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

Current guidance - staff in acute and hospital settings (including ambulance staff)

Table 1 outlines the following situations where staff providing direct care to individuals are strongly recommended to wear a face mask at all times throughout their shift.

Table 1

The table below sets out when FRSMs should be worn in hospitals:

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.

There is no plan to formally ‘police’ compliance. However, Healthcare Improvement Scotland, as part of their inspections process in hospitals, will observe compliance of this guidance.  Some areas have introduced ‘PPE Champions’ to support staff to adhere to the guidance, by offering support to mitigate the risks.

Supporting patients and staff with additional needs 

The increased use of face masks has resulted in additional challenges to individuals who are deaf or rely on lip-reading, as well as others with different communication needs.

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 which can be worn to protect staff in healthcare settings where a Type IIR FRSMs 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:

• 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
• 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 can also remove the FRSM if the individual they are supporting/caring for is a person who lip-reads to communicate (if transparent mask is not available/suitable), or if the individual is showing signs of distress. Staff should consider, wherever possible, physical distancing if the FRSM removed.

Current guidance - primary care (GP practices, dentists, opticians and pharmacies) and wider community healthcare settings (excluding care homes)

Table 2

Table 2 outlines the following situations where when FRSMs are strongly recommended to be worn in primary care (GP practices, dentists, opticians and pharmacies) and wider community healthcare settings:

Guidance for patients, outpatients and visitors across all healthcare settings

Table 3 outlines the following situations where when FRSMs are strongly recommended to be worn by patients, outpatients and visitors across all healthcare settings.

Staff should ensure that anyone who is not able to wear a face covering due to an existing medical condition is not forced to do so or refused treatment. Boards should consider what other mitigations can be put in place. 

Clinical teams may wish to include a pre- admission/pre- appointment triage question regarding the individual’s ability to wear a face mask and take the opportunity to encourage the use of face masks.

It may be helpful to advise the individual that the reason for continuing to ask patients to use face masks in healthcare settings is to help protect the many vulnerable individuals using the services.

Table 3

Specific guidance for hospital patients

Patients who are being transferred or transported to hospital are also strongly encouraged to continue to wear a face mask.

Staff are encouraged to engage in a discussion with patients as early as possible in the admission process to promote the importance of using face masks and adhering to other COVID-19 control measures. Posters to support this can be found on the Public Health Scotland website.

If a patient declines to wear a face mask or is unable to tolerate one, the discussion and refusal to wear a FRSM should be noted in their patient/medical records, each time. First and foremost, it helps ensure that a conversation takes place between the clinician and patient about the importance of wearing a face mask. Secondly, in the event that there is transmission within a ward, it is helpful as part of outbreak investigation to understand which controls were in place, including mask wearing.

It is recognised that it will be impractical for individuals to wear face mask at all times and these will have to be removed for reasons such as eating, drinking, sleeping or showering. Individuals should be provided with a new replacement face mask to put on after such activities where removal is required.

The wearing of face masks is particularly important when patients are moving out with their immediate bed space, including when moving around a multi-occupancy room, a ward, department and/or hospital and when transferring between wards, departments and/or hospitals. However, patients should be strongly encouraged to also wear face masks when in bed as much as possible. Even when patients are in single rooms, they are strongly encouraged to wear a mask whenever anyone enters their room, i.e. Including when receiving direct care or receiving visitors.

In cases where patients feel they can’t tolerate wearing a face mask, the option of wearing a face covering should be available to them.

It is recognised that some patients may require respite from wearing a face mask for long periods of time. They should be encouraged to put on a new face mask after a reasonable period of respite time. This should be decided on an individual case-by-case basis.