Trust with record covid deaths sees high rate of hospital acquired infection

The discovery comes as the Care Quality Commission confirmed to HSJ that it has sought and received further information from East Kent Hospitals University Foundation Trust on the high covid death rate at the trust. It is now deciding whether to take further action over the issue.

Reporting data shows that, between 30 June and 26 July, 12 per cent of hospital covid cases at East Kent were diagnosed 15 or more days after admission, compared to 6 per cent across all other English acute trusts. Under national NHS guidance, cases first diagnosed 15 days or more after admission are considered “definite healthcare-associated”. 

The discrepancy is even greater in the share of all hospital cases (including cases diagnosed before admission) diagnosed eight or more days after admission. This was 46 per cent at East Kent during this period, and only 16 per cent across other trusts. These are “probably healthcare-associated”, according to the official guidance.

The share of cases which were already diagnosed on admission — very likely to mean they caught it in the community — was much smaller in East Kent than elsewhere.

The data shows potential signs of consistent improvement from about 20 July, with the total number of new hospital cases, and the share which are contracted in hospital, both declining. The trust claimed the discrepancy may be in part because it has been testing more asymptomatic inpatients. 

As these figures involve low numbers of cases and there are a number of explanations for them, they should not be taken as definitive proof that EKHUFT has an infection control problem. But they do indicate the trust is an outlier in when patients are diagnosed with covid, compared with other trusts.

EKHUFT accounted for 11.5 per cent of all the in hospital deaths in England from 16 to 24 July. In the last 30 days, the trust has had 64 covid deaths – more than double of that of the next trust. Last week, the trust tested all 9,000 staff and found 15 cases. 

After coverage from HSJ, the trust asked for help with infection control from NHS England on around 16 July, then announced it was taking new steps to improve infection control. The trust is also receiving support with infection control from both NHSE and the Kent and Medway Clinical Commissioning Group.

The trust now appears to be coming under greater scrutiny from the CQC.

Chief inspector of hospitals Professor Ted Baker told HSJ: “We continue to engage directly with EKHUFT regarding the infection prevention and control measures they have in place, working closely with NHS England and Improvement. We have requested further information from the trust which we are currently reviewing to determine whether further action is required on our part to address any risks to the safety of patients and staff.”

Kent and Medway CCG chief nurse Paula Wilkins said at a monthly board meeting yesterday that the CCG was “aware that there have been cases of on-site covid infections” at East Kent. CCG accountable officer Wilf Williams said he was “very well aware of the situation” at East Kent and the “legitimate public scrutiny” it has attracted.

He added: “We need to properly understand what has happened…we take it extremely seriously…it’s a very important issue”.

Staff speak out

Meanwhile, several staff and their families have told HSJ they fear speaking out about infection control issues there.

One nurse said she felt “bullied and made to feel worthless”, and that protective equipment was locked away, while infection control concerns were not answered. Another member of staff who left the trust recently said: “Denial is the culture in East Kent.”

Another person who worked at the trust recently was concerned that social distancing was not being observed by staff in communal areas such as nursing stations. “The whole premise was that we did not need to do that,” the source said. “Having been in the hospital in the last week I still saw areas where computers and desks were next to each other. Not enough is being done to change the working conditions so that infection does not spread.”

A spokesman for EKHUFT said: “The trust has carried out a high rate of patient testing throughout the pandemic, including frequently testing all patients who are not showing any symptoms of covid-19. We would anticipate that a high rate of patient testing would be reflected in any testing data.

“We have worked hard to listen to staff and answer any concerns over the last few months, through daily catch ups and regular time to allow staff to ask the chief executive, chief medical officer and other senior managers questions.

“We have followed national guidance on the use of PPE, introduced PPE safety officers across clinical areas to support staff and all areas of the hospital have been risk assessed with adjustments made to support social distancing and reduce the risk of transmission.

*The Ashford area has had the highest rate of deaths of any local authority region in the country in June at 37.2 per 100,000. Most of these deaths occurred in the William Harvey Hospital or large care homes locally. Rates were also high in the Dover and Folkestone areas.

”Since the start of the pandemic, East Kent accounts for 1.5 per cent of the overall Covid-19 deaths in the country, which is in the expected range when risk adjusted for age, sex, comorbidities and deprivation.”

Covid-related deaths at EKHUFT accounted for 1.1 per cent of the English total up to the end of May, but in the two months since then it has recorded 6.3 per cent of all hospital covid fatalities. University Hospitals of Leicester which serves an areas with much higher infection rates than in Kent saw 60 deaths during that time.