COVID-19 Nosocomial Review Group minutes: 30 April 2021

Minutes from the meeting of the Nosocomial Review Group, held on 30 April 2021.

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Items and actions

1. CNRG were presented with the latest COVID-19 statistics which indicated that there are now very few cases of nosocomial COVID in the published data to week ending 4th April. CNRG were informed that the incidence of cases in hospital continues to follow the decreasing trend in the wider population.

2. CNRG were then presented with the latest incident and outbreak clusters of hospitalised cases. These data include community and hospital onset associated cases. At the time of the CNRG there were no open clusters/ incidents in hospitals in Scotland for the first time since July 2020. 

3. The incidence rate of healthcare associated Staphylococcus aureus bacteraemia per 100,000 total occupied beds days (TOBDs) for year ending December 2020 was higher than the previous year (ending December 2019). Similarly, the incidence rate of healthcare associated Clostridioides difficile infection was significantly higher in year ending December 2020 compared with the previous year. The incidence rate of healthcare associated Escherichia coli bacteraemia was not significantly different in year ending 2020 compared with the previous year.

4. CNRG were informed that during the pandemic period, there were significant changes to the patient population including their risk of HAI and in hospital activity and services. This confounding will present a challenge in the interpretation and comparison of other HAI data during this time period and in the future as services are remobilised. CNRG agreed that CNOD review the paused aspects of surveillance systems and requirements for policy in this regard and ARHAI establish further modelling to adjust for changes of services during the pandemic in order to better consider risks. 

5. CNRG were updated on the last HCW testing and LFD figures. It was highlighted to members that there had been a modest increase in the numbers of HCWs testing (as reported in the App) recently when compared with the previous week on week decreases.

6. CNRG were informed that there was a feeling of apathy and testing fatigue towards recording test results, and anecdotal feedback indicates that some staff do not see point in reporting negatives. It is anticipated that the changes to the portal will support making recording results easier. CNRG noted the importance of staff testing as part of the defence layers to prevent Nosocomial Infection and noted the importance of the ‘why’ being communicated as part of this.

7. SG have issued a communication regarding HCW testing to NHS Board Chief Execs and Chairs testing, and Health Board Chairs have submitted informal action plans to encourage testing take up. CNRG were also informed that scoping work is underway into creating a bespoke marketing campaign targeted at HCWs to further encourage recording of test results.

8. CNRG were asked to give advice  to the Cabinet Sectary for Health and Social Care regarding using LFD testing to extend patient visiting further and whether this could support expanding to beyond the current one visitor.

9. The CNRG board consensus was that visitor LFD testing should not be an enabler to opening up patient visiting fully, as the basis for that decision should be about epidemiology. Additionally, as there is evidence of a possible third and potentially fourth wave of infection and uncertainty about the impact these may have on hospitals, there is some hesitancy from CNRG to open visiting wider.

10. However, there was agreement that under certain circumstances this could be used as another defence layer in reducing risk and enabling visiting in specific circumstances. CNRG also highlighted the importance of equity in long term care facilities (LTCF) and that visiting in hospitals in this context should be the same as in care homes, given that the patient populations are broadly similar. .

11. Recent papers on masks, ventilation and airborne transmission were shared with the CNRG to view including the recent SAGE publication which reviewed masks for healthcare workers to mitigate the risk of airborne transmission in SARS-CoV-2. It was noted that this SAGE paper also included the UK IPC cell position as an appendix. CNRG noted that this position was reflective of previous CNRG discussion and no new evidence was presented in the SAGE paper which impacted on Scottish IPC guidance.

12. CNRG were updated on the outputs of the UK IPC Cell. It was confirmed to members that the UK IPC cell is currently undergoing discussions on what (if anything) needs to be updated in the guidance in respect of the recent SAGE paper on masks in healthcare.  The CNRG noted that the Scottish guidance had already been updated prior to this SAGE paper in light of CNRG advice and as a result included the evidence from the SAGE paper and was in line with their recommendations already.

13. It was concluded that the evidence presented in the papers reviewed provided a low quality rationale for improving ventilation in healthcare settings. CNRG noted that the IPC guidance in Scotland included this in risk assessment and the previous commission to SAGE EMG in this regard and so no further additional action was required currently.

14. CNRG were informed of the outputs of the Behavioural Insights task group. The original outputs were set up to receive behavioural insights and address improvement of adherence with IPC measures. The group has achieved their planned outputs

15. CNRG were also informed of the additional work the group has fed into. This includes: having developed an internal HCW focused marketing campaign with the strap line ‘It’s kind to remind,’ to make sure HCWs are reminding each other to stick to COVID mitigations in a caring way. The toolkit for this campaign (posters, pens etc.) is being sent out to Health Board Comms leads. It was noted that the recorded webinar sessions held in March have  been published, and the Q&A to follow.

16. It was confirmed to the CNRG that those who had volunteered at the 25th CNRG to be members of the Future IPC Preparedness Sub Group will be contacted and invited to the first meeting. The group will be chaired by Laura Imrie.

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