COVID-19 Nosocomial Review Group minutes: 3 July 2020

Items and actions

1. Updates on Remobilisation, Urgent and Unplanned Care, Healthcare Built Environment.  The group discussed the IPC needs for remobilisation of NHS services. It was noted that new UK IPC cell guidance was to cover pathways, testing and IPC measures to support this. The group noted the importance of physical distancing and wider mitigating risks in all health and care settings.

Consideration of those who are shielding in the pathways was also discussed and it was noted that further guidance will be issued on this also.

With respect to the Healthcare Built Environment, the group supported the further work planned across the UK, inclusive of two short life working groups who will look at specific requirements for dental and endoscopy services. This will come back to the group by the end of July.

2. IPC practice in hospitals - next steps and long term plans.  Work is underway at UK level on updating existing 4 country IPC guidance with a view to four country agreement by CNO/CMO by the end of July.  Scotland (via NSS ARHAI) have contributed to this work and it is being considered in the light of remobilisation needs.   Isolation capacity was discussed, particularly in relation to additional testing decisions and their impact, and the needs of shielded patients in hospitals. Two different types of isolation capacity are needed for this and the guidance will consider red and green pathways for future cohorting to supplement this, as required, in preparation for further easing of lockdown and preparedness for a surge in cases if this occurs.  

3. IPC and AMU indicators – agreed indicators and implementation of monitoring update. The group noted the further IPC indicator work which will focus on structure and process indicators in hospitals to inform intelligence about outbreak preparedness. The additional work going on more broadly in public health on early warning systems is another aspect the group will consider for hospitals at the next meeting for future development.

4. Hospital visiting guidance policy. It was noted that the Cabinet Secretary has set out future hospital visiting plans and that these are on a phased basis.  The plans included IPC considerations and patient leaflets with an emphasis on measures visitors should take to minimise infection – hand hygiene, physical distancing, face coverings. The group noted the number of visitors was restricted to mitigate any additional risk and that future considerations of any additional changes to visiting should ensure these are made with respect to current epidemiology, inclusive of the need to restrict again in the context of a risk in cases or incidents and outbreaks in hospitals.

5. Review of Testing in hospitals.  The group considered the recently published ECDC testing strategy and the recommendation that countries should have a comprehensive testing strategy. The group considered their previous advice on HCW testing and patient testing met the criteria and further consideration in the light of wider UK guidance, which is imminent and included in the wider IPC guidance,  would be made at the next meeting.

6. Review of WGS transmission data in hospitals.  The group reviewed the latest developments in WGS data and how this may contribute to the investigation of clusters and incidents in hospitals. The group supported the use of this currently in retrospectively analysing data and looked forward to when this may be able to support prospectively. The group noted that the data suggest that what we see in hospital mirrors what we see in community, therefore important to look at system level to explore transmission.

7. Scottish Renal Registry developing intelligence relating to COVID-19 in Scottish renal patients.  The chair of the Scottish renal registry presented on the COVID-19 experience for transplant patients who are immunosuppressed. Transplant patients were shielded from outset and managed well through the peak with planned IPC measures. Future preparedness for potential surges in cases and longer term additional support inclusive of segregated dialysis is being considered.

8. Update on Ethnicity and Race Equality.  The group discussed the SG issued national guidance on 21st May, best practice in terms of risk assessments and best conversations. It was noted that there is not a specific ask of NRG at the moment but we should be mindful of this work and IPC and wider guidance implications.