Germs and Dirt and Bacteria, Oh My!
Ask any seasoned home health provider and they’ll tell you that they have encountered their fair share of unsanitary conditions in the homes of patients. Entering an unkempt environment can put clinicians at risk for infections and contagious disease, including but not limited to CoVid-19.[i] Let’s consider some ways to keep yourself healthy in these situations.
Use as much personal protective equipment (PPE) as you need.
PPE has become more visible and familiar to the general public due to the coronavirus pandemic. While mask mandates are lifting in many public spaces across the country, this does not mean that healthcare providers are obliged to go mask-less at all times. Wearing a mask or respirator while working with patients can help protect you from CoVid-19, as well as other airborne illnesses like the flu. Here are the recommendations from CMS for proper PPE use in home care:2
- Put on your mask/respirator and any eye protection you choose to use before you enter the client’s home.
- If conditions are such that a gown and gloves are necessary for further protection, don them once inside the home, and dispose of them just outside, before you get into your car.
- Use hand sanitizer both before and after treatment, and ensure that it consists of >60% ethanol or >70% isopropanol.
Protect your equipment and belongings too
Germs aren’t only attracted to your person: they can be just as insidious if they attach themselves to your bag or laptop and travel home with you. OSHA recommends reducing the risk of traveling bugs with the following precautions:[ii]
- At each home, only bring in the supplies that are absolutely necessary for that patient’s treatment.
- Consider placing disposable pads like Chux underneath any equipment or bags, rather than placing them directly on carpet or the floor.
- Use non-latex gloves and hand sanitizer to avoid transmitting germs from your hands to your equipment.
Maintaining Physical Safety in the Home
While work-related injuries are exceedingly common among home health practitioners, this does not mean they are unavoidable. Let’s consider some tactics to mitigate your risk of bodily injury.
Use those Ergonomic Skillz!
PTs and OTs are widely regarded as the experts on ergonomics and body mechanics, but it is still all too easy to let that knowledge go out the window when working in cramped spaces that aren’t built with rehab in mind.
Don’t let all that practice you did in grad school with gait belts and sliding boards go to waste! Using basic, easily transportable safety equipment like this can go a long way to reduce musculoskeletal strain during transfers and balance training.[iii]
Additionally, don’t be afraid to move furniture, rugs, or other belongings that pose a threat to the safety of you or your patient or impede your ability to use good body mechanics.4 Common courtesy applies here: be sure to ask your client for permission first, and thoroughly explain your concern and why you feel that moving the item will improve the treatment experience.
Stay on your guard around pets and people
While this is hopefully a less common concern, the potential for violence and bodily harm from your patient or others in the home is still an important threat to consider. OSHA recommends that providers use a keen eye to inspect the scene before entering a patient’s home, looking for signs or sounds of any altercations occurring in the area: if there are signs of unrest, drive away without entering the dwelling and call your supervisor.[iv]
Upon entering the home, you should be on the lookout for any weapons or physical evidence of drug use that could impact the behavior of your patient or their cohabitants.5 Stay vigilant for any signs of agitation, and employ de-escalating techniques if possible, such as using a calm, measured speaking voice and avoiding sudden movements that could interpreted as threatening.6
If your patient has pets, ask that they be secured in a separate space prior to the start of each treatment. Regardless of how harmless Fido may seem at first, it is impossible to predict how an animal might respond to a stranger interacting closely with its owner.3 It’s best to prevent any negative animal interaction before it occurs.
Managing Risk as a Solo Practitioner
Even outside the realm of home health, many rehab providers may sometimes work alone with patients. In these situations, it’s equally important to be mindful of personal safety.
Many of the recommendations above for the prevention of interpersonal violence apply here as well. When working alone with a client in any setting, it’s important to stay vigilant for any warning signs of impeding violent outbursts; it’s also smart to keep a phone in very close proximity in case there is a need to call for help.[v]
Hopefully, aggressive patient behavior is an extremely rare threat that therapists almost never encounter during treatment. However, a much more common—but no less upsetting—form of interpersonal issue is the potential for inappropriate sexual advances from patients.
A 2017 survey of nearly 900 PTs and PT students found that 84% had dealt with some sort of inappropriate sexual behavior from patients at some point in their careers, and nearly 50% had experienced an episode of this in the last year.[vi] Therapists who were younger and female were at higher risk for exposure to these behaviors.7
While sexual advances and remarks cannot always be avoided in the clinical setting, particularly when working with patients with impaired cognition, you can take key steps to protect yourself from ill effects of such encounters:
- Immediately reporting of any such incident to your supervisory staff.7
- Undertake basic training on inappropriate sexual behaviors, including techniques on how to manage them: there is evidence that providers who feel they have some control over these situations suffer fewer ill effects when they occur.7
We hope this primer on workplace safety for solo providers helps you stay safe and healthy on the job, so you can focus on what you love: helping your patients!