Title: Evaluation of the implementation of pandemic preparedness plans during COVID-19 at the interface with infection prevention and control services in acute and community care.
Funder: Department of Health and Social Care

Abstract: Background: During the UK COVID-19 epidemic Infection Prevention & Control (IPC) services faced unique challenges in preventing transmission of infection in health and social care settings. It is unclear how healthcare pandemic preparedness plans informed the response to COVID-19 and the extent to which they were effective. Evaluation of the pandemic response is essential in order to learn critical lessons for IPC services and build more effective and resilient IPC plans for future pandemics Research question: How did IPC services in local healthcare systems in England function in relation to pandemic preparedness, and innovate to provide an expert service for preventing transmission of COVID-19 to patients, healthcare workers and the public during the pandemic? Aims: to understand and learn critical lessons from challenges faced by IPC services managing the COVID-19 pandemic across local healthcare systems in England and inform the effective and resilient pandemic preparedness plans for recovery and the future. Objectives: Conduct a secondary analysis of key documents to inform the development of a pandemic policy timeline and identify how IPC services featured in the decision-making processes. Identify how local pandemic plans impacted on the operationalisation of IPC services response to COVID-19. Identify how national guidance and policy decisions impacted on IPC services workload, advice, activity and success in preventing the transmission of COVID-9. Explore how local pandemic plan worked/ did not work in the context of IPC services and how IPC services innovated technically and system wide in response to national and local circumstances. Map how IPC service decisions were made, managed, operationalised and communicated nationally and within local healthcare system. Assess the impact of IPC services decisions on the experience of patients and relatives. Methods: A two-phase, explanatory mixed methods design will be used to evaluate the local context of IPC services in implementing pandemic preparedness plans and the impact of national guidance and policy decisions. Phase 1 will comprise an analysis of UK policy documentation and review of pandemic planning literature, together with a survey of IPC leaders to investigate how local pandemic plans informed the IPC service response to COVID-19. Phase 2 will use 6-8 case studies of local healthcare systems to determine how the IPC service adapted and managed the complexity of the COVID-19 pandemic and why IPC services need to be re-designed to meet the IPC challenges of novel pandemic infections. Findings will be triangulated to produce a pandemic preparedness framework for IPC services and set of indicators to assess local healthcare system preparedness and response to novel pandemic threats. Timeline: 18 months Anticipated impact: Enhanced clarity about the role, requirements and activities of IPC services in pandemic preparedness to underpin NHS England policies and guidance and DHSC oversight of emergency preparedness. Improved understanding how to operationalise the IPC service in pandemic planning for future outbreaks, improving patient safety and patient experience. Dissemination: policy makers, practitioners, patients and the wider NHS system through a stakeholder event, publication and other formats such as blogs, infographics and social media.

Lay abstract: Background Design and methods Infection prevention and control (IPC) services within hospitals and community health settings are an essential part of how the NHS responds to and deals with infections caused by viruses and bacteria. The role of IPC services is to prevent the harms caused by infection to patients and healthcare workers. SARS-Cov-2 is a new virus for which people have no protection (immunity) and there is no vaccine available to prevent infection. This created unique challenges for how IPC services prevent its spread in health and social care settings. All healthcare settings are required to have pandemic preparedness plans which draw on learning from previous outbreaks of infections, such as pandemic influenza. These plans are designed to ensure that control measures are in place and essential services maintained. This study aims to understand and learn lessons from the challenges faced by IPC services in respect of their role in managing the COVID-19 pandemic. This learning will inform effective and robust pandemic preparedness for the future. The project will be undertaken in two phases. Phase one involves a) reviewing key documents published by government bodies and advisory groups, and local health system pandemic plans; b) a national survey of IPC service leaders who we will recruit through their professional societies. Phase 2 will be informed by what we find in Phase 1 and will include an in-depth look at 6-8 local healthcare systems (case studies). We will undertake interviews with key informants such as healthcare chief executives, directors of infection control, GPs and service users/patients. The results of the study will provide health and social care decision makers at national and local levels with a greater clarity of the role of IPC services in pandemic preparedness. A pandemic preparedness framework for IPC and set of indicators will be developed to improve future plans. Patient and Public Involvement The research team includes senior clinicians working in healthcare and academic researchers with a collective expertise in understanding how infections are spread and controlled and how to develop practical solutions to preparing for any future pandemics and a lay researcher to contribute to the patient and carer voice in Phase 2. We are involving patients and the public (PPI) in the study to ensure the study captures information important to patients and any potential negative impacts of PPP on patients and their relatives/carers is minimised. A project advisory group including policy stakeholders, PPI representatives, collaborating professional societies will meet virtually to inform, advise and receive reports on progress. Dissemination: policy makers, practitioners, patients and the wider NHS system through a stakeholder event, publication and other formats such as blogs, infographics and social media.

Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INFECTION