Guidelines for the protection of
home care employees

General information on work tasks and shifts

Responsibilities and providing instructions

• The employer must provide the employees with the information required for preventing infection and ensure that they have the required skills to share the information.
• In their work, employees must protect themselves as well as the person receiving assistance.
• The employees must the provide person receiving assistance and their family members with instructions on hygiene and on how to protect themselves from viruses.
• Municipalities must ensure the continuity of home nursing and personal assistance even if the persons receiving assistance or the assistants are taken ill with COVID-19.
• In accordance with guidelines issued by the authorities, municipalities must prepare instructions for informal caregivers, people who receive personal assistance and personal assistance employers.
• The municipality must ensure that the required protective equipment is available to disabled persons who act as personal assistance employers in the same fashion as they are in home care services.
• Contact the municipality in order to make sure that there are enough PPE available and that they are compensated. If you need to pay for them, keep the expences separately from other expenses. Additional information  Heta association heta@heta-liitto.fi 
• In addition to the protection ability the employer must  take into consideration the health of the employee and  ergonomics when selecting the personnel protective equipment  (PPE) for the employee.  
• If one has not had any previous training on how to use the FFP respirators the users are recommended to consult the experts of the hospital districts.
• The use of the FFP respirators need to be practised and it must be made sure  the respirator sit tight on your face without any air leak on the sides. You can test this when breathing the respirator on your face.
• When selecting personal FFP respirators it is good to notice that if the respirator does not sit tight on the face it will not protect the user from the aerosols. When buying FFPs the tightness needs to be considered.
• A valved model must not be used when there are persons who do not use a respirator and who could be infected in the room. Face masks are not personal protective equipment (PPE).
• Working in heat. Respirators, surgical masks and other masks increase the heat load of the workers. Especially working in heat must be taking into consideration when using and selecting the Personnel Protective Equipment during the hot summer days. The employees need breaks once an hour and they need to drink a lot of water. Working in heat (in Finnish) 

Organising work

• In order for as few employees as possible to come into contact with the person receiving assistance, the employees should be divided into small groups responsible for specific individual clients.
• If the same person receiving assistance must be visited repeatedly, they should be assisted by a specific person or group. The employees visiting a person receiving assistance may not be changed constantly.
• An employee must be designated for each person receiving assistance. The person receiving assistance must have a phone number from which they can reach the designated employee or a substitute.
• In addition, it is agreed in advance which group will care for clients with possible COVID-19 infections. These workers need to be listed.
• If possible, work and breaks should be organised so that employees caring for COVID-19 patients do not meet other employees.

Before visiting the person receiving assistance

• Before visiting the client, employees should phone them to ensure whether the person receiving assistance has any symptoms of COVID-19.
• Home care employees may not come to work if they have any symptoms of a respiratory infection, even if the symptoms are very mild. Occupational health care can be requested to assess the situation, if necessary. After having COVID-19, an employee may return to work according to instructions given by the employer and occupational health care.
• In order to protect clients, handwashing and the use of alcohol-based hand sanitizer must be ensured in all services provided at the client’s home.
• If a client suspecs to have COVID-19 he/she must inform the home care workers in advance.  

Employee protection and hygiene with a person receiving assistance who does not have symptoms of COVID-19

Adhere to the usual precautions when treating an asymptomatic person receiving assistance (Finnish Institute for Health and Welfare: Usual precautions and classification of precautions, in Finnish):

• Use disposable surgical mask. If there are no masks available or if it is not possible to wear them for some reason, the staff should wear washable or disposable fabric masks or face visors covering their face and mouth. The masks are to protect the clients from any diseases that the staff may be carrying. 
• A fabric face mask or scarf is only used once and is either washed in 90 °C or disposed of afterwards. A pre-wash with a disinfecting detergent is required if washing at a temperature of under 90°C.

Before visiting the person receiving assistance

Pack the following equipment:

• a surgical mask or a fabric face mask or or visor-like face protector. 

• FFP2 or FFP3 respirator, protective gloves and an apron. These are taken in case the person receiving assistance has developed symptoms of COVID-19 regardless of previous information.

• a bottle of hand sanitizer

• disposable hand towels for cleaning and drying your hands

• sprayable disinfectant or disinfectant wipes for cleaning equipment

During the visit

• Wash your hands with soap and water or use alcohol-based hand sanitizer.

• Dry your hands with disposable paper towels.

• First, cover your face with a surgical mask, a fabric face mask or a visor-like face protector. 

• Avoid using mobile devices as much as possible.

• Wash your hands before leaving the client.

After the visit

• Put used disposable protective equipment and other disposable items used during care into a refuse bag, close it tightly and take it to the mixed waste container.
•  If the face visor or apron are not disposable, put them in their own bag and supply for washing. 

Employee protection and hygiene with a person receiving assistance who has symptoms of COVID-19

• When treating a client with a respiratory infection, adhere to the usual precautions as well as precautions regarding contact and droplets (Finnish Institute for Health and Welfare: Usual precautions and classification of precautions, in Finnish)
• Use disposable protective gloves, a surgical mask, visor/eye-protector and a protective coat or apron.
• If the patient has a COVID-19 infection and he/she is coughing a lot, FFP2 and FFP3 respirators need to be used when taking care of the patient based on the employer’s risk assessment.

Before visiting the person receiving assistance

• Pack the following equipment:
  • disposable protective gloves, disposable surgical mask, eye-protector or a visor, disposable long-sleeved protective coat/apron. The eye-protector is not necessary if using an IIR surgical mask.
  • a bottle of hand sanitizer for cleaning your hands.
  • sprayable disinfectant or disinfectant wipes for cleaning equipment.
• Consider in advance where you can safely put on and take off your protective equipment: outside the client’s door, in the hallway or somewhere else. Take a bag for your outdoor clothes, if necessary.
  • Tie your long hair, including long front hair and cover the hais with a headdress. 
  • Wash your hands with soap and water prior to putting on the protective equipment. 
  • After putting on the protective equipment, wash your hands one more time before putting on protective gloves. 

During the visit

• Wash your hands with soap and water prior to putting on the protective equipment.
• After putting on the protective equipment, wash your hands one more time before putting on protective gloves.
• Have paper towels on hand for drying your hands after washing with soap and water.
• Keep your equipment bag in a disposable plastic bag when visiting a COVID-19 patient.
• Put your cell phone and other mobile devices in a disposable plastic bag. Avoid using the devices during the visit.
• Disinfect used equipment and the equipment bag before leaving the client or immediately outside the client’s apartment. If you cannot disinfect your equipment, put it in its own plastic bag for transporting and disinfecting/sterilizing at a later time.
• When leaving the client, clean your hands with hand sanitizer. Clean-up to the forearms if you have worn a short-sleeved work suit. 

After the visit

• Put used disposable protective equipment and other disposable items used during care as well as the plastic bags used for protecting the equipment bag and mobile devices into a refuse bag, close it tightly and take it to the mixed waste container.
• If your eye-protector and apron are not disposable, put them a separate bag and deliver them to cleaning.

Taking off protective equipment when caring for COVID-19 patients

Taking off the protective equipment in the correct order can prevent microbes from spreading into your surroundings and your own hands contaminating the mucous membranes of the eyes, nose and mouth. As they are taken off, the protective equipment is put directly into a separate bag.

1. Take off the disposable long-sleeve coat/apron and protective gloves and put them in a refuse bag.
2. Disinfect your hands
3. Take off the reusable eye-protector and put in a transfer bag for washing.
4. Disinfect your hands
5. Take off the surgical mask or FFP respirator and put into a refuse bag.
6. Disinfect your hands.

Please note the following instructions:

The Finnish Institute of Occupational Health’s additional information Instructions for taking off disposable gloves (in Finnish).

Finnish Institute for Health and Welfare: Preventing coronavirus infections in home care services (in Finnish)

Finnish Institute for Health and Welfare’s hand hygiene rules of thumb (in Finnish)

For more information, please contact viestinta@ttl.fi

The guidelines of the Finnish Institute of Occupational Health (FIOH) are drawn up together with the Ministry of Social Affairs and Health (SMAH) and the Finnish Institute for Health and Welfare. We also follow the publications of the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO).

European Centre for Disease Prevention and Control (ECDC), COVID-19

World Health Organization (WHO), coronavirus