COVID-19 Nosocomial Review Group minutes: 23 October 2020

Items and actions

1. CNRG received an update at the role of ventilation in controlling the spread of COVID-19 in enclosed spaces. Ventilation is a key mitigation in reducing transmission. It was conveyed to the group that is ventilation is doubled then the risk of transmission within that space is halved. Conversely if the number of people within a space is doubled there is a four-fold increase in exposure.

2. CNRG were informed that air conditioning devices may be a source of potential environmental risk for COVID -19, as they primarily utilise recirculated air from the environment rather than feed in fresh air. It was noted that the UK SAGE EMG are publishing advice on ventilation risks more broadly and that HFS will ensure guidance is updated if required. In the meantime the advice from CNRG to CNO as outlined in her letter to the NHS boards stands, which related to ensuring extant building notes (SHTM) were implemented and systems checked to ensure ventilation is optimised in hospitals.

3. CNRG were presented with an update on the anti-microbial stewardship data. Overall the data is encouraging in regards to AMS, however a number of key areas for monitoring were identified and CNRG endorsed the new SAPG guidance in this regard. CNRG were informed that while there were less patients overall in hospital there was a slight increase in anti-microbial prescribing.

4. CNRG were shown the new ARHAI Scotland dashboard for NHS Boards. It has been designed as requested by CNRG to allow local IPCTs to bring together all the information sources related to COVID-19 in hospitals to support IPC. Training for the new system has been rolled out across Boards.

5. It was noted that data on hospital admissions indicated admission with COVID-19 continue to raise in line with the high community prevalence seen currently, however not yet at April/May 2020 levels.

6. Presentation was provided on current HCW testing, current epidemiology and priorities going forward. Noted that some evidence from research studies carried out during the first peak pointed to potential increased risk of COVID-19 in HCW compared to the general population, others note differences within different specialities of hospitals and more recent studies from Imperial (REACT study) suggesting similar risk to the general population.

7. CNRG were also presented with the prevalence data from HCW testing and noted the variation in uptake between boards. CNRG noted their previous advice re HCW testing and CNOD noted this was being considered for policy.

8. CNOD sought clarification if repeat testing advice given for all emergency admission testing applied to the serial overs 70s testing. CNRG confirmed that over 70s testing has a different purpose than nosocomial risk alone, as it is to identify those who may have the worst outcomes and decisions re this policy should be considered by those who initiated that policy to ensure all aspects were considered.

9. Validation of POC testing machines has concluded and it has been found that they are not sensitive enough for testing in hospitals. It was confirmed to CNRG that further work is underway in scoping alternative uses of these POC testing machines.

10. CNRG were also informed that the UK Govt. is also looking to validate alternative machines with a 30 -90 min testing turnaround time. CNRG noted that the advice re emergency admission testing was based on evidence which said a 24 hour turnaround time was sufficient to reduce risk, however if this could be reduced further with POC testing then this was positive.