Safety-Care® Infection Precautions for Physical Management

North America has experienced a pandemic of Coronavirus Disease (COVID-19). During the pandemic, we recommend that any organization using Safety-Care provide clear guidance to staff if there is the possibility that they might need to use physical management as an emergency intervention.

Keep in mind that different parts of the U.S. and Canada are experiencing different levels of risk, which means that precautions appropriate for some locations may differ from those best for other locations. We recommend consultation with medical professionals and compliance with all relevant laws and regulations.

    Precautions for the Individual in a Hold

    Regardless of COVID-19 risk, Safety-Care has always strongly emphasized prevention and avoidance of restrictive procedures whenever possible. During the pandemic, adherence to a proactive and least restrictive approach is even more important. All of the tools in Safety-Care for prevention and de-escalation should be used by staff to avoid any need for physical management. In addition, we have the following recommendations.

    • Update behavior plans, safety plans, schedules, policies, and other documents to reflect the changed situation during the pandemic.

    • Safety-Care standards currently state that nothing should be placed over the face of a person in a hold. Thus, we do not recommend placing a mask on a person who is in a hold (if the person is already wearing a mask, we recommend removing it as soon as that is practical). Masks can limit airflow. The individual can spit into the mask, moistening the inside and reducing the flow of air in a manner that may not be observable to staff. Masks reduce the ability of staff to monitor the individual’s breathing and medical status. The person may bite or even try to swallow the mask. Overall, we consider the risks of placing a mask on the person in a hold to be greater than the potential infection control benefit.

    • An eye/face shield may be an appropriate item to place on the person in a hold. It should be properly constructed (some shields currently on the market are very flimsy). Do not struggle with or hold the head in order to put a shield on the person. If the person is highly resistant, it may be necessary to give up on placing a shield on that individual during the current incident, or until the person is less agitated. Be cautious about allowing the person to retain the mask after the hold is released (consider the likelihood that the person might do something dangerous with it).

    • It is particularly important to ensure that holds are as brief as possible. Consider establishing a maximum allowed duration for holds (or reducing the time if there already is a maximum time in your policy). Establish this time frame based on discussion with qualified medical professionals.

    • After an incident, encourage the person to wash hands or use hand sanitizer.

    Precautions for Staff

    If a hold is necessary, it is important to minimize the risk of infection passing between the person in the hold and the staff involved in the hold.

    • We recommend that appropriate and authorized kinds of personal protective equipment (PPE) be provided in convenient locations where staff is working with individuals with the potential to require holds. Equipment could include masks, disposable gloves, disposable fluid-resistant gowns, and eye/face shields.

    • If a person is beginning to exhibit escalated behavior, be aware of the potential triggering effect of staff putting PPE on in preparation for a potential hold. The person may respond with further escalation. Consider ways to mitigate this effect, such as having staff wear PPE sometimes in non-escalation situations, using masks with friendly and non-threatening graphics or patterns on them, putting on PPE out of sight of the individual when possible, etc.

    • Be aware of potential fear and psychological trauma issues associated with staff intervening while wearing PPE. One possible approach would be to have a staff person who is not part of the hold, maintaining social distancing, who is the one attempting de-escalation during the hold while, for example, keeping a mask available but not on.

    • If staff implement a hold without putting on PPE, they should call for assistance so that other staff can don PPE and switch with them as quickly as possible.

    • Staff will likely find that implementing a hold while wearing a mask or face shield can be more tiring than without. They may become winded more quickly than usual. Be prepared to switch staff every few minutes (or release if necessary), before they become too fatigued.

    • After a hold or significant incident, clean all affected surfaces using approved disinfection methods. Staff should remove and dispose of used PPE, then wash and use sanitizer.

    • Encourage staff to have a change of clothing available at their worksite.

    • After an incident, make sure that a thorough debriefing and incident review are recommended. Adapt behavior plans, safety plans, policies, schedules, availability of PPE, etc., on the basis of lessons learned from what goes right and what goes wrong during any incidents that occur.

    • Supervisors should be aware of the stresses placed on staff if they need to or are concerned about participating in holds or other physical contacts during the pandemic. There can be considerable fear and anxiety and extra support, assistance, and information should be offered.

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