Definition of Hospitals

Classification Of Hospital……………………………………………………………………3

Hospital Function………………………………………………………………………….…4

Guidelines In The Planning And Design

Of A Hospital And Other Health Facilities………………………………………….….…..6

Guidelines & Main Requirements In The

Planning And Design Of Hospitals………………………………………………….....…..13

General Organization Of A Hospital…………………………………………………...….16

Specialized Services………………………………………………………………………….19

Safety Standards…………………………………………………………………………..…25

Bibliography………………………………………………………………………………....29

DEFINITION OF HOSPITAL

Page 1 of 28
Definition of Hospital WHO Expert Committee, 1963:
‘A hospital is a residential establishment which provides short-term and long-
term medical care consisting of observational, diagnostic, therapeutic and
rehabilitative services for persons suffering or suspected to be suffering from a
disease or injury and for parturient. It may or may not also provide services for
ambulatory patients on an out-patient basis’.

WHO expert committee, 1956:

‘The hospital is an integral part of a social and medical organization, the
function of which is to provide for the population complete healthcare, both
curative and preventive, and whose out- patient services reach out to the family in
its home environment; the hospital is also a centre for the training of health
workers and for bio- social research’.

Classification of Hospital
Basing on Objective
a. General hospitals
b. Special hospitals
c. Teaching cum Research Hospital
Basing on Administration, ownership, control or financial income
a. Governmental or public
b. Non-governmental or private
c. Semi Govt Hospital d. Voluntary Agency Hospitals
Basing on Length of Stay
a. Short-term or short-stay hospitals (Stay less than 30 days)
b. Long-term or long-stay hospitals: (Stay more than 30 days)
Depending on Type of Medical Staff
a. Closed-staff hospital:
b. Open-staff hospital:
Basing on bed capacity (Size)
a. Small hospital (Upto 100 beds)
b. Medium hospital (More than 100 to less than 300 beds)
c. Large hospital (More than 300 beds) 6
Basing on type of care:
a. Primary Care
b. Secondary Care
c. Tertiary Care
Basing on regionality
a. Regional
b. District
c. Upazila Health Complex
d. Union Health and Family Welfare Centres
e. Community Clinics
As per WHO Classification:
a. Regional Hospital
b. Intermediate/ District Hospital
c. Rural Hospital

Page 2 of 28
 General hospitals:
General Hospitals are meant to provide wide-range of various types of healthcare, but
with limited capacity. They care for patients with various-disease conditions for both sexes to all
ages, medical, surgical, paediatrics, obstetrics, eye and ear etc. Usually, General hospitals are
devoid of super-specialist medical care. Special hospitals: They limit their service to a particular
condition, orthopedics, maternity, paediatrics, geriatrics, oncology etc. Teaching cum Research
Hospital: College is attached for medical/ nursing/ dental/ pharmacy education. Main objective is
to provide medical care, teaching and research is secondary

Governmental or public hospital:

They are owned, administered and controlled by the government. They provide free care
for patients. The governmental hospitals are owned by: • The Ministry of Health. • The
University • Others. A public hospital or government hospital is a hospital which is owned by a
government and receives government funding. In some countries, this type of hospital provides
medical care free of charge, the cost of which is covered by government reimbursement. In
Australia, public hospitals are operated and funded by each individual state's health department.
The federal government also contributes funding.

Private Hospital:
Privately owned or controlled by an individual or group of physicians or citizens or by
private organization. eg, Square Hospital. Purpose is to provide services for profit making. Semi
Govt Hospital: Hospitals run both by the govt and private entity. eg Cantt Board Hospital.
10. Corporate Hospital Hospitals which are public limited companies formed under the
companies act. Run on commercial lines. eg, Apollo Voluntary Agency Hospital: Not for profit
hospitals by the Voluntary Organizations. eg, HOPE Foundation Fistula Hospital

Short-term or short-stay hospitals: These are hospitals where over 90% of all patients
admitted stay less than 30 days. Long-term or long-stay hospitals: These are hospitals where over
90% of all patients admitted stay 30 days or more, i.e. mental hospital. Closed-staff hospital:
Physicians are held responsible for all medical activities in the hospital including the diagnosis
and treatment of patient fee paying and emergency. Open-staff hospital: This type of hospital
permits other physicians in the community to admit and treat patients to the hospital' and treat
them.

Open Staff Hospital: Open medical staff, which means any physician can request to practice at
the facility, regardless of their hospital affiliation. Close Staff Hospital: A closed hospital system
is one in which all doctors are on staff, and also doctors that aren't on staff may not have access
or privileges at said hospital.

According to Level of Care: Primary Care Hospital

Primary care is the day-to-day healthcare given by a health care provider. Typically this provider
acts as the first contact and principal point of continuing care for patients within a healthcare
system, and coordinates other specialist care that the patient may need. Provides mostly basic
health care. It is generally regarded as the ‘gateway’ to receiving more specialist care. eg,
Upazila Health Complex

Page 3 of 28
  These are usually 50-200 bedded hospitals.
 This also includes Divisional and National Level Hospitals

WHO Classification (Expert Committee 1957) Regional Hospital: Provides complex range of
treatment and highly specialized services. Serves a larger area than a local hospital. Example-
Govt Medical College Hospital Intermediate/ District Hospital: A district hospital typically is the
major health care facility in its locality (For Bangladesh in a district level). Specialty services in
major disciplines (eg, Medicne, Surgery, Gynae etc) Rural Hospital: Remote hospitals with small
number of beds and limited service capacity. It should have 20-100 beds.

Hospital Function
1. Intramural: Services within the wall of hospital
2. Extramural: Services outside the wall of hospital. eg, OPD, Outreach services, Medical
Camps, Immunization Program

The Rehabilitation Services are dedicated to providing high quality, individualized, and effective
interventions aimed at promoting both patient safety and a return to independent function.
Services include Physical Therapy, Occupational Therapy, and Speech-Language therapy etc
with compassion and empathy in a patient and family centered care environment.

Page 4 of 28
 GUIDELINES IN THE PLANNING AND
DESIGN OF A HOSPITAL AND OTHER
HEALTH FACILITIES

A hospital and other health facilities shall be planned and designed to observe
appropriate architectural practices, to meet prescribed functional programs, and to
conform to applicable codes as part of normal professional practice. References shall be
made to the following:
 P. D. 1096 – National Building Code of the Philippines and Its Implementing
Rules and Regulations
 P. D. 1185 – Fire Code of the Philippines and Its Implementing Rules and
Regulations
 P. D. 856 – Code on Sanitation of the Philippines and Its Implementing Rules
and Regulations
 B. P. 344 – Accessibility Law and Its Implementing Rules and Regulations
 R. A. 1378 – National Plumbing Code of the Philippines and Its
Implementing Rules and Regulations
 R. A. 184 – Philippine Electrical Code
 Manual on Technical Guidelines for Hospitals and Health Facilities Planning
and Design. Department of Health, Manila. 1994
 Signage Systems Manual for Hospitals and Offices. Department of Health,
Manila. 1994
 Health Facilities Maintenance Manual. Department of Health, Manila. 1995
 Manual on Hospital Waste Management. Department of Health, Manila. 1997
 District Hospitals: Guidelines for Development. World Health Organization
Regional Publications, Western Pacific Series. 1992
 Guidelines for Construction and Equipment of Hospital and Medical
Facilities.
American Institute of Architects, Committee on Architecture for Health. 1992
 De Chiara, Joseph. Time-Saver Standards for Building Types. McGraw-Hill
Book Company. 1980

1 Environment: A hospital and other health facilities shall be so located that it is

readily accessible to the community and reasonably free from undue noise, smoke,
dust, foul odor, flood, and shall not be located adjacent to railroads, freight yards,
children's playgrounds, airports, industrial plants, disposal plants.

2 Occupancy: A building designed for other purpose shall not be converted into a
hospital. The location of a hospital shall comply with all local zoning ordinances.

3 Safety: A hospital and other health facilities shall provide and maintain a safe
environment for patients, personnel and public. The building shall be of such
construction so that no hazards to the life and safety of patients, personnel and
public exist. It shall be capable of withstanding weight and elements to which they

Page 5 of 28
 may be subjected.

3.1 Exits shall be restricted to the following types: door leading directly outside
the building, interior stair, ramp, and exterior stair.

3.2 A minimum of two (2) exits, remote from each other, shall be provided for each
floor of the building.

GUIDELINES IN THE PLANNING AND

DESIGN OF A HOSPITAL AND OTHER
HEALTH FACILITIES

3.3 Exits shall terminate directly at an open space to the outside of the building.

4 Security: A hospital and other health facilities shall ensure the security of person
and property within the facility.

5 Patient Movement: Spaces shall be wide enough for free movement of patients,
whether they are on beds, stretchers, or wheelchairs. Circulation routes for
transferring patients from one area to another shall be available and free at all times.

5.1 Corridors for access by patient and equipment shall have a minimum width of
2.44 meters.

5.2 Corridors in areas not commonly used for bed, stretcher and equipment transport
may be reduced in width to 1.83 meters.

5.3 A ramp or elevator shall be provided for ancillary, clinical and nursing areas
located on the upper floor.

5.4 A ramp shall be provided as access to the entrance of the hospital not on the
same level of the site.

6 Lighting: All areas in a hospital and other health facilities shall be provided with
sufficient illumination to promote comfort, healing and recovery of patients and to
enable personnel in the performance of work.

7 Ventilation: Adequate ventilation shall be provided to ensure comfort of patients,

personnel and public.

8 Auditory and Visual Privacy: A hospital and other health facilities shall observe
acceptable sound level and adequate visual seclusion to achieve the acoustical and
privacy requirements in designated areas allowing the unhampered conduct of
activities.

Page 6 of 28
9 Water Supply: A hospital and other health facilities shall use an approved public
water supply system whenever available. The water supply shall be potable, safe for
drinking and adequate, and shall be brought into the building free of cross
connections.

10 Waste Disposal: Liquid waste shall be discharged into an approved public sewerage
system whenever available, and solid waste shall be collected, treated and disposed
of in accordance with applicable codes, laws or ordinances.

11 Sanitation: Utilities for the maintenance of sanitary system, including approved

water supply and sewerage system, shall be provided through the buildings and
premises to ensure a clean and healthy environment.

GUIDELINES IN THE PLANNING AND

DESIGN OF A HOSPITAL AND OTHER
HEALTH FACILITIES
12 Housekeeping: A hospital and other health facilities shall provide and maintain a
healthy and aesthetic environment for patients, personnel and public.

13 Maintenance: There shall be an effective building maintenance program in place.

The buildings and equipment shall be kept in a state of good repair. Proper
maintenance shall be provided to prevent untimely breakdown of buildings and
equipment.

14 Material Specification: Floors, walls and ceilings shall be of sturdy materials that
shall allow durability, ease of cleaning and fire resistance.

15 Segregation: Wards shall observe segregation of sexes. Separate toilet shall be

maintained for patients and personnel, male and female, with a ratio of one (1) toilet
for every eight (8) patients or personnel.

16 Fire Protection: There shall be measures for detecting fire such as fire alarms in
walls, peepholes in doors or smoke detectors in ceilings. There shall be devices for
quenching fire such as fire extinguishers or fire hoses that are easily visible and
accessible in strategic areas.

17 Signage. There shall be an effective graphic system composed of a number of

individual visual aids and devices arranged to provide information, orientation,
direction, identification, prohibition, warning and official notice considered
essential to the optimum operation of a hospital and other health facilities.

18 Parking. A hospital and other health facilities shall provide a minimum of one (1)
parking space for every twenty-five (25) beds.

Page 7 of 28
19 Zoning: The different areas of a hospital shall be grouped according to zones as
follows:

19.1 Outer Zone – areas that are immediately accessible to the public: emergency
service, outpatient service, and administrative service. They shall be located
near the entrance of the hospital.

19.2 Second Zone – areas that receive workload from the outer zone: laboratory,
pharmacy, and radiology. They shall be located near the outer zone.

19.3 Inner Zone – areas that provide nursing care and management of patients:
nursing service. They shall be located in private areas but accessible to
guests.

19.4 Deep Zone – areas that require asepsis to perform the prescribed services:
surgical service, delivery service, nursery, and intensive care. They shall be
segregated from the public areas but accessible to the outer, second and inner
zones.

Page 8 of 28
 GUIDELINES IN THE PLANNING AND
DESIGN OF A HOSPITAL AND OTHER
HEALTH FACILITIES
19.5 Service Zone – areas that provide support to hospital activities: dietary
service, housekeeping service, maintenance and motorpool service, and
mortuary. They shall be located in areas away from normal traffic.

20 Function: The different areas of a hospital shall be functionally related with each
other.

20.1 The emergency service shall be located in the ground floor to ensure
immediate access. A separate entrance to the emergency room shall be provided.

20.2 The administrative service, particularly admitting office and business office,
shall be located near the main entrance of the hospital. Offices for hospital
management can be located in private areas.

20.3 The surgical service shall be located and arranged to prevent non-related
traffic. The operating room shall be as remote as practicable from the
entrance to provide asepsis. The dressing room shall be located to avoid
exposure to dirty areas after changing to surgical garments. The nurse station
shall be located to permit visual observation of patient movement.

20.4 The delivery service shall be located and arranged to prevent non-related
traffic. The delivery room shall be as remote as practicable from the entrance
to provide asepsis. The dressing room shall be located to avoid exposure to
dirty areas after changing to surgical garments. The nurse station shall be
located to permit visual observation of patient movement. The nursery shall
be separate but immediately accessible from the delivery room.

20.5 The nursing service shall be segregated from public areas. The nurse station
shall be located to permit visual observation of patients. Nurse stations shall
be provided in all inpatient units of the hospital with a ratio of at least one (1)
nurse station for every thirty-five (35) beds. Rooms and wards shall be of
sufficient size to allow for work flow and patient movement. Toilets shall be
immediately accessible from rooms and wards.

20.6 The dietary service shall be away from morgue with at least 25-meter distance.

21 Space: Adequate area shall be provided for the people, activity, furniture, equipment
and utility.

Space Area in Square Meters

Page 10 of 28
Administrative Service
Lobby
Waiting Area 0.65/person
Information and Reception Area 5.02/staff
Toilet 1.67
Business Office 5.02/staff
Medical Records 5.02/staff

DESIGN OF A HOSPITAL AND OTHER

HEALTH FACILITIES

Space Area in Square Meters

Office of the Chief of Hospital 5.02/staff
Laundry and Linen Area 5.02/staff
Maintenance and Housekeeping Area 5.02/staff
Parking Area for Transport Vehicle 9.29
Supply Room 5.02/staff
Waste Holding Room 4.65
Dietary
Dietitian Area 5.02/staff
Supply Receiving Area 4.65
Cold and Dry Storage Area 4.65
Food Preparation Area 4.65
Cooking and Baking Area 4.65
Serving and Food Assembly Area 4.65
Washing Area 4.65
Garbage Disposal Area 1.67
Dining Area 1.40/person
Toilet 1.67
Cadaver Holding Room 7.43/bed
Clinical Service
Emergency Room
Waiting Area 0.65/person
Toilet 1.67
Nurse Station 5.02/staff
Examination and Treatment Area with Lavatory/Sink 7.43/bed
Observation Area 7.43/bed
Equipment and Supply Storage Area 4.65
Wheeled Stretcher Area 1.08/stretcher
Outpatient Department
Waiting Area 0.65/person
Toilet 1.67
Admitting and Records Area 5.02/staff
Examination and Treatment Area with Lavatory/Sink 7.43/bed
Consultation Area 5.02/staff
Surgical and Obstetrical Service
Major Operating Room 33.45
Delivery Room 33.45

Page 10 of 28
 Sub-sterilizing Area 4.65
Sterile Instrument, Supply and Storage Area 4.65
Scrub-up Area 4.65
Clean-up Area 4.65
Dressing Room 2.32
Toilet 1.67
GUIDELINES IN THE PLANNING AND Nurse 5.02/staff
Station
Wheeled Stretcher Area 1.08/stretcher
Janitor’s Closet 3.90

GUIDELINES IN THE PLANNING AND

DESIGN OF A HOSPITAL AND OTHER
HEALTH FACILITIES

Space Area in Square Meters

Nursing Unit
Semi-Private Room with Toilet 7.43/bed
Patient Room 7.43/bed
Toilet 1.67
Isolation Room with Toilet 9.29
Nurse Station 5.02/staff
Treatment and Medication Area with 7.43/bed
Lavatory/Sink
Central Sterilizing and Supply Room
Receiving and Releasing Area 5.02/staff
Work Area 5.02/staff
Sterilizing Room 4.65
Sterile Supply Storage Area 4.65
Nursing Service
Office of the Chief Nurse 5.02/staff
Ancillary Service
Primary Clinical Laboratory
Clinical Work Area with Lavatory/Sink 10.00
Pathologist Area 5.02/staff
Toilet 1.67
Radiology
X – Ray Room with Control Booth, Dressing Area 14.00
and Toilet
Dark Room 4.65
Film File and Storage Area 4.65
Radiologist Area 5.02/staff
Pharmacy 15.00

Page 10 of 28
 Notes:

1. 0.65/person – Unit area per person occupying the space at one time
2. 5.02/staff – Work area per staff that includes space for one (1) desk and one (1)
chair, space for occasional visitor, and space for aisle
3. 1.40/person – Unit area per person occupying the space at one time
4. 7.43/bed – Clear floor area per bed that includes space for one (1) bed, space for
occasional visitor, and space for passage of equipment
5. 1.08/stretcher – Clear floor area per stretcher that includes space for one
(1)stretcher

Guidelines & Main Requirements in the

Planning and Design of Hospitals

General requirements;

The following general requirements are to be obtained :

I. Environment: A hospital and other health facilities shall be so located that it is readily
accessible to the community and reasonably free from undue noise, smoke, dust, foul odor,
flood, and shall not be located adjacent to railroads, freight yards, children's playgrounds,
airports, industrial plants, disposal plants.

II. Occupancy: A building designed for hospital / healthcare facility shall be used only for
this purposes.

III. Safety: A hospital and other health facilities shall provide and maintain a safe
environment for patients, personnel and public. The building shall be of such construction so
that no hazards to the life and safety of patients, personnel and public exist. It shall be
capable of withstanding weight and elements to which they may be subjected.

 Exits shall be restricted to the following types: door leading directly outside the
building, interior stair, ramp, and exterior stair.
 Minimum of two (2) exits, remote from each other, shall be provided for each floor of
the building.
 Exits shall terminate directly at an open space to the outside of the building.

IV. Security: A hospital and other health facilities shall ensure the security of person and
property within the facility.

V. Patient Movement: Spaces shall be wide enough for free movement of patients, whether
they are on beds, stretchers, or wheelchairs. Circulation routes for transferring patients from
one area to another shall be available and free at all times.

 Corridors for access by patient and equipment shall have a minimum width of 2.44
meters.
Page 10 of 28
  Corridors in areas not commonly used for bed, stretcher and equipment transport may
be reduced in width to 1.83 meters.
 A ramp or elevator shall be provided for ancillary, clinical and nursing areas located
on the upper floor.
 A ramp shall be provided as access to the entrance of the hospital not on the same
level of the site.

VI. Lighting: All areas in a hospital and other health facilities shall be provided with
sufficient illumination to promote comfort, healing and recovery of patients and to enable
personnel in the performance of work.

VII. Ventilation: Adequate ventilation shall be provided to ensure comfort of patients,

personnel and public.

VIII. Auditory and Visual Privacy: A hospital and other health facilities shall observe
acceptable sound level and adequate visual seclusion to achieve the acoustical and privacy
requirements in designated areas allowing the unhampered conduct of activities.

IX. Water Supply: A hospital and other health facilities shall use an approved public water
supply system whenever available. The water supply shall be potable, safe for drinking and
adequate, and shall be brought into the building free of cross connections.

X. Waste Disposal: Liquid waste shall be discharged into an approved public sewerage

system whenever available, radioactive waste and others hazards liquid waste to be collected
and treated in accordance to international rules and solid waste shall be collected, treated and
disposed of in accordance with applicable codes, laws or ordinances.

XI. Sanitation: Utilities for the maintenance of sanitary system, including approved water

supply and sewerage system, shall be provided through the buildings and premises to ensure
a clean and healthy environment

XII. Housekeeping: A hospital and other health facilities shall provide and maintain a
healthy and aesthetic environment for patients, personnel and public.

XIII. Maintenance: There shall be an effective building maintenance program in place. The

buildings and equipment shall be kept in a state of good repair. Proper maintenance shall be
provided to prevent untimely breakdown of buildings and equipment.

XIV. Material Specification: Floors, walls and ceilings shall be of sturdy materials that shall
allow durability, ease of cleaning and fire resistance.

XV. Segregation: Wards shall observe segregation of sexes. Separate toilet shall be

maintained for patients and personnel, male and female.

XVI. Fire Protection: There shall be measures for detecting fire such as fire alarms in walls,
Peepholes in doors or smoke detectors in ceilings. There shall be devices for quenching fire
such as fire extinguishers or fire hoses that are easily visible and accessible in strategic areas.

Page 10 of 28
XVII. Signage: There shall be an effective graphic system composed of a number of
individual visual aids and devices arranged to provide information, orientation, direction,
identification, prohibition, warning and official notice considered essential to the optimum
operation of a hospital and other health facilities.

XVIII. Parking: A hospital and other health facilities shall provide a parking space

XIX. Zoning: The different areas of a hospital shall be grouped according to zones as follows

(fig.1):

 Outer Zone – areas that are immediately accessible to the public: emergency service,
outpatient service, and administrative service. They shall be located near the entrance
of the hospital.
 Second Zone – areas that receive workload from the outer zone: laboratory,
pharmacy, and radiology. They shall be located near the outer zone.
 Inner Zone – areas that provide nursing care and management of patients: nursing
service. They shall be located in private areas but accessible to guests.
 Deep Zone – areas that require asepsis to perform the prescribed services: surgical
service, delivery service, nursery, and intensive care. They shall be segregated from
the public areas but accessible to the outer, second and inner zones
 Service Zone – areas that provide support to hospital activities: dietary service,
housekeeping service, maintenance and motor pool service, and mortuary. They shall
be located in areas away from normal traffic.

XX. Function: The different areas of a hospital shall be functionally related with each other;

 The emergency service shall be located in the ground floor to ensure immediate
access. A separate entrance to the emergency room shall be provided.
 The administrative service, particularly admitting office and business office, shall be
located near the main entrance of the hospital. Offices for hospital management can
be located in private areas.
 The surgical service shall be located and arranged to prevent non-related traffic. The
operating room shall be as remote as practicable from the entrance to provide asepsis.
The dressing room shall be located to avoid exposure to dirty areas after changing to
surgical garments.
 The delivery service shall be located and arranged to prevent non-related traffic. The
delivery room shall be as remote as practicable from the entrance to provide asepsis.
The dressing room shall be located to avoid exposure to dirty areas after changing to
surgical garments. The nursery shall be separate but immediately accessible from the
delivery room.

 The nursing service shall be segregated from public areas. The nurse station shall be
located to permit visual observation of patients. Nurse stations shall be provided in all
inpatient units of the hospital.
 In wards the Rooms shall be of sufficient size to allow for work flow and patient
movement.
Page 10 of 28
  In wards the Toilets shall be immediately accessible from rooms.
 The dietary service shall be away from morgue.

I. General organization of a hospital

1. Area

 A hospital has to be placed:

- In a quiet place,
- On a healthy and flat plot without dust, bad smells, insects…
 Some vacant places have to be planned for future extensions of the hospital.

2. Layout
 A hospital consists of
several sectors:
- Treatments, cares,
examinatin,
- Administration,
- Technical and storage zones,
- Waste water discharge,

- External areas: park and parking.

 There are two main types of

building layouts:
- Wings/Pavilions for specialized
sectors,
- A central space and rays.

 It is necessary:
- To differentiate main sectors/annexes/circulation passages,
- To separate hospitalized patients and other patients,
- To minimize distances between services.

 Note that:
- A park is required for acoustic isolation of rooms,
- A maximal partition in isolated sections is required.

3. Plot orientation (in the northern hemisphere)

 Treatment zones and storage locals: in the North, North-West or North-East.

 Patients’ rooms: in the South or South-East.

 However, few patients’ rooms have to be placed in the North (no direct sun light).

Page 10 of 28
  Required area/volume for one bed (for the whole built area/volume
including annexes, technical and storage rooms):
- Area: from 70 m2 to 100 m2,
- Volume: from 200 m3 to 280 m3.

 Area sharing in a
common hospital
(advised): Ea= effective
area

Supplying/ discharging 30-50 m2 (ea per bed)

Cares 19-25 m2 (ea per bed)
Intensive treatment 30-40 m2 (ea per bed)
Operating wings 130-160 m2 (ea per wing)
Re-education 19-22 m2 (ea per treatment unit)
Radiology 60-70 m2 (ea per unit)
Waking units 25-30 m2 (ea per bed)
Reception 140-160 m2 (ea per unit)
Maternity unit 85-100 m2 (ea per bed)
Specialized services 55-75 m2 (ea per unit)
4. Connections between services

Interdependent services have to be close to each others:

Car Operati Intensiv Steril Maternit Emergenci Labor Exam Radiograp
es n g e i- y units es a- i- hy
wings treatmen zatio tory natio
t n n
Cares   
Operating     
wings
Intensive    
treatment
Sterilization
Maternity  
units
Emergencies  
Laboratory 
examination 
radiography

 Short and required connection

 Short and useful connection
 Advised connection

Page 10 of 28
 5. Entrances
 Main entrance:
- Only one main entrance,
- Secondary entrances have to be pointed out apart (hygiene measures).

 Entrance hall:
- Conceived as a waiting room for visitors (principle of open doors),
- Like a hotel hall,
- Its size depends of number of beds,
- Different ways (for patients, visitors, staff) separated from the entrance hall,
- Reception (12 m2): with a reception desk to supervise
entrances and circulation ways.

 Entrances for laying patients:

- For admission, a closed hall and an entrance slope are required;
they have to be separated from the entrance hall but visible
from the reception,

- Shorts connections with emergencies separated from main

circulation ways are required.

6. Circulation

 Circulation ways have to be dimensioned for the most important circulation.

- Access passages: 1.5m wide,
- Passages for lying patients’ transfer: 2.25m wide minimum,
- Ceilings in passages: 2.40m high minimum,
- Maximal distance between two windows in a passage way: 25m,
- Width of passage ways mustn’t be reduced by any object or post,
- According to the regulations fire doors are required in passage ways.

 Doors:
- Coverings have to be resistant to the maintenance and disinfectant products.
- The same sound insulation as the one for walls is required: a
leaf with two walls can absorb noises up to 27 dB minimum.
- Height of doors: 2.1-2.2m,
- Height of over designed doors for cars: 2.5m,
- Height of doors for the passage of transport vehicles: 2.7-2.8m,
- Minimal height of doors for access to a hall for lying people: 3.5m.

7. Circulation for handicapped people

 Circulation in a wheelchair requires a specific design of the circulation ways
(Picture 1)
- Passages: 1.30m wide minimum, better if 2m wide,
Page 10 of 28
 - Doors: 0.95m wide minimum, a magnetic closure is advised,
- Switches, handles, windows closure... have to be within easy reach: 1-1.05m
high,
- Wide pushbuttons are required,
- Access ways: 1.20-2m wide,
- Slopes: 5% maximum, 6m long maximum,
- Width between handrails: 1.20m.

 Connections have to be as short as possible.

8. Duration of use

 Equipment and second work have to be changed every 10-15 years.

So a sufficient space has to be planned for assembling and dismantling.

II. Specialized services

9. Surgical services

 Localization:
- Generally speaking surgical units have a central localization in the hospital.
- Surgical services have to be placed close to emergencies,
intensive cares services, waking units and sterilization services.
Short connections between those services are required,
particularly with emergencies units.
- Hygiene standards require a disconnection between
surgical units and other services: tambours are advised for
this separation.

 Organization of a surgical unit:

- Operating room: 40-48 m2
- Ante-operating room: 15-20 m2
- Post-operating room: 15-20 m2
- Cleaning room: 12-15 m2
- Implement room: 10-15 m2

 Are required:
- A airlock for staff,
- A airlock for patients,
- Sterilized passages for work,
- An anesthesia local,
- A airlock for distribution and evacuation,
- A local for nurses,
- A waiting room,
- A waking room.
Page 10 of 28
  35 m2 more are required (in the airlock for patients if possible) for :
- Changing of beds,
- Preparation and storage of operating tables,
- Washbasins.

 A two-passage circulation:
- A separation between different working units is
required to reduce germs transmission,
- A separation between circulation of non-sterilized and
sterilized patients and implements is also required

- A squared room is advised,

- Height of artificial lighting: 3m +0.7m for ventilation and electric fittings,

- Shades are required,

- Safety electrical supply: 1.20m above the floor minimum,
- Operating rooms have to be fit with a mobile ceiling fixture
- Uniformly smooth and easily washable walls and floors.

 Postoperating room:
- 3.80 m x 3.80 m
- Fit up like the ante-operating room: a refrigerator,
washtubs, cupboards, connectors for anesthesia
implements, a safety generator,
- A pivoted door, 1.25m wide, opening on the working passage,
- A sliding door with a glazed oculus and an electrical
control, opening on the operating room, 1.40m wide, is
required.
 Local for sterilized implements:
- 10 m2 fit up with shelves,
- A direct connection with the operating room is advised.
 Apparatus room:
- 20 m2, close to the operating room,
- A direct connection is advised.
 Sterilization room:
- A direct connection with the operating room is required,
- Two different sides are required: a non-sterilized side
with non sterilized implements and a sterilized one,
- Fit up with a sink, working and storage areas.
 Plaster casts room:
- For hygiene standards: not localized in the operating unit, but in cares
services,
- In case of emergency, the patient has to go trough a airlock to
enter the operating room.
 Waking room:
Page 10 of 28
 - It is advised to avoid a too important proximity between beds,
- A bed has to be accessible on 3 sides for the anesthetist and care apparatus,
- Supply in vacuum, oxygen and electricity is required,
- Several doors between the waking room and the operating one are required.

10. Postoperative cares – watching of patients

 Waking room:
- This room has to be planned for receiving patients from different operating
units,
- Number of beds: 1.5 x number of operating rooms,
- Natural lighting is required for the patient,
- An annexed room is required for nurses (fit up with a sink
and a large pane for observation of patients).
 Nurses local:
- The area depends on the size of surgical services,
- 8 persons per operating team,
- Fit up with cupboards, sinks and chairs.
 Office of the head of nurses:
- A central localization is required,
- It has to be glazed on the passage way,
- Fit up with a board and a cupboard,
- An annexed local for debriefings can be planned (5 m2)
 Medicines local:
- Revolving shelves are advised for storing medicines.
 Cleaning local:
- 5 m2, close to the operating room,
- An area for disinfected beds is required.
- An area close to the patients’ tambour has to be planned for
preparing disinfected beds and storing a clean bed per operating
room.
 Annexes :
- They have to be served by proper passages that aren’t
designed for patients’ circulation.
- In annexes: sliding doors, 1m wide.
 Toilets
- Only in the airlock area, not in the operating room for hygiene standard.

11. Intensive cares

 Organization of intensive cares units:
- A airlock,
- A room for registration and administration,
- A secretary’s office: nurses have to watch the arrival of patients, medicines…
- Cares units,

 For one care unit:

Page 10 of 28
 - 6-10 beds,
- An office for nurses,
- A care room (to prepare medicines),
- A local for apparatus,
- In general: 1 chamber for 2-3 beds with visual partition between beds.

 Annexes:
- An operating room (for slight operations): 25-30 m2
- A laboratory,
- A sterilization local: 20 m2
- A local for non sterilized apparatus,
- A local for sterilized apparatus,
- A cleaning local.

 Hygiene standards:
- Beds have to be accessible on 3 sides,
- Supply in vacuum, oxygen and electricity (low and high
current) is required for each bed.

12. Treatment zone including beds

 For one unit: 18-24 patients.

 Rooms:
- With 1, 2 or 3 beds,
- Fit up with toilets, a shower or a bath (no separated showers),
- With natural light,
- Beds have to be accessible on 3 sides,
- For each bed: a bedside table, a table (90cm x 90cm), a chair and
a cupboard built into the wall. This cupboard has to be opened
without moving any sanitarian piece of furniture.
- On each head of bed a supply of fluids (oxygen,
pressured air, vacuum) is required,
- A wooden or synthetic protective strip has to cover all the
walls in chambers and passages,
- An acoustic insulation (up to 32dB) is advised.

 Dimension of a room: 3.20m wide minimum

- With 1 bed: 10 m2 minimum, (Pictures 6a, b)
- With 2 or 3 beds: 8 m2 per bed, (Picture 7)
- Each bed has to be evacuated out of the chamber without moving the other
ones,

Page 10 of 28
Doors of the chambers: 1.25 x 2.13 m2; an electric

- Annexes and staff rooms.

- closure is advised.

In the washroom: specific design for wheelchairs:

Height of the dressing table: 86cm minimum
Height of the toilet: 49cm

 Shared washrooms for patients:

- Bath with an elevator, accessible on 3 sides.

 An office for nurses:

- Central localization,
- Area: 25-30 m2
- Glazed on the passage way
- Regulated access to a local for the storage of medicines

 Sterilized local:
- Required for a group of 6 beds,
- Area: 8-10 m2
- Direct access for the staff from the room,
- Fit up with a washbasin, cupboards, and a lit desk.

 Non sterilized local:

- Area: 10 m2 minimum,
- Fit up with cupboards.

Technical local:
Area: 8 m2
Fit up with a secondary electric supply.

 Room for the doctor on duty:

- Fit up for examination of patients: an examination bed and cupboards.

 Relaxation room: 15 m2
Shared room for patients: area of 22-25 m2

13. Radiology
 This service requires a direct access from the emergencies for lying patients.
It must be situated on the ground floor or at the first ground (because
of weight of apparatus).
Page 10 of 28
 It is required to minimize distances between rooms.

 Area of locals for sonography,

mammography, jaws: 15-18 m2 Area of
locals for radiography and reception: 20-
30 m2 Patients have to enter those rooms
through two cabins, Width of doors:
1.25m,
A supply of medical gas is required.

 Tomography local: 35 m2 fit up with a computer, Angiography local:

a preparatory local fit up with a washbasin and a refrigerator (to store
medicines) is advised.

 Safety standards:

- A protector covering made of lead on walls, doors and ceilings is required,

- Its characteristics depend on the apparatus.

14. Obstetrics
 An operating local is required near delivery rooms.
The obstetrics service has to be separated from the units for patients
after delivery and for infants.

- Organization of the obstetrics service: it consists of:

- A watching room,
- Reception and waiting rooms,
- Rooms for pre-delivery,
- Delivery rooms (fit up with a bash for patients),
- An operating room (12 m2 ) has to be near delivery rooms,
- A sterilized local (12 m2 ),
- A non sterilized local (12 m2 ),
- A registration office (12 m2 ),
- A living room for the staff (15 m2 ),
- A local for midwives (20 m2 ),
- Toilets.

15. Maternity unit

 Temperature: 24-26°C,
 Ventilation: renewal of 8 volumes per hour,

 In care units for children and infants:

Page 10 of 28
 - A safety system on each window is required,
- Electric installations and radiators have to be secured,
- Floors and walls (up to 1.50m) have to be easily washable.

16. Laboratories
 They are designed for blood samples and analysis of those samples.

 They consist of:

- Locals for rinse, disinfecting, preparation of sterilized implements,
- A storage room,
- A cold room,
- A meeting room,
- A waiting room,
- An administration office.

 For microbiology: independent unit or access through a tambour.

 All rooms ought to be lit with natural light.
 Rooms with microscopes have to be orientated northern.
 Width of doors: 1m minimum.
17. Examination unit
- It consists of:
- Examinations rooms: 15 m2, access through cabins
- An administration office,
- A waiting room,
- A storage local.

 Flexibility of this unit is advised for a later extension

18. Dairy hospital

 For patients hospitalized only for one da

 A special entrance, a hall and a recepti desk are required for these patients.

III. Safety standards

19. Electrical installation

 220V for normal current,
 380V for high current,
 At least two isolated transformer sections with antivibratil functions are required.

 In surgical wings:

Page 10 of 28
 - Safety electrical supply: 1.20m above the floor minimum,
- extra accumulators for electricity supply and emergency power supply,
- Have to work continually:
o One operating lamp/ceiling fixtures in each
operating room for 3 hours minimum,
o Devices to maintain vital bodily functions.

20. Gas installation

 Pumps for Oxygen, Nitrogen, vacuum and pressured air have to be installed in
double.
 Oxygen: supplying with air stored in steel bottles out of battery with an automatic
switch.

21. Lighting
 Lighting standards in hospitals:
- Luminosity of 1000 lx in operating rooms,
- Luminosity of 500 lx in annexes.

 Operating rooms have to be fit with a mobile ceiling fixture.

22. Ventilation
 Filtering, dilution and extraction of air,
 Renewal: 15-20volumes for one hour.
 It is required to consult safety measures for ventilation ducts

 Any uncontrolled air current can’t enter the operating room by:
- A hermetically sealed closure of the room

Page 10 of 28
 - Keeping an overpressure in the room.

 High pressure: in the operating room to take the air away

from the room, Low pressure: in annexes.

23. Sanitarian installations

 For horizontal water network: looped pipes are advised
 Water distribution pipes should be put in the plenum of the suspended
ceiling, to make future transformations easier.
 Water preparation is centralized except for specific services (sterilization…).
 Water quantity per bed and per day: 400-450 L.

24. Airlocks
 A airlock is a specific zone situated between care areas and examination zones.

 There are different types of airlock s:

- Airlock for patients is required to separate sterilized and not
sterilized rooms (1. 2)
- A airlock for staff: (3 – 8)
o One airlock per gender,
o It is an access to care zones,
o Two rooms inside:
 A ‘dirty’ room = cloakroom and showers,
 A ‘clean’ room = to put on operating clothes,
- A airlock for supplying and discharge, (9)
 It can be used as a dump room,
 Passage through this type of airlock is forbidden,
- Airlock s in front of intensive care zones to disinfect implements. (12)

 Hygiene standards require a disconnection between surgical units and

other services: airlocks are advised for this separation.
25. Sterilization zone
 It has to be close to specialized services.
 It is advised not to place it in operating sector [green zone].

26. Storage locals for anesthesia product

 In those locals explosives and inflammable products are stored.
 Electrical fittings have to be installed 1.20m minimum above the floor.
 Those locals can’t have any connections with anesthesia, delivery and operating
rooms.

 It is required:
 - To avoid materials with a high electrostatic charge,
- To use conductors materials (conductor rubber),
- To cover the floor with a conductor covering,
- To keep the rate of air humidity between 60 and 65%.

27. Radiology units:

 It is required to respect safety standards (depending on apparatus) to
define thickness and rate of lead in protecting covering on walls, floors
and doors to absorb radiations.

28. Supplying
 Supplying on the Northern side of the hospital is advised.

 It consists of supplying with:

- Medicines,
- Beds and sheets,
- Technical material.

 On this side it is advised to put also:

- The heating system,
- The gas power station,
- The waste water discharge system.
Bibliography:

Sandeep Singh, Location & Layout Of Hospital, 1st SEM MHA Guru NANAK DEV University
2008.

American Institute of Architects (AIA), Guidelines for Design and Construction of Hospital and
Health Care Facilities: 2006 edition.

Les éléments et projets de construction (8e édition) – Ernst NEUFERT

Editions DUN

https://www.linkedin.com/pulse/20140613201200-65586394-guidelines-main-requirements-in-
the-planning-and-design-of-hospitals-part-ii

https://www.doh.gov.ph/sites/default/files/publications/
planning_and_design_hospitals_other_facilities.pdf
https://www.who.int/hospitals/en/

http://www.uia2017seoul.org/P/papers/Full_paper/Special_Session/Oral/O-0631.pdf

file:///C:/Users/HP/Downloads/249761359-Jan-Allen-Gomez-Hospital-Thesis.pdf

http://publications.lib.chalmers.se/records/fulltext/229756/229756.pdf

https://www.lisc.org/charter-schools/understanding-your-needs/site-selection/determine-criteria-
site-selection/

http://www.nzdl.org/gsdlmod?e=d-00000-00---off-0cdl--00-0----0-10-0---0---0direct-10---4-------0-
1l--11-en-50---20-about---00-0-1-00-0--4----0-0-11-10-0utfZz-8-
10&cl=CL1.115&d=HASH41879df8bce63ec6f54433.17.5&gt=1

http://www.architecture-student.com/thesis-project/site-selection-and-analysis-architectural-
thesis/

No author, (November 2004) Guidelines in the Planning and Design of a Hospital and other
Health Facilities, PDF Documentation research [DOH.gov.ph] Retrieve from:
https://www.doh.gov.ph/sites/default/files/publications/planning_and_design_hospitals_other_fa
cilities.pdf?
fbclid=IwAR1gAiRAcDIGoVeMSsFoctbDsL7jKzn9xxsdY9CpHRES50CXvFWVyDZaYoI

Paz, J.J. Hospital Thesis University of Perpetual Help System Dalta Molino III, Bacoor, Cavite,
Philippines, PDF Documentation research [Academia.edu] Retrieve from:
https://www.academia.edu/31985622/hospital_thesis?
fbclid=IwAR3Q60jXAQWPDeENE8WKDBTW9zk2IkNxnq30XCywU6annRS5MrlsVsNFNX
Y