1 Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts Interim guidance 17 March 2020 Background WHO has developed this interim guidance to meet the need for recommendations on safe home care for patients with suspected COVID-19 who present with mild symptomsa and on public health measures related to the management of their contacts. This document was adapted from the interim guidance on Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 20181 and is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic- prone acute respiratory diseases in health care,2 and based on current information on COVID-19. This rapid advice has been updated with the latest information and is intended to guide public health and infection prevention and control (IPC) professionals, health care managers and health care workers (HCWs) when addressing issues related to home care for patients with suspected COVID-19 who present with mild symptoms and when managing their contacts. This guidance is based on evidence about COVID-19 and the feasibility of implementing IPC measures at home. For the purpose of this document, “caregivers” refers to parents, spouses, and other family members or friends without formal health care training. Please refer to the Global Surveillance for human infection with coronavirus disease (COVID-19) for case definitions. Please refer to Infection prevention and control during health care when COVID-19 is suspected for guidance on IPC at the health care facility level. Where to manage COVID-19 patients WHO recommends that all laboratory confirmed cases be isolated and cared for in a health care facility. WHO recommends that all persons with suspected COVID-19 who have severe acute respiratory infection be triaged at the first point of contact with the health care system and that emergency treatment should be started based on disease severity. WHO has updated treatment guidelines for patients with ARI associated with COVID-19, which includes guidance for vulnerable populations (e.g., older adults, pregnant women and children). In situations where isolation in a health care facility of all cases is not possible, WHO emphasizes the prioritization of those with highest probability of poor outcomes: patients with severe and critical illness and a Mild illness may include: uncomplicated upper respiratory tract viral infection symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise, muscle pain, sore those with mild disease and risk for poor outcome (age >60 years, cases with underlying co-morbidities, e.g., chronic cardiovascular disease, chronic respiratory disease, diabetes, cancer). If all mild cases cannot be isolated in health facilities, then those with mild illness and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and laboratory tests for COVID-19 virus are negative. Alternatively, patients with mild disease and no risk factors can be managed at home. Home care for patients with suspected COVID-19 who present with mild symptoms For those presenting with mild illness, hospitalization may not be possible because of the burden on the health care system, or required unless there is concern about rapid deterioration.3 If there are patients with only mild illness, providing care at home may be considered, as long as they can be followed up and cared for by family members. Home care may also be considered when inpatient care is unavailable or unsafe (e.g. capacity is limited, and resources are unable to meet the demand for health care services). In any of these situations, patients with mild symptoms1 and without underlying chronic conditions − such as lung or heart disease, renal failure, or immunocompromising conditions that place the patient at increased risk of developing complications − may be cared for at home. This decision requires careful clinical judgment and should be informed by an assessment of the safety of the patient’s home environment.b2 In cases in which care is to be provided at home, if and where feasible, a trained HCW should conduct an assessment to verify whether the residential setting is suitable for providing care; the HCW must assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house) and can address safety concerns (e.g., accidental ingestion of and fire hazards associated with using alcohol-based hand rubs). If and where feasible, a communication link with health care provider or public health personnel, or both, should be established for the duration of the home care period – that is, until the patient’s symptoms have completely resolved. More throat, dyspnea, nasal congestion, or headache. Rarely, patients may also present with diarrhoea, nausea, and vomiting. b A sample checklist for assessing environmental conditions in the home is available in the Annex C of reference 2. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 2 comprehensive information about COVID-19 and its transmission is required to define the duration of home isolation precautions. Patients and household members should be educated about personal hygiene, basic IPC measures, and how to care as safely as possible for the person suspected of having COVID- 19 to prevent the infection from spreading to household contacts. The patient and household members should be provided with ongoing support and education, and monitoring should continue for the duration of home care. Household members should adhere to the following recommendations. • Place the patient in a well-ventilated single room (i.e. with open windows and an open door). • Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated (keep windows open). • Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 metre from the ill person (e.g. sleep in a separate bed).c3 • Limit the number of caregivers. Ideally, assign one person who is in good health and has no underlying chronic or immunocompromising conditions.3 Visitors should not be allowed until the patient has completely recovered and has no signs or symptoms of COVID-19. • Perform hand hygiene after any type of contact with patients or their immediate environment.4 Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water. • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently. • To contain respiratory secretions, a medical maskd 4 should be provided to the patient and worn as much as possible, and changed daily. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene; that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g. wash handkerchiefs using regular soap or detergent and water). • Caregivers should wear a medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask. c An exception may be made for breastfeeding mothers. Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother could can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document. Remove the mask using the appropriate technique – that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene. • Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine, and other waste. Perform hand hygiene before and after removing gloves and the mask. • Do not reuse masks or gloves. • Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded. • Daily clean and disinfect surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bedframes, and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1% sodium hypochlorite (i.e. equivalent to 1000 ppm) should be applied. • Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1% sodium hypochlorite should be applied. • Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water or machine wash at 60–90 °C (140–194 °F) with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes. • Gloves and protective clothing (e.g. plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.1% sodium hypochlorite solution. Single-use gloves (e.g. nitrile or latex) should be discarded after each use. Perform hand hygiene before putting on and after removing gloves. • Gloves, masks, and other waste generated during home care should be placed into a waste bin with a lid in the patient’s room before disposing of it as infectious waste.e5The onus of disposal of infectious waste resides with the local sanitary authority. • Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g. do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths, or bed linen). d Medical masks are surgical or procedure masks that are flat or pleated (some are shaped like a cup); they are held in place by strings that tie around the back of the head. e The local sanitary authority should adopt measures to ensure that the waste is disposed of at a sanitary landfill and not at an unmonitored open dump. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 3 • When HCWs provide home care, they should perform a risk assessment to select the appropriate personal protective equipment and follow the recommendations for droplet and contact precautions. • For mild laboratory confirmed patients who are cared for at home, to be released from home isolation, cases must test negative using PCR testing twice from samples collected at least 24 hours apart. Where testing is not possible, WHO recommends that confirmed patients remain isolated for an additional two weeks after symptoms resolve. Management of contacts Persons (including caregivers and HCWs) who have been exposed to individuals with suspected COVID-19 are considered contacts and should be advised to monitor their health for 14 days from the last day of possible contact. A contact is a person who is involved in any of the following from 2 days before and up to 14 days after the onset of symptoms in the patient:5 • Having face-to-face contact with a COVID-19 patient within 1 meter and for >15 minutes; • Providing direct care for patients with COVID-19 disease without using proper personal protective equipment; • Staying in the same close environment as a COVID-19 patient (including sharing a workplace, classroom or household or being at the same gathering) for any amount of time; • Travelling in close proximity with (that is, within 1 m separation from) a COVID-19 patient in any kind of conveyance; • and other situations, as indicated by local risk assessments. A way for caregivers to communicate with a health care provider should be established for the duration of the observation period. Also, health care personnel should review the health of contacts regularly by phone but, ideally and if feasible, through daily in-person visits, so specific diagnostic tests can be performed as necessary. The health care provider should give instructions to contacts in advance about when and where to seek care if they become ill, the most appropriate mode of transportation to use, when and where to enter the designated health care facility, and which IPC precautions should be followed. If a contact develops symptoms, the following steps should be taken. • Notify the receiving medical facility that a symptomatic contact will be arriving. • While traveling to seek care, the contact should wear a medical mask. • The contact should avoid taking public transportation to the facility if possible; an ambulance can be called, or the ill contact can be transported in a private vehicle with all windows open, if possible. • The symptomatic contact should be advised to perform respiratory hygiene and hand hygiene and to stand or sit as far away from others as possible (at least 1 metre) when in transit and when in the health care facility. • Any surfaces that become soiled with respiratory secretions or other body fluids during transport should be cleaned with soap or detergent and then disinfected with a regular household product containing a 0.5% diluted bleach solution. Acknowledgements The original version of the MERS-CoV IPC guidance (1) that constituted the basis for this document was developed in consultation with WHO’s Global Infection Prevention and Control Network and other international experts. WHO thanks those who were involved in developing the IPC documents for MERS-CoV. WHO thanks the following individuals for providing review: Abdullah M Assiri, Director General, Infection Control, Ministry of Health, Saudi Arabia; Michael Bell, Deputy Director of the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Gail Carson, ISARIC Global Support Centre, Director of Network Development, Consultant in Infectious Diseases, and Honorary Consultant with Public Health England, United Kingdom; John M Conly, Department of Medicine, Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary, Calgary, Canada; Barry Cookson, Division of Infection and Immunity, University College London, United Kingdom; Babacar NDoye, Board Member, Infection Control Network, Dakar, Senegal; Kathleen Dunn, Manager, Healthcare-Associated Infections and Infection Prevention and Control Section, Centre for Communicable Disease Prevention and Control, Public Health Agency of Canada; Dale Fisher, Global Outbreak Alert and Response Network Steering Committee; Fernanda Lessa, Epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Moi Lin Ling, Director, Infection Control Department, Singapore General Hospital, Singapore, and President of Asia Pacific Society of Infection Control; Didier Pittet, Director, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and Faculty of Medicine, Geneva, Switzerland; Fernando Otaiza O’Ryan, Head, National IPC Program, Ministry of Health, Santiago, Chile; Diamantis Plachouras, Unit of Surveillance and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden; Wing Hong Seto, Department of Community Medicine, School of Public Health, University of Hong Kong, China, Hong Kong Special Administrative Region; Nandini Shetty, Consultant Microbiologist, Reference Microbiology Services, Health Protection Agency, Colindale, United Kingdom; Rachel M. Smith, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 4 From WHO we also thank: Benedetta Allegranzi, Gertrude Avortri, April Baller, Ana Paula Coutinho, Nino Dal Dayanghirang, Christine Francis, Pierre Clave Kariyo, Maria Clara Padoveze, Joao Paulo Toledo, Nahoko Shindo, Valeska Stempliuk, and Maria Van Kerkhove. References 1. World Health Organization. Home care for patients with Middle East respiratory syndrome coronavirus (MERS- CoV) infection presenting with mild symptoms and management of contacts: interim guidance (accessed 26 January 2020). 2. World Health Organization. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. (accessed 26 January 2020). 3. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID- 19 disease is suspected. Geneva: World Health Organization; 2020 (accessed 17 March 2020). 4. World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge. (accessed 20 January 2020). 5. World Health Organization. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance (accessed 17 March 2020). Further references World Health Organization. Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance, (accessed 20 January 2020). World Health Organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance, (accessed 20 January 2020). World Health Organization. Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS- CoV) infection: interim guidance. (accessed 20 January 2020). Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44167, accessed 20 January 2020). Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/330676, accessed 20 January 2020). Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013; 18(11): 20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO will issue a further update. Otherwise, this interim guidance document will expire 2 years after the date of publication. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. WHO reference number: WHO/nCov/IPC/HomeCare/2020.3
1 Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts Interim guidance 17 March 2020 Background WHO has developed this interim guidance to meet the need for recommendations on safe home care for patients with suspected COVID-19 who present with mild symptomsa and on public health measures related to the management of their contacts. This document was adapted from the interim guidance on Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 20181 and is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic- prone acute respiratory diseases in health care,2 and based on current information on COVID-19. This rapid advice has been updated with the latest information and is intended to guide public health and infection prevention and control (IPC) professionals, health care managers and health care workers (HCWs) when addressing issues related to home care for patients with suspected COVID-19 who present with mild symptoms and when managing their contacts. This guidance is based on evidence about COVID-19 and the feasibility of implementing IPC measures at home. For the purpose of this document, “caregivers” refers to parents, spouses, and other family members or friends without formal health care training. Please refer to the Global Surveillance for human infection with coronavirus disease (COVID-19) for case definitions. Please refer to Infection prevention and control during health care when COVID-19 is suspected for guidance on IPC at the health care facility level. Where to manage COVID-19 patients WHO recommends that all laboratory confirmed cases be isolated and cared for in a health care facility. WHO recommends that all persons with suspected COVID-19 who have severe acute respiratory infection be triaged at the first point of contact with the health care system and that emergency treatment should be started based on disease severity. WHO has updated treatment guidelines for patients with ARI associated with COVID-19, which includes guidance for vulnerable populations (e.g., older adults, pregnant women and children). In situations where isolation in a health care facility of all cases is not possible, WHO emphasizes the prioritization of those with highest probability of poor outcomes: patients with severe and critical illness and a Mild illness may include: uncomplicated upper respiratory tract viral infection symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise, muscle pain, sore those with mild disease and risk for poor outcome (age >60 years, cases with underlying co-morbidities, e.g., chronic cardiovascular disease, chronic respiratory disease, diabetes, cancer). If all mild cases cannot be isolated in health facilities, then those with mild illness and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and laboratory tests for COVID-19 virus are negative. Alternatively, patients with mild disease and no risk factors can be managed at home. Home care for patients with suspected COVID-19 who present with mild symptoms For those presenting with mild illness, hospitalization may not be possible because of the burden on the health care system, or required unless there is concern about rapid deterioration.3 If there are patients with only mild illness, providing care at home may be considered, as long as they can be followed up and cared for by family members. Home care may also be considered when inpatient care is unavailable or unsafe (e.g. capacity is limited, and resources are unable to meet the demand for health care services). In any of these situations, patients with mild symptoms1 and without underlying chronic conditions − such as lung or heart disease, renal failure, or immunocompromising conditions that place the patient at increased risk of developing complications − may be cared for at home. This decision requires careful clinical judgment and should be informed by an assessment of the safety of the patient’s home environment.b2 In cases in which care is to be provided at home, if and where feasible, a trained HCW should conduct an assessment to verify whether the residential setting is suitable for providing care; the HCW must assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house) and can address safety concerns (e.g., accidental ingestion of and fire hazards associated with using alcohol-based hand rubs). If and where feasible, a communication link with health care provider or public health personnel, or both, should be established for the duration of the home care period – that is, until the patient’s symptoms have completely resolved. More throat, dyspnea, nasal congestion, or headache. Rarely, patients may also present with diarrhoea, nausea, and vomiting. b A sample checklist for assessing environmental conditions in the home is available in the Annex C of reference 2. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 2 comprehensive information about COVID-19 and its transmission is required to define the duration of home isolation precautions. Patients and household members should be educated about personal hygiene, basic IPC measures, and how to care as safely as possible for the person suspected of having COVID- 19 to prevent the infection from spreading to household contacts. The patient and household members should be provided with ongoing support and education, and monitoring should continue for the duration of home care. Household members should adhere to the following recommendations. • Place the patient in a well-ventilated single room (i.e. with open windows and an open door). • Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated (keep windows open). • Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 metre from the ill person (e.g. sleep in a separate bed).c3 • Limit the number of caregivers. Ideally, assign one person who is in good health and has no underlying chronic or immunocompromising conditions.3 Visitors should not be allowed until the patient has completely recovered and has no signs or symptoms of COVID-19. • Perform hand hygiene after any type of contact with patients or their immediate environment.4 Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water. • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently. • To contain respiratory secretions, a medical maskd 4 should be provided to the patient and worn as much as possible, and changed daily. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene; that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g. wash handkerchiefs using regular soap or detergent and water). • Caregivers should wear a medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask. c An exception may be made for breastfeeding mothers. Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother could can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document. Remove the mask using the appropriate technique – that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene. • Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine, and other waste. Perform hand hygiene before and after removing gloves and the mask. • Do not reuse masks or gloves. • Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded. • Daily clean and disinfect surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bedframes, and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1% sodium hypochlorite (i.e. equivalent to 1000 ppm) should be applied. • Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1% sodium hypochlorite should be applied. • Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water or machine wash at 60–90 °C (140–194 °F) with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes. • Gloves and protective clothing (e.g. plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.1% sodium hypochlorite solution. Single-use gloves (e.g. nitrile or latex) should be discarded after each use. Perform hand hygiene before putting on and after removing gloves. • Gloves, masks, and other waste generated during home care should be placed into a waste bin with a lid in the patient’s room before disposing of it as infectious waste.e5The onus of disposal of infectious waste resides with the local sanitary authority. • Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g. do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths, or bed linen). d Medical masks are surgical or procedure masks that are flat or pleated (some are shaped like a cup); they are held in place by strings that tie around the back of the head. e The local sanitary authority should adopt measures to ensure that the waste is disposed of at a sanitary landfill and not at an unmonitored open dump. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 3 • When HCWs provide home care, they should perform a risk assessment to select the appropriate personal protective equipment and follow the recommendations for droplet and contact precautions. • For mild laboratory confirmed patients who are cared for at home, to be released from home isolation, cases must test negative using PCR testing twice from samples collected at least 24 hours apart. Where testing is not possible, WHO recommends that confirmed patients remain isolated for an additional two weeks after symptoms resolve. Management of contacts Persons (including caregivers and HCWs) who have been exposed to individuals with suspected COVID-19 are considered contacts and should be advised to monitor their health for 14 days from the last day of possible contact. A contact is a person who is involved in any of the following from 2 days before and up to 14 days after the onset of symptoms in the patient:5 • Having face-to-face contact with a COVID-19 patient within 1 meter and for >15 minutes; • Providing direct care for patients with COVID-19 disease without using proper personal protective equipment; • Staying in the same close environment as a COVID-19 patient (including sharing a workplace, classroom or household or being at the same gathering) for any amount of time; • Travelling in close proximity with (that is, within 1 m separation from) a COVID-19 patient in any kind of conveyance; • and other situations, as indicated by local risk assessments. A way for caregivers to communicate with a health care provider should be established for the duration of the observation period. Also, health care personnel should review the health of contacts regularly by phone but, ideally and if feasible, through daily in-person visits, so specific diagnostic tests can be performed as necessary. The health care provider should give instructions to contacts in advance about when and where to seek care if they become ill, the most appropriate mode of transportation to use, when and where to enter the designated health care facility, and which IPC precautions should be followed. If a contact develops symptoms, the following steps should be taken. • Notify the receiving medical facility that a symptomatic contact will be arriving. • While traveling to seek care, the contact should wear a medical mask. • The contact should avoid taking public transportation to the facility if possible; an ambulance can be called, or the ill contact can be transported in a private vehicle with all windows open, if possible. • The symptomatic contact should be advised to perform respiratory hygiene and hand hygiene and to stand or sit as far away from others as possible (at least 1 metre) when in transit and when in the health care facility. • Any surfaces that become soiled with respiratory secretions or other body fluids during transport should be cleaned with soap or detergent and then disinfected with a regular household product containing a 0.5% diluted bleach solution. Acknowledgements The original version of the MERS-CoV IPC guidance (1) that constituted the basis for this document was developed in consultation with WHO’s Global Infection Prevention and Control Network and other international experts. WHO thanks those who were involved in developing the IPC documents for MERS-CoV. WHO thanks the following individuals for providing review: Abdullah M Assiri, Director General, Infection Control, Ministry of Health, Saudi Arabia; Michael Bell, Deputy Director of the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Gail Carson, ISARIC Global Support Centre, Director of Network Development, Consultant in Infectious Diseases, and Honorary Consultant with Public Health England, United Kingdom; John M Conly, Department of Medicine, Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary, Calgary, Canada; Barry Cookson, Division of Infection and Immunity, University College London, United Kingdom; Babacar NDoye, Board Member, Infection Control Network, Dakar, Senegal; Kathleen Dunn, Manager, Healthcare-Associated Infections and Infection Prevention and Control Section, Centre for Communicable Disease Prevention and Control, Public Health Agency of Canada; Dale Fisher, Global Outbreak Alert and Response Network Steering Committee; Fernanda Lessa, Epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Moi Lin Ling, Director, Infection Control Department, Singapore General Hospital, Singapore, and President of Asia Pacific Society of Infection Control; Didier Pittet, Director, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and Faculty of Medicine, Geneva, Switzerland; Fernando Otaiza O’Ryan, Head, National IPC Program, Ministry of Health, Santiago, Chile; Diamantis Plachouras, Unit of Surveillance and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden; Wing Hong Seto, Department of Community Medicine, School of Public Health, University of Hong Kong, China, Hong Kong Special Administrative Region; Nandini Shetty, Consultant Microbiologist, Reference Microbiology Services, Health Protection Agency, Colindale, United Kingdom; Rachel M. Smith, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 4 From WHO we also thank: Benedetta Allegranzi, Gertrude Avortri, April Baller, Ana Paula Coutinho, Nino Dal Dayanghirang, Christine Francis, Pierre Clave Kariyo, Maria Clara Padoveze, Joao Paulo Toledo, Nahoko Shindo, Valeska Stempliuk, and Maria Van Kerkhove. References 1. World Health Organization. Home care for patients with Middle East respiratory syndrome coronavirus (MERS- CoV) infection presenting with mild symptoms and management of contacts: interim guidance (accessed 26 January 2020). 2. World Health Organization. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. (accessed 26 January 2020). 3. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID- 19 disease is suspected. Geneva: World Health Organization; 2020 (accessed 17 March 2020). 4. World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge. (accessed 20 January 2020). 5. World Health Organization. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance (accessed 17 March 2020). Further references World Health Organization. Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance, (accessed 20 January 2020). World Health Organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance, (accessed 20 January 2020). World Health Organization. Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS- CoV) infection: interim guidance. (accessed 20 January 2020). Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44167, accessed 20 January 2020). Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/330676, accessed 20 January 2020). Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013; 18(11): 20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO will issue a further update. Otherwise, this interim guidance document will expire 2 years after the date of publication. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. WHO reference number: WHO/nCov/IPC/HomeCare/2020.3
1 Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts Interim guidance 17 March 2020 Background WHO has developed this interim guidance to meet the need for recommendations on safe home care for patients with suspected COVID-19 who present with mild symptomsa and on public health measures related to the management of their contacts. This document was adapted from the interim guidance on Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 20181 and is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic- prone acute respiratory diseases in health care,2 and based on current information on COVID-19. This rapid advice has been updated with the latest information and is intended to guide public health and infection prevention and control (IPC) professionals, health care managers and health care workers (HCWs) when addressing issues related to home care for patients with suspected COVID-19 who present with mild symptoms and when managing their contacts. This guidance is based on evidence about COVID-19 and the feasibility of implementing IPC measures at home. For the purpose of this document, “caregivers” refers to parents, spouses, and other family members or friends without formal health care training. Please refer to the Global Surveillance for human infection with coronavirus disease (COVID-19) for case definitions. Please refer to Infection prevention and control during health care when COVID-19 is suspected for guidance on IPC at the health care facility level. Where to manage COVID-19 patients WHO recommends that all laboratory confirmed cases be isolated and cared for in a health care facility. WHO recommends that all persons with suspected COVID-19 who have severe acute respiratory infection be triaged at the first point of contact with the health care system and that emergency treatment should be started based on disease severity. WHO has updated treatment guidelines for patients with ARI associated with COVID-19, which includes guidance for vulnerable populations (e.g., older adults, pregnant women and children). In situations where isolation in a health care facility of all cases is not possible, WHO emphasizes the prioritization of those with highest probability of poor outcomes: patients with severe and critical illness and a Mild illness may include: uncomplicated upper respiratory tract viral infection symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise, muscle pain, sore those with mild disease and risk for poor outcome (age >60 years, cases with underlying co-morbidities, e.g., chronic cardiovascular disease, chronic respiratory disease, diabetes, cancer). If all mild cases cannot be isolated in health facilities, then those with mild illness and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and laboratory tests for COVID-19 virus are negative. Alternatively, patients with mild disease and no risk factors can be managed at home. Home care for patients with suspected COVID-19 who present with mild symptoms For those presenting with mild illness, hospitalization may not be possible because of the burden on the health care system, or required unless there is concern about rapid deterioration.3 If there are patients with only mild illness, providing care at home may be considered, as long as they can be followed up and cared for by family members. Home care may also be considered when inpatient care is unavailable or unsafe (e.g. capacity is limited, and resources are unable to meet the demand for health care services). In any of these situations, patients with mild symptoms1 and without underlying chronic conditions − such as lung or heart disease, renal failure, or immunocompromising conditions that place the patient at increased risk of developing complications − may be cared for at home. This decision requires careful clinical judgment and should be informed by an assessment of the safety of the patient’s home environment.b2 In cases in which care is to be provided at home, if and where feasible, a trained HCW should conduct an assessment to verify whether the residential setting is suitable for providing care; the HCW must assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house) and can address safety concerns (e.g., accidental ingestion of and fire hazards associated with using alcohol-based hand rubs). If and where feasible, a communication link with health care provider or public health personnel, or both, should be established for the duration of the home care period – that is, until the patient’s symptoms have completely resolved. More throat, dyspnea, nasal congestion, or headache. Rarely, patients may also present with diarrhoea, nausea, and vomiting. b A sample checklist for assessing environmental conditions in the home is available in the Annex C of reference 2. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 2 comprehensive information about COVID-19 and its transmission is required to define the duration of home isolation precautions. Patients and household members should be educated about personal hygiene, basic IPC measures, and how to care as safely as possible for the person suspected of having COVID- 19 to prevent the infection from spreading to household contacts. The patient and household members should be provided with ongoing support and education, and monitoring should continue for the duration of home care. Household members should adhere to the following recommendations. • Place the patient in a well-ventilated single room (i.e. with open windows and an open door). • Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated (keep windows open). • Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 metre from the ill person (e.g. sleep in a separate bed).c3 • Limit the number of caregivers. Ideally, assign one person who is in good health and has no underlying chronic or immunocompromising conditions.3 Visitors should not be allowed until the patient has completely recovered and has no signs or symptoms of COVID-19. • Perform hand hygiene after any type of contact with patients or their immediate environment.4 Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water. • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently. • To contain respiratory secretions, a medical maskd 4 should be provided to the patient and worn as much as possible, and changed daily. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene; that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g. wash handkerchiefs using regular soap or detergent and water). • Caregivers should wear a medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask. c An exception may be made for breastfeeding mothers. Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother could can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document. Remove the mask using the appropriate technique – that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene. • Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine, and other waste. Perform hand hygiene before and after removing gloves and the mask. • Do not reuse masks or gloves. • Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded. • Daily clean and disinfect surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bedframes, and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1% sodium hypochlorite (i.e. equivalent to 1000 ppm) should be applied. • Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1% sodium hypochlorite should be applied. • Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water or machine wash at 60–90 °C (140–194 °F) with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes. • Gloves and protective clothing (e.g. plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.1% sodium hypochlorite solution. Single-use gloves (e.g. nitrile or latex) should be discarded after each use. Perform hand hygiene before putting on and after removing gloves. • Gloves, masks, and other waste generated during home care should be placed into a waste bin with a lid in the patient’s room before disposing of it as infectious waste.e5The onus of disposal of infectious waste resides with the local sanitary authority. • Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g. do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths, or bed linen). d Medical masks are surgical or procedure masks that are flat or pleated (some are shaped like a cup); they are held in place by strings that tie around the back of the head. e The local sanitary authority should adopt measures to ensure that the waste is disposed of at a sanitary landfill and not at an unmonitored open dump. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 3 • When HCWs provide home care, they should perform a risk assessment to select the appropriate personal protective equipment and follow the recommendations for droplet and contact precautions. • For mild laboratory confirmed patients who are cared for at home, to be released from home isolation, cases must test negative using PCR testing twice from samples collected at least 24 hours apart. Where testing is not possible, WHO recommends that confirmed patients remain isolated for an additional two weeks after symptoms resolve. Management of contacts Persons (including caregivers and HCWs) who have been exposed to individuals with suspected COVID-19 are considered contacts and should be advised to monitor their health for 14 days from the last day of possible contact. A contact is a person who is involved in any of the following from 2 days before and up to 14 days after the onset of symptoms in the patient:5 • Having face-to-face contact with a COVID-19 patient within 1 meter and for >15 minutes; • Providing direct care for patients with COVID-19 disease without using proper personal protective equipment; • Staying in the same close environment as a COVID-19 patient (including sharing a workplace, classroom or household or being at the same gathering) for any amount of time; • Travelling in close proximity with (that is, within 1 m separation from) a COVID-19 patient in any kind of conveyance; • and other situations, as indicated by local risk assessments. A way for caregivers to communicate with a health care provider should be established for the duration of the observation period. Also, health care personnel should review the health of contacts regularly by phone but, ideally and if feasible, through daily in-person visits, so specific diagnostic tests can be performed as necessary. The health care provider should give instructions to contacts in advance about when and where to seek care if they become ill, the most appropriate mode of transportation to use, when and where to enter the designated health care facility, and which IPC precautions should be followed. If a contact develops symptoms, the following steps should be taken. • Notify the receiving medical facility that a symptomatic contact will be arriving. • While traveling to seek care, the contact should wear a medical mask. • The contact should avoid taking public transportation to the facility if possible; an ambulance can be called, or the ill contact can be transported in a private vehicle with all windows open, if possible. • The symptomatic contact should be advised to perform respiratory hygiene and hand hygiene and to stand or sit as far away from others as possible (at least 1 metre) when in transit and when in the health care facility. • Any surfaces that become soiled with respiratory secretions or other body fluids during transport should be cleaned with soap or detergent and then disinfected with a regular household product containing a 0.5% diluted bleach solution. Acknowledgements The original version of the MERS-CoV IPC guidance (1) that constituted the basis for this document was developed in consultation with WHO’s Global Infection Prevention and Control Network and other international experts. WHO thanks those who were involved in developing the IPC documents for MERS-CoV. WHO thanks the following individuals for providing review: Abdullah M Assiri, Director General, Infection Control, Ministry of Health, Saudi Arabia; Michael Bell, Deputy Director of the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Gail Carson, ISARIC Global Support Centre, Director of Network Development, Consultant in Infectious Diseases, and Honorary Consultant with Public Health England, United Kingdom; John M Conly, Department of Medicine, Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary, Calgary, Canada; Barry Cookson, Division of Infection and Immunity, University College London, United Kingdom; Babacar NDoye, Board Member, Infection Control Network, Dakar, Senegal; Kathleen Dunn, Manager, Healthcare-Associated Infections and Infection Prevention and Control Section, Centre for Communicable Disease Prevention and Control, Public Health Agency of Canada; Dale Fisher, Global Outbreak Alert and Response Network Steering Committee; Fernanda Lessa, Epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Moi Lin Ling, Director, Infection Control Department, Singapore General Hospital, Singapore, and President of Asia Pacific Society of Infection Control; Didier Pittet, Director, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and Faculty of Medicine, Geneva, Switzerland; Fernando Otaiza O’Ryan, Head, National IPC Program, Ministry of Health, Santiago, Chile; Diamantis Plachouras, Unit of Surveillance and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden; Wing Hong Seto, Department of Community Medicine, School of Public Health, University of Hong Kong, China, Hong Kong Special Administrative Region; Nandini Shetty, Consultant Microbiologist, Reference Microbiology Services, Health Protection Agency, Colindale, United Kingdom; Rachel M. Smith, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 4 From WHO we also thank: Benedetta Allegranzi, Gertrude Avortri, April Baller, Ana Paula Coutinho, Nino Dal Dayanghirang, Christine Francis, Pierre Clave Kariyo, Maria Clara Padoveze, Joao Paulo Toledo, Nahoko Shindo, Valeska Stempliuk, and Maria Van Kerkhove. References 1. World Health Organization. Home care for patients with Middle East respiratory syndrome coronavirus (MERS- CoV) infection presenting with mild symptoms and management of contacts: interim guidance (accessed 26 January 2020). 2. World Health Organization. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. (accessed 26 January 2020). 3. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID- 19 disease is suspected. Geneva: World Health Organization; 2020 (accessed 17 March 2020). 4. World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge. (accessed 20 January 2020). 5. World Health Organization. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance (accessed 17 March 2020). Further references World Health Organization. Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance, (accessed 20 January 2020). World Health Organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance, (accessed 20 January 2020). World Health Organization. Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS- CoV) infection: interim guidance. (accessed 20 January 2020). Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44167, accessed 20 January 2020). Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/330676, accessed 20 January 2020). Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013; 18(11): 20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO will issue a further update. Otherwise, this interim guidance document will expire 2 years after the date of publication. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. WHO reference number: WHO/nCov/IPC/HomeCare/2020.3
1 Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts Interim guidance 17 March 2020 Background WHO has developed this interim guidance to meet the need for recommendations on safe home care for patients with suspected COVID-19 who present with mild symptomsa and on public health measures related to the management of their contacts. This document was adapted from the interim guidance on Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 20181 and is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic- prone acute respiratory diseases in health care,2 and based on current information on COVID-19. This rapid advice has been updated with the latest information and is intended to guide public health and infection prevention and control (IPC) professionals, health care managers and health care workers (HCWs) when addressing issues related to home care for patients with suspected COVID-19 who present with mild symptoms and when managing their contacts. This guidance is based on evidence about COVID-19 and the feasibility of implementing IPC measures at home. For the purpose of this document, “caregivers” refers to parents, spouses, and other family members or friends without formal health care training. Please refer to the Global Surveillance for human infection with coronavirus disease (COVID-19) for case definitions. Please refer to Infection prevention and control during health care when COVID-19 is suspected for guidance on IPC at the health care facility level. Where to manage COVID-19 patients WHO recommends that all laboratory confirmed cases be isolated and cared for in a health care facility. WHO recommends that all persons with suspected COVID-19 who have severe acute respiratory infection be triaged at the first point of contact with the health care system and that emergency treatment should be started based on disease severity. WHO has updated treatment guidelines for patients with ARI associated with COVID-19, which includes guidance for vulnerable populations (e.g., older adults, pregnant women and children). In situations where isolation in a health care facility of all cases is not possible, WHO emphasizes the prioritization of those with highest probability of poor outcomes: patients with severe and critical illness and a Mild illness may include: uncomplicated upper respiratory tract viral infection symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise, muscle pain, sore those with mild disease and risk for poor outcome (age >60 years, cases with underlying co-morbidities, e.g., chronic cardiovascular disease, chronic respiratory disease, diabetes, cancer). If all mild cases cannot be isolated in health facilities, then those with mild illness and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and laboratory tests for COVID-19 virus are negative. Alternatively, patients with mild disease and no risk factors can be managed at home. Home care for patients with suspected COVID-19 who present with mild symptoms For those presenting with mild illness, hospitalization may not be possible because of the burden on the health care system, or required unless there is concern about rapid deterioration.3 If there are patients with only mild illness, providing care at home may be considered, as long as they can be followed up and cared for by family members. Home care may also be considered when inpatient care is unavailable or unsafe (e.g. capacity is limited, and resources are unable to meet the demand for health care services). In any of these situations, patients with mild symptoms1 and without underlying chronic conditions − such as lung or heart disease, renal failure, or immunocompromising conditions that place the patient at increased risk of developing complications − may be cared for at home. This decision requires careful clinical judgment and should be informed by an assessment of the safety of the patient’s home environment.b2 In cases in which care is to be provided at home, if and where feasible, a trained HCW should conduct an assessment to verify whether the residential setting is suitable for providing care; the HCW must assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house) and can address safety concerns (e.g., accidental ingestion of and fire hazards associated with using alcohol-based hand rubs). If and where feasible, a communication link with health care provider or public health personnel, or both, should be established for the duration of the home care period – that is, until the patient’s symptoms have completely resolved. More throat, dyspnea, nasal congestion, or headache. Rarely, patients may also present with diarrhoea, nausea, and vomiting. b A sample checklist for assessing environmental conditions in the home is available in the Annex C of reference 2. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 2 comprehensive information about COVID-19 and its transmission is required to define the duration of home isolation precautions. Patients and household members should be educated about personal hygiene, basic IPC measures, and how to care as safely as possible for the person suspected of having COVID- 19 to prevent the infection from spreading to household contacts. The patient and household members should be provided with ongoing support and education, and monitoring should continue for the duration of home care. Household members should adhere to the following recommendations. • Place the patient in a well-ventilated single room (i.e. with open windows and an open door). • Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated (keep windows open). • Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 metre from the ill person (e.g. sleep in a separate bed).c3 • Limit the number of caregivers. Ideally, assign one person who is in good health and has no underlying chronic or immunocompromising conditions.3 Visitors should not be allowed until the patient has completely recovered and has no signs or symptoms of COVID-19. • Perform hand hygiene after any type of contact with patients or their immediate environment.4 Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water. • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently. • To contain respiratory secretions, a medical maskd 4 should be provided to the patient and worn as much as possible, and changed daily. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene; that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g. wash handkerchiefs using regular soap or detergent and water). • Caregivers should wear a medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask. c An exception may be made for breastfeeding mothers. Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother could can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document. Remove the mask using the appropriate technique – that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene. • Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine, and other waste. Perform hand hygiene before and after removing gloves and the mask. • Do not reuse masks or gloves. • Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded. • Daily clean and disinfect surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bedframes, and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1% sodium hypochlorite (i.e. equivalent to 1000 ppm) should be applied. • Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1% sodium hypochlorite should be applied. • Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water or machine wash at 60–90 °C (140–194 °F) with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes. • Gloves and protective clothing (e.g. plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.1% sodium hypochlorite solution. Single-use gloves (e.g. nitrile or latex) should be discarded after each use. Perform hand hygiene before putting on and after removing gloves. • Gloves, masks, and other waste generated during home care should be placed into a waste bin with a lid in the patient’s room before disposing of it as infectious waste.e5The onus of disposal of infectious waste resides with the local sanitary authority. • Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g. do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths, or bed linen). d Medical masks are surgical or procedure masks that are flat or pleated (some are shaped like a cup); they are held in place by strings that tie around the back of the head. e The local sanitary authority should adopt measures to ensure that the waste is disposed of at a sanitary landfill and not at an unmonitored open dump. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 3 • When HCWs provide home care, they should perform a risk assessment to select the appropriate personal protective equipment and follow the recommendations for droplet and contact precautions. • For mild laboratory confirmed patients who are cared for at home, to be released from home isolation, cases must test negative using PCR testing twice from samples collected at least 24 hours apart. Where testing is not possible, WHO recommends that confirmed patients remain isolated for an additional two weeks after symptoms resolve. Management of contacts Persons (including caregivers and HCWs) who have been exposed to individuals with suspected COVID-19 are considered contacts and should be advised to monitor their health for 14 days from the last day of possible contact. A contact is a person who is involved in any of the following from 2 days before and up to 14 days after the onset of symptoms in the patient:5 • Having face-to-face contact with a COVID-19 patient within 1 meter and for >15 minutes; • Providing direct care for patients with COVID-19 disease without using proper personal protective equipment; • Staying in the same close environment as a COVID-19 patient (including sharing a workplace, classroom or household or being at the same gathering) for any amount of time; • Travelling in close proximity with (that is, within 1 m separation from) a COVID-19 patient in any kind of conveyance; • and other situations, as indicated by local risk assessments. A way for caregivers to communicate with a health care provider should be established for the duration of the observation period. Also, health care personnel should review the health of contacts regularly by phone but, ideally and if feasible, through daily in-person visits, so specific diagnostic tests can be performed as necessary. The health care provider should give instructions to contacts in advance about when and where to seek care if they become ill, the most appropriate mode of transportation to use, when and where to enter the designated health care facility, and which IPC precautions should be followed. If a contact develops symptoms, the following steps should be taken. • Notify the receiving medical facility that a symptomatic contact will be arriving. • While traveling to seek care, the contact should wear a medical mask. • The contact should avoid taking public transportation to the facility if possible; an ambulance can be called, or the ill contact can be transported in a private vehicle with all windows open, if possible. • The symptomatic contact should be advised to perform respiratory hygiene and hand hygiene and to stand or sit as far away from others as possible (at least 1 metre) when in transit and when in the health care facility. • Any surfaces that become soiled with respiratory secretions or other body fluids during transport should be cleaned with soap or detergent and then disinfected with a regular household product containing a 0.5% diluted bleach solution. Acknowledgements The original version of the MERS-CoV IPC guidance (1) that constituted the basis for this document was developed in consultation with WHO’s Global Infection Prevention and Control Network and other international experts. WHO thanks those who were involved in developing the IPC documents for MERS-CoV. WHO thanks the following individuals for providing review: Abdullah M Assiri, Director General, Infection Control, Ministry of Health, Saudi Arabia; Michael Bell, Deputy Director of the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Gail Carson, ISARIC Global Support Centre, Director of Network Development, Consultant in Infectious Diseases, and Honorary Consultant with Public Health England, United Kingdom; John M Conly, Department of Medicine, Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary, Calgary, Canada; Barry Cookson, Division of Infection and Immunity, University College London, United Kingdom; Babacar NDoye, Board Member, Infection Control Network, Dakar, Senegal; Kathleen Dunn, Manager, Healthcare-Associated Infections and Infection Prevention and Control Section, Centre for Communicable Disease Prevention and Control, Public Health Agency of Canada; Dale Fisher, Global Outbreak Alert and Response Network Steering Committee; Fernanda Lessa, Epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Moi Lin Ling, Director, Infection Control Department, Singapore General Hospital, Singapore, and President of Asia Pacific Society of Infection Control; Didier Pittet, Director, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and Faculty of Medicine, Geneva, Switzerland; Fernando Otaiza O’Ryan, Head, National IPC Program, Ministry of Health, Santiago, Chile; Diamantis Plachouras, Unit of Surveillance and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden; Wing Hong Seto, Department of Community Medicine, School of Public Health, University of Hong Kong, China, Hong Kong Special Administrative Region; Nandini Shetty, Consultant Microbiologist, Reference Microbiology Services, Health Protection Agency, Colindale, United Kingdom; Rachel M. Smith, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts 4 From WHO we also thank: Benedetta Allegranzi, Gertrude Avortri, April Baller, Ana Paula Coutinho, Nino Dal Dayanghirang, Christine Francis, Pierre Clave Kariyo, Maria Clara Padoveze, Joao Paulo Toledo, Nahoko Shindo, Valeska Stempliuk, and Maria Van Kerkhove. References 1. World Health Organization. Home care for patients with Middle East respiratory syndrome coronavirus (MERS- CoV) infection presenting with mild symptoms and management of contacts: interim guidance (accessed 26 January 2020). 2. World Health Organization. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. (accessed 26 January 2020). 3. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID- 19 disease is suspected. Geneva: World Health Organization; 2020 (accessed 17 March 2020). 4. World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge. (accessed 20 January 2020). 5. World Health Organization. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance (accessed 17 March 2020). Further references World Health Organization. Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance, (accessed 20 January 2020). World Health Organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance, (accessed 20 January 2020). World Health Organization. Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS- CoV) infection: interim guidance. (accessed 20 January 2020). Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44167, accessed 20 January 2020). Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/330676, accessed 20 January 2020). Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013; 18(11): 20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO will issue a further update. Otherwise, this interim guidance document will expire 2 years after the date of publication. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. WHO reference number: WHO/nCov/IPC/HomeCare/2020.3
-1- Уход на дому за пациентами со слабо выраженными симптомами COVID-19 и тактика ведения контактных лиц Временные рекомендации 17 марта 2020 г. Справочная информация ВОЗ разработала настоящие временные рекомендации для восполнения потребности в указаниях по безопасному уходу на дому за пациентами с подозрением на заражение COVID-19, у которых заболевание протекает в легкой формеa, а также по мерам общественного здравоохранения, касающимся тактики ведения контактных лиц. 1 Данный документ представляет собой адаптированную версию временных рекомендаций, разработанных для ближневосточного респираторного синдрома, вызванного коронавирусом (БВРС-КоВ), которые были опубликованы в июне 2018 г.1, и был составлен на основе опубликованных ВОЗ научно обоснованных рекомендаций, включая руководство «Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care» (Профилактика инфекций и борьба с острыми респираторными инфекциями, способными вызывать эпидемии и пандемии, при оказании медико-санитарной помощи)2, а также имеющейся на сегодняшний день информации о COVID-19. Настоящие краткие рекомендации были обновлены с учетом последних данных и предназначены для применения специалистами в области общественного здравоохранения, работниками служб профилактики инфекций и инфекционного контроля (ПИИК), руководителями системы здравоохранения, а также медицинскими работниками при решении вопросов, связанных с организацией ухода на дому за пациентами с подозрением на заражение COVID-19, имеющими слабо выраженные симптомы, и при ведении контактных лиц. В основу данных рекомендаций положены фактические данные о COVID-19 и о возможностях реализации мер ПИИК на дому. Для целей настоящего документа понятие лиц, осуществляющих уход, относится к родителям, супругам и другим членам семьи или близким, не имеющим медицинского образования. Определения случаев заболевания представлены в документе Глобальный эпиднадзор за случаями заболевания COVID-19, вызванного заражением человека новым коронавирусом (COVID-19). Рекомендации в отношении мер ПИИК на уровне лечебно-профилактических учреждений (ЛПУ) представлены в документе Профилактика инфекций и инфекционный контроль при оказании медицинской помощи пациентам с подозрением на COVID-19. a К симптомам легкого течения заболевания могут относиться симптомы неосложненного течения вирусной инфекции верхних дыхательных путей, такие как повышение температуры тела, утомляемость, кашель (с отделением или без Места оказания помощи пациентам с COVID-19 ВОЗ рекомендует изолировать и оказывать помощь всем пациентам с лабораторно подтвержденными случаями заболевания в ЛПУ. ВОЗ рекомендует проводить сортировку всех пациентов с подозрением на заражение COVID-19 и симптомами тяжелого течения острой респираторной инфекции при первом обращении за медицинской помощью, а при соответствующей степени тяжести – приступать к экстренному лечению. ВОЗ обновила рекомендации по лечению пациентов с ОРИ, ассоциированными с COVID-19, которые включают рекомендации в отношении уязвимых групп населения (например, пожилых людей, беременных женщин и детей). ВОЗ подчеркивает, что в ситуациях, при которых изоляция всех заболевших в ЛПУ невозможна, первоочередное внимание должно быть уделено лицам, имеющим наивысшую вероятность неблагоприятного исхода: пациентам в тяжелом и крайне тяжелом состоянии, а также лицам с легкой формой заболевания, находящимся в группе риска по неблагоприятному исходу (возраст старше 60 лет, наличие фоновых заболеваний, например, хронических сердечно-сосудистых заболеваний, хронических респираторных заболеваний, диабета, рака). Если обеспечить изоляцию в ЛПУ всех пациентов с легкой формой заболевания невозможно, пациенты, на которых не распространяются факторы риска, подлежат изоляции нетрадиционным способом, например, в переоборудованных гостиницах, стадионах или спортзалах, где они смогут находиться до момента разрешения симптомов заболевания и получения отрицательных лабораторных тестов на COVID-19. В качестве альтернативы, уход за пациентами с легкой формой заболевания и без факторов риска также может быть организован на дому. Уход на дому за пациентами с подозрением на заражение COVID-19, имеющими слабо выраженные симптомы В случае пациентов со слабо выраженными симптомами госпитализация может быть невозможна ввиду существующей нагрузки на систему здравоохранения или не требоваться, если нет риска быстрого ухудшения состояния3. Для пациентов, имеющих только слабо выраженные симптомы, возможна организация ухода на дому при условии наблюдения и ухода за такими пациентами со стороны родственников. Кроме того, отделения мокроты), анорексия, недомогание, боль в мышцах, боль в горле, одышка, заложенность носа или головная боль. В редких случаях у пациентов может отмечаться диарея, тошнота и рвота. Уход на дому за пациентами с легкой формой заболевания COVID-19 и тактика ведения контактных лиц -2- организация ухода на дому может быть рассмотрена в ситуациях, когда госпитализация невозможна или небезопасна (то есть при дефиците потенциала и ресурсов, не позволяющем удовлетворить спрос на медицинские услуги). В любой из этих ситуаций пациентам со слабо выраженными симптомами и отсутствием фоновых хронических заболеваний, таких как болезни легких или сердца, почечная недостаточность или иммунодефицитные состояния, повышающих риск развития осложнений, может быть предложено лечение в домашних условиях. Такое решение следует принимать на основе тщательного анализа клинической ситуации и оценки домашних обстоятельств пациента с точки зрения безопасности лечения в домашних условиях b.2 При планировании помощи на дому в случаях, когда это возможно, в первую очередь необходимо, чтобы подготовленный медицинский работник оценил жилищные условия на предмет их пригодности для организации ухода; необходимо, чтобы медицинский работник оценил готовность пациента и членов семьи к соблюдению мер предосторожности, которые будут рекомендованы для обеспечения изоляции в домашних условиях (например, гигиена рук, респираторная гигиена, уборка помещения, ограничения на перемещение внутри дома и за его пределами), а также к обращению с возможными источниками опасности (например, спиртосодержащими средствами для обработки рук, которые случайно могут быть приняты внутрь, а также являются пожароопасными). При оказании помощи на дому, когда это возможно, в течение всего периода, то есть до полного исчезновения симптомов заболевания, должно быть налажено взаимодействие с поставщиком медицинских услуг или с работником органов общественного здравоохранения, либо с обеими этими службами одновременно. Для определения продолжительности мер предосторожности при изоляции пациента на дому необходима более полная информация о заболевании COVID-19 и особенностях передачи возбудителя. Необходимо разъяснить пациентам и членам домохозяйства правила личной гигиены, основные меры ПИИК, а также порядок организации безопасного ухода за лицом с подозрением на заражение COVID-19, с тем чтобы оказание помощи создавало как можно меньший риск заражения членов домохозяйства. Пациенту и членам домохозяйства необходимо оказывать непрерывную поддержку, проводить с ними санитарно- просветительскую работу и постоянно наблюдать за их состоянием в течение всего периода ухода на дому. Члены домохозяйства должны соблюдать следующие рекомендации. b Образец контрольного перечня для оценки домашних условий представлен в приложении С к документу 2 в списке литературы. c Для кормящих матерей может быть сделано исключение. Учитывая преимущества грудного вскармливания и незначительную роль грудного молока в передаче других респираторных вирусов, мать может продолжать кормить ребенка грудью. При этом, когда находится рядом с ребенком, поместите пациента в отдельную, хорошо проветриваемую комнату (то есть с открытыми окнами и открытой дверью); ограничьте передвижения пациента по дому и постарайтесь свести к минимуму его пребывание в одном помещении с другими людьми. Следите за тем, чтобы общие помещения (например, кухня, ванная комната) хорошо проветривались (держите окна открытыми); члены домохозяйства должны оставаться в другой комнате или, при отсутствии такой возможности, находиться на расстоянии не менее одного метра от заболевшего (например, спать на отдельной кровати) c;3 ограничьте количество лиц, ухаживающих за пациентом. В идеале выберите одного человека с крепким здоровьем, без хронических заболеваний или иммунодефицитных состояний3. Необходимо исключить визиты посетителей к больному до момента полного выздоровления и исчезновения любых признаков и симптомов COVID-19; осуществляйте гигиену рук, после любого контакта с пациентом или с окружающими его предметами4. Кроме того, гигиену рук необходимо осуществлять до и после приготовления пищи, перед едой, после посещения туалета и всякий раз, когда они выглядят грязными. Если на руках нет видимых следов загрязнения, то их можно обрабатывать спиртосодержащими средствами для рук. Если руки заметно загрязнены, их следует мыть водой с мылом; для вытирания рук после мытья водой с мылом желательно использовать одноразовые бумажные полотенца. Если бумажных полотенец нет в наличии, следует использовать чистые тканевые полотенца и регулярно их заменять; 4 пациенту следует предоставить медицинскую маскуd, которую он должен носить по возможности постоянно и которую необходимо ежедневно менять, что будет препятствовать распространению выделений из дыхательных путей. Если человек не переносит наличия на лице медицинской маски, он должен строго соблюдать правила респираторной гигиены: прикрывать рот и нос при кашле или чихании одноразовой бумажной салфеткой. Материалы для прикрывания рта или носа после применения следует утилизировать или очистить соответствующим образом (например, стирать носовые платки в воде с помощью обычного мыла или моющих средств); ухаживающий за больным, находясь в одной комнате с пациентом, должен носить медицинскую маску, которая защищает нос и рот. Не следует прикасаться к маске или поправлять ее во время использования. она должна носить медицинскую маску и тщательно соблюдать гигиену рук до и после тесного контакта с младенцем. Кроме того, она должна выполнять другие правила гигиены, описанные в настоящем документе. d Медицинские маски – это хирургические или процедурные маски, плоские или плиссированные (некоторые из них имеют чашкообразную форму), которые фиксируются с помощью завязок со стороны затылка. Уход на дому за пациентами с легкой формой заболевания COVID-19 и тактика ведения контактных лиц -3- Если маска промокла или загрязнилась выделениями, ее следует немедленно заменить новой сухой и чистой маской. Снимайте маску, используя надлежащую методику, то есть взявшись за резинки сзади, не прикасаясь к передней части маски. Использованную маску следует утилизировать, после чего необходимо осуществить гигиену рук; избегайте прямого контакта с биологическими жидкостями больного, особенно с выделениями из ротовой полости или дыхательных путей, и с калом больного. При осуществлении ухода за полостью рта или дыхательными путями больного и при обращении с его калом, мочой и другими отходами используйте одноразовые перчатки и маску. До и после снятия перчаток и маски необходимо осуществить гигиену рук; не допускайте повторного использования масок или перчаток; для пациента следует выделить отдельное постельное белье и столовые приборы; после использования их следует мыть водой с мылом, и их можно повторно использовать, а не утилизировать; поверхности, к которым регулярно прикасается больной, такие как прикроватные тумбочки, спинки кровати и другие предметы мебели в комнате больного, необходимо ежедневно мыть и дезинфицировать. Для первичной обработки следует использовать бытовое мыло или моющие средства; после ополаскивания поверхности обрабатываются бытовым дезинфицирующим средством, содержащим 0,1% гипохлорита натрия (эквивалент 1000 чнм); поверхности ванны и туалета следует мыть и дезинфицировать не реже одного раза в сутки. Для первичной обработки следует использовать бытовое мыло или моющие средства; после ополаскивания поверхности обрабатываются бытовым дезинфицирующим средством, содержащим 0,1% гипохлорита натрия; одежду, постельные принадлежности, полотенца для душа и рук, которыми пользуется больной, следует стирать вручную с обычным хозяйственным мылом или в стиральной машине с обычным стиральным средством при температуре 60–90°C (140-1940F), а затем тщательно просушивать. Грязное белье больного следует складывать в мешок для стирки. Его не следует встряхивать, и необходимо избегать контакта кожи или одежды с контаминированными материалами; очистку и обработку поверхностей, одежды или постельного белья, загрязненных жидкими выделениями больного, следует производить только в одноразовых перчатках и с использованием защитной одежды (например, фартуков из полимерного материала). В зависимости от конкретных обстоятельств следует пользоваться хозяйственными или одноразовыми перчатками. e Местным органам санитарно-эпидемиологического надзора следует принять меры для обеспечения доставки таких отходов на санитарные свалки, не допуская их попадания на После использования хозяйственные перчатки следует вымыть с мылом и деконтаминировать 0,1%-ным раствором гипохлорита натрия. Использованные одноразовые перчатки (например, нитриловые или латексные) следует утилизировать. Перед надеванием и после снятия перчаток осуществляйте гигиену рук; перчатки, маски и другие отходные материалы, которые образовались при уходе за пациентом на дому, до утилизации следует хранить в закрывающемся контейнере в комнате больногоe. Ответственность за утилизацию инфицированных отходов лежит на местных органах санитарно-эпидемиологического надзора; 5 избегайте других контактов с контаминированными предметами, которыми пользуется пациент (например, избегайте совместного пользования зубными щетками, сигаретами, столовыми приборами, посудой, чашками, полотенцами, мочалками или постельными принадлежностями); медицинские работники, оказывающие помощь на дому, должны провести оценку риска, чтобы выбрать надлежащие средства индивидуальной защиты, а также следовать рекомендациям в отношении мер предосторожности для защиты от воздушно-капельных и контактных инфекций; период изоляции пациентов, страдающих от легкой формы лабораторно подтвержденного заболевания и получающих уход на дому, завершается после двукратного получения отрицательных результатов ПЦР-исследования с интервалом не менее 24 часов. При невозможности выполнения такого тестирования ВОЗ рекомендует пациентам с подтвержденными случаями заболевания дополнительно продлить срок изоляции на две недели после исчезновения симптомов. Тактика ведения контактных лиц Всех лиц (включая лиц, осуществлявших уход, и медицинских работников), которые могли контактировать с больными, подозрительными на заражение COVID-19, целесообразно считать контактными, и следует рекомендовать им контролировать состояние своего здоровья в течение 14 дней с момента последнего возможного контакта. Определению контактных соответствуют лица, которые в период от двух дней до или 14 дней после возникновения симптомов у пациента5: имели непосредственный контакт с пациентом, зараженным COVID-19, на расстоянии в пределах одного метра свыше 15 минут; непосредственно осуществляли уход за пациентом, зараженным COVID-19, без применения надлежащих средств индивидуальной защиты; открытые свалки, расположенные на неохраняемой территории. Уход на дому за пациентами с легкой формой заболевания COVID-19 и тактика ведения контактных лиц -4- находились в непосредственной близости от пациента, зараженного COVID-19 (включая нахождение на рабочем месте, в классе, в домохозяйстве, на собрании), в продолжение любого времени; совершали поездки в любом виде транспорта в непосредственной близости от пациента с COVID-19 (то есть на расстоянии менее одного метра); совершали иные действия, предусмотренные местными рекомендациями по оценке риска. Необходимо определить способ поддержания связи между медицинскими работниками и лицами, осуществлявшими уход, в течение всего периода наблюдения. Кроме того, в задачу медицинского персонала должна входить регулярная оценка состояния здоровья контактных лиц посредством телефонных звонков, а в идеале, если возможно, посредством личных посещений ежедневно с назначением при необходимости специфических диагностических тестов. Медицинский работник должен заранее дать инструкции контактным лицам о том, когда и куда обратиться за помощью в случае заболевания, на каком виде транспорта необходимо прибыть в назначенное медицинское учреждение, а также какие меры ПИИК следует применять. При возникновении у контактного лица симптомов заболевания следует принять следующие меры: уведомить принимающее медицинское учреждение о направлении пациента, находившегося в контакте с больным и имеющего симптомы заболевания; по пути в медицинское учреждение контактное лицо должно пользоваться медицинской маской; для проезда в медицинское учреждение контактное лицо должно по возможности избегать пользования общественным транспортом; необходимо воспользоваться услугой скорой помощи или перевезти больного на личном автомобиле, открыв все окна автомобиля, если это возможно; контактное лицо, имеющее симптомы заболевания, должно быть информировано о необходимости соблюдения правил респираторной гигиены и гигиены рук, а также о необходимости стоять или сидеть как можно дальше от других людей (не ближе одного метра) как в транспорте, так и в медицинском учреждении; все поверхности, на которые во время транспортировки могли попасть выделения из дыхательных путей или биологические жидкости пациента, следует вымыть с мылом или бытовым моющим средством, а затем обработать бытовым дезинфицирующим средством, содержащим разведенный 0,5%-ный раствор хлорной извести. Выражение признательности Первоначальная версия руководства по мерам ПИИК в отношении БВРС-КоВ (1) была подготовлена при участии Глобальной сети ВОЗ по профилактике инфекций и инфекционному контролю, а также других международных экспертов. ВОЗ выражает благодарность всем, кто принимал участие в разработке и обновлении документов по мерам ПИИК в отношении БВРС-КоВ. ВОЗ благодарит следующих лиц за выполненный ими обзор (в порядке английского алфавита): Абдулла М. Ассири, генеральный директор Службы инфекционного контроля Министерства здравоохранения Саудовской Аравии; Майкл Белл, заместитель директора Отдела повышения качества здравоохранения Центра по контролю и профилактике заболеваний г. Атланта, США; Гейл Карсон, директор по развитию сети Международного центра поддержки ISARIC, консультант по инфекционным заболеваниям и почетный консультант Службы общественного здравоохранения Англии, Соединенное Королевство; Джон М. Конли, Отдел медицины, микробиологии, иммунологии и инфекционных заболеваний, Институт хронических болезней им. Кальвина, Фебе и Джоан Синдер, Медицинский факультет Университета Калгари, Канада; Барри Куксон, Отделение инфекций и иммунитета, Университетский колледж, Лондон, Соединенное Королевство; Бабакар Н. Дуай, член правления Сети инфекционного контроля, Дакар, Сенегал; Катлин Данн, менеджер Секции инфекций, связанных со здравоохранением, профилактики инфекций и инфекционного контроля Центра по профилактике инфекционных болезней и инфекционному контролю Агентство здравоохранения Канады; Дейл Фишер, член руководящего комитета Глобальной сети оповещения о вспышках болезней и ответных мерах; Фернанда Лесса, эпидемиолог Отдела повышения качества здравоохранения Центра по контролю и профилактике заболеваний г. Атланта, США; Мои Лин Линь, директор Отдела инфекционного контроля Сингапурской клинической больницы и президент Азиатско-Тихоокеанского общества инфекционного контроля; Дидье Пите, директор программы ПИИК и Сотрудничающего центра ВОЗ по безопасности пациентов, больницы при Женевском университете и медицинском факультете, Женева, Швейцария; Фернандо Отайза О’Раян, руководитель Национальной программы ПИИК Министерства здравоохранения, Сантьяго, Чили; Диамантис Плачурас, Отдел наблюдения и поддержки реагирования, Европейский центр профилактики и контроля заболеваний, Сольна, Швеция; Вин Хун Сето, Кафедра общественной медицины Факультета общественного здравоохранения Университета Гонконга, Гонконг, Китайская Народная Республика; Нандини Шетти, микробиолог-консультант Справочной службы микробиологии, г. Колиндейл, Агентство защиты здоровья, Соединенное Королевство; Рэйчел Смит, Отдел повышения качества здравоохранения Центра по контролю и профилактике заболеваний г. Атланта, США. Благодарим следующих сотрудников ВОЗ: Бенедетта Аллегранци, Гертруда Авортри, Эйприл Баллер, Ана Паула Коутиньо, Нино Дал Даянгиранг, Кристина Фрэнсис, Пьер Клаве Карийо, Мария Клара Падовезе, Жуан Паула де Толедо, Нахоко Синдо, Валеска Стемплюк и Мария Ван Керхове. Уход на дому за пациентами с легкой формой заболевания COVID-19 и тактика ведения контактных лиц -5- Список литературы 1. World Health Organization. Home care for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection presenting with mild symptoms and management of contacts: interim guidance, по состоянию на 26 января 2020 г. 2. World Health Organization. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care, по состоянию на 26 января 2020 г. 3. Всемирная организация здравоохранения. Клиническое ведение тяжелой острой респираторной инфекции (ТОРИ) при подозрении на COVID-19. Женева: Всемирная организация здравоохранения; 2020 г., по состоянию на 17 марта 2020 г. 4. World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge, по состоянию на 20 января 2020 г. 5. Всемирная организация здравоохранения. Глобальный эпиднадзор за случаями инфекции человека, вызванной новым коронавирусом (2019-nCoV): временные рекомендации, по состоянию на 17 марта 2020 г. Список дополнительной литературы Всемирная организация здравоохранения. Ведение бессимптомных пациентов с положительным результатом ОТ-ПЦР тестирования на коронавирус ближневосточного респираторного синдрома (БВРСКоВ). Временные рекомендации, по состоянию на 20 января 2020 г. Всемирная организация здравоохранения. Клиническое руководство по ведению пациентов с тяжелыми острыми респираторными инфекциями при подозрении на инфицирование коронавирусом ближневосточного респираторного синдрома (БВРС-КоВ): временные рекомендации, по состоянию на 20 января 2020 г. Всемирная организация здравоохранения. Профилактика инфекций и борьба с ними во время оказания медицинской помощи при вероятных или подтвержденных случаях инфицирования коронавирусом ближневосточного респираторного синдрома (БВРС-КоВ). Временное руководство, по состоянию на 20 января 2020 г. Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009. Имеется по адресу (http://apps.who.int/iris/handle/10665/44167, по состоянию на 20 января 2020 г.). Лабораторное тестирование при подозрении на заражение человека новым коронавирусом 2019 г. (2019-nCoV). Временные рекомендации, 17 января 2020 г. Женева: Всемирная организация здравоохранения; 2020 г. Имеется по адресу https://apps.who.int/iris/bitstream/handle/10665/ 330676/9789240001053-rus.pdf?sequence=9&isAllowed=y, по состоянию на 20 января 2020 г. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013; 18(11): 20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140- 6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316 Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. ВОЗ продолжает внимательно следить за ситуацией на предмет любых изменений, которые могут повлиять на эти временные рекомендации. В случае изменения каких-либо факторов ВОЗ выпустит дополнительную обновленную информацию. В противном случае срок действия настоящих временных рекомендаций истекает через 2 года после даты публикации. © Всемирная организация здравоохранения, 2020. Некоторые права защищены. Данная работа распространяется на условиях лицензии CC BY-NC-SA 3.0 IGO. WHO reference number: WHO/2019-nCoV/IPC/HomeCare/2020.3
-1- 症状轻微的 COVID-19 患者的家庭护理及其 接触者管理 临时指导文件 2020年 3月 17日 背景 这份临时指导文件由世卫组织编写，以满足对症状 轻微 a的疑似COVID-19患者的安全家庭护理以及与其接 触者管理相关的公共卫生措施建议的需求。 本文件改编自 2018年 6月发布的关于中东呼吸综合 征冠状病毒（MERS-CoV）感染的临时指导文件 1，参 考了世卫组织发布的循证指南，包括《卫生保健中易流 行和大流行的急性呼吸道感染的感染预防和控制》2，并 以关于 COVID-19的现有信息为基础。 这项快速建议利用最新信息进行了更新，旨在指导 公共卫生和感染预防与控制专业人员、卫生保健管理者 和卫生保健工作者解决与症状轻微的疑似 COVID-19 患 者的家庭护理相关的问题，并对其接触者进行管理。本 指导文件基于关于 COVID-19 的证据和在家中实施感染 预防和控制措施的可行性。就本文件而言，“看护者” 是指未经正式卫生保健培训的父母、配偶及其他家庭成 员或朋友。 关于病例定义，请参阅人类感染冠状病毒病 （COVID-19）情况全球监测。关于医疗机构的感染预 防和控制指导文件，请参阅怀疑 COVID-19 时卫生保健 期间的感染预防和控制。 在哪里管理 COVID-19患者 世卫组织建议隔离所有实验室确诊病患，并在医疗 机构护理这些病患。世卫组织建议，所有有严重急性呼 吸道感染的疑似 COVID-19 患者应在与卫生保健系统接 触的第一时间进行分类，并根据疾病严重程度开始紧急 治疗。世卫组织更新了与 COVID-19 相关的急性呼吸道 感染患者治疗指南，其中包括针对弱势人群（如老年 人、孕妇和儿童）的指南。在不可能在医疗机构中隔离 所有病人的情况下，世卫组织强调应优先考虑最有可能 出现不良结果的患者：重症和危重症患者以及有不良结 果风险的轻症患者（年龄>60 岁，有潜在合并症的患 a 轻症可能包括：无并发症的上呼吸道病毒感染症状，如发 热、疲劳、咳嗽（有痰或无痰）、厌食、不适、肌肉疼痛、喉 咙痛、呼吸困难、鼻塞或头痛。极少情况下，患者还会出现腹 泻、恶心和呕吐。 者，如慢性心血管疾病、慢性呼吸道疾病、糖尿病、癌 症）。 如果不能在医疗机构中隔离所有轻症患者，那么可 能需要在非传统设施中隔离那些没有危险因素的轻症患 者，例如改变了用途的宾馆、体育场或体育馆，轻症患 者可以待在这些设施中，直至症状消失且 COVID-19 病 毒的实验室检测呈阴性。另外，没有危险因素的轻症患 者也可以在家接受管理。 症状轻微的疑似 COVID-19患者的家庭 护理 就症状轻微的患者而言，住院治疗也许因为卫生保 健系统的负担而没有可能，或者并非必需，除非担心病 情迅速恶化 3。如果患者病情轻微，可以考虑在家提供 护理，只要他们能够得到家庭成员的随时关注和护理。 当无法住院治疗或住院治疗不安全时（例如，能力有 限，资源无法满足对卫生保健服务的需求），也可以考 虑家庭护理。 在这些情况下，症状轻微1且没有肺或心脏疾病、肾 衰竭或免疫功能低下等会加大其罹患并发症风险的基础 性慢性疾病的患者可以在家接受护理。这一决定需要审 慎的临床判断，并应考虑患者的家庭环境安全性评估 b。 在需要提供家庭护理的情况下，如果可行，受过培 训的卫生保健工作者应进行评估，以核实居住环境是否 适合提供护理；卫生保健工作者必须评估患者及其家人 是否能够遵守将作为家庭护理隔离措施的一部分推荐的 预防措施（例如，手卫生、呼吸卫生、环境清洁、限制 在室内或室外活动），是否能够解决安全问题（例如， 与使用含酒精成分的免洗洗手液有关的意外摄入和火灾 危险）。 如果可行，在整个家庭护理期间——即直至患者的 症状完全得到解决——应与卫生保健提供者或公共卫生 工作人员或二者建立沟通联系。需要关于 COVID-19 及 b 参考文献 2 的附件 C 中提供了评估家庭环境条件的样本清 单。 症状轻微的 COVID-19患者的家庭护理及其接触者管理 -2- 其传播的更全面信息来确定家庭隔离预防措施的持续时 间。 患者及其家属应接受个人卫生、基本的感染预防和 控制措施、如何尽可能安全地护理疑似患有 COVID-19 的人以防家庭接触者被感染方面的教育。应向患者及家 庭成员提供持续的支持和教育，并且在家庭护理期间持 续进行监测。家庭成员应遵循以下建议。 将患者置于通风良好的单间（将门窗打开）。 限制患者在室内的活动，尽量减少共享空间。确保 共享空间（如厨房、浴室）通风良好（保持窗户打 开）。 家庭成员应待在另一房间，如果不可能，应与病人 保持至少 1米的距离（例如睡在另一张床上）c。2 限制看护者的人数。最好是指定一个健康状况良好 且无基础性慢性疾病或免疫功能低下情况的人看护 患者 3。应谢绝访客，直至患者完全康复并且没有 COVID-19的迹象或症状。 在与患者或其周围环境进行任何形式的接触后应采 取手卫生措施 4。在准备食物之前和之后、吃饭 前、上厕所后以及手显得脏的时候也应采取手卫生 措施。如果手没有明显弄脏，可以使用含酒精成分 的免洗洗手液。在手明显弄脏时，使用肥皂和水。 在使用肥皂和水洗手时，用一次性纸巾擦干手是可 取的。如果没有纸巾，可使用干净的毛巾，并经常 更换。 为了控制呼吸道分泌物，应该向患者提供医用口 罩d3，应尽可能佩戴并每天更换口罩。不能忍受医 用口罩的人应该采取严格的呼吸卫生做法，也就是 说，在咳嗽或打喷嚏时，应该用一次性纸巾遮住口 鼻。用来遮住口鼻的东西应在使用后丢弃或适当清 洗（例如，用普通肥皂或清洁剂和水清洗手帕）。 看护者在与患者同处一室时，应佩戴用来遮住口鼻 的医用口罩。在使用过程中不应触摸或摆弄口罩。 如果口罩被分泌物弄湿或弄脏，必须立即换上干 净、干燥的新口罩。应采用适当的方法取下口罩— —也就是说，不要触摸口罩正面，而是解开口罩。 使用后应立即丢弃口罩，并采取手卫生措施。 避免直接接触体液，尤其是口腔或呼吸道分泌物以 及粪便。在进行口腔或呼吸道护理以及处理粪便、 c 进行母乳喂养的母亲可以例外。考虑到母乳喂养有好处并且 母乳在其它呼吸道病毒传播中的作用微不足道，母亲可以继续 进行母乳喂养。母亲在靠近婴儿时应佩戴医用口罩，并且在与 婴儿密切接触之前和之后应采取手卫生措施。她还需要遵循本 文件中描述的其它卫生措施。 尿液和其它废物时，应使用一次性手套和口罩。在 取下手套和口罩之前和之后应采取手卫生措施。 不要重复使用口罩或手套。 患者应有专用的床上用品和餐具；这些物品在使用 后应该用肥皂和水进行清洗，并且可以重复使用而 不是丢弃。 每天应对病人所在房间内经常接触的表面进行清洁 和消毒，如床头柜、床架和其它卧室家具。先用普 通家用肥皂或清洁剂进行清洁，然后，在冲洗后， 使用含有 0.1%次氯酸钠的普通家用消毒剂（即相当 于 1000 ppm）进行消毒。 每天至少对浴室和卫生间的表面进行一次清洁和消 毒。先用普通家用肥皂或清洁剂进行清洁，然后， 在冲洗后，使用含有 0.1%次氯酸钠的普通家用消毒 剂进行消毒 使用普通洗衣皂和水清洗患者的衣服、床上用品、 浴巾和手巾等，或用普通家用洗涤剂在 60-90℃ （140–194°F）的温度条件下进行机洗，并彻底烘 干。将被污染的床上用品放入洗衣袋中。不要摇晃 要洗的脏衣服，避免皮肤和衣服与污染物接触。 清洁表面或处理被体液弄脏的衣物或床上用品时， 应使用手套和防护服（如塑料围裙）。根据具体情 况，可以使用实用手套或一次性手套。使用后，应 使用肥皂和水清洗实用手套，并用 0.1%的次氯酸钠 溶液进行消毒。一次性手套（如橡胶或乳胶手套） 应在每次使用后丢弃。在戴上手套之前和取下手套 之后应采取手卫生措施。 手套、口罩和家庭护理过程中产生的其它废物在作 为传染性废物处理之前，应放入患者房间里带盖的 垃圾箱中 e。处置传染性废物的责任在当地卫生主 管部门。 避免与患者周围环境中的被污染物品有任何其它形 式的接触（例如，不要共用牙刷、香烟、餐具、盘 子、饮料、毛巾、浴巾或床上用品）。 卫生保健工作者在提供家庭护理时应进行风险评 估，以选择合适的个人防护装备，并遵循飞沫和接 触预防措施方面的建议。 就接受家庭护理的病情轻微的实验室确诊患者而 言，要解除居家隔离，患者必须接受两次 PCR检测 d 医用口罩是平坦的或打褶的外科或手术口罩（有些形状像杯 子）。它们通过绑在脑后的绳子固定在适当的位置。 e地方卫生主管部门应采取措施，确保废物在卫生填埋场处 置，而不是在无人监督的露天垃圾场。 症状轻微的 COVID-19患者的家庭护理及其接触者管理 -3- （使用至少相隔 24小时采集的样本），检测结果均 为阴性才行。在无法进行检测的情况下，世卫组织 建议确诊患者在症状消失后再隔离两周。 接触者管理 接触过疑似 COVID-19 患者的人（包括看护者和卫 生保健工作者）被视为接触者，应建议他们从可能接触 的最后一天起监测自身健康状况 14天。 接触者是指在患者出现症状前 2天至出现症状后 14 天内有以下任何一种情况的人 5： 在 1 米的距离内与 COVID-19 患者面对面接触超过 15分钟； 在没有使用适当的个人防护装备的情况下为 COVID-19疾病患者提供直接护理； 与 COVID-19 患者待在同一封闭环境中，无论时间 长短（包括在同一工作场所、教室或家庭或参加同 一聚会）； 与 COVID-19 患者近距离（即与患者相距 1 米以 内）同乘任何类型的交通工具； 当地风险评估所示其它情况。 应确定观察期内看护者与卫生保健提供者进行沟通 的方式。此外，卫生保健工作人员应通过电话定期检查 接触者的健康状况，但理想情况下，如果可行的话，应 每天亲自上门检查，以便根据需要进行特定的诊断测 试。 卫生保健提供者应提前告知接触者如果发病的话应 在什么时候去哪里就医，最合适的交通方式是什么，什 么时候从哪里进入指定的医疗机构，以及应遵循什么感 染预防和控制措施。 如果接触者出现症状，则应采取以下步骤： 通知医疗机构有症状的接触者将来到该机构。 接触者前去就医时应佩戴医用口罩。 可能的话接触者应避免搭乘公交前往医疗机构；可 以叫救护车，也可以用私家车运送患病的接触者， 可能的话应打开所有车窗。 应建议有症状的接触者始终采取呼吸卫生和手卫生 措施，在前往医疗机构的途中和在医疗机构时，尽 可能站在或坐在远离他人（至少 1米）的地方。 应用肥皂或清洁剂对运送病人过程中被呼吸道分泌 物或体液污染的表面进行清洁，然后用含有 0.5%稀 释消毒液的普通家用产品进行消毒。 鸣谢 构成本文件基础的 MERS-CoV感染预防和控制指导 文件(1)的最初版本是与世卫组织全球感染预防和控制网 络及其他国际专家协商制定的。世卫组织对参与为 MERS-CoV编写感染预防和控制文件的人表示感谢。 世卫组织感谢下列人员提供的审查：Abdullah M Assiri，沙特阿拉伯卫生部感染控制司司长；Michael Bell，美国佐治亚州亚特兰大市疾病控制和预防中心医 疗质量提升部副主任；Gail Carson，ISARIC全球支持中 心，网络发展主任，传染病顾问，英国公共卫生荣誉顾 问；John M Conly，加拿大卡尔加里市卡尔加里大学医 学院卡尔文、菲比和琼•斯奈德慢性疾病研究所医学、 微生物学、免疫学和传染病系；Barry Cookson，英国伦 敦大学学院感染和免疫系；Babacar NDoye，塞内加尔达 喀尔感染控制网络董事会成员；Kathleen Dunn，加拿大 公共卫生署传染病预防和控制中心卫生保健相关感染和 感染预防和控制科主管；Dale Fisher，全球疫情警报和 应对网络指导委员会；Fernanda Lessa，美国佐治亚州亚 特兰大市疾病控制和预防中心医疗质量提升部流行病学 家；Moi Lin Ling，新加坡总医院感染控制部主任，亚太 感染控制学会会长；Didier Pittet，瑞士日内瓦大学医院 和医学院感染控制规划和世卫组织患者安全合作中心主 任；Fernando Otaiza O’Ryan，智利圣地亚哥卫生部国 家感染预防和控制规划负责人；Diamantis Plachouras， 瑞典索尔纳欧洲疾病预防和控制中心监测和反应支助 股，Wing Hong Seto，中国香港特别行政区香港大学公 共卫生学院社区医学系；Nandini Shetty，联合王国科林 代尔健康保护局参考微生物服务机构顾问微生物学家； Rachel M. Smith，美国佐治亚州亚特兰大市疾病控制和 预防中心医疗质量提升部。 我们还感谢下述世卫组织工作人员：Benedetta Allegranzi、Gertrude Avortri、April Baller、Ana Paula Coutinho、Nino Dal Dayanghirang、Christine Francis、 Pierre Clave Kariyo、Maria Clara Padoveze、Joao Paulo Toledo、Nahoko Shindo、Valeska Stempliuk 以及 Maria Van Kerkhove。 参考文献 1. World Health Organization. Home care for patients with Middle East respiratory syndrome coronavirus (MERS- CoV) infection presenting with mild symptoms and management of contacts: interim guidance （2020年 1 月 26日访问）。 症状轻微的 COVID-19患者的家庭护理及其接触者管理 -4- 2. World Health Organization. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. （2020年 1月 26日 访问）。 3. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID- 19 disease is suspected. Geneva: World Health Organization; 2020 （2020年 3月 17日访问）。 4. World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge. （2020年 1月 20日访问）。 5. World Health Organization. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance （2020年 3月 17日访问）。 其它参考文献 World Health Organization. Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance, （2020年 1月 20日访问）。 World Health Organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance, （2020年 1月 20日访问）。 World Health Organization. Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS- CoV) infection: interim guidance. （2020年 1月 20日访 问）。 Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 （http://apps.who.int/iris/handle/10665/44167 2020年 1月 20日访问）。 Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. Geneva: World Health Organization; 2020 （https://apps.who.int/iris/handle/10665/330676 2020年 1月 20日访问）。 Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013; 18(11): 20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. 世卫组织继续密切监测可能影响本临时指导文件的 任何变化。如果任何因素发生变化，世卫组织将发布进 一步的更新。否则，本临时指导文件将在发布日期后 2 年到期。 ©世界卫生组织 2020。 部分版权保留。作品署名-非商业性使用-相同方式共享的政府间组织 3.0版本适用于该 作品 (CC-BY-NC-SA 3.0 IGO)。 WHO reference number：WHO/2019-nCoV/IPC/HomeCare/2020.3
-1- معلʨمات أساسʽة تلʰʽًة الإرشادات الʺʰʙئʽةوضعʗ مʻʤʺة الʸʴة العالʺʽة هʚه للʴاجة إلى تʨصʽات Ǽʷأن الʛعاǽة الʺʻʜلʽة الʺأمʨنة للʺʛضى ا ًǽعانʨن أعʛاضالʚيʧ الʺʷʱʰه فʽها 91-الʺʸابʽʧ ǼعʙوȐ ؗʨفʽʙ وȃʷأن تʙابʽʛ الʸʴة العʺʨمʽة الʺʱعلقة Ǽالʱʙبʽʛ أ،خفʽفة العلاجي لʺʵالʢʽهʦ. اقُʱʰʶʗ هʚه الʨثʽقة مʧ الإرشادات الʺʰʙئʽة الʵاصة وقʙ ǼالعʙوȐ Ǽفʽʛوس ؗʨرونا الʺʶʰʖ لʺʱلازمة الʷʛق الأوسȌ شʙ وتʶʱʛ ،1 8102حʜȄʛان/ يʨنʽʨ الʱʻفʶʽة الʱي ُنʷʛت في Ǽالʺʰادȏ الʱʨجʽهʽة الʺʶّʻʙة Ǽالʰّʽʻات الʱي نʷʛتها الʺʻʤʺة، Ǽʺا الʨقاǽة مʧ العʙوȐ Ǽالأمʛاض الʱʻفʶʽة الʨثʽقة الʺعʻʨنة في ذلʥ الʴادة الʱي قʙ ُتʶʰʖ أوȃʯة وجʨائح ومȞافʴʱها في الʛعاǽة ، وتʶʱʻʙ إلى الʺعلʨمات الʺʱاحة حالʽًا Ǽʷأن مʛض 2 الʸʴʽة .91-كʨفʽʙ الʱي ǽʳʛȑ تʴʙيʲها وȄʱʺʲل الغʛض مʧ هʚه الʻʸائح الʶʛȄعة في تʨجʽه الʺهʻʽʽʧ الʺعʻʽʽʧ Ǽالʸʴة العʺʨمʽة Ǽآخʛ الʺعلʨمات في الʛعاǽة والعاملʽʧ والʨقاǽة مʧ العʙوȐ ومȞافʴʱها، والʺʙيʛȄʧ معالʳʱهʦ للʺʶائل الʺʱعلقة Ǽالʛعاǽة الʸʴʽة عʻʙ الʸʴʽة، Ȅعانʨن و الʺʷʱʰه فʽها 91-للʺʛضى الʺʸابʽʧ Ǽʺʛض ؗʨفʽʙ لʱʙبʽʛ العلاجي لʺʵالʢʽهʦ. امʧ أعʛاض خفʽفة، وعʻʙ تقʙǽʦ 91-ʺʛض ؗʨفʽʙǼ الʺʱعلقةوتʶʱʻʙ هʚه الإرشادات إلى الʰّʽʻات وȃإمȞانʽة تʻفʽʚ تʙابʽʛ الʨقاǽة مʧ العʙوȐ ومȞافʴʱها في الʺʻʜل. "الʛعاǽة القائʺʽʧ على"ولأغʛاض هʚه الʨثʽقة، ǽʷʽʛ مʸʢلح الʚيʧ الأسʛة، أو الأصʙقاء ʨالʙيʧ والأزواج وسائʛ أفʛادإلى ال لʦ يʱلقʨا تʙرȄʰًا رسʺʽًا على الʛعاǽة الʸʴʽة. الʰʷʛȄة Ȑ الʱʛصʙ العالʺي للعʙو " وȄُʛجى الʛجʨع إلى إرشادات للاʡلاع على تعارȄʅ "(91-Ǽʺʛض فʽʛوس ؗʨرونا )كʨفʽʙ الʨقاǽة مʧ العʙوȐ "الʴالات. ؗʺا ُيʛجى الʛجʨع إلى إرشادات أثʻاء الʛعاǽة الʸʴʽة عʻʙ الاشʱʰاه ǼالإصاǼة Ǽʺʛض ومȞافʴʱها " للاʡلاع على الإرشادات الʵاصة Ǽالʨقاǽة مʧ 91-كʨفʽʙ .العʙوȐ ومȞافʴʱها على مʶʱʨȐ مʛافȘ الʛعاǽة الʸʴʽة ʻʰغي تقʙǽʦ الʱʙبʽʛ العلاجي لʺʛضى أيʧ ي 91-كʨفʽʙ الʴالات الʺʕؗʙة مʵʱʰʛȄًا ورعايʱها جʺʽع لʜ عتʨصي الʺʻʤʺة Ǽ في مʛفȘ للʛعاǽة الʸʴʽة. وتʨصي الʺʻʤʺة Ǽفʛز جʺʽع الʚيʧ ǽعانʨن 91-ʺʛض ؗʨفʽʙǼ ʱʷʰه في إصابʱهʦالʺʛضى الʺ الʛعاǽة وخʽʦ، عʻʙ أول اتʸال بʻʤام ي حاد تʻفʶ مʛضمʧ الʸʴʽة، وȃʰʙء العلاج الʢارȏ Ǽالاسʱʻاد إلى مʙȐ وخامة إرشادات علاج الʺʛضى الʚيʧ وقʙ حʙّثʗ الʺʻʤʺة الʺʛض. ، 91-ǽعانʨن مʧ مʛض تʻفʶي حاد مʛتʰȌ Ǽʺʛض ؗʨفʽʙ لʶȞانʽة الأشʙ عʛضة للʵʢʛ لʱʹʺʽʻها إرشادات Ǽʷأن الفʯات ا )كالʰالغʽʧ الأكʰʛ سʻًا والʴʨامل والأʡفال(. وفي الʴالات الʱي لا ǽʺȞʧ فʽها عʜل جʺʽع الʴالات في مʛفȘ للʛعاǽة الʸʴʽة، فإن الʺʻʤʺة تʷʙد على أهʺʽة إعʢاء الأولʨȄة لعʜل الأشʵاص سʽʯة، ومʻهʦ: الʺʛضى لʻʱائجالʚيʧ تʜداد احʱʺالات تعʛضهʦ وحʛجة والʺʛضى الʺʸابʽʧ ʧ Ǽأمʛاض وخʽʺة الʺʸابʽ Ǽأعʛاض خفʽفة ولؔʧ الʺعʛضʽʧ لʻʱائج سʽʯة )كالʴالات الʱي أخʛȐ سʻة والʴالات الʺʸاǼة Ǽأمʛاض 06تʜȄʙ أعʺارها عʧ كالأمʛاض القلʰʽة الʨعائʽة الʺʜمʻة والأمʛاض الʱʻفʶʽة الʺʜمʻة والʶȞʛȑ والʶʛʡان(. فʽفة في مʛافȘ الʛعاǽة وȂذا لʦ يʱʶʧ عʜل جʺʽع الʴالات الʵ الʸʴʽة، فقʙ يʱعʽʧ حʽʻʯʚ عʜل الʺʸابʽʧ Ǽاعʱلال خفʽف دون عʨامل خʢʛ مʸاحʰة في مʛافȘ غʽʛ تقلʽʙǽة، مʲل الفʻادق والʺلاعʖ والʸالات الʛȄاضʽة الʺعاد تهʽʯʱها لهʚا الغʛض، حʽʘ ǽʺȞʧ مȞʨثهʦ فʽها إلى أن تʱلاشى الأعʛاض وُتʤهʛ نʱائج سلʰʽة. وؗʰʙيل 91-ʨفʽʙالفʴʨص الʺʵʱʰʛȄة لفʽʛوس ؗ عʧ ذلʥ، ǽʺȞʧ تʨفʽʛ الʱʙبʽʛ العلاجي في الʺʻʜل للʺʛضى الʺʸابʽʧ Ǽأعʛاض خفʽفة دون عʨامل خʢʛ مʸاحʰة. تقʙǽʦ الʛعاǽة الʺʻʜلʽة للʺʛضى الʺʷʱʰة في الʺʸʴʨب 91-إصابʱهʦ Ǽʺʛض ؗʨفʽʙ Ǽأعʛاض خفʽفة أعʛاض خفʽفةتʤهʛ علʽهʦ الʺʛضى الʚيʧ إيʙاع قʙ لا يʱʶʻى Ǽʶʰʖ العʖء الʨاقع على نʤام الʛعاǽة الʺʶʱʷفʽات في هʻاك ما الʸʴʽة، أو قʙ لا ǽȞʨن ذلʥ ضʛورȄًا، ما لʦ ǽȞʧ . فإذا 3ʴالʱهʦلسʛȄع تʙهʨر حʙوث يʙعʨ للقلȘ Ǽʷأن إمȞانʽة ǽʺȞʧ الʻʤʛ في الʺʛضى ǽعانʨن أعʛاضًا خفʽفة فقȌ، كان لإمȞان مʱاǼعʱهʦ ورعايʱهʦ ʡالʺا ؗان Ǽا تقʙǽʦ الʛعاǽة في الʺʻʜل مʧ أفʛاد أسʛتهʦ. وȄʺȞʧ الʻʤʛ ؗʚلʥ في تقʙǽʦ الʛعاǽة الʺʻʜلʽة عʙم مأمʨنʽʱهاتʨافʛ الʛعاǽة داخل الʺʶʱʷفʽات أو في حال عʙم غʽʛ ؗافʽة مʨاردهاالاسʱʽعابʽة مʴʙودة، أو قʙرتها)عʻʙما تؔʨن لʱلʰʽة الʢلʖ على خʙمات الʛعاǽة الʸʴʽة، مʲًلا(. الʸʶʲʦȁة Ǻأعʙاض 91-الʙعاǻة الʸʹʚلʻة للʸʙضى الʸʶابʻʥ ǺعʗوȎ ؕʦفʻʗ خفʻفʻة والʯʗبʻʙ العلاجي لʸʳالʠʻهʤ إرشادات مʰʙئʽة 0202 آذار/مارس 71 لʺʵالʢʽهʦالʺʸʴʨȃة Ǽأعʛاض خفʽفة والʱʙبʽʛ العلاجي 91-الʛعاǽة الʺʻʜلʽة للʺʛضى الʺʸابʽʧ ǼعʙوȐ ؗʨفʽʙ -2- أȑ مʧ هʚه الʴالات، ǽʺȞʧ تقʙǽʦ الʛعاǽة الʺʻʜلʽة إلى وفي مʧ أساسا ً ولا ǽعانʨن أالʺʛضى الʺʸابʽʧ Ǽأعʛاض خفʽفة مʲل أمʛاض الʛئة أو القلʖ، أو الفʷل -حالات مʛضʽة مʜمʻة ض الʺʛȄʠ لʜȄادة عʛ ّالؔلʨȑ أو حالات نقʟ الʺʻاعة الʱي ت ُ حȞʺًا مʵاʡʛ الإصاǼة Ǽالʺʹاعفات. وȄʱʢلʖ هʚا القʛار وȄʻʰغي أن ǽʶʱʛشʙ بʱقʽʽʦ مʙȐ مأمʨنʽة الʰʽʯة سʛȄʛȄًا مʱأنʽا ً بالʺʻʜلʽة للʺʛȄʠ. ، ؗلʺا وفي الʴالات الʱي ُتقʙم فʽها الʛعاǽة في الʺʻʜل، يʻʰغي أن يʱʨلى أحʙ العاملʽʧ في الʛعاǽة الʸʴʽة كان ذلʥ مʺȞʻًا، إجʛاء تقʽʽʦ للʱʴقȘ مʧ مʙȐ ملاءمة الʰʽʯة الʺʻʜلʽة لʱقʙǽʦ ʛعاǽة الʸʴʽة، وȄʳʖ على هʚا العامل تقʽʽʦ مʙȐ قʙرة ال الʺʛȄʠ وأسʛته على الالʱʜام Ǽالاحʱʽاʡات الʱي سʽʨصي بها في إʡار العʜل مʧ أجل الʛعاǽة الʺʻʜلʽة )مʲل نʤافة الʽʙيʧ والʻʤافة الʱʻفʶʽة والʻʤافة الʰʽʯʽة والʴʙ مʧ الʱʴʛك داخل مʸادر القلȘ معالʳة قʙرتهʦ علىو ،(الʵʛوج مʻهالʺʻʜل أو الʺʱعلقة Ǽالʺأمʨنʽة )مʲل مʵاʡʛ ابʱلاع الʺʴلʨل الؔʴʨلي لʱʙلʽʥ الʽʙيʧ عʧ ʡʛȄȘ الʵʢأ ومʵاʡʛ نʷʨب الʴʛائȘ (.الʻاجʺة عʻه للاتʸال Ǽʺقʙم تʴʙيʙ وسʽلة ، ؗلʺا ؗان ذلʥ مʺȞʻًا،وȄʻʰغي الʛعاǽة الʸʴʽة أو العاملʽʧ Ǽالʛعاǽة الʸʴʽة، أو ؗلʽهʺا، الʸʴʽة، أȑ حʱى تʻʱهي الأعʛاض الʱي ʡʨال مʙة الʛعاǽة . وȄلʜم الʴʸʨل على معلʨمات تʺاما ً ǽʷȞʨ مʻها الʺʛȄʠ وانʱقاله لʱʴʙيʙ مʙة الاحʱʽاʡات 91-شاملة عʧ مʛض ؗʨفʽʙ الʵاصة Ǽالعʜل الʺʻʜلي. Ǽʷأن الʻʤافة الʺقʽʺʽʧ معه أسʛتهوȄʻʰغي تʨعʽة الʺʛضى وأفʛاد الʷʵʸʽة، والʱʙابʽʛ الأساسʽة للʨقاǽة مʧ العʙوȐ ومȞافʴʱها، الʺʷʱʰه في لفʛد ل على أأمʧ نʴʨ مʺȞʧ ʛعاǽةال تقʙǽʦ وؗʽفʽة لʺʻع انʱقال العʙوȐ إلى مʵالʢʽه 91-ؗʨفʽʙʺʛض Ǽ إصابʱه تقʙǽʦ الʙعʦ والʱʨعʽة مʨاصلة مʧ أفʛاد الأسʛة الʺعʽʷʽة. وȄʻʰغي ʡʨال مʙة الʛعاǽة الʺʶʱʺʛ الʛصʙ وȂجʛاءه، إلى الʺʛȄʠ وأسʛت للʱʨصʽات الʱالʽة: أفʛاد الأسʛةيʻʰغي أن ǽʺʱʲل ؗʺا الʺʻʜلʽة. )أȑ جʽʙة الʱهʨȄة مʻفʛدة ضع الʺʛȄʠ في غʛفةو يʻʰغي بها نʨافʚ مفʱʨحة وȃاب مفʱʨح(. ʴʙ مʧ الʙ مʧ حʛؗ ة الʺʛȄʠ داخل الʺʻʜل و الʴيʻʰغي أن ʱأكʙ مʧالو إلى أدنى قʙر. معه الʺʷʱʛؗ ة اتالʺʶاح قʙ ǽʷʺل الʺʛض الʵفʽف أعʛاض الالʱهاب الفʽʛوسي للʺʶالʥ أ الʴʺى،غʽʛ الʺʸʴʨب Ǽʺʹاعفات، مʧ قʰʽل: الʱʻفʶʽة العلʽا وألʦ والʱʨعʥ،وفقʙان الʷهʽة، ، )بʰلغʦ أو مʧ دونه( والʶعال والʱعʖ، وضʽȘ الʻفʝ، واحʱقان الأنف، والʸʙاع. وألʦ الʴلȘ، العʹلات، وتʷʺل الأعʛاض الʻادرة الʱي قʙ تʤهʛ على الʺʛضى: الإسهال والغʲʽان والقيء. تʛد قائʺة مʛجعʽة لʱقʽʽʦ الʤʛوف الʰʽʯʽة في الʺʻʜل، في الʺلʴȘ ب .2"ج" للʺʛجع لفʨائʙ الʱي إلى االأمهات الʺʛضعات مʧ ذلʥ. نʤʛًا ǽʺȞʧ اسʱʲʻاء ج تعʨد بها الʛضاعة الʢʰʽعʽة وعʙم أهʺʽة دور لʰʧ الأم في انʱقال الʺʶاحات الʺʷʱʛؗ ة )مʲل الʺʢʰخ ودورة الʺʽاه( جʽʙة .اسʱʰقاء الʻʨافʚ مفʱʨحة، مʲًلا(ǼالʱهʨȄة ) يʻʰغي لأفʛاد الأسʛة الʺعʽʷʽة الإقامة في غʛفة مʵʱلفة، أو مʱʛ واحʙ على الأقل الابʱعاديʻʰغي لهʦ إذا تعʚر ذلʥ، ج، مʲًلا(.مʻفʸلʧ الʷʵʟ الʺʛȄʠ )الʻʨم على فʛاش ع في الʴالات و الʛعاǽة. القائʺʽʧ علىمʧ عʙد الʴʙيʻʰغي شʵʟ واحʙ يʱʺʱع Ǽʸʴة جʽʙة ولا ǽعاني تعʽʽʧالʺʲلى، 3مʧ حالات مʛضʽة مʜمʻة أو مʧ نقʟ الʺʻاعة. أساسا ً Ȅʻʰغي عʙم الʶʺاح للʜوار Ǽعʽادة الʺʛȄʠ حʱى ǽȞʱʺل و .91-مʛض ؗʨفʽʙ أو أعʛاض علامات وتʜولشفاؤه ل أو تعام ُ لʺʛȄʠلقʰل أȑ مʵالʢة تʻʤʽف الʽʙيʧيʻʰغي تʻʤʽف الʽʙيʧ قʰل أǽʹًا وȄʻʰغي . 4مع الʰʽʯة الʺʴʽʢة Ǽه إعʙاد الʢعام وȃعʙه، وقʰل تʻاول الʢعام، وȃعʙ اسʱʵʙام الʽʙاندورة الʺʽاه، وؗلʺا اتʶʵʗ الʽʙان. وȂذا لʦ تؔʧ ا Ǽʺʴلʨل ʺ، ǽʺȞʧ تʻʤʽفهللعʽان مʱʶʵʱʽʧ على نʴʨ واضح على نʴʨ ʱʽʧمʱʶʵ اإذا ؗانʱوأما ،كʴʨلي لʱʙلʽʥ الʽʙيʧ ʵʙام الʺاء والʸابʨن.يلʜم اسʱ للعʽان واضح مʻاشففʹل اسʱʵʙام عʻʙ غʶل الʽʙيʧ Ǽالʺاء والʸابʨن، ǽ ُ . وفي حال عʙم هʺاتʳفʽففي ورقʽة ُتʶʱʵʙم مʛة واحʙة م مʻاشف نʤʽفة مʸʻʨعة مʧ القʺاش اتʨافʛها، اسʱʵʙ .واسʱʰʙالها Ǽانʱʤام ǼȞʺامة لاحʱʨاء الإفʛازات الʱʻفʶʽة، يʻʰغي تʜوȄʙ الʺʛȄʠ وȄغّʽʛها قʙر الإمȞان اعلى أن يʙاوم على اسʱʵʙامه دʡʰʽة ʽʻʰغي وȂذا لʦ ǽȞʧ الʷʵʟ يʱʴʺل ارتʙاء الؔʺامة، ف. يʨمʽا ً أȑ تغʢʽة الفʦ -له اّتʰاع تʙابʽʛ الʻʤافة الʱʻفʶʽة Ǽʸʛامة حʙة عʻʙ الʶعال أو والأنف Ǽʺʻاديل ورقʽة ُتʶʱʵʙم مʛة وا العʢʝ. وȄʻʰغي الʱʵلʟ مʧ الʺʨاد الʺʶʱʵʙمة في تغʢʽة الفʦ والأنف أو تʻʤʽفها جʽʙًا Ǽعʙ اسʱʵʙامها )أȑ غʶل الʺʻاديل Ǽاسʱʵʙام الʺاء والʸابʨن أو الʺʻʤفات(. غʢي الفʦ ؗʺامة ʡʰʽة تالʛعاǽة وضع للقائʺʽʧ علىيʻʰغي الʺʛȄʠ. والأنف عʻʙما ǽȞʨنʨن في الغʛفة نفʶها مع أثʻاء الاسʱʵʙام. اأو تʴʛȄȞه الؔʺامةȄʻʰغي عʙم لʺʝ و ʗ الؔʺامة مʰʱلة أو مʱʶʵة، فʽʳʖ اسʱʰʙالها وȂذا أصʰʴ نʜع Ȅʻʰغي و ǼأخʛȐ جʙيʙة ونʤʽفة وجافة على الفʨر. الʢʛȄقة الʶلʽʺة، أȑ Ǽفʥ الʛȃاȋ دون لʺʝ Ǽاتʰاع الؔʺامة سائʛ الفʽʛوسات الʱي تʸʽʖ الʳهاز الʱʻفʶي، فإنه في إمȞان الأم عʻʙما ؗʺامة ʡʰʽةأن تʶʱʺʛ في الإرضاع. وȄʻʰغي للأم أن تʹع قʰل وȃعʙ مʵالʢة الʛضʽع عʧ تقʱʛب مʧ الʛضʽع وأن تʻʤف يʙيها قʛب. ؗʺا سʽلʜم علʽها اّتʰاع سائʛ تʙابʽʛ الʻʤافة الʸʴʽة الʺʨضʴة في هʚه الʨثʽقة. الʺʶʢʴة أو ذات الʢʽات )يʱʵʚ الؔʺاماتالʢʰʽة هي الؔʺامات د Ǽعʹها شȞل الؔʨب( الʱي ُتʶʱʵʙم في الʳʛاحة أو العʺلʽات، وُتʲʰʗ الʛأس.في مȞانها بʨاسʢة خʽʨȋ ُتʛȃȌ خلف لʺʵالʢʽهʦالʺʸʴʨȃة Ǽأعʛاض خفʽفة والʱʙبʽʛ العلاجي 91-الʛعاǽة الʺʻʜلʽة للʺʛضى الʺʸابʽʧ ǼعʙوȐ ؗʨفʽʙ -3- على الفʨر Ǽعʙ الؔʺامةʱʵلʟ مʧ الو ،الʳʜء الأمامي .وتʻʤʽف الʽʙيʧ ااسʱʵʙامه تʳʻʖ الʺلامʶة الʺʰاشʛة لʶʨائل الʳʶʦ، ولاسʽʺا يʻʰغي م قفازȄʧ ااسʱʵʙو ،الإفʛازات الفʺʨȄة أو الʱʻفʶʽة، والʰʛاز ǽُʶʱʵʙمان مʛة واحʙة عʻʙ ملامʶة الʰʛاز والʰʨل وأȑ نفاǽات .والؔʺامةقʰل وȃعʙ خلع القفازȄʧ وتʻʤʽف الʽʙيʧأخʛȐ. .القفازاتأو الؔʺامةاسʱʵʙام عʙم إعادةيʻʰغي مʵ ّʸ ʸة لʢعام لة وأدوات ʛ ّلأس ِلم مفʛوشات ااسʱʵʙ يʻʰغي للʺʛȄʠ، وȄʻʰغي غʶل هʚه الأشʽاء Ǽالʺاء والʸابʨن Ǽعʙ وȄʺȞʧ إعادة اسʱʵʙامها بʙًلا مʧ الʱʵلʟ ،الاسʱʵʙام مʻها. الأسʢح الʱي يʱؔʛر تʻʤʽف وتʢهʽʛ ǼʷȞل يʨمي يʻʰغي لʺʶها في الغʛفة الʱي يʱلقى فʽها الʺʛȄʠ الʛعاǽة، مʲل أثاثالʺʻاضʙ الʺʳاورة للفʛاش وأʡʛ الأسʛة وسائʛ عʻاصʛ غʛفة الʻʨم. وȄʻʰغي اسʱʵʙام الʸابʨن أو الʺʻʤف الʺʻʜلي العادȑ أوًلا، ثʦ Ǽعʙ الʷʢف Ǽالʺاء، اسʱʵʙام الʺʢهʛ هʽʰʨؗلʨرȄʗ الʸʨديʨم الʺʻʜلي العادȑ الʚȑ ǽʴʱʨȑ على (. جʜء Ǽالʺلʽʨن 0001)أȑ ما ǽعادل ٪1.0بʻʶʰة مʛة وتʢهʽʛهادورة الʺʽاه وأسʢح الʺʛحاض تʻʤʽف يʻʰغي واحʙة يʨمʽًا على الأقل. وȄʻʰغي اسʱʵʙام الʸابʨن أو الʺʻʤف الʺʻʜلي العادȑ أوًلا، ثʦ Ǽعʙ الʷʢف Ǽالʺاء، ǽʴʱʨȑ على اسʱʵʙام الʺʢهʛ الʺʻʜلي العادȑ الʚȑ .٪.01هʽʰʨؗلʨرȄʗ الʸʨديʨم بʻʶʰة الʶʛȄʛ ومʻاشف وأغʢʽةملاǼʝ الʺʛȄʠ تʻʤʽفيʻʰغي صابʨن الغʶʽل العادȑ أو و الʴʺام والأيʙȑ Ǽاسʱʵʙام الʺاء 09و 06على درجة تʱʛاوح بʽʧ غʶالة الʺلاǼʝغʶلها في Ǽاسʱʵʙم درجة فهʛنهايʗ( 491-041) درجة مʯʨȄة ضع وȄʻʰغي و جʽʙًا. وتʻʷʽفهاد الʺʻʤف الʺʻʜلي الʺعʱا نفʠ ، وعʙمالʺفʛوشات الʺلʨثة في ؗʽʝ للغʶʽل ʳلʙلوتʳʻʖ ملامʶة الأدوات الʺلʨثة ل ،الʺفʛوشات الʺلʨثة .ʺلاǼʝالأو ةفازȄʧ وملاǼʝ واقʽة )مʲل الʺʽʙعيʻʰغي اسʱʵʙام ق الʰلاسʱʽȞʽة( عʻʙ تʻʤʽف الأسʢح أو مʻاولة الʺلاǼʝ أو الʺفʛوشات الʺلʨثة Ǽʶʨائل الʳʶʦ. وȄʺȞʧ اسʱʵʙام قفازات وفقًا ،الأعʺال الʺʻʜلʽة أو القفازات الʱي ُتʶʱعʺل مʛة واحʙة الأعʺال وȃعʙ الاسʱʵʙام، يʻʰغي غʶل قفازȑ . لʤʛوفل ʙام مʴلʨل الʺʻʜلʽة Ǽالʺاء والʸابʨن وȂزالة الʱلʨث Ǽاسʱʵ . وأما القفازان اللʚان ٪1.0هʽʰʨؗلʨرȄʗ الʸʨديʨم بʱʛؗ ʽʜ لاتؔʝ( الʻʱʛȄل أو الʺʸʻʨعان مʧ الǽُʶʱعʺلان مʛة واحʙة ) وتʻʤʽف الʽʙيʧفʽʻʰغي الʱʵلʟ مʻهʺا Ǽعʙ ؗل اسʱʵʙام. وضع القفازات وȃعʙ خلعها. قʰل تʙابʽʛ لʹʺان تعʱʺʙالʺʴلʽة أن الإصʴاح يʻʰغي لʶلʢات ه في مʙفʧ قʺامة صʴي ولʽʝ في مقلʖ الفʹلاتالʱʵلʟ مʧ .مʛاَقʖنفاǽات مفʱʨح غʽʛ الʻاتʳة الʺʵلفاتوسائʛ والؔʺاماتيʻʰغي وضع القفازات له غʢاء الʛعاǽة الʺʻʜلʽة للʺʛȄʠ في صʻʙوق قʺامة عʧ يʨضع في غʛفة الʺʛȄʠ قʰل الʱʵلʟ مʻها مʴȞʦ وتقع مʶʕولʽة الʱʵلʟ مʧ هʚه همعʙǽة. مʵلفات Ǽاعʱʰارها الʺʵلفات الʺعʙǽة على عاتȘ سلʢة الإصʴاح الʺʴلʽة. الʱي أخʛȐ للأدوات الʺلʨثة Ǽʢʛق تʳʻʖ الʱعʛضيʻʰغي في مʷاؗر ʱه)عʙم الʺʛȄʠ اسʱʵʙامًا مʰاشʛا ًǽʶʱʵʙمها اسʱʵʙام فʛشاة الأسʻان أو الʶʳائʛ أو أدوات الʢعام أو الʸʴʨن أو الʺʷʛوȃات أو الʺʻاشف أو أدوات تʻʤʽف ة(.ʛ ّالʳʶʦ والاسʱʴʺام أو مفʛوشات الأس ِ عʻʙما ǽقʙم العاملʨن في الʛعاǽة الʸʴʽة العʻاǽة الʺʻʜلʽة، لاخʱʽار يʻʰغي لهʦ إجʛاء تقʽʽʦ لʺعʙات الʴʺاǽة الʷʵʸʽة واّتʰاع الʱʨصʽات Ǽʷأن الاحʱʽاʡات ما يلائʺهʦ مʻها، الʵاصة Ǽالُقʢʽʛات وȃالʺʵالʢة. Ǽالʻʶʰة للʺʛضى الʺʸابʽʧ Ǽʴالات خفʽفة مʕؗ ʙة مʵʱʰʛȄًا مʧ العʜل للʵʛوجʛعاǽة في الʺʻʜل، ǽُʷʱʛȋ الʚيʧ يʱلقʨن ال خʱʰار الʱفاعل الʶلʶلي للʰʨلʽʺʽʛاز الʺʻʜلي الʵʹʨع لا بʻʱʽʳة سلʰʽة مʕؗʙة مʛتʽʧ لعّʽʻʱʽʧ تفʸل بʽʻهʺا (RCP) ساعة على الأقل. وȂذا لʦ يʱʶʧ إجʛاء هʚا الفʴʟ، 42 تʨصي الʺʻʤʺة بʰقاء الʴالات الʺʕؗ ʙة رهʧ العʜل لʺʙة أسʰʨعʽʧ إضافʽʽʧ Ǽعʙ تلاشي الأعʛاض. ىالʱʙبʽʛ العلاجي لʺʵالʢي الʺʛض اǽة والعاملʨن الʛع القائʺʨن على)Ǽʺا في ذلʥ الأشʵاص ǽُعʙ ّ الʺʷʱʰه في الʛعاǽة الʸʴʽة( الʚيʧ تعʛضʨا للأشʵاص ، مʵالʢʽʧ للʺʛȄʠ وȄʻʰغي 91-ʺʛض ؗʨفʽʙǼإصابʱهʦ Ǽ آخʛ يʨم يʨمًا مʧ 41لʺʙة حالʱهʦ الʸʴʽةنʸʴهʦ بʛصʙ ǽُʴʱʺل مʵالʢʱهʦ فʽه للʺʛȄʠ. تعʛّض لأȑ مʺا يلي ابʱʙاًء مʧ يʨمʽʧ ʺʵالȌ هʨ شʵʟ الو يʨمًا Ǽعʙ 41الأعʛاض على الʺʛȄʠ إلى قʰل ʣهʨر : 5ʣهʨرها -الʺʛȄʠ الʺʸاب Ǽʺʛض ؗʨفʽʙالʱʨاصل وجهًا لʨجه مع دقʽقة؛ 51ضʺʧ مʶافة مʱʛ واحʙ ولʺʙة تʜȄʙ عʧ 91 Ǽʺʛض مʛضى مʸابʽʧإلى تقʙǽʦ الʛعاǽة الʺʰاشʛة دون اسʱʵʙام معʙات الʴʺاǽة الʷʵʸʽة 91-كʨفʽʙ الʺʻاسʰة؛ -ʽȘ ǼʺʛȄʠ مʸاب لʺʛض ؗʨفʽʙالʱʨاجʙ في مʴʽȌ لʸ )Ǽʺا في ذلʥ تقاسʦ نفʝ مȞان العʺل أو الفʸل 91 الʙراسي أو الأسʛة أو الʱʳʺع( لأȑ مʙة مʧ الʜمʧ؛ على مقʛȃة )أȑ ضʺʧ مʶافة فاصلة لا تقل عʧ الʶفʛ Ǽأȑ 91-Ǽʺʛض ؗʨفʽʙ مʱʛ واحʙ( مع مʛȄʠ مʸاب ؛وسʽلة مʧ وسائل الʻقل لʺʵالʢʽهʦالʺʸʴʨȃة Ǽأعʛاض خفʽفة والʱʙبʽʛ العلاجي 91-الʛعاǽة الʺʻʜلʽة للʺʛضى الʺʸابʽʧ ǼعʙوȐ ؗʨفʽʙ -4- لʺʵاʡʛ الʺʴلʽة. أȑ حالات أخʛȐ تʴʙدها تقʽʽʺات ا أحʙ و الʛعاǽة لقائʺʽʧ علىتʴʙيʙ ʡʛȄقة الʱʨاصل بʽʧ ا وȄʻʰغي يمقʙمي الʛعاǽة الʸʴʽة ʡʨال فʱʛة الʺʛاقʰة. ؗʺا يʻʰغي لʺʨʣف صʴة مʵالʢي الʺʛȄʠ Ǽانʱʤام عʰʛ تʴʛȑ الʛعاǽة الʸʴʽة ، أن ǽȞʨن ذلʥ مʧ خلال ، عʻʙ الإمȞانالهاتف، وȄُʶʱʴʶʧ إجʛاء اخʱʰارات تʷʵʽʸʽة حʱى يʱʶʻىزȄارات شʵʸʽة يʨمʽة مʴʙدة حʶʖ الاقʱʹاء. وȄʻʰغي لʺقʙم الʛعاǽة الʸʴʽة تʜوȄʙ مʵالʢي الʺʛȄʠ مʱى وأيʧ يʻʰغي لهʦ الʱʺاس الʛعاǽة Ǽʷأنمقʙمًا Ǽالإرشادات وما هي أنʶʖ وسʽلة مʨاصلات ǽʺȞʧ ، شعʛوا Ǽالʱʨعʥإذا ʸʴʽة مʛافȘ الʛعاǽة ال ǽʺȞʧ دخʨلومʱى وأيʧ اسʱʵʙامها، ، وما هي احʱʽاʡات الʨقاǽة مʧ العʙوȐ ومȞافʴʱها الʱي الʺعʽʻة يʻʰغي اتʰاعها. ، يʻʰغي اتʵاذ الʺʵالʢʽʧوȂذا ʣهʛت الأعʛاض على أحʙ الʵʢʨات الʱالʽة: ʺʵالȌ الʚȑ بʙت الر الʺʛفȘ الʢʰي الʚȑ سʽʶʱقʰل اخʢإ .Ǽʺʳيء الʺʵالȌ قʛȄʰاعلʽه الأعʛاض يʻʰغي للʺʵالȌ ارتʙاء ؗʺامة أثʻاء تʻقله لالʱʺاس الʛعاǽة الʢʰʽة. للʱʨجه ʺʵالȌ تʳʻʖ ؗر ʨب وسائل الʻقل العامة ليʻʰغي ل وȄʺȞʧ الاتʸال Ǽʶʽارة إلى مʛفȘ الʛعاǽة الʸʴʽة؛ خاصة مع سʽارةالʺʛȄʠ في الʺʵالȌإسعاف، أو نقل فʱح جʺʽع نʨافʚها إن أمȞʧ. الأعʛاض Ǽاّتʰاع الʚȑ بʙت علʽه ʺʵالȌاليʻʰغي نʸح إجʛاءات الʻʤافة الʱʻفʶʽة وتʻʤʽف الʽʙيʧ على الʙوام وȃالʨقʨف أو الʳلʨس أǼعʙ ما ǽʺȞʧ عʧ الآخʛȄʧ )مʱʛ في مʛفȘ الʛعاǽة أثʻاء الʱʻقل والʱʨاجʙواحʙ على الأقل( الʸʴʽة. أȑ أسʢح تʱلʨث Ǽالإفʛازات الʱʻفʶʽة أو يʻʰغي تʻʤʽف Ǽالʸابʨن أو الʺʻʤف ،غʽʛها مʧ سʨائل الʳʶʦ أثʻاء الʻقل الʺʻʜلي ثʦ تʢهʽʛها Ǽأحʙ الʺʻʱʳات الʺʻʜلʽة العادǽة الʱي .الʺʰّʽʠمʧ مʴلʨل ٪5.0تʴʨȑ على نʶʰة شȞʛ وتقʙيʛ أُعʙت الʻʶʵة الأصلʽة للإرشادات الʵاصة Ǽالʨقاǽة مʧ العʙوȐ وس ؗʨرونا الʺʶʰʖ لʺʱلازمة الʷʛق الأوسȌ الʱʻفʶʽة Ǽفʽʛ والʱي شلؔʗ أساسًا لʸʽاغة هʚه الʨثʽقة، ،(1ومȞافʴʱها ) Ǽالʱʷاور مع خʰʛاء الʷʰȞة العالʺʽة للʨقاǽة مʧ العʙوȐ ومȞافʴʱها الʱاǼعة لʺʻʤʺة الʸʴة العالʺʽة وغʽʛهʦ مʧ الʵʰʛاء الʙولʽʽʧ. وتʷȞʛ الʺʻʤʺة ؗل مʧ شارك في إعʙاد الʨثʽقة الʵاصة Ǽالʨقاǽة مʧ العʙوȐ Ǽفʽʛوس ؗʨرونا الʺʶʰʖ لʺʱلازمة الʷʛق الأوسȌ الʱʻفʶʽة ومȞافʴʱها. وتʱقʙم الʺʻʤʺة ǼالʷȞʛ إلى الأشʵاص القائʺʽʧ على عʺلʽة الʺʶʽʛȑ، الʺʙيʛ .: عʰʙ الله مالʱالʽة أسʺاؤهʦ ،الاسʱعʛاض العام لʺȞافʴة العʙوȐ، وزارة الʸʴة Ǽالʺʺلؔة العʛȃʽة الʶعʨدǽة؛ وماǽȞل بل، نائʖ مʙيʛ شعʰة تعʜȄʜ جʨدة الʛعاǽة الʸʴʽة، مʛاكʜ مȞافʴة الأمʛاض والʨقاǽة مʻها، أتلانʱا، جʨرجʽا، الʨلاǽات الʺʱʴʙة الأمʛȄȞʽة؛ وغʽل ؗارسʨن، مʛؗ ʜ الʙعʦ Ǽأمʛاض الʳهاز الʱʻفʶي العالʺي الʱاǼع للاتʴاد العالʺي الʺعʻي والʺʶʱʷار الʱʻʺʽة، مʙيʛ شʰȞة والʺʶʱʳʙةالʴادة الʨخʽʺة الʺعʻي Ǽالأمʛاض الʺعʙǽة والʺʶʱʷار الفʵʛȑ لʨؗالة الʸʴة ؗʨنلي، قʶʦ الʢʖ .جʨن م العامة الإنؔلʽʜȄة، الʺʺلؔة الʺʱʴʙة؛ والʺʻاعʽات والأمʛاض الʺعʙǽة، معهʙ ؗالفʧ اوالʺʽȞʛوȃʽʨلʨجʽ ان سʻايʙر للأمʛاض الʺʜمʻة، ؗلʽة الʢʖ Ǽʳامعة وفʽʰي وجʨ كالغارȑ، ؗالغارȑ، ؗʻʙا؛ وȃارȑ ؗʨؗʶʨن، شعʰة العʙوȐ ʙوȑ، والʺʻاعة ǼȞلʽة لʻʙن الʳامعʽة، الʺʺلؔة الʺʱʴʙة؛ وȃاǼاكار ن ْ شʰȞة مȞافʴة العʙوȐ، داكار، الʶʻغال؛ ؗو اثلʽʧ عʹʨ مʳلʝ والʨقاǽة مʧ دن، مʙيʛة فʛع العʙوȐ الʺʛتʰʢة Ǽالʛعاǽة الʸʴʽة العʙوȐ ومȞافʴʱها، ؗو الة الʸʴة العامة في ؗʻʙا؛ وديل فʽʷʛ، لʷʰȞة العالʺʽة للإنʚار Ǽʴʙوث الفاشʽات لاللʳʻة الʱʨجʽهʽة ومʨاجهʱها؛ وفʛنانʙا لʽʶا، أخʸائʽة وȃائʽات، شعʰة تعʜȄʜ جʨدة الʛعاǽة الʸʴʽة، مʛاكʜ مȞافʴة الأمʛاض والʨقاǽة مʻها، ومʨȑ لʽʧ لʽʻغ، لاǽات الʺʱʴʙة الأمʛȄȞʽة؛أتلانʱا، جʨرجʽا، الʨ مʙيʛة إدارة مȞافʴة العʙوȐ، سʻغافʨرة، ورئʽʶة جʺعʽة مȞافʴة ʗ، مʙيʛ بʛنامج العʙوȐ في آسʽا والʺʴʽȌ الهادȏ؛ وديʙيʽه ب ʱʽِ مȞافʴة العʙوȐ والʺʛؗ ʜ الʺʱعاون مع مʻʤʺة الʸʴة العالʺʽة Ǽʷأن سلامة الʺʛضى، جامعة مʶʱʷفʽات جʻʽف، وؗلʽة وفʛنانʙو أوتايʜا أورايʧ، رئʽʝ الʰʛنامج الʢʖ، جʻʽف، سʨȄʶʛا؛ الʨʡʻي للʨقاǽة مʧ العʙوȐ ومȞافʴʱها، وزارة الʸʴة، سانʱʽاغʨ، شʽلي؛ ودǽامانʱʽʝ بلاشʨراس، وحʙة دعʦ الʱʛصʙ والاسʱʳاǼة، الʺʛؗ ʜ الأوروȃي للʨقاǽة مʧ الأمʛاض ومȞافʴʱها، الʢʖ الʺʳʱʺعي، ؗلʽة ووȄʻغ هʨنغ سʽʱʨ، إدارة سʨلʻا، الʶʨȄʙ؛ الʸʴة العʺʨمʽة، جامعة هʨنغ ؗʨنغ، الʸʽʧ، مʻʢقة هʨنغ كʨنغ الإدارȄة الʵاصة؛ ونانʙيʻي شʽʱي، خʰʽʛ اسʱʷارȑ في الʺʽȞʛوȃʽʨلʨجʽا، خʙمات الʺʽȞʛوȃʽʨلʨجʽا الʺʛجعʽة، وؗالة .الʴʺاǽة الʸʴʽة، ؗʨلʽʻʙيل، الʺʺلؔة الʺʱʴʙة؛ وراشʽل م لʛعاǽة الʸʴʽة، مʛاكʜ مȞافʴة سʺʽʘ، شعʰة تعʜȄʜ جʨدة ا الأمʛاض والʨقاǽة مʻها، أتلانʱا، جʨرجʽا، الʨلاǽات الʺʱʴʙة الأمʛȄȞʽة. ونʷȞʛ الʺʷاؗر ʽʧ مʧ مʻʤʺة الʸʴة العالʺʽة، الʱالʽة أسʺاؤهʦ: بِʻʙِّ تا ألِّغʛانʜȑ، وجʛتʛود أفʨرتʛȑ، وȂيʰʛِل Ǽاّلʽʛ، وآنا ʱʽʧ فʛانʶʽʝ، Ǽاولا ؗʨتʽʻهʨ، ونʽʻʨ دال داǽانغʽʛانغ، وؗʛȄʶ وȃʽʽʛ ؗلافي ؗارȄʽʨ، ومارȄا ؗلارا Ǽادوِفʜȑ، وجʨاو Ǽاولʨ تʨلʽʙو، وناهʨؗʨ شʽʻʙو، وفالʽʶȞا سʱʺʰلʽʨك، ومارȄا فان كʽʛؗ هʨف. ʙʽفʨؗ ȐوʙعǼ ʧʽباʸʺلا ىضʛʺلل ةʽلʜʻʺلا ةǽاعʛلا-19 يجلاعلا ʛʽبʙʱلاو ةفʽفخ ضاʛعأǼ ةȃʨʴʸʺلاʦهʽʢلاʵʺل -5- عجاʛʺلا 1. World Health Organization. Home care for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection presenting with mild symptoms and management of contacts: interim guidance (accessed 26 January 2020). 2. World Health Organization. Infection prevention and control of epidemic- and pandemic prone acute respiratory diseases in health care. (accessed 26 January 2020) . 3. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Geneva: World Health Organization; 2020 (accessed 17 March 2020). 4. World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge. (accessed 20 January 2020) . 5. World Health Organization. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance (accessed 17 March 2020). عجاʛم Ȑʛخأ World Health Organization. Management of asymptomatic persons who are RT PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance, (accessed 20 January 2020) . World Health Organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS CoV) infection is suspected: interim guidance, (accessed 20 January 2020). World Health Organization. Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: interim guidance. (accessed 20 January 2020). Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44167, accessed 20 January 2020). Laboratory testing for 2019 novel coronavirus (2019- nCoV) in suspected human cases: interim guidance, 17 January 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/330676, accessed 20 January 2020) . Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140 6736(20)30154-9 . Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person- to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013; 18(11): 20427. doi:10.2807/ese.18.11.20427-en . Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5 . Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316 . Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. ȑأ ةعǼاʱʺل ʖʲؗ ʧع عضʨلا ʙصر ةʽʺلاعلا ةʴʸلا ةʺʤʻم لصاʨت ىلع ʛثʕت نأ ʧȞʺǽ تاʛʽغت ʛʽʽغت أʛʡ اذȂو .ةʽئʙʰʺلا تاداشرلإا هʚه لماʨع ȑأ ىلع ةلص تاذ ةثʙّʴم تاداشرإ ةʺʤʻʺلا رʙʸت فʨʶف ، ةʽئʙʰʺلا تاداشرلإا ةقʽثو ةʽحلاص يهʱʻت ،ʥلذ فلاʵȃو .ةʽفاضإ .اهراʙصإ ʧم ʧʽʱʻس ʙعǼ هʚه ©ةمظنم ةحصلا ةيملاعلا 2020 ضعب قوقحلا ةظوفحم. اذه فنصملا حاتم ىضتقمب صيخرتلا. SA 3.0 IGO-NC-CC BY.( WHO reference number: WHO/2019-nCoV/IPC/HomeCare/2020.3