{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:17:45Z","timestamp":1785428265838,"version":"3.56.0"},"reference-count":30,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X26104875_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Transmission of respiratory illnesses in health care settings poses significant risks to patients and staff. Without clear, standardized masking thresholds, policies may vary, resulting in confusion. We developed statewide consensus thresholds to guide masking in Minnesota health care systems over three respiratory seasons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104875_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A multidisciplinary workgroup consisting of infection preventionists, infectious disease providers, occupational health specialists, and representatives from the state health department reviewed available data, including hospitalization rates, influenza-like illness levels, test positivity, and wastewater data. Thresholds used for masking were evaluated and updated each year after analyzing performance and feedback from health care facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104875_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Analysis of the first season thresholds revealed issues with data sources selected and resulted in the group changing threshold recommendations from illness levels to hospitalization rates. Analysis of the second season thresholds revealed issues with masking timing and threshold recommendations for COVID-19 hospitalization leading to changes in COVID-19 masking thresholds and the addition of a masking implementation date for season three. Nine of out ten health systems reporting implementing universal masking during the respiratory season. Those that implemented masking reporting strong staff and leadership support due to the aligned metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104875_as4\">\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Development of standardized thresholds improved staff support for masking and reduced staff and patient confusion. Use of basic epidemiology tools in threshold development allowed for replication across healthcare systems and easy communication of thresholds to staff and patients. Data reporting lags can delay masking during periods of rapidly increasing illness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2026.10487","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:56:10Z","timestamp":1781160970000},"page":"823-829","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Collaborative approaches to masking: statewide threshold development and performance across three respiratory seasons"],"prefix":"10.1017","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0679-6977","authenticated-orcid":false,"given":"Jessica","family":"Nerby","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04esegk75","id-type":"ROR","asserted-by":"publisher"}],"name":"Safety, Quality and Experience, Allina Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7815-0101","authenticated-orcid":false,"given":"Wendy","family":"Berg","sequence":"additional","affiliation":[{"name":"Infection Prevention and Control, Children\u2019s Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindy","family":"McFarren","sequence":"additional","affiliation":[{"name":"Infection Prevention and Control, M Health Fairview"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Rhame","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04esegk75","id-type":"ROR","asserted-by":"publisher"}],"name":"Safety, Quality and Experience, Allina Health"},{"name":"University of Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"S0899823X26104875_ref8","unstructured":"8. CDC. Infection prevention and control strategies for seasonal influenza in healthcare settings. https:\/\/www.cdc.gov\/flu\/hcp\/infection-control\/healthcare-settings.html. Accessed August 25, 2025."},{"key":"S0899823X26104875_ref5","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2023.143"},{"key":"S0899823X26104875_ref30","unstructured":"30. Centers for Disease Control and prevention RSV-NET interactive dashboard. https:\/\/www.cdc.gov\/rsv\/php\/surveillance\/rsv-net.html. Accessed December 2025."},{"key":"S0899823X26104875_ref11","doi-asserted-by":"publisher","DOI":"10.7326\/M23-1190"},{"key":"S0899823X26104875_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnsa.2024.100261"},{"key":"S0899823X26104875_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.idh.2020.11.004"},{"key":"S0899823X26104875_ref4","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2021.392"},{"key":"S0899823X26104875_ref17","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.46405"},{"key":"S0899823X26104875_ref1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.29441"},{"key":"S0899823X26104875_ref14","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-0869-5"},{"key":"S0899823X26104875_ref7","unstructured":"7. CDC. Infection control guidance: SARS-CoV-2, 2024. https:\/\/www.cdc.gov\/covid\/hcp\/infection-control\/index.html, Accessed August 2025."},{"key":"S0899823X26104875_ref3","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.25652"},{"key":"S0899823X26104875_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(21)00141-8"},{"key":"S0899823X26104875_ref10","doi-asserted-by":"publisher","DOI":"10.7326\/M23-0793"},{"key":"S0899823X26104875_ref12","doi-asserted-by":"publisher","DOI":"10.7326\/M23-1230"},{"key":"S0899823X26104875_ref24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1750-2659.2012.00422.x"},{"key":"S0899823X26104875_ref9","unstructured":"9. Healthcare Infection Control Practices Advisory Committee. Draft 2024 guideline to prevent transmission of pathogens in healthcare settings. https:\/\/www.cdc.gov\/hicpac\/media\/pdfs\/DRAFT-2024-Guideline-to-Prevent-Transmission-of-Pathogens-2023-10-23-508.pdf. Accessed August 2025."},{"key":"S0899823X26104875_ref27","unstructured":"27. Centers for Disease Control and Prevention COVID Surveillance and Data Analytic. https:\/\/www.cdc.gov\/covid\/php\/surveillance\/index.html, Accessed December 2025."},{"key":"S0899823X26104875_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz020"},{"key":"S0899823X26104875_ref13","first-page":"223","article-title":"Estimating the extent of asymptomatic COVID-19 and its potential for community transmission: systematic review and meta-analysis","volume":"5","author":"Byambasure","year":"2020","journal-title":"J Assoc Med Microbiol Infect Dis Can"},{"key":"S0899823X26104875_ref28","unstructured":"28. Minnesota Department of Health Respiratory Illness Report. https:\/\/www.health.state.mn.us\/diseases\/respiratory\/stats\/index.html. Accessed December 2025."},{"key":"S0899823X26104875_ref20","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.39443"},{"key":"S0899823X26104875_ref25","unstructured":"25. Minnesota Department of Health. https:\/\/www.health.state.mn.us\/data\/economics\/hccis\/facilities.html. Accessed November 2025."},{"key":"S0899823X26104875_ref26","unstructured":"26. Centers for Disease Control and Prevention Influenza Summary. https:\/\/www.cdc.gov\/fluview\/surveillance\/usmap.html. Accessed December 2025."},{"key":"S0899823X26104875_ref29","unstructured":"29. University of Minnesota Wastewater Surveillance Study. https:\/\/wastewater.uspatial.umn.edu\/sars-cov-2\/. 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Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}