Organization
Bataan General Hospital and Medical Center
Best Practice Focus Area/s
Strategy, Citizens / Customers, Operations
Year Implemented
16 April 2020
This is a GBPR Entry
Summary
The Bataan General Hospital and Medical Center have managed the outbreak in the hospital by taking appropriate measures to control the transmission of COVID-19 within and outside the hospital, such as quarantining all employees, in-patients, and watchers who were inside BGHMC at the time of recognition of the problem wherein strict quarantine house rules were implemented, risk stratification was used as a tool for cohorting the employees and also food, accommodation, and PPEs were provided for all.
Background and Problem
On 13 March 2020, the first COVID-19 patient was admitted to BGHMC, followed by another five (5) confirmed COVID-19 patients in the succeeding days. However, despite strict observance of infection control protocol, the hospital management has decided to optimize its operations due to the increased number of its health workers infected by COVID-19. Said optimization is necessary to prevent further virus transmission between and among the hospital staff and community. As of April 27, 2020, twenty medical doctors, eighteen nurses, nine nursing attendants, three respiratory therapists, two physical therapists, and three support personnel tested positive for COVID-19. The management has conducted Root Cause Analysis (RCA) to determine the reasons behind the increased healthcare worker infection based on four categories, namely: materials (PPE supplies & resources), workforce, methods (policy & management), and mother nature (environmental factors).
For the materials, the following problems were identified: scarcity and poor quality of personal protective equipment, prolonged usage of PPEs, inappropriate donning and doffing procedures, and misleading guidelines on the use of PPEs. For the workforce, the problems identified were community-acquired COVID-19 infection, traveling and commuting, other hospital-acquired COVID-19 infection, a breach in infection prevention and control protocol, and no strategic workforce and response team for COVID-19 patients. On methods, the identified problems were delayed COVID-19 test results, insufficient infrastructure/facilities for a pandemic, such as isolation rooms, and no zoning. Lastly, environmental factors causing increased healthcare worker infection are non-disclosure of patient’s travel history and exposure, non-disclosure of patient’s symptoms, uncontrolled movement of watchers and visitors, and lack of awareness on COVID-19. Another challenge came when the Bataan IATF designated BGHMC as a referral hospital for COVID-19 cases only in the province, effective on 17 April 2020.
Solution and Impact
A task group was created to optimize the BGHMC’s operations and response on COVID-19, spearheaded by the designated Responsible Official and the Incident Command Officer/Operations Officer. The task group is composed of different hospital personnel or section heads who act as the following: COVID-19 Point Person, Liaison Officer, Operation Center Data Manager, Communications / Press Release, Donning & Doffing Officer, Infection Control Officer, Surveillance Officer, Medical Management, Ancillary Management, PCR Lab Accreditation & Management, Quarantine Officer, Contact Tracing Officer & Swabbing, Rapid Test Approval, Dormitory / Hotel / Transportation, Discharge Officer Manager, Logistics Point Person–receiving, Logistics Management, Finance & Food Manager, Physical lay-out, ICT Officer and Workforce monitoring. The group regularly meets at 9:00 AM to discuss the day’s objectives, assign tasks and gather updates from each point person.
During this COVID-19 pandemic, the task group decided on six (6) objectives in crafting policies, namely:
- Provide quality treatment for all BGHMC employees and patients positive for COVID-19;
- Control transmission within BGHMC;
- Control transmission outside BGHMC,
- Operationalize a BSL 2 / PCR Laboratory;
- Set up BGHMC annex at capitol compound; and
- Ensure continuity of Residency Training Programs.
These six objectives were also the strategic functions of BGHMC personnel for July to December 2020 as far as the Individual Performance Commitment Review (IPCR) is concerned.
For the first objective, which is to provide quality treatment for all BGHMC employees and patients positive for COVID-19, BGHMC is using the guidelines given by the Philippine Society for Microbiology and Infectious Diseases in managing patients who are probable or confirmed with COVID-19. All confirmed COVID-19 employees who were admitted to the hospital were fully recovered, which is also the same as the admitted COVID-19 patients except only for the one recorded death as a severe case of COVID-19 as of 30 June 2020.
For the second and third objectives, controlling transmission within and outside BGHMC, the task group implemented a strict quarantine protocol wherein the Lead Quarantine Officer and Quarantine Point Persons were designated for every housing area occupied by the BGHMC employees.
The task group also designated donning and doffing officers who supervise the health workers every time they don and doff PPEs. The hospital is also implementing the three stages of cleaning and disinfection, which start with the air and surface disinfection machine, followed by manual cleaning and decontamination, then the UV-C disinfection procedure.
For the fourth objective, operationalizing a BSL 2/PCR Laboratory, BGHMC, in partnership with the Provincial Government of Bataan, successfully launched the 1Bataan-BGHMC PCR Laboratory, one of the DOH-accredited COVID-19 testing centers in the country last 11 June 2020, at the Provincial Health Office compound. It can accommodate and test up to 200 swab specimens daily, and the results will be released within 2-3 days. Aside from this, BGHMC was licensed by the DOH as a hospital-based laboratory that can perform independent testing for COVID-19 (SARS-CoV-2) through Rapid PCR Testing (Xpert Xpress SARS-Cov-2) last 27 May 2020.
For the fifth objective, which is to set up the BGHMC annex at the capitol compound, BGHMC successfully opened its annex ward to the public located at the Old Provincial Capitol building last 16 June 2020. This annex ward of BGHMC is just 200 meters from the main BGHMC, and its main objective is to provide a COVID-free environment for patients to minimize the risk of exposure to COVID-19 suspected and confirmed cases. It has a 50-bed capacity dedicated for Obstetrics-Gynecology (20), Pediatrics (10), Internal Medicine (10) and Surgery (10).
The last objective is the continuity of the hospital’s different accredited residency training programs, which include Anesthesiology, Family and Community Medicine, Internal Medicine, Pediatrics and Surgery. Each clinical department made several efforts to address the training needs of their respective residents, such as having a regular webinar with the consultants, etc.
Other measures implemented were repurposing or reassignment of the workforce to other areas (Physical Therapists, Dentists and Administrative staff with RN licenses), skeletal workforce or flexibility in government hours aside from job rotation, constant communication with the employees, timely grant of financial benefits, recognition of the heroism of all infected health workers, extra special care for the infected ones and also, most importantly, the enhanced infection prevention and control measures.
Milestones/Next Steps
Mass testing was also done among the high-risk population, especially those exposed to a confirmed COVID-19 patient or employee. Those who were symptomatic but not confirmed with a test were isolated and treated accordingly, while those who already had a positive PCR result were admitted in cohort. The cases in the wards were also revisited, wherein a step-down protocol was implemented for those asymptomatic with at least one negative PCR result to complete the 14-day quarantine.
The cases in the wards were also revisited, wherein a step-down protocol was implemented for those asymptomatic with at least one negative PCR result to complete the 14-day quarantine. Other measures implemented were repurposing or reassigning the workforce to other areas (Physical Therapists, Dentists, and Administrative staff with RN licenses), skeletal workforce or flexibility in government hours aside from job rotation, constant communication with the employees, timely grant of financial benefits, recognition of the heroism of all infected health workers, extra special care for the infected ones and also most importantly, the enhanced infection prevention and control measures.
For the new BGHMC Annex, admission is guided by the bed tracker system to determine vacancy prior before making referrals from different health facilities, which shall be coordinated via BGHMC Service Delivery Network (SDN) Online Referral System, which avoids overcrowding in the new facility and ensures high-priority patients can be admitted. The BGHMC SDN Online Referral System was one of 10 best practices from the public sector that received accolades at the Government Best Practice Recognition 2020.