COVID-19 Nosocomial Review Group minutes: 21 May 2020

Items and Actions

1. The group discussed the current hospital data, noting that the number of hospital onset cases continues to decrease. The R transmission value within hospital settings based on available data was presented and was noted to be limited due to data available and statistically uncertainty and not helpful for monitoring more widely. It was agreed that Scotland, in the context of wider UK discussions, would adopt a simpler version of ECDC definition to enable data gathering. This definition enables lab surveillance without additional data collection burden on IPCTs and allows flexibility to move to advanced surveillance if needed thereafter.
2. Initial findings admission testing policy of patients over 70 years was presented. It was noted that the proportion of testing has increased since policy for testing was announced, however the % of positives is decreasing, as the prevalence is also decreasing in the community and hospitals. The key parameters for evaluating this policy require an ability to differentiate symptomatic from asymptomatic cases. Local data will also require to be accessed to enable some evaluation. It was noted that the limited data and numbers involved would make it difficult to assess against the original objectives of the policy. It was agreed that at the end of the 4 week pilot period, all available data would be evaluated and a decision about recommendations for future policy made by the group.
3. Virology testing data were discussed. The science to date indicates lower detection rates in asymptomatic testing, compared to symptomatic testing which the test is designed for.  However, it was noted that the test does pick up the RNA (virus) in asymptomatic cases. There is less data available in asymptomatic cases and the detection rates in this will depend on the setting, prevalence and exposure of the virus. The group concluded that asymptomatic testing may be best prioritised to high risk settings and further research is needed on what it means for infectivity.
4. The group also noted that there is also no added value of testing a person more than twice and an absence of evidence about the need to test HCWs for confirming they are negative, more important to ensure they are asymptomatic before returning to work. However, with new data emerging on infectious virus this needs to be kept under review.
5. Hospital IPC and AMU indicators were presented to the group. These were based on WHO and ECDC broad IPC and AMR components and indicators evidence and COVID-19 specific ones too.
6. The group heard the results of the SAPG survey of antibiotic prescribing COVID-19 patients, which found that whilst antibiotic use and prescribing for respiratory infections had increased over the period of COVID-19 hospitalised cases increased, overall Scotland AMU indicators are on track and require monitoring to continue and be fed back to this group as part of the indicators data.
7. Planned updates to UK IPC guidance were noted. Key issues currently being considered include the wider use of face masks in all healthcare settings being considered by UK IPC group.