Republic of the Philippines

Department of Health
-

OFFICE OF THE SECRETARY

February 4, 2020

DEPARTMENT MEMORANDUM
No. 2020 - 0062

TO: ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES;

MINISTER OF HEALTH — BANGSAMORO_ AUTONOMOUS
REGION IN MUSLIM MINDANAO (MOH-BARMM); CENTERS
FOR HEALTH DEVELOPMENT (CHD), BUREAU AND SERVICE
DIRECTORS; EXECUTIVE DIRECTORS OF SPECIALTY
HOSPITALS; CHIEFS OF MEDICAL CENTERS, HOSPITALS
AND SANITARIA; AND OTHERS CONCERNED

~Lip0\
SUBJECT: 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
(PUD for 2019 Novel Coronavirus (nCoV)

In response to the current or potential influx of Patients Under Investigation (PUT) 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).
ns 3. While transfer to AIIR or discharge from the facility is pending, put face mask on the
|9 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
23,2020 without high-efficiency particulate air (HEPA) filtration.
4. Follow CDC guidelines on placement of patient with known or suspected nCoV
AMENDED,
infection and adhere to standard, contact, and airborne precautions (ANNEX A).
7
on/by:

B. Standards of Airborne Infection Isolation Room (AIIR)

AIJIR must be
Postad

No,
Date.
1. 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.

Building 1, San Lazaro Compound, Rizal Avenue, Sta, Cruz, 1003 Manila e Trunk Line 651-7800 local 1113, 1108, 1135
Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http:/Avww.doh.gov.ph; e-mail: [email protected]
 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.

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

. 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
to
introducing other air spaces.
All healthcare personnel shall strictly adhere to hand hygiene following the World
Health Organization’s Multimodal Hand Hygiene Strategy: 5 Moments of Hand
Hygiene.
Place wall-mounted alcohol-based hand rubs at point of care and outside the isolation
room.
Medical supplies needed for patient care shall be made readily available at point of
care.
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.

Il. 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
“ftom
Tv
LILIBETH C. DAVID, MD, MPH, MPM, CESOI
Undersecretary of Health
Health Facilities Infrastructure and Development Team
 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/hep/infection-control.html)

Once in an Airborne Infection Isolation Room (AIIR), the patient’s facemask may be
removed. Transport and movement of the patient outside of the AIJR must be limited to
medically-essential purposes. When not in an AJIR (e.g. during transport), patients must
wear a facemask to contain secretions.
Personnel entering the room must use PPEs, including respiratory protection (i.e. fit-tested
disposable N95 mask).

. 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.

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

. 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.
. 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
to routine use.
it is returned

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

. 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

Hospital: Department of Health

ROOM DATA SHEET
250-Bed (Level 3) HEALTH FACILITY
DEVELOPMENT BUREAU
Updated Reference: Department: Room Title: Reference Sheet Number:
April 2016 NURSING WARDS ISOLATION ROOM {TYPICAL} 250B-NU-RDS-07A
FUNCTIONAL DESIGN REQUIREMENTS:
This activity space provides facilities needed EQUIPMENT AND
QUANTITY REMARKS
for the following activities: ACCESSORY CHECKLIST

a. Patient arrives on foot, in wheelchair or on a stretcher Television 1

trolley Waste bin w/ yellow lining 1 infectious

b. Transfer of patient to a hospital bed froma Waste bin w/ black lining 1 general
wheelchair or
a stretcher trolley and vice versa ater Heater 1

c. Patient undresses/dresses in the vicinity of iConsole, bedhead 1

hospital bed, with or without assistance

d. Patient takes meal in bed or in sitting area FURNITURE AND QUANTITY REMARKS

e. Patient receives visitors FIMTURE CHECKLIST

f. Patient stores clothing and other personal Hospital bed, adjustable; with 1

belongings adjustable side rails

8. Patient requires privacy Chair, upright; stacking 1

h. Patient uses toilet and bath Faotstcal 1

i. Patient uses monitoring/diagnostic equipment Bench, cushioned 1

j. Physictans and nurses check on patients Table, side; with cabinet 1

k, Handwashing and other clean activities

up Table, overbed 1

I. Nurse gives medication to patient Closet, wardrobe 1

m. Nurse may feed or wash patient, in the absence of Lavatory, wall-hung 1

a relative or watcher Concealed floor drain 1

Cabinet, PPE 1

Water closet 1

Lavatory 1

People Involved: Shower set 1

1x Patient
2x Visitors ADDITIONAL EQUIPMENT &
QUANTITY REMARKS
1x Resident Physician/ Medical Specialist ENGINEERING TERMINALS

4.x Nurse or Nursing Aide Window curtain rail 1

Bedhead light w/ night famp fluorescent, 20W

Outlet, 10A,2P,240V, duplex 7 Grounding type,
universal
Planning Relationships: Outlet, 10A,2P,240V, single 1 for emergency light
a. Acessible to Nurse Station Nurse call station, emergency a w/ pendant switch
b. Located at end portion of Nursing Ward Outlet, antenna/Cable 1

c. Close to medical/surgical services Smoke Detector 1

&
Hospital: Department of Health

250-Bed (Level 3)
ROOM DATA SHEET HEALTH FACILITY
DEVELOPMENT BUREAU
Updated Reference: Department: Room Title: Reference Sheet Number:
April 2016 NURSING WARDS ISOLATION ROOM (TYPICAL) 250B-NU-RDS-07B
TECHNICAL DESIGN DATA:

ENVIRONMENTAL CONDITIONS DESIGN DATA ENVIRONMENTAL CONDITIONS DESIGN DATA

fp
AIR LIGHTING AND VISUAL

Outdoor air temperature (°C) ave. local station temp. reading |General illumination (LUX) 250

50 oS

|
Room temperature coy 23 ight illumination (LUX)

|
Mechanical ventilation [Task illumination (LUX) 500

ee
“Volume (cumynr-person)
, :
25SS«MColorrenring essentiaDESIRABLE:unnecessary

Velocity (m./min.} 30 Standby light ESSENTIAL: desirable:unnecessary

Pressure Differential: ESSENTIAL:desirableunnecessary
Emergency light

Negative Pressure (Pa) 10 Daylight essential: DESIRABLE:unnecessary

"

Positive Pressure (Pa) p NA iew out

—_ “essential: DESIRABLE:unnecessary

Dust filtration

oo _ 6g 93%-99%@ 1 micron

|
Privacy desirable:unnecessary
'% ESSENTIAL:

Humidity (oun) Black. out

,
— “essential:desirable: UNNECESSARY

Cooling load (TR) 0.75

a
SOUND SAFETY

ag ||
po
Acceptable sound level (db} 40 tAccessible hot surface: NA

ee aee
Speech privacy
jak DESIRABLEunnecessary
Maximum NA —_
temperature (°C)

OO
ns
Quality which cannot be tonal Impact Domestic hot water: at lavatory
" ,
‘tolerated Maximum tc)
~
temperature
" .
medical staff, relatives/watcher
access limit
a __.._Patient_
Fire risk

Other risks
3
Hospital: Department of Health

a
ROOM DATA SHEET
250-Bed (Level 3) HEALTH FACILITY
DEVELOPMENT BUREAU
Updated Reference: Department: Room Title: Reference Sheet Number:
ISOLATION ROOM
April 2016 250B-NU-RDS-07C
=
NURSING WARDS
{TYPICALL

rs
TECHNICAL DESIGN DATA: LAYOUT OF ROOM AND SPACE COMPONENTS:

oo
DIRECT SERVICES DESIGN DATA

Disposal hospital solid waste type: A&G 6000

a
‘

—_
Hot Water required at shower 3700 2300 1

i
|
lav
|
Cald Water & toilet fixtures

ne |
req'd
1 epeeomeee
at
~

(Ee\
j
Ph
Drainage req'd at lay, toilet fixt. & floor i UB
4 i
—
|
1

3!
\

lf

eS
301
! 3

_
a
wo
sg! ke |

oy
Medical Vacuum 40 ipm @ 450mm Hg ~ 4 psaorry} Se
fo
Compressed Air

steam
NA

NA
i

I
71 ;
f
i /
{

Others suction outlet required

DIRECT DEMANDS ON FLOOR AND WALL

Loading NA

a
Spillage SUGHT-occasional:frequent
Foot Traffic
wo light: MEDIUM: heavy
KEY SCALE 1:100 M

sore
Re
1
Hospital bed, adjustable; with 8 Console, bedhead: for nurse calt
Wheel Traffic light: MEDIUM:heavy adjustable side rails medica! gas outlets, power
Tren nonn Chair, upright; stacking outlets, lamp, etc.

7
Impacts
wn
NA
Footstool 9 Waste bin, infectious
.
Bench, cushioned 40 Waste bin, general
Abrasion NA
Table, side; with cabinet
NOE

Easy Maintenance ESSENTIAL:desirable:unnecessary Table, overbed ANTE ROOM:

Closet, wardrobe 44. Lavatory, wall-hung
Vibration Free ESSENTIAL:desirable:unnecessary 12 Concealed floor drain
13 Cabinet, PPE
Door Set bed, wheelchair, &

stretcher trolley access ISPACE DEMANDS (Total Minimum Space Required in sq.m.) :

Windows clear, solar control, Space Components Minimum Space Required/Component (sq.m.}

privacy control

internal Glazing, none

REGULATIONS AND NOTES:

 ANNEX C

PROPOSED FLOOR PLAN FOR CONVERTED PRIVATE ROOM

3000.00
KEY:
I. HOSPITAL BED, ADJUSTABLE; WITH
ADJUSTABLE SIDE RAILS
CHAIR, UPRIGHT; STACKING
UN
FOOTSTOOL
BENCH, CUSHIONED
OTP
TABLE, SIDE; WITH CABINET
3500.00.
TABLE, OVERBED
ON
CLOSET, WARDROBE
CONSOLE, BEDHEAD; FOR NURSE CALL,
MEDICAL GAS OUTLETS, POWER OUTLETS,
6000.00 LAMP, ETC.
9. WASTE BIN; INFECTIOUS
10. WASTE BIN; GENERAL
PROVIDE: <
ADDITIONAL
DOOR & WALL ANTE ROOM:
Ih. LAVATORY; WALL-HUNG
2500.00

I2. CONCEALED FLOOR DRAIN

IS. CABINET; PPE

> PROVIDE:
WASH SINK 8 PPE CABINET

1400.00, 1600.00

CONVERTED PRIVATE ROOM

 ANNEX D

ADDITIONAL REFERENCE MATERIALS ON ISOLATION ROOMS

. 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”

. 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”

. Total Alliance Health Partners International (TAHPD), “International Health Facility

Guidelines”

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

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