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National Nosocomial COVID-19 Programme

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Learning from healthcare-acquired COVID-19 infections in Wales 

The COVID-19 pandemic has had a significant impact on population health and healthcare systems worldwide. NHS Wales rapidly adapted and altered its operational focus to minimise harm as far as possible. NHS staff worked tirelessly to maintain healthcare services for those most in need. However, COVID-19 was a new and unpredictable infection which made it extremely difficult to manage. 

Due to the scale and severity of the pandemic, patients who required care in hospitals and other in-patient settings faced an inevitable increased risk of acquiring COVID-19. Managing the spread of COVID-19 in healthcare settings was challenging, particularly when prevalence was so high in the community, and in hospitals, there were higher levels of seriously unwell patients, longer lengths of stay and more people in hospital beds. 

The nature of the pandemic meant that unusually high numbers of patient safety incidents of nosocomial (hospital-acquired) COVID-19 were recorded, affecting 18,360 patients and their families/ carers across Wales between March 2020 and April 2022. 

Healthcare acquired infections are sometimes considered a patient safety incident, depending on how and when the infection was acquired. Review of these cases was essential to provide as many answers as possible to loved ones, as well as capturing valuable learning and experience.

 

 
What is the National Nosocomial COVID-19 Programme? 

In April 2022, the National Nosocomial COVID-19 Programme was established to support NHS Wales organisations in their duty to conduct investigations into the high number of patient safety incidents of nosocomial COVID-19. 

The National Nosocomial COVID-19 Programme, led by the NHS Wales Executive, formed a collective membership of NHS organisations across Wales, establishing a national framework to ensure NHS Wales organisations adopted as consistent an approach as possible to the investigation process, ensuring investigations are done once and done well. The programme also provided a forum for sharing local and national learning from investigations.

 

 
Learning and improvement across NHS Wales 

Acknowledging the impact of COVID-19 on patients, families, carers and NHS Wales staff, the programme adopted a learning approach that sought not to place blame, but maximise the opportunity for learning and improvement. 

NHS Wales has published its National Nosocomial COVID-19 Programme End of Programme Learning Report, providing an overview of the programme and summarising national learning themes that have been identified during the investigation process. 

 

The learning themes have been categorised as follows: 

People’s experiences 

  • Bereavement support and care-after-death services 

  • Supporting the service user during the investigation process 

  • Visiting restrictions 

  • Communication with families and carers 

 

Patient safety incidents and concerns 

  • Patient safety incidents outside of NHS Wales settings 

  • Identification, reporting and investigation of Health Care Acquired Infections (HCAIs) as a patient safety incident 

  • Application of Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions 

  • Clinical record keeping 

  • Staffing and resource 

 

Infection prevention and control 

  • Publication and distribution of guidance 

  • Outbreak management 

  • Discharge planning 

  • Hospital environments 

 

More information on each of the learning themes, in addition to good practice, can be found in the National Nosocomial COVID-19 Programme End of Programme Learning Report.