The findings are contained in the final report of RCEM’s three-year Quality Improvement Programme (QIP) recently published on Infection Control and Prevention (IPC). The QIP collated and analysed data and captured patient experiences from 127 Emergency Departments (EDs) across all four nations.
It found that the number of EDs achieving the standards seen in 2020 at the height of the pandemic had fallen but concluded that the increasing pressure and crowding in EDs will have impacted clinicians’ ability to attain the previous levels.
The infection control and prevention measures included things such as screening patients on arrival for COVID-19, isolating vulnerable patients in side rooms and moving those with infections to isolation areas. The report also highlighted the drop in the number of staff obtaining and maintaining their own vaccinations.
The QIP team, led by Dr Fiona Burton, EM Consultant, IPC topic team lead and co-chair of the RCEM Quality Assurance and Improvement (QA&I) committee made the following recommendations:
- Awareness that COVID-19 is present and real risk to both patients and staff should be maintained.
- Screening and documentation of IPC measures by healthcare staff must be routinely completed.
- Staff vaccinations must be promoted and actively encouraged.
IPC teams must use their local intelligence to work with each ED to guide PPE and departmental configuration to try and ensure appropriate areas are available to maximise staff and patient safety.
Dr. Burton said: “The drop in the standards we observed is worrying but it has to considered in the highly unusual context of a global pandemic, combined with the escalating demands being heaped on our overstretched and over capacity Emergency Departments.
“As COVID emerged there was naturally strong messaging about the importance of escalating infection control measures including the focus on identifying the people who were most vulnerable.
“However, with the successful vaccination programme the messaging has lessened and assessing people’s vulnerability as soon as they enter the ED is perhaps no longer as prominent a consideration as it was – especially as other system pressures mount.
“But we have to remember that COVID has not gone away and it, and other infectious diseases, still pose a serious threat to patients and to staff. And that not being able to provide adequate IPC measures can put people’s lives at risk. It must remain a priority.
“We will now be sharing this important piece of work with healthcare leaders in the four nations and also their governments to ensure the lessons and good practice that were commonplace during the pandemic do not slip as time passes.”
President of the Royal College of Emergency Medicine Dr Adrian Boyle said: “I’m grateful to Dr Burton and the Quality Improvement team for doing this important work.
“It is unconscionable that directly after a terrible pandemic that the system is not providing the standards that staff and patients need.
“We must ensure that an environment where staff and patients are protected properly against infectious diseases is the norm. Everyone has a part to play in this.”
Responding to the report, RCN General Secretary and Chief Executive, Professor Pat Cullen, said: “Emergency departments are crowded, undignified and dangerous. Nursing staff are doing everything possible to keep their patients safe but mounting pressures make everything a relentless battle.
“When beds are lining the corridors and patients are sitting on chairs and treated in cupboards, safety is compromised. Infection prevention and control should be paramount but high standards become harder to maintain in these circumstances and the staff of emergency departments, including nursing, feel set up to fail. The health and care system needs to be brought back from this perilous position.”