Healthcare Worker Perceptions of Mask Use during a Nosocomial Pertussis Outbreak—Pennsylvania, 2003

BACKGROUND: Recent experiences with severe acute respiratory syndrome (SARS) and influenza have led to new Respiratory Hygiene and Cough Etiquette (RHCE) recommendations that include use of surgical masks by healthcare workers (HCWs) who come within 3 feet of all patients with symptoms of respiratory infection. In September 2003, prior to these recommendations, eight HCWs at a Pennsylvania tertiary-care hospital developed respiratory symptoms after exposure to an infant with pertussis. We observed that HCWs did not routinely wear masks while caring for patients with cough illness. Anticipating the new recommendations and in an effort to understand potential barriers for implementation, we evaluated perceptions of mask use among HCWs in this hospital. METHODS: We conducted focus group discussions (FGDs) with two groups of nurses and one group of physicians (n1=4, n2=6, n3=9). Based on the discussions, we developed a structured, self-administered questionnaire for distribution to all HCWs present during two consecutive hospital shifts. RESULTS: Overall, 96 of 120 (80%) HCWs responded. Forty-nine (51%) respondents viewed coughing patients as potentially contagious to other patients and HCWs, and 67 (70%) believed that they and their patients would be protected against droplet infections by masks. Forty-three (45%) HCWs perceived obstacles to using mask. Masks were considered a barrier to a trusting provider-patient relationship: 20 HCWs felt that a provider in a mask increased worries among patients, and 26 thought that the mask was a barrier to communicating with patients. Thirty respondents indicated that wearing a mask was uncomfortable and/or a burden. HCWs were less likely to perceive obstacles if they recognized a risk for patient-to-patient transmission (27/35 versus 31/61; P=0.0095). CONCLUSIONS: Our findings suggest several potential barriers among HCWs to mask use, despite a recent pertussis outbreak in the hospital. HCWs may benefit from education regarding the risk of nosocomial transmission of respiratory pathogens such as SARS, influenza, and pertussis. Patients should be educated on the benefits of HCW mask use and its association with quality medical care.