Guidance to Regional Directors for Action on Requests by Local Government Units to Use DepEd Schools as Quarantine or Isolation Areas for COVID-19

March 26, 2020

DEPED OFFICE MEMORANDUM OM-OSEC-002-20

GUIDANCE TO REGIONAL DIRECTORS FOR ACTION ON REQUESTS BY LOCAL GOVERNMENT UNITS TO USE DEPED SCHOOLS AS QUARANTINE OR ISOLATION AREAS FOR COVID-19

1. The President issued Proclamation No. 922 dated March 8, 2020, Declaring a State of Public Health Emergency Throughout the Philippines, in view of the COVID-19 public health situation. Section 2 of Proclamation No. 922, s. 2020, states that "(a)ll government agencies and LGUs are hereby enjoined to render full assistance and cooperation and mobilize the necessary resources to undertake critical, urgent, and appropriate response and measures in a timely manner to curtail and eliminate the Covid-19 threat."

2. The Department of Education (DepEd) has received a growing number of requests by various Local Government Units (LGUs) for the use of DepEd schools as places for quarantine or isolation as part of their response to COVID-19.

3. DepEd is fully cooperating with the Office of the President, the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF), and the Cabinet on decisions concerning COVID-19. DepEd is committed to render full assistance and cooperation, and to mobilize the necessary resources to undertake critical, urgent, and appropriate response and measures in a timely manner to curtail and eliminate the COVID-19 threat, as enjoined by the President's Proclamation 922.

4. The matter of utilization of schools as quarantine or isolation areas has been discussed in the IATF. The agreement was that any decision concerning public schools should be made in consultation with DepEd, and in cooperation with DepEd officials on the ground and in compliance with the Department of Health (DOH) guidelines, with due consideration to specific conditions.

5. Consistent with this agreement, one of the provisions of Memorandum Circular No. 2020-062 (March 21, 2020) issued by the Department of the Interior and Local Government states:

5.1.10. LGUs shall not use DepEd schools as quarantine or isolation areas. As a general rule, LGUs must refrain from using schools as quarantine or isolation areas unless explicitly allowed by the Department of Education and strictly following the guidelines it may set.

6. DOH also issued Department Memorandum No. 2020-0123 (March 16, 2020) on Interim Guidelines on the Management of Surge Capacity through the Conversion of Public Spaces to Operate as Temporary Treatment and Monitoring Facilities for the Management of Persons under Investigation and Mild Cases of Coronavirus Disease 2019 (COVID-19).Among the public spaces it identified are auditoriums, gymnasiums, classrooms, vacant hotels, courts, open fields with tents.

7. I hereby delegate to Regional Directors the responsibility to approve or deny requests by LGUs to use DepEd schools for quarantine and isolation purposes within their respective jurisdiction, based on evaluation of the request by the Schools Division Superintendent in consultation with the school heads and with the Department of Health.

8. In adherence to DOH Department Memorandum No. 2020-0123 and other applicable DOH and World Health Organization (WHO) guidelines, the evaluation of the request shall be guided by the following:

a. The LGU must state in its request the specific intended purpose or use for the school, and identify the particular facility in the school that will be used as well as the duration of their use, subject to extension, if necessary;

b. The LGU must show that all other facilities have been duly assessed and were found to be inadequate. Schools can be recommended only when no other facilities are available;

c. The LGU must present an assessment by the municipal, city, or provincial health officer that the facility within the school is suitable for the specific intended purpose;

d. The LGU must present the planned management of the facility, which shall be under the supervision of the City/Municipal Health Officer, as stated in DOH Department Memorandum No. 2020-0123, and must conform to existing DOH standards and guidelines, including, but not limited to, patient management, safety standards within the facility and immediate community, waste management/disposal, and other similar/related health requirements; and

e. The LGU request must include an undertaking: for the safekeeping of all property and valuables in the school premises during the operation of the facility; payment of utilities for the period; the conduct of the general cleaning and fumigation, and repair and/or replacement of damaged school facilities as a result of the use of the school; and, payment of expenses related to the setting-up, operation and clearing of the areas used.

9. When a request is granted by the Regional Director based on the recommendation by the concerned Schools Division Superintendent, the school heads must coordinate with the LGU on the following preparations before actual use of the facility for the intended purpose:

a. Designation and vacating of the approved school spaces/structures to be used by the LGU as quarantine or isolation areas, including removal of all chairs, tables, furniture, equipment and other school properties. Such approved school spaces/structures to be used as quarantine or isolation areas shall be cordoned off from the rest of the school;

b. Designation of sufficient number of comfort rooms and handwashing facilities to be used;

c. Safekeeping and/or proper storage of all learning and education materials, resources, equipment, and school records;

d. Documentation of the condition of school facilities and resources before use of the facility;

e. Signing of the minimum Terms and Conditions (TAC) for the Use of DepEd Schools as Quarantine or Isolations Areas, as provided by the Regional Director; and

f. All DepEd personnel involved in the preparation of the school premises shall strictly observe all existing health precautions and social distancing protocols of DepEd.

10. The LGU shall sign the TAC provided by the Regional Director. Should there be other terms to be agreed upon between the Schools Division Office (SDO) and the LGU, the SDO shall draft a Memorandum of Agreement (MOA) between the SDO and LGU, detailing the roles and responsibilities of the parties, among others. The TAC shall be attached to the MOA as an Annex and shall form an integral part of the MOA. In case of conflict between the MOA and the TAC, the TAC shall prevail.

11. The following documents are hereto enclosed as reference to evaluate the health-related undertaking by the LGUs:

Enclosure No. 1 — Interim Guidelines on the Management of PUMs suspected with COVID-19 for Home Quarantine issued as DOH Memorandum No. 2020-0090

Enclosure No. 2 — Interim Guidelines on the Management of Surge Capacity through the Conversion of Public Spaces to Operate as Temporary Treatment and Monitoring Facilities for the Management if PUIs and Mild Cases of COVID-19 issued by the Department of Health (DOH) as DOH Memorandum No. 2020-0123

Enclosure No. 3 — Decontamination, Disinfection, and Sterilization practices issued by the DOH (Annex A4 of DOH Memorandum DOH Memorandum No. 2020-0072; which is also Annex A4 of DOH Memorandum No. 2020-0123)

Enclosure No. 4 — Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19) by the World Health Organization

Enclosure No. 5 — Minimum Standards for Social Distancing/Baseline Protocols to be observed in the workplace, travel, and home and private space and time of deployed personnel during the enhanced community quarantine by DepEd Task Force COVID-19

12. The Regional Directors shall devise an appropriate system for monitoring the use of schools within their jurisdiction as quarantine or isolation areas. For this purpose, DRRM coordinators shall provide support to the School Health and Nutrition personnel in monitoring the use of school facilities. In light of precautionary and social distancing measures, offsite monitoring through close coordination with LGUs is encouraged; physical monitoring shall be done when deemed feasible.

13. For clarifications and concerns, contact the DepEd Task Force COVID-19 Quick Response and Recovery Team (DTF COVID-19 QRRT) at the Bureau of Learner Support Services through email at [email protected] or at telephone number (02) 8632-9935.

14. For immediate dissemination and implementation.

(SGD.) LEONOR MAGTOLIS BRIONESSecretary

ATTACHMENT

February 17, 2020

DOH DEPARTMENT MEMORANDUM NO. 0090-20

 

I. BACKGROUND

After a cluster of pneumonia cases of unknown etiology was reported in Wuhan City, Hubei Province of China last December 31, 2019, Chinese health authorities preliminarily identified the cause of this viral pneumonia as a new or novel type of coronavirus.

With an increasing number of cases spreading to various territories and confirmed human-to-human transmission, the World Health Organization declared the outbreak as a Public Health Emergency of International Concern (PHEIC) last January 30, 2020.

The Department of Health (DOH) hereby issues interim guidelines on the management of persons under monitoring (PUMs) suspected with Coronavirus Disease 2019 (COVID-19) for home quarantine.

II. GENERAL GUIDELINES

A. Any person, regardless of nationality, race and age, who does not exhibit any sign nor symptom, has history of travel to other areas of China and/or history of exposure to a confirmed case of COVID-19, within the past 14 days, shall be required to undergo monitored home quarantine.

B. Any person, regardless of nationality, race and age, who exhibits fever or any symptom of lower respiratory illness, and has a history of travel to other countries with a confirmed case of COVID-19 but without any history of exposure, shall be advised to undergo monitored home quarantine.

C. These undergoing home quarantine shall be prohibited to leave their rooms/homes where they are quarantined until they have been certified by the local health official to have finished the 14-day requirement for quarantine procedures.

D. Initial coordination should be done with the Local Government Epidemiologic Surveillance Unit on the logistical, administrative and clinical parameters to be standardized in any attempt to refer a PUM for transfer or consultation.

III. IMPLEMENTING GUIDELINES

A. Room Isolation and Contacts of Persons Under Monitoring (PUM)

1. Place the PUM alone in a well-ventilated room, preferably with toilet and bathroom. If this is not possible, maintain a distance of at least 1 meter from the PUM (e.g.,sleep in a separate bed).

2. Assign one person who is in good health as caretaker of the PUM.

3. Visitors, family members and even caregivers are not allowed in the PUM's room, if possible.

4. Confine activities of the PUM in his/her room only. If this is not possible, ensure that shared spaces (e.g.,kitchen, bathroom) are well ventilated (e.g.,keep windows open).

B. Use of Disposable Surgical Mask

1. The PUM should wear a surgical mask fitted tightly to the nose, mouth, and chin when in the same room with another household member or when talking to other people. The use of masks is not required for the person/s the PUM is/are interacting with.

2. If alone, the PUM is not required to wear a mask.

3. Masks should not be touched or handled during use. If the mask gets wet or dirty with secretions, it must be changed immediately and disposed properly.

4. Discard the used mask after a maximum use of 8 hours. Masks are not reusable and should not be washed. After removal of mask, wash hands using water and soap, or rub hands with 70% alcohol or any hand disinfectant.

C. Hand Hygiene Practice for ALL

1. All PUMs and household members should perform hand hygiene following contact with PUM or if in contact with their immediate environment.

2. Perform hand hygiene by washing hands with soap and water. If hands are not visibly soiled, 70% alcohol or any alcohol-based hand rub can be used.

3. When using soap and water, disposable paper towels to dry hands is desirable. If not available, use dedicated cloth towels and replace them when they become wet.

4. Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet, and whenever hands look dirty.

5. Address safety concerns (e.g.,accidental ingestion by children and fire hazards) on the use of alcohol-based hand rubs.

D. Respiratory Hygiene and Standard Precaution for ALL

1. Respiratory hygiene/cough etiquette should be practiced by all at all times. Respiratory hygiene refers to covering the mouth and nose during coughing or sneezing using surgical masks, tissues, flexed elbow, sleeves of clothes, or inside the neckline of shirts, followed by hand hygiene.

2. Avoid direct contact with body fluids, particularly oral or respiratory secretions, and feces. Use disposable gloves to provide oral or respiratory care and when handling feces, urine and waste. Wash hands before putting on and after removing gloves.

3. Avoid other types of possible exposure to PUM or contaminated items in their immediate environment (e.g.,avoid sharing toothbrushes, cigarettes, towels, washcloths, bed linen).

E. Food Handling of PUM on Home Quarantine

1. The assigned caretaker of the PUM shall serve their plates/meal trays only up to the room door.

2. After eating, plates/meal trays should be picked up at the room door by the caretaker using disposable gloves to avoid contamination. Perform hand hygiene afterwards.

3. Eating utensils and dishes should be cleaned with soap or detergent and water after use and may be re-used instead of being discarded.

4. Do not share eating utensils, dishes, and drinks with PUM.

F. Disposal of Used Gloves, Tissues Papers, and Masks

1. Immediately discard materials used to cover the mouth or nose into the trash or clean reusable items appropriately after use (e.g.,wash handkerchiefs using regular soap or detergent and water).

2. Gloves, tissues, masks and other waste generated by PUM should be placed in a container in PUM's room before disposal with other household waste.

G. Cleaning and Disinfection

1. PUMs are encouraged to clean and disinfect frequently touched surfaces such as bedside tables, doorknobs, bedframes, and other bedroom furniture daily with regular household disinfectant containing a diluted bleach solution (1-part bleach to 99 parts water).

2. Clean and disinfect bathroom and toilet at least once daily with regular household disinfectant containing diluted bleach solution (1-part bleach to 99-parts water).

3. Clean clothes, bedclothes, bath and hand towels, etc. of PUM using regular laundry soap and water or machine wash at 60-90ºC with common household detergent, and sun-dry. Place used linen into a laundry bag. Do not shake soiled laundry. Additional measures may be needed to prevent unhygienic reuse of gloves, masks, avoid direct contact of the skin and clothes with the contaminated materials.

4. Use disposable gloves and protective clothing (e.g.,plastic aprons) when cleaning or handling surfaces, clothing or linen soiled with body fluids. Perform hand hygiene before and after removing gloves.

H. Reporting

1. PUM who developed symptoms should be reported immediately to Regional Epidemiology and Surveillance Unit (RESU) or Local Surveillance Officer for transport to nearest health facility.

2. All household members of PUM should be advised to seek immediate medical care when signs and symptoms developed.

For strict compliance of all concerned.

(SGD.) FRANCISCO T. DUQUE III, MD, MScSecretary of Health

March 16, 2020

DOH DEPARTMENT MEMORANDUM NO. 0123-20

 

I. BACKGROUND

On March 10, 2020, the Philippines was declared to be under Alert Level 4, Code Red Sublevel 2. Over the succeeding days, with the number of COVID-19 cases observed to rise, the capacities of all our health facilities are expected to be fully utilized.

In order to reduce the exposure of the general population to COVID-19 patients and enhance the surge capacity of our existing health facilities, the Department of Health (DOH) hereby issues these interim guidelines to provide guidance for health managers and among Local Government Units (LGUs) to improve the surge capacity of the local health system by identifying and converting viable public spaces such as auditoriums, gymnasium, classrooms, vacant hotels, courts, open fields with tents, and the like as temporary treatment and monitoring facilities to manage COVID-19 PUIs and confirmed cases of mild COVID-19.

II. OBJECTIVE

This shall provide guidance in managing the potential surge of COVID-19 patients in different health facilities through the identification, assessment and conversion of viable public spaces into temporary treatment and monitoring facilities.

III. SCOPE AND COVERAGE

These interim guidelines shall cover all LGUs and health managers who require temporary treatment and monitoring facilities

IV. GENERAL GUIDELINES

A. Urban health centers and rural health units are enjoined to provide services for 24 hours, 7 days a week, or operate on an on call basis after office hours.

B. The health manager or LGU may identify and consider converting public spaces into temporary treatment and monitoring facilities when necessary, to cater to the increasing number of Persons Under Investigation (PUI) and cases of COVID-19 patients with mild symptoms in the following conditions:

1. Municipality, City, or Province has declared an enhanced community quarantine;

2. Current health facilities are operating nearing its maximum surge capacity.

C. Possible areas that may be converted include auditoriums, gymnasium, classrooms, vacant hotels, courts, and open fields with tents. They may consider partnership with Non-Government Agencies and Private Sector for the use of these public spaces.

D. Operations of these temporary treatment and monitoring facilities shall be under the supervision of the City/Municipal Health Officer who shall assign a facility manager when necessary, and shall serve as an extension of their Urban Health Centers/Rural Health Units.

E. These treatment facilities shall provide the following services:

1. Outpatient Services

a) Consultation for patients experiencing mild respiratory symptoms (fever, cough, colds, etc.);

b) Provision of supportive treatment and psychosocial service;

2. Treatment and monitoring services for PUIs who do not have optimal isolation space in their homes, and confirmed COVID-19 patients with mild symptoms, which includes vital signs monitoring, appropriate clinical management;

3. Timely referral to appropriate health facilities as needed.

F. The health manager or LGU may develop mechanisms to ensure coordination with Urban Health Centers/Rural Health Units and access to higher centers or health facilities that provide intensive care services and for proper and timely referral of patients as indicated in Department Memorandum No. 2020-0072, "Interim Guidelines for 2019 Novel Coronavirus Acute Respiratory Disease (2019-nCOV ARD) Response in Hospitals and Other Health Facilities (ANNEX A).

G. Conversion of public spaces into temporary treatment and monitoring facilities shall follow principles and protocols related to Infection Prevention and Control. Confirmed COVID-19 patients may be placed in shared space or rooms. PUIs shall be separated in a different space/tent/room provided with individual enclosed spaces and separate entrance.

H. The health manager or LGU shall ensure the provision of basic needs for patients, such as food, water, sanitation, and communication.

I. The temporary treatment and monitoring facility shall be limited only to health workers and patients. No visitors shall be allowed in the area.

J. The temporary treatment and monitoring facility shall provide for infection control measures, water, sanitation and hygiene facilities including but not limited to availability of toilets, solid waste management/disposal, vector control and other similar/related health requirements.

V. SPECIFIC GUIDELINES

A. Patient Management

1. Patients classified as Persons Under Investigation (PUI)

a) May be accommodated in temporary treatment and monitoring facilities provided they are in separate isolation rooms that meet the standards on converted private rooms detailed in Department Memorandum No. 2020-0062, "Guidelines on the Standards of Airborne Infection Isolation Room and Conversion of Private Rooms and/or Wards into Temporary Isolation Rooms for the Management of Patients Under Investigation (PUI) for 2019 Novel Coronavirus (nCOV)" (ANNEX B).

b) In compliance with Infection Prevention and Control standards, PUI cannot be cohorted together.

2. Confirmed COVID-19 with mild symptoms, no comorbidities, and aged 18-60 years may be accommodated and managed in the converted treatment and monitoring facilities.

3. Confirmed COVID-19 with severe symptoms, with comorbidities, aged 0-18 or 60 years and above may be referred to the nearest Level 2 or Level 3 hospital accepting PUI or confirmed COVID-19 patients for appropriate management.

B. Location Features

Identified space should:

1. Be accessible within a maximum of two (2) hours to a Level 2 or Level 3 hospital accepting PUI or confirmed COVID-19 patients;

2. Have uninterrupted access to electricity, potable water source, and sewer line.

C. Minimum Infrastructure Requirement

1. Temporary treatment and monitoring facilities must be fully enclosed with adequate lighting;

2. There should be at least fan ventilation to be provided;

3. There should be a separate entrance and exit for the patients and healthcare workers;

4. The facility should be divided into three (3) zones namely: contaminated, buffer and sterile zones.

a) Contaminated Zone: serve as the area where patients are admitted/contained.

b) Buffer Zone: serves as an area for doffing of PPE, decontamination, and hand hygiene.

c) Sterile Zones: serves as holding area and entrance for healthcare workers, and the area for Personal Protective Equipment (PPE) donning of health workers.

5. Distance between patient beds should be maintained at least 3 feet apart on all sides;

6. Temporary partitions should be provided to ensure patient privacy (i.e.,drapes or low walls) for COVID-19 patients placed in a shared space or room.

7. A backup supply of electricity and free-flowing water for at least 72 hours must be ensured, in case of water and power interruption;

8. The provision of fixed or temporary plumbing fixture per person must follow the following requirements:

a) Ratio requirements:

(1) One (1) water closet per 25 males and one (1) per 20 females

(2) One (1) urinal per 10-50 males, adding one (1) fixture for each additional 50 males

(3) One (1) lavatory for every 10 males and one (1) for every 10 females

(4) One (1) shower per 8 persons

b) Confirmed cases of COVID-19 may share toilets and showers. Regular disinfection should be practiced in accordance with DM 2020-0072 (see ANNEX A).

c) A dedicated toilet and shower for each PUI should be provided when possible. In cases where this arrangement is not feasible, the toilet/shower facilities must be disinfected after every use.

9. There may be provision or access to laundry services.

D. Minimum Medicines, Medical Supplies, and Equipment Requirement:

1. The LGU must ensure the availability of necessary medicines and medical supplies for supportive treatment and emergency care (Annex C);

2. The temporary treatment and monitoring facilities must have access to at least a secondary clinical laboratory and basic radiologic services such as X-ray.

E. Minimum Human Resources Requirements:

1. The LGU may source from its health network or private sector partners the necessary human resources needed to operationalize the temporary treatment and monitoring facility to ensure a 24/7 operation.

2. Each temporary and treatment monitoring may have the following minimum human resource:

a) At least one (1) Physician per shift

b) At least three (3) Nurses per shift (1 Nurses: 12 Patients)

c) Support Staff

(1) At least two (2) security personnel per shift (1 for each entrance).

(2) At least one (1) maintenance staff per shift.

3. The LGU may likewise provide the following additional human resources as the need arises:

a) At least one (1) pharmacist per shift (1 pharmacist: 100 patients)

b) At least one (1) nutritionist-dietitian (1 ND: 50 patients)

c) At least one (1) medical social worker per shift (1 MSW: 25 patients)

d) At least five (5) food handlers: (10:100 patients)

4. The LGU should also ensure the availability of psychosocial interventions for healthcare workers deployed in these temporary treatment and monitoring facilities.

F. Minimum Requirements for the Adherence to Infection Prevention and Control

1. Adequate Personal Protective Equipment (PPE) must be provided to both patients and all healthcare workers and deployed in these facilities, which may include:

a) For healthcare workers

(1) Surgical masks

(2) Gowns

(3) Goggles/face shields

(4) N95 respirators

b) For patients

(1) Surgical masks

2. Rationa1 use of the provided PPE must be ensured.

G. Minimum Requirements for Healthcare Waste Management

1. Segregation, collection, and handling of all waste generated from these temporary treatment and monitoring health facilities may abide by the principles of healthcare waste management.

2. LGUs may refer to DM No. 2020-0072 in Annex A for a more detailed guide on healthcare waste management for highly infectious waste and the appropriate treatment of soiled linens and clothes.

H. Availability of Transport and Referral Protocols

1. All temporary treatment and monitoring facilities shall have access to at least a Type I Basic Life Support (BLS) Ambulance as defined in the Administrative Order No. 2018-0001, "Revised Rules and Regulations Governing the Licensure of Land Ambulances and Ambulance Service Providers."

2. All patients whose symptoms progressed may be referred to a facility with intensive care services. Referral to these health facilities may be in accordance with Department Memorandum No. 2020-0108, "Guidelines for Management of Patients with Possible and Confirmed COVID-19" and its amendments.

For guidance and strict compliance.

By Authority of the Secretary of Health

(SGD.) LILIBETH C. DAVID, MD, MPH, MPM, CESO IUndersecretary of Health

ANNEX A

February 3, 2020

DOH DEPARTMENT MEMORANDUM NO. 0072-20

 

I. BACKGROUND

After a cluster of pneumonia cases of unknown etiology was reported in Wuhan City, Hubei Province of China last December 31, 2019, Chinese health authorities preliminarily identified the cause of this viral pneumonia as a new or novel type of coronavirus (2019-nCOV).

With an increasing number of cases spreading to various territories and confirmed human-to-human transmission, the World Health Organization declared the outbreak as a Public Health Emergency of International Concern (PHEIC) last January 30, 2020.

The Department of Health (DOH) hereby issues these interim guidelines for all health facilities and institutions whether public or private on the necessary precautions, preparations of the health facilities, and management of persons under investigation (PUI) and confirmed cases of the 2019-nCoV ARD.

II. GENERAL GUIDELINES

1. All Level 2 and Level 3 hospitals shall attend to all PUIs.

2. All hospitals and health facilities shall establish and maintain an Infection Prevention and Control Committee (IPCP) in the health facility, headed by an infection control physician and infection control nurse. The IPCP shall be responsible for the formulation, implementation, and monitoring of policies, guidelines, and procedures related to infection control. (Refer to the National Standards in Infection Control for Healthcare Facilities, 2009 Edition)

3. All hospitals and health facilities shall ensure that all hospital personnel are familiar with and adhere to infection prevention policies, guidelines, and procedures of the hospital, and shall be protected at all times since they are the first in line for exposure.

4. All hospitals and health facilities shall ensure that all resources and contingencies needed for the implementation of infection prevention and control measures are adequately available.

5. All hospitals and health facilities shall ensure that appropriate personal protective equipment (PPE) are appropriately used by patients and hospital personnel, according to existing protocols.

III. SPECIFIC GUIDELINES

A. Infection Prevention and Control

Universal precautionary measures are implemented in all health facilities. However, for an emerging infectious disease event such as the 2019-nCoV ARD, standard prevention and control strategies must be employed.

IPC strategies to prevent or limit infection transmission in health-care settings are summarized in Annex A.

B. Case Definition

1. Patient under Investigation (PUI)

Clinical features and epidemiological risk should be considered in identifying persons as PUI for 2019-nCoV ARD. A person meeting the following criteria should be evaluated as a PUI in association with the outbreak of 2019-nCoV ARD:

a) A person with Severe Acute Respiratory Infection (SARI),with history of fever and cough requiring admission to hospital, with no other etiology that fully explains the clinical presentation (clinicians should also be alert to the possibility of atypical presentations in patients who are immunocompromised),and ANY of the following:

(1) A history of travel to China and other 2019-nCoV ARD affected areas in the 14 days prior to symptom onset.

(2) The disease occurs in a health care worker who has been working in an environment where patients with severe acute respiratory infections are being cared for, without regard to place of residence or history of travel;

(3) The person develops an unusual or unexpected clinical course, especially sudden deterioration despite appropriate treatment, without regard to place of residence or history of travel, even if another etiology has been identified that fully explains the clinical presentation.

OR

b) Individuals with acute respiratory illness of any degree of severity who, within 14 days before onset of illness, had ANY of the following exposures:

(1) Close physical contact with a confirmed case of 2019-nCoV ARD infection, while that patient was symptomatic;

(2) A healthcare facility in a country where hospital associated 2019-nCoV ARD infections have been reported;

(3) Direct contact with animals (if animal source is identified) in countries where the 2019-nCoV ARD is known to be circulating in animal populations or where human infections have occurred as a result of presumed zoonotic transmission.

PUIs may present a range of signs and symptoms from mild, moderate, or severe illness; the latter includes severe pneumonia, ARDS, sepsis and septic shock. (See page 3 of Annex B for clinical manifestation of 2019-nCoV ARD) The criteria and the DOH decision tool (Annex C) shall be used to guide evaluation.

2. Close Contact

Persons visiting patients or staying in the same close environment of a 2019-nCoV ARD confirmed case who are either:

a) Within approximately 6 feet (2 meters),or within the room or care area, of a confirmed case for a prolonged period of time while not wearing recommended personal protective equipment or PPE (e.g.,gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection);OR

b) Having direct contact with infectious secretions of a novel coronavirus case (e.g.,being coughed on) while not wearing recommended personal protective equipment.

Close contact can include caring for, living with, visiting, or sharing a health care waiting area or room with a confirmed case.

The epidemiological link may have occurred within a 14-day period before or after the onset of illness in the case under consideration.

C. Patient Screening

The objective of screening is to quickly identify people with a travel history to countries with ongoing transmission of 2019-nCoV ARD. All personnel in health facilities should be trained on the following 2019-nCoV ARD screening procedures:

1. Screen at all points of entry to the health facility (to catch every patient and visitor).

2. Use broad criteria to quickly identify all patients at risk (i.e.,travel to China in the last 14 days).

3. Train screening staff on what to probe. e.g.,Have you traveled overseas in the last 14 days? Did you travel to China? Have you visited any animal or seafood market? Did you visit any healthcare facility or sick person during your travel?

4. Train screening staff on what to do once a PUI is identified.

5. Identify holding and isolation areas and healthcare workers who will perform further assessment of patients.

6. Ensure that effective triage checklist and patient flow are in place.

7. Ensure that necessary precautions are observed:

a) Designate a well-ventilated area.

b) Maintain a minimum 1-meter distance from patients.

c) Provide symptomatic patients with facemask for source control when possible.

d) Perform hand hygiene frequently.

e) Follow standard precautions and droplet precautions when evaluating patients with acute respiratory tract infections.

8. Once identified, immediately isolate PUIs in designated holding or isolation areas with full infection control precautions.

9. There should be prompt reporting of cases to surveillance units for immediate contact tracing and quarantine measures. Ensure that the relevant contact numbers are readily available.

D. Patient Triage

The objective of triage is to determine if patients have symptoms of 2019-nCoV ARD infection and if so, to promptly isolate them. Only health care personnel should perform triage.

1. Triage should ideally be conducted in an isolation room with negative pressure and/or adequate ventilation.

2. Other respiratory hygiene supplies (such as facial tissues),trash cans, and hand hygiene facilities should be available inside the room.

3. Triage officers should wear the appropriate PPE.

4. Triage officers shall conduct a complete history and physical examination, and decide whether a patient fulfills the case definition or criteria for the specific Respiratory Infection of Pandemic or Outbreak Potential (RIPOP) in consultation with surveillance officers and consultant(s) in charge of EREIDs.

5. If patients are in queue (surge of patients),separate the "sick" from the "well" patients by 6 feet (2 meters),and ensure patients are at least 3 feet (1 meter) apart from each other.

E. Referral for Admission

1. Symptomatic contacts or PUIs should be considered for admission for close observation in a health facility.

2. Based on WHO guidelines, coordination with a health facility and/or health care provider should be done during the observation period. Medical personnel should be involved in reviewing the current health status of the contacts by phone and, ideally, by scheduled visits on a regular (e.g.,daily) basis, performing specific diagnostic tests as necessary.

3. Doctors and other health care professionals should give advance instructions on where to seek care when a contact becomes ill, what should be the most appropriate mode of transportation, when and where to enter the designated health care facility, and what infection control precautions should be followed.

4. Once the receiving medical facility has been notified that a symptomatic contact will be referred to their facility, the facility should facilitate transport of patient to the facility.

5. The ill contact should be advised to perform respiratory hygiene and stand or sit as far away from others as possible or at least 3 feet (1 meter),when in transit and when in the health care facility.

6. Appropriate hand hygiene should be employed by the ill contact and caregivers. Any surfaces that become soiled with respiratory secretions or body fluids during transport should be cleaned with regular household cleaners or a diluted bleach solution, whichever is most appropriate.

F. Isolation Precautions

1. The duration of infectivity for 2019-nCoV ARD is unknown. While Standard Precautions should continue to be applied always, additional isolation precautions should be used during the duration of symptomatic illness and continued for 24 hours after the resolution of symptoms. (Annex A2)

2. Given that little information is currently available on viral shedding and the potential for transmission of 2019-nCoV ARD, testing for viral shedding should assist the decision making when readily available.

3. Patient information (e.g.,age, immune status and medication) should also be considered in situations where there is concern that a patient may be shedding the virus for a prolonged period.

G. Notification

1. Designated disease surveillance officers in hospitals and other facilities shall be responsible for doing the preliminary assessment of suspected cases in their respective health facility and report accordingly using the form in Annex D.

2. Healthcare providers should immediately notify the infection control personnel at their healthcare facility and report any event of a possible case of 2019-nCoV ARD to the Municipal Health Officer (MHO) or City Health Officer (CHO) for verification and initial investigation. The MHO/CHO shall then report to the Regional Epidemiology Surveillance Unit (RESU) using the Event-Based Surveillance System (ESR) system of the Epidemiology Bureau (EB) of DOH.

H. Clinical Management

1. There is no current evidence from RCTs to recommend any specific anti-2019-nCoV ARD treatment for PUIs or confirmed cases.

2. All healthcare providers are advised to use the latest available clinical practice guidelines issued by local specialty societies and duly-endorsed by the DOH. In the interim, a separate issuance will be published by the DOH.

I. Discharge and Follow-up

Due to the evolving nature of the etiology of 2019-nCOV, guidance for discharge criteria and management during follow-up shall be regularly updated and published in a separate issuance. In the interim, the following shall apply.

1. Confirmed positive cases on admission SHOULD ONLY be discharged if ALL of the following conditions are fulfilled:

a. Two negative RT-PCR tests for 2019-nCoV ARD done 48 hours apart.

b. Afebrile and asymptomatic (including cough and respiratory symptoms) for 48 hours.

c. Laboratory and radiologic tests done according to clinical case management (e.g.,chest x-ray WBC, platelet count, CPK, liver functions tests, plasma sodium) previously abnormal returning to normal.

2. PUIs admitted as per DOH Decision Tool (Annex C),shall be discharged upon NEGATIVE 2019-nCoV ARD test from RITM. Until then PUIs shall be admitted in isolation even if asymptomatic. Repeat testing for patients with an initial negative nCoV test result may be performed if a high index for suspicion for 2019-nCoV ARD remains despite an initial negative test result. Such conditions include, but are not limited, to the following:

a. Clinical deterioration in the presence of an established disease etiology and with adequate treatment. A single negative test result, particularly if this is from an upper respiratory tract specimen, does not exclude infection. Repeat sampling and testing, preferably of lower respiratory specimen, is strongly recommended in severe or progressive disease. Consider a possible co-infection with 2019-nCoV.

b. No other etiology for the patient's signs and symptoms has been identified despite work-up.

c. Clinical specimen(s) initially sent was/were deemed to be unsatisfactory or insufficient (delay in transport and processing, only NPS or OPS was sent).

3. For mortalities of 2019-nCoV ARD, refer to guidelines for Disposal and Shipment of the Remains of confirmed cases of 2019-nCoV ARD.

4. Hospital Disease Surveillance Officer shall report to the RESU within 24 hours the patients that have been discharged. The RESU shall then report to the DOH Regional Director and the 2019-nCoV ARD Task Force

a. One week after discharge, confirmed cases should submit to mandatory follow-up and retesting for chest x-ray, complete blood count, and other laboratory tests which previously yielded abnormal results.

H. Sources of 2019-nCoV ARD Information and Advisories

1. Everyone is advised to refrain from sharing unverified reports and/or false news to avoid undue stress and worry due to misinformation.

2. For announcements and public advisories, you may visit the following official DOH channels:

• Website: https://www.doh.gov.ph/2019-nCoV

• Facebook: https://www.facebook.com/OfficialDOHgov/

• Twitter: https://twitter.com/DOHgov

3. DOH health promotion materials (e.g.,infographics, social media cards among others) may be reproduced by hospitals and other health facilities for instructional use or to keep health workers and patients informed free of charge.

For strict compliance of all concerned.

(SGD.) FRANCISCO T. DUQUE III, MD, MScSecretary of Health

ANNEX A

Infection Prevention and Control Practices

1. HAND HYGIENE

a. Proper handwashing is the single most effective way to prevent infections in the hospital.

b. Hand hygiene practices in the health facility must be emphasized using the WHO Multimodal Hand Hygiene Strategy: 5 Moments of Hand Hygiene (Annex A1) and proper handwashing technique.

c. The availability of alcohol-based hand rubs at point-of-care and other areas of the facility must be ensured.

2. ISOLATION PRECAUTION

To achieve effective interruption in the transmission of an infectious agent, it is essential to use two tiers of precautions (Annex A2)

a. Standard Precautions for the care of all patients; AND

b. Transmission-based precautions for patients with known or suspected disease spread by any of these routes: Airborne Precautions, Droplet Precautions or Contact Precautions.

3. PERSONAL PROTECTIVE EQUIPMENT

a. Appropriately wearing personal protective equipment (PPE),such as gloves, masks, and gowns, is also essential to protect healthcare workers from contact with infectious agents. The selection of PPE is based on the nature of the patient interaction and/or mode of transmission (Annex A3).

b. Hand hygiene is always the first and the final step before wearing or alter removing and disposing of PPE.

4. DECONTAMINATION, DISINFECTION AND STERILIZATION

Proper cleaning, disinfection and sterilization is one of the most effective ways of disrupting the transmission and spread of microorganisms in the healthcare setting. Existing protocols need to be strictly implemented by healthcare personnel (Annex A4).

5. SPECIMEN COLLECTION

a. All specimens collected for laboratory testing shall be regarded as potentially infectious.

b. All Health Care Workers who will collect, handle or transport, perform testing any clinical specimens shall adhere rigorously to the standard precaution measures such as Personal Protective Equipment (i.e.,gloves, laboratory gown, N95 Masks, face shield, etc.),and ensure biosafety practices are observed to minimize the possibility of exposure to pathogens.

c. For further details of the guidelines kindly refer to the "Interim Laboratory Biosafety Guidelines for Handling and Processing Suspected 2019 Novel Coronavirus (2019 nCoV) Specimens" of Research Institute for Tropical Medicine.

6. SPECIMEN HANDLING, PROCESSING, PACKAGING AND TRANSPORT

To ensure that proper handling, processing, packaging and transport of laboratory specimens from suspected Person Under Investigation (PUI) is observed, please refer to the DOH Manual on Packaging and Transport of Laboratory Specimen for Referral and Interim Laboratory Biosafety Guidelines for Handling and Processing Suspected 2019-nCoV Specimens (http://bit.ly/2tdLr4x)

7. FLOW OF PATIENTS SUSPECTED TO BE INFECTIOUS

Early detection and placement of patients to appropriate areas in the health facility is critical in the prevention of spread of infectious diseases. For guidelines on the management of patients suspected to be infectious, kindly refer to the Interim Guidelines on the Preparedness and Response to Novel Coronavirus (2019-nCoV) issued.

Health facilities should ensure that all resources and contingencies needed to support the management of patients and for the implementation of infection prevention and control measures are adequately available.

8. DISPOSAL OF INFECTIOUS BODY

For proper handling of infectious body, strict adherence to precautionary measures is a must. Kindly refer to the Guidelines on Disposal of Dead Persons from Dangerous Communicable Diseases for guidance.

9. HEALTHCARE WASTE MANAGEMENT

a. "Health Care Waste" (HCW) includes all the solid and liquid waste generated as a result of any of the following: (Annex A5)

i. Diagnosis, treatment, or immunization of human beings;

ii. Research pertaining to the above activities;

iii. Research using laboratory animals for the improvement of human health;

iv. Production or testing of biological products; and

v. Other activities performed by health care facilities.

b. Management of health care waste, more specifically of the hazardous waste types (which include infectious waste) must be done through proper waste disposal to mitigate risks and potential health hazards to people exposed. Infectious waste should always be assumed to potentially contain a variety of pathogenic microorganisms that may enter the human body through the following routes:

i. through a puncture, abrasion, or cut in the skin

ii. through the mucous membrane

iii. by inhalation

iv. by ingestion

10. REFERENCES

Full WHO guidelines are available at Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. Retrieved from the following:

- https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125;and

- https://www.who.int/publications-detail/advice-on-the-use-of-masks-the-community-during-home-care-and-in-health-care-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak

ANNEX A1

Five Moments of Handwashing

ANNEX A2

Isolation Precautions

A. Standard Precautions

1. Standard precautions are recommended for all hospitalized patients should consist of hand hygiene and respiratory hygiene with cough etiquettes. This also includes safe disposal of instruments and soiled linens.

2. All healthcare workers should use appropriate barrier precautions to avoid skin and mucous membrane exposure when contact with blood or body fluids from any patient.

3. Gloves should be worn for contact with blood and body fluids, mucous membranes, or non-intact skin; when handling surfaces or items soiled with blood or body fluids; or for venipuncture or other procedures involving vascular access.

4. Gloves should be changed after each patient contact.

5. Masks and protective eyewear or face shields should be worn when procedures are likely to generate aerosols or droplets of blood or other body fluids.

6. Gowns should be worn for procedures that are likely to soil clothing.

7. Hands or skin contaminated with blood or body fluids should be washed immediately using soap and water. Hand hygiene should be done after removing gloves.

8. Precautions should be taken to prevent sharps or needlestick injuries. Needles should not be recapped, removed from disposable syringes, or manipulated by hand. After use, needles, disposable syringes, scalpels, and other disposable sharp instruments should immediately be placed in a designated puncture-resistant container.

9. Mouthpieces and resuscitation devices should be readily available for use in areas where resuscitation procedures may be anticipated.

10. All healthcare workers with exudative skin lesions should not be involved in direct patient care or should not handle patient-care equipment until the condition has resolved.

B. Transmission-based Precautions

1. When standard precautions are not able to completely interrupt the route of transmission of certain infections, transmission-based precautions are implemented.

C. Contact Precautions

1. Contact Precautions are intended to prevent transmission of pathogens which are spread by direct or indirect contact with the patient or the patient's environment. It applies when there is presence of excessive wound drainage, fecal incontinence, or other discharges from the body suggest an increased potential for extensive environmental contamination and risk of transmission.

2. A single-patient room is preferred for patients who require Contact Precautions.

3. When a single-patient room is not available, consultation with the ICC is recommended to assess the various risks associated with other patient placement options (e.g.,cohorting, keeping the patient with an existing roommate).

4. In multi-patient rooms, ≥3 feet spatial separation between beds is advised to reduce the opportunities for inadvertent sharing of items between the infected/colonized patient and other patients.

5. Healthcare personnel caring for patients on Contact Precautions MUST wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient's environment.

6. Donning PPE upon room entry and discarding before exiting the patient room is done to contain pathogens, especially those that have been implicated in transmission through environmental contamination.

D. Droplet Precautions

1. Droplet Precautions are intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions. Because these pathogens do not remain infectious over long distances in a healthcare facility, special air handling and ventilation are not required to prevent droplet transmission.

2. A single patient room is preferred for patients who require Droplet Precautions.

3. When a single-patient room is not available, consultation with the ICC is recommended.

4. Spatial separation of ≥3 feet and drawing the curtain between patient beds is especially important for patients in multi-bed rooms with infections transmitted by the droplet route.

5. Healthcare personnel caring for patients on Droplet Precautions MUST wear a mask (a respirator is not necessary) for close contact with infectious patient; the mask is generally donned upon room entry.

6. Patients on Droplet Precautions who must be transported outside of the room should wear a mask if tolerated and follow Respiratory Hygiene and Cough etiquette.

E. Airborne Precautions

1. Airborne Precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air (i.e.,rubeola virus [measles],varicella virus [chickenpox],M. tuberculosis, and SARS-CoV).

2. The preferred placement for patients who require Airborne Precautions is in an airborne infection isolation room (AIIR).

3. An AIIR is a single-patient room that is equipped with special air handling and ventilation capacity that meet international standards (i.e.,monitored negative pressure relative to the surrounding area, 12 air exchanges per hour for new construction and renovation and 6 air exchanges per hour for existing facilities, air exhausted directly to the outside or recirculated through HEPA filtration before return).

4. It is best that isolation rooms are present in hospitals, emergency departments, and nursing homes that care for patients with M. tuberculosis.

5. In settings where Airborne Precautions cannot be implemented due to limited engineering resources (e.g.,physician offices),masking the patient, placing the patient in a private room (e.g.,office examination room) with the door closed, and providing N95 or higher level respirators or masks if respirators are not available for healthcare personnel will reduce the likelihood of airborne transmission until the patient is either transferred to a facility with an AIIR or returned to the home environment, as deemed medically appropriate.

6. Healthcare personnel caring for patients on Airborne Precautions MUST wear a mask or respirator, depending on the disease-specific recommendations that is donned prior to room entry.

ANNEX A3

Personal Protective Equipment (PPE)

A. Gloves

1. Gloves are used to prevent contamination of healthcare personnel hands when:

a) anticipating direct contact with blood or body fluids, mucous membranes, non-intact skin and other potentially infectious material

b) having direct contact with patients who are colonized or infected with pathogens transmitted by the contact route

c) handling or touching visibly or potentially contaminated patient care equipment and environmental surfaces

2. The healthcare personnel should use the following during specimen collection on a PUI: Double Gloves (preferably: Nitrile);Scrub suit; Disposable Laboratory Gown (impermeable/breathable/long sleeves/back enclosure);Fit Tested N95 mask; Face shield/visor.

3. During patient care, transmission of infectious organisms can be reduced by adhering to the principles of working from "clean" to "dirty" and confining or limiting contamination to surfaces that are directly needed for patient care.

4. It may be necessary to change gloves during the care of a single patient to prevent cross-contamination of body sites.

5. It also may be necessary to change gloves if the patient interaction also involves touching portable computer keyboards or other mobile equipment that is transported from room to room.

6. Discarding gloves between patients is necessary to prevent transmission of infectious material.

7. Gloves must not be washed for subsequent reuse because microorganisms cannot be removed reliably from glove surfaces and continued glove integrity cannot be ensured.

8. When gloves are worn in combination with other PPE, they are put on last.

9. Hand hygiene following glove removal further ensures that the hands will not carry potentially infectious material that might have penetrated through unrecognized tears or that could contaminate the hands during glove removal.

B. Isolation Gowns

1. Isolation gowns are used as specified by Standard and Transmission-Based Precautions to protect the HCW's arms and exposed body areas; and to prevent contamination of clothing with blood, body fluids, and other potentially infectious material.

2. When applying Standard Precautions, an isolation gown is worn only if contact with blood or body fluid is anticipated.

3. When Contact Precautions are indicated, donning of both gown and gloves upon room entry is indicated to address unintentional contact with contaminated environmental surfaces.

4. Gowns are usually the first piece of PPE to be donned. Full coverage of the arms and body front, from neck to the mid-thigh or below will ensure that clothing and exposed upper body areas are protected.

5. Isolation gowns should be removed before leaving the patient care area to prevent possible contamination of the environment outside the patient's room.

6. Isolation gowns should be removed in a manner that prevents contamination of clothing or skin. The outer, "contaminated" side of the gown is turned inward and rolled into a bundle, and then discarded into a designated container for waste or linen to contain contamination.

C. Face Protection

a. Face Masks

1. Masks are used for three primary purposes:

a. Placed on HCWs to protect them from contact with infectious material from patients, example, respiratory secretions and sprays of blood or body fluids, consistent with Standard Precautions and Droplet Precautions;

b. Placed on HCWs when engaged in procedures requiring sterile technique to protect patients from exposure to infectious agents carried in a HCW's mouth or nose;

c. Placed on coughing patients to limit potential dissemination of infectious respiratory secretions from the patient to others (Respiratory Hygiene/Cough Etiquette).

2. Masks may be used in combination with goggles to protect the mouth, nose and eyes, or a face shield may be used instead of a mask and goggles, to provide a more complete protection for the face.

b. Goggles

1. The eye protection chosen for specific work situations depends upon the circumstances of exposure, other PPE used, and personal vision needs.

2. Personal eyeglasses and contact lenses are NOT considered adequate eye protection.

3. Even if Droplet Precautions are not recommended for a specific respiratory tract pathogen, protection for the eyes, nose and mouth by using a mask and goggles, or face shield alone, is necessary when it is likely that there will be a splash or spray of any respiratory secretions or other body fluids.

ANNEX A4

Decontamination, Disinfection and Sterilization

A. Decontamination and Disinfection Practices

The following must be observed in the decontamination and disinfection practices:

1. Use appropriate hand hygiene, PPE (e.g.,gloves),and isolation precautions during cleaning and disinfecting procedures.

2. Have clear instructions and provide feedback to the personnel on how to properly wear PPE appropriate for a surface decontamination and cleaning task.

3. Discard used PPE by using routine disposal procedures or decontaminate reusable PPE as appropriate.

4. Use standard cleaning and disinfection protocols to control environmental contamination.

5. Pay close attention to cleaning and disinfection of high-touch surfaces in patient-care areas (e.g.,bed rails, carts, charts, bedside commodes, bed rails, doorknobs, or faucet handles).

6. Ensure compliance by housekeeping staff with cleaning and disinfection procedures by putting up checklists.

7. When contact precautions are indicated for patient care, use disposable patient-care items wherever possible to minimize cross-contamination with multiple-resistant microorganisms.

B. Spaulding Classification for Disinfection & Sterilization of Healthcare Items

 

CLASSIFICATION	ITEM USE	GOAL	APPROPRIATE PROCESS
Critical Items	Items entering sterile tissue, the body cavity, the vascular system and non intact mucous membranes, e.g.,surgical instruments	Objects will be sterile (free of all microorganisms including bacterial spores)	Sterilization (or use of single use sterile product) • Steam sterilization • Low temperature methods (ethylene oxide, peracetic acid, hydrogen peroxide plasma)
Semi-critical Items	Items that make contact, directly or indirectly, with intact mucous membranes or non intact skin, e.g.,endoscopes, diagnostic probes (vaginal/rectal),anesthetic equipment	Objects will be free of all microorganisms, with the exception of high numbers of bacterial spores	High level disinfection • Thermal disinfection • Chemical disinfection (glutaraldehyde, OPA)   * It is always preferable to sterilize semi-critical items whenever they are compatible with available sterilization processes
Non-critical Items	Objects that come into contact with intact skin but not mucous membranes, e.g.,crutches, BP cuffs	Objects will be clean	Low level disinfection • Cleaning (manual or mechanical)

ANNEX A5

Healthcare Waste

A. Healthcare Waste Types

Healthcare waste (HCW) can be broadly categorized into "hazardous" and "non-hazardous" waste types, as listed below.

 

HAZARDOUS	NON-HAZARDOUS (General)
- Sharps	- Recyclable
- Infectious	- Biodegradable
- Pathological	- Residual
- Anatomical
- Pharmaceutical
- Genotoxic
- Chemical
- Radioactive
- Pressurized Containers

 

Hazardous HCW, which includes infectious wastes, refers to waste that may pose a variety of environmental and health risks. Infectious waste is most likely to contain pathogens (bacteria, viruses, parasites, or fungi) in sufficient concentration or quantity to cause disease in susceptible hosts.

B. Risks Associated with Health Care Waste

1. All individuals coming into proximity with hazardous HCW are potentially at risk, including those who generate hazardous HCW, as well as those who either handle such waste or are exposed to it as a consequence of improper management.

2. The main groups of people at risk to potential health hazards associated with HCW are the following:

a. HCF staff, e.g.,doctors, nurses, auxiliaries, and maintenance personnel

b. Patients in the HCF or receiving home care

c. Visitors to the HCF

d. Workers providing support and allied services to the HCF, such as laundry

e. Workers transporting hazardous HCW to treatment, storage, and disposal facilities

f. Workers and operators of waste management facilities (e.g.,sanitary landfill and Treatment, Storage, Disposal (TSD) facilities) including informal recyclers or scavenger.

3. The General Public could also be at risk whenever hazardous HCW is abandoned or disposed of improperly.

C. Health Care Waste Disposal

1. HCW that is properly treated with the applicable technology as stated in the Health Care Waste Management Manual can be disposed of in a sanitary landfill but must not be mixed with the municipal waste. Dedicated cells for the treated HCW must be provided in a sanitary landfill. To allow the disposal of HCW to the sanitary landfill, the following must be met:

a. The waste treatment facility/system passed the standards for microbial inactivation test;

b. The properly treated HCW passed the spore strip test;

c. The waste treatment facility/system has a valid CPR from the DOH-Bureau of Health Devices and Technology (BHDT);and

d. The waste treatment facility is an EMB-registered TSD facility.

ANNEX B

Clinical Management of Severe Acute Respiratory Infection When Novel Coronavirus (2019-nCoV) Infection is Suspected (Interim guidance as of January 28, 2020)

ANNEX C

Decision Tool for Novel Coronavirus Assessment for Bureau of Quarantine and Hospitals

 

Fever≥ 38ºC (current fever or with history of fever)	Respiratory Infection (cough AND/OR colds)	Travel History for the past 14 days in China	History of Exposure1	Case Category/Intervention
+	+	+	+	Category: Patient Under Investigation (PUI)
+	+	+	-	Bureau of Quarantine (BoQ)
+	+	-	+	• Gives mask and isolate PUI • Collects and evaluates the BoQ Health Declaration Card
+	-	+	+	• Endorses patient for admission in a hospital • Arranges transportation of PUI to hospital
-	+	+	+	Hospitals • Completes the case investigation form (CIF)
+	-	+	-	• Trained hospital staff collects specimens (nasopharyngeal swab [NPS] and oral pharyngeal swab [OPSD]) and sends to RITM. (NPS/OPS must be collected upon admission and after 24 to 48 hours)
-	+	+	-
+	-	-	+
-	+	-	+	• Coordinates with RESU for reporting and transport of specimens • Manages PUI accordingly
-	-	+	+	Category: Person under Monitoring* Bureau of Quarantine • Collects and evaluates the BoQ Health Declaration Card • Advises person to go on self-quarantine for 14 days, monitor body temperature daily, and observe any signs and symptoms of respiratory infection
-	-	+	-	• If symptoms worsen, immediately notify the nearest hospital for consultation and provide travel history Centers for Health Development
-	-	-	+	• Monitor strictly those who are self-quarantined * Anyone who came from other parts of the world with confirmed 2019-nCoV ARD infection except China, has no history of exposure,but with fever and/or cough,is considered Person under Monitoring and is advised to go on self-quarantine for 14 days

1 History of exposure Include: a. close contact who took care, handled specimens and/or lived with a confirmed case of 2019-nCoV infection; or • Close contact is defined as: o Health care associated exposure, including providing direct care for nCoV patients, working with health care workers infected with novel coronavirus, visiting patients or staying in the same close environment as a nCoV patient o Working together in close proximity or sharing the same classroom environment with a nCoV patient o Traveling together with a nCoV patient in any kind of conveyance o Living in the same household as a nCoV patient b. visiting/working in a live animal market in China c. direct contact with animals in China with circulating 2019-nCoV in human and animals

 

ANNEX D

Interim Case Reporting Form for 2019 Novel Coronavirus (2019-nCoV) of Confirmed and Probable Cases

ANNEX B

February 4, 2020

DOH DEPARTMENT MEMORANDUM NO. 0062-20

 

In response to the current or potential influx of Patients Under Investigation (PUI) for 2019 Novel Coronavirus (nCoV) in our health facilities, all DOH Hospitals are hereby urged to comply with the patient placement guidelines and isolation standards adopted from the CDC Guidelines and Standards for Transmission-based Precautions. This shall facilitate the management of PUIs and prevent the transmission of the virus within the health facility.

I. For health facilities with Airborne Infection Isolation Room (AIIR),the following standards shall be followed:

A. Isolation of Patients Under Investigation for nCoV Patients

1. Place patient with known or suspected nCoV

2. Airborne Infection Isolation Room (AIIR).

3. While transfer to AIIR or discharge from the facility is pending, put face mask on the patient and isolate in an examination room with the door closed. The patient must not be placed in any room where room exhaust is re-circulated within the building without high-efficiency particulate air (HEPA) filtration.

4. Follow CDC guidelines on placement of patient with known or suspected nCoV infection and adhere to standard, contact, and airborne precautions (ANNEX A).

B. Standards of Airborne Infection Isolation Room (AIIR)

1. AIIR must be single-occupancy rooms with negative pressure relative to the surrounding areas.

2. There must be at least six (6) air changes per hour, or twelve (12) air changes per hour for newly constructed or renovated rooms.

3. Air exhaust should be directed away from people and air intakes. If this is not possible, air must be filtered through a HEPA filter before recirculation.

4. Doors must be kept closed except when entering or leaving the room. Minimize unnecessary entry and exit.

5. Air pressure must be monitored daily with visual indicators (e.g.,smoke tubes, flutter strips),regardless of the presence of differential pressure sensing devices (e.g.,manometers).

6. For the standard floor plan for AIIR, refer to ANNEX B.

II. For facilities with limited Airborne Infection Isolation Rooms, private rooms may be utilized for the management of PUIs.

A. Conversion of Single Private Room

For the conversion of private rooms to isolation rooms, the following guidelines must be followed:

1. Use private rooms at the end of the hallway for conversion into a temporary isolation room. It must be away from the stairs and nurses' station.

2. Keep doors closed except when entering or leaving the room. Entry and exit should be minimized.

3. Keep the windows in the converted isolation rooms open regardless of use and non-use of air conditioning. Windows connecting to hallways should not be opened.

4. The use of air conditioning in the isolation room is allowed provided it is not part of the general air conditioning system of the facility.

5. Use temporary portable solutions, such as exhaust fans or unidirectional fans, to create a negative pressure environment in the converted area. Discharge air directly outside, away from people and air intakes, or through HEPA filters before introducing to other air spaces.

6. All healthcare personnel shall strictly adhere to hand hygiene following the World Health Organization's Multimodal Hand Hygiene Strategy: 5 Moments of Hand Hygiene.

7. Place wall-mounted alcohol-based hand rubs at point of care and outside the isolation room.

8. Medical supplies needed for patient care shall be made readily available at point of care.

9. Ensure that the relatives or carers of minors and elderly patients are provided with Personal Protective Equipment (PPEs).Instructions on the appropriate use and disposal of PPES must be provided.

10. Refer to ANNEX C for the Proposed Floor Plan for Converted Private Room. If access to a lavatory in the ante room is not feasible, wall mounted alcohol-based hand rubs are recommended.

B. Conversion of Ward

Wards may also be utilized for the management of PUIs. For the conversion of wards into isolation rooms, the following guidelines must be followed:

1. Follow the same guidelines for conversion of private rooms.

2. Place cohorted PUIs in a converted ward room provided that they have the same test results. Do not include patients with pending confirmatory test results in the cohort.

3. General ward rooms must have adequate ventilation with at least 60 L/s of air flow per patient.

4. All patient beds should be placed at least three (3) feet apart with a curtain separator for privacy.

III. Exclusive Use of Converted Private Rooms and Wards

Private rooms and wards converted into isolation rooms must not be used for the management and treatment of patients other than PUIs until after appropriate environmental cleaning and disinfection procedures are undertaken.

IV. Additional Information on Isolation Rooms

Additional reference materials on establishment and types of isolation rooms are listed on ANNEX D.

For guidance and strict compliance.

By Authority of the Secretary of Health:

(SGD.) LILIBETH C. DAVID, MD, MPH, MPM, CESO IUndersecretary of Health

ANNEX A

CDC Standard, Contact, and Airborne Infection Precautions for Patient with Known or Suspected 2019-nCoV(Source: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html)

1. Once in an Airborne Infection Isolation Room (AIIR),the patient's facemask may be removed. Transport and movement of the patient outside of the AIIR must be limited to medically-essential purposes. When not in an AIIR (e.g.,during transport),patients must wear a facemask to contain secretions.

2. Personnel entering the room must use PPEs, including respiratory protection (i.e.,fit-tested disposable N95 mask).

3. Only essential personnel must enter the room. Staffing policies must be strictly observed to minimize the number of healthcare professionals (HCP) who enter the room.

4. Facilities must take precautions to minimize the risk of transmission and exposure to other patients and other HCP.

5. Facilities must keep a log of all persons who provide care and enter the room or care areas of these patients.

6. Dedicated or disposable noncritical patient-care equipment must be used (e.g.,blood pressure cuffs).If equipment will be used for more than one patient, clean and disinfect such equipment before use on another patient according to manufacturer's instructions.

7. HCP entering the room after a patient vacates the room must use respiratory protection. Standard practice for pathogens spread by the airborne route (e.g.,measles, tuberculosis) is to restrict unprotected individuals, including HCP, from entering a vacated room until sufficient time has elapsed for enough air changes to remove potentially infectious particles. Currently, there is no data on how long 2019-nCoV remains infectious in the air. In the interim, apply a similar time period before entering the room without respiratory protection as used for pathogens spread by the airborne route (e.g.,measles, tuberculosis).In addition, the room should undergo appropriate cleaning and surface disinfection before it is returned to routine use.

8. HCP must perform hand hygiene before and after contacts with patients, potentially infectious material and PPE, including gloves.

9. Healthcare facilities must ensure that hand hygiene supplies are readily available in every care location.

ANNEX B

Standards and Floor Plan for Airborne Infection Isolation Room

ANNEX C

Proposed Floor Plan for Converted Private Room

ANNEX D

Additional Reference Materials on Isolation Rooms

1. Administrative Order No. 2012-0012, "Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines," as amended.

Refer to A.O. No. 2012-0012-A, "Amendment to Administrative Order (A.O.) No. 2012-0012 entitled "Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines"

2. Administrative Order No. 2016-0042, "Guidelines in the Application for Department of Health Permit to Construct (DOH-PTC)"

Refer to the following documents:

- Annex H-6A, "Checklist for Review of Floor Plans, Level 1 Hospital"

- Annex H-6B, "Checklist for Review of Floor Plans, Level 2 Hospital"

- Annex H-6C, "Checklist for Review of Floor Plans, Level 3 Hospital"

3. Total Alliance Health Partners International (TAHPI),"International Health Facility Guidelines"

Refer to Chapter IV, "Isolation Rooms" (Visit: https://bit.ly/3bbu45L)

4. Centers for Disease Control and Prevention (2007)."2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Setting," updated July 2019. https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html

ANNEX C

(List of Medicines and Medical Supplies)

 

Medicine	Medical Supplies and Equipment
Antipyretic	Monitoring
Paracetamol 500mg tablets Paracetamol 200mg/ampule	Thermometer (Thermal scanner or digital)
Sphygmomanometer
Respiratory Medications:	Pulse Oximeters
Lagundi 300mg to 600mg tablets 300mg/5mL, 60mL Syrup	Stethoscopes
Ipratropium + Salbutamol 500mcg + 2.5mg x2.5mL (unit dose) Respiratory	Airway
Salbutamol 1mg/mL 2.5mL nebule	Oxygen Tanks
Butamirate Citrate 50mg tablet	Oxygen Cannula (Adult and Pediatric)
Anti-Inflammatory Medications:	Bag Valve-Mask (Adult and Pediatric)
Hydrocortisone 100mg, 200mg or 500mg powder vial	Laryngoscope and Blade (Adult and Pediatric)
Antidiarrheal Medications	Nebulizer
Oral Rehydration Salts	Nebulizing kits
Loperamide 2mg Capsule	ET Tubes of varying sizes
Others	Circulation
Clonidine 75mcg/tab Clonidine 150 mcg/mL, 1mL ampule	Intravenous Set (IV Cannula, Macro/Microset) Soluset
IV Fluids (PLR, PNSS, D5LR, D51MB) Sterile water for IV meds preparation	Syringes (1cc, 3cc, 5cc, 10cc and 30 syringe)
Epinephrine ampule	Sterile needles (varied gauges)
	Others Supplies and Equipment
	Surgical tapes of different sizes (for IV insertion and intubation)
	Cotton balls
	Sterile gauze
	Surgical gloves (sterile & non-sterile)
	Tongue Depressor
	Sterile cotton swab
	Tourniquet
	Isopropyl alcohol
	Povidone Iodine
	Disinfectant solutions
	Surgical Masks
	Gowns
	Goggles/Face shields
	N95 Respirators
	Liquid antibacterial hand soap
	Bed linens, pillows and cases
	Color coded solid wastes disposal bins and plastic bags
	Wheel chair
	IV Stand

Considerations for Quarantine of Individuals in the Context of Containment for Coronavirus Disease (COVID-19)

Interim Guidance

World Health Organization

On 30 January 2020, the WHO Director-General determined that the outbreak of coronavirus disease (COVID-19) constitutes a Public Health Emergency of International Concern.1As the outbreak continues to evolve, Member States are considering options to prevent introduction of the disease to new areas or to reduce human-to-human transmission in areas where the virus that causes COVID-19 is already circulating.

Public health measures to achieve these goals may include quarantine, which involves the restriction of movement, or separation from the rest of the population, of healthy persons who may have been exposed to the virus, with the objective of monitoring their symptoms and ensuring early detection of cases. Many countries have the legal authority to impose quarantine. Quarantine should be implemented only as part of a comprehensive package of public health response and containment measures and, in accordance with Article 3 of the International Health Regulations (2005),be fully respectful of the dignity, human rights and fundamental freedoms of persons.2

The purpose of this document is to offer guidance to Member States on implementing quarantine measures for individuals in the context of the current COVID-19 outbreak. It is intended for those who are responsible for establishing local or national policy for the quarantine of individuals and for ensuring adherence to infection prevention and control (IPC) measures.

This document is informed by current knowledge of the COVID-19 outbreak and by considerations undertaken in response to other respiratory pathogens, including the severe acute respiratory syndrome coronavirus (SARS-CoV),the Middle East respiratory syndrome (MERS)-CoV and influenza viruses. WHO will continue to update these recommendations as new information becomes available.

Quarantine of persons

The quarantine of persons is the restriction of activities of or the separation of persons who are not ill but who may been exposed to an infectious agent or disease, with the objective of monitoring their symptoms and ensuring the early detection of cases. Quarantine is different from isolation, which is the separation of ill or infected persons from others to prevent the spread of infection or contamination.

Quarantine is included within the legal framework of the International Health Regulations (2005),specifically:

• Article 30 — Travellers under public health observation;

• Article 31 — Health measures relating to entry of travellers;

• Article 32 — Treatment of travelers.2

Member States have, in accordance with the Charter of the United Nations and the principles of international law, the sovereign right to legislate and to implement legislation, in pursuit of their health policies, even if this involves the restriction of movement of individuals.

Before implementing quarantine, countries should properly communicate such measures to reduce panic and improve compliance.1

• Authorities must provide people with clear, up-to-date, transparent and consistent guidelines, and with reliable information about quarantine measures.

• Constructive engagement with communities is essential if quarantine measures are to be accepted.

• Persons who are quarantined need to be provided with health care; financial, social and psychosocial support; and basic needs, including food, water, and other essentials. The needs of vulnerable populations should be prioritized.

• Cultural, geographic and economic factors affect the effectiveness of quarantine. Rapid assessment of the local context should evaluate both the drivers of success and the potential barriers to quarantine, and they should be used to inform plans for the most appropriate and culturally accepted measures.

When to use quarantine

Introducing quarantine measures early in an outbreak may delay the introduction of the disease to a country or area or may delay the peak of an epidemic in an area where local transmission is ongoing, or both. However, if not implemented properly, quarantine may also create additional sources of contamination and dissemination of the disease.

In the context of the current COVID-19 outbreak, the global containment strategy includes the rapid identification of laboratory-confirmed cases and their isolation and management either in a medical facility3or at home.4

WHO recommends that contacts of patients with laboratory-confirmed COVID-19 be quarantined for 14 days from the last time they were exposed to the patient.

For the purpose of implementing quarantine, a contact is a person who is involved in any of the following from 2 days before and up to 14 days after the onset of symptoms in the patient:

• Having face-to-face contact with a COVID-19 patient within 1 meter and for >15 minutes;

• Providing direct care for patients with COVID-19 disease without using proper personal protective equipment;

• Staying in the same close environment as a COVID-19 patient (including sharing a workplace, classroom or household or being at the same gathering) for any amount of time;

• Travelling in close proximity with (that is, within 1 separation from) a COVID-19 patient in any kind of conveyance;

• and other situations, as indicated by local risk assessments.5

Recommendations for implementing quarantine

If a decision to implement quarantine is taken, the authorities should ensure that:

• the quarantine setting is appropriate and that adequate food, water, and hygiene provisions can be made for the quarantine period;

• minimum IPC measures can be implemented;

• minimum requirements for monitoring the health of quarantined persons can be met during the quarantine period.

Ensuring an appropriate setting and adequate provisions

The implementation of quarantine implies the use or creation of appropriate facilities in which a person or persons are physically separated from the community while being cared for.

Appropriate quarantine arrangements include the following measures.

• Those who are in quarantine must be placed in adequately ventilated, spacious single rooms with en suite facilities (that is, hand hygiene and toilet facilities).If single rooms are not available, beds should be placed at least 1 metre apart.

• Suitable environmental infection controls must be used, such as ensuring are adequate air ventilation, air filtration systems, and waste-management protocols.

• Social distance must be maintained (that is, distance of at least 1 metre) between all persons who are quarantined.

• Accommodation must provide an appropriate level of comfort, including:

- provision of food, water, and hygiene facilities;

- protection for baggage and other possessions;

- appropriate medical treatment for existing conditions;

- communication in a language that those who are quarantined can understand, with an explanation of their rights, services that will be made available, how long they will need to stay and what will happen if they get sick; additionally, contact information for their local embassy or consular support should be provided.

• Medical assistance must be provided for quarantined travellers who are isolated or subject to medical examinations or other procedures for public health purposes.

• Those who are in quarantine must be able to communicate with family members who are outside the quarantine facility.

• If possible, access to the internet, news, and entertainment should be provided.

• Psychosocial support must be available.

• Older persons and those with comorbid conditions require special attention because of their increased risk for severe COVID-19.

Possible settings for quarantine include hotels, dormitories, other facilities catering to groups, or the contact's home. Regardless of the setting, an assessment must ensure that the appropriate conditions for safe and effective quarantine are being met.

When home quarantine is chosen, the person should occupy a well-ventilated single room, or if a single room is not available, maintain a distance of at least 1 metre from other household members, minimize the use of shared spaces and cutlery, and ensure that shared spaces (such as the kitchen and bathroom) are well ventilated.

Minimum infection prevention and control measures.

The following IPC measures should be used to ensure a safe environment for quarantined persons.

1. Early recognition and control

• Any person in quarantine who develops febrile illness or respiratory symptoms at any point during the quarantine period should be treated and managed as a suspected case of COVID-19.

• Standard precautions apply to all persons who are quarantined and to quarantine personnel:

- Perform hand hygiene frequently, particularly after contact with respiratory secretions, before eating, and after using the toilet. Hand hygiene includes either cleaning hands with soap and water or with an alcohol-based hand rub. Alcohol-based hand rubs are preferred if hands are not visibly dirty; hands should be washed with soap and water when they are visibly dirty.

- Ensure that all persons in quarantine are practicing respiratory hygiene and are aware of the importance of covering their nose and mouth with a bent elbow or paper tissue when coughing or sneezing and then immediately disposing of the tissue in a wastebasket with a lid and then performing hand hygiene.

- Refrain from touching the eyes, nose and mouth.

• A medical mask is not required for persons with no symptoms. There is no evidence that wearing a mask of any type protects people who are not sick.

2. Administrative controls

Administrative controls and policies for IPC within quarantine facilities include but may not be limited to:

• establishing sustainable IPC infrastructure (for example, by designing appropriate facilities) and activities;

• educating persons who are quarantined and quarantine personnel about IPC measures. All personnel working in the quarantine facility need to have training on standard precautions before the quarantine measures are implemented. The same advice on standard precautions should be given to all quarantined persons on arrival. Both personnel and quarantined persons should understand the importance of promptly seeking medical care if they develop symptoms;

• developing policies to ensure the early recognition and referral of a suspected COVID-19 case.

3. Environmental controls

Environmental cleaning and disinfection procedures must be followed consistently and correctly. Cleaning personnel need to be educated about and protected from COVID-19 and ensure that environmental surfaces are regularly and thoroughly cleaned throughout the quarantine period.

• Clean and disinfect frequently touched surfaces — such as bedside tables, bed frames and other bedroom furniture — daily with regular household disinfectant containing a diluted bleach solution (that is, 1-part bleach to 99 parts water).For surfaces that cannot be cleaned with bleach, 70% ethanol can be used.

• Clean and disinfect bathroom and toilet surfaces at least once daily with regular household disinfectant containing a diluted bleach solution (that is, 1-part bleach to 99 parts water).

• Clean clothes, bed linens, and bath and hand towels using regular laundry soap and water or machine wash at 60-90°C (140-194°F) with common laundry detergent, and dry thoroughly.

• Countries should consider implementing measures to ensure that waste is disposed of in a sanitary landfill and not in an unmonitored open area.

• Cleaning personnel should wear disposable gloves when cleaning surfaces or handling clothing or linen soiled with body fluids, and they should perform hand hygiene before putting on and after removing their gloves.

Minimum requirements for monitoring the health of quarantined persons.

Daily follow up of persons who are quarantined should be conducted within the facility for the duration of the quarantine period and should include screening for body temperature and symptoms. Groups of persons at higher risk of infection and severe disease may require additional surveillance owing to chronic conditions or they may require specific medical treatments.

Consideration should be given to the resources and personnel needed and rest periods for staff at quarantine facilities. This is particularly important in the context of an ongoing outbreak, during which limited public health resources may be better prioritized for health care facilities and case-detection activities.

Respiratory samples from quarantined persons, irrespective of whether they have symptoms, should be sent for laboratory testing at the end of the quarantine period.

References

1. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV).In: World Health Organization/Newsroom [website].Geneva: World Health Organization; 2020 (https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov),accessed 29 February 2020).

2. Key considerations: quarantine in the context of COVID-19. In: Social Science in Humanitarian Action: A Communication for Development Platform [website].New York: UNICEF, Institute of Development Studies; 2020 (https://www.socialscienceinaction.org/resources/february-2020-social-science-humanitarian-action-platform/,accessed 29 February 2020).

3. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected.(accessed 16 March 2020).

4. World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: interim guidance,17 March 2020. Geneva: World Health Organization; 2020 (accessed 17 March 2020).

5. World Health Organization. Global Surveillance for human infection with coronavirus disease (COVID-19):interim guidance.

6. World Health Organization. Advice on the use of masks in the community, during home care and in health care settings in the context of COVID-19: interim guidance,29 January 2020. Geneva: World Health Organization; 2020 (accessed 16 March 2020).

WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO will issue a further update. Otherwise, this interim guidance document will expire 2 years after the date of publication.

© World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence.

WHO reference number: WHO/2019-nCoV/IHR_Quarantine/ 2020.2

March 25, 2020

DEPED TASK FORCE COVID-19 MEMORANDUM NO. 025-20

 

 

 

This memorandum is being issued pursuant to the directive of the Secretary to the DepEd Task Force COVID-19 to "prepare for the baseline protocols to be observed in the workplace, travel, and home and private space and time of the deployed personnel, and the coordination mechanism for the effective implementation of these," per Office Memorandum OO-OSEC-2020-001, titled Authorization of Office and Field Work for Identified Critical Services in Areas Covered by the Enhanced Community Quarantine,or "to issue the uniform and minimum standards for social distancing within the workplace, during travel, and in private premises and activities," per DM 43, s. 2020, titled Guidelines on the Alternative Work Arrangements in the Department of Education in Light of the Covid-19 Stringent Social Distancing Measures.

1. Guidelines on work arrangement

a. Personnel on work-from-home

i. The following factors shall be considered when identifying the personnel that will make up the skeletal workforce:

(1) The overall health of the personnel.Personnel considered as high-risk individuals shall be prioritized for home-from-work arrangement. "Persons who are at high risk of being infected" are elaborated as "those sixty (60) years old and above,those who are immunocompromised or with co-morbidities,and pregnant women," based on the Memorandum from the Executive Secretary, IATF-MEID and DOH.

(2) Distance between the residence of the personnel and the office (workstation) (e.g.,those who reside outside the National Capital Region and require daily travel shall be prioritized for home-from-work arrangement, if a service cannot be provided).

ii. All personnel who are on work-from-home arrangement are advised to observe applicable preventive measures contained in this memorandum (Item No. 2).

b. Personnel on skeletal workforce

i. Those part of the skeletal workforce shall be provided with a door-to-door vehicle service where applicable preventive measures (as enumerated in Item No. 2 of this memorandum),including social distancing, shall be strictly observed. The vehicle used for transportation shall be cleaned and disinfected after every trip.

ii. Proper orientation on safety and precautionary measures including social distancing of passengers shall be provided to the drivers.

iii. The skeletal workforce shall report only during their assigned schedule or as necessary.

iv. The skeletal workforce shall adhere to the preventive measures enumerated in Item No. 2 and No. 3 of this memorandum.

v. The Central Office Task Force COVID-19 and similar task forces at the Regional Offices, Division Offices and Schools are enjoined to formulate implementing rules on the above items.

2. General preventive measures for the skeletal workforce (Based on DOH Circular No. 2020-0039)

a. Respiratory etiquette

i. Cough and sneeze into tissue or into shirt sleeve if tissue is not available. Dispose used tissues properly and disinfect hands immediately after a cough or sneeze.

ii. Avoid touching the mouth, eyes, and nose to help slow the spread of the virus.

iii. The use of masks, which provides a physical barrier from COVID-19 by blocking large-particle respiratory droplets propelled by coughing or sneezing, is only recommended for:

(1) Persons caring for the sick

(2) Healthcare workers attending to patients with respiratory infections/symptoms (cough/cold)

(3) Persons with respiratory infection/ symptoms

iv. People in good health do not need to use face masks, except in crowded places where social distancing is not feasible.

b. Hand hygiene.Perform regular and thorough handwashing with soap and water. Use alcohol-based hand sanitizers containing at least 60 ethanol or isopropanol when soap and water are not available.

c. Social distancing measures

i. Whenever possible, keep a distance of at least 3 feet or 1 meter away from other people to reduce the possibility of person-to-person transmission. This distance should be observed even as to apparently healthy persons without symptoms.

ii. Offer telecommuting and replace in-person meetings in the workplace with video or telephone conferences.

d. Environmental measures

i. Clean frequently-touched surfaces and objects, including tables, doorknobs, desks, and keyboards.

ii. Maintaining the environment clean, especially common-use areas and those with touchpoints such as elevators, railings, staircases, light switches and the like.

iii. Make dispensers with alcohol-based hand rub available in public areas.

3. Practical measures for the offices at the DepEd Central, Regional, Division, Facilities and/or Schools while on skeletal workforce

a. One major consideration when determining the skeletal workforce to report to the office is the workspace. The number of personnel to report each day shall permit strict observance of social distancing within the office.

b. All personnel who are reporting as part of the skeletal workforce shall always have the "mindset" and be conscious to behave as if they may be possibly be infected with the virus, albeit asymptomatic, and may be potentially exposing their colleagues to the virus.

c. All reporting staff must as much as possible stay only in their respective workstations, and avoid moving around the office.

d. Talking closely between personnel during reporting hours is highly discouraged. Talking is also discouraged in common areas such as near the water dispenser or the photocopier.

e. All personnel are advised to always carry their own pens with them so that they use it when filling-out log-sheets at the entrance.

f. All personnel are advised to wash their hands with soap upon arrival at the DepEd Complex before entering their respective officers.

g. Doors may be slightly opened so that feet or elbows may be used when opening and closing them, instead of opening them through the doorknobs.

h. Social distancing — keeping a distance of at least 3 feet or 1 meter away from other people — shall be strictly observed at all times in the entire DepEd complex.

i. Personnel who manifests symptoms of respiratory infection shall be immediately provided with appropriate health care and automatically removed of the skeletal workforce. Likewise, personnel who will have exposure to a confirmed case, or whose household members will be eventually categorized as Person Under Monitoring or Person Under Investigation shall immediately disclose such information to their immediate supervisor for appropriate referral and intervention.

The DepEd Task Force COVID-19 welcomes suggestions and ideas on how social distancing and other preventive measures can be further practiced in the workplace. Such feedback and other concerns may be e-mailed at [email protected]

For proper guidance.

(SGD.) ALAIN DEL B. PASCUAUndersecretary

 

Footnotes

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