Republic of the Philippines MAYOR HILARION A. RAMIRO SR MEDICAL CENTER Ozamiz City MHARSMC COVID19 TASK FORCE. January 23, 2024 Office Memorandum 2024 - 001 ‘To: All Hospital Staff From: MHARSMC Hospital Infection Prevention and Control (HIPC) Subject: Revised MHARSMC Coronavirus Disease (COVID-19) Protocol based on Updated Health Protocols following the lifting of the COVID-19 Public Health Emergency In line with the Department of Health Department Circular 2023-0324, which outlines the revised guidelines following the lifting of the COVID-19 Public Health Emergency, the MHARSMC COVIDI9 ‘Task Force has implemented the following updated COVID-19 protocols, effective immediately: L.__ Updated Recommended Risk-Based Personal Protective Equipment (PPE) = While no longer mandated, the Department of Health (DOH) recommends the retention of ‘mandatory mask usage in health facilities to protect vulnerable patients and reduce nosocomial infections. = The Hospital Infection Prevention and Control Committee of MHARSMC retains mandatory ‘masking for the following: ‘a. All staff members who have direct patient contact or engage in close proximity with patients, must wear masks at all times. b. This requirement is crucial to ensure the safety of both our staff and patients, = Mask Wearing Recommended: For individuals who may not fall under the category of direct patient contact but are in certain high-risk groups or situations, mask wearing is strongly recommended, ‘These groups include: Elderly individuals Individuals with immunocompromised comorbidities Pregnant women Unvaccinated individuals ‘Symptomatic individuals pacer - Additionally, wearing masks is highly encouraged, especially in crowded or poorly ventilated public spaces or conference rooms, fo reduce the risk of transmission,Republic of the Philippines — MAYOR HILARION A. RAMIRO SR MEDICAL CENTER Ozamiz City MHARSMC COVID19 TASK FORCE, RECOMMENDED PPE TO LEVEL OF EXPOSURE Level T Green Zone What to wear: ‘+ Administrative Offices 1, 4Well-fitted medical © Mandatory masking for high-risk groups mask Level Orange Zone What to wear ‘+ Regular non-COVID Wards whenever within 6 feet 1. Well-fitted medical mask from patients or Fit tested N9S/KNOS * Outpatient Department 1 & 2 ‘mask or equivalent + Radiology 2. 4 Face shield + Emergency Room I 3. 4 Washable isolation Non- COVID Critical Care Areas ~ ICU, PICU, gown NICU, DR, HDU, OR 4. 4 Gloves ‘+ Fittested N95 mask © When performing aerosol-generating procedures (AGP)- Intubation, suctioning, nebulization, et. © OPD Clinics: Dental Clinic, EENT Clinic, TB- bors ‘© _Communicable Disease Ward Level ‘Red Zone What to wear: © Triage 1. Fittested N9S/KN9S + ERII(COVID ER) mask or equivalent + COVID ICU C2) 2. Goggles! Face shield + COVID Wards 3. Disposable Isolation + COVID Delivery Room Gown/ Disposable © COVID Operating Room coveralls © COVID Dialysis 4. Gloves * Lab processing of respiratory specimens fiom suspect, 5._Shoe Cover ‘probable, or confirmed patients. Updated Testing Protocols The following testing protocols shall be implemented for patients and healthcare workers, regardless of vaccination status: ‘TESTING RECOMMENDATION FOR HEALTHCARE WORKERS AND PATIENTS Clinical Status Patient Healthcare worker ‘Asymptomatic | No testing on admission/pre-procedure | No testing required Wear a well-fitted mask Wear a well-fitted mask ‘Symptomatic | Testing using RT-PCR immediately Testing using RT-PCR immediately Wear a well-fitted mask | Wear a well-fitted mask All hospital staff and admitted patients in non-covid wards who will later exhibit symptoms compatible with COVID-19 should be tested using RT-PCR.Republic of the Philippines MAYOR HILARION A. RAMIRO SR MEDICAL CENTER ‘Ozamiz City MHARSMC COVID19 TASK F ‘ORCE Patients with a positive SARS-COV?2 PCR result within the last 90 days who present with non-COVID symptoms in the ER shall not be tested for COVID-19 provided that they will show evidence of previous COVID-19 Disease (¢:g., SARS-COV2 PCR result, medical certificate, or medical abstract). IIL Updated Quarantine and Isolation Protocols = The updated quarantine and isolation protocols for patients and hospital staff with Confirmed COVID-19, regardless of vaccination status are as follows: QUARANTINE AND ISOLATION PROTOCOLS FOR HEALTHCARE WORKERS AND PATIENTS, Glinical Status Patient Healthcare worker ‘Asymptomatic exposed to | No quarantine required No quarantine required confirmed COVID-19 ‘Wear a well-itted mask for 10 | Wear a well-fitted mask for 10 positive individual days ____| days ‘Asymptomatic but Preferred: HOME isolation (c/o Wellness confirmed COVID-19 _| HOME isolation (c/o LGU) Center) positive case I cannot discharge: for 5 days from positive test 5 days from positive test (sample | (sample collection date) collection date) Wear a well-ftted mask for 10 ‘Wear a well-fitted mask for 10 days, days. Confirmed COVID-19 | Preferred: HOME isolation (c/o Wellness positive case with Mild | HOME isolation (c/o LGU) Center) for S days from onset of symptoms If cannot discharge: symptoms OR until afebrile/fever- S$ days from onset of symptoms | fiee for at least 24 hours without OR until afebrile/fever-ftee for at | use of antipyretics and with least 24 hours without use of improvement of respiratory antipyretics and with improvement | symptoms, whichever is earlier of respiratory symptoms, ‘Wear a well-ftted mask for 10 whichever is earlier days Wear a well-ftted mask for 10 Cont oe firmed COVID-19__| Preferred: HOME isolation (e/o Wellness positive case with HOME isolation (c/o LGU) Center) for 10 days from onset of foderate symptoms Iecannot discharge: symptoms OR until afebrile/fever- 10 days from onset of symptoms | free for at least 24 hours without OR until afebrile/fever-free for at Teast 24 hours without use of antipyretics and with improvement of respiratory symptoms, whichever is earlier Wear a well-fitted mask for 10 days use of antipyretics and with improvement of respiratory symptoms, whichever is earlier Wear a well-ftted mask for 10 daysWV. v. Republic of the Philippines MAYOR HILARION A. RAMIRO SR MEDICAL CENTER ‘Ozamiz City MHARSMC COVID19 TASK FORCE Confirmed COVID-19 [21 days from onset of symptoms Positive case with Severe | Isolation may be shortened upon the advice of HIPC or Critical symptoms _ Immunocompromised 21 days from onset of symptoms Regardless of Severity Isolation may be shortened upon the advice of HIPC Visitor and Patient's Watcher Policy Only ONE (1) watcher is allowed at the patient's bedside except but not limited to the following wherein TWO (2) watchers may be allowed 1, Pediatric patients 2. Patients with developmental disorders (impairments in physical, cognitive, language, or behavioral development) 3. Critically ill, incapacitated patients who require invasive or non-invasive mechanical ventilation 4, Non-ambulatory patients who need assistance in activities of daily living, 5. With Morse Fall Risk Assessment Score of >45 or higher No watchers shall be allowed inside the Intensive Care Unit. ‘The following visiting hours are implemented: 1. Between 0900H ~ 1200H 2. Between 1600H - 1900H. Up to THREE (3) persons (visitor plus watcher) atthe bedside at the same time is allowed; may switch out throughout the day. Patient's watcher and visitors must wear masks at all times and follow the hospital's guidelines regarding hand hygiene and social distancing, Infection Control Measures Strict hand hygiene practices, including regular handwashing with soap and water for at least 20 seconds or the use of alcohol-based hand sanitizers, must be observed by all sta, patients, and visitors. Hand sanitizers will be provided at strategic locations throughout the hospital All frequently touched surfaces, including doorknobs, countertops, and equipment, should be regularly sanitized using hospital-approved disinfectants. Isolation protocols for suspected or confirmed COVID-19 cases must be strictly followed, including the use of designated COVID-19 rooms and proper waste disposal procedures.VI. Accordion Type Surge Cay Republic of the Philippines MAYOR HILARION A. RAMIRO SR MEDICAL CENTER ‘Ozamiz City MHARSMC COVIDI9 TASK FORCE city Whilst the state of public health emergency has already been lifted, MHARSMC remains vigilant to ensure that adequate health system capacity in the event that itis required. “This plan will be activated at any time at the discretion of the Medical Center Chief in close coordination with the Task Force. Decreasing morbidity Increasing morbidity and incident demands and incident demands a e COVID ICU. ‘COVID Ward ‘ARUSARI ‘COVID ER raw ‘COVID MANAGEMENT TEAM Hospital Infection Prevention | Recommends and monitors compliance to infection control and Control (HIPC) guidelines Recommends time-based isolation according to guidelines for healthcare workers and patients who test RTPCR positive. Tntemnal Medicine Department | Admits and manages adult patients (general public and HCWs) with moderate, severe, and critical COVID-19 and immunocompromised adults with COVID-19 regardless of the severity Family Medicine Department | Admits and manages adult patients (general public and HCWs) with mild and moderate COVID-19 Pediatrics Department ‘Admits and manages pediatric patients with moderate, severe, and ‘ritical COVID-19 and immunocompromised pediatric patients with COVID-19 regardless of the severity Cutting specialties (General "Admits and manages adult patients with asymptomatic and mild ‘Surgery, OB-Gyne, Orthopedies / COVID-19 with primary surgical/obstetrics problem Department) _ Wellness Clinic ‘Manages HCWs with asymptomatic and mild COVID-19 as out- patient (HOME monitoring) Nursing staf Provides nursing care for COVID-19 patients Respiratory therapist Provides ventilator management, oxygen therapy, airway clearance, aerosolized medication administration, breathing, exercises and rehabilitation for COVID-19 patients ‘Medical technologist Collects and process specimen for diagnosticsRepublic of the Philippines MAYOR HILARION A. RAMIRO SR MEDICAL CENTER Ozamiz City MHARSMC COVID19 TASK FORCE ‘computed tomography, mammography. cardiac ] [Faerie technologist wr interventional, and ultrasound procedures VIL. Burial for COVID-19-Related Deaths + Evidence suggests a decreased risk of transmission associated with COVID-19-related deaths. Consequently, it has been removed from the list of dangerous communicable diseases. Adherence to infection prevention and control precautions continues to be recommended ‘These revised COVID-19 protocols aim to provide a safe environment for our patients, staff, and visitors while maintaining high-quality healthcare services. It is crucial for everyone to strictly adhere to these protocols to prevent the spread of the virus and protect ourselves and our community. nea “é tak fannor ‘Thank you for your cooperation. ra C9 ou - on Dan con PCP, FPSMID G- A, cw On 5. Recommending Approval: 10 — A 9 Canes * 36> oy Oil Gaul a Chairman, Hospital InfectRepublic of the Philippines MAYOR HILARION A. RAMIRO SR MEDICAL CENTER Ozamiz City MHARSMC COVID19 TASK FORCE References + Department Circular No. 2023-0324 entitled “Updated Health Protocols following iting] of the COVID-19 Public Health Emergency" + Administrative Order No. 2021-0056-A entitled Amendment to Administrative Orded (AO) No. 2021-0056 entitled “Revised Implementing Rules and Regulations of the Code on] Sanitation of the Philippines (PD 856) Chapter XX1 Disposal of Dead Persons”