Chamber and committees

Health Boards have been routinely testing healthcare workers in key areas (oncology, long stay elderly care and mental health wards where the length of stay is over three months) since 08 July.

The way in which the test is administered will be determined locally by occupational health, or public health. The test should be performed at the place of work and the preferred method of testing would be self or peer testing in the clinical area.

The preferred route of testing is a decision made by Health Boards and those receiving the test, and the method is not recorded at the time of the test taking place.

The Scottish Government has been working closely with Health Boards to develop key data on the testing of NHS staff to ensure robust and reliable information. We are working to ensure the data is robust and aim publish this data once this is confirmed .

Since the beginning of March 2020, National Services Scotland National Procurement has issued six alerts to Health Boards requiring PPE to be withdrawn from use. In one case, additional testing proved the product fit for use, in the other five cases, products were permanently withdrawn.

Details are as follows:

1. An alert was issued in March 2020 for FFP3 respirator masks from Cardinal/Medline that had failed revalidation testing. 23,500 of these had been shipped to Health Boards, who were instructed to dispose of the masks locally.

2. An alert was issued in May 2020 for Goggles from Tiger Eye that had failed splash testing required for Covid-19 response. These masks had been in use for years, but were no longer suitable for the current situation. Health Boards disposed of these items locally.

3. An alert was issued in June 2020 for type IIR masks from Cardinal Health that were found to be at risk of mask deterioration. 6 million of these masks had been shipped to Health Boards, who were instructed to dispose of masks locally.

4. An alert was issued in August 2020 for type IIR masks from Continuum and were withdrawn from use. However, further testing showed that they were fit for use and the quarantine on these masks was lifted, allowing them to be placed back into circulation.

5. An alert was issued in September 2020 regarding one batch of testing swabs from Supply Chain Coordination Ltd due to reports of swabs unravelling and leaving a small piece of the swab in patients’ nasal passages. Health Boards are disposing of these items locally.

6. A recall was issued in October 2020 for FFP3 respirator masks from Alpha Solway that were found to have the wrong wire used in the nose clip. 87,000 masks have been recalled, but fewer than 10% of these are estimated to be faulty. Masks are being recalled to the vendor.

1 The evidence to date indicates the route of transmission for COVID-19 to be droplet and contact and both the UK and WHO guidance recommends droplet and contact precautions. In the UK, this includes the use of a fluid resistant surgical face mask (FRSM). This aligns with the WHO guidance.

2 Where Aerosol Generating Procedures (AGPs) are carried out, both the UK and WHO guidance recommends airborne precautions. This is because during AGPs, aerosols as well as droplets can be produced. Airborne precautions include the use of respiratory protective equipment (RPE), including an FFP respirator, full face shield/eye protection, a gown, apron and disposable gloves to protect against aerosols and excess splash/spraying of body fluids. Airborne precautions would also apply in any other setting COVID or non-COVID if an AGP was being undertaken.

3 A scientific brief published by the WHO on 9th July 2020 recommends continuous use of a medical mask by health workers and caregivers working in all clinical areas, during all routine activities throughout the entire shift. Scottish Government guidance on the extended use of face masks in healthcare settings and elderly care homes, published on 23 June, and updated on 18 September to include primary, community, care at home and adult care home settings, recommends FRSM Type IIR, as opposed to Type II facemasks, as they offer protection for the wearer, as well as source control.

1. On 21 August, new UK Infection Prevention and Control (IPC) remobilisation guidance for health and care settings was published. The guidance outlines key COVID-19 IPC measures such as the appropriate use of PPE, extended use of face masks and coverings, physical distancing, and outbreak management, as well as risk assessed patient care pathway scenarios to help guide the implementation of measures for safe and effective care.

2 Patients in medium or high risk pathways need to wear Fluid Resistant (Type IIR) Surgical Mask if this can be tolerated and does not compromise their care.

3 As part of remobilisation, Health Facilities Scotland have provided diagrammatic guidance to support health and social care to ensure physical distancing of 2m can be maintained in terms of bed, chair and desk spacing. This guidance uses a risk-based approach in terms of reducing the risk of transmission of COVID-19 to staff, patients and visitors using the hierarchy of risk control as legislated by the HSE.

4 More generally, NHS Boards have access to a risk assessment and guidance tool which helps both the employer and individual understand the workplace and individual risks.

5 We are aware that there is emerging evidence that people from Black, Asian and Minority Ethnic (BAME) background may be disproportionately affected by COVID19. The COVID-19 Occupational Risk Assessment Guidance, published on the Scottish Government website on 4 September, uses multiple personal characteristics including age, sex, ethnicity, BMI and underlying health conditions, to give an overall assessment of the the vulnerability of a member of staff. This will support managers to have supportive discussions with their staff members around their individual risk from COVID-19 in an occupational context.

1 .All staff on mental health wards should follow the UK IPC remobilisation guidance for all health and care settings, published on 21 August. This guidance is based on the latest scientific and epidemiological evidence. All staff engaged in direct patient care should wear a Fluid Resistant (Type IIR) Surgical Mask throughout their shift.

2. Fluid Resistant (Type IIR) Surgical Masks act as a two way barrier – protecting both the wearer and the patient or individual they are caring for. Where the person is suspected or positive for COVID-19 or any other infection, the staff are required to wear single-use gloves and aprons where they deem a risk of contact with blood or body fluids and a visor where there is a risk of splashing into the eyes.

3. Clinical Guidance for NHS Scotland: Using Physical Restraint for Patients with Confirmed or Suspected COVID- 19 was published on the Scottish Government website on 20 April. The guidance states that The Step Wise Management Plan for COVID-19 positive/symptomatic patients based on principles of least restrictive care should be implemented. It is vital that essential IPC precautions are reinforced including hand hygiene, social distancing where possible and wearing of appropriate personal protective equipment (PPE).

1. Both the UK Government’s New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) and Health Protection Scotland (HPS) have given careful consideration to the available evidence and, during the course of the pandemic, have reviewed what should be considered an AGP. Coughing is not considered an aerosol generating procedure (AGP) and therefore a Fluid Resistant (Type IIR) Surgical Mask (FRSM) is the appropriate face mask in the situation described.

2. FRSMs or Type IIR masks protect against droplet transmission and act as a two-way barrier, protecting both staff members and patients, with the FRSM or Type IIR mask conferriing 98% source control against droplet transmission.