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Coronavirus (COVID-19) Nosocomial Review Group minutes: 22 April 2022

Minutes from the thirty-eighth meeting of the group, held on 22 April 2022.

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Items and actions

  1. Coronavirus (COVID-19) Nosocomial Review Group (CNRG) were given an update of the current COVID-19 nosocomial situation week ending 3 April and noted the decrease in cases from the previous week. CNRG noted that this was in line with the community prevalence of COVID-19 which was on a downward in recent weeks.
  2. The majority of patients with nosocomial infection were aged 65 year or older. Nosocomial infection (NI) accounted for 0.8 percent of all COVID-19 cases. An additional analysis of patient admission testing data using PCR and POC testing data from October 2021 to 27 March 2022 reported that a fifth of cases of COVID-19 diagnosed in hospital were not tested on admission. The complexity of identifying those cases which are NI was noted. The majority of nosocomial cases are currently asymptomatic at the point of testing and have been detected as part of wider asymptomatic testing, however this data is limited as reporting is not comprehensive.
  3. CNRG were given an update on the whole genome sequencing (WGS) work. It was highlighted that since the beginning of the Omicron variant in late November 2021, there has now an observable shift from the BA.1 variant to the BA.2 sub variant. Pillar 1 and Pillar 2 testing are also reflecting this shift – with an approx. 50/50 split in variant type.
  4. A review of (non COVID-19) healthcare associated infection (HAI) data, using data to December 2021, noted that the total occupied bed days denominator used in calculating HAI rates has shifted during the pandemic response – with longer hospital stays, patient demographic and activity changes. This will impact on producing rates and evaluating the progress against extant HAI standards.
  5. The Anti-Microbial prescribing trends for 2022 show that the respiratory antibiotics prescribing is approaching typical seasonal norms. It was noted that the dental prescribing of Phenoxymethylpenicillin had increased over course of the pandemic. This was due to the prolonged closure of dental practices over the pandemic and is expected to reduce as more of the service remobilises.
  6. The UK IPC cell updated the UK Seasonal Respiratory Infection IPC guidance on 14th April to reflect a change to isolation period for cases of COVID-19 in hospitals from 10 days with clinical improvement to a locally agreed testing protocol to reduce the isolation period down from 10 days in patients who meet the clinical criteria. Patients should have two negative tests taken 24 hours apart as well as showing clinical improvement, before discontinuing transmission based precautions (TBPs). If either of the two tests are positive, isolation should continue until day 10. CNRG were made aware that UKHSA consider the residual risk to individuals after day 6 or 7 (after testing) is the same risk as isolating for 10 days without testing. CNRG endorsed this advice for the Scottish guidance and noted the changes made to the Winter Respiratory Infections IPC Addendum on 1 April to consider vaccination as part of the risk assessments to align with current PHS guidance for the community.
  7. CNRG were presented with further considerations from the Testing Sub Group for asymptomatic and symptomatic testing. The pre surgical testing requirements will be based on vaccination status. For patients who are fully vaccinated, an LFD test on the day before surgery is adequate. For patients who are not fully vaccinated, then a PCR test is required 48 hours prior to surgery. However, it was highlighted to members that this has greater chance of disrupting theatre lists and flow due turnaround time for PCR results. CNRG noted the proposed changes to pre surgical testing should be considered by Clinical Cell group in the light of balancing harms.
  8. CNRG endorsed the current UKHSA guidance which requires HCWs to recommence LFD testing on return to the workplace. CNRG noted the number of HCWs tested within a four-week period has decreased from last week.
  9. The Respiratory Precautions Task Group outputs on the learning from the pandemic regarding TBPs, and relevant discussions from a recent ECDC meeting in this regard were considered. It was noted that ARHAI will consider this as part of their review of the NIPCM chapter on transmission based precautions this year.
  10. CNRG members were informed that the intention is that the May meeting of CNRG will be the last meeting before a summer recess. CNRG members were made aware that the CNO had been informed.
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