Influenza

Influenza affects around one in four New Zealanders.

Immunisation remains our best community defense against influenza. A vaccine is available and funded for those aged over 65, pregnant women, and some people under 65 with certain medical conditions (check HealthPathways for criteria).  Vaccination can be done up til 31 December 2019. We encourage General Practice teams to focus on ‘at risk’ families within their practice.

Planning for the Canterbury flu season is undertaken by the Canterbury Influenza Group, facilitated by the Canterbury Primary Response Group (CPRG). This group meets monthly to monitor and plan a response across the region.

The predominant influenza viruses identified by WHO for the southern hemisphere and in the quadrivalent vaccine this season are: A/Michigan (H1N1) pdm09-like virus, A/Switzerland (H3N2), B/Colorado and B/Phuket. The quadrivalent vaccine is funded according to usual funding criteria and will be distributed from 1 April 2019.

The Canterbury District Health Board maintains their flu-related website, https://flufree.co.nz, and there are many good resources, including Coping with Flu at Home information in different languages.

The Immunisation Advisory Centre has good information and resources on the New Zealand approach to vaccination.

Community & Public Health publish weekly statistics of viral pathogens in Canterbury. (These will be produced as soon as sentinel monitoring starts in general practice.)

ESR (the Institute of Environmental Science and Research) has developed a dashboard to show up-to-date influenza rates and severity of disease across New Zealand. This will give a near real time impact of the disease. The ESR dashboard includes information on flu activity, flu severity and which viruses are circulating this season. This information is gathered as part of the national influenza surveillance programme from a range of sources including laboratories, intensive care units, emergency departments, GPs and Healthline.

See the Canterbury Community HealthPathways Influenza pathway for more information on:

  • influenza management
  • infection control
  • respiratory virus testing.

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, reminding patients to wash their hands and alerting staff if they have a cough or cold. If you’ve had the same posters up for several years, it is recommended that you update them so that they attract more attention.
    • Consider displaying signs encouraging hand washing and cough etiquette in the waiting room. A selection of posters are available from here:
    • 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.
    • Use an alcohol-based hand sanitizer that contains at least 60% 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.
    • Selection 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. [resource]
    • 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, 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 cards and are phoned/texted when ready to be taking 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.

KEY DOCUMENTS

CPRG Influenza Updates can be found via the Resources page. Click on the Event Category column and sort for ‘Update’.