OSPITAL

LITERATURE STUDY

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GENERAL HOSPITAL

Areas of care provision

Examination
Treatmen
t
Supply and disposal
Administration and technology
Operational

(There are residential areas and

possibly areas for teaching and
research s well as support areas
for services operations)
TYPES OF HOSPITALS
Smallest hospitals(upto 50 beds)

Small hospitals(up to 150 beds)

Standard hospitals(upto 600 beds)

Large hospitals.

According to the function:

⁻ general hospitals
⁻ Specialist hospitals
⁻ University hospitals
Shortest practicable OUTPATIENT IS KING, VISITORS’ EXPERIENCES
horizontal and PARAMOUNT:
vertical links A large majority of hospital services are now
focused on outpatient treatment, making a
patient's trip an event. Often Mr. outpatient
While at the same thinks- “I’m not sick, I’m not in a hospital. Im an
time demarcating outpatient”.
the individual This perception needs to be catered to in the
departments as far design of your building and structure. Think
as possible medical mall. Don’t think old hospital.

Understand the Its imperative to keep inpatient flow and

demographics, outpatient flow independent of each other,
needs, wants and making medical staff circulation as smooth and
goals of the discrete as possible.
healthcare facility.
• More and more we’re seeing an increase in the use of natural light in hospital designs due to
the link between natural light and the healing process.
• Incorporating natural surroundings such as indoor gardens, landscapes and aquariums into a
hospital’s floor plan provides a more pleasing environment for patients and visitors alike.

PRIVACY IS A PRIORITY:

• Privacy should be a goal in design plans

CONSTRUCTABILITY AND EXPANDABILITY:

• The future of hospital is unpredictable, as advancements in

technology and treatment processes are always improving.
SET BACKS

• The open spaces around the building shall be not less than 6 m.
• Side and rear open spaces to be left around building
• HEIGHT OF THE BUILDING - OPEN SPACE
10 m - 3
15 m - 6
18 m - 7
21m - 7
• Maximum height of the building – 20m

• Cellar shall be with a setback of at least 3m in the sites of extent of more than 2000sq.m from the
property line.
• In case of more than one cellar, 0.5m additional setback for every additional cellar floor shall be
insisted.
• Up to 10% of cellar may be utilised for utilities and non-habitation purpose like A/C Plant room,
Generator room, Sewerage Treatment Plant (STP), Electrical installations, Laundry, etc,
AIRLOCKS

A airlock is a specific zone situated between care areas and examination zones.
- Airlock for patients is required to separate sterilized and not sterilized rooms
⁻ One airlock per gender,
⁻ It is an access to care zones,
⁻ Two rooms inside

A ‘dirty’ room = cloakroom and showers,

A ‘clean’ room = to put on operating clothes,
- A airlock for supplying and discharge,
- It can be used as a dump room,
- Passage through this type of airlock is forbidden,
- Airlock s in front of intensive care zones to disinfect implements.
- Hygiene standards require a disconnection between surgical units and other services:
airlocks are advised for this separation.
GENERAL WARD :-
ROOMS /REQUIRED AREA FOR BED
Dimension of a room: 3.20m wide minimum
- With 1 bed: 10 sqm minimum,
- With 2 or 3 beds: 8 sqm per bed,
- Each bed has to be evacuated out of the chamber without moving the other ones,
- Doors of the chambers: 1.25 x 2.13 sqm; an electric closure is advised.
In the washroom: specific design for wheelchairs:
- Height of the dressing table: 86cm minimum
- Height of the toilet: 49cm
Required area/volume for one bed (for the whole built
area/volume including annexes, technical and storage rooms):
- Area: from 70 m2 to 100 m2,
- Volume: from 200 m3 to 280 m3.
Casuality entrance :
Examination room for first aid – 15 sqm
Wash room – 15 sqm
Ante room 10 sqm
Communal rooms :
Dining area and cafeteria
OPERATION THEATRE:-

A squared room is advised,

- Height of artificial lighting: 3m +0.7m for ventilation and
electric fittings,
- Shades are required,
- Safety electrical supply: 1.20m above the floor
minimum,
- Operating rooms have to be fit with a mobile ceiling
fixture
- - Uniformly smooth and easily washable walls and Sub sterilisation room :
floors Surgical instruments are prepared in this room
- Eye operations – dark rooms - A direct connection with the operating room is
Each operating room – 3 non- splash wash basins with required,
foot controls. - Two different sides are required: a
Sterile goods room : non-sterilized side with non sterilized
Size – flexible implements and a sterilized one,
Direct access from operating theatre - Fit up with a sink, working and storage areas.
Roughly 10sqm area required per operating theatre .
CIRCULATION:

⁻ Entrance and circulation within the building must consider wheelchair users, parents with
small children and people with disabilities etc.
⁻ Effective zoning is required:
⁻ Public zone, clinical zone, and staff zone.
⁻ Privacy and confidential ae important, especially at the reception desk and clinical rooms
during consultations and treatments.

Circulation in a wheelchair requires a specific design of the circulation ways -

Passages: 1.30m wide minimum, better if 2m wide,
- Access ways: 1.20-2m wide,
- Slopes: 5% maximum, 6m long maximum,
Connections have to be as short as possible.
ADMINISTRATION BLOCK

⁻ Rooms for administration should be connected by the corridor to the entrance hall
and be close to the main circulation routes.

⁻ A suitable route to the supplies area must be planned.

⁻ In the administrative area 7-12m.sq per member of staff should be planned.

⁻ Links to the casualty are also important, there should be at least 2 reception, the
cash-desk(12m.sq) and accounts (12m.sq).

⁻ Rooms for dealing with patients and relatives need to be connected to reception
(entrance j\hall), admissions and accounts (25m.sq.).
ADDITIONAL ROOMS NEEDED INCLUDE:
⁻ An office for administrative director (20m.Sq)
⁻ A secretarial room(10sq.M)
⁻ An administrator office(15sq.M, possibly in supply area)
⁻ A nurse office(20sq.M)
⁻ A personal office(25sq.M)
⁻ Central archives (40sq.M, possibly in the basement with a link to the administration department via
stairs)
ACCORDING TO REQUIREMENTS, THE PLAN SHOULD ALSO PROVIDE
⁻ Duty rooms for matron and welfare workers
⁻ A doctors staff room and consulting room
⁻ A messenger room
⁻ A medical records archive
⁻ Specialist and patients libraries
⁻ A hairdresser’s room (with 2 seats)
ARCHIVE AND STORE ROOMS:

⁻ A short route between archives and work areas is advantageous but generally difficult to provide.

⁻ One possibility is to locate them in basement and have link by stairs.

⁻ Distinctions should be made between store and archive room for files, documentation and film
from administration, the X-ray department etc. and supplies (pharmacy, disinfection, kitchen etc. )
and equipment (kitchen, administration, workshops etc.).

⁻ The necessary depth of shelves and cupboards depends on the goods stored. For files, books and
film, 250-400mm is adequate; for equipment, china spare parts etc., 400-600mm is needed.
 COMMUNAL ROOMS:

⁻ Dining rooms and cafeteria are the nest situated on the ground floor, or on the top floor
to give a good view.
⁻ The connection to the central kitchen is by goods life, which is not accessible to visitors,
consider whether it is sensible to separate visitors, staff and patients.

CASUALTY ENTRANCE:
⁻ For incoming casualty patients- A covered access road or closed hall overlooked by the administration
department, but not visible from the main entrance,
⁻ short routes to outpatients
⁻ the surgical/X-ray departments and the wards should be planned and these must be free of general traffic.
⁻ An examination room for
first aid (15sq.m),
a washroom (15sq.m),
an ante-room (10sq.m),
standing room for at least 2 stretchers, and
a laundry store should be included in an area where they are accessible directly beyond the entrance.
STAIRS

⁻ Accommodate all the vertical circulation- for safety reasons.

⁻ Must have hand rail on both the sides without projecting tips.
⁻ Winding staircase cannot be included as part of the regulatory staircase
provision.
⁻ Effective width of stairs and landing – min. 1.5m and should not exceed 2.5m.
⁻ Doors must nor constrict the useful width of the landings and in accordance
with hospital regulations, doors to the staircases must open in the direction of
escape.
⁻ Step heights of170mm are permissible and min req. tread depth is 280mm.
(better with 150:300mm)
CORRIDORS
⁻ Corridors must be designed for the maximum expected circulation flow.
⁻ Access must be atleast 1.5m wide.
⁻ Corridors in which patients will be transported on trolleys should have a min. effective width of 2.25m.
⁻ Suspended ceiling in the corridors may be installed upto 2.4m.
⁻ Windows for lighting and ventilation should not be further than 25m apart.
⁻ Effective width of the corridors must not be constricted by projections, columns or other building
elements.
⁻ Smoke doors must be installed in ward corridors in accordance with local regulations.
DOORS
⁻ When designing doors the hygiene requirements should be considered.
(coating)
⁻ They must be designed to prevent the transmission of sound, odours and
draughts.
⁻ Doors must meet the same standard of noise insulation as the walls
surrounding them.
⁻ Double skinned door - min. sound reduction of 25dB.

CLEAR HEIGHTS OF DOORS

LIFTS
⁻ Lift transport people, medicines, laundry, meals and hospital beds between floors, and
for hygiene and aesthetic reasons separate lifts must be provided for some of these.
⁻ If care, examination or treatment areas are accommodated on upper floors, at least 2
lifts suitable for transporting beds must be provided.
⁻ Elevator car- adequate room for a bed and 2 accompanying people,
⁻ Internal surface must be smooth, washable and easy to disinfect, the floor must be
no-slip.
⁻ Lift shaft must be fire resistant.
⁻ One multipurpose lift should be provided per 100 beds, with a min, of two smaller
hospitals.
⁻ In addition there should be a min. of 2 smaller lifts for portable equipment, staff and
visitors.
clear dimension of lift car: 0.9x1.20m
clear dimension of shaft : 1.25x1.5m
FORM OF BUILDING
⁻ The form of a building is strongly influenced by the choice of access and circulation routes.
⁻ It is therefore necessary to decide early on whether to choose spine form with branching
sections (individual departments), or whether circulation will be radially outwards from a
central core.
⁻ Consideration must be given to future expansion: this is most easily carried out with an
extended main tract.
⁻ Self-contained circulation routes should be avoided as they make extension work far more
costly and disruptive.
⁻ The vertical arrangement within a hospital should be designed so that the functional areas-
care, treatment, supply and disposal, access for bedridden patients, service yard,
underground garage, stores, administration, medical services- can be connected and accessed
most efficiently.
TOP FLOOR : ⁻ helipad, air-conditioning plant room,
nursing school, laboratories.

2ND/3RD FLOOR: ⁻ Wards

⁻ surgical area, central sterilization,
1ST FLOOR:
intensive care, maternity, children’s
hospital.
GROUND
FLOOR: ⁻ entrance, radiology, medical services,
ambulance, entrance for bedridden
patients, emergency ward, information,
administration, cafeteria.
BASEMENT:
⁻ stores, physiotherapy, kitchen, heating and
ventilation plant room, radio therapy,

SUB-BASEMENT: linear accelerator.

FUNCTION AND LAYOUT
⁻ In the surgical dept., treatment is given to the patients whose conditions have been diagnosed
but cannot be cured solely with medication.
⁻ It should be close to the intensive care dept., the recovery room and the central sterilization area
because there is extensive interaction between these departments and so easy access must be
assured. The hygiene precautions require the surgical unit to be isolated from the rest of the
hospital operations.
⁻ This is achieved by the demarcation system using lobbies.
⁻ Surgical departments are best located centrally in the core area of the hospital where they are
easy to reach.
⁻ The reception area for emergency cases must be as close as possible to the surgical area since
such patients often need to be moved into surgical immediately
ORGANISATION OF THE SURGERY DEPARTMENT
⁻ Every single department requires the following
rooms:
⁻ Operating theatre: 40-48sq.m
⁻ Entry room: 15-20sq.m
⁻ Exit room: 12-15sq.m
⁻ Equipment room: 10-15sq.m

⁻ Two operating theatres - share the same exit room

Essential to surgical department:
⁻ Staff lobby
⁻ Patient lobby
⁻ Clean work corridor
⁻ Anesthetic workroom
⁻ Waste lobby
⁻ Supply lobby
⁻ Standing area for 2 operating trolleys
⁻ Recovery room (nearby)
IPHS-GUIDELINES FOR 31- 100 BEDDED HOSPITAL
• The term Sub-district/Sub-divisional Hospital is used here to mean a hospital at the secondary referral level
responsible for the Sub-district/Sub-division of a defined geographical area containing a defined
population
• the number of beds required for a Sub-district having a population of 5 lakhs will be around 100-150 beds.
• Category II: Sub-district hospitals norms for 51-100 beds.
• services include OPD, indoor and emergency services.
• Essential
⁻ General Medicine ⁻ Dental care
⁻ General Surgery ⁻ Dot centre
⁻ Accidents and emergency services including ⁻ Designated Microscopy centre
poisoning and trauma Care ⁻ AYUSH
⁻ General Orthopaedic ⁻ Public Health Management
⁻ Obstetrics & Gynaecology ⁻ Integrated Counseling and Testing Centre
⁻ FP services like Counseling, Tubectomy (Both ⁻ Disability Certification (as per guidelines
Laparoscopic and Minilap), NSV, IUCD, OCPs, notified by state Government)
Condoms, eCPs, Follow up services ⁻ Therapy and Appliances
⁻ Paediatrics including Neonatalogy and ⁻ Services provided under other National
Immunization Health
⁻ Anaesthesia ⁻ Programmes including lifestyle disorders
⁻ Ophthalmology ⁻ Diagnostic and other Para clinical services:
⁻ ent ⁻ Laboratory services, X-ray, Ultrasound, ECG,
⁻ Radiology including Imaging services Blood
⁻ transfusion and storage
IPHS-GUIDELINES FOR 31- 100 BEDDED HOSPITAL
For the purpose of convenience the average size of the Sub district is taken in this document as 2,50,000 populations. 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 Sub district having a population of 2,50000 will be as follow:
The total number of admissions per year = 2,50,000 x 1/50 = 5,000
Bed days per year = 5,000 x 5 = 25,000
Total number of beds required when occupancy is 100% = 25000/365 = 69 beds
Total number of beds required when occupancy is 80% = 25000/365 x 80/100 = 55 beds

The area will include the service areas such as

⁻ waiting space,
⁻ entrance hall,
⁻ registration counter etc.
In addition,
⁻ Hospital Service buildings like Generators,
⁻ Heat Ventilation and Air conditioning Plant (HVAC plant),
⁻ Manifold Rooms,
⁻ Boilers,
⁻ Laundry,
⁻ Kitchen and essential staff residences are required in the Hospital premises
Building structure and the internal structure of Hospital should be made disaster proof especially earthquake proof, flood proof and
equipped with fire protection measures.
Hospital should not be located in low lying area to prevent flooding.
IPHS-GUIDELINES FOR 31- 100 BEDDED HOSPITAL
ADMINISTRATIVE BLOCK
Administrative block attached to main hospital.
CIRCULATION AREAS:
Circulation areas like corridors, toilets, lifts, ramps, staircase and other common spaces etc. in the hospital
should not be more than 55% of the total floor area of the building.
FLOOR HEIGHT:
The room height should not be less than approximately 3.6 m measured at any point from floor to floor
height.
AMBULATORY CARE AREA (OPD):
Waiting Spaces- Registration, assistance and enquiry counter facility
proper sitting arrangement, drinking water, ceiling fans and toilet facility separate for male and
female
Clinics- The clinics should include ⁻ Post Partum Unit,
⁻ general, ⁻ paediatrics,
⁻ medical, ⁻ dermatology and venereology (Desirable),
⁻ surgical, ⁻ psychiatry (Desirable),
⁻ ophthalmic, ⁻ neonatology,
⁻ ENT, ⁻ orthopaedic and social service
⁻ dental, department
IPHS-GUIDELINES FOR 31- 100 BEDDED HOSPITAL
• The clinics for infectious and communicable diseases should be located in isolation, preferably, in remote corner, provided with
independent access.
• Doctor chamber should have ample space to sit for 4-5 people.
• Chamber size of 12.0 sq meters is adequate. For National Health Programme, adequate space be made available. Immunization Clinic with
waiting Room having an Area of 3 m x 4 m in PP centre/Maternity centre/Pediatric Clinic should be provided.
• One room for HIV/STI Counseling is to be provided.

DIAGNOSTIC SERVICES
Provision for following space be made
- separate room for doctors/consultants
- rooms for reporting
- space for technicians
- storage/records areas
- sufficient waiting areas

IMAGING:
BLOOD STORAGE UNIT:
The department should be located
The area required for setting up the facility is only 10
at a place which is accessible to both OPD and wards
square meters, well-lighted, clean and preferably air conditioned.
and also to operation theatre department.

CLINICAL LABORATORY:
A small sample collection room facility shall be provided.
Separate Reporting Room for doctors should be there.
IPHS-GUIDELINES FOR 31- 100 BEDDED HOSPITAL
WARD UNIT:
• It is desirable that upto 20 % of the total beds may be earmarked for the day care facilities,
• It should be ensured that nursing station caters to around 40-45 beds, out of which half will be for acute patients and rest for chronic
patients.
• The distances to be traveled by a nurse from bed areas to treatment room, pantry etc. should be kept to the minimum.
• Ward unit will include
⁻ nursing station,
⁻ doctors’ duty room,
⁻ pantry,
⁻ isolation room,
⁻ treatment room,
⁻ nursing store along with wards and toilets as per the norms.
PRIVATE WARD:
10% of the total bed strength is recommended as private wards beds.
PHARMACY:
size should be adequate to contain 5 percent of the total clinical visits to the OPD in one session.
INTENSIVE CARE UNIT:
• The number of patients requiring intensive care may be about 5 to 10 percent of total medical and surgical patients in a hospital.
• The unit shall not have less than 4 beds nor more than 12 beds.
• Number of beds for both the units will be restricted to 10% of the total bed strength.
• Out of these, they can be equally divided among ICU and High Dependency Wards. For example, in a 100 bedded hospital, total of 10
beds will be for critical care.
• Out of these 4 may be ICU beds and 6 will be allocated for high dependency wards.
IPHS-GUIDELINES FOR 31- 100 BEDDED HOSPITAL
• This unit should be located close to operation theatre department and other essential departments, such as, X-ray and
pathology so that the staff and ancillaries could be shared.
• Easy and convenient access from emergency and accident department is also essential.
• A good natural light and pleasant environment would also be of great help to the patients and staff as well.
FACILITIES:
⁻ Nurses Station
⁻ Clean Utility Area
⁻ equipment Room
ACCIDENTS AND EMERGENCY SERVICES :
⁻ preferably have a distinct entry independent of OPD main entry
⁻ easy ambulance approach with adequate space for free passage of vehicles and covered area for alighting patients.
⁻ Emergency should have separate X-ray and basic laboratory facilities.
⁻ Mobile X-ray, Plaster room and minor OT facilities are also to be provided.
⁻ Separate emergency beds may be provided.
⁻ Duty rooms for Doctors/nurses/paramedical staff and medico legal cases.
⁻ Sufficient waiting area for relatives and located in such a way which does not disturb functioning of emergency services.
OPERATION THEATRE:
The location of Operation theatre should be in a quite environment, free from noise and other disturbances, free from
contamination and possible cross infection, maximum protection from solar radiation and convenient relationship with
surgical ward, intensive care unit, radiology, pathology, blood bank and CSSD.
 IPHS-GUIDELINES FOR 31- 100 BEDDED HOSPITAL
FOUR WELL DEFINED ZONES:
⁻ Protective Zone,
⁻ Clean Zone,
⁻ Aseptic or Sterile Zone and
⁻ Disposal or Dirty Zone
An Operation Theatre should also have
⁻ Preparation Room,
⁻ Pre-operative Room and
⁻ Post Operative Resting Room
The delivery Suit Unit should include the facilities of
accommodation for various facilities as given below:
Reception and admission
⁻ Examination and Preparation Room
⁻ Labour Room (clean and a septic room)
⁻ neo-natal Room
⁻ sterilizing Rooms FOR STORAGE OF VACCINES AND OTHER LOGISTICS :
⁻ sterile store Room Cold Chain Room: 3.5 m x 3 m in size.
⁻ scrubbing Room Vaccine & Logistics Room: 3.5 m x 3 m in size.
⁻ Dirty Utility WATER SUPPLY :
⁻ Newborn care corner in Labour room.
Approximately 450 to 500 litres of water per bed per day is required for a
⁻ Newborn care Stabilization Unit: Details at
100 bedded hospital.
IPHS-GUIDELINES FOR 31- 100 BEDDED HOSPITAL

PHYSICAL MEDICINE AND REHABILITATION: (PMR)

The department is more frequently visited by out-patients but should be located at a place
which may be at convenient access to both outdoor and indoor patients with privacy.
HOSPITAL KITCHEN (DIETARY SERVICE)
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.
CENTRAL STERILE 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.
MORTUARY:
It should be so located that the dead bodies can be transported unnoticed by the general
public and patients.
IPHS-GUIDELINES FOR 31- 100 BEDDED HOSPITAL
ROOMS : EMERGENCY -
OPD -CLINIC - DOCTOR CHAMBER INTENSIVE CARE UNIT AND HIGH DEPENDENCY WARDS
COUNSELLING ⁻ Nurse station
-NURSING SERVICES – DRESSING ROOM ⁻ Clean utility area
⁻ Side lab ⁻ Equipment room
⁻ Injection room OPERATION THETRE
⁻ Social service ⁻ Preparation room
⁻ Treatment rooms ⁻ Pre-operative rooom
⁻ Post operative room
DIAGNOSTIC SERVICES - CONSULTATION ROOMS
DELIVERY SUIT UNIT
⁻ Reporting rooms
⁻ Examination and Preparation Room
⁻ Technicians rooms
⁻ Labour Room (clean and a septic room)
⁻ Storage ⁻ Neo-natal Room
⁻ Waiting areas ⁻ Sterilizing Rooms
⁻ Imaging ⁻ Sterile Store Room
⁻ Clinical lab ⁻ Scrubbing Room
⁻ Blood storage unit ⁻ Dirty Utility
INTERMEDIATE CARE AREA ⁻ Post partum unit
⁻ General wards PHYSICAL MEDICINE AND REHABILITATION
⁻ Private wards HOSPITAL SERVICES -
⁻ Special wards ⁻ Management info system
WARD UNIT – NURSING STATION ⁻ Hospital kitchen
DOCTORS DUTY ROOM ⁻ Central sterile supply dept. (cssd)
⁻ Pantry ⁻ Hospital laundry
⁻ Isolation room ⁻ Medical and general stores
⁻ Treatment room ⁻ Mortuary
⁻ Nursing store ENGINEERING SERVICES
⁻ Toilets ⁻ Electrical eng
⁻ Public health eng
⁻ Fire protection