LITERATURE REVIEW

In relation to study:

The review includes related works, legal standards, technical

To be a functional hospital, it must consider and render the

principles, guidelines for planning and design, facilities and

proper flow of services, time management and the personnels

development.

availability for the health services.

RELATED LITERATURE
LOCAL

CAGRARAY DISTRICT HOSPITAL Cabasan, Bacacay,

Albay

NAGA CITY HOSPITAL (NCH)

Naga City Hospital is under the leadership of Chief of

Hospital Dr. Luningning Luciano.

The NCH which is a primary hospital is operated and funded
by the city government. General Medicine, Pediatrics, Obstetrics
and Minor Surgery are the services rendered by NCHs doctors.
Drugs are also distributed to the patients with prescriptions from
other hospitals and free medicine is given to patients whenever
available.

Cagraray District Hospital is a 25-bed Level 2 (two) district

hospital in Bacacay. It is owned and classified as government
structure. The personnel involved are the following. From the

administrative services: administration officer, cashier, storekeeper,

security guard. From medical and nursing services: the staff

FOREIGN

EASTAR EAST CAMPUS Muskogee, Oklahoma

nurses, nursing aide and the doctor. While from the ancillary
services:

the

medical

technologist,

radiologic

technologist,

nutritionist, dietician and cook are involved. It caters people from

different barangays of Cagraray Islands. They hold a maximum
number of 10 for in-patients and 11 for out-patients (OPD) per day.
It offers services like minor surgery, OPD, and general medicine.
Formerly, they render laboratory services and examination but due
to absence of experiencing and undertaking.
In relation to study:
The present but inoperative laboratories due to lack of
personnel to this hospital is the main concern of the proponents
study.

In every hospital it should be functional in terms of

laboratory services and be able to inculcate the importance of

laboratory facilities in the community for the proposed hospital.

The 45-bed Eastar East Campus, formerly Muskogee

Community Hospital, opened in 2009. It was one of the first few
hospitals in the world to attain LEED Gold certification, and it was
the first hospital in the United States to earn the Environmental
Protection Agency's Energy Star for "superior energy performance."
Survey data for the latest year available shows that 9,756 patients
visited the hospital's emergency room. The hospital had a total of

1,694 admissions. Its physicians performed 738 inpatient and 4,068

outpatient surgeries.
In relation to study:
The Environmental Protection Agency said the hospital's
lower energy usage cuts carbon emissions by 24 percent every
year, making it "a leading hospital in the fight against climate
change."
Eastar East Campus employs several green measures,
including workspaces that maximize daylight and native plants
which the proponent will adapt to her study

Californias first green-certified hospital, Laguna Honda, is

designed to promote recovery in a healthy environment that fosters

LAGUNA HONDA HOSPITAL San Francisco, California

community. The hospital's LEED Silver rating offers a number of
services and amenities not typically found in most hospitals,
including a hair salon, a multi-media library with a fireplace, a stateof-the-art multi-media library and outdoor gardens with raised
planting beds for growing vegetables and flowers. The hospital was
developed

through

joint

venture

between

architecture
9

firms Anshen + Allen and Stantec Architects, and is comprised of

two residential towers, and a four-story central building. All of the
buildings open onto a central park, which is home to the Laguna

The operable windows also help residents to control their

own environment.
Ninety percent of the regularly occupied interior spaces have

Honda animal therapy center.

windows and views to the outdoors, bringing in sunlight and

(Laguna Honda, Californias First LEED Certified Hospital |

enhancing therapeutic benefits.

Inhabitat - Sustainable Design Innovation, Eco Architecture, Green

Building)

REVIEW OF CODES

In relation to study:
The hospitals three new buildings address environmental
impacts in their design, construction and operation across six

GUIDELINES IN PLANNING AND DESIGN OF A HOSPITAL

AND OTHER RELATED HEALTH FACILITIES

LEED-designated categories: sustainable sites, water efficiency,

A hospital and other health facilities shall be planned and
energy

and

atmosphere,

materials

and

resources,

indoor
designed to observe appropriate architectural practices, to meet

environmental quality, and innovation and design process.

prescribed functional programs, and to conform to applicable codes
Each resident room has its own large operable window.
as part of normal professional practice.
Open windows allow gentle breezes and fresh air into the building,
1. Environment: A hospital and other health facilities shall be so
creating comfortable rooms without raising energy consumption.
located that it is readily accessible to the community and
reasonably free from undue noise, smoke, dust, foul odor,
10

flood, and shall not be located adjacent to railroads, freight

3.2 A minimum of two (2) exits, remote from each

yards, childrens playgrounds, airports, industrial plants,

other, shall be provided for each floor of the

disposal plants.

building.

2. Occupancy: A building designed for other purpose shall not

3.3 Exits shall terminate directly at an open space to

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

the outside of the building.

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

maintain a safe environment for patients, personnel and

5. Patient Movement: Spaces shall be wide enough for free

public. The building shall be of such construction so that no

movement of patients, whether they are on beds, stretchers,

hazards to the life and safety of patients, personnel and

or wheelchairs. Circulation routes for transferring patients

public exist. It shall be capable of withstanding weight and

from one area to another shall be available and free at all

elements to which they may be subjected.

times.

3.1 Exits shall be restricted to the following types:

door leading directly outside the building, interior
stair, ramp, and exterior stair.

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.

11

5.3 A ramp or elevator shall be provided for ancillary,

9. Water Supply: A hospital and other health facilities shall use

clinical and nursing areas located on the upper

an approved public water supply system whenever available.

floor.

The water supply shall be potable, safe for drinking and

5.4 A ramp shall be provided as access to the

entrance of the hospital not on the same level of
the site.

adequate, and shall be brought into the building free of cross

connections.
10. Waste Disposal: Liquid waste shall be discharged into an

6. Lighting: All areas in a hospital and other health facilities

approved public sewerage system whenever available, and

shall be provided with sufficient illumination to promote

solid waste shall be collected, treated and disposed of in

comfort, healing and recovery of patients and to enable

accordance with applicable codes, laws or ordinances.

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

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.

facilities shall observe acceptable sound level and adequate

12. Housekeeping: A hospital and other health facilities shall

visual seclusion to achieve the acoustical and privacy

provide and maintain a healthy and aesthetic environment

requirements in designated areas allowing the unhampered

for patients, personnel and public.

conduct of activities.

12

13. Maintenance:

There

shall

be

an

effective

building

17. Signage: There shall be an effective graphic system

maintenance program in place. The buildings and equipment

composed of a number of individual visual aids and devices

shall be kept in a state of good repair. Proper maintenance

arranged to provide information, orientation, direction,

shall be provided to prevent untimely breakdown of buildings

identification,

and equipment.

considered essential to the optimum operation of a hospital

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.

prohibition,

warning

and

official

notice

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

16. Fire Protection: There shall be measures for detecting fire

accessible to the public: emergency service,

such as fire alarms in walls, peepholes in doors or smoke

outpatient service, and administrative service.

detectors in ceilings. There shall be devices for quenching

They shall be located near the entrance of the

fire such as fire extinguishers or fire hoses that are easily

hospital.

visible and accessible in strategic areas.

13

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 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

and management of patients: nursing service.

ground floor to ensure immediate access. A

They shall be located in private areas but

separate entrance to the emergency room shall

accessible to guests.

be provided.

19.4

Deep Zone areas that require asepsis to

20.2

The

administrative

service,

particularly

perform the prescribed services: surgical service,

admitting office and business office, shall be

delivery service, nursery, and intensive care.

located near the main entrance of the hospital.

They shall be segregated from the public areas

Offices for hospital management can be located

but accessible to the outer, second and inner

in private areas.

zones.

20.3

The surgical service shall be located and

Service Zone areas that provide support to

arranged to prevent non-related traffic. The

hospital activities: dietary service, housekeeping

operating room shall be as remote as practicable

service, maintenance and motor pool service,

from the entrance to provide asepsis. The

19.5

14

dressing room shall be located to avoid exposure

station shall be provided in all inpatient units of

to dirty areas after changing to surgical garments.

the hospital with a ratio of at least one (1) nurse

The nurse station shall be located to permit visual

station for every thirty-five (35) beds. Rooms and

observation of patient movement.

wards shall be of sufficient size to allow for work

20.4

The delivery service shall be located and

flow and patient movement. Toilets shall be

arranged to prevent non-related traffic. The

immediately accessible from rooms and wards.

delivery room shall be as remote as practicable

20.6

from the entrance to provide asepsis. The

dressing room shall be located to avoid exposure
to dirty areas after changing to surgical garments.

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.

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

ACCESSIBILITY LAW (B.P. 344)

The Accessibility Law provides minimum requirements for
accessibility.
A. Outside and Around Buildings
1. Dropped Curbs

permit visual observation of patients. Nurse

15

a) Changes in level at walkways should be effected by

slight ramps and dropped curbs;
b) Dropped curbs should be provided at pedestrian
crossings and at the end of footpaths of a private street
or access road;
c)

Dropped curbs at crossings should have a length

corresponding to the width of the crossing; otherwise,
the minimum width should be 0.90 m.

d) Dropped curbs shall be ramped towards adjoining curbs

with a gradient not more than 1:12;

a) Curb cut-outs should only be allowed when it will

not obstruct a walkway or in any way lessen the
width of a walkway;
b) The minimum width of a curb cut-out should be
0.90m;
c) Curb cut-outs should not have a gradient not more
than 1:12;
3. Walkways
a.) Walkways should be kept as level as possible
and provided with slip-resistant material;

e) Dropped curbs shall be sloped towards the road with a

b.) Whenever and wherever possible, walkways

maximum cross gradient of 1:20 to prevent water from

should have a gradient not more than 1:20 or

collecting at the walkway;

5%

f)

The lowest point of a dropped curb not exceed 25 mm

height above the road or gutter.

2. Curb Cut-Outs

c.) Walkways should have a maximum cross

gradient of 1:100;
d.) Walkways should have a minimum width of
1.20 meters; 3.5 If possible, gratings should

16

never be located along walkways; when

g.) To guide the blind, walkways should as much

occurring along walkways, gratings openings

as possible follow straight forward routes with

should have a maximum dimension of 13mm x

right angle turns;

13mm and shall not project more than 6.5mm

above or below the level of the walkway;

h.) Where planting is provided adjacent to the

walkway, regular maintenance is essential to

e.) Walkways should have a continuing surface

ensure branches of trees or shrubs do not

without abrupt pitches in angle or interruptions

overhang walkways or paths, as they do not

by cracks or breaks creating edges above 6.5

present a particular danger to the blind, but

mm;

they also reduce the effective footway width

f.) In lengthy or busy walkways, spaces should be

available

to

pedestrian;

3.10

Walkway

provided at some point along the route so that

headroom should be less than 2.00m and

a wheelchair may pass another or turn around;

should preferably be higher;

these spaces have a minimum dimension of

i.) Passageways for the disabled should not be

1.5 meters and should be spaced at a

obstructed by street furniture, bollards, sign

maximum distance of 12.00 meters between

posts or columns along the defined route, as

stops;

they can be hazardous.

17

4. Handrails

a) Where open spaces are provided, the blind can

a) Handrails should be installed at both sides of ramps

become particularly disoriented.

Therefore, it is

and stairs and at the outer edges of dropped curbs at

extremely helpful if any walkway or path can be given

crossings; handrails should not be installed beyond

defined edges either by the use of planters with dwarf

the width of any crossing so as not to obstruct

walls, or a grass verge, or similar, which provides a

pedestrian flow;

texture different from the path.

b) Handrails shall be installed at 0.90m and 0.70m

above steps or ramps; handrails for protection at
great heights may be installed at 1.00m to 1.06m;
c) A 0.30m long extension of the handrail should be
provided at the start and end of ramps and stairs;
d) Handrails that require full grip should have a
dimension of 30cm to 50cm;
e) Handrails attached to walls should have a clearance
no less than 50mm from the wall; handrails on ledges

B. Parking
1. Parking Areas
a) Parking spaces for the disabled should allow enough
space for a person to transfer to a wheelchair from a
vehicle;
b) Accessible parking space should be located as close
as possible to building entrances or to accessible
entrances;

should have a clearance not less than 40mm;

5. Open Spaces

18

c) Whenever and wherever possible, accessible parking

spaces should be perpendicular or at an angle to the
road or circulation aisles;

width of 3.70 m;

accessible from arrival and departure to the interior

lobby;

e) A walkway from accessible spaces of 1.20 m. clear

width shall be provided between the front ends of
parked cars;

b) One (1) entrance level should be provided where

elevators are accessible;
c) In case entrances are not on the same level of the

f) Provide dropped curbs or curb cut-outs to the parking

level where access walkways are raised;

delineate

parking

spaces

of

the

handicapped;
h) Parking spaces for the disabled should never be
located at ramped or sloping areas.

site arrival grade, ramps should be provided as

access to the entrance level;

g) Pavement markings, signs or other means shall be

to

1. Entrances
a) At least one entrances to every building should be

d) Accessible parking slots should have a minimum

provided

C. Inside Buildings and Structures

d) Entrances with vestibules shall be provided a level

area with at least a 1.80 m. depth and a 1.50 m.
width.
2. Ramps
a) Changes in level require a ramp except when served
by a dropped curb, an elevator or other mechanical
device;

19

b) Ramps shall have a minimum clear width of 1.20 m;

3. Doors

c) The maximum gradient shall be 1:12;

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

d) The length of a ramp should not exceed 6.00m. if the

b) Clear openings shall be measured between the

gradient is 1:12; longer ramps whose gradient is 1:12

surface of the fully open door at the hinge and the door

shall be provided with landings not less than 1.50

jamb at the stop;

e) A level area not less than 1.80 m. should be provided

at the top and bottom of any ramp;
f) Handrails will be provided on both sides of the ramp
at 0.70 m. and 0.90 m. from the ramp level;
g) Ramps shall be equipped with curbs on both sides
with a minimum height or 0.10 m;

c) Doors should be operable by a pressure or force not

more than 4.0 kg the closing device pressure in interior
door shall not exceed 1 kg;
d) A minimum clear level space of 1.50 m x 1.50 shall be
provided before and extending beyond a door;
EXCEPTION: where a door shall open onto but not

h) Any ramp with a rise greater than 0.20 m. and leads

into a corridor, the required clear, level space on the

down towards an area where vehicular traffic is

corridor side of the door may be a minimum of 1.20 m

possible, should have railing across the full width of

corridor width;

its lower end, not less than 1.50 meters from the foot
of the ramp.

e) Protection should be provided from doors that swing

into corridors;

20

f) Out swinging doors should be provided at storage

rooms, closets and accessible restrooms stalls;
g) Latching or non-latching, hardware should not require
wrist action or fine finger manipulation;
h) Doorknobs and other hardware should be located
between 0.82m. and fine finger manipulation;
i) Doorknobs and other hardware should be located
between 0.82m. and 106 m. above the floor; 0.90 is
preferred;
j) Doors along major circulation routes should be
provided with kick plated made of durable material at a
height of 0.30 m to 0.40 m.
4. Corridors
a) Corridors shall have a minimum clear width of 1.20;
waiting areas and other facilities or spaces shall not
obstruct the minimum clearance requirements;

b) Recess or turnabouts 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;
c) Turnabout space should also be provided at or within
3.50m. of every dead end;
d) As in walkways, corridors should be maintained level
and provided with a slip-resistant surface.
5. Thresholds
a) Thresholds shall be kept to minimum; whenever
necessary, thresholds and sliding door tracks shall
have a maximum height of 25 mm and preferably
ramped
6. Washrooms & Toilets
a) Accessible public washrooms and toilets shall permit
easy passage of a wheelchair and allow the occupant

21

to enter a stall, close the door and transfer to the

accessible to the disabled shall be one (1) where the

water closet from either a frontal or lateral position;

total number of water closets per sex on that level is

b) Accessible water closets stalls shall have a minimum

area of 1.70 x 1.80mts. One movable grab bar and

20; and two (2) where the number of water closets

exceed 20;

one fixed to the adjacent wall shall be installed at the

f) The maximum height or water closets should be

accessible water closet stall for lateral mounting;

0.45m; flush control should have a maximum height of

fixed grab bars on both sides of the wall be installed

11.20 m;

for stalls for frontal mounting;

g) Maximum height of lavatories should be 0.80 m with a

c) A turning space of 2.25 sq. m. with a minimum

dimension of 1.50 m. for wheelchairs shall be
provided outside water close stall;

such as mirrors, paper dispensers, towel racks, and

such

as

faucets

mounted

0.50m depth;
h) Urinals should have an elongated lip or should be

d) All accessible public toilets shall have accessories

fittings

knee recess of 0.60 - 0.70m vertical clearance and a

at

heights

reachable by a person in a wheelchair;

e) The minimum number of accessible water closets on
each floor level or on that part of a floor level

trough-type; the maximum height of the lip should be

0.48.
7. Stairs
a) Tread surfaces should be of a slip-resistant material;
nosing should be provided with slip-resistant strips to
further minimize slipping;

22

b) Slanted nosing are preferred to protruding nosing so

8. Elevators

as not to impose difficulty for people using crutches

a) Accessible elevators should be located not more than

or braces whose feet have a tendency to get caught

30.00 m. form the entrance and should be easy to

in the recessed space of protruding nosing; for the

locate with the aid of signs;

same reason, open stringers should be avoided;

c) The leading edge of each step of both runner and
riser should be marked with a paint or non-skid

b) Accessible

elevators

shall

have

minimum

dimensions of 1.10m x 1.40 m.

9. Water Fountains

material that has a color or gray value which is in

a) At least one (1) fountain shall be provided for every

high contrast to the gray value of the rest of the

2,000 sq. m. of floor area and there shall not be less

stairs; markings of this sort would be helpful to the

than one (1) on each floor. Waterspouts shall be at

visually impaired as well as to the fully sighted

the front and shall be push-button controlled. If wall

person;

mounted, the maximum height of the water fountain

d) A tactile strip 0.30 m. wide shall be installed before

hazardous areas such as sudden changes in floor

shall be 0.85 m. from the floor to the rim, either

provide paper cups or another lower fountain.

levels and at the tip and bottom of stairs; special

care must be taken to ensure the proper mounting or
adhesion of tactile strips so as not cause accidents.

23