Infection Control Measures in the Home

Whether you're delivering food to the home of a sick person, helping family members keep the house clean, or providing hands-on care; getting sick is always a concern. In a recent report, 76% of Americans worried about becoming sick if they had to take care of a family member during an influenza pandemic¹.This section presents information about the three levels of infection control that individuals, families, and communities of care can use during an influenza pandemic.

Level 1

If you are a family or community of care member who delivers food or meals, runs errands or does outside chores, but does not enter the home, you should:

• Wash your hands before doing any of the outside chores
• Cover a cough or a sneeze with tissue
• Do not touch your face, nose, or mouth while you are doing chores
• Use waterless hand cleaner until you are back home and can wash your hands with soap and water
• Do not go into the house or have direct contact with anyone in the home

Level 2

If you are a family or community of care member who does chores in the house for other healthy family members including food preparation, taking care of healthy children, and housework, but does not enter the sick room, you should:

• Wash your hands before and after cooking, cleaning, and doing laundry
• Wear disposable or exam gloves when handling dirty laundry that has any body fluids like phlegm, mucus, vomit, or diarrhea
• Wash clothes on warm cycle with regular detergent. Dry on warm cycle
• Wash dishes in warm, soapy water or in a dishwasher on regular cycle
• Leave supplies outside the sickroom door or in a place where the caregiver can easily pick items up. Do not enter sick room

Level 3

If you are a caregiver who is involved in daily monitoring and care of the sick person, go in and out of the sick room, but do not do other needed chores, you should: 

• Wash your hands before entering the sick room and after you leave the sick room
• Wear an apron, mask (or N95 respirator) and disposable or exam gloves if you are taking care of a sick person with a cough
• Have the sick person cover his or her face with a tissue when coughing
• Have the sick person wash his or her hands after using a tissue
• Do not do other family chores like cooking or cleaning
• Stay healthy. If you become sick with fever, coughing, or muscle aches, you should stop taking care of sick people in the home

Additional Infection Prevention and Control Information 

The U.S. Department of Health & Human Services Pandemic Influenza Plan Supplement 4 Infection Control, available online at http://www.hhs.gov/pandemicflu/plan/sup4.html provides the following recommendation for infection control measures in the home under section G-3:

• "All persons in the household should carefully follow recommendations for hand hygiene (i.e., hand-washing with soap and water or use of an alcohol-based hand rub) after contact with an influenza patient or the environment in which care is provided.
• Although no studies have assessed the use of masks at home to decrease the spread of infection, use of surgical or procedure masks by the patient and/or caregiver during interactions may be of benefit. The wearing of gloves and gowns is not recommended for household members providing care in the home.
• Soiled dishes and eating utensils should be washed either in a dishwasher or by hand with warm water and soap. Separation of eating utensils for use by a patient with influenza is not necessary."
• "Laundry can be washed in a standard washing machine with warm or cold water and detergent. It is not necessary to separate soiled linen and laundry used by a patient with influenza from other household laundry. Care should be used when handling soiled laundry (i.e., avoid "hugging" the laundry) to avoid contamination. Hand hygiene should be performed after handling soiled laundry.
• Tissues used by the ill patient should be placed in a bag and disposed with other household waste. Consider placing a bag for this purpose at the bedside.
• Normal cleaning of environmental surfaces in the home should be followed."

As of April 25, 2008, the Centers for Disease Control and Prevention (CDC) had not released additional guidelines for infection control measures in the home².Current World Health Organization (WHO) guidelines3] and CDC guidelines for infection control in hospital settings are available^4. 

Basic infection control measures used in hospitals include:

• "Isolating the infected person (keeping them in a room away from others)
• Limiting contact with the person by staying at least 3 feet away
• Wearing a gown if the caregiver is likely to come in contact with any body fluid
• Wearing a surgical or procedural mask once, and then discarding it
• Using disposable gloves if there is contact with respiratory secretions, blood, or body fluids
• Hand-washing
• Remembering to not touch eyes, nose or mouth with contaminated hands"

¹Blendon, R. J., L. M. Koonin, J. M. Benson, M. S. Cetron, W. E. Pollard, E. W. Mitchell, et al. "Public Response to Community Mitigation Measures for Pandemic Influenza." Policy Review. Vol. 14, No. 5, May 2008. Found at Emerging Infectious Diseases on Centers for Disease Control website. <http://www.cdc.gov/eid/content/14/5/778.htm>  p. 779.

²Centers for Disease Control. "Guidelines for Control of Infection in Home Care Settings." 5 May 2008.  <http://www.cdc.gov/ncidod/dhqp/gl_home_care.html>  accessed 24 Mar. 2008.

³World Health Organization. "Non-pharmaceutical Interventions for Pandemic Influenza, National and Community Measures." Emerging Infectious Diseases.Vol.1,No. 12, 2006. pp. 88-94.

⁴Siegel, J. D., E. Rhinehart, M. Jackson, L. Chiarello, and the Healthcare Infection Control Practices Advisory Committee. "Standard Precautions." Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007. June 2007. <http://www.cdc.gov/ncidod/dhqp/gl_isolation.html>  accessed 24 Mar. 2008.