Observance of the New Normal in All Health Facilities
The Philippine Department of Health (DOH) has issued guidelines to ensure health facilities adapt to the "New Normal" in response to the COVID-19 pandemic. These guidelines emphasize the integration of public health measures such as physical distancing, mandatory use of face masks, and strict infection control protocols across all healthcare settings. Health facilities are required to implement operational adjustments, utilize telehealth services, and maintain safety measures for both patients and staff, including regular health screenings and mental health support. Additionally, infrastructure improvements, such as enhanced ventilation and sanitation practices, are mandated to facilitate safe healthcare delivery while managing COVID-19 risks. Compliance with these guidelines is critical to maintaining public health standards as the country navigates the ongoing pandemic.
June 22, 2020
DOH DEPARTMENT CIRCULAR NO. 2020-0286
| TO | : | All Undersecretaries and Assistant Secretaries; Directors of Bureaus and Centers for Health Development (CHD); Minister of Health of the Bangsamoro Autonomous Region in Muslim Mindanao; Medical Directors of Hospitals; Heads of Other Health Facilities; Chiefs of the Regulation, Licensing and Enforcement Division (RLED); Chiefs of Health Facilities and Services Regulatory Bureau, All Regulatory Officers and All Other Concerned Stakeholders |
| SUBJECT | : | Observance of the New Normal in All Health Facilities |
As a response to the current COVID-19 pandemic, the Philippines has implemented several strategies recommended by the World Health Organization (WHO), such as strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing. Likewise, the Inter-Agency Task Force (IATF) for the Management of Emerging Infectious Diseases promotes the adoption of the "New Normal" in the current lifestyle of the Filipinos. New Normal is defined as a phase of emerging behaviors, situations, and minimum public health standards that will have to be integrated in common or routine everyday practices, and will be observed even after the pandemic or while the disease is not totally eradicated.
The Department of Health issued Department Memorandum (DM) No. 2020-0268 titled "Interim Guidelines on Health Facilities in the New Normal," which enumerates the health protocols to be practiced as part of the New Normal.
In line with this, the Health Facilities and Services Regulatory Bureau highly recommends the adoption and strict implementation of the guidelines provided in DM No. 2020-0268. The recommended practices shall not only be applicable to the daily activities of the health facilities but shall extend to the remote collection activities of the diagnostic laboratories.
For strict compliance.
By Authority of Secretary of Health:
(SGD.) MARIA ROSARIO SINGH-VERGEIRE, MD, MPH, CESO IVUndersecretary of HealthHealth Regulation Team
ATTACHMENT
Department of Health
May 28, 2020
DEPARTMENT MEMORANDUMNo. 2020-0268
| TO | : | ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES; DIRECTORS OF BUREAUS/SERVICES AND CENTERS FOR HEALTH DEVELOPMENT; CHIEFS OF MEDICAL CENTERS, HOSPITALS, SANITARIA, AND TREATMENT AND REHABILITATION CENTERS; EXECUTIVE DIRECTORS OF SPECIALTY HOSPITALS AND ATTACHED AGENCIES; AND ALL OTHERS CONCERNED |
| SUBJECT | : | Interim Guidelines on Health Facilities in the New Normal |
I. Background:
On May 15, 2020, the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID) announced the transition from an Enhanced Community Quarantine (ECQ) to either a Modified Enhanced Community Quarantine (MECQ) or a General Community Quarantine (GCQ) of several provinces and cities in the country. After the GCQ period is lifted, provinces and cities will enter the New Normal phase.
The Omnibus Guidelines on the Implementation of Community Quarantine in the Philippines of IATF-EID defines the New Normal as the emerging behaviors, situations, and minimum public health standards that will be institutionalized in common or routine practices and remain even after the pandemic while the disease is not totally eradicated through means such as widespread immunization.
As the country transitions into the New Normal, health facilities must plan ahead and adopt policies, protocols, and behaviors to ensure that there is continued health service delivery while maintaining public health standards for COVID-19 disease.
II. OBJECTIVE
To provide guidance on health facilities across the Health Care Provider Network (HCPN) as they transition into the New Normal phase.
III. SCOPE AND COVERAGE
These guidelines shall cover all health facilities — primary care facilities, dental clinics, diagnostic facilities, specialized outpatient facilities, infirmaries and hospitals, Treatment and Rehabilitation Centers, and pharmaceutical outlets.
IV. GENERAL GUIDELINES
All health facilities, whether public or private, shall do the following:
A. Plan and revise its operations to 1) Increase Physical and Mental Resilience, 2) Reduce contact, 3) Reduce transmission, and 4) Reduce duration of Illness in accordance with Administrative Order 2020-0016, "Minimum Health System Capacity Standards for COVID-19 Preparedness and Response Strategies" (bit.ly/AO2020_0016).
B. In coordination with the Local Government Unit, endeavor to be part of an HCPN as defined in Administrative Order 2020-0019, "Guidelines on the Service Delivery Design in Health Care Provider Networks" (bit.ly/AO2020_0019) and in accordance with the Universal Health Care Act or Republic Act 11223.
C. Institutionalize infection prevention and control measures through the establishment of administrative, engineering, and environmental controls, in accordance with DOH Department Memorandum (DOH-DM) No. 2020-0208, "Interim Guidelines on Enhancing the Infection Prevention and Control Measures through Engineering and Environmental Controls in All Health Facilities and Temporary Treatment and Monitoring Facilities during the COVID-19 Pandemic." (bit.ly/DM2020_0208).
D. Continue providing necessary support for essential workforce such as lodging, food, shuttle services, as necessary.
E. Ensure all healthcare workers are oriented and trained in standard Infection Prevention and Control measures and shall be subjected to risk assessment and subsequent management based on DOH Department Circular (DOH-DC) 2020-0106, "Use of World Health Organization Interim Guidelines for Health Workers Exposure Risk Assessment and Management in the Context of COVID-19 Virus" (bit.ly/DC2020_0106).
F. Provide Mental Health and Psychosocial Services (MHPSS) to patients and staff in accordance with Department Memorandum 2020-0230, "Interim Guidelines on the Implementation of Mental Health and Psychosocial Support (MHPSS) in the Corona Virus Disease 2019 (COVID-19) Response" (https://bit.ly/DM2020-0230).
G. Allow operations of commercial establishments inside the health facilities such as restaurants, stores, etc. in accordance with the IATF-EID Guidelines and Resolutions.
H. Utilize the Preparedness Checklist in Annex A applicable to their setting to assess their capacity in transitioning to the New Normal.
V. SPECIFIC GUIDELINES
A. HCPN-Related Interventions
All health facilities shall perform the following:
1. Work as a network of facilities in an HCPN following the policies for patient navigation and medical transport system including the IPC protocols during transfers;
2. Communicate protocols for referral including the established patient pathways to all concerned staff;
3. Adopt an Information and Communication Technology system (ICT) that allows sharing of information such as patient records across health facilities; and
4. Implement the necessary logistic arrangements to ensure that they have the adequate essential supplies to ensure minimum health standards.
B. Patient-Related Interventions
All health facilities shall observe the following measures to ensure patient safety:
1. Standard and mandatory safety measures shall include:
a) Physical distancing of at least one (1) meter or 3-feet between individuals in all areas including waiting area and cafeterias at all times;
b) Wearing of face mask by patients and visitors within the facility premises;
c) Active body temperature and symptoms screening for all individuals prior to entrance to the facility with proper advice for symptomatic persons;
d) Provision of safety precautions for vulnerable populations such as the elderly, pregnant, children, and persons with disability such as priority lanes, separate waiting areas, etc.;
e) Restricting visitors for suspect, probable, or confirmed COVID-19 patients; and
f) Limiting companions and visitors for non-COVID-19 patients for outpatient care, emergency care and admission to private rooms and wards.
2. Use of telehealth and telemedicine, when feasible, to reduce contact and limit patients in the facility which may include:
a) Implementation of a scheduling mechanism for consults through SMS/text message, phone call, or online platforms;
b) Provision of ambulatory care through telemedicine during follow-ups or whenever appropriate so that only patients with serious concerns are seen in the clinic for a face-to-face consultation;
c) Use of tele-pharmacy strategies (i.e., medication counselling) through appropriate ICT System by a licensed pharmacist to limit patient contact in the facility in accordance with FDA guidelines and Republic Act 8792, "Electronic Commerce Act of 2000" (bit.ly/RA_8792).
C. Health Care Worker-Related Interventions
All health facilities shall implement the following for health care workers:
1. Use of appropriate Personal Protective Equipment (PPE) by health care workers subject to DOH-DM No. 2020-0176, "Interim Guidelines on the Rational Use of Personal Protective Equipment for Corona Virus Disease 2019" and DOH-DM No. 2020-0197, "Interim Guidelines on the Optimal Use of Personal Protective Equipment During Severe Shortage of Supplies" (bit.ly/DM2020-0176 and bit.ly/DM2020-0197);
2. Implement Administrative Controls to strengthen Infection Prevention and Control measures in the workplace such as:
a) Strict adherence to the prescribed number of people permitted to hold mass gatherings (e.g., maximum of 10 people under IATF-EID Moderate Risk Severity Grading, maximum of 50 people under IATF-EID Low Risk Severity Grading) and use of required PPE during conduct of patient rounds, etc.;
b) Utilization of online platforms and other technologies as an alternative to traditional face-to-face conferences, assemblies, lectures, and meetings;
c) Create and/or adopt policies and protocols related to:
(1) Risk-based assessment and management of exposure, duty schedules, sick leaves, if there are any;
(2) Reporting of symptoms and probable breaks in IPC protocols;
(3) Exclusive use of clothing/uniform during the tour of duty within the health facility;
(4) Laundry of used/dirty uniforms, and/or scrubs worn during duty by healthcare workers; and
(5) Accommodation arrangement and transportation for healthcare workers.
3. Ensure health care worker safety and mental health through:
a) Training and orientation of all health care workers on Infection Prevention and Control protocols and measures which include, but are not limited to, the following:
(1) Triaging, early recognition of signs and symptoms, high-risk individual and source control of COVID-19
(2) Isolation Precautions
(3) Respiratory Etiquette and Physical Distancing
(4) Reporting procedure for COVID-19 surveillance as established by the healthcare facility
(5) Physical layout and workflow map of important areas and zones in the health facility
(6) Healthcare worker Risk Assessment and Management in the Context of COVID-19 virus
(7) Proper Hand Hygiene and 5 moments of Hand Hygiene
(8) Proper donning and doffing of PPE
(9) Environmental cleaning and disinfection of patient care areas, including training of the use of decontamination materials
b) Setting up a system to monitor and report healthcare workers who take care of suspect/confirmed cases.
c) Conduct immediate case investigation and contact tracing when suspect, probable, or confirmed cases among health facility staff are reported.
d) Monitor temperature and respiratory symptoms before and after the tour of duty with appropriate protocols for managing symptomatic health workers in accordance with DOH-Department Circular (DOH-DC) 2020-0106, "Use of World Health Organization Interim Guidelines for Health Workers Exposure Risk Assessment and Management in the Context of COVID-19 Virus" (bit.ly/DC2020_0106):
(1) For Low Risk Exposure
(a) Self-monitoring of temperature and respiratory symptoms daily for 14 days after the last day of exposure to a COVID-19 patient.
(2) For High Risk Exposure
(a) Stop all health care interaction with patients for a period of 14 days after the last day of exposure to a COVID-19 patient; and
(b) Quarantine for 14 days through home isolation or designated temporary treatment and monitoring facilities.
(3) Testing of low and high risk healthcare workers shall be in accordance with the current DOH guidelines on Expanded Testing for COVID-19.
e) Ensure appropriate staffing ratio and work schedule for staff in accordance with Civil Service Commission Rules and Regulations and Department of Labor and Employment Guidelines; and
f) Provision of mental health services and psychosocial services.
4. An active and functional Infection Prevention and Control Committee/Team or a Designated IPC Officer based on the following:
a) Assignment of personnel forming the IPC Committee/Team and designation of the IPC Officer who issues out IPC policies;
b) Adoption of necessary policies and review of existing strategies related to IPC;
c) Conduct of IPC Committee/Team meetings;
d) Assessment of the facility's implementation to IPC protocols including Engineering, Environmental, and Administrative controls; and
e) Investigation of IPC breaks and observance of staff's compliance to IPC policies.
5. Assignment of dedicated healthcare workers to specific stations to limit and control movement of personnel around the facility premises.
a) Preferably, health care workers assigned to high-risk areas such as COVID-19 Wards, COVID-19 Emergency Department, ICU, Isolation Areas, etc. do not belong to the vulnerable population (i.e., elderly or with co-morbidities).
b) Ensure proper physical distancing of staff in common areas such as quarters and pantry.
c) There must be a specifically-trained healthcare personnel to oversee the triage process in health facilities.
6. Promotional and/or educational materials on the following are posted in appropriate places and within visible range in the health facility, which may include but are not limited to:
a) Proper handwashing;
b) Respiratory etiquette and social distancing;
c) Appropriate PPE per zone; and
d) Proper Donning and Doffing of PPE.
D. Infrastructure and Maintenance Interventions
All health facilities shall implement the following measures related to infrastructure:
1. Use of the following Engineering Controls, as deemed applicable, to ensure safety of healthcare workers and patients:
a) Installation of hand washing facilities or sanitizing stations in common areas and other strategic places such as walkways, entrances and exits, information desks, waiting areas and dining areas and ensure 24/7 availability of soap and running water or alcohol-based sanitizers;
b) Designation of dedicated areas in triage, emergency department, patient wards, and operating room theater, for the use of COVID-19 and Non-COVID-19 Patients.
c) Establish clear workflow and foot traffic as follows:
(1) Separate entrance and exit for patients and healthcare workers;
(2) After initial screening and triage, patients will follow the dedicated walkway for COVID-19 and non-COVID-19 set by the facility;
(3) Unidirectional flow/foot traffic when moving from one area to another for suspect, probable, and confirmed COVID-19 patients and non-COVID-19 patients; and
(4) Placement of signages, floor markers, or physical barriers to reinforce physical distancing and direct pathways in the health facilities.
d) Implement the prescribed zoning in areas where suspect, probable and confirmed COVID-19 patients are cared for according to DM2020-0208.
e) Improve ventilation in all facilities as follows:
(1) Increase passage of natural ventilation in all parts of the facilities.
(2) Use a dilution ventilation system for patient rooms and wards (e.g., use of unidirectional electric fans to direct airflow).
(3) Use a mechanical ventilation system to induce negative pressure for isolation rooms and Intensive Care Unit.
f) Ensure that appropriate patient placement standards are followed:
(1) Suspect, probable, and confirmed COVID-19.
(2) Patients shall follow patient placement in accordance with DOH-DM No. 2020-0062, "Guidelines on the Standard of Airborne Infection Isolation Room and Conversion of Private Rooms and/or Wards into Temporary Isolation Rooms for the Management of Patients Under Investigation and its Amendment" (bit.ly/DM2020_0062 and https://bit.ly/DM2020_0062a).
(3) Beds are placed at least 1 meter (3-feet) apart with partitions to ensure privacy.
g) Installation of a non-porous barrier (e.g., acrylic sheets, polycarbonate sheets, clear corrugated sheets, or glass) between patients and health facility staff in administrative areas (i.e., Information desks, cashier, billing).
2. Implementation of the following Environmental Controls to improve Infection Prevention and Control:
a) General strategies to follow include:
(1) Conduct of visual preliminary site assessment to ensure that the appropriate materials and disinfectant are used.
(2) Proceed in a methodical systematic manner, ensuring that cleaning and disinfection is from cleaner to dirtier area and from high to low area.
b) High contact surfaces such as buttons, switches, handrails, etc. shall be disinfected as least once every two hours using disinfectant solution or wipes.
c) Areas where suspect, probable, and confirmed COVID-19 patients receive care (e.g., rooms, observation units, etc.) shall be cleaned and disinfected using the recommended disinfectants at least once a day, and after a patient is discharged.
d) For other areas, routine cleaning may be performed with detergent or disinfectant solution or wipes at least once a day or when visibly dirty.
e) Toilets should be cleaned and disinfected at least twice a day or more frequently as the need arises.
f) For non-critical items, disinfection shall follow the standards of DOH-DM 2020-0167, Interim Guidelines on the Proper Handling and Disinfection of Non-critical Items Used in the Management of COVID-19 Patients in All Health Facilities and Temporary Treatment and Monitoring Facilities (https://bit.ly/3fbzrnb).
g) Recommended disinfectants include:
(1) 70% ethyl alcohol to disinfect small surface areas and equipment between uses, such as reusable dedicated equipment.
(2) Sodium hypochlorite at 0.1% (1000 ppm) for disinfecting surfaces and 0.5% (5000 ppm) for disinfection of blood or bodily fluids spills (note: for surfaces or walls with blood or bodily fluids, allow the disinfectant to sit for 30 mins).
h) Proper collection, storage, transfer, treatment, transport and disposal of infectious waste from healthcare facilities and COVID-19 treatment units shall be done in accordance with Department Memorandum 2020-0170, "Interim Guidelines on the Management of Health Care Waste in Health Facilities, Community quarantine Units, and Temporary Treatment and Monitoring Facilities with Cases of Corona Virus Disease 2019 (COVID-19)" (bit.ly/DM2020_0170) and Department Circular 2020-0191, "Circulation of the Health Care Waste Management Manual 4th Edition."
For strict compliance and dissemination to all concerned.
(SGD.) FRANCISCO T. DUQUE III, MD, MScSecretary of Health
ANNEX A
Health Facilities in the New Normal Preparedness Checklist(bit.ly/NewNormalChecklist)
The purpose of this checklist to guide health facility managers in transitioning into the New Normal. The checklist is divided into 4 main components: (1) HCPN-related Interventions; (2) Patient-related Interventions; (3) Health care worker-related Interventions; and (4) Infrastructure and Maintenance-related Interventions
I. Primary Care Facilities, Dental Clinics, Specialized Outpatient Clinics, and Diagnostic Facilities in the New Normal Checklist
|
HCPN-Related Interventions |
OK |
|
Referral • Work as a network of facilities in HCPN following the policies for patient navigation and medical transport system including the IPC protocols during transfers of the HCPN and communicate these to all concerned staff |
|
|
ICT Technology • Adopt an information and communication technology system that allows sharing of information such as patient records across health facilities |
|
|
Logistics and Supplies • Implement the necessary logistic arrangements to ensure that they have the adequate essential supplies to ensure minimum health standards |
|
|
Patient-Related Interventions |
OK |
|
Safety measures for Patient and Visitors • Physical distancing of at least one (1) meter or 3-feet between individuals in all areas including waiting area and cafeterias at all times • Wearing of face mask by patients within the facility premises • Body temperature and symptoms screening for all individuals prior to entrance to the facility with proper advice for symptomatic persons • Provision of safety precautions for vulnerable populations such as the elderly, pregnant, children, persons with disability and persons deprived of liberty |
|
|
Telehealth and Telemedicine • Scheduling mechanism for consults through SMS/text message, phone call, or online platforms in order to limit patients inside the facility • Telemedicine providing medical advice or ambulatory care and consultation if feasible |
|
|
Health care worker-related Interventions |
OK |
|
PPE in Clinics • Surgical mask as a standard precaution • Full PPE set for direct care of suspect, probable, and confirmed COVID cases • N95 respirators for specialized outpatient clinics performing aerosol-producing procedures |
|
|
IPC Team • Active Infection Prevention and Control Committee/Team or a Designated IPC Officer |
|
|
Training • Training and orientation of all health care workers about standard Infection Prevention and Control measures: - Triaging, early recognition of signs and symptoms, high-risk individual and source control of COVID-19 - Isolation Precautions - Respiratory Etiquette and Physical Distancing - Reporting procedure for COVID-19 surveillance as established by the healthcare facility - Physical layout and workflow map of important areas and zones in the health facility - Healthcare worker Risk Assessment and Management in the Context of COVID-19 virus - Proper Hand Hygiene and 5 moments of Hand Hygiene - Proper donning and doffing of PPE - Environmental cleaning and disinfection of patient care areas, including training of the use of decontamination materials |
|
|
Mental Health Services • Provision of mental health and psychosocial services |
|
|
Policies • Assignment of healthcare workers to a dedicated clinic to limit and control movement around the clinic • Strict adherence to the prescribed number of people permitted to hold mass gatherings and use of the required PPE • Conduct of online meetings for multi-disciplinary team meetings, lectures and conferences instead of face-to-face meetings • Detection and isolation at home or in designated community quarantine or isolation facilities of symptomatic staff • Conduct of immediate case investigation and contact tracing when suspect, probable, or confirmed cases among health facility staff are reported |
|
|
Educational Materials • Promotional and/or educational materials on the following are posted in appropriate places - Proper handwashing; - Respiratory etiquette and social distancing; - Appropriate PPE per zone; and - Proper Donning and Doffing of PPE. |
|
|
Infrastructure and Maintenance Interventions |
OK |
|
Hand Hygiene Facilities • Installation of hand washing facilities or sanitizing stations in strategic areas such as walkways, entrances and exits, information desks, waiting areas - 24/7 availability of soap and running water or alcohol-based sanitizers |
|
|
Physical Barrier • Installation of a non-porous barrier (e.g., acrylic sheets, polycarbonate sheets, clear corrugated sheets, or glass) between patients and health facility staff in administrative areas (i.e., Information desks, cashier, billing) |
|
|
Dedicated Treatment and Waiting Area • Clear and unidirectional flow/foot traffic when moving from one area to another • Separate entrance and exit for patients (with and without respiratory symptoms) and healthcare workers • Placement of signages or floor markers to reinforce physical distancing and direct pathways in the health facilities |
|
|
Ventilation • Increase natural ventilation in all parts of the facilities • Use a dilution ventilation system for patient rooms and wards |
|
|
Patient Placement • Arrangement of rooms and areas to ensure at least 1 meter (3-feet) distance between patients at all times |
|
|
Environmental Controls Surfaces • High contact surfaces such as buttons, switches, handrails, etc. shall be disinfected at least once every two hours using disinfectant solution or wipes |
|
|
Areas • Areas where suspect, probable, and confirmed COVID-19 patients receive care (e.g., rooms, observation units, etc.) shall be cleaned and disinfected using the recommended disinfectants at least once a day, and after a patient is discharged • For other areas, routine cleaning may be performed with detergent or disinfectant solution or wipes at least once a day or when visibly dirty |
|
|
Toilets • Toilets should be cleaned and disinfected at least twice a day or more frequently as the need arises |
|
|
Non-Critical Items • For non-critical items, disinfection shall follow the standards of DOH-DM2020-0167 (https://bit.ly/3fbzrnb) |
|
|
Waste Management • Proper collection, storage, transfer, treatment, transport and disposal of infectious waste from healthcare facilities and COVID-19 treatment units based on DOH-DM 2020-0170 (bit.ly/DM2020_0170) |
|
II. Hospitals, Infirmaries and Treatment and Rehabilitation Centers in the New Normal Checklist
|
HCPN-Related Interventions |
OK |
|
Referral • Work as a network of facilities in HCPN following the policies for patient navigation and medical transport system including the IPC protocols during transfers of the HCPN and communicate these to all concerned staff |
|
|
ICT Technology • Adopt an information and communication technology system that allows sharing of information such as patient records across health facilities |
|
|
Logistics and Supplies • Implement the necessary logistic arrangements to ensure that they have the adequate essential supplies to ensure minimum health standards |
|
|
Patient-Related Interventions |
OK |
|
Telehealth and Telemedicine • Scheduling mechanism for consults through SMS/text message, phone call, or online platforms in order to limit patients inside the facility • Telemedicine providing medical advice or ambulatory care and consultation if feasible |
|
|
Safety measures for Patient and Visitors • Physical distancing of at least one (1) meter or 3-feet between individuals in all areas including waiting area and cafeterias at all times • Wearing of face mask by patients within the facility premises • Body temperature and symptoms screening for all individuals prior to entrance to the facility with proper advice for symptomatic persons • Provision of safety precautions for vulnerable populations such as the elderly, pregnant, children, persons with disability and persons deprived of liberty • Restriction of visitors for suspect, probable, or confirmed COVID-19 patients • Limiting companions and visitors for non-COVID-19 patients for outpatient care, emergency care and admission to private rooms and wards |
|
|
Health care worker-related Interventions |
OK |
|
IPC Team • Active Infection Prevention and Control Committee/Team or a Designated IPC Officer |
|
|
Mass gatherings • Strict adherence to the prescribed number of people permitted to hold mass gatherings and use of the required PPE - Maximum of 10 people under IATF-EID Moderate Risk Severity Grading - Maximum of 50 people under IATF-EID Low Risk Severity Grading • Utilization of online platforms and other technologies as an alternative to traditional face-to-face conferences, assemblies, lectures, and meetings |
|
|
Staff Monitoring • Setting up a system to monitor and report healthcare workers who take care of suspect/confirmed cases • Monitor temperature and respiratory symptoms before and after the tour of duty with appropriate protocols for managing symptomatic health workers in accordance with DC 2020-0106 (bit.ly/DC2020_0106): - For Low Risk Exposure - Self-monitoring of temperature and respiratory symptoms daily for 14 days after the last day of exposure to a COVID-19 patient. - For High Risk Exposure - Stop all health care interaction with patients for a period of 14 days after the last day of exposure to a COVID-19 patient; and - Quarantine for 14 days through home isolation of designated temporary treatment and monitoring facilities. - Testing of low and high risk healthcare workers shall be in accordance with DM 2020-0174 (bit.ly/DC2020_0174) • Conduct immediate case investigation and contact tracing when suspect, probable, or confirmed cases among health facility staff are reported. |
|
|
Policies and protocols related to: • Risk-based assessment and management of exposure, duty schedules, sick leaves, if there are any; • Reporting of symptoms and probable breaks in IPC protocols; • Exclusive use of clothing/uniform during the tour of duty within the health facility; • Laundry of used/dirty uniforms, and/or scrubs worn during duty by healthcare workers; and • Accommodation arrangement and transportation for healthcare workers. |
|
|
Training • Training and orientation of all health care workers on Infection Prevention and Control protocols and measures which include, but are not limited to, the following: - Triaging, early recognition of signs and symptoms, high-risk individual and source control of COVID-19 - Isolation Precautions - Respiratory Etiquette and Physical Distancing - Reporting procedure for COVID-19 surveillance as established by the healthcare facility - Physical layout and workflow map of important areas and zones in the health facility - Healthcare Worker Risk Assessment and Management in the Context of COVID-19 virus - Proper Hand Hygiene and 5 moments of Hand Hygiene - Proper donning and doffing of PPE - Environmental cleaning and disinfection of patient care areas, including training of the use of decontamination materials |
|
|
Mental Health • Provision of mental health services and psychosocial services |
|
|
Assignment of Health Care Workers • Assignment of dedicated healthcare workers to specific stations to limit and control movement of personnel around the facility premises. - Preferably, health care workers assigned to high-risk areas such as COVID-19 Wards, COVID-19 Emergency Department, ICU, Isolation Areas, etc. do not belong to the vulnerable population (i.e., elderly or with co-morbidities) - Ensure proper physical distancing of staff in common areas such as quarters and pantry - There must be a specifically-trained healthcare personnel to oversee the triage process in health facilities |
|
|
Educational Materials • Promotional and/or educational materials on the following are posted in appropriate places and within visible range in the health facility, which may include but are not limited to: - Proper handwashing; - Respiratory etiquette and social distancing; - Appropriate PPE per zone; and - Proper Donning and Doffing of PPE. |
|
|
Infrastructure and Maintenance-Related Interventions |
OK |
|
Hand Hygiene Facilities • Installation of hand washing facilities or sanitizing stations in strategic areas such as walkways, entrances and exits, information desks, waiting areas - 24/7 availability of soap and running water or alcohol-based sanitizers |
|
|
Physical Barriers • Installation of a non-porous barrier (e.g., acrylic sheets, polycarbonate sheets, clear corrugated sheets, or glass) between patients and health facility staff in administrative areas (i.e., Information desks, cashier, billing) |
|
|
Ventilation • Increase natural ventilation in all parts of the facilities • Use a dilution ventilation system for patient rooms and wards |
|
|
Signages and Visual Cues • Placement of signages, floor markers, or physical barriers to reinforce physical distancing, indicate zoning and direct pathways in the health facilities • Placement of visual cues remind correct use and procedure of PPE |
|
|
Emergency Room • Dedicated area to triage patients with respiratory symptoms that is separate from other clinical triage and evaluation area is provided • Separate entrance and exit for patients and healthcare workers • Unidirectional flow/foot traffic when moving from one area to another for suspect, probable, and confirmed COVID-19 patients and non-COVID-19 patients • Beds are placed at least 1 meter (3 feet) apart with partitions to ensure privacy • Dedicated medical equipment should be used when caring for patients with known or suspected COVID-19, if possible |
|
|
Wards • Proper zoning (sterile, buffer, and contaminated) in areas where suspect, probable and confirmed COVID-19 patients are cared for • Curtains between patients in shared areas • Improved natural ventilation or use of a dilution ventilation system for patient rooms and wards • Installation of a non-porous barrier (i.e., clear plastic or glass) between patients and health facility staff in administrative areas (i.e., Information desks, cashier, billing) |
|
|
Special Areas (ICU, Isolation Units) • Proper zoning (sterile, buffer, and contaminated) in areas where suspect, probable and confirmed COVID-19 patients are cared for • Preferably, negative pressure rooms (AJIR) for isolation areas and ICU |
|
|
Outpatient Department • Separate areas for the management of suspect, probable, and COVID-19 cases and non-COVID-19 patients • Arrangement of the waiting area such that physical distancing is maintained at 1 meter (3-feet) between patients • Improved natural ventilation or use of a dilution ventilation system for clinics • Placement of signages or floor markers to reinforce physical distancing and direct pathways in the health facilities. |
|
|
Operating Room • Designated OR theater for non-COVID 19 patients separate from suspected, probable and confirmed COVID-19 patients • Dedicated OR instruments, anesthesia machines, and other devices for non-COVID 19 patients only • A separate set of OR staff shall handle the non-COVID-19 cases • Ample supply of PPEs in storage and a reliable supply chain to ensure availability of all supplies needed for the planned procedures especially for high risk aerosol generating procedures. • Minimize the number of health personnel in the operating or procedure room to reduce exposure Ex. Anesthesiologist and nurse only during intubation and extubation in the OR theatre |
|
|
Environmental Controls Surfaces • High contact surfaces such as buttons, switches, handrails, etc shall be disinfected as least once every two hours using disinfectant solution or wipes. |
|
|
Areas • Areas of suspect, probable, and confirmed COVID-19 patients are cleaned and disinfected at least once a day, and after a patient is discharged using the following: - 70% ethyl alcohol to disinfect small surface areas and equipment between uses, such as reusable dedicated equipment - Sodium hypochlorite at 0.1% (1000 ppm) for disinfecting surfaces and 0.5% (5000 ppm) for disinfection of blood or bodily fluids spills (note: for surfaces or walls with blood or bodily fluids, allow the disinfectant to sit for 30 mins). • Proper and thorough disinfection and clean-up of all spills of blood or body fluids of the operating room and all devices after each procedure. • For other areas, routine cleaning may be performed with detergent or disinfectant solution or wipes at least once a day or when visibly dirty. |
|
|
Toilets • Toilets should be cleaned and disinfected at least twice a day or more frequently as the need arises. |
|
|
Non-Critical Items • For non-critical items, disinfection shall follow the standards of DM2020-0167 (https://bit.ly/3fbzrnb) |
|
|
Waste Management • Proper collection, storage, transfer, treatment, transport and disposal of infectious waste from healthcare facilities and COVID-19 treatment units based on DOH DM 2020-0170 (bit.ly/DM2020_0170) • Storage location to cater for large volumes, transport mechanism in decontaminated trucks and final disposal arrangements through autoclaves and other technologies is indicated in the DC No. 2020-0191 entitled "Circulation of the Health Care Waste Management Manual 4th Edition" (bit.ly/HCWMmanua14thed). |
|
III. Pharmaceutical Outlets in the New Normal Checklist
|
|
|
HCPN-Related Interventions |
OK |
|
Logistics and Supplies • Implement the necessary logistic arrangements to ensure that they have the adequate essential supplies to ensure minimum health standards. |
|
|
Patient-Related Interventions |
OK |
|
Telehealth and Telemedicine • Use of tele-pharmacy strategies (i.e., counselling) by a trained pharmacist to limit patient contact in the facility. • Limiting the number of customers in the pharmacy at any given time to prevent crowding at the pharmacy counter or checkout area |
|
|
Safety measures for Patient and Visitors • Physical distancing of at least one (1) meter or 3-feet between individuals in all areas including waiting area and cafeterias at all times • Wearing of face mask by patients within the facility premises • Body temperature and symptoms screening for all individuals prior to entrance to the facility with proper advice for symptomatic persons; • Provision of safety precautions for vulnerable populations such as the elderly, pregnant, children, persons with disability and persons deprived of liberty |
|
|
Health care worker-related Interventions |
OK |
|
IPC Officer • Active Infection Prevention and Control Committee/ Team or a Designated IPC Officer |
|
|
Training • Training and orientation of all health care workers about standard Infection Prevention and Control measures: - Early recognition of signs and symptoms, high-risk individual and source control of COVID-19 - Respiratory Etiquette and Physical Distancing - Reporting procedure for COVID-19 surveillance as established by the healthcare facility - Proper Hand Hygiene and 5 moments of Hand Hygiene - Environmental cleaning and disinfection of surfaces and areas. |
|
|
Policies • Assignment of healthcare workers to a dedicated station to limit and control movement around the facility • Strict adherence to the prescribed number of people permitted to hold mass gatherings and use of the required PPE • Conduct of online meetings instead of face-to-face meetings. |
|
|
Staff Monitoring • Setting up a system to monitor and report healthcare workers who take care of suspect/confirmed cases. • Detection and isolation at home or in designated community quarantine or isolation facilities of symptomatic staff • Conduct of immediate case investigation and contact tracing when suspect, probable, or confirmed cases among health facility staff are reported. |
|
|
Educational Materials • Promotional and/or educational materials on the following are posted in appropriate places - Proper handwashing; - Respiratory etiquette and physical distancing; and - Appropriate PPE. |
|
|
Infrastructure and Maintenance-Related Interventions |
OK |
|
Hand Hygiene Facilities • Installation of hand washing facilities or sanitizing stations in strategic areas such as walkways, entrances and exits, information desks, waiting areas - 24/7 availability of soap and running water or alcohol-based sanitizers |
|
|
Physical Barrier • Installation of a non-porous barrier (i.e., clear plastic or glass) between patients and health facility staff in administrative areas (i.e., Information desks, cashier, billing). |
|
|
Signages • Placement of signages or floor markers to reinforce physical distancing and direct pathways |
|
|
Patient Placement • Arrangement of waiting areas to ensure at least 1 meter (3-feet) distance between patients at all times |
|
|
Ventilation • Increase natural ventilation in all parts of the facilities • Use a dilution ventilation system for patient rooms and wards. |
|
|
Environmental Controls Surfaces • High contact surfaces such as buttons, switches, handrails, etc. shall be disinfected as least once every two hours using disinfectant solution or wipes. • Cleaning and disinfection of toilets at least twice a day or more frequently as the need arises. |
|
|
Waste Management • Proper collection, storage, transfer, treatment, transport and disposal of infectious waste from healthcare facilities and COVID-19 treatment units based on DM 2020-0170 (bit.ly/DM2020_0170) |
|
Omnibus Guidelines on the Implementation of Community Quarantine in the Philippines