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Review unpacks ‘vicious cycle’ of staffing and PPE shortages at Newmarch

The government has today released the findings of a review into the outbreak of COVID-19 at Newmarch House in Sydney where 19 residents died.

To unpack the virus’s spread and impact, review authors Professor Lyn Gilbert and Adjunct Professor Alan Lilly consulted with stakeholders, including staff and the family members of residents.

They found a “vicious cycle” of staff and PPE shortages, and suboptimal infection prevention and control (IPAC) practice.

“Providing sufficient, appropriately skilled staff to manage and deliver person-centred care to residents at Newmarch House proved to be one of the most significant challenges during the course of the outbreak,” the review’s authors wrote.

On top of that it was reported by on-site managers, agency staff and by a later IPAC review that the quality of many items of PPE was inferior, including vinyl rather than nitrile gloves, plastic aprons, non-impermeable gowns and and non-standard respirators.

That was conflated by the finding that some agency staff reported having received no IPAC training at Newmarch House.

On top of the lack and inconsistent use of PPE – and failure from staff to change to fresh PPE on entry to the rooms of COVID-19 negative residents – there were “frequent instances of staff-to-staff contact” due to a lack of physical distancing during meal breaks, at meetings, when sharing transport to and from the workplace or when socialising in groups after hours.

The debate about whether to care for aged care residents diagnosed with COVID-19 on site or transfer them to hospital has raged in the months after the outbreak, with many citing Newmarch as a reason to opt for the latter.

In their review, Gilbert and Lilly said despite the advantages of hospital-in-the-home services (HITH), there were “significant impediments to its successful implementation” at Newmarch House, including the shortfall in staff familiar with the regular care needs of residents.

“In addition, the increasing numbers of COVID-19 positive residents in the home were a continued source of infection to other residents and staff because of imperfect IPAC practices, including cohorting.”

The authors said: “Until they were rectified, staff and PPE shortages and the presence of COVID-19 positive residents in different zones of the home, undoubtedly contributed to IPAC breaches and ongoing transmission of COVID-19.”

Family members of both current and deceased residents reported that one of the biggest failures was the lack of communication.

“Concerns or queries from family members, which may have been otherwise easily resolved, became much more significant in the absence of effective, two-way communication,” the report’s authors said. “There were frequent reports of extensive delays in responding to inquiries from those seeking information or updates about their loved ones, as well as experiences where telephone calls, messages and emails simply went unanswered.”

The authors added: “Many family members recognised and were appreciative of the extended efforts of staff, who continued to provide care and comfort to their loved ones. However, this was often outweighed and overshadowed by the emotional enormity of living through the outbreak and in some cases, the grief of having lost a loved one.”

Reacting to the review, Minister for Aged Care and Senior Australians Richard Colbeck said lessons learned are being already implemented in Victoria and as part of the national response.

“The outbreak at Anglicare’s Newmarch House was incredibly challenging and underlined the impact this infection can have within an aged care facility,” Colbeck said.

“The Australian Government is committed to learning from the experience at Newmarch House and to doing all we can to ensure aged care providers are prepared to address future outbreaks so that residents receive safe and quality care.”

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