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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.

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Current guidance - staff in hospitals

It is recommended that staff providing direct care to individuals in the following settings should wear a FRSM at all times throughout their shift, as per the National Infection Prevention and Control Manual (NIPCM) Scottish Winter (21/22) Respiratory Infections in Health and Care Settings Addendum. This includes acute hospitals (including mental health, maternity, neonatal and paediatrics) and community hospitals. “Extended” in this regard means that an FRSM will be worn throughout the shift, but should be removed and replaced as necessary (observing hand hygiene before the mask is removed and before putting another mask on), and as recommended during the shift, including e.g. if it becomes contaminated, damaged or moist. A poster, which contains key points and advice on how to wear a face mask, can be found in the winter (21/22), Respiratory Infections in Health and Care Settings Infection Prevention and Control (IPC) Addendum.

Type IIR FRSMs are provided for use by staff in Scotland as part of the extended use of face masks policy. These exceed the WHO minimum standard and are the same masks used by staff when providing direct care. Using the same masks across health and social care settings will help to avoid any confusion or potential errors in mask selection. Staff following this updated guidance should use PPE at the level stipulated, but not exceed it. At the present time, the national stockpile is supplying and delivering these masks via NHS National Services Scotland (NSS).

The increased use of face masks in clinical settings due to the pandemic has resulted in additional challenges for healthcare staff and patients. This includes individuals who are deaf or rely on lip-reading, as well as others with different communication needs.

Health and community healthcare staff should use their professional judgement and undertake a risk assessment in instances where it is necessary to remove the FRSM for a short period, and ensure it is safe to do so - for example, when the person they are supporting / caring for is showing signs of distress, or to communicate with a person who lip-reads.

However, to address this issue, a transparent face mask has been developed which features a clear anti-fog front panel, which has been positioned to prevent reflection and make lip reading easier and can be worn to protect staff in healthcare settings where a Type IIR FRMS would be worn.

NHS Scotland has approved the transparent mask for use by both healthcare staff and patients. This is the first medical grade transparent face mask available for use in Scotland.

These masks have been approved for the use of staff and patients, including those with:

  • additional support needs (speech, language and communication)
  • craniofacial anomalies or conditions
  • adults with brain injury, head and neck cancer, neurological conditions, stroke patients
  • elderly patients, including those with dementia
  • autism or Asperger’s
  • dysphagia
  • hearing impairment or loss
  • mental health needs
  • those with multiple disabilities

as well as staff and patients that need to communicate with other NHS employees that have communication impairments. This list is not exhaustive, and it will be for boards to judge who should have access to transparent face masks.

Staff are not required to wear an FRSM during mealtimes in staff restaurants but should do so when not seated at a table, such as when queueing, entering or leaving the canteen. Carrying out good hand hygiene and safely optimising ventilation within the area is essential during these times. During breaks, and where possible, consideration should be given to facilitating the use of outdoor spaces, which provide a safer alternative than enclosed indoor spaces. Additionally, consideration should be made to the staggering of staff breaks to prevent large numbers of staff from the same care setting spending extended periods of time together whilst not wearing an FRSM.

There will also be instances of staff who may suffer from breathing difficulties, or suffer from genuine discomfort or distress when wearing a FRSM. We expect staff to be fully supported and appropriate steps taken locally to implement the guidance in a way that has regard to staff well-being. A workforce risk assessment should be undertaken in conjunction with occupational health departments.

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