Crucial Charge: Attending to Infection Prevention in Home Care

As the number of people diagnosed with coronavirus disease 2019 (COVID-19) multiplies across the U.S. and around the world, demand is increasing for home-based care of people affected. Diligent attention to infection prevention and control protocols is vital for those providing home care for patients with COVID-19.

Interim guidance on COVID-19 care from the Centers for Disease Control and Prevention (CDC) notes that home care is preferable to hospitalization if the person’s situation allows it. Many healthcare experts have said that caring for people with COVID-19 at home can inhibit community spread of the disease and relieve hospitals so they don’t become overburdened.

As of March 16, a Home Health Care News poll conducted March 5 to 13 found that only 31% of home care organizations surveyed said their operations had been affected by the spread of COVID-19 at that point. Now cases of COVID-19 have been reported in every state and Washington, DC, and in Guam, Puerto Rico, and the U.S. Virginia Islands.

Lack of Training Increases Risk

The importance of keeping nurses and direct care workers healthy and limiting the spread of the disease while they care for elderly clients at home is painfully clear.

If newly hired home care staff members have not already received education about infection prevention and control of infectious diseases, they can take online training immediately. Those who have had training may desire a refresher in light of the current pandemic.

Team members can access free courses on infection control in the Relias COVID-19 toolkit, which provides resources that include a free training module from the World Health Organization (WHO).

Home health agency directors are tasked with providing strong oversight to ensure that training is provided and protocols are followed to prevent the spread of infection. With many agencies already understaffed, as a PHI commentary notes, the response to the coronavirus “will fall short if the workforce implementing it is too under-resourced and destabilized to rise to the challenge.”

Precautions for Safe Care of COVID-19 Patients

During a March 16 press conference, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MS, said it is critical for caregivers of patients with COVID-19 to “follow WHO’s guidance on how to provide care as safely as possible. For example, both the patient and their caregivers should wear a medical mask when they are together in the same room.” The caregivers should wash their hands after any contact with patients, he emphasized.

The Centers for Medicare and Medicaid Services (CMS) on March 10 issued infection control and prevention guidance for home health agencies dealing with COVID-19. The guidelines include having the patient stay separate from other people and animals in the home and wear a facemask when others are present.

Family members can make sure:

• Everyone in the home covers coughs and sneezes.
• Anyone who coughs or sneezes follows up with handwashing or use of an alcohol-based hand rub.
• Someone cleans high-touch surfaces daily.

CMS advises home health workers providing close care for patients with COVID-19 to do the following:

• Limit the people in attendance to only essential healthcare personnel.
• Ask others in the home to move to a different room or keep a 6-foot distance.
• Ensure that all supplies brought into or removed from the patient’s home are cleaned and disinfected.
• Wear all recommended personal protective equipment (PPE), including face protection, gown, and gloves.
• Before putting on PPE and after removing it, perform hand hygiene using hand sanitizer that contains 60% to 95% alcohol.
• If possible, put on PPE before entering the home. If not, at least put on a respirator and eye protection before entering.
• Discard PPE in an external trash can.

No matter the care setting, the CDC has acknowledged the need for alternatives to standard precautions with COVID-19, as some PPE is in short supply—especially respirators. Other facemasks may be used if respirators are not available, the CDC says.

Home Health Emergency Plans Being Tested

Home health agencies with Medicare clients should already have infection prevention programs in place to prevent the transmission of infections and to control communicable diseases. That action is required under the Conditions of Participation (CoPs) updated by CMS in 2018.

Healthcare organizations also have been required to have emergency plans in place, and now those plans will be tested. One home health and personal care agency, AccentCare, noted in a Home Health Care News article that officials realized in February that the COVID-19 situation was unprecedented.

AccentCare, a Relias client, emphasized that administrators acted quickly to manage risk by ensuring that team members were educated in sterilization procedures and use of respirator masks and other PPE. The agency also made plans to triage PPE supplies.

Before COVID-19 reared its ugly head, the CDC noted in an Emerging Infectious Diseases article that home-based nurses or caregivers have the opportunity to spot signs of infection during wound care, respiratory care, infusion therapy, enteral therapy, and urinary tract care.

In the CoPs for home health agencies, CMS underscores the importance of the following CDC precautions for infection control in the home:

• Hand hygiene.
• Environmental cleaning and disinfection.
• Injection and medication safety.
• Appropriate use of personal protective equipment.
• Minimizing potential exposures.
• Reprocessing of reusable medical equipment between each patient and when soiled.

As home health personnel will be challenged to distinguish COVID-19 from other respiratory infections, the CDC said, they should apply the COVID-19 interventions broadly to minimize exposure and transmission.