COVID: ‘we could have done better’

The COVID pandemic provides an opportunity to shape the future of infection control within aged care facilities, expert Kathy Dempsey told delegates at an industry forum this week.

“The message is to learn from these experiences,” she said, while appearing on a panel at the ACSA National Summit.

Ms Dempsey – a chief advisor on infection prevention and control for the New South Wales Department of Health – said one of the most important lessons learned was to respond to outbreaks with more nuance.

“We had to respond very quickly and some of those early rules were set in a black and white mentality – that’s not usual infection control,” Ms Dempsey told delegates. “Unfortunately, with COVID, people didn’t see beyond restrictions.”

Speaking at the National Convention Centre in Canberra, Ms Dempsey asked: “Did we get it wrong? I think at the time there was definitely a need to protect the vulnerable. When you’re dealing with a virus like COVID, the whole aim is zero transmission.”

However, Ms Dempsey admitted: “I certainly think we could have done better, particularly around visitations. I was onsite at a number of nursing homes and to see the elderly that have been in their rooms for going on eight weeks, 10 weeks was heart-breaking.”

Governance has been one of the “major points of contention” throughout the course of the pandemic, said Ms Dempsey. “Partnerships with public health should not be a dictatorship. It should be, ‘this is what we can offer, what do you need? How can we improve the system?’”

Engagement with families and carers could have been improved upon too, she said. In future, families and carers ought to be included in outbreak management measures. “Bring them along in the journey. It’s about having conversations with the residents and their family members. There’s still a lot for us to do at a policy level to make sure that happens.”

Lack of preparedness

Also of concern, many aged care providers did not implement or embrace infection control preparedness as much as they should have in advance of COVID, Ms Dempsey told delegates. “Yes, there were standards, but when you look at those standards they were pretty light in terms of what the requirements are.”

Whilst workforce awareness of infection control has improved markedly since the beginning of the pandemic, it has been a case of too little too late, said Ms Dempsey: “So you’ve only decided to clean that piece of equipment because of COVID, but you should have been cleaning that beforehand.”  

Other basic precautions were also lacking in aged care homes, said Ms Dempsey. “You need to look at ventilation. You need to look at airflows, you need to look at air exchanges.”

Nevertheless, Ms Dempsey said it was unfair to throw aged care “under the bus” as COVID had been “an absolute battle in mainstream health as well.”

Not enough experts

Another lesson to learn from COVID is for Australia to have more infection experts on the ground. Ms Dempsey told delegates that there are only 60 credentialled infection control practitioners nationwide. “When you look at credentialling as being the benchmark to provide a consistent speciality, that’s completely undervalued,” she said.

While acknowledging that 3,000 aged care staff have been on a foundation course for infection prevention and control, Ms Dempsey said: “That doesn’t make you an IPC practitioner.”

As for how long COVID will linger, Ms Dempsey said the end is not yet in sight. “All the experts are saying we’re going to see a massive rise, another wave. We do think we’ll get other variants.”

On top of that, Australia is approaching flu season. “We are preparing for the worst winter we’ve had in a couple of years,” said Ms Dempsey. ‘Flurona’ – a flu and coronavirus combo – is a distinct possibility, she added. “The assumption is: let’s prepare for the worst.”

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