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Associate Professor Noleen Bennett, Senior Infection Control Consultant at the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre and the National Centre for Antimicrobial Stewardship (NCAS) at the Doherty Institute.

Can you introduce yourself and your role at the Doherty Institute?

I am an infection prevention and control (IPC) Consultant, currently employed at both the Victorian Healthcare Associated Infection Surveillance System (VICNISS) and the National Centre for Antimicrobial Stewardship (NCAS). At VICNISS, I am the coordinator of the Victorian smaller hospital and Public Sector Residential Aged Care Services healthcare associated infection surveillance programs. At NCAS, I am the project coordinator of the annual Aged Care National Antimicrobial Prescribing Survey. Since late March, I have been seconded to the Department of Health and Human Services (DHHS) part time to assist with the state-wide infection prevention and control (IPC) response to the COVID-19 pandemic. 

What initially attracted you to the field of infection control and aged care?

IPC encompasses both a scientific evidence based and practical approach to preventing and managing infections. Also, it ideally involves working with all disciplines, including infectious disease physicians and epidemiologists. In the aged care sector, the implementation of best practice IPC recommendations is critical because frail elderly persons are especially and tragically at high risk for the development of infectious diseases, as has been clearly evident during the COVID-19 pandemic. 

What projects/initiatives are you currently working on?

As part of the department IPC cell, I am currently reviewing high level policy advice about personal protective equipment (PPE) use in Victorian residential aged care facilities. For example, it has been queried as to whether all aged care workers or only those who have face-to-face contact with residents should be required to continuously wear eye protection. To answer this query involves reviewing the literature and consulting with key stakeholders. Current PPE recommendations for the Victorian facilities differs from similar facilities in other states/territories because of the significant community transmission of COVID-19 within Victoria. 

What are the principles of infection control? 

Similar to the ‘hierarchy of control’ applied in many industries, IPC principles rank from the highest to lowest levels of protection and reliability. In order of ranking, the principles are physically removing the hazard (elimination), replacing the hazard (substitution), isolating people from the hazard (engineering controls), changing the way people work (administrative controls) and providing PPE protection. 

How do these principles related to controlling the spread of COVID-19, particularly in aged care facilities? 

The best method for preventing and controlling infections in all settings - aged care facilities included - is that everyone (staff, patients or residents and visitors) consistently and diligently applies the recommended IPC practices for each principle. An example of a recommended practice for each of the principles (highest to lowest ranking) include requesting unwell persons stay home, planning for alternatives to aerosol generating procedures (e.g. nebulisers) where possible, using single rooms for COVID-19 patients where available,minimising face-to-face ‘close contact’ between staff during breaks and using personal protective equipment as recommended. 

What do you believe is the biggest challenge in your line of work?

An immediate and significant IPC challenge is to provide coordinated support and standardised advice to the Victorian residential aged care facilities. These facilities are grateful for the IPC support and advice they are currently receiving from many different governing groups; not surprising, however, they are finding the enormity of sometimes conflicting information from the different groups somewhat overwhelming. 

What have your insights been from assisting with the COVID-19 pandemic?

First and foremost, the unwavering intent of staff working across different settings is to protect the health and safety of their clients and colleagues. Specific to the aged care sector, I agree with the Royal Commission into Aged Care Quality and Safety findings recently published in a special report about the impact of COVID-19. Of note: “There is nothing more important to help providers prepare for and respond to COVID-19 outbreaks than access to high level IPC expertise”. 

I, like all involved with the aged care sector, will need to take any ‘key lessons’ learned from the COVID-19 pandemic and work to effect long term meaningful positive change. This will obviously involve engaging with governing bodies to ensure that the Royal Commission into Aged Care Quality and Safety COVID-19 recommendations are implemented.  

How should we be preparing in advance for infection control during an outbreak and what should be included in an outbreak plan?

All organisations should be maintaining an up-to-date and comprehensive COVID-19 management plan. Importantly, this plan should be informed by a risk assessment that takes into account the current context of the epidemiology of COVID-19 and local transmission. A systematic approach should be used to ensure all IPC principles are addressed and all recommended practices aligned with these principles are considered and - if necessary -implemented.