 Good day, viewers. Welcome to Kalosugan, Aykarapatan. I am Dr. Menchit Padilia, your host for today. This is part of a series of episodes on COVID-19. The COVID-19 pandemic, which has affected almost every country, has made many healthcare systems around the world operate at more than maximum capacity for many months now. As millions of people stay at home to minimize transmission of the virus, healthcare workers prepare to do the exact opposite. They go to the hospitals and other healthcare facilities, putting themselves at high risk from COVID-19. As a pandemic accelerates, access to personnel protective equipment for health workers has been a key concern. In the Philippines, an alarming number of healthcare workers infected with a new coronavirus rose to 1,619 as of April 30, 2020, counting to nearly 20% of the country's total COVID-19 cases. In this pandemic, healthcare workers are every country's most valuable resource. Hence, the safety of health workers must be ensured. We are with Dr. Regina Berba, Associate Professor of the Hittie College of Medicine and Chair of the Hospital Infection Control Unit of the Philippine General Hospital. This time, we will discuss protection at the hospitals. Good day, Dr. Nina. Welcome back to Kalusuganay Karapatan. Hello, everybody. Thank you for inviting me again. So last time, we talked about protecting oneself from COVID-19. This time, we are going to concentrate on protecting the health worker from COVID-19. But before we go to the details, can you give us a general definition of what protection is? So protection is like a series of strategies or a system that either a person and institution or a facility takes so that he can guard or defend vulnerable populations against something bad, okay? So I think today we will be talking about protection against the COVID-19 for healthcare workers. So let's start the discussion of Dr. Nina. So just how does one protect the health worker from COVID-19? Ram niyo, mamanchit. When we started off planning on a hospital level how we will deal with the COVID-19, mo'on coronavirus pataw sa kanya when we started planning this. You know, our number of beds we allotted for COVID-19 in CGH past only two. Yon niyo sabi namin, siguro tulang ang pupunta sa center natin kasi at the time, the risk factors were travel to certain countries. Anang ganyong initial risk factors. But then lo and behold, in a few weeks we were converted into a COVID-19 center. So it took a lot from, not just from the infection control and the infectious disease people, but it really took the whole hospital to plan to protect people from getting infected or have the transmission of the COVID-19 within our facility. So Yon, how do we protect? So it was a long series of careful planning, really trying to step up everything we could to really protect our own healthcare workers and our patients also. Okay, so we were talking about protecting the health worker and you gave a lot of insights on what hospital planning actually contributed to the whole protection plan, okay? For our viewers, I'd like you to know that Dr. Burbanina, Dr. Nina is in charge of coming up with the policies to protect only the patients but the health workers. For any kind of infection. So I'd like to ask now, Dr. Nina, what makes this infection so difficult or so different such that the measures that you put in to the hospital, into PGH are actually more comprehensive and more drastic compared to the past? Perhaps it's the degree of being very, very infectious. I think it's really highly contagious. So it takes very little for a person to get infected, to get the virus into oneself. Tapas, the presentation is also not very clear. Hindi ba katulad ng tuberculosis? Alam mo na na TB siya or dengay, alam mo na na dengay siya. But the COVID, it started off with symptoms that was like difficult to exactly pin-down. So there would be some patients you thought, ah, siguro hindi ko COVID pero will turn out to be COVID. So in that way, it was this this kind of infection is unique. It's highly contagious. So we needed really drastic measures in place para we couldn't leave anything to chance. We had to, we committed the PGH committed to admitting 130 beds, 130 patients na COVID positive kaagad. So we needed to plan this very carefully. And you know what, the caramanship everything we knew about infection control and infectious disease had to come in here to be able to design a good plan for our hospital. Okay, so as you said, now we had to bring to the table all the knowledge and all the things that we knew about infections and how to protect. But now there are different kinds of health workers in the hospital setting and like you to share with us the different levels of protection that we give the health workers within the hospital. So actually we there's like a hierarchy there's because of maybe the epidemics and the pandemics that the world has experienced there's already this kind of science of infection control. It starts off with engineering controls. So the very first thing we did to make sure that there's like just the whole building or the whole institution was to some degree had protection would be to be able to navigate the ventilation to control where the air was going to. Remember, this is a human-to-human transmission of infectious droplets. So kailangan kaya namin ima-new where it traffic where these droplets will go and that means planning the ventilation where the fans will be where the exos fans will go what windows were open and what windows were closed. So all of those were things that we had to put in place. The beds, the placement of the beds how far they were from each other parang pinuporgas namin a siguro yung infectious droplets pag umubutong paciente na to dapat hindi siya maka-up doon sa next bed. So we needed to position the beds kahit cohorting kasi cohorting is putting patients of the same dialysis together pero kahit magkakasama sila sa isang wide di sila mag-giging each person won't get affected or negatively affected by the people around them. So those are engineering controls. There were also administrative controls that meant we had to plan every meter of PGH sinabi namin, ito same zone, ito green. Ito red to masyado makasang possibility na makaka-covid ko nandito ka sa red. So we labeled all areas of the hospital so whenever a person was seen a particular part of the hospital nangyari na sa second floor siya ward 2 alam niya na ito dapat ang suit ko kasi na sa red zone na ko. Ah ito siya, pwede ko kumain dito kasi na sa green zone. So every part of the hospital each by each nilagyan namin niya ng label so that's part of administrative control and of course yung pa'yung visible sa public hindi atawag na personal protective equipment. So ito po yung on an individual basis nilibigyan natin bawat healthcare worker ng some amount of protection through barriers ang tawagyan. Barriers pwede yung hindi kumunta yung virus sa kanilang person. So takyan nina before we go to the PPEs I just want to highlight the point na the role of engineering if you're in a hospital setting it is crucial that administration recognizes the role of the engineering design if you will commit to a COVID hospital because that is actually a major component of protecting not only the patients but also the health workers. And that is a commitment that PGH committed to at the very beginning. So my question on that end is that since we don't know whether patients have COVID or no COVID should we really be shouldn't the hospitals be considering reviewing the engineering design of the other hospitals whether it's a COVID hospital or not? Mayan tinatawag na isolation facilities kailagang and before before all of this pandemic happened there's really the ideal setting which is really very difficult to get mahal mahiraphanapin yung equipment that is required to maintain the negative pressure na tinatawag but along the way we learned that there are ways to still be able to achieve good engineered centrally controlled kind of ventilation maaachieve mo rin yun pagisipin mo rin lang mabuti how things flow, maintaining na yung air will come from clean to dirty and panang biglang na tutunga kami doing to during the COVID pandemic of course guided by our engineers in the hospital so the answer to your question maa yes we need the guidance engineering experts kasi ito yung isa sa mga major controls and if you're able to maneuver enough the kind of ventilation and others within your hospital parang 50% siguro na protection is already achieved at that point that's good to know because our health workers in PGH will appreciate knowing that PGH planned it well by starting off looking at engineering design after COVID-19 so it's really nice to hear that there are major external factors that's contributing to protecting the health worker because if you read the newspaper you read the Facebook and the Viber you all hear about just PPE is the protection the PPE is the mass and so on but here you're saying that that's only half of the picture we have to make sure that the workplace is also safe for our health workers so I'd like to thank you for highlighting that point because for the hospital administrators who are watching our show I hope that they realize that we in administration have a major responsibility now let's talk to the PPEs that everybody's talking about the PPEs the lay people know what the PPEs are there's so much fun racing happening for the PPE but just tell us a little about what are PPEs what's the composition of the PPEs okay so PPEs tali sa kanila personal protective equipment it's these are equipment or mga gamyan na pwede iso they're meant to be barriers so that even if you're carrying up close patients who are very ill and very infectious the risk na you will get whatever they have is not that high in fact if you wear this properly dapat you're protected enough you have to believe in the science of PPEs I always tell my students the fellows the nurses when we were starting this nagiiyakan lahat ng tao ayoko ayoko ganito we had this I told them you just have to believe that all of this is science and all of this are meant to protect us hindi tayo mama matay lahat we are pouring so much effort and there's been so much resources donations help from all to come up with yun nga engineering administrative and all of these PPEs to protect the healthcare workers so let me pwede tayo describe wearing po ako nga ngalang mga gamit to show you exactly what PPEs are so ang we in PGH we tried to make it a little bit easier for everybody to understand so if you see in the YouTube may yung mga healthcare workers in China for example in other countries nakakasmap na cover all covered na cover sila hindi lahat ng tao in the hospital would need that it really depends on what the tasks you are supposed to do who you are caring for and the skills that you have that will all determine what kind of PPEs you will wear so for example na sa office ka lang so siyempre may mga office people kami the administrative people you don't need to wear the house mask we called at lowest risk or level one we called it in PGH level one and for that we just need the surgical mask so these are the surgical mask usually three clients we prefer the ones that are colored and you always wear the colored side palabas kasi the colored side is supposed to be fluid resistant so kahit na acingyang ka ng mga office mates mo may some degree of protection hindi mo siya manigina and there's like a small plastic here on top so that's the one you put over your nose so you want to wear them like this yan yan so good way to wear it is over your nose and then under your chin and all the way to the back okay so kung may choice kayo you'd like to wear to buy the three clients ayaw mo yung puti lang kasi sobrang may peace or if you're working in the hospital ayaw mo rin yung paper okay so this is level one okay ayaw mo rin na nandyan na nakakita ka nandyan naminsan wala, wala na protection when you put it under your chin sometimes people wear it like this this is also wrong kasi siyempre you'd like to also not breathe dirty air so that's what we purchased here and for example you're the person who's coughing na basay na yung mask mo two hours mo palang di na gamit pasang basay na paro mo na siya away safely aog mo siya kalat sa mga tables kasi siyempre kong contaminated na siya in the change into a new mask in the hospital setting unlike at home where we accept cloth masks if you're working in the hospital we prefer you to wear a surgical mask because in the hospital setting it's been said and experts would say that the level of protection is high enough you need a surgical mask okay so that's for office workers level two is low risk so that means you may be seeing patients pero they're not probably most likely covid patients so based on everything you know when you saw the patient hindi siya siguro covid it's fairly safe non-covid wards so green areas but you'd like to still have some protection so level two is a face mask and a face shield okay sometimes we can wear basa eye protection ang pre-no protect mo dito ay yung mucus membrane sa wear eye so kahit atsingyang kaulit ng paciente hindi siguro pukunta yung infectious infection so this is more like this and you can move around the cold day wearing the face mask ninsan mahilap lang makiming so you have to just increase the volume of your pose and listen a little bit more I like this one kasi we can clean it after use so hindi siya masyadong single use we just wipe it with alcohol there's some of us who are fortunate to have been given donations like this so they're more sturdy I like wearing this I don't need to remove it when you can't hear the patients anymore and you're outside the patients rooms you can just put up your shield and put it down again okay so we deliberately made level two for non-COVID areas kasi even if you inadvertently missed a diagnosis of COVID tapos napunta siya sa non-COVID where it is ito ka natinitig na siya the presence of wearing a face mask and the facial will protect you significantly and the risk of you getting the infection is still low we add that we add to that the fact na ngayon lahat ng patients namin sa PGH and should be the standard of care for all hospitals lahat ng patients dapat naka surgical masks okay we go to level three yung level three may three and four ka pa so what is level three level three and level four are for healthcare workers who work in the COVID wards okay so ang kaibahan lang nila ng level three at level four na ka coveralls na sila yung level three na ka down lang sila manaki yung difference sa price nila the amount of protection is probably the same so ang down parang ganito itura niya like this okay it's long sleeves it should protect your clothes underneath usually naka scrub suit ako ngayon naka scrub suit ako we require our doctors who will be entering the COVID wards to be in a hospital scrub suit which after duty they should remove also to be laundered by the hospital also so over the scrub suit is wearing the gown we also want them to wear the N95 mask so ito level two lang ko ang level three requires us to wear a certain N95 mask like this there are different brands already like ito pwede rin or sometimes they're shaped like this basa ang tawag sa kanila N95 in the US and in China they're called KN95 ngayon kasi parang may proliferation of fake masks so we made it our policy to fit test that means at finit test we make sure that the seal is effective there's an effective seal that is formed by the mask kahit na merong contaminated air around you, you probably won't inhale any of the viral particles so that's fit testing the N95 mask sometimes we care for our patients very up close na insan we think baka may additional materials that are maybe splash into the healthcare workers insan alam nyo yung mga nurses mga manoms mga nurse aides they really care for their patients up close parang kina carry nila chinachasin nila yung diapers pinapaliguan nila they're a very high risk contact type of of activity so nga add pa kami ng impermeable apron on top of the gowns to give added protection of course on top of all of this are again the face shields okay tapas the level 4 is the wearing of the coveralls so you see this in different colors insan we like iba ibang colors kasi na-identify namin ko siyung yung mga persons ko lab people, kula iblew filcare people kula iblew so this means almost the entire surface of the skin of the healthcare workers is covered so meri si lang food so covered yung ito na lang yung nakalabas pero with the face shield and the N95 wala na talaga matiti rada ba nakaganyan tapas na face n95 plus the food will cover the entire body this is again long sleeves with with the coveralls is pants all the way down to the shield level so the entire body of the healthcare worker is almost 100% covered okay yung that's it about PPEs there's this series of steps that are in place para step one and step two step three step four we need to make sure people know how to properly and doffing, removing of course by the time you leave the patient's bedside kung niya re, nakakover all ka, nga ba so the possibility na itong ating overall ay natalsika na nang mga infectious droplets is very high so by the time you leave the entire area of the COVID parang challenge din to remove this PPEs safely ilangan in the process of docking it may mong mag-contaminate yourself with things that are already in your clogging so donning and docking the PPEs are a skill by itself sacrifice in a way kasi sobrang init sa Pilipinas na init din naman aircon yung hospital natin even if there are a lot of fans so they really need this PPEs but they need to just tolerate them kasi protection it's their lifeline and again removing them again is a challenge so anong ginawan namin sa PGH we set up dun sa donning merong kami exact donning and docking places so dun sa donning may mga posters so everybody knew or prior to all of this pala meron na sila mga videos na pinanood power points lectures ganyan apas meron pang guide while they are in the areas and then number three we had safety officers so safety officers I think baka PGH lang yung nag-umpisan ng concept nato dito at least during the COVID pandemic in the Pilipinas and it's been kept them in place and we have actually added more safety officers any safety officer siya yung naka anong siya mga doctor dintang mga residents usually derma rehab gagaling nila kasi they've mastered the donning and the docking pinapanood nila yung bad health care worker and making sure that they do it correctly again they don't give anything to chance yun that complete, walang na miss walang na iwan, tama yung process and the likelihood of transmission is slow yun ang galingan ng mga derma safety officers na remission kikita pa nila yung mga doka kailangan ka ng mag-add ng lotion or additional skin tips kasi when you're inside the PPEs for eight hours kasi yung eight hours shifts namin by the time you leave panang nasira na talaga yung skin mo with all the tips that you put to keep yourself to keep the PPEs in place so yun, these are the things we've tried to do to protect the health care workers on the PPEs side just your description can vividly show us how difficult it is to become a frontliner and the sacrifice of having to go through the PPE as a safety measure even actually emphasize as the role of the team in administration and your committee in making this happen so I do want to commend your HIKO it's actually for the viewers this is the hospital infection control unit and before the before the pandemic she was already in charge of this ansabi nga yan nyo e talagang kiba, no, it's drastic and we had to think of all the possibilities to even add protection to our health workers Dila Dr. Nina, I have another question for you because this has been asked many times so when do you test a health worker because I know that not all health workers are tested so what is our criteria for testing? Despite all the measures you do parang meron paring pwede magkasakiyap mo so what we do we've set up also part of the administrative controls believe it or not we actually gave our staff a quarantine period each time they work so for example we divided everybody into three teams so team A team B, team C and each of the teams who work only for 10 consecutive dila na 14 days and this is based on the incubation period of the virus but you can't skip the team days after your last exposure okay ka na, so that's the principle behind this parang paradoxical because we need many people putting people at long quarantine periods and putting them only but we found out that it really helps because for one na rejuvenate because it's so good na I think it's not just the physical aspect of going on duty yung 8 hours pa nandon it's probably also mentally very difficult psychologically and everything else emotionally so they just go to Donning sa sarili na na yung atsigaya napat physically ready ka kumain ka na, pumunta ka na sa baan yung kasi ang mahal mahal ppp kaya namin na after 10 minutes lalobos ka, di tatanggali mo sa ulit and desayang lahat na so we'd like them to try to make it 4 hours to 8 hours na nagsacrify sila talaga na 8 hours yung na yung di makasirap mo na kasi hindi ka na pa nandon talaga for 8 straight hours yung you need to be physically mentally, psychologically ready yung mga girls sinigas yung nags na make up pa lahat natin kasi mag sisiira yung mas we'd like to protect the mas wala ng jeweling pa kahit naan ko kasi masisipa makunit yung mga PPEs and I think the biggest sacrifice is the cell phone because we didn't allow the cell phone inside the COVID areas na walang tataguhan mas madudumihan I think that's the biggest sacrifice for 8 hours to imagine people without their cell phones it's very difficult but again moment shit I'd like to just I think I'd like to share this also yung PPE part parang nescience yun kailangan ganito ha kailangan sa sabi namin this is how to increase service per transmission but alam na yung mga nurses namin kasi pag nakapul battle di mo nang makilala yung mga poway to keep the personal touch liberation naglalagay sila ng mga photos nila dito or smiling face nila nila yung names nila sa mga hazmats nila parang they can still connect with their patients which I thought was didn't teach them this but out of their own parang they felt the need to reach out to very lonely patients I think lonely yung patients kasi walang kumakusap sa kanil at tapos at sila wala family nila but our nurses and the doctors they go out of their way despite the risk they try to help this patient I thought that was very good to add on Thank you Dr. Nina I mean you know such a very unique way of adding protection the one week and two weeks off or the front liners you're right it's not just the physical thing but the psychological way of getting back to hard work maki talagang panahon natin Dr. Berba but in that mix give your final sage to the health workers and also to the hospital administrators because feeling you know with this episode you've got two big groups that we really want to address let's start with the health workers Actually I wasn't able to answer your question about the testing so the healthcare workers our goal is to of course to the hospital community are the reason we are there are really for the patients to care for them kahit na sobrang sakit nila atang sobrang infectious nilang so they're really a risk to us this is our work this is our job this is what we committed to this clinic and what we want to do so let's do it well as I said let's believe in the science of the PPEs we think this will work and it's been working and just really hang in there and I'm sure together we'll be able to um ah hindi ko pa rin nasagad yung tanang sa testing so if during the quarantine yung 14 days that they are on rest they develop any kind of symptom kahit ano kahit na very mild sipons or fruit ed a nga yung nasakit na mas or hindi nga kong mga medyo ordinary for that particular healthcare worker then we go ahead and test them ataw din self monitoring we give them a form to be a physical form or an online form to check on them every day the UPH does that tapas kung at any point there's any doubt na nga kasakit siya maybe she got something so we test them right away okay thank you and just a few words one short message to our hospital administrators so the the whole covid pandemic challenge really took the entire PGH administration community and i think it really brought the best out of us individually and collectively panang naging yung bayanihan spirit was so visibly there you could feel it talaga and it's very inspiring to be part of that theme so gunon din i hope that feeling but to just continue working getting control this but we're one of the systems as a hospital working towards that and with all the other systems in our country surely and globally we'll be able to make it there so thank you thank you Dr. Aninya for giving us your on how to protect the health worker and well we thank you for having a second episode with us and hopefully post gcq and by the time we have the gcq we'll have another opportunity to have you as our guest thank you very much healthcare workers around the world at the front line of the battle the occupational safety and health of healthcare workers is fundamental to enable them to do their jobs during this crisis their protection must be a priority to ensure their safety advocate provision of pp is just the first step our other practical measures to ensure psychological support this is menchit padilia this is kalosugan ay karapatan