Coronavirus (COVID-19): care home outbreaks - root cause analysis

6. IPC knowledge and expertise

The care home managers reported inconsistency in the receipt of IPC advice given to them as part of the visits for assurance and inspection carried out by various parts of the system. They also identified a need for access to expertise to support them in the IPC risk assessment within the care home environment.  

Historically in Scotland there were infection prevention and control nurses working in community settings, however the last decade has seen the focus on hospital settings, where estimation of the need was greatest and risk was highest. Some community IPCNs joined hospital IPC teams and others joined HP teams in PH departments. Most of those with IPC backgrounds have since retired and many of the Health Protection Nurses (HPNs) recruited in recent years have no experience, or qualifications, in IPC. It is important to note that the HPN career framework (NES) does not require IPC qualifications for the role as these HPN roles are wider public health roles and the scope of practice is health protection, rather than IPC per se.

HPNs have diploma or degree level general training, some have masters level qualifications such as an MPH, and some are registered as UKPHR practitioners or specialists. We were informed of one HPN in these HPTs with responsibility for IPC in care homes but the expertise for IPC in other homes had been sourced from the acute service. During the COVID-19 pandemic response a number of capacity and capability issues have arisen with respect to specialist IPC advice and roles in all settings, but especially in care homes. The care home managers told us the hospital IPCN experience with their clinical focus, was unhelpful at times, within the context of a care home. 

New roles have been developed at pace to support the response, such as the HP associate nurse, Advanced HP practitioner and IPC associate practitioners. These new roles do not feature in extant career frameworks for these specialties.  An opportunity therefore exists to review these frameworks, to ensure future career pathways include new roles, widen access and enable career development and succession planning. This will facilitate future capacity and capability building in the public health system locally, regionally and nationally and system thinking about these roles for workforce planning purposes. Community IPCNs and building IPC capacity in or connected to the HPTs, who know their local care homes and the context, may be a helpful asset for the HPTs to support the response and for future prevention efforts.

Recommendation:

• Local IPC capacity requires to be developed at H&SCP level and with HPTs to support care homes with expert IPC advice which is risk based, proportionate and supports compassionate care in a homely setting