CHAPTER I
PREFACE
I.1. BACKGROUND
Medical Rehabilitation (MR) is a part of hospital which roles are
important in health implementation including improvement (promotif), prevention
(preventif), healing (kuratif), and especially rehabilitation (rehabilitatif).
Rehabilitation itself used to be taken only as one of supporting service facility to
support curing of motoric function of patient’s body after receiving medical
treatment in a hospital. Along with the advancement of medical technology,
Medical-Rehabilitation service developed into an Integrated Unit or an MR
Installation (IRM - Instalasi Rehabilitasi Medik) which is the final version and
integrated with other medical Specialization or even is a Sub-Specialization. In
that case, a manual book of MR facility aimed to be the Guidelines for Hospital
organizers including to achieve planning and design of an MR facility properly
and correctly and follow the rules of MR of medical science.
I.2. AIM & OBJECTIVE
The aim of preparation of this book is for it to become Book of Guidelines
for Hospital Organizers, basic development of science for advanced Planning and
Design of MR Facility in the future according to advancement of MR science.
[PAGE 2 IS MISSING]
The Vision to achieve INDONESIA SEHAT (HEALTHY INDONESIA)
– 2010 is “a description of future Indonesian society achieved through health
development is the society, the nation and the country; which marked by healthy
living environment and behavior of the people, possess ability to reach quality,
fair and evenly distributed health service, having the highest health level all over
Indonesia where with this formulation the expected service for the future is a
peaceful service for healthy condition to be achieved” 2
2 Vision and Mission of INDONESIA SEHAT – 2010, Health Dept. of Indonesia, 2002, Jakarta, Indonesia
1
I.5. DESCRIPTION AND LIMITATION
Description and limitation consisted in this manual book i.e.:
• Manual here means a reference which can be used as a source for direction
to perform an activity or work.
• Building here means a Building where according to Decision of Minister
of Residential and Area Facility No 332/KPTS/M/2002: “… functioned as
a place for humans to perform their housing or staying, business, social,
culture, and/or special activities …”
• MR meant here refers to the book of “MANUAL OF MR SERVICE OF
HOSPITAL CLASS A, B AND C” 2nd edition of 1997 published by
Directorate of Public Hospital and Education, Directorate General of
Medical Service of Health Dept. of Indonesia which is “ … a form of
integrated health service with medical, psychosocial – educational –
vocational approaches to achieve functional ability as much as possible
…”
• Hospital meant here generally is a public facility, according to Indonesian
Act No 23/1992, Chapter I, Article 1, Item 4: “… a place used to run
health efforts …”
• Manager / Head / Vice Head of the Department / Installation / MR Unit
meant in this book is someone assigned by Hospital Officials / Board of
Directors to sit as the chief of the Department / Installation / Unit and fully
responsible of the whole MR service provided by the Hospital for patients.
• Chief / SMF (Staf Medik Fungsional – Functional Medical Staff) Chief of
MR is someone appointed by Hospital Board of Director (legalized
together with Board of Dean / Director of Medical Faculty when the
Hospital is in form of Educational Hospital) to be a leader of a group of
doctors (Sp.RM (Specialist in MR), doctors with other specialization
2
related to MR, Medical Doctor Plus with MR ability) commonly named as
MR SMF and professionally responsible on any kind of medical services
occur in Department / Installation / Unit of MR to Hospital Medical
Committee.
• Assistant Manager / Coordinator / Section Head / Head of Service is
someone appointed and stated by Hospital Organizers / Hospital Board of
Director to assist the Manager / Head / Vice Head of MR to run service
operational function according to possessed specialization/profession.
• Specialist Doctor of MR meant in the manual is someone graduated as
Bachelor of Medic (Sarjana Kedokteran – S.Ked.) and attending
education of professional doctor (Ko-As / Co-Assistance) and graduated
as a doctor. Then the dr. (Med. Doctor) or commonly preferred as “Dokter
Umum” / “Medical Doctor” attends MR Specialization and graduated and
also stated to earn the degree of Sp. RM (MR Specialist).
• Psikolog (Psychologist) meant in this book is someone who has graduated
as Bachelor of Psychology and attend the education of professional
Psychologist and graduated and also earns profession as Psychologist.
• Physiotherapist, Speech Therapist, Orthetic – Prosthetic, Medical Social
Worker (Pekerja Sosial Medis – PSM) and MR Nurse meant in this book
are some ones commonly preferred as MR Paramedic (either from Nursery
or Non-Nursery Paramedic) i.e. someone who has graduated from Mid –
Expert education program (Ahli Madya Diploma III) or the same level as
High School Plus (with additional expertise education in form of skill &
expertise courses) according to specialization in MR environment.
• Administration & Finance Person meant in this book is someone or are
some ones who perform administration-arrangement starting from
registration and scheduling of patients, patient medical record up until
finance reporting and administration of persons.
• Patient meant in this book is someone in need of medical services from the
hospital and has been registered as a person with illness in the hospital
3
medical record system and has the right on the whole health services of
the hospital according to the kind of appropriately received medical
services.
• Facility meant in this book is anything related to Tools, Facilities, or
Devices (either medical or non-medical tools) needed by the hospital in
providing the best services for patients.
• Tool meant in this book is any kind of physical matter which can be
visualized by eyes or sensed by five-senses and easily recognized by
patients and (usually) a part of a building (i.e. entrance / exit doors, floors,
walls, columns, windows) or the building itself.
• Facility or infrastructure meant in this book is the whole thing or a
network/installation which makes the available tools functioned as
purposed. Some examples of facilities i.e.:
1. Clean water installation which has an output of clean water tap.
2. Electrical installation which has an output of lamp spots, power
plug, or its controller in form of electrical switches and fuses.
3. Wastewater installation which has an input from Lavatories /
Toilets / Sink and output in Wastewater Treatment Installation
(IPAL – Instalasi Pengolahan Air Limbah) of the hospital.
4. Medical Gas Installation which has an output of Suction outlet, O2,
Pressured Air in service rooms.
5. Hot Water Installation which has an output of hot water outlet for
Hydrotherapy or Hot Water Tap at the sink.
6. Installation of Telephone / Intercom / LAN which has an output of
telephone / intercom device / computer with online facility.
7. Air Conditioning Installation which has an output of indoor units
or diffuser outlets (for Central AC) to exhaust cool / warm air.
• Devices limited to those related to MR and generally classified into 2
(two) big groups which are:
1. Medical Device (Health Device and Device used by doctors) is one
or more things / tools functioned directly to patients / persons with
4
illness in performing prevention, healing and rehabilitation action
as a form of MR health service from the hospital.
2. Non-Medical Device or Medical Supporting Device is a thing /
tool used to make possible / make easy of providing of MR service
to patients (usually preferred as supporting device and can be seen
in daily use, not only in hospitals) even though not classified as
medical device (health device and device used by doctors).
5
CHAPTER II
PROGRAMS OF FUNCTION AND ROOM
II.1. ORGANIZATION STRUCTURE AND MANPOWER
Mainly organization structure of MR can be described with diagram model of
organization structure as seen in the figure below:
Fig. 1 Diagram Model of Medical Rehabilitation Organization Structure in the Hospital
6
(*) Outside of hospital structure (**) Coordinative & Consultative Relationship (***) Direct Service to Patient(s) (****) Asst. Mgr. / Coordinator / development when it is an Educational Hospital
Board of Heads / Directors of University (*)
Dean / Director of Medical Faculty
(**)
(**)
Head of SMF of Medical Rehabilitation
Medical Hospital Committee
Head (Manager) / Vice Head of Department / Installation / Unit of Medical
Rehabilitation
(**)
(**)
SMF of Medical Rehabilitation
Coordinator / Section Head / Assistant Manager of
Administration – Finance & Persons
Coordinator / Section Head / Asst.
Mgr. of Education and Training (****)
Coordinator / Section Head / Asst. Mgr. of R & D (****)
Coordinator / Section Head / Asst.
Mgr. of Medical Rehabilitation Service (****)
Coordinator / Section Head / Asst. Mgr. of Logistic and
Support (****)
Physiotherapy
Workgroup
Speech-Therapy
Workgroup
Orthetic - Prosthetic Workgroup
Occupational-Therapy Workgroup
Medical Social Worker
Workgroup
Psychology Workgroup
Counter & Medical Record
Internal of Medical
Rehabilitation Workgroup
(***)
Medical Rehabilitation Patient(s) (***)
Hospital Board of Directors
From the example of diagram model of organization structure as seen on Figure 1,
generally Head of MR SMF and Head of Installation / Unit of MR in a Hospital.
Education managed by one person called Head of Department / MR Manager where
MR Service Unit in a Hospital is in the form of a Department and no longer in the
form of Installation / Unit anymore. Organization Structure should comply with the
situation, condition and needs of the Hospital; and when possible, Section Head /
Assistant Manager also act as Head of Occupational Therapy Workgroup Service and
also serves patient as Occupational therapy officer.
In relation with the Organization Structure, to know more the needs of rooms
for Hospital Worker(s)2) (Health Officers, Supporting Officers & Administrative
Officers) in an MR Service Unit reference about “Manpower” which recommended
by Health Department of Indonesia as described in the table on Figure 2 below:
Fig. 2 Table of Public Hospital Rehabilitation Worker Minimum Requirement 3)
PUBLIC HOSPITAL
Manpower Needs CLASS A CLASS B II/B+ CLASS B I/B CLASS C
Sp. RM Doctors 6 4 2 (*)
Psychologist 3 2 1 -
Physiotherapist 15 10 8 1
Speech Therapist 5 3 2 1
Occupational Therapist
(OT) 6 5 3 1
Orthotic Prosthetic 4 3 2 -
Medical Social Worker
(PSM) 3 4 3 1
MR Nurse 15 10 1 -
(*) Med Doctor or Specialist Doctor other than Sp. RM with MR training
Figure 2 above is an ideal needs fulfillment requirement for a Hospital and the
manpower may increase in numbers along with increase of services provided by a
hospital to patient(s). 2) Worker(s) meant here refer to the definition of worker by Indonesian Department of Manpower & Transmigration 3) Directorate of Public Hospital & Education, “MANUAL OF MR IN HOSPITAL CLASS A, B, & C”, 2nd Edition, Health Dept. of Indonesia, Jakarta, 1997
7
II.2. SERVICE FLOW AND ROOM NEEDS
Service flow of patients in an MR Service Unit generally can be modeled as
follows: Fig. 3 MR Patient Service Flow Model (Page 10)
Ambulance
TIn/
PHYSIOTHERAPY
HospitalPatient
Referred Patients
from other Hospitals & CBR
Emergency
Service Unit / Installation
Staying Treatment Installation
MR Internal Registration & Medical
Record Counter
MR Check-Up, Consultation & Assessment
Non-Staying MR Services
OT
ST
OP
PSICHOLOGY
MEDICAL SOCIAL
WORKER
Staying Treatment MRServices
Doctor Referral
Non-Staying reatment stallation Polyclinic
MR Services in SpecialUnits (i.e. IntegratedCardio Services, Geriatric Services,
Sport Medicine Services)
8
Based on Figure 3, it can be described that Hospital medical rehabilitation service
performed inside and outside of a building / structure / room under authorization of
Department / Installation / Unit of MR (other than services with pick-up pattern e.g.
MR Homecare Services performed by MR Health Officers or Homecare Visit Service
performed by Medical Social Worker (PSM)). In planning and designing needs of
rooms, total number of health officers owned by the MR Department / Installation /
Unit should be considered, especially in designing room for discussion / internal
meeting, Med. Doctor & Paramedic Lounge Room, Locker Room, Bathroom,
Lavatory / Water Closet in order to anticipate ideal room needs when all health
officers under MR Unit attending a meeting or coordination in MR Building. Other
thing which also needs consideration is that Educational Hospital usually owns
Medical Staff Building (MSF) including room for MR Functional Medical Unit
(SMF).
As a basis for planning & design of MR Service Facility, “Room Need” of an
MR Service Unit should be inventoried first in a table model as follows:
Figure 4 Table of MR Room Need
No. Room Name Room Function Room Characteristic
1. Lounge Room for MR Patients
& Their Attendants
As a waiting room for patients and their attendants
before receiving medical treatment
Public, accessible from
hospital corridor
2. MR Registration & Medical
Record Counter
As a re-registration counter for patients previous to
service & also for officers to record the
registration4)
Public, accessible from
hospital corridor
3. Check-Up & Evaluation Room
for Sp. RM
For Sp. RM to perform Check-Up (e.g. Anamnesis,
Physical Check-Up & Assessment), Diagnose,
Prognosis of patients, or a room for patients to do
medical consultation with the Sp. RM doctor.
Private, limited to served
patients & evaluating
doctors.
4) A place for patients to pay for service when the hospital billing service hasn’t support integrated online system
9
No. Room Name Room Function Room Characteristic
4. Psychological Check-Up &
Evaluation Room
Room for Psychologist to perform Check-Up (e.g.
Anamnesis, Physical Check-Up & Assessment),
Diagnose, Prognosis of patients, or a room for
patients to do psychological consultation with the
Psychologist.
Private, limited to served
patients & evaluating
Psychologist.
5. Physiotherapy Room **)
The room which usually large enough and consists
of smaller rooms (Modular rooms for: 1 patient bed
+ Therapy Device + Work Area for Physiotherapist
+ partition walls between rooms) and used to
provide medical service in form of radiation /
electromagnetic wave intervention and traction
Private, limited to patients
who need traction /
radiation / electromagnetic
wave intervention by
removing some clothes.
Outside of the particular
room is Semi-Private.
6. Orthetic & Prosthetic (OP)
Fitting Room
For PwDs or MR Patients who need OP services to
receive Measurement / Fitting & Suiting of their OP
devices.
Private, where usually
PwDs and MR Patients
need privacy when putting
on their OP device.
7.
Individual Speech Therapy
Room with Audiometer
operator **)
For Speech Therapist performs therapy for a
patient individually / personally (only two of them),
usually because the patient needs special
treatment (with Audiometer operator as assistant
therapist)
Private, where usually
patients need special
concentration and
attention
8. Classical Speech Therapy
Room *)
For Speech Therapist to perform therapy in Group
for patients (usually more than three patients) for
them to socialize and interact with other PwDs or
MR patients with the similar handicap.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
9a. Individual Occupational
Therapy Room for Adults. *)
For occupational therapist to perform Individual /
Personal Therapy (two persons only), usually
because the patient needs special attention.
Private, where usually the
patient needs special
concentration & attention
9b. Occupational Therapy Room
for Adults. **) (OT Indoor Area)
For occupational therapist to perform Group
Therapy to patients (usually more than 3 patients),
Semi-Private, even
though, people with no
**) The size of the room depends on the number & type of available MR facilities. *) Establishment of the room depends on the needs and abilities of MR services owned by the hospital
10
No. Room Name Room Function Room Characteristic
usually purposed for the patients to socialize and
interact with other patients with similar Handicap.
particular business should
stay outside of the room
10. ADL (Activity Daily Living)
Therapy Room **)
For occupational therapist to perform Group or
Individual Therapy in a Room Model which formed
like rooms in a house (e.g.: Kitchen, Bathroom,
Dining R., Guest R., Bedroom), an office (e.g.:
Work R., Workshop R., Studio R.), Praying Room,
Shopping Room up to Vehicle Room Model (e.g.:
Boarding & Seating Place on a Public Bus, Driving
Room on a motorcycle or in a car for PwDs).
Semi-Private, even
though, people with no
particular business should
stay outside of the room
11. Individual Occupational
Therapy Room for Children. *)
For occupational therapist to perform Individual /
Personal Therapy (two persons only), usually
because the child patient needs special attention.
Private, where usually the
child patient needs special
concentration & attention
12. Classical Occupational
Therapy Room for Children. *)
For occupational therapist to perform Group
Therapy to children patients (usually more than 3
patients), usually purposed for the children patients
to socialize and interact with other patients with
similar Handicap.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
13. Integration Censor Room for
Children. *)
For occupational therapist to perform Group
Therapy to children patients (usually more than 3
patients), usually purposed for the patients to
socialize and interact with other patients with
similar Handicap.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
14. Audio-Visual Relaxation /
Stimulation Room. *)
For occupational therapist to perform audio-visual
stimulation therapy (usually for children) in a closed
room equipped with audio-visual or light emitting
devices (e.g.: Protected Fiber optic Lamp and
Plexiglas Aquarium which able to emit multiple
colored lights), this room is also a relaxation room
for patients.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
15. Children & Adults Gymnasium
and MR Community Service **)For MR patients to perform gymnasium activity for
their healing process usually in groups with
Semi-Private, even
though, people with no
11
No. Room Name Room Function Room Characteristic
guidance from MR Therapist for patients of MR or
patients from Integrated Service Units who need
MR Services (e.g.: Gym for Patients from
Integrated Neurology & Neurosurgery Service Unit
or Cardio Patients from Integrated Cardio Service
Unit)
particular business should
stay outside of the room
16. Hydrotherapy Room. **)Usually in form of one or more Hydrotherapy
Swimming Pool(s) / Soaking Pond(s) equipped with
Water Heater and Whirlpool System (if any).
Semi-Private, even
though, people with no
particular business should
stay outside of the room
17. OP Workshop Room. **)A room where aid & prosthetic devices are being
designed & created for MR Patients.
Private, only OP officers
should be allowed to be in
the room.
18. MR Sports Room. *)
Usually for Athletes who use special Sport
Medicine Devices (usually system from Cybex are
being used in Indonesia) to improve measured
physical ability to achieve a particular performance
target.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
19. MR Patients Motor Function
Research & Testing Room. *)
Closed room used for education and research
facility to monitor detailed ability development of
MR patients in a long-shaped room with two
separate room (for object and subject / observer of
research) equipped with observation window,
surveillance cameras, recorder, data processing
computer and special markings on walls, floors,
and ceilings.
Private, where patients
usually will feel a stress
because they think that
they are becoming a
research object even
though the research might
be useful for them.
20. VIP Service Room. *)
A room prepared by the Hospital in MR Service
Unit with better interior design, furniture and
comfort compared to other rooms and equipped
with special accessibility for particular patients.
This room also uses the same medical equipments
as regular rooms, but are being provided
particularly for VIP patients (as long as it doesn’t
Private, where usually
patients are willing to
spend extra cost for extra
comfort and privacy
12
No. Room Name Room Function Room Characteristic
interrupt with general MR services)
21.
MR Dept. / Installation / Unit
Manager / Head / Vice Head
Room. **)
For Manager / Head / Vice Head of MR Service
Unit to work. The room should be able to retain 1
office chair + 1 office desk + 2 additional chairs for
unit heads + 1 set of furniture for 5 persons + 1 set
of PC & Printer + bookcase(s) for literature or
archive holder which belong to the Manager / Head
/ Vice Head
Semi-Private, even
though, people with no
particular business should
stay outside of the room
22.
Room of MR Workgroup Asst.
Manager / Coordinator /
Section Head / Service Head. **)
For MR Workgroup Asst. Manager / Coordinator /
Section Head / Service Head to perform
administrative duties. The room should be able to
retain 1 office chair + 1 office desk + 1 set of PC &
Printer + archive cabinet
Semi-Private, even
though, people with no
particular business should
stay outside of the room
23. MR MD Head Room. *)
For MR SMF Head to work in. The room should be
able to retain 1 office chair + 1 office desk + 2
additional chairs for unit heads + 1 set of furniture
for 5 persons + 1 set of PC & Printer + bookcase(s)
for literature or archive holder which belong to the
SMF Head. Good hospitals usually preserve a
particular building for this room.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
24. MR MD Discussion Room. *)MR MD & Therapist Lounge Room before or after
treatment of patients.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
25. MR Meeting Room. *)
Internal meeting room for MR Department /
Installation / Unit to discuss about internal
problems related to MR Services in the hospital.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
26.
MR Administration, Finance &
Personal Administration Work
Room. **)
For Hospital Officials who deal with administration,
finance and personal administration to perform
their duties
Semi-Private, even
though, people with no
particular business should
stay outside of the room
13
No. Room Name Room Function Room Characteristic
27. MR Treatment Room. *)Treatment room for staying MR patients, usually
integrated with other treatment room or a building
under control of Treatment Dept. / Installation / Unit
Semi-Private, even
though, people with no
particular business should
stay outside of the room
28. MR Medical Devices
Warehouse. **)For storage of unused or not yet used MR Devices
Service (Non Medical),
with specific access.
29. Room of OP Raw Material &
Tools. **)For storage of raw material or not yet used tools in
OP Workshop.
Service (Non Medical),
with specific access.
30. MR Pharmacy & Linen
Warehouse. *)
For storage of clean Linen (e.g.: towels, curtains &
sheets) and also pharmaceutical supplies for
therapy (e.g.: paraffin, alcohol, cotton, tissue, gel).
Service (Non Medical),
with specific access.
31. MR Waste Warehouse. *)
For storage of no longer used MR stuff but could
be eliminated immediately. This room should be
separated from other rooms and faced directly
outside of the building complex.
Service (Non Medical),
with specific access.
32. Locker Room for Male Hospital
Workers. **)
A room for changing wardrobe and to keep
personal things which are not needed when
providing service for male.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
33. Locker Room for Female
Hospital Workers. **)
A room for changing wardrobe and to keep
personal things which are not needed when
providing service for female.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
34. Locker Room for OP
Workshop Workers. *)
A room for changing wardrobe and to keep
personal things which are not needed when
providing service for OP Workshop workers.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
35. Locker Room for Male
Patients. *)
A room for changing wardrobe and to keep
personal things which are not needed when
receiving service for male patients.
Semi-Private, even
though, people with no
particular business should
14
No. Room Name Room Function Room Characteristic
stay outside of the room
36. Locker Room for Female
Patients. *)
A room for changing wardrobe and to keep
personal things which are not needed when
receiving service for female patients.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
37. Locker Room for Hydrotherapy
Patients. **)
A room for changing wardrobe and to keep
personal things which are not needed when
receiving service for hydrotherapy patients.
Semi-Private, even
though, people with no
particular business should
stay outside of the room
38. Bathroom/Lavatory for Male
Hospital Workers. **)Bathroom / Lavatory for Male Hospital Workers.
Usually located near the locker room.
Service (Non Medical),
with specific access.
39. Bathroom/Lavatory for Female
Hospital Workers. **)Bathroom / Lavatory for Female Hospital Workers.
Usually located near the locker room.
Service (Non Medical),
with specific access.
40. Bathroom/Lavatory for OP
Workshop Workers. *)Bathroom / Lavatory for OP Workshop Workers.
Service (Non Medical),
with specific access.
41. Bathroom/Lavatory for Waiting
Room. **)Bathroom / Lavatory for patients and patient
attendants who wait for service in the waiting room.
Public Service (Non
Medical), with easy
access.
42. Bathroom/Lavatory for Male
(MR Therapy Area). **)
Bathroom / Lavatory for male patients who are
currently receiving treatment in an MR
room/building.
Public Service (Non
Medical), with easy
access.
43. Bathroom/Lavatory for Female
(MR Therapy Area). **)
Bathroom / Lavatory for female patients who are
currently receiving treatment in an MR
room/building.
Public Service (Non
Medical), with easy
access.
44. Hand washing / scrubbing area
for Waiting Room. **)Hand-washing / scrubbing area for anyone about to
enter MR service room.
Public Service (Non
Medical), with easy
access.
45. Hand washing / scrubbing area Hand-washing / scrubbing area for anyone in the Public Service (Non
15
No. Room Name Room Function Room Characteristic
for MR Therapy Area. **) Therapy Area, usually in a room/connecting
corridor between rooms (Foyer) of MR service
building/room.
Medical), with easy
access.
46. Pantry & Small Dining Room. **)
A room for performing kitchen activities (e.g.:
Warming, Pouring, Food Preparation) for (usually)
Hospital Workers and to eat snacks and drink,
equipped with dining chairs and tables.
Service (Non Medical)
Semi Private with limited
access for Hospital
Workers in MR Unit.
47. Janitor / Cleaning Service
Room. **)A room for cleaning service officers to prepare their
tools; keep cleaning materials; and clean the tools.
Service (Non Medical)
with limited access.
48. MR Park or OT Outdoor Area. *)
An area (usually near MR facility) of a park / green
open area which also used as OT Practice Area
consisted of Walking Track(s) which equipped with
Therapy Facility Devices (e.g.: Parallel Bars) and
Multidimensional Layers i.e.: gravel, cements,
sands & ceramic tiles to provide different
stimulation for feet; and also consisted of ramps for
wheelchair users & walker which can be used by
MR patients and PwDs to improve their
performances to adapt with the nature and their
daily lives.
Public, easy to be
accessed by anyone. But
MR patients and PwDs
are prioritized.
49. MR Fitness Room. *)
Hospital Fitness Room which located in MR Unit in
collaboration with Faculty of Sport Medicine for
Hospital users and workers to understand and use
MR Facility even in a good health shape.
Public, easy to be
accessed by anyone. But
Hospital users and
workers are prioritized.
50. MR Utility Room. *)
MR building service rooms e.g.: Panel R., IPAL R.,
Medical Gas R., Pump R., AHU R., other Engine R.
including Shaft and Lift Area, Ramp and Stairs to
support MR Health Service Activities.
Service (Non Medical)
with limited access for
hospital users and
workers on duty.
51. MR OT Diagnostic Room. *)The development of MR Function where BERA,
EMG, EEG and Sleep Lab diagnostic are being
performed for OT or Psychology patients in needs.
Private, patients
diagnosed really need
some quietness.
16
Room Need as described in Fig. 4 depends on Resources (usually Human Resources,
Finance Ability or Land Availability for MR) owned by a particular hospital. Other
factors which need to be considered are frequency of use and number of patients.
II.3. ACTIVITY CIRCULATION FLOW
Activity Circulation in an MR Service Unit can be described in the following
model of activity circulation:
Figure 5. Model of Hospital Workers, Patients and Goods Circulation Flow
17
Patients (Policlinic, Overnight, Referral (MD, Other
Hospital, RBM))
Sp. RM Doctor / MD
with MR Certificate
MR
Psychologist
MR / PSM Therapist / Paramedic
Supporting Officers (Administration, Finance,
Personal, Medical Record, Technical)
Linen, Used Materials &
OP Raw Materials
OP Officers
MR Registration & Internal Medical Record Counter
Locker Room of MR Unit Hospital Workers
MR Waiting Room
Sp. RM Doctor Check-Up & Assessment
Room
Psychologist Check-Up & Assessment
Room
Admin, Personnel, Finance & Logistic
Room
Logistic Inventory Record
OP Workshop
Locker Room**)
OP Workshop **)
Logistic Warehouse
Locker Room for Patients Gymnasium &
Public Campaign Place
Physio-therapy &
Hydro-therapy Services
OP Services (Measurement,
Fitting, Adjustment &
Training)
OT Services
Medical Social Worker
Services
Speech Therapy Services
Hazardous
Waste
Hospital Incinerator
Laundry + Sterilization Room General Waste Hospital TWD *)
MR SERVICES
Patient Circulation Flow
Hospital Worker Circulation Flow
Goods Circulation Flow
Beginning of Circulation
Connecting Dot
MR Service Area
*) TWD: Temporary Waste Disposal **) If possible, this facility should not be directly connected with MR Service Area even if at the same building.
According to Fig. 5 can be described from the model that at least 1 (one)
circulation of goods (used up materials, clean linen and raw materials for OP
workshop) and 3 (three) human circulations for Hospital Patients, Hospital Workers
who work in MR Service Room and OP Workshop.
OP Workers circulation is being separated with MR Service Room Area in
order to avoid the dust and dirt from OP Workshop to enter MR Service Room and
disturb the patients. Even though, planning and design of rooms which make possible
of connection between OP Workshop and MR Service Room Area by making the
Measurement, Fitting & Adjustment Room of OP easily accessible with Waiting
Room Area of MR Patients and MR Service Room.
In circulation of goods, after the goods are being inventoried, it will be stored
in logistic warehouses (Linen, Pharmacy, Medical Equipment of MR, and Raw
Material of OP Warehouses), and distributed according to the needs of MR
Workgroups.
The results of the use of materials consist of two types i.e. recyclable /
reusable materials and waste from services. The waste will be distributed according to
its condition, whether or not it’s hazardous (including sharp hazardous waste i.e. non-
reusable needle) and non-hazardous / public waste.
Activity flow as shown in Fig. 5 is a model of proposal but in reality it will
depend on the building / room & the size of the land provided by the Hospital for MR
Service Unit.
18
CHAPTER – III MEDICAL REHABILITIATION
FACILITY REQUIREMENT
III.1. MR TOOLS FACILITY REQUIREMENT
III.1.1. MR Tools Room Size Requirement
As described in Fig. 4 “Table of MR Room Needs” in Chapter II; the size of a
room should be based on service capacity which will be given to MR patients or the
number of MR Health Worker who will use a particular room. Based on room
function consideration and health service capacity, room size requirement can be seen
in the following table:
No Room Name Room Size Needs Minimum Ideal Unit
1 Waiting Room for MR patients and attendants
Assuming that 1 patient is being attended by 1 attendant. 1 seat = 0.75 m2
Circulation / seat = 1.5 m2
Total need per patient = 3 m2
Minimum for 5 patients = 5 x 3 m2 = 15 m2
9 (assuming that not all patients are being attended)
15 m2 / 5 patients (with 5 attendants)
2 MR Registration & Medical Record Counter
1 worksite = 2.4 m2
1 archive cabinet = 2.16 m2
Activity Circulation = 60% x (2.4 + 2.16) m2
= 2.736 m2
Total need for 1 officer = 2.4 + 2.16 + 2.736 = 7.296 m2
4 (Archive cabinet can be used collectively)
8 m2 / Counter Officer
3 Sp. RM Doctor Check-Up & Assessment Room
1 worksite = 2.4 m2
2 face-to-face chairs for patient & doctor = 1.8 m2
1 bed for patient = 4.4 m2 1 cabinet for doctor = 2.16 m2
Activity Circulation = 60% x (2.4 + 1.8 + 4.4 + 2.16) m2 = 6.456 m2
Total = (2.4 + 1.8 + 4.4 + 2.16 + 6.456) = 17.216 m2
9 (Some furniture used collectively)
18 m2 / doctor
4 Psychologist Check-Up & Assessment Room
1 worksite = 2.4 m2
2 face-to-face chairs for patient & doctor = 1.8 m2
1 cabinet for doctor = 2.16 m2
Activity Circulation = 60% x (2.4 + 1.8 + 2.16) m2 = 3.816 m2
Total = (2.4 + 1.8 + 4.4 + 2.16 + 6.456) = 10.176 m2
5 (Some furniture used collectively)
12 m2 / psychologist
5 Physiotherapy Room 1 bed + therapy device + work area for therapist = 4.4 m2 Activity circulation = 60% x 4.4 m2 2.64 m =Total needs = 7.04 m
2
2 x 6 devices = 42.24 m2
6 devices: SW (Short Wave), MW (Micro Wave), Ultrasound, Radiant Therapy, Liquid Paraffin (with Paraffin Bath), Traction.
12 (assuming that some bed modules are holding 2 devices only)
45 m2 / 6 Service Devices for patient
Figure 13. Table of MR Room Size Requirement
19
No Room Name Room Size Needs Minimum Ideal Unit
6 OP Measurement, Fitting & Adjustment Room*)
1 working desk = 2.4 m2
Changing / fitting room = 2.4 m2
Cabinet for Working Tools & Components = 2.16 m2
Activity Circulation = (2.4 + 2.4 + 2.16) x 60% = 4.176 m2
Total Needs = (2.4 + 2.4 + 2.16 + 4.176) = 11.136 m2
4 (some furniture are not procured)
12 m2 / service of OP patient
7 Audio-tight Individual Speech Therapy Room with Audiometer Operator*)
1 worksite for therapist = 1.8 m2
1 therapy area for patient = 1.8 m2
Audiometer Operation = 4.0 m2
Activity Circulation = (1.8 + 1.8 + 4.0) x 60% = 4.56 m2
Total = 12.16 m2
12 (some areas are being shrunk to as small as possible)
15 m2 / service of Speech Therapy Patient
8 Classical Speech Therapy Room*)
Minimum for 5 (five) patients which will attend group therapy Total = 5.76 m2 x 5 = 28.8 m2
Usually 1 assistant will assists 1-3 patients
20 (some areas are being shrunk to as small as possible)
30 m2 / Group of 5 patients
9a Individual OT Room for Adults
*)Therapist work area & patient therapy area = 4.4 m2
OT tools cabinet = 2.16 m2
Activity Circulation = (4.4 + 2.16) x 60% = 3.936 m2
Total = 10.496 m2
9 (some areas are being shrunk to as small as possible)
12 m2 / service of OT Patient
9b OT Practice Room for Adults Average need for OT patient = 3 m2
Activity Circulation = 60% x 3 = 1.8 m2
Total = 4.8 x 20 devices = 96 m2
50 (some modules hold more than one OT devices)
100 m2 / 20 OT service devices
10 ADL Therapy Room*) Aid Device Module Aid Device Practice Room = 4-16 m2
Living Area Module a. Kitchen and Dining Room = 4-20 m2 b. Bedroom, Living room, Lounge = 9-25
m2 c. Toilet, Bathroom & Laundry = 4-20 m2
Worksite Module a. Office = 4-12 m2 b. Workshop = 4-25 m2
Socialization Module a. Praying Room & Facilities = 4-9 m2 b. Public Transport Mock-Up = 4-25 m2 c. Cashier & Public Service Counter Mock-
Up = 4-16 m2
9 (depend on ability and resources of MR Services)
100 m2 / or the whole ADL Service
11 Individual OT Room for Children*)
1 worksite for therapist = 1.8 m2
1 therapy area for patient = 1.8 m2
Activity Circulation = 60% x (1.8 + 1.8) = 2.16 m2
Total = 5.76 m2
4 (some areas are being shrunk to as small as possible)
6 m2 (OT Service for patient)
12 Classical OT Room for Children*)
Minimum for 3 patients who will attend group therapy Total need = 5.76 x 3 = 17.28 m2
Usually 1 assistant will assists 1-3 patients
9 (assuming that not all patients are being attended)
30 m2 / 3 patients
13 Integration & Censor (IC) Room for Children*)
Area for large toys = 4-10 m2
Total = 10 x 10 toys = 100 m2
Large Toys e.g.: Swing, Footbridge, Trampoline, Special Sitting Bench (all of it are being covered with protection seal to prevent injuries)
16 (assuming that not all toys owned by hospital)
100 m2 / IC Service
14 Audio Visual Relaxation / Stimulation Room (Snelling
Space for every device including small toys = 2.25-6.25 m2
9 (minimum distance from TV
45 m2 / Snelling Room Service
*) Establishment of the room depends on the needs and available resources of the hospital
20
No Room Name Room Size Needs Minimum Ideal Unit
Room) Total = 6.25 x 7 devices = 43.75 m2
Small Toys e.g.: Multiple Colors Fiber optic Cables, Multi-display Colors Aquarium (with Bubble Compressor & Artificial Environment e.g. plastic fishes), Multi-Colored Switch Board Buttons with Multiple-Colors Display Lamp, Multiple-Colors Projection Lamps & AV System (TV + DVD + Audio) with Elastic Bumpy Ball.
is 3 x diagonal size of TV screen)
15 MR Gymnasium and Community Service Room
Space for someone to stretch arms forward in standing position 8) = 1.45 m Mattress length for lying down position 8) = 2.0 m Space for someone to stretch arms sideward in lying down position8) = 1.75 m
.: Space per person = 2.0 x 1.75 = 3.5 m2
Activity Circulation = 60% x 3.5 m2 = 2.1 m2
Total per person = 5.6 m2
Area prepared for minimum of 12 participants + 1 instructor / group = 5.6 x 13 = 72.8 m2
40 (assuming that activity circulation done before or after gym)
80 m2 / 10 gym participants (or 20 MR Community Service Participants)
16 Hydrotherapy Room *) Usually Modular Hydro bath Therapy Butterfly Bath shaped: 3.0 x 2.5 = 7.5 m2
Regular Swimming Pool with Whirpool & Water Heater = 5 x 7 = 35 m2
Activity Circulation = 60% x 35 = 21 m2
Total = 56 m2
20 (Butterfly Bath excluding Locker Room & Shower Room)
60 (excluding Locker Room & Shower Room)
m2 / hydrotherapy service (swimming pool for 2-6 patients)
17 OP Workshop Room*) Worksite for Gyps Positive Molding = 3 m2 / worker Worksite for Metal Work = 2.25 m2 / device (Usually 5 devices i.e. Cutting, Bending, Metal & Leather Drilling, Welding, and Lathe devices) Worksite for Leather Work = 3 m2 / worker Worksite for Positive Modeling = 3 m2 / worker Oven Worksite = 3.75 m2
Polymer / Resin Molding Worksite = 3 m2 / workerWorksite for Wooden Prosthetic Work = 3 m2 / worker Cabinet for tools, models, materials, mold = 4.32 m2
Activity circulation = 20.592 m2
Total = 54.912 m2
20 (not all of services are available)
60 (excluding warehouse and toilet)
m2 / OP workshop service
18 MR Sport Medicine Room Space for PC operator desk – device diagnostic = 2.4 m2
Space for devices = 9 m2
Activity Circulation = 6.84 m2
Total = 86.4 m2
36 (some areas are being shrunk to as small as possible)
90 m2 / MR Sport Medicine Room
19 Body Motor Function Research & Testing Room
Space for Patient Practice & Therapy Path = 30 m2
Observation, Picture Recording & Editing Room = 24 m2
Activity Circulation = 32.4 m2
Total = 86.4 m2
36 (some areas are being shrunk to as small as possible)
90 m2 / MR Sport Medicine Room
20 VIP Service Room Similar to Physiotherapy room (2-4 rooms) = 4 rooms x 4.4 m2 = 17.6 m2
Couch = 9 m2
VIP Counter = 4.5 m2
Activity Circulation = 18.66 m2
Total = 49.76 m2`
20 (some areas are being shrunk and only 2 service rooms provided)
50 m2 / MR VIP service
21 Head / Vice Head / Manager of Department / Installation /
Space for work per person = 3.6 m2
1 bookcase = 2.16 m220 (some areas are being shrunk
30 m2 / person
8) E. Neufert (Tranlated by Sjamsu Amri), “DATA ARSITEK”, Erlangga Publishing, Jakarta, 1987.
21
No Room Name Room Size Needs Minimum Ideal Unit
Unit of MR Couch = 9 m2
Space for personal secretary = 3 m2
Activity Circulation = 10.65 m2
Total = 28.4 m2
to as small as possible)
22 Room for Asst. Manager / Coordinator / Section Head / Service Head / Workgroup Coordinator of Dept./Installation/Unit of MR
Workspace per person = 3 m2
1 bookcase = 2.16 m2
Activity Circulation = 3.88 m2
Total = 9.04 m2
Couch + its circulation area (collectively used) = 9 x 160 % = 14.4 m2
9 (some areas are being shrunk to as small as possible)
12 m2 / official
23 Room for MR Functional Medical Staff (FMS) Head*)
Workspace per person = 3.2 m2
1 bookcase = 2.16 m2
Space for personal secretary = 3 m2
Activity circulation = 5.25 m2
Total = 14.01 m2
9 (some areas are being shrunk to as small as possible)
16 m2 / official
24 MR FMS Discussion Room*) Space for 6 persons = 11.84 m2
1 bookcase = 2.16 m2
Activity Circulation = 8.4 m2
Total = 22.4 m2
12 (some areas are being shrunk to as small as possible)
24 m2 / 6 discussion participants
25 MR Meeting Room Space / person = 0.625 x 0.875 = 0.54 m2
Activity circulation = 0.32 m2
Total / person = 0.86 m2
Class A Hospital: 57 persons x 0.86 = 49.02 m2
Class B-II / B+: 41 persons x 0.86 = 35.25 m2
Class B-I / B: 22 persons x 0.86 = 18.92 m2
Class C: 4 x 0.86 = 3.44 m2
Space for Projector & Cabinet = 2.4 x 4.0 x 160% = 15.36 m2
Class A: 50x2/3 ≈ 35 Class B-II: 36x2/3 ≈ 24 Class B-I: 19x2/3 ≈ 16 Class C: 4x2/3 ≈ 9
Class A: 50+16=66 Class B-II: 36+16=52 Class B-I: 19+16=35 Class C: 4+16=20
m2 / Hospital
26 Room for MR Administration, Finance & Personnel
Work space / person = 2.4 m2
1 Archive Cabinet = 2.16 m2
Activity Circulation = 2.736 m2
Total / person = 7.296 m2
4 (some areas are being shrunk)
9 m2 / worker
27 MR Treatment Room*) 1 bed for patient = 4.4 m2
Cabinet for patient = 0.6 m2
Activity Circulation = 3 m2
Total needs per bed = 7.4 m2
MR Patient Toilet/Bathroom8) = 5.67 m2
Total for 4 patients / room = 35.27 m2
20 (some areas are being shrunk to as small as possible)
36 m2 / 4 patients
28 MR Medical Equipment Warehouse*)
1 storage cabinet = 2.16 m2
Cabinet activity circulation = 1.29 m2
Space for 1 cabinet = 3.45 m2
Space for 4 cabinets = 13.8 m2
9 (only 2 cabinets)
15 m2 / warehouse unit
29 OP Raw Material & Tools Warehouse*)
1 storage cabinet = 2.16 m2
Cabinet activity circulation = 1.29 m2
Space for 1 cabinet = 3.45 m2
Space for 4 cabinets = 13.8 m2
9 (only 2 cabinets)
15 m2 / warehouse unit
30 MR Pharmacy & Linen Warehouse*)
1 storage cabinet = 2.16 m2
Cabinet activity circulation = 1.29 m2
Space for 1 cabinet = 3.45 m2
Space for 4 cabinets = 13.8 m2
9 (only 2 cabinets)
15 m2 / warehouse unit
31 MR Waste Warehouse*) 1 storage cabinet = 2.16 m2
Cabinet activity circulation = 1.29 m2
Space for 1 cabinet = 3.45 m2
Space for 4 cabinets = 13.8 m2
9 (only 2 cabinets)
15 m2 / warehouse unit
32 Male Worker Locker Room 1 locker = 0.96 m2
Activity Circulation = 0.57 m2
10 lockers + activity circulation = 6.6 m2
Changing Room = 1.5 m2
4 (some areas are being shrunk to as small as possible)
9 m2 / worker
22
No Room Name Room Size Needs Minimum Ideal Unit
Total = 8.1 m2
33 Female Worker Locker Room
1 locker = 0.96 m2
Activity Circulation = 0.57 m2
10 lockers + activity circulation = 6.6 m2
Changing Room = 1.5 m2
Total = 8.1 m2
4 (some areas are being shrunk to as small as possible)
9 m2 / worker
34 OP Worker Locker Room*) 1 locker = 0.96 m2
Activity Circulation = 0.57 m2
10 lockers + activity circulation = 6.6 m2
Changing Room = 1.5 m2
Total = 8.1 m2
4 (some areas are being shrunk to as small as possible)
9 m2 / worker
35 Male Patient Locker Room*) 1 locker = 0.96 m2
Activity Circulation = 0.57 m2
10 lockers + activity circulation = 6.6 m2
Changing Room = 1.5 m2
Total = 8.1 m2
4 (some areas are being shrunk to as small as possible)
9 m2 / patient
36 Female Patient Locker Room*)
1 locker = 0.96 m2
Activity Circulation = 0.57 m2
10 lockers + activity circulation = 6.6 m2
Changing Room = 1.5 m2
Total = 8.1 m2
4 (some areas are being shrunk to as small as possible)
9 m2 / patient
37 Hydrotherapy Patient Locker Room
1 locker = 0.96 m2
Activity Circulation = 0.57 m2
10 lockers + activity circulation = 6.6 m2
Changing Room = 1.5 m2
Total = 8.1 m2
4 (some areas are being shrunk to as small as possible)
9 m2 / patient
38 Male Worker Toilet/Bathroom
Space for Toilet & Bathroom8) = 2x1.35 = 2.7 m2 2.7 3 m2 / toilet unit
39 Female Worker Toilet/Bathroom
Space for Toilet & Bathroom8) = 2x1.35 = 2.7 m2 2.7 3 m2 / toilet unit
40 OP Worker Toilet/Bathroom*)
Space for Toilet & Bathroom8) = 2x1.35 = 2.7 m2 2.7 3 m2 / toilet unit
41 Waiting Room Toilet/Bathroom
Space for Toilet & Bathroom8) = 2.1x2.7 = 5.67 m2 5.67 9 m2 / toilet unit
42 Male Toilet/Bathroom (MR Therapy Area) *)
Space for Toilet & Bathroom8) = 2.1x2.7 = 5.67 m2 5.67 9 m2 / toilet unit
43 Female Toilet/Bathroom (MR Therapy Area) *)
Space for Toilet & Bathroom8) = 2.1x2.7 = 5.67 m2 5.67 9 m2 / toilet unit
44 Washing Room Area for Waiting Room
Washing vessel 8) = 0.76 x 1.52 = 1.14 m2
Activity Circulation = 1.14 x 60% = 0.68 m2
Total = 1.82 m2
1.82 3 m2 / unit
45 Washing Room Area for MR Therapy Area
Washing vessel 8) = 0.76 x 1.52 = 1.14 m2
Activity Circulation = 1.14 x 60% = 0.68 m2
Total = 1.82 m2
1.82 3 m2 / unit
46 Pantry & Small Dining Room Space for stoves 8) = 1.67 m2
Space for sink 8) = 1.43 m2
Space for Refrigerator = 1.78 m2
Space for storage cabinet = 2.2 m2
Total = 7.08 m2
6 9 m2 / unit
47 Janitor / Cleaning Service Room
Washing Area 8) = 1.9 m2
Cabinet Storage for Cleaning Tools8) = 1.8 m2
Activity Circulation = 1.92 m2
Total = 5.62 m2
4 6 m2 / unit
23
No Room Name Room Size Needs Minimum Ideal Unit
48 OT Outdoor Area*) Green Area space / patient = 9-15 m2
For 100 patients = 15x100 = 1500 m2
Toilet/Bathroom (1 per 2000 m2) 8) = 2.7 m2
1 Open Space Therapy Device = 4.4 m2
For 10 devices = 44 m2
Total = 1544 m2
950 1600 m2 / 100 patients (with 10 outdoor therapy devices)
49 MR Fitness Room*) Space for 1 OT equipment = 3 m2
For 10 equipments = 30 m2
Accessible Changing Room8) = 2.25 m2
Space for Fitness Room Storage Cabinet / Module = 0.4 x 2 = 0.8 m2
Accessible Toilet8) = 2.85 m2
Accessible Bathroom8) = 2.85 m2
Activity Circulation = 27.57 m2
Total for 10 equipments, Changing R., 30 Lockers, 1 Bathroom, 1 Toilet = 73.52 m2
25 75 m2 / Fitness Room for 10 – 30 users
50 MR Utility Room*) Space for AHU (Air Handling Unit) for Central Air Conditioner = 9 m2
Electrical MDP (Main Distribution Panel) = 2.52 m2
Communication & Medical Gas Control Panel = 1.62 m2
Activity Circulation = 13.32 m2
Total = 35.52 m2
24 36 m2 / 1000 m2 or less of MR floor width
51 MR OT Diagnostic Devices Room
Space for OT Diagnostic Check-Up = 4.4 m2
Washing Vessel 8) = 1.14 m2
Computer Desk for BERA,EMG,EEG & Sleep Lab = 2.16 m2
Cabinet for OT Diagnostic Materials & Tools Storage = 2.16 m2
Activity Circulation = 5.91 m2
Total = 15.68 m2
9 16 m2 / MR OT Diagnostic Unit
III.2.2. Technical Requirement of MR Tools Components
III.2.2.1. Cover of MR Floor
MR floor covering materials usually have the same technical requirements as
other rooms i.e.:
1. Not made from materials which have a surface of high porosity (will tend
to hold hazardous dust)
2. Easy to clean and can stand from friction (especially from wheels of
patient stretcher, bed, wheelchair, food trolley, linen trolley, logistic
trolley, garbage trolley)
3. Bright colored but not glowing (shiny).
4. Floor pattern should be able to be followed by patients with low vision.
5. For areas with more than 100 of slope, beside easily visible floor pattern,
the floor should have non-slippery covers (even in wet condition).
24
6. For areas which will easily be affected by water should have non-slippery
covering when soaked with water. (e.g. hydrotherapy room, bathroom &
toilet)
7. Particularly for OP warehouse, the floor should be resistant to fire,
chemical substances, and collisions/bumps.
8. Particularly for Speech Therapy Room, the floor should be voice-proof
and doesn’t make any noise when stepped on.
III.2.2.2. MR Wall Component
Like other hospital facility wall component, MR wall component has the
following requirements:
1. Easy to clean, weather-proof, and fungus-free.
2. Wall finishing overlay should be non-porous for it to be free from
hazardous dust.
3. Wall color should be bright but not glowing (shiny) – usually called as
pastel colors – especially for rooms which connected to children activity.
Eye catching colors like bright red, bright yellow, bright blue, bright
orange and bright green are suitable to stimulate children.
4. In MR Areas, the entire walls should have Wall Railings with around 80-
100 cm in height from the surface of the floor. The railings should be able
to cope with a person weighing in at ± 75 kg holding on to the railings
with one hand. The railing material should be fire-resistant, easy to clean
and non-porous. Particularly for OP warehouse, the wall should be
resistant to fire, chemical substances, and collisions/bumps; while at
Physiotherapy areas especially around devices which use Electromagnetic
(EM) Wave e.g. Short Wave (SW) and Micro Wave (MW) Diathermy the
wall material shouldn’t be using metal or steel material. In Speech
Therapy Areas the wall should use Voice-proof covering which absorb
voices and echo-less.
25
III.2.2.3. MR Facility Opening Components
Opening components in MR facility (e.g. doors, windows and its frames) as
well as in other hospital facilities have the following requirements:
1. The free range of door opening in MR facility should not be less than 100
cm for single door or 120 cm for double door.
2. Door Handle height in MR facility should not be lower than 100 cm
measured from the lowest floor level.
3. Mechanical Door Closer should not be used in MR facility because it will
cause difficulties for patients especially when no attendant is around.
4. Automatic / Motorized Door Closer may be used if the opening-closing
censor installed 20 cm above the ground (can detect something with 20 cm
of height e.g. footstep of wheelchair) either from outside or inside of
room.
5. For doors which directly connected with outside of the building the door
should be able to be opened outwards or in both directions.
6. Opening Components located at OT workshop or areas with possibility of
fire spark to arise should be fire-resistant.
7. Opening Components located at Speech Therapy Rooms should be made
from sound-absorbing materials, echo-less and resonance-less.
8. Opening Components located at areas which directly affected by water i.e.
Hydrotherapy Room, Bathroom and Toilet should be made from water
resistant and water proof materials.
9. If opening components use keys, it should be able to be opened from both
sides.
10. Opening components made from transparent materials (e.g. glass) should
be equipped with protector (e.g. covered with steel screen), and if it
shattered, the fragments should be in form of small blunt grain
(Unsharpened Tempered Glass With Safety Mesh Inside) and provided
with clear opening direction sign (e.g. PULL/PUSH) using fluorescent
materials and big enough to be clearly read (letter height is around 10-20
cm and width of around 2/3 to 3/5 of its height). The sign should be put at
26
around 100-120 cm above the floor for it to be accessible for everyone
including wheelchair users.
11. For emergency doors in MR facility; the opening handlebar should be
accessible for everyone including wheelchair users with the height at
around 80-100 cm above the floor.
III.3. REQUIREMENT OF MEDICAL REHABILITATION FACILITY
EQUIPMENT
III.3.1. Requirement of Lighting and Electricity Equipment
Electrical Requirement in MR Unit is related to available Electrical Power in
the hospital.
III.3.1.1. Requirement of MR Electricity Network
This line of equipment stretched from Hospital Main Relay Station to
Electrical Plug for every electrical device in MR Service Rooms. Basically,
arrangement of Electrical Panel in an MR Building can be modeled as
follows: Fig. 14 Diagram Model of Electrical Panel in MR Building (Page 32 – The diagram is not clear enough)
The above diagram shows an Electrical Control Panel in a Room or Floor of
MR Service Area:
Fig. 15 Diagram Model of Electrical Panel in MR Room / Floor (Page 32 – The
diagram is not clear enough)
As seen in Fig. 14, some rooms in MR Service Area proposed to have Back-
Up Source Line (JSC – Jalur Sumber Cadangan) from Hospital Generator Set
i.e. for Physiotherapy, Hydrotherapy, Audiometer, OT-MR Diagnostic Room
(for EEG,EMG,BERA-Test, etc.) and MR Sport Medicine Room (usually
using products from Cybex). The other rooms aren’t prioritized to have JSC
27
except for some lights in circulation corridors and some service rooms (as
emergency lighting in emergency circulation situation).
From Fig. 14 & 15 can also be seen installation of KWh Meter, Voltmeter and
Ampere meter equipped with Pilot Lamps, merely to make power using
control easier (for efficiency and effectiveness of resources).
The Building Panel as shown on Fig. 14 should follow Electrical Installation
General Rules (PUIL – Peraturan Umum Instalasi Listrik) where some
devices in MR Rooms are directly connected to electrical plug which
minimum classification of 1-E according to PUIL. The requirements are:
1. Protection system on power down because of electrical short-circuit,
isolation disturbance, or other usual disturbance should not endanger
officers on duty and/or patients.9)
2. The switch mechanism between electrical Main Source Line (JSU – Jalur
Sumber Utama) and Back-Up Source Line (JSC – Jalur Sumber
Cadangan) should take no more than 10 seconds for automatic line-switch
or 3 minutes for manual line-switch. Therapy to MR patients allowed to be
delayed and restarted again after the power has been restored, and should
not endanger the safety of officials and patients.
3. Electrical Network in class 1-E rooms advised to improve the electrical
distribution protection mechanism, where if at least 0.5 mA of electrical
current flows directly through human body as a direct leak current or
body-contact leak current, the network system should automatically
protects the person, which will cause Electrical Shock or even death.
Another requirement which expected to be applied in Medical Rehabilitation Unit
i.e.:
1. Electrical resistance of the main grounding line should not exceed 5 Ω,
while at electrical plugs of devices; it should not exceed 0.2 Ω.
9) Article 3.1.2., Article 3.7.1.1. and Article 3.7.1.2. of PUIL 200, Jakarta, Indonesia.
28
2. The capacity of installed cables and panels are at least 150% of installed
power planned in MR or at the floor and room of MR Service.
3. The panels should be equipped with enough protection and warning signs
(e.g.: WARNING – RISK OF ELECTRICAL SHOCK, etc.) using
fluorescent materials or at least light reflecting materials.
4. Electrical Panels should have emergency lighting with rechargeable
emergency light put at the outside compartment of the panels.
5. Handle Bar of electrical panels should not be easily reached by children
(150-175 cm above the floor).
6. Electrical Panel of MR Room / Floor should not be located inside the
room / floor.
7. Case of electrical plug of devices in Physiotherapy rooms should be made
from non-metal materials.
8. Electrical Plug in Hydrotherapy Service rooms should be made from
waterproof and water-resistant materials.
9. Electrical plugs in MR rooms should be protected when not in use.
10. Lighting switch and electrical plug should be installed at the height which
will be easily accessed by wheelchair users of around 80-100 cm above
the floor (non-MR rooms are 140 cm).
11. Lighting switch of MR rooms should be able to be accessed / operated
either from outside or inside of the room, equipped with operating
direction (letter height is around 2-4 mm), and if possible a pilot lamp
which indicate the status of the switch (on/off).
12. Electrical Plug should be equipped with protection fuse (either a
mechanical thermal fuse or miniature circuit breaker (MCB)), and pilot
lamp which indicate the status of the plug (powered/not); if financial
situation of the hospital allowed.
The electrical network requirement above could be fulfilled either step by step
or altogether which depend on the capability of each hospital, either its
resources, general hospital management, or MR Service management in
29
preparing and developing its human resources in fulfilling a Standard
Operation Procedure (SOP) or Permanent Procedure (ProTap – Prosedur
Tetap).
III.3.1.2. Lighting Requirement in MR Unit
MR Lighting should follow requirement stated in the book of “PEDOMAN
PENCAHAYAAN DI RUMAH SAKIT”, Direktorat Instalasi Medik, Ditjen
Pelayanan Medik, Depkes RI of 1992 (HOSPITAL LIGHTING MANUAL of
Medical Installation Directorate of Directorate General of Medical Services,
Indonesian Health Department, 1992) especially in page 37, as seen from the
table below:
Fig. 16, Table of Medical Rehabilitation Lighting Category
No Room Name Activity Lighting Category
Minimum Lux (Lumen/m2)
Ideal Lux (Lumen/m2)
1 Administration Read, Write, Type & Line D 200 500
2 Doctor/Psychologist Read, Write, Examine, Consult C 100 200
3 Staff Read, Write, Examine, Consult C 100 200
4 Locker Store & Change clothes C 100 200
5 Waiting Room Waiting room C 100 200
6 Gymnasium Gym for patients D 200 500
7 Treatment Room Patient treatment & therapy D 200 500
8 Exam Rom Patent examination & training D 200 500
9 Physical & Vocational Therapy & Training E 500 1000
10 Exercise Treatment & Training D 200 500
11 Hydrotherapy Training D 200 500
12 Bathroom/Toilet/Shower Non-Medical service C 100 200
13 Pump Room/ME/Utility Non-Medical service B 50 100
14 Physiotherapy Room Treatment D 200 500
15 Accident Rehabilitation Treatment C 100 200
If we take a look at Fig. 4 (MR Room Need – Chapter II) and Fig 13 (MR
Room Size Requirement – Chapter III), some rooms which haven’t been listed
in the table of Fig. 16 above can be determined its similarity according to the
function of each room in present or in the future. These tables below will help
us to calculate the average power needed for MR rooms according to lighting
category:
30
Fig. 17, Table of Light Source11)
No Light Source Lumen / Watt
Average Last (Hour) Use
1 Regular Bulb 11 – 18 1000 Indoor & Outdoor
2 Tube Lamp (with IC Ballast) 50 – 60 900 – 1800 Indoor & Outdoor
3 Halogen 16 – 20 1000 Outdoor (Sport Court)
4 Mercury (IC Ballast) 30 – 60 16000 Outdoor (Park & Side road)
5 Meta Halide 80 – 100 7500 – 15000 Outdoor (Spotlight)
6 Sodium 120 – 140 16000 – 24000 Outdoor (Side road)
We can also calculate Light Loss Factor (LLF) caused by the use of light
cover or the type of lighting system as seen from the table below:
Fig. 18, Table of Lighting System Type11)
No Type of Lighting System LLF (%) 1 Direct Lighting 90 – 100
2 Semi-direct Lighting 80
3 Combination of Direct & Indirect Lighting 40 – 60
4 Semi Indirect Lighting 60 – 90
5 Indirect Lighting 60
Wall and ceiling colors and light location will also affect lighting system
effectiveness (Coefficient of Utilization (CU)), where for the white colored
wall and ceiling and 200 – 250 cm of distance between the light and the work
area, the CU is 50 – 65 % 11) (the higher the distance and the darker the colors,
the lower the CU rate). To make the calculation easier, example model of
needs per 100 Lux for a room is used as seen in the case example below:
Case: An MR Service Room needs 100 Lux of lighting. The room dimension is 10 m (L) x 10 m (W) x 2.8 m (H). Wall and ceiling use bright white paint, dark clouded in the afternoon and using 40W of TL with 75 Lumen/Watt (data taken from the lamp’s brochure) using a 10W Ballast and power plug with Fk = 20%. Question:
1. How many lights needed to light the entire room? 2. What is the total power needed?
11) Poerbo, Hartono, “UTILITAS BANGUNAN” (Building Utility), Djambatan Publisher, Jakarta, 2002
31
3. How many watt/m2 are needed to light the room with 100 Lux of luminance? Answer: Q = 75 Lumen / Watt x 40 Watt = 3000 Lumen CU = 60% = 0.6 LLF = 80% = 0.8 A = 10 x 10 = 100 m2
E = 100 Lux (Lumen/m2) Plamp = 40W Pballast = 10W Fk = 20%
22.4100420
420%120507)%100()(
794.6144010000
8.06.03000100100
−===∴
==++=∴
≈====∴
WmE
PP
WxxFkxPPnxPxx
xQxCUxLLF
ExAn
totA
ballastlamptot
Q : Lighting strength / light CU : Coefficient of Utility LLF : Light Loss Factor A : Work Area E : Expected Lighting Strength Ptot : Total power Plamp : Power per lamp Pballast : Power per ballast Fk : Power plug loss factor PA : Power per square meter
1. 7 (seven) 40W TL are needed to light a 10m x 10m room with 100 Lux of required lighting strength
2. Total power needed in the room is 420 Watts 3. Power needed per square meter is 4.2 Watts to illuminate the room at a rate of
100 Lux of luminance
From the case example above, we can then further determine a table of power
needs approximation according to Lighting Category deciphered from the
book of “PEDOMAN PENCAHAYAAN DI RUMAH SAKIT” (Hospital
Lighting Manual) especially from the page of 25 (using TL with 75
Lumen/Watt of luminance, room height of 280-300 cm, and white colored
paint) i.e.:
32
Fig. 19 Table of Lighting Category (TL, 75Lumen / Watt)
No Lighting Category
Minimum Luminance
(Lux)
Ideal Luminance
(Lux)
Minimum Lux Power Needs per m2 (W/m2)
Ideal Lux Power Needs per m2
(W/m2) Comments
1 A 20 50 0.84 2.10
2 B 50 100 2.10 4.20
3 C 100 200 4.20 8.40
4 D 200 500 8.40 21.00
5 E 500 1000 21.00 42.00
6 F 1000 2000 42.00 84.00
7 G 2000 5000 84.00 210.00
8 H 5000 10000 210.00 420.00
9 I 10000 20000 420.00 840.00
♦ Using 40 W & 75 Lumen/Watt TL
♦ CU = 0.6 ♦ LLF = 0.8 ♦ Room height = 280-300 cm
According to Fig. 17 (Lighting Source Table), when we replace the TL with
regular bulbs, in order to gain the same luminance the power needed will
increase to:
28.161575
1040402.4 −=⎟
⎠⎞
⎜⎝⎛
+Wmxx
4.2 (Wm-2) : Power needed per square meter when using TL 40 (W) : Power of the Bulb used 40 + 10 (W) : Power of the TL + ballast used 75 (Lumen/Watt) : Luminance of TL 15 (Lumen/Watt) : Luminance of Regular Bulb
We can conclude that regular bulbs will require approximately 300% more
power than TL of the same power (40 W bulbs and 40 W TL + 10 W of
ballast). If we put it into the table of Fig. 16, we can make a comparison of
needed power when using TL and bulbs:
Fig. 20, Table of Medical Rehabilitation Lighting Category (Comparison of TL and Bulbs)
No Room Name Lighting Category
Minimum Lux Power Needs per m2 (W/m2) for TL
of 75 Lumen/Watt
Ideal Lux Power Needs per m2
(W/m2) for TL of 75 Lumen/Watt
Minimum Lux Power Needs per
m2 (W/m2) for Bulbs of 15 Lumen/Watt
Ideal Lux Power Needs per m2
(W/m2) for Bulbs of 15 Lumen/Watt
1 Administration D 8.40 21.00 33.60 84.00
2 Doctor/Psychologist C 4.20 8.40 16.80 33.60
33
No Room Name Lighting Category
Minimum Lux Power Needs per m2 (W/m2) for TL
of 75 Lumen/Watt
Ideal Lux Power Needs per m2
(W/m2) for TL of 75 Lumen/Watt
Minimum Lux Power Needs per
m2 (W/m2) for Bulbs of 15 Lumen/Watt
Ideal Lux Power Needs per m2
(W/m2) for Bulbs of 15 Lumen/Watt
3 Staff C 4.20 8.40 16.80 33.60
4 Locker C 4.20 8.40 16.80 33.60
5 Waiting Room C 4.20 8.40 16.80 33.60
6 Gymnasium D 8.40 21.00 33.60 84.00
7 Treatment Room D 8.40 21.00 33.60 84.00
8 Exam Rom D 8.40 21.00 33.60 84.00
9 Physical & Vocational E 21.00 42.00 84.00 168.00
10 Exercise D 8.40 21.00 33.60 84.00
11 Hydrotherapy D 8.40 21.00 33.60 84.00
12 Bathroom/Toilet/Shower C 4.20 8.40 16.80 33.60
13 Pump Room/ME/Utility B 2.10 4.20 8.40 16.80
14 Physiotherapy Room D 8.40 21.00 33.60 84.00
15 Accident Rehabilitation C 4.20 8.40 16.80 33.60
The table in Fig. 20 determined with assumptions that the lights are able to
illuminate with 100% of its potentials and the wall and ceiling are colored
perfectly bright (very high CU and LLF). Therefore, when creating a design of
a room of MR facility, the ideal calculation should be used.
III.3.2. Requirement of Clean Water Facility Equipment
III.3.2.1. Total Needs of Clean Water of MR Facility
A few things which will need to be considered in planning clean water needs
i.e.:
1. Hospital need of clean water : 400 – 650 liters / day / bed 12)
2. Hand washing activity : 0.5 – 1.5 liters / use.
3. Washing activity using shower : 6.5 – 12 liters / use.
4. Urinary : 1.5 – 3 liters / use.
5. Toilet : 3 – 6.5 liters / use.
6. Middle-sized Butterfly Bath typed Hydrotherapy (2 x 2 x 0.8) = 3.2 m3.
Water in whirlpool & heating system = 20% x 3.2m3 = 0.64 m3.
Total needs : 3,840 liters.
12) Putstep, Ervin, “MODERN HOSPITAL”, LLOYD-LUKE Ltd., London, 1979
34
7. Swimming Pool typed Hydrotherapy (1.5 x 12 x 4) = 72 m3. Water in
whirlpool & heating system blower = 30% x 72 = 21.6 m3.
Total needs : 93,600 liters.
8. OT workshop will require the largest amount of water after hydrotherapy
facility especially for creating polymer using prosthetic devices.
OT workshop : 12 – 15 liters / device / day.
9. Cooking in pantry : 3 – 6 / person 13)
III. 3.2.2. Water Temperature
1. Normal / room temperature : 25 – 34 0C (depends on weather)
2. Warm water : 32 – 39 0C
Hot water : 43 0C 12)
3. Shower water : 38 – 40 0C 12)
4. Hand washing : 43.5 0C (in patient service rooms)12)
III. 3.2.3. Water Hygiene
1. Smell-free, color-free, taste-free
2. Should not contain disinfectant of > 5 NTU13)
3. Free from radioactive & chemical substances
4. Free from microorganism contamination e.g. Faecal Coliform Bacteria
(usually >99% is E. Coli Bacteria) 13)
5. Free from vegetative microorganism which will cause moss or fungus to
grow especially in hydrotherapy facility
6. Free from viruses which will cause Diarrhea & Typhus
III. 3.3. Heating Ventilation & Air Conditioning (HVAC) and Room Noise Level
III. 3.3.1. Requirement of Air Conditioning Equipment
This facility will provide comfort and air circulation for officials and patients
in MR facility. The requirements are:
13) The Spere Project, “Spere Basic Cooking Need”, 2004 12) Putstep, Ervin, “MODERN HOSPITAL”, LLOYD-LUKE Ltd., London, 1979
35
1. Cool and environmentally-comfortable temperature: 24 – 24.5 0C
2. Humidity (other than hydrotherapy facility): 40 – 60%
3. The most sophisticated Split and Package AC ability: 9000 – 10,500 BTU
(British Thermal Unit) / HP (Horse Power)
4. The most sophisticated Outdoor Unit for Split and Package AC power
efficiency: 650 – 750 W / HP (used to be 850 – 950 W / HP) at 220 – 240
VAC, 50 Hz, 1 phase.
5. Air Flow Speed in Air Ducting Distribution blown by Air Handling Unit
Blower should be no less than 0.15 ms-1 12)
6. Every MR room will need basic ventilation and infiltration which will
cause sensible and latent load (sensible and latent CFM).
7. CFM is the need for basic ventilation and infiltration: )1158.0xxfVCFM roomroom=
Vroom : Room volume (l x w x h) froom : Frequency of air circulation per hour 0.58 : Constant (from 35.31 / 60)
8. Sensible CFM (in BTU) will cause load of: )11508.1 xCFMxCFM sensible =
1.08 : Constant in BTU. 5 : Constant of temperature difference of Indonesia and foreign countries
9. Latent CFM (in BTU) will cause load of: )1167.0 hgxCFMxCFM latent ∆=
0.67 : Constant in BTU. hg∆ : Difference of humidity between indoor and outdoor
10. Every one human being will cause sensible load and latent load on AC
which will decrease AC ability (in HP) by:
)1105.09000
1)250200( HPxnxP =+=∆
P∆ : Power decrease n : Number of people
36
11. Sensible load of every 40 W TL (in HP):
)1101.09000
14.325.140 HPxxxP ==∆
P∆ : Power decrease
12. Every glass window at daylight will cause sensible load of 800 – 1000
BTU / hr / m2 of window size (depending on sunlight direction)11)
13. Every wall will create sensible load of 2.15 – 2.16 BTU / hr / m2 / 0F 11)
14. If the MR Service Room is right under the roof, it will create sensible load
of 11.5 BTU / hr / m2 / 0F 11)
15. Comparison of temperature measurement: 0R(Reamure):0C(Celcius): 0F(Fahrenheit) = 4:5:9+32
K(Kelvin) = 0C - 273
16. Hydrotherapy and Physiotherapy rooms will need 1.5 – 2 x as much AC
Power as other rooms because many devices in these rooms emit heat.
17. MR room with a volume of 100 m3 should at least be equipped with air
distribution duct which able to contain blowers of 50 cm in minimum
diameter, 0.5 m3s-1 of air flow and air circulation frequency of 2 – 12 h-1
(per hour).
18. Air intake duct in Air Handling Unit of MR building should be placed at
least 90 cm from the roof and 750 cm from building exhaust area or other
heat emitting areas (e.g. hospital incinerator)10).
19. Indoor unit installment in form of Air Intake Diffuser (For Central AC) or
mechanical air flow control e.g. Exhauster Fan, Window AC, Indoor Unit-
AC Split should be placed at least 200 cm above the floor and minimum
20 cm from ceiling10)
20. Exhauster should be installed in OP workshop and be placed at least 7.5
cm above the floor10). Especially in areas where dust is likely to exist.
21. Design and planning of Air Conditioning System in MR facility should
consider the requirements mentioned in point 7 – 19.
37
22. Indoor unit of AC System in MR facility should be cleaned with aerosol
cleaner (resorcinol, trietilyne glycol) at least once a month10)
23. Monitoring of air quality in MR Facility should be performed at least
twice a year by sample gathering and air quality parameter inspection
(germ, dust, gas)10)
III. 3.3.2. Requirement of Room Noise
This requirement refers to Minister of Health Regulation No.
718/Menkes/Per/XI/1987 which divides noise tolerance as follows:
Fig. 21 Noise Level Table
No Zone Ideal Noise Level (dB) Maximum Noise Level (dB)
1 A 35 45
2 B 45 55
3 C 50 60
4 D 60 70
Based on Minister of Health Decision No. 1204/Menkes/SK/X/2004 for
implementation in MR, noise level adjustment can be performed in some ways
i.e.:
1. Arrangement of MR Rooms should allow rooms which need quietness to
be free from noise.
2. Sources of noise from MR Rooms should be able to be controlled, i.e. by:
2.1. Room muffling, partitioning, re-arrangement, maintenance of
machinery or other activities which might cause some noises.
2.2. Noises which come from outside should be controlled by room
partitioning and noise muffling i.e. by planting trees (green belt
installation), wall barrier installment, and increase the ground level
(site barrier installation).
To determine empirically about the noise level in MR Facility, the book of
“MODERN HOSPITAL” by Ervin Putsep (LLOYD-LUKE, London, 1979)
describe it as follows:
38
Fig. 22, Table of Noise Category based on Activity
No Noise Category Activity Noise (dB)
1 Faintly heard Noise of stepping away footstep (<10m) 10
2 Faintly heard Whispering (2 persons) 15
3 Faintly heard Isolation Room 20
4 Faintly heard Patient treatment room at night 25
5 Very quiet Patient treatment room at noon, Bedroom of apartment 30
6 Quiet Library / Quiet road 40
7 Quiet Public Area in hospital (corridor at noon) 45
8 Rather quiet Warehouse, restaurant, typing (by 1 hospital official) 50
9 Normal Hospital Administration room 55
10 Normal Airflow of Air Conditioner at 0.15 ms-1 from 6 meters away 60
11 Normal Traffic on the main road which is 25 meters away 64
12 Normal Normal conversation of 2 persons 1 meter apart 65
13 Normal TV, medium volume 70
14 A little noisy Ambulance (sirens off) at 105 kmh-1 from 8 meters away 77
15 A little noisy Linen laundry machine 78
16 A little noisy Linen trolley / garbage trolley 80
17 Noisy Crying infant 85
18 Very Noisy Motorcycle machine at 3000 rpm (normal exhaust) 90
19 Very Noisy 2500 cc Conventional Direct Injection Diesel Engine (Non Silent Type) 98
20 Very Noisy Rock ‘N Roll Band music from less than 10 m away 114
21 Causing headache Jet Engine from less than 10 m away 130
22 Causing direct hearing trauma Jet Engine testing facility from less than 10 m away 140
23 Skin burning Jet Engine testing facility from less than 10 m away 150
24 Causing death Apollo rocket launch from less than 10 m away 200
Other thing which needs to be taken into consideration is ability limitation of
a worker in accepting noise tolerance in performing activities in the hospital,
which can be described as follows:
Fig. 23, Table of Relation between Maximum Work hour and Noise Intensity
No Noise Intensity (dB) Maximum Work hour (h/day)
1 85 8
2 90 4
3 95 2
4 100 1
5 105 0.5
6 110 0.25
39
Referring to the Ministry of Health Decision No. 1204/Menkes/SK/X/2004
(Table I.5), we can determine the Noise Index as follows:
Fig. 24, Table of Noise Index
No Room / Unit Maximum Noise (dB A / 8 hours)
1 Patient Room: ♦ Awake ♦ Asleep
45 40
2 General Surgery Room 45
3 Anesthetic Room, Recovery Room 45
4 Endoscope Room, Lab 65
5 X-Ray Room 40
6 Corridor 40
7 Stairway 45
8 Office / Lobby 45
9 Warehouse / Equipment Room 45
10 Pharmacy 45
11 Kitchen 78
12 Laundry 78
13 Isolation Room 40
14 Teeth Polyclinic 80
Based on table in Fig. 21 – Fig. 24 and considering table in Fig. 4 (Chapter II),
Table of MR Noise Index can be determined as follows:
Fig. 25, Table of MR Room Noise Index
No Room Zone Ideal Noise Level (dB A / 8 hours)
Maximum Noise Level (dB A / 8 hours)
Maximum Work Hour (h/day)
1 Waiting Room D 60 70 8
2 MR Registration & Medical Record Counter C 50 60 8 3 Examination & Assessment Room for Doctor
/ Psychologist B 45 55 8
4 Physiotherapy Room A 35 45 8 5 Measurement, Fitting & Adjustment Room B 45 55 8 6 Individual Speech Therapy Room with
Audiometer < A 10 20 8
7 Classical Speech Therapy Room C 50 60 8 8 Individual OT Room for Adults B 45 55 8 9 OT Practice Room for Adults C 50 60 8
10 ADL Therapy Room C 50 60 8
40
No Room Zone Ideal Noise Level (dB A / 8 hours)
Maximum Noise Level (dB A / 8 hours)
Maximum Work Hour (h/day)
11 Individual OT Room for Children B 45 55 8 12 Classical OT Room for Children C 50 60 8 13 Integration Sensor Room for Children D 60 70 8 14 Audio Visual Relaxation / Stimulation A 35 45 8 15 Gymnasium & Community Service C 50 60 8 16 Hydrotherapy Room C 50 60 8 17 OP Workshop > D 80 90 8 18 MR Sport Medicine C 50 60 8 19 MR Motor Function Research & Testing B 45 55 8 20 VIP Service Room A 35 45 8 21 Room of Manager / Asst. Mgr. / FMS B 45 55 8 22 Discussion & Meeting Room B 45 55 8 23 MR Administration, Finance & Personnel B 45 55 8 24 MR Treatment Room A 35 45 8 25 MR Warehouses B 45 55 8 26 MR Locker Rooms B 45 55 8 27 MR Toilets B 45 55 8 28 MR Hand-Washing Area B 45 55 8 29 MR Pantry D 60 70 (± 78) 8 30 MR Janitor / Cleaning Service D 60 70 (± 78) 8 31 MR Garden C 50 60 8 32 MR Fitness Room C 50 60 8 33 MR Utility Room > D 80 90 4 34 MR OT Diagnostic Room A 35 45 8 35 MR Corridor B 45 55 8 36 MR Stairway & Elevator Lobby B 45 55 8
Fig. 25 describes a standard reference for noise level in MR Facility. But
when designing MR Facility rooms, it would be better if the designer uses a
higher standard (meaning that noise level for each room is lower than
standard), especially in rooms which usually will cause a lot of noise (e.g. OP
Workshop & its utility rooms).
41
Hospital buildings should consider standard of noise level and tremor
according to its functions by considering comfort and health level according
to the current technical standard5).
Standard of noise level and/or tremor of Hospital Structure should refer to
AMDAL (Environmental Effect Analysis) 5) issued by related Agency /
Council in a district area.
III.3.4. Requirement of Vertical & Horizontal Transportation and Circulation
Facility Equipment
Generally the requirement of vertical & horizontal transportation and
circulation facility equipment are:
1. Buildings for public and social services must be equipped with
accessibility facilities for PwDs 5).
2. Regulation about accessibility for PwDs should comply with Minister of
Public Work Regulation No. 468/KPTS/1999 about “Technical
Requirement of Accessibility of Public Building and Environment”.
III.3.4.1. Requirement of MR Vertical Transportation and Circulation
1. All vertical transportation and circulation facilities should be equipped
with fire-resistant shaft wall which can stand fire of 800 0C for at least 60
minutes.
2. The width of stairs and balustrades should be at least 180 cm.
3. The minimum width of emergency stairways in public buildings is 120
cm, but for hospitals and especially MR Facilities, it should be at least 180
cm wide.
4. Emergency stairways should be equipped with smoke-impenetrable
emergency doors, automatic door closer and resistant to 800 0C fire for at
least 60 minutes.
5) Depkimpraswil, “PEDOMAN TEKNIS PEMBANGUNAN GEDUNG NEGARA” (Technical Manual of State Structure Building, BP-PU Foundation, Jakarta, 2002
42
5. Every stair shaft (especially in emergency stairways) should be equipped
with exhauster, placed at the roof of the shaft which will work on
emergency situations, especially when an internal disaster happens, e.g.
fire.
6. MR stairs should be equipped with enough lighting in normal and
emergency situations (At least equal to lighting of category-C as seen in
Fig. 19, Lighting Category Table).
7. Each end of stairways should be equipped with non-slippery mat (stop-
nosing) and different in color than any other stair shafts.
8. Every stairway should be equipped with continuous railings (except in
front of emergency exit).
43
9. Every stairway should be equipped with direction (e.g. arrow or line),
made from materials which will glow in the dark and reflect lights.
10. Non-mechanical circulation should be equipped with ramps of 50
maximum elevations in form of regular U-typed, Box-typed or circular
plain stairs, with 180 cm of maximum width and 500 cm of minimum
circular radius.
11. End of escalators and mechanical plain stairs should be painted with eye-
catching colors (e.g. yellow, bright red or white) and different from the
rest of the stair shafts, and also should be equipped with lighting on both
ends.
12. Control panel in elevators should be able to be easily reached by
wheelchair users and normal people.
13. Cars in elevators should fit hospital beds or at least 240-270 cm in length
(>250 cm of length usually have to be specially ordered or hospitals), 170-
200 cm in width, and 120 cm of door width.
14. Elevators should be equipped with at least 2 pairs of infra red door
opening sensors where one pair placed at 100-150 cm another pair placed
at 10-20 cm above car stop floor position to sense wheelchair footstep. For
elevators which used parallel bars sensor mode, the lowest end of the bar
should be placed at 10-20 cm above car stop floor position.
15. Elevators should be equipped with Audio Guiding Assistance to indicate
floor position and pressed floor destination for accessibilities for People
with Vision Impairment.
16. Elevators should be equipped with Automatic Rescue Device which guide
elevator to the nearest floor or ground floor on power down or disaster in
the building.
III. 3.4.2. Requirement of MR Horizontal Transportation and Circulation
1. MR corridor width should be at least 180 cm5), while ideal width is 240
cm for two patient trolleys to pass each other/meet without stopping8).
5) Depkimpraswil, “PEDOMAN TEKNIS PEMBANGUNAN GEDUNG NEGARA” (Technical Manual of State Structure Building, BP-PU Foundation, Jakarta, 2002
44
2. Every entrance to MR Building should be accessible, especially for
circulation of vehicles with 4 wheels or more in loading and dropping
patients.
3. Patient dropping and loading area should be equipped with plain
stair/ramp and railing with the height of around 100 cm towards
4. Circulation of goods, hospital workers, and patient (and attendance(s))
should use different door from one another.
5. Height differences on the floor should be easily seen or felt even if only 1-
2 cm i.e. by coloring or covering (e.g. with rubber) of each floor height to
prevent accidents.
6. Every building should be equipped with situation map (room locations),
room directions, and room names with capital letters 10-15 cm in width
and 15-25 in height (3:5 of width : height proportion).
7. Directional boards and elevator buttons should be equipped with Braille
for accessibilities of People with Vision Impairment.
8. Toilets/Lavatory/Urinary should be equipped with hand-rails for
accessibility of wheelchair, walker/tripod, and stick/crutch users.
9. Every corridor which is directly connected with outside part of MR
buildings should be equipped with security devices of at least hand-rails.
III.3.5. Requirement of Gas Equipment Facility
1. Gas Installation in the hospital consists of Energy and Medical Gas
Installation.
2. Energy Gas Installation: Its use has no relation with direct treatment or
healing of patients.
3. Energy Gas Installation e.g.: Natural Gas Fuel or Liquid Petroleum Gas
Installation from Gas Company owned by the state (PGN – Perusahaan
Gas Negara) or the city which usually used in OP workshop for fuel, Hot
8) E. Neufert (Tranlated by Sjamsu Amri), “DATA ARSITEK”, Erlangga Publishing, Jakarta, 1987
45
Steam Installation from hospital boiler for Autoclave mechanism in
Sterilization Center, Steam Stove, and Drying Machine in Laundry Room.
4. Medical Gas Installation: Directly used in treating or healing of patients.
5. Medical Gas Installation e.g.: Oxygen Installation, Medical Compressed
Air / Press Air / Breathing Air, Suction / Vacuum Air, and N2O (Nitrous
Oxide). Oxygen outlets are the most commonly used in MR facilities,
especially for emergency situations. While other types of facilities i.e. CO2
(Carbon Dioxide), N2 (Nitrogen), He (Helium), C3H6 (Cylopropane), and
Mixture Gas are being used in the hospital in general for specific uses.
6. Every Gas Installation in the hospital (especially Medical Gas Installation)
should comply with the standard and completed with technical
certification permit issued by authorized related agency / sub-agency or by
authorized Department or Technical Council.
III.3.6. Requirement of Fire-Security Infrastructure
III.3.6.1. Emergency Stairs
1. Every hospital building of three stories or higher should be equipped with
emergency stairs5).
2. Doors of emergency stairs should be able to withstand fire for at least 2
hours, with opening direction towards the stairs (except for ground floor
which connected to building exit door) and should be able to close
automatically. The door should also be equipped with lights and “EXIT”
label5).
3. Emergency stairs which placed inside the building should be separated
from other rooms, equipped with fire-resistant doors, free from smoke,
and maximum reaching range of 25 meters5).
4. Minimum width of stair step is 120 cm.5)
5. Emergency stairways should not be in circular shape.5)
5) Depkimpraswil, “PEDOMAN TEKNIS PEMBANGUNAN GEDUNG NEGARA” (Technical Manual of State Structure Building, BP-PU Foundation, Jakarta, 2002
46
III.3.6.2. Emergency Lighting and Exit Direction
1. Building for public service and utilities should be equipped with
emergency lighting and “EXIT” direction. 5)
2. Exit direction should be placed in corridor intersections, paths to
stairways, balcony or terrace and doors to emergency stairways.5)
III.3.6.3. Emergency Doors
1. Every hospital building of three stories or higher should be equipped with
emergency doors5).
2. The width of the doors is at least 100 cm which open toward the
emergency stairways except for the ground floor, which opens towards the
outside.
3. Distance between emergency doors within a block of buildings should be
at most 25 meters from every direction.
III.3.6.4. Corridor
1. The width of corridors should be at least 180 cm.5)
2. Distance of any point in a corridor to the nearest emergency door should
be at most 25 meters.5)
3. Corridors should be equipped with signs which indicate the direction to
the exit and emergency doors.5)
III.3.6.5. Gathering Point Location
1. Gathering Point (GP) location is the destination point of hospital
evacuation when internal disaster happens.
2. Ideal GP ideally should be at least 100 m away from the disaster area.
3. GP location and the path to reach it should be socialized to all users of
hospital building according to evacuation groups stated by the hospital
management.
III.3.6.6. Danger Warning System
1. Every building for public service e.g. hospital should be equipped with
internal communication system and danger warning (alarm) system.5)
5) Depkimpraswil, “PEDOMAN TEKNIS PEMBANGUNAN GEDUNG NEGARA” (Technical Manual of State Structure Building, BP-PU Foundation, Jakarta, 2002
47
2. Alarm system should be equipped with UPS (Uninterruptible Power
Supply) or backup batteries.
3. Alarm system should be tested its functionality at least once in every 6
months.
Every hospital building should also be equipped with fire prevention and
handling system which comply with these rules5):
1. Minister of Public Works Decision No. 10/KPTS/2000 about Technical
Regulation of Building and Environment Fire-Threat Security.
2. Minister of Public Works Decision No. 11/KPTS/2000 about Technical
Regulation of City Fire Handling Management.
III.3.7. Requirement of Telecommunication Facility Infrastructure
1. Every hospital building should be equipped with internal and external
communication equipment.5)
2. The type and the number of communication equipment depend on building
function and common needs.5)
III.3.8. Requirement of Waste Water Facility Infrastructure
III.3.8.1. Rainwater Ditch
1. All rainwater should be directed to the city drainage network5), or if not
available, it should be treated e.g. through absorption process or any other
processes agreed by related government agency / sub agency.
2. Rainwater ditch should be built in accordance with the current technical
regulation or complies with SNI (Indonesian National Standard)5)
III.3.8.2. Dirty Water Disposal
1. Dirty water which came from the kitchen, toilets / bathrooms, and laundry
should be disposed through open or closed channel according to the
current technical requirement5).
2. Dirty water which came from the kitchen, toilets / bathrooms, and laundry
should be directed to the city drainage network5).
48
3. If city drainage network is not available, the wastewater should be treated
e.g. through absorption process or any other processes agreed by related
government agency / sub agency.5)
III.3.8.3. Waste Disposal
1. Every hospital building which its use produced liquid or solid waste
should be equipped with temporary waste disposal or waste treatment
plant according to the current technical requirement5).
2. Waste disposal and treatment plant should be made from water-resistant
material and comply with the current technical requirement for it not to
cast negative effects to the environment5).
III.4. REQUIREMENT OF MEDICAL REHABILITATION FACILITY
TOOLS AND EQUIPMENTS
III.4.1. Requirement of Medical Facility Equipment
Medical equipment i.e. medicine free instruments, apparatus, engines, and
implants which used to prevent, diagnose, heal and lighten illness, treating
people with illness and to restore people’s health and or to form the structure
and restore the function of human body6). Some of the requirements of the
medical facility equipment of MR are:
1. The equipments should be kept in clean condition (some even insist to
maintain it in sterile / germ-free condition).
2. Disposable equipment (equipment which should be disposed after being
used) should be destroyed after used and not being applied / used to other
patients.
3. Reusable / Non-Disposable equipment should be treated through
decontamination or even sterilization process before being used to other
patients.
4. After use equipments should be treated as infectious matter. It should be
carried in Container Carrier to prevent contamination to the surroundings
6) Indonesian Act No. 23 of 1992 about “HEALTH”
49
and transportation route before being decontaminated, destroyed, washed
or sterilized.
5. Medical equipments should be equipped with Instruction / Operation
Manual or Standard Operation Procedure which should be at least
socialized to the users.
6. Sophisticated Medical Equipments should have a minimum of 1 year
repair warranty or 5 years of spare-part availability. If the equipment is
brand new, it has to have a Certificate of Origin, Certificate of
Authenticity, and Quality Check Pas / QC Pass Certificate to guarantee
that it’s a brand new product instead of a refurbished / restored product.
7. Sophisticated Medical Equipments should be equipped with Practical
Troubleshooting Manual, Service Manual, Wiring Diagram, and Spare-
part List / Catalogue for efficiency and effectiveness of its maintenance.
8. Maintenance of sophisticated medical equipment after the end of warranty
period by a third party in form of service contract should consider
principle of efficiency, effectiveness and benefit especially towards
hospital resources (usually problems occur because of limited human
resources capability, spare-part availability, and financial situation of the
hospital).
9. Sophisticated Medical Equipments should be equipped with calibration
certificate before use. Calibration should be performed by a health
equipment calibration-test institution which has been admitted its legality
by Indonesian authority.7)
10. Sophisticated Medical Equipments should be re-calibrated according to
the standard of use stated by equipment manufacturer or at least once a
year. 7)
11. The equipments should comply with Indonesian National Standard (SNI)
or international and other county standard e.g. ISO (International Standard
7) The Minister of Health Regulation No. 363/MENKES/PER/1998 about “Testing and Calibration of Medical Equipment in Health Service Facility”
50
Organization), TUV (Germany), IEC, IEEC, IEEE, BS (British Standard),
and JIS (Japan Industrial Standard).
III.4.2. Requirement of Supporting Equipment Facility
Supporting equipments are medical and healthcare devices functioned to
support medical service operation e.g. Generator Sets (for main or emergency
power supply system), clean water distribution pumps, chiller unit and cold
water distribution pumps in Centralized Air Conditioning System, Electric
Transformer and Capacitor Bank in Power Distribution System, UPS, Boiler,
Wastewater Treatment Plant, IT & Communication System (e.g. PABX
(Public Automated Board Exchange), Computer Servers, Routers, Modems,
PCs, Telephones). Requirements of Supporting Equipments i.e.:
1. Power sources of supporting equipment should be placed in a particular
room for supporting devices and be separated from the health service
rooms.
2. MR supporting equipments should be easy to be installed, maintained and
fixed with as minimum risk as possible to cause disturbance towards
health service circulation flow and to the room itself.
3. High Tech & High Risk Equipments (sophisticated medical equipments
which closely related to the safety of human life and MR environment)
should be equipped with Instruction / Operation Manual or Standard
Operation Procedure; especially those which closely related to K3RS
(Hospital Health & Safety of Work). The OM and SOP should be
socialized to the device users of the hospital or at least to the operator of
the particular equipment.
4. High Tech & High Risk Equipments should also be equipped with
Troubleshooting Manual, Service Manual, Wiring Diagram, Operation
Flowchart Diagram, and Spare-part List / Catalogue for easy maintenance
and repair.
5. Maintenance of high tech medical equipments after the end of warranty
period by a third party in form of service contract should consider
51
principles of efficiency, effectiveness and benefit especially towards
hospital resources (usually problems occur because of limited human
resources capability, spare-part availability, and financial situation of the
hospital).
6. High Tech & High Risk Equipments (e.g. Boilers, Lightning & Surge
Protector System, Electrical Transformers & Panels, Gas Network System,
Helipads, Wastewater Treatment Plant, and Disaster Alarm System)
should possess operation certificate from testing institution (i.e. Technical
Department, Government Technical Agency / Sub-Agency or Private
Testing Institution) which legality is being admitted in Indonesian
Territory through a Testing & Commissioning Process which is a part of
equipment certification process.
7. Certification of High Tech & High Risk Equipments which are still
working and in operation should be renewed before expiry date. Repair
and restoration of the devices should also be done by the hospital authority
to insure its operational safety as a part of performing K3RS.
8. Sophisticated supporting equipments should comply with Indonesian
National Standard (SNI), Indonesian Industrial Standard (SII), and also
international or other country’s standards e.g. ISO, TUV, IEC, IEEC,
IEEE, BS, and JIS.
52
CHAPTER IV
DESIGN MODEL OF
PLANNING AND DESIGN
IV.1. MR BUILDING PLACEMENT IN HOSPITAL SITE PLANNING
(The content is the result of MR coordination meeting).
IV.2. DIAGRAM MODEL OF ROOM CONNECTION
(The content is the result of MR coordination meeting).
IV.3. BUILDING MODEL OF MR INSTALLATION FOR CLASS-A
EDUCATIONAL HOSPITAL (Typology Study of BLU (Public Service
Council) of Central Public Hospital of Adam Malik, Medan, Sumatera
Utara)
(The content is the blueprint of location survey result).
IV.4. BUILDING MODEL OF MR IDEPARTMENT FOR CLASS-A
EDUCATIONAL HOSPITAL (Typology Study of BLU of District Public
Hospital of Dr. Sutomo, Surabaya, Jawa Timur)
(The content is the blueprint of new & old location survey result).
IV.5. BUILDING MODEL OF MR DEPARTMENT FOR CLASS-A
EDUCATIONAL HOSPITAL (Typology Study of BLU of National Central
Public Hospital of Cipto Mangunkusumo, Jakarta)
(The content is the blueprint of location survey result).
IV.6. BUILDING MODEL OF MR DEPARTMENT FOR CLASS-B
HOSPITAL (Typology Study of BLU of Fatmawati Hospital, Jakarta)
(The content is the blueprint of location survey result).
53
IV.7. BUILDING MODEL OF MR DEPARTMENT FOR Special CLASS-B
HOSPITAL (Typology Study of BLU of RSOS (Prof. DR. Soeharso
Hospital), Solo)
(The content is the blueprint of location survey result).
IV.8. BUILDING MODEL OF MR DEPARTMENT FOR CLASS-A
EDUCATIONAL HOSPITAL (Typology Study of Syaiful Anwar District
Hospital, Malang, Jawa Timur)
IV.9. INTERIOR DESIGN MODEL OF PHYSIOTHERAPY ROOM
(The content is the result of MR coordination meeting).
IV.10. INTERIOR DESIGN MODEL OF HYDROTHERAPY ROOM
(Typology Study of BLU of Mohammad Hoesin Hospital, Palembang,
Sumatera Selatan)
(The content is the blueprint of location survey result).
IV.11. INTERIOR DESIGN MODEL OF INDIVIDUAL SPEECH THERAPY
AND AUDIOMETRY ROOM
(The content is the result of MR coordination meeting).
IV.12. INTERIOR DESIGN MODEL OF OP WORKSHOP
(The content is the result of MR coordination meeting).
IV.13. INTERIOR DESIGN MODEL OF SENSOR & INTEGRATION ROOM
(The content is the result of MR coordination meeting).
IV.14. INTERIOR DESIGN MODEL OF BATHROOMS AND TOILETS
(The content is the result of MR coordination meeting).
54
IV.15. SPECIAL FURNITURE MODELS FOR MR
(The content is the result of MR coordination meeting).
IV.16. SPECIAL PRODUCTS MODEL DESIGN FOR MR
(The content is the result of MR coordination meeting).
IV.17. MODELS OF OUTDOOR DESIGN ELEMENTS FOR MR
(The content is the result of MR coordination meeting).
55
TYPOLOGY STUDY OF PRODUCT DESIGN
Gb.Dp.1. Chair of Children OT for hyperactive children.
Location: MR Installation - RSCM
Gb.Dp.2. Chair of Children OT for children with CV.
Location: MR Installation - RSCM
Gb.Dp.3. Chair of Children OT for children with CV.
Location: MR Installation - RSCM
Gb.Dp.4. Chair of Children OT for children with CV.
Location: MR Installation - RSCM
Gb.Dp.5. Chair of Children OT for children with CV.
Location: MR Installation - RSCM
Gb.Dp.6. Table of Children OT for YPAC Students
Location: YPAC-Medan
Gb.Dp.7. Chair of Children OT for children with CV.
Location: YPAC-Medan
Gb.Dp.8. Chair of Children OT for children with CV.
Location: MR Installation – Fatmawati
Gb.Dp.9. Child Walker Trainee w/ Safety Rollbar
Location: MR Installation – Fatmawati
Gb.Dp.10. Angular Finger Ladder for Adults OT
Location: MR Installation – Dr.Sardjito
Gb.Dp.11. Vertical Finger Ladder for Adults OT
Location: MR Installation – Dr.Sardjito
Gb.Dp.12. MR Installation Garbage Disposal
Location: MR Installation – Dr.Sardjito
56
INTERIOR TYPOLOGY STUDY
Gb.Int.1. Toilet Interior.
Location: MR Installation – RSCM
Gb.Int.2. Toilet Interior.
Location: MR Installation – RSCM
Gb.Int.3. Toilet Door Interior.
Location: MR Installation – RSCM
Gb.Int.4. Hydrotherapy Swimming Pool Interior
Location: MR Installation - Fatmawati
57