History

INTRODUCTION :
 The evolution of the hospital is trade from its on set in ancient mesopotamia towards the end of the second millennium to the end of the middle
ages
 The foundation of modern medicine can be traced back to ancient greeks .
 In the earliest pre – historic days , a different kind of medicine was practiced in countries such as EGYPT , GREECE , ROME , MESOPOTAMIA ,
INDIA , TIBET , CHINA etc .

MIDDLE AGE ( 500 – 1500 AD ) DARK AGES OF MEDICINE :

 Developed the unani system of medicine

 During the time of mohammad , a real system of hospitals was developed . He was the first to order the establishment of small mobile military
bimaristan ( hospital )

 In addition , islamic physicians were responsible for the establishments of pharmacy and chemistry as sciences

 The best known of the great hospitals in the middle ages were in baghdad , damascus & cairo

 The oldest hospital still in existence are the “ HOTEL – DEIU “ in lyons and paris , france .
Definition:
The term District Hospital is used here to mean a hospital at the secondary referral level responsible for a district of a
defined geographical area containing a defined population.

Grading of District Hospitals :The size of a district hospital is a function of the hospital bed
requirement, which in turn is a function of the size of the population it serves. In India the population size of
a district varies from 35,000 to 30,00,000 (Census 2001). Based on the assumptions of the annual rate of
admission as 1 per 50 populations and average length of stay in a hospital as 5 days, the number of beds
required for a district having a population of 10 lakhs will be around 300 beds. However, as the population of
the district varies a lot, it would be prudent to prescribe norms by grading the size of the hospitals as per the
number of beds.

• Grade I: District hospitals norms for 500 beds

• Grade II: District Hospital Norms for 400 bed
• Grade III: District hospitals norms for 300 beds
• Grade IV: District hospitals norms for 200 beds
• Grade V: District hospitals norms for 100 beds.
 ELEMENTS AND DIVISIONS OF THE HOSPITAL :
The main divisions of hospitals are :
Central sterilization department
1.Administration division 6.Inpatient division includes
2.Out patient division , includes Patient ward
Nurses wards
Outpatient clinics Inpatient services
Pharmacy 7.General service division includes
Kitchen
Emergency reception
Laundry
3.Dianostic services division, includes Storages
Work shops
Laboratories
Mechanical services
Radiology(diagnostic) Mortuary
4.Therapeutic services division , includes Security
Landscaping
Physical therapy Parking
Radiology (therapeutic)
5.Internal medical treatment division
,includes
Operation theatres
Intensive care unit
Maternity section
 LOCATIONS
ADMINISTRATION DIVISION : Very close to main entrance of the hospital
Parts and components of the division Entrance area , registration , accounts should face the entrance, while the
manager office should be back for privacy
 reception hall
EMERGENCE RECEPTION :
 Waiting area  parts and components of the division
Entrance for the waiting area
 Registration
Registration
 Treasury and accounts Staff room
Mini-surgery
 Staff offices
Test room
 General manager office Medical utilities
Mini sterilization
 Staff lounge
LOCATION:
 Nursing head office Very close to exist of the emergency
Very close to radiology
 W.cs
Clos e to the pharmacy, laboratories, central sterilization
OUT PATIENT DIVISIONS: Direct access to the stairs and elevators
• OPD is a very important department in hospital A. PHYSICAL FACILITIES OF OPD:
• OPD is vested by large section of communities Emergency care
• OPD is an ambulatory care center [ also called polyclinic] Operation theater
• Patient care is the primary care of the OPD Ancillary accommodation
• It also impart educations to professional staff
Auxiliary accommodation
Sanitary
• It provides medical students ,house physicians, nurse and technical
with valuable and diversified clinical experience. For individual departments a separate Doctor room
[ examination, treatment room]
Nurse rooms, staff rooms
1. Reception/Registration 25. Shopping arcade
2. Pharmacy 26. Casualty
3. Examination/Consultation 27. Blood bank
4. Nursing station 28. Physiotherapy
5. Clinical laboratory 29. Fire-protection
6. Imaging 30. Residential accommodation
7. Patient area 31. Park
8. Nursing station
9. Operating theatre
10. Labour room
11. General administration
12. Medical-cum-general store
13. Manifold
14. Central sterilization and supply department ,
15. Laundry
16. Kitchen
REQUIREMENTS
17. Sub-station
18. Workshop
19. Mortuary
20. Incinerator
21. Entrance
22. Parking
23. Library/Conference
24. Intensive Care
Area division for hospital
Area requirement for hospital is to be derived from carpet area of various services
and functions as outlined in functional programe by applying conversion factor for
circulation space. The circulation space will include corridors, stairs, fire escapes,
walls, ramps and lifts, etc.
• While applying 40 percent conversion factor over carpet area of 66 sq.m per bed, the covered area
of the hospital works out to 92.5 sq.m per bed.
• Land requirement depends on factors, like, horizontal or vertical development, FAR (floor area
ratio) regulations and ground coverage regulated by local self government/municipal regulations
correlated to availability of land. Area requirement can thus be calculated with the above
parameters assumed as under:
• Total hospital beds 100
• Number of storeys 3
• By placing 40 percent of area on ground floor and remaining in 2 upper floors,
Municipal regulations
• F. A. R 100
• Ground coverage permitted 25 percent
• Covered area per bed 92.5 sq.m
• Total covered area 92.5 X100 = 9250 sq.m
• 40 percent of covered area 3700 sq.m
• •
Since ground coverage allowed is 25 percent, plot area ,will be 4 times of 3700 sq.m , that is, 14800 sq.m or 1.48, say, 1.5hectare
 ORIENTATION:
•  Treatment and operating rooms are preferred between north-west and north-east.
•  For nursing ward facades, south and south-east is favourable due to: Pleasant morning sun Minimal heat build up Little requirement for sun
shading Mild in the evenings
•  East and west facing rooms have comparatively deeper sun penetrations, though less winter sun.
•  The orientation of wards in hospitals with short average stay is not so important.
•  Some departments might require rooms on the north side so that patients are not subjectes to direct sunlight

EFFECTIVE ARRANGEMENTS:
Top floor:
•  Helipad, ac plant room, nursing school, laboratories.
2nd/3rd floor:
•  Wards can be provided. 
1st floor:
•  Central sterilisation unit, surgical area, intensive care, maternity, children’s hospital.
Ground floor:
•  Entrance, radiology, medical services, ambulance, entrance for bed- ridden patients, emergency ward, information centre, administration,
cafeteria. 
Basement:
•  Stores, physiotherapy, kitchen, heating and ventilation plant room, radio therapy , linear accelerator.
Sub-basement:
•  Under ground garage, electricity supply.
 DEPARTMENTS
Pediatrician: specialization in children and their disease.providing Physician (general medicine)
Medical care for children upto the age of 12 years
One who specializes in diagnosis and medical treatment
Equipments and play area/waiting area. as Distinct from surgery.

NEUROLOGY: study of functions and organic

NEPHROLOGIST: who specializes in kidney care and treating disorders of nerves and the nervous system.
Diseases of the kidneys.
E.E.G
X-ray examiner,nebiliser,examination bed,electromyography, E.M.G
polysomnograph.etc SLEEP LAB.
GYNAECOLOGY: the functions and diseases specific to women and girls . the clinic should be planned close to in – patient
ward units to enable them to make use of the clinics at times for antenatal and postnatal care , it should aslo be at a
convenient distance from other clinics in the OPD

Fetal monitor
OB gynic table
Endoscopic equipment table
Birthing beds
Defibrillator
E.K.G mechine.

ORTHOGRAPHY: study the correction of deformities of bones or muscles . this clinic should include arrangements for
plaster preparation , fracture treatment besides consultation cum - examination

SURGICAL CLINIC
The clinic should have facilities for treatment-cumdressings. For convenience, this should be placed next to consultation-cum-
examination room with adequate waiting space.
PICU should be : Room Layout and Bed Area
• a separate unit from the Neonatal and Adult ICU dedicated to
• Patient area in open PICU should be 150 to 200 sq ft. In a
infants and children • into consideration future adaptability
cubicle, the minimum area should be 200 to 250 square feet
and expansion and must maximize the resource of space,
with at least one wash basin for two beds.
equipment, and personnel in a most affordable way for
individual institutions.
• At least one, preferably two rooms should have an isolation
capability with an area of 250 square feet with an ante room
• located near lift with easy access to emergency department
(separate area at least 20 square feet for hand washing and
and operation theatre, laboratory and radiology department.
wearing mask and gown) and separate ventilation

Clean and Dirty Utility Room

• Clean and dirty utility rooms must be separate.
• Covered bins must be provided for soiled linen and
waste materials.
• An area for emptying and cleaning bed pans and urine
bottles is also necessary
Pediatrician
 PEDIATRIRION PHYSICIAN NEFROLOGY

NEUROLOGY ORTHOGRAPHY GYNIC

 IN – PATIENT WARD
 PRIMARY ACCOMMODATION
 ANCILLARY ACCOMMODATION
 AUXILLARY ACCOMMODATION
 SANITATION

PRIMARY ACCOMIDATION
• Area of ward - bed ( 8 – 10 sq.meter )
ANCILLARY ACCOMMODATION
• X- RAY
• Distance between centre of two beds - 2.25 meters, • PANTRY
• Dietician
not less than 2 meters
• Service in – ward
• Distance between bed end and wall - 0.25 meters • Mobile pharmacy
• Distance between bed wall and bed nearest to side wall - 0.65 meters
• Width of corridor - 2.4 meters AUXILLARY ACCOMODATION
• Doctors room – 12 sq.m
• Nurse room – 12 sq.m
Sanitary • Space for stretcher trolley – 2 sq.m
• Toilet with washroom & wc – • Store room – 20 sq.m
• Only wc – 0.37 to 0.46 sq.m • Clean utility room – 8 sq.m
• Only shower – 0.6 sq ft • Sluice room – 12 sq. m
• Dirty utility – 12 sq ft
• Urinals – 1: 16
• Wc – 1: 8
• Bathrooms – 1: 12
 OUT – PATIENT DEPARTMENT

 The facility shall be planned keeping in mind the maximum peak hour patient load and shall have the scope for future
expansion . OPD shall have approach from main road with signage visible from a distance

LAYOUT OF OPD
Reception and Enquiry
1.Enquiry/May I Help desk shall be available with competent
staff fluent in local language.

2.Services available at the hospital displayed at the enquiry.

3.Name and contacts of responsible persons like Medical
superintendent, Hospital Manager, Causality Medical officer,
Public Information Officer etc. shall be displayed

Nursing Station: need based space required for nursing

Station in OPD for dispensing nursing services. (Based on OPD
load of patient)
 OTHER ROOMS
EMERGENCY
NURSE ROOMS

II) Hospital Kitchen (Dietary Service) The dietary service of a hospital is an important therapeutic tool.
It should easily be accessible from outside along with vehicular accessibility and separate room for dietician
and special diet. It should be located such that the noise and cooking odours emanating from the department
do not cause any inconvenience to the other departments. At the same time location should involve the
shortest possible time in delivering food to the wards. Apart from normal diet diabetic, semi solid diets and
liquid diet shall be available Food shall be distributed in covered container. Quality and quantity of diet shall
be checked by competent person on regular basis.

III) Central Sterile and Supply Department (CSSD) As the operation theatre department is the
major consumer of this service, it is recommended to locate the department at a position of easy access to
operation theatre department. It should have a provision of hot water supply. Department shall develop and
implement the Standard Operating Procedures (SOPs) for transfer of unsterile and sterile items between CssD
and departments, sterilization of different items, complete process cycle, validation of sterilization process,
recall, labelling, first in first out, calibration and maintenance of instruments.
 OTHER ROOMS
TREATMENT ROOM : treatment room of the department shall include space for the infra x-ray & contact therapy apparatus
which is of simple character , occupies little space and may not need elaborate stuctural requirements .

INJECTION ROOM : for administering injection to patients a central injection room should be provided in conjunction with
the dispensary

DARK ROOM : film developing and processing shall be provided in the department for loading , unloading , developing and
processing of x-ray films . The room should be provided between a pair of radiography rooms so that new and exposed x-ray
films may be easily passed through the cassette pan with 2.0 mm lead backing installed in the wall in between the room
should be completely cut of from direct light through provision of air lock

CLEAN UTILITY AREA : this should contain all the essential supplies , linen , medicines , lotions , syringes , trolleys , various
mobile equipment etc…

BLEEDING ROOM : blood taking also requires a comfortable reception and toilet . Bleeding room should be quiet and not a
thorough fare and should be divided into cubicles for privacy . A rest room should also be provided for donors to rest and
take light refreshment before returning home

RADIOGRAPHY AND FLUOROSCOPY ROOM : the size of the room shall depend upon the type of equipment installed . The
room Should have a sub waiting area with toilet facility and a change room facility , if required . Fluoroscopy room shall be
completely cutoff from direct light .
 PLANNING CONSIDERATIONS
• Roof height – not less than 3.6 m
• height of suspended ceiling fan – at least 2.6 m
• Windows – if only in one wall then it should be 20% of floor area
if multiple windows then 15% of floor area
• corridors – the width of corridor recommended is 3m to facilitate movement of trolley , bed , stretchers , wheechairs etc
• Door – should not be less than 1.2 m wide and 2.25 m tall
• Ramp – it should have a slope of 1:15 to 1:18
Public Health Engineering

Water Supply
Arrangement should be made for round the clock piped water
supply along with an overhead water storage tank with
pumping and boosting arrangements. Water requirement per
bed per day = 450 to 500 litres (Excluding requirements for AC,
Fire-fighting, Horticulture and steam).

Drainage and Sanitation

The construction and maintenance of drainage and sanitation
system for waste water, surface water, subsoil water and
sewerage shall be in accordance with the prescribed standards.
Prescribed standards and local guidelines shall be followed.
TRANSPORT

Hospital Fittings & Necessities

Hospital Plants
x) Accident and Emergency Services

1.24 x 7 operational emergency with dedicated emergency room shall be available with adequate man power.

2.It should preferably have a distinct entry independent of OPD main entry so that a very minimum time is lost in giving immediate treatment to casualities
arriving in the hospital. There should be an easy ambulance approach with adequate space for free passage of vehicles and covered area for alighting patients.

3.Lay out shall follow the functional flow.

4.Signage of emergency shall be displayed at the entry of the hospital with directional signage at key points.

5.Separate provision for examination of rape/ sexual assault victim should be made available in the emergency as per guidelines of the Supreme Court.

6.Emergency should have mobile x-ray/ laboratory, side labs/plaster room/and minor OT facilities. Separate emergency beds may be provided. Duty rooms for
Doctors/nurses/ paramedical staff and medico legal cases. Sufficient separate waiting areas and public amenities for patients and relatives and located in such a
way which does not disturb functioning of emergency services.
Signage
FIRE SAFETYS(N.B.C)
SETBACKS
Stands beds and sterilization units
BARRIER FREE CONCEPTS
TYPES OF DISABILITIES
Adequate space should be allocated for persons using mobility devices,
e.g. wheelchairs, crutches and walkers, as well as those walking with the
assistance of other persons
The range of reach (forward and side; with or without obstruction) of a
person in a wheelchair should be taken into consideration
SEMI AMBULATORY
• Design requirements
• * Width of passage for crutch users (min. 900 mm)
• * Finishes of floor surface with non slip floor material.
• * Installation of handrail to support the body weight at the critical places
e.g. staircase, toilet, ramp, passage with a change of level (800-850 mm).
• * Extension of handrail on the flat landing at the top and bottom of the
stairs (300 mm).
• * To prevent slipping off the cane or crutch from the side of the stairs or
ramps (20 mm high lip on the exposed edge).
SIGHT DISABILITIES
• Design requirements
• * Use of guiding blocks for persons with impaired vision to guide them
within the buildings and facilities and out side the building. (Refer
details of guiding/warning blocks).
• * Installation of information board in braille.
• * Installation of audible signages (announcements)
• * Removal of any protruding objects and sufficient walking space for
safe walking.
• * For persons with limited vision use of contrasting color arrangements
HEARING DISABILITIES

• Design requirements

• * Provision of information board in an easily understandable manner.

• * Provision of illuminated signages, layout diagrams to help the
persons easily reach the desired place
PARKING
APPROACH TO PLINTH LEVEL
• Ramped Approach : Ramp shall be finished with non slip material to
enter the building. Minimum width or ramp shall be 1800 mm. with
maximum gradient 1:12, length of rarnp shall not exceed 9.0 M having
double handrail at a might of 800 and 900 mm on both sides
extending 300 mm. beyond top and bottom of the ramp. Minimum
gap from the adjacent wall to the hand rail shall be 50 mm.
CORRIDOR SPACE
• Lifts

• :- Wherever lift is required as per bye-laws, provision of at

least one lift shall be made for the wheel chair user with the
following cage dimensions of lift recommended for
passenger lift of 13 persons capacity by Bureau of Indian
Standards.
• Clear internal depth : llOOmm.
• Clear internal width : 2000 mm.
• Entrance door width : 900 mm.
• A hand rail not less than 600 mm. long at 800-1000 mm.
above floor level shall be fixed adjacent to the control panel.
• The lift lobby shall be of an inside measurement of 1800 x
1800 mm. or more.
• c) The time of an automatically closing door should or
minimum 5 seconds and the closing speed should not
exceed 0.25 M/ Sec. d)
• The interior of the cage shall be provided with a device that
audibly indicates the floor the cage has reached and
indicates that the door of the cage for entrance/exit is either
open or closed.
 TOILETS
• The minimum size shall be 1500 x 1750
mm.
• * Minimum clear opening of the door shall
be 900 mm. and the door shall swing out.
• * Suitable arrangement of
vertical/horizontal handrails with 50 mm.
clearance from wall shall be made in the
toilet.
• * The W.C. seat shall be 500 mm. from the
floor