Waitākere Hospital staff caring for Covid-19 patients from St Margaret's Hospital faced several problems with personal protective equipment (PPE), an urgent review has found.
The review, released at 2pm, was ordered by Waitematā District Health Board after three nurses who cared for the patients tested positive for the coronavirus.
Four other nurses, who were close contacts of the original cases, tested positive for Covid-19 after the review was requested and were not spoken to for the report.
It found the protective gowns and goggles supplied did not fit staff correctly, and some nurses used ties to hold their protective eyewear in place.
Staff had to learn how to use various brands of PPE as supply kept changing, which was stressful for staff, the report said.
Nurses had to leave the patients' rooms and remove their protective gear up to eight times per shift, it said - increasing the chance of transmission - so they could gather equipment, medications and communicate with other staff.
Covid-19 patients transferred from St Margaret's
According to the 19-page report, Waitematā District Health Board in March made preparations for the Covid-19 pandemic at North Shore and Waitākere Hospitals. These included identifying areas of the hospitals patients with Covid-19 could be placed, ensuring equipment and resources were in place, and staff were prepared.
Two suitable wards at Waitākere Hospital were identified and renovated and PPE was stocked and available, the report said.
Three patients infected with the coronavirus were admitted to the wards at the hospital in late March and early April and managed without incident, it said.
The report shows in early April, the DHB was alerted to an outbreak of cases at St Margaret's Hospital and resthome in West Auckland and asked the hospital to help manage the situation.
Staffing and the suppy of PPE quickly became issues, it said.
"Senior managers and nursing staff from [Waitākere Hosptial] were asked to volunteer to support the facility given it is an organisation independent of the DHB. Over
the following 10 days it became difficult to staff the facility in increasing numbers. There was a shortage of bureau nursing staff, the DHB had to rely on its staff to volunteer, and there was a reluctance to work at the facility."
By 16 April, the report said, it "became evident that it would be very difficult to safely staff the [aged residential care] facility over the weekend".
The next day, senior DHB agreed to move up to 20 residents out of the facility, it said. They decided to move the residents to Waitākere Hospital so they were closer to family and because of the design of the ward, it said.
Six positive cases were moved to Waitākere Hospital that day and another group of residents was moved the next day, according to the report.
Staff on the ward the six positive cases were moved to had just three hours to prepare for their arrival, the report revealed.
Upon arrival, the patients required full nursing care, "there were skin integrity issues and signs of dehydration. One of the patients required oxygen via nasal prongs. Over the following 48 hours the patients deteriorated becoming lethargic, confined to their beds, they were incontinent, all were coughing and were unable to follow instructions.
"Patients were all fully dependent on staff for their personal care."
Personal protective gear
The report found numerous problems with the personal protective gear supply at the Auckland hospital.
All staff entering the patients' rooms used gloves, fluid repellent gowns, eye protection and an N95 mask, the report said. They would don the PPE outside the patients' room before entering it and would remove the gloves and gown in the bathroom inside the patients' rooms before removing their mask and eyewear outside the room, it said.
However, the protective gowns and goggles supplied did not fit staff correctly, and some nurses used ties to hold their protective eyewear in place.
"Nursing staff were also concerned about the exposure of their hair and shoes as these areas were not required to be covered," the review said.
It said staff had to learn how to use various brands of PPE because supply kept changing, which was stressful for staff.
Nurses also had to leave the patients' rooms and remove their PPE up to eight times per shift so they could gather equipment, medications and communicate with other staff, because they could not communicate from inside the ward.
The report found the problems with PPE at Waikātere Hospital increased the risk of viral transmission.
"In a stressful environment, consistency of quality and supply of essential equipment is very important."
It urged the DHB to minimise the number of times staff put on and remove PPE, but balance this with the need to ensure staff not be exposed to infected patients for prolonged periods of time.
The DHB has been recommended it introduce a two-way communication system so staff in a Covid-19 patient's room can ask staff outside the room to do tasks for them.
Other recommendations included ensuring a consistent style of PPE was available in a variety of sizes, prioritised for high risk areas, as well as training for all relevant staff.
Three nurses and one health care assistant were caring for the six patients at one time, the report shows.
Staffing challenges meant creating a 'nursing bubble' roster for staff working only with Covid-19 patients was not possible, it said.
"Staffing challenges were exacerbated by exclusion of some staff as they are vulnerable workers and unable to work on the ward."
The DHB said it was acceptable for staff to work between wards, as long as they did not move between them in one day.
According to the report, this was reviewed by senior staff after staff raised concerns, but deemed it safe.
Staff agreed, it said, that the levels of nursing staff were "reasonable."
Waitematā District Health Board has apologised to staff who have contracted the virus.
Deputy chief executive Andrew Brant said the review highlighted that staff were well trained and the preparations at the hospital were "well advanced".
However, the DHB needed to improve its communcation with clincal staff, Dr Brant said, especially in response to an emergency situation.
It also needed to find a way of ensuring consistency of the national PPE supply, "reducing the need to change products in the middle of responding to a pandemic, which caused significant concerns to staff".
Dr Brant also called for a national plan for DHBs to support aged care facilities when the health system is already responding to a crisis.