HOSPITAL SERVICES

BY

MNUTIYAJ AHMAD IVTH YEAR

ROLL NO.TAR-1101016

SESSION 2014-2015

UNDER THE GUIDANCE OF

AR. ARSHAD ABIDEEN

A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE ACADEMIC

REQUIREMENTS OF THE BACHELOR DEGREE OF ARCHITECTURE

TEERTHANKER MAHAVEER COLLEGE OF ARCHITECTURE

TEERTHANKER MAHAVEER UNIVERSITY

MORADABAD, UP, 244001

ACKNOWLEDGEMENT

The accomplishment of any task requires the effort of many and this work is no different. I take this
opportunity to thank my guide Mrs. ARSHAD ABIDEEN, ar. NITIN SHARMA whose patience, support
and guidance was instrumental for the completion of the dissertation.

I thank all my coordinators whose diligent efforts made this possible, who took time from their busy
schedule and provide me with necessary information and guidance.

A vote of thanks also goes for my friends who directly or indirectly helped me in accomplishment of my
study.

Date : 15-06-2015 MNUTIYAJ AHMAD

Content
INTRODUCTION

Hospital and dispensary have gone forth from ancient human civilization. Vedas and Puranas as the incarnation of God himself
was the first
Physician. 5,000 hospitals in the year or even evidence of ancient history, including physician and Slykovid (surgeon) were
working. The physician and surgeon to
Heal patients and their Artinasn Janvriddhi and expressions of humanity, like volunteer Inspired by the force of karma lived.
As- civilization and learn to see the
Population grew and organized medical department requires all hospitals also began to appear. Therefore, the government and
the hospital opened on behalf of a
Public service mentality inspired to get into the history of the evidence. Even in far-off villages in our country there was no
such person, whether he be illiterate,
Which gives patients and their medical drug, used? Thereafter, in modern times became tehsil and district hospital where
intimate (indoor) and outdoor (outdoor) was
Managing departments. Menasptal nowadays have built large cities, in which different medical specialist has been appointed to
departments. Each of medicine
(Medical) institutions are affiliated with large hospital and each department are subject to a specialist, who is also the teacher of
that subject in college. Now days it is
Being tried in the villages every five miles must be a medical centre in the region.

CLASSIFICATION OF HOSPITAL

GROUPING OF GENERAL HOSPITALS

CATEGORY A 25 TO 50 BEDS

CATEGORY A 51 TO 100 BEDS

CATEGORY A 100 TO 300 BEDS

CATEGORY A 301 TO 500 BEDS

CATEGORY A 501 TO 750 BEDS

SCOPE

This standard covers spatial, functional and environmental

Requirements of medical services department buildings. This standard does not cover requirements of dispensaries and
Health centres and also does not cover the requirements for specialised
Hospitals such as teaching, tuberculosis, and cancer, etc.

TOTAL AREA

The total area to be provided for a hospital complex shall depend on The availability of land. However, for
guidance an area of 1 hectare for Every 25 beds are recommended.
SITE PLANNING

Hospital sites with high degree of sensitivity to outside noise should be Avoided, but may be compatible with other
considerations such as accessibility And availability of services. The buildings should be so planned that
CLASSIFICATION OF SERVICES

Various departments which an engineering services building should

Have for comfort and well-being of patients, shall be as follows. This standard does not cover requirements of dispensaries and
Health centres and also does not cover the requirements for specialized Hospitals such as teaching, tuberculosis and cancer.

CIVIL ENGINEERING
DEPARTMENT

MISCELLANEOUS MECHANICAL ENGINEERING

SERVICES ARCHITECTURE DEPARTMENT
DEPARTMENT DEPARTMENT

ELECTRICAL
ENGINEERING
DEPARTMENT

CLASSIFICATION OF ARCHITECTURE SERVICES

 Emergency and casualty
Out –patient department department

In- Patient or Nursing unit: Digonsostic and treatment

Department

The department should be located close to the main Entrance with independent approach and should be segregated from the in-
patient department (IPD)
So that patients visiting the out-patient department need not pass through the in-patient areas. Further some of the treatment
facilities like radiology, pathology, physiotherapy and blood bank should be interposed between OPD and IPD so as to be
equally accessible to both. Clinics such as antenatal, gynaecology and sometimes

Out-Patients Department:
General facilities;
Clinics for various medical disciplines;
Supporting facilities like laboratory, injection room, etc.
Pharmacy
Blood bank.

General - The out-patient department (OPD) is needed to perform

Following chief functions, namely: a) To diagnose and treat patients at an early stage, b) Follow up treatment after discharge
from the hospital, and c) to institute health education programme to educate the public in
Environmental hygiene.

Location – (a) The department should be located close to the main Entrance with independent approach and
should be segregated from the In-patient department (IPD) so that patients visiting the out-patient
Department need not pass through the in-patient areas. Further some of The treatment facilities like radiology,
pathology, physiotherapy and blood Bank should be interposed between OPD and IPD so as to be equally
Accessible to both. Clinics such as antenatal, gynaecology and sometimes Paediatrics also share equipment with
their counterparts in respective inpatient Wards. The size of the OPD depends upon the volume of attendance,
The clinics provided and the extent of other facilities, like laboratory, Blood bank, health education programme,
operating facilities, emergency Wards, etc.

(b) In hospitals of Category A and B, the OPD may be located in ground floor alone. However, in hospitals of
Category C, D and E the Number of clinics being more, it might need distribution between two or More floors. In
such cases besides general and supporting facilities, it Is recommended to site surgical, orthopaedic, antenatal and
paediatric Clinics on the ground floor. Rest of the clinics may be placed on upper
Floors, if necessary. The extent of facilities which would be provided for an OPD in Any general hospital would
depend upon the size of the community served, Location of the department, the programme and, resources,
population and Their needs, transport facilities and other factors. A careful assessment of these factors is necessary
to assess the future requirements. The OPD, Therefore, should be so laid out that it is capable of expansion and
Alterations.

Out-Patients Department:
 BLOOD BANK CLINICAL VARIOUS
MEDICAL

GENERAL FACILITIES
PHARMACY

SUPPORTING FACILITIES
LIKE LABORATORY,
INJECTION ROOM

GENERAL FACILITIES
GENERAL
 Madical Clinic

PSYCIATRIC CLINIC

Surgical Clinic

Skin & STD clinic

Orthopaedic clinic
Obstetric and
Gyanaeco logical clinic
Paediatrice Clinic

EYE CLINIC ENT CLINIC

Family planing
clicnic

DENTAL

GENERAL

Entrance hall with enquiry counter ,

cash counter
And record room
Officer room Nurse
in charge with toilet
sanitation inspector room
key room

OPD medical record

room canteen

Medical
Consultation and examination room
clinic Cardiographic examination
Waiting

Surgical
clinic
Consultaion & examination
Treatment and minor surgery
Waiting

ORTHOPAEDICE
CLINICE

Consutation & examination

Room plaster & spilnt storage
room fracture and teatment
plaster & cutting room rocovery
room waiting

Eye
clinic consultation examination & refrection
minor surgery & treatment
room orthpadice cum tonography
dark room waiting

ENT
CLINIC
Consultaion & examination
Treatment audimetrice room
Electrony stagemography
Waiting

DENTAL
CLINIC

Consutation & examination

Dental hygienist room recovery dental work
Shop processing room for X. ray waiting

Obstectrict
gynaecology
clinic Reception and ragistration
Consultion & examination
treatment clinical laboratry
toilet cum changing (atteached)
mothers craft demonstration
 Family
planning

Consultaion & examination

Treatment health eductor
And social worker room
Recovery waiting

Paediatric Clinic

Consutation & examination

Dressing treatment and dispencing
Theraphy room immunisstion room
Recreation and play room waiting

Skin &
STD
Consultion & examination
treatment room biopsy room
Superficial skin laboratory barber’s
Waiting
 Psychiatric
clinic

Consultaion & examination

ECT room recovery room
Psychologist room social worker
Electro encophalo graphy room
Occuptional theraphy room waiting

Supporting facilities

Central injection room speciman

Clinial laboratory social worker room
waiting
Entrance Hall - It serves as waiting area for the patients before getting registered and for the followers
who wait for the return of the patients. The size of the hall may be determined on the basis of number of beds
Available to back up the OPD. Adequate toilet facilities may also be provided close to it.

Waiting spaces - Apart from the entrance hall, general waiting per clinic and subsidiary waiting spaces are required
adjacent to each consultation and treatment room in all the clinics. In hospitals of Category C, D and E the number of units
under various clinics may be more than one depending upon the clinic load. In such cases the waiting spaces shall be planned as
common between them. Waiting space for eye clinic should Not be subjected to direct-sunlight or glare. Waiting space in the
paediatric clinic should provide for mirror recreation and play facilities for children in addition to toilet facility.

Medical Records -- It is desirable to maintain the medical records of the out-patients in continuation of registration area.

Clinics for Various Medical Discipline - These clinics include medical, surgical, orthopaedic, eye, ENT, dental,
obstetric and gynaecological, family planning, paediatric, skin and psychiatric, etc. Each category of hospital may have all or
few of the clinics depending upon the volume of attendance and resources available. The clinics for infections 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 cubicles for consultation and examination in all types of clinics
should provide for a doctor’s chair and table, patient’s stool, follower’s seat, wash basin, examination couch and equipment for
examination. The treatment and dressing room should he spacious enough to accommodate a medicine chest, a work counter
for preparing dressings, medicines, sinks, dressing tables with screen in between and a pedal operated bins to hold soiled
Material.

Medical clinic - The clinic should have a number of consultation- cum-examination rooms depending upon the load of out-
patients. The clinic should also have facilities for cardiographic examination.

-
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.

Orthopaedic clinic The clinic should include arrangements for plaster preparation, fracture treatment besides
consultation-cu examination. 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.

Eye clinic - The clinic should include consultation-cu refraction, minor surgery, treatment and a dark room. For testing the
state of refractive power of the eye, room length not less than 6 m is
Essential. However by use of mirror length of room can be reduced. Dark room should be placed close to consultation
preferably with a intercommunicating door.

ENT clinic - The clinic should have facilities for treatment and a sound-proof audiometry room.

Dental clinic - The clinic should have facilities for dental hygienist, dental workshop and room for patient’s recovery.
Consultationcum- examination room should serve as combined purpose room for consultation, examination, dental surgery, and
treatment and X-ray facilities.

Obstetric And Gynaecological 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 be at a convenient certain formalities prior
to examination by the doctors, clinical laboratory for the purpose is essential. Should also be provided. Distance from other
clinics in the OPD. Antenatal patients have to undergo a toilet-cum-changing close to treatment

Family planning clinic - The clinic should provide educative, preventive, diagnostic and curative facilities for obstetric
gynaecological treatment, paediatric and health education. Importance of
Health education is being increasingly recognised 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

Paediatric clinic – The clinic should provide medical care for infants (including new born) and children up to the age of 12
years. Owing to risk of infection it is essential to isolate the clinic from other clinics. The clinic shall be provided with a
separate dressing, treatment and immunisation room.

Skin and STD clinic - The clinic should provide diagnostic and curative facilities for dermatology, STD (sexually
transmitted disease) and leprosy. The treatment rooms for dermatology and STD may be combined, but treatment for leprosy
should always be segregated. The clinic should also have facilities for superficial therapy and a skin laboratory.

Psychiatric clinic - The facilities required for the clinic should include consultation-cum-examination room, ECT treatment
room, recovery, psychologists and a social 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 one metre high and all electrical fittings shall be protected.
In ECT room the patient is subjected to electroconvulsive therapy (shock). Resuscitation (recovery room) is needed

Psychiatric clinic - The facilities required for the clinic should include consultation-cum-examination room, ECT
treatment room, recovery, psychologists and a social 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 one metre high and all electrical fittings shall be
protected. In ECT room the patient is subjected to electroconvulsive therapy (shock). Resuscitation (recovery room) is needed

Supporting Facilities - Various clinics under OPD requires supporting facilities in common which include clinical
laboratory, injection room, social service department, etc. Space requirements for these facilities

Injection room - For administering injection to patients a central injection room should be provided in conjunction with
the dispensary.

Clinical laboratory - For quick diagnosis of blood, urine, etc., small work room facilities should be provided close to
injection room with all essential requirements.

Social service - A social worker room to render service to the patients should also be provided.

Pharmacy
 Office with toilet dispensing
Area with counter preparation
compounding area bottle
Queuing area pharmacists room
With toilet store janitors closet trolley bay

The dispensary should be located in an area conveniently accessible from several clinics. The size should be adequate to
contain 5% of the total clinical visits to the out-patient department in one session at the rate of 0.8 m 2per patient. The dispensing
and compounding room shall have multiple dispensing windows, compounding counters, drug storage cabinets and shelves.
The pattern of arranging the counters and shelves shall depend on the size of the room. In hospitals of category C, D and E a
separate store attached to dispensary shall be provided for storing weekly requirements which are drawn from main stores and
for preparing stock mixtures, etc. Medicines which require cold storage may be kept in refrigerators. The provisions of various
areas required for pharmacy department

Blood
Bank

Reception Motivator’s Room

Bleeding Area Doctors’ Room

Laboratory

Bottle Washing
 Office Storage

Blood Bank - The function of blood bank is to maintain current blood Groupings, to collect, store and issue blood and also to
supplv the blood for transfusion to the patients. The 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. Blood taking also requires a comfortable reception with toilets. Bleeding room should be quiet and not a thoroughfare
and should be divided into cubicles for privacy. A rest room should also be provided for donors to rest and take light
refreshment before returning home.

Supporting
facilities

Central injection room speciman

Clinial laboratory social worker room
waiting

ACCIDENT AND EMERGENCY DEPARTMENT

The department is also termed as casualty wing for emergent cases as such it should have a distinct entry
independent of OPD main entry so that a very minimum time is lost in giving immediate treatment to causalities
arriving in the hospital. In hospitals of category C, D and E it should be an independent department working round
the clock like a mini hospital. In hospitals of category A and B it should again be independent but may
be scheduled to function outside working hours of other clinics in OPD. 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 OLI
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 particularly in hospitals of category C, D and E 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 including X-ray unit, operation theatres, clinical laboratory, 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 serve 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.

PATHOLOGY DEPARTMENT
Pathology is concerned with the analysis of diseased tissue or fluids and other elements in the body. The pathology department
in a hospital is mainly diagnostic in function and depending on the bed strength of the hospital may comprise activities like
biochemistry, microbiology, clinical pathology and haematology, histology, cytology and serology. Other activities connected
with the department are mortuary and autopsy. The department should be located at a place which may Be easily accessible to
both indoor and outdoor patients. In hospitals of category B it may form a part of OPD. The space requirements for various
facilities

Pathology is concerned with the analysis of diseased tissue or fluids and other elements in the body. The pathology
department in a hospital is mainly diagnostic in function and depending on the bed strength of the hospital may comprise
activities like biochemistry, microbiology, clinical pathology and haematology, histology, cytology and serology. Other
activities connected with the department are mortuary and autopsy. The department should be located at a place which may
be easily accessible to both indoor and outdoor patients. In hospitals of category B it may form a part of OPD.
Requirement - The space requirements for various facilities required for the department are given in
Laboratory - Separate laboratories should be provided for biochemistry, microbiology, clinical pathology and haematology,
histology and

Cytology and serology. Each laboratory should be provided with 600 mm wide and 800 mm high bench of length about 2
m per technician and to full width of room for pathologist in charge of the laboratory. Each laboratory bench shall have
laboratory sink with swan neck fittings, reagent shelving, gas and power point and under counter cabinet. bench shall be of acid
and alkali-proof material. Top of the laboratory

1Drive-in ambulance (Reception, Public telephone Booths, trolley Bay, Relatives

Waiting areas with toilets, staff Toilets, Police Special worker Room, etc
2 Doctor’s duty room with toilet
3. Examination cubicles
4. Medico legal Specimen and record room
5. Brought in dead room
6. Retiring room for ambulance drivers and nursing assistant
7. ECG room
Fracture treatment room with plaster preparation Treatment room Theatre unit
Operation Theatre b) Instrument Sterilization c) Scrub up
d) Dirty washed) Anaesthesia room tell. Resuscitation
12. X-ray room with dark room facility
13. Clinical laboratory
14. Blood storage area
15. Drug dispensing facility
16Police Special worker Room, etc)

16. Stores
17 Sluice room and janitor closet
18. Nurses’ station with toilet
19. Observation 1 14room (1 had) Emergency ward

Biochemistry. - Laboratory is concerned with the chemical analysis of body tissue and fluids.
Microbiology - Laboratory is concerned with the bacteria or pathogens found in the body or the environment.
Clinical Pathology and Haematology - Laboratory is concerned with pathogens found in the body or the environment.
Histology and Cytology - Laboratory is concerned with the structural composition and function of tissues and also with the
preparation of tissue for analysis.
Serology - Laboratory is concerned with the analysis of medicine effect on body tissue or fluid of animals.

RADIOLOGY DEPARTMENT
General - The role of radiology department should be radio-diagnostic and radiotherapy. The diagnostic units generally deal
with radiography, ultrasound, nuclear medicine, CAT scanner, etc. The therapy unit includes treatment of various types of
radiations, ranging from superficial therapy to megavoltage therapy. The size of the department depends upon the load, the
scope of work and the type of equipment employed. Radiology is a fast developing technique and the department should be
designed keeping in view the future scope of expansion.

Location- The department shall be located at a place which is easily accessible to both OPD and IPD and also to the operation theatre
department. As the department deals with the high voltage, presence of moisture in the area should be avoided. All the equipments of the
department should be earthed. Sometimes a radiotherapy department may be located underground ( basement ).
Radiography and Fluoroscopy
Radiography is a device of making pictorial records by means of X-ray on sensitised film whereas fluoroscopy is direct visualization through
medium of X-ray. Various facilities required in this unit are given in The space requirements for these facilities are given in Reception cum
Registration with Waiting Areas and Toilet – An independent registration section shall be provided where
radiology forms an independent department. The size of the counter should be sufficient to accommodate a clerk’s seat and
record chests. It may be interposed with the waiting area. In all categories of hospitals one waiting hall should be sufficient but
it should be so planned as to serve the patients waiting before and after registration. Toilet facilities, separately for men and
women patients, may be placed close to waiting areas.

Radiography and Fluoroscopy Room - The size of the room shall depend upon the category of the equipment
installed. The number of
Rooms should be one or more depending upon the category of the hospital. Each room should have a sub waiting area with
toilet facility, and a
Change room facility if required. The fluoroscopy room shall be completely cut off from the direct light through provision of
airlocks. The radiography units should be operated from separate control room or behind a lead mobile protection screen of l-5
mm lead equivalent, wherever
Necessary.

Film Developing and Processing Room - Film developing and dark rooms shall be provided in the department for
loading, unloading, Developing and processing of X-ray films. The room should be provided between a pair of radiography
rooms so that new and exposed X-ray films may be easily passed through the cassette pan with 2-0 mm lead backing installed
in the wall in between. The room should be completely cut off from direct light through provision of airlock. For ventilations,
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. Processing tank should be of size 900 x 560 x 600
mm with water outlet at bottom of tank and other outlet at a height of 510 mm from bottom for solution, whereas washing tank
should be of the size 1500 x 550 x 600 mm fitted with two 10 mm rods 1550 mm long fitted at a distance

Film Drying - Provision of a space shall be made for drying films either by atmospheric drying or by mechanical
contrivances in the form of hot chambers.

Contrast Studies and Preparation Room - In certain cases of radiography, in order to produce an opaque silhouette
for the exposure of stomach, intestine or other body cavities, the patient is given a cocktail of barium. The drink is prepared in
the room. Besides, barium there are other contrast media which are administered to the patients. The room should also have
sinks and electric outlet for mixer.

Stores - The cupboards or built-in cupboards required for storing films and chemicals may either be
placed in the radiologist’s room or a separate store. The unexposed films should be stored away from the
radiography room. However, in case the unexposed films are to be stored
in the dark room adjacent to radiography room for temporary period, these may be stored in a 2.0 mm lead
lined box,

X-Ray Record Room - A separate room for maintaining the records of dcvclopcd X-ray films which may be needed at
subsequent visit of patients should also be located in the department.
 Radiologist’s Room - For hospitals of category C, D and E, the department is placed under the charge of a
radiologist. Size of this room may be governed by the space needed for study of films, holding discussion with
other specialists. Adequate number of viewing boxes is essential.

Offer Areas - Other facilities for the department include room for technicians, nurses, trolley bay, switch room to house
phase changer

Radiotherapy Unit - The

radiotherapy unit should include its associated facilities such as radiotherapist room, physicist
room, electronics laboratory, mould room, workshop, simulator, treatment planning system ( TPS ), etc. The size of
various facilities will depend on the size of the unit, work load envisaged, etc. The types of therapy treatments to be
provided in a hospital should depend upon the category of the hospital

Treatments depending upon the order of capacity for penetration

Should be provided in the categories of hospitals marked against them:
Category of Hospital
a) Infra X-ray therapy All categories
b) Contact therapy All categories
c) Superficial therapy C, D and E
d) Intermediary therapy C, D and E
e) Deep therapy D and E (optional)
f ) Cobalt therapy D and E ( optional )

Each therapy installation should have adequate space for accommodating the therapy apparatus and free movement of couch,
etc, the high voltage generator ( whenever necessary ), control desk and dressing cubicle for the patients. The control desk and
dressing cubicle should be kept outside the therapy treatment room., A viewing system such as closed circuit TV
(CCTV)/lead glass viewing window may be provided near the control

Desk for viewing the patients undergoing radiotherapy. The radiotherapy room and room with control desk should preferably
be air-conditioned for the efficient functioning of the electronic equipment’s.
Infra X-ray and Contact Therapy -Apparatus for both these therapy is of simple character, occupies little
space and may not need elaborate
Structural requirements. *The department of skin, gynaecology and ophthalmology make use this apparatus.

Superficial Therapy and Intermediary Therapy - This room shall include space for the apparatus and a
couch ( bed ) control desk and dressing cubicle may be provided outside the therapy room(influence of radiation ).
There should be a lead glass viewing window for viewing the patients undergoing therapy
Deep Therapy - Room shall be designed functionally similar to superficial and intermediary therapy rooms. Since the
intensity of radiation is relatively high and penetration is deep, higher order of protection is required against
radiation. The protection measures should be ensured by providing walls, floors and roofs of adequate thickness
duly cleared by the competent authority that is the Division of Radiological Protection of the Bhabha Atomic
Research Centre. For monitoring the therapy lead glass viewing system or closed circuit TV ( CCTV ) may be
employed.

Cobalt Therapy/Megavoltage Therapy - It involves deeper penetration and greater radiation. The protection against
radiation of still higher order should be provided. Access to the room shall be through a covered passage along one length of the
room. The entrance doors of the room should be interlocked with the control panel of the machine. These therapy room need
air-conditioning. However, megavoltage room will need central air-conditioning. These rooms may be constructed in the
basement to save on thick concrete walls. However, excavation cost may be taken into account before going in for a basement
plan. These rooms are of more height compared to other ordinary rooms.
Radiotherapist’s room - The radiotherapist doctor of the department should be provided with a separate room with
examination cabin arc toilet facility.

Physicist’s Room - The physicist of the hospital should be provided with a separate room and toilet facility. An area for this laboratory
for radiation measuring instrument should also be provided. In hospital of category C, D and E, another room for staff may also be provided.

Simulator room - It is a machine with X-ray unit, used for localizing the tumours. It is necessary for a hospital having
radiotherapy machines.31

Treatment planning systems (TPS) - It is a facility with computer for getting iodise curves. This may be provided along
with the physicist’s room. This room also needs air-conditioning computer for getting iodise curves. This may be provided
along with the physicist’s room. This room also needs air-conditioning

.
Essential Constructional Requirements - The structure should be such as to prevent the escape of radiation. Walls
shall have radiation protection of 2 mm lead lining up to a height of 2 m. For superficial and intermediary therapy rooms, 300
mm thick brick walls and 150 mm thick RCC roofs should be adequate. These may be painted with lead borne paints. For deep
and cobalt therapy rooms the walls and ceiling should be of reinforced cement concrete 300 to 350 mm thick. Doors should also
be made radiation proof by lead cladding or lined steel doors either hinged or sliding.

10. Physiotherapy Department

General - The physiotherapy department provides treatment facilities to patients suffering from crippling diseases and
disabilities. Treatments may be classified as physical and electro-therapy, hydrotherapy, occupational therapy and exercise
(gymnasium)

Location - The department is more frequently visited by outpatients but should be located at a place which may be at
convenient
access to both outdoor and indoor patients. Availability of natural light, 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.

Space Requirements - The provision for various facilities in the physiotherapy department
Physical- and Electra-therapy - The nature of treatment and equipment employed may be of various kinds such as diathermy,
ultraviolet, Combined treatment, infra-red, radiant heat and massage, etc. Facilities for all kinds may not be provided in all
categories of hospitals. Each cubicle for treatment should be large enough for the physical therapist 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.

Hydrotherapy -MI general hospital of category C, D and E should provide facilities for hydrotherapy. A small tank
should be provided with arrangements to fill with hot water also. The tank should be 2 x 3 m partly sunk in the
floor having l-2 m depth at deep end and 0.5 m at shallow end. Pipe railing above water level along long side of the
tank shall also be provided. Arrangement for shower bath and dressing cubicle shall also be provided. The therapy
rooms should have non-skid type floor. fresh air and adequate ventilation are of extreme importance for the

Gymnasium - A large hall shall be provided for group or individual cxcrcise activities including parallel bars, pulleys, wall
bars, ladders, etc, in Ilocpitah of category C, I) and E. It is used extensively by patients in wheel chairs, crutches or with
walking sticks or other disabilities which limit motion and ability. It may be oblong in shape with the wall bars, and climbing
bars fixed to one of the long walls. Mirrors should be provided for correcting walking disabilities. Flooring of gymnasium shall
be
Occufiational Therapy - A variety of gadgets and articles which patients use icu daily life are required for
occupational therapy. The facilities for training of hands in hospitals of category D and E which may comprise
tailoring, carpentry, canning, hosiery, watch and radio making, book making, etc, should be provided in a big hall
or in separate cubicles

.
O&E - The physiotherapist should have an office room where patients may be interviewed and examined. In addition there
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 wheel chairs.

OPERATION THEATRE DEPARTMENT

11.1 General - Operating suite is technically a therapeutic aid in which a team of surgeons, anaesthesists, nurses and sometime
pathologists
and radiologists operate upon or care for the patients. For optimum utilization of the operating units, the operation theatres, as a
rule, should
not be reserved rigidly for use by a particular department. The operation theatres should further be similar in design and
character to make it easy for all surgeons and nurses to use them without the necessity of familiarizing themselves every time
with a new set of conditions.

Location - The location of the department should be decided on zoning - A high degree of asepsis should be ensured to
provide
Appropriate environment for staff and patients. For this, the passing of the patients and the equipment’s through long corridors
and other unprotected areas should be avoided. Zoning shall be done to keep the theatrics free 34 from microorganisms. There
may be four well defined zone of varying degree of cleanliness.

Protective tone ( A ) - Containing mostly theatre supply, changing rooms, pre-anaesthetic examination room and waiting area.
Clean zone ( B ) - It includes the casualty theatres, recovery wards, plaster room, theatre pack preparation and pre-operative
Wards.

Aseptic or sterile zone ( C ) - It consists of operation theatres,

anaesthetic and sterilizing rooms. It shall provide the highest
degree of antibacterial precautions.
Disposal or dirty zone ( D ) - The soiled instruments and dressings
Are transacted through this area for washing and resterilization or disposal. It includes the sluice rooms and disposal corridor. It
should be ensured that flow of traffic from one zone to another is arranged through proper barrier nursing. All soiled material
both disposable and non-disposable should move without crossing the sterile and clean zone. The disposable material should go
for the incineration
directly and non-disposable material like instruments, etc, should be cleaned in dirt washing rooms and they shall
be returned for sterilization.
All communication between the operation theatres, dirty utility, and instrument sterilization shall be carried out
through well designed hatches
or a door through which the material is passed

Circulation - Normally there are three types of traffic flow, namely (a ) patients, (b) staff, and (c) supplies. All these should
be
properly channelized.

Patients - Patients are brought from the ward and should not cross the transfer area in their ward clothing which is a
great source
of infection. Change-over of trolleys should be effected at a place which will link up both pre-anaesthesia and
recovery rooms.

Staff- The doctors, nurses, technicians and class IV staff should cuter from a separate route and through a set of
change rooms
And through an air lock. They should communicate with the sterile corridor. A shoe change and gowning space
near the air lock should also be
Provided.

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.
Orientation - The primary consideration should be to ensure glare free natural light which will also reduce the
radiation of heat. Good
natural light and ventilation is of added advantage.

Comfort Condition - An optimum comfort level in the operation theatres is of vital importance. Temperature
between 16 to 21°C with 50
% relative humidity shall be maintained through central air-conditioning plant. For hospitals of category A and B
window type air-conditioners are recommended. Ventilation should be of 15 to 20 air changes per
Hour.

In order to minimize the electrical, and explosive hazards, the following precautions shall be provided for:
Safety -
a) Adequate fire-fighting arrangement.

b) Electra-conductive flooring in operation theatres and anaesthesia room. It can be achieved by brass or copper
grid embedded in
the suitable material floor spaced at 100 to 150 mm to ensure that a person’s foot would have contact with the grid
at all times.
All crossings of the grid are to be soldered together to ensure continuity of conductivity and finally the grid is to be
grounded
through a resistance coil to a metal riser preferably a cold water pipe.

c)Provision of concealed conduit wiring circuit. Moreover electrical wiring layout shall be flexible enough to take
care of new developments
and changing technology of medical science gadgets.
Space Requirements - The area required for various facilities of the department

Relatives Waiting Room - Space adjoining to recovery ward should be provided for the relatives attending the
patients to wait and meet them after the operations. Toilet facilities may also be provided attached to the waiting
room.

Change Rooms - Separate change rooms for doctors, nurses and technicians should be provided, with arrangement
for lockers, bathing and
toilet facilities.

Storage - Store rooms should be provided for storing theatre supplies like stretcher, trolley, sterile material, medical
gas cylinders,
Instruments and linen.

Casualty Theatre - For operating septic cases of minor nature a casualty theatre should be provided. Facilities for plaster preparation,
Splint storage for fracture cases should also be located close to this theatre. 36

Pre-anaesthesia Room - Patients are transferred from respective ward to this room for premeditation before
operation. Segregation of
Male and female patients are needed to be taken care of. The room should have toilet facility separately for men and
women
.
Recovery Room -. Immediately after the operation, the patients are kept in a ward situated close to the operation theatre until such time
they are found fit to be taken back to their parent ward/room.
Theatre Pack Preparation Room - It should be a work work room for arranging of sutures, dressings and all other surgical items.

1. OT reception bay
2. Relatives waiting room (including 2 toilets of 3’5 ma each)
3. Officer-in-charge of OT with toilet
4. Doctor’s room change
5. Nurses room change
6. Technician change room
7. Class IV staff change room
8. Sterile storage area
9. Instrument and linen room
10. Trolley bay
11. Gas cylinder storage
12. Switch room (keep light)
ONE B
1. Fracturecum Casualty theatre
a) Instrument sterilization
b) Scrub up
c) Dirty wash up
2. Plaster preparation
3. Splint store
4. Pre-operative room with toilet
5. Recovery room 1 212 beds)
6. Nurses duty room
7. Theatre pack preparation room
8. Frozen section --
9. X-ray with dark
10. Pantry
Operation theatres (Major)
b) Operation theatres (Minor)
Instrument sterilization Scrub up
4. Anaesthetist room
5. Anaesthetic storage
6. Anaesthesia room
7. Doctor’s work room
Nurses work room I D
1. Dirty utility
2. Janitor’s closet

NOTE: 1 – (Wherever ‘with toilet’ is mentioned, it is to be 3.5 m’ inclusive in the total requirement of room area.)
NOTE 2 - This department should have provision for piped oxygen, nitrous oxide and suction facility, in all OTs, fracture-cum-
casualty theatre and recovery room.
NOTE 3 - Additional space for weather maker room should be provided.
NOTE= 4 - Additional space for TSSU may be provided. Change room includes attached toilet. To be located adjoining to
fracture-cum-casualty theatres’ with additional space for toilet facilities. Common for two operation theatrics, to be located
between theatres.
Frozen Section - It is a section of pathology department where examination of specimens can be made and a report made
available to the surgeon within short time.
X-ray with Dark Room - This room should have a mobile X-ray unit with arrangement for developing and processing X-
ray films of
Immediate cases.

Operation Theatres - unit with arrangement for developing and processing X-ray films of immediate cases. One operation
theatre per 50 beds is recommended for larger hospitals to take care of all medical discipline operative needs, and they should
be major and minor in size. All operating ro facilitate cleaning. Floor, wall and ceiling finishes should be moisture-poof. 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 large Windows and general illumination by means of fluorescent tubes. The operating rooms should be normally
arranged in pairs with scrub-up and Instrument sub-sterilizing rooms. oms should be made dust-proof and corners and junctions
of walls, floor, ceiling shall be rounded to prevent accumulation of dust and to

Scrub up in this room the operating team washes and scrub-up their hands and arms, but on their sterile gowns, gloves and
other covers before entering the operation theatre. It should have a single leaf door with self-closing devices and a viewing
window to communicate with the O.T. A pair of surgeon’s sinks with elbow or knee operated taps are essential to be provided
in this space.

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
sterilizing apparatus. Instrument cupboard and a work bench with sinks are essential to be provided in this room.

Anaesthetising Facilities - Separate rooms for anaesthetists with toilet facility, anaesthesia material administering area
and anaesthesia
storage should be provided. These rooms should be grouped together and placed very close to operation theatres. Storage areas
should have enough space for storing anaesthesia equipment medicines and gases. The rooms shall be dust- and moisture-proof
with doors minimum 1.5 m wide.

Dirty Utility - Theatre refuse such as dirty linen, used instruments and other disposable/non-disposable stuff is removed to
this room
after each operation. Non-disposable instruments after initial wash is given back to instrument sterilization and rest of the
disposable items are
disposed and destroyed. Dirty linen is sent to laundry through a separate exit. The room should be provided with sink, slop sink,
or bed pan sink, work bench and draining boards.

IN-PATIENTS NURSING UNITS

General - In-patients unit, 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. Nursing care should fall under the following categories:
a) General Wards - Wards of traditional type of patients who are not critically ill but need continuous care or
observation andhave to be in bed. These includes wards for medical, surgical ENT and eye disciplines
.

b) Ward for Specialities - Wards for patients who are suffering and needs hospitalization in particular specialities like post
operation, Orthopaedic, paediatric, psychiatry, infection, skin, obstetrics and gynaecology, etc.

c) Intensive Care Unit - Wards for acute coronary, post-operative and critically ill patients. The basic consideration in
placing wards is to ensure sufficient nursing care, segregating patients according to three categories, locating them according to
the needs of treatment in respective medical discipline and checking cross infection.

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 may be conveniently piled up vertically one above the other which will result in
efficiency, easy circulation and services economy. Wards for particular specialities, however, should be located closer to their
respective department to act as self-contained centres. In such case post-operative ward may be placed horizontal to operation
theatre and maternity ward to the delivery rooms.

Planning of a 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 be minimum.

Normally, a ward unit shall comprise 24 to 36 beds, unless small strength wards are needed for specific reasons in multiple beds
and isolation unit. An area of 7 Ms per bed is recommended, and should be arranged with a minimum distance of 2.25 m
between centres of two beds and a clearance of minimum 200 mm between the bed and wall. The space should accommodate a
patient bed and a bedside locker. Separate ward units shall be provided for male and female patients for each medical
discipline. In wards the width of doors shall not be less than l-2 m and all wards should have dado to a height of 1.2 m.41
Isolation unit in the form of two single bedded rooms per nursing unit should be provided to cater for certain cases requiring
isolation from other patients. An area of 14 mas for such rooms to contain a bed, bedside locker, 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. In hospitals of category C, D and E few single and two bedded units may be provided for patients on the basis of hotel
type accommodation with independent toilet facility. Area recommended for these rooms is 14 and 21 Ms respectively.

Type of Ward - are d s may be either nightingale 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 4 to 6 beds are arranged parallel to the longitudinal walls and facing
each other. A rigs type ward is recommended from socio environmental stand point.

General Ward Facilities - Each ward unit should have a set of ward ancillaries, requirement of such facilities

Nursing Station - 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 be placed in clean utility room, a drug cupboard, sink, chair, small
table and space for call system points and records. Separate toilet facilities for nurses shall be provided.
Treatment Room - Major dressing and complicated treatments should be carried out in the treatment room to avoid the risk of
cross infection
.Curd 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’s

.
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, a room shall be provided in the ward unit itself. It should afford an easy access to patients and supervision by the
nursing staff and should be provided with easy chairs, book shelves

Sanitary- Toilet for an individual room (single or two bedded) in a ward unit shall be 3.5 m2 comprising a bath, a wash basin
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. For multiple beds of a ward unit, requirement of fitments

Post Iterative and Orthopaedic Wards - Bed space should be 8.75 Ms to accommodate treatment apparatus and
wheel chair. Post-operative wards should be located close to the operation theatres department. Air-conditioning of the post-
operative ward is essential.

Paediatric Ward - A separate ward unit shall be provided in hospital of category C, D and E. The ward unit shall have at
least 25 perceptive patients in isolated cubicles in single and two bedded rooms. These cubicles should be separated by glazed
partition for better supervision. Each pair of cubicles may be provided with a common toilet of 25 Ms having WC, bath and
wash basin. Further 25 percept of beds should be in the form of cubicles of 4 to 6 beds to provide extra space for 5.

Psychiatry Ward - All windows and verandas opening should be protected with steel grill or concrete jail. The
ward shall be located on the ground floor or lower floors. All electrical fittings and fixtures shall also be suitably
protected.

Skin Ward - Twenty-five percent of the beds in the ward shall be in the form of 2- and 4-bedded rooms for segregation.
Arrangement for long bath should be provided in the toilet.

Infectious Disease Ward - This unit should accommodate bothmale and female patients suffering from infectious
ailments. It should beplanned as a separate building connecting the main building througha covered passage. The unit may be
placed in the main ward block itselfbut should be separated by an airgap and shall be provided for 4 to 6 percentof male and
female patients. Additional ward ancillaries to that ofgeneral ward are a sink room of 10.5 m2, two staff changing room 10.5ms
each and a discharge room IO.5 ms.
OBSTETRIC AND GYNAECOLOGY DEPARTMENT
General - 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 labour the patient is confined to bed in the
nursing unit. The out-patient clinic should also 45provide diagnostic facilities for gyneo patients. Since these services are
cyclic, it is recommended to place the in-patient unit close to the outpatient clinic making it easily accessible to the child
bearing women. Thin-patient unit shall comprise (a) delivery suite unit, (b) nursing unit, and(c) neonatal unit, and they should
be placed on the same floor. Delivery Suite Unit - The delivery suite unit should include thefacilities of accommodation for
various facilities as given in 13.2.1to 13.2.9. The areas for these facilities for various categories of hospitalsare given in Table
Reception and Admission - As the patients many a time, arrive ina state of imminent delivery, the registration counter should
open into an entrance lobby. Examination and Preparation Room - The room should accommodateone or two beds and provide
space for the doctor with the worktable, etc. A change room with attached toilet facilities shall be provided with the
examination cubicle. The provision of lockers for keeping the personal clothes and articles may also be kept in view.13.2.3
Labour Room - Labour rooms should preferably be in the form of cubicles; two labour rooms for every 10 maternity beds. As
birth follows labour, the labour rooms should be placed adjacent to delivery rooms. In hospitals of category A and B the
examination-cum-preparation room and labour room may be combined into a single room.13.2.4 Delivery Rooms - Delivery
rooms shall be of the following types: a) Clean delivery room for normal deliveries) Operation theatre for caesarean, andc)
Septic delivery room. Delivery rooms shall be provided at the rate of one for every 20maternity beds. The size of the operating
theatre for caesarean rooms shall be the same as that of the operating theatres. Sterility and other requirements shall be
maintained like operation theatres department.13.2.5 Sterilizing Room - The facilities for sterilization of the equipment in the
delivery suites should be made. This room should hous work counter, sink, small high-speed pressure instruments sterilizer,
etc.13.2.6 Sterile Store Room Close to the sterilizing room, a room to store sterile material should be provided. It should be
provided with issuewindows.13.2.7 Scrubbirlg Room - Scrub-up facilities may be provided between two delivery rooms similar
to those provided in operation theatre department
Nursing Unit - Nursing unit for the department shall include antenatal, postnatal, eclampsia, post-operative, and
gynaecological units. Antenatal Word - 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 labour. The ward would need the same facilities as
recommended for general ward in The ward should also have provision for a fully equipped laboratory. The treatment
room should also be bigger in such ward unit. E clamp..ria Ward - These patients fall under antenatal and postnatal
category. The ward should either form part of antenatal nursing unit or placed close to delivery suite unit. Number of beds shall
be one in every 20 postnatal beds. Single and two-bedded rooms with attached toilet should be provided.
Postnatal or Lying-in Ward - 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 thebe side of the patients. The unit should be close to maternity ward. 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 Post-
Operative Ward - The post-operative ward for the patients who have undergone operation shall be able to accommodate two
beds per delivery room including operating delivery room. Area per bed may be8.75 ma. The unit should be placed in between
the delivery suite and lying-in ward. Ward ancillaries should be same as for general ward unit.
Neonatal Unit - Wellbeing of the new born becomes the responsibility of the paediatrician. A separate neonatal unit for
premature, high-risk babies, and sick new burns should be established as independent unit.
Facilities like nurseries, nurses station, formula-cum-breast feeding room, store, photo therapy and a sluice room should be
provided. The area required for all these facilities shall . Premature hosiery - Premature babies in individual heated bassinets or
incubators with temperature and humidity control should be accommodated and oxygen outlet installed. Floor space per
bassinet maybe 3.5 ma. Septic Nursery - Babies known to be or suspected of being infected shall be kept in an isolated room
with cubicles. They should be segregated from normal and crenature nurseries. Floor space per bassinet should be3.5ms.50

Premature hosiery - Premature babies in individual heated bassinets or incubators with temperature and humidity control
should be accommodated and oxygen outlet installed. Floor space per bassinet maybe 3.5 ma.
Septic Nursery - Babies known to be or suspected of being infected shall be kept in an isolated room with cubicles. They
should be segregated from normal and crenature nurseries. Floor space per bassinet should be 3.5 ms.50
Normal Nursery - An independent nursery for normal and healthy babies is not considered essential. However, a nursery
with 2 to 4 bassinets may be provided. Floor space per bassinet may be 3.5 Ms. Niirses Station - It should be so placed so as to
ensure continuous watch over the nurseries and to render efficient treatment to infants.
CIVIL DEPARTMENT
Building maintenance,

Horticulture,

Water supply and plumbing,

Drainage and sanitation.

MECHANICAL DEPARTMENT
.

Air-conditioning,

Refrigeration.

ELECTRICAL ENGINEERING DEPARTMENT.

Illumination,

Ventilation.

MISCELLANEOUS DEPARTMENT
.

Gas supply,

Transport and communication,

Fire protection,