Emails obtained by the Herald reveal serious concerns from nurses helping at St Margaret's rest home. Photo / Sylvie Whinray
Emails obtained by the Herald reveal serious concerns from nurses helping at St Margaret's rest home. Photo / Sylvie Whinray
Nurses sent to a rest home struck by a deadly Covid outbreak had "poor or non-existent" orientations and were extremely concerned about a lack of gowns and eye protection, a damning chain of emails reveals.
The Herald has obtained correspondence between CHT St Margaret's residential aged-care home in Auckland's TeAtatu, the local DHB and health unions, exchanged as a Covid-19 outbreak took hold.
Waitematā DHB set-up an incident management team and sent in its own nurses and healthcare assistants; covering up to 85 per cent of the staffing as the facility's workforce fell sick or went into isolation.
"Members were extremely concerned about their safety and reported a lack of appropriate PPE when they arrived for shifts there, specifically no availability of gowns or eye protection when they were required to have close contact with covid 19+ve residents," NZ Nurses Organisation organiser Sarah Barker emailed DHB managers on April 16 - a day before staffing pressure meant some residents were taken to hospital, where three would die over the following week.
"We are advised that three WDHB [registered nurses] who worked at St Margaret's are now in quarantine because of exposure without the correct PPE."
Ambulances transport a group of St Margaret's residents to Waitakere Hospital. Photo / Sylvie Whinray
Andy Hipkiss, the union's lead Auckland organiser, followed up four days later, saying members sent to other aged care facilities in the Auckland region had complained "that access to PPE and basic infection control precautions such as cleaning are very poor", and NZNO needed to know nurses at St Margaret's would be safe.
In reply, Waitematā DHB's head of nursing, Marianne Cameron, said the facility had been following PPE guidelines for aged care, issued by the Ministry of Health and on advice from regional health authorities. After some DHB staff raised concerns, hospital-level PPE was quickly made available.
Barker thanked her for that reassurance, but said there had been significant confusion around the deployment.
"Our members have said mixed things about the PPE - it wasn't there and then there wasn't enough and then the DHB brought some and then they had to bring some more!"
An April 25 email between DHB managers and St Margaret's noted a health care assistant employed by the rest home had worn black plastic bags over their shoes, and a cleaner worked between both the hospital wing and dementia unit, despite a directive forbidding that.
Situation report documents showed "ongoing concerns with the safe doffing and disposal of PPE due to lack of rubbish bins".
Max Robins, chief executive of CHT Healthcare Trust, a charity that runs St Margaret's, said PPE and infection control were critically important, and were discussed at length daily.
This was to "keep on top of escalating PPE stock levels and adaptation to our usual clinical practices to ensure that all staff felt as confident as possible while working at our facility".
"Our commitment to the Ministry of Health guidelines for PPE in aged residential care facilities was unwavering, even in the face of a situation that was evolving with incredible pace under very stressful circumstances," Robins said.
"We were absolutely aware of the concerns raised by DHB staff working at CHT St Margarets about the difference between PPE recommended by the Ministry of Health for use in an aged care setting compared with that used in a public hospital. We worked closely with, and followed the advice of the Waitematā DHB on infection control processes and practices."
The Rosewood Rest home in Christchurch was the epicentre of NZ's deadliest Covid cluster. Photo / supplied
A Waitematā DHB spokeswoman said hospital-level PPE was requested by staff on April 12, and delivered within hours "over and above Ministry of Health requirements for aged residential care settings".
Prior to that, PPE appropriate for aged care was already in use, and the DHB had given arriving staff a briefing document advising them of how this differed to what they'd be used to wearing at hospital. A charge nurse made multiple visits to support staff at St Margaret's, and after Easter was based there full-time.
"Where it was able to, St Margaret's provided an orientation session...given the rapidly evolving situation and the demands this created, St Margaret's was unable to orientate all DHB staff in this way."
DHB nurses and health care assistants were stood down as a precaution because of close contact with an asymptomatic Covid case, the spokeswoman said - not because of issues with PPE.
The Herald has used multiple Official Information Act requests and interviews to reveal details about what happened in the two rest homes linked to 16 of the country's 22 coronavirus deaths.
Rosewood rest home in Christchurch, which had 12 deaths, was found in breach of its obligations including cleanliness, food and laundry services, and authorities became frustrated after a lack of contact by the owner.
St Margaret's residents were only all swabbed 11 days after a staffer returned the first positive test - turning up three undetected cases in residents, two of whom would die soon after being moved to hospital. The NZ Aged Care Association has said testing gaps were despite its efforts and those of facilities to have more residents swabbed.
Chief Ombudsman Peter Boshier has brought forward targeted inspections of some secure aged care facilities, following the Covid-related outbreaks and deaths. His report is due imminently.
The last case linked to the St Margaret's "cluster" was announced as recovered on June 8, making NZ officially free of Covid-19 - until the recent border-related cases.
