Risk assessments and face masks are commonly used at hospital Trusts in England when dealing with respiratory viral infections (RVIs), but local approaches vary substantially across the country, suggesting a need for more standardised implementation tools.
Infection prevention and control (IPC) guidance in England is produced centrally but adapted locally by NHS Trusts.
A national cross-sectional online survey, published in the Journal of Hospital Infection, evaluated local workplace policies on the use of fluid-resistant surgical masks (FRSMs) and filtering facepiece protection level 3 (FFP3) respirators, as well as individual worker risk assessment tools, in cases of suspected or confirmed RVIs.
The work followed the April 2022 update to national IPC guidance, which emphasised local risk assessment when considering the use of FFP3 respirators.
Infection prevention risk assessment practices
Trusts were eligible to participate if they had emergency hospital admissions or hospital settings caring for patients with suspected or confirmed infections.
The survey response rate was 59%, and respondents included 75 acute Trusts, 24 mental health Trusts and 10 community Trusts.
Most Trusts (94%) used workplace risk assessment tools for RVIs. Among these, 75% used a published tool, 53% used a locally developed tool and 28% used both.
In locally developed workplace tools, commonly included factors were patient symptoms, recent test results and the hierarchy of controls, each cited by 85% of Trusts using local tools.
Individual staff risk assessment was also common but inconsistent. Overall, 94 of the 106 Trusts that responded used a tool for individual healthcare worker risk assessment. Of these, 61% (57/94) used a locally developed tool and 49% (46/94) used a published tool.
Local tools most often considered pre-existing medical conditions or comorbidities (96%), place of work (91%) and pregnancy (86%), while personal preference was included by 19%.
Face mask use in direct patient care
At the time of the survey, 63% of Trusts required staff to wear FRSMs at all times in clinical areas, although this was not mandated nationally. All Trusts required either FRSMs (87%) or FFP3 respirators (13%) when caring for patients with suspected RVIs.
For confirmed Covid-19 cases, 74% of Trusts required staff to wear FRSMs and 26% required FFP3 respirators during direct patient care. For confirmed influenza, the usage was 86% for FRSMs and 14% for FFP3 respirators.
When staff were in the proximity of patients with suspected or confirmed respiratory viral infection but were not providing direct care, 90% of responding Trusts required FRSMs and 9% required FFP3 respirators.
Among the Trusts that required only FRSMs across all three direct-care scenarios, 87% reported that FFP3 respirators were available, based on staff preference. Adherence to mask use was audited or monitored by 83% of Trusts.
Voluntary participation, self-reported IPC practice and potential over-representation of Trusts with greater IPC interest or capacity were cited as limitations. As the survey was conducted in early 2023, the results may also reflect practices shaped by the Covid-19 pandemic.
The survey results suggested that national IPC guidance and implementation tools could reduce unwarranted variation in English hospitals, prompting the authors to call for standardised individual risk assessment tools and further pragmatic clinical and behavioural research into masking policies and compliance.
Reference
Foster CR et al. Infection prevention and control risk assessment and policy for respiratory viral infections in National Health Service trusts in England: a national survey. J Hosp Infect 2026;170:246–52.
This article was originally published by our sister publication Hospital Healthcare Europe.
