NAME:SHUBHAM KUMAR

REG. NO. 1180100787

INDIAN PUBLIC HEALTH

STANDARDS FOR
DISTRICT HOSPITAL
1.1 INTRODUCTION
The district hospitals cater to the people living in urban and the rural people in the
district. District hospital system is required to work not only as a curative centre but
at the same time should be able to build interface with the institutions external to it
including those controlled by non-government and private voluntary health
organisations. The current functioning of most of the district hospitals in the public
sector are not up to the expectation especially in relation to availability, accessibility
and quality. The staff strength, beds strength, equipment supply, service availability
and population coverage are not uniform among all the district hospitals.Most of the
district hospitals suffer from large number of constraints such as:
● Buildings are either very old and in dilapidated conditions or are not
maintained properly,because of lack of convergence with the maintenance
department.
● The facilities at district hospitals require continued upgradation to keep pace
with the advances in medical knowledge, diagnostic procedures, storage and
retrieval of information.
● It has been observed that development of hospitals is not keeping pace with
scientific development.
● A typical district hospital lacks modern diagnostics and therapeutic equipment,
proper
● emergency services, intensive care units, essential pharmaceuticals and
supplies, referral support and resources.
● There is a lack of trained and qualified staff for hospital management and for
the management of other ancillary and supportive services viz. medical
records, central sterilisation department,laundry, housekeeping, dietary and
management of nursing services.
1.2 GRADING OF DISTRICT HOSPITAL
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 beds
● Grade III: District hospitals norms for 300 beds
● Grade IV: District hospitals norms for 200 beds
● Grade V: District hospitals norms for 100 beds.
The disease prevalence in a district varies widely in type and complexities. It is not
possible to treat all of them at district hospitals. Some may require the intervention of
highly specialist services and use of sophisticated expensive medical equipment.
Patients with such diseases can be transferred to tertiary and other specialised
hospitals. A district hospital should however be able to serve 85-95% of the medical
needs in the districts. It is expected that the hospital bed occupancy rate should be
at least 80%.
1.3 FUNCTION OF HOSPITAL
A district hospital has the following functions:
● It provides effective, affordable health care services (curative including
specialist services,preventive and promotive) for a defined population, with
their full participation and in cooperation with agencies in the district that have
similar concern. It covers both urban population (district head quarter town)
and the rural population in the district.
● Function as a secondary level referral centre for the public health institutions
below the district level such as Sub-divisional Hospitals, Community Health
Centres, Primary Health Centres and Sub-centres.
● To provide wide ranging technical and administrative support and education
and training for primary health care.

1.4 PHYSICAL INFRASTRUCTURE

Size of the hospital
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 50,000 to 15,00,000. For the purpose of convenience the
average size of the district is taken in this document as one million people. Based on
the assumptions of the annual rate of admission as 1 per 50 population 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 as follows:
The total number of admissions per year = 10,00,000 × 1/50 = 20,000
Bed days per year = 20,000 × 5 = 100,000
Total number of beds required when occupancy is 100% = 100000/365 = 275
beds
Total number of beds required when occupancy is 80% = 100000/365 × 80/100 =
220 beds
Requirement of beds in a District Hospital would also be determined by following
factors:
• Urban and Rural demographics and likely burden of diseases
• Geographic terrain
• Communication network
• Location of FRUs and Sub-district Hospitals in the area
• Nearest Tertiary care hospital and its distance & travel time
• Facilities in Private and Not-for profit sectors
• Health care facilities for specialised population– Defence, Railways, etc.
Area and Space norms of the hospital
Land Area
Minimum Land area requirement are as follows:
Upto 100 beds = 0.25 to 0.5 hectare
Upto 101 to 200 beds = 0.5 hectare to 1 hectare
500 beds and above = 6.5 hectare (4.5 hectare for hospital and 2 hectare for
residential)
Size of hospital as per number of Beds
General Hospital : 80 to 85 sq. M per bed to calculate total plinth area.
The area will include the service areas such as waiting space, entrance hall,
registration counter etc. In addition, Hospital Service buildings like Generators,
Manifold Rooms, Boilers, Laundry,Kitchen and essential staff residences are
required in the Hospital premises.
In case of specific requirements of a hospital, flexibility in altering the area be kept.
Teaching Hospital : 100 to 110 sq.M per bed to calculate total plinth area.
Facilities
iii. Operation Theatre
a. One OT for every 50 general in-patient beds
b. One OT for every 25 surgical beds.
iv. ICU beds = 5 to 10 % of total beds
v. Floor space for each ICU bed = 25 to 30 sq m (this includes support services)
vi. Floor space for Paediatric ICU beds = 10 to 12 sq m per bed
vii. Floor space for High Dependency Unit (HDU) = 20 to 24 sq m per bed
viii. Floor space Hospital beds (General) = 15 to 18 sq m per bed
ix. Beds space = 7 sq m per bed
x. Minimum distance between centres of two beds = 2.5 m (minimum)
xi. Clearance at foot end of each bed = 1.2 m (minimum)
xii. Minimum area for apertures (windows/Ventilators opening in fresh air)
a. = 20% of the floor area (if on same wall)
b. = 15% of the floor area (if on opposite walls)

1.4 PLANNING AND LAYOUT

Hospital Management Policy should emphasise on hospital buildings with
earthquake proof, flood proof and fire protection features. Infrastructure should be
eco-friendly and disabled (physically and visually handicapped) friendly. Local
agency Guidelines and Bylaws should strictly be followed.
Appearance and upkeep
● The hospital should have a high boundary wall with at least two exit gates.
● Buildings shall be plastered and painted with a uniform colour scheme.
● There shall be no unwanted/outdated posters pasted on the walls of the
building and boundary of the hospital.
● There shall be no outdated/unwanted hoardings in hospital premises.
● There shall be provision of adequate light in the night so the hospital is visible
from the approach road.
● Proper landscaping and maintenance of trees, gardens etc. should be
ensured.
● There shall be no encroachment in and around the hospital.
Signage
● The building should have a prominent board displaying the name of the
Centre in the local language at the gate and on the building. Signage
indicating access to various facilities at strategic points in the Hospital for
guidance of the public should be provided. For showing the directions, colour
coding may be used.
● Citizen charter shall be displayed at OPD and Entrance in local language
including patient rights and responsibilities.
● Hospital layout with location and name of the facility shall be displayed at the
entrance.
● Directional signages for Emergency, all the Departments and utilities shall be
displayed appropriately, so that they can be accessed easily.
● Fluorescent Fire Exit plan shall be displayed at each floor.
● Safety, Hazard and caution signs displayed prominently at relevant places.
● Display of important contacts like higher medical centres, blood banks, fire
department, police,and ambulance services available in nearby area.
● Display of mandatory information (under RTI Act, PNDT Act, MTP Act etc.).
General Maintenance
Building should be well maintained with no seepage, cracks in the walls, no broken
windows and glass panes. There should be no growth of algae and mosses on walls
etc. Hospital should have anti-skid and non-slippery floors.
Condition of roads, pathways and drains
● Approach road to hospital emergency shall be all weather motorable road.
● Roads shall be illuminated at night.
● There shall be dedicated parking space separately for ambulances, Hospital
staff and visitors.
There shall be no stagnation/over flow of drains.
There shall be no water logging/marsh in or around the hospital premises.
There shall be no open sewage/ditches in the hospital.
Environmental friendly features
 ● The Hospital should be, as far as possible, environmentally friendly and
energy efficient.Rainwater harvesting, solar energy use and use of
energy-efficient bulbs/equipment should be encouraged. Provision should be
made for horticulture services including herbal gardens.
● A room to store garden implements, seeds etc. will be made available.
Barrier free access
For easy access to non-ambulant (wheel-chair, stretcher), semi-ambulant, visually
disabled and elderly persons infrastructure as per “Guidelines and Space Standards
for barrier-free built environment for Disabled and Elderly Persons” of Government of
India, is to be provided. This will ensure safety and utilisation of space by disabled
and elderly people fully and their full integration into the society. Provisions as per
‘Persons with Disability Act’ should be implemented.
Administrative Block
Administrative block attached to main hospital along with provision of MS Office and
other staff will be provided. Block should have independent access and connectivity
to the main hospital building,
wherever feasible.
Circulation Areas
Circulation areas comprise corridors, lifts, ramps, staircase and other common
spaces etc. The flooring should be anti-skid and non-slippery.
Corridors
Corridors shall be at least 3M Wide to accommodate the daily traffic. Size of the
corridors,
ramps, and stairs shall be conducive for manoeuvrability of wheeled equipment.
Corridors shall be wide enough to accommodate two passing trolleys, one of which
may have a drip attached to it.Ramps shall have a slope of 1:15 to 1:18. It must be
checked for manoeuvrability of beds and trolleys at any turning point.
Roof Height
The roof height should not be less than approximately 3.6 m measured at any point
from floor to roof.
Entrance Area
Barrier free access environment for easy access to non-ambulant (wheel-chair,
stretcher), semi ambulant, visually disabled and elderly persons as per “Guidelines
and Space Standards for barrier free built environment for Disabled and Elderly
Persons” of CPWD/Min of Social Welfare, GOI.
Ramp as per specification, Hand- railing, proper lighting etc. must be provided in all
health facilities and retrofitted in older ones which lack the same.
The various types of traffic shall be grouped for entry into the hospital premises
according to their nature. An important consideration is that traffic moving at
extremely different paces (e.g. a patient on foot and an ambulance) shall be
separated. There can be four access points to the site, in order to segregate the
traffic.
● Emergency: for patients in ambulances and other vehicles for the emergency
department.
 ● Service: for delivering supplies and collecting waste.
● Service: for removal of dead
Residential Quarters All the essential medical and para-medical staff will be provided
with residential accommodation. If the accommodation cannot be provided due to
any reason, then the staff may be paid house rent allowance, but in that case they
should be staying in the near vicinity, so that essential staff is available 24 x 7.

1.5 DISASTER PREVENTION MEASURES

(For all new upcoming facilities in seismic zone 5 or other disaster prone areas)
Building structure and the internal structure of Hospital should be made disaster
proof especially earthquake proof, flood proof and equipped with fire protection
measures.
Earthquake proof measures – structural and non-structural should be built in to
withstand quakes as per geographical/state Govt. guidelines. Non-structural features
like fastening the shelves, almirahs, equipment etc. are even more essential than
structural changes in the buildings. Since it is likely to increase the cost substantially,
these measures may especially be taken on priority in known earthquake prone
areas.
Firefighting equipment – Fire extinguishers, sand buckets, etc. should be available
and maintained to be readily available when there is a problem.
Every district hospital shall have a dedicated disaster management plan in line with
the state disaster management plan. Disaster plan clearly defines the authority and
responsibility of all cadres of staff and mechanism of mobilisation resources.
All health staff should be trained and well conversant with disaster prevention and
management aspects.
Regular mock drills should be conducted. After each drill the efficacy of the disaster
plan, preparedness of hospital and competence of staff shall be evaluated followed
by appropriate changes to make the plan more robust.

1.6 DEPARTMENTAL LAYOUT

Outdoor Patient Department (OPD)
The facility shall be planned keeping in mind the maximum peak hour patient load
and shall have the scope for future expansion. OPD shall approach from the main
road with signage visible from a distance.
a. Reception and Enquiry
● Enquiry/May I Help desk shall be available with competent staff fluent in local
language.
● The service may be outsourced. Services available at the hospital displayed
at the enquiry.
● Name and contacts of responsible persons like Medical superintendent,
Hospital
Manager, Casualty Medical officer, Public Information Officer etc. shall be
displayed.
b. Waiting Spaces
Waiting area with adequate seating arrangement shall be provided. Main entrance,
general waiting and subsidiary waiting spaces are required adjacent to each
consultation and treatment room in all the clinics. Waiting area at the scale of 1 sq
ft/per average daily patient with a minimum 400 sq ft of area is to be provided.
c. Layout of OPD shall follow functional flow of the patients, e.g.:
Enquiry→ Registration→ Waiting→ Sub-waiting→ Clinic→ Dressing
room/Injection Room→ Billing→Diagnostics (lab/X-ray)→ Pharmacy→ Exit
d. Patient amenities (norms given in following pages)
• Potable drinking water.
• Functional and clean toilets with running water and flush.
• Fans/Coolers.
• Seating arrangement as per load of patient.
e. Clinics
The clinics should include general, medical, surgical, ophthalmic, ENT, dental,
obstetrics and
gynaecology,Post-Partum Unit, paediatrics, dermatology and venereology,
psychiatry, neonatology,orthopaedic and social service department. Doctor chamber
should have ample space to sit for 4-5 people. Chamber size of 12.0 sq metres is
adequate. The clinics for infectious and communicable diseases should be located in
isolation, preferably, in remote corners, provided with independent access. For the
National Health Programme, adequate space be made available.Immunization Clinic
with waiting Room having an area of 3 m × 4 m in PP centre/Maternity
centre/Paediatric Clinic should be provided. 1 Room for HIV/STI counselling is to be
provided. Pharmacy shall be in close proximity to OPD. All clinics shall be provided
with examination table, X-ray- View box, Screens and hand washing facility.
Adequate number of wheelchairs and stretchers shall be provided.
f. Nursing Services
Various clinics under Ambulatory Care Area require nursing facilities in common
which include dressing room, side laboratory, injection room, social service and
treatment rooms etc.
Nursing Station: Need based space required for Nursing Station in OPD for
dispensing nursing services. (Based on OPD load of patient)
g. Quality Assurances in Clinics
● Workload at OPD shall be studied and measures shall be taken to reduce the
Waiting
Time for registration, consultation, Diagnostics and pharmacy.
● Punctuality of staff shall be ensured.
● Cleanliness of OPD area shall be monitored on a regular basis.
● There shall be provision of complaints/suggestion box. There shall be a
mechanism to redress the complaints.
● Hospitals shall develop standard operating procedures for OPD management,
train the staff and implement it accordingly.
● Assessment of each patient shall be done in standard format.
 ● To avoid overcrowding, hospitals shall have patient calling systems
(manual/Digital).
h. Desirable Services
● Air-cooling
● Patient calling system with electronic display
● Specimen collection centre
● Television in waiting area
● Computerised Registration
● Public Telephone booth
● Provision of OPD manager

Imaging
The department shall be located at a place which is accessible to both OPD and
wards and also to the operation theatre department. The size of the room shall
depend on the type and size of equipment installed. The room shall have a
sub-waiting area with toilet facility and a change room facility. Film developing
and processing (dark room) shall be provided in the department for loading,
unloading, developing and processing of X-ray films. Room shall be completely cut
off from direct light. Exhaust fan, ventilators shall be provided. Room shall have a
loading bench (with acid and alkali resistant top), processing tank, washing tank and
a sink. Separate Reporting Room for doctors shall be there.
Ultrasound room shall contain a patient couch, a chair and adequate space for the
equipment. The lighting must be dim for proper examination. Hand-washing facility
and toilet shall be attached with ultrasound room.
Clinical Laboratory
The department shall be situated such that it has easy access to IPD as well as
OPD patients. The Laboratory shall have adequate space from the point of view of
workload as well as maintenance of high level of hygiene to prevent the infection.
Storage space shall be adequate (10% of total floor space) with separate storage
space for inflammable items. The layout shall ensure logical flow of specimens from
receipt to disposal. There shall be separate and demarcated areas for sample
collection, sample processing, haematology, biochemistry, clinical pathology and
reporting. The tabletop shall be acid and alkali proof.
Blood Bank
Blood bank shall be in close proximity to the pathology department and at an
accessible distance to the operation theatre department, intensive care units
and emergency and accident department. Blood Bank should follow all existing
guidelines and fulfil all requirements as per the various Acts pertaining to setting up
of the Blood Bank. Separate Reporting Room for doctors should be there.

Intermediate Care Area (Indoor Patient Department)

General IPD beds shall be categorised as following
• Male Medical ward
• Male surgical ward
• Female Medical ward
• Female surgical ward
• Maternity ward
• Paediatric ward
• Nursery
• Isolation ward
As per need and infrastructure hospital have following wards
• Emergency ward/trauma ward
• Burn Ward
• Orthopaedic ward
• Post-operative ward
• Ophthalmology Ward
• Malaria Ward
• Infectious Disease Ward
• Private ward: Depending upon the requirement of the hospital and catchment
area, appropriate beds may be allowed for private facilities. 10% of the total bed
strength is recommended as private ward beds.
Location
Location of the ward should be such to ensure quietness and to control the number
of visitors.
Ward Unit
It is desirable that up to 20 % of the total beds may be earmarked for the day care
facilities, as many procedures can be done on day care basis in modern times
The basic aim in planning a ward unit should be to minimise the work of the nursing
staff and provide basic amenities to the patients within the unit. The distances to be
travelled by a nurse from bed areas to treatment room, pantry etc. should be kept to
the minimum. Ward unit will include a nursing station, doctors’ duty room, pantry,
isolation room, treatment room, nursing store along with wards and toilets as per the
norms. On an average one nursing station per ward will be provided. It should be
ensured that the nursing station caters to around 40-45 beds, out of which half will
be for acute patients and half for chronic patients.
The following quality parameters should be ensured:
● There shall be at least 2.5 metre between centres of two beds to prevent
cross infection and allow bedside nursing care.
● Every bed shall be provided with an IV stand, bed-side locker and stool for the
attendant. Screen shall be available for privacy.
● Dedicated toilets with running water facility and flush shall be provided for
each ward.
● Dirty utility room with sluicing facility and janitors rooms shall be provided
within the ward.
● All wards shall be provided with positive ventilation (except isolation ward)
and fans.
Pharmacy
The pharmacy should be located in an area accessible from all clinics. The size
should be adequate to contain 5 percent of the total clinical visits to the OPD in one
session. For every 200 OPD patients daily there should be one dispensing counter.
Pharmacy should have a component of medical store facility for indoor patients and
separate pharmacy with accessibility for OPD patients.

Intensive Care Unit and High Dependency Wards

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 may be restricted to 5% of the total bed
strength initially but should be expanded to 10% gradually. Out of these, they can be
equally divided among ICU and High Dependency Wards. For example, in a
500-bedded hospital, total of 25 beds will be for Critical Care. Out of these, 13 may
be ICU beds and 12 will be allocated for High Dependency Wards. Changing room
should be provided for.
Location
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. This
unit will also need all the specialized services, such as, piped suction and medical
gases, uninterrupted electric supply, heating, ventilation, central air conditioning and
efficient life services. 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

Patient Conveniences
Number of toilets etc. to be provided as per number of beds of Hospital/OPD
load.
Accident and Emergency Services
• A 24 x 7 operational emergency having a dedicated emergency room shall be
available with adequate man power.
• 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 causalities 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.
• Layout shall follow the functional flow.
• Signage of emergency shall be displayed at the entry of the hospital with
directional signage at key points.
• Emergency shall have dedicated triage, resuscitation and observation area.
Screens shall be available for privacy.
• Separate provision for examination of rape/sexual assault victim should be
made available in the emergency as per guidelines of the Supreme Court.
• 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.

Operation theatre
1.The location of Operation theatre should be in an 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. This unit also needs
constant specialised services, such as piped suction and medical gases, electric
supply, heating, air-conditioning, ventilation and efficient lift service

2.There may be four well defined zones of varying degree of cleanliness/asepsis

namely,Protective Zone, Clean Zone, Aseptic or Sterile Zone and Disposal or
Dirty Zone. Normally there are three types of traffic flow, namely, patients, staff and
supplies.

3..An Operation Theatre should also have a Preparation Room, Pre-operative

Room and Post-Operative Resting Room. Operating room should be made
dustproof and moisture proof. There should also be a Scrub-up room where the
operating team washes and scrub-up their hands and arms, put on their sterile gown,
gloves and other covers before entering the operation theatre. Laminar flow of air is
maintained in the operation theatre. It should have a single leaf door with a
self-closing device and viewing window to communicate with the operation theatre.

4.Operation Theatre should also have a Sub-Sterilizing unit attached to the

operation theatre limiting its role to operating instruments on an emergency basis
only.
Post-Partum Unit
It is desirable that every District Hospital should have a Postpartum
Unit and infrastructure to provide Postnatal services, all Family
Planning Services, Safe Abortion services and immunisation in an
integrated manner.
Physical Medicine and Rehabilitation (PMR)
The PMR department provides treatment facilities to patients suffering
from crippling diseases and disabilities. 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. It should also have a physical and electro-therapy rooms,
gymnasium, office, store and toilets separate for male and female.
Normative standards will be followed.

Hospital Administrative and Support Services

Management Information System (MIS)
Computers with Internet connection are to be provided for MIS
purposes. Provision of flow of Information from PHC/CHC to district
hospital and from there to district and state health organisation should
be established. Relevant information with regards to emergency,
outdoor and indoor patients be recorded and maintained for a sufficient
duration of time as per state health policy.
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 containers. Quality and quantity of diet shall be checked by
competent persons on a regular basis.
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 the 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 non sterile
and sterile items between CSSD and departments, sterilisation of
different items, complete process cycle, validation of sterilisation
process, recall, labelling, first in first out, calibration and maintenance
of instruments.
Hospital Laundry
It should be provided with necessary facilities for drying, pressing and
storage of soiled and cleaned linens. It may be outsourced.
Medical and General Stores
Medical and general stores should have vehicular accessibility and
ventilation, security and firefighting arrangements. Hospital shall have
standard operating procedure for local purchase, indent management,
storage preparation of monthly requirement plan and Inventory
analysis.
For Storage of Vaccines and other logistics
Cold Chain Room: 3.5 m × 3 m in size Vaccine & Logistics Room: 3.5
m × 3 m in size
Minimum and maximum Stock shall be 0.5 and 1.25 month
respectively. Indent order and receipt of vaccines and logistics should
be monthly. Timely receipt of required vaccines and Logistics from the
District Stores, should be ensured.
Mortuary
It provides facilities for keeping of dead bodies and conducting autopsy.
The Mortuary shall be located in separate building near the Pathology
on the Ground Floor, easily accessible from the wards, Accident and
emergency Department and Operation Theatre. It shall be located
away from general traffic routes used by public.
Post-mortem room shall have stainless steel autopsy table with sink, a
sink with running water for specimen washing and cleaning and
cup-board for keeping instruments. Proper illumination and air
conditioning shall be provided in the post mortem room.
A separate room for body storage shall be provided with at least 2
deep freezers for preserving the body. There shall be a waiting area for
relatives and a space for religious rites.
Engineering Services
Electric Engineering Sub Station and Generation
Electrical load requirement per bed = 3 KW to 5 KW.
Electric substation and standby generator room should be provided.
Illumination
The illumination and lightning in the hospital should be done as per the prescribed
standards.

Emergency lighting
Shadow less light in the operation theatre and delivery rooms should be
provided. Emergency portable light units should be provided in the wards and
departments.
Call Bells
Call bells with switches for all beds should be provided in all types of wards with
indicator lights
Mechanical Engineering
Air-conditioning and Room Heating in operation theatre and
neonatal units should be provided. Air coolers or hot air convectors
may be provided for the comfort of patients and staff depending on
the local needs. Hospitals should be provided with water coolers
and refrigerators in wards and departments depending upon the
local needs.
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
systems for wastewater, surface water, subsoil water and sewerage
shall be in accordance with the prescribed standards. Prescribed
standards and local guidelines shall be followed.
Other Amenities
Disabled friendly WC with basins wash basins as specified by
Guidelines for disabled friendly environment should be provided.
Waste Disposal System
As per National guidelines on Bio-medical Waste (Management & Handling)
Rules, 1998
Mercury Waste Disposal
● As mercury waste is a hazardous waste, the storage,
handling, treatment and disposal practices should be in line
with the requirements of Government of India’s Hazardous
Waste (Management, Handling and Trans-boundary
Movement) Rules 2008, which may be seen at website
www.cpcb.nic.in.
● Mercury-contaminated waste should not be mixed with other
biomedical waste or with general waste. It should not be
swept down the drain and wherever possible, it should be
disposed off at a hazardous waste facility or given to a
mercury-based equipment manufacturer.
● Precaution should be taken not to handle mercury with bare
hands and as far as possible; jewellery should be removed
at the time of handling mercury. After handling mercury,
hands must be carefully washed before eating or drinking.
Appropriate personal protective equipment (rubber gloves,
goggles/face shields and clothing) should be used while
handling mercury.
● Mercury-containing thermometers should be kept in a
container that does not have a hard bottom. Prefer a plastic
container to a glass container, as the possibility of breakage
will be less.
 ● In case of breakage, cardboard sheets should be used to
push the spilled beads of mercury together. A syringe should
be used to suck the beads of mercury. Mercury should be
placed

5
9

GREEN BUILDING RECOMMENDATION FOR HOSPITALS

Some of its key recommendations are as follows:
Benefits of green hospital
• Can reduce patient recovery time.
• Eliminate sick building syndrome (SBS).
• Reduce stress levels in hospital workers, thus improving quality
of care.
• Lower energy and water consumption.
Focus areas of green hospital design
• Lighting
• Indoor air quality-passive and active measures.
• Green house keeping
• Clean and green cleaner building, material.
• Gardens and landscape.
Lighting
A good hospital design should maximise the daylight and optimise the
artificial lighting requirement.Daylighting is the controlled admission of
natural light from the sky, (direct and diffused) into a, so as to reduce
the use of electrical energy for lighting.
Artificial lighting is required in the sensitive areas of the
hospital-including OTs, medical dispensaries- interior corridor and
passages .However with energy costs and high initial investment, it is
imperative to reduce operational cost of lighting in hospitals – by
combining natural lighting and efficient artificial lighting.
Benefits of lightings and views in hospital:
• Enhance health and well-being of the patients and reduce the
stress level of hospital employees, thus improving quality of care.
• Combats seasonal affective disorder, or winter depression,
through view connectivity to natural vistas.
• Improves facility’s overall operational efficiency.
Few of the passive design aspects to enhance natural lighting in
hospitals:
• Design glazing facade so as to have both view and daylight.
• Install translucent skylight having soothing colours.
• Have transparent and operable openings to green courtyards.
• Consider ledge seating at windows - engaging nature in the
curative process. Few of the design aspects enhance efficiency of
artificial lightings in hospitals.
• Use occupancy sensors in passage-ways, storage rooms, labs,
etc.
• Install low energy LED lighting to save on indoor lighting energy
cost up to 40%.
• Use task lightings to provide illuminations in task areas like
consulting rooms, labs, wards.

Indoor Air Quality

As restoring and safeguarding is the main purpose of healthcare
facilities, indoor air quality is considered critical to green hospitals.
The following parameters may be followed for good indoor
environment:
• Install permanent entry ways systems to capture dust particle
like slotted systems, gates or
grills at the primary entrances.
• Use certain species of indoor plants which not only produce
oxygen but also reduce indoor pollutants like VOCs from air.
• Improve fresh air by providing courtyard spaces with native and
adaptive plant species, which are free from any allergic effects.

FIRE SAFETY IN HOSPITALS

Expected Levels of Fire Safety In Hospitals
Hospitals shall provision for two levels of safety within their premises:
1. Comparative Safety: which is protection against heat and smoke within the
hospital premises, where removal of the occupants outside the premises is not
feasible and/or possible. Comparative Safety may be achieved through:
a. Compartmentation
b. Fire Resistant wall integrated in the Flooring
c. Fire Resistant Door of approved rating
d. Pressurised Lobby, Corridor, Staircase
e. Pressurised Shaft (All vertical openings)
f. Refuge Area
g. Independent Ventilation system
h. Fire Dampers
i. Automatic Sprinkler System
j. Automatic Detection System
k. Manual Call Point
l. First Aid
m. Fire Fighting Appliances
n. Fire Alarm System
o. Alternate Power Supply
p. Public Address System
q. Signage
r. Fire Exit Drills and orders
2. Ultimate Safety: which is the complete removal of the occupants from the
affected area to an assembly point outside the hospital building. Ultimate Safety may
be achieved through:
a. Compartmentation
b. Fire Resistant Door of approved rating
c. Protected Lobby, Corridor, Staircase and Shaft
d. Public Address System
e. Signage
f. Fire Drills and orders

Structural Elements of Fire Safety

Open Spaces
1. Hospitals shall make provisions for sufficient open space in and around the
hospital building to facilitate the free movement of patients and emergency/fire
vehicles.
2. These open spaces shall be kept free of obstructions and shall be motorable.
3. Adequate passageway & clearance for fire fighting vehicles to enter the
hospital premises shall be provided.
4. The width of such entrances shall not be less than 4.5 mtrs with clear head
room not less than 5 mtrs.
5. The width of the access road shall be a minimum of 6 mtrs.
6. A turning radius of 9 mtrs shall be provided for fire tender movement.
7. The covering slab of storage/static water tank shall be able to withstand the
total vehicular load of 45 tone equally divided as a four point load (if the slab forms a
part of path/driveway).
8. The open space around the building shall not be used for parking and/or any
other purpose.
9. The Set back area shall be a minimum 4.5 mtrs.
10. The width of the main street on which the hospital building abuts shall not be
less than 12 mtrs & when one end of that street joins another street, the street shall
not be less than 12 mtr wide.
11. The roads shall not be terminated in dead ends.
Basements
1. Basements, if provided shall be of type-1 construction and material used shall
conform to class A material.
2. Basements shall be used only for parking vehicles and shall be protected with
automatic sprinkler systems.
3. Each basement shall be separately ventilated.
4. Each vent shall have a cross-sectional area (aggregate) not less than 2.5% of
the floor area spread evenly round the perimeter of the basement.
5. A system of air inlets and smoke outlets shall be provided & clearly marked as
“AIR INLET” and “SMOKE OUTLET”.
6. Clear headroom of minimum 2.4 mtrs shall be provided for the entire
basement.
7. A minimum ceiling height of any basement shall be 0.9 mtrs and maximum
1.2 mtrs above the average surrounding ground level.
8. The access to the basement shall be separate from the main and alternative
staircase providing access and exit from higher floors. Where the staircase
continues, in the case of buildings served by more than one staircase, the same
shall be of enclosed type serving as a Fire Separation between the basement and
higher floors.
9. Open ramps shall be permitted if they are constructed within the building line
and surface drainage does not enter the basement.
10. The staircase of the basement shall be of enclosed type having fire resistance
not less than 02 hrs & shall be situated at the periphery of the basement to be
entered at ground level from the open air and in such a position that smoke from any
fire in the basement shall not obstruct any exit serving the ground & upper stores of
the building. The staircase shall communicate with the basement through a lobby
provided with fire resisting, self closing doors of 02 hrs resistance. Additional stairs
shall be provided if travel distance does not meet specifications given in Table 22 of
the NBC.
11. For multi-storey basements, one intake duct may serve all basement levels,
but each level & basement compartment shall have a separate smoke outlet duct or
ducts. The ducts shall have the same fire resistance rating as the compartment itself.
12. Mechanical extractors for smoke venting system from lower basement levels
shall also be provided. The actuation of the system shall be incorporated with the
detection and sprinkler systems. The performance of the system shall be superior
than standard units. (13) Mechanical extractors shall have an interlocking
arrangement, so that extractors shall continue to operate and supply fans shall stop
automatically with the actuation of fire detection system.
13. Mechanical extractors shall be designed to permit 30 air changes per hour in
case of a fire emergency.
14. Mechanical extractors shall have an alternate source of electricity supply.
15. Ventilation ducts shall be integrated with the structure of the building and shall
be made out of brick masonry or reinforced cement concrete as far as possible.
Wherever this duct intersects the transformer area or an electrical switch board, fire
dampers shall be provided.
16. The basement shall not be permitted below the ward block of a hospital.
17. No cut outs to upper floors shall be permitted in the basement.
18. An openable window on the external wall shall be fitted with locks that can be
easily opened.
19. All floors shall be compartmented by a separation wall with 2 hrs fire rating,
such that
20. each compartment shall have a surface area not exceeding 750 sq. mtr.
Floors which are fitted with sprinkler systems may have their surface areas
increased by 50%. In long building fire separation wall shall be at distances not
exceeding 40 mtrs.
21. Elevators shall not normally communicate with basements; if, however, Lifts
are in communication, the lift lobby of the basement shall be pressurised. A positive
pressure between 25 and 30 Pascal (Pa), shall be maintained in the lobby & a
positive pressure of 50 Pa shall be maintained in the Lift shaft. The mechanism for
pressurisation shall act automatically with the Fire Alarm. Provision shall be made to
operate the system manually as well. The Lift car door shall have a Fire resistance
rating equal to the Fire resistance of the lift enclosure. The material used for interior
finishing shall conform to class-1 materials.
Internal Staircases
1. Internal staircases shall be constructed with non-combustible materials
2. Internal stairs shall be constructed as self-contained units along an external
wall of the building constituting at least one of its sides and shall be completely
closed
3. A staircase shall not be arranged around a Lift shaft.
4. Hollow combustible construction shall not be permitted
5. The construction material shall have 02 hrs fire resistance.
6. Minimum width of stairs shall be 2 mtrs.
7. Width of the tread shall not be less than 300 mm.
8. The height of the riser shall not be less than 150 mm and the number of stairs
per flight shall not exceed 15
9. Handrails shall be provided at a height of 1000 mm, which is to be measured
from the base of the middle of the treads to the top of the handrails.
10. Bannisters or railings shall be provided such that the width of staircase is not
reduced.
11. Minimum head room in a passage under the landing of a staircase and under
the staircase shall be 2.2 mtrs.
12. The staircase shall be continuous from ground floor to the terrace and the exit
door at the ground level shall open directly to the open spaces or a large lobby.
13. The number of people in between floor landings of staircases shall not be less
than the population on each floor for the purpose of the design of the staircase.
14. Fire/Smoke check doors shall be provided for a minimum of 2 hrs fire
resistance rating.
15. (15) Lift openings and any other openings shall not be permitted.
16. (16) No electrical shaft and panel, AC ducts or gas pipelines, etc. shall pass
through or open onto the staircases.
17. No combustible material shall be used for decoration/wall panelling in the
staircases.
Protected Staircases
Provisions given for internal staircases shall apply to protected staircases. Also,
additional safeguards shall be provided as under:
1. The staircases shall be enclosed by walls having 02 hrs fire resistance
2. The external exit doors at ground floor shall open directly onto open spaces or
a lobby and Fire & Smoke check doors shall be provided.
3. Protected staircases shall be pressurized. Under no circumstances shall they
be connected to a corridor, lobby and staircase which is unpressurized

4. Pressurization systems shall be incorporated in protected staircases where

the floor area is more than 500 sq. mtr. The difference in pressurization levels
between staircase and lobby/ corridor shall not be greater than 5 Pa. Where 2 stage
pressurization system is in use the pressure difference shall be as under:
a. In normal conditions - Minimum 8Pa to 15 Pa.
b. In emergency conditions - 50 Pa.
5. The pressurization system shall be interconnected with the automatic/manual
fire alarm system for actuation.
External Staircases
1. External staircases serving as a required means of egress shall be of
permanent fixed construction.
2. External staircases shall be protected by a railing or guard. The height of such
a guard/railing shall not be less than 1200 mm.
3. External staircases shall be separated from the interior of the building by walls
that are fire resistant and have fixed or self closing opening protectives’, as required
for enclosed stairs. External staircases shall extend vertically from the ground to a
point 3 meters above the topmost landing of the stairway or the roof line whichever is
lower, and atleast 3 meters horizontally.
4. All openings below and outside the external staircases shall be protected with
requisite fire resistance rating.
5. External staircases shall be so arranged to avoid any discomfort/obstruction
for persons with a fear of heights, from using them.
6. External staircases shall be so arranged to ensure a clear direction of egress
to the street.
7. External staircases shall be continuous from the ground floor to the terrace
level
8. The entrance to the external staircases shall be separate and remote from
internal staircases.
9. External staircases shall have a straight flight with a width not less than 2
mtrs, a tread not less than 300 mm, a riser not more than 150 mm and the number of
risers shall be limited to 15 per flight.
10. The handrail shall have a height not less than 1000 mm and not exceeding
1200 mm.
11. Banisters shall be provided with a maximum gap of 150 mm.
12. Stair treads shall be uniformly slip resistant and shall be free of projections or
lips that could trip stair users
13. External staircases used as fire escapes shall not be inclined at an angle
greater than 45o from the horizontal
14. Unprotected steel frame staircases shall not be acceptable means of egress;
however steel staircases in an enclosed compartment with a fire resistance of 2 hrs
will be accepted as means of escape.
15. Elevators constitute a desirable supplementary facility though they are not
counted as required exits. Patient’s lifts shall have sufficient space for Stretcher
trolley.
Horizontal Exits
A horizontal exit implies that the occupants will be transferred from one side of a
partition to the other. Essential fire safety provisions for horizontal exits are as
follows:
1. Width of the horizontal exits shall be the same as the exit doorways.
2. A horizontal exit shall be equipped with at least one fire/smoke door of
minimum 2 hrs fire resistance of self closing type. Further they shall have direct
access to the fire escape staircase for evacuation.
3. A refuge area of 15 Sq. Mtr. or an area equivalent to 0.3 Sq Mtr. per person
for the number of occupants in two consecutive floors, whichever is more, shall be
provided on the periphery of the floor or preferably on an open air cantilever
projection with at least one side protected with suitable railings/guards with a height
not less than 1 mtr.
4. Within the aggregated area of corridors, patient rooms, treatment rooms,
lounges, dining area and other low hazards areas on each side of the horizontal exit,
a single door may be used in a horizontal exit given that the exit serves one direction
only. Such doors shall be swinging doors or a horizontal sliding door.
5. Where there is a difference in the level between areas connected by a
horizontal exit, ramps not more than 1 in 10 mtr slope shall be provided. The steps
shall not be used.
6. Doors shall be accessible at all times from both sides.
7. A horizontal exit involving a corridor 8 ft or more in width serving as a means
of egress from both sides of the doorway shall have the opening protected by a pair
of swinging doors arranged to swing in the opposite direction from each other.
8. An approved vision panel is required in each horizontal exit. Center mullions
are prohibited.
9. The total exit capacity of other exits (stairs, ramps, doors leading outside the
building) shall not be reduced to below one third of the amount that is required for
the entire area of the building.
Corridors and passageway
1. The minimum width and height of corridors and passage ways shall be 2.4
mtr. The exit
corridor and passage ways shall have a width not less than the aggregate required
width of Exit doorways leading from them in the direction of travel to the exterior.
Corridors shall be adequately ventilated.
2. Corridor walls shall form a barrier to limit the transfer of smoke,toxic gases
and heat.
3. Transfer grills, regardless of whether protected by fusible link operated
dampers, shall not be used in corridor walls or doors.
4. Openings if required in corridor walls for specific use, shall be suitably
protected.
PLANNING POLICIES