arena chapter ii (final)

8/19/2019 arena Chapter II (Final)

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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.


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.


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)


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.

arena chapter ii (final)

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