Safe Hospitals in Emergencies and Disasters: Philippine Indicators

Protect hospitals and health facilities in emergencies and disasters Second edition

Editors
Dr Carmencita A. Banatin Dr Marilyn V. Go Arch Ma. Rebecca M. Peafiel Dr Romeo A. Bituin

DRAFT

Health Emergency Management Staff

Emergency and Humanitarian Action

Department of Health
Manila Philippines

World Health Organization

Regional Office for the Western Pacific Manila Philippines

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

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. All rights are reserved. Subject due to acknowledgement of DOH-HEMS, all the articles in this manual may be freely reviewed, abstracted, reproduced or translated, in part or in whole, for non-commercial purposes only. If the entire work or substantial portions will be translated or reproduced, permission should be requested from the Department of Health-Health Emergency Management Staff.

Project supported by the European Commission through its Humanitarian Aid department
http://ec.europa.eu/echo/index_en.htm

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

Contents
Foreword Francisco T. Duque III Secretary of Health, Republic of the Philippines Preface Acknowledgements Technical Working Committee on Safe Hospitals 5

6 7 8

Section I. Introduction Introduction Safe Hospital Section II. Philippine Indicators Structural Indicators of Safe Hospitals Non-structural Indicators of Safe Hospitals Functional Indicators of Safe Hospitals Additional Non-structural Indicators for Hospitals with Special Functions Additional Functional Indicators for Highly Infectious Diseases Section III. National Codes, Policies and Guidelines The National Building Code of the Philippines (PD 1096) The National Structural Code of the Philippines (5th ed, 2001) Philippine Electrical Code Fire Code of the Philippines (PD 1185) Republic Act 8495 - Philippine Mechanical Code Republic Act 344 - Accessibility Law Republic Act 9275 - Philippine Clean Water Act of 2004 Republic Act 9003 - Ecological Solid Waste Management Act of 2000 Administrative Order No. 2008 - 0021 Gradual Phase-out of Mercury in all Philippine Health Care Facilities and Institutions 39 39 40 40 41 41 41 41 42 12 16 26 31 10 11

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Safe Hospitals in Emergencies and Disasters: Philippine Indicators

Foreword
Every year, many hospitals and health facilities in the country are damaged and destroyed by disasters to which the Philippines has a very high vulnerability. However, the government through the Department of Health has been non-stop in its efforts to ensure that our countrymen are not left without the vital care that they need in the midst of these catastrophes. 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 the Bicol and Visayas regions and in earlier years in the Quezon Province highlight the tremendous 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 are ready to deliver healthcare especially in times of great suffering and need. To achieve and maintain quality of health care during health emergencies, these personnel will have to be supported by enabling them to work in safe health facilities where they can do what they do best --- save lives and limit injuries among disaster victims. Among the objectives of the global campaign for "Hospitals Safe from Disasters" is to reinforce both the structural and non-structural resilience of health care facilities and to ensure that they continue to function after a disaster strikes. The first points to structures in safe geographical locations; while the latter refers to health personnel and emergency preparedness plans which will keep hospitals operational in the wake of disasters. By applying current knowledge and exercising strong political leadership, it is possible to protect health facilities from disasters, even in resource-constrained settings like the Philippines. The Hyogo Framework for Action calls for government support to ensure that existing and new health care facilities will be re-structured or engineered to remain functional at the height of an emergency. Therefore, I commend the Steering Committee and Technical Working Groups who painstakingly labored in consolidating indicators into this manual that will guide all Hospital Administrators in the pursuit of one vision - to make every hospital safe from disaster and accessible at all times for all disaster victims. Likewise, this Manual signifies the continuing partnership between the Department of Health, World Health Organization, and other members of the health sector in making our health system strong, reliable and resilient for the Filipino people.

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

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

Preface
This Manual emanated from a research concept by the Department of Health-Health Emergency Management Staff (DOH-HEMS) to assess hospitals structural, non-structural and functional elements in times of emergencies and disasters. This eventually became a project entitled, Capacity Assessment of Metro Manila Tertiary Hospitals in Responding to Emergencies and Disasters," which was funded by the Health Policy Development and Planning Bureau (HPDPB), coursed to the National Capital Region, and started in October 2008. An Assessment Team was organized to oversee the implementation of the research project in 25 hospitals in the National Capital Region. Meanwhile, the Department Personnel Order 0254 series of 2008 mandated the Steering Committee to provide assistance and technical guidance to the different Technical Working Groups which determined, defined, and finalized the structural, non-structural, and functional indicators through a series of write-shops and critiquing sessions. This body came up with a Manual on Safe Hospitals' Indicators which was supported by the National Center for Health Facility Development (DOH-NCHFD), the Association of Hospital Administrators and the World Health Organization - Western Pacific Regional Office (WHO-WPRO). After the research implementation, the sets of indicators found on the Manual were revisited and revised through several write-shops with the Technical Working Groups. The output of which is this second edition. In this new version, the structural, non-structural and functional indicators which were deemed important and most applicable to the country setting were retained, while the others were either revised or removed. National codes, policies and guidelines are also included in this new version as additional resource materials for the readers and users. This Manual neither provides nor claims to be the definite and only guide to follow in ensuring safety in health facilities. Readers are encouraged to other complementary references and documents. The contributors recognize that this Manual is an evolving reference and may need to be adapted to different contexts considering that some indicators may not be necessary, appropriate nor tailored to some hospitals or health facilities.

Health Emergency Management Staff Department of Health

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

Acknowledgements
The revision for this second edition of the Philippine Indicators for Safe Hospitals in Emergencies and Disasters was done throug h the efforts of the Assessment Team composed of the following individuals: Dr Joseph Bacareza; Dr Jose Edgar Balita; Engr Aida Barcelona; Dr Romeo Bituin; Ms Josefina Blanco, RN; Arch Allen Buenaventura; Dr Emmanuel Bueno; Engr Israel Camposano; Mr Elmer Benedict Collong, RMT; Arch Leonard Cordero; Dr Ma. Paz Corrales; Arch Corazon Cruz; Ms Aida Cuadra, RN; Arch Ferdinand dela Paz; Dr Alex Dimapilis; Mr Philip Du; Engr Marilyn Ebuen; Arch Christopher Espina; Dr Jasminda 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; Mr Gerardo Lirag, RN; Engr Jesus Lorenzo; Arch Prosperidad Luis; Engr Nilo Marayag; Dr Rommel Menguito; Dr Joseph Nocom; Dr Antoinette Pacapac; Ms Celia Pangan, RN; Engr Jennifer 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 technical expertise in conducting the research project; Dr Asuncion Anden and Dr Irma Asuncion for overseeing 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, Florinda Panlilio and Glenda Ensigne for the administrative support; Zando Escultura for the cover design; 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 Humanitarian Action of the World Health Organization - Western Pacific Region through the technical supervision of Dr Arturo Pesigan, technical assistance of Dr Lester Sam Geroy and administrative support of Ms Glessie Salajogg. This project was supported by the European Commission through its Humanitarian Aid department.

Health Emergency Management Staff Department of Health

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

Technical Working Committee on Safe Hospitals

Advisers
Dr Mario Villaverde Dr Soe Nyunt-U Dr Arturo Pesigan Undersecretary of Health, Department of Health (DOH) WHO Representative to the Philippines WHO Western Pacific Regional Office,

Emergency and Humanitarian Action Steering Committee

Dr Mario Villaverde DOH Policy and Standard Development Team for Service Delivery (PSDTSD) DOH Health Emergency Management Staff (DOH-HEMS) DOH National Center for Health Facility Development (DOH-NCHFD) DOH Bureau of Health Facilities and Services (DOH-BHFS) Jose Reyes Memorial Medical Center Quirino Memorial Medical Center National Center for Mental Health Philippine Health Insurance Corporation (PHIC)

Dr Carmencita Banatin Dr Criselda Abesamis

Dr Ma. Alicia Lim Atty Nicolas Lutero III Dr Rosalinda Arandia Dr Bernardino Vicente Dr Shirley Domingo

Technical Working Group for Structural Indicators

Arch Ma. Rebecca Peafiel Engr Maximo Adan Arch Christopher Espina Arch Corazon Cruz Engr Fernando Germar Engr Michael Abundo Engr Peter Lim Engr Ricardo Balog Engr. Ronaldo Ison Engr Anthony Pimentel Engr Jorge Genota Arch Herminio Prudente DOH NCHFD DOH NCHFD UP College of Architecture UST College of Architecture UP College of Engineering UP College of Engineering UST College of Engineering UST College of Engineering Association of Structural Engineers of the Philippines Association of Structural Engineers of the Philippines Association of Structural Engineers of the Philippines United Architects of the Philippines 7

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

Technical Working Group for Non-structural and Functional Indicators

Dr Roland Cortez Dr Marilyn Go Dr Arturo Cabanban Dr Arnel Rivera Dr Romeo Bituin Dr Edmundo B. Lopez Dr Joseph Bacareza Arch Prosperidad Luis Engr Carlos Bariring Engr Abraham Castanaga Engr Ramon Alfonso Dr Ma. Theresa Vera Engr Bayani San Juan Engr William Juan East Avenue Medical Center DOH-HEMS San Lazaro Hospital DOH-HEMS Dr. Jose Fabella Memorial Hospital Las Pias General Hospital and Satellite Trauma Center Bureau of Fire Protection United Architects of the Philippines DOH-NCHFD DOH-NCHFD Tondo Medical Center DOH-BHFS DOH Bureau of Health Devices and Technology Institute of Integrated Electrical Engineers

Technical Working Group for Advocacy

Ms Angelina Sebial Dr Victor dela Cruz Dr Ricardo DG Lustre Dr Ruben Flores Dr Edgardo Javillonar Dr Mario Panay Dr Isabelita Estrella Dr Robert Enriquez Dr Teodoro Castro DOH National Center for Health Promotion Tondo Medical Center Amang Rodriguez Medical Center Dr. Jose Fabella Memorial Hospital Dr. Jose N. Rodriguez Memorial Hospital Valenzuela Medical Center San Lorenzo Ruiz Womens Hospital National Childrens Hospital Philippine Orthopedic Center

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

SECTION I

Introduction
Hospitals and other health facilities should be a source of strength during emergencies and disasters. They should be ready to save lives and to continue providing essential health services such as laboratories, medicines, treatment and rehabilitation. They should also be the symbol of hope during these critical times and contribute to the communitys sense of security and well-being. However, there are circumstances where hospitals and health facilities are made vulnerable, especially during an emergency or disaster. The hospitals or health facilities may be damaged or destroyed; or their capacities stretched to the limit by the surge in number of patients seeking health services and support. The Hyogo Framework for Action in 2005 emphasizes the importance of "making hospitals safe from disasters by ensuring that all new hospitals are built with a level of resilience that strengthens their capacity to remain functional in disaster situations and implement mitigation measures to reinforce existing health facilities, particularly those providing primary health care. The roles of hospitals and health facilities in emergencies and disasters cannot be underestimated. The World Health Organization, in support of the World Disaster Reduction Campaign on Hospitals Safe from Disasters (2008-2009) aims to raise awareness in making hospitals safe in emergencies and from disasters: Protect the lives of patients and health workers by ensuring the structural resilience 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 also describes the essentials in supporting safe hospitals. It also lists the structural and nonstructural indicators as well as functional indicators which every hospital and health facilities should consider as standards to be achieved. This manual, Safe Hospitals in Emergencies and Disasters: Philippine Indicators is a guide to help assess the vulnerability and resilience of hospitals and health facilities to ensure patient safety and staff security, and guarantee continuous operations in times of emergencies and disasters. This manual is intended for people who recognizes the important role of hospitals and health care facilities during emergencies and disasters. These people include: hospital administrators, health emergency management staff, and health professionals. The sets of indicators listed in this manual were arrived at, after a comprehensive review of existing codes and guidelines which are related to structures, non-structural elements and functions of hospitals and health facilities. This manual neither provides nor claims to be the definite and only guide to follow in ensuring safety in health facilities. This is a work in progress and subsequent revisions will be made accordingly to ensure that hospitals and health facilities are safe in emergencies.

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

Safe Hospital
Safe hospitals are health facilities whose services remain accessible and functioning, at maximum capacity and within the same infrastructure, during and immediately following disasters, emergencies or crises. A safe hospital . . . 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 their vulnerability, which includes: Buildings: The location and design specifications and the resiliency of the materials used 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 beds frequently decreases even as the demand for emergency care increases. Medical and support staff: The loss or unavailability of personnel disrupts the care of the injured; hiring outside personnel to sustain the response capacity adds to the overall economic burden. Equipment and facilities: Damage to non-structural elements can sometimes surpass the cost of the structure itself. Even when the damage is less costly, it can still force the hospital to halt operations. Basic lifelines and services: A hospitals ability to function relies on lifel ines and other basic services such as electrical power, water and sanitation, and waste treatment and disposal. When some services are affected, the performance of the entire hospital suffers.

Supporting safe hospitals entails vision and commitment to ensure that they are fully functional especially in times of emergencies and disasters. There should be involvement of various 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 critical facilities to increase levels of protection

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

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SECTION II

Structural Indicators of Safe Hospitals

The structural elements of health facilities, such as foundations, columns, beams, slabs, loadbearing walls, braces, and trusses, are essential elements that determine the overall safety of the building. The following is a list of structural indicators for safe hospitals in the Philippines based on the (1) National Structural Code of the Philippines (NSCP) Revised 2001 Guidelines, (2) National Building Code Revised 2006 Guidelines and (3) Association of Structural Engineers of the Philippines (ASEP) Recommended Guidelines on Structural Design Peer Review of Structures. This can be used as a checklist to identify strengths and vulnerabilities when planning for new construction or reviewing existing hospital or health facility. Instruction:
Encircle the thumbs-up sign (means Yes or complies completely with what is asked for) and thumbsdown 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 write essential observations when doing the assessment, especially when the result is No..

1. Buildings must be located in highly suitable sites and away from areas that will diminish its accessibility and threaten its operations in times of emergencies. 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): 5kms and nearer to the fault line 1.2.2 Medium Risk (Zone 2): over 5kms-10kms to the fault line 1.2.3 Low Risk (Zone 3) : over 10kms -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: 250kph 1.7.2 Medium Risk: 200kph 1.7.3 Low Risk: 175kph 1.8 Not near active volcano

Remarks

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)

2. The design of the hospital structural system must strictly conform with the requirements of the National Structural Code of the Philippines (NSCP, 2001); especially for wind and earthquake design (per structural computations). 2.1 Foundation 2.2 Columns 2.3 Beams 2.3.1 Underside of arches, balconies or overhangs free from structural cracks and falling cement plasters 2.3.1 Other fixtures such as ceiling liner are properly fastened or attached 2.4 Floor and Roof Slabs Soffit or the underside of floor slab has no cracks and 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 and insulation materials, slope, type of connection, condition, thickness at least gauge 24 or 26 2.8.3 Considered regional location, e.g. in Bicol areas it should be heavily fastened or anchored 3. The shape and form of the hospital building must be simple and regular. 3.1 Hospital has simple shape and is symmetrical in both the lateral and longitudinal axes (e.g. square or rectangle) making it resilient when subjected to stress such as that produced by an earthquake 3.2 Number of building floors (storeys) less than five floors

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

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3.3 Building form (Elevations) 3.3.1 3.3.2 3.3.3 3.3.4 Not top heavy No cantilevers Balanced massing Balanced loading

4. The hospital structural system must be continually checked and reviewed during construction and the entire period of occupancy. Structural design of building constructed before 2001 should have undergone any of the following: 4.1 Peer review using Association of Structural Engineers of the Philippines (ASEP) guidelines 4.2 Rapid evaluation using DPWH Guidelines 4.3 Structural certification by qualified structural engineer 5. Cracks on the hospital structural system must be immediately investigated and addressed especially if they appear after an earthquake. Major structural cracks or visible damages does not appear on any of the following structural members: 5.1 Foundation (Investigate for any settlement, tilting of building) 5.2 Columns (Investigate end and midpoint columns) 5.3 Beams (Investigate end support and mid-span) 5.4 Floor slabs 5.5 Trusses (Investigate sagging, movement, corrosion, rotting) 5.6 Walls and partitions 5.7 Shear Walls

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

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6. As-Built/As Found Plans of all hospital buildings must be kept on record and readily available for reference purposes. 6.1 Architectural plans 6.2 Structural Plans including structural computations 6.3 Electrical Plans including electrical computations 6.4 Sanitary Plans 6.5 Mechanical Plans 6.6 Electronics and Communications Plans 7. Building Permit and Occupancy Permit issued by the building official are prerequisites for the start and occupancy respectively of any new building construction or renovation; therefore should have the following: 7.1 Building Permit per Project 7.2 Occupancy Permit per Project 7.3 Fire Safety Permit 7.4 Elevator Permit where applicable 7.5 Generator Permit where applicable 7.6 Other Permits as needed

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

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Non-Structural Indicators of Safe Hospitals

The non-structural elements are all other elements that, without forming part of the resistance systems, enable the facility to operate. They include architectural elements, equipment and contents 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 and services or lifelines. As with the structural indicators, this list can be used to identify strengths and vulnerabilities when planning for new construction or reviewing existing hospital or health facility. Instruction:
Encircle the thumbs-up sign (means Yes or complies completely with what is asked for) and thumbsdown 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 write essential observations when doing the assessment, especially when the result is No..

1. Safety of Ceilings 1.1 Ceiling materials such as fiber cement , gypsum board, or glass securely fastened 1.2 Ceilings made of wood are coated/treated with fire retardant paints and termitecontrolled 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 transparent wired glass mounted in steel frames 2.3 In the event of power failure, poweroperated doors may be opened manually to permit 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 less than 112 cm. and not more than 122 cm. (Note: if power operated doors in the event of power failure the door may be opened manually to permit exit travel) 2.6 Doors in rooms below 30 persons occupant load capacity single door 112 cm wide 2.7 Doors in rooms more than 30 persons occupant load capacity (conference rooms, function rooms),112 cm wide, remotely located from each other, swing out

Remarks

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Safe Hospitals in Emergencies and Disasters: Philippine Indicators

2.8 Smoke partition doors located along hallways and corridors should be double swing, per groups of rooms/section, for compartmentation 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 so arranged that they can be locked only from the corridor side. Such locks arranged to permit exit from room by a simple operation without the use of key 2.11 Any device or alarm installed to restrict the improper use of a means of egress so designed and installed that it cannot, even in case of failure, impede or prevent emergency 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 normally closed as a means of egress, such as a door to a stair or horizontal exit, provided with a reliable self closing mechanism, and shall not at any time be secured in the open position. A door designed to be kept normally closed shall bear a sign as follows: FIRE EXIT, KEEP DOOR CLOSED 3. Safety of Windows and Shutters 3.1 Windows have wind and sun protection devices (e.g. sun baffles) 3.2 Window grilles to secure the safety of the patient, provided with fire exit opening 3.3 Windows are leak-proof 3.4 Windows which could be mistaken for doors have protective barriers or railings 3.5 All glass panels or windows are made of tempered glass or with appropriate thickness or provided with protective films 4. Safety of Walls, Divisions and Partitions 4.1 Exterior walls meet the fire resistance rating of 2 hours 4.2 Interior walls made of fire-resistive materials and from floor to floor 4.3 Smoke-proof stairs, lobbies and vestibules are made of non-combustible materials 4.4 Partitions for fire zones are fire-resistive, floor-to-floor and compartmented

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

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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 properly fastened/secured 6. Safety of Floor Coverings 6.1 Non-slippery floor without crevices in all clinical/service areas 6.2 Durable floor materials 6.3 Fire-resistive interior floor materials

7. Safety of Lifeline Facilities 7.1 Electrical System 7.1.1 Electrical system must conform with the Philippine Electrical Code (PEC) requirements for health facilities except for some provisions as may be required by the endusers 7.1.2 Emergency generator has the capacity to meet 100% of hospital demand (provision for back-up electrical system to include aircon units, and stockrooms) 7.1.3 Generator housing or power house made of reinforced concrete 7.1.4 Generator housing or power house elevated from the ground line 7.1.5 Generators and other vibrating equipment can be fixed by special brackets which allow some movement but prevent them from overturning 7.1.6 Non-vibrating and silent type generators 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 in bath/shower rooms and in wet or damp locations 7.1.11 All convenience outlets (COs) provided with grounding pole/type 7.1.12 Ducting system/conduits Polyvinyl Chloride (PVC) for power and lighting; Rigid Steel Conduit (RSC)

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Safe Hospitals in Emergencies and Disasters: Philippine Indicators

7.1.13 7.1.14 7.1.15

7.1.16 7.1.17

or Intermediate Metal Conduit (IMC) for fire alarm and detection systems, telephone, intercom, Closed-circuit (CCTV), Cable TV (CATV), computer network data lines Adequate lighting in all areas of the hospital Exterior electrical system installed underground Functional electrical and emergency lights with battery backup in all areas Energy-saving Compact Flourescent Lighting (CFL) Non-mercury bulb/lights

7.1.18 Automatic monitoring system installed (Extension wires/cord unplugged 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 system installed in the hospital grounds 7.1.21 All electrical systems/rooms protected with appropriate chemical type automatic fire suppression units 7.1.22 Explosion-proof switch and outlets for hazardous areas 7.1.23 Antennas and lightning rods protection terminals with bracing/support for safety 7.1.24 Lightning arrester provided

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7.2 Communication System 7.2.1 Radios have back-up direct current power source (battery) 7.2.2 Presence of back-up communication system 7.2.3 Communication equipment and cables secured with anchors and braces 7.2.4 Alarm signalling system arranged so that the normal operation of any required alarm initiating device will automatically transmit an alarm to the nearest fire station or to such other outside assistance as may be available 7.2.5 Exterior communication systems installed underground

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

7.3 Domestic Water Supply System 7.3.1 Water storage tank has sufficient reserve to satisfy the hospital demand 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 storage tank, or fire truck delivery 7.3.4 Fusion-weld pipes or galvanized iron pipes, valves, and fittings are free from breakage, leaks and free from harmful agents 7.4 Medical and Industrial Gases (oxygen, nitrous oxide, etc.) System 7.4.1 Hospitals using pipe-in medical gas should have minimum storage of 3 days 7.4.2 Hospitals using individual cylinders should have minimum storage of 3 days 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, vandalism and pilferage 7.4.6 Ensured the safety of medical gas provided with an audio-visual alarm distribution 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 fire at the OR complex, zone valve can be shut off) 7.4.13 Secured back-up oxygen tanks in case of emergency patient evacuation 7.4.14 Industrial gases located outside the building and provided with automatic 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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Safe Hospitals in Emergencies and Disasters: Philippine Indicators

processes or storage area, such as boiler room, motor pool, electrical rooms, and housekeeping rooms. 7.4.17 Automatic gas leak detection system interconnected with the automatic fire alarm system 7.5 Fire Suppression System 7.5.1 Detection, alarm and extinguishing systems 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 Accredited monitoring agency 7.5.4 Heat and Smoke Detection installed in all areas 7.5.5 Smoke detectors must be spaced not further apart than nine meters on center and more than four and six-tenths (4.6) from any wall 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), Hydrochlorofluorocarbon (HCFC),or Fluoroethane 36 used 7.5.7 Provided with wet standpipe system with complete accessories for building more than 5-storey 7.6 Emergency Exit System 7.6.1 Every floor of the building must have at least 2 emergency exits remote 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, and with panic bar hardware (of 7 kilograms or less pressure) 7.6.4 The floors of beams of egress are illuminated at all points including angles and intersections of corridors and passageways, landings of stairs and exit doors with bulbs of not less than one thousandth (0.001) lumens per square centimetre 7.6.5 Illumination system of the exits is not battery-operated 7.6.6 Emergency lighting facilities maintain the specified degree of illumination in the event of failure of

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Safe Hospitals in Emergencies and Disasters: Philippine Indicators

7.6.7

7.6.8

7.6.9

the normal lighting for a period of at least half of an hour Illuminated EXIT signs distinctive in color, reliable source, located just above the door frame Size of Exit Signs plainly legible letters not less than fifteen centimetres high with the principal strokes of letters not less than nineteen millimeters wide Luminous directional exit signs located one foot above floor level leading to the nearest fire escape route

8. Heating, Ventilation and Air Conditioning (HVAC) Systems in Critical Areas 8.1 Provide adequate bracing for pipes and ducts 8.2 Leak-free pipes, valves, and fittings 8.3 Anchored central heating and/or hot water equipment 8.4 Anchored air-conditioning equipment 8.5 Safety enclosures or guards for rotating parts of HVAC equipment 8.6 Fire-stopping materials for all pipes and ducts 9. Medical and Laboratory Equipment and Supplies used for Diagnosis and Treatment 9.1 With color coded sign: FOR PRIORITY IN SAVING DURING EVACUATION 9.2 Medical Equipment in operating rooms and recovery 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 and that table on cart wheels are locked 9.3 Radiological Equipment and Other Support Devices on the Radiology Department (X-ray units, ultrasound scanners, CT scanners, MRI scanners) 9.3.1 Heavy and movable equipment anchored or bolted on the floor (Xray machine) or to the wall 9.3.2 Available steel frames for securing of equipment 9.3.3 Adequately shielded room (radiation protection, radiofrequency, magnetic fields, etc.) 9.3.4 Air conditioned room with controlled humidity 9.3.5 Safe from flooding

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Safe Hospitals in Emergencies and Disasters: Philippine Indicators

9.4 Laboratory Equipment and Other Support Devices for the Laboratory Department/ Services 9.4.1 Supplies and contents of laboratories secured on shelves and in racks. (Anchor the cabinets to the walls and strap the shelves) 9.4.2 Safe and secured storage of culture organisms/media 9.4.3 Available standard decontamination area (fixed/mobile) 9.4.4 Waste water connected to neutralization tank before disposal to 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 wheel lock or anchor 9.5.2 Equipment and accessories needed for treatment and placed near the bed are supported, anchored or fixed 9.5.3 Supplies and contents of medical cabinets secured on shelves and in racks. (Anchor and strap the shelves to the wall) 9.6 Medical Equipment in ICU Areas 9.6.1 Each bed is provided with wheel lock or anchor 9.6.2 Equipment and accessories are supported, anchored or fixed 9.6.3 Anchor bolts should be provided on the walls in appropriate locations so that the equipment can be removed and fixed in a safe place when not in use 9.7 Medical Equipment in the Pharmacy Departments 9.7.1 Supplies and contents of pharmacy cabinets are secured on shelves and in racks. (Anchor the cabinets to 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 Sterilization Units 9.8.1 Supplies and contents of sterilization unit cabinets should be secured 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 to the wall (e.g., autoclave) 9.9 Medical Equipment in the Wards 9.9.1 Each bed is provided with wheel lock or chains 9.9.2 Equipment and accessories must be supported, anchored or fixed 9.9.3 Equipment on roller trolleys must have proper anchoring system using hooks and chains, and can be attached 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 that ward in times of emergencies) for proper / continuous management of patients 9.10 Equipment and Other Support Devices in Nuclear Medicine Department and Radiation Therapy Units (including Chemical/Poisoning) 9.10.1 Adequately shielded room 9.10.2 Airconditioned room 9.10.3 Proper storage, handling and disposal of chemicals and radioactive materials and wastes 9.10.4 Equipment and accessories needed for treatment and placed must be supported, 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 to sewerage 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, radiopharmaceuticals and other

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diagnostic kits 9.10.11 Asbestos free 9.10.12 Proper anchorage of equipment and the materials used for the attachments do not cross react with the chemical agents 9.10.13 Presence of the following safety equipment: Shields Protective clothing Tools for remote handling Containers for radioactive materials 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 for inspection such as metal detectors

10. Safety of Personnel and Patients 10.1 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 for patients and personnel on what to do during emergencies/disasters

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Functional Indicators of Safe Hospitals

Instruction:
Encircle the thumbs-up sign (means Yes or complies completely with what is asked for) and thumbsdown 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 write essential observations when doing the assessment, especially when the result is No.

1. Site and Accessibility 1.1 Hospital is located along/ near good roads readily accessible to the community with adequate 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, industrial plants, disposal plants. 1.3 The location of the hospital shall comply with all zoning regulations and ordinances 1.4 There shall be no road obstructions leading to the hospital

Remarks

25

1.5 There should be access to more than one road (alternative routes) 1.6 There should be separate ingress and egress routes 1.7 Well paved access roads should be properly identified/labelled 1.8 Available, safe and well lighted parking lots 1.9 Provide available parking lots for the disabled near the main entrance 1.10 Available covered walk way, to interconnect service areas 1.11 Directional signages are available and properly fastened 1.12 Outdoor stairs must have enclosed and protected openings 1.13 All entrances, especially main and emergency entrances, shall be provided with canopies for protection from the elements 1.14 Provide entrance ramps using ratio of 1:12

Safe Hospitals in Emergencies and Disasters: Philippine Indicators

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 nearest to the entrance (e.g., OPD, ER, etc) 2.1.2 Departments that receive their workload from the wards or inner zones should be located closer to these zones (Radiology, Laboratory) 2.1.3 In-patient departments should be in the inner zones 2.2 General service areas are located in separate structures such as power plant, boilers, water storage facilities, laundry area, and pump house 2.3 Areas to be converted to spaces for patients during disasters properly identified with adequate lighting, electrical outlets, water supply and toilets/bathrooms 2.4 Diagnostic areas with heavy equipment are preferably at the ground floor but safe from flooding 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 2nd and 3rd floors only 2.10 Use of elevators as access for 4th 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 per ward at least two sets 3.2 Basic equipment should be available at treatment area at least two sets 3.3 Basic emergency supplies available 3.4 Diagnostic and therapeutic basic equipment are functional and properly labelled 3.5 Stock pile of medical supplies good for at least one week 3.6 Basic PPEs are available at the ER 3.7 PPEs are available in all service areas

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Safe Hospitals in Emergencies and Disasters: Philippine Indicators

4. Hospital Emergency Preparedness, Response and Recovery Plan approved by the Chief of Hospital / Director, disseminated, tested and updated 4.1 Operational Plan and Contingency Plans for Internal or External Disasters 4.1.1 The hospital has available, accessible, tested, updated and disseminated Hospital Emergency Preparedness, Response and Recovery Plan which contains Hazard Prevention and Mitigation Plan, Vulnerability Reduction Plan and Capacity Development Plan. 4.1.2 The hospital has contingency plans for medical treatment during different types of disasters such as Typhoon, Floods, Earthquake, Fire, Disease outbreaks, Emerging and Re-emerging Infections/Diseases, Biological, Chemical, Radio-nuclear terrorism, Control of Infections acquired during hospitalization, pathogens with epidemic potential, etc. 5. Hospital Emergency Management Systems, Procedures and Protocols written and attached/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 of patients 5.4 Emergency response procedure/ guidelines 5.5 Treatment guidelines/protocols 5.6 Special administrative procedures for disasters 5.7 Procedures for resource mobilization (funds, logistics, human resources) to include shifting of duties during emergencies 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 and preventive 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 logistic support 5.15 SOP/guidelines for food and supplies of hospital staff during emergency 5.16 Measures to ensure well being of additional personnel mobilized during emergency 5.17 Guidelines for mental health and psychosocial support 5.18 Guidelines on drills / simulation exercises Fire Other disasters 5.19 SOP for handling of volunteers especially during emergencies/disasters 5.20 SOP for hospital security system during emergencies 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 Fire Brigade which has undergone seminar/training on Fire Drill/ Fire Evacuation Drill/ Earthquake Drill 5.22.2 Conduct of regular Fire Drills/ Fire Evacuation Drill 5.22.3 Conduct of fire mitigation prevention and suppression training 5.22.4 Fire fighting equipment available 5.22.5 Conduct of preventive maintenance of fire fighting equipment 5.22.6 Available Fire Exit Plan and provision of Fire exit/evacuation plan in conspicuous places at every floor level 5.23 Users/Operations manual for all medical equipment 6. Availability of Back-up System for the following critical services 6.1 Back-up generators 6.2 Alternate source of drinking water 6.3 Fuel reserves 6.4 Medical gases 6.5 Wastewater Treatment 6.6 Solid Waste Treatment 7. Human Resources 7.1 Organization of Hospital Disaster Committees and Emergency Operation Center 7.1.1 Crisis Management Committee Committee lower than the Executive Committee, with technical expertise, who could give advice to the Executive Committee regarding crisis/ emergency/ disaster management

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7.1.2

7.1.3

7.1.4

7.1.5

Emergency Response Team led by a designated Hospital Emergency Management Coordinator and composed of Physicians, Nurses, Emergency Management Technician (EMT) trained staff, Paramedics, trained Ambulance Driver on emergency/disaster Health Emergency Planning Group responsible for the development of Health Emergency Preparedness, Response and Recovery Plan and other hospital response plans Safety Committee headed by a Safety Officer. The committee is in charge of promoting safety in the hospital from all types of hazards Hospital Operation Center headed by the Hospital Emergency Management Coordinator (incharge of monitoring incidents of emergency or disaster, dispatching of response teams, mobilizing other resources for emergency) operational 24 hrs/day 7days/week. It has a designated office/unit with personnel equipped with computer system, directories, communication facilities (with alternate in case the system bogs down)

7.2 Capability Building of Personnel 7.2.1 100% of health workers trained in Basic Life Support and Cardiopulmonary Resuscitation 7.2.2 100% of health workers trained in Standard First Aid 7.2.3 Emergency Room medical staff trained in Advance Cardiac Life Support and Pediatric Advance Cardiac Life Support 7.2.4 Hospital Responders trained in Emergency Medical Responders Course Incident Command System (ICS), Mass Casualty Incident (MCI) 7.2.5 Hospital managers are trained in Hospital Emergency Incident Command System (HEICS) 7.3 Drills and Exercises Conducts of Fire drills at least twice a year 7.3.2 Conducts of simulation drills or exercises at least once a year 8. Monitoring and Evaluation 8.1 Conducts post-incident evaluation of emergencies or disasters (responded to) 7.3.1

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Additional Non-Structural Indicators for Hospitals with Special Functions

Instruction:
Encircle the thumbs-up sign (means Yes or complies completely with what is asked for) and thumbsdown 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 write essential observations when doing the assessment, especially when the result is No.

1. Hospital For Highly Infectious Diseases 1.1 Isolation Room/ Biological Unit/Negative Pressure 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 type of the ante room and the room of the patient, tightly closed 1.1.4 Leak proof ceiling, windows and doors 1.1.5 With signage ISOLATION 1.2 Divisions/Partitions 1.2.1 Isolation room has an ante room for dressing with Personal Protective Equipment (PPE) 1.2.2 Ante room has lavatory and PPE rack 1.3 Floor Covering 1.3.1 Reinforced concrete 1.3.2 Non-slippery floor tiles without crevices 1.4 Attachments 1.4.1 Heating, Ventilation and Air Conditioning (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; while the faucet is sliding that can be operated/ opened by pushing of the elbow

Remarks

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Safe Hospitals in Emergencies and Disasters: Philippine Indicators

 Color coded trash bins Refrigerator near the Nurses Station for storage of biological specimens 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 for inside and outside communication 1.5.2 Water Supply System Safe and adequate water supply in all areas Water tank storage has sufficient reserve to satisfy the hospital demand for three days Water containers for storage in the ante 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 related equipment 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 source five thousand lumens (0.005) per square centimeters Provide luminous directional exit signs located one foot or below floor level 1.6 Heating, Ventilation and Air Conditioning Systems 1.6.1 Negative pressure room 1.6.2 Exhaust system with filter that exits into the open air far from human activity 1.6.3 Airtight

2. Operating Room and Recovery Room 2.1 Medical and Laboratory Equipment and Supplies used for Diagnosis and Treatment

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2.1.1 Medical Equipment in Operating Room and Recovery Room Dedicated equipment mounted on rollers or roller trolleys must be anchored or fastened near the operating table during operations and can be removed afterwards Lamps, equipment for anesthesia and surgical tables are secured and table or cart wheels are locked Equipment on roller trolleys must have proper anchoring system using hooks and chains, and can be attached 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 Biosafety and Bio-security) 3.1 Safety of Laboratory Equipment 3.1.1 Safe washing area 3.1.2 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 Room 3.2.1 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 to responsible people 3.2.6 Proper Laboratory Holding P3 laboratory - negatively pressurized environment for highly contagious organisms 3.2.7 Decontamination Area Fixed autoclave Mobile autoclave 3.2.8 Knowledgeable Workers Experienced Trained
IF POSSIBLE: All laboratory doors should be labeled with emergency contact information. If an accident occurs during office hours, respondents need to know the names and telephone numbers of people responsible for laboratory operations. Properly trained and experienced laboratory workers have the greatest ability to control laboratory risks.

4. Emergency Room 4.1 Safety of Medical Equipment in Emergency Room 4.1.1 Separate ER 4.1.2 Dedicated supplies and equipment for diagnosis and treatment 4.1.3 Disposable PPEs (masks, goggles, gowns, caps, gloves, booties) 5. Security and Safety 5.1 Provision of Close Circuit TV (CCTV) cameras with recorder 5.2 Secured entrance and exit points 5.3 Available appropriate PPEs (gloves, N95 masks, goggles, gowns, booties, caps) 5.4 Available dedicated sterilizing equipment and supplies 5.5 Dedicated staff assigned in Isolation Room/Biological Unit 5.6 Signages for restricted areas

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Additional Functional Indicators for Highly Infectious Diseases

Instruction:
Encircle the thumbs-up sign (means Yes or complies completely with what is asked for) and thumbsdown 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 write essential observations when doing the assessment, especially when the result is No.

1. Site and Accessibility 1.1 Properly identified/labeled Isolation Room/Biological Unit 1.2 Directional signages available and properly fastened 1.3 Admitted cases have separate entrance to the Isolation room/ER from the rest of the hospital 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 Room for highly infectious patients away from the usual ER and OPD 2.3 Presence of decontamination areas near the entrance at the ER, at the laboratory, and at the Isolation Room/Biological Unit 2.4 Nurses at the Stations can oversee the patients inside the Isolation Room/Biological Unit 2.5 Gender based wards (female, male) and common sanitary toilets 2.6 Observe proper zoning: Isolation Room/Biological Unit must be secured, regulated, and located in the hospital away from the busy wards 2.7 Identified safe perimeter for patients and personnel with proper signage (3 meters away from the door of Isolation Room/ Biological Unit) 3. Equipment and Supplies 3.1 Dedicated equipment and supplies for the Isolation Room/Biological Unit/ER 3.2 Dedicated portable X ray, ventilators, diagnostic and treatment tools (i.e stethoscope, laryngoscope, BP apparatus, etc) 3.3 Laboratory has bio-safety cabinet with hood 3.4 Available special PPEs like N95 masks, goggles, caps, gowns, gloves, booties, all of which are disposable 3.5 Hand lotion and disinfectants 3.6 Proper waste disposal materials/supplies

Remarks

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Safe Hospitals in Emergencies and Disasters: Philippine Indicators

4. Hospital Plans 4.1 Hospital Contingency Plan for Highly Infectious Disease Outbreak 4.2 Hospital Contingency Plan for Bioterrorism 4.2.1 SOP/Guidelines on Infection Control 4.2.2 Decontamination Procedures/ Guidelines 4.2.3 Bio-safety and Bio-security Guidelines 5. Hospital Emergency Management Policies, Guidelines, Procedures, and Protocols 5.1 SOP for internal referral of patients 5.2 Treatment Guidelines/Protocols for Emerging/Re-emerging Infections 5.3 Procedures for hospital epidemiologic Surveillance 5.4 Procedures for preparing sites for temporary placement of dead bodies for highly infectious disease 5.5 SOP/Guidelines for food and supplies of dedicated hospital staff during emergency 6. Hospital Systems 6.1 Logistics Management System 6.1.1 System for prioritizing hospital personnel to be given prophylactic/ therapeutic drugs for highly infectious diseases in times of drug scarcity 6.1.2 Surveillance System Established hospital disease surveillance system for the patients and personnel 6.1.3 Water Supply System Presence of adequately safe water at all times even during emergency for hygienic purpose, for flushing toilets and other utilities Presence of alternate source of water in case the main supply is cut off Identified agencies responsible for timely restoration of water service Supplementary pumping system in case system fails or services disrupted 6.1.4 Electrical System Presence of emergency power generator or alternative power for emergency lighting and operation of essential equipment 6.1.5 Security System Dedicated security personnel Tightened security of the Isolation Room/Biological Unit, being a restricted area Only authorized personnel are allowed to enter Separate entrance or access route With proper signages

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6.1.6 Transportation and Communication System Available back-up communication facilities (cellular phone, handheld radios satellite communication facilities,etc) Dedicated ambulance for highly infectious patients with glass separator between the driver and the patient compartment equipped with proper decontamination/disinfection supplies and materials 6.1.7 Public Information System Presence of established Public Information Center where public can go to request information concerning family members Public Information Center is coordinated by a social worker and staffed by personnel or volunteers Available public awareness and public education campaign with advisories, IECs, warning messages Designated spokesperson for risk communication Procedures for communicating with the public and media 6.1.8 Hospital Emergency Incident Command System (HEICS) The Chief of Hospital as the Incident commander and other staff to fill up the position of the Incident Command Structure System of activating and deactivating the Incident Command System System of activating the Hospital Response Plan Hospital Early Warning and Code Alert System in order for hospital to prepare and mobilize resources in response to early warning signs or signals System of recalling staff and positioning them for possible response to emergencies System of activating and deactivating the Code Alert System 6.1.9 Information Management System Preparation of a census of admitted patients and those referred to other hospitals Proper recording and reporting using standard forms Ways of sharing information with proper authorities

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7. Operational Plan and Contingency Plans for internal or external disasters 7.1 The hospital must have available, accessible, tested, updated and disseminated Hospital Emergency Preparedness, Response and Recovery Plan and Contingency Plan for Highly Infectious Diseases (SARS, AI) This plan

includes the developed systems, guidelines, SOPs and protocols for emergency management
7.2 Procedures to activate and deactivate the plan 8. Plans for the Operation, Preventive Maintenance, and Restoration of Critical Services 8.1 Electrical supply and back-up generators 8.2 Drinking water supply 8.3 Fuel reserves 8.4 Medical gases 8.5 Standard and back-up communication systems 8.6 Wastewater Treatment 8.7 Solid waste Treatment 8.8 Fire suppression system 9. Human Resources 9.1 Organization of Hospital Disaster Committees and Emergency Operation Center 9.1.1 Crisis Management Committee 9.1.2 Dedicated trained and competent staff in managing highly infectious cases 9.1.3 Dedicated trained and competent security personnel 9.1.4 Dedicated trained and competent Ambulance drivers 9.1.5 Dedicated trained and competent maintenance/utility personnel 9.1.6 Dedicated trained and competent Safety Committee members 9.1.7 Dedicated trained, competent, and active Infection Control Committee 9.1.8 Hospital Operation Center staff (headed by the Hospital HEMS Coordinator) to be operational 24 hours a day and seven days a week 9.2 Capability Building of Personnel 9.2.1 100% of staff trained on management of highly infectious diseases

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10. Availability of medicines, supplies, instruments, and other equipment dedicated for highly infectious diseases (SARS, AI) 10.1 Emergency Medicines at the Emergency Room and in the critical service areas (OR, RR, ICU, NICU, etc) 10.2 Items for treatment and other supplies 10.3 Instruments for emergency procedures 10.4 Medical gases 10.5 Ventilators 10.6 Electro-medical equipment 10.7 Life support equipment 10.8 Personal Protective equipment for epidemics (disposable) 10.9 Crash cart for cardio-pulmonary arrest 10.10 Triage tags and other supplies for managing mass casualties 11. Monitoring and Evaluation 11.1 Conduct of post-incident evaluation of emergencies or disasters responded 11.2 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. 1096 was formulated and adopted as a uniform building code to embody up-to-date and modern technical knowledge on building design, construction, use, occupancy and maintenance. The Code provides for all buildings and structures, a framework of minimum standards and requirements 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, property and public welfare by regulating and controlling the design, construction, quality of materials pertaining 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 work located primarily in a public way, public utility towers and poles, hydraulic flood control structures, 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 recognized structural engineers to perform design review for certain structures, and the installation of recording accelographs for every building over six storeys (with floor area of 5,500 square meter 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 adopt the new strength-based seismic forces, and special load combinations to reflect the provision of the 1997 Uniform Building Code (UBC). Near-source factors are specified in seismic zone 4 to recognize the amplified ground motions that occur close to known acyive faults. The Philippine Institute of Volcanology and Seismology (PHIVOLCS) issued the maps showing the active faults throughout the country as reference for determining near-source factors. Also basic wind speed are revised based on statistical studies of PAGASA data over 30 years and recommendations 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 of reinforced concrete design. Shear-governed concrete walls are designed for increased forces and special detailing requirements are clarified and improved, many of which reflect changes in 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 of seismic design and much of the current knowledge on design and quality assurance following intensive research and testing in the U.S. Significant issues associated with moment frames and AISC's Seismic Provisions are also addressed. Likewise, important issues and considerations 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 of persons and property from hazards arising from the use of electricity. Adequacy. This Code contains provisions that are considered the minimum requirements necessary for safety. Compliance therewith and proper maintenance will result in an installation that is essentially free from hazard but not necessarily efficient, convenient, or adequate for good service of future expansion of electrical use. Intention. This Code is not intended as a design specification nor an instruction manual for untrained persons. Volume 1 Installation for Voltages up to 600 volts Scope: Public and Private Buildings, Electric Generating Plants, Industrial Plants, Transformer Stations, Permanent and Temporary Substations, Airfields, Railways Switchyards, 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 Installations Article 2. Branch Circuit Feeder and Service Calculations, Over-current Protections, Surge Protection Article 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 Equipments rated 30 volts and above) Article 5. Wiring Methods and Materials for Special Occupancies classified Hazardous Locations (Health Care Facility, Gasoline Dispensing and Service 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 and Amplification Equipments, Information Technology, X-Ray, Induction and Dielectric Heating, Electrical System, Solar Photovoltaic System, Fire Pumps, Air Field Lighting Article 7. Wiring Methods and Materials for Emergency System Article 8. Wiring Methods and Materials for communication System Article 9. Tables Article 10. Wiring Methods and Materials for Watercrafts Volume II Installation for Voltages more 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 establishment which 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 to property 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 shall reasonably enhance the mobility of disabled persons, such as sidewalks, ramps, railings and the 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 Management Act 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 - 0021

Subject: 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 the unnecessary 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 thermometers to patients through the distribution of hospital admission/ discharge kits. 2. All Hospitals shall follow the guidelines for the gradual phase-out of mercury in health care facilities described in this document in the timeline specified. 3. All new Health Care Facilities applying for a License to Operate shall submit an inventory of all mercury-containing devices that will be used in their facilities and a corresponding mercury elimination program. 4. All other Health Care Facilities other than hospital shall make a Mercury Minimization Program based on the guidelines set by the Administrative Order.

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42