Our biggest blind spot: Infection control does NOT properly protect worker health and safety

In Australia, we have a deeply held belief that our hospitals are safe places which provide good quality care. In recent years, Aged Care has engendered less confidence with the Royal Commission telling some hard truths – but I’d still rather grow old in Australia than many other countries.

Then COVID-19 happened, and has spread throughout the world's health and aged care sectors - including among workers in those settings - at an alarming rate, demonstrating that these are extremely high-risk environments. COVID-19 is going to be one of the top causes of workplace-related deaths in Australia in 2020. Large numbers of infections are going both ways between workers and patients. Deaths are resulting and will continue to rise.

Is this rate of infection just a consequence of something we cannot control ? No.

Since March, our governments have generally done the right thing, listening to the economists and the disease specialists. Thankfully, our national response to COVID-19 has been less about politics and more about common sense. However there has been a major blind spot with worker health and safety in healthcare, and despite the best efforts of many agencies, it's not being repaired. Health and safety practices in hospitals and aged care across the country are inadequate. In Victoria, the failure has been spectacular, resulting in infections of more than 2400 workers. The AIHS issued a public statement about this issue on Thursday 6 August.

Given the scale of the pandemic, we might assume that everything has been done to protect workers, but this is not the case. Health and safety controls have stubbornly remained inadequate despite growing concerns and the weight of evidence presented by experts. COVID-related Health and Safety controls on many building sites are better than in many healthcare settings. 

The federal government has stated recently in the media, based on the expert advice they are receiving, that they believe the current standards are adequate. We could not disagree more with that advice which ignores basic facts. A large body of professional agencies like ours across the country, have been working together trying to get the message across.

What needs to change

The issues behind the failures are not insurmountable, and there is still an opportunity to save lives in Victoria and ensure that waves in other states do not produce the same result.

Inadequate infection control standards which do NOT deliver worker health and safety

The large majority of hospitals and aged care settings work to infection control standards, the specific contents of which are not mandated by governments, and which are largely focused on the protection of patients while workers are an ancillary consideration. Where these standards they have been applied, basic mistakes have been made, and the standards set the bar too low. They do not drive basic common-sense work health and safety practice. These standards need to be improved and standardized.

Many hospitals also assume that compliance with these guidelines means they are meeting their health and safety duties as an employer. It does not.  

Evidence is not being used to manage risk

As we have proceeded through this pandemic, we have learnt a lot about the virus and how it can be transmitted. Management of hospitals and aged care facilities are not considering this new evidence and what it means for how they manage health and safety risks. Here is what we know:

·      there has been an alarming increase in infections among workers in the healthcare and aged care sectors.

·     there is emerging evidence that COVID-19 is airborne.

·      there are still many things we DON’T know about transmission

·      we have higher levels of PPE available that are not being used.

Given this, any logical health and safety assessment would apply the precautionary principle and mandate increased personal protective equipment (PPE) including take-up of P2/N95 masks for all workers who have contact with COVID-19 positive patients - but this is not happening. Medical advisors to government continue to state that PPE controls are adequate, referencing infection control guidelines in the mistaken perception that they represent adequate health and safety controls. By any reasonable WHS measure, they do not.

A resistance to other advice and clear evidence: Hubris?

Why have CMO’s and their advisors resisted multiple calls from most of Australia’s evidence-based professional agencies, to take more precautionary workplace approaches in the face of the overwhelming evidence of failing infection controls ? This resistance to acknowledging the problem and failure to upgrade advice is now a contributing factor to the extent of the problem.

Failing to mandate the use of P2/N95 masks working with COVID patients, and continuing to resist call for that, was the first major example. The latest are statements that only a low percentage of COVID-positive healthcare staff have caught the virus from their workplace, are drawing on data from a failing contact tracing system that has an increasing number of healthcare staff with the source of infection unknown. The notion that the majority of workers are becoming infected outside of their workplace, when they are being infected at a rates many multiples higher than the general community, is frankly ridiculous.

Improper use of PPE

Improper use of PPE is extensive and known to have been the cause of infections. In the case of masks, even when the correct P2/N95 masks are used, fit testing has been almost non-existent. Fit-testing is an essential part of a respiratory protection program, yet the debate continues in our highest-risk hospitals in Victoria as to whether it should be implemented. This demonstrates more defiance and stubbornness in the face of the evidence of failures. It is critically important to provide levels of training which ensure that safe work practice is properly embedded in work behavior.

Public health experts aren’t health and safety experts

Government medical advice through CMO’s is coming from various medical panels which have generally not had health and safety expertise represented. They have been populated by epidemiologists and public health experts with a focus on patient care and community transmission. These panels have the high-level capability, but need the knowledge and skills to provide guidance that takes into account the risks that workplaces present in outbreaks, and how to address those risks.

A hidden regulator

WorkSafe Victoria has been almost invisible in the government’s response to this workplace heath crisis. Just as the many agencies are having little impact on advice to CMOs, the regulator has had no prominence in the daily advice from the Government, and does not appear to be carrying out its full role in hospitals and aged care. If they ARE acting, they're certainly doing it quietly. Many hospitals and aged care facilities are not using higher levels of PPE despite it being available, and if only some of the media reports of work conditions are well-founded, it seems clear that a number of healthcare services have been in breach of health and safety legislation. WorkSafe Victoria are the single most important agency for the prevention of workplace COVID-19 deaths in this state, and they have a leadership role to play in prevention in hospitals and aged care. They need to act now.

We can still learn from our mistakes

We can still act to reduce the damage done in Victoria and the other states and territories can learn from our mistakes.

In an outbreak we now know where one of the greatest risks is - infection of workers in healthcare - and unless we put a priority focus on the prevention of those infections or this problem will keep happening. In Victoria, health and safety knowledge, expertise, guidance and Workplace Health and Safety regulation must be urgently be brought to bear in the healthcare sector. These services need proper guidance and support from the right experts, and if they don’t take that guidance, then they need to be prosecuted.

Waves of COVID-19 may not be preventable, but rates of infection in healthcare services, and the subsequent death and suffering that comes from them CAN be vastly reduced if we apply sensible evidence-based health and safety practices, and use the protective measures that are available.