The Situation Report | February 13, 2023
On Friday, the state Department of Health (DOH) issued a press release and posted a “Dear Administrator Letter” (DAL) whose purpose is to provide updated recommendations for the use of masks and face coverings that all healthcare settings, including home care and hospice, in New York should follow during the ongoing COVID-19 pandemic.
The DAL, effective February 12, 2023, is available here.
The DAL was issued to coincide with the expiration of DOH’s Face Coverings for COVID-19 Prevention emergency rule that expires February 12, 2023.
In the DAL, DOH affirms the importance of non-pharmacological infection prevention strategies in health care settings such as appropriate usage of well-fitting face masks. DOH notes that this guidance supersedes all previous DOH guidance, recommendations, and requirements pertaining to the use of face masks and face coverings for COVID-19-related source control in healthcare facilities in New York.
However, DOH notes that this advisory does not affect any (mask) requirements under the Regulation for Prevention of Influenza Transmission by Healthcare and Residential Facility and Agency Personnel.
The DAL notes that all personnel, regardless of COVID-19 vaccination status, in a healthcare setting (i.e., facilities or entities regulated under Articles 28, 36, and 40 of the Public Health Law) should wear an appropriate face mask according to the Centers for Disease Control and Prevention’s (CDC) Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.
The current CDC recommendations apply regardless of COVID-19 vaccination status and are based on Transmission Levels, not on COVID-19 Community Levels.
Home care, hospice and other health care providers are advised by DOH to develop and implement policies for personnel and visitor masking based on the CDC and DOH recommendations. Facility policies should be at least as strict as CDC recommendations and may be stricter at the discretion of the facility.
DOH also states that, in addition to these masking recommendations, healthcare facilities are reminded of the importance of following other infection prevention and control recommendations related to COVID-19.
CDC Guidelines
According to the CDC, when SARS-CoV-2 Community Transmission levels are high, “source control” is recommended for everyone in a healthcare setting when they are in areas of the healthcare facility where they could encounter patients. Source control refers to use of respirators or well-fitting facemasks or cloth masks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing.
- Healthcare Personnel (HCP) could choose not to wear source control when they are in well-defined areas that are restricted from patient access (e.g., staff meeting rooms) if they do not otherwise meet the criteria described below and Community Levels are not also high. When Community Levels are high, source control is recommended for everyone.
When SARS-CoV-2 Community Transmission levels are not high, healthcare facilities could choose not to require universal source control. However, even if source control is not universally required, CDC recommends it for individuals in healthcare settings who:
- Have suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g., those with runny nose, cough, sneeze); or
- Had close contact (patients and visitors) or a higher-risk exposure (HCP) with someone with SARS-CoV-2 infection, for 10 days after their exposure; or
- Reside or work on a unit or area of the facility experiencing a SARS-CoV-2 outbreak; universal use of source control could be discontinued as a mitigation measure once no new cases have been identified for 14 days; or
- Have otherwise had source control recommended by public health authorities.
The CDC states that HCP and healthcare facilities might also consider using or recommending source control when caring for patients who are moderately to severely immunocompromised.
If SARS-CoV-2 infection is not suspected in a patient presenting for care (based on symptom and exposure history), HCP should follow Standard Precautions (and Transmission-Based Precautions if required based on the suspected diagnosis). HCP who enter the room of a patient with suspected or confirmed SARS-CoV-2 infection should adhere to Standard Precautions and use a NIOSH-approved particulate respirator with N95 filters or higher, gown, gloves, and eye protection (i.e., goggles or a face shield that covers the front and sides of the face).
As community transmission levels increase, the potential for encountering asymptomatic or pre-symptomatic patients with SARS-CoV-2 infection also likely increases. In these circumstances, healthcare facilities should consider implementing broader use of respirators and eye protection by HCP during patient care encounters. For example, facilities located in counties where Community Transmission is high should also consider having HCP use PPE as described here.
Questions can be directed to covidhomecareinfo@health.ny.gov (please copy Andrew Koski at akoski@hcanys.org).