‘It’s our duty to help’: Hospital steps up pandemic plan

It has been more than a decade since Jillian Hickey worked in intensive care, but when the experienced nurse was called on to redeploy to a new ward caring for patients with COVID-19, it didn’t feel like she had much of a choice.

"It almost sounds cliched saying it’s your duty, but you do feel compelled to because you know that you can help," she said.

Critical care nurse Jillian Hickey.Credit:Justin McManus

Ms Hickey is among a team of 50 extra nurses that have been assembled to staff Cabrini hospital’s new 14-bed intensive care unit, one of the first completed expansions for the coronavirus pandemic.

The facility was put together in a few weeks and planning for how it will be managed provides insight into how hospitals around Australia may adapt to handle the expected influx of seriously ill patients.

At the peak of the pandemic, Cabrini doctors are planning for up to 30 per cent of staff to be unavailable because they are in isolation, while nurses have been brought in as "spotters" to ensure anyone working with infectious patients wears protective equipment properly.

Associate Professor David Brewster, intensive care deputy director, outside two of the new intensive care rooms at Cabrini hospital.Credit:Justin McManus

The Malvern hospital has begun admitting patients with COVID-19 to existing ICU facilities, but it is now prepared for many more.

A former paediatric ward has been stripped of toys and replaced withbeds with ventilators, many of which were nearing the end of their life but have been revived with batteries made by the hospital’s engineering department.

All the rooms are "negative pressure" – which means viral particles are sucked up by a vent in the ceiling instead of being blown around.

"It means if there are any droplets in the air with viral particles, they will be cleared out of the room, which makes the staff safer," said the deputy director of intensive care Associate Professor David Brewster.

Across Victoria, plans like this are being put in place at hospitals. Some already have unused intensive care beds to call upon, while others are expanding into different areas, such as operation recovery wards.

Registered nurse Seema Chauhan.Credit:Justin McManus

"It’s like a sprinter in the starting blocks ready to go as soon as the starter’s gun goes," said Dr Stephen Warrillow, a director with the Australian and New Zealand Intensive Care Society.

Senior staff at Cabrini’s ICU decided to expand their intensive care capacity in early March. Within a month they had increased the number of beds with ventilators from 12 to 26, with a further nine available at short notice.

One of their first steps was to more than double their specialist medical staff, recruiting 15 private anaesthetists who will help part-time on the ward.

Meanwhile, 50 registered nurses who have put their hands up to join the ICU team under supervision are undergoing weeks of additional training, including being taught skills in ventilation and dialysis. Some may do other types of job that don’t need critical-care training.

ICU nurse unit manager Helen Thompson said one "spotter" would be allocated to every four beds to check everyone’s personal protective equipment was put on correctly.

David Brewster, ICU nurse manager Helen Thompson and ICU director Associate Professor Vineet Sarode.Credit:Justin McManus

"No visitor, no doctor, no cleaner, no one goes in until the spotter says you're safe," she said.

Ms Hickey, who is rejoining intensive care after more than a decade working in operating theatres, said she would shower at work, then use an outdoor shower at home.

She left intensive care because the long hours and night shifts made it difficult to care for her three children, but the lockdown has made it possible for her to take on the role again – because her children, aged 12 to 16, are not going to school or sport.

Cabrini hospital is planning to provide intensive care for COVID-19 patients.Credit:Justin McManus

"I have the skills to help," she said.

Cabrini's ICU director Associate Professor Vineet Sarode said he was planning for one-third of his workforce to be in isolation or otherwise unavailable during the worst of the pandemic, with doctors and nurses forced away from the hospital after coming into contact with COVID-19 in the community or at work.

During normal operations fewer than 5 per cent of nurses are away at any one time, Associate Professor Sarode said.

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