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Swine flu: are you ready for a pandemic?

Emergency plans for a potential swine flu pandemic could reduce the risk of infection and save lives. Has your surgery or workplace got a plan? Has it been shared with you?

Marilyn Eveleigh
Consultant Editor

The threat of swine flu or Influenza A (H1N1) has dominated the working hours of health protection and emergency planning staff over the last few weeks. It's not a pandemic; that status is determined by the numbers and spread of infected cases. As I write, we have 78 confirmed cases in the UK and are at Phase 5 of the World Health Organization classification of seriousness. Phase 6 is considered a pandemic.

Nationally, every health and council service are making coordinated local population plans for the care of the most vulnerable, the mass allocation of antivirals and keeping essential services going should a significant number of us be infected and need to remain at home. Every household has received their swine flu information leaflet. All organisations and businesses have been warned for some time to have emergency plans for a pandemic. Large ones, like NHS trusts and local authorities, specifically employ emergency officers who coordinate staffing, equipment and responsibilities in a pandemic. What is happening in primary care practices or independent nursing homes?

This recent alert has been a wake-up call for healthcare organisations – but especially for general practice. Primary care trusts (PCTs) have required practices to make arrangements for a pandemic, which includes a stockpile of personal protective equipment (PPE), in addition to the allocation that may be made by the government. It has not happened in many surgeries.

When the national suppliers of surgical masks had none in stock, surgeries did not receive their orders for over two weeks – clinicians had no masks to undertake routine patient care. And this was only a little Phase 5 alert – what will happen in a real pandemic?

There is a necessity for surgeries to get better organised – it is likely there will be a second surge of cases in the autumn. All surgeries have been sent a Pandemic Checklist with practical goals to have in place. This includes having a current list of all staff contact numbers, a list of the most vulnerable patients and of those living alone, indentifying a buddy practice for support when staff and equipment levels are low,  and staff training in identifying risk and infection control measures. GP employers have a responsibility to reduce the risk of infection to staff while at work.

Nurses have a vital role to play in implementing contingency plans in a pandemic.  Infection control is core to nursing practice. So, for starters, I would suggest that
nurses consider the following:

  • Every nursing team should arrange a hand hygiene training session for all staff, including doctors – and ensure patients know the drill.
  • Nurses should reinforce respiratory hygiene with the "Catch it, bin it, kill it" campaign for patients and all
  • surgery staff.
  • Cleaning regimens should be scrutinised and door handles, hard surfaces and keyboards should be included;
  • decluttering of surfaces facilitates
  • cleaning significantly.
  • Cleaning of clinical equipment, such as stethoscopes, and the use of disposable ends for thermometers and otoscopes should be reviewed.
  • The disposal of clinical waste, especially for home visiting, should be reinforced.
  • The use, and especially the sequence of removal, of PPE and masks should be taught to all staff including doctors.
  • There should be a discussion regarding what type of PPE is required, including the grade of mask (respirator FFP3 and surgical) and for which staff.
  • Stocks of PPE should be reviewed and additional supplies ordered and stored for pandemic activity; the British Medical Association (BMA) and PCTs have advised GPs of this.
  • The criteria for prioritising patients in a pandemic.
  • What extended roles nurses should undertake.

As primary and community care nurses, we will be frontline when the pandemic is declared; we have a responsibility to manage and reduce the risk of spread. Make it your business to know what plans are in place to reduce any risk to you, your colleagues and your patients. And NOW is the time to
find out.