Ask ECRI: Patient Refusals to Wear Masks

​​​​​​A member recently asked what a medical practice should do if patients refuse to wear masks in the practice's office, citing a disability or health issue.

In our response we noted that requiring people to wear face masks is an increasingly contentious issue as seen in the news nearly every day during the COVID-19 pandemic. Public health organizations and regulatory bodies have been clear, however, that when interacting with the public, those working, visiting, or being treated in a healthcare setting need to wear face masks. For those with a documented health issue or disability that prevents them from wearing masks, reasonable accommodations may be appropriate (e.g., offering telehealth services instead of in-person visits, requiring patients with documented health issues or disabilities to wear face masks only when moving through the practice setting, or when speaking directly with healthcare providers).

The World Health Organization's (WHO) Advice on Using Face Masks focuses on face mask use by healthcare workers but also defines "universal masking" in health facilities as "the requirement to wear a mask by all health workers and anyone entering the facility, no matter what activities are undertaken." WHO recommends: "Decision makers should consider the transmission intensity in the catchment area of the health facility and the feasibility of implementing a policy of continuous mask use for all health workers compared to a policy based on assessed or presumed exposure risk." Healthcare entities that lie within geographic regions with a surge in positive...