Planning Brief:

UPGRADING OF MJANYANA

HOSPITAL IN THE EASTERN CAPE PROVINCE

CDC/127/13

o Report N

CDC-CD-REP-004-13

April 2013

DOCUMENT INFORMATION SHEET

Title of Report : Design Brief: Upgrading of Mjanyana Type of Report : Planning Document Report Number : CDC-CD-REP-004-13 Prepared by : Duncan Angus – MDA Architects Typed by : MDA Architects cc Business Unit : CDC – Health Programme Prepared for : Department of Health Date of Issue : 13 April 2013

SUBMITTED BY

Thesele Mokoma

Coega Development Corporation Corner Alcyon & Zibuko Street Zone 1

Coega IDZ; PORT ELIZABETH;

6100 Tel: 041-403-0400; Fax: 041-403-0401 e-mail: [email protected]

PREPARED FOR:

Department of Health Eastern Cape Province BHISHO, 5608

Copyright

All rights reserved. No part of this document may be reproduced or distributed in any form or by any means, electronic, mechanical, photocopying or recording or otherwise, or stored in a database or retrieval system, without the prior written permission of the Coega Development Corporation (Pty) Ltd. ©

LIST OF ACTIVITIES / DOCUMENTATION SUBMITTED

Documentation submitted

Name/type of document Date submitted Version number

Design Brief: Mjanyana Hospital 05.11.2012 1

Design Brief: Mjanyana Hospital 24.01.2013 2

Design Brief Mjanyana Hospital 3

Design Brief: Mjanyana Hospital 07.02.2013 4

Design Brief: Mjanyana Hospital 01.03.2013 5

Design Brief: Mjanyana Hospital 11.03.2013 6

Planning Brief: Mjanyana Hospital 13.04.2013 7

Planning Brief: Mjanyana Hospital 16.04.2013 8

Meetings / Presentation

Type Dates held Representatives from

Engagement with Hospital Board 22.11.2012 Gibb / CDC / Hospital Board

Engagement with Hospital Board 15.04.2013 Gibb / CDC / Hospital Board

Planning Brief: Mjanyana Hospital - 2 - Rev 8 16.04.2013

TABLE OF CONTENTS

1 INTRODUCTION ...... 4 1.1 Locality ...... 4 1.2 Demographic Information ...... 7

2 GUIDELINES AND REGULATIONS ...... 7

3 SERVICE PACKAGE ...... 8

4 PATIENT BED CONFIGURATION ...... 11 4.1 Inpatients ...... 11 4.2 Outpatients ...... 12 4.3 Hospital Bed Configuration ...... 13

5 DEPARTMENTAL CONFIGURATION ...... 14 5.1 Departmental Zoning ...... 14 Hospital Zoning Diagram (Figure 5.1) ...... 17 5.2 Arrival Zone ...... 18 5.2.1 Entrance...... 18 5.3 Outer Zone ...... 19 5.3.1 Outpatients Department ...... 19 5.3.2 Casualty / Trauma ...... 23 5.4 Second Zone ...... 26 5.4.1 X-Ray / Radiography ...... 27 5.4.2 ...... 28 5.4.3 NHLS Blood Bank and Laboratory ...... 31 5.5 Specialist Zone ...... 33 5.5.1 Theatre Suite ...... 33 5.5.2 Obstetrics (Maternity) ...... 35 5.2.2.1 Post Natal...... 39 5.5.3 Central Sterile Supply Department (C.S.S.D.) ...... 41 5.5.4 High Care Unit ...... 42 5.5.5 Day Surgical / Recovery Unit ...... 44 5.5.6 Burns Unit ...... 45 5.6 Inner Zone ...... 46 5.6.1 Hospital Wards ...... 46 5.6.2 Ward Specific Requirements to be provided in addition to general ward Requirements ...... 50 5.7 Service Zone ...... 51 5.7.1 Hospital Administration ...... 51 5.7.2 Support Services ...... 54 5.7.2.1 Security ...... 55 5.7.2.2 Medical Gas ...... 56 5.7.2.3 Mortuary ...... 57 5.7.2.4 Medical Archives ...... 58 5.7.2.5 Maintenance Workshop & Garden Services ...... 58 5.7.2.6 Hospital Vehicle Parking ...... 59 5.7.2.7 Waste Management ...... 59 5.7.2.8 Laundry Services ...... 61 5.7.2.9 Hotel Services / Catering Services ...... 64 5.7.3 Staff Accommodation ...... 66 5.8 Ancillary Services ...... 66 5.8.1 Gateway Clinic ...... 66 5.8.2 Recreational Facilities ...... 67 5.8.3 Isolation Ward / Circumcision Unit ...... 67 5.8.4 Access Road ...... 68

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1 INTRODUCTION

Mjanyana Hospital has been identified as part of the Rationalised Service Delivery Platform (RSDP) by the Eastern Cape Provincial Department of Health (DoH) as requiring a complete upgrade. The hospital is situated between the towns of iDutywa and eNgcobo in the Chris Hani District, in the Eastern Cape Province. Mjanyana Hospital is currently operating primarily as a TB hospital.

Mjanyana Hospital (MH) is a 100 bed rural district hospital. The hospital complex is composed of four (4) main components totalling 48 Ha including (a) The Main Hospital Complex – 12 Ha; (b) Administration Complex – 11 Ha; (c) Engineering and Workshop Complex – 10 Ha; (d) The Clinic Complex – 11 Ha. These components are widely spaced covering a total distance of 5km in total and are linked by gravel roads and jeep tracks. On each of the four components are staff accommodation buildings.

1.1 Locality

Access to the hospital is gained off the R408 tarred road from iDutywa to eNgcobo. The hospital is located about 10km along a gravel road turning right off the R408 at the coordinated point: 31047’17.7’’ S and 28008’47.00’’ E.

Figure 1.1 below shows the locality of the hospital in relation to the Eastern Cape Province, nearest towns of iDutywa and eNgcobo and access to and from these towns.

See maps overleaf:

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South African Map (Figure 1.1A)

Map of Eastern Cape

N

Eastern Cape Map (Figure 1.1B)

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Map showing route from N2 to Mjanyana (Figure 1.1C) Mjanyana Hospital Locality in relation to the Eastern Cape Province and nearest towns

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1.2 Demographic information (a) District: (i) Chris Hani District (eNgcobo Sub District) (b) Population served (eNgcobo Sub District): • 137 490 (c) Referral facilities: (i) 23 Rural Clinics refer to Mjanyana Hospital; (ii) Mjanyana Hospital refers to referral to: • All Saints Hospital (Level 1); • (Level 2); • (Level 2); (d) Site specific information: (i) Originally a mission hospital built in 1837; • Original buildings built are in an extremely poor condition; • Demolition and or re-use of these existing buildings will need to be done in accordance with the dictates of the National Heritage Act; (ii) The hospital is situated far from major city centres and access to it is poor; • Access to the hospital is through the gravel roads off the tarred R408 from iDutywa to eNgcobo; • The gravel roads are in a very bad condition; • The upgraded hospital may be cut off from supply and tributary areas in the event of major floods; • Provision of basic grocery shops and amenities is lacking. This may have led to poor affinity and retention of critical health services professionals; (iii) There is a shortage of decent staff accommodation at the hospital; (iv) Essential medical & clinical facilities are aged, non-operational or non- existent;

2 GUIDELINES AND REGULATIONS

2.1 Documents Used

The documents used in determining and formulating the design brief are the following:

(a) The Eastern Cape Hospital Design Guide (Edition 2.1 of 17 May 2011); (b) R158 Regulation: Confirming Minimum Requirements (Physical Facilities) pertaining to the design of private in South Africa;

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(c) Department of Health Guidelines for the Planning and Design of Hospital and health facilities; and (d) National Health Act 61 of 2003 – Regulations relating to categories of hospitals and all amendments thereto.

2.2 Definition of District Hospitals

District Hospitals are categorised into small, medium and large district hospitals (according to Government Gazette 35101 dated 2nd March 2012) with the following number of beds: (a) Small district hospitals with no less than 50 beds, and no more than 150 beds; (b) Medium size district hospitals with more than 150 beds, and no more than 300 beds; and (c) Large district hospitals with no less than 300 beds and no more than 600 beds.

A district hospital must: (a) Serve a defined population within a health district and support primary health care; (b) Provide a district hospital package of care on a 24 hour basis; (c) Have general practitioners and clinical nurse practitioners primary health services; (d) Provide services that include in-patient, ambulatory health services as well as emergency health services; and (e) Where practical, provide training for health care service providers.

A district hospital receives outreach and support from general specialists based at regional hospitals.

A district hospital may only provide the following specialist services: (a) Paediatric Health Services; (b) Obstetrics and Gynaecology; (c) Internal ; (d) General ; and (e) Family Physician

3 SERVICE PACKAGE

The service package proposed for the upgraded MH is based on the National Health Act, 2003, Regulations Relating to Categories of Hospitals – regulations for a small district hospital. The services are to include:

(a) Clinical Services; (b) Clinical Support Services;

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(c) Medical Services; (d) Inpatient & Outpatient Services; (e) General Support Services; (f) Facilities Management; (g) Management & Administration; (h) Electrical, Mechanical and ICT Systems; (i) Site Specific Services (i) Nurses and Doctors accommodation; (ii) Tuckshop

A summary of the Hospital Services to be provided is as follows:

Clinical Inpatients, Outpatients, Emergency Care and Clinical Support

Hours of Service Description Referral Service Trauma / Casualty and Emergency Centre for Casualty / 24 Hr Level 2 Hospital Victims Support Trauma at hospital entrance Service Medical Imaging / X- X-Ray and Ultrasound Suite 24 Hr Level 2 Hospital Ray Service Pharmacy Pharmacy to serve the Inpatients 8 Hr Nil and Outpatients Service Blood Bank N.H.L.S. Blood storage for Emergencies 24 Hr Nil Service Laboratory Clinical Testing 08 Hr Nil Sample collection Service Obstetric Services and Obstetric services and neonatal unit 24 Hr Level 2 Hospital Neo Natal Unit including Kangaroo care beds Service Paediatrics Care Ward designed specifically for child 24 Hr Level 2 Hospital care & treatment Service Paediatric Isolation Isolation unit within the paediatric 24 Hr Level 2 Hospital ward Service Adult Inpatient Wards: Wards with ward specific ablutions & 24 Hr Level 2 Hospital Male & Female support functions Service Medical & Surgical Psychiatric Services A 1 x bed ward to be provided in 24 Hr Psychiatric Hospital male and female wards for patients Service requiring 72 hr observation Outpatients General outpatients department 8 Hr Level 1 or Level 2 Department Patients are seen on a referral basis Service Hospital from surrounding clinics. Procedure Room / Day Procedure room 12 Hr Nil Surgery Ward Space Service Minor surgery

Duty Rooms & Staff Nurses stations, staff change, 24 Hr Nil Facilities common rooms and unit managers Service office at each clinical nursing unit Rehabilitative Sciences Physiotherapy, Dietician, Social 8 Hr Nil (At OPD) worker, Audiology, Speech and Service Dental Operating Theatres 2 Small Operating Theatres 24 Hr Nil Service

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Clinical Inpatients, Outpatients, Emergency Care and Clinical Support (Continued)

Hours of Service Description Referral Service CSSD Central Sterilisation Supply 8 Hr Nil Department Service Mortuary Room to store bodies awaiting burial 24 Hr Nil Service EMS Parking space and wash facility for 24 Hr Regional EMS ambulance & hospital bus Service Helicopter landing pad A heli-pad should be provided with 24 Hr Nil close access to the trauma unit Service

Management and Administration

Hours of Service Description Referral Service Patient Management Patient liaison & record keeping 24 Hr Service Nil Management and Office space for hospital and sub- 8 – 24 Hr Sub-structure Administration district management Service management Telecommunication Offices for the switchboard 24 Hr Service Nil Hospital Administration Office space for hospital administration 8 – 24 Hr Hospital Service management Hospital Stores Stores for hospital and sub-district 8 Hr Service Service to the sub-district Medical Records Storage for patient medical records at 24 Hr Service Nil reception Hospital Archives Storage for hospital files and 8 Hr Service Nil documentation Reception Reception, admissions and cashier 24 Hr Service Nil facility Transport Office Patient transport service at reception 8 Hr Service Nil Security Hospital Security 24 Hr Service Nil

General Support Services

Service Description Hours of Service Referral

Hotel Catering Main kitchen, cafeteria, ward kitchens 12 / 24 Hr Service Nil Services and special feeds. Public and Staff Cafeteria where fast food and snacks 12 Hr Service Nil Cafeteria may be bought: Tuck Shop Cleaning Services Facilities for cleaning services 12 / 24 Hr Service Nil Linen Services Central laundry 8 Hr Service Nil Archives & Kit Room Safe keeping of patient valuables. 12 Hrs Nil Storage of hospital records Workshop General repairs & maintenance at a local 12 Hrs Nil level Medical Gas Bank Medical gas distribution to key areas of 24 Hr Nil the hospital Wash Bay For cleaning of hospital equipment 12 Hr Nil

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Clinical Inpatients, Outpatients, Emergency Care and Clinical Support (Continued)

Facilities Management

Service Description Hours of Service Referral

Security Services Gate house and perimeter security 24 Hr Service Nil Gardening Garden Store 8 Hrs Nil Service Waste Management Separate facilities for medical waste, 8 Hrs Nil general waste and recycling Service Parking Separate parking for staff and 24 Hrs Nil visitors Service Facility Maintenance Infrastructure management of the 8 – 24 Hrs Service Nil facility

Staff Accommodation – For Skilled Essential Clinical Personnel

Staff accommodation is required as part of the recruitment and retention strategy.

Service Description Hours of Service Referral

Scarce skills staff (Dr’s, Space in the “old hospital” will be 24 Hr Service Nil Pharmacists and Com- assessed and will be renovated if serve staff) found to be suitable Staff Parking Secure safe parking 24 Hr Service Nil

Ancillary Services

Service Description Hours of Service Referral

Tuckshop To provide basic service of 8 Hr Service Nil commodities to remote rural community Games Room / Basic sporting facilities for staff / 8 Hr Service Nil Sporting Facilities patients (Soccer / Netball / Table Tennis) Vegetable Garden Provide space for vegetable garden 8 – 24 Hr Service Nil

4 PATIENT BED CONFIGURATION

4.1 Inpatients

Information sourced from the Eastern Cape District Health Surveillance Unit, resulted in the following analysis:

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(a) The average monthly in-patient bed occupancy for 2012 is 52% (52 beds); (b) The bed occupancy rate for February 2013 (confirmed by the hospital) is 56% (56 beds); (c) The months of April and November 2012 reflected the highest bed occupancy of 65%; (d) The average day patient occupancy is not recorded. We propose an allowable of 10 days for planning purposes; (e) A collective total of the maximum bed occupancies for 2012 (maximum long stay and maximum day patients) realises a worst case bed occupancy of 75 beds; (f) Assuming an increase in occupancy after the completion of the hospital upgrade it is proposed to allow a buffer of 15 %; (g) The design bed occupancy for Mjanyana Hospital is therefore projected as 100 beds which should be sufficient for the hospital needs until 2025; (h) The DoH data for Mjanyana appears to be incomplete as there are notable exclusions with certain clinical / medical occurrences reflected as nil, e.g. the incidence of gunshot wounds.

4.2 Outpatients

Information sourced from the Eastern Cape District Health Surveillance Unit, resulted in the following analysis:

(a) The outpatients department records an average of 35 patients per day. (b) This additional load on hospital infrastructure and services is equivalent to an additional 22 beds; (c) The DoH data for Mjanyana appears to be incomplete as there are notable exclusions with certain clinical / medical occurrences reflected as nil, e.g. the incidence of gunshot wounds.

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4.3 Hospital Bed Configuration

Table 4.3 below lists the bed numbers currently available, and the proposed number of beds for the Mjanyana Hospital

Table 4.3: Proposed Bed Numbers and Split Discipline Number of Beds Current Proposed Male medical ward unit 11 10 Male surgical ward unit 11 Female medical ward unit 11 10 Female surgical ward unit 11 Maternity / Obstetrics: Ante-natal 0 6 Post-natal 0 10 Mothers Lodge 0 4 Kangaroo Beds 0 2 High care ward unit 4 Paediatric medical unit 10 4 Paediatric surgical unit 4 Chronic care (TB) male unit 43 7 Chronic care (TB) female unit 27 7 Chronic Care XDR – TB Male 2 0 Female 2 Chronic Care MDR - TB Male 2 0 Female 2 Total 100 100

The following considerations were factors influencing the allocation of beds and hospital clinical services.  The hospital is currently a TB hospital with 70 % of available beds allocated to TB treatment.  Current DoH policy is for TB patients once treated (non-contagious) to recuperate at home and to receive ongoing treatment as Outpatients. TB specific beds at the hospital are therefore reduced significantly.  The Chris Hani area has an efficient network of referral clinics. The effectiveness of the clinic referral system suggests that the provision of a gateway clinic is not an immediate priority and may be excluded but provision is to be made in masterplanning for the future

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provision of a gateway clinic. It is noted that the present Gateway Clinic is more than 2km from the hospital which is not ideal.  The creation of a Level 1 District Hospital demands a broad spread of clinical services / beds as reflected on table 4.3 reflecting the bed split in accordance with the requirements of a Level 1 District Hospital.  Maternity / childbirth is seen as a core service as reflected on the bed split.  The provision of a circumcision unit is excluded. Consultation with the hospital management has confirmed that this unit requires further consultation and should be located in isolation away from the hospital to cater for all cultural requirements. It was confirmed that this unit could be provided at a later date.

During the development of this brief, consultations with Hospital Management resulted in the following requirements (excluding bed numbers) being tabled by the hospital management::

(a) 1 Male surgical ward (including burns); (b) 1 x Female surgical ward (including burns); (c) 1 x Female medical ward; (d) 1 x Male medical ward; (e) 1 x Paediatric medical ward; (f) 1 x Paediatric surgical ward; (g) 1 x Paediatric orthopaedic ward; (h) 7 x Delivery rooms (beds); (i) 1 x Chronic care ward (TB); (j) Isolation wards at different areas.

5 DEPARTMENTAL CONFIGURATION

5.1 Departmental Zoning

The interdepartmental relationship for the proposed upgraded facility is based on a zoning configuration which takes into account the flow of patients from one section to another without compromising security and high care facilities. The designation of the various zones indicates areas which are readily accessible to patients, and ensures that the high risk or secure areas are not easily accessed by unauthorised staff, patients or visitors. The zones also reflect the clinical profile of the hospital.

The zones as defined in Figure 5.1 below are as follows and are described in detail in sections 5.2 to 5.7:

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(a) Arrival Zone: The point of arrival, porte cochere and hospital entrance are located in this zone with ancillary accommodation such as public ablutions, security / porter desk, trolley bay, public telephones and general sub-waiting area. Signage and general information to be prominent; Patient waiting, help desks, security, porters to be in this zone; (b) Outer Zone: Areas that are immediately accessible to the public: Trauma / Casualty service, outpatient service, and patient administrative service shall be located near the entrance of the hospital; The Trauma / Casualty service will be a 24 Hr emergency, trauma & life support service. Allied to this unit is a disaster management facility. The OPD will only see patients on a referral basis from surrounding district clinics or other hospitals. (c) Second Zone: Areas that receive workload from the outer zone: Laboratory, pharmacy, and radiology. They shall be located near the outer zone for ease of access from Casualty / Trauma and OPD. This zone acts as a buffer to the more private and more secure inner & specialist zones of the hospital. (d) Specialist Zone: Areas that require asepsis to perform the prescribed services: surgical service, delivery service, nursery, and high care. They shall be segregated from the public areas but accessible to the outer, second and inner zones; A high level of security is required for all services at this zone. (e) Inner Zone: Areas that provide nursing care and management of patients. They shall be located in private areas with controlled access by guests. The nursing service will be allocated to the wards that are consistent with the clinical service offered by a level 1 District Hospital:  Male Surgical  Female Surgical  Male Medical  Female Medical  Paediatric Care  Post-natal  Make TB  Female TB (f) Service Zone: All services that provide support to the clinical activities of the hospital are located in this zone:  Medical Gas  Bulk Stores  Mortuary  Archives  Facilities Management  Security  Workshop

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 Hotel Services  Waste Management  Laundry Service  Garden Service Hospital management (administration) and staff accommodation are required and can be located in a service zone or in a convenient location that does not jeopardise patient flow.

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Figure 5.1: Hospital Zoning Diagram

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5.2 Arrival Zone The point of arrival should have prominent signage and general information and is to be prominent.

5.2.1 Entrance To have prominent signage that is clearly visible and giving easy to understand directional information:  The entrance is to have a covered arrival porte cochere.  Security control room is to be close to the entrance control desk.  Security & porter service & trolley bay is required at the main entrance.  Public ablutions are required at the main entrance (disabled friendly).  A general sub-waiting area is required at the main entrance.  A friendly inviting atmosphere is a pre-requisite.  Directional & information signage is to be prominent.  A general reception help desk is to be located at the main entrance.

Figure 5.2.1: Entrance relationship diagram

The entrance schedule of accommodation is shown in Table 5.2.1 overleaf:

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Table 5.2.1: Entrance accommodation schedule Description No/ Qty Comments Porte Cochere 1 Main entrance – Covered external arrival public offloading facility Public sub-waiting 1 Public waiting area for ± 20 people area / entrance Waiting area to be fitted with hardwearing finishes and secure lobby seating. Area to have natural & forced ventilation and good lighting. Public phones 2 To be easily accessible by public. Public ablutions 3 1 Male; 1 Female; 1 Disabled (can be 1 male / 1 female, both disabled friendly) Reception Desk / 1 To be located at main entrance before the Patient Management Security Desk Desk. Trolley / 1 Located adjacent to Porters desk for ease of access. Wheelchair / Stretcher Parking Area Link to Security 1 Security Desk; Security office & security centre may be housed in Control Room & administrative section. Office

5.3 Outer Zone These are areas that are immediately accessible to the public: emergency service, outpatient service, and administrative service. They shall be located near the entrance of the hospital for easy and emergency access by patients.

5.3.1 Out Patients Department The Out Patients Department (OPD) should be located at the hospital public entrance (outer zone). It should be easily accessible by patients arriving by vehicle or on foot, and must have a public waiting area for 60 people.  The outpatient department will work on an 8 hr daily service package.  Outpatient consultations are expected to be between 50 – 75 people daily on a referral basis from district clinics or other hospitals.

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 Consulting rooms are to be provided on a rotational basis where non-specific clinical examinations occur. The back up services to the consultation rooms are listed in the accommodations schedule attached.  Clinical specific examination spaces will be provided for dentistry and audio therapy.  OPD to have good natural light & ventilation.  Dentistry consulting room to include: • Specialist dental chair & light • Piped suction, air, water to chair. • Dental store. • Dental x-ray. • Area for dentist and assistant to change. • Wash / scrub sink. • X-ray viewing. • Desk / writing tablet / chairs.  ARV care will be at the OPD.  Mental health consultations and care will be at the OPD.

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Figure 5.3.1: OPD relationship diagram

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The OPD schedule of accommodation is shown in Table 5.3.1 below: Table 5.3.1: OPD accommodation schedule Description No/ Comments Qty Public waiting area / 1 Public waiting area for ± 60 people entrance lobby Trolley bay at entrance. Waiting area to be fitted with hardwearing finishes and secure seating. Area to have natural & forced ventilation and good lighting. Electronic patient management & advisory systems, trolleys & porter services. Easy link to X-Ray and Pharmacy required. Patient 1 Walk-in patients will report to desk, obtain their folders from Medical Management Desk Records or have a new folder opened and pay for the service. High (Registration desk / security at pay point & cashier is a priority. Folders of the patients if they Admissions) are escorted will be obtained from Medical Records by the patient / escort, if the patient / escort is unable to assist, runners will fetch the folders. Cashier 1 Adjacent to patient management desk High security. Records Room / 1 To be located adjacent to the Patient Management Desk for ease of Data Retrieval access by administrative staff and patients to retrieve records. Unit Managers 1 Unit manager office provided with desk, telephone, computer and Office network connectivity. Nurses station 1 To be shared between 4 – 5 clinical staff. The nurses’ station must be easily accessible to patient areas. Workspace is to be created for doctors and clinical staff to record documents. Sub-waiting area 1 In close proximity to all consulting services and able to cater for 10 people. General consulting 4 Must be private rooms for general consulting with allowances for rooms Shared specialist consulting. Can be also used as counselling rooms for sensitive consultations and bereavement counselling. Consulting rooms to operate on a hot desk rotational basis and must include: Examination couch; examination light; Wash basin with medical taps; Small desk for staff; X-ray viewing facility, patient chairs, cupboards & storage. Consulting services to include the following: TB assessment, screening and consultation; Eye Clinic; Dietetics (Including child health & nutrition); Social Services; S.T.D.’s; Victim Support; Women’s Health; Antenatal; H.I.V. / Aids Support; Adolescent / Youth Clinic; Family Planning; and Child Health. Observation room 1 Clinical basin and medical tap Examination couch Cupboards / storage Specialist Dental 1 Dental consulting room with space for X-Ray machine. Consulting Room Dental store & cupboard to be provided. Specialist Audiology 1 Audiology / Speech consulting room provided as private cubicle with / Audio Therapy / facilities for equipment storage. Speech Therapy Occupational 1 Consulting / Examination room; Provide storage cupboard therapy Physiotherapy 1 Consulting / Examination room; Provide storage cupboard Doctors Offices for 2 Provide office with 2 x workstations per office. visiting Doctors / Doctors to use staff ablutions. Specialists

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Table 5.3.1: OPD accommodation schedule Description No/ Comments Qty Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Dirty utility / sluice 1 Portable bins for refuse, must be sealable to contain medical waste. room Sluice room is located near the patient triage area. The area is to cater for general & medical waste and general sluicing. Cleaner store 1 Cleaning station to be provided. To include slop hopper facility. Storage Facilities 1 The following storage facilities are to be provided with shelving and worktops as necessary: Linen room; Sterile store / clean utility; General equipment storage; Secure drug storage Patient Ablutions 3 1 Male; 1 Female; 1 Disabled (Can be 1 Male / 1 Female, both disabled friendly) Plaster of Paris 1 Large consulting room with medical basin & medical taps. Used for Room & Store application / removal of POP. To provide worktops and storage space. Floors preferably vinyl, must be fully washable with floor drains. Specimen Room 1 This room for taking specimens / blood for lab work. To have a patient couch, hand wash basin with elbow taps, worktops and lockable cupboards. The room will be used for sputum collection (TB assessment) and be designed to prevents infectious droplets / material being drawn back into the consulting area. Rehabilitative 2 Physiotherapy. Must be easily accessible by wheelchair patients. Services & Storage Storage provided for equipment.

5.3.2 Casualty / Trauma

The Casualty / Trauma should be easily accessible by patients with emergency needs arriving by vehicle or on foot. It should be located in the outer zone, close to the X-Ray department and should have a separate entrance open 24 hours every day. (a) The trauma unit is to be located close to the hospital public entrance. The unit is to have easy access for stretcher & ambulance cases as well as walk in cases; (b) The unit will primarily stabilise serious cases for referral to Level 2 or 3 hospitals; (c) The trauma unit is to be equipped to handle 25 to 30 patients on a 24 hour rotational cycle; (d) The unit will offer obstetric, medical & trauma care on an emergency basis. (e) Emergency service categories would be: • Ambulance arrivals Life & non life threatening • Walk in patients: Non life threatening • High risk patients: Accident cases Stretcher cases Life threatening

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• Mentally & behaviourally disturbed patients: Non life threatening Needing counselling / Needing observation (at hospital ward) May be referred • Respiratory problems: Varied risk – Observation / treat / referral • Victims of Violence: Varied risk – Observation / treat / referral

Figure 5.3.2: Casualty / Trauma relationship diagram

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The Casualty / Trauma schedule of accommodation is shown in Table 5.3.2 below:

Table 5.3.2: Casualty / Trauma accommodation schedule Description No/ Comments Qty Ambulance bay & entrance 1 Under cover ambulance parking / offloading bay at entrance; Wheelchair / trolley parking and stretcher area; Foyer/entrance 1 Pedestrian entrance for walk in patients. Patient arrival / management 1 Allow for stretchers / trolleys at the entrance Public waiting space 1 Public waiting area: up to 20 people; Located in foyer/part of foyer Cashier / admissions / control 1 Close to foyer / reception / waiting. desk IT connectivity essential. High security at pay point & cashier is a priority. Counselling room/data 1 Close to entrance. capturing room Used for data collection. Used for collection of samples. Basin with medical taps. Unit manager’s office 1 Unit manager office provided with desk, telephone, computer and network connectivity. Records room/strong room 1 Storage of records. Nurses station 1 To be shared between 4 – 5 clinical staff. The nurses’ station must be easily accessible to patient areas. Workspace is to be created for doctors and clinical staff to record documents. Duty room / general office 1 Staff working area. Emergency treatment area: 4 1 Whb with medical taps; Bed head trunking: Full services for 4 beds beds; Curtains at bed stations; Enough cupboard storage space; Enough equipment storage space. Sufficient workspace to be around bed. Resuscitation “treatment” bay 1 Separate area with whb, counter space, blood fridge and with small laboratory / storage space for laboratory supplies. working area and blood fridge Can be closely linked to 4 bed emergency treatment area. Emergency procedure room / 1 Sterile room for smaller procedures with wash hand basin suture room with medical taps, work space and storage for supplies. Plaster of paris room 1 Large consulting room with medical basin & medical taps. Used for application / removal of POP. To provide worktops and storage space. Floors preferably vinyl, must be fully washable with floor drains. Storage: 1 Consumables & Stationary 1 Equipment general 1 Disaster management store (linked to and controlled by Admission desk) 1 Drugs cupboard (High security) Fridge Surgical equipment: Sterile 1 Blood (refrigerated) 1 Sterile store / clean utility 1 Clean linen Dirty utility / sluice room 1 Portable bins for refuse, must be sealable to contain medical waste. Sluice room is located near the patient triage area. The area is to cater for general & medical waste and general sluicing. Cleaner store 1 Cleaning station to be provided. To include slop hopper facility. Doctor’s change room and 1 Doctors change rooms / ablutions with showers, whb’s, and ablution w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Patient ablutions 1 1 Male; 1 Female (Both disabled friendly) with whb, w.c. & Shower

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Table 5.3.2: Casualty / Trauma accommodation schedule Description No/ Comments Qty Staff facilities Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Portable X-Ray parking space 1 Provide space for portable X-ray machine to be stored when not in use, must be easily accessible to staff. Body (DOA) Room 1 Private room for temporary storage of DOA’s. Calming / counselling room for 1 Enclosed area to enable behaviourally disturbed patients to acute behaviourally disturbed be calmed without causing a disturbance in the hospital. This patients unit could also be utilised as a counselling / grieving room to ensure all space usage is maximised. Decontamination shower 1 Decontamination shower for patients to be available with hot & cold facilities. Can be linked to patient ablutions. Resuscitation / observation 1 Space for resuscitation equipment. Room Enclosed space to be provided for resuscitation / observation in emergency cases. Trolley washbay room 1 Located externally away from but close to entrance to trauma unit.

5.4 Second Zone These are areas that are immediately accessible to the public emergency service, outpatient service, and administrative service. They shall be located near the entrance of the hospital.

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5.4.1 X-Ray / Radiography The X-Ray / Radiography should be centrally located in the second zone; close to the wards, outpatients and casualty / trauma departments.

Figure 5.4.1: X-Ray / Radiography relationship diagram

The X-Ray / Radiography schedule of accommodation is shown in Table 5.4.1 below:

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Table 5.4.1: MH X-Ray / Radiography accommodation schedule Description No/ Comments Qty Reception & Porters 1 Provide desk space / workstation with telephone, computer with network connectivity, lockable storage under desk. Front desk to be disabled friendly. Trolley Bay Provide parking space for trolleys and hospital bed Records Room 1 To link to administrative area. Waiting Area 1 Patient waiting area (10 – 15 chairs). Patients to report to reception, then move to waiting area to be called by radiographer / staff members. Patient Ablutions 2 1 Male & 1 Female – both disabled friendly. Patient Dressing Cubicle 6 Patient cubicles to be provided for undressing. Provide clothes hanging hooks and seating. X-Ray Rooms 2 DOH to confirm any new equipment requirements (which will confirm further spatial provisions). To house existing equipment (if any retained). To allow for digital adaption of existing equipment. Digital processing and viewing stations must be immediately to the rear of the X-Ray and screening rooms. Sliding doors must be used (lead lined). Radiation protection essential. Ultra sound room 1 Private consulting with block out blinds required. 1 x ultrasound unit. Mobile x-ray Unit 1 X-Ray unit to be stored in lockable storage unit with electrical plug point in unit. Door should open to the outside. Include Fluoroscopy control area. Admin Office 1 Viewing area to be provided. Computer processing area including a server and viewing stations. Store room 1 Provide storage for consumables, equipment, clean linen, clean utility and sterile store. Unit Managers Office 1 Office for unit manager with computer, telephone and network connectivity. Shared with tele-radiology. Admin Workstation 1 Workstation for Admin staff including computer, telephone and network connectivity. Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Cleaners Room 1 Cleaning station to be provided. To include slop hopper facility.

5.4.2 Pharmacy  The Pharmacy should be centrally located in the second zone and easily accessible from all parts of the hospital.  The pharmacy is to be in close proximity to the OPD. Patients from the OPD are to be able to access the pharmacy for prescribed medication.  Security of the pharmacy is to be of a high priority.  Pharmacy will serve all inpatient and outpatient needs.  Legislated infrastructure requirements for to influence pharmacy design.  Counselling booths to be provided.

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 Goods delivery / drug receiving to be in high security zone.  Stock control in and out of pharmacy to be tightly monitored. IT system integration a high priority.  Ambient temperature control essential.  A high level of security and monitoring is required.  The dispensing system to all parts of the hospital to be factored into the pharmacy design.

Figure 5.4.2: Pharmacy relationship diagram

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The Pharmacy schedule of accommodation is shown in Table 5.4.2 below:

Table 5.4.2: Pharmacy accommodation schedule Description No/ Comments Qty Waiting Room 1 Waiting area to be provided. Dispensing 1 Dispensing to patients from OPD to be through security hatch(es) – max 4. cubicle 1 x serving hatch to be for wheelchair patients (disabled). Service hatch to patients / public to promote confidentially & privacy. High level of security at pharmacy will demand HD roller hatches at all openings. Provide secure lock up facility for scheduled drug issue with secure control systems. Dispensing to 1 Dispensing to wards (inpatients) to be via secure cubby hole system. Hospital wards Dispensing to be managed by pharmacy. Ward requirements / script to be signed off by pharmacist on duty and placed in secure cubbyhole for collection / delivery. Ward sister on duty to sign for receipt of drugs. I.T. connectivity & connection to server essential. Counselling 2 Counselling booths to be provided for confidential client counselling. To be rooms accessible from the pharmacy, foyer. Patient / client friendly environment. Secure drug 1 High security and high level of stock control. storage for IT connectivity to server essential. scheduled drugs CCTV monitoring Dispensary 1 Provide working surfaces and shelving for storage. Provide sufficient workspace for 3 pharmacists Empty bottle 1 Provide a small sore near the repacking area for storage of packing materials store once dispensing is complete. Expired drug 1 Store for expired drugs. To be returned to supplier or exited as medical store waste. Office space 1 Provide a standard office space for pharmacist manager with desk, cupboards, telephone, computer and network connectivity. The office must be centrally located in the pharmacy for the purpose of observation and supervision. There must be desk height viewing panels into the store and into the main pharmacy to support supervision and control of the pharmacy. Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Cleaning Station 1 General 1 Bulk store must be fitted with adjustable impermeable shelving that will allow Pharmacy Bulk for optimum flexibility. Storage: Shelving must be washable.  IV Store Separate Intravenous Fluid store with strong adjustable shelving (floor  ARV mounted).  Cold Store A section of the store must make provision for ARV medication, a cold store  Scheduled and lock up facility for scheduled drugs – only accessible by registered nurse. drugs CCTV monitoring. Goods receiving 1 Storekeepers workstation with worktop and IT network connectivity. (Quarantine High security. area) CCTV Monitoring

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Table 5.4.2: Pharmacy accommodation schedule Description No/ Comments Qty External Goods 1 To be a completely enclosed lockable delivery vehicle parking. Receiving Area Vehicular access to be controlled. Security level to be H.D. slatted roller shutter door. An intercom system to link exterior to pharmacy office and goods receiving bay. Goods receiving parking / offloading to be directly linked to the internal goods receiving area. The zone to be separated by a galvanised expanded metal screen with hatch & gate. The internal receiving area to have work surfaces for receipt of goods and stock control. Adequate shelving for document storage. Adequate workspace for recording and cataloguing of bulk drug supplies when received. Ambient temperature control. Good lighting essential. Clinical basin with medical mixer. Storage for protective gear to be used in handling of drugs. Waste facilities for used protective gear. Flammable store 1 Must comply with the safe storage of hazardous substances requirements. General storage 1 Small general store for clinical & non clinical items.

5.4.3 NHLS Blood Bank and Laboratory

The NHLS Blood Bank should be located in the second zone with and office / workstation for a NLHS staff member and must have a registered blood storage facility. The NHLS is

(a) To serve trauma, inpatient & outpatient care; (b) To be easily accessible by staff; (c) Primarily a blood storage function. Note ambient temperature requirements; (d) A close relationship exists between the laboratory and NHLS which suggests that administrative spaces might be shared;

The Laboratory should be located centrally in the second zone and should be close to outpatients department. It is to

(a) To receive and despatch specimens. Limited on site testing; (b) To serve impatient & outpatient care; (c) To be close to trauma unit & OPD; (d) To be easily accessible by staff; (e) To have sufficient storage space for equipment; (f) Centralised location in hospital.

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The NHLS schedule of accommodation is shown in Table 5.4.3 below:

Table 5.4.3: NHLS accommodation schedule Description No/ Comments Qty Office / Workstation 1 Office with desk, work station, computer, telephone and network connectivity for NHLS staff member. Unit Manager Office 1 Unit manager office provided with desk, telephone, computer and network connectivity. Refrigerated blood Secure lock up refrigerated storage for blood storage. storage Storage 1 Storage separated into 2 for stationery and equipment stores. Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly)

The Laboratory schedule of accommodation is shown in Table 5.4.4 below:

Table 5.4.4: Laboratory accommodation schedule

Description No/ Comments Qty Reception Area 1 Reception desk, window hatch and plug points. Sample Room 1 Counter for receiving of samples with lock up fridge. Laboratory Offices 1 Office for 3 x max laboratory technicians General laboratory 1 General laboratory provided with reception area, specimen collection area, specimen sorting area, workstation with printing station. Effective separation between different activity areas. Unit Manager Office 1 Unit manager office provided with desk, telephone, computer and network connectivity. Storage 1 Storage separated into 2 for stationery and equipment stores. To include storage space for protective clothing. Records Room 1 Secure storage of records with suitable shelving / filing units. Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Trainee / Student 1 Provide male & female ablutions and change rooms with lockers for Ablutions trainees and students (disabled friendly)

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5.5 Specialist Zone

The specialist zone has sections that require asepsis to perform surgical service, delivery service, nursery, and intensive care services. They shall be segregated from the public areas but accessible to the outer, second and inner.

5.5.1 Theatre Suite

The Theatre Suite should be located in the specialist zone close to casualty / trauma and C.S.S.D. Areas of importance include the following:

(a) Controlled access – secure area. (b) A secure sterile area (red line principal); (c) Strict security – no unauthorised access; (d) Easy access from Casualty / Trauma Unit & child birth unit. (e) Close to and direct link to C.S.S.D; (f) Theatre suite to comprise of 2 small sized theatres (36 sq m each) and ancillary accommodation (set up & scrub). (g) Infection control is critical and will define the design of this area. (h) Noise levels to be kept to a minimum. (i) Ancillary accommodation to include:  Unit Manager  Records room  Lobby – patient receiving & patient holding area.  Storage  Pre-operation patient beds – 2  Post-operation patient beds – 3 (j) Staff facilities & change facilities. (k) Theatre storage

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.

Figure 5.5.1: Theatre Suite relationship diagram

The Theatre Suite schedule of accommodation is shown in Table 5.5.1 below:

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Table 5.5.1: Theatre Suite accommodation schedule Description No/ Comments Qty Porter / Patient Holding 1 Porter desk & telephone with intercom facility connected to OT’s. Bay Holding bay to be provided for patients (Trolley Bay) Doctor / Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Intercom connection to nurses station. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Lobby 1 Waiting space on dirty side of red line. Control Desk 1 Theatre Control admissions desk / security desk. Unit Managers Office 1 Unit managers office / Sister in charge to have desk. Office to have computer with network connectivity and telephone. Records Room Storage of theatre records Nurses Station Located near the entrance with clear view of pre and post-operative areas Pre & Post-Operative 1 Pre-op 2 x spaces; Post-op 3 x spaces with all wall mounted bed Rooms head services Theatre 2 2 small size theatres (35 sq meters each) Scrub Room 1 1 Scrub room with whb, medical taps and shelving / storage for sterile consumables / equipment – shared between 2 theatres. Storage 1 Storage area for clean linen; general equipment; instrument store; sterile store / clean utility; sterile equipment store with direct connection to theatre; location for flash autoclave. Dirty Utility / Sluice Room 1 Portable bins for refuse. Sluice room is located near the patient triage area. Also used for clinical functions such as urine testing. Storage for patient basins, bedpans and urinals. Can be shared by both theatres. Connection to CSSD via dirty exit. Anaesthetist 1 Provide storage for Anaesthetist Link to CSSD 2 From each theatre

5.5.2 Obstetrics, Maternity / Child Birth

The Maternity Suite should be located in the specialist zone close to the theatre suite and post natal / neo-natal wards.  The Level 1 District Hospital will only manage normal and caesarean section births. Cases with complications will be transferred to a level 2 hospital.  Close proximity to theatre is essential for caesarean section births.  Easy access is required from OPD and trauma / casualty unit.  Strict security & access control is a requirement.  The obstetric unit is to comprise of the following: • Ante-natal: . 2 x 2 bed wards (first stage) with en-suite ablution. . 1 x 2 bed observation ward with en-suite ablution. . 2 x 1 bed delivery rooms with en-suite ablution with gas (entonox), medical basins & full wall mounted bed head services.

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• Post-natal: . 10 beds with baby bassinettes at bedside. . The requirements for the post-natal ward will be the same as those for general ward unit. . Baby specific facilities to include baby baths, milk kitchen, fridge, sterilizer. • Kangaroo Bed Unit for Mothers of Premature Babies: . 2 beds. . Close to post natal ward. . Lounge / dining (TV) area to be shared by kangaroo mothers. . Bathroom facilities for kangaroo mothers. • Mothers Lodge: . For mothers of babies that have not been discharged from hospital and where the mothers have been discharged and are still breast feeding. . 4 bedroom flat . Shared lounge (TV / dining / kitchen. . Shared ablution. • Neo-natal: . A neo-natal unit at / adjacent to nurses station for direct observation of problem babies / births. . Space for 2 incubators. . Dedicated baby bath in neo-natal.

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Figure 5.5.2: Obstetrics relationship diagram

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The Obstetrics schedule of accommodation is shown in Table 5.5.2 below:

Table 5.5.2: Obstetrics baby birth unit accommodation schedule Description No/ Comments Qty Reception / 1 Small reception area for 4 – 5 people Security Admissions & control desk Waiting Room 1 For family & friends (controlled access) Outside antenatal & delivery room area. Ablution for waiting family. New patient 1 Data capturing / patient observation. holding zone Nurses Station 1 To be shared between 4 – 5 clinical staff. The nurses’ station must be central to the patient areas. A central trauma desk for patient observation with telephone, computer and network connectivity and space where doctors can write up patient files on the inside and around the outside of the worktop. Emergency trolleys, ECG machines and files can be stored on the outside under the worktop to save space and reduce clutter. Wall storage space for forms must be provided near the nurses’ station. Office for Unit 1 Office space provided for unit manager with telephone, computer and Manager network connectivity. Antenatal Wards 2 2 beds per ward En-suite bathroom per ward. Screening facilities per bed Clinical basins in each ward Observation room 1 2 beds per ward En-suite bathroom per ward. Screening facilities per bed Clinical basins in each ward Delivery Room 2 Full services as per high care beds. Clear access around delivery beds. Good light & forced ventilation Clinical / sterile environment Clinical basins & scrub facilities Adequate space for equipment Baby bath & baby resuscitation Trolley Bay 1 For mother & baby Close to nurses’ station To have resuscitation facility Storage 1 Provide store room for consumables, equipment, clean linen, clean utility and sterile store. Dirty Utility / 1 Portable bins for refuse – must be sealable. Sluice The standard sluice room is required near the patient triage area. The area is used for clinical functions (urine testing, store of patient basins, bedpans and urinals) Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Patient Ablutions 2 1 Male; 1 Female (Both disabled friendly) with whb, w.c. & Shower Public Ablutions 1 1 Male; 1 Female – both disabled friendly at waiting. Lobby 1

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5.5.2.1 Post Natal Requirements

 Ward areas for convalescing mothers and their new born babies.

Figure 5.5.2.1: Post natal relationship diagram

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Table 5.5.2.1: Post natal accommodation schedule

Description No/ Comments Qty Entrance Foyer 1 Public Waiting 1 For family & friends (controlled access) Ablution for waiting family. Hand washing 1 Hand washing bays provided for staff, patients and visitors. bays En-suite Single 1 Adjacent to nurses station with viewing window. bed (Isolation ward) with airlock chamber / annex. 2 Bed Ward Standard ward configuration & requirements 3 Bed Ward Standard ward configuration & requirements 4 Bed Ward Wards to increase in increments of 4 beds to realise the target number of beds. Nurses Station 1 To be shared between 4 – 5 clinical staff. The nurses’ station must be easily accessible to patient areas. Workspace is to be created for doctors and clinical staff to record documents. Duty Room / 1 2 x workstations per office for admin use. General Admin Counselling Office 1 Must be private rooms for sensitive consultations and bereavement counselling. Provide chairs and writing desk. Doctors Office(s) 1 Examination couch; examination light; Wash basin with medical taps; Small desk; X-ray viewing facility, patient chairs, cupboards & storage. Training Room(s) 1 Space for training with tables & chairs. Records Room 1 To be located adjacent to the Patient Management Desk for ease of access by administrative staff and patients to retrieve records. Unit Manager 1 Unit manager office provided with desk, telephone, computer and network Office connectivity. General 1 1 room at each ward unit for multi usage Procedure Room Storage: 1 Clean utility / sterile store 1 Drugs cupboard 1 Clean linen 1 Surgical equipment store 1 General equipment store Cleaners Room 1 Cleaning station to be provided. To include slop hopper facility. Dirty utility / sluice 1 Portable bins for refuse. room Sluice room is located near the patient triage area. Also used for clinical functions such as urine testing. Storage for patient basins, bedpans and urinals. Ward kitchen 1 Patient Ablutions 1 1 Male; 1 Female (Both disabled friendly) with whb, w.c. & Shower (Allowance for assisted bathroom facilities in male & female). Staff facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Milk kitchen 1 Refrigerated storage Breast feeding - Private room for breastfeeding mom’s with comfortable seating. room Baby wash - Provide baby wash facilities facilities Nursery (10 To be located adjacent to mothers beds. basinettes)

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Lodger mothers 1 Provide for 4 mothers in self-contained flatet. accommodation Kangaroo mothers 1 2 bed facility for kangaroo mothers.

Ward Specific Requirements to be provided at the post-natal ward in addition to general ward requirements

(a) Will provide the same facilities as a normal inpatient ward. (b) Breast feeding room at maternity ward. (c) Milk kitchen at maternity ward with sterilizer. (d) Space to be provided for 10 baby bassinettes. (e) Baby wash facilities. (f) 2 Kangaroo mothers beds to be provided close to post natal ward. Must include: • Shared Bathroom • Lounge, dining, kitchen • T.V. • Resuscitation Bay (g) Mothers Lodge: • 4 Beds required. • Shared lounge / dining / kitchen • TV • Shared ablution

5.5.3 Central Sterile Supply Department (C.S.S.D)

The C.S.S.D should be located in the specialist zone close to the theatre suite, maternity and neo natal.

 The CSSD will provide sterile packs for use through all department of the hospital.  The CSSD should be in close proximity to the operating theatre. Most of the sterile packs will be for use in the theatre.  A strict flow from dirty receiving through cleaning / sluicing to sterilizing at the autoclave, packing in a secure sterile store to despatch to theatre & hospital is to be followed.  Entrance is to be controlled. CSSD staff only.

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Figure 5.5.3: CSSD relationship diagram

The C.S.SD schedule of accommodation is shown in Table 5.5.3 below:

Table 5.5.3: C.S.S.D accommodation schedule Description No/ Comments Qty Receiving Area 1 Controlled “dirty” access with dirty trolley parking area. Receiving space at the end of the passage for “soiled” goods. Sorting / 1 For sorting, cleaning, washing and drying instruments and goods. Decontamination Area Instrument washer to be provided in this area. Dirty Utility / Sluice 1 Store space for dirty linen and refuse Sluicing of goods to be sterilised. Autoclave Alcove 1 2 Autoclaves to be provided (back up one on one) Size of autoclave to be confirmed. Workspace for autoclave unpacking; sterile storage and dispensing. Controlled clean egress to packing & storage . Store 1 Sterile storage and dispensing. Provide for clean trolley parking area. Packing Area 1 Sterile unit for making up of surgical and other packs, the area should have a fitted ventilation system. Controlled clean egress to despatch area. Sterile Store 1 Storage of sterile packs in a controlled sterile environment. Despatch Area 1 Area for despatch to wards as well as for receiving of ward stock. Directional flow is important: sterile store into despatch area.. Office 1 Supervisors Office Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly)

5.5.4 High Care Unit

The High Care unit should be located in the specialist zone close to the C.S.S.D and the Theatre Suite. (a) Located in the inner zone; (b) A 4x bed high care unit is required;

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(c) The high care unit to have restricted controlled access; (d) Nurses’ station to be located centrally for constant observation of all beds; (e) All piped & fixed services and to be available at the head of each bed; (f) Easily accessible to be provided to all sides of high care beds (min bed head wall length of 3 meters); (g) Normal ancillary ward services to be provided: • Sluice • Storage • Staff facilities • Patient ablution

Figure 5.5.4: High care relationship diagram

The High Care unit schedule of accommodation is shown in Table 5.5.4 below:

Table 5.5.4: High Care unit accommodation schedule Description No/ Comments Qty Lobby: Waiting & 1 Controlled access point patient receiving High security levels – electronic access system to restrict access. 4 Bed High Care 1 All medical piped, fixed and gas services Unit Screening of beds – privacy. Min bed head wall length of 3m per bed Controlled ambient temperatures Natural & artificial light Nurses Station 1 To be shared between 4 – 5 clinical staff. The nurses’ station must be central to the patient areas. The ward clerk’s workstation will be at the nurses’ station. A central trauma desk for patient observation with telephone, computer and network connectivity and space where doctors can write up patient files on the inside and around the outside of the worktop. Emergency trolleys, ECG machines and files can be stored on the outside under the worktop to save space and reduce clutter. Wall storage space for forms must be provided near the nurses’ station. Office for Unit 1 Office space provided for unit manager with telephone, computer and Manager network connectivity. Records Room 1 To be located adjacent to the Patient Management Desk for ease of access by administrative staff and patients to retrieve records.

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Storage 1 Provide store room for consumables, equipment, clean linen, clean utility and sterile store. Table 5.5.4: High Care unit accommodation schedule Description No/ Comments Qty Dirty Utility / Sluice 1 Portable bins for refuse, must be sealable containers. Sluice room is located near the patient triage area, also used for clinical functions (patient basins, bedpans and urinal sluicing) Cleaners Room 1 Cleaning station to be provided. To include slop hopper facility. Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Patient Ablutions 2 Assist shower Assist w.c. Assist whb

5.5.5 Day Surgical / Recovery Unit

(a) To be close to operating theatre suite. (b) To be easily accessible from casualty trauma unit for use in emergencies. (c) To be managed by theatre staff. (d) To have easy access from casualty / trauma unit. (e) The room will be used for minor surgery & emergencies. (f) Waiting room to be close by. (g) Recovery wards for day patient care with en-suiite bathroom facilities.

Figure 5.5.5: Day Surgical / Recovery Unit relationship diagram

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The Day Surgical / Recovery Unit schedule of accommodation is shown in Table 5.5.5 below:

Table 5.5.5: Day Surgical / Recovery Unit accommodation schedule Description No/ Comments Qty Reception / Lobby 1 Circulation zone Patient waiting Enough space for 2 x trolleys / beds Hard wearing finishes, good lighting Natural & forced ventilation Connectivity to ICT systems Unit Managers Office 1 Unit manager office provided with desk, telephone, computer and network connectivity. Treatment / 1 Privacy to be monitored Consulting Room Must be multi-purpose for use as counselling room Good lighting Wash basin with medical taps, small desk, chair for doctor, chairs for patients Forced & natural ventilation Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Waiting Room 1 Must be able to accommodate 10 people. Hard wearing finishes Natural & forced ventilation Public Ablutions 1 Linked to waiting room Procedure Room 1 To be considered as a minor theatre of 25 sq m. Stores 1 Provide store room for consumables, equipment, clean linen, clean utility and sterile store. 4 Bed Wards 1 Shared back up facilities Refer to ward descriptions in inner zone. Nurses Station 1 To be shared by 2 – 3 clinical staff. Central in patient area. Dirty Utility / Sluice 1 Portable bins for refuse, must be sealable to contain medical waste. Sluice room is located near the patient triage area. The area is to cater for general & medical waste and general sluicing.

5.5.6 Burns Unit

(a) Located in the specialist zone; (b) To be close to High Care unit; (c) Facilities to be shared with high care unit: • Storage; Staff Facilities; Ancillary ward services; (d) Dedicated Facilities: • Sluice; • Nurses control desk / nurses’ station; • Burns treatment room with burns bath; • 2 x 2 bed Recovery rooms with options for beds & cots;

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• Patient ablutions: Adult size & paediatric size.

5.6 Inner Zone The inner zone contains areas that provide nursing care and management of patients: nursing service. They shall be located in private areas and accessible to guests

5.6.1 Hospital Wards

The Hospital wards should be located in the inner zone to ensure patient recovery and security.

(a) Mjanyana Hospital will offer Level 1 District health care services & refer patients to Level 2 and Level 3 hospitals as required. (b) Hospital wards are divided into the following categories: • Surgical: Male and Female; • Medical: Male and Female; • TB: Male and Female; • Obstetrics / Maternity; • Paediatrics; (c) Ward configurations are multiples of: • 4 Bed wards; • 2 Bed wards; • 1 Bed (Isolation) wards;

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(d) Wards to be designed to maximise patient observation and patient security. (e) Each ward units to have facilities: • Patient ablutions & bathrooms (assisted friendly); • Nurses station & unit managers office; • Duty room; • Ward kitchen; • Cleaning facilities • Storage: Linen; Drugs (Secure); Equipment • Public waiting / arrival; • Sluice; • Clean utility; • Staff facilities;

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Figure 5.6.1: Hospital Wards relationship diagram

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The Hospital Wards schedule of accommodation is shown in Table 5.6.1 below:

Table 5.6.1: Hospital Wards accommodation schedule Description No/ Comments Qty Entrance foyer 1

Public waiting 1 Waiting area with seating. Medical Hand washing basins 1 Hand washing bays provided for staff, patients and visitors in each ward En-suite Single bed (Isolation - Adjacent to nurses’ station with viewing window ward) with airlock chamber / annex. 2 Bed Ward - Standard ward configuration & requirements 3 Bed Ward - Standard ward configuration & requirements 4 bed Ward - Wards to increase in increments of 4 bed wards to realise the target number of beds. Resuscitation Bay 1 Nurses Station 1 To be shared between 4 – 5 clinical staff. The nurses’ station must be easily accessible to patient areas. Workspace is to be created for doctors and clinical staff to record documents. Duty Room / General Admin 1 2 x workstations per office for admin use. Counselling Office 1 Must be private rooms for sensitive consultations and bereavement counselling. Provide chairs and writing desk. Doctors Office(s) 1 Examination couch; examination light; Wash basin with medical taps; Small desk for staff; X-ray viewing facility, patient chairs, cupboards & storage. Training Room(s) 1 Space for training with tables & chairs. Records Room 1 To be located adjacent to the Patient Management Desk for ease of access by administrative staff and patients to retrieve records. Unit Manager Office 1 Unit manager office provided with desk, telephone, computer and network connectivity. General Procedure Room 1 1 room at each ward unit for multi usage Storage: 1 Clean utility / sterile store 1 Drugs cupboard 1 Clean linen 1 Surgical equipment store 1 General equipment store Cleaners Room 1 Cleaning station to be provided. To include slop hopper facility. Dirty utility / sluice room 1 Portable bins for refuse. Sluice room is located near the patient triage area. Also used for clinical functions such as urine testing. Storage for patient basins, bedpans and urinals. Ward kitchen 1 Patient Ablutions 1 Male; 1 Female (Both disabled friendly) with whb, w.c. & Shower (Allowance for assisted bathroom facilities in male & female). Staff facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Day Room / Patients Lounge 1 Seating to be provided in day room. Preferably opening into courtyard. For use of patients not confined to their beds.

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5.6.2 Ward Specific Requirements to be provided in addition to general ward requirements

Maternity – Post Natal:

Refer item 5.2.1: Obstetrics / Maternity / Child Birth

Paediatrics: (a) Lodger accommodation • 4 Beds • Ablutions to accompany 4 beds (b) Isolation wards (c) Burns bath in general procedure room (d) Sanitary fittings to be down sized to suite paediatrics wards (e) Positioning of ironmongery to be down dimensioned to suite paediatrics needs (f) Barrier beds & cots to be provided: • 10 Cots • 12 Barrier beds (g) Juvenile, toddlers & babies to be accommodated separately on a flexible basis depending on patient ratio.

TB: (a) Single bed wards / isolation wards to be en-suite and air flow controlled by means of an airlock chamber. (b) Adequate cross ventilation to be generated by the design (natural ventilation may be augmented with forced mechanical ventilation). (c) Post-infectious TB recuperation policy is generally as an outpatient.

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5.7 Service Zone The service zone provides support to hospital activities. It shall be located in areas away from normal traffic

5.7.1 Hospital Administration The Hospital administration could be located in the existing buildings renovated and recycled for usage. (a) Adminstration functions located in the service zone are non-clinical. (b) Administrative functions located in the service zone are not accessible to the general public. (c) Administrative functions will include: • Hospital administrator & PA; • Hospital manager & PA; • Nursing Management & PA; • Heads of Departments; • Chief Medical Officer; • Financial administration; • Human resources management; • Support services management; • Secretarial services; • Q.A. & OHS Management; • General administration: . Technical services . Facilities management . Boardroom . Switchboard . Records room

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. Stationary . Training room . Kitchen . Ablutions

The Hospital Administration schedule of accommodation is shown in Table 5.7.1 below:

Table 5.7.1: Hospital Administration accommodation schedule

Hospital Administrator

Position Accommodation QTY Description or extra requirements Reception / Waiting Area Wait Area 1 General with furniture CEO Office 1 Large office, desk & chairs, carpet, air- conditioner PA / Secretary Shared Office Space 1 Storage cabinets Support office General Work Space 1 Printing & photocopying junior staff General office Office 1 Normal office.

Senior Management

Senior Management Office and Secretary 5 Operations manager, combination. Medium Nurse manager, sized office. Financial manager, Human resource manager, risk management P.A. to Management – Shared office space 1 Storage cabinets Shared

Board room 1 With kitchenette and guest wc Meeting rooms 2 Multi-purpose senior staff meeting rooms Managers Offices 1 1 Single 1 Shared for 4 people

QA and Infection Control

QA / Infection Control Single Office 1 Offices Support Office Shared Office 2 Shared with data typist Support Office Infrastructural 1 Storage & filing

Finance Department

Manager Office 1 Large office, desk & chair Staff Shared Office 1 Admin support office Staff Shared Office 1 Admin support office Clerical Shared Office 1 Asset Management Shared Office 1 Admin support office Supply Chain Management Office 1 Receptionist / Secretary Counter Printing & Photocopying Work room 1

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Table 5.7.1: Hospital Administration accommodation schedule Position Accommodation QTY Description or extra requirements

Human Resources Management

Unit Manager Office 1 Large office with desk & chair Secretary Office 1 Secretary to manager Photocopying and printing Work room 1 Admin support office Staff Shared office Shared 2 people 1x2 Performance Manager and Office 1 Shared office Labour Relations Officer Meeting Rooms Office 1 Records room Large safe room for 1 Fit with space saving active staff files shelving that is fire proof Union Office 1 Offices for union meetings

Employee Assistance & Advancement

Trainer offices Normal office for 2 -3 1 Shared office layout people with notice boards Store Room 1 Shelving Training Room 1 Tables and chairs, audio-visual monitors, network points for 10 staff. AV equipment to be secured. Small Library 1 Medical and clinical text books. Could be part of training room. Student Tea Kitchen 1 Small kitchen Staff Ablutions Male / Female 1 Conveniently / centrally located. Disabled friendly. To comply with SANS norms. Facilities Management

Office of Head of Normal office 1 Medium sized office Department General Support Office Shared office 1 Normal admin office for 2 people Secretarial support Shared office 1 General office – max 2 people. Storage and shelving / fitting.

Registry

Office for Department Head Normal office 1 Medium sized office Clerical Staff Shared office 1 Shared office: 6 people General support office Shared office 1 Storage, sorting & copying

General

Staff Facilities Shared 1 Tea Kitchen Male & Female Ablutions (disabled friendly)

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5.7.2 Support Services The Support Services are to be located at “rear” of hospital in the service zone with a separate dedicated service entrance.

The service area zone and support services zone is not accessible to the public. Access is via secure entrance or appointment. (a) Security: Central Control Room Gate House / Security Building Perimeter Security Patient, Staff & Equipment Safety Dedicated Ambulance Entry Controlled Vehicular Access Controlled Service Access Controlled Patient / Public Access (b) Medical records and archives; (c) Maintenance workshop; (e) Mortuary; (f) Ambulance / bus / official vehicle parking; (g) Hotel services / catering unit; (h) Laundry services; (i) Waste Management: Condemned material Medical / clinical waste Kitchen waste General waste Recycling (j) Garden Services; (k) Medical gas; (l) Bulk stores.

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Details of Support services are as follows:

5.7.2.1 Security  Security is a high priority.  24 Hour service  Will include security guards, perimeter fencing, electronic surveillance devices, access control devices, vehicle control & surveillance.  Security in the hospital zones are as follows: • Entrance: Guard(s) CCTV Surveillance Security desk at entrance with weapons safe. Security control room, security department & staff to be close to entrance. • OPD & Trauma: Guards in the entrance zone and at unit entrance. CCTV surveillance • Pharmacy: High level of security Heavy duty roller doors at delivery bay All windows barred All doors gated Secure screen above ceiling Electronic access control CCTV monitoring • NHLS & Laboratory: Access Control CCTV surveillance • X-Ray: Access Control CCTV surveillance • Theatre Suite: Access Control CCTV surveillance • Obstetrics / Maternity: Access Control CCTV surveillance • High Care: Access Control CCTV surveillance • Day Ward / Procedure Room: Access Control CCTV surveillance • Hospital Wards: Access Control CCTV surveillance • Stores, Workshops, Medical Gas, Mortuary, Hotel

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Catering Services: Access Control CCTV surveillance  Security of the hospital grounds is to be as follows: • Perimeter fence (“clearview” with razor wire) • Controlled access onto grounds at single entry / exit point. • Access / entrance gatehouse: . Control vehicular movements (boom) . Facility to search vehicles (search bay) . Monitor pedestrian movement . All pedestrian traffic to pass through metal detector. . Hand bags to be subject to search. . Body search cubicle to be provided. . Weapons safe – public to hand over weapons for safe keeping. . CCTV surveillance of entrance / gate house / guard house.  CCTV Monitoring & recording base to be in control room.  Gate house building: • Secure structure • Barred windows • Laminated (HPR) glazing • Heavy duty doors & security gates • IT & telecom link to control room. • Hard wearing surfaces & building elements. • Guards change & ablutions with lockers.

Table 5.7.2.1: Security accommodation schedule Description No/ Comments Qty Head of Security 1 Office Secretary 1 Support Office Waiting Room 1 At entrance to unit Centralised Control Room 1 All monitoring screens centrally located 2 – 3 Staff Work benches General Admin Office 1 General office: Max 3 staff Telephone Exchange & Pager 1 PABX: Central switchboard Server Room 1 Serving entire hospital Staff Change Rooms 1 Male & female change rooms with lockers Ablutions 1 Male & Female (Disabled friendly)

5.7.2.2 Medical Gas  Centralised bulk gas supply to hospital.  Design & selection to take cognisance of access road conditions and likely frequency of deliveries.

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 Medical gas to be piped to: • Trauma Unit • Theatre Suite • Procedure Room • Maternity / Obstetrics delivery unit • High care • Burns unit  Medical gas facility to be under control of the bulk storage management & located close to the bulk stores.

5.7.2.3 Mortuary  To be accessible by the public (controlled) and service vehicles.  Provides cold room storage for bodies.  Public waiting space is required.  Viewing room is required.  Permanent staff at the mortuary are to be catered for.

Figure 5.7.2.3: Mortuary relationship diagram

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Table 5.7.2.3: Mortuary accommodation schedule Description No/ Comments Qty Entrance & waiting area 1 Waiting for 4 – 8 people Body Storage 1 3 Tier refrigerated body cabinets for 12 bodies Viewing room 1 Soft furnishings Dignified Ablutions 1 For use by public and staff. Disabled friendly. Body wash facility 1 Hard surfaces, floor drains Cleaners & trolley Wash 1 Slop hopper, hose pipe, floor drain Staff Duty Room / Change 1 2 – 4 staff members Room Loading Bay 1 External for vehicle loading body transit.

5.7.2.4 Medical Archives  Stored old & redundant records for prescribed period.  Controlled humidity & temperature  Access controlled entrance.  Dedicated storage & shelving: • Medical archives • Clinical archives • General archives • Patient archives  Archives are to be controlled & managed by Registry staff.

5.7.2.5 Maintenance Workshop & Garden Services  Workshop Services • Handyman repairs • Small projects (Painting / electrical / welding / general repairs)  Garden services • Grounds maintenance • Horticulture

Table 5.7.2.5: Maintenance Workshop & Garden Services accommodation schedule Description No/ Comments Qty Workshop Manager 1 Office Workshop Staff 2 Based in workshop Grounds Manager 1 Office Grounds Staff 4 Outdoors Workshop 1 Space for tools Workbenches Storage of consumables in use Workshop Store 1 Secure CCTV surveillance Grounds Store 1 Storage of equipment

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Table 5.7.2.5: Maintenance Workshop & Garden Services accommodation schedule Description No/ Comments Qty Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly)

5.7.2.6 Hospital Vehicle Parking  Office for Transport Clerk (reports to facilities manager)  Driver sleep-in facility with ablutions  Car / vehicle wash bay  Storage for cleaning consumables & minor spares.  Secure (gated) parking for: • 1 x Ambulance • 1 x Minibus • 1 x Light delivery truck • 1 x official cars  Parking to be under CCTV surveillance

5.7.2.7 Waste Management  Waste generated at the hospital will be specific as follows: • Kitchen waste • General waste (municipal waste) • Medical waste • Clinical waste  Medical & clinical waste to be outsourced to a waste management company for disposal.  Medical & clinical waste to be packaged and sealed for removal.  Medical & clinical waste storage to be in a temperature controlled environment.  Recycling to be promoted as follows: • Paper & packaging • Glass • Plastics • Metals  Recycling bins to be provided for collection of recyclable material by waste management company

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 Kitchen waste • To be disposed of from main kitchen • To be macerated into pulp • To be stored in containers for collection • To be offered to local community as animal feed

Table 5.7.2.7: Waste management relationship diagram

Table 5.7.2.7: Waste management accommodation schedule Description No/ Comments Qty Office for waste control clerk 1 At entrance to waste facility Medical waste storage 1 Controlled environment Secure access control & CCTV surveillance Clinical waste storage 1 Controlled environment Secure access control & CCTV surveillance General waste store 1 Controlled environment Secure access control & CCTV surveillance Recycled store 1 Controlled environment Secure access control & CCTV surveillance Loading bay 1 For loading & removal of hospital waste Wash down facilities at all waste 1 storage External skip 2 For large waste Garden waste Hospital to be encouraged to create a compost heap for vegetable garden Waste management office to be part of facilities management

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5.7.2.8 Laundry Services  The hospital will manage its own laundry.  A dedicated on site laundry facility is a requirement  The laundry will receive soiled linen, garments from the hospital; and deliver clean linen to the hospital.  The flow of the laundry is important.  Laundry equipment to include: • 55kg Sluice • Industrial washing machines (min 2) • Industrial tumble dryers (min 2) • Industrial ironing facility  Laundry store for storage of clean items pending distribution to the hospital.

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Table 5.7.2.8: Laundry relationship diagram

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Table 5.7.2.8: Laundry Services accommodation schedule Description No/ Comments Qty Office for unit manager 1 Small / medium office for 2 people Reception 1 Circulation zone Arrival point Offices 1 For housekeeping interfacing with hospital units Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Trolley parking 1 At dirty soiled goods entrance for 6 trolleys in soiled goods arrival area At clean store for 6 trolleys Soiled goods receiving area & 1 Can be combined or can be separate spaces. sorting area Enough working space to package laundry for sluicing & washing Hard wearing easily cleaned surfaces Sluicing area 1 For contaminated linen Space for 55kg sluice machine Provide facilities for manual sluicing Washing area 1 Space for electronic heavy duty industrial washing machines (min 2) Space for loading & emptying machines Drying area 1 Provide secure external area with wash lines Provide heavy duty industrial tumble dryers (min 2) Space for loading & emptying machine Sorting & Folding 1 Receiving of clean linen Folded for storage or sent for ironing. Ironing Room 1 Provide heavy duty industrial flat bed ironing facility Packing for storage & 1 Linen is packed for storage or distribution into hospital. distribution Clean store 1 Storage of clean linen Shelving on wall bands Distribution room 1 Controlled distribution out of laundry to hospital Trolley parking is required for 6 trolleys Exit & distribution stock control process to be accommodated. Linen to clean exit / entrance to laundry Sewing room 1 Repair to laundry Space for sewing machine Worktop 1 x seamstress Staff Facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Kit room 1 For storage of patients clothing. To be handed back on patient discharge.

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5.7.2.9 Hotel Services / Catering Services  Food preparation for all hospital units will be from a centralised kitchen.  Inpatients will receive meals in the hospital wards.  Meals are to be prepared and served onto plates which are sealed and transported to the inpatients in food trolleys. Food will be kept warm at the ward kitchens.  Ad hoc teas / snacks will be prepared for inpatients at the ward kitchens.  Bulk deliveries are to accommodated at the centralised kitchen.  Bulk food storage is to be accommodated at the centralised kitchen.

Figure 5.7.2.9: Hotel services relationship diagram

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Table 5.7.2.9: Hotel services / catering accommodation schedule Description No/ Comments Qty Office unit manager & 1 Shared office assistance Cupboard storage included Supervisor office & dietician 1 Clear vision of kitchen workspace (shared) Full IT connectivity Storage for food supplements Staff facilities 1 Staff tea room with standard kitchenette provided with the following: Wall mounted hydro boil, microwave oven, bar fridge and lockable counters. Staff rest room with seating. Staff change rooms / ablutions with showers, whb’s, and w.c.’s. Lockers to be located in passage leading to ablutions. 1 Male / 1 Female (Both disabled friendly) Off loading bay 1 To be secure Goods receiving bay & stock 1 To be central to operations. control desk To connect to storage facilities To control issue of stock to kitchen To have scales To have full IT connectivity Daily issue of stock to day store to be controlled from stock control desk. Bulk food storage 4 Refrigeration & freezer storage Dry store Fruit & veg store General storage Food preparation 1 Separate areas for Meat, fish & chicken Fruit & vegetables Breads & special diets Tube feeds Milk kitchen Cooking area 1 Cooking facilities Stove Fryers Ovens Cooking pots Dedicated extraction Packing & serving 1 Fir distribution to wards. Packing surfaces for serving onto plates before loading onto trolleys. Trolley parking. Sorting & packing returned 1 Cleaning soiled plated. soiled crockery & cutlery from Discard waste food to waste disposal hospital Prepare plates, cutlery etc for washing Have trolley wash facilities Scullery 1 Heavy duty dish washer machines (min 2) Pot wash facilities Drying / packing area for crockery / cutlery Utensil store 1 Storage for clean utensils, pots, crockery & cutlery. Cleaners room 1 Slop hopper cleaner facility

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5.7.3 Staff Accommodation Staff accommodation is to be provided for key staff in terms of DoH policy:  There is no suitable accommodation in the nearby village.  The area is isolated and has no attractions to interest voluntary moves to the area.  Without suitable accommodation the hospital will be unable to provide a meaningful service.

Table 5.7.3: Staff accommodation schedule Description No/ Comments Qty 2 Bedroom married quarters 6 2 Bedrooms, bathroom, w.c., open plan living / dining / kitchen 1 Bedroom single quarters 6 1 bedroom could be amalgamated; Bathroom, w.c., open plan living / dining / kitchen 6 Bedroom shared 10 Shared kitchen / dining. accommodation male / female Shared bathroom for 06 beds units Shared laundry for 06 beds Parking To suite Recreational facilities for staff Soccer field, netball court, games room, lapa Total staff facilities 72

5.8 ANCILLARY SERVICES

5.8.1 Primary Healthcare Clinic & Gateway Support

The clinic should be provided to primary healthcare support to the hospital, screening primary health patients before entering the hospital. This separation of patients will assist in managing patients at the lowest level of care at an affordable cost.

The clinic should be provided as a standalone building. The existing gateway clinic is in a building of poor structural integrity, is not located near the hospital entrance and was not designed as a clinic:  To be custom designed & located near hospital entrance.  External undercover waiting area to be provided to augment internal waiting.  Security is of high importance at drug storage. CCTV surveillance to be provided.  Provides primary healthcare service: • Chronic Medication (eg Diabetes) • General Medicine Distribution • Immunisation • Family Planning Clinic • Ante-Natal service

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Table 5.8.1: Ancillary Services accommodation schedule Space Quantity Description 1

Reception 1 x General reception with Porters desk Public ablutions 1 x Male / Female and a baby change: disabled friendly. Waiting 1 x Waiting room with 20 seats Waiting (External) 1 x External waiting room for the clinic, OPD and visitors who arrive early and need to wait outside the hospital Registration / Help Desk 1 x Wheelchair friendly front desk with telephone, computer and network connectivity. Medical records 1 x Medical records store with space saving racks Unit Manager Office 1 x Unit manager office provided with desk, telephone, computer and network connectivity. Staff Duty Room Provide office with 2 x workstations per office. Patient administration 1 x with 3 Cashier desks fitted according to the correct financial serving regulations hatches Nurse observations / data 2 x with The work stations should provide privacy for both patients collections and history toilet taking between Consulting rooms 4 x Consulting and counselling Treatment room / 1 x For dressings lab samples, and sputum specimens, and patient emergency room treatment Medicine room 1 x Dispensing room, air-conditioned: Secure storage Store rooms 3 x Consumables, linen and general store. Staff rest 1 x Tea and rest room with separate ablution facilities Office 1 x Office provided for general admin / doctors use (shared facility)

Wardroom 1 x Nurses wardroom Server Room 1 x Secure room to house server Dispensary 1 x Dispensing of medication

5.8.2 Recreational Facilities

 Recreational facilities to be provided for staff and patients (Soccer field, netball court, games room, lapa).

5.8.3 Isolation Ward / Circumcision Unit

 Currently this service is provided at an outbuilding (rondavel) on the hospital grounds.  A new circumcision unit is required that will take cognisance of cultural requirements and offer a controlled sterile hygienic service.  The new unit should be a standalone unit (perhaps close to the Gateway Clinic).  A consideration is to provide an isolation ward for general usage (hospital request) which would also serve as a convalescing ward for circumcision patients.  The detailed requirements for a new circumcision unit are to be resolved in consultation with hospital management.

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5.8.4 Access Road

 The gravel road that connects the hospital with the R408 tar road is in a poor condition.  The gravel road does not receive regular maintenance.  The road is not suitable for normal motor vehicle usage.  That the hospital is unable to secure and retain key staff is directly attributable to the condition of the road.  A successful upgrade of Mjanyana Hospital to the Level 1 District Hospital status demands the upgrade of the access road.

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