New research questions have been considered as part of this update. These look at:
New search terms have been added. The evidence search goes back to include all scientific papers that have been published since the year 2000.
See the NIPCM literature review development process for more information.
See the full list of research questions considered and the search terms within the revised literature review. Part A of the Considered Judgement Form has been published alongside the revised literature review to provide a summary of the evidence. The review does not contain any recommendations for practice as these are still being developed by the ARHAI Scotland National Policies Guidance and Evidence (NPGE) Working Group.
Due to the scope and complexity of this work, additional external specialist engagement required, and stakeholder involvement to date, ARHAI Scotland have revised the timelines for this review. It is anticipated that the recommendations for practice will be developed during the summer months of 2025, with a revised implementation phase commencing in spring 2026
Stakeholders requested that this review also considers where and when healthcare workers should wear masks and the type of mask they should wear (surgical mask or respirator). Evidence for mask effectiveness has been considered in separate literature review updates.
The pandemic highlighted that the way in which respiratory transmission is currently described (droplet and airborne transmission) may not reflect what is happening in real life. We need to look at whether there is a better way to describe transmission, and whether this would lead to any improvements in infection prevention and control (IPC) practice.
Understanding how infectious agents are released into the air and the risks associated with particle size and distance from source will help inform this. Reviewing the evidence to understand if there is increased risk associated with certain medical procedures will also inform IPC practice.
The World Health Organization (WHO) and Centers for Disease Control (CDC) have also reviewed transmission descriptors indicating a global shift in the way transmission routes are described. ARHAI Scotland were invited to meet with the WHO global IPC unit to discuss the topic and our literature review findings and guidance proposals were well received.
Work began on reviewing transmission descriptors in 2022 in the third year of the pandemic. The literature review has assessed over 26,000 scientific articles. 61% of all studies included to answer the main research question were published between 2019 and 2022 which reflects the growing interest in this area as the pandemic continued.
The ARHAI Scotland National Policies Guidance and Evidence (NPGE) Working Group are currently finalising new Transmission Based Precautions, Surgical Mask and Respiratory Protective Equipment recommendations for practice.
The terms ‘droplet transmission’ and ‘airborne transmission’ will soon be replaced with new definitions to describe respiratory transmission.
Aerosol Generating Procedures (AGPs) will be withdrawn from upcoming guidance alongside associated fallow times. There will no longer be a finite list of medical or care procedures to which specific precautions apply.
All of the above will mean changes throughout the NIPCM to update or remove terminology including the addition of resources to support any guidance changes. Guidance changes are scheduled for publication in August 2026.
Respiratory infectious agents will be categorised according to the hazard they pose, which will be the starting point for determining which type of mask (FRSM or respirator) to select.
Other key changes include consideration in guidance of vulnerable healthcare workers (those at higher risk of severe infection outcomes). Guidance will also retain the element of personal choice to select RPE where an FRSM is indicated.
Masks worn for the care of patients with respiratory infections will require to be donned on room entry and worn for the entirety of the time spent within the patient’s room or area.
Importantly, the change in guidance will better prepare us for the next pandemic, ensuring that controls applied are informed by the severity of outcome associated with the emerging pathogen.
The goal of the NIPCM is to provide healthcare workers in Scotland with guidance that is evidence based, up-to-date, effective, practical, and as a result, safe. There should be a clear benefit associated with any guidance change and this benefit should outweigh any potential harms. Guidance is changing based on these conditions having been met.
Supporting resources and education needs will be published alongside changes to the NIPCM to enable application to practice.