Table 3 Themes and subthemes derived from thematic analysis of WBPHU outbreak documentation
Themes | Subthemes | Quotes – Enablers | Quotes - Barriers |
|---|---|---|---|
Resources | RATs | ‘Over 1000 RATs’ | ‘RATs reserved for symptomatic cases’ |
PPE | ‘Adequate PPE supply’ | ‘Delayed access to PPE even with known cases’ | |
Antivirals | ‘Recent supply of antivirals largely untouched’ | ‘Difficulty accessing prescriptions for antivirals’ ‘Ran out of antivirals due to recent outbreak’ | |
Communication | PHU | ‘Routine daily update from facility…’ | ‘Difficult to contact facility, sent emails and left voicemail’ |
External stakeholders | ‘daily contact with COVID virtual ward’ | ‘Case acquired in hospital… facility unaware of [need to] isolate’ | |
Case detection | Symptom monitoring | ‘Checklist of symptoms performed routinely’ | ‘Difficult to distinguish COVID-19 symptoms from COPD’ |
Detection of cases | ‘Low threshold to test residents if symptomatic’ | ‘Staff working while symptomatic from recent booster vaccination’ ‘Asymptomatic staff working while infectious’ ‘Multiple residents refused testing’ ‘Resident mildly symptomatic but low CT value’ ‘Unsure who was present in dining room with [case]’ ‘New resident case… retested when actually historic case’ | |
RAT vs. PCR | ‘Staff RATs prior to each shift’ ‘Symptomatic resident tested immediately via RAT’ ‘RATs for [close contacts] commenced immediately’ | ‘Symptomatic staff attending work if RAT negative’ ‘[staff] reported RAT positive but PCR negative’ ‘Resident symptomatic but RAT negative… [moved] around facility’ | |
Delayed results | ‘PCR results received promptly [next day]’ ‘PCR testing arranged for [tomorrow]’ | ‘PCR results pending from [6 days prior]’ ’48 hours for Commonwealth to approve PCR testing’ ‘Swabs lost…’ ‘Unable to lift restrictions as some PCR results still pending’ | |
Staffing | Cohorting of staff | ‘Non clinical staff working from home to provide ongoing support’ ‘Staff cohorted to [area] on a permanent basis’ | ‘Unable to cohort due to staffing shortages’ |
Workplace exclusion – close contacts and cases | ‘Staff furloughed until day 8’ ‘All staff close contacts furloughed’ | ‘Close contacts attend work unless symptoms develop’ ‘Unsure where [staff case] worked and close contacts’ | |
Breaks alone | ‘Staff breaks taken alone and outside’ | ‘Staff taking breaks with a buddy’ ‘Shared smoking breaks occurring’ | |
Staffing shortages | ‘Staff who agree are working 12 hour shifts’ | ‘Staff calling in sick rather than working’ ‘Unsafe staff numbers’ ‘Agency staff not available’ ‘Multiple staff absences due to COVID or booster vaccine side effects’ ‘Majority of staff off with COVID’ ‘Extreme staff shortages… asymptomatic COVID-19 positive staff to work with positive residents’ ‘Much needed recruitment paused due to outbreak’ ‘Staff shortages at baseline… now critical’ | |
PPE use | ‘Staff wearing N95 mask and goggles at baseline’ ‘PPE increased on [day initial case detected]’ ‘Separate donning and doffing stations’ ‘Recent PPE training for staff’ | ‘Staff wearing surgical masks during outbreak’ ‘PPE removed at nurses station’ ‘Staff redonning dirty masks’ ‘Removing masks when required’ (RASS) ‘Multiple PPE breaches identified in case interviews’ ‘…reinforced importance of PPE with staff’ | |
Facility perception |  | ‘Red zone commenced’ ‘All positive residents referred straight away to GP’ ‘Screening of close contacts has already commenced’ | ‘Facility asking daily if they can come out of lockdown’ [in context of ongoing transmission] ‘Staff member refused to wear PPE during night shift… looked after positive and negative residents’ |
Infection control | Cohorting of residents | ‘Cohorting residents into positive, negative, recovered to reduce PPE burden’ ‘Cohorting residents in [name of wing/area] from [name of other wing/area]’ ‘Ceased group activities, residents having meals in rooms’ | ‘Due to behaviours in our dementia unit, residents unable to be cohorted’ |
Isolation | ‘[case] prefers to stay in their room’ ‘has not been outside his room in days’ | ‘Resident wandered into the room of a positive case… getting into PPE bins’ ‘[case] has been sitting in corridor’ ‘Doors open [of positive case’s room]’ ‘Visitors to positive cases’ | |
Cleaning | ‘Regular disinfection… signage for high touch areas’ ‘Extra bins supplied and daily emptying of bins’ |  |