Senior doctors have spoken of feeling demoralised in their attempts to secure higher levels of personal protective equipment from hospital administrators, and say the approach to protection in some workplaces amounts to negligence.
In Victoria, there are 1,064 health workers with active infections of Covid-19.
On Monday the premier, Daniel Andrews, said of the PPE being provided to hospitals: “I’m certainly not aware of anything other than the timely delivery of what’s needed. The distribution network is, I think, working well.”
But Dr Mark Rudelic, an anaesthetist who works across Melbourne hospitals, said that in one hospital he and other staff read the latest international guidelines on PPE and recommended hospital administrators increase use beyond the Australian guidelines.
“We were told, ‘Just leave it to us. We have very clever people working on this,’ ” Rudelic said. “But when we tried to pin them down and get them to share their thoughts on better PPE recommendations, they didn’t have any.”
As more information about the virus and its spread had emerged, many health workers had begun pushing to use the more protective N95 masks more often, but even with Victoria in the middle of a second wave protocols around N95 use were “all over the place” between hospitals.
“Certainly now in a lot of the big hospitals you have to wear a face shield and N95 in any patient interaction, so it’s started to ramp up, but that’s not the case in every hospital,” Rudelic said.
“The premier keeps saying that we have loads of masks and gloves being distributed. Well if that’s the case, why are there still health workers getting infected? On Friday around 30% of the new cases announced that day were in healthcare workers. So what is going on?”
A senior ear, nose and throat surgeon who could not be identified over fear of repercussions said it was not about just having access to masks, but the right kind of masks. The most basic level of protection for doctors and nurses are surgical masks, all the way through to the top level of protection, a positive pressure personnel suit.
“And the middle ground between the two is what we call N95 or P2 masks, and this is for aerosol protection,” he said.
“Back when there was low community transmission, the advice was a surgical mask was sufficient for most health workers. But the guidelines haven’t changed to account for the unique situation in Victoria where we have higher levels of community transmission.
“I am swabbing people’s throats all day in Melbourne, and yet I have the same PPE guidelines as for surgeons working in Broome or Hobart. America and the UK say we need N95 masks for all health workers who have patient contact, especially those examining noses and throats, which is what I do every day.
“I feel like the Australian advice, especially the advice for Victoria, is behind the evidence.”
In some hospitals when he asked for an N95 mask for surgery he got it straight away, while in others, administrators and managers said no because then they would then have to provide a mask for everyone in his surgical team, including anaesthetists and nurses.
“They are worried it will set a precedent and everyone will want one,” he said. “Operating theatre supply is usually allocated by the nurse in charge or medical officer in charge on the day, and whether you get the mask you want depends on that.”
Prof Danuta Mendelson is the lead author of a paper to be published next week in the Journal of Law and Medicine, which found: “Although several international bodies have issued recommendations for a very high-level PPE to be used when [surgical] procedures are undertaken, the current PPE guidelines in Australia have tended to be more relaxed, and hospital authorities relying on them might not comply with legal obligations to their employee healthcare workers.”
Mendelson, the chair of law at Deakin University, told Guardian Australia she expects civil suits to be filed by health workers who contracted Covid after asking managers for higher levels of PPE.
We are not learning the same lessons history taught us before
Dr Michael Keane
“Workplace law is very clear,” she said. “In previous workplace actions, courts say very clearly that if you can’t provide a safe environment as an employer then you shouldn’t be operating. We know for some people who get the virus their are long-term impacts on their health which may affect their ability to work.
“There is enough in the literature to show masks are essential and paper surgical masks are often not enough, and the fact the hospitals didn’t stock more protective N95 masks or wouldn’t give them to staff will not protect employers from facing consequences. It would like an employer telling cleaners who wash windows in high-rise towers: ‘Well I’m out of safety harnesses.’ It won’t work. It won’t wash with the courts.”
The paper found some Australian hospitals provide PPE for teams performing intubation that leaves the neck fully exposed, which while still in compliance with Australian clinical guidelines, did not match international best practice.
“Some of the face shields provide no protection when teams perform intubation using the technique recommended for Covid-19 patients,” the paper found. “In such circumstances, virus-infected droplets from a coughing patient would go in a straight line from the patient’s mouth to under the lower edge of face shields that end at the chin level.
“In other words, infected airborne droplets would directly reach the team member’s face. In contrast … in several overseas countries, and in some Australian hospitals, anaesthetists are provided with full protective coverage of the body.”
A co-author of the paper, Dr Michael Keane, an anaesthetist working across several public and private Melbourne hospitals, said he feared “we are not learning the same lessons history taught us before”.
He referred to the Canadian commission into the 2003 Sars epidemic which found: “It would have been one thing if all had been infected at the start of the outbreak when little was known about the disease. The full extent of worker safety failings during Sars is revealed by the fact that workers continued to get sick.
“Sars demonstrated over and over the importance of the principle that we cannot wait for scientific certainty before we take reasonable steps to reduce risk.”
Keane said health authorities should heed this advice when responding to Covid-19.
“It’s almost like you could almost exactly cut and paste that quote from the Canadian commission to use in a future royal commission in Australia into Covid-19 and health workers,” he said.
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