COVID-19 Nosocomial Review Group minutes: 18 June 2021

Items and actions

1. CNRG were provided with the latest update to the current COVID-19 situation in Scotland. At time of CNRG there was continuing low numbers of cases of nosocomial infection. Seven 7 clusters of cases at ward level (including community importations and hospital cases) were reported in the last 4 weeks, across 3 Health Boards, and each had a low number of cases compared to previous waves, typically consisting of 2-3 patient cases, majority with no staff cases and fewer contacts. CNRG noted that the high vaccine uptake appears to be reducing hospitalisation and therein risk of nosocomial infection. In addition, clusters were being identified quickly and managed in a way which means there are fewer cases in clusters. The importance of testing and WGS in hospital clusters was noted.
2. An update on the SIREN study from the Scotland coordination team at Glasgow Caledonian University was given. The recruitment to the study had concluded 31st March 2021. The study will be a one year follow up study, and is due to end in March 2022. The SIREN Dataset, including participant questionnaires, linked ECOSS data (PCR test results), COVID vaccine data, and genomic data and the future planned analysis on SIREN data set; hospitalisation within the SIREN cohort, vaccine comparison, timing of vaccines, and baseline serology were considered. CNRG contributed additional questions to be considered in future analyses to support the work in Scotland on NI and HCW infection.
3. Data on respiratory infections in ICU patients during the pandemic period of February 2020 and March 2021 were reviewed. CNRG were informed that the data was gathered from three data sets ECOSS, COVID-19 Hospital onset data and ICU SICSAG data all with CHI linkage. The data had some indication of higher rates of ICU acquired respiratory infection and noted that this differed by organism. CNRG were made aware of the limitations in assessing the impact of the pandemic on rates of ICU-acquired respiratory infection (including secondary and co-infection) and that further analysis of population at risk and controlling for confounding is required. CNRG endorsed the next steps in the analysis including undertaking multivariate analysis to account for the changing patient population in ICU over the pandemic period. ARHAI intend to progress this work with SICSAG and publish these data.
4. The finalised action plan and outputs from the Behavioural Insights task group were reviewed. CNRG noted that the task group had fulfilled its role and had officially closed. Additionally, members were informed that the marketing campaign had been fully rolled out, and that the feedback from NHS Boards was positive. A similar messaging campaign is being considered for care homes. The chair thanked the group for this work.
5. CNRG members were updated on their advice for a SAGE EMG commission in April 2021 regarding ventilation in health and care settings. Members were informed that the paper had been considered by GO Science, who considered the request was too technical/operational for consideration by SAGE EMG. SG had therefore agreed to establish a ventilation working group in Scotland to discuss matters covered in the commission. CNRG noted that this group will discuss the efficacy of air cleaners – as there are no current national standards or guidance in this regard at the UK level.
6. CNRG considered the newly updated Australian IPC Task Force COVID-19 Guidance. It was noted that this guidance is a ‘living systematic review’ based on GRADE methodology and supplemented with consensus advice. With respect to RPE the evidence in the guidance was 1 randomised control trial (RCT) and 11 observational studies. Of the meta-analysis of 11 observational studies they found no significant difference in infection rates when wearing surgical masks vs. respirators. CNRG noted that the main recommendation of the guidance was that the use of a N95 respirator/ surgical mask should be based on an assessment of risk of transmission. It was noted that guidance made no direct mention of AGPs and this were subject to an on- going review and in the interim wider factors considered in the risk assessment in the Australian guidance. It was noted that this guidance was drafted at a time of low community prevalence in Australia and the consensus recommendations took account of wider matters than NI risk. It was agreed that the ARHAI team and UK IPC cell would consider any implications for IPC guidance arsing form this.
7. Following a review of the stage of the pandemic and emerging evidence, a proposal to move away from COVID IPC precautions and return to Transmission Based Precautions (TBPs) in medium risk pathways had gone to the UK IPC cell from ARHAI Scotland. It was noted this would enable review of physical distancing to >1m and other measures in a risk based and proportionate way in health and care settings. Members were told that the IPC cell had agreed in principle, however there was currently no appetite to change the UK IPC guidance currently. The move for Scotland to consider returning to TBPs, with specific reference to stepping down routine additional cleaning in medium risk pathways (with the ability to step up again as required) was endorsed by CNRG for the Scottish guidance. The use of gowns as specific COVID specific precautions in medium risk pathways was further proposed for discussion with the IPC networks prior to implementing and that this should come back to CNRG for endorsement pending that advice, especially in relation to ICU/ critical care team views.
8. CNRG were updated on the latest HCW testing figures. CNRG were informed that the number of recorded test results at similar levels; 23 percent of the expected results recorded on the ePortal. CNRG were also informed that there has been an increase in the number of positive LFD results being recorded. CNRG noted the importance of understanding if this increase is real or artefact in reality mirroring the reporting issues and also noted the importance of increasing uptake of testing and encouraging reporting. CNOD agreed and noted that improvement meetings with NHS boards are due to commence w/c 21 June to discuss areas of best practice and how to improve uptake.
9. CNRG were then given a presentation on confirmatory testing using LumiraDX (LDX) test machines. CNRG were reminded that the PCR confirmatory tests for detection of SARS-CoV-2 can be delayed due to centralised laboratory testing, and that the LDX is a rapid antigen test which produces a readout on an associated instrument in a timely manner. CNRG were informed that the LDX compares moderately well with PCR tests on sensitivity in high virus prevalence settings and may be useful in informing patient pathways within NHS settings with almost immediate results whilst awaiting PCR confirmation. CNRG were then informed that the UK Government position on the use of LDX testing machinery is unknown at the time of CNRG. The CNRG testing subgroup reviewed the SBAR and supported this and this was endorsed by CNRG members.