‘Be very, very careful’: Internal messages reveal difficult state of Sydney hospitals

Sydney's hospitals are struggling to cope with limited availability of critical protective equipment, with nurses at one clinic inadvertently told to break guidelines and reuse supplies.

"Please be very, very careful with your use of all types of [personal protective equipment] as stocks are in very, very short supply," one nursing director at Cumberland Hospital wrote to staff in an email on Friday. "Westmead [Hospital] has run out of visors and are using goggles."

Gladys Berejiklian is calling on NSW businesses to start thinking outside the square and help the coronavirus pandemic.Credit:AAP

It's one of many emails and an internal memo, which cover several weeks and show supply shortages hampering the operation of some clinics, and come a day after Premier Gladys Berejiklian made a direct appeal to local businesses to turn their production capacity toward manufacturing urgently required medical supplies.

On Tuesday, the nursing director told staff that she had erred when she "sent out an earlier communication which suggested reusing thermometer probe covers". "To clarify the Mental Health Service position on this, this communication was erroneous," she wrote in an email.

"I have since been made aware by one of the Nurse Managers that it is impossible to re-use a thermometer probe cover and therefore there is no point in keeping them," she wrote. "If anyone has any ideas at all about how we can preserve the [personal protective equipment] that we have please let us know."

This email came despite, in response to inquiries on Monday, the Health Department telling the Herald that staff "have not been asked to recycle or reuse supplies, including … ear thermometer covers".

Earlier, on March 17, nursing staff were also advised that the hospital's pharmacy was out of Avagard antiseptic hand sanitiser. "There is 30 cartons on order, and according to Westmead Store the manufacturer 3M is unable to supply. Westmead store is working on the problem," that email reads.

Cumberland Hospital is a specialist mental health facility adjacent to Westmead Hospital, one of the largest in the city. However, according to minutes of a pandemic planning meeting held on February 12, Cumberland had put in place procedures to deal with patients who had tested positive for the coronavirus.

"Discussions around quarantine and gazetted areas for patient cohort is currently being discussed, and details such as this and other broader service planning will be led by the executive team," the minutes read.

But staff were told on Friday that despite completing training in swabbing for the coronavirus, it had been decided that "NO … SWABBING for coronavirus is to occur at Cumberland Hospital over the next few days". "If such patients present to admissions, they should be briefly assessed to assess level of risk, e.g. suicide, and then sent to Westmead Emergency Department for medical assessment," senior managers wrote.

Northern Sydney Local Health District chief executive Deborah Willcox — who oversees Royal North Shore, Ryde, Hornsby and the Northern Beaches hospitals — has also acknowledged many staff have "raised concerns about the availability, suitability and use of personal protective equipment".

In an email circulated on Thursday, Ms Willcox said new supplies had arrived but "we continue to carefully manage our use of masks until the supply chain improves". "Hand sanitiser supply is limited so washing with hand wash and water is encouraged," she wrote.

At Nepean Hospital, and with 80 cases in the area, staff were reminded last week in hand-written notes they would be given "1 mask per day to wear". "If you are caring for a patient [with the coronavirus] you must change it after every encounter, as per normal care. As more masks arrive we will update this advice," the note reads.

A Health Department spokeswoman said there was "sufficient personal protective equipment in its public hospitals". The department will receive an additional $700 million from the Berejiklian government "to boost its preparedness for COVID-19 including, more than doubling its ICU capacity, purchasing additional ventilators and medical equipment [and] establishing additional acute respiratory clinics," she said.

One worker at Hornsby Hospital, The Sun-Herald reported over the weekend, said they were deeply concerned staff in general wards were not being given masks despite patients there testing positive for the coronavirus before being transferred to a specialised unit. "We have all been exposed … without masks," they said.

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An earlier version of this story incorrectly reported 80 patients with the coronavirus were being treated at Nepean Hospital. There were, in fact, 80 confirmed cases in the local health district who have not necessarily been admitted to hospital.

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