Revisions in Admissions and Testing Protocols during COVID-19 Surge

Premises:

1. The threat of COVID-19 infection is more rampant now than when the pandemic first started.
2. Colleagues and family members have been infected already.
3. Everyone around us should be assumed to be infected by the virus unless proven otherwise.
4. Our hospital is already running at full capacity in terms of COVID-19 patient admissions.
5. Guidelines are put to ensure the safety of our patients, our colleagues, our hospital staff, and our
families.
6. Doctors and hospital staff are reminded to strictly follow the guidelines.
7. The situation is dynamic, and these guidelines could change depending on the circumstances as
per approval of the ExeCom and Hospital Board.
8. The implementation of these guidelines will continue as long as there is a surge of COVID-19 cases
in NCR-Plus region.

General Guidelines:

1. Elective surgery admission followed by inpatient swabbing is suspended for now. All elective
surgery/medical admissions should have a chest X-ray result, a negative COVID-19 RT PCR swab
done within 7 days of admission, quarantined within 7 days of the RT-PCR swab, and have no
COVID-19 infection related symptoms prior to admission.
2. All admissions from the ER must undergo a chest X-ray and the COVID-19 package (Rapid
Antigen + RT-PCR swab test).
3. Admissions from the ER presenting WITH respiratory symptoms and/or COVID-19 infection
related symptoms; regardless of the Rapid Antigen test and Chest X-ray results; shall be
admitted in the COVID-19 designated wards.
4. Admissions from the ER presenting with NO respiratory symptoms and NO COVID-19 infection
related symptoms; and are being admitted for some other medical or surgical complaint may
be admitted in the non-COVID-19 floors provided they have a negative Rapid Antigen test and
a non-COVID compatible Chest X-ray result.
5. Patients who come to the hospital for regularly scheduled procedures (e.g. hemodialysis,
rehabilitation therapy, etc.) should be swabbed every 2 weeks using the rapid antigen test. For
COVID-19 infection symptomatic patients, an RT-PCR swab test should be done.
6. Each patient should only be allowed 1 companion during admission. The designated companion
should have no COVID-19 infection related symptoms and should at least have a negative Rapid
Antigen test result. If the designated companion has to leave the hospital premises, he/she will
undergo a symptom screen/check to be allowed back into the hospital. The designated
companion should not be less than 18 years old and not a senior citizen. They should also sign
a waiver knowing the risks involved in being inside the hospital premises. An exception would
be in pediatric patients younger than 2 years old, in which 2 designated companions could be
allowed provided they are both negative in their Rapid Antigen tests and with no COVID-19
infection related symptoms.
7. No visitors are allowed for now in all inpatient units.
8. Direct admission of elective patients is still in effect with previously set protocol with a
designated companion who is at least negative in Rapid Antigen testing and has no COVID-19
infection related symptoms.
9. OPD clinics will remain open but by appointment basis only. Non-ambulatory OPD patients
should only have 1 companion with them. Minors should only have 1 companion with them
except for patients younger than 2 years old in which 2 companions could be allowed.
10. Strict reinforcement of the screening triage should be done in all entrances of the hospital.
 Operating Room Guidelines during “Second Surge” ECQ

1. Only 1 major (COVID or Non-COVID case) + 1 minor Non-COVID case or 2 minor Non-COVID cases
can be allowed to be done at one time. Subsequent surgeries for the day would be on a “to follow”
basis.
2. During this ECQ, only urgent elective and emergency cases are encouraged to be scheduled. True
elective surgeries/admissions are allowed but these patients should follow strict COVID-19
admission protocols. This situation is dynamic and might change depending on further
announcements.
3. Elective surgeries are encouraged to be scheduled during office hours (7AM to 5PM) and should
be scheduled at least 1 day before the surgery. For urgent elective surgeries after office hours and
during Holy Wednesday to Easter Sunday, additional surcharges will be applied. These surgeries
would first need approval from the OR nurse supervisor or OR Head prior to proceeding with the
surgery.
4. For a Major case, last start of cutting time should be at 3:00 PM and for minor cases, last start of
cutting time should be at 4:00 PM.
5. Emergency surgeries being done at night, during Sundays, and/or on a holiday will not incur the
surcharge of Major OR fee.
6. Scheduling of elective cases should be done at least a day before and is subject to approval of the
OR nurse supervisor and OR head.
7. If a scheduled elective case has not yet started and a patient arrived at the ER requiring emergent
surgery, the elective case would have to be bumped off to accommodate the emergency surgery.
The elective case will not incur surcharge of OR fee if it will be done beyond office hours due to
being bumped off by another emergent case.
8. If the scheduled elective surgery has started, the emergency surgical case would have to be
stabilized first in the ER and the hospital will try its best to recall OR personnel immediately to
accommodate the emergency case. If unfortunately, adequate manpower is not available for the
emergency surgery to proceed, the patient will be coordinated for hospital transfer. Situations
like this should be coordinated with the OR nurse supervisor and OR head.
9. We have 2 COVID theaters, Theater 2 and Theater 4. These theaters are isolated from each other
and could function separately.
10. Theater 2 is reserved for Major surgeries involving suspected, COVID positive, or patients awaiting
swab results.
11. Theater 4 is reserved for Minor surgeries (examples: DM extremity debridement, IJ catheter
insertions, normal vaginal deliveries, thoracentesis, tracheostomy, etc.) involving suspected,
COVID positive patients, or patients awaiting swab results. Theater 4 is limited to minor surgeries
only because of the condition of the anesthesia machine in the room.
12. If an emergency surgical case suspected of having a COVID-19 infection arrives in the ER but
there is still an ongoing surgery in the COVID theater (Theater 2), and if the surgery could not
be done in Theater 4, the emergency surgical case in the ER should be transferred to another
hospital after first aid and stabilization procedures have been given. Situations like this should be
coordinated with the OR nurse supervisor and OR head.
13. All major elective cases will require a negative RT-PCR swab test (within 7 days of swabbing and
confirmed to have quarantined during that time period), a normal Chest radiograph within 7
days, and with no COVID symptoms before proceeding.
a. Previous set guidelines for major elective cases should still be followed.
14. All minor elective cases, especially Aerosol Generating Procedures (AGPs), will require a
negative RT-PCR swab test (within 7 days of swabbing and confirmed to have quarantined
during that time period), a normal Chest radiograph within 7 days, and with no COVID
symptoms before proceeding.
15. Rapid antigen test will be limited to procedures that are urgent/emergent and cannot wait for
the result of the RT-PCR swab test. For example, a ruptured appendicitis, an imminent
spontaneous vaginal delivery, an emergent Caesarean section, or an emergency trauma case
from the ER. These patients will be done in the COVID theaters regardless of the rapid antigen
results and they will all still undergo RT-PCR swab (COVID-19 package: Rapid antigen test + RT-
PCR swab). If patient is asymptomatic and with a negative rapid antigen result, this patient can
be admitted in the new building post-operatively; otherwise, the patient will be admitted in the
designated COVID ward floors (4th or 5th floors old building). While waiting for the RT-PCR swab
results, doctors and nurses who do rounds for these patients should wear appropriate (Level
IV) PPE for their own protection.
16. Procedures such as repeat debridement of diabetic foot ulcers and arthrocentesis should be done
for now in the doctor’s clinics. It is also the discretion of the doctor if he/she wants a rapid antigen
test done for these patients prior to clinic appointment.
17. In truly elective surgical procedures, a positive RT-PCR swab or a positive Rapid Antigen test will
result in cancellation and re-scheduling of admission and surgery.
18. In all admissions, the designated watcher should undergo and have at least a negative Rapid
Antigen test to be allowed as a watcher during the patient’s admission.
19. In truly elective surgical procedures, the designated watcher of the patient is encouraged to also
undergo RT-PCR swab prior to the admission. There is no need to undergo a Rapid Antigen test if
the designated watcher already has a negative RT-PCR swab result.
20. In surgical procedures wherein an implant technician is needed during the surgery, the technician
should undergo a Rapid Antigen test within 2 days of the scheduled procedure.
21. Proper donning and doffing of PPEs in the operating room cannot be overemphasized.
22. Level 3 or Level 4 PPEs should always be worn within the operating room complex especially
during surgeries.
23. OR staff and doctors should not eat at the same time and should not remove their
masks/respirators when another person is near. Strict wearing of PPE will be implemented in the
OR complex.
24. For now, all patients for surgery will enter the backdoor of the operating room complex.
25. Pediatric/NICU babies will still follow previously set protocols.
26. OB Gyne cases will still follow previously set protocols except that emergency CS or normal vaginal
deliveries (without “within 7 days” negative RT-PCR swab result) should get a COVID rapid antigen
test, a chest radiograph, and a RT-PCR Swab test as part of the admission package before
proceeding to COVID designated theaters (Theater 2 or Theater 4). A patient with a negative Rapid
Antigen test result and with no COVID-19 infection related symptoms could be admitted in a non-
COVID floor; otherwise, the patient will be admitted in the COVID-19 designated floors. The
designated companion of the patient should also have a Rapid Antigen Test done upon admission
of the patient.