Download important: ebola threat!

I ISSUE
S S U E 3 11
The Employment Relations
Amendment Bill was introduced to
Parliament on 26 April 2013, received its second
reading on 19 March 2014, but was then shelved
until after the election. It was reported back to the
House on 22 October and now only requires a
third reading, and the Royal Assent.
It is reasonable to assume that the Bill will be
enacted in its current form given the Government’s
majority in which case it will come into force by
March 2015 at the latest.
In the next newsletter we will be providing more
information on the impact of the changes to
collective bargaining including strike action. Ahead
of this, the issue of meal breaks and rest periods
deserves some attention. Most of you (if not
all) will have provisions relating to meal and rest
breaks in your collective agreements, so we would
not expect much to change for you personally.
Other employees may not be so lucky!
Meal breaks and rest periods are provided
to guard against fatigue – a health and safety
provision that should be given due regard and
attention. How the new legislation will fit with
Worksafe also enacted under this Government
to protect employees from the negative
consequences of workplace risk, including that
of fatigue, is yet to be seen. It does suggest
however that our Government might be mindful
to “look” the part when it comes to Health and
Safety, but not “act” the part in reality.
You might not have pondered the “right” to a
cup of tea whilst at work before; you might have
assumed it is a given…. But it is and it never was
a given. Most employment rights are governed by
your collective agreements rather than legislation;
breaks were one provision that was protected at
law for those without a collective agreement, and
as this proves can so easily be lost. When you
next meet colleagues in the tea room or the café
for a cuppa, it might be timely to raise your cup to
your collective, give some thought to why these
documents are so important and spare a thought
for those who don’t have one.
Can we also suggest the act of skipping your
breaks gives weight to the government’s argument
that employees want the flexibility to work without
respite…..really?
IMPORTANT: EBOLA THREAT!
Readiness for emerging infectious disease
threats, including Ebola Virus Disease (EVD)
We recently attended a briefing with the
Ministry of Health (MOH) on Ebola readiness
in New Zealand. The following is a summary
of what was discussed however if you want
to know more, please have a look at the
links below and if that still does not satisfy
you, let us know.
You should also be aware of what your
employer has in place to protect you and
your colleagues from the risk of infection,
should you be involved in the care of, or in
contact with the body fluids etc. of a patient
affected (or potentially affected) by Ebola.
Before we go further – do you HAVE to
be involved in the care of a patient with a
disease such as Ebola where there may be
a personal risk to you? This question may
have been “muddied” by CMDHB recently
suggesting they would call for “volunteers”
should an Ebola patient be admitted to
their facility. Also to put in context, whilst
doctors and nurses may have a patient in
front of them who is so identified, many
of you may not know that what you are
working with has an Ebola risk associated
with it – Laboratories would be a case in
point where perhaps (not a current plan but
for the sake of example) a blood sample
seeking to determine potassium levels in a
patient with fever and diarrhoea could be….
There is a balance here between your
rights as an employee and therefore the
employers (and your own) responsibility
under health and safety legislation to
minimise risk, and the fact that it is your job
to care for people who are ill. In the lab
example, all specimens are normally treated
as infectious – because whether Ebola, HIV,
H1N1, TB, meningococcal…. We may not
know until the lab itself does the diagnosis
(and maybe not even then). So standard
protection protocols are in place… which
brings us on to the answer for the primary
question. Our view is that yes you can be
required to treat a patient IF the employer
takes all reasonable steps to ensure your
safety. In the case of Ebola, whilst much
has been said about health care workers
being infected, we must remember that
this has largely been in countries where
protection for the helpers has been minimal,
and in the case of the nurse in Dallas,
where they failed to use the protective
www.nzmlwu.org.nz
equipment provided properly.
For your information, this is some of the
advice the NZ Medical Council has given
doctors which may be pertinent to the wider
health professional audience.
•As long as the doctor has access to
and uses the correct personal protective
equipment, has the appropriate
assistance to use the equipment,
and understands and is versed in the
necessary infection control practices of
the institution, the Council expects the
doctor to be able to treat any patient with
Ebola or any other infectious illness.
•Overseas experience has clearly shown
that health care workers can safely
provide care to patients with Ebola
as long as the health care workers
adhere to the strict protocols in the use
and disposal of personal protective
equipment at all times.
•Any departure from the established
protocols places not only the doctor at
risk, but also the community at large. A
deliberate departure could be considered
unethical.
•Council does not expect any doctor to
deliberately put themselves in danger
to treat a patient in an emergency;
therefore no doctor should risk exposure
to Ebola if personal protective equipment
is inadequate or not available. Similarly
it is clear that the correct use of
personal protective equipment includes
appropriate assistance to both don
and remove the equipment. A lack of
such support would place the doctor at
unacceptable personal risk.
•It is good medical practice for all doctors
to be aware of the infection control
policies and practices in their places of
work.
contact us: [email protected]
personal protective equipment (PPE) is
used and used correctly is reportedly very
low. Plans are underway to form identified
staff groups for Ebola response and case
management in NZ and senior staff will be
identified to lead these teams. However if
you might be called on to care for a patient,
please take this opportunity to check with
your DHB as to when your training will occur,
or for confirmation that you will not be required
to be involved in care.
It goes without saying that if you have not
been trained, you cannot be required (and
should not) risk exposure. So we suggest
that rather than wait for your DHB to come
and ask you, be proactive and ask them
where their planning is at:
•Who is on the staff list of those who might
be involved in care; and
What is NZ doing?
First we have pre-screening of all passengers
at the border. NZ Customs is checking
passengers travel histories and passengers
are also being asked to self-declare.
Any risk including a level of uncertainty is
being referred to public health for further
investigation.
We have a setup with Australia to do Ebola
testing. It makes sense to limit the number of
labs doing this testing to get a level of clinical
expertise as well as limiting potential sources
of exposure and risk of spread through poor
“waste management”. That does not mean
Labs won’t have samples from patients with
Ebola should we get a case here however
(note the “process for patient management”
below).
• if you are on it, where is your training?
An Ebola Technical Advisory Group has been
formed to lead and advise best practice.
Bigger Picture
•Professor John Crump, ID physician,
microbiologist, previous experience as a
US CDC Epidemic Intelligence Service
Officer
The risk to New Zealand of a patient with
Ebola reaching us remains low. New Zealand
is isolated by travel time, distance and low
numbers of travellers to and from affected
countries; however that doesn’t preclude us
from being prepared.
And being prepared is key. Countries that
have had Ebola transmission have been able
to clear themselves of disease e.g. Senegal
had an imported case and was subsequently
cleared of infection. In the words of WHO
“an immediate, broad based, and wellcoordinated response can stop the Ebola
virus, carried into a country in an infected
traveller, dead in its tracks.
Some facts about
Ebola:
>Infection can only be acquired through
contact with infected blood or body fluids
from symptomatic individuals.
>The incubation period is 2-21 days, usually
between 8-10 days.
>Individuals cannot infect others until
they have symptoms so it is not like the
Flu where we can shed virus and infect
others up to two weeks before we get any
symptoms (hence increased need for Flue
vaccination!).
>As the illness develops, so too does
infectivity.
>Ebola is not airborne and not as infectious
as flu or measles. WHO advises that there
is also no evidence that viruses such as
Ebola change their mode of transmission –
i.e. that it will suddenly become infectious
through an airborne route?
•Dr Mark Beale, GP and ID physician, prior
experience as head of Viral Haemorrhagic
Fever unit
•Dr Colin McArthur, Intensive Care Specialist
•Dr Deborah Williamson, Microbiologist
PPE
The latest Centre for Disease Control (CDC)
guidelines for those caring for and treating
Ebola patients is - no skin exposure. Staff
members who are a part of the Ebola care
and response teams will need to have
adequate training about Ebola, and the
correct use of PPE. Middlemore Hospital
has elected to use a one piece suit to reduce
the risk of contamination, other DHB’s are
yet to formalise plans. To reduce the risk of
infection, a buddy system must be used to
ensure the correct removal and disposal of
contaminated PPE i.e. one disrobing, one
watching to ensure they do so safely.
Laboratory Testing
As we say, Ebola confirmation testing by
PCR will be undertaken by one laboratory in
Australia. The majority of testing will be done
in the patient’s room by Point of Care Testing
(POCT). Further planning around the testing
and disposal of samples that have reached
the laboratory prior to diagnosis, or for testing
for supportive therapies is underway, we have
requested details of this be supplied to us
also. Be aware of any requirement to QA
POCT that may be used or of any implications
around waste management the arise from the
POCT equipment.
Waste management of
contaminated blood/
body fluids/ samples
Whilst planning around waste disposal for
the isolation units has been made, further
planning for waste disposal in other areas is
unclear, we have asked for further details of
this to be provided to us.
Process for patient
management
From first presentation, patients (and
contacts as necessary) will be “contained”
in negative pressure rooms at the local DHB
and assessed by a clinical team on site.
Special training for individuals involved in this
front line should be underway by now (but
if it is not, please let us know). The local
medical officer of health will be notified who
will then coordinate between the referring
and subsequent receiving specialist unit/
hospital (Middlemore, Auckland, Wellington or
Christchurch). Ambulance transfer will occur
to the receiving unit.
If a patient is identified in the community,
again transfer to the local hospital’s negative
pressure facility and thereafter to the specialist
unit will occur.
Sites for treatment
of suspected and
confirmed Ebola
patients
Middlemore Hospital (located close to
the airport) is set up to take all suspected
international travellers, and to be the main
treatment centre. We have toured this facility
and can confirm they appear to have thought
of everything – right down to the possibility
that an Ebola patient may simultaneously have
appendicitis so what would we do? Other
treatment sites (we have not yet had the
opportunity to check these out) are as follows:
• Auckland City Hospital
• Wellington Hospital
• Christchurch Hospital
Useful Links if you want to know more:
•
http://www.health.govt.nz/our-work/
diseases-and-conditions/ebola-updates/
ebola-information-health-professionals
• h
ttp://www.health.govt.nz/our-work/
diseases-and-conditions/ebola-updates/
ebola-readiness
This newsletter is sponsored by NZMLWU, but the views expressed are those of the authors and do not necessarily reflect the views of NZMLWU or its National
Executive. Its contents are provided for general information purposes only. This information is not advice and members needing advice should contact their local
delegate or the union office. NZMLWU and CNS work to maintain up-to-date information from reliable sources; however, no responsibility is accepted for any
errors or omissions or results of any actions based upon this information.