This is the 2020/21 edition of State of Care
Infection prevention and control (IPC) is an essential part of safety in care settings. It became even more important during the COVID-19 pandemic in protecting people using services and staff by preventing the spread of infection.
Our IPC inspections of care homes and hospitals were able to shed a light on some of the challenges faced by services, but also share good practice.
In November 2020, we published a report on how care homes managed infection prevention (IPC) and control during the coronavirus pandemic, based on a programme of 440 care home inspections in August and September 2020 that looked at assurance across eight questions.
Across these inspections, most providers demonstrated that they had faced the challenges of the pandemic well, with assurance in all eight questions for nearly two-thirds of care homes (65%).
Since our report, we have continued to inspect, using information we gather about services, including feedback from staff or people using services and their families, to make sure that people receive appropriate and personalised care, while being protected from the spread of COVID-19.
Across our inspections of more than 5,000 care homes from summer 2020, we were assured in 69% of care homes against all eight IPC questions. This represents a four percentage point increase between September 2020 and August 2021.
Assurance has also risen against almost all the questions we looked at (figure 4). The biggest improvement has been for the question about whether people are admitted into the service safely, which saw a six percentage point increase.
Some services were carrying out pre-admission assessments remotely, accounting for people’s individual needs and involving families where appropriate.
“[Person] had dementia and was very physically fit and active. Decision at pre-assessment that self-isolating on arrival would not be successful and impact on their mental health. Risk assessment completed, [person] had both vaccines, testing and self-isolating at their own home prior to admission.”
The other highest increases were seen in access to testing, shielding and social distancing, and up-to-date IPC policies (all five percentage point increases).
For our question about whether there is adequate access and take up of testing, care home managers told our inspectors that they would talk to staff and people using services to reassure and educate them about the importance of testing and vaccinations.
“Where staff have been hesitant about vaccination, they had 1:1 discussions with a manager to understand their concerns and to try to address them.”
In our July 2021 COVID-19 Insight report, we reviewed our first nine focused well-led inspections in acute NHS services to monitor infection prevention and control.
The inspections highlighted that good IPC practices have been implemented in most trusts inspected. They have adapted existing guidance and processes to respond to the COVID-19 pandemic to ensure the safety of staff and patients. This is despite challenges to good infection prevention, which included the layout of some hospital buildings limiting patient flow, and vacancies in the IPC team reducing staff support.
“There was daily oversight of safe staffing levels. Part of this process was to ensure that staff were not moved between COVID-19 positive and negative areas to minimise the risk of spread of infection.”
The trusts had dedicated IPC directors and teams that provided expertise to staff and regular updates to the board. In most occasions, these teams were comprised of staff from across the trust who had been redeployed.
“The trust’s IPC nursing team had development posts for nurses to gain the skills and experience needed to proceed to a more senior role.”
Prior to our inspections, several trusts had seen an increase in the number of nosocomial infections (infections acquired in the hospital), particularly around December 2020 to January 2021, and had action plans and objectives to reduce them. They carried out reviews and shared learning from any outbreaks.
Separately, the Healthcare Safety Investigation Branch have investigated the factors that underpin the management of nosocomial infections. They identified some of the challenges hospitals faced in reducing the risk of nosocomial infection and they have made a number of recommendations.
In the 2020 Urgent and Emergency Care survey, just under seven in 10 (69%) people who attended a major consultant-led A&E (type 1 services) said the department was ‘very clean’. This was 78% for urgent treatment centres or minor injury units (type 3 services). For both types of service, this is an 11 percentage point increase on 2018 results. These findings are among the largest year-to-year differences ever observed by NHS Patient Survey Programme surveys and are likely to reflect enhanced infection control and prevention measures in urgent and emergency care services in response to the COVID-19 pandemic.
In the 2020 Adult Inpatient survey, patients also experienced good levels of cleanliness in their hospital room or ward.