Coronavirus (COVID-19) care home outbreaks - root cause analysis: progress report November 2020 to September 2022

6. IPC knowledge and expertise

The RCA indicated that care home managers reported inconsistency in local board level IPC advice provided and the need for access to expertise to support them in a context specific way for the IPC risk assessment within the care home environment. Acknowledging the lack of IPC specialists in community settings, the report recommended building local IPC capacity at Health and Social Care Partnership (HSCP) level through for example Community IPC Nurses and building IPC capacity in or connected to the HPTs, who know their local care homes and the context.

Recommendations:

6.1 Local IPC capacity requires to be developed at HSCP level and with HPTs to support care homes with expert IPC advice which is risk based, proportionate and supports compassionate care in a homely setting

Progress

A review of the antimicrobial stewardship (AMS) and IPC workforce was commissioned in 2020 with a final infection services workforce strategic plan due for publication at the end of 2022. This will be of significant relevance to those providing support to the sector. This takes into account the rapid changes experienced through the COVID-19 pandemic, demographic shifts in care from acute to community settings, and opportunities brought by new data and analytical services, new technology and new ways of working.

This workforce plan aims to build capacity and capability of AMS, Health Protection (HP) (with relevance to IPC) and IPC workforce in all health and care settings. It contains recommendations around developing the optimal workforce along with appropriate education and training.

A review of current available learning opportunities is being conducted by NES. This will allow for key priorities to be identified for development and to meet future and evolving needs. In addition, NES are currently undertaking a review of the existing IPC frameworks for the IPC workforce. Furthermore, work has begun on the creation of an AMS framework as well as other career frameworks for IPC/HP and AMS workforce can be found in Section 7.

Learning events, held by the CI , have encouraged sector staff to create a TURAS account to give access to a range of health and wellbeing information including the Scottish Infection Prevention and Control Education Pathway (SIPCEP) modules to help develop skills to care/support people experiencing care. These events were open for all staff to attend. The SSSC provided resources, including induction resources, which linked to the TURAS resources. They signposted care staff to NHS Education Scotland resources.

An IPC Sub Group of the CPAG was established on 29^th April 2021. Reporting to the CPAG, the subgroup was a multidisciplinary group which aimed to address the RCA recommendations related to IPC, support embedding of IPC within the social care sector and provide clinical and professional advice for the care home sector regarding all aspects of IPC. The group has now concluded but consideration of IPC issues in the context of adult social care is undertaken in AHRAI community Scotland's Community IPC Programme Working Group

The CI led, developed and delivered learning events to the social care sector, including care homes, care at home and housing support services about consistent IPC practice and the IPC Standards. Over 600 staff attended these events between June and August 2022. The events have evaluated very well and have been supported by a number of agencies. This has allowed the CI to facilitate discussions about each standard: In response to feedback, two additional dates for care at home, housing support and adult day care providers and staff were added to allow more focus on these settings.

Preventing the spread of infections has always been important within care homes, and has been even more apparent during the COVID-19 pandemic. Care homes are not and should not become sterile 'clinical' settings, but they must remain safe environments for people to live in. The Healthcare Improvement Scotland (HIS) Infection Prevention and Control (IPC) standards (see description below Section 7) are a requisite for safe, high quality care in all settings. They must be supported by access to relevant IPC guidance, advice, education/training and guidance. By applying best practice, infections such as respiratory tract, gastrointestinal or wound infections, may be prevented. It is essential that this is part of routine compassionate care in a homely environment. IPC plays a part but so does hydration, mobility and medicines management. In addition, the aforementioned nurse directors responsibilities under oversight also covered IPC support.

Going forward

• The Scottish Government will consider ways to implement at local level IPC SICPs capacity in context of Health and Social Care Partnerships (HSCPs) and to ensure consistency of messaging on IPC in the care home context.
• The Scottish Government will work with partners to consider the development an IPC strategy for social care settings setting out vision, aims priorities including around workforce development and capacity building.
• Consideration should be given to whether this should be combined with an overall integrated strategy for health and social care settings.