Dr Tony Bartone - Infection control at aged care facilities

VIRGINIA TRIOLI:  Dr Tony Bartone is the Federal President of the AMA. Dr Bartone, good to talk to you again. Good morning.

TONY BARTONE:    Good morning, Virginia.

VIRGINIA TRIOLI:  Is this evidence that infection control at aged care centres has been poor?

TONY BARTONE:    What we can say is that it's evidence that the system’s under stress and under-resourced. So, if we just step back a bit, last September, we as an association, stood side by side with the nurses, the Australian Nursing and Midwifery Association. At the Royal Commission, we said we needed more doctors and more nurses in aged care facilities to deliver the clinical care that residents require, because of the increase in complexity of conditions and co-morbidities that these residents were coming into facilities with.

So, the COVID-19 pandemic has sharpened that lens of necessity, you might say, and really focused the attention on the underlying lack of resourcing in the sector, particularly. So, COVID-19's come in, we know that these facilities were going to be potential sources of outbreaks and high-risk areas - they were. It was focused that they needed to increase their infection control measures which, according to the accreditation standards, are very significant to begin with. But because of that increase in clinical need in residents coming into these facilities, of course, it's- no one understands that infection control better than doctors and nurses. And so-

VIRGINIA TRIOLI:  [Interrupts] I just want to jump in there, though, and I'm not arguing with you about the lack of resourcing for these particular centres. But right at the beginning of COVID-19, when abattoirs and aged care facilities were identified as real at-risk areas for outbreaks of COVID-19, that wasn't necessarily to do with whether they were under-resourced or not. I mean, is it really an issue of resourcing when it comes to basic infection control?

TONY BARTONE:    Well, unfortunately, it really comes down to having the redundancy in terms of that resourcing. So, if you've got staff members that are unwell, that can't come into work, you need to replace them. In an already constrained environment, that puts additional stress on other measures that need to take place in terms of the clinical care - number one. Two, you need to have additional levels of cleaning and other practices that go on to ensure that the facilities remain at the highest standard of infection control possible. So, all this flows through the system.

Then, unfortunately, if one resident does develop symptoms, they need to be managed in their room away from the rest, especially if they have clinical needs that are above the usual expectations for aged care residents. That again puts further stress in terms of everything from dressings and bandaging and other activities that need to be looked at in that process.

So, it just highlights the increasing clinical need of our aged care residents to begin with and the importance of infection control. And it only requires one slip up in that process to then create a situation. And then, from there, it's easily spread.

The measures that have been put in place now, in terms of visiting residents, families of residents visiting facilities, the temperature checks, limiting of number of people in; they're appropriate. And it's a really difficult balance but it really comes down to that, you know, if you look at what's having to be required. When we get an outbreak, we're having to fly in specialist teams of doctors and nurses to bolster the resources at those facilities to ensure that we're lifting that infection control up to the highest level possible.

VIRGINIA TRIOLI:  It sounds - if I'm interpreting you correctly - and Dr Tony Bartone's with you this morning, the Federal President of the AMA, speaking about the outbreaks of COVID-19 at a number of aged care facilities this morning. If I'm interpreting you correctly, Dr Bartone, you do seem protective, if not defensive, of the aged care facilities in a sense that you seem to be saying they've done the best they can, they're not at fault. It's the under-resourcing of the system that's the issue? Or do you think they could have done better?

TONY BARTONE:    At a sector-wide level, that's the case. Obviously, we know - because of the reported notices on accreditation through the process - that there are a number of facilities that have not met the standards required. That's a case by case issue. But at a sector-wide level, the under-resourcing remains a key factor in all of this as well. But of course, can some facilities do better? Absolutely.

VIRGINIA TRIOLI:  [Talks over] Sure. But Dr Bartone, there's been such a deal of, you know, variation between facilities - those that have fallen prey to this and those who haven't. Are some much better than managing this than others? And, if that's the case, does that then actually take us away from the issue of this simply being a sector-wide resourcing one?

TONY BARTONE:    Virginia, there is no doubt in my mind that some facilities are coping and adhering to the requirements better than others. Now, without commenting on any specific facility, obviously, the investigations will show where that has been the case and where it hasn't. But just because there hasn't been a case reported doesn't mean that that facility is beyond reproach and doesn't need to draw attention to its own standards of infection control and the processes put in place there.

I think it's highlighted that the sector is vulnerable. COVID-19 has created an increased stress on an already weakened system, and we can expect, I would imagine, further occasions such as these that we've had to confront in the past few months occurring again and again as we continue to deal with this long-running battle with COVID-19.

VIRGINIA TRIOLI:  Dr Bartone, thanks for joining us today.

20 May 2020

CONTACT:        John Flannery             02 6270 5477 / 0419 494 761
                            Maria Hawthorne        02 6270 5478 / 0427 209 753

Follow the AMA Media on Twitter: http://twitter.com/ama_media
Follow the AMA President on Twitter: http://twitter.com/amapresident
Like the AMA on Facebook https://www.facebook.com/AustralianMedicalAssociation