Safe Hospital Emergencies and Disaster

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Safe Hospitals in Emergencies and Disasters: Philippine Indicators 1

Safe Hospitals in Emergencies andDisasters: Philippine Indicators

Protect hospitals and health facilitiesin emergencies and disasters

Second edition

Edi tors

Dr Carmencita A. BanatinDr Marilyn V. Go

Arch Ma. Rebecca M. PeafielDr Romeo A. Bituin

DRAFT

Health Emergency Management Staff

Department of HealthManila Philippines

Emergency and Humanitarian Action

World Health OrganizationRegional Office for the Western Pacific

Manila Philippines


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Copyright Department of Health, Republic of the Philippines, 2009

This document is issued by the Health Emergency Management Staff,Department of Health, Republic of the Philippines, for general distribution. Allrights are reserved. Subject due to acknowledgement of DOH-HEMS, all the

articles in this manual may be freely reviewed, abstracted, reproduced ortranslated, in part or in whole, for non-commercial purposes only. If theentire work or substantial portions will be translated or reproduced,permission should be requested from the Department of Health-HealthEmergency Management Staff.

Project supported by the European Commission

through its Humanitarian Aid department

http://ec.europa.eu/echo/index_en.htm


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Contents

Foreword

Francisco T. Duque IIISecretary of Health, Republic of the Philippines

5

Preface 6

Acknowledgements 7

Technical Working Commit tee on Safe Hospi ta ls 8

Section I. Introduction

Introduction 10

Safe Hospital 11

Section II. Philippine Indicators

Structural Indicators of Safe Hospitals 12

Non-structural Indicators of Safe Hospitals 16

Functional Indicators of Safe Hospitals 26

Additional Non-structural Indicators for Hospitals withSpecial Functions

31

Additional Functional Indicators for Highly Infectious Diseases 34

Section III. National Codes, Policies and Guidelines

The National Building Code of the Philippines (PD 1096) 39The National Structural Code of the Philippines (5th ed, 2001) 39Philippine Electrical Code 40Fire Code of the Philippines (PD 1185) 40Republic Act 8495 - Philippine Mechanical Code 41Republic Act 344 - Accessibility Law 41Republic Act 9275 - Philippine Clean Water Act of 2004 41Republic Act 9003 - Ecological Solid Waste Management

Act of 200041

Administrative Order No. 2008 - 0021 Gradual Phase-out of Mercuryin all Philippine Health Care Facilities and Institutions

42


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Foreword

Every year, many hospitals and health facilities in the country are damaged and destroyed bydisasters to which the Philippines has a very high vulnerability. However, the governmentthrough the Department of Health has been non-stop in its efforts to ensure that ourcountrymen are not left without the vital care that they need in the midst of thesecatastrophes.

The price to pay for the failure of health care facilities when disasters happen is too high in comparison to the cost of making these safe and resilient."Recent disaster experiences in theBicol and Visayas regions and in earlier years in the Quezon Province highlight thetremendous impact that disasters can have on health facilities and local health systems.

The health sector is filled with highly trained, committed, and dedicated personnel who areready to deliver healthcare especially in times of great suffering and need. To achieve andmaintain quality of health care during health emergencies, these personnel will have to besupported by enabling them to work in safe health facilities where they can do what they dobest --- save lives and limit injuries among disaster victims.

Among the objectives of the global campaign for "Hospitals Safe from Disasters" is toreinforce both the structural and non-structural resilience of health care facilities and toensure that they continue to function after a disaster strikes. The first points to structures insafe geographical locations; while the latter refers to health personnel and emergencypreparedness plans which will keep hospitals operational in the wake of disasters.

By applying current knowledge and exercising strong political leadership, it is possible toprotect health facilities from disasters, even in resource-constrained settings like thePhilippines. The Hyogo Framework for Action calls for government support to ensure thatexisting and new health care facilities will be re-structured or engineered to remain functionalat the height of an emergency.

Therefore, I commend the Steering Committee and Technical Working Groups whopainstakingly labored in consolidating indicators into this manual that will guide all HospitalAdministrators in the pursuit of one vision - to make every hospital safe from disaster andaccessible at all times for all disaster victims. Likewise, this Manual signifies the continuingpartnership between the Department of Health, World Health Organization, and othermembers of the health sector in making our health system strong, reliable and resilient for theFilipino people.

FRANCISCO T. DUQUE III, MD, Msc.Secretary of Health


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Preface

This Manual emanated from a research concept by the Department of Health-HealthEmergency Management Staff (DOH-HEMS) to assess hospitals structural, non-structuraland functional elements in times of emergencies and disasters. This eventually became aproject entitled, Capacity Assessment of Metro Manila Tertiary Hospitals in Responding toEmergencies and Disasters," which was funded by the Health Policy Development andPlanning Bureau (HPDPB), coursed to the National Capital Region, and started in October2008. An Assessment Team was organized to oversee the implementation of the researchproject in 25 hospitals in the National Capital Region.

Meanwhile, the Department Personnel Order 0254 series of 2008 mandated the SteeringCommittee to provide assistance and technical guidance to the different Technical WorkingGroups which determined, defined, and finalized the structural, non-structural, and functionalindicators through a series of write-shops and critiquing sessions. This body came up with aManual on Safe Hospitals' Indicators which was supported by the National Center for HealthFacility Development (DOH-NCHFD), the Association of Hospital Administrators and theWorld Health Organization - Western Pacific Regional Office (WHO-WPRO).

After the research implementation, the sets of indicators found on the Manual were revisitedand revised through several write-shops with the Technical Working Groups. The output ofwhich is this second edition. In this new version, the structural, non-structural and functionalindicators which were deemed important and most applicable to the country setting wereretained, while the others were either revised or removed. National codes, policies andguidelines are also included in this new version as additional resource materials for thereaders and users.

This Manual neither provides nor claims to be the definite and only guide to follow in ensuringsafety in health facilities. Readers are encouraged to other complementary references anddocuments. The contributors recognize that this Manual is an evolving reference and mayneed to be adapted to different contexts considering that some indicators may not benecessary, appropriate nor tailored to some hospitals or health facilities.

Health Emergency Management StaffDepartment of Health


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Acknowledgements

The revision for this second edition of the Philippine Indicators for Safe Hospitals inEmergencies and Disasters was done through the efforts of the Assessment Teamcomposed of the following individuals: Dr Joseph Bacareza; Dr Jose Edgar Balita; Engr AidaBarcelona; Dr Romeo Bituin; Ms Josefina Blanco, RN; Arch Allen Buenaventura; DrEmmanuel Bueno; Engr Israel Camposano; Mr Elmer Benedict Collong, RMT; Arch LeonardCordero; Dr Ma. Paz Corrales; Arch Corazon Cruz; Ms Aida Cuadra, RN; Arch Ferdinanddela Paz; Dr Alex Dimapilis; Mr Philip Du; Engr Marilyn Ebuen; Arch Christopher Espina; DrJasminda Espiritu; Ms Ma. Belinda Evangelista, RN; Ms Jacinta Garcia; Mr Manny Guevarra,RN; Engr Eric Gutierrez; Dr Rodrigo Hao; Dr Joseph Juico; Dr Cesar Brence Labastida; MrGerardo Lirag, RN; Engr Jesus Lorenzo; Arch Prosperidad Luis; Engr Nilo Marayag; DrRommel Menguito; Dr Joseph Nocom; Dr Antoinette Pacapac; Ms Celia Pangan, RN; EngrJennifer Quintero; Dr Mary Grace Reyes; Dr Myrna Rivera; Dr Epifania Simbul; Dr Alexis Uy;

Mr Willy Veloria, RN;and Engr Vivian Young.

Grateful appreciation also goes to Dr Noel Juban and Prof Nina Carandang for their technicalexpertise in conducting the research project; Dr Asuncion Anden and Dr Irma Asuncion foroverseeing the management of the project in the National Capital Region; and Arch Ma.Rebecca Peafiel and Dr Nathaniel Carl Tan for their technical inputs to the project.

Acknowledgement is also given to DOH-HEMS administrative staff, especially, FlorindaPanlilio and Glenda Ensigne for the administrative support; Zando Escultura for the coverdesign; and Sheila Bonito and Charmeih Pagulayan for the copy editing.

The completion of this Manual is also due to the support of the Emergency and HumanitarianAction of the World Health Organization - Western Pacific Region through the technical

supervision of Dr Arturo Pesigan, technical assistance of Dr Lester Sam Geroy andadministrative support of Ms Glessie Salajogg. This project was supported by the EuropeanCommission through its Humanitarian Aid department.

Health Emergency Management StaffDepartment of Health


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Technical Working Committee on Safe Hospitals

Advisers

Dr Mario Villaverde Undersecretary of Health, Department of Health (DOH)

Dr Soe Nyunt-U WHO Representative to the Philippines

Dr Arturo Pesigan WHO Western Pacific Regional Office,

Emergency and Humanitarian Action

Steer ing Comm it tee

Dr Mario Villaverde DOH Policy and Standard Development Team for ServiceDelivery (PSDTSD)

Dr Carmencita Banatin DOH Health Emergency Management Staff (DOH-HEMS)

Dr Criselda Abesamis DOH National Center for Health Facility Development(DOH-NCHFD)

Dr Ma. Alicia Lim DOH Bureau of Health Facilities and Services (DOH-BHFS)

Atty Nicolas Lutero III Jose Reyes Memorial Medical Center

Dr Rosalinda Arandia Quirino Memorial Medical Center

Dr Bernardino Vicente National Center for Mental Health

Dr Shirley Domingo Philippine Health Insurance Corporation (PHIC)

Technical Working Group for Structural Indicators

Arch Ma. Rebecca Peafiel DOH NCHFD

Engr Maximo Adan DOH NCHFD

Arch Christopher Espina UP College of Architecture

Arch Corazon Cruz UST College of Architecture

Engr Fernando Germar UP College of Engineering

Engr Michael Abundo UP College of Engineering

Engr Peter Lim UST College of Engineering

Engr Ricardo Balog UST College of Engineering

Engr. Ronaldo Ison Association of Structural Engineers of the Philippines

Engr Anthony Pimentel Association of Structural Engineers of the Philippines

Engr Jorge Genota Association of Structural Engineers of the Philippines

Arch Herminio Prudente United Architects of the Philippines


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Technical Working Group for Non-st ructural and Funct ional Indicators

Dr Roland Cortez East Avenue Medical Center

Dr Marilyn Go DOH-HEMS

Dr Arturo Cabanban San Lazaro Hospital

Dr Arnel Rivera DOH-HEMS

Dr Romeo Bituin Dr. Jose Fabella Memorial Hospital

Dr Edmundo B. Lopez Las Pias General Hospital and Satellite Trauma Center

Dr Joseph Bacareza Bureau of Fire Protection

Arch Prosperidad Luis United Architects of the Philippines

Engr Carlos Bariring DOH-NCHFD

Engr Abraham Castanaga DOH-NCHFD

Engr Ramon Alfonso Tondo Medical Center

Dr Ma. Theresa Vera DOH-BHFS

Engr Bayani San Juan DOH Bureau of Health Devices and Technology

Engr William Juan Institute of Integrated Electrical Engineers

Technical Working Group for Advoc acy

Ms Angelina Sebial DOH National Center for Health Promotion

Dr Victor dela Cruz Tondo Medical Center

Dr Ricardo DG Lustre Amang Rodriguez Medical Center

Dr Ruben Flores Dr. Jose Fabella Memorial Hospital

Dr Edgardo Javillonar Dr. Jose N. Rodriguez Memorial Hospital

Dr Mario Panay Valenzuela Medical Center

Dr Isabelita Estrella San Lorenzo Ruiz Womens Hospital

Dr Robert Enriquez National Childrens Hospital

Dr Teodoro Castro Philippine Orthopedic Center


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SECTION I

Introduction

Hospitals and other health facilities should be a source of strength during emergencies anddisasters. They should be ready to save lives and to continue providing essential healthservices such as laboratories, medicines, treatment and rehabilitation. They should also bethe symbol of hope during these critical times and contribute to the communitys sense ofsecurity and well-being. However, there are circumstances where hospitals and healthfacilities are made vulnerable, especially during an emergency or disaster. The hospitals orhealth facilities may be damaged or destroyed; or their capacities stretched to the limit by thesurge in number of patients seeking health services and support.

The Hyogo Framework for Action in 2005 emphasizes the importance of "making hospitalssafe from disasters by ensuring that all new hospitals are built with a level of resilience thatstrengthens their capacity to remain functional in disaster situations and implement mitigationmeasures to reinforce existing health facilities, particularly those providing primary healthcare. The roles of hospitals and health facilities in emergencies and disasters cannot beunderestimated.

The World Health Organization, in support of the World Disaster Reduction Campaign onHospitals Safe from Disasters (2008-2009) aims to raise awareness in making hospitals safein emergencies and from disasters:

Protect the lives of patients and health workers by ensuring the structuralresilience of health facilities

Ensure that health facilities and health services are able to function in the

aftermath of emergencies and disasters, when they are most needed

Improve the emergency management capacity of health workers and institutions

This Manual defines what a safe hospital is during an emergency or disaster. It alsodescribes the essentials in supporting safe hospitals. It also lists the structural and non-structural indicators as well as functional indicators which every hospital and health facilitiesshould consider as standards to be achieved.

This manual, Safe Hospitals in Emergencies and Disasters: Philippine Indicators is a guideto help assess the vulnerability and resilience of hospitals and health facilities to ensurepatient safety and staff security, and guarantee continuous operations in times ofemergencies and disasters. This manual is intended for people who recognizes the important

role of hospitals and health care facilities during emergencies and disasters. These peopleinclude: hospital administrators, health emergency management staff, and healthprofessionals.

The sets of indicators listed in this manual were arrived at, after a comprehensive review ofexisting codes and guidelines which are related to structures, non-structural elements andfunctions of hospitals and health facilities. This manual neither provides nor claims to be thedefinite and only guide to follow in ensuring safety in health facilities. This is a work inprogress and subsequent revisions will be made accordingly to ensure that hospitals andhealth facilities are safe in emergencies.


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Safe Hospital

Safe hospitals are health facilities whose services remain accessible and functioning, atmaximum capacity and within the same infrastructure, during and immediately following

disasters, emergencies or crises.

A safe ho spital . . .

will not collapse in disasters, killing patients and staff

will be able to continue to function and provide critical services in emergencies

will be organized, with contingency plans in place and health personnel trained to keep

the network operational

Supporting safe hospitals involves knowledge of the many factors that contribute to theirvulnerability, which includes:

Buildings: The location and design specifications and the resiliency of the materialsused contribute to the ability of hospitals to withstand adverse natural events.

Patients: A disaster will inevitably increase the number of potential patients.

Hospital beds: In the aftermath of a disaster, the availability of hospital bedsfrequently decreases even as the demand for emergency care increases.

Medical and support staff: The loss or unavailability of personnel disrupts the care ofthe injured; hiring outside personnel to sustain the response capacity adds to theoverall economic burden.

Equipment and facilities: Damage to non-structural elements can sometimes surpassthe cost of the structure itself. Even when the damage is less costly, it can still forcethe hospital to halt operations.

Basic lifelines and services:A hospitals ability to function relies on lifelines and otherbasic services such as electrical power, water and sanitation, and waste treatmentand disposal. When some services are affected, the performance of the entirehospital suffers.

Supporting safe hospitals entails vision and commitment to ensure that they are fullyfunctional especially in times of emergencies and disasters. There should be involvement ofvarious sectors such as: planning, finance, public services, architecture and engineering.

Protecting health facilities includes: Ensuring risk reduction in the design and construction of all new health facilities

Improving the non-structural and functional vulnerability of existing health facilities

Adopting legislative and financial measures to select and retrofit the most criticalfacilities to increase levels of protection


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SECTION II

Structural Indicators of Safe Hospitals

The structural elements of health facilities, such as foundations, columns, beams, slabs, load-bearing walls, braces, and trusses, are essential elements that determine the overall safety ofthe building. The following is a list of structural indicators for safe hospitals in the Philippinesbased on the (1) National Structural Code of the Philippines (NSCP) Revised 2001Guidelines, (2) National Building Code Revised 2006 Guidelines and (3) Association ofStructural Engineers of the Philippines (ASEP) Recommended Guidelines on StructuralDesign Peer Review of Structures. This can be used as a checklist to identify strengths andvulnerabilities when planning for new construction or reviewing existing hospital or healthfacility.

Instruct ion:Encircle the thumbs-up sign (means Yes or complies completely with what is asked for) and thumbs-down sign (means No or may not comply completely with what is asked for) when assessing the

hospital or health facility according to the following indicators. Use the Remarks column to writeessential observations when doing the assessment, especially when the result is No..

1. Buildings must be located in highlysuitable sites and away from areasthat will diminish its accessibility andthreaten its operations in times ofemergencies.

Remarks

1.1 Not at the edge of a slope

1.2 Not close to a seismic fault line:

1.2.1 High Risk (Zone 1): 5kmsand nearer to the fault line

1.2.2 Medium Risk (Zone 2): over5kms-10kms to the fault line

1.2.3 Low Risk (Zone 3) : over10kms -15kms to the fault line

1.3 Not near the foot of a mountain

1.4 Near bodies of water(creeks, rivers,

sea) provided with water barrier (i.e.

rip-rap, dikes, other forms)

1.5 Not on a reclaimed site

1.6 Not in flood-prone areas

1.7 Not within typhoon zone:

1.7.1 High Risk: 250kph1.7.2 Medium Risk: 200kph1.7.3 Low Risk: 175kph

1.8 Not near active volcano

References:

Risk Maps and Hazard Scoring from the Center for Environmental Geomatics of the Manila

Observatory. Available online at http://www.observatory .ph

Valley Fault Systems and Distribution of Active Faults and Trenches of the Philippines,Philippine Institute of Volcanology and Seismology (PHIVOLCS)


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2. The design of the hospital structuralsystem must strictly conform with therequirements of the NationalStructural Code of the Philippines(NSCP, 2001); especially for wind and

earthquake design (per struc turalcomputat ions) .

2.1 Foundation

2.2 Columns

2.3 Beams

2.3.1 Underside of arches,balconies or overhangs freefrom structural cracks andfalling cement plasters

2.3.1 Other fixtures such as

ceiling liner are properlyfastened or attached 2.4 Floor and Roof Slabs Soffit or the

underside of floor slab has no cracksand leaks

2.5 Trusses

2.6 Walls and Partitions

2.7 Shear Walls

2.8 Roof System:

2.8.1 Roofing completely and

securely fastened, welded,riveted, or cemented

2.8.2 Considered roof cover andinsulation materials, slope,type of connection,condition, thickness at leastgauge 24 or 26

2.8.3 Considered regionallocation, e.g. in Bicol areas itshould be heavily fastenedor anchored

3. The shape and form of the hospitalbuilding must be simple and regular.

3.1 Hospital has simple shape and issymmetrical in both the lateral andlongitudinal axes (e.g. square orrectangle) making it resilient whensubjected to stress such as thatproduced by an earthquake

3.2 Number of building floors (storeys)less than five floors


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3.3 Building form (Elevations)

3.3.1 Not top heavy

3.3.2 No cantilevers

3.3.3 Balanced massing

3.3.4 Balanced loading

4. The hospital structural system mustbe continually checked and reviewedduring construction and the entireperiod of occupancy. Structuraldesign of building constructed before

2001 should have undergone any ofthe following:

4.1 Peer review using Association ofStructural Engineers of thePhilippines (ASEP) guidelines

4.2 Rapid evaluation using DPWH

Guidelines 4.3 Structural certification by qualified

structural engineer

5. Cracks on the hospital structuralsystem must be immediatelyinvestigated and addressed especiallyif they appear after an earthquake.Major structural cracks or visibledamages does not appear on any ofthe following structural members:

5.1 Foundation (Investigate for anysettlement, tilting of building)

5.2 Columns (Investigate end andmidpoint columns)

5.3 Beams (Investigate end support andmid-span)

5.4 Floor slabs

5.5 Trusses (Investigate sagging,movement, corrosion, rotting)

5.6 Walls and partitions

5.7 Shear Walls


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Non-Structural Indicators of Safe Hospitals

The non-structural elements are all other elements that, without forming part of the resistancesystems, enable the facility to operate. They include architectural elements, equipment andcontents and services or lifelines. In the case of hospitals, nearly 80% of the total cost of the

facility is made up of non-structural components (WHO 2008).

The following are the indicators for the architectural elements, equipment and contents andservices or lifelines. As with the structural indicators, this list can be used to identify strengthsand vulnerabilities when planning for new construction or reviewing existing hospital or healthfacility.

Instruct ion:Encircle the thumbs-up sign (means Yes or complies completely with what is asked for) and thumbs-down sign (means No or may not comply completely with what is asked for) when assessing thehospital or health facility according to the following indicators. Use the Remarks column to writeessential observations when doing the assessment, especially when the result is No..

1. Safety of Ceilings Remarks

1.1 Ceiling materials such as fiber cement ,gypsum board, or glass securely fastened

1.2 Ceilings made of wood are coated/treatedwith fire retardant paints and termite-controlled

1.3 Ceiling materials not made of asbestos

1.4 Ceiling accessories or light fixtures

adequately fastened and supported

2. Safety of Doors and Entrances

2.1 Doors securely attached to jambs

2.2 Any glass panel in doors is transparentwired glass mounted in steel frames

2.3 In the event of power failure, power-operated doors may be opened manually topermit exit travel

2.4 Doors are either double swing or swing-out:

2.4.1 Double swing main doors,ER/OR/DR/ICU/Nursery/Radiology/patients rooms, Dietary, kitchen,laundry, linen and other support

areas

2.4.2 Swing-out toilets and exit doors

2.5 Each single door with a width of not lessthan 112 cm. and not more than 122 cm.(Note: if power operated doors in theevent of power failure the door may beopened manually to permit exit travel)

2.6 Doors in rooms below 30 persons occupantload capacity single door 112 cm wide

2.7 Doors in rooms more than 30 personsoccupant load capacity (conference rooms,function rooms),112 cm wide, remotely

located from each other, swing out


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2.8 Smoke partition doors located alonghallways and corridors should be doubleswing, per groups of rooms/section, forcompartmentation

2.9 In high rise buildings/structures, the interior

vertical exit stairwell/staircase, is a

pressurized fire exit or smoke proof fire exit,suitably sealed against smoke, heat and fire

2.10 Locks installed on patient wards soarranged that they can be locked onlyfrom the corridor side. Such locksarranged to permit exit from room by asimple operation without the use of key

2.11 Any device or alarm installed to restrictthe improper use of a means of egress sodesigned and installed that it cannot, evenin case of failure, impede or preventemergency use of such means of egress

2.12 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

2.13 A door designed to be kept normallyclosed as a means of egress, such as adoor to a stair or horizontal exit, providedwith a reliable selfclosing mechanism,and shall not at any time be secured inthe open position. A door designed to bekept normally closed shall bear a sign asfollows: FIRE EXIT, KEEP DOORCLOSED

3. Safety of Windows and Shutters

3.1 Windows have wind and sun protectiondevices (e.g. sun baffles)

3.2 Window grilles to secure the safety of thepatient, provided with fire exit opening

3.3 Windows are leak-proof

3.4 Windows which could be mistaken for doorshave protective barriers or railings

3.5 All glass panels or windows are made oftempered glass or with appropriate

thickness or provided with protective films

4. Safety of Walls, Divisions and Partitions

4.1 Exterior walls meet the fire resistance ratingof 2 hours

4.2 Interior walls made of fire-resistive materialsand from floor to floor

4.3 Smoke-proof stairs, lobbies and vestibulesare made of non-combustible materials

4.4 Partitions for fire zones are fire-resistive,floor-to-floor and compartmented


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5. Safety of Exterior Elements (cornices,ornaments, faade, plastering etc.)

5.1 Securely fastened on walls

5.2 Hanging lighting fixtures properly anchored

5.3 Electrical wires and cables properlyfastened/secured

6. Safety of Floor Coverings

6.1 Non-slippery floor without crevices in allclinical/service areas

6.2 Durable floor materials

6.3 Fire-resistive interior floor materials

7. Safety of Lifeline Facilities7.1 Electrical System

7.1.1 Electrical system must conform withthe Philippine Electrical Code(PEC) requirements for healthfacilities except for some provisionsas may be required by the end-users

7.1.2 Emergency generator has thecapacity to meet 100% of hospitaldemand (provision for back-upelectrical system to include airconunits, and stockrooms)

7.1.3 Generator housing or power housemade of reinforced concrete

7.1.4 Generator housing or power houseelevated from the ground line

7.1.5 Generators and other vibratingequipment can be fixed by specialbrackets which allow somemovement but prevent them fromoverturning

7.1.6 Non-vibrating and silent typegenerators

7.1.7 Exhaust system made of critical

type silencer or hospital grade 7.1.8 Provided with generator automatic

transfer switch (ATS) 7.1.9 Protected control panel, with

electrical surge suppressor 7.1.10 Ground fault circuit interrupters

(GFCIs) provided in outlets inbath/shower rooms and in wet ordamp locations

7.1.11 All convenience outlets (COs)

provided with grounding pole/type 7.1.12 Ducting system/conduits Polyvinyl

Chloride (PVC) for power andlighting; Rigid Steel Conduit (RSC)


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or Intermediate Metal Conduit (IMC)for fire alarm and detectionsystems, telephone, intercom,Closed-circuit (CCTV), Cable TV(CATV), computer network datalines

7.1.13 Adequate lighting in all areas of thehospital

7.1.14 Exterior electrical system installedunderground

7.1.15 Functional electrical andemergency lights with battery back-up in all areas

7.1.16 Energy-saving Compact

Flourescent Lighting (CFL) 7.1.17 Non-mercury bulb/lights

7.1.18 Automatic monitoring system

installed (Extension wires/cordunplugged when not in use) 7.1.19 All non-current carrying metallic

parts of the electrical system (i.e.electrical enclosures, boxes,gutters, ducts, trays, etc.)adequately grounded

7.1.20 Perimeter/Exterior lighting systeminstalled in the hospital grounds

7.1.21 All electrical systems/roomsprotected with appropriate chemicaltype automatic fire suppressionunits

7.1.22 Explosion-proof switch and outletsfor hazardous areas

7.1.23 Antennas and lightning rodsprotection terminals withbracing/support for safety

7.1.24 Lightning arrester provided

7.2 Communication System

7.2.1 Radios have back-up direct currentpower source (battery)

7.2.2 Presence of back-up

communication system 7.2.3 Communication equipment and

cables secured with anchors andbraces

7.2.4 Alarm signalling system arranged

so that the normal operation of anyrequired alarm initiating device willautomatically transmit an alarm tothe nearest fire station or to suchother outside assistance as may beavailable

7.2.5 Exterior communication systemsinstalled underground


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7.3 Domestic Water Supply System

7.3.1 Water storage tank has sufficientreserve to satisfy the hospitaldemand for 3 days at all times

7.3.2 Water storage tank has safe

location and support system 7.3.3 Alternate water source provided:

deep well, mobile water storagetank, or fire truck delivery

7.3.4 Fusion-weld pipes or galvanized

iron pipes, valves, and fittings arefree from breakage, leaks and freefrom harmful agents

7.4 Medical and Industrial Gases (oxygen,nitrous oxide, etc.) System

7.4.1 Hospitals using pipe-in medical gasshould have minimum storage of 3days 7.4.2 Hospitals using individual cylindersshould have minimum storage of 3days

7.4.3 Tanks, cylinders and related

equipment anchored 7.4.4 Alternative sources of medical

gases available 7.4.5 Medical gases appropriately located

and secured from theft, vandalismand pilferage

7.4.6 Ensured the safety of medical gas

provided with an audio-visual alarmdistribution system (valves, pipes,fittings)

7.4.7 Functional pressure gauge and

fittings 7.4.8 Use of standard copper tubings for

medical gas 7.4.9 Undergoes regular testing

procedures 7.4.10 Medical gas pipes embedded in

walls are provided with pipe sleeves 7.4.11 Non-interchangeable piping

connection 7.4.12 Provided zone/shut off valves in

case of leaks, (e.g., in case of fireat the OR complex, zone valve canbe shut off)

7.4.13 Secured back-up oxygen tanks in

case of emergency patientevacuation

7.4.14 Industrial gases located outside the

building and provided withautomatic shut off device (e.g. LPG)

7.4.15 Tanks bear an intact safety seal

from the supplier 7.4.16 Explosion venting system provided

outside the building for hazardous


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processes or storage area, such asboiler room, motor pool, electricalrooms, and housekeeping rooms.

7.4.17 Automatic gas leak detectionsystem interconnected with theautomatic fire alarm system

7.5 Fire Suppression System

7.5.1 Detection, alarm and extinguishingsystems are interconnected/interphased

7.5.2 Fire Alarm system is a combination

of automatic and manual system 7.5.3 Fire alarm system is monitored by

Fire Service Station or Accreditedmonitoring agency

7.5.4 Heat and Smoke Detection installed

in all areas 7.5.5 Smoke detectors must be spacednot further apart than nine meters

on center and more than four andsix-tenths (4.6) from any wall

7.5.6 Each room provided with portable

fire extinguishers 7.5.6.1 For general services areas,

ABC fire extinguishers used 7.5.6.2 For electronic and electrical

equipment, Carbon Dioxide(CO2), Hydrochloro-fluorocarbon (HCFC),orFluoroethane 36 used

7.5.7 Provided with wet standpipe systemwith complete accessories forbuilding more than 5-storey

7.6 Emergency Exit System

7.6.1 Every floor of the building musthave at least 2 emergency exitsremote from each other

7.6.2 Revolving Doors and Elevators are

not considered emergency exits 7.6.3 Fire Exit Doors are fire resistive,

swing-out type, self-enclosing, andwith panic bar hardware (of 7kilograms or less pressure)

7.6.4 The floors of beams of egress areilluminated at all points includingangles and intersections ofcorridors and passageways,landings of stairs and exit doorswith bulbs of not less than onethousandth (0.001) lumens persquare centimetre

7.6.5 Illumination system of the exits isnot battery-operated

7.6.6 Emergency lighting facilities

maintain the specified degree ofillumination in the event of failure of


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the normal lighting for a period of atleast half of an hour

7.6.7 Illuminated EXIT signs distinctive in color, reliable source,located just above the door frame

7.6.8 Size of Exit Signs plainly legible

letters not less than fifteencentimetres high with the principalstrokes of letters not less thannineteen millimeters wide

7.6.9 Luminous directional exit signslocated one foot above floor levelleading to the nearest fire escaperoute

8. Heating, Ventilation and Air Conditioning(HVAC) Systems in Critical Areas

8.1 Provide adequate bracing for pipes andducts

8.2 Leak-free pipes, valves, and fittings

8.3 Anchored central heating and/or hot waterequipment

8.4 Anchored air-conditioning equipment

8.5 Safety enclosures or guards for rotatingparts of HVAC equipment

8.6 Fire-stopping materials for all pipes andducts

9. Medical and Laboratory Equipment and

Supplies used for Diagnosis and Treatment

9.1 With color coded sign: FOR PRIORITY INSAVING DURING EVACUATION

9.2 Medical Equipment in operating rooms andrecovery rooms 9.2.1 Equipment in the operating room

must be anchored or fastened 9.2.2 Lamps, equipment for anesthesia

and surgical tables are secured andthat table on cart wheels are locked

9.3 Radiological Equipment and Other

Support Devices on the RadiologyDepartment (X-ray units, ultrasoundscanners, CT scanners, MRI scanners)

9.3.1 Heavy and movable equipmentanchored or bolted on the floor (X-ray machine) or to the wall

9.3.2 Available steel frames for securing

of equipment 9.3.3 Adequately shielded room

(radiation protection, radio-frequency, magnetic fields, etc.)

9.3.4 Air conditioned room with controlled

humidity

9.3.5 Safe from flooding


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9.4 Laboratory Equipment and OtherSupport Devices for the LaboratoryDepartment/ Services

9.4.1 Supplies and contents oflaboratories secured on shelves

and in racks. (Anchor the cabinetsto the walls and strap the shelves)

9.4.2 Safe and secured storage of cultureorganisms/media

9.4.3 Available standard decontaminationarea (fixed/mobile)

9.4.4 Waste water connected toneutralization tank before disposalto sewerage treatment plant

9.4.5 Fume hood provided (depends on

level of laboratory) 9.4.6 Material Safety Data Sheet (MSDS)

available for all chemical substance

9.5 Medical Equipment in Emergency

Rooms

9.5.1 Each bed is provided with wheellock or anchor

9.5.2 Equipment and accessories neededfor treatment and placed near thebed are supported, anchored orfixed

9.5.3 Supplies and contents of medical

cabinets secured on shelves and inracks. (Anchor and strap the

shelves to the wall)

9.6 Medical Equipment in ICU Areas

9.6.1 Each bed is provided with wheellock or anchor

9.6.2 Equipment and accessories aresupported, anchored or fixed

9.6.3 Anchor bolts should be provided onthe walls in appropriate locations sothat the equipment can be removedand fixed in a safe place when notin use

9.7 Medical Equipment in the PharmacyDepartments

9.7.1 Supplies and contents of pharmacycabinets are secured on shelvesand in racks. (Anchor the cabinetsto the walls)

9.7.2 Proper storage for hazardous

materials free from leaks 9.7.3 Air-conditioned room or well

ventilated


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9.8 Medical Equipment in the SterilizationUnits

9.8.1 Supplies and contents ofsterilization unit cabinets should besecured on shelves and in racks.

(Anchor the cabinets to the walls)

9.8.2 Heavy and movable equipment

anchored or bolted to the floor or tothe wall (e.g., autoclave)

9.9 Medical Equipment in the Wards

9.9.1 Each bed is provided with wheellock or chains

9.9.2 Equipment and accessories mustbe supported, anchored or fixed

9.9.3 Equipment on roller trolleys musthave proper anchoring system using

hooks and chains, and can beattached to beds or walls (ECG,monitors, suction units, ventilators,incubators, BP monitors,resuscitation equipment, etc.)

9.9.4 Patients charts must be secured(esp. if you have to evacuate thatward in times of emergencies) forproper / continuous management ofpatients

9.10 Equipment and Other Support Devicesin Nuclear Medicine Department and

Radiation Therapy Units (includingChemical/Poisoning)

9.10.1 Adequately shielded room

9.10.2 Airconditioned room

9.10.3 Proper storage, handling anddisposal of chemicals andradioactive materials and wastes

9.10.4 Equipment and accessories needed

for treatment and placed must besupported, anchored or fixed

9.10.5 Use of Proper Personal Protective

Equipment (PPE) 9.10.6 Available standard decontamination

area (fixed/mobile) 9.10.7 Waste water connected to delay to

decay tank before disposal tosewerage treatment plant

9.10.8 Use of Proper Illumination

9.10.9 Independent circuit breaker

9.10.10 Has a separate facility for the

processing of the reagents/

chemical substance, radio-pharmaceuticals and other


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diagnostic kits

9.10.11 Asbestos free

9.10.12 Proper anchorage of equipmentand the materials used for the

attachments do not cross react withthe chemical agents

9.10.13 Presence of the following safetyequipment:

Shields

Protective clothing

Tools for remote handling

Containers for radioactivematerials

Dose rate monitors with alarm

Contamination meters

Signs, labels, records

Emergency kits

9.10.14 Security

Provided with Close Circuit TV(CCTV) cameras with recorder

Roving guard available

Secured entrance and exit points

Provided with equipment forinspection such as metaldetectors

10. Safety of Personnel and Patients10.1 Available PPEs for universal precaution

(gloves, masks, gowns) 10.2 Available sterilizing unit for equipment and

supplies 10.3 Available Information Education

Communication (IEC) materials forpatients and personnel on what to doduring emergencies/disasters


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Functional Indicators of Safe Hospitals

Instruct ion:Encircle the thumbs-up sign (means Yes or complies completely with what is asked for) and thumbs-down sign (means No or may not comply completely with what is asked for) when assessing thehospital or health facility according to the following indicators. Use the Remarks column to writeessential observations when doing the assessment, especially when the result is No.

1. Site and Accessibility Remarks

1.1 Hospital is located along/ near good roadsreadily accessible to the community withadequate means of transportation

1.2 Hospital reasonably free from undue noise,smoke, dust, foul odor, flood, and not

located near railroads, freight yards,children's playgrounds, airports, industrialplants, disposal plants.

1.3 The location of the hospital shall complywith all zoning regulations and ordinances

1.4 There shall be no road obstructions leadingto the hospital

1.5 There should be access to more than oneroad (alternative routes)

1.6 There should be separate ingress andegress routes

1.7 Well paved access roads should beproperly identified/labelled

1.8 Available, safe and well lighted parking lots

1.9 Provide available parking lots for thedisabled near the main entrance

1.10 Available covered walk way, tointerconnect service areas 1.11 Directional signages are available and

properly fastened

1.12 Outdoor stairs must have enclosed andprotected openings

1.13 All entrances, especially main andemergency entrances, shall be providedwith canopies for protection from theelements

1.14 Provide entrance ramps using ratio of 1:12


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1.15 Secured and controlled of entry points

2. Internal Circulation and Inter-Operability

2.1 Proper zoning of areas 2.1.1 Departments most closely linked to

the community are located nearestto the entrance (e.g., OPD, ER, etc)

2.1.2 Departments that receive their

workload from the wards or innerzones should be located closer tothese zones (Radiology,Laboratory)

2.1.3 In-patient departments should be inthe inner zones

2.2 General service areas are located inseparate structures such as power plant,

boilers, water storage facilities, laundryarea, and pump house

2.3 Areas to be converted to spaces for

patients during disasters properly identifiedwith adequate lighting, electrical outlets,water supply and toilets/bathrooms

2.4 Diagnostic areas with heavy equipment are

preferably at the ground floor but safe fromflooding

2.5 Nurses at the Stations can oversee the

wards and are accessible to the patients 2.6 Gender sensitive wards (female, male) and

sanitary toilets 2.7 Morgue is located separately from the

service areas 2.8 Corridors, hallways and aisles are 2.45

meters in width 2.9 Use of ramps as access to 2

nand 3

rfloors

only 2.10 Use of elevators as access for 4 floor

and above 2.11 Use of stairways with safe and adequately

secured balusters and railings

3. Basic Equipment and Supplies

3.1 Basic equipment should be available perward at least two sets

3.2 Basic equipment should be available attreatment area at least two sets

3.3 Basic emergency supplies available

3.4 Diagnostic and therapeutic basic equipmentare functional and properly labelled

3.5 Stock pile of medical supplies good for atleast one week

3.6 Basic PPEs are available at the ER

3.7 PPEs are available in all service areas


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4. Hospital Emergency Preparedness,Response and Recovery Plan approved bythe Chief of Hospital / Director,disseminated, tested and updated

4.1 Operational Plan and Contingency Plans forInternal or External Disasters

4.1.1 The hospital has available,accessible, tested, updated anddisseminated Hospital EmergencyPreparedness, Response andRecovery Plan which containsHazard Prevention and MitigationPlan, Vulnerability Reduction Planand Capacity Development Plan.

4.1.2 The hospital has contingency plansfor medical treatment duringdifferent types of disasters such asTyphoon, Floods, Earthquake, Fire,Disease outbreaks, Emerging and

Re-emerging Infections/Diseases,Biological, Chemical, Radio-nuclearterrorism, Control of Infectionsacquired during hospitalization,pathogens with epidemic potential,etc.

5. Hospital Emergency Management Systems,Procedures and Protocols written andattached/incorporated in the Plan 4.1

5.1 SOP/Guidelines on infection control

5.2 Decontamination procedures/ guidelines

5.3 SOP for internal and external referral ofpatients

5.4 Emergency response procedure/ guidelines

5.5 Treatment guidelines/protocols

5.6 Special administrative procedures fordisasters

5.7 Procedures for resource mobilization(funds, logistics, human resources) to

include shifting of duties duringemergencies or disasters

5.8 SOP for admission to Emergency

Department during emergency/disaster 5.9 Procedures to expand services, spaces and

beds, in case of surge of patients 5.10 Procedures to protect patients records

5.11 Procedures for regular safety inspection

of equipment by appropriate authority andpreventive maintenance

5.12 Procedures for hospital epidemiologic

surveillance 5.13 Procedures for preparing sites for

temporary placement of dead bodies for


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forensic medicine

5.14 Procedures for transport and logisticsupport

5.15 SOP/guidelines for food and supplies ofhospital staff during emergency

5.16 Measures to ensure well being of

additional personnel mobilized duringemergency

5.17 Guidelines for mental health and psycho-social support

5.18 Guidelines on drills / simulation exercises

Fire

Other disasters

5.19 SOP for handling of volunteers especiallyduring emergencies/disasters

5.20 SOP for hospital security system duringemergencies or disasters

5.21 Health care waste management program

during emergencies or disasters 5.22 Fire Safety Program

5.22.1 There must be an organized FireBrigade which has undergoneseminar/training on Fire Drill/ FireEvacuation Drill/ Earthquake Drill

5.22.2 Conduct of regular Fire Drills/ FireEvacuation Drill

5.22.3 Conduct of fire mitigationprevention and suppression training

5.22.4 Fire fighting equipment available5.22.5 Conduct of preventive maintenance

of fire fighting equipment

5.22.6 Available Fire Exit Plan andprovision of Fire exit/evacuationplan in conspicuous places at everyfloor level

5.23 Users/Operations manual for all medicalequipment

6. Availability of Back-up System for thefollowing critical services

6.1 Back-up generators6.2 Alternate source of drinking water6.3 Fuel reserves6.4 Medical gases

6.5 Wastewater Treatment6.6 Solid Waste Treatment

7. Human Resources

7.1 Organization of Hospital DisasterCommittees and Emergency OperationCenter

7.1.1 Crisis Management CommitteeCommittee lower than theExecutive Committee, withtechnical expertise, who could giveadvice to the Executive Committee

regarding crisis/ emergency/disaster management


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7.1.2 Emergency Response Team led bya designated Hospital EmergencyManagement Coordinator andcomposed of Physicians, Nurses,Emergency ManagementTechnician (EMT) trained staff,

Paramedics, trained AmbulanceDriver on emergency/disaster

7.1.3 Health Emergency Planning Groupresponsible for the development ofHealth Emergency Preparedness,Response and Recovery Plan andother hospital response plans

7.1.4 Safety Committee headed by aSafety Officer. The committee is incharge of promoting safety in thehospital from all types of hazards

7.1.5 Hospital Operation Center headed

by the Hospital Emergency

Management Coordinator (in-charge of monitoring incidents ofemergency or disaster, dispatchingof response teams, mobilizing otherresources for emergency)operational 24 hrs/day 7days/week.It has a designated office/unit withpersonnel equipped with computersystem, directories, communicationfacilities (with alternate in case thesystem bogs down)

7.2 Capability Building of Personnel

7.2.1 100% of health workers trained inBasic Life Support and Cardio-pulmonary Resuscitation

7.2.2 100% of health workers trained in

Standard First Aid 7.2.3 Emergency Room medical staff

trained in Advance Cardiac LifeSupport and Pediatric AdvanceCardiac Life Support

7.2.4 Hospital Responders trained in

Emergency Medical RespondersCourse Incident Command System

(ICS), Mass Casualty Incident (MCI)

7.2.5 Hospital managers are trained in

Hospital Emergency IncidentCommand System (HEICS)

7.3 Drills and Exercises

7.3.1 Conducts of Fire drills at least twicea year

7.3.2 Conducts of simulation drills orexercises at least once a year

8. Monitoring and Evaluation

8.1 Conducts post-incident evaluation ofemergencies or disasters (responded to)


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Additional Non-Structural Indicators for Hospitalswith Special Functions

Instruct ion:

Encircle the thumbs-up sign (means Yes or complies completely with what is asked for) and thumbs-down sign (means No or may not comply completely with what is asked for) when assessing thehospital or health facility according to the following indicators. Use the Remarks column to writeessential observations when doing the assessment, especially when the result is No.

1. Hospital For Highly Infectious Diseases Remarks

1.1Isolation Room/ Biological Unit/NegativePressure Room

1.1.1 Closed, air tight windows and doors

1.1.2 Glass transparent doors for the ante

room and the room of the patient,tightly closed

1.1.3 Automatic shut off doors, swing typeof the ante room and the room of thepatient, tightly closed

1.1.4 Leak proof ceiling, windows and doors

1.1.5 With signage ISOLATION

1.2Divisions/Partitions

1.2.1 Isolation room has an ante room fordressing with Personal ProtectiveEquipment (PPE)

1.2.2 Ante room has lavatory and PPE rack

1.3Floor Covering

1.3.1 Reinforced concrete

1.3.2 Non-slippery floor tiles withoutcrevices

1.4Attachments

1.4.1 Heating, Ventilation and AirConditioning (HVAC) With air-conditioning With electric fan

1.4.2 Pipes/Medical Gases Closed, built in pipes

1.4.3 Fixtures and Equipment No nebulizer No Oxygen tank; to be used only in

life and death situation No suction machine (dedicated) Minimized dedicated equipment:

only life saving equipment Lavatory of ante room with foot

operated trash bin, soap dispenser,and disinfectant dispenser; whilethe faucet is sliding that can beoperated/ opened by pushing of theelbow


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Color coded trash bins Refrigerator near the Nurses

Station for storage of biologicalspecimens and culture media

1.4.4 Electrical Lighting Well lighted

Back-up emergency lights

1.5 Lifeline Facilities (Critical Systems)1.5.1 Communication System

Dedicated 2 telephone lines forinside and outside communication

1.5.2 Water Supply System

Safe and adequate water supply inall areas

Water tank storage has sufficientreserve to satisfy the hospitaldemand for three days

Water containers for storage in theante room

1.5.3 Medical Gases, pipes (oxygen,nitrous oxide, etc.) Sufficient storage for minimum of 15

day supply Securely anchored tanks, cylinders

and related equipment Protection of medical gas tanks

and/or cylinders and relatedequipment

Functional pressure gauge Leak proof Medical gas pipes not embedded in

walls Individualized piping system Automatic shut off mechanism in

case of leaks

1.5.4 Emergency Exit System Exclusive Emergency Exit Illuminated EXIT signs

distinctive in color (Reliable sourcefive thousand lumens (0.005) persquare centimeters

Provide luminous directional exitsigns located one foot or belowfloor level

1.6 Heating, Ventilation and Air Conditioning

Systems

1.6.1 Negative pressure room

1.6.2 Exhaust system with filter that exitsinto the open air far from humanactivity

1.6.3 Airtight

2. Operating Room and Recovery Room

2.1 Medical and Laboratory Equipment and

Supplies used for Diagnosis andTreatment


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2.1.1 Medical Equipment in OperatingRoom and Recovery Room Dedicated equipment mounted on

rollers or roller trolleys must beanchored or fastened near theoperating table during operations

and can be removed afterwards Lamps, equipment for anesthesia

and surgical tables are secured andtable or cart wheels are locked

Equipment on roller trolleys musthave proper anchoring systemusing hooks and chains, and can beattached to beds or walls (ECG,monitors, suction units, ventilators,incubators, BP monitors,resuscitation equipment, etc.)

2.1.2 Safety of Radiology Equipment Dedicated portable mobile X ray

machine that is battery operated

3. Laboratory Room (P3 Laboratory and Bio-

safety and Bio-security)

3.1 Safety of Laboratory Equipment

3.1.1 Safe washing area3.1.2 Available standard decontamination

area, (fixed/mobile)3.1.3 Hospitals maintain lab as per their

category (Category 3)3.1.4 Manual on collection, transport,

storage, and handling of specimen

3.2 Safe Laboratory Room3.2.1 Adequate Facilities

Good and proper ventilation Non-slip surfaces (floor & working

areas) Hand-washing facilities

3.2.2 Safety Equipment Personal Protective Equipment

- Gowns- Goggles- Mask- Gloves

Safety devices on laboratory Safety Laboratory Equipment

Biosafety Cabinet Class II

3.2.3 Emergency Equipment Fire extinguishers Emergency showers Eye wash station

3.2.4 Appropriate Procedures Good housekeeping Personal hygiene (handwashing) Laboratory safety protocol


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3.2.5 Proper Storage Area(secured/anchored) Properly stored ordinary

reagents/chemicals Non-corrosive building materials for

acid-containing chemicals and

reagents Dedicated storage for pathogenic

organisms accessible only toresponsible people

3.2.6 Proper Laboratory Holding P3 laboratory - negatively

pressurized environment for highlycontagious organisms

3.2.7 Decontamination Area

Fixed autoclave Mobile autoclave

3.2.8 Knowledgeable Workers

Experienced Trained

IF POSSIBLE: All laboratory doors should be labeledwith emergency contact information. If an accident occursduring office hours, respondents need to know the namesand telephone numbers of people responsible forlaboratory operations. Properly trained and experiencedlaboratory workers have the greatest ability to controllaboratory risks.

4. Emergency Room4.1 Safety of Medical Equipment in Emergency

Room4.1.1 Separate ER

4.1.2 Dedicated supplies and equipment fordiagnosis and treatment

4.1.3 Disposable PPEs (masks, goggles,gowns, caps, gloves, booties)

5. Security and Safety5.1 Provision of Close Circuit TV (CCTV)

cameras with recorder5.2 Secured entrance and exit points5.3 Available appropriate PPEs (gloves, N95

masks, goggles, gowns, booties, caps)5.4 Available dedicated sterilizing equipment

and supplies5.5 Dedicated staff assigned in Isolation

Room/Biological Unit5.6 Signages for restricted areas


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Additional Functional Indicators for HighlyInfectious Diseases

Instruct ion:

Encircle the thumbs-up sign (means Yes or complies completely with what is asked for) and thumbs-down sign (means No or may not comply completely with what is asked for) when assessing thehospital or health facility according to the following indicators. Use the Remarks column to writeessential observations when doing the assessment, especially when the result is No.

1. Site and Accessibility Remarks

1.1 Properly identified/labeled IsolationRoom/Biological Unit

1.2 Directional signages available and properlyfastened

1.3 Admitted cases have separate entrance to

the Isolation room/ER from the rest of thehospital patients and personnel

2. Internal Circulation and Inter-Operability

2.1 There is a dedicated Isolation Room/Biological Unit for highly infectious cases(i.e. SARS, Avian Flu)

2.2 There is a dedicated ER/Consultation Roomfor highly infectious patients away from theusual ER and OPD

2.3 Presence of decontamination areas nearthe entrance at the ER, at the laboratory,and at the Isolation Room/Biological Unit

2.4 Nurses at the Stations can oversee thepatients inside the Isolation Room/BiologicalUnit

2.5 Gender based wards (female, male) andcommon sanitary toilets

2.6 Observe proper zoning: IsolationRoom/Biological Unit must be secured,regulated, and located in the hospital awayfrom the busy wards

2.7 Identified safe perimeter for patients andpersonnel with proper signage (3 metersaway from the door of Isolation Room/Biological Unit)

3. Equipment and Supplies3.1 Dedicated equipment and supplies for the

Isolation Room/Biological Unit/ER3.2 Dedicated portable X ray, ventilators,

diagnostic and treatment tools (i.estethoscope, laryngoscope, BP apparatus,etc)

3.3 Laboratory has bio-safety cabinet with hood3.4 Available special PPEs like N95 masks,

goggles, caps, gowns, gloves, booties, all ofwhich are disposable

3.5 Hand lotion and disinfectants3.6 Proper waste disposal materials/supplies


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4. Hospital Plans4.1 Hospital Contingency Plan for Highly

Infectious Disease Outbreak4.2 Hospital Contingency Plan for Bioterrorism

4.2.1 SOP/Guidelines on InfectionControl

4.2.2 Decontamination Procedures/Guidelines

4.2.3 Bio-safety and Bio-securityGuidelines

5. Hospital Emergency Management Policies,Guidelines, Procedures, and Protocols

5.1 SOP for internal referral of patients5.2 Treatment Guidelines/Protocols for

Emerging/Re-emerging Infections5.3 Procedures for hospital epidemiologic

Surveillance5.4 Procedures for preparing sites for temporary

placement of dead bodies for highly

infectious disease5.5 SOP/Guidelines for food and supplies of

dedicated hospital staff during emergency

6. Hospital Systems

6.1 Logistics Management System6.1.1 System for prioritizing hospital

personnel to be given prophylactic/therapeutic drugs for highly infectiousdiseases in times of drug scarcity

6.1.2 Surveillance System Established hospital diseasesurveillance system for the patientsand personnel

6.1.3 Water Supply System Presence of adequately safe waterat all times even during emergencyfor hygienic purpose, for flushingtoilets and other utilities Presence of alternate source ofwater in case the main supply is cutoff Identified agencies responsible fortimely restoration of water service Supplementary pumping system incase system fails or servicesdisrupted

6.1.4 Electrical System Presence of emergency powergenerator or alternative power foremergency lighting and operation ofessential equipment

6.1.5 Security System Dedicated security personnel Tightened security of the IsolationRoom/Biological Unit, being arestricted area Only authorized personnel areallowed to enter Separate entrance or access route

With proper signages


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10. Availability of medicines, supplies,instruments, and other equipment dedicatedfor highly infectious diseases (SARS, AI)

10.1 Emergency Medicines at the EmergencyRoom and in the critical service areas (OR,RR, ICU, NICU, etc)

10.2 Items for treatment and other supplies10.3 Instruments for emergency procedures10.4 Medical gases10.5 Ventilators10.6 Electro-medical equipment10.7 Life support equipment10.8 Personal Protective equipment for

epidemics (disposable)10.9 Crash cart for cardio-pulmonary arrest10.10 Triage tags and other supplies for

managing mass casualties

11. Monitoring and Evaluation

11.1 Conduct of post-incident evaluation of

emergencies or disasters responded11.2 Conduct of drills


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SECTION III

These are the Codes, Policies and Guidelines from which the indicators in this manual are

based on. Hospitals and health facilities are advised to have a copy of these materials for

reference.

The National Building Code of the Philippines (PD 1096)

The National Building Code of the Philippines, also known as Presidential Decree No. 1096was formulated and adopted as a uniform building code to embody up-to-date and moderntechnical knowledge on building design, construction, use, occupancy and maintenance. TheCode provides for all buildings and structures, a framework of minimum standards andrequirements to regulate and control their location, site, design, quality of materials,construction, use, occupancy and maintenance.

The National Structural Code of the Philippines (5th ed, 2001)

The purpose of this code is to provide minimum standards to safeguard life or limb, propertyand public welfare by regulating and controlling the design, construction, quality of materialspertaining to the structural aspects of all buildings and structures within its juroisdiction.

The provision of this code shall apply to the construction, alteration, moving, demolition,repair, maintenance and use of any building or structure within its jurisdiction, except worklocated primarily in a public way, public utility towers and poles, hydraulic flood controlstructures, and indigenous family dwellings.

The Fifth edition has the following significant revisions:

In Chapter 1. General Design Requirements, major changes in this section include

provisions where building owners are required to get the services of independent recognizedstructural engineers to perform design review for certain structures, and the installation ofrecording accelographs for every building over six storeys (with floor area of 5,500 squaremeter or more), and every building over ten storeys in height regardless of fool area.

In Chapter 2. Minimum Design Loads, revisions of load combinations were made to adoptthe new strength-based seismic forces, and special load combinations to reflect the provisionof the 1997 Uniform Building Code (UBC). Near-source factors are specified in seismic zone4 to recognize the amplified ground motions that occur close to known acyive faults. ThePhilippine Institute of Volcanology and Seismology (PHIVOLCS) issued the maps showing theactive faults throughout the country as reference for determining near-source factors. Alsobasic wind speed are revised based on statistical studies of PAGASA data over 30 years andrecommendations of the sub-committee on Design Loads and Lateral forces and on the

ASCE 7 95 provisions.

In Chapter 4. Structural Concrete, includes significant changes in several aspects ofreinforced concrete design. Shear-governed concrete walls are designed for increased forcesand special detailing requirements are clarified and improved, many of which reflect changesin American Concrete Institute (ACT 318-99).

In Chapter 5. Steel, recommendations to adopt AISC's 1997 Edition of the Seismic Provision

for Structural Steel Buildings (AISC Seismic '97) incorporates on-going development ofseismic design and much of the current knowledge on design and quality assurance followingintensive research and testing in the U.S. Significant issues associated with moment framesand AISC's Seismic Provisions are also addressed. Likewise, important issues andconsiderations on braced frames, eco-centric braced frames, and truss moment frames

following much research and development in recent years are also discussed.


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Philippine Electrical Code

Purpose:

Practical Safeguarding. The purpose of this Code is the practical safeguarding ofpersons and property from hazards arising from the use of electricity.

Adequacy. This Code contains provisions that are considered the minimumrequirements necessary for safety. Compliance therewith and proper maintenancewill result in an installation that is essentially free from hazard but not necessarilyefficient, convenient, or adequate for good service of future expansion of electricaluse.

Intention. This Code is not intended as a design specification nor an instructionmanual for untrained persons.

Volume 1 Ins tal lat ion for Voltages up to 600 volts

Scope: Public and Private Buildings, Electric Generating Plants, Industrial Plants,Transformer Stations, Permanent and Temporary Substations, Airfields, RailwaysSwitchyards, yards, Carnivals and other Lots, Quarries and Mines, Watercraft,

Dockyards, Trailers, Mobile Homes and Recreational Vehicles, Offshore Facilities

Article 1. Definition of Terms, Requirements for Electrical InstallationsArticle 2. Branch Circuit Feeder and Service Calculations, Over-current Protections,

Surge ProtectionArticle 3. Wiring Methods and Materials (Raceways, Boxes, Wires and Cables)Article 4. Wiring Methods for Equipment for General Use (Fixed appliances such as

Space Heating, Motors, Air Conditioning and Refrigeration Equipmentsrated 30 volts and above)

Article 5. Wiring Methods and Materials for Special Occupancies classifiedHazardous Locations (Health Care Facility, Gasoline Dispensing andService Stations, Air Craft Hangars, Marinas, Movie Theaters)

Article 6. Wiring Methods and Materials for Special Equipment (Lifting and Moving

Equipments, Vehicle Charging System, Electric Welders, Audio andAmplification Equipments, Information Technology, X-Ray, Induction andDielectric Heating, Electrical System, Solar Photovoltaic System, FirePumps, Air Field Lighting

Article 7. Wiring Methods and Materials for Emergency SystemArticle 8. Wiring Methods and Materials for communication SystemArticle 9. TablesArticle 10. Wiring Methods and Materials for Watercrafts

Volum e II Instal lat ion for Voltages mo re than 600 volts

Scope: Covers Overhead and Underground Transmission, Distribution and Communication

lines as well as Conductors and Equipments in Electric Supply and Generating Power

Stations. It does not cover installation for commercial and industrial establishmentwhich do not require the sole control of access to the installation by a properly

qualified person.

Fire Code of the Philippines (PD 1185)

The Fire Code of the Philippines (PD 1185) sets the uniform standards and regulations for the

prevention and suppression of fires; for incorporating fire safety design and constructions; and

for the provision of protective and safety devices in buildings, facilities, and structures in order

to effect a meaningful reduction in death and injury to persons, and loss and damage toproperty by fire.


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Republic Act 8495 Philippine Mechanical Code

Republic Act 8495, also known as the Mechanical Engineering Act of 1998 or Mechanical

Code, is the law regulating the practice of mechanical engineering in the Philippines. Its

purpose is to set minimum standards for the design, construction and quality of materials

pertaining to the mechanical works, processes, and equipment of all building, structures,mechanical plants, to safeguard life or limb, property and public welfare.

Republic Act 344 - Accessibility Law

An Act to enhance the mobility of disabled persons by requiring certain buildings, institutions,establishments and public utilities to install and incorporate in such buildings, establishments,institutions or public utility, such as architectural facilities or structural features that shallreasonably enhance the mobility of disabled persons, such as sidewalks, ramps, railings andthe like.

Republic Act 9275 - Philippine Clean Water Act of 2004

The Philippine Clean Water Act of 2004 or R.A. 9275 aims to pursue a policy of

economic growth in a manner consistent with the protection, preservation, and revival of the

quality of our fresh, brackish, and marine waters. To guarantee effective water utilization and

conservation, the Clean Water Act of 2004 has set the standards that would determine how

clean is water; how to achieve it and how important is the role of every citizen, in the public

and private sectors in regulating and minimizing pollution, maintaining environmental policies,

waste managing, environmental education and information recognizing the impacts of human

activity to the health of the water bodies.

Republic Act 9003 - Ecological Solid Waste ManagementAct of 2000

Republic Act 9003 sets the guidelines and targets for solid waste avoidance and volume

reduction through source reduction and waste minimization measures, including composting,

recycling, re-use, recovery, green charcoal process, and others, before collection, treatment

and disposal in appropriate and environmentally sound solid waste management facilities in

accordance with ecologically sustainable development principles. It is equipped with the

proper machinery to carry on the task stated by the law, through the National Solid Waste

Management Commission.

The Act in a nutshell is about- Segregation, Storage and Collection systems; Selection of

Vehicle for Solid Waste Collection; Designing and Planning a Collection System; Operation of

a Transfer Station; Intelligent Service Contracting; Public Education and Awareness; and the

critical part is the Policy Formulation of the Act as well as its enforcement. Under the latter is

the Solid Waste Management Financing, Incentives and Cost Recovery, wherein the money

aspect and proceedings of the Act is discussed.


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Administrative Order No. 2008 - 0021Subject: Gradual Phaseo-ut of Mercury in all Philippine Health Care Facilities and

Institutions

The Department of Health (DOH) provides the following policies and guidelines for the

gradual phase-out of mercury in all Philippine health care facilities. Recognizing theunnecessary risks posed by the continued use of mercury-containing products in the health

care system, the DOH hereby orders that:

1. All Hospitals shall immediately discontinue the distribution of mercury thermometersto patients through the distribution of hospital admission/ discharge kits.

2. All Hospitals shall follow the guidelines for the gradual phase-out of mercury inhealth care facilities described in this document in the timeline specified.

3. All new Health Care Facilities applying for a License to Operate shall submit aninventory of all mercury-containing devices that will be used in their facilities and acorresponding mercury elimination program.

4. All other Health Care Facilities other than hospital shall make a MercuryMinimization Program based on the guidelines set by the Administrative Order.

Documents

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