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Annex H-5 Hemodialysis clinic checklist

DOH checklist for review of floor plans for hemodialysis clinic

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
ANNEX H.5
A.O. No.20',6-

CHECKLIST FOR REVIEW OF FLOOR PLANS
HEMODIALYSIS CLINIC
Name of Health Facility:
Address:
Date:

Review:

Classification According to Ownership:

lnstitution-Based

1"t

2nd

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1. PHYSICA PLANT

1.1 A. Treatment Area
1.1.1 Dialpis Station (at least 6m2 per station)

3ro

Free-Standing

-

1.1.2 Nursing Station
1.1.3 Work Area (within nurses' station)
1.1.3.1 Work Counter
1 .1.3.2 Hand Washing sink
1 .1.3.3 Storage Cabinets

B. Treatment Support Area

.1.1 Storage Room for sterile instruments/supplies, etc.
1.1.2 Toilet Facility with water closet, urinal and lavatory
1.1.3 WaterTreatment Area (min. 12m2)
1.1.4 Reprocessing Room (optional) for reprocessing of dialyzer
1.1.5 Janitor's c/osef and waste holding area
1

1.2 Non-Treatment Area
Business Area
1.2.1.1 Information
1.2.1.2 Admitting
1.2.1.3 Cashier
Waiting Area
Pantry
Toilet

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1.2.2
1.2.3
1.2.4

2. PLAIINING Al.lD DESIGN
2.1 Floor plans properly identified and completely labeled
2.2 The Dialysis Treatment Area and fhe Nurses' Station are cohesively planned in "an
enclosed section or environment" provided appropriately with control doors for
entry and exit of patients and staff in order to attain/maintain Patient Safety
including Patient Comfort, Privacy/Convenience and at the same time lnfection
Control.
2.3 Nurses' station located and designed to allow adequate surveillance of patients on
dialysis machines
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All other Support Areas/Rooms such as but not limited to the Water Treatment
Room, Reprocessing Room, Sforage Room, Patients' Toilet, Staff Pantry, Offices
and the like are properly planned and located "outside" or "zoned" from the
D i al y si s T re atm e nt Secfion.
The staff and service access or passage to these Support Areas/Rooms does not
_2.5
intrude the Dialysis Treatment Section in view of maintaining Patient Safety
including Patient Comfort, Privacy/Convenience and at the same time lnfection
Control at alltimes.
2.6 Appropriate waiting area is provided and found commensurate to the number of
companions/relatives of dialysis patients (provide at least 0.65 sq.m /person).

COMMENTS:

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Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

Name of Health Facility:
Address:

COMMENTS:

HEALTH FACTLTTTES EVALUATTON AND REVTEW COMMITTEE (HFERC)

[

]Approved

[

]Disapproved

Chairperson, HFERC

Vice-Chairperson,

H

FE RC

Member

Member

MemDer

MemDer

MemDer

MemDer

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