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Influenza Assessment Clinic – Activation and Operational requirements in a pandemic

CHHS16/124

Canberra Hospital and Health Services

Operational Procedure

Influenza Assessment Clinic – Activation and Operational requirements in a pandemic

Contents

Contents1

Purpose2

Scope2

Section 1 – Governance and Systems; Infectious Threat Committee2

Section 2 – The purpose of an Influenza Assessment Clinic3

Section 3 – Establishment, utilisation and administration of an Influenza Assessment Clinic4

Section 4 – Staffing and operational requirements of an Influenza Assessment Clinic7

Implementation9

Related Policies, Procedures, Guidelines and Legislation9

Definition of Terms10

Search Terms10

Attachments10

Attachment 1 - Material resources12

Attachment 2 - Flow chart for patient journey in the IAC13

Attachment 3 - Clinical Assessment Flowchart for IAC14

Attachment 4 - Emergency Department Clinical Assessment Flowchart15

Attachment 5 - Contact numbers for notifications and alerts16

Purpose

The purpose of this document is to outline operational systems to ensure effective organisation wide strategies are established in order to protect patients from an infectious diseases threat and effectively manage infections when they occur.

This operational procedure provides guidelines regarding the establishment, utilisation and administration of an Influenza Assessment Clinic (IAC) site on the declaration of a pandemic in the ACT. It is a directed care plan encompassing assessment, triage, treatment and follow up during an infectious threat event.

Influenza is an infectious disease. All documented information has been aligned with the National Safety and Quality Health Service (NSQHS) Standards actions list for Healthcare Acquired Infections (HAI).

For information on the clinical management (including testing) of a patient presenting to Canberra Hospital with suspected Influenza please refer to the Clinical Procedure Influenza and Respiratory Illnesses management for Adults and Children.

Back to Table of Contents

Scope

This procedure applies to all Canberra Hospital and Health Services (CHHS) staff, students and trainees undertaking clinical placement and all contracted agents working on CHHS premises.


Section 1 – Governance and Systems; Infectious Threat Committee

The role of The Infectious Threat Committee is to provide leadership and direction on infectious disease threat preparedness at CHHS. The committee reports as required to CHHS Strategic Executive Committee through the Executive Director of Critical Care.

The functions of the committee are to:

monitor ongoing global infectious disease threats

monitor and direct ongoing operational readiness to meet infectious disease threats at CHHS including seasonal influenza preparations and readiness, and

direct the management of infectious disease outbreaks involving the services of CHHS.

In the event of an infectious threat, the response of the Committee is to call for the establishment of extenuated triage at CHHS Emergency Department and the Influenza Assessment Clinic (IAC). Clinical management of an infectious threat may also call for the involvement of the Walk-in Centres (WiCs).

For further information on the role of the Walk-in Centres in a Public Health response such as an Influenza pandemic please refer to the Walk-in Centre Operational Model of Care located on the Policy Register.


Section 2 – The purpose of an Influenza Assessment Clinic

Due to the large number of patients who would normally require medical services during an influenza pandemic, communities and health care organisations must have guidelines in place in the event that health care facilities are overwhelmed. The establishment of the Influenza Assessment Clinic (IAC) serves to reduce the load that would otherwise be placed on general practitioners (GPs) and acute facilities by providing an assessment and treatment facility specifically for patients with symptoms of influenza. As a result, there would be a reduction in the risk of transmission of influenza in hospitals, community health centres and medical practices by keeping potentially infectious people separated from those seeking acute or community based health care for other reasons.

The IAC is intended to provide a dedicated primary care service for the assessment and management of patients potentially affected with pandemic influenza. This involves several key tasks:

assessing whether patients presenting with respiratory symptoms fit the case definition for a probable case of pandemic influenza

arranging for virological samples to be taken as appropriate

providing Tamiflu as appropriate, and

providing information and advice for home quarantine as appropriate.

It is anticipated that the IAC would operate at the Geriatric Registrar Clinic, located in Building 3 on the Canberra Hospital campus. Normal business activity would cease at this site whenever the IAC is required. Establishment of an IAC could be anticipated within 24 hours.

The Centre will not be involved in ongoing care. If a person presents to the IAC with a non-influenza respiratory condition, they would be referred to the Emergency Department or their own GP as appropriate.

For the patients journey through the IAC please refer to Attachment 2.


Section 3 – Establishment, utilisation and administration of an Influenza Assessment Clinic

This section provides guidelines regarding the establishment, utilisation and administration of an IAC site on the declaration of a pandemic in the ACT. It includes clearly defined roles and responsibilities, procedural information, resource requirements and communication and management strategies. The governance structures and processes described are for one clinic but can equally be replicated across multiple sites should the need arise.

Activation of the IAC will be in conjunction with existing ACT Health Directorate divisional and unit emergency plans.

Activation Procedure

The activation of the IAC will be on the authority of the Deputy Director General (DDG) of Canberra Hospital and Health Services, or delegate, following the declaration of a Public Health Emergency by the ACT Chief Health Officer (CHO), or delegate, and direction from the Director General (DG) Health Directorate.

The following flow chart illustrates the lines of authority:

(ACT CHO declares public health emergencyCentral Coordination Group convenesCHHS DDG activates IAC and Chair of Infectious Threat committee implements plan in consultation with the Director of Operations IAC Site controllers assume operational commandIAC commences operation)

Key Roles and Responsibilities

ACT Health Population Health Division:

provide direction and advice regarding strategic and operational management of pandemic situations, and

information to the public.

ACT Health’s Government and Communications Division:

provide information and media releases as directed by the CHO and the DG Health, and

monitor media information regarding the pandemic.

Health Protection Unit/Communicable Disease Control:

provide information for distribution to IAC patients, and

liaise with Site Controller regarding follow up of identified contacts.

Deputy Director General Canberra Hospital and Health Services

Will call an outbreak management meeting and then:

activate IAC

advise Central Coordination Group

determine IAC site to be activated

identify time frame for activation

circulate pre-prepared notification for staff re action if becoming unwell

Chair Central Coordination Group

provide regular status reporting to DG Health, and

resolve management issues

Central Coordination Group (CCG)

Membership: RACC ED, RACC DON, RACC ADON, ADON Division of Operations, RACC Administration Manager, Infection Prevention and Control, Deputy Director Pharmacy, Security Manager, and invited persons as required.

Responsibilities:

instigate service cancellation/rescheduling/relocation plan for staff and clinical services affected by establishment of the IAC

ongoing strategic and operational direction

workforce planning

issues management

liaison with other health sectors, including security and cleaning services, and

meet daily or as required.

Canberra Hospital Pharmacy:

coordinate management of post exposure antiviral supply for patients attending IAC, in consultation with Population Health

provide information regarding medications, any interaction with other drugs, side effects, issues when breast feeding etc, and

maintain the medication supply register.

Security Personnel:

provide staff security for the waiting area inside and outside the established IAC;

provide security for staff in IAC assessment area and antiviral dispensing area

Prevent entry or re-entry of patients through exit door

provide security for staff transiting to vehicles after hours/in darkness

liaise with Supply Department, Mitchell to provide security cover for release, transport and delivery of stock and supplies to IAC site, if required

provide security for stored stock and supplies within IAC,

liaise with Site Controller regarding providing security for stock and supplies within the IAC site over 24 hours, and

provide security for antiviral recipients departing premises.

IAC Site Controllers

Site controllers will be nominated and will be rostered to ensure coverage for the IAC.

Responsibilities will include:

oversee activation and operational management of IAC, including staffing and signage

advise Emergency Departments (CH and Calvary) of establishment of IAC and closure of the Registrar Clinic for normal business

ensure all IAC staff are orientated to site, roles and responsibilities

report issues not resolved to RACC ED as per issues matrix – see Attachment 3

report activity to RACC ED daily

conduct shift handover with incoming site controller

liaise with the site controller in other ACT IACs as required; and

liaise with Security Coordinator regarding providing security for stock and supplies within IAC site over 24 hours.

RACC Administration Manager

manage administrative staff rostering

ensure adequate supply of patient progress notes and information packs

liaise with InTACT regarding any IT issues

coordinate waste removal from assessment area Coordinate daily disposal of clinical and land waste

report directly to Site Controller, and

meet daily with Site Controller.

IAC Nurse Manager

Assistant Director of Nursing (ADON) for the Walk in Clinic (WiC), RADAR, ACAT, will assume this role, with support from other RACC nursing managers as required

operational charge of all IAC clinical staff

report directly to Site Controller

conduct daily meeting with Site Controller

conduct hand over between shifts for clinical staff

coordinate stock and equipment management

liaise with security personnel as required, and

report issues.

IAC Nurses

report directly to IAC Nurse Manager

liaise with IAC Nurse Manager regarding clinical issues

triage arriving patients and oversee management of waiting room area

conduct primary patient assessments

check ID and current medications

liaise with Emergency Department Admitting Officer for secondary assessment of patients as required, See Attachments 3 and 4

liaise with pharmacists regarding dispensing of antiviral medication

redirect patients to GP/Emergency Department as per WiC protocol

restocking clinical supplies as required

assessment and management of patients when they arrive in the IAC or ED See Attachments 2, 3 and 4

IAC Administrative Assistants

prepare assessment forms for use as required

ensure adequate supply of stationary such as: toner and paper

register patients on ACTPAS

establish and maintain sufficient waiting area equipment and supplies such as: waste bins, masks and hand washing solution

facility requirements

ACT Ambulance Service (refer to the ACT Health Emergency sub plan for more information):

provide transport to acute facility for acutely unwell patients on request from nursing Manager in the event an additional IAC is located off hospital campus.

Cleaning Personnel – contracted agents:

entry floors and toilets are to be cleaned regularly as per cleaning contract

rubbish bins and waste removed may require emptying fourth hourly and as required, (including after hours) in assessment and waiting areas;

daily cleaning for office areas, and

weekly cleaning for windows/glass petitions/curtains.


Section 4 – Staffing and operational requirements of an Influenza Assessment Clinic

Operational Requirements

The projected operational requirements are based on estimated assessments of 80 – 100 patients per day per IAC; and

Hours of operation are recommended to be from 0700 to 2300 hours (i.e. 16 hours per day), 7 days per week.

Waiting Room

The waiting room is to be stocked with personal protection equipment (PPE) for staff and patients to use. Reception staff will advise patients to attend to hand hygiene and use tissues or masks provided to cover their mouth and nose if coughing or sneezing to minimise the risk of infection to others.

Assessment rooms

Each room must be stocked with an oxygen saturation monitor, sphygmomanometer, stethoscope, tympanic thermometer and covers, tissues, alcohol wipes, gloves, replacement masks for patients, hand hygiene product.

Entry and Exit Flow

Patients should enter through one main entry and exit through a separate exit point so that cross infection is minimised. See Attachment 2- Flow chart for patient journey in the IAC

Waste Management

clinical and landfill waste is be collected and disposed in accordance with ACT Clinical Waste Act 1990 and ACT Waste Minimization Act 2001, and

all clinical and landfill waste is collected daily. Facilities Management is accessible through TCH switchboard.

Material resources

The stock and supplies are only to be ordered from Mitchell Supplies. Orders should be placed in advance to ensure adequate supplies available for operational material requirements of IAC (See Attachment 1 and 5).

Human resources

The following staffing requirements for each IAC have been recommended as a guide for a 24-hour period, 7 days a week, factoring in relief for meal and tea breaks, handover, and restocking.

Table of staffing requirements

Staff

AM

PM

Site Controller

1 0800hrs – 1630hrs

(Mon – Fri)

On call after hours and weekends

Nurse Manager

1 0800hrs – 1630hrs

(Mon – Fri)

On call after hours and weekends

Nurses

2 0700hrs – 1530hrs

1 0900hrs – 1730hrs

1 1200hrs – 2030hrs

2 1500hrs –2330hrs

Administration Officer

1 0700hrs – 1530hrs

1 1500hrs – 2330hrs

Security

1 0700hrs – 1530hrs

1 1500hrs – 2330hrs

Medical Officers

As required

As required

Pharmacists

1 0800hrs – 1630hrs

On call after hours

Cleaners

Contractual arrangement and as required

(Monday – Sunday)

Contractual arrangement and as required


Implementation

This procedure is to be communicated to all CHHS staff via CHHS Deputy Director General email alerts notifying staff of new Policy.


Related Policies, Procedures, Guidelines and Legislation

Policies

ACT Intensive Care Pandemic Guideline Policy

Procedures

CHHS Healthcare Associated Infections Procedure, CHHS15/072

CHHS Influenza and Respiratory Illness Management procedure, CHHS16/078

Walk in Centre Operational Model of Care, CHHS13/621

Australian Immunisation Handbook 10th Edition 2013-Place Holder document, CHHS15/064

Guidelines

Guidelines for the Prevention and Public Health management of Influenza Outbreaks in Residential Care Facilities in Australia ; Communicable Disease Network of Australia (CDNA) August 2015.

Legislation

Health Protection Services, Communicable Disease Control http://www.health.act.gov.au/public-information/public-health/communicable-diseases

ACT Public Health Act, Public Health (Infectious and Notifiable Diseases) Regulations 2007 http://www.legislation.act.gov.au/sl/1998-6/default.asp


Definition of Terms

Epidemic - a disease that spreads and affects a large number of people at the same time with a common localised demographic feature

Infectious diseases - are transmissible illnesses caused by infectious agents. Patients with an infectious disease (confirmed or suspected) require isolation and infection prevention and control management

Influenza - is an acute viral illness caused by infection with influenza viruses A, B and rarely C.

ILI - Influenza like illness

Notifiable disease - an illness or disease which by law must be reported to governmental agency

PPE - personal protective equipment worn by healthcare workers to prevent the transmission of infectious microorganisms.

Tamiflu (oseltamivir phosphate) - an antiviral medicine for treatment of flu in people 2 weeks of age and older and for prevention of flu in people 1 year of age and older.


Search Terms

Healthcare Acquired Infection, Influenza, Influenza Assessment Clinic, Infection Control, Infectious Diseases, Infectious Threat, Intensive Care, Pandemic, RACC, Respiratory, Walk-in Centre


Attachments

Attachment 1 - Material resources

Attachment 2 - Flow chart for patient journey in the IAC

Attachment 3 - Clinical Assessment Flowchart for IAC

Attachment 4 -Emergency Department Clinical Assessment Flowchart

Attachment 5 -Contact numbers for notifications and alerts

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended

Section Amended

Approved By

Eg: 17 August 2014

Section 1

ED/CHHSPC Chair

Attachment 1 - Material resources

Consideration for 12 hour delivery timeframe should be given to ensure adequate supplies of the follow stock items are available in the IAC:

Description

P2/N95 masks for staff

Surgical masks for patients and carers

Single use gown – non sterile - yellow or blue

Gloves – small – non latex

Gloves – medium – non latex

Gloves – large – non latex

Safety glasses/ face shield – non disposable

500ml pump pack bottle 0.5% chlorhexidine hand rub

Alcohol surface wipes

Liquid soap for public toilets for wall mounted dispensers

Tissues

Rubbish bags / bins liners 50 L

Disposable covers for tympanic thermometers

Disposable Linen

O2 saturation monitors

Tympanic Thermometers

Attachment 2 - Flow chart for patient journey in the IAC

(Patient arrives in the IAC waiting room and is asked to put on a mask and clean their hands with the hand hygiene product)

(Clerical staff give patient a pack for registration)

(Clerical staff enter Patient registration details into ACTPAS )

(Patient enters consultation room for assessment by IAC nurse )

(Patient has an oropharyngeal viral flocked swab collected for testing and is commenced on Tamiflu if indicated by clinical criteria)

(Patients are notified of positive results by the Centre for Disease Control)

(Patients are provided with oral and written information about influenza including what to do about isolation and infection control at home)

(A sick certificate for 7 days is provided for patients with positive flu symptoms)

Attachment 3 - Clinical Assessment Flowchart for IAC

(Patient presents to Influenza Assessment Clinic (IAC))

(Standard and droplet precautions apply. Give patient a mask and direct them to use hand hygiene products to clean their hands)

(Triage the patient for flu like symptoms (fever, cough, fatigue, myalgia))

(Flu like symptoms) (Nil Symptoms)

(Refer patient to ED or GP depending on reason for presentation) (Patient to wear mask) (Staff to wear contact & droplet PPE)

(Triage for abnormal oxygen saturation, respiratory rate and chest auscultation)

(Abnormal)

(Normal) (Refer to Emergency department for ongoing assessment and management)

(Treat in IAC and manage as per patient journey (refer to Attachment 2))

Attachment 4 - Emergency Department Clinical Assessment Flowchart

(Patient presents to ED)

(Standard and droplet precautions apply. Give patient a mask and direct them to use hand hygiene products to clean their hands)

(Triage the patient for flu like symptoms (fever, cough, fatigue, myalgia))

(Flu like symptoms) (Nil Symptoms)

(Patient to wear mask) (Patient is to remain in the waiting room for normal triage) (Staff to wear contact & droplet PPE)

(Triage for abnormal oxygen saturation, respiratory rate and chest auscultation)

(Normal) (Abnormal)

(Refer to Influenza Assessment Clinic (IAC) for management)

(Triaged in ED with full observationsPatient to be managed in ED)

(Triage and registration in IAC)

Attachment 5 - Contact numbers for notifications and alerts

ACT Health Directorate

Mobile

Landline

Director of Operations

0419 960 019

N/A

ADON of Operations

0423 294 387

624 42831

Executive Director, Rehabilitation, Aged & Community Care

0409 460 789

624 43579

Director of Nursing, Rehabilitation, Aged & Community Care

0466 770 236

6244 2205

Assistant Director of Nursing, Infection Prevention and Control

0478 408 787

6244 3695

Assistant Director of Nursing (WiC, RADAR, ACALU)

0403 050 967

6205 4926

Clinical Nurse Consultant, Walk-in Centre

Nil

6205 4437

Administration Manager, Rehabilitation, Aged & Community Care

0421 158 634

6244 2767

Walk-in Centre Reception

Nil

6205 4437

ACT Public Health Unit – Emergency Ops. Centre

Emergency Management Coordinator

Chief Pharmacist

Fax 6205 3139

0417 691 976

0419 516 399

NA

6208214

6205 0961

ACT Chief Nurse

0414 192855

620 50893

CHHS – Senior Medical Advisor

Contact through TCH switchboard

624 42222

CHHS – Executive Director Nursing & Midwifery

CHHS – Director of Pharmacy

CHHS - Security

Calvary – Director of Medical Services

Contact through Calvary Switchboard

6201 6111

Calvary – Director of Nursing

Occupational Medical Unit (on site TCH)

Not Applicable

624 42321 / 42323

Supply Operations Manager - Mitchell Supply – on call person

0434 660 734

0419 216 602

620 50800

Not Applicable

Facilities Management – water, power, air con., sewerage, general and clinical waste etc.

Contact through TCH switchboard

624 42222

Cleaning contractor

ACT Government

ACT Policing/AFP – operations 24/24 hours

000 – life threatening emergency

6256 7777

ACT Ambulance Service

6207 9988 (duty manager).

Doc Number

Version

Issued

Review Date

Area Responsible

Page

CHHS16/124

1

15/08/2016

01/08/2019

CSS

1 of 16

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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