Horizon drops masks for health-care workers in non-clinical settings Monday, memo reveals

Horizon health-care workers in non-clinical settings won't be required to wear a mask, starting Monday, as part of the "transition phase" of the pandemic, even as the province continues to have "very high rates of COVID-19," according to an internal memo.

Nurses and other professionals are "encouraged but not required to wear a mask" in non-clinical areas, such as offices, break rooms, conference rooms and shuttle services, or where patients/clients and the public are not present, the March 30 bulletin from the infectious diseases and infection prevention and control COVID-19 committee says.

Patients, designated support persons and social visitors will still be required to mask in Horizon facilities, a spokesperson confirmed to CBC, but they will now be asked to screen themselves for COVID-19 symptoms before entering.

Even if patients fail their self-screening at a main entrance, they will still be allowed to proceed to their appointment, the memo obtained by CBC reveals.They will be advised to go directly to their appointment and inform staff they failed.

There are infection prevention and control guidelines in place for the safe management of these patients, said Merita MacMillan, Horizon's regional infection prevention and control lead. They will be placed in a separate area and managed on isolation precautions, she said.

Active screening, where staff ask people questions about COVID symptoms and other potential risks, will continue in emergency departments, it says.

Vitalité will also be "presenting updated guidelines early next week," an unidentified media spokesperson said in an emailed statement. They declined further comment.

Hospital-acquired COVID more likely to kill

New Brunswick continues to have "very high rates of COVID-19," with an estimated prevalence of one per cent, with one person dying per day from the virus, the committee notes under a "Did you know?" section of the memo.

Clinical studies have shown that continuous masking has been associated with a 70 per cent decrease in COVID-19 transmission, it says.

"Masking has been maintained in hospitals, as they house our most vulnerable citizens."

Patients with hospital-acquired COVID-19 have a 30 per cent higher mortality rate than citizens in the community, according to the memo.

Most hospital-acquired COVID-19 is contracted from health-care workers who became infected in the community, it says.

"Horizon is continuing to closely monitor COVID-19 transmission rates and is working on a new plan on how to best use masks to protect our patients when these rates improve."

Asked why Horizon is implementing the changes now, MacMillan replied, "Similar to many other health care organizations, we are gradually easing certain measures where and when it is safe to do so."

Many of Horizon's infection prevention and control protocols, such as continuous masking in all areas, were implemented early in the pandemic, when vaccination rates were low and there was little immunity to COVID -19, MacMillan said in an emailed statement.

The "landscape has changed," she said. "We now have a highly vaccinated population and a substantial portion of our population has hybrid immunity from natural infection."

As to what, if any role worker satisfaction or the desire to attract new workers played in decision, MacMillan said it was based on scientific evidence and aligns with strategies across the country. She did not cite any examples.

The Horizon committee was asked to determine if the colour phase approach to managing the pandemic would continue, according to the memo.

"It was noted that pandemics tend to follow three phases — an acute phase (previously broken down into colour phases), a transition phase and endemic phase (new normal)," it says.

"It was determined that Horizon is currently in the transition phase of the pandemic."

Masks still required in clinical and public areas

As a result, a "de-escalation" of the continuous masking policy begins Monday.

If health-care workers opt not to wear a mask in non-clinical areas, physical distancing of two metres "will be respected whenever possible unless a physical barrier is in place," the memo advises.

Continuous masking will still be required in acute and long-term care clinical settings, in public and common areas, and when leaving a non-clinical setting to travel through clinical settings, it says.

A clinical setting is defined as an area where care or services are provided to a patient or client, such as care units, including nursing stations, outpatient clinics and services, therapeutic services and registration.

Outbreaks, staff shortages may prompt return to masking 

Continuous masking will also still be required in community clinical settings and public and common areas, but optional for those who work outside a Horizon facility and don't provide direct patient or client care, the memo says. In these situations, health-care workers must follow the masking policy of the external organization, it advises.

The memo goes on to note that all department managers may choose to implement continuous masking in non-clinical settings based on multiple factors and "their unique circumstances."

These can include COVID-19 activity and evidence of in-hospital transmission, such as outbreaks, hospitalizations and intensive care unit admissions, as well as health-care worker positivity rates and absenteeism.

Operational capacity is another example, such as critical staffing shortages that could be affected by transmission between health-care workers, the memo says.

New posters to help with self-screening

To assist with the move to passive screening, a poster has been developed to guide people entering Horizon facilities to self-screen for signs and symptoms of COVID-19 and other respiratory viruses.

Although patients who fail will be advised to proceed to their appointment, designated support persons and social visitors who fail are advised not to enter.

Staff who used to serve as screeners will now hand out medical masks and ask people to clean their hands, the memo says.