Care workers worked for six months with a rule that is not without risk, has no concrete scientific basis, and is partly motivated by scarcity. At the end of August, Nieuwsuur discovered that the advice that mouth caps are not necessary in the event of brief contact with coronapatients had been removed from the guidelines for elderly care.
For months, nursing and home care staff heard that this advice was safe. But the new RIVM advice is that oral caps are necessary for short contact. How did the RIVM achieve this striking turnaround?
Elderly care had to follow RIVM guidelines
Hospitals drew up their own guidelines during the corona crisis. However, care for the elderly was asked to follow the RIVM guidelines. Over the past few months, ministers have consistently called for the use of no more mouth caps than necessary in view of the worldwide scarcity. The care for the elderly had to follow the RIVM advice on whether or not mouth caps were necessary. These guidelines would ensure safety for care staff while avoiding unnecessary use.
Many care workers felt unsafe about the RIVM recommendations from the outset. One of these recommendations was that if they had short contact with a (suspected) coronavirus patient, they did not have to wear a mouth mask. For example, when indicating a glass of water or medicine or having a short conversation. Mouth caps would also not be necessary if they were one and a half metres away from the corona patient.
This is how the directive for mouth masks in elder care changed:
In July, New Years Eve published a triptych on the RIVM guidelines for the care of the elderly, which showed that there is no concrete scientific basis for exceptions of this kind for oral caps. Several care workers stated in the broadcast that they thought they had contracted corona as a result of the limited guidelines, and that they had infected patients.
The most important umbrella organisations in elder care also went public. They alerted the Ministry of Health internally as early as March. They asked for the scientific substantiation of the RIVM recommendations, but received no response. The Ministry rejected their suspicion that the guidelines were based on scarcity. The guidelines are based on medical advice and safety, not scarcity, according to ministers. The disputed opinions remained unchanged.
Even if Nieuwsuur asks the ministry whether scarcity played a role in the adoption of the mouthguards directive or parts of it, the answer is in the negative. No, scarcity did not play a role at any time, the Ministry e-mailed on 9 June. The starting point for the guidelines was the safety of healthcare workers and patients/clients
But at the end of August, the advice not to wear a mouth shield in the event of short contact suddenly disappeared from the guideline. Normally the changes are kept up to date in the version management of the guideline. But there is nothing in the adaptation history.
Below is the RIVMs adaptation history
When Nieuwsuur asks the RIVM for an explanation, the institute says that the advice was indeed deleted on 17 August. The care umbrella organisations concerned have also been informed about this, the RIVM writes.
However, when asked, the care umbrella organisations turned out not to have been informed, even though they had been criticising the advice for months. The Association of Nurses & Caregivers, ZorgthuisNL and ActiZ are surprised when they hear from New Hour that the advice has been cancelled.
Then the RIVM says that things turned out differently after all. The institute had told the care umbrella organisations about a guideline on testing and quarantine, not about this. The institute says that this was not a deliberate act, but was simply forgotten by someone. That does not inspire confidence, says Conny Helder of ActiZ.
Phone call from Jan Kluytmans
The advice was in force for six months in the care of the elderly. And the direct reason for its deletion appears to have been a telephone call from microbiologist Jan Kluytmans on 17 July, two days after New Hour had broadcast part 1 of the aforementioned triptych.
Kluytmans called the RIVM after the broadcast and expressed his astonishment at the advice not to wear any protective equipment in elder care in the event of short contact and a distance of one and a half metres. In the hospital, staff always wear mouth caps when entering the room of a corona patient, he said. The RIVM tells Kluytmans that the advice comes from the period when there was a lack of personal protective equipment for long-term care
So it was removed from the directive.
Below is the e-mail that the RIVM sent to Nieuwsuur
That one phone call from a doctor is apparently enough to remove this passage, which we have been agitating against for so long, from the directive, says V&VN chairman Gerton Heyne. I find that disrespectful towards nurses and carers
The question is why RIVM did not remove the advice in question until 17 August. At the end of April, Rob van der Kolk, the foreman of the National Aids Consortium, told the House of Representatives that there were enough mouth caps for the care. If the rules broadened, we could simply supplement them and there was room for that He also said that he was perfectly capable of increasing the number of surgical mouthguards at least fivefold in terms of orders
When New Years Eve asked the National Institute for Public Health and the Environment (RIVM) why the directive was not amended until 17 August, the institute replied: Given the high workload and the fact that several colleagues were on holiday, already seems more appropriate here than only…
Part of the exchange of e-mails with the RIVM