‘Outdated’ infection control rules ‘crippling’ hospitals, government told

Infection prevention and control rules require contacts of confirmed covid cases in health and care settings to be isolated for 14 days, regardless of testing negative – even though contacts among the general public and staff are now subject to much more limited requirements if they test negative.

This was intended to prevent nosocomial spread of covid, which has caused many infections and deaths in previous waves.

However, very large numbers of omicron cases are being discovered in hospitals several days or more after admission, either because the virus was still incubating when they were tested on admission, or because it was caught in hospital, and is often not showing clear covid symptoms.

In these cases, while the confirmed-covid patient is moved to a room or covid-positive cohort, the remainder of the ward must also be isolated for 14 days. It means any remaining beds can’t be used and makes it very hard to move the patients within hospitals, and sometimes difficult to discharge them.

Several senior hospital clinicians with covid expertise said this was causing major problems and did not appear to be necessary.

It comes amid very high pressure on general and acute beds at many hospitals, as winter demand, omicron and staff absences combine, and are expected to grow further – with “covid surge hub” tents being erected outside several sites. Systems are scrambling to discharge as many people as possible in case omicron admissions surge.

HSJ understands the issue has been raised with the UK Health Security Agency, which oversees the national rules, and with NHS England national directors, and that senior officials are reviewing it.

Pat Cattini, an infection control nurse and former president of the Infection Prevention Society, said on Twitter: “While in hospital [contacts] have to be isolated for 14 days. This guidance has never changed despite vaccination and changing epidemiology and is crippling healthcare.” 

She called for the issue to be reviewed “urgently” and said: “This is a huge driver of bed pressure.”

It causes a particular problem in older hospitals, such as those with large Nightingale wards, because more beds and a larger share of total capacity are affected.

A London hospital consultant said: “So many patients are turning positive at day one/two/three/four – admitted as non-covid but incubating covid – that it is causing devastation because of contacts and blocked beds.

“It is much, much harder to manage than delta due to [high] infectivity… [Trusts] need to adopt different strategies and make risk assessments.” It was contributing to hospitals “running out of both covid and non covid capacity”, the person said.

A senior hospital consultant in another region said: “It creates another major headache for bed management as it creates another stream of patients that have to be separated. Effectively what we are having to do now is create four hospitals within the hospital.” (For symptomatic respiratory covid, incidental covid, covid contacts, and non-covid).

The source added: “This headache grows when care homes won’t take patients back until they are out of the 14 day window which delays discharge.” Several sources said while it was permitted to discharge contacts within the 14 days, it was often difficult or impossible because of local objections.  

A UKHSA spokesperson, asked about the issue, said: “The current guidance is in place to help limit the spread of covid-19 to vulnerable people and NHS staff. We continue to work in partnership with NHSEI to review the guidance and will make changes where appropriate.”