How to handle a cluster
Atawhai Assisi Rest Home in Waikato was NZ’s first care facility to battle a Covid-19 outbreak. But there have been no deaths. Belinda Feek finds out why.
Kitted out in PPE, they cleaned the handrails and the common use areas. It may have saved lives. At Atawhai Assisi Rest Home and Hospital, just south of Hamilton, 37 staff had been sent home and all the residents were in lockdown after one resident tested positive for Covid-19.
Tamahere Eventide Trust chief executive Louis Fick and his remaining staff had to swing into action, working double shifts and even finding onsite accommodation for staff whose landlords would no longer support them.
Fick credits the clean-quarantineand-send-home method as the key to keeping a stronghold on the virus and escaping its deadly grasp without any loss of life.
On Thursday, the last remaining resident still afflicted with the virus returned a negative result. The rest home is now clear of coronavirus.
The outbreak at Atawhai — which the trust owns, along with the Tamahere Eventide Home & Retirement Village — began in mid-March, before Kiwis were holed up inside their homes under strict level 4 lockdown rules.
One resident’s Australia-based daughter returned a positive test after visiting the rest home, which has 40 rest home level beds and 46 hospitallevel beds.
On March 20, 27 of the staff were immediately sent home and all residents isolated in their rooms after management received word from the daughter.
A further 10 staff were sent home when a resident tested positive.
It put Atawhai in the spotlight as the country’s first rest home Covid-19 case and cluster.
Five other rest homes around the country would later have their own outbreaks, several with fatal results. Canterbury’s Rosewood Rest Home accounts for 11 deaths alone in New Zealand’s fatality rate, which on Thursday sat at 21.
Though Atawhai was the country’s first rest home cluster, it managed to avoid any deaths.
Fick, who has been at the helm for
22 years, believes the lessons learned from past outbreaks of illness helped Atawhai staff and residents get through.
Fick was in charge when the contagious norovirus clawed its way on to New Zealand’s shores around
2004.
The elderly and the vulnerable were especially susceptible to the virus, bearing the brunt of its symptoms: vomiting, diarrhoea, fever, chills and muscle aches.
Having dealt with norovirus and earlier illnesses, Fick says the rest home was ready with a pandemic plan, which included the concentrated cleaning of common surfaces and isolating all staff and residents they deemed close contacts.
Of the 37 staff who were sent home for self-isolation, eight returned a positive result.
Four residents in Atawhai’s hospital service were isolated and three tested positive.
“However, none of the residents who tested positive became sick or showed symptoms.”
By the end of April, they had carried out 166 swabs of staff and residents.
Fick says the trust has an “ongoing active infection control procedure” for its facilities.
Training courses in infection control are updated annually which includes training on handwashing.
“Once we knew that we could have a case of Covid-19 we locked down our sites and isolated residents to their rooms to give us time to evaluate how we were going to deal with the situation.
“In aged care, outbreaks of viruses happen from time to time and we learn what responses work best.
“A norovirus some years ago was defeated quickly in our rest home at Eventide with cleaners wiping the corridor rails a minimum twice a day.
“Procedures are updated over time. In the above example we made
part of our outbreak plan cleaning of the hand rails and prioritised cleaning common space ahead of individual rooms as we had proven that this approach reduced the spread of a virus.
“So when this virus was suspected we immediately went into pandemic mode, rolled out our outbreak kits and everyone started working to the plan.”
Waikato DHB staff were making multiple visits a day, but communication was also key.
“I believe that you must let the staff on the front line have access to management to allow issues to be dealt with quickly.
“We had little choice here as our two clinical nurse leaders were stood down within a week of the lockdown.”
A couple of days in, managers were attending both morning and afternoon handovers at the hospital to find out what was working and what wasn’t.
“A critical question we asked of staff was ‘is there anything you need to do your job?’
“We then fixed these issues quickly and efficiently and as a result the front line staff believed in what we were doing and worked hard to keep this virus at bay.”
All requests were dealt with, even if it meant digging deep into pockets; when they needed equipment and supplies Fick “just ordered it”.
“So having a healthy business and liquidity helps as well and this comes from good management and governance right across the leadership team.”
That financial position helped provide new hot boxes for the delivery of food and getting motor homes and caravans on site to house staff who had been pushed out of their accommodation by nervous landlords, fearful of their own Covid-19 outbreak.
While managers attended to the needs of staff and residents, the phone was ringing off the hook with calls from concerned family members.
“We went on the offensive and produced a daily newsletter and emailed this to staff and residents’ families keeping them up to date.
“The phone calls then slowed down, allowing us to concentrate on the task at hand.”
A private Facebook page for residents and their families was also set up.
The facility got into its new rhythm; the continuous hand washing, the daily uniform and clothing washing, the immediate showering upon returning home.
Staff remained in their designated areas, not moving between the rest home or hospital. Managers set up distancing, and separate kiosks for staff entering and leaving work, with sanitisation stations at each. They even bought in infrared temperature equipment for staff to use at the start of each shift. Turning up for a workplace short by 37 staff, many of them highly skilled, and working 24/7, Fick says everyone knew “there was a mountain to climb”. More than half of those workers who were selfisolating were integral care staff. Just under two thirds of his total 100 staff were left.
“The faces were a mirror of scared individuals. Nurses and carers and cooks and cleaners and gardeners and maintainers are ‘doers’ by nature.
“When they started ‘doing’ the task at hand, it seemed to diminish somehow into what needed to be done and what things could wait. “There were truly not enough hands that first week to do the work.” They had to get more hands on deck. They needed volunteers. The first call was for staff to work double shifts, often in alternative areas of the business.
“Our trainer and nurse manager and physio and day programme organiser just changed roles and started nursing and caring.
“They were the first volunteers. Then staff just put up their hands and worked double shifts, filling in the gaps as our second volunteers.”
DONNA HALL, a registered nurse stuck in the area as she was unable to travel back to her job in rural Australia, put her hand up to help. She continues to cover shifts. Then there’s Robert Brooks, a 53-year-old authorised officer at Hamilton District Court, which was closed during level 4.
He took long service leave and annual leave and “just came in to help”, Fick says.
“We knew him already and quickly worked out that his role in the courts assisting and caring for vulnerable prisoners ... matched what we had a gap for.”
He donned the PPE too, and was one of several volunteers who helped feed residents and take them outside for walks in the gardens.
While volunteers helped, Atawhai still had to hire casual staff who knew their way around a rest home to fill in the remaining gaps.
“This had to be done quickly. There was no time for our usual orientation of new staff.”
Being down so many staff was daunting for those still left at work.
“Staff were anxious about the possibility they could contract the virus and impact on their families.
“The staff in the hospital who remained rolled up their sleeves and got to work. They were fantastic . . . and supportive of each other.”
All of the infected staff have recovered, and most have returned to work. A couple continue to have “ongoing problems” despite negative
staffing issues initially as many staff had to be stood down”.
“I think the results speak for themselves — considering the virus we are dealing with and the impact it can have on ARC facilities, there was a relatively low number of cases, particularly among residents, and thankfully no deaths.”
As the country prepares for a possible move into level 2, Atawhai remains
“We are still operating now as if we were in level 4, not level 3.
“If the country moves to level 2 we will be very reluctant to.
“We don’t know what level 2 means for aged residential care, but we will be reluctant to move down those levels until all our clusters are clear of Covid.”
All six rest homes with Covid-19 clusters are in the middle of a review, which is being led by a panel of experts involving senior staff from the Ministry of Health, DHBs, and Dr Francis Hughes, who is also on the association’s leadership group.
“They will be looking at everything that’s happened at each of those facilities, their infection control processes, their visitor protocols, all of those and more.”
The review will be completed by the end of this month. With Covid-19 getting into just six of ACA’s approximately 600-member rest homes, it showed how prepared the industry was, says Wallace.
“I think that, on the whole, aged care in New Zealand has done a remarkable job of managing the situation when compared to what’s been happening overseas.
“We’ve had it in six facilities, that’s not a good situation, but actually in the context of 650 facilities in New Zealand, for what is a very aggressive and tricky virus to manage I think we’ve done really well.”