The Sick Room

The United States is lucky to have had few cases of Ebola on its shores, but who knows what will happen in the uncertain future. In good times, we have the luxury of modern medical facilities and advanced techniques to isolate a sick patient from healthy people. If we ever find ourselves in an epidemic scenario, hospitals will be overloaded and your only choice may be to fend for yourself. Our modern advantages will go the way of the dinosaur, and we will be placed in, essentially, the same medical environment we experienced in the nineteenth century.

Not completely, however. We have better knowledge of sterilization and the modes of transmission of infectious diseases like Ebola than we had in previous centuries. If we put this knowledge to work, the average person can become a medical asset in times of trouble.

With highly contagious diseases such as Ebola, it makes sense to separate the sick from the healthy. To do this, every household should designate a “sick room” before an epidemic arrives. The family “medic” can put together a working isolation area that will protect the healthy while giving an organized place to care for the sick.

When I say “protect the healthy,” that means you as caregiver as well as everyone else. Ebola is harsh on medical personnel, infecting hundreds and killing more than half.

The sick room should be an area at one end of the house, preferably away from common areas like the kitchen. This room should have plenty of light and ventilation from the outside. Open windows will decrease the concentration of viral particles that may be suspended in the air. Assuming that you have power, air ducts are acceptable for diseases like Ebola, which is spread mostly via bodily fluids. For severe influenzas like bird flu, these ducts should be taped.

Your home may not be large enough to keep a clear space between the infected and the healthy. In this circumstance, screens and plastic sheets will come in handy. Even if the room has a door, plastic sheets should be hung to provide a barrier.

Furnishings in the sick room should be minimal. A bed or beds, an area for exams, a work surface, and a “latrine” may be sufficient for your purposes. Cloth surfaces, such as what you see in sofas, carpets, etc., can harbor pathogens (disease‑causing organisms) and should be avoided, if possible. Plastic covers on bedding or furniture in the room will make daily cleanings more manageable. In the case of Ebola, a blood‑splattered mattress may need to be thrown away and burned if it’s not covered with plastic. Remember: the more areas that can be wiped down and disinfected easily, the better. Carpet and soft plush furnishings are your enemy.

It’s important to have a way to eliminate waste products, especially from bedridden patients, even if it’s just a five‑gallon bucket and some bleach. Have closed containers like hampers to put used sick room items that need to be cleaned (or thrown away). We’ll discuss proper disinfecting techniques later.

It’s wise to establish a station near the entrance of the room or tent for masks, gloves, gowns, and disinfectants. Here you’ll need a basin with water, alcohol, bleach, and towels that should be kept for exclusive use by the caregiver. If at all possible, there should only be one person involved in caring for an Ebola patient, in an effort to place few people at risk for contamination.

TIP

It’s important to have a way to eliminate waste products, especially from bedridden patients, even if it’s just a five‑gallon bucket and some bleach. Have closed containers like hampers to put used sick room items that need to be cleaned (or thrown away).

The average citizen won’t be able to afford $1,000 Powered Air‑Purifying Respirator equipment. He or she will have to make do with items that will afford some protection, at least, from the infection.

For supplies, get plenty of masks and gloves. I strongly recommend putting on two pairs of gloves every time. Gowns can be commercially made, can be plastic coveralls, or, in extreme situations, even dry cleaner clothes covers. Many people consider medical supplies to consist of gauze, tourniquets, and battle dressings. These are useful for injuries, but you must also dedicate sets of sheets, towels, pillows, and other items to be used in the sick room. Keep these items separate from the bedding, bathing, and eating materials of the healthy members of your family or group. You’ll never have enough of these items, as you’d discover if you found yourself having to deal with an Ebola victim.

Accumulating all these items may seem excessive to you, but you can never have enough dedicated medical supplies. You may save the life of a loved one or even your entire family if you are diligent in putting together your medical stores.

You’ll want to clean the sick room as thoroughly as possible on a daily basis. It’s imperative to clean surfaces that may have germs on them with a bleach‑and‑water solution. These include doorknobs, tables, sinks, toilets, counters, and even toys. Wash bed sheets and towels frequently; boil them if you have no other way to clean them. As a rule, all bedding, clothes, and personal items of the ill are infectious. Wash your hands right after touching them. The same goes for plates, cups, etc. Any equipment brought into the sick room should stay there.

You won’t be able to give IV fluids to the Ebola patient in your sick room, but it’s still important to keep them hydrated. They’ll have many symptoms, like bleeding, that will be difficult to treat, but some medications will give “supportive care” to make them feel better and give their immune system an opportunity to kick in:

• Fever reducers (acetaminophen/Tylenol; stay away from ibuprofen or aspirin, as they could worsen bleeding issues)

• Pain relief (acetaminophen)

• Decongestants (pseudoephedrine/Sudafed)

• Antidiarrheals (loperamide/Imodium)

• Antinausea/vomiting drugs (ondansetron/Zofran)

• Vitamins and natural immune boosters

• Oral rehydration solutions These can be commercially purchased or you can make your own. To a liter of water, add:

6–8 teaspoons sugar/liter

1 teaspoon salt/liter (sodium chloride)

1/4–1/2 teaspoon salt substitute (potassium chloride)/liter

1/4 teaspoon baking soda/liter

For children, mix the above in two liters of water.

Give your patient a noisemaker of some sort that will allow them to alert you when they need help. This will decrease anxiety and give them confidence that you will know when they are in trouble.

Compare the above to official CDC recommendations for health‑care professionals and you’ll see that you can follow most of the guidelines in your own home rather effectively.

HEALTH‑CARE PROFESSIONAL PRECAUTIONS

• Treat each person in their own area, with their own bathroom, if possible, or at least provide a barrier between patients.

• Take a careful log of medical professionals entering and exiting the room.

• Absolutely no visitors–only health‑care providers permitted, and only those specially assigned to the case.

• Protective gear should be worn by all medical professionals entering the room–gloves, gowns (fluid resistant or impermeable), eye protection (goggles or face shields), facemasks, as well as double gloving, leg coverings, and disposable shoe coverings to protect from copious amounts of blood, other bodily fluids, vomit, or feces present in the environment.

• Only dedicated, preferably disposable medical equipment is to be used. That which is not disposable needs to be cleaned and disinfected regularly.

• Limit use of needles, and take extreme care when used; dispose in puncture‑proof, sealed containers.

• All aerosol‑generating procedures should be avoided if possible; if not, a combination of measures to reduce exposures from aerosol‑generating procedures should be employed, ideally in an Airborne Infection Isolation Room (AIIR) with closed door and limited exit and entry.

• Health‑care providers should wear gloves, gowns, disposable shoe covers, and either a face shield that fully covers the front and sides of the face or goggles, and respiratory protection that is at least as protective as a NIOSH certified fit‑tested N95 filtering face piece respirator or higher (e.g., powered air purifying respirator) during aerosol‑generating procedures.

• The surfaces in the room should be cleaned regularly.

• Collection and handling of soiled reusable respirators must be done by trained individuals.

• Hands should be washed before and after all patient contact, and before putting on and upon removal of PPE, including gloves.

• If contact is made with fluids, health‑care provider should stop working and immediately wash the affected skin surfaces with soap and water. Mucous membranes (e.g., conjunctiva) should be irrigated with copious amounts of water or eyewash solution, and an occupational health/supervisor should be contacted for assessment.

TIP

Health‑care providers should wear gloves, gowns, disposable shoe covers, and either a face shield that fully covers the front and sides of the face or goggles, and respiratory protection that is at least as protective as a NIOSH certified fit‑tested N95 filtering face piece respirator or higher (e.g., powered air purifying respirator) during aerosol‑generating procedures.

• Health‑care providers who develop sudden onset of fever, intense weakness or muscle pains, vomiting, diarrhea, or any signs of hemorrhage after an unprotected exposure (i.e., not wearing recommended PPE at the time of patient contact or through direct contact to blood or bodily fluids) to a patient with Ebola should immediately stop working, notify their supervisor, seek prompt medical evaluation and testing, notify local and state health departments, and comply with work exclusion until they are deemed no longer infectious to others.

• An asymptomatic health‑care provider who had an unprotected exposure should receive medical evaluation and follow‑up care including fever monitoring twice daily for twenty‑one days after the last known exposure. (Source: CDC.gov)