COVID-19 Nosocomial Review Group minutes: 27 November 2020

Items and actions

1. CNRG were updated on the Dental Services Built Environment guidance, which has been adopted by the IPC cell as an appendix and approved by the 4 country CDOs. There are some key remaining IPC issues to be addressed in relation to extant Scottish Guidance related to fallow times and the re-processing of PPE. It was noted that reduced fallow times needs considered in the context of the ventilation in the dental room and that each setting will be different. Aerosol Generating Procedures (AGPs) should not be undertake where ventilation is not adequate and HFS are working with the dental community to support risk assessment and mitigation therein.

2. Presentation of key findings from the IPC review undertaken by ARHAI and a focus on two recent papers and their key findings. The chair noted we had much to learn from countries with more experience of pandemics, such as Singapore. Both papers confirm the IPC measures in place mirror those in the UK and point to the importance of leadership and culture as part of the multimodal strategy needed to implement IPC guidance. It was noted that leadership and hospital culture are important in supporting adherence to IPC measures and that it focuses on how senior managers enable that adherence. Discussion on what more can be done nationally to support this and a further CNO policy letter may be required to provide an overview of all the multimodal elements needed; including the new testing policy.

3. CNRG noted the approved proposed testing policy informed by their previous advice – that all patient-facing staff in hospitals, COVID-19 Assessment Centres and the Scottish Ambulance Service will be tested twice a week using Lateral Flow Device testing. Additionally, the group noted the expansion of emergency admission testing to all patients, which was announced by the Cabinet Sectary, and was to be rolled out by the end of the first week in December.

4. It was noted that positive LFD tests recorded by patient-facing staff will be confirmed by PCR. The CNRG noted the importance of communication to all those using these tests that even if a negative LFD tests is reported, all staff must continue to follow the IPC guidance and FACTS and not assume negative status infers otherwise. 

5. CNRG noted the importance of capturing data in relation to the usage of the tests and the results themselves given they are not part of laboratory reporting and that any additional data burden should be avoided if possible; digitalisation was a key enabler of data capture.

6. CNRG reviewed the ARHAI and SAPG data on prescribing in the COVID-19 context, detailing the monitoring underway inclusive of primary care, where prescribing is down compared to previous years and dental, where prescribing is higher than previous years. They noted that OPAT services were importance for enabling services, however challenged with current competing interests for nursing staff. CNRG noted this and the importance of continued virulence on prescribing and the importance of OPAT services as a consideration for all boards, acknowledging the many competing demands for nursing staff, inclusive of COVID-19 vaccination needs.

7. CNRG were presented with recent cluster data and noted this is not at the level of the previous peak and there are a lower proportion of the staff affected in these clusters now. This suggested IPC measures were working where applied. The key lesson learned to date is around about the importance of reliable and enabled implementation of the IPC measures that we know work.

8. CNRG were presented with preliminary analysis comparing wave one (March – July 2020) and wave two (August – present). It was noted that testing has increased significantly between wave one and wave two and that activity is higher now in hospitals than in the first peak as services have remobilised. There is a less steep incidence of definite and probable hospital onset in the second wave. Further, the number of hospital onset COVID-19 is less than the peak of the first wave. CNRG further noted that in the second wave, changes made to reporting mean that clusters remain open for 14 days; this skews the figures when comparing with the first wave, i.e. the second wave may appear artificially high as a prevalence measure.