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Waitākere Hospital staff caring for patients with Covid-19 from St Margaret Hospital faced several problems with personal protective equipment (PPE), an urgent review found.
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The review, released at 2 p.m., was ordered by the Waitematā District Health Board after three nurses who cared for the patients tested positive for the coronavirus.
Four other nurses, who were close contacts of the original cases, tested positive for Covid-19 after the review was requested and the report was not requested.
She found that the supplied gowns and goggles did not fit properly on staff, and some nurses wore ties to keep their goggles in place.
Staff had to learn how to use various brands of PPE as supplies changed, which was stressful for staff, according to the report.
Nurses had to leave patient rooms and remove protective equipment up to eight times per shift, he said, increasing the chances of transmission, so they could gather equipment, medications and communicate with other staff.
Covid-19 transferred patients from St Margaret’s
According to the 19-page report, the Waitematā District Health Board conducted preparations for the Covid-19 pandemic in March at North Shore and Waitākere Hospitals. These included identifying areas of hospitals with Covid-19 patients that could be placed, ensuring equipment and resources were in place, and staff were prepared.
Two suitable rooms were identified and renovated at Waitākere Hospital and the PPE was stored and made available, according to the report.
Three coronavirus-infected patients were admitted to hospital wards in late March and early April and were treated without incident, he said.
The report shows that in early April DHB was alerted to an outbreak of cases at St Margaret Hospital and returned to live in West Auckland and asked the hospital to help manage the situation.
PPE staff and supply quickly became problems, he said.
“Senior managers and nursing staff from [Waitākere Hosptial] They were asked to volunteer to support the facility as it is an independent organization from DHB. Finished
Over the next 10 days it became difficult to staff the facilities in ever-increasing numbers. There was a shortage of office nursing staff, the DHB had to rely on its staff to volunteer, and there was a reluctance to work at the facility. “
By April 16, according to the report, “it became clear that it would be very difficult to have safe staff [aged residential care] installation over the weekend. “
The following day, the senior DHB agreed to move up to 20 residents off-site, he said. They decided to transfer residents to Waitākere Hospital to be closer to the family and because of the design of the room, he said.
Six positive cases were transferred to Waitākere Hospital that day and another group of residents was transferred the following day, according to the report.
Staff in the room where the six positive cases were transferred had only three hours to prepare for their arrival, the report revealed.
Upon arrival, the patients required full nursing care, “there were skin integrity problems and signs of dehydration. One of the patients required oxygen through the nasal tips. Over the next 48 hours, the patients deteriorated and returned Lethargic, confined to their beds, they were incontinent, everyone coughed and could not follow the instructions.
“All the patients were completely dependent on the staff for their personal care.”
Personal protection equipment
The report found numerous problems with the supply of personal protective equipment at Auckland hospital.
All staff who entered patient rooms wore gloves, fluid-repellent gowns, eye protection and an N95 mask, according to the report. They would put on the PPE outside the patient room before entering and remove the gloves and gown in the bathroom inside the patient rooms before removing the mask and glasses outside the room, he said.
However, the gowns and goggles provided did not fit properly on staff, and some nurses wore ties to keep their goggles in place.
“The nursing staff was also concerned about exposing their hair and shoes, since these areas did not need to be covered,” the review said.
He said staff had to learn how to use various brands of PPE because supply kept changing, which was stressful for staff.
Nurses also had to leave patient rooms and remove PPE up to eight times per shift in order to gather equipment, medications, and communicate with other staff, because they were unable to communicate from inside the room.
The report found that problems with PPE at Waikātere Hospital increased the risk of viral transmission.
“In a stressful environment, consistency of quality and supply of essential equipment is very important.”
He urged DHB to minimize the number of times personnel put on and take off PPE, but balances this with the need to ensure that staff are not exposed to infected patients for prolonged periods of time.
DHB has been recommended to introduce a two-way communication system so that staff in a Covid-19 patient’s room can ask staff outside the room to do tasks for them.
Other recommendations included ensuring that a consistent style of PPE was available in a variety of sizes, prioritized for high-risk areas, as well as training for all relevant personnel.
Rostering
Three nurses and a health care assistant were caring for the six patients at once, according to the report.
The staffing challenges meant that creating a list of ‘nursing bubbles’ for staff working only with Covid-19 patients was not possible, he said.
“The staff challenges were exacerbated by the exclusion of some staff members, as they are vulnerable workers and cannot work in the room.”
DHB said it was acceptable for staff to work between rooms as long as they didn’t move between them in one day.
According to the report, this was reviewed by senior staff after staff expressed concerns, but deemed it safe.
The staff agreed, he said, that the levels of nursing staff were “reasonable.”
DHB responds
The Waitematā District Health Board apologized to the staff who contracted the virus.
Executive Vice President Andrew Brant said the review noted that the staff was well trained and that hospital preparations were “well underway.”
However, DHB needed to improve its communication with clinical staff, Dr. Brant said, especially in response to an emergency situation.
It also needed to find a way to ensure the consistency of the national PPE supply, “reducing the need to change products in the midst of responding to a pandemic, which caused significant concerns for staff.”
Dr. Brant also called for a national plan for DHBs to support senior care facilities when the health system is already responding to a crisis.
