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NSW Health COVID-19

Maternity, Neonatal, Special Care Nurseries and Child and Family Health

Community of Practice

30 July 2020

Respiratory Pandemic Preparedness

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Today’s Agenda

►Welcome and update from Dr Nigel Lyons

►Pandemic Kindness Movement, Linda Soars, ACI

►Feedback from issues arising in last week

►Prof Michael Nicholl (Maternity)

►Dr Srini Bolisetty (NICU & SCN)

►A/Prof Elisabeth Murphy (Child and Family Health)

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Clinical Communities of Practice (CoPs)

Update from Dr Nigel Lyons, Deputy Secretary

► Continuously monitoring the situation - visit the CEC and NSW Health COVID-19

pages regularly

► Clinical Communities of Practice

► Bendelta consultations complete – report by August 2020

► What’s new this week

► Accelerating virtual care and telehealth

► PPE, surveillance and medication updates

► The Clinical Council – met on 22 July

► Clinical guidance and resources

► New, revised and under development

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DATA – from Jan 2020 – date

► Twenty-one pregnant women have been diagnosed with COVID-19. This represents a small

proportion of all COVID-19 cases (0.63%). None of these women identify as Aboriginal.

► Of the 21 cases, 7 most likely acquired their infection overseas and the remaining 14 acquired

their infection locally in NSW. Of those who acquired their infection in NSW, 11 were linked to a

family member who was a confirmed case or a venue where there was known transmission.

The source of infection is unknown for three of the cases whose infection was locally acquired.

► Most symptoms that pregnant women reported were mild. Of the 20 women who were

symptomatic, 15 have fully recovered. Recovery status is not yet known for the remaining

pregnant women at this stage. There have been no deaths in pregnant women.

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DATA – From Jan 2020 to dateChildren 0 – 2 years

► Twenty-eight children aged 0-2 years have been diagnosed with COVID-19. This represents a

small proportion of all COVID-19 cases (0.84%). Most (68%) of cases are male (noting small

case numbers), and one child identifies as Aboriginal.

► Of the 28 cases, 12 most likely acquired their infection locally in NSW and 16 acquired theirs

overseas. Of those who acquired their infection in NSW, 10 were linked to a family member

who was a confirmed case or venue where there was known transmission.

► There is low positivity across all children aged 0-2 years who were tested for COVID-19

suggesting low rates of COVID-19 infection among this cohort.

► Most symptoms that children reported were mild. Of the 15 children who were symptomatic, 11

have recovered. Recovery status is not yet known for the remaining children at this stage.

There have been no deaths in children aged 0-2 years.

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Updated guidance available

► Guidance for maternity and newborn services (V4)

► https://www.health.nsw.gov.au/Infectious/covid-19/Pages/guidance-for-maternity-services.aspx

► Guidance for pregnant women and new parents

► https://www.health.nsw.gov.au/Infectious/covid-19/communities-of-practice/Pages/guide-pregnant-women-and-new-parents.aspx

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Relevant issues for all areas

Important elements to remember

► Case Definitions available – CDNA National Guidelines for Public Health Units

► Confirmed case

► Probable case

► Suspect case

► Update on vertical transmission

► CEC Document – Management of COVID-19 in Healthcare settings V3.2 -http://www.cec.health.nsw.gov.au/data/assets/pdf_file/0019/582112/Management-of-COVID_19-in-Healthcare-Settings.pdf

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Relevant issues for all areas

Important elements to remember

► NSW Health has moved to a moderate risk level of Amber

► Information available in the COVID-19 Infection Prevention and Control Response and escalation framework by the CEC

► Watch PPE training videos in My Health Learning

► Mandatory training must continue

► Safe working environment

► Resources from HETI

► https://www.heti.nsw.gov.au/resources-and-links/covid-19/virtual-environments

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NATIONAL COVID-19 CLINICAL EVIDENCE TASKFORCEhttps://covid19evidence.net.au/

Provides: Living Guidelines, Clinical flowcharts, Evidence under review, Opportunity to ask a clinical question

Pregnancy and perinatal care living guideline – includes conditional recommendations

- Mode of Birth: For pregnant women with COVID-19, mode of birth should remain as per usual care

- Breastfeeding: Breastfeeding is supported irrespective of the presence of COVID-19. However, women with COVID-19 who are breastfeeding should use infection control and prevention measures (mask and hand hygiene) while infectious.

- Rooming-in: For women with COVID-19 who have given birth, support rooming-in of mother and newborn. However, women with COVID-19 should use infection control and prevention measures (mask and hand hygiene) while infectious

Listen to Professor Caroline Homer speak about the recommendations and their development.

Membership includes:

- Includes Cochrane Australia, Professional Associations, Councils and Colleges, Universities, Vic Health

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Linda Soars,Clinical Associate Director,Agency for Clinical Innovation

ACI Workforce Wellbeing Initiative

Linda Soars, Clinical Associate Director, Agency for Clinical Innovation

Focusing on the wellbeing of our health workforce during the COVID-

19 pandemic

ACI acknowledges the traditional owners of the land that we work on.

We pay our respect to Elders past and present and extend that respect

to other Aboriginal peoples present here today.

Pandemic Kindness Movement - A clinician wellbeing initiative

The Agency for Clinical Innovation (ACI) is supporting the Pandemic Kindness

Movement through a clinician-led “way-finder” website that supports the wellbeing of

all health workers during the COVID-19 pandemic.

It is based on Maslow's Hierarchy of Needs

It consists of 6 working groups of subject matter experts who curated wellbeing resources that

are:

• Up-to-date

• Evidence-informed

• Succinct

• Relevant

A collaboration with SA, Queensland and Victoria

Pandemic Kindness Leads

Tracey Tay - Clinical Executive Director, Care across the Lifecycle and Society CATALYST ACI

Samantha Bendall - Emergency Physician, Retrieval Physician at CareFlight & Ambulance NSW

Lynne McKinlay - Medical Director, Learning and Workforce

Jane Munro - Head of Rheumatology at The Royal Children's Hospital

Shahina Braganza - Emergency Physician Gold Coast Health

Mary Freer - Director, Freer thinking & Executive Producer Compassion Revolution

Kym Jenkins - President of the Royal Australian and New Zealand College of Psychiatrists

Why Maslow’s Hierarchy of Needs?

Maslow's Hierarchy of Needs provides a comprehensive view of wellbeing - physical, psychological and spiritual.

The Pandemic Kindness Movement uses a modified version to develop a broad approach to caring for our health

workforce.

The goal is to protect and boost the physical and

psychological health and wellbeing of our workforce.

There is no intention to offer any clinical or public

health advice or information, or training, except as it

relates to self-directed training in well-being

strategies.

All information links will point to advice that has

been endorsed by the expert PKM team and the ACI.

Jacqui Cross, Chief Nurse and Midwifery Officer

acknowledges the contribution and support

particularly in these current times.

https://youtu.be/bMaOxVHu33A

Podcast

Clinicians can prioritise their own

wellbeing and ease anxiety

33min Dr Lynne McKinlay Qld Health

Australian Red Cross

Pandemic Kindness Movement PKM

Lifeblood donation give blood save lives

https://www.donateblood.com.au/lifeblood

-teams/join

Responding to stress experienced

by hospital staff working with

COVID19 ….early interventions

The Kings Fund UK

2 minute toolkit – set the scene

#1 introduction video

#2 simulation video

https://vimeo.com/413005874

https://vimeo.com/413007940

Clinician wellbeing in the time of COVID19 resource examples

Accessibility to resources and support - Website

Website is hosted by ACI.

The Website is a responsive web design

(mobile/tablet compatible) to enhance accessibility

for all health staff.

Appropriate due diligence and governance of content

is carried out in accordance with existing health

policies and processes.

Physical/psychological safety is always paramount.

The Web build will ensure appropriate language is

used to support trauma-informed care and trauma-

informed kindness.

67,458 page views since launch

Most commonly “clicked” is Basic

Needs

Most popular resource set

Latest analytics

Trauma-informed kindness

Level 4, 67 Albert Avenue

Chatswood NSW 2067

PO Box 699

Chatswood NSW 2057

T + 61 2 9464 4666

F + 61 2 9464 4728

aci-info@health.nsw.gov.au

www.aci.health.nsw.gov.au

• Pandemic Kindness Movement

ACI-Kindness@health.nsw.gov.au

@PKMAUS1

• COVID Connexion – 24 hour

phone line 1300 509 989

Trusted and confidential advice for

health workers

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Specific issues and information week ending 30 July 2020

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Maternity

Issue What we know

Number of support people

allowed during labour and

birth, and number of visitors

In Victoria, new restrictions have been placed on support persons and visitors during

labour/birth and postpartum which reflect the high community transmission of COVID-

19.

NSW Health continues to maintain a conservative approach to the number of support

people allowed during labour and birth, and the number of visitors.

The Guidance for maternity and newborn care (V4) document advises that:

• for women at low risk of COVID-19, one support person may be present during

labour and birth, and one visitor postpartum, noting partners and carers should not

be considered visitors.

• for women who are suspected, probable or confirmed cases of COVID-19, one

consistent support person may be present during labour and birth, and one visitor

postpartum, noting partners and carers should not be considered visitors.

• Any compassionate or cultural considerations should be locally managed

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Neonatal

Issue What we know What we are doing Next steps

Does vertical

transmission of

COVID-19 occur?

A small number of cases have been reported, but

larger numbers in case studies have shown low

rates of transmission overall.

Irrespective of the possibility of vertical transmission

there is no requirement at this stage to change

guidance around clinical management, including the

use of personal protective equipment.

Providing clear direction in NSW Health

guidance for the COVID environment

(see links above)

Notify the

CoP if this

changes

The latest Guidance for maternity and neonatal services can be found here:

• Neonatal Services https://www.health.nsw.gov.au/Infectious/covid-19/communities-of-practice/Pages/nicu-and-special-care-

nursery.aspx

• Maternity and Newborn https://www.health.nsw.gov.au/Infectious/covid-19/communities-of-practice/Pages/maternity-and-newborn-

care.aspx

• The Safety Notice regarding the use of viral filters can be found here:

Use of Viral Filters for Respiratory Care in Neonates http://internal.health.nsw.gov.au/quality/sabs/

• Management of COVID-19 in Healthcare Settings Version v3.2

http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0019/582112/Management-of-COVID_19-in-Healthcare-Settings.pdf

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Neonatal

Issue What we know What we are doing Next steps

Is a screaming baby

considered an

aerosolising event?

A newborn baby who screams is not an aerosolising event.

The PPE Staff should wear when caring for the baby will be

guided by the individualised care plan developed following a

risk assessment.

At birth the PPE required when caring for the baby will mirror

the PPE required for the mother

Providing clear direction in

NSW Health guidance for the

COVID environment (see

links in slide above)

Encouraging clinicians to

develop individualised care

plans for women and babies

who are positive for COVID-

19

Notify the

CoP if this

changes

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Child and Family HealthNew and emerging issues

Issue What we know What we are doing Next steps

Guidance on Child and Family

Health Services

Version 5 is currently being

drafted.

Developing advice that is

focused on continuing to offer

a service adhering with the

current PPE requirements.

Districts to continue to offer

CFH services with use of a

mix of modalities.

Advice on groups Advice is required on

conducting groups in a COVID

safe manner.

Guidance is currently being

developed by the CEC and will

be available shortly.

Districts to be able to offer

group services to families.

PPE Healthcare workers are

required to wear a mask if

caring/working within 1.5m of

any patient.

Seeking specific advice on

how this applies to Child and

Family Health service delivery.

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Child and Family HealthResources for Parents and Carers

• Information for parents and carers,

Raising Children’s Network

• World Health Organisation,

#HealthyAtHome- Healthy Parenting

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Child and Family HealthResources for Clinicians

• Leading through COVID-19: Supporting health

and care leaders in unprecedented times, The

King’s Fund

• Families in Australia Survey, Life during COVID-

19, Report 1: Early Findings, Australian Institute

of Family Studies

• Stress, Resilience, and the Role of Science:

Responding to the Coronavirus Pandemic,

Centre on the Developing Child, Harvard

University

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Australian Institute of Family Studies

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Thank youAsk questions via:

MOH-maternityNICU-SCN-CFH-COVID-

19@health.nsw.gov.au

Find COVID-19 NSW Health Information:

www.health.nsw.gov.au/Infectious/diseases/Pages/coronaviru

s.aspx

Next meeting: 9am 27 August 20