Integrated Design III, HOSPITALS

Prepared by Ermyas Tekle

Id- no ENGR/144/05
November 11/2016

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Literature review
Introduction to hospital
Hospitals are unique among building planning and design projects for their high level of
complexity interims on their complex circulation patterns and constant use as much as for their technical
systems.

Definition of hospital
By definition hospital is a place where healthcare service are delivered to patients whom may stay
overnight accommodations or may visit briefly for specific care and their families caregivers and
administrators come together for the common purpose of restoring to good health.

History of hospital
Hospital is unique building type is less than 100 years old in history hospitals where generally
charitable place where bed ridden patients could be cured for and given simple treatment.
At the start of 20th century new advance in radiology aseptic germ theory anesthetic surgery and
later electronics and communications made the former nursing care facility to highly specialized
workshop for medial service the hospital took on a new physical form as a larger dense building with
many specialized parts.

History in Ethiopia of healthcare

The ministry of health (MOH) historical account and time line of health care in Ethiopia reads as
follows
 The first modern government-run hospital was built by Emperor Menelik II in 1906 in Addis
Ababa with only 30 beds and was named Menelik II hospital.
 In Ethiopia, the quest for modern medicine beyond traditional practice started during Emperor
Lebnedingil’s reign in the 15th century, when the emperor appealed to the Portuguese king for
physicians and surgeons to cure illnesses. It  time (1889-
1913) that the first foreign-trained Ethiopian medical doctor, Hakim Workneh Eshete, began
practicing medicine in Addis Ababa. Not surprisingly, organized and sustainable modern
medical practice was nonexistent until the Battle of Adwa in 1886. Given the shortage of modern
medicine, traditional medical practice that has prevailed over many centuries was still accepted
and for many it was a culturally preferred mode of treatment.

 The genesis of modern medicine in Ethiopia was formulated by the thoughts and ideas brought
by medical practitioners from Ethiopia, Africa, America, the British Commonwealth, Belgium,
China, Czechoslovakia, Egypt, France, Germany, Greece, Holland, Hungary, India, Israel, Italy

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,Pakistan, the Philippines, Poland, Portugal, Russia, Spain, Scandinavia, Switzerland,

Yugoslavia, and other parts of the world.

Types of hospital
Hospitals subdivided in two ways
1. According to the number of beds
2. According to health care delivered (function)
1, according to the number of beds
 Large(up to 600 beds)
 Small(up to 150beds)
 Smallest(up to 50 beds)
2, according to the health care delivered
 General hospitals
 University hospitals
 Specialist hospitals
 Distinict hospitals
General hospitals
Medical institution’s which provide treatment for the care of patients with a wide range of acute and
chronic condition.
University hospitals
A hospital which provide medical as well as academics and large general hospitals
Specialist hospital
A hospital in which individual type of treatment or medical field causality rehabilitation allergies
orthopedics gynecology etc. Also included in this category are special clinics dealing with e.g. cancer,
skin problems, lung etc.
Distinct hospitals
A hospital type which is demarcated or isolated from the compound in the case of infectious disease.

General hospital
A primary healthcare center provides a range of medical service including; consultation treatment
/diagnosis, minor surgery, and health education sometimes it may also include day care for
physiotherapy and occupational therapy, and outpatient emergency treatment
 In some cases there may be in patient short-stay beds
There are several factors that should be considered in the design of primary health care buildings
these include

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

 Circulation:-entrance and circulation with in the building must consider
wheelchair users parents with small children and people with disabilities.
 Effective zoning is required:-public zone clinical zone and staff zone
 Privacy and confidentiality: - are important, especially at the reception desk and
clinical rooms during consultation and treatments’.
 Security and supervision: - in the premises will be necessary including staff
protection against personal assault and equipment safe guarded against theft and
vandalism.
 Location and zoning:-most probably if the site is in the residential area is
recommended because of the reason there will be silent quiet, fresh air as well as
there will be users and no crowded vehicles.

Lighting:-A study of the rooms shows that no single, a few double, and most four-bed rooms have
ceiling fixtures for general illumination. In almost all rooms there is a wall fixture over head of bed,
mounted from 5 ft-2 in. to 6 ft. - 6 in. Above floor. There are numerous fixtures on the market today for
this purpose, providing varying combinations of direct and indirect light. The one prevailing comment of
a number of administrators is that no wall light gives adequate illumination for examining the patient.
Another caution is to control light in multi-bed rooms so that it will not

 Shine in another patient's eyes-this frequently happens across the room in four-bed rooms.
Almost all rooms have night-lights, either set in wall at a low elevation or incorporated in over-
bed light. The one prevailing comment here recommends switching the night-light out in corridor
or near room door, rather than at bedside.

 Doors and Windows Standard bedroom door width is 3 ft-10 in. or 4 ft-0 in. This can be reduced
by 2 in. with offset hinges. A slight majority of doors to single and double rooms are hinged on
side toward beds, so that door ajar serves as screen to patient. Toilet room door widths are 2 ft-0
in. to 2 ft-4 in. swinging out into bedroom, except where surface-bolted or pivoted hinges are
Used, so that doors can be removed in the event a patient in toilet room faints and falls against
door .The wide variety of window treatment suggests that climate, orientation, esthetics,
economics and other considerations do more to govern this architectural feature than any
predetermined optimum standard. It is interesting that administrators' comments in this general
area say little about psychological or therapeutic values of wide vs. narrow or high vs. low
windows, but do offer practical complaints. About windows that are drafty or difficult to clean
and wood stools that spot too easily. Preferences are expressed for marble and laminated plastic
stools. A definite division of opinion is found between those who prefer nothing but drapes and
those who favor only Venetian blinds at windows. The committee notes that low window stools
offer patient an opportunity to see out when his motorized bed is in its low position.

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Circulations in hospitals
There are two types of circulation (vertical and horizontal)
1. Horizontal circulation(corridors)
Types of corridor’s (depending up on the swinging direction of the door)
 When the swinging direction of the door towards the corridor (un recommended for
hospitals)
 Vice versa of number one (recommended for hospitals due to light traffic)
 Corridors must be designed for maximum expected circulation flow
 Generally access corridor’s must be at least 1.50 m width
 Corridors in which patients will be transported on trolleys should have a minimum effective
width of 2.5 m
 Windows for lighting and ventilation should not be further than 25m apart
 Main corridor 3.00m, medical service corridor 1.5-2.25m, service corridor deliveries storage
areas 3.05-4m, working corridor surgical area 2.25m, ward corridor intensive care.
2. Vertical circulations ( lift, stair, ramp)
Lift:-lifts transport people, medicine, laundry, meals and hospital beds between floors and for
hygiene and aesthetics reason separate lifts; those are patient lift staff lift and goods lift

Dimension of bed lift

 Small goods lift (pay load greater than or equal to300kg,car floor area greater than or
equal to 0,8m2 for transporting small goods documents , food linen etc. small goods lift
might be loaded from one side ,or corner loading.
Stair: - for safety reasons stairs must be designed in such way that if necessary thy can
accommodate the entire vertical circulation .winding stair case cannot be included as a
part of regulatory stair case provision. Staircase must be minimum of 1.50m and should
not exceed 2.50m.step height 170mm are permissible and the minimum required tread
depth is 280mm it is better to have a rise and tread depth of 150:300mm.
Ramp:-should be available with in all the entrances and in connections with other department with 2%
pitches.
Demarcation
Demarcation areas are is formed by the intermediate zone (lobby) between different care areas
(gown demarcation lobbies, patient demarcation lobbies, and demarcation lobbies of transition before
intensive care units
Demarcation may be achieved in different ways depending on the required function and
specialist area patient lobby staff lobby ,combined staff and visitor lobby , disposal lobby gown lobby
,lobbies before intensive care rooms , in addition lobbies differ according to their hygiene function

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contact control ,air control and the constructional requirement (single lobby ) control multi lobby
,control air conditioned and non-air conditioned control.
The demarcation areas do not necessarily have to be rooms they may instead be formed by segregating
traffic areas.

Departments of hospital
o Accident and emergence(A&E)
o Outpatient department (opd )
o Maternity
o Inpatient beds (ward )
o Rehabilitation
o Operating department
o Day surgery
o Morgue
o Day surgery
o Intensive care unit (ICU)
o Diagnostic and imaging
o Radiotherapy and nuclear medicine
o Operating areas care provision
o Mental health service and their building
o And there are residential areas possibly areas for teaching and research as well as support areas
for service operations

Mandatory departments in general hospital

o Accident and emergencies
o Outpatient department
o Maternity
o In patient
o Operating department
o Day surgery
o ICU

Hospital Support Services

o Pharmacy
o Pathology
o Mortuary

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o Religious facilities
o Health records
o Administration
o Catering
o Education
o Staff facilities

Surgical department
 In the surgical department, treatment is given to the patient whose conditions has been diagnosed
but cannot be cured solely with medication.
 It should be close to intensive care department the recovery room and the central sterilization
because there is extensive interaction between this department and s easy access must be assured.
The operating theater should be designed to be as square as possible to allow working whatever
direction the operating table is turned in
 6:50x6:50 m with clear height at 3m for air conditioning and other service.it is best located
centrally in the core area of the hospital where they are easy to reach from every department
Advantage and dis- advantage of centralization
Advantage: - (for better utilization of space equipment and staff, better patient supervision under
management of specialists, for better accessibility from other departments and functionally
preferable)
Dis advantage :- (high organizational costs, increased risk of infection because of large number of
people brought together, the combination of septic and aseptic waste)
Organization of surgical department
Every surgical department require the following room
o Operating theater :- minimum area of 42 m2
o Anesthetics rooms :-should be approximately 3:80x3:80m,have electric sliding door in to
operating theater, these doors must have windows to give a visual link with the operating
theater, the room should be equipped with refrigerator draining sink rinsing line
cupboards for cannula connections for Anastasia equipment and emergency power.
o Dictation room :- no larger than 5m2,a place where doctors prepare report following an
operation , they are not absolutely necessary
o Nurse workstation: - should located centrally, must have large glass screen to allow the
working corridor to be viewed.
o WCs :-for hygiene reason toilets should be located only with in the lobbies and not in the
surgical area
o Standing areas for clean bed: - close to patient demarcation lobby, the requirement is for
one additional clean bed for each operation.
o Recovery room :-30 m2 minimum ,adjoining is a small sluice room with drainage sinks

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o Pharmacy :-a 20m2 pharmacy can supply a combination of anesthetics and surgical
medication and other material’s
o Sterile goods room:-one room of roughly 10m2 required for operating theater, it must be
directly accessed from Operation Theater, sufficient shelf and cupboard space.
o Cleaning room :- a size of 5m2 s sufficient
o Equipment room size of approximately 20m2,although direct access to the operating
theater is preferable it is not always feasible
o Sub sterilization room :-25 m2 minimum ,this room may or may not be connected
directly to operating area, it should be equipped with sink storage surface and steam
sterilizer’s
o Routiening:-a way or road taken in getting from the starting point to a destination,
different activities should be separated in order to reduce the transmission of germs
through contact. The single corridor system in which the pre-operative and post-operative
staff clean and non-clean goods use a single working corridor without segregation .it is
better to have dual corridor system in which patients and staff or patients and non-clean
materials are separated (dirt corridor & clean corridor )
o Anesthetics discharge room :- is set out identically to the anesthetics room .the door to
the working corridor should be designed as door with clear width of 1:25 m

Intensive care area

The task of intensive care is to prevent life threatening disruption of the vital bodily functions
for instant disruption, infection, sever pain and metabolic disturbances, organ failures (e.g. liver kidney).
Sometimes the operating theater is often located in the intensive care unit so the patients can
economically be cared by the same staff

Arrangement
The intensive care department must be a separate area ,and accessible through lobbies ( for
hygiene reason ).the central point of an intensive care unit must be an open nurses workstation from
which it is possible to oversee every room
The arrangement of the rooms is dependent up on the class, type and seriousness of the illness. These
care areas divided in to four according to their illness
o Normal nursing care (16-24 beds):-particularly for short term and acute illness, primary with a
short length of stay. Have a large central nurse service area.
o Intensive care area (6-12):- are for patients under constant observation and tend to be assigned to
particular examination and treatment room. They should be wide because more instrument and
equipment need to be accommodated
o Special care (6-12):-includes anew born babies people with infections disease, the coronaricaly
ill rehabilitation patient, neurotics, and hypochondriac’s .it took longer time in average to other.
o Isolation rooms a function which is provided for extreme care and illness of transmitted disease

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Rooms
o Nursing team: - each station served by an independent nursing team which has full
responsibility of patients care. Must have direct connection to the nurse rest room with an area of
minimum 15 m2.
o Wet cells :- WCs and shower or bath
o Non clean work room: - approximately 10m2 in size for handling solid material. The room will
contain a sink sluice prefabely in stainless steel.
o Nurse work area (workstation); - should be situated in a central position and requires size of
about 25-30 m2, the corridor wall must be glazed.
o Rest room (kitchenette):- roughly 15m2 should be allocated for staff break time facilities.
o Station doctor: - it must be provided with 16-202 room in which to examine patients in addition
to shelve and examination on which the doctor can rest when on call.
o Clean work room :- should have an area of about 10 m2 and should be equipped with fixed
shelving (600mm deep ) or a flexible storage system consisting of modules which can be filled
up in the central store
o Patient bath room: - it is an option for mobile patients allowing a space of 1400mmx1400mm).
o Assisted bath:-for non-mobile patients with an area of 5m2.

Outpatient department
 A place where consultation investigation or examination and diagnosis for the patients
takes place. They are generally attend by appointment provided for patients who require
little or no recovery service either afterward or not
 There must be a close link to x ray and laboratory. A more flexible and economical
arrangement is along row or a string of combined consulting and examining (Ce) rooms.

Rooms
o Waiting room: - minimum area of 40 m2. a place where patients and their families wait for a
service
o Cashier :- area of minimum size 12 m2 palace where payment taking place for the provided
service
o Registration:- 24 m2 minimum area
o Examination and treatment :- each should be 14-15 m2 with sound resisting
intercommunicating doors
o Cleaners store equipment store etc.

Accident and emergency (A&E)

 Provides the first impression of the hospital for the mast ill and anxious patients and their equally
anxious family and friends.
 A helicopter landing pad will be needed as close as possible to the accident and emergency
entrance. Traditionally two entrances provide one for the walking wounded and one for
ambulance case. The single entrance reduces ambiguity or a confusion to where people should be
go and traffic discomfort for patients.
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 In the case of series ill or injured patient the serious emergency go straight to the ressecuition
room (with medical gas and x ray facilities )or minor treatment room sometimes called minor
operating theater

Rooms
Waiting: - minimum of 40m2
Admission: - accident and emergency a place where hospitality began by taking the patient .minimum
area 40m2
Bed to bed transfer: - we can use this as a demarcation lobby minimum up to 25m2.
First aid: - this is a place used when alight accident occurs the room should be wide in order to give the
service for mass patient 30m2. .
Emergency treatment room: - must be large minimum area of 45 m2. This must be provided with
ressecuition
Nurse station:-a work area for nurses with an area of 15m2.
Examination and treatment:-where the patient is examined for high medical diagnosis (surgery) provided
with an area of 20m2.
Operating theater:-as the same as explained above contain all surgery room function.
And as usual cleaners store and toilet should be provided

Rehabilitation
It serves mainly out patients and day patients .it should be at ground entrance level and
convinantely placed for paring including space for people with disabilities, at list one of which should be
under cover to provide degree of protection from rain for wheelchair transfer. This department includes
facilities for phisio therapy occupational therapy and speech and hearing language therapy.

The medical area of a rehabilitation center provides the following services: medical evaluation,
performed by the physician and his staff; physical therapy, including hydrotherapy; occupational
therapy; speech and hearing therapy. It also furnishes the services of a prosthetic and/or orthotics
appliance shop
This section will contain much specialized examination, treatment, and therapy equipment some of this
will be heavy, requiring a floor designed to accommodate such concentrated loads; the electrical service
to these machines is important. Patients will be wearing lightweight examination or treatment gowns
here, and the heating system will have to compensate for this. The records for all sections of this area are
extensive; therefore, adequate storage for them is mandatory. Conferences with patients and staff make
further demands on the available space. Many different kinds of activities will be housed here and the
space needs to be adjustable accordingly. Accessibility to all other areas is also essential for the medical
area of activity.

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Location within Building

As all patients receive medical evaluation, the physician's unit should be near the center's main
entrance.
For purposes of admission, and for the keeping of records, location of the unit near the
administrative department is desirable. If an in-patient nursing unit is included, the physician should
have, if possible, convenient access to the nursing unit. In smaller centers, the main waiting room for the
building may serve as the waiting area for the physician's unit. Place the unit in a quiet zone.
Organization of Space the: - physician's unit should form a self-contained area, with access to the
consultation room and the medical examination room by means of a sub corridor, if possible. To make
full use of the physician's time, there should be two examination rooms for each consultation room.
Recommended for the area is a toilet designed for wheelchair occupancy, accessible from the
examination room.
Rooms
o Waiting Room: - Arrange the furniture to allow space for wheelchair patients. Also, include coat
hanging facilities.
o Secretary: - Include in the furnishings a secretary's desk, writing table, and letter size file
cabinets.
o
o Consultation Room: - include in the furnishings for the physician's office and consultation room
an executive desk and chair, bookshelves, and film illuminator. Allow space for two visitors'
chairs and a wheelchair. Provide a convenient coat closet.
o Lab-Utility Room: - if a lab-utility room is provided, equip it with a pressure sterilizer, sink, and
plaster cart, work counter, and storage cabinets.
o Radiology:-radiology is usually provided for rehabilitation centers by x-ray departments of
hospitals, clinics, and other institutions. If radiology is to form a part of the center's services,
standard practice in the design and construction of the department should be followed.

o Physical Therapy: - The objectives of physical therapy are to correct or alleviate bone and joint
or neuromuscular disabilities. This entails a concern with all types of physical disabilities, such
as neurological diseases, arthritis, amputation, paralysis, spasticity, structural and postural mal-
alignments, crippling accidents, postsurgical conditions, etc.
 Treatment Cubicles: - Divide the cubicles with curtain tracks for easy access by
wheelchair and stretcher patients and for flexibility in use of space, as for instructional
activity or gait training.
 Waiting Area Provide space for wheelchair and ambulant patients; and if there is a
nursing unit, space also for a stretcher. Place the therapist's office near the waiting area
for control. From the waiting area, the patient should be able to go to the exercise room,
hydrotherapy, or treatment cubicles with a minimum interference of activities.
 Therapist's Office:- There should be staff office space for interviewing patients and
attending to administrative duties,

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 Examining Room: - The room should be convenient to the entrance of the physical
therapy department. Equip it with an examination table, lavatory, and space for
examination equipment.
 Exercise Area This area should be a flexible, clear space for individual and group
exercise activities.
 Gymnasium: - In larger centers or centers with inpatients, a gymnasium is recommended.
It serves a variety of uses, such as individual and group exercises, recreational programs,
and meetings.
 Hydrotherapy: - The space for hydrotherapy is frequently the most expensive area of the
center; consequently, it should be planned with considerable selectivity almost all
exercises and treatments can be. Conducted with a Hubbard tank and a wading pool and
tank. Combinations of Hubbard tanks with wading facilities are available where space is
limited.

 Whirlpools: - This includes equipment for the treatment of arms, hips, and legs. Some
models are available as movable units.
 Tank Room: - a treatment table with storage space is an essential requirement. Allow
space for wheel stretchers and provide 1.2 m.-wide doors. (A 1.4 m. wide opening is
necessary to install combination treatment and wading tank.)Allow space for stretcher
and wheelchair storage.
 Showers and Dressing Rooms: - Directly related to the efficient use of a
hydrotherapy pool is the provision of adequate dressing room facilities.
 Hydrotherapy Pool Many variations in size are possible. The depth of the pool should
be graduated. Variations of depth in 5 in. Increments are recommended. For children
the shallow end should be 2 ft. deep, for adults, 3 ft. The deep end of the pool should
be 5 ft. There should be a continuous gutter around the pool for the use of the patients
and for the

 Purpose of attaching plinths. A portion of the floor surrounding the pool may be
depressed to form an observation area for the therapist.

 Speech and Hearing: - The speech and hearing unit serves those with disabilities of
deafness, stuttering, or delayed speech and voice disorders which may result from various
basic abnormalities, diseases, or injuries.
 A wide variety of programs is possible. Some provide for treatment of
postoperative disorders resulting from tonsillectomies and ear operations, cerebral
palsy, meningitis, cleft palate, hemiplegia, vocal cord anomalies.
 Audiometric Testing: - The audiometric testing room (or, in some cases, booths)
is a facility for pure-tone threshold testing and short form hearing screening tests.

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Space should be provided for the audiologist's desk with an audiometer and one
patient's chair or wheel chair.
 Control Room and Test Room This facility is essential for an audiology program.
It is preferable to place these rooms off the sub corridor or hall, and to control the
activity in surrounding rooms in order that extraneous noises be eliminated.

 Orthotic and/or Prosthetic Appliance Shop:-Orthotic appliances are medically prescribed

for the support of weakened parts of the body and to increase or control their function.
Prosthetic appliances are medically prescribed artificial substitutes for a missing body
part. Such devices are constructed by orthetists and prosthetics’ in cooperation with the
physician, the physical therapist, and the occupational therapist. There should be fitting
room and work room for the appliance.

In-patient beds
Even though in-patient bed areas are diminishing as a proportion of the whole hospital’s
accommodation, they are still generally the largest single element, and the one that causes most public
interest.

Rooms in in-patient beds

WC (preferably with shower),isolated room , 4 bed ward ,3 bed ward ,2 bed ward , and one bed
ward, assisted bath rooms ,nurse station, cleaners store .

Maternity
The maternity and neonatal care the maternity and neonatal department provides continual
physical medical, physiological, and social care for mothers and new babies following a hospital
delivery .after uncomplicated births the care of new mothers can be consider part of normal care
.however new mothers highly infectious disease such as typhoid, to and hepatitis need to be housed in an
isolation care ward. Whew vital function are disrupted provision should be made for easy transfer in to
the intensive care ward. Neonatal withe infection respiratory difficult (e.g. premature babies) have to be
transferred to special department nearest children’s hospital
The division of maternity care is the same as for normal care, basic care, treatment care patient care
,administration and supply .organization of the processes with the option of ward care ,group care
,individual care, are also the same as for normal care with centralized neonatal provision ,the care unit
for neonates is located at the side of or with in the maternity care unit . To reduce unit to reduce
infection the area is divided in to small rooms or compartments neonates are carried in to the mothers
room on trolleys or by hand for breast feeding. This achieves more frequent and more intensive contact
between and child than in previous designs with central feeding room. Accommodating mothers and
neonates in one room (rooming in 0 means the infants do not need to be moved, which those relives the
staff, but requires an economic local neonatal provision despite this, it has become standard practice in
some hospital

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Childbirth is a natural process, but one that may occasionally threaten the life or health of both mother
and child, and this presents dilemmas for designers of maternity units. For the great majority of cases, a
stay of only a day or two is enough. Traditionally the components of a maternity unit are the antenatal
clinic, wards (mainly post-natal, but also for the few who need observation before birth), the delivery
suite, and the neonatal (or special care baby) unit. With ever shortening lengths of stay, the logic of
separation of delivery suite and post-natal ward has been questioned.
(Labor, delivery, recovery, post-partum) room.:- This room - fully equipped as a normal delivery room,
but with domestic decor and equipment located out of sight, and toilet and small sluice en suite – is
accepted by the mother for the whole of her stay. An abnormal delivery room and full operating theatre
are still needed for Caesarian and other more difficult births.
Rooms
o The rooms are divided in two categories post natal and neonatal (meaning before delivery care
for the mother and the baby and after delivery care for the infant as will for the mother.
o Before delivers contain post natal (post natal 50m2 with toilet and shower. Ultrasound with
15m2, examination and treatment-12m2 and deliveries (two types of delivery special and normal
the special includes surgery room with all functions of operating theater. And midwifery tanning
center -40m2 with skill room-40m2.)
o After delivery contains the obestrics for infants (incubator room minimum 50m2, with nurse
station30m2 linen-6m2mothers rest room with kitchen and toilet).
o Other separate services but important and should be included are doctors and nurses rest room
with their own toilet.

Mortuary
The mortuary of a hospital contains a storage room and post moreterm especially there must
be coffin store refrigerated storage for purposes an area for pathologist.
As an independent hospital department it should be so planned as to have access by a short route a
group of lifts (to the nursing station )
The entrance must be clearly marked for the relatives and there should be a short drive on entry point
for the undertake depending on the site of the hospital, this area can be extended with the addition of
laboratory archive research center

Rooms
Waiting for the families either the waiting or the morgue should be at the back 40m2. Cold store
32 m2 record room, 9m2,eree coffin stand ,washing dessicatin 30m2 store examination and treatment
20m2 .technician office 12m2.doctor office 12 m2 equipment store 15m2. Ophlamatic and so on

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Treatment areas
Radiotherapy:-in radiotherapy, condition diagnosed in the radiography department (e.g. tumors) the
treated. the radiotherapy department comprises a reception area waiting area, doctors room
(approximately 18 m2 ) a switch room (18m2) possibly localization room (20-25m2) a service room
(20m2) a film developing room (10m2),stores and a cleaners room each treatment room requires
changing cubicle for patients ,if the department includes a linear accelerator workshop (15m2) and at
least one physics laboratory (15-18m2)will also be necessary ,the clear height the radiation rooms must
be 4.30m
For hygiene reasons the patient waiting area, examination, localization, preparation and radiation rooms
must be well vented and well ventilated. And should be with outpatient department

Urological treatment:-this discipline is related to x ray diagnosis. The treatment room should be (25-
30m2) in size and it must be close to the surgical department. The room should contain an examination
and treatment for endoscopy investigation and be equipped with a wash-basin, suspended irrigation
,floor drainage 4-6 volt power points (cystoscopy) ,to changing cubicles and a WC there should also
be an instrument room adjoining (roughly 15m2),with sterilizer ,sink and a wash-basin and patient
waiting area
Eye treatment:-eye treatment can be carried out in aroma approximately (25m2)in size which can be
darkened as required .the necessary equipment includes a treatment chair ,examination and diagnostic
instrument , an examination couch, a wash-basin and writing desk . A patient’s waiting room should be
situated to the front of treatment room
Ear, nose and throat (ENT) treatment: - ENT treatment is carried out for inpatients in their own care
area. The treatment room (25-30m2) which can be darkened ,should contain treatment table for
examination a treatment chair ,sterilizer ,a sink and wash-basin ,storage space for portable equipment
,up to 6 vault power point compressed air/suction lines .adjoining the treatment room should be rest
room and patient waiting room.
Dental treatment: - this specialist area of treatment should be provided primarily in special ENT and
rheumatism clinics. The treatment room needs to be 25-30m2 in size and contain a treatment chair with
dental unit , a desk a wash-basin ,x ray and anesthetic equipment ,a sink alcove with a sterilizer and ,if
possible a dark room.
Radiology: - includes the specialist areas which useionising radiation for diagnostic and therapeutic
purpose. These include x-ray diagnosis, radiotherapy and nuclear medicine. The radiology department
should always be close to the ambulance entrances and. because of the great weight of the
equipment(up to 14t) ,it is sensible to plan tis areas on the ground or first basement floor the room of the
individual diagnostic areas must be so arranged as to minimize the distant between them . a connecting
corridor which can be used simultaneously as a store dictating room and , possible , switch room as
well as for staff circulation is desirable .the size of the room depends on their use and what they
contain for e.g. ,sonographer, mammography and jaw x-ray require about 12-18m2 whereas standard x-
ray and admission room need to be 20-30m2 the access route for patients should be through tow

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changing cubicles ,and wide door (greater than or equal to 1250mm)for beds is necessary .WCs should
be installed in x-ray room used for stomach /intestinal inspection angiography rooms require an
auxiliary room with a sink and built –in storage (e.g. medicine refrigerator) medical gases must be
also be available .the admission room for comptertomography (CT)must be about 35m2 in area .the
patient pass through lobbies or changing room in order to reach the admission room .the switch room is
connected by a door and a window . An additional room for switch cupboards and film developing is
desirable. The walls ceilings and floors must be shielded with lead sheeting, the thickness of which
depends on the type of equipment to be used. Co-operation with the manufactures of x-ray equipment is
absolute essential.
X ray :- a type of examination taken for internal part of the body I will be provided with a room of 42
m2 minimum and with rooms such as changing room (9m2) equipment store (12 m2) doctors room
(12m2) technician office (9m2) and dark room (9m2) toilet (4m2)
It have a high link with outpatient department and accident and emergency as much as possible it is
recommended if it is in the ground level
Protection in x-ray room may be provided by lead or barium plaster which prevent the emission of
radiation beyond the room
Where control positions are with in the room operators may be protected by lead screen either by
providing a shear wall
During investigation staff who must work in close proximity to the patient may additional wear load
aprons, and patients themselves may require specific shielding from radiation to sensitive zones such
gonads

HOSPITAL SUPPORT SERVICES

Pharmacy
A wide range of functions is briefly described here. Many of these are not entirely specific to
hospitals; for others, the technology changes rapidly, and reference to the NHS Estates Health Building
Notes and other frequently updated guidance is recommended. Pharmacy A dispensary is needed, close
to the out-patient department and with a comfortable waiting area. If the main hospital pharmacy cannot
be so located, pneumatic tubes from it to the dispensary and some other user areas may be justified.
More and more pharmaceutical items are commercially produced; where manufacturing is undertaken at
the hospital, increasingly stringent sterility requirements prevail. Security is of the highest importance,
especially associated with the entrance used for deliveries.
Pathology
The four main laboratory disciplines in hospitals are
Histology
Microbiology
Hematology

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Biochemistry.
The last two may be grouped together as they can share much automated equipment. The whole
department will generally have a shared receiving area for specimens and records. Ventilation and other
safety standards must meet current legislation. There is a tendency for large hospitals or commercial
laboratories to take in work from smaller hospitals; economies of scale may increase this tendency.
Laboratories in the past were mainly spaces with benches with equipment on them. More and more
equipment now takes the form of floor mounted cabinets. Change is endemic, and flexibility in access
for engineering services is crucial.

Mortuary
It is desirable, but not essential, for the mortuary to be near the pathology department, as the histologist
is responsible for post-mortems. The main elements are the body store, post-mortem rooms, and
facilities for visitors. The access route into the mortuary for bodies from the hospital should be separate
from that taken by visitors, although mortuary trolleys are discreet enough that separate lifts and
circulation routes through the hospital are not needed. Particular care is needed for the furnishing and
outlook of the visitors waiting and visiting areas; a toilet and kitchenette unit is required. Access by
hearses should be out of sight from windows of wards and other patients’ areas.
Religious facilities
Depending on the nature of the local community, this may need to satisfy the needs of different
faiths whose representatives should be consulted. It must be easily found - preferably near the main
entrance - and be easy to reach and use by patients in wheelchairs.
Health records
Computerization of records is coming, but how soon is hard to predict. At present, health records occupy
much space. Although they may be remote from patients’ areas, ease of access to records, especially to
and from the OPD, is important.
Administration
The extent of offices provided in the hospital depends on whether they are also the headquarters of the
Trust. Main functions include Trust Board and Secretariat, finance, personnel, supplies, and senior
nursing and other professional staff. Ancillary spaces include computer facilities, stationery and other
stores. The post room and telephone exchange are often associated with the main entrance. Other
administrative functions do not need priority locations, and may be on an upper floor. Clinical
Directorates’ offices are generally near their clinical areas. Offices for consultants (shared if not full-
time) may be centralized or near clinical areas.
Catering
The most common systems for in-patients are centrally processed - often off-site - with local
regeneration on the wards. Pantries are needed for preparing snacks and beverages outside normal meal
times. It has been traditional to provide a large central dining room for staff, but in some hospitals the
development of ‘shopping clusters’ near the main entrance, incorporating fast food and other specialist

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cafis, has reduced the use of staff dining rooms. It is possible to envisage all staff meals provided from
such outlets - and shared with outpatients and visitors - as long as services for night and evening staff
are maintained. The dieticians, whose main role is advice to out-patients and inpatients, may have an
advisory role in catering services, especially concerning special diets and the promotion of healthy
eating generally.
Education
Undergraduate nurse training is now in the education sector rather than part of the hospital function.
However, continuing post-graduate training of doctors, nurses and other health professionals has a vital
role, and provides an interface forum between GPs, community nurses and others. Accommodation is
required for these functions, as well as for conferences and meetings. Catering facilities are required
and these may be supplied from the regular staff or patients’ catering sources.

Staff facilities
The extent of central changing rooms needed will be determined by the whole hospital and departmental
operational policies. A crochet may be justified for the children of staff, as may a staff club. Sports and
recreational facilities may be warranted if they are not available nearby in the community and they are
thought likely to help in staff recruitment.
Laboratory: - a room for scientific experiments researcher or teaching or for manufacture of drugs.
Contain the function of lab rooms(50m2 minimum) sterilization room of an area 30m2 chemical room
of an area 25m2 minimum ,cold store of an area25, reserve room minimum 50 m2 and special rom
25m2 sometimes the central sterilization might be located in the laboratory
The central sterilization
These is where all hospital instrument are prepared
The majority of instrument are used by the surgical department (40%), surgical intensive and internal
intensive care (15%) for this reason central sterilization should be installed close to this reason
central sterilization should be installed close to this specialist area . it is recommended that the
sterilization area be situated in areas with relatively volumes of traffic (both people and material )
The no of sterilizers is dependent on the Size of the hospital and surgical department and can occupy an
area of approximately 40-120m2.
Emergency care

The provision of facilities for emergency care has evolved to enable cost-effective provision to be
provided as quickly as possible. Greater emphasis is placed on para-medic services by response teams to
emergency calls and on the provision of facilities for minor injuries, Minor Injury Units (MIU) are
providing services between approximately 8.00am–11.00pm for patients not requiring the full scope of
emergency care. This requires a degree of ‘self-diagnosis’ and has yet to achieve its full potential in
efficiency savings.

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Emergency care is increasingly being associated with other elements of critical care such as
Intensive Therapy and Operating Theatres as a management unit and the overall facility is now under
the umbrella of Critical Care. Emergency care has an obvious requirement for ground-floor access,
operating theatres, being highly dependent on mechanical ventilation provisions tend to be
at an upper floor. Dedicated vertical circulation is therefore important between the Accident &
Emergency (A&E) and Operating Theatres. An alternative would be the provision of an interstitial
plant floor. The Intensive Therapy Unit (ITU) would usually be co-located with the Operating Theatres
and would share this vertical access from the A&E, 25.4 and 25.5. Specialist A&E facilities for Cardiac
care may be provided Because of the urgent nature of a high proportion of accident
cases, the relationship with supporting departments is crucial. In particular, there should be direct access
– by separate entrance if necessary – to the X-ray Department for speedy diagnosis; alternatively
separate X-ray facilities can be provided within A&E. Circulation of patients on beds or trolleys means
that dimensions for these items are critical, 25.6 and 25.7. If X-ray facilities are not integral to the A&E
facility a means of providing 24 h access to a limited section of the X-ray Department will be required.

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Conclusion
 Hospital is a vital building which need to be designed and constructed carefully with efficient
internal lay out of rooms (function) conceding with light and ventilation but there are so many
recommendations that have to be kept in mined as the hospital is to satisfy the health care
delivery of the society it should be very easy to use easily accessible for the vehicle’s and so on.
 Beginning from the site the location should be silent no pressure of users provide an access
without traffic of vehicles
 There are so many departments in designing of general hospital but the obligatory departments
are opd, A&E in-patient maternity surgical department rehabilitation and ICU
 With supply services such as laboratory pharmacy administration café morgue etc.
 There are also treatment areas that have to be provided under general hospital which gives the
purpose of identifying the case such as laboratory, x-ray, radiotherapy, ultrasound, radiology,
ENT treatment, and city-scan.
 Conceding the above description the general hospital can be built.

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Reference
o The architects hand book
Edited by QUENTIN PICKARD RIBA
o Timesaver standard for building 2nd edition
By JOSEPH DECHIAR and JOHN CALLENDER
o Architects data 3rd edition
o Guidelines for design and construction of hospital and health care facilities. 2001 edition
THE AMERICAN INISTITUTE OF ARCHITECTES ACADAMY OF ARCHITECTURE FOR
HEALTH
THE FACILLITY GIDELINES INISTITUTE WITH ASSISTANCE FRAM THE US
DEPARETEMENT OF HEALTH AND HUMAN SCERVICE.
o The manual of Ethiopian medical history
By ENGEDAW MEHARI MD
KIFE GEBEYEHU MD
ZERGABACHEAW ASFAWE MD
o Health institutions and service
By AYNALEM ADUGA

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