PRINCIPLES OF HOSPITAL DESIGN

Dr A PRAKASH
Sr. Professor, Health Management
National Academy of Indian Railways
(Formerly Railway Staff College)
VADODARA – 390 004
 Dutch architectural historian Cor Wagenaar has
called many hospitals:
"... built catastrophes, anonymous institutional
complexes run by vast bureaucracies, and totally
unfit for the purpose they have been designed
for ... They are hardly ever functional, and instead
of making patients feel at home, they produce
stress and anxiety."

The research of British Medical Association
shows that good hospital design can reduce
patient's recovery time.

Exposure to daylight is effective in reducing
depression.

Exposure to nature and hospital gardens is also
important - looking out windows improves patients'
moods and reduces blood pressure and stress
level.

Eliminating long corridors can reduce nurses'
fatigue and stress.
 THE PLOT

Where the clients want it

Easy reach of captive population

Free access

Area not less than double the floor area

IS 10905 Pt I – one hectare per 25 beds

Gates – Main / Emergency / Service
 BUILDING

Maintenance free

Environment friendly

Minimum energy expenditure for ambient light &
climate control

Functional segregation

Emergency exits, ramps, fire alarms

Disabled friendly
 FLOOR AREA OF HOSPITAL


700 – 900 sq ft per bed

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


OPD – 12%-18%

Wards – 37%-45%

Diagnostic & Therapeutic – 18%-22%

Administration – 8%-12%

Service Departments – 15%-20%
 FLOOR AREA
DETAILED BREAKUP

Nursing – 250-280

Nursery – 12-18

Labour Room – 15-20

OT – 30-50

Physical Medicine – 12-18

Radiology – 25-35

Laboratory – 25-35

Pharmacy - 4-6
 FLOOR AREA
DETAILED BREAKUP

CSSD – 8-25

Dietary – 25-35

Medical Record – 8-15

House Keeping – 4-5

Laundary – 12-18

Mechanical Installations – 50-75

Maintanence Workshop – 4-6

Stores - 25-35
 FLOOR AREA
DETAILED BREAKUP

Public Areas – 8-10

Staff Facilities – 10-15

Administration – 40-50

Circulation – 115-140

TOTAL – 681-991

Add Partitions, Walls etc – 95-125

GROSS TOTAL - 780-1005
 CORRIDORS

Main corridor should allow for passage of two
beds with persons on sides

It requires ~2.5 metre width

Less than 100 beded hospitals can have one
bed passage

It requires ~2.0 metre width

Segregation of clean and dirty corridors
 LIFTS

Depends upon number of beds above ground
floor

Up to 60 – one

Up to 200 – two

Up to 350 – three


Size – >2280X1600X2300 mm
with door size >1300X2100 mm
 OPD

For every bed three patients are seen in OPD

60% of area should be for waiting & corridors

Seats for 1/3 of daily attendance @ 8 sq ft/pt.

Consultation room – 150 sq ft

Attached examination room – 80 sq ft
 CASUALTY

Easy access

Consultation room 150 sq ft

Resuscitation room 175 sq ft

Waiting area
 WARDS

24 to 32 beded

75 sq ft area for each bed

Center to center distance between beds 8 ft

Edge to edge distance between beds 4 ft

Service corridor between bed rows 8 ft

Wash basin one between 10 beds

Sluice room 120 sq ft

Broom closet 40 sq ft

MGPS
 WINDOWS IN WARDS


Window area 20% of floor area if only on one
wall

Window area 15% of floor area if on opposite
walls at same sill level
 CABINS


At least 6 cabins per 100 beds


Australian standard is 25% of beds in single,
double & quadruple units
 BED DISTRIBUTION

Medical 30%-40%

Surgical 25%-30%

(includes Orthopedics – 5%)

Obs & Gynae 15%-18%

Peadiatrics 10%-12%

ENT & Eye etc 10%-15%
 ICU

Bed strength – 2% to 5% of total beds

Not less than 5 or more than 15 in a unit

Each bed 150 – 200 sq ft

Not more than 40%-50% floor area for beds

Hence ICU size 500 sq ft per bed

Power – 2X15 amp & 3X5 amp at least

MGPS

Monitor cabling
 OT – THE NUMBER

One OR per 50 beds


No. of Operations = Surgical BedsXBORX365
ALSX100XWorking Days

No. of OT = No. of Operations per day

Expected Output per OT
 OT – THE NUMBER
BEDS MINOR MAJOR EM MINOR EM MAJOR

50 0 1 0 1

100 1 1 0 1

300 2 3 0 1

500 2 5 1 1

750 2 8 1 1

1000 2 10 1 1
 ZONING IN OT

Protective Zone

Clean Zone

Sterile Zone

Disposal or Sluice Zone
 ENVIRONMENTAL CONTROL

Temperature – 20+2

Relative Humidity – 40%-60%

Air Changes 25/hr (at least 10 of fresh air)

Clean air thru HEPA filter (0.3μ & 99.7%
efficiency)

Clean area – 12 or more air changes, same
temperature & RH
OT FLOOR AREA DISTRIBUTION

Special OR (25'X25') – 625 sq ft

Major OR (20'X20') – 400 sq ft

Minor OR (18'X18') – 324 sq ft

Scrub Room – 80 sq ft

Fracture Room – 249 sq ft

Plaster Room – 80 sq ft

Sterile Storage – 160 sq ft

Equipment Storage – 240 sq ft
OT FLOOR AREA DISTRIBUTION

Instrument Storage – 160 sq ft

Anaesthetist's Room – 160 sq ft

Anaesthesia Store – 80 sq ft

Anaesthesia Room* – 160 sq ft

Doctor's Change Room – 120 sq ft

Nurses' Change Room – 120 sq ft

Staff Change Room – 120 sq ft

OT Office – 120 sq ft
OT FLOOR AREA DISTRIBUTION

General & Linen Store – 120 sq ft

2 bed recovery – 160 sq ft

Mobile X ray & Dark Room – 120 sq ft

Trolley Bay – 80 sq ft

Safaiwala Alcove – 80 sq ft
OT FLOOR AREA DISTRIBUTION

ADD IN CASE OF DAY CARE SURGERY

Reception – 100 sqft

Men's Change Room – 120 sqft

Ladies' Change Room – 120 sqft

Patient's Preparation – 120 sqft

Gowned Waiting Area – 80 sqft
PLUS Circulation Area
 SERVICES FOR OT

Electricity – Clean

Water Supply – Clean

Lighting – General Background /
Operation /Special

MGPS
? SEAMLESS / MODULAR OT
 LABOUR ROOMS

Septic & Aseptic Segregation

Lighting

MGPS

Neonatal Resuscitation Area

Vicinity of Nursery & OT
 NURSERY

Vicinity of Labour Room

Natural Light
 MORTUARY

Connected to Service Gate

Cold Room

Side Room with Plumbing

Waiting Area
 PROVISION FOR GROWTH

Area Growth Acceleration

Indoor 8.7% 1.0%

Outdoor 10.8% 4.1%

Medical Services 28.4% 15.3%

Teaching & Research 45.9% 31.1%

Staff 18.5% 4.9%

Services 9.5% 1.8%

Administration 23.3% 6.5%
 AIRCONDITIONING

Dilution

CO2 / Heat Load / Microbial Load

Control of Microbial Spread

Room to Room Pressure Difference

Flow Control within Room

Humidity Control

Air Purification

Filters / UV / Ozone
 AIRCONDITIONING

Integration of –

Ventilation

Lighting

Fire fighting

MGPS

Cabling for computers & monitors etc
 AC – OT

Temp – 20-23

RH – 50%- 60%

Pressure – Positive, Negative in Sluice Room

Air changes – 10 fresh / 25 total

Air Filtration – HEPA (0.3 μ) in OR 20μ else

Pressure maintained in OR 24X7
 AC – ENDOSCOPY ROOM

Temp – 20-23

RH – 30%-60%

Pressure – Negative

Air Changes – 2 fresh / 12 total

Air filtration – 20 μ

All air vented out
 AC – POSTOPERATIVE

Temp – 21-24

RH – 30%-60%

Pressure – Positive

Air change – 2 fresh / 6 total

Air Filtration – 5 μ
 AC – MICU/SICU

Temp – 21-24

RH – 30%-60%

Pressure – Positive

Air change – 5 fresh / 15 total

Air Filtration – 5 μ
 LABOUR ROOM

Temp – 20-23

RH – 30%-60%

Pressure – Positive

Air Changes – 3 fresh / 15 total

Air Filtration – 5 μ
 NURSERY

Temp – 22-26

RH – 30%-60%

Pressure – Positive

Air Changes – 3 fresh / 15 total

Air Filtration – 5 μ
 WARDS

Temp – 21-24

RH – 30%-60%

Pressure – Positive

Air Changes – 3 fresh / 15 total

Air Filtration – 20 μ


Over crowding in visiting hours
 PATHOLOGY

Temp – 24

RH – 30%-60%

Pressure – Negative

Air Changes – 6 total

All air exhausted outside
 RADIOLOGY

Temp – 24

RH – 30%-60%

Pressure – Positive, Negative in Dark Room

Air Changes – 6 total, 10 total in Dark Room

Heat Load Calculation is important
 REFERENCES
Private Hospital Guidelines Australia IIIed
Private Health Care Facilities Lisencing
Procedures & Specifications UAE
Hospital Planning and Administration, R
Llewellyn-Davies & HMC Macaulay
Principles of Hospital Administration and
Planning, BM Sakharkar
Hospital Administration, CM Francis & Mario C de
Souza
 REFERENCES
IS 10905 (Indian Hospital Standards)
HTM 2025 (Ventilation in Health Care Facility)
HTM 05 (Fire Safety) & HTM 06 (Electrical
Services)
HTM 2014 Electromagnetic Interference to
Medical Equipment
EN 12464 for lighting
thank you