Victoria has strengthened PPE requirements for aged care – should other states follow suit?

Matt Woodley

6/08/2020 4:22:32 PM

GPs in aged care must now wear surgical masks and goggles at all times, while N95 masks are required for treating suspected COVID-19 cases.

Healthcare workers at Epping Gardens Aged Care.
Healthcare workers in full PPE attending Epping Gardens Aged Care, which has been linked to 155 COVID-19 cases. (Image: AAP)

Of the 162 COVID deaths in Victoria as of 6 August, 130 have been linked to the more than 100 RACFs where outbreaks have occurred.
The Victorian Department of Health and Human Services (DHHS) has responded to these outbreaks and increased community transmission by strengthening personal protective equipment (PPE) guidelines for healthcare workers at residential aged care facilities.
While these guidelines differ from those recommended by federal authorities, they are now closer to PPE guidelines used in other developed nations, such as those recommended by the Europe Centre for Disease Prevention and Control.
Professor Dimity Pond, a NSW-based GP with a special interest in aged care, told newsGP she would support similar guidelines being adopted in her state, even though she is yet to encounter a COVID-19 case at a residential aged care facility (RACF).
‘I’ve got some N95 masks in my doctor’s bag, and I would definitely wear one if there was a confirmed or suspected case of COVID in the facility,’ she said.
‘If there’s any reason to suspect it, that’s what we should be doing … [and] where there’s a lot of community transmission, I think it would be well worth considering making [N95 mask use] mandatory – but GPs need to be provided with it.’
The number of deaths linked to Victorian RACFs is likely to rise, with 1435 active cases in the state connected to the aged care sector, and recent evidence published in The Lancet suggesting an infection fatality rate of 5.6% in people aged 65 and over.
The issue is not restricted to Victoria, however, with almost 90% of the country’s deaths occurring in people aged 70 and over, while Sydney’s Newmarch House was the site of one of Australia’s worst outbreaks.
Dr Sachin Patel, the founder of a general practice service that sends GPs to 70 RACFs across Melbourne, told newsGP the rest of Australia should follow Victoria’s lead with regard to PPE in aged care.
‘No one is going to suffer because we are being extra cautious with PPE,’ he said.
But Dr Patel added that such a policy would put additional pressure on general practices and GPs who are already having issues sourcing appropriate PPE.
‘PPE costs are putting strain on general practices,’ he said.
‘We have invested $50,000 in PPE to keep the team safe so far, but our resources are limited and we can’t continue that level of investment indefinitely.
‘This PPE needs to be funded. We need to protect GPs and patients.’
According to Dr Lucas De Toca, Acting First Assistant Secretary of the Department of Health’s COVID-19 Primary Care Response, 500,000 face shields have been dispatched to each of the 770 RACFs in Victoria. But he made no mention of gowns or gloves, and also encouraged GPs to source their own PPE rather than rely on supplies distributed by Primary Health Networks.
‘The national medical stockpile is a precious asset of our response, and so any part of the health system, any practitioner, any worker, [is] encouraged to try to source PPE through commercial supplies, which [have] significantly improved in the last couple of months,’ he said.
‘We understand that the Victorian situation and the New South Wales recommendation is putting a strain [on] those supply lines, and that is why the fallback of sourcing of masks through the PHNs is there for general practitioners to access.’
While hospital-based healthcare workers are given PPE, sourcing similar equipment has been a constant and ongoing source of frustration and fear for many GPs, and Dr Patel said more support is required.
‘There have been more than 5000 healthcare workers who have died around the world. We don’t want members of our profession becoming another statistic,’ he said.
‘GPs are stepping up to support the effort, the Government need to support us to do the work safely.’ 

Aged-care-PPE-article-2.jpgThe Victorian Government has transferred residents out of some affected facilities and into hospitals. (Image: AAP)

Accessing adequate PPE for RACF staff and healthcare workers does not appear to be the only issue putting residents at risk.
According to The Australian, many RACFs have not adequately prepared for a second wave of outbreaks, with more than 100 facilities failing federal compliance standards designed to ensure preparedness for a COVID-19 outbreak between 1 March and 31 May.
The Federal Government has reportedly provided a Senate Inquiry with a list of 29 homes served with non-compliant notices – which includes Newmarch House – but the identity of most RACFs remains a secret. 
Dr Ken McCroary, a GP and lecturer who regularly sees patients in RACFs, told newsGP any new PPE recommendations ‘are not going to achieve any protection’ if staff are not taught how to wear, manage, remove and replace them properly.
‘I went to an RACF this morning and you’re supposed to put a mask on if you enter – but where are the masks? They’re lying on the nurse’s station desk. That’s a high touch place,’ he said.
‘They’ve been opened out of their packet and there’s a pile of them sitting on the desk. So you’re supposed to just pull one out of that pile which, for all I know, means I’m putting on a contaminated mask.
‘My first three encounters with RACF staff wearing masks today, within 20 seconds of the entering the room, they’d touched their face masks half a dozen times … they don’t even realise they’re doing it.’
According to Deputy Chief Medical Officer Professor Michael Kidd, the Department of Health’s free online training in infection control has reached more than one million people, including 150,000 RACF staff across the country.
However, Dr McCroary says aged care staff need more support, and training has to be better tailored and refreshed more often than it currently is.
‘We need to get the equipment in there and then we need to guarantee the equipment is used correctly. That education relates to everything – infection control, masks, gowns, hygiene. It all needs to be taught, reviewed and followed up with some sort of facility-based assessment,’ he said.
‘Sending out a pamphlet or video with instructions from the health department, which is not geared towards the right literacy levels, won’t achieve anything.
‘If we’re not supporting them with the training to use PPE correctly, it’s just going to be a hollow recommendation that’s not going make any difference.
‘It will only take one visitor or staff member to bring the virus to one facility and it will spread, because they’re still not ready.’
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Dr Ian Mark Light   7/08/2020 8:34:31 AM

The PPE of the health workers transferring aged patients out of Covid 19 affected homes includes Head Visors N95 masks Gowns and gloves .
This is the PPE that ought be given to General Practitioner Teams that commit to look after aged care residents who show signs of illness such as a sudden delirium .
And they ought work in teams to ensure careful donning and doffing of PPE and to carry equipment for history examination and testing with care .
Double surgical masking is an alternative to N95 some believe .
There are sources of PPE in the Private health and safety sector but the PHN’s have not been allowed to source them because of cost .
Same applies to hospitals .
Yet the Governments are committed to multi billion dollar deficits to fight this difficult pandemic .

Dr Roberto Celada   7/08/2020 11:29:46 AM

95% of my work is in the 4 Age Care Facilities I visit in Warragul and Drouin in Gippsland. Not once I have been contacted by any authority to discuss strategies to prevent or manage Covid patients in the facilities. We GPs are invisible. So sad.

Dr Paul Vernon Jenkinson   8/08/2020 7:31:00 PM

It;s been over 5 months since we have known that the aged and those with specific co-morbidities are at greatest risk from Covid.Despite that very little effort and money has been directed to protecting RACFs from infection at least in Victoria,my disaster State.
Instead billions of dollars have been lost and spent on other priorities far less important.
Even now,if the media reports are accurate,and anecdotally as in the above article,we are not spending anywhere enough time and effort to protect the Aged .
The Victorian Aged Care Response team was only established last week as many lives have already been lost.Let's hope they are effective in short and long time.