PHYSIOTHERAPY AND OCCUPATIONAL THERAPY

General Guidelines for Patient Care

NOT SUSPECTED OF CONTAMINATION

• Perform hand hygiene with soap and water or 70% alcohol;before and immediately after any physical contact with the resident or common surfaces;
• Wear a disposable mask (always replacing it when it is wet;
• Do not use materials that cannot be cleaned with 70% alcohol;
• Avoid using the cell phone during service, if the use of the device is necessary, sanitize it before and after use;
• Carry out individual activities and suspend group activities;
• Whenever possible, guide the elderly about the measures taken to contribute to them and still understand their importance. This attitude will also help in their emotional state;
• Maintain natural ventilation in the rooms, where individual therapy will also be performed, as walking and activities outside the room should also be avoided;
• Provide adequate guidance to other professionals and the elderly for proper hand hygiene, before and immediately after the appointments. Use gel alcohol (70%) if your hands are free of visible dirt or soap and water if there is dirt. 

Specific Guidelines

• For physiotherapy care in the elderly confirmed for COVID-19, it will be necessary to use a disposable apron, procedure gloves, N95 mask, cap and goggles. Perform hand hygiene before and after dressing. Remembering that the surgical glove should be placed inside the elderly’s room only after hand hygiene;
• If the physiotherapist observes signs / symptoms related to COVID-19 in any resident, he must immediately inform the medical and / or nursing staff.
• If the physiotherapist also observes any change in the general condition of a resident (such as immobility, sudden cognitive changes and diarrhea), even in the absence of signs / symptoms of COVID-19, he must immediately inform the medical team and / or nursing and maintain observation.
• When possible, keep the materials in individual use and perform the correct cleaning (70% alcohol or 1% sodium hypochlorite) before and after the therapies. Avoid using materials that do not allow proper hygiene.
• Guide professionals to inform the management of the ILPI if they present symptoms such as fever, cough, sore throat, lack of
  air or malaise, immediately leave the ILPI environment for 14 days and seek a health service.
• Physiotherapists and other health professionals should wear a surgical mask for 14 days if they have had direct contact with someone with a positive result for COVID-19,
  even if you don’t have the signs / symptoms;
• Pay attention to the recommendations provided for in Regulatory Standard 32 (NR32), especially with regard to NOT using rings, bracelets, watches or other adornments, as they can hinder proper hand hygiene, hair must be tied or covered with a cap
  protective, keep nails short and free of nail polish;
• Suggest for management and assist in preparing an area for respiratory isolation of symptomatic residents in order to prevent the spread of the virus;
• The use of non-invasive ventilation is not indicated for elderly people with COVID-19, as it increases the spread of the virus
  through the exhalation valve;
• Do not perform IPRP;
• If NIV is required, use only with non-exhaling masks with double branch with humidifier filter and barrier filter at the ventilator exhalation outlet;
• Avoid using inhalation, replace with inhaled medications and standardized spacers.
• If there is a need for nasotracheal aspiration, in addition to all the PPE’s already mentioned, it will be necessary to use the “Face Shield” helmet, as well as in case of orotracheal intubation.

References

• Villas Boas PJF, Bremenkamp MG, JSR Filho, MC Kairalla, DCA Gomes, RGB de Mello, CA Uehara. Recomendações para Prevenção e Controle de infecções por coronavírus (SARS-Cov-2) em Instituições de Longa Permanência para Idosos (ILPIs). Sociedade Brasileira de Geriatria e Gerontologia, 17 mar 2020.
• Crefito3. Recomendações para fisioterapeutas que estão no combate à pandemia nos hospitais. Acesso em: 28/03/2020. Disponível em: <http://www.crefito3.org.br/dsn/noticias.asp?codnot=7771>
• CDC (2020). Coronavirus Disease 2019 (COVID-19).
• Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, Hodgson C, Jones AYM, Kho ME, Moses R, Ntoumenopoulos G, Parry SM, Patman S, van der Lee L. Physiotherapy management for COVID-19 in the acute
  hospital setting: Recommendations to guide clinical practice. Version 1.0, 23/3/2020.