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‘Shouting and kicking’: Hospitals reveal new source of COVID spread


“Aged care wards is probably where we have had more challenges. Occasionally it will be mental health issues or substance abuse, but the vast majority would be people who were in delirium or confused.”

While Victoria recorded 43 new cases of coronavirus on Friday and four new deaths – one of the lowest daily tallies since the start of the second wave in late June – healthcare worker infections have been comparatively stubborn, falling 25 per cent the same week overall infections dropped by almost 35 per cent.

There are 888 health workers, aged care staff and nursing home residents still with active infections, more than 66 per cent of the state’s cases.

An investigation into the Royal Melbourne Hospital healthcare-worker outbreak in July and August, which eventually led to the shutdown of four wards, revealed several distressed and delirious patients with COVID-19 had been shouting, vocalising loudly, and vigorously coughing, which was suspected to have spread the virus.

Delirium is an acute state of confusion, often manifesting as either increased agitation or lethargy. There is some evidence that COVID-19 can cause, or worsen, delirium in elderly patients.

Professor Peter Collignon, an infectious diseases physician at the Australian National University, said there had been a focus on medical procedures such as intubation putting healthcare workers at higher risk of catching coronavirus.

Professor Peter Collignon, an infectious diseases physician at the Australian National University.

Professor Peter Collignon, an infectious diseases physician at the Australian National University.Credit:Alex Ellinghausen

But he said specific situations could be dangerous too.

“That’s particularly patients who you can’t control, who are patients with dementia from nursing homes, in unfamiliar surroundings,” Professor Collignon said.

In July, Royal Melbourne Hospital’s Royal Park campus, which houses its geriatric and rehabilitation wards, experienced an influx of elderly patients with COVID-19 who had been sent from aged care homes dealing with their own outbreaks.

Despite plenty of personal protective equipment being available, those patients soon passed the virus onto the small staff of healthcare workers charged with their care, according to a study of the hospital’s outbreak, led by infectious diseases physician Professor Kirsty Buising.

Patients at the highest risk of spreading the virus were placed in negative pressure rooms, but were not restrained, infection control staff said.

Some 262 healthcare workers fell sick at the hospital in July and August, 107 of them at the Royal Park campus.

“You have patients who might be extremely unwell, coughing or shouting or breathing very heavily. And they are not covering their mouth with their cough,” said Associate Professor Caroline Marshall, the Royal Melbourne Hospital’s head of infection prevention.

The hospital made a number of changes to stop the transmission, including issuing N95 masks to all staff working with COVID-19 patients, in an attempt to lessen the amount of virus workers were exposed to.

Dr Kainer said Western Health’s investigations linking multiple coronavirus cases with patients who had been shouting and otherwise spreading particles led the team to coin the phrase “aerosol generating behaviour” and influenced guidelines introduced across Victoria.

The guidelines advise healthcare workers to wear high-grade respirators when working with suspected coronavirus patients who have a risk of “aerosol generating behaviours”.

Throughout the pandemic, some hospital infection control teams have conducted in-house contact tracing. Alongside informing close contacts of staff and patients with COVID-19, they have been endeavouring to establish how people got coronavirus in the first place.

Western Health has conducted more than 200 of its own contact tracing investigations for staff and patients, each taking about 10 hours of work.

Terri Butcher, the nurse in charge of the team, said they initially found staff were doing all the right things on the ward, but letting their guard down during their breaks and taking their masks off in the tea rooms.

Nurse Terri Butcher is in charge of the contact tracing team at Western Health.

Nurse Terri Butcher is in charge of the contact tracing team at Western Health.Credit:Justin McManus

“Every time we learnt something new from contact tracing, the prevention team would be out there trying to put strategies in place to stop it,” she said.

The state government’s new healthcare worker infection prevention task force recently introduced a number of initiatives to tackle spread of the virus, including requiring all hospitals to audit their tea rooms and lockers to see if they allowed for adequate social distancing.

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