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CHAPTER I

PREFACE

I.1. BACKGROUND

Medical Rehabilitation (MR) is a part of hospital which roles are

important in health implementation including improvement (promotif), prevention

(preventif), healing (kuratif), and especially rehabilitation (rehabilitatif).

Rehabilitation itself used to be taken only as one of supporting service facility to

support curing of motoric function of patient’s body after receiving medical

treatment in a hospital. Along with the advancement of medical technology,

Medical-Rehabilitation service developed into an Integrated Unit or an MR

Installation (IRM - Instalasi Rehabilitasi Medik) which is the final version and

integrated with other medical Specialization or even is a Sub-Specialization. In

that case, a manual book of MR facility aimed to be the Guidelines for Hospital

organizers including to achieve planning and design of an MR facility properly

and correctly and follow the rules of MR of medical science.

I.2. AIM & OBJECTIVE

The aim of preparation of this book is for it to become Book of Guidelines

for Hospital Organizers, basic development of science for advanced Planning and

Design of MR Facility in the future according to advancement of MR science.

[PAGE 2 IS MISSING]

The Vision to achieve INDONESIA SEHAT (HEALTHY INDONESIA)

– 2010 is “a description of future Indonesian society achieved through health

development is the society, the nation and the country; which marked by healthy

living environment and behavior of the people, possess ability to reach quality,

fair and evenly distributed health service, having the highest health level all over

Indonesia where with this formulation the expected service for the future is a

peaceful service for healthy condition to be achieved” 2

2 Vision and Mission of INDONESIA SEHAT – 2010, Health Dept. of Indonesia, 2002, Jakarta, Indonesia

1

I.5. DESCRIPTION AND LIMITATION

Description and limitation consisted in this manual book i.e.:

• Manual here means a reference which can be used as a source for direction

to perform an activity or work.

• Building here means a Building where according to Decision of Minister

of Residential and Area Facility No 332/KPTS/M/2002: “… functioned as

a place for humans to perform their housing or staying, business, social,

culture, and/or special activities …”

• MR meant here refers to the book of “MANUAL OF MR SERVICE OF

HOSPITAL CLASS A, B AND C” 2nd edition of 1997 published by

Directorate of Public Hospital and Education, Directorate General of

Medical Service of Health Dept. of Indonesia which is “ … a form of

integrated health service with medical, psychosocial – educational –

vocational approaches to achieve functional ability as much as possible

…”

• Hospital meant here generally is a public facility, according to Indonesian

Act No 23/1992, Chapter I, Article 1, Item 4: “… a place used to run

health efforts …”

• Manager / Head / Vice Head of the Department / Installation / MR Unit

meant in this book is someone assigned by Hospital Officials / Board of

Directors to sit as the chief of the Department / Installation / Unit and fully

responsible of the whole MR service provided by the Hospital for patients.

• Chief / SMF (Staf Medik Fungsional – Functional Medical Staff) Chief of

MR is someone appointed by Hospital Board of Director (legalized

together with Board of Dean / Director of Medical Faculty when the

Hospital is in form of Educational Hospital) to be a leader of a group of

doctors (Sp.RM (Specialist in MR), doctors with other specialization

2

related to MR, Medical Doctor Plus with MR ability) commonly named as

MR SMF and professionally responsible on any kind of medical services

occur in Department / Installation / Unit of MR to Hospital Medical

Committee.

• Assistant Manager / Coordinator / Section Head / Head of Service is

someone appointed and stated by Hospital Organizers / Hospital Board of

Director to assist the Manager / Head / Vice Head of MR to run service

operational function according to possessed specialization/profession.

• Specialist Doctor of MR meant in the manual is someone graduated as

Bachelor of Medic (Sarjana Kedokteran – S.Ked.) and attending

education of professional doctor (Ko-As / Co-Assistance) and graduated

as a doctor. Then the dr. (Med. Doctor) or commonly preferred as “Dokter

Umum” / “Medical Doctor” attends MR Specialization and graduated and

also stated to earn the degree of Sp. RM (MR Specialist).

• Psikolog (Psychologist) meant in this book is someone who has graduated

as Bachelor of Psychology and attend the education of professional

Psychologist and graduated and also earns profession as Psychologist.

• Physiotherapist, Speech Therapist, Orthetic – Prosthetic, Medical Social

Worker (Pekerja Sosial Medis – PSM) and MR Nurse meant in this book

are some ones commonly preferred as MR Paramedic (either from Nursery

or Non-Nursery Paramedic) i.e. someone who has graduated from Mid –

Expert education program (Ahli Madya Diploma III) or the same level as

High School Plus (with additional expertise education in form of skill &

expertise courses) according to specialization in MR environment.

• Administration & Finance Person meant in this book is someone or are

some ones who perform administration-arrangement starting from

registration and scheduling of patients, patient medical record up until

finance reporting and administration of persons.

• Patient meant in this book is someone in need of medical services from the

hospital and has been registered as a person with illness in the hospital

3

medical record system and has the right on the whole health services of

the hospital according to the kind of appropriately received medical

services.

• Facility meant in this book is anything related to Tools, Facilities, or

Devices (either medical or non-medical tools) needed by the hospital in

providing the best services for patients.

• Tool meant in this book is any kind of physical matter which can be

visualized by eyes or sensed by five-senses and easily recognized by

patients and (usually) a part of a building (i.e. entrance / exit doors, floors,

walls, columns, windows) or the building itself.

• Facility or infrastructure meant in this book is the whole thing or a

network/installation which makes the available tools functioned as

purposed. Some examples of facilities i.e.:

1. Clean water installation which has an output of clean water tap.

2. Electrical installation which has an output of lamp spots, power

plug, or its controller in form of electrical switches and fuses.

3. Wastewater installation which has an input from Lavatories /

Toilets / Sink and output in Wastewater Treatment Installation

(IPAL – Instalasi Pengolahan Air Limbah) of the hospital.

4. Medical Gas Installation which has an output of Suction outlet, O2,

Pressured Air in service rooms.

5. Hot Water Installation which has an output of hot water outlet for

Hydrotherapy or Hot Water Tap at the sink.

6. Installation of Telephone / Intercom / LAN which has an output of

telephone / intercom device / computer with online facility.

7. Air Conditioning Installation which has an output of indoor units

or diffuser outlets (for Central AC) to exhaust cool / warm air.

• Devices limited to those related to MR and generally classified into 2

(two) big groups which are:

1. Medical Device (Health Device and Device used by doctors) is one

or more things / tools functioned directly to patients / persons with

4

illness in performing prevention, healing and rehabilitation action

as a form of MR health service from the hospital.

2. Non-Medical Device or Medical Supporting Device is a thing /

tool used to make possible / make easy of providing of MR service

to patients (usually preferred as supporting device and can be seen

in daily use, not only in hospitals) even though not classified as

medical device (health device and device used by doctors).

5

CHAPTER II

PROGRAMS OF FUNCTION AND ROOM

II.1. ORGANIZATION STRUCTURE AND MANPOWER

Mainly organization structure of MR can be described with diagram model of

organization structure as seen in the figure below:

Fig. 1 Diagram Model of Medical Rehabilitation Organization Structure in the Hospital

6

(*) Outside of hospital structure (**) Coordinative & Consultative Relationship (***) Direct Service to Patient(s) (****) Asst. Mgr. / Coordinator / development when it is an Educational Hospital

Board of Heads / Directors of University (*)

Dean / Director of Medical Faculty

(**)

(**)

Head of SMF of Medical Rehabilitation

Medical Hospital Committee

Head (Manager) / Vice Head of Department / Installation / Unit of Medical

Rehabilitation

(**)

(**)

SMF of Medical Rehabilitation

Coordinator / Section Head / Assistant Manager of

Administration – Finance & Persons

Coordinator / Section Head / Asst.

Mgr. of Education and Training (****)

Coordinator / Section Head / Asst. Mgr. of R & D (****)

Coordinator / Section Head / Asst.

Mgr. of Medical Rehabilitation Service (****)

Coordinator / Section Head / Asst. Mgr. of Logistic and

Support (****)

Physiotherapy

Workgroup

Speech-Therapy

Workgroup

Orthetic - Prosthetic Workgroup

Occupational-Therapy Workgroup

Medical Social Worker

Workgroup

Psychology Workgroup

Counter & Medical Record

Internal of Medical

Rehabilitation Workgroup

(***)

Medical Rehabilitation Patient(s) (***)

Hospital Board of Directors

From the example of diagram model of organization structure as seen on Figure 1,

generally Head of MR SMF and Head of Installation / Unit of MR in a Hospital.

Education managed by one person called Head of Department / MR Manager where

MR Service Unit in a Hospital is in the form of a Department and no longer in the

form of Installation / Unit anymore. Organization Structure should comply with the

situation, condition and needs of the Hospital; and when possible, Section Head /

Assistant Manager also act as Head of Occupational Therapy Workgroup Service and

also serves patient as Occupational therapy officer.

In relation with the Organization Structure, to know more the needs of rooms

for Hospital Worker(s)2) (Health Officers, Supporting Officers & Administrative

Officers) in an MR Service Unit reference about “Manpower” which recommended

by Health Department of Indonesia as described in the table on Figure 2 below:

Fig. 2 Table of Public Hospital Rehabilitation Worker Minimum Requirement 3)

PUBLIC HOSPITAL

Manpower Needs CLASS A CLASS B II/B+ CLASS B I/B CLASS C

Sp. RM Doctors 6 4 2 (*)

Psychologist 3 2 1 -

Physiotherapist 15 10 8 1

Speech Therapist 5 3 2 1

Occupational Therapist

(OT) 6 5 3 1

Orthotic Prosthetic 4 3 2 -


(PSM) 3 4 3 1

MR Nurse 15 10 1 -

(*) Med Doctor or Specialist Doctor other than Sp. RM with MR training

Figure 2 above is an ideal needs fulfillment requirement for a Hospital and the

manpower may increase in numbers along with increase of services provided by a

hospital to patient(s). 2) Worker(s) meant here refer to the definition of worker by Indonesian Department of Manpower & Transmigration 3) Directorate of Public Hospital & Education, “MANUAL OF MR IN HOSPITAL CLASS A, B, & C”, 2nd Edition, Health Dept. of Indonesia, Jakarta, 1997

7

II.2. SERVICE FLOW AND ROOM NEEDS

Service flow of patients in an MR Service Unit generally can be modeled as

follows: Fig. 3 MR Patient Service Flow Model (Page 10)

Ambulance

TIn/

PHYSIOTHERAPY

HospitalPatient

Referred Patients

from other Hospitals & CBR

Emergency

Service Unit / Installation

Staying Treatment Installation

MR Internal Registration & Medical

Record Counter

MR Check-Up, Consultation & Assessment

Non-Staying MR Services

OT

ST

OP

PSICHOLOGY

MEDICAL SOCIAL

WORKER

Staying Treatment MRServices

Doctor Referral

Non-Staying reatment stallation Polyclinic
MR Services in SpecialUnits (i.e. Integrated
Cardio Services, Geriatric Services,

Sport Medicine Services)

8

Based on Figure 3, it can be described that Hospital medical rehabilitation service

performed inside and outside of a building / structure / room under authorization of

Department / Installation / Unit of MR (other than services with pick-up pattern e.g.

MR Homecare Services performed by MR Health Officers or Homecare Visit Service

performed by Medical Social Worker (PSM)). In planning and designing needs of

rooms, total number of health officers owned by the MR Department / Installation /

Unit should be considered, especially in designing room for discussion / internal

meeting, Med. Doctor & Paramedic Lounge Room, Locker Room, Bathroom,

Lavatory / Water Closet in order to anticipate ideal room needs when all health

officers under MR Unit attending a meeting or coordination in MR Building. Other

thing which also needs consideration is that Educational Hospital usually owns

Medical Staff Building (MSF) including room for MR Functional Medical Unit

(SMF).

As a basis for planning & design of MR Service Facility, “Room Need” of an

MR Service Unit should be inventoried first in a table model as follows:

Figure 4 Table of MR Room Need

No. Room Name Room Function Room Characteristic

1. Lounge Room for MR Patients

& Their Attendants

As a waiting room for patients and their attendants

before receiving medical treatment

Public, accessible from

hospital corridor

2. MR Registration & Medical

Record Counter

As a re-registration counter for patients previous to

service & also for officers to record the

registration4)

Public, accessible from

hospital corridor

3. Check-Up & Evaluation Room

for Sp. RM

For Sp. RM to perform Check-Up (e.g. Anamnesis,

Physical Check-Up & Assessment), Diagnose,

Prognosis of patients, or a room for patients to do

medical consultation with the Sp. RM doctor.

Private, limited to served

patients & evaluating

doctors.

4) A place for patients to pay for service when the hospital billing service hasn’t support integrated online system

9


4. Psychological Check-Up &

Evaluation Room

Room for Psychologist to perform Check-Up (e.g.

Anamnesis, Physical Check-Up & Assessment),

Diagnose, Prognosis of patients, or a room for

patients to do psychological consultation with the

Psychologist.

Private, limited to served

patients & evaluating

Psychologist.

5. Physiotherapy Room **)

The room which usually large enough and consists

of smaller rooms (Modular rooms for: 1 patient bed

+ Therapy Device + Work Area for Physiotherapist

+ partition walls between rooms) and used to

provide medical service in form of radiation /

electromagnetic wave intervention and traction

Private, limited to patients

who need traction /

radiation / electromagnetic

wave intervention by

removing some clothes.

Outside of the particular

room is Semi-Private.

6. Orthetic & Prosthetic (OP)

Fitting Room

For PwDs or MR Patients who need OP services to

receive Measurement / Fitting & Suiting of their OP

devices.

Private, where usually

PwDs and MR Patients

need privacy when putting

on their OP device.

7.

Individual Speech Therapy

Room with Audiometer

operator **)

For Speech Therapist performs therapy for a

patient individually / personally (only two of them),

usually because the patient needs special

treatment (with Audiometer operator as assistant

therapist)


patients need special

concentration and

attention

8. Classical Speech Therapy

Room *)

For Speech Therapist to perform therapy in Group

for patients (usually more than three patients) for

them to socialize and interact with other PwDs or

MR patients with the similar handicap.

Semi-Private, even

though, people with no

particular business should

stay outside of the room

9a. Individual Occupational

Therapy Room for Adults. *)

For occupational therapist to perform Individual /

Personal Therapy (two persons only), usually

because the patient needs special attention.

Private, where usually the

patient needs special

concentration & attention

9b. Occupational Therapy Room

for Adults. **) (OT Indoor Area)

For occupational therapist to perform Group

Therapy to patients (usually more than 3 patients),

Semi-Private, even


**) The size of the room depends on the number & type of available MR facilities. *) Establishment of the room depends on the needs and abilities of MR services owned by the hospital

10


usually purposed for the patients to socialize and

interact with other patients with similar Handicap.



10. ADL (Activity Daily Living)

Therapy Room **)

For occupational therapist to perform Group or

Individual Therapy in a Room Model which formed

like rooms in a house (e.g.: Kitchen, Bathroom,

Dining R., Guest R., Bedroom), an office (e.g.:

Work R., Workshop R., Studio R.), Praying Room,

Shopping Room up to Vehicle Room Model (e.g.:

Boarding & Seating Place on a Public Bus, Driving

Room on a motorcycle or in a car for PwDs).

Semi-Private, even




11. Individual Occupational

Therapy Room for Children. *)

For occupational therapist to perform Individual /

Personal Therapy (two persons only), usually

because the child patient needs special attention.

Private, where usually the

child patient needs special

concentration & attention

12. Classical Occupational

Therapy Room for Children. *)


Therapy to children patients (usually more than 3

patients), usually purposed for the children patients

to socialize and interact with other patients with

similar Handicap.

Semi-Private, even




13. Integration Censor Room for

Children. *)


Therapy to children patients (usually more than 3

patients), usually purposed for the patients to

socialize and interact with other patients with

similar Handicap.

Semi-Private, even




14. Audio-Visual Relaxation /

Stimulation Room. *)

For occupational therapist to perform audio-visual

stimulation therapy (usually for children) in a closed

room equipped with audio-visual or light emitting

devices (e.g.: Protected Fiber optic Lamp and

Plexiglas Aquarium which able to emit multiple

colored lights), this room is also a relaxation room

for patients.

Semi-Private, even




15. Children & Adults Gymnasium

and MR Community Service **)For MR patients to perform gymnasium activity for

their healing process usually in groups with

Semi-Private, even


11


guidance from MR Therapist for patients of MR or

patients from Integrated Service Units who need

MR Services (e.g.: Gym for Patients from

Integrated Neurology & Neurosurgery Service Unit

or Cardio Patients from Integrated Cardio Service

Unit)



16. Hydrotherapy Room. **)Usually in form of one or more Hydrotherapy

Swimming Pool(s) / Soaking Pond(s) equipped with

Water Heater and Whirlpool System (if any).

Semi-Private, even




17. OP Workshop Room. **)A room where aid & prosthetic devices are being

designed & created for MR Patients.

Private, only OP officers

should be allowed to be in

the room.

18. MR Sports Room. *)

Usually for Athletes who use special Sport

Medicine Devices (usually system from Cybex are

being used in Indonesia) to improve measured

physical ability to achieve a particular performance

target.

Semi-Private, even




19. MR Patients Motor Function

Research & Testing Room. *)

Closed room used for education and research

facility to monitor detailed ability development of

MR patients in a long-shaped room with two

separate room (for object and subject / observer of

research) equipped with observation window,

surveillance cameras, recorder, data processing

computer and special markings on walls, floors,

and ceilings.

Private, where patients

usually will feel a stress

because they think that

they are becoming a

research object even

though the research might

be useful for them.

20. VIP Service Room. *)

A room prepared by the Hospital in MR Service

Unit with better interior design, furniture and

comfort compared to other rooms and equipped

with special accessibility for particular patients.

This room also uses the same medical equipments

as regular rooms, but are being provided

particularly for VIP patients (as long as it doesn’t


patients are willing to

spend extra cost for extra

comfort and privacy

12


interrupt with general MR services)

21.

MR Dept. / Installation / Unit

Manager / Head / Vice Head

Room. **)

For Manager / Head / Vice Head of MR Service

Unit to work. The room should be able to retain 1

office chair + 1 office desk + 2 additional chairs for

unit heads + 1 set of furniture for 5 persons + 1 set

of PC & Printer + bookcase(s) for literature or

archive holder which belong to the Manager / Head

/ Vice Head

Semi-Private, even




22.

Room of MR Workgroup Asst.

Manager / Coordinator /

Section Head / Service Head. **)

For MR Workgroup Asst. Manager / Coordinator /

Section Head / Service Head to perform

administrative duties. The room should be able to

retain 1 office chair + 1 office desk + 1 set of PC &

Printer + archive cabinet

Semi-Private, even




23. MR MD Head Room. *)

For MR SMF Head to work in. The room should be

able to retain 1 office chair + 1 office desk + 2

additional chairs for unit heads + 1 set of furniture

for 5 persons + 1 set of PC & Printer + bookcase(s)

for literature or archive holder which belong to the

SMF Head. Good hospitals usually preserve a

particular building for this room.

Semi-Private, even




24. MR MD Discussion Room. *)MR MD & Therapist Lounge Room before or after

treatment of patients.

Semi-Private, even




25. MR Meeting Room. *)

Internal meeting room for MR Department /

Installation / Unit to discuss about internal

problems related to MR Services in the hospital.

Semi-Private, even




26.

MR Administration, Finance &

Personal Administration Work

Room. **)

For Hospital Officials who deal with administration,

finance and personal administration to perform

their duties

Semi-Private, even




13


27. MR Treatment Room. *)Treatment room for staying MR patients, usually

integrated with other treatment room or a building

under control of Treatment Dept. / Installation / Unit

Semi-Private, even




28. MR Medical Devices

Warehouse. **)For storage of unused or not yet used MR Devices

Service (Non Medical),

with specific access.

29. Room of OP Raw Material &

Tools. **)For storage of raw material or not yet used tools in

OP Workshop.



30. MR Pharmacy & Linen

Warehouse. *)

For storage of clean Linen (e.g.: towels, curtains &

sheets) and also pharmaceutical supplies for

therapy (e.g.: paraffin, alcohol, cotton, tissue, gel).



31. MR Waste Warehouse. *)

For storage of no longer used MR stuff but could

be eliminated immediately. This room should be

separated from other rooms and faced directly

outside of the building complex.



32. Locker Room for Male Hospital

Workers. **)

A room for changing wardrobe and to keep

personal things which are not needed when

providing service for male.

Semi-Private, even




33. Locker Room for Female

Hospital Workers. **)



providing service for female.

Semi-Private, even




34. Locker Room for OP

Workshop Workers. *)



providing service for OP Workshop workers.

Semi-Private, even




35. Locker Room for Male

Patients. *)



receiving service for male patients.

Semi-Private, even



14



36. Locker Room for Female

Patients. *)



receiving service for female patients.

Semi-Private, even




37. Locker Room for Hydrotherapy

Patients. **)



receiving service for hydrotherapy patients.

Semi-Private, even




38. Bathroom/Lavatory for Male

Hospital Workers. **)Bathroom / Lavatory for Male Hospital Workers.

Usually located near the locker room.



39. Bathroom/Lavatory for Female

Hospital Workers. **)Bathroom / Lavatory for Female Hospital Workers.

Usually located near the locker room.



40. Bathroom/Lavatory for OP

Workshop Workers. *)Bathroom / Lavatory for OP Workshop Workers.



41. Bathroom/Lavatory for Waiting

Room. **)Bathroom / Lavatory for patients and patient

attendants who wait for service in the waiting room.

Public Service (Non

Medical), with easy

access.

42. Bathroom/Lavatory for Male

(MR Therapy Area). **)

Bathroom / Lavatory for male patients who are

currently receiving treatment in an MR

room/building.

Public Service (Non

Medical), with easy

access.

43. Bathroom/Lavatory for Female

(MR Therapy Area). **)

Bathroom / Lavatory for female patients who are

currently receiving treatment in an MR

room/building.

Public Service (Non

Medical), with easy

access.

44. Hand washing / scrubbing area

for Waiting Room. **)Hand-washing / scrubbing area for anyone about to

enter MR service room.

Public Service (Non

Medical), with easy

access.

45. Hand washing / scrubbing area Hand-washing / scrubbing area for anyone in the Public Service (Non

15


for MR Therapy Area. **) Therapy Area, usually in a room/connecting

corridor between rooms (Foyer) of MR service

building/room.

Medical), with easy

access.

46. Pantry & Small Dining Room. **)

A room for performing kitchen activities (e.g.:

Warming, Pouring, Food Preparation) for (usually)

Hospital Workers and to eat snacks and drink,

equipped with dining chairs and tables.

Service (Non Medical)

Semi Private with limited

access for Hospital

Workers in MR Unit.

47. Janitor / Cleaning Service

Room. **)A room for cleaning service officers to prepare their

tools; keep cleaning materials; and clean the tools.


with limited access.

48. MR Park or OT Outdoor Area. *)

An area (usually near MR facility) of a park / green

open area which also used as OT Practice Area

consisted of Walking Track(s) which equipped with

Therapy Facility Devices (e.g.: Parallel Bars) and

Multidimensional Layers i.e.: gravel, cements,

sands & ceramic tiles to provide different

stimulation for feet; and also consisted of ramps for

wheelchair users & walker which can be used by

MR patients and PwDs to improve their

performances to adapt with the nature and their

daily lives.

Public, easy to be

accessed by anyone. But

MR patients and PwDs

are prioritized.

49. MR Fitness Room. *)

Hospital Fitness Room which located in MR Unit in

collaboration with Faculty of Sport Medicine for

Hospital users and workers to understand and use

MR Facility even in a good health shape.

Public, easy to be

accessed by anyone. But

Hospital users and

workers are prioritized.

50. MR Utility Room. *)

MR building service rooms e.g.: Panel R., IPAL R.,

Medical Gas R., Pump R., AHU R., other Engine R.

including Shaft and Lift Area, Ramp and Stairs to

support MR Health Service Activities.


with limited access for

hospital users and

workers on duty.

51. MR OT Diagnostic Room. *)The development of MR Function where BERA,

EMG, EEG and Sleep Lab diagnostic are being

performed for OT or Psychology patients in needs.

Private, patients

diagnosed really need

some quietness.

16

Room Need as described in Fig. 4 depends on Resources (usually Human Resources,

Finance Ability or Land Availability for MR) owned by a particular hospital. Other

factors which need to be considered are frequency of use and number of patients.

II.3. ACTIVITY CIRCULATION FLOW

Activity Circulation in an MR Service Unit can be described in the following

model of activity circulation:

Figure 5. Model of Hospital Workers, Patients and Goods Circulation Flow

17

Patients (Policlinic, Overnight, Referral (MD, Other

Hospital, RBM))

Sp. RM Doctor / MD

with MR Certificate

MR

Psychologist

MR / PSM Therapist / Paramedic

Supporting Officers (Administration, Finance,

Personal, Medical Record, Technical)

Linen, Used Materials &

OP Raw Materials

OP Officers

MR Registration & Internal Medical Record Counter

Locker Room of MR Unit Hospital Workers

MR Waiting Room

Sp. RM Doctor Check-Up & Assessment

Room

Psychologist Check-Up & Assessment

Room

Admin, Personnel, Finance & Logistic

Room

Logistic Inventory Record

OP Workshop

Locker Room**)

OP Workshop **)

Logistic Warehouse

Locker Room for Patients Gymnasium &

Public Campaign Place

Physio-therapy &

Hydro-therapy Services

OP Services (Measurement,

Fitting, Adjustment &

Training)

OT Services


Services

Speech Therapy Services

Hazardous

Waste

Hospital Incinerator

Laundry + Sterilization Room General Waste Hospital TWD *)

MR SERVICES

Patient Circulation Flow

Hospital Worker Circulation Flow

Goods Circulation Flow

Beginning of Circulation

Connecting Dot

MR Service Area

*) TWD: Temporary Waste Disposal **) If possible, this facility should not be directly connected with MR Service Area even if at the same building.

According to Fig. 5 can be described from the model that at least 1 (one)

circulation of goods (used up materials, clean linen and raw materials for OP

workshop) and 3 (three) human circulations for Hospital Patients, Hospital Workers

who work in MR Service Room and OP Workshop.

OP Workers circulation is being separated with MR Service Room Area in

order to avoid the dust and dirt from OP Workshop to enter MR Service Room and

disturb the patients. Even though, planning and design of rooms which make possible

of connection between OP Workshop and MR Service Room Area by making the

Measurement, Fitting & Adjustment Room of OP easily accessible with Waiting

Room Area of MR Patients and MR Service Room.

In circulation of goods, after the goods are being inventoried, it will be stored

in logistic warehouses (Linen, Pharmacy, Medical Equipment of MR, and Raw

Material of OP Warehouses), and distributed according to the needs of MR

Workgroups.

The results of the use of materials consist of two types i.e. recyclable /

reusable materials and waste from services. The waste will be distributed according to

its condition, whether or not it’s hazardous (including sharp hazardous waste i.e. non-

reusable needle) and non-hazardous / public waste.

Activity flow as shown in Fig. 5 is a model of proposal but in reality it will

depend on the building / room & the size of the land provided by the Hospital for MR

Service Unit.

18

CHAPTER – III MEDICAL REHABILITIATION

FACILITY REQUIREMENT

III.1. MR TOOLS FACILITY REQUIREMENT

III.1.1. MR Tools Room Size Requirement

As described in Fig. 4 “Table of MR Room Needs” in Chapter II; the size of a

room should be based on service capacity which will be given to MR patients or the

number of MR Health Worker who will use a particular room. Based on room

function consideration and health service capacity, room size requirement can be seen

in the following table:

No Room Name Room Size Needs Minimum Ideal Unit

1 Waiting Room for MR patients and attendants

Assuming that 1 patient is being attended by 1 attendant. 1 seat = 0.75 m2

Circulation / seat = 1.5 m2

Total need per patient = 3 m2

Minimum for 5 patients = 5 x 3 m2 = 15 m2

9 (assuming that not all patients are being attended)

15 m2 / 5 patients (with 5 attendants)

2 MR Registration & Medical Record Counter

1 worksite = 2.4 m2

1 archive cabinet = 2.16 m2

Activity Circulation = 60% x (2.4 + 2.16) m2

= 2.736 m2

Total need for 1 officer = 2.4 + 2.16 + 2.736 = 7.296 m2

4 (Archive cabinet can be used collectively)

8 m2 / Counter Officer

3 Sp. RM Doctor Check-Up & Assessment Room

1 worksite = 2.4 m2

2 face-to-face chairs for patient & doctor = 1.8 m2

1 bed for patient = 4.4 m2 1 cabinet for doctor = 2.16 m2

Activity Circulation = 60% x (2.4 + 1.8 + 4.4 + 2.16) m2 = 6.456 m2

Total = (2.4 + 1.8 + 4.4 + 2.16 + 6.456) = 17.216 m2

9 (Some furniture used collectively)

18 m2 / doctor

4 Psychologist Check-Up & Assessment Room

1 worksite = 2.4 m2

2 face-to-face chairs for patient & doctor = 1.8 m2

1 cabinet for doctor = 2.16 m2

Activity Circulation = 60% x (2.4 + 1.8 + 2.16) m2 = 3.816 m2

Total = (2.4 + 1.8 + 4.4 + 2.16 + 6.456) = 10.176 m2

5 (Some furniture used collectively)

12 m2 / psychologist

5 Physiotherapy Room 1 bed + therapy device + work area for therapist = 4.4 m2 Activity circulation = 60% x 4.4 m2 2.64 m =Total needs = 7.04 m

2

2 x 6 devices = 42.24 m2

6 devices: SW (Short Wave), MW (Micro Wave), Ultrasound, Radiant Therapy, Liquid Paraffin (with Paraffin Bath), Traction.

12 (assuming that some bed modules are holding 2 devices only)

45 m2 / 6 Service Devices for patient

Figure 13. Table of MR Room Size Requirement

19


6 OP Measurement, Fitting & Adjustment Room*)

1 working desk = 2.4 m2

Changing / fitting room = 2.4 m2

Cabinet for Working Tools & Components = 2.16 m2

Activity Circulation = (2.4 + 2.4 + 2.16) x 60% = 4.176 m2

Total Needs = (2.4 + 2.4 + 2.16 + 4.176) = 11.136 m2

4 (some furniture are not procured)

12 m2 / service of OP patient

7 Audio-tight Individual Speech Therapy Room with Audiometer Operator*)

1 worksite for therapist = 1.8 m2

1 therapy area for patient = 1.8 m2

Audiometer Operation = 4.0 m2

Activity Circulation = (1.8 + 1.8 + 4.0) x 60% = 4.56 m2

Total = 12.16 m2

12 (some areas are being shrunk to as small as possible)

15 m2 / service of Speech Therapy Patient

8 Classical Speech Therapy Room*)

Minimum for 5 (five) patients which will attend group therapy Total = 5.76 m2 x 5 = 28.8 m2

Usually 1 assistant will assists 1-3 patients


30 m2 / Group of 5 patients

9a Individual OT Room for Adults

*)Therapist work area & patient therapy area = 4.4 m2

OT tools cabinet = 2.16 m2

Activity Circulation = (4.4 + 2.16) x 60% = 3.936 m2

Total = 10.496 m2


12 m2 / service of OT Patient

9b OT Practice Room for Adults Average need for OT patient = 3 m2

Activity Circulation = 60% x 3 = 1.8 m2

Total = 4.8 x 20 devices = 96 m2

50 (some modules hold more than one OT devices)

100 m2 / 20 OT service devices

10 ADL Therapy Room*) Aid Device Module Aid Device Practice Room = 4-16 m2

Living Area Module a. Kitchen and Dining Room = 4-20 m2 b. Bedroom, Living room, Lounge = 9-25

m2 c. Toilet, Bathroom & Laundry = 4-20 m2

Worksite Module a. Office = 4-12 m2 b. Workshop = 4-25 m2

Socialization Module a. Praying Room & Facilities = 4-9 m2 b. Public Transport Mock-Up = 4-25 m2 c. Cashier & Public Service Counter Mock-

Up = 4-16 m2

9 (depend on ability and resources of MR Services)

100 m2 / or the whole ADL Service

11 Individual OT Room for Children*)

1 worksite for therapist = 1.8 m2

1 therapy area for patient = 1.8 m2

Activity Circulation = 60% x (1.8 + 1.8) = 2.16 m2

Total = 5.76 m2


6 m2 (OT Service for patient)

12 Classical OT Room for Children*)

Minimum for 3 patients who will attend group therapy Total need = 5.76 x 3 = 17.28 m2

Usually 1 assistant will assists 1-3 patients

9 (assuming that not all patients are being attended)

30 m2 / 3 patients

13 Integration & Censor (IC) Room for Children*)

Area for large toys = 4-10 m2

Total = 10 x 10 toys = 100 m2

Large Toys e.g.: Swing, Footbridge, Trampoline, Special Sitting Bench (all of it are being covered with protection seal to prevent injuries)

16 (assuming that not all toys owned by hospital)

100 m2 / IC Service

14 Audio Visual Relaxation / Stimulation Room (Snelling

Space for every device including small toys = 2.25-6.25 m2

9 (minimum distance from TV

45 m2 / Snelling Room Service

*) Establishment of the room depends on the needs and available resources of the hospital

20


Room) Total = 6.25 x 7 devices = 43.75 m2

Small Toys e.g.: Multiple Colors Fiber optic Cables, Multi-display Colors Aquarium (with Bubble Compressor & Artificial Environment e.g. plastic fishes), Multi-Colored Switch Board Buttons with Multiple-Colors Display Lamp, Multiple-Colors Projection Lamps & AV System (TV + DVD + Audio) with Elastic Bumpy Ball.

is 3 x diagonal size of TV screen)

15 MR Gymnasium and Community Service Room

Space for someone to stretch arms forward in standing position 8) = 1.45 m Mattress length for lying down position 8) = 2.0 m Space for someone to stretch arms sideward in lying down position8) = 1.75 m

.: Space per person = 2.0 x 1.75 = 3.5 m2

Activity Circulation = 60% x 3.5 m2 = 2.1 m2

Total per person = 5.6 m2

Area prepared for minimum of 12 participants + 1 instructor / group = 5.6 x 13 = 72.8 m2

40 (assuming that activity circulation done before or after gym)

80 m2 / 10 gym participants (or 20 MR Community Service Participants)

16 Hydrotherapy Room *) Usually Modular Hydro bath Therapy Butterfly Bath shaped: 3.0 x 2.5 = 7.5 m2

Regular Swimming Pool with Whirpool & Water Heater = 5 x 7 = 35 m2

Activity Circulation = 60% x 35 = 21 m2

Total = 56 m2

20 (Butterfly Bath excluding Locker Room & Shower Room)

60 (excluding Locker Room & Shower Room)

m2 / hydrotherapy service (swimming pool for 2-6 patients)

17 OP Workshop Room*) Worksite for Gyps Positive Molding = 3 m2 / worker Worksite for Metal Work = 2.25 m2 / device (Usually 5 devices i.e. Cutting, Bending, Metal & Leather Drilling, Welding, and Lathe devices) Worksite for Leather Work = 3 m2 / worker Worksite for Positive Modeling = 3 m2 / worker Oven Worksite = 3.75 m2

Polymer / Resin Molding Worksite = 3 m2 / workerWorksite for Wooden Prosthetic Work = 3 m2 / worker Cabinet for tools, models, materials, mold = 4.32 m2

Activity circulation = 20.592 m2

Total = 54.912 m2

20 (not all of services are available)

60 (excluding warehouse and toilet)

m2 / OP workshop service

18 MR Sport Medicine Room Space for PC operator desk – device diagnostic = 2.4 m2

Space for devices = 9 m2

Activity Circulation = 6.84 m2

Total = 86.4 m2


90 m2 / MR Sport Medicine Room

19 Body Motor Function Research & Testing Room

Space for Patient Practice & Therapy Path = 30 m2

Observation, Picture Recording & Editing Room = 24 m2


Total = 86.4 m2


90 m2 / MR Sport Medicine Room

20 VIP Service Room Similar to Physiotherapy room (2-4 rooms) = 4 rooms x 4.4 m2 = 17.6 m2

Couch = 9 m2

VIP Counter = 4.5 m2


Total = 49.76 m2`

20 (some areas are being shrunk and only 2 service rooms provided)

50 m2 / MR VIP service

21 Head / Vice Head / Manager of Department / Installation /

Space for work per person = 3.6 m2

1 bookcase = 2.16 m220 (some areas are being shrunk

30 m2 / person

8) E. Neufert (Tranlated by Sjamsu Amri), “DATA ARSITEK”, Erlangga Publishing, Jakarta, 1987.

21


Unit of MR Couch = 9 m2

Space for personal secretary = 3 m2


Total = 28.4 m2

to as small as possible)

22 Room for Asst. Manager / Coordinator / Section Head / Service Head / Workgroup Coordinator of Dept./Installation/Unit of MR

Workspace per person = 3 m2

1 bookcase = 2.16 m2


Total = 9.04 m2

Couch + its circulation area (collectively used) = 9 x 160 % = 14.4 m2


12 m2 / official

23 Room for MR Functional Medical Staff (FMS) Head*)

Workspace per person = 3.2 m2


Space for personal secretary = 3 m2


Total = 14.01 m2


16 m2 / official

24 MR FMS Discussion Room*) Space for 6 persons = 11.84 m2



Total = 22.4 m2


24 m2 / 6 discussion participants

25 MR Meeting Room Space / person = 0.625 x 0.875 = 0.54 m2


Total / person = 0.86 m2

Class A Hospital: 57 persons x 0.86 = 49.02 m2

Class B-II / B+: 41 persons x 0.86 = 35.25 m2

Class B-I / B: 22 persons x 0.86 = 18.92 m2

Class C: 4 x 0.86 = 3.44 m2

Space for Projector & Cabinet = 2.4 x 4.0 x 160% = 15.36 m2

Class A: 50x2/3 ≈ 35 Class B-II: 36x2/3 ≈ 24 Class B-I: 19x2/3 ≈ 16 Class C: 4x2/3 ≈ 9

Class A: 50+16=66 Class B-II: 36+16=52 Class B-I: 19+16=35 Class C: 4+16=20

m2 / Hospital

26 Room for MR Administration, Finance & Personnel

Work space / person = 2.4 m2

1 Archive Cabinet = 2.16 m2


Total / person = 7.296 m2

4 (some areas are being shrunk)

9 m2 / worker

27 MR Treatment Room*) 1 bed for patient = 4.4 m2

Cabinet for patient = 0.6 m2

Activity Circulation = 3 m2

Total needs per bed = 7.4 m2

MR Patient Toilet/Bathroom8) = 5.67 m2

Total for 4 patients / room = 35.27 m2


36 m2 / 4 patients

28 MR Medical Equipment Warehouse*)

1 storage cabinet = 2.16 m2

Cabinet activity circulation = 1.29 m2

Space for 1 cabinet = 3.45 m2

Space for 4 cabinets = 13.8 m2

9 (only 2 cabinets)

15 m2 / warehouse unit

29 OP Raw Material & Tools Warehouse*)





9 (only 2 cabinets)


30 MR Pharmacy & Linen Warehouse*)





9 (only 2 cabinets)


31 MR Waste Warehouse*) 1 storage cabinet = 2.16 m2




9 (only 2 cabinets)


32 Male Worker Locker Room 1 locker = 0.96 m2


10 lockers + activity circulation = 6.6 m2

Changing Room = 1.5 m2


9 m2 / worker

22


Total = 8.1 m2

33 Female Worker Locker Room

1 locker = 0.96 m2




Total = 8.1 m2


9 m2 / worker

34 OP Worker Locker Room*) 1 locker = 0.96 m2




Total = 8.1 m2


9 m2 / worker

35 Male Patient Locker Room*) 1 locker = 0.96 m2




Total = 8.1 m2


9 m2 / patient

36 Female Patient Locker Room*)

1 locker = 0.96 m2




Total = 8.1 m2


9 m2 / patient

37 Hydrotherapy Patient Locker Room

1 locker = 0.96 m2




Total = 8.1 m2


9 m2 / patient

38 Male Worker Toilet/Bathroom

Space for Toilet & Bathroom8) = 2x1.35 = 2.7 m2 2.7 3 m2 / toilet unit

39 Female Worker Toilet/Bathroom


40 OP Worker Toilet/Bathroom*)


41 Waiting Room Toilet/Bathroom

Space for Toilet & Bathroom8) = 2.1x2.7 = 5.67 m2 5.67 9 m2 / toilet unit

42 Male Toilet/Bathroom (MR Therapy Area) *)


43 Female Toilet/Bathroom (MR Therapy Area) *)


44 Washing Room Area for Waiting Room

Washing vessel 8) = 0.76 x 1.52 = 1.14 m2

Activity Circulation = 1.14 x 60% = 0.68 m2

Total = 1.82 m2

1.82 3 m2 / unit

45 Washing Room Area for MR Therapy Area

Washing vessel 8) = 0.76 x 1.52 = 1.14 m2

Activity Circulation = 1.14 x 60% = 0.68 m2

Total = 1.82 m2

1.82 3 m2 / unit

46 Pantry & Small Dining Room Space for stoves 8) = 1.67 m2

Space for sink 8) = 1.43 m2

Space for Refrigerator = 1.78 m2

Space for storage cabinet = 2.2 m2

Total = 7.08 m2

6 9 m2 / unit

47 Janitor / Cleaning Service Room

Washing Area 8) = 1.9 m2

Cabinet Storage for Cleaning Tools8) = 1.8 m2


Total = 5.62 m2

4 6 m2 / unit

23


48 OT Outdoor Area*) Green Area space / patient = 9-15 m2

For 100 patients = 15x100 = 1500 m2

Toilet/Bathroom (1 per 2000 m2) 8) = 2.7 m2

1 Open Space Therapy Device = 4.4 m2

For 10 devices = 44 m2

Total = 1544 m2

950 1600 m2 / 100 patients (with 10 outdoor therapy devices)

49 MR Fitness Room*) Space for 1 OT equipment = 3 m2

For 10 equipments = 30 m2

Accessible Changing Room8) = 2.25 m2

Space for Fitness Room Storage Cabinet / Module = 0.4 x 2 = 0.8 m2

Accessible Toilet8) = 2.85 m2

Accessible Bathroom8) = 2.85 m2


Total for 10 equipments, Changing R., 30 Lockers, 1 Bathroom, 1 Toilet = 73.52 m2

25 75 m2 / Fitness Room for 10 – 30 users

50 MR Utility Room*) Space for AHU (Air Handling Unit) for Central Air Conditioner = 9 m2

Electrical MDP (Main Distribution Panel) = 2.52 m2

Communication & Medical Gas Control Panel = 1.62 m2


Total = 35.52 m2

24 36 m2 / 1000 m2 or less of MR floor width

51 MR OT Diagnostic Devices Room

Space for OT Diagnostic Check-Up = 4.4 m2

Washing Vessel 8) = 1.14 m2

Computer Desk for BERA,EMG,EEG & Sleep Lab = 2.16 m2

Cabinet for OT Diagnostic Materials & Tools Storage = 2.16 m2


Total = 15.68 m2

9 16 m2 / MR OT Diagnostic Unit

III.2.2. Technical Requirement of MR Tools Components

III.2.2.1. Cover of MR Floor

MR floor covering materials usually have the same technical requirements as

other rooms i.e.:

1. Not made from materials which have a surface of high porosity (will tend

to hold hazardous dust)

2. Easy to clean and can stand from friction (especially from wheels of

patient stretcher, bed, wheelchair, food trolley, linen trolley, logistic

trolley, garbage trolley)

3. Bright colored but not glowing (shiny).

4. Floor pattern should be able to be followed by patients with low vision.

5. For areas with more than 100 of slope, beside easily visible floor pattern,

the floor should have non-slippery covers (even in wet condition).

24

6. For areas which will easily be affected by water should have non-slippery

covering when soaked with water. (e.g. hydrotherapy room, bathroom &

toilet)

7. Particularly for OP warehouse, the floor should be resistant to fire,

chemical substances, and collisions/bumps.

8. Particularly for Speech Therapy Room, the floor should be voice-proof

and doesn’t make any noise when stepped on.

III.2.2.2. MR Wall Component

Like other hospital facility wall component, MR wall component has the

following requirements:

1. Easy to clean, weather-proof, and fungus-free.

2. Wall finishing overlay should be non-porous for it to be free from

hazardous dust.

3. Wall color should be bright but not glowing (shiny) – usually called as

pastel colors – especially for rooms which connected to children activity.

Eye catching colors like bright red, bright yellow, bright blue, bright

orange and bright green are suitable to stimulate children.

4. In MR Areas, the entire walls should have Wall Railings with around 80-

100 cm in height from the surface of the floor. The railings should be able

to cope with a person weighing in at ± 75 kg holding on to the railings

with one hand. The railing material should be fire-resistant, easy to clean

and non-porous. Particularly for OP warehouse, the wall should be

resistant to fire, chemical substances, and collisions/bumps; while at

Physiotherapy areas especially around devices which use Electromagnetic

(EM) Wave e.g. Short Wave (SW) and Micro Wave (MW) Diathermy the

wall material shouldn’t be using metal or steel material. In Speech

Therapy Areas the wall should use Voice-proof covering which absorb

voices and echo-less.

25

III.2.2.3. MR Facility Opening Components

Opening components in MR facility (e.g. doors, windows and its frames) as

well as in other hospital facilities have the following requirements:

1. The free range of door opening in MR facility should not be less than 100

cm for single door or 120 cm for double door.

2. Door Handle height in MR facility should not be lower than 100 cm

measured from the lowest floor level.

3. Mechanical Door Closer should not be used in MR facility because it will

cause difficulties for patients especially when no attendant is around.

4. Automatic / Motorized Door Closer may be used if the opening-closing

censor installed 20 cm above the ground (can detect something with 20 cm

of height e.g. footstep of wheelchair) either from outside or inside of

room.

5. For doors which directly connected with outside of the building the door

should be able to be opened outwards or in both directions.

6. Opening Components located at OT workshop or areas with possibility of

fire spark to arise should be fire-resistant.

7. Opening Components located at Speech Therapy Rooms should be made

from sound-absorbing materials, echo-less and resonance-less.

8. Opening Components located at areas which directly affected by water i.e.

Hydrotherapy Room, Bathroom and Toilet should be made from water

resistant and water proof materials.

9. If opening components use keys, it should be able to be opened from both

sides.

10. Opening components made from transparent materials (e.g. glass) should

be equipped with protector (e.g. covered with steel screen), and if it

shattered, the fragments should be in form of small blunt grain

(Unsharpened Tempered Glass With Safety Mesh Inside) and provided

with clear opening direction sign (e.g. PULL/PUSH) using fluorescent

materials and big enough to be clearly read (letter height is around 10-20

cm and width of around 2/3 to 3/5 of its height). The sign should be put at

26

around 100-120 cm above the floor for it to be accessible for everyone

including wheelchair users.

11. For emergency doors in MR facility; the opening handlebar should be

accessible for everyone including wheelchair users with the height at

around 80-100 cm above the floor.

III.3. REQUIREMENT OF MEDICAL REHABILITATION FACILITY

EQUIPMENT

III.3.1. Requirement of Lighting and Electricity Equipment

Electrical Requirement in MR Unit is related to available Electrical Power in

the hospital.

III.3.1.1. Requirement of MR Electricity Network

This line of equipment stretched from Hospital Main Relay Station to

Electrical Plug for every electrical device in MR Service Rooms. Basically,

arrangement of Electrical Panel in an MR Building can be modeled as

follows: Fig. 14 Diagram Model of Electrical Panel in MR Building (Page 32 – The diagram is not clear enough)

The above diagram shows an Electrical Control Panel in a Room or Floor of

MR Service Area:

Fig. 15 Diagram Model of Electrical Panel in MR Room / Floor (Page 32 – The

diagram is not clear enough)

As seen in Fig. 14, some rooms in MR Service Area proposed to have Back-

Up Source Line (JSC – Jalur Sumber Cadangan) from Hospital Generator Set

i.e. for Physiotherapy, Hydrotherapy, Audiometer, OT-MR Diagnostic Room

(for EEG,EMG,BERA-Test, etc.) and MR Sport Medicine Room (usually

using products from Cybex). The other rooms aren’t prioritized to have JSC

27

except for some lights in circulation corridors and some service rooms (as

emergency lighting in emergency circulation situation).

From Fig. 14 & 15 can also be seen installation of KWh Meter, Voltmeter and

Ampere meter equipped with Pilot Lamps, merely to make power using

control easier (for efficiency and effectiveness of resources).

The Building Panel as shown on Fig. 14 should follow Electrical Installation

General Rules (PUIL – Peraturan Umum Instalasi Listrik) where some

devices in MR Rooms are directly connected to electrical plug which

minimum classification of 1-E according to PUIL. The requirements are:

1. Protection system on power down because of electrical short-circuit,

isolation disturbance, or other usual disturbance should not endanger

officers on duty and/or patients.9)

2. The switch mechanism between electrical Main Source Line (JSU – Jalur

Sumber Utama) and Back-Up Source Line (JSC – Jalur Sumber

Cadangan) should take no more than 10 seconds for automatic line-switch

or 3 minutes for manual line-switch. Therapy to MR patients allowed to be

delayed and restarted again after the power has been restored, and should

not endanger the safety of officials and patients.

3. Electrical Network in class 1-E rooms advised to improve the electrical

distribution protection mechanism, where if at least 0.5 mA of electrical

current flows directly through human body as a direct leak current or

body-contact leak current, the network system should automatically

protects the person, which will cause Electrical Shock or even death.

Another requirement which expected to be applied in Medical Rehabilitation Unit

i.e.:

1. Electrical resistance of the main grounding line should not exceed 5 Ω,

while at electrical plugs of devices; it should not exceed 0.2 Ω.

9) Article 3.1.2., Article 3.7.1.1. and Article 3.7.1.2. of PUIL 200, Jakarta, Indonesia.

28

2. The capacity of installed cables and panels are at least 150% of installed

power planned in MR or at the floor and room of MR Service.

3. The panels should be equipped with enough protection and warning signs

(e.g.: WARNING – RISK OF ELECTRICAL SHOCK, etc.) using

fluorescent materials or at least light reflecting materials.

4. Electrical Panels should have emergency lighting with rechargeable

emergency light put at the outside compartment of the panels.

5. Handle Bar of electrical panels should not be easily reached by children

(150-175 cm above the floor).

6. Electrical Panel of MR Room / Floor should not be located inside the

room / floor.

7. Case of electrical plug of devices in Physiotherapy rooms should be made

from non-metal materials.

8. Electrical Plug in Hydrotherapy Service rooms should be made from

waterproof and water-resistant materials.

9. Electrical plugs in MR rooms should be protected when not in use.

10. Lighting switch and electrical plug should be installed at the height which

will be easily accessed by wheelchair users of around 80-100 cm above

the floor (non-MR rooms are 140 cm).

11. Lighting switch of MR rooms should be able to be accessed / operated

either from outside or inside of the room, equipped with operating

direction (letter height is around 2-4 mm), and if possible a pilot lamp

which indicate the status of the switch (on/off).

12. Electrical Plug should be equipped with protection fuse (either a

mechanical thermal fuse or miniature circuit breaker (MCB)), and pilot

lamp which indicate the status of the plug (powered/not); if financial

situation of the hospital allowed.

The electrical network requirement above could be fulfilled either step by step

or altogether which depend on the capability of each hospital, either its

resources, general hospital management, or MR Service management in

29

preparing and developing its human resources in fulfilling a Standard

Operation Procedure (SOP) or Permanent Procedure (ProTap – Prosedur

Tetap).

III.3.1.2. Lighting Requirement in MR Unit

MR Lighting should follow requirement stated in the book of “PEDOMAN

PENCAHAYAAN DI RUMAH SAKIT”, Direktorat Instalasi Medik, Ditjen

Pelayanan Medik, Depkes RI of 1992 (HOSPITAL LIGHTING MANUAL of

Medical Installation Directorate of Directorate General of Medical Services,

Indonesian Health Department, 1992) especially in page 37, as seen from the

table below:

Fig. 16, Table of Medical Rehabilitation Lighting Category

No Room Name Activity Lighting Category

Minimum Lux (Lumen/m2)

Ideal Lux (Lumen/m2)

1 Administration Read, Write, Type & Line D 200 500

2 Doctor/Psychologist Read, Write, Examine, Consult C 100 200

3 Staff Read, Write, Examine, Consult C 100 200

4 Locker Store & Change clothes C 100 200

5 Waiting Room Waiting room C 100 200

6 Gymnasium Gym for patients D 200 500

7 Treatment Room Patient treatment & therapy D 200 500

8 Exam Rom Patent examination & training D 200 500

9 Physical & Vocational Therapy & Training E 500 1000

10 Exercise Treatment & Training D 200 500

11 Hydrotherapy Training D 200 500

12 Bathroom/Toilet/Shower Non-Medical service C 100 200

13 Pump Room/ME/Utility Non-Medical service B 50 100

14 Physiotherapy Room Treatment D 200 500

15 Accident Rehabilitation Treatment C 100 200

If we take a look at Fig. 4 (MR Room Need – Chapter II) and Fig 13 (MR

Room Size Requirement – Chapter III), some rooms which haven’t been listed

in the table of Fig. 16 above can be determined its similarity according to the

function of each room in present or in the future. These tables below will help

us to calculate the average power needed for MR rooms according to lighting

category:

30

Fig. 17, Table of Light Source11)

No Light Source Lumen / Watt

Average Last (Hour) Use

1 Regular Bulb 11 – 18 1000 Indoor & Outdoor

2 Tube Lamp (with IC Ballast) 50 – 60 900 – 1800 Indoor & Outdoor

3 Halogen 16 – 20 1000 Outdoor (Sport Court)

4 Mercury (IC Ballast) 30 – 60 16000 Outdoor (Park & Side road)

5 Meta Halide 80 – 100 7500 – 15000 Outdoor (Spotlight)

6 Sodium 120 – 140 16000 – 24000 Outdoor (Side road)

We can also calculate Light Loss Factor (LLF) caused by the use of light

cover or the type of lighting system as seen from the table below:

Fig. 18, Table of Lighting System Type11)

No Type of Lighting System LLF (%) 1 Direct Lighting 90 – 100

2 Semi-direct Lighting 80

3 Combination of Direct & Indirect Lighting 40 – 60

4 Semi Indirect Lighting 60 – 90

5 Indirect Lighting 60

Wall and ceiling colors and light location will also affect lighting system

effectiveness (Coefficient of Utilization (CU)), where for the white colored

wall and ceiling and 200 – 250 cm of distance between the light and the work

area, the CU is 50 – 65 % 11) (the higher the distance and the darker the colors,

the lower the CU rate). To make the calculation easier, example model of

needs per 100 Lux for a room is used as seen in the case example below:

Case: An MR Service Room needs 100 Lux of lighting. The room dimension is 10 m (L) x 10 m (W) x 2.8 m (H). Wall and ceiling use bright white paint, dark clouded in the afternoon and using 40W of TL with 75 Lumen/Watt (data taken from the lamp’s brochure) using a 10W Ballast and power plug with Fk = 20%. Question:

1. How many lights needed to light the entire room? 2. What is the total power needed?

11) Poerbo, Hartono, “UTILITAS BANGUNAN” (Building Utility), Djambatan Publisher, Jakarta, 2002

31

3. How many watt/m2 are needed to light the room with 100 Lux of luminance? Answer: Q = 75 Lumen / Watt x 40 Watt = 3000 Lumen CU = 60% = 0.6 LLF = 80% = 0.8 A = 10 x 10 = 100 m2

E = 100 Lux (Lumen/m2) Plamp = 40W Pballast = 10W Fk = 20%

22.4100420

420%120507)%100()(

794.6144010000

8.06.03000100100

−===∴

==++=∴

≈====∴

WmE

PP

WxxFkxPPnxPxx

xQxCUxLLF

ExAn

totA

ballastlamptot

Q : Lighting strength / light CU : Coefficient of Utility LLF : Light Loss Factor A : Work Area E : Expected Lighting Strength Ptot : Total power Plamp : Power per lamp Pballast : Power per ballast Fk : Power plug loss factor PA : Power per square meter

1. 7 (seven) 40W TL are needed to light a 10m x 10m room with 100 Lux of required lighting strength

2. Total power needed in the room is 420 Watts 3. Power needed per square meter is 4.2 Watts to illuminate the room at a rate of

100 Lux of luminance

From the case example above, we can then further determine a table of power

needs approximation according to Lighting Category deciphered from the

book of “PEDOMAN PENCAHAYAAN DI RUMAH SAKIT” (Hospital

Lighting Manual) especially from the page of 25 (using TL with 75

Lumen/Watt of luminance, room height of 280-300 cm, and white colored

paint) i.e.:

32

Fig. 19 Table of Lighting Category (TL, 75Lumen / Watt)

No Lighting Category

Minimum Luminance

(Lux)

Ideal Luminance

(Lux)

Minimum Lux Power Needs per m2 (W/m2)

Ideal Lux Power Needs per m2

(W/m2) Comments

1 A 20 50 0.84 2.10

2 B 50 100 2.10 4.20

3 C 100 200 4.20 8.40

4 D 200 500 8.40 21.00

5 E 500 1000 21.00 42.00

6 F 1000 2000 42.00 84.00

7 G 2000 5000 84.00 210.00

8 H 5000 10000 210.00 420.00

9 I 10000 20000 420.00 840.00

♦ Using 40 W & 75 Lumen/Watt TL

♦ CU = 0.6 ♦ LLF = 0.8 ♦ Room height = 280-300 cm

According to Fig. 17 (Lighting Source Table), when we replace the TL with

regular bulbs, in order to gain the same luminance the power needed will

increase to:

28.161575

1040402.4 −=⎟

⎠⎞

⎜⎝⎛

+Wmxx

4.2 (Wm-2) : Power needed per square meter when using TL 40 (W) : Power of the Bulb used 40 + 10 (W) : Power of the TL + ballast used 75 (Lumen/Watt) : Luminance of TL 15 (Lumen/Watt) : Luminance of Regular Bulb

We can conclude that regular bulbs will require approximately 300% more

power than TL of the same power (40 W bulbs and 40 W TL + 10 W of

ballast). If we put it into the table of Fig. 16, we can make a comparison of

needed power when using TL and bulbs:

Fig. 20, Table of Medical Rehabilitation Lighting Category (Comparison of TL and Bulbs)

No Room Name Lighting Category

Minimum Lux Power Needs per m2 (W/m2) for TL

of 75 Lumen/Watt


(W/m2) for TL of 75 Lumen/Watt

Minimum Lux Power Needs per

m2 (W/m2) for Bulbs of 15 Lumen/Watt


(W/m2) for Bulbs of 15 Lumen/Watt

1 Administration D 8.40 21.00 33.60 84.00

2 Doctor/Psychologist C 4.20 8.40 16.80 33.60

33

No Room Name Lighting Category

Minimum Lux Power Needs per m2 (W/m2) for TL

of 75 Lumen/Watt


(W/m2) for TL of 75 Lumen/Watt

Minimum Lux Power Needs per

m2 (W/m2) for Bulbs of 15 Lumen/Watt


(W/m2) for Bulbs of 15 Lumen/Watt

3 Staff C 4.20 8.40 16.80 33.60

4 Locker C 4.20 8.40 16.80 33.60

5 Waiting Room C 4.20 8.40 16.80 33.60

6 Gymnasium D 8.40 21.00 33.60 84.00

7 Treatment Room D 8.40 21.00 33.60 84.00

8 Exam Rom D 8.40 21.00 33.60 84.00

9 Physical & Vocational E 21.00 42.00 84.00 168.00

10 Exercise D 8.40 21.00 33.60 84.00

11 Hydrotherapy D 8.40 21.00 33.60 84.00

12 Bathroom/Toilet/Shower C 4.20 8.40 16.80 33.60

13 Pump Room/ME/Utility B 2.10 4.20 8.40 16.80

14 Physiotherapy Room D 8.40 21.00 33.60 84.00

15 Accident Rehabilitation C 4.20 8.40 16.80 33.60

The table in Fig. 20 determined with assumptions that the lights are able to

illuminate with 100% of its potentials and the wall and ceiling are colored

perfectly bright (very high CU and LLF). Therefore, when creating a design of

a room of MR facility, the ideal calculation should be used.

III.3.2. Requirement of Clean Water Facility Equipment

III.3.2.1. Total Needs of Clean Water of MR Facility

A few things which will need to be considered in planning clean water needs

i.e.:

1. Hospital need of clean water : 400 – 650 liters / day / bed 12)

2. Hand washing activity : 0.5 – 1.5 liters / use.

3. Washing activity using shower : 6.5 – 12 liters / use.

4. Urinary : 1.5 – 3 liters / use.

5. Toilet : 3 – 6.5 liters / use.

6. Middle-sized Butterfly Bath typed Hydrotherapy (2 x 2 x 0.8) = 3.2 m3.

Water in whirlpool & heating system = 20% x 3.2m3 = 0.64 m3.

Total needs : 3,840 liters.

12) Putstep, Ervin, “MODERN HOSPITAL”, LLOYD-LUKE Ltd., London, 1979

34

7. Swimming Pool typed Hydrotherapy (1.5 x 12 x 4) = 72 m3. Water in

whirlpool & heating system blower = 30% x 72 = 21.6 m3.

Total needs : 93,600 liters.

8. OT workshop will require the largest amount of water after hydrotherapy

facility especially for creating polymer using prosthetic devices.

OT workshop : 12 – 15 liters / device / day.

9. Cooking in pantry : 3 – 6 / person 13)

III. 3.2.2. Water Temperature

1. Normal / room temperature : 25 – 34 0C (depends on weather)

2. Warm water : 32 – 39 0C

Hot water : 43 0C 12)

3. Shower water : 38 – 40 0C 12)

4. Hand washing : 43.5 0C (in patient service rooms)12)

III. 3.2.3. Water Hygiene

1. Smell-free, color-free, taste-free

2. Should not contain disinfectant of > 5 NTU13)

3. Free from radioactive & chemical substances

4. Free from microorganism contamination e.g. Faecal Coliform Bacteria

(usually >99% is E. Coli Bacteria) 13)

5. Free from vegetative microorganism which will cause moss or fungus to

grow especially in hydrotherapy facility

6. Free from viruses which will cause Diarrhea & Typhus

III. 3.3. Heating Ventilation & Air Conditioning (HVAC) and Room Noise Level

III. 3.3.1. Requirement of Air Conditioning Equipment

This facility will provide comfort and air circulation for officials and patients

in MR facility. The requirements are:

13) The Spere Project, “Spere Basic Cooking Need”, 2004 12) Putstep, Ervin, “MODERN HOSPITAL”, LLOYD-LUKE Ltd., London, 1979

35

1. Cool and environmentally-comfortable temperature: 24 – 24.5 0C

2. Humidity (other than hydrotherapy facility): 40 – 60%

3. The most sophisticated Split and Package AC ability: 9000 – 10,500 BTU

(British Thermal Unit) / HP (Horse Power)

4. The most sophisticated Outdoor Unit for Split and Package AC power

efficiency: 650 – 750 W / HP (used to be 850 – 950 W / HP) at 220 – 240

VAC, 50 Hz, 1 phase.

5. Air Flow Speed in Air Ducting Distribution blown by Air Handling Unit

Blower should be no less than 0.15 ms-1 12)

6. Every MR room will need basic ventilation and infiltration which will

cause sensible and latent load (sensible and latent CFM).

7. CFM is the need for basic ventilation and infiltration: )1158.0xxfVCFM roomroom=

Vroom : Room volume (l x w x h) froom : Frequency of air circulation per hour 0.58 : Constant (from 35.31 / 60)

8. Sensible CFM (in BTU) will cause load of: )11508.1 xCFMxCFM sensible =

1.08 : Constant in BTU. 5 : Constant of temperature difference of Indonesia and foreign countries

9. Latent CFM (in BTU) will cause load of: )1167.0 hgxCFMxCFM latent ∆=

0.67 : Constant in BTU. hg∆ : Difference of humidity between indoor and outdoor

10. Every one human being will cause sensible load and latent load on AC

which will decrease AC ability (in HP) by:

)1105.09000

1)250200( HPxnxP =+=∆

P∆ : Power decrease n : Number of people

36

11. Sensible load of every 40 W TL (in HP):

)1101.09000

14.325.140 HPxxxP ==∆

P∆ : Power decrease

12. Every glass window at daylight will cause sensible load of 800 – 1000

BTU / hr / m2 of window size (depending on sunlight direction)11)

13. Every wall will create sensible load of 2.15 – 2.16 BTU / hr / m2 / 0F 11)

14. If the MR Service Room is right under the roof, it will create sensible load

of 11.5 BTU / hr / m2 / 0F 11)

15. Comparison of temperature measurement: 0R(Reamure):0C(Celcius): 0F(Fahrenheit) = 4:5:9+32

K(Kelvin) = 0C - 273

16. Hydrotherapy and Physiotherapy rooms will need 1.5 – 2 x as much AC

Power as other rooms because many devices in these rooms emit heat.

17. MR room with a volume of 100 m3 should at least be equipped with air

distribution duct which able to contain blowers of 50 cm in minimum

diameter, 0.5 m3s-1 of air flow and air circulation frequency of 2 – 12 h-1

(per hour).

18. Air intake duct in Air Handling Unit of MR building should be placed at

least 90 cm from the roof and 750 cm from building exhaust area or other

heat emitting areas (e.g. hospital incinerator)10).

19. Indoor unit installment in form of Air Intake Diffuser (For Central AC) or

mechanical air flow control e.g. Exhauster Fan, Window AC, Indoor Unit-

AC Split should be placed at least 200 cm above the floor and minimum

20 cm from ceiling10)

20. Exhauster should be installed in OP workshop and be placed at least 7.5

cm above the floor10). Especially in areas where dust is likely to exist.

21. Design and planning of Air Conditioning System in MR facility should

consider the requirements mentioned in point 7 – 19.

37

22. Indoor unit of AC System in MR facility should be cleaned with aerosol

cleaner (resorcinol, trietilyne glycol) at least once a month10)

23. Monitoring of air quality in MR Facility should be performed at least

twice a year by sample gathering and air quality parameter inspection

(germ, dust, gas)10)

III. 3.3.2. Requirement of Room Noise

This requirement refers to Minister of Health Regulation No.

718/Menkes/Per/XI/1987 which divides noise tolerance as follows:

Fig. 21 Noise Level Table

No Zone Ideal Noise Level (dB) Maximum Noise Level (dB)

1 A 35 45

2 B 45 55

3 C 50 60

4 D 60 70

Based on Minister of Health Decision No. 1204/Menkes/SK/X/2004 for

implementation in MR, noise level adjustment can be performed in some ways

i.e.:

1. Arrangement of MR Rooms should allow rooms which need quietness to

be free from noise.

2. Sources of noise from MR Rooms should be able to be controlled, i.e. by:

2.1. Room muffling, partitioning, re-arrangement, maintenance of

machinery or other activities which might cause some noises.

2.2. Noises which come from outside should be controlled by room

partitioning and noise muffling i.e. by planting trees (green belt

installation), wall barrier installment, and increase the ground level

(site barrier installation).

To determine empirically about the noise level in MR Facility, the book of

“MODERN HOSPITAL” by Ervin Putsep (LLOYD-LUKE, London, 1979)

describe it as follows:

38

Fig. 22, Table of Noise Category based on Activity

No Noise Category Activity Noise (dB)

1 Faintly heard Noise of stepping away footstep (<10m) 10

2 Faintly heard Whispering (2 persons) 15

3 Faintly heard Isolation Room 20

4 Faintly heard Patient treatment room at night 25

5 Very quiet Patient treatment room at noon, Bedroom of apartment 30

6 Quiet Library / Quiet road 40

7 Quiet Public Area in hospital (corridor at noon) 45

8 Rather quiet Warehouse, restaurant, typing (by 1 hospital official) 50

9 Normal Hospital Administration room 55

10 Normal Airflow of Air Conditioner at 0.15 ms-1 from 6 meters away 60

11 Normal Traffic on the main road which is 25 meters away 64

12 Normal Normal conversation of 2 persons 1 meter apart 65

13 Normal TV, medium volume 70

14 A little noisy Ambulance (sirens off) at 105 kmh-1 from 8 meters away 77

15 A little noisy Linen laundry machine 78

16 A little noisy Linen trolley / garbage trolley 80

17 Noisy Crying infant 85

18 Very Noisy Motorcycle machine at 3000 rpm (normal exhaust) 90

19 Very Noisy 2500 cc Conventional Direct Injection Diesel Engine (Non Silent Type) 98

20 Very Noisy Rock ‘N Roll Band music from less than 10 m away 114

21 Causing headache Jet Engine from less than 10 m away 130

22 Causing direct hearing trauma Jet Engine testing facility from less than 10 m away 140

23 Skin burning Jet Engine testing facility from less than 10 m away 150

24 Causing death Apollo rocket launch from less than 10 m away 200

Other thing which needs to be taken into consideration is ability limitation of

a worker in accepting noise tolerance in performing activities in the hospital,

which can be described as follows:

Fig. 23, Table of Relation between Maximum Work hour and Noise Intensity

No Noise Intensity (dB) Maximum Work hour (h/day)

1 85 8

2 90 4

3 95 2

4 100 1

5 105 0.5

6 110 0.25

39

Referring to the Ministry of Health Decision No. 1204/Menkes/SK/X/2004

(Table I.5), we can determine the Noise Index as follows:

Fig. 24, Table of Noise Index

No Room / Unit Maximum Noise (dB A / 8 hours)

1 Patient Room: ♦ Awake ♦ Asleep

45 40

2 General Surgery Room 45

3 Anesthetic Room, Recovery Room 45

4 Endoscope Room, Lab 65

5 X-Ray Room 40

6 Corridor 40

7 Stairway 45

8 Office / Lobby 45

9 Warehouse / Equipment Room 45

10 Pharmacy 45

11 Kitchen 78

12 Laundry 78

13 Isolation Room 40

14 Teeth Polyclinic 80

Based on table in Fig. 21 – Fig. 24 and considering table in Fig. 4 (Chapter II),

Table of MR Noise Index can be determined as follows:

Fig. 25, Table of MR Room Noise Index

No Room Zone Ideal Noise Level (dB A / 8 hours)

Maximum Noise Level (dB A / 8 hours)

Maximum Work Hour (h/day)

1 Waiting Room D 60 70 8

2 MR Registration & Medical Record Counter C 50 60 8 3 Examination & Assessment Room for Doctor

/ Psychologist B 45 55 8

4 Physiotherapy Room A 35 45 8 5 Measurement, Fitting & Adjustment Room B 45 55 8 6 Individual Speech Therapy Room with

Audiometer < A 10 20 8

7 Classical Speech Therapy Room C 50 60 8 8 Individual OT Room for Adults B 45 55 8 9 OT Practice Room for Adults C 50 60 8

10 ADL Therapy Room C 50 60 8

40

No Room Zone Ideal Noise Level (dB A / 8 hours)

Maximum Noise Level (dB A / 8 hours)

Maximum Work Hour (h/day)

11 Individual OT Room for Children B 45 55 8 12 Classical OT Room for Children C 50 60 8 13 Integration Sensor Room for Children D 60 70 8 14 Audio Visual Relaxation / Stimulation A 35 45 8 15 Gymnasium & Community Service C 50 60 8 16 Hydrotherapy Room C 50 60 8 17 OP Workshop > D 80 90 8 18 MR Sport Medicine C 50 60 8 19 MR Motor Function Research & Testing B 45 55 8 20 VIP Service Room A 35 45 8 21 Room of Manager / Asst. Mgr. / FMS B 45 55 8 22 Discussion & Meeting Room B 45 55 8 23 MR Administration, Finance & Personnel B 45 55 8 24 MR Treatment Room A 35 45 8 25 MR Warehouses B 45 55 8 26 MR Locker Rooms B 45 55 8 27 MR Toilets B 45 55 8 28 MR Hand-Washing Area B 45 55 8 29 MR Pantry D 60 70 (± 78) 8 30 MR Janitor / Cleaning Service D 60 70 (± 78) 8 31 MR Garden C 50 60 8 32 MR Fitness Room C 50 60 8 33 MR Utility Room > D 80 90 4 34 MR OT Diagnostic Room A 35 45 8 35 MR Corridor B 45 55 8 36 MR Stairway & Elevator Lobby B 45 55 8

Fig. 25 describes a standard reference for noise level in MR Facility. But

when designing MR Facility rooms, it would be better if the designer uses a

higher standard (meaning that noise level for each room is lower than

standard), especially in rooms which usually will cause a lot of noise (e.g. OP

Workshop & its utility rooms).

41

Hospital buildings should consider standard of noise level and tremor

according to its functions by considering comfort and health level according

to the current technical standard5).

Standard of noise level and/or tremor of Hospital Structure should refer to

AMDAL (Environmental Effect Analysis) 5) issued by related Agency /

Council in a district area.

III.3.4. Requirement of Vertical & Horizontal Transportation and Circulation

Facility Equipment

Generally the requirement of vertical & horizontal transportation and

circulation facility equipment are:

1. Buildings for public and social services must be equipped with

accessibility facilities for PwDs 5).

2. Regulation about accessibility for PwDs should comply with Minister of

Public Work Regulation No. 468/KPTS/1999 about “Technical

Requirement of Accessibility of Public Building and Environment”.

III.3.4.1. Requirement of MR Vertical Transportation and Circulation

1. All vertical transportation and circulation facilities should be equipped

with fire-resistant shaft wall which can stand fire of 800 0C for at least 60

minutes.

2. The width of stairs and balustrades should be at least 180 cm.

3. The minimum width of emergency stairways in public buildings is 120

cm, but for hospitals and especially MR Facilities, it should be at least 180

cm wide.

4. Emergency stairways should be equipped with smoke-impenetrable

emergency doors, automatic door closer and resistant to 800 0C fire for at

least 60 minutes.

5) Depkimpraswil, “PEDOMAN TEKNIS PEMBANGUNAN GEDUNG NEGARA” (Technical Manual of State Structure Building, BP-PU Foundation, Jakarta, 2002

42

5. Every stair shaft (especially in emergency stairways) should be equipped

with exhauster, placed at the roof of the shaft which will work on

emergency situations, especially when an internal disaster happens, e.g.

fire.

6. MR stairs should be equipped with enough lighting in normal and

emergency situations (At least equal to lighting of category-C as seen in

Fig. 19, Lighting Category Table).

7. Each end of stairways should be equipped with non-slippery mat (stop-

nosing) and different in color than any other stair shafts.

8. Every stairway should be equipped with continuous railings (except in

front of emergency exit).

43

9. Every stairway should be equipped with direction (e.g. arrow or line),

made from materials which will glow in the dark and reflect lights.

10. Non-mechanical circulation should be equipped with ramps of 50

maximum elevations in form of regular U-typed, Box-typed or circular

plain stairs, with 180 cm of maximum width and 500 cm of minimum

circular radius.

11. End of escalators and mechanical plain stairs should be painted with eye-

catching colors (e.g. yellow, bright red or white) and different from the

rest of the stair shafts, and also should be equipped with lighting on both

ends.

12. Control panel in elevators should be able to be easily reached by

wheelchair users and normal people.

13. Cars in elevators should fit hospital beds or at least 240-270 cm in length

(>250 cm of length usually have to be specially ordered or hospitals), 170-

200 cm in width, and 120 cm of door width.

14. Elevators should be equipped with at least 2 pairs of infra red door

opening sensors where one pair placed at 100-150 cm another pair placed

at 10-20 cm above car stop floor position to sense wheelchair footstep. For

elevators which used parallel bars sensor mode, the lowest end of the bar

should be placed at 10-20 cm above car stop floor position.

15. Elevators should be equipped with Audio Guiding Assistance to indicate

floor position and pressed floor destination for accessibilities for People

with Vision Impairment.

16. Elevators should be equipped with Automatic Rescue Device which guide

elevator to the nearest floor or ground floor on power down or disaster in

the building.

III. 3.4.2. Requirement of MR Horizontal Transportation and Circulation

1. MR corridor width should be at least 180 cm5), while ideal width is 240

cm for two patient trolleys to pass each other/meet without stopping8).


44

2. Every entrance to MR Building should be accessible, especially for

circulation of vehicles with 4 wheels or more in loading and dropping

patients.

3. Patient dropping and loading area should be equipped with plain

stair/ramp and railing with the height of around 100 cm towards

4. Circulation of goods, hospital workers, and patient (and attendance(s))

should use different door from one another.

5. Height differences on the floor should be easily seen or felt even if only 1-

2 cm i.e. by coloring or covering (e.g. with rubber) of each floor height to

prevent accidents.

6. Every building should be equipped with situation map (room locations),

room directions, and room names with capital letters 10-15 cm in width

and 15-25 in height (3:5 of width : height proportion).

7. Directional boards and elevator buttons should be equipped with Braille

for accessibilities of People with Vision Impairment.

8. Toilets/Lavatory/Urinary should be equipped with hand-rails for

accessibility of wheelchair, walker/tripod, and stick/crutch users.

9. Every corridor which is directly connected with outside part of MR

buildings should be equipped with security devices of at least hand-rails.

III.3.5. Requirement of Gas Equipment Facility

1. Gas Installation in the hospital consists of Energy and Medical Gas

Installation.

2. Energy Gas Installation: Its use has no relation with direct treatment or

healing of patients.

3. Energy Gas Installation e.g.: Natural Gas Fuel or Liquid Petroleum Gas

Installation from Gas Company owned by the state (PGN – Perusahaan

Gas Negara) or the city which usually used in OP workshop for fuel, Hot

8) E. Neufert (Tranlated by Sjamsu Amri), “DATA ARSITEK”, Erlangga Publishing, Jakarta, 1987

45

Steam Installation from hospital boiler for Autoclave mechanism in

Sterilization Center, Steam Stove, and Drying Machine in Laundry Room.

4. Medical Gas Installation: Directly used in treating or healing of patients.

5. Medical Gas Installation e.g.: Oxygen Installation, Medical Compressed

Air / Press Air / Breathing Air, Suction / Vacuum Air, and N2O (Nitrous

Oxide). Oxygen outlets are the most commonly used in MR facilities,

especially for emergency situations. While other types of facilities i.e. CO2

(Carbon Dioxide), N2 (Nitrogen), He (Helium), C3H6 (Cylopropane), and

Mixture Gas are being used in the hospital in general for specific uses.

6. Every Gas Installation in the hospital (especially Medical Gas Installation)

should comply with the standard and completed with technical

certification permit issued by authorized related agency / sub-agency or by

authorized Department or Technical Council.

III.3.6. Requirement of Fire-Security Infrastructure

III.3.6.1. Emergency Stairs

1. Every hospital building of three stories or higher should be equipped with

emergency stairs5).

2. Doors of emergency stairs should be able to withstand fire for at least 2

hours, with opening direction towards the stairs (except for ground floor

which connected to building exit door) and should be able to close

automatically. The door should also be equipped with lights and “EXIT”

label5).

3. Emergency stairs which placed inside the building should be separated

from other rooms, equipped with fire-resistant doors, free from smoke,

and maximum reaching range of 25 meters5).

4. Minimum width of stair step is 120 cm.5)

5. Emergency stairways should not be in circular shape.5)


46

III.3.6.2. Emergency Lighting and Exit Direction

1. Building for public service and utilities should be equipped with

emergency lighting and “EXIT” direction. 5)

2. Exit direction should be placed in corridor intersections, paths to

stairways, balcony or terrace and doors to emergency stairways.5)

III.3.6.3. Emergency Doors

1. Every hospital building of three stories or higher should be equipped with

emergency doors5).

2. The width of the doors is at least 100 cm which open toward the

emergency stairways except for the ground floor, which opens towards the

outside.

3. Distance between emergency doors within a block of buildings should be

at most 25 meters from every direction.

III.3.6.4. Corridor

1. The width of corridors should be at least 180 cm.5)

2. Distance of any point in a corridor to the nearest emergency door should

be at most 25 meters.5)

3. Corridors should be equipped with signs which indicate the direction to

the exit and emergency doors.5)

III.3.6.5. Gathering Point Location

1. Gathering Point (GP) location is the destination point of hospital

evacuation when internal disaster happens.

2. Ideal GP ideally should be at least 100 m away from the disaster area.

3. GP location and the path to reach it should be socialized to all users of

hospital building according to evacuation groups stated by the hospital

management.

III.3.6.6. Danger Warning System

1. Every building for public service e.g. hospital should be equipped with

internal communication system and danger warning (alarm) system.5)


47

2. Alarm system should be equipped with UPS (Uninterruptible Power

Supply) or backup batteries.

3. Alarm system should be tested its functionality at least once in every 6

months.

Every hospital building should also be equipped with fire prevention and

handling system which comply with these rules5):

1. Minister of Public Works Decision No. 10/KPTS/2000 about Technical

Regulation of Building and Environment Fire-Threat Security.

2. Minister of Public Works Decision No. 11/KPTS/2000 about Technical

Regulation of City Fire Handling Management.

III.3.7. Requirement of Telecommunication Facility Infrastructure

1. Every hospital building should be equipped with internal and external

communication equipment.5)

2. The type and the number of communication equipment depend on building

function and common needs.5)

III.3.8. Requirement of Waste Water Facility Infrastructure

III.3.8.1. Rainwater Ditch

1. All rainwater should be directed to the city drainage network5), or if not

available, it should be treated e.g. through absorption process or any other

processes agreed by related government agency / sub agency.

2. Rainwater ditch should be built in accordance with the current technical

regulation or complies with SNI (Indonesian National Standard)5)

III.3.8.2. Dirty Water Disposal

1. Dirty water which came from the kitchen, toilets / bathrooms, and laundry

should be disposed through open or closed channel according to the

current technical requirement5).

2. Dirty water which came from the kitchen, toilets / bathrooms, and laundry

should be directed to the city drainage network5).

48

3. If city drainage network is not available, the wastewater should be treated

e.g. through absorption process or any other processes agreed by related

government agency / sub agency.5)

III.3.8.3. Waste Disposal

1. Every hospital building which its use produced liquid or solid waste

should be equipped with temporary waste disposal or waste treatment

plant according to the current technical requirement5).

2. Waste disposal and treatment plant should be made from water-resistant

material and comply with the current technical requirement for it not to

cast negative effects to the environment5).

III.4. REQUIREMENT OF MEDICAL REHABILITATION FACILITY

TOOLS AND EQUIPMENTS

III.4.1. Requirement of Medical Facility Equipment

Medical equipment i.e. medicine free instruments, apparatus, engines, and

implants which used to prevent, diagnose, heal and lighten illness, treating

people with illness and to restore people’s health and or to form the structure

and restore the function of human body6). Some of the requirements of the

medical facility equipment of MR are:

1. The equipments should be kept in clean condition (some even insist to

maintain it in sterile / germ-free condition).

2. Disposable equipment (equipment which should be disposed after being

used) should be destroyed after used and not being applied / used to other

patients.

3. Reusable / Non-Disposable equipment should be treated through

decontamination or even sterilization process before being used to other

patients.

4. After use equipments should be treated as infectious matter. It should be

carried in Container Carrier to prevent contamination to the surroundings

6) Indonesian Act No. 23 of 1992 about “HEALTH”

49

and transportation route before being decontaminated, destroyed, washed

or sterilized.

5. Medical equipments should be equipped with Instruction / Operation

Manual or Standard Operation Procedure which should be at least

socialized to the users.

6. Sophisticated Medical Equipments should have a minimum of 1 year

repair warranty or 5 years of spare-part availability. If the equipment is

brand new, it has to have a Certificate of Origin, Certificate of

Authenticity, and Quality Check Pas / QC Pass Certificate to guarantee

that it’s a brand new product instead of a refurbished / restored product.

7. Sophisticated Medical Equipments should be equipped with Practical

Troubleshooting Manual, Service Manual, Wiring Diagram, and Spare-

part List / Catalogue for efficiency and effectiveness of its maintenance.

8. Maintenance of sophisticated medical equipment after the end of warranty

period by a third party in form of service contract should consider

principle of efficiency, effectiveness and benefit especially towards

hospital resources (usually problems occur because of limited human

resources capability, spare-part availability, and financial situation of the

hospital).

9. Sophisticated Medical Equipments should be equipped with calibration

certificate before use. Calibration should be performed by a health

equipment calibration-test institution which has been admitted its legality

by Indonesian authority.7)

10. Sophisticated Medical Equipments should be re-calibrated according to

the standard of use stated by equipment manufacturer or at least once a

year. 7)

11. The equipments should comply with Indonesian National Standard (SNI)

or international and other county standard e.g. ISO (International Standard

7) The Minister of Health Regulation No. 363/MENKES/PER/1998 about “Testing and Calibration of Medical Equipment in Health Service Facility”

50

Organization), TUV (Germany), IEC, IEEC, IEEE, BS (British Standard),

and JIS (Japan Industrial Standard).

III.4.2. Requirement of Supporting Equipment Facility

Supporting equipments are medical and healthcare devices functioned to

support medical service operation e.g. Generator Sets (for main or emergency

power supply system), clean water distribution pumps, chiller unit and cold

water distribution pumps in Centralized Air Conditioning System, Electric

Transformer and Capacitor Bank in Power Distribution System, UPS, Boiler,

Wastewater Treatment Plant, IT & Communication System (e.g. PABX

(Public Automated Board Exchange), Computer Servers, Routers, Modems,

PCs, Telephones). Requirements of Supporting Equipments i.e.:

1. Power sources of supporting equipment should be placed in a particular

room for supporting devices and be separated from the health service

rooms.

2. MR supporting equipments should be easy to be installed, maintained and

fixed with as minimum risk as possible to cause disturbance towards

health service circulation flow and to the room itself.

3. High Tech & High Risk Equipments (sophisticated medical equipments

which closely related to the safety of human life and MR environment)

should be equipped with Instruction / Operation Manual or Standard

Operation Procedure; especially those which closely related to K3RS

(Hospital Health & Safety of Work). The OM and SOP should be

socialized to the device users of the hospital or at least to the operator of

the particular equipment.

4. High Tech & High Risk Equipments should also be equipped with

Troubleshooting Manual, Service Manual, Wiring Diagram, Operation

Flowchart Diagram, and Spare-part List / Catalogue for easy maintenance

and repair.

5. Maintenance of high tech medical equipments after the end of warranty

period by a third party in form of service contract should consider

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principles of efficiency, effectiveness and benefit especially towards

hospital resources (usually problems occur because of limited human

resources capability, spare-part availability, and financial situation of the

hospital).

6. High Tech & High Risk Equipments (e.g. Boilers, Lightning & Surge

Protector System, Electrical Transformers & Panels, Gas Network System,

Helipads, Wastewater Treatment Plant, and Disaster Alarm System)

should possess operation certificate from testing institution (i.e. Technical

Department, Government Technical Agency / Sub-Agency or Private

Testing Institution) which legality is being admitted in Indonesian

Territory through a Testing & Commissioning Process which is a part of

equipment certification process.

7. Certification of High Tech & High Risk Equipments which are still

working and in operation should be renewed before expiry date. Repair

and restoration of the devices should also be done by the hospital authority

to insure its operational safety as a part of performing K3RS.

8. Sophisticated supporting equipments should comply with Indonesian

National Standard (SNI), Indonesian Industrial Standard (SII), and also

international or other country’s standards e.g. ISO, TUV, IEC, IEEC,

IEEE, BS, and JIS.

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CHAPTER IV

DESIGN MODEL OF

PLANNING AND DESIGN

IV.1. MR BUILDING PLACEMENT IN HOSPITAL SITE PLANNING

(The content is the result of MR coordination meeting).

IV.2. DIAGRAM MODEL OF ROOM CONNECTION


IV.3. BUILDING MODEL OF MR INSTALLATION FOR CLASS-A

EDUCATIONAL HOSPITAL (Typology Study of BLU (Public Service

Council) of Central Public Hospital of Adam Malik, Medan, Sumatera

Utara)

(The content is the blueprint of location survey result).

IV.4. BUILDING MODEL OF MR IDEPARTMENT FOR CLASS-A

EDUCATIONAL HOSPITAL (Typology Study of BLU of District Public

Hospital of Dr. Sutomo, Surabaya, Jawa Timur)

(The content is the blueprint of new & old location survey result).

IV.5. BUILDING MODEL OF MR DEPARTMENT FOR CLASS-A

EDUCATIONAL HOSPITAL (Typology Study of BLU of National Central

Public Hospital of Cipto Mangunkusumo, Jakarta)


IV.6. BUILDING MODEL OF MR DEPARTMENT FOR CLASS-B

HOSPITAL (Typology Study of BLU of Fatmawati Hospital, Jakarta)


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IV.7. BUILDING MODEL OF MR DEPARTMENT FOR Special CLASS-B

HOSPITAL (Typology Study of BLU of RSOS (Prof. DR. Soeharso

Hospital), Solo)


IV.8. BUILDING MODEL OF MR DEPARTMENT FOR CLASS-A

EDUCATIONAL HOSPITAL (Typology Study of Syaiful Anwar District

Hospital, Malang, Jawa Timur)

IV.9. INTERIOR DESIGN MODEL OF PHYSIOTHERAPY ROOM


IV.10. INTERIOR DESIGN MODEL OF HYDROTHERAPY ROOM

(Typology Study of BLU of Mohammad Hoesin Hospital, Palembang,

Sumatera Selatan)


IV.11. INTERIOR DESIGN MODEL OF INDIVIDUAL SPEECH THERAPY

AND AUDIOMETRY ROOM


IV.12. INTERIOR DESIGN MODEL OF OP WORKSHOP


IV.13. INTERIOR DESIGN MODEL OF SENSOR & INTEGRATION ROOM


IV.14. INTERIOR DESIGN MODEL OF BATHROOMS AND TOILETS


54

IV.15. SPECIAL FURNITURE MODELS FOR MR


IV.16. SPECIAL PRODUCTS MODEL DESIGN FOR MR


IV.17. MODELS OF OUTDOOR DESIGN ELEMENTS FOR MR


55

TYPOLOGY STUDY OF PRODUCT DESIGN

Gb.Dp.1. Chair of Children OT for hyperactive children.

Location: MR Installation - RSCM

Gb.Dp.2. Chair of Children OT for children with CV.








Gb.Dp.6. Table of Children OT for YPAC Students

Location: YPAC-Medan


Location: YPAC-Medan


Location: MR Installation – Fatmawati

Gb.Dp.9. Child Walker Trainee w/ Safety Rollbar

Location: MR Installation – Fatmawati

Gb.Dp.10. Angular Finger Ladder for Adults OT

Location: MR Installation – Dr.Sardjito

Gb.Dp.11. Vertical Finger Ladder for Adults OT


Gb.Dp.12. MR Installation Garbage Disposal


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INTERIOR TYPOLOGY STUDY

Gb.Int.1. Toilet Interior.

Location: MR Installation – RSCM

Gb.Int.2. Toilet Interior.


Gb.Int.3. Toilet Door Interior.


Gb.Int.4. Hydrotherapy Swimming Pool Interior

Location: MR Installation - Fatmawati

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