Mask use among health care workers and feelings of safety at work pre- and post- COVID-19 vaccine

•Correct mask use is a highly adopted habit among health care workers. Over 1,600 mask observations showed > 94% compliance in patient facing areas.•Health care workers have diverging narratives of safety about exposure to COVID-19 when around their colleagues, though there was a significant increase in feelings of safety (P < 0.001) after COVID-19 vaccine roll out at our institution.•Direct observation can help quantify mask use among health care workers, similar to its use in hand hygiene promotion.•The common psychological phenomenon of naïve realism and attribution bias likely impact the implementation of safety behaviors among health care workers.•Understanding the behaviors and attitudes of health care workers in shared spaces compared to patient-facing areas help improve safety policies and reduce colleague to colleague infections. Correct mask use can prevent the spread of COVID-19 and hospitals require correct mask use. Despite this, there is variation in mask use among health care workers (HCW). Incorrect mask use may lead to increased infections and decreased feelings of safety. The purpose of this study was to determine variation in mask use among HCW as well as feelings of safety from exposure to COVID-19 when around colleagues before and after COVID-19 vaccine roll out. This study used direct observation to assess mask use in patient-facing areas before and after COVID-19 vaccine. A staff survey was used to assess feelings of safety. Over 1,600 mask observations showed increased compliance from 94.6% to 97.5% (P = .001). Three hundred survey responses showed significantly increased feelings of safety (P < .001) after vaccine roll out, and 203 free-text responses with respondant reasoning were categorized into 6 themes. Understanding mask use behaviors and safety attitudes of HCW can help improve policies, workplace culture, and reduce HCW to HCW infections. Correct mask use was a highly adopted habit in patient-facing areas. The COVID-19 vaccine led to significantly increased feelings of safety among HCW, though the diverging narratives seen in the survey may be helpful to consider when crafting safety interventions.