LITERATURE STUDY

SALUTOGENIC DESIGN FOR CANCER CENTRE

KARPAGAVALLI.S
2013-2018 BATCH
2601131AR141
 CONTENTS

• What is a Hospital and its classifications?

• Parts of Cancer Hospital
• Quantitative Factors
 CLASSIFICATION OF HOSPITALS:
HOSPITAL
Hospital is An institution providing
medical and surgical treatment and
nursing care for sick or injured people.

ETYMOLOGY:
Latin word: Hospes = Stranger/ guest
Hence,
Hospitium = Hospitality
Shelter for hospitality = Hospital
 Classification of Hospitals
By Function By Ownership
General Hospital: Specialty
Hospitals: Government Hospital: NGO or Charitable Trust
A Hospital not
Run Hospitals:
specializing in the Types of specialized These are hospitals that are
treatment of any hospitals include owned and operated by the They usually follow the
particular illness or Government of India or a economic model of
trauma centres, particular state. charging the rich to
patient of a particular rehabilitation hospitals, subsidize the treatment of
sex or age group They are usually charitable in
children's hospitals, poor. They are often run
nature offering highly
Multi-Specialty seniors' (geriatric) by donations and
subsidized treatment,
Hospitals: hospitals, hospitals for government subsidy. Often
diagnosis and medicines.
lack the cutting edge
These are hospitals dealing with specific technology due to lack of
that have various medical needs such as funds.
specialties in one
campus. psychiatric problems
and certain disease Private (For Profit) Hospitals:
Medical College:
categories such as
These are owned by private companies or multinational
It is one which cardiac, oncology, or companies specializing in hospitals. They are for-profit.
combines nursing to orthopaedic etc..,
patients with teaching
to medical students
 PARTS OF CANCER HOSPITAL
• Out patient • Treatment Department • Pharmacy
Department i) Cobalt Therapy • Sterile Supply Dept
• Administration ii) Linear Acc Therapy
iii) Branchy Therapy • Central Store
• In patient department iv) Tomotherapy • Central Kitchen
• Oncology department v) Chemotherapy • Physical &
• Diagnostic Department vi) Bone Marrow Occupational Therapy
i) X-Ray Dept Transplant
• Mortuary
ii) MRI Dept
iii) Nuclear Med Dept • Hospital Services
iv) Endoscopy Dept
v) Pathology Dept
SPACE AND STANDARDS
 ENTRANCE
There should be 3 Prominent entrances to a hospital site
1. Main Entrance:
This is the main entrance to the visitors, doctors and patients;
It should be widest as it will be used by maximum users;
The pathway should lead clearly to the Entrance foyer and Parking
2. Emergency Entrance:
This Entrance is exclusively for the ambulance and emergency cases
3. Service Entrance:
There should be a separate entrance for the services required in the Hospital
This should not disturb the main Traffic Flow in the Hospital
Moreover, these services should be hidden from the public view

The pathways from the entrances must not intersect with each other as it will disturb the
function of each entrances. And the pathways must have multiple lanes to maintain
continuous flow of Traffic. Security rooms can be provided with each entrances.
 PARKING
• A Parking space for the
public has to be
provided
• A reserved Parking
space for the Doctors
and Staffs can be
provided separately or
even away from the
public parking in the
site.
• Parking spaces for the
Public transports such
as Automobiles and
Taxis can be provided
which will be
convenient for the
visitors and patients Source : Time saver standards for all building type
 PARKING
Source : Time saver standards
for all building type
Entrance Foyer:
• High and Generous entrance
ways are more welcoming
and uplifting
• Low or narrow entrance are
claustrophobic and
oppressive and causes
uncertainty
• There should be
uninterrupted view of the
entrance from the approach
of the site
• This gives a sense of
uniqueness, friendliness and
identity for the faceless
building
Reception:
• The reception or information
help desk must be visible to
the visitors immediately after
the entry to the hospital
• Must not become itself an
obstacle for the rest of the
spaces
• Staircase and lifts can be
visible from the entrance so it
helps find their way quickly
• Also being able to see other
facilities, reduce the need for
any sign boards
ACCIDENT AND EMERGENCY DEPARTMENT (A&E)

• The accident and emergency department must be near the

entrance
• It should be in a good proximity with main entrance, the
pharmacy and reception
• It should be thru a ramp and there has to be an enough space
outside the dept for ambulance to park
• This department should have a lift for critical cases
• It should have minor OT, Casuality, a doctor’s cabin who will
supervise the department
 OUT PATIENT DEPARTMENT
• The Out-Patient Department of a hospital mainly is about
diagnosis and where people come for procedures that do
not require admission to the hospital. Here is where
many come for the first time when they suspect
cancer.
• It is imperative for an Architect to put himself in a patients
shoes when designing such an environment. The space
must be large enough not to feel cramped, easy flow
pattern and signage to avoid confusion for the patients.
Waiting area should have plenty of circulation space.

Source : Time saver standards for all building type

ADMINISTRATION
DEPARTMENT

• This is where the main

administration of the hospital has
their offices. They are restricted
only for certain members.
• Must be secure from infiltration,
however the waiting must be
adequate to ensure comfort for
visitors and not create a
disturbance for the hospital
personnel.

Source : Time saver standards for all building type

IN-PATIENT WARD TYPOLOGY:
DEPARTMENT • General ward • Paediatric ward
• The In-patient wards must have • Semi-private ward • Intensive therapy ward
restricted access to only patients, • Private ward • Surgical ward
doctors and nurses. The admission
on visitors should be restricted to RESTROOM FOR
different times. The wards should be PATIENTS
spacious to prevent a feeling of TOILETS WARD IT
claustrophobia. Their should be
WARD II
adequate entertainment facilities and NURSE
privacy. PANTRY ROOM WARD III
• At the same time all wards must be in
UTILITY AND SLUICE
sight of a nurses station to detect an
MACHINE
emergency situation. The Nurses STORAGE TREATMENT
station forms the focus of the wards. ROOM AREA
FLOW CHART FOR THE IN-PATIENT DEPARTMENT
Source : Time saver standards for all building type
 OT(ONCOLOGY) COMPLEX
The OT Complex/Floor mainly
consists of
• Surgical Oncology Department,
• Surgical Ward,
• Preparation Room,
• Operating Theatres,
• Scrub Rooms,
• Nurses Station,
• Anaesthesia Room,
• Dirty Corridor,
• clean Corridor etc.
• The surgical Oncology Department. This area
is highly sterile in nature. There must be no
entry of germs and bacteria in this area.
• Usually this is achieved using a positive
pressure HVAC system with Hepa-filters. This
allows for air inside this space to be of a
higher pressure that that of the inside.
• Thus ensuring that there is no intake of air
from other parts of a hospital. And the rate of
return air is lower than the throw of air
ensuring the air only moves out of this area.
 Suggested flow chart for operating rooms
Source : Time saver standards for all building type Typical example for operating rooms
DIAGNOSTIC DEPARTMENT
1. X-RAY Dept.
• The primary and most
basic form of diagnostic is
an X-Ray.
• This department has two
basic methods of
checking.
• X-ray & CT Scan. Typical example for X-Ray department

• A CT Scan is a simple
X-RAY/CT
procedure which requires Waiting area
SCAN ROOM
only the additional
machine room and the
equipment room.
Control Electrical
t room

FLOW CHART FOR X-RAY DEPT

Source : Time saver standards for all building type
2. MRI DEPARTMENT:
• Magnetic resonance imaging (MRI), or magnetic resonance tomography (MRT) is a
medical imaging technique used in radiology to visualize detailed internal structures.
• This machine has a strong magnetic field and hence requires that there be no long-
term occupancy in the magnetic field of the machine.

Source : ACR Guidance Document for Safe MR Practices: 2007

3.NUCLEAR MEDICINE DIAGNOSIS:
• Nuclear medicine is a medical specialty
involving the application of radioactive
substances in the diagnosis and treatment of
disease.
• In nuclear medicine procedures, radionuclides
are combined with other elements to form
chemical compounds, to form
radiopharmaceuticals.
• These radiopharmaceuticals, once
administered to the patient, can localize to
specific organs or cellular receptors. This
property of radiopharmaceuticals allows
nuclear medicine the ability to image the
extent of a disease process in the body, based
on the cellular function and physiology, rather
than relying on physical changes in the tissue
anatomy.
PET-CT:
Positron emission tomography - computed is a
medical imaging device which combines in a single
gantry system both a Positron Emission Tomography
(PET) and an x-ray Computed Tomography.
The procedure involves the patient being injected
by a radioactive isotope (FDG) prior to imaging.
This entire department usually has concrete walls
of specified thickness and lead lined windows (if
at all any)
Gamma Camera:
A gamma camera, is a device used to image gamma
radiation emitting radioisotopes, in the medical
profession it is called Scintigraphy. One of the
applications of scintigraphy is nuclear medical
imaging to view and analyse images of the human
body or the distribution of medically injected, inhaled,
or ingested radionuclides emitting gamma rays. This
room requires thick concrete walls along the path
of the radiation.
 Typical layout for
Gamma camera / Scintigraphy

Typical layout for PET/CT room

Typical layout for Nuclear medicine diagnosis

Source : ACR Guidance Document for Safe MR Practices: 2007
4. ENDOSCOPY:
Endoscopy allows the doctor to look into the body through a thin, lighted tube called an
endoscope. The exam is named for the organ involved (for example, colonoscopy to look
inside the colon). This mostly takes place in the operation rooms or a separate diagnosis room
WAITING
5. CLINICAL LABORATORIES- PATHOLOGY
DEPARTMENT: SPECIMEN COLLECTION

Laboratory tests such as blood and urine tests

give the doctor important information. In some STORAGE
cases, special tests are used to measure the HAEMATOLOGY
amount of certain substances in the blood, urine,
and other body fluids, or tumour tissue. The UROLOGY TECHNICIAN
levels of these substances may become abnormal ANALYSIS
when certain kinds of cancer are present. BIOCHEMISTRY
REPORT
HISTOLOGY GENERATION

BACTERIOLOGY BIOCHEMISTRY
Flow chart of pathology department
TREATMENT DEPARTMENT:
1. COBALT THERAPY:
• Cobalt therapy or cobalt-60 therapy is the medical
use of gamma rays from cobalt-60 radioisotopes
to treat conditions such as cancer.
• Layout includes restrictions on occupation in
and around the units, Extra Thick Concrete
Walls for Cobalt Unit.
2. LINEAR ACCELERATOR THERAPY (LINAC)
• LINAC have many applications: they generate X-
rays and high energy electrons for medicinal
purposes in radiation therapy, This technique is
generally quick and reliable.
• Here as well there are restrictions on
occupations as well as the thickness of the
wall is high. And precisely shaped to the beam
of radiation when machine is in use.
3. BRACHY- THERAPY
• Brachytherapy also known as
internal radiotherapy, is a form of
radiotherapy where a radiation
source is placed inside or next to the
area requiring treatment.
4. TOMO-THERAPY
• Stereotactic radiation is a specialized
type of external beam radiation
therapy. It uses focused radiation
beams targeting a well-defined
tumour using extremely detailed
imaging scans.
• Tomotherapy is a type of radiation
therapy in which the radiation is
delivered slice-by-slice
 COBALT THERAPY
ROOM - LOCATION

Typical room standards for

cobalt therapy

Source : Time saver standards for all building type

 5. RADIOISOTOPE THERAPY (RIT):
TYPICAL LAYOUT • It is a form of targeted therapy. Targeting can
FOR LINAC be due to the chemical properties of the
THERAPY isotope such as radioiodine, which is
specifically absorbed by the thyroid gland a
thousand fold better than other bodily organs.
The radioisotopes are delivered through
TYPICAL LAYOUT FOR BRACHY THERAPY:
infusion (into the bloodstream)or ingestion.

6. BONE MARROW TRANSPLANT :

Source : The Design of Radiotherapy Treatment Room
Facilities, Report No: 75, IPEM, York, UK, 1998
The HSC are removed from a large bone of the
donor, typically the pelvis, through a large
needle that reaches the center of the bone.
After several weeks of growth in the bone
marrow, expansion of HSC and their progeny is
sufficient to normalize the blood cell counts and
reinitiate the immune system.
The Design of Radiotherapy Treatment Room
Facilities, Report No: 75, IPEM, York, UK, 1998
THE PHYSICAL AND
OCCUPANCY THERAPY:

Physical therapy (PT) is

care that aims to ease
pain and help you
function, move, and live
better. You may need it to:
Relieve pain. Improve
movement or ability.
OCCUPANCY THERAPY- TYPICAL LAYOUT
Occupational therapy (OT) is
the use of assessment and
intervention to develop, the
meaningful activities, of
Patients. It is an allied health
profession performed by
occupational therapists. OT
often work with people with
mental health problems or
disabilities
PHYSICAL THERAPY- TYPICAL LAYOUT- MINIMUM EEG AND RECOMMENDED LAYOUT
Source : Time saver standards for all building type
THE PHARMACY:
It is the main medication distribution
method for all in-patient and out-patient
users of the hospital.
LAUNDRY / CENTRAL STERILE
DEPARTMENT:
• Dirty Zone: Storage of all dirty soiled
items.
• Sterilization Zone: Treatment
instruments and clothes are cleared
and sterilized.
• Sterile zone: All cleaned and sterile
items are stored here to be
dispatched to the various departments
that require it.
CENTRAL STORE:
The central store should be located at the
base level and away from the hustle of the
hospital. It should be close to a loading and
unloading dock. This department also
houses the Purchases Department.
CENTRAL KITCHEN
The Kitchen serves all the food
requirements of the in-patient and out-
patient department. It mostly consists of
stores, large scale kitchen, toilet.
MORTUARY:
Here the hospital takes the deceased
person to conduct a post-mortem and then
hands over the body to the next of kin. This
area often has a prayer hall and must be
accessible to a hearse van.
 Mortuary typical layout

TYPICAL LAYOUT FOR

THE PHARMACY AND
ITS REQUIREMENTS

Source : Time saver standards LAUNDRY/ CENTRAL STERILE

for all building type DEPARTMENT FLOW CHART
 QUANTITATIVE FACTORS
Corridors:
• Corridors must be designed for the maximum
expected circulation flow. Corridors must be minimum
of 1.50m.
• Corridors in which patients are transported on trolleys
should have a minimum effective width of 2.25m.
• The suspended ceiling in corridors may be installed
upto 2.4m.

Source : Neufert’s Architect design data

Doors:
• Doors widths should be adequate to let stretchers pass by making them
minimum Of 1.2m wide.
• Doors must be
-hygiene requirements
-long lasting in spite of the cleanings and disinfectants
-prevention of transmission of sound
-with standard of same noise insulation as walls
• Double skinned door leaf construction must meet the recommended
requirement of 25dB
• Clear height of the door depends on the function and type of the space

Source : Neufert’s Architect design data

Stairs:
• In a hospital environment it is essential for barrier free architecture should
be enforced. All the ramps and staircases should be as per standards for
barrier free architecture.
• The stairs must have handrails on both sides without projecting tips
• The relevant width of the stairs and landing must be minimum of 1.50m
and not exceed 2.50m
• The doors to the staircase must open in the direction of escape
• Step heights of 170mm are permissible and tread of minimum 280mm;
while riser/tread radio is 150:300mm

Source : Neufert’s Architect design data

Lifts:
• The lift must be adequate for
transporting one bed and 2 persons.
• The surfaces must be smooth,
washable with disinfectants
• The floor must be non slip
• As per standards, one multipurpose
lift must be provided for 100 beds
with a minimum of 2 for small
hospitals
• In addition, there must be a 2
minimum lift for the portable
equipments, visitors and patients
• Such Clear dimension of lift
car:0.9mx1.20m and clear dimension
of shaft: 1.25mx1.50m
Source : Neufert’s Architect design data
• WHEELCHAIR

• RAMP
 DEPARTMENTS REQUIRED SPACE

Main entrance 265 sq.m

Emergency and accident 165 sq.m

Administration 300 sq.m

Out Patient department 400 sq.m

Diagnosis Department 660 sq.m

FRAMING OF Radiology Department 575 sq.m

REQUIREMENTS Operation Theatre Suite 330 sq.m

Intensive Care Unit 260 sq.m

In Patient Department 1780 sq.m

Canteen and Cafeteria 180 sq.m

Hospital Services 610 sq.m

Engineering Services 285 sq.m

Open Spaces 2000 sq.m

Overall 7810 sq.m or 84060 sq.ft