Things we need to do immediately to keep Australian healthcare workers safe. A THREAD.

@drajm @Nishaobgyn @NjbBari3 @patientsafe3 @dlmetcalf @VSTMMJJ @drdavidallen @rajah_mich @venessb @eyerait58 @SParnis @omarkhor @nick_coatsworth @VictorianCHO @maffygirl

1/24

Upgrade to airborne / N95 precautions for all suspect and actual COVID patients and for all patients in areas of higher community transmission.

2/24

Regular fit-testing of all healthcare workers with stocking of different brands in different sizes and a database of who needs which mask. If your mask isn’t in stock, you don’t work that day.

3/24

Upgrading of other protections to include EN14216-compliant (infective barrier) coveralls, hair protection, shoe protection.

4/24

Creation of dedicated donning/doffing areas with absolute separation of staff coming on shift and going off shift. Rosters to be adjusted to ensure handover takes place in the red zone. ...

5/24

… With showers and high temp (90 degrees) hospital laundering of scrubs. No HCW goes home ‘feeling dirty’.

6/24

Total separation of COVID+ve patients from -ve. Total separation of staff caring for COVID+ve from -ve. System of traffic flow in hospitals to ensure no mixing at all (modified traffic control bundling, as per SARS in Taiwan 2003).

7/24

Roster ‘spotters’ (24/7) to ensure accurate donning and doffing and to provide psychological support for HCWs coming and going off shift.

8/24

Roster ‘marshals’ with OH+S expertise to patrol healthcare facilities to ensure social distancing between staff, provision and use of dedicated workstations and that people are managing to take breaks.
9/24

Increase provision of PAPRs for high intensity areas. Allow use of user-provided PPE such as reusable elastomeric respirators, with disinfection provision available, as per established protocols.

10/24

Set Zero HCW infections and other Key Performance Indicators (KPIs) for infection control, performance against these metrics to be shared with staff. KPIs to include surveys of staff confidence in infection control and their own assessments of their mental health.

11/24

Working group (with timely reporting) to devise system to assess which staff should not be working on the frontline in the present pandemic due to excess risk as a result of combination of age, sex, co-morbidities, BMI, ethnicity etc. ...

12/24

… e.g. I am an Ashkenazi Jewish male and evidence suggests I have twice the mortality rate of a non-Jewish male: https://www.thejc.com/news/uk/jewish-males-twice-at-risk-of-dying-from-covid-19-than-christian-men-ons-report-reveals-1.500840

13/24

Audit of ventilation systems in healthcare facilities with upgrading to the maximum level of protection possible.

14/24

Involvement of industrial OH+S specialists and frontline staff in design, implementation and audit of infection control systems in their workplaces.

15/24

Confidential reporting line for bullying of staff in relation to PPE and other infection control concerns.

16/24

Provision of mental health support for those in quarantine or who have tested positive.

17/24

Provision of compensation payments for the families of those who have died or those who have been harmed as a result of COVID contracted at work.

18/24

A recognition of the stresses and pressures inherent in any healthcare system, so rostering and other factors to have enough ‘slack in the system’ to ensure that urgency or pressure of work NEVER…

19/24

… results in the infection control barrier being breached. In other words, an infection control system for the real world, not the ideal world politicians and managers think we inhabit.

20/24

The precautionary principle must sit over the whole infection control regime: the maximum possible level of protection must be provided, until such time as level one evidence indicates it can be scaled back.

21/24

Diverse representation on guideline setting bodies, to include OH+S specialists and frontline staff of all ethnicities and sexes. Published minutes of these meetings.

22/24

For more background to all this, please see the paper @drajm and I wrote for submission to WA Health on 14th April this year:

https://bit.ly/3i31Ooj 

23/24

Come on, people, Australia is a wealthy civilised country, none of this stuff is complex or hard, it’s all just simple logistics. We can do it. We must enfold our healthcare workers in our arms and protect them while they do this dangerous job on behalf of us all.

24/24

@threadreaderapp Unroll, s'il vous plaît!