Findings and progress outlined after Ysbyty Gwynedd Covid outbreak review

As part of its response to the outbreak in March 2021, Betsi Cadwaladr University Health Board (BCUHB) commissioned an independent review. This was in response to a significant number of nosocomial infections and outbreaks at BCUHB.

The purpose of the review was to determine the preparedness of the Ysbyty Gwynedd in Bangor for risks around Covid-19 nosocomial transmission and outbreak prevention. It was also undertaken to analyse previous recommendations made, following outbreak report(s) from Wrexham Maelor Hospital and Glan Clwyd Hospital sites and how lessons shared with Ysbyty Gwynedd informed practice and management of patients across elective and non-elective pathways.

Reviewers also identified areas of good practice and areas for improvement.

A final report updated health board members during today's meeting (September 23) and outlined what work had been undertaken and the current position

The review took place early to mid May 2021 and the following methodologies were utilised:

• Focus Groups with the following teams: Estates and Facilities, Clinical staff, Infection Prevention team
• Onsite visits reviewing signage, well–led processes, Patient placement, facilities, equipment, communication, assurance mechanisms, Infection Prevention Control (IPC) audit plan and general observation of compliance.

The Health Board also started an improvement plan building on the 'Safe Clean Care' initiative and lessons learned from the pandemic.

Addressing members, Gill Harris, executive director of Nursing and Midwifery at Betsi Cadwaladr University Health Board, said: "It is ensuring that we are beginning to embed some of the changes and we are getting good... better medical representation within that group. The points I want to pull out particularly the balance we are having to take between assurance audits and that fatigue that staff are demonstrating and we are working with informatics colleagues to see what we could put in place that could mitigate against the amount of work that is being undertaken. Not only with those audits but ensuring that we have got patients in the right beds at the right time so we can monitor the movements. That continues to be an ongoing conversation.

"I have already called out the unscheduled care pressures are continuing to add a level of concern and very specifically the workforce gaps that we are seeing. We are closing those gaps in domestic services and elsewhere but they do remain a challenge and recruitment is ongoing."

The report was provided by Hilda Gwillilams, Executive Director of Nursing, and Dr Andrea Denton, Independent Nurse Consultant.

Key findings included:

• Good Compliance with Personal Protective Equipment (PPE), hand hygiene and social distancing.
• There were Clear pathways on entry into the Emergency Department
• Staff were knowledgeable regards IPC requirements when questioned and able to articulate clear understanding
• A sense of commitment to the prevention of nosocomial transmission
• There was good communication and engagement between the Infection Prevention team and site Management
• Good access to gel facilities and decontamination stations on entry
• There had been refresher training introduced for domestic staff
• The visiting teams overall observation is that of an aged estate although maintained overall, it provided challenges

There were no immediate concerns raised at the time of the review or within the report.

Several of the recommendations are labelled as 'new', and demonstrated that some of the lessons learned from previous outbreaks had not been fully embedded, including the restrictions for staff communal areas.

It also questioned the effectiveness of the current cross site communications.

The health board say they are exploring alternative methods to better ensure critical messages are received and acted upon

It was also noted previously that the outbreak was not escalated in a timely way to help mitigate spread of the outbreak.

The Hospital Management Team (HMT) has since "reflected" on their experience and shared their learning in various forms across the health board and changes within the Hospital Management Team have taken place to strengthen operational delivery.

In August, BCUHB said they were managing a Covid-19 outbreak on two medical wards at Ysbyty Gwynedd and a ward at Ysbyty Eryri in Caernarfon.

This is a new outbreak after the earlier 'outbreak' was declared closed in May.

Ms Harris gave an update about the current outbreak on September 21. She said: “We are continuing to manage Covid-19 outbreaks at Ysbyty Gwynedd, Glan Clwyd Hospital, Colwyn Bay Hospital and Llandudno Hospital.

“As of this morning, we are caring for 23 patients in the West area who are currently Covid-19 positive and 22 patients who are recovering who have had Covid-19. A small number of these patients are confirmed hospital acquired infection and linked to the outbreak.

“The ward affected by the outbreak at Ysbyty Eryri has now reopened to admissions and we are confident the situation is improving at Ysbyty Gwynedd.

“In the Central area we have 59 patients who are currently Covid-19 positive and 12 patients who are recovering who have had Covid-19.

“A small number of these patients are confirmed hospital acquired infection and linked to the outbreak.

“Due to the high community Covid-19 transmission rate we ask that when the public visit us for an appointment or treatment they wear one of our fluid resistant surgical masks which are available at entrances into our healthcare settings and use the available hand sanitiser as often as possible.

“Tighter visiting restrictions remain in place at the affected hospitals, this decision does not impact visiting guidelines for our our maternity, paediatrics and neonatal services or wards at Ysbyty Gwynedd and Glan Clwyd Hospital.

“Exceptional visiting requests such as visiting a relative who are at end of life must be made directly with the ward and will be require an individual risk assessment to be completed both in advance of and on arrival of an agreed visit so that we can keep patients, staff and visitors safe.”