Precautions and personal protective equipment (PPE)
When providing routine care for a resident with suspected or confirmed COVID-19, contact precaution and droplet precautions should be practiced. Detailed instructions on precautions for COVID-19 are available.
- PPE should be put on and removed carefully following recommended procedures to avoid contamination.
- Hand hygiene should always be performed before putting on and after removing PPE.
- Contact and droplet precautions include the following PPE: medical mask, gloves, gown, and eye protection (goggles or face shield).
- Employees should take off PPE just before leaving a resident’s room.
- Discard PPE in medical waste bin and preform hand hygiene.
When caring for any residents with suspected or confirmed COVID-19 practice contact plus airborne precautions during any aerosol-generating procedures (e.g. tracheal suctioning, intubation; refer to Infection prevention and control during health care). Airborne precautions include the use of N95, FFP2, or FFP3 respirators or equivalent level mask, gloves, gown and eye protection (goggles or face shield). Note: use N95 mask only if the LTCFs has a programme to regularly fit-test employees for the use of N95 masks.
Cleaners and those handling soiled bedding, laundry, etc., should wear PPE, including mask, gloves, long sleeve gowns, goggles or face shield, and boots or closed toe shoes. They should perform hand hygiene before putting on and after removing PPE.
Environmental cleaning and disinfection
Hospital-grade cleaning and disinfecting agents are recommended for all horizontal and frequently touched surfaces (e.g., light switches, door handles, bed rails, bed tables, phones) and bathrooms being cleaned at least twice daily and when soiled.
Visibly dirty surfaces should first be cleaned with a detergent (commercially prepared or soap and water) and then a hospital-grade disinfectant should be applied, according to manufacturers’ recommendations for volume and contact time. After the contact time has passed, the disinfectant may be rinsed with clean water.
If commercially prepared hospital-grade disinfectants are not available, the LTCFs may use a diluted concentration of bleach to disinfect the environment. The minimum concentration of chlorine should be 5000 ppm or 0.5% (equivalent to a 1:9 dilution of 5% concentrated liquid bleach).8
Laundry
Soiled linen should be placed in clearly labelled, leak-proof bags or containers, after carefully removing any solid excrement and putting it in a covered bucket to be disposed of in a toilet or latrine.
Machine washing with warm water at 60−90°C (140−194°F) with laundry detergent is recommended. The laundry can then be dried according to routine procedures.
If machine washing is not possible, linens can be soaked in hot water and soap in a large drum using a stick to stir and being careful to avoid splashing. The drum should then be emptied, and the linens soaked in 0.05% (500 ppm) chlorine for approximately 30 minutes. Finally, the laundry should be rinsed with clean water and the linens allowed to dry fully in sunlight.
Restriction of movement/ transport
If a resident has suspected or confirmed COVID-19 infection, the LTCFs should:
- Confirmed patients should not leave their rooms while ill.
- Restrict movement or transport of residents to essential diagnostic and therapeutic tests only.
– Avoid transfer to other facilities (unless medically indicated). - If transport is necessary, advise transport services and personnel in the receiving area or facility of the required precautions for the resident being transported. Ensure that residents who leave their room for strictly necessary reasons wear a mask and adhere to respiratory hygiene.
- Isolate COVID-19 patients until they have two negative laboratory tests for COIVID-19 taken at least 24 hours apart after the resident’s symptoms have resolved. Where testing is not possible, WHO recommends that confirmed patients remain isolated for an additional two weeks after symptoms resolve.
LTCFs should be prepared to accept residents who have been hospitalized with COVID-19, are medically stable and are able to care for the patients in isolated rooms. LTCFs should use the same precautions, patient restrictions, environmental cleaning, etc., as if the resident had been diagnosed with COVID-19 in the LTCFs.
Reporting
Any suspected or confirmed COVID-19 cases should be reported to relevant authorities as required by law or mandate.
Minimizing the effect of IPC on mental health of residents, employees, and visitors
Considerations for care
- Guidance for the clinical care for COVID-19 patients is available.
- Older people, especially in isolation and those with cognitive decline, dementia, and those who are highly care-dependent, may become more anxious, angry, stressed, agitated, and withdrawn during the outbreak or while in isolation.
- Provide practical and emotional support through informal networks (families) and health care providers.
- Regularly provide updated information about COVID-19 to residents, employees, and staff.
Support health care workers and caregivers
- As much as possible, protect staff from stress both physically and psychologically so they can fulfil their roles, in the context of a high workload and in case of any unfortunate experience as a result of stigma or fear in their family or community.9
- Regularly and supportively monitor all staff for their wellbeing and foster an environment for timely communication and provision of care with accurate updates.
- Consider rest and recuperation and alternate arrangements as needed.
- Mental health and psychosocial support10 and psychological first aid training11 can benefit all staff in having the skills to provide the necessary support in the LTCFs.
- Staff need to ensure that safety measures are in place to prevent excessive worries or anxiety within the LTCFs.