What are you doing with your cloth masks?

[KSera]

8 minutes ago, J-rap said:

My guess is that in a busy medical clinic, it's quicker to just have everyone put on one of its own surgical masks rather than take time to examine the ones people are bringing in.  (Yes, I'm in the US.)

Yeah, but a surgical mask provides such low inward protection that they should either be providing better masks or in the very least looking for the NIOSH symbol on the outside of someone’s N95. They’re  all required to be marked right on the outside so it’s not difficult to see. It’s just so wrong to make medically vulnerable people takeoff a highly protective mask to put on one that’s insufficient for the current strains. We had an ER visit earlier in the pandemic where they wanted us to do that and I had to push to be allowed to keep our much better masks on. 

[wathe]

3 hours ago, KSera said:

Oh, I wouldn’t rely on a surgical mask either. Surgical masks perform similar to an Enro. We do KF94 or N95 masks here and get good fits with our favorites styles of those—really tight fits with 3M Aura N95s, which the vast majority of adults can pass fit testing with. If I had only surgical masks to rely on, I would get a mask brace like Fix the Mask. 

Other than being cheap, I’m not sure why surgical masks are so popular. They don’t work very well and they sit right up against your mouth, which I think would be much less comfortable than a 3d mask shape that sits away from your face. We rotate and reuse kf94 and N95 masks, so we don’t go through them very quickly. 

Cheap, and also one-size-fits-all (sort of), ear-loops easy to wear for most people, do not pose a strangulation hazard to children, much better tolerated by most, socially acceptable as good enough.

@J-rap@EKS We had the must-replace-your-own-mask-with-one-of-our-baggy-blues policy at our hospital.  It seems straight-forward that you should be able to wear your own superior n95 if you want, but it's actually quite complex on a policy level.

There were concerns that people's own masks might be dirty and pose an infection hazard (and, objectively, some people do come in with visibly dirty. soiled masks).  I actually don't think that a dirty mask poses much of an infection risk to anyone other than the person wearing it, but IPAC disagrees.  IPAC is firm on this.

The bigger issue is who gets to decide which masks are good enough, and which need to be replaced with one of our blue pleated ear-loopers.  We have people coming into the hospital with all kinds of "masks", in all kinds of states of disrepair, some of which are clearly useless (bandanas, or buffs, or loose weave, with actual holes, or clear plastic shield "mask", or masks that really don't fit, valved).  Our screeners are not able to make medical decisions - for both policy reasons and because many aren't medical professionals.  Assessing whose mask is good enough (and whose isn't good enough) is outside their scope.  Even many credentialed HCP have differences of opinion about what's "better" than a surgical mask (is a happy mask or and enro objectively better?  probably not, but their marketing would have you believe differently, and I can just imagine trying to convince a dedicated HM wearer that their mask isn't as good as the other guy's n95, and that they have to replace theirs with a surgical mask, but the other guy in an n95 does not, at the waiting room door........), and judging masks is properly outside our scope anyway - we aren't most of us biomedical engineers or IPAC specialists.  So, making everyone replace their mask for one of our good enough surgical masks became the policy solution - cheap, and easy to implement at scale. 

Add to that the culture of droplet dogma pervasive in the IPAC community.  Change-your-mask-at-the-door policy was formed in early days.  HCW were issued n95 only for Aerosol Generating Procedures.  Were supposed to wear pleated ear-loopers even for care of covid patients.  The official policy was that pleated procedure masks really were plenty good enough.    So the institution was at least being consistent. (Aside:  We still formally classify COVID as droplet -- a new invented category of "enhanced droplet" --, not airborne, because regulatory reasons. It's maddening)

I challenged the policy when n95's became more plentiful.  Much resistance from IPAC for all the reasons listed above.  Handing out n95's to everyone would solve the who decides which mask is good enough issue, but is not a realistic solution;  can't use them for kids (don't fit, straps are a strangulation hazard) and many of our patients, particularly frail patients really can't tolerate them - you can put an ear-looper on a person with dementia and they might tolerate it, but an n95 with tight straps, definitely not; hard to get off in a hurry (vomiting, airway issues), lots of legit concerns about  n95 becoming hazards .  Many patients object to the head harness.  We have enough trouble getting people to keep their pleated ear-loopers on, n95's would be impossible.    Also, people who really  care about their own masks tend to be invested in their particular model and don't want to change for one of ours (entirely reasonable!), even if ours were a good one.  And $$$$$$$$.  

Some hospitals hand out kn95 ear-loopers as a compromise.  Ours doesn't.  $$$$$, and the same issue of people with better masks wanting to keep their own.

So, eventually the hospital formally changed the policy to either change your mask for one of our clean pleated-earloopers, or keep your mask and wear our clean mask over top.  Masks that are visibly soiled must be changed. Good compromise.  And hard-won, let me tell you.

Next was the problem of communicating policy change in a system with many moving parts that been in crisis for 2+ years, which, IME was not done well.  Screener is a role with very high staffing turnover.   Non-screeners sometimes fill the role in a pinch.  Institutional practices that have become entrenched are hard to change.  We are in legit crisis mode in  ED's now, and this is just not an issue that staff have bandwidth for.   Pt are still sometimes asked to change their masks at the door.  When I see pts in an ear-looper with a better mask peeking out of a purse of bag, I ask them about it, and advise them that they are free to wear their own mask, with ours on top.  If anyone challenges them on it, I tell the to send them to me.  It's the best I can do.

When asked to change my mask in healthcare settings outside my own workplace , I politely take the mask offered, place over top of mine, and move along.  I've yet to be challenged.  

 

Edited September 4, 2022 by wathe

[wathe]

I really should respond to the OP (OP, thank you for tolerating my tangent posted above):

Our cloth masks are in a box. I put a lot of effort in to making them, and don't have the heart to throw them out just yet.  So they sit in a box.  I don't think that we will ever use them again (unless disposables become unavailable, which seems unlikely - that's the only circumstance where I can see we'd actually ever use them)

[wathe]

On 9/3/2022 at 11:36 AM, KungFuPanda said:

Shove them into clear Christmas tree bulbs and decorate with them. Then, break glass for emergencies. 😷🤣🎄

Some of mine would look really nice!

Maybe I will make some sort of art out of them.  They might make an interesting quilt or something.