Fifty people each day catching covid in region’s hospitals

The numbers of probabale hospital-acquired covid infections have been surging in the region since the start of the second wave in September - rising more quickly than covid admissions from the community.

More than 20 per cent of the new covid cases seen by trusts in the North West over the last week appear to have been caught on the wards, a rate which has been rising steadily, according to NHS England data. The proportion in the rest of England has been rising at a slower rate and is now at around 15 per cent.

Hotspot trusts for what are known as “nosocomial infections” over the last fortnight have been Warrington and Halton Hospitals Foundation Trust, Southport and Ormskirk Hospitals Trust, and Blackpool Teaching Hospitals FT (see table below).

HSJ analysed data for covid cases diagnosed eight or more days after admission to hospital, and therefore probably caught in hospital, according to NHSE and international definitions.

Some doctors suggested the higher proportion of hospital acquired infections for the region (see chart below) was to some extent inevitable as they deal with more patients admitted for covid; and higher covid prevalence among those coming in for other reasons. They suggested that once a certain level of covid occupancy is reached, it is then very difficult to stop it spreading more quickly.

Outbreaks within hospitals mean more bays, wards and services have to close, and have to be split into covid/non-covid areas, taking beds out of use. This will further limit capacity to continue with non-urgent elective care, as many hospitals are still trying to do although some have already scaled back their operations significantly.

The North West is in the process or introducing more routine testing of asymptomatic NHS staff, which is aimed to helping prevent spread among staff, and from staff to patients.  

A senior doctor in Greater Manchester told HSJ the poor physical state of some hospital buildings and ward reconfigurations exacerbates the problem.

The source added: “It’s a nightmare trying to keep non-covid patients cohorted. Were we all in luxurious accommodation with single patient rooms and the staff to look after that configuration safely, the story would be different to a degree. But you also need the patients themselves to do their bit.”

Simon Mardel, an emergency consultant at Lancashire Teaching Hospitals and an expert in infection control, told Times Radio this week: “It’s an incredibly big ask of colleagues to apply these levels of infection control religiously almost to a military level of discipline to every single patient.

“My worry is as always when winter pressures come on and the second wave, we won’t have the luxury where we were protected by the phenomenal reduction of workload (in terms of reduced A&E attendances/admissions) we experienced in the first wave.

“I’m more worried than I would ever have imagined for our hospitals if the surge in cases continues and we see that combined with winter pressures. If we end up with patients in emergency departments in corridors for example, all our systems for infection control …start to unravel and that can have high risk consequences for other patients in hospital as well as our colleagues.”

Professor Tim Cook, a hospital consultant who has carried out research into covid spreading within hospitals for the University of Bristol, said: “We know that patients who become infected in hospital are at increased risk of harm and it is essential to prevent this, particularly as we enter the second surge with the added challenges of winter pressures and efforts to maintain non-covid healthcare service alongside covid-care.

“The current screening guidance from NICE [which does not require self-isolation ahead of elective admissions] is suitable for situations of low viral prevalence and is designed to increase patient access to hospitals, but it adds to the challenge of maintaining covid-free pathways during a surge.

“Screening elective patients before admission, screening staff in hospitals and maintaining social distancing, mask-wearing and more general infection control behaviours within hospitals are all important to maintain safety.”

The trusts mentioned above were contacted for comment.

A spokesman for NHS England’s regional directorate said: “Rising community covid transmission increases the risk in healthcare settings, so hospitals in the North West have been asked to ensure they are accurately recording their data and are rigorously following infection prevention and control protocols, including now the introduction of asymptomatic staff testing.

“It has never been more important that everyone does what they can to reduce the risk of spreading the virus by following the Hands, Face, Space guidance.”