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Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers

Educational Objective
To understand the association between universal masking in a health care system and SARS-CoV-2 positivity among health care workers
1 Credit CME

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has severely affected health care workers (HCWs).1 As a result, hospital systems began testing HCWs2 and implementing infection control measures to mitigate workforce depletion and prevent disease spread.3 Mass General Brigham (MGB) is the largest health care system in Massachusetts, with 12 hospitals and more than 75 000 employees. In March 2020, MGB implemented a multipronged infection reduction strategy involving systematic testing of symptomatic HCWs and universal masking of all HCWs and patients with surgical masks.4 This study assessed the association of hospital masking policies with the SARS-CoV-2 infection rate among HCWs.

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Article Information

Corresponding Author: Deepak L. Bhatt, MD, MPH, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (dlbhattmd@post.harvard.edu).

Accepted for Publication: July 1, 2020.

Published Online: July 14, 2020. doi:10.1001/jama.2020.12897

Author Contributions: Dr Bhatt had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Wang and Ferro contributed equally to this article.

Concept and design: Wang, Ferro, Hashimoto, Bhatt.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Wang, Ferro.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Wang, Zhou.

Administrative, technical, or material support: Wang, Ferro, Hashimoto.

Supervision: Hashimoto, Bhatt.

Conflict of Interest Disclosures: Dr Bhatt discloses the following relationships: advisory board: Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, Level Ex, Medscape Cardiology, PhaseBio, PLx Pharma, Regado Biosciences; board of directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; chair: American Heart Association Quality Oversight Committee, NCDR-ACTION Registry Steering Committee, VA CART Research and Publications Committee; data monitoring committees: Baim Institute for Clinical Research, Cleveland Clinic, Contego Medical, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; honoraria: American College of Cardiology, Baim Institute for Clinical Research, Belvoir Publications, Duke Clinical Research Institute, HMP Global, Journal of the American College of Cardiology, K2P, Level Ex, Medtelligence/ReachMD, MJH Life Sciences, Population Health Research Institute, Slack Publications, Society of Cardiovascular Patient Care, WebMD; deputy editorship: Clinical Cardiology; research funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardax, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lexicon, Lilly, Medtronic, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; royalties: Elsevier; site coinvestigator: Biotronik, Boston Scientific, CSI, St Jude Medical, Svelte; trustee: American College of Cardiology; unfunded research: FlowCo, Merck, Novo Nordisk, Takeda. No other disclosures were reported.

Additional Contributions: We thank Stacey A. Duey, MT(ASCP), MCHP, Mass General Brigham, for assistance in extracting data from the Research Patient Data Registry, and Karen Hopcia, ScD, ANP-BC, Mass General Brigham, for assistance in extracting data from Occupational Health Services. No compensation was received for their roles.

References
1.
Adams  JG , Walls  RM .  Supporting the health care workforce during the COVID-19 global epidemic.   JAMA. 2020;323(15):1439-1440. doi:10.1001/jama.2020.3972PubMedGoogle ScholarCrossref
2.
Hunter  E , Price  DA , Murphy  E ,  et al.  First experience of COVID-19 screening of health-care workers in England.   Lancet. 2020;395(10234):e77-e78. doi:10.1016/S0140-6736(20)30970-3PubMedGoogle ScholarCrossref
3.
Black  JRM , Bailey  C , Przewrocka  J , Dijkstra  KK , Swanton  C .  COVID-19: the case for health-care worker screening to prevent hospital transmission.   Lancet. 2020;395(10234):1418-1420. doi:10.1016/S0140-6736(20)30917-XPubMedGoogle ScholarCrossref
4.
Klompas  M , Morris  CA , Sinclair  J , Pearson  M , Shenoy  ES .  Universal masking in hospitals in the Covid-19 era.   N Engl J Med. 2020;382(21):e63. doi:10.1056/NEJMp2006372PubMedGoogle Scholar
5.
Sen  S , Karaca-Mandic  P , Georgiou  A .  Association of stay-at-home orders with COVID-19 hospitalizations in 4 states.   JAMA. 2020;323(24):2522-2524. doi:10.1001/jama.2020.9176PubMedGoogle ScholarCrossref
6.
Massachusetts Department of Public Health COVID-19 dashboard—April 30, 2020. Accessed June 27, 2020. https://www.mass.gov/doc/covid-19-dashboard-april-30-2020/download
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