Office of The Secretary: Temporary Treatment
Office of The Secretary: Temporary Treatment
Office of The Secretary: Temporary Treatment
Department of Health
OFFICE OF THE SECRETARY
__
April 2, 2020
DEPARTMENT MEMORANDUM
No. 2020 - DIRS
I. BACKGROUND
Il. OBJECTIVE
This issuance shall provide guidance to nurses who shall manage suspect,
probable, and confirmed cases of COVID-19 in temporary treatment and monitoring
facilities.
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 e URL: http://www.doh.gov.ph; e-mail: [email protected]
III. SCOPE AND COVERAGE
These guidelines shall cover all temporary treatment and monitoring facilities for
suspect, probable, and confirmed cases of COVID-19 with mild signs and symptoms
following the interim guidelines set by Department Memorandum No. 2020-0123
(Annex A).
B. Infection prevention and control protocols must strictly implemented in the nursing
be
care of patients at all times. Confirmed COVID-19 cases may be cohorted in shared
spaces or rooms while suspect or probable cases shall be placed in a single-occupancy
room orin separated/enclosed spaces.
C. There shall be dedicated nurses for the care of confirmed COVID-19 patients with
mild signs and symptoms. A different set of nurses shall be assigned to provide care
for suspect or probable cases to prevent cross-contamination.
V. SPECIFIC GUIDELINES
A. Workflow Arrangement
5. Moving and transporting patients out of their room or area must be avoided
unless medically necessary. Patients shall be required to wear masks.
6. Visitors shall not be allowed to enter the temporary treatment and monitoring
facilities at any time. The facilities shall be limited only to the healthcare
providers and patients.
7. Single-use or disposable, and dedicated equipment such as stethoscopes, blood
pressure cuffs and thermometers must be used for each patient especially for
suspect or probable cases. If equipment needs to be shared among patients, proper
disinfection must be done between use for each individual patient.
8. Reusable medical devices and equipment shall be disinfected in accordance with
safe routine procedures.
9. All wastes generated from care of suspect, probable, and confirmed COVID-19
patients shall be considered as infectious medical wastes and disposed of
properly.
10. Environmental cleaning and disinfection procedures shall be followed correctly
and consistently.
ay
SEQUENCE FOR PUTTIN
PERSONAL PROTECTIVE Se (PPE)
The
type used will vary based
of PPE the
level of precautions required, such as standard and contact, droplet or
on
1. GOWN
e Fully cover torso from neck to knees, arms
to end of wrists, and wrap around the back
e Fasten in back of neck and waist
2. MASK OR RESPIRATOR
Secure ties
or elastic bands at middle
of head and neck
Fit flexible band to nose bridge
Fit snug to face and below chin
Fit-check respirator
4. GLOVES
e Extend to cover wrist of isolation gown
©8250872-E
HO WTO SAFELY REIM(
LAD Cc
PERSONAL PROTECTIVE EQUIPMENT (PPE)
rLoe t
3. GOWN
¢ Gown front and sleeves are contaminated!
¢ Ifyour hands get contaminated during gown removal, immediately
wash your hands or
use an alcohol-based hand sanitizer
¢ Unfasten gown ties, taking care that sleeves don’t contact your body
when reaching for ties
¢ Pull gown away from neck and shoulders, touching inside of gown only
¢ Turn gown inside out
¢ Fold or roll into a bundle and discard in a waste container
4. MASK OR RESPIRATOR
Front of mask/respirator is contaminated — DO NOT TOUCH!
e
t
¢ Ifyour hands get contaminated during mask/respirator removal,
immediately wash your hands or use an alcohol-based hand sanitizer
¢ Grasp bottom ties or elastics of the mask/respirator, then the ones
the top, and remove without touching the front
at :
:
}
¢ Discard in a waste container
¢ Grasp the gown in the front and pull away from your body so
that the ties break, touching outside of gown only with gloved
hands
¢ While removing the gown, fold or roll the gown inside-out into
a bundle
° As you are removing the gown, peel off your gloves at the
same time, only touching the inside of the gloves and gown
with your bare hands. Place the gown and gloves into a waste
container
3. MASK OR RESPIRATOR
* Front of mask/respirator is contaminated — DO NOT TOUCH!
t s
* Ifyour hands get contaminated during mask/respirator removal,
immediately wash your hands or use an alcohol-based hand sanitizer
¢ Grasp bottom ties or elastics of the mask/respirator, then the ones at
the top, and remove without touching the front
i
‘
)
¢ Discard in a waste container
Current evidence suggests that the virus that causes COVID-19 is transmitted between people through close contact and droplets.
People most at
risk of acquiring the disease are those who are in contact with or care for patients with COVID-19. This inevitably
places health care workers (HCWs) at
high risk of infection. Protecting HCWs is of paramount importance to WHO. Understanding
how HCW exposure to COVID 19 virus translates into risk of infection is critical for informing infection prevention and control
(IPC) recommendations. This data collection form and risk assessment tool can be used to identify IPC breaches and define policies
that will mitigate HCW exposure and nosocomial infection.
This tool is for health care facilities with COVID 19 patients. The form should be completed for all HCWs who have been exposed
to a patient with confirmed COVID-19. This tool aids in the risk assessment for HCWs after exposure and provides
recommendations for
their management.
¢ To determine the risk categorization of each HCW after exposure to a COVID-19 patient (see below Part 1: COVID-19
virus exposure risk assessment form for HCWs):
¢ To inform the management of
the exposed HCWs based risk (see below Part 2: Management of health worker exposed
on
to COVID-19 virus).
Facilities using these forms are encouraged to share deidentified data with WHO
WHO should not include any personably
to
guidance related to IPC. Data shared with
identifiable information (Questions 2A, 2B and 2G).
1. Interviewer information
A.Interviewer name:
B. Interview date (DD/MM/YYYY): inal
C. Interviewer phone number:
D. Does the HCW have
a
historyof staying in the same
household or classroom environment with a confirmed
oYes No
COVID-19 patient?
E. Does the HCW have history of traveling together in oYes oNo
close proximity (within 1 meter) with a confirmed COVID-
19 patient in any kind of conveyance?
Yes, to questions D —
management recommendations
1 IE
is in
considered community exposure to COVID-19. HCWs should be managed as
such. The
Part 2: Management of health workers exposed to COVID-19 virus apply only to exposure in
health care settings.
Risk assessment and management of exposure of health care workers in the context of COVID-19: Interim guidance
A. Last nam
B. First name:
C. Age
E. City:
F. Country:
a Pharmacist
a Pharmacy technician or dispenser
a Laboratory personnel
co Admission/reception clerk
a Patient transporter
a Catering staff
a Cleaner
1 Other (specify):
a Medical unit
a Intensive care unit
0 Cleaning services
a Laboratory
a Pharmacy
J.
co Other, specify:
|
A.Date of health worker first exposure
COVID-19 patient:
to confirmed Date (DDIMMYYYYY):
G Not known
—
“4HCW astivilies performed on COVID-19 patientin health carefaciiy
A. Did you provide direct care to a confirmed COVID-19 patient? aYes oNo a Unknown
B. Did youhave face-to-face contact (within 1 metre) with a confirmed aYes No oUnknown
COVID-19 patient in a health care facility?
C. Were you present when
any
aerosol-generating procedures were aYes oNo oUnknown
performed on the patient? See below for examples
- If yes, what type of procedure? 0 Tracheal intubation
o Nebulizer treatment
0 Open airway suctioning
a Collection of sputum
a Tracheotomy
co Bronchoscopy
cu Cardiopulmonary resuscitation (CPR)
1 Other (specify):
D. Did you have direct contact with the environment where the confirmed aYes oNo a Unknown
COVID-19 patient was cared for?
E.g. bed, linen, medical equipment, bathroom etc
‘Always, as recommended’ means more than 95% of the time; ‘Most of the time’ means 50% or more but not 100%; ‘occasionally’ means
20% to under 50% and ‘Rarely’ means less than 20%.
A. During a health care interaction with a COVID-19 patient, did you wear o Yes aNo
personal protective equipment (PPE)?
- If
yes, for each item of PPE below, indicate how often you used it:
- 1. Single-use gloves a Always, as recommended
1 Most ofthe time
a Occasionally
o Rarely
2. Medical mask a Always, as recommended
0 Most of the time
a Occasionally
uo Rarely
B. Duringa health care interaction with the COVID-19 patient, did you c Always, as recommended
remove and replace your PPE according to protocol (e.g. when medical a Most of the time
mask became wet, disposed the wet PPE in
the waste bin, performed hand a Occasionally
hygiene, etc.)? a Rarely
C. During a health care interaction with the COVID-19 patient, did you 0 Always, as recommended
perform hand hygiene before and after touching the COVID-19 patient © Most of the time
D. During a health care interaction with the COVID-19 patient, did you ou Always, as recommended
perform hand hygiene before and after any clean or aseptic procedure was a Most of the time
performed (e.g. while inserting a peripheral vascular catheter, urinary a Occasionally
catheter, intubation, etc.)? a Rarely
E. During a health care interaction with the COVID-19 patient, did you a Always, as recommended
perform hand hygiene after exposure to body fluid? Most of the time
a Occasionally
o Rarely
F. During a health care interaction with the COVID-19 patient, did you ca Always, as recommended
perform hand hygiene after touching the patient's surroundings (bed, door c Most of
the time
handle, etc.), regardless of whether you were wearing gloves? a Occasionally
a Rarely
G. During a health care interaction with the COVID-19 patient, were high- o Always, as recommended
touch surfaces decontaminated frequently (at
least three times daily)? a Most of the time
a Occasionally
a Rarely
6. Adherence toIPC measures when performing aerosol-generating procedures (e.g. tracheal intubati Debus! Heainet 900.”
airway suctioning, collection of sputum, tracheotomy, bronchoscopy, cardiopulmonary resuscitation (CPR), etc.).
i
a
For the following questions, please quantify the frequency with which you wore PPE, as recommended:
‘Always, as recommended’ means more than 95% of the time; ‘Most of the time’ means 50% or more but not 100%; ‘occasionally’ means
20% to under 50% and ‘Rarely’ means less than 20%.
A. During aerosol-generating procedures on a COVID-19 patient, did you a Yes aNo
wear personal protective equipment (PPE)?
- If yes, for each item of PPE below, indicate how often you used it:
1. Single-use gloves 0 Always, as recommended
a Most of the time
a Occasionally
ci Rarely
- 2,NQ5 mask (or equivalent respirator) c Always, as recommended
a Most of the time
0 Occasionally
o Rarely
- 3. Face shield or goggles/protective glasses ca Always, as recommended
a Occasionally
o Rarely
=
Risk assessment and management of exposure of health care workers in the context of COVID-19: Interim guidance
B. During aerosol-generating procedures on the COVID-19 patient, did you a Always, as recommended
remove and replace your PPE according to protocol (e.g. when medical 0 Most of
the time
mask became wet, disposed the wet PPE in
the waste bin, performed hand a Occasionally
hygiene, etc.)? a Rarely
C. During aerosol-generating procedures on the COVID-19 patient, did you a Always, as recommended
perform hand hygiene before and after touching the COVID-19 patient, a Most of the time
regardless of whether you were wearing gloves? a Occasionally
a Rarely
D. During aerosol-generating procedures on the COVID-19 patient, did you o Always, as recommended
perform hand hygiene before and after any clean or aseptic procedure was o Most of the time
performed? a Occasionally
o Rarely
E. During aerosol-generating procedures on the COVID-19 patient, did you c Always, as recommended
perform hand hygiene after touching the patient's surroundings (bed, door 0 Most of the time
handle, etc), regardless of whether you were wearing gloves? a Occasionally
o Rarely
The HCW
did not respond ‘Always, as recommended’ to Questions:
e S5A1-—5G, 6A—6F
e Or responded ‘Yes’ to 7A.
—
Part 1: Management of HCWs exposed to COVID-19 virus
The management of HCWs exposed to COVID-19 varies according
to the risk categorization, as above.
¢ Provide review of IPC training for the health care facility staff, including HCWs
quarantine period.
athigh risk for infection after 14-day
e
exposure to body fluid, after touching a patient, and after touching
Practice respiratory etiquette at all times. a
patient’s surroundings;*
References
1. WHO Considerations for quarantine of individuals in the context of containment
for coronavirus disease (COVID-19): Interim
guidance 28 February 2020 (https://Avww.who.in/publications-detail/considerations-for-quarantine-of-individuals-in-the-context-
of-containment-for-coronavirus: se-(covid-19).
2. WHO Infection prevention and contro! during health care when novel coronavirus (nCoV) infection is suspected: Interim
guidance 25 January 2020 (https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-
novel-coronavirus-(ncov)-infection-is-suspected-20200125).
3. WHO Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected: Interim
guidance 25 January 2020 (https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-
novel-coronavirus-(ncoy)-infection-is-suspected-20200125).
4. WHO guidelines on hand hygiene
in health care: first global patient safety challenge — clean care is safer care. Geneva: World
Health Organization; 2009 (https://apps.who. inviris/handle/10665/44102).
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.
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