August 8, 2020

Public Health

Public health employee information for COVID-19

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The NSW Nurses and Midwives’ Association is providing support and advice to any members seeking information regarding the novel coronavirus (COVID-19).

Join the NSWNMA to ensure you’re covered at work.

The Commonwealth Department of Health website contains detailed guidance for health sector workers and is updated regularly.

If members are concerned their employer is not following these guidelines, the NSWNMA can provide assistance to ensure appropriate measures are in place. Contact us.

Click here for the latest Workforce Advice for NSW Health staff

Click here for the latest Supplementary Workforce Advice for NSW Health staff

Click here for the latest WHS Advice for NSW Health staff

Escalation to moderate risk

Given the current context of local transmission, NSW Health is advising Local Health Districts (LHDs) and Specialty Health Networks (SHNs) to escalate to a moderate risk level (Amber). This requires all health workers wear a surgical mask if they are within 1.5m of patients. Read more here.

Latest COVID-19 case locations in NSW

Have you been to a potential case location? Please check this list regularly and watch for COVID-19 symptoms.

Staff who may have visited potential case locations are advised to immediately:
• Attend a clinic for testing, even if they have no symptoms
• Watch for respiratory symptoms and get re-tested should any symptoms occur
• Self-isolate and remain in self-isolation until 14 days have passed since they attended a potential case location in the specified period, even if a negative test result is received.

Special Leave is available to NSW Health staff who are self-isolating because of Crossroads or Picton Hotel.

Where a NSW Health staff member is self-isolating on Special Leave and becomes sick for any reason, they should transition onto Sick Leave.

Don’t travel to Victoria

NSW Health staff, along with the wider community, are strongly advised not to travel to Victoria until further notice.

Special Leave will not be granted in the event that self-isolation is required on return to NSW for NSW Health staff who choose to travel recreationally to Victoria from Wednesday, 8 July 2020 until further notice.

Public Health (COVID-19 Border Control) Order 2020

The border between Victoria and NSW is now closed.

The Public Health (COVID-19 Border Control) Order 2020 was issued on 7 July, which supersedes the previous Public Health Order (PHO) pertaining to Victorian hot spots.

Under the new PHO, those providing “critical services” (included in the definition “medical or hospital care”) are required to hold an entry permit to cross the border into NSW.

For more information or queries in relation to travel to Victoria, email MOH-WorkplaceRelationsCOVID-19@Health.nsw.gov.au

Personal Protective Equipment (PPE)

When staff are directed to work with patients who are COVID-19 positive or COVID-19 symptomatic the CEC guidelines state, in all circumstances:

  • staff are to wear PPE as prescribed in the CEC guidelines
  • staff are not to undertake or be required to undertake tasks requiring PPE if the PPE is not available for use. Any such tasks are not to proceed until required PPE is available.

Where staff are performing tasks requiring P2/N95 Mask use under the CEC guidelines and where the employee has fit checked the available P2/N95 mask sizes and these sizes are not a correct fit, then the employee is to be temporarily redirected to work which does not require the use of a P2/N95 mask until suitable masks with correct fit become available.

For more detailed advice on PPE, visit this page.

Special paid leave

Thanks to ongoing NSWNMA negotiations around leave entitlements, NSW Health employees will have access to 20 days of paid special leave (for COVID-19) prior to a accessing their own accrued leave. This will be granted to employees who are unable to work because they are:

  • Self-isolating due to travel or close contact COVID-19 exposure (exclusions apply)
  • Caring for family members sick with COVID-19
  • Caring for family members due to closure of school/daycare
  • Unable to attend work due to transport disruptions or workplace closure
  • A vulnerable health worker who, following completion of a risk assessment, is unable to be redeployed to a lower COVID-19 risk environment and is unable to work from home or self isolation

After the 20 days total paid special leave has been used, employees may access accrued leave entitlements (in accordance with normal processes).

The 20 days special leave will be provided on a pro-rata basis for part time staff.

Where an employee is self-isolating on special leave and becomes sick for any reason; at that point the employee should transition onto sick leave. Where sick leave is exhausted, Health Agencies may grant additional sick leave on a case by case basis.

Those who travelled overseas from 16 March 2020, despite current notifications, will NOT be granted paid special leave to cover isolation upon return to Australia.

For travel prior to 16 March 2020, the entitlement to paid special leave will be dependent on the Smartraveller advice level on the date of their departure (see previous advice dependent if alert status was Level 1, or Levels 2-4).

Use of annual leave

The Association has had reports of members being ‘requested’ or directed if they had excess annual leave to take individual days of annual leave to cover specific shifts (due to low demand and occupancy). These are only to be via agreement between the employer and employee and must be in full compliance with the Award.

Staff who have contact with a confirmed case of COVID-19

If close contact of a person confirmed to have COVID-19 has occurred

Until 14 days have lapsed from last contact, the staff member must:

  • not attend work
  • self-isolate other than for seeking individual medical care for 14 days from the last day of contact
  • monitor symptoms for 14 days since last contact
  • seek medical attention as soon as possible if fever or respiratory illness (even if mild) occur. Call the healthdirect helpline 1800 022 222 for advice or call ahead before seeing your GP or go directly to the local Emergency Department or COVID-19 clinic.

If casual contact of a person confirmed to have COVID-19 has occurred

The staff member must:

  • continue to attend work if well
  • self-isolate and seek assessment if they develop fever or respiratory illness.

Temporary paid accommodation

Provisions for temporary paid accommodation for health workers providing frontline health services (including hospital and ambulance staff) were announced on 6 March 2020.

Due to the changing nature of the pandemic, Public Health Organisations (PHOs) will be required to use a risk-based approach when approving access to temporary accommodation. The immediate focus will be on:

Health workers providing frontline health services including permanent, temporary, casual (with booked shifts), hospital, ambulance and community staff. This includes Visiting Medical Officers (while working for NSW Health).

Temporary accommodation can be utilised in the following circumstances:

  1. Staff who have contracted COVID-19;
  2. Staff awaiting COVID-19 test results and/ or in self-isolation due to close contact with a positive COVID-19 case;
  3. Frontline staff living with vulnerable high-risk family members; and
  4. Frontline staff working extended hours, short shift changes, extensive overtime due to COVID-19 workload.

To note:

  • Use of the accommodation option is voluntary and is not mandated by the employer.
  • Different arrangements will be provided for COVID-19 and non COVID-19 affected staff.  For example, if someone has COVID-19 they will be required to isolate.
  • Staff will be accommodated in motels and hotels (the use of Bed and Breakfasts and Airbnbs may be considered later, subject to the capacity of the motel and hotel sector.)  Hotels near hospitals have been identified and will be used for health worker accommodation where ever possible.
  • Meals will be included.
  • Booking will be undertaken by the PHO using government approved processes and not by the individual health worker.

Staff parking

The NSW Government has guaranteed health workers that staff parking on public hospital premises will be at no charge with any automatic and recurring deductions facilitated by HealthShare NSW to be suspended. Those staff who park in facilities with parking managed by private operators will also have this benefit applied – albeit direct discussion will be necessary between the LHD, private provider and staff member(s). Some Local Councils are also making provisions to allow free parking for health staff.

Employees who remain overseas and are unable to return

Available FACS leave can be used for employees unable to return home due to COVID-19. Districts should be flexible with other leave requests (e.g. ADO, Annual and Long Service Leave and Leave without pay if FACS leave has been exhausted). Special paid leave is not granted for this purpose.

Staff Returning from Overseas Travel

From 12am on 16 March 2020, return to Australia from any overseas travel requires 14 days isolation.

In settings where the absence of the healthcare worker will have a significant impact on health services, a case-by-case risk assessment will be undertaken with input from the Public Health Unit. Work from home arrangements may be arranged where appropriate.

Official Work Related Travel Arrangements for All Overseas and Domestic Travel (Including TESL)

All official overseas travel is to be cancelled. Domestic travel remains restricted to essential travel only.

Attendance at meetings and conferences

Agencies should review any planned events which involve meetings of large numbers of staff to minimise the absence of staff who are needed to assist with surge planning and service delivery.

Consideration should be given to postponing these events or managing them in a different way (e.g. webinars,
circulation of papers, etc) and:

  1. Non-essential meetings or conferences of workforce especially critical workforce such as healthcare professionals and emergency services should be limited. Proactive measures for compliance with social distancing advice to keep a safe distance (1.5 metres) between staff should be maintained in all circumstances where possible to do so.
  2. Outdoor gatherings of more than 500 people and indoor gatherings of more than 100 people are not to proceed in accordance with the public health orders on 23 March and 24 March. NOTE: An indoor gathering takes place within a single enclosed area (i.e. a single room or venue).

Essential activities such as healthcare settings, pharmacies, food shopping, schools, workplaces and public transport are not included in this restriction. However, social distancing and good hygiene practices should be applied in these settings where possible.

Previous full advice by the Committee includes the specific recommendation that mitigation strategies include: “limiting non-essential meetings or conferences of critical workforce e.g. healthcare professionals and emergency services”.

Vulnerable Staff

The Australian Health Protection Principal Committee (AHPPC) considers that, based on the limited current evidence, the following people are, or are likely to be, at higher risk of serious illness if they are infected with the virus:

  • Aboriginal and Torres Strait Islander people 50 years and older with one or more chronic medical conditions
  • People 65 years and older with chronic medical conditions. Conditions included in the definition of ‘chronic medical conditions’ will be refined as more evidence emerges. The most current list can be accessed on the Department of Health website
  • People 70 years and older
  • People with compromised immune systems (see Department of Health website)

AHPPC recommends that where vulnerable workers undertake essential work, a risk assessment must be undertaken. Risk needs to be assessed and mitigated with consideration of the characteristics of the worker, the workplace and the work. This includes ensuring vulnerable people are redeployed to non-customer based roles where possible. Where risk cannot be appropriately mitigated, employers and employees should consider alternate arrangements to accommodate a workplace absence. In this case, those workers should be able to access the paid special leave (for COVID-19).

AHPPC recommends that special provisions apply to essential workers who are at higher risk of serious illness and, where the risk cannot be sufficiently mitigated, should not work in high risk setting. (AHPPC advice, 30 March 2020)

There is limited evidence regarding the risk in pregnant women. Currently there is no evidence of an increased risk of miscarriage, teratogenicity or vertical transmission of the COVID-19 virus. There is a possibility of an increased incidence of premature birth but there is insufficient evidence at this point in time. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommends that, where possible, pregnant healthcare workers be allocated to patients, and duties that have reduced exposure to patients with confirmed or suspected COVID-19 infection.

Commonwealth support

A $2.4 billion health package has been released to support primary care, aged care, hospitals, research and the national medical stockpile.

Other useful resources

NSW Health is continuing to provide comprehensive information, fact sheets and updates about COVID-19 here.

More COVID-19 / Flu clinics are being established within all Local Health Districts to assess and diagnose patients with possible COVID-19 infections and other respiratory illness, such as influenza, as winter approaches.

NSW Health has existing policies for an operational response to COVID-19 and the emergency department preparedness for an influx of patients. Both guidelines below are from the NSW Health Influenza Pandemic Plan:

Further information on PPE

Further information for private health nurses and midwives

The NSWNMA will continue to provide further updates for members as we receive them. Contact us here.

Personal Protective Equipment (PPE)

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The NSW Nurses and Midwives’ Association is providing support and advice to any members seeking information regarding the novel coronavirus (COVID-19).

Join the NSWNMA to ensure you’re covered at work.

The Commonwealth Department of Health website contains detailed guidance for health sector workers and is updated regularly.

Escalation to moderate risk

Given the current context of local transmission, NSW Health is advising Local Health Districts (LHDs) and Specialty Health Networks (SHNs) to escalate to a moderate risk level (Amber). This requires all health workers wear a surgical mask if they are within 1.5m of patients. Patients are also required to wear a mask, where possible. This advice applies to hospital and community health settings and came into effect from Friday 24 July 2020.

The new advice on mask use is underpinned by expert risk assessments. The recommendations are detailed in the COVID-19 Infection Prevention and Control Response and Escalation Framework and this poster.

Access Frequently Asked Questions (FAQs) about the escalation to Amber Alert here.

Your rights

If you are providing care for patients who have or are suspected to have COVID-19 or are working in a high-risk clinical area, your employer must provide you with appropriate PPE to ensure you can do your job safely. Such as:

  • You are to wear prescribed PPE as instructed (your employer needs to ensure you are trained in how to use PPE safely).
  • Do not undertake tasks requiring PPE if the PPE is not available for use. Any such tasks are not to proceed until required PPE is readily available.
  • If you are concerned for your safety, you must raise your concerns immediately with your manager.

Where staff are performing tasks requiring P2/N95 mask use under the CEC guidelines and where the employee has fit checked the available P2/N95 mask sizes and these sizes are not a correct fit, then the employee is to be temporarily redirected to work which does not require the use of a P2/N95 mask until suitable masks with correct fit become available.

What PPE do I need?

Refer to CEC guidance to determine the correct use of PPE in your area:

Fit testing program

The NSW Government and Clinical Excellence Commission (CEC) have recognised the need for clearer and consistent fit testing thanks to ongoing campaigning from unions. A fit testing program will now be recognised as an addition to current infection prevention and control education and guidance on the adequate use of PPE.

Implementation across NSW will be carried out as a rolling program, commencing by working with Sydney LHD (SLHD) and Hunter New England LHD (HNELHD) who have both been focusing on limited fit testing with high risk staff in high risk areas, caring for high risk patients.

The program will learn from them in the first instance on areas including:

  • Appropriate training providers
  • Optimal training programs for frontline clinical staff on how to fit test and fit check their masks
  • Alternative masks and protection for staff who do not achieve a fit test
  • Processes to identify and record which staff have been tested and which mask is a fit for them
  • Optimising the current supply chain around fit testing training and implementation
  • Embedding this approach into the CEC guidance on Transmission Based Precautions.
  • Creating capacity and capability at an LHD level to support sustainability of any approach
Phase 1 Process

Implementation will focus on the high risk areas of anaesthesia and ICU in SLHD and HNELHD. Within these environments it will focus on clinicians who are caring for patients who are COVID-19 positive or symptomatic and who are required to administer Aerosolised Generating Procedures (AGPs) individually or as a clinical team. Staff who are caring for COVID positive or symptomatic patients who are required to apply PPE for contact and droplet precautions, which includes a surgical mask, will not require fit testing.

If clinical staff are required to administer AGPs in anaesthesia or ICU they will be fit tested. Specific AGPs for the relevant specialties would be confirmed in partnership with SLHD and HNELHD clinicians and would include:

  • insertion or removal of endotracheal tube
  • deliberate or inadvertent disconnection/reconnection of a closed ventilator circuit
  • high frequency oscillatory ventilation (HFOV)
  • open oropharyngeal or tracheal suctioning
  • upper respiratory instrumentation e.g. bronchoscopy, tracheostomy
  • intercostal catheter insertion for relief of pneumothorax
  • manual or non-invasive ventilation (NIV)
    – bi-level positive airway pressure ventilation (BiPAP)
    – continuous positive airway pressure ventilation (CPAP)
  • collection of induced sputum
  • high flow nasal oxygen (HFNO)
  • chest physiotherapy
Post Phase 1 Process

This would inform the development of an NSW implementation plan for fit testing and ongoing emphasis on the responsibility of staff to comply with infection control standards and guidance.

Additional masks for healthcare workers

On 8 April, Minister for Health, Greg Hunt, advised 11 million masks will be distributed to healthcare workers across the country immediately.

Seven million will go to hospitals, 2.3 million to the primary health network, including 1.5 million for general practice clinics.

Respiratory clinics, set up by the government for those with mild and moderate COVID-19 symptoms, will receive 160,000 masks.

The National Aboriginal Community Controlled Health Organisation will receive 75,000 masks and 500,000 will to pharmacies.

The aged care sector will receive 1.7 million masks.

Another 500 million have been ordered from domestic supplies and internationally.

NSW Health is also implementing a statewide strategy to ensure all staff have the personal protective equipment needed to protect them at work. This includes:

  • collaborating with the Federal Government to access the national medical stockpile
  • seeking alternative supply chains
  • expediting equipment orders since January
  • working around the clock to secure and move stock into NSW to meet future needs
  • pursuing all channels of existing supply, new supply and alternative supplies
  • engaging new and existing manufacturing opportunities in Australia
  • supporting local PPE stock management to maintain consistent standards across the system
  • centralising ordering and management of incoming supplies to ensure appropriate and effective allocation of supplies across the state.​

Further details to ensure the safety of NSW Health workers at all times and during the COVID-19 crisis, can be found here.

When do I need to wear PPE?

Guidance on 3 April from the Clinical Excellence Commission directs nurses working in high-risk areas to wear PPE (previously it was only when working with confirmed or suspected cases).

Health workers caring for patients in high-risk clinical areas (see list below) should comply with contact and droplet precautions for all close contacts (gown, surgical mask, eye protection and gloves). When performing aerosol generating procedures, comply with contact, droplet and airborne precautions.

High-risk clinical areas include:

  • Intensive Care Units (ICU)
  • Emergency Departments (ED)
  • COVID-19 Wards
  • Acute Respiratory Assessment Clinics

A dedicated floor plan in Emergency Departments should be established that clearly designates areas assigned for suspected or confirmed COVID-19 patients. If possible, consider rostering of staff to support the separation of areas and resourceful use of PPEs. For staff working directly in the area of suspected or confirmed cases of COVID-19, PPE should be worn accordingly.

What PPE do I need at work for COVID-19?

This 11-page document provides detailed information about the application of PPE, but does not cover broader infection control issues. It’s a great resource for specific types of masks, gowns etc, that are appropriate when working with confirmed or suspected COVID-19 patients.

Broader infection control guidance (with some PPE info included)

Hospital setting – this 9-page document looks more broadly at COVID-19 infection control in the hospital setting. It includes information about PPE (less detailed than the link above) but also provides information about things like environmental cleaning, linen and waste management.

Residential aged care – this 21-page document looks at COVID-19 infection control in residential aged care. It includes some information on PPE, but also information on what the organisation should do if one or more residents and/or staff have COVID-19, e.g. isolating, cohorting, visitor restrictions etc.

Primary and Community Care – this 6-page document looks at principles for infection control in primary and community settings, including details of PPE, cleaning etc.

National guidelines

The Australian Government has also published recommendations for the use of PPE when caring for people with possible COVID-19 infection.

Report PPE concerns

If you have concerns that your employer is not providing you with the necessary PPE (or is making it very difficult to access) and/or is not training people in its safe use, then you should:

  1. Put in an incident report at your workplace
    AND
  2. Escalate your concerns to your manager in writing and ask for an urgent response

If your concerns are not being taken seriously, we can assist to ensure appropriate measures are in place. Contact us here. You can also contact SafeWork NSW on 13 10 50.

Further information for public health nurses and midwives

Further information for private health nurses and midwives

Further information for aged care nurses

 

US officially notifies WHO of its withdrawal

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The move is widely condemned as COVID-19 continues to rage around the planet.

The US administration has formally notified the World Health Organization of its withdrawal from the UN body despite widespread criticism.

When he flagged the move in late May, President Trump, accused WHO of helping the Chinese government in a cover up in the early stages of the coronavirus epidemic in Wuhan.

The New York Times said this accusation was baseless.

“There is no evidence that the WHO or the government in Beijing hid the extent of the epidemic in China, and public health experts generally view Mr Trump’s charges as a way to deflect attention from his administration’s own bungled attempts to respond to the virus’s spread in the United States,” it said.

“In fact, the agency issued its first alarm on Jan 4, just five days after the local health department of Wuhan announced a cluster of 27 cases of an unusual pneumonia at a local seafood market. The WHO followed up with a detailed report the next day.”

Public health experts in the United States reacted to the move to withdraw from WHO with dismay.

“Turning our back on the WHO makes us and the world less safe,” said Dr Thomas Frieden, the former director of the Centers for Disease Control and Prevention.

The Infectious Diseases Society of America “stands strongly against President Trump’s decision,” said its president, Dr Thomas M. File.

Pacific Island economies face collapse over COVID-19

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The Pacific region is almost COVID-19-free but economies have been devastated.

Strict border closures have devastated tourism, a crucial revenue earner and restricted much-needed imported foods in Pacific Island states.

“COVID-19 is clearly the job-killer of the century,” Fiji Prime Minister Frank Bainimarama said.

“You can’t suddenly work from home when you earn your pay cheque as a scuba instructor, or in a garment factory dependent on regional supply chains, or as a handicraft maker who usually sells to tourists.”

Cook Islands deputy prime minister Mark Brown said the pandemic lockdowns were an “economic tsunami”. Tourism makes up 65 per cent of the islands’ economic activity.

A report published by the Hawaii Journal of Health and Social Welfare, says some measures taken to fight Covid-19 are likely to increase the long-term risk of non-communicable diseases common across the Pacific, such as hypertension, diabetes, and heart disease.

“For example, trade and movement restrictions within and between countries has reduced availability and accessibility to healthier foods, and increased reliance on unhealthy processed foods,” the report said.

“In addition, there is potential for individuals becoming less physically active as a result of curfews and restricted movement; abuse of tobacco and alcohol while being isolated at home; and an increase in domestic violence.”

Small Pacific Island states typically produce less than 65 per cent of their country’s dietary energy supply domestically.

Masks directive highlights workplace risks for nurses

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After five months of raising safety concerns held by members, the NSW Nurses and Midwives’ Association (NSWNMA) has welcomed today’s decision by NSW Health instructing all public health workers to wear surgical masks within 1.5 metres of patients.

NSWNMA General Secretary, Brett Holmes, said the union had repeatedly highlighted the workplace risks for thousands of nurses and midwives because of their need to deliver care in close proximity to patients.

“While we welcome the decision to move to an amber alert, this clearly demonstrates our members have been working in much higher risk environments than the health service has been prepared to admit,” said Mr Holmes.

“Since the beginning of the pandemic, nurses and midwives have endured ongoing issues with access to adequate personal protective equipment (PPE) and, at times, conflicting infection prevention advice.

“An expert risk assessment of the increase in community transmission of COVID-19 has prompted this ‘moderate’ risk warning and we appear to now have an abundant supply of masks for public health workers.

“Mask use is a welcome protection for all public hospital and community health workers and we will continue to pursue NSW Health over the issue of ‘fit testing’ and ‘fit checking’ for P2/N95 masks where required.

“This reinforces the essential work value of nurses and midwives who continue putting their own lives on the line to tackle the pandemic and protect their communities. Meanwhile, we’re in the NSW Industrial Relations Commission begging for their 2.5% standard wage increase.

“All nurses and midwives, at a minimum, deserve to be acknowledged and deserve proper financial recognition for their daily sacrifices.

“It’s an appalling situation, considering public health workers are essential but not valued by this government.”

The NSWNMA is in the NSW Industrial Relations Commission again today, alongside other public sector unions, to oppose the wage freeze and further hearings are scheduled for 30 and 31 July.

Doctor wears six surgical masks, to prove that masks don’t reduce oxygen levels

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In a now viral Twitter video, Dr Maitiu O Tuathail donned six surgical masks while measuring his oxygen levels on a pulse oximeter.

The experiment shows the Irish doctor putting the masks on one at a time, while his oxygen levels remained stable at 99 percent.

The doctor shot the video in response to numerous patients asking if wearing a face mask had an effect on oxygen levels. He noted that much of this misinformation came from what they had read on social media.

Dr O Tuathail encouraged his audience to wear face masks where social distancing was not possible, including while seeking medical attention. 

A NSW Ministry of Health directive now requires health care workers to wear masks when within 1.5 metres of a patient. All patients are also required to wear masks when presenting to a health service, with exceptions made for children under 12 years old. 

If you have any questions about PPE or the use of masks, and you are a member of the NSW Nurses and Midwives’ Association, check out our article or contact us. If you are not yet a member, join today.