key: cord-0944354-8aqxtv5c
authors: Reay, Selina; Fryer, John; Patel, Mitul
title: Knitted fluid resistant surgical mask extenders as potential sources of Healthcare Acquired Infections
date: 2020-12-30
journal: Infect Prev Pract
DOI: 10.1016/j.infpip.2020.100112
sha: 3a402db3266e3087df8a8b81bd35d81727095f5c
doc_id: 944354
cord_uid: 8aqxtv5c

nan

Public Health England has published Infection Prevention and Control guidance for use in NHS and non-NHS healthcare settings in the United Kingdom. The guidance recommends fluid-resistant surgical masks (FRSM) as personal protective equipment (PPE) for healthcare workers (HCW) providing direct care to patients in various settings [1] .

Elastic bands on both sides hook up behind the ears to ensure the rectangular mask can cover areas surrounding the mouth and nose. HCWs were required to keep the FRSM on during an entire working shift; up to 12 hours in some cases. The pull of the elastic bands led to complaints of soreness behind the ear among HCWs. To help reduce this soreness, some HCWs procured knitted extenders (Figure 1) informally. Though not endorsed by the local Infection Prevention and Control Team (IPCT) they became widely used by HCWs. Unlike single-or 'sessional-' use masks, an extender is used repeatedly over days. It was felt within the IPCT that these may pose a cross-contamination risk as, like a tie, these would invariably become contaminated while inadvertently adjusting and touching them and were unlikely to be washed on a daily basis.

To test the IPCT's hypothesis we undertook bacterial culture of 15 knitted extenders, worn by HCWs for at least one shift, collected between 17 and 24 August 2020. They were inoculated into nutrient broth for 24 hours and then sub-cultured onto CLED, blood and selective pseudomonas agar plates. After 24 hours, organisms cultured from the plates were identified by mass spectromtetry (MALDI-ToF). All 15 specimens grew at least one coliform organism (Escherichia coli or Klebsiella species) Figure 2 . In addition, three out of 15 grew Pseudomonas aeruginosa (20%) and one out of 15 (6.7%) grew Staphylococcus aureus. A quantitative analysis was not possible due to the use of enrichment broth prior to subculture on solid media.

Following the results a communication was sent out to all HCWs across hospital sites about the cross-contamination risk, advising them to avoid using the knitted extenders.

The global COVID-19 pandemic has seen an unprecedented rise in the use of FRSM in healthcare facilities across the world. Millions of previously unaccustomed HCW are now required to use PPE while at work. The pandemic has also seen a rise in acts of kindness and generosity and a willingness to help [2] . The knitted extenders are generally provided free of charge by charities and individuals with the altruistic aim to help HCWs alleviate pain and soreness behind their ears. However, our results show that they easily become contaminated with known pathogens (predominantly coliforms) and that in a healthcare facility they present a risk of inadvertently transmitting these pathogenic organisms, potentially leading to healthcare associated infection. 

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Mitul Patel* Birmingham Women's and Children's NHS Foundation Trust

We recommend that while acts of charity and altruism should be encouraged, any such interventions must be risk assessed to avoid unforeseen health related consequences.

The authors have no conflicts to declare.

No funding was received in relation to this work.