Policy for Expanded Use of PPE for COVID-19
The safety and well-being of our patients and staff remain our number one priority. As a System – and with input from our local affiliates, the Centers for Disease Control and Prevention (CDC) and other medical experts – we are constantly re-evaluating our guidance by reviewing and vetting all possible sources to help us make informed decisions regarding team member and patient protection.
The UMMS Policy for Expanded Use of PPE for COVID-19 provides specific guidance regarding the type of PPE that should be worn in clinical areas, depending on the patient’s COVID-19 status and the role of the team member. The policy references the color-coded UMMS Tiered Approach to Infection Prevention Practice and Presence in the Workplace (UMMS Tiered Approach), which UMMS has adopted to guide our infection prevention (IP) policies and guidance.
As of September 7, UMMS is operating at Level Yellow. Any changes in level will be communicated to team members via email and posted on the Insider.
Under Level Yellow, the following are the major takeaways regarding masking, which were updated on February 28, 2023:
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Team members are required to wear a mask for all patient contact or while in public spaces in UMMS facilities, regardless of vaccination status; in these settings:
- Team members who are up to date with vaccination, as defined by the CDC, should wear at least a well-fitting medical mask (no gaping); KN95/N95 recommended
- Team members who are not up to date with vaccination should wear at least a KN95 mask or N95 respirator
- Unvaccinated team members are required to wear an N95 respirator for all patient contact and at least a KN95 mask at all other times
- Team members are not required to wear masks in solely administrative buildings with no clinical areas or in private spaces in hospital buildings and patient care units, such as meeting or break rooms; in these settings:
- It is recommended that team members who are not up to date with vaccination wear masks at all times when with others
- When capacity exceeds 50 people, universal masking is recommended, regardless of vaccination status; this guidance is based on the likelihood of an individual with COVID-19 present in a group, at the current community COVID-19 prevalence rate (2-3%)
- Please remember that KN95 masks should not be used in place of N95 masks or other respirators in situations where a respirator is recommended, such as the care of a patient confirmed or suspected to have COVID-19 or medium- to high-risk aerosol-generating procedures in any patient
Please refer to the UMMS Tiered Approach for a detailed list of the requirements and recommendations for PPE in various situations under the current level.
*Please note: In the UMMS Tiered Approach, distinction is made between “required” and “recommended” for certain tasks. Recommended means it is not a requirement but still recommended for optimal protection at the team member’s discretion.
FAQS
Are patients and care partners (visitors) required to wear masks at all times?
Yes. Because we care for vulnerable populations, patients and care partners must wear a mask while in an UMMS facility. Cloth masks are permitted, while neck gaiters or masks with exhalation ports are not permitted. However, every effort should be made to provide care partners with medical face masks or KN95 masks. If a care partner arrives without a mask, they will receive one at the front entrance (Guest Services or Security) and be required to wear it while in our facilities. If a care partner is staying overnight, they are not required to wear a mask while sleeping.
What type of mask should I wear?
During periods of high community transmission of COVID-19, a KN95 mask or respirator may be required in an UMMS facility. At other times, a medical face mask may be sufficient. Team members should reference the UMMS Tiered Approach to determine the type of mask they are required to wear in which settings, which depends on the color-coded level at which the System is currently operating. Cloth masks, while effective in protecting both the wearer and others from the wearer’s secretions, are not recognized as medical PPE in health care settings.
How do I recognize that my medical face mask does not fit well?
For your medical face mask to be considered “well-fitting” it must:
- Stay up over your nose, even while speaking
- NOT gape at the sides
- NOT fog your eyewear or face shield
I’m concerned my medical face mask doesn’t fit well. What should I do?
We recognize that not all medical face masks provide a good fit for all face types. In that situation, you may opt to wear a KN95 mask as an alternative to a medical face mask. Contact your manager to obtain a KN95. If you opt to wear a KN95 mask, we recommend wearing a full-face shield or medical face mask over top, to prevent surface contamination and extend the use of the KN95. KN95 masks should be discarded when they lose fit or are soiled or damaged.
Alternatively, you may opt to knot or tuck your mask to improve the fit.
Can I wear two masks if I want to?
Yes. Team members who wish to wear two masks are allowed to do so. Should you choose to wear two masks, please make sure that at least one of these is a well-fitting medical face mask or KN95 or that the second (top) mask serves to improve the fit of the first (bottom) mask. Combining two loose-fitting medical face masks is unlikely to improve the level of protection afforded.
Please note: It has been shown that wearing a surgical or procedure mask over an N95 mask may interfere with proper fit of the N95 mask. We recommend team members do not wear a surgical or procedure mask over a fit-tested N95. This will allow team members to maintain optimal protection from the use of a fit-tested N95. N95 masks should be changed when they lose fit or if they become visibly contaminated or soiled.
What is the difference between a KN95 and an N95?
An N95 is a National Institute for Occupational Safety and Health (NIOSH) approved respiratory protective device. Use an N95 (an elastomeric respirator, or a PAPR) whenever you are caring for a patient suspected or confirmed to have COVID-19 or performing a high-risk Aerosol Generating Procedure (AGP) on any patient. A KN95 is the Chinese equivalent of an N95 and is manufactured to achieve 95% filtration efficiency, approved under Chinese standards. We provide these for your use because they may fit tighter on your face.
Can I wear a KN95 instead of an N95?
No. We are recommending KN95 masks as an alternative to medical face masks. We recommend continuing to use fit-tested N95 masks or other respirators (elastomeric, PAPR or CleanSpace Halo) when caring for known COVID-19 confirmed patients or PUIs, or when recommended or required per the UMMS Tiered Approach.
I have a respirator that I have been wearing regularly. Can I continue to do that?
Yes. Team members who have been fit-tested for respirators (N95s or reusable respirators) should continue to wear them in all situations where those are recommended or required per the UMMS Tiered Approach. Team members should also continue to wear a medical face mask with their elastomeric or under a PAPR while masking for source control is in effect (but not over an N95 as explained above). Please note: While KN95s can be worn as an alternative to a medical face mask, they should not be used as a substitute for a fit-tested N95 respirator or reusable respirator, e.g., when caring for patients known or suspected to have COVID-19.
Is it safe to re-use a disposable N95?
Yes. SARS-CoV-2 is primarily transmitted via inhalation of respiratory aerosols, and fomite or contact transmission is much less frequent. Therefore, fit and function of masks and respirators remain the most important attribute for protection against inhalation or aerosol exposure, and studies show that fit and function of N95s can be retained through multiple uses.
How many times can an N95 respirator be reused by a single health care worker?
N95 masks can be reused as long as they fit well.
Respirators should be discarded any time they lose fit or fail the seal check at time of donning.
If at any point a respirator becomes damaged or visibly contaminated, it should be immediately discarded.
Are there any problems associated with wearing a KN95 or respirator at all times or wearing two masks at all times?
For most healthy people, wearing KN95s, N95s or other respirators, or more than one mask does not pose a health risk. However, breathing discomfort due to increased breathing resistance can occur when wearing an N95 mask or multiple masks. It is recommended that you remove the mask any time it becomes difficult to breathe and take one or more breaks from wearing N95 masks through your day/shift. If you have a pre-existing heart or lung problem, you should discuss the use of a KN95 or N95 with your physician.
What constitutes good eye protection? Can I purchase my own protective eyewear?
Both face shields and goggles are acceptable when providing patient care. It is important that eyewear fit snugly, particularly from the corners of the eye across the brow. Full face shields are preferred during aerosol generating procedures as the shield protects your entire face and also protects your mask from surface contamination. Face shields that are attached to a surgical mask or that fit loosely around the face should not be relied upon as optimal protection. Glasses with side protectors and extenders may be considered when your ability to complete tasks is impaired due to visual distortions that can occur for some individuals using goggles or face shields.
You may purchase your own protective eyewear if you cannot find any that provide a good fit amongst UMMS-supplied eyewear.
Can an elastomeric respirator be reused?
Yes, re-usable elastomeric respirators may be disinfected and reused.
What should I do if my KN95 does not fit well?
If your KN95 does not fit well, there are a number of different things that you can try to improve the fit, including wearing an alternate brand of KN95 (some subtle differences in brands may improve fit) or using an extender to pull the straps away from your ears. If you have a beard, consider shaving to improve the fit of the mask. Alternatively, you may choose to wear an N95 or other respirator instead of a KN95.
Where are UMMS masks procured from?
All UMMS masks and other PPE are purchased from approved and vetted manufacturers.
Can a team member wear their own KN95?
Yes, if the KN95 mask provided by UMMS does not fit well, team members may purchase their own masks. You may also have come across KF94 masks, the South Korean equivalent of N95 masks. KF94s are manufactured to a 94% filtration efficiency standard and are considered a KN95-equivalent for the purposes of UMMS policy. If you purchase your own KN95 or KF94 masks, refer to the CDC/NIOSH list to avoid purchasing counterfeit masks. You should also look out for the following, which may indicate a counterfeit product:
An FDA logo on the box or statement of “FDA approval”
- Loose ear loops
- Loosely packed masks without any packaging or labeling
- Lack of manufacturer’s name on the package
- Lack of an approval number (starting with “GB-” for KN95s and imprinted on the mask or packaging; note that KF94s do not have this approval number, but the package should say “Made in Korea” and include the product, manufacturer, and distributor names)
Do I need to be fit tested for N95s?
Yes. A fit test is required to ensure the N95 is properly sized and fitting for you. KN95s do not require fit testing because they are not being used as respirators. However, you should ensure that the KN95 you are using fits your face well. If this is not the case, we recommend using an N95 or other respirator, or trying an alternate KN95 as there might be subtle differences in brands that can improve fit.
Do I need to be clean-shaven to wear an N95?
Yes. It is important to have a good seal between the N95 and your face. Facial hair can interfere with this fit. KN95s do not require you to be clean-shaven, but fit is likely to improve if clean-shaven.
Are there different sizes for N95s and KN95s?
N95s come in sizes for the best fit. KN95s are one size fits most.