Coronavirus (COVID-19): Nosocomial Review Group minutes: 10 December 2021

Items and actions

1. Coronavirus (COVID-19) Nosocomial Review Group (CNRG) were presented with the latest situation COVID-19 sitrep for week ending 21 November 2021. The group observed that the number of clusters and outbreaks remain lower than previous waves, it was noted that booster vaccine uptake in long term care settings is important for inpatients and health care workers (HCWs).
2. CNRG noted that the Scottish Winter Respiratory Guidance was published on 29 November 2021 and Boards were given two weeks to implement the guidance (by 13 December 2021). A short summary paper has been developed by Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) as a quick reference guide that highlights the relevant changes for implementation support.
3. CNRG discussed the Omicron variant threat regarding higher transmissibility and uncertainty in the evidence re severity, in comparison to the Delta variant. The continued importance of vaccine booster coverage in HCWs was discussed and also the risks of immune escape with Omicron. CNRG assessed the threat from the Omicron variant in the context of healthcare system pressures and noted an expected higher nosocomial risk. Where there is high community prevalence, community importations present a risk to in hospital transmission. The risks of higher occupancy in hospitals in the current situation, and challenged staffing ratios will also contribute to higher risk for all healthcare associated infections.
4. CNRG noted the UKIPC cell, ARHAI, Public Health Scotland (PHS) and UK Health Security Agency (UKHSA) were in agreement that extant Infection Prevention and Control (IPC) guidance remains important for all variants and emphasised the importance of risk assessment. It was also noted that the European Centre for Disease Prevention and Control (ECDC), Centres for Disease Control and Prevention (CDC) and World Health Organisation (WHO) have not changed IPC guidance in relation to the threat of Omicron, this will be kept under review.
5. CNRG noted that the importance of risk assessment of all closed healthcare setting areas, particularly for situational airborne risk and making sure organisations are supporting situational assessment of risk to enable use of additional measures, such as improving ventilation where possible and use of FFP3, where required. Optimising adherence with all the IPC measures is key, and consideration of higher frequency of testing HCWs in the NHS is merited. This testing advice was referred to the SG testing group for consideration.
6. The importance of community public health measures, community prevalence and its impacts on importation of cases to hospital were also noted with respect to NI risk. Travel to and from work for healthcare workers is an important part of the risk picture. The risk of social contact related importation risks to hospitals and further staff to staff transmission outside of the patient zone was also noted in the light of several reported clusters and outbreaks during this wave. The wider staffing challenges due to staff absence as a result of contacts and isolation needs were also noted.
7. CNRG received a request from the CPO on the Limited Deployment of COVID-19 Therapeutics to High Risk Patients 6th December 2021; for IPC advice related to new pathways for these new treatments. It was noted that boards have decided locally how they will deliver this service and there are different models from each Board. The overarching IPC guidance will be same for extant high risk pathways, if managed in acute care. Risk assessment will need to be context specific otherwise, for wider community settings or home administration.
8. CNRG were presented with the key findings from the ARHAI SONAAR report, including the impact of the pandemic, using data to the end of 2020. Data from 2016 to 2020 shows a year on year reduction in the use of antibiotics in the NHS in Scotland. The last year of data is impacted by the different patient demographics and occupancy in hospitals and care practice in other settings being restricted during the pandemic.
9. Primary Care was shown to have a 20.9% decrease in use and 2020 is the lowest use year in approximately seven years. Clinicians are continuing to follow local prescribing policies by optimising course duration and not prescribing broad spectrum antibiotics unnecessarily.
10. The acute setting has shown a 2.3% increase between 2016 and 2020. There was a 10.4% decrease in broad spectrum antibiotics and no substantial increase in use of IV antibiotics. There have been noticeable improvements in the use of ACCESS in acute hospitals in Scotland, whilst the same trend not been observed in other parts of the UK.
11. HCW LFD testing remaining consistent and PCR testing is consistent with 95% of total staff testing regularly.