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A Guide to Practicing Care for Homebound COVID-19 Patients

Updated: Feb 5, 2021

Coronavirus Disease 2019 (COVID-19) is contagious, and at this moment there isn’t any cure or vaccine available yet to stop its spread. Health organizations all over the world, both private and government-owned, are now on the race to come up with effective specific treatment for the infected and preventive measures for everybody else. There have been good news from vaccine trials conducted by various international organizations as clinical research have showed positive outcome. Still, no one knows (at least for now) when the vaccine for COVID-19 will be ready.

The Centers for Disease Control and Prevention (CDC) suggests that the best way to prevent COVID-19 is to avoid being exposed to 2019-nCoV, the virus that causes the disease in the first place. This is not always a feasible option, especially for healthcare professionals who will need to be in close contact with suspected or confirmed COVID-19 patients and perform health evaluations on regular basis. That being said, there are some precautions to minimize the risk of getting infected.

Use Reliable Screening Tool to Asses Risk Levels

All healthcare facilities in the U.S. – including but not limited to hospitals, ambulatory care, assisted living facilities, nursing homes, pharmacies, dialysis facilities, dental settings, blood and plasma facilities, long-term care facilities, and alternate care sites – must follow the guidance by CDC.

· For professionals working in healthcare facilities, the CDC has compiled a comprehensive list guidance for risk assessment of healthcare personnel with potential exposure in healthcare setting to patients with COVID-19.

· Especially for home health care, the agency has also compiled guidance for implementing home care of people with suspected or confirmed COVID-19 but not requiring hospitalization.

Some organizations have their own risk-assessment tools, for example Mayo Clinic, which are based on the guidance already available on CDC website. Adherence to the guidance can significantly reduce risk of getting exposed to the virus.

Personal Protective Equipment

Know the proper types of PPE as well as when and how to use them. Equally important is to understand how to dispose of the equipment. Put in mind the Coronavirus can live on surfaces for up to several days. Disposable PPE must be removed in a way that prevents self-contamination. Some PPE such as gowns and eye protection may be reused after thoroughly disinfected. Home health care workers should keep clean and dirty PPE separated.

Pay Attention to Symptoms and Vital Signs

Utilize “no contact” equipment to check patients’ vital signs, if possible. For home health workers or personal care attendants performing visits and non-medical services to homebound patients, avoid taking patient’s body temperatures orally. Home Health Agencies must devise a new method (or invest in new devices) to help their personnel minimize risk of infection during visits. Some equipment can be difficult to sanitize, for example blood pressure cuff, so aides must use it with precautions. Using no contact health evaluation equipment and avoiding patients’ respiratory system whenever possible are recommended.

Prepare the Visit

Based on patients’ conditions available on record, home health workers should be able to prepare the next visit. Assuming there will be procedures that will increase risk of infection, wearing PPE is obligatory. Any medical and non-medical procedure that may induce coughing or generate aerosol from patient, such as nebulizer treatment and tracheostomy changes, must be performed while wearing at least a proper-fitting face shield and N95 respirator. When performing such procedures, limit the number of individuals present in the room or area. Once the procedure is done, the room must be immediately disinfected.

Put in mind that cloth face covering is not considered PPE due to its poor filtration capability. Gown is also necessary because aerosol particles can stay in the air for several hours. Many home health aides are not registered nurse and physicians, so when such procedures are required, the aides should stay clear of the area as well. When home health aides need to make the next visit, they should arrive at least three hours after the procedure.

Effective Bag Technique

Home health workers may need to use the same technology devices for different visits and patients. After ending every visit, caregiver must be thoughtful about the exchange of such devices and equipment for examples tablets, laptops, thermometer, blood pressure cuff, and so on.

All devices must be disinfected before they are place in nursing bag. Removal of PPE should be performed outside of patients’ home, followed by proper hand hygiene. Disposable PPE should be placed in a bag and treated as household waste unless it contains body fluids or blood.

Shortages of PPE

Home Health Agencies need to come up with various strategies to cope with the shortages of PPE in the wake of Coronavirus pandemic. Any kind of protection that helps prevent infection is crucial for home health workers to be able to perform their duties effectively.

Home health workers must monitor their health closely as well. In case they develop symptoms associated with COVID-19 (such as cough, fever, and shortness of breath), they must immediately call registered physicians for thorough examination.

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