NHS to target risk of Covid outbreaks on wards after watchdog investigation

Safety watchdog warns of risk to staff and patients from poor hospital design

Hospitals can be a major source of Coronavirus infection between staff and patients (PA)

NHS bosses are to crack down on hospitals hit by Covid outbreaks after a safety watchdog warned of widespread risks of infection to staff and patients within hospitals.

NHS England has started publishing weekly rates of coronavirus cases caught by patients and staff in hospitals and will target those NHS trusts with high rates for investigation.

It comes as a new report by the Healthcare Safety Investigation Branch warned hospital staff and patients were at risk from being infected because they were forced to congregate in areas to use computers, access records and take breaks.

In some hospitals older buildings with narrow corridors, small rooms and poor ventilation also increased risks of infection.

The safety body warned of the impact on staff and said it had received reports of mental health issues because of the workload during the pandemic including one attempted suicide by a hospital worker.

It warned of confusing guidance on infection prevention and delays of up to three days for some patients test results to be returned.

The risk of coronavirus spreading in hospitals, known as nosocomial transmission, has been highlighted by the government scientific advisers who estimated up to 20 per cent of hospital Covid cases were caught in hospital, including 11 per cent of hospitals deaths linked to the virus.

HSIB carried out a rapid investigation during July and August, visiting six NHS trusts to look at what could be done to prevent in hospital transmission of the virus.

Dr Stephen Drage, HISB’s director of investigations and an intensive care consultant in Brighton, said the body had not been provided with data on the scale of transmission within hospitals despite requesting it from the NHS but he added: “Our investigation heard from families who believed their relative had and in some cases died as a result of contracting coronavirus in hospital. The impact of that is devastating.”

He added the consequences of infections in hospital meant “wards get closed, staff go off sick or have to isolate and the remaining staff become fatigued and which can impact on patient safety.”

Dr Drage said hospitals needed to consider changes to the environment to encourage changes in staff behaviour.

In its report, published on Thursday, the safety body said it had “identified evidence to suggest that people were being admitted to hospital without signs of Covid-19 and by the time they were discharged, or soon after, they had contracted Covid-19.”

It added the risks of spreading the virus between staff who had no symptoms was not “always well understood”.

It added problems with “hospital design” increased the risk of the virus spreading in hospitals.

It said: “One trust told the investigation that ‘staff still gather around without PPE in staff rooms and communal areas’. Some families reported seeing staff without PPE in “staff areas” and this impacted on how safe they felt in hospital.

“Often, these examples were found in non-clinical areas where staff gathered, such as staff break areas.”

The body said the size and layout of these areas did not allow for social distancing including “corridors that were not wide enough to maintain a two-metre distance among staff.

“Many wards were still reliant on fixed computer and telephone terminals to enable staff to access IT systems and communicate about patient care. In addition, medical records were often stored at central points in wards, encouraging staff to return regularly to these areas.”

In response to the report NHS England said: “Data on nosocomial transmission rates would begin to be published on a weekly basis” adding: “Data will be reviewed to allow targeted investigation of known nosocomial hot-spots.”

It will also be increasing testing of NHS staff in areas under Tier 3 restrictions and working to roll out more rapid testing for patients. It added there will be “reinforced messaging” around social distancing and wearing masks.

Miriam Deakin, director of policy and strategy at NHS Providers, said the report “has highlighted yet again the impact of years of inadequate capital investment” in NHS hospitals and buildings.

“The report also rightly highlights the potential consequences of staff fatigue and emotional distress. In our recent survey of trust leaders 99% said they were concerned about current levels of burnout across the workforce.”

An NHS England spokesperson said: "Hospitals have been asked to rigorously follow PHE’s infection control guidance and the NHS offers support sessions to staff to ensure it is implemented effectively, while infection data is also being published so that trusts can share their learning with others in order to help control the virus.

"ONS and other data demonstrates conclusively that the root cause of rising covid infections and hospitalisations is actually due to rising community transmission, so the public have an important role to play in reducing infection rates, but people should continue to come forward for NHS care as and when they need it.”