PRINCIPLES OF HOSPITAL DESIGN

Dr A PRAKASH
Sr. Professor, Health Management
National Academy of Indian Railways
(Formerly Railway Staff College)
VADODARA 390 004
 Dutch architectural historian Cor Wagenaar has
called many hospitals:
"... built catastrophes, anonymous institutional
complexes run by vast bureaucracies, and totally
unfit for the purpose they have been designed for
... They are hardly ever functional, and instead of
making patients feel at home, they produce stress
and anxiety."
The research of British Medical Association
shows that good hospital design can reduce
patient's recovery time.
Exposure to daylight is effective in reducing

depression.
Exposure to nature and hospital gardens is also

important - looking out windows improves patients'

moods and reduces blood pressure and stress
level.
Eliminating long corridors can reduce nurses'

fatigue and stress.

 THE PLOT
Where the clients want it
Easy reach of captive population
Free access
Area not less than double the floor area
IS 10905 Pt I one hectare per 25 beds
Gates Main / Emergency / Service
 BUILDING
Maintenance free
Environment friendly
Minimum energy expenditure for ambient light &
climate control
Functional segregation
Emergency exits, ramps, fire alarms
Disabled friendly
National Building Code
 FLOOR AREA OF HOSPITAL

700 900 sq ft per bed

One bed requires 75-100 sq ft

Total floor area required is 10 times this
 FLOOR AREA ALLOCATION

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

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

Window area 20% of floor area if only on one

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

At least 6 cabins per 100 beds

Australian standard is 25% of beds in single,

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

No. of Operations = Surgical BedsXBORX365

ALSX100XWorking Days

No. of OT = No. of Operations per day

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

50 0 1 0 1

100 1 1 0 1

300 2 3 0 1

500 2 5 1 1

750 2 8 1 1

1000 2 10 1 1
 ZONING IN OT
Protective Zone
Clean Zone
Sterile Zone
Disposal or Sluice Zone
 ENVIRONMENTAL CONTROL
Temperature 20+2
Relative Humidity 40%-60%
Air Changes 25/hr (at least 10 of fresh air)
Clean air thru HEPA filter (0.3 & 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 sqft
Men's Change Room 120 sqft
Ladies' Change Room 120 sqft
Patient's Preparation 120 sqft
Gowned Waiting Area 80 sqft
PLUS Circulation Area
 SERVICES FOR OT
Electricity Clean
Water Supply Clean
Lighting General Background /
Operation /Special
MGPS
? SEAMLESS / MODULAR OT
 LABOUR ROOMS
Septic & Aseptic Segregation
Lighting
MGPS
Neonatal Resuscitation Area
Vicinity of Nursery & OT
 NURSERY
Vicinity of Labour Room
Natural Light
 MORTUARY
Connected to Service Gate
Cold Room
Side Room with Plumbing
Waiting Area
 PROVISION FOR GROWTH
Area Growth Acceleration
Indoor 8.7% 1.0%
Outdoor 10.8% 4.1%
Medical Services 28.4% 15.3%
Teaching & Research 45.9% 31.1%
Staff 18.5% 4.9%
Services 9.5% 1.8%
Administration 23.3% 6.5%
 AIRCONDITIONING
Dilution
CO2 / Heat Load / Microbial Load
Control of Microbial Spread
Room to Room Pressure Difference
Flow Control within Room
Humidity Control
Air Purification
Filters / UV / Ozone
 AIRCONDITIONING
Integration of
Ventilation
Lighting
Fire fighting
MGPS
Cabling for computers & monitors etc
 AC OT
Temp 20-23
RH 50%- 60%
Pressure Positive, Negative in Sluice Room
Air changes 10 fresh / 25 total
Air Filtration HEPA (0.3 ) in OR 20 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
All air vented out
 AC POSTOPERATIVE
Temp 21-24
RH 30%-60%
Pressure Positive
Air change 2 fresh / 6 total
Air Filtration 5
 AC MICU/SICU
Temp 21-24
RH 30%-60%
Pressure Positive
Air change 5 fresh / 15 total
Air Filtration 5
 LABOUR ROOM
Temp 20-23
RH 30%-60%
Pressure Positive
Air Changes 3 fresh / 15 total
Air Filtration 5
 NURSERY
Temp 22-26
RH 30%-60%
Pressure Positive
Air Changes 3 fresh / 15 total
Air Filtration 5
 WARDS
Temp 21-24
RH 30%-60%
Pressure Positive
Air Changes 3 fresh / 15 total
Air Filtration 20

Over crowding in visiting hours

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