It's no secret that healthcare providers - hospitals, nursing homes, clinics, doctor's offices - and home health agencies - have run out of - or are running out of - personal protective gear (PPE). Because of the shortage of PPE, the CDC has announced methods to optimize the supply of dwindling and non-availability of face masks, gowns, goggles, and ventilators.
The absence of respiratory protective equipment increases workplace risks. Interim infection protection is indicated to safely provide patient care.
1. If you don't have a face mask do this.
According to the CDC you can use a face shield that covers the entire front (that extends to the chin or below) and sides of the face.
As a LAST RESORT, home health nurses, therapists and aides might use homemade masks (e.g., bandana, scarf) during care of patients. Since homemade masks are not considered personal protective gear (PPE) the capability to protect the worker is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.
Application of Homemade Face masks
Face masks are applied BEFORE you enter the patient home and BEFORE you leave the patient home.
2. If you don't have goggles do this.
According to the CDC you can use safety glasses (e.g., trauma glasses) that have extensions to cover the side of the eyes.
Adhere to recommended manufacturer instructions for cleaning and disinfection.
Properly clean and disinfect the safety glasses in the following manner: carefully wipe the outside of face shield or goggles with clean water or alcohol to remove residue. Fully dry (air dry or use clean absorbent towels).
Remove gloves and perform hand hygiene.
Application of Safety Glasses
Goggles are applied BEFORE you enter the patient home and BEFORE you leave the patient home.
3. If you don't have isolation gowns use these.
In situations of severely limited or no available isolation gowns, the following pieces of clothing can be considered as a last resort for care of COVID-19 patients.
- Disposable laboratory coats
- Reusable (washable) patient gowns
- Reusable (washable) laboratory coats
- Disposable aprons
- Combinations of clothing: Combinations of pieces of clothing can be considered for activities that may involve body fluids and when there are no gowns available:
- Long sleeve aprons in combination with long sleeve patient gowns or laboratory coats
- Open back gowns with long sleeve patient gowns or laboratory coats
- Sleeve covers in combination with aprons and long sleeve patient gowns or laboratory coats
Since none of these options can be considered personal protective equipment, the capability to protect the home health clinician is unknown. Preferable features include long sleeves and closures (snaps, buttons) that can be fastened and secured.
Reusable patient gowns and lab coats can be safely laundered according to routine procedures.
Application of Isolation Gown
AFTER entering the home apply the isolation gown. BEFORE leaving the home remove the isolation gown.
4. Limit care to priority patients only.
Since the corona virus in the US is not contained, the presumption must be that anyone can have the COVID-19 virus. Under these circumstances your HHA must limit contact to patients to those that have only home health agency personnel to provide the service.
Priority patients includes those with the following skilled needs:
- administer critical medications that cannot be administered by anyone other than home health personnel
- perform critical procedures that cannot be administered by anyone other than home health personnel such wound care, IV therapy, TPN, ventilator care, etc. covid-19 home health