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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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COVID-19 guidance on the extended use of fluid resistant (Type IIR) surgical masks (FRSMs) and face coverings in hospitals, primary care and wider community care 

Below you will find answers to help anyone affected by the new guidance understand how it applies to staff, individuals receiving care and visitors in a health care or community healthcare setting. To help you find the information you are looking for, the questions have been split up into the following sections:

This is a live document which provides clarity around any points of uncertainty. It will be regularly updated as we receive further feedback. Please ensure you are using the latest version of this guidance. 

Guidance overview

This guidance is for

  • all staff, patients and visitors in hospitals and primary care settings including office based, domestic and non-direct care staff working within these areas
  • health professionals working in the wider community including providing health and direct care in individuals homes
  • individuals whom receive care from health professionals within their homes

Why the guidance has changed

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 fluid resistant surgical masks (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

There is scientific evidence about the risk of spread of COVID-19 from people who are not displaying any symptoms but can still be infectious - either because they have the virus but have not yet become unwell –‘pre-symptomatic’- or because they are carrying the virus and have no symptoms – ‘asymptomatic’.

There is a risk of COVID-19 transmission between staff when in close contact and therefore the extended use of FRSMs by health and wider community healthcare workers is designed to protect staff. 

The extended use of FRSMs to cover primary care (GP practices, dentists, opticians and pharmacies) and wider community healthcare recognises that as NHS services remobilise, an increase in footfall is expected and so there is potential for greater risk of exposure in these areas.

Key changes for hospital staff

All staff in hospitals are strongly recommended to continue to wear a FRSM, at all times, throughout their shift, except in a limited number of circumstances, such as working alone in a closed office, or seated in a non-clinical area, where all control measures are in place, i.e. good ventilation, easy access to hand washing and/or hand sanitising facilities and regular cleaning of the area.

Boards may choose to maintain physical distancing in non- clinical areas to prevent large numbers of staff being identified as contacts or subsequent cases and resulting in service impact when high numbers have to self-isolate.

Staff who work solely in non-clinical buildings - such as NHS Board headquarters or other standalone offices – and who do not enter buildings where patient care is provided, would not be expected to wear FRSMs, but instead may wear their own face covering when not seated at their desk and when walking about the office. Staff members who work in non-clinical buildings but as part of their job role will enter a building where patient care is provided should change to a FRSM.

Boards may choose to maintain physical distancing in these areas to prevent large numbers of staff being identified as contacts or subsequent cases and resulting in service impact when high numbers have to self-isolate.

Key changes for individuals receiving care in hospital

All individuals in all pathways in hospitals will be strongly recommended to continue to wear a FRSM if this can be tolerated and does not compromise care, such as when receiving oxygen therapy, or during labour, or they have an existing medical condition which prevents the wearing of a FRSM.

The expectation would be that patients would be are strongly recommended to continue to wear FRSM in bed, where patients in bed are two metres or more apart, but is particularly important where patients are moving about the ward or between different areas. 

This also applies to patients who are being transferred or transported to hospital. In NHS Scotland, FRSM are provided to all in-patients.

Key changes for visitors to hospitals

Long stay and/or overnight visitors, such as birthing partners, parents of children who are in long stay wards, or appropriate adults or families of patients who have learning disabilities, and who are required to stay in hospital with the patient for a prolonged period of time, are strongly recommended to continue to wear a FRSM (unless they have an existing medical condition which prevents this).

Key changes for staff working in non-direct patient care areas in primary and community healthcare settings (excluding care homes)

If you work in an office/reception, or other non-clinical area where there are no patients/residents, it is recommended that you wear a face covering when not seated whilst at work, except in a limited number of circumstances, such as when working alone in a closed office. Control measures continue to be essential, i.e. good ventilation, easy access to hand washing and/or hand sanitising facilities and regular cleaning of the area.

Boards may choose to maintain physical distancing in these areas to prevent large numbers of staff being identified as contacts or subsequent cases and resulting in service impact when high numbers have to self-isolate.

Staff

Mask wearing for office-based staff

Office based staff in hospitals

If you work in an office, or other non-direct care area within an acute hospital, it is recommended that you wear a face covering when not seated whilst at work, except in a limited number of circumstances, such as when working alone in a closed office. Control measures continue to be essential, i.e. good ventilation, easy access to hand washing and/or hand sanitising facilities and regular cleaning of the area.

Boards may choose to maintain physical distancing in these areas to prevent large numbers of staff being identified as contacts or subsequent cases and resulting in service impact when high numbers have to self-isolate.

Wearing of a FRSM in corridors and other public spaces in hospitals is also still recommended.

Office based staff in surgeries and adult community healthcare settings

If you work in an office, or other non-direct care area, it is recommended that you wear a face covering when not seated whilst at work, except in a limited number of circumstances, such as when working alone in a closed office. Control measures continue to be essential, i.e. good ventilation, easy access to hand washing and/or hand sanitising facilities and regular cleaning of the area.

Boards may choose to maintain physical distancing in these areas to prevent large numbers of staff being identified as contacts or subsequent cases and resulting in service impact when high numbers have to self-isolate.

Wearing of a FRSM in corridors and other public spaces is also still recommended in surgeries and community settings. Employers will decide locally how best to apply the guidance by staff in their facility/workplace.

Removng FRSM to take a drink

It is important to keep hydrated throughout your shift, particularly as it can become hot and uncomfortable wearing masks over a long period of time. Staff must observe hand hygiene prior to removing their FRSM and taking a drink. Hand hygiene must be observed after taking a drink and before putting a new FRSM on.

Direct care staff wearing a FRSM in GP practice or in the community

The guidance covers the use of FRSM in primary care (GP practices, dentists, opticians and pharmacies) and health professionals working in community healthcare settings excluding care homes in addition to acute hospitals (including mental health, maternity, neonatal and paediatrics) and community hospitals, in direct care settings. It outlines that it is strongly recommended that staff engaged in direct care wear a FRSM at all times throughout their shift.

Mask wearing for staff working in out of hours and primary care services who work out of hospital outpatient departments

We are asking all staff who work from a hospital base to follow the guidance and wear a FRSM as outlined above.

Mask wearing for health professional working in the community visiting users of health and care services at home

If you are a health professional it is strongly recommended that you wear a FRSM at all times when carrying out your role within an individual’s home. If you are involved in direct care, you will be required to wear a FRSM and other PPE as set out in the Scottish Winter (21/22) Respiratory Infections in Health and Care Settings Addendum.

Individuals receiving care are recommended to wear a face covering in their own home. However, they may choose not to do so and this should be respected.

As the person providing care will have a FRSM, this will provide both protection to the wearer and client.

Other household members wearing face coverings when a health professional is providing a service within the home

Other household members are strongly recommended to wear a face covering in their own home when they are present during a care episode. Staff should continue to wear a FRSM and ensure other IPC measures such as hand hygiene, respiratory etiquette, ventilation and physical distancing are observed.

Face coverings for receptionists in health centre/doctors surgeries

If you work in an office/reception, or other non-clinical area where there are no patients, it is strongly recommended that you wear a face covering when not seated whilst at work, except in a limited number of circumstances, such as when working alone in a closed office. Control measures continue to be essential, i.e. good ventilation, easy access to hand washing and/or hand sanitising facilities and regular cleaning of the area.

Boards may choose to maintain physical distancing in these areas to prevent large numbers of staff being identified as contacts or subsequent cases and resulting in service impact when high numbers have to self-isolate.

Wearing an FRSM or face covering when you have a medical condition, which makes it difficult to wear

Please discuss this with your line manager in the first instance to ensure that you have the support you need and that you are confident that you are appropriately protected. You will not be forced to wear a face mask/covering.

Where this applies to a visitor wearing a face covering/ FRSM, health boards will need to mitigate the risks and put appropriate measures in place. A risk assessment tool and guidance have been developed to enable a conversation between yourself, your manager and occupational health.

Managing issues with glasses steaming up when wearing a FRSM

The nose strip on the FRSM has been changed to improve the fit around the nose. This will help minimise the risk of your glasses steaming up. You may also wish to change your FRSM more frequently. If this is not the case, please speak to your line manager or occupational health team.

Using personal face coverings at work 

This will be a decision for your employer and will depend on your role. Those involved in direct patient care should wear a FRSM throughout their shift as noted above. Some NHS Boards, may put in place a local policy that staff should wear a FRSM rather than a face covering. It should be noted that face coverings are not appropriate for clinical care areas. It may also be difficult for uniformed staff to safely store, launder and easily access their own face coverings for use whilst on duty and it may not be appropriate to wear the same face covering that you wear on public transport. 

Wearing a face covering when traveling on public transport to work

Health boards will not provide face coverings for the provision of traveling to work on public transport. Individuals can choose which type of face covering they wish to wear outside of work. Members of the public are encouraged to wear a face covering when using public transport.

Waste disposal of FRSMs

Hands must be washed or decontaminated with soap and water, or alcohol-based hand rub, before and after touching/removing a face mask. FRSMs must be disposed of in line with Scottish Winter (21/22) Respiratory Infections in Health and Care Settings Addendum and determined by the COVID-19 respiratory pathway the patient is on.

Managing supply of FRSMs to meet everyone’s needs

National procurement have confirmed there is plentiful stock available to meet any increase in demand.

Accessing FRSMs within the workplace

A local decision will be made by health boards regarding how staff access FRSMs. NHS boards may choose to make FRSMs available at the entrance to all wards and departments, and at additional PPE stations provided throughout the sites. 

Mask wearing for staff members whom provide direct care

a) in hospitals

You are strongly recommended to wear a FRSM at all times regardless if you are in a clinical or non-clinical area (including communal areas such as canteens and rest rooms), except in a limited number of circumstances, such as when working alone in a closed office, or when seated in a non-clinical area where all other control measures are in place.

Boards may choose to maintain physical distancing in non- clinical areas to prevent large numbers of staff being identified as contacts or subsequent cases and resulting in service impact when high numbers have to self-isolate.

b) in primary care and community healthcare settings

If you work in a direct care role, you are strongly recommended to wear a FRSM at all times regardless of your ability to physically distance from others. If you are in a non-clinical/non-direct care area/or not providing direct care to an individual, a face covering will be required when seated, except in a limited number of circumstances when working alone in a closed office, or in a non-clinical area, such as when seated on your break, where all other control measures are in place.

Boards may choose to maintain physical distancing in non-clinical areas to prevent large numbers of staff being identified as contacts or subsequent cases and resulting in service impact when high numbers have to self-isolate.

Community nurses and other health professionals will be able to remove FRSMs when travelling between locations, unless car sharing, and should wear a face covering if travelling on public transport.

Process for ensuring compliance with FRSMs wearing in corridors where social distancing cannot be achieved

We expect all staff to act as good role models and comply with the guidance provided. 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.

Wearing a FRSM when face fit testing

All testers should wear a FRSM when carrying out face fit testing as this role will prevent you from physical distancing.

Wearing a face covering/ FRSM during mealtimes

Staff are not required to wear a face covering/ FRSM during mealtimes in staff restaurants or break areas but should do so when not seated at a table, such as when queueing, entering or leaving the canteen/ communal break area (in line with other hospitality venues).

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. Alternatively, consideration should be made to the staggering of staff breaks etc.

It is important to note that overcrowding in any area of a healthcare facility, including inpatient areas, waiting areas, outpatient departments, canteens and rest areas increases transmission risk for respiratory viruses including COVID-19 and it is important to remain mindful of the volume of people in a space at any one time taking account of healthcare workers, patients and visitors. Settings must not return to pre-pandemic practices which facilitated overcrowding and steps should be taken to prevent this.

Boards may choose to maintain physical distancing in these areas to prevent large numbers of staff being identified as contacts or subsequent cases and resulting in service impact when high numbers have to self-isolate.

Wearing a face covering/FRSM in other communal workplace areas

a) in hospitals

FRSMs are strongly recommended to be worn at all times in communal areas.

b) in primary care and community healthcare settings (excluding care homes)

Face coverings/FRSMs (depending on your whether your role involves providing direct care) are strongly recommended to be worn in communal areas during your shift.

Definition of “direct care” for the purpose of this guidance

When we talk about “direct care”, we are referring to a staff member’s role, rather than distinct activities. This would include anyone who is providing care to a patient, or users of a health service. Staff in this situation should continue to wear appropriate PPE in line with the Scottish Winter (21/22) Respiratory Infections in Health and Care Settings Addendum and according to their own professional judgement.

Wearing a face covering whilst travelling between people’s homes for the provision of professional health care

If travelling between people’s homes using public transport, or placed in a situation where physical distancing is not possible in line with wider national guidance, personal face coverings should be worn. If you are travelling alone between people’s homes, you do not have to wear a face covering.

Individuals receiving care and visitors

Visitor wearing face coverings when physically distance from others

Any individual visiting or attending an acute adult hospital (including mental health, maternity, neonatal and paediatrics), community hospitals and primary care premises (GP practices, dentists, opticians and pharmacies), are strongly recommended to wear a face covering.

Visitors are strongly recommended to continue to wear face coverings when seated at the bedside of patients.

Long stay and/or overnight visitors, such as birthing partners, parents of children who are in long stay wards or appropriate adults or families of patients who have learning disabilities, and who are required to stay in hospital with the patient for a prolonged period of time, are strongly recommended to continue to wear a FRSM, (or face covering if this cannot be tolerated), unless they have an existing medical condition which prevents this).

The hospital and primary care service should provide visitors with a FRSM where required.

Mask wearing for in-patients receiving care in bed

All individuals in all pathways in hospitals are strongly recommended to use a FRSM if this can be tolerated and does not compromise care, for example, when receiving oxygen therapy, during labour, or they have an existing medical condition which prevents the wearing of a FRSM. The expectation would be that patients would be required to wear a FRSM in bed, where patients in bed are two metres or more apart, but is particularly important where patients are moving about the ward or between different areas. 

In cases where patients feel they cannot tolerate the wearing of a FRSM, the option of wearing a face covering should be available to them. 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. They should be encouraged to put on a new mask after a reasonable period of respite time. This should be decided on an individual case-by-case basis.

Guidance on what face coverings patients and visitors should wear when attending for appointments

All patients attending clinics, and all hospital visitors are strongly recommended to wear a face covering when attending (unless they have an existing medical condition which prevents this). A face mask can be offered if necessary.

Children over the age of 5 years old are also strongly encouraged to wear a face covering when visiting or attending a hospital, or any other health service or social care service, based on the WHO guidance published on 21 August 2020.

Communications of face covering requirement to patients by health boards

Health boards can include generic information on the use of face coverings in appointment letters and other communications.

Other communication methods could include using social media to promote this requirement and clear signage at entry points. A poster is available here.

Providing members of the public with replacement face coverings in the event of contamination or the face covering getting wet

Members of the public can wear their own face coverings to hospitals. If the face covering worn gets wet or is contaminated, hospitals should provide a replacement mask to the member of the public. Face masks will be available in all wards and departments, or a replacement mask can be provided on request.

Actions that can be taken if an individual receiving care or a visitor refuses to wear a face covering in hospital

a) individual receiving care in hospital

A discussion should take place with the individual asking them if they are content to wear a FRSM, or for people who lack capacity, their legal guardian or a family member, unless they have an existing medical condition which prevents them from wearing one. 

If they refuse, this should only be noted in their patient/medical records each time. Staff should continue to wear a FRSM in this situation and ensure other IPC measures such as hand hygiene, respiratory etiquette and ventilation are observed.

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

b) visitors and outpatients in hospitals

Politely encourage all individuals to use a face covering, or offer them a FRSM to wear, and where necessary, highlight the benefits of wearing a face covering. The hospital, primary care service should provide visitors with a FRSM where required.

Where visitors decline to wear face coverings, clinicians should apply judgement and consider if other IPC measures, such as hand hygiene, respiratory etiquette, ventilation are sufficient depending on the patient/ resident/client’s condition and the care pathway.

The vast majority of people can wear a face covering and if they do not have an existing medical condition which prevents them from wearing one, then are strongly encouraged to do so. The support of employers and staff in encouraging the use of face coverings is vital to their success as a healthcare intervention.

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