COVID-19 Nosocomial Review Group minutes: 8 January 2021

Items and actions

1. CNRG reviewed available provisional data up to week ending 20 December 2020. CNRG were made aware that the data presented, in terms of denominators being used from PHS national datasets, was provisional and not validated. Peak one and two probable and definite nosocomial data were presented in a funnel plot chart at board level. It was noted that outliers in the funnel plots mirrored high and low community prevalence in the region the hospital or board was located in during peak 1 and 2. CNRG were informed that NHS England have not published any nosocomial data to date, however comparisons were made with Wales and this indicated nosocomial infection (NI) is broadly similar between the countries as a proportion of all cases and over time.

2. CNRG were presented with the latest data on the growth of the S gene drop out seen in the new variant (which is used as the current indicator of the new UK variant of concern B.1.1.7) and the impact on hospital admissions in Scotland; these are data from the Lighthouse laboratory testing only. It was noted this is circulating in Scotland and the proportion of COVID-19 attributable to this new variant is increasing. CNRG noted that the NHS Whole Genome Sequencing (WGS) service went live on the 30th November 2020 and work is underway to connect the WGS to nosocomial clusters and outbreaks. Detail on the new SARS-CoV-2 variant B.1.1.7, was presented to the group, current case definition for the VOC-202012/01 covers 15 mutations, 13 substitutions and 2 deletions.

3. CNRG were presented with an update on bloodstream co-infection data and secondary infection in Scottish COVID-19 cases.  The provisional available data indicated that there was a small percentage of confirmed cases of co-infection. CNRG noted this was important work to consider further and a sub group would be established to consider the further analysis and bring back recommendations to a future CNRG meeting.

4. CNRG heard about the Norwegian COVID-19 hospital response from colleagues in the Norwegian Public Health Institute. The demographics of Norway are similar to that of Scotland in terms of population size, types of hospitals and remote and rural agenda. Norway has a large number of smaller hospital sites; HCWs moving between acute and community settings; and a number of HCWs who commute from other Nordic nations. The principles of the Norwegian response were summarised, these included: use of standard and transmission (droplet and contact) IPC precautions informed by evidence; routine meetings with the IPC centres in the local administrations/municipalities; weekly meetings with HCW unions; and maintained contact with the ECDC and neighbouring Nordic nations.

5. The outbreak management protocol was overviewed which includes antigen tests, exclusion criteria for contact tracing, and upscaling IPC measures for outbreak management. Outbreak intelligence thus far in Norway indicates that HCWs in long term care facilities had a higher risk of COVID-19 than those in hospitals.

6. It was noted that the main difference in the IPC guidance between the UK and Norway was there was no mandate for mask wearing for hospital visitors in Norway, but people are encouraged to do so in areas with high infection rates. Additionally, CNRG were made aware that antibiotic prescribing was reduced in primary care but remained unchanged in secondary care – similar to Scotland. It was noted that Norway’s success in suppressing community transmission of COVID-19 meant there were fewer hospital admissions with COVID-19 and risk of nosocomial infection was therefore low.

7. CNRG reviewed the recent outputs from international evidence inclusive of CDC, WHO and SAGE. The chair noted CNRG should be clear on the position regarding aerosol transmission risk in Scotland, as should the UK more broadly, and any guidance needs therein.