Dear Center for Phlebotomy Education:

Our phlebotomy staff is being told by our infection prevention professionals that masking during this Covid-19 outbreak isn't necessary unless they are entering an isolation room. Understandably there is a lot of fear among the staff and they are not happy with that decision. What should we do?

My response:

If your hospital is screening all outpatients for symptoms before they enter, as is the case in an increasing number of facilities, it could be that your infection control folks feel the risk to your staff is too low to warrant masks. Depending on your state, region, or city, they may be right. It could also be that there simply aren't enough masks available at your facility to provide to those in contact with asymptomatic patients. Keep in mind, the CDC recommends cloth masks in public when social distancing is difficult. Such would be the case for phlebotomists drawing samples from patients' arms. We suspect your facility is actively engaged in procuring masks for your staff, and would allow personnel to procure or make their own until their inventory is replenished. We would also suggest you reinforce the need for gloving and hand hygiene between patients with your staff. 

We recently posted a question on our facebook page asking what kinds of precautions, if any, phlebotomists are being asked to take in light of the coronavirus outbreak. Although the response was light, most said it was business as usual at their place of employment. Some said they were masking, but not necessarily with N-95 masks.

In addition to the obvious, there are two issues that need to be factored into the decision to require/not require masks for the phlebotomy staff. First, the concerns of patients who know the phlebotomist is exposed to other patients, most of whom are not well. When phlebotomists don masks, even if the infectivity risk is deemed to be low, it provides patients who may not have accurate information on the risk with much needed confidence in the facility's approach to this crisis.

The other issue that cannot be ignored is the concerns of the phlebotomy staff who feel they are not being fully protected. Whether their fear is unfounded or not, it is real. If they feel they are being put at risk, there needs to be an aggressive education campaign to allay those fears. It seems those fears are not being taken into consideration in your workplace. If the situation is not managed properly and the staff isn't provided with an understanding from an infection control professional about the lack of a mask requirement, it could spiral into a much bigger problem. You may find your absentee rate skyrocket, people calling in sick, not because they are but because they feel their employer is putting them at risk. You don't need that on top of everything else.

So we would strongly advocate for greater communication with the staff. They need to know why masks are not being required. The rationale is critical to them, and understandably so. Those who want to make or obtain their own masks should be allowed to do so. The Joint Commission issued a statement recently supporting the use of face masks brought from home.

Got a challenging phlebotomy situation or work-related question? Email us your submission at [email protected] and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)