Dr. Antonio B. Ramos, manager of the Lung Center of the Philippines (LCP) Department of Administrative Services and resource speaker for the sixth episode of the University of the Philippines’ “STOP COVID DEATHS: Clinical Management Updates” webinar series held on May 29, talked about the LCP experience in promoting hospital personnel safety during the COVID-19 pandemic.
The LCP serves as the country’s premier hospital for the treatment of lung diseases and as a referral center for COVID-19 moderate to severe respiratory diseases. Dr. Ramos said their personnel are now using about 500 personal protective equipment (PPEs) per day due to the increasing number of patients over the past weeks, and the hospital is still stockpiling PPEs for appropriate personnel safety and patient care.
According to Dr. Ramos, the LCP decided to make personnel safety its priority. He further talked about the hospital’s incident command system, safety officer and zoning, infrastructure modifications, equipment, supplies, and personnel care.
The structure of the incident command system includes the hospital’s officers for public information, safety, liaison, planning, operations, logistics, finance, and sub units, taskforces (medical, triage, personnel), and teams under these main sections. They hold daily briefings at the incident post situated outside of the hospital buildings. This post maintains an open-air ventilation setup to prevent virus transmission among personnel.
Hospital zoning and safety policies
Dr. Ramos said the hospital was divided and labelled into “safety zones”, with the red colored zones indicating “very high risk” areas, orange for “high risk”, yellow for “medium risk”, and blue for “lower risk”. He said that “for red zones, hospital personnel must wear full PPEs with boots. For orange zones, they have to change PPEs every time they have to enter a new room since there they are not yet sure if the patients are COVID positive or negative. For yellow zones, the laboratories and radiology areas, they wear their face mask unless there is need to wear full PPE if procedures are done. For blue zones, all other areas of the LCP, they are required to wear their face mask. There are no green zones or safe zones.”
“Upon entering the hospital grounds, everyone must wear a face mask and regularly perform hand hygiene,” Dr. Ramos said. “There are colored signs, pictures, maps, instructions, and reminders posted in all corners and hallways of the complex to increase LCP personnel’s awareness. Medical and non-medical personnel are also segregated, wherein passageways and elevators are also designated to prevent possible contact and virus transmission among personnel,” he explained.
Modifications and innovations
According to Dr. Ramos, the LCP infrastructure modifications include the putting up of: CCTV cameras, patients’ monitors, translucent and plastic doors, controlling ACH (air change per hour), temporary plastic walls, donning and doffing areas, and other modifications. He elaborated that these modifications allow the hospital personnel to see and monitor their patients better, control flow of air, and prevent virus transmission. “Another advantage of the LCP architecture is that it has interconnected halls and corridors that allow a one-way flow of personnel” wherein the entry for one area is at one end while the exit is on the opposite end, he added.
Dr. Ramos described their COVID-19 ward: “The air is controlled, the supplies, equipment and other needed items are segregated, including the tables, trashcans and disinfectants that are adequately replenished after every shift.” The nurses’ station is equipped with monitors for displaying patients’ vital stats side by side with CCTV display to allow them to see the patients’ conditions. In the intensive care unit, the nurses can directly see the patients through a glass wall while computer monitors and CCTV also allow them to see the patients’ stats.
Among the tips mentioned during the webinar were: COVID-19 facilities should not have centralized air conditioning; hospitals should separate medical and non-medical personnel; and other (non-hospital) buildings must rethink the use of centralized air conditioning or recirculated air to prevent transmission of the virus.
In addition, Dr. Ramos said the LCP, together with their partners and donors, are attending to the healthcare workers’ needs for shelter, food, transportation, and psychosocial support. He said the temporary shelters donated to LCP have beds, toilets, showers, and Wi-Fi, and that they also have services for personnel haircut, manicure/pedicure. He added that the LCP, with a heightened sense of preparedness, is still accepting donated PPEs and ventilators for the hospital to be able to have a reliable supply of needed equipment in case there would be a surge of COVID-19 patients.
Safety officers and promoting a culture of safety
Dr. Ramos shared how their safety reminders and precautions for personnel extend outside the hospital grounds, to their homes and families. He said the LCP campaigns to maintain safety and awareness at all times. Their safety reminders feature detailed, step-by-step instructions for maintaining hand hygiene, eating habits, wearing and removing protective equipment, and other reminders for conducting daily activities under the “new normal”.
Dr. Ramos furthered that every hospital, all homes, and all businesses should have a safety officer. He said everybody should eventually imbibe the role of the safety officer, and that the safety officer of corporations should even be able to cite their CEO for any violation. While the zoning prevents the spread of viruses and the wastage of PPE worn by the healthcare personnel, he said the safety officers in every unit make sure that everyone in their unit is wearing proper PPE, practicing regular hand hygiene, and observing physical distancing. Safety officers have to guarantee that all the precautions and disinfection procedures are followed, even in the upkeep of equipment, air conditioning and for needed repairs.
Dr. Ramos emphasized that “the best way to take care of our patients is to take care of our health personnel.” He concluded his presentation with a reminder: “the bottom line is, if you cannot protect healthcare workers and they get sick, the whole system goes down.” This sums up the LCP prioritization for personnel safety.
UP webinar series
More than 250 participants from across the nation and even from abroad attended this webinar. This webinar was hosted by Dr. Raymond Francis Sarmiento of the National Telehealth Center, and Dr. Susan Pineda-Mercado of Philhealth. The video of this webinar is available at TVUP’s website and YouTube channel. The webinar series is made possible by the University of the Philippines, in partnership with the National Telehealth Center and the Philippine Health Insurance Corporation. It provides the country’s health professionals and clinicians a venue to share the best information on how to best manage COVID-19 cases and to protect the entire health system.
Upcoming webinar: The Cebu Experience