HOSPITAL LITRATURE REVIEW

INTRODUCTIONTO HEALTH CARE FACILITY

BUILDING GENERAL HOSPITAL
Hospital are the most complex of building types. Each hospital is comprised of 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 inpatient care or bed-related functions function. This diversity is reflected in the
breadth and specificity of regulation, codes, and oversight that govern hospital constriction and
operations. Each of the wind-ranging and constantly evolving functions of a hospital, including highly
complicated mechanical, electrical, and telecommunications system, requires specialized knowledge and
expertise. No one person can reasonably have complete knowledge, which is why specialized consultants
ply an important role in hospital planning and design. The functional units within the hospital can have
competing needs and priorities. Idealization scenarios and strong-held individuals preference must be
balanced against mandatory requirements, actual functional needs (internal traffic and relationship to
other departments), and the financial status of the organization.
Since hospital is an institution where both in and out patients receive medical care at all levels and
are even admitted when the need to do so arises. The evolution of hospitals, medicine and the services
they provide has led to the need of better planned structures. This has also been aggravated by the
increased demand for health care services. More people have realized that the hospitals should not only be
attended at the terminal stages of diseases but right from the diagnosis.
The hospital’s architectural designs have been developing over time as more innovations are being
made in the medical section. As the medics discovered more about diagnosis of diseases, anesthesia and
controlling the spread of information, surgery procedures and equipment’s as well as facilities were also
going through an enormous transformation. Issues regarding the environment began to be of more
importance as hospitals chose their architectural designs by the end of the 19 th century. Environmental
issues such as use of natural instead of artificial lighting in the surgery rooms became more important thus
considerable.
By the 20th century, the healthcare section had experienced more medical innovations. This meant
they had to do away with some of those used in the past. Natural ventilation is one of those aspects that
had to be dismissed. Hospitals needed to expand their facilities more so as to accommodate out patients.
The introduction of elevators also caused a major change in the architectural designs of hospitals
especially in the cities. This was back in the year 1889. Hospitals could now take up a vertical dimension
since space was limited in the cities to expand facilities from the ground. Technology was the most
influential factor in hospital architectural designs. The rate at with more innovations were being made was
challenging to match up in terms of infrastructural development. Flexibility should be considered when
designing hospital buildings. Adopting loose fit designs that can easily adapt to activity change is a good
idea. The shift from tight fit architectural designs to the loose fit designs is meant to increase the
hospital’s buildings to change while ensuring main hospital services are not being interrupted.

HISTORICAL BACKGROUND OF HEALTH CARE FACILITY

BUILDING (HOSPITALS)
The original facilities for the sick were most likely temples dedicated to “healing gods.” Imhotep
was the Egyptian healing god while Asclepius was revered in the Greek civilization. Prayers, sacrifices,
and dream interpretations played a role in their healing process, but the ancient physicians also stitched

KASAHUN WORKNEH 1
 HOSPITAL LITRATURE REVIEW

wounds, set broken bones, and used opium for pain. Plans for a 5th century BC temple in Athens
dedicated to Asclepius show a large room 24 x 108 for multiple dreamer-patients.
Some believe the earliest dedicated hospitals were in Mesopotamia, while other researchers believe
they were at Buddhist monasteries in India and Sri Lanka. Ancient writings indicate that the Sinhalese
King Pandukabhaya had hospitals built in present day Sri Lanka in the 4th century BC. The oldest
architectural evidence of a hospital appears to be at Mihintale in Sri Lanka which can be dated to the 9th
century AD. The extensive ruins suggest there were patient rooms which measured 13 x 13’ which is
surprisingly close to the patient rooms used today. In addition to surgical instruments, archeologists found
a stone “medicinal trough” approximately seven feet in length and 30 inches wide that may have been
used for the first hydrotherapy with mineral water or medicinal oils.
While the Greeks were recognized as the originators of “rational” medicine, they did not have
hospitals. The physicians made calls and treated patients in their homes, a practice that continued for
hundreds of years. The Romans provided us with the root of the word “hospital” from the Latin word
“hospes” for host or “hospitium” meaning a place to entertain. While medical schools were established
in Greece in the 6th Century BC, there is general consensus that the first teaching hospital with visiting
physicians and scholars from Egypt, India, and Greece was founded at Gondisapur in present day Iran in
300 AD.
Among the early, well-documented healthcare facilities were the Roman military hospitals. The
plans for the one in Vindossa in present day Switzerland built in the 1st century AD shows small patient
rooms with ante rooms built around courtyards. Each room was thought to hold three beds indicating the
ward concept was used early in the history of hospital development. One source indicated that similar
hospitals may have also been built for gladiators and slaves due their financial value, however public
hospitals were not available and physicians made house calls.
As the Roman Empire turned to Christianity, the Church's role in providing for the sick became
firmly established. After 400 AD, many monasteries were constructed generally including
accommodations for travelers, the poor, and the sick. The monarchs of the 6th century reinforced this role
with emperors, such as Charlemagne, who directed that a hospital should be attached to every cathedral
that was built in his empire. Religious institutions continued to provide most of the healthcare to the poor
in large, open wards, while physicians continued the practice of making house calls to the upper class.
The religious influence in early healthcare is illustrated by duties of the Warden (Administrator) of St
Mary's Hospital in England in 1390. He was required to not only satisfy himself of the seriousness of the
medical complaint, but to also hear the confession of the patient before admission.

Late Roman Empire (Byzantine medicine)

The declaration of Christianity as an accepted religion in the
Roman Empire drove an expansion of the provision of care.
Following the First Council of Nicaea in 325 A.D. construction of
a hospital in every cathedral town was begun. Among the earliest
were those built by the physician Saint Sampson in
Constantinople and by Basil, bishop of Caesarea in modern-day

KASAHUN WORKNEH 2
 HOSPITAL LITRATURE REVIEW

Turkey. Called the "Basilias", the latter resembled a city and included housing for doctors and nurses and
separate buildings for various classes of patients. There was a separate section for lepers. Some hospitals
maintained libraries and training programs, and doctors compiled their medical and pharmacological
studies in manuscripts. Thus in-patient medical care in the sense of what we today consider a hospital,
was an invention driven by Christian mercy and Byzantine innovation. Byzantine hospital staff included
the Chief Physician (archiatroi), professional nurses (hypourgoi) and the orderlies (hyperetai). By the
twelfth century, Constantinople had two well-organized hospitals, staffed by doctors who were both male
and female. Facilities included systematic treatment procedures and specialized wards for various
diseases.
A hospital and medical training center also existed at Gundeshapur. The city of Gundeshapur was
founded in 271 CE by the Sasanian king Shapur I. It was one of the major cities in Khuzestan province of
the Persian empire in what is today Iran. A large percentage of the population were Syriacs, most of
whom were Christians. Under the rule of Khusraw I, refuge was granted to Greek Nestorian Christian
philosophers including the scholars of the Persian School of Edessa (Urfa)(also called the Academy of
Athens), a Christian theological and medical university. These scholars made their way to Gundeshapur
in 529 following the closing of the academy by Emperor Justinian. They were engaged in medical
sciences and initiated the first translation projects of medical texts. The arrival of these medical
practitioners from Edessa marks the beginning of the hospital and medical centre at Gundeshapur. It
included a medical school and hospital (bimaristan), a pharmacology laboratory, a translation house, a
library and an observatory. Indian doctors also contributed to the school at Gundeshapur, most notably the
medical researcher Mankah. Later after Islamic invasion, the writings of Mankah and of the Indian doctor
Sustura were translated into Arabic at Baghdad.

Medieval Islamic world (Medicine in medieval Islam)

The first prominent Islamic hospital was founded in Damascus, Syria in around 707 with assistance
from Christians. However most agree that the establishment at Baghdad was the most influential; it
opened during the Abbasid Caliphate of Harun al-Rashid in the 8th century. The bimaristan (medical
school) and bayt al-hikmah (house of wisdom) were established by professors and graduates from
Gundeshapur and was first headed by the Christian physician Jibrael ibn Bukhtishu from Gundeshapur
and later by Islamic physicians.
In the ninth and tenth centuries the hospital in Baghdad employed twenty-five staff physicians and
had separate wards for different conditions. The Al-Qairawan hospital and mosque, in Tunisia, were built
under the Aghlabid rule in 830 and was simple, but adequately equipped with halls organised into waiting
rooms, a mosque, and a special bath. The first hospital in Egypt was opened in 872 and thereafter public
hospitals sprang up all over the empire from Islamic Spain and the Maghrib to Persia. The first Islamic
psychiatric hospital opened in Baghdad in 705. Many other Islamic hospitals also often had their own
wards dedicated to mental health.
In contrast to medieval Europe, medical school under Islam did not have faculties and did not
develop a system of academic evaluation and certification.

KASAHUN WORKNEH 3
 HOSPITAL LITRATURE REVIEW

Medieval Europe
Medieval hospitals in Europe followed a similar pattern to
the Byzantine. They were religious communities, with care
provided by monks and nuns. (An old French term for hospital is
hôtel-Dieu, "hostel of God.") Some were attached to monasteries;
others were independent and had their own endowments, usually
of property, which provided income for their support. Some
hospitals were multi-functional while others were founded for
specific purposes such as leper hospitals, or as refuges for the
poor, or for pilgrims: not all cared for the sick. The first Spanish
hospital, founded by the Catholic Visigoth bishop Masona in
580AD at Mérida, was a xenodochium designed as an inn for
travellers (mostly pilgrims to the shrine of Eulalia of Mérida) as
well as a hospital for citizens and local farmers. The hospital's
endowment consisted of farms to feed its patients and guests.
The church at Les Invalides in France
The Ospedale Maggiore, traditionally named Ca' Granda showing the often close connection
(i.e. Big House), in Milan, northern -Italy, was constructed to between historical hospitals and churches

house one of the first community hospitals, the largest such

undertaking of the fifteenth century. Commissioned by Francesco
Sforza in 1456 and designed by Antonio Filarete it is among the first examples of Renaissance
architecture in Lombardy.

The Hospital of the Holy Spirit (Polish: Szpital św. Ducha) is the oldest preserved hospital in
Poland alone and one of the oldest preserved in Europe. The Catholic Church first began establishing
hospitals in Western Europe during the 8th century. The first Polish hospitals were established during the
13th century, where they were administered by various religious orders. Each hospital had an attached
parish and church. A legend exists surrounding the hospital. During the tour of the newly constructed
building, Queen Jadwiga of Poland noticed at the end of the hall a lonely patient. Beside him on the wall
hung a cross. Seeing that nobody was keen to help the poor man, the Queen herself decided to bandage
his body in the name of God's mercy. Suddenly the wounds healed and when the monarch asked for his
name, the man only smiled and instantly disappeared. Queen Jadwiga towards the end of her life claimed
that it was Jesus Christ himself. The bed used by the patient was stored for centuries as a precious relic
and was endowed with great reverence. Unfortunately, it was stolen during World War I.
The wards housing multiple patients continued to be expanded and became the standard for the
public hospitals for hundreds of years. Often the wards were configured so the sick could see the altar to
assist with their recovery. The cross-shaped plan, which is thought to have originated in Florence, Italy, in
the 1400s achieved this goal with the altar in the middle and multiple wards radiating from it. The plan is
similar to many hospitals today with the nurse's station rather than the altar at the center. Florence was
well known for quality hospitals with good physicians and clean beds. Martin Luther, who was generally
critical of all Roman Catholic institutions, even recognized the quality of the facilities during a visit in
1500.
Early modern and Enlightenment Europe

KASAHUN WORKNEH 4
 HOSPITAL LITRATURE REVIEW

In Europe the medieval concept of Christian care evolved

during the sixteenth and seventeenth centuries into a secular
one. After the dissolution of the monasteries in 1540 by King
Henry VIII the church abruptly ceased to be the supporter of
hospitals, and only by direct petition from the citizens of
London, were the hospitals St Bartholomew's, St Thomas's and
St Mary of Bethlehem's (Bedlam) endowed directly by the
crown; this was the first instance of secular support being
provided for medical institutions.
1820 Engraving of Guy's Hospital in
London one of the first voluntary hospitals
to be established in 1724. The voluntary hospital movement began in the early
18th century, with hospitals being founded in London by the
1710s and 20s, including Westminster Hospital (1719) promoted by the private bank C. Hoare & Co and
Guy's Hospital (1724) funded from the bequest of the wealthy merchant, Thomas Guy. Other hospitals
sprang up in London and other British cities over the century, many paid for by private subscriptions. St.
Bartholomew's opened in London in 1730, and the London Hospital in 1752.

These hospitals represented a turning point in the function

of the institution; they began to evolve from being basic places of
care for the sick to becoming centres of medical innovation and
discovery and the principal place for the education and training of
prospective practitioners. Some of the era's greatest surgeons and
doctors worked and passed on their knowledge at the hospitals.
They also changed from being mere homes of refuge to being
complex institutions for the provision of medicine and care for
sick. The Charité was
founded in Berlin in A hospital ward in sixteenth century
1710 by King France. Frederick I of Prussia as a response to
an outbreak of plague.
The concept of voluntary hospitals also spread to Colonial America; the Bellevue Hospital Center
opened in 1736; the Pennsylvania Hospital opened in 1752, New York Hospital in 1771, and
Massachusetts General Hospital in 1811. When the Vienna General Hospital opened in 1784 (instantly
becoming the world's largest hospital), physicians acquired a new facility that gradually developed into
one of the most important research centers.
Another Enlightenment era charitable innovation was the dispensary; these would issue the poor
with medicines free of charge. The London Dispensary opened its doors in 1696 as the first such clinic in
the British Empire. The idea was slow to catch on until the 1770s, when many such organizations began
to appear, including the Public Dispensary of Edinburgh (1776), the Metropolitan Dispensary and
Charitable Fund (1779) and the Finsbury Dispensary (1780). Dispensaries were also opened in New York
1771, Philadelphia 1786, and Boston 1796.
19th century

KASAHUN WORKNEH 5
 HOSPITAL LITRATURE REVIEW

English physician Thomas Percival (1740-1804) wrote a comprehensive system of medical

conduct, 'Medical Ethics, or a Code of Institutes and Precepts, Adapted to the Professional Conduct of
Physicians and Surgeons” (1803) that set the standard for many textbooks.
In the mid-19th century, hospitals and the medical profession became more professionalized, with a
reorganization of hospital management along more bureaucratic and administrative lines. The
Apothecaries Act 1815 made it compulsory for medical students to practice for at least half a year at a
hospital as part of their training.
Nightingale was instrumental in reforming the nature of the hospital, by improving sanitation
standards and changing the image of the hospital from a place the sick would go to die, to an institution
devoted to recuperation and healing. She also emphasized the importance of statistical measurement for
determining the success rate of a given intervention and pushed for administrative reform at hospitals.
By the late 19th century, the modern hospital was beginning to take shape with a proliferation of a
variety of public and private hospital systems. By the 1870s, hospitals had more than trebled their original
average intake of 3,000 patients. In continental Europe the new hospitals generally were built and run
from public funds. The National Health Service, the principal provider of health care in the United
Kingdom, was founded in 1948.
During the nineteenth century, the Second Viennese Medical School emerged with the
contributions of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von
Hebra, and Ignaz Philipp Semmelweis. Basic medical science expanded and specialization advanced.
Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded
in Vienna, being considered as the birth of specialized medicine.
Criticism
While hospitals, by concentrating equipment, skilled staff and other resources in one place, clearly
provide important help to patients with serious or rare health problems, hospitals also are criticized for a
number of faults, some of which are endemic to the system, others which develop from what some
consider wrong approaches to health care.
One criticism often voiced is the 'industrialized' nature of care, with constantly shifting treatment
staff, which dehumanizes the patient and prevents more effective care as doctors and nurses rarely are
intimately familiar with the patient. The high working pressures often put on the staff can sometimes
exacerbate such rushed and impersonal treatment. The architecture and setup of modern hospitals often is
voiced as a contributing factor to the feelings of faceless treatment many people complain about.
Funding
In the modern era, hospitals are, broadly, either funded by the
government of the country in which they are situated, or survive
financially by competing in the private sector (a number of
hospitals also are still supported by the historical type of charitable Clinical Hospital Dubrava Modern
or religious associations). Medical Centre in Zagreb, Croatia.
In the United Kingdom for example, a relatively
comprehensive, "free at the point of delivery" health care system exists, funded by the state. Hospital care
is thus relatively easily available to all legal residents, although free emergency care is available to
anyone, regardless of nationality or status. As hospitals prioritize their limited resources, there is a
tendency for 'waiting lists' for non-crucial treatment in countries with such systems, as opposed to letting
higher-payers get treated first, so sometimes those who can afford it take out private health care to get

KASAHUN WORKNEH 6
 HOSPITAL LITRATURE REVIEW

treatment more quickly. On the other hand, some countries, including the USA, have in the twentieth
century introduced a private-based, for-profit-approach to providing hospital care, with few state-money
supported 'charity' hospitals remaining today. Where for-profit hospitals in such countries admit
uninsured patients in emergency situations (such as during and after Hurricane Katrina in the USA), they
incur direct financial losses, ensuring that there is a clear disincentive to admit such patients. In the
United States, laws exist to ensure patients receive care in life-threatening emergency situations
regardless of the patient's ability to pay.

HOSPITAL REQUIREMENTS ON ZONING OF BUILDING

Reliability
A general hospital should be easily reachable by public transport, assessed on the basis of transport
frequency and the distance to the stop, and also by taxi, car or bicycle.
This requirement is complied with if a general hospital is situated at one of the
geographic/demographic concentration points in its catchment area. A geographic/demographic
concentration point is a municipality where the population level and level of amenities (schools, retail
trade, recreation, and public services) is such that a substantial proportion of the population in the
catchment area of the hospital is more or less automatically orientated towards that municipality.
Zoning: The different areas of a hospital shall be grouped according to zones as follows
 Outer Zone – areas that are immediately accessible to the public: emergency service, outpatient
service, and administrative service. They shall be located near the entrance of the hospital.
 Second Zone – areas that receive workload from the outer zone: laboratory, pharmacy, and
radiology. They shall be located near the outer zone.
 Inner Zone – areas that provide nursing care and management of patients: nursing service. They shall
be located in private areas but accessible to guests.
 Deep Zone – areas that require asepsis to perform the prescribed services: surgical service, delivery
service, nursery, and intensive care. They shall be segregated from the public areas but accessible to
the outer, second and inner zones

KASAHUN WORKNEH 7
 HOSPITAL LITRATURE REVIEW

 Service Zone – areas that provide support to hospital activities: dietary service, housekeeping
service, maintenance and motor pool service, and mortuary. They shall be located in areas away from
normal traffic.
 A
c
c
es
s
to

and inside building

The site needs to be easily accessible by patients, visitors and staff. In this connection,
specifications apply to pavements/ footpaths (minimum width, minimum free height, maximum slope,
maximum height of Krebs), ramps (minimum width, maximum slope and length, halfway and end
platforms), outside stairs (minimum width, maximum rise, installation, height and design of handrails),
material properties of paving surfaces (flat, rough and joint less) and lighting. Regulations also apply to
the measurements and layout of parking places.
There are additional requirements for the disable, such as the size of parking places and the height
of parking meters. Obstacles should be indicated by warning paving, continuous guiding lines must be
present.
 Taxis should be able to come right up to the main entrance and the entrance to the outpatient unit.
 The entrance to the emergency department and if necessary the main entrance should be accessible by
ambulance.
 Public entrances to a hospital building should comply with minimum dimensions and also be
accessible by people with a physical handicap. These entrances should be covered over and provided
with good lighting.
 There are also specifications that apply to the entrance hall (sheltered situation, minimum dimensions,
location of the doors, lighting), thresholds (maximum heights) and door handles. In the case of
revolving or carrousel doors, there must be an extra swing or sliding door provided
Flexibility

KASAHUN WORKNEH 8
 HOSPITAL LITRATURE REVIEW

The main structural design of a hospital should possess a high degree of flexibility. The building
structure should be simple to extend at different points and should be able to cope with internal
displacement
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:
 Ward-related inpatient functions  Administrative functions
 Outpatient-related function  Service functions (food, supply)
 Diagnostic and treatment functions  Research and teaching functions
These flow diagrams show the movement and communication of people, materials, and
waste. Thus the physical
configuration of a
hospital and its transportation and
logistics systems are
inextricably intertwined. The
transportation
systems are influenced by the
building configuration, and
the configuration is
heavily dependent on the
transportation
systems. The hospital
configuration is also influenced by site restraints and opportunities, climate, surrounding
facilities, budget, and available technology. New alternatives are generated by new medical needs
and new technology.
In a large hospital, the form of the typical nursing unit, since it may be repeated many times, is a
principal element of the overall configuration. Nursing units today tend to be more compact shapes than
the elongated rectangles of the past. Compact rectangles, modified triangles, or even circles have been
used in an attempt to shorten the distance between the nurse station and the patient's bed. The chosen
solution is heavily dependent on program issues such as organization of the nursing program, number of
beds to a nursing unit, and number of beds to a patient room. (The trend, recently reinforced by HIPAA,
is to all private rooms.)
ORGANIZATION OF HEALTHCARE
Until a few years ago, organization of healthcare was largely based on the perspective of the
medical specializations available in a hospital and the availability of diagnostic and treatment facilities.
Furthermore, due to the largely mono disciplinary approach to the patient’s care requirements, virtually
every specialization had its own beds in the ward unit and diagnostic and treatment facilities in the
outpatient unit.

KASAHUN WORKNEH 9
 HOSPITAL LITRATURE REVIEW

As a result of the developments in specialist medical care described due to an increasing shift from
inpatient to outpatient care and day treatment, inpatient care is being increasingly reserved for complex
and difficult medical cases, attention has been paid in recent years to a more integrated organization of
healthcare, based on the patient’s perspective.

This trend has led to a reorientation regarding the way in which the demand for hospital care is
offered. This reorientation process concerns the logistic process in both the hospital organizations and the
entire care chain. It is consequently also possible to combine the different planning models. The choice
and detailing of the organization of the care is dependent on the situation and is largely determined by
weighing up the interests of the patient and the care provider in relation to management.
Elements and division of hospital
The main division of the hospitals are:
1. Administration division.  Outpatient clinics.
2.  Pharm
Outpatients’ acy.
division,
includes;

KASAHUN WORKNEH 10
 HOSPITAL LITRATURE REVIEW

 Emergency reception.  Nurses wards.

3. Diagnostic services division, includes;  Inpatient services.
 Laboratories. 7. General service division, includes;
 Radiology (diagnostic).  Kitchen.
4. Therapeutic services division, includes;  Laundry.
 Physical Therapy.  Storages.
 Radiology (therapeutic).  Workshops.
5. Internal medical treatment division, includes;  Mechanical services.
 Operation Theatres.  Mortuary.
 Intensive Care unit.  Security.
 Maternity section.  Parking.
 Central Sterilization Department.  Landscaping
6. Inpatient division, includes;
 Patient wards.

CLASSIFICATION OF HOSPITALS
There are many methods of classification of the hospitals, such as;
1. According to the level of care:
a. Secondary hospitals; District Hospital and some of Specific Hospitals .
b. Tertiary hospitals; Central High Specialized Hospital, Educational Hospital and some
of Specific Hospitals.
2. According to the size of the hospital:
a. Mini size hospital; <50 bed.
b. Mid-size hospital; 50-250 beds.
c. Big hospital; 250-500 bed.
d. Huge hospital; >500 bed.
3. According to the size of the medical specialists:
a. Specialist hospital; pediatric hospital, eye hospital. etc.
b. General hospital; all medical specialists are provided.
4. According to the owners of the hospital:
a. Private hospitals. b. Public hospitals; university hospitals, etc.
FLOW CHARTS
The hospital as a building type is composed of complex components, each of which could well
tax the talents of architects, mechanical engineers, and the other professions end skills involved in their
design and construction. Material relating to all these components would fill a book. Therefore, the
following have been selected for discussion in this section:
 Bedrooms  Cobalt-60
 Nursing units  Electroencephalographic suite
 Surgical suite  Physical therapy department
 Nursery  Occupational therapy department
 Pediatric unit  General hospital laboratory
 Diagnostic x-ray suite  Labor-delivery suite
 Tele therapy unit  Radioisotope facility
The critical space organization involving specialized equipment and facilities which are peculiar to
a hospital. The extent of services, kind of equipment, space requirements, etc., will vary with each
hospital and must be related to the services the hospital is to perform. Consequently, the information

KASAHUN WORKNEH 11
 HOSPITAL LITRATURE REVIEW

presented here must, of course, be adapted in each case. Much has been written on the subject of the
design and construction of hospitals. An adequate bibliography of this material is beyond the scope of this
section.
Generalized flow charts for the hospital as a whole and for various department.
1. Receptionist Registration 9. Operating theatre 16. Kitchen 24. Intensive Care
2. Pharmacy 10. Labor room 17. Sub-station 25. Shopping arcade
3. Examination/Consultation 11. General administration 18. Workshop 26. Casualty
4. Nursing station 12. Medical-cum-general store 19. Mortuary 27. Blood bank
5. Clinical laboratory 13. Manifold 20. Incinerator 28. Physiotherapy
6. Imaging 14. Central sterilization and supply 21. Entrance 29. Fire-protection
7. Patient area dep’t, 22. Parking 30. Residential accommodation
8. Nursing station 15. Laundry 23. Library/Conference 31. Park
ARCHITECTERAL FORMS AND STRUCTURES
Introduction
Show how concepts such as flexibility, functional relationships and design were translated in the
relevant period or are currently being translated into the building structure of the hospital.
The following models will be dealt with:
 The Breitfuss model  The branched structure
 The double comb structure  The linear structure
 The arcade model  The pavilion structure
 The cross structure
The building structure of a hospital has undergone a development that shows a decreasing
dominance of the ward block. The treatment and outpatient departments and the flexibility and design of
the main
traffic areas
have had
an

increasing impact on the main design of the hospital. Post-war hospital building in the early decades
generated many hospitals with imposing, sometimes monumentally designed ward blocks. In the eighties,
when flexibility became an important concept, more neutrally designed hospital structures evolved.
Subsequent developments show a more internally-oriented design of the buildings, through the use of
covered streets and plazas. Recently developed hospital designs are characterized on the one hand by
more emphasis placed on the design. On the other hand, since hospitals have been increasingly built in an

KASAHUN WORKNEH 12
 HOSPITAL LITRATURE REVIEW

urban context due to land problems, fitting them into the urban environment has become an important
concept.
Breitfuss model
General
A typical feature of the Breitfuss model is that a tall building block with nursing functions is
placed above a flat building block with treatment and outpatient functions. The structure of the building
shows a clear division between the static nursing units in the ward block and the dynamic departments on
the lower two (or three) stories. The external appearance of the ward block is often of an imposing design
due to its definitive status.

Access
In general it may be said that the Breitfuss model produces a compact building with relatively short
walking distances. However, staff and visitors do have to make frequent use of the lifts. The number of
lifts is partly determined by the number of stories of the ward block. In the case of high-rise with around
10 floors, a considerable part of the ward block will be taken up by provisions for vertical traffic (lifts and
staircases). Due to its compact design, this model usually has a clearly recognizable main entrance.
Functional relationships
Since the low-rise structure contains all diagnostic and treatment functions, it is possible to create
good spatial relationships with this type of building. Where the medical staff is concerned, the stacking of
the wards can mean that there is a considerable distance between the outpatient unit and the wards. The
Breitfuss model, originally designed according to functional planning of the care provided (outpatient
appointment unit, nursing unit, imaging diagnostics, laboratories, etc.), offers in principle sufficient
possibilities for planning the facilities for care provided on the basis of patient flows or on the basis of the
care process. The Breitfuss model is less suitable for planning on the basis of target-groups.
Flexibility
Where flexibility is concerned, account has only been taken of the possibility of adaptation and
expansion in relation to functions on the lowest floors. No possibilities for expansion or adaptation have
usually been provided for in the ward block. As a result of these limitations in the design, it is more
difficult with this type of building to comply with policy concerning the new style hospital that advocates
a shift

from inpatient to outpatient.

Example of Breitfuss model
Location and name of institution The Hague – Leyenburg Hospital
date of completion 1971
number of beds 750 beds
gross floor area 90 ,000 m²

KASAHUN WORKNEH 13
 HOSPITAL LITRATURE REVIEW

Double comb structure

General
The double comb structure is characterized by a traffic zone in the center from which different building
wings protrude like the teeth of a comb. The building structure is designed like a uniform grid. It
comprises many end walls, the so-called “open ends”, which make it simple to add extensions.

Access
Due to the many open ends, the external architecture gives the impression of being unfinished. In
contrast with the Breitfuss model, for example, an overall picture of the hospital is not visible. If located
in the heart of the traffic zone, the main entrance may be hidden between the teeth of the comb. In the
case of large hospitals, this structure can lead to a sprawling design.
Functional relationships
Functions which have to comply with the same requirements are grouped in one wing. From the
point of view of size and technical requirements, the teeth of the comb are geared to the functions to be
housed there. Practical experience has shown that stacking spatially related functions with specific
requirements regarding installations can also be successfully done in one wing. For example, the
emergency department is located on the ground floor, intensive care on the first floor and the operating
unit on the second floor. Other designs may include all laboratories in one wing, plus the pharmacy and
the central sterile supply services unit, or wings with only nursing functions.
The double comb structure is in principle suitable regarding too accommodating the care organization.
Flexibility
The double comb structure was developed at a period when flexibility had become one of the most
important design criteria. Flexibility is guaranteed by extending the teeth of the comb or by extending the
traffic structure by adding a new wing. The basic structure of the hospital remains unchanged after these
extensions.
Example of double comb structure
location and name of institution Nieuwegein – St. Antonius Hospital
date of completion 1979
number of beds 579 beds
gross floor area 61 ,000 m²

KASAHUN WORKNEH 14
 HOSPITAL LITRATURE REVIEW

Arcade Structure
General
The arcade hospital emerged as a new model in the early eighties and has been used a number of
times in the Netherlands. In this model, the building elements of the hospital are linked with each other by
a glass-covered arcade for main traffic. Located on both sides of this arcade, on several floors, are the
rooms or internal access routes that look out onto the arcade. In the arcade on the ground floor are a
number of public amenities such as shops and a restaurant.

Access
The high arcade is a clear structuring element. The main entrance at one end of the arcade is easily
recognizable. From the arcade, the vertical means of access to the upper floors are clearly visible.
Functional relationships
It is evident from the hospitals built in accordance with this model that organization can take place in
various different ways.
First the functions are located above each other. On the ground floor are the outpatient clinics, on
the first floor the operating department and the laboratories, and above those a technical floor. The top
two story’s house the nursing wards.
Second also based on an arcade model, but in this instance the functions have been placed behind
each other in different parts of the building. The outpatient departments, imaging diagnostics and the
accommodation for management functions are situated near the main entrance. In the centrally located
areas of the building are the operating department, the emergency department, laboratories and
physiotherapy. At the end of the arcade are two building elements containing the nursing wards.
The other is also be built according to the arcade structure. A section of the building for treatment
functions is planned in the heart of the complex, at right angles to the arcade. Parallel to the arcade on the
ground floor and the first floor will come the outpatient department facilities. Above these, on the top
three floors, will be the nursing wards.
The arcade structure is in principle suitable for all three planning models regard to accommodating
the care organization.
Flexibility
In a similar way to the double comb structure, the traffic structure (arcade) can be extended while
retaining the basic structure and new building elements can be added to it. The building elements linked
to the arcade usually have open ends on the other side that make it simple to add extensions in the future.

Cross structure
General

KASAHUN WORKNEH 15
 HOSPITAL LITRATURE REVIEW

In the case of this model, two building blocks each in the form of a cross have been linked to each
other so as to create a large covered hall between the two building blocks. The covered hall is the center
of the building and contains the central facilities.
Access
The main entrance is located in on corner of the covered hall. This plaza is the heart of the structure

and contains the central facilities. The vertical access points in the cross-shaped building blocks are
clearly visible from the plaza. This structure lends itself well to the development of a relatively large
hospital within a compact design.
Functional relationships
Virtually all the nursing wards are housed on the top four stories of this hospital. The outpatient
departments and treatment & diagnostics units are located on the lower level. Between the upper and
lower level is a technical floor. From the two intersections, a walkway diagonally crosses the central hall
at a first floor level, thereby reducing walking distances. The cross structure is in principle suitable for all
three planning models described in § 3.3 with regard to accommodating the care organization.
Flexibility
The open ends of the cross-shaped building sections can be extended while retaining the basic structure.
Example of cross structure
location and name of institution Arnhem – Rijnstate Hospital
date of completion 1994
number of beds 750 beds
gross floor area 82 ,000 m²

Branched
structure
General

KASAHUN WORKNEH 16
 HOSPITAL LITRATURE REVIEW

Under the heading branched structure, a look will be taken at two completed hospitals where the
most characteristic element of the structure is formed by the number of branches and open ends.

Access
The main entrance is directly linked to the central hall. The central hall is the center of the structure

and contains amenities such as boutiques and a restaurant. From this central hall the patients and visitors
can gain access to the most important departments of the hospital. The main stairwells and the lifts are
easily accessible from the central hall.
Functional relationships
The Canisius-Wilhelmina Hospital in Nijmegen was built according to this design. With an average
of 3 stories, this hospital is relatively low-rise. The outpatient departments have their own entrance, but
this is located on the same side of the square as the main entrance. Most nursing wards are located in the
branches leading off the square. The operating department and intensive care are situated on the top floor.
The situation and size of the site made it possible to build a relatively low-rise hospital. This means that
all the wards have a pleasant view over the green surroundings.
The Antonius Hospital built in Sneak is also characterized by low-rise building. In this hospital,
separate buildings elements were developed per main function. The services building is located
separately so that this function can respond to future developments. Functions which require a higher
building height have been located on the top floor. This concerns the X-ray and operating departments,
physiotherapy, pharmacy and laboratories.
A branched structure is in principle suitable for all three planning regard to accommodating the care
organization.
Flexibility
Due to the existence of many open ends, a branched structure possesses by definition sufficient
external flexibility. The following observations may be made regarding flexibility in the Antonius
Hospital. The different function groups have been housed in separate building elements with a
construction and raster size geared to the function group. Supporting outside walls have been used for
patient accommodation, while diagnostic, treatment and service functions have a skeleton structure. Since
each main function is located at an open end, the possibility of expansion is guaranteed. All beds in the
multi bed rooms are of equal quality due to the fact that the beds are located by a window. In addition, all
multi-bed rooms can be partitioned into maximum one-bed rooms.
Example of branched structure
location and name of institution Nijmegen – Canisius-Wilhelmina Hospital
date of completion 1992
number of beds 638 beds
gross floor area 63 ,000 m²
KASAHUN WORKNEH 17
 HOSPITAL LITRATURE REVIEW

Linear structure
General
This design has been developed consisting of a single linear block that can accommodate all
hospital functions in accordance with their inter-relationships. The depth of the block is approximately 22
meters and is designed for the application of a double corridor.
Stairwells
and cable and piping shafts
have been incorporated
in a rational design in the
central zone.
Access
The linear block
forming the hospital is
designed with a
number of kinks so that
the overall shape
resembles a hairpin. An
entrance is located on
both sides and opens
into a high glass hall that
is wedged between the
linear building
block. The different lifts
and stairwells can
be reached from the
central hall. In places
where a short link is required for functional purposes, additional glass connection corridors have been
designed between departments located opposite each other. In this way acceptable walking distances have
been achieved.
Function relationships
The dimensions of the linear building have been geared to house both outpatient clinics and nursing
wards. On different floors, outpatient departments are located next to nursing wards. In the case of future

KASAHUN WORKNEH 18
 HOSPITAL LITRATURE REVIEW

bed reductions, wards can easily be converted into outpatient clinic space. This design is fully in
accordance with policy on new style hospitals where a shift from inpatient to outpatient is advocated.
Flexibility
There are limitations regarding the external flexibility of the design of Vlietland Hospital on
account of the fact that it only has two open ends and due to the size of the site. Internal flexibility is
good, due for instance to the rational uniform design which makes it possible to interchange functions.
The linear structure is in principle suitable for all three planning models described in § 3.3 with regard to
accommodating the care organization.
Example of linear structure
location and name of institution Schiedam – Vlietland
Hospital
date of completion 2006 ( planned )
number of beds 453 beds
gross floor area 48 ,000 m²

Pavilion structure
General

KASAHUN WORKNEH 19
 HOSPITAL LITRATURE REVIEW

During the pre-war years, larger hospitals were built according to the pavilion structure. A cluster of
categorical hospitals was built on the site. This method was abandoned after the war. Today, however,
some designs for large hospitals are returning to the pavilion structure and opting for a plan according to
clinical entities, themes or type of care. An example of this is the design for the Isala Clinics in Zwolle. A
characteristic feature of the pavilion structure is that the spatial facilities that form part of the chosen plan
are grouped together.
Access
The design of the new building for the Isala Clinics comprises four blocks, varying from four to six
stories. Each block has an atrium. The building blocks will be built on three sides of the existing complex.

Situated beneath the new building blocks is a parking garage from which all four blocks can be reached.
In addition, the main entrance is located between two blocks, passing into a central hall into which opens
an extensive system of corridors providing access to all the building elements. This design has several
different entrances as a result of which extra measures will be necessary from the point of view of
security and surveillance.
Functional relationships
The new building will house virtually all patient-related functions, organized per block according to
clinical entity. As you move higher up the building, facilities for outpatients decrease as inpatient
facilities increase.
The pavilion structure is particularly suitable for a plan based on care according to target-
groups/clinical entities.
Flexibility
A design based on planning according to clinical entity in one or more building elements has a negative
effect on flexibility. Changes in activities and space between the functional units as a result of
developments in the care sector will be difficult to achieve in the future without a change in the basic
organization principles
.
HOSPITAL BUILDING REQUREMENT
CIRCULATION

KASAHUN WORKNEH 20
 HOSPITAL LITRATURE REVIEW

Circulation areas, such, as, corridors, staircases, etc., in the hospital buildings should not be more
than 40% of the total floor area of the building.

Floor Height - The height of all the rooms in the hospital should not be less than 3.00 m measured
at any point from the surface of the floor to the lowest point of the ceiling. The minimum head-room,
such as, under the button of beams. Fans and lights shall be 2.50 m measured vertical under such beam,
fan or light.
Rooms shall have, for the admission of light and air, one or more apertures, such as, windows and
fanlights, opening directly to the external air or into an open verandah. The minimum aggregate areas of
such openings excluding doors, inclusive of frames, shall be not less than 20 % of the floor area, in case
such apertures are located in one wall and not less than 15 % of the floor area, in case such apertures are
located in two opposite walls at the same sill level.
The architectural finishes in hospitals shall be of such quality which will help in maintenance of
better hygienic conditions.
The design of building shall ensure control of noise due to walking, movement of trollies and
banging of doors, etc. Expansion joint should have a nonmetallic beading finish. The doors should be
openable on both sides in operation theatre while inside at other places.
ENTERANCE AREA
Physical facilities - The hospital should have entrances as shown in the work flow analysis
Pharmacy/Dispensary/ - The dispensary should be located in an area conveniently accessible for
all clinics. The size should be adequate to contain 5 % of the total clinical ‘visits to the OPD in one
session at the rate of 0.8 m2perpatient.
The dispensary and compounding room should have multiple dispensing windows, compounding
counters and shelves. The pattern of arranging the counters and shelves shall depend on the size of the
room. The medicines which require cold storage and blood required for operations and emergencies may
be kept in refrigerator.
AMBULATORY CARE AREA
Waiting space - Apart from the main entrance, general waiting, subsidiary waiting spaces are
required adjacent to each consultation and treatment room in all the clinics. Waiting space for eye clinic
should not be subjected to direct-sunlight or glare. Waiting space in the pediatric clinic should provide
for minor recreation and play facilities for children.
Clinics - These clinics include general, medical, surgical, ophthalmic, ENT, dental, obstetrics and
gynecology, pediatrics, dermatology and venereology (optional),psychiatry (optional), neonatology
(optional) and orthopedic.

The cubicles for consultation and examination in all clinics should provide for doctor ‘stable,
chair, patient’s stool, follower’s seat, wash basin, examination couch and equipment for examination. The
clinics for infectious and communicable diseases should be located in isolation, preferably, in remote
corner, provided with independent access and completely cut off from the rest of the hospital.
The treatment and dressing room should be spacious enough to accommodate a medicine chest, a
work counter for preparing dressings, medicines, sink dressing tables with screen in between and a pedal
operated bin to hold soiled material.
 Medical clinic - The clinic should have a consultation and examination room depending upon
the load of out-patients. The clinic should also have facilities for cardio graphic examination.

KASAHUN WORKNEH 21
 HOSPITAL LITRATURE REVIEW

 Surgical Clinic - The clinic should have facilities for treatment-cum dressings. For
convenience, this should be placed next to consultation-cum-examination room with adequate
waiting space.
 Eye Clinic - The clinic should include consultation-cum- refraction and minor surgery-cum-
treatment room. For testing the state of refractive power of the eye, room length not less than
6m is essential. However by use of mirror length can be reduced. Dark room should be placed
close to consultation, preferably, with an intercommunicating door
 ENT clinic - The dental clinic may have facilities for dental hygiene and room for patient’s
recovery. Consultation-cum examination room should serve as combined purpose room for
consultation, examination dental surgery and treatment.
 Obstetric and Gynecological Clinic- The clinic should include a separate reception and
registration, consulting-cum examination, treatment and clinical laboratory.

The clinic should be planned close to in-patient ward units to enable them to make use of the clinics
at times for ante and postnatal care. The clinic should also beat a convenient distance from other clinics in
the OPD. Antenatal/before birth/ patients have to undergo certain formalities prior to examination by the
doctors, clinical laboratory for the purpose is essential. A toilet-cum-changing room close to treatment
should also be provided

 Pediatric Clinic - The clinic should provide medical care for 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 treatment room for immunization.
 Family Welfare Clinic - The clinic should provide educative, preventive, diagnostic and
curative facilities for maternal, child health, school health and health education. Importance
of health education is being increasingly recognized as an effective tool of preventive
treatment. People visiting hospital should be informed of environmental hygiene, clean
habits, need for taking preventive measures against epidemics, family planning, etc.
Treatment room in this clinic should act as operating room for IUCD insertion and
investigation, etc.
 Dermatology and Venereology Clinic (Optional) - The clinic should provide diagnostic
and curative facilities for dermatology, sexually transmitted disease and leprosy.
The treatment rooms for dermatology and venereology may be combined, but treatment
for leprosy should always be segregated. The clinic may also have facilities for superficial
therapy and a skin laboratory.
 Psychiatric Clinic (Options) - The facilities required for the clinic should include
consultation-cum-examination room, ECT treatment room, recovery, psychologist and asocial
worker room.
The clinic should preferably be located on ground floor to reduce the risk of suicide and accident.
All rooms of the clinic shall have dado/ level of sill from the ground/ one meter high and all electrical
fittings shall be protected. In ECT room the patient is subjected to electroconvulsive therapy (shock). A
resuscitation (recover) room is needed close to this room.
Neonatology Clinic (Optional) - the clinic should include a consultation- cum -examination,
counseling room and waiting facilities.
Orthopedic Clinic - The clinic should include arrangements for plaster preparation, fracture
treatment, besides consultation cum-exanimation.

KASAHUN WORKNEH 22
 HOSPITAL LITRATURE REVIEW

For X-ray facilities the clinic should be in close proximity of radiology department, emergency and
accident, in order to make the maximum use of equipment and to reduce the circulation. Plaster and splint
storage room is necessary for storing plaster materials, splints and other therapeutic aids and for preparing
plaster, bandages, etc. Fracture and treatment should be spacious enough to accommodate a dressing
couch and a mobile X-ray unit, a recovery room adjacent to the fracture and treatment room is essential.
1. Nursing Services - Various clinics under Ambulatory Care Area require nursing facilities in
common which include nursing station side laboratory, injection room, social service and treatment
rooms, with bed, etc.
 Nursing Station for Ambulatory Care Area - The nursing station shall be, centered, such
that it serves to all the clinics from that place. The nursing station should be spacious enough
to accommodate medicine chest, a work counter for preparing dressings, medicines, sinks,
dress tables with screen in between and a pedal operated bin to hold soiled material.
 Side Laboratory - For quick diagnosis of blood, urine, etc., a side laboratories required.
 Injection Room - For administering injection to patients a central injection room should be
provided in conjunction with the dispensary.
 Social Service - A social worker room to render service to the patients may be provided.
 Integral with bed -Bed control (within patient's reach, but with nurse-controlled cut-off
feature).

KASAHUN WORKNEH 23
 HOSPITAL LITRATURE REVIEW

Function of nursing units

1. It permits a closer relationship between the patient bedrooms and the nursing station and other
service areas.
2. It permits greater flexibility in segregation of patients for various medical reasons.
3. Much of the staff activity and particularly conversation can be carried on within the service unit
complex, thus cutting down noise in the patient corridor.
DIAGNOSTIC SERVICES
Imaging – Generally The role of imaging department should be radio diagnosis and ultrasound.
Radiology is a fast developing technique and the department should be designed keeping in view
the future scope for expansion. The department should be located at a place which is easily accessible to
both OPD and wards and also to operation theatre department.
As the department deals with high voltage, presence of moisture in the area should be avoided.
Radiography is a device of making pictorial records by means of X-ray at sensitized film whereas
fluoroscopy’s direct visualization through medium of X-ray.
 Radiography and Fluoroscope Room - The size of the room shall depend upon the type
of equipment installed. The room should have –
 A sub waiting area with toilet facility and
 A change room facility, if required.
Fluoroscope room shall be completely cut off from direct light through provisions of air-locks. The
radiography units should be operated from separate control room or behind a lead mobile protection
screen of 1.5 mm lead equivalent where ever necessary.
 Film Developing and Processing Room (Dark Room) - Film developing and processing
(darkroom) shall be provided in the department for loading, unloading, developing and
processing of X-ray films.
The room should be provided between a pair of radiography rooms so that new and exposed X-ray
films maybe easily passed through the cassette pan with 2.0 mm lead backing installed in the wall in
between. The room should be completely cut off from direct light through provision of airlock. For
ventilation, exhaust fans shall be provided. The room shall have a loading bench (with acid and alkali
resistant top), processing tank, washing tank and a sink. Flooring for the room shall be acid and alkali
proof.
Dark room this room is located between the two x-ray rooms to facilitate handling of films
Cassettes are loaded and unloaded on the counter. Space is provided for loading and stacking cassettes at
both ends of the counter.
A utility sink with a drain board, located opposite the processing tank, is provided for mixing
chemical solutions and hand washing. A refrigerating unit for the tank is located in the space beneath the
drain board.
X-ray films are processed in an area separated from the loading counter by a partition at the end of
the developing tank which helps to avoid accidental splashing and damage to the screens and films on the
loading counter. A through-wall processing unit tank permits the radiologist or staff doctors to read the
wet films in the light room area without interrupting darkroom procedures
A light lock between the darkroom and the light room, equipped with interlocking doors,
is necessary to allow entrance into the darkroom of other personnel during film processing. Although a
maze has some advantages over the light lock, the additional space needed is not justifiable in a facility of

KASAHUN WORKNEH 24
 HOSPITAL LITRATURE REVIEW

this size. Access panels, located in the light lock and in the control space, are provided to simplify
installation and servicing of the processing tanks
Fills Processing Area To reduce unnecessary traffic, the film processing rooms are located near the
collection and distribution area. This layout allows the technician to work without interruption during the
processing routine. Processing of films begins at the developing tank in the darkroom, and continues to
the final rinsing tank in the light room where the films may be wet-viewed at an illuminator, if desired,
end then dried. After the films are dried, they are brought to the counter in the technicians' corridor for
final trimming, and passed through to the film collection end distribution area.
 Film Drying and Storing - There shall be some space available for film drying and storing near
the room for film developing.
 Treatment Room - Treatment room of the department shall include space for the infra X-
ray and ‘contact therapy apparatus which is of simple character, occupies little space and
may not need elaborate structural requirements. Gynecology and ophthalmology clinic
make use of this apparatus.
 Ultrasound - Ultrasound, a scanning device of imaging department, also requires a small
room for use mainly by gynecology and obstetrics clinic.
 Collection and Distribution Area - Film sorting bins ore provided above the counter in the
collection and distribution area for temporary filing. After ell films have been assembled, they are
passed through the film peas slot to the radiologist for interpretation. He returns the films in a file
cart or through a slot which leads into a box under the distribution counter. The films may then be
temporarily filed for viewing by staff doctors or placed in the active files.
GENERAL HOSPITAL LABORATORY
Preliminary Planning
Locate the department as favorably as possible for the laboratory staff and the ambulant
inpatients and outpatients. A space on the first floor near an elevator is preferable. Also, another
determinant in locating the laboratory is the consideration for future expansion.
In determining the overall size of the laboratory, the first concern is the individual technical units. It
is only after the size of these units has been established and an architectural layout has been developed to
fit the program that the sum of the areas can accurately reflect the size of the laboratory department.
The key to this method is to estimate the word volume and its breakdown into work units for
hospitals of different sizes. The following is an outline of the procedure which may be used in estimating
needed laboratory space, based on the number of tests performed, personnel, and equipment.
1. Break down the total volume of work in to units, such as hematology, urinalysis, and
chemistry, as previously noted.
2. Determine the number of technologists required in each department.
3. Determine the necessary equipment and space for the number of technologists
Laboratory Guide Plan
The laboratory services of a general hospital having this work volume would require work areas for
six main technical units: hematology, blood bank, urine lysis, biochemistry, histology, and serology-
bacteriology.
The block plan has been utilized here, as it provides a good functional relationship for all units. The
pathologist's office in the center provides for easy supervision of the work stations; the hematology unit is
near the waiting room the bacteriology unit is at the end of the laboratory, yet near the washing and
sterilizing areas and the histology unit is near the pathologist's office.

KASAHUN WORKNEH 25
 HOSPITAL LITRATURE REVIEW

Open plan arrangement between histology and serology-bacteriology units has several advantages
over the "separate room for each unit" scheme for hospitals of this size. These advantages include: easier
supervision; common use of such equipment as desks, refrigerators, and centrifuges; flexible use of
personnel; and more available space since many doors and partitions are eliminated. If desired, partitions
could be erected between each unit, as indicated on the plan for the histology and serology-bacteriology
units.
Technical Areas Hematology-Blood Bank Unit. A standard module is assigned to the
Hematology - blood bank unit. One half of this module is provided with a workbench for
procedures such as hemoglobin tests, sedimentation rates, staining, and washing of pipettes Knee apace
and storage cabinets are provided below the counter.
The micro-hematocrit centrifuge, because of its noise and vibration when in use, is placed in the general
technical area along the interior wall directly opposite the hematology unit. The other equipment needed
by this work unit, such as e refrigerator, centrifuge, and recording desk, is located conveniently opposite
the unit, where it is shared with the urinalysis and the chemistry units.
A blood bank refrigerator is provided for this purpose in the examination and test room.
Compatibility tests on the blood are done in the hematology unit. A hospital which operates a self-
contained blood bank, that is, collects and does complete processing of all blood, should provide a
separate bleeding room, processing laboratory, donors' recovery room, and an office available for
preliminary physical examinations.
Urinalysis Unit - The urinalysis unit is assigned one half of a standard module, consisting of a
workbench, 12 linear ft. long and 30 in. high, and serves as the work area for the microscopic and
chemical examinations. Five linear ft. of the workbench and s knee space are provided for personnel
performing the microscopic examinations ; the remainder of the workbench is used for the chemical
examinations A sink located at one end of the workbench provides a continuous working surface for the
technologists .
Biochemistry Unit - The biochemistry unit requires an area that occupies one and a half
standard laboratory modules. The half module is shared with the urinalysis unit and is used for the
necessary preliminary procedures that are done prior to the actual chemical analyses. A knee space is
provided in this workbench for personnel who perform titrations and other procedures while seated. The
adjoining module provides workbench area where a variety of chemical procedure may be performed and
includes a fume hood for removal of vapors and gases.
Laboratory - The clinical laboratory should be provided with 600mm wide and 900 mm high
bench of length about 2 m per technician and to full width of room for pathologist charge of the
laboratory. 13achlaboratory 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, alkali proof
material.
 Sample Collection Room -For quick diagnosis of blood urine, etc., a small sample
collection room facility shall be provided.
 Blood Bank - The function of blood bank is to maintain current blood groupings, to collect,
store and issue blood. Blood bank shall be in close proximity to pathology department and
at an accessible distance to operation-theatre department, intensive care units and
emergency and accident department. The units shall include a reception cum-waiting room,
bleeding room, laboratory for groupings, recovery room and a room for storage of blood.

KASAHUN WORKNEH 26
 HOSPITAL LITRATURE REVIEW

 Bleeding Room - Blood taking also requires a comfortable reception with toilet.
Bleeding room should be quiet and not thoroughfare and should be divided into
cubicles for privacy.
 A restroom - shall also be provided for donors to rest and take light refreshment
before returning home.

INTERMEDITE CARE AREA (INPATIONT NURSING UNITS)

General - Inpatient nursing units, that is, ward concept is fast changing due to policy of early
ambulation and in fact only a few patients really need to be in the bed.
The basic considerations in placement wards is to ensure sufficient nursing care, locating them
according to the needs of treatment, in respective medical discipline and checking cross infection.
Nursing care should fall under the following categories:
 General Wards — Wards of traditional type for patients who are not critically ill but need
continuous care or observation and have to be in bed. These include wards for medical,
surgical, ENT and eye disciplines, etc.
 Private Wards (Optional) — Wards for patients who are in a position to pay high towards
Medicare. These may be air-conditioned or non-air conditioned.
 Wards for Specialties — Wards for patients who are suffering and need hospitalization in
particular specialties, like, pediatric, obstetrics, gynecology dermatology, venereology,
psychiatry, etc.
 Location - Wards should be relegated at the back to ensure quietness and freedom from
unwanted visitors. General ward units are of repetitive nature and hence they maybe
conveniently piled up vertically one above the other which will result in efficiency, easy
circulation and service economy.
Wards for particular specialties, however, should be located closer to their respective department to
act as self-contained centers. In such case, post-operative ward may be placed horizontal to operation
theatre and maternity ward to the delivery rooms.
 Ward Unit - In planning a ward, the aim should be to minimize 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.

The ward unit may be made of desired number of beds at the rate of 7 m 2per bed and should be
arranged with a minimum distance of 2.25 m between center of two beds and a clearance of 200 mm
between the bed and wall. Inwards, the width of doors shall not be less than 1.2 m and all wards should
have dado to a height of 1.2 isolation unit in the form of one single bedded room per ward unit should be
provided to cater for certain cases requiring isolation from other patients. An area of 14 m 2 for such rooms
to contain a bed, bedside locker, and easy chair for patient, a chair for the visitor and a built-in cupboard
for storing clothes is recommended. This isolation unit should have separate toilet facilities.

 Type of Wards - Wards may be either right angle or rigs type. In the former, beds are arranged
at right angle to the wall with the feet towards the central corridor and in the latter 4to 6 beds
are arranged parallel to the longitudinal walls and facing each other. A rig type ward is
recommended from socio-environment’s stand point.
 General Ward Facilities - Each ward unit should have a set of ward ancillaries as given
below-

KASAHUN WORKNEH 27
 HOSPITAL LITRATURE REVIEW

 Nursing station (Nurses desk and clean utility) - It should be positioned in such a way
that the nurse can keep a continuous watch over the patients.
The room shall contain a cupboard to hold materials which might otherwise, placed in clean utility
room, a drug cupboard, sink, chair, small table and space for call System points & and records. Separate
toile facilities for nurses shall be provided.
 Ward pantry - For collection and distribution of meals and preparation of beverages, a ward
pantry shall be provided. It should be fitted with a hot-water supply geyser, refrigerator and a
hot case and should have the facilities for storing cutlery, etc.
 Ward store - A store shall be provided for storing the weekly requirements of clothes, bed
sheets, and other ward equipment.
 Treatment room - Major dressing and complicated treatments & should be carried out in the
treatment room to avoid the risk of cross-infection.
 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, storage of stool and urine
specimen, etc.
 Day space - For those patients who are allowed to sit and relax, room shall be provided in the
ward unit itself. It should afford an easy access to patients and supervision byte nursing staff
and should be provided with easy chairs, book shelves and small tables. It may also serves
dining space.
 Patient conveniences - Toilet for an individual room (single or two bedded) in ward unit
shall be 3.5 m2 comprising a bath, a washbasin and WC. Toilet common to serve two such
rooms shall be 5.25 m2 to comprise a bath, a WC in separate cubicle and a wash basin.
Ward Unit for Particular Specialties
The provisions recommended for general ward unit shall apply with additional requirements as
described below.
 Obstetric Ward - Maternity service includes antenatal care, delivery and postnatal care. Before
and after child birth, the patient should be attended to in the out-patient clinic and during labor
the patient is confined to bed in the nursing unit.
The out-patient clinic should also provide diagnostic facilities for gynecology patients. Since these
services are cyclic, it is recommended to place the in-patient up it close to the out-patient clinic making it
easily accessible to the childbearing women. The inpatient unit shall comprise –
(a) Delivery suite unit
(b) Nursing unit, and
(c) Neonatal unit, and they should be placed on the same floor.
 Nursing Unit - Nursing unit for the department shall include antenatal, postnatal, eclampsia,
post-operative, and gynecological units.
 Prenatal Beds - The female patients admitted for treatment during the period of their
pregnancy should be housed in a ward separate from those who have undergone the labor.
The ward would need the same facilities as recommended for general ward in 5.4. The ward should
also have provision for a fully equipped laboratory. The treatment room should also be bigger in such
ward unit.
 Toxemia Beds - These patients fall under prenatal and postnatal category. The ward should
either form part of antenatal nursing unit or placed close to delivery suite unit. Number of beds

KASAHUN WORKNEH 28
 HOSPITAL LITRATURE REVIEW

shall be one in every 20 postnatal beds. Single and two-bedded rooms with attached toilet
should be provided.
 Postnatal beds - Patients who have had normal deliveries and do not suffer any complication,
calling for medical care are admitted to this ward. The size of the ward depends upon whether
the babies are kept with the mothers or all 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 side of the patients. The unit should be close to maternity
ward. Area per bed for such cases may be suitably increased.

 Post-operative Bed - The post-operative bed for the patients who have undergone operation
shall be able to accommodate two beds per delivery room including operating delivery room.
Area per bed maybe 8.75 m2.
 Gynecological Beds - The proportion of gynecological beds should be 40% of the maternity
beds.

KASAHUN WORKNEH 29
 Neo-natal Unit
Wellbeing of the new born comes the responsibility of the pediatrician. A separate neonatal unit for
premature, high risk babies and sick new horns should be established as independent unit. Facilities like
- Nurseries, - Store
- Nurses station - Photo therapy and
- Formula-cum-breast feeding room, - A sluice room should be provided.

 Premature Nursery - Premature babies in individual heated bassinets/child weaker bed/ incubators
with temperature and humidity control should be accommodated and oxygen outlet installed. Floor
space per bassinet maybe 3.5 m2.
 Septic Nursery - Babies known to be or suspected of being infected shall be kept in an isolated room
with cubicles/small partition of a room/. They should be segregated from normal and premature
nurseries. Floor space per bassinet should be 3.5 m2.
 Normal Nursery - An independent nursery for normal and healthy babies is not considered essential.
However, a nurse with 2 to 4 bassinets may be provided. Floor space per bassinet maybe 3.5 m 2.
 Nurses Station - It should be so placed so as to ensure continuous watch over the nurseries and to
render efficient treatment to infants.
 Photo Therapy Room - A room with one transparent sidewall for observation of babies in natural
light.
 Formula Room - A formula room shall be provided close to the nursery for the preparation of food
for the infants who are not fully breastfed. The size of the room shall be increased, if washing and
sterilizing of feeding bottles is done in the room.

Intensive care unit

General - 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, head
injuries, severe hemorrhage, acute/critical or serious/ coronary occlusion, kidney and respiratory
catastrophe, poisoning, etc.
It should be the ultimate Medical care the hospital can provide with highly specialized staff
and equipment. The number of patients requiring intensive care may be tit 2 to 5 % of total
medical and surgical patients in a hospital. The unit shall not have less than 4 beds nor more than
12 beds.
 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, continuous electric supply, heating, ventilation, air-conditioning and efficient lift services.
A good natural light and pleasant environment would 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
nurses’ station. The area per bed in this unit should be 10.5 m 2 to cater/provide food & drink/
for free movement check against infection and at time utilization of specialized bulky
equipment.
 Planning of the Ward - The basic consideration in planning should be to have Fully visible
patients area with adequate space all round for positioning of specialized equipment,
• A central nurses station with minimum possible walking distance,
• An adequate stock of medicines, and
• Distinct clean and dirty utility area where movement of staff and supplies could be
 Facilities - Various facilities required for the unit are given below.
 Nurses Station ( Control Console) - This should be planned as an open area with
adequate counter space for writing, telephones, patients monitoring equipment’s, X-ray
viewing boxes, etc. Open planning should be adopted for visibility as well as audibility of
the entire patient’s area. A small pantry space along with the nurses’ station may be
helpful.
 Clean Utility Area - This should contain all the essential supplies, linen, medicines,
lotions, syringes, trolleys, various mobile equipment, etc.
 Equipment Room and Intensive Care Laboratory - This should provide for immediate
clinical tests and investigations. All essential testing equipment should be housed in it.

Critical care area (Emergency services)

The department is also termed as casualty wing for emergent cases. As such, 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 casualties arriving in the hospital. It should be located in the
complex of the OPD for reasons of easy accessibility and sharing medical facilities with the OPD.
It shall be placed on ground floor of the hospital. Guidance to the route from main gate to
the doorways of reception hall shall be ensured. The physical facilities of the department should
include accommodation for out-patients and in-patients in one block with a separate entrance for
ambulance, all facilities for reception and immediate treatment, operation theatres, the necessary
supporting services and resuscitation services.
There should be an easy ambulance approach with adequate space for free passage of
vehicles and covered area for alighting patients. The arrangements for reception of trollies and
walking patients should be close by but independent. It should seine as waiting space also for
persons accompanying the patients. As the accident cases are closely associated with police
department, a separate room for their use shall be provided in this area. Separate toilet facility for
men and women should be provided nearby.
Therapeutic services
Operation Theatre Staff - Operation theatre suite is technically a therapeutic aid in which a
team of surgeons, anesthetists, nurse’s and sometime pathologist and radiologist operate upon or
care for the patients. For optimum utilization of the operation/labor room units, the department, as
a rule, should not be reserved rigidly for use by a particular department.
 Location - The location of the department should be decided on the following factors:
A. Quite environment
B. Freedom from noise and other disturbances;
C. Freedom from contamination and possible cross infection,
D. Maximum protection from solar radiation and
 E. Convenient relationship with surgical ward, intensive care unit, radiology, pathology,
blood bank and CSSD.
This unit also needs constant specialized services, such as, piped suction and medical gases,
electric
supply, heating, air-conditioning, ventilation and efficient lift service, if the theatres are
located on upper floors
 Zoning - A high degree of asepsis/exclusion of bacteria/ should be ensured to provide
appropriate environment for staff and patients. For this, the passing of the patients and the
equipment through long corridors and other unprotected areas should be avoided. Zoning shall
be done to keep the theatres free from microorganisms.
 There maybe four well defined zones of varying degree of cleanliness.
A. Protective zone (A) - Containing mostly theatre supply, changing rooms, pre-anesthetic
examination room and waiting area.
B. Clean zone (B) - It includes the casualty theatres, recovery wards, plaster room, theatre
pack preparation and pre-operative wards.
C. Aseptic or sterile zone (C) - It consists of operation theatres, anesthetic and sterilizing
rooms. It shall provide the highest degree of antibacterial precautions.
D. Disposal or dirty zone (D) - The soiled instruments and dressings are transacted through
this area for washing and re-sterilization or disposal. It includes the sluice/sliding gate/
rooms and disposal corridor:
 Circulation - Normally there are three types of traffic flow, namely
(a) Patients
(b) staff, and
(c) Supplies. All these should be properly channelized.
 Patients - Patients are brought from the ward and should not cross the transfer area
in their ward clothing which is great source of infection. Change-over of trolleys
should be effected at a place which will link up both pre-operative and post-operative
rooms.
 Preparation Room (Theatre pack) - It should be a work room for arranging for
sutures, dressings and all other surgical items.
 Pre-operative Room - Patients are transferred from respective ward to this room for
premeditation before operation. Segregation of male and female patients is to be
taken care of. The room should have toilet facility separately for men and women.
 Post-operative Resting - Immediately altered operation, the patients are kept in a
room situated close to the operation theatre/labor room until such time they are found
fit to be taken to their parent ward.
 Staff - The doctors, nurses, technicians and class IV staff should enter from a
separate route and through a set of change rooms and an air lock. They should
communicate with the sterile corridor. A shoe change and gowning space near the air
lock shall also be provided. Separate change rooms for doctors, nurses and
technicians shall be provided, with arrangement for lockers, bathing and toilet
facilities.
 Supplies - All sterile goods should have a separate entry point reaching the clean
corridor independently; soiled material should be taken out by the exit only.
 Storerooms shall be provided for storing theatre supplies like stretcher, trolley, sterile
material, medical gas cylinders, instruments and linen.
 Operation Theatre - Operating room should be made dust-proof and moisture
proof. Comers and junctions of walls, floor and ceiling should be rounded to prevent
accumulation of dust and to facilitate cleaning. All doors should be two leaf type with
a minimum 1.5 m width and shall have self-closing devices. Natural lighting shall be
provided with fixed light windows (where there is no operable shutter) and general ill
ruination by means efflorescent tubes. The operating room/labor room should be
normally arranged in pairs with scrub-up and instrument sub-sterilizing room.
 Scrub-up - In this room 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.

It should have a single leaf door with self-closing device and viewing window to
communicate with the operation theatre. A pair of surgeon’s sinks with elbow or knee operated
taps are essential.

 Instrument Sterilization - It is a sub-sterilizing unit attached to the operation theatre

limiting its role to operating instruments on an emergency basis only. This room
should be equipped with high pressure, quick sterilization apparatus. Instrument
cupboard and a workbench with sinks are essential.
 Disposal - Theatre refuse, such as, dirty linen, used instruments and other
disposable/non-disposable items should be removed to a room after each operation.
Non disposable instruments after initial wash are given back to instrument
sterilization and rest of the disposable items are disposed of and destroyed. Dirty
linen is sent to laundry through a separate exit. The room should be provided with
sink, slop sink, workbench and draining boards.

 Delivery Suite Unit - The delivery suite unit should include the facilities of accommodation
for various facilities as given below.
 Reception and Admission - As the patients, many a time, arrive in a state of imminent
delivery, the registration counter should open into an entrance lobby.
 Examination and Preparation Room - The room should accommodate one or two beds
and provide space for the doctor with the work table, etc. A change room with attached
toilet facilities shall be provided with the examination cubicle. The provision of lockers
for keeping personal clothes and articles may also be kept in view.
 Labor Room - Labor rooms should preferably be in the form of cubicles; two labor
rooms for every 10 maternity beds.
As birth follows labor, the labor rooms should be placed adjacent to delivery rooms. The
examination cum-preparation room and labor room may be combined into a single room.
 Delivery Room - Delivery rooms shall be of the following types:
a) Clean delivery room for normal deliveries, and
b) Operation theatre for caesarean.
 One delivery bed shall be provided for every 10 maternity beds. The size of the operating
theatre for caesarean shall be the same as that of the operating theatres. Sterility and other
requirements shall be maintained like operation theatres department.
 Sterilizing Rooms - The facilities for sterilization of the equipment in the delivery suites
should be provided. This room should house a work counter, sink, small high-speed
pressure instruments sterilizer, etc.
 Sterile Store Room - Close to the sterilizing room, a room to store sterile material should
be provided. It should be provided with issue windows.
 Scrubbing Room - Scrub-up facilities may be provided between two delivery rooms
similar to those provided in operation theatre department.
 Dirty Utility - For collection and transferring of blood stained clothes to the laundry unit,
a sluice room shall be provided. It’s desirable to install mechanical aid for washing of
bedpans, urinals, etc.
 Other Facilities – Other facilities for the unit should include change rooms for doctors,
nurses, technicians, anesthesia room, pack preparation rooms, instrument and linen
storage, recovery room, etc., and these should be identical to operation theatres
department. They should be arranged in the same degree of asepsis.
 Physiotherapy - The physiotherapy department provides treatment facilities to patients
suffering from crippling diseases and disabilities. Treatments may be classified as physical and
electro-therapy, hydro-therapy and exercise (gymnasium).
 Location - The department is more frequently visited by outpatients but should be
located at a place which may beat convenient access to both outdoor and indoor patients.
Availability of natural light, fresh air and adequate ventilation are of extreme importance
for the department. Physiotherapy demands complete privacy.
Accommodation should therefore be provided in the form of booths. A long room provided
with curtains which could be drawn to form cubicles and afford adequate privacy should be
suitable.
 Physical and Electro-therapy - The nature of treatment and equipment employed maybe
of various kinds, such as, electrotherapy, thermotherapy, traction and massage, etc.
Each cubicle for treatment should be large enough for the physiotherapist to work on either
side of table without having to move the equipment. Cubicles should be divided by curtains for
easy movement of wheel chairs and stretcher.
 Gymnasium - A large hall shall be provided for group or individual exercise activities
including parallel bam, pulleys, wall bars, ladders, etc. It is used extensively by patients
in wheel chairs, crutches or with walking sticks or other disabilities which limit motion
and ability.
It maybe oblong in shape with the wall bar and climbing bars fixed to one of the long walls.
Mirrors should be provided for correcting walking disabilities. Flooring of gymnasium shall be
wooden parquet type.
 Office - The physiotherapist should have an office room where patients may be
interviewed and examined. In addition, here shall be sufficient space for staff to maintain
clinical records of patients.
 Store - Articles and equipment which are not in use should have space for storage.
  Toilets - Separate toilet facility for patients should be provided and they should be
designed to accommodate wheelchairs.

Hospital services
Hospital Kitchen (Dietary Service) - The dietary service of a hospital is an important
therapeutic tool. Properly rendered, it shall be a clinical and administrative means of stimulating
rapid recovery of patients thereby shortening patients stay in the hospital.
The aim in hospital catering, therefore, should be to produce well cooked, appetizing and
nutritious food as economically as possible. The achievement of this objective shall depend on
administrative efficiency of the staff, planning department, layout and equipment.

The hospital kitchen could be alone responsible for spreading diseases if hygienic
conditions are not maintained. Use of cooking gas and electricity will definitely improve the
hygienic conditions of a hospital kitchen. Good natural light and ventilation is of great
importance.

 Location - Location should ensure that any noise or cooking odors emanating from the
department do not cause any inconvenience to the other departments. At the same time
the location should involve the shortest possible time in delivering food to the wards.
 Central Sterile and Supply Department (CSSD) - Sterilization, being one of the most
essential services in a hospital, requires the utmost consideration in planning. Centralization
increases efficiency, results in economy in the use of equipment and ensures better supervision
and control. The materials and equipment dealt in CSSD should fall under three categories
A. those related to the operation theatre department,
B. common to operating and other departments, and
C. Pertaining to other departments alone.
 Location - Since the operation theatre department is the major consumer of this service,
it is recommended to locate the department at a position of easy access to operation
theatre department.
 Hospital Laundry - Laundering of hospital linen shall satisfy two basic considerations,
namely, cleanliness and disinfection. Manual/electric laundry can be provided with necessary
facilities for drying, pressing and storage of soiled and cleaned linens. Air change in laundry
area maybe 10times per hour.
 Medical and General Stores - Hospital stores comprise of stores needed for various hospital
functioning and should be grouped centrally in the service complex. The area for each type of
stores should be utilized to the optimum by providing built in shelves at different heights
according to the type of stores. Adequate ventilation and security arrangement shall be
provided. Stores should also be provided with firefighting arrangement.
 Mortuary - Mortuary shall provide facilities for keeping of dead bodies and conducting
autopsy. It should be so located that the dead bodies can be transported unnoticed by the
general public and patients. Relatives and mourners should have direct access to the mortuary.
The mortuary shall have facilities for walk in cooler, post mortem area, etc.
Engineering services
 Electrical Engineering
  Sub Station and Generation - Electric substation to accommodate transformer, HT/L.T
panel and generating set to meet the electrical lead requirements of the hospital shall be
provided. Stand by generators should be provided to generate power requirements for
essential and critical areas of the hospital, like, OT/LR radiology department, etc.
 Illumination - General lighting of all hospital areas except stores and lavatory block
shall be fluorescent. In other areas, it is recommended to be of incandescent lamps.
Shadow less Light Shadow less light (mountable type) shall be provided in operation
theatres and operating delivery rooms whereas in other areas, where operation of minor nature are
carried out, shadow less light (portable type) shall be provided.
 Emergency Lighting - Emergency portable light units should also be provided in the
wards and departments to serve as alternative source of light in case of power failure.
 Lighting Protection - The lighting protective system of hospital buildings shall be in
accordance with IS 2309.20.1.6 Call Bells Call bells (see IS 2268) with switches for all
beds should be provided in all types of wards with indicator lights and location indicator
situated in the nurses duty room of the wards.
 Ventilation - Ventilation of hospital buildings maybe achieved by either natural supply
and natural exhaust of air, or natural supply and mechanical supply and mechanical
exhaust of air.
The following standards of general ventilation are recommended for various areas of the
hospital building based on maintenance of required oxygen, carbon-dioxide and other air quality
levels and for the control of body odors when no products of combustion or other contaminants
are present in the air or anesthesia gases, which are highly explosive are present:
 Mechanical Engineering
 Air conditioning and Room Heating - Air conditioning units shall be provided only for
the operation theatre and neonatal unit. However, air coolers or hot air connectors may be
provided for the comfort of the patients and the staff depending upon the local needs.
 Refrigeration - Hospitals shall be provided with water coolers and refrigerator inwards
and departments depending upon the local needs.
 Public Health Engineering
 Water Supply - Arrangements shall be made to supply 10000 liters of potable water per
day to meet all the requirements (including laundry) except firefighting. Storage capacity
for 2 days requirements should be on the basis of the above consumption.
Round the clock water supply shall be made available to all wards and departments of the
hospital. Separate reserve emergency overhead tank shall be provided for operation theatre.
Necessary water storage overhead tanks with pumping/boosting arrangement shall be made. Cold
and hot water supply piping should be run in concealed form embedded into wall with full
precautions to avoid any seepage.
 Drainage and Sanitation - The design, construction and maintenance of drains for waste
water, surface water, sub-soil water and sewerage shall be in accordance with
international standards.
 The selection, installation and maintenance of sanitary appliances shall be in accordance
with IS the design and installation of soil, waste and ventilating pipes shall be as given in
 Waste Disposal System - The guidelines provided by Central Pollution Control Board,
Ministry of Environment and Forests shall be followed.
 Fire Protection
 First-aid Firefighting Equipment - adequate first-aid, fire-fighting equipment shall be
provided and installed.
 Fire Alarm - Manually-operated tire alarm facilities shall be provided in hospital
buildings which sound an audible alarm in administrative department, engineering semis
offices, fire office and such other locations where gongs, sirens, whistles or bells do not
disturb the patients.
Distinctive visual or audible alarm shall be installed at each nurse’s duty room, duty station
and used for tire alarm purpose only.
 Telephone and Intercom
Wiring in conduits shall be provided to give telephone outlet points in rooms, wards and
departments as desired by the authority. An intercom system may also be provided in addition to
the telephones.
The communication system should be adequately designed in hospitals for alerting all
persons charged with duties for patient care and all employees of the hospital who are within the
building in the event of emergency. The alerting system shall be capable of being operated from
intercoms, telephones and the administrative office.
 Medical Gas - Medical gases comprise mainly of oxygen and nitrous oxide. The cylinder
supply should be made available.
 Medical gas supply through centralized gas supply system may also be considered.
 Cooking Gas - For better hygienic conditions use of LPG (liquefied petroleum gas) cylinders is
recommended.
 Laboratory Gas - LPG (liquefied petroleum gas) cylinders should be made available for
pathological lab. Alternatively, kerosene stove may be made available where gas supply is not
available.
 Building Maintenance - An office-cum-store should be provided to handle day to day
maintenance work of the hospital building
 Horticulture - To maintain the hospital landscaping, a room to store garden implements, seeds,
etc., should be provided.
 Parking - Sufficient parking space shall be provided.
Administrative services
General Administration - The administration department of hospital shall essentially look
after organized group of people, patients and resources in order to accomplish the task of
providing best patient care.
It shall have two main sections, namely, general and medical records. General section shall deal
with all matters relating to overall upkeep of the hospital as well as welfare of its staff and
patients. Medical records section shall function for professional work in diagnosis, treatment
and care of patients.
 ARCHITECTURE DESIGN CONSIDERATION AND
STANDARED
Method of study: The study includes:
1. Parts of each division.
2. The functional relationship b/w the parts of each division.
3. Area of the division. Depending on:
 Recommendations and studies of large WHO experts. “District Hospitals:
Guidelines for Development”, World Health Organization, Geneva, 1992.
 Recommendations and studies of large World Bank experts “Building for Health Care: a Guide
for Planners and Architects of First and Second Level Facilities”, World Bank, 1996.
 Recommendations and studies of the American architect and planner of health care facilities (E.
Todd); “Hospital Design and Function”, McGraw Hill, New York, 1964.

1. Administration division
 Parts and components of the division:

a. Reception hall.
b. Waiting area.
c. Registration.
d. Treasury and Accounts.
e. Staff offices.
f. General Manager Office.
g. Staff lounge.
h. Nursing head office.
i. WCs.
Location:
• Very close to main entrance of the
hospital.
• Entrance area, registration, accounts
should face the entrance, while the
manager office should be back for
privacy.

Area of the department:

1. U.S. Public Health Service (USPHS):

• 50 bed hospital area = 214 m2
• 100 bed hospital area = 363 m2
• 200 bed hospital area = 567 m2
2. World bank estimations (Hopkinson & Kostermans):
• 50 bed hospital area = 199 m2
• 100 bed hospital area = 328 m2
 • 200 bed hospital area = 409 m2
*Examples for admin department
Example 1. 50 bed hospital, total area = 214 m2

Example
2. 100 bed

hospital, total area = 363 m2

Example 3. 200 bed hospital, total area = 576 m2

2. Outpatients’ division

 External Outpatient Clinics:

 Parts and components of the division:
• Consultation room.
• Examination room.
• Treatment room.
 • Waiting area.
• Staff room.
• WCs.

Location:
• Very close to the main entrance of the hospital.
• Close to the diagnostic services (labs and x-ray).
• Close the pharmacy.
Area of the department:
1. U.S. Public Health Service (USPHS):
• 50 bed hospital area = 215 m2
• 100 bed hospital area = 350 m2
• 200 bed hospital area = 540 m2
2. World bank estimations (Hopkinson & Kostermans):
• 100 bed hospital area = 345 m2
• 200 bed hospital area = 505 m2
*Examples for Clinics department
Example 1. 50 bed hospital, total area = 215 m2
Example 2. 100 bed hospital, total area = 305 m2
Example 3. 200 bed hospital, total area = 542 m2

3. Emergency reception:

 Parts and components of the division:

• Entrance + waiting area.
• Registration.
• Staff room.
• Mini-surgery.
• Test room.
• Medical utilities.
• Mini sterilization room.
Location:
• Very close to the exit door of the emergency.
• Very close to the radiology.
• Close to the pharmacy, laboratories, and central
sterilization.
• Direct access to the stairs and elevators.
Area of the department:
1. U.S. Public Health Service (USPHS):
• 100 bed hospital area = 100 m2
• 200 bed hospital area = 215 m2
*Examples for Emergency department
Example 1. 100 bed hospital, total area = 100 m2Example 2. 200 bed hospital , total area = 215 m2
 4. Diagnostic services division

 Laboratories:
 Parts and components of the division:
• Work area.
• Waiting area.
• Sample room.
• Cleaning room.
• Staff offices.
The most important labs in the hospital are:
• Chemical lab.
• Bacteriology lab.
• Histology lab.
• Pathology lab.
• Serology lab.
• Hematology lab.
• Microbiology lab.
 Location:
• Very close to the emergency department and external clinics.
• Easily accessible from internal division.
• Easily accessible from maternity and surgery departments.
• Accessibility from central storages.
 Area of the department:
1. U.S. Public Health Service (USPHS):
• 50 bed hospital area = 25 m2
• 100 bed hospital area = 60 m2
• 200 bed hospital area = 103 m2

Or area can be counted by the number of the A. 50 bed hospital.

beds, 0.7-0.8 m2 / bed. B. 100 bed hospital.
C. 200 bed hospital.
 5. Radiology division:

 Parts and components of the division:

• X-ray rooms.
• Control room.
• Waiting area.
• Staff office.
• Utility room.
• Dark room.
• Film view.
• Store.

 Location:

• Very close to the emergency department and external clinics.

• Easily accessible from internal division.
• Ground floor is preferred.

 Area of the department:

1. U.S. Public Health Service (USPHS):

• 50-100 bed hospital area = 65-104 m2
• 200 bed hospital area = 220-240 m2

Examples for radiology department

Example 1. 100 bed hospital, total area = 155m Example 2. 200 bed hospital, total area = 175m2
6. Therapeutic services division (Physical therapy division)

 Parts and components of the division:

• Waiting area.
• Office.
• Hydrotherapy.
• Exercise room.
• WCs.

 Location:

• Close to the main entrance of the hospital.

• Easy accessible from external clinics.
• Easy accessible from internal division.
• Must be in the ground floor.

 Area of the department:

1. U.S. Public Health Service (USPHS):

• 50-100 bed hospital area = 65-104 m2
• 200 bed hospital area = 155-225 m2

Examples for physical department

Example 1. 200 bed hospital area = 155 m2

 7. Internal medical treatment division (Operation theatre)

 Parts and components of the division:

• Entrance.
• Storage.
• Preparation room.
• Access area.
• Staff clothes room + WCs.
• Operation theatre.
• Cleanup room.
• Sub sterilizing room.
• Supervision room.
• Staff lockers.

 Location:

• Very close to the intensive care division and

should be touchable both of them.
• Very close to the central sterilization
division of the hospital.
• Close to the inpatient wards.
• Can be easily accessible from the
emergency division.

 Area of the department:

1. U.S. Public Health Service (USPHS):

• 50 bed hospital area = 185 m2
• 100 bed hospital area = 360 m2
• 200 bed hospital area = 550 m2

Examples for operation department

Example 1. 50 bed hospital area = 185 m2

Example 2. 100 bed hospital area = 360 m2
Example 3. 200 bed hospital area = 550 m2

8. Intensive care unit:

 Parts and components of the division:

• I.C.U space.

 Location:

• Very close to the recovery room in the

operation theatre.
• Can be easily accessible from the emergency
division by elevator.

 Area of the department:

Must be designed 1-2 % of Hospital beds

 9. Maternity
division:

 Parts and components of the

division:
• Open room. 20-40 m2
• Operation. 26 m2
• WCs.
• Utilities. 8 m2
• Office. 15 m2
• Unclean room. 8 m2
• Cleanup room. 5 m2
• Storage. 10 m2
• Waiting area. 10 m2
• Corridors w = 2.2 m

10.Central sterilization
division:
  Parts and components of the division:

• Work space.
• Receiving area.
• Washing area.
• Supplies storage.

 Location:

• Very close to the operation theatre and

maternity division.
• Can be easily accessible from the
emergency division, laundry and central
storages.

 Area of the department:

1. U.S. Public Health Service (USPHS):

• 100 bed hospital area = 65 m2
• 200 bed hospital area = 110 m2

Or 0.6-0.9 m2/bed, 0.6 m2 for large hospitals and 0.9 m 2 for small hospitals.
Examples for central sterilization department Example 1. 100 bed hospital area = 65 m2

Example 2. 200 bed hospital area = 110 m2

 11.Inpatient division

 Parts and components of the division:

• Inpatient wards. 11.5m2/bed – 8m2/bed.

• WCs.
• Nursing station. Not less than 12m2 for 30 patients.
• Treatment rooms. 10-15m2 for 60 patients.
• Day rooms. 0.7m2/bed and not less than 15m2
• Nurses’ lounge. Not less than 12m2
• Storage. 8-12m2
• Kitchen. 12m2
• Doctor room. 15m2

The most suitable beds in the hospital is 20-40 patient / unit.

A Nightingale ward is a type of hospital ward, which contains one large room without subdivisions
for patient occupancy.
Nightingale wards contain about 24 to 34 beds usually arranged along the sides of the ward. 

12.General service division

  Dietary division:

 Spaces of the division:

• Storage room.
• Kitchen.
• Preparing and supply area.
• Cleaning.

 Location:

• In the ground floor.

• Direct opening to the service
entrance.

 Area of the department:

1. Rosen field
• 100 bed hospital area
= 195 m2
• 200 bed hospital area = 355 m2

Examples for dietary division

Example 1. 100 bed hospital area = 195 m2

Example 2. 200 bed hospital area = 355 m2

13.Housekeeping division:

 Spaces of the division: • In the ground floor.

• Close to central storages.
• Office.
• Dirty linen.  Area of the department:
• Clean linen.
• Storage. 1. U.S. Public Health Service (USPHS):
• Laundry.
• Mechanical room. 50 bed hospital area = 150 m2

 Location: 100 bed hospital area = 180 m2

200 bed hospital area = 270 m2

14.General Storages:

 Spaces of the division:

• Medicine storage.
• Furniture storage.
• Food storage.
• Utilities storage.
• Achieve.
• General storages.

 Location:

• In the ground floor.

• Close to housekeeping and
dietary division.
• Direct access to the service
entrance.
  Area of the department:

1. U.S. Public Health Service (USPHS):

• 100 bed hospital area = 260 m2
• 200 bed hospital area = 520 m2

Generally the area of the storages is 2-2.6m 2 /bed.

15.Mortuary division:

 Location:

• In the ground floor or basement floor.

• Exit from emergency entrance or service entrance.

 Area of the department:

1. U.S. Public Health Service (USPHS):

• 50 bed hospital area = 25 m2
 • 100 bed hospital area = 45 m2
• 200 bed hospital area=70 m

16.Maintenance workshops:

 Location:

• In the ground floor or basement floor.

• Direct relation with service entrance.

 Area of the department:

1. WHO experts:
• 50 bed hospital area = 65 m2
• 100 bed hospital area = 90 m2
17.Entrances and circulation
Entrances:

• Patient visitor’s entrance.

• External clinics entrance.
• Emergency entrance.
• Service entrance.
• Mortuary entrance.