General practice - Pandemic alert period – Overseas 3 = Now

Page contents: Practices | General practice business survival planning | Clinical | Public health: ‘keep it out’ | Checklist | Worksheet - current situation

Practices

Train your staff

Cover the following topics:

• signs, symptoms and epidemiology of H5N1 influenza
• investigation
• what to do with a suspected case
• how to notify DHS
• management of contacts
• using personal protective equipment.

Use personal protective equipment to protect you from contact with H5N1 virus with suspected H5N1 flu cases.

Personal protective equipment consists of:

• P2 (N95) mask
• protective eyewear
• gown to cover clothes against spills
• gloves.

Buy 10 sets of personal protective equipment now in case a suspected case of H5N1 flu comes to your practice. Train your staff on using personal protective equipment. Learn about personal protective equipment use in the CD-ROM Prepared and protected available at the Department of Health and Ageing website.

Everyone needs to be trained in personal protective equipment use and know where personal protective equipment is kept in the practice.

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General practice business survival planning

During a pandemic, general practices need business survival plans. Start thinking about the possible impacts on practice functioning and how you might respond.

For more information, download the information kit below:

Information kit and workplan for General Practice (317kb, pdf)

Clinical

When to suspect H5N1 human influenza?

H5N1 influenza in humans has a high mortality rate (over 50 per cent) and presents as the usual flu symptoms of fever, myalgia, headache but with high rates of gastrointestinal and pulmonary symptoms including viral pneumonia. Suspect it in patients with recent travel in currently affected areas, who have had close contact with poultry, poultry farms, or raw poultry products.

Remember

Take a travel/work history from all patients with fever or influenza-like illness.

Watch out for health alerts from DHS updating GPs on the situation.

Report any suspected cases of H5N1 influenza immediately to DHS on 1300 651 160.

Further information on the clinical features of H5N1 influenza see the Department of Health and Ageing website.

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Public health: ‘keep it out’

Current public health responses include forward surveillance in affected countries, isolation of suspected imported cases and contacts, and education of inbound travellers and border workers.

Infection control in your practice:

• wash your hands before and after every patient, every time
• clean potentially contaminated surfaces
• use personal protective equipment — P2 (N95) mask, protective eyewear, a gown to cover clothes against spills and gloves when assessing a suspected case
• reduce the number of contacts of suspected cases by avoiding exposing suspected cases to uninfected people.

Triage planning: seeing patients with suspected H5N1 flu

While no confirmed cases of H5N1 infection in humans or birds have been reported within Australia, patients concerned about H5N1 infection in themselves or a close contact, particularly after recent travel to an affected country, may present to GPs for advice and assessment.

When they call for an appointment

If patients mention risk of H5N1 or avian flu when they call for appointments, that is, travel to affected areas and flu-like illness:

• have a triage plan ready for front-desk staff to follow
• try to see these patients at home if at all possible
  • decide now how, who, where, and when you will handle home visit requests
  • have a home visit bag prepared with personal protective equipment and receipts/Medicare forms, for example, in it already.

If seen at the clinic

Avoid unnecessary contact with other patients and staff:

• ask suspected H5N1 flu patients to wait in their car outside or in a suitably-covered area
• provide surgical masks for all those with respiratory symptoms
• choose a specific consulting or treatment room to see the patient which is well-ventilated and easily-cleaned after the consultation (transmission through air-conditioning systems in not likely)
• use personal protective equipment when seeing the patient and put it in the infectious waste bin afterwards
• call DHS for advice on management and access to testing on 1300 651 160.

If a suspected case is only identified once in the consulting room

• ask your practice manager or clinic nurse to record who may have been in the waiting room with a suspected case — despite minimal risk of human-to-human transmission, contacts may require isolation and prophylaxis (to be organised and supplied by DHS)
  • you do not necessarily need to inform possible contacts immediately, but you do need to know their names (as a minimum)
• put on personal protective equipment and give patient a mask to put on
• get instructions from DHS — call them on 1300 651 160.

Cleaning and disinfection

Follow your standard cleaning procedures for control of potentially infectious materials or see the Royal Australian College of General Practitioners’ infection control guidelines at www.racgp.org.au/infectioncontrol. Use the practice ‘spill’ bucket to clean up after seeing a patient.

For further information go to the Department of Health and Ageing website.

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Patient education

Post signs that promote cough etiquette in common areas (for example, waiting areas and toilets) where they can serve as reminders to all persons in the practice. Signs should instruct persons to:

• cover the nose/mouth when coughing or sneezing
• use tissues to contain respiratory secretions
• dispose of tissues in the nearest waste receptacle after use
• wash their hands after contact with respiratory secretions.

Vaccination: seasonal flu and pneumococcal disease

Vaccinate staff and high-risk patients for seasonal flu to reduce co-infection with two different types of virus, which may increase the chances of a mutated virus emerging.

Vaccinate at risk patients with pneumococcal vaccination. Pneumococcal pneumonia is one of the common complications of infl uenza so it is important to achieve high coverage in at risk groups. See the Immunisation website.

Worksheet - Current situation

Worksheet: current situation (29kb, pdf)

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