Occupational Therapy Services in the Client's Home: Infection, Prevention and Control – Are you Prepared?

BACKGROUND 

Sally is a community occupational therapist (OT) scheduled to complete a home visit with a new client Mr. Garrison. During the initial pre-screen phone conversation, Mr. Garrison speaks openly about his concerns about COVID-19 cases on the rise and reveals that he is nervous having someone enter his home. Mr. Garrison considers himself high risk as he has underlying medical conditions.  

CONSIDERATIONS

Sally assures Mr. Garrison that she stays informed about personal protective equipment (PPE) changes and adjusts her practice accordingly. She educates him that “while the use of gloves and eye protection (e.g., a face shield) for home visits is strongly recommended (but not mandatory), [she] uses these during all visits .” Sally also mentions that she would prefer that Mr. Garrison also wears as mask for the visit as sometimes she may not be able to maintain physical distancing.

As part of her consent process, Sally explains to Mr. Garrison the need to complete a point of care risk assessment (PCRA) before the home visit.

Seeing that Mr. Garrison is so concerned about safety for this visit, Sally reviews the infection control measures recommended for in-person visits during Phase 2 of COVID-19 reopening: 

  • Wear gloves throughout the visit; 

  • Perform hand hygiene: 
  • Between client encounters
  • On entry and exit from the client's home;
  • Before donning and after PPE removal according to public health recommendations;
  • Before and after contact with a client or the environment (e.g., medical equipment, bed, table, door handle);
  • After other personal hygiene practices (e.g. using toilet facilities, using tissues);
  • Wear a mask and face shield securely over her mouth and nose;

  • Care taken to avoid dangling the mask under the chin, off the ear, or under the nose;

  • Maintain 2 meter or more distance if the assessment permits.

OUTCOME

Mr. Garrison confirms with Sally that her wearing a mask, gloves and face shield will improve his comfort with the visit. Prior to attending Mr. Garrison’s home location, Sally checks if there are any additional public health restrictions for requirements for his area. We know each OT may have unique practice situations, OTs should include in their considerations client and environmental factors, as well as the public health location. Upon arrival for the visit, Sally confirms that Mr. Garrison remains comfortable with her entering the home, and again reviews the PPE she is wearing. He consents to the home visit continuing.

DISCUSSION

OTs must remain updated about infection, prevention and control measures and continue to have open communication with clients, exploring any client concerns when conducting occupational therapy services within the client's home environment. OTs should ensure they work in collaboration with their client to employ safe practices, and to prevent the spread of COVID-19.

NOTE

Case scenarios are for information purposes only and intended to demonstrate an example of a possible practice situation. Protocols pertaining to COVID-19 are rapidly changing, OTs are encouraged to check frequently for updates and follow current Chief Medical Officer’s directives and public health safety measures.

REFERENCES 

Government of Canada. Infection, prevention and Control Interim Guidance for Home Care Settings.  Retrieved November 4, 2020 from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/infection-prevention-control-covid-19-interim-guidance-home-care-settings.html.


College of Occupational Therapists of Ontario (2020). COVID-19 Return to Work Guidance for Occupational Therapists V3

CONTACT

If you have any questions about this case, or have any ideas or requests for future cases, contact the Practice Resource Service: 1.800.890.6570/416.214.1177x240 or practice@coto.org.

Want more case studies? Sign up to stay up to date and receive the latest cases when they’re released.  


Back to Case Study Archive