospitalized patients, suggesting that policies like targeted masking should remain part of the healthcare response toolkit during respiratory viral surges.
For more details, the full study is available in JAMA Network Open.
Reference:
Pak, T. R., Chen, T., Kanjilal, S., et al. (2024). Testing and Masking Policies and Hospital Onset Respiratory Viral Infections. JAMA Network Open, 7(11), e2448063. doi:10.1001/jamanetworkopen.2024.48063
