Chamber and committees

Evidence from the progress of the COVID-19 pandemic highlights that there is a risk of the virus spreading where people are grouped together in enclosed spaces, like hospitals.

The NHS has been alive to this risk and has taken steps to minimise risks of transmission. These steps have included strict adherence to Infection Prevention and Control (IPC) guidance, the wide use of appropriate PPE, frequent hand washing, decontamination of the care environment and physical distancing between staff, where this is possible. Efforts have been made in particular to establish and enforce separation between COVID-19 and non-COVID-19 areas of hospitals, and the direction of patients to different routes has been adapted to take account of developing evidence in relation to symptoms.

Visits to patients have also been restricted to those that are considered essential. These include a birth partner during childbirth; to a person receiving end-of-life care; to support someone with a mental health issue such as dementia, a disability or autism where not being present would cause the patient to be distressed; and, to accompany a child in hospital. Visiting times are managed to ensure social distancing and prevent accumulation of visitors in the ward, and visitors must adhere to strict hand and respiratory hygiene.

Work also continues to enhance the effectiveness of action taken to minimise risks of hospital transmission. A sub group of the Chief Medical Officer’s COVID-19 Advisory Group is examining domestic and international evidence to consider new steps that might be taken. The Government expects to make an announcement shortly about the additional circumstances in which health care workers might be tested for the virus. Consideration is also being given to how to enhance measures to limit transmission in non-clinical areas of hospitals. The group is also developing recommendations in relation to wider patient admission screening.These efforts will be of particular importance as the NHS seeks to both continue suppressing the virus but also begin to re-commence elective surgery and other activity that was paused as priority was given to ensuring sufficient capacity existed to cope with patients suffering from COVID-19.

Where outbreaks have occurred steps are taken quickly to seek to determine the source of transmission and to curtail it, and management of incidents can often involve the temporary closure of wards, or part of a ward. Infection prevention and control has been and remains a priority for NHS Scotland, in all settings.

NHS Boards have been reporting incidents that have involved COVID-19 appearing outside the dedicated ward areas. Reports of incidents first arose in mid-March (from 18 March) and increased in line with the trend of the community outbreak. Reports of incidents have been declining since the beginning of May.

In the period up to 3 June, Health Boards reported to Health Protection Scotland (HPS) a total of 125 incidents involving COVID-19 cases outside the COVID-19 wards. Of these incidents, 120 are now classified as closed. Incidents are classified as closed by Health Boards when there is no evidence of continuing transmission taking into account possible contacts and the incubation period of the virus. Some incidents are also closed where there are sufficient isolation facilities or where COVID-19 positive patients are transferred to COVID-19 wards.

These reports constitute incidents of suspected transmission in hospitals. Because of the varying incubation period of COVID-19 it will have been the case that some patients admitted have not presented with symptoms on admission but will have already acquired the virus in the community.