Policy objective and scope

• This policy protects health care workers (clinical and non-clinical), patients, residents, clients, visitors, and the public by outlining provincial expectations for the implementation of infection prevention and control (IPC) measures in health authority facilities, programs and services, including outpatient clinics and ambulatory care settings.

Definitions

• Medical mask: A medical grade face mask that meets the American Society for Testing and Materials International (ASTM), International Organization for Standardization (ISO) or equivalent performance requirements for bacterial filtration efficiency, particulate filtration efficiency, fluid resistance, pressure differential, flame spread, skin sensitivity and cytotoxic testing.
• Non-clinical staff: All health care workers that are not providing clinical care, including, but not limited to, administrative and office staff, facilities staff, contractors and volunteers.
• Patient care area: An area within a health care facility (including a contracted facility), hallway or lobby, accessible to patients, residents or clients who are there to access care or services. This includes any other location where care is provided, such as home and community care locations (including a client’s home). It does not include locations such as administrative areas or private offices, which patients, residents, or clients do not generally access.
• Respirator: A medical grade particulate filtering facepiece authorized by Health Canada, which meets minimum performance certification requirements, including fit testing, filter efficiency, and breathing resistance (e.g., N95 respirator).
• Should: A recommended practice to be implemented at the discretion of the organization or the individual.
• Must: A mandatory requirement based on the BC Ministry of Health directive.

Guiding considerations

1. This guidance is based on current evidence about the known mechanisms for transmitting viral respiratory illnesses. Specifically, viral respiratory illnesses (e.g., COVID-19 and influenza) are primarily spread by liquid droplets from the mouth and nose when coughing, sneezing, and sometimes talking.
2. Personal Protective Equipment (PPE), including masks, is part of the hierarchy of infection prevention and exposure control measures for infectious diseases. As such, PPE is supplemental to, and not a replacement for, other measures on the hierarchy. These additional measures include, but are not limited to:
   1. Public health measures (Orders from the Provincial Health Officer, testing, isolation).
   2. Environmental measures (being outdoors, frequent cleaning and disinfection).
   3. Administrative measures (screening for symptoms and risk factors, appropriate signage, patient scheduling).
   4. Personal measures (rigorous hand hygiene, respecting personal space, staying home when sick, practicing respiratory etiquette, ensuring immunizations are up to date).

Policy

1. Long-Term Care, Private Hospitals, Stand Alone Extended Care Hospitals Designated Under the Hospital Act, Seniors’ Assisted Living Settings and Provincial Mental Health Facilities.

Masking:

• Healthcare workers (clinical and non-clinical staff):
  • Regardless of immunization status, all persons working in a patient care area must wear a medical mask over their nose and mouth, except when eating and drinking.
  • Healthcare workers must wear other PPE indicated by a point of care risk assessment (PCRA) that considers all occupational risks, including potential viral respiratory illnesses.
  • Access to additional PPE for health care workers, such as respirators, must be provided when, based on a point of care risk assessment, a health care worker determines an elevated risk of viral respiratory illness transmission through patient/resident interaction.
  • Medical masks in non-patient care areas (e.g., administrative offices) must be worn if required by workplace communicable disease safety plans or as directed by a medical health officer.
• Visitors:
  • Patient care areas:
    • Regardless of immunization status, visitors in Long-Term Care, Private Hospitals, Stand Alone Extended Care Hospitals Designated Under the Hospital Act, Seniors’ Assisted Living Settings and Provincial Mental Health Facilities must wear a medical mask over their nose and mouth in all patient care areas, including communal areas and when participating in indoor group events, celebrations, gatherings and activities, except when eating and drinking.
  • Visiting multiple residents:
    • If the purpose of a visit requires visiting directly with more than one resident during a single visit (e.g., spiritual care by a faith leader), the visitor must wear a medical mask over their nose and mouth for the duration of the visit.
  • Residents who live in single-bed rooms:
    • Visitors are not required to wear a medical mask when visiting directly with a resident in a single bedroom, an assisted living unit, or a standard care home/residence area when others are not around.
  • Residents who live in multi-bed rooms:
    • Visits with residents who live in multi-bed rooms must take place in a separate, private room, wherever possible.
    • Visitors are not required to wear a medical mask if a private room is available.
    • Suppose a private room is unavailable, and other occupants (s) are in the multi-bedroom while a visit occurs. In that case, visitors must wear a medical mask over their nose and mouth.
    • Visitors must only visit with their loved one(s) in a multi-bed room.
    • Visitors must respect the personal space of others in a multi-bed room.
    • Room curtains must be drawn closed to divide the room, where available.
• Residents:
  • Regardless of immunization status, residents must wear a medical mask over their nose and mouth when directed by a healthcare worker.
  • In all other circumstances, residents should wear a medical mask based on personal choice.

Resources:

• RESOURCE | Donning PPE
• RESOURCE | Doffing PPE
• RESOURCE | Instruction for disposable respirators

Ambassadors:

• Ambassadors must be positioned at the entrances of all healthcare facilities.
• At a minimum, Ambassadors must:
  • Actively screen all visitors for symptoms of viral respiratory illness upon entry.
  • Direct all individuals to perform hand hygiene upon entry.
  • Provide medical masks.

Hand Hygiene:

• Facility operators must have alcohol-based hand rub (ABHR) available at the entrances to all facilities and at the point of care.
• Facility operations must post appropriate signage at entrances, washrooms, and common areas, directing people to clean their hands.
• Healthcare workers must perform rigorous hand hygiene by the four moments of hand hygiene.

Resources:

• RESOURCE | Handwashing with soap and water
• RESOURCE | Handwashing with alcohol-based hand rub
• RESOURCE | Poster – How to wash your hands
• RESOURCE | Safety huddle – Hand washing

Immunization:

• Healthcare workers must meet immunization requirements by Provincial Health Officer (PHO) Orders and employer policies.
• Proof of vaccination is not required for patients, clients, residents or visitors.

Resources:

• RESOURCE | Vaccine Basics 
• RESOURCE | Vaccine Basics for Leaders
• RESOURCE | Seasonal flu vaccines

Enhanced Cleaning and Disinfection:

• Facility operations must continue enhanced cleaning and disinfection procedures in resident rooms, treatment rooms, and high-touch points.

Resources:

• RESOURCE | Safety huddle | Environmental cleaning

Health Care Worker Illness and Return to Work:

• Healthcare workers must follow provincial viral respiratory illness exposure and return-to-work guidance, available at http://www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/Return-to-work-management-exposures-health-care-workers. This includes self-monitoring for signs and symptoms of illness before work and staying home when sick.

Resources:

• RESOURCE |Exposure control plan checklist
• RESOURCE | Exposure control plan template
• RESOURCE | Hierarchy of control for long-term care

Visitation:

• Unless directed by a medical health officer, limits on the number of visitors in Long-Term Care, Private Hospitals, Stand Alone Extended Care Hospitals Designated Under the Hospital Act, Seniors Assisted Living Settings and Provincial Mental Health Facilities are not required.
• Unless directed by a medical health officer, COVID-19 testing (e.g., rapid antigen testing) is not required for visitation.

Occupancy Limits and Physical Distancing:

• Unless directed by a medical health officer, occupancy limits and physical distancing are not required as infection prevention and control measures in waiting rooms, meeting rooms, and communal areas.
• Facility operators must follow all other mandated occupancy limits and requirements set out in, for example, local fire regulations.

2. Other Healthcare Facilities and Settings where Healthcare is Provided.

Masking:

• Healthcare workers (clinical and non-clinical staff):
  • Regardless of immunization status, all persons working in a patient care area must wear a medical mask over their nose and mouth, except when eating and drinking.
  • Healthcare workers must wear other PPE indicated by a point of care risk assessment (PCRA) that considers all occupational risks, including potential viral respiratory illnesses.
  • Access to additional PPE for health care workers, such as respirators, must be provided when, based on a point of care risk assessment, a health care worker determines an elevated risk of viral respiratory illness transmission through patient/resident interaction.
  • Medical masks in non-patient care areas (e.g., administrative offices) must be worn if required by workplace communicable disease safety plans or as directed by a medical health officer.
• Visitors:
  • Regardless of immunization status, visitors must wear a medical mask over their nose and mouth in all patient care areas.
• Patients:
  • Regardless of immunization status, patients must wear a medical mask over their nose and mouth when directed by a healthcare worker.
  • Patients and those accompanying them must wear a medical mask over their nose and mouth in all emergency departments and waiting rooms.
  • In all other circumstances, patients should wear a medical mask based on personal choice.

Resources:

• RESOURCE | Donning PPE
• RESOURCE | Doffing PPE
• RESOURCE | Direct care PPE guidance for long-term care
• RESOURCE | Direct care PPE guidance for home and community support
• RESOURCE | Masks and respirators
• RESOURCE | Instruction for disposable respirators

Ambassadors:

• Ambassadors must be positioned at the entrances of all healthcare facilities.
• At a minimum, Ambassadors must:
  • Actively screen all visitors for symptoms of viral respiratory illness upon entry.
  • Direct all individuals to perform hand hygiene upon entry.
  • Provide medical masks.

Hand Hygiene:

• Facility operators must have alcohol-based hand rub (ABHR) available at the entrances to all facilities and at the point of care.
• Facility operations must post appropriate signage at entrances, washrooms, and common areas, directing people to clean their hands.
• Healthcare workers must perform rigorous hand hygiene by the four moments of hand hygiene.

Resources:

• RESOURCE | Handwashing with soap and water
• RESOURCE | Handwashing with alcohol-based hand rub
• RESOURCE | Poster – How to wash your hands
• RESOURCE | Safety huddle – Hand washing

Immunization:

• Healthcare workers must meet immunization requirements by Provincial Health Officer (PHO) Orders and employer policies.
• Proof of vaccination is not required for patients, clients, residents or visitors.

Resources:

• RESOURCE | Vaccine Basics 
• RESOURCE | Vaccine Basics for Leaders
• RESOURCE | Seasonal flu vaccines

Enhanced Cleaning and Disinfection:

• Facility operations must continue enhanced cleaning and disinfection procedures in patient rooms, treatment rooms, and high-touch points.

Resources:

• RESOURCE | Safety huddle | Environmental cleaning

Health Care Worker Illness and Return to Work:

• Healthcare workers must follow provincial viral respiratory illness exposure and return-to-work guidance, available at http://www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/Return-to-work-management-exposures-health-care-workers. This includes self-monitoring for signs and symptoms of illness before work and staying home when sick.

Resources:

• RESOURCE |Exposure control plan checklist
• RESOURCE | Exposure control plan template
• RESOURCE | Hierarchy of control for home and community care

Visitation:

• Unless directed by a medical health officer, limiting the number of visitors is not required.
• Unless directed by a medical health officer, COVID-19 testing (e.g., rapid antigen testing) is not required for visitation.

Occupancy Limits and Physical Distancing:

• Unless directed by a medical health officer, occupancy limits and physical distancing are not required as infection prevention and control measures in waiting rooms, emergency departments, meeting rooms, and communal areas.
• Facility operators must continue to follow all other mandated occupancy limits and requirements set out in, for example, local fire and safety regulations.

Implementation:

• All healthcare administrators must develop guidance materials aligned with this policy to support local implementation.
• Exceptions to the medical masking requirements must be allowed for:
  • People under five years old.
    • People unable to wear a mask because of a health condition, developmental delay, physical or mental impairment.
    • People unable to put on or remove a mask without help from another person.
    • People communicating with someone with a hearing impairment.
  • People who are required to wear a mask and can wear a mask but who choose not to, as a matter of preference, are not exempt.
  • As indicated in this policy, all health care facilities must provide medical masks, respirators and other PPE for healthcare workers, non-clinical staff, patients, residents and visitors.