NHS told to raise its game on IPC or face omicron-driven surge in hospital infections

The warning came from NHS England national clinical director for antimicrobial resistance and infection prevention and control Mark Wilcox during a webinar for NHS leaders this evening.

He said that the effectiveness of the vaccination programme had led “understandably” to the NHS being more relaxed when it came to covid IPC.

However, he warned that “the effectiveness of the vaccines has diminished substantially with respect to two doses” because of the omicron variant, and that “if we carry on with the level of IPC that we have been lulled into then we will see very significant problems with nosocomial infection”.

He called on NHS boards to ensure “assiduous attention to detail” in following existing IPC guidance and that the “optimal implementation of [IPC] measures are in place”.

Professor Wilcox mentioned research conducted during the spring 2020 covid wave showing that effective IPC could dramatically cut nosocomial infection in both patients or healthcare workers. Staff should be shown this evidence, he said.

The current IPC guidance had been reviewed by the chief medical and nursing officers of all four UK nations last Thursday, he said.

It had remained unchanged despite the new variant’s increased virulence as “the mode of transmission has not changed”.

However, a consensus statement agreed between the eight clinical leaders, and due to be published in the next 24 hours, stressed a change of “emphasis” to spotlight the need to apply the guidance assiduously and consistently.

Professor Wilcox said: “We know from wave one that there are large differences in nosocomial rates between NHS trusts that are apparently similar in other respects.”

This was down to a myriad of factors he suggested, including the behaviour of patients.

“We have very good evidence that the most dominant route of transmission of the virus in hospital is patient to patient.”

This, he said, suggested “considerable room for improvement in mask wearing by patients”, adding “there’s a difference between not being possible and not being liked – one is acceptable and the other needs to be addressed”.

It was also vital to ensure that “setting-specific risk assessments” took place, taking into account issues like the level of patient contact and the quality of ventilation.

Professor Wilcox said the IPC guidance had already been reviewed over 600 times and that this process would continue as more was learned about omicron.

Amid perceived reductions in the risk of nosocomial infections in recent months — and pressure to increase services’ efficiency and flow — national health agencies have moved to relax IPC rules in recent months.

There are some signs of the rate of nosocomial infections increasing in London in recent days (see chart below), as prevalence in the community and total covid admissions have increased, but it is not known if this is linked to omicron.