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Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

May 26, 2020

DEPARTMENT CIRCULAR
No. 2020 - 0213

FOR: ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES;


DIRECTORS OF BUREAUS, SERVICES, AND CENTERS FOR
HEALTH DEVELOPMENT (CHD); MINISTER OF HEALTH —
BANGSAMORO AUTONOMOUS REGION IN MUSLIM
MINDANAO (MOM-BARMM); FACILITY MANAGERS OF
NATIONAL GOVERNMENT-LED TEMPORARY TREATMENT
AND MONITORING FACILITIES {MEGA- TTMFs[

SUBJECT: Advisory on the Use of the National Government—Led Mega


Temporary Treatment and Monitoring Facilities (TTMF) Readiness
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 Management for the National Capital Region Mega Temporary Treatment and
Monitoring Facilities in the Philippine International Convention Center (PICC), World Trade
Center (WTC), Rizal Memorial Coliseum (RMC), Ninoy Aquino Stadium, and Philippine
Arena. ”

Dissemination of the information to all concerned is requested.

FRANCISCO T. DUQUE III, MD, MSc


Secretary of Health

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila 0 Trunk Line 651-7800 local 1 113, 108, 135
1 1

Direct Line: 711-9502; 711-9503 Fax: 743-1829 0 URL: http://www.doh.gov.ph; e-mail: liduqucw doheovph
Temporary Treatment and Monitoring Facility (TTMF) Readiness Checklist
(National Government-Led TTMF)
The purpose of this checklist to guide facility managers in preparing the 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) Outsourced Services.

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 Electricity with 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 accredited Treatment, Storage and Disposal
provider, if waste storage facility is not available

Toilet and Bath minimum requirements:


I For cohorted confirmed1
0 Water Closet: 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 Individual toilet 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 of air 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 contaminated zone 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 healthcare workers should be established
0 Entrance and exit of HCW should be 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 Individual enclosed rooms with own toilet and bath of about 929 sqm.
o If without provision for individual toilet 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 Holding Area
I Staff's toilet and bath
I Pharmacy
- Provision for storing and handling Medicines and Medical Supplies
- Shelves and cabinets
- Desk and chairs
- At squ staff
the minimum 4.25 sqm for storage and work area of 5.02
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

Buffer Zone:
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 hauler service provider
I Laundry Holding Area (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-19 and 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-based Precautions-
Airborne, Contact, and Droplet)
I Physical layout and workflow map of important areas and zones in the facility
I Healthcare worker Risk Assessment and Management in 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 healthcare waste
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/ shower facilities 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.
Work Arrangements
I Compliance with 40 hr work week and 8 hrs of clinical duty per day in compliance with
080 rules and DM 2020-0145
I Risk-based management of exposure for Healthcare workers based on existing
guidelines (ie low risk - 14 days of self-monitoring after tour of duty, High risk- stop all
healthcare related interaction with patient, quarantine and testing) based on DC 2020-
0106

Laboratory Testing for Healthcare Workers


I Provision for testing (antibody testing and RT-PCR) of healthcare workers in accordance
.

with DM 2020-0180
Medicines, Supplies, and Equipment

ITEMS OK
Medicines

Antipyretics
- Paracetamol 500mg tablet
Respiratory Medications:
- Lagundi 300 mg or 600 mg tablet
- Lagundi 300mg/5mL, 60mL syrup and 120mL Syrup
- lpratropium + Salbutamol 500mcg +2.5mg x 2.5mL (unit dose) Respiratory
- Salbutamol 1mg/mL 2.5mL nebule
- Butamirate Citrate 50mg tablet

Antidianheal Medications
- Oral Rehydration Salts
- Loperamide 2mg Capsule

Vitamin Supplementation
- Ascorbic Acid 500mg/tab
- Multivitamins + Zinc tab

Supplies
Complete set of Personal Protective Equipment
- Face shield/ Goggles
- Face Masks
- N95 masks
- Isolation Gowns/ Coveralls
- Gloves
- Shoe Cover

- Oxygen Tanks with holder, cart and gauge regulator


- Oxygen Cannula
- Oxygen mask
- Nebulizing kits
- Nebulizers

- Papers for Health Records


- Bed linen
- Pillows
- Pillow Cases
- Plastic Trash Bin with foot pedal (Yellow, Black, and Green)
- Trash bags
- Tissue
- Chlorine granules
- Liquid soaps and dispensers

Equipment
*Ideally dedicated 1 per patient. If not feasible, should be dismfected after every use
_

- Stethoscopes
- Pulse Oximeters

BP Apparatus
— Thermal Scanners
Emergency Medicine, Supplies and Equipment (On standby)
Medicines
- Clonidine 75mcg tab

Clonidine 150mcg/mL, 1mL amp
- IV Fluids (Plan N88 and PLR)
- Epinephrine 1mg/mL, 1mL amp
Medical Supplies
- Endotracheal tube with cuff of varying sizes
- IV stand
- IV cannula
- IV infusion
- Surgical tape
- Cotton Balls
- Sterile Gauze
- Tourniquet
- Povidone Iodine
- Syringes (3cc, 5cc, 10 cc syringe)

Equipment
- Laryngoscope and Blade
- Bag Valve Mask
IT Equipment

Desktop Computer with printer
- Laptop
- Phone connection (whether landline or cellular phone)

Provision for Internet Connection speed of at least 5—10 Mbps dedicated for receiving
and sending reports

Toiletry Pack (per patient good for 14 days)



Shampoo
- Bar Soap
- Toothbrush
- Toothpaste
- Sanitary Pads (for women)
Outsourced Service: FOOD SERVICE

ITEM OK
Service Expected
I Provision of meals per day shall be given in three (3) meals and two (2) snacks.
I A cycle menu shall be provided and should contain a variety of meals and snacks
per day
I Meals and snacks should contain the following food items and serving portions:

A meal should contain the following:


Food items Serving portion

- Rice and alternatives 1


cup (160 g)
- Vegetable dish 1/2
cup (100 g)
- Meat/Fish/Chicken dish or viand 1
pc (80 g)*
- Dessert - preferably fruit 1
pc (50g)*

Beverage - water or fresh fruit juices 1 bottle/cup (250 g)*

*The amount of serving may vary depending on the type of food item.

A snack should contain the following:


Food item Serving portion

- Any of the following: bakery products 1


pc (50-1009)*
(e.g ensaymada, cheese roll, etc.),
sandwiches. rice porridge, pancit
noodles/pasta, kamote cue, turon, and
other food items applicable for healthy
snacks
- Beverage - water or fresh fruit juices 1 bottle/cup (250 g)*
*The amount of serving may vary depending on the type of food item.

Equipment! Supplies
I Disposable wares and utensils, preferably biodegradable utensils and wares for packaging
and distribution
I Food Trolly
I PPE for Food Distributors
Human Resource
I Food Distributors (if the facility has limited HR)
Documentary Requirements
I Service contract
I Sanitary permit
I Medical certificates of personnel
I Water analysis
I Mayor’s permit to operate.
Outsourced Service: LAUNDRY (For Linen and uniform of stafl)

ITEM OK

Service Expected
I Collection and Pick up of Laundry at the specified time
I Adherence to the CDC recommendation on Laundry Cycle* consisting of:
o Flush
0 MainWash
0 Bleaching"
o Rinsing
o Souring
I Protocols/ Contingencies for Delays in pick-up and delivery
I Protocols for Lost/ Damaged linen and uniforms collected
** The use of chlorine or oxygen-activated bleach shall be used during the bleaching cycle
* lfhot water cycle is used, the optimum temperature is at least 160°F (71°C) for a minimum of
25 min

Equipment/Supplies
I Separate bags for collecting linens of patients and Healthcare Workers
I PPE for personnel collecting linen and uniforms

Human Resources
I Personnel to collect laundry from the wards

Documentary Requirements
I Service contract
I Business permit
I Sanitary Permit
I Other permit as necessary
Outsourced Service: SECURITY and SAFETY

ITEM OK

Service Expected
I Safety and Security of the vicinity 24 hours a day/ 7 days a week

Equipment
I Communication devices on each post
I Guard Touring Monitor
I Side arm for Security guards manning the gates

Human Resources
I All security personnel shall be licensed and trained
At least 1 security personnel on each gate, entrance and exits of the facility
Dedicated roving security personnel outside the facility
Detachment Commander/ Supervisor

Documentary Requirements which may include but are not limited to


I Service contract
DOLE Registration
SSS. PAG-IBIG, Philhealth etc
SOSIA accreditation
Business permit
Outsourced Service: SANITATION, DISINFECTION, AND HEALTHCARE WASTE MANAGEMENT

lTEM OK

Services Expected
I Ensure that cleaning and disinfection of the facility is based on the prescribed schedule
per zone
- Contaminated Area: at least 4x a day
- Buffer and Sterile! Clean Zone: at least 2x daily
- Toilet and Bath: at least 2x daily
- Disinfection of frequently touched surfaces such as knobs, faucets, flush lever
after use
I Waste should be collected from all receptacles at least 4x a day
I Management of temporary storage area for waste generated in the facility
I Transport, treatment, and disposal of collected waste
Equipment! Supplies
I Standard Disinfectants
- 70% ethyl alcohol to disinfect small surface areas and equipment between
uses
- Sodium hypochlorite at 0.1% (1000 ppm) for disinfecting surfaces
- Sodium hypochlorite at 0.5% (5000 ppm) for disinfecting surfaces with blood or
bodily fluids spills (allowing 30 mins for the disinfectant to sit)
Provision for complete and appropriate PPE of utility personnel
Provision for waste bins with proper labels
Dedicated cleaning materials for each zone of the facility
Wheeled trolley for collection of waste

Human Resource
I Utility Personnel
I Training on the protocols/ standards for sanitation, disinfection and healthcare waste
management
I Training on proper donning and doffing of PPE

Documentary Requirements
I Service contract
Business permit
Sanitary Permit
Other permit as necessary