Infection Control Guidelines of Home Delivered Care during COVID- 19 Worldwide Pandemic
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General measures during COVID- 19 worldwide pandemic: -
• During the pandemic of COVID- 19, screening of the households for COVID- 19 likely symptoms and risk factors can be done prior to home visits.
• Postpone non- emergent home visits for suspected cases or contacts (epidemiological link with no signs and symptoms). Give them instructions for proper home isolation and reporting immediately any signs and symptoms to (937)
• Reassess the patient again on home visits for COVID- 19 risk factors, signs and symptoms according to case definition- last update.
• In case of emergency home visits for suspected patients, follow the recommendations for droplet and contact precautions.
• Limit the number of caregivers. Ideally, assign one person who is in good health and has no underlying chronic or immunocompromising conditions.
• Suspected health care providers are not allowed to share in home visits particularly for old aged patients, immunocompromised or patients with chronic diseases.
• The health care provider should ask the patient or household to contain respiratory secretions if there is coughing or sneezing by wearing mask or use tissues.
• Mask is not used by care provider if there is no suspicious of COVID- 19 or other respiratory illness.
• In case of home visits for suspected cases for evaluation and takingnasopharyngeal swab, health care provider should do the following: -
1. Adhere strictly to standard, contact, and droplet precautions.
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. Educate patients and his household members about personal hygiene, basic IPC measures, and how to care as safely as possible for the person suspected of having COVID19 to prevent the infection from spreading to household contacts.
4. Wear appropriate PPE during taking swab including (N95 mask or surgical mask, isolation gown, gloves, face shield) in a closed well-ventilated room with only necessary person in the room.
Education
• Health care provider receive basic infection control training pre- employment and updated annually
• Specific infection control training related to COVID- 19 pandemic with updating knowledge related to case definition and infection control measures.
• Encourage and support a high index of suspicion in healthcare workers regarding suspect COVID-19 cases.
Employee health
• All health care providers should update the vaccination status as per facility policy
• The health care provider receives specific training on how to manage occupational exposure incidents.
Standard precautions: - Hand hygiene
• The service provider should have an alcohol-based hand rub portable dispenser and do hand hygiene as per 5- moments of WHO. Hand washing with soap and water should be done if there is visible contamination.
• Hand hygiene is done with a proper technique and duration.
PPE
• The service provider should have available supply of PPE including non-sterile gloves, surgical mask, and non- sterile gown to be used only if indicated.
• Gloves are used only if there is a risk of exposure to blood or body fluids or patient’s skin or health service provider’s skin is not intact.
• Mask should be worn if there is a risk of exposure to blood or body fluids.
• Other PPE is used only based on exposure risk assessment and type of procedures.
• Used PPE removed immediately after the procedure and followed by hand hygiene Safe injection
• Apply a 60–70% alcohol-based solution (isopropyl alcohol or ethanol) on a single-use swab or cotton-wool ball.
Wipe the area from the center of the injection site working outwards, without going over the same area. Apply the solution for 30 seconds then allow it to dry completely.
• Single used syringes and needle are used at a time
• Needle and syringes are disposed of immediately into puncture resistant containers
• Single dose vials or prefilled syringes is used whenever possible Home delivered immunization
• Hand hygiene is done with a proper technique and duration before and after taking the vaccine and when indicated.
• Preparation in a clean, designated area that is free from any visible contamination
• Alcohol swab is used for disinfection of the table used for preparation of the vaccine.
• Gloves are not used as a routine while giving SC, ID, or IM vaccines.
• The vaccination site is washed with soap and water and allowed to dry. N.B. Alcohol is not used for disinfection of the vaccination’ site
• The service provider is giving the vaccine aseptically without touching the vaccination site
• Prepare each dose immediately before its administration
• Disinfection of the top of the vial with alcohol swab is done prior to access the vaccine
• The vaccine expiry date is checked before accessing the vaccine
• Keep the vaccine at recommended temperature during transportation. Vaccine storage box is equipped with thermometer to check the temperature.
Reprocessing of instruments
• If noncritical equipment (i.e., blood pressure cuff, stethoscope, etc.) was used, clean the supplies if soiled and return to the supply bag. If not soiled, return to the supply bag.
• Semi -critical /critical equipment that may be used in home delivered care should be disinfected/ sterilized as per Spaulding classification and manufacturer’s instructions. Safe transportation of contaminated critical instruments in closed containers to avoid cross contamination.
References: -
• Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts. WHO guidance 2020.
• Managing Childhood Immunization Clinics - best practice guidelines. Royal college of nursing 2018.
• CDC website for COVID-19
GDIPC, April 2020
