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Calls for action to protect healthcare workers from COVID-19 risk

Victoria’s efforts to protect its health care workers from COVID-19 infections have been labelled too little, too late, writes Nicole MacKee.


Nicole MacKee writes:

Revelations that up to 80 percent of the more than 2,500 Victorian healthcare workers who have contracted COVID-19 have done so at work have sparked urgent calls for revised guidelines on personal protective equipment for (PPE). 

The news came after the Victorian Health Minister Jenny Mikakos last month estimated that up to 15 percent of active infections in health care workers had been acquired at work, and the rest had been acquired in the community. 

Speaking to ABC News Breakfast, AMA President Dr Omar Khorshid said he wasn’t surprised to find that the majority of COVID-19 infections in healthcare workers were in fact contracted in the workplace. 

“The sheer numbers of healthcare workers getting infected being three, four, five, six times as likely as any other Victorian suggested to us that it had to be being contracted in the workplace,” he said.

“And the head-in-the-sand approach by the Victorian Government wasn’t helpful and didn’t add any urgency to the need to actually change what was going on in the various aged care centres and hospitals to stop health care workers getting infected.”

On Tuesday, the Victorian Government released its review of COVID-19 cases in healthcare workers in the state. 

The review found that (as of 23 August, 2020):

  • 2,692 cases of coronavirus (COVID-19) had been diagnosed in healthcare workers. Of these, 2,450 (or 91 percent) of cases were diagnosed in July and August
  • In August, the average number of daily new infections is 33.7
  • In wave one, 22 percent of healthcare workers who acquired COVID-19 did so it at work
  • In wave two (reflecting the increased case load), at least 69 percent of all healthcare worker cases were workplace acquired (although a number remain under investigation).

Based on analysis of second-wave data (of which 79 percent of the 2,255 COVID-19 cases diagnosed in healthcare workers from 1 July 2020 had been investigated to date):

  • Of the 924 aged and disability carer cases, 84 percent have been investigated. Of these, 90 percent of the cases were acquired by carers at work
  • Of the 106 medical practitioner cases, 76 per cent have been investigated. Of these, 77 percent of the cases were acquired by practitioners at work
  • Of the 922 nurse cases across all settings, including aged and disability care and in hospitals, 79 percent have been investigated. Of these, 89 percent of the cases were acquired by nurses at work.
  • Of the 303 cases occurring among other types of healthcare workers, 65 percent have been investigated. Of these, 69 percent were acquired by healthcare workers at work.

The report found that, in total, 69 percent of all infections were likely to have been acquired at work.

“If we exclude cases where investigations are still ongoing, this number rises to 86 percent. In only six percent of completed investigations were infections acquired outside the workplace,” the analysis states.

In response to these findings, the Victorian Government has announced a package of initiatives to “drive down” infections in health care workers. The program includes the introduction of “PPE spotters”, potential aerosol hotspots will be studied, and fit-testing will be trialled for staff at highest risk. 

The newly nestablished Healthcare Worker Infection Prevention and Wellbeing Taskforce has also recommended broadening the setting for the use of N95 masks to include emergency departments, intensive care units, COVID-19 wards, and aged care facilities.

An MJA paper released this month stated that “fit-testing is recommended to ensure proper fit of respirators for individual health care worker and is required to comply with respirator standards”.

The AMA’s Dr Omar Khorshid said it was “way too late” to be doing a trial of whether fit-testing was needed for masks.

“We know that if you’re going to use respirator masks, then they need to fit your face otherwise they just don’t work – that’s pretty basic stuff,” he said. “That was known well before this pandemic.”

Khorshid said national leadership was needed, as well as an acceptance that “something has gone wrong here”.

He said:

If we have another outbreak like this in another state, we’re likely to see exactly the same problem.

That means we need guidelines that are actually appropriate, we need appropriate PPE available to every single staff member in every single facility.

We need adequate training, we do need fit-testing for absolutely every health care worker who needs to wear a respirator mask and acknowledgement that this is actually a workplace safety issue.

It’s a basic right of any worker and health care workers should be treated the same as all our other workers in other workplaces.”