COVID-19 Nosocomial Review Group minutes: 21 May 2021

Items and actions

1. The latest Covid-19 statistics show that there were 2 cases of nosocomial Covid week ending 25th April. CNRG noted the latest data on outbreak/clusters of hospitalised cases. Outbreaks and clusters involve community importations to hospitals as well as nosocomial cases.
2. Monitoring COVID-19 variants in healthcare settings was considered. Members were informed that there had been no recorded nosocomial cases of any other variants other than the dominant Alpha variant to date (at time of meeting). CNRG noted these data were biased towards outbreaks and clusters and the purpose of monitoring COVID-19 variants was to develop evidence relating to the nosocomial transmission of new variants and mutations and to link genomic data with epidemiology and local context to inform response in hospital settings. Consideration to widening WGS of hospitalised cases was recommended.
3. CNRG noted the increase in the capacity for WGS in Scotland. CNRG were also informed of the latest WGS sampling - across all settings in Scotland; the dominant is the Alpha variant and the newly designated variant of concern is the Delta Variant. CNRG were also informed of the latest available information on the Delta variant; there is evidence of increased transmissibility and the importance of optimising hospital IPC measures was noted.
4. CNRG reviewed the monthly update on antibiotic prescribing data. Total antibiotic prescribing was trending below seasonal norms compared to 2019. This may be due to a reduction in GP consultations. Conversely, dental prescribing was trending higher than seasonal norms. This is thought to be due to the prolonged delay in dental procedures which has led to increased need for antibiotic prescribing. However, there is an expected reduction in dental prescribing as non-emergency treatment continues to remobilise.
5. A Health Care Worker (HCW) testing update was given. Members were made aware that PCR results are only included in the reporting if taken up to 48 hours after a positive LFD test result has been recorded on the ePortal. It was also noted that contact tracing starts with the recording of a positive LFD test on the ePortal and before a confirmatory PCR.
6. CNRG were informed of the progress of the Behavioural Insights Task Group and that the HCW ‘Kind to Remind’ communication campaign has been shared for use with NHS Boards. It was highlighted to CNRG that NHS Boards are able to tailor the messaging to their local needs i.e. vaccine messaging. CNRG were informed that the sub group on Behavioural Insights will have wound down prior to the next CNRG and will be replaced by the governance group which will oversee the continuing collaboration with Edinburgh University research project. The chairs of the CNRG sub group were thanked for their leadership on behalf of CNRG.
7. CNRG noted an update to the Scottish COVID-19 Infection Prevention and Control Addendum for Acute Settings, which further strengthens local risk assessment guidance in line with WHO Occupational Health guidance which CNRG had previously endorsed. CNRG were made aware of concerns regarding the definition of “adequate” when referring to ventilation and bed spacing, given the variation in extant estates and guidance applicable at the time of build. Members were advised that NSS ARHAI is working with HFS to support the boards with local risk assessment needs.
8. CNRG considered the latest data on the vaccines indicating they were still effective against the newly identified variants of concern and noted the importance of ensuring second doses have a high uptake is all eligible groups. CNRG noted that it was less likely as a result of vaccinations that the NHS would be as overwhelmed by COVID-19 as in the previous winter, however there was a third and fourth wave expected in the epidemic and uncertainty about the size and impact. The risk of seasonal influenzas and other respiratory illnesses was considered to be high. The risk of RSV in paediatrics was also highlighted for this winter. CNRG noted UK IPC cell preparations for guidance in this regard.