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

Published: 9 Nov 2020
Last updated: 8 Oct 2021 - see all updates

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

Coronavirus (COVID-19): guidance on the extended use of face masks and face coverings in hospitals, primary care and wider community care
More information (questions and answers)

More information

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 care 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

On 26 October 2020, the Scottish COVID-19 Infection Prevention & Control Addendum for Acute settings was published as an addition to the National Infection Prevention and Control Manual (NIPCM). This addendum was developed in collaboration with NHS boards to provide Scottish context to the UK COVID-19 IPC remobilisation guidance, published on 21 August 2020, as some deviations exist for Scotland, which have 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. 

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’.

The extended use of FRSMs by health and wider community care workers is designed to protect staff. Because it is often difficult in hospitals and other community health care settings to maintain physical distancing – there is a risk that the infection can be spread from staff to 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 recommended to wear FRSM, at all times, throughout their shift, except in a limited number of circumstances, such as working alone in a closed office, or in a non-clinical area, where all control measures are in place, i.e. good ventilation; physical distancing, with staff 2 metres apart; easy access to hand washing and/or hand sanitising facilities; and regular cleaning of the area.

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. Staff members who work in non-clinical buildings but as part of their job role will enter a building where patient care is provided would be expected to change to a FRSM.

Key changes for individuals receiving care in hospital

All individuals in all pathways in hospitals should use a FRSM if this can be tolerated and does not compromise care, such as when receiving oxygen therapy, or during labour, or fall under one of the exemptions specified in the regulations. The expectation would be that patients would be required to wear FRSM in bed, where patients in bed are 2m 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. As outlined above, guidance on in-patient mask wearing is included separately via the Scottish COVID-19 Addendum.

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, will be asked to wear surgical face masks, (or face covering if FRSM cannot be tolerated, unless they fall under one of the exemptions specified in the regulations).

Key changes for staff working in non-direct patient care areas in primary and community health care 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 at all times, whilst at work, except in a limited number of circumstances, such as when working alone in a closed office or in a non-clinical area where all other control measures are in place, i.e. good ventilation; physical distancing, with staff 2 metres apart; easy access to hand washing and/or hand sanitising facilities; and regular cleaning of the area.

Key changes for visitors to primary and community care

Wording has been strengthened to confirm visitors should wear a face covering where this can be tolerated, where it does not compromise care and they are not exempt.

Staff

Mask wearing for office based staff

a) in hospitals

If you work in an office, or other non-direct care area within an acute hospital, you should wear a FRSM at all times, whilst at work, except in a limited number of circumstances, such as when working alone in a closed office, or in a non-clinical area, where all other control measures are in place, i.e. good ventilation; physical distancing, with staff 2 metres apart; easy access to hand washing and/or hand sanitising facilities; and regular cleaning of the area.

Every effort should be made by boards or care providers to ensure staff are able to physically distance, for instance staggered start times, working from home, etc.

You should wear a FRSM in corridors and other public spaces in hospitals.

b) 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 at all times, whilst at work, except in a limited number of circumstances, such as when working alone in a closed office, or in a non-direct care area, where all other control measures are in place, i.e. good ventilation; physical distancing, with staff 2 metres apart; easy access to hand washing and/or hand sanitising facilities; and regular cleaning of the area.

You should wear a face covering in corridors and other public spaces in surgeries and community settings where it is not always possible to observe physical distancing measures.  Employers will decide locally how best the guidance should be applied by staff in their facility/workplace.

The protocol for staff returning to work from shielding

Where you have staff who are returning to work from shielding, and if they are routinely or regularly less than 1 metre or more to 2 metres  distance from others (depending on the local setting), they may wish to discuss how physical distancing impacts them with their line manager and/or occupational health. Every effort should be made by boards and care providers to ensure staff are able to physically distance, for instance staggered start times, working from home.

Every effort should be made by boards and care providers to ensure staff are able to physically distance, for instance staggered start times, working from home.

Read further shielding advice on our website

Removing 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 should observe hand hygiene prior to removing their FRSM and taking a drink. Hand hygiene should be observed after taking a drink and before putting a new FRSM on. We would also encourage employers to plan breaks in such a way that allows 1 metre or more to 2 metres physical distancing (depending on local setting, with 2 metres being the minimum requirement for staff removing masks) and in outdoor environments and therefore staff not having to wear a face mask, when on their break.

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 care 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 staff engaged in direct care should 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 you will be required to wear an FRSM at all times when in 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 per the Scottish IPC COVID-19 addendum. Individuals receiving care are encouraged 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, and provide source control.

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

Other household members should be encouraged 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.

FRSMs for receptionists  working in outpatient departments in acute hospitals

Receptionists should also wear a FRSM at all times throughout their shift.

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 recommended that you wear a face covering at all times, whilst at work, except in a limited number of circumstances, such as when working alone in a closed office or in a non-clinical area where all other control measures are in place, i.e. good ventilation; physical distancing, with staff 2 metres apart; easy access to hand washing and/or hand sanitising facilities; and regular cleaning of the area.

Wearing an FRSM or face covering when you have a medical condition, which makes it difficult for me 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 steam 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 care must wear a FRSM throughout their shift as noted above. Some NHS Boards, may put in place a local policy that staff must 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. Face coverings are also provided by some transport providers. However, it is mandatory to wear a face covering, at this time.

Waste disposal of FRSMs

Hands should be washed or decontaminated with soap and water, or alcohol based hand rub, before and after touching/removing a face mask. FRSMs should be disposed of in line with COVID-19 Scottish addenda and determined by the COVID-19 care 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 through this change of policy.

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 and are physically distanced from others

a) in hospitals

You will be required 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 - when working alone in a closed office, or in a non-clinical area where all other control measures are in place, i.e. good ventilation; physical distancing, with staff 2 metres apart; easy access to hand washing and/or hand sanitising facilities; and regular cleaning of the area.

b) in primary care and community health care settings

If you work in a direct care role you will be required 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, except in a limited number of circumstances, when working alone in a closed office, or in a non-clinical area, such as when on your break, where all other control measures are in place, i.e. good ventilation; physical distancing, with staff 2 metres apart; easy access to hand washing and/or hand sanitising facilities.

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).

Again, carrying out physical distancing is essential during these times as is hand hygiene, using alcohol rub where hand washing facilities are not available. 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.

Wearing a face covering/FRSM in other communal workplace areas

a) in hospitals

FRSMs should 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) should be worn in communal areas, during your shift. On 15 October 2020, the First Minister announced that the wearing of face coverings was to become mandatory in communal workplace areas, such as corridors, changing rooms, canteens and social spaces.

Car sharing with colleagues

Wherever possible, car sharing should be avoided with anyone outside of your household or your extended household.

Where car sharing cannot be avoided, individuals should adhere with the guidance below to reduce any risk of cross transmission:

  • staff (and students) must not travel to work/car share if they have symptoms compatible with a diagnosis of COVID-19.
  • ideally, no more than 2 people should travel in a vehicle at any one time
  • use the biggest car available for car sharing purposes
  • car sharing should be arranged in such a way that staff share the car journey with the same person each time, to minimise the opportunity for exposure. Rotas should be planned in advance to take account of the same staff commuting together/car sharing as far as possible
  • the car must be cleaned regularly (at least daily) and particular attention should be paid to high risk touch points such as door handles, electronic buttons and seat belts. General purpose detergent is sufficient unless a symptomatic or confirmed case of COVID-19 has been in the vehicle in which case a disinfectant should be used.
  • occupants should sit as far apart as possible, ideally the passenger should sit diagonally opposite the driver.
  • windows in the car must be opened as far as possible taking account of weather conditions to maximise the ventilation in the space
  • occupants in the car, including the driver, should wear a fluid resistant surgical mask (FRSM) provided it does not compromise driver safety in any way.
  • occupants should perform hand hygiene using an alcohol based hand rub (ABHR) before entering the vehicle and again on leaving the vehicle. If hands are visibly soiled, use ABHR on leaving the vehicle and wash hands at the first available opportunity
  • occupants should avoid eating in the vehicle
  • passengers in the vehicle should minimise any surfaces touched – it is not necessary for vehicle occupants to wear aprons or gloves
  • keep the volume of any music/radio being played to a minimum to prevent the need to raise voices in the car

Adherence with the above measures will be considered should any staff be contacted as part of a COVID-19 contact tracing investigation.

For the most up to date guidance, please refer to Section 5.12 of Scottish COVID-19 Addendum.

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 COVID19 addendums 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), is asked to wear a face covering of the same kind that the Scottish Government has made mandatory in most indoor public places and indoor communal spaces, including retail and public transport.

Visitors should 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, will be asked to wear a FRSM, (or face covering if cannot be tolerated, unless they fall under one of the exemptions specified in the regulations).

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 should use a FRSM if this can be tolerated and does not compromise care, for example, when receiving oxygen therapy, during labour, or fall under one of the exemptions specified in the regulations. The expectation would be that patients would be required to wear a FRSM in bed, where patients in bed are 2m 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. The minimum requirement set out in the extant national guidance is that all outpatients and visitors must wear a face covering or mask when entering health and care settings. This aligns with the health protection regulations, which set out the mandatory requirement for individuals to wear face coverings or masks in indoor communal spaces in workplaces, including in health and care settings. See the regulations, including the full list of exemptions.

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 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

The guidance asks that all patients attending clinics, and all hospital visitors should wear a face covering when attending. This advice is in line with existing public health advice to the public asking for face coverings to be worn in public places where physical distancing is not possible. Please note: physical distancing rules may vary from 1 metre or more to 2 metres depending on the part of the hospital patients or visitors are attending. Patients and visitors should be guided by local hospital information. A face mask can be offered if necessary.

Children over the age of 5 years old should also wear a face covering when visiting or attending a hospital, or any other health service or social care service, in line with national policy, and 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 physical distancing and 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.

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 are exempt from wearing one.  If they refuse, this should only be noted in their patient/ medical records each time, and not enforced. Staff should continue to wear a FRSM in this situation and ensure other IPC measures such as hand hygiene, respiratory etiquette, ventilation and physical distancing 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. The minimum requirement set out in the extant national guidance is that all outpatients and visitors must wear a face covering or mask when entering health and care settings. This aligns with the health protection regulations, which set out the mandatory requirement for individuals to wear face coverings or masks in indoor communal spaces in workplaces, including in health and care settings. See the regulations, including the full list of exemptions.

b) visitors and outpatients in hospitals

Politely encourage all individuals to comply with the request 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 or 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 and physical distancing 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 are not exempt from doing so, then they are legally obliged to do so in the mandated spaces. Police Scotland or a relevant person designated by the local authority, have enforcement powers to attend an incident and issued a Fixed Penalty Notice; however, the support of employers and staff in encouraging the use of face coverings is vital to their success as a public health intervention.


First published: 9 Nov 2020 Last updated: 8 Oct 2021 -