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Fit-testing is mandatory for workers dealing with asbestos and silica, but not always for hospitals dealing with COVID-19, leaving doctors and nurses vulnerable to the deadly virus.
“Why you need a trial to work out if people should be fit tested is beyond comprehension,” Australian Medical Association national president Omar Khorshid said.
Why you need a trial to work out if people should be fit tested is beyond comprehension. We know this works.
AMA national president Omar Khorshid
He has demanded revised guidelines on protective gear, arguing the current infection control measures were clearly not working in Victoria.
“We know this works and it should be immediately rolled out to all front-line healthcare workers across the country,” he said. “Will it take the deaths of healthcare workers to convince them?”
More than 100 healthcare workers have been hospitalised during the pandemic, 12 of whom were admitted to intensive care. A disability nurse died after contracting the virus.
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Victoria recorded 148 new coronavirus cases and another eight deaths on Tuesday.
The fatalities include two men in their 70s, four women and one man in their 80s and one woman in her 90s. Of the deaths, seven were linked to aged care outbreaks.
The AMA’s Victorian president Julian Rait said fit-testing should be mandatory for any workers wearing N95 face masks, noting it was already routine practice in some hospitals in South Australia and NSW. The higher-grade masks are recommended for any workers caring for coronavirus patients.
“Experts advising the AMA believe that fit testing is justified for all healthcare workers required to wear N95 masks,” he said, adding that the AMA had requested the government’s raw data to do their own analysis and examine infection control and safety protocols in health institutions where there had been outbreaks.
Victorian Chief Medical Officer Andrew Wilson said there had been 2692 cases of COVID-19 among Victorian healthcare workers as of August 23, most occurring in July and August.
He said about 70 to 80 per cent of the healthcare workers who had caught the virus contracted it at work. In the first wave, only 22 per cent of infected healthcare workers were believed to have caught coronavirus on the job.
The analysis found aged care workers in Victoria accounted for more than 60 per cent of all COVID-19 infections during the state’s second peak in cases.
Poor infection practice was deemed the main driver of infection within aged care homes.
“We increased our recommendation for N95 respirators so that staff could use those in those environments, and that was above the level of recommendation that the national guidance gives us,” Professor Wilson said.
In hospitals, 70 per cent of infections were among nurses, while about 11 per cent were doctors, the data showed.
Leading causes of infection in hospitals included substandard personal protective equipment – including misuse of face masks – and transmission through shared spaces, such as contact in break rooms, the analysis found.
Dr Khorshid said the analysis showed health authorities had failed to adequately protect Victorian healthcare workers, which should be a “warning and wake-up call for the rest of Australia”.
Australian Medical Association president Omar Khorshid says current infection control measures are not working in Victoria.Credit:Tony McDonough
Dr Khorshid said he had asked the federal government to revise current guidelines that do not require higher-grade P2 or N95 respirator masks for use with all COVID-19 patients.
“We need to ensure this diaster is not replicated,” he said.
Melbourne doctor Benjamin Veness is one of a group of front-line healthcare workers who have called on federal Health Minister Greg Hunt to reform the national advisory panel on infectious disease, arguing its advice on masks in hospitals is outdated.
“To tell us now they are only going to do a trial for some staff in a single site when you’ve got nearly 3000 workers infected with COVID-19 is not only insulting, but it also completely underlines this lack of emphasis on occupational health and safety,” Dr Veness said. “This is an absolutely appalling denial of responsibility.”
Yet a healthcare worker who was infected with the virus at a Melbourne hospital said she caught the virus despite adhering to strict infection control protocols.
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The worker, who spoke on condition of anonymity for fear of losing her job, said she always wore an N95 mask while treating patients suspected to have COVID-19.
She said she had “no idea” whether she had contracted the virus from a patient or a co-worker, as “there’s positive people everywhere”.
She said hospitals were notorious for the cramped quarters in which healthcare workers had their breaks and got changed before and after shifts, due to funding being prioritised for “patient-centred” initiatives.
“They buy a new MRI machine, they build more inpatient beds … They don’t redo the change rooms. They don’t build more bathrooms for the staff,” she said. “PPE is important but so is having enough space to have your break and not remove people.”
Health Workers Union Victorian president Diana Asmar said the vast majority of infections in the aged care sector were among workers at facilities run by private providers.
“Why weren’t Victorian aged care workers given adequate PPE when they were screaming for it back in April. Why weren’t providers training their staff on how to use PPE correctly,” she said. “It’s all about cutting costs and maximising profits.”
Last week the Australian and New Zealand College of Anaesthetists wrote to Mr Hunt as well as Victorian and NSW health ministers to raise serious concerns that fit testing was not being conducted at all hospitals.
Victorian Health Minister Jenny Mikakos said the virus had often spread among colleagues when they had taken off their masks while on a meal break, or were having a cup of coffee together in a tea room.
She said the government’s healthcare worker infection prevention and wellbeing taskforce would examine the adequacy of lunch and break rooms at aged care facilities and hospitals.
Ms Mikakos said the efficiency of fit-testing was still being debated and the findings of the Northern Health trial would help guide any changes to clinical pratice.
Ms Mikakos also vowed the government would ensure there were regular, asymptomatic testing of healthcare workers in COVID wards, as well as fit testing of N95 masks.
The government has also announced a range of measures to reduce healthcare worker infections, with staff to have greater access to N95 masks in emergency departments, intensive care units, aged care facilities and COVID-19 wards. Designated spotters will also help monitor the proper use of protective gear in all health services.
Melissa Cunningham is The Age’s health reporter.
Dana is health and industrial relations reporter for The Sydney Morning Herald and The Age.
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