Specific healthcare settings

This guidance is in addition to other IPC advice in these guidelines.

7.1. Primary care and community settings

Primary care and community settings include services provided in:

• Primary and community health settings and professional clinics, including medical/general practice, pharmacy, dental, nursing, allied health, day programs and social services.
• Residential dwellings (private homes and group housing) such as home-based care services including nursing, mental health, allied health, disability support, and social services.
• Institutional settings such as schools (sick bays, boarding schools), camps, disability housing, group housing, mental health facilities, youth housing, detention, youth justice, justice, or police and correctional facilities.

All community services staff, contractors and volunteers must wear appropriate PPE and follow IPC principles. Health workers required to use P2/N95 respirators should be fit tested and trained in correct respirator use, including completing a fit (seal) check every time a respirator is put on.

Services should complete a pre-consultation risk assessment (by telephone, telehealth, online meeting, or a screening station at the entry). Consider COVID-19 risk related to the client, environment, staff, and other people present.

General principles:

• face masks are recommended when visiting or working in sensitive settings
• minimise the number of people present during the interaction to those essential to the consultation
• maintain 1.5-meter physical distancing unless closer contact is essential to the interaction
• maximise ventilation and/or fresh air flows with open doors or windows where possible
• minimise and remove all items not essential to the consultation
• limit the number of people in clinics and waiting rooms to maintain physical distancing measures
• minimise contact during check-in
• on presentation, complete COVID-19 pre-screening for symptoms of COVID-19. If clinically appropriate, consider alternative appointment arrangements for:
  • clients with ARI
  • close contacts of known positive cases (until isolation period ends)
  • clients with COVID-19 who are still in their infectious period
• use transmission-based precautions when COVID-19 risk has been identified
• establish donning and doffing stations in convenient and protected locations
• consider preparing designated rooms for high-risk interactions/clients.

When entering residential settings, in addition to the above:

• before entry, check the COVID-19 risk of the client and others who will be present during the interaction
• ensure you have resources for cleaning/disinfecting equipment, donning and doffing, and clinical waste bins or bags for PPE
• take only those items essential for the consultation into the home
• limit time inside the home
• ensure all items taken into residential dwellings are cleaned and disinfected when taken out.

7.2. COVID-19 testing clinics

If establishing drive-through, pop-up or mobile van COVID-19 testing clinics, it is important to consult with the local infection prevention and control team and to consider a range of infection prevention and control practices as follows.

Physical set up

When planning the location and workflow of a clinic, consider:

• ventilation of enclosed clinics (established or temporary building or a pop-up tent)
• physical distancing of >1.5 metres wherever possible
• signage to direct and inform patients, control traffic and queues, limit speed, etc.
• separate areas for staff to don and doff PPE safely
• allocated PPE-free zone for a staff break area
• separated and enclosed storage for both used and reprocessed items, for example, shared patient equipment and PPE. All reusable equipment/items must be reprocessed as per manufacturer’s instructions
• waste collection areas
• access for pathology couriers to collect specimens.

The clinic will need supplies of this equipment and consumables:

• ABHR
• equipment for specimen collection and security of specimens
• PPE for standard and transmission-based precautions, including uniforms
• products for routine and enhanced environmental cleaning
• products for cleaning shared patient care equipment (including chairs) after each use
• patient information resources.

Staffing

Staff will need:

• orientation and an education program on infection prevention and control
• training to enable good practice in taking swabs and enough resources to allow for practice.

Collecting specimens

When collecting respiratory specimens, transmission-based precautions for COVID-19 should be observed whether respiratory symptoms are present or not. Consider the need for eye protection following a risk assessment.

7.3. Aquatic facilities

There is no evidence that COVID-19 can spread directly to humans from water in treated aquatic facilities. Proper operation, maintenance, and chemical disinfection should destroy the virus. For hydrotherapy practices, conduct risk assessments of clients and staff to reduce risk.

7.4. Companion animals

The Australian Department of Agriculture, Water and the Environment have assessed that there is currently no evidence of transmission of COVID-19 to or from domestic animals – either pets or livestock. The current spread of COVID-19 is driven by human-to-human transmission. The use of therapy animals in the healthcare setting is therefore considered safe.