Recomendaciones en tiempos de COVID-19: una mirada a la atención domiciliaria

Estudio reflexivo, producido a partir de lecturas relacionadas con el área temática, disponibles en directrices actuales de la Organización Panamericana de la Salud, Organización Mundial de la Salud y Ministerio de la Salud.

Resultados:

Han sido construidas recomendaciones a partir de evidencias científicas actuales para prevención de infecciones, control de epidemias y pandemias en el contexto domiciliario brasileño.

Conclusiones:

Las reflexiones realizadas contribuyen para orientar acciones con vistas a una mejor asistencia al paciente, familiares cuidadores y comunidad en la perspectiva de una atención domiciliaria segura en relación a la COVID-19; se caracterizan como una discusión inicial sobre el tema, estimulando que nuevos estudios sean realizados a partir de la evolución del escenario actual.

Descriptores:
Virus del SARS; Pacientes Domiciliares; Enfermería Domiciliar; Servicios de Asistencia Domiciliaria; Asistencia a la Salud

Recommendations for the patients^* * If the patient is unable to perform the tasks mentioned above, assistance from a family caregiver is necessary.

- Stay alone in a well-ventilated room (that is, with open windows and an open door).
- Avoid sharing spaces, if necessary, do this at separate times from other residents of the house.
- Do not take in visitors until your complete recovery and the signs or symptoms of COVID-19 disappear.
- Wash hands frequently and also before eating, after using the bathroom and whenever your hands look dirty, using soap and water. If your hands are not visibly dirty, you can rub them with 70% alcohol hand sanitizer.
- Use disposable paper towels to dry your hands after washing them with soap and water. If they are not available, use clean cloth towels and replace them frequently.
- Use a surgical mask to hold back respiratory secretions⁽⁷7 World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance, 13 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 17]. Available from: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
https://www.who.int/publications-detail/... ⁾ and you should change it whenever it is wet, avoiding handling it.
- Perform severe nose/nostrils hygiene when you do not tolerate a surgical mask, that is, cover your mouth and nose with a disposable tissue when coughing or sneezing, then discarding them and washing your hands. If you use cloth tissues, wash them with soap and water.
- Clean and sanitize surfaces that are frequently touched such as bedside tables, bed frames and other bedroom and bathroom furniture daily, when in private use. First, use common soap or detergent and, after rinsing, apply a common disinfectant containing 0.1% sodium hypochlorite (for example, equivalent to 1000 ppm)⁽³3 World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
https://www.who.int/publications-detail/... ⁾.
- Keep a covered trash can in the room with a plastic bag on top of it.
- Place contaminated clothing in a laundry bag⁽³3 World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
https://www.who.int/publications-detail/... ⁾.
- Stay away from vulnerable people, the elderly and immunosuppressed people.
- Pay attention to the symptoms and if you feel a worsening request a reassessment.

Recommendations for family caregivers

- Minimize sharing spaces. Family members must stay in a different room or, if this is not possible, keep a distance of at least 1 meter from the sick person (for example, sleeping in a separate bed)⁽⁶6 World Health Organization. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care [Internet]. Geneva: World Health Organization; 2014 [cited 2020 Jan 26]. Available from: https://www.who.int/csr/bioriskreduction/infection_control/publication/en/
https://www.who.int/csr/bioriskreduction... ⁾.
- Keep sharing spaces (for example, kitchen, bathroom) well ventilated (with windows open).
- Reduce the number of caregivers. Preferably, designate a person who is in good health and who does not have chronic conditions or is immunocompromised⁽⁶6 World Health Organization. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care [Internet]. Geneva: World Health Organization; 2014 [cited 2020 Jan 26]. Available from: https://www.who.int/csr/bioriskreduction/infection_control/publication/en/
https://www.who.int/csr/bioriskreduction... ⁾.
- Wash hands after any type of contact with patients or their close environment⁽⁷7 World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance, 13 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 17]. Available from: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
https://www.who.int/publications-detail/... ⁾, and also before and after preparing food, before eating, after using the bathroom and whenever your hands look dirty, using soap and water. If hands are not visibly dirty, 70% alcohol-based rubbing can be used.
- Use disposable paper towels to dry your hands after washing them with soap and water. If they are not available, use clean cloth towels and replace them frequently.
- Clean and sanitize the bathroom surfaces at least once a day. First, use common soap or detergent and, after rinsing, apply a common disinfectant containing a 0.1% sodium hypochlorite (for example equivalent to 1000 ppm)⁽³3 World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
https://www.who.int/publications-detail/... ⁾.
- Utensils used by the patient must be washed with water and common detergent after use, and they can be reused (preferably by the patient) instead of being discarded⁽³3 World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
https://www.who.int/publications-detail/... ⁾.
- Wash beddings in the machine/tank with regular washing powder, hot water, between 60-90º C (140-194º F) and dry them thoroughly⁽³3 World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
https://www.who.int/publications-detail/... ⁾.
- Do not shake dirty clothing and prevent contact of contaminated materials with the skin and clothing you are using⁽³3 World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
https://www.who.int/publications-detail/... ⁾.
- Protective gloves and clothing (for example, plastic aprons) should be used when cleaning surfaces or when handling clothes or sheets soiled with body fluids⁽³3 World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
https://www.who.int/publications-detail/... ⁾.
- Depending on the context, rubber (reusable) or disposable gloves can be used. After use, rubber gloves should be cleaned with soap and water and decontaminated with 0.1% sodium hypochlorite solution. Disposable gloves must be discarded after each use.
- Wash hands before putting on and after removing gloves⁽³3 World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
https://www.who.int/publications-detail/... ⁾.
- Avoid other types of exposure to contaminated items in the patient's close environment (for example, do not share toothbrushes, cigarettes, kitchen utensils, plates, drinks, towels, clothes or bedding).
- Gloves, masks and other waste generated during home care should be placed in a trash can with a lid in the patient's room before disposing of it as infectious waste⁽⁸8 World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge [Internet]. Geneva: World Health Organization; 2009[cited 2020 Jan 20]. Available from: https://www.who.int/gpsc/5may/tools/who_guidelines-handhygiene_summary.pdf
https://www.who.int/gpsc/5may/tools/who_... ⁾.
- Disposal of infectious waste must be provided for and provided by the local health authorities (specialized staff)⁽³3 World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
https://www.who.int/publications-detail/... ⁾.
- In places where there is no specialized team, identification of the contaminated material should be done for the management of the selective collection team.

Recommendations for Nurses in home care

- Wear a surgical mask that covers your mouth and nose when you are in the same room as the patient. Masks must not be touched or handled during use⁽³3 World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
https://www.who.int/publications-detail/... ⁾.
- Replace the mask immediately if it gets wet or dirty⁽³3 World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
https://www.who.int/publications-detail/... ⁾.
- Remove the mask using the appropriate technique - that is, do not touch the front, but untie it.
- Discard the mask immediately after use and wash hands.
- Wear gloves and a disposable N95 mask when providing mouth or respiratory care and handling feces, urine and other waste.
- Wash hands before and after removing gloves and masks.
- Do not reuse masks or gloves.
- Disposal of materials must be provided for and provided by the local health authorities (specialized staff)⁽⁸8 World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge [Internet]. Geneva: World Health Organization; 2009[cited 2020 Jan 20]. Available from: https://www.who.int/gpsc/5may/tools/who_guidelines-handhygiene_summary.pdf
https://www.who.int/gpsc/5may/tools/who_... ⁾.
- In places where there is no specialized team, identification of the contaminated material should be done for the management of the selective collection team.
- Perform, when indicated and possible, the collection of diagnostic tests before releasing patients from home isolation.
- Establish communication with the patient and family caregiver during the observation period.
- Supervise the health of others living in the same house by calling them regularly, but best and if possible, through daily home visits, so that specific diagnostic tests can be performed as needed⁽⁹9 World Health Organization. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance, 31 January 2020 [Internet]. Geneva: World Health Organization; 2020[cited 2020 Mar 17]. Available from: https://apps.who.int/iris/handle/10665/330857
https://apps.who.int/iris/handle/10665/3... ⁾.
- Keep an eye on compliance with home isolation by the patient and others living in the same house, clarifying them about the importance of this measure.
- Give psychological support to the patient and family members and call on psychology professionals when necessary.
- Informthe people living in the same house in advance about when and where to seek care, if they become ill, the most appropriate transport to use, when and where to go for the designated health facility and what precautions should be followed⁽⁹9 World Health Organization. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance, 31 January 2020 [Internet]. Geneva: World Health Organization; 2020[cited 2020 Mar 17]. Available from: https://apps.who.int/iris/handle/10665/330857
https://apps.who.int/iris/handle/10665/3... ⁾.
- Inform the patient and family about possible signs of worsening of the clinical condition and conduct to be followed.
- Record all information in the patient's medical record, remembering that paper records should be avoided and electronic devices used for registration purposes and should be disinfected after use.

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Luana Tonin E-mail: luanatonin@gmail.com