Updated guidance for community pharmacies on COVID-19, including prevention of infection. 

The health, wellbeing and safety of community pharmacy staff delivering services to members of the community is of the utmost importance to NSW Health.

Community pharmacies must actively assess their service interactions with patients and customers to identify the risk of transmission of COVID-19. Pharmacies must identify what preventative steps need to be taken based on regularly updated advice provided by NSW Health.


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Limits on dispensing and sales at pharmacies

There are specific limits on the supply of prescription and over-the-counter medicines to ensure equitable access to medicines during the COVID-19 pandemic.


Poster - Pharmacy symptoms

Details are published on the TGA website​ and it is recommended pharmacists regularly review information provided by the TGA.

There are specific restrictions on salbutamol inhalers, in addition to the restrictions in the Schedule 3​ salbutamol entry in the Poisons Standard.

A new regulation limits the prescribing of hydroxychloroquine which is only indicated for use in clinical trials in COVID-19 – see supply of hydroxychloroquine​.

Supply of quantities that are not clinically required for an individual may be illegal under the NSW Poisons and Therapeutic Goods Regulation 2008​ (Clauses 23, 34, 79) and contravene Pharmacy Board Professional Practice guidelines​,  which for example generally limit supply of Schedule 2 and 3 medicines to one pack at a time and require the pharmacist to be satisfied there is therapeutic need.

Limits on orders from wholesalers apply to ensure equitable distribution of stock, including to regional and rural pharmacies. 


Managing the supply of medicines in the pandemic and assisting patients in home isolation

For practical advice for pharmacists for managing the supply of medicines in the pandemic and assisting patients in home isolation and for physical distancing, refer to Advice for pharmacists for managing the supply of medicines in the pandemic and assisting patients in home isolation.

Advice is provided on:

A one-page summary is also available.

General precautions and hygiene

When someone who has Coronavirus Disease 2019 (COVID-19) coughs or exhales, they release droplets of infected fluid. Most of these droplets fall on nearby surfaces and objects – such as benches or telephones. People could become infected with COVID-19 by touching contaminated surfaces or objects – and then touching their eyes, nose or mouth. If they are standing within 1.5m of a person diagnosed with COVID-19 they could become infected by breathing in droplets coughed out or exhaled by the infected person. In other words, COVID-19 spreads in a similar way to all respiratory viruses like the common cold and influenza.

Most persons infected with COVID-19 experience mild symptoms and recover without medical intervention. However, some go on to experience more serious illness and may require hospital care. Risk of serious illness rises with age: people over 40 seem to be more vulnerable than those under 40. People with weakened immune systems and people with chronic conditions such as diabetes, heart and lung disease are also more vulnerable to serious illness or complications.

Infection prevention and control precautions for COVID-19 will also help prevent the spread of other common infections which present to pharmacies and protect your patients and staff. Community pharmacies are recommended to implement these precautions and hygiene measures as soon as practicable.

COVID-19 Infection Prevention and Control guidance is available for Primary, Community and Outpatient Settings​.


Principles of infection prevention and control in the community pharmacy

  • Promote physical distancing
    Physical distancing limits the transmission of COVID-19. Where practical, staff and patients are to remain 1.5 metres apart with the exception of when staff may be providing direct care to patients or others such as examining a skin rash, providing vaccination services, providing first aid, or in an emergency.

  • Promote good respiratory hygiene and cough etiquette
    Good respiratory hygiene and cough etiquette prevents the spread of COVID-19 through respiratory secretions. Community pharmacies should encourage staff and patients to:
    • cover coughs and sneezes with disposable tissues or clothing (e.g. into elbow)
    • dispose of used tissues in the nearest waste bin after use
    • clean hands afterwards with soap and water or alcohol-based hand rub

  • Promote regular and thorough hand-hygiene
    Hand hygiene kills the virus on hands and prevents the spread of COVID-19. Hand Hygiene can be done using soap and water or a waterless alcohol-based hand rub/foam for at least 20 seconds.
    Wash your hands:
    • before entering an area used by other people
    • before commencing dispensing activities 
    • after using the bathroom
    • after coughing or sneezing
    • before preparing food or eating
    • regularly throughout the work day.
  • Keep the environment clean​

    Contamination on surfaces touched by staff and patients is one of the main ways that COVID-19 spreads. Enhanced environmental cleaning, particularly of highly-touched surfaces such as counter tops, light switches, door knobs, desks, computers and communal pens is an important measure to reduce the spread of COVID-19 and other infections.

  • Encourage sick staff members to remain at home and seek testing if they have COVID-19 like symptoms
  • Symptoms of COVID-19 include fever (≥37.5°C) or history of fever (e.g. night sweats, chills) or acute respiratory infection (e.g. cough, shortness of breath, sore throat). Other reported symptoms include loss of smell, loss of taste, runny nose, muscle pain, joint pain, diarrhoea, nausea/vomiting and loss of appetite.

    NSW Health recommends any healthcare workers which includes pharmacists and community pharmacy staff with patient contact, staff, students and volunteers with even the mildest symptoms should be tested for COVID-19.

    Pharmacists and other staff providing direct clinical care should follow advice on testing for healthcare workers, staff, students and volunteers​.​

    Practical infection prevention and control steps in the community pharmacy​

    For patients

    • Display signage/posters in the pharmacy to encourage patients with symptoms to identify themselves early to pharmacy staff so they can be triaged accordingly
    • Provide patients with symptoms ​with a mask to self-fit before assisting
    • Prioritise symptomatic patients; wherever possible, isolate the patient in a separate area
    • Encourage physical distancing of 1.5 metres where possible, for example through floor markings and barriers to create space at counters, seated areas, etc. Speak to patients from a safe distance to avoid contact with respiratory droplets.
    • Display signage/posters in the pharmacy to encourage patients to practice hand hygiene, cough etiquette and respiratory hygiene whilst in the pharmacy and generally in the community.
    • Put alcohol-based hand rub dispensers in prominent places including the entrance around the pharmacy especially at counters where surfaces are touched. Inform patients of places where they can wash their hands with soap and water for the minimum of 20 seconds.
    • Display signage/posters to encourage patients with symptoms to seek testing for COVID-19 by:

    For pharmacy staff

    • Implement systems to identify and exclude unwell staff – for example asking staff if they have any symptoms at the start of each shift
    • Ensure staff are aware of the symptoms of COVID-19 and how to seek testing if they do become unwell by:
    • For information on when staff can return to work after COVID-19 testing, please see NSW Health advice on release from isolation
    • Ensure staff providing advice to patients seeking cold and flu preparations are aware of local COVID-19 testing sites (noting some clinic locations may change over time) and encourage symptomatic patients to get tested. 
    • Ensure staff have access to handwashing facilities and alcohol-based hand rub.
    • Practice effective hand hygiene, wash hands thoroughly or use an alcohol-based hand rub throughout the work day and avoid touching your face as much as possible. Display signage/posters in staff areas such as in dispensing areas, consultation/vaccination rooms, staff rooms or kitchens and toilets.
    • Practice good cough etiquette and respiratory hygiene.
      • Staff with respiratory symptoms from any respiratory illness should stay at home and get tested.
      • Ensure that surgical masks and / or paper tissues are available for staff who develop a runny nose or cough at work, along with closed bins for hygienically disposing of them. Symptomatic staff should be sent home and advised to seek testing. Masks are not recommended as a precautionary measure.
    • Physical distancing​ is an effective measure, and should be used where practicable.
      • Within a pharmacy environment this may mean attempting to keep a distance of 1.5 metres between staff and patients where possible, for example through floor markings and barriers to create space at counters, seated areas, etc. Speak to patients from the other side of a counter or desk where possible.
      • Ensure all staff are aware of the need to comply with the maximum number of people (staff and patients) in the community pharmacy:
        • minimum of 4 square metres per person
        • ​maximum number of persons able to be on site (100 people for indoor premises).
      • Physical distancing is also important in other areas such as dispensing areas, preparation areas and staff rooms, where this is feasible. Staff may consider rotating into these areas to limit the number of people in an enclosed space at any one time where it is safe and practical to do so.
      • Pharmacists undertaking direct clinical services (e.g. vaccination or examining a skin rash) should do so following standard precautions​ – personal protective equipment, such as a mask or gloves, would not be required as a routine unless there is a risk of exposure to blood or body substances. Hand hygiene remains the cornerstone of infection prevention. Wearing gloves is not a substitute for hand hygiene.
    • Implement systems to triage and risk assess patients presenting to pharmacists for direct clinical services (e.g. vaccination) through pre-screening prior to the visit (for scheduled appointments) and on arrival. For example:
    1. ​Do you have any symptoms of COVID-19 such as fever (e.g. night sweats, chills) or acute respiratory infection (e.g. cough, shortness of breath, sore throat) or loss of sense of taste or smell?
    2. Have you been in contact with anyone diagnosed with COVID-19?

    Further guidance on implementing a pre-screening process and other example questions are provided in the CEC’s COVID-19 Infection Prevention and Control guidance for Primary, Community and Outpatient Settings​.

    Pharmacists may choose not to vaccinate to individuals have been identified as fulfilling these risk criteria and delay the scheduled appointment until the person has been released from isolation.

    • Implement enhanced environmental cleaning regimes (see below), paying particular attention to highly-touched surfaces such as counter tops in the retail and dispensing area, light switches, door knobs, desks and computers.
    • Encourage staff to get the annual influenza vaccination to protect themselves, their families and vulnerable patients from seasonal flu. See more information on the importance of influenza vaccination during the pandemic.
    • Incorporate recommendations on infection prevention into each step of service models, including:
      • pre-screening of patients before and at the time of providing direct clinical care
      • timing scheduled appointments to support physical distancing and appropriate cleaning of surfaces
      • limiting the number of people in the consultation room to the pharmacist, patient +/- carer
      • ensuring there is adequate space to allow the recommended duration for post-vaccination observation​.

    Patients who present with symptoms of respiratory tract infection

    On presentation to the pharmacy, the symptomatic patient should:

    • self-identify through use of signage in the pharmacy or screening questions where they are receiving direct clinical services such as vaccination
    • be given a surgical/procedural mask (if available) to wear during the pharmacy presentation. Masks can be obtained from your local Primary Health Network (PHN)​

    Call 000 for an ambulance if the patient has severe symptoms such as difficulty breathing.

    Masks

    Pharmacy staff are advised to not wear face masks (neither surgical masks or P2/N95 respirator masks) as a precautionary measure. Correct use of face masks requires personal protective equipment (PPE) training, particularly for P2/N95 respirator masks where incorrect donning and doffing can lead to increased risk of transmission. More information on the recommended use of masks is available from the Clinical Excellence Commission​.

    P2/N95 respirator masks are not required to be worn by patients unless they are immunocompromised and have been directed to do so by their treating specialist. Recent information is available on the use of masks by the public in the community​.

    Unless masks are used correctly they are unlikely to protect against airborne pathogen spread. Inappropriate use of masks may also be associated with risks. Other measures such as good hand hygiene, cough etiquette and respiratory hygiene, staying home if unwell and physical distancing are more important whilst there are low rates of community transmission of COVID-19 in NSW.

    There are currently significant pressures on the global supply chain for PPE.  When considering need for PPE supplies, community pharmacies should:

    • consider whether the pharmacy or service requires PPE
    • assess the service being provided including the rationale for providing face-to-face encounters
    • consider what are the items needed
    • consider scenarios where services will need to continue to be provided to patients who have tested positive for COVID-19. Where PPE is essential to mitigate risks, no service should be delivered unless relevant PPE can be provided to clients, patients or staff.
    • assess current stock levels and weekly requirements of each 
    • consider how to maximise stock and ensure it is used efficiently 
    • ensure that stock is being used for patients and staff at risk

    Cleaning

    Regular environmental cleaning in the pharmacy is important for reducing the risk of transmission of pathogenic organisms, it is particularly important in containing the risk of spread of COVID-19. Contamination on surfaces touched by staff and patients is one of the main ways that COVID-19 spreads.

    Pharmacy staff can ensure that the pharmacy is clean and hygienic by cleaning surfaces using a detergent and disinfectant. This can be either by a 2-step cleaning/disinfecting process, or using a product that combines both steps.

    • Using a detergent
      • A detergent is a surfactant that facilitates the removal of dirt and organic matter.
      • Most hard surfaces including counters can be adequately cleaned with warm water and a neutral detergent as per the manufacturer’s instructions.
      • Allowing the cleaned surfaces to dry is an important aspect of cleaning.
      • Routine cleaning of floors with detergent and water is recommended.
    • Using a disinfectant
      • A disinfectant rapidly kills or inactivates most infectious agents.
      • Disinfectants are not to be used as general cleaning agents, unless combined with a detergent as a combination cleaning agent.
      • Disinfection should always be undertaken following, and in addition to, detergent cleaning.

    More information is available on cleaning and disinfection in the workplace​. The Australian Department of Health has also issued guidance on cleaning and disinfection for health facilities​ and in the community​.

    Waste management

    There are no additional controls required for disposing of waste, follow routine processes for disposal. Ensure closed bins are provided for safe disposal of tissues by staff and patients.

    More information

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    Current as at: Thursday 23 July 2020
    Contact page owner: Health Protection NSW