Managing pandemic influenza in general practice

A guide for preparation, response and recovery
7.3 Infection prevention and control
☰ Table of contents

The goal is for staff to stay well, prevent cross-infection of patients and appropriately manage patients with pandemic influenza. At-risk staff should not be allocated febrile patients.12 Re-organise the clinic schedule to minimise cross-infection with minimal disruption of usual services.50 However, consider delaying non-urgent and routine non-essential consultations (eg. Pap smears) during a pandemic.30

During a crisis, when staff are stressed and exhausted, infection prevention and control standards can slip. The importance of infection prevention and control procedures is critical during this time. GPs and clinical staff are encouraged to lead by example by taking a proactive approach and reinforcing the critical importance of essential infection prevention and control measures during a pandemic.35

Review your current infection prevention and control plans in light of available pandemic information. Update or adapt protocols on:

  • hand hygiene (eg. increase the number of alcohol-based hand rub dispensers)
  • use of PPE for staff and patients, including providing clear signage on how and why PPE is used
  • practice cleaning (including removal of clutter and non-cleanable items such as waiting room toys) and waste disposal (no-touch waste dispensers)
  • use of quarantine and social isolation (eg. increasing home visits or practice modification to create separate waiting areas for influenza and non-influenza patients)
  • assigning personnel to different tasks and patients (eg. one GP does not see any influenza patients, a practice nurse to see the ‘worried well’, one GP to do influenza home visits)
  • throat swabbing
  • vaccines (depending on availability, distribution and immunisation strategies).

Ensure that these protocols are clear, simple, easy to implement and are scaled appropriately to the level of risk. Display alert and education materials for staff and patients.

Febrile staff with respiratory symptoms should not come to work until regarded as non-infectious (based on current information about the influenza strain).

7.3.1 Personal protective equipment

General practice staff should use standard, droplet, contact and airborne precautions until the Chief Medical Officer directs otherwise.

All members of the practice team must be informed that PPE is available and where it is stored, as availability of PPE may influence the likelihood of work attendance during a pandemic.38

Staff also need to know how to order more supplies and should establish contingency plans where primary sources could become limited. Consult with local state or territory health departments about access to potential stockpiles or communicate with alternative sources (eg. veterinary hospitals).

Schedule a team meeting and get staff to fit and check P2/N95 masks.

Ensure staff and patients understand how to put on, take off and dispose of PPE.

7.3.2 Vaccination

General practices may choose to encourage seasonal influenza vaccination of staff.35

Pneumococcal pneumonia is likely to be a significant complication of pandemic influenza. Practices should identify at-risk patients and offer pneumococcal vaccination.12

Check regularly with the state or territory health department about pandemic vaccination availability and distribution and immunisation strategies. It is unlikely that vaccination will be available for the first 3–6 months of a pandemic.12

7.3.3 Antivirals

Practices will need to check antiviral protocols with the state or territory health department.12 In some cases there may be targeted antiviral prophylaxis for contacts and frontline health workers.

7.3.4 Contact tracing

During a pandemic, vigilance in detection and immediate reporting of suspected cases of pandemic influenza is critical. A person is ‘classified’ a contact if they have been in close contact with a person who has been diagnosed with pandemic influenza and therefore has the potential of becoming infected. The exact definition of a contact depends on the nature of the illness and the phase of the pandemic.

It is important to be aware of the changes of ‘case definitions’ as a pandemic develops. The case definitions used by state and territory health departments will change at different phases of the pandemic, as knowledge about the disease increases.

Practice staff may be asked to supply to health authorities the name and contact details of patients who have been in close contact with a patient with suspected pandemic influenza. Patient confidentiality and privacy is a core element to the management of patient health information. However, during a pandemic confidentiality and privacy may be overridden by public health concerns and mandatory reporting requirements. 

Table 3 Infection prevention and control measures

*Standard precautions consist of:

  • hand hygiene, before and after every episode of patient contact
  • the use of personal protective equipment
  • respiratory hygiene and cough etiquette
  • the safe use and disposal of sharps
  • routine environmental cleaning
  • aseptic non-touch technique
  • waste management
  • appropriate handling of linen
  • reprocessing of reusable medical equipment and instruments

**Aerosol-generating procedures

In the current NHMRC ICP guidelines, aerosol generating procedures include nose/throat swabbing, nebulised medicine administration, airway suctioning, CPR diagnostic sputum induction, positive pressure ventilation via facemask, and endotracheal intubation. In a general practice setting, staff doing multiple coughinducing procedures such as nose/throat swabbing on potential influenza patients might consider use of properly fitted P2/N95 mask, or frequent changes of well-fitting surgical masks. Routine throat examination is not an aerosol generating procedure.

  1. Collins N, Litt J, Winzenberg T, Shaw K, Moore M. Plan your pandemic – guide for GPs. Aust Fam Physician 2008;37:794–99, 802–4.
  2. Anikeeva O, Braunack-Mayer AJ, Street JM. How will Australian general practitioners respond to an influenza pandemic? A qualitative study of ethical values. Med J Aust 2008;189:148–50.
  3. Carlson AL, Budd AP, Perl TM. Control of influenza in healthcare settings: early lessons from the 2009 pandemic. Curr Opin Infect Dis 2010;23:293–99.
  4. Devnani M. Factors associated with the willingness of health care personnel to work during an influenza public health emergency: an integrative review. Prehosp Disaster Med 2012;27:551–66.
  5. Lee A, Chuh AA. Facing the threat of influenza pandemic – roles of and implications to general practitioners. BMC Public Health 2010;10:661.