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Infection control highlights during COVID-19 and beyond

Link Healthcare Advantage and MatrixCare have teamed up to help give insight into what is happening within the industry and hopefully address some of those unanswered questions, that maybe you didn’t even know to ask.

Are you having trouble deciphering guidance from the Centers for Disease Control and Prevention (CDC) in relation to home care practices? You are not alone. CDC guidance for infection control practices for COVID-19 has changed over the past weeks as they learn more about the virus. In this week’s blog post, we will look at the recommendation for infection control for home care providers from several different sources including the CDC, National Association of Home Care, Community Health Accreditation Partner (CHAP), and the Joint Commission.

Worst case scenario – My staff member has tested positive when can they return?

The CDC released new guidance for health care personnel to return to work on April 13, 2020. The new guidelines for COVID-19 positive or those who have suspected COVID-19 (symptomatic) but never got tested include new preferences. First, they state that the decision to return to work is going to be based on your local circumstances including testing availability. They recommend that the test-based strategy be the preferred method to determine fitness for duty.

The test-based strategy includes resolution of fever AND improvement in respiratory symptoms AND two consecutive negative nasopharyngeal swab specimens > 24 hours apart.

If testing is not readily available in your area, then the second option is a non-test-based strategy. In this instance, they can return to work when 3 days (72 hours) have passed since the resolution of fever AND improvement in respiratory symptoms AND at least 7 days have passed since the first symptom appeared.

Lastly, they have those individuals that tested COVID 19 + but didn’t have symptoms– in this case, they can return to work no sooner than 10 days since the first positive test assuming they haven’t had any further symptoms develop.

Once returning to work they should wear a facemask at all times, be restricted from caring for immunocompromised patients, and continue to self-monitor for symptoms.

Masks, gowns, goggles, gloves, oh my!

The shortage of PPE is a nationwide issue and as we would love to say use all four of these, this is not our reality- so here are the latest recommendations:

  • COVID + patients or high potential (symptomatic) for COVID
    • PPE including mask, gown, gloves and eye protection should be worn before entering home and removed outside the home with alcohol-based hand sanitizer after removal of PPE
      • Some agencies have designated a COVID-19 team. These teams are assigned COVID-19 patients and are the priority to be given the PPE. This has helped with conserving PPE for the highest risk personnel and patients.
    • All patient visits
      • Masks
        • Face masks should be worn for all patient visits
        • N95 should be saved for COVID + patients or symptomatic patients if N95 is not available, then use of face mask is recommended
        • If any aerosolized treatments are being performed (nebulizer, suctioning, trach care) then N95 is a must
        • Reusing masks is our new reality the following are recommendations on reuse
          • Masks should not be reused if aerosol treatments have been performed
          • Masks should be worn for one household and stored after use in a paper bag labeled with patient name. Mask should be stored in vehicle, not left in the home
          • When removing the mask, wash hands, remove mask by ties or ear loops, fold mask inward with contaminated (outside) touching each other- place in paper bag with ear loops/ties at top, wash hands, label bag with patient identification – best case scenario is 72 hours between use of face mask will allow time for virus to be inactivated
          • What about homemade masks? These are the last resort for use if patient is symptomatic or COVID 19 +. Visits for other patients wearing a homemade mask can be used but they need to be washed (separately from other laundry) between visits and preferably not worn between patients
        • Gowns
          • Disposable isolation gowns should be worn for all COVID + patients if possible
          • If disposable gowns are not available, then
            • Full coveralls or plastic aprons with long sleeves can be used
            • Cloth gown would be next in line for protection
              • Each home should have a separate cloth gown
              • Cloth gowns should not be left in the home but placed in bag and washed separately in hot water
        • Goggles
          • COVID + patients or potential symptomatic patients – clinicians should wear eye protection
          • Goggles or face shields can be worn – normal prescription glasses, contacts or sunglasses do not provide protection
          • Some agencies are using swim goggles
          • Eye protection must be cleaned between visits using approved disinfectants
        •  Gloves
          • COVID + or potential symptomatic patients – gloves should be worn at all times
          • All other patients’ gloves should be used as indicated for universal precautions
          • Hand hygiene is a must whether gloves are worn or not

Equipment cleaning is another topic that needs to be addressed.  Anything that goes into a home needs to be considered ‘dirty’ especially in COVID + patient homes. So what should be our best practice?

  • Only take the essential items for the visit into a home
  • If a patient has their own thermometer, blood pressure cuff, etc. Use the patient’s.
  • Items used (stethoscope, blood pressure cuff, thermometer, pulse ox, computer) should be cleaned with EPA approved cleaning product found on list N. Alcohol pads that are commonly used to clean equipment are not effective for COVID-19. Products such as Sani-Cloth, Cavicide, and CleanCide, Clorox commercial solutions are effective along with household products such as Lysol disinfecting wipes, Windex disinfectant cleaner, Fantastic multi-surface, and Scrubbing Bubbles can be used. A complete list of cleaning products is available here. The EPA List N also includes the amount of time required for each cleaner
  • Paper products, such as signed consents, are another source of concern. The recommendation is to leave paper forms in the home and use HIPAA approved picture/text message to capture the form.  If this is not available, then the form should be placed in a paper envelope and kept closed for 72 hours allowing time for deactivation of the virus.

Agencies should also be checking their state health department guidelines for any state, county, and/or local specific requirements regarding infection control practices including disposal of used PPE.

We hope this has helped clear up some of the confusion around infection control practices in the home care setting. Future blogs will focus on the CARES Act, HR issues, and FAQ submitted. Don’t forget to send me questions to diane@linkhealthcareadvantage.com.

Learn more about how MatrixCare Home Health & Hospice is supporting providers through COVID-19 and beyond.

Disclaimer: we are not endorsing this information for accuracy or validity of the content. We encourage you as appropriate, to verify clinical and regulatory content with your own trusted sources.

 

Sources:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Fcontrol-recommendations.html

https://education.chaplinq.org/

https://www.nahc.org/wp-content/uploads/2020/04/QA_COVID-19-Infection-Prevention-and-Control-Strategies-040620.pdf

https://www.jointcommission.org/en/covid-19/


Diane Link
Diane Link

Diane Link has over 25 years of home health and hospice experience. She is currently owner of Link Healthcare Advantage, providing home health and hospice consulting services including operation assessments, survey readiness, regulatory and compliance programs, outsource QAPI program and outcome improvements. Diane is also COO and partner with Curaport, an online education platform for post-acute care providers. Her experience includes a variety of roles in home health and hospice from field nurse to executive director, and was a surveyor for home health, hospice, and private duty services for CHAP (Community Health Accreditation Partners) for the past five years as both an independent consultant and as a director of clinical consulting at a large consulting company.

Physician in medical face mask holding syringe while senior lady keeping arm on cushion stock photo

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