Plans to discontinue enhanced cleaning in low-risk areas have been criticised by experts in infection prevention and control

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An expert in microbiology has expressed concern about the new UK Health Security Agency (UKHSA) recommendations on COVID-19 infection prevention and control (IPC) around elective procedures.

The recommendations include interventions that relate to social distancing and testing in NHS and Social Care elective care services, and the removal of enhanced cleaning practices.

The new recommendations advise that enhanced cleaning can be discontinued in low-risk areas. Providers have been told that they can now revert to standard cleaning procedures. The decision is based on advice by the Scientific Pandemic Insights Group on Behaviour (SPI-B) that hand hygiene is likely to be more effective than enhanced cleaning of surfaces.

But Dr Simon Clarke, Associate Professor in Cellular Microbiology at the University of Reading, says that the removal of enhanced cleaning ‘smacks of corner cutting’.

SPI-B advice 

The SPI-B advice is based on ‘observations’ that hand hygiene is likely to be more effective than surface cleaning in controlling the coronavirus, but that does not mean that it is unimportant and can safely be cut, Dr Clarke has cautioned.

‘Moreover’, he said, ‘SPI-B are a committee of behavioural scientists, not virologists or microbiologists, and they are unlikely to be qualified to make such judgements. Indeed, SPI-B cite a NERVTAG paper which also called for further studies in this area, rather than leaning on any hard data. Enhanced cleaning is common in healthcare settings which are exposed to influenza patients, so it seems that penny pinching by removal of enhanced hygiene measures may well lead to transmission of COVID-19 and other infections in our hospitals.’

He also warned that the elimination of polymerase chain reaction (PCR) testing before procedures will leave vulnerable patients at risk of infection.

The UKHSA has recommended that selected patients in low-risk groups who are fully vaccinated and asymptomatic will now only require a negative lateral flow test on the day of their procedure, and will no longer need to have a negative PCR test and isolate for 3 days.

‘The removal of the requirement for negative PCR testing before certain procedures for fully vaccinated, low-risk patients reflects the level of protection that the vaccine provides against severe disease. However, false-negative test results will mean that some asymptomatically infected patients will be put on wards with vulnerable patients’, Dr Clarke said.

Physical distancing 

The recommendations also include a reduction in physical distancing from 2 metres to 1 metre in areas where patient access can be controlled. This will not apply to emergency departments and other areas where access cannot be controlled. The UKHSA says that the guidance is based on advice from the World Health Organization that physical distancing can be reduced to 1 metre in healthcare settings.

The UKHSA hopes that the recommendations around starting to reduce enhanced COVID-19-specific IPC measures will also help to ease the pressure created by the pandemic on NHS capacity over the next few months, balancing the different health needs of the population as we learn to live with the virus.

Commenting on the new guidance, Dr Jenny Harries, UKHSA Chief Executive, said: ‘We have reviewed the existing COVID-19 IPC evidence-based guidance and made a series of initial pragmatic recommendations on how local providers can start to safely remove some of the interventions that have been in place in elective care specifically for COVID-19.

‘This is a first step to help the NHS treat more patients more quickly, while ensuring their safety and balancing their different needs for care.’

The NHS Confederation, which represents the whole healthcare system in England, Wales, and Northern Ireland, has broadly welcomed the UKHSA recommendations, but says that the need for vigilance remains important.

Dr Layla McCay, Director of Policy at the NHS Confederation, said: ‘Healthcare leaders will welcome this review of the restrictions introduced during the early days of the pandemic. The recommended changes will help to increase efficiency and capacity within healthcare settings, and give healthcare leaders and their teams the flexibility they need at a time when everyone is working so hard to increase the numbers of patients that can be safely diagnosed and treated.’

She said that the guidance will offer an opportunity to increase bed capacity on wards, and will allow an increase in the number of patients being seen for a variety of procedures.

‘However’, she added, ‘we must remember that COVID-19 has not gone away. NHS organisations know this well, and will not take their eye off the ball when it comes to infection prevention and control—not least as we approach what we anticipate will be a very difficult winter, with the NHS affected by rising infections from COVID-19 to flu.’

She cautioned that some healthcare organisations and systems may have to adapt their IPC measures again, depending on local need.

Local risk assessments 

The UKHSA says that implementation of the recommendations should be based on a risk assessment of local factors, such as the configuration of wards and departments, local capacity, and ability to ventilate spaces.

It also advises that staff working in areas where COVID-19 control measures have been relaxed should be fully vaccinated and asymptomatic, and should not be a contact of a positive case. Staff will be required to continue to comply with the current guidance on asymptomatic testing. Rigorous adherence to routine IPC precautions by all staff remains critical for patient safety, and must continue to be implemented.

The recommendations only apply to elective care. The UKHSA describes them as the first step, and says that further changes are planned in relation to other services and environments.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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