Adamson University

900 San Marcelino St, Ermita, Manila, 1000

Metro Manila

Bachelor of Science in Architecture

College of Architecture

Research for Design 5

25-Bed Hospital Safe from Disaster and Pandemic

MANALO, Gio Aldrin O.

201512788

BS Architecture

Ar. Christopher Coma

 Table of Contents

Department of Health Technical Guidelines for Hospital and Health .................................... 1

Hospital Waste Management.................................................................................................... 8

Covid-19 Health Care Planning .............................................................................................. 10

Summary ................................................................................................................................. 12

Conclusion .............................................................................................................................. 12

References .............................................................................................................................. 13

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 I. DOH Technical Guidelines for hospitals and health

Department of Health has a policy to provide preventive and curative health care that
will be available, accessible and acceptable to the people. It determines to a large
extent the provisions of hospitals and other health facilities.

The primary objective of the guidelines is to serve as a tool for health facility planning
and design of the hospital. It is the intension of this guideless to provide basic
information on the technical requirements for the planning and design of the hospital.

Here are the guidelines released by the Department of Health of Philippines for
hospitals and health:

GUIDELINES IN THE PLANNING AND DESIGN

OF A HOSPITAL AND OTHER HEALTH FACILITIES
A hospital and other health facilities shall be planned and designed to observe
appropriate architectural practices, to meet prescribed functional programs, and to
conform to applicable codes as part of normal professional practice. References shall
be made to the following:

 P. D. 1096 – National Building Code of the Philippines and Its Implementing

Rules and Regulations
 P. D. 1185 – Fire Code of the Philippines and Its Implementing Rules and
Regulations
 P. D. 856 – Code on Sanitation of the Philippines and Its Implementing Rules
and Regulations
 B. P. 344 – Accessibility Law and Its Implementing Rules and Regulations
 R. A. 1378 – National Plumbing Code of the Philippines and Its Implementing
Rules and Regulations
 R. A. 184 – Philippine Electrical Code
 Manual on Technical Guidelines for Hospitals and Health Facilities Planning
and Design. Department of Health, Manila. 1994
 Signage Systems Manual for Hospitals and Offices. Department of Health,
Manila. 1994
 Health Facilities Maintenance Manual. Department of Health, Manila. 1995
 Manual on Hospital Waste Management. Department of Health, Manila. 1997
 District Hospitals: Guidelines for Development. World Health Organization
Regional Publications, Western Pacific Series. 1992
 Guidelines for Construction and Equipment of Hospital and Medical Facilities.
American Institute of Architects, Committee on Architecture for Health. 1992

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  De Chiara, Joseph. Time-Saver Standards for Building Types. McGraw-Hill
Book Company. 1980 1
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
2.44 meters.
5.2. Corridors in areas not commonly used for bed, stretcher and equipment
transport may be reduced in width to 1.83 meters.
5.3. A ramp or elevator shall be provided for ancillary, clinical and nursing areas
located on the upper floor.
5.4. A ramp shall be provided as access to the entrance of the hospital not on the
same level of the site.

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

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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.

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.

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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.
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

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 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
Space Area in Square Meters
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
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

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 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 7.43/bed
Lavatory/Sink
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 7.43/bed
Lavatory/Sink
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
Space Area in Square Meters
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 7.43/bed

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 Lavatory/Sink
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, 14.00
Dressing Area and Toilet
Dark Room 4.65
Film File and Storage Area 4.65
Radiologist Area 5.02/staff
Pharmacy 15.00

Notes:

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

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 II. Hospital Waste Management

The risk with health care waste and its management has brought attention
over the world in various occasions, local and international meetings. However, the
need for proper hospital waste management has been slowly recognized due to the
improper management that burdens associated medical people.

According to World Health Organization, Waste and by-products cover a

diverse range of materials, as the following list illustrates:

 Infectious waste: waste contaminated with blood and other bodily fluids (e.g.
from discarded diagnostic samples),cultures and stocks of infectious agents from
laboratory work (e.g. waste from autopsies and infected animals from
laboratories), or waste from patients with infections (e.g. swabs, bandages and
disposable medical devices);
 Pathological waste: human tissues, organs or fluids, body parts and
contaminated animal carcasses;
 Sharps waste: syringes, needles, disposable scalpels and blades, etc.;
 Chemical waste: for example solvents and reagents used for laboratory
preparations, disinfectants, sterilants and heavy metals contained in medical
devices (e.g. mercury in broken thermometers) and batteries;
 Pharmaceutical waste: expired, unused and contaminated drugs and vaccines;
 Cytotoxic waste: waste containing substances with genotoxic properties (i.e.
highly hazardous substances that are, mutagenic, teratogenic or carcinogenic),
such as cytotoxic drugs used in cancer treatment and their metabolites;
 Radioactive waste: such as products contaminated by radionuclides including
radioactive diagnostic material or radio therapeutic materials; and
 Non-hazardous or general waste: waste that does not pose any particular
biological, chemical, radioactive or physical hazard.

The management of health-care waste requires attention and diligence to avoid

unnecessary health outcomes from poor practice, including exposure to infectious
agents and toxic substances.

World Health Organization stated that the key elements in improving health-care waste
management are:

 promoting practices that reduce the volume of wastes generated and ensure
proposer waste segregation;

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  developing strategies and systems along with strong oversight and regulation to
incrementally improve waste segregation, destruction and disposal practices with
the ultimate aim of meeting national and international standards;
 where feasible, favouring the safe and environmentally sound treatment of
hazardous health care wastes (e,g, by autoclaving, microwaving, steam
treatment integrated with internal mixing, and chemical treatment) over medical
waste incineration;
 building a comprehensive system, addressing responsibilities, resource
allocation, handling and disposal. This is a long-term process, sustained by
gradual improvements;
 raising awareness of the risks related to health-care waste, and of safe practices;
and
 selecting safe and environmentally-friendly management options, to protect
people from hazards when collecting, handling, storing, transporting, treating or
disposing of waste.

Most importantly, the government commitment and support is needed for long-term
improvement, although immediate action can be taken locally.

Managing healthcare waste can be crucial as we face a pandemic. The Department

of Environment and National Resources worries on the large amount of waste due to
the pandemic would now be properly disposed and might cause environmental
problems in the future. The lack of proper implementation of Republic Act 9003 or the
Ecological Solid Waste Management Act of 2000 and RA 6969 or the Toxic Substances
and Hazardous and Nuclear Wastes Control Act of 2000 will put the risk of frontliners
and workers involved with the management. As per Oceana Philippines Vice President,
Gloria Estenzo-Ramos, just like from the past management, everything just goes to the
landfill. She stated the there’s a solution for such and the law has even been provided.

To promote proper hospital waste management, DENR cited St. Paul’s Hospital of
Iloilo as one of the hospitals that reduced hospital waste during the crisis. The hospital
has provided

- Reusable PPEs, gowns, head caps and booties made from taffeta cloth, which
can be washed and safely reused
- cloth masks with filters where they can put their surgical or polypropylene masks
- laundry gloves for housekeeping, which are also reusable, instead of nitrile and
latex gloves.
- Reprocessing single use plastic

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These are only few of the things the hospital has been doing to reduce waste and
properly uphold the hospital waste management. DENR chose to promote this kind to
help not worse the amount of waste especially this pandemic.

III. Covid-19 Health Care Planning

Department of Health has established a plan to establish the new normal in the daily
routines of Filipinos. As per DOH, it revolves around the four strategies to reduce
COVID 19 related and non COVID 19 deaths which are:

o Increase physical and mental resilience

a) Ensure access to basic needs of individuals, including food, water,
shelter and sanitation.
b) Support adequate nutrition and diets based on risk.
c) Encourage appropriate physical activity for those with access to open
spaces as long as physical distancing is practiced.
d) Discourage smoking and drinking of alcoholic beverages.
e) Protect the mental health and general welfare of individuals.
f) Promote basic respiratory hygiene and cough etiquette.
g) Protect essential workforce through provision of food, PPE and other
commodities, lodging, and shuttle services as necessary.
h) Provide financial and healthcare support for workforce who contracted
COVID-19 through transmission at work.
i) Limit exposure of MARP groups, such as through limitation in entry or
prioritization in service or provision of support.
j) Provide appropriate social safety net support to vulnerable groups for
the duration of the COVID-19 health event.
o Reduce transmission
a) Encourage frequent hand washing with soap and water, and
discourage the touching of the eyes, nose, and mouth, such as through
appropriate information and education campaigns.
b) Encourage symptomatic individuals to stay at home unless there is a
pressing need to go to a health facility for medical consultation, if
virtual consultation is not possible.
c) Ensure access to basic hygiene facilities such as toilets, hand washing
areas, water, soap, alcohol/ sanitizer.
d) Clean and disinfect the environment regularly, every two hours for high
touch areas such as toilets, door knobs, switches, and at least once
every day for workstations and other surfaces.
e) Ensure rational use of personal protective equipment (PPEs) that is
suitable to the setting, and the intended user.

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 f)Medical-grade protective apparel shall be reserved for health care
workers and other frontlines, and symptomatic individuals at all times.
o Reduce contact
a) Implement strict physical distancing at all times, specially at public
areas, workstations, eating areas, queues, and other high traffic areas.
b) Reduce movement within and across areas and settings.
c) Restrict unnecessary mass gatherings.
d) Limit non-essential travel and activities.
e) Install architectural or engineering interventions, as may be deemed
appropriate.
f) Implement temporary closure or suspension of service in high risk
areas or establishments, as necessary.
o Reduce duration of infection
a) Identify symptomatic individuals and immediately isolate, such as
through the use of temperature scanning, symptom self-monitoring,
and voluntary disclosure.
b) Coordinate symptomatic individuals through appropriate health system
entry points such as primary care facilities or teleconsulting platforms.
c) Trace and quarantine close contacts of confirmed individuals
consistent with Department of Health guidelines.

As DOH implements the strategies for the public, they also developed policies for
industries and private sector as they were one of the most affected too by the
pandemic.

Local Government Units shall:

o Ensure implementation of risk-based public health standards for COVID-19

mitigation;
o Set up mechanisms to monitor compliance and submit reports according to
provided tools
o Coordinate with DOH and other NGAs in carrying out these guidelines;
o Develop counterpart local ordinances, to ensure compliance with national
directives at the local level;
o Ensure immediate and widest dissemination of these guidelines to all
units/sectors within their jurisdiction

Industries and the Private Sector shall:

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 o Comply with the risk-based public health standards set by DOH, sector-
specific policies and plans by other NGAs, and other relevant rules and
regulations

IV. Summary

The provision of hospitals involves a significant amount of investment and

expenditure thus, it is a need to give attention and concern on hospital planning and
design considering the country’s socio-economic and technological conditions. Although
Philippines have been using the same guidelines for centuries, the medical and design
technology has been advancing even with the country’s limited resource.

As the outbreak of novel corona virus was declared, the administration has critical
preparedness and response. Within the equipping of healthcare workers and healthcare
facility management with the information, procedures, and tools required to safely and
effectively work up to the management of sectors for the long run has come to drastic
change. Moreover, hospital waste management has been improved to reduce the risk of
workers and facilities in lined with it.

The pandemic surely shifted priorities for many Filipinos people. The new normal
truly brought drastic change however, the country is slowly responding to it so all
sectors can bounce back and recoup their losses.

V. Conclusion

The changes brought by the pandemic have affected the system of all sectors in the
country. First, the government focused on bringing the new normal to the lives of
Filipino people to become accustomed to it so that secondly, the sectors could continue
to operate according to its function.

However, it has to be said that the technical guidelines for hospital and health will be
altered to the present situation of the country. To help in improving the conditions, it is
set to have changes to fully cater the protection needed by health workers and affected
people. Moreover, hospital waste management is another concern that needs to be
taken seriously and also subject to possible changes. This would lower the risk of the
health workers and especially those who are involved in its management.

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 All changed should be altered on how to put the health care system of the
Philippines into proper condition. The pandemic has turn the country’s system upside
down, but hopefully, it will be slowly addressed to ensure the safety, not only of the
health worker and facility who are mostly involved with it, but also of the Filipino
community as all were truly affected by it.

VI. References

A Guide To The New Normal, (2020 August 25) Department of Health, Retrieved from
https://covid19.healthypilipinas.ph/resources/educational-materials/a-guide-to-the-new-
normal

Adminstrative Order No. 2020-0015 of April 27 2020, Guidelines on the Risk-Based

Public Health Standards for COVID-19 Mitigation, Department of Health, Retrieved from
https://www.doh.gov.ph/sites/default/files/health-update/ao2020-0015.pdf

Cabico, G. (2020 August 16) 'Lockdown litter': Can hospitals, homes reduce plastic use
amid COVID-19 crisis? , PhilStar Global, Retrieved from
https://www.philstar.com/headlines/2020/08/16/2034987/lockdown-litter-can-hospitals-
homes-reduce-plastic-use-amid-covid-19-crisis

Guideline in the Planning and Design of a Hospital and other health facilities (November
2004), Department of Health, Retrieved from
http://chd11.doh.gov.ph/rledweb/guidelines%20planning_and_design_of%20hospital.pd
f

Health Care Waste (2018) World Health Organization, Retrieved from

https://www.who.int/news-room/fact-sheets/detail/health-care-waste

In the Philippines, medical waste piles up as COVID-19 cases rise (2020 August 27),
Earth Journalism Network, Retrieved from https://earthjournalism.net/stories/in-the-
philippines-medical-waste-piles-up-as-covid-19-cases-rise

Manual on Technical Guidelines from Hospital and Health Facilities Design and
Planning, (2001), Department of Health, Retrieved from
https://www.doh.gov.ph/sites/default/files/publications/Volume1_IntroductionandInstructi
onforUse_1.pdf

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