COVID-19 Nosocomial Review Group minutes: 11 September 2020

Items and actions

1. CNRG reviewed the current WGS work currently being undertaken. 5,500 samples have been sequenced to date. Initial findings for hospital sequencing suggests that there were repeat introductions of COVID-19 into hospitals from the community. What happens in hospitals is determined by wider community prevalence and so community interventions and keeping prevalence low there, keeps hospitals safer.

2. It was noted that the turnaround time could be rapid enough now to shift the epi curve, rather than retrospectively describing what happened. A live service should be available by 31st October to further support the pandemic efforts and outputs from this will be key to CNRG review in the coming months. 

3. CNRG were informed of current data and recent incidents of possible COVID-19 HAI. The main lesson learned remains about improving adherence to IPC practices in hospitals for HCWs, patients and visitors. It was noted that the work underway to implement the new UK IPC guidance in Scotland would have supplementary work on implementation support and communications to help with continuous improvement of IPC practice during the coming months.

4. An overview of current COVID-19 epidemiology pointed to recent changes in the demographics of those testing positive in the community and rise in number of cases and consideration was given to what additional measures should be considered from a preparedness perspective as the likelihood of increased hospitalisations was higher now. This was also being evidenced in data from France and Spain in recent weeks.

5. The group noted the need for Anticipatory Care Planning to be an ongoing focus across the service. This will be important as the epidemiology changes in the community, so do the risks for introduction into hospital. The group noted the importance of risk communication regarding infection being different than the risk of severe illness. Nosocomial transmission is about who comes into the hospital with COVID-19 and how that is transmitted within the hospital - emergency admissions in younger age groups are likely to be positive. The impact on older people in terms of higher risk of mortality remains important too.

6. CNRG noted the review of the evidence related to the 2 metre distancing rule and challenges in remobilising some services. There is a limited evidence base to provide an accurate physical distancing recommendation however evidence supports that 2m is likely to be more effective at reducing transmission risk than 1m; in light of this, the existing rule of 2m between individuals should be maintained where possible in all health and care settings.

7. The group also considered recommendations for spacing between patient chairs, beds and couches which are provided in Health Facilities Scotland (HFS) guidance. These recommendations are not specifically focused on infection control but rather ergonomic principles. Health and care facilities should be compliant with these recommendations in order to meet the needs of patient privacy and choice, comply with the Equality Act 2010 and meet the needs of Health & Safety, e.g. Manual Handling Operations Regulations 1992, particularly in regards to lifting patients.

8. The group agreed maintaining 2 metres where possible was key to control of COVID-19 and that in circumstances where compliance with 2m physical distancing is not possible or is likely to have a significant detrimental effect on patient outcomes (i.e. reduced access to diagnostics and treatment), use of alternate spaces, reducing occupancy and additional IPC measures should be considered in addition to applying the current UK COVID-19 IPC guidance. This advice and guidance will be shared with the NHS boards.

9. The group reviewed the current testing advice for hospitals in light of emerging evidence and current epidemiology. Currently in Scottish hospitals, all patients and healthcare staff who develop symptoms of COVID-19 should be tested in line with current guidance. This is the first priority in the Scotland’s Testing Strategy – Adapting to The Pandemic. The CNRG noted the current challenges with testing capacity required an evidence and risk based approach to the use of additional testing capacity when testing asymptomatic individuals in the hospital setting and more broadly. The group updated its advice regarding HCW testing and admission testing in hospitals in light of the evidence to date and in line with the recently published ECDC testing strategy advice.