Publication - Advice and guidance

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
Purpose and background


To provide guidance in relation to the extended use of Fluid Resistant (Type IIR) Surgical Masks (FRSM) by health care staff. This guidance covers primary care (GP practices, dentists, opticians and pharmacies) and wider community health care (including adult community care and adult residential settings (excluding adult care homes)[1], and health professionals who  visit people in their own homes (including supported living settings), in addition to acute hospitals (including mental health, maternity, neonatal and paediatrics)and community hospitals in areas where individuals are directly cared for and areas where they are not.

This guidance has now been updated to reflect:

  • the wider wearing of FRSMs by clinical and non-clinical hospital staff
  • the importance of FRSMs used by in-patients in hospitals, as well as long stay/overnight visitors
  • strengthened wording around the need for outpatients, to wear face coverings

This guidance also outlines advice about the wearing of face coverings by any individuals who visit these places, including children aged 5 and over.

The guidance for social care staff, adult care home residents, visitors and users of social care has been removed from this document and made into a separate guide.


Across health and community care, the fundamental principles of infection prevention and control (IPC) are essential for preventing the spread of COVID-19. Compliance with hand hygiene, respiratory etiquette, physical distancing, safely optimising ventilation and the appropriate use of PPE in line with national guidance continues to be critical in all settings at all times. This guidance does not replace these measures, but aims to supplement them.

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.

On 5 June 2020, the World Health Organisation (WHO) issued interim guidance about the use of face masks in the context of COVID-19. The WHO guidance reflected emerging evidence about potential transmission from symptomatic, pre-symptomatic and asymptomatic people infected with COVID-19 in locations where there is geographical evidence of sustained community transmission. In these circumstances, the WHO guidance recommends the extended use of medical face masks by health and care staff beyond the clinical or care area.  On 21 August, WHO also issued Q&A, providing information on when children should wear face coverings. This updated guidance meets all WHO guidance to date and is also consistent with current national Scottish guidelines on face coverings, including for children aged 5 and over. Babies, toddlers and children under 5 years of age are not required to wear a face covering due to the possibility of overheating, suffocation and strangulation.

The CNRG considered the new WHO guidance, as well as evidence from the SAGE Hospital-onset COVID-19 Working Group that the use of face masks can reduce transmission of COVID-19. “Nosocomial” here means a healthcare-associated infection.

The CNRG has attached particular importance to the evidence around transmission events, and pre-symptomatic or asymptomatic carriage of COVID-19 in individuals and staff in acute hospitals and adult care homes in Scotland, where there have been clusters of nosocomial infections. Pre-symptomatic means a person has the virus but has not yet become unwell, while asymptomatic means a person is carrying the virus and has no symptoms. This additional guidance document provides advice on the extended use of face masks by staff within health and community health care settings. The CNRG has also reached conclusions about the wearing of face coverings by individuals who visit these places.

It is important to note the difference between face coverings and face masks. Face coverings are made of cloth or other textiles that cover the mouth and nose. Face coverings are largely intended to protect others, not the wearer, against the spread of infection because they cover the nose and mouth which are the main confirmed sources of transmission of the virus that causes COVID-19. Everyone needs to be aware of and follow the Scottish Government guidance on the use of face coverings in the community. When we refer to face masks, this means surgical or other medical grade masks that are used in certain health and social care settings to protect the wearers against hazards and risks.

Changes to physical distancing guidance

The Scottish COVID-19 Addendums have been updated to include some updates to the physical distancing guidance. Healthcare settings house some of the most clinically vulnerable in society and whilst the COVID-19 pandemic remains a threat, it is recommended that physical distancing remains although reductions from 2 metres to 1 metre or more can now be advised in some areas. Further information can be found in Section 5.13.4 of Scottish COVID-19 Infection Prevention and Control Addendum for Acute Settings and in Section 7.15 of Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum.

It is important to note that in all circumstances 2 metre physical distancing must be adhered to when a FRSM or face covering is removed.


1. Includes: Community based settings for people with mental health needs, community based settings for people with a learning disability, community based settings for people who misuse substances, supported accommodation settings, rehabilitation services, residential respite (non-care home), sheltered housing, hospice settings, prison and detention settings.

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