Hospital

Ar. Jayakrishna Gutta

 TYPES OF HOSPITALS:

The type of Hospitals vary by :

• The type of services they cater and
• According to the no. of beds they can accommodate.

Some patients go to a hospital just for diagnosis, treatment, or

therapy and then leave ('outpatients') without staying overnight;
while others are 'admitted' and stay overnight or for several days
or weeks or months ('inpatients'). Hospitals usually are
distinguished from other types of medical facilities by their ability
to admit and care for inpatients
 Hospitals distinguished by function

General Hospital:
The best-known type of
hospital is the general
hospital, which is set up
to deal with many kinds
of disease and injury, and
normally has an
emergency department
to deal with immediate
and urgent threats to
health.
 Hospitals distinguished by function

Teaching Hospital:
A teaching hospital
combines assistance to
patients with teaching to
medical students and
nurses and often is linked
to a medical school,
nursing school or
university, generally deal
with all types of ailments,
which is having a
minimum of 500 beds.
 Hospitals distinguished by function

Specialized Hospitals:
specialized hospitals include trauma centers, rehabilitation
hospitals, children's hospitals, seniors' (geriatric) hospitals, and
hospitals for dealing with specific medical needs such as
psychiatric problems (see psychiatric hospital), certain disease
categories such as cardiac, oncology, or orthopedic problems.

Hospitals are also distinguished by the areas of Specialization

services they offer. They include Cardiology, Neurology, Oncology,
Chest, Urology, Ophthalmology, ENT, Psychiatry, Fever,
Orthopedics etc.,
 Hospitals Design

The basic form of a hospital , ideally based on its function.

• Bed related in-patient functions.

• Out-patient related functions.
• Diagnostic and treatment functions.
• Administrative functions.
• Service functions ( food, supply)
• Research and teaching functions
 SPACE PLANNING FOR HOSPITALS

A hospital facility requires three or four major entrances.

These entrances are determined by adjacencies and traffic flow inside

the facility, and in turn will determine traffic flow outside and location
of parking lots.

The major entrances are:

a) Main hospital entrance

b) Outpatient entrance

c) Emergency and ambulance entrance, and

d) Service entrance
Main hospital entrance
Outpatient entrance
Emergency and ambulance entrance
Service entrance
The hospital design should permit flexibility and expansion
possibility in practically every area so that when expansion
becomes necessary, it can be brought about with minimum
disruption of daily activities and without major construction costs.
It is better to omit a major service or function in the design than
squeeze the whole facility.
Hospital layout
Hospital layout
GENERAL PRINCIPLES:

The most important factor in hospital planning is circulation.

Separate all departments, yet keep them close together, separate
all types of traffic, yet save steps for everybody; that is all to
hospital planning.

•Protection of the patient is the primary rule.

•The second rule is to plan for the shortest traffic routes.
•The third rule is separation of dissimilar activities.
•Control is the fourth rule.
•Allowing maximum light and breeze to all parts of the building is
an important factor.
•In principle there should be four separate entrances to a hospital
though smaller hospitals can do with less.
GENERAL PRINCIPLES:

•The service entrance should be adjacent to the kitchen and

storage areas which receive bulk of the supplies, and wherever
possible to a service elevator.
•A great deal of thought should be given to planning for the
development of traffic flow for patients, personnel and visitors
within the building and within and between the departments.
The objective is to expedite traffic, eliminate congestion and
promote efficiency of operation.
•Separating public corridors from patient and staff corridors as
far as possible reduces the staff and patients’ transit time.
•Movement of supplies and materials and removal of garbage
should not interfere with the movement of people.
GENERAL PRINCIPLES:
•The hospital should be designed in such a way that the staff,
patients and visitors can easily orient themselves within the
building and go where they want to.
•Out patients may be routed from the registration and medical
records to sub-waiting areas and from there to the laboratory, X-
ray, pharmacy, special therapeutic and other service areas. They
should not be routed to pass through inpatient areas.
•Inpatients may be routed from the admitting office and medical
social worker’s office, if necessary, to laboratory, X-ray, and other
departments and then to rooms on the patient floors according
to established admitting procedure.
•Medical staff is better routed from the staff lounge passing
through the medical records department for the convenience of
completing patient records
GENERAL PRINCIPLES:

•Visitor’s routes should be controlled carefully.

•Staff should pass from the entrance to locker rooms, and then to
the place where they punch time cares/swipe identification cards
or signs their attendance before entering their respective work
areas.
•Corridors of 2.44m (8 ft) width with a finished ceiling height of
2.44m are the most widely accepted pattern. They should be as
straight as possible. Where ramps are used the gradient should
not exceed 1:10.
•They should be at least two stairways leading from the top floor
to the ground level. They should be located in separate areas of
the building and be provided with lighted exit signs.
GENERAL PRINCIPLES:

•Elevators should be located where there is maximum

concentration of traffic. Elevator doors should not open to the
main lobby, but preferably to an alcove or a side corridor.
•The size of the hospital type elevator car should preferable be
1.52x2.28m and the door at least 1.22m.
•Fire escapes are hardly used. They are however, mandatory. To
be of any value, personnel should know how to operate them.
Fire escapes should be sufficiently wide at the turns to allow a
stretcher to be carried conveniently. There should be
appropriate lighted signs to indicate their locations.
Major Connectivity Patterns
Major Connectivity Patterns
Out Patient Activity
Out Patient Activity
Diagnostic Facilities
Diagnostic Facilities
Diagnostic Facilities
Diagnostic Facilities
PHARMACY
 PHARMACY

(Diagram of a Pharmacy unit in a 100 bedded hospital)

PHARMACY
Patient Rooms
Patient Rooms
Patient Rooms
Patient Rooms
Patient Rooms
Patient Rooms
Patient Rooms
 Nursing Units

(Flow chart of a typical nursing unit) (Typical Nursing Unit)

Nursing Units
Nursing Units
Nursing Units
Labor/ Delivery/Birthing Suits
Labor/ Delivery/Birthing Suits
Labor/ Delivery/Birthing Suits
Labor/ Delivery/Birthing Suits
Operation Theatres
 Operation Theatres

(Plan of a typical surgical suite)

Operation Theatres
Operation Theatres
Operation Theatres
Operation Theatres
Operation Theatres
Operation Theatres
Operation Theatres
ICCU
ICU
ICU
Dialysis Unit
Dialysis Unit
Dialysis Unit
Hospital Services
Hospital Services
Hospital Services
Hospital Services
Hospital Services
Hospital Services
Hospital Services
Hospital Services
 Hospital Services -Incinerator
Incineration is a waste treatment process that involves the
combustion of organic substances contained in waste materials.
Incineration and other high-temperature waste treatment
systems are described as "thermal treatment". Incineration of
waste materials converts the waste into ash, flue gas and heat.

Hospital waste management is complex and requires a multi

prong approach with a combination of chemical disinfection,
steam sterilization and incineration. Incinerators for medical
waste need to be used for wastes which are highly infectious as
only a combustion process changes the chemical structure of the
wastes and prevents any re-infection. The ash from the
incinerator will be sterile and can be safely land filled. Pathogen
destruction is only possible at high temperatures and an
incinerator is ideal for this.
Hospital Services -Incinerator
Hospital Services -Incinerator
Hospital Services –Solid waste Management
Hospital Services –Solid waste Management
Hospital Services –Solid waste Management
Hospital Services –Solid waste Management
 Type of Waste and its treatment
Sl. Waste Container Transportation Treatment/Dispo
No. sal
1 Sharps (Cat-4) Blue Container In Garbage Incineration
(Syringe with needle, broken Trolley
ampoules, and glasses, scalp
vein
2 Solid infectious (Cat-6)
2a) Cotton swabs and Yellow plastic bag Red Wheel chair Incineration
dressing materials ( in bucket, card or by hand
board box)

2b)Anatomical Yellow plastic bag Red Wheel chair Incineration

(Cat-1) Ex. Placenta, organs ( in bucket) or by hand

2c)Urosac, Ryles tubes, Green Plastic Red Wheel chair Central disinfection
Foleys Cathetor, drainage Bucket or by hand and then disposal
bottles, B.T sets (Cat-6) in garbage bin

3 Solid-non infectious Red big plastic Red wheel chair Cut and disposed
(Cat-7) bucket
Used I.V. bottles, [Link]
 Type of Waste and its treatment

Sl. Waste Container Transportation Treatment/Dispo

No. sal
4 General Waste(Cat-7) G.I. tub Red Wheel chair Disposed by Public
Scrap papers, food material, or by hand Health Dept. for
wrappers land filling

5 Micro Biology and Yellow plastic bag Local Local

Biotechnology waste (Cat-3) in bucket autoclaving/steam
Culture swabs, stocks of sterilization at 100°
specimens, human and C for 2 hours,
animal cells incineration
6 Incineration ash Plastic bag Garbage trolley Garbage
bin/Disposal by
Public Health Dept.

N.B: All the handlers must use the protective gears.

Source:
1)Technical paper - A TQM Approach To Implementation Of Handling And Management Of
Hospital Waste In
Tata Main Hospital by - N K Das, Sushant Prasad & K Jayaram
2)Indian Public Health Standards for 51-100 Bedded Hospitals
Hospital Services –Solid waste Management
 Hospital Services- STP
SEWAGE TREATMENT PLANT:

•Sewage Treatment Plant shall have a capacity to handle the

amount of sewage generated per day.
•Separate Grey water treatment plant also can be installed.
 Hospital Services- Rain water Harvesting
RAINWATER HARVESTING:
If rainwater collection and reuse can save 10% of potable water demand in a building, rain
water collection should be done, otherwise rainwater infiltration to the ground water
should be practiced.
If rainwater collection is done on site, the filtration system and tank size have to be chosen
such that at least 90% of the rain water falling on the roof shall be collected and reused.

WATER RECYCLING.
As per NBC 2005, part 9 – Plumbing Services-
4.2.4 Treated sewage or other waste water of the community may be utilized for non-
domestic purposes such as water for cooling, flushing, lawns, parks, fire fighting and for
certain industrial purposes after giving the necessary treatment to suit the nature of the
use.
Note: Grey water is wastewater generated from domestic activities such as laundry,
dishwashing, and bathing, which can be recycled on-site for uses such as landscape
irrigation and constructed wetlands. Grey water differs from water from the toilets which is
designated sewage or black water to indicate it contains human waste.
 Bibiliography

Site Planning – Kevin Lynch

Hospital Architecture & Beyond –Isadore Rosenfield
Hospitals - Facilities Planning & Management – [Link]
Hospitals –Planning, Design & Management – G.D. Kunders
UDPFI Guidelines
Guidelines for Design and Construction of Hospital & Healthcare Facilities – Journal
published by The American Institute of Architects
Designing for total Quality in Healthcare – [Link]
Time Saver Standards – Building Types
Proposed Minimum Standards for Private Hospitals/Nursing Homes –[Link] J
Muralidhar
Indian Public Health Standards (IPHS) For 101 to 200 bedded District Hospitals
National Building Code 2005
Hospital Designing and Planning – by Sangeet Sharma & Purnima Sharma
Bio-Medical Waste (Management & Handling) Rules, 1998” in July, 1998.
Environmental Building Guidelines for Greater Hyderabad — Ver. 1.2(2010)
Queries ???