IPCC’s Fundamental Best Practices
By Ruth C. Doligon, MD
Dr. Ruth C. Doligon is an Internist specializing in Infectious Diseases. She is the Chair of the Infection Prevention and Control Committee of VRPMC. Dr. Doligon is the COVID core team lead during the pandemic. With her exceptional skills, knowledge, and dedication to fight Covid, she stood up and helped everyone at her utmost capability. She facilitated planning sessions and town hall meetings to disseminate information on infection prevention and control and safety protocols for patients and healthcare workers. Dr. Doligon received her Medicine Degree from the University of Santo Tomas. She is a Fellow of the Philippine College of Physicians and Diplomate of the Philippine Society of Microbiology and Infectious Diseases.
When the cases of COVID-19 surged in the Philippines in March 2020, the government put the nation into lockdown. Fears, anxiety, and insecurity sheathed every Filipino. Every day was uncertain. Although every one of us has our way of battling the wrath of the pandemic, I cannot fathom the bravery and courage that VRPMC’s frontliners showed to contain the pandemic, nevertheless gave exceptional patient care.
Being part of the hospital’s Infection Prevention and Control Committee (IPCC), protecting the employees, healthcare workers, and the patients was a tough grind and still is. Confronted with an unseen and unknown virus (at that time) was both a physical and mental challenge.
The IPCC reviewed all literature sources from international and local societies concerning control of transmission of SarsCOV-2 virus and came up with best practices which we started implementing in VRPMC:
- Establishing an effective triage system for early screening and recognition of COVID-related symptoms and immediate isolation or containment protocol. The system appropriately separates patients in the Emergency Department and controls foot traffic. Healthcare workers and employees also have to undergo the daily symptoms check before reporting to duties.
- Wearing appropriate personal protective equipment (PPE). World Health Organization (WHO) affirmed that the SarsCOV-2 virus is transmitted via droplets, and additional contact and airborne precaution may be applied if necessary. Wearing a medical mask and face shield at all times was strictly implemented in VRPMC. No mask and No-Faceshield, No Entry. Frontliners attending to suspected and confirmed COVID cases were trained on appropriate PPE, specifically donning and doffing.
- Cohorting patients to minimize cross-contamination. There were designated floors or wards for COVID and non-COVID cases with dedicated HCWs per floor. Medical equipment exclusive for these patients were made available.
- Strengthening disinfection and sanitation protocol. The housekeeping section’s roles and duties were equally important as the frontliners. They ensure that our hospital is a safe place for patients and employees. Alcohol rubs and hand washing areas are easily accessible to everyone.
- Encouraging telemedicine over the face-to-face consult. During the lockdown, doctors’ clinics were also temporarily closed. Doctors signed up for E-Konsulta telemedicine, which became the norm during Enhance Community Quarantine (ECQ) until we transitioned with partial Balik-Klinik face-to-face outpatient consults.
- Posting infographics in visible areas as constant reminders and hospital-wide voice reminders every three hours – to wear face masks and face shields, handwash, and observe physical distancing.
- Observing physical distancing at all times. One-companion per patient, clinic consult by appointment only, limited number of elevator passengers, no social gathering, no loitering, and no eating-together in the pantry for HCW on-duty.
This COVID-19 pandemic continuously gives us new experiences and challenges, yet it also teaches us to be resilient and adaptive. These best practices are continually evolving as we journey into the new normal to contain the transmission and significantly decrease exposure to the virus.
The end is not far away, and we see hope in the forthcoming effective vaccines. While waiting to get our vaccine shot, we continue to remind everyone of our ethical responsibility to ourselves and our fellow Filipinos.
Department of Health
Philippine Society for Microbiology and Infectious Diseases
CENTER STAGE: DEPARTMENT OF INTERNAL MEDICINE
By Prescillano V. Zamora
Dr. Prescillano Zamora, Jr, is the Chairman of the Department of Internal Medicine of VRP Medical Center. He has been an Active Consultant of VRPMC for 13 years now. He graduated with a Medicine Degree from the University of the Philippines Manila and had his training and practice at UP-PGH Department of Internal Medicine – Pulmonology Section. During the COVID-19 pandemic, he was one of the key players of the core team of doctors who helped formulate the Covid guidelines for VRPMC. The core COVID team continuously updates and integrates new protocols to provide safe and quality care amidst the pandemic.
In February 2020, when the Department of Health reported the first few cases of COVID-19 in the Philippines, our Internal Medicine Department started to monitor the situation to prepare infection control and management protocols. We had staff meetings wherein our infectious disease specialist gave updates about the virus based on the Department of Health and World Health Organization advisories. The medical staff members started implementing infection control measures, including social distancing, proper handwashing, and proper donning and doffing of personal protective equipment.
Early in March 2020, there was a sudden surge of patients suffering from respiratory problems. We felt overwhelmed as there was insufficient information on how the virus behaves and how to deal with it. We had an inadequate supply of testing kits and personal protective equipment, and treatment options were all experimental. There was simply a lot of uncertainty at that time with mounting tension and anxiety. We were encroached by fear for the fate of our patients, ourselves, and our loved ones.
We then had our first suspect case of NCOV in the hospital who eventually turned out confirmed of SARS COV2 after more than a week from testing. Some of our resident physicians got exposed after carrying out emergency procedures to stabilize the index patient’s condition. Eventually, 15 out of the 18 resident physicians became symptomatic in five days. They underwent COVID RT-PCR testing and were quarantined in the hospital facility provided by the management. At this time, the IM consultants took turns going on duty in the Intensive Care Unit, General Wards, and Emergency Department. Consultants and residents from the other clinical departments (Obstetrics and Gynecology, Pediatrics and Surgery) offered the much-needed assistance by augmenting the workforce in the Emergency Department and triage areas.
Most of the residents had mild symptoms. Results of COVID RT PCR tests usually took at least seven days to be released, contributing significantly to staffing assignments difficulties. There were two confirmed cases among the residents. Our chief resident had mild symptoms and recovered after two weeks. Our 2nd-year resident, who went on duty in the Emergency Department during the surge of COVID-19 cases, deteriorated and became critical on her second week of illness. She eventually needed invasive mechanical ventilation and spent almost one month in the Intensive Care Unit and another month for recovery.
Indeed, the situation was dire, but our healthcare team received much-needed encouragement from our VRPMC family, friends, and donors to rise to the challenge. Donations and support came in different forms – food, PPEs, cash donations for supplies, thoughtful words, kindhearted gestures, and prayers.
As clinicians directly involved in the care of COVID cases, we witnessed patients crash right before our eyes, succumb to respiratory failure and multiple organ dysfunction despite our best efforts. We organized COVID Teams to maximize collaboration among members of the healthcare team, to implement appropriate management plans, and hope to achieve better outcomes for our patients. The COVID team is primarily composed of infectious disease specialists, pulmonologists, intensivists, and other specialists, depending on the case. We also consulted our colleagues and mentors from specialty societies and other institutions struggling to cope with the situation. There was a blast of interaction virtually as everybody was desperate to look for answers and solutions.
During the first few months of the pandemic, since we were on group practice, a pulmonologist in VRPMC would usually do rounds on 15-20 patients who were Suspect, Probable, and Confirmed cases in the ICU and wards. As we returned to regular practice, we usually see 3 to 5 admitted COVID cases.
Admittedly, the battle against COVID-19 is not over yet. The coming of the COVID-19 vaccine in the Philippines will help reduce the cases. Still, it should not become an excuse to be passive and to relax because it will take a year or more to achieve the target population for immunization.
Our team will continue to study, learn from the cases that we handle, and work together to fight against this virus. We look forward to seeing the mortality rate decreasing significantly from the current 26% down to nil.
FAST TALK WITH DR. BERNADETTE SELUDO
Dra. Bernadette T. Seludo has been an Active Consultant for Adult Infectious Diseases at VRPMC for ten years. She is currently the Adviser of the Infection Prevention and Control Committee and Chair of the Covid vaccination team of VRPMC. She is now the team lead in the formulation of guidelines of VRP Covid vaccination. Dr. Seludo is a former President of the Philippine Hospital Infection Control Society and a Medical Attaché at the Philippine Consulate Hongkong SAR. Dr. Seludo took her Master’s Degree in Public Health at UP Open University and Postgraduate Studies on Adult Infectious Diseases at Harvard University.
In the light of the COVID-19 pandemic, Dr. Bernadette T. Seludo readily answered our questions about her experience dealing with the crisis being part of the COVID core team of doctors in VRPMC. Her extensive knowledge of infection control undoubtedly contributed to the planning and execution of clinical practice guidelines during the COVID pandemic.
1. What types of doctors compose the COVID team in VRPMC
Multispecialty-Infectious Disease Specialist or Infection Control Practitioner, Pulmonologist, Cardiologist, Intensivist and Nephrologist
2. How and in what way did VRP doctors respond at the onset of the pandemic?
By creating the COVID Team, activating the Infection Prevention and Control Committee, developing and formulating Policies and Guidelines against COVID 19 Infection, and educating and training all frontliners and healthcare workers.
3. How was it like during the first couple of months of the pandemic in VRP?
There were anxious moments and difficulties in managing COVID 19 infection cases because it’s a novel deadly infection with no specific treatment.
4. How many COVID patients do you usually attend to in a day?
At the height of the pandemic, it was like 15-20 patients a day.
5. Which month last year had the highest number of COVID patients in VRP?
From the surge in March until May 2020
6. What is a typical day for you as an attending physician of COVID patients?
I do the daily treadmill for endurance before making my COVID rounds.
7. What is the most challenging part of being a physician of COVID patients?
When I make my regular rounds and then talk to the patients about their condition and update their immediate family about it, especially in critical cases.
8. What is the most rewarding part of being a physician of COVID patients?
Saving the lives of patients with severe to critical COVID 19 Pneumonia.
9. How do you protect yourself and your family and household as a frontliner?
Prayers, proper donning and doffing of PPEs and strict adherence to COVID 19 health protocols.
10. What are the sacrifices you’ve embraced being a COVID warrior?
No travels, no vacation since the start of lockdown, no hugs, and kisses for my immediate family.
11. What has changed in your life since you become part of the COVID Team?
I became more prayerful.
12. How do you and your team fight the battle against COVID?
With faith and doing the best of what you can to save patients’ lives with severe to critical Covid infection.
13. Who and what do you want to thank for amidst the pandemic?
I thank God, my family, my friends, and the people who believed in me that I could do it.
14.How do you see 2021 as far as the health landscape is concerned?
Better and hopeful because the vaccines against COVID 19 infection are coming.
15. Has the curve already flattened? Why or why not?
No, it’s like a rollercoaster ride; sometimes, it’s up and down.
16. Is the vaccine the answer to COVID? What is your recommendation related to COVID vaccines?
Definitely yes. I recommend all the available COVID vaccines available on the market
17. Your special message to the public related to COVID and this pandemic?
BEAT COVID BE VACCINATED