BACKGROUND:Guidance on the use of fluid-resistant surgical masks (FRSMs) and filtering facepiece protection level 3 (FFP3) respirator masks by healthcare staff in England is produced nationally and applied locally by hospital trusts. In April 2022, national infection prevention and control guidance was updated with reference to the importance of local risk assessment when considering the use of FFP3 respirator masks. AIM:Our aim was to evaluate local hospital policies for use of face masks and risk assessment for healthcare staff. METHODS:A cross-sectional online survey (February-March 2023) of National Health Service trusts in England was conducted. Responses were analysed using Fisher's exact tests and the framework approach. RESULTS:Fifty nine percent (109/186) of eligible hospital trusts responded. All trusts required staff to wear FRSMs or FFP3 respirator masks when providing direct care to patients with suspected respiratory viral infection (RVI), 87% (95/109) and 13% (14/109), respectively. FFP3 respirator masks were required by 13% of trusts (14/109) when providing direct care to individuals with suspected RVI and by 9% of trusts (10/109) when present in a bay/ward with patients with suspected RVI. Over half of the trusts used locally developed risk assessment tools. CONCLUSIONS:There was clear variation in policies for use of face masks and use of workplace and individual risk assessments across hospital trusts. There was also variation in application of mask use, fit testing and audit of adherence. Further work is required to explore whether development of further guidance and national implementation tools could reduce unwarranted variation.

Whilst healthcare workers (HCWs) are at high risk of contracting COVID-19, measures can be put in place to reduce the spread of COVID-19 and other respiratory infections in healthcare settings. These currently include the use of masks: fluid-resistant surgical masks and respiratory protective equipment. However, for mask policies to be effective, compliance with their use must be high. This study interviewed 12 HCWs from a variety of backgrounds to understand their experiences of mask use. We explored factors associated with compliance with mask use and potential impacts on HCW wellbeing. Overall, participants reported good understanding of the benefits of masks and high compliance levels with policy. However, factors that reduced their compliance with mask policy and impacted their ability to carry out their role were highlighted. These included wearing masks for longer durations, policy being perceived as out of proportion with risk, communication challenges, and discomfort. This study highlights the importance of clear communication of guidance, particularly when it has changed, ensuring staff are familiar with up-to-date research on efficacy of masks, and ensuring guidance aligns with risk. Furthermore, this study highlights the importance of masks being required for an appropriate duration (based on risk).