Norwegian National Advisory Unit on Long-term Mechanical Ventilation (NLTMV)

Coronavirus for users of BiPAP or home ventilators

Information on Coronavirus for users of BiPAP or home ventilators (LTMV - long-term mechanical ventilation user).
The NLTMV and collaborators in all hospitals are working to ensure that you get the best possible care. Here is some general advice about the Corona pandemic.

  • Follow your treatment routines and the general advice on infection prevention published by the Norwegian institute of public health
  • Mask ventilation does not increase your risk of being infected
  • In most cases, the virus infection appears to be mild
  • In some situations, special precautions may be necessary to protect those who help you

Most patients who use breathing aid with BiPAP or home ventilator have diseases that do not affect the immune system and many have "healthy lungs". There is no information to indicate that you are more prone to get the severe type of viral pneumonia than other people are. However, since respiratory and / or cough function is reduced, there is a greater risk of complications in the course of a viral infectious disease, e.g. in the form of a bacterial pneumonia. Other risk factors apply similarly to the general population.

The Public Health Institute information to patients in the high-risk groupGeneral advice to patients with neuromuscular diseases

We recommend users of all respiratory equipment, as well as family and possibly auxiliary personnel to follow the general advice of FHI to reduce the risk of infection

Updates on corona virus: Facts, advice what to do

1. For those of you who use BiPAP or cough machines and are able to self-help (do not have home nursing or personal assistants).

a. If you are healthy and have not been exposed to coronary infection yourself:

Normal cleaning routines for BiPAP and cough assist machines are sufficient. If you are unsure of these routines, you can contact your local hospital department / outpatient clinic or BHM central (centre for treatment aids).

b. If you have been exposed to infection and have symptoms of an upper respiratory tract infection or proven coronary infection:

For most patients, it will be possible to stay home and use BiPAP as usual, but infection control measures must be implemented. If you are suspected of having coronavirus disease and have family members in the same household, you should follow advice to limit infection. See general description at Institute of Public Health.

There may be an increased risk of infecting other household members when using BiPAP machines. Aerosol (small droplets/particles that can carry viruses) are more easily formed when breathing through a mask with a large airflow. You should therefore keep as much distance as possible between yourself and other members of the family. You should sleep/use BiPAP in your own bedroom and the BiPAP mask should be treated as contagious and cleaned in warm soapy water at 60 degrees.

It is important for you as a patient to get enough rest, and maintain your food and drink intake. If you develop fever, use an antipyretic such as paracetamol as required. If you have mucus that is difficult to cough up, or feel your breathing is becoming laboured, you may want to rest and use your BiPAP for short periods, e.g. 15 - 30 minutes, during the day. Your general condition will determine the need to contact a doctor.

Some patients will already have specific instructions from their doctor about symptoms it is most important to recognise and what to do should they becomes ill. For example, this may include the use of other respiratory aids such as a cough assist machine or starting another medication. Remember, using a cough machine also creates aerosol that can be infectious so use this in your own room and clean the equipment in the same way as BiPAP mask.

2. For those who use BiPAP and are dependent on help from a nursing care or personal assistant at home.

a. If you are healthy and have not been exposed to corona infection yourself:

Infection prevention is the most important measure. See introduction.

Remember: good procedures for hand and cough hygiene. Assistants must also practice good hand hygiene (washing or disinfecting with alcohol) before any close contact or handling of the patient's equipment (mask, mouthpiece, etc.) that can have been in contact with the face. This applies when taking on/off the mask as well as when cleaning the equipment.

b. If you have been exposed to infection and have symptoms of respiratory infection or have been diagnosed with coronavirus:

 For most patients, it will be possible to stay home and use BiPAP as usual, but some may need hospitalization.
If their general condition is good and can remain at home, it important to evaluate whether it is possible to implement adequate infection control measures in the home.
Note, the use of BiPAP and cough assist machines are associated with an increased risk of aerosols and contamination measures is necessary. Aerosols are small fluid particles that can carry viruses over greater distances drops expelled when coughing.

You should contact the organization that provide your home nurse care or personal assistants and inform them about the situation. They will need to consider whether their staff should be tested for infection and what infection control measures should be implemented.

For patients

It is important that you get enough rest, food and drink. If you develop fever, use antipyretics (e.g. paracetamol) if necessary. If you have a lot of mucus that is difficult to cough up or feel your breathing is becoming laboured, you may want to rest and use your BiPAP for short periods, e.g. 15 - 30 minutes, during the day. Your general condition will determine the need to contact a doctor.
Some patients will have specific instructions from their doctor about symptoms it is most important to recognise and what measures should be taken (use of nebulizer, cough machine or antibiotics). This may be sufficient to avoid hospitalization.


For Assistants/Caregivers

Assistants and caregiver must follow the local authorities or service provider's guidelines for infection control.

In practice, this means an assistant/caregiver who assists with connecting BiPAP and/or cough assist machine must wear gloves, respiratory protection, eye protection and long-sleeved protective garment with hood. The machine must be switched off before removing the facemask.
If the assistant only provides care or visits when breathing equipment is not in use, they can use surgical mask, isolation gown and gloves. The patient should use surgical mask.

Cleaning

Ventilation  equipment must be cleaned carefully. The BiPAP mask (incl.  nozzle or cough mask) should be cleaned daily with soapy water (60 degrees). The BiPAP hose should be cleaned weekly.
Used fabrics and bedding are placed directly in the washing machine and washed at a minimum of 60 degrees. Frequent cleaning of surfaces, such as bathroom sink, toilet, door handles and kitchen surfaces, is recommended. Ordinary cleaning agents can be used.

3. For those who use life-sustaining treatment, BiPAP or home-based ventilator 24 hours a day and rely on help from home nursing or user-controlled personal assistance (BPA) 24 hours daily.

All patients who use life-sustaining treatment at home should have a plan for emergencies including a list of important phone numbers that includes contacts in the local authorities' home service department, or agency that employs personal assistants and the hospital. Make sure you have an updated contact list! Contact your local and specialist health service coordinator if you do not have all of these.
Ensure that you have adequate access to respiratory equipment supplies.

It is important to be prepared for eventualities such as occur when assistants are absent due to illness or quarantine. The team leader or person performing this function should have an overview of the personnel situation at all times. All Health Authorities should now have an overview of patients who require life-sustaining treatment at home and which of them is at risk of failing care services. Plans should be made for how to best meet the needs of the individual without resorting to hospitalization. how to organize this and whether temporary agency services are available will vary between local authorities and between the various health authorities. If it is not possible to secure appropriate care at home, hospitalization will be necessary. Keep in touch with your coordinator / contact person in the local authority for updates on the situation.

a. If you are healthy and have not been exposed to corona virus infection:

Infection prevention is the most important measure. See introduction:

Remember: good procedures for hand and cough hygiene. Assistants must also practice good hand hygiene (washing or disinfecting with alcohol) before any close contact or handling of the patient's equipment (mask, mouthpiece, etc.) that can have been in contact with the face. This applies when taking on/off the mask as well as when cleaning the equipment.

b. If you have been exposed to infection and have symptoms of upper respiratory tract infection or corona virus.

If the patients general condition is good and hospitalization is considered unnecessary, the coordinator in the local authority/service provider must be contacted to clarify what measures must be taken regarding home care. The purpose is to prevent personnel who help you from being infected and to prevent the spread of infection. Pending clarification, use infection prevention as with droplet based regimen. The coordinator should be aware of what this entails and what equipment/consumables are necessary. In cases of proven coronavirus disease, where there is a high risk of infection, a respiratory protection regime with eye protection, long-sleeved gown, hood, and gloves is required for those staying in the same room as the patient. When such measures are considered necessary, the home care coordinator should contact the LTMV coordinator at the hospital for advice concerning what other measures staff may need to employ in addition to those applying to infection control equipment.

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