“Community pharmacies in

outbreak-affected and unaffected

areas are often the first point of

contact with the health system for

those with health-related concerns

or simply in need of information

and reliable advice.”International Pharmaceutical Federation:

Coronavirus SARS-CoV-2 / COVID-19 pandemic: Information and Guidelines

for Pharmacists and the Pharmacy Workforce

The difference in the distance travelled between droplet and airborne

particles after aerosol generation through coughing and sneezing

5-10 μm <5 μm

Department Health RSA, COVID-19 Disease:

Infection Prevention and Control Guidelines version 1 April 2020

Symptoms: fever, cough, shortness of breath,

muscle ache

Incubation period: 2 – 14 days (median 5.1 days)

Transmission: respiratory droplets, transmission from contaminated surfaces

Patients are contagious: 2 to 7 days before symptoms appear and for up to 2 weeks after remission of symptoms

The occupation of a pharmacist falls into the risk categories of:

Medium exposure risk› An area where there is ongoing community transmission, workers in this

category may have contact with the general public

› Examples: high-volume retail settings as in some community pharmacies,

PHC clinics and CHCs

Low exposure risk› Occupation does not require contact with people known to be, or

suspected of being infected with COVID-19, no frequent close contact (i.e. within 2 m) with the general public.

› Workers have minimal contact with the public and other co-workers

Apply strategies to minimise close contact with patients

Reference: Department: Employment and Labour: Notice on compensation from occupationally–acquired novel corona virus disease (COVID-19)

Screening to

eliminate

exposure

Not possible in

pandemic

Physical/

environmental

Procedures

PPE

http://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-

the-issues/PPE-Best-Practice-Suggestions.pdf

Make the pharmacy environment safe for your staff and the public

Entrances: preferably separate for staff and patients

Limit the number of people entering the pharmacy at a time

Screening (staff and patients/public)

Hand sanitiser applicators at entrance

Easy access to sufficient hand sanitiser dispensers

Good ventilation

Signage and directions for patients, respiratory and hand hygiene

Examples of information posters and signs

Poster at entrance indicating local dedicated COVID-19 testing sites,

private and public Address TSHWANE COVID TESTING SITES-signed.pdf

Floor strips indicating 1.5 m social distancing in queues

1.5 m distance from dispensing hatches and counters, till points

Perspex screen at dispensing hatch/counters

Screening

COVID-19 screening› Patient COVID-19 screening at pharmacy entrance, separate

suspected cases, line list* for tracing, refer

Screen staff on arrival at work for fever› Dedicated staff member to screen for fever using an infrared

forehead thermometer

› Monitoring on return to work after illness

*Line list: Patient and contact details: Name, telephone number and

address NCID website https://www.nicd.ac.za/diseases-a-z-

index/covid-19/covid-19-guidelines/

Screening for COVID-19

Patient/customer reports to

screening station at

entrance to pharmacy

Patient details and Line listing for tracing purposes: Name,

telephone number and address

Screen for any sign of upper respiratory tract infection

Patient issued with a

surgical mask

Referred for testing for

COVID-19 as per

facility procedures

Patient may enter

pharmacy

Follow social distancing

guidelines

Hand sanitising

instructions

No signs of acute

upper respiratory

tract infection

Signs of acute

upper respiratory

tract infection

Staff member administers hand

sanitiser onto hand of patient

Temperature monitoring

Identify

symptomatic

patients asap

Limit chance of

transfer of infection

in pharmacy

Protect personnel

and other patients

Do you have a fever (≥ 38°C measured)?

Do you have a cough (sudden onset)?

Do you have shortness of breath/difficulty

breathing?

Do you have a sore throat?

Have you been in close contact with a

probable case of COVID-19?

Have you been in close contact with a

person with ARI who has been in an area with

community transmission of COVID-19?

Acute

respiratory

infection

In the last

14 days

prior to

onset of

symptoms

&

National COVID-19 Hotline: 0800 029 999

HAND SANITISERS AT ALL CRITICAL POINTS› Entrances, till points, card machines, dispensary, clinic, counter tops

Hand sanitiser administered by a staff member for every

person entering the pharmacy or no-touch hand sanitiser

dispenser

SOCIAL DISTANCING

Social distancing instructions, waiting, submission of

prescription and collection of medicines

Limit number of customers entering at a time

Dispensing

Electronic prescriptions where possible

Paper prescriptions: do not handle medical aid cards – take

a photo or patient to read aloud

Maintain 1.5 to 2 m distance from patient; floor marker,

Perspex screen with pass-through opening at bottom

If you touch any item handled by customer, sanitise hands

Declutter dispensing area for easy cleaning

Sanitise surfaces between each new prescription

Use speaker phone if you need to communicate with patient

or prescriber

Stock

Receipt of stock› Clean packages

› Sanitise hands after unpacking

Cleaning of stock on shelves where the public have access

Delivery of medicines › Sanitise packages prior to packing into scooter

› Clean delivery scooter and container daily

› Deliver to patient by arranging drop-off site and ensure no physical

contact during handover of package

› Confirmation of receipt by patient, no close contact, verbal recording if

possible

› Sanitise hands

Avoid touching face, nose, eyes, mouth

Point-of-care screening services, close contact with patient

unavoidable

Surgical mask and gloves to be worn› N95 respirators to be used for aerosol generating procedures which are

not performed by pharmacists in SA at this point in time

Don and doff properly

› Wash hands – click link to see proper washing of hands video proper handwashing procedure

› Don mask with correct side outwards, do not touch outer side (link to

video of proper way to don and doff face mask proper donning and doffing of mask donning and doffing surgical mask

› Doff mask correctly

› Dispose of mask properly in biohazard waste

› Wash hands

Sanitise consulting /clinic area after each patient

Rule for EVERYONE

Avoid touching face, nose, eyes, mouth

Avoid touching face, nose, eyes, mouth

Avoid touching face, nose, eyes, mouth

Avoid touching face, nose, eyes, mouth

This cannot be emphasised enough!!

The types and rational use of PPE

Masks› Surgical masks - use by pharmacists

› N95 respirator - use for aerosol generating procedures

› Cotton masks - use by the general public

Gloves› Non-sterile - pharmacist if patient contact

› General purpose heavy duty - cleaning staff

Clinical coat› Pharmacists and pharmacists’ assistants

Over-coat for support personnel› Driver and cleaner

Staff Activity PPE Other measures

Pharmacist

Pharmacist internCOVID-19 Screening Surgical mask Clinical coat

Hand sanitisingSurface cleaningArea cleaning

PharmacistPharmacist internPost basic and basic

pharmacist’s assistantPharmacy student

Dispensing Surgical maskNone if no patient contact

Clinical coatHand sanitisingSurface cleaningArea cleaningDistance at least 1.5 m from patient

PharmacistPharmacy intern

Point-of-care patientscreening and vaccinations(e.g. cholesterol,

blood glucose, uric

acid, vaccination)

Surgical maskNon-sterile gloves

Change gloves between patientsConsultation area disinfection

between each patientEquipment disinfection between each patient

Cleaning staff Cleaning and sanitising all areas floors and surfaces

Non-sterile heavy duty glovesSurgical mask

Dust coatClean counters and other surfaces as per riskDo not spray, wipe

Administrative staff Regular office duties Surgical mask Work area disinfection daily

Masks Description

Surgical Layers of non-woven fabric,

secured with ties or loops.

Reserved for use by healthcare

personnel.

N95

respirator

Specifically for use by

healthcare personnel when

performing aerosol generating

procedures (AGP), e.g. taking

swabs for COVID-19 screening.

Cotton

mask

Effectiveness not fully proven.

Not recommended for healthcare workers in South Africa, but the

Minister of Health on Friday 10 April recommended the wearing of cloth

masks (3 layers of fabric) by the public when they leave their homes. For more information on making cloth masks see: https://www.cdc.gov/coronavirus/2019-

ncov/prevent-getting-sick/diy-cloth-face-coverings.html

For more information on N95 respirators types https://www.thomasnet.com/articles/other/how-surgical-masks-are-made/

TOP

Video Handwashing2 2020-04-10 at

12.42.03.mp4

Note !!!

Wash and dry your hands before donning face mask or gloves

Do not touch your face or mask with your hands

Wash your hands often

https://youtu.be/ZnSjFr6J9HI

Note !!!

Only use ABHR if your hands are not visibly dirty

Do not touch your face or mask with your hands

Apply ABHR to dry hands

Wash hands with soap and water if visibly contaminated

Do not apply ABHR to gloves

Use ABHR which contains at least 70% alcohol

Video https://youtu.be/9VbojLOQe94

Note !!!

Wash hands before donning mask

Do not touch mask with your hands during use

Wash hands before and after removing mask

Be careful not to touch your eyes, nose, and mouth when removing

the mask and wash hands immediately after removing

Do not touch the front outside area of mask when removing

Dispose of mask into appropriate waste container

May be worn for 8 hrs unless contaminated

If contaminated, soiled or it gets wet

If you touch the outside of the mask with

unwashed hands

If removed from your face

Use a new surgical mask every day

Dispensing area and keyboard, pens• Between each prescription dispensed

Patient screening area• Between each patient

Counter tops, till area in front shop

• Every 3 hours or as per contamination risk

Cleaning agents

Sodium hypochlorite (bleach)1:1000 ppm chlorine: dilute 1 part bleach to 6 parts water (0.5%)

Chlorhexidine and bleach mixtures

Ethanol 70% (v/v)

Dispose of used masks into a closed bin for paper

waste

Biohazard waste in biohazard yellow closed

container

Clinical coats /dust coats Wear a clean clinical coat/dust coat daily

Train all staff in the pharmacy on procedures to be followed

during the COVID-19 outbreak

Audits on Infection Prevention and Control (IPC) practice

› Hand hygiene, PPE use

Audits on IPC supplies

Ensure efficient use of IPC equipment and PPE (no waste)

Cleaning of pharmacy, environment control (ventilation)

Signage

Evaluate staff on efficient and correct procedures

SOP on patient management and screening for COVID-19

› Triage, isolation, screening, referral

General information on the disease, COVID-19 and the virus, SARS-CoV-2

› FIP: https://www.fip.org/coronavirus

SOUTH AFRICAN OUTBREAK

› DOH:

http://www.health.gov.za/index.php/antimicrobial-resistance/category/629-infection-prevention-and-control-documents?download=3977:national-infection-prevention-and-control-strategic-framework-march-2020

› http://www.health.gov.za/index.php/antimicrobial-resistance/category/629-infection-prevention-and-control-documents?download=3976:practical-manual-for-implementation-of-the-national-ipc-strategic-framework-march-2020

› SAPC

https://www.sapc.za.org/NE_RegisteredPersons

› SAHPRA

› http://www.sahpra.org.za/be-prepared-for-covid-19/

Latest statistics: DOH RSA

› https://sacoronavirus.co.za/

Masks: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

Clinical trials and treatments being investigated

› https://www.who.int/health-topics/clinical-trials/#tab=tab_1

In vitro Diagnostic Devices

› http://www.sahpra.org.za/be-prepared-for-covid-19

› https://www.finddx.org/covid-19/

› https://www.ecdc.europa.eu/sites/default/files/documents/Overview-rapid-test-situation-for-COVID-19-diagnosis-EU-EEA.pdf

› https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2

FAQs

› https://www.nicd.ac.za/diseases-a-z-index/covid-19/frequently-asked-questions/

› https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

FIP: International Pharmaceutical Federation

› CORONAVIRUS SARS-CoV-2/ COVID-19 PANDEMIC: Information and interim guidelines for pharmacists and the pharmacy workforce, 19 March 2020

SA DOH

› http://www.health.gov.za/index.php/antimicrobial-resistance/category/629-infection-prevention-and-control-documents?download=3977:national-infection-prevention-and-control-strategic-framework-march-2020

› http://www.health.gov.za/index.php/antimicrobial-resistance/category/629-infection-prevention-and-control-documents?download=3976:practical-manual-for-implementation-of-the-national-ipc-strategic-framework-march-2020

SAHPRA

› http://www.sahpra.org.za/

SAPC

› https://www.sapc.za.org/NE_RegisteredPersons

World Health Organisation

› https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Visuals

› https://unsplash.com/@visuals?utm_medium=referral&utm_campaign=photographer-credit&utm_content=creditBadge

https://www.sahpra.org.za/wp-content/uploads/2020/03/SAHPRA_A3_Poster-COVID-19.pdf

https://sacoronavirus.co.za/category/tool-kits/

General COVID-19 information for the public,

various SA official languages on DOH website

For the pharmacy profession

SAPC

› https://www.sapc.za.org/NE_RegisteredPersons

PSSA

› https://pssa.org.za/

› https://icpa.co.za/wp-content/themes/ypo-theme/media-files/2019/08/COVID-19-SOP-for-Community-Pharmacy-V3.0.pdf

Tshwane University of Technology, Department of

Pharmaceutical Sciences

Pharmaceutical Society of South Africa, Pretoria

branch

Compiler: G Enslin