General Hospital Literature Review - Zemran, Abdisa, Lensa

JIMMA UNIVERSITY
JIMMA INSTITUTE OF TECHNOLOGY

LITERATURE REVIEW
DEPARTMENT OF ARCHITECTURE
AND URBAN PLANNING
NAME ID No
Zemran Girma------------------------------------------RU0182/12
Abdisa Haji-----------------------------------------------RU1677/12
Lensa Amanuel-----------------------------------------RU0339/12
Submitted To: Mr. Olifan

Ms. Betelehem
Mr. Degaga
Submission Date: - 11/06/2023
Jimma, Ethiopia
JIMMA UNIVERSITY
LITERATURE REVIEW
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ACKNOWLEDGMENTS
This review paper has explored the topic of a Literature Study on General Hospital. The findings
of the review have shown that design consideration and principles. The research has also
identified a number of implications for architectural practice, including functional layouts of
spaces and standard sizes or areas of spaces set by the Ethiopian standard Agency.
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TABLE OF CONTENTS
1. INTRODUCTION ......................................................................................................................................................... 1
2. DEFINITION OF HOSPITAL ......................................................................................................................................... 1
3. HISTORY OF HOSPITAL .............................................................................................................................................. 2
3.1. ETHIOPIAN HEALTH CENTER HISTORY ............................................................................................................ 4
4. TYPES AND CLASSIFICATIONS OF MODERN HOSPITAL ....................................................................................... 6
4.1. BASED ON OWNERSHIP OF HOSPITAL ........................................................................................................... 7
4.2. BASED ON LENGTH OF STAY ........................................................................................................................... 8
4.3. BASED ON CLINICAL SPECIALTIES .................................................................................................................. 8
4.4. ACCORDING TO THE LEVEL OF CARE ........................................................................................................ 10
5. HOSPITAL SERVICES ................................................................................................................................................ 11
6. THE MAIN DIVISIONs OF THE HOSPITALS .............................................................................................................. 12
I. Administration Division ...................................................................................................................................... 12
II. Outpatients’ Division ......................................................................................................................................... 13
III. Diagnostic Services Division ......................................................................................................................... 13
IV. Therapeutic Services Division ...................................................................................................................... 15
V. Internal Medical Treatment Division ............................................................................................................... 15
VI. Inpatient Division ............................................................................................................................................ 17
VII. General Service Division ............................................................................................................................... 18
7. DESIGN CONSIDERATIONS FOR A GENERAL HOSPITAL ................................................................................... 20
8. PHYSICAL FACILITY STANDARDS FOR GENERAL HOSPITAL .............................................................................. 23
8.1. BUILDING SPACE AND ELEMENTS ................................................................................................................ 23
8.2. BUILDING SYSTEMS.......................................................................................................................................... 26
8.3. ELECTRICAL SYSTEM ....................................................................................................................................... 28
8.4. FIRE PROTECTION SYSTEM ............................................................................................................................. 29
8.5. CALL SYSTEMS ................................................................................................................................................. 30
8.6. MEDICAL GAS SYSTEM ................................................................................................................................... 30
8.7. HEALTH FACILITY ENVIRONMENT ................................................................................................................. 31
8.8. SPECIFIC SERVICE AREAS .............................................................................................................................. 31
8.9. CARE AND TREATMENT AREAS ..................................................................................................................... 33
8.10. ANCILLARY AREAS ..................................................................................................................................... 33
Conclusion ....................................................................................................................................................................... 35
References .................................................................................................................................................................. 36
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LIST OF FIGURES
Figure 1: Ancient Greek Ruins................................................................................................................... 2
Figure 2: Lyon: Hôtel-Dieu ......................................................................................................................... 3
Figure 3: Types of Hospitals ....................................................................................................................... 6
Figure 4: National Health Service ............................................................................................................. 7
Figure 5: X-rays of patients infected with tuberculosis .......................................................................... 9
Figure 6: Leprosy treatment center at Kalaupapa ............................................................................... 9
Figure 7: Functional Relation between Admin and Other Services .................................................. 12
Figure 8: Division Functional Relations ................................................................................................... 12
Figure 9: Out Patient Division Layout ..................................................................................................... 13
Figure 10: Emergency Room Functional Layout and Relation .......................................................... 13
Figure 11: Laboratory Functional Relation and Layout....................................................................... 14
Figure 12: Radiology Division Functional Layout and Relation .......................................................... 14
Figure 13: Physical Therapy Division Layout .......................................................................................... 15
Figure 14: Operation Theatre Layout and Functional Relation ......................................................... 15
Figure 15: ICU Functional Layout and Relation .................................................................................... 16
Figure 16: CSD Functional Layout and Relation .................................................................................. 16
Figure 17: Inpatient Division Layout and Relation ............................................................................... 17
Figure 18: Nightingale ward layout example ....................................................................................... 17
Figure 19: Standard area of bed ........................................................................................................... 18
Figure 20: General Storage Layout and Relation ................................................................................ 19
Figure 21: Standard Corridor and Elevator Dimension ....................................................................... 20
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1. INTRODUCTION
General hospitals are complex and critical infrastructure that play a vital role in providing
healthcare to communities of all sizes. The design of general hospitals has a significant impact
on the quality of care provided, the efficiency of operations, and the well-being of patients, staff,
and visitors. In recent years, there has been a growing recognition of the importance of
evidence-based design (EBD) in hospital architecture. EBD is a process that uses research
evidence to inform the design of healthcare facilities in order to improve patient outcomes, staff
satisfaction, and operational efficiency.
This literature review will examine the latest research on the architectural design of general
hospitals. The review will focus on the following key areas:
 Hospital layout and zoning

 Patient room design
 Staff and visitor spaces
 Way finding and signage
 MEP Systems
The findings of this literature review will be used to develop a set of recommendations for the
design of new and renovated general hospitals. These recommendations will be based on the
best available evidence and will take into account the needs of all stakeholders, including
patients, staff, visitors, and the community.
The objective of this literature review is to identify and synthesize the latest research on the
architectural design of general hospitals. The review will focus on the key areas that have been
shown to have a significant impact on patient outcomes, staff satisfaction, and operational
efficiency.
2. DEFINITION OF HOSPITAL
According to the American Hospital Association (AHA), hospitals are licensed institutions with at
least six beds whose primary function is to provide diagnostic and therapeutic patient services
for medical conditions; they have an organized physician staff; and they provide continuous
nursing services under the supervision of registered nurses. (Centers for desease control and preventation,
2022)
The World Health Organization (WHO) considers an establishment to be a hospital if it is

permanently staffed by at least one physician, can offer inpatient accommodation, and can
provide active medical and nursing care. Hospitals may be classified by type of service,
ownership, size by number of beds, and length of stay.
(Centers for desease control and preventation, 2022)
Hospital is a healthcare facility that provides specialized medical and nursing care as well as
medical supplies to patients. The most well-known form of the hospital is the general hospital,
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which usually carries an emergency department to handle urgent health issues such as fire and
accident victims, as well as medical emergencies. (vendatu, 2023)
Hospital is an institution that is built, staffed, and equipped for the diagnosis of disease; for
the treatment, both medical and surgical, of the sick and the injured; and for their housing during
this process. The modern hospital also often serves as a center for investigation and for teaching.
(w.douglas, harold, & Pamela, 2023)
3. HISTORY OF HOSPITAL
Figure 1: Ancient Greek Ruins
As early as 4000 BCE, religions identified certain of their deities with healing. The temples of Saturn,
and later of Asclepius in Asia Minor, were recognized as healing centers. Brahmanic hospitals
were established in Sri Lanka as early as 431 BCE, and King Ashoka established a chain of
hospitals in Hindustan about 230 BCE. Around 100 BCE the Romans established hospitals
(valetudinaria) for the treatment of their sick and injured soldiers; their care was important
because it was upon the integrity of the legions that the power of ancient Rome was based.
It can be said, however, that the modern concept of a hospital dates from 331 CE when Roman
emperor Constantine I (Constantine the Great), having been converted to Christianity, abolished
all pagan hospitals and thus created the opportunity for a new start. Until that time disease had
isolated the sufferer from the community. The Christian tradition emphasized the close
relationship of the sufferer to the members of the community, upon whom rested the obligation
for care. Illness thus became a matter for the Christian church. (w.douglas, harold, & Pamela,
2023)
About 370 CE St. Basil the Great established a religious foundation in Cappadocia that included
a hospital, an isolation unit for those suffering from leprosy, and buildings to house the poor, the
elderly, and the sick. Following this example, similar hospitals were later built in the eastern part
of the Roman Empire. Another notable foundation was that of St. Benedict of Nursia at
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Montecassino, founded early in the 6th century, where the care of the sick was placed above
and before every other Christian duty. It was from this beginning that one of the first medical
schools in Europe ultimately grew at Salerno and was of high repute by the 11th century. This
example led to the establishment of similar monastic infirmaries in the western part of the empire.
Figure 2: Lyon: Hôtel-Dieu
The Hôtel-Dieu of Lyon was opened in 542 and the Hôtel-Dieu of Paris in 660. In these hospitals
more attention was given to the well-being of the patient’s soul than to curing bodily ailments.
The manner in which monks cared for their own sick became a model for the laity.
The monasteries had an infirmitorium, a place to which their sick were taken for treatment. The
monasteries had a pharmacy and frequently a garden with medicinal plants. In addition to
caring for sick monks, the monasteries opened their doors to pilgrims and to other travelers.
Religion continued to be the dominant influence in the establishment of hospitals during

the middle Ages. The growth of hospitals accelerated during the Crusades, which began at the
end of the 11th century. Pestilence and disease were more potent enemies than the Saracens in
defeating the crusaders. Military hospitals came into being along the traveled routes; the
Knights Hospitallers of the Order of St. John in 1099 established in the Holy Land a hospital that
could care for some 2,000 patients. It is said to have been especially concerned with eye disease,
and it may have been the first of the specialized hospitals. This order has survived through the
centuries as the St. John Ambulance. (w.douglas, harold, & Pamela, 2023)
Throughout the Middle Ages, but notably in the 12th century, the number of hospitals grew
rapidly in Europe. Arab hospitals such as those established at Baghdad and Damascus and in
Córdoba in Spain were notable for the fact that they admitted patients regardless of religious
belief, race, or social order. The Hospital of the Holy Ghost, founded in 1145 at Montpellier in
France, established a high reputation and later became one of the most important centers in
Europe for the training of doctors. By far the greater number of hospitals established during the
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middle Ages, however, were monastic institutions under the Benedictines, who are credited with
having founded more than 2,000. (w.douglas, harold, & Pamela, 2023)
The middle Ages also saw the beginnings of support for hospital-like institutions
by secular authorities. Toward the end of the 15th century, many cities and towns supported
some kind of institutional health care: it has been said that in England there were no fewer than
200 such establishments that met a growing social need. This gradual transfer of responsibility for
institutional health care from the church to civil authorities continued in Europe after the
dissolution of the monasteries in 1540 by Henry VIII, which put an end to hospital building in
England for some 200 years. (w.douglas, harold, & Pamela, 2023)
The loss of monastic hospitals in England caused the secular authorities to provide for the sick,
the injured, and the handicapped, thus laying the foundation for the voluntary hospital
movement. The first voluntary hospital in England was probably established in 1718
by Huguenots from France and was closely followed by the foundation of such London hospitals
as the Westminster Hospital in 1719, Guy’s Hospital in 1724, and the London Hospital in 1740.
Between 1736 and 1787, hospitals were established outside London in at least 18 cities.
The initiative spread to Scotland, where the first voluntary hospital, the Little Hospital, was opened
in Edinburgh in 1729. (w.douglas, harold, & Pamela, 2023)
The first hospital in North America (Hospital de Jesús Nazareno) was built in Mexico City in 1524
by Spanish conquistador Hernán Cortés; the structure still stands. The French established a
hospital in Canada in 1639 at Quebec City, the Hôtel-Dieu du Précieux Sang, which is still in
operation (as the Hôtel-Dieu de Québec), although not at its original location. In 1644 Jeanne
Mance, a French noblewoman, built a hospital of ax-hewn logs on the island of Montreal; this
was the beginning of the Hôtel-Dieu de St. Joseph, out of which grew the order of the Sisters of
St. Joseph, now considered to be the oldest nursing group organized in North America. The first
hospital in the territory of the present-day United States is said to have been a hospital for soldiers
on Manhattan Island, established in 1663. (w.douglas, harold, & Pamela, 2023)
The early hospitals were primarily almshouses, one of the first of which was established by English
Quaker leader and colonist William Penn in Philadelphia in 1713. The first incorporated hospital in
America was the Pennsylvania Hospital, in Philadelphia, which obtained a charter from
the crown in 1751. (w.douglas, harold, & Pamela, 2023)
3.1. ETHIOPIAN HEALTH CENTER HISTORY

Ethiopia adopted modern medicine in the 16th century, and every emperor after that embraced
medicine and health. In 1886, Western medicine was introduced by Swedish medical staff and
more Western countries were investing time and resources in countries like
Ethiopia. (columbia university irving medical center, n.d.)
Before the end of the 19th century, Ethiopia did have little knowledge of exercising the modern
type of health care practices. People were dependent on natural resources and the various
techniques that they had developed to enhance health care facilities. Traditional techniques
and herbal remedies were widely used by traditional health care system throughout the
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country. The delivery of the basics of health care services in Ethiopia was started towards the
end of the 19th century. (History of EPHI, n.d.)
“The first health unit to be established on a permanent basis was a Russian hospital. After the
battle of Adwa in 1896, Emperor Menilek II had over 3000 wounded soldiers, and he had invited
for help from the Russian Red Cross. The first medical mission, consisting of three physicians, four
nurses, and several orderlies, arrived and treated wounded soldiers in Harar area (Ministry of
Health, 1980:13).” (History of EPHI, n.d.)
Members of the Russian Red Cross Missionary, after the accomplishment of their mission, they
did not return to their country. Instead, they move to Addis Ababa to provide their health
services. (History of EPHI, n.d.)
“After the completion of the task, the medical mission arrived in Addis Ababa and established
a hospital with 50 beds near the area which is now known as “Russian street”. It is interesting to
note that the mission produced a small booklet of 22 pages in Amharic, which was to serve as
a textbook for Ethiopian staff in the Hospital. The Russian missionaries stayed in the country for
ten years, and in 1906 the Hospital was closed (Ibid).” (History of EPHI, n.d.)
Consequently, the delivery of modern health care services by the Russian medical missionaries
initiated Emperor Menilek II and led him to think about the establishment of a hospital in the
country. (History of EPHI, n.d.)
“In that year, 1906, Menilek II established the first Ethiopian Hospital on the site of the Russian
Hospital. At the beginning it had 30 beds. The Hospital has been in operation ever since then on
the same site, and even today it is called by the original name “Menilek II Hospital (Ibid).” (History
of EPHI, n.d.)
According to a 1967 article of The Milbank Memorial Fund Quarterly by E. Torrey, the first hospital
in Ethiopia was built in 1909 by the Russian Red Cross in Addis Ababa. By 1936, Ethiopia had
eleven hospitals, two leprosaria, and a serological for vaccine production. (columbia university
irving medical center, n.d.)
The Italian-Ethiopian War (1936-1941) slowed progress of their health system, overburdened their
current system, and communicable diseases spread more rapidly. After their liberation in 1941,
hospitals and clinics were gradually added and the country was able to strengthen its overall
infrastructure. (columbia university irving medical center, n.d.)
As Torrey goes on to say, in 1946, the Public Health Laboratory and Research Institute was opened
followed by a Public Health Proclamation; this proclamation created a legal foundation for
health programs. Shortly after, in 1948, the Ministry of Public Health was created. Public Health
administration was transferred from the Ministry of the Interior to the newly created Ministry of
Public Health. (columbia university irving medical center, n.d.)
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In 1954 the Gondar Public Health College and Training Center was opened with help from WHO,
UNICEF and USAID. This improved health greatly by training health officers, community nurses,
and sanitarians to staff the health centers. The first Faculty of Medicine was opened at the
University of Addis Ababa in 1965.7 (columbia university irving medical center, n.d.)
Ethiopia has made various attempts to achieve universal primary health care, starting with the
Alma-Ata Declaration of Primary Health Care in 1978. This act intended to provide health for all
by the year 2000 and had support from the Ethiopian Government. The act failed due to lack of
clear policies and strategies at the national level, lack of clear instructions at the central level
and inadequate dissemination of information on the policies. (columbia university irving medical
center, n.d.)
Progress in health care in Ethiopia also suffered during the Derg Era (1974-1991) where many of
the country’s doctors either emigrated or never returned from their training abroad. Although
the socialist regime fell in 1991, many of the negative effects have not been reversed. (columbia
university irving medical center, n.d.)
Another plan to achieve universal access to primary health care was implemented into the
Health Sector Development Program III in 2005 to address shortcoming coverage within the
health system through overall expansion and strengthening of primary health services. (columbia
university irving medical center, n.d.)
4. TYPES AND CLASSIFICATIONS OF MODERN HOSPITAL

A modern hospital is a facility that specializes in the diagnosis and treatment of illness and injury.
Hospitals provide a wide range of medical services, including emergency care, surgery, and
childbirth. They also offer a variety of other services, such as outpatient care, diagnostic tests,
and rehabilitation. (sri chitanya educational institute, n.d.)
To better serve the wide-ranging needs of the community, the modern hospital has often
developed outpatient facilities, as well as emergency, psychiatric, and rehabilitation services. In
addition, “bed less hospitals” provide strictly ambulatory (outpatient) care and day surgery.
Patients arrive at the facility for short appointments. They may also stay for treatment in surgical
or medical units for part of a day or for a full day, after which they are discharged for follow-up
by a primary care health provider. (w.douglas, harold, & Pamela, 2023)
Figure 3: Types of Hospitals
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Hospital
Owner Length of stay Specialty Function System
4.1. BASED ON OWNERSHIP OF HOSPITAL

The issues of hospital ownership and control underwent significant analysis and change in the
late 20th and early 21st centuries. Such transformation was prevalent in developed countries,
particularly those in which fiscal sustainability was problematic. (w.douglas, harold, & Pamela, 2023)
Figure 4: National Health Service
I. PUBLIC HOSPITAL OR GOVERNMENTAL HOSPITAL

These hospital are run by the central or state government municipal bodies/corporations to
provide wide-range of various types of health care free of charge. (Brainkart.com, n.d.)
II. CHARITABLE HOSPITALS

These hospital are established under societies Registration Act run for service motive. These are
generally funded by donations, grants & aids from charitable organizations. (Brainkart.com, n.d.)
III. CORPORATE HOSPITALS

These hospitals are established by registered companies formed under companies Act.
(Brainkart.com, n.d.)
IV. PRIVATE HOSPITALS

These hospitals are generally owned by an individual or a group of individuals, which are
generally self – funded. (Brainkart.com, n.d.)
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4.2. BASED ON LENGTH OF STAY

I. Long – term hospital:
These are hospitals where over 90% of all patients admitted to stay for more than 30 days.
II. Short term hospitals:

These are hospitals where over 90% of all patients admitted to stay for less than 30 days.
III. Day care hospitals:

These hospitals offer care only during daytime. Patients are admitted on the same day,
procedure is performed, and then discharged on the same day. For example, eye care
hospitals (Brainkart.com, n.d.)
4.3. BASED ON CLINICAL SPECIALTIES

I. THE GENERAL HOSPITAL
These hospitals are run to provide care for patients with various disease condition for both sexes
to all ages. (Brainkart.com, n.d.)
General hospitals may be academic health facilities or community-based entities. They are
general in the sense that they admit all types of medical and surgical cases, and they
concentrate on patients with acute illnesses needing relatively short-term care. (w.douglas,
harold, & Pamela, 2023)
II. SPECIALIZED HOSPITALS

These hospitals limit their service to a particular condition, cardiology, neurology, nephrology etc.
Those providing diagnostic and treatment services for patients who have specified medical
conditions, both surgical and nonsurgical. (Centers for desease control and preventation, 2022)
Hospitals that specialize in one type of illness or one type of patient can generally be found in
the developed world. In large university centers where postgraduate teaching is carried out on
a large scale, such specialized health services often are a department of the general hospital or
a satellite operation of the hospital. Changing conditions or modes of treatment have lessened
the need or reduced the number of some types of specialized institutions; this may be seen in
the cases of tuberculosis, leprosy, and mental hospitals. On the other hand, specialized surgical
centers and cancer centers have increased in number. (w.douglas, harold, & Pamela, 2023)
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1) Tuberculosis and Leprosy Hospitals
Figure 5: X-rays of patients infected with tuberculosis
Between 1880 and 1940, tuberculosis hospitals provided rest, relaxation, special diets, and fresh
air, and even if the tuberculosis was in an early stage, a stay of more than two years was thought
necessary to effect a healing of the disease; a permanent cure was not considered
entirely feasible. Today the use of antibiotics, along with advances in chest surgery and routine
X-ray programs, has meant that the treatment of tuberculosis need not be carried out in a
specialized facility. (w.douglas, harold, & Pamela, 2023)
Figure 6: Leprosy treatment center at Kalaupapa
Leprosy has been known for centuries to be contagious. Lazar houses (hospitals for individuals
with infectious disease) were established throughout Europe in the Middle Ages to isolate those
with leprosy, at that time a common disease, from the community. In the 14th century there may
have been some 7,000 leper houses in France alone, and some of the earliest hospitals in England
were established for lepers. (w.douglas, harold, & Pamela, 2023)
Thanks to an intense campaign for leprosy elimination begun in the early 1990s, leprosy is now
relatively rare. The purpose of the modern leprosarium is not so much isolation as it is treatment.
The chronic form of the disease is treated by surgical correction of deformities, occupational
therapy, rehabilitation, and sheltered living in associated villages. Acute leprosy is treated in
general hospitals, clinics, and dispensaries. (w.douglas, harold, & Pamela, 2023)
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2) Mental health facilities
Psychiatric patients traditionally have been cared for in long-stay mental health facilities, formerly
called asylums or mental hospitals. Today the majority of large general hospitals have a
psychiatric unit, and many individuals are able to maintain lives as regular members of
the community. There are still facilities that specialize in the treatment of mental illness.
The hospital stay of many persons with chronic mental illness has been shortened by modern
medication and better understanding on the part of the public. Patients are encouraged to
participate in facility-based activities and programs. They may be encouraged to return to the
community, beginning with trial visits at home, or they may be placed in assisted-living or group
homes. Every effort is now made, through the use of appropriate medication and support
services, to have the patient integrated into the community. Even those individuals who require
custodial care are no longer isolated from contact with their relatives, friends, and the
community at large.
In addition, the strong correlation between mental illness and addiction has been noted and has
given rise to numerous programs incorporating the simultaneous treatment of both conditions.
Such programs are prevalent in developed countries in particular. In some cases special hospitals
addressing both mental illness and addiction have been established for instance, the Centre for
Addiction and Mental Health in Toronto.
3) Long-term-care facilities
Historically, long-term-care facilities were homes for the elderly, the infirm, and those with chronic
irreversible and disabling disorders, especially if the patients were indigent. Medical
and nursing care was minimal. Today, however, long-term-care facilities have a more active role
in health care. Some facilities are transitional from an acute hospital setting to the community.
Others have residents who have a need for professional health care but do not need the
intensive care found in an acute-care facility. As a result, long-term-care facilities often are
staffed with health professionals and are equipped to care for patients with extensive needs for
daily living or to help patients prepare to live at home or with a member of the family. Long-term-
care facilities represent a significant extension of the hospital health care system, helping to
conserve expensive facilities for the acutely ill and improving the prospects of the chronically
disabled.
4.4. ACCORDING TO THE LEVEL OF CARE

- Primary level hospital: few specialties mainly internal medicine, obstetrics and gynecology,
pediatrics, and general surgery, or just general practice; limited laboratory services
available for general but not specialized pathological analysis.
- Secondary hospitals: District Hospital and some of Specific Hospitals.
- Tertiary hospitals: Central High Specialized Hospital, Educational Hospital and some of
Specific Hospitals
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5. HOSPITAL SERVICES
Hospital Services refers to the clinical services provided by the Hospital, as well as the operational
activities that support those clinical services, which are funded in whole or in part by the LHIN,
and includes the type, volume, frequency, and availability of Hospital Services; HSAA Indicator
Technical Specifications refers to the document titled "HSAA Indicator Technical Specifications,"
as amended or replaced from time to time. (vendatu, n.d.)
Hospital services are the foundation of a hospital's services. They are frequently influenced by the
demands or wishes of the hospital's key users, with the goal of making the hospital a one-stop or
core institution of the local community or medical network. Hospitals are facilities with basic
services and personnel—usually medicine and surgical departments—that provide clinical and
other services for specific diseases and ailments, as well as emergency care. Hospital services
include everything from basic health care to training and research for major medical school
centers, as well as services created by a network of industry-owned institutions such as health
maintenance organizations.
Below mentioned are some of the hospital services:-

 Emergency room services
 Short-term hospitalization
 X-ray/radiology services
 General and specialty surgical services
 Blood services
 Laboratory services
Health maintenance organization hospitals supplement the basic list with a variety of specialized
and auxiliary services, such as:
 Pediatric specialty care
 Prescription services
 Good access to surgical specialists
 Rehabilitation services and physical therapy
 Home nursing services
 Mental health care
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 Nutritional counseling
 Genetic testing and counseling
 Family support services
 Financial services
 Case management or social work services
6. THE MAIN DIVISIONs OF THE HOSPITALS

I. Administration Division
It consists the following spaces and functional rooms: -
 Reception hall.
 Waiting area.
 Registration.
 Treasury and Accounts.
 Staff offices.
 General Manager Office.
 Staff lounge.
 Nursing head office.
 WCs
Location:
Figure 7: Functional Relation between Admin and
 Very close to main entrance of the hospital. Other Services
 Entrance area, registration, accounts should

face the entrance, while the manager office should be back for privacy. (PhD. Eng.
Arch. Mazen)
Figure 8: Division Functional Relations
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II. Outpatients’ Division

1. EXTERNAL OUTPATIENT CLINICS: Parts and
components of the division:
 Emergency Room
 Consultation room.
 Examination room.
 Treatment room.
 Waiting area.
 Staff room.
 WCs
Location:
 Very close to the main

entrance of the hospital.
 Close to the diagnostic
services (labs and x-ray). Figure 9: Out Patient Division Layout
 Close the pharmacy.
2. EMERGENCY: Parts and components of the division:
 Entrance + waiting area.

 Registration.
 Staff room.
 Mini-surgery.
 Test room.
 Medical utilities.
 Mini sterilization room
Location: Figure 10: Emergency Room Functional Layout and

Relation
 Very close to the exit door

of the emergency.
 Very close to the radiology.
 Close to the pharmacy, laboratories, and central sterilization.
 Direct access to the stairs and elevators.
III. Diagnostic Services Division

It includes;
1. LABORATORIES: Parts and components of the division:

 Work area.
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 Waiting area.
 Sample room.
 Cleaning room.
 Staff offices.
The most important labs in the hospital are:
 Chemical lab.
 Bacteriology lab.
 Histology lab.
 Pathology lab.
 Serology lab.
 Hematology lab.
 Microbiology lab Figure 11: Laboratory Functional Relation and Layout
Location:
 Very close to the emergency department and external clinics.

 Easily accessible from internal division.
 Easily accessible from maternity and surgery departments.
 Accessibility from central storages.
2. RADIOLOGY DIVISION: Parts and components of the division:
 X-ray rooms.
 Control room.
 Waiting area.
 Staff office.
 Utility room.
 Dark room.
 Film view.
 Store
Location: Figure 12: Radiology Division Functional Layout and Relation
 Very close to the emergency department and external clinics.

 Easily accessible from internal division.
 Ground floor is preferred.
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IV. Therapeutic Services Division

It includes;
1. PHYSICAL THERAPY DIVISION: Parts and

 Waiting area.
 Office.
 Hydrotherapy.
 Exercise room.
 WCs
Location:
 Close to the main entrance of

Figure 13: Physical Therapy Division Layout
the hospital.
 Easy accessible from external clinics.
 Easy accessible from internal division.
 Must be in the ground floor.
2. RADIOLOGY (THERAPEUTIC)
V. Internal Medical Treatment Division

It includes;
1. OPERATION THEATRE: Parts and components of the division:
 Entrance.
 Storage.
 Preparation room.
 Access area.
 Staff clothes room + WCs.
 Operation theatre.
 Cleanup room.
 Sub sterilizing room.
 Supervision room.
 Staff lockers Figure 14: Operation Theatre Layout and Functional Relation
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Location
 Very close to the intensive care division and should be touchable both of
them.
 Very close to the central sterilization division of the hospital.
 Close to the inpatient wards.
 Can be easily accessible from the emergency division.
2. INTENSIVE CARE UNIT: Parts and

 I.C.U space.
Location:
 Very close to the recovery room in

the operation theatre.
 Can be easily accessible from the Figure 15: ICU Functional Layout and Relation
emergency division by elevator.
3. CENTRAL STERILIZATION DIVISION: Parts and components of the division:
 Work space.
 Receiving area.
 Washing area.
 Supplies storage
Location:
 Very close to the operation theatre

Figure 16: CSD Functional Layout and Relation
and maternity division.
 Can be easily accessible from the
emergency division, laundry and central storages.
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VI. Inpatient Division

It includes the following parts and components:
 Inpatient wards. 11.5m2/bed – 8m2/bed.

 WCs.
 Nursing station. Not less than 12m2 for 30
patients.
 Treatment rooms. 10-15m2 for 60 patients.
 Day rooms. 0.7m2/bed and not less than
15m2 Figure 17: Inpatient Division Layout and Relation
 Nurses’ lounge. Not less than 12m2

 Storage. 8-12m2
 Kitchen. 12m2
 Doctor room. 15m2
 The most suitable beds in the hospital is 20-40 patient / unit.

 A Nightingale ward is a type of hospital ward, which contains one large room without
subdivisions for patient occupancy.
 Nightingale wards contain about 24 to 34 beds usually arranged along the sides of the
ward.
Figure 18: Nightingale ward layout example
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Figure 19: Standard area of bed
VII. General Service Division

It includes;
1. DIETARY DIVISION: Spaces of the division:
 Storage room.
 Kitchen.
 Preparing and supply area.
 Cleaning.
Location:
 In the ground floor.

 Direct opening to the service entrance.
2. HOUSEKEEPING DIVISION: Spaces of the division:
 Office.
 Dirty linen.
 Clean linen.
 Storage.
 Laundry.
 Mechanical room.
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Location:

 Close to central storages.
3. GENERAL STORAGES: Spaces of the division:
 Medicine storage.
 Furniture storage.
 Food storage.
 Utilities storage.
 Achieve.
 General storages. Figure 20: General Storage Layout and Relation
Location:

 Close to housekeeping and dietary division.
 Direct access to the service entrance.
4. Mortuary division:
Location:
 In the ground floor or basement floor.

 Exit from emergency entrance or service entrance.
5. Maintenance workshops:
Location:
 In the ground floor or basement floor.

 Direct relation with service entrance.
6. Entrances and circulation
Entrances:
 Patient visitor’s entrance.

 External clinics entrance.
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 Emergency entrance.
 Service entrance.
 Mortuary entrance.
Figure 21: Standard Corridor and Elevator Dimension
7. DESIGN CONSIDERATIONS FOR A GENERAL HOSPITAL

A hospital and other health facilities shall be planned and designed to observe appropriate
architectural practices, to meet prescribed functional programs, and to conform to applicable
codes as part of normal professional practice. (Agency)
Essential points which should be kept in mind while planning for general hospitals are:
1. ENVIRONMENT: A hospital and other health facilities shall be so located that it is readily
accessible to the community and reasonably free from undue noise, smoke, dust, foul
odor, flood, and shall not be located adjacent to railroads, freight yards, children's
playgrounds, airports, industrial plants, disposal plants. (Agency)
2. OCCUPANCY: A building designed for other purpose shall not be converted into a
hospital. The location of a hospital shall comply with all local zoning ordinances. (Agency)
3. SAFETY: A hospital and other health facilities shall provide and maintain a safe
environment for patients, personnel and public. The building shall be of such construction
so that no hazards to the life and safety of patients, personnel and public exist. It shall be
capable of withstanding weight and elements to which they may be subjected. (Agency)
 Exits shall be restricted to the following types: door leading directly outside the
building, interior stair, ramp, and exterior stair.
 A minimum of two (2) exits, remote from each other, shall be provided for each
floor of the building.
 Exits shall terminate directly at an open space to the outside of the building.
4. SECURITY: A hospital and other health facilities shall ensure the security of person and
property within the facility. (Agency)
5. PATIENT MOVEMENT: Spaces shall be wide enough for free movement of patients, whether
they are on beds, stretchers, or wheelchairs. Circulation routes for transferring patients
from one area to another shall be available and free at all times. (Agency)
 Corridors for access by patient and equipment shall have a minimum width of
2.44 meters.
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 Corridors in areas not commonly used for bed, stretcher and equipment
transport may be reduced in width to 1.83 meters.
 A ramp or elevator shall be provided for ancillary, clinical and nursing areas
located on the upper floor.
 A ramp shall be provided as access to the entrance of the hospital not on the
same level of the site.
6. LIGHTING: All areas in a hospital and other health facilities shall be provided with sufficient
illumination to promote comfort, healing and recovery of patients and to enable
personnel in the performance of work. (Agency)
7. VENTILATION: Adequate ventilation shall be provided to ensure comfort of patients,
personnel and public. (Agency)
8. AUDITORY AND VISUAL PRIVACY: A hospital and other health facilities shall observe
acceptable sound level and adequate visual seclusion to achieve the acoustical and
privacy requirements in designated areas allowing the unhampered conduct of activities.
9. WATER SUPPLY: A hospital and other health facilities shall use an approved public water
supply system whenever available. The water supply shall be potable, safe for drinking
and adequate, and shall be brought into the building free of cross connections. (Agency)
10. WASTE DISPOSAL: Liquid waste shall be discharged into an approved public sewerage
system whenever available, and solid waste shall be collected, treated and disposed of
in accordance with applicable codes, laws or ordinances. (Agency)
11. SANITATION: Utilities for the maintenance of sanitary system, including approved water
supply and sewerage system, shall be provided through the buildings and premises to
ensure a clean and healthy environment. (Agency)
12. HOUSEKEEPING: A hospital and other health facilities shall provide and maintain a healthy
and aesthetic environment for patients, personnel and public. (Agency)
13. MAINTENANCE: There shall be an effective building maintenance program in place. The
buildings and equipment shall be kept in a state of good repair. Proper maintenance shall
be provided to prevent untimely breakdown of buildings and equipment. (Agency)
14. MATERIAL SPECIFICATION: Floors, walls and ceilings shall be of sturdy materials that shall
allow durability, ease of cleaning and fire resistance. (Agency)
15. SEGREGATION: Wards shall observe segregation of sexes. Separate toilet shall be
maintained for patients and personnel, male and female, with a ratio of one (1) toilet for
every eight (8) patients or personnel. (Agency)
16. FIRE PROTECTION: There shall be measures for detecting fire such as fire alarms in walls,
peepholes in doors or smoke detectors in ceilings. There shall be devices for quenching
fire such as fire extinguishers or fire hoses that are easily visible and accessible in strategic
areas. (Agency)
17. SIGNAGE: There shall be an effective graphic system composed of a number of individual
visual aids and devices arranged to provide information, orientation, direction,
identification, prohibition, warning and official notice considered essential to the optimum
operation of a hospital and other health facilities. (Agency)
18. PARKING: A hospital and other health facilities shall provide a minimum of one (1) parking
space for every twenty-five (25) beds. (Agency)
19. ZONING: The different areas of a hospital shall be grouped according to zones as follows:
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 Outer Zone – areas that are immediately accessible to the public: emergency
service, outpatient service, and administrative service. They shall be located near
the entrance of the hospital.
 Second Zone – areas that receive workload from the outer zone: laboratory,
pharmacy, and radiology. They shall be located near the outer zone.
 Inner Zone – areas that provide nursing care and management of patients: nursing
service. They shall be located in private areas but accessible to guests.
 Deep Zone – areas that require asepsis to perform the prescribed services: surgical
service, delivery service, nursery, and intensive care. They shall be segregated from
the public areas but accessible to the outer, second and inner zones.
 Service Zone – areas that provide support to hospital activities: dietary service,
housekeeping service, maintenance and motor pool service, and mortuary. They
shall be located in areas away from normal traffic. (Agency)
20. Function: The different areas of a hospital shall be functionally related with each other.
 The emergency service shall be located in the ground floor to ensure immediate
access. A separate entrance to the emergency room shall be provided.
 The administrative service, particularly admitting office and business office, shall
be located near the main entrance of the hospital. Offices for hospital
management can be located in private areas.
 The surgical service shall be located and arranged to prevent non-related
traffic. The operating room shall be as remote as practicable from the entrance
to provide asepsis. The dressing room shall be located to avoid exposure to dirty
areas after changing to surgical garments. The nurse station shall be located to
permit visual observation of patient movement.
 The delivery service shall be located and arranged to prevent non-related
traffic. The delivery room shall be as remote as practicable from the entrance
to provide asepsis. The dressing room shall be located to avoid exposure to dirty
areas after changing to surgical garments. The nurse station shall be located to
permit visual observation of patient movement. The nursery shall be separate
but immediately accessible from the delivery room.
 The nursing service shall be segregated from public areas. The nurse station shall
be located to permit visual observation of patients. Nurse stations shall be
provided in all inpatient units of the hospital with a ratio of at least one (1) nurse
station for every thirty-five (35) beds. Rooms and wards shall be of sufficient size
to allow for work flow and patient movement. Toilets shall be immediately
accessible from rooms and wards. (Agency)
 The dietary service shall be away from morgue with at least 25-meter distance.
21. SPACE: Adequate area shall be provided for the people, activity, furniture, equipment
and utility. (Agency)
All these consideration should be part of the drawing board when hospital planning is initiated.
(Choudhary)
In addition to the above factors, there are a number of other design considerations for general
hospitals, such as:
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 Building orientation and site planning: The hospital should be oriented to maximize
natural light and ventilation. The hospital should also be located on a site that is
large enough to accommodate future expansion.
 Mechanical, electrical, and plumbing systems: The hospital should have reliable
and efficient mechanical, electrical, and plumbing systems. These systems should
be designed to meet the needs of the hospital's various departments and to
support the hospital's infection control procedures.
 Security and safety: The hospital should have a comprehensive security and safety
plan in place. This plan should include measures to protect patients, staff, and
visitors from crime and violence. The hospital should also have a disaster plan in
place to ensure the safety of patients and staff in the event of a natural disaster or
other emergency.
By carefully considering all of these factors, architects can design general hospitals that are safe,
efficient, and patient-centered. (Bard, n.d.)
8. PHYSICAL FACILITY STANDARDS FOR GENERAL

HOSPITAL
Every general hospital subject to these Minimum Standards shall be housed in a safe building
which contains all the facilities required to render the services contemplated in the application
for license. The term "safe" used in this Section shall be interpreted in the light of compliance with
the requirements of the latest country building codes presently in effect. (Agency)
8.1. BUILDING SPACE AND ELEMENTS

1) All horizontal and vertical circulation areas that include stairs, doors, windows, corridors,
exits and entrances of the hospital shall be kept clear and free of obstructions and shall
not be used for other functional purposes that include storages.
2) Rooms: All room size and space allocation shall consider room loadings based on the
current staff, clients involved, usable medical equipment, furniture and applicable
functions.
3) The hospital circulation (main and sub corridors): shall be wide enough to allow passage
for its function.
4) Patient serving corridors: should not be less than 240cm wide, and proportionally the
openings to the corridor needs to be designed to allow easy movement of coaches and
be equipped as needed by the patient with safety and all assistive devices (it includes:
door stopper, protecting girders, alarms, self-opening electronic devices, etc.).
5) Doors: all Doors shall be able to easily open and close, doors swing into corridors shall be
avoided.
6) Patient Rooms: Each patient room shall meet the following requirements:
I. All patient functioning rooms, toilet, and bathing room doors shall provide
privacy yet not create seclusion or prohibit staff access for routine or
emergency care.
II. Area: Shall contain 9.20m2 (100ft2) of floor area for a single bedroom and
7.50m2 (80ft2) per bed in multi-bedrooms.
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III. Ceiling Height: Ceiling height needs to be determined based on the functional
requirements considering air space, technical requirements, room size
proportions, number of occupants and other parameters. The height of the
ceiling of the rooms shall not less than 240cm high for support services, 220cm
for technical corridors (Operation Theater 320 cm, X-ray 320 cm, room requiring
interstitial floor needs to be more than 580cm) and 280cm for other clinical
rooms.
IV. Windows: All rooms housing patients shall have access to natural light and
ventilation, or prove the availability of artificial ventilation and light at all times.
Rooms shall have window area proportional to that of floor areas which is equal
to 1/8th of the floor area. The sill shall not be higher than 36 inches above the
floor and shall be above grade. For toilets and washing rooms, over desk
laboratory tables, laundry and kitchen utensils, the height can be modified
accordingly) Windows shall not have any obstruction to vision (wall, cooling
tower, etc.) within 50 feet as measured perpendicular to the plane of the
window.
V. Storage: Each patient shall be provided with a hanging storage space of not
less than 40.cm x 60.cm x 130cm (16" x 24" x 52") for his personal belongings.
VI. Furnishings: A hospital shall provide comfortable patient trigonometric designs,
applicable functions, and technical requirements. They have to be hygienic
(washable, dust and bacteria protective and resistant for cleansing reagents)
durable that can control vandalism and avoid accidents.
VII. Curtains: rooms shall be equipped with curtains or blinds at windows. All
curtains shall have a flame spread of 25 or less or as per the national fire
protection code. And all as per the national infection prevention guidelines
requirements.
VIII. Cubicle curtains or equivalent built-in devices for privacy in all multi-bed rooms
shall be provided. They shall have a flame spread of 25 or less or as per the
national fire protection code.
IX. Finishing
 Walls, floors and ceilings of procedure rooms, isolation rooms, sterile
processing rooms, work room, laundry and food-preparation areas shall
be suitable for easily washing. All floors of the hospital clinical service
areas shall be washable, smooth, non- adsorptive, surfaces which are not
physically affected by routine housekeeping cleaning solutions and
methods. Acoustic lay-in ceilings, if used, shall be non-perforated.
 Public spaces such as reception areas, waiting areas, cafeterias, areas
requiring silence and sub specialty areas like psychiatry shall be designed
with acoustic control and the lamination/lay shall be non-perforated.
 Scrub-able room finishes provided in operating rooms and isolation rooms
shall have smooth, non-adsorptive, non-perforated surfaces that are not
physically affected by harsh germicidal cleaning solutions and methods.
 All walls and ceiling finishing materials used shall have a 1-hour fire rating
(One hour rated products offer more than "one hour's" worth of fire
protection).
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X. Sanitary Finishing
 A lavatory equipped with wrist action handles, shall be located in the
room or in a private toilet room.
 For hospitals with multiple bed wards without private toilet room shall
provide bedpan washer.
 All sanitary room facilities floors, walls and ceilings shall be completed with
washable finishing materials
 Floors and walls penetrated by pipes, ducts and conduits shall be tightly
sealed to minimize entry of rodents and insects
XI. Electrical Finishing
 Patient bed light shall be controlled by the patients. Room light
luminescence shall be bright enough for staff activities but needs to be
controlled not to disturb the patients.
 All electrical fixtures inlets, outlets shall fulfill Ethiopia Electrical Safety
requirements and if applicable fitted with guards
 For psychiatry service area light fixtures, sprinkler heads and other
apparatus shall be of a temper resistant type.
7) Outdoor Areas: the hospital outdoor area shall be equipped and situated to allow for the
safety and abilities of patients, care givers, staff and visitors.
 The landscape shall be designed with patient room visual acquit or access
 Walkways, connection roads and elevation differences shall be designed to
allow movements of coaches/stretchers and persons with disabilities.
 The outdoor traffic arrangement shall not cross each other to avoid accidents.
8) Windows: In all rooms, windows shall comply with lux requirements of room space without
compromising room temperature and ventilation.
 Windows shall be a minimum of 50 cm wide x 100cm high. However, in case of
hot climate areas, this may not be applicable
 No window shall swing inside the room except those which require security and
safety measures such as grid for theft and insect mesh for malaria porn areas.
 Windows that frequently left open for cross ventilation purpose (like TB clinic
room windows) shall be equipped with insect screen. At least a top portion of a
window shall be left open fitted with insect mesh for uninterrupted circulation of
air.
 Safety glass, tempered glass or plastic glass materials shall be used for pediatrics
and psychiatric service units to avoid possible injuries.
9) Vertical Circulation: All functioning hospital rooms shall be accessible horizontally.
a. Stairs: All stairways and ramps shall have handrails and their minimum width
shall be 120cm.
 All stairways shall have a 2-hour fire enclosure with a (1.5 hour) label
door at all landings or as per the national fire protection code.
 All stairways shall be fitted with non-slippery finishing materials
 All stair threads, riser and flight shall comply with patient type as per
the Ethiopia Building proclamation
b. Elevators: at least one hospital type elevator shall be installed where 1-100
patient beds are located in the upper floors. In case of more than 100 beds,
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the number of elevators shall be determined from a study plan and expected
vertical transportation requirements. Minimum cab dimensions required for
elevators transporting patients is 195cm x 130cm inside clear measurements
and minimum width for hatchway and cab doors shall be 100cm.
c. Ramp: Ramps shall be designed with a slope of 6 to 9 percent, minimum width
of 120 cm and the landing floor of 240cm wide on both sides.
d. Shoots: Hospital buildings having services in the upper floor shall have shoots
facility. Shoots shall be free of possible accidents and the inlets and outlets
shall be confined in a lockable room.
10) Fire Safety Considerations:
a) One-Story Building: Wall, ceiling and roof construction shall be of 1-hour fire
resistive construction as defined by National Fire Protection "Life Safety Code
or laws. Floor systems shall be of non-combustible construction.
b) Multi-Story Buildings: Must be of two-hour fire resistive construction as defined
in National Fire Protection "Life Safety Code or laws.
c) Travel Distances and alternative vertical circulation: Hospital facilities travel
distance from service giving room to the stairs should be as specified in the
National Fire Protection "Life Safety Code or laws. Alternative fire escape stair
should be provided otherwise.
11) Parking areas:
a) The hospital shall have separate parking spaces for hospital ambulance.
b) Parking space shall have a clear mark for Staff, Patients and Visitors with
separate 10% of it for person with disability parking all as per Ethiopia Building
Proclamation and building code.
c) General services of the hospital that require loading unloading docks, heavier
truck movement and temporary truck parking place shall be available.
d) The parking space shall not cross pedestrian walkways, if it is mandatory to cross
proper precaution measures such as Zebra Road, Speed Breaker, guiding notice
and traffic stopping culverts or signals should be provided. (Agency)
8.2. BUILDING SYSTEMS

Hospitals shall have building systems that are designed, installed and operated in such a manner
as to provide for the safety, comfort and well-being of the patient.
1) Water supply and plumbing:

A. Continuously circulated as per the type of fixture used, filtered and treated water
systems shall be provided as required for the care and treatment in the hospital.
B. All hospitals subject to be connected to an approved municipal water system
whose purity has been certified by the concerned body. The water supplies must
be sampled, tested, and its purity certified at least twice annually and
immediately following any repair or modification to the underground lines, the
elevated tank, or to the well or pump.
C. All hospitals subject to be connected to its own separate water supply system
shall qualify and certified by the concerned body regularly. In house quality
control shall be established, the water supplies must be sampled, tested, and its
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purity certified at least twice semi-annually and immediately following any repair
or modification to the underground lines, the elevated tank, or to the well or
pump.
D. The hospital shall have and maintain an accessible, adequate both as to volume
and pressure, safe and potable supply of water. Where an authorized public
water supply of satisfactory quantity, quality, and pressure is available, the
hospital shall be connected to it and its supply used exclusively. Deficiencies in
either safety and adequacy in volume or pressure must be remedied by the
provision of auxiliary pumps, pressure tanks or elevated tanks as may be required.
E. The collection, treatment, storage, and distribution potable water system of a
hospital shall be constructed, maintained, and operated in accordance with all
provisions of the Safe Drinking Water of the country.
F. Supply piping within the building shall be in accordance with plumbing
standards. Special care must be taken to avoid use of any device or installation
which might cause contamination of the supply through cross connections or
the water distribution system shall be protected with anti-siphon devices, and air-
gaps to prevent potable water system and equipment contamination.
G. A treated backup water supply shall be readily available in the hospital like a
reservoir or dedicated well. In case, if for any reason the main water supply is
inaccessible. A contingency plan should be envisage in severe cases where
supply disconnected and backup finished.
H. The hospital shall have an approved method of supplying hot water for all
hospital consumption. Water to lavatories and scrub sinks must be 37.8 - 540C.
Water to mechanical dishwashers must be delivered at 82 0C for rinsing.
2) Sewerage and Waste Processing Systems
A. The hospital shall maintain a sanitary and functioning sewage system in
accordance with the national healthcare waste management guidelines and
Ethiopian building code.
B. In addition, the hospital shall fulfill the following requirements;
I. The hospital shall dispose all sanitary wastes produced in the hospital
through connection to a suitable municipal sewerage system or through
a private sewerage system if applicable. Where there is no municipal or
private sewerage system the hospital shall provide a designed and well-
marked septic tank, or other similar facility according to the local
environment and protected method that require the approval of the
appropriate organ.
II. The hospital sewage system shall be segregated from hazardous hospital
waste before it enters the municipal or private sewage system.
III. The hospital shall provide areas to collect, contain, process, and dispose
of medical and general waste produced within the hospital in such a
manner as to prevent the attraction of rodents, flies and other insects and
vermin, and to minimize the transmission of infectious diseases in
accordance with waste management standards of this health facility.
IV. The hospital shall have all the required waste management facilities
(Such proper segregation and disposal system by the nature of waste,
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over 600 degree Celsius combustor incinerator or sterilizer steam grinder,

etc.) as recommended by the national healthcare waste management
guidelines.
3) Heating and Cooling, Ventilating and Air-Conditioning Systems:
I. The hospital shall provide a heating and air conditioning system for the comfort
of the patient and capable of maintaining the temperature in patient care and
treatment areas.
II. In the hospital, the system shall be capable of producing a temperature of at
least seventy five degrees Fahrenheit (75°F) during heating conditions and a
temperature that does not exceed eighty-five degrees Fahrenheit (85°F) during
cooling conditions.
III. The hospital to have a central air distribution and return systems which have the
following percent dust spot rated filters:
 General areas: thirty (30) +%; and
 Care, treatment, and treatment processing areas: ninety (90) +%.
IV. Surgical areas shall have heating and cooling systems that are capable of
producing a room temperatures at a range between sixty-eight Fahrenheit (68°F)
and seventy-three degrees Fahrenheit (73°F) and humidity at a range between
thirty (30%) and sixty percent (60%) relative humidity.
V. Airflow shall move from clean to soiled locations. Air movement shall be designed
to reduce the potential of contamination of clean areas.
VI. Floors in operating rooms, procedure rooms and other locations subject to wet
cleaning methods or body fluids shall not have openings to the heating and
cooling system.
VII. All hospitals shall provide adequate ventilation and/or clean air to prevent the
concentrations of contaminants which impair health or cause discomfort to
patients and employees.
VIII. Hospitals shall provide a mechanical exhaust ventilation system for windowless
toilets, baths, laundry rooms, housekeeping rooms, kitchens and similar rooms at
ten air changes per hour.
IX. Hospitals shall provide mechanical ventilation system(s) capable of providing air
changes per hour.
X. Hospitals shall provide an emergency backup ventilation system for all patient
rooms without operable windows.
8.3. ELECTRICAL SYSTEM

1) The hospital shall have an electrical system that has sufficient capacity to maintain the
care and treatment services and other services that are provided and that properly
grounds care and treatment areas.
2) All facilities shall provide the minimum average illumination levels as follows or as per the
Ethiopian Electrical Design Code:
I. General purpose areas: five (5) foot candles;
II. General corridors: ten (10) foot candles;
III. Personal care and dining areas: twenty (20) foot candles;
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IV. Reading and activity areas: thirty (30) foot candles;

V. Food preparation areas: forty (40) foot candles;
VI. Hazardous work surfaces: fifty (50) foot candles;
VII. Care and treatment locations: seventy (70) foot candles;
VIII. Examination task lighting: one hundred (100) foot candles;
IX. Procedure task lighting: two hundred (200) foot candles;
X. Surgery task lighting: one thousand (1000) foot candles; and
XI. Reduced night lighting in patient rooms and corridors.
XII. Three hours Emergency light shall be provided in exit, entry and in all landing of
staircase.
3) Essential Power System: Hospitals shall have an automatic power generator for all care
and treatment locations which involve general anesthetics or electrical life support
equipment, and in emergency procedure and treatment rooms.
I. Different generators shall be available, at least diesel generator and white fuel
generator.
II. There shall be enough stored fuel to maintain power for at least 24 hours.
III. If a generator is used, there must be a staff member assigned to the regular
maintenance of the generator to guarantee it will function properly when
needed.
IV. Staff member will also ensure a sufficient supply of diesel gas and charged
batteries for start-up purposes
V. Solar panels are also an acceptable if used as backup power option.
VI. Central UPS system for ups outlets of selected area (like ICU, delivery, Operation
Theater, laboratory) shall be provided as backup power option.
8.4. FIRE PROTECTION SYSTEM

1) The hospital shall comply with the National Fire Protection "Life Safety Code”.
2) The Hospitals shall have an automatic fire alarm and smoke detector system for all care
and treatment rooms.
 Heat detectors used for car park, kitchen, and transformer room lift pit area.
 Sounder base photo electric smoke detector will be proposes for the bedroom
and all other rooms.
 Typical floor station located to convenient location in the lobby.
3) Essential Public Address System: Hospitals shall have an automatic voice communication
/evacuation signal, from different sources; automatic control signal from fire alarm system,
tape/CD player for prerecorded message to all care and treatment locations rooms.
4) Lightening Arrestor and Grounding System: Hospitals shall have technically advised
lightning protection system, comprises air termination, down conductor and earth
termination. Protection zone shall cover a minimum of the diameter of the building
5) All employees shall be trained in procedures to be followed in the event of a fire and
instructed in the use of fire-fighting equipment and patient evacuation of hospital
buildings as part of their initial orientation and at least annually thereafter.
6) All employees shall receive printed instructions on procedures to be followed in case of
emergency, including patient evacuation of the buildings.
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7) A written evacuation diagram specific to the unit that includes evacuation procedure,
location of fire exits, alarm boxes, and fire extinguishers shall be posted conspicuously on
a wall in each patient care unit.
8) Fire extinguishers shall be visually inspected at least monthly; fully inspected at least
annually, recharged, repaired and hydro tested as required by manufacturer's
instructions; and labeled with the date of the last inspection.
9) Fire detectors and alarm systems shall be inspected and tested at least twice a year by a
certified testing agency. Written reports of the last two inspections shall be kept on file.
10) There shall be a comprehensive, current, written preventive maintenance program for fire
detectors, alarm systems, and fire suppression systems that includes regular visual
inspection. This program shall be documented.
11) There shall be a procedure for investigating and reporting fires. All fires that result in a
patient or patients being moved shall be reported to the appropriate organ. Immediately
in writing within72 hours. In addition, a written report of the investigation shall be forwarded
to the appropriate organ as soon as it becomes available.
8.5. CALL SYSTEMS

1) Call systems shall be operable from all patient private spaces. Such us from patient beds
(except at psychiatric or mental hospital beds), procedure and operating rooms, and
recovery bed, bathing and toilet locations.
2) The system shall transmit a receivable (visual, audible, tactile, or other) signal to on-duty
staff which readily notifies and directs the staff to the location where the call was
activated.
3) In locations where patients are unable to activate the call, a dedicated staff assists or
code call device shall promptly summon other staff for assistance or continuous visual
connection to supper attending staff should be provided.
8.6. MEDICAL GAS SYSTEM

1) The hospital shall safely provide centrally managed medical gas and vacuum by means
of portable equipment or building installation systems as required. Electromechanical
system for central supply shall be installed for areas such as operation theater, Delivery,
special procedure rooms, Intensive care unit, laboratory and sterilization,
2) The installation, testing, and certification of nonflammable medical gas, clinical vacuum,
and air systems shall comply with the requirements of the Life Safety Code (National Fire
Protection agency proclamation).
3) The hospital shall identify portable and system components, and periodically test and
approve all medical gas piping, alarms, valves, and equipment for patient care and
treatment. The hospital shall document such approvals for review and reference.
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8.7. HEALTH FACILITY ENVIRONMENT

1) The hospital shall provide and maintain a safe environment for patients, caregivers, visitors,
staff and the general public.
2) All facilities shall comply with the following applicable codes and standards for safe
environment:
a. Ethiopian Environmental requirements for hospital facilities
b. National Fire Protection Life Safety Code and laws; and
c. Other related Regulations
3) Existing and new hospital shall comply with the physical facility standards stated under this
standard. The hospital shall maintain all building materials and structural components so
that total loads imposed do not stress materials and components more than one and one-
half times the working stresses allowed in the building code for new buildings of similar
structure, purpose, or location.
8.8. SPECIFIC SERVICE AREAS

1) Bathing and Toilet Rooms:
I. In case of common bathing and toilet room, one shall be dedicated for seven
patients at all times.
II. A hospital shall provide a bathing room consisting of a tub and/or shower
adjacent to each bedroom or provide a central bathing room on each floor
with patient rooms. Tubs and showers regardless of location shall be equipped
with hand grips or other assistive devices as needed or desired by the bathing
patient.
III. The hospital shall provide toilet rooms with hand-washing sinks for patient and
staffs shall use separately for each service units. In addition the following
requirements shall be ensured
 Flushable toilets shall be available throughout the workplace.
 Posted signs (written and/or visual messages) shall be indicated
describing which is for ladies and gentle (or female and male)
 Indicating arrows shall be located on the corridors
 At least one toilet room shall be designated for patients with disability
with all assisted services.
2) Patient Rooms: the hospital shall provide patient rooms which allow the provision of
medical intervention, shall have space for sleeping, afford privacy, provide access to
furniture and belongings, and accommodate inpatient care and treatment. In addition
Patient Rooms:
I. Shall be arranged to maximize staff supervision and nursing assistances.
II. No patient room shall be located away from nursing stations without proper
covered gangway.
III. Shall not be accessed directly through a bathroom, food preparation area,
laundry or another bedroom;
IV. Shall be located on an outside wall with a window with a minimum glass size of
8 square feet or equivalent meter square per patient.
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V. If they have multiple beds, shall allow for an accessible arrangement of furniture,
which provides a minimum of three (3) feet or equivalent meter between beds.
3) Isolation Rooms: The number and type of isolation rooms in a hospital shall be determined
by the hospital and direct caregiver. The determination shall be based upon an infection
control risk assessment, patients’ requirements and patients influence on other room
occupants. In addition:
I. Hospitals shall make provisions for isolating patients with infectious diseases
prevention.
II. An isolation room shall have an adjoining bath and toilet room.
III. Hospitals shall equip isolation rooms with hand-washing and gown changing
facilities at the entrance of the room.
4) Observation Areas: If the hospital provides medical observation, extended recovery or
behavior intervention methods, the hospital shall provide one or more appropriately
equipped rooms for patients needing close supervision. Each room shall:
I. Have appropriate temperature control, ventilation and lighting;
II. Be void of unsafe wall or ceiling fixtures and sharp edges;
III. Have a way to observe the patient, such as an observation window or if
necessary, flat wall mirrors so that all areas of the room are observable by staff
from outside of the room;
IV. Have a way to assure that the door cannot be held closed by the patient in
the room which could deny staff immediate access to the room; and
V. Be equipped to minimize the potential of the patient's escape, injury, suicide
or hiding of restricted substances.
VI. Shall be provided with proper safety communication systems and emergency
signaling.
5) Critical Care Rooms/ICU: If monitored complex nursing care is provided, the hospital shall
provide one or more rooms for patients needing the care.
I. Each room shall be appropriately located and equipped to promote staff
observation of patients.
II. Rooms with a single occupant shall have a minimum floor area of not less than
one hundred and thirty (130) square feet or equivalent meter square.
III. Multiple bed locations shall contain at least one hundred and ten (110) square
feet or equivalent meter square per bed with a minimum of four (4) feet or
equivalent meter between beds.
IV. The room shall include provision for life support, medical gas, sleeping, and
convenient bathing and toileting facilities.
6) Cubicles: Patient care and treatment cubicles shall have a minimum floor area of sixty
(60) square feet with at least three (3) feet between bedsides and adjacent side walls.
7) Examination Rooms: Each examination room shall have a minimum floor area of eighty
(80) square feet and a minimum of three (3) feet clear dimension around three (3) sides
of the examination table or chair.
8) Treatment Rooms: Treatment room for procedures performed under topical, local, or
regional anesthesia without pre-operative sedation shall have a minimum floor area of
one hundred and twenty (120) square feet and a minimum of ten (10) feet clear
dimension.
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9) Procedure Rooms: Procedure rooms for invasive and minor surgical procedures performed
in conjunction with oral, parenteral, or intravenous sedation or under analgesic or
dissociative medicines shall have a minimum floor area of two hundred (200) square feet
and a minimum of fourteen (14) feet clear dimension.
10) Operating Rooms: Operating rooms for major surgical procedures that require general or
regional block anesthesia and support of vital bodily functions shall have a minimum floor
area of three hundred (300) square feet and a minimum of sixteen (16) feet clear
dimension.
11) Privacy: In multiple bed patient rooms, visual privacy, and window curtains shall be
provided for each patient. The curtain layout shall totally surround each care and
treatment location which will not restrict access to the entrance to the room, lavatory,
toilet, or enclosed storage facilities.
8.9. CARE AND TREATMENT AREAS

1) The hospital shall not share care and treatment areas for those services which require
dedicated space
2) The hospital shall not provide services in detached structures unless the way of service
delivery allows or proper building configuration established.
3) The care and treatment areas of the hospital shall comply with the requirements stipulated
under the premises of each service standards.
8.10. ANCILLARY AREAS

1) Dietary: If food preparation is provided in the hospital (in case of inpatient services), the
hospital shall dedicate space and equipment for the preparation of meals and separate
washing room (dishes and other food preparation equipment), refrigerated and non-
refrigerated storage areas in accordance with the standards mentioned under the Food
and dietary services of this health facility.
I. If contractual services are used for dietary services, the hospital shall have
areas for immediate storage spaces, cleaning and disposal spaces.
II. If contractual services are used, the hospital shall have a clear contractual
agreement and the contractor shall comply with all the requirements
prescribed under this standards.
2) Laundry: The hospital shall provide laundry services by contract or onsite.
I. Contract:
 If contractual services are used, the hospital shall have areas for soiled linen
awaiting pickup and separate areas for storage and distribution of clean linen.
 Separate clean linen supply storage area shall be conveniently located in
each care and treatment locations
 If contractual services are used, the hospital shall have a clear contractual
agreement and the contractor shall comply with all the requirements
prescribed under this standard.
II. On-site: If on-site services are provided, the hospital shall have areas dedicated
to laundry in accordance with the following requirements:
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 The laundry areas shall be equipped with a washer and dryer for use by patients. The
hospital shall provide a conveniently located sink for soaking and hand-washing of
laundry.
 Hospital laundry area for hospital processed bulk laundry shall be divided into separate
soiled (sort and wash areas) and clean (drying, folding, and mending areas) rooms. In
new facilities a separate soaking and hand-washing sink and housekeeping room shall be
provided in the laundry area.
 Separate clean linen supply storage facilities shall be conveniently located in each care
and treatment location.
 In general the standards stipulated under housekeeping, laundry section of this standard
shall be respected.
3) Administrative Areas: Administrative Offices shall be located separately from care and
treatment areas and it shall be clearly labeled and easily accessible to patients, care
givers and visitors. It includes;
a. Finance and business office.
b. Administration office.
c. Human resource management office
d. Staff rooms with toilet separate for male and female
e. Staff cafeteria
f. Visitors cafeteria
g. Spaces for conferences and in-service training
h. General Library
4) General Storage areas: There shall be a two hour fire rated lockable room large enough
to store.
5) Boiler Room: Space shall be adequate for the installation and maintenance of the
required machinery.
6) Maintenance Area: Sufficient area for performing routine and preventive maintenance
activities shall be provided (workshop area) and shall include office for maintenance
personnel.
7) Incinerator: there shall be a dedicated area for incinerators and the hospital shall comply
with the nation directives for healthcare waste management and disposal.
8) Janitor rooms: the hospital shall have separate janitor rooms in each care and treatment
areas.
9) Green area: The hospital shall dedicate at least 20% of the total hospital compound for
green area.
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Conclusion
This architectural literature study has highlighted the importance of designing general hospitals
in the Ethiopian standard context that are functional, efficient, and patient-centered. General
hospitals in Ethiopia play a vital role in providing essential healthcare services to people in rural
areas and underserved communities. By carefully considering the principles of accessibility,
zoning functional spaces, infection control, patient privacy, comfort and convenience, and
sustainability, architects can create general hospitals that meet the needs of the community and
provide a high-quality healthcare experience for all.
In addition to the principles listed above, there are a number of other factors that should be
considered when designing general hospitals in the Ethiopian standard context, such as the size
and scope of services offered, the needs of the community, and the budget available. By
carefully considering all of these factors, architects can create general hospitals that are
sustainable, affordable, and accessible to all.
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References
Agency, E. S. (n.d.). forsslund.org. Retrieved from forsslund.org:
https://www.forsslund.org/StandardHealthFaclitiy/General%20Hospita.pdf
Bard, G. (n.d.). Google Bard. Retrieved from Google Bard: https://bard.google.com/chat/cdaa3f93c248d5d3
Brainkart.com. (n.d.). Retrieved from https://www.brainkart.com/article/Types-of-Hospitals_35459/
Centers for desease control and preventation. (2022, 08 21). Retrieved from National Center for Health Statistics:
https://www.cdc.gov/nchs/hus/sources-
definitions/hospital.htm#:~:text=The%20World%20Health%20Organization%20%28WHO%29%20conside
rs%20an%20establishment,by%20number%20of%20beds%2C%20and%20length%20of%20stay.
Choudhary, D. S. (n.d.). LinkedIn. Retrieved from LinkedIn.com: https://www.linkedin.com/pulse/hospital-design-

considerations-dr-salil-choudhary/
columbia university irving medical center. (n.d.). Retrieved from columbia university irving medical center:
https://www.publichealth.columbia.edu/research/others/comparative-health-policy-library/ethiopia-
summary
History of EPHI. (n.d.). Retrieved from Ethiopian Public Health Institute: https://ephi.gov.et/about-us/history-of-
ephi/#:~:text=%E2%80%9CIn%20that%20year%2C%201906%2C,II%20Hospital%20(Ibid).%E2%80%9D
PhD. Eng. Arch. Mazen, F. (n.d.). Understand The Design of General Hospital. AL Andalus University – Syria.
sri chitanya educational institute. (n.d.). Retrieved from https://infinitylearn.com/surge/biology/modern-

hospital/
vendatu. (n.d.). Retrieved from https://www.vedantu.com/biology/hospital
vendatu. (2023, 10 28). Retrieved from vendatu: https://www.vedantu.com/biology/hospital
w.douglas, p., harold, s., & Pamela, C. F. (2023, 11 01). britannica. Retrieved from britannica:
https://www.britannica.com/science/hospital
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JIMMA UNIVERSITY

JIMMA INSTITUTE OF TECHNOLOGY

Submitted To: Mr. Olifan

 Hospital layout and zoning

The World Health Organization (WHO) considers an establishment to be a hospital if it is

Figure 1: Ancient Greek Ruins

Figure 2: Lyon: Hôtel-Dieu

Religion continued to be the dominant influence in the establishment of hospitals during

3.1. ETHIOPIAN HEALTH CENTER HISTORY

4. TYPES AND CLASSIFICATIONS OF MODERN HOSPITAL

Figure 3: Types of Hospitals

Owner Length of stay Specialty Function System

4.1. BASED ON OWNERSHIP OF HOSPITAL

Figure 4: National Health Service

I. PUBLIC HOSPITAL OR GOVERNMENTAL HOSPITAL

II. CHARITABLE HOSPITALS

III. CORPORATE HOSPITALS

IV. PRIVATE HOSPITALS

4.2. BASED ON LENGTH OF STAY

II. Short term hospitals:

III. Day care hospitals:

4.3. BASED ON CLINICAL SPECIALTIES

II. SPECIALIZED HOSPITALS

1) Tuberculosis and Leprosy Hospitals

Figure 5: X-rays of patients infected with tuberculosis

Figure 6: Leprosy treatment center at Kalaupapa

2) Mental health facilities

4.4. ACCORDING TO THE LEVEL OF CARE

Below mentioned are some of the hospital services:-

 General and specialty surgical services

 Pediatric specialty care

 Good access to surgical specialists

 Rehabilitation services and physical therapy

 Home nursing services

 Mental health care

 Genetic testing and counseling

 Family support services

 Case management or social work services

6. THE MAIN DIVISIONs OF THE HOSPITALS

 Entrance area, registration, accounts should

Figure 8: Division Functional Relations

II. Outpatients’ Division

 Very close to the main

2. EMERGENCY: Parts and components of the division:

 Entrance + waiting area.

Location: Figure 10: Emergency Room Functional Layout and

 Very close to the exit door

III. Diagnostic Services Division

1. LABORATORIES: Parts and components of the division:

The most important labs in the hospital are:

 Very close to the emergency department and external clinics.

2. RADIOLOGY DIVISION: Parts and components of the division:

Location: Figure 12: Radiology Division Functional Layout and Relation

 Very close to the emergency department and external clinics.

IV. Therapeutic Services Division

1. PHYSICAL THERAPY DIVISION: Parts and

 Close to the main entrance of

V. Internal Medical Treatment Division

1. OPERATION THEATRE: Parts and components of the division:

2. INTENSIVE CARE UNIT: Parts and

 Very close to the recovery room in

3. CENTRAL STERILIZATION DIVISION: Parts and components of the division:

 Very close to the operation theatre