PHYSICAL LAYOUT OF THE HOSPITAL

Hospitals are the most complex of building types. Each hospital is comprised of a widerange of services
and functionalunits. These include diagnostic and treatment functions, such asclinical laboratories,
imaging, emergency rooms, and surgery; hospitality functions, such as foodservice and housekeeping;
and the fundamental inpatient care or bed-related function. Thisdiversity is reflected in the breadth and
specificity of regulations, codes, and oversight thatgovern hospital construction and operations.In
addition to the wide range of services that must be accommodated, hospitals mustserve and support
many different users and stakeholders. Ideally, the design process incorporatesdirect input from the
owner and from key hospital staff early on in the process. The designer alsohas to be an advocate for the
patients, visitors, support staff, volunteers, and suppliers who do notgenerally have direct input into the
design. Good hospital designintegratesfunctionalrequirements with the human needs of its varied users.

The basic form of a hospital is, ideally, based on its functions:

 bed-related inpatient functions

outpatient-related functions

diagnostic and treatment functions

administrative functions

service functions (food, supply)

research and teaching functions

Hospital design

No. of beds Land in acres Storey of building

50 beds 10 acres Single storey

100 beds 15-20 acres -do-

200 beds 20-25 acres Double storey

500 beds 55-70 acres 3-5 storey

700beds 80-90 acres 4-6 storey

1000 beds 90-100 acres 6-9 storey

Building Attributes

Regardless of their location, size, or budget, all hospitals should have certain common attributes.

1.Efficiency and cost-effectiveness

An efficient hospital layout should:

 Promote staff efficiency by minimizing distance of necessary travel between frequentlyused spaces

 Allow easy visual supervision of patients by limited staff

 Include all needed spaces, but no redundant ones. This requires careful pre-design programming.

 Provide an efficient logistics system, which might include elevators, pneumatic tubes, box conveyors,
manual or automated carts, and gravity or pneumatic chutes, for theefficient handling of food and clean
supplies and the removal of waste, recyclables, andsoiled material

 Make efficient use of space by locating support spaces so that they may be shared byadjacent
functional areas, and by making prudent use of multi-purpose spaces

 Consolidate outpatient functions for more efficient operation on first floor, if possible for direct access
by outpatients

 Group or combine functional areas with similar system requirements

 Provide optimal functional adjacencies, such as locating the surgical intensive care unitadjacent to the
operating suite. These adjacencies should be based on a detailedfunctional program which describes the
hospital's intended operations from thestandpoint of patients, staff, and supplies.

2.Flexibility and Expandability

Since medical needs and modes of treatment will continue to change, hospitals should:

 Follow modular concepts of space planning and layout

 Use generic room sizes and plans as much as possible, rather than highly specific ones

 Be served by modular, easily accessed, and easily modified mechanical and electricalsystems

Where size and program allow, be designed on a modular system basis, such as theVAHospital Building
System. This system also uses walk-through interstitial space betweenoccupied floors for mechanical,
electrical, and plumbing distribution. For large projects,this provides continuing adaptability to changing
programs and needs, with no first-cost premium, if properly planned, designed, and bid. The VA Hospital
Building System alsoallows vertical expansion without disruptions to floors below.
 Be open-ended, with well planned directions for future expansion; for instance positioning "soft
spaces" such as administrative departments, adjacent to "hard spaces"such as clinical laboratories.

3.Therapeutic Environment

Hospital patients are often fearful and confused and these feelings may impede recovery.Every effort
should be made to make the hospital stay as unthreatening, comfortable, andstress-free as possible.

 Using familiar and culturally relevant materials wherever consistent with sanitation andother
functional needs

 Using cheerful and varied colors and textures, keeping in mind that some colors areinappropriate and
can interfere with provider assessments of patients' pallor and skintones, disorient older or impaired
patients, or agitate patients and staff, particularly some psychiatric patients.

 Admitting ample natural light wherever feasible and using color-corrected lighting ininterior spaces
which closely approximates natural daylight

 Providing viewsof the outdoors from every patient bed, and elsewhere wherever possible; photo
murals of nature scenes are helpful where outdoor views are not available

 Designing a "way-finding" process into every project. Patients, visitors, and staff all needto know
where they are, what their destination is, and how to get there and return. A patient's sense of
competence is encouraged by making spaces easy to find, identify, anduse without asking for help.

4 .Cleanliness and Sanitation

Hospitals must be easy to clean and maintain. This is facilitated by:

 Appropriate, durable finishes for each functional space

 Careful detailing of such features as doorframes, casework, and finish transitions to avoiddirt-catching
and hard-to-clean crevices and joints

 Adequate and appropriately located housekeeping spaces

 Special materials, finishes, and details for spaces which are to be kept sterile, such asintegral cove
base. The new antimicrobial surfaces might be considered for appropriatelocations.

 Incorporating O&M practicesthat stress indoor environmental quality(IEQ)

5.Accessibility

All areas, both inside and out, should:

 Comply with the minimum requirements of the Indian Government Standards

 In addition to meeting minimum requirements of ADA and/or UFAS, be designed so asto be easy to
use by the many patients with temporary or permanent handicaps

 Ensuring grades are flat enough to allow easy movement and sidewalks and corridors arewide enough
for two wheelchairs to pass easily

 Ensuring entrance areas are designed to accommodate patients with slower adaptationrates to dark
and light; marking glass walls and doors to make their presence obvious

6.Controlled Circulation

A hospital is a complex system of interrelated functions requiring constant movement of peopleand

goods. Much of this circulation should be controlled.

 Outpatients visiting diagnostic and treatment areas should not travel through inpatientfunctional
areas nor encounter severely ill inpatients

 Typical outpatient routes should be simple and clearly defined

 Visitors should have a simple and direct route to each patient nursing unit without penetrating other
functional areas

 Separate patients and visitors from industrial/logistical areas or floors

 Outflow of trash, recyclables, and soiled materials should be separated from movement offood and
clean supplies, and both should be separated from routes of patients and visitors

 Transfer of cadavers to and from the morgue should be out of the sight of patients andvisitors

 Dedicated service elevators for deliveries, food and building maintenance services’

7.Aesthetics

Aesthetics is closely related to creating a therapeutic environment (homelike, attractive.) It isimportant

in enhancing the hospital's public image and is thus an important marketing tool. A better environment
also contributes to better staff morale and patient care. Aestheticconsiderations include:

 Increased use of natural light, natural materials, and textures

 Use of artwork

 Attention to proportions, color, scale, and detail

 Bright, open, generously-scaled public spaces

 Homelike and intimate scale in patient rooms, day rooms, consultation rooms, and offices

 Compatibility of exterior design with its physical surroundings.

8.Security and Safety

 In addition to the general safety concerns of all buildings, hospitals have several particular security
concerns:

 Protection of hospital property and assets, including drugs

 Protection of patients, including incapacitated patients, and staff

9. Safe control of violent or unstable patients

Vulnerability to damage from terrorism because of proximity to high-vulnerability targets, or because

they may be highly visible public buildings with an important role in the public healthsystem.

10.Sustainability

Hospitals are large public buildings that have a significant impact on the environment andeconomy of
the surrounding community. They are heavy users of energyand waterand producelarge amounts of
waste. Because hospitals place such demands on community resources they arenatural candidates for
sustainable design.

PHASES OF PLANNING AND DESIGNING A HOSPITAL

1.FINANCE

2.LOCATION

3. PREPARING THE DESIGN

1.FINANCE:-

An assessment should be made of available finance and possible sources of arrangingfinance. Banks
such as the industrial development bank of India (IDBI)

2.LOCATION:-

The objective/ purposes of the hospital along with the need of the community todetermine the demand
for hospital services identification and location.

Information gathered from the “needs assessment survey” of the community

1) Local cultural practices

2)Climate

3)Population birth rate

 4)Economic status

5) Sources of income
6) Disease pattern
7) Major prevalent illness.
8) Morbidity rate.
9) Mortality rate.
10) Available medical facilities

11)Average charge of medical facilities.

12)Available of manpower

13)Status of supportive service such as water, electricity etc

Factor determining the demands for hospitals services:-

1.Morbidity ( include prevalence of disease, accident rates, specific disease)

2.Demographic (include the character of the population such as age group, sex ratio )

3.Socio economic factor ()

4.Hospitals statistics

CATCHMENT AREA:-

1. Urban — a radius of 10-15 km initially may be considered in areas where good transportis
available

2. Rural — a radius of 20-25 km which could be increased depending on futurerequirement.

3.PREPARING THE DESIGN:

Once the location of the hospitals has been decided, the following factors should beconsidered:

1)Site selection

2)Legal requirement

3)Size of the land.

4)Plot ratio.

5)Landscaping.

6)Designing consideration

7)Possibility of future growth

8)Color coding.

ORGANIZING OF OPD

Care of the ambulatory patient is the main consideration in the OPD. For maximum efficiencythere must
be perfect coordination with the inpatient department (IPD) and the r facilities of thehospital.

The main considerations are:

1)Within the OPD, the physical facilities should be placed such that smooth flow ofoperation and easy
and quick intercommunication is maintained.

2) Service to common to both the IPD and OPD (radiology, laboratory, blood bank) should be readily and
easily accessible.

3)Provision of adequate auxiliary department.

4)Installation and review of an appointment systems based on the doctors hours ofworking

.5) Detailed review of amenities for patient.

•LOCATION AND PHYSICAL FACILITIES

1.LOCATION

The OPD is the showcase of any hospitals, and reflects its image. It should leavean independent
approach at the hospitals and should 3e on the ground floor foreasy access. Some treatment facilities
like radiology, pathology, physiotherapyand blood bank should be interposed between the OPD and IPD.

2.PHYSICAL FACILITIES AND SPACE REQUIREMENTS

The OPD of a general hospital should have five distinct sections:

1. General facilities.

2.Clinics of different medical disciplines.

3.Supporting facilities such as laboratory and injection room.

4.Pharmacy.

5.Blood bank

3. PLANNING

1.The size of the OPD depends upon the volume of attendance, the clinics providedand the extent of
other facilities such as laboratory, blood bank, and health education programmed, operating facilities
and emergency ward.
2. The size of the OPD also depends on the land available and the location of thehospitals.

3.The guideline is 0.66 sq. ft per annual OPD attendance.

•The physical facilities may be considered under four groups

1. Public areas.

2.Clinical areas.

3.Administrative areas.

4.Circulation areas.

Allocation of area (in sq. ft) for various utilities

Number ofhospital bed 50 beds 100 beds 200 beds 300 beds 400 beds 500 beds

Public areas 1025 2125 3000 3400 4300 4350

Clinical areas 5655 7105 11205 14695 17525 20815

Administrativeareas 2260 2960 1420 5280 6200 7000

Circulationareas 3060 3810 5175 6625 7965 9835

Total areas 12000 16000 21000 30000 36000 42000

Wall andpartition 1200 1600 2400 3000 3600 4200

areas(10%)

Gross areasfor 13600 17600 26400 30000 39600 462001

totalbuilding.

PUBLIC AREAS:

These will include the following

1)Traffic

2)Main Entrance
3)Reception and Information

4)Registration and Records Area

5) Non-clinical Areas

A.Entrance Hall

B.Waiting-Area

C.Public Toilets and Washrooms

D.Snack Bar

6)Consultation Room

7)Special Examination Room

Medicine ECG 150 sq. ft

ENT Audiometry 120 sq. ft

Psychiatry EEC 100 sq, ft

Eye , Refraction room 160 sq. ft

Perimetry room 120 sq. ft

Tonography room 120 sq. ft

Slit lamp room 120 sq. ft

Orthopedics Plaster room etc 150 sq. ft each room

8)Treatment/Dressing Room - The size will vary from120 sq. ft — 160 sq.

2.CLINICAL AREAS:

1.An OPD include surgical, dental, ophthalmic, ENT, maternity, and gynecology, pediatric, medicine,
psychiatric, and emergency department.

2.There are ancillary facilities such as treatment section which minor OT, injectionand dressing room,
dispensary.

3.There is also a growing need to institute health education program inenvironmental hygiene, family
planning.
CLINICAL AREAS ARE CLASSIFIED

A. Clinics for various Medical Disciplines:

1)Medical Clinic

2)Surgical Clinic

3)Orthopedic Clinic

4)Eye Clinic

5)ENT Clinic

6)Dental Clinic

7)Obstetric and Gynecological Clinic

8)Family Planning Clinic

9)Pediatric Clinic

10)kin and STD Clinic

11)Psychiatric Clinic

B. Ancillary Facilities:

1)Injection clinic

2)Pharmacy

C. Auxiliary Facilities:

1)Laboratory

2)Radiology

3)Blood Bank

4)Health Education

5)Social Service

6)Screening Clinic

7)Preventive and Social Medicine

A.Early diagnosis and detection of tuberculosis, cancer,rheumatic heart disease.

B.Health education and advice on nutrition and dietetics.

C.Rehabilitation and prevention of handicapped and disabilities.

3.ADMINISTRATIVE AREAS

1)Administrator's Office

2)Business Office

3)Housekeeping

4.STORAGE FACILITIES

1)General Stores

2)Drugs Stores

3)Linen Storage

PLANNING AND ORGANIZING AN INPATIENT UNIT

While planning a ward, the aim should be to minimize the work of the nursing staff and provide basic
amenities to the parents so that his/her stay is made as comfortable as possible.

1.POLICY OF THE HOSPITAL:

2.PHYSICAL FACILITIES

3. STAFF

1.POLICY OF THE HOSPITAL:

The policy of the hospital will decide whether the hospital will be a general one with allfacilities or
specific (super specialty hospital) e.g. neuroscience center.

2. PHYSICAL FACILITIES
3. 1)Location and area:

The inpatient area should be located away from main and the OPD area. It isrelegated to the back to
ensure quietness and avoid disturbance and potentialsources of cross infection

Important measurement to keep in mind while designing the ward.

1.The size of a hospital bed is 6’6” X 3’3”.

2.The minimum distance between the center of two beds should be 0.25 m, space atthe foot-end 0.90m,
space at the head-end 0.25m, thus the space required would be 3.15 m, x 2.25 m = 7.09 m2 (75 sq.ft)

3.The area per in a ward is 79-90 sq. ft.

4.The area per bed in an acute ward is 100-120 sq. ft.

5.The area per bed in the ICU is 120-150 sq.ft.

6.A single bed room with independent toilet should have a minimum space of 125sq. ft.

7.Space between two rows of beds is 5 ft.

8.The distance between two beds should be is 3 to 4 ft.

9.The width of a dormitory should be 20 ft.

10.The size should of an isolation units should be 14 m.

11.Width of the hospitals corridors should be 3 m wide to accommodate two passingtrolleys.

2)SIZE:

The size of the ward or nursing unit varies in different hospitals. Various factorhave a bearing on the
optimum size of the unit

a. Type of the patient

b.Requirement of staff

c. Position of staff

d.Position of the head nurse and ward clerk

3)SHAPE/DESIGN:

The primary objective of the ward design is to enable the nurse to react toemergencies with maximum
efficiency and minimum efficiency and minimum physical and emotional stress.

1)OPEN WARD

1.The regular pavilion type of ward was first constructed in 1770 by a manFrenchmen about 80 years
later.

2. The Florence nightingale adopted this design and it is still known after hername. This ward
consists of patient beds in two rows at right angles to thelongitudinal walls the bathrooms and
WC.
 3.About 30-35 patients were housed in such wards and the length of theward was not less than 96
feet.

4.This type of ward was in use till 1925.

Advantages Disadvantages

Nurses have ample Visibility and canobserve Danger of A critically ill patient, placed closer to thenurse's for
cross-infection patientsdirectly. maximum attention would lie in thecentre of greatest
traffic-density

 Danger of cross-infection.

There is cross-ventilation  Noise and lack of privacy

It is economical to construct and maintain thus Constant glare which disturbs the patients.

Natural light is available .Danger of cross-infection

2)RIG'S WARD:the first major development over the above mentioned defects appeared in rig’s
hospital, Denmark and thus the name rigs ward. In this design the ward unit is divided into small
compartment.

• Cubicles separated from each other by low partition.

•cubicles separated from each other by low partitions, each cubicle having 1, 2, 4 or 6 beds arranged
parallel to the longitudinal walls

•Disadvantages of rigs ward

1.Communication between the nurse and patient becomes more difficult.

2.Patients cannot be directly observed by the nurse.

3.Wards are longer; consequently, the nurse has to walk more.

4.More nurses are required.

5.Costly to build and maintain.

• Types of Ward Design

1.Nightingale Ward: - open ward with 20 — 30 beds.

2.L-shaped Ward: - in this, the nursing station is placed at the 90 degree junction.

3.T-shaped Ward: - the nursing station is at the vertical arm and the patientareas are located on the
horizontal arm. Serious patient and nurse to theminimum.
4.Circular Ward: -this design occupies the minimum space and reducesthe walking distance between
patient and nurses to the minimum.

4)ANCILLARY ACCOMMODATION:-

Types of ancillary accommodation: -

1. Nursing station

2.Treatment room

3.Clean utility room

4.Ward kitchen/pantry

5. Day room

6.Stores

7. Dirty utility room

8. Bathrooms and toilets

9. Janitors room

5)AUXILIARY ACCOMMODATION: -

A.Duty room for doctors

B.Seminar room

C.Attendant room

D.Side room laboratory

E.Locker room for staff

SUPPLY OF WATER AND ELECTRICITY, AND AIR-CONDITIONING

3.STAFF

1)Medical

2) Nursing

3)Supportive

SPECIALTY WARD UNITS

1. Postoperative and orthopedic wards

2. Paediatric ward

3. Psychiatry ward

4.Skin ward

5. Infectious diseases ward

6.Obstetrics and gynecology department: -the space needed for thevarious are the:-

i.Reception and admission

ii.Examination and preparation room

iii.Labor room

iv.Delivery room

v.Sterilizing room

vi.Sterile room

vii.Scrubbing room

viii.Dirty utility room

ix. Other facilities

NURSING UNIT: -

1.Antenatal Ward

2.Eclampsia Ward

3.Postnatal or Lying-in Ward

4.Formula Room

INTENSIVE CARE UNIT: -

Following should be taken in to account while planning & organizing.

1.Location of the ICU

2.Separate isolation rooms

3.nurses station

4.area allocated for patient care (140-200 sq.ft./bed)

5.Beds

6.Wall installation of equipments

7.Adequate lighting

8.adequate ventilation

9.Temperature

10.Relative humidity

11. Noise level

12.Design

OPERATION THEATER UNIT:-

The location of the department should be

1.Free from general traffic

2.Free from noise & other disturbances

3.Free from contamination & possible sources of infection

4. Protected from solar vr5adiation, wind & dust.

5.Conveniently placed in relation the surgical ward, ICU, Radiology,Pathology, Blood bank, CSSD, TSSU
(theater sterile supply unit)

DIETRY SERVICES

Factors influencing the workload: -

various factor influences the workload of the departmentand personal required to handle it size of the
hospital.

1.Type of institution ( private hospital may a more menu )

2.Design of the hospital

3.Plan of food service

4.Patient-turnover

5. Percentage of modified diet.

6.Use of selective menus.

7.Amount of catering.

8.Purchase of ready-to-use food.

CENTER STERILE SUPPLY DEPARTMENT (CSSD)1. LOCATION: -

oIt varies indifferent constituent and location has advantage and disadvantage.

oThe common consideration is that the major uses of CSSD such as the casualty, wardunit, labour room
and OT should be near of have direct and easy access to it.

2. FLOOR SPACE: -

In CSSD, the floor space is divided into 6 basic units. Their relativefloor area is given below

1.Clean work-area including sterilization area

2.Sterile storage

3.Equipment storage

4.Fluids, needles and syringes

5.Reception and clean-up area

6.Gloves processing area

A.Reception and clean up area

B.Equipment storage

C.Sterile storage

D. Clean work area

LAUNDRY SERVISES

1.LOCATION AND SPACE: -

Whether the laundry is the main building of the hospital or in as space one. Or with oneor more of the
hospitals support services, its location should be convenient to the userunits

2. DESIGN CONSIDERATIONS AND PHYSICAL FACILITIES:-

the design of thelaundry should be that it helps in the following main laundering process:

1.Sorting (counting, weighing),

2.Washing (sluicing, if blood-stained)

3.Hydroextraction,

4.Drying/Flat ironing,

5.Pressing/Hand ironing/folding,

6.Packing.

LABORATORY SERVISES

Cities and very often function as a reference library and forms part of a teaching hospital. At thislevel,
the laboratory should have most of the units of clinical and morphological pathology.

•Location and Space: -

it should be centrally for easy access by clinicians. At the sametime, it must be so situated that future
expansion will not be impeded in designing aregional hospital laboratory, the requirement of space will
be based on the servicesavailable, number of specialized units, the level of research to be carried out
and possiblefuture expansion.

•Personnel: -

the staff will consist of medical and non-medical professional, bothtechnical and non-technical. The
number will depend on the size of the department andthe workload. The laboratory workload will vary,
depending on the population, and thequality and kind of medical practice in the hospital.