Infection prevention and control

Our new data collection and digital monitoring tools – the Emergency Support Framework (ESF) – enabled our inspectors to have structured and consistent discussions with providers about the impact of coronavirus on staff and people using services, and helped us identify where we might need to inspect or escalate concerns to partners. A key part of the framework focuses on infection prevention and control.

We saw an increase in calls to our national contact centre from health and social care staff raising concerns about care. The biggest increase came from staff in the adult social care sector: we received 2,612 calls from adult social care staff raising concerns in the period 2 March 2020 to 31 May 2020, compared with 1,685 for the same period in 2019 – a rise of 55%.

We also saw an increase in information sharing from people using services, their relatives, and staff, including through our online Give Feedback on Care service. At 12 July, we had received more than 4,600 COVID-19 enquiries, relating to more than 3,300 services. These peaked in the two weeks beginning 13 April, when more than 2,000 enquiries were raised.

Infection prevention and control (IPC) was the most common theme from this feedback, appearing in 44% of enquiries. Related issues included:

• how hygiene and infection control is practised in the service
• cleaning facilities and the wearing of personal protective equipment (PPE)
• movement of staff between wards, services or people’s homes
• self-isolation of people with symptoms
• movement of people using the service.

NHS acute and specialist trusts told our inspectors in ESF calls that they had high board assurance around their IPC procedures, and we heard of a number of good practice examples. While most trusts assured themselves that they were managing IPC well and mitigating risks, there were some examples of where the systems and procedures were ineffective. Robust audits did not always take place during the peak of the pandemic, including audits of PPE, waste disposal and the screening of other health care-associated infections. Oversight of IPC training varied between trusts, meaning some could not always be assured that staff had been adequately trained in IPC procedures. And some trusts had challenges on space that limited their ability to isolate and cohort COVID-19 positive patients.

Results of our survey of hospital inpatients during April and May 2020 showed that the observation of IPC-related practices (such as handwashing with hand sanitiser or soap, staff wearing PPE, staff disposing of gloves and plastic aprons, cleaning of surfaces and waste bins being provided) were all relatively high (90% or above in all cases). However, respondents reported seeing social distancing measures (such as markers on the floor or signage at the entrance) to a lesser extent (65%).

During August, we carried out a special programme of IPC inspections in 301 care homes selected as potential examples of where IPC was being done well. We have been encouraged by the findings so far, with more than 90% assurance across all the elements we were looking at, and plenty of good practice examples. In an analysis of IPC in 139 inspections in high-risk services from 1 August to 4 September, we were mostly assured by the approaches those care homes had taken. The main areas that needed to improve were around having out-of-date IPC policies and not using PPE in the most effective way.

In the first months of the pandemic, we have not seen any clear relationship between care home ratings and the number of deaths due to COVID-19 in those homes. As at 7 July 2020, for every 1,000 beds there were 40 deaths in care homes rated overall as inadequate, 47 in those rated as requires improvement, 44 in those rated as good and 41 in those rated as outstanding. There was a similar pattern when comparing against the specific ratings for the safe and well-led questions.

Our calls to a sample of GP practices showed that they generally had good PPE and cleaning procedures, procedures for social distancing and audits of IPC. Those we talked to said that one challenge had been around the clarity and effectiveness of communication around national IPC guidance – saying that messages, particularly in the early stages of the pandemic, were inconsistent and confusing.

Next page

The unequal impact of COVID-19

Previous page

The impact on health and social care staff