PLANNING & ORGANIZING A HOSPITAL, UNIT & ANCILLARY SERVICES

PLANNING & ORGANIZING A HOSPITAL

A functional design can promote skill, economy, conveniences, and comforts; a non-functional design can
impede activities of all types, detract from quality of care, and raise costs to intolerable levels."
... Hardy and Lammers
Hospitals are the most complex of building types. Each hospital is comprised of a wide range of services
and functional units. These include diagnostic and treatment functions, such as clinical laboratories, imaging,
emergency rooms, and surgery; hospitality functions, such as food service and housekeeping; and the
fundamental inpatient care or bed-related function. This diversity is reflected in the breadth and specificity of
regulations, codes, and oversight that govern hospital construction and operations.
Designing a hospital is a much more complex and drawn out process than, say, designing a shopping
mall or a hotel. The design process of a hospital involves all of the following activities but is not necessarily
limited to them:
1. One of the main considerations before embarking on the process is number of specialties that are required in
the hospital;
2. Consideration of legal aspects & legislations, building regulations, health service technical memorandums;
3. Consideration of environmental legislations and changes in environment, weather and temperatures;
4. Safety and security – from terrorism to safety of drugs in pharmacies;
5. Hospital Personnel/Staff safety ;
6. Aspects dealing with safe usage of dangerous drugs, gasses, radioactive substances and the like as well as
their safe disposal;
7. Recycling/Incineration issues;
8. Day to day hospital infrastructure and equipment maintenance issues;
9. Structural requirements for walls, ceilings and floor – such as a theatre lights.

Good hospital design  integrates  functional requirements with the human needs of its varied users.
The basic form of a hospital is, ideally, based on its functions:
÷ Bed-related inpatient functions
÷ Outpatient-related functions.
÷ Diagnostic and treatment functions.
÷ Administrative functions.
÷ Service functions (food, supply).
÷ Research and teaching functions.
Physical relationships between these functions determine the configuration of the hospital.

TYPES OF HOSPITAL
There are 3 main types of hospitals:-
1. The regional hospitals, which may be located at district places or chief towns & may be associated with a
medical college. These hospitals will give high standard of medical, surgical & midwifery services. These
hospitals may also have tertiary care & super-speciality departments.

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2. The intermediate hospitals are usually at other smaller town in district. They may be a civil or general
hospital with departments like medicine, surgery, obstetrics, paediatrics & specialities like ENT,
ophthalmology, etc. these usually have well- established X-ray departments & are used for referral by small
hospitals.
3. The local hospitals or dispensaries at villages or taluka places including primary health centres, which take
care of day-to-day needs of a smaller local group & provide basic medical, surgical & obstetrics care.

OPENING A NEW HOSPITAL

Planning is the most important aspect of establishing a hospital. If the plan is good, all may go well. If the plan
is not carefully planned, the work may never be completed. Planning facilitates identification & selection of
means to achieve goals within a reasonable cost. It is much more than planning to buy equipment & for
recruitment of a specific doctor. The planning of hospitals should be based on the needs of the area it is going to
serve. The objectives of physical facilities planning are mainly 3 at the macro level. These are—
 Maintenance of current bed population ratio.
 Improvement of facilities in the rural areas.
 Improvement of quality of services in the existing hospitals.

BED POPULATION RATIO

There are no rigid recommendations about number of beds general hospitals should have. But generally it
should not be too large & so it should not have more than 600 beds. The Medical Council of India also
recommends 500 bedded hospitals for a medical college with 100 admissions per year & for 150 admission
750 beds are required.
The population-bed ratio required will depend mainly upon the local conditions. The factors which
should be considered in deciding the above are—
1. Age distribution of population.
2. General standard of living, specially the housing & transport facilities, whether the town or mostly
residential one. The industrial zones may need a hospital to take care of occupational diseases.
3. The population density- The urban areas with sufficiently large population & with high density will need
regional hospital as compared to rural areas with small scattered population. The number of beds per 1000
population will be decisive in organizing the type of hospital in the region. The hospital with more than 4
million inhabitants will need specialized tertiary care regional hospitals. Those with population between 1
t0 4 million are ideal for establishing a tertiary care regional hospital. With a population of 2,50,000
inhabitants the region should have an intermediary hospital, while the local hospitals may cover the needs
of about 20,000 to 60,000 people. These figures are subject to modifications based on geographical
conditions & the density or concentration of the population in the area.
4. Incidence of disease & injury - If the region is more prone to certain diseases, like leprosy, goiters, etc. or
more prone to natural disasters like annual floods, earthquakes, etc & more road accidents. These factors
should also be considered when establishing a hospital. A general hospital with adequate beds for medicine,
surgery, midwifery, paediatric & also for ophthalmology, ENT, STD departments with usual laboratory &
radiological investigation departments can be instituted if any disease is very prominent in the area like

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 leprosy, TB, Goiter, etc. special cells to deal with these may be added to the general hospital. A speciality or
referral hospital needs much more intensive planning than the general hospital.
5. The level of health care provided by the medical practitioners, private nursing homes & other hospitals in
the region.
6. The financial support for speciality recurring expenses, whether it will be borne State or Central
Government, local Government, insurance schemes by charities or the hospital has to generate its own
financial resources.

DATA
It is the basis for hospital planning & for this purpose various parameters are required-
1. Demographic data
2. Meteorological data
3. Disease patterns
4. Geographic data
5. Vital statistics data
6. Pattern of use of existing facilities
7. Existing medical care facilities- The doctors should be part of team planning the hospital & should guide
the architects about space, sanitation, flooring, colour scheme & interior arrangements & decoration.
8. Future development & expansion plans- The bed population ratio will help to decide the number of beds to
be planned in the hospital. The following formulae may help to calculate the beds required:
A) A x S = 100,
where A= inpatient admission/1000 patients/year & S= average stay occupation.
B) 365 x po;
po = % of occupancy.
C) Bed/Population ratio = 365 x 70 = 511 = 255 beds
100 2

According to WHO guidelines, indices of direct & indirect admissions give the coverage hoped to be attained
the assumed average of stay & the occupancy rate indicates efficiency in the use of services. About 85 % bed
occupancy.
Example,
Direct population 700,000 (number) 165 (admission/year/1000) 7,00,000 x 165
1000
= 1,15,500

Indirect population 800,000 (number) 55 (admission/year/1000) 8,00,000 x 55

1000
= 44,000
Total admissions (Direct + Indirect) = 1,15,500 + 44,000
= 1,59,500
Average length of stay in (ALS) hospital =6
Total beds days per year = 1,59,500 x 6
(Total admissions x ALS) = 9,57,000
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 100% Occupancy = 9,57,000
365
{Total bed days per year} = 2622
365
If total beds required with 85% occupancy = {Total beds with 100% occupancy}
85%
= 2622 x 100 = 3084
85
If the hospital already has beds, then this need to be deducted from figures, which will give the number of more
beds required.
Suppose a hospital is constructed earlier with 1500 beds, then there is need to construct 1584 more beds
to meet the need of community.
More beds required = 3084-1500 = 1584

It is 0.6 beds/1000 population in India, whereas 8-12 beds/1000 population in other countries.

So the number of patients expected to serve will decide the number of beds to Be instituted in the hospital-
taking 1/1000 BP (Bed/Population) ratio, 500 bed hospital is expected to serve 5 lakh people.

HOSPITAL SIZE
A very large hospital of say 750 beds or a very small hospital of say 50 beds or so, on the need of each area.
From functional efficiency standpoint, it is advisable to plan 2 separate hospitals of 400 beds, each with scope
for future expansion, rather than single 750 beds, or instead of building a small hospitals of 50 beds, it would be
profitable if these beds are added to an existing hospital in the area under & expansion project rather than
separate hospital.
If too big, the hospital tends to lose human touch & becomes somewhat soul less, impersonal. The
general hospital should not contain less than 100 beds, as it becomes difficult to provide differentiated service.
A hospital of 200 to 400 beds enables adequate departments of general surgery, medicine, eye & ENT, etc., the
several departments being large enough to justify the appointment of full-time specialists to the staff.

LAND REQUIREMENTS
Determining the requirement of land depends upon many factors. In rural & semi-urban areas, plentiful land
may be available permitting the hospital to grow horizontally, however, in urban areas there will always be
great premium on land & the only available avenue will be a vertical growth.
Site cover on a plot land is expressed as percentage as under—
Site cover percentage = Total ground floor area of all building x 100
Total area of site available
Big building is impressive. However, even smaller size hospitals can be visually comforting. A building can
make a good situation better or a bad situation worse. A good hospital building stimulates good hospital care.

SITE

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The site is also important. If the hospital is in the middle of town near railway station or bus-stand, it will be
easy for the people to commute from far & near areas & in-patient inflow will be considerable.
However, if it is situated outside the town say 4-5 kms away, the commutation will be a problem & the
patient attendance will be comparatively less leading to less bed occupancy & stay. Commutation adds to the
overall expenses of the treatment. It same services are available at the same or slightly more cost in town then
people prefer it, because it will save their time & inconvenience caused due to commutation.
The reputation of doctors is also a deciding factor. People will travel a long distance to be treated by
well known, effective & expert doctor even if the hospital is far off.
The reputation of hospital & quality of services if offers as well as the behaviour of its staff are also
determinants in patients visiting a hospital.
Be ascertained before any construction work is undertaken: the future expansion plan 20-50 years
hence should also be considered while laying the basic facilities like warm water supply, drainage lines, electric
supply, and foundation of weight bearing of the present buildings.
Environmental pollution levels or index for noise pollution, chemical pollution or their industrial
pollution should also be considered while selecting the site for the hospital. A pollution & noise free area is to
be preferred.

AREA OF BUILDING
The total area of building &relation to size of the plot---
a. In a crowded area; it is in 2:1 ratio.
b. In a less crowded area; it is in 0.5-1.0 or less per plot- in 1:1 ratio
c. Rural area in 1:2; urban in 2:1 ratio

GROSS SPACE REQUIREMENTS

Indian standard Institution in their standard IS 10905 part-I recommend an area of one hectare for every 25
beds.
Taking liberal figure of 100 sq feet per bed the land requirement for a 500 bedded hospital is about 22
acres, at floor area ratio of 0.5 to 1, about 6 acres at floor area of 1.5 to 1 & about 6 acres at a floor area ratio of
2 to 1.
Breakdown of Space Requirements in General Hospitals
S.No. Area Square ft per bed
1 Nursing Unit 250-280
2 Nursery 12-18
3 Delivery suite 15-20
4 Operation theatres 30-50
5 Physical medicine 12-18
6 Radiology 25-35
7 Laboratory 25-35
8 Pharmacy 4-6
9 Dietary 25-35
10 Medical Records 8-15
11 Housing keeping 4-15
12 Laundry 12-18
13 Stores 8-10
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 14 Administration 40-50

The soil test should be preformed & the subsoil water level should be tested. Some basic laws of planning can
further guide in establishing the physical facilities—
1. Unity- Harmony of departmental work, the registration OPD, investigative departments & casualty,
pharmacy & treatment rooms should be on the same floor (ground preferably) & should ne adjacent, so that
patient does not have to move all across the hospital.
2. Diversity- Accepts, size, orientation with frame work.
3. Facility of Operation- An intimate knowledge of each department is necessary.
4. Flexibility- Plan should have inbuilt flexibility to adapt to rapid changes in medicine & the scope of
updating & improving services should be a part of the plan.
5. Good Hygiene- Is basic to all hospital; clean, hygienic, well lighted & ventilated spaces should be planned.
6. ECONOMY- SITE IN URBAN AREA:-
25 beds 80 square meters 5 Acres
100 beds 800 square meters 15 Acres
200 beds 25 Acres
500 beds 50 Acres
750 beds 80 Acres
1000 beds 100 Acres

A) Water- Sufficient economic supply- 500 ltr/bed/day.

B) Electricity- Sufficient economic supply 1 kw/bed/day/2-3 grid supply.
C) Communicability- Accessible in 30 mins.
D) Cooking gas- As sufficient economical supply.
E) Sewerage- 400 ltr/bed/day.
F) Garbage- 2-3 kg/bed/day- to be incinerated.
7. Traffic Lanes- Broad & one-way preferred. There should be separate traffic lanes inside & outside of the
hospitals. The parking for patients should be near the main entrance & doctors & staff vehicles to be parked
at a distance. The casualty at the nearest point in the hospital complex on entrance & the lanes (one way)
always kept free, no parking in the area, except for ambulances carrying the patients. They should also leave
as soon as the patient is put on stretcher & goes in to the casualty.
8. Zoning of patient areas.
9. Planning for expansio.
10. Ward size- 25-30 bed/ward less than 30 beds in not economical 60 beds- in two units, floor is ideal.
11. Speciality department- at the back of general patient area or on higher floors.
12. Shape & size of the hospital- 300 beds- horizontal; More beds- Vertical but not more than 8 stories high as
the problem of fire fighting, lift services, over water pumping & others increase. Beyond 18 stories the
construction cost rises significantly. All rapid growth departments should be on ground floor.
13. Climate conditions-
A) In hot humid areas like Mumbai, the building should be North-South with thin walls.
B) Hot & dry or cold & dry climate like Delhi or Punjab- use small windows, full glass pane- are of no use,
not only they are costly but are uncomfortable to patients.
C) Ventilation- Natural, cross ventilation is to preferred to central or other type of air conditioning.

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14. Beds-
 Single bed-rooms- should have at least 100 sq feet area with attached toilets.
15. Colour scheme- Use light colours.
a) Size & orientation of windows should allow sufficient natural light & sun rays in the room.
b) Artificial light, fluorescent light for ECG & EEG rooms.
c) Use warm colours.
16. Maintenance- No major problems should arise in 20 years. After 40 years, replacement is necessary due to
technical advances. Ability to expand & flexibility & convertibility should be inbuilt in the plan.
17. Control of cross infection- The bed distribution & planning should consider the prevention of cross-
infection in wards, OTs, laboratories & service areas.
18. Parking- One car parking space per two beds is desirable in metropolitan towns, lesser in smaller urban
areas, less in semi urban & rural areas. Additional for 3 wheelers, scooters & motor cycle & separate
parking for bicycles & rickshaws should be considered.

BED DISTRIBUTION- SUGGESTED (%) BEDS--

Medicine 30
Surgery 20
OBGYN 17.5
Pediatric 7.5
Ortho 2.5
Eye 5
ENT 5
Skin 2.5
Emergency 2.5
Isolation 5
Psychiatry 2.5
TOTAL 100

These are some of the things which should be considered while planning a hospital.

WATER
Water is required for patients & patient care activities inwards & also for the supportive services. The national
building code of the ISI suggests 455 Litres of water Per Consumer Day (LPCD) for hospitals up to 100 beds &
34 LPCD for hospitals of 100 beds & over. For planning purposes, the overall requirement of water in hospitals
is estimated at about 30 to 400 litres per bed per day.

SEWAGE DISPOSAL
Liquid & semisolid effluent in the hospital originates from all departments & services areas. Solid waste from
hospitals is approximately 1 kg per bed per day. Liquid effluents will be about the same as the hospital’s
requirement of water i.e. between 300 to 400 per bed per day. If a public sewage disposal system is in existence
then the hospital sewage disposal can be connected to this system. Otherwise, the hospital will have to build &
operate its own sewage disposal plant.

POWER
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Requirement of electric power is approximately 1 KW on a per bed per day basis. This includes the needs of all
departments & services including power requirement of X-ray department, operation theatres, laboratories,
CSSD, laundry, & kitchen. A hospital with many life-support systems cannot afford to remain without power
even for a short-time. Stand-by generator is a necessity.

CIRCULATION
The utility & success of hospital plans depend to a large extent on the circulation routes on hospital site &
within buildings. There are two types of circulation in the hospital. Internal circulation, are required for linking
major clinical departments for use by patients & staff, & for delivery of supplies to these departments. The
circulation space involves corridors, stairways & lifts, corridors with less than 8 feet width are not desirable in
hospitals, & protective beading is a necessity in hospital corridors. External circulation, only one entrance to
the hospital for vehicular traffic from the main road is suitable. Provided the entrance & exist points are wide
enough to exit the advantage of clarity for all visiting traffic, & one exit the advantage of security from
administrative view point.

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.
÷ Provide an efficient logistics system, which might include elevators, pneumatic tubes, box conveyors,
manual or automated carts, and for the efficient 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.
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.
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. The interior designer plays a major role in this effort to create a therapeutic environment. A
hospital's interior design should be based on a comprehensive understanding of the facility's mission and its
patient profile. The characteristics of the patient profile will determine the degree to which the interior
design should address aging, loss of visual acuity, other physical and mental disabilities, and abusiveness.
Some important aspects of creating a therapeutic interior are:
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÷ 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 daylight.
÷ Providing views of the outdoors from every patient bed, and elsewhere wherever possible.
÷ 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.
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.
5 Accessibility- All areas, both inside and out, should:
÷ Be designed so as to 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
 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
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. Aesthetic considerations 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
8 Security and Safety- In addition to the general safety concerns of all buildings, hospitals have several
particular security concerns:
 Protection of hospital property and assets, including drugs
 Protection of patients, including incapacitated patients, and staff
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 Safe control of violent or unstable patients
 Vulnerability to damage from terrorism because of proximity to high-vulnerability targets, or because they
may be highly visible public buildings with an important role in the public health system.
9 Sustainability- Hospitals are large public buildings that have a significant impact on the environment and
economy of the surrounding community. They are heavy users of energy and water and produce large
amounts of waste. Because hospitals place such demands on community resources they are natural
candidates for sustainable design.

PLANNING & ORGANIZING A UNIT

Hospitals provide best possible care to patients at least cost. The hospitals differ in size & complexity. It has
many departments which are designed to serve patients. A ward is the vital area of the hospital where the patient
spends most of their inpatient care unit after time admission in hospital. The ward environment determines the
extent of recovery of patient. So there is need to focus most of services in patient care unit.
A ward can be conceptualized as a system whose internal environment has ample interaction with the
external environment. The internal environment of the ward comprises its physical facilities, e.g., beds, medical
equipment, drugs & side laboratories for common investigations & the human resources- the doctors, nurses,
etc.

TYPES OF UNITS/WARDS
1. General wards- where patients with non-specific ailments, requiring no life saving care are admitted. These
are big wards with patient nurse ratio 0f 5:1 & cater to patients’ routine investigations, treatment & care
needs, till the patient is discharged.
2. Specific wards- where patient admitted with specific care, due to illness like ICU, Postoperative ward,
Neonatal ward, etc. The type of service provided by a ward is denoted by its name. The nurse patient ratio is
less like 1:1 in ICU, emergency, etc.
3. Units with specialist nursing, treatment & equipment - like burns ward, transplant ward & functioning
usually at national or regional centers where particular service skill are concentrated.

ELEMENTS OF PLANNING OF THE PATIENT CARE UNIT

The elements of patient care unit are-
Physical facilities- Adequate physical facilities have equal importance in ward planning as well-defined &
balanced administrative policy. Every nursing unit should be designed in such a way that it can be built &
operated at the lowest possible cost & at the same time it can achieve the functional goals of the unit.

Objectives of unit management-

1. To provide the highest possible quality of medical care for the patients.
2. To furnish the most desirable patient environment.
3. To provide highest degree of job satisfaction for the nursing & medical staff.
4. To provide the facilities to meet the needs of the visitors & attendants.

Ward planning includes-

 Space planning.
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 Location of nursing unit.
 Material planning.
 Personnel planning, etc.
 In each nursing unit, planning may be done to provide following basic facilities—
 Patients’ rooms with attached/separate bathrooms & toilet facilities.
 Nursing duty room.
 Treatment room.
 Waiting area for relatives.
 Storage space for linen & other supplies & equipment.
Besides these, there is need for manpower planning, i.e., identifying the actions to be taken by various personnel
for performing different activities & identifying the position by which personnel requirements may be grouped
to determine types, numbers & qualifications.

 SIZE OF THE WARD- Varies from hospital to hospital. Normally a ward with 20-40 beds is found. The
size will be determined by type of patient (for critical patients, area of 100-120 sq. ft/bed is required &
smaller rooms of 2-4 beds are preferable; for chronic diseases, larger wards of 50 or more beds);
requirement of ward staff & presence of head nurse & ward clerk.
 PATIENT HOUSING AREA- Modern trend is to have a few single bed rooms, 2-3 double bed rooms &
majority of beds placed in 4-6 bed bays. Avoid dormitory type of wards (because of noise & lack of
privacy).
Size of rooms-
 Single room- 125 sq. ft
 Two-bed room- 160 sq ft
 4-bed room- 320 sq. ft
 6-bed room- 400 sq ft
 ICU= 120-150 sq ft per bed
 Obstetrics & orthopedic- 120 sq. ft. per bed
The area per bed within the ward is 80 sq ft but in acute ward it is 100-120 sq ft.
 Space between 2 rows of beds- 5 ft
 Space between two beds- 3 ft
 Space between wall & bed- 2 ft
 Length of the bed- 6’6”
 Width of the bed- 3 ft

 SUPPORT SERVICE AREA – This section of a ward includes-

1. Nursing station/duty room- It should be located at such a place that the time taken by a nurse for moving
from one place to another is limited. Centralized location is desirable. All records are kept here. Acutely
sick patients should be located closer to the nursing station. Emergency drugs should be available on a
trolley for quick movement. It should have sufficient space with storage area for stationery, records & an
adequate medication unit. It should also provide sufficient space for the office of the ward clerk, sister in-
charge, work area for the staff nurse & a toilet.

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2. Treatment room- Examination of patient & certain procedures are conducted here. It should be well
equipped with examination table, spot light, dressing material, hand washing facility, etc.
3. Clean work room- This is the working room for the staff nurses in the nursing unit. It contains work
benched for the preparation of trays, care of materials, equipment &supplies used in the unit. Shelves &
storage space for the equipment & supplies of daily use type should be provided.
4. Pantry- Where dishes are washed, cleaned & stored is also necessary. It should be equipped with sinks with
running hot & cold water.
5. Unit store- One or two stores rooms are also needed for each nursing unit where linens & other supplies
should be stored & kept safe.
6. Dining & day room- A day room-cum-dining for the ambulatory patients is considered desirable in each
unit. It helps the recovery of the patients. It should normally be placed at one side wing of the ward with
proper sitting arrangements.

 SANITARY AREA – The components of this area of the ward are-

1. Baths & toilets- The modern trend is to have toilet facilities attached to each room irrespective of its size or
capacity. One bath for 8 patients and 1 toilet for 5 patients are considered optimum. Separate toilet facilities
are required for male & female employees & visitors.
2. Dirty utility room- There should be separate dirty utility areas where arrangements for washing of bed pans,
urinals, specimen bottles etc. can be carried.
3. Store for sweepers- Space for receptacles, hangers for mops & brooms, shelves for storage of cleaning
materials is necessary.
4. Wash bottles- in each patient room or bay there should be a wash basin fixed so that patients do not need to
go up to the toilet only for hand washing purposes.

 AUXILIARY AREA
1. Duty room for doctors- There should be an arrangement for doctors duty room where doctors can work
during the day & rest during the night duty period.
2. Clinical side room- A ward laboratory where routine types of tests can be done is needed for each floor or
block which can serve 2, 3 or 4 nursing units on a hospital floor.
3. Seminar room- One seminar room for each floor or block for teaching purposes can be allotted if the
hospital can provide. All the clinical teaching can be conducted in this room without disturbing the rest of
the patients.
4. Attendant room- a small area for one or two nursing units is needed as a retiring room for the visitors &
attendants of patients. Lockers should be provided so that personnel articles of the attendants can be kept
safe.
5. Locker room for staff- A room with lockers should be provided to staffs who do not reside in the hospital
campus for their changing & keeping their belonging safe. Besides these, there should be provision of areas
for staircase, lift, arranged for each nursing unit.

Broad groups of ward planning are as under—

1. Patient housing area: Consists of
÷ General wards
÷ Semi-private rooms
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 ÷ Private rooms
÷ Special rooms
2. Ancillary area
 Nursing station
 Treatment work room
 Clean work room
 Pantry
 Unit store
 Dining & day room
3. Sanitary area
÷ Bath & toilets
÷ Dirty utility room
÷ Store for sweepers
÷ Wash basin
4. Auxiliary area
 Duty room for doctors
 Clinical side room
 Seminar room
 Attendant room
 Lockers room for staff
 Recreation room

Put together, the ward or in-patient area occupies one-third of the hospital area.

WARD DESIGN
The primary objective of a ward design is to facilitate the nurse to hear & see everything that happens in the
ward & to react accordingly with most efficiency & minimum physical & emotional stress. And secondly, to
enable the patients to easily call the nurse when they need her help. Many changes in designing a ward have
been made & accepted during last three to four decades.
1. OPEN WARD- In an open hall, beds is placed in rows facing each other & the nursing station is placed in
the center of the hall. The stand-by services areas either in the center surrounding nursing station or at both
sides of the hall.
Advantages-
a) Nurses have ample visibility of patients at all times.
b) Cross ventilation is maintained.
c) Economical to construct & maintain.
Disadvantages-
a) Noisy & lack of privacy.
b) The space between the rows of beds serves as corridor.
c) A critically ill patient if placed closer to the nurses’ desk, as he needs maximum attention, then lies in
the center of greatest traffic density.

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2. RIGG’S WARD- Such a ward is so named because it was first made in Rig’s hospital in Denmark. In this
design three to four beds are placed parallel to the windows in open bays separated from each other by low
partition.
3. UNILATERAL RIGG’S WARD- Beds are placed in each bay & bays are separated by common corridor.
4. UNILATERAL RIGG’S WARD- Side beds were placed in each bay. Bays were separated from nurses’
station with its stand by services by a common corridor. Noise could not be reduced but the activities of
nurses & doctors are confirmed to each bay only. In this design nurses do not have ample visibility &
calling bells should be fixed.
5. BILATERAL WARD- Bilateral ward or double corridor ward has been accepted by most organizations as
most suitable & workable proposition under conditions where controlled environment & mechanized
ventilation is not a problem. In a design, two unilateral Rigg’s type wards are on either side of a central
nursing station. It facilities optimum observability of patients & reduces walking distance for the nursing
staff.
6. T-SHAPED WARD- In this design, bed bays are placed in front of the nursing station. Critical patients’
bays are in front of nursing station. Critical patients’ bays are in front of nursing station. Isolation bays are
at both sides & ancillary & other service areas are behind the nursing station. The shape of the ward can be
changed to any shape like ‘X’, ‘Y’, ‘circular’, ‘semi-circular’, etc., arranging the patients cubicles or bays &
other service area. This seems to be the best type of general ward. But care should be taken & maintain
ventilation mechanically & to arrange for nurse-patient communication system.

PLANNING & ORGANIZING ANCILLARY SERVICES

A KITCHEN
Dietary services in a hospital are as important as a component of patient care as any other ancillary services. In
our country, by & large, hospital food service has not been given due importance it actually merits. Kitchens of
our district & other hospitals merit immediate attention because of gross neglect. They not only lack adequate
facilities of washing, storage & cooking etc., but are also very poorly staffed & supervised.

SPACE REQUIREMENT
Hospital kitchen is divided into number of divisions which have a particular activity. The broad areas are
supplies receiving area, storage area, cooking area, pots & pan wash, garbage disposal, LPG stove &
refrigeration facilities, housekeeping, dietician & steward offices & circulation area.
Following space requirements are recommended for different sizes of hospitals.
200 beds or less : 20 sq ft per bed
200 to 400 beds : 16 sq ft per bed
500 beds & above : 15 sq ft per bed

STAFF REQUIREMENT
According to the Indian Dietetics Association, various categories of staff & other members for different sides
of hospitals are as

Number of Beds
Category of staff 100 200 300 500 750
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 Chief dietician - - - - 01
Senior dietician - - - - 01
Dietician - - - 01 01
Asstt. Dietician 1 2 3 5 7
Steward - - 1 1 1
Store keeper (ration) - - - 1 1
Store keeper (general) - - - 1 1
Clerk/Typist - - - 1 1
Head cook 1 1 1 2 2
Therapeutic cook - - 2 2 3
Cooks 4 6 8 10 16
Asstt. Cook or bearer 6 14 20 28 32
Masalchi 4 4 6 8 10
Store attendant - 1 1 2 2
Sweeper 1 1 2 2 3

Note- Additional 10 to 30% staff will be requires to compensate for weekly offs, causal leave, earned leave, etc.
This staff would take care of the “Two shift work”.

FUNCTIONS OF VARIOUS STAFF

1. DIETICIAN-
÷ Administrative functions (menu & budget planning, cost accounting, condemnation of equipment,
housekeeping, etc);
÷ General food services (timing of meal service, infection control, control of vermin, etc);
÷ Clinical functions (diet plan for various diseases, diet advices to patients) &
÷ Educational functions (various training programmes for graduate dieticians, nurses & other
paramedical workers).
2. STEWARDS-
 Receive diet sheets from the wards & prepare a consolidated demand;
 Record all the correspondence relating to diet sheet, diet indents, diet & census, etc;
 To carry out daily inspection of the kitchen staff for appearance, cleanliness & uniforms, etc;
 To check dietary equipments, supervise distribution of foods to the wards,
 To see the handling & disposing off of the garbages, general sanitation of the entire kitchen, etc.
3. STORE KEEPER-
÷ Receive all goods, verify the various accounts of stores including LPG cylinders, etc received by head
cook in his absence,
÷ To place goods in proper binds, shelves,
÷ To keep store room clean & orderly,
÷ To issues supplies according to requisitions, to check bills, verify & submit to the dietician in charge.
÷ To maintain records & stock books.
4. HEAD COOK- Care & maintenance of the therapeutic diet kitchen, sanitation & cleanliness of kitchen.
 To check wastage, adulteration & spoilage of food.
 Maintain & improve standards of food preparation.
 Special care with regard to diet kitchen.
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5. BEARERS-
÷ To carry food from the kitchen in trolleys to various wards & get proper receipts.
÷ To use & clean proper utensils for taking the food to various wards.
÷ To help cook in cleaning, cutting & washing vegetables, pulses, etc.
÷ To help the store keeper in weighing ration items to be issued.
6. MASALCHIS-
 Transfer of soiled dishes from the kitchen to the dish washing area.
 Scraping & washing pots & pans thoroughly.
 Use of proper detergents & methods for cleaning as per instructions.

INTERNAL PURCHASE COMMITTEE

The committee members should come & check the various supplies coming to the kitchen & to ensure that the
supply is made according to the specifications. Excepting the dietician, the other members of the committee
should visit the stores thrice a week. Their regular visits will be immensely valuable to keep the kitchen stores
in order, e.g., regular & timely supply of food items, & bottlenecks in procurement, quality inspection, wastage
reduction, maintenance of discipline, preparation & distribution of food, complaint settlement & pilferage
reduction, all these activities would need to be strengthened.
Besides the Internal Purchase Committee, the medical superintendent should also appoint a surprise
round committee consisting of three senior doctors of the hospital who are supposed to make surprise rounds
in the kitchen & check any items in the stores as far as its stock position & quality is concerned.

SUPPLIES DISTRIBUTION
All supplies to the kitchen can be categorized under perishable & non-perishable stores. The non-perishable
stores are generally received by the store keeper & the perishable stores like milk, eggs. Bread, etc can be
received by either steward or the dietician herself. Head cook can also be authorized for this job.

B LAUNDRY
The first environment of a patient is his cloths and bedding. Care of the linen in a hospital, therefore assumes
great importance. To ensure infection free first environment, laundry services has to affect it meticulously,
handled by trained personnel insuring full satisfying medical standards.

INTRODUCTION
The laundry plant is responsible for providing clean and quality washed linen after collecting dirty/soiled linen
from all hospital areas i.e. OT, the indoor wards, OPD, ICU, etc. Laundry plant remains functional on all 365
day in a year in order to ensure the uninterrupted timely supply of the washed linen to the areas mentioned
above since the hospital services run round the clock. It should have proper drainage arrangements

LOCATION OF LAUNDRY
The location should be convenient to the user units. If possible, it should be in the same building of hospital
with separate entrance & exit rate & should be in close proximity to CSSD & dietary services due to common
requirements of steam from the boiler plant.

SPACE REQUIREMENT
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It should be approximately 10-15 sq ft per bed. In terms of number of beds, the space requirement is-
200-350 beds - 3750 sq ft
300-500 beds - 5670 sq ft
500-650 beds - 6460 sq ft
More than 650 beds - 8210 sq ft

FLOOR AREA/SPACE REQUIREMENT

The area for laundry for teaching hospital should be at least 5800 sq ft according to Dr JR McGibony. The
space requirement is 10 sq ft per bed or 10 sq ft for 2.5 kg of linen per day.

LAYOUT & DESIGN

3 types of layout of laundry can be planned
a. Straight through- installation of equipment in a straight- line flow from the dirty end to the clean end.
b. U flow- Where the clean & dirty ends are in the same direction.
c. Gravity flow- Dirty lend at the top & clean one at the bottom.

The design of the laundry should be such that it should help in the following main laundewring process---
1. Reception of linen from wards.
2. Sluicing of blood stained clothes.
3. Counting & weighing.
4. Sorting for repairs & condemnation.
5. Washing.
6. Hydro extraction.
7. Drying.
8. Calendaring (pressing of big sheets by passing on rolls in steam) & pressing.
9. Packing & distribution.

SCHEMATIC DESIGN OF FUNCTIONAL AREAS-

Reception bay -----Sorting area-----Sluice room-----Main washing area: washing, hydro extracting, drying-----
Ironing area-----Clean storage area-----Issue Bay.

ANCILLARIES
ó Stores.
ó Worker’s Rest Room.
ó Boiler Room.

1. MATERIAL & DÉCOR- Smooth, non slippery, water impervious floor; smooth, washable, pastel coloured
rather than white to reduce glare & free of corners, edges & projection walls. It should have smooth &
washable ceiling, high enough to allow installation of equipment & wide doors.
2. VENTILATION- Recommended air changes are 10/hour with provided enough exhaust fans.
3. LIGHTING- Day light should be used wherever possible. Good lighting should be there & should be free
from glare & shadows.

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4. POWER SUPPLY- Usually it is 220 or 440 watts, 3- phase, alternating current & connected to alternative
standby generator. The distribution panel must be readily accessible, preferably located near the load center
away from the direct path of escaping steam or vapour.
5. STEAM- Requirement is 170o C with 100 psi. Ideal is 178oC at 100 psi. the steam supply must deliver steam
to the equipment in the required quantities & temperature. All steam lines should be properly insulated for
protection of the personnel, economy of operation & redirection of the heat load of the environment.
6. WATER- Provision of adequate water supply throughout the day is of great importance. For every kg of
linen 30 litres of hot water at a temperature 70oc to 80oC & 10 litres of cold water are required. The hot
water supply should be piped to the laundry directly from the bolier room.
7. FIRE SAFETY MEASURES- Provision of fire extinguishers is a must & workers must be taught of it. The
area should be smoking free & no electrical equipment should be left switched on after the working hours.
8. TOILET, LOCKER & SHOWER FACILITIES - Should be enough with facility of changing clothes
(working clothes or uniform) & cleaning themselves.
9. SEWING ROOM- Should be located near to clean linen & pack preparation room. The torned linens can be
sorted out, stitched & stored there.
10. LAUNDARY MANAGER’S OFFICE- Should be located as centrally as possible so that the manager may
properly supervise the entire laundry operation. The walls should include large vision panel to allow for full
view of each area.

EQUIPMENT REQUIREMENT
Equipment’s number may be estimated considering the linen load, i.e., total weight of linen (in kg or lb) to be
washed or it can depend upon the number of beds, space available, number of laundry shifts per day, etc.
The following equipments are required for a mechanized laundry—
1. Washing machine
2. Hydro-extractor (80-90% of water is taken out in the process)
3. Drying tumbler
4. Calendaring machines (for pressing big linens with steam)

ORGANINATION CHART OF PLANT

MEDICAL SUPERINDENTENT

DY. MED. SUPERITENDENT

Laundry Manager

Supervisor Laundry

Asstt. Supervisor

Storekeeper

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 Clerk

Tailors

Laundry operators (Tech Gd I)

Hospital Attendants

Daily Wagers

Sanitary Attendants

C LABORATORY SERVICES
Planning labs including microbiology, biochemistry and hematology should be fairly simple and straight
forward. But if careful thought is not given at the design and planning stage, the simplest of things can and most
probably will go wrong.
The primary function of pathology services is to give assistance to attending doctors in the diagnosis &
treatment of patients. The laboratory situated in the hospital also will be concerned with diagnostic laboratory
tests, not only for in-patients & out-patients but also for special services clinics, for general practitioners in the
area, public health services, etc.
The size of laboratory depends upon the hospital size. A laboratory in small hospital (less than 100 beds)
may perform only very routine test procedures. Complicated & infrequently requested tests may be sent to
reference laboratories. In a medical laboratory in a medium sized hospital (upto 300 beds), routine tests & many
more complicated tests are performed. Only the most recently developed tests with high levels of complexity
would need to be sent to reference laboratories. Most medical laboratories in large hospitals (more than 300
beds) handle large volume of work & perform complex tests.

LOCATION
Ideally it should be located at such position in a hospital that it is easily accessible to OPD & in patients & near
to emergency & OT. It should be away from rush area.

Although designing a hospital is a painstaking procedure best left to the professionals, still the following
three basic aspects pertaining to hospital lab design need to be remembered:
1. Lab Benching- The material and surface are first consideration. For labs that deal with strong chemicals
string material should be used.
The other important aspect is the height & depth of the lab benching. The recommended height is 920mm for
standing and depths are 600mm. This may be needed to accommodate a deep equipment above or below the lab
benching.
2. Services- The second important consideration is the quantity and type of services required for each piece of
equipment dotted around the labs and the need for power, data, potable or special water (distilled, de-
ionised), lab gasses, sinks and drainage. Some of these are normally placed at regular measurements around
the labs depending on the activities being carried out.

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3. Environment- Depending on chemicals and equipment used, fumes and heat dissipation (such as -70 degree
freezers and blood fridges) issues can be significant. This has to be dealt with ventilation and convection
cooling/air-conditioning.
While on ventilation, attention needs to be given to the fume cabinets and safety cabinets that require very
careful and purpose built exhausts. These can be re-circulating (requiring specific filtration) or exhaust type that
take the extract out to a certain level outside the building.

D EMERGENCY
The emergency patient is considered to need or considers he needs immediate care. Genuine emergency patients
have to be examined & treated without delay. The emergency department must be operational 24 hours a day &
expected to deal with a wide variety of complex problems.
Emergency services should be physically & administratively separated from other services in a hospital
setup.

LOCATION
There are 2 essential requirements-
1. Must be on ground floor & easily accessible to both ambulatory & ambulance patients & there should be
minimal separation between it & the radiology department.
2. The emergency department should have ready access to the acute patient care areas, e.g., operation complex,
intensive care treatment unit, obstetric unit. The blood bank, clinical laboratories, X-ray unit, record
department & morgue should be nearby.
Emergency departments must be designed to handle peak loads; usually 1000 is required for daily patient load
of 100 patients.

INSTRUCTIONS
1. The emergency department should be clearly identified from all approaches. Illuminated signage is
required for some signs to ensure visibility at night. The use of graphic and character display (eg. a white
cross on a red background with the word "emergency") is encouraged. Multilingual signage may be required
in departments with a significant caseload of culturally and linguistically diverse patients.
2. Place the waiting room, the triage room and the doctors/nurses offices in the same area. That way, when
people walk into the emergency room, the nurses can take them straight to the triage room to evaluate their
vitals, such as blood pressure and body temperature. Their loved ones can be out in the waiting room filling
out forms that they received from the front desk.
3. Design the area so that the examination rooms are located directly next to the laboratory and the X-ray
rooms. When a patient is weak and needs to have an X-ray taken or blood drawn, he shouldn't have to walk
very far to get to his destination. Also, this will prevent the nurses from having to walk too far when pushing
a patient in his bed.
4. Position the area where the ambulances arrive next to the trauma and examination rooms. That way, when
patients arrive via ambulance and need immediate care, they are right where they need to be. The doctors
have instant contact with the patient and can give him the necessary treatment.
5. Situate all the equipment and waste rooms in one area so that when doctors and nurses need to obtain or get
rid of something quickly, they know exactly where to go. This works out well especially when they deplete
an item and need to get more. They can go to this area to drop off a soiled item and pick up a new one.
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6. Put all of the equipment that is inside the patient rooms’ right next to the bed, especially items such as the
IV. This allows the IV to be hooked to the patient so that she can receive the necessary medication. Place
chairs inside of the rooms so that family members can sit with their loved one. Situate the TV in an area
where the patient and her family members can see it.
7. Stack cabinets that contain medical records and other files on top of one another to save space.
8. Plan enough space for the nurses and doctors to move the patients around in the rooms. Don't clutter
everything so that there is no room for movement.

MAJOR SPACE DETERMINANTS

 GENERAL- Space determinants revolve around the major functional areas of the department. These may
be divided broadly into:
• Ambulance and ambulatory entrances; Reception/Triage/Waiting area; Administrative area; Resuscitation
area; Acute Treatment area (of non-ambulant patients); Consultation area/fast track area (for ambulant patients);
Staff workstations; Specialty areas, eg. Paediatric areas; Distressed relatives/interview room; Procedure
room(s); Plaster room; Pharmacy/drug preparation; Ophthalmology/ENT; Mental Health Assessment; Isolation
room(s); Decontamination areas; Teaching areas; Tutorial room; Support services; Storage; Clean and dirty
utility; Shower/bathroom/toilets; Staff rooms; Linen trolley bay; Mobile equipment bay; Mobile X-Ray
equipment bay; Cleaner's room; Offices and administration area; Diagnostic areas eg. Medical imaging unit/
laboratory area (optional); Emergency department short stay/observation ward (optional)

TOTAL SIZE
The total internal area of the emergency department, excluding observation ward and internal
medical imaging area if present, should be at least 50m/1000 yearly attendances or 145m/1000 yearly
admissions, whichever size is greater. The minimum size of a functional emergency department that can
incorporate all of the major areas is 700m.
The total size and number of treatment areas will also be influenced by factors such as: patient numbers;
projected population growth and changing population demographics; anticipated changes in technology;
laboratory and medical imaging turnaround time; inpatient bed accessibility; and staffing number and structure.

Total Number of Treatment Areas

The total number of patient treatment areas should be at least 1/1100 yearly attendances or 1/400 yearly
admissions, whichever is greater in number. Areas such as procedure, plaster and interview rooms are not
considered as treatment areas nor are holding bays or observation unit beds for admitted patients. The number
of resuscitation areas should be no less than 1/15,000 yearly attendances or 1/5,000 yearly admissions and at
least 1/2 of the total number of treatment areas should have physiological monitoring.

FUNCTIONAL RELATIONSHIPS
1. Medical Imaging
The Unit is dedicated to the imaging of emergency department patients. It should have a general X-Ray table,
upright X-Ray facilities and an additional overhead gantry in the trauma bay/resuscitation area is recommended.
Immediate access to CT scanning, Magnetic Resource Imaging (MRI), and Ultrasound will enhance the
emergency department's effectiveness.

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2. Medical Records
Access is required so that patients’ previous medical histories are obtainable without delay. A system of
mechanical or electronic medical record transfer is desirable to minimize delays and labour costs. Access to
medical records must be available 24 hours/day.
3. Intensive Care Unit and Coronary Care Unit
Rapid access is highly desirable to minimize transfer times of critically ill patients.
4. Operating Rooms
Rapid access is highly desirable in certain surgical emergencies, eg. ruptured aortic aneurysm, ectopic
pregnancy, major trauma etc
5. Pathology
Rapid access is highly desirable to minimize turnaround times for laboratory investigations.
6. Pharmacy
Proximity is desirable to enable prescriptions to be filled by patients with limited mobility.

DESIGN CONSIDERATIONS
 General
This should allow rapid access to every space with a minimum of cross traffic. There should be close proximity
between the Resuscitation/Acute Treatment areas for non-ambulant patients and other treatment areas for
ambulant patients, as staff may require relocation at times of high workload. Protection of visual, auditory and
olfactory privacy is important whilst recognizing the need for observation of patients by staff.

 Parking- Car parking should be close to the entrance, well lit and available exclusively for patients, their
relatives and staff. Protected proximate parking areas should be available for urgent call in staff.
Appropriate physical barriers should protect “drop off” zones.
Undercover parking should be available for:
 Appropriate number of ambulances. This will be determined by case load and availability of ambulance
access to other parts of the hospital for non-emergency patients.
 On call duty emergency physician
 Taxis and private vehicles which drop off/pick up patients (including those with limited mobility) adjacent
to the ambulance patient entrance.
 Police vehicles
 Fire Brigade
 Fire Safety- Emergency Departments should be constructed to comply with fire regulations.
 Bed Spacing - In the Acute Treatment area there should be at least 2.4 metres of clear floor space between
beds. The minimum length should be 3 metres.
 Lighting- It is essential that a high standard focused examination light is available in all treatment areas.
Each examination light should have a power output of 30,000 lux, illuminate a field size of at least 150mm
and be of robust construction.
Clinical care areas should have exposure to daylight wherever possible to minimize patient and staff
disorientation.

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 Sound Control- Clinical care areas should be designed so as to minimize the transmission of sound between
adjacent treatment areas. Distressed relatives/Interview rooms and selected offices should have a high level
of sound control to ensure privacy.
 Service Panels- Service panels should be minimally equipped as follows:
a. Resuscitation room (for each patient space)
• 3 x oxygen outlets • 2 x medical air outlets • 3 x suction outlets • 1 x nitrous oxide outlet (optional)
b. Acute Treatment bed - adult and paediatric
• 2 x oxygen outlets • 1 x medical air outlet • 2 x suction outlets • 1 x nitrous oxide outlet (optional)
c. Procedure room/suture room/plaster room
• 2 x oxygen outlets • 1 x medical air outlet • 1 x suction outlets • 1 x nitrous oxide outlet
d. Consultation room
• 1 x oxygen outlet • 1 x suction outlet

 Physiological Monitors
Each Acute Treatment area bed, should have access to a physiological monitor. Central monitoring is
recommended. Monitors should have printing and monitoring functions which include a minimum of:
• ECG • NIBP • Temperature
 Storage around Bed- Adequate storage space for disposable and non-disposable medical equipment should
be available near each bed space. Storage space may consist of modular plastic type bins or other materials
involving a similar design concept. There should be adequate consideration for the temporary holding of
patient belongings.
 Cabling- Provision should also be made for cabling of telephone, patient call, emergency call, and
computers to areas where these are necessary.
 Medical Gases- Medical gases should be internally piped, to all patient care areas.
 Doors- All doors through which patients may pass must be of sufficient size to accommodate a full hospital
bed with attached intravenous flasks and traction apparatus with ease. There should be at least one pathway
through the emergency department to key areas (imaging, OR, ICU).
 Corridors- In general, the total corridor area within the department should be minimized to optimize the use
of space. Where corridors are necessary, they should be of adequate width to allow the cross passage of
two hospital beds or a hospital bed and linen trolley without difficulty. There should be adequate space for
trolleys to enter or exit any of the consulting rooms, and to be turned around. Standard corridors should not
be used for storage of equipment, linen, waste or patients.
 Air Conditioning- The emergency department should have a separate air system capable of rapid change
from recirculation to fresh air flow. Special purpose rooms (eg. Infectious Disease Isolation Room) or areas
(ie. paediatric waiting area) may have special flow and filtering requirements.
 Information/Communications Support- Emergency departments are high volume users of
telecommunications and information technology. Telephones should be available in all offices, at all staff
stations, in the clerical area and in all consultation and other clinical rooms. A central communications area
for the disposition of all incoming calls is recommended.
 Patient or Emergency Call Facilities - All patient care areas including toilets and bathrooms require
individual patient call facilities. Emergency department bed spaces should have call buttons that can be
easily reached by a patient on the emergency department trolley.

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 Alarm- A alarm system should be available to staff working in any area with potentially aggressive patients,
particularly those in isolated areas, to ensure safety.
 Hand Washing Facilities- Alcohol hand rubs should be available at each bedside. Basins for hand washing
should be available within each treatment area and should be accessible without traversing any other clinical
area. There should be basins at a ratio of 1 for every 4 beds and at the ratio of 1 to 1 for every
Procedure/Resuscitation/Consulting room/Triage/Isolation area. Taps in clinical areas should be fitted with
anti-splashback devices and operated hands free. Dispensers for non-sterile latex gloves face masks and
gowns should be available in the vicinity of each hand basin.
 Emergency Power- Emergency power must be available to all lights
 Wall Finish- Hospital beds, ambulance trolleys, and wheelchairs may cause damage to walls. All wall
surfaces in areas which may come into contact with mobile equipment should be reinforced and protected
with buffer rails or similar. Bed stops should be fitted to the floor.
 Floor Covering- The floor covering in all patient care areas and corridors should have the following
characteristics
• Non slip surface; Impermeable to water, body fluids; Durable; Easy to clean

STRETCHER, TROLLEY, WHEEL CHAIR STORE

It should be located immediately adjacent to the entrance.

WORK AREA
It should be spacious with enough room for personnel & patients.

WAITING AREA
Waiting area should be different for-
a. Emergency department patients- passage way to the patient examination & treatment area. It should be
easily accessible from entrance.
b. Relatives; provided recreational facilities. The waiting area must be of a total size of at least 5.0m/1000
yearly attendances in area, that includes seating, telephones, vending machines, display for literature, public
toilets and circulation space. The waiting room should include one seat per 1000 yearly attendances.

ISOLATION ROOMS
Isolation rooms should be provided for the treatment of potentially infectious patients. They should have
negative ventilation, an ante room with scrub up facilities. Position of these rooms should be adjacent to areas
where patients are received i.e. Triage to allow for the immediate isolation of potentially highly infectious
patients.
Isolation rooms may also be used to treat patients with conditions that require separation from other
patients e.g. patients who require privacy for clinical conditions, or who are a source of visual or auditory
distress to others. These rooms must be completely enclosed by floor to ceiling partitions and have a solid door.
Each department must have at least 2 single rooms, with at least one room/10,000 annual attendances being
recommended.

DECONTAMINATION ROOM
A decontamination room should be available for patients who are contaminated with toxic substances.
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EXAMINATION & TREATMENT AREA/INTERVIEW ROOM
This area should always be in readiness to receive patients at all times. The area should consist of a larger room
& number of separate smaller rooms for examination & treatment. An arrangement for washing with shower
bath & wash basin should be available. A large illuminated space with oxygen supply & other resuscitation
should be there.
The open emergency treatment room should not be smaller than 7.0 by 13.5 with door 1.3m. It should
have electric outlets, wall oxygen, etc. The separate examination rooms of at least 3.3 by 4.5 should be
available, e.g., one equipped with gynecological examination. A dark room equipped with a slit lamp should
also be available.

NURSES STATION & ADMINISTRATIVE OFFICE

The Staff Station in the Acute Treatment area will be the major staff area within the department. The station
should provide an uninterrupted view of patients and the floor may be raised to achieve this aim. It should be
centrally located and constructed in such a fashion to ensure that confidential information can be conveyed
without breach of privacy. An enclosed area is recommended for this reason and also to provide security of
staff, information and privacy. The staff station(s) must be at least 10m in size or 1m/1000 yearly attendances.
The following equipment and fittings should be accessible:
• Telephones • Computer terminals • Dangerous drugs/medication cupboards
• Emergency and patient call display • Under-desk alarm
• Valuables storage • Storage for stationery

SHORT STAY UNIT/OBSERVATION ROOM

A Short Stay Unit is used to describe a unit managed within and by the Emergency Department whose prime
orientation is to manage acute problems for patients with an expected length of stay of less than 24 hours.
Where provided, a short stay unit should be facilitated similar to a hospital ward. The configuration of the short
stay unit should be a minimum of 1 bed per 4000 attendances per year.

SECURITY ROOM
The location of an office for security personnel near the entrances should be considered. This room should be so
positioned as to enable direct visualization of the waiting room, triage and reception areas with immediate
access to these areas being essential. Remote monitoring of other areas in the department by CCTV and of staff
duress/personal alarms should also occur from this area.

RECEPTION/TRIAGE AREA
The department should be accessed by two separate entrances; one for ambulance patients and the other for
ambulant patients. Access to treatment areas should also be restricted by the use of security doors. The
Reception/Triage area should have clear vision to the waiting room, and the ambulance entrance. Assessment,
observation and first aid are provided in the Reception/Triage area which should have visual and auditory
privacy.
The Triage area should have access to the following equipment and fittings:
• NIBP monitor • Hand basin for hand washing, equipment for standard precautions
• Examination light • Mobile examination trolley
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• Telephone • Chairs and desk
• Scales • Storage space for bandages, basic medical equipment, stationery

RECEPTION/CLERICAL OFFICE
Administrative staff at the reception counter may receive patients arriving for treatment and direct them to the
Triage area. After assessment at the Triage area, patients or relatives will generally be directed back to the
Reception/Clerical area where clerical staff will conduct registration interviews, collate the medical record, and
print identification labels. When the decision to admit has been made, clerks interview patients or relatives at
the bedside or at the reception counter to finalize admission details.
The counter should provide seating and be partitioned for privacy at the interview. The area should be
designed with due consideration for the safety of staff, and access for the disabled. The combined area of the
reception/triage/clerical area should be at least 1.8m/1000 yearly attendances (not including storage areas for
medical records).

RESUSCITATION ROOM
The patient is to be stabilized in this room before he is shifted to treatment room. It should be well equipped.
The area should be about 30 sq metres protected from electrical hazards & connected to emergency light supply.

OPERATION ROOM
A self sufficient operation room to serve patients who need minor surgery & no admission, or those critically ill
who require tracheotomy, cardiac massages, etc.

FRACTURE ROOM
A separate fracture room equipped similar to OT & with additional facilities for reduction of closed fracture
under local anesthesia (in bigger hospitals with turnover of emergency patients in excess of 15,000 per annum).

PLASTER ROOM
It is needed for treatment of fractures & application of plasters. It should also have traction equipments.

CARE OF BURNS
A separate room with 20 m2 area should be reserved for immediate care of burn patients.

CONFERENCE/TUTORIAL ROOM
This room provides facilities for formal undergraduate and postgraduate education and meetings. It should be in
a quiet non-clinical area, near the Staff room and offices. Provision should be made to have the following
available:
• VCR/DVD • Television • Slide projector • Overhead projector
• Projection screen • Whiteboard • Computer terminal and outlet
• X-Ray viewing facilities/digital imaging system • Telephone
• Examination couch
This room must be at least 0.8m/1000 yearly attendances in area.

LIBRARY
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A quiet area containing appropriate written, audiovisual and electronic reference materials. Ideally, all computer
terminals will be able to access knowledge databases.

CLINICAL SUPPORT AREAS

 Clean Utility
 Dirty Utility/Disposal Room
 Equipment/Store Room- This is used for the storage of equipment (eg. IV poles) and disposable medical
supplies for the department. There should be sufficient space to store and charge battery powered
equipment, eg. Infusion pumps. The total area of dedicated store rooms must be at least 2.2m/1000 yearly
attendances.
 Pharmacy/Medication Room
 Disposal Room
 Disaster Equipment Store
 Cleaners Room
 Patient Bathroom- Shower and toilet facilities
 Laboratory

STAFF FACILITIES
1. Staff Room- At least one room should be provided within the department to enable staff to distress during
rest periods. Food and drink should be able to be prepared and appropriate table and seating arrangements
should be provided. It should be located away from patient care areas and have access to natural lighting
and appropriate floor and wall coverings. The staff room should be based upon the number of staff working
at any one time and their anticipated needs.
2. Staff Change/Lockers/Toilets/Shower Facility - Access to male and female staff change, locker rooms and
shower facilities should be available. Appropriate security and restricted access to this area should be
available.

SECURITY
Security personnel should be available round the clock. A police outpost in the department is desirable.

STAFFING OF EMERGENCY DEPARTMENTS

It depends upon the type of organization (private or government), the case load, the needs of the hospital & the
desires of the medical staff.
÷ Coverage by a group of full time emergency trained staff.
÷ Part time staff
÷ A combination of the above plan.
÷ Rotation of staff (voluntary or mandatory; most common method) especially where no trained staff is
available & separate emergency departments do not exist.

NURSING STAFF
Number depends upon staff availability, patient load, etc. A well staffed emergency department needs 8 nurses’
shifts of 8 hours each per 100 daily patient visits. Additional staff will be required if there is observation unit

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attached. Each 8 hours shift needs at least 2 attendants if the patient load exceeds 30,000 per year. They should
be taught special skills like application of splints & traction, help in cast application & in resuscitation.

OTHER PERSONNEL
1. Clerical help- for registration & records maintenance, usually 3 clerks work in day & afternoon shift & 1
clerk would suffice during night.
2. Public relations & social workers or volunteers - should be available to take care of the anxious & disturbed
patients.

E CSSD (CENTRAL STERILE SUPPLY DEPARTMENT)

One of the most important & critical departments in a hospital is the CSSD. The objective of establishing a
Central Sterile Supply Department is to make reliably sterilized articles available at the required time and place
for any agreed purpose in the Hospital as economically as possible, having regard to the need to conserve the
time of users [especially Doctors And Nurses]. The control of hospital infections & aseptic surgeries &
procedures all depend upon how good the dressing materials, operating instruments, masks, gowns & other
linen, cotton, gauze, bandages, etc. used in the above procedures are sterilized & made non-infective.
The Sterile Supply Department within a hospital receives stores, sterilizes and distributes to all
departments including the wards, OPD and other special units such as OT. Major responsibilities of CSSD
include processing and sterilization of syringes, rubber goods, surgical instruments, treatment trays and sets,
dressings etc. It is also responsible for economic and effective utilization of equipment resources of the Hospital
under controlled supervision.

The main objectives of the Central Sterile Supply Department are:

ó To provide sterilized material from a central department where sterilizing practice is conducted under
conditions, which are controlled, thereby contributing to a reduction in the incidence of hospital infection.
ó To take some of the work of the Nursing staff so that they can devote more time to their patients.
ó To avoid duplication of costly equipment’s, which may be infrequently used.
ó To maintain record of effectiveness of cleaning, disinfection and sterilization process.
ó To monitor and enforce controls necessary to prevent cross infection according to infection control policy.
ó To maintain an inventory of supplies and equipment.
ó To stay updated regarding developments in the field in the interest of efficiency, economy, accuracy and
provision of better patient care.
ó To provide a safe environment for the patients and staff.
ó It will institute quality control measures & research.

The CSSD also aims at assuming total responsibility for processing hospital items thereby assuring that all of
them receive the same degree of cleaning and sterilization. It also contributes to the educational program within
the hospital relating to infection control and develops a cost-effective program by cost analysis of personnel,
supplies and equipment.

AREA REQUIREMENTS
The minimum area requirement per bed is as follows:
75-99 beds - 10 sq ft per bed
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 100-149 beds - 09 sq ft per bed
150-199 beds - 08 sq ft per bed
200-249 beds - 08 sq ft per bed
250-300 beds - 7.5 sq ft per bed
300 & above beds - 07 sq ft per bed

BASIC DIVISION
There are 6 basic divisions-
1. Unserviceable equipment storage room.
2. Receiving counter & clean-up room.
3. Needles & syringes processing room.
4. Gloves assembling room.
5. Clean work area including sterilizers.
6. Sterile storage area & issue counter.
In addition to these, there can be gauze & dressing assembly area.

LAYOUT
 The CSSD should be so designed that there is no back tracking of sterile goods.
 Continuous flow of equipment from the receiving counter straight through the department to dispensing
counter.
 Take every possible care to eliminate contamination of sterile goods.
 Important in planning is that the sterilizing area should be the last area before the sterile storage &
dispensing counter.

EQUIPMENT REQUIRED IN CSSD

 Hot & cold running water.
 Chemicals to clean material.
 Needle sharpening & gauze cutting machine.
 Autoclaves of various sizes.
 Boiler for steam.
 Wall fixtures line sink, swan, head taps, etc.
 Various types of trays.
 Syringe containers.

STAFING PATTERN
Following factors should be considered-
ó 3 shift work.
ó Leave & off duty reserve.
ó Messenger service.
ó Maintenance service.
ó 6 to 7 divisions of CSSD.

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Different categories of staff required are—
 Supervisor with training & experience in CSSD.
 CSSD technicians.
 CSSD attendants.
 Messengers for ward/OT delivery
 Boiler attendant.
 Clerks.
 Sweepers.

STAFFING PATTERN: One CSSD worker per 30 beds plus one supervisor. In 200-300 beds hospital need 10-
15 persons. Staff for 1000 bed hospital:
Supervisor - 1(senior most & trained technician)
Asstt. Supervisor - 1 (one of the sr. technician)
Technicians - 6 (promoted attendants)
Sweeper - 15
Clerk - 1

ISSUE OF MATERIALS
The principal of first- in first-out in drug store of issue, should be followed in supply of sterilized materials.
This ensures proper rotation of supplies in CSSD & prevents any item being kept for longer time so that its
sterilization date expires. This also avoids necessity of re-sterilization of such materials of such materials &
helps in cost containment in CSSD.

ORGANISATIONAL STRUCTURE
Central Sterile Supply Department should be under technical supervision of a responsible officer who is
concerned with the day management of the unit. The Central Sterile Supply Department manager will liaise
with the infection control team, OT manager and clinical departments. The CSSD manager is administratively
responsible to the head of the health care facility

REFERENCES
1. Basavanthappa B T. Nursing Administration. 1st edn. New Delhi: Jaypee Brothers Medical Publishers.
2005.364-377

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2. Chandorkar A.G. Hospital Administration & Planning. 1st edn.Hyderabad: Paras Medical Publisher; 2004.
9-12,33-39,52-57,82-90, 133-145,216-218,229,397-404
3. Kumara N. A Textbook of management & Nursing Services & Education. 3 rd edn.Jalandhar: Pee Vee
Publishers; 2011.159-161
4. http://www.qcin.org/nabh/index.php
5. http://www.hospitaldesigntips.com/2008/07/easy-guide-to-lab-design/#more-66
6. http://www.hospitaldesigntips.com/2008/04/hospital-design-tips/
7. http://www.wbdg.org/design/hospital.php
8. http://www.aimshospital.org/hospital/cssd/cssd.php
9. http://www.ehow.com/how_5770287_design-emergency-room.html
10. http://www.acem.org.au/media/policies_and_guidelines/G15_ED_Design.pdf

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