Health Care Systems Unlikely to Stop Masking Despite New Guidelines


Although new guidelines from the CDC say that masks need not be worn in counties where transmission level for COVID-19 isn’t high, many health systems still plan to mask.

Most health systems planned to continue masking despite new CDC guidelines that altered the guidance on control and prevention of COVID-19, according to a study published in Infection Control & Hospital Epidemiology.

The new guidelines would allow health care personnel (HCP) and health care facilities to “opt out of the universal source control use by HCP providing care in counties where [COVID-19] transmission level is not high.”

This guidance does not apply to HCP who care for patients who have or are testing for COVID-19, those who have had close contact with someone with COVID-19, or who are in a facility that has a COVID-19 outbreak. This study aimed to evaluate whether acute care hospitals would adopt different approaches than what is recommended by the CDC.

Health care epidemiologists in the United States were surveyed after the release of the updated guidelines. A representative from each US-based, nonfederal, acute care hospital or health system was invited and study data were collected with Research Electronic Data Capture at the University of Pittsburgh Medical Center.

There were 34 respondents to the survey that represented health systems across the United States. A total of 76.5% represented health systems that had multiple acute care hospitals and 17.6% represented facilities with 500 beds or more.

Of the 34 respondents, 33 (97.1%) reported that their facility was not planning to halt universal masking, with the remaining facility reporting that they had discontinued or planned to discontinue masking once transmission levels of COVID-19 were no longer higher. None of the respondents surveyed indicated that universal masking would cease regardless of transmission levels.

The most cited reasons for continuing to mask in their facilities. regardless of transmission levels, were to prevent non–COVID-19 seasonal respiratory viruses (90.9%) and the effect masking had on employee staffing capacity (72.7%). Standardizing the masking approach across facilities, operational challenges of variable masking policies, and presence of high-risk individuals were other reasons that were cited by 7 facilities. There were 7 respondents who cited locations that were inaccessible to patients or visitors as locations where unmasking may be permitted.

The survey revealed that there were still significant concerns about using the updated recommendations, as mandates could change week to week in health care facilities if they were to use the CDC guidelines. The once-weekly reporting of the levels of COVID-19 transmission could also lead to delays in escalating universal masking as transmission increases. This could result in harm and infection among HCP and their patients.

The participants were self-selected, which may make the results not representative of all health care facilities in the United States. This study was also done very soon after the guidelines were released, which makes it a temporal snapshot.

The researchers concluded that the majority of health care facilities will not adopt the new guidance for masking. The researchers suggested that the guidelines could be reevaluated in the spring of 2023.


Snyder GM, Passaretti CL, Stevens MP. Hospital approaches to universal masking after public health “unmasking” guidance. Infect Control Hosp Epidemiol. Published online March 22, 2023. doi:10.1017/ice.2023.9

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