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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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Table 3. Space Requirements
Table 3. Space Requirements
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Table 3. Space Requirements
Table 3. Space Requirements
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Table 3. Space Requirements
Table 3. Space Requirements
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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.
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