All staff working with NHS Scotland healthcare facilities must maintain 2 metres physical distancing wherever possible.  This does not apply to the provision of direct patient care where appropriate PPE should be worn in line with section 5.6. 

Outbreaks amongst staff have been associated with a lack of physical distancing in recreational areas during staff breaks and when car sharing.

There are many areas within healthcare facilities where maintaining 2 metres physical distancing is a challenge due to the nature of the work undertaken.  Where 2 metres physical distancing cannot be maintained, staff must ensure they are wearing face masks in line with the extended use of facemasks 5.6.1.

Staff must adhere to physical distancing as much as possible and should:

• stagger tea breaks to reduce the number of staff in recreational areas at any one time
• maintain 2-metre physical distancing when removing FRSMs to eat and drink
• not car share when commuting to and from work unless absolutely necessary – where this is absolutely necessary, staff should sit as far apart as possible, wear a face covering or face mask and keep windows open in the car to improve ventilation

5.13.1 Inpatient bed spacing and OPD chair spacing

Health Facilities Scotland have undertaken an assessment of bed and chair spacing within NHS Scotland facilities taking into account compounding factors applied in conjunction with physical distancing (patient placement, ventilation, hand hygiene, face coverings, environmental cleaning).  The purpose of this document aims to help support boards in reviewing bed spacing to ensure 2 metre physical distancing, or as close to it as possible, can be maintained for inpatient beds and treatment chairs.

Note: This assessment will be added to the addendum in the near future.

Existing SHPN 04-01 guidance relating to bed spacing can be found here and recognises that spacing requirements are in place to contribute towards the control of healthcare associated infections.  Published in 2010 it stipulates that dimensions of bed spacing in any new builds should meet 3.6m (width) x 3.7m (depth).  To achieve 3.6m between bed spaces, measurements should be taken from bed centre to bed centre.

5.13.2 Engineering and Administration control measures in healthcare settings

Boards and departments should apply administrative controls to establish separation of patient pathways and minimise contact between the pathways.  Due to the wide variance in the layout, structure and fabric of NHS facilities across Scotland it is not possible to be descriptive in exactly how these should be applied and full assessment should be undertaken locally.  The following bullet points provide guidance which boards and departments may use when considering how best to develop pathways and promote 2-metre physical distancing.

• Signage on entry to buildings, wards and departments advising of the necessary precautions to take (face coverings, hand hygiene, physical distancing) including advice for visitors not to enter the premises if symptomatic of COVID-19.
• Ensure signage is clearly displayed to clearly identify pathways. Floor markings may also be used.  Physical barriers may be used where appropriate to prevent cross over of pathways.
• Ensure there are adequate hand hygiene facilities (wash hand basins or alcohol-based hand rub stations) available including the use of posters promoting hand hygiene and detailing the effective method for doing so. Appendix 1 how to handwash and Appendix 2 how to handrub.
• Where required, facilitate the use of screens to reduce exposure risk, for example at admission desks or help desks. Screens may be used in clinical care areas to help segregate patients however installation of these must not hinder the ability of staff to observe their patients and must be assessed by fire officers and health and safety teams first to ensure all other regulations remain compliant. There is limited evidence supporting the use of partitions for face-to-face interactions or between bed spaces, but it appears logical that a physical barrier can reduce contact between individuals and reduce the spread of infected particles from an infective source.
  • Full bed length, floor to ceiling partitions are likely to be the most efficacious in preventing transmission of COVID-19.  Partitions for face-to-face interactions, as a minimum, should cover both individuals breathing zone which encompasses a radius of 30cm from the middle of the face.
• Consider remote consultations where possible rather than face to face.
• Ensure areas are well ventilated where possible – open windows if temperature/weather conditions allow. Note that specific guidance applies to specialist ventilation areas such as theatres and endoscopy suites.