The COVID-19 pandemic is the biggest healthcare challenge we have ever faced in our lifetime. Even as we are learning more about the disease and its level of contagion, we are also worried about our families, friends, ourselves, and the patients we serve.
We fear catching the virus and spreading it within our home. We are afraid of inadvertently infecting our patients and their families. The economic issues, while secondary to the illness, are substantial as businesses close down and we face staff shortages due to confirmed and potential COVID-19 diagnoses.
Best Practices: A Moving Target
As home care leaders and clinicians, we must keep up with the daily news and sometimes rapidly changing recommendations from the Centers for Disease Control and Prevention (CDC). New best practices include screening both our home care workers and our patients daily for COVID-19 signs and symptoms. We face the challenge of trying to secure the availability of personal protective equipment (PPE) availability and ensure its proper and judicious use, along with appropriate hand hygiene. We must also attend to endless but appropriate questions and concerns, especially those from our field staff.
We must step up to the challenge and do our best to allay anxieties while protecting our home care clinicians and the patients and families we serve. As the weeks go on and the pandemic spreads, we will care for many more COVID-19 positive patients at home. We must look at this as our opportunity, as home care leaders and clinicians, to help mitigate community viral spread.
The Role of the Home Care Provider in Mitigating COVID-19
How do we do this? As home care providers, we recognize that our patients are generally safer—and happier—recovering from illness at home. As always, we need to assess our homebound patients’ ability to obtain resources such as food and medications as well as provide direction and assistance.
In these times of concern for unnecessary exposure, PPE limitations, and the possibility of technology-based solutions, an appropriate plan of care should be developed. It is a reality that some patients may desire limited home visits out of fear of contagion while others are afraid and feeling very isolated.
Organizations may consider telephone follow-up and telehealth technology in supplementing the need for in-home visits. Decreasing home visits should not be done out of fear, but rather as a part of a comprehensive, thoughtful process and reasonable approach to an appropriate plan of care—one that meets patient needs. And of course, specific interventions sometimes dictate the need for in-home visits such as complicated wound care and infusions. Regardless, it is important to assess and monitor all of our home care patients carefully and identify severe signs and symptoms indicative of the need for acute care.
PPE and Home Care Staff
Home care staff are not used to routine use of PPE beyond gloves and need to be re-educated. Putting on and taking off PPE correctly must be reviewed so that all clinicians are competent and confident with these procedures.
At this time, we should be well educated about required PPE during home visits for patients with suspected or confirmed COVID-19, known as a “person under investigation,” or PUI. Yet there are still many questions and misinterpretations, and it can be confusing.
Required PPE includes non-sterile gloves, a surgical mask, and eye protection. Eye protection includes reusable goggles, which must be disinfected after each use, or a face shield worn over the surgical mask. Right now, gowns are generally in short supply and should be limited to activities where splashes and sprays are anticipated or during performance of high-contact activities that may result in the transfer of pathogens to the clinician’s clothing.
With a shortage of N95 respirators, usage is generally limited to situations where there are aerosolized procedures being performed, such as suctioning or the use of nebulizers. Notably, the CDC provides guidance for both extended use and re-use of both surgical masks and N95 respirators. With increasing community spread in a number of geographic areas, many home care organizations have evolved to the practice of extended wear of the surgical mask; that is, wearing a mask all day long with all home care patients regardless of COVID-19 status. The general public are also being asked to wear masks, which may be homemade, when performing essential activities such as grocery shopping or picking up medications at a pharmacy.
Packing the Home Care Bag
We must also consider our home care “bags.” We should avoid bringing unnecessary equipment and supplies into the home. If disposable blood pressure cuffs and stethoscopes are available, they should be left in the home for only that patient’s use. If any equipment must be brought in, make sure that you have disinfection procedures in place. Additionally, avoid whenever possible bringing computers, tablets, or other documentation devices into the home. If this is done, they must be disinfected.
A foundational role for home care clinicians is educating and supporting patients, caregivers, and family members. While most people are taking this pandemic very seriously, there remain those who do not and who may be risking themselves, their families, and the community at large.
Teach patients and family members how to isolate within the home and the concept of social distancing. Because hand hygiene is so critical, take extra time to educate and address when to do it, how long to do it, and technique. Wash for at least 20 seconds when using soap and water. If using an alcohol-based hand rub, demonstrate how much to use and how to rub all surfaces of the hands until completely dry, which generally takes about 15 to 20 seconds. Teach also the importance of disinfecting high touch surfaces, such as doorknobs, light switches, remotes, handles, desks, toilets, and sinks, in the home. Provide education with attention to plain, understandable language and evaluate learning using teach-back technique. MedBridge’s collection of free community COVID-19 resources are created with these principles in mind and can help clinicians communicate these concepts to patients, caregivers, and families.
This is our opportunity to shine as home care clinicians—this is where we can impact the spread of COVID-19.