All acute NHS Trusts Hospitals have been in the eye of a covid-19 storm. This has been driven by rapid rises in community infection rates in March/April, Sept/Oct and Dec. But before and after these surges, there were concerns raised about patients who went into hospital without Covid; and acquired it during their hospital stay.
From mid-June 2020, NHS Improvement and NHS England required all trusts to report on the number of Hospital Acquired Covid – technically known as “nosocomial” infections.
It only became mandatory in mid June 2020, for all NHS staff, visitors and outpatients in hospitals in England to wear face masks; which was twelve weeks after the first lockdown begun on March 23rd 2020.
We note the East Kent Hospital University Foundation Trust Council of Governors minutes for August 2020 state:
an update on Covid-19 and explained that there had been an increase in infections throughout the Trust which had arisen in the middle of June.
This would mean the increase in infections was up to 14 days prior to the middle of June [max Covid incubation time is 14 days]. Meaning Covid was spread around EKHUFT Hospitals prior to the mandatory introduction of masks.
Below is a chart (March 2020 – Jan 31st 2021) showing the combined number of patients who probably caught Hospital Acquired Covid; and definitely caught Hospital Acquired Covid, in each of the four Kent Acute NHS Trusts.
There is no public data on how many patients who became infected with Hospital Acquired Covid subsequently died.
The data above published by NHS England clearly shows patients who entered hospital without Covid, began to catch Hospital Acquired Covid in increasing numbers from Oct/Nov onwards.
The current data for Hospital Aquired Covid in Kent Acute NHS Trusts has yet to fall significantly in three out of four of the Trusts.
This increase can be attributed to the Kent variant, which Sir Patrick Vallance HMGs Chief Scientific Adviser said was more transmissible and more deadly. However there remains huge uncertainty about Sir Patrick’s claim.
To find hospital acquired Covid infections—that is, positive tests of patients who were in hospital for more than eight days (probably caught in hospital) and fifteen days (definitely caught in hospital)- we were advised to find the difference between sets of data on new hospital cases and new hospital cases from the community and subtract one from the other.
Three of the four Kent acute NHS Trusts ( D&G, M&TW and Medway) responded to an Environmental Information Request, but none of their data corresponded with the data they had sent to NHS England. As such we have used the NHS England data.
In May 2020, NHS England estimated that 10-20% of people in hospital with coronavirus had been infected while they were inpatients. Remember, it was not mandatory to wear a mask for NHS staff, visitors and outpatients in hospitals in England until mid June.
On the 11 August, the Trust were visited by the Care Quality Commission, who by the end of the month had issued a s31 order under the Health & Social Care Act 2008.
A s31 order makes it clear, if the CQC has reasonable cause to believe any person will or may be exposed to the risk of harm, those responsible for that harm must stop as soon as practibable. EKHUFT was the first NHS trust in the country, to face such action.
On 7 Oct 2020, the CQC released their report regarding their visiting in August.
The HSIB report is clear that many of the root causes lay in building design, ventilation, huge pressure on overcrowded beds, Trusts being short staffed and overwhelmed clinical teams, and a lack of testing and PPE in those early months.
The HSIB report, while sympathetic to staff and the conditions they were working in last spring (2020), did not pull any punches about some basic failings in adherence to best infection control practice.
However, it is clear failings to adhere to best infection control practice were still not in place by the end of Dec 2020 within EKHUFT at least.
On or around the 30th Dec 2020 there was an outbreak of Covid-19 on Harvey Ward (a Neurorehabilitation Unit) at the Kent & Canterbury Hospital. It is known that several patients tested positive. All of them had been on the ward for more that 15 days, so did not bring Covid onto the Ward from the community. This was Hospital Acquired Covid.
All staff were tested on and after the 30th Dec 2020, with positive results occuring. However, patients were not tested until the 4th, and 5th of Jan 2021. After infection, symptoms can take up to 10 days to appear (although the average is five to six days), while some people never develop symptoms at all.
On the 6th & 7th all staff were wearing full PPE. This had not been the case previously. Also, on the 6th & 7th Jan, patients who tested positive were moved to a variety of wards in the Kent & Canterbury.
The Harvey Ward was closed due to the outbreak of Covid and had not re-opened by Wednesday 27th Jan 2021. All the patients on that Ward prior to the 6th Jan 2021 received Hospital Acquired Covid.
This incident on just one ward provides further proof that best infection control practice was not being adhered to.
All four acute NHS Trusts NHS Trusts have received formal complaints from people angry and distressed that they, or a family member, had contracted Hospital Acquired Covid in what they expect to be a place of safety.
Teams battling to deliver clinical care in a highly pressurised environment; and at significant personal risk, should not at present be sent down a distracting, demoralising warren of complaint handling and root cause analysis, for something which is more often than not out of their control. Any investigation ought to begin after the pandemic is over.
We make it very clear we are NOT SAYING those in any Trust, be it in Kent, or elsewhere, are deliberately or maliciously or malevolently being careless. The whole healthcare profession is desperately trying their best in extremely difficult circumstances.
We thank all NHS Staff for what they’ve done throughout this pandemic. We send our condolences to all those who’ve lost a loved one to Covid, whether that be Hospital Acquired Covid, or acquired in the community.
The Shepway Vox Team
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