M O H   C U R R E N T   N O R M S   A N D   G U I D E L I N E S  T H A T   M A Y   A F F E C T   T H E PLANNING,DESIGN, EQUIPMENT AND THE OPERATION OF A HOSPITAL.

1Emergency Department1.1Provision of spaces for different levels of care i.e. resuscitation area( Red Zone ), intermediate area ( Yellow Zone ), consultative area( Green Zone ) and observation ward.1.2Separate entrance for walk-in and ambulance cases with dedicatedexamination and treatment areas for paediatric cases in shall beprovided hospital with more than 500 beds.1.3No opera t ion   theat re   (OT)  sha l l  be  prov ided   in   the  emergencydepartment except hospitals identified asTrauma Centre eg. TheNew Sg. Buloh Hospital.1.4Crisis centre / one stop centre shall be provided.1.5Dedicated general x-ray unit may be considered for hospitals largerthan 700 beds.1.6Mobile x-ray unit shall be provided at the resuscitation area.1.7Each resuscitation bay shall be provided with 2 medical gas pendants(dry and wet type)1.8F a c i l i t i e s   f o r   c e r t a i n   d i s c i p l i n e s   s u c h   a s   d e n t a l ,   e y e  a n d   E N T examination shall be provided in a separate procedure room forhospitals larger than 500 beds.1.9A covered  area   fo r  d isas ter  management  sha l l  be  prov ided   inhospitals with more than 500 beds

1.10No medical gas outlets shall be provided in the disaster managementarea.1Specialist Clinic1.11A centralised registration area is required. However follow-upappointments will be done by the respective clinics.1.12

 The department shall use the concept of multi-user clinic with acombinat ion  o f  appropr ia te  d isc ip l ines  as  per  medica l  b r ie f  o f   requirements.1.13Each clinic unit shall have its own dedicated investigation / treatmentareas e.g. echocardiography rooms for cardiac clinic, phototherapyroom for dermatology clinic, etc.

1.14Certain disciplines may need dedicated clinics e.g. ENT, Eye andDental.1.1550% of consultation and examination ( CE ) rooms are to be equippedfully with equipment for dedicated specialities.1.16CE rooms for hospitals with visiting ENT specialists will be providedonly with the basic specialist set. For more intensive diagnosticinvestigations, cases have to be referred to referral hospitals.1.17For obstetrics and gynaecology (O&G) clinic, only 25-50% will beequipped with low-end ultra sound. One room shall be dedicated forhigh-end ultra sound to cater to the entire clinic’s needs.1.18In  v iew o f   the   f lex ib le  usage o f  c l in ics  accord ing   to  schedu les ,electronic digital signage shall be provided.

1.19Provision for a specimen-taking area ( venepuncture room ) shall beshared among the clinics except for O&G and Urology Clinic where astat lab shall be provided.1.20Genera l  x - ray   fac i l i t ies  may be cons idered   i f   the  depar tment   is located far away from the Imaging Department.1.21 The clinic shall be fully air-conditioned including waiting areas.2Day Care (A Multidisciplinary Day Surgery & Medical Day Care)2.1It shall have its own entrance if possible. Services provided are:−Medical day care.−Surgical day care.

−Endoscopy procedures.2.2Number of OTs required :−5 0 0 - b e d d e d   h o s p i t a l s   a n d   a b o v e   : 5   -   8  O T s−250 to 500-bedded hospitals : 2 - 4 OTs−Less than 250 beds : to share with hospital main OTs.1Dialysis Unit2.3A dialysis unit is to be provided in hospitals with 250 beds or more.2.4 This unit shall carry out both peritoneal dialysis and haemodialysisservices.2.5No. of bays required :−500 to 1000-bedded hospitals : 10 - 20 bays−250 to 500- bedded hospitals : 4 - 8 bays2.6Space for additional bays to be provided for future needs.

2Labour and Delivery (L&D) Unit2.7Provision of individual delivery rooms. Attached toilet to be sharedbetween 2 rooms.2.850% of labour and delivery (L & D)suites in hospitals with less than500 beds shall be equipped with cardiotochography (CTG) machine.In hospitals with more than 500 beds, 75% of the L&D suites shall beequipped with the CTG machine which will be linked to a centralmonitor and hospital information system (HIS).2.9Infant resuscitation equipment shall be provided in designated infantresuscitation area.3

Intensive Care Unit (ICU) / High Dependency Ward (HDW) / CardiologyRehabilitative Ward ( CRW ).3.1Multidisciplinary HDW is to be provided in hospitals with 250 beds or more.3.2 The design and general equipping of HDW and ICU shall be identical so that HDW can be converted into ICU if and when the need arises. Medical gas outlets and M&E requirements shall be similar.3.325% of HDW beds shall be equipped with ventilators.3.4CRW shall be provided in hospitals with a cardiology department.3.5All rooms shall be provided with collapsible sliding doors.3.6Each bed in ICU and HDW shall be provided with 2 medical gaspendants (dry and wet type).3Burns Unit3.7A burns unit is to be provided as a separate unit in hospitals of 700beds and more and may require a dedicated OT.3.8For hospitals with less than 500 beds, it shall be part of the ICU.3.9Every burns bed shall have a dedicated burns bath.3.10 The sterility and infection control policy shall be as in accordance withOT environment.3.1150% of burns beds shall be provided with 2 medical gas pendants (dryand wet type) each .4Coronary Care Unit (CCU)4.1Provision of CCU beds :−500 to 1000-bedded hospitals : 8 - 10 CCU beds−250 to 500-bedded hospitals : 4 - 6 CCU Beds−Less than 250 beds : to combine with ICU.8.2

Each bed shall be provided with 2 medical gas pendants (dry and wettype).4Special Care Nursery/ Neonatal ICU (NICU)

4.2P r o v i s i o n   o f   s p a c e   f o r   d i f f e r e n t   l e v e l s   o f   c a r e   i . e .  i n t e n s i v e , intermediate, convalescence and isolation.4.3New design concept - cots arranged in circular pattern for moreefficient nursing care ( however this needs about 15% morespace )4.4Beds shall be provided for mothers ( in the form of a dormitary )whose newborns are admitted in NICU . The number of these bedsshall be about 25% of the intensive and the intermediate care beds. For convalescent beds, individual “ mother accompany child” (MAC)beds shall be provided.4.5NICU  in  hosp i ta ls  w i th  more   than  500 beds  sha l l  have  i ts  ownrespiratory and haemodynamic unit if located far away from the ICU. This unit shall be managed by the anaesthetic department.5Infant Nutrition Unit4.6Infant nutrition unit (IFN) shall be provided in hosppitals with morethan 250 beds.4.7Automated washer, dispenser, blender and pasteurizer for the milkkitchen will be provided in hospitals with more than 700 beds.4.8For hospitals with less than 250 beds, a milk kitchen will not beprovided. Ward pantries to be used for milk preparation.

Operating Theatre (OT)

4.9Other   than   the  main   theat re  complex ,  ded ica ted  OTs sha l l  beprovided in the following units.−L&D suite : 1-2 OTs for hospitals with 500 - 1000beds.−

Day Care Surgery : for hospitals with 250 beds ormore.4.10Anaesthetic preparation area is to be shared between 2 OTs.4.11 The OT complex shall have direct access to the respiratory andhaemodynamic unit (RHU).4.12 The number of recovery rooms / bays shall be at least one and half times the number of operating rooms.4.13 The holding area for patients shall have bays for at least the samenumber of operating rooms.4.14Each OT room shall have its own air handling unit ( AHU ).4.15E a c h   O T   r o o m   s h a l l   b e   p r o v i d e d   w i t h   2   m o v a b l e  m e d i c a l   g a s pendants.4.16Certain OT rooms need to be lead lined particularly Orthopaedic OT,Urology OT, emergency Otand others or as specified in the brief.7Wards4.17 The norm used is 28 beds per ward. Maximum beds allowed in ageneral ward are 36. It shall be designed in the form of 4-bedded and2-bedded rooms / bays to maintain patient’s privacy.4.18Other than the clinical areas, the following areas are required:

−Visitors lounge (may be shared between 2 wards)−For hospital with 500 beds or more, a seminarroom shall be provided in each ward. Hospitalswith less than 500 beds, a seminar room may beshared between 2 wards.−Day area for patients in each ward.−Shower/WC for each bay or room.−I n d i v i d u a l   a r m c h a i r   f o r   p a t i e n t ,   l o c k e r   a n d wardrobe (not bank of wardrobes).

−Wash and drying area for patients.4.19Requirements of specific wards :-a ) P a e d i a t r i c   W a r d−A mother's bed cum sofa to every paediatric bed.−Play area.−Rest area and pantry for mothers.−School room and library.−(  The mother ’s  pant ry ,   the  schoo l   room and library may be shared if designs permit )−It shall be designed, decorated and equipped as acheerful environment for children.b ) G y n a e   w a r d -U l t r a s o u n d   m a c h i n e   s h a l l   b e  l o c a t e d   i n   t h e procedure room.c ) O p h t h a l m o l o g y   w a r d− Treatment room with ̀black-out’ curtains.4.20 TV set shall only be provided in day lounge of all wards. Howeverwall-mounted TV sets shall be provided in the VIP rooms

4.21Provision of medical gas shall adhere to HTM 2022 or as specified inthe latest standards / guidelines.4.22Automatic washer disinfector shall be provided in all dirty utilityrooms.4.23Ceiling fans shall be provided for each individual third-class bed.8CSSD/TSSU4.24Provision of autoclaves and low temperature sterilisation.4.25Cold sterilisation facilities / equipment shall also be provided in themain operation theatre complex and day care unit.

4.26Respiratory and haemodynamic unit shall not be part of the CSSD.4.27Automatic cart washer shall be provided for hospitals with 250 bedsor more.4.28CSSD to have direct access to the main operation theatre. If locatedat different level, dumb waiter has to be provided. However the dumbwaiter shall be able to accommodate the various instrument trolleys.9Imaging Departments4.29Invasive radiology investigation will be the future trend, such asangiography.4.30CT Scan, Magnetic Resonance Imaging (MRI) and Angiography shallbe provided in all ̀state' hospitals and hospitals more than 500 beds.4.31Mammography with facilities for biopsy shall be provided for hospitalswith more than 250 beds.4.32Dedica ted   imaging   fac i l i t ies  sha l l  be  prov ided   for  EmergencyDepartment for hospitals with more than 500 beds. For hospitals withless   than  500 beds,  mobi le  x - ray  un i t  sha l l  be  prov ided  in   theEmergency Department.4.33Specialist clinics shall have its own basic X-ray equipment if locatedaway from the Imaging Department4.34Ultra-sound shall be provided not only in Imaging Department butalso in other departments e.g. Specialist Clinics, Labour & DeliveryUnit (LDR) , etc. Suggested distribution are as follows:-a ) H o s p i t a l s w i t h l e s s t h a n 2 5 0 b e d s :−1 in O&G clinic−1 in LDRb ) H o s p i t a l s   w i t h   2 5 0   –   5 0 0   b e d s :−1 in O&G clinic−1 in LDR−1 in Imaging Dept.c ) H o s p i t a l s   w i t h m o r e t h a n 5 0 0 b e d s :−

1 in Gynae ward−1 in O & G ward−1 in LDR−1 in OT−1 in Medical Clinic−1 in Surgical Clinic−25-50% of CE rooms in O&G Clinic−1 in Imaging Dept.4.35Future imaging rooms shall be provided with lead lined wall and all the required mechanical and electrical (M&E) services.10Pathology Department4.36 The level of laboratory services shall be able to support the level of specialities provided by the hospitals.4.37 The design shall be of modular and open concept.4.38]Fully automated machines such as Clinical Chemistry Analysers andHaematology Analysers shall be provided. However the level of specifications shall be in accordance with the expected workload.4.39 There shall be provision for a dedicated laboratory for training of doctors and other relevant staff in hospitals with 500 beds or more.4.40Dedicated areas for simple tests such as dipstix shall be provided atthe specialist clinics e.g. Antenatal, Urology and Nephrology Clinics.4.41For hospitals with 250 beds or more, specimens will be sent to thelaboratory through the pneumatic tube system and the results will beconveyed to the wards through computer terminals.4.42In fully computerised hospitals (hospitals with 500 beds or more), thelaboratory shall be provided with Laboratory Information System (LIS)which is fully interfaced with the Hospital Information System (HIS).

4.43 Therapeutic Drug Monitoring (TDM) shall be provided in the laboratoryin hospitals with more than 500 beds.4.44Microb io logy   labora tory  sha l l  have an a i r   lock  w i th   i t s  own a i r -conditioning and exhaust system.4.45Designated AHU shall be provided for different working areas such asMicrobiology, Histopathology, Virology , etc.11Pharmacy4.46Satellite pharmacy shall be provided in hospitals with 250 beds or more.  Each sate l l i te  pharmacy  sha l l   serve  a  number  o f  wardsaccording to the layout and design ( 4 – 8 wards ) or serve several wards within a building.4.47Areas for sterile preparation such as for eyedrop , cytotoxic drug and Total Perenteral Nutrition ( TPN ) shall be provided only in hospitals with more than 500 beds.12Catering4.48Catering Department shall be designed to cater forcentral platingsystemandcentral washing systemwi th   the   fo l lowingcharacteristics:-−c o n v e y e r   p l a t i n g   ( b e l t ) } f o r  h o s p i t a l s−t u n n e l   w a s h e r   s y s t e m } w i t h  m o r e   t h a n 500 beds.−hospitals with less than 500 beds shall use dishwasher and manual plating system.−area for manual wash in case of system failure.−area for food trolleys.−crockery store.

4.49 Trolleys with plated food will be delivered to the ward by the cateringstaff.4.50Cold rooms are to be provided for kitchen in hospitals with more than500 beds.

13Transport Systems4.51Multi-channel pneumatic tube system shall be used in the PathologyDepartment for receiving of specimens from other departments andwards.−Pneumatic tubes of 6-inch diameter and frontloading shall be provided in hospitals with morethan 500 beds.−F o r   h o s p i t a l s   o f   l e s s   t h a n   5 0 0   b e d s   4 - i n c h diameter pneumatic tubes shall be used.4.52  T h e   n u m b e r   o f   s t a t i o n s   s h a l l   b e   a b l e   t o   m e e t   t h e  f u n c t i o n a l requirements of the hospital. Depending on the design and layout, awork station can be shared between units.1On-Call Complex / On-Call Rooms4.53On-call complex shall be provided within the hospital compound in hospitals with more than 250 beds.4.54Dedicated on-call rooms shall be provided in all wards and othercritical units e.g. Labour and Delivery Suite, ICU, CCU, NICU, OTs,Emergency Department, etc. In hospitals of less than 250 beds, the room shall be shared.5Hospital Information System (HIS)5.1Information Technology (IT) shall be implemented in all new hospitals,as part of the project.5.2In MOH hospitals, there are 3 levels of Hospital Information System :-a ) B a s i c   H I S   f o r   h o s p i t a l s   o f   l e s s   t h a n   2 5 0   b e d s .

b ) I n t e r m e d i a t e   H I S   f o r   h o s p i t a l s   h a v i n g  b e t w e e n 250 -500 beds.c ) T o t a l   H I S   f o r   h o s p i t a l s   o f   m o r e   t h a n   5 0 0   b e d s .5.3Infrastructure e.g. cabling and trunking for future IT expansion shallbe provided in all hospitals.5.4IT terminals and work stations shall be determined based on thepolicy and work process of the IT environment.1Other Areas5.5All hospitals shall be designed as baby-friendly and community-friendly hospitals, therefore facilities for the disabled, breast -feedingroom and nappy change area shall be provided in all hospitals.5.6Prayer   rooms may be shared  among s ta f f ,  pub l ic  and pat ien ts .Depending on the design and layout, a prayer room may be shared between departments, units and wards.5.7All working areas shall have windows and natural light.5.8 Taps of a clinical wash-hand basins shall be of the elbow action type.5.9Outdoor therapeutic gardens shall be provided in all hospitals. It shall be accessible to the public including the handicapped.5.10A meeting room shall only be provided in general administrationoffice, specialist office and CME complex.5.11Epoxy paint shall be used in all clinical areas and waiting areas.5.12Glass partitions / walls shall be used in offices, clinic and waitingareas.

5.13Car parks:a ) H o s p i t a l s w i t h m o r e t h a n 5 0 0 b e d s m a y r e q u i r e basement carparks ( 1 or two levels) which hasdirect access to the Emergency Department fordisaster management.b ) S t a f f   a n d   p u b l i c   c a r p a r k   a r e a s  s h a l l   b e separated.14

Hot Water System5.14Copper type calorifier shall be use for the hospital’s hot watersystem to prevent the possibility of Legionnaire’s disease.15Drainage5.15Covered drain system shall be built.16Fence5.16Decorative fencing shall be provided for the hospital frontage.5.17Perimeter fencing for nurses hostel shall not be provided unlessindicated.17Access Road5.18 There shall be a separate entrance for the service vehicles away fromthe main entrance.5.19A ring road is to be developed around the hospital complex to ensurethat the fire engine has access to any part of the buildings in case of fire.

5.20Covered linkway to the hospital complex shall be provided from thehostels and the hospital’s / nearest public bus stand.18Staff Accommodation5.21Sta f f  accommodat ion  sha l l  be  o f  apar tment - type   (mul t i -s toreybuilding). Balcony shall not be provided.5.22 The number of carparks shall not be less than the no. of units.5.23Outdoor recreation facilities including children’s playground shall beprovided.5.24Security grilles shall be provided to the ground floor of all staff quarters / accommodation including hostels.5.25

 The furniture for quarters will follow the guidelines as stated in the General Orders (G.O). Long bath and hot water system shall not beprovided in the staff accomodation.19Balai Pelawat with Cafeteria5.26Balai Pelawat and cafeteria may be built as one building.