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