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Scanned Image Republic of the Philippines Department of Health OFFICE OF THE SECRETARY May 26, 2020 DEPARTMENTCIRCULAR No.2020- 99.13 FOR: ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES' DIRECTORS OF BUREAUS, SERVICES: AND CENTERS FOR HEALTH DEVELQ’MENT (CHD): MINISTER OF HEALTH — BANGSAMORO AUTONOMOUS REGION IN MUSLIM MINDANAO MOM-BARM ' FACILITY MANAGERS OF NATIONAL GOVERNMENT-LED TEMPORARY TREATMENT AND MONITORING FACILITIES (MEGA- TTMFs) SUBJECT: Advisory on thefiUse of the National Government-Led Mega T_emporarv Treatment and Monitorij Facilities (TTMF) Reatfiness Checklist The Department of Health (DOH) hereby issues the Temporary Treatment and Monitoring Facility (TTMF) Readiness Checklist, based on existing DOH guidelines for standards and operation of Temporary Treatment and Monitoring Facilities, to assist the National Incident Command Emergency Operations Centers and Facility Managers in ensuring the effective and efficient operations of Mega TTMFs. The checklist shall serve as a guide in four main components: 1) Infrastructure, Planning and Design, 2) Human Resources, 3) Medicines, Supplies and Equipment and 4) Outsourced Services. A soft copy of the checklist may be accessed through bit.ly/TTMFChecklists. This shall supplement Department Memorandum No. 2020-0160 or the “Interim Guidelines on Managementfor the National Capital Region Mega Temporary Treatment and Monitoring Facilities in the Philippine International Convention Center (PICC), WorldTrade Center (WTC), Rizal Memorial Coliseum (RMC), Ninoy Aquino Stadium, and Philippine Arena. ” Dissemination of the information to all concerned is requested. ISCO. T. D QUE III;MD, MSc Secretary of Health Building 1 San Lazaro Compound Rizal Avenue, Sta. Cruz, 1003 Manila 0 Trunk Line 651 -7800 local 1113,1108,1l35 Direct Line: 711 —;9502 711-9503 Fax: 743-1829 0 URL: http://wwwdohgov. ph; e-mail: liduquegfia(1()h.L0v,1p| Temporary Treatment and Monitoring Facility (TTMF) Readiness Checklist (National Government-Led TTMF) The purpose of this checklist to guide facility managers in preparingthe TTMF for operations. The checklist shall be divided into 4 main components (1) Infrastructure, Planning and Design (2) Human Resources (3) Medicines, Supplies and Equipment (4) OutsourcedServices. INFRASTRUCTURE, PLANNING, AND DESIGN Infrastructure OK Site selection: I Access to a COVlD-19 Referral Hospital or an L2/ L3 Hospital Accepting Suspect, Probable and Confirmed COVlD-19 patients with severe or critical symptoms I Fully enclosed space with adequate lighting Water and electricity: I Access to continuous supply of Electricitywith back up supply I Access to uninterrupted free-flowing water for at least 72 hours Waste disposal: I Liquid waste: plumbing system shall have access/ attached to the public sewer line. If toilet are not connected to sewer, hygienic on-site treatment systems should be ensured such as pit latrines and septic tanks, or excreta should be safely stored and transported for off-site treatment. I if to use portalets, regular disinfection should be observed I Solid waste: must be collected daily by accreditedTreatment, Storage and Disposal provider, if waste storage facility is not available Toilet and Bath minimum requirements: I For cohorted confirmed 0 Water Closet: 1 per 25 males l 1 per 20 females 0 Urinal: 1 per 10-50 males, additional 1 urinal every 10 additional patients 0 Showers: 1 per 8 persons 0 Lavatory: 1 per 10 males; 1 per 10 females I For suspect and probable 0 Individualtoilet and bath of at least 1.67 sqm o In extreme cases where T&B will be shared, stringent disinfection should be implemented (See disinfection) Planning and Design OK Ventilation I Level ofair pressure should follow a decreasing value from the clean/ sterile zone area, buffer zone and to the contaminated zone to ensure the unidirectional airflow from one zone to another. I Diluted ventilation in all areas, with air exhausted to an air space with no people I Provision of at least fan ventilation in patient rooms or patient observation area User Flow Circulation/ Foot traffic Unidirectional user flow circulation/ foot traffic should be established for healthcare workers from one zone to another Clear flow traffic of utility/ aide, food servers, and other non- health professionals 0 Collection of dirty linen/ laundry must be from contaminatedzone directly to the laundry area 0 Utility/ aide who will disinfect or sanitize the contaminated zone must go through the buffer zone for donning and doffing of PPE 0 Food servers are limited to clean zone only. A separate entrance and exit for patients and healthcareworkers should be established 0 Entrance and exit of HCW shouldbe connected to the clean/ sterile area 0 Entrance and exit of the patient is connected to the contaminated area Patient placement For Facilities catering to Confirmed COVlD-19 patients 0 Ward type may be allowed considering each patient observation area of at least 7.43 sq.m 0 Partition of at least 1.5 meters between patients, if not applicable, the use of floor to ceiling curtains maybe an alternative as wall partition 0 Each patient bed should be at least 1 m apart on all sides I For Facilities catering to SusEectl Probable 0R Close Contact 0 Individualenclosed rooms with own toilet and bath of about 929 sqm. o If without provision for individualtoilet and bath, the room should be at least 7.43 sqm. 0 Floor to ceiling height of at least 2.4 m if with artificial ventilation and 2.7 m if with natural ventilation I Each patient room or patient observation area shall have the following: 0 Patient Bed 0 Chair and table 0 Power/Electrical Outlet 0 Light source Floor Plan and Zones OK General requirements I Has Clean, Buffer, and Contaminated Zones Separate doonNay from clean to contaminated zone and vice versa Each zone is divided by a non-porous partition such as glass, steel, or drywall. Each functional room should be adequately ventilated with proper lighting Footbath should be placed in all exits of the facility Footbath in the passageway from the contaminated area to the buffer area Clean/ Sterile Zone: I Staff Entry and Exit I Staff HoldingArea I Staff's toilet and bath I Pharmacy - Provision for storing and handling Medicines and Medical Supplies - Shelves and cabinets - Desk and chairs - At the minimum 4.25 sqm for storage and work area of 5.02 squ staff I Central Supply/ Stock Room - Shelves and cabinets that are moisture-resistant and made from materials that can be easily cleaned - Storage containers and shelves are labeled and with protective covers - Room size of at least 4.65 sqm I Records Storage Room - Temporary Storage of Health Records prior to submission to LGU upon discharge - May serve as an area for encoding reports etc. - Storage area of at least 4.25 sqm - Work area of 5.02 squ staff BufferZone: I Donning Area - Ante-Rooms _ - Level 1: Lockers for change of clothes per staff (Change from outsrde clothes to uniform) - Level 2: Hand washing sinks, foot-operated waste receptacles (Hand Hygiene) - Level 3: Cabinets for PPE supply (Wearing of Complete PPE) I Doffing Area - Ante-Rooms - Level 1: Receptacles for disposable PPEs, Bins for disinfection of reusable PPEs, Misting (if applicable) (For removal and disposal of gloves and gown) - Level 2: Hand washing sinks, foot-operated waste receptacles (Hand hygiene, removal of mask and goggles) - Level 3: Hampers for used uniforms or scrubs (Change from uniform to outside clothes) Contaminated Zone: I Patient Entry and Exit - Main door shall be 0.90m to 1.20m is length to easily accommodate patients regardless of type of movement — Accessible to main driveway I Patient receiving or triage area — At least 5 sqm to allow at least 1 staff to man and receive patients and documents I Patient ward/rooms (as indicated in Patient Placement) I Specimen Collection Areal Room (if applicable) - Individual booths - Physical barrier between patient and specimen collector Other Areas (located outside the main infrastructure of the Temporary Facility) I Waste Disposal and Storage Area - At least 4.65sqm - Accessible to driveway for access of haulerservice provider I Laundry HoldingArea (if applicable) - At least 4.65 sqm if for storage only - Accessible to driveway for access of laundry service provider Human Resource Management ITEMS OK Pre-deployment Orientation: I Signs and symptoms of COVID-19and how to monitor patients with such I Chain of infection and how to break the chain of transmission I Triaging, early recognition of signs and symptoms, high risk individuals and source control of COVlD-19 I Medical and Psychosocial management of COVlD-19 patients I Respiratory Etiquette and Social Distancing I isolation Precautions(Standard Precaution and Transmission-basedPrecautions- Airborne, Contact, and Droplet) I Physical layout and workflow map of important areas and zones in the facility I Healthcare worker Risk Assessment and Managementin the Context of COVlD-19 Virus I Reporting procedures for COVlD-19 surveillance as established in the facility I Policies or protocols on accommodation arrangement, transportation, laundry of dirty uniforms and/ or scrubs worn during duty Training I Hand Hygiene Technique, Five (5) Moments of Hand Hygiene I Appropriate use of Personal Protective Equipment I Proper Donning and Doffing of PPE I Proper cleaning and disinfection of environmental surfaces and equipment I Proper collection and handling of healthcarewaste I Safe Management of Cadaver Orientation for out-sourced Personnel I Hand Hygiene Technique I Proper Donning and Doffing of PPE I Protocols for reporting any breaks in infection control Provision for Accommodation and Transport I Accommodation shall be provided whether onsite or offsite I Health workers shall preferably be placed in individual rooms with individual toilets and showers. In cases where this arrangement is not feasible, beds shall be at least 3 ft apart and toilet/ showerfacilities must be disinfected after use. I Transportation services shall be provided to all healthcare workers. I Food shall be provided throughout their entire tour of duty.
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