Home care for patients with suspected COVID-19 infection

For those presenting with mild illness, hospitalization may not be required unless there is concern about rapid deterioration

Criteria for home care:

  1. If there is only mild symptom such as low-grade fever; cough; malaise; runny nose; or sore throat without any warning signs, providing care at home may be considered
  2. Patients who are symptomatic but no longer require hospitalization
  3. When inpatient care is unavailable or unsafe (e.g., capacity is limited, and resources are unable to meet the demand for healthcare services)
  4. Without underlying chronic conditions − such as lung or heart disease, renal failure or immunocompromising conditions that place the patient at increased risk of developing complications

Warning signs are: shortness of breath or difficulty in breathing; profuse or blood mixed  sputum,  gastrointestinal symptoms, such as nausea, vomiting, and/or diarrhoea; changes in mental status, such as confusion or lethargy.

Role of health care worker (HCW):

  1. Careful clinical judgment after assessment of safety of patient’s home environment
  2. Assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house)
  3. A communication link with a healthcare provider or public health personnel, or both, should be established for the duration of the home care period – that is, until the patient’s symptoms have completely resolved
  4. Patients and household members should be educated about personal hygiene, basic Infection Prevention and Control (IPC) measures and how to care for the member of the family suspected of having COVID-19 disease as safely as possible to prevent the infection from spreading to household contacts
  5. Monitoring should continue for the duration of home care. Healthcare personnel should review the health of contacts regularly by phone but, ideally and if feasible, through daily in-person visits, so specific diagnostic tests can be performed as necessary

Role of patient and family

Patients and families should adhere to the following recommendations.

  • Place the patient in a well-ventilated single room (i.e., with open windows and an open door).
  • Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces (e.g., kitchen, bathroom) are well ventilated (e.g., keep windows open).
  • Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 m from the ill person (e.g., sleep in a separate bed).
  • Limit the number of caregivers. Ideally, assign one person who is in a good health and has no underlying chronic or immunocompromising conditions. Visitors should not be allowed until the patient has completely recovered and has no signs and symptoms.
  • Perform hand hygiene after any type of contact with patients or their immediate environment (4). Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water.
  • When washing hands with soap and water, it is preferableto use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them when they become wet.
  • To contain respiratory secretions, a medical mask should be provided to the patient and worn as much as possible. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene − that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover themouth and nose should be discarded or cleaned appropriately after use (e.g., wash handkerchiefs using regular soap or detergent and water).
  • Caregivers should wear a tightly fitted medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions,it must be replaced immediately with a new clean, dry mask. Remove the mask using the appropriate technique– that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene.
  • Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine and other waste. Perform hand hygiene before and after removing gloves and the mask.
  • Do not reuse masks or gloves.
  • Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded.
  • Clean and disinfect daily surfaces that are frequently touched in the room where the patient is being cared for,such as bedside tables, bedframes and other bedroomfurniture. Regular household soap or detergent should beused first for cleaning, and then, after rinsing, regularhousehold disinfectant containing 0.5% sodiumhypochlorite (i.e., equivalent to 5000 pm or 1 part bleach5to 9 parts water) should be applied.
  • Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regularhousehold disinfectant containing 0.5% sodium hypochlorite should be applied.
  • Clean the patient’s clothes, bed linen, and bath and handtowels using regular laundry soap and water or machinewash at 60–90 °C with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes.
  • Gloves and protective clothing (e.g., plastic aprons)should be used when cleaning surfaces or handling

clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.5% sodium hypochlorite solution. Single-use gloves (e.g., nitrile orlatex) should be discarded after each use. Perform hand hygiene before and after removing gloves.

 

  • Gloves, masks and other waste generated during at-home patient care should be placed into a waste bin with a lid in the patient’s room before being disposed of as infectious waste.
  • Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g., do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths or bed linen).
  • When HCWs provide home care, they should perform a risk assessment to select the appropriate personal protective equipment and follow the recommendations for droplet and contact precautions.

An exception may be made for breastfeeding mothers. Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures

 

Management of contacts persons (including caregivers and HCWs) who have been exposed to individuals with suspected COVID-19 disease. These are considered contacts and should be advised to monitor their health for 14 days from the last possible day of contact.

A contact is a person who has had any of the following exposures:

  • A healthcare-associated exposure, including providing direct care for patients with COVID-19 disease,

working with HCWs infected with the virus that causes COVID-19 disease, visiting patients or staying in   the same environment as a patient with COVID-19 disease;

  • An exposure through working together in close proximity to or sharing the same classroom with a patient with COVID-19 disease;
  • An exposure through traveling with a patient who has COVID-19 disease in any kind of vehicle;
  • An exposure through living in the same household as a patient with COVID-19 disease within 14 days after the onset of symptoms in the patient.

 

 

Source: WHO