Coronavirus (COVID-19) Nosocomial Review Group: 15 October 2021

 

Items and actions

1. CNRG were given a verbal update on the upcoming COP26 and the potential impact on nosocomial infection rates. CNRG members were informed that Public Health Scotland (PHS) will produce a daily situation report, and it was confirmed to the group that Infection Control teams will receive these daily updates to help manage any associated risk.
2. CNRG were presented with the latest situation COVID-19 data for week ending 26 September 2021 and noted that Nosocomial Infection (NI) risk remained relatively low compared to previous waves. It was noted that the rate of COVID-19 admissions is decreasing and NI risk was expected to follow. ARHAI presented an analysis of the length of ward closure days on outbreaks. Overall, the larger the cluster the longer the ward closes. Those clusters and outbreaks with longer duration and higher numbers of cases were in wards which were opened early. The key recent lessons learned included: early ward opening, capacity and staffing, COVID hospital occupancy, placement pending admission screens, staff working with atypical COVID-19 symptoms and negative LFD. The chair noted that the lessons learned are routinely shared with the ICMs in boards in real time.
3. The CNRG Testing sub-group updated on their advice on LFD testing, in the light of recent UKHSA advice on use of LFD on the non-respiratory pathway and if droplet precautions for staff could be considered to be safe, provided the patient has undergone an LFT beforehand (in non-emergency situations). CNRG noted the subgroup recommendation and that risk assessment remains important in all pathways and agreed that testing is an important part of this. Views from the clinical cell, SMVN and OH clinicians would be sought in advance of giving advice.
4. CNRG discussed two key publications of national relevance to IPC guidance. The first of these was the IPC update guidance published on1 October 2021 by the World Health Organization (WHO) and noted the update provided recommendations on HCW preference in the use of masks and respirators for healthcare workers providing care to suspected or confirmed COVID-19 patients. It was noted that the WHO annex is very clear in describing how the Guidance Development Group (GDG) formed the recommendations, stating that the decision-making process was also informed by the perspectives and experience of experts represented in the panel. GDG members stated that the “balance of benefits and harm” and the “certainty of evidence” were the two most important factors influencing their decision.
5. CNRG considered if a broader statement was required in the Scottish winter respiratory guidance; reflecting the WHO recommendation for HCWs in all settings caring for COVID-19 patients, irrespective of AGPs, to make a decision based on personal preference, was warranted. This was therefore not a matter for IPC evidence informed decision making, but rather wider consideration of occupational health, workforce and policy considerations, inclusive of balancing harms (which has been subject to previous CNRG advice). CNRG advised that these groups be engaged in the decision making in this regard.
6. The second report was the Public Health England (PHE) independent panel review of systematic reviews on masks on 14 October 2021.  The search for this review was conducted 6 months ago in April 2021. CNRG noted the conclusion from PHE does not provide a clear direction for decision-making with regards to any additional mask use in healthcare settings for COVID-19 and no specific recommendations were made in this regard by PHE. The extant NIPCM guidance in Scotland includes provision for the use of respirators in those settings the report pointed to as high risk.
7. The NES supplementary educational materials to the IPC Winter Respiratory Guidance were welcomed by CNRG.  The supplementary material hosted on the TURAS learns page includes: mini-series, introduction to the new guidance key points, and breakdown of hierarchy of controls. Additionally, NES presented an animation created outlining the Winter Respiratory Guidance. NES confirmed to CNRG that additional communications will take place via Twitter and other media channels in support of implementation.
8. CNRG were given an update on antimicrobial prescribing. Primary care has seen an increase in 2021, in that GP prescribing is similar to 2019 levels, but significantly higher than last year (2020) – with Amoxicillin, Doxycycline use was noted to be back to pre-pandemic levels. Overall there was shown to be a reduction of antibiotic use in dental settings in recent months, however, there was a 24% increase in Amoxicillin use. To improve this situation and to mitigate possible risks SAPG are promoting use of penicillin rather than Amoxicillin in these settings.
9. CNRG noted that asymptomatic staff testing was important and would continue to be prioritised, with the anticipation that there will be increased demand in testing over the winter.