Masks may be required by staff and visitors in hospitals under new HSE guidance

Masks may be required by staff and visitors at some hospitals and other health facilities under new guidance from the Health Service Executive.

Individual health facilities have been advised to conduct their own risk assessment to consider whether use of face coverings should be widened in light of the current high rates of transmission of flu, Covid-19 and other respiratory viruses.

The advice was drawn up by the HSE’s infection control team and endorsed by chief clinical officer Dr Colm Henry in a letter sent to top staff just before Christmas.

“Factors to consider include the number of respiratory virus cases among the residents or patients and among the staff/ local community, staff vaccination uptake, as well as the physical environment (including ventilation) and the experience of transmission in that setting,” Dr Henry states.

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Among the options he suggests are the use of masks by all staff and visitors in an entire building – both clinical and non-clinical areas –, the use in clinical settings only and their use in a particular bay, ward or unit.

“At this time of high community transmission, it may be appropriate to advise that all staff and visitors in a hospital emergency department use masks as it highly likely that unsuspected cases of respiratory viral infection will be present,” Dr Henry suggests.

Alternatively, it may be appropriate to advise mask use by all staff and visitors in a multi-bed ward or in a community setting that had infection outbreaks in the past. “It may be the experience of settings that in previous seasons, the use of masks by all staff in all areas, clinical and non-clinical, was useful in reducing staff absence and transmission within that setting; and this may influence the decision to introduce masks in all areas again at this time.” It is envisaged the wider use of masks would end once the period of high circulation of viruses ended. At present, they are generally used only where patients have symptoms of viral respiratory infection.

Soaring flu cases and a new dominant variant of Covid-19 will keep hospitals under pressure into the spring, Dr Henry warned in comments made during an online webinar for nursing home operators.

The JN.1 variant of Covid-19 is quickly becoming dominant, with a 28 per cent rise in cases before Christmas. There were almost 80 outbreaks of the virus in the second-last week of 2023.

The Covid-19 outbreaks included 30 in hospitals and 24 in nursing homes, officials said.

Flu and Covid-19 are expected to peak in the next week or so but will continue to exert “lingering effects” on the health service well into spring, according to Dr Henry.

While there is no indication JN.1 is more severe than previous variants, the fact that it is more transmissible will result in increased pressure on hospitals, said Dr Greg Martin, director of the Health Protection Surveillance Centre.

The World Health Organisation last month declared JN. 1, another descendant of the Omicron variant, which is of interest due to its “rapidly increasing spread”. Symptoms are similar to previous variants: sore throat, fatigue, headache, congestion, coughing and fever.

RSV (respiratory syncytial virus) cases and hospitalisations are declining but still high, and this virus will continue to put the service, especially children’s hospitals, under pressure throughout January, Dr Henry said.

An estimated 800 people will need to be hospitalised for flu when it peaks shortly at about 2,700 cases a week, the HSE estimates. Cumulatively over a five-week period, 10,000 cases of flu and 2,900 hospitalisations are forecast.

Flu cases jumped 53 per cent before Christmas, with the number of hospitalisations rising 7 per cent. The number of patients in ICU with flu rose 72 per cent.

Hospital emergency departments set a record for attendances in mid-December, at 27,908. Much of the increase is driven by a rise in the number of over-75s attending.

Despite the rise in demand, Dr Henry said hospitals were in a higher state of readiness this year compared with January 2023, when a record of over 1,000 patients on trolleys was set.

There were 532 patients waiting for admission on Wednesday morning, according to the Irish Nurses and Midwives Organisation. Cork University Hospital had the worst overcrowding, with 79 patients on trolleys, followed by University Hospital Limerick at 69.

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