Specific guidance for hospitals
FRSMs must also be made available to and worn by all hospital inpatients (unless exempt) across all pathways, where it can be tolerated and does not compromise clinical care (e.g. when receiving oxygen therapy or when in labour). This also applies to patients who are being transferred or transported to hospital. Staff are encouraged to engage in a discussion with patients as early as possible in the admission process to promote the importance of using facemask and adhering to other COVID-19 control measures.
In hospital, if a patient declines to wear a FRSM or is unable to tolerate one, the discussion and refusal to wear a FRSM should be noted in their patient/ medical records, each time, and not enforced. First and foremost, it helps ensure that a conversation takes place between the clinician and patient about the importance of wearing a FRSM. 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 FRSM 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 FRSM to put on after such activities where removal is required. When sleeping, patient heads should be at least 2 metres apart (i.e. centre of bed to centre of adjacent bed at least 2.7m, ≥2.9m preferred; centre of patient treatment chair/trolley to centre of adjacent chair/trolley at least 2.5m).
This is particularly important when patients are moving outwith their immediate bed space (i.e. within 2m of other people), 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 also wear face masks when in bed as much as possible. Even when patients are in single rooms, they should 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 FRSM, the option of wearing a face covering should be available to them. The minimum requirement set out in the extant national guidance is that all patients and visitors must wear a face covering or mask when entering health and care settings, unless they are exempt.
If someone is not wearing a face covering when they enter your workplace, it’s probably because they’ve forgotten to put it on. Employees should assess whether they feel comfortable and confident to approach patients, and if they do, they can say ‘unless you’re exempt, you need to wear a face covering in this space/building.’
It is recognised that some patients may require respite from wearing a FRSM for long periods of time. If so, they should be supported to do so whilst remaining within their bed space and more than 2 metres from all other patients. They should be encouraged to put on a new FRSM after a reasonable period of respite time. This should be decided on an individual case-by-case basis.
In longer stay areas, such as secure care mental health settings, there may be security reasons for patients’ faces to be seen at all times. In such areas, carrying out 2 metre physical distancing is essential, as is good hand hygiene and safely optimising ventilation.