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LITERATURE REVIEW
The review includes related works, legal standards, technical
principles, guidelines for planning and design, facilities and
development.
RELATED LITERATURE
LOCAL
NAGA CITY HOSPITAL (NCH)
Naga City Hospital is under the leadership of Chief of
Hospital Dr. Luningning Luciano.
The NCH which is a primary hospital is operated and funded
by the city government. General Medicine, Pediatrics, Obstetrics
and Minor Surger y are the services rendered by NCH’s doctors.
Drugs are also distributed to the patients with prescriptions from
other hospitals and free medicine is given to patients whenever
available.
In relation to study:
To be a functional hospital, it must consider and render the
proper flow of services, time management and the personnel’s
availability for the health services.
CAGRARAY DISTRICT HOSPITAL – Cabasan, Bacacay,
Albay
Cagraray District Hospital is a 25-bed Level 2 (two) district
hospital in Bacacay. It is owned and classified as government
structure. The personnel involved are the following. From the
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administrative services: administration officer, cashier, storekeeper,
security guard. From medical and nursing services: the staff
nurses, nursing aide and the doctor. While from the ancillary
services: the medical technologist, radiologic technologist,
nutritionist, dietician and cook are involved. It caters people from
different barangays of Cagraray Islands. They hold a maximum
number of 10 for in-patients and 11 for out-patients (OPD) per day.
It offers services like minor surgery, OPD, and general medicine.
Formerly, they render laboratory services and examination but due
to absence of experiencing and undertaking.
In relation to study:
The present but inoperative laboratories due to lack of
personnel to this hospital is the main concern of the proponents
study. In every hospital it should be functional in terms of
laboratory services and be able to inculcate the importance of
laboratory facilities in the community for the proposed hospital.
FOREIGN
EASTAR EAST CAMPUS – Muskogee, Oklahoma
The 45-bed Eastar East Campus, formerly Muskogee
Community Hospital, opened in 2009. It was one of the first few
hospitals in the world to attain LEED Gold certification, and it was
the first hospital in the United States to earn the Environmental
Protection Agency's Energy Star for "superior energy performance."
Survey data for the latest year available shows that 9,756 patients
visited the hospital's emergency room. The hospital had a total of
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1,694 admissions. Its physicians performed 738 inpatient and 4,068
outpatient surgeries.
In relation to study:
The Environmental Protection Agency said the hospital's
lower energy usage cuts carbon emissions by 24 percent every
year, making it "a leading hospital in the fight against climate
change."
Eastar East Campus employs several green measures,
including workspaces that maximize daylight and native plants
which the proponent will adapt to her study
LAGUNA HONDA HOSPITAL – San Francisco, California
California’s first green-certified hospital, Laguna Honda, is
designed to promote recovery in a healthy environment that fosters
community. The hospital's LEED Silver rating offers a number of
services and amenities not typically found in most hospitals,
including a hair salon, a multi-media library with a fireplace, a state-
of-the-art multi-media library and outdoor gardens with raised
planting beds for growing vegetables and flowers. The hospital was
developed through a joint venture between architecture
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firms Anshen + Allen and Stantec Architects, and is comprised of
two residential towers, and a four-story central building. All of the
buildings open onto a central park, which is home to the Laguna
Honda animal therapy center.
(Laguna Honda, California’s First LEED Certified Hospital |
Inhabitat - Sustainable Design Innovation, Eco Architecture, Green
Building)
In relation to study:
The hospital’s three new buildings address environmental
impacts in their design, construction and operation across six
LEED-designated categories: sustainable sites, water efficiency,
energy and atmosphere, materials and resources, indoor
environmental quality, and innovation and design process.
Each resident room has its own large operable window.
Open windows allow gentle breezes and fresh air into the building,
creating comfortable rooms without raising energy consumption.
The operable windows also help residents to control their
own environment.
Ninety percent of the regularly occupied interior spaces have
windows and views to the outdoors, bringing in sunlight and
enhancing therapeutic benefits.
REVIEW OF CODES
GUIDELINES IN PLANNING AND DESIGN OF A HOSPITAL
AND OTHER RELA TED HEALTH FACILITIES
A hospital and other health facilities shall be planned and
designed to observe appropriate architectural practices, to meet
prescribed functional programs, and to conform to applicable codes
as part of normal professional practice.
1. Environment : A hospital and other health facilities shall be so
located that it is readily accessible to the community and
reasonably free from undue noise, smoke, dust, foul odor,
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flood, and shall not be located adjacent to railroads, freight
yards, children’s playgrounds, airports, industrial plants,
disposal plants.
2. Occupancy : A building designed for other purpose shall not
be converted into a hospital. The location of a hospital shall
comply with all local zoning ordinances.
3. Safety : A hospital and other health facilities shall provide and
maintain a safe environment for patients, personnel and
public. The building shall be of such construction so that no
hazards to the life and safety of patients, personnel and
public exist. It shall be capable of withstanding weight and
elements to which they may be subjected.
3.1 Exits shall be restricted to the following types:
door leading directly outside the building, interior
stair, ramp, and exterior stair.
3.2 A minimum of two (2) exits, remote from each
other, shall be provided for each floor of the
building.
3.3 Exits shall terminate directly at an open space to
the outside of the building.
4. Security : A hospital and other health facilities shall ensure
the security of person and property within the facility.
5. Patient Movement : Spaces shall be wide enough for free
movement of patients, whether they are on beds, stretchers,
or wheelchairs. Circulation routes for transferring patients
from one area to another shall be available and free at all
times.
5.1 Corridors for access by patient and equipment
shall have a minimum width of 2.44 meters.
5.2 Corridors in areas not commonly used for bed,
stretcher and equipment transport may be
reduced in width to 1.83 meters.
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5.3 A ramp or elevator shall be provided for ancillary,
clinical and nursing areas located on the upper
floor.
5.4 A ramp shall be provided as access to the
entrance of the hospital not on the same level of
the site.
6. Lighting : All areas in a hospital and other health facilities
shall be provided with sufficient illumination to promote
comfort, healing and recovery of patients and to enable
personnel in the performance of work.
7. Ventilation: Adequate ventilation shall be provided to ensure
comfort of patients, personnel and public.
8. Auditory and Visual Privacy : A hospital and other health
facilities shall observe acceptable sound level and adequate
visual seclusion to achieve the acoustical and privacy
requirements in designated areas allowing the unhampered
conduct of activities.
9. Water Supply : A hospital and other health facilities shall use
an approved public water supply system whenever available.
The water supply shall be potable, safe for drinking and
adequate, and shall be brought into the building free of cross
connections.
10.Waste Disposal : Liquid waste shall be discharged into an
approved public sewerage system whenever available, and
solid waste shall be collected, treated and disposed of in
accordance with applicable codes, laws or ordinances.
11.Sanitation: Utilities for the maintenance of sanitary system,
including approved water supply and sewerage system, shall
be provided through the buildings and premises to ensure a
clean and healthy environment.
12.Housekeeping : A hospital and other health facilities shall
provide and maintain a healthy and aesthetic environment
for patients, personnel and public.
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13.Maintenance: There shall be an effective building
maintenance program in place. The buildings and equipment
shall be kept in a state of good repair. Proper maintenance
shall be provided to prevent untimely breakdown of buildings
and equipment.
14.Material Specification: Floors, walls and ceilings shall be of
sturdy materials that shall allow durability, ease of cleaning
and fire resistance.
15.Segregation: Wards shall observe segregation of sexes.
Separate toilet shall be maintained for patients and
personnel, male and female, with a ratio of one (1) toilet for
every eight (8) patients or personnel.
16.Fire Protection: There shall be measures for detecting fire
such as fire alarms in walls, peepholes in doors or smoke
detectors in ceilings. There shall be devices for quenching
fire such as fire extinguishers or fire hoses that are easily
visible and accessible in strategic areas.
17.Signage: There shall be an effective graphic system
composed of a number of individual visual aids and devices
arranged to provide information, orientation, direction,
identification, prohibition, warning and official notice
considered essential to the optimum operation of a hospital
and other health facilities.
18.Parking : A hospital and other health facilities shall provide a
minimum of one (1) parking space for every twenty-five (25)
beds.
19.Zoning : The different areas of a hospital shall be grouped
according to zones as follows:
19.1 Outer Zone – areas that are immediately
accessible to the public: emergency service,
outpatient service, and administrative service.
They shall be located near the entrance of the
hospital.
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19.2 Second Zone – areas that receive workload
from the outer zone: laboratory, pharmacy, and
radiology. They shall be located near the outer
zone.
19.3 Inner Zone – areas that provide nursing care
and management of patients: nursing service.
They shall be located in private areas but
accessible to guests.
19.4 Deep Zone – areas that require asepsis to
perform the prescribed services: surgical service,
delivery service, nursery, and intensive care.
They shall be segregated from the public areas
but accessible to the outer, second and inner
zones.
19.5 Service Zone – areas that provide support to
hospital activities: dietary service, housekeeping
service, maintenance and motor pool service,
and mortuary. They shall be located in areas
away from normal traffic.
20.Function: The different areas of a hospital shall be
functionally related with each other.
20.1 The emergency service shall be located in the
ground floor to ensure immediate access. A
separate entrance to the emergency room shall
be provided.
20.2 The administrative service, particularly
admitting office and business office, shall be
located near the main entrance of the hospital.
Offices for hospital management can be located
in private areas.
20.3 The surgical service shall be located and
arranged to prevent non-related traffic. The
operating room shall be as remote as practicable
from the entrance to provide asepsis. The
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dressing room shall be located to avoid exposure
to dirty areas after changing to surgical garments.
The nurse station shall be located to permit visual
observation of patient movement.
20.4 The delivery service shall be located and
arranged to prevent non-related traffic. The
delivery room shall be as remote as practicable
from the entrance to provide asepsis. The
dressing room shall be located to avoid exposure
to dirty areas after changing to surgical garments.
The nurse station shall be located to permit visual
observation of patient movement. The nursery
shall be separate but immediately accessible
from the delivery room.
20.5 The nursing service shall be segregated from
public areas. The nurse station shall be located to
permit visual observation of patients. Nurse
station shall be provided in all inpatient units of
the hospital with a ratio of at least one (1) nurse
station for every thirty-five (35) beds. Rooms and
wards shall be of sufficient size to allow for work
flow and patient movement. Toilets shall be
immediately accessible from rooms and wards.
20.6 The dietary service shall be away from morgue
with at least 25-meter distance.
21.Space: Adequate area shall be provided for the people,
activity, furniture, equipment and utility.
ACCESSIBILITY LAW (B.P. 344)
The Accessibility Law provides minimum requirements for
accessibility.
A. Outside and Around Buildings
1. Dropped Curbs
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a) Changes in level at walkways should be effected by
slight ramps and dropped curbs;
b) Dropped curbs should be provided at pedestrian
crossings and at the end of footpaths of a private street
or access road;
c) Dropped curbs at crossings should have a length
corresponding to the width of the crossing; otherwise,
the minimum width should be 0.90 m.
d) Dropped curbs shall be ramped towards adjoining curbs
with a gradient not more than 1:12;
e) Dropped curbs shall be sloped towards the road with a
maximum cross gradient of 1:20 to prevent water from
collecting at the walkway;
f) The lowest point of a dropped curb not exceed 25 mm
height above the road or gutter.
2. Curb Cut-Outs
a) Curb cut-outs should only be allowed when it will
not obstruct a walkway or in any way lessen the
width of a walkway;
b) The minimum width of a curb cut-out should be
0.90m;
c) Curb cut-outs should not have a gradient not more
than 1:12;
3. Walkways
a.) Walkways should be kept as level as possible
and provided with slip-resistant material;
b.) Whenever and wherever possible, walkways
should have a gradient not more than 1:20 or
5%
c.) Walkways should have a maximum cross
gradient of 1:100;
d.) Walkways should have a minimum width of
1.20 meters; 3.5 If possible, gratings should
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never be located along walkways; when
occurring along walkways, gratings openings
should have a maximum dimension of 13mm x
13mm and shall not project more than 6.5mm
above or below the level of the walkway;
e.) Walkways should have a continuing surface
without abrupt pitches in angle or interruptions
by cracks or breaks creating edges above 6.5
mm;
f.) In lengthy or busy walkways, spaces should be
provided at some point along the route so that
a wheelchair may pass another or turn around;
these spaces have a minimum dimension of
1.5 meters and should be spaced at a
maximum distance of 12.00 meters between
stops;
g.) To guide the blind, walkways should as much
as possible follow straight forward routes with
right angle turns;
h.) Where planting is provided adjacent to the
walkway, regular maintenance is essential to
ensure branches of trees or shrubs do not
overhang walkways or paths, as they do not
present a particular danger to the blind, but
they also reduce the effective footway width
available to pedestrian; 3.10 Walkway
headroom should be less than 2.00m and
should preferably be higher;
i.) Passageways for the disabled should not be
obstructed by street furniture, bollards, sign
posts or columns along the defined route, as
they can be hazardous.
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4. Handrails
a) Handrails should be installed at both sides of ramps
and stairs and at the outer edges of dropped curbs at
crossings; handrails should not be installed beyond
the width of any crossing so as not to obstruct
pedestrian flow;
b) Handrails shall be installed at 0.90m and 0.70m
above steps or ramps; handrails for protection at
great heights may be installed at 1.00m to 1.06m;
c) A 0.30m long extension of the handrail should be
provided at the start and end of ramps and stairs;
d) Handrails that require full grip should have a
dimension of 30cm to 50cm;
e) Handrails attached to walls should have a clearance
no less than 50mm from the wall; handrails on ledges
should have a clearance not less than 40mm;
5. Open Spaces
a) Where open spaces are provided, the blind can
become particularly disoriented. Therefore, it is
extremely helpful if any walkway or path can be given
defined edges either by the use of planters with dwarf
walls, or a grass verge, or similar, which provides a
texture different from the path.
B. Parking
1. Parking Areas
a) Parking spaces for the disabled should allow enough
space for a person to transfer to a wheelchair from a
vehicle;
b) Accessible parking space should be located as close
as possible to building entrances or to accessible
entrances;
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c) Whenever and wherever possible, accessible parking
spaces should be perpendicular or at an angle to the
road or circulation aisles;
d) Accessible parking slots should have a minimum
width of 3.70 m;
e) A walkway from accessible spaces of 1.20 m. clear
width shall be provided between the front ends of
parked cars;
f) Provide dropped curbs or curb cut-outs to the parking
level where access walkways are raised;
g) Pavement markings, signs or other means shall be
provided to delineate parking spaces of the
handicapped;
h) Parking spaces for the disabled should never be
located at ramped or sloping areas.
C. Inside Buildings and Structures
1. Entrances
a) At least one entrances to every building should be
accessible from arrival and departure to the interior
lobby;
b) One (1) entrance level should be provided where
elevators are accessible;
c) In case entrances are not on the same level of the
site arrival grade, ramps should be provided as
access to the entrance level;
d) Entrances with vestibules shall be provided a level
area with at least a 1.80 m. depth and a 1.50 m.
width.
2. Ramps
a) Changes in level require a ramp except when served
by a dropped curb, an elevator or other mechanical
device;
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b) Ramps shall have a minimum clear width of 1.20 m;
c) The maximum gradient shall be 1:12;
d) The length of a ramp should not exceed 6.00m. if the
gradient is 1:12; longer ramps whose gradient is 1:12
shall be provided with landings not less than 1.50
e) A level area not less than 1.80 m. should be provided
at the top and bottom of any ramp;
f) Handrails will be provided on both sides of the ramp
at 0.70 m. and 0.90 m. from the ramp level;
g) Ramps shall be equipped with curbs on both sides
with a minimum height or 0.10 m;
h) Any ramp with a rise greater than 0.20 m. and leads
down towards an area where vehicular traffic is
possible, should have railing across the full width of
its lower end, not less than 1.50 meters from the foot
of the ramp.
3. Doors
a) All doors shall have a minimum clear width of 0.80 m;
b) Clear openings shall be measured between the
surface of the fully open door at the hinge and the door
jamb at the stop;
c) Doors should be operable by a pressure or force not
more than 4.0 kg the closing device pressure in interior
door shall not exceed 1 kg;
d) A minimum clear level space of 1.50 m x 1.50 shall be
provided before and extending beyond a door;
EXCEPTION: where a door shall open onto but not
into a corridor, the required clear, level space on the
corridor side of the door may be a minimum of 1.20 m
corridor width;
e) Protection should be provided from doors that swing
into corridors;
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f) Out swinging doors should be provided at storage
rooms, closets and accessible restrooms stalls;
g) Latching or non-latching, hardware should not require
wrist action or fine finger manipulation;
h) Doorknobs and other hardware should be located
between 0.82m. and fine finger manipulation;
i) Doorknobs and other hardware should be located
between 0.82m. and 106 m. above the floor; 0.90 is
preferred;
j) Doors along major circulation routes should be
provided with kick plated made of durable material at a
height of 0.30 m to 0.40 m.
4. Corridors
a) Corridors shall have a minimum clear width of 1.20;
waiting areas and other facilities or spaces shall not
obstruct the minimum clearance requirements;
b) Recess or turnabouts spaces should be provided for
wheelchairs to turn around or to enable another
wheelchair to pass; these spaces shall have a
minimum area of 1.50 m x 1.50 m. and shall be
spaced at a maximum of 12.00 m;
c) Turnabout space should also be provided at or within
3.50m. of every dead end;
d) As in walkways, corridors should be maintained level
and provided with a slip-resistant surface.
5. Thresholds
a) Thresholds shall be kept to minimum; whenever
necessary, thresholds and sliding door tracks shall
have a maximum height of 25 mm and preferably
ramped
6. Washrooms & Toilets
a) Accessible public washrooms and toilets shall permit
easy passage of a wheelchair and allow the occupant
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to enter a stall, close the door and transfer to the
water closet from either a frontal or lateral position;
b) Accessible water closets stalls shall have a minimum
area of 1.70 x 1.80mts. One movable grab bar and
one fixed to the adjacent wall shall be installed at the
accessible water closet stall for lateral mounting;
fixed grab bars on both sides of the wall be installed
for stalls for frontal mounting;
c) A turning space of 2.25 sq. m. with a minimum
dimension of 1.50 m. for wheelchairs shall be
provided outside water close stall;
d) All accessible public toilets shall have accessories
such as mirrors, paper dispensers, towel racks, and
fittings such as faucets mounted at heights
reachable by a person in a wheelchair;
e) The minimum number of accessible water closets on
each floor level or on that part of a floor level
accessible to the disabled shall be one (1) where the
total number of water closets per sex on that level is
20; and two (2) where the number of water closets
exceed 20;
f) The maximum height or water closets should be
0.45m; flush control should have a maximum height of
11.20 m;
g) Maximum height of lavatories should be 0.80 m with a
knee recess of 0.60 - 0.70m vertical clearance and a
0.50m depth;
h) Urinals should have an elongated lip or should be
trough-type; the maximum height of the lip should be
0.48.
7. Stairs
a) Tread surfaces should be of a slip-resistant material;
nosing should be provided with slip-resistant strips to
further minimize slipping;
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b) Slanted nosing are preferred to protruding nosing so
as not to impose difficulty for people using crutches
or braces whose feet have a tendency to get caught
in the recessed space of protruding nosing; for the
same reason, open stringers should be avoided;
c) The leading edge of each step of both runner and
riser should be marked with a paint or non-skid
material that has a color or gray value which is in
high contrast to the gray value of the rest of the
stairs; markings of this sort would be helpful to the
visually impaired as well as to the fully sighted
person;
d) A tactile strip 0.30 m. wide shall be installed before
hazardous areas such as sudden changes in floor
levels and at the tip and bottom of stairs; special
care must be taken to ensure the proper mounting or
adhesion of tactile strips so as not cause accidents.
8. Elevators
a) Accessible elevators should be located not more than
30.00 m. form the entrance and should be easy to
locate with the aid of signs;
b) Accessible elevators shall have a minimum
dimensions of 1.10m x 1.40 m.
9. Water Fountains
a) At least one (1) fountain shall be provided for every
2,000 sq. m. of floor area and there shall not be less
than one (1) on each floor. Waterspouts shall be at
the front and shall be push-button controlled. If wall
mounted, the maximum height of the water fountain
shall be 0.85 m. from the floor to the rim, either
provide paper cups or another lower fountain.
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