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Are gowns necessary, especially in home care?

Disasters   (227 Views | 5 Replies)

Kitiger has 40 years experience as a RN and specializes in Private Duty Pediatrics.

1 Follower; 19,456 Profile Views; 1,082 Posts

I understand that COVID is spread by droplet, contact with contaminated fomites, and it is aerosolized when the patient coughs or receives a nebulizer treatment. And I understand why gowns are necessary in the hospital, where you go from one patient to the next. But in the home, I would have only one infected client. Staying for a 12-hour shift with one client does not give the opportunity to spread the virus to anyone else. 

Is a gown necessary?

Right now, my clients are probably not infected (no symptoms, and very little opportunity). When I get home, shoes come off at the door. All clothes go straight into the washing machine (near the door). I wash my hands, glasses & hearing aides off, then straight to the bathroom to take a bath and wash my hair. Once I'm in clean clothes, I go around and disinfect anything I might have touched, and run the load of laundry. I also disinfect whatever I may have touched in the car.

If I had reason to suspect my clients or any of their family were infected, I would also drape an old sheet over the car seat, and that would get washed along with my clothes.

With those precautions, is a gown necessary?

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NRSKarenRN has 40 years experience as a BSN, RN and specializes in Vents, Telemetry, Home Care, Home infusion.

5 Followers; 10 Articles; 14,903 Posts; 165,317 Profile Views

Caring for homecare patients since 1985 thru few epidemics, this is advice learned and followed.  However, Covid-19 is 10x more contagious per WHO so use caution:

Established Client you have been caring for with  no acute new respiratory illness, no gown needed. 

New client Trached or vent needing suctioning, multiple family members in/out of home, apron, face shield mask best worn until home 2 weeks and no acute illness then could stop apron.   Disenfecting wipes to clean hard surfaces afterwards -- bedrails if used, etc.   No wipes: solution 1/2  white vinegar+ 1/2 boiled water-cooled, mixed and placed in spray bottle wipe with paper towels, replace solution every 2 days.  

WASH HANDS WITH SOAP AND WATER, dry with paper towels after each hands on patient encounter best way prevent infection.

Resources:

Cleaning of vent equipment: https://www.ncbi.nlm.nih.gov/books/NBK214361/

Apria- Manual ventilator patient care: https://www.apria.com/wp-content/uploads/2014/10/RES-2041_Manual_Ventilator_07-14_v15_online.pdf

National Association for Home Care & Hospice: Coronavirus Resources for Home Care & Hospice   https://www.nahc.org/resources-services/coronavirus-resources/

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NRSKarenRN has 40 years experience as a BSN, RN and specializes in Vents, Telemetry, Home Care, Home infusion.

5 Followers; 10 Articles; 14,903 Posts; 165,317 Profile Views

I'm not a germaphobe, concerned that excessive disinfectant use/antibacterial soap reduces body's immune response  so I don't wipe down every surface.

Cell Phone/TV remote/ front door switch and door nob, car steering wheel periodically cleaned.  Wipe off shopping cart handle with baby wipe, and clean my hands after placing groceries in trunk.   White New Balance sneakers cleaned off prior to getting into home + can be thrown into washer if I've been in very dirty home.   Some patients want us to use shoe covers. Laundry + bathing as you do. 

My high flow O2 dependent DH used Triliogy vent going to doctors past 2 years due to Pulmonary Hypertension; on homecare with RN/HHA/Therapist in and out of home---no infections. 

Take care out there.

🙂

 

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Kitiger has 40 years experience as a RN and specializes in Private Duty Pediatrics.

1 Follower; 1,082 Posts; 19,456 Profile Views

3 hours ago, NRSKarenRN said:

Caring for homecare patients since 1985 thru few epidemics, this is advice learned and followed.  However, Covid-19 is 10x more contagious per WHO so use caution:

Established Client you have been caring for with  no acute new respiratory illness, no gown needed. 

New client Trached or vent needing suctioning, multiple family members in/out of home, apron, face shield mask best worn until home 2 weeks and no acute illness then could stop apron.   Disinfecting wipes to clean hard surfaces afterwards -- bedrails if used, etc.   No wipes: solution 1/2  white vinegar+ 1/2 boiled water-cooled, mixed and placed in spray bottle wipe with paper towels, replace solution every 2 days.  

WASH HANDS WITH SOAP AND WATER, dry with paper towels after each hands on patient encounter best way prevent infection.

Resources:

Cleaning of vent equipment: https://www.ncbi.nlm.nih.gov/books/NBK214361/

Apria- Manual ventilator patient care: https://www.apria.com/wp-content/uploads/2014/10/RES-2041_Manual_Ventilator_07-14_v15_online.pdf

National Association for Home Care & Hospice: Coronavirus Resources for Home Care & Hospice   https://www.nahc.org/resources-services/coronavirus-resources/

On the CDC website, I do not find vinegar recommended for corona virus. They recommend EPA-registered disinfectants, diluted bleach or 70% alcohol.

I read somewhere that vinegar does not kill this virus, but I can't remember where I read this.

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CampyCamp has 18 years experience as a RN.

247 Posts; 1,171 Profile Views

On 4/25/2020 at 7:42 PM, NRSKarenRN said:

I'm not a germaphobe, concerned that excessive disinfectant use/antibacterial soap reduces body's immune response  so I don't wipe down every surface.

Cell Phone/TV remote/ front door switch and door nob, car steering wheel periodically cleaned.  Wipe off shopping cart handle with baby wipe, and clean my hands after placing groceries in trunk.   White New Balance sneakers cleaned off prior to getting into home + can be thrown into washer if I've been in very dirty home.   Some patients want us to use shoe covers. Laundry + bathing as you do. 

My high flow O2 dependent DH used Triliogy vent going to doctors past 2 years due to Pulmonary Hypertension; on homecare with RN/HHA/Therapist in and out of home---no infections. 

Take care out there.

🙂

 

I've always been unworried about the microbes at work. This one has me scrubbing and wiping and everything. 

Thanks for what you do in the home. My mom is getting a nurse twice a week and I'm so grateful for her. 

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NRSKarenRN has 40 years experience as a BSN, RN and specializes in Vents, Telemetry, Home Care, Home infusion.

5 Followers; 10 Articles; 14,903 Posts; 165,317 Profile Views

Bleach solution is fine for HARD SURFACE cleaning only.

COVID-19 – Disinfecting with Bleach   how to prepare solution depending on bleach strength.  Bleach only good for up to ONE YEAR from production, less once opened.   https://www.canr.msu.edu/news/covid-19-disinfecting-with-bleach

Soft supplies:  nebulizer treatment, trach, suction machine tubing, trach holders, intermittent catheters, catheter leg straps etc. - diisinfect with vinegar solution; air dry on paper towels or clean hand towel then store in clean plastic bag till time of use.

🙂

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