Question

You are an RN working in a community agency and need to develop a clear plan to respond to the COVID-19 pandemic. In your leadership role, you must develop a protocol to keep your employees and clients safe. To complete this assignment, you will need to briefly describe your agency, the services it provides and its role in the community. In response to COVID-19, do these services need to be altered in any way? Think through what needs to be done to minimize the risk of spreading COVID-19. And balance that with the necessity of the services your agency provides. Write up your protocol, based on the most recent guidance by either the CDC, NYC Department of Health or the World Health Organization. Below are some resources to complete this assignment.

Answer 1

If you are at higher risk for serious illness from COVID-19 because of your age or because you have a serious long-term health problem, it is extra important for you to take actions to reduce your risk of getting sick with the disease.

• Stock up on supplies.
• Take everyday precautions to keep space between yourself and others.
• When you go out in public, keep away from others who are sick, limit close contact and wash your hands often.
• Avoid crowds as much as possible.
• Avoid cruise travel and non-essential air travel.
• During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.

Have supplies on hand

• Contact your healthcare provider to ask about obtaining extra necessary medications to have on hand in case there is an outbreak of COVID-19 in your community and you need to stay home for a prolonged period of time.
• If you cannot get extra medications, consider using mail-order for medications.
• Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home.
• Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time.

Take everyday precautions

Avoid close contact with people who are sick.

Take everyday preventive actions:

• Clean your hands often
• Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place.
• If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
• To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something.
• Wash your hands after touching surfaces in public places.
• Avoid touching your face, nose, eyes, etc.
• Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones)
• Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick.
• Avoid all non-essential travel including plane trips, and especially avoid embarking on cruise ships.

If COVID-19 is spreading in your community

Take extra measures to put distance between yourself and other people to further reduce your risk of being exposed to this new virus.

• Stay home as much as possible.
• Consider ways of getting food brought to your house through family, social, or commercial networks

If a COVID-19 outbreak happens in your community, it could last for a long time. (An outbreak is when a large number of people suddenly get sick.) Depending on how severe the outbreak is, public health officials may recommend community actions to reduce people’s risk of being exposed to COVID-19. These actions can slow the spread and reduce the impact of disease.

Have a plan for if you get sick

• Consult with your health care provider for more information about monitoring your health for symptoms suggestive of COVID-19.
• Stay in touch with others by phone or email. You may need to ask for help from friends, family, neighbors, community health workers, etc. if you become sick.
• Determine who can care for you if your caregiver gets sick.

Watch for symptoms and emergency warning signs

• Pay attention for potential COVID-19 symptoms including, fever, cough, and shortness of breath. If you feel like you are developing symptoms, call your doctor.
• If you develop emergency warning signs for COVID-19 get medical attention immediately. In adults, emergency warning signs*:
  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face

*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

What to do if you get sick

• Stay home and call your doctor.
• Call your healthcare provider and let them know about your symptoms. Tell them that you have or may have COVID-19. This will help them take care of you and keep other people from getting infected or exposed.
• If you are not sick enough to be hospitalized, you can recover at home. Follow CDC instructions for how to take care of yourself at home.
• Know when to get emergency help.
• Get medical attention immediately if you have any of the emergency warning signs listed above

What others can do to support older adults

Community support for older adults

• Community preparedness planning for COVID-19 should include older adults and people with disabilities, and the organizations that support them in their communities, to ensure their needs are taken into consideration.
  • Many of these individuals live in the community, and many depend on services and supports provided in their homes or in the community to maintain their health and independence.
• Long-term care facilities should be vigilant to prevent the introduction and spread of COVID-19. Information for long-term care facilities can be found here.

Family and caregiver support

• Know what medications your loved one is taking and see if you can help them have extra on hand.
• Monitor food and other medical supplies (oxygen, incontinence, dialysis, wound care) needed and create a back-up plan.
• Stock up on non-perishable food to have on hand in your home to minimize trips to stores.
• If you care for a loved one living in a care facility, monitor the situation, ask about the health of the other residents frequently and know the protocol if there is an outbreak.

Stay home except to get medical care

• Stay home: People who are mildly ill with COVID-19 are able to recover at home. Do not leave, except to get medical care. Do not visit public areas.
• Stay in touch with your doctor. Call before you get medical care. Be sure to get care if you feel worse or you think it is an emergency.
• Avoid public transportation: Avoid using public transportation, ride-sharing, or taxis.

Separate yourself from other people in your home, this is known as home isolation

• Stay away from others: As much as possible, you should stay in a specific “sick room” and away from other people in your home. Use a separate bathroom, if available.
• Limit contact with pets & animals: You should restrict contact with pets and other animals, just like you would around other people.
  • Although there have not been reports of pets or other animals becoming sick with COVID-19, it is still recommended that people with the virus limit contact with animals until more information is known.
  • When possible, have another member of your household care for your animals while you are sick with COVID-19. If you must care for your pet or be around animals while you are sick, wash your hands before and after you interact with them. See COVID-19 and Animals for more information.

If someone in your home is sick

Call ahead before visiting your doctor

• Call ahead: If you have a medical appointment, call your doctor’s office or emergency department, and tell them you have or may have COVID-19. This will help the office protect themselves and other patients.

Wear a facemask if you are sick

• If you are sick: You should wear a facemask when you are around other people and before you enter a healthcare provider’s office.
• If you are caring for others: If the person who is sick is not able to wear a facemask (for example, because it causes trouble breathing), then people who live in the home should stay in a different room. When caregivers enter the room of the sick person, they should wear a facemask. Visitors, other than caregivers, are not recommended.

Cover your coughs and sneezes

• Cover: Cover your mouth and nose with a tissue when you cough or sneeze.
• Dispose: Throw used tissues in a lined trash can.
• Wash hands: Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol.

Clean your hands often

• Wash hands: Wash your hands often with soap and water for at least 20 seconds. This is especially important after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.
• Hand sanitizer: If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry.
• Soap and water: Soap and water are the best option, especially if hands are visibly dirty.
• Avoid touching: Avoid touching your eyes, nose, and mouth with unwashed hands.

Handwashing tips

Avoid sharing personal household items

• Do not share: Do not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people in your home.
• Wash thoroughly after use: After using these items, wash them thoroughly with soap and water or put in the dishwasher.

Clean all “high-touch” surfaces everyday

Clean high-touch surfaces in your isolation area (“sick room” and bathroom) every day; let a caregiver clean and disinfect high-touch surfaces in other areas of the home.

• Clean and disinfect: Routinely clean high-touch surfaces in your “sick room” and bathroom. Let someone else clean and disinfect surfaces in common areas, but not your bedroom and bathroom.
  • If a caregiver or other person needs to clean and disinfect a sick person’s bedroom or bathroom, they should do so on an as-needed basis. The caregiver/other person should wear a mask and wait as long as possible after the sick person has used the bathroom.

High-touch surfaces include phones, remote controls, counters, tabletops, doorknobs, bathroom fixtures, toilets, keyboards, tablets, and bedside tables.

• Clean and disinfect areas that may have blood, stool, or body fluids on them.

• Household cleaners and disinfectants: Clean the area or item with soap and water or another detergent if it is dirty. Then, use a household disinfectant.

• • Be sure to follow the instructions on the label to ensure safe and effective use of the product. Many products recommend keeping the surface wet for several minutes to ensure germs are killed. Many also recommend precautions such as wearing gloves and making sure you have good ventilation during use of the product.
  • Most EPA-registered household disinfectants should be effective. A full list of disinfectants can be found hereexternal icon.

Complete disinfection guidance

Monitor your symptoms

• Seek medical attention, but call first: Seek medical care right away if your illness is worsening (for example, if you have difficulty breathing).
  • Call your doctor before going in: Before going to the doctor’s office or emergency room, call ahead and tell them your symptoms. They will tell you what to do.
• Wear a facemask: If possible, put on a facemask before you enter the building. If you can’t put on a facemask, try to keep a safe distance from other people (at least 6 feet away). This will help protect the people in the office or waiting room.
• Follow care instructions from your healthcare provider and local health department: Your local health authorities will give instructions on checking your symptoms and reporting information.

alert icon

Call 911 if you have a medical emergency: If you have a medical emergency and need to call 911, notify the operator that you have or think you might have, COVID-19. If possible, put on a facemask before medical help arrives.

How to discontinue home isolation

• People with COVID-19 who have stayed home (home isolated) can stop home isolation under the following conditions:
  • If you will not have a test to determine if you are still contagious, you can leave home after these three things have happened:

• • • You have had no fever for at least 72 hours (that is three full days of no fever without the use medicine that reduces fevers)
      AND
    • other symptoms have improved (for example, when your cough or shortness of breath have improved)
      AND
    • at least 7 days have passed since your symptoms first appeared
  • If you will be tested to determine if you are still contagious, you can leave home after these three things have happened:
    • You no longer have a fever (without the use medicine that reduces fevers)
      AND
    • other symptoms have improved (for example, when your cough or shortness of breath have improved)
      AND
      you received two negative tests in a row, 24 hours apart. Your doctor will follow CDC guidelines.

There is much to learn about the novel coronavirus that causes coronavirus disease 2019 (COVID-19). Based on what is currently known about the novel coronavirus and similar coronaviruses that cause SARS and MERS, spread from person-to-person with these viruses happens most frequently among close contacts (within about 6 feet). This type of transmission occurs via respiratory droplets. On the other hand, transmission of novel coronavirus to persons from surfaces contaminated with the virus has not been documented. Transmission of coronavirus occurs much more commonly through respiratory droplets than through fomites. Current evidence suggests that novel coronavirus may remain viable for hours to days on surfaces made from a variety of materials. Cleaning of visibly dirty surfaces followed by disinfection is a best practice measure for prevention of COVID-19 and other viral respiratory illnesses in households and community settings.

Purpose

This guidance provides recommendations on the cleaning and disinfection of households where persons under investigation (PUI) or those with confirmed COVID-19 reside or may be in self-isolation. It is aimed at limiting the survival of the virus in the environments. These recommendations will be updated if additional information becomes available.

These guidelines are focused on household settings and are meant for the general public.

• Cleaning refers to the removal of germs, dirt, and impurities from surfaces. Cleaning does not kill germs, but by removing them, it lowers their numbers and the risk of spreading infection.
• Disinfecting refers to using chemicals to kill germs on surfaces. This process does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.

General Recommendations for Routine Cleaning and Disinfection of Households

Community members can practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks) with household cleaners and EPA-registered disinfectants that are appropriate for the surface, following label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.

General Recommendations for Cleaning and Disinfection of Households with People Isolated in Home Care (e.g. Suspected/Confirmed to have COVID-19)

• Household members should educate themselves about COVID-19 symptoms and preventing the spread of COVID-19 in homes.
• Clean and disinfect high-touch surfaces daily in household common areas (e.g. tables, hard-backed chairs, doorknobs, light switches, remotes, handles, desks, toilets, sinks)
  • In the bedroom/bathroom dedicated for an ill person: consider reducing cleaning frequency to as-needed (e.g., soiled items and surfaces) to avoid unnecessary contact with the ill person.
    • As much as possible, an ill person should stay in a specific room and away from other people in their home, following home care guidance.
    • The caregiver can provide personal cleaning supplies for an ill person’s room and bathroom, unless the room is occupied by child or another person for whom such supplies would not be appropriate. These supplies include tissues, paper towels, cleaners and EPA-registered disinfectants (examples at this linkpdf iconexternal icon).
    • If a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person. If this is not possible, the caregiver should wait as long as practical after use by an ill person to clean and disinfect the high-touch surfaces.
• Household members should follow home care guidance when interacting with persons with suspected/confirmed COVID-19 and their isolation rooms/bathrooms.

How to clean and disinfect:

Surfaces

• Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning. If reusable gloves are used, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes. Consult the manufacturer’s instructions for cleaning and disinfection products used. Clean hands immediately after gloves are removed.
• If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
• For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common EPA-registered household disinfectants should be effective.
  • Diluted household bleach solutions can be used if appropriate for the surface. Follow manufacturer’s instructions for application and proper ventilation. Check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted.
    • Prepare a bleach solution by mixing:
      • 5 tablespoons (1/3rd cup) bleach per gallon of water or
      • 4 teaspoons bleach per quart of water
  • Products with EPA-approved emerging viral pathogens claimspdf iconexternal icon are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).
• For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces. After cleaning:
  • Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely, or
    Use products with the EPA-approved emerging viral pathogens claims (examples at this linkpdf iconexternal icon) that are suitable for porous surfaces.

Clothing, towels, linens and other items that go in the laundry

• Wear disposable gloves when handling dirty laundry from an ill person and then discard after each use. If using reusable gloves, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other household purposes. Clean hands immediately after gloves are removed.
  • If no gloves are used when handling dirty laundry, be sure to wash hands afterwards.
  • If possible, do not shake dirty laundry. This will minimize the possibility of dispersing virus through the air.
  • Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry from an ill person can be washed with other people’s items.
  • Clean and disinfect clothes hampers according to guidance above for surfaces. If possible, consider placing a bag liner that is either disposable (can be thrown away) or can be laundered.

Hand hygiene and other preventive measures

• Household members should clean hands often, including immediately after removing gloves and after contact with an ill person, by washing hands with soap and water for 20 seconds. If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains at least 60% alcohol may be used. However, if hands are visibly dirty, always wash hands with soap and water.
• Household members should follow normal preventive actions while at work and home including recommended hand hygiene and avoiding touching eyes, nose, or mouth with unwashed hands.
  • Additional key times to clean hands include:
    • After blowing one’s nose, coughing, or sneezing
    • After using the restroom
    • Before eating or preparing food
    • After contact with animals or pets
    • Before and after providing routine care for another person who needs assistance (e.g. a child)

Other considerations

• The ill person should eat/be fed in their room if possible. Non-disposable food service items used should be handled with gloves and washed with hot water or in a dishwasher. Clean hands after handling used food service items.
• If possible, dedicate a lined trash can for the ill person. Use gloves when removing garbage bags, handling, and disposing of trash. Wash hands after handling or disposing of trash.
• Consider consulting with your local health department about trash disposal guidance if available.