Liverpool Hospital’s Covid-19 safety protocols under scrutiny

The Sydney hospital at the centre of a growing cluster of Covid-19 cases and deaths has had three unconnected infection breaches.

Liverpool Hospital in Sydney’s southwest. Picture: Jeremy Piper

The Sydney hospital at the centre of a growing cluster of Covid-19 cases and deaths has had three unconnected infection breaches, including one that occurred after management rejected advice pleas to test a patient from a hotspot zone before an operation.

Seven patients from Liverpool Hospital in Sydney’s southwest have died, and dozens of staff and patients have contracted the virus, since the first case almost four weeks ago.

Operating theatre staff at the hospital were placed at risk on July 14 when a patient from the Fairfield local government area – then the epicentre of Sydney’s Delta outbreak – was taken into theatre without operating staff knowing a Covid-19 swab had been taken pre-operatively, which turned out to be positive.

Staff learned of the woman’s positive status during her caesarean section operation, and none was wearing a N95 mask. Two days later, an anaesthetist who had worked across Liverpool and Campbelltown Hospitals tested positive for Covid-19.

And in late July, a nurse who had only received one dose of a vaccine brought the virus into Liverpool Hospital’s geriatric ward, where it spread to at least six other staff members and ultimately 29 elderly patients, seven of whom have now died.

Doctors first became alarmed at the infection prevention procedures at Liverpool Hospital in mid-July when management deemed pre-operative Covid-19 testing was not necessary for ­patients from hotspot locations.

On July 14, the woman from Fairfield presented for a caesarean section at the hospital. A senior surgeon at the hospital had issued a directive that all ­patients from Fairfield LGA should be tested for Covid-19 before surgery, but the surgeon on duty on the day of the woman’s caesarean disagreed with the ­decision.

The matter was escalated to management and it was decided that the woman’s operation should proceed without Covid swabbing in line with NSW Health policy at the time.

That directive came after the woman from Fairfield had been swabbed for Covid. Her result did not come back until she was already in theatre. Staff in theatre received the news that the woman, who was asymptomatic, was Covid-19 positive during the procedure.

All of the surgical staff were wearing only surgical masks and no gloves, gowns or other PPE.

The hospital began to test all patients going into surgery and required full PPE for staff only after the woman’s case.

“There have been several significant failings due to a top-down approach to management and clinicians and nursing staff being ignored, and this has led to the disaster developing in the South Western Sydney Local Health District,” one doctor said.

Liverpool Hospital said in a statement that that “NSW Health policy at the time did not require a negative Covid result for the (caesarian) to proceed”.

“All staff working in high-risk clinical areas including those involved in surgeries are required to wear full PPE equipment including N95 masks and goggles,” a spokesperson for the hospital said.

The woman from Fairfield who had the caesarean does not appear to have spread the virus to anyone else at the hospital. An anaesthetist who worked across Liverpool and Campbelltown Hospitals also tested positive for Covid-19 on July 14, but that case was unrelated to the woman who had the caesarean section.

Liverpool Hospital was hit by a further outbreak in late July when two nurses working in the geriatric ward and across other wards tested positive.

Eight ­patients from the geriatric ward tested positive on July 27 and the virus spread to 29 other patients.

By August 12, seven elderly patients infected in the outbreak had died. NSW Health issued an apology to all patients and their families on August 6.

Health Care Workers Australia spokesman Benjamin Veness said it defied logic that operating theatre staff were not wearing full PPE and observing airborne precautions in circumstances in which a Covid-19 swab had been taken on a patient and the result was still pending.

NSW Health guidelines require N95 masks and full PPE are worn when healthcare staff are caring for suspected or confirmed positive patients.

“It’s entirely reasonable in an outbreak scenario to be requiring patients to be swabbed before surgery, and in a circumstance where you can’t wait for the swab result to come back it stands to reason that you should treat that patient as a suspected Covid patient and employ full Covid precautions,” Dr Veness said.

“That would mean airborne precautions, including a fit-tested N95 respirator and eye protection, given that SARS-CoV-2 transmits via the airborne route.”

NSW Nurses and Midwives Association general secretary Brett Holmes said he was concerned staff had been placed at risk.

“I’m surprised to know that the hospital did not have a procedure in place to screen patients before surgery,” Mr Holmes said.