Case study

Remove all non-essential items from exposed surfaces.

Tape a line on the floor 1.5 metres from the doctor’s/nurse’s chair/desk as a physical indicator to maintain social distancing when possible.

Make sure you have enough personal protective equipment in the room, including spares.

Check that the room has handwashing facilities and enough hand sanitiser/tissues.

Place a clinical waste disposal bin in a convenient location.

Put all relevant pathology forms, examination tools, etc in the room to avoid having to leave the room.

Have relevant health and follow-up information ready to give the patient:

• COVID-19 information
• isolation guidance
• referral information
• follow-up details.

Implement the following:

• The patient wears a surgical mask at all times.
• The doctor wears appropriate PPE at all times.*
• The patient remains behind the line on the floor 1.5 metres from the doctor’s chair/desk where possible.
• When collecting the specimen, the doctor stands to the side in front of the patient.
• The doctor swabs the tonsillar area of the oropharynx first; then, using the same collection swab, swabs the nasopharynx.

* Appropriate PPE is determined by risk assessment:

• Likely low risk of SARS-CoV-2 transmission – use PPE in accordance with existing guidance for standard, contact and droplet precautions, as specified in the Australian guidelines for the prevention and control of infection in healthcare. This includes wearing a surgical mask.
• Likely high risk of SARS-CoV-2 transmission – use P2/N95 respirators, rather than surgical masks, along with the other required PPE, as specified in the Australian guidelines for the prevention and control of infection in healthcare.

Immediate measures may include:

• checking that ventilation is adequate (6–8 fresh air changes per hour)
• placing signs at the entrance to the practice advising patients to phone if they suspect they have measles
• displaying patient information at reception warning that measles cases have been diagnosed at this time in this area
• for suspected cases, performing the consultation in a room with adequate ventilation that can remain vacant for at least 30 minutes post consultation
• identifying any patients known to be at risk (eg immunocompromised) who may have an appointment at the general practice and consider potential for exposure
• decontaminating door handles with detergent (or combined detergent/disinfectant) solution or wipes.

Urgently report confirmed cases to the local public health unit immediately on clinical diagnosis, pending confirmation by the pathology laboratory.

Urgently report suspected cases to the local public health unit.

Notify potentially exposed patients and advise them to attend an emergency department for immunoglobulin therapy (after first contacting the emergency department and receiving instructions on how to isolate and attend safely).