A PROPOSED

EMERGENCY 50 BED
MATERNITY HOSPITAL
(RESEARCH)

PLATE NO. 1

IN

ARCHITECTURAL DESIGN 7
(ARD 415)
(MON 9:00AM-6:30PM; TUE 2:00PM-6:30PM)

Submitted by:

NACIONAL, GERALD

OBONG, ANTHONY EVAN G

BSAR 4

SUBMITTED TO:

AR. LENCE LYDEL L. LAGAMON

INSTRUCTOR

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TABLE OF CONTENTS

I. INTRODUCTION…………………………………………………………………...3

II. SENSORY DESIGN IN THE BIRTH ENVIRONMENT: LEARNING FROM

EXISTING CASE STUDIES ………………………………………………….........5

III. DESIGN AND DECISIONS IN A HOSPITAL BUILDING PROJECT

REGARDING A TEST ROOM ……………………………………………………7

IV. IMPORTANCE AND INFLUENCE OF THE PHYSICAL ENVIRONMENT IN

BIRTHING SETTINGS……………………………………………...……………...9

V. BIRTH SENSORY REQUIREMENTS…………………………………………...10

VI. SPACE REQUIREMENTS…………………………………………….….………13

VII. HUMIDITY, VENTILATION AND AIR CONDITIONING……………………29

VIII. DEPARTMENT OF HEALTH GUIDELINES FOR LEVEL 1 HOSPITAL…..32

IX. DEFINITION OF TERMS………………………………………………………...40

X. FIRE CODE (RA9514) ………………………………………………………….…44

XI. PARKING PROVISIONS………………………………………………………….48

XII. REFERENCES……………………………………………………………………...55

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MATERNITY HOSPITAL

Maternity hospital focuses on providing care to women during pregnancy and childbirth. It may

serve as a center for clinical midwifery and obstetrics training as well as providing care for

newborn babies. They were once known as "lying-in hospitals," but like cottage hospitals, the

majority of them have been incorporated into bigger general hospitals where they now serve as

the maternity unit.

The first known hospital for lying-in is thought to have been one established by Richard

Manningham in Jermyn Street, London, in 1739, which later became the Queen Charlotte's

Maternity Hospital. A better documented foundation is that of the Dublin Lying-In Hospital,

established in 1745 by Bartholomew Mosse, and which served as a model for three subsequent

London foundations: the British Lying-In Hospital, a 1749 establishment in Holborn; the 1750

City of London Lying-In Hospital, in the City; and the General Lying-In Hospital on

Westminster Bridge Road, established in 1767. A number of other such hospitals were formed in

the mid-18th century. Since women were prohibited from completing medical school until the

1870s, all of these were operated by male doctors.

FACTORS TO CONSIDER IN HOSPITAL DESIGN AND CONSTRUCTION

Hospitals are the most complicated building kinds since they offer a wide variety of services and

are made up of numerous functional sections. Hospitals provide hospitality services like

housekeeping and food service, as well as inpatient care or bed-related duties. They also provide

diagnostic and therapeutic services including clinical laboratory, radiology, emergency

departments, and surgery. Functional needs and the human needs of the hospital's many users are

integrated into good hospital design. The range and detail of rules, procedures, and oversight that

control hospital development and operations reflect this necessity for a variety of activities. A

hospital's many diverse and continuously changing operations, including its intricate mechanical,

electrical, and telecommunications systems, call for specific knowledge and experience. Site

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constraints and opportunities, climate, and other factors are also taken into consideration while

designing hospitals.

 EFFICIENCY AND COST-EFFECTIVENESS

An efficient hospital layout should promote staff efficiency by minimizing distance of necessary

travel between frequently used spaces; allow visual supervision of patients; provide an efficient

logistics system for supplies and food (and removal of waste); make efficient use of multi-

purpose spaces and consolidate spaces when possible.

 FLEXIBILITY AND EXPANDABILITY

Medical needs and modes of treatment will continue to change. Therefore, hospitals should

follow modular concepts of space planning and layout; use generic room sizes and plans as much

as possible; use modular, easily accessed, and easily modified mechanical and electrical systems;

and be open-ended, with well-planned directions for future expansion.

 THERAPEUTIC ENVIRONMENT

Patients and visitors should perceive a hospital as unthreatening, comfortable, and stress-free.

The interior designer plays a major role in this effort to create a therapeutic environment.  For

example, this can be accomplished by using cheerful and varied colors and textures, by allowing

ample natural light wherever feasible, by providing views of the outdoors from every patient bed,

and by designing a “way-finding” process into every environment.

 CLEANLINESS AND SANITATION

Hospitals must be easy to clean and maintain. This is facilitated by appropriate, durable finishes

for each functional space; careful detailing of such features as doorframes, casework, and finish

transitions to avoid dirt-catching and hard-to-clean crevices and joints; and adequate and

appropriately located housekeeping spaces.

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  ACCESSIBILITY

All areas, both inside and out, should comply with all standards and minimum requirements of

Americans with Disability Act, and ensure grades are flat enough to allow easy movement and

sidewalks and corridors are wide enough for two wheelchairs to pass easily.

 SECURITY AND SAFETY

Hospitals have several particular security concerns, such as protection of patients and staff,

hospital property and assets (including drugs), and also vulnerability to terrorism because of high

visibility. Security and safety must be built into the design with these things in mind.

 SUSTAINABILITY

Hospitals are large public buildings that have a significant impact on the environment and

economy of the surrounding community. They are heavy users of energy and water and produce

large amounts of waste. Because of this, sustainable design must be considered when designing

and building hospitals.

STRATEGIES TO DESIGN WELCOMING, INCLUSIVE AND SAFE SPACES FOR

MOTHER AND BABY CARE

Labor, delivery and postpartum maternity care differs from other types of health care for several

reasons. Childbirth is the only instance when health care staffs are responsible for two patients at

the same time, and one of the rare instances when generally healthy people require significant

care.

However, even healthy patients can suddenly become high-risk, and childbirth morbidity and

mortality remain high even among industrialized nations. Improvements require a multifaceted

approach, much of which can be supported by design.

Through observations, photographs, tours and interviews with clinicians and design

professionals, the researchers found areas where the physical environment can support better

outcomes. These included provisions to support blood availability for hemorrhage management,

appropriate space for neonatal resuscitation and access to equipment and supplies.

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One of the main challenges in designing for the birthing experience is meeting individual patient

needs for such a personal and significant event, while also addressing safe patient outcomes for a

wide variety of circumstances and potential complications.

A recent study in Sweden by Skogström and colleagues looked at what women find important in

a birthing room. Women in labor were assigned to either a traditional birthing room or a room

designed with several options such as dimmable lights, music, a bathtub and a window with an

option of a screen with programmable nature scene projections. Medical devices were hidden

behind wooden panels unless needed. Women shared that they felt “welcomed and strengthened”

by the room and they appreciated the variety of options, especially the bathtub.

The aim of a recent review of the literature by Blair and colleagues was to provide an update on

the current state of the evidence around design for maternity care for women with physical

disabilities. Even though this review focused on studies in high-income countries, the results

highlighted disappointing and even unsafe birthing experiences for many women with

disabilities.

Findings revealed the frustrating and demeaning experience of giving birth at a facility without

accessible parking, ramps, automatic doors and accessible bathrooms. There also appeared to be

a lack of adjustable equipment (e.g., exam tables and baby cots) in many facilities, making it

impossible for women to comfortably receive care and to care for their new babies.

DESIGN AND DECISIONS IN A HOSPITAL BUILDING PROJECT REGARDING A

TEST ROOM

Of all design features differing from the regular birthing rooms, the following nine prominent

features were selected to be ranked from 1 to 9 by the women being cared for in the test room

and who the participants in some of the studies.

1. Curtain between entrance hall and birthing room prevents visible contact when the door to the

room opens onto the corridor in the ward.

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2. Full-length sofa with cushions is a place for the woman giving birth and the partner to be

together and a space for the partner to sit or lie down to rest. The sofa can be turned into a

simpler bed. Hygiene – wipeable with disinfection possible as the material can withstand it. All

textiles are removable and washable.

3. Adjustable chair for birth companion, moveable on wheels in the room. The birth companion

is given the opportunity to sit comfortably in connection with supporting the woman giving birth

in different positions or e.g., for massage or next to the bathtub.

4. Bathtub that can be moved in the room. It provides the opportunity for different positions

both sitting, lying down and hanging with the arms over the edge or squatting. The hot bath is

used for pain relief purposes and for childbirth if desired. The bathtub is also height-adjustable,

which facilitates the staff’s work environment and comfort.

5. Lighting, general in the room, with a panel for the birthing women and companions to create

an environment according to their wishes. There are also spotlights for staff in need of better

work light.

6. Lighting, dimmable, adjustable light points around the room that can create an environment

according to the wishes of the birthing women and companions.

7. Projection on two walls, covering the window, in the birthing room with its own touch screen

to choose from a number of nature films with different environments, landscapes and seasons

with associated nature sounds or calm music where sound volume can be adjusted.

8. Wooden panels covering the medico technical equipment, easily accessible when needed

though. Birthing bed with a bedspread that gives a more familiar/homely look in the room.

9. Birth support rope, hangs down from the ceiling and can be used as support in upright

positions.

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SENSORY DESIGN IN THE BIRTH ENVIRONMENT: LEARNING FROM EXISTING

CASE STUDIES

Studies have shown how built environments for hospitals can influence psychological and

physiological conditions and status for childbearing women. Sensory attributes of birth spaces

can enhance comfort, feelings of wellbeing, and, to some extent, clinical outcomes.

Sensory environments represent spaces where sensory stimulations such as light, sound, colours,

etc., can be controlled to affect experiences, e.g., stress in patients and staff. These stimulations

are important aspects in contributing to the environmental comfort in healthcare spaces and have

been found to support health and wellbeing outcomes in clinical settings. Sensory environments

can benefit and stimulate relaxation, self-regulation, positive emotions, and the reduction of

chronic pain. Emotions and feelings play a central role in behaviour regulation and decision

making. Specifically, in the birthing environment, spatial, psychological, and sensory features of

the birth spaces can influence health outcomes and affect physiological birth by limiting

interventions. A calm atmosphere can reduce stress and enable relaxation, which can support

normal birth and increase physiological benefits. Environmental comfort and wellbeing could

affect women’s (and partners’) behaviours and has an important role in their individual and

collective experiences. It can also support midwives’ work and their relationship with patients.

Importance and Influence of the Physical Environment in Birthing Settings

Hospital physical environments have been shown to impact users’ health outcomes and

wellbeing, both positively and negatively. Spatial and formal characteristics of spaces can

enhance feelings of wellbeing as well as clinical outcomes in different functional units of the

hospital such as operating rooms, intensive care units, and wards. Favourable physical features

for wellbeing and comfort are good ventilation, windows, views or access to nature, real or

artificial, and design that promote orientation and distraction, as well as comfortable and

ergonomic furnishings. Furthermore, in a built environment for healthcare, the physical

environment plays an important role in affecting stress levels, governing behaviours, and

contributing to the care experience.

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Research suggests that birth environment design is strongly related to increased medical

interventions, as environmental stressors impede labour, increasing the risk of clinical

interventions, including induction or augmentation of labour and operative birth. During the

birth, women can be supported both by high-quality care to minimise risks of complications and

a familiar, calm, safe, and secure environment to make the hormonal system function optimally.

BIRTH SENSORY REQUIREMENTS

 Window, Daylight

 Nature, Scenarios Projections

 Acoustic Insulation

 Music/Sounds of Nature

 Aromas/Olfactory Insulation

 Soft Surfaces

 Coloured Walls

 Controlled Lighting: Dim and Colours

 Automation System

 Active Birth Equipment

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 • Intensive Care Unit (ICU)

Most Intensive Care Unit are fairly large

sterile areas with a high concentration of specialized,

technical and monitoring equipment needed to care

for critically ill patients.

The Intensive Care Unit environment can be

confronting for some patients and visitors who may find the activity, sounds, machines, tubes

and monitors intimidating.

Intensive Care Unit can be an uncomfortable experience – you may feel helpless,

overwhelmed, frustrated and sad

Typically, Intensive Care Unit also has a higher ratio of doctors and nurses to patients.

• Maternity and Surgery Suite

The Maternity and Surgery Suite is designed for nearly all births. It can handle a birth

for women choosing to go unmedicated or those who wish to have an epidural. The vast majority

of these rooms can also handle minor emergencies and procedures including forceps and vacuum

deliveries.

• Full Laboratory Suite

Maternity Laboratory tests are performed to identify conditions that may increase the

probability of complications during pregnancy. These tests include routine blood work (e.g.,

CBC, blood typing, Rh factor), urinalysis, urine culture, and tests for specific diseases.

• Pharmacy Center

Pharmacy Center are

positioned to help answer questions and alleviate concerns of pregnant

patients. Pregnant women often either overestimate teratogenic risks of

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medications, which can worsen underlying conditions, or underestimate risks, with both

scenarios leading to potential harm to the growing fetus.

• Outpatient Clinic

Outpatient Clinics enable people to receive a

diagnosis, procedure, assessment, treatment or education

without admission to hospital; reducing the demand on

other parts of the health system, as well as providing a

critical link between primary and tertiary health care.

• Inpatient Bed Ward

The prime function of the Inpatient Bed Ward

is to provide appropriate accommodation for the

delivery of health care services including diagnosis,

care, and treatment to inpatients. The Unit must also

provide facilities and conditions to meet the needs of

patients and visitors as well as the workplace

requirements of staff.

• Radiology Suite

A Radiology Suite is an image testing

room that uses high-frequency sound waves to

create live, cross-sectional images of the inside of

the body. It is commonly done to check the

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development of a fetus during pregnancy, but it is also used to detect abnormalities in the

internal organs and other soft tissues.

• Cafeteria

Cafeteria Servers delivers patient meals and

supplemental nourishments to patient and floor

pantries. Cleans and sanitizes food service equipment

before and after meal services. Deals directly with

customers, hospital staff, patients and visitors,

preparing and serving food. Manages cash and charge

transactions.

• Staff Housing

Are based primarily on improving the conditions under which women give birth in their

area. The main initiatives here involve retraining and supervising traditional midwives, and

training the women acting as intermediaries.

• Generator Room

Patients on life

support cannot

afford a moment

without the

electricity necessary

to power those machines. Currently, hospital standby

power must activate within no greater than ten seconds.

Furthermore, hospitals must store enough fuel on-site to

keep generators running for a total of 96 hours, in case a

power outage lasts for days.

SPACE REQUIREMENTS:

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A. MEDICAL LABORATORY

A medical laboratory or clinical laboratory is a laboratory where tests are conducted out

on clinical specimens to obtain information about the health of a patient to aid in diagnosis,

treatment, and prevention of disease. Clinical medical laboratories are an example of applied

science, as opposed to research laboratories that focus on basic science, such as found in some

academic institutions.

Medical laboratories vary in size and complexity and so offer a variety of testing

services. More comprehensive services can be found in acute-care hospitals and medical centers,

where 70% of clinical decisions are based on laboratory testing. Doctors’ offices and clinics, as

well as skilled nursing and long-term care facilities, may have laboratories that provide more

basic testing services. Commercial medical laboratories operate as independent businesses and

provide testing that is otherwise not provided in other settings due to low test volume or

complexity.

 HOSPITAL LOBBY - Where people check in for appointments, wait to receive care, or

pass through on their way to visit a loved one. Traditionally, hospital lobbies have

included a front desk, ample seating, and perhaps an adjoining space to grab a coffee or

tea.

 RECEPTION COUNTER - The reception in an office or hospital is the place where

people's appointments and questions are dealt with.

 SPECIMEN EXTRACTION ROOM – An area of a hospital where clinical specimens

such as blood and stool are collected.

 LABORATORY AREA - a room or area where research, experiments, and

measurement in medical and physical sciences are performed requiring examination of

fine details. The area may include workbenches, countertops, scientific instruments, and

associated floor spaces.

 X-RAY/RADIOLOGY ROOM – General radiography exams take images of different

parts of the body such as the chest, foot, hand or even spine. X-rays are relatively quick

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 procedures that require the patient to hold still for only a few minutes at a time. One

parent is typically welcomed in the room with the child.

Radiology Room Requirements and Sizes

Rooms are typically smaller in size from 10'0" x 12'0" and up to 16'0" x 20'0" and require

shielded walls, x-ray glass control window minimum 18" x 18" or larger for a clear view of

patient and procedures, and shielded door(s).

Shielding must be calculated by a certified Radiation or Health Physicist, or other "Radiation

Expert" (as defined by NCRP or ICRP) and retained by the facility.

Shielding Requirements wall-by-wall calculations are based on these basic factors:

 Specific Model/Type of Imaging Equipment utilized radiation field

 Orientation / Location of Equipment relative to each wall segment

 Primary Beam Target areas, and Secondary Scatter radiation fields

 Projected Use Exposures-Procedures Per Day / Workloads

 Surrounding Occupancy Factors / Common Wall

 Materials used / Existing Materials/ Wall Construction

 Controlled VS Uncontrolled (monitored by dosimeter, general access)

 Other unique considerations per application

 FORENSIC PHATOLOGIST - A forensic pathology practitioner will analyze the

medical history of the deceased individual and crime scene evidence and witness

testimonials, perform an autopsy to assess whether death was caused by injury or disease,

as well to collect further evidence from the body.

B. HOSPITAL PUBLIC/PRIVATE TOILETS

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 A public toilet (also called a bathroom, restroom, comfort room, powder room, toilet

room, washroom, water closet, W.C., public lavatory) is a public toilet facility — in contrast to a

private usually residential toilet room, which may be a standalone water closet, or part of a

bathroom.

o PWD TOILETS - Are toilets that have been specially designed to better

accommodate people with physical disabilities. Persons with reduced mobility

find them useful, as do those with weak legs, as a higher toilet bowl makes it

easier for them to stand up.

Accessible toilets are designed to accommodate different transfer preferences of

wheelchair users and therefore require more space than a standard or ambulant

accessible toilet. In addition to a higher toilet pan and grab rails, it is fitted with

shelves (for colostomy and general use) and a basin with lever or sensor taps. It

has an emergency alarm facility for assistance. A right hand transfer is more

common need but where more than one accessible toilet is provided, alternating

transfer hands should be offered.

UNISEX ACCESSIBLE TOILET DIMENSIONS

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C.

CASHIER AND ACCOUNTING OFFICE

The Cashier and Accounting Office is in-charge of the collection of fees and other funds related

to the campus. It deposits all collections of the hospital within the period allowed by law and

prepares and submits regularly reports of collections.

The office also prepares and supervises remittances of taxes due the government through the

Bureau of Internal Revenue (BIR); insurance premiums, loans and other mandatory contributions

of personnel. It handles immediate salaries, disbursement of wages and other obligations of the

hospital. The unit renders periodic report of checks issued and cancelled, and records cash

advances.

D. HOSPITAL ADMINISTRATOR’S OFFICE

Healthcare administrators regularly interact with doctors, nurses, surgeons, and technicians. They

direct the operation of healthcare organizations and rarely meet directly with the patients in the

healthcare facility. 

An administrators' duty is to shape the policy that runs the facility and improve the patients’

experience. Healthcare administration careers are essential to successful and efficient healthcare

facilities. 

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Due to the constant need for healthcare facilities, from hospitals to nursing homes, healthcare

administration is a vital, stable job for those interested in improving healthcare policy. 

What Is a Healthcare Administrator?

Healthcare administrators work behind the scenes to make large-scale decisions for the

healthcare facility or institution. They deal directly with policy and budgets to create better

patient experiences and ensure the safety of guests and staff. 

Healthcare administrators have in-depth knowledge of the regulatory framework in patient care.

Their responsibilities are entirely different from the responsibilities of a doctor or physician.

While physicians manage patients directly, healthcare administrators oversee the facility itself

and usually have a bachelor’s degree or master’s degree in healthcare administration. 

What Do Healthcare Administrators Do?

A healthcare administrator’s job responsibilities may change depending on the facility.

Healthcare administrators can work in nursing home, surgery, physical therapy, and other

healthcare facilities. 

The most common job responsibilities for a healthcare administrator include: 

 Develop work schedules for staff and physicians. 

 Manage facility finances. 

 Manage patient fees and billing. 

 Improve facility efficiency and quality. 

 Ensure that the facility complies with all laws and regulations.

 Train staff members. 

 Communicate with physicians and nurses.

 Present investor meetings and meet with governing boards. 

 Monitor budgets and spending. 

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Healthcare administrators have a wide range of roles and need to be flexible enough to pick up

new roles through their employment. The location and size of the healthcare facility may also

influence the job responsibilities. 

Some healthcare administrators may manage an entire facility, while others may focus on a

single department within a facility. No matter where the healthcare administrator is employed,

they are required to know both state and federal laws and ensure that HIPAA laws are followed.

E. RECORDS ROOM

Departmental Location

Every day, many members of the medical staff visit Medical Record department for completion

of medical records or for records reference. Proper location of the medical record department and

the provision of proper facilities are essential.

If the medical record department is not staffed 24 hours a day, it should be located within easy

walking distance from the admitting or outpatient department to ensure that the staff can easily

refer files and retrieve records on an emergency basis. Secure surveillance to safeguard medical

record information and equipment during non-working hours should also be considered.

Layout:

Proper layout of the medical record department adds to its efficiency and attractiveness.

The key considerations in layout are

1. Workflow

2. Equipment’s should be near the user.

3. The flow of record work from desk to desk.

4. Placing desk side be side in the same direction is said to be the most compact desk

arrangement.

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 5. The records room should not be near the main office entrance. Placing it at the rear end of

the department helps to reduce the accessibility of medical records to unauthorized

personnel.

6. A supervisor should be placed behind the group of workers he supervises

Space:

Space allocation is determined by departmental services to be provided, equipment and systems

to be used and daily workload. Although services may vary somewhat from hospital to hospital,

services and tasks to be considered in allocating space include the record filing cabins, master

patient indexing cabin (manual), coding and indexing desk, and correspondence desk, op

registration area, admitting and discharging office. However the best guide is the past experience

in the particular hospital, or that of a similar institute.

Equipment’s:

In general, equipment needs for the individual hospital medical record department are affected

by:

 Planning the work environment

Part of the planning function is providing employees with the proper work environment.

This includes planning for office space and location, office furniture and equipment, and

spatial conditioning factors such as lighting, color, sound and air.

 Temperature, color and lighting

When designing an office layout, the medical record technician should also consider

environmental factors such as temperature, humidity and ventilation. These factors have

been proven to have a direct effect on employee productivity and comfort. Recommended

means of keeping the air moving in the office include air conditioning, window fans, and

ventilators.

The proper use of color is another important consideration in office design. Effective use

of color not only spruces up an office, but also improves working conditions.

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 Psychologically color can affect human emotions, senses, and thought processes, as well

as individuals’ ability to relax.

Lighting is another environmental factor, which cannot be over looked. Light

sources on the ceiling can usually provide enough light for the entire office area at a

prescribed level of illumination. It is recommended that the medical record technician

consult a lighting expert about the most efficient methods for obtaining adequate

illumination.

Safety & Security

The entire medical record department, especially the filing area of records and X-

rays, should be protected from fire by installing fire extinguishers in key areas. Important

documents such as medico legal cases should be preserved in fire-proof cabinets. All

electrical cords should be covered to avoid short-circuiting.

Safety control:

Necessary safety measures should be taken for the welfare of both the

departmental staff and visitors to the department. Filing shelves and other mechanical

equipment devices should be well erected to avoid accidents.

Infection control:

Adequate measures should be taken to protect employees from infections and

other diseases. Regular medical checkups and examinations should be available to the

staff.

Manpower planning:

The manpower planning deals with the personnel requirements according to the

bed strength and patient load of the hospital and the job description of the medical record

staff.

F. MATERNITY HOSPITAL

 EMERGENCY ROOM – CONSIDERATIONS:

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The Needs of Patients;

The ED should be a welcoming environment in which patients can access the highest

contemporary standards of Emergency Care. The department design should promote a sense of

caring, efficiency, safety and well-being. A patient’s rights to confidentiality and privacy must be

protected. The needs of the patient’s relatives, friends and visitors must also be considered.

Patients and visitors with special needs must be accommodated. Cultural factors may also

influence patients’ needs and should be considered in the design. The process of patient care,

sometimes termed the patient’s journey, should be facilitated by good design and the availability

of appropriate equipment and services.

Emergency Department Staff requirements;

Emergency medicine requires relatively high levels of staffing, provided by a multi-disciplinary

team, working on a 24/7 basis. The ED must provide a suitable environment for ED staff and

also for those who work episodically in the department. This includes clinical staff from other

hospital specialties and workers from other agencies who may attend with patients.

Temperature and Lighting;

Where possible natural (ambient) light should be used and color schemes chosen should be

appropriate given the stressful environment of many, if not all, EDs Both patients and

staff require an environment in which the ambient temperature is controlled within an

appropriate range. Air conditioning should be provided to maintain this. 

Interface with other clinical areas;

Clinical areas which should be adjacent to the ED include;

 ED Inpatient Facilities 

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  Intensive Care / High Dependency Units  
 Coronary Care Units
 Clinical Lab 
 Diagnostic Imaging Department  
 Operating Theatres or Emergency Operating Theatres
 Interventional Cardiology, if on-site 
 Inpatient Wards (including Observation Ward)
 Pharmacy

G. DELIVERY ROOM/LABOUR ROOM

The Delivery Suite or the Labour Room is a place where childbirth takes place. It is also termed

as ‘Birthing Unit’. This unit provides facilities for safe prenatal care, delivery and immediate

postnatal care of mothers and infants. It is also called as ‘LDR’ (Labour, Delivery and

Resuscitation). LDR shall be located in a restricted area and shall be near to the Obstetric

department and NICU (Neo-Natal Intensive Care Unit). Normally, the LDR complex is divided

into three zones:

(1) Unsterile zone, consisting of administrative area, shoe change, attendants waiting area, public

utility, linen and instrument pre wash room;

(2) Protective zone, having eclampsia room, change rooms, pre-labour ward/room, post-labour

ward/room, unsterile store, medicine/consumable store, pantry and doctors’ night duty room;

(3) Delivery zone having clean supply room, instrument trolley layup, scrub station, sterilization

room and delivery rooms. There are different types of LDR’s like simple room, pre-fabricated

modular, semi-modular, modular and hybrid OR. Designers of the LDR complex shall well

consider the sizes of the rooms in LDR including infrastructure of the delivery room, and also

design for door/windows, furniture, electrical and other points in rooms of LDR complex,

HVAC, equipment/instruments and tools in LDR’s, interiors, signage and way finding.

H. OPERATING ROOM

Building a new operating room is a complex process that involves balancing needs of facility

staff with construction costs, while also looking forward to future healthcare trends. To make

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planning and construction go smoothly, it helps to consider every possible variable at the outset

of the growth process. Often, this includes an evaluation of current practices.

 EVALUATE THE CURRENT OPERATING ROOM

Before officially embarking on the facility planning process, it’s necessary to take stock of how

existing operating room space is utilized. Are there any navigation or bottlenecking issues in the

current operating room? During this process, identify and consult with staff members to collect

their feedback. This not only includes the surgery team, but also those in radiology,

administration, laboratory, and beyond.

 SET GOALS FOR THE NEW PROJECT

What will be the focus of the new operating room? Does the facility plan to integrate or expand

its imaging capabilities? Will the new space require more room for specialized procedures,

which can require a larger surgical staff?

To begin the planning and design phases, several factors must be taken into account. These can

easily be broken down into the room’s size, orientation and layout, and supporting systems.

Further designs for accompanying spaces are also key.

 ROOM SIZE

In its 2014 Operating Room Requirements Guidelines, the Facility Guidelines Institute

recommends that the minimum inpatient operating room size be no less than 400 square

feet. Operating spaces designed for specialized procedures generally require more staff,

and are recommended to be at least 600 square feet.

 ESTIMATED INDUSTRY-STANDARD OPERATING ROOM SIZES

 Small OR - 400 sq ft
 Standard OR - 500 sq ft
 Orthopedic OR - 600 sq ft
 Cardiac OR - 600 sq ft
 Neurological OR - 600 sq ft
 Hybrid OR - 650 sq ft (Plus 120 sq ft separate control room)
 Transplant OR - 800 sq ft

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  Determining the size of any operating room requires factoring in the above estimates, while
also accommodating for future changes. The room will need to be optimized for the various
equipment, supplies, staff, and general work flow.  

COMMON OPERATING ROOM EQUIPMENT

 Anesthesia Machine  Blood Warmer

 Anesthesia Monitor  Defibrillator
 Video Monitors and Cameras  Case Cart / Crash Cart
 Anesthesia cart  Prep Tables
 C-arm  Back Tables
 ESU  Specialty Cart
 Surgical Microscope  IV poles
 EKG Machine  Mayo stands
 Operating Table  Ring stands
 Operating Lights  Kick buckets
 Auto-transfusion  Hazardous waste bins
 Laser  Trash bins
 Forced Air Warmer  Storage Cabinets
 SCD  Desk / Computer
 Pneumatic Tourniquet  Linen hamper

ESTIMATED EQUIPMENT SPACE REQUIREMENTS

 Nitrous Oxide Machine - 4ft x 4ft - right side head of table

 Anesthesia Machine - 3.5ft x 3.5ft
 Anesthesia Cart - 2ft x 5ft (single) 2ft x 7ft (double)
 Transesophageal Echocardiograph (TEE) 4ft x 2ft
 Rapid Infusion Machines - 2ft x 2ft
 Airway Cart - 3ft x 2ft
 Robotic Surgery - 5ft x 5ft at foot of table
 Robotic Surgery Control Console - 6ft x 6ft behind or at the side of the anesthesia
machine.

I. RECOVERY ROOM

A traditional recovery room is described with clear instructions for setting out floor space, trolley
bays, and nurses’ station. Diagrams and illustrations show the type of recovery room most
commonly used with more imaginative designs also included.

It is best to have the intensive care unit on the same level and close to the recovery room. Ideally
there should be restricted as well as public access, and a separate entrance for goods to be
delivered so that supplies do not take the same route as patients. There should be adequate space
for administration.

Patients requested 30% less pain medication in the case study of well-designed rooms.

In addition to making patients more comfortable, smart design techniques decrease the frequency
of staff errors.  These techniques include double-door lock boxes for medications and same
handed room design, as opposed to mirrored room design.  

Designing a hospital or healthcare facility from scratch obviously makes integrating these
modern approaches easier.  However, many of these strategies can be utilized in a well-planned
and thoughtful renovation.  

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HOW TO DESIGN THE PERFECT RECOVERY SPACE

With day surgery design, understanding the intention of a space will help guide practitioners in
deciding what design elements fit best for a recovery room.

For patients recovering from anaesthesia, there are practical aspects of designing a recovery
room, such as having enough space per bed, with easy access to a patient’s head, and a clear line
of sight to a wall clock from the patient’s bed. Designing around these requirements (and more),
will help implement features that ultimately benefit the speedy recovery of patients that come
through.

BENEFITS BEYOND THE PATIENT

Elements of design can help the recovery process for patients by reducing anxiety, says Jillian
Payne, Director of Community Development and Outreach for Loma Linda’s East Campus. In
private hospital design, even simple things such as a wood-grain façade can have a calming
effect.

Recovery rooms are designed for the benefit of visitors too. According to Jillian, patient-centred
design is not just about creating a beautiful space, but rather recreating a homely environment
that encourages friends and family to stay at length, providing that essential emotional support
patients need for recovery.

J. NURSERY

The Different Types of Hospital Nurseries

Think there's just one kind of hospital nursery? Think again. Here are the different levels of
neonatal care.

There are three different levels of nurseries.

Level I: This nursery is also called a newborn or a well-baby nursery and is for healthy babies
who don’t need any special monitoring, oxygen or an intravenous tube. Many babies born
between 35 and 37 weeks will be able to go to a level I nursery. Not all hospitals have a level I
nursery, though, so in these facilities healthy babies stay in a bassinet in the room with Mom.

Level II: This nursery is a neonatal intensive care unit (NICU) that can provide care for a baby
who is moderately sick but expected to improve quickly. To be in a level II nursery, baby should
be 32 weeks or more and weigh more than 1,500 g (3 lbs 5 oz). Here, babies may have an
intravenous catheter, receive oxygen and be fed through a tube.

Level III: A level III nursery offers the most intensive care possible for the sickest and the

smallest of babies. This includes babies who need mechanical ventilation (the help of a breathing

tube and machine) for more than 24 hours. In general, level III nurseries are subdivided based on

the degree of critical care they can provide. Here’s the breakdown:

Level IIIA: Babies stay here who are 28 weeks gestation or more and weigh more than 1,000 g

(2.2 lbs).

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Level IIIB: Babies at any gestational age or weight can stay here; pediatric surgeons are always

available to perform any surgeries should the need arise.

Level IIIC: This level has all the staffing and equipment of a level IIIB NICU, with the added

ability to provide open-heart surgery and an advanced form of critical care called ECMO

(extracorporeal membrane oxygenation).

K. WARDS

A group of Hospital Beds with associated treatment facilities managed as a single unit for the

purposes of staffing and treatment responsibilities. All the rooms in a small hospital may be

managed by one senior NURSE and as a single unit and thus they would comprise one WARD.

GENERAL MEDICINE WARD

Typically, hospitals are set up with a hierarchical and divisional structure to help the facility

operate effectively. The structure involves various levels of staff – ranging from high to lower-

level positions that are responsible for the patients within their respective wards.

Wards are useful for accountability purposes and often work in their own silos, so that patients

can be placed according to the treatment and expertise that they require. Most general hospitals

are often divided into the following wards, though this is by no means an exhaustive list:

 Admissions ward  Paediatrics

 General medicine ward  Oncology

 Acute care units  Surgery

 ICU  Elderly care

 Accident and emergency (A&E)  Outpatient services

 Maternity services

L. NURSES’ STATIONS

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An area of a health care facility (such as a hospital ward or nursing home), which nurses and

other health care staff work behind when not working directly with patients and where they can

perform some of their duties. The station has a counter that can be approached by visitors and

patients who wish to receive attention from nurses. Stored behind the table are materials for

which access is limited to health care staff, such as patient files, medicines, and certain types of

equipment.

The nurses' stations not only carry out administrative tasks, but also clinically associated

functions that have impact on the delivery of care to the patients. The key functions performed

are:

1. Inquiries, information and referrals 4. Monitoring of patients

2. Secretarial work 5. Medication preparation.

3. Chart processing and Management

M. DENTAL CLINIC

DENTAL CLINIC DESIGN CONSIDERATIONS

• Operational work flow • Barrier Free Access

• Occupational safety and Health • Comfort

• Infection control • Professional image

• Ergonomics • Esthetic

 Infection control should be considered in the design stage of a dental clinic.

 Rectification work may be very difficult after operation of a dental clinic.

BASIC PRINCIPLES

• Zoning clean and dirty zones, clinical area and support area

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• Flows from clean to dirty

• Simple to decrease contact surfaces

• Seamless to avoid un-cleansable area

• Smooth to allow easy disinfection

• Durable material able to withstand repeated disinfection

ZONING

• Clinical area-dental surgeries, sterilization room, x-ray room, recovery room…

• Supportive area-reception office, waiting area, server room, plant room, pantry, toilets...

• Use color for easy compliance, e.g. red for dirty and green for clean

HUMIDITY, VENTILATION AND AIR CONDITIONING

• Temperature: 22 o C for clinical area(25.5 o C for general offices)

• Relative Humidity: 50-60%

• Air Change per Hour (ACH): 2-6

• Air flow: from clean to dirty area

N. HOSPITAL PARKING REQUIREMENTS

Healthcare facilities need to provide a sufficient number of parking spaces for patients, staff,

service traffic, and the public. At a minimum, parking standards or requirements developed by

local authorities having jurisdiction should be consulted since these will reflect the availability of

public transportation, public parking facilities, or other alternatives. This article provides some

general rules-of-thumb for estimating the number of parking spaces for patients being

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admitted/discharged, visitors to inpatient nursing units, hospital staff, outpatients, and emergency

patients and their escorts.

Generally, the peak parking demand for acute care hospitals and outpatient facilities occurs

weekdays during the day shift. This is when the demands of the peak shift staffing and outpatient

traffic coincide. Inpatients being admitted or discharged ― along with their escorts ― will also

be greatest during the day shift. Separate space is needed for service vehicles who tend to access

the hospital site during the weekday business hours as well. A formal parking or site traffic study

may be necessary to ensure that there is adequate parking, particularly during peak periods ―

with the highest demand generally between 10:00 a.m. and 2:00 p.m., Monday through Friday.

Some general rules-of-thumb to estimate the number of parking spaces required for various types

of parking are as follows:

Inpatient admissions/discharges — one space per each five hospital beds — this generally

accommodates inpatients being admitted/discharged (with their escorts) for an acute care

hospital with a four-day average length of stay at 85 percent occupancy; inpatient facilities with

longer lengths of stay would require less parking spaces.

Visitors to inpatient nursing units — a maximum of one space per bed — this will depend

greatly on the community, both in terms of the number of visitors per inpatient and daily visiting

patterns (daytime versus evening), and will also depend on hospital visitation policies.

Hospital staff (including physicians) — up to one space per each day shift employee — this

should be considered the maximum and would be reduced by the availability of public

transportation, offsite parking due to a constrained site, or other staff incentives to minimize

onsite parking.

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Outpatients — up to three spaces per exam/procedure room — maximum demand assumes that

each exam/procedure room is occupied by a patient with one patient waiting and another patient

leaving (including their escorts).

Emergency patients — one space per each four average daily ED visits — assumes that up to

75 percent of the average daily visits occur during the peak eight-hour shift with an average

turnover of about three hours.

1. Dietary Department

The dietary department provides meals for its patients/residents and employees three

times a day. Patients are able to choose from a variety of menu items listed on our patient menu.

Along with meal planning, the dietary department must supply nutritional care for its patients by

providing diet counseling.

2. Clean Utility

Clean and dirty utility rooms might sound banal, but they serve a critical function in

regard to infection control. They cover the join at crucial points where infection can spread;

when patients come into contact with medical supplies, and where used medical supplies must be

disposed of, or cleaned.

3. Central Sterile & Supply Department

The Central Sterile Supply Department is responsible for preparing medical/ surgical

supplies and equipment so that they are sterile and ready for use in patient care. With the

centralization of the pre-disinfection, cleaning, packing and sterilization of all items in one

department, it is of paramount importance to provide consistently high standards in the

sterilization techniques and product quality.

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4. Laundry

Hospital laundry services provide a range of services for hospitals and healthcare

facilities. They include sorting, cleaning, sanitizing, and disinfecting used linen. This ensures

that patients’ bed sheets and other linen items remain fresh and clean. It also helps to prevent the

spread of disease by providing a safe environment for patients.

5. Motor Pool

The Motor Pool Division in Hospital is responsible for maintaining all Hospital vehicles

and related equipment. The Division keeps individual records on each vehicle and piece of

equipment to help determine whether cost of repair is justified, or if the equipment is to be

replaced.

6. Maintenance Office

Proactively maintaining assets and infrastructure. Making sure your healthcare facility

complies with all of the regulatory requirements. Managing maintenance vendors and

contractors. Planning for and managing capital projects (facility and equipment upgrades, buying

new physical assets)

7. Morgue

A morgue or mortuary is a place used for the storage of human corpses awaiting

identification, removal for autopsy, respectful burial, cremation or other methods of disposal. In

modern times, corpses have customarily been refrigerated to delay decomposition.

DEPARTMENT OF HEALTH GUIDELINES FOR LEVEL 1 HOSPITAL

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1. PHYSICAL PLANT

1.1 Administrative Service

1.1.1 Lobby

1.1.1.1 Waiting Area

1.1.1.2 Information. Reception Area and Admitting Section

1.1.1.3 Public Toilet (Male/Female/PWD)

1.1.1.4 Staff Toilet

1.1.2 Business Office

1.1.3 Medical Records Office

1.1.4 Prayer Area/Room

1.1.5 Office of the Chief of Hospital

1.1.6 Laundry and Linen Section

1.1.7 Maintenance and Housekeeping Section*

1.1.8 Parking Area for Transport Vehicle

1.1.9 Supply Room

1.1.10 Waste Holding Room

1.1.11 Dietary

1.1.11.1 Dietitian Area

1.1.11.2 Supply Receiving Area*

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 1.1.11.3 Cold and Dry Storage Area*

1.1.11.4 Food Preparation Area*

1.1.11.5 Cooking and Baking Area*

1.1.11.6 Serving and Food Assembly Area

1.1 117 Washing Area

1.1.11.8 Garbage Disposal Area

1.1.11.9 Dining Area

1.1.11.10 Toilet 1.1.12 Cadaver Holding Room

1.2 Clinical Service

1.2.1 Emergency Room

1.2.1.1 1.2.1.2 Tollet Waiting Area

1.2.1.3 Nurses' Station with Work Area with Lavatory/Sink

1.2.1.4 Minor Operating Room/Surgical Area

1.2.1.5 Examination and Treatment Area with Lavatory/Sink

1.2.1.6 Observation Area

1.2.1.7 Equipment and Supply Storage Area

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 1.2.1.8 Wheeled Stretcher Area

*When the services are contracted out, these areas are not required. However, a contract of

service or memorandum of agreement with a service provider should be secured as a prerequisite

for license to operate.

1.2.2 Outpatient

1.2.2.1 Department (Separate from ER Complex) Waiting Area

1.2.2.2 Toilet (Male/Female/PWD)

1.2.2.3 OPD Nurses' Station with work area with Lavatory/sink

1.2.2.4 OPD Medical Records Section

1.2.2.5 Consultation Area Examination and Treatment Area with Lavatory/Sink (OB,

Medicine, Pedia, Surgery, Dental-optional)

1.2.3 Surgical and Obstetrical Service

1.2.3.1 Major Operating Room

1.2.3.2 Labor Room with toilet

1.2.3.3. Delivery Room

1.2.3.4 Recovery Room

1.2.3.5. Sub-sterilizing Area/Work Area

1.2.3.6 Sterile Instrument, Supply and Storage Area

1.2.3.7 Scrub-up Area

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 1.2.3.8 Clean-up Area

1.2.3.9 Dressing Room

1.2.3.10 Toilet

1.2.3.11 Nurses' Station with Work Area

1.2.3.12 Wheeled Stretcher Area

1.2.3.13 1.2.4 Nursing

1.2.4.1 Unit Janitor's Closet (with mop sink)

1.2.4.2 Patient Room with toilet Isolation Room with Toilet and Ante Room with sink,

PPE Rack and hamper

1.2.4.3 Nurses' Station with Medication Area with Lavatory/Sink

1.2.4.4 Central Treatment Area Sterilizing and Supply Room 1.2.5

1.2.5.1 Receiving and Cleaning Area

1.2.5.2 Inspection and Packaging Area

1.2.5.3 Sterilizing Room

1.2.5.4 Storage and Releasing Area

1.3 Nursing Service

1.3.1 Office of the Chief Nurse 1.4 Ancillary Service

1.4.1 Secondary Clinical Laboratory with Blood Station

1.4.1.1 Clinical Work Area with Lavatory/Sink (min. Floor Area: 20.00 sq. m.)

1.4.1.2 Pathologist Area

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 1.4.1.3 Toilet

1.4.1.4 Extraction Area Separate from Clinical Lab. Work area

1.4.2 Radiology 1st Level

1.4.2.1 X-Ray Room with Control Booth, Dressing Area and Toilet

1.4.2.2 Dark Room

1.4.2.3 Film File and Storage Area

1.4.2.4 Radiologist Area 1.4.3 Pharmacy (with work counter and sink)

2.PLANNING AND DESIGN

2.1 Floor plans properly identified and completely labeled

2.2 Conforms to applicable codes as part of normal professional service:

2.2.1 Exits restricted to the following types: door leading directly outside the

building, interior stair, ramp, and exterior stair

2.2.2 Minimum of two (2) exits, remote from each other, for each floor of the

building

2.2.3 Patient Corridors for ingress and egress shall be at least 2.44 meters in clear

and unobstructed width

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

2.2.5 Minimum of one (1) toilet on each floor

2.3 Meets prescribed functional programs

2.3.1 Main entrance of the hospital directly accessible from public road

36 | P a g e
 2.3.2 or elevator for clinical, nursing and ancillary services located on the upper floor

2.3.3 Administrative Service

2.3.3.1 Business office located near the main entrance of the hospital

2.3.4 Emergency Room Located in the ground floor to ensure easy access for

2.3.4.1 patients

2.3.4.2 Separate entrance to the emergency

2.3.4.3 Ramp for wheelchair access (with a clear width of at least 1.22 m. or 4 ft.)

2.3.4.4 Easily accessible to the clinical and ancillary services (laboratory,

radiology, pharmacy, operating room)

2.3.4.5 Nurses' station located to permit observation of patient and control of

access to entrance, waiting area, and treatment area

2.3.5 Outpatient Department

2.3.5.1 Located near the main entrance of the hospital to ensure easy access for patients

2.3.5.2 Separate toilets for patients and staff (Male/Female/PWD) 2.3.6 Surgical and

Obstetrical Service

2.3.6.1 Located and arranged to prevent non-related traffic through the suite

2.3.6.2 Operating room and delivery room located as remote as practicable from the

entrance to the suite to provide greater asepsis

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 2.3.6.3 Operating room and delivery room arranged to prevent staff and patients to travel

from one area to the other area

2.3.6.4 Dressing room arranged to avoid exposure to dirty areas after changing to surgical

garments

2.3.6.5 Nurses' station located to permit visual observation of patient and movement into

the suite

2.3.6.6 Scrub-up area recessed into an alcove or other open space out of the main traffic

2.3.6.7 Sub-sterilizing area shall be provided and shall be accessible from the Operating

room and delivery room

2.3.7 Nursing Service

2.3.7.1 Nurses' station located and designed to allow visual

2.3.7.2 observation of patient and movement into the nursing unit Nurses' station

provided in all nursing units of the hospital with a ratio of at least one (1) nurses' station

for every thirty-five (35) beds

2.3.7.3 Toilet immediately accessible from each room in a nursing unit

2.3.7.4 Separate rooms with toilets for male and female patients

2.3.8 Dietary, maintenance and other non-patient contact services located in areas away from

normal traffic within the hospital, or located in separate buildings within the hospital premises

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

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 REVISED IMPLEMENTING RULES AND REGULATIONS (RIRR) OF CHAPTER VII
- INDUSTRIAL HYGIENE OF THE CODE ON SANITATION OF THE PHILIPPINES,
P.D. 856
I.    BACKGROUND/RATIONALE

The Code on Sanitation of the Philippines, P.D. 856 was promulgated in 1975 and one of its
chapters on Industrial Hygiene provides the standards and guidelines for the protection and
promotion of workers’ health. The first implementing rules and regulations (lRR) of the said
chapter was developed in 1991. To cope up with the trends in industrialization and globalization,
amendments were made in 1999.

With the resurgence of the manufacturing industries to achieve the Philippine government’s goal
of inclusive growth, there is a need to strengthen the implementation of the P.D. 856 through the
IRR. This would include the active involvement of the Investment Promotion Agencies (IPAs) in
support to the Local Government Unit (LGU) in the implementation of the IRR in all industrial
establishments inside the economic zones. To facilitate enforcement, standards and operational
procedures need to be harmonize with the Department of Labor and Employment and other
partner agencies (e.g. Department of Environmental and Natural Resources, Civil Service
Commission, Department of Interior and Local Government, Philippine Economic Zone
Authority, etc.).

Hence, the Revised Implementing Rules and Regulations (RIRR), that will contribute to a more
responsive health system addressing workers’ health.

II.   OBJECTIVES
 
Chapter VII - Industrial Hygiene of the Sanitation Code of the Philippines, PD 856, to promote
and protect workers’ health.

III.  SCOPE AND COVERAGE

This Revised Implementing Rules and Regulations (RIRR) shall apply to all industrial
establishments which are either engaged in the manufacture, storage, sale, and distribution of
goods or processing of raw materials into end-products operated by the government agencies or
its instrumentalities including government-owned or controlled corporations, private
organizations or firms, individuals or entities.

IV.  DEFINITION OF TERMS

1. Department - refers to the Department of Health (DOH).

2. Employer - refers to persons, entity, or organization who employ one or more paid
workers in the operation of their businesses or trades.
3. Industrial Establishment - refers to workplace, which is either engaged in the
manufacture, storage, sale, distribution, treatment and disposal of goods or  processing 
of  raw  materials  into  end-products  except  mining  and quarrying operations.
4. Investment Promotion Agency (IPA) - refers to the authority managing Economic
Zones, Freeport Zones, Industrial Estates, and Retirement Areas as identified by the
Department of Trade and Industry.
5. Health Officer - refers to the Provincial Health Officer, City Health Officer, Municipal
Health Officer, or Investment Promotion Agency Health Officer. He/she must be a
licensed medical practitioner.

39 | P a g e
 6. Health and  Safety Committee -  refers to  the  industrial establishment's planning and
policy-making group in-charge of all matters pertaining to occupational health and safety,
the composition of which shall be in accordance with the rule as stated in the DOLE’s
Occupational Safety and Health Standards, as amended.

7. Local  Government  Unit  (LGU)  -  refers  to  the  provincial,  municipal, chartered and
component cities.

8. Local Health Authority - refers to the Provincial Governor, City or Municipal Mayor or
Administrator of Investment Promotion Agency.

9. Occupational Health Worker -  refers  to  the  qualified first-aider, nurse, dentist, or
physician, whose service/services have been engaged by the employer in order to provide
occupational health services in the industrial establishment.

10. RIRR - refers to Revised Implementing Rules and Regulations on Chapter VII -
Industrial Hygiene of the Code on Sanitation of the Philippines, P.D. 856

11. Worker - refers to any employed person regardless of nationality in the industrial
establishment including its working owner/s, officers and administrative personnel.

12. Workplace - refers to the office, premises or worksite, where the workers are habitually
employed and shall include the office or place where the workers who have no fixed or
definite worksite, regularly report for assignment in the course of their employment.

V.   GENERAL GUIDELINES

 
1. All workers shall be entitled to a healthy and safe workplace through compliance with the
attached RIRR.

2.    The requirements for operating an industrial establishment shall be in accordance with this
Order and the attached RIRR.

3.    The Local Government Units and Investment Promotion Agencies shall be responsible in the
enforcement of the provisions of the attached RIRR.

VI.  SPECIFIC GUIDELINES

1.    The provisions to a healthy and safe workplace shall follow Rule III of the RIRR -
Responsibilities of Employer, Worker and Health and Safety Committee.

2.    The procedures in securing a Sanitary Permit shall be in accordance with Rule IV of the
RIRR - Application, Issuance, Renewal and Revocation of the Sanitary Permit.

3.    In the operation of industrial establishments, the following Rules of the RIRR
shall apply:
a.   Rule V - specifies the Sanitary Requirements in the operation of
Industrial Establishments
b.   Rule VI- prescribes the Environmental Control Provisions to be followed in the prevention
and control of occupational hazards in the workplace.
c.   Rule VII - specifies the required Personal Protective Equipment, whenever engineering and
administrative control measures are not feasible or insufficient/inadequate as specified in Rule

40 | P a g e
VI of this RIRR.
d.   Rule VIII - requires the appropriate Occupational Health Services to be provided to all
workers, depending on the size of establishment, number of workers and nature of undertaking.
4.    The policies and standards adopted from other agencies shall be of the latest issuance.

5.    The Department of Health in the form of issuance of Administrative Order may amend,
modify and change any word, sentence, paragraph, provisions and requirements contained in the
RIRR as it deems necessary for the improvement of its implementation at the field level.

VII. RECORDING AND REPORTING

1.    The owner/general manager of industrial establishment shall  submit  the reportorial
requirements to the City/Municipal Health Office as stated in the RIRR. In case of industrial
establishments in the economic zones, it shall be submitted to the Investment Promotion Agency
(IPA.)

2.    The consolidation and submission of reportorial requirements shall be done by area of
jurisdiction and level of authority, as follows:
a.   From the Component City / Municipal Health Office to the Provincial
Health Office;
b.   From   the   Chartered   Cities,   Provincial   Health   Office   (PHO)   and
Investment Promotion Agencies (IPA) to the DOH Regional Office; and
c.  From the Regional Office to the DOH Central Office through the Occupational  Diseases  
Division,   Disease   Prevention   and   Control Bureau.

VIII. MONITORING AND EVALUATION

 
1. The monitoring and evaluation by area of jurisdiction and level of authority shall be done
annually. It shall include the following indicators:
 
For City / Municipal Health Offices, Chartered Cities and Investment Promotion Agencie
a.   List of medical illness and injuries by classification (highly hazardous and hazardous), size
(small, medium, large scale), and location of industrial establishments; and

b.   List of industrial establishments issued sanitary permit by classification, size, and location.

For Provincial Health Office, DOH Regional Office and DOH Central Office

a.   No. of medical illness and injuries by classification, size, and location of industrial
establishments; and
b.   No. of industrial establishments issued sanitary permit by classification, size, and location.
IX.  ROLES AND RESPONSIBILITIES

Consistent with the defined roles and responsibilities under the RIRR, the following national
government agencies and local government units shall:

1.    Department of Health

a.   Formulates  policies,  plans  and   programs  for   the   promotion  and protection of workers’
health.

b.  Prescribes standards, guidelines, and means of control on workplace hazards.

c.   Capacitates the DOH Regional Offices, IPAs, and other partner agencies to implement the
provisions of this RIRR.
2.    DOH Regional Offices
a.   Provides technical assistance to LGUs and IPAs for the implementation of this RIRR.

41 | P a g e
b.   Monitors and evaluates the implementation of this RIRR.

c.   Networks and collaborates with other agencies in the implementation of this RIRR.

d. Consolidates, maintains and analyzes yearly reports submitted by Provincial Health Office,
City Health Office (Chartered) and Investment Promotion Agencies, and submits to the
Department.
3.    Local Health Authority
Provincial Level

a.   Oversees the enforcement of this RIRR.

b.   Enacts local ordinances to support and strengthen the implementation of this RIRR.
c.  Provides technical assistance to component city / municipality for the implementation of this
RIRR.
d. Coordinates with other government agencies at the provincial level relative to the
implementation of this RIRR;

City / Municipal Level

a.   Exercises jurisdiction in the enforcement of this RIRR.

b.   Issues licenses / business permits and suspends or revokes the same for any violation of the
conditions upon which said licenses or permits had been issued, pursuant to existing laws or
ordinances.
c.   Ensures compliance to submission of reportorial requirements of this
RIRR.
d. Coordinates  with  other  government  agencies  relative  to  the implementation of this RIRR.
e. Enacts city / municipal ordinances to support and strengthen implementation of the provisions
of this RIRR.
4.    Investment Promotion Agency
a.   Exercises jurisdiction in the enforcement of this RIRR in the economic zone.
b.   Appoints / designates Health Officer who shall perform both the sanitary and public health
functions in the economic zone.
c.   Issues licenses/business permits and suspends or revokes the same for any violation of the
conditions upon which said licenses or permits had been issued, pursuant to existing laws or
ordinances.
d. Coordinates with DOH and local government units relative to the implementation of this
RIRR.
e.  Issues memoranda to support and strengthen implementation of the provisions of this RIRR in
the economic zone.
f.    Ensures compliance to submission of reportorial requirements of this
RIRR.
X.   SEPARABILITY CLAUSE

In the event that any rule, section, paragraph, sentence, clause or word of this Administrative
Order is declared invalid for any reason, the other provisions thereof shall not be affected.

XI. REPEALING CLAUSE

This Administrative Order rescinds the 1999 Implementing Rules and Regulations on Chapter
VII - Industrial Hygiene of the Sanitation Code of the Philippines, P.D. 856 Amending
Administrative Order No. III s. 1991 and other related issuances which are inconsistent or
contrary with the provisions of this Administrative Order. All other provisions of existing
issuances which are not affected by this Order shall remain valid and in effect.

XII. EFFECTIVITY

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This Order shall take effect fifteen (15) days following the date of its publication in a newspaper
of general circulation.

HOSPITAL ZONES - The different areas of a hospital shall be grouped according to zones as

follows:

 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.

 Second Zone – areas that receive workload from the outer zone: laboratory, pharmacy,

and radiology. They shall be located near the outer zone.

 Inner Zone – areas that provide nursing care and management of patients: nursing

service. They shall be located in private areas but accessible to guests.

 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.

 Service Zone – areas that provide support to hospital activities: dietary service,

housekeeping service, maintenance and motor pool service, and mortuary. They shall be

located in areas away from normal traffic.

FIRE CODE (RA9514)

Sec.10.2.11.2- Exit Details

C. ACCESS TO EXIT

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

accordance with Section 10.2.5.2 of this RIRR, except as modified in the succeeding paragraphs

of this Subsection.

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2. Travel distance shall comply with the following: a. Between any room door intended as exit

access and an exit shall not exceed thirty meters (30 m); b. Between any point in a room and an

exit shall not exceed forty-six meters (46 m); 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 meters (15 m); d.

Travel distance shall be measured in accordance with Section 10.2.5.2 of this RIRR; and e. The

travel distances in paras 2.a and 2.b above may be increased by fifteen meters (15 m) in

buildings completely equipped with an automatic fire suppression system.

3. Every health care sleeping room, unless it has a door opening at ground level, shall have an

exit access door leading directly to a corridor which leads to an exit. One (1) adjacent room, such

as a sitting or anteroom, may intervene if all doors along the path of exit travel are equipped with

non-lockable hardware, and this intervening room is not intended to serve more than eight (8)

health care sleeping beds. However, special 95 nursing suites or nurseries permitted in this

Division shall not be limited to eight (8) cribs or bassinets.

4. Aisles, corridors and ramps required for exit access of exit in hospitals or nursing homes shall

be at least two and forty-four hundredths’ meters (2.44 m) in clear and unobstructed width.

Corridors and ramps in adjunct areas not intended for the housing, treatment, or use of inpatients

shall be at least one and eighty-three hundredths’ meters (1.83 m) in clear and unobstructed

width.

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) and/or a common path of travel exceeding ten meters (10 m).

7. Any health care sleeping room which complies with the requirements previously set forth in

this Section may be subdivided with non-fire-rated, non-combustible barriers, provided that the

arrangement allows for direct and constant visual supervision by nursing personnel. Rooms

which are so subdivided shall not exceed four hundred sixty-five square meters (465 m2).

D. Doors
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1. Doors shall be in accordance with Section 10.2.5.3, except as modified in this Subsection.

Door requirements in horizontal exits and smoke partitions shall be in accordance with Sections

10.2.5.6 and 10.2.6.3 and, this Section.

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. Exit access doors from hospital and nursing home sleeping rooms, diagnostic and treatment

rooms or areas, such as X-ray, surgery and physical therapy, all doors between these spaces and

the required exits, and all exit doors serving these spaces shall be at least one and twelve

hundredths’ meters (1.12 m).

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 10.2.5.3 of this RIRR. 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

F. Horizontal Exits

1. At least two and eight tenths square meters (2.8 m2) per occupant in a hospital or nursing

home shall be provided on each side of the horizontal exit for the total number of occupants in

adjoining compartments.

2. A single door may be used as a horizontal exit if it serves one (1) direction only and is at least

one and twelve hundredths’ meters (1.12 m) wide for a hospital or nursing home. The swing

shall be in the direction of exit travel.

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3. A horizontal exit involving a corridor two and four tenths’ meters (2.4 m) or more in width

serving as means of egress from both sides of the doorway shall have the opening 96 protected

by a pair of swinging doors, each door having a clear width of one and fifty-five thousandths’

meters (1.055 m) and swinging in the opposite direction from the other.

H. Emergency Lighting, Exit Markings, Alarms and Communication Systems

1. Each hospital shall be provided with emergency lighting as described in Section 10.2.5.11 and

exit markings as described in Section 10.2.5.12 of this RIRR. 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 paragraphs (c), (d) and (e), Section 312 of

the same reference.

2. Each nursing home shall have emergency lighting in accordance with Section 10.2.5.11 of this

RIRR. Emergency lighting with at least one and a half (1.5) hour duration shall be provided.

3. Exit signs shall be provided in each hospital and nursing home in accordance with Section

10.2.5.12 of this RIRR.

I. Emergency Evacuation Plan

Emergency Evacuation Plan shall be provided in accordance with Section 10.2.5.13 of this

RIRR.

SECTION 10.2.11.3- PROTECTION

A. Subdivision of Building Spaces

5. Corridor openings in smoke partitions shall be protected by a pair of swinging doors, door to

swing in a direction opposite from the other. The minimum width of each door for hospitals and

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nursing homes shall be one and twelve hundredths’ meters (1.12 m)

E. Interior Finish

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

in accordance with Section 10.2.6.4 of this RIRR, while floor finish material shall be Class A or

B throughout all hospitals and nursing homes.

F. Alarm, Detection and Extinguishment Systems

2. An approved automatic heat and/or smoke detection system shall be installed in all corridors

of hospitals and nursing homes; such systems shall be installed in accordance with the applicable

standards of the NFPA 72, but in no case shall smoke detectors be spaced farther apart than nine

meters (9 m) on centers or more than four and six tenths’ meters (4.6 m) from any wall. All

automatic heat and/or smoke detection systems required by this Section shall be electrically

interconnected to the fire alarm system.

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

homes, except for one (1) storey building with a bed capacity of not exceeding five (5).

Replenishment of water supplies shall be strictly considered in the design. Quick-response

sprinklers shall be required in smoke compartments containing patient sleeping rooms.

SECTION 10.2.21.5 HEALTH CARE OCCUPANCIES

Evacuation Plan and Fire Exit Drills:

A. The administration of every hospital and nursing home shall have an approved evacuation

plan for the guidance of all persons in the event of fire. Copies of such plans shall be made

available to all supervisors and personnel. All employees shall be instructed and kept informed

of their detailed duties under the plan. A copy of the plan shall be readily available at all times,

in the telephone operator’s position, or at the security center.

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B. Every bed intended for use by institutional occupants shall be easily movable under

conditions of evacuation and shall be equipped with the type and size of casters to allow easy

mobility, especially over elements of the structure such as expansion plates and elevator

thresholds. The C/MFM having jurisdiction may make exceptions in equipping beds intended for

use in areas limited to patients such as convalescent, self-care or psychiatric patients.

C. Fire exit drills in hospitals shall include the transmission of a fire alarm signal and simulation

of emergency fire conditions, except the movement of infirm or bed-ridden patients to safe areas

or to the exterior of the building. Drills shall be conducted quarterly on each shift to familiarize

hospital personnel (nurses, interns, maintenance personnel and administrative staff) with signals

and emergency action required under varied conditions.

Parking Provision

According to Presidential Decree 1096, otherwise known as the Implementing Rules and

Regulations of the National Building Code of the Philippines:

"The parking slot, parking area and loading/unloading space requirements listed hereafter are

generally the minimum off-street cum on-site requirements for specific uses/occupancies for

buildings/structures, i.e. all to be located outside of the road right-of-way (RROW)."

While most parking lots and establishments subscribe to the standard parking requirements of the

Building Code, there are still some that walk the fine line between the mandatory and patently

illegal. The Building Code is clear regarding the minimum size and the number of parking slots

required before a structure is granted a building permit.

PARKING STANDARDS AND REQUIREMENTS

17.27.020 Off-street parking and requirements.

E. Community Facilities.

7. Hospitals: three spaces per bed.

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1. Parking space requirements

 The size of the average parking area is 2.5m x 5m for perpendicular or diagonal parking.
 2.15m x 6m for parallel parking.
 3.6m x 18.0m for Articulated Truck with 12.0 m container
 3.0m x 9.0m for Jeepney
 3.7m x 5.0m for Disabled
 Truck or bus parking shall have a minimum of 3.6m x 12m.

2. Loading slot requirements

TYPE OF OCCUPANCY PARKING REQUIREMENT

Hotels and hospitals 1 truck loading slot

Hospitals 1 slot/ 25 beds

I. URBAN DESIGN CONSIDERATIONS

7. PARKING

1. PROBLEM IDENTIFICATION

Poor parking facilities.

Insufficient width of the parking aisle.

No allocation of parking space for the disabled.

2. PLANNING PRINCIPLE

To provide accessible parking facilities as close as possible to the point of destination.

3. DESIGN CONSIDERATIONS

3.1 General

*Accessible parking provisions apply to both outdoor and underground facilities.

*For multi-storey indoor parking facilities, at least one level should be served by an accessible

elevator.

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3.2 Number

*For parking facilities of less than 50 cars, at least one accessible parking space should be

provided in every parking facility.

*For parking facilities of a maximum number of 400 spaces, accessible parking spaces should at

least be provided in the ratio of 1:50 (one accessible space for every 50 spaces).

*For parking facilities of more than 400 spaces, at least 8 accessible parking spaces should be

provided plus 1 space for each additional increment of 100 cars over 400.

3.3 Location

*For outdoor parking, accessible parking spaces should be located not more than 50 m from

accessible building entrances.

*For indoor parking, accessible parking spaces should be located right next to accessible

elevators, or as close as possible to exits.

*The ends of rows are preferable for vans with lifts for wheelchair users.

3.4 Dimensions

*The minimum width of an accessible parking space is 3.60 m. The recommended width is 3.90

m (fig. 1).

*An access aisle 1.20 m wide can be located between two ordinary parking spaces (fig. 2).

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*For indoor parking, the minimum height clearance for vans with hydraulic lifts is 2.40 m.

*Where parking spaces are angled, the extra space at the end of a row can be used as a parking

aisle for disabled persons (fig. 3).

3.5 Parking curb

*If a curb exists, curb ramps should be provided to link accessible parking spaces to accessible

pathways (fig. 2).

*If no curb exists, a textured surface at least 0.60 m wide is needed to separate the pathway from

the vehicular area; otherwise bollards should be used (see Street Furniture). Pre-cast wheelstops

can also be used to set apart a passage at least 0.90 m wide (fig. 4) (fig. 5).

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3.6 Curbside parking

*Curbside parking is dangerous for disabled people unless it is designed as an accessible drop-

off area.

3.7 Drop-off areas (fig. 6)

*Drop-off areas are beneficial for picking up and dropping off people with physical limitations,

parents with children, people carrying loads, etc.

*Drop-off zones should be provided at public transport stops such as bus stops, and not more

than 30.00 m from accessible building entrances.

*The drop-off area should be at least be 3.60 m wide and incorporate an aisle 1.20 m wide to

allow for maneuvering. The length should accommodate at least two cars.

*Appropriate curb ramps should be provided to facilitate circulation over paved surfaces.

*Where no curb exists to mark the separation between pedestrian and vehicle zones, the

installation of a cue is necessary to guide sightless pedestrians:

(a) Bollards may be used (see Street Furniture); (b) A tactile marking strip at least 0.60 m wide

can be constructed at the edge of the pathway to warn of the transition to a vehicular area.

*A protected shelter or canopy with seating facilities is a recommended design feature at

passenger loading zones.

*Signs should be installed to identify a drop-off zone and prevent its misuse as a parking space.

3.8 Surface

*The surface of a parking facility should beuniform and smooth.

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*The slope of a parking ramp should not exceed 1:20.

3.9 Signs (fig. 7)

*Accessible parking areas should be marked by the international symbol of accessibility. (1)

4. EXISTING CONSTRUCTIONS

*If the parking area is more than 50.00 m from the building entrance, a vehicular drop-off area

within 30.00 m of the entrance should be built or an accessible parking space close to the

entrance should be constructed.

*If no accessible parking space is available, one of the following measures should be

implemented:

(a) Block a peripheral regular stall with bollards to get one accessible parking space (fig. 8).

(b) Block a central regular stall with bollards to get two accessible parking spaces (fig. 9).

(c) Two accessible parking aisles (fig. 9).

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*For indoor parking spaces with clear height of less than 2.40 m, alternative outdoor provisions

for vans carrying disabled people should be provided.

REFERENCES:

https://www.linkedin.com/pulse/hospital-design-considerations-dr-salil-choudhary

https://hfsrb.doh.gov.ph/wp-content/uploads/2021/05/Hospital-Level-1.pdf

https://elibrary.judiciary.gov.ph/thebookshelf/showdocs/10/90419

https://www.linkedin.com/pulse/mother-child-hospital-planning-designing-tarun-katiyar

https://arcmaxarchitect.com/maternity-hospital-design-architecture-planning

https://avantehs.com/learn/buying-guides/intro-operating-room-design

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https://link.springer.com/chapter/10.1007/978-981-16-8456-2_20

https://www.linkedin.com/pulse/main-considerations-design-planning-emergency-ed-part-

tarawneh

https://www.raybar.com/shielding-information/radiation-room-types/x-ray-radiology-

radiographic-imaging-rooms

https://ecoglo.ph/wp-content/uploads/RA9514-RIRR-rev-2019-compressed.pdf

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