IMASA GUIDELINES FOR DELIVERY AND USE OF MEDICAL EQUIPMENT AT HOME FOR PATIENTS WITH COVID19

20 June 2020

As the COVID19 epidemic takes hold in South Africa, it is likely that hospitals and other clinical facilities will be under severe strain. This will mean that many people in need of care for both COVID19 and other conditions may be forced to continue care at home. Organizations that supply equipment to communities for home-based use will need to take special care when delivering or retrieving equipment. This is because it is usually needed to set up or educate families on the use of this equipment at home. It involves members of these organizations entering households which may be contaminated with COVID19. This means that these volunteers and staff where applicable will need to be equipped for this.

POTENTIAL EQUIPMENT NEEDED:

  1. Oxygen Concentrators
  2. Bipap / Cpap machines
  3. Pulse Oximeters
  4. Hospital Beds
  5. Wheelchairs
  6. Commodes
  7. Ripple Mattresses
  8. Drip Stands
    Some equipment like wheelchairs, pulse oximeters and commodes are easy to use. They can be delivered or picked up without direct contact with an infected person or environment.

Where equipment must be delivered the following should apply. It is preferable at this time to treat cases as COVID19 unless proven otherwise.

  1. Deliveries should preferably be done by people under 50 years of age with no high-risk comorbidities like hypertension, diabetes mellitus, obesity or chronic lung, liver, heart or kidney disease. People who are on medicines which suppress their immune systems should also not
    do deliveries.
  2. The room where the equipment is needed should be prepared beforehand by the family. This includes
    a. Wiping down all surfaces, door handles, etc and cleaning of the floor with a bleach based cleaner or other effective disinfectant.
    b. Ventilating the delivery area well for 3-4 hours prior to delivery preferably with the patient in another area.
    c. Family members who are self-isolating should not be in contact with staff / volunteers unless the staff / volunteers have full Personal Protection Equipment [PPE].
  3. When entering the area of delivery, the patient should be in another room if possible. If the patient is in another closed room and the preceding cleaning was done the staff / volunteers will only need to wear a facemask, visor and gloves to demonstrate the use of the equipment.
    Family members should remain 1,5 – 2m away at all times and should have a mask.
  4. Where it is not possible for the patient to be in another room and / or there needs to be contact with the patient then full contact precautions and Personal Protection Equipment [PPE] are necessary. Only one individual should do this where possible to save resources and minimize risk. Minimum requirements are: a. A scrub suit or other clothing which can be washed easily afterwards should be worn. b. A N95 or similar medical, respirator mask c. A visor or equivalent for eye protection d. A hair covering and if possible, a neck covering. e. Shoe coverings. f. A surgical, non-porous gown g. Gloves
  1. Members will need training for adequate donning and doffing procedures for Personal Protection Equipment [PPE].
  2. Contact time should be minimized, especially time in the patient’s room. If possible, family members can be educated by telephonic or other online means on equipment use.
  3. Medical treatments should be prescribed and overseen by an appropriate professional.

RETRIEVAL OF EQUIPMENT

  1. The family should deep clean all equipment thoroughly prior to collection. This includes cleaning any visible dirt and using a disinfectant solution to wipe all surfaces. If possible, the equipment can be stored in a clean area after use for 4-5 days before collection. This will decrease the possibility of live virus being present but may not be practical if demand is high.
  2. Disposable parts should not be reused.
  3. Linen should not be included.
  4. The equipment should be cleaned again after retrieval by wiping down all surfaces with appropriate disinfectant. A surgical mask, gloves and apron should be used. Avoid using pressure cleaners or spray generating equipment to clean.
  5. Take care to wash all surfaces including mattresses.

PPE DONNING
General recommendations:

  1. Remove personal clothing and items / jewellery in the car. Remember to leave your cell phone in the car.
  2. You can don at a clean place and then drive to the house.
  3. Place the car keys outside of the house in a safe area. Take three bin packets with you.
  4. Place the bin packets outside of the house where you will doff off. Open the bin packets and place it down.
  5. Place a sanitizer on the side of the packets.

ONCE PPE ON:

  1. Do not touch face.
  2. Always work from clean to dirty.
  3. Limit the number of surfaces that you touch.
  4. Change PPE if torn or contaminated heavily
    (https://www.infectioncontroltoday.com/personal-protective equipment/donning-and-removing-ppe-infection-prevention; cited 29 March 2020)

SEQUENCE OF DONNING

  1. Put on boot covers: Sit on the chair and put it on.
  2. Put on inner gloves. Don as normal.
  3. Put on the gown. Take time and put gown on slowly. Let the second person check for any tears or holes.
  4. Put on n95 respirator. Always hold the duck shaped respirator on the straps. Open the mask by putting the top straps in both index fingers and the bottom straps in thumbs. Put the n95 over putting the bottom strap at the occiput and the top straps at the crown. Press the mask against the bridge of the nose to ensure it is fitted. Check your mask by blowing in, it is appropriate if the mask falls in. Blow out and assess if any air leak. It should blow out with no air leak.
  5. Put the head cover over your head.
  6. Put a neck cover around your neck.
  7. Put on your visor over the head.
  8. Put on an outer apron.
  9. Put on your second pair of gloves (use the appropriate size surgical gloves). Ensure gloves are fitted snuggly over the sleeves of the gloves. Verify Ensure no holes and mask is correct. This should be checked by the second person.

PPE DOFFING
Before doffing off, tell the family that Packet one can be discarded after 4 days. Doff the PPE outside the house. There will be 3 packets outside the house

  1. Remove the first pair of gloves from inside out and slowly into the bin so as not to spread the droplets. Packet 1
  2. Spray hands with sanitizer.
  3. Remove your boots inside out and only handle the inside. Packet 1
  4. Spray hands with sanitizer.
  5. Break the outside apron by pulling at the shoulder part of the apron and roll it only touching the inside. Packet 1
  6. Spray hands with sanitizer.
  7. Give yourself a hug at the shoulders and tear the disposable gown off and roll it over only touching the inside. Packet 1
  8. Spray hands with sanitizer.
  9. Remove the shield. Remember the front is contaminated therefore you should handle it at the straps only and discard slowly. Packet 2 (If this is not disposable)
  10. Wash the gloves with alcohol.
  11. Then remove mask. Remember outside of the mask is contaminated and should be only handled at the straps. Hold the straps and remove over the face and hold away from face and discard in the bin which is in the doffing area.
  12. If you have the disposable masks it should be disposed of in Packet 1.
  13. If you have the 3M reusable mask, then place it in packet 2.
  14. Wash hands with sanitizer.
  15. Remove head cover slowly and discard into the Packet 1.
  16. Wash gloves with sanitizer.
  17. Remove the other gloves handling only the inside of the gloves and discard into packet 1.
  18. Wash the hands with sanitizer up to and including the elbows.
  19. Tie packet 2.
  20. Wash hands with sanitizer.
  21. Place packet 2 into packet 3.
  22. Wash hands with sanitizer up to and including the elbows.
  23. If at any time, you feel contamination then keep on washing your gloves with sanitiser.
  24. Packet 2 and 3 which contains your disposable visor and mask should be kept in a place outside of your house for 4 days. After 4 days you can open the packets and put the visor and mask in Jik and water or an alcohol-based sanitiser and thereafter wash it.

There is a need to recruit younger people to assist as well as to raise funds for appropriate Personal Protection Equipment [PPE]. This is similar to the issues we are encountering with burial societies etc.
It also creates the opportunity to capacitate a new generation of much needed community workers.


Compiled by:
Islamic Medical Association of South Africa
COVID19 Working Committee

Join Islamic Medical Association Today! Join
Copyright © 2019 IMA South Africa | All Rights Reserved