COVID-19 Nosocomial Review Group minutes: 9 October 2020

Items and actions

1. IPC guidance update to CNRG noted that a table of additional FAQs have been added to the latest draft of the UK IPC Scottish addendum for COVID-19. The ARHAI Scotland team were working on pathways with NHS boards and a sub group of CNRG agreed to support the practical operational aspects being further worked on. This would also be connected to the NHS test and protect design authority. 

2. Evidence rapid review of masks and eye protection of available evidence was presented and it was noted that there were no COVID-19 specific clinical trials. MERS and SARS evidence is available and these studies are mostly observational in design.  Also found conflicting advice from 6 international health organisations. All countries reserve FFP3 for AGPs. ECDC recommends N95/ FFP2 mask is preferred but also suggests that FRSM masks for other tasks.  UK guidance aligns with WHO and Canadian guidance re use of FRSM. Australia has recently changed their guidance for N95 use in aged care. No change is proposed to extant UK IPC guidance which is FFP3 for AGPs and FRSM for all other care. 

3. The eye protection review found that indirectly vented googles and visors offered the best level of protection. Safety glasses are not recommended. Review also found that face shields are not effective protection against airborne transmission when not used with a facemask. No change to UK IPC guidance from the review. This advice was endorsed by CNRG.

4. On the latest CDC transmission advice, CNRG noted that CDC conclude in their latest advice on their website this week that airborne transmission is possible, but the main transmission route remains droplet/ short range aerosol. CDC cite that the risk of airborne transmission is specific to being enclosed spaces with infectious individuals, prolonged exposure to respiratory exertion i.e. singing, exercising etc. 

5. However, it was highlighted to CNRG by ARHAI Scotland that CDC does not provide references for this and there is a lack of available evidence to substantiate these statements. In the outbreak reports published to date where airborne transmission is inferred it is not possible to discount the transmission route being droplet and short range aerosol. CNRG noted this and that no change to current IPC guidance was required.

6. CNRG received a presentation highlighting the lessons learned from the nosocomial cluster reported to ARHAI Scotland March – April 2020 and from May 2020 onwards. Whist asymptomatic and atypical presentation featured less frequently from May onwards this was still seen as a challenge in identifying positive cases and implementing controls quickly. 

7. Physical distancing both in clinical areas and in non-clinical areas such as changing and rest facilities continue to be highlighted in lessons learned. Adherence with FRSM policy has been identified as an area for improvement and the importance of ensuring FRSM are worn when physical distancing is not possible between any individuals including colleagues. Car sharing and ensuring IPC guidance is followed where this is required for essential travel to work.  Other factors include communication between Occupational health and ICPT and staff not recognising mild symptoms and continuing to work, patient movement within and between hospitals and the ward environment particularly nightingale wards.

8. COVID-19 hospital data CNRG noted that there is a continuing increase in cases among the 40–60, and 60 + patient populations with multiple comorbidity risk groups. Also many more hospitalisations now and trend is projected to continue rising given the high community prevalence in the central belt of Scotland. 

9. CNRG noted that new additional regional testing hubs are being built. These hubs would allow for prioritisation of tests and provide contingency for local hubs with secondary samples to be sent to regional labs. 

10. CNRG noted that there is no ‘one size fits all’ approach for all boards re POC testing. As placement of POC may become an issue for some sites, not all sites have dedicated free space to conduct tests and hold patients pending results and will potentially add additional pathway issues. These factors are being considered by those involved in the operationalisation of the national testing strategy work.