Republic of the Philippines

Department of
Health
OFFICE OF THE SECRETARY

June 10, 2020

DEPARTMENT MEMORANDUM
No. 2020-_0270

TO: ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES;

MINISTER OF HEALTH-BANGSAMORO _AUTONOMOUS
REGION IN MUSLIM MINDANAO; DIRECTORS OF CENTER
FOR HEALTH DEVELOPMENT (CHD), BUREAUS AND
SERVICES; PRESIDENT OF THE PHILIPPINE HEALTH
INSURANCE CORPORATION AND OTHERS CONCERNED

SUBJECT: Guidelines in the Certification of LIGTAS COVID Community

Isolation Units

I. BACKGROUND

The Department of Health (DOH) with the Department of Interior and Local
Government (DILG) issued Joint Administrative Order (JAO) No. 2020-0001, titled
“Guidelines on LIGTAS COVID and the Community Based Management of Mild COVID-
19 Cases” in order to guide Local Government Units (LGUs), their instrumentalities and
constituent households and individuals in the prevention of transmission and management of
contact, suspect, probable, and confirmed cases of COVID-19 at the family and community
level.

In particular, the JAO seeks to guide the LGUs in planning, establishing, and
maintaining designated isolation or quarantine units in their localities for contacts, suspect,
probable and confirmed cases of COVID-19. Hence, the establishment of Local Isolation and
General Treatment Areas for COVID-19 cases (LIGTAS COVID Center, and Mega LIGTAS
COVID Center), as Community Isolation Unit (CIU), for those COVID-19 cases whose
conditions cannot support home quarantine.

Specific requirements for LIGTAS COVID Centers stipulated in the DILG-DOH

JAO No. 2020-0001 shall be the basis for the DOH’s certification. Some Centers for Health
Development (CHD), identified in the aforementioned DILG-DOH JAO, the certifying as
body for LIGTAS COVID centers have developed their own Assessment Tool certifying in
such facilities. Variations in the requirements have been noted in the formulated assessment
tools. Likewise, assessors come from different offices or units of CHDs assigned by the as
concerned Regional Director, from Development Management Officers (DMOs) or Provincial
Health Officers (PHOs) or personnel from Regulation, Licensing and Enforcement Division
(RLEDs), or personnel of RLEDs and/or Health Facility Development Unit (HFDU).

Thus, to standardize and clarify the requirements, the following guidelines are being
issued for harmonious implementation.
local 1108, 1111, 1112, 1113
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila Trunk Line 651-7800
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Direct Line: 711-9502; 711-9503 Fax: 743-1829 ¢ URL: http://www.doh.gov.ph; e-mail: [email protected]
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I. SCOPE

This shall apply to CIUs specifically to LIGTAS COVID Centers managed

by LGUs.

Tif. GENERAL GUIDELINES

A. LIGTAS COVID Centers certified prior to this issuance shall be honored and
shall maintain its status as DOH certified LIGTAS COVID Centers. However,
the certified LIGTAS COVID Centers shall submit a Memorandum of
Undertaking (MOU) that it shall comply with any deficiency/ies based on the
checklist, if any.

The CHD, in charge of evaluating and certifying the LIGTAS COVID Centers,
shall prioritize those that are already in operation, or is already attending to
contact, suspect, probable and confirmed cases of COVID-19.

The CHD may develop their own checklist for certifying LIGTAS COVID
Centers, based on the DILG-DOH JAO No. 2020-0001 and the requirements in
this circular.

The Regional Director or in his/her absence or unavailability, or when delegated,

the Assistant Regional Director, shall approve the issuance of the certificate of
LIGTAS COVID Center.

IV. SPECIFIC GUIDELINES

A. Standards

LIGTAS COVID Center shall be organized to provide safe, quality, effective and
efficient services as to:

1. Physical Piant - space, location and infrastructure (see Annex A)

2. Human Resources (see Annex B)
3. Equipment, Supplies and Essential Medicines (see Annex C)

Infection Prevention and Control (IPC)

1. Practice of Infection Prevention and Control shall be based on Annex Al to

AS of DOH- Department Memorandum (DM) No. 2020-0072 (“Interim
Guidelines for 2019 Novel Coronavirus Acute Respiratory Disease (2019-
nCOV ARD) Response in Hospitals and Other Health Facilities”), in addition
to Annex J of the DILG-DOH JAO.

2. For cleaning and disinfection please refer to 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
Page 2 of 4
 COVID-19 Pandemic”), DOH-DM No. 2020-057 (“Interim guidelines for
2019 Novel Coronavirus Acute Respiratory Disease (2019-nCov ARD)
Response in Hotels and Other Similar Establishments”); and DOH-DM No.
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”).

3. It shall be the responsibility of the Sanitation Officer to supervise the

cleaning and disinfection activities including proper waste management
especially of infectious materials and health care waste. It shall be the
responsibility of the patients to clean and disinfect immediate surroundings of
their beds and the common areas they have used. Moreover, it is the
responsibility of the Sanitation Officer to orient the staff on the IPC and
disinfection guidelines.

The Sanitation Officer shall be responsible in developing its own Information

Education and Communication (IEC) materials for this purpose, taking note
of IPC strategies.

C. Health Care Waste Management (HCWM)

The LIGTAS COVID center shall develop its own policies, guidelines and
protocols on handling, collection, segregation and disposal of wastes in
conformity with the latest edition of the Health Care Waste Management
Manual of the Department of Health and DOH-DM 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 Coronavirus Disease 2019 (COVID-19,” for health care
wastes generated in a facility with case/s of COVID-19.

D. Referral and Transport of Patients and Specimens

Only ambulances duly licensed by the DOH, based on Administrative

Order (AO) No. 2018-0001, “Revised Rules and Regulations Governing the
Licensure of Land Ambulances and Ambulance Service Providers,” shall be
used in the conduction of patients to referral hospitals.

Other service vehicles may be used in the transport of specimens but the
correct protocols for handling/transport and storage of specimens shall be strictly
observed.

E. Reporting

Accurate and timely reporting shall be implemented by

the facility using the
COVID-19 information system prescribed by the DOH.

Page 3 of 4
ra

Vv. PROCEDURAL GUIDELINES

A. The implementation of the certification procedure and issuance of the

certificate
shall follow the guidelines set by the respective CHDs in accordance to their
rules.

B. The Team to conduct the assessment shall be assigned by the CHD’s Regional
Director.

C. The validity of the Certificate of LIGTAS COVID Center shall be one year.

D. Representative from the CHDs, as delegated by the Regional Directors may

conduct unannounced visits to ensure continuous compliance to the requirements.
Guidelines for the monitoring of the LIGTAS COVID Centers shall be developed
by respective CHDs.

VI. COMPLAINTS

Complaints against any personnel or the condition of the LIGTAS COVID

Centers shall be filed and resolved by concerned CHDs.

Vil. APPEAL

Any LIGTAS COVID Center aggrieved by the decision of the CHD Regional
Directors, may file an appeal to the Field Implementation Coordination Team
(FICT). All pertinent documents and records of the applicant shall then be elevated
by the CHD to the head of the FICT. The decision of the head of the FICT, if still
contested, maybe brought on a final appeal to the Secretary of Health whose decision
shall be absolute and executory.

VI. EFFECTIVITY

This Circular shall take effect immediately.

For strict compliance.

1SCO7£. DUQUE III, MD, MSc

_Secfetary of Health

Page 4 of 4
 D.M. No. 2020-
Annex A
Annex A. SPACE, LOCATION AND INFRASTRUCTURE
Requirement Remarks
A. Be accessible within a maximum of two (2) hours travel to
a higher level facility. If cannot be managed
coordination and referral with
in
that facility,
appropriate transport
proper
to a more capable health facility shall be provided.

B. Have uninterrupted access to electricity, potable water

source, and sewerage system.

_—
C. Must be fully enclosed with adequate lighting.

D. There should be at least fan ventilation to be provided. For

facilities handling confirmed cases of COVID-19,
establishing an Airborne Infection Isolation Room (AIIR)
based on the guidelines in DOH- DM No. 2020-0062 is
recommended.

E. There should be a separate entrance and exit for the patients

and healthcare workers.
F. A unidirectional user flow circulation/foot traffic shall be
established for healthcare workers from one zone to
another.

G. The facility should be divided into three (3) zones namely:

a) Contaminated Zone: serve as the area where patients

area is admitted / contained.
b) Buffer Zone: serves as an area for donning and doffing
of Personal Protective Equipment (PPE),
decontamination, and hand hygiene.
c) Clean / Sterile Zone: serves as holding area and
entrance for healthcare workers.

H. Thefacility shall follow the prescribed patient placement in

accordance with DOH- DM No. 2020-0123 “Interim
Guidelines on the Management
the Conversion of Public Spaces
of
to
Surge Capacity through
Operate as Temporary
Treatment and Monitoring Facilities for the Management
of Persons Under Investigation and Mild Cases of
Coronavirus Disease 2019 (COVID-19).”

IL In compliance with Infection Prevention and Control (IPC)

protocols, contact, suspect/probable cases shall be in
individual enclosed rooms with individual toilet and bath.
In cases where this arrangement is not feasible (e.g.
existing facility to be converted as LIGTAS COVID
Center), the toilet and shower facilities must be disinfected
after every use.
 D.M. No. 2020-
Annex A
Annex A. SPACE, LOCATION AND INFRASTRUCTURE

J. Confirmed cases may be cohorted together and be placed in

a shared room, provided that the required clearances and
partitions for privacy and IPC are followed.

1. Beds shall be spaced at least two (2) meters apart.

2. Temporary partitions to ensure patient privacy
preferably with an opaque impermeable sheet or divider
(e.g. tarpaulin, shower curtain, etc.) between them. This
partition shall maintain have a minimum height of two
(2) meters.

Confirmed cases of COVID-19 may share toilets and

showers, provided that the toilet and shower facilities must
be disinfected after every use.

Proper signage identifying the premises as a “LIGTAS

COVID Center. ” The rooms shall be properly labelled
and directional signages shall be placed in strategic
locations.

. A backup supply of electricity and free-flowing water for at

least seventy two (72) hours must be ensured, in case of
water and power interruption.

N. The provision of fixed or temporary plumbing fixture per

person must follow the following ratio requirements:
‘Fixture to
Plumbing... | Fixture ‘to “Male .

‘Female Patient
Fixture | : Patient Ratio. Ratio
Water Closet 1:25 1:20
1:10-50,
add 1 for each Not applicable
Urinal
additional 50 male
patients
Lavatory 1:10 1:10
Shower 1:8 1:8

0. Shared toilets and baths shall be cleaned and disinfected by

staff wearing the appropriate PPEs at
least two times a day.
Patients using shared toilets and baths shall be trained and
assisted in cleaning and disinfection immediately after each
use. Ensure that all toilets and baths, either dedicated or
shared, are well-ventilated with natural or mechanical or
hybrid ventilation.
P. There may be
provision or access to laundry services.
A fully enclosed nurse station, which permits visual
observation and access to the patient wards/rooms, is
recommended.
 D.M. No. 2020-
Annex B. PERSONNEL / HUMAN RESOURCE Annex B

Requirement Remarks
A. FACILITY MANAGER
1. Background on medical and health allied field not
required.
2. For functions, please refer to DOH-DILG JAO No.
2020-0001, Guidelines on Local Isolation and General
Treatment Areas for COVID-19 cases (LIGTAS COVID)
and the Community-based management of Mild COVID-
19 Cases.

B. FACILITY PHYSICIAN
1, The physical presence of the physician shall depend on
the classification of the patient he/she handles. The
number of physician must follow the following ratio
requirements:
:
|
Ratio of
Classification * bine to
]

Required Duty Physician

«ad

of Patients Patient
Conduct daily rounds and
on-call or accessible
Contact through telehealth after 1:50
performing his/her duties
in the facility

Conduct daily rounds and

on-call or accessible
1:35
,.

Probable! through telehealth after

P
performing his/her duties
in the facility

Conduct daily rounds and

Confirmed physically present at all 1:20
times.
*For addditional functions, please refer to DOH-DILG JAO No. 2020-0001.

C. NURSE AND NURSING AIDE

1. There should always be a registered nurse (RN) per shift

who shall provide the patient care and another staff (e.g.
an under board nurse
nursing aide) who
or
shall
a registered midwife to serve as
assist the nurse on duty.

2. Only 8-hour per shift shall be allowed as per Republic

Act (RA) 5901 (“‘An Act of Prescribing Forty (40) hours
a week of Labor for Government and Private Hospitals
or Clinic Personnel).
 D.M. No. 2020-
Annex B. PERSONNEL / HUMAN RESOURCE Annex B

3, The number of RN/s and nursing aide/s must follow the

following ratio requirements:

“2,

Contact
Classification,
of Patients
-
Ratio of Nurse
to Patient. | Ratio of
ursing
to Patient
. Ade

1:50 1:50
(level of care is minimal)

Suspect/Probable 1:35 1:35

Confirmed 1:12 1:24

4.
shall have a valid
in
Atleast one of the RNs assigned the “Confirmed” areas
Advanced Cardiac Life Support
(ACLS) training per shift.

D. SECURITY AND MAINTENANCE OFFICER

1. There shall be at least two (2) Security Officers per shift,
one (1) assigned in each entrance and exit.

2. There shall be at least one (1) Maintenance Officer per

shift per area.

E. SANITATION OFFICER

1. There shall be at least one (1) Sanitation Officer.

2. For the functions, please refer to DOH-DILG JAO No.

2020-0001, “Guidelines on Local Isolation and General
Treatment Areas for COVID-19 cases (LIGTAS COVID)
and the Community-based management of Mild COVID-
19 Cases”

F. BARANGAY HEALTH WORKER (BHW)

COMMUNITY HEALTH VOLUNTEER
1. In the LIGTAS COVID Centers, BHWs shall only be
allowed to peform clerical work, and not direct patient
care. It is recommended that they be utilized more in
contact tracing and monitoring of those who are under
home quarantine.

G. NUTRITIONIST / DIETICIAN AND FOOD HANDLERS

1. There should be one (1) Nutritionist/Dietician but

LIGTAS COVID Centers may outsouce their
engagement. Other personnel may be employed.
 D.M. No. 2020-
Annex B. PERSONNEL / HUMAN RESOURCE Annex B

H. DATA MANAGER

1. There shall be at least one (1) Data Manager.

2. For the functions, please refer to DOH-DILG JAO No.

2020-0001, ”Guidelines on Local Isolation and General
Treatment Areas for COVID-19 cases (LIGTAS COVID)
and the Community-based management of Mild COVID-
19 Cases”.

I. PHARMACIST (OPTIONAL)

1. The pharmacy shall also be licensed by the Food and

Drug Administration (FDA).

2. Ifthe facility has a pharmacy, at least one (1) pharmacist

per shift.

J. At least one (1) personnel in charge of the activites for the

Mental Health and Psychosocial Support (MHPSS) on an
on-call basis (e.g. Medical Social Worker,Psychologist)

K. Alt personnel should have training in Infection Prevention

and Control (IPC) and shall wear an appropriate PPE based
on their functions (may be an in-house training).

L. All staff involved in patient care shall have a training in

Basic Life Support (BLS).
 D.M. No. 2020-
Annex C

Annex C. MEDICINES,MEDICAL SUPPLIES, EQUIPMENT AND INSTRUMENTS

The requirement for medicines, medical supplies, instruments and equipment are detailed as
follows:

REQUIREMENTS REMARKS
I. EMERGENCY CART
A. EQUIPMENT
1, Defibrillator (manual or AED)
2. Electrocardiograph (ECG)
3. Patient Monitor/Cardiac Monitor

/
4. Suction Machine
B. INSTRUMENTS SUPPLIES
1. Intubation Kit (Laryngoscope with Blade 1,2,3 with
stylet)
2. Bag-valve mask (adult)
3. Cardiac Board (adult)
4. Electrodes (Adult)
5. Electrode Cream/ Lubricant
6. Oxygen Tank with gauge and humidifier with at least
1000 PSI
7. Sharps Container
8. Endotracheal Tubes of varying sizes (adult)
9. Nebulizer
10. Face shield
11. Splash Apron
12. Goggles
13. Sterile Gloves
14. Clean/examination gloves
15. IV Cannula (ail gauge size)
16. IV Tubing
17, Nasal Cannula (Adult)
18. N95 mask/Surgical Mask (for personnel)
19. IV Film/Transparent Dressing
20. Micropore/ ET Mounting Tape
21. Suction Catheter/tubing F12
C. MEDICINES
1.Epinephrine ampule
2.Amiodarone HCL
3. Atropine
D. IV FLUIDS
1. PLRS iL
2. PNSS 1L
3._ DSLR AL
 DM. No. 2020-
Annex C

Annex C. MEDICINES,MEDICAL SUPPLIES, EQUIPMENT AND INSTRUMENTS

II. FLOOR STOCKS

A. EQUIPMENT / INSTRUMENTS
1. Nebulizer
2. Pulse Oximeter
3. Sphygmomanometer ( non-mercurial)
4. Stethoscope
5. Thermometer (non-mercurial and non-contact)
B. MEDICINES
dy
Ipratropium + Salbutamol 500 mcg + 2.5 mg x 2.5 ml
Paracetamol 250mg/5ml syrup
Rw
Paracetamol 300 mg/ampule
Paracetamol 500mg tablet
MP Butamirate Citrate 50 mg tablet
AUN
Lagundi 300 mg or 600 mg tablets or
Lagundi 300mg/Sml, 60 ml syrup
SP}
Salbutamo! Img/ml 2.5 ml nebule
$2]
Hydrocortisone 100 mg, 200 mg, 500 mg powder vial
10. Antidiarrheal Medications
11. Loperamide 2mg capsule
12. Oral Dehydration Saits
13. Clonidine 75 mcg/tablet
14. Clonidine 150 mcg/ml, 1 ml ampule
15. Sterile water for (IV medicine preparation)
C. SUPPLIES
Nebulizing kits
Sys
Oxygen Cannula
Intravenous Set (IV cannula, macroset/microset)
Volumetric Set/ Soluset
Sterile needles (various gauges)
AMS

. Syringes (lcc, 3cc, 5cc, 10cc and 30cc)

D. OTHER SUPPLIES
1. linens, pillows and cases
Bed

2. Cotton balls
3. Color-coded solid waste disposal bins and plastic
bags
Disinfectant solutions
n]
Foot Cover
os] Goggles/ Face shields
~a] Gowns
90] Isopropyl! alcohol
$0] IV stand
10.
Liquid antibacterial hand soap
11. N95 respirators
12. Povidone iodine solution
13. Sterile cotton swab
 D.M. No. 2020-
Annex C

Annex C. MEDICINES,MEDICAL SUPPLIES, EQUIPMENT AND INSTRUMENTS

14. Sterile gauze
15. Surgical gloves (sterile and non-sterile)
16. Surgical masks
17. Surgical tapes of different sizes (for IV insertion and
intubation)/or [TV Film
18. Waterproof aprons
19. Tongue depressor
20. Tourniquet
21. Wheelchair
22. Table and chair
23. Provider data records
24. Signed performance commitment