Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

September 24, 2021

DEPARTMENT MEMORANDUM
No. 2021 - 0405
TO: ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES;
DIRECTORS OF CENTERS FOR HEALTH DEVELOPMENT
(CHD), BUREAUS, AND SERVICES: MINISTER OF HEALTH -
BANGSAMORO AUTONOMOUS REGION IN MUSLIM
MINDANAO (BARMM): EXECUTIVE DIRECTORS OF
SPECIALTY HOSPITALS; CHIEFS OF MEDICAL CENTERS
HOSPITALS, SANITARIA, AND DOH TREATMENT AND
REHABILITAION CENTERS; AND OTHERS CONCERNED

SUBJECT: Reiteration of Infection Prevention and Control Policies and

Guidelines on the Use of the Healthcare Worker COVID-19
Infection Dashboard

Department of Health hereby reiterates the following measures to address the rise in the
number of healthcare workers (HCW), quarantined or isolated due to COVID-19, from 4,499
in the first week of August to 11,967 in the second week of September:

1. The following policies are hereby reiterated to provide guidance to health facilities on
infection prevention and control:
a. Department Memorandum (DM) No. 2020-0268, “Interim Guidelines on Health
Facilities in the New Normal”
b. Department Circular (DC) No. 2020-0298, “Compendium of DOH Issuances on
Infection Prevention and Control in the Health Facilities in the Context of
Coronavirus Disease 2019 (COVID-19)”
DC No. 2021-0168, “Recommendations to Address the Rising Numbers of
Healthcare Workers Infected by COVID-19”
DM No. 2020-0162, “Interim Guidelines on the Accommodation Arrangement for
COVID-19 Health Emergency Response Period”
DM No. 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)”
DM No. 2020-0208, “Interim Guidelines on Enhancing the Infection Prevention
and Control Measures through Engineering and Environmental Controls in All
Facilities and Temporary Treatment and Monitoring Facilities during the COVID-
19 Pandemic”
Administrative Order No. 2021-0043, “Omnibus Guidelines on the Minimum
Public Health Standards for the Safe Reopening of Institutions”

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ® Trunk Line 651-7800 loc. 1113, 1108, 1135
Direct Line: 711-9502; 711-9503 Fax: 743-1829 ¢ URL: http://www.doh.gov.ph; e-mail: fiduque@doh.gov.ph
2. The Healthcare Worker COVID-19 Infection Dashboard (see Annex A for link) being
managed and updated by the Health Facility Development Bureau (HFDB) shall be
utilized by the Centers for Health Development (CHDs) and Ministry of Health -

~~
BARMM (MOH-BARMM) to determine the trends of HCW infection per region.

3. CHDs and MOH-BARMM, through their Infection Prevention and Control

Coordinator, shall facilitate the conduct of Root Cause Analysis (RCA) in each health
facility as needed for clustering of HCW infections, then provide technical assistance
and recommendations for interventions to the health facilities. The CHDs and MOH-
BARMM shall submit to HFDB the accomplished RCAs along with summary reports
(see Annex A for link to RCA and summary report formats).

4. CHDs and MOH-BARMM shallcoordinate with HFDB regarding additional technical

assistance and recommendations for updating of policies.

5. The following interventions at the level of CHDs and MOH-BARMM are

recommended to mitigate healthcare worker infection:
a.Facilitate review of procurement planning, health facility investments, retrofitting,
and engineering controls of health facilities in their respective regions.
b. Promote capacity building platforms for healthcare workers such as the DOH
Academy’s Infection Prevention and Control modules (learn.doh.gov.ph):
i. Infection Prevention and Control (IPC) for COVID-19
ii. IPC for COVID-19 (Home and Community Settings)
iii.
iv.
IPC for COVID-19 for Frontline Healthcare Workers
Orientation Course for COVID-19 Treatment
inthe Facilities

v. Orientation to COVID-19 Testing

vi. Supply Chain Management for COVID-19
vil. Risk Communication and Community Engagement for COVID-19
viii. Healthcare Waste Management
¢. Supplement the needs of HCWs for isolation/quarantine facilities and personal
protective equipment (PPE).
d. Utilize available tools and checklists for monitoring of healthcare facilities:
i. DM No. 2020-0249, “Use of IPC Checklist for Healthcare Workers
Readiness”
ii. DM No. 2020-0202, “Use of the Infection Prevention and Control
Assessment Form for Health Facility Managers and Healthcare
Professionals in the Context of COVID-19”
ili. DC No. 2020-0225, “Advisory on the Use of the Infection Prevention and
Control Checklist for Temporary Treatment and Monitoring Facilities”
e. Facilitate conduct of quality checks and reports on poor quality PPE.

6. The following interventions

HCW infection:
at the level of health facilities are recommended to mitigate
a. Coordinate with
the CHDs and MOH-BARMM regarding the conduct of RCAs:
i. Submit
the accomplished RCAs to the CHDs
ii. Follow
through implementation of action plans stated in these reports
b. For engineering
controls, coordinate with the CHDs and MOH-BARMM on the
implementation of the interventions specified above relative to the conduct of
 quality checks and reports on poor quality PPE, review of procurement planning,
health facility investments, retrofitting, and other engineering controls.
c. For administrative controls, adopt the following guidelines:
i. Shorten quarantine period for fully vaccinated HCWs
ii. Review hospital IPC protocols
ili. Ensure the safety and well-being of HCWs through the following:
(1) Accommodation arrangements and transportation for HCWs
(2) Provision of mental health services and psychosocial services
(3) Medical assistance to HCWs, PhilHealth, sickness and compensation
benefits
iv. Create guidelines on having meals and eating together:
(1) Adopt staggered meal schedules
(2) Encourage eating alone
(3) Physical distancing of at least one (1) meter in canteens, and refrain
from talking with one another
(4) Signages, physical barriers, and other means
(5) Makeshift dining areas:
to ensure compliance
(a) Immediately wear masks after eating
(b) Prohibit use of communal items
(c) Prohibit buffet service for meals
d. For HCW-related interventions, conduct the
following in coordination with the
CHDs and MOH-BARMM:
i. Use checklists and tools specified for the above
ii. Train or build capacities through DOH Academy as mentioned above
e. For PPE concerns, the DM No. 2020-0249, “Use of
the Infection Prevention and
Control Checklist for Healthcare Workers Readiness” shall be used
as guide for the
proper donning and doffing of PPE. In addition, fit testing and seal checking shall
be conducted. (See Annex B.1 and B.2)

For strict compliance.

By Authority of the

wi Health:

LILIBETH C. DAVID, MD, MPH, MPM, CESO I

Undersecretary of Health
Health Facilities and Infrastructure Development Team
 ANNEX A. Important Links Relative to this Issuance

Content Description Link

Healthcare Worker COVID-19 Infection
https://bit.ly/ HCW InfectionDashboard
Dashboard

Root Cause Analysis Template https://bit.ly/TemplateRCA

Summary Report for Root Cause Analysis

Template
https:/bit.ly/3kuFF6A

Online Drive for the Submission of Root

Cause Analyses and Summary Reports https://bit.ly/RCADrive
 ANNEX B.1. Guidelines on Fit Testing and Seal Checking
(Source: Centers for Disease Control and Prevention Hospital Respiratory Protection Program Toolkit, 2015)

1. Fit testing shall be done the first time a healthcare worker will use the N95 respirator.
Records regarding the sizes shall be kept for future reference.
2. Ideally, fit testing is to be performed annually, and when there are new suppliers for the
respirators. This shall also be done when there are noted physical changes that may
affect the fit (weight gain/loss, dental work, etc.)
3. Ideally, the health facility shall have a respiratory protection program in order to ensure
the proper use of N95s and the safety of the healthcare workers.
4. For further guidance on the specific quantitative and qualitative methods of fit
testing,
please refer to the CDC Hospital Respiratory Protection Program Toolkit here:
https://bit.ly/CDCFitTesting
5. User seal checks shall be performed as a regular part of the donning process to ensure
that an adequate seal is achieved each time the respirator
for instructions.
is
put on. See the image below

6. User seal checks are not substitutes for qualitative or quantitative fit tests.
 ANNEX B.2. Instructions for Seal Checking
(Source: Emory University, 2020)

Important notes
With any N95, you should always @
perform a seal check each time it If you are reusing
is donned. Follow the manufacturer's
manual for best practice. the mask, use
gloved hands.
Each time, Every time.
Your Safety Depends on it.

Positive pressure user seal check

®
Exhale gently Ensure that the
while blocking the face piece is slightly
paths for airto pressurized before
exit the face piece.¢ pressure causes
outward leakage.

Ensure that the

Inhale sharply face piece collapses
while blocking slightly under negative
the paths for air
to enter the face pressure that is
/ created with this
“piece. \ procedure.

If the air leaks out between If you are still unable

your face and the respirator, DO NOT ENTER Readjust the to get a good seal, talk
the respirator does not fit a hazardous respirator and check to your supervisor for a
your face properly. area. the seal again. new N95.

© EMORY @
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