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Petition title: Welsh Government to take action to protect people from airborne infections in health care settings Text of petition: § Improve air quality in health and social care settings through addressing ventilation, air filtration and sterilisation; § Reintroduce routine mask-wearing in those settings (as per WHO recommendation 20 December 2023), particularly respiratory masks; § Reintroduce routine Covid testing- it is asymptomatic; § Ensure staff manuals fully cover preventing airborne infection; § Provide public health information on the use of respiratory masks and HEPA air filtration against airborne infections. Infections like Covid, flu, RSV, measles and TB are spread by inhaling tiny airborne aerosols hanging in the air like smoke. Key ways to prevent it are to improve air quality and wear well-fitting respiratory masks. Reinfection increases risk of long-term serious damage potentially for anyone, to brain, heart, immune system, etc. Care workers top the long Covid league. Repeated illness and job loss put avoidable pressure on services. The rate of hospital acquired Covid infection has been shown to be higher than in the community. Clinically vulnerable people often must use care but cancel essential health appointments. Transmission is often asymptomatic. Covid isn’t seasonal. Routine testing is thus essential. There are many tools to protect health. Only one is being used: vaccination – unavailable to many, including some clinically vulnerable people. |
The petition is calling for several measures to be implemented in health and social care settings in Wales to protect people from airborne infections.
The World Health Organisation (WHO) states that proper ventilation and air filtration can help reduce the concentration of airborne pathogens, potentially lowering the risk of infection.
In a Q&A about ventilation and air conditioning, the WHO explains that ventilation is the process of bringing fresh, outdoor air inside and letting indoor air outside in order to maintain or improve air quality. The risk of getting infections like Covid-19 is increased in crowded and poorly ventilated settings. This is because the virus passes between people through infected respiratory particles in the form of droplets and aerosols. In poorly ventilated spaces, infected aerosols can remain suspended in the air or travel farther than conversational distance. Improving indoor ventilation reduces the risk of the virus spreading indoors.
The WHO published a roadmap to improve and ensure good indoor ventilation in the context of Covid-19. The WHO also continues to recommendmask-wearing in poorly ventilated health and social care settings, irrespective of the local epidemiological situation.
With regard to Covid-19 testing, the Welsh Government and Public Health Wales has updated their guidance on routine testing for Covid-19 to align with other respiratory infectious diseases.
The Public Health Respiratory Framework 2023 to 2024 outlines plans for managing respiratory viruses. It sets out that testing for Covid-19 in a range of settings is provided but that the routine provision of free Covid-19 lateral flow device tests for the management of outbreaks has come to an end.
Infection Prevention and Control (IPC) measures remain a key component of practice in health and social care settings to reduce transmission of respiratory viruses and norovirus. The Welsh Government says it is committed to zero tolerance of preventable healthcare associated infections (HCAIs).
Healthcare settings in Wales are implementing several measures to reduce the spread of airborne infections including:
The responsibility for ensuring compliance with IPC regulations in health settings in Wales is shared among several entities including health boards, Public Health Wales and non-NHS providers of healthcare. Healthcare Inspectorate Wales (HIW) is responsible for ensuring that healthcare providers in Wales meet the minimum necessary IPC arrangements.
§ HIW Annual Report 2021-2022: The report considered how IPC measures were managed during the pandemic.
§ Investigation of Hospital-Acquired Covid Infections: The Nosocomial Transmission Group was set up in May 2020 to help prevent infections through learning and publishing a national framework in relation to patient safety incidents of hospital-acquired Covid-19.
There have been criticisms about the Welsh Government’s handling of airborne infections in healthcare settings.
The petitioner, on behalf of the Covid-19 Bereaved Families for Justice Cymru group, wrote a letter to Eluned Morgan MS, the then Minister for Health and Social Services in December 2023 calling for “swift and proactive measures to enhance airborne infection control” in healthcare settings in Wales.
The petitioner also wrote an article in January 2024, criticising the Welsh Government’s handling of airborne infections in healthcare settings, pointing out that wards have been closed and visits suspended in hospitals across Wales due to increases in airborne infections. The article also criticised Public Health Wales for its public health messaging.
In February 2023, Eluned Morgan MS issued a written statement to update Senedd Members on the Welsh Health Protection System Review. The review was commissioned in 2022 to provide recommendations on how the health protection system in Wales can be strengthened.
The report was published in February 2023, however, it did not address health protection arrangements and responses within or related to primary care, nor the infection prevention and control arrangements in health settings
The Welsh Government is also facing criticism for its decision not to appoint an independent Patient Safety Commissioner, a role established in England last year and currently being legislated for in Scotland.
The Welsh Government says it has recently introduced its own legislation and other measures to improve patient safely.
The Welsh Government provided a response to the Petitions Committee on 8 July stating that:
§ The Welsh Government, with the support of NHS Wales Shared Services Partnership – Specialist Estates Services (NWSSP-SES) and Public Health Wales (PHW), is working to improve air quality across health and social care settings through effective ventilation and filtration.
§ A new Welsh Health Technical Memorandum (WHTM) 03-01 has been issued, providing detailed ventilation recommendations for all healthcare buildings (see Parts A and Part B).
§ Every health board and NHS trust in Wales has appointed Authorised Persons (APs) for ventilation, ensuring installations, maintenance, and monitoring are completed to a compliant standard.
§ Ventilation Safety Groups (VSG) are in place at all health boards and NHS trusts in Wales, responsible for ensuring all ventilation systems are designed, installed, tested, and maintained in accordance with the guidance.
§ NWSSP-SES provides the services of an Authorising Engineer-Ventilation (AE-V), appointed as an independent advisor by health boards and NHS trusts.
§ Work is ongoing with NHS Improvement England (NHSI/E) and the rest of the UK NHS, including representatives from the Scientific Advisory Group for Emergencies (SAGE), to validate the effectiveness of sterilisation, including air High Efficiency Particulate Air (HEPA) filter purification, in healthcare settings.
§ The social care sector in Wales has been provided with advisory publications through PHW and the Welsh Government, focusing on infection transmission and the importance of effective ventilation systems.
§ Under Section 44 (4) (a) of The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, providers of regulated services must ensure premises are “accessible, adequately lit, heated and ventilated”.
§ PHW’s Infection Prevention and Control Measures for Acute Respiratory Infections (ARI) including COVID-19 for Health and Care Settings provides detailed advice about the appropriate use of face masks in clinical settings.
§ In line with the Long-term strategy for living safely with Covid-19, access to free testing focuses on supporting clinical management of people who are eligible for anti-viral treatments.
§ The prevention of airborne infections is covered by PHW’s Infection Prevention and Control Measures for Acute Respiratory Infections (ARI) including COVID-19 for Health and Care Settings
§ The Welsh Government works closely with PHW about public health information about all communicable diseases, including airborne infections.
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