Urgent advice- protocols for carers visiting Covid positive homes

[SLAW70s]

Urgent advice please from HCP with knowledge of health care protocols.

DD is carer but only 18 and worried about safe practices.

Saw Covid positive client today.

The agency expect her to visit uninfected clients later today on her rounds.

I’ve told her to come home. Obviously.

Advice please on what correct protocols should be regarding visiting different homes on a round.

I really need advice from those in this sector with knowledge of relevant legislation.

Thanks

Actual advice rather than outrage please x

Did she receive any training about Covid, was she given PPE.

Didn’t know they had it until inside the house.

Ppe put on hurriedly after 1-2 mins

I’m not sure about training tbh

Dd had confirmed Covid in early October so hopefully lowish risk now.

Had mask on anyway before other PPE put on

I'm not a carer but sen teacher so similar.
Doesn't matter if she's had it, she's been in contact with a positive. She needs to isolate now for 2 weeks. No questions. She obviously cannot see anyone else.

www.gov.uk/government/publications/coronavirus-covid-19-providing-home-care/coronavirus-covid-19-provision-of-home-care

But it if in full PPE do HCPs have to
isolate?? My DB says not. He treats people therapeutically (in PPE ) and it’s not counted as close contact if a client tests positive, apparently due to PPE

I think she can carry on as long as she is in full PPE

She's been badly let down by her employers. She should have had training and had PPE in her car, so she could change, bag up her phone and ID before going in. Then very strict protocol for after she leaves of how to bag up apron and mask and clean everything possible.

@SLAW70s

But it if in full PPE do HCPs have to isolate?? My DB says not. He treats people therapeutically (in PPE ) and it’s not counted as close contact if a client tests positive, apparently due to PPE

I don't know for care, but we carry out full personal care for our students and medical procedures... We wear ppe for them - if someone had covid we would have to isolate.

I would have thought every staff member needs to act as if every client is potentially positive, receive training, have full PPE on before they enter someones house. Have you been in touch with the agency to ask for a copy of their protocol.

Was the agency aware in advance of the covid + status? If so this should have been communicated to all carers in attendance before they visit so that correct ppe protocols can be taken before entry. If unaware then upon notification they should have told your dd to self isolate due to not entering with correct ppe to enable her to continue.

Either way, after entering without correct ppe, 10 days self isolation is required.

It is normal for non covid clients to be seen on the same day as covid + ones, in just the same way as someone with flu, TB, etc. It just requires the proper precautions to be taken prior to entry.

Hi Op; so sorry but link won’t copy on my phone. However, there is info on www.gov.uk which advises on policy around home care providers and COVID. Just looked now; not sure if it gives the exact advice you’re looking for but seems to suggest Test and Trace and the CQC would be involved. Search under Corona-virus; provision of Homecare and you’ll get this info.
Long time since I worked as a frontline nurse so can’t give you more practical advice. Seems that at the very least your daughter should now be exercising caution around the extremely vulnerable and I do wonder if Test and Trace would just advise to isolate now?
Sorry; not sure that helps.

She was in full PpE after the first minute.

She plans to come home wash, change antibac and everything.

@OpheliasCrayon it’s 10 days not 2 weeks.

This is a mine field.

Thanks everyone.

My thinking is that just for today, the risk is of crossed contamination only. Hence washing, changing etc.

After today the risk will be due to possibly incubating virus. So the question is does she isolate as she was exposed for 2 minutes before knowing about Covid+ cases?

She’s already complained to her supervisor about not being told and not having the PPE available before entering the house.

I will look at the link. Thanks.

It’s all very well about involving CQC and asking for their protocols but dd is only 18. It’s quite an ask to expect her to be a whistleblower. I agree that those issues are extremely important, of course but I just need to focus on immediate next steps for her as she’s under huge pressure to cover shifts for sick colleagues etc

I think test and trace may be our next port of call.

I can tell you ambulance service policy if it helps at all.
We assume everyone potentially has covid.
Don level 2 ppe before entering a property.
Level 2 is surgical paper mask, plastic apron and gloves.
Level 2 is worn for every case, also worn for confirmed covid positive patients.
We upgrade to level 3 ppe (powered hood and tyvek suit) only if Aerosol Generating Procedures are being performed (eg. Cardiac arrest, ventilated patients, cpap, trachy patients) this is witn regardless if the patient is confirmed positive or not.

Obviously we regularly go from covid positive patients to non covid but vulnerable patients.
We doff (remove) ppe on leaving the property.
All equipment is wiped down thoroughly, including all touch points.
We do not change or wash uniforms between cases.
The only time the ambulances are covid cleaned (almost a bleach bomb if you like) are when AGPs have been performed on board. Obviously they are also cleaned end of shift.
Fresh ppe is worn for the next case.

So you're saying she had a surgical mask on? So she put her apron and gloves on whilst already in the property for 1 min? Had she actually touched the patient before putting these on?
Why had she not already put her full ppe on before entering? Has she not been given appropriate training?

I would in future advise her to treat everyone as potentially having covid and therefore donning ppe before entering.

She doesn’t need to self isolate but she should be putting full PPE on before she enters every property - not just people with confirmed Covid.

If she had a mask on she won’t be told to self isolate by test and trace.

Also your db is correct in that as long as a hcp or carer has had the correct level of ppe on whilst providing treatment or care services, they do not need to isolate after contact with a positive case.

If hcps had to isolate after contact with a positive case whilst wearing ppe then there would literally not be a nhs at present. I would say every member of frontline ambulance and a&e staff have had physical contact with a positive case at this point.

Thank you so much everyone. This advice has been incredibly helpful.

Also, good to have HCP perspective and actually a bit of a reality check about the likelihood of front line HCPs treating Covid and non Covid patients on the same shift.