Health Emergency Response

Influenza

Influenza affects around one in four New Zealanders.

Immunisation remains our best community defense against influenza. Vaccines have been released two weeks early this year and General Practice teams have been asked to prioritise people over 65 years old, people with multiple chronic conditions, pregnant women and healthcare workers.

The predominant influenza viruses identified by WHO for the southern hemisphere and in the quadrivalent vaccine this season are: A/Brisbane/02/2018 (H1N1)pdm09-like virus, A/South Australia/34/2019 (H3N2)-like virus, B/Washington/02/2019-like (B/Victoria lineage) virus and B/Phuket/3073/2013-like (B/Yamagata lineage) virus.

The Canterbury District Health Board maintains their public flu-related website, https://flufree.co.nz, and there are many good resources, including Coping with Flu at Home information in different languages. Community HealthPathways has clinical guidelines for this year’s influenza vaccination programme.

Given the current situation with COVID-19, we need to think about doing things differently this year. Some suggestions are:

• Can you vaccinate at set times when face-to-face consultations are not going on, or in a separate part of your practice, i.e., coming and going through a different entrance
• Consider drive-thru flu clinics. You don’t need to wear PPE for this, just stand 2m away to ascertain if the patient is well enough for vaccination, complete the informed consent form and vaccinate. They can remain in their cars for the requisite wait period.
• IMAC has advised that if someone is >13 years old, meets all the below criteria, they do not have to wait for the full 20 minutes after vaccination:
  • do not have a history of severe allergic reactions
  • have been assessed for any immediate post vaccination adverse reactions (5 minutes)
  • are aware of when they need to, and how to seek post-vaccination advice
  • will have another adolescent or adult with them for the first 20 minutes post-vaccination
  • have the ability to contact emergency services if required.

For the full IMAC position statement, click here. If you have any questions please contact your Immunisation Coordinator first, or the NIR team at NIR@cdhb.health.nz.

The Ministry of Health is once again running the Flutracking service. See the website for more info: https://www.flutracking.net.

Preparing Your Workplace for the Next Influenza Season

Before the ‘flu season’ it is timely to review your infection prevention and control procedures within your general practice or community pharmacy. Especially in the flu season, any patient presenting to your premises has the potential to be infectious. For this reason, systems must be set up to protect staff and other patients from possible cross infection by patients. This is a health and safety requirement.

Quick Checklist

Standard precautions underpin safe protection and should be used at all times with every patient. The following checklist is intended as a guide for general practice facilities, but are also applicable to other facilities such as community pharmacies.

1. Signage visible
   • Check signage at the entrance to your practice to alert patients if they have a cough or cold and to tell the Reception staff if they have flu-like symptoms.
   • Door signs are available for general practices and community pharmacies below.
   • If you’ve had the same posters up for several years, it is recommended that you update them so that they attract more attention.
   • Display other signage in your waiting room to encourage hand washing and cough etiquette. A selection of posters are available here:
     • Hand Hygiene
     • CDC
   • Door signs are available for general practice and community pharmacies below.
2. Alcohol hand hygiene products readily available for both patients and staff
   • Hand washing is the single most important step in reducing the spread of infection.
   • All patients should be asked to use an alcohol-based hand rub when they enter your surgery – this is for the patients’ protection as much as for the protection of general practice staff.
   • Ensure all staff have ready access to hand sanitizer.
   • Use an alcohol-based hand sanitizer that contains 70% alcohol.
   • Remember the Five Moments of Hand Hygiene:
     • Moment 1: Before patient contact
     • Moment 2: Before a procedure
     • Moment 3: After a procedure or body fluid exposure risk
     • Moment 4: After patient contact
     • Moment 5: After contact with patient surroundings.
3. Personal protective equipment (PPE) is to be worn by you and your staff to protect them from risks of cross infection.
   • The level of PPE is based on an assessment of the risk of transmission, level of exposure and the nature of the disease.
   • It is important that all staff understand when to use PPE as part of standard and transmission-based precautions and also the correct way to put on and remove PPE (see below).
   • Continue to have disposable multi-purpose masks available for patients presenting with respiratory symptoms and ask them to wear these at all times in your practice.
4. Maintaining a clean environment
   • Review your workplace cleaning schedule – does it include items and areas that need to be cleaned, and how often should this happen? An excellent cleaning resource is available on HealthPathways.
   • Remember the influenza virus can remain viable on hard surfaces for up to 48 hours, therefore these surfaces (e.g., reception, bench tops, doors, door handles, tills, EFTPOS machines, telephones, computer keyboards, etc.) should be wiped down regularly throughout the day with an appropriate solution or 70% alcohol-based wipes.
   • A cost effective option for cleaning is to use a clean, disposable cloth and a solution of bleach (prepared daily, 10mls bleach to 500mls water). Ensure the spray nozzle is directed to ‘squirt’ not ‘spray’ to avoid the spread of any potential pathogens.
5. Discuss possible ‘streaming’ options for seeing patients with influenza-like-illnesses (ILIs) within your practice
   • You may wish to consider streaming patients who present with flu-like symptoms to your practice. We acknowledge that each practice will adapt protocols, depending on the size of the facility, population of the practice and staff preferences. Suggestions include:
     • Identifying separate waiting areas
     • Different times of clinics for flu/non-flu patients
     • Flow of people through the practice – is it possible to arrange it so that people move in one direction rather than coming back past each other?
     • Minimise amount of time in the waiting area, e.g., flu patients wait in their cars and are phoned/texted when ready to be taken in
     • If demand exceeds capacity, you may consider delaying non-urgent activities, e.g. recalls for cervical screening.

It is also important that all staff understand and follow your workplace’s written policies and procedures on all aspects of infection prevention and control.