COVID-19 Nosocomial Review Group minutes: 17 July 2020

Items and actions

1. COVID-19 Nosocomial Review Group (CNRG) were updated on the status of two UK short life working groups (SLWG) within dentistry and endoscopy. The group noted how important the guidance was to enable remobilisation of the NHS and may impact on pathways. It was noted that the latest IPC guidance was being finalised, the main changes include the introduction of COVID-19 pathways in hospitals. The UK IPC cell is awaiting NICE guidance on elective surgery patient testing (due to be published) which will be used to inform the final IPC guidance. Noted that epidemiology is different in Scotland so considering pathways for now and the future is key. Each devolved country will need to consider this locally in adopting the UK guidance now.

2. CNRG discussed a strategy for COVID-19 elimination and what this means for IPC guidance measures and testing in hospitals.  The UK IPC cell was considering this for the current guidance being developed so the group discussion was focussed on the impact of testing and the value added in reducing nosocomial risk from published evidence to date, modelling work from PHE and wider operational aspects from feedback from the NHS.

• A. Existing recommendations with respect to testing HCWs in high incidence settings and incident/ outbreak situations were confirmed as still extant. The group noted the importance of focussing wider HCW testing as part of the UK SIREN study, as the main route to inform what that future strategy should look like.
• B. Existing recommendations for prevalence surveys in emergency admissions were supported, given the current low prevalence from existing testing, including the patients aged over 70s asymptomatic testing. It was noted that the situation in Scotland at present is different to other UK countries, R value is around 0.7, therefore the PHE model assumptions on this and sensitivity/ specificity of the test mean that this reduction is unlikely in the Scottish context. If R value is >1 (closer to 1.2) then testing all admissions would have more of an impact in term of reducing nosocomial risk. It was concluded that point prevalence surveys locally (PPS) of emergency admissions would assist in the development of local processes to support implementation in the event of identifying the need for stepping up wider testing/screening. CNRG considered that if the epidemiology changed these could be revisited. 
• C. It was noted that reducing nosocomial risk was one aspect and purpose related to this testing policy for patients and healthcare workers and other SG groups were considering wider purposes of testing.

3. The role of WGS is prospectively supporting outbreak investigations was considered and supported by the nosocomial group. The potential for this depended on the turnaround time of the sequencing and reporting being within the window of the cases arising during an outbreak. This was noted as an important part of the considerations of moving towards a WGS service as the next part of its development in Scotland.

4. CNRG reviewed available data on NHS 24 and laboratory testing activity by Scottish postcodes.  These data are being developed to inform early warning system indicators for public health– they are used as part of wider winter preparedness currently and can support with COVID- 19 too. It was agreed by the CNRG that a subgroup would be set up to scope how such data could be used as an early warning mechanisms for potential nosocomial risks.

5. The group recognises the importance of monitoring of IPC process and these too may act as part of an early warning system. The group will look at this topic further and consider what additional processes and roles are required in Scotland.