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COVID-19 (coronavirus) advice for care providers

Visiting a person in their own home

Contents

Training

An eLearning module is available: e-Learning for Healthcare - Coronavirus (opens in a new window).

The programme has been created by Health Education England e-Learning for Healthcare (HEE e-LfH) in response to the Coronavirus (COVID-19) global pandemic.

The programme includes key materials to help the health and care workforce respond to Coronavirus.

Step 1 - Before making a home visit

Be clear on basic COVID-19 principles:

  • symptoms: high temperature (>37.8oC) and/or new continuous cough
  • transmission: main route is from cough and sneeze droplets – directly inhaled or contact

Consult current guidance: GOV.UK - COVID-19: guidance for residential care, supported living and home care (opens in a new window).

Where possible, identify whether an individual receiving care is self-isolating and the reason(s) for this. People may be self-isolating for a number of possible reasons:

If a visit to a self-isolating individual is deemed necessary, a risk assessment should be conducted.

Consider your own health, if a member of staff is concerned they have COVID-19 symptoms they should follow NHS - Advice for everyone - Coronavirus (COVID-19) (opens in a new window) and self-isolate at home. Please follow the stay at home guidance from GOV.UK - COVID-19: guidance for households with possible coronavirus infection (opens in a new window) and notify your line manager.

Step 2 - Visit risk assessment

If an individual receiving care is in self isolation, there should be a discussion with the individual, the commissioning organisation and provider as to how and whether care should be delivered. Consider if the contact can be deferred.

If the individual’s condition is deteriorating, and you are concerned for their wellbeing:

Remember: if the individual receiving care has symptoms or has been diagnosed with COVID-19, risks of transmission will be minimised through safe working procedures.

Step 3 - Advice for if person has symptoms/does not have symptoms

An Individual being cared for who has no symptoms but is part of a household that is isolating

PPE includes a disposable apron, gloves, fluid resistant surgical mask and if risk of splashing*, eye protection should be worn for direct care within 2 metres if a household member has possible or confirmed COVID -19.

If the symptomatic person can move to a different room, this will reduce risks to staff during the visit.

Contact must be limited with any household member with symptoms.

*Risk assessment on the use of eye protection should consider the likelihood of encountering a case(s) and the risk of droplet transmission (risk of droplet transmission to eye mucosa such as with a coughing patient) during the episode of care.

An individual being cared for who has symptoms of COVID-19

Should be cared for using PPE. This includes a disposable apron, gloves, fluid repellent surgical mask and if risk of splashing*, eye protection.

Staff who come into contact with a COVID-19 patient while not wearing PPE can remain at work. This is because in most instances this will be a short-lived exposure.

From international data, the balance of evidence is that most people will have sufficiently reduced infectivity 7 days after the onset of symptoms.

*Risk assessment on the use of eye protection should consider the likelihood of encountering a case(s) and the risk of droplet transmission (risk of droplet transmission to eye mucosa such as with a coughing patient) during the episode of care.

If no symptoms are present

Should be cared for using PPE if giving care within 2 metres. This includes a disposable apron, gloves, fluid resistant surgical mask. A risk assessment* should be completed to determine if eye protection is required.

 A risk assessment should be completed if giving care within 2 metres to determine if PPE required.

Take only take the minimum number of items required into the house.

When you are unable to identify if someone has possible symptom prior to your visit, if delivering care within 2 metres ensure you wear PPE including a FRSM and risk assess the need for eye protection.

*Risk assessment on the use of eye protection should consider the likelihood of encountering a case(s) and the risk of droplet transmission (risk of droplet transmission to eye mucosa such as with a coughing patient) during the episode of care.

Extremely vulnerable

Direct care or visit to any individuals in the extremely vulnerable group or where a member of the household is within the extremely vulnerable group undergoing shielding – a single use mask must be worn for that visit and clean eye protection. For more information on shielding visit GOV.UK - Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19 (opens in a new window).

Coming out of isolation

Advise to remain in isolation for 7 days after symptoms first started.

If symptoms worsen during isolation or are no better after 7 days, suggest contacting their GP for further advice.

See stay at home guidance for households with possible symptoms: GOV.UK - COVID-19: guidance for households with possible coronavirus infection (opens in a new window)The first person with symptoms must stay at home for 7 days, but all other household members who remain well must stay at home and not leave the house for 14 days. The 14-day period starts from the day when the first person in the house became ill. Further information via GOV.UK - COVID-19: guidance for households with possible coronavirus infection (opens in a new window)

It is likely that people living within a household will infect each other or be infected already. Staying at home for 14 days will greatly reduce the overall amount of infection the household could pass on to others in the community.

Personal protective equipment (PPE)

PPE is an important component of safe working that includes hand hygiene, cleaning surfaces, decontaminating equipment, not touching your face etc that will all reduce the risks of transmission.

Recommended PPE

Download: Additional considerations, in addition to standard infection prevention and control precautions, where there is sustained transmission of COVID-19, taking into account individual risk assessment for this new and emerging pathogen, NHS and independent sector poster (opens in a new window)

Care workers should use personal protective equipment (PPE) for activities that bring them within 2 metres of a person. This includes activities such as washing and bathing, personal hygiene and contact with bodily fluids.

The following Personal Protective Equipment (PPE) is recommended for care of a person with possible or confirmed Covid-19:

  • fluid repellent surgical mask (FRSM)
  • gloves
  • apron

If there is a risk of splashing*, then eye protection should be worn.

*Risk assessment on the use of eye protection should consider the likelihood of encountering a case(s) and the risk of droplet transmission (risk of droplet transmission to eye mucosa such as with a coughing patient) during the episode of care.

How to use PPE

Please see COVID-19: personal protective equipment use for non-aerosol generating procedures (opens in a new window) for guidance.

Download: A visual guide to safe PPE poster

Download: Guide to donning and doffing standard Personal Protective Equipment (PPE) poster

Download: Taking off personal protective equipment (PPE) for non-aerosol generating procedures (AGPs) poster

New aprons and gloves must be worn for each episode of care and new patient/person with safe disposal and hand hygiene after each patient contact.

Sessional masks/face/eye protection

Please see the latest PPE guidelines GOV.UK - COVID-19 personal protective equipment (PPE) (opens in a new window). The guidelines allow for sessional use of masks and face protection which can be worn over a period of time. For more information download: Additional considerations, in addition to standard infection prevention and control precautions, where there is sustained transmission of COVID-19, taking into account individual risk assessment for this new and emerging pathogen, NHS and independent sector poster.

A face mask should: 

  • be well fitted covering both nose and mouth
  • not be allowed to dangle around the neck of the wearer after or between each use
  • not be touched once put on
  • be changed when mask become moist or damaged

PPE should not be worn continually if damaged, soiled, damp, uncomfortable and difficult to breathe. The manufacturers’ guidance should be followed in regard to the maximum duration of use.

Direct care or visit to any individuals in the extremely vulnerable group or where a member of the household is within the extremely vulnerable group undergoing shielding – a single use mask must be worn for that visit and clean eye protection.

Summary

For all care within 2 metres, staff should wear standard gloves and aprons (and change for every patient and task and clean hands between) and a FRSM and if risk of splashing to the face/eyes wear eye/face protection. The FRSM and eye protection can be worn for a sessional basis (more than one patient). If reusable eye protection is worn this should be decontaminated on removal prior to next sessional use.

Important

  • remember to take breaks and hydrate yourself regularly
  • do not touch the mask / face once it is put on
  • should you mistakenly touch your mask/face then immediately wash your hands
  • the use of home-made masks are now advised
  • where staff consider there is a risk to themselves or the individuals, they are caring for, they should wear a fluid repellent surgical mask with or without eye protection, as determined by the individual staff member for the care episode/single session

Please see GOV.UK - COVID-19: infection prevention and control (IPC) (opens in a new window) for more information.

Hand hygiene

Whilst delivering care the worker must be bare below the elbow. This includes no long sleeves, no hand or wrist jewellery/ wristwatch. Ensure fingernails are clean, short and that artificial nail products are not worn. Ensure all cuts/abrasions are covered with a waterproof plaster/dressing.

Ensure hands are washed with soap and water:

  • on arrival at the home
  • before and after putting on/taking off PPE
  • before and after contact with the client
  • in between tasks
  • before leaving the home

If soap and water are not available, then alcohol hand rub (70% alcohol content) is an alternative if hands are visibly clean. Otherwise hand wipes should be used, followed by alcohol hand rub. 

For more information please download the following posters:

Download: Alcohol handrub hand hygiene technique

Download: Hand-washing technique with soap and water

Download: Wash your hands

Waste

All waste that has been in contact with the individual, including used tissues, continence pads and other items soiled with bodily fluids, should be put in a plastic rubbish bag and tied. The plastic bag should then be placed in a second bin bag and tied. This must be put aside for at least 72 hours before being put in the usual domestic or household waste bin.

The principle behind this is that after 72 hours outside the body the virus is no longer viable and the relevant waste (suitably double bagged) can be put into outside waste and collected as normal.

Cleaning and laundry

Use household cleaning products such as detergents and bleach. These are very effective. Wear a plastic apron and disposable gloves if available or washing up gloves. Use a disposable cloth, paying particular attention to frequently touched surfaces. Further information on cleaning in non-healthcare settings GOV.UK - COVID-19: cleaning in non-healthcare settings (opens in a new window).

Download: Cleaning and disinfection guidance poster

If supporting laundry in the home

  • do not shake used linen (minimises virus dispersal into the air)
  • wash in line with manufacturer’s instructions
  • items can be washed together at home
  • keep laundry for 72 hrs after 7 days isolation has finished if taking to public laundry facility

Staff workwear

Wearing PPE will protect staff clothing. Staff should have a uniform or dedicated clothing for work and wash separately from other items in a load not more that half full. Wash on the hottest wash the items will tolerate. Dry items well. Staff wearing their own clothes as a part of care protocol: change clothes at work then transport home in a disposable plastic bag. This bag should be disposed of into the household waste stream. Clothes should be laundered, separately from other household linen, in a load not more than half the machine capacity, at the maximum temperature the fabric can tolerate, then ironed or tumbled-dried.

It is recognised that staff will need to travel between visits in the same workwear.

Decontamination/cleaning of equipment

Where possible use a single use/disposable item.

When reusable item used, always check manufacturer’s instructions for suitability of cleaning products.

Wear gloves and an apron to clean equipment.

Any reusable equipment taken into the persons house must be cleaned.

If the person has no signs of infection, neutral detergent and water or detergent wipes can be used. Rinse and dry thoroughly.

If visibly soiled or the person has signs of infection the equipment should be cleaned with detergent and then disinfected with a solution of 1000 ppm available chlorine. Combined detergent and chlorine releasing wipes are available.

Remember contact times for disinfectants to work properly.

Services will need to identify equipment used and develop procedures for decontaminating reusable equipment between patient uses.

Reusable (communal) equipment must be decontaminated:

  • between each patient and after patient use
  • after blood and body fluid contamination
  • at regular intervals as part of equipment cleaning

Clean using either a combined detergent disinfectant solution at a dilution of 1000 parts per million (ppm) available chlorine (av.cl.)  or a neutral purpose detergent followed by disinfection (1000 ppm av.cl.). Detergent and chlorine releasing wipes are available as an easy alternative to making up fresh solutions. Equipment where chlorine is not advised by manufacturers, can be cleaned with neutral detergent followed by wiping with 70% alcohol.

Download: Routine decontamination of reusable non-invasive patient care equipment

Staff welfare – health and wellbeing

The current COVID-19 pandemic will affect us all in different ways: physically, emotionally, socially and psychologically. Staff on the front line of health and social care services will experience varying levels of stress and distress at points.

There are a range of resources to help staff look after health and wellbeing of themselves and others:

Please consider using these resources and discussing any staff-related health and wellbeing concerns with your line manager. 

Please note

All the posters/guidance documents are available at the COVID-19 (coronavirus) advice for care providers documents (opens in a new window) page.

For general information and updates please visit the Coronavirus page.