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Mask use in health care facilities during COVID-19

On November 4, 2020, the Ministry of Health has announced a new provincial policy that requires all health care workers, non-clinical staff, patients and visitors to wear a medical mask at all times in health care facilities and settings where health care is provided.  

Key updates for staff:

  • All health-care workers and non-clinical staff working in long-term care must wear medical masks.
  • All health-care workers and non-clinical staff working in clinical units/patient care settings must wear medical masks.
  • For non-clinical staff working in non-clinical areas, follow the WorkSafe BC safety plan according to the hierarchy of infection prevention and exposure control measures for communicable diseases. Medical masks are preserved for clinical areas only.
  • Personal protective equipment (PPE), including medical masks, are one part of the hierarchy of infection prevention and exposure control measures for communicable diseases. PPE does not replace other measures.
  • If you are not able to wear a medical mask due to medical reasons, please talk to your employee health representative.

Key updates for visitors:

  • Visitors to all health-care facilities and settings must:
  • Be screened and assessed prior to entry
  • Perform hand hygiene
  • Follow existing provincial visitor guidance
  • Wear a PHC-provided medical mask for the duration of their visit

Please find the full Q&A document here: Mask Use in Health Care Facilities During the COVID-19 Pandemic (PDF)

Here are select Q&As from the December 14 document: 

OVERVIEW

When is the mask use in health-care facilities policy in effect?
The Ministry of Health’s Mask Use in Health Care Facilities During the COVID-19 Pandemic policy took effect on November 4, 2020. All health authorities’ health-care facilities, health-care workers, primary care providers and medical specialists in community clinics are required to follow the provincial policy. Visitors and patients are also required to adhere to the policy.
What health-care settings are affected by this policy?
The health-care settings that are applicable to this policy are:
  • Acute care hospitals
  • Long-term care (public and private)
  • Seniors’ assisted living facilities
  • Family physician offices
  • Medical specialists in community clinics
  • Outpatient clinics (e.g., endoscopy, pain management, medical daycare, outpatient rehabilitation)
  • Laboratories
  • Public health and community health clinics
  • Home support and community care
  • Hospice and palliative care
  • Ambulance and ambulance stations
  • In-patient mental health services including forensic clinics and correctional health
  • Women’s health clinics

HEALTH CARE WORKER MASK USE

What type of mask is required in health-care settings?
Health-care workers are required to wear a medical mask in clinical areas and while providing any clinical services. The exception to this is when in a closed office or in a non-clinical office area that is not open to the public and where a two metre distance can be maintained. However, for any travel to or through common areas (i.e. elevators, hallways, bathrooms and break rooms or any other area where there is chance of less than a two metre separation), medical masks are required.

Medical masks must also be worn by patients, staff and visitors in clinical areas and while providing or receiving any clinical service, even if there is plexiglass in a work area and/or a distance of two metres can be maintained. Medical masks are not required for admitted patients while in their own room.

Medical masks must meet American Society for Testing and Materials (ASTM) International and International Organization for Standardization (ISO) or equivalent performance requirements for bacterial filtration efficiency, particulate filtration efficiency, fluid resistance, pressure differential, flame spread, skin sensitivity and cytotoxic testing. Medical masks ordered through your health authority and the new centralized PPE distribution system for general practitioners, nurse practitioners and specialist physicians in community clinics will meet the standards required. If obtaining PPE directly from a vendor, please check the specifications of the mask to ensure they meet the policy requirements.

Medical masks should be available upon entry to clinical and patient-care areas or supplied prior to entry. They should be put on before entry with proper procedure and hand hygiene. Signage explaining how to do this is available here.

Do health-care workers need to put on a medical mask upon entry to a health-care facility?
Yes, health-care workers working in a clinical unit or setting, or a patient-care area must wear a medical mask upon entry and while they are on-site, including in common areas including break rooms unless eating or drinking while maintaining a two metre distance from others.

Staff can wear a non-medical mask while commuting to and from work, but it is expected that they will wear a medical mask as they enter the facility premise, including in common areas, and clinical or patient-care areas.

How do health-care workers get medical masks at the door when arriving outside of “greeter” hours?
Masks should be made available at the entrance of a health-care facility or be provided prior to entry.
If health-care workers arrive wearing a medical mask, should they be given a new one?
If a health-care worker arrives with a medical mask, they are not required to change to a new mask unless their mask is visibly soiled, wet or damaged.
Do staff need to wear masks if they are behind plexiglass?
Under the mask policy, all staff working in a clinical unit/setting/patient care area must wear a medical mask, including in common areas and break rooms unless eating and/or drinking while maintaining a distance of at least two metres from others.

While plexiglass offers additional protection between staff and patients, a medical mask is still required while they are in the clinic. This will help protect patients and other staff when they cannot remain behind a plexiglass and need to move around the clinic.

What level of mask (Level 1,2,3) is required for health-care workers and staff for different procedures?
Surgical and procedure masks are categorized into one of three barrier levels based on the ASTM testing and associated fluid resistant to synthetic blood (mm Hg). ASTM levels (1,2,3) takes into account five elements:
  1. fluid resistance (80, 12, 160 mm Hg)
  2. particulate filtration efficiency (>= 95, >= 98, >= 98)
  3. breathability (<4, <5, <5 mm H20) differential pressure
  4. bacterial filtration efficiency (>= 95, >=98, >= 98%)
  5. flame spread (Class 1, Class 1, Class 1)

All rated procedure and surgical masks (ASTM Level 1, 2 and 3) provide sufficient protection for droplet precautions (including COVID-19 patients). Selection of the most appropriate mask must be based on the risk of blood and body fluid exposure anticipated for the patient care needed. There is increased fluid resistance with Level 2 and Level 3 masks, and these should be used for tasks where higher amounts of fluid exposure and risk of splash are present.

Please see chart below for examples of the recommended level for each situation (source: https://sn.astm.org/?q=features/standards-medical-face-masks-and-protective-clothing-.html)

  • Level 1 - Can resist splash or spray at venous pressure (e.g. for general procedures and respiratory etiquette).
  • Level 2 - Can resist splash or spray at arterial pressure.
  • Level 3 - Have the highest fluid resistance (e.g. used during orthopedic surgery or trauma

As the risk level and PPE requirement varies based on different factors, we recommend you do a point-of-care risk assessment with patients as the best way to determine the appropriate level of medical mask and other PPE you may require.

When are N95 respirators required for health-care workers?
N95 respirators are required for patients on airborne precautions, and for aerosol generating medical procedures (AGMPs) on suspected or confirmed COVID-19 patients. For AGMPs on patients without suspected or confirmed COVID-19, a medical mask is sufficient.
Are there exemptions to the medical mask policy (e.g., if an employee has a medical reason not to wear one)?
If a staff member has a medical condition that prohibits them from wearing a mask, they may request a medical accommodation via the employer’s disability management process (as applicable). Such an accommodation of a medical condition may result in that employee being temporarily reassigned to other duties where masking is not required.
What will occur if an employee declines to wear one without a medical reason?
Workers must abide by the protocols and policies in their employer’s COVID-19 safety plan, which includes the use of masks in certain circumstances. We encourage compliance through education and awareness, and we are hopeful that staff will understand the value of wearing a medical mask as part of the overall infection and prevention control strategy to protect patients, visitors and staff. Based on what we have heard from many health-care workers, staff and stakeholders, most support the use of masks and other PPE.
Are guidelines for extended use of PPE still in place?
Yes, guidelines for the extended use of PPE for health-care workers are still in place as outlined in the COVID-19: Emergency Prioritization in a Pandemic Personal Protective Equipment (PPE) Allocation Framework.

MASK USE IN NON-CLINICAL AREAS

What is a non-clinical area?
A non-clinical area within a health-care facility is an area where there is no direct patient care provided.
What type of mask is required in non-clinical areas of health-care facilities?
Medical masks are required in clinical units and patient care areas. If you are already wearing a medical mask as part of your work duties (i.e. you have to enter a clinical unit/patient care setting), then you should continue using a medical mask when travelling through common areas (i.e. elevators, hallways, bathrooms and break rooms or any other area where there is chance of less than a two metre separation).

If you are a non-clinical staff, working in a non-clinical area, you should use the mask provided/indicated as per your WorkSafe BC COVID-19 safety plan. A mask is required when travelling through common areas.

Visitors and patients are required to wear medical masks, when entering and moving around any health care facility, including clinical and non-clinical areas, as they are likely entering clinical units/patient care settings.

In multi-use facilities that contain clinical and non-clinical services, should we advise staff, patients and visitors to use medical grade masks throughout the building?
Medical masks are required on clinical units and patient care areas. If you are already wearing a medical mask as part of your work duties (i.e. you have to enter a clinical unit/patient care setting), then you should continue using a medical mask when travelling through common areas (i.e. elevators, hallways, bathrooms and break rooms or any other area where there is chance of less than a two metre separation).

If you are a non-clinical staff, working in a non-clinical area, you should use the mask provided/indicated as per your WorkSafe BC COVID-19 safety plan. A mask is required when travelling through common areas.

Visitors and patients are required to wear medical masks, when entering and moving around any health-care facility, including clinical and non-clinical areas, as they are likely entering clinical units/patient care settings.

Are medical masks required when entering or exiting a facility from the parking lot or parkade?
Staff can wear a non-medical mask while commuting to and from work, but it is expected that they will wear a medical mask when entering the health-care facility.

Non-clinical staff, working in a non-clinical area, should use the type if mask indicated as per their WorkSafe BC COVID-19 safety plan.

PATIENT MASK USE

Where should masks for patients be located?
It is recommended that medical masks and alcohol-based sanitizer (minimum 70% alcohol content) be available inside your facility or clinic for distribution to patients. We also recommend that tissues, and no-touch waste receptacles be made available at the entrance and throughout the facility.
What types of masks are acceptable for patients to use?
Under the provincial policy, patients must wear a medical mask when entering and moving around any health care facility, including clinical and non-clinical areas, with the exception of admitted patients when they are in their rooms (based on a health-care professional’s point-of-care risk assessment). Admitted patients must wear a medical mask when they leave their room.
If a patient arrives wearing a medical mask or N95 respirator, do we still need to provide a new medical mask?
The provincial mask policy states that all health care facilities must provide medical masks for all patients and visitors. Because it is difficult to ensure that masks purchased outside of the facility meet the standards for medical masks, patients should be provided with a medical mask, no matter whether they are wearing one when they arrive.
Why did the government choose ‘medical masks’ over asking patients to wear non-medical (three- layer) masks?
Based on the current COVID-19 situation in B.C. and the advice of infection prevention and control experts, the ministry has updated the policy to protect the most vulnerable populations in health- care settings and health-care workers working within those settings.

Medical masks are now the minimum standard within health-care facilities. A medical mask offers a higher level of protection, both for the person wearing the medical mask and as source control, than non-medical masks.

This is especially important in long-term care, assisted living facilities and health-care facilities where there are patients/residents who are at a higher-risk of health complications from COVID-19 and health-care workers who work with these patients/residents.

While the ministry policy now requires medical-grade masks, it is important to emphasize that masks are one of the measures in the overall infection prevention and exposure control strategy to reduce the risk of COVID-19. Masks should be used along with other measures that are already in place at your facilities/offices/clinics, such as physical distancing, barriers, patient screening, people staying home when sick, proper hand washing and respiratory etiquettes. When all of these measures are in place, they are highly effective at stopping transmission of COVID-19 and other respiratory diseases.

What are the expectations for patients when wearing masks?
Patients will be provided with medical masks when they enter the facility (patients who arrive wearing their own mask will be asked to change into the medical mask provided). They are expected to wear a medical mask while in the facility especially if they are moving to different rooms or areas of the building. However, admitted patients are not required to wear a mask while in their own room.
What if a patient refuses to wear a mask or change their cloth mask to medical mask?
The requirement to wear a medical mask in health-care settings is intended to provide an additional layer of safety for health-care workers, patients and visitors. We are hopeful that most patients will understand the value of wearing a medical mask and comply.

Encourage medical mask use by having signage as well as the provincial policy posted at the entrance and/or inside your clinic or facility. For patients presenting without a mask, provide a verbal reminder and assurance that you can provide a medical mask to wear at no cost. If they refuse, ask them if it is because they have a medical or physical reason that prohibits them from wearing a mask.

If you have a patient who cannot wear a mask due to a medical reason or a patient refuses to comply*, care must still be provided. However, if feasible, consider how the patient can be accommodated during their visit in way that minimizes risk to health-care workers, staff and other patients. For example, in a non-acute care setting you may be able to reschedule their appointment to a quieter time when there are fewer patients/clients and staff at your clinic to reduce the risk for the patient, other patients and your staff. In some cases, a virtual consultation may be appropriate based on the patient’s condition and the risk level.

For health-care staff working in health authorities’ facilities and requiring support with patients or visitors who refuse to comply with the policy, staff should speak to their management team for support.

*Please note, under the provincial orders effective November 24, 2020, everyone is required to wear face covering (non-medical masks) in indoor public spaces, including health professionals’ offices. However, there are exemptions to the orders, including:

  • A person who is less than 12 years of age;
  • A person who is unable to wear a face covering because of
    • a psychological, behavioural or health condition, or
    • a physical, cognitive or mental impairment;
  • A person who is unable to put on or remove a face covering without the assistance of another person
What is your advice for staff who work with patients where asking the patient to don a mask may escalate behaviour?
The safety of health-care workers and staff is extremely important. We understand there are some patients and situations where enforcement of the medical mask policy would be more harmful to the patient and staff. The health-care professional should assess each individual case and has the discretion to determine the most appropriate approach based on the circumstances. Exceptions to the provincial policy may need to be applied for people with certain medical conditions and/or to accommodate site-specific circumstances.

For those working in a health authority facility and requiring support with patients or visitors who refuse to comply with the policy, please speak to your management team for support.

  • Please note, under the provincial orders effective November 24, 2020, everyone is required to wear face covering (non-medical masks) in indoor public spaces including a health professional’s office and indoor common spaces in a hospital. However, the following populations are exempted from the orders:
  • A person who is less than 12 years of age;
  • A person who is unable to wear a face covering because of
    • a psychological, behavioural or health condition, or
    • a physical, cognitive or mental impairment
  •  A person who is unable to put on or remove a face covering without the assistance of another person.

Please see the orders for more details:

https://www.bclaws.gov.bc.ca/civix/document/id/mo/mo/m0425_2020

Are there any consequences for people not wearing a mask when walking around the hospital?
Under the provincial orders effective November 24, 2020, everyone over the age of 12 is required to wear a face covering or mask in indoor public spaces. People who cannot wear a mask or who cannot put on or remove a mask on their own are exempt.

We hope to achieve compliance through education and awareness but failure to comply or abusive and belligerent behaviour towards others may result in persons being asked to leave the premises and could ultimately lead to a ticket being issued by an enforcement officer.

What if a visitor cannot or will not wear a mask?
As safety is key, a visitor may be denied entry into a health-care facility of any kind if they cannot or will not wear a mask. Exceptions to this would be for medical or compassionate reasons. In these cases, a point-of-care risk assessment would be performed and a plan developed for that visitor.
Are patients in ambulances and other forms of patient transport required to wear a medical mask?
Yes. All patients must wear a medical mask during medical transport including in ambulances, unless exempted or when requested to remove their mask by a health-care provider.
Are masks required for patients in large common areas such as dialysis, post-anesthesia care units, etc.?
Yes, all patients must wear a medical mask when in clinical areas of a health-care facility, unless requested to remove their mask by a health-care professional.
Are asymptomatic hemodialysis patients required to wear their mask throughout the entire dialysis run while sitting/lying at their station or can they not have a mask on while at their station similar to admitted patients in their rooms?
All patients and visitors must wear a medical mask while in a clinical area.

POLICY EXEMPTIONS

Are there exemptions to the policy and can you provide some examples?
It is important to note that most people can tolerate wearing face masks. Exceptions to the medical mask policy may be applied for people with certain medical conditions in accordance with a human rights approach to mask-wearing during the COVID-19 pandemic.

Examples of medical conditions include:

  • cognitive impairment
  • intellectual and developmental challenges
  • mental health conditions
  • other sensory sensitivities (such as autism spectrum disorder)
  • a serious allergic reaction
  • a physical inability to put on or remove a mask

INFECTION PREVENTION CONTROL

What are donning and doffing procedures for medical masks?
Please see the How to Wear a Surgical/Medical Mask poster on BCCDC’s website on how to wear a face mask. We recommend you have this poster available at the entrance where the medical masks are available to patients/visitors and inside your facility for staff.

For you and your staff who are wearing PPE in addition to masks, for example, eye goggles, face shields and gowns: please visit BCCDC’s webpage on PPE for health-care professionals for more information on how to don and doff PPE.

Does everyone with a mask also need to be wearing eye protection and gloves?
Eye protection (e.g. goggles, face shields), gloves, gowns and other PPE are required in accordance with a point-of-care risk assessment when providing direct patient care and when performing potentially hazardous tasks within health-care facilities (e.g., using chemicals or compounding drugs).

Please conduct a point-of-risk care assessment to determine if other PPE such as eye protection, gloves or gowns are required in addition to a medical mask. Visit the BC Centre for Disease Control’s website for PPE resources for health-care professionals: http://www.bccdc.ca/health- professionals/clinical-resources/covid-19-care/infection-control/personal-protective- equipment#For--health--professionals

Is there anything else I should know about masking or safety protocols in my workplace?
Yes. Check your COVID 19 safety plan.

WorkSafe BC requires all workplaces in B.C. to have developed safety plans for their area. They outline any specific protocols required. If you do not have one and need assistance, contact your Occupational Health and Safety department or Joint Occupational Health and Safety committee if you are with a health authority. Please visit the WorkSafe BC website for more information on COVID-19 safety plans.

MASK USE IN LTC

Are residents required to wear masks in their long-term care facility in all areas? For example, in their rooms?
Under the policy, only health-care workers and staff as well as visitors are required to wear a medical mask on-site. They should conduct a point-of-care risk assessment to determine if other PPE is required.

In general, residents who are not suspected or confirmed cases of COVID-19 are not required to wear a medical mask when they move around in the facility. In exceptional circumstances, such as an outbreak, the health-care professional providing care to long-term care and assisted living residents has the discretion to decide if PPE or other preventative measures are required for the health and safety of other residents and staff, under the guidance of the Medical Health Officer or delegate.

Reinforce the importance of other preventive measures, such as physical distancing with staff, residents and visitors on an ongoing basis. For example, where possible, facilitate physical distance between residents in communal areas through reducing foot traffic, furniture placement and seating arrangements.

If you have residents who are suspected or confirmed cases of COVID-19, please restrict the resident to their room or bed space, including during meals and any other clinical or social activities, unless absolutely necessary, to minimize the risk of transmission to other residents and staff.

In the rare circumstances where a resident with COVID-19 symptoms must leave their room, they should wear a medical mask (if tolerated) or use tissues to cover their mouth and nose. Please see the Infection Prevention and Control Requirements for COVID-19 in Long Term Care and Seniors’ Assisted Living guidance on BCCDC’s website for more information.

Does the policy apply to private long-term care and seniors’ assisted living facilities? Has this been communicated to those operators?
Yes, this policy applies to private long-term care and seniors’ assisted living facilities as well. The ministry has communicated the expectation to all regional health authorities and facility operators.
What if a symptomatic long-term care and assisted living resident or symptomatic patient in behavioural units are not able to wear masks? Are there other guidelines?
There are some residents who are not able to wear a medical mask for medical or other reasons where enforcement would be more harmful to the resident, other residents and staff. The health- care professional should assess each individual case and exercise their discretion to determine the most appropriate approach based on the circumstances.

PHC Q&A

What is the mandatory mask policy?

The Ministry of Health has announced a new provincial policy that requires all health care workers, non-clinical staff, patients and visitors to wear a medical mask at all times in health care facilities and settings where health care is provided. 

Medical masks will be provided to patients and visitors at PHC’s health facility entrances by the screeners. However, to reduce congestion at our few public entrances, staff and physicians are encouraged to take a mask home in a clean plastic bag at their previous end of shift and don the mask prior to entering the facility through a staff entrance.  

Why was this policy created?
Physical distancing, or staying more than two metres (six feet) apart from others is one of the most important strategies to prevent the spread of COVID-19 from person to person. Some people who have COVID-19 may not have symptoms but can still spread the virus without knowing. By asking all health care workers, non-clinical staff, patients and visitors to wear masks when they cannot keep at least two metres apart from others, we can help keep everyone at our care facilities safe. 
How does wearing a mask help?
Masks can decrease the spread of COVID-19 in two ways. First, people wearing masks help protect others around them by limiting the spread of their own droplets when coughing, sneezing and speaking. Second, those wearing masks protect themselves by reducing the chance of inhaling contaminated droplets from others who are within two metres. 
Do we enough medical-grade masks at PHC?
Yes.
What should I do if my unit runs out of medical masks?  
Please contact your local Stores Attendant for replenishment.
Why has so much changed in such a short time? 
As the COVID-19 situation continues to evolve so do the practices at PHC and other health care organizations. We believe that asking staff, visitors patients to wear masks will help keep our patients, families and staff safe during this challenging time.
How do I safely wear my mask?
Masks must cover nose, mouth and chin at all times. If you wear a medical grade disposable mask, it must be new and clean and it cannot be torn, have holes or vents. If it is a reusable medical grade mask it must be freshly washed. The mask should feel comfortable and fit snuggly against your face. You must always clean your hands before putting on a mask, when you touch your mask and after you take off your mask. 
The patient I am visiting is in isolation precautions, what should I do?
If you are visiting a patient who is in isolation precautions, you must first speak with the patient’s care team. The care team will provide information on how to safely visit your loved one. You may need to wear added personal protective equipment. 
As we wear masks more, some people are experiencing skin breakdown, example behind the ears. Who can staff talk to about ways to mitigate this effectively?
We do have different mask options, as well as ear savers being available, so if you are struggling, please reach out to your manager or OH&S for options.
Are there any known side-effects to wearing masks? 
Some people can have a skin reaction to the mask material.  OHS will work with them to find the mask that will work for them. Others may have a specific medical condition that prohibits them from wearing a mask. However there is no evidence that mask wearing creates any inherent risk. 
This page last updated Jan 4, 2021 3:51pm PST