Primary healthcare news, information & resources

COVID-19 - questions from practices

On this page we're sharing some of the questions we've had from practices which we think will be useful reading for others. You'll also see these in the Pinnacle GP discussion group. We'll also link to great resources that may also answer your questions.

Go back to our main COVID-19 webpage

bpacnz bulletin
Read the daily bulletin from bpacnz which has a particular focus on answering clinical questions.

Questions from practices

Should we be increasing our regular cleaning?
We recommend daily cleaning, particularly of all 'high-touch' surfaces such as desks, counters, table tops, doorknobs, bathroom fixtures, toilets, phones and keyboards. The Ministry of Health has produced guidance for cleaning personnel.

What shall we do if the media call?
The media have a role to play in informing the public. It is important they are given good facts, as the spread of misinformation can be very harmful. The Ministry of Health and public health units need to be the sources of truth on COVID-19.

If you are contacted by the media you are welcome to pass this over to the Pinnacle communication team. You can either:

  • let them know to call Pinnacle on 07 839 2888 and ask for the communication lead
  • get their name, media outlet, contact details and any specific questions they ask you and forward it to
If the media call or arrive unannounced, please rest assured you do not need to answer their questions just because they are there. They may emphasise the deadlines they are working to, but they are driven by the commercial and competitive environment of the New Zealand media landscape and you do not need to let their urgency be your urgency. 

What is the required cleaning of a room that has been used for suspected COVID-19? I understand all the surfaces need to be disinfected however as it is an airborne/droplet illness I am wondering about walls/ceiling? My other thought is to leave the room closed for a certain time, however research suggests this would need to be 9 hours, which would mean the room would be unusable?
The MOH cleaning advice is to wipe down hard surfaces with detergent and water, then hospital grade disinfectant.
There is no need for a stand down period. Cleaning should be done by someone wearing PPE of course. The advice is in the interim advice for health professionals

I am worried for my safety dealing with patients with any sort of viral illness now, I am personally more at risk if I pick up COVID-19 because of my age and medical conditions. I think I will just be turning people away and telling them I'm not seeing anyone with any viral symptoms.
There are lots of reasons why a clinic might be unable to safely deal with probable or suspected cases of COVID-19. Practices may run out of PPE, they may be overwhelmed with patients, they may have staff away with sickness, they may simply be scared. You are not alone with your anxiety, and no one is expecting you to put yourself at risk. Please feel reassured it is perfectly safe for health professionals to take viral swabs in the community. See the MOH infection prevention and control information for more details

For COVID-19 suspected or probable cases it is important to be wearing full PPE (a surgical mask, gloves, a gown and eye protection) when clinically assessing a patient -who should also be wearing a surgical mask and gloves. Taking a nasal swab may or may not cause the patient to sneeze or cough, but your PPE will protect you. 

It is important to be able to take off the PPE properly. PPE should be put on in the following order:
  • hand hygiene
  • gown
  • mask
  • protective eye wear
  • gloves.

It is taken off in the following order:
  • gloves
  • hand hygiene
  • protective eye wear (if separate from mask)
  • gown
  • hand hygiene
  • mask
  • hand hygiene.

There is a video that demonstrates this above on this page, or you can download a poster for your practice walls.

If you, or any of your colleagues, remain concerned about taking a viral swab in the community you are going to need to have an agreed process for how your patients are going to get access to this service. It is not acceptable to simply turn people away from your door without having a plan for them when they are sick or worried. We will work with DHBs on providing alternative pathways, and are working with other PHOs and the MOH to prepare for some of the consequences in time and loss of revenue and extra costs this will bring to practices, but in the meantime please talk to your colleagues and come to a local arrangement for your patients to get the care they need. 

I have heard some discussion around whether giving a nebuliser can cause aerosols and then would require extra mask protection. Is this correct? Should we be avoiding giving nebs whenever possible to suspected cases, and if we do give it would we then need to wear different PPE/clean the room differently?

The MOH advice is NOT to use a nebuliser in a primary care setting for patients with suspected or probable COVID-19 disease - for detailed information see the MOH website advice for health professionals - under managing suspected cases

Remember a spacer and MDI inhaler does not carry the same risk as a nebuliser and is as effective. In this situation the patient should be in isolation, the clinician would be wearing a surgical mask, gloves, gown and eye protection and no extra cleaning is required.

The procedures that should only be undertaken in hospital because they may cause increased aerosols and potential wider spread of virus are listed by the MOH in their FAQs for health professionals

How can we manage patients who are making an appointment via the patient portal?
  • Consider not letting people make their own appointments via the portal for the meantime.
  • If your system allows it, put up a message advising people to ring the Healthline number (0800 358 5453) if they are concerned about COVID-19.
  • As practices know their patients very well, it may also be worth "fishing" ahead through the appointment book each day, guessing what appointment is for, and phoning the patient ahead of the appointment if COVID-19 is a potential.

We  will be seeing lots of people who come to the medical centre after trips say to OZ, Canada, Fiji, Cook Islands, South Africa (i.e. non category 1 and 2 countries) who have say sore throats etc without temps or coughs. What do we do with those ones? Do they go into isolation, get seen in the car etc? Mostly those ones will be coming in with their coral cuts etc. When do we ring the MOH about these ones?
Can you please advise me on what to do should a patient call stating travel overseas to a non-category 1 or 2 country with fevers/cough/SOB?
The MOH advice is that for a case to be probable or suspected the patient needs to combine both the epidemiological criteria and the clinical criteria. Travel to countries that are not on the lists, and even when people have travelled, but there are other aetiologies that explain the condition would exclude the person being seen as a suspect or probable case. 

There is no need for them to be treated any differently from normal. 

What about passengers who transit through countries/areas of concern?
We are raising this question with the Ministry of Health in a teleconference tonight. Currently the case definition excludes patients who transit through countries of concern, but we understand the reasons why this is being questioned.

Read the current case definition here

What does self-isolation mean?
We understand patients who are asked to self-isolate will have many questions. The Ministry of Health have a comprehensive web page about self-isolation for COVID-19.

Are you able to offer any advice on what we do with the room the patient with suspected Coronavirus has been in? Do you shut the room for two hours? Do you clean it, and if so what would be the recommended cleaning agent? 
Coronavirus is relatively easy to kill on surfaces any hospital grade disinfectant is usually sufficient. Most suppliers of wipes and chemicals have put out updated testing of their product against coronavirus - just check the website of the product you are using for disinfection. The WHO recommends the below if you are unsure if your current product may be ineffective. 

Environmental cleaning in healthcare facilities or homes housing patients with suspected or confirmed COVID-19 infection should use disinfectants that are active against enveloped viruses, such as COVID-19 and other coronaviruses. There are many disinfectants, including commonly used hospital disinfectants, that are active against enveloped viruses. Currently WHO recommendations include the use of:

  • 70 per cent ethyl alcohol to disinfect reusable dedicated equipment (such as thermometers) between uses
  • sodium hypochlorite at 0.5 per cent (equivalent 5000ppm) for disinfection of frequently touched surfaces in homes or healthcare facilities.

Ideally the patient will be identified before entering into the medical clinic and a surgical mask will be supplied for the patient to wear.  

This will give staff a chance to remove extra items from the clinic room to decrease potential contamination for example, removing extra clinical supplies, and to move the patient's chair about two meters from workstations.

Once the person leaves the clinic room the surfaces touched by the patient or health care worker will need to be cleaned with detergent and then disinfected with an appropriate disinfectant. There is no stand down of room discussed in either the WHO or MOH information currently - so once it has been cleaned it can be reused.

In terms of waiting rooms your general cleaning should be sufficient. If a suspect case was in your waiting room a clean of the area where they were sitting is enough.

A quick query about the gowns. Are they full sleeve, round neck gowns? Just don't want to order inappropriate items?
Yes, full sleeve, disposable is what the MOH is asking about - round neck makes sense as opposed to V neck that leaves exposed skin.

We think each practice needs at least two FULL sets of PPE - full sleeve, disposable gowns, eye protection (either face shield or goggles), ordinary surgical masks, and gloves.

We believe it is starting to make sense for practices to always have this level of PPE available.

In addition, we think it would be worthwhile having N95/P2 masks (they mean the same thing) for any future issues. This type of mask is not required with what we currently know about COVID-19, but given the levels of international travel, the rapidity with which these events develop it would be useful to have some available in your practice.

For more information

 Please see our main COVID-19 webpage

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