arena Chapter v (Final)

8/19/2019 arena Chapter v (Final)

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PROGRAM STATEMENT

A secondary hospital is a hospital with 25 to 99 beds and

equipped with the services capabilities needed to support licensed

physicians rendering services in the fields of Medicine, Pediatrics,

Obstetrics and Gynecology, General Surgery and other ancillary

services.

This chapter discusses: the functional aspect of the hospital

such as circulation of activities, movement of people, and how the

different areas are linked together. These relationships should be

thoroughly understood in order to create a well-planned hospital.

The technical aspect which tackles how the researchers

made use of the information, statistical data, and standard

requirements in determining the number of beds, sizes of rooms,

the number of personnel and other related topics.

And lastly, the building features to be adopted, the projected

building shape and site utilization, how the design concept will

evolve to build a structure that will create a sense of place in the

community and the structural stability of the main facility and lastly

the projected vision of the researchers to the secondary hospital.

I. HOSPITAL PLANNING CONSIDERATIONS

The planning and designing of hospitals is a systematic

process. There must be participation between the users and the

professionals. A need to identify the end-users of the hospital is

important. There are 4 main end-users namely: patients, medical

staff, administration, service staff, and others (public information,

visitors, etc.). These users need to have the adequate

infrastructure, equipment, utilities and systems, and services.

The hospitals challenge is to create a patient-oriented

system, thereby providing the best experience for the patients and

also to the other users. There are five categories that enumerate

the user’s and patient’s experience.


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1. Space and sui tabi l i ty of space – size, functionality,

adopting standards/minimum requirements

2. Privacy – desired in bed, treatment, toileting, access to

social support

3. Comfor t – personal comfort, colours, views, shape of room,

etc.

4. Variety – contact with outdoors, radio and television,

pictures

5. Communicat ion – access to the hospital at car parking,

reception, signage, etc.

BUILDING ATTRIBUTES

A thorough understanding of the main building is

important for the designer to come up with a well-planned

design.

1. Effic iency and cost-effectiveness – distance of travel,

adjacencies of spaces, support spaces

2. Flexibi l i ty and expandabi l i ty – modular concepts, generic

room sizes, directions for future expansion

3. Therapeutic environment – colors and textures, natural

light

4. Cleanl iness and sani tation – durable finishes

5. Accessibi l i ty – minimum requirements, way finding process

6. Control led circulation – simple routes for outpatients and

visitors, cadavers route to be out of sight, soiled materials

7. Aesthetics – increased natural light, proportions, artwork

8. Securi ty and safety – protection of hospital property,

patients, protection from violent patients

9. Sustainabi l i ty –utilities for conserving water and energy,

recycling, byproducts.


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PROGRAM REQUIREMENTS

SITE DEVELOPMENT

1. Parking Requirements

A public hospital is classified under Group D (Division D-2)

of the National Building Code. As stated in the NBC (P. D.

1096), the Minimum Required Off-Street cum On-Site Parking

Slot, Parking Area and Loading/Unloading Space Requirements

by Allowed Use or Occupancy under this division shall be:

One (1) off-street cum on-site car parking slot for every

twenty five (25) beds;

One (1) off-RROW (off-street) passenger loading space that

can accommodate two (2) queued jeepney/shuttle slots;

Provide at least one (1) loading slot for articulated truck or

vehicle (12 meter long container van plus 6 meter length for

a long/hooded prime mover);

One loading slot for a standard truck for every 5000 sq.

meters of gross floor area; and

Provide truck maneuvering area outside of the RROW

(within property or lot lines only).

2. Green Areas

These areas are comprised of the open spaces for future

developments, gardens, natural buffer zones, and site protection.

The intended structure will be a vertical development to preserve

natural spaces and utilize the others for gardens. These gardens

provide significant effects in the healing of patients.

3. Traffic Circulation

The external routes are comprised of the traffic lines outside of the

buildings. These are utilized by patients, staff, visitors, suppliers,

and other clients (e.g. those who collect garbage, remove the

deceased) whether they are on foot or on vehicle. The researchers

use four access points to separate the traffic:


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Service: for delivering supplies and collecting garbage

Service: for removal of the deceased

Emergency: for patients in ambulance and other vehicles

going to emergency department

Main: for all others

INTERNAL SPACES (MAIN BUILDING)

1. Functional Relationships

Hospital Services

The researchers recognize four main divisions of hospital

namely: clinical, ancillary, domestic, and administrative. The

clinical services provide the diagnostic and curative services.

The ancillary services provide the technical support to the

clinical services, while the domestic and administrative

services provide the direction and overall support to the

clinical and ancillary.

Zoning

The different sections of the hospital can be grouped

according to zone 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


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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.

Flow of Activities

The movement of services in every department and

services of a hospital is a complex one. The Time Saver

Standards provided flow charts for selected hospital services

and departments which will serve as a guide for the

researchers to understand better the movement of patients,

personnel, and visitors.

2. Patient Movement

Patient movement in the hospital should not be restricted,

whether they are on stretchers, their own beds, or wheel chairs.

Spaces should be wide enough for free movement of patient.

Similar conditions should also be considered in designing

corridor and door width. Circulation of patients is very important,

hence, circulation routes for transferring patients from one

area/room should be available and free at all times. With

regards to vertical routes, the use of lifts or ramps are

preferable.

3. Staff Movement

There should be a clear route for staff movement from

outside the hospital going inside the hospital. Several entry

points shall be plotted accordingly, parking area near that entry

point should be available. Staff working area (departments)

should be distributed harmoniously and in balance of hospital


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wide facilities. There should not be any high concentration of

staffs in one area and low concentration in other areas. All

facilities that need a considerable number of staff should be

equipped with staff amenities such as comfort rooms, changing

rooms with lockers and conference/study room when necessary.

4. Supplies Delivery

The hospital should adopt a centralized system for storage

and delivery of medical supplies for better inventory control of

medical supplies. There should be different storage space for

flammable and dangerous materials. Separate storage might be

necessary for engineering supplies such as

electrical/mechanical inventories. With regards to pharmacy

supplies, central pharmacy department may store its supplies in

the central pharmacy department. Satellite pharmacy should

also be constructed in strategic places such as inpatient

department. Delivery of supplies would utilized trolleys and

other mode of transporting materials using hospital’s regular

route/corridor. Entry to facilities should be through alternative

doors, not doors for patients/staffs. Those doors should

accommodate the dimension of trolleys.

5. Disposal of Used Goods

The effective management of health care waste considers

the basic elements of waste minimization, segregation and

proper identification of the waste. Appropriate handling,

treatment and disposal of waste by type reduce costs and do

much to protect public health. Segregation at source should

always be the responsibility of the waste producer. Segregation

should take place as close as possible to where the waste is

generated and should be maintained in storage areas and

during transport.

Segregation is the process of separating different types of

waste at the point of generation and keeping them isolated from


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each other. Appropriate resource recovery and recycling

technique can be applied to each separate waste stream.

Moreover the amount of hazardous waste that need to be

treated will be minimized or reduced subsequently prolonging

the operational life of the disposal facility and may gain benefit

in terms of conservation of resources.

Hazardous waste should be placed in clearly marked

containers that are appropriately labeled for the type and weight

of the waste. Except for sharps and fluids, hazardous wastes

are generally put in plastic bags, plastic lined cardboard boxes,

or leaked proofed containers that meet specific performance

standards.

To improve segregation efficiency and minimize incorrect

use of containers, proper placement and labeling of containers

must be carefully determined. General waste containers placed

beside infectious waste containers could result in better

segregation. Too many hazardous waste containers tend to

inflate waste volume but too few containers may lead to non-

compliance. Minimizing or eliminating the number of hazardous

waste containers in patient care areas (except sharp container,

which should be readily accessible,) may further reduce waste.

Facility management should develop a segregation plan that

includes staff training.

Categories of Health Care Waste

a) General Waste – Comparable to domestic waste, this

type of waste does not pose special handling problem

or hazard to human health or the environment. It

comes mostly from the administrative and

housekeeping functions of health care establishments

and may also include waste generated during

maintenance of health care premises. General waste

should be dealt with by the municipal waste disposal

system.


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b) Infectious Waste – This type of waste is suspected

to contain pathogens (bacteria, viruses, parasites, or

fungi) in sufficient concentration or quantity to cause

disease in susceptible hosts. This includes:

Cultures and stocks of infectious agents from

laboratory work;

Waste from surgery and autopsies on patients with

infectious disease (e.g. tissues, materials or

equipment that have been in contact with blood or

other body fluids);

Waste from infected patients in isolation wards

(e.g. excreta, dressings from infected or surgical

wounds, clothes heavily soiled with in human

blood or other body fluids);

Waste that has been in contact with infected

patients undergoing hemodialysis (e.g. dialysis

equipment such as tubing and filters, disposable

towels, gowns, aprons, gloves and laboratory

coats);

Any other instruments or materials that have been

in contact with infected persons.

c) Pathological Waste - This type of waste contains

tissues, organs, body parts, human fetus, blood and

body fluids. Within this category, recognizable human

body parts are also called anatomical waste. This

category should be considered as a subcategory of

infectious waste, even though it may also include

healthy body parts

d) Sharps – include needles, syringes, scalpels, saw,

blades, broken glass, infusion sets, knives, nails, and

any other items that can cause a cut or puncture

wounds. Whether or not they are infected, such items

are usually considered as highly hazardous health

care waste


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e) Pharmaceutical Waste – includes expired, unused,

spilt, and contaminated pharmaceutical products,

drugs or vaccines, and sera that are no longer

required and need to be disposed of appropriately.

This category also includes discarded items used in

handling of pharmaceuticals such as bottles or boxes

with residues, gloves, masks, connecting tubing and

drug vials.

f) Genotoxic Waste – May include certain cytostatic

drugs, vomit, urine or feces from patients treated with

cytostatic drugs, chemicals and radioactive materials.

This type of waste is highly hazardous and may have

mutagenic, teratogenic, or carcinogenic properties

g) Chemical Waste – Consists of discarded solid, liquid

and gaseous chemicals, for example from diagnostic

and experimental work and from cleaning,

housekeeping, and disinfecting procedures. Chemical

waste from health care may be hazardous or non-

hazardous

Chemical waste is considered hazardous if it has at

least one of the following properties

Toxic

Corrosive

Flammable

Reactive (explosive, water-reactive, shock-

sensitive)

Genotoxic (e.g. cytostatic drugs)

Non-hazardous chemical waste consists of chemicals

with none of the above properties such as sugars,

amino acids, and certain organic and inorganic salts.

h) Waste with high content of heavy metals –

represent a subcategory of hazardous chemical

waste, and are usually highly toxic. Mercury wastes

are typically generated by spillage from broken clinical


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equipment (thermometers, blood pressure gauges,

etc). Whenever possible, spilled drops of mercury

should be recovered. Residues from dentistry have

high mercury content. Cadmium waste comes mainly

from discarded batteries. Certain “reinforced wood

panels” containing lead is still being used in radiation

proofing of X-ray and diagnostic departments. A

number of drugs contain arsenic but these are treated

here as pharmaceutical waste.

i) Pressurized Containers – many types of gas are

used in health care and are often stored in

pressurized cylinders, cartridges, and aerosol cans.

Many of these, once empty or of no further use

(although they may still contain residues), are

reusable, but certain types notably aerosol cans, must

be disposed of. Whether inert or potentially harmful;

gases in pressurized containers should always be

handled with care; containers may explode if

incinerated or accidentally punctured.

j) Radioactive Waste – includes disused sealed

radiation sources, liquid and gaseous materials

contaminated with radioactivity, excreta of patients

who underwent radionuclide diagnostic and

therapeutic applications, paper cups, straws, needles

and syringes, test tubes, and tap water washings of

paraphernalia.

Color Coding Scheme for Health Care Waste

The most appropriate way of identifying the categories of

health care waste is by sorting the waste into color-coded

plastic bags or containers. Recommended color-coding scheme

for health care waste is shown in the table below:


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Waste Storage

All health care waste should be collected and stored in

waste storage until transported to a designated off-site

treatment facility. This area shall be marked with warning sign:

“CAUTION: BIOHAZARDOUS WASTE STORAGE AREA –

UNAUTHORIZED PERSONS KEEP OUT.”

Storage areas for health care waste should be located within

the establishment or research facility. However, these areas

should be located away from patient rooms, laboratories,

hospital function/operation rooms or any public access areas.

The waste in bags or containers should be stored in a separate

area, room or building of a size appropriate to the quantities of

waste produced and the frequency of collection. In cases where

the health care facility lacks the space, daily collection and

disposal should be enforced.

Cytotoxic waste should be stored separately from other

waste in a designated secured location. Radioactive waste

should be stored separately in containers that prevent

dispersion, and if necessary behind lead shielding. Waste that

is to be stored during radioactive decay should be labeled with

the type or radionuclide, the date, and details of required

storage conditions. Storage facility for radioactive waste must

bear the sign “Radioactive Waste” placed conspicuously.

Methods of treatment and disposal of radioactive waste shall

conform to the requirements and guidelines of the PNRI.

During “storage for decay”, radioactive waste should be

separated according to the length of time needed for storage,

for example, short-term storage (half-lives less than 30 days)


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and long-term storage (half-lives from 30 to 65 days). Low level

radioactive waste should be stored for a minimum of ten times

the half-life of the longest-lived radionuclides in the container

and until radioactivity decays to background levels as

confirmed by radiation survey.

Requirements for Storage Facilities

The storage area should have an impermeable, hard-

standing floor with good drainage; it should be easy to

clean and disinfect.

There should be water supply for cleaning purposes.

The storage area should allow easy access for staff in

charge of handling the waste.

It should be possible to lock the storage area to

prevent access of unauthorized persons.

Easy access for waste collection vehicle is essential.

There should be protection from sun, rain, strong

winds, floods, etc.

The storage area should be inaccessible to animals,

insects and birds.

There should be good lighting and adequate

ventialtion.

The storage area should not be situated in the

proximity of fresh food stores or food preparation

areas.

A supply of cleaning equipment, protective clothing,

and waste bags or containers should be located

conveniently close to the storage area.

Floors, walls and ceilings of the storage must be kept

clean in accordance to established procedures, which

at a minimum should include daily cleaning of floors.

Biodegradable general and hazardous waste should

not be stored longer than 2 days to minimize microbial

growth, putrefaction, and odors. If the waste must be

stored longer than 2 days, application of treatment


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like chemical disinfection or refrigiration at 4 degrees

Celsius or lower is recommended.

SEWAGE TREATMENT PLANT

Sewage treatment is the process of removing

contaminants from wastewater, including household sewage

and runoff (effluents). It includes physical, chemical, and

biological processes to remove physical, chemical and

biological contaminants. Its objective is to produce an

environmentally safe fluid waste stream (or treated effluent)

and a solid waste (or treated sludge) suitable for disposal or

reuse (usually farm fertilizer).

Sewage collection and treatment is typically subject to

local, state and federal regulations and standards. Industrial

sources of sewage often require specialized treatment

processes.

Sewage treatment generally involves three stages,

called primary, secondary and tertiary treatment.

Primary treatment consists of temporarily holding the

sewage in a quiescent basin where heavy solids can

settle to the bottom while oil, grease and lighter solids

float to the surface. The settled and floating materials are

removed and the remaining liquid may be discharged or

subjected to secondary treatment.

Secondary treatment removes dissolved and

suspended biological matter. Secondary treatment is

typically performed by indigenous, water-borne micro-

organisms in a managed habitat. Secondary treatment

may require a separation process to remove the micro-

organisms from the treated water prior to discharge or

tertiary treatment.

Tertiary treatment is sometimes defined as anything

more than primary and secondary treatment in order to

allow rejection into a highly sensitive or fragile

ecosystem (estuaries, low-flow rivers, coral reefs).


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Treated water is sometimes disinfected chemically or

physically (for example, by lagoons and microfiltration)

prior to discharge into a stream, river, bay, lagoon or

wetland, or it can be used for the irrigation of a golf

course, green way or park. If it is sufficiently clean, it can

also be used for ground water recharge or agricultural

purposed.

6. Laundry Service

Laundry service needs to be centralized with the advantage

in terms of economy of building and operation. The first principle

to observe in the laundry arrangement is that dirty and clean

linen should be kept entirely separate, both in the laundry or

linen room and at the points of use. The design, equipment and

management of the laundry itself are matters to be highly

considered. The clean linen will go to a ‘clean’ section of the

linen room for sorting and return to the point of use. Under the

centralized stores and supplies system advocated elsewhere,

the various units and departments of the hospital do not

themselves maintain stocks of linen. This stock is the

responsibility of the central linen or stores department while

subsequently collects the used materials, removes trolley and

replaces all the items used.

7. Food Service

The total number of staff in a modern hospital is roughly

equal to the number of beds, so the number of meals served to

staff would be at least equal to that served to patients. It is best

to centralize catering service. The standard of hygiene in the

hospital kitchen must be maintained at very high level. Each

ward receives two trolleys from the central kitchen, one

containing the food, and the other containing clean plates and

eating utensils. Central washing is likewise recommended. The

removal of washing up from the ward also reduces noise and


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nuisance to patients, and the number of persons who have to

work in the wards.

8. Domestic Service

Centralized domestic service is preferable for the hospital.

The most obvious advantage is better control of linen and

cleaning equipment, domestic service staff/housekeepers.

Housekeeping and domestic service areas should be grouped

around a service yard, laundry, kitchen, housekeeping,

maintenance, storage and motor pool. Workshops are needed

for the maintenance staff to look after the building and

equipment for storage space. It is practicable to site the

mortuary so that it is easily accessible in the department of

pathology, so that specimens removed at autopsy could be

readily conveyed for examination to the laboratories of morbid

anatomy and histology.

9. Security

The number of entrances and exits are often the concern of

the security unit of the administrative office the hospital. The

circulation routes in a hospital consist of external and internal

routes. External routes are discussed in the previous sections.

Internal traffic streams link departments. Some important

guidelines are as follows:

Corridor size in relation to traffic intensity

Corridor size in relation to maneuverability

Vertical circulation

10. Engineering Service

About a third of the cost of hospital building goes into the

mechanical engineering services, heating and ventilation,

electricity, lifts and communications. These services for the

circulation and nervous systems, without which, the hospital

cannot function. The mechanical services must be planned so


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that easy access can be obtained to all equipment for repairs

and maintenance without the disruption of the daily functions of

the hospital.

II. SPACE PROGRAMMING

The space requirements provided below are based on the

Manual on Technical Guidelines for Hospitals and Health Facilities

Planning and Design.

The researcher provided a tabulation showing the users and

number of personnel who will use the spaces, the space

requirements, the minimum areas, and lastly the derived or actual

areas for the overall building and facility.

Table 3. Space Requirements


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ORGANIZATIONAL CHART


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NURSING PERSONNEL REQUIREMENTS

Staffing

Staffing is the process of determining and providing

acceptable number and mix of nursing personnel to produce a

desired level of care to meet the patients’ demand.

The Hospital Nursing Service Administration Manual of the

Department of Health has recommended the following nursing care

hours for patients in the various nursing units of the hospital.

Cases/Patients NCH/Patient/DayProf. to Non-Prof.

Ratio

General Medicine 3.5 60:40

Medical 3.4 60:40

Surgical 3.4 60:40

Obstetrics 3.0 60:40

Pediatrics 4.6 70:30

Pathologic Nursery 2.8 55:45

ER/ICU/RR 6.0 70:30

Table 4. Nursing Care Hours for patients in the various units of the hospital

Patient Care Classification System

The patient care classification system is a method of

grouping patients according to the amount and complexity of their

nursing care requirements and the nursing time and skill they

require (Helberg, J., Nursing Management p. 989).

Patient care classifications have been developed primarily

for medical, surgical, pediatrics, and obstetrical patients in acute

care facilities.

Classification Categories

Level I – Self Care or Minimal Care – Patient can take a

bath on his own, feed himself, feed and perform his activities of

daily living. Falling under this category are patients about to be

discharged, those in non-emergency, those newly admitted, do not


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exhibit unusual symptoms, and requires little treatment/observation

and/or instruction.

Level II – Moderate Care or Intermediate Care – Patients

under this level need some assistance in bathing, feeding, or

ambulating for short periods of time. Extreme symptoms of their

illness must have subsided or have not yet appeared. Patients may

have slight emotional needs, with vital signs ordered up to three

times per shift, intravenous fluids or blood transfusion; are semi-

conscious and exhibiting some psychosocial or social problems;

periodic treatments, and/or observations and/or instructions.

Level III – Total, Complete or Intensive Care – Patients

under this category are completely dependent upon the nursing

personnel. They are provided complete bath, are fed, may or may

not be unconscious, with marked emotional needs, with vital signs

more than three times per shift, may be on continuous oxygen

therapy, and with chest or abdominal tubes. They require close

observation at least every 30 minutes for impending haemorrhage,

with hypo or hypertension and/or cardiac arrhythmia.

Level IV – Highly Specialized Critical Care – Patients

under this level need maximum nursing care. Patients need

continuous treatment and observation; with many medications, IV

piggy backs; vital signs every 15-30 minutes; hourly output. There

are significant changes in doctor’s orders and care hours per

patient per day may range from 6-9 or more.

Levels of CareNCH

Needed/Patient/Day

Ratio of Prof. to

Non-Prof.

Level I – Self Care or

Minimal Care1.50 55:45

Level II - Moderate

or Intermediate Care3.0 60:40

Level III – Total or

Intensive Care4.5 65:35


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Level IV – Highly

Specialized or

Critical Care

6.0

7.0 or higher

70:30

80:20

Table 5. Categories or levels of care of patients, nursing care hours

needed per patient per day and ratio of professionals to non-

professionals

Percentage of Nursing Care Hours

The percentage of nursing care hours at each level of care

also depends on the setting in which care is being given.

Percentage of Patients in Various Levels of Care

Type of

Hospital

Minimal

Care

Moderate

Care

Intensive

Care

Highly

Special

Care

Primary

Hospital70 25 5 -

Secondary

Hospital 65 30 5 -

Tertiary

Hospital30 45 15 10

Special

Tertiary

Hospital

10 25 45 20

Table 6. Percentage of patients at various levels of care per type of

hospital

Computing for the Number of Nursing Personnel Needed

When computing for the number of nursing personnel in the

various nursing units of the hospitals, one should ensure that there

is sufficient staff to cover all shifts, off-duties, holidays, leaves,

absences, and time for staff development programs.

Staffing Formula

To compute for the staff needed in the In-Patient unit of the

hospital having 25 patients, the following steps are considered:

1. Categorize the patients according to levels of care needed.

25 x 0.65 = 16.25 or 17 patients need minimal care


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25 x 0.30 = 7.5 or 8 patients need moderate care

25 x 0.05 = 1.25 or 2 patients need intensive care

2. Find the number of nursing care hours (NCH) needed by

patients at each level of care per day.

17 x 1.5 (NCH at Level I) = 25.5 26 NCH/day

8 x 3 (NCH at Level II) = 24 NCH/day

2 x 4.5 (NCH at Level III) = 9 NCH/day

Total 59 NCH/day

3. Find the total NCH needed by 25 patients per year.

59 x 365 (days/year) = 21,535 NCH/year

4. Find the actual working hours rendered by each nursing

personnel per year.

8 (hrs. /day) x 213 (working days/year) = 1, 704 working

hours/year

5. Find the total number of nursing personnel needed.

Total NCH/year = 21,535

Working hrs. /year 1, 704

Answer = 12.6 or 13

Relief x Total Nursing Personnel = 13 X 0.15 = 1.95 or 2

Total Nursing Personnel needed = 13 + 2 = 15

6. Categorize to professional and non-professional personnel.

Ratio of professionals to non-professionals in a secondary

hospital is 60:40.

15 x 0.60 = 9 professional nurses

15 x 0.40 = 6 nursing attendants

7. Distribute by shifts.

9 nurses x 0.45 = 4.05 or 4 nurses on AM shift

9 nurses x 0.37 = 3.33 or 3 nurses on PM shift


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9 nurses x 0.18 = 1.62 o 2 nurses on night shift

a. Total = 9 nurses

6 nursing attendants x 0.45 = 2.7 or 3 NA on AM shift

6 nursing attendants x 0.37 = 2.22 or 2 NA on PM shift

6 nursing attendants x 0.18 = 1.08 or 1 NA on night shift

b. Total = 6 Nursing Attendants

STAFFING PATTERN

The researcher provided tabulation for the identification of

the minimum number of personnel. The ratio and the fixed numbers

in the tabulation are indicated in the standard requirements for the

Licensing of a Level 1 Hospital. Actual numbers may vary

depending on the hospital administration.

PersonnelRatio/

Required Number

Actual

Number

Administrative Service

Chief of Hospital 1 1

Administrative Officer 1 1

Clerk (Pool) 1:50 beds 1

Bookkeeper 1 1

Billing Officer 1 1

Cashier 1 1

Medical Records

Officer1 1

Medical Records Clerk 1:75 beds 1

Supply Officer 1 1

Storekeeper 1 1

Laundry Worker 1:50 beds 1

Utility Worker a.m. shift = 1:75 beds 1


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p.m. shift = 1:75 beds 1

night shift = 1 1

Security Guard 1/shift 3

Maintenance

Personnel1/shift 3

Driver 1/shift 3

Nutritionist/Dietician 1 1

Cook 1:100 beds 1

Food Service

Supervisor1 1

Food Service Worker 1:50 beds 1

Medical Social Worker 1 1

Clinical Service

Chief of Clinics 1 1

Physician 50 beds & below = 6 6

every additional 50 beds

= additional 2

Dentist 1 1

Dental Aide 1 1

Nursing Service

Chief Nurse 1 1

Supervising Nurse

50 beds & below = 1

151 – 100 beds = 2

101 – 150 beds = 3

151 beds & above = 4

Head Nurse 1:15 staff nurses 1

Staff Nurse 1:12 beds at any time 3

* for every three (3) nurses, there must be one (1)

reliever1

Nursing

Attendant/Midwife

1:24 beds at any time 2

Table 7. Number of required personnel


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FIRE PROTECTION

Fire Safety Principles must be observed which are:

Fire Avoidance – reduction of the possibility of accidental

ignition of materials or separation of heat source from

inflammable materials.

Fire Control – firefighting equipment such as fire hose and

fire extinguishers must be easily visible and accessible for

immediate use.

ENVIRONMENTAL DESIGN REQUIREMENTS

Vegetation – serves also the landscaping using deciduous

trees to control sun and shapes.

Building Materials – open interior and higher ceiling

encourage ventilation and cooler temperature.

Orientation – the orientation of a building is the relationship

to its environments.

Safe from flooding, landslide, erosion and other

environmental hazards.

Possibilities for sewage disposal.

Soil must have a good value as foundation materials.

HOSPITAL SAFETY INDICATORS

A hospital should not only focus on the aesthetic side. It

should also be structurally sound to avoid further harm to the

occupants and to withstand natural forces. The following selected

structural indicators can serve as a checklist to identify strengths

and vulnerabilities in the planning for a new construction of hospital

and other related health facilities.

Buildings must be located in highly suitable sites and away

from areas that will diminish its accessibility and threaten its

operations in times of emergencies.

The design of the hospital structural system must strictly

conform to the requirements of the National Structural Code


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of the Philippines (NSCP, 2001); especially for wind and

earthquake design.

The shape and form of the hospital building must be simple

and regular.

Non-structural Indicators should also be given emphasis on the

planning aspect of the hospital. The non-structural elements are

those without forming part of the resistance systems, but those

enabling the facility to operate. Nearly 80% of the hospital cost is

made up of the non-structural elements (WHO, 2008).

The following specifications should be properly observed:

1. Safety of Ceilings:

Ceilings made of wood are coated/treated with fire

retardant paints and termite- controlled.

2. Safety of Doors and Entrances:

Double swing – main doors, ER / OR / DR / ICU /

Nursery / Radiology/ patients’ rooms, Dietary, kitchen,

laundry, linen and other support areas

Swing-out – toilets and exit doors

Smoke partition doors located along hallways and

corridors should be double swing, per groups of

rooms/section, for compartmentation.

With manual door closer - Operating Room (OR),

Intensive Care Unit (ICU), Recovery Room (OR),

Delivery Room (DR), Labor Room (LR), Isolation Rooms

(IR) and other sterile areas.

A door designed to be kept normally closed as a means

of egress, such as a door to a stair or horizontal exit,

provided with a reliable self –closing mechanism, and

shall not at any time be secured in the open position. A

door designed to be kept normally closed shall bear a

sign as follows: FIRE EXIT, KEEP DOOR CLOSED


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3. Safety of Windows and Shutters

Windows have wind and sun protection devices (e.g. sun

baffles).

Window grilles to secure the safety of the patient,

provided with fire exit opening.

All glass panels or windows are made of tempered glass

or with appropriate thickness or provided with protective

films.

4. Safety of Walls. Divisions, and Partitions

Exterior walls meet the fire resistance rating of 2 hours.

Interior walls made of fire-resistive materials and from

floor to floor.

5. Fire Suppression Systems

Alarm system is a combination of automatic and manual

system.

Heat and Smoke Detection installed in all areas.

Smoke detectors must be spaced not further apart than

nine meters on center and more than four and six-tenths

(4.6) from any wall

This chapter also consist program development which includes

three developmental programs namely – Site, Building

Development and Technology and Program for Building

Technology; to be attained.

a) SITE

Site Preservation

The agricultural land surrounding the site is not be abolished

nor destroyed for it could be helpful in the balance of ecology and

maintaining green environment. It shall only be preserved and

restored.


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Site Improvement

a) Putting up a better ambiance in the site such as

landscaping for aesthetic purposes and natural

temperature.

b) To lessen hazards, walkways, parking spaces and areas

and pedestrian lanes shall be incorporated within the site;

the same must go for persons with disabilities.

c) Lightings must be improved inside the building, outside

the institution and within the premises of the hospitals.

d) Recreational facilities shall be made to terminate

boredom among patients.

e) For accessible and feasible movements, there must be

the development of emergency walkways like ramps,

steps, exit, entrance and separate roadways for

ambulance.

Site Protection

The proposal would be taking up the typical protection

scheme for institutions like this which is walls and fences that

ensure security and peace all over the site. Also, perimeter fences

shall be built along the parcel of lot where the building rises and the

same goes with plants and vines; the use of gates would also be

very helpful.

Landscape

Preserved vegetation within the site can be used as natural

barricades.

a) BUILDING DEVELOPMENT

The hospital’s architectural characteristics shall be redeveloped

to a relaxed atmosphere while reducing the sensory stimulating

elements inside it; design a building character considering

maintenance, strength, functionality and appropriation and green

architectural concepts that connive with the site’s climate and

surrounding.


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a) Controlling Microclimate

Ventilation - The building shall incorporate the use of natural

ventilation to reduce electric consummation through green

environment, proper arrangement of windows and openings.

b) Saving Energy

Illumination - Also to be included in the design concept of

redevelopment s the use of wide windows to allow natural lighting

with renewable source as the sun, not only it could save energy but

it will improve environment comfort.

c) Waste Management

The municipality is now implementing zero plastic use all

over its barangays so the site must follow the ordinance in

accordance with the building redevelopment; years also passed

that this town implemented proper waste segregation system.

Pharmaceutical wastes such as expired medicines shall be

disposed either by pulverization and disposing by burying method

or into sink. Incombustibles will be buried after incineration. The

degradable ones shall undergo aerobic composting, while

incineration shall be applied for non-degradable.

All exterior storage; trash collection dumpsters, trash pads,

disposal areas shall be located and oriented.

b) PROGRAM FOR BUILDING TECHNOLOGY

a) Foundation

The building’s foundation shall be in accordance with the soil

and building type. Spread footing though will be applied since the

site has fine sandy clay loam, for a strong and safe architectural

building.

b) Columns and Beams

The site is prone to earthquake, strong winds and flashfloods;

with these natural forces, the building frame shall have long spans

which will rigidly form the building to resists these occurrences

c) Acoustic


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Acoustical tiles, sound insulators, natural buffers and acoustical

materials and treatments shall be provided to control intensity and

excessive sounds, improve hearing conditions, comfort and

convenience.

d) Electric Supply

Power supply of the hospital and around the site shall be on the

SORECO which also provides electricity for the Province. Also, the

use of solar panels will be utilized to maximize energy efficiency.

e) Water Supply

Potable, safe and adequate drinking, irrigation and cleaning

waters shall be provided by the local water supply system, Bulan

Water District.

f) Utilities

For hygiene purposes, septic tanks shall be built to receive

the discharge of wastes which shall reduce organic and bacterial

content. The use of solid waste facilities is important as well as the

proper and efficient collection, storage and disposal of solid wastes

generated shall be also provided.

g) Fire Alarm

Use of materials for prevention of fires such as liquids and

asbestos shall be provided. Fire Alarms, smoke detectors, sprinkler

systems, house boxes and fire extinguishers shall be installed

inside and outside the building. Fire exits and fire prevention shall

be easy and accessible at any time and place. Also, fire safety

plans shall be installed in every wall.

h) Walls and Partition

Interior – To use the materials appropriate for the function of

each area in terms of stability and flexibility.

Exterior – to adopt the appropriate materials for walls that will

protect the interior of the structure from different elements as well

as present an attractive exterior appearance.

Alternatives: plasterboards, concrete, plywood


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Materials shall be adapted in the basis of availability, ease of

application, maintenance and aesthetic quality.

It should facilitate efficient sun control and ventilation to

minimize use of air-conditioner.

Paints will be used to cover unsightly surfaces, for aesthetics,

and to prevent moisture absorption, to act as vapor barrier and to

provide a washable are of infection control.

Smooth form or plain groove finish shall be applied depending

upon the nature of the building, painted with light color schemes for

a relax atmosphere. (Interior surfaces)

Finishes must be applied to material that are properly cured and

dried. Concrete and other surfaces should be tested with a

moisture meter before being painted. To avoid subsequent

deterioration, avoid using epoxy paints unless proper application

techniques are guaranteed to be nearly perfect. Colorless sealers

are usually more effective but must be applied over well-cured,

thoroughly dry concrete that has not been previously painted.

i) Roofing

To provide roofing materials based on quality, wind

resistance and appearance criteria.

A number of rooting materials are available: shingles of all

kind, wooden shakes, clay roofing tile, cement roofing tile, slate,

sheet metal, asphalt roofing, glass and plastics.

Plastic is the most appropriate material for curve roofing.

Reflective roofing or coatings help send the heat back into the sky

than into the building.

j) Ceiling System

Ceiling function not just an attractive overhead surface but

also as a primary sound absorption surface containing lightning

fixtures, concealing utility services and an outlet for heated and air

conditioned air.

Use of acoustic ceiling panels and tiles that are non-

combustible and light weight to be observed.

Documents

arena Chapter v (Final)