GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND

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Department of Health

November 2004

GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER HEALTH FACILITIES A hospital and other health facilities shall be planned and designed to observe appropriate architectural practices, to meet prescribed functional programs, and to conform to applicable codes as part of normal professional practice. References shall be made to the following: • P. D. 1096 – National Building Code of the Philippines and Its Implementing Rules and Regulations • P. D. 1185 – Fire Code of the Philippines and Its Implementing Rules and Regulations • P. D. 856 – Code on Sanitation of the Philippines and Its Implementing Rules and Regulations • B. P. 344 – Accessibility Law and Its Implementing Rules and Regulations • R. A. 1378 – National Plumbing Code of the Philippines and Its Implementing Rules and Regulations • R. A. 184 – Philippine Electrical Code • Manual on Technical Guidelines for Hospitals and Health Facilities Planning and Design. Department of Health, Manila. 1994 • Signage Systems Manual for Hospitals and Offices. Department of Health, Manila. 1994 • Health Facilities Maintenance Manual. Department of Health, Manila. 1995 • Manual on Hospital Waste Management. Department of Health, Manila. 1997 • District Hospitals: Guidelines for Development. World Health Organization Regional Publications, Western Pacific Series. 1992 • Guidelines for Construction and Equipment of Hospital and Medical Facilities. American Institute of Architects, Committee on Architecture for Health. 1992 • De Chiara, Joseph. Time-Saver Standards for Building Types. McGraw-Hill Book Company. 1980 1

Environment: A hospital and other health facilities shall be so located that it is readily accessible to the community and reasonably free from undue noise, smoke, dust, foul odor, flood, and shall not be located adjacent to railroads, freight yards, children's playgrounds, airports, industrial plants, disposal plants.

2

Occupancy: A building designed for other purpose shall not be converted into a hospital. The location of a hospital shall comply with all local zoning ordinances.

3

Safety: A hospital and other health facilities shall provide and maintain a safe environment for patients, personnel and public. The building shall be of such construction so that no hazards to the life and safety of patients, personnel and public exist. It shall be capable of withstanding weight and elements to which they may be subjected. 3.1

Exits shall be restricted to the following types: door leading directly outside the building, interior stair, ramp, and exterior stair.

3.2

A minimum of two (2) exits, remote from each other, shall be provided for each floor of the building.

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Department of Health

November 2004

GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER HEALTH FACILITIES 3.3

Exits shall terminate directly at an open space to the outside of the building.

4

Security: A hospital and other health facilities shall ensure the security of person and property within the facility.

5

Patient Movement: Spaces shall be wide enough for free movement of patients, whether they are on beds, stretchers, or wheelchairs. Circulation routes for transferring patients from one area to another shall be available and free at all times. 5.1

Corridors for access by patient and equipment shall have a minimum width of 2.44 meters.

5.2

Corridors in areas not commonly used for bed, stretcher and equipment transport may be reduced in width to 1.83 meters.

5.3

A ramp or elevator shall be provided for ancillary, clinical and nursing areas located on the upper floor.

5.4

A ramp shall be provided as access to the entrance of the hospital not on the same level of the site.

6

Lighting: All areas in a hospital and other health facilities shall be provided with sufficient illumination to promote comfort, healing and recovery of patients and to enable personnel in the performance of work.

7

Ventilation: Adequate ventilation shall be provided to ensure comfort of patients, personnel and public.

8

Auditory and Visual Privacy: A hospital and other health facilities shall observe acceptable sound level and adequate visual seclusion to achieve the acoustical and privacy requirements in designated areas allowing the unhampered conduct of activities.

9

Water Supply: A hospital and other health facilities shall use an approved public water supply system whenever available. The water supply shall be potable, safe for drinking and adequate, and shall be brought into the building free of cross connections.

10 Waste Disposal: Liquid waste shall be discharged into an approved public sewerage system whenever available, and solid waste shall be collected, treated and disposed of in accordance with applicable codes, laws or ordinances. 11 Sanitation: Utilities for the maintenance of sanitary system, including approved water supply and sewerage system, shall be provided through the buildings and premises to ensure a clean and healthy environment.

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Department of Health

November 2004

GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER HEALTH FACILITIES 12 Housekeeping: A hospital and other health facilities shall provide and maintain a healthy and aesthetic environment for patients, personnel and public. 13 Maintenance: There shall be an effective building maintenance program in place. The buildings and equipment shall be kept in a state of good repair. Proper maintenance shall be provided to prevent untimely breakdown of buildings and equipment. 14 Material Specification: Floors, walls and ceilings shall be of sturdy materials that shall allow durability, ease of cleaning and fire resistance. 15 Segregation: Wards shall observe segregation of sexes. Separate toilet shall be maintained for patients and personnel, male and female, with a ratio of one (1) toilet for every eight (8) patients or personnel. 16 Fire Protection: There shall be measures for detecting fire such as fire alarms in walls, peepholes in doors or smoke detectors in ceilings. There shall be devices for quenching fire such as fire extinguishers or fire hoses that are easily visible and accessible in strategic areas. 17 Signage. There shall be an effective graphic system composed of a number of individual visual aids and devices arranged to provide information, orientation, direction, identification, prohibition, warning and official notice considered essential to the optimum operation of a hospital and other health facilities. 18 Parking. A hospital and other health facilities shall provide a minimum of one (1) parking space for every twenty-five (25) beds. 19 Zoning: The different areas of a hospital shall be grouped according to zones as follows: 19.1

Outer Zone – areas that are immediately accessible to the public: emergency service, outpatient service, and administrative service. They shall be located near the entrance of the hospital.

19.2

Second Zone – areas that receive workload from the outer zone: laboratory, pharmacy, and radiology. They shall be located near the outer zone.

19.3

Inner Zone – areas that provide nursing care and management of patients: nursing service. They shall be located in private areas but accessible to guests.

19.4

Deep Zone – areas that require asepsis to perform the prescribed services: surgical service, delivery service, nursery, and intensive care. They shall be segregated from the public areas but accessible to the outer, second and inner zones.

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Department of Health

November 2004

GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER HEALTH FACILITIES 19.5

Service Zone – areas that provide support to hospital activities: dietary service, housekeeping service, maintenance and motorpool service, and mortuary. They shall be located in areas away from normal traffic.

20 Function: The different areas of a hospital shall be functionally related with each other. 20.1

The emergency service shall be located in the ground floor to ensure immediate access. A separate entrance to the emergency room shall be provided.

20.2

The administrative service, particularly admitting office and business office, shall be located near the main entrance of the hospital. Offices for hospital management can be located in private areas.

20.3

The surgical service shall be located and arranged to prevent non-related traffic. The operating room shall be as remote as practicable from the entrance to provide asepsis. The dressing room shall be located to avoid exposure to dirty areas after changing to surgical garments. The nurse station shall be located to permit visual observation of patient movement.

20.4

The delivery service shall be located and arranged to prevent non-related traffic. The delivery room shall be as remote as practicable from the entrance to provide asepsis. The dressing room shall be located to avoid exposure to dirty areas after changing to surgical garments. The nurse station shall be located to permit visual observation of patient movement. The nursery shall be separate but immediately accessible from the delivery room.

20.5

The nursing service shall be segregated from public areas. The nurse station shall be located to permit visual observation of patients. Nurse stations shall be provided in all inpatient units of the hospital with a ratio of at least one (1) nurse station for every thirty-five (35) beds. Rooms and wards shall be of sufficient size to allow for work flow and patient movement. Toilets shall be immediately accessible from rooms and wards.

20.6

The dietary service shall be away from morgue with at least 25-meter distance.

21 Space: Adequate area shall be provided for the people, activity, furniture, equipment and utility. Space Administrative Service Lobby Waiting Area Information and Reception Area Toilet Business Office Medical Records

Area in Square Meters 0.65/person 5.02/staff 1.67 5.02/staff 5.02/staff

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Department of Health

November 2004

GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER HEALTH FACILITIES Space Office of the Chief of Hospital Laundry and Linen Area Maintenance and Housekeeping Area Parking Area for Transport Vehicle Supply Room Waste Holding Room Dietary Dietitian Area Supply Receiving Area Cold and Dry Storage Area Food Preparation Area Cooking and Baking Area Serving and Food Assembly Area Washing Area Garbage Disposal Area Dining Area Toilet Cadaver Holding Room Clinical Service Emergency Room Waiting Area Toilet Nurse Station Examination and Treatment Area with Lavatory/Sink Observation Area Equipment and Supply Storage Area Wheeled Stretcher Area Outpatient Department Waiting Area Toilet Admitting and Records Area Examination and Treatment Area with Lavatory/Sink Consultation Area Surgical and Obstetrical Service Major Operating Room Delivery Room Sub-sterilizing Area Sterile Instrument, Supply and Storage Area Scrub-up Area Clean-up Area Dressing Room Toilet Nurse Station Wheeled Stretcher Area Janitor’s Closet

Area in Square Meters 5.02/staff 5.02/staff 5.02/staff 9.29 5.02/staff 4.65 5.02/staff 4.65 4.65 4.65 4.65 4.65 4.65 1.67 1.40/person 1.67 7.43/bed 0.65/person 1.67 5.02/staff 7.43/bed 7.43/bed 4.65 1.08/stretcher 0.65/person 1.67 5.02/staff 7.43/bed 5.02/staff 33.45 33.45 4.65 4.65 4.65 4.65 2.32 1.67 5.02/staff 1.08/stretcher 3.90 5 of 6

Department of Health

November 2004

GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER HEALTH FACILITIES Space Nursing Unit Semi-Private Room with Toilet Patient Room Toilet Isolation Room with Toilet Nurse Station Treatment and Medication Area with Lavatory/Sink Central Sterilizing and Supply Room Receiving and Releasing Area Work Area Sterilizing Room Sterile Supply Storage Area Nursing Service Office of the Chief Nurse Ancillary Service Primary Clinical Laboratory Clinical Work Area with Lavatory/Sink Pathologist Area Toilet Radiology X – Ray Room with Control Booth, Dressing Area and Toilet Dark Room Film File and Storage Area Radiologist Area Pharmacy

Area in Square Meters 7.43/bed 7.43/bed 1.67 9.29 5.02/staff 7.43/bed 5.02/staff 5.02/staff 4.65 4.65 5.02/staff 10.00 5.02/staff 1.67 14.00 4.65 4.65 5.02/staff 15.00

Notes: 1. 0.65/person – Unit area per person occupying the space at one time 2. 5.02/staff – Work area per staff that includes space for one (1) desk and one (1) chair, space for occasional visitor, and space for aisle 3. 1.40/person – Unit area per person occupying the space at one time 4. 7.43/bed – Clear floor area per bed that includes space for one (1) bed, space for occasional visitor, and space for passage of equipment 5. 1.08/stretcher – Clear floor area per stretcher that includes space for one (1) stretcher

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