Patients with SARS-CoV disease who do not require hospitalization for
medical indications may be isolated at home.
A. Assessment of the Residence
Objective: Ensure
that the residential setting is suitable and appropriate for isolation
of a SARS patient.
Activities
- Before
a SARS patient occupies a residence for home isolation, there should
be an assessment (by phone or direct observation) to ensure that
the residence has the features necessary for provision of appropriate
care and infection control precautions. Because of the variability
of household settings, professional judgment is needed in determining
whether a home is an appropriate location for a patient with SARS-CoV
disease.
- There
should be a bathroom in the home for use by the patient and household
members only. If there are multiple bathrooms, one should be designated
solely for the patient's use, especially if the patient has diarrhea.
- The
patient should have a bed and preferably a private room for sleeping.
- If
the home is a multiple family dwelling (e.g., apartment building),
the area in which the patient will be housed should have a separate
air-handling system (if one is present).
- Basic
amenities, such as heat, electricity, potable and hot water, sewer,
and telephone access, should be available.
- There
should be a primary caregiver to assist the patient with basic needs
in the home and social service support for obtaining groceries, prescriptions,
and other personal needs.
B. Infection Control Precautions for SARS Patients Isolated at Home
Objective: Ensure the use of proper infection control
precautions in the home setting to minimize the potential for SARS-CoV
transmission.
Infection control principles used in healthcare settings also apply
in the home care setting. However, due to practical limitations, there
are some differences between what can be done in the home and the healthcare
setting. For example, AII Precautions cannot be practiced completely
outside of fully controlled settings such as healthcare facilities. Since
SARS-CoV is most likely transmitted through contact and droplet spread,
the use of modified precautions that focus on preventing droplet and
contact spread are recommended for isolation in the household setting.
Activities
Duration of infection control measures
- Continue
the infection control precautions outlined below until 10 days
following resolution of fever (given respiratory symptoms are absent
or resolving) or until the health department has determined that
home isolation precautions can be safely discontinued (e.g., diagnosis
of SARS-CoV disease is ruled out).
Home isolation precautions
- Patients
should not leave the home for the duration of the isolation period,
except as necessary for follow-up medical care. When movement outside
the home is necessary, the patient should wear a mask, if tolerated,
and should not use public transportation.
- Separate
the patient from other persons in the household to the extent possible.
Use a separate room and bathroom if available.
- Limit
the number of persons in the household to those who are essential for
patient support. Other household members should either be relocated
or minimize contact with the patient in the home. This is particularly
important for persons at risk of serious SARS-CoV disease complications
(e.g., persons with underlying heart or lung disease, diabetes mellitus,
older age).
- Unexposed
persons who do not have an essential need to be in the home should
not visit.
Infection control measures in the home
- Hand
hygiene -- All persons in the household should carefully follow
recommendations for hand hygiene (i.e., hand washing with soap and
water or use of an alcohol-based hand rub) after touching body fluids
(e.g., respiratory secretions, stool, urine, vomitus) and potentially
contaminated surfaces and materials (e.g., linen). Hand hygiene supplies
(soap/water, alcohol-based hand rub, disposable towels) should be
available and replenished as needed. (See Hand Hygiene in Healthcare Settings
.)
- Source
control -- Patients should cover the nose/mouth when coughing and
dispose of tissues in a lined waste container. If possible, the patient
should wear a surgical mask when others are present. If the patient
cannot wear a mask, persons in close contact with the patient should
wear a mask. Masks should fit snugly around the face and should not
be touched or handled during use. If masks will be reused by persons
in the home, procedures for identifying each person's mask and containing
it between uses should be in place. A supply of masks should be available
based on the volume needed each day.
- Gloves
and other protective attire -- Use of disposable gloves should be considered
for any direct contact with the body fluids of a patient with possible
or known SARS-CoV disease. However,
gloves are not intended to replace proper hand hygiene. Immediately
after gloves are removed, they should be discarded and hand hygiene should
be performed. Gloves must never be washed or reused.
- Laundry
(e.g., bedding, towels and clothing) -- Towels and bedding should
not be shared. Laundry may be washed in a standard washing machine
with warm water and detergent; bleach may be added but is not necessary.
Gloves should be worn when handling soiled laundry, and care should
be used when handling soiled laundry to avoid direct contact of skin
and/or clothing with contaminated material. Soiled laundry should not
be shaken or otherwise handled in a manner that may aerosolize infectious
particles.
- Dishes
and other eating utensils -- Objects used for eating should not be
shared, but separation of eating utensils for use by the SARS patient
is not necessary. Soiled dishes and eating utensils should be washed
either in a dishwasher or by hand with warm water and soap.
- Household
waste -- Gloves, tissues, and other waste generated in the care of
a SARS patient should be bagged and placed in another container for
disposal with other household waste.
- Cleaning
and disinfection of environmental surfaces -- Environmental surfaces
that are frequently touched by the patient or are soiled with body
fluids should be cleaned and disinfected with a household disinfectant.
The bathroom used by the patient should be cleaned daily, if possible.
Household utility gloves should be worn during the cleaning process.
C. Follow-up
of Contacts
Objective: Ensure appropriate follow-up and care of
exposed close contacts of SARS patients in home isolation.
Activities
- Household
members and other close contacts of SARS patients should be vigilant
for fever (i.e., measure temperature at least daily) and/or respiratory
symptoms.
- If
household contacts develop fever or respiratory symptoms, arrangements
should be made immediately for a medical evaluation.
In advance of the evaluation, healthcare providers should be informed
that the person (and those who may accompany him or her) is a close contact
of a SARS patient so arrangements can be made, to prevent transmission
to others in the healthcare setting.
- Symptomatic
household or other close contacts should follow the same precautions
recommended for the SARS patient.
- In the
absence of fever or respiratory symptoms, household contacts need
not limit their activities outside the home, unless otherwise required
by quarantine regulations.
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