Physical Layout
Physical Layout
OF HOSPITAL
AND
EDUCATIONAL
INSTITUATION
Building Attributes
Regardless of their location, size, or budget, all hospitals should have certain common attributes.
1. Efficiency and cost-effectiveness
An efficient hospital layout should:
Promote staff efficiency by minimizing distance of necessary travel between frequently
used spaces
Allow easy visual supervision of patients by limited staff
Include all needed spaces, but no redundant ones. This requires careful pre-
design programming.
Provide an efficient logistics system, which might include elevators, pneumatic
tubes, box conveyors, manual or automated carts, and gravity or pneumatic chutes, for th
eefficient handling of food and clean supplies and the removal of waste, recyclables, and
soiled material
Make efficient use of space by locating support spaces so that they may be shared by
adjacent functional areas, and by making prudent use of multi-purpose spaces
Consolidate outpatient functions for more efficient operation — on first floor,
if possible — for direct access by outpatients
Group or combine functional areas with similar system requirements
Provide optimal functional adjacencies, such as locating the surgical intensive care unit
adjacent to the operating suite. These adjacencies should be based on a detailed
functional program which describes the hospital's intended operations from the
standpoint of patients, staff, and supplies.
2. Flexibility and Expandability
Since medical needs and modes of treatment will continue to change, hospitals should:
Follow modular concepts of space planning and layout
Use generic room sizes and plans as much as possible, rather than highly specific ones
Be served by modular, easily accessed, and easily modified mechanical and electrical
systems
Where size and program allow, be designed on a modular system basis, such as the VA
Hospital Building System. This system also uses walk-through interstitial space between
occupied floors for mechanical, electrical, and plumbing distribution. For large projects,
this provides continuing adaptability to changing programs and needs, with no first-
cost premium, if properly planned, designed, and bid. The VA Hospital Building System
also allows vertical expansion without disruptions to floors below.
Be open-ended, with well planned directions for future expansion; for
instance positioning "soft spaces" such as administrative departments, adjacent to "hard s
paces"such as clinical laboratories.
3. Therapeutic Environment
Hospital patients are often fearful and confused and these feelings may impede recovery.
Every effort should be made to make the hospital stay as unthreatening, comfortable, and stress-
free as possible.
Using familiar and culturally relevant materials wherever consistent with sanitation and
other functional needs
Using cheerful and varied colors and textures, keeping in mind that some colors are
inappropriate and can interfere with provider assessments of patients' pallor and skin
tones, disorient older or impaired patients, or agitate patients and staff, particularly
some psychiatric patients.
Admitting ample natural light wherever feasible and using color-corrected lighting in
interior spaces which closely approximates natural day light
Providing views of the outdoors from every patient bed, and elsewhere
wherever possible; photo murals of nature scenes are helpful where outdoor views are not
available
Designing a "way-finding" process into every project. Patients, visitors, and staff all need
to know where they are, what their destination is, and how to get there and return.
A patient's sense of competence is encouraged by making spaces easy to find, identify,
and use without asking for help.
4. Cleanliness and Sanitation
Hospitals must be easy to clean and maintain. This is facilitated by:
Appropriate, durable finishes for each functional space
Careful detailing of such features as doorframes, casework, and finish transitions to avoid
dirt-catching and hard-to-clean crevices and joints
Adequate and appropriately located housekeeping spaces
Special materials, finishes, and details for spaces which are to be kept sterile, such as
integral cove base. The new antimicrobial surfaces might be considered for appropriate
locations.
Incorporating O&M practices that stress indoor environmental quality(IEQ)
5. Accessibility
All areas, both inside and out, should:
Comply with the minimum requirements of the Indian Government Standards
In addition to meeting minimum requirements of ADA and/or UFAS, be designed so asto
be easy to use by the many patients with temporary or permanent handicaps
Ensuring grades are flat enough to allow easy movement and sidewalks and corridors are
wide enough for two wheelchairs to pass easily
Ensuring entrance areas are designed to accommodate patients with slower adaptation
rates to dark and light; marking glass walls and doors to make their presence obvious
6. Controlled Circulation
A hospital is a complex system of interrelated functions requiring constant movement of
people and goods. Much of this circulation should be controlled.
Outpatients visiting diagnostic and treatment areas should not travel through inpatient
functional areas nor encounter severely ill inpatients
Typical outpatient routes should be simple and clearly defined
Visitors should have a simple and direct route to each patient nursing unit
without penetrating other functional areas
Separate patients and visitors from industrial/logistical areas or floors
Outflow of trash, recyclables, and soiled materials should be separated from movement of
food and clean supplies, and both should be separated from routes of patients and visitors
Transfer of cadavers to and from the morgue should be out of the sight of patients and
visitors
Dedicated service elevators for deliveries, food and building maintenance services’
7. Aesthetics
Aesthetics is closely related to creating a therapeutic environment (homelike, attractive.) It is
important in enhancing the hospital's public image and is thus an important marketing tool.
A better environment also contributes to better staff morale and patient care. Aestheticconsiderati
ons include:
Increased use of natural light, natural materials, and textures
Use of artwork
Attention to proportions, color, scale, and detail
Bright, open, generously-scaled public spaces
Homelike and intimate scale in patient rooms, day rooms, consultation rooms, and offices
Compatibility of exterior design with its physical surroundings.
ORGANIZATION OF OPD
Care of the ambulatory patient is the main consideration in the OPD. For maximum
efficiency there must be perfect coordination with the inpatient department (IPD) and the
facilities of the hospital.
The main considerations are
Within the OPD, the physical facilities should be placed such that smooth flow of
operation and easy and quick intercommunication is maintained.
Service to common to both the IPD and OPD should be readily and easily accessible.
Provision of adequate auxiliary department.
Installation and review of an appointment systems based on the doctors hours ofworking.
Detailed review of amenities for patient.
LOCATION AND PHYSICAL FACILITIES
LOCATION
The OPD is the showcase of any hospitals, and reflects its image. It should leave an
independent approach at the hospitals and should 3e on the ground floor for easy access. Some
treatment facilities like radiology, pathology, physiotherapy and blood bank should be interposed
between the OPD and IPD.
PHYSICAL FACILITIES AND SPACE REQUIREMENTS
The OPD of a general hospital should have five distinct sections:1.
General facilities.
Clinics of different medical disciplines.
Supporting facilities such as laboratory and injection room.
Pharmacy.
Blood bank
PLANNING
The size of the OPD depends upon the volume of attendance, the clinics provided and
the extent of other facilities such as laboratory, blood bank, and health
education programmed, operating facilities and emergency ward.
The size of the OPD also depends on the land available and the location of the
hospitals.
The guideline is 0.66 sq. ft per annual OPD attendance.
The physical facilities may be considered under four groups
Public areas.
Clinical areas.
Administrative areas.
Circulation areas.
Allocation of area (in sq. ft) for various utilities
Number of 50 beds 100 beds 200 beds 300 beds 400 beds 500 beds
hospital bed
Public areas 1025 2125 3000 3400 4300 4350
Clinical areas 5655 7105 11205 14695 17525 20815
Treatment/Dressing Room - The size will vary from120 sq. ft— 160 sq.
CLINICAL AREAS:
An OPD include surgical, dental, ophthalmic, ENT, maternity, and gynecology, pediatric,
medicine, psychiatric, and emergency department.
There are ancillary facilities such as treatment section which minor OT, injection and
dressing room, dispensary.
There is also a growing need to institute health education program in environmental
hygiene, family planning.
CLINICAL AREAS ARE CLASSIFIED
Clinics for various Medical Disciplines:
Medical Clinic
Surgical Clinic
Orthopedic Clinic
Eye Clinic
ENT Clinic
Dental Clinic
Obstetric and Gynecological Clinic
Family Planning Clinic
Pediatric Clinic
kin and STD Clinic
Psychiatric Clinic
Ancillary Facilities:
Injection clinic
Pharmacy
Auxiliary Facilities:
Laboratory
Radiology
Blood Bank
Health Education
Social Service
Screening Clinic
Preventive and Social Medicine
o Early diagnosis and detection of tuberculosis, cancer, rheumatic heart disease.
o Health education and advice on nutrition and dietetics.
o Rehabilitation and prevention of handicapped and disabilities.
ADMINISTRATIVE AREAS
Administrator's Office
Business Office
Housekeeping
STORAGE FACILITIES
General Stores
Drugs Stores
Linen Storage
Advantages Disadvantages
Nurse have ample visibility and can A critically ill patient, placed closer to the
observe Danger of cross- infection nurse’s for maximum attention would lie
patients directly. in the centre of greatest traffic- density.
There is cross- ventilation o Danger of cross-infection
o Noise and lack of privacy
It is economical to construct and Constant glare which disturb the patients.
maintain thus.
Natural light is available Danger of cross-infection
B. Rig’s ward
The first major development over the above mentioned defects appeared in rig’s hospital,
Denmark and thus the name rigs ward. In this design the ward units is divided into small
compartment.
Cubicles separated from each other by low partition.
Cubicles separated from each other by low partitions, each cubic having 1,2,4 or 6
beds arranged parallel to the longitudinal walls.
Disadvantages of rigs ward
o Communication between the nurse and patient becomes more difficult.
o Patients cannot be directly observed by the nurse.
o Wards are longer; consequently, the nurse has to walk more.
o More nurses are required.
o Costly to build and maintain.
Types of ward design
o Nightingale ward: open ward with 20- 30 beds.
o L- shaped ward: in this, the nursing station is placed at the 90 degree
junction.
o T- shaped ward: the nursing station is at the vertical arm and the patient area
are located on the horizontal arm. Serious patient and nurse to the minimum.
o Circular ward: this design occupies the minimum space and reduces the
walking distance between patient and nurses to the minimum.
4. ANCILLARY ACCOMMODATION
Nursing station
Treatment room
Clean utility room
Ward kitchen/ pantry
Day room
Stores
Dirty utility room
Bathrooms and toilets
Janitors room
5. AUXILIARY ACCOMMODATION:
Duty room for doctors
Seminar room
Attendant room
Side room laboratory
Locker room for staff
SUPPLY OF WATER ANJD ELECTRICITY AND AIR- CONDITIONING
STAFF
Medical
Nursing
Supportive
Various factors influences the workload of the department and personal required to
handle it size of the hospital.
Type of institution
Design of the hospital
Plan of food service
Patient- turnover
Percentage of modified diet
Use of selective menus
Amount of catering
Purchase of ready-to-use food
CENTRAL STERILE SUPPLY DEPARTMENT (CSSD)
LOCATION:
It varies indifferent constituent and location has advantage and disadvantage.
The common consideration is that the major uses of CSSD such as the casualty, ward
unit, labour room and OT should be near of have direct and easy access to it.
FLOOR SPACE:
In CSSD, the floor space is divided into 6 basic units. Their relative floor area is given
below
Clean work-area including sterilization area
Sterile storage
Equipment storage
Fluid, needle and syringes
Reception and clean-up area
Gloves processing area
o Reception and clean up area
o Equipment storage
o Sterile storage
o Clean work area
LAUNDRY SERVISES
LOCATION AND SPACE: -
Whether the laundry is the main building of the hospital or in as space one. Or with one
or more of the hospitals support services, its location should be convenient to the user units.
DESIGN CONSIDERATIONS AND PHYSICAL FACILITIES:-
The design of the laundry should be that it helps in the following main laundering
process:
Sorting (counting, weighing),
Washing (sluicing, if blood-stained)
Hydroextraction,
Drying/Flat ironing,
Pressing/Hand ironing/folding,
Packing.
LABORATORY SERVISES
Cities and very often function as a reference library and forms part of a teaching hospital.
At this level, the laboratory should have most of the units of clinical and morphological
pathology.
Location and Space: -
It should be centrally for easy access by clinicians. At the same time, it must be so
situated that future expansion will not be impeded in designing a regional hospital laboratory, the
requirement of space will be based on the services available, number of specialized units, the
level of research to be carried out and possible future expansion.
Personnel: -
The staff will consist of medical and non-medical professional, both technical and non-
technical. The number will depend on the size of the department and the workload. The
laboratory workload will vary, depending on the population, and the quality and kind of medical
practice in the hospital.
The launching of National Rural Health Mission (NRHM) has provided this opportunity.
Physical layout/rooms
Admission room
Labour room
Staff rooms 1
Staff rooms 2
Immunization room
Dressing room
OPD
Toilet
Laboratory
Pharmacy
Operation theatre
Store room
Sub center:
In the public sector, a Sub-health Centre is the most peripheral and first contact
point between the primary health care system and the community. As per the population norms,
oneSub-centre is established for every 5000 population in plain areas and for every 3000
population in hilly/tribal/desert areas. A Sub-centre provides interface with the community at the
grass-root level, providing all the primary health care services. As sub- centres are the first
contact point with the community, the success of any nationwide programme would depend
largely on well functioning sub- centres providing services of acceptable standard to the people.
Physical layout/Room
Dressing room
Injection room
Staff room
Toilet
Office
District Hospitals
1/1 lakh Pop
Secondary
level
Community Health Centre
(CHC)
1/30000 Pop
Primary Health Care Centre
1/5000 Pop
Sub Centre Primary level
1/1000 Pop
Building:
The college of Nursing should have a separate building. The college of Nursing should be
near to its parent hospital having space for expansion in an institutional area. For a college with
an annual admission capacity of 40-60 students, the constructed area of the college should be
23720 square feet.
Teaching block:
Class rooms
There should be at least four classrooms with the capacity of accommodating the number
of students admitted in each class. The rooms
should be well ventilated with proper lighting system. There should be built inBlack/Green/
White Boards. Also there should be a desk/ dais/a big table and a chair for the teacher and
racks/cupboards for keeping teaching aids or any other equipment needed for the conduct of
classes also should be there.
Departments
College should have following departments
Fundamentals of Nursing including Nutrition
Medical Surgical Nursing
Community Health Nursing
Obstetric and Gynecological Nursing
Child Health Nursing
Psychiatry and Mental Health Nursing
Laboratories
There should be at least seven laboratories as listed below:
Nursing Foundations and Medical Surgical
Community Health Nursing
OBG and Pediatrics
Nutrition
Computer with 10 computers
Pre-Clinical Science Lab. (Biochemistry, Microbiology, Biophysics, Anatomy
& Physiology)
Auditorium
Auditorium should be spacious enough to accommodate at least double the
sanctioned/actual strength of students, so that it can be utilized for hosting functions of the
college, educational conferences/ workshops, examinations etc. It should have proper stage with
green room facilities. It should be well-ventilated and have proper lighting system. There should
be arrangements for the use of all kinds of basic and advanced audio-visual aids
Multipurpose Hall
College of Nursing should have multipurpose hall, if there is no auditorium.5.
Library
There should be a separate library for the college. The size of the Library should be of
minimum 2400 sqr. Ft. It should be easily accessible to the teaching faculty and
the students. Library should have seating arrangements for at least 60 students for reading and
having good lighting and ventilation and space for stocking and displaying of books and
journals. The library should have at least 3000 books. In a new College of Nursing the total
number of books should be proportionately divided on yearly
basis in four years. At least 10 sets of books in each subject to facilitate for the students to refer
the books. The number of journals should 15 out of which one- third shall be foreign journals
and subscribed on continuous basis. There should be sufficient number of cupboards, book
shelves and racks with glass doors for proper and safe storage of books, magazines, journals,
newspapers and other literature.
In the library there should be provision for:
Staff reading room for 10 persons.
Rooms for librarian and other staff with intercom phone facility
Video and cassette / CD room (desirable) -Internet facility.
Offices Requirements
(a) Principal’s Office
There should be a separate office for the Principal with attached toilet and
provision for visitor’s room. Independent telephone facility is a must forthe Principal’s
office with intercom facility connected/linked to the hospital and hostel and a computer
with internet facility. The size of the office should be 300 sqr. ft.
(b) Office for Vice-Principal
There should be a separate office for the Vice-Principal with attached toilet and provision
for visitor’s room. Independent telephone facility is a must for Vice- principal’s office
with intercom facility connected/linked to the hospital and hostel and a computer with
internet facility. The size of the office should be 200 sqr. Ft
(c) Office for faculty members
There should be adequate number of office rooms in proportion to the number of
teaching faculty. One office room should accommodate 2 teachers only. Separate toilet
facility should be provided for the teaching faculty with hand washing facility. There
should be a separate toilet for male teachers. The size of the room should be 200 sqr. ft.
Separate chambers for heads of the department should be there.
(d) One separate office room for the office staff should be provided with adequate
toilet facility. This office should be spacious enough to accommodate the entire office
staff with separate cabin for each official. Each office room should be adequately
furnished with items like tables, chairs, cupboards, built-in racks and shelves, filing
cabinets and book cases. Also there should be provision for type writers, computers and
telephone.
Common Rooms
A minimum of 3 common rooms should be provided. One for the teaching faculty, one
for the student and one for the office staff. Sufficient space with adequate seating arrangements,
cupboards, lockers, cabinets, built-in-shelves and racks should be provided in all the common
rooms. Toilet and hand washing facilities should be made available in each room.
Record Room
There should be a separate record room with steel racks, built-in shelves and racks,
cupboards and filing cabinets for proper storage of records and other important papers/
documents belonging to the college.
Store room
A separate store room should be provided to accommodate the equipments and other
inventory articles which are required in the laboratories of the college. This room should have
the facilities for proper and safe storage of these articles and equipments like cupboards, built-in-
shelves, racks, cabinets, furniture items like tables and chairs. This room should be properly
lighted and well-ventilated.10.
Room for Audio-Visual Aids
This room should be provided for the proper and safe storage of size 600 sq. ft. for all the
Audio- Visual Aids.
Other Facilities
Students’ welfare hall of size 400 sqr. ft. Indoor games hall of size 4000 ft. Safe drinking
water and adequate sanitary/toilet facilities should be available
for both men and women separately in the college in each floor common toilets forteachers
(separate for male and female) i.e 4 toilets with Wash basins. Common toilets for
students (separate for male and female) 12 with Wash Basins for 60 students.
Garage
Garage should accommodate a 60 seater vehicle.
Fire Extinguisher
Adequate provision for extinguishing fire should be available as per the local bye-laws.
Playground
Playground should be spacious for outdoor sports like Volleyball, football, badminton
and for Athletics.
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