Podcast: Insights into Infection Prevention and Control

This HealthLeaders podcast focuses on several infection prevention topics, including respiratory virus season, emerging pathogen considerations, and healthcare-acquired conditions.

Health systems and hospitals are entering the respiratory virus season with little guidance from local and federal public health agencies, according to the executive medical director of infection prevention and control at UChicago Medicine.

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Infection prevention and control staff are the first line of defense for infectious diseases and infections at health systems and hospitals. They help health systems and hospitals manage interventions such as masking and promote best practices in areas such as healthcare-acquired conditions.

Coming out of the COVID pandemic, there are a lot of questions about the role of masking and other interventions for respiratory viruses such as restricting visitors in hospitals, says Emily Landon, MD, executive medical director of infection prevention and control at UChicago Medicine.

"For a long time, we had a lot of rules that we had to follow from our local public health agencies and the Centers for Disease Control and Prevention," Landon says. "Most of those rules sunset before this year's respiratory virus season."

In the absence of guidance from public health agencies, it is challenging to know when to require masks at healthcare settings, but it is clear that masking helps prevent transmission of respiratory viruses, Landon explains.

"What type of mask you wear helps determine whether or not you are going to be protected," Landon says. "If you want to be protected from a sick person near you, then you need to wear a tight-fitting, N95 mask. If you want to help prevent yourself from giving someone else COVID or influenza, you can do that safely by wearing a surgical mask."

Emily Landon, MD, is executive medical director of infection prevention and control at UChicago Medicine. Photo courtesy of UChicago Medicine.

UChicago Medicine has created a "masking ladder" to manage the wearing of masks during this respiratory virus season.

"We have a team of people including ambulatory staff, people from occupational medicine, people from pharmacy, and people from infection control, and we huddle every Thursday for about 15 minutes," Landon says. "We use a set of metrics to determine how we move up and down the masking ladder."

The bottom rung of the masking ladder is when staff wear masks when they are sick. The next rung of the masking ladder is called the yellow level, according to Landon.

"At the yellow level, we know something is coming such as seeing a new variant or seeing more cases of influenza," Landon says. "At the yellow level, staff still wear masks when they are sick, but we also tell people that respiratory virus season is heating up and they should be more careful, they should stay home if they are sick, and they should get tested if they feel sick."

The next rung on the ladder is the orange level.

"When we start seeing higher respiratory virus numbers in our community and among staff at our care settings, we switch to the orange level," Landon says, "which requires all staff members to wear masks when they are in direct patient care."

The top rung on the ladder requires universal masking, including for patients.

"If we see widespread problems such as lots of people being admitted to the hospital with respiratory viruses or lots of staff sick in multiple areas of the hospital," Landon says, "then we would consider universal masking, including for patients."

So far during the early days of this year's respiratory virus season, UChicago Medicine has been able to limit infections in healthcare settings, according to Landon.

"We track hospital-acquired COVID, influenza, and RSV at the University of Chicago, and we have been successful in preventing patients from getting sick in the hospital just by requiring masks for staff members when we see infections in healthcare workers," Landon says. "You can get by using fewer masks than you did during the COVID pandemic, but masking has the benefit of patients not getting sick from healthcare workers."