General practices can reduce the risk or prevent the transmission of infectious diseases by embedding infection control measures in everyday practice. All GPs, clinical staff and non-clinical staff should have a good understanding of infection control principles.
Key for GPs and practice teams is to ensure good triage protocols and avoid having patients suspected of having the virus, in the waiting room with other patients. Practices can utilise the available Patient alert posters to quickly identify, and appropriately manage, patients presenting with symptoms.
GPs should not treat or carry out testing on suspected coronavirus patients if they do not have the correct PPE equipment. They should seek advice from their local public health unit on where to send the patient for treatment or testing and how to minimise the risk of infection while the patient is being transported.
Patients who notify of symptoms before attending a practice and who have epidemiological evidence, should be asked not to enter the practice until precautions are put in place.
A suspected case is currently defined by the Australian Federal Government Department of Health (DoH) as meeting the below epidemiological AND clinical criteria:
Epidemiological criteria:
- Travel to (including transit through) mainland China in the 14 days before onset of illness
OR
- Close* or casual** contact in 14 days before illness onset with a confirmed case of coronavirus.
Clinical criteria:
OR
- Acute respiratory infection (e.g. shortness of breath or cough) with or without fever.
The DoH are advising that as the full clinical spectrum of illness is not known, clinical and public health judgment should also be used to determine the need for testing in patients who do not meet the epidemiological or clinical criteria above. See the DoH
Information for Primary and Community Health Workers fact sheet for definitions of close and casual contacts.
Interim advice to Public Health Units (updated on 15 February 2020) by the Communicable Diseases Network Australia includes the following relating to
Persons under investigation:
It is recommended that clinicians should consider testing people with a clinically compatible illness who travelled to any of the following countries in the 14 days before onset of symptoms:
- Hong Kong
- Indonesia
- Japan
- Singapore
- Thailand
This list is based on the volume of travel between those countries, Australia and China, and/or the current epidemiology of COVID-19; however, the risk of COVID-19 in these countries is currently thought to be low. Clinical and public health judgement should be applied. The recommendation does not apply to passengers who have only been in transit through an airport in these countries. Note: if a clinician determines that a person under investigation should be tested then that person must be managed as a suspect case.
In suspected cases, current advice from the DoH for clinicians is:
- Place a surgical mask on the patient
- Place patient in isolated room
- Contact and follow advice from their local public health unit on the exact specimens required for specialised testing, the approved collection methods and equipment for collecting specimens and the protocols for handling, storage and transport to correct laboratory
- See DoH fact sheet Information for Primary and Community Health Workers
- The RACGP also recommends practice staff in contact with any patients suspected of having coronavirus ie at reception, should wear a surgical face mask when dealing with these patients.
The requirements for PPE differ based on the patients respiratory symptoms. Current advice from the DoH is:
- For most patients with mild or no respiratory symptoms in the community, collection of respiratory specimens is a low risk procedure and can be performed using contact and droplet precautions
- Patients with severe symptoms suggestive of pneumonia should be managed in hospital. For patients meeting this criteria, the collection of respiratory specimens can be performed using contact and airborne precautions
- For droplet precautions the room the room does not need to be left empty after sample collection
- At completion of the consultation, remove PPE and place in a biohazard container, perform hand hygiene, wipe any contacted/contaminated surfaces with detergent/disinfectant
- See DoH fact sheet Information about the use of personal protective equipment (PPE) during clinical care and the RACGP poster Correct use of Personal Protective Equipment (PPE)
If GPs and practice staff have worn PPE when dealing with a patient who is then confirmed as having the virus this is not considered a close contact so self isolation for 14 days is not required.
For up-to-the-minute information, visit the Australian Federal Government
Department of Health website.