- Infectious and tropical disease expert outlines guides to set up home care amid the lack of hospital rooms for COVID patients.
- How to evaluate patient risk factors; the capacity of a home environment; the ability of caregivers to assess patient status.
- Requirements for home care and what to prepare as a home care kit.
- There are hospitals offering home care for COVID cases with healthcare professionals guiding the family to provide good home care.
- Follow WHO-recommended guide to infection prevention and control.
- When to seek emergency medical attention.
Having knowledge on home care for asymptomatic and mild symptom family members is important.
You’ve heard stories about hospitals getting overwhelmed that even serious cases have to wait in line to get in. If a family member tested positive for COVID-19 but is asymptomatic or has a mild case of COVID-19, take time to learn from a medical expert on how to give proper home care.
Infectious and tropical disease expert Dr. Anna Lisa T. Ong-Lim said “home care” is a potential solution to address the “extremely challenged” healthcare system due to the high number of coronavirus disease (COVID-19) cases.
In a virtual forum initiated by the Santuario de San Antonio Parish, and supported by the Philippine General Hospital last Saturday, April 10, Dr. Ong-Lim explained the following important factors for home care:
- How to evaluate patient risk factors,
- The capacity of a home environment,
- The ability of caregivers to assess patient status
Citing the World Health Organization’s (WHO) guidelines for home care, she said the decision as to whether or not a patient needs to be cared for at home will depend on these three important factors.
Does the patient qualify for home care?
Ong-Lim said the WHO emphasized that patients who are asymptomatic or with mild or moderate disease and without risk factors or poor outcome can qualify for home care.
Absence of shortness of breath
“The criteria that we want to see first includes the absence of difficulty in breathing…does not have a shortness of breath. They can speak in full sentences very comfortably. Hindi hinihingal, hindi hinahapo. [Not breathless nor exhausted]. They don’t catch their breath when they speak,” she said.
She said the patient’s respiratory rate should be less than 30 breaths per minute at rest, while oxygen saturation on room air should be at least 94 percent.
“Another thing we need to look at is whether or not they have risk factors. If they are above 60 years old, smokers, obese, or have non-communicable diseases such as cardiovascular disease, diabetes mellitus, chronic lung disease, chronic kidney disease, immunosuppression, and cancer. This category of patients will not qualify for home care,” Ong-Lim pointed out.
The medical expert said a patient who met the criteria for mild disease can consider home care “as long as they are able to implement appropriate infection prevention and control measures.”
If feasible, the patient should also be closely monitored by a trained healthcare worker, she added.
Quarantine vs isolation
Ong-Lim explained that isolation should be implemented if a person is tested positive for COVID-19.
“That means you separate that person in an individual room, and, if possible, it should have a separate bathroom because the objective of this isolation is to prevent this person from spreading the disease to someone else,” she said.
“The goal is to stay home until at least 10 days since symptoms first appeared and at least 24 hours with no fever without fever-reducing meds, and symptoms have improved for at least three days,” she added.
Close contact with positive case
Meanwhile, Ong-Lim noted that quarantine is intended to observe those who have been in close contact with a positive case for 14 days–the period during which symptoms are expected to show.
“People can be contagious even before they test positive or even before they start having symptoms. And because it’s impossible to turn back the clock, you want to make sure that during those time you may have been contagious already and you may have started passing on the disease that your movements are already limited so that you’re no longer spreading the infection around,” she said.
Quarantined individuals should watch for symptoms, check body temperatures, and stay away from high-risk people.
What are the requirements for home care?
Ong-Lim said an appropriate setup for home care should have a separate room and bathroom; the room where the patient would stay should have good airflow; able to keep the door closed; and able to implement a good delivery system for the daily needs of the individual without a lot of contact between the household and the isolated or infected individual.
Use PPE when you check on them
“If you may need to assist and need to get into their rooms to check on them then you will need at least a face mask and face shield. If PPE (personal protective equipment) is available in your home, then that will be helpful as well,” she said.
As recommended by the WHO, Ong-Lim said it is important to continue to practice infection prevention and control.
She said people taking care of their family members must follow these WHO recommendations:
- Limit patient’s movement around the house and minimize shared space, like kitchen or bathroom. Ensure shared spaces are well ventilated. After that person has left the area it is important to sanitize.
- Household members should also avoid entering the room where the patient is located or if not possible you have to have a distance of at least one meter.
- Limit the number of caregivers. Ideally, only one person is assigned. This person should be in good health and should not have any underlying chronic conditions.
- Visitors should not be allowed in the home.
- Proper hand hygiene is important.
- Provide medical mask to patients, cloth mask is not sufficient.
- Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use.
- Caregivers should also have medical masks that should cover their nose and mouth whenever they are in the same room with the patient.
- Avoid direct contact with the patient’s body fluids.
- We do not recommend reusing medical masks or gloves. However, if you do use reusable equipment like utility gloves or plastic aprons then you need to clean and disinfect them properly.
- Clean and disinfect surfaces at least once daily. Regular household soap or detergent should be used first for cleaning and then after rinsing regular household disinfectant containing 0.1 percent of sodium hypochlorite should be applied by wiping surfaces.
- Linens and eating utensils should be dedicated to the patient alone.
- Place contaminated linen in a laundry bag. Do not shake soiled laundry. Clean with regular soap and water afterward.
- Dispose of waste very carefully.
- Avoid other types of exposure to contaminated items from the patient’s immediate environment such as toothbrushes, towels.
Home care kit
Ong-Lim said households should also have a home care kit, which should contain:
- PPEs, such as mask, face shield, and gloves.
- Cleaning and disinfection supplies (bleach solution: dilute 45 mL per liter of water). “This has to be freshly prepared daily because it does evaporate and your concentration might change.”
- Monitoring supplies, such as vital signs record, thermometer, blood pressure cuff, pulse oximeter. She said these will be used “to observe trends and communicate these trends to your healthcare professional.”
“Organize data put the date, time, heart rate, respiratory rate, temperature, BP (who has hypertension) oxygen saturation. Doing this one to three times a day should be more than enough. Typically every eight hours will be fine for mild cases,” she added.
- Medications for fever, cough and colds, and patient’s maintenance medications.
Can the caregivers assess the patient appropriately?
Ong-Lim said it is important to ensure that the patient can be adequately monitored at the home under the home care setting.
“You need somebody who can be a reliable caregiver so that if they relay information to the healthcare professional the accuracy or validity of that information can be assured. It cannot be an elderly person, it cannot be somebody who is already sick,” she said.
When to seek urgent care
Here are the Centers for Disease Control and Prevention’s guide for when to seek emergency medical attention:
- Trouble breathing, in the form of increased respiratory rate, or in the form of difficulty speaking (forming complete sentences), or short of breath even with ordinary activities.
- There can be persistent pain or pressure in the chest, which can also be a sign of difficulty in breathing.
- Confusion, when the patient cannot answer properly because he is disoriented and this is probably a sign of decreasing oxygen levels in the body.
- Inability to wake up or stay awake is also a danger sign once again this can be associated with decreasing oxygen levels.
- If the patient looks pale, or bluish-gray skin, lips, or nail beds, depending on skin tone needs immediate medical attention is also a sign of decreased oxygen level.
Ong-Lim advised households to establish contact with healthcare professionals or local government units at the start of illness.
“There are also hospitals offering home care for COVID cases at home. Healthcare professionals can guide us to be able to provide good home care for our family members,” she added.