MOH CURRENT NORMS AND GUIDELINES THA

T M A Y A F F E C T T H E PLANNING,DESIGN, EQUIPMENT
AND THE OPERATION OF A HOSPITAL.
1Emergency Department
1.1
Provision of spaces for different levels of care i.e. resuscitation area( Red Zone ),
intermediate area ( Yellow Zone ), consultative area( Green Zone ) and
observation ward.
1.2
Separate entrance for walk-in and ambulance cases with
dedicatedexamination and treatment areas for paediatric cases i
n shall beprovided hospital with more than 500 beds.
1.3
No operation theatre (OT) shall be provided in the emerg
e n c y department except hospitals identified as
Trauma Centre eg. TheNew Sg. Buloh Hospital.
1.4
Crisis centre / one stop centre shall be provided.
1.5
Dedicated general x-ray unit may be considered for hospitals largerthan 700 beds.
1.6
Mobile x-ray unit shall be provided at the resuscitation area.
1.7
Each resuscitation bay shall be provided with 2 medical gas pendants(dry and wet
type)
1.8
Facilities for certain disciplines such as dental, eye
a n d E N T examination shall be provided in a separate procedur
e room forhospitals larger than 500 beds.
1.9
A covered area for disaster management shall be provide
d i n hospitals with more than 500 beds
1.10
No medical gas outlets shall be provided in the disaster managementarea.
1
Specialist Clinic
1.11
A centralised registration area is required. However followupappointments will be done by the respective clinics.

1.12
The department shall use the concept of multi-user clinic with
ac o m b i n a t i o n o f a p p r o p r i a t e d i s c i p l i n e s a s p e r m e d i c a l b r i
e f o f requirements.
1.13
Each clinic unit shall have its own dedicated investigation / treatmentareas e.g.
echocardiography rooms for cardiac clinic, phototherapyroom for dermatology
clinic, etc.
1.14
Certain disciplines may need dedicated clinics e.g. ENT, Eye an
dDental.
1.15
50% of consultation and examination ( CE ) rooms are to be equippedfully with
equipment for dedicated specialities.
1.16
CE rooms for hospitals with visiting ENT specialists will be
providedonly with the basic specialist set. For more intensive diag
nosticinvestigations, cases have to be referred to referral hospitals.
1.17
For 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 clinics needs.
1.18
In view of the flexible usage of clinics according to sched
u l e s , electronic digital signage shall be provided.
1.19
Provision 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.
1.20
General x-ray facilities may be considered if the
d e p a r t m e n t i s located far away from the Imaging Department.
1.21
The clinic shall be fully air-conditioned including waiting areas.
2
Day Care (A Multidisciplinary Day Surgery & Medical Day Care)
2.1
It shall have its own entrance if possible. Services provided are:

Medical daycare.

Surgical daycare.

Endoscopy procedures.
2.2
Number of OTsrequired :

500-bedded hospitals and above :5 - 8

OTs

250 to 500-bedded hospitals : 2 - 4 OTs

Less than 250 beds : to share with hospital main OTs.

1
Dialysis Unit
2.3
Adialysis unit is to be provided in hospitals with 250 beds or more.
2.4
This unit shall carry out both peritoneal dialysis and
haemodialysisservices.
2.5
No. of bays required :

500 to 1000-bedded hospitals : 10 - 20 bays

250 to 500- bedded hospitals : 4 - 8 bays

2.6
Space for additional bays to be provided for future needs.
2
Labour and Delivery (L&D) Unit
2.7
Provision of individual delivery rooms. Attached toilet to be sharedbetween
2 rooms.
2.8
50% 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).
2.9
Infant resuscitation equipment shall be provided in designated infantresuscitation area.
3

Intensive Care Unit (ICU) / High Dependency Ward (HDW) /

CardiologyRehabilitative Ward ( CRW ).
3.1
Multidisciplinary 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.
3.3
25% of HDW beds shall be equipped with ventilators.
3.4
CRW shall be provided in hospitals with a cardiologydepartment.
3.5
All rooms shall be provided with collapsible sliding doors.
3.6
Each bed in ICU and HDW shall be provided with 2 medical
gaspendants (dryand wet type).
3
Burns Unit
3.7
A burns unit is to be provided as a separate unit in hospitals of 700beds
and more and may require a dedicated OT.
3.8
For hospitals with less than 500 beds, it shall be part of the ICU.
3.9
Everyburns bed shall have a dedicated burns bath.
3.10
The sterility and infection control policy shall be as in accordance withOT
environment.
3.11
50% of burns beds shall be provided with 2 medical gas pendants (dryand wet type)
each .
4
Coronary Care Unit (CCU)
4.1
Provision 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).
4
Special Care Nursery/ Neonatal ICU (NICU)
4.2
Provision of space for different levels of care i.e. in
t e n s i v e , intermediate, convalescence and isolation.
4.3
New design concept - cots arranged in circular pattern for more
efficient nursing care ( however this needs about 15% morespace )
4.4
Beds 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.
4.5
NICU in hospitals with more than 500 beds shall have its
o wn respiratory and haemodynamic unit if located far away from the ICU. This unit
shall be managed by the anaesthetic department.
5
Infant Nutrition Unit
4.6
Infant nutrition unit (IFN) shall be provided in hosppitals with morethan 250
beds.
4.7
Automated washer, dispenser, blender and pasteurizer for the milkkitchen
will be provided in hospitals with more than 700 beds.
4.8
For hospitals with less than 250 beds, a milk kitchen will not
beprovided. Ward pantries to be used for milk preparation.

Operating Theatre (OT)

4.9
O t h e r t h a n t h e m a i n t h e a t r e c o m p l e x , d e d i c a t e d O Ts s h a l l
b e provided in the following units.

L&D suite : 1-2 OTs for hospitals with 500 - 1000beds.

Day Care Surgery : for hospitals with 250 beds ormore.

4.10
Anaesthetic preparation area is to be shared between 2 OTs.
4.11
The OT complex shall have direct access to the respiratory and
haemodynamic 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.
4.14
Each OTroom shall have its own air handling unit (AHU ).
4.15
Each OT room shall be provided with 2 movable med
i c a l g a s pendants.
4.16
Certain OT rooms need to be lead lined particularly Orthopaedic OT,UrologyOT,
emergency Otand others or as specified in the brief.
7
Wards
4.17
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 patients privacy.
4.18
Other than the clinical areas, the following areas are required:

Visitors lounge (maybe shared between 2 wards)

For hospital with 500 beds or more, a seminar room shall be

provided in each ward. Hospitalswith less than 500 beds, a seminar room may
beshared between 2 wards.

Dayarea 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.

4.19
Requirements of specific wards :-a ) P a e d i a t r i c
W a r d

Amother's bed cum sofa to everypaediatric bed.

Play area.

Rest area and pantry for mothers.

School room and library.

( T h e m o t h e r s p a n t r y, t h e s c h o o l r o o m a n d librarymay 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-outcurtains.

4.20
TV set shall only be provided in day lounge of all wards. Howeverwallmounted TV sets shall be provided in the VIProoms
4.21
Provision of medical gas shall adhere to HTM 2022 or as specified inthe latest
standards / guidelines.
4.22
Automatic washer disinfector shall be provided in all dirty utilityr
ooms.
4.23
Ceiling fans shall be provided for each individual third-class bed.
8
CSSD/TSSU
4.24
Provision of autoclaves and low temperature sterilisation.
4.25
Cold sterilisation facilities / equipment shall also be provided in themain
operation theatre complex and day care unit.
4.26

Respiratory and haemodynamic unit shall not be part of the CSSD.

4.27
Automatic cart washer shall be provided for hospitals with 250 bedsor more.
4.28
CSSD 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.
9
Imaging Departments
4.29
Invasive radiology investigation will be the future trend, such as
angiography.
4.30
CT Scan, Magnetic Resonance Imaging (MRI) and Angiography shallbe provided in
all `state' hospitals and hospitals more than 500 beds.
4.31
Mammography with facilities for biopsy shall be provided for hospitalswith more than
250 beds.
4.32
Dedicated imaging facilities shall be provided for Emerge
n c y Department for hospitals with more than 500 beds. For hospitals
withl e s s t h a n 5 0 0 b e d s , m o b i l e x - r a y u n i t s h a l l b e p r o v i d e d
i n t h e Emergency Department.
4.33
Specialist clinics shall have its own basic X-ray equipment if locatedaway from the
Imaging Department
4.34
Ultra-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
250 beds:

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.
4.35
Future imaging rooms shall be provided with lead lined wall and all the required
mechanical and electrical (M&E) services.
10
Pathology Department
4.36
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.
4.40
Dedicated areas for simple tests such as dipstix shall be provided atthe specialist
clinics e.g. Antenatal, Urology and Nephrology Clinics.
4.41
For 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.
4.42
In 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.
4.44
Microbiology laboratory shall have an air lock with its own
a i r - conditioning and exhaust system.
4.45
Designated AHU shall be provided for different working areas such asMicrobiology,
Histopathology,Virology, etc.
11
Pharmacy
4.46
Satellite pharmacy shall be provided in hospitals with 250 beds or
more. Each satellite pharmacy shall serve a number of wa
r d s according to the layout and design ( 4 8 wards ) or serve several
wards within a building.
4.47
Areas 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.
12
Catering
4.48
Catering Department shall be designed to cater for
central platingsystem
and
central washing system
w i t h t h e f o l l o w i n g characteristics:
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.
4.50
Cold rooms are to be provided for kitchen in hospitals with more than500 beds.
13
Transport Systems
4.51
Multi-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
The number of stations shall be able to meet the fu
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.
1
On-Call Complex / On-Call Rooms
4.53
On-call complex shall be provided within the hospital compound in
hospitals with more than 250 beds.
4.54
Dedicated 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.
5
Hospital Information System (HIS)
5.1
Information Technology (IT) shall be implemented in all new hospitals,as part of the
project.
5.2
In 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)Intermediate HIS for hospitals having betwee

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 .
5.3
Infrastructure e.g. cabling and trunking for future IT expansion shallbe provided in
all hospitals.
5.4
IT terminals and work stations shall be determined based on the
policy and work process of the ITenvironment.
1
Other Areas
5.5
All hospitals shall be designed as baby-friendly and communityfriendly hospitals, therefore facilities for the disabled, breast -feedingroom and nappy
change area shall be provided in all hospitals.
5.6
P r a ye r r o o m s m a y b e s h a r e d a m o n g s t a f f , p u b l i c a n d p a t i
e n t s . Depending on the design and layout, a prayer room may be
shared between departments, units and wards.
5.7
All working areas shall have windows and natural light.
5.8
Taps of a clinical wash-hand basins shall be of the elbow action type.
5.9
Outdoor therapeutic gardens shall be provided in all hospitals. It shall be accessible
to the public including the handicapped.
5.10
A meeting room shall only be provided in general administration
office, specialist office and CME complex.
5.11
Epoxy paint shall be used in all clinical areas and waiting areas.
5.12
Glass partitions / walls shall be used in offices, clinic and
waitingareas.
5.13
Car 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 System

5.14
Copper type calorifier shall be use for the hospitals hot watersystem to
prevent the possibility of Legionnaires disease.
15
Drainage
5.15
Covered drain system shall be built.
16
Fence
5.16
Decorative
fencing shall be provided for the hospital frontage.
5.17
Perimeter fencing for nurses hostel shall not be provided unless
indicated.
17
Access Road
5.18
There shall be a separate entrance for the service vehicles away fromthe main entrance.
5.19
A 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.
5.20
Covered linkway to the hospital complex shall be provided from
thehostels and the hospitals / nearest public bus stand.
18
Staff Accommodation
5.21
S t a f f a c c o m m o d a t i o n s h a l l b e o f a p a r t m e n t - t yp e ( m u l t i s t o r e y building). Balcony shall not be provided.
5.22
The number of carparks shall not be less than the no. of units.
5.23
Outdoor recreation facilities including childrens playground shall beprovided.
5.24
Security 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
staffaccomodation.
19
Balai Pelawat with Cafeteria
5.26
Balai Pelawat and cafeteria may be built as one building.