Staffing: A Clear Communication Upgrade

For most patients, wearing a surgical mask is a minor inconvenience and a necessary part of receiving care in the era of COVID-19. For patients with a hearing impairment who rely on reading lips, however, a mask effectively severs their communication lifeline. With a small tweak to the standard mask design, you can adhere to critical infection prevention protocols and ensure hearing-impaired patients receive clear information about their care. That's the beauty of a see-through surgical mask, a face covering with a clear vinyl window that allows patients to read their providers' lips.

Like so many great ideas, this one came about organically for us. During a monthly staff meeting, one of our team members mentioned window masks she'd seen on Facebook. Initially, we hoped to simply purchase the masks outright. But during the critical shortage of PPE early in the pandemic, we couldn't find them anywhere. So, we did what any creative and industrious team of healthcare professionals would do: We made the masks ourselves.

A member of our ethics team, Rebecca Tall, was volunteering with a sewing group in the community who pulled together at the start of the COVID-19 crisis to sew masks for health care providers. They called themselves the "Mask Force" and they designed and produced some prototype window masks for us to try. We settled on a preferred design and then took over much of the production ourselves with the help of Grace Donatelli, a retired seamstress and friend of our department.

Over time, we produced more than 200 window masks and shared them across our 12 Sentara hospitals to ensure our providers, chaplains, patient advocates and other staff have access to these tools. The masks were an immediate hit and we kept on making them as time permitted, eventually hitting the 500 mark. In fact, we recently sent a shipment to a physician group at a local ASC to help them communicate with elderly patients who were not only having trouble understanding the physicians, but who were also nervous and in desperate need of little non-verbal things — like a reassuring smile — that weren't possible when the providers' entire face was covered with a mask. We're currently getting requests from a wide range of people who interact with patients, from hospital chaplains to rehab and physical therapy providers. The masks have become a regular tool in our "Communication in a Box" kits that help providers communicate with patients who have hearing impairments or limited English proficiency.

A patient was in tears over how the masks improved interactions with our physicians and nurses.

You don't need a manufacturing plant to create your own window masks but, if you're interested, there are certain things you should know before taking on the task.

• An expert is a must. If you're enlisting volunteers to put together surgical masks, everybody on your Mask Force (or whatever creative name you decide to call it) must know how to sew. I'd strongly encourage you to have at least one expert seamstress at the helm. One of our team members was a retired professional seamstress with all the right equipment. She was able to put together a mask within minutes. For reference, assembly takes about 40 minutes for our less experienced team members.
• Design changes will occur. The mask design we settled on — a 4-inch x 2.5-inch vinyl window with a quarter-inch seam around the outside — is not the design we started with. We went through several prototypes before settling on the mask shown in the picture. For instance, the size of the window went through a few tweaks, and we initially had tie straps, something we decided against in the long run. Even with the help of a professional seamstress, there was some trial and error before we wound up with a usable mask. Flexibility and patience are important. Be prepared to go through some test runs before you find the right design. Finally, whenever you settle on a template, you'll want to check with infection control professionals to make sure it meets all the necessary standards. For detailed instruction on how we created our mask, go to outpatientsurgery.net/forms. Window masks are also more readily available for purchase during the pandemic (osmag.net/NW3ejC).
• Material matters. Because the masks aren't single use, you need to use a material that's strong enough withstand your sterilization process. Ours are made from a combination of Halyard material, a sturdy fabric used in standard hospital masks and gowns, and sheet vinyl for the see-through windows. We tested the sturdiness of our masks through several rounds of hydrogen peroxide disinfection, the process we use for sterilizing N95s so they can be reused.

Our health system's 12 hospitals average about 150 interactions with hearing impaired patients each month, so the masks have a major impact on a macro level. But, to me, it's the individual stories that really stand out. A recent patient with hearing loss and her daughter were literally in tears over how the masks changed everything about their interactions with our physicians and nurses. It really drove home how much of a positive impact these masks can have on patient care.

We're happy to be getting rave reviews from our colleagues across the Sentara system, but the reward is in helping them enhance patients' experiences during the pandemic by being able to communicate clearly and thus serve the Sentara Healthcare mission to improve health every day. OSM