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On Wednesday July 5 UHN is updating its masking policy to refine where masks need to be worn and, where they are optional. UHN News invited Dr. Susy Hota, UHN Medical Director of Infection Prevention and Control to detail the scope of the changes.
Q: DR. HOTA LET'S START WITH WHERE IS MASKING OPTIONAL AT UHN?
Dr. Hota: Starting July 5, masking will be optional in public common spaces across UHN, so this would include lobbies, elevators, and hallways for example. Masking will also be optional in most shared spaces on inpatient units – such as nursing stations, hallways, charting rooms, meeting rooms and family lounges. This said, there are exceptions where masking will remain mandatory throughout the inpatient unit, due to a heightened level of vulnerability of the patients.
Q: OKAY SO WHERE IS MASKING GOING TO REMAIN MANDATORY?
Dr. Hota: The answer to that is tied to the activities you're performing, and where. Anytime you enter an inpatient room to provide direct patient care, or anytime you're having direct interactions with a patient – regardless of their isolation status - you must wear a mask. Masking applies to all healthcare workers at UHN, as well as family, visitors, and essential care partners who might be assisting patients or sitting at the patient bedside in these settings.
Masking also remains mandatory in outpatient and diagnostic waiting rooms as patients are within that environment waiting to be seen. These spaces qualify as areas where there is a high degree of direct interaction with patients.
In specific inpatient and ambulatory areas, we're going to maintain universal masking. This includes units where we have highly immunocompromised patients - the multi organ transplant units and 6ES at Toronto General Hospital, and the high risk Oncology units at Princess Margaret Cancer Centre where we have malignant hematology patients, stem cell transplant patients etc. So when you're coming onto those units, everyone is required to mask upon entry - and throughout the unit - including when you are in the hallways and nursing stations. Similarly, masking will remain mandatory in all areas of the chemotherapy, malignant hematology, allotransplant and autotransplant day units at Princess Margaret Cancer Centre.
We've always required masking when patients are under additional precautions such as droplet precautions where masking is a part of the PPE requirements. This remains in effect. Also - when patients are coughing and displaying symptoms that could indicate a respiratory virus infection - we continue to require masking.
Q: TALK TO US ABOUT THE DECISION TO RETAIN MASKING IN THESE AREAS – WHAT'S THE PREMISE BEHIND THAT MOVE?
Dr. Hota: Firstly, UHN's approach is in keeping with the Toronto Region Hospital Operations Table and Public Health Ontario guidance, and is based primarily upon the current epidemiology of respiratory viruses. What's unique to UHN is we serve a significant immune-compromised patient population, so we included some additional masking requirements. Bottom line: our goal is protect the most vulnerable patients within the hospital environment, and we know masking is an important tool to help protect against any respiratory virus infection, including COVID-19 and influenza.
Q: WITH ALL THIS CHANGE HOW WILL PATIENTS AND STAFF KNOW WHERE TO MASK AND WHERE IT'S OPTIONAL?
Dr. Hota: There will be new signage throughout the organization. Those visual cues are really important because we recognize that there have been a number of changes to masking policies that have occurred over the last few years, and particularly in the past four months. We want to make sure that everyone's clear on what kind of space they're in, and what the requirements are. And we want to be clear - if you choose to mask in an optional area - we support you. [Ed. Note – please go to our website – uhn.ca for more information on the UHN Masking Policy update]
Q: HERE'S A SITUATIONAL 'WHAT IF' FOR YOU - WHAT IF A UHN STAFF MEMBER ENCOUNTERS A PATIENT WHO IS MASKED IN AN OPTIONAL MASKING AREA - AND THEY ASK US TO MASK – WHAT'S YOUR ADVICE?
Dr. Hota: My general advice is first of all have patience and compassion. Understand that we all come from different risk situations and environments, and people have different preferences. When it comes to masking policy updates, for some it may take time to adjust, and so they may take a little more time to feel comfortable with being mask optional in an area. So try to respect other people's perspectives. If someone feels most comfortable being masked and asks us to do the same, I think the right thing to do is to respect their wish and wear a mask in their presence. We recognize some people will feel more comfortable continuing to wear a mask in all spaces within the organization and we want to make it clear that everyone's choice is welcome in areas where masks aren't required.
Q: THERE ARE SOME WHO WILL SAY IT'S TOO SOON TO MOVE AWAY FROM UNIVERSAL MASKING – WHAT DO YOU SAY TO THEM?
Dr. Hota: It's important to note we didn't make this decision lightly. We're always committed to following provincial guidance. In fact, back in April, the province released an update to their masking recommendations, which essentially said we should be adjusting our measures according to what the risk is of respiratory viruses and COVID-19 at that time. We've waited until now to feel comfortable with understanding the risk of our environment. Since April we've been looking at the local epidemiology of COVID-19 and other respiratory viruses, and we now deem them to be low to moderate depending on which virus you're looking at in the Toronto region. Other factors are that we've been looking at what's happening with hospitalizations related to these infections, what the death rates are, and other severe consequences. In addition, we know that the population immunity to COVID-19 is not the same as it was when we first started masking in 2020. Yes, we do still see COVID-19 outbreaks, a lot of them are in long term care at the moment, but they are decreasing. All those indicators have guided our decision to say now is the time that we can adjust our masking policy while at the same time providing a level of protection to our immune-compromised patients. At the same time, we know full well that if the situation changes in terms of risk, say in the Fall, as we typically start to see more respiratory viruses, then we will be reassessing things and there may be a possibility that we would need to update our policy again.