Mask wearing in healthcare settings

Mask wearing in healthcare settings remains an important measure in preventing transmission of respiratory viruses

Presently in New Zealand there is ongoing but low-level community transmission of COVID-19 and low level of community transmission of other respiratory viruses. The focus for mask recommendations at the current time is on the patient care environment. 

Mask use should always be considered in conjunction with other interventions to reduce transmission of COVID-19 and other respiratory infections in healthcare settings. These include using standard and transmission-based precautions for all patient/client and resident care, having clean indoor air through good ventilation, access to testing, having occupational health processes that promote staff vaccination and enable staff to stay home from work when unwell.

Clinical zone/patient care zone

A clinical zone/patient care zone is defined as:

• An area where a healthcare worker is providing care, assessment, expertise or therapy to a patient/client e.g., assessment or treatment room, patient room, procedure room or during patient transport
• Patient/resident rooms where care is being delivered in a home-based or residential care setting

Mask recommendations glossary:

• Required: A mask must be worn in this situation. This is usually due to a public health order requiring the use of mask, or due to best practice evidence as part of transmission-based precautions.
• Recommended: A mask is strongly advised to be worn in these situations as the balance of evidence favours mask use to reduce transmission.
• Encouraged: Wearing a mask is at the choice of the staff member.

Note – any healthcare worker who chooses to wear a medical mask or P2/N95 particulate respirator for respiratory protection while anywhere on a healthcare facility for their own protection may do so. This may be due to their own health needs and this choice should be facilitated.

1.    In all healthcare settings

Patients/clients

• Patient/client has symptoms suggestive of an acute respiratory virus infection: Medical mask is recommended for patient to wear, provided this is tolerated by the patient/client.
• In all other situations: use of medical mask is encouraged when in waiting rooms or non-inpatient areas shared with others who may be unwell.

Visitors/support people

• Advice for visitors/ support people of patients at healthcare facilities is unchanged and is directed by public health order: Visitors/support people at all healthcare facilities are required to wear a mask. Those with mask exemptions should follow the local facility policy.

2.   Pharmacies (except those in supermarkets)

The advice for pharmacies is unchanged and is directed by public health order:

• All staff are recommended to wear a medical mask when in a public facing area or when providing patient/client care.
• All members of the public entering a pharmacy are required to wear a medical mask, whether they are a patient/client or consumer/visitor.

3.   Community-based healthcare settings which provide acute care

This advice applies to community-based healthcare settings which provide acute care to patients/clients who may present with acute respiratory infections:

• Primary and community care (e.g., general practice)
• Iwi and Pacific healthcare providers
• Oral health services
• Urgent care services (e.g., after-hours clinics, urgent care clinics, ambulance workers)

Clinical staff (nursing, medical, allied health staff)

• Providing care to patients with symptoms of acute respiratory virus infections (including suspected or confirmed COVID-19): mask use required. Follow transmission-based precautions (usually this will mean P2/N95 particulate respirator). Where practical to do so, streaming of patients according to risk of acute respiratory virus infection is recommended.
• Providing care to patients in other situations: medical mask recommended in other care situations.
  • Note – in very low risk situations where use of mask may impact negatively on care delivery, clinical judgment may be used to remove masks but is recommended only after a risk assessment is performed by the clinician and agreed to by patient.
• Staff only zones and transit areas: medical mask use is encouraged, especially in situations where ventilation is not optimal.

Non-clinical staff (administrative, clinical support, facilities)

• Reception areas/waiting rooms: medical mask use is encouraged in areas where staff will be in prolonged contact with public or in open waiting rooms.
• Staff only zones and transit areas: mask use is encouraged, especially in situations where ventilation is not optimal.

4.   Other community-based healthcare settings

This advice applies other community-based healthcare settings including:

• Disability support services
• Residential care (aged and disability related)
• Diagnostic services (e.g., diagnostic laboratories, collection rooms, radiology services)
• Allied health services (e.g., Dietetics, Occupational therapy, Osteopathy, Physiotherapy, Podiatry, Acupuncture treatment, Audiology services, Chiropractic treatment)

Clinical staff (nursing, medical, allied health staff)

• Providing care to patients with symptoms of acute respiratory virus infections (including suspected or confirmed COVID-19): follow transmission-based precautions (usually this will mean P2/N95 particulate respirator).
• Providing care to patients in other care situations: medical mask encouraged
  • Note - in very low risk situations where use of mask may impact negatively on care delivery, clinical judgment may be used to remove masks but is recommended only after a risk assessment is performed by the clinician and agreed to by patient.
• Staff only zones and transit areas: medical mask use is encouraged, especially in situations where ventilation is not optimal.

Non-clinical staff (administrative, clinical support, facilities)

• Reception areas/waiting rooms/shared resident or client areas: Mask use is encouraged in areas where staff will be in prolonged contact with public or in open waiting rooms.
• Staff only zones and transit areas: mask use is encouraged, especially in situations where ventilation is not optimal or where staff will be in prolonged contact with public.

5.   Hospitals and other secondary care settings

This advice applies to hospitals and other secondary care settings (e.g., hospice). It is intended to provide guidance on safe minimum practice and local requirements may be added by healthcare facilities based on local situations (epidemiology, facility-based outbreak, staff resourcing).

Clinical staff (nursing, medical, allied health staff)

• Providing care to patients with confirmed COVID- 19 or patients with symptoms of acute respiratory virus infections (including suspected COVID-19): mask use required. Follow transmission-based precautions (usually this will mean P2/N95 particulate respirator).
• Providing care to patients in other situations: medical mask recommended in other care situations.
  • Note 1: - in units where there is higher/more frequent risk of exposure, including acute assessment units/emergency departments, specialist units involving procedures on upper respiratory tract (bronchoscopy, upper GI endoscopy, ENT airway procedures), or other higher risk scenarios, units may recommend N95/P2 particulate respirator use based on local situation or as per of normal clinical practice.
  • Note 2: – in very low risk situations where use of mask may impact negatively on care delivery, clinical judgment may be used to remove masks but is recommended only after a risk assessment is performed by the clinician and agreed to by patient.
• Staff only zones and transit areas: medical mask use is encouraged, especially in situations where ventilation is not optimal.

Non-clinical staff (administrative, clinical support, facilities)

• Reception areas/waiting rooms: Mask use is encouraged in areas where staff will be in prolonged contact with public or in open waiting rooms.
• Staff only zones and transit areas: mask use is encouraged, especially in situations where ventilation is not optimal or where staff will be in prolonged contact with public.
• Staff providing patient transport services (e.g., orderlies, drivers, aeromedical transfer staff, ambulance transport staff): mask use is recommended if working within patient care zone or as part of transmission-based precautions.

Fit testing/ fit checking a P2/N95 particulate respirator

Fit testing is a procedure through either a qualitative or quantitative test to ‘match’ the right P2/N95 particulate respirator with the wearers face shape to ensure maximum protection.

Fit testing is strongly recommended for all healthcare workers who wear a P2/N95 at least once, and then repeated if any major changes to face shape occur or if available products change. Health and Safety recommendations regarding frequency of fit testing requirements are subject to review.

Fit checking /user seal check is a ‘quick check’ method used by the wearer to ensure the respirator is properly positioned on their face and there is a tight seal between the respirator and face. A fit check/user seal check must be done every time a P2/N95 particulate respirator is put on.

In situations where fit testing has not yet been carried out and a P2/N95 particulate respirator is recommended for use, refer to our interim guidance. 

Fit testing is a procedure through either a qualitative or quantitative test to ‘match’ the right P2/N95 particulate respirator with the wearers face shape to ensure maximum protection.

Fit testing is strongly recommended for all healthcare workers who wear a P2/N95 at least once, and then repeated if any major changes to face shape occur or if available products change. Health and Safety recommendations regarding frequency of fit testing requirements are subject to review.

Fit checking /user seal check is a ‘quick check’ method used by the wearer to ensure the respirator is properly positioned on their face and there is a tight seal between the respirator and face. A fit check/user seal check must be done every time a P2/N95 particulate respirator is put on.

In situations where fit testing has not yet been carried out and a P2/N95 particulate respirator is recommended for use, refer to our interim guidance. 

Posters are available to facilitate use of masks in health care settings.

They are available for download from the Unite Against COVID-19 Resource Toolkit. 

Face mask album – Unite against COVID-19 Resource Toolkit.