Coronavirus: ‘Poor habits, apathetic medicos to blame’

The chair of the chief advisory committee on infection control has blamed poor infection control practices within public hospitals for the high rate of COVID-19 cases in healthcare workers.

Infection Control Expert Group chair Lyn Gilbert.

The chair of the commonwealth’s chief advisory committee on infection control has blamed poor infection control practices within public hospitals and doctors’ ­apathy for the high rate of COVID-19 cases in healthcare workers, rejecting airborne spread of the virus as the predominant mode of transmission.

Lyn Gilbert, chair of the Infection Control Expert Group, has rejected accusations that inade­quate guidelines on the use of personal protective equipment contributed to the spread of coronavirus among thousands of healthcare workers in Victoria who tested positive to the disease.

Professor Gilbert, a clinical professor in immunology and infectious diseases, said many doctors had until recently had “little interest” in infection control, and hospitals had failed to instil robust practices.

More than 3500 healthcare workers in Victoria have tested positive to COVID-19, with 2602 of those infections acquired in the workplace, health department figures show.

Professor Gilbert said accusations of failure to protect healthcare workers by the ICEG, which advises chief medical officers who sit on the Australian Health Protection Principal Committee, were misguided. “This committee consists of some of the most experienced experts in infection control and infectious disease in the country. Some people who have most strongly criticised us have been doctors who until recently had little interest in routine infection control designed to protect patients. They are quite rightly concerned when they feel themselves to be at risk, but a lot of people who’ve never been experts have suddenly become experts.

Q&A: Infection control chief answers critics

“Even if the guidance had been wrong, there are lots of reasons why healthcare workers have become infected not related to the guidance … Unfortunately, there’s been an attitude amongst hospital administrators, in the past, that infection control is something that can be managed by appointing a few infection control professionals. But they don’t put a lot of effort in to actually making sure that healthcare workers observe infection control measures.”

Many doctors have urged nat­ional infection control guidelines to mandate wearing respirators during the care of patients with untriaged respiratory illness and suspected/confirmed COVID-19.

ICEG’s guidelines state that “the use of PPE, including masks and respirators, is relatively low in the hierarchy of controls for managing risk”. The guidelines stipulate that only a surgical mask is required in routine care of patients with suspected or confirmed COVID-19, but that a P2 or N95 respirator may be worn where there are high numbers of suspected or confirmed COVID-19 patients and a risk that a patient may exhibit “challenging behaviour”.

Doctors say the advice ignores evidence that aerosol transmission is a major mode of spread of COVID-19, but Professor Gilbert said she believed aerosol transmission was a mostly “a small part” of the spread of disease.

Professor Raina Macintyre, the head of the biosecurity program at the University of NSW’s Kirby Institute, said “there’s very convincing evidence of aerosol trans­mission of SARS-CoV-2”.

“We need recognition that respiratory aerosol transmission is the predominant mode of spread; until we have that recognition, we’re going to keep seeing infected health workers and preventive measures will not be optimal.”