Dec 01, 2020

Full report released into the timeline of COVID-19 outbreak in Sydney nursing home

A review of the COVID-19 outbreak at Dorothy Henderson Lodge has concluded that infection control practices should be embedded into the culture of aged care homes, and all aged care staff in Australia should receive nationally consistent infection control training.

Infection prevention and control (IPC) was “often neglected” in aged care homes, said the author of the review, Gwendolyn Gilbert, Clinical Professor, Medicine (Immunology & Infectious Diseases), Westmead Institute for Medical Research, which was published in the Medical Journal of Australia this week.

However, IPC should be an “essential” aspect of training for all aged care staff, not only to help during pandemics, but in daily routine care, she said.

The additional training might add to the cost of delivering aged care, but it would lead to less absenteeism from illness or quarantine, one of the key reasons COVID-19 outbreaks were so devastating in aged care, Professor Gilbert suggested.

She also noted that even outside the pandemic, better IPC in aged care homes would reduce the impacts of seasonal flu outbreaks and antimicrobial resistance – two causes of hospitalisation and added costs in aged care.

In the report, titled ‘COVID-19 in a Sydney nursing home: a case study and lessons learnt’, Professor Gilbert said IPC training should be tailored to aged care staff’s roles, and should be nationally consistent. This recent report published in the MJA is a more detailed version than was released in July 2020.

Modern residential aged care homes are “overcrowded” and have “limited staffing”, making them “not conducive” to either preventing or controlling infectious diseases, Professor Gilbert observed.

Aged care residents 74% of all COVID-19 deaths in Australia

Aged care residents represented 74 per cent of all COVID-19 deaths in Australia, the report noted.

The mortality rate at DHL lodge was 8 per cent, which was relatively low compared with some overseas aged care homes which saw mortality rates of between 25 and 30 per cent.

The attack rate – the number of people in a given population diagnosed with COVID-19, divided by the total of the given population – at DHL was also relatively low at 21 per cent. This compares, for example, with an attack rate of 78 per cent at an aged care home in King County, the United States.

Yet, the case fatality rate (CFR) DHL was relatively high. At DHL the CFR was 38 per cent. In King Country, the CFR was 34 per cent.

Major challenges and lessons learned

The report uncovers the key weaknesses in DHL’s responses to COVID-19, and made several corresponding recommendations.

As well as better IPC training, aged care providers should have “contingency plans” to ensure surge capacity of qualified, experienced aged staff are available when suddenly needed.

Allied health support is also essential to maintaining social connection, mobility and nutrition among aged care residents, and to minimise the risks of residents enduring prolonged periods of isolation.

Hospital admission for RACF residents with COVID-19 should be determined according to medical need, resident preference and facility resources.

A single case of COVID-19 in a resident, staff member or visitor requires an immediate outbreak response, Professor Gilbert recommended.

Barriers to controlling the outbreak

The report provided a timeline of the outbreak, and listed the key barriers that prevented DHL from controlling the outbreak.

Some of the barriers that prevented DHL from being able to control the oubreak included:

  • Carpets, soft furnishings, residents’ personal possessions
  • Intermingling of residents, communal activities
  • Shared rooms and/or bathrooms
  • Crowding
  • Clutter
  • Poor ventilation
  • Porous, difficult-to-clean surfaces
  • Inadequate cleaning of communal areas and residents’ rooms
  • Inadequate staff to resident ratios
  • High proportion of part-time, temporary or agency staff
  • Inadequate or absent staff IPC training
  • Staff moving between residents’ rooms or zones unnecessarily or without the proper IPC precautions 
  • Inadequate isolation, transfer or cohorting of infected residents during an outbreak
  • Failure of staff to observe general outbreak/IPC precautions, for example, failure of staff to stay home when unwell and failure of staff to maintain physical distancing in communal areas or community settings 
  • Failure to promptly identify and isolate an infectious disease case
  • Failure to immediately activate an outbreak response

Preventing further COVID-19 deaths in aged care

In total, 685 aged care residents have died from COVID-19 in Australia. 

DHL was in the unfortunate position of being the first aged care home in Australia to experience an outbreak, due to its location in north-west Sydney, the site of the country’s first COVID-19 cluster. 

The better we understand what went wrong at DHL, and glean lessons from those mistakes, the better prepared aged care homes will be to protect their staff and residents, should the virus strike again.

Just as aged care homes in Asia upped their IPC practices after SARS, Australia must do the same here in the wake of COVID-19.

Image: SheraleeS, iStock.

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  1. Caroline I manage aged care facilities and it really angers me that you always give aged care a bad wrap. There are people dying in hospitals as well, where one would think the infection control is 100%.
    Aged care is a home not a hospital, we try to replicate their homes as much as possible.
    Leave us alone, I am fed up with ignorant people making a comment about something they know nothing about. Unless you have done AT LEAST 12 MONTHS working in aged care you have not right to make comments.
    Who are the people you are interviewing, families? They have no idea either, if you had heard the stories I have heard from families whose loved ones are in my facility I wonder what planet they are on. Do you even understand carers can be even more ignorant and they are actually working in aged care. I do toolbox education every week on a topic, every carer gets this education and yet you can ask them something on the toolbox topic 3 weeks later and they look at you like you have 2 heads……………I cannot tell you why? My theory is that this is a ‘job’ to them, not a passion, so they come to work to do what they have too and that is it. Or is it because they do not have to have a registration so they have no fear of losing their registration, as soon as they have to have a registration as i do then they will be accountable. NOT EVEN THE ROYAL COMMISSION HAVE ANY IDEA ON HOW AGED CARE WORKS………………Why because they are getting this information from people who have no idea on what they are talking about.
    Let me give you an example. I have a resident with advanced dementia, when she is in the dining room for meals she is destructive, so i have given a directive for her not to have her meals in her room, the reason was explained to staff very clearly why. A carer came to me 2 days ago and said it is unfair that you are not allowing the person to have meals in the dining room, so I asked her why was I not allowing her to have meals in the dining room, she said because she throws water and food all over the tables and floor. So i then took this to all staff, they all said the same thing. I was appalled!! The reason i have said she is not to go into the dining room is because of the ‘white noise’ . Some dementia residents do not cope with over stimulation, noise, a lot of activity or other people, this resident is one of those people. She needs nice quiet place to have her meals, she never mixes with the other residents and it saddens me that staff who have been working in aged care for more than 10 years NEVER look at the person.
    Once i retire I will be going on 60 minutes to talk about aged care and people like you who make it 10 times harder for us, who are trying so hard to do the right thing

    1. Hi Mary, thank you for your comment. The article is not about my personal views, I am merely the journalist reporting on the research of Gwendolyn Gilbert, who is a Clinical Professor, Medicine (Immunology & Infectious Diseases) at the Westmead Institute for Medical Research. In a pandemic involving a completely new virus it is imperative that as much information as possible about dealing with it is shared. Thanks again Mary, Caroline

  2. With so many burdens placed on the staff I can only pray that we all see this $5 an hour pay rise happen in the near future otherwise nothing will change!

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