Nurses would not be infected with Covid-19 at such devastating rates if more privately operated aged care homes had surge workforce plans in place, and were audited regularly to ensure those plans were adequate, the nurses’ union says.
As of Wednesday, 2,799 healthcare workers had been infected with the virus during Victoria’s second wave, of which 2,557 (91%) were diagnosed since July. Of the total cases, at least 69% were, or were likely to have been, workplace acquired, with a number of cases still under investigation. The highest number of health worker cases are in aged care and disability workers followed by nurses.
Of the 922 nurse infections identified as of Tuesday, 89% were acquired at work. However, the source of 21% of nurse cases is still under investigation.
“In total, 69% of all infections have been determined as likely to have been acquired at work,” a report from the Department of Health and Human Services said. “If we exclude cases where investigations are still ongoing, this number rises to 86%. In only 6% of completed investigations were infections acquired outside the workplace.”
The data contradicts repeated claims made by the government until recently that most infections in health workers were being acquired in the community – and has prompted a widespread review of workplaces.
The Australian Nursing and Midwifery Federation Victorian branch secretary, Lisa Fitzpatrick, said when Covid-19 began infecting aged care staff, it was public and private-sector nurses who had to fill the gap, and many then acquired infections in the nursing homes.
“We are most confident that the number of cases in nurses wouldn’t be so high if they had not gone into appalling situations in private aged care to try and help and care for residents at short notice,” Fitzpatrick said.
“When Covid did hit some of these facilities, the administration rarely hung around to help the nurses who came in and who are propping up these private care facilities. These homes didn’t have a surge workforce and still don’t, and they are still relying on intervention from the public and private-sector nurses here in Victoria to run facilities and provide face-to-face training to ensure infection control . It also means there is now less of a surge workforce available for the public sector.”
Fitzpatrick said aged care deaths and health worker infections would be “nowhere near what they are” if the commonwealth had said to providers not only “this is what you must do” but then checked and audited the work was done.
Aged care homes took advantage of previous state government messaging that most health worker infections were community-acquired, the union leader said.
“We had aged care employers we took to task after they put notices out saying nurses must come to work, because if they wear personal protective equipment (PPE) they won’t contract the virus because nurses are only getting the virus in the community,” Fitzpatrick said. “We were horrified that a private aged care provider would make those assertions in writing. It was a real misnomer managers with ulterior motives tried to jump on.”
But ongoing investigations into why thousands of Victoria healthcare workers have been infected needed to go beyond PPE and also scrutinise the way nurses, doctors, and other staff interact with each other in tearooms and on wards, Fitzpatrick said. Hospital boards and the policies implemented at individual hospitals should also be interrogated, she said.
“Hospitals in Victoria, unlike in other states, are legal entities in their own right. We should have a more centralised system in relation to public hospitals and who owns and runs them. They all have individual boards and so there is a lot of difference in terms of procedures and practices.”
The medical director of infection prevention and epidemiology at Monash Health, Associate Prof Rhonda Stuart, said reviews of workplace infections “can’t just be about an N95 mask”. Whether PPE was being removed appropriately, whether social distancing was being observed in tearooms, and differences in infection rates on different wards also needed to be examined, she said.
But Stuart disagreed with Fitzpatrick that some hospitals were taking a stronger approach to infection control than others.
“While I can only really speak on behalf of Monash, I do interact with colleagues from other health districts and none of them wants health workers to become sick,” Stuart said. “I think everyone is taking it seriously. We are all doing our best in a very difficult environment and I think it’s unfair to say some are doing better than others.”
Some hospitals were dealing with higher case numbers and sicker patients with higher viral loads, she added.
The chair of the Australian Healthcare Reform Alliance, Jennifer Doggett, said the impact of a casual workforce on health worker infections should be central to the health department’s investigations of worker cases.
“With casual workers cycling in and out of facilities the risk of infection goes up so much,” she said. “Because of cost pressures and the way the workforce is structured there are massive incentives not to pay overtime to on-staff nurses and to call in casuals instead. You’re then relying on work agencies to do screening and training. It’s incredibly risky.”
The Victorian government also announced on Tuesday that it would roll out a trial of fit-testing of N95 masks as part of measures to combat health worker infections. N95 masks only effective when they are sealed to the wearer’s face. The Australian Medical Association president, Dr Omar Khorshid, said it was not enough to just trial fit-testing, it should be mandatory.
“This trial is unnecessary – fit testing is a requirement for all people who wear N95s, whether they work in hospitals, aged care homes, or disability services,” he said. “The Victorian government is still not taking this issue seriously, despite more than 2,500 infections. Will it take the deaths of healthcare workers to convince them?”
Source: The Guardian