Management of COVID-19 in Nursing Home Residents Without Respiratory Symptoms
COVID-19 positive nursing home residents without respiratory symptoms should be isolated in well-ventilated single rooms with restricted activity, monitored for symptom development, and provided appropriate supportive care while following strict infection control measures. 1, 2
Isolation Requirements
- Place residents in well-ventilated single rooms when possible (preferred strategy) or maintain at least 1 meter bed distance if single rooms are unavailable 1, 2
- Restrict patient activities and limit visits from relatives and friends to minimize contact with others 1, 2
- Ensure the environment is clean and disinfected, using 500 mg/L chlorine-containing disinfectant frequently every day 1
- Implement proper medical waste management with closed garbage bags that are replaced frequently 1
Monitoring and Supportive Care
- Monitor vital signs regularly including body temperature, heart rate, respiration rate, and oxygen saturation (SpO2) 2, 3
- Ensure adequate nutritional support and hydration 2, 4
- Provide nasal catheter or mask oxygen therapy only if needed, adjusting flow according to the patient's condition 1, 2
- Monitor for symptom development - seek medical attention if temperature exceeds 38°C or if breathing worsens 1, 2
Infection Control Measures
- Patients should wear medical masks when in the presence of others, with N95 masks preferred 1, 2
- Caregivers should wear N95 masks (preferred) or disposable surgical masks (alternative) when in the same room as patients 1, 2
- Avoid sharing personal items such as toothbrushes, towels, tableware, and bed sheets with patients 1
- Clean and disinfect hands after contact with the patient, before leaving patient's room, before and after eating, and after using the toilet 1
Special Considerations for Dementia Patients
- Provide information and explanation to persons with dementia if they express concerns about their situation 1
- Use simple reminders and visual instructions to explain the current situation 1
- Interact with persons with dementia frequently, ask how they are doing and take time to listen 1
- Avoid using negative language (words such as 'crisis', 'pandemic', 'lockdown' or 'isolation') 1
- Use old photographs, objects, or songs from the past for distraction 1
- Stimulate movement, exercise, and creative or household activities to maintain routine 1, 5
Social Support Measures
- Reduce social isolation by encouraging families to drop off letters, drawings, or other packages 1, 5
- Facilitate the use of technology (tablets, smartphones) for online social engagement with relatives 1, 6
- Maintain small group activities when possible while maintaining social distancing 1, 5
- Collaborate with mental health professionals and social workers to deliver adequate mental health care 1, 5
Criteria for Hospital Transfer
- Persistent high fever despite supportive measures 2, 7
- Development of dyspnea or respiratory distress 2, 7
- Signs of pneumonia development or worsening symptoms 2, 7
- Patients with comorbidities or risk factors for severe disease showing clinical deterioration 2, 7
End of Isolation Criteria
- Body temperature returned to normal for more than 3 days 1, 2
- Respiratory symptoms (if they develop) have significantly improved 1, 2
- Respiratory nucleic acid tests negative for two consecutive times with at least one-day sampling interval 1, 2
Caregiver Recommendations
- Caregivers should be healthy individuals without underlying diseases when possible 1, 2
- Wear disposable gloves (double layers) when providing care, handling patient's personal items, or cleaning the patient's room 1
- Avoid direct contact with patient's secretions or discharges 1
- Monitor their own body temperature and symptoms closely 1, 2