21248591 an architectural brief for a proposed 100 bedded hospital

7/27/2019 21248591 an Architectural Brief for a Proposed 100 Bedded Hospital

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AN ARCHITECTURAL BRIEF FOR A PROPOSED100-BEDDED HOSPITAL

DISSERTATION WORK DONE BY

Dr. Preet Matani

AT

HOSMAC (India) Pvt. Ltd


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AN ARCHITECTURAL BRIEF FOR A PROPOSED 100 BEDDED HOSPITAL

ACKNOWLEDGEMENT

The dissertation period gave me an opportunity to explore the field which has

always intrigued me and where my interest was- that of facility planning.

I am indebted to Dr. Vivek Desai Director HOSMAC (India) Pvt. Ltd. for giving me an

opportunity to work in his organization as there are but a handful of such organizations where

I could have pursued such a study.

I am extremely grateful to Mr. Hussain Varawalla- Sr. Architect HOSMAC (India) Pvt. Ltd., my

guide who took a lot of efforts for my sake.

I am also extremely grateful for the support provided by my seniors Mr. Sameer Mehta and

Mr. Kapil Rawal who were a constant source of encouragement at HOSMAC.

I would like to thank Brig. S.K. Puri, my guide, for having faith in me and I hope that I would

be able to live up to his expectations.

I am also indebted to my teachers Dr. S.G. Kabra and Dr. Hari Singh for their guidance

throughout my academic career.

Lastly but not the least I would like to thank my friends - Shekhar, Rupesh, Gaurav Tripathi

and Benjamin for always being with me throughout my stay at IIHMR.

PREET MATANI

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TABLE OF CONTENTS

CHPT

NO

TOPIC PAGE

NO.

1 STUDY DESIGN

1.1 INTODUCTION AND BACKGROUND INFROMATION 1

1.2 RATIONALE FOR THE STUDY 3

1.3 OBJECTIVE 4

1.4 SPECIFIC OBJECTIVES 4

1.5 METHODOLOGY 4

1.6 LIMITATIONS OF THE STUDY 5

1.7 TIME PERIOD AND PLACE 5

2 ABOUT THE ORGANIZATION 6

3 LITERATURE REVIEW 15

4 SPACE PROGRAM 23

5 OPERATION THEATRE 38

6 INTENSIVE CARE UNITS 50

7 RADIOLOGY 61

8 LABORATORY 72

9 CENTRAL STERILE PROCESSING DEPARTMENT 80

10 PATIENT ROOM 87

BIBLIOGRAPHY 89

ANNEXURES

1 LIST OF LICENCES, REGISTRTIONS AND APPROVALS 90

2 AERB SPECIFICATIONS FOR MEDICAL DIAGNOSTIC

EQUIPMENT (X-Rays)

91

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EXECUTIVE SUMMARY

This study was carried out at HOSMAC (India) Pvt. Ltd, a consultancy firm of

repute. HOSMAC has experience of building several hospitals with many new

projects in the pipeline. This study is about a brief for a proposed 100-bed

hospital. It is both exploratory and descriptive in nature.

Once a decision has to build the hospital has been taken the next step is its

architectural design. A detailed architects brief has to be first prepared to enable

the architect in drawing up his plans. The landscape, facility mix, bed mix,

availability of utilities in the vicinity will have to be considered. Considerable

inputs from other agencies like air-conditioning, electrical, plumbing, etc. will be

required to finalize the working plan for the building. Inputs from the equipmentvendors especially in specialty areas like Cath-labs, CT-scanners, MRI, linear

accelerators, operation theatres etc. will be essential. In India a common thing is

lack of emphasis given to support services like kitchen, laundry, CSSD, back-up

electricity and so on. Not only are these services vital, but these also have high

capital cost and recurrent expense and hence should be properly planned. Just to

illustrate the standards for healthcare design in India, we are still designing

facilities where total area per bed is hardly 600 sq. ft. whereas western standards

are close to 1,400 2,000 sq.ft. per bed and WHO recommends an area of 800-

1200 sq. ft per bed. While it may not be prudent to follow the western concepts

blindly, one needs to pick up the good things from the modern methods. Some of

the issues that could be adapted from developed countries are flexibility for

future expansion, larger secondary areas for better patient comfort, proper

utilities for wait areas, nurse stations, storage, changing rooms, alcoves for

stretchers/ wheelchairs, adequate transport facilities, parking facilities, proper

light and ventilation etc.

In the case of hospitals functional complexities far outweigh physical complexities

and demand an addition to the planning and design team of persons who

understand not only the work process of individual departments but those of the

hospital operating system as a whole.

The study will help in formulating a functional brief or an architects brief that will

have an analysis of functional needs, interrelationship of departments, area

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requirements, major equipment, the grouping of accommodation and the main

outline of traffic flow.

This document would help the architect in understanding the complex needs of

hospital functioning and enable him to build a hospital that is functional, efficient

and yet economical without compromising on the design aspect.

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1.1 INTRODUCTION AND BACKGROUND INFORMATION:

Planning can be defined as ' The specification of the means necessary for the

accomplishment of goals and objectives before action towards these goals has

begun'

What are the various things that must be addressed to during healthcare

programming and design process?

1. Provide a functional design that ensures efficient, safe and appropriate work

spaces.

2. Accommodate technical requirements for highly sophisticated equipment.

3. Create clear, segregated paths for movement of people and material within

the building.

4. Create a humane environment for patients and staff.

5. Develop building systems that can accommodate rapid change.

6. Blend technical and functional requirements into a design that brings delight

to those who use the building and those who pass by it.

Architects and construction oriented professionals acting alone may provide a

building that operates efficiently as a physical structure, however, it is equally

possible that they may entirely miss the mark in terms of operationalfunctionality.

And Functionality as a prime determinant of operational efficiency is a major

factor in the total life cycle cost of all hospital structures. There is also little doubt

that quality of care and treatment is also affected by the degree to which design

accommodates both inter and intra-departmental functions. Hence a new

discipline called functional planning has emerged over the past few years, which

augurs well for the future of hospital design. Individuals possessing adequate

training and experience in this field have made and are making substantial

contributions to the planning and design process. Usually such planners have

backgrounds in hospital management. They could also be architects who have

specialized in hospital architecture or trained personnel of consulting firms.


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Responsibilities of a functional planner:

1. Physical evaluation of existing facilities (along with architect)

2. Functional evaluation of existing facilities.

3. Preparation of workload projections.

4. Functional programming.

5. Space programming (along with architect).

6. Master site planning (along with architect).

Although functional planning of hospitals has not reached its maturity and

indeed may never do so, concepts springing from its practice are burgeoning

yearly as intense study is made of alternative operational and building systems.There are even more innovative changes in operational methods and procedures

on the horizon as demands for greater employee productivity are considered. All

this will directly depend upon architectural design for implementation and few

can be brought into being without direct input to the design process by

functional planners.

Determination of the services to be provided in quantitative terms requires

consideration of the following:

Functions

Locations

Relationship

Utilization

Staffing pattern

Space requirements

Work flow.

Before an architect can develop a hospital design that will best serve its

functions he has to be provided a written programme explaining these

requirements. This is the architects brief from the interpretation of which he

prepares schematic drawings and sketch plans.

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The brief would contain the permission required from various regulatory bodies,

spatial needs of various departments, manpower required, special requirements

of various departments, inter and intra departmental relationships.

1.2 RATIONALE FOR THE STUDY:

The future will see a continued demand for the construction of healthcare

facilities including completely new or replacement facilities and projects involving

major additions and modernization. The annual value of healthcare construction

projects will see an uptrend in the immediate years ahead owing to various

factors like opening up of the insurance sector and privatization initiatives.

Therefore planning and design will continue to merit prime emphasis amongst

other responsibilities of healthcare officials. In the case of hospitals functional

complexities far outweigh physical complexities and demand an addition to the

planning and design team of persons who understand not only the work process

of individual departments but those of the hospital operating as a single

functional system. Functional planning is the responsibility of a trained hospital

administrator who should be capable of interpreting complex relationships,

internal traffic flows (personnel and supplies),

Technological requirements and operational procedures to the extent a product of

beauty, reasonable cost and optimal utility will result. A functional design can

promote skill, economy, conveniences and comforts whereas a nonfunctional

design can impede activities of all types, detract from the quality of care and

raise costs. A non-functional building is the nemesis of any hospital striving to

compete in the current climate of competition and emphasis on productivity. Thus

this stage consisting of preparation of the architects brief is important as the

design of the hospital will become crystallized during this phase. Time and

trouble spent during this stage will be well repaid and will enable the whole

project to proceed smoothly with a minimum of subsequent revision.

In undertaking any complex activity it is well to examine the experiences of

others in similar situations if such information can easily be found and properly

interpreted.

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1.3 OBJECTIVE:

To prepare an architectural brief that would help the architect to build a

functional, economical and efficient hospital.

1.4 SPECIFIC OBJECTIVES:

1. To study/understand the issues involved in functional planning of a hospital.

2. To determine the recent trends and changes in the healthcare facility needs

and to evolve a document that can incorporate these changes so as to enable

the architects to build hospitals in tune with modern requirements.

3. To draw up a space plan for the proposed hospital.

4. To study certain departments in greater detail and to provide a brief that may

be used as a basis for detailed programming later on.

1.5 METHODOLOGY:

Both primary and secondary research was carried out with more emphasis on

the latter.

Primary research will involve in-depth interviews with hospital consultants and

architects experienced in building healthcare facilities.

Secondary research will involve descriptive studies of the functional planning

carried out while building hospitals in the recent past. This will also involve

literature review by going through different books and journals.

Thus the study design is both exploratory and descriptive in nature.

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1.6 LIMITATIONS OF THE STUDY:

Considering the time factor all the departments of the hospital were not

dealt with: only certain key departments were covered.

The study could provide only a preliminary brief for the architect. It would

be the basis for the development of a more detailed brief.

1.7 TIME PERIOD AND PLACE:

The study was carried out at HOSMAC (India) Pvt. Limited, Mumbai from 24th

January till 17th April 2003.

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Chpt. 2 ABOUT THE ORGANIZATION:

HOSMAC India Private Limited is a pioneering name in the field of Hospital

Planning & Management consultancy in India. Since its inception in 1996,

HOSMAC has grown rapidly to become a Unique hub of skill sets which cuts

across various facets of a health care facility be it architecture, engineering,

management, or information technology.

In a short span of 6 years, HOSMAC has notched up an impressive string of more

than 80 projects in India and abroad. HOSMAC provides the entire range of

services that any health care service provider, may require: undertaking market

research, feasibility studies, detailed architectural design, project co-ordination,

equipment procurement, commissioning assistance, conducting an operational

audit for existing hospitals.

To provide such wide ranging services HOSMAC has a motivated team of highly

qualified and experienced professionals (doctors, MBAs, architects, engineers andproject managers). On a cumulative basis these professionals have more than

245 man years of experience and have rendered more than 60,000 hours of

management consulting services, designed 1.4 million sq feet of hospital space,

and are coordinating hospital projects worth more than 3.34 billion INR.

Unlike other industries, the health care industry is extremely complex in terms of

the wide spectrum of specialties, technologies, and the skilled/unskilled

manpower. The smooth interplay of these factors only will lead to a successful

health care organization. The alarming rise in cost for providing quality healthcare will drive hospitals to cut costs rather than only enhancing revenue.

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Some of HOSMACs services

OSPITAL PLANNING & PROJECT MANAGEMENT

Market Research For Project Conceptualization

A comprehensive market research is undertaken to ascertain the needs in the

local health care market. HOSMAC's field workers are specifically trained to

conduct surveys and gather secondary data from various governmental and non-

governmental agencies.

The survey could include

households

medical professionals

diagnostic centres

nursing homes

hospitals.

relevant data from census report, demographic surveys,

government/media publications, and various other sources is also

searched

Such a market study is essential:

to primarily know the deficiencies in the health care market, thereby

assisting us arriving at a proper facility & bed mix.

to helps us finalizing the project size

for existing hospitals to undertake benchmarking in areas like tariff

rationalization, compensation policies, utilization reviews for various

services etc.

Feasibility Reports

Having decided on the facility mix, the next value added service provided by

HOSMAC includes a very detailed and comprehensive feasibility study of the

project. This has been our major strength and we have to credit more than 30

such studies. We are proud to mention here that many of our reports have been

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accepted by leading Financial Institutions in the country like IDBI, ICICI, IL&FS

and also multilateral agencies like the World Bank, Kfw etc.

The feasibility report would essentially contain the following vital information:

Brief description on the major findings of the market research

Proposed facilities plan

Detailed project cost inclusive of land & building, medical equipment, non-

medical equipment, furniture & fixtures, utilities, pr-operative costs,

contingencies, and working capital requirement, and the means of finance

Income and expenditure projections based on the feedback from themarket research and form HOSMAC's exhaustive database

Profit and Loss/ Balance sheet/Cash flow statements

Break even analysis

Sensitivity analysis

Architectural Designing

It is a known fact that Hospital Architecture in India is a neglected specialty.

HOSMAC's aim is to bridge this gap by providing modern yet practical cost-

effective solutions to the health care industry.

Healthcare architecture differs from that of other building types in the complexity

of the functional relationships between the various parts of the hospital. In the

residential and commercial building types the design brief is relatively easy to

understand and cater to. Healthcare architecture, however, requires specialized

knowledge on the part of the architect and the supporting engineering team. The

lack of such trained professionals results in many of the hospitals in India todaybeing ill conceived and costing their promoters much more in construction and in

inefficient operation than they need to. Eventually it is the patient who bears the

brunt of this incompetence through lack of quality in the medical care provided,

physical and mental discomfort and increased cost of hospitalization.

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Specialized healthcare architecture is a field that is still in its infancy in India. As

pioneers in the field, HOSMAC is uniquely positioned to advise its' clients. This

advice is based on the combination of the skills and knowledge of our varied

team of professionals, which consists of doctors, architects, engineers and

hospital management graduates and the resource of an extensive database ofinformation compiled over the years.

However, this specialized field is not only about satisfying the stringent functional

demands that the hospital makes on its designer. The emphasis of healthcare

architecture is also on improving the quality of the environment for patient and

caregivers alike. It must meet the needs of people who use such facilities in

times of uncertainty, stress, and dependency on doctors and nurses. It must

recognize and support patients' families and friends by providing pleasant spaces.

At the same time the building should project an underlying reassurance that the

patient is in the hands of competent medical staff and in a technically sound

healthcare facility.

In the future patients will be increasingly demanding of healthcare organizations.

Those facilities that are designed to be most responsive to patients in terms of

convenience, caring encounters, service orientation and the quality of care will do

best in meeting these new demands.

Architects are regarded as talented problem solvers. The problem here is to finda way to deliver a high quality of care and access in a setting that is also highly

supportive of human relationships during times of great anxiety and fear. The

particular skills of HOSMAC's design team are well suited to meeting this

challenge.

We invite you to proceed to learn more about how HOSMAC (India) can help you

design and construct your proposed healthcare facility.

Project Management

Apart from providing Architectural Designing solutions, HOSMAC also provides

the most vital project management services. An ardent need was felt for this as

most hospital projects in India suffer from lack of co-ordination between various

agencies like the promoters, architects, contractors, consulting agencies, doctors,

equipment vendors etc. HOSMAC thus identified this as a vital growth area and

has been rendering such services to help our clients in combating TIME/COST

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overrun apart from giving functionally sound infrastructure solutions.

This service includes important activities

Liaison with all Agencies - Architects/contractors/equipment

vendors/utility service consultants and suppliers

Monitoring Project with PERT/CPM

Managing Change in Project Plans - most vital and complicated component

due to the various fall outs from the change in project design

Managing equipment planning schedule including cost-feature analysis,

procurement process, installation etc.

MANEMENT CONSULTANCY

Management Consultancy Services

Turn Around Strategies

Such assignments include studying the historical trends of the hospital in terms

of its income/expenditure patterns, identifying cost/profit centers, identifying the

key success criteria for improving the bottomline. Having done this we provide a

strategic business plan with definite milestones to implement our

recommendations and monitor the same.

Operational Audits

This is again a niche service provided by HOSMAC for health care institutions

requiring specific departments to be studied for improvement which may be

qualitative and/or efficiency related. An example of studies could include:

improvement of the lab services

operation theatre utilization reviews

manpower audits

medical audits

infection control programs

reorganization of profit centres

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support service audits etc.

Costing of Services

This is a highly specialized service which we provide. It is a well known fact that

hospitals in India set their tariffs in comparison to the market rates. This leads to

skewed rate setting and the customer is the looser. HOSMAC has conducted

several costing exercises for our clients to help them understand the real cost of

providing services by virtue of which our clients have an advantage over their

competitors. In many cases we found that hospitals were under pricing their

services hoping that volumes will cover up the cost, whilst they were actually

increasing their losses. We have developed an in-house format for costing of

various services on a department wise basis which enables us to conduct our

studies in a systematic manner within a short span of time.

Systems Study & Re-design

Though HOSMAC does not provide computerization solutions, we are thorough in

system analysis and provide vital interface solution with the agency providing the

computer solutions. Also such assignments are essential for hospitals which do

not have computerized systems for various activities. The activities involved

include 'walking through' the processes, identifying the stumbling blocks, finding

solutions, redesigning the systems/processes/forms/reports/records,

implementing the 'changed' processes and providing online correctional

interventions. Many of our clients have found our association to be invaluablewhilst implementing the computerization modules.

Manpower Audit & Training

Hospitals are labour intensive institutions and salary expenditure forms the major

head of expenditure. Therefore it is of paramount importance that a proper

manpower plan is formed and implemented. Also notable feature is that in

hospital setting the interaction between the highly skilled and unskilled workforce

is of a very high magnitude leading to IR problems. Whilst conducting such study,

we undertake an exhaustive manpower audit of all departments and benchmarkit with the industry standards to ascertain the deficiencies. Wherever required re-

distribution of manpower, job enlargement, and job enrichment solutions are

recommended. Customized training programs are conducted targeting specific

needs like attitudinal change, team building, grooming in etiquettes, etc.

Marketing Strategies

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This has been one of our most popular services and we have devised and

implemented successfully our marketing plans. We begin our assignment by

benchmarking the services against the best hospitals in the client's service

segment and conducting a customer satisfaction survey to understand the

drawbacks in our services and products to be marketed. This followed by aproper product development for marketing, which includes improvement in the

service delivery mechanisms, proper pricing, identification of target audience,

preparation of brochures/mailers, and setting milestones for productivity

enhancement. We help our clients in implementation of the strategy by making

visits to the corporates and monitoring the overall process of marketing.

L EQUIPMENT PLANNING

Biomedical Equipment - Planning & Procurement Norms

Advances in Engineering and Information Technology in the recent years havebrought about several changes in the field of Medical Science. Medical Equipment

play a very significant role in the field of medicine and healthcare delivery

system. Sophisticated biomedical equipment requires a host of utilities like the air

conditioning and refrigeration, stabilized power supply systems etc. The design

criteria of these support systems are of paramount importance.

Hospital equipment fall into an extremely wide spectrum ranging right from a hi-

tech MRI and CT scanner to a simple patient trolley. These all account for a major

part of any hospital project cost, which could go upto almost 60%. Of this,biomedical equipment could account for nearly 50% of the cost. Keeping this in

view it is essential to ensure maximum utilization of the equipment with

minimum downtime.

The health care industry is experiencing a new era in cost containment. In the

past, little attention was given to the financial impact of equipment related

decisions. Today, however, times have changed. In this new environment, "state-

of-the-art" is no longer sufficient as planning criteria for selecting new

technology. Today, for a technology to be appropriate, it must address the needs

for efficiency, cost-effectiveness, and productivity and at the same time, improve

or maintain the quality of patient care. In addition, hospitals are finding

themselves in an extremely competitive arena, which puts an additional emphasis

on a technology's marketability. The challenge faced by hospital executives today

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is to gain the management and control required to make effective equipment

planning decisions.

Whilst medical devices can be broadly categorized into diagnostic and therapeutic

equipment, the selection criteria for procurement would need to take into account

several factors viz. type of hospital & level of services provided; services

available in the neighbourhood and technology employed; background of the staff

that would operate the equipment; proposed tariff for the services employing

medical devoices; etc. Having addressed these issues one would need to carry

out a separate financial feasibility for the major and critical equipment and then

set out to prepare the specifications and features of the medical devices that

would be considered most appropriate for the hospital. After having undergone

this exercise too there are multiple products that one can choose from. For this

one would need to apply further criteria and do a detailed analysis of factors

related to the technology and design base of the equipment; the maintenance

convenience and available service support; forthcoming technology and

interchangeability with the current generation; presence of the manufacturer /

vendor in the existing market place; and once again the factors are several!

Product Development Assistance

Provide benchmarking data regarding market expectation from a hospital

management system

Details hospital best practices

Undertake detailed reviews of newer modules and upgrade versions and

provide recommendation of any enhancements/modification

Periodic comprehensive review and study of the existing modules to update

and upgrade continuously

Implementation Assistance

Jointly prepare implementation plan with solution provider

Undertake a comprehensive system study

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Gap analysis

Preparing specification for customization

Site monitoring assistance

Undertake audits of the sites where software is already installed to

identify areas of problem

Business Development Assistance

Provide business development assistance in terms of identifying

new leads, represent and recommend the business partner during

presentation to key clients as hospital consultants.

LITERATURE REVIEW:

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Since Henri Fayol's pioneering treatise on management in 1916, planning has

involved two considerations, i) Assessing the future and ii) making provisions for

it.

According to Robert M. Fuller "Planning is of course decision Making because it

involves selecting from among established alternatives" Certainly the adoption ofa systematic planning process is imperative in any hospital facility. Failure to

adopt and to adhere to a specific methodology almost invariably results in a

deterioration of the quality of planning. Architectural design represents the most

definitive act of planning any building project. Although representing a new

discipline, functional planning already has achieved recognition through its

contribution to operational functionality and has become a key factor in hospital

design. Future research in this area of planning and design process may further

enhance productivity in the healthcare field.

In terms of broad categories of activities the process of hospital project planning

can be a multistep process.

The steps are as follows:

1. Perception of need for a building program.

2. Strategic Planning and feasibility assessments.

3. Organizing for planning, design and construction.

4. Determining the planning, design and construction approach.

5. Scheduling planning, design and construction.

6. Opening the completed project.

The role of the Functional planner is most important in steps 3 and 4.

Selection of the professional planning team

A complete team should possess capabilities in

Financial Feasibility Consulting. Functional Planning.

Architectural and Engineering services

Construction Management.

Selection Timing:

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The Functional Planner, the architect and the construction manager can all

make valuable contributions in the early stages of a project and should be

contracted at approximately the same time. Because the functional planner has

the most intense involvement in the very first stages, he might be brought in

first, but the other two must closely follow.

The possibility to influence a project and its cost is reduced during the course of

its development after the client has decided to establish the requirements of the

user and started to investigate the problems. The largest reduction of possibilities

to influence the design occurs at point 1, which marks the clients decision

concerning implementation. The figure is based on a study by Stig Nordquist.

Responsibilities of a Functional Planner:

1. Physical evaluation of existing facilities (along with architect)

2. Functional evaluation of existing facilities.

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3. Preparation of workload projections.

4. Functional Programming.

5. Space programming (along with architect)

6. Master site planning (along with architect)

1. Physical evaluation of existing facilities:

This is a study to determine the degree of physical obsolescence of existing

facilities and to identify major code violations and physical problems and to

project future usability.

2. Functional evaluation of existing facilities:

This is a study to define functional problems that detract from operational

efficiency, quality of patient care, and convenience of building inhabitants to

evaluate traffic flows and physical relationships, to determine space

insufficiencies in terms of current requirements to study the need for

modernization, alterations and expansion, according to strategic plan findings

and to note possible alternative future uses of the structure as a whole as well

as of various departmental areas.

3. Preparation of workload projections:

The functional planner can determine and formulate concepts of operation for

the proposed project according to previous study findings. These concepts will

be incorporated in the functional program. These projections form the basis

for functional programming, revenue projections and staffing estimates.

4. Functional programming:

Using approved recommendations and findings of the strategic plan, findings

of physical and functional evaluations and workload projections, the functional

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planner formulates recommendations for operational concepts, the detailed

room composition of the project, required phasing, alterations, internal and

external traffic flows, interdepartmental relationships and operating systems.

5. Space programming:

Based on the functional program, as amended and approved by the hospital a

room by room listing is made of all areas in the proposed project. Net square

footage is assigned to each space, and totals accumulated for every

department or functional entity. using the net figures, appropriate calculations

are then made to set gross totals for each department or functional entity as

well as the total for the entire project.

Some pointers to successful hospital planning

Good planning is critical to the hospitals success:

If a hospital has to be successful it must be built on the bedrock of three sound

principle namely good planning, good design and construction and good

management. The absence of the first two of the equally important but closely

related triad, good planning and good design and construction means failure todesign the facilities for the optimum utilization of staff and services. This in turn

results in a mediocre hospital that fails to realize its economic goals.

Efficient, Functional and economical hospital:

The real test of any hospital is the quality of healthcare it provides. If the hospital

has to pass this test- a truly rugged test-planning and design must result in a

functional, efficient and economical hospital. It should be remembered that even

minor defects in designing could make the operation of a hospital inefficient. The

corollary of this is that an inefficient hospital costs significantly more to operate,

staff and maintain, not to mention the fact that the patients within it get less

health services for the money they pay.

It should be borne in mind that economy of operation and maintenance over the

life of the building as well as the quality care to patients depends in a large

measure on the proper planning and designing of the hospital and is more

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important than the economy of construction. The initial cost of building a hospital

is insignificant when compared to the cost of running and maintaining it over the

years- by one reckoning eighteen to twenty times over a period of say twenty

years. Another study says that the running cost of a hospital over 4 to 5 years

from the date of completion is about the same as the capital cost. and if thefacilities are not planned and designed properly this intangible cost can be

enormous. the efficiency with which the physicians and their assistants can

function has been greatly handicapped by obsolete design. Patient comfort and

provision for expansion have often been overlooked. Growing efficiency and

innovative ideas have revolutionized hospital building construction to meet

among other things, the special needs of patients. It is believed that a pleasant

environment that makes for an enthusiastic and more productive staff also

benefits the patients albeit indirectly.

Promoters and hospital planners often overlook to include in the facilities design

what helps to preserve the patients' dignity and status as a human being or

details that would make the hospital more livable. Many patients complain that

hospitals as institutions reduce privacy, individuality and more importantly

human dignity. Many of these details and facilities can be incorporated with little

or no extra cost.

While planning and designing a hospital the patients needs and expectations

should be kept uppermost in mind and any design should aim at his satisfaction

and comfort.

Today's healthcare facility is by its very nature a complicated entity and planning

and designing such a facility to serve the increasingly complex needs of its

patients, staff and management team is difficult and complicated. The problem is

compounded by rapid changes and advances that are taking place in the fields of

technology and medicine and the constant need to modernize, renovate, replace

and expand healthcare facilities.Process of planning:

A common understanding should be established between the architect and the

engineers on one hand and the promoters, doctors, administrators and planners

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on the other. A wide variety of professionals need to be integrated into a

planning team that is responsible for the implementation of this complex process.

Initial planning encompasses the general physical facilities that are being

considered, the space requirements, cost constraints, time schedules, standards

that must be included.In the next step details of the operational plan for each department should be

considered- location of each department, requirement of floor space,

intradepartmental and interdepartmental relationships, circulation, traffic flow

and requirements in relation to equipment, personnel and patients.

Operational and Functional planning first:

Before any plans can be drawn by the architect an understanding of the

requirements of the hospital in terms of services it is going to provide, number of

beds, departmental functions, departmental needs, major equipment, space

requirements, required personnel, relationships and adjacencies must be agreed

upon. All this must form a written document. This is called operational planning-

a written programme needed for any architectural project.

Operational planning establishes a dept-by dept description of needed space by

outlining for example, the no. and type of surgeries, X ray rooms, outpatient

services, laboratory services etc. the exercise thus determines current and

projected needs within the facility. A consultant or an administrator who is

knowledgeable and has experience in the operation of the hospital is by far the

best person to develop this document. Normally there is either no briefing of the

architect or the brief given to him is inadequate. The promoters must clearly tell

the architect the requirements of the hospital and not the other way round. The

architect should not dictate to them nor should he conjecture what the

requirements are or what he should design. More often than not there is no

written brief or operational program and to know what is needed the architecthas to fend for himself. Sometimes he is asked to prepare his building schedules

with the help of doctors, at other times he is asked to observe other hospitals

and take guidelines from them. Both these are unsatisfactory methods.

Key to Functional planning:

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The proper sequence is the development of operational planning that defines

the major requirements and needs first. The operational plan is then developed

into a functional plan. Planning of the hospital on a functional basis-that lists

every room and suggests net sizes for major functional rooms and the total sizeof the department. The key to functional planning is not just a room list but

understanding that travel and adjacencies will affect operational cost for the life

of the facility says David R. Porter the renowned hospital architect.

Mistakes in planning may prove costly:

Instances are aplenty of hospitals that were not planned with these critical

factors in mind-within five to ten years they found that the cost of construction

had been equalled or surpassed by operating expenses.

Functional grouping of high traffic areas such as X-ray, laboratories, surgical and

delivery suites, physical therapy and clinics on two floors is desirable. It permits

concentration of hospital activities in a manageable unit. When future expansion

or changes becomes necessary, they can be accomplished without disturbing the

nursing areas.

Operational Plan and Functional Plan must precede Architectural Plans:

Planning and Building a hospital to serve the increasingly complex needs of

modern healthcare is an intricate job. The architect though competent in his

profession may not be competent in the technical aspects of hospital architecture

and may lack knowledge of some of the specialized clinical and administrative

areas and matters. This document called the operational plan and functional plan

developed from it form the basis and are necessary prerequisites for the architect

to prepare the architectural plans.

Hospitals must be planned for the future:

A fundamental rule that promoters should remember is that the hospital should

be planned for at least 10 to 15 years ahead or else experts say plans will be

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obsolete when they come to the drawing board. With the rapid development and

advances in technological, medical and administrative sciences and innovative

techniques and therapies, space requirements of every department has increased

markedly. New departments come to be needed, and more space is required to

some specialties. In addition to space needs, technology is imposing a host ofphysical demands on our hospitals. Well planned systems must be built into them

to keep pace with the changes. Said one design expert ' We have got to design

`Smart hospitals that respond to present needs while anticipating future

change.

Within the building all departments must be planned in such a way that they can

stand individually. This can be done by freely locating each department with

space around for expansion. Further care should be taken that expensive

permanent fixtures and fixed equipment such as plants and elevators are not

located at the free ends of the departments as they would permanently block

expansion plans. Future expansion is rendered easy with free ended buildings

with extendable corridors.

Space Program:

The space plan is made on the basis of personal interviews with hospital

administrators experienced in building hospitals and also with the help of

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literature review and would help the architect in finalizing his plans. Hospitals are

a difficult planning subject as explained earlier. The maxim Design follows

function must be kept in mind while allocating space details. The area

specifications may be taken as indicative as suitable alterations would have to be

made by the architect to conform to the grid matrix.The total space area including the parking space, HVAC and water is 1,05,319 sq

ft which works out to be 1053.19 sq ft. This is in concurrence with modern

standards of constructing hospitals which provide for an area of 800-1200 sq ft

per bed.

Ground Floor:

Key Departments like OPD, Emergency, Radiology, Laboratory would be situated

on the ground floor. The Radiology dept. would be situated near the Emergency

dept.(According to a study nearly 40% of cases coming to Emergency require X

rays)

The administration department would be located on the 1st floor along with the

Blood bank and General and Paediatric wards.

The Labour room, Obstetric ward and NICU would be located on the 2nd floor

along with the semi-private ward.

The CSSD would also be located on the 2nd floor just below the operation theatre

with provision for dumb waiters between the CSSD and the OT.

The OTs will not be located on the top floor to avoid the excess heating nor will

they be located near the major traffic areas.

The ICUs and private wards will also be located on the 3rd floor.

The residential area will be located on the 4th floor just above the ICUs and the

OTs. So a doctor can easily attend to the patient when called.

30% of the area is kept for circulation.

Department wise area allocation

Department Area sq.ft

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General ward 3978

Semiprivate + deluxe 8437

Private+deluxe 8437

Obstetric Ward 3679

Paediatric Ward 2847

NICU 4921

ICU 7235

OT 5844

OPD 4940

Physiotherapy dept 975

Radiology 5005

Other diagnostic Facilities (ECG, 3380

EEG, Stress test, Endoscopy)

Laboratory 2425

Blood Bank 1840

Pharmacy Outlet 260

Pharmacy Store 520

MRD 1430

CSSD 1957

Laundry 1918

Kitchen 2300

Restaurant 2860

Housekeeping 325

Telecommunication 390

PR Department 260

Security 195

Auditorium 1950

Prayer Room 260Mortuary 975

Library 390

Manifold Room 390

Administration 2314

A/c Department 780

Stores 2405

EDP 780

Emergency Room 1937

Ambulance 325

Telephone Booth 260

Shoppe 130

Executive health checkup 1300Residents 15000

Total Space for 100 beds 105319

Area per bed 1053.19

(Current standards 800-1200 sq ft)

Parking Space 46875

Electrical+HVAC+Water 4550

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Distribution of floor space by wards and departments

Wards 45378 43%

Diagnostic Facilities 12650 12.01%

OPD+ Emergency+ Related Areas 10117 9.60%

Administrative Area 11349 10.78%

Service departments 10790 10.25%

Residential Areas 15000 14.25%

100%

Breakdown of Space Requirements of key departments

Area Sq ft per bed

Nursing Units 273.78

ICUs 121.56

Operation Theatres 58.44

Radiology 50.05

Laboratory 24.25

Pharmacy 7.8

CSSD 19.57

Dietary 23

MRD 14.3

Housekeeping Dept 3.25

Laundry 19.18

Mechanical Installations 49.4

Stores 24.05

Administration 30.94

Distribution of Beds

General 16

Semi- Private (two in one) 26Private 13

Deluxe 6

ICU 10

NICU 9

Obstetric Ward 10

Paediatric 10

Total 100

Other Beds

Pre -op 4

Post op 6

Emergency 4

Allocation of Departments floor wise

G+0

OPD 4940

Emergency 1937

Radiology 5005

Laundry 1918

Kitchen 2300

Physiotherapy 975

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Pharmacy outlet 260

PR Dept 260

Manifold room 390

Shoppe 130

Telecommunications 390

Prayer Hall 260

Ambulance 325

Telephone booth 260

Mortuary 975

Laboratory 2425

Total space 22750

G+1

Restaurant 2860

Housekeeping 250

Administration 2314

Security 195

Accounts Department 780

Executive Health Check Up 1300

Blood Bank 1840

MRD 1430

General Ward 3978

Paediatric 2847

Other Diagnostic Facilities 3380

Pharmacy Stores 520

EDP Dept 780

Total space 22474

G+2

CSSD 1957

Semiprivate ward + Deluxe beds 8437

Stores 2405

Obstetric ward 3679

NICU 4921

Total Space 21399

G+3

OT 5844

ICU 7235Private + Deluxe 8437

Total space 21516

G+4

Residential Area 15000

Library 390

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Auditorium 1950

Total space 17180

Department Wise Space Plan

General Ward

Beds 16 120 192

Nursing Station 1 200 20

Doctors room 1 100 10

Nurses room 1 100 10

Treatment room 1 100 10

Staff toilet 1 50 5

Store 1 60 6

Pantry 1 60 6

Clean utility room 1 60 6

Dirty utility room 1 60 6

Toilets General 3 50 15

Waiting Area 1 200 20

306

Add 30% circulation space 91

Total space 397

Semi private (2 in 1)

Beds 26 175 455Beds deluxe 3 350 105

Nursing station 1 200 20

Dr's room 1 100 10

Nurses rest room 1 100 10

Store 1 60 6

Pantry 1 60 6



Toilet 1 50 5

Waiting area 1 200 20

649Add 30% circulation space 194

Total Space 843

Single Room\ Private

Beds 13 350 455

Beds deluxe 3 350 105


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Dr's room 1 100 10

Nurses rest room 1 100 10

Store 1 60 6

Pantry 1 60 6



Toilet 1 50 5


649

add 30% circulation space 194

Total Space 843

ICU

Beds 8 225 180

Beds - Isolation room 2 250 50


Equipment Room 1 250 25

Stat Lab 1 50 5

Doctors Room 1 100 10

Nurses Rest room 1 100 10

Toilet (staff) 1 50 5

Toilets -General 2 50 10

Store 1 60 6

Pantry 1 60 6

Clean Utility Room 1 60 6

Dirty utility Room 1 60 6


Beds For Relatives 10 150 150

Toilets cum Bath 3 75 22556


Total space 723

NICU

Open Care units 9 125 112


Equipment store room 1 200 20

Doctors room 1 100 10Nurses rest room 1 100 10

Toilets staff 2 50 10

Component milk formula room 1 50 5

Feeding room 1 60 6

Nursing room 1 100 10

Toilets - General 3 50 15

Waiting Room 1 250 25

Beds for relatives 9 150 135

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378


Total space 492

Obstetric Ward

Beds 10 120 120




Clean utility 1 60 6

Dirty utility 1 60 6

Pantry 1 60 6

Staff toilet 1 50 5

General toilets 2 50 10

Store 1 100 10

Labour rooms 2 300 60


283


Total space 367

Paediatric Ward

Beds 10 120 120




Clean utility 1 60 6

Dirty utility 1 60 6

Pantry 1 60 6

Store 1 60 6

Toilet- Staff 1 50 5

Toilet- General 2 50 10


219

Add 30% circulation Space 65

Total space 284

Operation Theatre

OT roomsGeneral OT Room 2 450 90

Specialty OT Room 1 625 62

Scrub room 2 100 20

Instrument room 2 100 20

Wash room/ Dirty utility 2 60 12

Store room 1 200 20

Chief anaesthetist room 1 100 10

Dr's room 1 150 15

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OT incharge room 1 60 6

Nurse room 1 60 6

Dumbwaiters 2 20 4

Pantry 1 40 4

Equipment room 1 200 20

Trolley bay 1 150 15

Toilet 2 40 8

Change rooms 3 50 15

Reception 1 60 6

Waiting room 1 100 10

Pre operation room 4 beds 35

Post operation room 6 beds 60

449


Total 584

OPD

May I help you desk 1 50 5

Registration/billing 1 200 20

Waiting area-- Reception 1 500 50

Toilets (M&F) 8 25 20

Reception and Records room 1 250 25

OPD waiting area 1 400 40

Consultants rooms (Medicine, 5 150 75

Surgery, Gyn obs, Paed & Ortho)

Sub Waiting Areas 5 50 25

Staff toilets 2 50 10

Doctors toilets 1 75 7

Trolley/ Wheelchair bay 1 200 20

Collection room 1 50 5

Minor OT 1 300 30

OPD Store 1 75 7

Staff room 1 250 25

Administrators office 1 150 15

380


Total 494

Other Diagnostic Facilities

ECG Room 1 300 30

EEG Room 1 350 352 D echo room 1 500 50

Stress Test Room 1 750 75

Endoscopy Dept

Reception 1 50 5

Waiting 1 200 20

Consultation 1 100 10

Endoscopy room 1 350 35

260

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Add 30% circulation Space 78

Total 338

Physiotherapy Department 1 750 75

add 30% circulation space 22

total 97

Radiology

MRI 1 750 75

Ultrasound 1 350 35

Ultrasound Room

Change room

Sub Waiting

X ray- General 1 650 65

Radiography room

Control room

Change room

Sub waiting

Special X ray 1 900 90

Radiography room

Control room

Change room

Toilet

Barium Preparation

Sub- Waiting

Staff room 1 100 10

Radiologist room 1 100 10


Reception 1 100 10

Technicians room 1 100 10


Records room 1 150 15

Film Store 1 150 15

Reporting room 1 100 10

385


500

Laboratory Reception 1 75 7

Biochemistry 1 300 30

Haematology & clinical pathology 1 200 20

Histopathology 1 200 20

Microbiology 1 200 20

Serology 1 200 20

Sample collection 1 150 15

Toilet 1 40 4

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Toilets (staff) 2 50 10

Waiting 1 100 10

Report dispatch area 1 100 10

Staff room 1 100 10

Technicians 1 100 10

186


Total 242

Blood Bank


Examination room 1 75 7

Recovery& refreshment room 1 150 15

Bleeding room 1 150 15

Staff room 1 60 6

Blood bank in charge room 1 100 10

Component separation room 1 400 40

Toilet (staff/visitors) 2 40 8

Issue counter 1 50 5

Store room 1 150 15

141


Total 184

Pharmacy

Store area 1 400 40

Retail area 1 200 20

60


Total 78

MRD

Process room 1 500 50

Office room 1 100 10

Record cum store room 1 500 50

110


Total 143

CSSD Receipt area 1 100 10

Wash room 1 200 20

Gloves sterilizing room 1 75 7

Change room 1 50 5

CSSD Supervisor room 1 100 10

Clean area for packing 1 100 10

Actual sterilizing room 1 450 45

Sterile store room 1 200 20

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Trolley Park 1 150 15

Dumb Waiters 2 20 4

150


Total 195

Laundry

Receipt area 1 100 10

Dirty area 1 150 15

Ironing/ wash area 1 400 40

Laundry incharge room 1 150 15

Toilet 1 50 5

Store room 1 200 20

Mending room 1 100 10

Delivery/ Distribution 1 100 10

Trolley Park 1 100 10

135


Total 191

Kitchen

Receipt area 1 80 8

Dietician room 1 100 10

Store room 1 100 10

Utensils area for storage 1 100 10

Dry area 1 150 15

Cold area 1 100 10

Preparation area 1 150 15

Cooking Area 1 350 35

Washing area 1 150 15

Trolley park 1 150 15

Change area 1 50 5

Toilet 1 40 4

Dining room 1 200 20

Garbage room 1 50 5

177


Total 230

Restaurant Sitting area 1 1500 150

Preparation 1 500 50

Store 1 200 20

220


Total 286

Housekeeping

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Office 1 50 5

Store 1 200 20

25


Total 32

Telecommunication

Office 1 50 5

Cable area 1 250 25

30


Total 39

Personnel Relation department

Office 1 200 20


Total 26

Security

Office 1 150 15


Total 19

Mortuary 1 750 75


Total Space 97

Auditorium 1 1500 150


Total 195

Prayer room 1 200 20


Total 26

Library 1 300 30


Total 39

Electrical HVAC +Water+Boiler 1 3500 350 Compressor air & Vacuum


Total 455

Manifold room

Area 1 250 25

Office 1 50 5

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30


Total 39

Administration

MD/CEOs office 1 250 25

MS office 1 200 20

Office (secretary) 2 50 10


Manager administration 1 150 15

Clerical office 1 350 35

Nursing superintendent 1 200 20

Staff for nursing superintendent 1 200 20

Toilets

MD/CEO/MS 1 50 5

Clerical staff 2 40 8

178


Total 231

A/C department

Office 1 200 20

Process area 2 200 40

60


Total 78

Stores

Receipt area 1 100 10

Storage area 1 1500 150

Office 1 250 25

185


Total 240

EDP

Office 1 100 10

Server room 1 500 50

60Add 30% circulation space 18

Total 78

Emergency room

Triage 4 beds 500 50

Med. Officer 1 100 10


Dr change room 1 75 7

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Nurse change room 1 75 7

Toilet 1 40 4

Minor OT 1 250 25


Reception 1 100 10

149


Total 193

Ambulance

Control room 1 250 25

Telephone Booth 2 50 10

Shoppe 1 100 10

45


Total 58

Residential Area 1500

Executive Health Check Up

Reception 1 100 10


Doctors rooms 3 150 45

Collection room 1 50 5

Records & Storage 1 100 10

Toilets 2 50 10

100


Total 130

Parking space

Area for 1 car = 275 sq.ft

Area for parking 150 cars 4125

30 staff, 120 general

Area for I scooter = 75

Area for 75 scooters 562

25 staff, 50 general

Total 4687

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Operation Theatre

Function:

The function of this department is to receive patients after diagnosis, to

anaesthetize them, to operate upon them and to supervise their post-operative

condition before returning them to their wards. The surgical patients account for

30% to 40% of the in-patient admissions.

Location:

The OTs can be grouped together in a centralized form to have an entire OT

complex or they can be decentralized. However for having decentralized OTs eg

like those for gynaecology, ophthalmology and ENT the quantum of work should

justify the need for them. Centralized OTs are preferred normally as there is

greater economy of staff and equipment, better professional supervision and

greater efficiency.

There will be 3 OTs- 2 General and 1 Specialty OT. They will be located on the 3rd

floor. The location will be such that they will be away from major traffic areas and

also not on the top floor. This will avoid overheating. They will be located close tothe ICUs for the easy transport of patients. They will also be located close to

vertical transport and above the CSSD. There will be 2 dumbwaiters- one for

clean linen and one for soiled linen.

Key Factors influencing OT complex Planning:

The total volume of expected operations alongwith the anticipated work period is

used to calculate the no. of operating rooms needed. Around 1 operating suite is

recommended for every 50 beds. The number of operating rooms has also been

indicated to be 5 per cent of the total number of surgical beds. OR in larger

hospitals a thumb rule 0.1 operations per bed per day has been used. For Indian

theatres conducting general surgeries it is estimated that the average time taken

for each surgery will be around 75 minutes per operation. Hence one OT can

perform around 5 general surgeries daily. A separate emergency OT would be

justified when 50 or more cases are reported in the casualty. The other factors

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that would influence the planning are the case mix and the type of operations to

be performed and also the ALOS of surgical patients.

The no. of operating rooms forms the basis for determining the number of pre-

op beds and the post-op beds.

Number of operations per day = No. of surgical bedsALOS of surgical patients

Number of OT rooms = Total no. of operations in hospitals

Capacity of 1 OT

Basic Functions:

Reception and identification of the patient.

Pre- op supervision of the patient.

Depilation of the patient if not done in the ward. Transfer of patient to the operating table.

Induction/ Intubation/ Positioning

Preparation of the operative area and surrounding skin.

Draping of patient

SURGERY

Sewing up/ Removing drapes/ Extubation

Transfer of patient to post- anaesthetic recovery area.

Post- operative supervision of the patient/ Step down.

Layout :The OT will be independent of the general traffic and movements of the rest of

the hospital. The rooms should be arranged in a manner that allows continuous

progression from the entrance through the various zones that become

increasingly clean. The various zones in the OT are

Protective Zone

Restricted Zone

Clean zone

Super clean Zone

Ultra clean Zone.

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The protective zone is the area where the entry is restricted to the patients, the

staff and their relatives. It is till the waiting areas for the relatives.

The entry to the restricted zone is limited to the patients and the staff. This

area includes the patient reception area, the staff changing rooms.

The clean zone, which is the next zone, consists of the pre and post op areas,the administrative areas, the stores, laboratory, space for equipment storage.

The superclean zone consists of the operating theatre and its ancillary rooms

like the scrub room, the instrument room and wash room.

The ultraclean zone consists of an area of 1 metre on either side of the

operating table.

An operating room for general surgery will have an area of 450 sq ft. However

operating room for specialty surgeries like orthopaedic and Neurosurgery will be

around 625 sq ft. The operation suite will consist of an operating room, a scrub

room, a waste disposal room and an exit room. The waste disposal room will lead

into the dirty corridor so that waste can be disposed off without it being allowed

to renter the clean zones. There will be a service lift to carry away the waste and

also a dumb-waiter to carry the soiled linen to the CSSD.

In older times it was believed that it was desirable to have a separate induction

room. However while such a room reduces the operating rooms occupancy time

as the patients can receive pre-operative anaesthesia while other patients are on

the operating table. The disadvantages however outweigh the benefits. The main

disadvantage may be the huge increase in capital as well as running costs

incurred in such a room. Also there will be the cost of additional equipment and

the utilization of the room will be low.

The preop holding area and post op recovery room should have piped and

medical gas outlets.

Provisions should also be made for flash sterilizers.

If the operating room has windows this will increase the heat load inside and

provision should be made for it. Windows provide for visual relaxation butwhether operating rooms should have them or not is a debatable question as

they may cause distraction if provided.

The temperature inside the OTs will be maintained at 21 degrees. The

airflow is laminar airflow i.e. positive pressure is created such that air

flows from the clean zones to the dirty zones. The laminar airflow is

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created through a plenum in the ceiling. The velocity of air flowing

through this plenum is 60 ft/min. The size of the plenum will be around 6

by 6 feet. This will be enough to cover the patient on the operating table

and also the entire operating team. The air moves outwards through

outlets, piped gas, suction and nitrous oxide are provided throughpendants in the OT.

HEPA filters which can filter air upto 0.3 microns will be used.

Between 20- 100% fresh air is used. The rest is recycled.

Humidity levels will be 55% plus or minus 5%

The floor of the OT will be granite with brass strips. This helps in earthing

purposes for the electrostatic current. The walls can be of stainless steel ormarble whereas the ceiling can be of stainless steel or Plaster of Paris. The

theatre corridors will preferably be 3.2 metres and not less than 2.85

metres wide.

Circulation within the department:

Patient flow:

In-patient nursing units Holding area Operating room

Pt rooms Post op recovery

Staff:

Entrance Changing rooms Working area Restroom/changing

room

Exit

Equipment & supplies:

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Clean Entrance Supply area Theatre area User Area

Sterile:

CSSD Theatre Preparation area User Area

Dirty linen and instruments:

Theatre Disposal room CSSD

Laundry

Relationships with other departments:

- Patient areas

- Support areas

The surgery dept will be related to patient areas like the emergency dept, the

ICU, patient rooms. They should have direct horizontal or vertical access to

surgery. Support areas such as pharmacy, laboratory, CSSD and housekeeping

services should have access to surgery through nonpublic and non-sterile

corridors.

CSSD will have vertical adjacency to surgery and will be connected by

dumbwaiters with the Operation Theatre.

Equipment required:

Movable Equipment

Surgical tables

C arm machines

Anaesthesia machines

Heart lung Machines

Flash sterilizers

Fixed Equipment:

Medical gas

Surgery lights

Laminar flow

Functional Areas:

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Control Station: The control station is primarily a clerical area located in a

position to control traffic into the surgery department. A control station differs

from a nurse station in that less people work out of this area. Surgeries are

scheduled; records and administrative functions are maintained. Space is

provided for requisite items to be delivered or picked up by other departments.Casework and furniture required:

Computer support components

File drawers

Form trays to organize the large volume of paper and forms.

Marker board for posting daily surgery schedule.

Pre-Operative Holding:

Patients arriving for surgical operations will be held in this area until the

operating room is ready. Here patients may be given medications or intravenous

fluids under close observation of the nursing staff.

Casework and furniture required:

A small workstation for filling out forms and paperwork.

Locker to hold patient care supplies.

Sink unit.

Medicine prep/ Storage

Specialty procedure carts.

Scrub Area:

They are placed with access to the operating rooms. Surgical scrub sinks are

generally ceramic or stainless steel with foot or knee controls. Shelves will be

placed above the sink to hold scrub brushes and masks.

Casework and furniture required: Overhead storage of 2 feet per sink is required.

Operating room:

It is the area where surgical procedures are performed under sterile techniques.

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Operating room will have positive pressure ventilation systems, with controlled

temperature and humidity, to prevent corridor air from entering.

The work surface for the circulating nurse will be placed near the entrance door

and the movable modular casework on the wall at the foot end of the table

depending on the head orientation of the patient.Modular casework applications:

Procedure/supply carts used for

Anaesthesia supplies and equipment

Suction and cautery equipment

Monitoring equipment

Prep and dressing

Anaesthesia carts.

Lockers used for

General supply storage

Backup supplies

Specialty procedure carts.

Dirty utility:

Used linens, instrument sets and equipment are placed in soiled utility

immediately after surgery. This room may hold soiled linen and instruments until

they are returned to central supply.

This opens outside to the dirty corridor from where the things are removed via

the dumbwaiter to the CSSD or to the laundry via the service lift.

Movable modular caseworks:

Process tables or work surfaces for receiving soiled items.

Sink unit.

Staffs lounge:

A staff lounge is used primarily for coffee breaks, snacks and as a place for staff

to rest from the pressures of patient care. Space should be provided for a

refrigerator, microwave oven and large coffee maker.

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Staff change rooms usually adjacent to staff lounge are provided for male and

female staff to change from street clothing to surgery attire. Clothing lockers,

toilet facilities and showers are provided.

Movable modular caseworks and furniture: Tables and seating

Base cabinets for storage

Overhead storage for coffee maker and supplies.

Administrative office:

The following positions will require an administrative office

Director/ Head of Anaesthesiology

OT in charge

Operating room materials manager/ Store room

Movable Modular Casework and furniture systems:

Cantilevered work surfaces

Work surfaces for keyboard drawers or trays to accommodate computers and

printers

Overhead storage and marker boards for displaying information.

Task lights and personal lights.

Lighting:

Intensity:

At the plane of the incision it would be desirable to achieve an all round intensity

of about 40,000 lux.

Luminance:

Normal luminance brightness for the central field during an operation should be

2,000 to 3,000 cd/sq.m The floor around the surgical table should have a

luminance of 200 to 300 cd/sq m, the walls 300 to 500 cd/sq m and the ceiling

lights 1,000 cd/sq m at most.Operation lamp characteristics:

The intensity of light be variable, but generally at least 40,000 lux at the

working plane, and at least 8,000 lux at the bottom of a 13 cm deep and

5 cm wide incision.

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The operation lamp should with no part hang lower than 2.0 m above the

floor.

General Lighting in operation room:

General lighting in the operation room should attain a minimum of 400 lux. In the

U.S. general illumination capability of 2,000 lux uniformly distributed throughout

the room with provision for reducing this level has been recommended.

Lighting in Operation room:

A reasonable level of illumination at washbasins is 300 to 500 lux. In the U.S. for

scrub rooms the illumination level of 2000 lux has been recommended as

members of the surgical team will encounter in the operating room.

Lighting in post anaesthetic recovery room:

Patients are disoriented and aware of bright lights during the awakening period.

Therefore light fittings must be placed where they will not disturb the patient.

A lighting intensity of about 300 lux is recommended. A mounted wall or ceiling

source of higher intensity spot illumination about 10,000 lux must be available

for performing procedures if required.

Colour in surgical department:

Generally in the UK pale blue, grey and green have found to be most suitable.

Blues and yellows should be avoided. A light grey colour for the operating room

floor has been recommended.

For the scrub up room yellowish or red shades may be used.

For the anaesthetic room the reflections on the patients face would not obstruct

the anaesthesiologists judgement of the patients condition. The colour scheme in

the anaesthetic room may be the same as that for the operating room, possiblysofter and warmer.

Noise levels

In operating room:

The noise level in operation rooms should be below 50 decibels.

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In anaesthetic rooms as well as in the labour and delivery rooms the noise levels

should be below 45 decibels.

In recovery room:

A special sensitivity to noise and need for protection from it is found in newly

operated persons whose autonomic nervous system is in disorder. One of thepatients greatest irritations in the recovery area is the laughter and other noises

of the staff.

In recovery rooms sound absorbent ceiling materials and wall finishes with a

reflection factor of about 50 per cent should be used.

Temperature in the operating room:

The temperature in the operating room will be maintained between 21 to 23

degrees.

Humidity:

The acceptable limits for relative humidity as regards static electricity and

comfort are 45 to 60 per cent. Low relative humidity has been reported to be an

optimal condition for Kleibsiella pneumoniae Type A while high humidity in the

hospital enhances the danger of growth of Ps. Aeruginosa.

Humidity in the operation room is believed to contribute to the prevention of

dehydration of exposed tissues.

At a relative humidity of about 50 per cent a very thin invisible film of moisture

forms on operation equipment and other surfaces. The film of moisture conducts

static to earth before a spark producing potential is built up.

A standard of relative humidity between 40 to 65 per cent has been fixed for

operating rooms. (55 % + or 5%)

Flooring in operation room and anaesthetic room:

The rooms flooring in the operation rooms and the anaesthetic rooms should be

Non slippery when wet.

Withstand intensive application of water and disinfectantsNot absorb physically foreign molecules

Be elastic and recover after the removal of heavy objects.

Have a high resistance to breakdown.

Be fire resistant.

Be colourfast.

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PVC flooring is the floor finishing that satisfies the majority of the requirement

of the operating room flooring.

Walls:

Suitable surface materials include laminated polyesters with an epoxy finish

and hard vinyl coverings which can be heat sealed.

Semi matt wall surfaces reflect less light than high gloss finishes and are less

tiring to the staff.

The corners in the operating room should be rounded with the wall surfaces to

make cleaning routines easier.

Doors:

Door hardware should be designed with single lever action and should require

no more than 4 kg of pressure to open the door.

In the operation department, staff dressed in sterilized garments require a

minimum door opening width of 90 cm. A clearance of about 10 cm on either

side of the bed including special equipment is required to move it through an

opening.

A width of 150 cm for two leaf door openings can be recommended.

A device that holds the door open must be provided to simplify equipment

moving.

The sound insulation properties of the doors should be good.

Operating rooms and anaesthetic rooms should be provided with safety

glazed openings with blinds to save unnecessary opening.

In the postoperative recovery area the doorways should pass beds easily. A

door width of about 145 cm is recommended.

Electrical outlets and switches:Electrical outlets should not be placed so that the power cords between the

wall outlets and the junction boxes and apparatus hinder the staff.

In operating rooms about 20 outlets are needed for advanced operations.

Electrical outlets in the vicinity of the operating table should be combined in a

control panel comprising switches, fuses and plug outlets for main voltage

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and low voltage for electronic appliances. It is preferred to have the control

panel hanging from the ceiling from the pendant.

In post anaesthetic units upto 8 electrical points are necessary for each bed.

Medical gases, piped air, vacuum.

Oxygen, compressed air, nitrous oxide and vacuum are supplied via gas pipes

identified by colours according to international standards.

To maintain homeostasis the inspired gases should be warm and humidified.

Heated humidifiers which supply gases at 35 degrees centigrade and at 100

per cent relative humidity. The temperature of gases should be monitored to

prevent tracheobronchial burn.

Gas outlet points shall be at least 20 cm from electrical components to avoid

generation of sparks.

For preoperative areas oxygen, suction and compressed air are required.

For the operation theatre and postoperative areas oxygen, compressed air,

nitrous oxide and suction are required.

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v

Intensive Care Units:

Function:

ICUs are specialty nursing units designed, equipped and staffed with specially

skilled personnel for

21248591 an architectural brief for a proposed 100 bedded hospital

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