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 | — 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 BedsKXBORX365 ALSX100XWorking Days No. of OT = No. of Operations per day Expected Output per OTOT — THE NUMBER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 (0.3 & 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 saft * Men's Change Room — 120 sqft * Ladies' Change Room — 120 saft * Patient's Preparation — 120 sqft * Gowned Waiting Area — 80 sqft PLUS Circulation AreaSERVICES FOR OT Electricity — Clean Water Supply — Clean Lighting — General Background / MGPS Operation /Special2? 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 y) in OR 20u 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 u * All air vented outAC — POSTOPERATIVE * Temp — 21-24 * RH — 30%-60% * Pressure — Positive * Air change — 2 fresh / 6 total * Air Filtration - 5 yAC — MICU/SICU * Temp — 21-24 * RH — 30%-60% * Pressure — Positive * Air change — 5 fresh / 15 total * Air Filtration - 5 ypLABOUR ROOM * Temp — 20-23 * RH — 30%-60% * Pressure — Positive * Air Changes — 3 fresh / 15 total * Air Filtration - 5 yNURSERY * Temp — 22-26 * RH — 30%-60% * Pressure — Positive * Air Changes — 3 fresh / 15 total * Air Filtration - 5 yWARDS * Temp — 21-24 * RH — 30%-60% * Pressure — Positive * Air Changes — 3 fresh / 15 total * Air Filtration - 20 p * 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 Illed 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