Chamber and committees

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 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. 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.

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.

Health Protection Scotland (HPS) has published guidance on infection control, and this has been included in our updated uniforms and home laundering guidance . This will continue to be kept under review and necessary changes may be made dependent on new evidence.

Health Facilities Scotland has advised that NHS laundry services have enough capacity to meet current demands. This situation is being monitored and planning has been done to ensure capacity can be increased if needed.

Decisions on which type of PPE to use in different settings are based on clinical guidance, and as an employer the NHS is, under health and safety law, responsible for the protection of its staff. No price has never ever been used as a factor in deciding what product is to be issued.

The cost of PPE varies according to the negotiated cost of purchase on the market. The current cost of a single map of each type is as follows:

a)Type IIR mask: £0.16 (July 2020 onwards) – £0.70 (March/April 2020)

b)FFP2 mask (these are not used per guidance, and no longer purchased): £0.98 - £3.00 (March 2020)

c)FFP3 respirator masks: £1.85 - £6.00 (March 2020 to July 2020, prices are now near £2.00)

The Scottish Government has collected, monitored and published data on NHS staff absences since the outbreak of this pandemic. Data is continually collated from Health Boards on overall absences in the NHS workforce, as well as on the number and rate of absences associated with Covid-19. Covid-19-related absences are recorded on staff displaying symptoms, self-isolating, confirmed to have Covid-19, Covid-19-related caring responsibilities and those contacted by tracers and told to isolate for 14 days.

For the week 30 September – 6 October 2020, a daily average of 1.0% of the workforce were recorded absent for reasons related to Covid-19. The rate of Covid-19 related absence has been steady and decreasing in recent months, with a rate below 2% since late July and below 4% since early May. We will continue to pay close attention to staff absence data in the coming months.

This data does not include whether NHS staff have been wearing government approved PPE or not.