THESIS REPORT

ON

300 BEDDED MATERNITY HOSPITAL

Submitted in partial fulfilment of the

Requirement for the award of degree of
Master of Healthcare Architecture

Submitted by
Shubham Singh

Guided by
Ar. Arqam Khan

DEPARTMENT OF ARCHITECTURE
FACULTY OF ARCHITECTURE & EKISTICS

JAMIA MILLIA ISLAMIA

NEW DELHI-110025
2019-2020
 Faculty of Architecture & Ekistics,
Jamia Millia Islamia, New Delhi

Certificate
In the partial fulfilment of the Master of Healthcare Architecture (M. Arch)
degree program, this is to certify that ‘SHUBHAM SINGH’ has worked on the
Thesis report entitled “300 BEDDED MATERNITY HOSPITAL” under my
guidance and supervision.

Ar. Arqam Khan Dr. Hina Zia

(Guide) (Dean)

Prof. (Dr.) S M Akhtar

Head of the Department

External Examiner 1

External Examiner 2

External Examiner 3
 Declaration

I, Shubham Singh of M.Arch. Healthcare Architecture IV-Sem, hereby declare

that this Thesis report entitled “300 Bedded Maternity Hospital ” submitted in
the partial fulfilment of the requirements for the award of the degree of
Master of Healthcare Architecture (M. Arch.) is my own original work and
effort and that it has not been submitted anywhere for any award. Where
other sources of information have been used, they have been acknowledged
rightfully.

Shubham Singh
M. Arch | Healthcare Architecture
2019-20
 Acknowledgement

First of all I would like to thank the almighty God without whose blessings this
project would not have been possible.
I am grateful to have been able to select the topic for my thesis as it not only
helped me in learning about the Maternity healthcare System in India, but also
helped me in developing a design and thought process that will help me in my
career further.
It is a matter of great honour to express my heartfelt gratitude to the people
whose participatory efforts have contributed in the completion of this report.
Thanks to my thesis Guide Ar. Arqam Khan for his constructive guidance, his
inspirational teachings throughout the study which lead me to choose this
topic.
I would like to express my sincere thanks to my parents, and my friends
Hamza, Sanjar, Azhar and to all who supported me from time to time and also
all others who gave a hand of help, I say thank you very much.
 Contents
1 SYNOPSIS ..................................................................................................................................... 3

AIM: ...................................................................................................................................... 3

OBJECTIVES:.......................................................................................................................... 3

RATIONALE FOR SELECTION: ................................................................................................ 3

DESIGN BRIEF: ...................................................................................................................... 4

LIMITATION: ......................................................................................................................... 4

METHODOLOGY ................................................................................................................... 4

2 INTRODUCTION ........................................................................................................................... 5

3 HOSPITAL DESIGN ....................................................................................................................... 6

4 GYNAECOLOGY AND OBSTRETICS: .............................................................................................. 7

OBSTRETICAL UNIT ............................................................................................................... 8

Difference between gynaecology and obstetrics................................................................. 9

5 FUNCTIONAL REQUIREMENT: ................................................................................................... 10

6 Ward Ancillaries: ....................................................................................................................... 15

7 Planning of ICU:......................................................................................................................... 18

8 DESIGN CONSIDERATIONS: ....................................................................................................... 19

9 Spaces: ...................................................................................................................................... 19

10 DETAILED STUDY OF SPACES AND THEIR FUNCTIONAL RELATIONSHIP WITH EACH OTHER: .. 21

11 PREGNANCY (FETAL AND MATERNAL) ASSESSMENT UNIT: ..................................................... 22

12 BIRTHING FACILITIES (AND ASSOCIATED IN-PATIENT FACILITIES): ........................................... 24

BIRTHING SPACES: .......................................................................................................... 24

13 IN-PATIENT SPACES: .................................................................................................................. 26

14 HIGH DEPENDENCY AREA: ........................................................................................................ 27

15 OBSTETRIC OPERATING THEATRE SUITE:.................................................................................. 27

PREPARATION ROOM: .................................................................................................... 28

 LABOR ROOM: ................................................................................................................ 28

CAESARIAN SECTION ROOM ........................................................................................... 28

SCRUB FACILITIES ............................................................................................................ 28

RECOVERY ROOM ........................................................................................................... 28

16 ROOM LAYOUT OPTIONS: ......................................................................................................... 29

OPTION-1: SINGLE/TWIN BIRTH OPTION ....................................................................... 30

17 SPACE REQUIREMENT: .............................................................................................................. 31

18 FACILITIES/AREA CONSIDERED WHILE PLANNING HOSPITAL................................................... 34

19 CASE STUDY–............................................................................................................................. 35

20 Site ............................................................................................................................................ 44

21 DESIGN ...................................................................................................................................... 48

CONCEPT ......................................................................................................................... 48
 300 BEDDED MATERNITY HOSPITAL

1 SYNOPSIS

AIM:
To design a 300 bedded Maternity hospital in such a way that it acts as a cost and energy efficient
design with proper functionality, have all speciality departments regarding mother and childcare.
To study need of the maternity hospital in context with its design, circulation and function via
standards and case study and to draw, design criteria.

OBJECTIVES:
 Talk in term of planning.
 Designing the clusters as to make an easier flow for patients, doctors and other
paramedical staffs.
 To ensure that the hospital will have a safe and secure design against any natural or
manmade condition.
 Using built form, materials and finishes, including colours that blend in with the children
psychology & natural environment and that will achieve long lasting durability.
 To study about the historical design background of a mother and child care hospital.
 To determine the condition that create a healing environment of mother and children.

RATIONALE FOR SELECTION:

 Chief Minister Trivendra Singh Rawat announced that a new 300-bed maternity
hospital will be opened in Dehradun.
 The CM’s announcement made during the launch of the Ayushman Bharat Yojana in
the state came just days after the death of a 27-year-old woman who died along with
her newborn child while waiting for several days to get a bed at the Government
Doon Medical College and Hospital.
 To be constructed as a cost of Rs 164 crore, the 300-bed hospital will be Dehradun’s
second biggest government women hospital once functional.
 The 15 acres on which the hospital has to be constructed was donated by Mr. Rakesh
Oberoi, who is a local resident.
 The hospital will be named as Shakuntala Rani Sardarilal Oberoi Hospital after the
benefactor whose family has donated the land for the project.

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 300 BEDDED MATERNITY HOSPITAL

 The CM added that to provide emergency health facilities in the remote areas of the
state, air ambulance service will also be started and for this, the Centre has already
allocated funds.

DESIGN BRIEF:
 The whole design will include different departments such as; Out-patient department,
In-patient department.
 Diagnostic and therapeutic department, Emergency department,
 Administration and support services department, Child rehabilitation and recreation
department
 These will be integrated according to the functional requirements. And the vertical
stacking will be according to the needs and respective services provided.
 The children play and activity area will be built to have natural environment and will be
placed where it least disturb the hospital.

LIMITATION:
 Due to time constraints only, hospital building is under design consideration

METHODOLOGY
CASESTUDIES

Case studies to be done so as to be clear about the functionality of the hospital &come out from the
merits & demerits aspect of the hospital

LITERATURE STUDY

The literature study is from HBN, WHO GUIDELINES, Ministry of Health Family Welfare Guidelines, IPHS.
Also from online journals and extract inferences from these literature studies.

REQUIREMENT FRAMING AND AREA ANALYSIS

After case studies and literature study, requirements are framed out and area chart has to be finalized,
though it alter after final design but in initial stage it play the key role.

CONCEPT
Area analysis help in zoning layout of the function which further help in deriving concept plan. Before
Reaching the final stage concept has to be approved.

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 300 BEDDED MATERNITY HOSPITAL

2 INTRODUCTION
It is the hospital that specialize in caring for women while they are pregnant and during child
birth. The hospital also provides care for new born infants. Child birth is a life changing event
for women and families.

Architecture of hospitals have been changed and changing all through the ways from creating a
good form to humanizing hospitals. Things in the hospitals define a lot about the space and
create the atmosphere.
“Women are not dying because we cannot treat, they are dying because societies have yet to
make the decision that their lives are worth saving.”
Maternity mortality is a sensitive indicator. It helps to understand the health care system of a
state of the country and also indicates the prevailing socio-economic scenario.

The causes of death may be direct or indirect, the focus till now has largely been on addressing
the direct causes of maternal deaths. However, indirect causes also need to be addressed to
further reduce MMR and achieve the million development goal (mgd) on MMR. The indirect
causes that also include the socio-economic determinants of heath may be referred to as the
three known delays:
1. Delay in making a decision on the need for medical care.
2. Delay in reaching the appropriate facility in time.
3. Delay in initiating the correct treatment at the health facility.

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3 HOSPITAL DESIGN
Hospitals are the most complex of building types. Each hospital is comprised of a wide range of services
and functional units. These include diagnostic and treatment functions, such as clinical laboratories,
imaging, emergency rooms, and surgery; hospitality functions, such as food service and housekeeping;
and the fundamental inpatient care or bed-related function. This diversity is reflected in the breadth and
specificity of regulations, codes, and oversight that govern hospital construction and operations. Each of
the wide-ranging and constantly evolving functions of a hospital, including highly complicated
mechanical, electrical, and telecommunications systems, requires specialized knowledge and expertise.
No one person can reasonably have complete knowledge, which is why specialized consultants play an
important role in hospital planning and design. The functional units within the hospital can have
competing needs and priorities. Idealized scenarios and strongly-held individual preferences must be
balanced against mandatory requirements, actual functional needs (internal traffic and relationship to
other departments), and the financial status of the organization.

In addition to the wide range of services that must be accommodated, hospitals must serve and support
many different users and stakeholders. Ideally, the design process incorporates direct input from the
owner and from key hospital staff early on in the process. The designer also has to be an advocate for the
patients, visitors, support staff, volunteers, and suppliers who do not generally have direct input into the
design. Good hospital design integrates functional requirements with the human needs of its varied users.

The basic form of a hospital is, ideally, based on its functions:

 bed-related inpatient functions

 outpatient-related functions
 diagnostic and treatment functions
 administrative functions
 service functions (food, supply)
 research and teaching functions

What Types of Treatments Do Mother and child care hospital Provide?

It provide wide variety of illnesses and medical needs who require hospital care. Such medical needs
includes.

 Infectious illnesses of the blood, skin, lungs, and kidneys

 Respiratory illnesses such as pneumonia and croup
 Problems with chronic illnesses such as diabetes and asthma
 Common paediatric illnesses such as influenza and dehydration
 Care of new-born.
 Gynaecological problem.
 Obstetrical problem

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4 GYNAECOLOGY AND OBSTRETICS:

Gynaecology and obstetrics deals with care at every stage of life—from adolescence to
menopause and beyond. The Department of Gynaecology and Obstetrics offers the full
spectrum of women’s health care services, including yearly check-ups, child birth, prenatal
care and advanced gynaecologic surgeries, treatments and diagnosis. Whether it’s about
routine care, birth control, fertility or a gynaecologic cancer, all come under this department.
The difference in both is that gynaecology deals with the functions and diseases related to
women and obstetrics deals with the child birth and new born care.

The major specialties with which this department deals is:

 Routine Gyne Care

 Pregnancy and Giving birth
 Family Planning
 Fertility Centre
 Cancer Care
 Gynaecologic Surgery and Uro gyanecology

GYNAECOLOGY needs no special accommodation and may be treated in the gynaecology

section of surgical wards but modern gynaecology, especially laparoscopic surgery commonly
referred to as keyhole surgery, so requires special equipment and is performed in the
operating rooms. If we further classify the gynaecology care, it deals with the specialties like;

 Cervical Dysplasia
 Endometriosis
 Fibroids
 Gynaecological Cancers
 Infertility
 Menopause
 Menstrual Disorders
 Ovarian Cysts
 Pelvic Floor Disorders
 Urinary Incontinence

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 300 BEDDED MATERNITY HOSPITAL

OBSTRETICAL UNIT
It require special facilities. Hospitals are responsible for furnishing safe and efficient obstetrical
care that ensures utmost safety and comfort for the mother and the new-born child. Usually,
patients are kept in a separate wing of the hospital to avoid infection. Two specific areas make
up the obstetrical department:-

(a) PATIENT ACCOMMODATION: - which may consist of private and semi-private rooms and
general wards

(b) CLINICAL FACILITIES:-which consist of a preparation room, pre-delivery or labour room(s),

birth or delivery room(s) and nursery.

In addition to the above, the obstetrical department requires the services of a host of adjacent
and ancillary departments such as clinical laboratory, X-ray and ultrasound. The Obstetric Unit is
a discreet Unit providing facilities for the safe prenatal care, delivery and post natal care of
mothers and their babies. The number of birthing preparation rooms and the size of the
associated service areas shall be as required by the proposed obstetrical workload as outlined in
the Operational Policy.

The obstetrics department specialities are further divided as;

 Antepartum testing: Prenatal Diagnosis and Treatment Centre

 Birthing and breastfeeding classes
 Foetal diagnostic procedures
 Foetal therapy: Centre for Foetal Therapy
 Genetic counselling: Prenatal Diagnosis and Treatment Centre
 Labour and delivery: Birthing Centre
 Maternal-foetal medicine (High-risk pregnancies)
 Multiple pregnancy management
 Neonatal intensive care (NICU)

Obstetrics consists of the following processes:

 Labour.
 Delivery/ Birthing.
 Recovery.
 Postnatal (or Post-Partum).
 Separate from these 4 processes, the baby infant nurseries.
 The four main sections are:
 Out-patient and emergency services,
 Diagnostic and therapeutic services,

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 300 BEDDED MATERNITY HOSPITAL

 In-patient nursing units (wards), and

 Administrative, non-clinical and engineering support services.

This department also includes antenatal care, delivery and post-natal care, before and after child
birth, the patient should be attended to in the out-patient clinic and during labour the patient is
confined to bed in then using unit. The out-patient clinic should also provide diagnostic facilities
for gynaecological patients. Since these services are cyclic, it is recommended to place the in-
patient unit close to the out-patient clinic making it easily accessible to the child bearing women.

Difference between gynaecology and obstetrics

Gynaecology normally means treating women who aren’t pregnant, while obstetrics deals with
pregnant women and their unborn children, but there is lots of crossover between the two. For
example, women may be referred to gynaecologists in the earlier stages of pregnancy, and
obstetricians later in their term

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 300 BEDDED MATERNITY HOSPITAL

5 FUNCTIONAL REQUIREMENT:
 Out Patient and Emergency Services:
These are needed to perform following chief functions, namely:
a) To diagnose and treat patients at an early stage,
b) To follow up treatment after discharge from the maternity nursing home, and
c) To institute health education programme to educate the public in environmental hygiene.
These shall comprise of obstetric and gynaecological, family welfare, paediatric and general
purpose clinics.

 Obstetric and Gynaecological Clinic:

The clinic should include consulting-cum-examination room(s), treatment, and supported
with clinical laboratory. Facilities should be available for antenatal patients to undergo
certain formalities prior to examination such as a toilet and change.
 Family Welfare Clinic:
The clinic should provide educative, preventive, diagnostic and curative facilities for
obstetrics and gynaecology treatment, paediatric and health education. Treatment room
in this clinic should act as operating room for IUCD insertion and investigation etc.
 Paediatric Clinic
The clinic should provide medical care for infants (including new born) and children up to
the age of 12 years. Owing to risk of infection, it is essential to isolate the clinic from other
clinics. The clinic shall be provided with a separate dressing, treatment and immunization
room.
 General Purpose Clinic :
The clinic may cater consultation in the field of general medicine, general surgery, eye
and ENT. The consulting room of the clinic may be shared by the consultants by fixing
specific hours of specialty consultation.
 Emergency Unit:
The unit comprising examination cubicle, treatment and an observation room may be
scheduled to function outside out-patient clinics hours. The unit close to entrance lobby
should be provided for emergent cases so that a very minimum time is lost in giving
immediate treatment.
 Supporting Facilities:
Supporting facilities in common, namely, waiting spaces, clinical laboratory and injection
room should be provided.
 Clinical laboratory:
A small clinical laboratory for quick investigations and sample collection facilities should
be provided close to injection room with all essential requirements.

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 300 BEDDED MATERNITY HOSPITAL

 Injection room:
 Pharmacy (Dispensary):
 Diagnostic and Therapeutic Services:
Pathology and radio-diagnosis are the diagnostic function whereas surgical-cum-
obstetric suite unit is the therapeutic service which should be provided for a
Maternity nursing home.
 Pathology:

Pathology is concerned with the analysis of diseased tissue or fluid and other elements in the
body. It may comprise activities like biochemistry, clinical pathology and haematology.

 Biochemistry laboratory:
Biochemistry laboratory is concerned with chemical analysis of body tissue and fluids.
 Clinical pathology and haematology laboratory:
It is concerned with the study of urine, stool and blood specimens. Each laboratory should
be provided with600 mm wide and 800 mm high bench of length about1.6 m per
technician. Each laboratory bench shall have laboratory sink with swan neck fittings,
reagent shelving, gas and power point and under counter cabinet. Top of the laboratory
bench shall be of acid and alkali-proof material.
 Blood transfusion:
States/Union territories shall enact rules for registration of maternity nursing homes
wherein provision for affiliation with a licensed blood bank for procurement of blood for
their patients shall be incorporated.
 Radio-diagnosis:
The diagnostic unit of the maternity nursing home generally deals with radiography and
ultrasound to cover its basic need. Beside X-ray and ultrasound rooms, a film developing-
cum-processing room, and a room for the radiologist/technician should be
Provided for the unit.
 Radiography room:
The room should have a sub waiting area with a toilet and a change room facility. The
radiography unit should be operated from a separate control cabin or behind lead mobile
protection screen of 1.5 mm lead equivalent. From radiation protection and safety point
of view, normal one brick wall thickness is adequate.
 Ultrasound:
For ultrasound room, a patient toilet either accessible from the procedure room or from
the corridor, shall be provided.
 Consultation area:
An appropriate area for individual consultation with referring clinicians and for quality
control that is for viewing film shall be provided.

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 Obstetrical-cum-Surgical Suite:
A high degree of asepsis should be ensured to provide environment for staff and patients.
Zoning shall be done to keep the suite free from microorganisms. There shall be four well
defined zones of varying degree of cleanliness. These are protective, clean, sterile, and
disposal zones. The suite should comprise of obstetrical (delivery suite unit), operation
theatre unit for conducting gynaecological and general surgical operations. The suite
should include facilities described here after. Since delivery and operating rooms are in
the same suite, access and service arrangements shall be such that neither staff nor
patients need to travel through one area to reach the other.
 Zoning traffic flow:
It should be ensured that flow of traffic from one zone to another is arranged through
proper barrier nursing .All soiled material both disposable and non-disposable should
move without crossing the sterile and clean zone. Non-disposable material like
instruments, etc., should be cleaned in dirty wash and they shall be returned for
sterilization. All communication between the operation theatres, dirty utility, and
instrument layup shall be carried out through well designed hatches or a door through
which the material is passed.
 Circulation:
Normally there are three types of traffic flow, namely
(a) Patients,
(b) Staff, and
(c) Supplies.
All these should properly channelized. Patients are brought from ward and should not
cross the transfer area in their ward clothing which is great source of infection.
Changeover of trolleys should be done at a place which will link up both pre-operative
and post-operative rooms. Staff should enter from a separate route and through a set of
change rooms.
All sterile goods should have a separate entry point reaching the clean corridor
independently.
 Comfort condition:
An optimum comfort level in the operation theatre/delivery room is of vital importance.
Temperature between 16 to 21°C and with 50 percent humidity shall be maintained
through air-conditioning. Ventilation should be of 15 to 20 air changes per hour.
 Reception bay and relative waiting:
Reception bay with a relative waiting shall be provided close to the suite. Many a time,
patient may arrive in a state of imminent delivery, who can be received at the reception
bay. Waiting room with toilet facility for the relatives attending the patients to wait and
meet them after operation/delivery should be provided.

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 Change rooms:
 Theatre pack preparation room:
It should be a work room for arranging of sutures, dressings and all other surgical items.
 Pre-operative room:
Patients are transferred from ward to this room for premedication before
surgery/delivery. The room should have toilet facility.
 Examination and preparation room for delivery suite unit:
The room should accommodate one or two beds and provide space for the doctor with
the work table, etc. change room with attached toilet facilities shall be provided with the
examination cubicles. The provision of lockers for keeping the personal clothes and
articles may also be kept in view.
 Recovery room:
Immediately after the operation, the patients are kept in this room until such time they
are found fit to be taken back to their parent ward/room.
 Labour room(s)/labour delivery recovery room(LDR):
A minimum of two labour beds shall be provided for each caesarean/delivery room. Each
room shall be designed for either one or two beds. Each labour room should contain hand
washing fixture and to have access to toilet which may serve 2 labour rooms. Labour
Delivery- Recovery room to accommodate the birthing process from labour through
delivery and recovery of mother and baby may be provided if so desired.
 Delivery rooms:
Delivery rooms shall be of the following types:
a) Clean delivery room for normal deliveries,
b) Operation theatre for caesarean, and
c) Septic delivery room.
Delivery rooms shall preferably be provided at the rate of one for every 20 maternity
beds.
 Operation theatre/delivery room:
Operating room/delivery room should be made dustproof, moisture proof, corners and
junctions of walls, floor and ceiling coved to prevent accumulation of dust and to facilitate
cleaning. Its door should be two leaf type with a minimum 1.5 m width and shall have
self-closing devices. Natural lighting and general illumination should be provided. The
operating room/delivery room should be normally arranged in pairs so as to have scrub-
up and instrument sub-sterilizing/layup room facility in common.
 Scrub-up:
 Instrument sterilization:
It is a sub-sterilizing unit attached to the operation theatre/delivery room limiting its role
to sterile operating instruments on an emergency basis only, and lay-up instrument

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 300 BEDDED MATERNITY HOSPITAL

trolley. This room should be equipped with high pressure, quick sterilization apparatus,
and work top with sink and storage cabinets.
 Dirty utility:
Operation theatre/delivery refuse such as dirty linen, used instruments and other
disposable/non-disposal stuff is removed to this room after each procedure.

 In-patient Nursing Units (Wards):

In-patient services shall comprise of
a) Maternity ward,
b) Paediatric ward,
c) Neo-natal care unit,
d) Private ward, and
e) Intensive care unit.

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6 Ward Ancillaries:
Each of the nursing unit or ward should have a set of ward ancillaries.
 Nursing station:
It should be positioned in such a way that the nurse can keep a continuous watch over
the patients.

 Treatment room:
For carrying out major dressing and complicated treatments to avoid the risk of cross
infection.
 Ward pantry:
For collection and distribution of meals and preparation of beverages
Ward store:
A store for storing the weekly requirements of clothes, bed sheets, and other ward
equipment shall be provided.
 Sluice room:
A room shall be provided for emptying and cleaning bed pans, urine bottles, and sputum
mugs, disposing of used dressing and similar material, stool and urine specimen, etc.
 Day space:
For those patients who are allowed to sit and relax, as pace shall be provided. It should
afford an easy access to patients and supervision by nursing staff and should be provided
with easy chairs, book shelves. It may serve as dining space.
 Sanitary:
Toilet for an individual room (single or two bedded) in ward unit shall be of 3.5 sq.mts
Toilet common to serve two such rooms shall be 5.25 m2 comprising a bath, a wash basin
and a WC. For multiple beds of a ward unit, a lavatory block comprising of WC cubicle at
1for every 6 beds or part thereof, wash basin and shower bath cubicle at 1 each for every
12 beds or part thereof shall be provided. One bed pan sink and cleaner’s sink for washing
mackintosh shall also be provided.
 Maternity Nursing Unit (Ward): Nursing unit shall include ante-natal, post-natal,
eclampsia, post-operative and gynaecological beds.

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 Ante-natal beds:
The female patients admitted for treatment during the period of their pregnancy should
be in these beds separate from those who have undergone the labour.
 Post-natal or Lying-in beds:
Patients who have had normal deliveries and do not suffer any complication, calling for
medical care are forming these beds. The size of the bed space depends upon whether
the babies are kept with the mothers oral babies are kept in the central nursery. It is
recommended that in case of normal deliveries, the healthy babies may be kept with the
mothers in the baby cradle attached to the bed/placed by the side of the patients

 Eclampsia bed: is a disorder of pregnancy characterized by the onset of high blood

pressure and often a significant amount of protein in the urine.[1][8] When it arises, the
condition begins after 20 weeks of pregnancy
 Post-operative beds:
The post-operative beds for the patients who have undergone operation shall be able to
accommodate two beds per operating delivery room including operation theatre. Area
per bed may be 8.75 m.
 Gynaecological beds:
The proportion of gynaecological beds should be 40percent of the maternity beds.
 Paediatric Ward:
A separate ward unit shall be provided. The ward unit shall have at least 25 percent of
patients in isolated cubicles in single and two bedded rooms. These cubicles should be
separated through glazed partition for better supervision. Each pair of cubicles may be
provided with a common toilet of 5.25 m2 having WC, bath and wash basin.
 Neo-natal Care Unit:
Wellbeing of the new born becomes the responsibility of the paediatrician. A separate
neo-natal unit to include high dependency and low dependency should be established as
independent sub-units. Facilities like nurseries, nurses’ station, formula-cum-breast
feeding room, store, photo therapy and sluice room should be provided.
 High dependency unit:
Low birth weight and premature babies in individual heated bassinets or incubators with
temperature and humidity control should be accommodated and oxygen outlet installed.
They should also have electronic monitoring facilities.
 Low dependency unit:
Babies with problems that need short-term observation or treatment are kept in this
unit.

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 Nurses station:
 Formula-cum-breast feeding room:
A formula-cum-breast feeding room shall be provided close to the nurse’s station for the
preparation of food for the infants who are not fully breastfed. There shall washing and
sterilizing of feeding bottles facility in the room.
 Intensive Care Unit:
In this unit, critically ill patients requiring highly skilled lifesaving medical aid and nursing
care are concentrated. These should include major surgical and medical cases. It should
be the ultimate Medicare the maternity nursing home can provide with highly specialized
staff and equipment. The number of patients requiring intensive care may be 2 percent
of the total bed strength, however the unit shall have minimum of4 beds.
This unit should be located close to obstetrical-cum-surgical suite so that the staff and
ancillaries could be shared. This unit will also need all the specialized services such as
suction and medical gases, continuous electric supply, heating, ventilation, air-
conditioning and efficient lift services. A good natural light and pleasant environment
should also be of great help to the patients and staff as well.
 Floor space: All beds in this unit are to be arranged in glazed cubicles with centrally
located nurse’s station. The area per bed in this unit preferably should be 15.5 m2 to cater
for free movement, check against infection and at time utilization of specialized bulky
equipment’s.

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7 Planning of ICU:
The basic consideration in planning of ICU should be to have,
a) A fully visible patients area with adequate space all round for positioning of specialized
equipment;
b) A central nurses station with minimum possible walking distance;
c) An adequate stock of medicines;
 Equipment-cum-intensive care laboratory:
This should provide for immediate clinical tests and investigations. All essential testing
equipment should be housed in it.

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8 DESIGN CONSIDERATIONS:
 ANTENATAL CLINIC:
Antenatal clinics may also be used as gynaecology clinics. There are likely to be local
variations in where the early pregnancy assessment unit (EPAU) is located. The EPAU is
usually separate from the antenatal clinic, but nearby to allow patients with unexpected
problems on scanning to be referred easily.
. Wall décor should be non-clinical in nature and not adorned with medical diagrams.
 Specific clinical areas include:
• A suite of standard/multidisciplinary consulting and examination (C/E) rooms;
• Ultrasound rooms, which may be shared with the EPAU.
The size of the antenatal clinic suite will depend on the number of expected attendances
per session, the number of proposed sessions, the number of doctors and midwives, and
the number of education classes.
Clinic sessions may be dedicated to women with specific care needs, for example
Diabetes, other medical conditions or pregnancy.
 Functional relationships :
C/E rooms should have easy access to ultrasound. The link to pathology services may be
by way of a pneumatic tube transport system. Near-patient testing facilities may be
provided within the unit, depending on local policy. There should be easy access to the
birthing area and maternity in-patient beds.

9 Spaces:
Reception and waiting: The waiting area should have a welcoming and informal
atmosphere. Many pregnant women will be accompanied by a friend or relative and may
have small children with them. The area should be planned so that it can be subdivided
into separate waiting spaces. Within or adjacent to the waiting area, an
information/resource space should be provided. This is likely to include a combination of
printed and electronic media.
 Consulting/examination rooms:
A general-purpose single-sided C/E room should be used, to increase flexibility of use.
The C/E room will be large enough to accommodate electronic monitoring and diagnostic
equipment. The examination couch should be screened by a curtain to allow privacy. The
couch needs to be accessible on the right-hand side and at the foot. The design and layout
of the room should ensure that the privacy and dignity of the woman is protected.
Acoustic privacy is also important.

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Source :internet Source :internet

Treatment room:

A treatment room may be required for diagnostic and clinical

procedures, which may include specimen collecting and
cardiotocography (CTG). A couch and two chairs should be
provided, along with an adjustable examination lamp. A
clinical wash-hand basin is required. Adequate space is
required for mobile surgical trolleys, and monitoring and Source :internet
diagnostic equipment.

Ultrasound rooms:

A standard treatment room with black-

out and a dimmable lighting system is
appropriate for the procedures carried
out in this clinic. An examination light
should be provided. Privacy for women
dressing and undressing is essential.
Seating is required for the sonographer
and the woman’s escorts. In accordance
with current policy, instruments will be
sent to central sterilizing facilities.

 WCs: WC facilities should be

provided immediately adjacent
to ultrasound rooms. One WC is required per scanning room; one should be an accessible
WC. Additional WCs should be available in the waiting area.
 Support spaces :
Support facilities are required as for the antenatal clinic, with which they may be shared.

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 EARLY PREGNANCY ASSESSMENT UNIT:

The Early Pregnancy Assessment Unit (EPAU) is a specialised clinic dedicated to providing
care to women in early pregnancy Within a Consultant-led unit (CLU), a dedicated early
pregnancy assessment unit may be required with its own reception and waiting area. This
may be co-located with the gynaecology clinic/ward, with which it may share certain
facilities. For reasons of privacy and dignity, patient spaces in a dedicated EPAU should
be physically separate from the antenatal clinic and the pregnancy assessment unit.
 Specific clinical areas include:
o (pre-scanning);
o ultrasound room(s), although ultrasound facilities close by may be used;
o interview room(s) (post-scanning)

10 DETAILED STUDY OF SPACES AND THEIR FUNCTIONAL RELATIONSHIP WITH EACH OTHER:
A key consideration in its location is ease of accessibility for staff. It should also be within easy
reach of the in-patient beds and the operating theatre suite. Women who need to be admitted
overnight will be transferred to an in-patient area.

There should be good links to pathology facilities and the blood transfusion service. WCs should
be immediately adjacent. Easy access is required to rest facilities and counselling facilities.

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11 PREGNANCY (FETAL AND MATERNAL) ASSESSMENT UNIT:

Facilities are required for, ultrasound, phlebotomy, amniocentesis (invasive testing) and
continuous CTG. These may take the form of individual rooms and/or multi-bay spaces.
Reclining chairs and possibly beds should be provided, with access to ultrasound facilities
within or adjacent to the unit.
 Functional relationships :
The pregnancy assessment unit should ideally be located close to the birthing facilities. It
would then have access to emergency laboratory facilities. If the same workforce is
shared between the antenatal clinic and the pregnancy assessment unit, the proximity of
the two units is desirable.
 Pregnancy assessment room/bays :

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These are multi-use rooms with reclining chairs for performing CTGs. Sufficient space
should be provided by the recliners for using the CTG monitor and mobile ultrasound
machine. Curtains should be provided round each area.

Source: Internet
Source: Internet

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12 BIRTHING FACILITIES (AND ASSOCIATED IN-PATIENT FACILITIES):

In-patient accommodation should be easily accessible from, and within a short distance of, the

hospital entrance. Antenatal and postnatal areas should be co-located for flexibility and they
should not be located adjacent to gynaecological facilities.

BIRTHING SPACES:
 Birthing rooms :
The key principles for the design of birthing rooms are:
 ensuring the safety of mothers and babies;
 offering people privacy, dignity, comfort and freedom of movement;
 enabling staff, equipment and services to be available to women in one place, that is,
without them being moved;
 being functionally suitable for all activities that will take place in them;
 providing flexibility in their use both on a short-term basis and as needs and policies
develop;
 Reducing the risk of cross-infection.
 Providing access to water during labour to relieve pain.

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 All birthing rooms should include the following:

 sanitary facilities;
 convenient storage for the mother’s holdall and belongings;
 access to facilities to make hot drinks and to cold water;
 Local storage within or adjacent to the room for storage of equipment, sterile packs
etc. out of sight until required. Storage facilities will be fitted out to meet project-
specific storage requirements;
 Medical gas outlets (including oxygen, nitrous oxide/oxygen and vacuum) at the
bedhead for the mother.

Source: Internet

Source: Internet Source: Internet

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 Bed location and privacy

It is recommended that the bed is located around the corner from the door/entrance
location of the room to assist in protecting the woman’s privacy, within a room
depending upon the bed location and the use of a privacy screen.

 Storage at the head of the bed :

The storage zone shown at the head of the bed was only suitable for consumables and
small trolleys/CTG equipment. Storage space or consumables only amounts to three
small storage boxes-worth (approximately 150H × 150W × 300L each) and space for a
spare set of linen. 8.32 The size of the opening in the storage must allow easy access in
an emergency.

13 IN-PATIENT SPACES:
 Antenatal and postnatal bed spaces :

Single rooms are preferred for privacy and dignity reasons and to reduce noise (postnatal).
Bed spaces for antenatal and postnatal care should ideally be co-located and the rooms
should be suitable for both antenatal and postnatal care for maximum flexibility.

Standard single rooms are suitable for antenatal care and for postnatal care accommodating
twins.

A variable-height baby’s cot(s) will be provided in rooms used postnatal. In the event of an
emergency, a mobile resuscitative for the baby will be brought into the room.

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All single bedrooms should have en-suite WC, wash basin and shower facilities. It should be
possible to push sane-chairs easily into WCs.

Source: Internet

14 HIGH DEPENDENCY AREA:

The birthing rooms and single bedrooms will generally be suitable for postnatal high dependency
care. However, after giving birth, some mothers with suspected complications will need more
intensive monitoring than might be provided in the birthing/postnatal area, usually for short
periods. The four-bed space should be sufficient, but project teams will need to confirm that this
is appropriate for their local needs. Consideration may be given to equipping and servicing the
spaces as for a theatre recovery area. Mobile monitoring equipment can allow privacy without
compromising safety (such as for a woman who is in labour).

Depending on the location of the theatres and the maternity unit, the high dependency area and
the theatre recovery areas can be co-located.

15 OBSTETRIC OPERATING THEATRE SUITE:

In designing the labor and delivery suite, attention must be focused on four or five
major functional areas:-
 Preparation room
 Labor room(s)
 Delivery room(s)
 Recovery room
 Support service area.

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PREPARATION ROOM:
 Patient have to be prepared for labor and delivery. The patient is given a bath, is shaved
and given a enema before being sent to the labor room. The preparation room should
be located within the labor delivery suite but away from the labor and delivery rooms.
The room follow the procedures in connection with preparation such as an examining
table, bath, wash basin, kit for giving enema and preparation tray .A locker to keep the
patient’s clothes. If the hospital has an adequate number of single labor rooms, they
eliminate the need of patient preparation room and observation room for suspected
infectious patients.

LABOR ROOM:
 This is the room in which the patient remains during the first stage of labor, that is, from
the time the pains commence till she is ready to be moved to the delivery room. They
must be of adequate size, preferably 5.48 by 5.48 meters (18 ft by 18ft). The labor rooms
must provide maximum comfort and relaxation to the patient.
 The labor rooms should not be close to the delivery rooms, but not so close that the two
areas are almost one or that the patients can overhear or view delivery room procedures.

DELIVERY ROOMS
 These should be similar to operating rooms in their design with finishes that promote
maximum aseptic conditions. Facilities provided in the delivery room are essentially the same
as for the surgical suite. They are: Scrub-up area with view windows to observe the delivery
room, where possible, general lighting and operating lights, oxygen, suction and air, a clock
with a seconds timer, built in protection against explosion hazards, equipment and supplies.

CAESARIAN SECTION ROOM

It is strongly recommended that there should be an operating room in the department
where major obstetrical surgeries are performed. If this is not possible, one of the
delivery room may be completely equipped.

SCRUB FACILITIES
Two scrub positions should be provided near the entrance to each delivery room. One
area with three positions may serve two delivery rooms if they are adjacent. It is desirable
to have a viewing window at the scrub station to permit observation of delivery room
interiors.

RECOVERY ROOM
Recovery rooms should be designed for close observation and special care of the mother
by the labor and delivery staff. Modern maternity departments tend to have a recovery

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room comparable to the surgical post-anesthesia recovery room where all post-partum
patients are watched by the nurse or the doctor at least during the first six hours after
delivery for evidence of delayed hemorrhage.

 FUNCTIONAL RELATIONSHIPS:
 EXTERNAL
 The Obstetric Unit shall be located and designed to prohibit non-related traffic
through the unit. When Birthing and Operating Rooms are in close proximity, access
and service
 Arrangements shall be such that neither staff nor patients need to travel through one
area to reach the other.
 INTERNAL
 The entrance to the unit
shall provide direct access
to the reception area.
Adjacent reception
separate waiting areas are
required for males,
females and families.
From there, direct access
to assessment/
consultation/
examination, nursery,
inpatient and birthing
areas shall be provided
.

16 ROOM LAYOUT OPTIONS:

Single/twin birth – room layout options:

The overall room area will be dependent on the relationship of associated spaces (clinical wash-
hand basin, storage and en-suite) and

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OPTION-1: SINGLE/TWIN BIRTH OPTION

OPTION-2: SINGLE/TWIN BIRTH

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17 SPACE REQUIREMENT:

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Source:Indian Standards:BIS 2010

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18 FACILITIES/AREA CONSIDERED WHILE PLANNING HOSPITAL.

 Operation Theatre
(i) Operation Theatre a. One OT for every 50 general in-patient beds.
b. One OT for every 25 surgical beds.
(ii) ICU beds -5 to 10 % of total beds.
(iii) Floor space for each ICU bed= 25 to 30 sq m (this includes support services).
(iv) Floor space for Paediatric ICU beds= 10 to 12 sq m per bed.
(v) Floor space for High Dependency Unit (HDU)= 20 to 24 sq m per bed.
(vi) Floor space Hospital beds (General)= 15 to 18 sq m per bed.
(vii) Beds space = 8 sq m per bed.
(viii) Minimum distance between centers of two beds= 3.4 m .
(ix) Clearance at foot end of each bed.
DOCTORS CONNECTTION PATIENT AND VISITOR’S CONNECTTION:

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19 CASE STUDY–

CHACHA NEHRU BAL CHIKITSALAYA HOSPITAL

Chacha Nehru Bal Chikitsalaya is being developed as a state of the art super speciality pediatric
hospital with a bed strength of 221 to provide comprehensive medical care for all pediatric
related medical and surgical illnesses under one roof. It is located at Geeta Colony, Delhi in an
area of 1.6 hectare. Besides providing medical facilities it is being developed as a Post Graduate
Teaching/Training institute.
The Delhi government's Chacha Nehru Bal Chikitsalaya, the first public hospital to be certified by
the National Accreditation Board for Hospitals & Healthcare Providers (NABH), seems to be
struggling to save its child patients.
PROJECT INFORMATION
LOCATION- Geeta Colony, New Delhi, Delhi 110031
PLOT AREA: 1.6 hectare, 3.95 acres, 16000 Sq.m
SPECIALITY: Maternity and Pediatric Hospital

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SERVICES AVAILABLE

1. General Paediatric

2. Paediatric Nephrology

3. Paediatric Neurology Including EEG

4. Paediatric Gastroenterology Including Endoscopy

5. Hemato-onco Including Thalassemia

6. Polio Corrective Surgery & Rehabilitation Centre for Physically Handicapped

7. Paediatric Surgery with Endo Surgery/ Endo Urology

8. ENT

9. Ophthalmology

10. Paediatric Respiratory

11. Radiology Services

12. Diet Counselling

13. Integrated Counselling and Testing Centre

14. Paediatric Anaesthesia

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15. Orthopaedic Surgery

16. Physiotherapy and Occupational Therapy including Speech Therapy

17. Dermatology

18. Immunization

19. Dentistry

20. Neonatal Intensive Care

21. Paediatric Intensive Care

22. Laboratory Services

23. Child Guidance Clinic/Safe Parenting Clinic

24. Child Psychology

25. Dots Centre

SERVICES NOT AVAILABLE

1. Paediatric Cardiac Surgery

2. Paediatric Neurosurgery Including Head Injury

3. Burns and Plastic Surgery

4. Polytrauma

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FLOOR PLANS

FACILITIES ON GROUND FLOOR

1. Registration

2. OPD

3. Radiology

4. Pharmacy

5. Orthopedic

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6. Wards

7. Emergency

8. Minority

9. Dialysis

10. Kitchen

11. MRD dept.

FACILITIES ON FIRST FLOOR

1. Admin dept.

2. Private Wards

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3. Labs

4. OPD

5. Blood Bank

6. Sample Collection

7. NICU

8. IPD wards

9. Stored

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FACILITIES ON SECOND FLOOR

1. Operation Theatre

2. ICUs

3. Auditorium

4. PICU

5. NICU

6. Private Wards

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TYPICAL FLOOR 3RD - 5TH

1. General wards

2. Private Wards

MERITS:

1. Courtyard planning with well ventilation.

2. Huge area for registration.

3. There is a provision of ramps connected to al floors.

4. Blood bank and CSSD are located on adjacent and connected vertically.

5. Separate entry for OPD, IPD, and Emergency.

6. Sample collection area is located near to the OPD entry.

7. Interior was done in such a manner to suite to children psychology which was very attractive
for children.

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DE-MERITS:

1. Provision of waiting for OPD was very less.

2. Location of Dispensary was not appropriate.

3. Number of toilets were not sufficient.

4. Size of corridor was not sufficient.

5. There was no waiting space provided in emergency department.

6. No triage space was provided in emergency

7. Number of lifts are very less and located was very far from OPD department.

8. There was no provision for central gas-manifold, every floors had its own gas supply from
separate cylinders which were placed in the corridors.

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20 Site
DEHRADUN

Nestled in the mountain ranges of the Himalayas, Dehradun is one of the most beautiful cities in
the sub mountain tracks of India, known for its scenic surroundings. The name Dehradun is a
collection of two words “dera” meaning camp and “dun” meaning valley.

It is also known as one of the oldest cities in India, it is believed that Lord Rama and his brother
did penance here for killing Ravana, the demon king.

Under the British, Dehradun became an elite town with many a fine institution like Forest
Research Institute, Doon School and Welham Schools for girls and boys, many more, like the
ONGC and Wadia Institute of Himalayan Studies, were added in time. Dehradun has now become
an important tourist destination.

Dehardun Climatic Conditions

POPULATION: 12,79,083 (2001 census).

ALTITUDE: 960 m.
AREA: 300 sq km.
COORDINATES: 30.253168, 78.096623
LANGUAGES: Hindi and English

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CONNECTIVITY

NEAREST AIRPORT
Jolly Grant Airport, Dehradun 19.1 KM

NEAREST RAILWAY STATION

Dehradun Railway Station 9.8 KM

NEAREST BUS TERMINAL

Dehradun Inter-State Bus Terminal 12.5 KM

The site lies in the residential zone according to the Dehradun master plan 2020.

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SITE LOCATION
The site is located in the Harrawala Township of Dehradun near the Dehradun-Haridwar
Highway and adjacent to Nokronda road.

SITE DETAILS

AREA: 7.17 ACRES (29000 SQ. M)

BYE LAWS
FAR: 250
GROUND COVERAGE: 30% (MAX. PERMISSIBLE)
MAX. HEIGHT: 30M
SETBACKS: 15M (FRONT), 6M (SIDES)
ECS: 1.5

SITE CONTEXT

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SITE ZONING

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21 DESIGN

CONCEPT
Design concept evolved through modular space planning
accomodating all the requirements in modules. Enabling
efficient use of resources and time during constructions as
well when functioning. Beyond efficiency it has advantages of
flexiblity too. Modularity leads to a costant design
vocabulary.

SHUBHAM SINGH | HCA-IV SEM 48