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Report highlights risk of asymptomatic COVID transmission by NHS staff in hospital

29th October 2020 about a 3 minute read

A new report is warning that some NHS trusts are failing to understand the risk of asymptomatic staff transmitting COVID-19 to others.  

Meanwhile the NHS nationally needs to develop a more transparent and co-ordinated process to disseminate national guidance. 

And the report adds that more capacity for testing NHS patients and staff must be put in place as a matter of urgency. 

The Healthcare Safety Investigation Branch (HSIB)  launched a study in July following concern over the number of patients going in to hospital with no signs of COVID-19 but who had contracted the virus by the time they were discharged. 

Second wave

The report’s aim is to reduce the number of hospital-acquired COVID-19 cases in the second wave of the pandemic.

HSIB carries out independent investigations of patient safety concerns in NHS-funded care across England. Its study of COVID-19 transmission in hospital focused on six English trusts between July 13 and August 28 this year. 

The organisation highlighted a “lack of clarity” over national responsibility for the development of national infection prevention and control guidance. 

Researchers found that current national and local guidance and initiatives were very much focused on the role of personal protective equipment as a mitigation strategy. 

The report notes that NHS staff have struggled to interpret and implement guidance due to the sheer amount of information in circulation and the speed at which it is updated. 

Inconsistent guidance

Guidance has often been inconsistent and does not always reflect those measures proven to be effective.

The report warns that while in the first wave hospitals were able to manage bed occupancy by cancelling planned activity, this may to be possible in the second wave. 

“There was limited evidence of how technological developments had been used to address COVID-19 transmission risk in clinical areas.” Healthcare Safety Investigation Branch

None of the trusts in the study had a programme of regular surveillance testing of their staff outside of the Public Health England SIREN (Sarscov2 Immunity and Reinfection Evaluation) study.

However some trusts were trying to set up their own in-house testing system.

PPE shortage fears

Although trusts reported stocks of PPE were adequate some had concerns that there might be a shortage in any further peak in COVID-19 activity. 

Researchers said the staff they spoke to reported “significant fatigue and emotional distress associated with COVID-19 activity.” They warned this could impact on future ability to reduce hospital acquired infection. 

However all the trusts in the study had set up staff health and wellbeing initiatives and national approaches had also been developed to help NHS staff to access support services. 

Use technology to cut transmission

HSIB recommends that NHSX considers how technology can assist in mitigating transmission of COVID-19 in the ward environment.

In particular the use of digital communication technologies in assisting with deploying staff and the dissemination and circulation of key information. 

Also the increased use and availability of personal computing devices and electronic health record systems.

Among its other recommendations the HSIB calls for:

  • a national intensive infection prevention and control (IPC) safety support programme for COVID-19
  • a national IPC strategy focusing on developing capacity, capability and sustainability
  • NHS England and NHS Improvement should respond to emerging scientific evidence and shared learning when reviewing guidance for NHS trusts on COVID
  • NHSE and NHSI should investigate the risks of the potential impact of staff fatigue and emotional distress on hospital transmission of COVID-19.

A full version of the HSIB report COVID-19 Transmission in Hospitals: Management of the Risk – a prospective safety investigation is available here