Hospital:

Hospitals/Healthcare centres are the first contact point between members of thePublic and
health workers.

Medical institutions provide treatment for and care of patients with a wide range of
chronicacute conditions.

Construction must satisfy the needs of a number of functions: accommodation,

research,teaching, medical activity, storage and administration.

Most important to remember wihle designing is that you are designing for physically
unfitpeople.
here are several that should be considered in the design of a primary healthcare
building.These include

Location of the building: should be convenient in relation to the people it serves.

Circulation: Entrance and circulation within the building must consider wheelchair users,parents
with small children and people with disabilities, etc.

Effective zoning is required: public zone, clinical zone and staff zone.

Privacy and confidentiality are important, especially at the reception desk and clinical
roomsduring consultations and treatments.

Security and supervision in the premises will be necessary, including staff protection
againstpersonal assault and safeguarded against theft and vandalism.

For running costs, efficient staffing, energy efficiency, long-life and lowmaintenanceapproache should be adopted.

Flexibility and growth should be catered for: flexibility in use of some, and potential forfuture
extension of the building.
Location:

Site should offer sufficient space for self contained residential areas and hospital
departments.

Should be a quiet location with no possibility of future intrusive developmnet.

Adequate area should be there for future expansion.

Should be away from dust, noise and pollution.

PLANNING CONCEPTION
Orientation:

Treatment and operating rooms are preferred between north-west and north-east.

For nursing ward facades, south and south-east is favourable due to:Pleasant morning
sunMinimal heat build upLittle requirement for sun shadingMild in the evenings

East and west facing rooms have comparatively deeper sun penetrations, though less
wintersun.

The orientation of wards in hospitals with short average stay is not so important.

Some departments might require rooms on the north side so that patients are not subjectesto
direct sunlight.
Forms of building:

Spine form with branching sections.

Radial arrangement, i.e. circulation will be radially outward from the centre of the core.

Any form that goes with the proper connectivity of all the units.
Effective arrangements:

Top floor:
Helipad, ac plant room, nursing school, laboratories.

2
nd
/3
rd

floor:
Wards can be provided.

1
st
floor:
Central sterilisation
unit, surgical area, intensive care, maternity, childrens hospital.

Ground floor:
Entrance, radiology, medical services, ambulance, entrance for bed-riddenpatients, emergency
ward, information centre, administration, cafeteria.

Basement:
Stores, physiotherapy, kitchen, heating and ventilation plant room, radio
therapy,linear accelerator.

Sub-basement:
Under ground garage, electricity supply
Functional Area 1

Care
SurgeryRecovery areaRehabilitaionPhysiotherapyX-ray diagnosisNMR
diagnosisRadiotherapyClinico-chemical laboratoryClinicophysical laboratoryClinico-neurophysical laboratoryCentral reception
and treatmentDeliveryDialysisSpecialist anaesthesia departmentSpecialist eye
departmentSpecialist surgical departmentSpecialist gynaecology
departmentSpecialist obstetricts departmentSpecialist ENT
departmentSpecialist internal medicine departmentSpecialist surgical
departmentSpecialist paediatric departmentSpecialist neurology
departmentSpecialist psychiatry departmentSpecialist X-ray area
departmentSpecialist urology department

CORRIDORS, DOORS, STAIRS, LIFTS Corridors

: Must be designed for the max. Expected circulation flow.

Acess corridors must be atleast 1.50 m wide.

Corridors for access by patients and equipment shall have a min. width of 2.25 m.

Suspended ceiling in corridors may be installed upto 2.40 m.

Windows for lighting and ventilation should not be more than 25 m apart.

Effective width of the corridors must not be constricted by projections, columns or

otherbuilding elements.

Smoke doors must be installed in ward corridors in accordance with local regulations.
Doors
: Doors must be designed keeping the hygiene requirements in mind.

Surface coating must withstand the long term action of cleaning agents and disinfectants.

Designed to prevent the transmission of sound, odours and draughts.

The clear height of doors depends on their type and function -(1) Normal doors: 2.10 - 2.20
m(2) Vehicle entrances, oversized doors: 2.50 m(3) Transport entrances: 2.70 - 2.80 m(4) Min.
height on approach roads: 3.50 m
Stairs
: Must be designed in such a way that if necessary they can accommodate all of thevertical
circulation.

Should consist four flights and three landings between finished floor levels.

Finishing material should not be slippery.

Handrails must be provided on both sides at a height of 1000 mm.

The minimum headroom in a passage under the landing of a staircase and under the
staircaseshall be 2.2 m.

Winding staircase should be avoided for main access.


Doors must not constrict the useful width of the landings and, in accordance with
hospitalregulations, doors to the staircases must open in the direction of escape.

Effective width: 1.5 - 2.5 m.

Riser: 170 mm.

Tread: 280 mm.

Riser/tread ratio of 150:300 is preferable.

Lifts
: Transports people, medicines, laundry, meals, hospital beds/stretchers, etc.

At least two lifts for transporting beds/stretchers must be provided.

One multipurpose lift should be provided per 100 beds, with a minimum of
two for smallerhospitals.

A min. of two smaller lifts for portable equipment, staff and visitors.Clear dimensions of
lift car: 0.90 x 1.20 mClear dimensions of shaft: 1.25 x 1.50 m

Internal surfaces must be smooth, washable and easy to disinfect, the floor must be non-slip.

Lift shafts must be fire resistant

MEDICAL AND ANCILLARY SERVICES OUT PATIENT DEPARTMENT(O.P.D)
:
The O.P.D provides consultation, investigationand diagnostics for patients who require little or
no recovery services afterwards.
Outpatient :
Any person given general or emergency diagnostic, therapeutic or preventivehealth care and
who at that time is not registered as an in-patient in the hospital.
Location:
Should be located on the ground level preferably.

Should be close to vital adjunct services such as registration and medical records,
admitting,emergency and social service.

Should be easily accessible to the laboratories, radiology, pharmacy and physical departments.


Should have a separate entrance and adequate parking facilities.
Organization:
The staff is made up of four major organizational components

Medical staff (It is central to the organization)

Nursing staff (Consists of registered nurses, nursing and hospital aides)

Ancillary staff (Includes radiology, laboratory and ECG technicians)

Clerical staff (Carries out registration, patients billing, receiving cash, secretarial, records, etc
FUNCTIONS OF OPD:

Early diagnosis, curative, preventive and rehabilitative care on ambulatory services.

Effective treatment on ambulatory basis.

Screening for admission to hospital.

Follow up care and care after discharge.

Promotion of health by health education.

Rendering of preventive health care

SIZE OF O.P.D (GENERAL REQUIREMENT):
Recommendations a/c to BIS(Bureau of Indian Standards)
For entrance zone - 2 sq. m./bed.

Ambulatory zone - 10 sq. m./bed.

Diagnostic zone - 6 sq. m./bed.

Total hospital area - 60 sq. m./bed.Sub-waiting area - should be 1 /3rd of total patients visiting
clinic per day.Consultation room Space for doctors chair, patients stool, follower seat, wash basin,

examination couch and equipment for examination.Area - 15-17 sq. m. and each clinic should
handle 100 cases per day.Special examination room - Required for certain departments
IMPORTANCE OF OPD:

First point of contact.

Facilitates teaching.

About twice the in-patients attend O.P.D everyday.

A good O.P.D service can reduce the work load on in-patient services.

It is a place for implementing preventive and promotive health activities

FACILITIES AND SPACE REQUIREMENTS
Public Areas and Administration:

Wheelchair and stretcher storage alcove.

Reception and information desk.

Registration counter and cubicle for staff.

Lobby and waiting lounge.

Public toilet facilities.

Public telephone(s)/room with assisted STD/ISD call facilities, etc.

Water coolers or drinking fountains.

Space/office(s) for supplies, equipment, etc.


Multipurpose room(s) for conferences, meetings, health education programmes, etc.

Employees facilities including lockable drawers and cabinets and for personal belongings.

General storage for supplies, equipment, etc.

Coffee shop/snack bar in the vicinity.

Meditation room/retiring room.

Doormans station.
Clinical Facilities:

General purpose examination rooms

min. floor area 7.43 sq. m, excluding vestibules, toilets,closets, etc. Wash basin and a counter
top for writing.

Special purpose examination rooms

for specialty clinics such as eye(dark room required), ear,nose, throat

facilities as required for special procedures and equipment. Wash basin,counter/work top, etc.

Treatment room for minor procedures and cast work.

Nurses station with work counter, communication system, space for charting, supplies,
refrigerator, locked storage for drugs, etc.

Clean storage for storing clean and sterile supplies, cabinets and shelves.

Containers for storing clean and sterile supplies, cabinets and shelves.

Containers for collection, storage and disposal of soiled materials.

Sterilizing facilities.

Wheelchair storage space out of the direct line of traffic.

EMERGENCY SERVICES:
Purpose:
To treat patients who seek emergency services for situational medical conditions otherthan
acute medical services.
Location:
Should be located on the ground floor with easy access for patients and ambulances.

Should have a separate entrance to the department, which is away from the
main hospital andthe outpatient entrances.

The department should be close to the admitting department, medical records

and cashiers
booth.

Should be close to radiology unit, laboratory services, including the blood bank.

Should be close to elevators so that one can proceed to surgery without loss of time.
Design:
The entrance to the emergency should be sheltered to protect ambulance patients fromthe
weather while unloading.

Adequate reserved parking space for ambulances and cars of patients and medical staff.

Entrance should be large enough to admit one or more ambulances negotiating withstretchers.

Ramps should be provided for wheelchair and pedestrian access.

Design should facilitate good public relations and quick access to the patients by staff
andsupplies

Organization:
An efficient, prompt, well-equipped ambulance service with competent personnelin charge.

A well equipped emergency operating room with supplies always ready for use.

A small recovery room.

Efficient personnel including at least a component physician, nurse, and attendant onround-theclock duty or on call.

Supervision of treatment of fractures and other injuries by qualified and competent

surgeonsin their respective fields.

Adequate diagnostic and therapeutic facilities under competent medical staff.

A well documented medical record for every patient that includes immediate record of
allinjuries, physical findings, treatment, etc
FACILITIES AND SPACE REQUIREMENTS

Facilities in the emergency department can be considered broadly under two categories:

Administrative and public areas

Clinical facilities
Administrative and Public Areas:

Reception-control: For observation and control of access to the treatment area, public
waitingarea, and pedestrian and ambulance entrance area. Should be equipped with a
communicationsystem including intercommunication.

Waiting patients and their relatives should be better shielded from what is going on in
thetreatment area.

Space for stretchers and wheelchairs adjacent to the entrance but out of the stream of
traffic.


Stretchers should be provided with wheel locks.

Waiting area should be separated from the working or treatment area and should be
providedwith toilet facilities, water coolers, or drinking fountains, public telephones, STD and
ISDcall facilities and vending machines if possible.

Space/room for security staff, police, ambulance driver and attendant.

Office for the night adminnistrator/night supervisor

can be off site but not too far away.

Coffee snack bar in close vicinity

Clinical Facilities:
Four major functional areas can be identified. These are
Trauma care area where the severely surgical cases are handled.

Medical examining area.

Splintage and casting area for orthopaedic cases.

Observation beds for patients who need to be kept under observation for neurological
andother medical reasons.
Facilities Required:

Trauma rooms for emergency trauma procedure or where the severely injured surgical
casesare handled. Resuscitation and life support equipment and drugs, medical gas
outlets,examination table, examination lights, X-ray film illuminators, cabinets and supply
shelves. Fororthopaedic and cast work, it is necessary to have closed storage space for splints
and otherorthopaedic supplies, a plaster sink, traction hooks, etc.

Examination/treatment rooms with examination tables, examination lights, work

counters,cabinets, wash basins, X-ray film illuminators, medication storage facilities and medical
gasoutlets.

Scrub stations conveniently located to each trauma and orthopaedic room.

Additional adjustable space for triage, treatment, observation, etc. in the event of
disasterhandling.

Staff work area and charting space with counters, cabinets, medication storage
facilities,dictating facilities, etc.

Storage space for equipment such as portable Xray and crash carts (cardio
-pulmonaryresuscitation emergency carts) which should be easily accessible.

Separate soiled and clean utility rooms.

public toilets and janitors closet.

Rooms for duty/on-call doctors, separate for men and women, with sleeping
accommodation,shower and toilet facilities.

Locked cabinets, etc. for staffs personal effects.

OTHER CONSIDERATIONS

Triage Area:
The emergency department has an active role to play in situations when severalemergency
cases arrive in the hospital simultaneously, for example, victims of busor train accident, major
fire or other disaster.

The emergency staff are trained to recognize the nature and relative severity of a
patientscondition. In what is called the triage area, patients are rapidly sorted sent to
appropriate
treatment areas.

For example, hyper acute(life threatening) cases are sent to the emergency room,
seriouscasualties are sent to surgery area, ambulatory care(non-life threatening) cases to
outpatientdepartment, waiting room or observation area, the emotionally disturbed cases to the
chapelor meditation room, and the dead on arrival to the morgue.

A triage sorting system establishes priorities for treatment of critical patients. Priorities are
based on the degree to which the patients life is threatened.
Typically, patients are classified as follows:

Emergency: Patient requires immediate medical attention; life, limb or sight is threatened.

Urgent: Patient requires medical attention within a reasonable time and will be in danger if
notattended.

Non-emergency: Disorder is minor, not acute and can wait

CLINICAL LABORATORIES:
Purpose:
Primary function is to perform tests in the six main fields of bacteriology,
biochemistry,histology, serology, haemotology and cytology to assist medical staff in making
orconfirming diagnoses and in the treatment and prevention of disease.
Location:
Should be conveniently located on the ground floor to serve the outpatient,
emergency, and admitting departments. It should also be close to or easily accessible to sur
gery,intensive care, radiology and obstetrics.
FACILITIES AND SPACE REQUIREMENTS
Work counter with space for equipments.

Workstations should be equipped with vaccum, gas, electrical services, sinks and water.

Specimen collection area for blood, urine and faeces.

Work counter, space for patients seating and a wash basin.

Toilets with a washbasin for urine and faeces collection area.

Storage facilities for reagents, standards, supplies and stained specimen microscopic slides.

Admin. areas, offices for pathologists, secretarial and clerical work area, space for records.

Staff facilities.

Sterilizing area.

Glass washing area

dirty area that should be separated and closed.

Storage for surgical specimens

Blood Bank:
The functions of the blood bank encompass donor selection, collection of
blood,grouping and cross matching, testing for transmittable diseases, blood
componentseparation, storage of blood components, issue of components and data
management.According to the Government of India Drugs and Cosmetic Rules, existing blood
banks and thosethat intend to apply for a license to operate a blood bank are required to fulfil
the conditions setout in the amendments. The salient features of the conditions are

Seven rooms within a space of 100 sq. m.

Registration and medical examination room and blood collection room with suitable
furnitureand facilities.

Two laboratories, one for blood group serology and another for screening the blood for Hbs
Ag,HIV antibodies and syphilis. These should be air conditioned.

Two refrigerators for maintaining temperature between 4 to 6 degree C with

recordingthermometer and alarm device, one for the blood collection room and another for
laboratory.

Sterilisation and washing room.

Store and records room

RADIOLOGICAL SERVICES :
The main function of the radiological services is to assist clinicians in the diagnosis
andtreatment of diseases through the use of radiography, fluoroscopy, radioisotopes and
highvoltage acceleration