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 Home Based Care for Patients with COVID-19

 

 As Kenya sees a surge in number of persons with COVID-19, it is no longer possible to isolate all patients in hospital based treatment facilities.Hospital care should be prioritized for those with highest probability of poor outcomes, that is, patients with severe and critical illness and those with mild disease and risk for poor outcome (age>60 years, cases with underlying comorbidities, e.g., chronic cardiovascular disease, chronic respiratory disease, diabetes, cancer). Where possible safe home care should be considered for patients with suspected COVID-19 who present with no symptoms or mild symptoms. This should be done with guidance from medical and public health officials.

 

 Patients Eligible for Home Based Care:

  • Laboratory Confirmed COVID-19.

  • Asymptomatic patients or patients with mild symptoms of COVID-19.

  • Absence of co-morbidities.

  • Access to a suitable space for home based care

 

 Assessing Feasibility of Home-Based Care:

 It is important to note that the decision to care for a patient at home requires careful clinical judgment and should be informed by an assessment of the suitability of the patient’s home environment.

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  • The patient is stable enough to receive care at home.

  • Appropriate care givers are available at home.  

  • There is a separate bedroom or isolation space where the patient can recover without sharing immediate space with others.

  • Resources for access to food and other amenities and necessities are available.

  • The patient and other household members have access to appropriate, recommended personal protective equipment (at a minimum, gloves and face mask) and are capable of adhering to precautions recommended as part of home care or isolation (e.g. Respiratory hygiene, cough etiquette and hand hygiene).

  • Availability of thermometer and a person able to read and record the temperature. (non-contactor individually used thermometers)

  • There are NO household members who may be at increased risk of complications from COVID-19 infection e.g. people>65 years old, young children, pregnant women, people who are immune compromised or who have chronic heart, lung, or kidney conditions.

 

 Procedures for Home-Based Care:​

  • Place the patient in a well-ventilated single room (i.e. With open windows).

  • Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces (e.g. Kitchen, bathroom) are well ventilated (keep windows open).

  • Household members should stay in a different room. Limit the number of caregivers. Ideally, assign one person who is in good health and has no underlying chronic or immune compromising conditions.

  • Visitors should not be allowed in the isolation room, except the caregiver, until the patient has completely recovered and has no signs or symptoms of COVID-19 and has tested negative as per the protocol.

  • Perform hand hygiene after any type of contact with patients or their immediate environment. Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. Use of soap and water is highly encouraged, but in the event that either or both are not available an alcohol-based hand rub can be used.

  • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use single use clean cloth towels and wash with soap and water.

  • To contain respiratory secretions, a face mask should be provided to the patient and worn as much as possible. Individuals who cannot tolerate a face mask should use rigorous respiratory hygiene; that is the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g. wash handkerchiefs using regular soap or detergent and water and disinfected using 0.5% chlorine bleach).

  • Care givers should wear a face mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask. Remove the mask using the appropriate technique– that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene.

  • Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine, and other waste. Perform hand hygiene before and after removing gloves and the mask.

  • Do not reuse single use masks or gloves.

  • Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water and disinfected with 0.5% Chlorine bleach after use and maybe re-used instead of being discarded.

  •  Daily clean and disinfect surfaces that are frequently touched in the room where the patient is being cared for, such as bed side tables, bed frames, and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite should be applied.

  • Clean and disinfect bathroom and toilet surfaces at least twice daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite should be applied.

  •   Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water or machine wash at 60–90 °C with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes

  • Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g.do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths, or bed linen).

  • Isolation should be maintained for at least ten days or until advised by a Health Care Worker in the event that a patient continues to have symptoms beyond ten days. It is important that isolation is maintained for 10 days even in the absence of, or after resolution of, symptoms

 

 When to End Home Isolation:

  • No fever for at least 72 hours (that is three full days of no fever without using medicines that reduce fevers)  

  • Other symptoms have improved (for example, when cough or shortness of breath has improved)

  • At least 10 days have passed since their symptoms first appeared

  • If testing is available to determine if a patient is still infectious, then isolation can stop two negative tests in a row, 24 hours apart.

 

 N/B

 A communication link with health care workers should be established for the duration of the home care period–that is, until the patient’s symptoms   have completely resolved. Patients and household members should be educated about personal hygiene, basic IPC measures, and how to care as safely as possible for the person with COVID-19 to prevent the infection from spreading to household members. The patient and household members should be provided with ongoing support and education. Monitoring should continue for the duration of home-care AND SHOULD BE DONE BY CHVs supervised by HCWs. Any person suspecting him/herself of experiencing some symptoms should call 719 immediately

 

 Reference:

 M.O.H. (2020). Home Based Isolation. Home Based Isolation by the Ministry of Health Kenya, 7–11. https://www.health.go.ke/wp-   content/uploads/2020/06/Home-Based-Isolation.pdf

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