PRINCIPLES OF HOSPITAL DESIGN

Dr A PRAKASHSr. Professor, Health Management

National Academy of Indian Railways(Formerly Railway Staff College)

VADODARA – 390 004

Dutch architectural historian Cor Wagenaar has called many hospitals:

"... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally

unfit for the purpose they have been designed for ... They are hardly ever functional, and instead

of making patients feel at home, they produce stress and anxiety."

The research of British Medical Association shows that good hospital design can reduce patient's recovery time. Exposure to daylight is effective in reducing depression. Exposure to nature and hospital gardens is also important - looking out windows improves patients' moods and reduces blood pressure and stress level. Eliminating long corridors can reduce nurses' fatigue and stress.

THE PLOT

Where the clients want it Easy reach of captive population Free access Area not less than double the floor area IS 10905 Pt I – one hectare per 25 beds Gates – Main / Emergency / Service

BUILDING

Maintenance free Environment friendly Minimum energy expenditure for ambient light &

climate control Functional segregation Emergency exits, ramps, fire alarms Disabled friendly

FLOOR AREA OF HOSPITAL

700 – 900 sq ft per bed

One bed requires 75-100 sq ft Total floor area required is 10 times this

FLOOR AREA ALLOCATION

OPD – 12%-18% Wards – 37%-45% Diagnostic & Therapeutic – 18%-22% Administration – 8%-12% Service Departments – 15%-20%

FLOOR AREA DETAILED BREAKUP

Nursing – 250-280 Nursery – 12-18 Labour Room – 15-20 OT – 30-50 Physical Medicine – 12-18 Radiology – 25-35 Laboratory – 25-35 Pharmacy - 4-6

FLOOR AREA DETAILED BREAKUP

CSSD – 8-25 Dietary – 25-35 Medical Record – 8-15 House Keeping – 4-5 Laundary – 12-18 Mechanical Installations – 50-75 Maintanence Workshop – 4-6 Stores - 25-35

FLOOR AREA DETAILED BREAKUP

Public Areas – 8-10 Staff Facilities – 10-15 Administration – 40-50 Circulation – 115-140 TOTAL – 681-991 Add Partitions, Walls etc – 95-125 GROSS TOTAL - 780-1005

CORRIDORS

Main corridor should allow for passage of two beds with persons on sides

It requires ~2.5 metre width Less than 100 beded hospitals can have one

bed passage It requires ~2.0 metre width Segregation of clean and dirty corridors

LIFTS

Depends upon number of beds above ground floor

Up to 60 – one Up to 200 – two Up to 350 – three

Size – >2280X1600X2300 mm

with door size >1300X2100 mm

OPD

For every bed three patients are seen in OPD 60% of area should be for waiting & corridors Seats for 1/3 of daily attendance @ 8 sq ft/pt. Consultation room – 150 sq ft Attached examination room – 80 sq ft

CASUALTY

Easy access Consultation room 150 sq ft Resuscitation room 175 sq ft Waiting area

WARDS

24 to 32 beded 75 sq ft area for each bed Center to center distance between beds 8 ft Edge to edge distance between beds 4 ft Service corridor between bed rows 8 ft Wash basin one between 10 beds Sluice room 120 sq ft Broom closet 40 sq ft MGPS

WINDOWS IN WARDS

Window area 20% of floor area if only on one wall

Window area 15% of floor area if on opposite walls at same sill level

CABINS

At least 6 cabins per 100 beds

Australian standard is 25% of beds in single, double & quadruple units

BED DISTRIBUTION

Medical 30%-40% Surgical 25%-30% (includes Orthopedics – 5%) Obs & Gynae 15%-18% Peadiatrics 10%-12% ENT & Eye etc 10%-15%

ICU

Bed strength – 2% to 5% of total beds Not less than 5 or more than 15 in a unit Each bed 150 – 200 sq ft Not more than 40%-50% floor area for beds Hence ICU size 500 sq ft per bed Power – 2X15 amp & 3X5 amp at least MGPS Monitor cabling

OT – THE NUMBER

One OR per 50 beds

No. of Operations = Surgical BedsXBORX365 ALSX100XWorking Days

No. of OT = No. of Operations per day Expected Output per OT

OT – THE NUMBER

BEDS MINOR MAJOR EM MINOR EM MAJOR

50 0 1 0 1

100 1 1 0 1

300 2 3 0 1

500 2 5 1 1

750 2 8 1 1

1000 2 10 1 1

ZONING IN OT

Protective Zone Clean Zone Sterile Zone Disposal or Sluice Zone

ENVIRONMENTAL CONTROL

Temperature – 20+2 Relative Humidity – 40%-60% Air Changes 25/hr (at least 10 of fresh air) Clean air thru HEPA filter (0.3μ & 99.7%

efficiency) Clean area – 12 or more air changes, same

temperature & RH

OT FLOOR AREA DISTRIBUTION

Special OR (25'X25') – 625 sq ft Major OR (20'X20') – 400 sq ft Minor OR (18'X18') – 324 sq ft Scrub Room – 80 sq ft Fracture Room – 249 sq ft Plaster Room – 80 sq ft Sterile Storage – 160 sq ft Equipment Storage – 240 sq ft

OT FLOOR AREA DISTRIBUTION

Instrument Storage – 160 sq ft Anaesthetist's Room – 160 sq ft Anaesthesia Store – 80 sq ft Anaesthesia Room* – 160 sq ft Doctor's Change Room – 120 sq ft Nurses' Change Room – 120 sq ft Staff Change Room – 120 sq ft OT Office – 120 sq ft

OT FLOOR AREA DISTRIBUTION

General & Linen Store – 120 sq ft 2 bed recovery – 160 sq ft Mobile X ray & Dark Room – 120 sq ft Trolley Bay – 80 sq ft Safaiwala Alcove – 80 sq ft

OT FLOOR AREA DISTRIBUTION

ADD IN CASE OF DAY CARE SURGERY Reception – 100 sqft Men's Change Room – 120 sqft Ladies' Change Room – 120 sqft Patient's Preparation – 120 sqft Gowned Waiting Area – 80 sqft

PLUS Circulation Area

SERVICES FOR OT

Electricity – Clean Water Supply – Clean Lighting – General Background /

Operation /Special MGPS

? SEAMLESS / MODULAR OT

LABOUR ROOMS

Septic & Aseptic Segregation Lighting MGPS Neonatal Resuscitation Area Vicinity of Nursery & OT

NURSERY

Vicinity of Labour Room Natural Light

MORTUARY

Connected to Service Gate Cold Room Side Room with Plumbing Waiting Area

PROVISION FOR GROWTH

Area Growth Acceleration Indoor 8.7% 1.0% Outdoor 10.8% 4.1% Medical Services 28.4% 15.3% Teaching & Research 45.9% 31.1% Staff 18.5% 4.9% Services 9.5% 1.8% Administration 23.3% 6.5%

AIRCONDITIONING

Dilution CO2 / Heat Load / Microbial Load

Control of Microbial Spread Room to Room Pressure Difference Flow Control within Room

Humidity Control Air Purification

Filters / UV / Ozone

AIRCONDITIONING

Integration of – Ventilation Lighting Fire fighting MGPS Cabling for computers & monitors etc

AC – OT

Temp – 20-23 RH – 50%- 60% Pressure – Positive, Negative in Sluice Room Air changes – 10 fresh / 25 total Air Filtration – HEPA (0.3 μ) in OR 20μ else Pressure maintained in OR 24X7

AC – ENDOSCOPY ROOM

Temp – 20-23 RH – 30%-60% Pressure – Negative Air Changes – 2 fresh / 12 total Air filtration – 20 μ All air vented out

AC – POSTOPERATIVE

Temp – 21-24 RH – 30%-60% Pressure – Positive Air change – 2 fresh / 6 total Air Filtration – 5 μ

AC – MICU/SICU

Temp – 21-24 RH – 30%-60% Pressure – Positive Air change – 5 fresh / 15 total Air Filtration – 5 μ

LABOUR ROOM

Temp – 20-23 RH – 30%-60% Pressure – Positive Air Changes – 3 fresh / 15 total Air Filtration – 5 μ

NURSERY

Temp – 22-26 RH – 30%-60% Pressure – Positive Air Changes – 3 fresh / 15 total Air Filtration – 5 μ

WARDS

Temp – 21-24 RH – 30%-60% Pressure – Positive Air Changes – 3 fresh / 15 total Air Filtration – 20 μ

Over crowding in visiting hours

PATHOLOGY

Temp – 24 RH – 30%-60% Pressure – Negative Air Changes – 6 total All air exhausted outside

RADIOLOGY

Temp – 24 RH – 30%-60% Pressure – Positive, Negative in Dark Room Air Changes – 6 total, 10 total in Dark Room Heat Load Calculation is important

REFERENCES

Private Hospital Guidelines Australia IIIed

Private Health Care Facilities Lisencing Procedures & Specifications UAE

Hospital Planning and Administration, R Llewellyn-Davies & HMC Macaulay

Principles of Hospital Administration and Planning, BM Sakharkar

Hospital Administration, CM Francis & Mario C de Souza

REFERENCES

IS 10905 (Indian Hospital Standards)

HTM 2025 (Ventilation in Health Care Facility)

HTM 05 (Fire Safety) & HTM 06 (Electrical Services)

HTM 2014 Electromagnetic Interference to Medical Equipment

EN 12464 for lighting

thank you