Universal Masking in Patient Care Areas

Please note: This information is not for distribution outside of Unity Health; we are using a private section of our external website to allow staff easy access to these materials offsite and after hours.

After careful reflection and in alignment with many of our hospital partners, we have decided to make a shift in our use of masks at Unity Health Toronto.

Staff and physicians who work in patient care areas and those who need to travel through a patient care area (for example support services (i.e. security, nutrition services) and corporate (i.e. those who need to walk through or to a patient area to get to their office) will be required to wear a procedure mask at all times in patient areas including common spaces (i.e. lobbies, hallways, elevators, etc.).

  • The prevalence of COVID-19 is increasing in the community.
  • Some staff or physicians may develop mild symptoms while at work, or may not recognize their symptoms and may come to work. By masking, we can reduce the risk of transmission to our vulnerable patient population, even if this happens.

For staff and physicians in patient care areas, the wearing of a procedure mask will be integrated into the entry screening:

  1. All staff will continue to perform hand hygiene when they enter the building and throughout their shift.​

     

  2. Prior to scanning their badge at entrance screening, staff will go through a self-assessment about specific symptoms. Anyone with symptoms will not be able to work their shift – these staff and physicians are required to call Occupational Health regarding next steps which may include COVID-19 testing if necessary, and will help manage directions to return to work.
    • St. Joseph’s – 416-530-6800
    • St. Michael’s – 416-864-5400
    • Providence – 416-285-3666, ext. 4386

       

  3. Staff and physicians who pass the screen and self-identity as working in a patient care area will be given two procedure masks.

     

  4. Please do not wear your mask home. No used PPE is to be taken home for any reason – please discard it appropriately at the end of your shift.

     

  5. Staff who work in our corporate areas should continue to practice social distancing and proper hand hygiene. If these staff members are required to work intermittently in patient care areas, they can ask for a mask when they enter the hospital and go through our entrance screening process.

     

  6. Masks being worn must always be in the correct position, covering your mouth and nose. Pulling masks down and letting them rest under your chin or pulling them up and resting on your forehead is unsafe and should never be done. If you don’t require your mask, it should be removed and stored safely (or discarded if it is soiled or damaged).
  1. When caring for individuals with suspected or confirmed COVID-19, health care workers should follow droplet precautions (surgical/procedure mask, isolation gown, gloves and eye protection).

  2. This also applies to our COVID-19 Assessment Centres. The guidelines state that workers assessing and obtaining nasopharyngeal swab from staff and patients with COVID-19 symptoms do not require N95 respirators.

  3. N95 respirators, or approved equivalent or better protection, must be used by all health care workers in the room where emergent aerosol-generating medical procedures (AGMPs) are being performed, are frequent or probable, or with intubated patients with suspected or confirmed COVID-19 (see page 14 on this document for a full list of what is and is not considered an AGMP).

  4. As part of routine procedures, every health care worker should be performing a point-of-care risk assessment (PCRA) before every patient interaction. The PCRA should include the frequency and probability of routine or emergent AGMPs being required.

  5. If, based on that PCRA and following the provincial guideline, you determine that additional precautions are necessary given the unique patient presentation, you can connect with your manager for those additional precautions, which can include an N95 respirator.

information about mask use

  • Only staff providing essential clinical or support services should be entering patient care areas – these staff and physicians will be given two masks at the beginning of their shift when they enter the hospital
    • The mask should not be changed before entering or after exiting a patient room including patients in droplet-contact precautions (see instructions for droplet-contact rooms below)
  • Masks do NOT need to be changed unless removed (i.e. to eat or drink), soiled or damaged.
    • If the mask needs to be changed, it should be removed using the straps and discarded. As always, hand hygiene should be performed and the next mask immediately put on.
  • Staff working outside patient care areas can consider working from home as per the Unity Health work from home guidelines. Those who are required on site should practice physical distancing
  • These staff do not require masks – they should not be in patient care areas for any reason
  • Staff working outside patient care settings but within a clinical site may need masks for common areas and to walk through areas where patients may be to get to their offices or other areas. These staff members can access masks as part of their entrance screening
  • Staff should make efforts to identify opportunities to provide care for patients in droplet-contact precautions one after the other and delay charting and other activities until after all these patients have been seen.
  • Staff should NOT remove their mask prior to entering the room, unless you will be using an integrated face shield (face shield attached to a mask), in which case you can discard or store the mask and put on the integrated mask
  • Additional required personal protective equipment should be put on (gown, gloves, face shield).
    • When leaving the room, the gown and gloves should be removed and the mask left on, ensuring hand hygiene is performed as per PPE donning and doffing protocol/training
  • If the staff will be entering rooms of additional patients on droplet-contact precautions sequentially, prior to leaving the clinical area, the face shield (or integrated mask with face shield) should also be left on
  • The face shield or integrated mask with face shield should be discarded and hand hygiene performed only after all droplet-contact patient interactions have been completed
  • The mask (without integrated face shield) should stay on unless soiled or damaged
  • If the patient is also on droplet-contact precautions, regular procedures will continue to be followed
  • Staff should remove and discard their mask prior to entering the room
  • Staff should put on the required personal protective equipment (gown, gloves, face shield, N95 respirator)
  • When leaving the room, all PPE including the N95 respirator should be removed and discarded
  • After removing all PPE and performing hand hygiene, your next mask can be put on
  • Note: we are reviewing opportunities to safely store and reuse N95 respirators. Staff will be notified when/if this protocol is available.

frequently asked questions

Anyone who works in patient care areas and other areas where they are within a six-foot distance from patients. Staff behind a Plexiglas barrier do not need to wear a mask unless they are required to leave the Plexiglas barrier area.

Staff and physicians should dispose of masks when they are removed (i.e. to eat or drink), in addition to any time they become soiled, wet or otherwise contaminated. 

No. You can continue to wear the same mask between patients. Gowns and gloves should be removed. Face shields and masks should continue to be worn and then the face shield can be removed after all interactions with patients on droplet-contact precautions are completed.

  • Do not touch the mask.
  • If you do touch the mask, wash your hands immediately.
  • Do not pull the mask off and put around your neck or forehead as this will increase the risk for spreading infections – the mask should either be on and covering your mouth and nose, or it should be removed and stored.
  • Make sure the mask is covering both your mouth and your nose.

No. The mask should be worn at all times while in patient care areas, including in the nursing station.

Yes. This includes all patient care areas at Unity Health, both inpatient and outpatient settings. Only the patient care areas in these settings are impacted so if you are in an office with the door closed, the mask is not required, even if the office is within the clinical area.

Wearing the procedure mask in patient care areas is required. 

Procedures generating droplets/aerosols include:

  • Endotracheal intubation, including during cardio-pulmonary resuscitation
  • Cardio-pulmonary resuscitation
  • Open airway suctioning
  • Bronchoscopy (diagnostic or therapeutic)
  • Surgery and autopsy
  • Sputum induction (diagnostic or therapeutic)
  • Non-invasive positive pressure ventilation for acute respiratory failure 9CPAP, BiPaP3-5)
  • High flow oxygen therapy

Please check your fit testing card for the make and model and the date in which you were tested. Fit testing is valid for a period of two years. If you need to get retested, please visit the Occupational Health and Safety office at your site.

Providence
Location: OHSW, D207
Monday and Tuesday, 8 a.m. to 4 p.m.
Wednesday, 6:30 a.m. to 4 p.m.
 

St. Joseph’s
Location: OHS, Sunnyside room 204
Monday to Friday, 7:30 a.m. to 3 p.m.

St. Michael’s
Location: CHSS, 2-037 Shuter

Monday to Friday, 7 a.m. to 3 p.m.

As patients do come to the cafeteria, it is appropriate to wear your mask if your role puts you within six feet of patients.

Patients are screened upon admission and once in hospital are regularly assessed for symptoms and fever. Those that are symptomatic would be masked on route to tests. We are asking patients to stay in their rooms as much as possible and to avoid contact with other patients. From a patient safety (and staff safety) perspective, masking staff is our best option as staff may interact with multiple patients, other staff and different areas within the facility. For now, we plan to roll this out to staff and monitor the impact on our PPE supply.  

For now we are rolling this out to staff. We may end up including visitors, although currently we have a no visitor policy for Unity Health so the number of visitors is quite limited.  For those visitors approved under “exceptional situations”, they will be screened prior to entry and if they fail the screen, they will not be able to enter the building.

Here are some talking points you can use with your patients:

  • Staff and physicians in patient-facing roles and patient care areas are wearing procedure masks to protect patients, staff and physicians.
  • When you are in your room, you have enough distance and space around you to keep you protected so you do not need to wear a mask.
  • We are trying to limit the number of people walking around the unit so please use your call bell or speak to a member of your care team if you need assistance and avoid social contact with other patients. Staff who work in our corporate areas and are not patient-facing are practicing social distancing and proper hand hygiene. If these staff are required to work intermittently in a patient-facing area, they will have access to a mask.