Hospital workers are having to wear respirator masks that haven't been fitted, which one nurse warns can make them "useless" against the highly-infectious Delta strain of Covid-19.
Auckland City Hospital is scrambling to fit staff with N95 respirator masks, as cases in the community and hospital increase, and despite months to prepare for a possible Delta outbreak.
Nurses who are yet to be fitted for a mask - a process that takes about 20 minutes and is important to make sure airborne particles can't get through - are nonetheless being asked to wear them.
That's been backed by the Ministry of Health as acceptable "in times of a heightened pandemic response". However, a senior nurse at the hospital told the Weekend Herald the situation was worrying her colleagues, because an ill-fitted mask can provide little protection.
N95 respirator masks are designed to achieve a very close facial fit, including by sealing around the nose and mouth.
"The hospital has said to just use them anyway," the nurse said. "Staff are being placed into scary situations without support. They are getting pulled into an area they don't normally work in, they are then pressured to work with patients with PPE that they are not familiar with."
She questioned why staff hadn't been fitted for masks earlier: "Over the course of this year the DHB just hasn't got very many people, particularly on the wards, fit tested."
A DHB email sent to staff earlier this week addressed the fit testing backlog. Recent expert advice supported using N95 masks in more situations, the email explained, and the Ministry of Health had changed its guidance accordingly.
Auckland DHB now recommended staff wear the high grade masks in more situations, including when dealing with patients who haven't been screened for Covid-19.
"We recognise that this is a significant change for a large number of our staff... we have a team working on fit testing as many frontline workers as quickly as possible, this will need to be prioritised," stated the email, sent Thursday and seen by the Weekend Herald.
"We can't get to everyone who needs to be fit tested immediately. While you are waiting you can wear an N95 respirator without a fit test, but you must do a seal check every time you put on your respirator to confirm it's not leaking."
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That "seal check" essentially amounted to checking if you could feel breath on your hand, the nurse told the Weekend Herald, and staff were being taught how to do so by watching a training video.
In comparison, a fit test can involve exposing a substance, with analysis of what gets through, and what is filtered out. Smell or taste can sometimes be used to check if an irritant spray has got through. A person can be asked to do specific tasks to make sure the mask works in real life situations.
The nurse said a related concern was not keeping pods or groups of workers separate, to reduce the risk of transmission if someone did get sick. Short-staffing meant frequent redeployment from nurses "all over the hospital" to fill gaps.
"You're getting a spider web of exposure - staff pulled from one directorate into another - and it will cause transmission over the whole hospital."
Auckland DHB told the Weekend Herald that, where possible, clinical teams were being split into smaller teams to reduce their number of contacts. However, it was dealing with reduced staffing, including because of staff isolating after potential exposure from people who visited the hospital, or at locations of interest in the community.
The safety of staff was a priority, and they were encouraged to talk to their manager, leader or union if they had any concerns, said Dr Mike Shepherd, the DHB's director of provider services.
"We are fit testing additional people into N95/FFP2 respirators and ensuring that they are trained to wear them. We're prioritising staff according to risk and have processes in place to ensure they continue to be well protected."
A Ministry of Health spokesperson said priority for fit tests within DHBs is given to emergency department and ICU nurses. A seal check should be done each time each time a person puts on a respirator mask.
"In times of heightened pandemic response it is globally accepted that at minimum a fit seal check of a P2/N95 particulate respirator is acceptable, if a health professional has not had opportunity to engage with their fit test programme."
All DHBs fit test nurses for masks including N95s "as part of their onboarding programmes and annual health and safety requirements", the ministry spokesperson said, but compliance "is variable across the health and disability sector."
Nurses Organisation kaiwhakahaere Kerri Nuku said fit testing respirator masks was best practice, but often didn't happen in the health sector. A past survey by the union found 60 per cent of its members in primary care hadn't been fit tested.
The inability to keep enough hospital workers in pods was a symptom of chronic understaffing, Nuku said, and both issues reflected a lack of preparation before Delta struck.
"From where we are sitting some of the measures put in have been more about a crisis response, as opposed to a planned way of dealing with this."
David Wills, director of the Nurses Society of New Zealand (NSNZ) union, said ensuring respirator masks fitted was crucial. However, he viewed the overall situation positively, because N95s were being used more widely, something nurses had asked for since the pandemic began.
Auckland DHB's Delta preparations have had other problems. The Herald revealed this week that the outbreak response was hampered because the Auckland and Waikato DHBs didn't readily know which of their staff were vaccinated, making it difficult to quickly and safely redeploy them.
The current nursing shortages at Auckland Hospital have seen surgeries cancelled, including a kidney transplant made possible by a man's brother returning from overseas and going through MIQ.
The total number of community cases in Auckland as of yesterday was 333, with 19 people in a stable condition in hospital, including nine in Auckland City Hospital. One of the earliest cases identified was a fully vaccinated nurse who worked at the hospital.