Space crunch: How this Philippine hospital overcame an isolation space shortage

The huge surge of COVID-19 cases over the past year meant hospitals needed to create isolation spaces quickly, while ensuring strict infection control. We speak to St Luke’s Medical Center, Quezon City, on their experience

The unprecedented scale of COVID-19 caught the world by surprise last year, and sent many hospitals around the world scrambling to carve out sufficient isolation space in their facilities, to segregate those with the virus away from those without.

This was the case in the Philippines as well, says Ms Arnefelina S. Tamayo, Infection Control Service Department Manager at St. Luke’s Medical Center, Quezon City (SLMC-QC) in the Philippines.

“Every hospital in the Philippines has isolation rooms, but it is not a good number… it is usually less than 10 rooms per hospital,” says Ms Tamayo.

The need for more isolation space intensified in July 2020, when the Philippine Department of Health issued a mandate for private hospitals to allocate 20% of their beds to COVID-19 patients. Hospitals thus needed to quickly set up segregation measures to ensure COVID-19 and non-COVID-19 patients can be cared for safely in the facility.

Infection control at top of mind

infection control
Infection control team at SLMC-QC

At SLMC-QC, Ms Tamayo reveals that over 100 private rooms were converted to isolation rooms that were dedicated for COVID-19 patients, spread over four floors. Temporary barriers and doors were constructed to separate them from other areas.

Ms Tamayo shares that the construction was undertaken by the in-house engineering team. About two days to a week is needed to convert an area of about 15 to 20 beds, including planning and actual construction works.

“Collaboration meetings were held between infection control, engineering teams and the managers, where we decide where we install each door and barrier,” she says.

Public and patient safety was top of mind during this process. It was paramount to mitigate the risk of cross-infection to non-COVID patients and healthcare workers.

To this end, Ms Tamayo explains that the team constructed three zones, each separated by a door, which healthcare workers need to pass through to enter or exit the COVID-19 wards.

The first is the “Cold” or clean zone, where workers don their PPEs from a sterile stockpile. This is followed by the “Warm” zone, where they perform their hand hygiene regime; and for those exiting COVID-19 wards, this is where they doff and dispose of their PPEs and take their showers.

The last zone is the “Hot” or contaminated zone, where the patients are housed, and bed-side interactions, diagnostics and so on are conducted.

This process flow minimises the possibility of the virus being inadvertently carried out to the other parts of the hospital.

Challenges faced

The addition of isolation capacity at SLMC-QC were completed in early 2021, but the process was not without its challenges.

Such conversions were costly, says Ms Tamayo candidly, and put a strain on already stretched manpower resources. In addition, she points out that space is a constraint that many hospitals in Metro Manila, a densely built metropolis, are facing.

“For many hospitals, there is just not a lot of space around to expand… some may be next to buildings,” she notes. This limits their ability to construct additional capacity, an issue that traces back to hospital planning and design done decades ago, during which officials in charge did not anticipate pandemics of a scale like COVID-19. Thus, the only solution was to convert existing beds into isolation beds, which cuts into capacity to manage non-COVID-19 patients. Many hospitals in Manila have built temporary tents outside their facilities for triaging and holding areas for patients pending their COVID test results.

Another challenge was in communications with patients on the construction work. Some patients and visitors complained about the construction noise, and how it “added stress” to them, says Ms Tamayo. There was also the need to explain the new processes and protocols to patients and their family members, and to assure them that comprehensive safety measures are in place to safeguard their well-being.

This was the case for communications with staff as well. With workload and stress levels at all-time high, some staff initially saw the three zones as additional, time-consuming steps they had to take.

“But later on, when they see the purpose behind putting up those zones, they see that this is all for their safety. Now, after they exit the COVID wards, (going through the zones) make them feel like they are decontaminated from the exposure in the COVID wards,” Ms Tamayo adds.

The pandemic as an opportunity for growth

While the past year has been a challenging one full of ups and downs, Ms Tamayo personally believes that it has been an opportunity for learning and growth for healthcare professionals like herself.

“Firstly, it is important to stick to the basics. Even if the hospital has state-of-the-art technology – if you don’t have proper cleaning and disinfection, for example in high-touch areas – infection control will not be effective,” she emphasises.

She is also keenly aware of how the role of healthcare staff has grown over the pandemic, and thus encourages healthcare staff to be “influencers and advocates” of good public health behaviours, such as proper hand hygiene, to the people around them; and for infection control workers to stand their ground in “doing the right thing” – so they can contribute to better health outcomes in the future.

She views COVID-19 as an opportune time to educate children on hygiene and safety measures. With many of them growing up donning masks and taught hand washing techniques, the healthcare industry can ride the momentum to further inculcate healthy habits and basic concepts of disease prevention and control – which would bode well for the future generation.

The pandemic has also driven home the importance of building sufficient isolation capacity in hospitals – or at least having a plan in place to convert and create capacity rapidly in times of need. After this experience, isolation space is set to hold a greater role in the risk management and emergency planning functions at hospitals such as SLMC-QC – a silver lining, in ensuring that hospitals will be more prepared to manage future outbreaks and pandemics.

About Arnefelina S. Tamayo

Ms Arnefelina S. Tamayo is the Infection Control Service Department Manager at St. Luke’s Medical Center, Quezon City in the Philippines. She has 25 years of experience in the healthcare sector, and is a member of several national organisations, including Philippine Hospital Infection Control Nurses Association (PHICNA) and Philippine Hospital Control Society (PHICS). She is also President of the Philippine Association of Central Sterile Supply Management Inc. (PACSSM). She holds a Master of Arts in Nursing Administration (MAN) and Medical – Surgical Nursing (MSN) from Trinity University of Asia (TUA). She is also a member of different international Infection Control Organisations like International Society for Infectious Disease (ISID), International Association of Healthcare Central Sterilization Material Management (IAHSMM), and she is a member and 2019 International Ambassador of Society of Healthcare Epidemiology of America (SHEA).