Advisory on the Use of the National Government-Led Mega Temporary Treatment and Monitoring Facilities (TTMF) Readiness Checklist

Infrastructure

OK

Site selection:

• Access to a COVID-19 Referral Hospital or an L2/L3 Hospital Accepting Suspect, Probable and Confirmed COVID-19 patients with severe or critical symptoms

• Fully enclosed space with adequate lighting

Water and electricity:

• Access to continuous supply of Electricity with back up supply

• Access to uninterrupted free-flowing water for at least 72 hours

Waste disposal:

• Liquid waste: plumbing system shall have access/attached to the public sewer line. If toilet are not connected to sewer, hygienic on-site treatment systems should be ensured such as pit latrines and septic tanks, or excreta should be safely stored and transported for off-site treatment.

• If to use portalets, regular disinfection should be observed

• Solid waste: must be collected daily by accredited Treatment, Storage and Disposal provider, if waste storage facility is not available

Toilet and Bath minimum requirements:

• For cohorted confirmed

o Water Closet: 1 per 25 males/1 per 20 females

o Urinal: 1 per 10-50 males, additional 1 urinal every 10 additional patients

o Showers: 1 per 8 persons

o Lavatory: 1 per 10 males; 1 per 10 females

• For suspect and probable

o Individual toilet and bath of at least 1.67 sqm

o In extreme cases where T&B will be shared, stringent disinfection should be implemented (See disinfection)

Planning and Design

OK

Ventilation

• Level of air pressure should follow a decreasing value from the clean/sterile zone area, buffer zone and to the contaminated zone to ensure the unidirectional airflow from one zone to another

• Diluted ventilation in all areas, with air exhausted to an air space with no people

• Provision of at least fan ventilation in patient rooms or patient observation area

User Flow Circulation/Foot traffic

• Unidirectional user flow circulation/foot traffic should be established for healthcare workers from one zone to another

• Clear flow traffic of utility/aide, food servers, and other non-health professionals

o Collection of dirty linen/laundry must be from contaminated zone directly to the laundry area

o Utility/aide who will disinfect or sanitize the contaminated zone must go through the buffer zone for donning and doffing of PPE

o Food servers are limited to clean zone only

• A separate entrance and exit for patients and healthcare workers should be established

o Entrance and exit of HCW should be connected to the clean/sterile area

o Entrance and exit of the patient is connected to the contaminated area

Patient placement

• For Facilities catering to Confirmed COVID-19 patients

o Ward type may be allowed considering each patient observation area of at least 7.43 sq.m.

o Partition of at least 1.5 meters between patients, if not applicable, the use of floor to ceiling curtains maybe an alternative as wall partition

o Each patient bed should be at least 1 m apart on all sides

• For Facilities catering to Suspect/Probable OR Close Contact

o Individual enclosed rooms with own toilet and bath of about 9.29 sq.m.

o If without provision for individual toilet and bath, the room should be at least 7.43 sq.m.

o Floor to ceiling height of at least 2.4 m if with artificial ventilation and 2.7 m if with natural ventilation

• Each patient room or patient observation area shall have the following:

o Patient Bed

o Chair and table

o Power/Electrical Outlet

o Light source

Floor Plan and Zones

OK

General requirements

• Has Clean, Buffer, and Contaminated Zones

• Separate doorway from clean to contaminated zone and vice versa

• Each zone is divided by a non-porous partition such as glass, steel, or drywall

• Each functional room should be adequately ventilated with proper lighting

• Footbath should be placed in all exits of the facility

• Footbath in the passageway from the contaminated area to the buffer area

Clean/Sterile Zone:

• Staff Entry and Exit

• Staff Holding Area

• Staff's toilet and bath

• Pharmacy

- Provision for storing and handling Medicines and Medical Supplies

- Shelves and cabinets

- Desk and chairs

- At the minimum 4.25 sqm for storage and work area of 5.02 sqm/staff

• Central Supply/Stock Room

- Shelves and cabinets that are moisture-resistant and made from materials that can be easily cleaned

- Storage containers and shelves are labeled and with protective covers

- Room size of at least 4.65 sqm

• Records Storage Room

- Temporary Storage of Health Records prior to submission to LGU upon discharge

- May serve as an area for encoding reports, etc.

- Storage area of at least 4.25 sqm

- Work area of 5.02 sqm/staff

Buffer Zone:

• Donning Area

- Ante-Rooms

- Level 1: Lockers for change of clothes per staff (Change from outside clothes to uniform)

- Level 2: Hand washing sinks, foot-operated waste receptacles (Hand Hygiene)

- Level 3: Cabinets for PPE supply (Wearing of Complete PPE)

• Doffing Area

- Ante-Rooms

- Level 1: Receptacles for disposable PPEs, Bins for disinfection of reusable PPEs, Misting (if applicable) (For removal and disposal of gloves and gown)

- Level 2: Hand washing sinks, foot-operated waste receptacles (Hand hygiene, removal of mask and goggles)

- Level 3: Hampers for used uniforms or scrubs (Change from uniform to outside clothes)

Contaminated Zone:

• Patient Entry and Exit

- Main door shall be 0.90m to 1.20m is length to easily accommodate patients regardless of type of movement

- Accessible to main driveway

• Patient receiving or triage area

- At least 5 sqm to allow at least 1 staff to man and receive patients and documents

• Patient ward/rooms (as indicated in Patient Placement)

• Specimen Collection Area/Room (if applicable)

- Individual booths

- Physical barrier between patient and specimen collector

Other Areas (located outside the main infrastructure of the Temporary Facility)

• Waste Disposal and Storage Area

- At least 4.65 sqm

- Accessible to driveway for access of hauler service provider

• Laundry Holding Area (if applicable)

- At least 4.65 sqm if for storage only

- Accessible to driveway for access of laundry service provider

ITEMS

OK

Pre-deployment

Orientation:

• Signs and symptoms of COVID-19 and how to monitor patients with such

• Chain of Infection and how to break the chain of transmission

• Triaging, early recognition of signs and symptoms, high risk individuals and source control of COVID-19

• Medical and Psychosocial management of COVID-19 patients

• Respiratory Etiquette and Social Distancing

• Isolation Precautions (Standard Precaution and Transmission-based Precautions-Airborne, Contact, and Droplet)

• Physical layout and workflow map of important areas and zones in the facility

• Healthcare worker Risk Assessment and Management in the Context of COVID-19 Virus

• Reporting procedures for COVID-19 surveillance as established in the facility

• Policies or protocols on accommodation arrangement, transportation, laundry of dirty uniforms and/or scrubs worn during duty

Training

• Hand Hygiene Technique, Five (5) Moments of Hand Hygiene

• Appropriate use of Personal Protective Equipment

• Proper Donning and Doffing of PPE

• Proper cleaning and disinfection of environmental surfaces and equipment

• Proper collection and handling of healthcare waste

• Safe Management of Cadaver

Orientation for out-sourced Personnel

• Hand Hygiene Technique

• Proper Donning and Doffing of PPE

• Protocols for reporting any breaks in infection control

Provision for Accommodation and Transport

• Accommodation shall be provided whether onsite or offsite

• Health workers shall preferably be placed in individual rooms with individual toilets and showers. In cases where this arrangement is not feasible, beds shall be at least 3 ft apart and toilet/shower facilities must be disinfected after use.

• Transportation services shall be provided to all healthcare workers.

• Food shall be provided throughout their entire tour of duty.

Work Arrangements

• Compliance with 40 hrs work week and 8 hrs of clinical duty per day in compliance with CSC rules and DM 2020-0145

• Risk-based management of exposure for Healthcare workers based on existing guidelines (i.e., low risk — 14 days of self-monitoring after tour of duty, High risk-stop all healthcare related interaction with patient, quarantine and testing) based on DC 2020-0106

Laboratory Testing for Healthcare Workers

• Provision for testing (antibody testing and RT-PCR) of healthcare workers in accordance with DM 2020-0180

ITEMS

OK

Medicines

Antipyretics

- Paracetamol 500mg tablet

Respiratory Medications:

- Lagundi 300 mg or 600 mg tablet

- Lagundi 300mg/5mL, 60mL syrup and 120mL Syrup

- Ipratropium + Salbutamol 500mcg + 2.5mg x 2.5mL (unit dose) Respiratory

- Salbutamol 1mg/mL 2.5mL nebule

- Butamirate Citrate 50mg tablet

Antidiarrheal Medications

- Oral Rehydration Salts

- Loperamide 2mg Capsule

Vitamin Supplementation

- Ascorbic Acid 500mg/tab

- Multivitamins + Zinc tab

Supplies

Complete set of Personal Protective Equipment

- Face shield/Goggles

- Face Masks

- N95 masks

- Isolation Gowns/Coveralls

- Gloves

- Shoe Cover

Airway

- Oxygen Tanks with holder, cart and gauge regulator

- Oxygen Cannula

- Oxygen mask

- Nebulizing kits

- Nebulizers

Others

- Papers for Health Records

- Bed linen

- Pillows

- Pillow Cases

- Plastic Trash Bin with foot pedal (Yellow, Black, and Green)

- Trash bags

- Tissue

- Chlorine granules

- Liquid soaps and dispensers

Equipment

*Ideally dedicated 1 per patient. If not feasible, should be disinfected after every use

- Stethoscopes

- Pulse Oximeters

- BP Apparatus

- Thermal Scanners

Emergency Medicine, Supplies and Equipment (On standby)

Medicines

- Clonidine 75mcg tab

- Clonidine 150mcg/mL, 1mL amp

- IV Fluids (Plan NSS and PLR)

- Epinephrine 1mg/mL, 1mL amp

Medical Supplies

- Endotracheal tube with cuff of varying sizes

- IV stand

- IV cannula

- IV infusion

- Surgical tape

- Cotton Balls

- Sterile Gauze

- Tourniquet

- Povidone Iodine

- Syringes (3cc, 5cc, 10 cc syringe)

Equipment

- Laryngoscope and Blade

- Bag Valve Mask

IT Equipment

- Desktop Computer with printer

- Laptop

- Phone connection (whether landline or cellular phone)

- Provision for Internet Connection speed of at least 5-10 Mbps dedicated for receiving and sending reports

Toiletry Pack (per patient good for 14 days)

- Shampoo

- Bar Soap

- Toothbrush

- Toothpaste

- Sanitary Pads (for women)

ITEM

OK

Service Expected

• Provision of meals per day shall be given in three (3) meals and two (2) snacks.

• A cycle menu shall be provided and should contain a variety of meals and snacks per day

• Meals and snacks should contain the following food items and serving portions:

A meal should contain the following:

Food items

Serving portion

- Rice and alternatives

1 cup (160 g)

- Vegetable dish

1/2 cup (100 g)

- Meat/Fish/Chicken dish or viand

1 pc (80 g)*

- Dessert — preferably fruit

1 pc (50g)*

- Beverage — water or fresh fruit juices

1 bottle/cup (250 g)*

• The amount of serving may vary depending on the type of food item.

A snack should contain the following:

Food item

Serving portion

- Any of the following: bakery products (e.g., ensaymada, cheese roll, etc.), sandwiches, rice porridge, pancit noodles/pasta, kamote cue, turon, and other food items applicable for healthy snacks

1 pc (50-100g)*

- Beverage-water or fresh fruit juices

1 bottle/cup (250 g)*

* The amount of serving may vary depending on the type of food item.

Equipment/Supplies

• Disposable wares and utensils, preferably biodegradable utensils and wares for packaging and distribution

• Food Trolly

• PPE for Food Distributors

Human Resource

• Food Distributors (if the facility has limited HR)

Documentary Requirements

• Service contract

• Sanitary permit

• Medical certificates of personnel

• Water analysis

• Mayor's permit to operate.

ITEM

OK

Service Expected

• Collection and Pick up of Laundry at the specified time

• Adherence to the CDC recommendation on Laundry Cycle* consisting of:

o Flush

o Main Wash

o Bleaching**

o Rinsing

o Souring

• Protocols/Contingencies for Delays in pick-up and delivery

• Protocols for Lost/Damaged linen and uniforms collected

** The use of chlorine or oxygen-activated bleach shall be used during the bleaching cycle

* If hot water cycle is used, the optimum temperature is at least 160ºF (71ºC) for a minimum of 25 min.

Equipment/Supplies

• Separate bags for collecting linens of patients and Healthcare Workers

• PPE for personnel collecting linen and uniforms

Human Resources

• Personnel to collect laundry from the wards

Documentary Requirements

• Service contract

• Business permit

• Sanitary permit

• Other permit as necessary

ITEM

OK

Service Expected

• Safety and Security of the vicinity 24 hours a day/7 days a week

Equipment

• Communication devices on each post

• Guard Touring Monitor

• Side arm for Security guards manning the gates

Human Resources

• All security personnel shall be licensed and trained

• At least 1 security personnel on each gate, entrance and exits of the facility

• Dedicated roving security personnel outside the facility

• Detachment Commander/Supervisor

Documentary Requirements which may include but are not limited to:

• Service contract

• DOLE Registration

• SSS, Pag-IBIG, PhilHealth, etc.

• SOSIA accreditation

• Business permit

ITEM

OK

Services Expected

• Ensure that cleaning and disinfection of the facility is based on the prescribed schedule per zone:

- Contaminated Area: at least 4x a day

- Buffer and Sterile/Clean Zone: at least 2x daily

- Toilet and Bath: at least 2x daily

- Disinfection of frequently touched surfaces such as knobs, faucets, flush lever after use

• Waste should be collected from all receptacles at least 4x a day

• Management of temporary storage area for waste generated in the facility

• Transport, treatment, and disposal of collected waste

Equipment/Supplies

• Standard Disinfectants

- 70% ethyl alcohol to disinfect small surface areas and equipment between uses

- Sodium hypochlorite at 0.1% (1000 ppm) for disinfecting surfaces

- Sodium hypochlorite at 0.5% (5000 ppm) for disinfecting surfaces with blood or bodily fluids spills (allowing 30 mins for the disinfectant to sit)

• Provision for complete and appropriate PPE of utility personnel

• Provision for waste bins with proper labels

• Dedicated cleaning materials for each zone of the facility

• Wheeled trolley for collection of waste

Human Resource

• Utility Personnel

• Training on the protocols/standards for sanitation, disinfection and healthcare waste management

• Training on proper donning and doffing of PPE

Documentary Requirements

• Service contract

• Business permit

• Sanitary permit

• Other permit as necessary