Respiratory hygiene and cough/sneeze etiquette must be applied at all times as part of standard precautions. Covering sneezes and coughs reduces air dispersal of respiratory particles that could contain pathogenic bacteria or viruses.
Hand hygiene must be performed after coughing, sneezing, using tissues, or after contact with respiratory secretions or objects contaminated by these secretions. Place alcohol-based handrub within reach at all times to facilitate hand hygiene. However, if hands are visibly contaminated they must be washed with soap-based liquid hand cleanser and water.
Instruct everyone to follow respiratory hygiene and cough/sneeze etiquette, regardless of whether they have signs and symptoms of a respiratory infection, and regardless of the cause:
- Cover the nose/mouth with disposable single-use tissues when coughing, sneezing, wiping and blowing nose to contain respiratory secretions.
- Dispose of tissues in the nearest waste receptacle or bin after use.
- If no tissues are available, cough or sneeze into the inner elbow rather than the hand.
- Cleanse hands thoroughly immediately after contact with respiratory secretions and contaminated objects/materials before resuming other activities (see Hand hygiene).
- Keep contaminated hands away from the mucous membranes of the mouth, eyes and nose.
Patients requesting a consultation with respiratory symptoms should be triaged by a health professional via phone or videoconference to determine whether the consultation should be via telehealth or in person.
Patients presenting to the clinic must be routinely triaged (Table 5.1. Managing practice access and patient flow). Those with symptoms of respiratory infections arriving at the clinic must be given a surgical mask and shown how to wear it correctly. They can be either seen immediately, directed to a properly ventilated isolation area while waiting, asked to wait outside until called in, or even seen outside (see also Reception and triage).
Infective respiratory particles may remain suspended in the air for several hours. The risk can be reduced by wearing a mask and by adequate ventilation (a minimum of at least 6 air changes of fresh air per hour; see Ventilation).
Staff could assist patients who need help with containment of respiratory secretions (eg elderly, children). Those who are immobile will need a receptacle (eg plastic bag) readily at hand for the immediate disposal of used tissues and will need to be offered hand hygiene facilities. All patients with symptoms of respiratory infection must be encouraged to wear a mask inside the clinic, if able, or seen outdoors to reduce risk to other patients and staff.
Staff with viral respiratory tract infections must remain at home until their symptoms have resolved, or according to health department advice on specific pathogens.
Table 5.1. Managing practice access and patient flow
The practice’s infection prevention and control plan could include controlling the entry of patients with potentially infectious disease through the following strategies:
- Check the temperature of each person presenting to the practice and ask those who return a reading >37.5°C to remain outside of the practice until further assessment can be conducted.
- Use physical markers, such as lines taped on the floor, to promote physical distancing.
- Define the preferred flow of foot traffic through the practice using floor markings and signs.
- Display at the entrance any information about temporary or ongoing requirements of entry.
- Install screens at high-interaction areas such as reception.
- Minimise patient congestion in the practice waiting room by limiting the number of people on the premises at any one time.
- Space furniture in the waiting room.
- Provide access to alcohol-based handrub at entry and exit (and at appropriate locations throughout the practice).
- Encourage patients to book an appointment rather than walk in.
During an infectious disease outbreak:
- have a space that can be used for patient isolation
- implement a management plan to enable immediate isolation of patients presenting with symptoms suggestive of the infection
- provide staff with data information sheets or resource links for the disease
- limit patient access to defined entries and exits
- display information at the entrance and ensure clear messaging on all platforms (ie website, hold message, social media etc) asking patients to call ahead if they have any symptoms suggestive of the disease to enable appropriate triage
- require all people entering the practice to wear a face mask unless an exception or lawful excuse applies
- encourage telehealth consultations (where appropriate).