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Masks

In November 2020, the B.C. Ministry of Health released new provincial direction (PDF) about mask use in health care facilities. 

In alignment with this, PHSA released an organization-wide policy on mask use in health care facilities (PDF) and communications outlining the policy for its administrative buildings (PDF). 

  • In our health care facilities, it is now mandatory for everyone to wear a medical mask. This includes common areas and break rooms, unless you are eating and/or drinking. Patients, clients and visitors must also wear a medical mask. PPE protocols for the relevant patient care procedures/settings remain in place. Download PHSA’s poster for the do’s and don’ts of wearing medical masks (PDF). 
  • In our administrative buildings, everyone must wear a non-medical mask when they are in common areas, moving around the office, and when they cannot maintain a two-metre distance from others. 
As just one part of the hierarchy of controls, masks supplement but do not replace other important measures such as physical distancing, cleaning and disinfection, staying home when sick, and good hand hygiene. 

We must remember that we do not know everyone’s story. There may be reasons why someone is unable to wear a mask. Please continue to practice compassion, patience and understanding. 

General questions

Medical masks are masks that have been approved and distributed by the health authority and rated according to stringent North American standards.

Non-medical masks are masks that are not rated for use in health care settings, which includes cloth masks, other cloth face coverings, industrial respirators, and disposable masks that do not meet the standards of a medical mask.  

Read this information from Health Canada, which provides information about the different types of non-medical masks, or review the BCCDC’s information on masks.
 
Our provincial stockpiles of medical masks and PPE remain in very good shape and we monitor our supply levels rigorously.

Medical masks will be supplied at all clinical sites, for patients, clients, visitors and staff. 

Staff at our non-clinical sites are asked to bring their own non-medical masks. Reception areas may have limited stock available in the rare event that someone forgets their mask or has a visitor at one of our corporate buildings.
 
For medical masks, if it has been worn during contact while caring for patients/clients or is wet, soiled or damaged it must be discarded when removed and should not be re-used. Torn masks should not be worn or re-used. View PHSA’s poster for the do’s and don’ts of wearing medical masks (PDF).

For homemade or cloth masks, they should be cleaned and changed often. Review tips for cleaning these types of masks on the BCCDC’s website and view Health Canada’s poster on the dos and don’ts for non-medical masks (PDF).
 
Try to understand why they are not masking and highlight the purpose of the policy – to help ensure the safety of patients, visitors, and staff members. 

If needed, escalate to your supervisor, who can consult with HR if your concerns are not addressed. 

We must remember that we do not know everyone’s story. There may be reasons why someone is unable to wear a mask. Please continue to practice compassion, patience and understanding.
If the patient, client or visitor is aware of the policy but is still choosing not to wear a medical mask, staff must not compel them to wear one; rather staff should apply the other hierarchies of control to eliminate excess risk, including staff wearing medical-grade PPE where appropriate.   

Please practice compassion, patience and understanding. As health care professionals, we have a duty to provide care (PDF). This means that health care must be provided to a person choosing not to or unable to wear a mask. 

It’s important to recognize that the risk associated with a patient not wearing a mask is low in a health care setting where many other preventative measures are in place.

If you feel comfortable doing so, politely remind your leader that there is now an official mask policy in place. You may also want to try seeking support from your colleagues or other leaders on your team or organization in having this conversation.

 
Remember to practice patience, compassion and understanding. This is new for many of us – and it may just be that the individual is unaware of the proper way to way a mask. 

Try politely reminding the person that their mask isn’t adjusted properly and point them to helpful resources, such as the:
Remember, masks are only one part of the hierarchy of controls, and they must be supplemented with other important measures such as physical distancing, cleaning and disinfection, staying home when sick, and good hand hygiene.
In the event that staff are not complying with the policy, try to first understand why they are not masking as required.

Once you have a better understanding, try to educate them and help them understand the purpose of the policy – to ensure the safety of patients, visitors, and staff members.

The goal is to achieve compliance through education and training, which happens in the majority of cases. Managers can leverage their HR Business Partner and Union Stewards to support compliance as needed.

There are limited exemptions that are permitted under PHSA’s mask use policy (PDF). Review the policy and then speak to your immediate supervisor about your specific situation. Your supervisor can consult with Disability Management or their HR business partner.

 

No. Wearing a mask does not eliminate the requirement for the other hierarchies of control. Wearing a mask is not a substitute for physical distancing.

 

Yes, the policy applies to everyone entering our facilities for work purposes. This includes, but is not limited to, medical staff members (including physicians, midwives and dentists), nurse practitioners, residents, fellows and trainees, health care professionals, administrative and office staff, facilities staff, students, volunteers, doulas, contractors, researchers and other service providers (e.g. construction crews) engaged by PHSA.

 
The provincial direction (PDF) applies to all health authorities. However, specific details for implementation may vary across sites. 

As the “prime contractor,” the host health authority has overall site safety coordination responsibility. However, if you are a PHSA employee working on another host health authority’s site, you will need to follow PHSA guidelines as well.

If there is ever a conflict between the two requirements, the stricter safety guidelines should always be followed. If there is any dispute, please follow the guidance of the host health authority and ensure you speak with your manager. Your manager can reach out to a workplace health & safety representative or HR business partner for guidance.
 

Corporate buildings

Read this information from Health Canada, which provides information about the different types of non-medical masks.

 
PHSA’s policy for corporate buildings provides that you can wear any non-medical masks. 

Read this information from Health Canada, which provides information about the different types of non-medical masks.
 

Our Workplace Health & Safety guidelines for administrative/corporate facilities require that individuals wear masks in PHSA's common areas, including when entering or exiting meeting rooms, as well as in stairwells, hallways, bathrooms, elevators and cafeteria or break rooms (except when you are eating/drinking).


Updated: Feb. 24, 2021

 

There is no need to wear a medical mask in an individual, private office. For shared offices or cubicles, where there is adequate ventilation, physical distancing or barriers, then mask use is at the discretion of the occupants.

 
Yes. There will be medical masks available at the points-of-entry.

As health care facilities work towards full implementation of the policy, there may be situations where staff are not able to access medical masks at their point of entry. If this is the case, staff should wear their own non-medical mask until they are able to obtain and safely don a medical mask.
No. 

A face shield is used to protect the eyes of the person wearing it. Using a face shield without a mask won't protect you from potentially inhaling infectious respiratory droplets exhaled by others, nor will it protect others from your infectious respiratory droplets, as they can escape around the face shield.

Neck gaiters aren't well secured to the head or ears, are likely to move or slip out of place and are difficult to remove without contaminating yourself.
Staff at our non-clinical sites are asked to bring their own non-medical masks. 

Reception areas may have limited stock available in the rare event that someone forgets their mask or has a visitor at one of our corporate buildings.

The provincial and WorkSafeBC guidance on masks in workplaces apply to everyone entering our facilities. This includes but is not limited to visitors, contractors and service providers engaged by PHSA. 


Updated: Feb. 24, 2021

 
 

Health care facilities

For PHSA’s masking policy (PDF), “clinical delivery site” means all PHSA sites where health care is delivered (e.g. BC Children’s Hospital, BC Women’s Hospital, BC Cancer centres, Heartwood Centre for Women, Burnaby Centre for Mental Health and Addiction, Forensic Psychiatric Hospital, Correction Health Services, etc.). This also includes radiology reading rooms, laboratories, pharmacies. For BC Emergency Health Services, this also includes Virtual Way, ambulances and stations. 

This does not include buildings such as 1333 West Broadway, which have no patient/client care delivered on-site.
 
Yes. This policy applies to all staff working in clinical areas whether or not patients/clients are present.

Staff are expected to use the hospital or health care setting acquired medical grade masks provided at entry or by their clinical delivery site. 

There are some exceptions to when a medical mask must be worn, such as when eating/drinking or when in a private office. Please review the policy (PDF) for more details. 

We recognize that some work requires individuals to be clearly heard on the phone (e.g. dispatch) and therefore in these areas masks are not required as long as physical distancing in the workspace allows; however, masks are required when leaving the workspace or if physical distancing cannot be maintained.
 
Yes, there are some situations where a mask cannot be worn, such as for those whom masks may not be safe and for those whom masks may cause undue distress

Please review the policy (PDF) carefully for full details.
 
There may be many reasons why a patient/client or visitor is unable to or chooses not to wear a mask. 

Staff must not compel patients/clients and essential visitors to wear a medical mask in this situation; rather staff should apply the other hierarchies of control to eliminate excess risk. The risk associated with a patient/client/visitor not wearing a mask is low in a health care setting where we have many other preventative measures in place, including staff wearing medical-grade PPE.

Health care must be provided to a person choosing not to or unable to wear a medical mask, per the duty to provide care (PDF).
In health care settings where we have many other preventative measures in place, including staff wearing medical-grade PPE, the risk associated with a patient/client or visitor not wearing a mask is low. 

Remember, masks are supplementary to, but not replacements for, other measures in the hierarchies of control.

No. Patients/clients and visitors should be provided with same medical mask (hospital grade procedure masks) as staff.

 
No. There may be many reasons why a patient/client or visitor is unable to or chooses not to wear a mask.  Health Care must be provided to a person choosing not to or unable to wear a medical mask, per the duty to provide care (PDF). 

Staff must not compel patients/clients and visitors to wear a medical mask in this situation; rather staff will apply the other hierarchies of control to eliminate excess risk. 

The risk associated with a patient/client or visitor not wearing a mask is low in a health care setting where many other preventative measures are in place including staff wearing medical grade PPE.

Put simply, no patient is to be refused care for declining to wear a mask. All staff have a duty to provide care. Remember that there may be many reasons why someone declines to wear a mask. If a colleague refuses to provide care, please report and escalate to your area leader.
No. Medical masks must be worn by everyone working in a clinical delivery sites including in common areas and break rooms, unless eating and/or drinking. 

Upon entering a site, staff will need to clean their hands and change into a hospital or health care setting-provided medical grade mask before transiting through common areas of the clinical delivery site to their final destination.

As health care facilities work towards full implementation of the policy, there may be situations where staff are not able to access medical masks at their point of entry. If this is the case, staff should wear their own non-medical mask until they are able to obtain and safely don a medical mask.
This policy applies to all staff working in clinical areas whether or not patients/clients are present.

These areas typically do not have defined workspaces where distancing can be consistently maintained and often include high traffic areas where staff are regularly passing each other in close quarters.

Staff in these areas are also not able to effectively work from home if they fall ill and are required to self-isolate, unlike office workers. Extra precautions are required to maintain staff health and continuation of essential services.
Staff are expected to use the hospital or health care setting acquired medical grade masks provided at entry or by their clinical delivery site.

While there are medical grade masks available in local grocery stores/pharmacies, not all of them meet the actual standards of hospital/health care setting-based medical grade masks.  The only way to be sure that health care workers, patients/clients, visitors and families are wearing the appropriate masks in clinical delivery sites, is to provide them with the health authority acquired medical grade masks. 
Yes. PPE, including masks, are one part of the hierarchy of infection prevention and exposure control measures for communicable diseases. As such, PPE are supplemental to, and not replacements for other measures on the hierarchy. These other measures include, but are not limited to:

  • population-level measures (crowd limits, closures, quarantine/isolation, contact tracing)
  • environmental measures (physical distancing, physical barriers, cleaning and disinfection)
  • administrative measures (changes in work practices, decreased density)
  • personal measures (staying home when sick, hand hygiene)
  • other PPE guidance for direct patient/client care (eye protection and additional PPE as required by the point of care risk assessment)
Masks should not be pulled down. Try your best to only eat/drink within designated break times and don a new mask afterward.  

If masks need to be removed temporarily (e.g. drinking water), following the guidance for safely donning and doffing.

Review PHSA's poster for do’s and don’ts of wearing medical masks (PDF) or watch the donning and doffing videos from PICNet for instructions.

Yes. PHSA’s policy for health care facilities (as well as for our corporate buildings) requires that individuals wear masks in all common areas, including meeting rooms, stairwells, hallways, bathrooms, elevators and cafeteria or break rooms (except when you are eating/drinking).

 
Yes, except when eating and/or drinking. 

Staff locker rooms are considered common areas and the medical literature has shown us that staff-to-staff transmission can commonly occur in shared spaces. That is why staff must staff wear a medical grade mask in staff lounges and locker rooms, unless eating or drinking. Remember, wearing a mask is not a substitute for other measures such as physical distancing.

Masks are not required in outdoor spaces, as long as physical distancing guidance is applied. Remember to practice other infection prevention and control measures, such as cleaning your hands regularly.

 
It is generally not advised to re-don a medical mask after doffing. However, in some limited circumstances it may be necessary. In those cases, re-donning a medical mask needs to be done safely.

In order to safely re-don a mask, pay careful attention to ensure you avoid contamination from the outside to the inside of the mask. Avoid touching the mask for the remainder of wear. If there is a need to adjust the mask, thorough hand hygiene should be completed before and after any contact with the mask.

Do not re-don masks that were worn during patient/client care activities or if they are wet, soiled and/or damaged.
There is no need to wear a medical mask in an individual, private office. For shared offices where there is adequate ventilation, physical distancing or barriers then mask use is at the discretion of the occupants. 

Room occupancy and physical distancing requirements still apply in non-clinical areas within clinical delivery sites, such as offices, regardless of whether a medical mask is worn.

We recognize that some work requires individuals to be clearly heard on the phone (e.g. dispatch) and therefore in these areas masks are not required as long as physical distancing in the workspace allows; however, masks are required when leaving the workspace or if physical distancing cannot be maintained.

Yes. Medical masks must be worn over elastomeric respirators valves. Alternatively a disposable N95 mask can be worn.

 

No. These do not provide the extra layer of protection in the same way as a medical-grade face mask does.

 
There is no benefit to having a child wear an adult-sized mask which is too large; instead, the child should wear pediatric-sized mask, even if it is not medical grade. 

For young children or those with behavioural challenges, continuing to wear their own mask from home is better than no mask at all. However, the risk of COVID-19 spread to health care workers from young children is low in a health care setting where we have many other preventative measures in place, including staff wearing medical grade PPE.
For safety reasons. Children under two years of age should not wear masks because there are risks of breathing problems, choking or strangulation. Masks can also be irritating and may lead to increased touching of the face and eyes and are not safe for those that are unable to don and doff the mask themselves. 

The risk associated with a child not wearing a mask is low in a health care setting where many other preventative measures are in place including staff wearing medical grade PPE.
Yes. All ambulance stations and Virtual Way (where dispatch is located) are considered clinical care areas.

All paramedics, dispatchers and BCEHS staff are required to wear a medical grade procedure mask in situations where two metres of physical distance cannot be maintained with others.
In most cases, a medical-grade mask provides necessary protection. N95 masks are reserved for specific patient care situations. There are protocols in place for the use of N95 masks under the PPE allocation framework (PDF) for the specific settings in which they are required. 

Evidence from over 50 million cases worldwide suggests that COVID-19 is primarily spread by droplet and contact transmission. Liquid droplets come out of the mouth and nose when a person coughs, sneezes, and talks or sings. These droplets will quickly fall to the ground within 1-2 metres, but they can land on another person if they are within that range. COVID-19 can spread if droplets containing the virus enter another person’s body through the eyes, nose or throat or through contact if a person touches an infected surface and then touches their mouth, nose or eyes.  

There is some evidence demonstrating that COVID-19 can occasionally be spread via the aerosol (or airborne) route in specific circumstances.  Aerosols are generally smaller than droplets, and can linger in the air for longer. This means that there are rare situations where aerosols containing COVID-19 may occur and infect individuals (e.g. small spaces with many people and poor ventilation, such as fitness classes). This is not known to have occurred in health care settings, though an exception is aerosols produced by aerosol-generating medical procedures (AGMPs). With the exception of AGMPs, N95 masks are generally not required to protect from COVID-19.

We appreciate that the issue of COVID-19 being spread via aerosols has caused some concern. So far, the evidence continues to show that COVID-19 is spread primarily by droplets, with clear protection provided by physical distancing, mask use, and hand hygiene. These measures, once instituted in a widespread manner in B.C. in the spring, worked extremely well in reducing infections. If aerosols played a primary role in COVID-19 spread, the measures that we have been using would not have worked, and we would be seeing widespread outbreaks in areas implementing them, such as health care settings – something that has not been observed.
 

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