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Pullman MIQ Facility To Reopen To Full Capacity Following Report Release

An independent report into the three transmission events that occurred in January at the Pullman Hotel managed isolation facility in Auckland has been released today.

The Ministry of Health and the Ministry for Business, Innovation and Employment, which has oversight of Managed Isolation and Quarantine, noted that the report found while it was not possible to conclude with absolute certainty where and how transmission occurred, the most likely mode of transmission was as a result of respiratory particle transmission, which we are learning more about all the time.

The report notes the three cases of transmission occurred in the context of emerging new strains of COVID-19 with higher transmissibility, increased global incidence of COVID, growing international evidence of aerosol transmission and greater awareness of the role of ventilation systems.

Multiple areas for improvement to reduce the risk of future transmission events had been identified and implemented at the Pullman, both in immediate response to the cases of transmission and in the longer term while remedial ventilation work was undertaken. Some of the measures included operating at reduced capacity (50%) to reduce congestion in shared areas, the introduction of a booking system for exercise and smoking and the installation of CCTV cameras in corridors and lift lobbies.

Interim changes to the ventilation system and practices included placement of air purifiers in the lifts and corridors, and expanding the use of N95/P2 particulate respirators for workers during any close interaction with returnees in MIFs (noting this applied across all facilities).

Director of Public Health, Dr Caroline McElnay said it was important to note the overall risk to returnees and staff of contracting COVID-19 within our managed isolation and quarantine facilities has been, and remains, extremely low as is the risk of transmission of COVID-19 within MIQ facilities.

“Here in New Zealand we have a model of acting with caution, a model which has worked well for us as a country and has successfully seen over 133,000 returnees safely transit through managed isolation and quarantine facilities.

“The MIQ system is a cornerstone of New Zealander’s COVID-19 response and the Ministry of Health and MIQ regularly review our policies and procedures to ensure they are fit for purpose as we learn more about the science behind the virus. One of the things we are becoming more aware of is aerosol transmission and the need to ensure spaces are well ventilated to mitigate that risk,” Dr McElnay said.

Joint Head of Managed Isolation and Quarantine, Brigadier Jim Bliss said work was already underway looking at respiratory particle transmission and the role of ventilation systems (especially in confined spaces like lifts and corridors), and was expedited for the Pullman after the January transmission events. This was consistent with MIQ’s model of continuous improvement and is part of a wider ventilation review across all MIQ facilities.

“The ventilation work undertaken at the Pullman was to get the Heating Ventilation and Air Conditioning (HVAC) system operating as originally designed. It is important to remember that up until March 2020, these facilities were operating as hotels not managed isolation and quarantine facilities, but when vulnerabilities are identified we need to address them to ensure the continued safety of staff and returnees.

“I am pleased to advise the ventilation work is now successfully completed and the facility will be accepting returnees from tomorrow. The work done at the Pullman could not have been achieved without critical support and commitment from the owners of the property and Accor who have facilitated this remediation work while continuing to operate as a managed isolation facility. I am grateful for their continued support as part of New Zealand’s COVID-19 response. I also want to acknowledge the workers at the Pullman and across all MIQ facilities, I am extremely proud of the work they do at the frontline of keeping our communities safe from COVID-19.”

 

The report is available here:

https://www.health.govt.nz/about-ministry/information-releases/general-information-releases/independent-report-covid-19-cases-pullman-hotel

https://www.miq.govt.nz/about/related-information/#incident-reports

The report recommendations

The report made eight recommendations in the areas of operational processes, physical changes, resourcing, clinical governance and continuous improvement, many of which were already underway or already have existing systems in place.

 RecommendationProgress
1Review the Operations Framework, Standard Operating Procedures and audit programme to highlight the risks of aerosol-mediated transmission and the measures that are needed to reduce the risk of this mode of transmission.This has been implemented.
2Review the management and procedures for symptomatic returnees: symptomatic returnees should remain in their rooms until results are available and medical authorisation has been given to end isolation.This has been implemented.
3Review the information provided to returnees on exit from the MIFs regarding symptoms that should prompt a returnee to get tested, and encourage the returnee to seek testing if the returnee has any doubt.This has been implemented.
4Review the resourcing of the Health Team, their workload, and their responsibilities.This is underway.
5Review the resourcing of the IPC team across the Northern Region, including IPC nurses, nurse educators, and specialist IPC support for each facility and the region.This is underway.
6Identify groups of non-health staff with high turnover rates and identify ways to reduce turnover and requirements for constant training.Discussions on length of secondments for personnel assigned to MIQF is ongoing.
7Develop a multidisciplinary clinical governance framework and network with local (MIQF), regional and national clinical and IPC governance that is connected and has clear responsibilities.This is underway. Work is ongoing with reporting on any issues identified taking place.
8Develop a ‘learning system’ using information from incidents and audits, and adapt the audit programme to incorporate continuous quality improvement.The monitoring of incidents and the sharing of lessons emerging is ongoing.

Remedial ventilation work undertaken at the Pullman

· Ensuring all ducts are clean and free of obstructions that may reduce optimal airflow.

· Ensuring vertical risers between floors are sealed to ensure that air flows through the riser.

· Ensuring exhaust fans are capable of exhausting the required air volumes, and replacing fans where required.

· Ensuring air supply volumes on guest floors are as per design.

· Ensuring air extracts in bathrooms are working as intended to remove steam and odours.

These steps will improve airflow in the building and reduce the risk of aerosol transmission.

The remediation work began on 5 March and was undertaken in three stages. During stage one the facility was emptied of returnees, with work focussing on the lift lobby area. During stages two and three the facility operated at around 50% capacity.

Other measures at the Pullman

Prior to the release of this report, multiple areas for improvement to reduce the risk of future transmission events had been identified and implemented at the Pullman, both in immediate response to the cases of transmission and in the longer term while remedial ventilation work is undertaken. These measures included:

· Operating at reduced capacity (50%) to reduce congestion in shared areas.

· Introducing processes to control and minimise returnee movement throughout the facility, including the introduction of a booking system for exercise and smoking;

· Keeping returnees from different flights in separate cohorts on different floors of the facility.

· Installation of CCTV cameras in corridors and lift lobbies, and upgrade of existing cameras

· Interim changes to the ventilation system and practices, including:

§ running the fresh air system to the corridors 24hrs per day

§ placement of air purifiers in the lifts and corridors

§ the implementation of guidance for the opening and closing of windows in returnees’ rooms, to support negative pressurisation of the rooms relative to the corridor.

· Expanding the use of N95/P2 particulate respirators for all MIQF workers during any close interaction with returnees in MIFs (noting this applied across all facilities).

· De-commissioning select rooms that open directly into the lift lobbies

Remedial ventilation work at other facilities

Preliminary ventilation assessments of the design of the ventilation systems of all 32 facilities have already been undertaken, and on-site ventilation assessments across the 31 other facilities is underway.

Air Filtration Units
The installation of air filtration units is a Ministry of Health-led project and the procurement process is nearly complete. A roll-out schedule across the facilities is currently being developed. While the risk to returnees and staff of contracting COVID-19 within our managed isolation and quarantine facilities has been, and remains, extremely low the installation of the air filtration units will provide another layer of protection.

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