Coronavirus (COVID-19): extended use of face masks and face coverings in hospitals, primary care and wider community healthcare

Guidance for staff within acute hospitals, community hospitals, primary care and wider community healthcare, together with advice for visitors, including those attending for an appointment.

This document is part of a collection


To provide guidance in relation to the extended use of Fluid Resistant (Type IIR) Surgical Masks (FRSM) by healthcare staff (including students). This guidance covers primary care (GP practices, dentists, opticians and pharmacies) and wider community healthcare (including adult community care and adult residential settings (excluding adult care homes [1]), and health professionals who visit people in their own homes (including supported living settings), in addition to acute hospitals (including mental health, maternity, neonatal and paediatrics)and community hospitals in areas where individuals are directly cared for and areas where they are not.

This guidance has now been updated to reflect:

  • the context of continuing the extended use of FRSMs in light of the reduction in wider community COVID-19 restrictions and mitigations
  • the wider wearing of FRSMs by clinical and non-clinical hospital staff
  • the importance of FRSMs used by inpatients in hospitals, as well as long-stay/overnight visitors
  • strengthened wording around the need for outpatients to wear face coverings

This guidance also outlines advice about the wearing of face coverings by any individuals who visit these places, including children aged 5 and over.

The guidance for social care staff, adult care home residents, visitors and users of social care has been removed from this document and made into a separate guide.


Across health and community healthcare, the fundamental principles of infection prevention and control (IPC) are essential for preventing the spread of COVID-19. Compliance with hand hygiene, respiratory etiquette, safely optimising ventilation and the appropriate use of personal protective equipment (PPE) in line with national guidance continues to be critical in all settings at all times. This guidance does not replace these measures, but aims to supplement them.

As face coverings guidance in wider public settings in Scotland gradually stands down, certain settings remain where the extended use of facemasks and/or face coverings will still be necessary. In settings such as hospitals, primary care and within wider community healthcare, the wearing and the extended use of FRSM will still be required for healthcare workers, patients and patient visitors. This is due to these settings hosting more clinically vulnerable individuals, for whom COVID-19 infection still poses a greater risk.

On 31 March 2022, NHS Boards were informed of the 'De-escalation of COVID-19 Infection Prevention and Control (IPC) Measures in Health and Social Care Settings to alleviate System Pressures'. This de-escalation has been agreed through consultation with NHS Boards and approved by the COVID-19 Nosocomial Review Group (CNRG). It remains the responsibility of employers to ensure that their staff have the appropriate PPE for the tasks they will undertake.

The key changes relevant to this policy are:

  • removal of two metre physical distancing across all health and care settings (NB: while physical distancing should be reduced where possible, services such as NHS 24 may opt to continue to implement physical distancing in excess of guidance. This choice is based on local context and service needs and after risk assessment based on hierarchy of controls. Consideration should also be given to maximum numbers around a single bed space at any given time to prevent overcrowding in patient areas)
  • minimum bed spacing requirements to be maintained

Despite the changes noted above, the extended use of FRSMs in health and care settings will continue.

The CNRG has attached particular importance to the evidence around nosocomial transmission events, and pre-symptomatic or asymptomatic carriage of COVID-19 in individuals and staff in acute hospitals and adult care homes in Scotland. Pre-symptomatic means a person has the virus but has not yet become unwell, while asymptomatic means a person is carrying the virus and has no symptoms. This additional guidance provides advice on the extended use of face masks by staff within health and community healthcare settings. The CNRG has also reached conclusions about the wearing of face coverings by individuals who visit these places.

It is important to note the difference between face coverings and face masks. Face coverings are made of cloth or other textiles that cover the mouth and nose. Face coverings are largely intended to protect others, not the wearer, against the spread of infection because they cover the nose and mouth which are the main confirmed sources of transmission of the virus that causes COVID-19. When we refer to face masks, this means surgical or other medical grade masks that are used in certain health and social care settings to protect the wearers against hazards and risks.


1. Includes: Community based settings for people with mental health needs, community based settings for people with a learning disability, and community based settings for people who misuse substances, supported accommodation settings, rehabilitation services, residential respite (non-care home), sheltered housing, hospice settings and prison and detention settings.

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