Coronavirus: Nursing home memo urges staff to set up ‘dirty’ and ‘clean’ areas

Transmission of the coronavirus in a Dublin nursing home has become widespread in recent days and is now affecting more than a fifth of the 200 residents, according to an internal memo.

There is evidence of coronavirus outbreaks across nearly all units in St Mary's Hospital in the Phoenix Park, which has seen 11 Covid-19 related deaths in a two-week period.

The internal memo, dated April 13th, says that apart from one section all units in the home have “ evidence of more than 20 per cent” confirmed or suspected coronavirus infection.

“It is reasonable to assume that transmission is generalised. Therefore, in the context of generalised transmission, the entire clinical areas of the unit is designated a contaminated zone,” said the memo, which was circulated among staff in recent days.

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A source in the facility, which is run by the Health Service Executive (HSE), said the number of cases was likely even higher due to testing delays.

The home, which has 198 residential places, confirmed on Thursday night that 10 residents who had tested positive for Covid-19 and another suspected to have the condition had died within a two-week period.

The memo to staff set out measures to try and contain the spread of the virus by setting up “clean” and “dirty” areas.

It advised all staff to wear personal protective equipment (PPE) upon entry into a “contaminated zone” with suspected or confirmed cases. Staff treating patients in these zones were instructed to provide care to all residents “wearing the same PPE for each care period”.

Healthcare workers should change gloves between patients but were instructed to remain in the same gown, surgical mask and eye protection.

Medical gloves

Guidance from the Health Protection Surveillance Centre (HPSC) for residential care facilities dealing with Covid-19 outbreaks state staff should "ideally change their PPE" after every contact with a positive patient.

The HPSC’s advice outlined that in “exceptional circumstances” this can be limited to just a change of medical gloves if staff are caring for a group of patients with Covid-19.

To avoid spreading the virus, staff should begin by providing care to asymptomatic patients first, then suspected Covid-19 patients, and lastly confirmed cases, the St Mary’s memo said.

The instructions said the “clean zone” in the nursing home should if possible include the staff office space and toilets. “Residents should not have access to the clean zone – the latter point can be difficult to manage,” the memo said.

The memo referred to asymptomatic patients as the “cleanest”, those who were suspected cases as “dirty,” and confirmed coronavirus cases as the “dirtiest patients.”

The memo was written after a visit to the facility from Prof Martin Cormican, the HSE national clinical lead on infection control.

In a statement, a HSE spokeswoman said the memo was drafted internally within the hospital but was issued “without any formal approval”.

She said the memo, which stated the measures were based on the recommendations from Prof Cormican, was not written with his input.

“It is our strong preference that this unapproved memo and the information contained within it is not published.”

However, she did not dispute the figures in the memo and confirmed “that a significant number of residents have been affected by Covid-19 within St Mary’s Hospital.”