Sumner Health Centre
Pandemic Plan
Date: 05/09/2023
Purpose:
To ensure that we are prepared insofar as it is possible to do so for a pandemic.
Preamble:
Every pandemic is different, and the majority of pandemics require macro scale public health measures.
Experience of COVID-19 has shown:
- Waiting rooms are a significant source for infection
- Airborne infections are easily transmitted but wearing an n95 mask is effective protection
- Infection can spread through contact with mucous membranes such as eyes
- It is better to assume the worst than hope for the best
- People panic during pandemics
- Supplies of essential equipment can be disrupted
- testing can be unreliable
Policy:
We will maintain adequate stocks of Personal Protective Equipment including:
Masks n95 or better.
Masks surgical (which may be effective in reducing the transmission of droplet borne infections such as influenza)
Gowns, Waterproof, disposable.
Gloves (various sizes)
Eye protection (sealing type)
The amount kept shall be an estimate of 3 month's operation during a pandemic including:
2 n95 masks per staff member per working day
1 surgical mask for every enrolled patient
4 boxes of gloves per clinical staff member in appropriate sizes.
In addition we will store sufficient hand sanitiser for 3 months of regular use (1L per staff member, assuming that most cleaning will be with soap and water.
As phone and video consultations are valuable during a pandemic, all rooms are to be equipped with facilities for audio-visual consultations. Doxy.me is our preferred video conferencing system.
Pandemic Procedures:
There are three phases of pandemic spread:
- The disease is rare. There is a very low probability that any given person will have the disease.
- The disease is beginning to spread. Most infections are occurring in situations where one of a small number of infected people transmit the infection to others close to them.
- The disease is spreading widely. There are many infected people transmitting the disease.
- The disease is endemic. Most of the susceptible population has been infected.
The required response varies depending on the phase.
Initially, efforts may be aimed at disease elimination. This requires macro scale interventions and is almost impossible to achieve with high infecivity agents. During this phase it may be appropriate to close waiting areas, but still permit patients to attend the surgery after appropriate triage. Patients with symptoms suspicious of the transmissible disease should be seen outside or in the portacabin.
During stage 2, there is a high probability of contracting the disease in a medical setting - there is a concentration of unwell people ad there is a tendency for transmissible diseases to affect most of all those who are already sick and in need of medical care. Only those most in need of care in person should be seen at the medical centre at this stage. All patients should be seen outside where possible, or the portacabin where not. Staff numbers on site should be limited insofar as it is possible to do so.
During stage 3, most transmission occurs in the family home. The main thrust of management moves from protecting the entire population to protecting the vulnerable and keeping services running. Wherever possible staff should be working from home, and when in the office should keep apart as much as possible. The exact measures to be taken will depend on the infective agent and guidance at the time.
During stage 4, it is likely most people including staff will have been infected and recovered, so it may be appropriate to re-open the waiting area, trying to keep symptomatic people and the vulnerable waiting separately, outside. Particular plans may be needed for managing individuals who may be at particularly high risk from the disease. Protecting staff remains a priority.
In all stages, staff should consider their own safety and that of patients. Assume an airborne infection first and use n95 masks and sealing eyewear when seeing all patients duing stages 2 and 3. Try to limit PPE use by scheduling patients requiring PPE wear together. Recycling of PPE may be possible depending on the infective agent and advice at the time. If this is the case, mark masks with name to reduce cross-contamination.
Overall, experience of COVID-19 shows that agents of low transmissibility are relatively easily controlled with enough effort, and progression from stage 2 to 3 is relatively slow, perhaps several months. High transmissibioity agents such as most influenza viruses can spread very rapidly and endemic status is often reached in a matter of weeks. Evidence from overseas where the delta variant of COVID-19 had time to spread shows that efforts to control high lethality, high infectivity agents are essential, but inevitably futile. The key is being prepared to keep doing the mahi long enough to gain the best possible outcomes for all.