‘Insufficient’ occupational health resources for outbreak control

The Covid-19 pandemic has “highlighted gaps” in the occupational health (OH) service with “insufficient” OH resources identified in several hospital outbreaks, according to a HSE paper released under Freedom of Information law.

“The combination of an under-resourced service and an unprecedented increase in OH demand resulted in a number of issues; the OH service was unable to closely monitor staff, rapidly risk assess staff for derogation and provide advice to derogated staff who continued to work while identified as a close contact of a Covid-19 case,” stated the Health Protection Surveillance Centre paper, dated September 2020.

“Staff derogations were applied in several of the outbreaks, this decision was made locally. In some outbreaks derogations were made following a risk assessment, while in one hospital, a blanket derogation was applied to all nursing and medical staff, none of these HCWs tested positive for Covid-19.”

The paper also highlighted “the dearth” of public health (PH) resourcing, which was “particularly concerning” given this service held the statutory responsibilities and authority to investigate and control Covid-19.

This review described five hospital outbreaks that occurred between March and May 2020. The outbreaks ranged in size from three-to-115 cases and three outbreaks included cases of healthcare worker (HCW) infection. In the two larger outbreaks, the majority of cases occurred in HCWs.

Infection prevention and control measures, including social distancing and wearing of personal protective equipment, may have been applied to a lesser degree in non-patient facing areas of the hospital, eg, ward offices and staff changing rooms, the paper noted.

The engagement and leadership of senior management was “crucial in successfully controlling” hospital outbreaks, it found.