ISU UTAMA

ARSITEKTUR
PASCA COVID

Adi Utomo Hatmoko, IAI, AA

Adi Utomo Hatmoko
adiutomohatmoko@yahoo.com
Jakarta, January 29, 1969

Ir., Gadjah Mada University,

cum laude, 1991

M.Arch., Georgia Institute of Technology, Atlanta,

USA,
Fulbright Scholarship, 1996

IAI, Arsitek Utama,

Indonesian Institute of Architect
AA, Asean Architect

Lecturer, Architecture Department,

Gadjah Mada University, 1991-now
Lektor Kepala

Founder, Principal,
PT. Global Rancang Selaras, 2002-now
http://www.globalrancangselaras.com
More than 160 hospital design nationwide
 Bagian 1

KOTA PASCA COVID

Isu Utama Kota

Urban Context
Ruang Terbuka dan Hijau Kota

Peningkatan apresiasi
terhadap ruang terbuka dan
hijau kota

Perlu lebih banyak ruang

terbuka dan hijau kota
sebagai suatu sistem,
terdistribusi secara
proporsional merata
4
Isu Utama Kota

Urban Context
Sistem Transportasi Kota

Bahaya dari pemilihan

kendaraan pribadi ketimbang
kendaraan umum

Perlu meningkatkan
kenyamanan kota untuk
pejalankaki dan pesepeda

5
 Bagian 2

ARSITEKTUR PASCA COVID

Isu Utama
Arsitektur

Architecture
Sirkulasi

Melebarnya selasar dan

dihidupkannya selasar
terbuka

Bertambahnya moda sirkulasi

vertikal

Pembuka pintu dan pengatur

lift tanpa/minimal sentuhan
7

Toilet umum minimal pintu

Isu Utama
Arsitektur

Architecture
Ruang dan Fungsi

Bergantinya open layout

shared spaces

Kontak dengan udara luar

Pengaturan kepadatan,
termasuk memikirkan ulang
coworking spaces
8
 Bagian 3

RUMAHSAKIT
PASCA COVID
Isu Utama
Rumahsakit

Hospitals
1. Pisahkan pasien
sebelum memasuki
rumahsakit dengan
multiple entrance
Sumber: HKS

10
Isu Utama
Rumahsakit

Hospitals
2. Pisahkan pasien
dan pengunjung
dari staff medik
dengan membuat Sumber: HKS

sirkulasi yang
berbeda

11
Isu Utama
Rumahsakit

Hospitals
3. Buatlah alur atau
flow satu arah pada
area ruang-ruang
dengan pasien
yang terinfeksi
Sumber: HKS

12
Isu Utama
Rumahsakit

Hospitals
4. Buat ruang-
ruang pasien yang
lebih mudah
dibersihkan

13
Isu Utama
Rumahsakit

Hospitals
5. Bungkuslah atau
lindungi peralatan2
rumahsakit
semaksimal
mungkin dari Sumber: HKS

paparan pasien
infeksi
14
Isu Utama
Rumahsakit

Isolation Room
6. Perhatian khusus
pada tempat ganti
APD, toilet pasien,
dan toilet staff

15
 Isu Utama
Rumahsakit
Infection
The invasion of a foreign organism
(pathogens) in body, their multiplication,
and the reaction of host tissues to the
infectious agents and the toxins they
produce. Examples of pathogens include
bacteria, viruses, fungi, and prions.
Infection Prevention
in Hospitals
Infectious disease (also known as
transmissible disease or communicable
disease) is illness resulting from an
infection.
Infection can be transmitted in a variety
of ways, these include skin contact,
bodily fluids, contact with feces,
airborne particles, and touching an
object that an infected person has also
touched.
Introduction
Airborne disease
Is any disease caused by pathogens
(virus, bacteria, fungi) that can be
transmitted through the air. They may be
spread through breathing, talking,
coughing, sneezing, raising of dust,
spraying of liquids, toilet flushing or any
activities which generates aerosol
particles or droplets.
Preventions
• Avoid close contact with people who
have active symptoms of disease.
• Stay home when you’re sick. Don’t let
vulnerable people come in close
contact with you.
• If you must be around others, wear a
face mask to prevent spreading or
breathing in germs.
• Cover your mouth when you cough or
sneeze. Use a tissue or your elbow to
cut down on the possibility of
transmitting germs on your hands.
• Wash your hands thoroughly (at least
20 seconds) and often, especially after
sneezing or coughing.
• Avoid touching your face or other
people with unwashed hands.
 Risk Management

Overview

Establish the Context

Communicate and Consult

Monitor and Review

Risk Identification

Risk Analysis

Risk Evaluation

Risk Treatment
 Risk Management

Step 1: Establish the Context

Intensive
Care Unit

Operation Blood
Transfusion
Room Services

Coronary Care Emergency

Unit Room
 Risk Management

Step 2: Identify Risks

Process whereby the healthcare Sources of risk identification:

professional and the employees
become aware of the risks in the Discussions with
department chiefs, Patient Tracer Activity
healthcare services and
managers, and staffs (PTA): to trace the
environment.
journey of a patient
Use a register if necessary. Patient complaints from admission until
and satisfaction discharge
survey result
Healthcare Associated Facility management
Infections (HAI) and safety committee
reports reports

Incident reporting Specialized committee

system reports
Risk Management
Types of hazards and examples:
Category Definition
Chemical Chemicals that are toxic or
irritating to the body
Physical (forms of energy) Physical agents that can cause
tissue trauma or other damage
Biological Infectious biological agents
such as bacteria, viruses, fungal
infections, and parasites
Ergonomic The interfere between the
human characteristics,
behavioral & biological and the
working environment
Psychological Factors that create stress,
emotional strain, or
interpersonal problems
Examples
Toxic dusts, fumes, vapours,
mists, poisons, asphyxiants, etc
Noise, ionizing and non-ionizing
radiation, vibration, chafing,
cutting, bruising, etc
TB, Cholera, Hepatitis A, B, C, D
etc, fungal infections, Ebola, etc
Musculo skeletal stress, fatigue,
tactile feedback, posture, etc
Boredom, shift work, work
pace, stressful environment eg
trauma unit
Risk Management
Types of infections and examples:
Types Definition
Viral infections Caused by virus. A virus may remain
dormant for a period before
multiplying again. The person with
the virus can appear to have
recovered but may get sick again
when the virus reactivates.
Bacterial infections Bacteria can live in almost any kind
of environment, from extreme heat
to intense cold, and some can even
survive in radioactive waste.
Fungal infections Caused by fungus. Could appear in
the upper layers of the skin or to the
deeper layers. Inhaled fungal spores
can lead to systemic fungal
infections that could affect the
whole body.
Others Infection that caused by other than
the above.
Examples
Common cold (rhinovirus,
coronavirus, adenovirus),
Encephalitis and meningitis
(enterovirus and herpes viruses),
hepatitis C, HIV, polio, influenza,
H1N1, ebola, dengue fever
Cholera, diphtheria, dysentery,
pneumonia, tuberculosis, typhoid,
typhus, gastritis, sinusitis, bacterial
meningitis, skin infections, urinary
tract infections.
Valley fever, athlete’s foot,
ringworm, eye infections, rashes.
Prion disease (abnormal protein),
protozoan infection, ectoparasites
 Risk Management
Step 3: Analyze Risks
Is about developing an
understanding of the risks
identified. Includes:
• Level of the risks
• Underlying causes
• Existing control measures
Step 4: Risk Score Analysis
Consider both sequence (how bad?) and
likelihood (how often?), is there a need for
additional action? The law requires to
provide a service to do everything reasonably
practicable to protect patients from harm.
• Use organization’s risk matrix
• Decide on the precautions (controls) that
will reduce consequences and or likelihood
• Re-evaluate the risks assuming the
precautions (control) has been taken
Risk Management
Example of risk matrix
 Risk Management

Step 5: Risk Treatment

Controlling
the risk
Means taking actions to
eliminate or reduce the Treat the Transferring
likelihood that exposure to a Evaluate risk the risk
hazard that will result injury risks Accept the Avoiding
or disease. risk the risk
 Controlling the Risk

Personal Measures and

Administrative Control could be
instructed to patients, visitors and
clinical staff and can include a
variety of measures, including hand
Engineering
Control washing (even for airborne
diseases), the wearing of masks,
removal of jewelry (and ‘bare
below the elbow’), reduced
Personal Administrative physical contact (such as kissing,
Measures Control
etc.)
Engineering Control include
building ventilation, use of HEPA
and other air cleaning methods,
use of air disinfection methods, etc.
 Building Ventilation
Basic elements of ventilation
(both natural or mechanical)

Ventilation Airflow Air

Rate Direction Distribution
The external air
should be
delivered to
The amount of each part of the
The overall
outdoor air that space in an
airflow direction
is provided into efficient manner
in a building,
the space, and and the
which should be
the quality of airborne
from clean
the outdoor air pollutants
zones to dirty
should be generated in
zones.
considered. each part of the
space should
also be
removed.
Isu Utama
Rumahsakit

Hospitals
Ruang Isolasi

An isolation facility aims to

control the airflow in the
room so that the number of
airborne infectious particles
is reduced to a level that
ensures cross-infection of
other people within a
healthcare facility is highly
unlikely.
28
Overview

Isolation Room
Ways to reduce airborne infectious particles

• Control the quantity and quality of intake or

exhaust air
• Maintain different air pressures between adjacent
areas
• Designing airflow patterns for specific clinical
procedures
• Diluting infectious particles with large air volumes
• Air filtration (HEPA filters, etc.)

29
Overview

Isolation Room
Types

1 Class S – Neutral/ Standard 2 Class P – Positive

Neutral or standard isolation Positive room air pressure where
room uses standard air pressure. an immune-compromised patient
is protected from airborne
3 Class N – Negative transmission of any infection.
Negative room air pressure, where
others are protected from any
4 Class Q (Quarantine)

airborne transmission from a Negative room air pressure

patient who may be an infection with additional barriers
risk. including an Anteroom.

30
Class N

Isolation Room
Usage
For patients who are the source of infections. They
typically require airborne droplet nuclei isolation
(this includes pathogens such as measles, chicken
pox, legionella, tuberculosis).

Design Consideration
• Room pressure is lower than the adjoining rooms or corridor
• Exhaust system should be provided , and should remove a quantity of air greater than
supply air.
• Exhaust air duct should be independent of the building exhaust air system (to reduce the
risk of contamination)
• The Ensuite room exhaust should not be connected to the toilet exhaust system.

31
Class N
Recommended elements

Isolation Room
• Anteroom is optional
• A clinical handwash basin in the isolation room
and Anteroom
• An Ensuite shower and toilet
• A self closing door
• 100% outside air ventilation, with low level
exhaust ducts (100-300 mm height from floor
level)
• No return air permitted
• Exhaust air should be HEPA filtered
• Differential air pressure instrumentation panels
are required, and should be installed adjacent to
the corridor entry door.

Figure 3
Infection Isolation Room Ventilation Arrangement
Healthcare Isolation Rooms Architectural and Mechanical Design Considerations
32
Class N

Isolation Room
Recommendation for Class N
Room Pressure gradients:
• Isolation Room -30
Pa
• Anteroom -15 Pa
• Ensuite -30 Pa
Any additional pressure
gradients between
successive pressurized areas
should not be less than 15
Pa

Figure 4

Airflows and Relative

Pressure Gradients
International Health Facility Guidelines
33
 Class N

Isolation Room
Ensuite

Isolation Room

Anteroom

Zone for Low Level

Exhaust

Figure 5
Layout Plan
Australasian Health Facility Guidelines
34
Class N

Isolation Room
Elevation 1 Elevation 2

Figure 6
Elevation
Australasian Health Facility Guidelines
35
Class N

Isolation Room
Elevation 3 Elevation 4

Figure 7
Elevation
Australasian Health Facility Guidelines
36
 Isolation Room
Class N
Ensuite
Isolation room
Anteroom

Figure 8
Axonometric
International Health Facility Guidelines
37
 Class Q
Usage

Isolation Room
For accommodating highly infectious patients
with pathogens such as haemorrhagic fever
and pneumonic plague.

Design Consideration
• Requires negative pressure isolation with
additional protection
• The patient bedroom should be capable of
intensive care treatment with dialysis and able
to accommodate an oversized bed.
• The size of airlock should be large enough to
allow for bed movement.

Figure 12
Infection Isolation Room Ventilation Arrangement
Healthcare Isolation Rooms Architectural and Mechanical Design Considerations
38
 Class Q

Isolation Room
Recommended elements

• Anteroom is equipped with interlocking and

self closing doors
• An Ensuite shower and toilet
• A clinical handwash basin in the isolation
room and the anteroom
• Exhaust air should be HEPA filtered, supply
air should also be HEPA filtered
• Supply air ducts are to be independent of
the building supply air system
• Alarm to be activated on loss of differential
pressure

International Health Facility Guidelines

39
Class Q

Isolation Room
Legend:
Entry for patient and staff
Exit for staff, decontaminated
equipment
and waste

Figure 13
Typical Layout Plan
International Health Facility Guidelines
40
Comparison

Isolation Room
Table 1
Isolation Room Features
Tarawneh Walid, 2018
Patient Isolation Room" Main Considerations
in Design and Planning of Emergency
Department (ED)
41
 Number of Isolation Rooms
Consideration
Numbers of isolation rooms should be
determined by:
• Trends in disease of the general population
• Demographic trends of the population
catchment area
• The health facility’s speciality services
Number for Class N Isolation Room
At least one Class N- Negative pressure
isolation room per 100 inpatients’ beds.
International Health Facility Guidelines
Isolation Room
Number for Class P Isolation Room
No set standard for the provision of positive
pressure isolation rooms. It is determined by
the service profile and the model care of the
facility.
The service profile should be based on local
population requirements, including
prevalence of cancer, AIDS, cystic fibrosis,
organ transplant, and other conditions that
may compromise immunity.
42
Location
Location for the

Isolation Room
patient isolation rooms
to be at the end of the
patient rooms whether
in ED or others in
patient departments.

5 Decentralize nurse stations on larger units to

increase patient visibility and reduce nurse
1 Windows at end of corridors enable way travel distances
finding and bring natural light into the core
3 Separate public entry points from 6 Decentralize support functions to reduce
2 Locate support space doors in cross patient and service access hunt and gathering by staff
corridors off stage of main corridors to
reduce traffic and limit noise in patient
4 Locate nurse station or communication 7 Locate staff support close to unit but away
corridors. Access from both corridors. center adjacent to entrance to the unit from patient rooms for staff

Figure 14
Department of Veterans Affairs (VA), Medical / Surgical Inpatient Units & Intensive Care
8 Suggested locations for patient isolation
Location Nursing Units, November 29, 2011 room (Class N) 43
Location

Isolation Room
Figure 15
Location
Collin David, 2018
Considerations in Building a New
Haematology
Unit 44