A 50 BED

EMERGENCY AND
MATERNITY
HOSPITAL

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TABLE OF CONTENTS
INTRODUCTION

CHAPTER I - GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND

OTHER HEALTH FACLITIES

- 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 It’s 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

CHAPTER II – P. D. 1185 - FIRE CODE OF THE PHILIPPINES AND IT’S

IMPLEMENTING RULES AND REGULATIONS

- Division 10: Healthcare Occupancies

- Hospitals
- Fundamental Requirements
- Emergency Rooms, Operating Rooms, Intensive Care Units, Delivery Rooms
- and Other Similar Facilities
- Occupancy and Occupant Load
- Exit Details
- Access to Exit
- Doors
- Horizontal Exits
- Emergency Lighting, Exit Markings, Alarms and Communication Systems
- Minimum Construction Standards
- Construction of Corridor Walls
- Protection of Vertical Openings and Fire-stopping
- Interior Finish
- Alarm, Detection and Extinguishment Systems
- Hazardous Areas
- Building Service Equipment
- Air Conditioning, Ventilating, Heating, Cooking and Other Service

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CHAPTER III - P. D. 856 – CODE ON SANITATION OF THE PHILIPPINES AND IT’S
IMPLEMENTING RULES AND REGULATION

- Water Supply
- Standard Value for Biological Organism
- Standard Values for Physical and Chemical Quality: Health Significance
- Standard Values for Physical and Chemical Quality: Aesthetic Quality
- Standard Values for Disinfectants and Disinfectant By-Products
- Chemicals of No Health Significance at Concentrations Normally found in
Drinking-Water
- Standard Values for Radiological Constituents
- Pollution of the Environment
- Disposal of dead persons

CHAPTER IV – B.P 344 – ACCESSIBILITY LAW AND ITS IMPLEMENTING RULES

AND REGULATIONS

- Rule II – Minimum requirements for Accessibility

- Categories of Disabled Persons
- Anthropometrics and Dimensional Data as guide for Design
- Anthropometrics Data: Adult
- Anthropometrics Data: Child
- Basic physical Planning requirements
- Inside buildings and Structures

CHAPTER V – R.A. 1378 – NATIONAL PLUMBING CODE OF THE PHILIPPINES

AND ITS IMPLEMENTING RULES AND REGULATIONS

- Introduction
- Basic Principles
- Recommended Plumbing Fixture and Related Equipment
- General Requirements
- Fixture for specific Healthcare Areas
- Drainage systems for Laboratories

CHAPTER VI - SIGNAGE SYSTEMS FOR HOSPITALS AND OTHER HEALTH

FACILITIES

- Definition of Terms
- Five Basic Sign Types
- The three Basic Elements of a successful Signage System
- Classification of Symbol Signs
- Color
- General Functions
- General Usage
- Outdoor Sign Location
- Indoor Sign Location
- Typical Assembly (External Signs)
- Parking Lot identification/road Directional Signs
- Specifications

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CHAPTER VII - DISTRICT HOSPITALS: GUIDELINES FOR DEVELOPMENT.
WORLD HEALTH ORGANIZATION REGIONAL PUBLICATIONS, WESTERN
PACIFIC SERIES. 1992

- The District Health System

- Key Features of District Health System
- The general principles for developing such systems are based on the Declaration of
Alma Ata and the Global Strategy for Health for All and incorporate
- Methods of Planning and Design
- Inventory and Distribution of Health Facilities
- Service Catchment Area
- Factors to be considered in locating a District Hospital
- Site Selection
- Size
- Topography
- Drainage
- Departmental Planning and Design
- Primary Health Care Support Areas
- Education and Training Support Areas

CHAPTER VIII - GUIDELINES FOR CONSTRUCTION AND EQUIPMENT OF

HOSPITAL AND MEDICAL FACILITIES. AMERICAN INSTITUTE OF
ARCHITECTS, COMMITTEE ON ARCHITECTURE FOR HEALTH. 1992

- Renovation
- Design Standard for the Disabled
- Provision for Disasters
- Code and Standards
- Energy Conservation
- Location
- Facility Design
- Environmental Pollution Control
- Equipment
- Classification
- Building Service Equipment
- Fixed Equipment (Medical and Nonmedical)
- Movable Equipment (Medical and Nonmedical)
- Major Technical Equipment
- Equipment Shown on Drawings
- Electronic Equipment
- Construction
- Nonconforming Conditions

CHAPTER IX – SPACE REQUIREMENTS

- Medical Laboratory
- Hospital Lobby
- Reception Counter
- Specimen and Extraction room
- Laboratory Area
- X-ray room/Radiology
- Public/Private Toilet
- Cashier and Accounting Office
- Phil health Office
- Hospital Administration Office with Conference room
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- Hospital Record Room
- Pharmacy and Convenience Store
- Restaurant and Coffee Shop
- EMERGENCY ROOM
- Pediatric Room
- Obstetrics Room
- Gynecology Room
- General Medicine
- Rehydration Room
- Labor Room
- Delivery Room
- Operation Room with Scrub-up Area
- Recovery Room
- Nursery Room
- Intensive Care Unit(ICU)
- Hospital Ward
- Nursery Station
- Private Room
- Semi-Private Room
- Dental Clinic
- Hospital Staff Area
- SERVICE DEPARTMENT
- Dietary Departments
- Hospital Clean Utility
- Hospital Dirty Utility
- Hospital Central Sterile & Supply Department
- Hospital Laundry Area
- Motor pool
- Morgue

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INTRODUCTION

Due to growing demand for medical treatment and evolving disease structures, the

medical environment of the twenty-first century is changing, necessitating a new design of

medical services and hospital operations. Additionally, there has been a gap in the market for a

hospital that is directly insurer-operated and offers cutting-edge public healthcare services with a

distinctive management style. To offer Sta. Margarita with high-quality medical care in such

circumstances Building a 50-bed emergency and maternity hospital in Sta. Margarita, Samar,

which previously lacked medical facilities, will expand access to healthcare services for the

entire population, not only Sta. Margarita, as well as for the nearby areas.

CHAPTER I

GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER

HEALTH FACILITIES

As part of standard professional practice, hospitals and other healthcare facilities must be

planned and built in accordance with applicable architectural standards, functional programs, and

statutory requirements. References to the following must be made:

• 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 It’s 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

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• 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.

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

5.2 2.44 meters.

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5.3 Corridors in areas not commonly used for bed, stretcher and equipment transport may

be reduced in width to 1.83 meters.

5.4 A ramp or elevator shall be provided for ancillary, clinical and nursing areas located on

the upper floor.

5.5 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.

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.

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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.

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.

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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 Area in Square Meters

Administrative Service
Lobby
Waiting Area 0.65/person
Information and Reception Area 5.02/staff
Toilet 1.67
Business Office 5.02/staff
Medical Records 5.02/staff
Office of the Chief of Hospital 5.02/staff
Laundry and Linen Area 5.02/staff
Maintenance and Housekeeping Area 5.02/staff
Parking Area for Transport Vehicle 9.29
Supply Room 5.02/staff
Waste Holding Room 4.65
Dietary
Dietitian Area 5.02/staff
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Supply Receiving Area 4.65
Cold and Dry Storage Area 4.65
Food Preparation Area 4.65
Cooking and Baking Area 4.65
Serving and Food Assembly Area 4.65
Washing Area 4.65
Garbage Disposal Area 1.67
Dining Area 1.40/person
Toilet 1.67
Cadaver Holding Room 7.43/bed
Clinical Service
Emergency Room
Waiting Area 0.65/person
Toilet 1.67
Nurse Station 5.02/staff
Examination and Treatment Area with Lavatory/Sink 7.43/bed
Observation Area 7.43/bed
Equipment and Supply Storage Area 4.65
Wheeled Stretcher Area 1.08/stretcher
Outpatient Department
Waiting Area 0.65/person
Toilet 1.67
Admitting and Records Area 5.02/staff
Examination and Treatment Area with Lavatory/Sink 7.43/bed
Consultation Area 5.02/staff
Surgical and Obstetrical Service
Major Operating Room 33.45
Delivery Room 33.45
Sub-sterilizing Area 4.65
Sterile Instrument, Supply and Storage Area 4.65
Scrub-up Area 4.65
Clean-up Area 4.65
Dressing Room 2.32
Toilet 1.67
Nurse Station 5.02/staff
Wheeled Stretcher Area 1.08/stretcher
Janitor’s Closet 3.90
Nursing Unit
Semi-Private Room with Toilet 7.43/bed
Patient Room 7.43/bed
Toilet 1.67
Isolation Room with Toilet 9.29
Nurse Station 5.02/staff
Treatment and Medication Area with Lavatory/Sink 7.43/bed
Central Sterilizing and Supply Room
Receiving and Releasing Area 5.02/staff
Work Area 5.02/staff
Sterilizing Room 4.65
Sterile Supply Storage Area 4.65
Nursing Service
Office of the Chief Nurse 5.02/staff
Ancillary Service
Primary Clinical Laboratory
Clinical Work Area with Lavatory/Sink 10.00
Pathologist Area 5.02/staff
Toilet 1.67
Radiology
X – Ray Room with Control Booth, Dressing Area and Toilet 14.00
Dark Room 4.65
Film File and Storage Area 4.65
Radiologist Area 5.02/staff
Pharmacy 15.00

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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

CHAPTER II

P. D. 1185 - FIRE CODE OF THE PHILIPPINES AND IT’S IMPLEMENTING RULES

AND REGULATIONS

DIVISION 10: HEALTH CARE OCCUPANCIES

Hospitals

A building or part thereof used for the medical, psychiatric, obstetrical or surgical care,

on a 24-hour basis, of four (4) or more inpatients. Hospitals, wherever used in this Chapter, shall

include general hospitals, mental hospitals, tuberculosis hospitals, children's hospitals, and any

such facilities providing inpatient care.

Fundamental Requirements

1. All healthcare facilities must be planned, built, maintained, and operated in a way that

reduces the likelihood that a fire emergency may necessitate evacuating residents.

Because relying solely on evacuation cannot effectively ensure the safety of those who

reside in healthcare institutions, thorough planning of operation and maintenance

procedures must be developed in order to safeguard them from fire. These procedures

must include the following:

a. proper construction, compartmentation, and design;

b. provisions for extinguishment, alert, and detection; and

c. Preventing fires includes developing, practicing, and executing plans for

containing fires, moving people to safe spaces, or evacuating buildings.

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2. It is understood that in structures housing various psychiatric Patients, it could be

essential to bar windows and lock doors to keep people inside the building and to keep

them safe. The Chief, BFP, or his properly appointed agent may waive any provisions of

this Rule that require exits to be kept unlocked. It is also acknowledged that certain

psychiatric patients cannot find safety on their own. Provisions must be provided for

occupant removal from buildings with locked doors or barred windows, using dependable

methods such remote lock control or keying all locks to keys carried by attendants.

Emergency Rooms, Operating Rooms, Intensive Care Units, Delivery Rooms and Other

Similar Facilities

Intensive care units, operation rooms, and delivery rooms and such like facilities shall not

exceed one (1) level in height. Above or below the discharge floor at the exit. Existing buildings

that provide any of the aforementioned amenities above or below the floor of exit discharge must

have ramps that adhere to this IRR's Section [Link].

Occupancy and Occupant Load

1. Buildings housing other occupancies must provide for health care occupancies be entirely

separated from them by inflammable building design having a fire resistance rating of at

least two hours. All exits available from medical facilities that pass through non-medical

locations shall abide by the standards of these health care standard occupancies. Any

residence where there is a classified content risk taller and situated in the same building

as the health care as health care facilities must be safeguarded. Commercial, office,

businesses and storage facilities classified as high-hazard shall not be allowed in

structures housing health care-related businesses.

2. If certain criteria are met, portions of healthcare buildings may be classed as other

occupancies:

a. They are not designed to benefit patients in healthcare facilities of shelter,

medical care, usual access, or exit routes.

b. By having constructed with a two-hour fire resistant rating, they are sufficiently

segregated from areas used for healthcare.

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3. The use of auditoriums, chapels, staff housing, garages, and other similar spaces in

connection with the provision of healthcare services shall having exits available in line

with other relevant portions of a chapter.

4. The number of occupants for whom means of egress must be provided any floor must

accommodate the maximum number of people intended for that floor, but not less than

one (1) person for every twenty-two square meters (22.3 m2) of gross floor area for

inpatient health care treatment departments and one (1) person for every eleven and 153

square meters (11.1 m2). Gross floor areas must be measured entirely within the outer

building walls.

EXIT DETAILS

Number and Types

1. Exits shall be restricted to the following permissible types;

a. Doors leading directly outside the building

b. Stairs and smoke-proof enclosures

c. Ramps

d. Horizontal exits

e. Exit Passageways

2. At least two (2) exits of the above types, remote from each other, shall be provided for

each floor or fire section of the building.

3. Elevators constitute a supplementary facility, but-shall not be counted as required exits.

Access to Exit

1. Every aisle, passageway, corridor, exit discharge, exit location and access shall be in

accordance with Section [Link] of this IRR, except as modified in the succeeding

paragraphs of this subsection.

2. Travel distance shall comply with the following:

a) Between any room door intended as exit access and an exit shall not exceed thirty

(30) meters;

b) Between any point in a room and an exit shall not exceed forty six (46) meters;

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c) Between any point in a health care sleeping room or suite and an exit access door

of that room or suite shall not exceed fifteen (15) meters.

d) Travel distance shall be measured in accordance with Section [Link] of this

IRR.

e) The travel distances in para (2) (a) and (b) above may be increased by fifteen

meters (15 m) in buildings completely equipped with an automatic fire

suppression system.

3. Unless it has a door opening to the side, every healthcare sleeping room there must be an

exit access door on the ground floor that goes directly to a corridor with an exit. If all of

the doors along the course of exit travel have non-lockable hardware, one adjacent room,

such as a sitting or anteroom, may act as an intervening space as long as it is not meant to

accommodate more than eight (8) health care sleeping beds. However, the number of

cribs or bassinets in any special nurseries or nursing suites allowed under this Division

shall not be capped at eight.

4. Aisles, hallways, and ramps needed for exit access or egress in hospitals or nursing

homes must be at least 244 clear, unobstructed millimeters wide corridors, ramps, and

aisles at a residential-custodial care establishment for access or exit should have a

minimum clear and unobstructed width of 183 centimeters (cm). In auxiliary sections not

meant for inpatients' residence, care, or use, ramps and corridors must be at least a clean

and unobstructed breadth of at least 183 centimeters (cm) must be present.

5. Any rooms and any suite or rooms of more than ninety three square meters (93 m2) shall

have at least two (2) exit access doors remote from each other.

6. Every exit or exit access shall be so arranged that no corridor or aisle has a pocket or

dead-end exceeding six meters (6 m).

7. Any medical facility bedroom that satisfies the conditions previously described in this

section may be split by non-fire rated, non-combustible partitions as long as the

configuration enables direct and continuous visual supervision by nursing staff. Rooms

that are partitioned in this way cannot be larger than 465 square meters (465 m2).

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DOORS

1. Doors shall be in accordance with Section [Link], except as modified in this subsection.

For door requirements in horizontal exits and smoke partitions, see Section [Link],

Section 10.2.6.

2. Locks shall not be permitted on patient sleeping room doors.

Exception No. 1: Key-locking devices that restrict access to the room from the corridor

and that are operable only by staff from the corridor side shall be permitted. Such devices

shall not restrict egress from the room.

Exception No. 2: Door-locking arrangements shall be permitted in health care

occupancies, or portions of health care occupancies, where the clinical needs of the

patients require specialized security measures for their safety, provided that keys are

carried by staff at all times.

3. Exiting the sleeping quarters of a hospital or nursing home, spaces or rooms used for

diagnosis and treatment, including X-ray, surgery, and physical therapy, the necessary

doors between these locations, an exits, and there must be at least one exit door for each

exit serving these areas one hundred twelve (112) centimeters. Residence-custodial doors

sleeping quarters and the nursery's door sleeping quarters and every exit door serving

these areas must be at least 91 centimeters wide (91 cm) wide.

4. Any door in a fire separation, horizontal exit or a smoke partition may be held open only

by an electrical device which complies with Section [Link]. Each of the following

systems shall be so arranged as to initiate the self-closing action throughout the entire

health care facility.

a. The required alarm system

b. The required automatic fire detection system

c. An approved automatic fire suppression system

5. Doors in stair enclosures and in walls surrounding hazardous areas shall not be

equipped with hold-open devices.

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HORIZONTAL EXITS

1. At least two and eight-tenths (2.80) square meter per occupant in a hospital or nursing home

or one and four-tenths (1.40) square meter per occupant in a residential-custodial care

institution shall be provided on each side of the horizontal exit for the total number of 156

occupants in adjoining compartments.

2. A single door may be used as a horizontal exit if it serves one direction, only and is at least

one hundred twelve centimeters (112 cm) wide for a hospital or nursing home or at least

ninety one centimeters (91 cm) wide for residential-custodial care institutions. The swing A

horizontal exit involving a corridor two and four tenths (2.40) meters

3. or more in width serving as means of egress from both sides of the doorway shall have the

opening protected by a pair of swinging doors, each door having a clear width of 1055 mm

and swinging in the opposite direction from the other shall be in the direction of exit travel.

4. An approved vision panel is required in each horizontal exit door center mullions are

prohibited.

EMERGENCY LIGHTING, EXIT MARKINGS, ALARMS AND COMMUNICATION

SYSTEMS

1. Each hospital shall be provided with emergency lighting as described in Section

[Link] and exit markings as described in Section [Link] of this IRR. Such

emergency lighting and the illumination of required exits and directional signs shall be

supplied by the Life Safety Branch of the hospital electrical system as described in

NFPA 99, Standard for Health Care Facilities. The Life Safety Branch shall also serve

alarms, emergency communication systems and the illumination of generator set

locations as described in paragraph (c), (d) and (e), Section 312 of the same reference.

2. Each nursing home and residential-custodial care facility shall have emergency lighting

in accordance with Section [Link] of this IRR. Emergency lighting with at least 1 ½

hour duration shall be provided.

3. Exit signs shall be provided in each hospital, nursing home, and residential custodial care

facility in accordance with Section [Link] of this IRR.

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MINIMUM CONSTRUCTION STANDARDS

1. Health care buildings of one (1) storey only may be constructed of protected non-combustible

construction, fire-resistive construction, protected ordinary construction, protected wood frame

construction, heavy timber construction or unprotected noncombustible construction. For the

purpose of this subsection, storeys shall be 158 counted starting at the lowest floor of exit

discharge. All levels below the floor of exit discharge shall be separated from the floor of exit

discharge by at least protected non-combustible construction.

2. Health care buildings two (2) storeys or more shall be at least fire resistive construction.

3. Health care occupancies two (2) or more storeys shall have enclosure walls of non-combustible

materials having a fire resistance rating of at least two (2) hours around stairways, elevators,

chutes, and other vertical openings between floors.

4. All interior walls and partitions in buildings of fire-resistive and noncombustible construction

shall be composed on non-combustible materials.

5. Every health care sleeping room shall have an outside window or outside door arranged and

located so that it can be opened from the inside without the use of tools or keys to permit the

products of combustion and to permit any occupant to have direct access to fresh air in case of

emergency. The maximum allowable sill height shall not exceed ninety one centimeters (91 cm)

above the floor except that in special nursing care areas the window sill may be one and a half

meters (1.5 m) above the floor.

CONSTRUCTION OF CORRIDOR WALLS

1. Corridors shall be separated from use areas by partitions having a fire resistance rating of

at least one (1) hour.

2. These walls shall be continuous from the floor slab to the underside of the floor or rood

slab above, through any concealed spaces such as those above the, suspended ceilings

and through interstitial structural and mechanical spaces.

3. Doors with a twenty (20) minute fire protection rating shall be used on openings other

than those serving exits or hazardous areas. Doors shall be provided with latches of a type

suitable for keeping the door tightly closed.

4. Transfer grills, whether protected by fusible link-operated dampers or not, shall not be

used in these walls and doors.

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5. Fixed wired glass vision panels may be placed in corridor walls, provided they do not

exceed eighty four-hundredth square meters (0.84 m2) in size and are installed in

approved steel frames. Fixed wired glass vision panels may be installed in wooden doors,

provided they do not exceed forty six-hundredth square meters (0.46 m2) size and are

installed in approved steel frames all’s or doors.

6. Waiting rooms with a surface size of no more than 23 m2 a sleeping area in a building

with a floor area of 56 m2 or less if they are open to the corridor, further storeys may be

situated to allow for immediate institutional staff oversight, such positioned so as not to

hinder any necessary egress access. such regions should contain an electrically controlled

automatic smoke detector installed a detecting system in line with this Section. A

maximum each smoke compartment may have more than one such waiting room.

PROTECTION OF VERTICAL OPENINGS AND FIRE-STOPPING

1. Any stairway, ramp, elevator shaft, light and ventilation shaft, chute and other openings

between storeys shall be enclosed with noncombustible materials in accordance with

Section [Link]., Section [Link] of this IRR and this Section.

2. A door in a stairway enclosure shall be self-closing, shall normally be kept in closed

position and shall be marked in accordance with Section [Link] of this IRR.

3. Fire-stopping shall be provided in accordance with Section [Link] of this IRR.

INTERIOR FINISH

Interior finish of walls and ceilings in means of egress and of any room shall be Class A

in accordance with Section [Link] of this IRR, while floor finish material shall be Class A

or B throughout all hospitals, nursing homes and residential-custodial care facilities.

ALARM, DETECTION AND EXTINGUISHMENT SYSTEMS

1. Every structure must have an electrically controlled automatic fire system. Alarm system

with manual operation capability in compliance with this IRR's Section [Link].

Installing the fire alarm system is required includes plans for connecting to the closest

BFP station in the future.

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a. Locality there must be internal audible alarm systems in compliance with this

IRR's Section [Link]. Pre-signal systems are prohibited be allowed in healthcare

facilities.

2. There must be an authorized automatic heat and/or smoke detection system all automatic

heat and/or smoke detection systems required by this Section shall be installed in all

corridors of hospitals, nursing homes, and residential custodial care facilities, in

accordance with the applicable standards of the NFPA 72, but in no event shall smoke

detectors be spaced further apart than nine (9) meters on centers or more than four and

six-tenths meters (4.60 m) from any wall portion and the fire alarm system must be

electrically connected.

3. Approved, supervised sprinkler system shall be provided throughout all hospitals, nursing

homes, and residential-custodial care facilities. Replenishment of water supplies shall be

strictly considered in the design. Quick-response sprinklers shall be required in smoke

compartments containing patient sleeping rooms.

4. Approved, supervised sprinkler system shall be in accordance with the requirements of

Section [Link] of this IRR.

5. In light hazard occupancies, required automatic fire suppression systems shall be in

accordance with Section [Link] of this IRR for systems and shall be electrically

interconnected with the fire alarm system. The main automatic fire suppression control

valve shall be electrically monitored so that at least a local alarm will sound when the

valve is closed.

6. If the fire suppression system is an automatic sprinkler, its piping serving no more than

six (6) sprinklers for any isolated hazardous area, may be connected directly to a

domestic water supply system having a capacity sufficient to provide six (6) liters per

minute per square meters of floor area throughout the entire enclosed area. As outside-

screw and-yoke shutoff valve shall be installed in an accessible location between the

sprinklers and the connection to the domestic water supply.

7. Portable fire extinguishers shall be provided in all institutional occupancies in accordance

with Section [Link] of this IRR.

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HAZARDOUS AREAS

Any hazardous area shall be segregated and protected in accordance with Section

[Link] of this IRR. Hazardous areas include, but are not limited to the following:

Boiler and heater rooms

Laundries

Kitchens

Repair shops

Handicraft shops

Employee locker rooms

*Soiled linen rooms

*Paint shops

*Rooms or spaces, including shops, used for the storage of combustible supplies and

equipment in quantities deemed hazardous by the Chief, BFP or his duly authorized

representative.

Trash collection rooms

Gift shops

Those areas marked by asterisk (*) shall be both separated and provided with automatic fire

suppression system.

BUILDING SERVICE EQUIPMENT

Air Conditioning, Ventilating, Heating, Cooking and Other Service

Equipment

1. Air-conditioning, ventilating, heating, cooking and other service equipment shall be in

accordance with Division 7 of this Chapter.

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2. Any heating device other than a central heating plant shall be so designed and installed

that combustible material will not be ignited by it or its appurtenances. If fuel fired, such

heating devices shall be chimney or vent connected, shall take air for combustion directly

from outside, and shall be so designed and installed to provide for complete separation of the

combustion system from the atmosphere of the occupied area. The heating system shall have

safety devices to immediately stop the flow of fuel and shut down the equipment in

case of either excessive temperatures or ignition failure. Fire-places may be installed and

used only in areas other than patient sleeping areas, provided that these areas are separated

from patient sleeping spaces by construction having a one-hour fire resistance rating. In

Addition thereto, the fireplace shall be equipped with a hearth that shall be raised at least ten

centimeters (10 cm), and a heat tempered glass fireplace enclosure guaranteed against

breakage up to a temperature of three hundred forty three (343˚C) degrees Celsius. If special

hazards are present, a lock on the enclosure and other safety precautions may be required.

3. Combustion and ventilation air for Boiler, incinerator or heater rooms shall be taken

directly from and discharged directly to the outside air.

4. Any rubbish chute and linen chute including pneumatic systems shall be safeguarded in

accordance with Section 10.2.6.2and [Link] of this IRR. An incinerator shall not be directly

flue-fed nor shall any floor charging chute directly connect with the combustion chamber.

Any rubbish chute shall discharge into a rubbish collecting room used for no other purpose

and protected in accordance with Section [Link] of this IRR

CHAPTER III

P. D. 856 – CODE ON SANITATION OF THE PHILIPPINES AND IT’S

IMPLEMENTING RULES AND REGULATION

WATER SUPPLY

A. Prescribed Standards and procedures

Standards for drinking water must meet the requirements established by the National Drinking

Water Standards. This includes their bacteriological and chemical tests, as well as the evaluation

22
of results. Water must be treated to make it safe to drink, and contaminated water sources and

their distribution systems must be disinfected in accordance with the Department's guidelines.

B. Types of Water Examinations Required

The following examinations are required for drinking water:

(a) Initial examination the physical, chemical and bacteriological examinations of water from

newly constructed systems or sources are required before they are operated and opened for

public use. Examination of water for possible radio-active contamination should also be done

initially.

(b) Periodic examination Water from existing sources is subject to bacteriological examination as

often as possible but the interval shall not be longer than six months, while general systematic

chemical examination shall be conducted every 12 months or oftener. Examination of water

sources shall be conducted yearly for possible radioactive contamination.

C. Examining Laboratories and Submission of Water Samples

The examination of drinking water shall be performed only in private or government laboratories

duly accredited by the Department. It is the responsibility of operators of water systems to

submit to accredited laboratories water samples for examination in a manner and at such

intervals prescribed by the Department.

D. Other Protective Measures

To protect drinking water from contamination, the following measures shall be observed:

(a) Washing clothes or bathing within a radius of 25 meters from any well or other source of

drinking water is prohibited.

(b) No artesian, deep or shallow well shall be constructed within 25 meters from any source of

pollution.

(c) No radioactive sources or materials shall be stored within a radius of 25 meters from any well

or source of drinking water unless the radioactive source is adequately and safely enclosed by

proper shielding.

23
(d) No person charged with the management of a public water supply system shall permit any

physical connection between its distribution system and that of any other water supply, unless

the latter is regularly examined as to its quality by those in charge of the public supply to which

the connection is made and found to be safe and potable.

(e) The installation of booster pump to boost water direct from the water distribution line of a

water supply system, where low-water pressure prevails is prohibited.

E. Standard parameters and values for drinking-water quality

Standard Value for Biological Organism

Standard Values for Physical and Chemical Quality: Health Significance

A. Inorganic Constituents

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B. Organic Constituents (Pesticides)

Standard Values for Physical and Chemical Quality: Aesthetic Quality

Standard Values for Disinfectants and Disinfectant By-Products

Chemicals of No Health Significance at Concentrations Normally found in Drinking-Water

25
Standard Values for Radiological Constituents

The foregoing standard values are derived from the WHO Guidelines for Drinking Water

Quality of 1993 which are based on and reflect the latest available scientific facts, knowledge

and experience worldwide.

POLLUTION OF THE ENVIRONMENT

General Provisions For the purpose of this Chapter, the provisions of Republic Act No.

3931, the rules and regulations of the National Water and Air Pollution Control Commission

promulgated in accordance with the provisions of Section 6(a) 2 of the said Act, the provisions

of Presidential Decree No. 480, and the rules and regulations of the Radiation Health Office of

the Department of Health shall be applied and enforced.

Authority of the Secretary the Secretary is authorized to promulgate rules and regulations for the

control and prevention of the following types of pollution:

(a) Pollution of pesticides and heavy metals;

(b) Pollution of food caused by chemicals, biological agents, radioactive materials, and excessive

or improper use of food additives;

(c) Non-ionizing radiation caused by electronic products such as laser beams or microwaves;

(d) Noise pollution caused by industry, land and air transport and building construction;

(e) Biological pollutants including the causative agents of intestinal infections;

(f) Pollution of agricultural products through the use of chemical fertilizers and plant pesticides

containing toxic chemical substances and unsanitary agricultural practices; and

(g) Any other type of pollution which is not covered by the provisions of Republic Act 3931, the

Rules and Regulations of the National Water and Air Pollution Control Commission, the

provisions of Presidential Decree No. 480 and the rules and regulations of the Radiation Health

Office of the Department of Health which is likely to affect community Health adversely.

26
DISPOSAL OF DEAD PERSONS

Definition As used in this Chapter, the following terms shall mean:

(a) Embalming preparing, disinfecting and preserving a dead body for its final disposal.

(b) Embalmer a person who practices embalming.

(c) Undertaking the care, transport and disposal of the body of a deceased person by any means

other than embalming.

(d) Remains the body of a dead person.

A. Licensing and Registration Procedures The licensing and registration of undertakers

and embalmers are subject to the following requirements:

(a) Issuance of license to practice

1. Any person who desires to practice undertaking or embalming shall be licensed to practice

only after passing an examination conducted by the Department.

2. Licensed undertakers or embalmers shall practice undertaking or embalming in accordance

with requirements prescribed by the Department.

3. Licensed undertakers or embalmers shall display their licenses conspicuously in the

establishments where they work.

(b) Issuance of certificates of registration

1. An undertaker or embalmer shall apply annually for a registration certificates and pay an

annual registration fee of twenty-five pesos to the Regional Health Office concerned.

2. The first registration certificate issued shall cover the period from the date of issuance to the

last day of the current year. Subsequent certificates shall bear the date of January 1 of the year of

issue and shall expire December 31 of the same year.

3. Certificates of registration shall be posed conspicuously in establishments concerned.

(c) Exemption Government and private physicians may perform embalming without license and

registration certificates as exigencies require.

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B. Autopsy and Dissection of Remains The autopsy and dissection of remains are subject to

the following requirements:

(a) Person authorized to perform these are:

1. Health officers;

2. Medical officers of law enforcement agencies; and

3. Members of the medical staff of accredited hospitals.

(b) Autopsies shall be performed in the following cases:

1. Whenever required by special laws;

2. Upon orders of a competent court, a mayor and a provincial or city fiscal;

3. Upon written request of police authorities;

4. Whenever the Solicitor General, provincial or city fiscal as authorized by existing laws, shall

deem it necessary to disinter and take possession of remains for examination to determine the

cause of death; and

5. Whenever the nearest kin shall request in writing the authorities concerned to ascertain the

cause of death.

(c) Autopsies may be performed on patients who die in accredited hospitals subject to the

following requirements:

1. The Director of the hospital shall notify the next of kin of the death of the deceased and

request permission to perform an autopsy.

2. Autopsy can be performed when the permission is granted or no objection is raised to such

autopsy within 48 hours after death.

3. In cases where the deceased has no next of kin, the permission shall be secured from the local

health authority.

4. Burial of remains after autopsy After an autopsy, the remains shall be interred in accordance

with the provisions in this Chapter.

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C. Donation of Human Organs for Medical, Surgical and Scientific purposes Any person

may donate an organ or any part of his body to a person, a physician, a scientist, a hospital

or a scientific institution upon his death for transplant, medical, or research purposes

subject to the following requirements:

(a) The donation shall be authorized in writing by the donor specifying the recipient, the organ or

part of his body to be donated and the specific purpose for which it will be utilized.

(b) A married person may make such donation without the consent of his spouse.

(c) After the death of a person the next of kin may authorize the donation of an organ or any part

of the body of the deceased for similar purposes in accordance with the prescribed procedure.

(d) If the deceased has no next of kin and his remains are in the custody of an accredited hospital,

the Director of the hospital may donate an organ or any part of the body of the deceased in

accordance with the requirement prescribed in this Section.

(e) A simple written authorization signed by the donor in the presence of two witnesses shall be

deemed sufficient for the donation of organs or parts of the human body required in this Section,

notwithstanding the provisions of the Civil Code of the Philippines on matters of donation. A

copy of the written authorization shall be forwarded to the Secretary.

(f) Any authorization granted in accordance with the requirements of this Section is binding to

the executors, administrators, and members of the family of the deceased.

D. Use of Remains for Medical Studies and Scientific Research Unclaimed remains may be

used by medical schools and scientific institutions for studies and research subject to the

rules and regulations prescribed by the Department.

CHAPTER IV

B.P 344 – ACCESSIBILITY LAW AND ITS IMPLEMENTING RULES AND

REGULATIONS

RULE II - MINIMUM REQUIREMENTS FOR ACCESSIBILITY

CATEGORIES OF DISABLED PERSONS

29
The categories of disability dictate the varied measures to be adopted in order to create an

accessible environment for the handicapped. Disabled persons under these Rules may be

classified into those who have:

1. Impairments requiring confinement to wheelchairs; or

2. Impairments causing difficulty or insecurity in walking or climbing stairs or requiring the

use of braces, crutches or other artificial supports; or impairments caused by amputation,

arthritis, spastic conditions or pulmonary, cardiac or other ills rendering individuals semi-

ambulatory; or

3. Total or partial impairments of hearing or sight causing insecurity or likelihood of

exposure to danger in public places; or

4. Impairments due to conditions of aging and incoordination;

5. Mental impairments whether acquired or congenital in nature.

ANTHROPOMETRICS AND DIMENSIONAL DATA AS GUIDES FOR DESIGN.

The minimum and maximum dimensions for spaces in the built environment should consider the

following criteria:

1. The varying sizes and structures of persons of both sexes, their reaches and their lines of

sight at both the standing and sitting positions.

2. The dimensional data of the technical aids of disabled persons. Included in the second

consideration are the dimensions of wheelchairs; the minimum space needed for locking

and unlocking leg braces plus the range of distance of crutches and other walking aids

from persons using such devices. By applying at this very early stage dimensional criteria

which take into account wheelchair usage, the physical environment will ultimately

encourage and enable wheelchair users to make full use of their physical surroundings.

3. The provision of adequate space for wheelchair maneuvering generally insures adequate

space for disabled persons equipped with other technical aids or accompanied by

assistants. In determining the minimum dimensions for furniture and fixtures accessible

to disabled persons, the following anthropometric data shall serve as guides for design:

- The length of wheelchairs varies from 1.10 m to 1.30 m.

- The width of wheelchairs is from 0.60 m to 0.75 m.

30
- A circle of 1.50 m in diameter is a suitable guide in the planning of wheelchair

turning spaces.

- The comfortable reach of persons confined to wheelchairs is from 0.70 m to 1.20 m

above the floor and not less than 0.40 m from room corners. The comfortable

clearance for knee and leg space under tables for wheelchair users is 0.70 m.

- Counter height shall be placed at a level comfortable to disabled persons' reach.

ANTHROPOMETRIC DATA: ADULT

ANTHROPOMETRIC DATA: CHILD

BASIC PHYSICAL PLANNING REQUIREMENTS

No group of people shall be deprived of full participation and enjoyment of the environment or

be made unequal with the rest due to any disability. In order to achieve this goal adopted by the

United Nations, certain basic principles shall be applied:

31
1. ACCESSIBILITY. The built environment shall be designed so that it shall be accessible

to all people. This means that no criteria shall impede the use of facilities by either the

handicapped or non-disabled citizens.

2. REACHABILITY. Provisions shall be adapted and introduced to the physical

environment so that as many places or buildings as possible can be reached by all.

3. USABILITY. The built environment shall be designed so that all persons, whether they

be disabled or not, may use and enjoy it.

4. ORIENTATION. Finding a person's way inside and outside of a building or open space

shall be made easy for everyone.

5. SAFETY. Designing for safety insures that people shall be able to move about with less

hazards to life and health.

6. WORKABILITY AND EFFICIENCY. The built environment shall be designed to

allow the disabled citizens to participate and contribute to developmental goals.

INSIDE BUILDINGS AND STRUCTURES

ENTRANCES

- Entrances should be accessible from arrival and departure points to the interior lobby;

- One (1) entrance level should be provided where elevators are accessible;

- In case entrances are not on the same level of the site arrival grade, ramps should be

provided as access to the entrance level;

- Entrances with vestibules shall be provided a level area with at least a 1.80 m. depth

and a 1.50 m. width;

RAMPS

- Changes in level require a ramp except when served by a dropped curb, an elevator or

other mechanical device;

- Ramps shall have a minimum clear width of 1.20 m;

- The maximum gradient shall be 1:12;

- The length of a ramp should not exceed 6:00 m. if the gradient is 1:12; longer ramps

whose gradient is 1:12 shall be provided with landings not less than 1.50 m.;

32
- A level area not less than 1.80 m. should be provided at the top and bottom of any

ramp;

- Handrails will be provided on both sides of the ramp at 0.70 m. and 0.90 m. from the

ramp level;

- Ramps shall be equipped with curbs on both sides with a minimum height of 0.10 m.;

- Any ramp with a rise greater than 0.20 m. and leads down towards an area where

vehicular traffic is possible, should have a railing across the full width of its lower

end, not less than 1.80 meters from the foot of the ramp;

DOORS

- All doors shall have a minimum clear width of 0.80 m;

- Clear openings shall be measured between the surface of the fully open door at the

hinge and the door jamb at the stop;

- Doors should be operable by a pressure or force not more than 4.0 kg; the closing

device pressure an interior door shall not exceed 1 kg.;

- A minimum clear level space of 1.50 m x 1.50 m shall be provided before and

extending beyond a door;

- EXCEPTION: where a door shall open onto but not into a corridor, the required clear,

level space on the corridor side of the door may be a minimum of 1.20 m. corridor

width;

- Protection should be provided from doors that swing into corridors;

- Out swinging doors should be provided at storage rooms, closets and accessible

restroom stalls;

- Latching or non-latching hardware should not require wrist action or fine finger

manipulation;

- Doorknobs and other hardware should be located between 0.82 m. and 1.06 m. above

the floor; 0.90 is preferred;

- Vertical pull handles, centered at 1.06 m. above the floor, are preferred to horizontal

pull bars for swing doors or doors with locking devices;

- Doors along major circulation routes should be provided with kick plates made of

durable materials at a height of 0.30 m. to 0.40 m;

33
THRESHOLDS

- Thresholds shall be kept to a minimum; whenever necessary, thresholds and sliding

door tracks shall have a maximum height of 25 mm and preferably ramped;

SWITCHES

- Manual switches shall be positioned within 1.20 m to 1.30 m above the floor;

- Manual switches should be located no further than 0.20 from the latch side of the

door;

SIGNAGES

- Directional and informational sign should be located at points conveniently seen even

by a person on a wheelchair and those with visual impairments;

- Signs should be kept simple and easy to understand; signages should be made of

contrasting colors and contrasting gray matter to make detection and reading easy;

- The international symbol for access should be used to designate routes and facilities

that are accessible;

- Should a sign protrude into a walkway or route, a minimum headroom of 2.0 meters

should be provided;

- Signs on walls and doors should be located at a maximum height of 1.60 M. and a

minimum height of 1.40 meters. For signage on washroom doors, see C. Section 8.6.

- Signage’s labeling public rooms and places should have raised symbols, letters or

numbers with minimum height of 1 mm; braille symbols should be included in signs

indicating public places and safety routes;

CORRIDORS

- Corridors shall have minimum clear width of 1.20 m.; waiting areas and other

facilities or spaces shall not obstruct the minimum clearance requirement;

- Recesses or turnabout spaces should be provided for wheelchairs to turn around or to

enable another wheelchair to pass; these spaces shall have a minimum area of 1.50 m

x 1.50 m. and shall be spaced at a maximum of 12.00 m.;

- Turnabout spaces should also be provided at or within 3.50 m. of every dead end;

34
- As in walkways, corridors should be maintained level and provided with a slip

resistant surface;

WASHROOMS & TOILETS

- Accessible public washrooms and toilets shall permit easy passage of a wheelchair

and allow the occupant to enter a stall, close the door and transfer to the water closet

from either a frontal or lateral position;

- Accessible water closet stalls shall have a minimum area of 1.70 x 1.80 mts. One

movable grab bar and one fixed to the adjacent wall shall be installed at the accessible

water closet stall for lateral mounting; fixed grab bars on both sides of the wall shall

be installed for stalls for frontal mounting;

- A turning space of 2.25 sq.m with a minimum dimension of 1.50 m. for wheelchair

shall be provided for water closet stalls for lateral mounting;

- All accessible public toilets shall have accessories such as mirrors, paper dispensers,

towel racks and fittings such as faucets mounted at heights reachable by a person in a

wheelchair;

- The minimum number of accessible water closets on each floor level or on that part

of a floor level accessible to the disabled shall be one (1) where the total number of

water closets per set on that level is 20; and two (2) where the number of water

closets exceed 20;

- In order to aid visually impaired persons to readily determine whether a washroom is

for men or for women, the signage for men's washroom door shall be an equilateral

triangle with a vertex pointing upward, and those for women shall be a circle; the

edges of the triangle should be 0.30 m long as should be the diameter of the circle;

these signage’s should at least be 7.5 mm thick; the color and gray value of the doors;

the words "men" and "women" or the appropriate stick figures should still appear on

the washroom doors for the convenience of the fully sighted;

- Note: the totally blind could touch the edge of the signs and easily determine whether

it is straight or curved;

- The maximum height of water closets should be 0.45 m.; flush control should have a

maximum height of 1.20 mts.

35
- Maximum height of lavatories should be 0.80 m. with a knee recess of 0.60 - 0.70 M.

vertical clearance and a 0.50 m. depth.

- Urinals should have an elongated lip or through type; the maximum height of the lip

should be 0.48 m.

STAIRS

- Tread surfaces should be a slip-resistant material; nosings may be provided with slip-

resistant strips to further minimize slipping:

- Slanted nosings are preferred to projecting nosings so as not to pose difficulty for

people using crutches or braces whose feet have a tendency to get caught in the

recessed space or projecting nosings. For the same reason, open stringers should be

avoided.

- The leading edge of each step on both runner and riser should be marked with a paint

or non-skid material that has a color and gray value which is in high contrast to the

gray value of the rest of the stairs; markings of this sort would be helpful to the

visually impaired as well as to the fully sighted person;

- A tactile strip 0.30 m. wide shall be installed before hazardous areas such as sudden

changes in floor levels and at the top and bottom of stairs; special care must be taken

to ensure the proper mounting or adhesion of tactile strips so as not to cause

accidents;

ELEVATORS

- Accessible elevators should be located not more than 30.00 m. from the entrance and

should be easy to locate with the aid of signs;

- Accessible elevators shall have a minimum dimension of 1.10 m. x 1.40 m.;

- Control panels and emergency system of accessible elevators shall be within reach of

a seated person; centerline heights for the topmost buttons shall be between 0.90 m to

m from the floor;

- Button controls shall be provided with braille signs to indicate floor level; at each

floor, at the door frames of elevator doors, braille-type signs shall be placed so that

36
blind persons can be able to discern what floor the elevator car has stopped and from

what level they are embarking from; for installation heights, see Section 6.6,signages;

- Button sizes at elevator control panels shall have a minimum diameter of 20 mm and

should have a maximum depression depth of 1 mm;

CHAPTER V

R.A. 1378 – NATIONAL PLUMBING CODE OF THE PHILIPPINES AND ITS

IMPLEMENTING RULES AND REGULATIONS

INTRODUCTION

Plumbing systems for healthcare facilities, nursing homes, medical schools, and research

labs must be more complex than those for the majority of other building types. To properly

comprehend the plumbing needs for any new or specialized medical equipment, the plumbing

designer should collaborate closely with the architect and facility staff and participate in

meetings and discussions. To ensure that adequate provisions have been made for utility

capacities, for the necessary clearances and space requirements of the piping systems and

retrofitted plumbing equipment, and for compliance with applicable codes, the plumbing design

must be coordinated with the civil, architectural, structural, mechanical, and electrical designs.

Health-care facilities might be subject to different rules or be excluded from particular codes and

standards, such as those relating to the physically challenged and water and energy conservation.

The administrative authorities should be consulted by the plumbing engineer to verify

compliance with local legislation.

BASIC PRINCIPLES

The basic principles of the 1999 National Plumbing Code of the Philippines are an update of the

tenets established in the "Plumbing Law of the Philippines" approved on 18 June 1955 as

amended on 28 November 1959. The basic goal of the 1999 National Plumbing Code of the

Philippines is to ensure the unqualified observance of the latest provisions of the plumbing and

environmental laws.

37
Principle No. 1 - All premises intended for human habitation, occupancy or use shall be

provided with a supply of pure and wholesome water, neither connected with unsafe water

supplies nor subject to hazards of backflow or back-siphon age.

Principle No. 2 - Plumbing fixtures, devices and appurtenances shall be supplied with water in

sufficient volume and at pressure adequate to enable them to function satisfactorily and without

undue noise under all nominal conditions of use.

Principle No.3 - Plumbing shall be designed and adjusted to use the minimum quantity of water

consistent with proper performance and cleaning.

Principle No. 4 - Devices for heating and storing water shall be so designed and installed as to

prevent dangers from explosion through overheating.

Principle No. 5 - Every building having plumbing fixtures installed and intended for human

habitation, occupancy or use on premises abutting on a street, alley or easement where there is a

public sewer shall be connected to the sewer system.

Principle No.6 - Each family dwelling unit on premises abutting on a sewer or with a private

sewage-disposal system shall have at least one water closet and one kitchen type sink. Further, a

lavatory and bathtub or shower shall be installed to meet the basic requirements of sanitation and

personal hygiene.

Principle No.7 - Plumbing fixtures shall be made of smooth nonabsorbent material, free from

concealed fouling surfaces and shall be located in ventilated enclosures.

Principle No. 8 - The drainage system shall be designed, constructed and maintained to

safeguard against fouling, deposit of solids, clogging and with adequate cleanouts so arranged

that the pipes may be readily cleaned.

Principle No. 9 - All piping’s of plumbing systems shall be of durable NAMPAPAPPROVED

materials, free form defective workmanship, designed and constructed by Registered Master

Plumbers to ensure satisfactory service.

38
Principle No. 10 - Each fixture directly connected to the drainage system shall be equipped with

a water-sealed trap.

Principle No. 11 • The drainage piping system shall be designed to provide adequate circulation

of air free from siphon age, aspiration or forcing of trap seals under ordinary use.

Principle No. 12 - Vent terminals shall extend to the outer air and installed to preempt clogging

and the return of foul air to the building.

Principle No. 13 - Plumbing systems shall be subjected to such tests to effectively disclose all

leaks and defects in the workmanship.

Principle No. 14 - No substance which will clog the pipes, produce explosive mixture~ destroy

the pipes or their joints or interfere unduly with the sewage-disposal process shall be allowed to

enter the building drainage system.

Principle No. 15 - Proper protection shall be provided to prevent contamination of food, water,

sterile goods and similar materials by backflow of sewage. When necessary, the fixture, device

or appliance shall be connected indirectly with the building drainage system.

Principle No. 16 - No water closet shall be located in a room or compartment which is not

properly lighted and ventilated.

Principle No. 17 - If water closets or other plumbing fixtures are installed in buildings where

there is no sewer within a reasonable distance, suitable provision shall be made for disposing of

the building sewage by some accepted method of sewage treatment and disposal, such as a septic

tank.

Principle No. 18 - Where a plumbing drainage system may be subject tb backflow of sewage,

suitable provision shall be made to prevent its overflow in the building.

Principle No. 19 - Plumbing systems shall be maintained in serviceable condition by Registered

Master Plumbers. ·

Principle No. 20 - All plumbing fixtures shall be installed properly spaced, to be accessible for

their intended use.

39
Principle No. 11 - Plumbing shall be installed by Registered Master Plumbers with due regard to

the preservation of the strength of structural members and the prevention of damage to walls and

other surfaces through fixture usage.

Principle No. 22 - Sewage or other waste from a plumbing system which may be deleterious to

surface or sub-surface waters shall not be discharged into the ground or into any waterway,

unless first rendered innocuous through subjection to some acceptable form of treatment.

RECOMMENDED PLUMBING FIXTURE AND RELATED EQUIPEMENT

40
General Requirements

Health care facilities' plumbing fixtures should be made of solid, impermeable materials

with smooth surfaces. Commonly used plumbing fittings include those made of stainless steel,

enameled cast iron, and vitreous china. Chromium plating of fixture brass, such as faucets, traps,

strainers, escutcheons, stops, and supplies, must follow a procedure authorized by the

administrative authorities. Die-cast metals ought to be avoided. A laminar flow device made of

brass, monel metal, or stainless-steel trim is required on faucets; there is no substitute. Health

care facilities should have independent stop valves for each plumbing fixture. There must be

valves on every water service main, branch main, and riser. Every valve needs to have access.

Vacuum breakers that have received approval are required on all submerged inlets, faucets with

hose adapters, and flush valves.

FIXTURE FOR SPECIFIC HEALTH-CARE AREAS

General-use staff and public areas

Water closets

Vitreous china, siphon-jet water closet with elongated bowl design with open-front seat,

less cover, should be specified. Wall-hung water closets are preferred for easy cleaning; how-

ever, floor-set models are also acceptable by most local jurisdictions. All water closets should be

operated by water-saver flush valves.

Lavatories and sinks

Vitreous china, enameled cast iron or stainless-steel lavatories and sinks should be

specified. The most commonly specified size is h0 × 18 × 7< in. deep (508 ×457.h × 190.5 mm

deep). Hands-free controls (foot or knee controls) are generally employed for staff use and for

scrub-up sinks. In public areas, codes should be checked for the requirement of self-closing

valves and/or metered valves. Stops should be provided for all supply lines. Aerators are not

permitted; use laminar flow devices. Insulated and/or offset p-traps should be used for

handicapped fixtures.

Faucets Valves

41
Should be operable without hands, i.e., with wrist blades or foot controls or

electronically. If wrist blades are used, blade handles used by the medical and nursing staff,

patients, and food handlers shall not exceed 4< in. (11.43 cm) in length. Handles on scrub sinks

and clinical sinks shall be at least 6 in. (15.h4 cm) long. Water spigots used in lavatories and

sinks shall have clearances adequate to avoid contaminating utensils and the contents of carafes,

etc.

Urinals

Vitreous china wall-hung urinals with flush valves. Flush valves should be equipped with

stops and may be of the exposed or concealed design.

Showers

The shower enclosures and floor specified by the plumbing engineer may be constructed

of masonry and tile or of prefabricated fiberglass. Showers and tubs shall have nonslip walking

surfaces. The shower valve should automatically compensate for variations in the water-supply

pressure and temperature to de- liver the discharge water at a set temperature that will prevent

scalding’s.

Drinking fountains

Water coolers Drinking fountains are available in vitreous china, steel and stainless steel.

Units for exterior installations are available in suitable materials. Refrigerated water coolers are

available in steel or stainless steel. All of these materials are acceptable by most local

administrative authorities. These units may be of the surface-mounted, semi-recessed or fully-

recessed design. Mop-service basins Floor-mounted mop service basins can be obtained in

precast or (terazzo) molded-stone units of various sizes. The plumbing engineer should specify

the most suitable model. Rim guards are normally provided to protect the rims from damage and

wall guards are provided to protect walls from splashing and chemical stains. The water-supply

fixture is usually a two-handle mixing faucet mounted on the wall with a wall brace, vacuum

breaker, and hose adapter.

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Mop-service basins

Floor-mounted mope- vice basins can be obtained in precast or (terazzo) molded-stone

units of various sizes. The plumbing engineer should specify the most suitable model. Rim

guards are normally provided to protect the rims from damage and wall guards are provided to

protect walls from splashing and chemical stains. The water-supply fixture is usu- ally a two-

handle mixing faucet mounted on the wall with a wall brace, vacuum breaker, and hose adapter.

Floor drains

Floor drains in toilet rooms are optional in most cases; however, there are many instances

where the floor drains are required by the applicable codes. The plumbing designer should give

consideration to maintaining a trap seal in the floor drain through the use of deep- seal p-traps

and/or trap primers. Floor drains shall not be installed in operating and delivery rooms.

Ward rooms

Ward rooms are infrequently found in health-care facilities, particularly in the private

hospital field. These rooms require at least 1 lavatory. This lavatory should be a minimum h0 ×

18 in. (508 × 457.h mm) and made of vitreous china or stainless steel. The faucet should be of

the gooseneck-spout design and provided with wrist-blade handles or hands-free controls.

Nurseries

The hospital’s nursery is usually pro- vided with a minimum size h0 × 18 in. (508 ×457.h

mm) lavatory with hands-free controls and a high gooseneck spout. An infant’s bathtub, wall- or

counter-mounted with an integral large drain board and rinsing basin, is provided. Water-supply

fittings are filler spouts over the basins with separate hand-valve controls. The spout and the

spray are usually supplied and controlled through a thermostatic mixing valve. The ultimate in

maintaining a safe water temperature is a separate supply tank.

Intensive-care rooms

These rooms usually have utility sinks with hands-free controls with high gooseneck

spouts. A water-supply fitting equipped with a gooseneck spout and provision for bedpan

washing (either at an immediately adjacent water closet or at a separate bedpan washing station

43
within an enclosure in the room) should be provided. Newer designs have included combination

lavatory/water closets for patient use, especially in cardiac-care units.

Emergency (triage} rooms

The plumbing fixtures provided in emergency rooms include a utility sink with an

integral tray and a water- supply fitting with a gooseneck spout and wrist-blade handles. A

vitreous china clinic sink (or a flushing-rim sink), for the disposal of sol- ids, with the water-

supply fitting consisting of a flush valve and a separate combination faucet with vacuum breaker

mounted on the wall above the plumbing fixture, should also be provided.

Examination and treatment rooms

These rooms are usually provided with vitreous china or stainless-steel lavatories. The

water-supply fitting should be a hands-free valve equipped with a high, rigid, gooseneck spout.

For a particular examination room or a group of patient rooms, an adjacent toilet room is

provided containing a specimen-type water closet for inserting a speci- men-collecting bedpan.

The toilet room also requires a lavatory and a water supply with wrist- blade handles or hands-

free controls and with a gooseneck spout.

Physical-therapy treatment rooms

The plumbing fixtures and related equipment for these rooms usually include

hydrotherapy immersion baths and leg, hip, and arm baths. These units are generally furnished

with electric-motor- driven whirlpool equipment. The water is introduced into the stainless-steel

tank enclosure by means of a thermostatic control valve to prevent scalding, usually wall

mounted adjacent to the bath for operation by a hospital attendant.

Pharmacy and drug rooms

The plumbing fixtures for these rooms include medicine and solution sinks. These units

can be counter-type or made of stainless steel or vitreous china with a mixing faucet and a swing

spout. A solids interceptor should be considered for compounding areas.

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Operating-room

Areas No plumbing fixtures or floor drains are required in the hospital’s operating room.

However, the scrubbing station located adjacent to the operating room should have at least two

scrub sinks, usually made of vitreous china or stainless steel, furnished with hands- free water-

supply fittings, and equipped with gooseneck spouts. These sinks should be large and deep

enough to allow scrubbing of hands and arms to the elbow. A soiled workroom, designed for the

exclusive use of the hospital’s surgical staff, should be located near the operating room area.

This workroom should contain a vitreous china, flushing-rim clinical sink, for the disposal of sol-

ids, with the water-supply fittings consisting of a flush-valve bedpan washer and a separate

faucet mounted on the wall above the fixture and hand- washing facilities consisting of a vitreous

china or stainless-steel lavatory with a gooseneck spout and equipped with wrist-blade handles.

Sub sterile rooms should be equipped with an instrument sterilizer and general-purpose sink. The

plumbing designer should consult with the instrument sterilizer manufacturer for any special

requirements for the equipment. The general-purpose sink can be countertop-mounted and

equipped with a hands-free water-supply fitting with a gooseneck spout.

Recovery rooms

The rooms for the post-anesthesia recovery of surgical patients should include a hand-

washing facility, such as a vitreous china or stainless-steel lavatory equipped with a gooseneck

spout and wrist-blade handles; and a vitreous china, flushing-rim, clinical sink for the disposal of

solids, with the water-supply fitting consisting of a flush valve and a separate faucet mounted on

the wall above the fixture with a vacuum breaker. A bedpan washer should also be installed next

to the clinical sink. The type of bedpan washer will depend upon the hospital’s method of

washing and sterilizing bed- pans.

Birthing rooms

Each birthing room should include a vitreous china lavatory provided with a gooseneck

spout and wrist-blade handles or hands-free controls. Each labor room should have access to a

water closet and a lavatory. A shower should be provided for the labor-room patients. The

shower controls, including pressure/thermostatic mixing valve, should be located outside the wet

45
area for use by the hospital’s nursing staff. A water closet should be accessible to the shower

facility.

Anesthesia workrooms

This area is designed for the cleaning, testing, and storing of the anesthesia equipment

and should contain a work counter-mounted sink. The sink is usually made of stainless steel. The

faucet should be of the gooseneck spout design with wrist-blade handles and/or hands-free

controls.

DRAINAGE SYSTEMS FOR LABORATORIES

Special sanitary drainage systems may be required in healthcare institutions in addition to

the standard sanitary drainage systems (those found in most buildings). In operating or delivery

rooms, nurseries, food preparation areas, food serving areas, food storage areas, central services,

electronic data processing areas, electric closets, and other sensitive areas, drainage piping shall,

to the extent practicable, not be installed within the ceiling or exposed. Where it is impossible to

avoid having exposed, overhead drain piping in these locations, special provisions must be made

to shield the area below from leaks, dampness, or dust particles.

Acid-Waste Drainage Systems

Because corrosive solutions require particular treatment from the actual work area to an

allowed point at which such acid waste (and fumes) can be properly neutralized and discharged,

acid-waste drainage systems require special design standards. In this aspect, the plumbing

engineer must exercise utmost caution.

Where acids with a pH lower than 6.5 or alkalis with a pH higher than 8.5 are present, acid-

resistant waste and vent systems are required. In hospitals, research centers, and laboratories,

these unique circumstances are frequently seen. Proper drainage and venting are essential since

acid vapors are frequently more corrosive than the liquid acids themselves.

Model plumbing codes provide nationally accepted standards for sanitary systems that manage

acid wastes and other reagents; these systems are frequently further subject to municipal building

and safety or health department regulations. For these reasons, the plumbing engineer needs to

look for any unique design requirements that can have an impact on the project.
46
Corrosive-Waste Systems Materials

Sizes of borosilicate glass pipes range from 1 to 6. 40 to 150 mm pipe. High corrosion

resistance and easy visual inspection are made possible by the mechanical joint, flame resistance,

and clear pipe. Sizes of high-silicon cast iron range from one to four inches. (40 to 100 mm) pipe

Mechanical joint, strong corrosion resistance, cast iron-like fire stops at floor penetration, and

flame resistance. bulkier and more delicate than cast iron of normal weight, making it simpler to

break in the field. Excellent application for a project with a moderate to high budget.

Discharge to Sewers

Many local jurisdictions require that the building’s sanitary-sewer discharge be at an

acceptable pH level before it can be admitted into a sanitary-sewage system. In such cases, it is

recommended that a clarifying (or neutralizing) tank be added to the sanitary system. Small

ceramic or polypropylene clarifiers with limestone can be located under casework for low flow

rates; however, sufficient space must be allowed above the unit for servicing. Unless properly

maintained and monitored, this type of system can be rendered ineffective. Large clarifiers and

neutralizers may be regulated by the requirements of a local industrial-waste department.

Acidic-Waste Neutralization

The lower the pH number, the higher the concentration of acid. Discharging high

concentrations of acid into a public sewer may cause consider- able corrosion to piping systems

and eventual failure. Most local authorities do not allow acid wastes to be discharged to a public

sewer with- out some form of treatment. An acid-neutralization tank is typically and most

economically used to deal with the neutralization of acidic wastes. A tank for acid neutralization

could be made out of polyethylene, molded stone, stainless steel, or some other acid-resistant

substance. Tanks are designed to have dwell times between h and 3 h. (refer to Table h-3). Chips

of marble or limestone cover the tank's interior, helping to neutralize entering acid wastes. Chips

can range in size from 1 to 3 inches. (5.4 to 76.h mm) in diameter and should contain more than

90% calcium carbonate. To guarantee that the system functions effectively, a discharge pH

sensor and regular maintenance plan must be provided. Figure h-1 shows a picture of a

neutralization tank as an example.

47
CHAPTER VI

SIGNAGE SYSTEMS FOR HOSPITALS AND OTHER HEALTH FACILITIES

For the past years, there have been problems in meeting most of the information needs

and communication requirements of visitors and patients in hospitals.

These problems. Include:

- Lack of a unifying element in hospitals; .

- Lack of coherence in hospital signage;

- Lack of public information, coordinating mechanisms (or policies), and public awareness;

and lack of character in Department of Health hospitals.

As a solution to these problems, the DOH came up with a medium called Signage System

for all its hospitals and health facilities. The Signage System is being recognized as a new

necessity in upgrading DOH hospitals to the desired level of acceptability with the following

objectives:

- To provide the public with "guideposts" to the location of the various services available

in the facility;

- To inform the public and instill awareness of hospital policies, rules. and regulations;

- To provide a unifying element for all hospitals consisting of aids that promote the orderly

How of people; and to provide character to DOH hospitals.

DEFINITION OF TERMS

a. Communication - the art and act of conveying information from one entity to another.

b. Signage - is environmental graphic communication. It is a universal concept and can be

applied to any project through a systematic process where the only differences are in the actual

end products.

c. Signage System - is a discreet graphic system composed of a number of individual graphic

devices that are related by common characteristics or properties, and arranged to convey all

48
information considered essential to the optimum operation of a specific building and its

occupants

FIVE [Link] SIGN TYPES

ORIENTATION AND INFORMATION

These signs provide the user with information about the location of

services or departments, and other information of general nature.

DIRECTIONS

These are signs which include prominently displayed arrows to

direct the user towards roadways, departments, rooms, or facilities.

IDENTIFICATION

These are signs which identify departments, rooms, floors,

equipment, or buildings.

PROHIBITION AND WARNING

These signs tell the user what he is not allowed to do and what he

must be careful of. They are generally expressed in symbols or

symbol-signs (symbols combined with words).

OFFICIAL NOTICES

These signs display information of official nature and should not

"be confused with orientation signs.

THE THREE BASIC ELEMENTS OF A SUCCESSFUL SIGNAGE SYSTEM

GRAPHIC ELEMENTS

These include, but are not limited to, format, color, typography, size, symbols, and

lighting requirements. They ensure the optimum legibility and readability of each sign in the

system.

49
LEGIBILITY

concerns the viewers' physical ability to see a sign and to distinguish letters or colors.

READABILITY

involves the viewers' ability to perceive a message. Signs must be both legible and

readable to function properly. The choice and arrangement of words to be used in conveying the

message of signs is critical and should reflect CLARITY, SIMPLICITY, and FORCEFULNESS.

SEMIOTIC ELEMENTS

These are semantics, syntactic, and pragmatics. In the context of signage, SEMANTICS

involves the relationship of a visual image to a meaning, SYNTACTICS relates to the

relationship of one visual image to another, and PRAGMATICS deals with the relationship of a

visual image to the user.

MECHANICAL ELEMENTS

These are hardware components which utilize the latest material, fabrication, and

installation technologies available. A balanced application of all these elements will result in a

"customized" system that will be flexible in use and obtainable within acceptable budgetary

considerations.

CLASSIFICATION OF SYMBOL-SIGNS

PROHIBITION

All symbols in this classification denote an order for the prevention

of an action (e.g. "No Smoking"). Prohibition symbols shall have a

black symbol located inside a white field' circumscribed by a red

ring, diagonally bisected at 45 degrees by a red slash. The red slash

is interrupted for the black symbol.

OBLIGATION

All symbols in this classification denote an order for obligatory

action (e.g. "STERILE GOWNMUST BE WORN"). Obligatory

50
symbols shall have a white symbol located inside a black disk.

CAUTION

All symbols in this classification denote the presence of a potential

hazard (e.g. "X-Ray RoomDo Not Enter When the Red Light Is

On"). Caution symbols shall have a black symbol located inside a

solid yellow equilateral triangle.

DANGER

All symbols in this classification denote the presence of a definite

hazard (e.g. "Danger-Radiation"). Danger symbols shall have a

white symbol inside a solid red equilateral triangle.

FIRST AID. EMERGENCY AND FIRE PROTECTION

All symbols in this classification denote first-aidrelated equipment

as well as fire protection and emergency equipment (e.g. "First Aid

Station" or "Fire Extinguisher" or "Fire Hose"). First-aid and fire

protection symbol- signs shall have a white symbol located inside a

green square or rectangle.

MISCELLANEOUS

All symbols in this classification denote information that is not

covered by any other classification. Miscellaneous Symbol-signs

shall have a white symbol located inside a blue square or rectangle.

When, for aesthetic reasons only, it is deemed undesirable to have

these miscellaneous symbolsigns in blue, they may be produced in

any "neutral" color provided:

a. The symbol is reversed (in lighter color) from the neutral

background.

b. The neutral background shall have a total value(on the gray

scale) of not more than 60% and not less than 40%. This

51
exception applies exclusively to signs in this classification.

There is no similar exception to signs in the other

classifications

COLOR

Just as each symbol-sign has its distinctive shape, each also has a distinctive color background.

Thus, shape and color are utilized to ensure effective communication.

Red for Prohibition/Danger

Green for Emergency/First Aid/Fire Protection

Yellow for Caution

Blue for Miscellaneous

Black for Obligation

White for Other Classification

GENERAL FUNCTIONS

1. Identify a place and indicate whether it is accessible to everyone.

2. Indicate warnings and prohibitions where necessary.

3. Give routing information.

GENERAL USAGE

SITE

The hospital should be effectively signed. Upon arrival, the visitor shall be guided by

means of directional devices containing specific information and arrows.

PARKING

The parking lot entrance of a hospital shall have doctors', employees', and visitors' parking

designations along with the hospital name. Entrances and exits should be identified, with

52
appropriate information for the handicapped. Directions to the visitors' parking area within the

hospital premises should be clearly displayed. Other signs include:

- Level identification

- Exit directions and identification

- Traffic regulations

- Space designations

- Limited access

- Special instructions/regulations

- Handicapped parking identification

BUILDING IDENTIFICATION

The hospital shall have an identification sign which should be freestanding or directly

applied to the hospital's façade.

HOSPITAL DIRECTORY

Visitors will be directed from the parking areas to the hospital entrance(s) or lobbies

where the directories are generally located. These directories shall list all hospital

departments/services alphabetically, followed by their location in the facility.

ELEVATORS

Elevator lobbies on each floor shall include floor identification. Some hospitals may have

elevator floor service designations, such as "Express Elevator" or "Floors 1-6." Also located at

each elevator service area will be: notices, "In Case Of Fire, Use Exit Stairs" signs, and "Do Not

Use Elevator" signs. "No Smoking" signs, capacity signs, and the elevator number, along with an

emergency telephone number, will be displayed in elevator cabs.

FLOOR/CORRIDOR IDENTIFICATION

There is a need to identify floors at public access points. A plaque or color coding system

may be used. Corridor identification may be necessary in facilities where the floor plan is

complex.

53
FLOOR INFORMATION

Once the desired floor is reached, the visitor will see the specific floor directory. This

shall be located within, or directly adjacent to, the elevator lobby. Visitors arriving at the floor,

by means of bridges or secondary access, will also be guided to this directory.

INTERIOR DIRECTIONAL

Directional graphic devices shall guide the visitor from the hospital's initial entry point to

the building directory. A directional device at each floor directory location shall guide the visitor

to the different departments or services in the hospital.

ROOM NUMBERING SYSTEM

Room numbering should be consistent throughout the hospital to promote the orderly

flow of visitors, patients, and employees. Rooms requiring only a number will utilize the

"Inventory Room Number" device.

AREA IDENTIFICATION

Primary area identification shall be used to identify a' wing or floor where there are

multiple department/service functions in that area. Each department will be listed on this device.

OFFICE IDENTIFICATION

General office identification devices include room numbers and functions. No individual

names shall be listed. If the individual's name is interchangeable with the title of his/her office

(e.g., Given name-Hospital Director, Chief Administrator, etc.), the entrance to the said office

shall have the' room number and the person's name, or names if more than one individual

occupies that office.

NAME PLAQUES

Name plaques may be provided for hospital personnel. The individual's name, or name

and title, may be indicated on the plaque. Provisions are made for both desk-type and office

landscape partition-type name plaques:

54
EGRESS CONTROL

Egress control devices are required for all hospitals. The development of the specific

requirements needs to be coordinated with the local accident and fire protection personnel. .

STAIRS

To assist in emergency evacuation and floor circulation. it is recommended that the inside

walls of stairwells have floor number identification prominently displayed at each level landing.

It is also recommended that all stairs, in addition to existing illuminated exit signs, be identified

with an "Exit Stair" sign and a graphic symbol. This identification shall be located on the

corridor side of the door leading into the stairwell.

REST ROOMS

All rest rooms shall be identified according to use with symbol designations and, if

required, word designations.

BULLETIN BOARDS

These items are provided as options. They shall be located at key points of office

personnel circulation. Their prime purpose [Link] provide a standard, format and some degree of

control over the normally uncontrollable situation of notices, advertisements, etc.

INVENTORY ROOM NUMBER

These items provide a cost-efficient and simple method of providing an inventory room

number for rest rooms and non-public areas not in need of regular identification. These will be

located on the upper left or right corner of the door frame.

SIGNS FOR THE HANDICAPPED

These signs indicate the presence of accessibility features for disabled persons within the

facility.

GENERAL GUIDELINES FOR DESIGN

The information given on signs should always be clear and precise, and sign locations

should never present unnecessary hazards to the public.

55
READABILITY

The readability of any sign is a result of many factors. In choosing the format of a sign,

the following points should be considered:

a. Information should be as clear and concise as possible;

b. Lettering styles and graphic symbols should be as bold and simple as possible. Fancy styles

appear cluttered, are time consuming, and are hard to read; and

c. Schemes of contrasting colors with light images on dark backgrounds make signs both easier

to notice and read from longer distances.

PLACEMENT/LOCATION

Proper placement is important because wrongly located signs may act as obstacles or

hazards. Unless intended to be read by the blind or the partially sighted, signs should be set well

off a travelled way or high off the ground, or both, so as not to be inadvertently walked into.

OUTDOOR SIGN LOCATIONS

Pedestrian signs are, of course, smaller in scale than vehicular signs but the general

principles controlling their location are basically the same.

IDENTIFICATION

When two-way traffic is involved, place these signs

free-standing at right angles to the direction of traffic flow.

When one-way traffic is involved, locate these signs on the

building to enhance visibility and discourage vandalism.

DIRECTION

Directional signs are useful only insofar as they are located

to lead the users to the desired destination and are situated

for maximum effectiveness. If an opening or a ramp exists

for which directional signs are required, the sign should be

56
placed opposite (or over) the opening. Turn signs should be

located before the turn.

ORIENTATION/INFORMATION

These signs should be located in such a way as to maximize

their effectiveness without causing bottlenecks in the traffic

flow.

PROHIBITION

These signs should be located on or above doors and other

openings, or on walls, to tell the user what he is not allowed.

OFFICIAL NOTICES AND OTHER INFORMATION

These signs are located in the same manner as orientation

signs. They should be located to maximize their

effectiveness 'without causing' bottlenecks in the traffic

flow.

INDOOR SIGN LOCATIONS

Indoor signs are located on (or sometimes suspended from) building elements. Generally,

indoor signs are smaller in scale than exterior, signs, due to the fact that indoor signs are viewed

at a much closer range. It is important that these signs be located in a consistent and logical

manner that will maximize their effectiveness and keep their total number in the building to a

minimum.

ORIENTATION/INFORMATION

Directories should be located on walls inside the main

entrance.

DIRECTION

Directional signs should be placed wherever the visitor has

to make decisions as shown on these diagrams. Four signs

57
are required at intersections and three at "T" intersections

of corridors as shown.

IDENTIFICATION

If the only means of identifying a room is through its

number, it should be placed on the door. Otherwise, it

should be mounted on the wall to the right or left of the

door as necessary. Locate signs over counters either aligned

with the front or centered on them.

PROHIBITION/REGULATION

These signs should be located at key points along the

visitor's route to denote orders for the prevention of certain

actions.

OFFICIAL NOTICES

These signs should be located on columns or-walk where

they will be clearly visible to the public.

TYPICAL ASSEMBLY (EXTERNAL SIGNS)

58
PARKING LOT IDENTIFICATION/ROAD DIRECTIONAL SIGNS

The parking lot entrance should havedoctors', employees', and/or visitors' parking

designations. The entrance(s) and exirfs) should be identified using road directional signs

containing the appropriate information.

59
SPECIFICATIONS:

(Emergency Room and Out-Patient Department)

a. COLOR: White typography on a dark-green panel with white borders. Thickness shall be

dark-green.

b. LETTER STYLE: Helvetica medium with 130mm type.

c. SIGN PANEL SIZE: 900 mm x 1800 mm.

d. MATE-RIAI.S: Molded fiberglass panel with extruded aluminum legs.

e. MOUNTING: Recommended height of2300 mm above ground level. To be flush-mounted on

the ground (no mounting base revealed). Fabricate with ground level anchors with concrete

foundations.

f. GRAPHIC APPLICATION: Die-cut vinyl, pressure sensitive legends, minimum 0.003 to

0.006 in. maximum film thickness.

60
61
SPECIFICATIONS:

All Other Exterior Graphic Signs:

a. COLOR: As shown on the drawings. All signs" shall be reflectorized and with white borders

b. LETTERSTYLE: Helvetica medium with type size proportional to the sign panel size.

c. SIGN PANEL SIZES: As shown on the drawings.

d. MATERIALS: Calvanizediron, gao 26 and 50mm diameter galvanized iron pipe stand.

e. MOUNTING: Recommended height of1200 mm aboveground level, on iron pipe stand.

f. GRAPHIC APPLICATION: Graphics shall be silk-screen printed with the background area

spray-painted.

WARNING/PROHIBITORY SIGNS

These signs should be located at key points along the route ofthe visitor where specific

warning or prohibitory information is required to control visitor activity. Signs which indicate

rooms to which the public has no access should be located on doors.

62
CHAPTER VII

DISTRICT HOSPITALS: GUIDELINES FOR DEVELOPMENT. WORLD HEALTH

ORGANIZATION REGIONAL PUBLICATIONS, WESTERN PACIFIC SERIES. 1992

The Declaration drew attention to the stark disparities in health status between

industrialized and developing nations as well as between demographic groupings within nations.

It underlined the notion that these disparities could be eliminated with the support and

cooperation of many sectors, but particularly of the health services. Health professionals working

in straightforward settings near to their patients would deliver primary healthcare.

Essential medical care based on realistic, reliable scientific theory, and social in the spirit

of self-reliance and self-determination, appropriate practices and technologies should be made

widely available to all individuals and families in the community by their active participation and

at a cost that the community and the country can afford to maintain.

THE DISTRICT HEALTH SYSTEM

The concept of a district health system is not new; decentralization of power has long

been a crucial organizational and political tactic. The majority of health systems in both

developed and developing nations manage health services for specific geographic areas out of

regional, provincial, or district centers. The implementation of primary healthcare is what we are

supporting, and the intermediate level of control needs to be improved to encourage and support

this endeavor. Primary health care must have unwavering support from the top in the form of a

clear, solid national policy to thrive, but its full realization critically depends on the district-level

employees who are in charge of managing and putting primary health care initiatives into action.

If top and bottom are to meet at all, it will be in the district.

A great organizational framework for implementing improvements to the healthcare

system is provided by the district. At this level, if people and material resources are made

available and enough authority is assigned, policies, plans, and practical reality can collide to

create workable solutions.

Some key features of a district health system are:

-it is people-orientated

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-it is clearly defined

-it incorporates the principles of primary health care in all its activities

-it has substantial autonomy, so that it can manage and implement solutions as

effectively as possible in accordance with local conditions.

The general principles for developing such systems are based on the Declaration of Alma

Ata and the Global Strategy for Health for All and incorporate the following:

-equity

-accessibility

The district health system

- emphasis on promotion and prevention

- -intersect oral action

- -community development

- -decentralization

- -integration of health programmers

- coordination of separate health services

Before the role of the district hospital in the district and in the regional health system can be defined,

however, plans for developing health services must be outlined and planning objectives understood.

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METHODS OF PLANNING AND DESIGN

Hospital planning and design is a difficult process that calls for a multidisciplinary

approach. Given this, the process needs to be structured and systematized so that everyone

participating in it can clearly understand its stages, roles, activities, contributions, and expected

outputs, as well as its levels, standards, and levels of quality.

This section has the following objectives:

1. to present an overview of the planning and design process, to guide its participants, and

especially those working in units and agencies for health planning and designing in different

countries;

2. to present concisely the basic information that is important in the process of planning and

designing

3. to organize the overview and basic information in such a way that it can serve as checklists for

planning units, planning teams and professional designers, so that they can derive and organize

their own planning and design; and

4. to help strengthen and develop planning and design capabilities at the local level.

Preparation of the design brief

The design brief is a key document: it is the written expression of the client's needs, as

expressed in consultation with various professionals, including the architect and engineers. It is

important because "a good design is based on a good brief' and "a good brief is rich soil in which

to grow a good design". The brief should provide the following information about the hospital

and its parts or units:

1. Functional content: size and content of departments, such as number of operating

theatres, number of beds in wards

2. Philosophy of service: what the departments will and will not do

3. Workload: what hours the hospital departments will work, the shifts, maintenance time,
overtime

4. Planning principles: policies and procedures of the hospital with regard to: -patient
movement -staff movement -supply delivery --disposal of used goods -laundry service -

food service -domestic services

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5. Staffing: number and types of staff, peak periods of work

6. Functional relationships: between departments, between rooms within a department

7. Environmental factors and engineering: hospital policies with regard to: -fire protection
-electrical supply (mains and stand-by) -sterilizing and sterile supply -security -hot- and

cold-water supplies -heating and ventilation -lighting -medical gases and vacuum -

emergency alarm system --other engineering services -landscaping and pollution control

8. Schedule of accommodations: list of all rooms and spaces in each department, type and
number of occupants, sizes and activities performed in them

9. Financial aspects
(a) Costs: budget, or programmed amounts, to include:

-construction (a major budget item)

-professional services (architects, engineers)

-construction/project management services

-fixed equipment -furniture and movable equipment

extra utilities, if necessary

-professional procurement and installation of equipment

-site investigation and development, including purchase of land

-insurance, for fire and other liabilities required during construction

-legal counsel

-taxes, customs duty and other statutory charges

-contingencies, for unforeseen situations

(b) Possible sources of funds -central government

-gifts, donations or grants

-money generated by hospital activities prior to construction

-money to be repaid from future hospital activities

The following is a sample format and checklist of the contents of a typical design brief for a

district hospital:

1. Introduction

(a) Background, project initiative

(b) Project funding, source

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(c) Philosophy of service development plans

(d) Organization

(e) Other

2. Site information

(a) Physical description: bearings, boundaries, topography, surface area

(b) Land use in adjoining areas

(c) Any limitations of the site that would affect planning

(d) Maps of vicinity and landmarks or centers

(e) Existing utilities

(f) Nearest city, port, airport

(g) Rainfall and data on weather and temperatures

3. Policies for hospital operation: concepts on a general level, with implications at specific

levels, such as:

-patient movement

-staff movement

-delivery of supplies

-disposal of used goods

-laundry services

-food services

-domestic services

-security

-engineering services

-fire protection

-emergency alarm systems

4. Zoning: grouping of departments according to zoning principles

5. Departmental requirements: separate consideration for each department should include:

(a) Description of functions and facilities

-procedures, operational policies

-schedule of accommodation

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-list of rooms

-suggested area; critical dimensions, if any

(b) Qualitative parameters.

(i) Location, relationship to other rooms, services and departments

(ii) use

-function of or activities carried out in room

-space requirements for activities, when critical

-numbers of staff and/or patients using room at one time

-wheeled traffic

-goods or materials

-special uses and work flow

-occupancy or time in use

(iii) constraints

-privacy

-supervision

-security

-separation

-fire protection

(iv) environment

-wind direction

-lighting, natural and artificial

-heat, humidity, sterility

-cold, room heating

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-sound (acceptable noise levels)

-ventilation

(v) Fittings, fixtures and equipment (fixed and movable)

(vi) Loads on services

-electrical

-heating

-ventilation and air-conditioning

-hot water

(c) Functional relationships and physical proximities

(i) Closeness matrices'

(ii) Bubble diagrams2

(iii) Activity analyses, traffic movements.

(d) Flexibility and future expansion: possibility of future growth, with schedule

6. Cost of project, other financial aspects (in terms of capital and recurring costs)

(a) Financing scheme

(b) Cost limitations for each aspect of the project (working budget)

(c) Priorities for phasing, if necessary

(d) Expected flow of funding with time

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INVENTORY AND DISTRIBUTION OF HEALTH FACILITIES (THE MAPPING

EXERCISE)

One of the most effective ways of determining the

location of a new facility is to use a base map of the district

and vicinity, on which one can enter, translate and compare

data, facts and information (Fig. 4). A basic mapping

exercise is the first step in locating the positions of existing

facilities; a graphical analysis of data on where patients

come from can be used to determine the areas of influence

and service of those facilities. This kind of analysis shows

the overlapping of influence and any voids that need filling

and therefore warrant the provision of a new facility.

SERVICE CATCHMENT AREA

The catchment area for a health facility is determined by several factors:

(1) Politico-administrative boundaries are usually the strongest determinant, as they set a

defined area and imply an established organization which directs, manages and operates the

affairs of the population within its jurisdiction. In most countries, the hierarchy of physical

facilities parallels that of the politico-administrative organization, so that a particular level of

facility is under the jurisdiction of an equivalent level of the politicoadministrative unit

throughout the country.

(2) Geographical boundaries are natural physical barriers to

population movement and can therefore also be strong determinants of

catchment areas (Fig. 5). Mountain ranges and bodies of water, for

instance, deter cross movement. People may cross politico administrative

boundaries to reach a facility, however, if they are deterred by a natural

barrier within their own district. Geographic boundaries are often

formalized into politico administrative boundaries as a natural

consequence of the development of ethnic, cohesive or homogeneous

cultures on either side.

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3) 18 Time boundaries, although invisible, determine

catchment areas in regions without roads and easy means of

transport (Fig. 6). Populations gravitate towards the facilities that

are most easily accessible, that is, the facility they can get to in the

shortest time. The factor of geography also contributes to this

situation, as difficult terrain takes longer to negotiate.

FACTORS TO BE CONSIDERED IN LOCATING A DISTRICT HOSPITAL

1. It should be within 15-30 min travelling time. In a district with good roads and

adequate means of transport, this would mean a service zone with a radius of

about 25 km.

2. It should be grouped with other institutional facilities, such as religious (church),

educational (school), tribal (cultural) and commercial (market) centers.

3. It should be free from dangers of flooding; it must therefore not be sited at the

lowest point of the district.

4. It should be in an area free of pollution of any kind, including air, water and land

pollution.

5. It must be serviced by public utilities: water, sewage and storm-water disposal,

electricity, gas and telephone. In areas where such utilities are not available,

substitutes must be found, such as a deep well for water, generators for electricity

and radio communication for telephone.

SITE SELECTION

A rational, step-by-step process of site selection occurs only in ideal circumstances. In

some cases, the availability of a site outweighs other rational reasons for its selection, and

planners and architects are confronted with the job of assessing whether a parcel of land is

suitable for siting a hospital. In the case of either site selection or evaluation of adaptability, the

following items must be considered: size, topography, drainage, soil conditions, utilities

available, natural features and limitations.

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SIZE

The site must be large enough for all the planned functional requirements to be met and

for any expansion envisioned within the coming 10 years (Fig. 7). Recommended standards vary

from 1.25 to 4 ha per 100 beds; the following minimum requirements have been proposed:

25-bed capacity - 2 ha (800 m2 per bed)

100-bed capacity - 4 ha (400 m2 per bed)

200-bed capacity - 7 ha (350 m2 per bed)

300-bed capacity -10 ha (333 m2 per bed)

These areas are for the hospital buildings only, excluding the area needed for staff

housing. For smaller hospitals, single-storey construction generally results in lower building cost,

less reliance on expensive mechanical services and lower running and maintenance costs. Thus,

hospitals up to 150 beds should be single-storey constructions unless other parameters dictate

that they be multistoried.

Topography

Topography is a determinant of the distribution of form and space. A flat terrain is the

easiest and least expensive to build on. A rolling or sloping terrain is more difficult and more

expensive to build on, but the solutions can be interesting and innovative; by using the natural

slope of the ground, the drainage and sewage disposal systems can be designed so as to result in

lower construction and maintenance costs

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DRAINAGE

The terrain must allow for easy movement of water away from the site. A high point in

the community is ideal. If this is not available and the site is at a low point or in a depression, the

following must be checked:

-how the surrounding natural terrain and waterways can be used to move water away

from the site;

-whether the type of soil allows rapid absorption and disposal of water;

-the use of other technical means of ensuring drainage, such as placing the building on a

podium or on stilts, or digging temporary reservoirs

It should be noted that the placing on a site of hospital buildings and paved areas greatly

increases run-off of storm-water. A site with no apparent drainage problems when bare may be

subject to serious flooding when developed, if adequate provision is not made for disposal of

rainwater. Wherever possible, a site should be provided with surface openings to storm-water

drains, drainage channels or waterways. Storm-water run-off from roads and buildings should be

piped to such openings. It is also important to check that the waterways themselves are not

subject to flooding and that, in flood conditions, water will not back up on the hospital site.

When deciding the ground floor level of the buildings, care should be taken to safeguard against

temporary flooding of the building in a heavy downpour. In areas prone to regular flooding, a

raised ground floor, which allows for expected peak floods, is essential. Local engineering

advice on the possibilities of drainage from a site should be obtained before proceeding with its

purchase, when such advice is available (e.g., from records of the local authority or relevant
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government department). It may also be necessary to perform percolation tests to determine the

capacity of the soil to absorb liquids; this is particularly important when sewage must be treated

and effluents disposed of on the site.

DEPARTMENTAL PLANNING AND DESIGN

This section deals only with general principles of planning and design. The detailed design brief

should contain a comprehensive schedule of accommodation for each department and should

state the functional planning requirements for each activity to be carried out in each space.

The different departments of the hospital can be grouped according to zone, as follows:

1. Outermost zone, which is the most community orientated

- primary health care support areas

- out-patient department

- emergency department

- administration

- admitting office, reception

2. Second zone, which receives workload from (1)

- diagnostic x-ray

- laboratories

-pharmacy

3. Middle zone between outer and inner zones

- operating department

- intensive care unit

-delivery

-nursery

4. Inner zone, in the interior but with direct access for the public

- wards and nursing units

5. Service zone, disposed around a service yard

- dietary services

- laundry and housekeeping

-storage

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- maintenance and engineering

-mortuary

-motor pool

PRIMARY HEALTH CARE SUPPORT AREAS

The three ways in which a hospital supports primary health care are: education and

training, technical support and administrative support. Specific areas should be designed so that

the hospital can fulfil its role in primary health care in the community.

EDUCATION AND TRAINING SUPPORT AREAS

About 85-90% of out-patients seek solutions to medical problems that could be dealt with

at home; only 10-15% have been referred from general practitioners and peripheral health units.

Of the latter, 30-35% have major medical conditions. It is clear, therefore, that the number of

unnecessary trips to hospital could be diminished if people were educated about the nature of

various diseases, their causes, their treatment and how to stay healthy. As long as people run to

the hospital whenever they feel ill, however, the medical staff of the out-patient department can

serve as agents to teach better health rather than merely dispensing medical treatment.

CHAPTER IX

GUIDELINES FOR CONSTRUCTION AND EQUIPMENT OF HOSPITAL AND

MEDICAL FACILITIES. AMERICAN INSTITUTE OF ARCHITECTS, COMMITTEE

ON ARCHITECTURE FOR HEALTH. 1992

The material in this publication is meant to serve as a guide for developing and outfitting

new medical facility projects. Use of phrases like shall is necessary only if applied by an

adopting authority with jurisdiction. These standards are given in "code language" for

convenience and brevity. These standards, to the extent that they are applicable, relate to desired

performance, results, or both. Local building codes include construction and engineer details.

Design and construction must adhere to these guidelines' specifications. The criteria

outlined in these Guidelines shall be regarded as the absolute minimum. Local governing

building codes shall be applicable for design and construction elements not covered by these

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Guidelines. The predominant model code used in the region is hereby stated for all standards not

otherwise defined in these Guidelines when there is no local governing building code.

RENOVATION

Where renovation or replacement work is done within an existing facility, all new work

or additions, or both, shall comply, insofar as practical, with applicable sections of these

Guidelines and with appropriate parts of NFPA 101, covering New Health Care Occupancies.

Where major structural elements make total compliance impractical or impossible, exceptions

should be considered. This does not guarantee that an exception will be granted, but does attempt

to minimize restrictions on those improvements where total compliance would not substantially

improve safety, but would create an unreasonable hardship. These standards should not be

construed as prohibiting a single phase of improvement.

DESIGN STANDARDS FOR THE DISABLED

In July of 1990, President Bush signed into law the Americans with Disabilities Act

(ADA). This new law extends comprehensive civil rights protection to individuals with

disabilities. Under Titles II and III of the ADA, public, private, and public service hospitals and

other health care facilities will need to comply with the Accessibility Guidelines for Buildings

and Facilities (ADAAG) for alterations and new construction. United States government

facilities are exempt from the ADA as they must comply with the Uniform Federal Accessibility

Standards (UFAS), which was effective August 7, 1984.

Also available for use in providing quality design for the disabled is the American

National Standards Institute (ANSI) A117.1 American National Standard for Accessible and

Usable Buildings and Facilities.

State and local standards for accessibility and usability may be more stringent than ADA,

UFAS, or ANSI A1l7.1. Designers and owners, therefore, must assume responsibility for

verification of all applicable requirements.

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PROVISIONS FOR DISASTERS

In locations where there is a history of hurricanes, tornadoes, flooding, earthquakes, or

other regional disasters, planning and design shall consider the need to protect the life safety of

all health care facility occupants and the potential need for continuing services following such a

disaster.

CODES AND STANDARDS

Every health facility shall provide and maintain a safe environment for patients,

personnel, and the public. References made in these Guidelines to appropriate model codes and

standards do not, generally, duplicate wording of the referenced codes. standards for insuring

accessibility for the handicapped may be based upon either ADA or UFAS, in accordance with

the local authority having jurisdiction.

ENERGY CONSERVATION

The importance of energy conservation shall be considered in all phases of facility

development or renovation. Proper planning and selection of mechanical and electrical systems,

as well as efficient utilization of space and climatic characteristics, can significantly reduce

overall energy consumption. The quality of the health facility environment must, however, be

supportive of the occupants and functions served. Design for energy conservation shall not

adversely affect patient health, safety, or accepted personal comfort levels. New and innovative

systems which accommodate these considerations while preserving cost effectiveness are

encouraged.

LOCATION

Access

The site of any medical facility shall be convenient both to the community and to

service vehicles, including fire protection apparatus, etc.

Availability of Transportation

Facilities should be located so that they are convenient to public transportation

where available.

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Security

Health facilities shall have security measures for patients, personnel, and the

public consistent with the conditions and risks inherent in the location of the facility.

These measures shall include a program designed to protect human and capital resources.

Availability of Utilities

Facilities shall be located to provide reliable utilities (water, gas, sewer,

electricity). The water supply shall have the capacity to provide normal usage plus

firefighting requirements. The electricity shall be of stable voltage and frequency.

FACILITY SITE DESIGN

Roads

Paved roads shall be provided within the property for access to all entrances and

to loading and unloading docks (for delivery trucks). Hospitals with an organized

emergency service shall have the emergency access well marked to facilitate entry from

the public roads or streets serving the site. Other vehicular or pedestrian traffic should not

conflict with access to the emergency station. In addition, access to emergency services

shall be located to incur minimal damage from floods and other natural disasters. Paved

walkways shall be provided for pedestrian traffic.

Parking

Parking shall be made available for patients, personnel, and the public, as

described in the individual sections for specific facility types.

ENVIRONMENTAL POLLUTION CONTROL

Environmental Pollution

The design, construction, renovation, expansion, equipment, and operation of

hospitals and medical facilities are all subject to provisions of several federal

environmental pollution control laws and associated agency regulations. Moreover, many

states have enacted substantially equivalent or more stringent statutes and regulations,

thereby implementing national priorities under local jurisdiction while additionally

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incorporating local priorities (e.g., air quality related to incinerators and gas sterilizers;

underground storage tanks; hazardous materials and wastes storage, handling, and

disposal; storm water control; medical waste storage and disposal; and asbestos in

building materials).

EQUJPMENT

An equipment list showing all items of equipment necessary to operate the facility shall

be included in the contract documents. This list will assist in the overall coordination of the

acquisition, installation, and relocation of equipment. The equipment list should include the

classifications identified in Section 4.2 below and whether the items are new, existing to be

relocated, owner provided, or not-in-contract.

The drawings shall indicate provisions for the installation of equipment that requires

dedicated building services, or special structures, or that illustrate a major function of the space.

Adjustments shall be made to the construction documents when final selections are made.

Space for accessing and servicing fixed and building service equipment shall be

provided. Some equipment may not be included in the construction contract but may require

coordination during construction. Such equipment shall be shown in the construction documents

as owner-provided or not-in-contract for purposes of coordination.

Classification

Equipment will vary to suit individual construction projects and therefore will

require careful planning. Equipment to be used in projects shall be classified as building

service equipment, fixed equipment, or movable equipment.

Building Service Equipment

Building service equipment shall include such items as heating, air conditioning,

ventilation, humidification, filtration, chillers, electrical power distribution, emergency

power generation, energy management systems, conveying systems, and other equipment

with a primary function of building service.

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Fixed Equipment (Medical and Nonmedical)

Fixed equipment includes items that are permanently affixed to the building or

permanently connected to a service distribution system that is designed and installed for the

specific use of the equipment. Fixed equipment may require special structural designs,

electromechanical requirements, or other considerations.

a. Fixed medical equipment includes, but is not limited to, such items as fume

hoods, sterilizers, communication systems, built-in casework, imaging equipment,

radiotherapy equipment, lithotripters, hydrotherapy tanks, audiometry testing

chambers, and lights.

b. Fixed nonmedical equipment includes, but is not limited to, items such as

walk-in refrigerators, kitchen cooking equipment, serving lines, conveyors,

mainframe computers, laundry, and similar equipment.

Movable Equipment (Medical and Nonmedical)

Movable equipment includes items that require floor space or electrical connections but

are portable, such as wheeled items, portable items, office-type furnishings, and monitoring

equipment.

a. Movable medical equipment includes, but is not limited to, portable X-ray,

electroencephalogram (EEG), electrocardiogram (EKG), treadmill and exercise

equipment, pulmonary function equipment, operating tables, laboratory

centrifuges, examination and treatment tables, and similar equipment.

b. Movable nonmedical equipment includes, but is not limited to, personal

computer stations, patient room furnishings, food service trucks, and other

portable equipment.

Major Technical Equipment

Major technical equipment is specialized equipment (medical or nonmedical) that is

customarily installed by the manufacturer or vendor. Since major technical equipment may

require special structural designs, electromechanical requirements, or other considerations, close

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coordination between owner, building designer, installer, construction contractors, and others is

required.

Equipment Shown on Drawings

Equipment which is not included in the construction contract but which requires

mechanical or electrical service connections or construction modifications shall, insofar as

practical, be identified on the design development documents to provide coordination with the

architectural, mechanical, and electrical phases of construction.

Electronic Equipment

Special consideration shall be given to protecting computerized equipment such as

multiphasic laboratory testing units, as well as computers, from power surges and spikes that

might damage the equipment or programs. Consideration shall also be given to the addition of a

constant power source where loss of data input might compromise patient care.

Construction

Construction Phasing Projects involving alterations and/or additions to existing buildings

should be programmed and phased to minimize disruptions of retained, existing functions.

Access, exits, and fire protection shall be so maintained that the occupants' safety will not be

jeopardized during construction.

Nonconforming Conditions

It is not always financially feasible to renovate the entire existing structure in accordance

with these Guidelines. In such cases, authorities having jurisdiction may grant approval to

renovate portions of the structure if facility operation and patient safety in the renovated areas

are not jeopardized by the existing features of sections retained without complete corrective

measures.

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SPACE REQUIREMENTS

MEDICAL LABORATORY

HOSPITAL LOBBY

RECEPTION COUNTER

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SPECIMEN AND EXTRACTION ROOM (BLOOD AND STOOL)

LABORATORY AREA

XRAY ROOM/RADIOLOGY

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PUBLIC/PRIVATE TOILET

CASHIER AND ACCOUNTING OFFICE

PHILHEALTH OFFICE

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HOSPITAL ADMINISTRATORS OFFICE WITH CONFERENCE ROOM

HOSPITAL RECORD ROOM WITH WAITING AREA

HOSPITAL PHARMACY & CONVENIENCE STORE

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RESTAURANT AND COFFEE SHOP (CONCESSIONARE)

EMERGENCY ROOM

PEDIATRICS ROOM

OBSTETRICS ROOM

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GYNECOLOGY ROOM

GENERAL MEDICINE

REHYDRATION

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LABOR ROOM

DELIVERY ROOM

OPERATION ROOM WITH SCRUB – UP AREA

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RECOVERY ROOM

NURSERY ROOM WITH VIEWING AREA AND MOTHERS ROOM FOR

BREATFEEDING

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INTENSIVE CARE UNIT (ICU)

HOSPITAL WARD

NURSERY STATION

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PRIVATE ROOMS WITH TOILET AND BATH

SEMI - PRIVATE ROOMS WITH TOILET AND BATH

DENTAL CLINIC

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HOSPITAL STAFF AREA

SERVICES DEPARTMENT

DIETARY DEPARTMENT

HOSPITAL CLEAN UTILITY

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HOSPITAL DIRTY UTLITY

HOSPITAL CENTRAL STERILE & SUPPLY DEPARTMENT

HOSPITALS LAUNDRY AREA

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MOTOR POOL

HOSPITAL MORGUE

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