Coronavirus disease 2019 (COVID-19) causes upper respiratory symptoms, such as shortness of breath, cough, and can lead to more serious symptoms or even death.1 What makes COVID-19 so dangerous is the fact that it is highly contagious and is transmitted by air droplets from coughs or sneezes, personal contact, or touching objects and then touching your face. The best precautions that one can make are to wash hands for at least 20 seconds, maintain a distance of 6 feet from another person, wear a mask, and disinfect objects that you touch regularly.1

COVID-19 has disrupted the daily lives of everyone across the planet. In the wake of COVID-19, many people had to be hospitalized and often need to be placed on ventilators. This requires significant space in hospitals because patients needed to be in places where they won’t be able to contaminate other patients or health care providers treating them. In order to help hospitals with the increased need for space and beds, many companies are working with health systems to transition patients from the hospital to in-home care as quickly as possible.

Home infusion is the administration of drugs to an individual in their own home. The components needed to do home infusion is the drug, supplies, equipment, and nursing services.2 Nurses go to the homes to train and educate the patient and/or caregiver on the proper administration of the home infusion therapy.3,4

Home Infusion Companies
Option Care Health is a company focused on providing home infusion services to increase hospital bed capacity and use hospital resources for patients with COVID-19. According to Option Care Health Chief Operations Officer, Harriet Booker, her company has seen its home infusion services become more valuable during the pandemic. When a patient is in the hospital, Option Care Health works with the individual, their insurance company, and the hospital so that the transition to in-home care is as smooth and quick as possible.

Option Care Health develops a personalized care plan with their physician, prepares the needed medication for home infusion, and distributes and supplies it to the patient’s home. The company has trained nurses to teach the patient and/or caregiver on the best practices to self-administer their medication.3,4

General Operation Recommendations
In order to continue to provide patient care while protecting the safety of the patient and nurse/provider, many new recommendations have been added to general operations. The National Home Infusion Association (NHIA) has implemented several important recommendations to protect patients and staff.

The NHIA has stressed the importance of proper hand hygiene as they are entering the workplace and for employees to avoid leaving the workplace as much as possible. This is to decrease the chance of potentially contaminating the workplace or spreading the disease to patients.5

Screening
NHIA recommends that routine COVID-19 screening be done on onsite essential employees, direct patient care employees, patients, caregivers, and/or other members of the household.5

Staff Protocols if Suspected Exposure
Home infusion sites should develop and implement protocols for high risk COVID-19 patients and personnel. Staff should follow quarantine guidelines if they are suspected to have been exposed and to follow isolation guidelines if/when symptoms occur.

Staff are able to return to work following COVID-19 infection once they meet the CDC criteria for Return to Work for Healthcare Personnel guidelines.5 CDC criteria for health care workers who are symptomatic states that they should not work until their fever subsides without the use of fever-reducing medications, improvement of respiratory symptoms, and negative results of COVID-19 molecular assay from at least 2 consecutive respiratory specimens collected more than 24 hours apart. For asymptomatic workers, they should not work until they have 2 negative COVID-19 tests taken greater than 24 hours apart.6

Patient Protocol
If a patient has suspected or confirmed COVID-19, the nurses should wear enhanced personal protective equipment (PPE), such as gowns, N-95 respirators, face shield, googles, and gloves. Personnel should be trained on the appropriate steps on how to put on and take off their PPE.

Workers who have direct patient contact should conserve their PPE. The patient should be required to wear a face mask whenever any personnel present.5

Patient Delivery Protocol
Eliminate any direct contact between delivery personnel by leaving packages at the patient’s door and calling them or their caregiver to alert them of the delivery and use photo verification instead of signature. The delivery personnel should not be entering the workplace and should avoid making deliveries to hospitals. All of these protocols are in place to prevent the transmission of the disease to the patient and to health care workers.5

Since COVID-19 began the use of in-home care and home infusions have grown to increase space in hospitals and for the safety of the patients. I believe when COVID-19 is over the use of home infusions will still be needed and become the new norm for patients to use.

About the Authors
Greg Watanabe is a PharmD candidate at Pacific University’s School of Pharmacy, anticipated to graduate in spring 2021.

Jonathan Ogurchak, PharmD, CSP, is the founder and CEO of STACK, a pharmacy compliance management software, and serves as preceptor for a virtual Advanced Pharmacy Practice Experiential Rotation for specialty pharmacy, during which this article was composed.

References
  1. What is COVID-19? Georgia Department of Public Health. Available from: https://dph.georgia.gov/what-covid-19
  2. Home infusion therapy services. Centers for Medicare and Medicaid Services. 2020 February 5 [cited 2020 June 9]. Available from: https://www.cms.gov/Medicare/Medicare
  3. Donlan A. Aiming to ease burden on hospitals, CVS health enhances its in-home capabilities. Home Health Care. 2020 April 19 [cited 2020 June 10]. Available from: https://homehealthcarenews.com/2020/04/aiming-to-ease-burden-on-hospitals-cvs-health-enhances-its-in-home-capabilities/
  4. Donlan A. Coronavirus Paving the way for home infusion services moving forward. Home Health Care. 2020 April 19 [cited 2020 June 10]. Available from: https://homehealthcarenews.com/2020/04/coronavirus-paving-the-way-for-home-infusion-services-moving-forward/
  5. NHIA home and specialty infusion industry recommendations or providing services during the COVID-19 outbreak. National Home Infusion Association. Available from: https://www.nhia.org/covid-19_guidance/
  6. Criteria for Return to Work for Healthcare Personnel with Suspected or Confirmed COVID-19 (Interim Guidance). Centers for Disease Control and Prevention. 2020 May 2 [cited 2020 June 8]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html