Isolation Precautions: Quarantine (Home Health Care) - CE - INACTIVE

ALERT

For face-to-face education, don appropriate personal protective equipment (PPE) based on the patient’s exposure to an airborne- or droplet-transmitted infectious illness.

Use remote or distance education options to provide quarantine information whenever possible.

OVERVIEW

Quarantine and isolation measures may be implemented for a person or persons to practice community safety measures and to prevent the widespread transmission of an infectious illness. Quarantine is the separation of a person or group of persons who may have been exposed to an infectious illness and may or may not have been infected. Isolation in the home refers to the separation of a person or group of persons who have been infected with a transmissible illness, even if no signs or symptoms develop.

Self-quarantine and self-isolation are part of the social distancing requirements issued by the Centers for Disease Control and Prevention (CDC) to limit the spread of infectious illness.^{undefined#ref3">3} Quarantine and isolation time periods can be voluntary or enforced and usually equal the length of the incubation period for the infectious illness (e.g., coronavirus, measles, tuberculosis). The date of the exposure is considered day 0 since exposure to the infected person.³ Day 1 is the first full day after the last contact with the infected person.³

According to the CDC, if a person has been in close contact (e.g., within 1 to 1.8 m [3 to 6 ft]² for a cumulative total of 15 minutes or more over a 24-hour period) with someone who has been diagnosed with an infectious illness, a quarantine is warranted unless the exposed person is fully vaccinated.³ If the exposed person is fully vaccinated against the infectious illness and symptoms develop, the CDC’s guidelines for quarantine should be followed. The CDC suggests getting tested for certain infectious illnesses after exposure (e.g., coronavirus disease 2019 [COVID-19]) even if fully vaccinated against the illness.³

SUPPLIES

See Supplies tab at the top of the page.

EDUCATION

• Provide education to the patient and family remotely, if available, to limit the risk of exposure.
• Provide developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, and overall neurologic and psychosocial state.
• Educate the patient and family about the modes of infection transmission.
• Provide the patient and family information on the signs and symptoms of the infection to which they were exposed.
• Ensure that the patient and family can identify the ways that airborne or droplet transmission occurs.
• Encourage questions and answer them as they arise.

STRATEGIES

1. If providing face-to-face education, perform hand hygiene and don PPE as indicated by the patient’s signs and symptoms and suspected or known diagnosis.
2. Introduce yourself to the patient and family.
3. Verify the correct patient or patients using two identifiers.
4. Explain the procedure to the patient and family and ensure that they agree to strategies for infection prevention.
5. Screen the patient and family for potential exposure to transmissible infectious illnesses.

Strategies for Quarantine

1. Explain to the patient and family the methods of infection prevention.
   1. Perform hand hygiene often.
      1. Perform hand hygiene often with soap and water for at least 20 seconds² or use an alcohol-based hand rub (ABHR).
      2. Use soap and water if the hands are visibly soiled.
      3. Avoid touching the eyes, nose, and mouth with unwashed hands.
   2. Stay 1 to 1.8 m [3 to 6 ft]² away from others.
      1. Practice social distancing (e.g., provide 1 to 1.8 m [3 to 6 ft]² of physical space between self and others).
      2. Prohibit visitors to the home.
      3. If emergency services are required, inform the dispatcher that the patient is in quarantine or is infected with an airborne-transmitted infectious illness.
      4. Ensure that the patient stays in another room or away from other family members.
      5. Minimize trips into and out of the patient’s room for care.
      6. Avoid sharing items, such as dishes, cups, eating utensils, towels, bed linens, and clothing.
      7. Ensure that shared spaces have good ventilation (e.g., air conditioners, fans, open windows [if weather permits]).
      8. Ensure that the patient does not handle animals or pets while sick.
   3. Wear a mask indoors and in public.
      1. Ensure that the patient wears a disposable mask when around others.
      2. Wear a mask with the best fit, protection, and comfort for individual use.
      3. Ensure that family members wear disposable masks when caring for a patient with an infectious illness.
      4. Talk to the practitioner about additional precautions that may be necessary for persons who have a condition or take medications that weaken the immune system. These individuals may not be fully protected, even if up to date on vaccinations.
   4. Clean and disinfect.¹
      1. Keep a separate bedroom and bathroom for the patient (if possible).
      2. Provide dedicated cleaning and disinfecting supplies to the patient.
      3. Educate the patient in shared spaces to clean and disinfect surfaces and items after each use.
      4. If the patient cannot clean, use a protective mask and ask the patient to put on a mask before entering the room to be cleaned. Clean only when the area is soiled to limit contact with the patient.
      5. Use an Environmental Protection Agency (EPA)-registered disinfectant per the label instructions for use for cleaning and disinfection. If an EPA-registered disinfectant is not available, bleach solutions can be used if appropriate for the surface.
      6. Wear PPE, such as gloves, goggles, or glasses, per the label instructions for use.
      7. If someone in the household is ill or more likely to become ill from an infectious illness, clean all high-touch surfaces (e.g., counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, remote controls) every day.
      8. Open doors and windows and use heating, ventilation, and air conditioning (HVAC) settings to increase air circulation.
      9. Clean and disinfect different types of surfaces appropriately.
         1. Disinfect soft surfaces using an EPA-registered product.
         2. Launder items (if possible) using the warmest appropriate water setting and dry items completely.
         3. If handling dirty laundry from a patient, wear gloves and a mask. Perform hand hygiene after handling dirty laundry.
         4. Clean clothes hampers or laundry baskets according to guidance for surfaces.
         5. Follow the manufacturer’s instructions for cleaning electronic devices.
   5. Handle trash appropriately.
      1. Use a dedicated, lined trash can for a patient with an infectious illness.
      2. Use gloves when removing garbage bags and handling and disposing of trash.
      3. Perform hand hygiene immediately after disposing of waste into the container or disposing of the bag.
2. Educate the patient and family about the need to create a household plan for quarantine.
   1. Prepare for essential needed supplies for the quarantine period (e.g., groceries, medications, cleaning supplies, durable or disposable medical equipment or supplies).
   2. Prepare for necessary communication for the quarantine period (e.g., ensure telephone and internet are functioning, inform social circle of quarantine).
   3. Prepare for absence from work or school (e.g., work- or learn-from-home options).
   4. Arrange for transportation to daycare or school for dependent children or older adults (as applicable).
   5. Prepare for psychological adaptation to social isolation and loss of the ability to perform usual activities and rituals (e.g., church, social clubs, shopping).
   6. Plan to exercise or get fresh air during times or at places where coming into contact with other people is unlikely (to prevent further possibility of exposure) and to ensure social distancing of 1 to 1.8 m (3 to 6 ft).^2,3

Strategies for In-home Isolation

1. Designate a room for the patient for isolation.
2. Obtain PPE that is appropriate for the type of isolation used for a patient who has or is suspected of having an infectious illness (e.g., contact, droplet, airborne isolation infection precautions).
3. Explain the purpose of the isolation to the patient and family and any isolation infection precautions that the family should take when entering a room used for isolation and when used to separate an infected person from others in the home.
4. Demonstrate to the family how to don the appropriate PPE.
5. Demonstrate how to don a disposable mask and how to adjust the mask for a secure and comfortable fit.
   1. Ensure that the mask covers the nose and mouth.
   2. Adjust the metal nosepiece for comfort and fit.
   3. Ensure that the bottom of the mask extends to cover the chin.
6. Inspect PPE before donning. Ensure that the PPE is intact, that all required PPE and supplies are available, and that the correct size has been selected.
7. Once the family has donned PPE, instruct the family in additional protective measures.
   1. Keep hands away from the face. If the mask becomes displaced, leave the designated room and doff PPE, perform hand hygiene, and don new PPE instead of touching the face to adjust the mask.
   2. Limit touching surfaces and other patient care items in the room.
   3. Remove gloves when torn or heavily contaminated, perform hand hygiene, and don clean gloves.
8. Explain and demonstrate to the family how to doff the PPE in the correct order and dispose of it appropriately.¹
   1. Remove gloves; avoid touching the outside surface of the gloves.
   2. Dispose of the used gloves.
   3. Perform hand hygiene.
   4. Remove the face mask.
   5. Perform hand hygiene again.
9. Explain the proper disposal of used PPE and supplies (e.g., double bagging, using caution not to touch waste while closing the bag).
10. Ensure that the family members know that after providing patient care, they should leave the dedicated isolation room and close the door.
11. Document the procedure in the patient’s record.

EXPECTED OUTCOMES

• Patient and family are able to demonstrate understanding of in-home quarantine and in-home isolation and cooperate with specific isolation infection precautions.
• Family demonstrates correct use of PPE.
• Family is free from transmissible infectious illness.

UNEXPECTED OUTCOMES

• Patient and family are unable to demonstrate understanding of in-home quarantine and in-home isolation or do not cooperate with specific isolation infection precautions.
• Family cannot demonstrate correct use of PPE.
• Family shows signs of transmissible infectious illness.

DOCUMENTATION

• Education
• Procedures performed (as applicable)
• Patient’s response to social isolation
• Evidence or suspected breach of specific isolation infection precautions
• Unexpected outcomes and related interventions
• Patient’s progress toward goals

OLDER ADULT CONSIDERATIONS

• Isolation or quarantine can be a particular concern for older adults, especially those who have signs and symptoms of confusion or depression.

REFERENCES

1. Centers for Disease Control and Prevention (CDC). (2021). COVID-19: Clean and disinfect at home. Retrieved October 13, 2022, from https://www.cdc.gov/coronavirus/2019-ncov/easy-to-read/prevent-getting-sick/disinfecting-your-home.html (Level VII)
2. Centers for Disease Control and Prevention (CDC). (2022). COVID-19: How to protect yourself and others. Retrieved October 13, 2022, from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html (Level VII)
3. Centers for Disease Control and Prevention (CDC). (2022). COVID-19: Isolation and precautions for people with COVID-19. Retrieved October 13, 2022, from https://www.cdc.gov/coronavirus/2019-ncov/your-health/isolation.html (Level VII)

ADDITIONAL READINGS

National Institutes of Health (NIH). (2020). New coronavirus stable for hours on surfaces. Retrieved October 13, 2022, from https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces

Elsevier Skills Levels of Evidence

• Level I - Systematic review of all relevant randomized controlled trials
• Level II - At least one well-designed randomized controlled trial
• Level III - Well-designed controlled trials without randomization
• Level IV - Well-designed case-controlled or cohort studies
• Level V - Descriptive or qualitative studies
• Level VI - Single descriptive or qualitative study
• Level VII - Authority opinion or expert committee reports