ADES: RESEARCH PAPER NO.

HOSPITAL

PREPARED BY:
JARDIN, REXTER RYAN L.
BS-ARCHITECTURE 3A

SUBMITTED TO:
AR. CHCARMAINE ESSGUERRA
 A hospital is a structure that is designed, staffed, and prepared to
diagnose illness, heal sick and wounded people (both medically and
surgically), and house them while they are undergoing care. The new hospital
is also used as a research and education center. Hospitals provide high-
quality care in a coordinated manner, with patients at the heart. It suggests
that patients and families are in control of their own well being. It also involves
taking a longer-term view that extends beyond saving lives and improving
patients' quality of life.

FLOW CHARTS AND INTRODUCTION

The hospital as a building form is made up of several complex
elements, each of which can place a burden on the abilities of architects,
mechanical engineers, and other practitioners engaged in their design and
development. A book may be written on both of these aspects. As a
consequence, the following topics have been chosen for review in this
section:

Bedrooms
Nursing units
Surgical suite
Nursery
Pediatric unit
Diagnostic x-ray suite
Teletherepy unit
Cobalt-60
Electroencepholographic suite
Physical therapy department
Occupational therapy department
General hospital laboratory
Labor-delivery suite
Radioisotope facility

Each hospital's scope of care, facilities, and room needs will differ, and
must be connected to the services the hospital will provide. As a
consequence, the details provided here must be customized to each scenario.
The topic of hospital design and building has gotten a lot of attention.
The nature of this section does not provide for a detailed bibliography of this
material.

Figure 1 illustrates simplified flow charts for the whole hospital as well as
different departments not represented on the following pages.
Bedrooms

An overview of the number of beds per nursing unit, or the proportions

of single, double, and four-bed rooms within defined units, was not included in
the committee's mandate. This research is limited to an analysis of a single
space, as well as a number of minor yet important aspects that determine
whether a room is good or bad.This are small information that an
administrator or architect should be aware of before going on to something
more original, if that is his desire.
In general, the many room plans reviewed `Report by the AIA
Committee on Hospitals & Health have basic similarities but many variations
in detail . Accompanying plans have been specially drawn to illustrate the
majority of features that will be discussed . It must not be construed that these
represent ideal or minimum standards . (See Figs . 2 to 6 .)

Size
First point of interest is the considerable variation in room sizes
Ranges of net clear floor area from corridor door to window stool, not
including built-in wardrobes, are :Single rooms : 117 to 172 sq ft (deluxe are
larger)
Double rooms 157 to 210 eq ft
Four-bed rooms: 306 to 401 sq ft

Major differences are found in depth of rooms from inside of exterior

well to room side of corridor partition, all the way from 14 ft-6 in . for single
rooms or 15 ft-0 in . for double and four-bed rooms to 21 ft-6 in . for all types .
In the two and four-bed rooms a clear distance of 14 ft-0 in . for two
beds and two bedside tables is "snug," but it should be noted that the majority
of rooms studied measure nearer to 15 ft-0 in . clear, which is the USPHS
standard . Lavatory, toilet door, or wardrobe door do not encroach into these
clear dimensions in the better rooms .
In the other dimension, comments of administrators evoke no
complaints about single rooms as narrow as 10 ft-0 in . t o centers of
partitions-rooms up to 12 ft-0 in . on centers draw comments from "excellent"
to "more then ample ." Majority of double bedrooms are 12 ft-0 in . on centers
and are wall regardedsmaller ones are criticized for being too tight . Four-bed
rooms range from acceptable minimum of 20 ft-0 in . on centers to more than
24 ft-0 in .

Closets

Specific henging room is almost always given for each patient,

sometimes in the form of built-in metal wardrobes, which are often combined
with dressers and topped with mirrors. One word of caution: mirrors should
not be positioned in such a way that they project light into the patient's eyes.
Fig. 1 . Flowcharts
From Design and Construction of General Hospitals by Public Health Service, U.S . Department of Health, Education and
Welfare (1953) .
Furniture

Every plan reviewed has beds that are parallel to the outside wall,
allowing patients to peer out the window without looking straight into the bright
sky. Motorized high-low beds are also very popular; however, they can be as
long as 7 ft-3 in total length.

Plumbing Fixtures

The most significant architectural problem, aside from room size, is the
location of plumbing facilities.Although minimum budget hospitals ore still
being built without a toilet connecting to every bedroom, a private toilet is now
regarded as a basic feature with each bedroom . It is perhaps axiomatic that
in almost every case a bedpan cleansing device is incorporated . 2 ft-10 in . t
o 3 ft-2 in by 3 ft-10 in . to 4 ft- 10 in . are the dimensions noted for individual
toilet rooms, usually with grab-bars on one or both side walls . Locating water
closet slightly off-center in the room allows a little more space on wider side
for manipulating cleanser-the letter needs only cold water and is usually on
the right as you face beck wall . Some plans indicate bedpan rack or cabinet
within toilet room-otherwise bedpan is stored in bedside table .

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 . t o 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 treatments indicates that environment,
orientation, esthetics, economics, and other variables, rather than any fixed
optimal ideal, rule this architectural function.

Builtin Equipment
Combinations of built-in closet, dresser, and recessed mirror have
already been discussed. Separate 9 in. large flower shelves bracketed on wall
beside or opposite bed, around 4 ft-6 in. above floor, obtain some focus. In
multi-bed spaces, cubicle curtain configurations vary from the most basic
crossroom tracks to full enclosures around each bed.

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 . t o 6ft-
6 in . above floor.
The one prevailing comment here recommends switching the night-
light out in corridor or near room door,
rather than at bedside . (See Fig . 7 .)
A special wrinkle for single rooms, where private duty nurses may be in
attendance, is a ceiling down-light over a chair near door into the room, at
which location the nurse can guard patient from unwanted visitors and at
same time read comfortably day or night without bothering patient.
.
Portable Bedside Panel (Patient's Control)
" Nurses' call switch, pilot light, monitor light
" General room illumination switch, dimmer control
" Reading light switch
" Room thermostat remote control
" Electric blanket control
" Electric clock
" Duplex convenience receptacle
" Radio station selector (central radio system)
" Jack for pillow speaker (ceiling speaker in private rooms)
" Provision for TV remote control to be clipped onto panel
" Provision for telephone instrument (bracket type)

NURSING UNITS
Integral with bed
" Bed control (within patient's reach, but with nurse-controlled cut-off feature)
Ceiling
" Nurses' call micro-speaker
" Radio speaker (private rooms only) High on Wall (60 in . or higher)
" Over-bed light fixture (direct and indirect)
" Oxygen outlet Low on Wall (approximately 24 in .)
" Receptacle for portable bedside panel
" Night light (switched from corridor)
" Telephone jack
" Double duplex receptacle (bed, oxygen tent, portable x-ray, heating pad, etc)
" Remote recording instrument receptacles (temp, pulse, respiratory)
" Suction outlet
" Bracket for suction bottle.

Double Corridor Nursing Floor

Figure 14 shows a typical double-corridor nursing unit which is often
utilized in hospital planning It has the following advantages :
1 . It permits a closer relationship between the patient bedrooms and the
nursing station and other service areas .
2 . It permits greater flexibility in segregation of patients for various medical
reasons
3 . Much of the staff activity and particularly conversation can be carried on
within the service unit complex,thus cutting down noise in the patient corridor.

Figure 15 indicates more clearly the nursing station and utility room
arrangement. The clean utility is designed to accommodate carts for storing
linens, utensils, and other supplies, which would be brought from a central
supply and sterilizing unit . Elevators are located outside the nursing unit to
cut down on the amount of noise. This would also permits future nursing unit
to be located on the other side of the elevators.
 This nursing floor consists of two 25-bed nursing units, many
authorities believe that greater efficiencies are obtained in having a larger
ratio of beds per nursing station. This particular nursing floor might easily be
extended one or two bays, increasing the capacity to 62 or 70 beds .

SURGICAL SUITE
The surgical suite of the general hospital is a very complex workshop.It
is one of the most important departments of any hospital, and its planning is
complicated by the diversities of opinion and experience of the many persons
involved in policy decisions essential to development of a good program of
requirements.
The number and type of operating rooms is the first major decision . In the
general hospital, the tendency is to have all major operating rooms as nearly
identical as possible to facilitate scheduling of various surgical procedures .
Free floor space should be 18 ft by 20 ft, or approximately 350 eqft . Many
surgeons and surgical supervisors recommend 20 ft by 20 ft free floor space .
The planning and equipping of each operating room are based on a
series of questions,such as : (a) size, (b) usage, (c) environmental control`,
(d) lighting-surgical and general illumination`, (e) inter communications and
signal systems-, (f) electronic equipment and monitoring system', (g) service
lines, such as suction, oxygen, nitrious oxide, compressed air,(h) provision for
x-ray, not only x-ray tube stand but control, transformer, and necessary lead
protection, (i) provision for TV camera, movie cameras, other recording
equipment, (j) safety precaution in hazardous areas, (k) cabinet work, supply
cabinets and storage for operating table appliances, (I) need for clocks,film
illuminators .
Scrub areas, work and supply rooms, laboratory, dark room, post-
anesthesia recovery, keeping or induction areas, lobby, locker and toilet
rooms for different staff classes, meeting or lecture rooms, and departmental
circulation.
The analysis of various suites illustrating this article show a spread
from 1115 sq ft to 1585 sq ft total gross area per operating or cystoscopic
room (if included)-and every suite could use more gross floor area for storage,
according to comments . Thus, a suite of eight operating rooms averaging 350
aq ft each = 2800 sq ft X 4 = 11,200 sq ft estimated total area required-or
1400 sq ft per operating room .
 Within the surgical suite we have three basic zones predicated on three
types of activity and circulation involved, and the degree of sterility to be
maintained . The preplanning analysis of these areas is just as important as
the determination of the number and type of operating rooms.

Outer zone : Administrative elements and basic control where personnel enter
the department,patients are received and held or sent to proper holding areas
of inner zone ; conference, classroom areas, locker spaces, any outpatient
reception, etc .

Intermediate zone : Predominantly work and storage areas ; outside

personnel will deliver to this area but should not penetrate the inner zone .
The recovery suite, if completely integrated with the surgical suite, is an
intermediate
or outer zone activity .

Inner zone : The actual operating rooms, the scrub areas, the patient holding
or induction areas. All alien traffic should be eliminated . Here we want to
maintain the highest level of cleanliness and aseptic conditions .

Outer zone administrative areas have in . creased in importance. Offices are

needed for the surgical supervisor, the clerks who manage scheduling and
paper work, the clinical instructor (particularly if there is a school of nursing),
possibly the chief of staff. There must be provision for surgeons to dictate
medical records .

Surgeons (both male and female), nurses, technicians, aides, and

orderlies all need lounge, locker, and toilet space. Coffee and cola seem to
lubricate the whole department; some kind of mechanism for ensuring their
availability is needed. It is easy to explain a conference room or classroom for
departmental meetings and in-service training programs.

The planning and equipping of

the intermediate zone are based on the
method of processing and storing of the
thousands of items involved . It is fairly
common practice for the central sterile
supply department, elsewhere in the
hospital, to be responsible for the
preparation and autoclaving of all
surgical linen packs, gloves, syringes,
needles, and external fluids . The
storage of these items to be used in
surgery becomes the responsibility of
the surgical department and adequate
space must be provided for a
predetermined level of inventory . (See
Fig . 1 .)
 Suitable storage space must be provided for : (a) clean surgical
supplies such as extra linen, tape, bandage materials, etc . ; (b) parenteral
solutions, external fluids or sterile water ;(c) essential drugs and narcotics ; (d)
blood supplies, bone bank, tissue bank, eye bank, etc . ; (a) radium and
isotopes used in surgery .
Any frozen section laboratory should be located near the entrance of
the surgical suite so that laboratory personnel need not penetrate the inner
zone .
Any dark room facilities should be located near the rooms that produce
the most film, which are typically cystoscopic, urological, and orthopedic
services. To prevent alien traffic through any operating room, it should be
accessible from a corridor.
The program of need dictates the gross area required for the surgical
suite . Recent developments indicate that more efficient departments
with minimum travel distances can be planned in bulky squarish areas . This
tendency has affected the location of the surgical suite in relationship to the
hospital as a whole . The suite has come downstairs to a lower floor where it
is more possible to spread out and achieve the desired shape, divorced from
the usually narrow structural pattern of a nursing unit .The optimum conditions
of temperature, humidity, and light level can be controlled by mechanical
means far better than by nature . (See Fig . 2 .)
NURSERY'
The nursery should be designed to provide the best means for the
care, safety, and welfare of the infants because it is one of the areas in the
hospital where patients are most vulnerable to infection.Basic
recommendations for planning nurseries that have been developed, based on
clinical experience and study, include : limiting the number of infants in each
nursery ; wide spacing of bassinets within each nursery ; separation of
bassinets by cubicle partitions ; promoting the use of aseptic techniques and
individual care by providing, among other things, ample space and hand
washing facilities ; limiting the number of bassinets served
by one nurses' station ; separating facilities for premature infants and for
observing infants suspected of having infectious conditions ;
 The extent of the spread of infection in a nursery can be reduced as
the number of infants in each nursery room is reduced . The optimum number
of full-term infants that can be cared for by a member of the nursing staff is in
the range of 8 to 10 .
A door direct from each nursery to the corridor is recommended to
permit faster evacuation in case of fire and easier movement of bassinets
from the nursery to the mothers at feeding time and to avoid traffic through the
nurses' station . This door, hung in a steel frame, should have a wire glass
panel end must Conform to National Fire Code requirements .
Because premature babies require more specialized care than full-term
babies, a staff-to-premature-baby ratio of one to five is considered
reasonable. As a result, a premature nursery room should have a maximum
capacity of five infants and a minimum area per infant of 30 square feet. If
there are fewer than five infants to be cared for at once, a separate nursery is
usually not necessary.
A double desk for two nurses is required for a station between two
nurseries. One nurses' station should serve no more than two full-term
nurseries, each with 8 to 10 bassinets. Four nurseries, each with four
bassinets, can be served in this way using the cohort system.
DIAGNOSTIC X-RAY SUITE
In a recent study it was found that many hospitals allotted inadequate
space to the x-ray department, and expansion was often impractical .
Adequate space for waiting, toilets, and dressing rooms helps insure
continuous routines in handling patients . The lack of adequate space results
in needless waste of effort and time in efficiently scheduling examinations. An
unsatisfactory layout is a handicap to both the hospital and the radiologist
since the hospital loses potential revenue, and the radiologist's time, as well
as that of the staff, is needlessly wasted . This is particularly important to a
small hospital which has a visiting radiologist for it is to the advantage of the
hospital and radiologist to schedule as many examinations are possible during
his visit .

LOCATION
The diagnostic x-ray department should be on the first floor, where
outpatients and inpatients can easily reach it. It's also a good idea to position
the department by the elevators, next to the outpatient facility, and near other
medical and care centers.
The x-ray rooms are normally ideally located at the end of a wing to
meet the department's practical specifications. Because of the outside walls,
the operation inside the department will not be disrupted by by traffic from
other areas of the hospital, and less shielding will be needed. (See Fig. 1 for
more
information.)
Administration Spaces
A radiologist has their own ideas on the best ways to organize and run
the x-ray department's administrative functions. Assignment of resources and
roles, patient intake, order of patient examinations, video delivery, and end
staff viewing facilities are some of the factors concerned.This plan provides
for flexibility of space arrangements by allowing for variation of several of the
operations within the administrative unit .

Waiting Room
General waiting space for about ten patients is located at the entrance
to the department . From here the patient is directed to an assigned dressing
room . A separate area, to the left of the entrance and in sight of the
secretary-receptionist, is provided for wheelchair and stretcher patients . This
section is partitioned off by a curtain which may be partially drawn to provide
privacy, yet afford the necessary surveillance of unattended patients from the
secretary-receptionist's desk . Additional chairs in this area can be used to
accommodate the attendants of these patients or for an overflow of waiting
patients when needed .

Doctors' Viewing Room

The doctors' viewing room is located near the office of the radiologist
so that he may be immediately available for consultation . The room is near
the film files, convenient to the secretary and file clerk, and situated so as not
to intrude upon the functional flow of the work . Its location within the
administrative unit provides privacy so that diagnostic comments end
discussions will not be overheard by patients .

Radiologists Office
This office is conveniently situated near the x-ray rooms, the secretary
receptionist's desk and the filing distribution area, and is not too easily
accessible to the public ; it is also provided with a door which opens directly to
the technicians' corridor . The fire exit which is located off the technicians'
corridor provides a second exit from the department for the radiologist .

Technicians' Toilets and Lockers

During busy periods it is essential that the staff be available at all
times . Separate toilet and locker facilities are provided for technicians . This
reduces the time technicians must be absent from the area and contributes to
the efficiency of the department.

Storage Facilities
General Storage For bulk supplies, a storage cabinet equipped with
sliding doors and adjustable shelves is located inside each patients' corridor
near the entrance . Materials such as films, opaque solutions, developing
solutions, and office supplies are stored here .

Daily Linen Supplies (X-Ray Rooms)

 Clean linen,requisitioned from the hospital central supply, is stored on

a cart (No . 66) in each x-ray room ; soiled linen is placed in a hamper (No .
65) .
GOWN Storage
Open adjustable shelves for gown storage are placed next to each
general bulk supply cabinet, just inside the corridor entrance . The shelving
for clean gowns starts about 4 ft from the floor, leaving space beneath for a
linen hamper (No . 65) for soiled gowns.

Janitor's Closet
The janitor's closet should be easily accessible for emergency cleaning
and next to the x-ray rooms and restrooms. A floor receptor with a curb or a
janitor's service sink, a mop-hanging strip and a shelf, as well as room for
storing the mop truck, should all be included in the wardrobe.
Electrical Installations
The x-ray unit's voltage should be constant to ensure uniform
fluoroscopic pictures and radiographs. It's safer to use an individual feeder
with enough power to avoid a voltage drop of more than 3%. For most
installations, a separate transformer for the x-ray feeder is needed to reduce
voltage fluctuations.
 Administration and Waiting Areas A temperature of 72' F with a relative
humidity of 50 per cent and a ventilation rate of 1-11 air changes per hour .

Fire Safety
To provide an adequate measure of fire safety for the patients and the
staff in this department, consideration must be given to factors of design and
construction relating to fire prevention and fire protection . The basic structure
should be built with fire resistive materials and incombustible finishes and
provided with approved equipment .
For storing x-ray films, closed metal files are preferred. If open shelves
are used instead, an automated sprinkler device could be mounted over the
storage area to reduce the possibility of a fire triggered by the vast number of
combustible items that will be exposed. To help in the control of a fire, fire
extinguishers (carbon dioxide type preferred) should be given, as indicated on
the plans.

Fig . 5 Typical radiographic room.

LABOR-DELIVERY SUITE
Locating the Delivery Suite
Since the labor-delivery unit is basically self sufficient, it may be located
adjacent to the newborn nursery and maternity unit or elsewhere
in the hospital ; wherever possible, it should be located on the same floor .
Transportation of mother and infant is reduced and maximum utilization of
staff is obtained when all three units are together . However, in large hospitals
requiring more than one maternity nursing unit, another location may be
required .

Functional Arrangement of the Delivery Suite

The delivery suite includes three areas of activity : labor, delivery, and
recovery . Proper sequential arrangement of labor, delivery, and recovery
areas within the labor-delivery unit facilitates patient care and aids the staff in
carrying out proper medical techniques and practices . (See Fig . 1 .)
Labor, delivery, and recovery rooms should be located and related for
easy movement of patients from one area to another and for good patient
observation . In large suites, locating service facilities on subsidiary corridors
may help to reduce and control traffic .
Labor room

Labor rooms should provide maximum comfort and relaxation for the
patient and should have facilities for examination, preparation, and
observation . Unless an admitting and preparation unit outside the labor-
delivery unit is available, the patient may be admitted directly to the labor
room .
Although traditional practice has permitted two or more beds in labor
rooms, single occupancy rooms are recommended . They eliminate the
necessity for a patient preparation room, separate infectious patients, provide
greater privacy, end if in accordance with hospital policy, permit the husband
to visit the patient during labor . These rooms should have :C minimum floor
area of 100 sq ft . Multiple accupancy rooms should have not less then 80 sq
ft per bad . If only one delivery room is required, one labor room should be
arranged as an emergency delivery room end should have a minimum floor
area of 180 sq ft .

Nurses' Station
The nurses' station is the administrative end control center of the labor
delivery unit . Its size, complexity, and location will be determined by the
extent of responsibilities charged to the obstetrical supervisor as well as by
the size and staffing of the suite .
If patients are admitted directly to the labor delivery unit, the nurses'
station may be responsible for admitting procedures . Inventory end
requisitioning of supplies may be handled at the nurses' station, although
central service would assume this responsibility under a complement system .
 If office records are extensive, file cabinets may be necessary. In large
units, an office for the obstetrical supervisor may be required . A bulletin board
should be provided for work schedules and hospital bulletins . A desk-height
counter for the master station of the nurses' calling system, medical records,
and a telephone may be adequate if the daily workload is small .

Supply and Equipment Storage Supplies .

The main factor in determining the space allocation for supply storage
in the labor-delivery unit is the method and frequency of issuing supplies from
central supply areas. Supplies include all items processed by the laundry and
central sterile supply and those issued from central service. Excluded are
pharmacy, anesthetic, or equipment items. All supplies should be kept in
hospital central service and issued to the labor-delivery unit only after the
required processing.
Hazards
There are two ways in which radioactive materials may be hazardous :
First, some of their radiations present an external hazard to persons in their
vicinity, as in the case of X-ray machines ; second, when used in unsealed
solution or powdered form, radioisotopes may be accidentally ingested or
inhaled as a result of spillage or inexpert handling, thus becoming an internal
hazard to personnel. Therefore, careful attention must be given to safe
techniques and facilities to eliminate unintentional and potentially harmful
radiation exposure to both personnel and patients when radioactive medicines
are handled and administered.

Admitting
On the first visit, the patient is directed to one of the admitting interview
cubicles which form an integral part of the business office .
On completion of the admitting procedure, a clerk summons a messenger
whose station, which should be large enough to store wheelchairs, is adjacent
and connected to the business office . He [she] escorts the patient directly to
the intake screening center or, if it is fully occupied, to the public waiting area .
The repeat patient who has an appointment to a specific clinic stops at
the check-in station where he [she] receives instruction . He [she] may go
directly to the clinic or wait in the public waiting space until notified by the
control officer . (The business office is responsible for checking patients in
and out and for collecting fees, if applicable .)
Specialty Clinics
Adjacent to both the Administration and the Examination and
Treatment Center are the clinics designed and equipped for special
procedures . (See Figs . 2 and 3 ; see also Fig . 11 .)
All new patients pass through the intake screening center where
medical evaluation and disposition are made regarding subsequent medical
treatment . Medical history and documentation are initiated and routine
laboratory testing performed. Therefore, provision must be made for separate
specimen collection spaces for men and women, a routine testing laboratory,
and a sub waiting area with a registered nurse in attendance. Appropriate
spaces and fixtures are provided for handicapped persons .

Reference:

time-saver-standards-building-types
https://www.britannica.com/science/hospital
https://www.who.int/health-topics/hospitals