Daisy Hill and Craigavon Area Covid outbreaks were 'catastrophic'

The impact of Covid-19 outbreaks in two hospitals was "catastrophic" for patients, families and health care workers, a report has found.

The authors looked at outbreaks between August and October 2020 in Craigavon Area and Daisy Hill Hospitals, in which 15 of 32 patients with Covid-19 died.

They blamed poor facilities for the high death rate.

Isolation and toilet facilities were inadequate and ventilation was poor, the report said.

And overcrowding in the Craigavon Area Hospital's emergency department contributed to transmission.

The Southern Trust said it "fully recognised the enormous distress experienced by the families and hospital staff affected."

A spokesperson said the trust was "committed to learning and improving to help reduce the likelihood of Covid-19 outbreaks in our hospitals and minimise the impact of outbreaks if they occur".

As a result of the 2020 outbreaks, the trust and Public Health Agency (PHA) commissioned a serious adverse incident (SAI) review.

• Download and read the report here

The wards involved cared for haematology, medical and surgical patients, and many of the deceased patients had severe pre-existing comorbidities and limited life expectancy. The panel concluded that Covid-19 appeared to have contributed to the premature death of 12 of the 15 infected patients.

Two patients were already receiving palliative care due to terminal illness and the report found that Covid did not "materially contribute" to their deaths. And the report found nursing care was "generally of a good standard".

But as well as the issues with facilities, the report noted that in keeping with guidance prior to the outbreaks, there was a "relative relaxation of the visitor policy".

In keeping with the Northern Ireland regional guidance at the time of the outbreak, there was no regular screening of "patient facing" healthcare workers for Covid-19.

Craigavon Area Hospital treated the highest number of Covid-19 patients in NI during the height of the pandemic

Although patients were screened for Covid when admitted, there was no regular screening of inpatients.

And poor ward environments exacerbated difficulties in managing social distancing for patients and healthcare workers, the report found.

The report also found that there was "inconsistent and inadequate information provided to patients and family regarding the outbreaks".

No formal outbreak reports had been written following the outbreaks and the report noted that these would have been of benefit.

'Inadequate PPE and poor communication'

The report also spoke to families and patients, who commented on:

• delays in accessing care

• too many visitors on the wards

• overcrowding and lack of social distancing amongst healthcare workers and patients

• improper use of PPE

• poor infection control practice

• excessive use of temporary healthcare workers

• poor communication

Healthcare workers commented on:

• the poor state of the wards and poor ventilation

• the inability to maintain adequate social distancing on the wards and in healthcare workers' facilities

• inadequate and inappropriate supply of PPE

• excessive number of visitors

• difficulties in trying to keep up with changing and sometimes conflicting infection control guidance

• poor communication regarding the progress of the outbreaks

The Southern Trust said the findings and recommendations in the report around prevention, control, and treatment of Covid-19 were "important".

"We will continue to carefully consider the report and its recommendations and involve the families in this process," the spokesperson said.

The trust said it was committed to learning and improving to help reduce the likelihood of Covid outbreaks in its hospitals and to minimise the impact of outbreaks if they occur.

The trust noted that the report concluded that infection control protocols in both hospitals were "broadly in line with recommendations and practice at the time and that the nursing and medical care provided to manage patients with COVID-19 was also satisfactory".

It said the report's points about facilities underlined "the need for significant investment to ensure all our hospitals are fit for purpose to meet the challenges of Covid and other new viruses in the modern era".

The trust also noted that the report acknowledged that at the time of the outbreak, understanding of the transmission of COVID-19 was "incomplete and evolving."