Coronavirus (COVID-19) Nosocomial Review Group minutes: 18 March 2022

Items and actions

1. CNRG were given an update on the current COVID-19 nosocomial situation week ending 27 February. It was noted that the community prevalence of COVID-19 has increased in recent weeks and this is impacting on community importations of SARS-CoV-2 to hospitals. Of the cases week ending 27 February, nosocomial defined cases accounted for 0.6 percent of all COVID. All-cause mortality in cases decreased between September 2021 to January 2022.
2. It was noted that the number of clusters at the time of meeting were at their highest level since January 2021. This was related to high community prevalence, higher transmissibility and multiple community importations to the hospitals. It was noted that the IPCTs had reported that these clusters are cases in time and place, however the number of community importations and multiple introductions by staff and patients in wards mean not all cases are related to each other. Two thirds of nosocomial cases are currently asymptomatic at the point of testing, however this data is not complete as not all Health Boards report whether cases are asymptomatic or symptomatic. 
3. An additional analysis of acute hospital cluster data undertaken by ARHAI Scotland in acute care wards identified several key themes including; multiple introductions (staff and patients), patients walking with purpose, non-adherence to patient mask wearing, wards not being able to close due to speciality needs or closed for a very short time then reopening as a result of systems pressures. The limitations to cluster data and their quality was acknowledged, particularly as the number of clusters have increased in recent weeks and infection control teams are impacted by the data collection burden.
4. CNRG noted the rapid review of published literature assessing HCW risk from March 2021, the majority of studies were limited in the ability to demonstrate where HCWs acquired COVID-19 infection. The studies were of varying quality and comparisons and generalisability were limited.
5. A number of points were identified in these papers including transmission within HCW cohorts echoing that of community; in-hospital transmission outside of clinical area (shared social spaces); lack of mask wearing and physical distancing; multiple points of introduction; lack of WGS limiting findings (transmission often assumed) and challenges with assessing the temporality of interventions.
6. A review of hypotheses reported by NHS boards IPC teams in the ARHAI cluster reports indicated that approximately 2% of clusters reported a sole hypothesis of patient to staff transmission, although it was acknowledged that there were variable levels of detail provided, particularly during periods of high transmission. 
7. CNRG were presented with a rapid review of in-flight COVID-19 transmission risk and mitigations for interest. The studies included were mainly outbreak investigations. The risk was considered low. A number of limitations were noted including: lack of information relating to ventilation systems, high prevalence at origin and transmission events pre the flight, inclusive of the impact of family groups that had mixed prior to boarding. 
8. CNRG were informed that the UK IPC Cell is preparing to stand down, and NHS England have shared their step down plans. There is a plan for the UK IPC guidance to move back to pre-pandemic arrangements with some additional measures such as universal masking remaining. ARHAI presented a table of proposals developed with the NHS Scotland territorial boards over recent weeks for CNRG consideration. This is planned to inform the transition from the winter respiratory addendum guidance to the NIPCM. CNO had asked that this advice be considered by CNRG urgently in the context of current system pressures.
9. CNRG considered the wider use of LFDs in health and care settings including for; pre elective surgery testing, prior to undertaking an AGP, prior to transferring a patient, for contacts of a confirmed case, and for high risk patients. The rationale for the wider use of LFD tests was to support system pressures, which are resulting in harms beyond COVID-19, as PCR test turnaround times are challenging the system currently in its ability to optimise bed occupancy and impacts on system effectiveness. The previous SMVN view on LFDs and the recent UKHSA analysis of the performance of LFDs were considered as well as testing policy considerations in other UK countries.
10. CNRG supported proposed changes from ARHAI to physical distancing and car sharing guidance for HCWs, noting the mitigating actions if these measures were to be considered to be stepped down. It was agreed this required to be done in a phased and context/setting specific way.
11. The CNRG testing sub group considered proposed changes to patient testing and HCW testing guidance. The outputs from the sub group were considered as part of the wider advice from CNRG re IPC measures and included the value of asymptomatic testing in context of current epidemiology and health impacts, the importance of universal mask use and ensuring staff stay off work when symptomatic. CNRG noted that testing policy needs to be flexible enough to meet local epidemiology and IPCT decision needs for local units with high risk populations, and should therefore include an option to retain a local PCR screening approach. CNRG also considered the CDO commissionand agreed that dental practices could move to a more risk based approach with or without LFD use.