Safety Precautions

Bedbugs are a rare, but serious occupational hazard.  It is imperative that all clinicians practice prevention techniques while also taking measures to secure the living conditions of the patient.  If Lifespan is informed that a patient has bedbugs, this information will be relayed.  If you are not comfortable entering the home, please let the Lifespan office know so that the patient can be re-staffed.  While agencies accept that bedbugs are an unpleasant occupational hazard, the patient may still require medically necessary services -- including social work.  

Bed Bug Action Plan for Home Health Care

Bed Bug Action Plan for Home Health Care and Social Workers

Bug Bug Fact Sheet

Pets can be seen as family members, especially to patients who may be lonely or struggling with their illness.  That being said, dogs and other animals can present serious risks to home healthcare workers so it is important to prevent bites/attacks and also know how to handle them if they occur. 

Prevention

When scheduling your first visit, ask if the patient has any pets and, if so, that they be secured (put in another room with the door closed, leashed, crated, in the backyard, etc.) prior to your arrival.  You can let the patient know that your pets are also seen as part of your family, but it is a home health policy that pets be secured -- not only to prevent bites, and liability, but also so that you can focus on the patient and perform safe transfers, education, ambulation, etc. without distractions or fall risks.  

Action

If bitten by a pet, it is important to prevent infection which can require hospitalization and/or antibiotics.  

Right away you should wash the wound with soap and warm water for 5-10 minutes.  If there is bleeding, use a cloth to soak up the blood.  Apply antibacterial cream if available.  Wrap the wound with a sterile bandage.  Schedule an appointment with your doctor or an urgent care center, especially if there is concern of infection or rabies.  Change the bandage multiple times per day to keep the wound clean.  Watch for signs of infection such as redness, swelling, pain, and fever.  

It is appropriate to document an incident report regarding the occurrence.  It is also appropriate to report this to the department of public health for your location per state law.  Resources for reporting are available under Public Health Reporting Forms below. If you do not feel safe returning to the home, kindly alert the Lifespan office and the patient will be restaffed or returned to the agency.  

Public Health Reporting Forms

Los Angeles - http://publichealth.lacounty.gov/vet/biteintro.htm

San Diego - https://www.sddac.com/content/sdc/das/license-laws/laws/dog_bites.html 

San Bernardino - https://animalcare.sbcounty.gov/contactus/#other fax the RUFF Report https://www.sbcounty.gov/uploads/dph/acc/documents/2021BiteReportRUFF.pdf

Riverside - https://www.ruhealth.org/sites/default/files/PH/Disease%20Control/docs/rabies.pdf

Orange - https://www.ocpetinfo.com/field-operations/report-animal-bite

Lifting patients can create a risk for back injury for clinicians.  Below are tips from the CDC to prevent musculoskeletal injuries in healthcare workers. 

Use proper body mechanics. 

Even when assistive devices are used during client care, some amount of physical exertion may still be necessary. 

• Move along the side of the client’s bed instead of reaching while performing tasks at the bedside. 

• When manually moving the client, stand as close as possible to the client without twisting your back, keeping your knees bent and feet apart. To avoid twisting the spine, make sure one foot is in the direction of the move. Using gentle rocking motions can also reduce exertion. 

• Pulling a client up in bed is easier when the head of the bed is flat or down. Raising the client’s knees and encouraging the client to push (if possible) can also help. 

• Apply anti-embolism stockings by pushing them on while you are standing at the foot of the bed. You can use less force in this position than standing at the side of the bed.

Use ergonomic assistive devices if available.

• Products such as slip sheets, slide boards, rollers, slings, belts, and mechanical or electronic hoists (to lift the client) have been designed to help healthcare workers and clients.  

• Equipment such as adjustable beds, raised toilet seats, shower chairs, and grab bars are also helpful for reducing risk factors for musculoskeletal injuries. These types of equipment can allow the client to help during transfer.

Behavioral diagnoses, drug use (including prescribed medications), and the stressful nature of a patient's condition can make some patients uncomfortable to work with.  However, patients are receiving home health because of severe functional deficits, so regardless of their mental state, many are not high risk.  That being said, caregivers, others in the home, or others in the neighborhood could pose a real or perceived risk.  Below are tips from the CDC to protect yourself when going in to an unfamiliar environment.

CDC Tips

• Before getting out of the car, check the surrounding location and activity. If you feel uneasy, do not get out of the car

• Keep healthcare equipment, supplies, and personal belongings locked out of sight in the trunk of the vehicle.

• Park the vehicle in a well-lit area, away from large trees or shrubs where a person could hide. 

• When driving alone, have the windows rolled up and doors locked.

• Be sure of the location and have accurate directions to the house or apartment. 

• If possible, schedule visits during daylight hours.

• Stay in your car and contact [the office/home health agency team] if you notice anything that might threaten your security, such as strong odors from a drug lab, gunshots, or shouting and sounds of fighting.

• During the visit, use basic safety precautions by (1) being alert, (2) evaluating each situation for possible violence, and (3) watching for signals of impending violent assault, such as verbally expressed anger and frustration, threatening gestures, signs of drug or alcohol abuse, or the presence of weapons.

• Notify [the office/home health agency team] if you observe an unsecured weapon in the client’s home.  

• Maintain behavior that helps to defuse anger by (1) presenting a calm, caring attitude, (2) not matching threats, (3) not giving orders, and (4) acknowledging the person’s feelings.  

• Avoid behaviors that may be interpreted as aggressive (for example, moving rapidly or getting too close, touching unnecessarily, or speaking loudly).  

• If possible, keep an open pathway for exiting.  

• Trust your judgment.  

• Avoid situations that don’t feel right.  

• If you are being verbally abused, ask the abuser to stop. If the abuser does not stop, then leave and notify your employer.  

• If you cannot gain control of the situation, shorten the visit and remove yourself from the situation. If you feel threatened, leave immediately.  

• If you need help, use your cell phone to call your employer or 911, depending on the severity of the situation.  

• If you observe a crime, contact the police.

Lifespan's Role

While you are an independent contractor, you still have the support of both the Home Health Agency and the Lifespan Office.  No one wants you to be or feel unsafe.  If you would like us to call you at a specific time to ensure your safety, we would be happy to do so.  Additionally, if you would like a patient re-staffed due to safety concerns, please do reach out with your concerns.  Providing a detailed account of what has occurred will allow us to make the determination to either re-staff the case or return the case to the agency.    

When providing home health, it is essential to maintain a professional and respectful environment to minimize any potential discomfort or accusations of sexual misconduct. Here are some precautions that can help reduce these risks:

Tips

1. Clear communication: Establish clear and open communication with the patient from the beginning. Explain the purpose of the therapy, the techniques you will use, and the expected outcomes. Encourage the patient to ask questions and voice any concerns they may have.

2. Professional attire: Always dress in professional attire that is appropriate for the setting. It should be clean, neat, and non-revealing. Avoid clothing that could be misinterpreted or make the patient uncomfortable.

3. Informed consent: Obtain informed consent from the patient before initiating any treatment. Explain the procedures involved, their purpose, and any potential risks or discomfort. Document the patient's consent in their medical records.

4. Privacy and modesty: Respect the patient's privacy and modesty throughout the therapy session. Provide appropriate draping and ensure that only the necessary body parts are exposed during the treatment. Knock on doors and wait for permission before entering the patient's private space.

5. Chaperone or support person: If the patient feels more comfortable having a chaperone or support person present during the therapy sessions, respect their request and accommodate it when possible.

6. Professional boundaries: Maintain professional boundaries at all times. Avoid engaging in personal discussions unrelated to the therapy. Refrain from making inappropriate or offensive comments or jokes.

7. Documentation: Maintain accurate and detailed documentation of each therapy session, including the procedures performed, the patient's response, and any relevant information. This documentation can serve as evidence of your professionalism and the nature of the treatment provided.

8. Sensitivity to cultural and personal beliefs: Be sensitive to the cultural and personal beliefs of the patient. Respect their values and customs, and ensure that your actions align with their preferences as much as possible.

9. Continual education and training: Stay updated with the latest guidelines, best practices, and professional standards in physical therapy. Participate in ongoing education and training to enhance your knowledge and skills in providing patient-centered care.

10. Report any concerns: If you notice any signs of discomfort or potential misconduct from a patient or another healthcare professional, report it to your supervisor or the appropriate authority following the established reporting procedures.

Remember, maintaining professionalism, respecting boundaries, and fostering open communication are key to providing safe and comfortable home health physical therapy sessions.

The CDC's page Caring for Yourself While Caring for Others is a great resource that includes tips on working with patients with dementia, addressing threatening behavior, decreasing environmental exposure risk, and more.  

Caregivers of America provides a summary of many common safety procedures here.

NIOSH Hazard Review