DECISION

PROMULGATION OF "INTERIM GUIDANCE FOR COVID-19 QUARANTINE AT HEALTH FACILITIES”

MINISTER OF HEALTH

Pursuant to the Law on Prevention and Control of Infectious Diseases dated November 21, 2007;

Pursuant to the Government's Decree No. 101/2010/ND-CP , which elaborates some Articles on quarantine, quarantine enforcement and epidemic control of the Law on Prevention and treatment of infectious diseases;

Pursuant to the Government's Decree No. 75/2017/ND-CP dated June 20, 2017 defining functions, tasks, entitlements and organizational structure of the Ministry of Health;

Pursuant to the Prime Minister’s Directive No. 16/CT-TTg dated March 31, 2020 on implementation urgent measures for prevention and control of COVID-19;

Pursuant to the Prime Minister’s Decision No. 447/QD-TTg dated April 01, 2020 on Covid-19 epidemic declaration.

At the request of Director of Health Environment Management Agency – the Ministry of Health,

DECIDES:

Article 1. The "Interim Guidance for Covid-19 quarantine at health facilities” is promulgated together with this Decision.

Article 2. The "Interim Guidance for Covid-19 quarantine at health facilities” shall apply to health facilities nationwide.

Article 3. This Decision comes into force from the day on which it is signed.

Article 4. Chief of the Ministry Office, the Ministerial Chief Inspector, Directors of Departments of the Ministry of Health; heads of public service providers affiliated to the Ministry of Health; Directors of Provincial Departments of Health; heads of health departments of other ministries and relevant units are responsible for implementation of this Decision./.

INTERIM GUIDANCE

FOR COVID-19 QUARANTINE AT HEALTH FACILITIES
(Promulgated together with Decision No. 1551/QD-BYT dated April 03, 2020 of the Minister of Health)

A. PURPOSES AND SCOPE

I. PURPOSES

Containment and quarantine the area that has a confirmed case of Covid-19 infection within a health facility to prevent transmission in other areas of the health facility and the community.

Confirmed cases may include health workers, inpatients, carers, attendants, visitors and students learning at the health facility.

II. SCOPE

1. This guidance shall be applied when a ward/department or the entire health facility has to undergo quarantine.

2. This guidance does not apply to establishment of quarantine areas and quarantine rooms specified in the Guidance on Prevention and Control of Covid-19 infection enclosed with Decision No. 468/QD-BYT dated 19/02/2020 (hereinafter referred to as “Decision No. 468/QD-BYT").

B. LEGAL BASIS

- The Law on Prevention and Control of Infectious Diseases 2007.

- The Government's Decree No. 101/2010/ND-CP , which elaborates some Articles on quarantine, quarantine enforcement and epidemic control of the Law on Prevention and treatment of infectious diseases.

C. RULES

1. Quarantine shall be immediately carried out when a confirmed case is found at the health facility.

2. Ensure safety and maintain medical examination and treatment of inpatients at the health facility.

3. Prevent transmission of the disease during the quarantine period.

D. CLASSIFICATION OF QUARANTINED PEOPLE

1. The confirmed case shall be promptly moved to the quarantine area or quarantine room established in accordance with Decision No. 468/QD-BYT , or to another health facility that is assigned to treat Covid-19 patients by the National or Provincial Steering Committee for Covid-19 Control.

2. The inpatients and carers of seriously-ill patients who are not at risk of Covid-19 infection shall be moved to other wards/departments that are protected from infection or to other health facilities for continued treatment.

3. The inpatients and carers of seriously-ill patients who are at risk of Covid-19 infection shall be quarantined at their wards/departments or another area in the same health facility.

4. Managers, specialists, health workers ((hereinafter referred to as “health workers”) at risk of Covid-19 infection shall be:

- Quarantined at the health facility to ensure continued medical examination and treatment of patients. In case the health facility is able to provide accommodation at for health workers at a hotel, follow instructions in Decision no. 1462/QD-BYT dated 30/3/2020 promulgating the "Interim Guidance for Covid-19 quarantine of health workers at hotels”(hereinafter referred to as “Decision No. 1462/QD-BYT).

- Health workers who are not present at the health facility when the quarantine area is established shall be requested to self-monitor their health, be tested, quarantined and treated if necessary.

5. Carers of patients other than seriously-ill patients, attendants, visitors and other people:

- People who have close contact with the confirmed case (hereinafter referred to as “close contacts") shall be quarantined at a health facility assigned by the National or Provincial Steering Committee for Covid-19 Control.

- People having contact with a close contact shall be instructed to undergo home quarantine and monitor their own health.

- Other people shall undergo home quarantine and avoid going to public places.

E. ORGANIZATION OF QUARANTINE AT HEALTH FACILITY

I. SCOPE OF THE QUARANTINE AREA

The quarantine scope shall vary according to the result of epidemiological investigation. To be specific:

1.1. Quarantine a ward or a room if there is one or more confirmed cases in the ward/department.

1.2. Quarantine adjacent wards/departments if confirmed case has contact with other people in adjacent wards/departments in the same area.

1.3. Quarantine the entire health facility if the confirmed case has contact with people in many wards/departments in the health facility, or the extent and source of infection cannot be determined.

1.4. Note: If the confirmed case involves provision of services in the health facility:

- If only one ward/department is involved, that ward/department will be quarantined according to 1.1.;

- If one or more adjacent ward/department is involved, the adjacent wards/departments will be quarantined according to 1.2;

- If many wards/departments are involved, the entire health facility will be quarantined according to 1.3.

II. DECISION ON ESTABLISHMENT OF QUARANTINE AREA

1. The head of the health facility shall issue the decision to quarantine a ward/department according to I.1.1. or adjacent wards/departments according to I.1.2.

2. The Ministerial-level Steering Committee for Covid-19 Control shall issue the decision to quarantine the whole health facility according to I.1.3 at the request of the head of the health facility under the Ministry’s management.

3. The Provincial Steering Committee for COVID-19 Control shall issue the decision to quarantine the whole health facility according to I.1.3 at the request of Director of Provincial Department of Health and the head of the health facility under the of the Provincial Department of Health.

III. QUARANTINE DURATION

The quarantine duration shall be at least 14 days from the date of exposure to the last confirmed case in the quarantine area and the patient tests negative for SARS-CoV-2 twice.

IV. ESTABLISHMENT OF QUARANTINE AREA

4.1. Quarantine of a ward/department and adjacent wards/departments

4.1.1. Guard posts

- Set up guard posts at the gates and entrances to the quarantine area. Every guard post shall be put on watch 24/24 by the security guards of the health facility. The head of the health facility may request assistance from the local police authority where necessary.

- Unauthorized persons shall not be allowed to enter the quarantine area.

- Put on a red sign with yellow text: “KHU VỰC CÁCH LY Y TẾ - KHÔNG NHIỆM VỤ MIỄN VÀO” (“Quarantine Area - Authorized Personnel Only”)

- Every person who enters and leaves the quarantine area shall have their body temperature taken.

- Set up a hand-washing station with soap and clean water, or hand sanitizer that contains 60% alcohol if a hand-washing station is not available.

- Provide yellow foot-operated trash cans with plastic bags inside to contain contaminated wastes and the text “CHẤT THẢI CÓ NGUY CƠ CHỨA SARS-CoV-2” (“Danger of SARS-CoV-2 infection”) on the outside. All wastes produced within the quarantine area shall be considered contaminated wastes.

4.1.2. Entrance and exit of the decontamination point

- The entrance and exit shall be convenient for movement of vehicles.

- The decontamination point should be located near the entrance or exit. Provide a hand-washing station with soap and clean water, or hand sanitizer that contains 60% alcohol if a hand-washing station is not available.

- Surfaces of all vehicles, waste containers and cloth shall be decontaminated with 0,05% chlorine solution before leaving the quarantine area.

- Surface of medical devices shall be cleaned with 70% alcohol before removal from the quarantine area.

4.1.3. Containment of the quarantine area

The quarantine area shall be contained with movable or fixed fences, whichever is practicable.

4.1.4. Arrangement of sub-areas in the quarantine area

a) Sub-area for patients

- The head of the health facility shall rearrange the rooms so that people at the same level of risk stay in the same room; provide an anteroom for health workers to change and decontaminate their clothing before leaving the quarantine area.

- Where necessary, the head of the health facility may decide to utilize adjacent wards/departments in the same area to serve the quarantine process.

b) Arrangement of rooms, patient beds, sterilization, ventilation, personal protective equipment (PPE), waste treatment and other equipment for prevention of COVID-19 transmission in the quarantine area shall comply with Decision No. 468/QD-BYT .

c) Provide adequate meals and amenities for health workers being quarantined at the health facility. In case health workers are allowed to stay at a hotel after work, follow instructions in Decision No. 1462/QD-BYT.

d) Provide adequate meals and amenities for patients, carers and other people being quarantined at the health facility.

dd) Maintain provision of services (food and drink, laundry, waste collection and treatment, etc.) to sustain operation in the quarantine area. Stop providing services if a confirmed case is found in the service provision unit/area.

e) Supply reception area

- Place a table at the guard post to receive supplies for quarantined people sent by their family.

- The sender shall register with the security guard in charge at the guard post, place the supplies on the table, provide the names, ages and phone numbers of the sender and the recipient.

- Personal belongings of quarantined people must not be removed from the quarantine area before they are decontaminated.

4.1.5. Protection of security and order in the quarantine area

- The health facility shall implement necessary measures for protection of security and order in the quarantine area.

- Authorized personnel may enter and leave the quarantine area to perform their duties; may move from the quarantine area to the predetermined rest area and strictly follow infection prevention rules.

4.1.6. What to do when a Covid-19 patient dies

- Do not arrange a funeral to prevent transmission.

- Handle the dead body in accordance with instructions in Official Dispatch No. 495/BYT-MT dated 06/02/2020 of the Ministry of Health on biomedical waste management and handling of dead bodies of Covid-19 patients.

4.2. Quarantine of the entire health facility

4.2.1. Guard posts

- Set up guard posts at the gates and entrances to the health facility. Every guard post shall be put on watch 24/24 by the police or security guards of the health facility.

- Unauthorized persons shall not be allowed to enter the health facility.

- Put on a red sign with yellow text: “KHU VỰC CÁCH LY Y TẾ - KHÔNG NHIỆM VỤ MIỄN VÀO” (“Quarantine Area - Authorized Personnel Only”)

- Every person who enters and leaves the health facility shall have their body temperature taken.

- Set up a hand-washing station with soap and clean water, or hand sanitizer that contains 60% alcohol if a hand-washing station is not available.

- Provide yellow foot-operated trash cans with plastic bags inside to contain contaminated wastes and the text “CHẤT THẢI CÓ NGUY CƠ CHỨA SARS-CoV-2” (“Danger of SARS-CoV-2 infection”) on the outside. All wastes produced within the health facility shall be considered contaminated wastes.

4.2.2. Entrance, exit and decontamination point for vehicles

- The entrance and exit shall be convenient for movement of vehicles.

- The decontamination point should be located near the entrance or exit. Provide a hand-washing station with soap and clean water, or hand sanitizer that contains 60% alcohol if a hand-washing station is not available.

- All items and vehicles that are allowed to enter and leave the health facility shall be decontaminated with 0,05% chlorine solution.

4.2.3. Containment of the quarantine area

Fixed fences shall be put up around the health facility.

4.2.4. Arrangement of areas in the health facility

Immediately after issuing the decision to quarantine the entire health facility, the head of the health facility shall perform the following tasks:

- Suspend operation of the outpatient examination area; transfer outpatients who are not at risk of COVID-19 infection to other nearby health facilities. In case certain treatments, such as hemodialysis or peritoneal filtration, are not available in any other health facility , the National or Provincial Steering Committee for Covid-19 Control shall consider allowing the affected health facility to continue providing these treatments and establish procedures for protection of patients from Covid-19 infection during their treatment.

- Rearrange various sectors of the health facility to facilitate the quarantine process and prevent transmission of Covid-19 in the health facility and the community; maintain medical examination and treatment of inpatients, admission and treatment of seriously-ill patients (if the health facility is a tertiary hospital and allowed by the National Steering Committee for Covid-19 Control).

- Establish procedures for and continue admission and treatment of seriously-ill patients referred by inferior hospitals; procedures for safe transport of patients to other health facilities when allowed by the National or Provincial Steering Committee for Covid-19 Control.

- Provide adequate meals and amenities for health workers being quarantined at the health facility. In case health workers are allowed to stay at a hotel after work, follow instructions in Decision No. 1462/QD-BYT.

- Provide adequate meals and amenities for patients, carers and other people being quarantined at the health facility.

- Maintain provision of services (food and drink, laundry, waste collection and treatment, etc.) to sustain operation of the health facility . Stop providing services if a confirmed case is found in the service provision unit/area.

4.2.5.  Arrangement of rooms, patient beds, sterilization, ventilation, PPE, waste treatment and other equipment for prevention of COVID-19 transmission in the quarantine area shall comply with Decision No. 468/QD-BYT .

4.2.6. Supply reception area

- Place a table at the guard post to receive supplies for quarantined people sent by their family.

- The sender shall register with the security guard in charge at the guard post, place the supplies on the table, provide the names, ages and phone numbers of the sender and the recipient.

- Personal belongings of quarantined people must not be removed from the health facility before they are decontaminated.

4.2.7. Protection of security and order in the health facility

- The health facility and local police authority shall implement necessary measures for protection of security and order in the health facility.

- Ensure fire safety in the health facility.

- Do not hold events that involve a large group of people within the health facility.

- Authorized personnel may enter and leave the health facility to perform their duties; may move from the health facility to the predetermined rest area outside the health facility and strictly follow infection prevention rules.

4.2.8. What to do when a Covid-19 patient dies

- Do not arrange a funeral to prevent transmission.

- Handle the dead body in accordance with instructions in Official Dispatch No. 495/BYT-MT.

G. IMPLEMENTATION ORGANIZATION

I. Ministerial-level Covid-19 Control Committees shall:

- Issue or authorize issuance of decisions on initiate and end quarantine of entire health facilities under their management.

- Supervise the implementation of this document by health facilities under their management.

II. Provincial Covid-19 Control Committees shall:

- Issue or authorize issuance of decisions on initiate and end quarantine of entire health facilities under their management.

- Supervise the implementation of this document by health facilities under their management.

III. Ministries and ministerial agencies shall:

- Provide instructions and resources for health facilities under their management to implement this document.

- Supervise the implementation of this document.

IV. The People’s Committees of provinces shall:

1. Request relevant agencies and units to:

- Provide instructions and resources for health facilities in the province to implement this document.

- Assist health facilities under management of ministries and ministerial agencies in the province to implement this document.

2. Supervise the implementation of this document.

V. Provincial Departments of Health shall:

- Provide instructions and resources for their units to implement this document.

- Supervise the implementation of this document.

VI. Disease Control Centers/Preventive Medicine Centers of provinces shall:

- Provide training in implementation of this document for health facilities in their provinces.

- Cooperate with health facilities in their provinces in implementation of this document.

- Carry out medical tasks and decontamination of infection clusters as prescribed.

VII. Local police and militia forces shall:

- Cooperate with the affected health facility in setting up guard posts at its gates and entrances.

- b) Assign officers on duty 24/24 at the guard posts; enforce quarantine where necessary.

VIII. Health facilities shall:

1. Prepare a quarantine plan when a confirmed case is found in their facility; assigning health workers to work in shift to provide extensive care for patients therein. Compile a list of persons authorized to enter and leave the quarantine area.

2. Issue decisions to initiate and end quarantine of a ward/department or adjacent wards/departments.

3. Cooperate with the Disease Control Center/Preventive Medicine Center in epidemiological investigation to:

- Determine the scope of quarantine

- Compile a list of outpatients and inpatients who visited or stayed at the health facility during the affected period and inform the local health authority.

- Compile a list of students who studied at the health facility during the affected period and inform the local health authority.

- Inform the Ministerial or Provincial Steering Committee for Covid-19 Control in case the entire health facility has to be quarantine.

4. Cooperate with the local police and militia forces in setting up guard posts and protection of security and order in the health facility.

5. Set up the quarantine area, provide adequate meals and amenities for health workers being quarantined at the health facility.

In case health workers are allowed to stay at a hotel after work, follow instructions in Decision No. 1462/QD-BYT.

6. Provide adequate meals and amenities for patients, carers and other people being quarantined at the health facility.

7. Inform the quarantined people of information about the quarantine process to earn their trust and cooperation.

8. In case the entire health facility has to be quarantined:

- Stop admitting outpatients; transfer outpatients who are not at risk of COVID-19 infection to other nearby health facilities; continue providing certain treatments such as hemodialysis, peritoneal filtration, etc. as requested by the National or Provincial Steering Committee for Covid-19 Control.

- Admit and provide treatment for seriously-ill patients referred by inferior hospitals as requested by the National or Provincial Steering Committee for COVID-19 Control.

- Establish procedures for prevention of Covid-19 infection during admission, treatment and movement of patients.

9. Organize the implementation of this document./.