Prevention

Preventing the emergence of a novel virus capable of causing a pandemic is practically impossible. However, implementing evidence-based infection prevention and control strategies can vastly mitigate the impact of all infections, including a pandemic.

The prevention stage for pandemic influenza focuses on actions to identify and manage risks. Prevention activities for general practices should be integrated into and become part of everyday practice.

During the prevention stage, general practices will need to:

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.

Standard precautions are applied to the care of all patients. Hand hygiene is a key standard precaution.

Standard precautions should be used routinely and consistently to achieve a basic level of infection prevention and control when staff are likely to be in contact with:

• blood
• other body fluids, secretions or excretions, except sweat (eg urine, faeces)
• non-intact skin
• mucous membranes.

In preparing for a pandemic, practices may wish to scale up the use of standard precautions. For example, providing conveniently located dispensers of alcohol-based hand sanitiser near each workstation, in patient waiting areas, in consulting and treatment rooms (including allied health rooms) and in reception and staff meeting rooms.

Additionally, practices may prohibit staff from wearing ties to prevent the spread of infection.

Refer to the RACGP’s Infection prevention and control standards (5th edition) for more information.

Transmission-based precautions (previously known as additional precautions) are used where patients have suspected or known infectious conditions.

To minimise the spread of influenza, contact, droplet and airborne precautions (transmission-based precautions) are used in addition to standard precautions.

• Contact precautions are used to prevent both direct and indirect contact transmission. Contact precautions involve the use of gloves, gowns and distancing. Gloves need to be worn for all manual contact with patients, associated equipment and the immediate environment. A water-impermeable apron or gown needs to be worn if clothing could be in substantial contact with the patient or their immediate environment.
• Droplet precautions are used to minimise transmission of droplets generated by coughing, sneezing and talking. Droplet precautions involve the use of surgical masks (worn by staff and patients), protective eyewear (goggles or face shield) and distancing. Patients should be asked to observe respiratory (cough) hygiene.
• Airborne precautions may be used to minimise transmission of micro-organisms suspended in the air. Airborne precautions involve the use of P2/N95 masks, protective eyewear (goggles or face shield) and minimising exposure time to other patients (eg scheduling influenza patients at the end of the day, distancing, home visits). Where possible, avoid aerosol-generating procedures such as nebulisers. Additionally, preference should be given to the use of spacers for the delivery of salbutamol when needed.

Refer to the RACGP’s Infection prevention and control standards (5th edition) for more information.

Prevention of infection and disease transmission relies on the implementation of effective infection prevention and control measures. These measures can be viewed as three separate components: individual measures, organisational and environmental measures, and PPE.

The implementation of all three components will help to reduce the risk of practice staff and patients being exposed to the influenza virus; an individual component will not be effective if undertaken/used in isolation (eg PPE only).

Preparing for the management of outbreaks of respiratory (and other) infections should focus on good governance with planned, practiced and habitual infection prevention and control measures, and a stepwise response according to the extent and severity of the outbreak.²²

Practice staff should be familiar with infection prevention and control principles and how to appropriately scale usual measures in response to an outbreak of disease.

Staff education on preventing the spread of infection

All members of the practice team need to be educated about their role in preventing the spread of infection.

Education includes the teaching of the principles of infection prevention and control, including the various infectious agents, their modes of transmission, appropriate work practices for infection prevention and control, and what personal protection is required and when to use it.

All staff need to demonstrate competency (appropriate to their role) in:

• identifying the signs and symptoms of influenza
• hand-hygiene procedures
• standard precautions
• transmission-based precautions
• managing blood and body fluid spills
• managing blood or body fluid exposure
• waste management
• principles of environmental cleaning and reprocessing medical equipment
• notification and referral pathways to appropriate health authorities
• where to find information on other aspects of infection control and pandemic protocols in the practice.

Understanding why precautions (such as masks) are used and the factors that have an impact on their effectiveness is critical to ensuring that staff are adequately protected, comfortable and can perform their jobs.¹³

During a pandemic, roles within the practice team may change. Some staff will need to multitask and take on additional responsibilities. This may mean additional training in infection prevention and control practices.

For more information about hand hygiene, refer to an online hand-hygiene course.

Patient education on preventing the spread of infection

Patient education and engagement is vital for effective pandemic management. The public needs to be empowered to take responsibility for their own health.²³ Educating patients on the issues around pandemics increases awareness of risks, engenders cooperation, facilitates co-ownership and commitment, and assists in the prevention of transmission and complications.

Patients should be educated about infection prevention and control strategies (eg cough etiquette, hand hygiene) and be encouraged to report any potential infectious disease to practice staff as soon as possible. Research shows that providing information about influenza prevention at the community level can help reduce severe and complicated cases of influenza requiring hospitalisation.²⁴

During flu season and/or the standby stage, it is recommended that practices display posters to remind patients of the importance of handwashing and cough etiquette. The posters can be accessed on the RACGP’s emergency response web page.

Seasonal vaccinations

Seasonal influenza vaccines are ‘safe and efficacious and have the potential to prevent significant annual morbidity and mortality’ according to the WHO.²⁵ It is recommended that general practices encourage influenza vaccinations for all staff and patients as per the NHMRC’s Australian immunisation handbook (10th edition).²⁶ This serves as an effective measure to reduce transmission of influenza.

Seasonal influenza vaccination uptake is low among healthcare workers. After the 2009 H1N1 pandemic, Mexico was the only country that experienced a significant increase in uptake of seasonal influenza vaccination.²⁷ The most common reasons for healthcare staff rejecting vaccination are fear of adverse events, doubt regarding efficacy, believing to be part of a low-risk group and believing that influenza is not a serious illness. The main predictor of vaccine uptake is previous influenza vaccination.²⁸ Strategies to improve vaccination rates include in-practice vaccination programs for staff, use of practice ‘champions’, electronic databases to track vaccinations, and marketing campaigns.^29,30

• NHMRC’s Australian guidelines for the prevention and control of infection in healthcare
• RACGP’s Infection prevention and control standards for general practices and other office-based and community-based practices (5th edition)
• RACGP’s Guidelines for preventive activities in general practice (9th edition) (Red Book)
• ASPREN – The national GP disease surveillance network