Home-Based Care of the Patient With an Infectious Disease
The nurse who cares for the patient in the home should provide infection risk prevention for the patient, the family, and the care-giver (Chart 70-5).
Patients requiring home care are often those with immuno-suppression from underlying conditions, such as HIV infection or cancer, or those who have therapy-induced immunosuppression, as occurs with many antineoplastic agents. Careful assessment for signs of infection is important.
Hand washing or use of an alcohol-based hand disinfectant in the home is an important preventive strategy. Whether a treatment is performed by the nurse, the family, or the patient, appropriate hand hygiene reduces the risk of transient flora.
Health care equipment increases infection risk because it is com-plex and invasive. All caregivers must be taught to pay careful at-tention to disinfection and aseptic technique. The nurse and the family members should be alert for any redness, swelling, or drainage around a catheter insertion site. Catheter-related sepsis should be suspected in a patient who has unexplained fever.
There is no recommended interval for the changing of in-dwelling urinary catheters. The nurse should promptly report to the patientâ€™s physician signs of urinary tract infection or of generalized sepsis.
When assessing the immune-suppressed patient in the home en-vironment for infectious risk, it is important to realize that in-trinsic colonizing bacteria and latent viral infections present a greater risk than do extrinsic environmental contaminants. The patient and family need reassurance that their home should be clean but not sterile. Common-sense approaches to cleanliness and risk reduction are helpful. The severely neutropenic patient should refrain from eating uncooked fruits and vegetables. For patients with neutropenia or with T-cell dysfunction (eg, patients with AIDS), it is wise to restrict visits of people with potentially contagious illnesses.
Establishing careful barriers to infection transmission in the house-hold is an important part of home care. The route of transmis-sion of the organism in question must first be determined. The nurse can then teach household members strategies to reduce their risk of becoming infected. If the patient has active pul-monary TB, the public health department should be contacted to provide screening and treatment for family members. If a patient has shingles (herpes zoster), family members who have had vari-cella vaccine or who have previously had chickenpox are consid-ered immune and need no precautions. However, if a family member is immunosuppressed or otherwise susceptible to vari-cella, maintaining physical separation may be an important strat-egy during the time when the patient has draining lesions.
Organisms transmitted by the fecal-oral route may be readily spread in a household setting unless careful attention to food preparation and personal hygiene is maintained. Family care-givers may be vulnerable to acquiring organisms such as Shigella species and C. difficile when assisting in personal care. Hands should be thoroughly disinfected after such contact. The family should be reassured that common household disinfectants are effective in killing environmental sources of such organisms.
Family members who assist in the care of a patient with a blood-borne infection such as HIV or hepatitis C should be alert for the potential of transmission if sharp objects contaminated with blood are handled. Family teaching may be designed to discuss the need for caution when shaving the patient, performing dressing changes, or administering any intravenous, intramuscular, or subcutaneous medication. It is important to set up an impene-trable container for the collection of needles, syringes, and vas-cular access equipment.
The nurse should also teach the family about infections that are and are not contagious to family members. With the excep-tion of TB, the opportunistic infections associated with AIDS do not pose a risk to the healthy family member. Family members should be reassured that dishes are safe to use after being washed with hot water and that linens and clothing are safe to use after being washed in a hot-water cycle.
Recognizing that a health history may not identify all active or latent infections, the caregiver should carefully follow Standard Precautions in the home. Setting up a work environment in which hand disinfection and aseptic technique can be accom-plished as carefully as they are in a hospital setting is important.
It is important for the home caregiver to receive annual in-fluenza vaccine. This is especially true if the caregiver or the pa-tient is older than 50 years of age, has underlying cardiac or pulmonary disease, or has underlying immunosuppression.