Infection Control guidelines for management

during Respiratory Pandemic

Respiratory Pandemic Sub Plan

Document ID CHQ-PROC-63330 Version no. 1.0 Approval date 19/08/2020

Executive sponsor Chief Finance Officer Effective date 19/08/2020

Author/custodian Infection Management and Prevention Service Review date 19/08/2023

Supersedes Nil

Applicable to All Children’s Health Queensland staff and persons, contractors and volunteers

Authorisation Executive Director Clinical Services QCH

Purpose

Children’s Health Queensland (CHQ) Infection control guidelines for Management during respiratory pandemic

procedure supports the strategic Pandemic Sub-Plan outlining infection prevention and containment measures

to be enacted during a sustained and significant public health event.

Scope

The aim of the CHQ infection management and prevention during respiratory pandemic is to provide an

effective infection prevention health response framework to contain and control the disease, as well as reduced

morbidity and mortality associated with a pandemic disease.

This procedure applies to all Children's Health Queensland staff, students, volunteers, consultants and

contractors.

Procedure

1. Definition

For the purposes of this procedure, a respiratory pandemic is defined as an epidemic of respiratory illness with wide geographical spread affecting large numbers of susceptible people, potentially world-wide. A respiratory pandemic can occur when a susceptible population experiences the emergence or introduction of a transmissible infectious organism. The most likely infectious organisms to cause a respiratory pandemic include novel strains of influenza or coronavirus.

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2. CHQ supports the prevention of a respiratory pandemic overseas or in

Australia by:

• Promoting seasonal influenza vaccination of all health care workers (HCW), volunteers and contractors.

• Promoting and advocating good personal hygiene measures to health care workers and the public e.g.

respiratory hygiene, cough etiquette, not attending public places and work when unwell. Refer to

Respiratory Hygiene Poster.

• Promoting the 5 moments of hand hygiene as the first and most important defence against transmission of

pathogens. Refer to 5 Moments of Hand Hygiene.

• Contributing to the state-wide influenza surveillance programs. This is achieved through the surveillance,

review and reporting of respiratory pathology specimens.

3. CHQ will prepare for a respiratory pandemic through ongoing:

• Development, maintenance, testing / exercising and review of this plan and;

• Provision of education for all HCW, contractors and volunteers related to:

- Personal Protective Equipment (PPE) use including P2 / N95 respirator masks when required.

- PPE donning and doffing. Refer to CHQ-PROC-63317 - Donning and Doffing of personal protective

equipment (PPE).

- Signs and symptoms of influenza like illness (ILI), notification of illness, exclusion from work when

sick and resuming work after illness.

- Pandemic awareness and readiness.

4. Control and Containment

Patients presenting / requiring admission to QCH who have confirmed, or suspected pandemic respiratory

illness are to be managed with appropriate transmission-based precautions in accordance with the following

procedures or new evidence for novel pathogens:

• CHQ-PROC-63210 - Admission Screening and Safe Patient Placement including Cohorting

• CHQ-PROC- 63110 - Standard and Transmission and Protective Based Precautions

• CHQ-PROC-63317 - Donning and Doffing of Personal Protective Equipment (PPE)

• CHQ-PROC-63002 - Infection Control Guidelines for the Management of Coronavirus (MERS, SARS or

Novel Coronavirus)

• CHQ-PROC-63005- Transport of a suspected and confirmed (MERS, SARS, SARS-CoV-2 or Novel

Coronavirus)

In the event of pandemic, organisms with high morbidity or mortality of disease such as avian influenza and

novel infectious organisms, Airborne Plus precautions may apply for inpatient settings. Specific requirements

may be advised by Queensland Health at the time of the pandemic. See applicable procedures for specific

organism transmission-based precautions requirements.

5. At Risk populations

As with historical ILI / respiratory pandemics, at risk populations may include those who are immunosuppressed

and / or have chronic lung disease. Additional at-risk groups may be identified by State or National

bodies/organisations when specific novel organisms are circulating in the population.

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6. Establishment/functioning of Fever Assessment Clinics

See Appendix 5 Fever Clinic Checklist for clinic equipment.

Fever assessment clinics (also known as fever clinics) are designed to relieve the diagnostic burden on

hospitals and reduce the risk of disease transmission to vulnerable populations. This is achieved by triaging,

assessing and providing treatment (if appropriate) to individuals with ILI who are not in need of emergency

care. This process enables the Emergency Department (ED) to continue to provide clinical services to non-

influenza like illness and critically ill patients.

The role of fever assessment clinics are to:

• Assess, treat and refer suspected, probable or confirmed cases of respiratory pandemic / pandemic

influenza and novel organisms.

• Reduce the impact on scarce health resources through use of a controlled triage system.

Initiate isolation and/or quarantine for suspected, probable or confirmed cases and household contacts.

CHQ will establish a fever clinic on the direction of the State Health Coordinator or as deemed necessary by

the CHQ Health Emergency Operation Centre (HEOC). The specific timing of opening and operating a Fever

Clinic, and the capacity to maintain regular services in the ED when the clinic is closed, will be determined by

the HEOC in consultation with the ED. Consideration must be given to State/National priorities including the

need for fever assessment clinics within the community.

All staff, volunteers and contractors working in the fever assessment clinic must:

• Be screened to ensure they do not have high risk factors such as chronic lung disease, pregnancy,

immunosuppression. Staff identified with high risk factors should not be employed in a fever clinic. For

COVID-19 refer to Vulnerable Staff Guideline.

• Have completed the online Personal Protective Equipment (PPE) donning and doffing education (these

competencies are recorded on CHQ TeachQ+)

• Be competent and confident in donning and doffing PPE.

• Be able to perform ongoing risk assessments to determine the required PPE.

• Be able to perform their own fit check.

• Remain bare below the elbow.

Suggested staffing for Fever Assessment Clinics include (Dependent on size and scale of pandemic):

• Nursing Controller - a senior nurse team leader.

• Registered Nurses – 1-3 per shift.

• Medical Controller – an appropriate medical officer to coordinate triage and assessment. (Dependent on

size of the clinic)

• Administration Officer –to provide administration support.

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Support Staff – the Fever Clinic may also be manned with additional ED staff or staff from areas stood down

from regular activities as a result of the pandemic response. (Dependent on size of the clinic)

Access to additional staff as required (Dependent on size of the clinic):

• Radiographer

• Operational officers

• Security officers may be required.

Operational support services, as provided to ED and outpatient services, will be required by the Fever

Assessment Clinic. Therefore, on commencement of a Fever Assessment Clinic the Executive Director of

Clinical Support and the Operations Manager - Division of Clinical Support should be notified to advise axillary

services of the requirements– i.e. Porterage, food services, cleaning, waste and linen services.

6.2 Fever Assessment Clinic Patient Flow

Patient flow through the fever assessment clinic should include:

• Triage, streaming and prioritising of patients, including those who require immediate transfer into ED

• Determining which patients are appropriate for the clinic based on a standard set of questions

• Collection of demographic, epidemiological and clinical data;

• Patients not requiring admission may be provided with, as indicated:

- pandemic information for patients; and / or

- advice regarding quarantine and follow up

- treatment such as anti-viral medications (As applicable)

- vaccine if available

6.3 Fever Assessment Clinic Location

A fever assessment clinic location to accommodate an assessment and/or isolation zone/s should be

established with guidance from the Emergency Leadership Team. At present for COVID-19 there is a fever

assessment clinic located in the CCHR building for children and their families, QCH staff members with

symptoms of COVID-19.

6.4 Patient presentation and assessment

The following principles or actions are required to manage the presentation and assessment of patients who

have confirmed or suspected pandemic respiratory illness.

• Clear signage along with an appropriate staff member to be in place to advise and direct

• All patients presenting with ILI / respiratory pandemic symptoms should be provided with a

surgical/procedural mask and directed to perform hand hygiene prior to further assessment

Note: surgical/procedural masks should not be placed out for public use, they should be distributed by

Nursing or Admin staff as required.

• If there is a shortage of PPE, educate patients and families of good hand hygiene and appropriate respiratory

and cough etiquette. Refer to Respiratory Hygiene Poster.

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• Emergency departments should have in place a plan for managing infectious patients on presentation

including:

- separate waiting area e.g. cohort suspected / confirmed ILI patients in the internal waiting room and

non-suspected confirmed ILI patients in the reception area waiting zone. NB: ED to incorporate a

strategy into their pandemic response plan.

- specific isolation rooms - initially orange zone can be utilised but when patient numbers extend

beyond this capacity, consider utilising the extension of the ILI zone waiting room in the ambulance

bay.

- dedicated staff (where possible) to be assigned to assess suspected cases.

- carefully consider placement of patients who require use of nebulisers and / or delivery of high flow

oxygenation as this increases the risk of dispersal / transmission of ILI e.g. utilise ED orange zone

negative pressure rooms or rooms where the door can be closed to prevent air flow out of the area

for the use of this patient group or alternative areas of the hospital where air circulation and return

air flow can be minimised.

- TL / NUM to review patient allocation each shift to ensure:

▪ high risk staff (e.g. pregnant, immunocompromised) are not allocated to suspected /

confirmed ILI patients

▪ staff have the skills to care for patients with ILI/novel infections and are confident and

comfortable to do so.

- In the event of a resuscitation in orange zone equipment can be taken immediately from the

emergency trolley on a tray and into the room by a runner. This prevents the trolley having to come

into the room and potential contamination of trolley contents.

- Adrenaline is kept on the trolley and all other drugs are in a pack in the green zone medication

room, and all other emergency drugs are in a specific pandemic drug pack stored in the green zone

medication room”. There is a full range of IV equipment and pathology tubes.

• Specific procedures for assessment, testing and notification of respiratory pandemic / pandemic influenza

are usually guided by QLD Health based on known / suspected organisms. In the paediatric population this

is likely to include nasopharyngeal aspirate (NPA) / nasal swab specimen collection. For testing

recommendations for Coronavirus see CHQ-PROC-63002 - Infection Control Guidelines for the

Management of Coronavirus (MERS, SARS or Novel Coronavirus).

• Specific procedures for management of cases, especially with regard to use of nebulisers/aerosol

generating procedures are usually guided by QLD Health based on known / suspected organism.

• Specific procedures for movement of patients within the facility may be advised by QLD Health. As a

minimum CHQ procedures should be followed regarding quarantining of patients in transport lifts etc.

The Australian College for Emergency Medicine (ACEM) has published guidelines for the Management of

Respiratory Disease Outbreaks including Severe Influenza, Pandemic Influenza and Emerging Respiratory

Illness to provide guidance to emergency department staff at all levels in managing severe seasonal and

pandemic influenza and other emerging respiratory illnesses.

Refer to the Pandemic Sub plan for divisional flow considerations and capacity, fluctuation will occur between

phases 1, 2 and 3 as surge and demand fluctuates. As the demand changes ensure capability and scalability

are considered to allow for increased capacity.

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7. General principles

7.1 Precautions

• Appropriate transmission-based precautions are recommended to be applied to all suspected or confirmed

cases of pandemic influenza.

- Use the Personal Protection Equipment Flowchart outlining the appropriate precautions for the level of risk.

- Contact Droplet precautions, or Contact droplet and eye protection, or Airborne Plus precautions are recommended for all suspected or confirmed cases of novel pandemic respiratory illness in accordance with the following procedures and as advised by any current Queensland Health guidelines at the time:

▪ CHQ-PROC-63210 - Admission Screening and Safe Patient Placement including Cohorting

▪ CHQ-PROC-63110 - Standard and Transmission and Protective Based Precautions ▪ CHQ-PROC-63317 - Donning and Doffing of Personal Protective Equipment (PPE) ▪ CHQ-PROC-63002 - Infection Control Guidelines for the Management of Coronavirus

(MERS, SARS or Novel Coronavirus) ▪ CHQ-PROC-63005- Transport of a suspected and confirmed (MERS, SARS, SARS-

CoV-2 or Novel Coronavirus)

7.2 Room Allocation

• In the event of a respiratory pandemic, there will be an increased demand for isolation rooms. Suspected

or confirmed cases should be placed in negative pressure room as a first preference. Suspected or

confirmed cases should be placed in a single room with the door closed, if negative pressure room is

unavailable. Refer to Appendix 2 - QCH Negative Pressure Rooms.

• If a single room is not available, refer to Cohorting section 8.3 of this procedure.

- TL/NUM to review patient allocation each shift to ensure high risk staff (e.g. pregnant, immunocompromised) are not allocated to suspected / confirmed ILI patients and to ensure staff have the skills to look after the patient and are confident and comfortable to do so. Refer to COVID-19 Vulnerable employees.

- The number of persons entering the cohorted area should be limited to the minimum number necessary for patient care and support e.g. restrict volunteers, education staff and entertainment staff. Refer to CHQ-PROC-64712 - Visitation and Access during COVID-19 Pandemic Period.

- Limit patient transport by having necessary equipment (e.g. portable X-ray) available in cohort areas.

- If transfer within the facility or transport to another facility is necessary, appropriate transmission-based precautions should be maintained.

- Quarantine the lift 17 or 18 for patient transport. Refer to routes of transport.

- Staff allocated to these patients should have completed their Donning and Doffing training and be recorded on Teach Q +.

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7.3 Patient movement, transfer and retrieval

Plan patient transfer to limit exposure to others:

• See Appendix 3 for Routes of Transfer

• Staff to wear PPE in line with recommendations for the pandemic organism. CHQ will develop guidelines

for specific pathogens/pandemics as they emerge. Please review those on the Gov e-Catalogue.

• Where tolerated, patient to wear a surgical/procedural mask if not intubated or on oxygen therapy and

maybe we should say

• Quarantine lift 18 or 19 for patient transfer between floors

• Clear corridors / passages for patient transport

• Where possible restrict patient movement and transfer e.g. arrange for services in the patient room such as

mobile X-ray.

• For COVID-19 and transport of a patient view CHQ-PROC-63005 – Transportation of suspected and

confirmed (MERS, SARS, SARS-CoV-2 or Novel Coronavirus

8 Infection Management and Prevention Considerations

8.1 Pathology specimens and specimen collection

• Advice may be provided by National / State bodies regarding specific pathology specimens indicated and

any specific requirements regarding collection and / or transport.

• CHQ will develop guideline for specific pathogens/pandemics please review those on the e-catalogue

• Unless advised otherwise, nasopharyngeal swabs are the specimens of choice.

• Nasopharyngeal aspirates should only be collected by experienced staff with the appropriate equipment

and training to minimise any risk of production of aerosols. This is especially important when a new strain

with pandemic potential has emerged.

• As surveillance information becomes available, testing requirements may be modified according to disease

characteristics and the capacity of the health system.

If rapid review of specimens is required, CHQ Infection Management and Prevention Commander and / or

Controller should be advised and can then liaise with laboratory staff or establish processes to ensure this is

facilitated.

Standard methods of transport of specimens will suffice unless Queensland Pathology / CDIM / PHU advise

an alternative method. In this case, consultation with these agencies regarding transport is required.

ALERT

All GeneXpert testing must have approval by the Infectious Disease Consultant On Call before

ordering.

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8.2 Personal Protective Equipment

• CHQ nurses in the target areas for accommodation of patients requiring isolation are responsible to maintain

proficiency in pandemic preparedness and PPE donning and doffing and to oversee the donning and doffing

of other healthcare workers attending to / visiting the patient

• Where the patient is accommodated in a room with an anteroom, PPE should be donned and doffed in

accordance with the appropriate precautions poster.

• If a patient is not in a negative pressure room, then PPE removed in the room as per the poster and the

mask outside of the room in the hallway. The HCW should treat the hallway as an anteroom to remove the

mask.

• Additional supplies of PPE can be obtained from the pandemic emergency PPE supply storage (Level B3

lift-well). Access is restricted to security, specified porters, patient flow managers, IMPS nurses and safety

CNCs.

• Queensland Health (QH) has an additional stockpile of personal protective equipment (PPE) to be used in

the event of state and national significance e.g. pandemic.

• The QLD pandemic stockpile includes: P2 / N 95 masks, surgical masks, long sleeved gowns and goggles.

• The authority to release the QH emergency PPE stockpile to other Queensland Health distribution centres

and Queensland Health Public Hospitals sits with the Chief Health Officer (CHO).

• In times of PPE shortages a PPE rationalisation instruction may be implemented to conserve supplies.

Actions in this will depend on the pathogen and modes of transmission. Refer to specific organism guidelines

Eg:

- Personal Protective Equipment (PPE) Rationalisation within CHQ - COVID-19

Refer to PPE advice on the staff portal for Donning and Doffing videos and posters

Contact and Droplet Eye Precautions PPE Sequence

Before Entering Room Before Leaving Patient Room

• Perform HH

• Put on apron/gown

• Put on surgical mask/face shield

• Dispose of gloves

• Dispose of Eye protection *

• Dispose of apron/gown

• Perform HH

• Dispose of mask and face shield/goggles

• Perform Hand Hygiene

After Entering room

• Perform HH

• Put on gloves

• *Gown can be removed before eye protection if desired either option of removal is safe.

Airborne Plus Poster for confirmed or critically ill patients or when performing AGP. Refer to Table 2 for list of AGPs.

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Airborne Plus Precautions PPE Sequence (Pandemic Respiratory Infections)

Before any CHQ staff member can don PPE to enter a How to fit check a P2 / N95 mask patient room

with Airborne Plus Precautions in place, the following steps must be taken:

• Face must be clean shaven, hair tied back.

• All objects removed from pockets and uniform (e.g. pens, phone, ID badge).

• Complete cover of all skin surfaces / hair is not required (unlike Ebola PPE as below).

• Have an observer to check correct application of N95/P2 mask prior to room entry. Completion of written

PPE checklist not necessary. Ensure you write your name on the staff log on the door.

In the Anteroom Room Before Leaving Patient Room After Leaving Patient Room

(In Anteroom)

• Perform HH

• Put on gown

• Put on N95/P2 mask and

perform fit check

• Put on eyewear/face shield

• Put on gloves, ensure the

gloves go over the cuffs of the

gown

• Dispose of gloves

• Perform HH

• Dispose of eyewear/ face

shield *

• Perform HH

• Dispose of gown

• Perform HH

• Perform Hand Hygiene (as you

have touched the door handle)

• Dispose of Mask

• Perform HH

*Gown can be removed before eye protection is desired either option of removal is safe.

ALERT

If an emerging or pandemic respiratory illness, an observer is desirable to check that N95/P2

mask has been applied correctly before the staff member enters the patient room.

Additional information

• Hand hygiene should be undertaken in accordance with the 5 moments for hand hygiene.

• Gloves should be changed if they become torn or heavily contaminated.

• Gowns should be changed if they become soiled.

• If re-useable PPE is used such as goggles, these must be cleaned and disinfected prior to re-use. Staff

must be trained in this process. Prescription glasses are not a substitute for goggles.

• Patient notes / charts should be kept outside the patient room.

• Pens / paper should be provided in the room and remain in the room.

• Patient equipment such as stethoscopes and sphygmomanometers should remain in the patient room.

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8.3 QCH nominated inpatient accommodation (Cohorting)

Cohorting

Confirmed cases

Cohorting of confirmed cases of a pandemic organism must only be undertaken following consultation with

local experts, such as infectious diseases physicians and IMPS. Where practicable, managing patients with

mild illness in their own home is the preferred approach rather than cohorting patients.

Cohorting patients who are infected with a pandemic organism confines their care to one area and prevents

contact with other patients.

The following principles apply when making decisions about patient placement:

• Unrelated COVID patients must be in a single room and must not be cohorted. Cohorting places families

and caregivers at significant risk.

• Siblings can be cohorted, however 1.5 meters must be maintained between each person. This is taking into

account the risk of other pathogens.

• Confirmed cases of the confirmed pandemic organism take priority over other conditions requiring contact

and droplet precautions. Consult with the IMPS for other diseases/presentations requiring isolation.

• Prioritise patients who have severe pneumonia symptoms for placement in single rooms with negative

pressure air handling.

• Care should be taken to ensure that confirmed pandemic organism cases co-infected with influenza are not

cohorted

ALERT

Unrelated COVID patients must be in a single room and must not be cohorted.

Siblings may be cohorted, however 1.5 meter spacing is required between patients.

Suspected cases

The decision to cohort suspected cases needs to be taken following consultation with local experts, such as

infectious diseases physicians and IMPS. Cohorting suspected cases is not recommended.

See applicable DisMAP for applicable plans for each area for patient placement. DisMAP can be located in

CHQ-PROC-63326 – Respiratory Pandemic Sub Plan.

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Table 1 - Mask Considerations

**Mask considerations when are applicable when there is a shortage or advised by IMPS***

Mask considerations in pandemics with PPE

restrictions and availability

Infection Cohort with Infants <12 months of age Children >12 months of

age

RSV RSV or HMPV No Mask Required

Unless AGP**

No Mask Required

Unless AGP**

Parainfluenza 1,2,3 Parainfluenza 1,2,3 No Mask Required

Unless AGP**

No Mask Required

Unless AGP**

HMPV RSV, HMPV, respiratory

adenovirus (and vice versa)

No Mask Required

Unless AGP**

Surgical Mask* Required

Mycoplasma

Pnuemoniae

RSV, HMPV, respiratory

adenovirus (and vice versa)

No Mask Required

Unless AGP**

No Mask Required

Unless AGP**

Influenza A, B Influenza A, B – do not cohort with

other resp viruses

Surgical Mask required * Surgical Mask required *

SARS-CoV-2

(COVID-19)

COVID-19-COVID-19 - do not

cohort with other resp viruses

Surgical Mask* required

N95/P2 Masks are required

for AGP or prolonged

contact

Surgical Mask* required

N95/P2 Masks are required

for AGP or prolonged

contact.

*If surgical mask is not available then ASTM level 1 procedure mask is acceptable in severe shortages for

droplet pathogens excluding SARS CoV-2. ASTM level 2 procedure mask is an acceptable alternative in

emergent situations for all droplet pathogens.

**AGP – Aerosol Generating Procedure (AGP): Refer to Table 2.

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Table 2: Aerosol generating procedures in paediatrics (with highest risk procedures listed first)

High Risk of Generating Aerosols Potential risk of generating aerosols Low risk for generating

aerosols

• Insertion or removal of endotracheal tube

• Intentional or inadvertent disconnection/reconnection of closed ventilator circuit

• High frequency oscillatory ventilation

• Open oropharyngeal or tracheal suctioning

• Bronchoscopy/BAL

• Nasendoscopy

• Tracheostomy change/open suction

• Intercostal catheter insertion

• Thoracic surgery that involves entering the lung

• Surgery with exposure of respiratory mucosa

• Invasive dental surgery

• High flow nasal oxygen

• Manual or non-invasive ventilation (CPAP, BiPAP)

• Collection of induced sputum

• Transoesophageal echocardiography

• Nebulised medication

• PEP and oscillating PEP devices

• BubblePEP

• Manual hyperinflation

• Positioning/gravity assisted drainage techniques and manual techniques (eg expiratory vibrations, percussion, manual assisted cough, intra/extra pulmonary high frequency oscillation devices)

• Positive pressure devices/PEP techniques

• Air enema reduction of intussusception

• Nitrous oxide

• Removal of nasal foreign body

• Insertion of a nasogastric tube

• Respiratory function tests

• Prolonged and high volume sound stimulation exercises

• Nasal application of barium

• High intensity exercise

• Coughing

• Sneezing

• Collection of a nasopharyngeal swab

8.4 Antiviral management (when applicable)

• Antiviral medications can be used for the treatment of symptomatic cases and prophylaxis of exposed

contacts. Treatment with antivirals aims to reduce signs and symptoms in individuals and hence lower

morbidity and mortality.

• Prophylactic use of antivirals aims to reduce the risk of infection and illness in contacts, potentially lowering

the spread and hence disease attack rate.

• The strategy for the use of antivirals will depend on stage of the pandemic, the epidemiology (transmissibility

and clinical severity) and virological (antiviral resistance) characteristics of the virus, pre-existing immunity,

vaccine availability and practicalities such as logistics of antiviral delivery and availabil ity (Australian

Department of Health 2014).

• In the event of a pandemic, the Communicable Diseases Network of Australia (CDNA) will provide

information outlining the strategy and use of antivirals (Australian Department of Health 2014).

• During a pandemic there may be rationed or restricted use of antivirals in Australia. The CNDA will advise

regarding use of prophylaxis.

• The CHQ medication advisory committee should be consulted to approve the use of a standing order for

antivirals if not already governed by instruction from Queensland Health.

8.5 Vaccine management (When applicable)

• Queensland Health Immunisation Program (QHIP) in coordination with Queensland Health Central

pharmacy will authorise the use of pandemic influenza / respiratory pandemic vaccine if and when available

during a pandemic response.

• Vaccine ordering, storage, cold chain management and distribution should be managed by CHQ pharmacy.

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8.5.1 Public Mass Vaccination Clinic (When applicable)

• If a mass vaccination clinic response is required, use of existing services within the community (e.g. GP)

will be the primary method to provide the pandemic vaccine to the public.

• In addition to these community-based services, on the request of the State Health Incident Controller, HHSs

shall be required to contribute to the mass vaccination of target groups within Queensland

• Queensland Health Chief Health Officer and / or local public health unit (MSHHS PHU) may request CHQ

to establish a mass vaccination centre for paediatric patients and their families. The establishment and

commitment of resources is at the discretion of the CHQ Health Incident Controller.

8.5.2 CHQ Staff Assessment and Vaccination Centre

• The Incident Controller should consider the establishment of a CHQ Staff Assessment and Vaccination

Centre for the distribution of antivirals and vaccinations.

• Staffing considerations should include: a medical officer, immunisation nurse, supporting general and

immunisation nurses and administration staff.

• The CHQ Staff Immunisation Database can be utilised by IMPS nursing staff to record immunisation of staff

receiving pandemic respiratory / influenza vaccination and / or antiviral therapy.

• The incident controller should consider the need to be establish mobile immunisation clinics to deliver

vaccination to “at risk” clinical staff.

• A standing order may be provided by Queensland Health or CHQ Medicines Advisory Committee

(CHQMAC) to allow RNs to administer vaccinations and / or dispense antivirals.

• Guidance is provided at Appendix 5 CHQ staff mass immunisation clinic guide.

8.6 Handling of the deceased

• The risk of respiratory / pandemic influenza infection from deceased persons is low and is minimised using

infection control precautions.

• All staff handling persons who have died while infectious with pandemic / respiratory influenza should follow

the appropriate transmission-based precautions for the pathogen.

• Some high-risk procedures such as embalming and autopsy may require a higher level of PPE to be worn.

These do not occur at QCH.

• If demand for body storage extends beyond QCH capacity, there is a service level agreement with Mater

Public Hospital to provide deceased person storage prior to transfer to funeral home facilities.

• A death due to a pandemic will generally not require reporting to the coroner. Refer to Department of Justice

and Attorney-General for further information form the Coroners court of Queensland where necessary.

• For specific consideration regarding care of the deceased COVID-19 patient visit CHQ-PROC-63002

Infection Control Guidelines for the Management of Coronavirus (MERS, SARS, SARS-CoV-2 or Novel

Coronavirus)

Supporting documents

• Queensland Health Pandemic Influenza Plan

• Australian Health management plan for pandemic influenza (AHMPPI)

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• QH Drug therapy protocol – Pandemic influenza Program

• Australian Immunisation Handbook - Influenza

Resources

• CDNA National guidelines for public health units.

• The Australian College for Emergency Medicine has published guidelines for the management of Severe

Influenza, Pandemic Influenza and Emerging Respiratory Illnesses in Australasian Emergency

Departments

• Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19)

Procedures

• CHQ-PROC - 63110 Standard and Transmission and protective based precautions

• CHQ-PROC-63210 Admission Screening and Safe Patient Placement

• CHQ-PROC- 63505 Hand Hygiene and Bare Below the Elbow

• CHQ -PROC-62420 Code Brown External Emergency/ Disaster

• CHQ-PROC-63317 Donning and Doffing of Personal Protective Equipment (PPE)

• CHQ-PROC-63002 Infection Control Guidelines for the Management of Coronavirus (MERS, SARS,

SARS-CoV-2 or Novel Coronavirus)

• CHQ-GDL- 63327 -The Management of children with COVID-19

• CHQ-PROC-63326 – Respiratory Pandemic sub plan

• CHQ-PROC-64712- Visitation and access during COVID-19 pandemic-period

• CHQ-PROC-24703 -Special measures during the COVID-19 pandemic period.

• CHQ-WI-63324- Medirest cleaning and waste removal (PICU)- COVID-19

• CHQ-WI-63321 – Medirest Food Services Guide COVID-19

• CHQ-WI- 63322- Medirest Linen Guide – COVID-19

• CHQ-WI-63320 – Medirest Transport Guide - COVID-19

• CHQ-WI- 63319 – Medirest Cleaning and Waste Removal (Emergency and ward) -COVID-19

• CHQ-WI-63323 – Personal Protective Equipment (PPE) rationalisation within CHQ – COVID-19

• CHQ-WI- 64713 - Screening controls for visitation and access during COVID-19 pandemic period

• CHQ-PROC-63005 – Transportation of suspected and confirmed (MERS, SARS, SARS-CoV-2 or Novel

Coronavirus

Staff Resources

• Please visit the staff portal for details information about PPE and general IMPS information for staff.

• COVID-19 Personal Protection Equipment (PPE) Requirements for OPD and ED Assessment and Clinical

procedures.

• COVID-19 Personal Protection Equipment Flowchart

• COVID-19 Masks and uses

• COVID-19 Risk screening flowchart (Inpatient/Outpatient)

• All COVID-19 screening outside of emergency

• COVID-19 Personal Protection and Equipment chart guide

• CHQ-PROC-63002-1- Staff personal log for suspected or confirmed high risk cases of coronavirus

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Legislation

• Work Health and Safety Act Qld 2011

• Disaster Management Act Qld 2003

Consultation

Key stakeholders who reviewed this version:

• Director of Infection Management and Prevention Service

• IMPS Committee

• Clinical Nurse Consultant, Infection Management and Prevention Service

• Executive Director Medical Services

• Executive Director Clinical Services

• Director Strategy and Planning

• Executive Director Legal, Governance and Risk

• Disruption and Disaster Emergency Management Project Officer

• Nursing Director Clinical Support

• Nursing Director Critical Care

• QCH Emergency Management Working Group

• PICU Leadership

• Division of Medicine

• Medirest management

Audit/evaluation strategy

Level of risk High

Strategy The Infection Management and Prevention Service (IMPS) team will evaluate the management of the cases and make recommendations to the Disaster Management

Committee for future events.

Audit/review tool(s)

attached

Nil

Audit/Review date Annually

Review responsibility CNC. Infection Management and Prevention

Key elements /

Indicators / Outcomes

Management of all cases will be evaluated, and recommendations made to the emergency

management committee.

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Procedure revision and approval history

Version No. Modified by Amendments authorised by Approved by

1.0

19/08/2020

CNC, IMPS Divisional Director, Division of

Clinical Support

Executive Director Medical

Services

Keywords Pandemic, respiratory, influenza, flu, ILI, code brown, sub-plan, external emergency, 63326,

Coronavirus, COVID-19, 63330

Accreditation

references

NSQHS Standards (1-8): Standard 1 and 3

ISO 9001:2015 Quality Management System (4-10)

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Appendix 1 - P2/N95 respirator – how to perform a fit check

How to fit check a P2 / N95 mask

Fit checking is required to check your safety each time you don a high particulate mask (N95).

Two types of checks must be performed prior to patient room entry:

Negative Pressure Positive Pressure

The wearer inhales sharply. The mask should be drawn in to the face. If air can be drawn into the mask it will not

collapse. This indicates that the seal has failed. You need to reposition the mask and

perform the check again.

The wearer huffs or exhales sharply. Air should not be felt leaking around the edges of the mask. This indicates that

the seal is not adequate. Reposition the mask and perform the check again. The wearer should not feel any air leak between the mask and face. This is the

sign of a good face - mask fit, and a successful Fit Check.

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Appendix 2 - Negative Pressure rooms within QCH

Room and Ward Room Number Room Description AHU Location

Positive / Negative

Bed 1 - Orange Zone 01.2.262 Isolation Bed 1 02.2.285 Negative

Bed 2 - Orange Zone 01.2.265 Isolation Bed 2 02.2.285 Negative

Bed 3 - Orange Zone 01.2.322 Isolation Bed 3 02.2.285 Negative

PICU Bed 5 04.1.062 PICU Bed 5 05.3.502 Negative

Ward 9A - Bed 20 09.1.001 Medical Ward Bed 20 09.2.302 Negative

Ward 9B - Bed 15 09.4.812 Babies Ward Bed 15 09.4.801 Negative

Ward 9A - Bed 5 09.3.594 Medical Ward Bed 5 09.3.523 Negative

Ward 9B - Bed 1 09.2.262 Babies Ward Bed 4 09.2.302 Negative

Ward 9A - Bed 11 09.3.514 Medical Ward Bed 11 13.1.005 Negative

Ward 9A - Bed 10 09.3.534 Medical Ward Bed 10 13.1.005 Negative

Ward 9A - Bed 15 09.1.042 Medical Ward Bed 15 13.1.005 Negative

Ward 10A - Bed 20 10.1.001 Surgical Ward Bed 20 10.2.325 Negative

Ward 10B - Bed 22 10.4.842

Cardiac/Oncology Ward

Bed 22 10.4.772 Negative

Ward 11B - Bed 20 11.4.856

Oncology & Bone Marrow

Ward Bed 20 11.4.772 Negative

Ward 11A - Bed 5 11.3.581 Neurosciences Ward Bed 5 11.3.525 Negative

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Appendix 3. - Routes of transfer of a patient with confirmed or suspected

Coronavirus or pandemic Influenza

Lifts for use

How to call Lift 19 instructions:

Call security with ETA to isolate Lift 19, meet at arrival point and assist with quarantine of route used to move

patient throughout QCH to destination

Location of lifts 18 and 19

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ED to Lift 18 or 19 and CHQRS/Helicopter Landing services route Lift 19 to ED isolation rooms.

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PICU discharges to 9A (Lift 18 or19 to 9A rooms) and DEM transfers to 9A (Lift 18 or 19 to 9A

rooms)

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PICU and Thearter/PACU

Route to be used for:

Staff lifts/Lift 19 to Theatre/PACU

Theatre/PACU to Staff lifts/Lift 19

Staff lifts/Lift 19 to PICU directly.

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PICU admissions (includes MET calls) from ED, QCH inpatient wards or CHQRS (Lift 19 to

Riverside PICU) and PICU discharges to inpatient wards (PICU to Lift 19)

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Appendix 4 - Theatre Plan - Management of patients with High Risk or confirmed

Pandemic respiratory organism

• Patients with highly suspected or confirmed coronavirus are to be treated in Operating Room (OR) 14 only. In the

event the patient is a Cardiac patient theatre 7 is used, Cath lab patient Theatre 10 or MRI patient. the intraoperative

MRI room is used. In the event of two coronavirus patients occurring simultaneously theatre 5 is to be used as an

alternative.

• All items not required for use must be removed from the theatre before the patient’s arrival.

• OR staff who are immunocompromised cannot participate in direct patient care of patients with suspected or confirmed

coronavirus. Refer to COVID-19 Vulnerable employees guideline.

• The OR Wardman, anaesthetist and two anaesthetic assistants will attend the ward, obtain handover of the patient

and transport them to OR 14. Parental escort will only be considered in exceptional circumstances on a case by

case situation.

• The OR team will ensure any parent accompanying the child is wearing appropriate Airborne plus precautions prior

to leaving the ward. Parents must also wear a surgical/procedureal mask. If the patient is old enough and not on

oxygen therapy they are to don a surgical/procedural mask.

• OR staff must don PPE which includes:

- Long sleeved yellow gown

- Duck bill mask (if this is ill fitting a filter mask can be used)

- Face shields or goggles

- Gloves

- Hair must be protected under a disposable hat

• The PPE trolley is to remain in theatre 14’s induction room with a yellow rubbish bin.

• The patient is to enter OR 14 via the scrub area and brought straight into the OR.

• The patient is to be anaesthetised in OR 14. Induction room 14 is not to be used.

• While a case is underway, one staff member must remain outside by the infection control trolley as a ‘runner’ in OR

14’s induction room. If equipment or consumables are required, the team inside the OR must ask the outside scout

nurse to collect it on their behalf. It is handed to the team inside the OR at the induction room doorway.

• While a case is underway, signage will be placed on all doors external to OR 14 indicating ‘no entry – enter via

induction room door only’.

• Single use anaesthetic equipment must be used where available. The anaesthetic circuit and associated filters must

be discarded at the end of the case and the rubbish bin sealed. Reusable anaesthetic equipment must be immediately

sent down to CSU for reprocessing with used instrumentation.

• Staff entering OR 14 must sign the Health Care Worker staff Log (lives on infection control trolley). Staff are to don

PPE as per the procedure and then to enter OR via the OR 14 induction room and leave via the scrub sink area. Staff

must be competent and PPE donning and doffing and have it recorded on Teach Q +.

• All patients are to be recovered in OR 14. Once ready for discharge, the ward is contacted to come collect the patient

for return to the ward.

• One ORS staff member (with fully donned PPE) must meet ward staff at the staff lifts and escort them to OR 14.

Handover will be given IN the OR.

• Staff in the room are to clean the anaesthetic trolley and any equipment, and trolleys within the room following the

patients departure

• The used instrument transportation trolley must be brought to door of the theatre and instruments placed directly

inside the trolley. The trolley must be closed, and a Covid-19 sign applied to front of the trolley prior to being sent to

CSU for decontamination and re-sterilisation as soon as possible. The CSU team leader must be notified.

• Staff must remove all PPE within the induction room(following the Airborne plus signage).

• Once all PPE has been discarded, the bin must be tied off.

• Hand hygiene must then be performed.

• Cleaners who enter OR 14 to clean the theatre after use must also sign the staff log form. An orange clean must be

performed.

• Cleaners to clean all items in the room.

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Appendix 5 - CHQ staff mass immunisation clinic guide

CHQ staff mass immunisation clinic

Purpose

CHQ will conduct immunisation clinics for staff, students, volunteers and CHQ contractors for the

administration of vaccines in the following circumstances:

1. Respiratory pandemic / pandemic influenza like illness (ILI) where a vaccine is available.

2. Outbreak response where a vaccine is available.

Scope

This work instruction applies to CHQ staff, contractors and volunteers.

Instruction

CHQ will conduct immunisation clinics as on-site mass vaccination clinics within QCH and mobile clinics to

service CHQ community sites. Mass vaccination of health care workers will occur in line with the Australian

Immunisation Handbook and the Queensland Health Guideline: Vaccination of Healthcare Workers.

Roles, responsibilities and staffing

The preferred option is that the clinic lead will be a CHQ credentialed Immunisation Program Nurse (IPN).

Suggested staffing profiles are provided below under Staffing Requirements. As this is a mass vaccination

clinic staff for vaccination clinics should not be drawn from specialist services such as Emergency Department,

Intensive Care Units or Infection Control Units. It is suggested that staffing options are drawn from casual nurse

pools, agency and low acuity areas as services allow, minimising disruption to business as usual. Child and

Youth Community Health Service (CYCHS) has a cohort of IPNs who may be able to be utilised in pandemic

and outbreak situations.

Workflow design for a mass vaccination clinic

Clinical flow through a mass vaccination clinic should be organised to maximise throughput and minimise

waiting times. To facilitate efficient and safe administration of vaccine in a mass vaccination clinic, consider

the following:

• Clinic layout should promote a unidirectional flow of clients through the clinic (with side diversions for those

who are not processing quickly).

• Queue management systems should be in place. For example:

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- ticket controlled system to identify a person’s place in the queue.

- rigorous marshalling of individuals to prevent straying to improve efficiency and throughput.

- movable physical barriers could be used to delineate routes for clients to follow from station to

station.

Suggested stations in a mass vaccination clinic

Station Staffed by Functions / considerations

Entrance Security & greeter Large front entrance to reduce bottleneck effect.

Reception Administration officers (AOs)

Large reception area to reduce bottleneck effect.

Queue management process (e.g. ticket system) commenced.

Identify people who present with influenza like illness (ILI) and segregate them. Vaccination may or may not still be indicated. If

proceeding to vaccination – remain segregated for the duration of their clinic visit.

Clients given written information on the vaccine and side effects, a one-page medical questionnaire and / or pre-vaccination checklist

and consent form.

Clients advised to present completed consent forms to pre-vaccination assessment station.

- Note: clients should be given the opportunity to ask questions at the pre-vaccination assessment station prior

to completing the consent form.

Waiting area Volunteers and Queensland Health

staff.

Located next to reception area.

Clients to read information sheets & complete personal details / consent form.

Covered waiting area with adequate seating.

Toilets and hand washing facilities.

Drinking water available.

Management of clients who become unwell whilst waiting.

Public address system, preferably visual and audio, used to indicate next client to present to pre-vaccination area.

Pre-vaccination assessment

AOs, Registered Nurses (RNs), IPN

Answer any client questions prior to vaccination.

Clients’ eligibility for vaccination including contraindications and pre-vaccination checklist assessed. Eligible clients are directed to the pre-vaccination waiting area.

Clients not eligible or contraindicated for vaccination are counselled Clients who are acutely febrile (≥38.5°C) or show signs of systemic illness will need to be clinically assessed and referred. Adults may

need to be referred to an adult facility / GP.

Clinical queries addressed at this point.

AO role: Collation of completed forms and assessment.

Appropriate Storage of vaccines

Immunisation Program Nurse / RNs

Vaccines must be stored according to the current National Vaccine Storage Guidelines.

Appropriate equipment should be available to store and maintain the temperature of vaccines between +2˚C and +8 ˚C (i.e. a purpose-

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built vaccine refrigerator or purpose-built mobile vaccine refrigerators).

Vaccines management throughout the clinic must be closely monitored (i.e. the number of vaccines left out during a clinic should

be minimal and topped up when required).

At the end of the vaccination session (or up to a maximum interval of 4 hours after the vaccines have been drawn up), any remaining pre-

drawn syringes must be discarded unless otherwise instructed e.g. by PHU.

Multi-dose vials must not be used beyond 24 hours after first opening.

Vaccination administration

Vaccinators Vaccination stations should be clearly numbered.

Most work stations need to be able to accommodate family groups.

If possible, a degree of privacy should be afforded to the client e.g. a screen.

Clean area for drawing up vaccines.

Hand hygiene facilities.

Process for documenting vaccination records for client.

Pathway to post vaccination area where client must wait for 15 minutes unless otherwise instructed e.g. by PHU.

This area should not be used to manage people who present with

influenza like symptoms.

Post vaccination observation

Volunteer organisation / health staff

Large area that enables easy observation of clients post vaccination.

Adequate seating and access to drinking water for people post vaccination.

Process for transferring clients who become unwell from post vaccination area to first aid area.

First aid RN Located near post vaccination observation station.

Process for managing Adverse Events Following Immunisation (AEFI).

Mats or mattress with screen for privacy for unwell clients.

Emergency medications and equipment.

Telephone.

Medically compromised patients receive first aid and referred for further care as appropriate.

Complete AEFI form.

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Example of a mass vaccination clinic floor plan

Site Selection

Consider:

• Capacity to segregate areas and direct the flow in one direction with separate entrances and exits

• Capacity for emergency response access

At QCH suggested sites for a staff vaccination clinic include:

• Level 7 Auditorium

• CHQ School on level 8

• Marquees in the outdoor areas under cover on level 2

• Ambulance bay near the decontamination unit

• OPDs not in use by the patients and the public

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Mobile vaccination clinics in community-based locations are recommended to consider the requirements for

mass vaccination and the storage, security and transport requirements for all consumables and equipment

required.

Resources and consumables

Consumables

Medical stock and consumables can be ordered from the CHQ Central Resources Service – Consumables. Contact CHQ_CRS@health.qld.gov.au or phone (07) 3068 4720.

Storage

IMPS have a storage area in the B3 area at QCH, access via contact with the IMPS team.

Equipment

IMPS nursing team have the following items in IMPS storage for use in vaccination clinics:

• Mobile vaccination trolley (large)

• Immunisation clinic consumables packs – for mobile clinics

• Anaphylaxis kits (minus adrenaline – source from pharmacy prior to commencing clinic)

• Emergency airway management equipment

• Baseline level of immunisation consumables

Supply of sharps containers and alcohol-based hand rub are accessible by contacting the CHQ Medirest

Helpdesk – phone 07 3068 4357 (HELP)

Immunisation clinic set up and checklist

Mass vaccination clinics work best with multiple stations in a large area with multiple nurses immunising at

once. The following is a guide for the set-up of a safe and efficient immunisation station. Adequate space is

required for the nurse to complete the pre-vaccination assessment and have access to all resources required.

A privacy screen is preferred.

A chair Is required for both the nurse and the patient.

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Equipment

Clinic Checklist Yes or No

Opening checklist

Station set up as per instructions

Vaccine fridge cold chain maintained and recorded

Check expiry dates of vaccines and consumables

Orientate self and others to emergency equipment including location of emergency phone

Take note of the address of the clinic, location and telephone system

Allocate team roles for clinic session

Nurse resource folder accessible on each vaccination station

Resuscitation equipment

Adrenaline 1:1000 three (3) x ampules within expiry date

Three (3) x 1 ml syringes

Three (3) each drawing up needles and 25G 25mm needles

Recognition and treatment of anaphylaxis chart - in resource folder

Adult and child resuscitation masks and Air-viva

Oxygen cylinder and tubing if available

Emergency phone, charged and working

Adrenaline administration clinical documentation sheet, clipboard and pens

Stock trolley

Thermometer

Sphygmomanometer and stethoscope

Consider stock requirements relative to size of clinic

- Extra consumables including needles, cotton wool, micropore tape, tissues, sharps

containers etc

- PPE

- Extra ABHR

Vaccination Station set up and checklist

1 Nurse resource folder

3 Alcohol based hand rub

4 Safety Engineered Sharps (BD Eclipse)

5 Sharps container

6 Post vaccination information sheet (if applicable)

7 Pens

8 Tissues

9 Cotton ball or gauze ball

10 Micro pore tape

11 Rubbish bag

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Checklist

General Items Equipment Yes/No – Comments

Personal Protective Equipment (PPE) Masks (Staff and patients) n95 and Surgical

Gowns

Eye protection

Gloves (All sizes)

Observation Equipment Thermometers

Pulse Oximeters (Observations Machines)

Sphygmomanometers

Safety Equipment Oxygen Tubing

Oxygen Masks

Suction equipment all sizes

Suction equipment if none present on the wall.

Waiting room Chairs

Waste Bin

Tissues

Cleaning Rubbish Bags

Linen trolleys

Spare Linen Bags

Pathology Floq swabs

IeMR printers

Replacement stickers for printing

Patient Movement Wheelchairs

Technology Deck Phones

Security devices for staff

Computers

List of phone contacts

Vaccine

Prescribing and orders

IPNs working at CHQ are required to work under the CHQ Health Management Protocol when administering

vaccines under the funded National Immunisation Program Schedule. IPNs are required to have access to

the following resources in immunisation clinics:

1. Australian Immunisation Handbook

2. Drug therapy protocol

3. Health (Drugs and poisons) regulation 1996

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Stock

Vaccine stock is accessible by order for QH central pharmacy and needs to be organised in advance with the

Immunisation Pharmacist and or the Materials manager lead at CHQ Pharmacy

Storage options for staff vaccination clinics need to be discuss with the CHQ Immunisation Pharmacist and will

be dependent on space requirements. Lady Cilento has a number of dedicated vaccine fridges including two

portable ‘Twinbird’ vaccine fridges in the hospital.

Vaccine fridges are located at CHQ community sites in Acacia Ridge and Zillmere locations. CHQ has a mobile

vaccination vehicle equipped as a mobile vaccination clinic; this clinic operates out of the Logan community

site.

Cold Chain management

All vaccines must be monitored and maintained at appropriate cold chain temperatures as per the National

Vaccine Storage Guidelines – Strive for 5 (Australian Government Department of Health and Ageing 2013b).

Multi dose vials

Multidose vials are not routinely used in Australia however where mass vaccination of the population is

required multidose vials have some advantages over single-dose vaccines (Australian Government

Department of Health and Ageing 2013a). Multidose vials provide for the availability of a vaccine substantially

earlier than single dose or pre-filled syringes as the time it takes for the manufacturer to fill and finish the

vaccine is significantly reduced in comparison to single doses (Australian Government Department of Health

and Ageing 2011). This allows for more vaccine to be available for use in a shorter period of time.

Please refer to:

• The guideline for the administration of pandemic influenza vaccine from multi-dose vials

• Pandemic Influenza Vaccine from Multi Dose Vials Theory - iLearn module for instructions on appropriate

use including instructions for drawing up multiple doses for multi-use vials.

Staff Training

Staff working in vaccination clinics need to complete the following teaching and training as relevant. The Staff

Immunisation Nurse as the program coordinator will determine the training requirements for clinical staff

providing vaccinations:

1. BD Eclipse product – training video from BD

2. Multi dose vial use – iLearn link http://qheps.health.qld.gov.au/ilearn/

3. ANTT online education package - Teach Q

4. Hand hygiene online education package – Teach Q

5. PPE donning and doffing video – Teach Q

6. Mask Fit check – education via https://www.health.qld.gov.au/clinical-practice/guidelines-

procedures/diseases-infection/infection-prevention/transmission-precautions/p2n95-mask including

PowerPoint presentation

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The following tables provide guidance for staffing requirements for vaccination clinics. Complete the

appropriate table(s) below and delete the table(s) that does not apply.

Staffing requirements

Large vaccination clinic

This table is based upon the assumption that a large vaccination clinic could average 4,000 people per day

over an 8hour period.

Staff type Guide

estimated total

required

Guide

estimated number required

breakdown per role

Actual number rostered

District total *Where nurses will be accessed from

**Where admin officers will be accessed from

Other Whole of Government support

required

Site manager 1 1

Clinical team leader

1 1

Logistical team leader

1 1

Admin team leader

1 1

Clinical Staff

assessment area

vaccination area

post-vaccination area

first aid area

26 9

12

2-3

2

Administration staff

registration area

assessment area

10 8

2

Volunteers

registration area

waiting area

post-vaccination area

floaters

8 2

2

2

2

Security staff 3 3

Cleaner 1 1

Small vaccination clinic

This table is based upon the assumption that a small vaccination clinic could average 1,000 people per day

over an 8hour period.

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Staff type Guide

estimated total

required

Guide

estimated number required breakdown per role

Actual number rostered

District total

*Where nurses will be

accessed from

Where admin officers will

be accessed from

Other Whole of Government

support

required

Site/facility manager

1 1

Clinical team leader

1

Clinical Staff

assessment area

vaccination area

post-vaccination area and first aid area

11

4

5

2

Administration staff

3

Volunteers 2

Security staff 2 1-2

Cleaner 1 1

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Outreach clinic

This table is based upon the assumption that an outreach vaccination clinic could average 200 - 250 people

per day over an 8hour period.

Name of mass vaccination clinic facility:

Staff type Guide

estimated total

required

Guide

estimated number required

breakdown per role

Actual number rostered

District total

*Where nurses will be accessed from

Where admin officers will be accessed from

Other Whole of Government support required

Clinical team leader and

assessor

1 1

Clinical staff

vaccination area and assessor

floater – back up, post vaccination

area and first aid area

2

1

1

Administration staff

1 1