Guidelines and New Standards in Health Care

Facility Planning under The New Normal in the

Philippines: A Working Study
II. Background of the Study
Hospitals and healthcare facilities are complex
Ria Ricci D. Malubay institutions that need careful and as much as possible,
rrdmalubay2020@plm.edu.ph ARE THESE YOUR
faultless systems to ensure the safety of the community
riamalubay16@gmail.com OWN
that use such health services. ButWORDS? IF normal’
under the ‘new
NOT, CITE
circumstances, it poses a challenge to the planning and
Abstract designing of these spaces that provide healthcare
REFERENCES
especially in low-income and middle-income countries
The emergence of the coronavirus disease or COVID-19 has such as the Philippines. It becomes a priority to find
created a global health crisis145/150
and its threat to the safety of the ways to adapt because otherwise it may cause more
population made it crucial to assess the guidelines, standards, problems for the community.
and strategies for health care facility planning and to evaluate
BRIEFLY DISCUSS THE
if it is still capable of accommodating the current inundation of
INTRO, METHODS,
infected patients. In a country like the Philippines where the
number of COVID-19 cases RESULTS.
increase rapidly, the health care
system finding ways to adapt to the ‘new normal’ is an A. Historical Background
extremely important step 150 MIN WORDS
to effectively confront the impact of
the infectious disease. This 250 paper
MAX aims to provide and make
WORDS Hospitals have evolved and developed throughout the
suggestions for new guidelines4 MAX andKEY
standards
WORDS for health care years to adapt to the demands of modern medicine.
facility planning while considering the ‘new normal’ by However, not only the scientific perspective of healthcare
understanding how the environment and space can affect the has seen advancement during this time, but the
medical care for patients and how an architectural perspective architectural perspective as well. It has been recognized
can help in designing strategies for combating the pandemic. by professionals that there is indeed a relationship
between health and architecture and stating that a
Keywords: COVID-19, health care facility planning, new patient’s healing process is affected by the suitability of
normal the building or space being occupied.

The advancement of the architecture of medical facilities

I. Introduction was also helped as knowledge about transmissible
ARE
diseases and illnesses were THESEThrough
discovered. YOURLouis
The COVID-19 pandemic has caused stressful impacts to
Pasteur’s (a French chemist
OWNand microbiologist)
WORDS? IFwork, it
many aspects of the world. It presents a significant is now basic knowledge that prevention of disease and
challenge to public health, food systems, and has brought NOT, CITE
infection transmission can be done through isolation and
devastating economic andARE social THESE
disruptionYOUR
worldwide. REFERENCES
distancing of patients. The founder of modern nursing,
The rising number of COVID-19OWN WORDS? IF the
cases challenges
Florence Nightingale, also helped in the development of
capacity of all health facilities to assist all those who are hospitals as her caretaking experience during the
NOT,that
affected with all the resources CITE
are available. With Crimean war paved the way for healthcare facilities with
this crisis being a major REFERENCES
health concern, it brings pavilion models wherein different factors such as
immense pressure to healthcare systems and facilities to
ventilation, movement and circulation of patients, and
ensure that they can provide essential medical care to
lighting was considered and effectively lessening the rate
those who are affected by the virus in the most effective of infections and helping with patient recoveries.
way possible. This means that any previous standards, Nightingale’s discovery of the correlation between the
protocols and/or guidelines that are now deemed unsafe environment and a patient’s health/healing process
for the current demands of safety against the virus must
helped in minimizing the death rate during her time. It
be revised or appended, as well as proposing solutions to
also became a foundation for learning how diseases can
the problems encountered by healthcare systems and be spread to others (through air, water, and surfaces) and
facilities in order to provide the proper services without understanding how architecture can help in preventing
risking anyone’s health in the process. this.

1
ARD 211 – 2 - Architectural Design III Research Paper
Pamantasan ng Lungso d ng Maynila College of Architecture
Guidelines and New Standards in Health Care Facility Planning under The New Normal in the
Philippines: A Working Study
Ria Ricci D. Malubay
coronavirus can be spread through airborne/droplet
transmission or through contact/surfaces, the isolation
B. Research Problem of infected patients is important. Providing proper
HVAC systems is also crucial as it plays and vital role
With the growing number of COVID-19 cases and the in disease transmission. Hence, creating designs for
virus becoming an even more dangerous threat to the effective social distancing, for enhancing ventilation
WHERE ARE YOUR RESEARCH and lighting of areas, and adapting the materials and
lives of people (especially with the new variant of the
QUESTION THAT WILL BE ADDRESSED construction methods is a must in health care facility
virus), it isARCHITECTURAL
IN THIS crucial that there isRESEARCH?
a health system that
provide patients services while also ensuring that there is planning under the new normal.
minimal transmission of the disease. Which means
several restrictions and protocols will be implemented, F. Significance
such as isolation and distancing to prevent the spread of
the virus. However, health care facility planning can be It is a right for people to have access to the health
quite difficult to manage since the threat of the COVID- services they need, and it is a responsibility for health
19 is everywhere and without enough awareness or care providers/facilities to supply these needs and
caution it can cause even more harm. The previous services without the risk of exposing others to even
standards of health care facilities may no longer be more harm. This study is significant as it is important
sufficient to combat the virus and can possibly be even to identify which standards are no longer sustainable
more detrimental to the lives and safety of patients, staff, when it comes to ensuring safety of patients receiving
and other people within the facility. medical care, as well as the staff providing them so
hospitals can adapt quickly, effectively, and safely in
C. Goals and Objectives this new era of the coronavirus pandemic.

To understand health care facility planning in the context II. Review of Related Literature
of the COVID-19 pandemic, identifying certain factors
that can affect the new GOODguidelines
GOALand standards is
SETTING Having the architectural/engineering perspective in
needed. The objectives of this HOW
BUT study are
CAN as follows:
WE creating design strategies is an important aspect of
ACHIEVE THESE preventing and controlling the rate of infection and
1.) To understandWITHOUT
how COVID-19
OUR impacts the spread of diseases in a built environment. But this also
viability of pre-pandemic health care standards
OBJECTIVES? requires understanding the environmental factors, as
and guidelines. well as the nature of the virus itself, to fully comprehend
and be able to develop and plan an effective design for
2.) To identify and compare the old standards of healthcare facilities and other spaces.1
health care facility planning with the new
standards in relation to the current pandemic. COVID-19 had health care facilities facing several
challenges as they had to deal with treating not only
3.) To provide viable solutions and suggestions for COVID patients, but also those who still need treatment
a more effective planning of medical spaces. unrelated to the pandemic, while taking into
consideration the prevention of spreading the disease
D. Scope and Limitation among patients and staff. To do this there are two main
strategies that can be used to control the congestion of
This study is focused on the guidelines and standards spaces in hospitals and facilities. One is building as many
of health care facility planning in the context of the temporary facilities WHERE
dedicatedIStoTHE
treating
RRL?coronavirus
COVID-19 pandemic or what is call the ‘new normal’ patients and adhering to the recommendation of isolating
USE PROPER FORMAT
in the Philippines and make comparisons with the the infected patients as effectively as possible. Examples
OF WRITING RRL
previous regulations before coronavirus. of temporary facilities are tents, inflatable systems,
containers, etc. that can help in providing proper health
services to those who are affected by the virus. The other
E. Assumptions and Hypothesis
strategy is using and transforming non-medical
institutions that are not used during the pandemic into
Much of the pre-pandemic health facility guidelines
may no longer be suitable for the current situation.
The environmental/space factors play a huge part in 1
Emmanuel, U., Osondu, E. D., & Kalu, K. C. (2020).
the transmission of infectious diseases which means in Architectural design strategies for infection prevention and control
the architectural perspective of planning a health care (IPC) in health-care facilities: towards curbing the spread of Covid-19.
Journal of Environmental Health Science and Engineering, 18(2),
facility, it is required to understand the modes of
1699–1707. https://doi.org/10.1007/s40201-020-00580-y
infection transmission. Since it is speculated that the

2
ARD 211 – 2 - Architectural Design III Research Paper
Pamantasan ng Lungsod ng Maynila College of Architecture
Guidelines and New Standards in Health Care Facility Planning under The New Normal in the
Philippines: A Working Study
Ria Ricci D. Malubay

temporary health care facilities that can accommodate Ventilation. Several studies have proven that indeed air
even more patients and provide more spaces for quality affects the rate of infection, as well as the lighting
treatment.2 of a space or area and proper management of these
systems play an important role in mitigating the spread
III. Concepts and Framework of diseases. The risk of infections can be reduced with
two factors: dilution and removal. Dilution is the process
of having clean air dilute any airborne contaminants
Health Care within a room. The CDC and WHO has advised that the
Facility following ventilation rates should be provided for
Planning natural ventilation: (a)160 l/s/patient (hourly average
ventilation rate) for airborne precaution rooms (with a
minimum of 80 l/sec/patient for new health care
facilities and major renovations); and (b) 2.5 l/sec/m3 for
Enhanced corridors and other spaces without an exact number of
Social Distancing Ventilation lighting or patients.
and Isolation sunlight
Having adequate cross ventilation is crucial, and open-
PROPER LABEL OF IMAGES: FIGURE ended lobbies are also encouraged as it can provide more
The health facility that will be used to accommodate
01. ...(TITLE). increased air flow and higher ventilation rate. Courtyard
coronavirus patients must be a self-contained designs are also encouraged as it can integrate and utilize
establishment
THIS ISthat ONLY hasCONCEPT,
the sufficient and essential
NO THEORIES natural ventilation more. For mechanical ventilation,
resources to meet
WERE all theBUT
USED basicINSTEAD
needs of the
YOUestablishment. there are negative pressure rooms which allows entry of
This includes
EXPLAINED adequate ONLY space
THE forCONNECTION
all furnitures and air into an isolation room without letting it escape from
OF EACH
instruments, beds, etc., PROPER
ELEMENT.
proper LABEL
ventilation andOFregulated the room since air naturally flows from areas with high
flow of movement that as IMAGES:
much asFIGURE 01.
possible minimizes pressure compared to those with low pressure. This
the risk of infection and exposure. To effectively plan and
...(TITLE). prevents any contaminated air from escaping the room
design a health care facility under the ‘new normal’, and affecting outside areas.
there are certain guidelines and IS
THIS standards
ONLY that should be
followed and observed when creatingNO
CONCEPT, design strategies Enhanced lighting or sunlight. Some studies have
for the controlling and prevention
THEORIESofWERE infection
USEDamong indicated that sunlight can CHECK
kill certain bacteria LABEL.
PROPER and is
patients and staff: BUT INSTEAD YOU capable of preventing infection. However,
FUGURE 02,itAND
is said
SOthat
EXPLAINED ONLY THE the most effective wavelength for eradicating germs is
ON...
Social distancing and CONNECTION
isolation. There OFareEACH
research the ultraviolet C, which only a small percentage of it
studies that has shown how air droplets can travel reaches the earth. Regardless, it can still help in infection
ELEMENT.
distances of 1000mm – 2000mm which makes social prevention and control so designing buildings with
distancing a must especially in hospital facilities. This can adequate opening allowing in sunlight can inhibit the
be done through creating enough spacing in areas like transmission of infectious diseases.
entrance lobbies, waiting rooms, hallways, stairs, etc.
Any structures that are designed to encourage G. Images and Figures
unnecessary interactions among people should be
removed (such as benches). Opening up previously
closed health facilities and transforming other spaces like
exam rooms to provide more isolation units for infected
patients can be done to respond to any surge of
emergencies during the pandemic. Converting other non-
healthcare facilities can be helpful as well such as
schools, arenas, and theaters.

2
Capolongo, S., Gola, M., Brambilla, A., Morganti, A., Mosca,
E., & Barach, P. (2020). COVID-19 and Healthcare Facilities: a
Decalogue of Design Strategies for Resilient Hospitals. Acta Biomed
2020;, 91(9), 50–60. https://doi.org/10.23750/abm.v91i9-S.10117 Figure 1. Suggested corridor width

3
ARD 211 – 2 - Architectural Design III Research Paper
Pamantasan ng Lungsod ng Maynila College of Architecture
Guidelines and New Standards in Health Care Facility Planning under The New Normal in the
Philippines: A Working Study
Ria Ricci D. Malubay
care and hospital spaces. Since not only does strategizing
for the new normal design and architecture of medical
spaces means considering the conditions of the
coronavirus patients themselves, but also taking into
account the rest of the environment, flexibility and
sustainability of design is extremely important. There is
only limited space for multiple instruments and
equipment used, along with the demands of patient care
units so it is crucial to adapt by transforming different
spaces to accommodate all the needs of health care
facilities.

V. Conclusion
Developing structures, establishments, and other utilities
Figure 2. Example figure of an open-ended corridor to counter the rapid emergence of the COVID-19
outbreak requires multi-disciplinary response and
effective strategies as it risks a huge number of people’s
safety. Design strategies in the architectural perspective
plays a significant role in understanding the best way to
prevent infection and transmission of diseases and we
should continue to study
FORand learn the most productive
CONCLUSION,
way of preparing and WHAT
for surges
NEWof infected
BODYpatients.
OF
KNOWLEDGE HAVE
The pandemic has shown itself to be very difficult to
YOU LEARNED/
manage and control, EXTRACTED
and the role ofTHAT
built environment
CAN
becomes even more important in this
BE BENEFICIAL TO era. AndTHE
due to the
high infectious rate ofARCHITECTURAL
COVID-19, and communities
FIELD are
yet to determine the guarantee of vaccinations being
Figure 3. Conceptual figure of a multi-bedded isolation unit. AND FUTURE
beneficial to us, hospitals and the health care facilities
RESEARCHERS?
would still be highly relying on performing and adhering
to the guidelines/standards of the new normal and
committing to their role of promoting health and safety
Stairs Registration to all those who are vulnerable.

Elevator VI. References

1. Hui Cai, Frank Zilm, Hugo Sheward & Kerianne
Public Graham (2020) Responding to COVID-19:
Circulation Lobby Healthcare Surge Capacity Design for High-
Consequence Infectious Disease,
Technology|Architecture + Design, 4:2, 135-139,
Vestibule DOI: 10.1080/24751448.2020.1804752

2. Emmanuel, U., Osondu, E. D., & Kalu, K. C.

(2020). Architectural design strategies for
Figure 4. Conceptual figure of a hospital entrance/lobby. infection prevention and control (IPC) in health-
care facilities: towards curbing the spread of
Covid-19. Journal of Environmental Health Science
IV. Analysis WHERE ARE YOUR and Engineering,
USE PROPER18(2), REFERENCING
1699–1707.
DETAILED ANALYSIS IN https://doi.org/10.1007/s40201-020-00580-y
FORMAT. APA STYLE.
One of the most important factors inOFdeveloping
COMPARISON THE
guidelines and new standards
OLD ANDfor health care facility
THE NEW? 3. Capolongo, S., Gola, M., Brambilla, A.,
planning under the new normal is the concept of
Morganti, A., Mosca, E., & Barach, P. (2020).
isolation and distancing and caution when it comes to the COVID-19 and Healthcare Facilities: a
modes of transmission of bacteria or infectious diseases Decalogue of Design Strategies for Resilient
should always be practiced when designing for health
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ARD 211 – 2 - Architectural Design III Research Paper
Pamantasan ng Lungsod ng Maynila College of Architecture
Guidelines and New Standards in Health Care Facility Planning under The New Normal in the
Philippines: A Working Study
Ria Ricci D. Malubay

Hospitals. Acta Biomed 2020;, 91(9), 50–60.

https://doi.org/10.23750/abm.v91i9-S.10117

4. Baker J, Stevens D, Bloomfield S. Spread and

Prevention of Some Common Viral Infections in MARIA MONICA E. PUJALTE
Community Facilities and Domestic. J Appl FINAL GRADE: 2.75 09252021
Microbiol. 2001;91(1):7–21.
https://doi.org/10.1046/j.2365-
2672.2001.01364.x.

5. Marinelli, M. (2020). Emergency Healthcare

Facilities: Managing Design in a Post Covid-19
World. IEEE Engineering Management Review,
48(4), 65–71.
https://doi.org/10.1109/emr.2020.3029850

6. Agarwal, A., Nagi, N., Chatterjee, P., Sarkar, S.,

Mourya, D., Sahay, R., & Bhatia, R. (2020).
Guidance for building a dedicated health facility
to contain the spread of the 2019 novel
coronavirus outbreak. Indian Journal of Medical
Research, 0(0), 0.
https://doi.org/10.4103/ijmr.ijmr_518_20

7. Keenan, J. M. (2020). COVID, resilience, and the

built environment. Environment Systems and
Decisions, 40(2), 216–221.
https://doi.org/10.1007/s10669-020-09773-0

8. Hamidian Jahromi, A., Mazloom, S., & Ballard,

D. H. (2020). What the European and American
health care systems can learn from China
COVID-19 epidemic; action planning using
purpose designed medical telecommunication,
courier services, home-based quarantine, and
COVID-19 walk-in centers. Immunopathologia
Persa, 6(2), e17.
https://doi.org/10.34172/ipp.2020.17

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ARD 211 – 2 - Architectural Design III Research Paper
Pamantasan ng Lungsod ng Maynila College of Architecture