Handbook on Hospital Planning & Designing: For Medical Administrators, Architects, Planners and Students 9819990009, 9789819990009

This handbook is in reference to the book "Manual of Hospital Planning and Designing" which was earlier publis

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Table of contents :
Preface
Acknowledgement
Introduction
Contents
About the Author
Chapter 1: Phases of Planning and Designing
Further Reading
Section I: Planning
Chapter 2: Inception of the Idea
Further Reading
Chapter 3: Factors Assessing Feasibility of the Hospital
3.1 Several Key Factors Need to Be Analyzed During the Planning Phase
3.1.1 Demographics
3.1.2 Understanding the Type of Diseases
3.1.3 Community
3.1.4 Healthcare Systems and Hospitals Network
3.1.5 Innovations in Facility Planning and Management
3.1.6 Speciality Facilities and Departments
3.1.7 Medical Tourism
3.1.8 Health Insurance and Empanelment
3.1.9 Catchment Area
Further Reading
Chapter 4: Preparation of Detailed Project Report (DPR) and Techno-Commercial Feasibility Report (TCFR)
4.1 Information to Be Generally Provided in DPR
4.2 Documents DPR Should Contain
4.3 General Contents of DPR
4.4 Evaluation of DPR
Further Reading
Chapter 5: Site Selection
5.1 Size of the Land Rquired for Hospital
5.2 Assessment of the Covered Area Required for Hospital
5.2.1 Total FAR Allowed
5.2.2 Set Back Area
5.2.3 Maximum Permissible Land Coverage
5.2.4 Maximum Permissible Height of Building
5.3 Some of the Other Factors to Be Considered While Finalising the Land Are
5.3.1 Approach to the Site
5.3.2 Location of the Land
5.3.3 Availability of Transportation
5.3.4 Security
5.3.5 Availability of Utilities
5.3.6 Road Network in the Area
5.3.7 Environmental Pollution
5.3.8 Wind and Earthquake
5.3.9 Flood Protection
Further Reading
Chapter 6: General Issues to Be Considered While Designing Hospital Building
6.1 Importance of Hospital Planning and Designing
6.2 Various General Issues Relating to the Hospital Designing
6.2.1 Flexibility and Expandability
6.2.2 Patient-Focused Design
6.2.3 Design for Employee Productivity
6.2.4 Accessibility to the Patient
6.2.5 Security and Safety
6.2.6 Sustainability of Resources
6.2.7 Efficiency and Cost-Effectiveness
6.2.8 Adaptation of Technological Advancements
6.2.9 Stress and Fear of Patients and Visitors
6.2.10 Quality Care of Patients
6.2.11 Therapeutic Environment
6.2.12 Cleanliness and Sanitation
6.2.13 Noise Reduction
6.2.14 Minimizing Operative, Postoperative, and Hospital-Acquired Infections
6.2.15 Automation Wherever Possible
6.2.16 Environmental Pollution Control
6.2.17 Internal Road
6.2.18 Wind, Earthquake-Resistant and Flood Protection
6.2.19 Nature Plus Artwork
6.2.20 Colours to be Used
6.2.21 Choice of Building Materials
6.2.22 Flooring
Further Reading
Chapter 7: Area Requirement & Planning
7.1 Functional Areas
7.2 Room and Space Requirement
7.3 Sizes of the Rooms
7.4 Zoning
7.5 Placement of Zones in the Building
Further Reading
Chapter 8: Detailed Engineering Drawings
8.1 Schematic Design
8.2 Site Plan
8.3 Concept Drawings
8.4 Floor Plan Drawings
8.5 Cross Section Drawings
8.6 Elevation Drawings
8.7 Landscape Drawings
8.8 Finishing Drawing
8.9 Working Plan Drawings
8.10 Section Drawings
8.11 Structural Drawings
8.12 Column Layout Drawings
8.13 Plinth Beam Layout Drawings
8.14 Lintel Beam Layout Drawings
8.15 Roof Beam and Shuttering Layout Drawings
8.16 General Note
8.17 Excavation Drawings
8.18 Electrical Drawings
8.19 Plumbing Drawings
8.20 Fire Fighting and Detection Drawings
8.21 Shop Drawings
8.22 Furniture Layout Drawings
8.23 Furniture Design Drawings
8.24 Hospital Signage Drawings
8.25 As-Built Drawings
8.26 PERT Charts
Further Reading
Chapter 9: Preparation of Construction Documents
9.1 Definition of Construction Documents
9.2 Contents of Construction Document
9.2.1 General Information About the Hospital Project
9.2.2 Construction Contract Agreement
9.2.3 Scope of Work (SOW)
9.2.4 Construction Schedule
9.2.5 General Conditions
9.2.6 Special Conditions
9.2.7 Specifications
9.2.8 Bill of Quantities (BOQ)
9.2.9 Cost Estimate
9.2.10 Drawings
9.2.11 Other Documents
Further Reading
Section II: Design & Development
Chapter 10: Design of the Main Entrance Gate to the Hospital
10.1 Main Entrance Gate
Further Reading
Chapter 11: Designing of the Entrance Lobby of the Hospital
11.1 Location of the Entrance Lobby
11.1.1 The Infrastructure of the Entrance Lobby
11.2 Services in the Lobby
11.3 Reception and Enquiry Counter
11.4 Help Desk, Registration, and Admission and Discharge Counters
11.5 Cash Counter
11.6 Cafeteria
11.7 Pharmacy
11.8 Other Services in the Entrance Lobby
11.9 Public Utility for Patients/Visitors
11.10 Prayer Room/Meditation Spaces
11.11 Self-Service Kiosks
11.12 Interiors of the Entrance Lobby
11.13 Entrance Gates to the Lobby
11.14 Signage and Wayfinding in the Lobby
11.15 Acrylic or Glass Partitions
11.16 General Issues Related to the Entrance Lobby
11.17 Outside Entrance Lobby
11.17.1 Screening Areas
11.17.2 Hand Wash/Sanitizer Stations
11.17.3 Face Masks/Shoe Covers Dispensers
11.18 Reduction of People Landing in the Entrance Lobby
Further Reading
Chapter 12: Emergency Services
12.1 Location of Emergency Department
12.2 Size of the Emergency Department
12.3 Areas Required for Emergency Department
12.4 The Entrance of the Emergency Department
12.4.1 Main Gate
12.4.2 Entrance Door to the Emergency Department
12.4.3 Outside Entrance Lobby
12.4.4 Screening Areas
12.4.5 Hand Wash/Sanitizer Stations and Face Mask Dispenser
12.4.6 Decontamination Area
12.4.7 General Waiting
12.4.8 Ambulance Control
12.5 Reception
12.6 Triage and Patient Handling Zone with Resuscitation
12.6.1 Location of Triage
12.6.2 Size of Triage
12.6.3 Infrastructure of Triage
12.6.4 Bed Layout in Triage
12.6.5 Patient Furniture/Office Furniture/Equipment/Tools and Instruments in Triage
12.6.6 Doors and Windows
12.6.7 Hand Washing
12.6.8 Central Medical Gas Supply
12.6.9 Electrical Points in Triage
12.6.10 Other Communication Points in Triage
12.6.11 Curtain Partitions
12.6.12 Triage Nurses Duty Rooms in Triage
12.7 Patient Handling Zone with Resuscitation
12.7.1 Location of Patient Resuscitation and Handling Zones
12.7.2 Categories of Patient Resuscitation and Handling Zones
12.7.3 Size of Patient Resuscitation and Handling Zones
12.7.4 Infrastructure of Patient Resuscitation and Handling Zones
12.7.5 Bed Layout in Patient Resuscitation and Handling Zones
12.7.6 Isolation Room/Units/Area in Patient Resuscitation and Handling Zones
12.7.7 Resuscitation Rooms in Patient Resuscitation and Handling Zones
12.7.8 Patient Furniture/Office Furniture/Equipment/Tools and Instruments in Patient Resuscitation and Handling Zones
12.7.9 Doors and Windows of Patient Resuscitation and Handling Zones
12.7.10 Hand Washing in Patient Handling Zone
12.7.11 Central Medical Supply in Patient Resuscitation and Handling Zones
12.7.12 Electrical Points in Patient Resuscitation and Handling Zones
12.7.13 Other Communication Points in Patient Resuscitation and Handling Zones
12.7.14 Curtain Partitions in Patient Resuscitation and Handling Zones
12.7.15 Emergency Physician (EP)/Emergency Medical Officer (EMO) Duty Room
12.8 Treatment/Procedure Room/Minor Operation Theatre
12.8.1 Patient Furniture/Equipment/Tools and Instruments in Minor OT
12.8.2 Doors and Windows
12.8.3 Hand Washing
12.8.4 Central Medical Gas Supply
12.8.5 Electrical Points in Minor OT
12.9 Procedure and Diagnostic Setup
12.10 Emergency Operation Theatre Complex
12.11 Day Care Emergency/Observation Ward
12.11.1 Location of Emergency/Observation Ward
12.11.2 Size of Emergency/Observation Ward
12.11.3 Issues Related to the Infrastructure of Emergency/Observation Ward
12.11.4 Bed Layout in Emergency/Observation Ward
12.11.5 Isolation Room in the Emergency/Observation Ward
12.11.6 Patient Furniture/Office Furniture/Equipment/Tools and Instruments in Emergency/Observation Ward
12.11.7 Doors and Windows
12.11.8 Hand Washing
12.11.9 Central Medical Gas Supply
12.11.10 Electrical Points in Observation Ward
12.11.11 Other Communication Points in Observation Ward
12.11.12 Curtain Partitions
12.12 Other Issues Relating to Emergency Department
12.13 Disaster Plan
12.13.1 Factors for Disaster Plan
Further Reading
Chapter 13: Outpatient Department
13.1 Location of the OPD
13.2 Schemes of the Layout of the OPD
13.2.1 Single Corridor OPD
13.2.2 Double Corridor OPD
13.2.3 Clustered OPD Block
13.3 Infrastructure Requirements in the OPD
13.4 Reception & Enquiry Counter
13.5 Registration Counter
13.6 Waiting Lobby/Hall
13.7 Examination Rooms
13.8 Procedure/Treatment Rooms
13.9 Support Rooms
13.10 General Issue While Designing the OPD
13.11 Number of OPDs Required
13.12 Consultation Room
13.12.1 Size of the OPD Room
13.12.2 Doors and Windows
13.12.3 Hand Washing
13.12.4 Furniture
13.12.5 Instruments and Equipment
13.12.6 Electrical Points and Communication Ports in the Consultation Room
13.12.7 Curtain Partitions
13.13 Procedure/Treatment Room
13.13.1 Size of the Procedure/Treatment Room
13.13.2 Doors and Windows
13.13.3 Hand Washing
13.13.4 Furniture
13.13.5 Instruments and Equipment
13.13.6 Electrical Points and Communication Ports in Procedure/Treatment Room
Further Reading
Chapter 14: Intensive Care Units
14.1 Types of ICUs
14.2 Number of Beds in a Single Unit of ICU
14.3 Location of Intensive Care Units
14.4 Infrastructure of ICU
14.5 Size of the ICU
14.6 Sizing Considerations
14.7 Patient Care Zone
14.7.1 Bed Layout in ICU Hall
14.7.2 Isolation Room/Units/Area in ICU
14.7.3 Furniture in ICU
14.7.4 Equipment
14.7.5 Tools & Instruments
14.7.6 Doors and Windows
14.7.7 Nursing Station
14.7.8 Hand Washing
14.7.9 Toilets
14.7.10 Air Conditioning System of ICUs
14.7.11 Central Piped Medical Gas Supply
14.7.12 Electrical Points in ICU
14.7.13 Other Communication Points in ICU
14.7.14 Curtain Partitions
14.8 Procedure & Treatment Room
14.8.1 Location of Treatment/Procedure Room
14.8.2 Size of Treatment/Procedure Room
14.8.3 Issues Related to the Infrastructure of the Treatment/Procedure Room
14.8.4 Furniture in Treatment/Procedure Room
14.8.5 Equipment
14.8.6 Tools & Instruments
14.8.7 Doors and Windows
14.8.8 Hand Washing
14.8.9 Central Medical Gas Supply
14.8.10 Electrical Points in Treatment/Procedure Room
14.8.11 Other Communication Points in Treatment/Procedure Room
14.8.12 Other Issues on Patient Care Zone & Procedure/Treatment Room
14.8.13 Lighting in the ICU
14.8.14 Dialysis Equipment
14.8.15 Power Backup
14.9 Clinical Support Zone
14.9.1 Rigorous Monitoring
14.9.2 Radiology
14.9.3 Laboratory
14.9.4 Medication Rooms
14.9.5 Pneumatic Tube Systems (PTS)
14.9.6 Clean Utility
14.9.7 Dirty Utility/Sluice Room
14.9.8 Equipment Park/Store
14.9.9 Emergency Eyewash Station
14.10 Unit Support Zone
14.10.1 Change Room: Male/Female in ICU
14.10.2 Doctors’ Duty Rooms in ICU
14.10.3 Nurse’s Night Duty Rooms in ICU
14.10.4 Night Duty Room for On-Call Junior Doctors
14.10.5 Ward Pantry
14.10.6 Staff Lounge
14.11 Family Support Zone
14.11.1 Family Lounge
14.11.2 Consultation Rooms
14.11.3 Meditation Spaces
14.11.4 Family Cafeteria
14.11.5 Family Sleep Rooms
14.11.6 Family Laundry
14.12 Specialized Intensive Care Units
14.12.1 Intensive Coronary Care Unit
14.12.2 Respiratory Care Intensive Care Unit
14.12.3 Neurosurgical Intensive Care Unit
14.12.4 Burns Unit
14.12.5 Geriatric Intensive Care Unit
14.12.6 Neonatal Intensive Care Unit
14.12.6.1 Location of NICU
14.12.6.2 The Infrastructure of the NICU
14.12.6.3 Placement of Warmers
14.12.6.4 Equipment of NICU
14.13 Common Design Considerations
14.13.1 Signage and Way-Finding
14.13.2 Security and Access Control
14.13.3 Patient Safety Technology
14.13.4 Communications
14.13.5 Storage
14.13.6 Relationships with Other Departments
14.13.7 Central Nursing Station
14.13.8 Patient Records
14.13.9 X-Ray Viewing Area
14.13.10 Reception Area
14.13.11 Administrative Offices
Further Reading
Chapter 15: Operation Theatre Suite
15.1 Location of Operating Theatre (O.T.) Complex
15.2 Zones in O.T. Complex
15.2.1 Unsterile Zone
15.2.2 Protective Zone
15.2.3 Clean Zone
15.2.4 Sterile Zone
15.3 Infrastructure of O.T. Complex
15.4 Unsterile Zone
15.4.1 Administrative Area
15.4.2 Operation Theatre In-Charge or Manager
15.4.3 Room for Head of Anaesthesia
15.4.4 Surgeons Room for Office Work
15.4.5 Trolley Bay
15.4.6 Frozen Section Biopsy Laboratory
15.4.7 Shoe Change Area
15.4.8 Entry Door for Changing Room
15.4.9 Waiting Area for Attendants
15.4.10 Public Utility for Attendants
15.4.11 Linen Pre-Wash Room
15.4.12 Instrument Wash Room
15.5 Protective Zone
15.5.1 Changing Rooms
15.5.2 Entry Gate of Pre-Operative Ward
15.5.3 Unsterile Store for Equipment Storage
15.5.4 Store for Medicines, Consumables and Disposables
15.5.5 Pantry
15.6 Clean Zone
15.6.1 Pre-Operative Room
15.6.2 Preparation Room
15.6.3 Surgeons Rest Room
15.6.4 Restroom for Staff – Males & Females
15.6.5 Exit Doors of All Change Rooms
15.6.6 Pre Anaesthetic Check-Up Room (PAC)
15.6.7 Dirty Utility
15.6.8 Post-Operative Recovery Ward
15.7 Sterile Zone
15.7.1 Clean Supply Room
15.7.2 Instrument Trolley Layup
15.7.3 Scrub Station
15.7.4 Sterilization Room
15.7.5 Operating Theatres/Rooms (OR)
15.7.6 Number of OR
15.7.7 Location and Layout of the OR’s
15.7.8 Types of Operating Rooms
15.8 Simple Room OR
15.9 Pre-Fabricated Modular OR
15.9.1 Size of the OR
15.9.2 Walls of the OR
15.9.3 Ceiling of the OR
15.9.4 Corners of OR
15.9.5 Door of the OR
15.9.6 Window in OR
15.9.7 Control Panel
15.9.8 View Box
15.9.9 Writing Board
15.9.10 Pressure Relief Damper (PRD)
15.9.11 Peripheral Lights
15.9.12 Plenum
15.9.13 Plenum Lights
15.9.14 Pass-Through Windows/Hatch Boxes
15.9.15 Electrical Points
15.9.16 Anaesthetist Pendant
15.9.17 Surgeon Pendant
15.9.18 Flooring
15.9.19 Painting
15.9.20 Air Conditioning & Environment of OR’s
15.9.21 Supply Air Ducts
15.9.22 Return Air
15.9.23 Special Air Requirements for OR
15.9.24 Other Communication Points in OR
15.9.25 Equipment in OR
15.9.26 Furniture OR
15.10 Septic Operation Theatre
15.11 Endoscopy Suite
15.11.1 Endoscopy Room
15.11.2 Endoscope Washroom
15.11.3 Store
15.11.4 Change Room
15.11.5 Recovery Room
15.11.6 Consultation Room
15.12 Semi-Modular OR
15.13 Modular OR
15.14 Hybrid OR
Further Reading
Chapter 16: Delivery Room/Labor Room
16.1 Location of LDR Complex
16.2 Zones in LDR Complex
16.2.1 Unsterile Zone
16.2.2 Protective Zone
16.2.3 Delivery Zone
16.3 Infrastructure of LDR Complex
16.4 Unsterile Zone
16.4.1 Administrative Area
16.4.2 Labor Room In-Charge
16.4.3 Gynaecologist Room for Office Work
16.4.4 Trolley Bay
16.4.5 Shoe Change Area
16.4.6 Entry Door for Changing Room
16.4.7 Waiting Area for Attendants
16.4.8 Public Utility for Attendants
16.4.9 Linen Pre-Wash Room
16.4.10 Instrument Wash Room
16.5 Protective Zone
16.5.1 Changing Rooms
16.5.2 Store for Equipment, Medicines, Consumables and Disposables
16.5.3 Pre-Labor Room/Ward
16.5.4 Eclampsia Room
16.5.5 Examination/Preparation Room
16.5.6 Surgeons Rest Room
16.5.7 Dirty Utility
16.5.8 Post-Labour Recovery Ward
16.5.9 Doctors’ Night Duty Rooms
16.6 Delivery Zone
16.6.1 Clean Supply Room
16.6.2 Instrument Trolley Layup
16.6.3 Scrub Station
16.6.4 Sterilization Room
16.6.5 Delivery Rooms
16.6.5.1 Number of Delivery Rooms
16.6.6 Location and Layout of the Delivery Rooms
16.6.7 Types of Delivery Rooms
16.6.8 Equipment in Delivery Rooms
16.6.9 Furniture Delivery Rooms
16.6.10 Other Issues Relating to the Delivery Room
16.6.11 Septic Delivery Room
16.7 Baby Resuscitation Area
16.8 Other Important Issues to Be Considered While Designing LDR
16.8.1 Labor Table Specifications
16.8.2 Shifting Baby to NICU
16.8.3 Access to the Operating Room
16.8.4 Electronic Tagging for Newborn Safety
Further Reading
Chapter 17: Intermediate Care Area (Patient Rooms)
17.1 Provide Amenities and Comfort for the Family
17.1.1 Family Lounge
17.1.2 Consultation Rooms
17.1.3 Meditation Spaces
17.1.4 Family Cafeteria
17.1.5 Family Sleep Rooms
17.1.6 Family Laundry
17.2 Increase Staff Efficiency
17.3 Patient Room Furnishings
17.3.1 Room Decor
17.3.2 Lighting in the Patient Room
17.3.3 Ceiling Finishes
17.4 Types of Patient Rooms in the Hospital
17.4.1 Single Bed Occupancy
17.4.2 Sharing Rooms
17.4.3 General Wards
17.4.4 Isolation Ward/Rooms
17.5 Infrastructure Details of the Indoor Patient Units-
17.6 Location of the Indoor Patient Areas
17.7 Zoning of the Isolation Areas
17.8 Single Patient Room (Private Room)
17.8.1 Room Layout
17.8.2 Size of the Room
17.8.3 Walls
17.8.3.1 Headwall
17.8.3.2 Footwall
17.8.4 Doors
17.8.5 Windows
17.8.6 Toilets
17.8.7 Bed Layout in Patient Room
17.8.8 Furniture and Instruments in the Patient Room
17.8.8.1 Patient Furniture
17.8.8.2 Other Furniture
17.8.8.3 Equipment
17.8.8.4 Tools and Instruments
17.8.9 Air Conditioning System of Patient Rooms
17.8.10 Central Piped Medical Gas Supply
17.8.11 Electrical Points in Patient Room
17.8.12 Other Communication Points in the Patient Room
17.8.13 Curtain Partitions
17.8.14 IV Track
17.8.15 Psychiatric Patient Rooms
17.9 Deluxe Single Patient Room (Deluxe Room)
17.10 Family Suite with Single Patient Room (Suite Room)
17.10.1 Patient Room of the Suite
17.10.2 Family Room of the Suite
17.11 Sharing Patient Room (Semi-Private Room)
17.11.1 Room Layout
17.11.2 Size of the Semi-Private Sharing Room
17.11.3 Doors and Windows
17.11.4 Toilets
17.11.5 Bed Layout in Patient Room
17.11.6 Furniture and Instruments in Patient Room
17.11.6.1 Patient Furniture
17.11.6.2 Other Furniture
17.11.6.3 Equipment
17.11.7 Air Conditioning and Other Services
17.12 General Ward (Multiple Beds Room)
17.12.1 Location of the Multiple Bed Wards
17.12.2 Room Layout
17.12.3 Number of Beds in the Multiple Bed Ward
17.12.4 Size of the Multiple Bed Ward
17.12.5 Doors and Windows
17.12.6 Toilets
17.12.7 Bed Layout in Ward
17.12.8 Furniture and Instruments in Patient Room
17.12.8.1 Patient Furniture
17.12.8.2 Other Furniture
17.12.9 Air Conditioning System of Patient Rooms
17.12.10 Central Piped Medical Gas Supply
17.12.11 Electrical Points in the Ward
17.12.12 Other Communication Points in Ward
17.12.13 Curtain Partitions
17.13 Isolation Rooms/Wards
17.13.1 Isolation in ICU
17.13.2 Single-Bed Isolation Rooms
17.13.3 Air and Pressure Monitoring System for Isolation Rooms
17.13.4 Pressurization of the Isolation Rooms
17.13.5 Air Conditioning of the Isolation Wards/Units
17.13.5.1 Supporting Room/Units for Indoor Patient Service
17.14 Nursing Station
17.14.1 Hand Washing
17.14.2 Alcohol Gel/Sanitizer Dispensers
17.15 Nurses Duty Rooms
17.16 Doctors Duty Rooms
17.17 Procedure and Treatment Room
17.17.1 Furniture in Treatment/Procedure Room
17.17.1.1 Patient Furniture
17.17.1.2 Equipment
17.17.1.3 Tools and Instruments
17.17.2 Doors and Windows
17.17.3 Hand Washing
17.17.4 Central Medical Gas Supply
17.17.5 Electrical Points in Treatment/Procedure Room
17.17.6 Other Communication Points in Treatment/Procedure Room
17.18 Clean Utility
17.19 Dirty Utility/Sluice Room
17.20 Store for Medicines, Consumables and Disposables
17.21 Medication Areas
17.22 Equipment Park/Store
17.23 Trolley Park Area
17.24 Ward Pantry
Further Reading
Chapter 18: Radiology
18.1 Location of the Radiology Department
18.2 Infrastructure of Centralized Radiology Department
18.3 Utility Area
18.3.1 Reception and Enquiry
18.3.2 Registration and Cash Counter
18.3.3 Waiting Lobby
18.3.4 Reporting Room
18.3.5 Stores for Unused Consumables and Films
18.3.6 Stores for Used Films and General Items
18.3.7 Report Delivery Counter
18.4 X-Ray Zone
18.4.1 Radiography Rooms
18.5 UltraSound Zone
18.5.1 Ultrasound Room
18.5.2 Change Rooms
18.5.3 Toilets
18.5.4 Sub Waiting for Ultrasound
18.6 CT Scan Zone
18.6.1 CT Scan Machine Room
18.6.2 CT Control Room
18.6.3 UPS Room
18.6.4 CT Panel Room
18.6.5 Change Rooms
18.6.6 Sub Waiting for CT Scan
18.7 MRI Zone
18.7.1 MRI Machine Room
18.7.2 MRI Control Room
18.7.3 UPS Room
18.7.4 MRI Panel Room
18.7.5 Chiller
18.7.6 Change Rooms
18.7.7 Sub Waiting for MRI
18.8 Mammography Zone
18.8.1 Mammography Rooms
18.8.2 Change Rooms
18.8.3 Computerised Radiography (CR) Room
18.8.4 Sub Waiting for Mammography
18.9 DEXA Scan Zone
18.9.1 DEXA Scan Machine Room
18.9.2 Sub Waiting for DEXA Scan
18.10 PET CT/MRI Zone
18.10.1 Location of the Zone in the Hospital
18.10.2 PET CT Scan Machine Room
18.10.3 PET MRI Machine Room
18.10.4 Other Attached Areas
18.10.5 SPECT CT Machine Room
18.10.6 Operating Console Rooms
18.10.7 Low-Risk Areas or Cold Areas
18.10.7.1 Reception
18.10.7.2 Sub Waiting Room
18.10.7.3 Physicians Consulting Room
18.10.7.4 Store
18.10.7.5 Technologist Room
18.10.8 High-Risk Areas or Radiation Exposure Hot Areas
18.10.8.1 Hot Lab Cum Radiopharmacy Room
18.10.8.2 Injection Room
18.10.8.3 Post-Dose Waiting Area
18.10.9 Toilet
18.10.10 Control and Scanning Room
18.10.11 Post-Examination Waiting Room
18.10.12 Waste Disposal Room
Further Reading
Chapter 19: Clinical Laboratories
19.1 Infrastructure of Clinical Lab
19.1.1 Planning & Designing of Laboratory
19.2 Size of the Lab
19.3 Layout
19.4 Spaces
19.5 Location & Arrangement of Areas
19.6 Open- Lab Designs
19.7 Biosafety
19.8 Molecular Testing
19.9 Laboratories
19.10 Pneumatic Tube Systems (PTS)
19.11 Clear Floor Space
19.12 Electrical Points in Laboratories
19.13 Other Communication Points in Laboratories
19.14 Air Conditioning System of Laboratories
19.15 Furniture in the Laboratories
19.16 Main Equipment in the Clinical Laboratories
19.17 Support Services
19.17.1 Autoclave
19.17.2 Bulk Storage Room
19.17.3 Cold Storage Room
19.17.4 RO Water Closet
19.17.5 Gas Storage Closet
19.17.6 Record/File/Copy Room
19.17.7 Flammable Storage
19.17.8 Specimen Storage/Recycle
19.17.9 Block and Slide Storage
19.17.10 Penta Head/Deca Head Microscope Room
19.18 Utility Area
19.18.1 Doctors Room
19.18.2 Laboratory Manager
19.18.3 Technicians Room
19.19 Outpatient Phlebotomy
19.19.1 OPD Phlebotomy Room
19.19.2 Fine Needle Aspiration Room
19.19.3 Toilets
19.19.4 Waiting Area
19.20 Employee Support
19.20.1 Staff Lounge
19.20.2 Lockers
19.20.3 Shower with Water Closet
Further Reading
Chapter 20: Blood Bank
20.1 Location of the Blood Bank in the Hospital
20.2 Controlling Authority
20.3 Functions of Blood Bank
20.3.1 Receiving
20.3.2 Storage
20.3.3 Testing
20.3.4 Distribution
20.4 Infrastructure of the Blood Bank
20.5 Area of Blood Bank
20.6 Equipment in the Blood Bank
20.7 Receiving Area
20.7.1 Entrance
20.7.2 Reception
20.7.3 Registration
20.7.4 Waiting
20.7.5 Medical Examination
20.7.6 Bleeding Room
20.7.7 Refreshment/Recovery/Rest Room
20.7.8 Apheresis Room
20.8 Testing Area
20.8.1 Laboratories
20.8.2 Wall
20.8.3 Flooring
20.8.4 Doors
20.8.5 Lightning
20.8.6 Earthing
20.8.7 Working Slabs
20.8.8 Sinks
20.8.9 Electrical Points in Laboratories
20.8.10 Other Communication Points in Laboratories
20.8.11 Air Conditioning System of Laboratories
20.8.12 Furniture in the Laboratories
20.8.13 Fittings and Fixtures
20.9 Storage & Processing Area
20.9.1 Storage of Untested Blood
20.9.2 Storage of Tested Blood
20.9.3 Blood Bank Refrigerators
20.9.4 Blood Component Room
20.9.4.1 Flooring
20.9.4.2 Doors
20.9.4.3 Electrical Requirements
20.9.4.4 Furniture in the Component Room
20.9.4.5 Electrical Points in the Component Room
20.9.4.6 Other Communication Points in Laboratories
20.9.4.7 Air Conditioning System of Component Room
20.9.5 Use of Wood
20.9.6 Fitting and Fixtures
20.10 Distribution Area
20.10.1 Pneumatic Tube Systems (PTS)
20.11 Utility Area
20.11.1 Change Room
20.11.2 Doctors Rest Rooms
20.11.3 Store
20.11.4 Record Room
20.11.5 Medical Officer Room
20.11.6 Sterilization Room Cum Washing Room
20.11.7 Waste Management and Disposal
Further Reading
Chapter 21: Other Investigation & Procedures
21.1 Coronary Catheterization (Cath Lab)
21.1.1 Location of the Cath Lab
21.1.2 Number of Cath Lab Procedure Rooms
21.1.3 Other Issues Related to Cath Lab
21.1.4 Cath Lab Console Room
21.1.5 UPS Room
21.1.6 Cath Lab Panel Room
21.1.7 Change Rooms for Patients
21.1.8 Change Rooms for Staff
21.1.9 Waiting for Cath Lab
21.1.10 Stores for Unused Consumable
21.1.11 Stores for Records and CDs
21.1.12 Consultation Rooms
21.2 Thallium Scan
21.3 Audiometry
21.3.1 Location of the Audiometry Room
21.3.2 Room Designing
21.4 Bronchoscopy
21.5 Capsule Endoscopy, Cholangioscopy, Colonoscopy, Duodenoscopy, Endoscopic Ultrasound & Upper Gastrointestinal Endoscopy Etc.
21.6 Neurology
21.7 Polysomnography (Sleep Lab)
21.7.1 Location of the Sleep Lab
21.7.2 Room Designing
21.8 Ophthalmology
21.9 ESW Lithotripter of Urology
21.10 Dialysis
21.10.1 Location of the Dialysis Room
21.10.2 Dialysis Procedure Room
21.10.3 Other Issues of Dialysis Unit
21.10.4 Wash Room for Dialysers
21.10.5 Store
21.10.6 Change Rooms for Patients
21.10.7 Change Rooms for Staff
21.10.8 Waiting for Dialysis
Further Reading
Chapter 22: Radiation Therapy
22.1 Location of Radiotherapy Unit
22.2 Infrastructure of the Radiotherapy Department
22.3 Utility Areas
22.3.1 Entrance to the Department
22.3.2 Outside Entrance
22.3.3 Reception & Enquiry Counter
22.3.4 Registration Counter
22.3.5 General Waiting
22.3.6 Store
22.3.7 Consultation Room
22.4 Treatment & Planning Area
22.4.1 Mould Room
22.4.2 Mould Workshop
22.4.3 Medical Physics
22.4.4 CT Simulators
22.5 Radiation Therapy Treatment Area
22.5.1 External Beam Radiation Therapy
22.5.2 Internal Beam Radiation Therapy
22.6 Radiotherapy Ward
22.7 Trolley Bay
22.8 Change Rooms
22.9 Store
22.10 Signage and Wayfinding
22.11 Sub Waiting Lobbies
22.12 Clean Utility
22.13 Dirty Utility/Sluice Room
22.14 Hand Washing
22.15 Administration/Offices
22.16 Other Communication Points in the Radiation Department
22.17 Heating Ventilation and Air Conditioning
22.18 Central Piped Medical Gas Supply
22.19 Electrical Points in the Radiation Therapy Department
22.20 Power Backup
Further Reading
Chapter 23: Rehabilitation and Allied Health Therapies
23.1 Location of Physiotherapy Department
23.2 Infrastructure of the Physiotherapy Department
23.3 Entrance/Entrance Lobby
23.4 Reception
23.5 Waiting Areas
23.6 Examination Room with Exam Cubicles
23.7 Patient Therapy Areas
23.7.1 Physiotherapy
23.7.2 Occupational Therapy
23.8 Administrative Area
23.9 Store
23.10 Trolley Bay
23.11 Clean Utility
23.12 Dirty Utility/Sluice Room
23.13 Change Rooms
23.14 Other Issues About the Infrastructure of the Rehabilitation Department
Further Reading
Chapter 24: Pharmacy Unit
24.1 Location of the Pharmacy
24.2 Size of the Pharmacy
24.3 Infrastructure of Pharmacy
24.4 Pharmacy for Outpatients
24.4.1 Entrance
24.4.2 Drug Receiving Area
24.4.3 Disbursing Hall
24.4.4 Bulk Storage
24.4.5 Cold Store
24.4.6 Expiry Drug Room
24.4.7 Costly Drug Room
24.4.8 Drug Sorting Room
24.4.9 Narcotics and Controlled Drug Store
24.5 Pharmacy for Inpatients
24.6 Pneumatic Tube Systems (PTS)
24.7 Pharmacist Offices
24.8 Automation in the Pharmacy
Further Reading
Chapter 25: CSSD
25.1 Infrastructure of CSSD
25.2 Location
25.3 Area Required for CSSD Department
25.4 Material Flows
25.5 Functional Zones of CSSD
25.5.1 Receiving Zone (Unclean Area)
25.5.2 Decontaminating, Washing and Disinfecting Zone
25.6 Packaging Area
25.6.1 Location
25.6.2 Role of the Packing Room Shall Be
25.6.3 Contents of Packing Room
25.7 Sterilization Area
25.7.1 Location and Relationships
25.7.2 Main Activities of the Sterilization Process
25.7.3 Size of the Sterilization Room
25.7.4 Methods and Types of Sterilizers
25.7.4.1 Steam Sterilizers
25.7.4.2 Ethylene Oxide Gas Sterilizer (ETO)
25.7.4.3 Dry Heat Sterilizer
25.7.4.4 Hydrogen Peroxide Plasma Sterilizer
25.8 Clean Storage Area
25.8.1 Location of the Clean Storage Room
25.8.2 Designing of the Storage Shelves
25.9 Delivery Counter
25.10 Support Areas
25.10.1 Staff Changing Rooms
25.10.2 Administrative Area
25.11 Electrical Points
25.12 Air Conditioning
Further Reading
Chapter 26: Piped Medical Gas Supply System (MGPS)
26.1 System Components
26.2 Sources
26.3 Piping Networks
26.3.1 Pipeline Installation
26.3.2 Valves
26.3.3 Warning and Alarm Systems
26.3.4 Outlets and Inlets
26.3.5 Secondary Equipment
26.4 Designing the MGPS System
26.4.1 Analysis of the Area of the Hospital
26.5 Infrastructure for MGPS
26.6 Manifold Room
26.6.1 Location of the Manifold
26.6.2 Size of the Manifold Room
26.6.3 Fixing the Manifold Systems in the Hall/Room
26.7 Compressed Medical Air
26.7.1 Compressor Air Plant
26.7.2 Air Filtration
26.7.3 Medical Air 400 kPa
26.7.4 Surgical Air 700 kPa
26.8 Vacuum
26.8.1 Vacuum Plant
26.8.2 Filtration System
26.9 Issues While Designing the Plant Room and the Manifold Room
26.10 Medical Gases Outlet Terminals
26.11 Bulk Liquid Oxygen Gas System
26.11.1 Liquid Oxygen Vessel
Further Reading
Chapter 27: Hospital Kitchen
27.1 Infrastructure of Hospital Kitchen
27.2 Location of Hospital Kitchen
27.3 Size of the Kitchen
27.4 Entry
27.5 Change Rooms Cum Wash Areas
27.6 Receipt Area for Supplies
27.7 Storage Area
27.7.1 Bulk Storage
27.7.2 Fruit and Vegetable Store
27.7.3 Refrigeration, Cool Rooms, Freezers
27.7.4 Storage Areas for Dry Ration/Goods
27.8 Preparation Areas
27.9 Cooking Areas
27.10 Reheating Areas
27.11 Packing/Plating
27.12 Meal Trolley/Cart Parking
27.13 Food Distribution
27.14 Trolley Return/Stripping
27.15 Trolley/Cart Wash
27.16 Dishwashing
27.17 Pot Washing
27.18 Waste Disposal
27.19 Gas Storage Closet
27.20 Staff and Support Areas
27.21 Fixtures, Fittings and Equipment
Further Reading
Chapter 28: Laundry
28.1 Infrastructure of Laundry
28.2 Location of the Laundry
28.3 Size of the Unit
28.4 Dirty and Soiled Linen Generation
28.5 Dirty and Soiled Linen Interim Storage
28.6 Central Storage Area
28.7 Dirty Receipt
28.8 Sorting and Weighing
28.9 Washing Area
28.9.1 Loading and Washing
28.9.2 Extractors
28.9.3 Tumble Drying
28.9.4 Ironing
28.9.4.1 Pressing Machines
28.9.4.2 Calendar Dryer Irons
28.9.4.3 Flat Irons
28.10 Inspection and Repairing
28.11 Packaging and Storage
28.12 Dispatch Room
28.13 Trolley Washing
28.14 Store
28.15 Staff and Support Areas
28.16 Other Issues Relating to the Infrastructure of the Laundry
28.16.1 Infection Control
28.16.2 Airflow
28.16.3 Mechanical Ventilation
28.16.4 Hot-Air Extraction
28.16.5 Compressors
28.16.6 Steam
28.16.7 Water Supply, Heating, and Water Treatment Equipment
28.16.8 Fire Prevention and Detection
28.16.9 Communications
Further Reading
Chapter 29: Medical Record Department (MRD)
29.1 Electronic Medical Records (EMR)
29.2 Location of MRD
29.3 Infrastructure of MRD
29.4 Entry and Reception
29.5 Medical Record Receipt Room
29.6 Compilation Desk
29.7 Indexing and Coding
29.8 Statistical Analysis
29.9 Computer Lab
29.10 Medical Record Storage Room
29.11 Dictation Room/Cubicles
29.12 Transcription Room
29.13 Photocopying/Printing Room
29.14 Scanning Room
29.15 Binding Room
29.16 Waste Holding Room
29.17 Store
29.18 Administrative Area
29.19 Other Issues About the Infrastructure of MRD
Further Reading
Chapter 30: Mortuary
30.1 Mortuary
30.2 Autopsy Unit
30.3 Location of the Mortuary
30.4 Infrastructure of Mortuary
30.5 Mortuary
30.5.1 Entrance Lobby
30.5.2 Body Wash
30.5.3 Body Holding Area
30.5.3.1 Walk-in Cool Room
30.5.3.2 Refrigerated Cabinets
30.5.4 Waiting/Viewing Area
30.5.5 Storage
30.5.6 Administration Area
30.5.7 Exit Lobby
30.6 Autopsy Area
30.6.1 Pre Autopsy Room
30.6.2 Autopsy Room (Indoor)
30.6.3 Autopsy Room (Outdoor)
30.6.4 Post Autopsy Room
30.6.5 Autopsy surgeon’s room
30.6.6 Instrument Wash Room
30.6.7 Viscera Preparation Room
30.6.8 Viscera Stores
30.6.9 Surgeon Change Room
30.7 Other Infrastructural Issues Relating to the Mortuary/Autopsy Room
Further Reading
Chapter 31: Administration Area
31.1 Levels of Administrative Staff
31.2 Infrastructure of the Administrative Area
31.3 Location of the Administrative Area
31.4 Reception
31.5 Infrastructure of Reception
31.6 Waiting Lobby
31.7 Offices of the Senior Management
31.7.1 Electrical Points
31.7.2 Other Communication Points in the Room
31.7.3 Lighting in the Offices
31.7.4 Doors
31.7.5 Windows
31.7.6 Flooring
31.7.7 Air-Conditioning
31.7.8 Room Décor
31.7.9 Furniture in the Executive Offices
31.7.10 Acoustics
31.7.11 Privacy
31.8 Offices of the Senior Executive Level Management
31.8.1 Electrical Points
31.8.2 Other Communication Points in the Room
31.8.3 Lighting in the Offices
31.8.4 Doors
31.8.5 Windows
31.8.6 Flooring
31.8.7 Air-Conditioning
31.8.8 Furniture in the Executive Offices
31.8.9 Acoustics
31.9 Offices of the Executive Level Management
31.9.1 Electrical Points
31.9.2 Other Communication Points in the Room
31.9.3 Lighting in the Offices
31.9.4 Doors
31.9.5 Windows
31.9.6 Flooring
31.9.7 Air-Conditioning
31.9.8 Furniture in the Executive Offices
31.10 Offices of the Junior Level Management
31.10.1 Electrical Points
31.10.2 Other Communication Points
31.10.3 Lighting in the Offices
31.10.4 Doors
31.10.5 Windows
31.10.6 Flooring
31.10.7 Air-Conditioning
31.11 Support Room/Facilities
31.11.1 Senior Management’s PA Room
31.11.2 Secretarial Staff
31.11.3 Kitchen
31.11.4 Dining Area
31.11.5 Staff Toilets
31.11.6 Store
31.11.7 Notice Boards
31.12 Meeting Rooms
31.12.1 Electrical Points
31.12.2 Other Communication Points in the Room
31.12.3 Lighting
31.12.4 Doors
31.12.5 Windows
31.12.6 Flooring
31.12.7 Air-Conditioning
31.12.8 Room Decor
31.12.9 Furniture in the Meeting Room
31.12.10 Acoustics
31.12.11 Privacy
Further Reading
Chapter 32: Stores in the Hospital
32.1 Functions of Stores
32.2 Types of Hospital Stores
32.3 Planning of Hospital Stores
32.4 Location of the Stores
32.5 Infrastructure of Stores
32.5.1 Store
32.5.2 Storekeeper Room
32.5.3 Store Secretarial Staff
32.5.4 Kitchen
32.5.5 Staff Toilets
32.5.6 Special Store Room
32.5.7 Cold Room
32.5.8 Issue Counter
32.5.9 Receiving Area
32.6 Other Infrastructure Issues
32.6.1 Electrical Points
32.6.2 Other Communication Points in the Room
32.6.3 Lighting in the Stores
32.6.4 Doors
32.6.5 Windows
32.6.6 Flooring
32.6.7 Air-Conditioning
32.6.8 Furniture in the Stores
32.6.9 Notice Boards
Further Reading
Chapter 33: Engineering and Maintenance Unit
33.1 Works Shops
33.1.1 Biomedical Workshop
33.1.2 Electrical Workshop
33.1.3 HVAC Workshop
33.1.4 MGPS Workshop
33.1.5 Low Voltage Workshop
33.1.6 Building Maintenance
33.1.7 Mechanical Workshop
33.1.8 Fire Fighting Workshop
33.1.9 Automobile Workshop
33.2 Location of the Workshops
33.3 Infrastructure of Workshops
33.3.1 Workshop
33.3.2 Workshop In-charge Room
33.3.3 Workshop Engineers
33.3.4 Staff Toilets
33.3.5 Receiving/Issue Counter
33.4 Other Infrastructure Issues
33.4.1 Electrical Points
33.4.2 Other Communication Points in the Room
33.4.3 Lighting in the Workshops
33.4.4 Doors
33.4.5 Windows
33.4.6 Flooring
33.4.7 Air-Conditioning
33.4.8 Furniture in the Workshop
33.4.9 Notice Boards
Further Reading
Section III: MEP Planning & Designing
Chapter 34: HVAC (Air-Conditioning) System
34.1 Central Water Chilled Plant
34.1.1 Chillers
34.1.1.1 Water-Cooled Chillers
34.1.1.2 Air-Cooled Chillers
34.1.2 Cooling Towers
34.1.3 Air Handling Systems
34.1.3.1 Air Handling Units (AHU)
34.1.3.2 Fan Coil Units
34.1.4 Variable Air Volume (VAV) Ventilation
34.1.5 Diffusers, Registers and Grills
34.1.5.1 Grills
34.1.5.2 Registers
34.1.5.3 Diffusers
34.1.6 Ductwork
34.1.7 Air Intake and Exhaust
34.1.8 Filtration
34.2 Installation of Central Chilled Water Plant:
34.2.1 Chillers
34.2.2 Cooling Towers
34.2.3 Air Handling System
34.3 DX (Direct Expansion) Chilling
34.3.1 The Plant Room
34.3.2 Air Handling Unit Room
34.3.3 Air-Conditioned Room
34.3.4 Benefits of DX Air-Conditioning Systems
34.3.5 Disadvantages of the DX System
34.4 Split Air Conditioning
34.5 HVAC- Room Side Design
Further Reading
Chapter 35: Electrical Services
35.1 Primary Power Supply (PPS)
35.2 Secondary Power Supply (SPS)
35.3 Tertiary Power Supply (TPS)
35.4 Electrical Load Calculation
35.5 HT Distribution System
35.6 LT Power Distribution
35.7 Redundancy Due to Power Failure
35.8 Emergency Power Generation System
35.9 Uninterrupted Power Supply System (UPS)
35.10 Switching Arrangement
35.11 Emergency Lighting
35.12 Earthing System
35.13 System of Wiring and Cabling
35.14 Switches/Sockets and Boxes
35.15 Lightning Protection
35.16 Power Quality
35.17 Power Factor Correction
35.18 Street Lighting System
35.19 Lighting Management System
35.19.1 Occupancy Sensor
Further Reading
Chapter 36: ELV, ICT and IBMS Services
36.1 Data System
36.2 Nurse Call System
36.2.1 Desktop Console
36.2.2 Room Lights
36.2.3 Patient Call with Handset
36.2.4 Patient Call – in Toilets
36.2.5 Staff Assist Call
36.2.6 Emergency Call
36.2.7 Wireless Handset
36.2.8 Wireless Console
36.2.9 Audio-Video Nurse Call System
36.3 Electronic Security and Video Surveillance System
36.3.1 Closed Circuit Television System (CCTV)
36.4 Access Control System
36.4.1 No-Touch Access
36.5 Telecommunication System
36.6 Patient Entertainment and Information Systems
36.7 Queue Management System
36.8 Public Address System
36.9 Integrated Building Management Systems (IBMS)
Further Reading
Chapter 37: Information Technology and Computerization
37.1 Health Information System (HIS)
37.2 Modules of Hospital Information Software
37.2.1 Information Desk Module
37.2.2 Patient Registration Module
37.2.3 Outpatient Management Module
37.2.4 Inpatient Management Module
37.2.5 Admission, Transfer, Discharge (ADT) Module
37.2.6 Consulting Appointment Management Module
37.2.7 Bed Management Module
37.2.8 Ward Management Module
37.2.9 Nursing Management Module
37.2.10 Operating Room Module
37.2.11 Laboratory Module
37.2.12 Blood Bank Module
37.2.13 Radiology Module
37.2.14 Picture Archiving and Communication System (PACS) Module
37.2.15 Casualty & Emergency Management System
37.2.16 Pharmacy Information System
37.2.17 Order Management System Module
37.2.18 The Birth/Death Registration Module
37.2.19 Electronic Medical Records Module
37.2.20 Billing and Finance Module
37.2.21 Insurance and Medi-claim Module
37.2.22 Human Resources Module
37.2.23 Materials Management System (Stock, Purchasing and Fixed Asset Module)
37.2.24 Dietary Module/Catering Module
37.2.25 Statistics and Reporting Module (MIS)
37.2.26 Hospital Analytics
37.2.27 Interface Module
Further Reading
Chapter 38: Water Supply and Drainage System
38.1 Source of Water Supply
38.2 Water Storage
38.2.1 Water Storage Tank Locations
38.3 Systems of Water Treatment
38.3.1 Pasteurization
38.3.2 Chemical Treatment
38.3.3 Chlorine Water Treatment
38.3.4 Water Softener Plants
38.3.5 Silver-Copper Ionization
38.3.6 Reverse Osmosis Treatment
38.3.7 Ultraviolet Treatment
38.3.8 Ozone Water Treatment
38.3.9 Distilled Water
38.4 Drinking Water
38.5 Water Booster Pumps
38.6 Hot Water System
38.6.1 Electrical Hot Water Generation
38.6.2 Hot Water Generation from Boiler/Steam by Burning Fuel
38.6.3 Solar Hot Water Generation
38.6.4 Stand-Alone Hot Water Geysers
38.7 Sanitary Fittings
38.8 Irrigation Water Supply
38.9 WC Flushing Systems
38.10 Steam System
38.11 Drainage Strategy
38.12 Types of Drainage Systems
38.12.1 Wastewater Drainage
38.12.2 Soil Water Drainage
38.12.3 Storm Water Drainage
38.12.4 Chemical Drainage
38.12.5 Radiation Drainage
38.13 Methods of Drainage
38.13.1 Vent Pipes
38.13.2 Floor Drains
38.13.3 Soil Water Drainage
38.13.4 Rainwater Drainage System
38.13.5 Infectious Contaminated Drainage
38.13.6 Radiation Drainage
38.13.7 Kitchen Grease Drainage
Further Reading
Chapter 39: Vertical Transportation System
39.1 Lift Categories
39.1.1 General Passenger Lifts
39.1.2 Bed Lifts
39.1.3 Service/Goods Lift
39.2 Design Considerations
39.3 Engineering Guidelines
Further Reading
Chapter 40: Pneumatic Tube Systems (PTS)
40.1 Pneumatic Tube System Components
40.1.1 Blower & Air Reverse Valve
40.1.2 Carrier
40.1.3 Control Centre
40.1.4 Database
40.1.5 Inter-zone Connection
40.1.6 Station
40.1.7 Diverter
40.1.8 Tubing
40.1.9 Zone
40.1.10 Slow Speed Device
Further Reading
Chapter 41: Signage System
41.1 Categories Using Way-Finding
41.1.1 Patients and Visitors
41.1.2 Staff
41.1.3 Users with Special Needs
41.1.4 Sensory Impairment
41.1.5 Language and Illiteracy
41.2 Principles for Designing a Wayfinding System
41.3 Types of Sign Boards
41.3.1 Classified by Function
41.3.2 Signs Classified by Physical Characteristics
41.3.3 Other Factors in the Classification of Sign Boards
Further Reading
Chapter 42: Bio-Medical Waste Management
42.1 Classification of Hospital Waste
42.1.1 Bio-Medical Waste
42.1.2 General Waste
42.1.3 Other Wastes
42.2 Steps Involved in Bio-Medical Waste Management
42.3 Bio-Medical Waste Segregation
42.4 Bio-Medical Waste Collection
42.4.1 Time of Collection
42.4.2 Packing of Bio-Medical Waste & Labelling
42.4.3 Interim Storage
42.5 Transportation of Bio-Medical Waste in Hospital
42.5.1 Transportation Trolleys
42.5.2 Route of Transportation
42.5.3 Central Waste Collection Room for Bio-Medical Waste
42.6 Record Keeping
42.7 Updating Information on the Website
42.8 Management of General Waste
42.9 Management of Other Wastes
42.9.1 Used Batteries
42.9.2 Management of Radioactive Wastes
42.9.3 Management of E-Wastes
42.10 Effluent Treatment Plant (ETP/STP)
42.10.1 Preliminary Stage
42.10.2 Primary Stage
42.10.3 Secondary Stage
42.10.4 Tertiary Stage
Further Reading
Chapter 43: Fire Safety
43.1 Planning for Fire Safety in Hospitals
43.2 Structural Elements for Fire Safety
43.2.1 Compartmentalization
43.2.2 Open Spaces
43.2.3 Basements
43.2.4 General Exit Requirements
43.2.5 Corridors and Passageways
43.2.6 Staircases
43.2.7 Ramps
43.2.8 Electrical and Emergency Power
43.2.9 Air Conditioning, Ventilation and Smoke Control
43.2.10 Fire Barrier
43.2.11 Glazing
43.2.12 Surface Interior Finishes
43.2.13 Fire Command Center (FCC)
43.3 Fire Detection and Alarm
43.4 Fire Extinguishers/Fixed Fire Fighting Installations
43.4.1 Static Water Storage Tanks
43.4.2 Fire-Fighting Pump House
43.4.3 Automatic Sprinkler Installation
Further Reading
Chapter 44: Green Hospitals
44.1 What Is Green Hospital
44.2 Elements of a Green Hospital
44.2.1 Energy Conservation
44.2.2 Alternative Means of Energy Generation
44.2.3 Water Conservation
44.2.4 Indoor Environmental Quality and HVAC Optimization
44.2.5 Chemical Management
44.2.6 Solid Waste Management
44.2.7 Environmental Services
44.2.8 Food Services
44.2.9 Environmentally Preferable Purchasing
44.2.10 Sustainable Construction Materials
44.2.11 Pharmaceutical Minimization, Management and Disposal
44.2.12 Reducing Transportation Cost
44.2.13 Greenery
Further Reading
Section IV: Equipment Planning
Chapter 45: Equipment Planning
45.1 Choosing the Desired Equipment
45.1.1 Quality of the Equipment
45.2 Points to Be Considered While Purchasing the Medical Equipment
45.2.1 Equipment Specification and Configuration
45.2.2 Warranty
45.2.3 Maintenance Contracts
45.2.4 Availability of the Service Engineers and the Workshops
45.2.5 Period of Spare Part Availability
45.2.6 Cost of Consumables
45.2.7 Life Expectancy of the Equipment
45.2.8 Plan for Space and Development
45.2.9 Vendors Evaluation
45.2.10 Regulatory Compliance
45.2.11 Inspection and Testing Before the Transfer of Ownership
45.3 Equipment Used in the Hospital
Further Reading
Recommend Papers

Handbook on Hospital Planning & Designing: For Medical Administrators, Architects, Planners and Students
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Handbook on Hospital Planning & Designing For Medical Administrators, Architects, Planners and Students Ajay Garg

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Handbook on Hospital Planning & Designing

Ajay Garg

Handbook on Hospital Planning & Designing For Medical Administrators, Architects, Planners and Students

Ajay Garg Director Hospital Administration Teerthanker Mahaveer University Moradabad, Uttar Pradesh, India

ISBN 978-981-99-9000-9    ISBN 978-981-99-9001-6 (eBook) https://doi.org/10.1007/978-981-99-9001-6 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Paper in this product is recyclable.

First and foremost, we would like to thank God. We could never have done this without the faith we have in God, the Almighty. Dedicated to My wife, Mohini Garg, who was the main person by my corner, pushing me to share my experience by writing this book. You are my love and inspiration! Thanks for not just believing but knowing that I could do this! I Love You Always & Forever! To my children, Dr. Megha Garg, Parth Garg, Samarth Bachkheti (Son-in-Law) The hard work that you put into this book and all the suggestions and improvements that you made to it have not just made this book better but have also strengthened our bond. I wish you all the best of happiness and success in this world. Ajay Garg

Preface

Welcome to the Handbook on Hospital Planning and Designing. This book is like a friendly guide that helps you understand how to make really good healthcare buildings. I am excited to start this journey with you and explore the amazing world where architecture, new ideas, and caring for people come together. In the world of healthcare, things are always changing and getting better. People are always looking for ways to help patients more, make things work smoother, and create places where people can feel better. This handbook is the result of my many years of experience and sharing knowledge and experience with other experts in the healthcare industry. It’s like a special book that will help architects, designers, doctors, and anyone who loves healthcare. Making a hospital isn’t just about building with bricks and stuff. It’s like putting together a puzzle with many pieces that all have to fit just right. I have tried to show you how to plan and design hospitals in a way that makes them comfortable, calming, and healing. I have tried to talk about everything—from the first idea to the final touches like where to put lights. Every hospital has its own story—like a book with pages filled with its history, culture, and dreams. This handbook is like a flashlight that will guide you through the challenges of planning and designing hospitals. It will give you practical tips and ideas to make your projects even better. In these pages, you’ll learn about many things, from how buildings are put together to ways to keep patients safe from germs. I have also talked about making rooms that people can move around in easily and how to make everything work smoothly. Each chapter is like a spotlight that shines on a different part of planning and designing hospitals. Whether you’re already an expert looking for new ideas or just starting to learn about hospitals, this book is here to help you every step of the way. I hope this book inspires you, teaches you, and helps change the way hospitals are planned and designed. As you read on, let your curiosity guide you and your dreams push you forward. This book is like a treasure map leading you to explore, create, and make healthcare spaces that bring comfort, care, and a sense of connection to everyone who enters. vii

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Disclosure: ChatGPT, an AI language model developed by OpenAI, was used to edit my own previously published content for the purpose of improving clarity and comprehension. Welcome to this amazing journey. Moradabad, Uttar Pradesh, India

Ajay Garg

Acknowledgement

I am thankful to the Chancellor and Vice-Chairman of Teerthanker Mahaveer University, Moradabad, for providing me the platform for learning and gaining experiences in the field of healthcare. Without your support and input, it would have been difficult to write this book and share our experiences. Here, I would also like to thank Abhisekh Kapoor for providing us with all the help to write this book. Extending our gratitude towards Dr. Rohit Varshney, I would like to thank him for his constant support towards the vision, his regular discussions and brainstorming sessions during the compilation of this book, and his guidance on many small tasks. I would also like to thank him for helping me in compiling and sharing his experiences in a few chapters of this book. I am also thankful to Shailja Trivedi, who has helped a lot in editing this book. Lastly, I would like to thank everyone who believed in my vision and supported me throughout this amazing journey. I would also like to thank all the readers who have read my earlier reference book titled Manual of Hospital Planning and Designing published by Springer Nature. I hope this book helps everyone in some way and collectively I can make the medical society achieve great heights. Thank You! Ajay Garg

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Introduction

Welcome to the world of making hospitals better! This book is a handbook of my earlier reference book titled Manual of Hospital Planning and Designing published by Springer Nature. This Handbook on Hospital Planning and Designing is a helpful guide that shows how to create really good healthcare buildings. In this changing and growing field, planning and designing hospitals carefully is really important. It’s like mixing art, science, and caring. This book is like a summary of the essentials, for people who want to design hospitals. Architects, designers, doctors, and people can use it. It helps them make places that work well, look nice, and take care of patients the best way. Setting up the hospital project is more than just building. It’s about creating places where people get better and feel good. In these pages, I have tried to explore everything about planning and designing hospitals. I have started from the beginning, where the promotor imagines about the hospital project. Then I have gone through each steps covering all the departments until the hospital is all set up. I have tried to cover even the small things that can make a big difference in how well the hospital works and how patients and workers feel. My goal is simple: to make hospital planning and design easier to understand. I want to share knowledge and ideas to help you make amazing hospitals. Whether you’re an experienced architect with new ideas, a healthcare worker who wants the best for patients, or a student who loves learning about hospitals, this book is your friend. I have used whatever I had learned from experts and experiences in the healthcare industry. I have highlighted about the rooms, spaces, MEP service, safety, security, equipment, instruments, and other support services. As you read the book, you’ll find lots of helpful tips, rules, and standards for designing hospitals. This book isn’t just a bunch of facts—it’s like an invitation to explore and discover. It’s like a key that opens doors to a better way of making hospitals, where people can get better, feel hopeful, and be healthy.

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So, let’s start this exciting journey together. Let’s learn about the special art and science of planning and designing hospitals. I am here to guide you, inspire you, and help you create hospitals that are truly amazing places of healing and care. Ajay Garg

Contents

1

 Phases of Planning and Designing����������������������������������������������������������    1 Further Reading ����������������������������������������������������������������������������������������    2

Section I  Planning 2

 Inception of the Idea��������������������������������������������������������������������������������    5 Further Reading ����������������������������������������������������������������������������������������    6

3

 Factors Assessing Feasibility of the Hospital ����������������������������������������    7 3.1 Several Key Factors Need to Be Analyzed During the Planning Phase����������������������������������������������������������������������������    7 3.1.1 Demographics ����������������������������������������������������������������������    7 3.1.2 Understanding the Type of Diseases������������������������������������    7 3.1.3 Community ��������������������������������������������������������������������������    7 3.1.4 Healthcare Systems and Hospitals Network ������������������������    8 3.1.5 Innovations in Facility Planning and Management��������������    8 3.1.6 Speciality Facilities and Departments����������������������������������    8 3.1.7 Medical Tourism ������������������������������������������������������������������    8 3.1.8 Health Insurance and Empanelment ������������������������������������    8 3.1.9 Catchment Area��������������������������������������������������������������������    8 Further Reading ����������������������������������������������������������������������������������������    9

4

Preparation of Detailed Project Report (DPR) and Techno-Commercial Feasibility Report (TCFR)����������������������������������   11 4.1 Information to Be Generally Provided in DPR��������������������������������   11 4.2 Documents DPR Should Contain�����������������������������������������������������   11 4.3 General Contents of DPR������������������������������������������������������������������   13 4.4 Evaluation of DPR����������������������������������������������������������������������������   13 Further Reading ����������������������������������������������������������������������������������������   14

5

Site Selection��������������������������������������������������������������������������������������������   15 5.1 Size of the Land Rquired for Hospital����������������������������������������������   15 5.2 Assessment of the Covered Area Required for Hospital������������������   15 xiii

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5.2.1 Total FAR Allowed ��������������������������������������������������������������   16 5.2.2 Set Back Area������������������������������������������������������������������������   16 5.2.3 Maximum Permissible Land Coverage��������������������������������   16 5.2.4 Maximum Permissible Height of Building ��������������������������   16 5.3 Some of the Other Factors to Be Considered While Finalising the Land Are��������������������������������������������������������������������������������������   16 5.3.1 Approach to the Site�������������������������������������������������������������   16 5.3.2 Location of the Land������������������������������������������������������������   16 5.3.3 Availability of Transportation ����������������������������������������������   17 5.3.4 Security ��������������������������������������������������������������������������������   17 5.3.5 Availability of Utilities����������������������������������������������������������   17 5.3.6 Road Network in the Area����������������������������������������������������   17 5.3.7 Environmental Pollution ������������������������������������������������������   17 5.3.8 Wind and Earthquake������������������������������������������������������������   17 5.3.9 Flood Protection��������������������������������������������������������������������   17 Further Reading ����������������������������������������������������������������������������������������   18 6

General Issues to Be Considered While Designing Hospital Building ������������������������������������������������������������������������������������   19 6.1 Importance of Hospital Planning and Designing������������������������������   19 6.2 Various General Issues Relating to the Hospital Designing ������������   20 6.2.1 Flexibility and Expandability������������������������������������������������   20 6.2.2 Patient-Focused Design��������������������������������������������������������   20 6.2.3 Design for Employee Productivity����������������������������������������   20 6.2.4 Accessibility to the Patient����������������������������������������������������   21 6.2.5 Security and Safety ��������������������������������������������������������������   21 6.2.6 Sustainability of Resources��������������������������������������������������   21 6.2.7 Efficiency and Cost-Effectiveness����������������������������������������   21 6.2.8 Adaptation of Technological Advancements������������������������   22 6.2.9 Stress and Fear of Patients and Visitors��������������������������������   22 6.2.10 Quality Care of Patients��������������������������������������������������������   22 6.2.11 Therapeutic Environment������������������������������������������������������   22 6.2.12 Cleanliness and Sanitation����������������������������������������������������   22 6.2.13 Noise Reduction��������������������������������������������������������������������   23 6.2.14 Minimizing Operative, Postoperative, and Hospital-Acquired Infections������������������������������������������������   23 6.2.15 Automation Wherever Possible��������������������������������������������   23 6.2.16 Environmental Pollution Control������������������������������������������   24 6.2.17 Internal Road������������������������������������������������������������������������   24 6.2.18 Wind, Earthquake-Resistant and Flood Protection������������������������������������������������������������������������������   24 6.2.19 Nature Plus Artwork ������������������������������������������������������������   24 6.2.20 Colours to be Used����������������������������������������������������������������   24 6.2.21 Choice of Building Materials������������������������������������������������   25 6.2.22 Flooring��������������������������������������������������������������������������������   25 Further Reading ����������������������������������������������������������������������������������������   25

Contents

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 Area Requirement & Planning ��������������������������������������������������������������   27 7.1 Functional Areas ������������������������������������������������������������������������������   27 7.2 Room and Space Requirement����������������������������������������������������������   28 7.3 Sizes of the Rooms����������������������������������������������������������������������������   41 7.4 Zoning ����������������������������������������������������������������������������������������������   42 7.5 Placement of Zones in the Building��������������������������������������������������   42 Further Reading ����������������������������������������������������������������������������������������   42

8

Detailed Engineering Drawings��������������������������������������������������������������   45 8.1 Schematic Design������������������������������������������������������������������������������   45 8.2 Site Plan��������������������������������������������������������������������������������������������   45 8.3 Concept Drawings����������������������������������������������������������������������������   46 8.4 Floor Plan Drawings ������������������������������������������������������������������������   46 8.5 Cross Section Drawings��������������������������������������������������������������������   46 8.6 Elevation Drawings��������������������������������������������������������������������������   46 8.7 Landscape Drawings ������������������������������������������������������������������������   46 8.8 Finishing Drawing����������������������������������������������������������������������������   47 8.9 Working Plan Drawings��������������������������������������������������������������������   47 8.10 Section Drawings������������������������������������������������������������������������������   47 8.11 Structural Drawings��������������������������������������������������������������������������   47 8.12 Column Layout Drawings����������������������������������������������������������������   47 8.13 Plinth Beam Layout Drawings����������������������������������������������������������   47 8.14 Lintel Beam Layout Drawings����������������������������������������������������������   48 8.15 Roof Beam and Shuttering Layout Drawings����������������������������������   48 8.16 General Note ������������������������������������������������������������������������������������   48 8.17 Excavation Drawings������������������������������������������������������������������������   48 8.18 Electrical Drawings��������������������������������������������������������������������������   48 8.19 Plumbing Drawings��������������������������������������������������������������������������   48 8.20 Fire Fighting and Detection Drawings����������������������������������������������   49 8.21 Shop Drawings����������������������������������������������������������������������������������   49 8.22 Furniture Layout Drawings��������������������������������������������������������������   49 8.23 Furniture Design Drawings��������������������������������������������������������������   49 8.24 Hospital Signage Drawings��������������������������������������������������������������   49 8.25 As-Built Drawings����������������������������������������������������������������������������   50 8.26 PERT Charts��������������������������������������������������������������������������������������   50 Further Reading ����������������������������������������������������������������������������������������   50

9

 Preparation of Construction Documents ����������������������������������������������   51 9.1 Definition of Construction Documents ��������������������������������������������   51 9.2 Contents of Construction Document������������������������������������������������   51 9.2.1 General Information About the Hospital Project������������������   51 9.2.2 Construction Contract Agreement����������������������������������������   52 9.2.3 Scope of Work (SOW)����������������������������������������������������������   52 9.2.4 Construction Schedule����������������������������������������������������������   52 9.2.5 General Conditions ��������������������������������������������������������������   52 9.2.6 Special Conditions����������������������������������������������������������������   52

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9.2.7 Specifications������������������������������������������������������������������������   52 9.2.8 Bill of Quantities (BOQ)������������������������������������������������������   52 9.2.9 Cost Estimate������������������������������������������������������������������������   53 9.2.10 Drawings ������������������������������������������������������������������������������   53 9.2.11 Other Documents������������������������������������������������������������������   53 Further Reading ����������������������������������������������������������������������������������������   54 Section II  Design & Development 10 Design  of the Main Entrance Gate to the Hospital ������������������������������   57 10.1 Main Entrance Gate������������������������������������������������������������������������   57 Further Reading ����������������������������������������������������������������������������������������   58 11 Designing  of the Entrance Lobby of the Hospital ��������������������������������   59 11.1 Location of the Entrance Lobby ����������������������������������������������������   59 11.1.1 The Infrastructure of the Entrance Lobby ��������������������   59 11.2 Services in the Lobby����������������������������������������������������������������������   60 11.3 Reception and Enquiry Counter������������������������������������������������������   60 11.4 Help Desk, Registration, and Admission and Discharge Counters������������������������������������������������������������������������������������������   60 11.5 Cash Counter����������������������������������������������������������������������������������   61 11.6 Cafeteria������������������������������������������������������������������������������������������   61 11.7 Pharmacy����������������������������������������������������������������������������������������   62 11.8 Other Services in the Entrance Lobby��������������������������������������������   62 11.9 Public Utility for Patients/Visitors��������������������������������������������������   62 11.10 Prayer Room/Meditation Spaces����������������������������������������������������   62 11.11 Self-Service Kiosks������������������������������������������������������������������������   62 11.12 Interiors of the Entrance Lobby������������������������������������������������������   63 11.13 Entrance Gates to the Lobby����������������������������������������������������������   63 11.14 Signage and Wayfinding in the Lobby��������������������������������������������   63 11.15 Acrylic or Glass Partitions��������������������������������������������������������������   63 11.16 General Issues Related to the Entrance Lobby ������������������������������   63 11.17 Outside Entrance Lobby ����������������������������������������������������������������   64 11.17.1 Screening Areas ������������������������������������������������������������   64 11.17.2 Hand Wash/Sanitizer Stations����������������������������������������   64 11.17.3 Face Masks/Shoe Covers Dispensers����������������������������   64 11.18 Reduction of People Landing in the Entrance Lobby��������������������   65 Further Reading ����������������������������������������������������������������������������������������   65 12 Emergency Services ��������������������������������������������������������������������������������   67 12.1 Location of Emergency Department ����������������������������������������������   67 12.2 Size of the Emergency Department������������������������������������������������   67 12.3 Areas Required for Emergency Department����������������������������������   68 12.4 The Entrance of the Emergency Department����������������������������������   68 12.4.1 Main Gate����������������������������������������������������������������������   68 12.4.2 Entrance Door to the Emergency Department��������������   68 12.4.3 Outside Entrance Lobby������������������������������������������������   68

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12.4.4 Screening Areas ������������������������������������������������������������   69 12.4.5 Hand Wash/Sanitizer Stations and Face Mask Dispenser ����������������������������������������������������������������������   69 12.4.6 Decontamination Area ��������������������������������������������������   69 12.4.7 General Waiting ������������������������������������������������������������   69 12.4.8 Ambulance Control��������������������������������������������������������   69 12.5 Reception����������������������������������������������������������������������������������������   70 12.6 Triage and Patient Handling Zone with Resuscitation��������������������   70 12.6.1 Location of Triage ��������������������������������������������������������   70 12.6.2 Size of Triage����������������������������������������������������������������   70 12.6.3 Infrastructure of Triage��������������������������������������������������   71 12.6.4 Bed Layout in Triage ����������������������������������������������������   71 12.6.5 Patient Furniture/Office Furniture/Equipment/Tools and Instruments in Triage����������������������������������������������   71 12.6.6 Doors and Windows������������������������������������������������������   71 12.6.7 Hand Washing����������������������������������������������������������������   71 12.6.8 Central Medical Gas Supply������������������������������������������   71 12.6.9 Electrical Points in Triage ��������������������������������������������   72 12.6.10 Other Communication Points in Triage������������������������   72 12.6.11 Curtain Partitions����������������������������������������������������������   73 12.6.12 Triage Nurses Duty Rooms in Triage����������������������������   73 12.7 Patient Handling Zone with Resuscitation��������������������������������������   73 12.7.1 Location of Patient Resuscitation and Handling Zones   73 12.7.2 Categories of Patient Resuscitation and Handling Zones ����������������������������������������������������������������������������   73 12.7.3 Size of Patient Resuscitation and Handling Zones��������   74 12.7.4 Infrastructure of Patient Resuscitation and Handling Zones ����������������������������������������������������������������������������   74 12.7.5 Bed Layout in Patient Resuscitation and Handling Zones ����������������������������������������������������������������������������   74 12.7.6 Isolation Room/Units/Area in Patient Resuscitation and Handling Zones������������������������������������������������������   75 12.7.7 Resuscitation Rooms in Patient Resuscitation and Handling Zones������������������������������������������������������   75 12.7.8 Patient Furniture/Office Furniture/Equipment/Tools and Instruments in Patient Resuscitation and Handling Zones������������������������������������������������������   75 12.7.9 Doors and Windows of Patient Resuscitation and Handling Zones������������������������������������������������������   75 12.7.10 Hand Washing in Patient Handling Zone����������������������   75 12.7.11 Central Medical Supply in Patient Resuscitation and Handling Zones������������������������������������������������������   76 12.7.12 Electrical Points in Patient Resuscitation and Handling Zones ����������������������������������������������������������������������������   77 12.7.13 Other Communication Points in Patient Resuscitation and Handling Zones������������������������������������������������������   77

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12.7.14 Curtain Partitions in Patient Resuscitation and Handling Zones������������������������������������������������������   77 12.7.15 Emergency Physician (EP)/Emergency Medical Officer (EMO) Duty Room ������������������������������������������   77 12.8 Treatment/Procedure Room/Minor Operation Theatre������������������   78 12.8.1 Patient Furniture/Equipment/Tools and Instruments in Minor OT ����������������������������������������������������������������������   78 12.8.2 Doors and Windows������������������������������������������������������   78 12.8.3 Hand Washing����������������������������������������������������������������   79 12.8.4 Central Medical Gas Supply������������������������������������������   79 12.8.5 Electrical Points in Minor OT���������������������������������������   79 12.9 Procedure and Diagnostic Setup ����������������������������������������������������   79 12.10 Emergency Operation Theatre Complex����������������������������������������   80 12.11 Day Care Emergency/Observation Ward����������������������������������������   80 12.11.1 Location of Emergency/Observation Ward ������������������   80 12.11.2 Size of Emergency/Observation Ward��������������������������   80 12.11.3 Issues Related to the Infrastructure of Emergency/Observation Ward ��������������������������������������   80 12.11.4 Bed Layout in Emergency/Observation Ward ��������������   81 12.11.5 Isolation Room in the Emergency/Observation Ward ��   81 12.11.6 Patient Furniture/Office Furniture/Equipment/Tools and Instruments in Emergency/Observation Ward ��������������   81 12.11.7 Doors and Windows������������������������������������������������������   81 12.11.8 Hand Washing����������������������������������������������������������������   81 12.11.9 Central Medical Gas Supply������������������������������������������   82 12.11.10 Electrical Points in Observation Ward��������������������������   82 12.11.11 Other Communication Points in Observation Ward������   83 12.11.12 Curtain Partitions����������������������������������������������������������   83 12.12 Other Issues Relating to Emergency Department ��������������������������   83 12.13 Disaster Plan ����������������������������������������������������������������������������������   83 12.13.1 Factors for Disaster Plan������������������������������������������������   84 Further Reading ����������������������������������������������������������������������������������������   84 13 Outpatient Department ��������������������������������������������������������������������������   85 13.1 Location of the OPD ����������������������������������������������������������������������   85 13.2 Schemes of the Layout of the OPD������������������������������������������������   86 13.2.1 Single Corridor OPD ����������������������������������������������������   86 13.2.2 Double Corridor OPD����������������������������������������������������   86 13.2.3 Clustered OPD Block����������������������������������������������������   86 13.3 Infrastructure Requirements in the OPD����������������������������������������   86 13.4 Reception & Enquiry Counter��������������������������������������������������������   87 13.5 Registration Counter ����������������������������������������������������������������������   87 13.6 Waiting Lobby/Hall������������������������������������������������������������������������   88 13.7 Examination Rooms������������������������������������������������������������������������   88 13.8 Procedure/Treatment Rooms����������������������������������������������������������   88 13.9 Support Rooms�������������������������������������������������������������������������������   89

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13.10 General Issue While Designing the OPD����������������������������������������   89 13.11 Number of OPDs Required������������������������������������������������������������   89 13.12 Consultation Room ������������������������������������������������������������������������   90 13.12.1 Size of the OPD Room��������������������������������������������������   90 13.12.2 Doors and Windows������������������������������������������������������   90 13.12.3 Hand Washing����������������������������������������������������������������   90 13.12.4 Furniture������������������������������������������������������������������������   90 13.12.5 Instruments and Equipment������������������������������������������   90 13.12.6 Electrical Points and Communication Ports in the Consultation Room��������������������������������������������������������   91 13.12.7 Curtain Partitions����������������������������������������������������������   91 13.13 Procedure/Treatment Room������������������������������������������������������������   91 13.13.1 Size of the Procedure/Treatment Room������������������������   91 13.13.2 Doors and Windows������������������������������������������������������   91 13.13.3 Hand Washing����������������������������������������������������������������   92 13.13.4 Furniture������������������������������������������������������������������������   92 13.13.5 Instruments and Equipment������������������������������������������   92 13.13.6 Electrical Points and Communication Ports in Procedure/Treatment Room������������������������������������������   92 Further Reading ����������������������������������������������������������������������������������������   92 14 Intensive Care Units��������������������������������������������������������������������������������   95 14.1 Types of ICUs ��������������������������������������������������������������������������������   95 14.2 Number of Beds in a Single Unit of ICU����������������������������������������   95 14.3 Location of Intensive Care Units����������������������������������������������������   96 14.4 Infrastructure of ICU����������������������������������������������������������������������   96 14.5 Size of the ICU��������������������������������������������������������������������������������   97 14.6 Sizing Considerations ��������������������������������������������������������������������   97 14.7 Patient Care Zone����������������������������������������������������������������������������   97   14.7.1 Bed Layout in ICU Hall������������������������������������������������   97   14.7.2 Isolation Room/Units/Area in ICU��������������������������������   98   14.7.3 Furniture in ICU������������������������������������������������������������   98   14.7.4 Equipment����������������������������������������������������������������������   98   14.7.5 Tools & Instruments������������������������������������������������������   99   14.7.6 Doors and Windows������������������������������������������������������   99   14.7.7 Nursing Station��������������������������������������������������������������   99   14.7.8 Hand Washing����������������������������������������������������������������   99   14.7.9 Toilets����������������������������������������������������������������������������  100 14.7.10 Air Conditioning System of ICUs ��������������������������������  100 14.7.11 Central Piped Medical Gas Supply��������������������������������  100 14.7.12 Electrical Points in ICU������������������������������������������������  100 14.7.13 Other Communication Points in ICU����������������������������  101 14.7.14 Curtain Partitions����������������������������������������������������������  101 14.8 Procedure & Treatment Room��������������������������������������������������������  101   14.8.1 Location of Treatment/Procedure Room ����������������������  101   14.8.2 Size of Treatment/Procedure Room������������������������������  101

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  14.8.3 Issues Related to the Infrastructure of the Treatment/Procedure Room������������������������������������������  102   14.8.4 Furniture in Treatment/Procedure Room����������������������  102   14.8.5 Equipment����������������������������������������������������������������������  102   14.8.6 Tools & Instruments������������������������������������������������������  102   14.8.7 Doors and Windows������������������������������������������������������  102   14.8.8 Hand Washing����������������������������������������������������������������  103   14.8.9 Central Medical Gas Supply������������������������������������������  103 14.8.10 Electrical Points in Treatment/Procedure Room ����������  103 14.8.11 Other Communication Points in Treatment/Procedure Room ����������������������������������������������������������������������������  103 14.8.12 Other Issues on Patient Care Zone & Procedure/Treatment Room������������������������������������������  103 14.8.13 Lighting in the ICU ������������������������������������������������������  104 14.8.14 Dialysis Equipment ������������������������������������������������������  104 14.8.15 Power Backup����������������������������������������������������������������  104 14.9 Clinical Support Zone ��������������������������������������������������������������������  104   14.9.1 Rigorous Monitoring ����������������������������������������������������  105   14.9.2 Radiology����������������������������������������������������������������������  105   14.9.3 Laboratory ��������������������������������������������������������������������  105   14.9.4 Medication Rooms��������������������������������������������������������  105   14.9.5 Pneumatic Tube Systems (PTS)������������������������������������  105   14.9.6 Clean Utility������������������������������������������������������������������  106   14.9.7 Dirty Utility/Sluice Room ��������������������������������������������  106   14.9.8 Equipment Park/Store����������������������������������������������������  106   14.9.9 Emergency Eyewash Station ����������������������������������������  106 14.10 Unit Support Zone��������������������������������������������������������������������������  106 14.10.1 Change Room: Male/Female in ICU����������������������������  106 14.10.2 Doctors’ Duty Rooms in ICU����������������������������������������  107 14.10.3 Nurse’s Night Duty Rooms in ICU ������������������������������  107 14.10.4 Night Duty Room for On-Call Junior Doctors��������������  107 14.10.5 Ward Pantry ������������������������������������������������������������������  107 14.10.6 Staff Lounge������������������������������������������������������������������  107 14.11 Family Support Zone����������������������������������������������������������������������  108 14.11.1 Family Lounge��������������������������������������������������������������  108 14.11.2 Consultation Rooms������������������������������������������������������  108 14.11.3 Meditation Spaces ��������������������������������������������������������  108 14.11.4 Family Cafeteria������������������������������������������������������������  108 14.11.5 Family Sleep Rooms������������������������������������������������������  109 14.11.6 Family Laundry ������������������������������������������������������������  109 14.12 Specialized Intensive Care Units����������������������������������������������������  109 14.12.1 Intensive Coronary Care Unit����������������������������������������  109 14.12.2 Respiratory Care Intensive Care Unit����������������������������  109 14.12.3 Neurosurgical Intensive Care Unit��������������������������������  109 14.12.4 Burns Unit ��������������������������������������������������������������������  110

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14.12.5 Geriatric Intensive Care Unit����������������������������������������  110 14.12.6 Neonatal Intensive Care Unit����������������������������������������  110 14.13 Common Design Considerations����������������������������������������������������  111 14.13.1 Signage and Way-Finding����������������������������������������������  111 14.13.2 Security and Access Control������������������������������������������  111 14.13.3 Patient Safety Technology ��������������������������������������������  111 14.13.4 Communications������������������������������������������������������������  112 14.13.5 Storage��������������������������������������������������������������������������  112 14.13.6 Relationships with Other Departments��������������������������  112 14.13.7 Central Nursing Station ������������������������������������������������  112 14.13.8 Patient Records��������������������������������������������������������������  112 14.13.9 X-Ray Viewing Area������������������������������������������������������  112 14.13.10 Reception Area��������������������������������������������������������������  113 14.13.11 Administrative Offices��������������������������������������������������  113 Further Reading ����������������������������������������������������������������������������������������  113 15 Operation Theatre Suite��������������������������������������������������������������������������  115 15.1 Location of Operating Theatre (O.T.) Complex������������������������������  115 15.2 Zones in O.T. Complex ������������������������������������������������������������������  115 15.2.1 Unsterile Zone ��������������������������������������������������������������  115 15.2.2 Protective Zone��������������������������������������������������������������  116 15.2.3 Clean Zone��������������������������������������������������������������������  116 15.2.4 Sterile Zone ������������������������������������������������������������������  116 15.3 Infrastructure of O.T. Complex������������������������������������������������������  116 15.4 Unsterile Zone��������������������������������������������������������������������������������  116 15.4.1 Administrative Area������������������������������������������������������  116 15.4.2 Operation Theatre In-Charge or Manager ��������������������  117 15.4.3 Room for Head of Anaesthesia��������������������������������������  117 15.4.4 Surgeons Room for Office Work ����������������������������������  117 15.4.5 Trolley Bay��������������������������������������������������������������������  118 15.4.6 Frozen Section Biopsy Laboratory��������������������������������  118 15.4.7 Shoe Change Area ��������������������������������������������������������  118 15.4.8 Entry Door for Changing Room������������������������������������  118 15.4.9 Waiting Area for Attendants������������������������������������������  118 15.4.10 Public Utility for Attendants������������������������������������������  119 15.4.11 Linen Pre-Wash Room��������������������������������������������������  119 15.4.12 Instrument Wash Room ������������������������������������������������  119 15.5 Protective Zone ������������������������������������������������������������������������������  119 15.5.1 Changing Rooms ����������������������������������������������������������  119 15.5.2 Entry Gate of Pre-Operative Ward��������������������������������  120 15.5.3 Unsterile Store for Equipment Storage��������������������������  120 15.5.4 Store for Medicines, Consumables and Disposables����  120 15.5.5 Pantry����������������������������������������������������������������������������  120 15.6 Clean Zone��������������������������������������������������������������������������������������  120 15.6.1 Pre-Operative Room������������������������������������������������������  121

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15.6.2 Preparation Room����������������������������������������������������������  121 15.6.3 Surgeons Rest Room ����������������������������������������������������  121 15.6.4 Restroom for Staff – Males & Females ������������������������  121 15.6.5 Exit Doors of All Change Rooms����������������������������������  121 15.6.6 Pre Anaesthetic Check-Up Room (PAC) ����������������������  122 15.6.7 Dirty Utility ������������������������������������������������������������������  122 15.6.8 Post-Operative Recovery Ward��������������������������������������  122 15.7 Sterile Zone������������������������������������������������������������������������������������  122 15.7.1 Clean Supply Room������������������������������������������������������  122 15.7.2 Instrument Trolley Layup����������������������������������������������  123 15.7.3 Scrub Station ����������������������������������������������������������������  123 15.7.4 Sterilization Room��������������������������������������������������������  123 15.7.5 Operating Theatres/Rooms (OR)����������������������������������  123 15.7.6 Number of OR ��������������������������������������������������������������  123 15.7.7 Location and Layout of the OR’s����������������������������������  124 15.7.8 Types of Operating Rooms��������������������������������������������  124 15.8 Simple Room OR����������������������������������������������������������������������������  124 15.9 Pre-Fabricated Modular OR������������������������������������������������������������  124 15.9.1 Size of the OR ��������������������������������������������������������������  125 15.9.2 Walls of the OR ������������������������������������������������������������  125 15.9.3 Ceiling of the OR����������������������������������������������������������  125 15.9.4 Corners of OR����������������������������������������������������������������  125 15.9.5 Door of the OR��������������������������������������������������������������  125 15.9.6 Window in OR ��������������������������������������������������������������  126 15.9.7 Control Panel ����������������������������������������������������������������  126 15.9.8 View Box ����������������������������������������������������������������������  126 15.9.9 Writing Board����������������������������������������������������������������  126 15.9.10 Pressure Relief Damper (PRD) ������������������������������������  126 15.9.11 Peripheral Lights ����������������������������������������������������������  126 15.9.12 Plenum��������������������������������������������������������������������������  127 15.9.13 Plenum Lights����������������������������������������������������������������  127 15.9.14 Pass-Through Windows/Hatch Boxes ��������������������������  127 15.9.15 Electrical Points������������������������������������������������������������  127 15.9.16 Anaesthetist Pendant ����������������������������������������������������  127 15.9.17 Surgeon Pendant������������������������������������������������������������  127 15.9.18 Flooring ������������������������������������������������������������������������  128 15.9.19 Painting��������������������������������������������������������������������������  128 15.9.20 Air Conditioning & Environment of OR’s��������������������  128 15.9.21 Supply Air Ducts ����������������������������������������������������������  128 15.9.22 Return Air����������������������������������������������������������������������  128 15.9.23 Special Air Requirements for OR����������������������������������  129 15.9.24 Other Communication Points in OR������������������������������  129 15.9.25 Equipment in OR����������������������������������������������������������  129 15.9.26 Furniture OR������������������������������������������������������������������  130 15.10 Septic Operation Theatre����������������������������������������������������������������  130

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15.11 Endoscopy Suite������������������������������������������������������������������������������  131 15.11.1 Endoscopy Room����������������������������������������������������������  131 15.11.2 Endoscope Washroom ��������������������������������������������������  131 15.11.3 Store������������������������������������������������������������������������������  131 15.11.4 Change Room����������������������������������������������������������������  131 15.11.5 Recovery Room ������������������������������������������������������������  131 15.11.6 Consultation Room��������������������������������������������������������  131 15.12 Semi-Modular OR��������������������������������������������������������������������������  132 15.13 Modular OR������������������������������������������������������������������������������������  132 15.14 Hybrid OR��������������������������������������������������������������������������������������  132 Further Reading ����������������������������������������������������������������������������������������  132 16 Delivery Room/Labor Room ������������������������������������������������������������������  133 16.1 Location of LDR Complex ������������������������������������������������������������  133 16.2 Zones in LDR Complex������������������������������������������������������������������  133 16.2.1 Unsterile Zone ��������������������������������������������������������������  133 16.2.2 Protective Zone��������������������������������������������������������������  133 16.2.3 Delivery Zone����������������������������������������������������������������  134 16.3 Infrastructure of LDR Complex������������������������������������������������������  134 16.4 Unsterile Zone��������������������������������������������������������������������������������  134 16.4.1 Administrative Area������������������������������������������������������  134 16.4.2 Labor Room In-Charge��������������������������������������������������  134 16.4.3 Gynaecologist Room for Office Work��������������������������  135 16.4.4 Trolley Bay��������������������������������������������������������������������  135 16.4.5 Shoe Change Area ��������������������������������������������������������  135 16.4.6 Entry Door for Changing Room������������������������������������  135 16.4.7 Waiting Area for Attendants������������������������������������������  135 16.4.8 Public Utility for Attendants������������������������������������������  136 16.4.9 Linen Pre-Wash Room��������������������������������������������������  136 16.4.10 Instrument Wash Room ������������������������������������������������  136 16.5 Protective Zone ������������������������������������������������������������������������������  136 16.5.1 Changing Rooms ����������������������������������������������������������  136 16.5.2 Store for Equipment, Medicines, Consumables and Disposables��������������������������������������������������������������������  137 16.5.3 Pre-Labor Room/Ward��������������������������������������������������  137 16.5.4 Eclampsia Room������������������������������������������������������������  137 16.5.5 Examination/Preparation Room������������������������������������  137 16.5.6 Surgeons Rest Room ����������������������������������������������������  137 16.5.7 Dirty Utility ������������������������������������������������������������������  138 16.5.8 Post-Labour Recovery Ward������������������������������������������  138 16.5.9 Doctors’ Night Duty Rooms������������������������������������������  138 16.6 Delivery Zone ��������������������������������������������������������������������������������  138 16.6.1 Clean Supply Room������������������������������������������������������  138 16.6.2 Instrument Trolley Layup����������������������������������������������  139 16.6.3 Scrub Station ����������������������������������������������������������������  139 16.6.4 Sterilization Room��������������������������������������������������������  139

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16.6.5 Delivery Rooms ������������������������������������������������������������  139 16.6.6 Location and Layout of the Delivery Rooms����������������  140 16.6.7 Types of Delivery Rooms����������������������������������������������  140 16.6.8 Equipment in Delivery Rooms��������������������������������������  140 16.6.9 Furniture Delivery Rooms ��������������������������������������������  140 16.6.10 Other Issues Relating to the Delivery Room ����������������  140 16.6.11 Septic Delivery Room���������������������������������������������������  141 16.7 Baby Resuscitation Area ����������������������������������������������������������������  141 16.8 Other Important Issues to Be Considered While Designing LDR ������������������������������������������������������������������������������  141 16.8.1 Labor Table Specifications��������������������������������������������  141 16.8.2 Shifting Baby to NICU��������������������������������������������������  141 16.8.3 Access to the Operating Room��������������������������������������  142 16.8.4 Electronic Tagging for Newborn Safety������������������������  142 Further Reading ����������������������������������������������������������������������������������������  142 17 Intermediate  Care Area (Patient Rooms)����������������������������������������������  143 17.1 Provide Amenities and Comfort for the Family������������������������������  143 17.1.1 Family Lounge��������������������������������������������������������������  143 17.1.2 Consultation Rooms������������������������������������������������������  144 17.1.3 Meditation Spaces ��������������������������������������������������������  144 17.1.4 Family Cafeteria������������������������������������������������������������  144 17.1.5 Family Sleep Rooms������������������������������������������������������  144 17.1.6 Family Laundry ������������������������������������������������������������  144 17.2 Increase Staff Efficiency ����������������������������������������������������������������  145 17.3 Patient Room Furnishings��������������������������������������������������������������  145 17.3.1 Room Decor������������������������������������������������������������������  145 17.3.2 Lighting in the Patient Room����������������������������������������  146 17.3.3 Ceiling Finishes ������������������������������������������������������������  146 17.4 Types of Patient Rooms in the Hospital������������������������������������������  146 17.4.1 Single Bed Occupancy��������������������������������������������������  147 17.4.2 Sharing Rooms��������������������������������������������������������������  147 17.4.3 General Wards ��������������������������������������������������������������  147 17.4.4 Isolation Ward/Rooms ��������������������������������������������������  147 17.5 Infrastructure Details of the Indoor Patient Units-�������������������������  147 17.6 Location of the Indoor Patient Areas����������������������������������������������  148 17.7 Zoning of the Isolation Areas����������������������������������������������������������  148 17.8 Single Patient Room (Private Room)����������������������������������������������  148 17.8.1 Room Layout ����������������������������������������������������������������  148 17.8.2 Size of the Room ����������������������������������������������������������  149 17.8.3 Walls������������������������������������������������������������������������������  149 17.8.4 Doors ����������������������������������������������������������������������������  149 17.8.5 Windows������������������������������������������������������������������������  149 17.8.6 Toilets����������������������������������������������������������������������������  150 17.8.7 Bed Layout in Patient Room ����������������������������������������  150 17.8.8 Furniture and Instruments in the Patient Room������������  150

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17.8.9 Air Conditioning System of Patient Rooms������������������  151 17.8.10 Central Piped Medical Gas Supply��������������������������������  151 17.8.11 Electrical Points in Patient Room����������������������������������  152 17.8.12 Other Communication Points in the Patient Room ������  152 17.8.13 Curtain Partitions����������������������������������������������������������  152 17.8.14 IV Track������������������������������������������������������������������������  152 17.8.15 Psychiatric Patient Rooms ��������������������������������������������  152 17.9 Deluxe Single Patient Room (Deluxe Room) ��������������������������������  153 17.10 Family Suite with Single Patient Room (Suite Room) ������������������  153 17.10.1 Patient Room of the Suite����������������������������������������������  153 17.10.2 Family Room of the Suite����������������������������������������������  154 17.11 Sharing Patient Room (Semi-Private Room)����������������������������������  154 17.11.1 Room Layout ����������������������������������������������������������������  154 17.11.2 Size of the Semi-Private Sharing Room������������������������  155 17.11.3 Doors and Windows������������������������������������������������������  155 17.11.4 Toilets����������������������������������������������������������������������������  155 17.11.5 Bed Layout in Patient Room ����������������������������������������  155 17.11.6 Furniture and Instruments in Patient Room������������������  155 17.11.7 Air Conditioning and Other Services����������������������������  156 17.12 General Ward (Multiple Beds Room) ��������������������������������������������  156 17.12.1 Location of the Multiple Bed Wards ����������������������������  156 17.12.2 Room Layout ����������������������������������������������������������������  156 17.12.3 Number of Beds in the Multiple Bed Ward ������������������  157 17.12.4 Size of the Multiple Bed Ward��������������������������������������  157 17.12.5 Doors and Windows������������������������������������������������������  157 17.12.6 Toilets����������������������������������������������������������������������������  157 17.12.7 Bed Layout in Ward������������������������������������������������������  157 17.12.8 Furniture and Instruments in Patient Room������������������  157 17.12.9 Air Conditioning System of Patient Rooms������������������  158 17.12.10 Central Piped Medical Gas Supply��������������������������������  158 17.12.11 Electrical Points in the Ward ����������������������������������������  158 17.12.12 Other Communication Points in Ward��������������������������  158 17.12.13 Curtain Partitions����������������������������������������������������������  159 17.13 Isolation Rooms/Wards ������������������������������������������������������������������  159 17.13.1 Isolation in ICU ������������������������������������������������������������  159 17.13.2 Single-Bed Isolation Rooms������������������������������������������  160 17.13.3 Air and Pressure Monitoring System for Isolation Rooms������������������������������������������������������������  160 17.13.4 Pressurization of the Isolation Rooms��������������������������  160 17.13.5 Air Conditioning of the Isolation Wards/Units��������������  161 17.14 Nursing Station ������������������������������������������������������������������������������  161 17.14.1 Hand Washing����������������������������������������������������������������  162 17.14.2 Alcohol Gel/Sanitizer Dispensers����������������������������������  162 17.15 Nurses Duty Rooms������������������������������������������������������������������������  162 17.16 Doctors Duty Rooms����������������������������������������������������������������������  162

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17.17 Procedure and Treatment Room������������������������������������������������������  162 17.17.1 Furniture in Treatment/Procedure Room����������������������  163 17.17.2 Doors and Windows������������������������������������������������������  163 17.17.3 Hand Washing����������������������������������������������������������������  164 17.17.4 Central Medical Gas Supply������������������������������������������  164 17.17.5 Electrical Points in Treatment/Procedure Room ����������  164 17.17.6 Other Communication Points in Treatment/Procedure Room ����������������������������������������������������������������������������  164 17.18 Clean Utility������������������������������������������������������������������������������������  164 17.19 Dirty Utility/Sluice Room��������������������������������������������������������������  165 17.20 Store for Medicines, Consumables and Disposables����������������������  165 17.21 Medication Areas����������������������������������������������������������������������������  165 17.22 Equipment Park/Store ��������������������������������������������������������������������  165 17.23 Trolley Park Area����������������������������������������������������������������������������  165 17.24 Ward Pantry������������������������������������������������������������������������������������  166 Further Reading ����������������������������������������������������������������������������������������  166 18 Radiology��������������������������������������������������������������������������������������������������  167 18.1 Location of the Radiology Department������������������������������������������  167 18.2 Infrastructure of Centralized Radiology Department ��������������������  168 18.3 Utility Area��������������������������������������������������������������������������������������  168   18.3.1 Reception and Enquiry��������������������������������������������������  168   18.3.2 Registration and Cash Counter��������������������������������������  168   18.3.3 Waiting Lobby ��������������������������������������������������������������  168   18.3.4 Reporting Room������������������������������������������������������������  169   18.3.5 Stores for Unused Consumables and Films������������������  169   18.3.6 Stores for Used Films and General Items����������������������  169   18.3.7 Report Delivery Counter�����������������������������������������������  169 18.4 X-Ray Zone������������������������������������������������������������������������������������  170   18.4.1 Radiography Rooms������������������������������������������������������  170 18.5 UltraSound Zone����������������������������������������������������������������������������  171   18.5.1 Ultrasound Room����������������������������������������������������������  171   18.5.2 Change Rooms��������������������������������������������������������������  171   18.5.3 Toilets����������������������������������������������������������������������������  172   18.5.4 Sub Waiting for Ultrasound ������������������������������������������  172 18.6 CT Scan Zone ��������������������������������������������������������������������������������  172   18.6.1 CT Scan Machine Room ����������������������������������������������  172   18.6.2 CT Control Room����������������������������������������������������������  173   18.6.3 UPS Room ��������������������������������������������������������������������  174   18.6.4 CT Panel Room ������������������������������������������������������������  174   18.6.5 Change Rooms��������������������������������������������������������������  174   18.6.6 Sub Waiting for CT Scan����������������������������������������������  174 18.7 MRI Zone����������������������������������������������������������������������������������������  174   18.7.1 MRI Machine Room������������������������������������������������������  174   18.7.2 MRI Control Room��������������������������������������������������������  175   18.7.3 UPS Room ��������������������������������������������������������������������  175

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  18.7.4 MRI Panel Room ����������������������������������������������������������  176   18.7.5 Chiller����������������������������������������������������������������������������  176   18.7.6 Change Rooms��������������������������������������������������������������  176   18.7.7 Sub Waiting for MRI ����������������������������������������������������  176 18.8 Mammography Zone����������������������������������������������������������������������  176   18.8.1 Mammography Rooms��������������������������������������������������  177   18.8.2 Change Rooms��������������������������������������������������������������  178   18.8.3 Computerised Radiography (CR) Room ����������������������  178   18.8.4 Sub Waiting for Mammography������������������������������������  178 18.9 DEXA Scan Zone ��������������������������������������������������������������������������  178   18.9.1 DEXA Scan Machine Room ����������������������������������������  178   18.9.2 Sub Waiting for DEXA Scan����������������������������������������  179 18.10 PET CT/MRI Zone ������������������������������������������������������������������������  179 18.10.1 Location of the Zone in the Hospital����������������������������  180 18.10.2 PET CT Scan Machine Room ��������������������������������������  180 18.10.3 PET MRI Machine Room����������������������������������������������  180 18.10.4 Other Attached Areas����������������������������������������������������  180 18.10.5 SPECT CT Machine Room ������������������������������������������  180 18.10.6 Operating Console Rooms��������������������������������������������  180 18.10.7 Low-Risk Areas or Cold Areas��������������������������������������  181 18.10.8 High-Risk Areas or Radiation Exposure Hot Areas������  182 18.10.9 Toilet������������������������������������������������������������������������������  182 18.10.10 Control and Scanning Room ����������������������������������������  183 18.10.11 Post-Examination Waiting Room����������������������������������  183 18.10.12 Waste Disposal Room����������������������������������������������������  183 Further Reading ����������������������������������������������������������������������������������������  183 19 Clinical Laboratories ������������������������������������������������������������������������������  185 19.1 Infrastructure of Clinical Lab����������������������������������������������������������  185 19.1.1 Planning & Designing of Laboratory����������������������������  185 19.2 Size of the Lab��������������������������������������������������������������������������������  186 19.3 Layout ��������������������������������������������������������������������������������������������  186 19.4 Spaces ��������������������������������������������������������������������������������������������  186 19.5 Location & Arrangement of Areas��������������������������������������������������  186 19.6 Open- Lab Designs ������������������������������������������������������������������������  186 19.7 Biosafety ����������������������������������������������������������������������������������������  187 19.8 Molecular Testing ��������������������������������������������������������������������������  187 19.9 Laboratories������������������������������������������������������������������������������������  187 19.10 Pneumatic Tube Systems (PTS)������������������������������������������������������  188 19.11 Clear Floor Space����������������������������������������������������������������������������  188 19.12 Electrical Points in Laboratories����������������������������������������������������  188 19.13 Other Communication Points in Laboratories��������������������������������  189 19.14 Air Conditioning System of Laboratories��������������������������������������  189 19.15 Furniture in the Laboratories����������������������������������������������������������  189 19.16 Main Equipment in the Clinical Laboratories��������������������������������  189

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19.17 Support Services ����������������������������������������������������������������������������  190 19.17.1 Autoclave����������������������������������������������������������������������  191 19.17.2 Bulk Storage Room ������������������������������������������������������  191 19.17.3 Cold Storage Room ������������������������������������������������������  191 19.17.4 RO Water Closet������������������������������������������������������������  191 19.17.5 Gas Storage Closet��������������������������������������������������������  191 19.17.6 Record/File/Copy Room������������������������������������������������  192 19.17.7 Flammable Storage��������������������������������������������������������  192 19.17.8 Specimen Storage/Recycle��������������������������������������������  192 19.17.9 Block and Slide Storage������������������������������������������������  192 19.17.10 Penta Head/Deca Head Microscope Room ������������������  192 19.18 Utility Area��������������������������������������������������������������������������������������  193 19.18.1 Doctors Room����������������������������������������������������������������  193 19.18.2 Laboratory Manager������������������������������������������������������  193 19.18.3 Technicians Room ��������������������������������������������������������  193 19.19 Outpatient Phlebotomy ������������������������������������������������������������������  193 19.19.1 OPD Phlebotomy Room������������������������������������������������  194 19.19.2 Fine Needle Aspiration Room ��������������������������������������  194 19.19.3 Toilets����������������������������������������������������������������������������  194 19.19.4 Waiting Area������������������������������������������������������������������  194 19.20 Employee Support��������������������������������������������������������������������������  195 19.20.1 Staff Lounge������������������������������������������������������������������  195 19.20.2 Lockers��������������������������������������������������������������������������  195 19.20.3 Shower with Water Closet ��������������������������������������������  195 Further Reading ����������������������������������������������������������������������������������������  195 20 Blood Bank ����������������������������������������������������������������������������������������������  197 20.1 Location of the Blood Bank in the Hospital ����������������������������������  197 20.2 Controlling Authority����������������������������������������������������������������������  197 20.3 Functions of Blood Bank����������������������������������������������������������������  197 20.3.1 Receiving ����������������������������������������������������������������������  197 20.3.2 Storage��������������������������������������������������������������������������  198 20.3.3 Testing ��������������������������������������������������������������������������  198 20.3.4 Distribution��������������������������������������������������������������������  198 20.4 Infrastructure of the Blood Bank����������������������������������������������������  198 20.5 Area of Blood Bank������������������������������������������������������������������������  198 20.6 Equipment in the Blood Bank��������������������������������������������������������  199 20.7 Receiving Area��������������������������������������������������������������������������������  199 20.7.1 Entrance������������������������������������������������������������������������  199 20.7.2 Reception����������������������������������������������������������������������  199 20.7.3 Registration��������������������������������������������������������������������  200 20.7.4 Waiting��������������������������������������������������������������������������  200 20.7.5 Medical Examination����������������������������������������������������  200 20.7.6 Bleeding Room��������������������������������������������������������������  200 20.7.7 Refreshment/Recovery/Rest Room ������������������������������  200 20.7.8 Apheresis Room������������������������������������������������������������  200

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20.8 Testing Area������������������������������������������������������������������������������������  201 20.8.1 Laboratories������������������������������������������������������������������  201 20.8.2 Wall��������������������������������������������������������������������������������  201 20.8.3 Flooring ������������������������������������������������������������������������  201 20.8.4 Doors ����������������������������������������������������������������������������  201 20.8.5 Lightning ����������������������������������������������������������������������  201 20.8.6 Earthing ������������������������������������������������������������������������  201 20.8.7 Working Slabs����������������������������������������������������������������  202 20.8.8 Sinks������������������������������������������������������������������������������  202 20.8.9 Electrical Points in Laboratories ����������������������������������  202 20.8.10 Other Communication Points in Laboratories��������������  202 20.8.11 Air Conditioning System of Laboratories ��������������������  203 20.8.12 Furniture in the Laboratories ����������������������������������������  203 20.8.13 Fittings and Fixtures������������������������������������������������������  203 20.9 Storage & Processing Area ������������������������������������������������������������  203 20.9.1 Storage of Untested Blood��������������������������������������������  203 20.9.2 Storage of Tested Blood������������������������������������������������  203 20.9.3 Blood Bank Refrigerators����������������������������������������������  204 20.9.4 Blood Component Room����������������������������������������������  204 20.9.5 Use of Wood������������������������������������������������������������������  205 20.9.6 Fitting and Fixtures��������������������������������������������������������  205 20.10 Distribution Area����������������������������������������������������������������������������  205 20.10.1 Pneumatic Tube Systems (PTS)������������������������������������  206 20.11 Utility Area��������������������������������������������������������������������������������������  206 20.11.1 Change Room����������������������������������������������������������������  206 20.11.2 Doctors Rest Rooms������������������������������������������������������  206 20.11.3 Store������������������������������������������������������������������������������  206 20.11.4 Record Room����������������������������������������������������������������  206 20.11.5 Medical Officer Room��������������������������������������������������  207 20.11.6 Sterilization Room Cum Washing Room����������������������  207 20.11.7 Waste Management and Disposal����������������������������������  207 Further Reading ����������������������������������������������������������������������������������������  207 21 Other  Investigation & Procedures����������������������������������������������������������  209 21.1 Coronary Catheterization (Cath Lab)����������������������������������������������  209 21.1.1 Location of the Cath Lab����������������������������������������������  209 21.1.2 Number of Cath Lab Procedure Rooms������������������������  210 21.1.3 Other Issues Related to Cath Lab����������������������������������  210 21.1.4 Cath Lab Console Room ����������������������������������������������  211 21.1.5 UPS Room ��������������������������������������������������������������������  211 21.1.6 Cath Lab Panel Room����������������������������������������������������  211 21.1.7 Change Rooms for Patients ������������������������������������������  211 21.1.8 Change Rooms for Staff������������������������������������������������  212 21.1.9 Waiting for Cath Lab ����������������������������������������������������  212 21.1.10 Stores for Unused Consumable ������������������������������������  212

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21.1.11 Stores for Records and CDs������������������������������������������  212 21.1.12 Consultation Rooms������������������������������������������������������  212 21.2 Thallium Scan ��������������������������������������������������������������������������������  213 21.3 Audiometry ������������������������������������������������������������������������������������  213 21.3.1 Location of the Audiometry Room��������������������������������  213 21.3.2 Room Designing������������������������������������������������������������  213 21.4 Bronchoscopy ��������������������������������������������������������������������������������  213 21.5 Capsule Endoscopy, Cholangioscopy, Colonoscopy, Duodenoscopy, Endoscopic Ultrasound & Upper Gastrointestinal Endoscopy Etc. ����������������������������������������������������  214 21.6 Neurology ��������������������������������������������������������������������������������������  214 21.7 Polysomnography (Sleep Lab)��������������������������������������������������������  214 21.7.1 Location of the Sleep Lab����������������������������������������������  214 21.7.2 Room Designing������������������������������������������������������������  214 21.8 Ophthalmology ������������������������������������������������������������������������������  215 21.9 ESW Lithotripter of Urology����������������������������������������������������������  215 21.10 Dialysis ������������������������������������������������������������������������������������������  215 21.10.1 Location of the Dialysis Room��������������������������������������  215 21.10.2 Dialysis Procedure Room����������������������������������������������  215 21.10.3 Other Issues of Dialysis Unit����������������������������������������  216 21.10.4 Wash Room for Dialysers����������������������������������������������  216 21.10.5 Store������������������������������������������������������������������������������  216 21.10.6 Change Rooms for Patients ������������������������������������������  216 21.10.7 Change Rooms for Staff������������������������������������������������  217 21.10.8 Waiting for Dialysis������������������������������������������������������  217 Further Reading ����������������������������������������������������������������������������������������  217 22 Radiation Therapy ����������������������������������������������������������������������������������  219 22.1 Location of Radiotherapy Unit ������������������������������������������������������  219 22.2 Infrastructure of the Radiotherapy Department������������������������������  219 22.3 Utility Areas������������������������������������������������������������������������������������  220 22.3.1 Entrance to the Department ������������������������������������������  220 22.3.2 Outside Entrance ����������������������������������������������������������  220 22.3.3 Reception & Enquiry Counter ��������������������������������������  220 22.3.4 Registration Counter������������������������������������������������������  220 22.3.5 General Waiting ������������������������������������������������������������  221 22.3.6 Store������������������������������������������������������������������������������  221 22.3.7 Consultation Room��������������������������������������������������������  221 22.4 Treatment & Planning Area������������������������������������������������������������  221 22.4.1 Mould Room������������������������������������������������������������������  221 22.4.2 Mould Workshop ����������������������������������������������������������  222 22.4.3 Medical Physics������������������������������������������������������������  222 22.4.4 CT Simulators����������������������������������������������������������������  222 22.5 Radiation Therapy Treatment Area ������������������������������������������������  222 22.5.1 External Beam Radiation Therapy��������������������������������  222 22.5.2 Internal Beam Radiation Therapy����������������������������������  223

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22.6 Radiotherapy Ward��������������������������������������������������������������������������  224 22.7 Trolley Bay�������������������������������������������������������������������������������������  224 22.8 Change Rooms��������������������������������������������������������������������������������  224 22.9 Store������������������������������������������������������������������������������������������������  225 22.10 Signage and Wayfinding ����������������������������������������������������������������  225 22.11 Sub Waiting Lobbies ����������������������������������������������������������������������  225 22.12 Clean Utility������������������������������������������������������������������������������������  225 22.13 Dirty Utility/Sluice Room��������������������������������������������������������������  225 22.14 Hand Washing ��������������������������������������������������������������������������������  225 22.15 Administration/Offices��������������������������������������������������������������������  226 22.16 Other Communication Points in the Radiation Department ����������  226 22.17 Heating Ventilation and Air Conditioning��������������������������������������  226 22.18 Central Piped Medical Gas Supply ������������������������������������������������  226 22.19 Electrical Points in the Radiation Therapy Department������������������  226 22.20 Power Backup ��������������������������������������������������������������������������������  227 Further Reading ����������������������������������������������������������������������������������������  227 23 Rehabilitation and Allied Health Therapies������������������������������������������  229 23.1 Location of Physiotherapy Department������������������������������������������  229 23.2 Infrastructure of the Physiotherapy Department����������������������������  229 23.3 Entrance/Entrance Lobby����������������������������������������������������������������  230 23.4 Reception����������������������������������������������������������������������������������������  230 23.5 Waiting Areas����������������������������������������������������������������������������������  230 23.6 Examination Room with Exam Cubicles����������������������������������������  230 23.7 Patient Therapy Areas ��������������������������������������������������������������������  230 23.7.1 Physiotherapy����������������������������������������������������������������  230 23.7.2 Occupational Therapy����������������������������������������������������  231 23.8 Administrative Area������������������������������������������������������������������������  231 23.9 Store������������������������������������������������������������������������������������������������  232 23.10 Trolley Bay�������������������������������������������������������������������������������������  232 23.11 Clean Utility������������������������������������������������������������������������������������  232 23.12 Dirty Utility/Sluice Room��������������������������������������������������������������  232 23.13 Change Rooms��������������������������������������������������������������������������������  232 23.14 Other Issues About the Infrastructure of the Rehabilitation Department��������������������������������������������������������������������������������������  233 Further Reading ����������������������������������������������������������������������������������������  233 24 Pharmacy Unit ����������������������������������������������������������������������������������������  235 24.1 Location of the Pharmacy ��������������������������������������������������������������  235 24.2 Size of the Pharmacy����������������������������������������������������������������������  235 24.3 Infrastructure of Pharmacy�������������������������������������������������������������  236 24.4 Pharmacy for Outpatients ��������������������������������������������������������������  236 24.4.1 Entrance������������������������������������������������������������������������  236 24.4.2 Drug Receiving Area ����������������������������������������������������  236 24.4.3 Disbursing Hall��������������������������������������������������������������  236 24.4.4 Bulk Storage������������������������������������������������������������������  237 24.4.5 Cold Store����������������������������������������������������������������������  237

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24.4.6 Expiry Drug Room��������������������������������������������������������  237 24.4.7 Costly Drug Room��������������������������������������������������������  238 24.4.8 Drug Sorting Room ������������������������������������������������������  238 24.4.9 Narcotics and Controlled Drug Store����������������������������  238 24.5 Pharmacy for Inpatients������������������������������������������������������������������  238 24.6 Pneumatic Tube Systems (PTS)������������������������������������������������������  238 24.7 Pharmacist Offices��������������������������������������������������������������������������  239 24.8 Automation in the Pharmacy����������������������������������������������������������  239 Further Reading ����������������������������������������������������������������������������������������  239 25 CSSD ��������������������������������������������������������������������������������������������������������  241 25.1 Infrastructure of CSSD ������������������������������������������������������������������  241 25.2 Location������������������������������������������������������������������������������������������  241 25.3 Area Required for CSSD Department��������������������������������������������  242 25.4 Material Flows��������������������������������������������������������������������������������  242 25.5 Functional Zones of CSSD ������������������������������������������������������������  242 25.5.1 Receiving Zone (Unclean Area)������������������������������������  242 25.5.2 Decontaminating, Washing and Disinfecting Zone ������  243 25.6 Packaging Area ������������������������������������������������������������������������������  244 25.6.1 Location������������������������������������������������������������������������  244 25.6.2 Role of the Packing Room Shall Be������������������������������  244 25.6.3 Contents of Packing Room��������������������������������������������  244 25.7 Sterilization Area����������������������������������������������������������������������������  245 25.7.1 Location and Relationships ������������������������������������������  245 25.7.2 Main Activities of the Sterilization Process������������������  245 25.7.3 Size of the Sterilization Room��������������������������������������  245 25.7.4 Methods and Types of Sterilizers����������������������������������  245 25.8 Clean Storage Area ������������������������������������������������������������������������  247 25.8.1 Location of the Clean Storage Room����������������������������  247 25.8.2 Designing of the Storage Shelves����������������������������������  247 25.9 Delivery Counter����������������������������������������������������������������������������  248 25.10 Support Areas����������������������������������������������������������������������������������  248 25.10.1 Staff Changing Rooms��������������������������������������������������  249 25.10.2 Administrative Area������������������������������������������������������  249 25.11 Electrical Points������������������������������������������������������������������������������  249 25.12 Air Conditioning ����������������������������������������������������������������������������  249 Further Reading ����������������������������������������������������������������������������������������  250 26 Piped  Medical Gas Supply System (MGPS)������������������������������������������  251 26.1 System Components�����������������������������������������������������������������������  251 26.2 Sources��������������������������������������������������������������������������������������������  252 26.3 Piping Networks������������������������������������������������������������������������������  252 26.3.1 Pipeline Installation ������������������������������������������������������  252 26.3.2 Valves����������������������������������������������������������������������������  253 26.3.3 Warning and Alarm Systems ����������������������������������������  253 26.3.4 Outlets and Inlets����������������������������������������������������������  254 26.3.5 Secondary Equipment����������������������������������������������������  254

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26.4 Designing the MGPS System���������������������������������������������������������  254 26.4.1 Analysis of the Area of the Hospital������������������������������  254 26.5 Infrastructure for MGPS ����������������������������������������������������������������  255 26.6 Manifold Room������������������������������������������������������������������������������  255 26.6.1 Location of the Manifold����������������������������������������������  255 26.6.2 Size of the Manifold Room ������������������������������������������  256 26.6.3 Fixing the Manifold Systems in the Hall/Room������������  256 26.7 Compressed Medical Air����������������������������������������������������������������  256 26.7.1 Compressor Air Plant����������������������������������������������������  256 26.7.2 Air Filtration������������������������������������������������������������������  256 26.7.3 Medical Air 400 kPa������������������������������������������������������  257 26.7.4 Surgical Air 700 kPa������������������������������������������������������  257 26.8 Vacuum ������������������������������������������������������������������������������������������  257 26.8.1 Vacuum Plant����������������������������������������������������������������  257 26.8.2 Filtration System ����������������������������������������������������������  258 26.9 Issues While Designing the Plant Room and the Manifold Room������������������������������������������������������������������������������  258 26.10 Medical Gases Outlet Terminals ����������������������������������������������������  258 26.11 Bulk Liquid Oxygen Gas System ��������������������������������������������������  259 26.11.1 Liquid Oxygen Vessel����������������������������������������������������  259 Further Reading ����������������������������������������������������������������������������������������  259 27 Hospital Kitchen��������������������������������������������������������������������������������������  261 27.1 Infrastructure of Hospital Kitchen��������������������������������������������������  261 27.2 Location of Hospital Kitchen����������������������������������������������������������  261 27.3 Size of the Kitchen��������������������������������������������������������������������������  262 27.4 Entry������������������������������������������������������������������������������������������������  262 27.5 Change Rooms Cum Wash Areas ��������������������������������������������������  262 27.6 Receipt Area for Supplies ��������������������������������������������������������������  262 27.7 Storage Area������������������������������������������������������������������������������������  263 27.7.1 Bulk Storage������������������������������������������������������������������  263 27.7.2 Fruit and Vegetable Store����������������������������������������������  263 27.7.3 Refrigeration, Cool Rooms, Freezers����������������������������  263 27.7.4 Storage Areas for Dry Ration/Goods����������������������������  263 27.8 Preparation Areas����������������������������������������������������������������������������  263 27.9 Cooking Areas��������������������������������������������������������������������������������  264 27.10 Reheating Areas������������������������������������������������������������������������������  264 27.11 Packing/Plating ������������������������������������������������������������������������������  264 27.12 Meal Trolley/Cart Parking��������������������������������������������������������������  265 27.13 Food Distribution����������������������������������������������������������������������������  265 27.14 Trolley Return/Stripping ����������������������������������������������������������������  265 27.15 Trolley/Cart Wash ��������������������������������������������������������������������������  265 27.16 Dishwashing������������������������������������������������������������������������������������  265 27.17 Pot Washing������������������������������������������������������������������������������������  266 27.18 Waste Disposal��������������������������������������������������������������������������������  266 27.19 Gas Storage Closet��������������������������������������������������������������������������  266

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27.20 Staff and Support Areas������������������������������������������������������������������  266 27.21 Fixtures, Fittings and Equipment����������������������������������������������������  267 Further Reading ����������������������������������������������������������������������������������������  267 28 Laundry����������������������������������������������������������������������������������������������������  269 28.1 Infrastructure of Laundry����������������������������������������������������������������  269 28.2 Location of the Laundry������������������������������������������������������������������  269 28.3 Size of the Unit ������������������������������������������������������������������������������  269 28.4 Dirty and Soiled Linen Generation ������������������������������������������������  270 28.5 Dirty and Soiled Linen Interim Storage������������������������������������������  270 28.6 Central Storage Area ����������������������������������������������������������������������  270 28.7 Dirty Receipt����������������������������������������������������������������������������������  270 28.8 Sorting and Weighing����������������������������������������������������������������������  271 28.9 Washing Area����������������������������������������������������������������������������������  271 28.9.1 Loading and Washing����������������������������������������������������  271 28.9.2 Extractors����������������������������������������������������������������������  271 28.9.3 Tumble Drying��������������������������������������������������������������  272 28.9.4 Ironing ��������������������������������������������������������������������������  272 28.10 Inspection and Repairing����������������������������������������������������������������  273 28.11 Packaging and Storage��������������������������������������������������������������������  273 28.12 Dispatch Room��������������������������������������������������������������������������������  273 28.13 Trolley Washing������������������������������������������������������������������������������  273 28.14 Store������������������������������������������������������������������������������������������������  274 28.15 Staff and Support Areas������������������������������������������������������������������  274 28.16 Other Issues Relating to the Infrastructure of the Laundry������������  274 28.16.1 Infection Control ����������������������������������������������������������  274 28.16.2 Airflow��������������������������������������������������������������������������  275 28.16.3 Mechanical Ventilation��������������������������������������������������  275 28.16.4 Hot-Air Extraction��������������������������������������������������������  275 28.16.5 Compressors������������������������������������������������������������������  275 28.16.6 Steam ����������������������������������������������������������������������������  275 28.16.7 Water Supply, Heating, and Water Treatment Equipment����������������������������������������������������������������������  275 28.16.8 Fire Prevention and Detection ��������������������������������������  276 28.16.9 Communications������������������������������������������������������������  276 Further Reading ����������������������������������������������������������������������������������������  276 29 Medical  Record Department (MRD) ����������������������������������������������������  277 29.1 Electronic Medical Records (EMR)������������������������������������������������  277 29.2 Location of MRD����������������������������������������������������������������������������  277 29.3 Infrastructure of MRD��������������������������������������������������������������������  278 29.4 Entry and Reception������������������������������������������������������������������������  278 29.5 Medical Record Receipt Room������������������������������������������������������  278 29.6 Compilation Desk ��������������������������������������������������������������������������  278 29.7 Indexing and Coding����������������������������������������������������������������������  279 29.8 Statistical Analysis��������������������������������������������������������������������������  279 29.9 Computer Lab ��������������������������������������������������������������������������������  279

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29.10 Medical Record Storage Room������������������������������������������������������  279 29.11 Dictation Room/Cubicles����������������������������������������������������������������  280 29.12 Transcription Room������������������������������������������������������������������������  280 29.13 Photocopying/Printing Room����������������������������������������������������������  280 29.14 Scanning Room������������������������������������������������������������������������������  280 29.15 Binding Room��������������������������������������������������������������������������������  280 29.16 Waste Holding Room����������������������������������������������������������������������  281 29.17 Store������������������������������������������������������������������������������������������������  281 29.18 Administrative Area������������������������������������������������������������������������  281 29.19 Other Issues About the Infrastructure of MRD������������������������������  281 Further Reading ����������������������������������������������������������������������������������������  282 30 Mortuary��������������������������������������������������������������������������������������������������  283 30.1 Mortuary ����������������������������������������������������������������������������������������  283 30.2 Autopsy Unit����������������������������������������������������������������������������������  283 30.3 Location of the Mortuary����������������������������������������������������������������  283 30.4 Infrastructure of Mortuary��������������������������������������������������������������  284 30.5 Mortuary ����������������������������������������������������������������������������������������  284 30.5.1 Entrance Lobby ������������������������������������������������������������  284 30.5.2 Body Wash��������������������������������������������������������������������  284 30.5.3 Body Holding Area��������������������������������������������������������  284 30.5.4 Waiting/Viewing Area ��������������������������������������������������  285 30.5.5 Storage��������������������������������������������������������������������������  285 30.5.6 Administration Area������������������������������������������������������  286 30.5.7 Exit Lobby ��������������������������������������������������������������������  286 30.6 Autopsy Area����������������������������������������������������������������������������������  286 30.6.1 Pre Autopsy Room��������������������������������������������������������  286 30.6.2 Autopsy Room (Indoor)������������������������������������������������  286 30.6.3 Autopsy Room (Outdoor)����������������������������������������������  286 30.6.4 Post Autopsy Room ������������������������������������������������������  287 30.6.5 Autopsy surgeon’s room������������������������������������������������  287 30.6.6 Instrument Wash Room ������������������������������������������������  287 30.6.7 Viscera Preparation Room ��������������������������������������������  287 30.6.8 Viscera Stores����������������������������������������������������������������  287 30.6.9 Surgeon Change Room��������������������������������������������������  287 30.7 Other Infrastructural Issues Relating to the Mortuary/Autopsy Room����������������������������������������������������������������  288 Further Reading ����������������������������������������������������������������������������������������  288 31 Administration Area��������������������������������������������������������������������������������  289 31.1 Levels of Administrative Staff��������������������������������������������������������  289 31.2 Infrastructure of the Administrative Area ��������������������������������������  290 31.3 Location of the Administrative Area����������������������������������������������  290 31.4 Reception����������������������������������������������������������������������������������������  291 31.5 Infrastructure of Reception ������������������������������������������������������������  291 31.6 Waiting Lobby��������������������������������������������������������������������������������  291 31.7 Offices of the Senior Management ������������������������������������������������  291

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  31.7.1 Electrical Points������������������������������������������������������������  292   31.7.2 Other Communication Points in the Room ������������������  292   31.7.3 Lighting in the Offices��������������������������������������������������  292   31.7.4 Doors ����������������������������������������������������������������������������  292   31.7.5 Windows������������������������������������������������������������������������  292   31.7.6 Flooring ������������������������������������������������������������������������  292   31.7.7 Air-Conditioning ����������������������������������������������������������  293   31.7.8 Room Décor������������������������������������������������������������������  293   31.7.9 Furniture in the Executive Offices��������������������������������  293 31.7.10 Acoustics ����������������������������������������������������������������������  293 31.7.11 Privacy ��������������������������������������������������������������������������  293 31.8 Offices of the Senior Executive Level Management����������������������  294   31.8.1 Electrical Points������������������������������������������������������������  294   31.8.2 Other Communication Points in the Room ������������������  294   31.8.3 Lighting in the Offices��������������������������������������������������  294   31.8.4 Doors ����������������������������������������������������������������������������  294   31.8.5 Windows������������������������������������������������������������������������  294   31.8.6 Flooring ������������������������������������������������������������������������  295   31.8.7 Air-Conditioning ����������������������������������������������������������  295   31.8.8 Furniture in the Executive Offices��������������������������������  295   31.8.9 Acoustics ����������������������������������������������������������������������  295 31.9 Offices of the Executive Level Management����������������������������������  295   31.9.1 Electrical Points������������������������������������������������������������  295   31.9.2 Other Communication Points in the Room ������������������  296   31.9.3 Lighting in the Offices��������������������������������������������������  296   31.9.4 Doors ����������������������������������������������������������������������������  296   31.9.5 Windows������������������������������������������������������������������������  296   31.9.6 Flooring ������������������������������������������������������������������������  296   31.9.7 Air-Conditioning ����������������������������������������������������������  296   31.9.8 Furniture in the Executive Offices��������������������������������  296 31.10 Offices of the Junior Level Management����������������������������������������  297 31.10.1 Electrical Points������������������������������������������������������������  297 31.10.2 Other Communication Points����������������������������������������  297 31.10.3 Lighting in the Offices��������������������������������������������������  297 31.10.4 Doors ����������������������������������������������������������������������������  297 31.10.5 Windows������������������������������������������������������������������������  297 31.10.6 Flooring ������������������������������������������������������������������������  298 31.10.7 Air-Conditioning ����������������������������������������������������������  298 31.11 Support Room/Facilities ����������������������������������������������������������������  298 31.11.1 Senior Management’s PA Room������������������������������������  298 31.11.2 Secretarial Staff ������������������������������������������������������������  298 31.11.3 Kitchen��������������������������������������������������������������������������  298 31.11.4 Dining Area ������������������������������������������������������������������  299 31.11.5 Staff Toilets��������������������������������������������������������������������  299 31.11.6 Store������������������������������������������������������������������������������  299 31.11.7 Notice Boards����������������������������������������������������������������  299

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31.12 Meeting Rooms������������������������������������������������������������������������������  299 31.12.1 Electrical Points������������������������������������������������������������  300 31.12.2 Other Communication Points in the Room ������������������  300 31.12.3 Lighting ������������������������������������������������������������������������  300 31.12.4 Doors ����������������������������������������������������������������������������  300 31.12.5 Windows������������������������������������������������������������������������  301 31.12.6 Flooring ������������������������������������������������������������������������  301 31.12.7 Air-Conditioning ����������������������������������������������������������  301 31.12.8 Room Decor������������������������������������������������������������������  301 31.12.9 Furniture in the Meeting Room ������������������������������������  301 31.12.10 Acoustics ����������������������������������������������������������������������  301 31.12.11 Privacy ��������������������������������������������������������������������������  302 Further Reading ����������������������������������������������������������������������������������������  302 32 Stores  in the Hospital������������������������������������������������������������������������������  303 32.1 Functions of Stores ������������������������������������������������������������������������  303 32.2 Types of Hospital Stores ����������������������������������������������������������������  304 32.3 Planning of Hospital Stores������������������������������������������������������������  304 32.4 Location of the Stores ��������������������������������������������������������������������  304 32.5 Infrastructure of Stores ������������������������������������������������������������������  305 32.5.1 Store������������������������������������������������������������������������������  305 32.5.2 Storekeeper Room ��������������������������������������������������������  305 32.5.3 Store Secretarial Staff����������������������������������������������������  305 32.5.4 Kitchen��������������������������������������������������������������������������  306 32.5.5 Staff Toilets��������������������������������������������������������������������  306 32.5.6 Special Store Room ������������������������������������������������������  306 32.5.7 Cold Room��������������������������������������������������������������������  306 32.5.8 Issue Counter ����������������������������������������������������������������  306 32.5.9 Receiving Area��������������������������������������������������������������  306 32.6 Other Infrastructure Issues��������������������������������������������������������������  307 32.6.1 Electrical Points������������������������������������������������������������  307 32.6.2 Other Communication Points in the Room ������������������  307 32.6.3 Lighting in the Stores����������������������������������������������������  307 32.6.4 Doors ����������������������������������������������������������������������������  307 32.6.5 Windows������������������������������������������������������������������������  307 32.6.6 Flooring ������������������������������������������������������������������������  308 32.6.7 Air-Conditioning ����������������������������������������������������������  308 32.6.8 Furniture in the Stores ��������������������������������������������������  308 32.6.9 Notice Boards����������������������������������������������������������������  308 Further Reading ����������������������������������������������������������������������������������������  308 33 Engineering  and Maintenance Unit ������������������������������������������������������  309 33.1 Works Shops ����������������������������������������������������������������������������������  309 33.1.1 Biomedical Workshop ��������������������������������������������������  309 33.1.2 Electrical Workshop������������������������������������������������������  309 33.1.3 HVAC Workshop ����������������������������������������������������������  310 33.1.4 MGPS Workshop ����������������������������������������������������������  310

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33.1.5 Low Voltage Workshop��������������������������������������������������  310 33.1.6 Building Maintenance ��������������������������������������������������  310 33.1.7 Mechanical Workshop ��������������������������������������������������  310 33.1.8 Fire Fighting Workshop������������������������������������������������  310 33.1.9 Automobile Workshop��������������������������������������������������  310 33.2 Location of the Workshops ������������������������������������������������������������  311 33.3 Infrastructure of Workshops������������������������������������������������������������  311 33.3.1 Workshop����������������������������������������������������������������������  311 33.3.2 Workshop In-charge Room��������������������������������������������  311 33.3.3 Workshop Engineers������������������������������������������������������  312 33.3.4 Staff Toilets��������������������������������������������������������������������  312 33.3.5 Receiving/Issue Counter������������������������������������������������  312 33.4 Other Infrastructure Issues��������������������������������������������������������������  312 33.4.1 Electrical Points������������������������������������������������������������  312 33.4.2 Other Communication Points in the Room ������������������  312 33.4.3 Lighting in the Workshops��������������������������������������������  313 33.4.4 Doors ����������������������������������������������������������������������������  313 33.4.5 Windows������������������������������������������������������������������������  313 33.4.6 Flooring ������������������������������������������������������������������������  313 33.4.7 Air-Conditioning ����������������������������������������������������������  314 33.4.8 Furniture in the Workshop ��������������������������������������������  314 33.4.9 Notice Boards����������������������������������������������������������������  314 Further Reading ����������������������������������������������������������������������������������������  314 Section III  MEP Planning & Designing 34 HVAC (Air-Conditioning) System����������������������������������������������������������  317 34.1 Central Water Chilled Plant������������������������������������������������������������  317 34.1.1 Chillers��������������������������������������������������������������������������  318 34.1.2 Cooling Towers��������������������������������������������������������������  318 34.1.3 Air Handling Systems����������������������������������������������������  318 34.1.4 Variable Air Volume (VAV) Ventilation������������������������  319 34.1.5 Diffusers, Registers and Grills��������������������������������������  319 34.1.6 Ductwork ����������������������������������������������������������������������  320 34.1.7 Air Intake and Exhaust��������������������������������������������������  320 34.1.8 Filtration������������������������������������������������������������������������  321 34.2 Installation of Central Chilled Water Plant:������������������������������������  321 34.2.1 Chillers��������������������������������������������������������������������������  321 34.2.2 Cooling Towers��������������������������������������������������������������  321 34.2.3 Air Handling System ����������������������������������������������������  322 34.3 DX (Direct Expansion) Chilling ����������������������������������������������������  322 34.3.1 The Plant Room������������������������������������������������������������  322 34.3.2 Air Handling Unit Room ����������������������������������������������  322 34.3.3 Air-Conditioned Room��������������������������������������������������  322 34.3.4 Benefits of DX Air-Conditioning Systems��������������������  323 34.3.5 Disadvantages of the DX System����������������������������������  323

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34.4 Split Air Conditioning��������������������������������������������������������������������  323 34.5 HVAC- Room Side Design ������������������������������������������������������������  323 Further Reading ����������������������������������������������������������������������������������������  324 35 Electrical Services������������������������������������������������������������������������������������  327 35.1 Primary Power Supply (PPS)����������������������������������������������������������  327 35.2 Secondary Power Supply (SPS)������������������������������������������������������  327 35.3 Tertiary Power Supply (TPS)����������������������������������������������������������  327 35.4 Electrical Load Calculation������������������������������������������������������������  328 35.5 HT Distribution System������������������������������������������������������������������  328 35.6 LT Power Distribution��������������������������������������������������������������������  328 35.7 Redundancy Due to Power Failure ������������������������������������������������  329 35.8 Emergency Power Generation System��������������������������������������������  329 35.9 Uninterrupted Power Supply System (UPS)����������������������������������  329 35.10 Switching Arrangement������������������������������������������������������������������  330 35.11 Emergency Lighting������������������������������������������������������������������������  330 35.12 Earthing System������������������������������������������������������������������������������  330 35.13 System of Wiring and Cabling��������������������������������������������������������  331 35.14 Switches/Sockets and Boxes����������������������������������������������������������  331 35.15 Lightning Protection ����������������������������������������������������������������������  331 35.16 Power Quality ��������������������������������������������������������������������������������  331 35.17 Power Factor Correction ����������������������������������������������������������������  332 35.18 Street Lighting System��������������������������������������������������������������������  332 35.19 Lighting Management System��������������������������������������������������������  332 35.19.1 Occupancy Sensor ��������������������������������������������������������  332 Further Reading ����������������������������������������������������������������������������������������  333 36 ELV,  ICT and IBMS Services ����������������������������������������������������������������  335 36.1 Data System������������������������������������������������������������������������������������  335 36.2 Nurse Call System��������������������������������������������������������������������������  335 36.2.1 Desktop Console������������������������������������������������������������  335 36.2.2 Room Lights������������������������������������������������������������������  336 36.2.3 Patient Call with Handset����������������������������������������������  336 36.2.4 Patient Call – in Toilets��������������������������������������������������  336 36.2.5 Staff Assist Call ������������������������������������������������������������  336 36.2.6 Emergency Call ������������������������������������������������������������  336 36.2.7 Wireless Handset ����������������������������������������������������������  337 36.2.8 Wireless Console ����������������������������������������������������������  337 36.2.9 Audio-Video Nurse Call System ����������������������������������  337 36.3 Electronic Security and Video Surveillance System ����������������������  337 36.3.1 Closed Circuit Television System (CCTV) ������������������  337 36.4 Access Control System ������������������������������������������������������������������  338 36.4.1 No-Touch Access����������������������������������������������������������  339 36.5 Telecommunication System������������������������������������������������������������  340 36.6 Patient Entertainment and Information Systems����������������������������  340 36.7 Queue Management System ����������������������������������������������������������  340

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36.8 Public Address System��������������������������������������������������������������������  340 36.9 Integrated Building Management Systems (IBMS)������������������������  341 Further Reading ����������������������������������������������������������������������������������������  342 37 Information Technology and Computerization������������������������������������  343 37.1 Health Information System (HIS)��������������������������������������������������  344 37.2 Modules of Hospital Information Software������������������������������������  344 37.2.1 Information Desk Module ��������������������������������������������  345 37.2.2 Patient Registration Module������������������������������������������  345 37.2.3 Outpatient Management Module����������������������������������  345 37.2.4 Inpatient Management Module��������������������������������������  345 37.2.5 Admission, Transfer, Discharge (ADT) Module ����������  346 37.2.6 Consulting Appointment Management Module������������  346 37.2.7 Bed Management Module ��������������������������������������������  346 37.2.8 Ward Management Module ������������������������������������������  346 37.2.9 Nursing Management Module��������������������������������������  346 37.2.10 Operating Room Module����������������������������������������������  347 37.2.11 Laboratory Module��������������������������������������������������������  347 37.2.12 Blood Bank Module������������������������������������������������������  347 37.2.13 Radiology Module ��������������������������������������������������������  347 37.2.14 Picture Archiving and Communication System (PACS) Module������������������������������������������������  347 37.2.15 Casualty & Emergency Management System ��������������  348 37.2.16 Pharmacy Information System��������������������������������������  348 37.2.17 Order Management System Module������������������������������  348 37.2.18 The Birth/Death Registration Module ��������������������������  348 37.2.19 Electronic Medical Records Module ����������������������������  348 37.2.20 Billing and Finance Module������������������������������������������  348 37.2.21 Insurance and Medi-claim Module��������������������������������  349 37.2.22 Human Resources Module��������������������������������������������  349 37.2.23 Materials Management System (Stock, Purchasing and Fixed Asset Module)����������������������������  349 37.2.24 Dietary Module/Catering Module ��������������������������������  349 37.2.25 Statistics and Reporting Module (MIS)������������������������  349 37.2.26 Hospital Analytics ��������������������������������������������������������  349 37.2.27 Interface Module�����������������������������������������������������������  350 Further Reading ����������������������������������������������������������������������������������������  350 38 Water  Supply and Drainage System������������������������������������������������������  351 38.1 Source of Water Supply������������������������������������������������������������������  351 38.2 Water Storage����������������������������������������������������������������������������������  352 38.2.1 Water Storage Tank Locations��������������������������������������  352 38.3 Systems of Water Treatment ����������������������������������������������������������  352 38.3.1 Pasteurization����������������������������������������������������������������  353 38.3.2 Chemical Treatment������������������������������������������������������  353 38.3.3 Chlorine Water Treatment����������������������������������������������  353

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38.3.4 Water Softener Plants����������������������������������������������������  353 38.3.5 Silver-Copper Ionization ����������������������������������������������  353 38.3.6 Reverse Osmosis Treatment������������������������������������������  353 38.3.7 Ultraviolet Treatment����������������������������������������������������  354 38.3.8 Ozone Water Treatment ������������������������������������������������  354 38.3.9 Distilled Water ��������������������������������������������������������������  354 38.4 Drinking Water��������������������������������������������������������������������������������  354 38.5 Water Booster Pumps����������������������������������������������������������������������  354 38.6 Hot Water System ��������������������������������������������������������������������������  355 38.6.1 Electrical Hot Water Generation������������������������������������  355 38.6.2 Hot Water Generation from Boiler/Steam by Burning Fuel������������������������������������������������������������  355 38.6.3 Solar Hot Water Generation������������������������������������������  355 38.6.4 Stand-Alone Hot Water Geysers������������������������������������  355 38.7 Sanitary Fittings������������������������������������������������������������������������������  356 38.8 Irrigation Water Supply������������������������������������������������������������������  356 38.9 WC Flushing Systems��������������������������������������������������������������������  356 38.10 Steam System����������������������������������������������������������������������������������  357 38.11 Drainage Strategy����������������������������������������������������������������������������  358 38.12 Types of Drainage Systems������������������������������������������������������������  358 38.12.1 Wastewater Drainage ����������������������������������������������������  358 38.12.2 Soil Water Drainage������������������������������������������������������  358 38.12.3 Storm Water Drainage ��������������������������������������������������  358 38.12.4 Chemical Drainage��������������������������������������������������������  358 38.12.5 Radiation Drainage��������������������������������������������������������  359 38.13 Methods of Drainage����������������������������������������������������������������������  359 38.13.1 Vent Pipes����������������������������������������������������������������������  359 38.13.2 Floor Drains������������������������������������������������������������������  359 38.13.3 Soil Water Drainage������������������������������������������������������  359 38.13.4 Rainwater Drainage System������������������������������������������  359 38.13.5 Infectious Contaminated Drainage��������������������������������  359 38.13.6 Radiation Drainage��������������������������������������������������������  360 38.13.7 Kitchen Grease Drainage����������������������������������������������  360 Further Reading ����������������������������������������������������������������������������������������  360 39 Vertical Transportation System��������������������������������������������������������������  361 39.1 Lift Categories��������������������������������������������������������������������������������  361 39.1.1 General Passenger Lifts ������������������������������������������������  361 39.1.2 Bed Lifts������������������������������������������������������������������������  362 39.1.3 Service/Goods Lift��������������������������������������������������������  362 39.2 Design Considerations��������������������������������������������������������������������  362 39.3 Engineering Guidelines������������������������������������������������������������������  362 Further Reading ����������������������������������������������������������������������������������������  363 40 Pneumatic Tube Systems (PTS)��������������������������������������������������������������  365

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40.1 Pneumatic Tube System Components��������������������������������������������  365 40.1.1 Blower & Air Reverse Valve������������������������������������������  365 40.1.2 Carrier����������������������������������������������������������������������������  366 40.1.3 Control Centre ��������������������������������������������������������������  366 40.1.4 Database������������������������������������������������������������������������  366 40.1.5 Inter-zone Connection ��������������������������������������������������  366 40.1.6 Station����������������������������������������������������������������������������  366 40.1.7 Diverter��������������������������������������������������������������������������  366 40.1.8 Tubing����������������������������������������������������������������������������  367 40.1.9 Zone������������������������������������������������������������������������������  367 40.1.10 Slow Speed Device��������������������������������������������������������  367 Further Reading ����������������������������������������������������������������������������������������  367 41 Signage System ����������������������������������������������������������������������������������������  369 41.1 Categories Using Way-Finding ������������������������������������������������������  369 41.1.1 Patients and Visitors������������������������������������������������������  369 41.1.2 Staff ������������������������������������������������������������������������������  369 41.1.3 Users with Special Needs����������������������������������������������  370 41.1.4 Sensory Impairment������������������������������������������������������  370 41.1.5 Language and Illiteracy ������������������������������������������������  370 41.2 Principles for Designing a Wayfinding System������������������������������  370 41.3 Types of Sign Boards����������������������������������������������������������������������  371 41.3.1 Classified by Function ��������������������������������������������������  371 41.3.2 Signs Classified by Physical Characteristics ����������������  372 41.3.3 Other Factors in the Classification of Sign Boards�������  372 Further Reading ����������������������������������������������������������������������������������������  373 42 Bio-Medical Waste Management������������������������������������������������������������  375 42.1 Classification of Hospital Waste ����������������������������������������������������  375 42.1.1 Bio-Medical Waste��������������������������������������������������������  376 42.1.2 General Waste����������������������������������������������������������������  376 42.1.3 Other Wastes������������������������������������������������������������������  376 42.2 Steps Involved in Bio-Medical Waste Management ����������������������  376 42.3 Bio-Medical Waste Segregation������������������������������������������������������  377 42.4 Bio-Medical Waste Collection��������������������������������������������������������  377 42.4.1 Time of Collection��������������������������������������������������������  377 42.4.2 Packing of Bio-Medical Waste & Labelling������������������  377 42.4.3 Interim Storage��������������������������������������������������������������  377 42.5 Transportation of Bio-Medical Waste in Hospital��������������������������  378 42.5.1 Transportation Trolleys��������������������������������������������������  378 42.5.2 Route of Transportation������������������������������������������������  378 42.5.3 Central Waste Collection Room for Bio-Medical Waste 378 42.6 Record Keeping������������������������������������������������������������������������������  378 42.7 Updating Information on the Website ��������������������������������������������  379 42.8 Management of General Waste ������������������������������������������������������  379 42.9 Management of Other Wastes ��������������������������������������������������������  379

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42.9.1 Used Batteries����������������������������������������������������������������  379 42.9.2 Management of Radioactive Wastes������������������������������  379 42.9.3 Management of E-Wastes����������������������������������������������  380 42.10 Effluent Treatment Plant (ETP/STP)����������������������������������������������  380 42.10.1 Preliminary Stage����������������������������������������������������������  380 42.10.2 Primary Stage����������������������������������������������������������������  380 42.10.3 Secondary Stage������������������������������������������������������������  380 42.10.4 Tertiary Stage����������������������������������������������������������������  381 Further Reading ����������������������������������������������������������������������������������������  381 43 Fire Safety������������������������������������������������������������������������������������������������  383 43.1 Planning for Fire Safety in Hospitals����������������������������������������������  383 43.2 Structural Elements for Fire Safety������������������������������������������������  384 43.2.1 Compartmentalization ��������������������������������������������������  384 43.2.2 Open Spaces������������������������������������������������������������������  384 43.2.3 Basements����������������������������������������������������������������������  385 43.2.4 General Exit Requirements��������������������������������������������  385 43.2.5 Corridors and Passageways ������������������������������������������  385 43.2.6 Staircases ����������������������������������������������������������������������  386 43.2.7 Ramps����������������������������������������������������������������������������  386 43.2.8 Electrical and Emergency Power����������������������������������  386 43.2.9 Air Conditioning, Ventilation and Smoke Control��������  386 43.2.10 Fire Barrier��������������������������������������������������������������������  387 43.2.11 Glazing��������������������������������������������������������������������������  387 43.2.12 Surface Interior Finishes������������������������������������������������  387 43.2.13 Fire Command Center (FCC)����������������������������������������  387 43.3 Fire Detection and Alarm����������������������������������������������������������������  387 43.4 Fire Extinguishers/Fixed Fire Fighting Installations����������������������  388 43.4.1 Static Water Storage Tanks��������������������������������������������  388 43.4.2 Fire-Fighting Pump House��������������������������������������������  388 43.4.3 Automatic Sprinkler Installation ����������������������������������  388 Further Reading ����������������������������������������������������������������������������������������  389 44 Green Hospitals����������������������������������������������������������������������������������������  391 44.1 What Is Green Hospital������������������������������������������������������������������  391 44.2 Elements of a Green Hospital ��������������������������������������������������������  391 44.2.1 Energy Conservation ����������������������������������������������������  392 44.2.2 Alternative Means of Energy Generation����������������������  392 44.2.3 Water Conservation ������������������������������������������������������  393 44.2.4 Indoor Environmental Quality and HVAC Optimization������������������������������������������������������������������  393 44.2.5 Chemical Management��������������������������������������������������  394 44.2.6 Solid Waste Management����������������������������������������������  394 44.2.7 Environmental Services ������������������������������������������������  395 44.2.8 Food Services����������������������������������������������������������������  396 44.2.9 Environmentally Preferable Purchasing������������������������  397

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44.2.10 Sustainable Construction Materials������������������������������  397 44.2.11 Pharmaceutical Minimization, Management and Disposal ������������������������������������������������������������������������  398 44.2.12 Reducing Transportation Cost ��������������������������������������  398 44.2.13 Greenery������������������������������������������������������������������������  399 Further Reading ����������������������������������������������������������������������������������������  399 Section IV  Equipment Planning 45 Equipment Planning��������������������������������������������������������������������������������  403 45.1 Choosing the Desired Equipment ��������������������������������������������������  403 45.1.1 Quality of the Equipment����������������������������������������������  403 45.2 Points to Be Considered While Purchasing the Medical Equipment ��������������������������������������������������������������������������������������  404 45.2.1 Equipment Specification and Configuration������������������  404 45.2.2 Warranty������������������������������������������������������������������������  404 45.2.3 Maintenance Contracts��������������������������������������������������  404 45.2.4 Availability of the Service Engineers and the Workshops ��������������������������������������������������������������������  405 45.2.5 Period of Spare Part Availability ����������������������������������  405 45.2.6 Cost of Consumables����������������������������������������������������  405 45.2.7 Life Expectancy of the Equipment��������������������������������  405 45.2.8 Plan for Space and Development����������������������������������  405 45.2.9 Vendors Evaluation��������������������������������������������������������  405 45.2.10 Regulatory Compliance ������������������������������������������������  406 45.2.11 Inspection and Testing Before the Transfer of Ownership����������������������������������������������������������������������  406 45.3 Equipment Used in the Hospital ����������������������������������������������������  406 Further Reading ����������������������������������������������������������������������������������������  417

About the Author

Ajay Garg, FCA, DHA, SAP(FI)  Ajay Garg has been in the field of healthcare planning, designing, and administration for the last three decades. He has worked for about 30 years with various hospitals like Narinder Mohan Hospital & Heart Centre, Ghaziabad; Jeevan Rekha Hospital, Kashipur; Teerthanker Mahaveer Medical College, Moradabad; etc. He has also completed various hospital projects like Krishna Hospital (Kashipur), Narayan Hospital (Rudrapur), Le-Crest Hospital (Vasundra, Ghaziabad), and TSM Medical College and Hospital (Lucknow) as a hospital consultant.

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Chapter 1

Phases of Planning and Designing

A “Hospital or Health Care Facility” is a complex building/project that requires careful planning, design, construction, and operation. The quality of planning and design has a long-term impact on hospital performance. Hospital projects involve significant investments, making it impractical to frequently change designs once constructed. The design of hospitals directly affects the satisfaction of patients, staff, and family members. Well-planned hospitals contribute to reducing errors, infection rates, accidents, and staff injuries, while also improving patient recovery rates and staff satisfaction. A well-designed hospital can provide essential mental, physical, and psychological support to patients during the healing process. The phases involved in setting up a hospital project are as follows: 1. Hospital Planning Includes master planning, pre-design considerations, and feasibility reports along with the DPR. 2. Schematic Design Involves creating the initial outline of the hospital project, including conceptual designs and room layouts. 3. Construction Documents Converts detailed drawings into documents for cost estimation and construction planning. 4. Design and Development Includes drawing various units of the hospital and adding infrastructure and design details. 5. MEP Planning Focuses on planning MEP services such as electricity, plumbing, security systems, and IT networking. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_1

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1  Phases of Planning and Designing

6. Construction The actual building construction phase of the hospital. 7. Equipment Planning Involves determining equipment requirements, finalizing technical specifications, and procuring, and commissioning equipment. 8. Man Power Planning Assesses manpower requirements, finalize SOPs, and handles staff recruitment. 9. Finalising the Standard Operating Procedures (SOP) of the Hospital Establishes the rules, regulations, and rate lists for hospital operations. 10. Commissioning Tests services, trains staff, and prepares the hospital for operation. Hospitals are complex buildings with various functional units, each having specific infrastructure requirements. The design of hospitals may be influenced by climate, budget, technology, and available resources, but the best design should anticipate future changes and adopt flexibility to accommodate advancements in healthcare technology. It is challenging to predict hospital requirements far into the future due to rapid advancements in healthcare technology. Hospital designs must allow for easy adoption of changes to stay competitive. Demographic changes, technological developments, and policy shifts may put pressure on hospitals to adapt over time. Designers should avoid planning the hospital as per today’s requirement, but should think strategically with a long-term vision. Hospital infrastructure plays a crucial role in achieving hospital objectives, so it must be attractive, functional, and safe. Planning starts with the inception of the idea of building a hospital and includes selecting suitable land and designing individual units like emergency rooms, ICUs, operating rooms, and patient wards. Overall, a well-thought-out and adaptable hospital design is essential to ensure the success and efficiency of healthcare facilities in the long run.

Further Reading Garg A, Dewan A. Chapter 1, phases of planning and designing. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 3–5. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Section I

Planning

Chapter 2

Inception of the Idea

The planning of a hospital starts with the idea of setting it up. The first consideration is the location, which can depend on personal factors, assumptions about patient numbers, and the availability of hospitals in the area. However, promoters need to assess the purpose of the hospital and their role in managing it. Questions to address include: (a) Why am I building this hospital? (b) What is the hospital’s purpose and philosophy? Is it for community service or a business venture? (c) What is my profession, and how will I manage the hospital if I am not a medical professional? (d) What will happen to the hospital after my death? Are my children interested in continuing the project? (e) Do I want to incorporate charity into the hospital? If so, to what extent? Once these questions are answered, the promoter should proceed and decide the hospital’s status, such as trust-owned charitable, community, or corporate hospital. The next step is preparing a Feasibility Report, assessing the hospital’s success in the proposed location based on surveys in the nearby area. Survey-based answers to these questions can help promoters understand the potential business in the hospital’s location: (a) Coverage Area & Residents: Determine the area and population that will be benefited from the hospital’s services. (b) Service Reach: Assess the number of cities or villages the hospital can serve. (c) Expected Population: Estimate the population likely to use the hospital’s services. (d) Competing Hospitals: Gather data on nearby hospitals, their bed strength, and services offered.

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(e) Nursing Homes & Clinics: Collect information about nursing homes and individual practitioners’ clinics in the vicinity. These survey results, supported by documentary evidence, aid promoters in making informed decisions about the hospital’s location and potential business opportunities. Geographical details of the hospital location should then be collected, including proximity to transportation hubs, police and fire stations, public occupation, per capita income, living standards, paying capacity, and the presence of government offices and employees. Once all this information is gathered and analyzed, the promoter should make an informed decision about the hospital’s location.

Further Reading Garg A, Dewan A. Chapter 2, Inception of the idea. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 7. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 3

Factors Assessing Feasibility of the Hospital

Consideration of actual facts is crucial for developing appropriate hospital facilities. Pre-programming, research surveys, and discussions help determine the most suitable programming, planning, and designing of the hospital setup.

3.1 Several Key Factors Need to Be Analyzed During the Planning Phase 3.1.1 Demographics Assess population trends, life expectancy, age, gender, and population growth in the area to be served by the hospital.

3.1.2 Understanding the Type of Diseases Identify prevalent diseases in the region, including chronic, waterborne, and non-­ communicable ailments, to plan for prevention and treatment.

3.1.3 Community Evaluate the community’s knowledge, awareness, and health initiatives, considering factors like climate, culture, religion, financial wellness, education level, and paying capacity. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_3

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3.1.4 Healthcare Systems and Hospitals Network Analyze existing healthcare facilities, including clinics, nursing homes, and hospitals, to understand the demand for services and potential patient load.

3.1.5 Innovations in Facility Planning and Management Stay updated on the latest developments in hospital planning, design, construction, and operations for effective facility management.

3.1.6 Speciality Facilities and Departments Determine the need for specialized departments like OPDs, Intensive Care Units, and Emergency department based on expected patient numbers and critical care.

3.1.7 Medical Tourism Assess the potential for medical tourism, where people travel to other countries for cost-effective or high-quality medical treatment.

3.1.8 Health Insurance and Empanelment Consider the percentage of insured individuals and employees with access to free medical facilities in government, semi-government, and private institutions.

3.1.9 Catchment Area Analyze the catchment area from where patients are expected to avail of the hospital’s services, including existing facilities, distances, transportation, and referring physicians. A thorough analysis of these factors will aid in effective hospital planning and designing, ensuring better facility utilization and revenue generation.

Further Reading

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Further Reading Garg A, Dewan A. Chapter 3, Factors assessing feasibility of the hospital. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 9–11. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 4

Preparation of Detailed Project Report (DPR) and Techno-Commercial Feasibility Report (TCFR)

The Detailed Project Report (DPR) is a comprehensive document that outlines the planning and projections for a project. It covers aspects like financials, time planning, required activities, and resources. The DPR serves as a vital tool for management to assess project progress and viability, aiding decision-making throughout the project's lifecycle. The DPR provides real-time progress tracking and facilitates a comparison of actual vs projected figures.

4.1 Information to Be Generally Provided in DPR 1. General Information about the hospital project, including the promoters' background and experience in the industry. 2. Details of hospital beds, wards, departments, services, and critical units. 3. Schedule of the implementation period and project cost breakdown. 4. Manpower requirements, salary details, and staff planning. 5. Resources, financing arrangements, and working capital requirements. 6. Revenue projections, profit and loss statements, and cash flow analysis for the next 10–15 years. 7. Government approvals and statutory permissions are needed for the project.

4.2 Documents DPR Should Contain As the DPR is a complete set of planning and assessment documents, it shall contain the following documents:

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1. Location profile and geotechnical site characterization like climate & rainfall, map, physical characteristics, economy & industries and transportation and communications. 2. Synopsis and project at a glance. 3. Executive summary. 4. Organisation details like name and status of the organisation, name of the director(s)/management, name of hospital, capacity of the hospital (bed) etc. 5. Industry analysis including an overview of the healthcare industry, structure & segmentation of the hospital industry, market size of the healthcare and growth options. 6. Hospital management issues like management & commercial plans including a brief introduction of the hospital management, OPD, IPD, diagnostic, interventional services etc. 7. Planning the hospital including permissions & clearances required from the Govt., local bodies, advertising, marketing & promotional planning, mobilisation of the bank loans, planning to get hospital accreditations, and tentative project implementation plan. 8. Planning of hospital building including site selection, draft site plan, key flow chart, flow chart of departments, vendors and suppliers of building materials, contractors for construction, and contractor for MEP services. 9. Financials (projections are given for the next 10–15 years) including projections of the number of patients likely to avail services department-wise and service-wise, calculation of projected revenue/income/realisation from the hospital, calculation of projected expenses/cost of products/services/items for the hospital, projected surplus/deficit, financial charges, net profit after taxes, profits & appropriations, projected cash flow, projected balance sheets for 10–15 years. 10. Profitability ratios like Return Of Investment (ROI), D.S.C.R, Earnings Per Share (EPS), Debt Equity Ratio, Liquidity Ratios, Break-Even Analysis, Sensitivity Analysis-Price/Volume, Projected Pay-Back Period and IRR 11. The project cost of building including the cost of land, architect and consultants fees, building construction costs including costs of MEP services, finishing and furnishing etc. 12. The projected cost of hospital equipment, consumables, disposables, misc. small instruments, linen, backup services like (ambulances, autoclaves, computers with printers & UPS, fridges, hospital operating software, televisions, water coolers, oxygen cylinders etc.), patient furniture, library books, skill development, preoperative and preliminary expenses and provision of contingencies etc. 13. Means of funds for projects or sources and disposition of funds like Promoters Contribution, Equity Share Capital, Term Loan from Banks / Financial Institutions, Unsecured Loans etc. 14. Challenges in the hospital industry 15. Hospital equipment and facilities Photograph 16. Conclusion

4.4  Evaluation of DPR

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4.3 General Contents of DPR The DPR includes essential Guidelines, Information, Procedures, and Policies for planning and execution, as follows: (a) General guidelines and conditions for contractual agreements with agencies during project implementation. (b) Guidelines for dispute resolution and arbitration procedures, specifying powers, arbitrator selection, and venue. (c) Guidelines for supply, erection, installation, commissioning, and guarantee/ warranty of equipment. (d) Guidelines for vendor selection, tendering process, and model documents for the invitation to tenders. (e) Vendor short-listing guidelines with details on commitments, payments, testing procedures, and contract variations. (f) Estimate of capital funds required for each project phase, aiding strategic planning for funding. (g) Schedule for adequate fund flow, ensuring timely project completion with contingency provisions. (h) Recommended system for financial expense monitoring compared to project progress. (i) PERT chart depicting activity and project timelines, including dependent work starting and ending dates. (j) Contingency plans for coping with time lost due to delays in specific activities.

4.4 Evaluation of DPR The owner's evaluation of the DPR is crucial, and they may seek clarifications on the following questions: 1. Aunthausity of the critical data sources in the DPR (demand, capital cost, input cost, etc.)? 2. Reflection of top management's strategic plan in the design? 3. Methodology for considering alternatives and the selection process? 4. Compliance with statutory requirements and foreseeable regulations? 5. Identification of potential problems, hurdles, bottlenecks, and major risks? 6. Degree and depth of detailing in the plan and design? 7. Impact of complementary/completing projects? 8. Scope for future expansion, modification, and adoption of new technologies? The above is a sample of questions owners might ask during the selection, appraisal, and approval of the DPR.

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4  Preparation of Detailed Project Report (DPR) and Techno-Commercial Feasibility…

Further Reading Garg A, Dewan A.  Chapter 4, Preparation of Detailed Project Report (DPR) and Techno-­ Commercial Feasibility Report (TCFR). In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 13–27. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 5

Site Selection

The selection of a site for the construction of the hospital is an important issue. If the wrong site is selected, it can be very harmful to the overall project. When selecting a site for the hospital, consider the following factors:

5.1 Size of the Land Rquired for Hospital Hospitals require large spaces for various services like OPD, IPD, diagnostic, interventions, stores, administrative areas, and waiting rooms. Careful consideration should be given to the current and future space needs. Provision for future expansion is crucial, looking ahead at least 20 years. Expansion may be necessary due to population growth, increased patient load, the addition of specialities, advanced machinery, etc. Failing to plan for future expansion can be problematic later on.

5.2 Assessment of the Covered Area Required for Hospital Before finalizing the land size, conduct a detailed assessment of the covered area needed for the hospital building. List all services provided and determine the required rooms. Calculate the total area requirement by multiplying room sizes and numbers, including provisions for future expansion. Add a percentage for movement spaces like corridors, staircases, and elevators (e.g., 35%) to find the total area needed for the hospital. Next, consider norms specified by development authorities or government agencies for constructing commercial buildings. Some of these norms are:

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5.2.1 Total FAR Allowed FAR means the Floor Area Ratio. FAR can be different for different cities. Based on the allowed FAR, the area of land has to be calculated.

5.2.2 Set Back Area Consider the setback areas required to be left around the building as per norms.

5.2.3 Maximum Permissible Land Coverage Adhere to the allowed land coverage percentage.

5.2.4 Maximum Permissible Height of Building Consider height restrictions based on various factors. Evaluate how the calculated covered area fits within these norms to determine the land space required.

5.3 Some of the Other Factors to Be Considered While Finalising the Land Are 5.3.1 Approach to the Site Ensure easy access for both the community and service vehicles.

5.3.2 Location of the Land Consider the distance from the main road and the frontage of the land.

5.3  Some of the Other Factors to Be Considered While Finalising the Land Are

5.3.3 Availability of Transportation Ensure good public transport facilities in the area.

5.3.4 Security Choose an area with sufficient security measures.

5.3.5 Availability of Utilities Ensure reliable utilities like water, gas, sewer, and electricity are nearby.

5.3.6 Road Network in the Area Proper and wide roads should allow easy traffic movement.

5.3.7 Environmental Pollution One must try to choose the site having the least environmental pollution.

5.3.8 Wind and Earthquake Consider historical data on wind pressure and earthquake in the area.

5.3.9 Flood Protection Avoid flood-prone areas and select a location that can handle occasional floods.

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Further Reading Garg A, Dewan A. Chapter 5, site selection. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 29–31. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 6

General Issues to Be Considered While Designing Hospital Building

Hospital building design should prioritize adequate spaces for easy movement of materials, patients, and staff, ensuring efficient workflow and privacy. Compliance with regulatory and accreditation standards is essential. Considerations should include sun/daylight positioning, air pathways, and specific requirements of medical equipment. The design must accommodate flexibility and expandability, focus on patient experience, employee productivity, accessibility, security, safety, resource sustainability, cost-effectiveness, and technological advancements. Emphasis should be on reducing stress and fear, providing a therapeutic environment, cleanliness, noise reduction, infection control, and environmental pollution control. Additionally, internal roads and parking, resistance to natural disasters, and integration of nature, artwork, soothing colours, and appropriate materials and flooring are crucial.

6.1 Importance of Hospital Planning and Designing A hospital is a place where patients receive emergency care and medical treatments. To ensure efficient functioning and quality healthcare provision, the hospital building should be designed to accommodate all necessary equipment and facilitate easy movement of staff and materials. The design process should involve a professional team consisting of experts from various disciplines, such as doctors, administrators, architects, engineers, and planners. Factors to consider during hospital design include the location, patient and staff movement, treatment options, and community health needs. With modern hospitals becoming more patient-focused and providing specialized services, the design should prioritize patient privacy, dignity, and involvement in the treatment process. To meet the requirements of various authorities and industry standards, hospital designers should adhere to regulations like NABH in India and JCI internationally. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_6

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Additionally, the hospital environment should support patient well-being and the healing process. Before starting the design, the designer should clarify issues related to site location, land size and shape, setback areas, height restrictions, master planning, room and area requirements, services offered, future expansion plans, medical equipment needs, diagnostic facilities, staffing requirements, waiting area capacity, workflows, patient footfalls, patient needs, bed types and numbers, and operating room specifications. In summary, a well-designed hospital that considers these considerations can significantly impact how healthcare is provided and experienced, ensuring optimal patient care and comfort.

6.2 Various General Issues Relating to the Hospital Designing 6.2.1 Flexibility and Expandability Advancements in medical sciences are ongoing and will continue in the future, leading to changing treatment needs. Hospital designs should accommodate such advancements without extensive modifications, anticipating at least 20 years ahead and providing extra spaces for future expansion. Modular concepts, generic room sizes, and easily accessible mechanical and electrical systems should be considered to optimize cost factors.

6.2.2 Patient-Focused Design A hospital's main objective is patient diagnosis and treatment. Therefore, designers must create an environment that promotes patient well-being. This includes providing spaces for patient belongings, convenient mobile charging stations, comfortable waiting areas, and designated spaces for private discussions with physicians.

6.2.3 Design for Employee Productivity While patients are crucial to a hospital's success, employee satisfaction and productivity are equally important. Designers should consider the input of physicians and staff to create spaces that allow them to work efficiently and deliver quality services to patients and their families.

6.2  Various General Issues Relating to the Hospital Designing

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6.2.4 Accessibility to the Patient Accessibility is vital in hospitals to ensure patients and attendants can reach different areas easily. Hospital corridors, staircases, ramps, and elevators (such as Bed Elevators) should be wide and sufficient to accommodate patients on beds, wheelchairs, or crutches. Properly designed ambulance bays and helipads may also be necessary.

6.2.5 Security and Safety Hospitals being public places, security and safety are paramount concerns. Designers must incorporate features to protect hospital property, assets, patients, and staff. Patient safety is also crucial, so non-slip surfaces, secure fixtures, and suicide prevention measures should be included in the design. Windows should be designed to prevent jumping, and fittings that could be used for hanging should be avoided.

6.2.6 Sustainability of Resources A hospital building is a significant consumer of resources like energy and water, impacting the surrounding community. To reduce consumption and costs, sustainable designs should be employed, incorporating sensor technology for energy efficiency and considering alternate energy sources like solar power and rainwater harvesting.

6.2.7 Efficiency and Cost-Effectiveness Efficiency in hospital design should never be compromised. Although some additional costs may be involved in achieving efficiency, they should be considered. Efficient hospital layout includes minimizing travel distance between frequently used spaces, ensuring quick access during emergencies, visual patient supervision, and optimizing logistics for supplies and waste management.

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6.2.8 Adaptation of Technological Advancements With continuous advancements in electronics and web technology, hospital designers must plan spaces that can easily accommodate future technological upgrades. Adoption of telemedicine, electronic medical records, and clinical decision-support systems should be considered. Keeping the design adaptable to changing technology is crucial for providing timely and accurate care.

6.2.9 Stress and Fear of Patients and Visitors The hospital design should aim to reduce stress and fear for patients and visitors. Providing spaces for worship, positive quotes, religious photographs, and continuous counselling can create a positive environment. The design should focus on promoting well-being and comfort.

6.2.10 Quality Care of Patients Efficient design elements, such as the placement of critical units, operating theatre suits, and strategically placed medical officer rooms, can ensure quick and quality care for patients. Considering various factors while designing the building can contribute to efficient healthcare delivery.

6.2.11 Therapeutic Environment Creating a therapeutic environment involves incorporating natural light, fresh air, cheerful colours, and outside views from patient beds. Effective signage systems and designs that reduce fear, noise, and infection rates contribute to a safe and private environment for healing.

6.2.12 Cleanliness and Sanitation Hospital design must prioritize cleanliness and sanitation to prevent the spread of diseases and infections. A careful selection of materials that are easy to clean, sterilize, and resist punctures, impacts, and stains is essential for maintaining a hygienic environment.

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6.2.13 Noise Reduction In a hospital setup, noise can interfere with patients' comfort, communication, concentration, cognitive performance, and increase stress and fatigue. It may also adversely impact healing, disturb sleep, and reduce overall patient satisfaction levels. Noise sources can include the movement of people and material, patient screams, mechanical and electrical systems, outside traffic, unwanted announcements, and loud talking. To address these issues and reduce noise, the beds should be positioned on opposite walls rather than common walls, use noise-absorbing flooring materials like rubber or PVC, install triple glazed windows to provide better sound insulation, use nurse call systems with minimal tone and vibration features, install vibration pads for electrical and mechanical machines, walls shall be properly insulated to dampen sound transmission, opt for special ceiling tiles, encourage staff and visitors to keep their mobile phones on vibrating mode to avoid disturbances.

6.2.14 Minimizing Operative, Postoperative, and Hospital-Acquired Infections Due to the high number of people in hospitals, infection risks are significant. To reduce infection rates, hospital designers should consider the factors such as designing the operating complex with one-way movement, providing separate zones for infectious patients and implementing proper barricading in infectious areas, installing internal window blinds to reduce dust accumulation, providing air filtration systems with HEPA filters, consider using ultraviolet lights in clinical areas, the hospital layout should ensure cross ventilation, use radiant heat panels to prevent condensation, minimize waiting areas in patient treatment areas to reduce patient contact and potential transmission etc.

6.2.15 Automation Wherever Possible Integrate automation and technology in the hospital design to improve patient care and reduce reliance on manual systems. Some automation measures may include electronic medical records, bar-coding, physician order entry, pneumatic tube systems, computers in rooms, and sophisticated nurse call systems.

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6.2.16 Environmental Pollution Control Ensure compliance with environmental pollution control laws and regulations while designing, constructing, renovating, expanding, and operating the hospital. Address issues related to air quality, biomedical waste handling, noise pollution, hazardous materials storage, medical waste disposal, etc.

6.2.17 Internal Road Design paved or cemented roads inside the hospital property for easy access to all entrances, patient areas, and material delivery points. Separate emergency access should be marked for efficient entry and exit. Sufficient parking space should be provided for staff, patients, families, and the public, with proper security measures for vehicles.

6.2.18 Wind, Earthquake-Resistant and Flood Protection Design the hospital building to address potential disasters like earthquakes, tornadoes, flooding, and hurricanes. The design should prioritize the safety of hospital workers, occupants, and visitors, with continuity of services in mind following a disaster.

6.2.19 Nature Plus Artwork Incorporate nature and artwork into the hospital design to create a soothing and comforting environment for patients and attendants. Providing windows with natural views, attractive colours, and positive artwork can enhance the sense of well-being.

6.2.20 Colours to be Used Select colours that create a calming and soothing atmosphere in the hospital. Different colours can have varying effects on patient motivation, stress levels, and satisfaction. Ensure easy identification of different spaces using colour choices.

Further Reading

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6.2.21 Choice of Building Materials Consider safety and aesthetics while choosing materials for the hospital building. Opt for materials that meet infection control standards, provide durability, and are easily disinfectable and sanitized, especially after the Covid-19 period.

6.2.22 Flooring Choose appropriate flooring that adheres to strict health codes and meets specific requirements for different areas of the hospital. The flooring should promote safety, maintain hygiene, be easy to clean and disinfect and contribute to a positive patient experience.

Further Reading Garg A, Dewan A. Chapter 6, General issues to be considered while designing hospital building. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 33–40. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 7

Area Requirement & Planning

After the preparation of the DPR, the designer has to work out and calculate the area requirement. The area is the space required for the particular service, functionality or department and is termed as the carpet area. The difference between the carpet area and the total area is that the carpet area is the actual functional area and if the wall spaces and the movement spaces like corridors, ramps, staircases, lifts etc. are added to it, it is called the total area.

7.1 Functional Areas The foremost task for the designer is to calculate the area or space requirement, which forms the basis for architectural drawings. The functional areas of the hospital include: 1. Emergency Services: For critical patients or those with serious injuries or trauma or cases seeking medical assistance after OPD hours. 2. Entrance Area: Where patients and visitors arrive before accessing other hospital services. 3. OPD Services: Outdoor consultation area for non-critical or follow-up patients. 4. Diagnostic Services: Area for various diagnostic investigations to aid in disease diagnosis and patient management, including Imaging, Clinical Laboratories, Cath Lab and others. 5. Other Treatments: Providing support for para-medical treatments like dialysis or physiotherapy etc. 6. Intensive Care Services: Dedicated area for critical patients under strict supervision and monitoring, providing treatment.

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7. Therapeutic Services: Area for interventions and surgeries, including Operating Rooms and Labor Rooms. 8. Intermediate Care Area: Indoor admission area for further patient management and treatment, including General Wards, Semi-Private Rooms, Private Rooms, Deluxe rooms, VIP Suits, and Isolation rooms. 9. Administrative/Ancillary services: Administrative/Ancillary services: Area for hospital administration, including Directors’ office, MS office, NS office, IT Department, Personnel/Purchase/Marketing/Accounts office, etc. 10. Hospital Services: Indirectly supporting patient management and treatment, such as CSSD. 11. Engineering Services: Supporting departments ensuring smooth hospital operations, including Electrical, Mechanical, Public Health, Fire Protection, Communication, Medical Gases, HVAC, and various Workshops. 12. Other Services: Additional services like Security, Transport, Housekeeping, Conference, and Medical Record management.

7.2 Room and Space Requirement The next step after finalizing the functional areas is to prepare a list of rooms required for each function, taking into consideration various factors and issues. These factors include 1. Compliance with agencies’ norms like NABH or JCI 2. Patient projections 3. Footfall in the entrance lobby 4. Service counters and shops in the entrance hall 5. Pharmacy size and stock 6. Specialities and super speciality departments 7. OPD management system 8. Procedures and diagnostic services 9. Radiology services 10. In-house vs. outside lab investigations 11. Blood bank facilities 12. High-end procedures like Cath Lab, Oncology and Radiotherapy departments 13. Emergency and triage considerations 14. Paramedical treatment facilities 15. Dialysis facility 16. ICUs and HDU requirements 17. Operating Rooms for specialized surgeries 18. Delivery room planning 19. Bed capacity in each ward, Private, Semi-Private, Deluxe, and VIP Suites 20. Administrative staff seating 21. In-house or outsourced Laundry and Kitchen services

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22. Oxygen supply system. and so on… To answer these questions, a team of experts, including physicians and statisticians, should be formed to gather data from other hospitals or their own experiences. Feasibility studies conducted earlier will be valuable in addressing most of these questions. Once the answers are obtained, the actual work of determining room requirements can begin. This involves assessing the number of rooms needed for each functionality and service. The list of rooms required for the hospital, including main service rooms and ancillary rooms, has been prepared based on experience and practical use and is given in Table 7.1 Table 7.1  Rooms required for various zones/units/departments Entrance area Entrance lobby Entrance gate Trolley park Reception Enquiry counter Cash counter Records Pharmacy Storage & disbursing hall Cold room Expiry medicine room Arcade Temple Snack counter ATM Control rooms Security Housekeeping Service/staff entrance Staff utilities Lockers OPD services Medicine block Examination room with Exam. cubicles

General waiting

Public utilities

Discharge counter Admission Counter Health insurance counter

Registration counter Queuing tracks Empanelled patients counter

Costly medicine room Cut strip sorting room Public utility for staff

Bulk storage

Book shop Gift shop

Other shop – 1 Other shop – 2

Water supply Electrical safety

Fire safety Ambulance

Change rooms

Time keeping

Record room

Rooms for special clinics

Pharmacist office

(continued)

7  Area Requirement & Planning

30 Table 7.1 (continued) Clinical demonstration room

Store

Reception & enquiry

Public utility for faculty Public utility for patients & attendants

Sub waiting Surgery block Examination room with Exam. cubicles Clinical demonstration room Extra rooms for future expansion Registration Record room Endoscopy room Public utility for patients & attendants Ophthalmology block Examination room with Exam. cubicles Clinical demonstration room Extra rooms for future expansion Registration Public utility for faculty

Store

Rooms for special clinics Reporting room Minor operation theatre Sluice room Store Change room for OT Reception & enquiry Dressing Dressing room – male room – female Change room Public utility for faculty Sub waiting Orthopty Treatment Dressing room Store Public utility for patients & Attendants

Sub waiting ENT Block Examination room with Exam. cubicles

Audiometry

Speech therapy room

ENG lab

Extra rooms for future expansion Public utility for faculty

Store Public utility for patients & attendants Sub waiting

Record room Dental Block Examination room with dental chairs Clinical demonstration room Extra Rooms for future expansion Registration Dental laboratory

Extra rooms for future expansion Registration

Dental X-ray

Rooms for special clinics Dark room Reception & enquiry Record room Refraction

Rooms for special clinics Clinical demonstration room Reception & enquiry Registration

Rooms for special clinics Prosthetic dentistry. Reception & enquiry Record room

Dental surgery Store Public utility for faculty Public utility for Sub waiting patients & attendants

7.2  Room and Space Requirement

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Table 7.1 (continued) Obs & Gynae block Examination room with Exam. cubicles Clinical demonstration room Extra rooms for future expansion Reception & enquiry Registration Public utility for patients & attendants Sub waiting Paediatric block Examination room with Exam. cubicles Clinical demonstration room Extra rooms for future expansion Reception & enquiry record room Play area Orthopaedics block Examination room with Exam. cubicles Clinical demonstration room Extra rooms for future expansion Public utility for patients & attendants Record room Dermatology/VD block Examination room with Exam. cubicles Clinical demonstration room Extra rooms for future expansion Sub waiting

Family welfare clinic Sterility clinic Ultrasound room Store D & C room Public utility for faculty

Child welfare, immunization clinic Child guidance clinic Counselling Registration Public utility for patients & attendants

Rooms for Special Clinics Cancer Detection Clinic. Colposcopy Room Record Room IVF Clinic Antenatal Clinic

Rooms for special clinics Child rehabilitation clinic Store Public utility for faculty Sub waiting

Plaster room

Rooms for special clinics Plaster-cutting room Splint store Store Reception & enquiry Public utility for Registration faculty Sub waiting Skin lab

Rooms for special clinics Store Reception & enquiry

Treatment Room Public utility for faculty Public utility for Registration patients & attendants

Record room Psychiatry block Examination room with Exam. cubicles

ECT/recovery

NCV/EMG room

EEG room

Extra rooms for future expansion

Store

Rooms for special clinics Clinical demonstration room Reception & enquiry (continued)

7  Area Requirement & Planning

32 Table 7.1 (continued) Public utility for patients & attendants Record room TB & chest block Examination room with Exam. cubicles

Public utility for faculty Sub waiting

Registration

ICTC centre

Rooms for special clinics Clinical demonstration room Reception & enquiry Public utility for patients & attendants

PFT room

DOT centre

Extra rooms for future expansion Registration

Store Public utility for faculty Sub waiting

Record room Dietary Examination room with Exam. cubicles Reception & enquiry

Store

Counselling

Extra rooms for future expansion Record room

Public utility for faculty Registration Public utility for Sub waiting patients & attendants Cardiology, cardiac surgery, burns & plastic surgery, diabetes & endocrinology, geriatric medicine, gastroenterology medicine, gastroenterology surgery, nephrology, neurology, neurosurgery, oncology medicine, oncology surgery, oncology radiation therapy, paediatric surgery Exam/consultation Sub waiting Pulmonology Exam/consultation Sub waiting Procedure room Urology Exam/consultation Uro flow meter room Sub waiting Uro dynamics study room Imaging Utility area Reception & enquiry Public utility for Registration faculty Record room Public utility for Store for unused films patients & attendants and material Store for used films Report delivery Sub waiting room Extra rooms for future expansion X-ray Radiography rooms for DR or X-ray Sub-waiting Radiography room IITV system Room for mobile X-ray system Barium preparation Change rooms CR room Ultrasound Ultrasound Toilets Sub-waiting Change room

7.2  Room and Space Requirement

33

Table 7.1 (continued) CT Scan Examination room UPS room MRI Examination room UPS room Sub-waiting Mammography Examination room Change room PET scan Examination room UPS room Holding cubicles Medicine storage Other new investigation Examination room UPS room Machine room Support Electric panel room Staff accommodation HOD with toilet PA to HOD Clinical laboratories Utility area Sample collection room Reception & enquiry Record room Extra rooms for future expansion Clinical laboratories Biochemistry Pathology Support Washing & disinfection

Change room Store

Control room Sub-waiting

Change room Store

Control room Machine room

Store

Sub-waiting

Medicine preparation room Medicine infusion room Change room

Control room Machine room

Store

Toilet with settlement tank Sub-waiting

Change room Store

Control room Sub-waiting

Seminar cum library Reporting room Doctors rooms

Senior resident room

Public utility for faculty Public utility for patients & attendants Report delivery room Store for unused reagents and kits

Sample receipt/ preparation Registration

Histopathology Histology

Microbiology Cytology

Clinical demonstration room

Seminar cum library

Sub waiting

Media preparation (continued)

7  Area Requirement & Planning

34 Table 7.1 (continued) Blood Bank Reception waiting Apheresis’ room Refreshment/rest room Other investigations Cardiac investigations ECG room Echocardiography ABP rooms Record room Tilt test room Public utility for patients & attendants Sub waiting Cath lab Reception & enquiry Registration Record room Examination Sub waiting Store Pulmonology investigations Sleep clinic Body box diffusion

Blood testing room Record Doctors rest room

Bleeding Blood lab/storage

Dobutamine stress echocardiography Reception & enquiry Registration Store Thallium scan Public utility for faculty Extra rooms for future expansion

TMT room

Panel Staff change Cath wash

Doctors change Report delivery room Extra rooms for future expansion Toilet Control

Scrub CD store UPS Diffusion room for DLCO ET/CT room

Seno room TBNA room Neurology investigations Transcranial doppler

Endoscopic room

Speech and swallowing clinic Radiotherapy Utility area Reception & enquiry

NVC/EMG

Registration Public utility for faculty Treatment area Tele therapy unit

EEG Lab

Holter rooms Ultrasound rooms Electrophysiology lab Gamma camera Report delivery room

Spirometer rooms Pulmonary rehabilitation 6 min walk test room

Neuro physiotherapy room EEG Lab

Public utility for Report delivery room patients & attendants Record room Extra rooms for future expansion Sub waiting Store Control room

Intracavitary treatment room

7.2  Room and Space Requirement

35

Table 7.1 (continued) Interstitial, endocavitary, surface mould therapy room Planning room

Doctors change

Staff change

Scrub

Medical physics laboratory

Toilet

Metalling treatment planning, mould room Chemotherapy/ radiotherapy procedure room

Store Radiotherapy ward Patient beds Dirty utility/sluice room Store Clean supply room Emergency services Entrance lobby Trolley park Reception Enquiry counter Queuing tracks Attached rooms Procedure rooms Clean utility Medico-legal specimen and record Triage and patient handling zones Triage area Green zone Resuscitation area Examination cubicles Minor operating suite Minor OT Store Staff accommodation Nurse duty Emergency operation theatre complex Operation theatre Post operative recovery (5 beds) Sterilization

Ward pantry Resident doctors duty room Extra rooms for future expansion Public utility for patients & attendants

Nurses duty room

Public utilities

General waiting

Records Admission counter

Registration counter Cash counter

Public utility for staff Examination & treatment room

Dirty linen Plaster room Store ECG room Portable X-ray room Disbar storage room Red zone White zone EMO duty room Public utility for faculty

Yellow zone Black zone Waiting Public utility for patients & attendants

Dirty utility

Scrub/gowning

Ambulance driver/ nursing assistant

Doctors duty

Instrument/linen wash Store

Pre operative room (5 beds) Change room doctors – male Change room staff – male

Change room doctors – female

(continued)

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Table 7.1 (continued) Clean storage Sluice room Emergency ward Ward Examination and treatment room Ward Pantry Other treatments Physiotherapy Examination room with Exam. cubicles Extra rooms for future expansion Electrotherapy Reception & enquiry Public utility for patients & attendants Dialysis Procedure room

Change room staff – female

Toilet

Resident doctors duty room Night duty room for junior residents Public utility for faculty

Store

Massage therapy

Clinical demonstration room Gymnasium Record Room Registration Sub waiting

Traction Thermotherapy Store Public utility for faculty Media preparation room Store Sub waiting

Dialyser wash Toilet cum change room Intensive Care Area MICU, CCU, RICU, SICU, CTVS, PICU, Burn ICU, HDU etc. Patient beds Intensive care beds Clean utility Dirty utility/sluice room Change room – male Change room – female Neonatal ICU Patient beds Infected baby room Clean utility Dirty utility/sluice room Change room – male Change room – female

Nurses duty room Public utility for patients & attendants

Procedure room for positive cases RO plant room

Examination and treatment room Ward pantry Equipment park/store Public utility for Resident doctors duty staff room Public utility for Nurses night duty patients & attendants room Sub waiting area Night duty room for junior residents Examination and treatment room Mothers feeding room Cloth wash area Ward pantry Public utility for staff Sub waiting area

Clean baby room Ventilator room Equipment park/store Resident doctors duty room Public utility for patients & attendants Nurses night duty room

7.2  Room and Space Requirement

37

Table 7.1 (continued) Night duty room for junior residents Operation theatre suite Unsterile zone Waiting area for attendants Protective zone Changing technicians – males

Public utility for patients & attendants

Surgeons restroom

Changing technicians – females Changing class IV – females Restroom for staff – females Doctors change room – female Pantry

Soiled linen pre wash room

Lockers

Changing class IV – males Restroom for staff – males Doctors change room – male

Clean zone Dirty utility Preparation room Sterile zone Main operating theatres Endoscopy room Scrub/gowning Delivery suite Protective zone Nursing station Eclampsia beds Unsterile store Changing technicians – males

Doctors change room – male Changing class IV – males Pantry Observation gallery for students

Unsterile store

Students changing class – females Students changing class – males Office Observation gallery for students Soiled instruments wash room

Post-operative recovery Public utility for patients

Pre-operative room

Instrument trolley layup Clean supply room Clean store

Septic operation theatre Sterilization room

Pre labour patient beds Exam/prep Office Changing technicians – females Doctors change room – female Changing class IV – females Surgeons restroom

Trolley park

Soiled linen pre wash room

Post natal recovery Lockers Students changing – males Students changing – females Duty room for students – males Duty room for students – females Soiled instruments wash room (continued)

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Table 7.1 (continued) Public utilities for patient Delivery area Labor room Clean utility Intermediate care area General ward Patient beds Store Dirty utility/sluice room Examination & treatment room Semi-private ward Patient beds (twin sharing) with toilet Store Clean supply room Public utility for staff Private ward Patient beds (single bed) with toilet Store Dirty utility/sluice room Examination & treatment room Deluxe ward Patient beds (single bed) with toilet Store Clean supply room Examination & treatment room Family suites Patient beds (single bed) with toilet Nurse desk Store Clean supply room Visitors bay

Nursery baby bath Dirty utility

Scrub/gowning Store

Ward pantry Resident doctors duty room Clean supply room

Nurses duty room Extra rooms for future expansion Public utility for patients & attendants Visitors bay

Public utility for staff Ward pantry Resident doctors duty room Nurses duty room Extra rooms for future expansion

Nurse desk Dirty utility/sluice room Examination & treatment room Visitors bay

Ward pantry Resident doctors duty room Extra rooms for future expansion Public utility for staff

Nurse desk Nurses duty room

Ward pantry Resident doctors duty room Nurses duty room

Nurse desk Dirty utility/sluice room Extra rooms for future expansion Visitors bay

Public utility for staff Ward pantry Resident doctors duty room Nurses duty room Examination & treatment room

Clean supply room Visitors bay

Family room Extra rooms for future expansion Dirty utility/sluice room Public utility for staff

7.2  Room and Space Requirement

39

Table 7.1 (continued) Administrative/ancillary services Directors office Office Toilet Medical superintendent office Office Toilet Dy. Medical superintendent office Office Toilet Nursing superintendent office Office Toilet Dy. Nursing superintendent office Office Personnel office Personnel manager Training & skill development manager Account office Finance manager Clerks Officers Marketing office Marketing manager Marketing staff Public utility for staff Purchase office Purchase manager Purchase officer Hospital information IT manager IT control room Hospital services Hospital kitchen Entry of staff Receipt area for supplies

Secretarial staff Waiting area for visitors

Directors P.A room

Secretarial staff Waiting area for visitors

P.A room

Secretarial staff Waiting area for visitors

P.A room

Secretarial staff Waiting area for visitors

P.A room

Toilet Leaves record Clerks

Attendance management Toilet

Stores Sub waiting

Chief cashier Public utility for staff

Stores Sub waiting

Design room Meeting room

Sub waiting Public utility for staff

Stores

Server room

Public utility for staff

Trolley parking area Airlock entry Loading/distribution Change rooms cum hand wash (continued)

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Table 7.1 (continued) Bulk Storage for tableware, linen, crockery and utensils Pot wash Refrigerator/s, cool rooms and freezers Cooking/baking Reheating facilities Dietician Central sterile supply Staff change Washing/disinfection Sterile storage CSSD supervisor Hospital laundry Dirty receipt Washing Public utility for staff Medical & general stores Medical & general stores Surgical and dressing Chemicals and glassware Stores officer Mortuary Body store Medical records Receipt Statistical analysis Storage files/register Staff accommodation Engineering services Electrical Sub station Work shop Mechanical Lifts Public health Health officer

Trolley/cart washing area Dishwashing Manifold room and cylinder storage Staff accommodation Kitchen manager Dietetics staff

Fruit/vegetable storage Waste disposal area Storage areas for dry ration/goods Pre preparation

Assembly/packing ETO room Delivery room Public utility for staff

Dirty receipt Sterilization Staff Room

Packing/plating areas Public utility for staff

Mending & tailoring Sorting/weighing Ironing Clean storage

Furniture Awaiting condemnation Sanitation and misc. Public utility for staff

Linen and livery Stationery and printing Staff accommodation

Body wash Compilation desk Computer lab Medical record officer Public utility for staff

Indexing/coding Binding room Secretarial staff

Switch room Office

Standby generator Public utility for staff

Air handling unit

Air conditioning plant

Sewage disposal

Bio-medical waste storage

7.3  Sizes of the Rooms

41

Table 7.1 (continued) Water supply Public utility for staff Fire protection Fire detection Communication Telephone exchange Medical gases and vacuum Liquid oxygen tank area Manifold Public utility for staff Workshop Electro-mechanical workshop Maintenance control manager Painting workshop Aluminium works workshop Other services Security Supervisor Mobile transport Supervisor

ETP/STP tank

Staff

Fire extinguishers

Fire fitting (water storage)

Vacuum Medical gases control room

Landing bay Compressor

Air conditioning workshop Wooden works workshop Medical gases workshop Office staff for maintenance

Biomedical workshop

Public utility for staff

CCTV control room

Public utility for staff

Ambulance parking

Housekeeping Supervisor Material storage Hospital and staff committee (conference) room Conference room Central lecture theatre gallery type

Civil maintenance workshop Steel workshop Public utility for staff

Library

7.3 Sizes of the Rooms Once the list of required rooms is finalized, the sizes of these rooms are determined based on practical experience, regulating agency norms, patient load, and available space. Rooms should be of reasonable size to avoid waste or hindrance to work. The internal layout is planned, considering equipment placement, furniture, and required working and movement. A spreadsheet is often used to record the room names, number of rooms required, length, breadth, area per room, and total area for each service. Movement spaces

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like corridors, staircases, lift wells, and ramps are added to the functional area. Typically, 35–40% of the total functional area is added for movement areas. The resulting total area is used as a basis for the architectural drawings, where departments and services are placed.

7.4 Zoning The next step is to divide the building into different zones based on functionality and patient accessibility: 1. Outer Zone – Fast movement Zone: Open to the public and visited frequently by patients/attendants. Includes areas like emergency services, outpatient service, cafeteria, entrance hall, and administrative service. 2. Second Zone – Semi-movement zone: Serves patients but limited direct contact. Includes departments like laboratory, pharmacy, and radiology. 3. Inner Zone  – Limited movement zone: Primarily indoor wards and nursing care areas. Generally, allows patient/attendant access. 4. Deep Zone  – Banned Zone: Includes critical units and operating theatres, strictly restricted due to high sterility requirements. Includes ICUs, operation theatres, delivery service, NICU, etc. 5. Isolation Zone  – Restricted Zone: Reserved for infected patients who can transmit diseases. Includes isolation ICUs, wards, and rooms. 6. Service Zone – Provides support services to the hospital’s functionality, including areas like dietary service, housekeeping, laundry, workshops, and medical records.

7.5 Placement of Zones in the Building The placement of these zones within the building is carefully considered to ensure efficient movement and proximity of zones providing support to each other. Designers need to be mindful of the distances to be travelled and the movement of people and materials between zones. Zones that support each other should be in close vicinity.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Further Reading

43

Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 7, Area requirement and planning; p. 41–58.

Chapter 8

Detailed Engineering Drawings

Architectural drawings, created using AutoCAD with defined scale projections, precede the actual construction process. The two fundamental types are “Planning drawings,” which showcase the concept, appearance, and layout design. These drawings result from briefing, sketching, designing, and development stages and are used to seek construction permission and approvals from authorities. On the other hand, “Detailed Drawings” provide technical construction information. Designers meticulously consider technical details and construction-related issues crucial for actual construction and cost estimation. The detailed drawings are a bundle of different drawings, some of which are:

8.1 Schematic Design The schematic design phase involves creating a project design based on initial planning and the client’s budget. It considers hospital functionalities and building systems such as structural, mechanical, HVAC, fire-fighting, CCTV, plumbing, and electrical systems. Rough interior and exterior finishes are designed along with floor plans, site plans, and building elevations. After reviews and refinements, a chosen design aligns with the project vision, setting the scale for further progress, addressing functionality, usability, safety, security, code compliance, and aesthetics.

8.2 Site Plan A site plan is a bird’s eye view of the property, showing buildings, roads, landscape, utilities, parking, and topography to scale. It’s created after surveying and analyzing the potential site, considering size, slope, soil, hydrology, and vegetation. The site © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_8

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plan designates the land coverage area for the main building, with remaining space for services like roadways, parking, gardens, or facilities. It serves as a layout map for further floor plan designing and requires soil analysis for proper building structure design.

8.3 Concept Drawings These are the initial drafts of project drawings, providing an overall view of the building without many details.

8.4 Floor Plan Drawings Floor plan drawings offer detailed layouts of rooms, services, and functionalities on a specific area or floor. They analyze aspects such as movement efficiency, space adequacy, room layout, infection control, and proper ventilation. They also consider door and window placement for design enhancement.

8.5 Cross Section Drawings These drawings provide a vertical view of the building, displaying all floors and components, both visible and non-visible.

8.6 Elevation Drawings These drawings depict the building’s exterior surfaces, showcasing window locations and decorative elements. They indicate the building’s height, markings, and door and window sizes from the outside.

8.7 Landscape Drawings Landscape drawings show the external aesthetics and aerial view of the building area, highlighting the beautification of open spaces, including paths, roads, parking, trees, lights, parks, gardens, etc.

8.13  Plinth Beam Layout Drawings

47

8.8 Finishing Drawing These drawings provide specific details for space finishing, such as flooring, false ceiling, paints, textures, doors, fittings, and fixtures.

8.9 Working Plan Drawings Also known as construction plans, assist contractors in understanding the project scope. They help in material calculations and access based on the design. Drawings include precise measurements and dimensions of each component. Enlarged drawings may be included if needed.

8.10 Section Drawings They show the structure in a sliced form, identifying primary building components and materials used in construction.

8.11 Structural Drawings Structural Drawings focus on columns, beams, foundations, and slab casting. Certified by Structure Engineers, they consider earthquake, wind, soil analysis, flood, and load issues. Details of reinforcement and concrete mix composition are provided.

8.12 Column Layout Drawings Column Layout Drawings indicate column design and location, prepared floor-wise with exact sizes and distances between columns.

8.13 Plinth Beam Layout Drawings These drawings show the position, length, and sectional design of plinth beams that bind columns in the building.

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8  Detailed Engineering Drawings

8.14 Lintel Beam Layout Drawings Lintel Beam Layout Drawings reveal positions, dimensions, design, and number of support structures made above doors and windows.

8.15 Roof Beam and Shuttering Layout Drawings These are the drawing detailing shuttering for the upper beam and floor slab casting.

8.16 General Note General Note contains detailed information about by-laws, legends, codes, abbreviations, and other construction-related aspects.

8.17 Excavation Drawings Excavation Drawings depict excavation details for construction start, including basements, foundations, length, depth, width, and excavation processes.

8.18 Electrical Drawings Prepared by the Electrical Engineer, depict power and electricity planning, including transformer, energy meter, main panel, circuit diagrams, switchboards, and earthing. Shows locations of fittings and fixtures with capacity, design, and bill of quantity calculations.

8.19 Plumbing Drawings Plumbing Drawings relate to water supply and drainage, displaying layouts for bore wells, tanks, supply lines, and sanitary fittings. Drainage drawings include pipelines, STP/ETP tanks, rainwater harvesting layouts, and connection to the main sewerage line.

8.24  Hospital Signage Drawings

49

8.20 Fire Fighting and Detection Drawings These drawings cover firefighting setup, detection systems, and escape routes. They detail the tank, pump room, sprinkler line layouts, and hydrant locations. Fire detection drawings depict control panels, smoke detectors, and escape routes with staircases, ramps, and fire doors.

8.21 Shop Drawings Detailed line diagrams by contractors or suppliers for installations like Air-­ Conditioning, MGPS, CCTV, EPABX, IT, Public Address Systems, and PTS. Must comply with the original design and specifications.

8.22 Furniture Layout Drawings Furniture Layout Drawings depict furniture arrangement for patient and office spaces, showing patient beds, trolleys, chairs, tables, and other furniture along with size and dimensions.

8.23 Furniture Design Drawings Patient furniture often has fixed sizes, while office furniture is tailored to specific needs. Furniture design drawings detail the sizes, materials, and fittings required for manufacturing, along with estimating the furniture cost.

8.24 Hospital Signage Drawings Signage Drawings show carefully designed signage locations for an uninterrupted view. Separate drawings are prepared for each floor to depict signage location and design variations.

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8  Detailed Engineering Drawings

8.25 As-Built Drawings These Drawings are created during or after construction to compare actual construction with the original plan, highlighting any changes made.

8.26 PERT Charts PERT Charts display the project’s time frame, indicating activity start and completion dates. It helps management track project progress, including dependencies between activities.

Further Reading Garg A, Dewan A. Chapter 8, Schematic design; p. 61, Chapter 10, Site plan: pp 81–83 and Chapter 11, Detailed engineering drawings; pp 85–99. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 9

Preparation of Construction Documents

Once the set of detailed drawings is ready, the construction phase begins. Here the contractors are engaged to start the construction work. For this, some documents are required for the contractor to understand before he/she gives his/her rates and quotation. It is this set of construction documents.

9.1 Definition of Construction Documents Construction documents contain essential information for contractors, describing the project’s requirements and materials. In hospitals, separate contractors for different activities need specific sets of documents. These activities include soil analysis, excavation, civil construction, electrical, plumbing, fire fighting, air conditioning, IT, CCTV, public announcement, door windows, false ceiling, flooring, elevation, site development, elevators/lifts, MGPS, modular OT, signage, furniture and more. Construction documents usually contain general and supplementary conditions, owner’s special requirements, drawings, specifications, details, and change orders along with other documents.

9.2 Contents of Construction Document 9.2.1 General Information About the Hospital Project Includes site details, project size, ownership, mission, and services to be provided.

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9.2.2 Construction Contract Agreement Specifies terms and conditions between the contractor and hospital owner.

9.2.3 Scope of Work (SOW) Clearly defines the work to be done during construction, the rectification of defects, responsible personnel, techniques, materials, and conditions for changes.

9.2.4 Construction Schedule The construction schedule contains expected start and completion dates, leverage and penalties for delays.

9.2.5 General Conditions Outlines owner-contractor rights, responsibilities, and relationships, along with dispute resolution clauses.

9.2.6 Special Conditions Specifies activity-specific or job portion-specific conditions and clauses.

9.2.7 Specifications Includes technical data, materials details, techniques, and equipment, allowing contractors to seek clarifications.

9.2.8 Bill of Quantities (BOQ) Details itemized materials with quantities.

9.2  Contents of Construction Document

53

9.2.9 Cost Estimate Provides a breakdown of construction project items and estimated costs.

9.2.10 Drawings Includes simple graphics to help contractors understand the scope of work.

9.2.11 Other Documents As needed, the construction documents may include: 1. Information about liens 2. Staff and supervision requirements 3. Safety instructions and safe work method statements 4. Contractor pre-qualification terms 5. Defect management & liability clauses 6. Test requirements and terms 7. Inspection and test plans 8. Environmental monitoring system 9. Site meetings 10. Quality monitoring terms & conditions 11. Terms for extension of time 12. Materials ordering and inspections terms 13. Daily reporting system 14. Disposal of wastage Contract documents are given to qualified contractors after pre-bidding qualifications. Bidders can visit the site and seek clarification. The last date for bidding is fixed, and sealed bids must be submitted by that date. On the pre-decided date, the envelopes are opened in front of the bidders to determine the lowest bidder. Discussions are held with bidders to assess their work experience, capability, manpower, and tools. After satisfying these criteria, the final terms and conditions of the agreement are discussed and finalized, including price and payment terms. Once agreed, both parties sign the contract agreement, and the work order is issued.

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Further Reading Garg A, Dewan A.  Chap. 12, preparation of construction documents. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 103–6. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Section II

Design & Development

Chapter 10

Design of the Main Entrance Gate to the Hospital

Hospitals provide diverse services through various departments, each with unique requirements and challenges. ICU and patient rooms have different setup needs. OPDs also differ in their requirements. Designers must understand each department's key needs to create an efficient and patient-friendly environment. Failure to meet these requirements may compromise service quality. The upcoming chapters will cover layouts, equipment placement, internal design, finishing, and furniture for specific departments and spaces

10.1 Main Entrance Gate The hospital’s main entrance, connecting the public road and hospital road, is designed with key considerations: 1. The main gate is usually fixed in the hospital’s boundary wall. 2. Typically, hospitals have at least two gates for entrance and exit. 3. Gate width should be at least 20 ft, connected to a 20 ft internal road. 4. Avoid humps or speed breakers at the main gate. 5. Provide a small additional gate for pedestrians. 6. Install a 24-h security post at the main gate of the hospital premises. 7. Rustproof materials like Stainless Steel are recommended for gate fabrication. 8. Automated gates or barriers can be used for added technology. 9. Provision for vehicle checking at the main gate. 10. Trained guards to guide drivers to landing bays and parking. 11. Educate guards about the Gate Pass system.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_10

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Further Reading Garg A, Dewan A. Chap. 14, Design of the main entrance gate to the hospital. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 111–2. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 11

Designing of the Entrance Lobby of the Hospital

The entrance lobbies in hospitals serve as the initial point for patients, workers, and visitors. Entrance lobbies play a crucial role in providing quality healthcare services and creating the first impression of the hospital. These lobbies facilitate segregation, distancing, and infection control. Typically, services like Reception, Inquiry desk, Help desk, Registration, Admission and Discharge desk, Cash Counter, Cafeteria, Pharmacy and shops etc. are provided in the entrance lobby.

11.1 Location of the Entrance Lobby The lobby should be located on the ground floor, near the main hospital building entrance, and prominently visible from the outside. Signage should guide visitors/ patients to the entrance lobby.

11.1.1 The Infrastructure of the Entrance Lobby For infrastructures of the Entrance Lobby, please refer to “Table 1  – ROOMS REQUIRED FOR VARIOUS ZONES /UNITS/DEPARTMENTS” given in Chap. 7 of this book.

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11.2 Services in the Lobby The lobby should offer a range of services, acting as the first point of contact. It should include an information centre, waiting area, reception, inquiry desk, help desk, registration, admission and discharge desk, cash counter, cafeteria, pharmacy, banking facilities, shops, public toilets, parenting/baby change facilities, prayer rooms, back office for administrative support, and various shops such as florist, gift shop, book shop, and newspaper reading deck. An ATM of a bank can also be included.

11.3 Reception and Enquiry Counter The reception and inquiry counter should be strategically placed just opposite the main entrance. The reception counter’s size should accommodate two seated receptionists, about 3048–4572 mm long, made of civil work with an aesthetic look, or wood. Behind the reception, a storeroom of about 3657  mm  ×  3048  mm can be provided for storage. The counter should have a front side of about 1524 mm in height for comfortable interaction with receptionists, and the back side should have a 610 mm broad and 762 mm high working top. A storeroom should be provided behind the reception, where the receptionist can keep general items like stationery, forms, documents, discharged files, etc. This room should have only one door which should open in the reception. The size of this room should be about 3657  mm  ×  3048  mm. The required racks and cupboards should be provided in the storeroom. The reception area should have several electrical points, including six numbers of 6 Amp switch/socket for computers and printers, two 16 Amp switch/socket for other appliances, two RJ 45 points for computer networking, two RJ 11 points for intercom and extension line, and two USB points for charging mobiles.

11.4 Help Desk, Registration, and Admission and Discharge Counters For efficient service, Help Desk, Patient Registration, and Admission/Discharge counters should be placed on either side of the reception but at a distance to prevent mingling. Each counter should have space for two staff members, about 2438–3657  mm long. They can be made of civil work, granite, or wood for an appealing look. The front side should be about 1524 mm high, and the back side should have a 610 mm broad and 762 mm high working top. Each counter requires two chairs for staff, electrical points (six numbers of 6  Amp switch/socket for computers/printers, two 16  Amp switch/socket for

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appliances), two RJ 45 points for computer networking, two RJ 11 points for intercom/extension line, and two USB points for charging mobiles.

11.5 Cash Counter To facilitate financial transactions, a separate Cash Counter should be provided in the lobby, especially if registration and admission/discharge counters are present. The size of the Cash Counter should accommodate two seated cashiers, about 2438–3657 mm long, made of civil work, granite, or wood for an appealing look. Attached to the Cash Counter, a small secure room can be provided for the cashier to keep cash, but if cash is collected timely, this room may not be necessary. The Cash Counter’s front side should be about 1524 mm high with a glass partition up to 1219 mm height and a cut window for interactions. On the backside, a working top should be provided, about 610 mm wide and 762 mm high. Two chairs are needed for cashiers. Electrical points should include six numbers of 6 Amp switch/socket for computers/printers, two 16 Amp switch/socket for appliances, two RJ 45 points for computer networking, two RJ 11 points for intercom/extension line, and two USB points for charging mobiles.

11.6 Cafeteria To accommodate a large number of visitors, a visible cafeteria should be provided at the lobby’s corner with a separate entrance door. The cafeteria size should be at least 9144  mm  ×  6096  mm to accommodate 30 people. It should have a service counter made of civil work with granite tops and a working top for appliances like Microwave Ovens and Coffee machines. Proper seating arrangements with tables and chairs, along with standing tables, should be included. The cafeteria must have hand wash facilities, proper ventilation to prevent food smells from entering the lobby, and waste bins for disposal of the leftovers and disposable. Furniture includes chairs for cafeteria staff, dining tables with chairs, and standing dining tables. Electrical points include a main switchboard for fan and light control, air conditioning control, six numbers of 16 Amp switch/socket for cooking appliances, six numbers of 6 Amp switch/socket for computers and printers, two 16 Amp switch/ socket for other appliances, two RJ 45 points for computer networking, two RJ 11 points for intercom/extension line, and sufficient power/USB points for mobile charging in the dining area.

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11.7 Pharmacy The pharmacy should be conveniently located in the lobby, visible from the outpatient department’s exit point. It requires proper showcases and signage. A prescription explanation desk should be available to help customers understand medication dosage and side effects. For more details on Pharmacy, please refer to the chapter on ‘Pharmacy’ in this book.

11.8 Other Services in the Entrance Lobby Depending on the available space and needs of patients/visitors, facilities like Banking services, General shops, Florists, Gift Shops, Book Shop, ATM, and Newspaper reading decks can be allocated in the lobby. Electrical and connectivity points should be based on the shops.

11.9 Public Utility for Patients/Visitors Toilet facilities should be separate for males and females, with proper sanitary fittings and hand wash provision, about 6096 mm × 4572 mm in size. An Accessible toilet with handrails and grab bars should be included. A parenting/baby change facility can be provided, and a drinking water area with a tea/coffee vending machine can be placed at some distance from the.

11.10 Prayer Room/Meditation Spaces Prayer Rooms for meditation and reflection should be provided, considering space for different religions.

11.11 Self-Service Kiosks Self-service kiosks can expedite processes like hospital registration and information inquiry.

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11.12 Interiors of the Entrance Lobby The lobby’s interiors should include art galleries, various materials, colours, and textures for attractiveness, windows for natural light and views of nature, indoor plants, private spaces for discussions, play areas for children, interactive displays, laptop working areas with charging points, free internet or Wifi, sound-absorbing materials, slip-resistant floor finish, handrails, good lighting, television, fish tanks, and vending machines for food and drinks.

11.13 Entrance Gates to the Lobby The lobby shall have two sets of doors for entrance and exit, with each single door set at least 2438 mm wide. Sensor-operated glass doors can also be considered for automation. An Airlock space with two doors at a distance of 1829  mm from each other should be provided to maintain air-conditioning, temperature, and air pressurization between internal and external areas. An air curtain can also be used to prevent outside air contaminants from entering the building. The lobby shall have two sets of doors, one for entrance and the other for exit.

11.14 Signage and Wayfinding in the Lobby Proper signage and wayfinding solutions should be provided to help visitors navigate the lobby, with clear demarcation of visual zones and pathways.

11.15 Acrylic or Glass Partitions Acrylic or glass partitions of about 1219 mm in height can be used on counters and service desks to protect staff from potential infections.

11.16 General Issues Related to the Entrance Lobby 1. Clearly demarcate visual zones and pathways inside the lobby. 2. Place a security checkpoint near the lobby entrance. 3. Provide lockable security barriers for emergencies.

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4. Determine lobby size based on service counters, waiting spaces, and expected visitor volume. 5. Implement discreet CCTV surveillance in the area. 6. Install security features like Hooters and alarms. 7. Secure the Reception Desk to prevent unauthorized access. 8. Provide the cashier with a suitable safety barrier. 9. Ensure proper heating and air conditioning. 10. Include a wheelchair-accessible reception booth for disabled patients.

11.17 Outside Entrance Lobby 1. Provide a porch at the entrance gate as a shelter with sufficient width. 2. Maintain a clear traffic pattern outside the lobby. 3. Separate the emergency department’s entrance lobby from the main entrance lobby. 4. Include a trolley bay outside the lobby for parking wheelchairs and stretchers.

11.17.1 Screening Areas Use isolated screening cabins for performing screenings through questionnaires and body temperature measurements. Cabins should have negative pressure and UV sterilization with a glass partition for safe examination.

11.17.2 Hand Wash/Sanitizer Stations Place hand wash stations or sanitiser dispensers at doors and entrances and encourage staff, patients, and visitors to use them regularly.

11.17.3 Face Masks/Shoe Covers Dispensers Arrange for the face mask and shoe cover dispensers at hospital entrances and encourage their use by all entering the hospital.

Further Reading

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11.18 Reduction of People Landing in the Entrance Lobby Promote online registrations, admissions, and discharges to reduce in-person visits. Limit sitting provision in the lobby, with distancing measures in place for specific needs. Encourage the use of technology portals for various hospital-related tasks to minimize physical visits.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 15, Designing of the entrance lobby of the hospital. p. 113–21.

Chapter 12

Emergency Services

The Emergency Department is a critical unit within the hospital, providing urgent diagnostic and therapeutic care to patients with injuries, sudden attacks of illness, or exacerbations of existing conditions during non-OPD hours or holidays. The Emergency Department serves as the primary entry point, revealing the efficiency of the hospital’s care. Efficient handling of emergencies and a friendly environment influence opinion. Timely care saves lives and reduces illness severity. Patient safety is ensured through sufficient accommodation and infection prevention. It caters to diverse patients, including trauma cases, mental health issues, and infectious diseases. Skilled staff, support, and communication are vital for optimal care and coordination with other hospital units.

12.1 Location of Emergency Department The hospital’s emergency department should be on the ground floor, in front of the hospital, with a separate entry. It must be easily identifiable with signboards. Proximity to investigative departments like laboratory and radiology is essential.

12.2 Size of the Emergency Department The Emergency Department’s size depends on the volume and scope of services provided, with efficiency being the priority. Factors influencing the decision include the hospital’s location and the types of patients it receives. Academic activities and data analysis of patient attendance, diseases, length of stay, admission rates, and various case types play a role. Other considerations include space for stretchers, waiting areas, ventilation, toilets, operation theatres, triage, observation ward, and © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_12

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disaster handling. Total space shall be calculated by summing up individual room requirements.

12.3 Areas Required for Emergency Department For infrastructures of the Emergency Department, please refer to “Table 1  – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

12.4 The Entrance of the Emergency Department 12.4.1 Main Gate The emergency department’s main entrance gate should be separate, not combined with the general gate. Consider providing a separate main gate for the emergency department in the hospital’s boundary wall, unobstructed with a width of at least 6096 mm connected to an internal road, no humps or speed breakers, provision of a small pedestrian gate, and use of rustproof materials or automated gates. Free car parking spaces for disabled and caregivers, adequate ambulance parking, and trained guides for patient drop-off are essential.

12.4.2 Entrance Door to the Emergency Department The entrance doors of the emergency should be a set of two doors, each at least 2438 mm wide, or sensor-operated glass doors. Airlock space with two doors at a distance of 1829 mm to maintain air-conditioning and prevent contaminants. Use of air curtains to prevent outside air from entering the department.

12.4.3 Outside Entrance Lobby The entrance lobby for the emergency department should be separate and should have a landing bay for ambulances, a wide porch with a height of at least 4572 mm for shelter to enable the passing of two vehicles at a time, and a clear traffic pattern. Trolley bay for wheelchairs and stretchers, separate walk-in and ambulance entrances have to be separate and shall not conflict with the main entrance lobby.

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12.4.4 Screening Areas It is recommended screening area for questionnaires and vitals measurement, using isolated screening cabins with negative pressure and UV sterilization to identify infectious patients. Ensure that after proper screening, suspected/infected patients must enter the hospital from a separate entry other than that of non-infected patients.

12.4.5 Hand Wash/Sanitizer Stations and Face Mask Dispenser Space for hand wash stations or hand sanitiser dispensers should be provided outside the Emergency Entrance. Provision for face mask and shoe cover dispensers should be made at the entrance gate.

12.4.6 Decontamination Area The emergency department should have a separate decontamination area near the entrance, with possible provision for a tiled shower area.

12.4.7 General Waiting A separate waiting area for the accompanying attendants should be provided at the entrance of the emergency with a limited capacity. The waiting area should have a provision for social distancing, basic facilities like telephones, toilets, water dispensers, a public address system and mobile charging points etc.

12.4.8 Ambulance Control Near the emergency’s landing bay and parking area, the ambulance control area should be provided with a facility for cleaning and washing of ambulances, an ambulance control officer room, ambulance equipment storage, and a resting area for drivers. Consider the provision of Air Ambulances and Helipad if feasible and permissible by aviation authorities.

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12.5 Reception At the entrance of the emergency department, a dedicated reception shall be provided, serving as both Enquiry and Registration Counter. The reception counter should be near the entrance, visible, and reachable without obstructing traffic. The size of the reception can be adjusted based on patient volume, and it can be split into different sections for enquiry, registration, and cash handling. Provision for a wheelchair-­accessible booth, record room, and small strong room should be made. The furniture of the reception should include a reception counter and chairs. Necessary tools and instruments include a computer with printer and UPS, scanner, public announcement system, cash collection box, intercom, and telephone line. Electrical points should include six numbers of 6  Amp Switch/Socket on the counter wall for computers and printers, two numbers of 6/16 Amp Switch/Sockets at a suitable height, and two numbers of 6 Amp Switch/Socket on the wall behind the counter. Communication points comprise RJ 45 for computer networking, RJ 11 for intercom and extension lines, and HDMI points for computer display at other locations.

12.6 Triage and Patient Handling Zone with Resuscitation The triage serves as the heart of the emergency department, assessing patients’ conditions and urgency for treatment. Depending on the assessment outcome, patients shall be shifted to the concerned patient handling zone. In patient Handling Zone the patient is resuscitated, treated and then shifted to the Intensive Care Unit, or ward, or discharged after first aid.

12.6.1 Location of Triage Triage should be near the entrance and Patient Handling and Resuscitation Zone, with an uninterrupted entry corridor.

12.6.2 Size of Triage Size shall depends on patient volume, immediate attention needs, location near the main road or industrial area, time taken for categrotation of the patient before shifting to the Patient Handling Zone. The areas of not less than 120 sq feet per bed should be provided. .

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12.6.3 Infrastructure of Triage While designing the triage, the factors to be kept in mind are single hall triage with up to 10 beds with single entry, attached Triage Nurse room, Facilities for toilets, plaster room, treatment room, nursing station, clean and dirty utility, and general store rooms should also be provided.

12.6.4 Bed Layout in Triage To allow easy and smooth working all around the bed consider appropriate clear spaces around the bed, head and foot end for stretcher trolley turning. Provide space of 610 mm at the head end of the bed, about 1524 mm on the foot end, and inter-bed distance shall not be less than 1829 mm.

12.6.5 Patient Furniture/Office Furniture/Equipment/Tools and Instruments in Triage See Table 12.1

12.6.6 Doors and Windows The triage entrance door shall be at least 1829  mm wide, opening both ways. Windows preferred but avoid direct sunlight. The window bottom should be at least 1829 mm from the floor level. Tinted glass or curtains/blinds can be used.

12.6.7 Hand Washing Sensor-operated single-bay scrub for hand washing should be provided.

12.6.8 Central Medical Gas Supply MGPS with oxygen (two outlets), compressed air (one outlet), and wall-mounted suction (two outlets) shall be provided on each bed in the triage. Bedhead panels or ceiling-suspended pendants can be used for gas outlets. Each bed shall have specific

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Table 12.1  Patient furniture/office furniture/equipment/tools and instruments in triage Patient furniture Patient bed (multi-positional ICU bed on lockable wheels with bedside safety rails) Bed side locker Wheel chair Scrub Station Over bed table Stretcher trolley IV stand Examination table Step stool Office furniture Nursing counter Office tables in EMO room Equipment in triage Multi Para vital sign monitor ECG machine

Dressing trollies IV rod Instrument Crash cart trollies Filing cabinet Visitor chairs etc.

Laryngoscope

View boxes Defibrillator Tools and instruments Scissors and forceps of all styles and sizes Chetal forceps Examination light Extension cords and boxes Refrigerator

Oxygen cylinder trolley Back rest Patient transfer system Attendant stool Curtain partition for bed

Office chairs Stools

Almirah/cupboard Sofa set in EMO room

Suction machine Portable X-ray machine Oxygen cylinders

B.P. apparatus Glucometer Ambu bag

All other required instruments Instrument boxes Tray of all styles and sizes Sterilizing drums Weighing machine

gas outlets, electrical, and communication points on the bed head panel or the pendant.

12.6.9 Electrical Points in Triage The main switchboard at the entrance, air conditioning control, at least 3 pairs of 6/16 Amp switch/sockets on each bed connected to UPS, two numbers of 6/16 Amp switch/socket shall be provided in the centre of two beds at the height of 457 mm from the floor level, additional switch/sockets for medical equipment near to the nursing counter.

12.6.10 Other Communication Points in Triage Each bed should have points for Nurse Call devices, RJ 45 for Computer networking, RJ 11 for Intercom, and HDMI point for monitor display. Similar points should be provided at Nursing Station.

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12.6.11 Curtain Partitions All beds in Triage should be provided with hanging curtain partitions, movable and collapsible. Ceiling suspended curtain track fixed at 2134 mm above the floor level.

12.6.12 Triage Nurses Duty Rooms in Triage Duty rooms for Triage Nurses with attached toilets shall be provided in the emergency department. The room shall be of the size 4572 mm × 4267 mm. Each room should be furnished with an office table, chair, bed, cupboard, computer and intercom points, and air-conditioning control button.

12.7 Patient Handling Zone with Resuscitation Once the patient in the triage is prioritization based on the severity of injury/illness, prognosis, and availability of resources, the patient is shifted to the predesignated patient care zone for further management and treatment.

12.7.1 Location of Patient Resuscitation and Handling Zones Patient Handling and Resuscitation Zone should be near the Triage and other support services like Radiology, with an uninterrupted entry corridor.

12.7.2 Categories of Patient Resuscitation and Handling Zones The Patient Resuscitation and Handling Zones, shall have the spaces for the following categories of beds Red/Priority I (Immediate)  For patients have life threatening injuries or conditions that are survivable with immediate medical treatment. This area shall also have few resuscitation beds. Yellow/Priority II (Delayed)  This area is to manage the patients having serious injuries or have presented with several symptoms of a significant illness. Green/Priority III (Minimal)  This area is to manage patient with minimal injuries or illness detected but symptoms are less serious and not life-threatening.

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White/Priority IV (No Action Required)  No illness or injury detected. Black/Priority 0 (Expectant/Dead)  The patient has already died or has a mortal injury that will cause death.

12.7.3 Size of Patient Resuscitation and Handling Zones Size depends on patient volume, immediate attention needs, location near the main road or industrial area, time taken for investigations, the admission rate of the patients, number of patients of acute emergency, medico-legal cases attended per day, and average patient stay. Consider providing isolation areas, bed partitions, and areas of not less than 120 sq feet per bed.

12.7.4 Infrastructure of Patient Resuscitation and Handling Zones While designing the Patient Resuscitation and Handling Zone, the factors to be considered should be like single entry, attached Emergency Doctor’s room, support services like X-Ray, Ultrasound, Minor OT, and Isolation beds for infected patients. Facilities for toilets, plaster room, treatment room, nursing station, clean and dirty utility, equipment store, medicine store and general store rooms should also be provided. Also provides shall be the scrub stations, public toilets, janitors, eye wash stations, counselling room, consultations room, medication room, quite rooms for disturbed patients, medico legal room, linen trolley bay, and mobile equipment bay etc.

12.7.5 Bed Layout in Patient Resuscitation and Handling Zones To allow easy and smooth working all around the bed consider appropriate clear spaces around the bed, head and foot end for stretcher trolley turning. Provide space of 610 mm at the head end of the bed, about 1524 mm on the foot end, and inter-bed distance shall not be less than 1829 mm.

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12.7.6 Isolation Room/Units/Area in Patient Resuscitation and Handling Zones Provision for air-tightened, negatively pressured isolation rooms/units for infected patients, separate entry, and about 25% of triage beds allocated for isolation.

12.7.7 Resuscitation Rooms in Patient Resuscitation and Handling Zones The resuscitation area to provide extensive care and treatment to the patient, shall be created in the Red Zone the size of which shall depend on the requirement. The numbers of beds can be anywhere between 2 and 10.

12.7.8 Patient Furniture/Office Furniture/Equipment/Tools and Instruments in Patient Resuscitation and Handling Zones See Table 12.2

12.7.9 Doors and Windows of Patient Resuscitation and Handling Zones The triage entrance door shall be at least 1829  mm wide, opening both ways. Windows preferred but avoid direct sunlight. The window bottom should be at least 1829 mm from the floor level. Tinted glass or curtains/blinds can be used.

12.7.10 Hand Washing in Patient Handling Zone Sensor-operated single-bay scrub for hand washing should be provided.

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Table 12.2 Patient furniture/office furniture/equipment/tools and instruments in patient handling zone Patient furniture Patient bed (multi-positional ICU bed on lockable wheels with bedside safety rails) Bed side locker Wheel chair Scrub Station Over bed table Stretcher trolley IV stand Examination table Step stool Office furniture Nursing counter Office tables in EMO room

Dressing trollies IV rod Instrument Crash cart trollies Filing cabinet Visitor chairs etc.

Equipment in triage Multi Para vital sign monitor Invasive mechanical ventilator Non invasive ventilator High flow nasal cannula

ECG machine View boxes

Infusion pump Nebuliser Tools and instruments Scissors and forceps of all styles and sizes Walkers/crutches Examination light Splints Chetal forceps Extension cords and boxes Refrigerator Operating light

Needle holders

Oxygen cylinder trolley Back rest Patient transfer system Attendant stool Curtain partition for bed

Office chairs Stools

Almirah/cupboard Sofa set in EMO room

Suction machine Portable X-ray machine Blood gas analyzer Cardiac marker analyser Defibrillator

B.P. apparatus Glucometer Laryngoscope Oxygen cylinders Ambu bag

All other required instruments Instrument boxes Tray of all styles and sizes Proctoscope Suture sets Weighing machine Blood Bank refrigerator Sterilizing drums Torches

12.7.11 Central Medical Supply in Patient Resuscitation and Handling Zones MGPS with oxygen (two outlets), compressed air (one outlet), and wall-mounted suction (two outlets) shall be provided on each bed in the zone. Bedhead panels or ceiling-suspended pendants can be used for gas outlets. Each bed shall have specific gas outlets, electrical, and communication points on the bed head panel or the pendant.

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12.7.12 Electrical Points in Patient Resuscitation and Handling Zones The main switchboard at the entrance, air conditioning control, at least 3 pairs of 6/16 Amp switch/sockets on each bed connected to UPS, two numbers of 6/16 Amp switch/socket shall be provided in the centre of two beds at the height of 457 mm from the floor level, additional switch/sockets for medical equipment near to the nursing counter.

12.7.13 Other Communication Points in Patient Resuscitation and Handling Zones Each bed should have points for Nurse Call devices, RJ 45 for Computer networking, RJ 11 for Intercom, and HDMI point for monitor display. Similar points should be provided at Nursing Station.

12.7.14 Curtain Partitions in Patient Resuscitation and Handling Zones All beds in should be provided with hanging curtain partitions, movable and collapsible. Ceiling suspended curtain track fixed at 2134 mm above the floor level.

12.7.15 Emergency Physician (EP)/Emergency Medical Officer (EMO) Duty Room Duty rooms for EP/Emo and various physician disciplines with attached toilets shall be provided in the Patient Handling and Resuscitation Zone. The room shall be of the size 4572 mm × 4267 mm. Each room should be furnished with an office table, chair, bed, cupboard, computer and intercom points, and air-conditioning control button.

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12.8 Treatment/Procedure Room/Minor Operation Theatre Minor OT (Procedure Room/Treatment Room) is essential for conducting minor medical procedures in the emergency department. It should be attached or near the triage and not far from support services like Radiology. The size should be at least 4572 mm × 4572 mm with additional ancillary areas. Infrastructure includes a separate changing room, scrub room, store room, clean supply room, dirty utility, and equipment store. The Minor OT should be a sterilized area with a single OT table and a single-entry door.

12.8.1 Patient Furniture/Equipment/Tools and Instruments in Minor OT See Table 12.3

12.8.2 Doors and Windows The Minor OT (Procedure Room) requires a door that is at least 1829 mm wide, and openable on both sides. A window is not necessary. Table 12.3  Patient furniture/equipment/tools and instruments in minor OT Patient furniture OT table Step stool Stretcher trolley Scrub Station Dressing trollies IV stand Equipment Basic Boyle’s machine with a vaporizer Operating light single/double dome Defibrillator ECG machine Surgical cautery Laryngoscope Infusion pump Oxygen cylinders Tools and instruments Operating instruments as per requirement Extension cords and Examination boxes light Instrument boxes Chetal forceps All other required instruments

Instrument trollies Wheel chair Patient transfer system

IV rod Crash cart Oxygen cylinder trolley

Alternatively, anaesthesia work station can be provided Multi Para vital sign monitor Operating loupe Suction machine Ambu bag View boxes Nebulizer

Scissors and forceps of all styles and sizes Torches Needle holders Sterilizing drums Suture sets

Tray of all styles and sizes

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12.8.3 Hand Washing Handwashing should be facilitated with a double-bay scrub operated by sensors and foot pedals.

12.8.4 Central Medical Gas Supply Central medical supply should include two ports each for Oxygen, Compressed Air, Suction, and Nitrous Oxide. The Minor OT should have outlets for these gases, along with electrical and communication points provided on a ceiling-suspended pendent.

12.8.5 Electrical Points in Minor OT Electrical points should include a main switchboard, air conditioning control, at least 3 pairs of 6/16 Amp switch/socket pairs on the hanging pendant, with some on UPS supply, in the centre of each of the three walls a pair of two 6/16 Amp switch/ socket at the height of 457 mm from the floor level. Out of these two, one pair shall be on UPS. Communication points should include RJ 45 for computer networking, RJ 11 for intercom and extension line, and HDMI point for computer display. For other details of the Operating Room, please refer to the chapter on ‘Operation Theatre Suite’ of this book.

12.9 Procedure and Diagnostic Setup To provide effective care and treatment in the emergency department, essential investigation rooms should be provided in the emergency department. The room should include ECG, Sample Collection, Ultrasound, X-ray, CT Scan, and MRI. Apart from this, the room should be provided for Dirty Linen, Clean Utility, Store and Portable X-ray. Out of these few specialized diagnostic investigation rooms can be located in the Radiology department if the emergency department’s size is small or patient/investigation load is low in the emergency department. Location-wise, the investigation rooms need not be placed in the front but can be at the back of the Emergency Department, but connected through a wide corridor to allow easy movement of stretchers and patient beds. For other details of the Radiology Department and Pathology Department, please refer to the chapters ‘Radiology’ and ‘Clinical Pathology’ in this book.

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12.10 Emergency Operation Theatre Complex In some cases, patients arriving in the emergency department may require immediate major surgery. Depending on the department’s size, patient volume, and surgical needs, a Major OT complex can be planned within the Emergency Department. However, at times, the decision to establish this complex may also depend on the regulations set by governing bodies such as the Medical Council of India for medical colleges. If the Major OT complex is established, it should follow the same setup as any other major operating theatre. For other details of Major Operation Theatre Complex, please refer to the chapter on ‘Operation Theatre Suite’ of this book.

12.11 Day Care Emergency/Observation Ward An Emergency/Observation Ward shall be provided in the Emergency Department for patients requiring short-term monitoring.

12.11.1 Location of Emergency/Observation Ward Emergency/Observation Ward should be at a convenient location connected through a wide corridor. It should be near the emergency department but connected through a sufficiently wide corridor.

12.11.2 Size of Emergency/Observation Ward The size of the ward will depend on the number of beds placed in the ward. The ward shall have not less than 10, and not more than 30 beds. The per-bed area shall not be less than 8.36 sq. mtr.

12.11.3 Issues Related to the Infrastructure of Emergency/ Observation Ward The infrastructure of the emergency/observation ward should preferably be in a single hall with a single-entry door. It should be close to support services like X-Ray, Ultrasound, and Minor OT. Approximately 25% of the beds should be designated for isolation purposes. Separate male and female toilets, along with a

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centrally located nursing station, should be attached to the ward. The ward should also have areas for Clean Utility, Dirty Utility, Equipment Store, Medicine Store, General Store, Nurse duty room and Resident doctors’ duty room.

12.11.4 Bed Layout in Emergency/Observation Ward To allow easy and smooth working all around the bed consider appropriate clear spaces around the bed, head and foot end for stretcher trolley turning. Provide space of 305 mm at the head end of the bed, about 1524 mm on the foot end, and inter-bed distance shall not be less than 914 mm.

12.11.5 Isolation Room in the Emergency/Observation Ward Out of all normal beds in the emergency/observation ward, about 25% of beds, shall be provided for the infected patients. Isolation rooms shall be negatively pressurised and attached to toilets. These can be either as separate rooms or by converting a few beds using collapsible shutters or temporary partitions.

12.11.6 Patient Furniture/Office Furniture/Equipment/Tools and Instruments in Emergency/Observation Ward See Table 12.4

12.11.7 Doors and Windows The Emergency Observation Ward shall have doors with a minimum width of 1829 mm, openable on both sides. Windows are preferred but should be positioned above 1829 mm from the floor level to avoid direct sunlight.

12.11.8 Hand Washing Handwashing facilities shall be provided near the nurse station.

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Table 12.4  Patient furniture/office furniture/equipment/tools and instruments in emergency/ observation ward Patient furniture Patient bed (multi-positional ICU bed on lockable wheels & bedside safety rails) Bed side locker Oxygen cylinder Instrument trollies trolley Over bed table IV stand Stretcher trolley Wheel chair IV rod Dressing trollies Office furniture Nursing counter Filing cabinet Office chairs Visitor chairs etc. Equipment Multi Para vital sign monitor Infusion pump ECG machine Nebuliser Oxygen cylinders View boxes Tools and instruments Scissors and forceps of all styles and sizes Extension cords and boxes Chetal forceps Refrigerator Needle holders Tray of all styles and sizes

Step stool Crash cart Back rest Patient transfer system

Almirah/cupboard

Stools

Non invasive ventilator Suction machine Glucometer

High flow nasal cannula Defibrillator B.P. apparatus

All other required instruments Sterilizing drums Torches Instrument boxes Weighing machine

12.11.9 Central Medical Gas Supply For medical gas supply, each bed should have outlets for oxygen and wall-mounted suction, preferably through bedhead panels or hanging pendants.

12.11.10 Electrical Points in Observation Ward Electrical points shall include a main switchboard, air conditioning control, and two pairs of 6/16 Amp switch/sockets on each bed, some on UPS supply. Additionally, in the centre between two beds, a pair of two 6/16 Amp switch/socket shall be provided at the height of 457 mm from the floor level. Out of these two, one pair shall be on UPS. Apart from this, switch/sockets at the height of 1372 mm near the nursing counter for charging medical equipment, and 6 Amp switches on the nursing counter should be provided.

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12.11.11 Other Communication Points in Observation Ward Communication points in the Observation Ward include nurse call devices and RJ 45 points for computer networking. The nursing station should have points for Nurse Call Control Console, RJ 45 for computer networking, RJ 11 for intercom and extension line, and HDMI points for computer display at other locations.

12.11.12 Curtain Partitions All beds in the Observation Ward should have hanging curtain partitions, allowing easy cleaning with the bottom of the curtains approximately 457 mm above the floor.

12.12 Other Issues Relating to Emergency Department In the Emergency Ward, a backup power supply with auto-start generators must be available. All rooms and corridors should have battery-operated emergency lights. Natural light should be preferred, ensuring well-lit rooms and corridors with proper overlapping lights, and avoiding fancy lights. The Emergency Department should preferably be centrally air-conditioned, maintaining a comfortable temperature with proper air return and temperature control in all rooms. Encourage cross ventilation without mixing return air. A designated space should be provided for deceased patients awaiting further disposal procedures, separate from incoming patients/visitors. Calming colours, like pastel or soothing tones, are advised, avoiding bright colours. Incorporate artwork, pictures, posters, murals, and images in the department to reduce stress and anxiety. Ensure non-slippery flooring at zero level for all rooms and corridors, using jointless tiles without spacers.

12.13 Disaster Plan Hospitals must be ready to handle the sudden influx of casualties from major accidents and disasters caused by natural calamities. While it is impractical to maintain a vast inventory of equipment, staff, and supplies at all times, a well-prepared plan can empower the existing staff to efficiently provide quality patient care without confusion. This plan focuses on facilitating the collection and treatment of casualties resulting from events like air/train crashes, major industrial or traffic accidents, fires, hurricanes, earthquakes, and floods.

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12.13.1 Factors for Disaster Plan 1. Disasters of the type mentioned rarely come with a warning and can occur at any time, day or night. 2. The number of casualties is unpredictable, and the plan assumes approximately 50 casualties, primarily surgical cases (including burns). 3. The Observation Ward shall be designed to be converted into a Triage when required under such circumstances. 4. A separate room within the Emergency Department should store essential materials, consumables, instruments, and tools for managing such disasters. 5. Immediate provision of first-aid upon the patient’s arrival is crucial as many casualties may suffer from severe haemorrhage at the accident scene. 6. The sudden influx of casualties can strain hospital resources, including bed availability, leading to potential overtime for staff. There may also be a high demand for sterile dressings, syringes, splints, drugs, and general supplies, necessitating advanced planning and provision. 7. The arrival of mass casualties, along with concerned relatives and onlookers, may pose security concerns related to the cash and valuables of disabled patients

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A.  Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 16, Emergency services. p. 123–42.

Chapter 13

Outpatient Department

The Outpatient Department (OPD) Unit, also known as Ambulatory Care Unit, is a hospital department providing consultation to ambulatory patients by specialists. The OPD offers several functions, including consultation with medical specialists, physical examinations, day-care treatment, minor procedures, follow-up consultations, pre-operative screening, health education, and patient referrals.

13.1 Location of the OPD The location of the OPD is crucial, ideally on the ground floor with a separate entry for easy accessibility. In limited space, use the upper floors for examination rooms and the ground floor for Reception, Registration, and Waiting areas. Place OPDs near each other for easy patient cross-referencing. Diagnostic and commercial services like Radiology, Pathology, Minor Operation Theatre, and Medical Record section should be conveniently accessible. Guide illiterate patients with clear local language signage. Avoid in-patient disturbance by discouraging OPD access to in-patient areas. Use a guarded common gate if necessary. Share non-clinical services like accounting, housekeeping, and maintenance between OPD and in-patient facilities to avoid duplication. There are two main designs for locating the OPD: 1. Centralized Outpatient Services All services, including consultation chambers and diagnostic/therapeutic facilities, are provided in a single compact area. 2. Decentralized Outpatient Services Services are provided within the respective departments. 3. Separate Block

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Where separate OPD block or wing may be constructed to accommodate the department’s needs.

13.2 Schemes of the Layout of the OPD Two main designs for locating the OPD include:

13.2.1 Single Corridor OPD The OPDs are located on both sides of a single corridor with a common waiting and reception area. The drawback is the rush of visitors and patients in one corridor, which is used for both entry and exit.

13.2.2 Double Corridor OPD The OPDs are located on both sides of two parallel corridors with a shared waiting and reception area. One corridor serves as an entry, and the other serves as an exit.

13.2.3 Clustered OPD Block The OPDs are arranged side by side around a central hall where the waiting and reception areas are located. The concern with this design is patient privacy.

13.3 Infrastructure Requirements in the OPD For infrastructures of the OPD department, please refer to “Table 1  – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

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13.4 Reception & Enquiry Counter The OPD department’s reception area is the first point of contact for patients, providing information, guidance, and appointment bookings. It should be placed at the entry of the OPD Block for easy access. The reception counter should be around 3048–4572  mm long, accommodating two receptionists and constructed with an aesthetic look using materials like granite or wood. Furniture at the reception includes a front side of the counter that is about 1524  mm in height, allowing easy communication with the receptionists. On the working side of the counter, a top with dimensions of approximately 610 mm width and 762 mm height should be provided. Additionally, two chairs for the receptionists should be provided. Electrical and other points at the reception should include at least six numbers of 6 Amp Switch/Socket on the wall at a height of about 152 mm from the working top, intended for connecting computers, and other devices. Two 6/16 Amp Switch/ Socket on the wall behind the reception counter for other appliances. Furthermore, two RJ 45 points for computer networking, two RJ 11 points for intercom and extension lines, and two USB points for charging mobile devices or other purposes.

13.5 Registration Counter The registration counter, located next to the reception, handles patient registrations for OPD consultations, prepares consultation forms, receives payments, and issues token numbers. Case records may be retained and stored in the registration department, and patients are given a small card with their registration number for each visit. The registration counter should be about 2438–3658 mm long, accommodating two staff members and constructed with civil work, granite, or wood. A glass partition should be installed for cash transactions. Furniture at the reception includes a front side of the counter that is about 1524  mm in height, allowing easy communication with the receptionists. On the working side of the counter, a top with dimensions of approximately 610 mm width and 762 mm height should be provided. If handling cash transactions, a glass partition should be installed above the counter up to about 1219 mm from the top, with a cut window at the lower side. Two chairs should be provided for the staff at each registration counter. Electrical points at the registration counters should include at least six numbers of 6 Amp Switch/Socket on the wall, 152 mm from the working top, for connecting computers, and other devices. Additionally, two 6/16 Amp Switch/Socket should be provided on the wall behind each counter for other appliances. Two RJ 45 points for computer networking, two RJ 11 points for intercom and extension lines, and two USB points for charging mobile devices or other use should be available at each counter.

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13.6 Waiting Lobby/Hall Post-registration for OPD consultation, patients wait for their turn in a waiting area equipped with drinking water and toilet facilities. Some hospitals may include a temple or meditation room in the waiting hall. Post-Covid era, public spaces, including waiting areas, lobbies, and dining halls, require careful planning to ensure physical separation and appropriate queuing systems. To address these concerns: 1. The waiting area should be designed to maintain appropriate social distancing by providing individual seats. 2. Instead of large waiting lobbies, hospitals can create smaller sub-waiting lobbies serving one or two OPD rooms, accommodating around 30 seats. However, for smaller healthcare facilities, such measures might not always be practical. 3. Enclave waiting spaces, with seating in small clusters of 2–3 chairs, should be preferred to separate the sick from other patients or visitors. Partitions of at least 1524 mm acrylic or glass should be used to reduce exposure to others.

13.7 Examination Rooms There are two types of examination/consultation rooms: Combined Multi-­ Disciplinary Consultation rooms and Separate Consultation Rooms. (i) Combined Multi-Disciplinary Consultation Room - Several physicians of different disciplines share the same room at different times, and the required equipment is brought in when needed and stored when not in use. This arrangement saves floor space and allows for consultation by different specialities. (ii) Separate Consultation Room - Each speciality is allotted its individual room, and no other speciality can use it. The benefit is that equipment need not be removed from the room each time, reducing wear and tear.

13.8 Procedure/Treatment Rooms Procedure/treatment rooms are required for specific OPDs, and they should preferably be located near their respective OPD areas to minimize the wastage of physicians’ time and unnecessary patient movement.

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13.9 Support Rooms Support rooms provide backup and support to consultants conducting the OPD. The OPD-wise list of support rooms is given in Table number 13.03 above.

13.10 General Issue While Designing the OPD 1. Minimize noise transfer between consultation rooms. 2. Separate waiting rooms and play areas from clinical areas to avoid noise. 3. Maximize natural light or suitable lighting for a better environment. 4. Provide windows in waiting areas and consultation rooms. 5. Ensure patient privacy and comfort for reduced stress. 6. Use appropriate colours and lighting to facilitate patient examination. 7. Provide suitable seating for bariatric patients. 8. Ensure lockable OPD block and individual rooms for security and privacy. 9. Implement Bio-Medical Waste Management in relevant rooms. 10. Situate support services near the OPD for convenience.

13.11 Number of OPDs Required The number of required OPDs depends on various factors: 1. Number of physicians conducting OPD at a given time. 2. Type of OPD system (Combined Consultation Room or Separate Consultation Room), influencing the total OPD consultation rooms needed. 3. Size of the population served and demographic trends. 4. Expected number of OPD patients. 5. Average consultation duration. 6. Timing of the OPD; adopting chamber sharing for whole-day OPDs can reduce the required number of OPDs. 7. Referrals and transfers from other regions or hospitals.

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13.12 Consultation Room 13.12.1 Size of the OPD Room The ideal size of the consultation room should not be less than 4267 mm × 3658 mm, considering factors such as expected visitors, hospital policy, and furniture arrangements.

13.12.2 Doors and Windows The door of the OPD Room should be at least 1219 mm wide, unobstructed. It is advisable to position the examination couch on the opposite side of the door to ensure patient privacy. Windows are preferable in the room, but direct sunlight should be avoided. Tinted glass or curtains/blinds can be provided for light control.

13.12.3 Hand Washing A Hand Basin shall be provided in the room for proper handwashing facilities.

13.12.4 Furniture The following furniture shall be placed in the consultation room Doctors table with side rack Doctors chair

Two attendants chairs Step stool

Examination couch Revolving patient stool

13.12.5 Instruments and Equipment All the necessary equipment and gadgets shall be provided like B.P. apparatus Torch View box Intercom

Tongue depressor Stethoscope Weighing machine Knee hammer Finger pulse oxymeter Computer with accessories Special equipment required for different types of OPDs

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13.12.6 Electrical Points and Communication Ports in the Consultation Room The consultation chamber should have Main Switchboard at the entrance wall for controlling fan and lights, Air Conditioning Control button, one point on the wall 610 mm above the examination couch for examination light, two numbers of 6 Amp Switch/Socket above on the wall 305 mm above the doctor’s table, and one 16 Amp Switch/Socket adjacent to it, three numbers of 6 Amp Switch/Socket above on the wall, 305 mm above the doctor’s side rack for the computer and printer, and one 16 Amp Switch/Socket adjoining for other equipment or heater. Other communication points to be included in the OPD are an RJ 45 point for Computer networking, RJ 11 for Intercom and extension line, and HDMI point for computer display at other locations.

13.12.7 Curtain Partitions The examination couch of OPD should have ceiling-suspended hanging curtain partitions on the other three sides and the curtain should be fixed on the curtain track at 2133 mm above the floor level. Curtains should be movable and collapsible, hung on these tracks. Remember to leave a clear area of about 457 mm from the floor at the bottom of the curtain for floor cleaning.

13.13 Procedure/Treatment Room 13.13.1 Size of the Procedure/Treatment Room The size of the procedure/treatment room should be at least 4267 mm × 3658 mm, considering factors like equipment placement, required personnel, and movement spaces. However, the size can be adjusted as needed.

13.13.2 Doors and Windows The door should be 1524 mm wide, unobstructed, and placed on the opposite side of the procedure table to facilitate wheelchair/stretcher trolley movement. Windows may be avoided for patient privacy, but if provided, direct sunlight should be minimized with tinted glass or curtains/blinds.

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13.13.3 Hand Washing The room must have a Hand Basin with running water and proper drainage.

13.13.4 Furniture The following furniture shall be placed in the procedure/treatment room Procedure table Small writing table Doctors chair Instrument trollies

Step stool Scrub station IV stand Stretcher trolley

IV rod Crash cart Oxygen cylinder trolley Dressing trollies

13.13.5 Instruments and Equipment The procedure/treatment room shall be equipped with all necessary instruments and equipment as required for the respective department or procedure.

13.13.6 Electrical Points and Communication Ports in Procedure/Treatment Room For electrical points, there should be a main switchboard at the entrance wall; an Air Conditioning Control button; one point of 6 Amp switch/socket on the wall 610 mm above the procedure couch for examination light; three numbers of 6/16  Amp Switch/Sockets on the walls, 457 and 1457 mm above the floor level, for equipment, with one pair connected to UPS supply; two numbers of 6  Amp Switch/Sockets above the writing-table on the wall, along with one 16  Amp Switch/Socket adjoining it. For communication points, the room shall have RJ 45 points for Computer networking, RJ 11 for Intercom and extension line, and HDMI points for computer display at other locations.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a.

Further Reading

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Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 17, Outpatient department. p. 143–54.

Chapter 14

Intensive Care Units

An Intensive Care Unit (ICU) is a self-contained area of a hospital dedicated to critically ill patients. It provides specialized care and support for vital functions. Designing an ICU is challenging; the first step is determining the number of required ICUs, including advanced units like PICU, Neuro-intensive care, Cardiac Intensive Care, and Trauma units, along with the number of beds in each unit.

14.1 Types of ICUs ICU planning involves various types of units based on illness severity and departmental needs, such as Medical ICU, Surgical ICU, Cardiac ICU, Neuro ICU, and many more. Each hospital must assess its specific requirements, patient volumes, and staff needs before determining the type and number of ICUs to plan. The decision may lead to designing various levels like Level-1, Level-2, and Level-3 ICUs, considering the bed capacity, equipment, and staffing. Data on patient numbers, diseases, and required medical personnel play a crucial role in ICU planning to ensure appropriate facilities and equipment are provided for each unit.

14.2 Number of Beds in a Single Unit of ICU After deciding the number and types of ICUs to be established, the management must assess the expected patient influx, including future increases, and the average patient stay duration to determine the bed count for each unit. Some departments experience higher patient turnover, like Medical and Surgical ICUs, warranting bed strengths of around 10–15 each. Departments with moderate turnover, such as Cardiology, Neurology, Neurosurgery, Paediatric, and Respiratory, can have 6–10 © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_14

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beds per ICU. Departments with low ICU usage may forego dedicated ICUs, and their patients can be accommodated in other units. If unavoidable, these departments may have up to 5 beds in their ICUs. It is recommended not to exceed 20 beds per ICU as it may compromise patient care and justification.

14.3 Location of Intensive Care Units Two schools of thought exist regarding the location of ICUs. The first recommends a centralized ICU area to enhance hygiene, visitor control, and rapid access to specialized staff and equipment from other ICUs during emergencies. The second favours ICU placement based on the type of disease or patient, ensuring proximity to related departments like surgical ICU near operating theatres and medical ICU near medical wards. A compromise can be reached by centralizing ICUs on one floor in a single-block hospital, while in multi-building facilities, ICUs should be located near their respective departments. Regardless of location, strict infection control and restricted public access are crucial. Some advocate placing ICUs on the top floor for better traffic control and reduced infection risk, while others suggest sandwiching ICUs between floors to save on air-conditioning costs. Proximity to Emergency, Operating Room, and Radiology departments is essential, justifying ICU placement on the second or third floor in buildings with diagnostic and Emergency departments on the ground floor.

14.4 Infrastructure of ICU The ICU is divided into four major zones: 1. Patient Care Zone It includes Patient Rooms and Isolation Rooms, focusing on direct patient care. 2. Clinical Support Zone This zone supports direct patient care functions. 3. Unit Support Zone It provides administrative, materials management, and staff support functions. 4. Family Support Zone Designed to support families and visitors. For infrastructures of the Intensive Care Units, please refer to “Table 1 - ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

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14.5 Size of the ICU The ICU design process involves understanding equipment placement, support functions, staff movement, inventory, and future requirements. Flexibility for future expansions should be incorporated without major alterations. Efforts should be made to minimize staff travel distances by placing essential spaces and equipment nearby.

14.6 Sizing Considerations The per bed area for any ICU typically ranges between 13.94 and 16.26  Sq.  M, subject to variation based on patient criticality. For very sick patients, the area may increase to 18.58  Sq.  M, while less critical patients may require 13.0–13.94 Sq. M. Closed cubical single-bed ICUs and isolation chambers/rooms should have an area not less than 23.23 Sq. M. per bed. Now about the issues of all four zones one by one.

14.7 Patient Care Zone The Patient Care Zone consists of Patient Units/Rooms/Cubicles, Treatment/ Procedure Room, and the Nursing Counter.

14.7.1 Bed Layout in ICU Hall The ICU bed layout should allow smooth working around the bed, with appropriate inter-bed spaces to reduce cross-infection. Considerations include: 1. The head end of the bed should be 610 mm away from the wall. 2. Clear space of 1524 mm at the foot end for stretcher trolley access. 3. Bed-to-bed distance not less than 1829 mm. 4. If fixed walls or partitions are used, the upper portion should be clear glass for continuous patient monitoring, while curtains can provide privacy during procedures.

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14.7.2 Isolation Room/Units/Area in ICU ICU provides intensive monitoring and treatment for critically ill patients, including those with contagious diseases like Tuberculosis or Covid-19. Therefore, ICU should have both normal beds and isolation cabins for infected patients. About 25% of ICU beds can be reserved for isolation, with separate entries and attached toilets. Isolation rooms must be properly air-tightened and negatively pressurized, forming a separate zone with a barrier. Dedicated staff should care for patients in isolation. In case of space constraints, certain ICU beds can be converted to isolation units using collapsible shutters or temporary partitions around the bed.

14.7.3 Furniture in ICU The following furniture shall be placed in the ICU: Patient furniture Patient Bed (Multi-positional ICU Bed on lockable wheels with bedside safety rails) IV Stand IV Rod Over bed table Crash cart Examination table Oxygen cylinder trolley Wheel chair Instrument trollies Stretcher trolley Dressing trollies

Bed side locker Scrub Station Step stool Back rest Patient transfer system

Office furniture Nursing counter Almirah/cupboard

Filing cabinet Visitor chairs etc.

Office chairs Stools

14.7.4 Equipment Multi para vital sign monitor Invasive ventilator Non invasive ventilator DVT pumps ECG machine Blood gas analyser Oxygen cylinders Cardiac marker analyzers Ambu mask different sizes CRRT

Suction machine High flow nasal cannula Infusion pump Cardiac marker analyser B.P. apparatus Pulse oximeter Glucometer Air mattress ETO sterilization Fiberoptic bronchoscope

Portable X-ray machine Blood gas analyzer Nebuliser Defibrillator View boxes Laryngoscope Ambu bag Chest drainage equipment Electrolyte analyzer IABP

14.7  Patient Care Zone Dialysis machines Pacemaker Ultrasound and Echo machine

99 CO2 monitor – capnography Intubating video scope Spinal board Transport ventilator Invasive BP, SPO2, NIBP, ECG, RR, temp probes

14.7.5 Tools & Instruments Sterilizing drums Forceps of all sizes Splints Extension cords and boxes Tray of all styles and sizes Proctoscope

Torches Examination light Chetal forceps Instrument boxes Needle holders Suture sets

Walkers/crutches Operating light Refrigerator Computers Scissors of all sizes Weighing machine

14.7.6 Doors and Windows The ICU door should be at least 1829  mm wide, and openable on both sides. Windows are preferred in the ICU to provide natural light and reduce patient stress. The bottom of the window should be at least 1829 mm from the floor. Tinted glass or curtains can be used. Electronic windows may be considered if the budget allows.

14.7.7 Nursing Station The nursing station’s central location allows continuous monitoring of patients. A “U” shape counter is ideal, with nurses seated on three sides. The counter should be elevated for better visibility. Adequate storage, electrical points, and a view box are essential.

14.7.8 Hand Washing Two-way Scrub Stations with soap dispensers should be near the entrance. Hands-­ free operation is preferable for scrub stations. Additionally, alcohol gel/sanitiser dispensers should be available in patient rooms and staff locations, easily accessible at the foot end of patient beds.

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14.7.9 Toilets Attached toilets are generally provided in the ICU unit, suitable for cleaning bedpans and bed pots. Space should permit the use of mobile commode chairs for patients with limited mobility, ensuring privacy. Isolation rooms should have separate attached toilets and handicapped toilets with supports and handrails for bariatric and disabled patients. Adequate exhaust is required.

14.7.10 Air Conditioning System of ICUs ICUs must have fully air-conditioned environments to control temperature, humidity, and air exchanges, ensuring safe air quality. The Chilled/Hot Water Pipe Line with AHUs or Ductable Split/VRV systems can be chosen. Proper airflow, direction, and exchanges are essential, maintaining a temperature between 18 and 24 °C. The choice of positive or negative operating pressures depends on the room/unit type, with negative pressure adopted for isolation rooms.

14.7.11 Central Piped Medical Gas Supply Critical patients in ICU require oxygen and may need invasive/non-invasive ventilation, necessitating Piped Centralized Medical Supply. Every ICU bed should have outlets for Oxygen, Compressed Air, and Wall-mounted Suction. Bed Head Panels or Ceiling Suspended Pendants can be used to fix gas outlets and electrical points. Bed Head Panels are 5  ft. aluminium sections fixed at 1524–1829  mm height. Pendants, suspended from the ceiling, offer the same facilities and can revolve at 270°. Each bed should have two Oxygen, one Compressed Air, and two Suction outlets. Both Bed Head Panels and Pendants should also include electrical and communication points.

14.7.12 Electrical Points in ICU The ICU should have a main switchboard at the entrance wall for fan and light control, along with a 6 Amp Switch/Socket. Each Bed Head Panel or Hanging Pendant should have 8 numbers of electrical points, including 4 pairs of 6/16 Amp switches/ sockets on the UPS supply. Additionally, three pairs of 6/16 Amp switches/sockets should be provided between two beds on the back wall at a height of 457 mm. Five

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numbers of 6/16 Amp switches/sockets should be near the nursing counter, and two numbers of 6 Amp switches/sockets should be on the nursing counter.

14.7.13 Other Communication Points in ICU Each bed should have points for the Nurse Call device, RJ 45 for Computer networking, RJ 11 for Intercom, and a reading light. Nursing Station, points include Nurse Call Control Console, RJ 45 for Computer networking, RJ 11 for Intercom, and HDMI for computer display.

14.7.14 Curtain Partitions Beds in the ICU should be placed against one wall and have curtain partitions on the remaining three sides. Ceiling suspended curtain tracks should be fixed at 2134 mm above the floor, allowing for moveable and collapsible curtains with a clear area of about 457 mm from the floor for cleaning purposes.

14.8 Procedure & Treatment Room At times, in ICU, some patients may require minor procedures like catheterization, wound suturing, dressing, bandaging, and bronchoscopy which may be difficult to be performed in the ICU because of the privacy of the patient or procedure may require anaesthesia. Therefore, a treatment room or procedure room should be attached to the ICU.

14.8.1 Location of Treatment/Procedure Room The treatment/Procedure Room should be attached to or located very near the ICU. The room should not be far from other support services like Radiology and other necessary support services.

14.8.2 Size of Treatment/Procedure Room Its minimum size should be 4572 mm × 4572 mm.

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14.8.3 Issues Related to the Infrastructure of the Treatment/ Procedure Room Key considerations include sterilization, a single OT table, a single entry door, and an attached Gowning and Scrub Station.

14.8.4 Furniture in Treatment/Procedure Room The following furniture should be placed in the ICU: Patient furniture OT table Instrument trolley Stretcher trolley Crash cart

Step stool IV stand Dressing trollies Instrument trollies

Scrub station IV rod Oxygen cylinder trolley Patient transfer system

14.8.5 Equipment Multi para monitor Infusion pump Suction machine View boxes

Portable operating light Defibrillator Oxygen cylinders

Laryngoscope B.P. apparatus Ambu bag

14.8.6 Tools & Instruments Sterilizing drums Examination light Instrument boxes Suture sets

Torches Needle holders Extension cords and boxes Tray of all styles and sizes

Chetal forceps Scissors of all sizes Forceps of all sizes

14.8.7 Doors and Windows The door shall be unobstructed and not less than 1524 mm wide, allowing opening from both sides. Windows are not necessary for the Treatment/Procedure Room.

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14.8.8 Hand Washing A single-bay scrub with a sensor/foot-operated mechanism should be provided for hand washing.

14.8.9 Central Medical Gas Supply The Treatment/Procedure Room requires Oxygen, Compressed Air, and Suction supply. A ceiling-suspended pendant, fixed 1524  mm from the floor, should be installed, providing 2 outlets each for Oxygen, Compressed Air, and Suction.

14.8.10 Electrical Points in Treatment/Procedure Room Electrical points include a main switchboard with a 6  Amp Switch/Socket, Air Conditioning Control button, and at least 3 pairs of 6/16 Amp switch/socket on the pendant’s back wall. Additionally, on three walls, pair of 6/16 Amp switch/socket should be provided at 457 mm height from the floor, with one pair on UPS supply.

14.8.11 Other Communication Points in Treatment/ Procedure Room Communication points comprise RJ 45 for Computer networking, RJ 11 for Intercom, and HDMI for computer display at convenient places/walls within the Treatment/Procedure Room.

14.8.12 Other Issues on Patient Care Zone & Procedure/ Treatment Room 1. Clear Floor Space Maintain an 1829  mm distance between beds in ICU to allow ample clear space around the bed for medical equipment like portable X-ray, echocardiography, and dialysis machines. 2. Patient Room Furnishings ICU rooms should have a pleasing and functional design. Apart from furniture, furnish the room with items like a soiled linen collection hamper, waste collection per Bio-Medical Waste Management norms, wall clock, calendar, tack

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boards, whiteboards, charging points, internet connection, intercom, storage cabinets, and secure space for personal belongings. 3. Room Decor Create a pleasant atmosphere using appropriate colour schemes, waterproof washable paints, pictures, paintings, murals, artwork, and decorative ceilings for bed-ridden patients.

14.8.13 Lighting in the ICU Plan lighting carefully with proper lumens, use LED lights for energy efficiency, avoid surface exposed and wall lights, provide adjustable reading lights, emergency lighting, and consider variable-control dimmers.

14.8.14 Dialysis Equipment Ensure provision for Haemodialysis with separate water and drain connections.

14.8.15 Power Backup Equip the ICU with its own automatic power backup, provide internal batteries for essential equipment, connect important electrical points to UPS, and have a dedicated Auto Start Diesel Generator for the Intensive Care Floor. Avoid a common UPS for all ICUs to prevent system-wide failures.

14.9 Clinical Support Zone The Clinical Support Zone encompasses essential functions for patient diagnosis and treatment, occurring within or near the ICU complex or elsewhere in the hospital. Designing this zone requires careful consideration to ensure timely access to critical support services, as delays may pose life-threatening risks to patients. The main diagnostic and treatment support services in the Clinical Support zone are:

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14.9.1 Rigorous Monitoring Efficient patient monitoring involves utilizing all five senses. Sight, hearing, touch, smell, and taste play crucial roles. Proper monitor placement near the patient’s bedside is vital. Centralized monitoring through CNS or remote monitoring technology can also be used.

14.9.2 Radiology Radiology services, including X-rays, CT Scan, MRI, etc., should be readily accessible to the ICU.  Portable X-ray machines and Ultrasound/Echocardiography machines can be placed within the ICU. Online transmission of images via PACS allows swift access to reports.

14.9.3 Laboratory ICUs should have 24/7 access to clinical laboratory services. A Sample Collection Room near the ICU facilitates specimen handling. Space within the ICU can accommodate machines for specific tests like arterial and mixed venous blood gas analysis. Pneumatic Tube Systems (PTS) enable rapid specimen transport.

14.9.4 Medication Rooms Medication Rooms near the ICU ensure easy access to medicines around the clock. Adequate space and facilities for storage, dispensing, and refrigeration should be provided. Automated dispensing machines can also be used.

14.9.5 Pneumatic Tube Systems (PTS) PTS provides swift transport of documents, materials, and medicines using air pressure. It’s a reliable and quick system for small items and facilitates efficient communication between various hospitals.

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14.9.6 Clean Utility Clean Utility rooms store clean linen and sterilized materials like drapes. Adequate space and storage units are provided in this room, typically with a single door.

14.9.7 Dirty Utility/Sluice Room Dirty Utility rooms store soiled linen before pre-washing. The room should have appropriate linen collection hampers and containers. Two doors allow access from both the ICU and the corridor.

14.9.8 Equipment Park/Store This room or area in the ICU stores medical equipment not always in use. It helps free up floor space. The room should have grounded electrical charging points for the equipment.

14.9.9 Emergency Eyewash Station An emergency eyewash station should be located near the scrub station of the ICU to protect staff from hazardous fluids.

14.10 Unit Support Zone The Unit Support Zone houses administrative, logistic, and staff support functions.

14.10.1 Change Room: Male/Female in ICU Separate change rooms for male and female staff are essential in the hygienic ICU.  Each room, sized 4572  mm  ×  4267  mm, should include an attached toilet, chair, cupboards, intercom points, and air conditioning with temperature control. Staff lockers, sized 610  mm  ×  305  mm each, should be provided for personal belongings.

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14.10.2 Doctors’ Duty Rooms in ICU ICUs may require dedicated duty rooms for physicians from different departments. Rooms, sized 4267 mm × 3658 mm, should have an attached toilet, office table, chair, bed, cupboard, computer points with internet access, and air conditioning with temperature control.

14.10.3 Nurse’s Night Duty Rooms in ICU For tired nurses to rest during heavy workloads or double duties, a night duty room, sized 3658 mm × 3658 mm, should be available with an attached toilet, bed, cupboard, intercom point, and air conditioning with temperature.

14.10.4 Night Duty Room for On-Call Junior Doctors To accommodate junior doctors on night duty, one or more rooms, sized 4267 mm × 3658 mm, with an attached toilet, office table, chair, bed, cupboard, computer points with internet access, and air conditioning with temperature control are required.

14.10.5 Ward Pantry The Ward Pantry serves for storing and distributing patients’ meals. Sized approximately 3658 mm × 3658 mm, it should have a countertop with a sink (hot and cold water), waste bins, and a trolley for collecting soiled utensils. A microwave oven may be provided.

14.10.6 Staff Lounge A staff lounge near the ICU Complex, with a seating capacity of around 25–30 persons, should be provided for staff rest and refreshments. The lounge can include comfortable seating, a dining table with chairs, food storage facilities (refrigerator, microwave oven, coffee dispenser), a television, a computer with internet access, and a notice board. Connection to ICU by telephone or intercom should be available for emergency contact.

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14.11 Family Support Zone To cater to the needs of anxious family members and friends, a Family Support Zone is established at a reasonable distance from the main ICU Complex. It includes the following facilities.

14.11.1 Family Lounge A comfortable family and visitor’s lounge located adjacent to or near the ICU Complex should be provided. Each ICU may have its own lounge. The lounge should provide reclining chairs, privacy for conversations, telephone, intercom facilities, snacks bar, television, newspaper and magazine stand, small play area for children, and coffee and tea vending machines. Accessible toilets for males and females should be nearby.

14.11.2 Consultation Rooms Consultation rooms should be available for family members to interact with treating physicians. These rooms are approximately 4572 mm × 4267 mm and are equipped with a doctor’s table, chairs, and a sofa set. Security personnel should be stationed outside, and CCTV (with audio and video recording facilities) surveillance is maintained for safety and recording.

14.11.3 Meditation Spaces A dedicated space for meditation, reflection, and spiritual contemplation should be provided near the ICU to address the anxieties of family members. The design ensures inclusivity for all religions.

14.11.4 Family Cafeteria An adequately provisioned cafeteria should be available for the convenience of family members. Freshwater supply points are conveniently located within or near the cafeteria and lounge. Hygienic arrangements should be made for the disposal of utensils to avoid spreading food smells in the hospital complex.

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14.11.5 Family Sleep Rooms For patients or family members who need to stay at the hospital for an extended period, guest houses may be provided on-site, equipped with amenities such as a mess, toilet, bed, TV, fridge, and bedding. Alternatively, the hospital can arrange accommodation in nearby hotels for out-of-town visitors.

14.11.6 Family Laundry A separate facility may be provided for family members, especially for those staying long-term in the hospital. A dedicated counter can handle laundry services, with unwashed clothes sent to the central hospital laundry for cleaning. This service is payable by the visitors.

14.12 Specialized Intensive Care Units In addition to general ICUs like Medical and Surgical ICUs, specialized ICUs cater to specific diseases Few of them are as below:

14.12.1 Intensive Coronary Care Unit Intensive Coronary Care Unit (ICCU) is for cardiac patients with myocardial infarction. It should be designed for emergencies, and equipped with Pacemakers and Echocardiography machines.

14.12.2 Respiratory Care Intensive Care Unit Respiratory Care ICU treats patients with respiratory diseases like COPD, requiring ventilated support and Arterial Blood Gas tests.

14.12.3 Neurosurgical Intensive Care Unit Neurosurgical Intensive Care Unit manages head injuries, necessitating constant vital monitoring.

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14.12.4 Burns Unit Burns Unit requires careful planning as it deals with highly infected patients. It needs isolation beds, negative pressure, a shower room, a sterile dressing room, and sometimes Hyperbaric Chambers.

14.12.5 Geriatric Intensive Care Unit Geriatric ICU caters to elderly patients, focusing on reducing noise, providing easy-­ to-­understand systems, and making the environment safe with proper handrails and support in walking areas and toilets.

14.12.6 Neonatal Intensive Care Unit The Neonatal Intensive Care Unit (NICU) differs from other ICUs as it is exclusively for newborns. Instead of beds, bassinets or Servo Controlled Radiant Heat Warmers are used. Key considerations when designing the NICU include: 14.12.6.1 Location of NICU Ideally located near the birthing department to minimize exposure to infections during baby transfer. 14.12.6.2 The Infrastructure of the NICU Rooms include Inside baby clean ICU, Outside/infected baby ICU, Ventilation room, Step-down ICU, Mothers Feeding Room, Nappy Wash area, Formula Room, Store, Clean Supply Room, Dirty Linen/Sluice Room, Nurse Station, Change Room, Scrub Station, Medication Room, Doctors/Nurses Duty Room, and Staff Toilet. 14.12.6.3 Placement of Warmers Placement of Warmers: Each patient space should be around 11.15 Sq. M. per bassinet. Radiant warmers are wall-mounted with about 610 mm distance from the wall and 1219 mm inter-distance between two warmers. Each warmer should have medical gas points.

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14.12.6.4 Equipment of NICU The following are the main equipment used in NICU; Multi para vital sign monitor Neonatal mechanical ventilator with a low tidal volume starting from 5 or 10 onwards Non invasive ventilator High flow nasal cannula Infusion syringe pump Electronic weighing machine basket type Phototherapy unit – upper surface Phototherapy unit – under surface Humidifiers View boxes Oxygen hoods of various sizes Other small tools and instruments required

Slow suction machine Servo controlled radiant heat warmer mounted with the baby trolley Pediatric B.P. apparatus Defibrillator Skin sensor thermometer Oxygen cylinders with masks Ambu bag with pediatric masks Laryngoscope Transport incubator Bilirubin meter Vein finder Resuscitation units for delivery suites

14.13 Common Design Considerations 14.13.1 Signage and Way-Finding Clearly visible multilingual signage with arrow markers and colour-coded floors should be used in the ICUs. Landmarks, art, and floor patterns may aid way-finding. Public notices and rules should be posted in the Visitors Lounge.

14.13.2 Security and Access Control ICUs should have a guarded entrance with CCTV surveillance. Only authorized visitors with passes should be allowed, and visitor movement should be controlled. Card keys can be provided as an alternative.

14.13.3 Patient Safety Technology Bar-coding or radio frequency identification should be used for medication, blood transfusion, and procedures.

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14.13.4 Communications Efficient communication systems link ICUs, patient rooms, diagnostic departments, etc., using Intercoms, telephones, pneumatic tube stations, and dumbwaiters.

14.13.5 Storage Adequate storage for equipment, supplies, disposables, and personal items. Medicines should be stored securely under authorized control.

14.13.6 Relationships with Other Departments ICUs should be close to emergency, operation theatre, pathology, and radiology for easy patient transfer.

14.13.7 Central Nursing Station Located strategically with a view of monitors and patients. Provide space for staff, computer terminals, and lockable cupboards.

14.13.8 Patient Records Adequate space and seating for medical record charting and easy accessibility to forms.

14.13.9 X-Ray Viewing Area Separate area with an illuminated viewing box for patient radiological films.

Further Reading

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14.13.10 Reception Area Ideally placed to control visitor access, connected with ICUs via intercommunication systems.

14.13.11 Administrative Offices Adjacent space for administrative purposes, meetings, and consultations. A multipurpose conference room with audio-visual equipment and high-speed internet connections can be beneficial for staff meetings and training.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A.  Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 18, Intensive care units. p. 155–79.

Chapter 15

Operation Theatre Suite

The Operating Theatre (O.T.) is a sterile environment for surgical procedures and invasive interventions. Personnel wear protective clothing while going into the OT complex, to prevent the spread of infection.

15.1 Location of Operating Theatre (O.T.) Complex The O.T. complex consists of various rooms in different zones, ideally on the same floor. The location should be in a restricted area, with easy access to elevators and connected corridors for entry and exit. Placing it in the middle of the building should be preferred to minimize thermal losses and operational costs. Proximity to Intensive Care Units (ICU) is important. Avoiding scattering the complex into different areas is advisable.

15.2 Zones in O.T. Complex The O.T. complex is divided into four zones:

15.2.1 Unsterile Zone Allows unrestricted movement without any change.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_15

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15.2.2 Protective Zone Requires changing shoes for comparatively more sterile conditions, but movement may not always be restricted.

15.2.3 Clean Zone More sterile, for material supply and spaces like pre-operative and post-­ operative wards.

15.2.4 Sterile Zone Extremely sterile and reserved for surgeries, limited to essential personnel. The O.T. complex must have separate entry and exit doors connected to corridors, with one-way movement only. Clockwise or anti-clockwise movement can be adopted based on design.

15.3 Infrastructure of O.T. Complex For infrastructures of the Operation Theatre Suite, please refer to “Table 1  – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

15.4 Unsterile Zone This unsterile area in the O.T. complex allows movement for personnel providing services, materials, or communication with the O.T. staff. It should be located at the entry gate and connected through the entry corridor. The rooms in this zone include:

15.4.1 Administrative Area For general administrators and clerical staff managing the O.T. complex. Room size should be approximately 4572 mm × 6096 mm. It should include cabinets, drawers, racks, office tables, and chairs, and may have an attached toilet and a separate store.

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The room should be equipped with electrical points, an intercom connection, an I.T. network, CCTV surveillance, and air conditioning.

15.4.2 Operation Theatre In-Charge or Manager This room is for the In-charge of the O.T. complex, managing non-medical operations. Room size should be about 4572 mm × 4267 mm, with office tables, executive chairs, visitor chairs, side racks, etc. It should have an attached toilet and a P.A. room for a clerk. A small restroom/lounge can also be provided if needed. The room should be equipped with electrical points, an intercom connection, an I.T. network, and air conditioning.

15.4.3 Room for Head of Anaesthesia The anaesthetist is the medico person treated as the in-charge of the O.T. complex, limited to medical administration. The room should be located adjacent to the manager’s room and have a size of approximately 4572 mm × 4267 mm. It should contain office tables, executive chairs, visitor chairs, side racks, etc. The room should have an attached toilet and a P.A. room for a clerk. If required, a small restroom/ lounge can also be provided. The room should have proper arrangements for electrical points, intercom connection, I.T. network, and air conditioning.

15.4.4 Surgeons Room for Office Work This room is for surgeons and their assistants to carry out the official work related to surgeries, prepare surgery notes, etc. An O.T. register is usually kept here for daily entry. The room should be adjacent to the anaesthetist’s room, with a size of about 4572 mm × 4267 mm. It should contain office tables, executive chairs, visitor chairs, side racks, etc. It should have an attached toilet and a P.A. room for a clerk. The room should be equipped with electrical points, an intercom connection, an I.T. network, and air conditioning.

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15.4.5 Trolley Bay An area reserved for stretcher trollies and wheelchairs allotted to the O.T. complex. It should be located in the unsterile zone at the exit point of the O.T. complex. Stretcher trollies are mainly used after surgery, while bringing patients to the O.T. complex is handled by staff from the concerned ward or ICU.

15.4.6 Frozen Section Biopsy Laboratory A lab for quick freezing of biopsy samples and reporting histopathological findings. The lab size should be designed to accommodate a countertop for working, a lab sink, and sufficient electric points.

15.4.7 Shoe Change Area Space is provided for changing shoes before entering the O.T. complex. It includes a sufficient number of shoe racks and a chair for sitting while changing shoes.

15.4.8 Entry Door for Changing Room In the O.T. complex, separate change rooms are provided for Doctors, Technicians, Nurses, and Class Four workers in the sterile zone. The changing rooms should have dual doors – one for entry and one for exit. The entry door of the changing room should be provided in this zone to prevent staff from entering the unsterile zone after changing.

15.4.9 Waiting Area for Attendants This area is for attendants and family members of patients undergoing surgery in the O.T. The waiting area should be located outside the main entry door of the O.T. complex. It should be furnished with chairs for comfortable seating. The area should have a speaker connected to the O.T. complex’s microphone system. The area should be guarded by security and under CCTV surveillance to control unnecessary movement.

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15.4.10 Public Utility for Attendants Along with the waiting area, toilets should be provided, preferably separate for males and females. Drinking water facilities should also be available, and a tea/coffee vending machine can be placed in this area.

15.4.11 Linen Pre-Wash Room This room is used for pre-washing soiled linen used in the O.T. before sending it to the laundry. It should be located near the exit gate of the O.T. complex or the corridor behind the O.T. The room should include a sink, drainboard, and low-height water tap for washing clothes. Care should be taken to prevent water spillage outside the room.

15.4.12 Instrument Wash Room This room is used for pre-washing soiled surgical instruments before sending them to the CSSD for sterilization. It should be located near the exit gate of the O.T. complex. The room should include a large sink, drainboard, and countertop for drying the instruments.

15.5 Protective Zone The semi-sterile zone is more sterile than the unsterile zone, but the movement is still somewhat restricted. Access requires changing shoes or wearing shoe covers, but there is no need to change clothes. It follows the unsterile zone and should be separated by a guarded door. Details of the rooms in this zone are as follows:

15.5.1 Changing Rooms The O.T. complex provides changing rooms for doctors, technicians, nurses, class IV staff, and students, with separate facilities for males and females. Each change room should be approximately 4572 mm × 4267 mm in size and should have an attached toilet with a bath. Personal lockers, hooks, and hanger rods should be available for clothes storage. A cabinet holds sterilized O.T. dresses and a large bin should also be provided for dirty linen.

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15.5.2 Entry Gate of Pre-Operative Ward The Pre-Operative ward has dual gates, one for entry and one for exit, to maintain sterility. The entry gate should be in the Protective Zone and should have a width of 1829 mm.

15.5.3 Unsterile Store for Equipment Storage An Unsterile store for backup equipment and instruments measuring at least 4572 mm × 6096 mm should be provided. It should contain lockable cupboards, racks, and drawers, as well as multiple electric points for charging equipment.

15.5.4 Store for Medicines, Consumables and Disposables The Store for Medicines, Consumables, and Disposables should be about 4572  mm  ×  6096  mm and stocked with required items for surgeries. It should include lockable cupboards, racks, and drawers, along with a countertop for drug preparation.

15.5.5 Pantry A Pantry should be provided for staff breaks and offers tea/coffee and light snacks. It should measure approximately 3658 mm × 3658 mm and include a countertop with gas burners or inductions, a sink, a microwave, and a refrigerator. Ample electric points should be available to operate the appliances.

15.6 Clean Zone The area is cleaner than the protective zone, and entry is more restricted, requiring a change of outside clothes. It follows the protective zone and is separated by a guarded door. Details of the rooms in this zone are as follows:

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15.6.1 Pre-Operative Room This ward is where patients are examined before entering the operation theatre. The size varies depending on the number of beds, with 7.43–9.29 Sq Mtr. space per bed. Some beds should have a Medical Gas Pipeline supply. Each bed should have at least two electrical points for medical devices. It should include an adjoining toilet and a cloth changing room, with entry and exit doors to the protective and clean zones, respectively.

15.6.2 Preparation Room Patients are prepared before entering the O.T. This room should be approximately 3658 mm × 3658 mm and contain an examination couch, a cabinet for necessary items, a sink, and a portable O.T. light.

15.6.3 Surgeons Rest Room Surgeons can relax here between surgeries. The lounge should be about 6096 mm × 4572 mm, with a sofa set, a centre table, and an attached toilet. Tea/ coffee can be served from the pantry, and a single bed can be provided.

15.6.4 Restroom for Staff – Males & Females Separate lounges for male and female staff, with similar facilities as the surgeon’s lounge, shall be provided.

15.6.5 Exit Doors of All Change Rooms Exit doors from the changing rooms lead to a clean zone. These doors should be 914 mm wide and close automatically.

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15.6.6 Pre Anaesthetic Check-Up Room (PAC) The room for anaesthetists to perform pre-operative check-ups on patients. It should be about 3658 mm × 3658 mm, with an examination couch, cabinet, sink, and a portable O.T. light.

15.6.7 Dirty Utility Used items from surgeries are collected in this room before proper disposal. It should measure about 3048 mm × 3048 mm and contains bins for bio-medical waste management.

15.6.8 Post-Operative Recovery Ward After surgery, patients are transferred to this ward for specialized care until they recover from anaesthesia. It should be located at the exit end of the O.T. complex and have two recovery beds for each O.T. The ward setup should be similar to the ICU, with beds placed appropriately, provision for Central Medical Gas Pipeline, electric points, a nursing station, a general store, a medicine store, a clean utility room, a dirty utility room, and a toilet.

15.7 Sterile Zone This is the most sensitive zone in the O.T. complex, completely sterile and aseptic. It is separated from the Clean Zone by a swing-type door, at least 1829 mm wide, hermetically sealed to prevent unwanted organisms from entering. Authorized personnel with proper change, caps, and masks are allowed entry. Sterilized shoes or slippers are worn from the shoe rack at the entry, and an airlock double door is provided at the exit for patient transfer. Details of rooms in this zone:

15.7.1 Clean Supply Room Size about 4572 mm × 3658 mm, located near OR, with stainless steel racks for storing sterilized instruments and linen, and sterile consumables. The door should swing open both ways and ideally be hermetically sealed.

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15.7.2 Instrument Trolley Layup Size about 3658 mm × 3658 mm, where trolleys for specific surgeries or ORs are prepared using material from the Clean Supply Room. The door should swing open both ways and be sealed.

15.7.3 Scrub Station Adjoining the OR, this area is for handwashing before surgery. Should have stainless steel scrub station operated by foot or sensors, with two bays, hot and cold water, no hand-operated taps, and essential equipment.

15.7.4 Sterilization Room Size about 3658 mm × 3658 mm, with quick steam sterilizer, hot air oven, and formalin chamber. Proper water supply, exhaust, air exchange, and electrical points are required.

15.7.5 Operating Theatres/Rooms (OR) The most sterile area for surgeries/interventions, entry is restricted to authorized personnel wearing protective clothing.

15.7.6 Number of OR The number of ORs required depends on various factors: 1. Number of Surgical Departments like General Surgery, ENT, Eye, Gynae&Obs, Orthopaedic, Urology, Neurosurgery, CTVS, etc. 2. How many surgeons will be operating at the same time? 3. O.T. Timings. 4. Dedicated ORs or shared ORs. 5. Number of daily Surgeries. 6. Number of patients referred daily for surgeries. 7. Number of trauma patients daily. 8. Number of specialized surgeries like robotic surgeries or organ transplants.

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A rough guideline for a 500-bed hospital is to have around 10 ORs, i.e., one OR for every 50 beds. A suggested distribution could include dedicated ORs for advanced surgeries, robotic surgery, organ transplant, CTVS, Obs, and Eye Surgery, while the remaining ORs can be shared among other departments.

15.7.7 Location and Layout of the OR’s ORs should be in the most sterile and restricted zone, with different layout options available. A corridor can connect ORs, with doors opening into a gallery for added security.

15.7.8 Types of Operating Rooms Based on the requirements and technological advancements, different types of ORs are available: 1. Simple room OR 2. Pre-fabricated Modular OR 3. Semi-Modular OR 4. Modular OR 5. Hybrid OR Now little more detail on all these types of ORs.

15.8 Simple Room OR Basic ORs with no specific provisions for sterility or environmental control. Walls are plastered, with washable paint or glazed tiles. The ceiling is plastered or with a POP false ceiling. Flooring can be normal marble or glazed tiles. Air conditioning is done with Split Air-conditioners. O.T. light is fixed in the centre, and the O.T. table is placed in the middle. No specific size is mandated.

15.9 Pre-Fabricated Modular OR The most commonly used OR type, offers sterility, proper environment, temperature, humidity, air exchanges, cleanliness, airflow, and internal pressure control. The details of these ORs are as follows:

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15.9.1 Size of the OR The standard size is 6096 mm × 6096 mm (37.16 Sq Mtr) but for specialized surgeries. However, for specialized surgeries such as Cardiac, Neuro, Robotic Surgery, etc., the size shall be about 46.45 Sq Mtr. For transplant surgeries, the area shall be about 74.32 Sq Mtr.

15.9.2 Walls of the OR Walls are created using pre-fabricated panels made of Mild Steel or Stainless Steel with polyurethane filling, making them tough and thermally insulated. Asbestos sheets can be used in some cases.

15.9.3 Ceiling of the OR The ceiling is also made from pre-fabricated puff panels. A Plenum is hung from the ceiling with HEPA filters for air conditioning and lights. Slanted panels are used to avoid sharp corners.

15.9.4 Corners of OR All four corners are covered with return air ducts and puff panels to avoid sharp corners.

15.9.5 Door of the OR Instead of normal doors, pre-fabricated puff doors are installed. They are hermetically sealed and can be manually operated or automatic with sensors for hands-free control. A sealed glass is provided for observation.

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15.9.6 Window in OR Various arguments exist regarding providing a window in the OR. Some suggest not having windows due to distractions and infection risk, while others prefer them for stress relief. However, modern OR designs often include windows fixed in the outer walls. These windows are non-openable, double-glazed with a vacuum in between, and can have motorized vanishing blinds, tinting, or UV protection.

15.9.7 Control Panel The recessed control panel next to the OR entrance allows control of various OR functions, such as O.T. light, peripheral lights, plenum lights, time elapsed, clock, hand-free intercom, medical gases pressure, music system, temperature, and humidity meter.

15.9.8 View Box The LED view box is recessed in the wall in front of the surgeon, fixed at eye level, and can be single or double film with dimmable LED white light.

15.9.9 Writing Board A Magnetic White Writing Board is also recessed at eye level beside the view box.

15.9.10 Pressure Relief Damper (PRD) The PRD maintains OR pressure, and when excess pressure occurs, it pushes air out through Stainless Steel fins. It is installed at the bottom of a wall cut-out, about 305 mm from the floor.

15.9.11 Peripheral Lights Recessed 610 mm LED lights are fixed in the ceiling to provide general lighting in the OR and can be dimmed or switched off during surgery.

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15.9.12 Plenum The plenum is a box structure hung from the ceiling with HEPA filters for air filtration and unidirectional airflow.

15.9.13 Plenum Lights 1219 mm LED tube lights are fixed in the plenum, providing bright lighting and can be dimmed or switched off during surgery.

15.9.14 Pass-Through Windows/Hatch Boxes Used for passing clean supplies and material without opening the doors, these windows have two doors with a space in-between to prevent both doors from being open simultaneously.

15.9.15 Electrical Points Multiple electrical outlets shall be provided in the OR. There shall be at least two dual sets of 6/16 amp (it means 4 outlets) switch/socket provided at a height of 305  mm from the floor level, on each wall of the OR preferably with a UPS power supply.

15.9.16 Anaesthetist Pendant The pendant is hung from the ceiling on the left-hand side of the patient, with medical gas outlets, electric and communication ports, a service tray, drawers, and IV rod provision.

15.9.17 Surgeon Pendant On the right-hand side of the patient, a fixed arm surgeon pendant with electrical outlets and trays can be provided if required.

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15.9.18 Flooring The OR has anti-static PVC flooring with a carbon coating, glued with copper strips for earthing, and thermo-welded joints.

15.9.19 Painting All surfaces are painted with primer, metal putty, and washable antibacterial and anti-fungal paint in light and attractive colours.

15.9.20 Air Conditioning & Environment of OR’s The OR’s air conditioning system should be designed with consideration for temperature, humidity, airflow, and air exchanges to maintain suitable and safe air quality. Important points to consider are: 1. Opt for Chilled Water Pipe Line with AHUs or a Ductable Split system if the number of ORs is less. 2. Ensure airflow, direction, and air exchanges follow industry norms. 3. Use water pipelines and AHUs with hot water generators for heating; avoid room heaters in the OR.

15.9.21 Supply Air Ducts Insulated aluminium ducts carry air from AHUs to HEPA Filters and into the OR. The duct is split based on the number of HEPA Filters. The unidirectional airflow creates a unidirectional flow of air resembling an umbrella, which is then directed to the return air ducts at the corners of the OR.

15.9.22 Return Air Vertical return air ducts with vents are provided in all four corners of the OR. Excess air is induced and directed to the return air ducts, which then go to the AHU, filtered, mixed with fresh air, cooled, and returned to the OR.

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15.9.23 Special Air Requirements for OR 1. Air Changes Per Hour Minimum 20 air changes with at least 4 out of 20 air changes being fresh air. 2. Air Velocity Unidirectional airflow at 25–35 FPM from non-aspirating unidirectional laminar flow diffuser/ceiling array. 3. Positive Pressure Maintain a minimum positive pressure of 2.5 Pascal to prevent outside air entry into the OR. 4. Air handling and Air Filteration in the OR including air quality Use Terminal HEPA filters for air supply, with a filtration area extended around the OR table. AHU should have two sets of washable flange-type filters. AHUs can be floor model or ceiling suspended and should be dedicated to each OR 5. Service panels to be provided for servicing the filters, motors, and blowers Service panels should be provided for servicing filters, motors, and blowers. Use HEPA filters with an efficiency of 99.97% down to 0.3 microns or higher. Air quality at the grill level should be Class 100 at rest condition (no more than 0.5 microns per cubic foot of air). 6. Temperature and Relative Humidity Temperature and Relative Humidity: Maintain temperature at 21 °C ± 3 °C (18 °C ± 2 °C for joint replacements) and relative humidity between 20% and 60%, with an ideal of 55%. 7. Window and Split AC Avoid using Window and Split AC units in the OR as they are recirculating units with the potential for microbial growth.

15.9.24 Other Communication Points in OR Provide RJ 45 points for computer networking, RJ 11 for intercom and extension line, and reading light for the patient.

15.9.25 Equipment in OR The equipment to be placed in the OR varies based on discipline, but some commonly required equipment includes the following equipment shall be placed in the OR:

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130 Anaesthesia ventilator Anaesthesia work stations Blood pressure apparatus ECT machine Cryophthalmic unit

Mobile ultrasound

Boyle’s machine

CUSA

Morcellator

Cryogun

Defibrillator

Multipara monitor with ET Co2 Navigators for hip/knee Nephroscopes

Emergency light

Nerve stimulator

Femto Lasix Head light

Fetal Doppler Portable O.T. Light

Suction machine electrical Hysteroscope

Pneumatic tourniquet

Electro surgical Operating instruments cautery Operating light Operating table Operating microscope Operating table attachments Ophthalmic laser Phaco- fragmentation unit Heart-lung machine Heating block Sternum saw Saw, Drill & Remer operation table Sets Holmium laser Hysteroscopy pump

Laparoscope set Uretero-Renoscope

Lithotripter UPS 10 Kva

Telescopes

Image intensifier (C-arm) Vitreous aspiration

Intra-aortic balloon pump Vaporizer

15.9.26 Furniture OR The following furniture shall be placed in the OR: 1. Instrument Trolleys 2. Mayo Stand 3. Swab rack 4. Steel bucket with lid Footstool 5. Doctor stool 6. I.V. stand 7. Sterilization drums

15.10 Septic Operation Theatre An OR for infected cases with the same construction and specifications as any other. Equipment and furniture in this OR are separate and not used in the normal OR.

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15.11 Endoscopy Suite Used for Upper G.I. endoscopy, colonoscopy, and related procedures like ERCP. The complete suite includes:

15.11.1 Endoscopy Room An OR-like structure with an operating table, monitor, and endoscope processing unit. Follows the design of a prefabricated modular OR. Includes endoscope storage cabinet.

15.11.2 Endoscope Washroom Equipped with a long sink for washing and disinfecting endoscopes.

15.11.3 Store Provided to store consumables and infrequently used items.

15.11.4 Change Room Allows physicians and technicians to change clothes when the endoscopy room is outside the O.T. complex.

15.11.5 Recovery Room Used for post-endoscopy patient care when the endoscopy room is outside the O.T. complex.

15.11.6 Consultation Room For patient interaction when the endoscopy room is outside the O.T. complex.

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15.12 Semi-Modular OR An economical option with the modular wall structure avoided. Only the ceiling structure with plenum and HEPA filters are provided for achieving unidirectional airflow.

15.13 Modular OR A vacant hall with only outer walls is provided. A fabricated structure made of Mild Steel or Stainless Steel assembled to create a room-like structure. Includes wall panels, ceiling panels, control panel, view box, whiteboard, PRD, window, hermetic door, pendants, plenum, HEPA Filters, etc.

15.14 Hybrid OR A multi-disciplinary OR combining advanced imaging diagnostics and surgery. Allows real-time image guidance during complex surgeries. Larger than a normal OR (at least 55.74 Sq Mtr) and may require additional space for imaging equipment. The shape may be rectangular and construction follows pre-fabricated modular OR norms.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 19, Operation theatre suite. p. 181–201.

Chapter 16

Delivery Room/Labor Room

The Delivery Suite, also known as the Labor Room or Birthing Unit, is a specialized area for childbirth, providing safe prenatal, delivery, and postnatal care for mothers and infants, referred to as ‘LDR’ (Labor, Delivery, and Resuscitation).

16.1 Location of LDR Complex The LDR should be located in a restricted area, ideally on the same floor as a cluster and near the Obstetric department and NICU.

16.2 Zones in LDR Complex The LDR complex is divided into the following three zones:

16.2.1 Unsterile Zone Is normally unsterile and allows unrestricted movement without any change.

16.2.2 Protective Zone Restricted movement, accessed with a shoe change. Contains change rooms, a supply area, pre-labour, and post-labour rooms. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_16

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16.2.3 Delivery Zone Highly sterile for actual childbirth and baby resuscitation.

16.3 Infrastructure of LDR Complex For infrastructures of the Delivery Site, please refer to “Table 1  – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

16.4 Unsterile Zone The LDR Complex’s unsterile area allows movement, services, and communication with staff. It is located at the entry gate, connected through an entry corridor. Rooms in this zone are as follows:

16.4.1 Administrative Area The administrators’ room in the LDR Complex serves staff from various departments (Stores, Sterilization, Housekeeping, Nursing). Its size should be about 3658 mm × 4572 mm, adjustable based on staff count. It should include cabinets, drawers, racks, office tables, chairs, and ideally an attached toilet. If needed, a separate store should be added. The room should be equipped with electrical points, an intercom, an I.T. network, CCTV, and air conditioning.

16.4.2 Labor Room In-Charge Located at the LDR Complex entry, this room should be 4572 mm × 4267 mm and have office tables, executive chairs, visitor chairs, a side rack, and an attached toilet. Proper arrangements for electrical points, intercom, I.T. network, and air conditioning should be provided.

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16.4.3 Gynaecologist Room for Office Work For Gynaecologists and assistants, this office room handles official work related to deliveries, notes of delivery, etc. It should measure about 3658 mm × 4267 mm and have office tables, executive chairs, visitor chairs, a side rack, and an attached toilet. Proper arrangements for electrical points, intercom, I.T. network, and air conditioning should be provided.

16.4.4 Trolley Bay Reserved for stretcher trollies and wheelchairs allotted to the LDR Complex. Used to move patients after delivery.

16.4.5 Shoe Change Area This space allows staff to change shoes before entering the LDR Complex. Equipped with sufficient shoe racks and a chair for convenience.

16.4.6 Entry Door for Changing Room Different change rooms for Doctors, Technicians, Nurses, and Class Four workers in the LDR Complex. Separate rooms for males and females. Dual doors with one for entry and one for exit are recommended based on the size of the LDR complex and staff requirements.

16.4.7 Waiting Area for Attendants Provided for attendants and family members of patients undergoing delivery in the LDR.  Placed outside the main entry door of the LDR complex for easy access. Equipped with comfortable chairs, a speaker connected to the LDR complex’s announcement system, and an Intercom facility for staff communication. Guarded by security and under CCTV surveillance to control unnecessary movement.

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16.4.8 Public Utility for Attendants Adjacent to the waiting area, toilets should be provided for attendants. Separate toilets for males and females. A drinking water facility should be included, and optionally a tea/coffee vending machine can be added.

16.4.9 Linen Pre-Wash Room Used for pre-washing soiled linen before sending it to the laundry. Equipped with a sink, drainboard, and low-height water tap. Special attention to the slope to prevent water spillage.

16.4.10 Instrument Wash Room Used for pre-washing soiled surgical instruments before sending them to the CSSD.  Equipped with a large sink, drainboard, and countertop for drying instruments.

16.5 Protective Zone This zone is more sterile than the unsterile zone, and access is restricted by changing shoes or wearing shoe covers, without the need to change clothes. It is located just after the unsterile zone and is separated by a guarded door. Details of rooms in this zone:

16.5.1 Changing Rooms These rooms are provided for doctors and staff to change into LDR clothes. The pre-sterilized dress includes full-length bottom pants and half-sleeved long tops. Separate changing rooms should be provided for different staff categories and genders. Each room should be approximately 4267 mm × 4572 mm and comes with an attached toilet. Adequate personal lockers, hooks, hanger rods, and cabinets for LDR dresses should be included. A large bin for dirty linen should also be provided.

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16.5.2 Store for Equipment, Medicines, Consumables and Disposables To store extra equipment and supplies, a separate store is provided in the protective zone of the LDR Complex. The room size should be about 4572 mm × 6096 mm and contains lockable cupboards, racks, and drawers. Multiple electrical points should be available for charging equipment.

16.5.3 Pre-Labor Room/Ward This area is for pregnant women during labour pain until they are ready for delivery. Size-wise, the room/ward should generally be 4572 mm × 6096 mm for three beds or 4267  mm  ×  3658  mm for a single bedroom. It should include provisions like medical gas pipelines, electrical points for medical devices, adjoining toilets and bathrooms, nurse call buttons, and facilities for pain relief methods.

16.5.4 Eclampsia Room A separate room for eclampsia patients is recommended, with one room per labour table. The size should be about 4267 mm × 3658 mm.

16.5.5 Examination/Preparation Room This room (3658  mm  ×  3658  mm) is used to examine patients during labor and prepare them before sending them to the labor room. It should include an examination couch, cabinet, sink, and portable light.

16.5.6 Surgeons Rest Room This area (3658 mm × 4572 mm) serves as the ‘Surgeons Lounge,’ where gynaecologists can relax, complete patient files, and prepare prescriptions. It should include an attached toilet and provisions for tea/coffee. .

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16.5.7 Dirty Utility A room (3048 mm × 3048 mm) for disposing of used items like linen and instruments after delivery. It should follow bio-medical waste management rules.

16.5.8 Post-Labour Recovery Ward This ward provides specialized care to the mother and baby after delivery. The room sizes should generally be 4572 mm × 6096 mm for three beds or 4267 mm × 3658 mm for a single bedroom. Facilities should include a nursing station, baby bassinets, and attached stores and utilities.

16.5.9 Doctors’ Night Duty Rooms Separate rooms (3658 mm × 4267 mm) should be provided for male and female doctors on duty. The rooms should have an attached toilet, office table, chair, bed, cupboard, computer points, internet connection, intercom, and air conditioning.

16.6 Delivery Zone The delivery zone is the highly sensitive and sterile area where vaginal births occur. It is strictly separated from the protective zone by swing-type doors, at least 1829 mm wide, sealed to prevent any unwanted organisms from entering. Access is restricted to authorized personnel only, requiring proper change, caps, and masks. A shoe rack with sterilized shoes/slippers is placed at the entry. An airlock with double doors is provided at the exit to transfer the patient out of the recovery room. Details of the rooms in this zone are as follows:

16.6.1 Clean Supply Room Stores sterilized instruments, linen, consumables, and disposables for the labor room. Sized about 4572 mm × 3658 mm, with hermetically sealed swing-type doors and no windows. Equipped with stainless steel racks divided into bins.

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16.6.2 Instrument Trolley Layup Prepares delivery trolleys with material from Clean Supply Room. Sized about 3658 mm × 3658 mm with sealed swing-type doors and no windows.

16.6.3 Scrub Station Adjoining the Labor Room for personnel to wash up before entering. Stainless steel scrub station with foot-operated/sensor taps. Minimum two bays with hot and cold water. No hand-operated taps are allowed.

16.6.4 Sterilization Room Near Clean Supply Room for quick sterilization. Sized about 3658 mm × 3658 mm with quick steam sterilizer, hot air oven, and formalin chamber. Equipped with soft water supply, drain, exhaust, and electrical points.

16.6.5 Delivery Rooms The most sterile and aseptic area in the LDR complex. Protective clothing, shoe covers, masks, caps, and eye shields are required for entry. 16.6.5.1 Number of Delivery Rooms Number of delivery rooms is based on the number of delivery expected per month. The number of Delivery Rooms can be planned as follows: < 20 Deliveries/month – 1 Labor Room 20–99 Deliveries/month – 2 Labor Rooms 100–199 Deliveries/month – 4 Labor Rooms 200–499 Deliveries/month – 6 Labor Rooms If more than 500 deliveries per month are expected, there can be an increase of 2 labour rooms per 100 deliveries. However, based on the expected deliveries per month, the number of delivery rooms can be increased or decreased.

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16.6.6 Location and Layout of the Delivery Rooms Delivery rooms in the last zone of the LDR complex. Corridor in the centre, with delivery rooms on both ends. Doors open on the sidewall for privacy. A gallery between two delivery rooms with a common scrub station.

16.6.7 Types of Delivery Rooms Based on the requirements and technological development, there can be different types of delivery rooms as follows: 1. Simple Room Delivery Rooms 2. Pre-fabricated Modular Delivery Rooms 3. Semi-Modular Delivery Rooms 4. Modular Delivery Rooms The construction and design of all types of delivery rooms are exactly as per OR. Thus, for further detail on this topic, please refer to the chapter ‘Operation Theatre Suite’.

16.6.8 Equipment in Delivery Rooms Suction machine electrical Electrosurgical cautery Fetal doppler Labour table Portable O.T. Light Baby resuscitation unit

Multi para monitor with ET Co2 Blood pressure apparatus Surgical instruments UPS 10 KVA Portable ultrasound

Defibrillator Tools for assisted deliveries Operating light Emergency light A clock with seconds time

16.6.9 Furniture Delivery Rooms Instrument trolleys Swab rack Steel bucket with lid footstool

Doctor stool I.V. Stand

Mayo stand Sterilization drums

16.6.10 Other Issues Relating to the Delivery Room 1. Ensure privacy by avoiding direct views into the room through windows and doors. Use privacy curtains.

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2. Arrange the labor table’s foot end away from the door or access point. 3. Install sound-deadening material on walls to prevent noise transfer between rooms.

16.6.11 Septic Delivery Room Similar construction and design as other delivery rooms but with separate equipment and furniture for infected cases.

16.7 Baby Resuscitation Area Space for infant resuscitation/stabilization within delivery rooms. Windows and doors are designed for visual and acoustical privacy while allowing easy infant exchange. The ventilation system controls ambient temperature between 72 and 78 °F (22–26 °C) for newborn care. Essential equipment should include a radiant warmer, resuscitation kit, mucus extractor, etc. A minimum clear floor area of 7.43 Sq. Mtr. for infant space with oxygen, air, vacuum, and electrical outlets. Infant space remains in the delivery room even if a separate resuscitation room is provided.

16.8 Other Important Issues to Be Considered While Designing LDR 16.8.1 Labor Table Specifications The labor table should have adjustable side rails, facilities for Trendelenburg/reverse positions, height adjustment, stainless steel IV rods, swivelling castor wheels with brakes, washable waterproof mattress, disposable draw sheet, steel basin attachments, calf support, handgrip, and leg support.

16.8.2 Shifting Baby to NICU Preterm infants requiring NICU standards of care should be immediately shifted to NICU after resuscitation. A ‘Transport Incubator’ should be kept near the delivery room for this purpose.

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16.8.3 Access to the Operating Room The Obstetrics Operating Room should be located in the LDR Complex for quick access during emergencies requiring a Cesarean Section.

16.8.4 Electronic Tagging for Newborn Safety Implementing electronic tagging using ankle tags and sensor panels at access points to increase newborn safety after birth.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 20, Delivery room/labour room. p. 203–12.

Chapter 17

Intermediate Care Area (Patient Rooms)

In any hospital setup, Patient Rooms are crucial for treatment and recovery. They reflect the quality of care provided. Patients expect a quick response to emergencies and efficient care from the staff. The room’s design, interiors, comfort, cleanliness, and safety, along with attentive nursing staff, contribute to patient satisfaction. Designers face the challenge of balancing three functions: patient comfort, efficient navigation for health workers, and providing comfortable areas for family and visitors without disrupting workflow. While this may not always be possible for small hospitals, designers strive to accommodate such spaces. Streamlined staff workflow and patient recovery through thoughtful designs lead to higher patient satisfaction and increased hospital business. General issues to be considered while designing the Patient room/ward in the hospital.

17.1 Provide Amenities and Comfort for the Family A Family Support Zone near patient rooms is crucial for accommodating anxious family members and their role in patient recovery. The zone includes the following facilities:

17.1.1 Family Lounge Adjacent to patient rooms, a family and visitor’s lounge should be provided, ensuring comfort and privacy. It should include reclining chairs, a telephone/intercom facility, a television, newspaper and magazine stand, and a small play area for

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children. Snack, tea, and coffee vending machines should be available. Accessible toilets for males and females should be nearby.

17.1.2 Consultation Rooms Consultation rooms should be provided in the patient rooms area to update anxious family members on the patient’s condition/recovery. One room for 40–50 beds is sufficient, with a table, chairs, and a sofa set. Security personnel should be stationed outside, and the room should be under CCTV surveillance.

17.1.3 Meditation Spaces Rooms for meditation, reflection, and spiritual contemplation can provide near patient rooms, for disturbed family members.

17.1.4 Family Cafeteria A ground-floor cafeteria can offer refreshments to family members, with nearby drinking water fountains. Provision for serving meals to family members can be arranged, and vending machines can be installed for convenience.

17.1.5 Family Sleep Rooms Patient rooms may include provisions for family members to stay, or a separate guest house can be arranged for them on payment. These guest houses can offer amenities like bed, bedding, toilet, TV, fridge, and mess.

17.1.6 Family Laundry A dedicated counter can offer laundry services to family members, especially for longer stays. Clothes can be sent to the central laundry of the hospital and returned for collection, with the service being payable by the family member.

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17.2 Increase Staff Efficiency To reduce staff run-around and increase efficiency: 1. Decentralize supplies by making them available within or near patient rooms. 2. Place nursing counters near patient rooms. 3. Implement a Nurse Call System with audio-visual communication between patient rooms and the nurse station. A call activation button near the patient’s bed allows for easy communication, and video cameras can be fixed on the ceiling for visual monitoring. 4. Provide support rooms near nursing stations for efficient working. These rooms include a nurses’ duty room, staff change rooms, medication store, clean store, dirty utility, pantry, separate staff toilet, and janitor facilities. 5. Use touch screen monitors beside patient beds for charting. This saves time and effort by eliminating the need for manual note-taking and flipping through paper charts. Physicians’ instructions can be recorded in the system through the same monitor, providing immediate access to lab reports, vital signs, medications, and other patient details.

17.3 Patient Room Furnishings Patient rooms or units should have a decent and aesthetic finish for early patient recovery and a positive impression of the service quality. The furnishing of patient rooms/units should be carefully designed and include: 1. Soiled linen collection hamper. 2. Bio-Medical Waste Management compliant waste collection. 3. Wall Clock on the foot end of the patient. 4. Calendar. 5. Tack Board and White Board. 6. Horizontal surfaces for greeting cards/photos. 7. Mobile/Laptop charging points. 8. Internet Connection/Wifi. 9. Intercom with outside call facility. 10. Cabinet for personal belongings storage. 11. Television (not applicable for ICU).

17.3.1 Room Decor Creating a pleasant and aesthetic environment in patient surroundings can improve outcomes. Consider the following:

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1. Choose stress-reducing light green and blue colour schemes. 2. Use excellent waterproof and washable wall furnishings. 3. Place appropriate pictures, paintings, murals, and artwork for patients, families, and caregivers. 4. Consider painting the ceiling with pictures and scenery or opt for 3D laminated ceilings.

17.3.2 Lighting in the Patient Room Plan lighting carefully for general illumination and specific tasks. Address the following issues: 1. Ensure proper lumens, avoiding overly bright or dull lights as per standards. 2. Use energy-efficient LED lights with longer usage life. 3. Equally, distribute lights in the unit/room. 4. Prefer ceiling flush-mounted lights over surface exposed and wall lights. 5. Avoid fancy lights, incandescent, and halogen sources to prevent burns. 6. Use mechanically controlled flexible arms to prevent lamp contact with linen. 7. Provide adjustable reading light for patients’ comfort. 8. Include separate lighting for emergencies and procedures, ceiling-mounted directly above each patient bed, and used only during procedures. 9. Provide night low-level illumination near the patient’s bed, 457  mm from the floor. 10. Include emergency battery-operated lights in corridors and patient units. 11. Consider variable-control dimmers at the user end for better light control.

17.3.3 Ceiling Finishes Ensure smooth, scrub-able, non-absorptive, and crevice-free ceilings in patient rooms/units/wards. If using false ceilings, secure tightly-fitted service windows. Use elegant and pleasing ceiling paint.

17.4 Types of Patient Rooms in the Hospital Different hospital wards cater to various patient needs and paying capacities, including Family Suites, Deluxe Rooms, Single bed (Private) Rooms, Sharing beds (Semi-­ Private) Rooms, General Ward (Multiple Beds), Isolation Ward, Post-operative Ward, ICU, ICCU, and Nursery. Progressive patient care should be maintained,

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ensuring skilled attention in critical areas like post-operative and intensive care wards. Let us now discuss some other room types:

17.4.1 Single Bed Occupancy These rooms are also known as ‘Private Wards’ and have one patient bed with other amenities. They can be sub-categorised as follows: 1. Normal Private Room 2. Deluxe Room 3. Super Deluxe Room 4. Suites

17.4.2 Sharing Rooms These are also known as ‘Semi-Private Rooms’ and usually have 2–4 patient beds shared in a single room.

17.4.3 General Wards These are the wards having multiple beds, generally between 6 and 30 beds in a single hall.

17.4.4 Isolation Ward/Rooms These are separately demarcated areas for housing infectious patients. Under this category as well, there can be Private Rooms, Semi-Private Rooms and General Wards.

17.5 Infrastructure Details of the Indoor Patient UnitsFor infrastructures of the Intermediate Care Area, please refer to “Table 1 – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

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17.6 Location of the Indoor Patient Areas Zoning of the hospital’s indoor area requires careful planning to ensure limited movement and restricted access. The suggested indoor area can be planned between the fourth to seventh floor of a 12-storey building. Two options for allocating space to different room types are considered: Option 1: Plan all single room types in a cluster on a single floor, such as all single bedrooms (private/deluxe/suite) on one floor, semi-private rooms on another, etc. This option allows for better room design, family lounges, nursing stations, and controlled movement. Option 2: Each floor can have a mix of all wards/rooms, including a few private rooms, semi-private rooms, and one or more general wards. While both options have pros and cons, the first option is preferred for uniform room sizes and improved planning.

17.7 Zoning of the Isolation Areas Zoning of the isolation areas is essential, especially post-Covid-19 designs. Infected patients should be housed in a separate zone with different types of wards/rooms and, if required, a separate Intensive Care Unit. Isolated indoor units of a particular zone are recommended to be clustered together for better management.

17.8 Single Patient Room (Private Room) Multiple occupancy rooms are becoming less popular, and patients prefer single-­ occupancy rooms for privacy, comfort, and better care, even at a higher cost. Single occupancy rooms also aid in infection control. Well-designed patient rooms lead to improved patient care, satisfaction, shorter hospital stays, and better continuity of care

17.8.1 Room Layout The single patient occupancy room should be divided into three zones – a staff zone at the entrance for efficiency, a patient zone with the bed, and a family zone with comfortable seating for visitors.

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17.8.2 Size of the Room A private single room should have an area of about 23.22 Sq Mtr, including family space and a toilet.

17.8.3 Walls The room should have walls on all four sides, with a thickness of not less than 120 mm. Clay bricks or hollow blocks can be used for construction. 17.8.3.1 Headwall The wall behind and the ceiling over the patient’s head are crucial spaces for incorporating clinical care elements, medical gases, power, information systems, monitoring, and critical equipment storage. 17.8.3.2 Footwall The footwall displays items that the patient will directly view, such as a television, clock, and tack-board with information and artwork.

17.8.4 Doors The door of the room should not be less than 1829 mm wide to allow easy movement of the bed during emergencies.

17.8.5 Windows Windows should be preferred in the room to provide natural light but avoid direct sunlight. Tinted glass or curtains/blinds can be used. Electronic windows with switching capabilities can also be considered.

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17.8.6 Toilets A separate toilet and bathroom with a handwashing station should be provided in all rooms. The three models for the location of the toilet are Midboard Toilet Model, Inboard Toilet Model, and Outboard Toilet Model. It is recommended to opt for the Midboard Toilet Model as it provides several advantages, including proper room shape, visibility, natural light, space for fittings, safety considerations, and accessible facilities for bariatric and handicapped patients. Non-slippery tiles and flooring, proper exhaust system, and provision of both hot and cold water in the toilets are also essential considerations.

17.8.7 Bed Layout in Patient Room The bed in the patient room should be laid out in such a way that it allows easy and smooth working all around the bed. The following points should be kept in mind while laying down the bed in a room: 1. The head end of the bed should be at least 610 mm away from the wall. 2. The head support panel of the bed should be removable. 3. On the foot end, a clear space should be about 1524 mm so that the stretcher trolley can easily be turned around and the patient can be transferred from/to bed. 4. Distance of family couch/sitting from the patient bed should not be less than 914 mm.

17.8.8 Furniture and Instruments in the Patient Room 17.8.8.1 Patient Furniture Patient Bed (preferable should be Multi positional ICU Bed on lockable wheels with bedside safety rails or otherwise the Fowler bed with bedside railing can be used) Bed side locker IV stand Over bed table IV rod Step stool Back rest

17.8.8.2 Other Furniture Pull-out bed or plain sofa set Attendant bed Small dining table (if space is available)

Dining chairs Centre table Cupboard

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17.8.8.3 Equipment Multi Para vital sign monitor (if required)

Air mattress

17.8.8.4 Tools and Instruments Walkers (if required) Refrigerator

Weighing Machine Other required instruments

17.8.9 Air Conditioning System of Patient Rooms Patient rooms should be fully air-conditioned to allow control of temperature, humidity, and air exchanges, ensuring suitable and safe air quality at all times. The following issues are important while designing the Air Conditioning System: 1. The Chilled Water Pipeline with Fan Coil Units (FCU) or the Ductable Split or VRV system can be opted for air conditioning patient rooms. 2. Each room should have individual return air provisions to prevent mixing with other rooms/units/areas. 3. Airflow, direction, and air exchanges should be as per industry norms. 4. Heating should be done with a water pipeline and FCUs having hot water generators or room heaters can be used, though the latter is generally not recommended. 5. Maintain the temperature between 21 and 24 degrees Celsius. 6. Choose positive or negative operating pressures depending on the type of room/ unit, with negative pressure for isolation rooms.

17.8.10 Central Piped Medical Gas Supply All patient rooms should be equipped with Piped Centralized Medical Supply to handle emergencies, including oxygen and wall-mounted suction. The bedhead panel, typically made of extruded sections of aluminium, is used to fix gas outlets and electrical points. It also includes a service railing for an IV rod, monitor tray, and utility basket.

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17.8.11 Electrical Points in Patient Room 1. The main switchboard for fan and lights control, air conditioning control button with temperature adjustment, and on each of the Bedhead Panel, the electrical points are provided. There should be at least 3 pairs of 6/16 Amp switch/ socket, i.e. 6 points. Half of these points should be on UPS supply. Additionally, On the left and right side of the patient, and at a distance of 1219 mm from the centre of the bed, one pair of 6/16 Amp. switch/socket should be provided at the height of 457 mm from the floor level, i.e. 4 points. Two pairs should be on UPS supply.

17.8.12 Other Communication Points in the Patient Room Nurse call device point, RJ 45 point for computer networking, RJ 11 for intercom and extension line, and a point for the patient’s reading light.

17.8.13 Curtain Partitions Patient beds in the room should have hanging curtain partitions on three sides, allowing easy movement and collapsibility. The bottom of the curtain should have a clear area for easy floor cleaning.

17.8.14 IV Track A ceiling-suspended IV track should be provided above the centre of the bed, moveable in the track and with provision for 3, 4, or 5 hooks.

17.8.15 Psychiatric Patient Rooms Special attention should be paid while preparing psychiatric patient rooms, including tamper-resistant fixtures, non-lockable toilet doors, separate rooms for psychiatric patients, avoidance of windows or provision of grills, locked and guarded corridors leading to psychiatric rooms, and CCTV camera surveillance.

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17.9 Deluxe Single Patient Room (Deluxe Room) The deluxe single-bed room is an upgraded version of the single-bed patient room, with additional amenities to enhance the patient’s comfort and experience: 1. Size of the deluxe room should be about 27.87 Sq Mtr. 2. Toilets can be bigger and designed with appealing patterns on the walls using high-quality chinaware and sanitary fittings. 3. The bed head panel can be 1524 mm long with more electrical points. 4. Better-quality ceiling finishes for an improved aesthetic appeal. 5. A multi-positional ICU bed on lockable wheels with bedside safety rails should be provided for the patient’s convenience. 6. Elegant and high-quality patient furniture, including over-bed tables and bedside lockers. 7. A small kitchenette equipped with an electric kettle and a microwave to provide the convenience of making tea/coffee and snacks. 8. A larger refrigerator for more storage space. 9. A good quality pull-out bed or sofa set for visitors to rest comfortably. 10. More spacious area for family and visitors. 11. Higher quality dining table and chairs for a better dining experience. 12. Larger and more designer cupboards for storage. 13. Improved quality artwork and sceneries to enhance the room ambience. All other details and requirements should be the same as for single-­ patient rooms.

17.10 Family Suite with Single Patient Room (Suite Room) The family suite differs from other single-bed patient rooms as one additional room for the family is provided, which is attached to the patient room. Apart from this, it has a few additional amenities:

17.10.1 Patient Room of the Suite 1. Deluxe room size: Approx. 27.87 Sq Mtr. 2. Larger, appealing toilets with patterned wall designs and high-quality chinaware and fittings. 3. Extended 1524 mm bed head panel with additional electrical points. 4. Improved ceiling finishes. 5. Upgraded floorings. 6. Multi-positional ICU bed on lockable wheels with bedside safety rails.

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7. Elegant and high-quality patient furniture, including over-bed table and bedside lockers. 8. Bigger refrigerator for increased storage capacity. 9. High-quality pull-out bed or sofa set for visitors’ comfort. 10. More spacious area for family and visitors. 11. Improved quality dining table and chairs. 12. Bigger and more designer cupboards for enhanced storage and aesthetics. 13. Better quality artwork and sceneries

17.10.2 Family Room of the Suite 1. Family room size: Approx. 18.58 Sq Mtr. 2. Attached to the patient’s room. 3. Separation by either a solid wall or glass partition. 4. May or may not have a separate door. If one door is provided for the suite, the family room is in the front and the patient room at the back. 5. Prefer a separate toilet for the family room. 6. Kitchenette with an electric kettle and microwave for refreshments. 7. Kitchenette includes a working slab, washing sink, and drainboard. 8. Sofa set for 5–7 people and a centre table in the family room. 9. Dining table and chairs are included in the family room. 10. Additional refrigerator for family room. 11. Separate cupboard is provided in the family room. 12. Enhanced painting quality for the family room. 13. Dedicated television for the family room. 14. Optional computer with internet connection. 15. Provision for a reading table with a chair if needed. All other details and requirements should be the same as for deluxe and single-patient rooms.

17.11 Sharing Patient Room (Semi-Private Room) The twin-sharing room should have an occupancy of 2–4 patients. The following points are to be taken care of while designing semi-private rooms:

17.11.1 Room Layout The semi-private sharing room should be divided into three zones – a staff zone at the entrance, a patient zone with beds, and two separate family zones for visitors.

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17.11.2 Size of the Semi-Private Sharing Room The room should have an area of about 32.52 Sq Mtr, including family spaces and toilets.

17.11.3 Doors and Windows Doors should not be less than 1829 mm wide, unobstructed, for easy movement of the bed during emergencies. A window should be preferred on the outer wall, left or right side of the patient, opposite the door side, with the option of being openable or non-openable. Glass can be tinted or curtains/blinds provided.

17.11.4 Toilets Common toilet and bathroom with a handwashing station should be provided for both patients using the Midboard concept.

17.11.5 Bed Layout in Patient Room Two patient beds should be laid down in the room with a 1219 mm distance between them. Curtain partitions should be provided for privacy between the beds.

17.11.6 Furniture and Instruments in Patient Room 17.11.6.1 Patient Furniture Patient Bed (Fowler bed with bedside railing can be used) Bed side locker Over bed table Step stool

IV stand IV rod Back rest

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17.11.6.2 Other Furniture Two numbers of Pull-out beds or plain sofa sets (separate Two Attendant beds (if a Pull-out bed for families of each patient) is not provided) Two chairs (if space is available) Two cupboards (separate for each patient)

17.11.6.3 Equipment Multi Para vital sign monitor (if required)

Air mattress

17.11.7 Air Conditioning and Other Services The air conditioning system, central piped medical gas supply, electrical points, communication points, curtain partitions, IV track, and lighting in the semi-­ private sharing room should be the same as that of a single occupancy patient room, with the addition that these provisions should be provided for both beds separately.

17.12 General Ward (Multiple Beds Room) The demand for multiple-bed wards has decreased over time due to several issues associated with them, such as increased chances of infection spread, compromised environmental conditions, difficulties in maintaining hygiene, reduced privacy, lack of proper entertainment sources like televisions, noisy atmosphere, and limited inter-bed spaces. Despite these challenges, some charitable and free hospitals continue to offer multiple-bed wards to cater to patients with limited financial resources. However, a well-designed multiple-bed ward can help mitigate some of these issues.

17.12.1 Location of the Multiple Bed Wards Multiple bed wards should be clustered in a specific zone and floor of the hospital, while isolation wards should be located in the isolation zone.

17.12.2 Room Layout The multiple-bed wards should have a patient area, nursing area, and service area.

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17.12.3 Number of Beds in the Multiple Bed Ward The number of beds in a ward can vary from 6 to 30, depending on the hospital’s requirements. It is recommended to have cubicles with glass partitions, containing a maximum of 4 beds each, to ensure better ventilation and infection control.

17.12.4 Size of the Multiple Bed Ward The ward size will depend on the number of beds, with a minimum per bed space of 100 sq. ft. for 4 beds and 9.29 sq. m for 30 beds.

17.12.5 Doors and Windows Doors should be wide enough for easy movement of beds in emergencies. Windows should be provided on the outer wall with options for openness and privacy.

17.12.6 Toilets Each ward should have separate male and female toilets and bathrooms, with at least one WC for 4 patients and one bathroom for 8 patients.

17.12.7 Bed Layout in Ward Beds should be placed along the large-sized walls opposite each other, leaving a free movement area in between. A clear space of 1829 mm should be provided at the foot end of both beds for stretcher trolleys. Interbed distance should be at least 914 mm, and in larger wards, a low-height wall can be used to organize bed rows.

17.12.8 Furniture and Instruments in Patient Room 17.12.8.1 Patient Furniture Patient Bed (Semi fowler bed with bedside railing can be used or otherwise plain patient bed can also be used)

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Bed side locker Over bed table Step stool

IV stand IV rod Back rest

17.12.8.2 Other Furniture Stool or reclining chair for attendants

Cupboard (if possible)

17.12.9 Air Conditioning System of Patient Rooms It should remain the same as that of a single occupancy patient room, except that instead of FCU, AHU and ducting should be used in the general wards.

17.12.10 Central Piped Medical Gas Supply It should remain the same as that of a single occupancy patient room.

17.12.11 Electrical Points in the Ward The electrical setup in the ward includes a main switchboard at the entrance wall for controlling fans and lights, along with one 6 Amp switch/socket. An air conditioning control button with temperature adjustment is provided. Each bed head panel has at least two pairs of 6/16 Amp switch/sockets (4 points), with half of them on UPS supply. Additionally, between two beds at the centre, two pairs of 6/16 Amp switch/socket should be installed on the wall at a height of 457 mm from the floor level, with one pair on UPS supply.

17.12.12 Other Communication Points in Ward 1. Point for Nurse Call device 2. Point for reading light for patient

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17.12.13 Curtain Partitions IV track and lighting points in the multiple-bed ward will be similar to those in a single occupancy patient room, but provided on all the beds.

17.13 Isolation Rooms/Wards Controlling the spread of airborne infections in hospitals is vital, as demonstrated during the Covid-19 pandemic, which highlighted the need for isolation beds. To address this concern, hospitals must design airborne infection isolation rooms with negative pressure or protective environment rooms with positive pressure. These designated isolation areas, called the Isolation Zone, should have restricted access, and proper barricading, and be under security control. Services like pantry, gas supply, and laundry in this zone should be separate from other areas. All isolation patient units, including single occupancy rooms or sharing rooms/ wards, should be located solely within this dedicated isolation zone, and if possible, the isolation ICU as well. In addition to meeting general requirements, isolation rooms/wards must have specific features such as single patient beds, designated spaces for donning and doffing PPE kits, and storage for clean and soiled materials near the entry door. Each room should also have a separate toilet with a hand-­ washing sink, and a well-sealed construction to maintain efficient air pressure differential and prevent air leakage. Utilizing self-closing doors and airflow monitoring devices is recommended.

17.13.1 Isolation in ICU ICUs require isolation provisions for patients with contagious diseases like Tuberculosis or Covid-19. Ideally, a separate ICU in the isolation zone is recommended; otherwise, around 25% of general ICU beds can be reserved for isolation using collapsible shutters or temporary partitions. Isolation rooms must have separate entries and attached toilets, be airtight, and be maintained at negative pressure. They should be a separate zone with a barrier between non-infected patients. Separate staff should take care of the patients in isolation cabins.

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17.13.2 Single-Bed Isolation Rooms Pressure differentials are used in single-bed isolation rooms to contain infectious agents effectively, but their success relies on tightly sealed rooms. Infection control in isolation and patient rooms depends on nurses adhering to evidence-based practices for hand washing and aseptic techniques to minimize risks.

17.13.3 Air and Pressure Monitoring System for Isolation Rooms Each isolation room should have a permanently installed visual device or mechanism to monitor the air pressure differential when occupied by an isolated patient. An electronic room-pressure monitor typically consists of a wall-mounted control panel and a sensor. The control panel, placed on the corridor wall near the room entrance, displays pressure difference in inches of water column (WC) and includes both audible and visual alarms to alert staff if room pressurization is compromised. For instance, in a room with a pressure differential of minus 0.03-inch WC, the alarm can activate when it falls to minus 0.01-inch WC. Monitors may have an extra signal for remote display of pressure differential and alarms, usually at the nurses’ station or building’s automation system.

17.13.4 Pressurization of the Isolation Rooms The isolation rooms can have either negative or positive pressurization. Negative-pressure rooms are used to isolate patients with airborne infectious diseases, requiring a minimum of 12 air changes of exhaust per hour and maintaining a minimum pressure differential of 0.01-inch WC. An anteroom may be provided to help maintain pressure, and exhaust must be directly discharged outdoors. Positive-pressure rooms are designed to protect patients with compromised immune systems, needing a minimum of 12 air changes of supply air and a positive 0.01-inch WC differential. HEPA-filtered air is used, and an anteroom can be utilized. Supply air is located in the ceiling above the patient bed, while return air is taken from the ceiling near the patient room door, maintaining constant ventilation in the room.

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17.13.5 Air Conditioning of the Isolation Wards/Units When designing air-conditioning for isolation rooms, the airflow, temperature, and pressure requirements must be calculated for maintaining proper pressure differential and temperature. Instead of smaller standalone units, a single larger system can be more economical to serve multiple rooms, depending on the number and type of isolation rooms. The same air-handling system used for standard patient rooms can be utilized for isolation rooms, with the difference being in the filtration and treatment of return air. The AHU serving isolation rooms should have proper pre-filters and high-efficiency particulate air (HEPA) final filters. 17.13.5.1 Supporting Room/Units for Indoor Patient Service Apart from patient units/rooms/wards, other essential rooms and utilities are necessary to serve patients and provide them with quality care and treatment. Some of these include:

17.14 Nursing Station For efficient patient care, the nursing station’s strategic location is vital, ensuring continuous monitoring of all patients in the unit. In general multiple bed wards, the nursing station should be centrally positioned on the back wall, with a straight or L-shaped counter. For semi-private rooms, private rooms, deluxe rooms, and suites, the nursing station should be placed outside the rooms, serving a group of 8–10 rooms. It is advantageous to position the nursing counter centrally among these rooms for a minimal distance. Elevating the nursing station in multiple bed wards allows better visibility of patients, achieved by providing a 305 mm high platform for the counter. Considering infection control, hospitals should avoid open nurse stations and instead opt for enclosed “glass bubbles” with an 1829  mm high acrylic or glass partition on top of the nurse counter. This ensures staff-patient/visitor interaction occurs with a barrier in between, reducing the risk of infection spread. Utilizing technology like Audio-Video Controlled Nurse Call System can further enhance communication. Adequate storage, electrical points, and communication facilities should be available at the nursing station, including 5–7 numbers of 6 Amp. switch/ socket, Nurse Call Control Console, RJ 45 point for Computer networking, RJ 11 for Intercom and extension line, and HDMI point for computer display at other locations.

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17.14.1 Hand Washing For hand hygiene, two-way scrub stations should be placed near nursing stations in the indoor patient area. The scrub stations should enable hands-free operation with sensor-controlled and/or foot-operated mechanisms. Both hot and cold water provisions are necessary.

17.14.2 Alcohol Gel/Sanitizer Dispensers Alcohol gel/sanitiser dispensers should be available in patient rooms and various staff locations throughout the unit. In patient rooms, holders can be used to hang the dispensers at the foot end of the bed.

17.15 Nurses Duty Rooms These rooms are designated areas for nurses to take breaks and store personal belongings while on duty. They should have a size of 3048  mm  ×  3048  mm, an attached toilet, one bed, and a cupboard. Essential facilities include lighting, a fan, points for a computer with an internet connection, and an intercom facility. The room should be air-conditioned with temperature adjustment control.

17.16 Doctors Duty Rooms Doctors’ Duty Rooms should be provided with a group of patient rooms, with one room per 50 patients or adjusted as per requirements. They should have a size of 4572 mm × 4267 mm, an attached toilet, an office table, a chair, a bed, and a cupboard. Additionally, essential facilities include lighting, a fan, points for a computer with an internet connection, and an intercom facility. Air conditioning with temperature adjustment control should also be provided.

17.17 Procedure and Treatment Room These rooms are necessary for minor medical procedures that cannot be performed in patient rooms due to infection risk, patient privacy, or the need for anaesthesia. Each set of patient rooms should have one such room, sufficient for 50 patients in the indoor area.

17.17  Procedure and Treatment Room

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The Treatment/Procedure Room should be conveniently located near patient rooms, preferably in the centre of the rooms, such as between two general wards. The minimum size of the Treatment/Procedure Room is 4572 mm × 4572 mm. The room must maintain a sterile environment and should have a single OT table. Access is through a single-entry door, and a gowning and scrub station should be attached to the room.

17.17.1 Furniture in Treatment/Procedure Room 17.17.1.1 Patient Furniture OT Table Stretcher trolley Dressing trollies Instrument trollies Step stool

Scrub Station IV stand IV rod Crash cart Oxygen cylinder trolley

17.17.1.2 Equipment Multi para vital sign monitor Portable operating light single dome Infusion pump Defibrillator

Laryngoscope Suction machine Oxygen cylinders with masks View boxes

17.17.1.3 Tools and Instruments Sterilising drums Extension cords and boxes Instrument boxes Torches Examination light All other required instruments

Chetal forceps Forceps of all styles and sizes Needle holders Tray of all styles and sizes Scissors of all styles and sizes General operating instruments

17.17.2 Doors and Windows The door of the Treatment/Procedure Room should be at least 1524 mm wide, unobstructed, and openable on both sides in and out. Windows are not required in the Treatment/Procedure Room.

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17.17.3 Hand Washing For hand washing, a single-bay scrub station with sensor and foot operation should be provided.

17.17.4 Central Medical Gas Supply The ceiling-suspended pendant in the room should have the following gas outlets: 2 outlets for Oxygen, 2 outlets for Compressed Air, and 2 outlets for Suction Oxygen.

17.17.5 Electrical Points in Treatment/Procedure Room Electrical points in the Treatment/Procedure Room include a main switchboard at the entrance wall for controlling fans and lights, an air conditioning control button with temperature adjustment, and at least 3 pairs of 6/16 Amp. switch/socket on the back wall of the pendant. Additionally, a pair of two 6/16  Amp. switch/socket should be provided on three walls of the Treatment/Procedure room, except the wall with the door, at the height of 457 mm from the floor level. Lighting provision for patient examinations should also be available on the bed head panel or wall column.

17.17.6 Other Communication Points in Treatment/ Procedure Room Other communication points include RJ 45 point for computer networking, RJ 11 for Intercom and extension line, and HDMI point for computer displays at other locations.

17.18 Clean Utility A clean utility room should be attached to each nursing station for storing clean linen and sterilized materials. The size of the room should be 3658 mm × 3658 mm with closed cabinets, drawers, and racks. It should have one door of about 915 mm.

17.23  Trolley Park Area

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17.19 Dirty Utility/Sluice Room A dirty utility or sluice room should also be attached to each nursing station for storing soiled linen before pre-washing and sending it to the laundry. The size of the room should be 3658  mm  ×  3658  mm with covered linen collection hampers or containers. It should have two doors, one opening in the ward/nursing station and the other in the corridor for laundry staff to collect linen. Exhaust fans are a must for this room.

17.20 Store for Medicines, Consumables and Disposables All nursing stations should have a general store to keep ample stock of medicines, consumables, and disposables. The store should be at least 3048 mm × 3048 mm with lockable cupboards, racks, and drawers, managed by the Ward Supervisor.

17.21 Medication Areas A designated area or cupboard should be provided in the nursing station for keeping patient medications in clear plastic boxes, marked with patient details. The medication area should be lockable and include a refrigerator.

17.22 Equipment Park/Store Each nursing station should have an equipment storage area of not less than 2438 mm × 2438 mm for storing less frequently used medical equipment. This area can be a closed room with a door or an open area attached to the nursing station and should have grounded electrical charging points for the equipment.

17.23 Trolley Park Area Each nursing station should be provided with a trolley park area for parking wheelchairs and stretches when not in use.

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17.24 Ward Pantry A Ward Pantry should be provided for storage and further distribution of patient diets. The pantry’s size is about 3658 mm × 3658 mm with a single door opening outside in the corridor. It should have a countertop, sink with hot and cold water, waste bin, and a trolley for collecting soiled utensils. A microwave oven may also be useful.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 21, Intermediate care area (patient room). p. 213–39.

Chapter 18

Radiology

Radiology is a crucial department using various imaging techniques like X-Ray, Ultrasound, CT, MRI, etc., to diagnose and treat diseases. Imaging modalities based on these techniques are: 1. X-ray Radiography 2. Ultrasound Machines 3. Computed Tomography (CT) 4. Magnetic Resonance Imaging (MRI) 5. Mammography Imaging 6. Nuclear Positron Emission Computed Tomography (PET CT) 7. Nuclear Positron Emission Magnetic Resonance Imaging (PET MRI) 8. SPECT CT 9. Cyclotron/Radio Pharmacy 10. Densitometer, Bone 11. Digital Subtraction Angiography (DSA)

18.1 Location of the Radiology Department The department should be easily accessible for OPD, emergency, IPD, ICU, and operating rooms. To ensure protection from radiation exposure, it is better to locate the department on the ground floor or in the basement. Special attention should be given to corridor dimensions to accommodate equipment transportation and installation. Proper planning is necessary to avoid any hindrance during equipment transportation, and manufacturers’ specifications must be consulted if needed.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_18

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18.2 Infrastructure of Centralized Radiology Department For infrastructures of the Imaging Department, please refer to “Table 1 – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

18.3 Utility Area This patient zone is designed for the utility and comfort of patients. It includes spaces for registration, enquiry, and reports delivery, along with waiting areas for pre and post-procedure. The main design considerations for this area include:

18.3.1 Reception and Enquiry The first point of contact for patients is the reception, guiding them through registration, appointment booking, and explaining the collection of reports. It should be easily accessible and have a counter length of 2438–3048 mm with a 914 mm high acrylic sheet for staff protection.

18.3.2 Registration and Cash Counter Located near the reception, this counter handles patient registration, payment, and token issuance, and guides them to the investigation room. The counter length is 2438–3048 mm with a 914 mm high acrylic sheet for staff protection. It’s recommended to keep the cash counter about 1829 mm away from the registration counter.

18.3.3 Waiting Lobby Patients wait here for their turn. Size should be based on patient load and average investigation time. Provide comfortable chairs, drinking water, and toilets. Post-­ Covid, create physical separation and appropriate queuing for patient safety: 1. Maintain social distancing by providing individual seats in waiting areas. 2. Consider designing sub-waiting lobbies for each imaging modality to manage patient flow efficiently, although it may not be practical for small healthcare facilities.

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3. Minimize interactions by implementing self-check-in and self-rooming. Create smaller waiting spaces with clustered seating, separated by 1524 mm acrylic or glass partitions. 4. Encourage patients and families to wait outside or in their cars instead of waiting in the lobby. 5. Introduce a token system to reduce waiting lobby crowding. Patients receive tokens at registration, allowing them to wait elsewhere. Use LCDs or SMS service to notify token holders of their turn

18.3.4 Reporting Room The central reporting room in most hospitals should ideally be at least 6096 mm × 4572 mm in size, equipped with computers, printers, tables, and comfortable chairs. Wall-mounted big-size view boxes for up to four films are necessary for film examination. The room should also accommodate a typist and ensure a secure network connection to PACS (Picture Archiving and Communication System) for image storage and transfer.

18.3.5 Stores for Unused Consumables and Films The department requires a store for consumables and films, preferably sized at 3658 mm × 3658 mm, with adequate countertops, cupboards, and drawers. Fire-­ proof cabinets are recommended for film storage. The room temperature should be maintained between 17 and 21 °C without direct sunlight exposure.

18.3.6 Stores for Used Films and General Items A dedicated space for storing exposed films, medico-legal cases, and machine accessories should be available, sized around 3658 mm × 3658 mm. It must have ample countertops, cupboards, and drawers with a fire-proof cabinet. The temperature should be controlled, and no windows should be present to avoid direct sunlight.

18.3.7 Report Delivery Counter A report delivery counter can be either an open counter or located in a room. We suggest an open counter for an elegant look, with a length of about 2438–3048 mm. An acrylic sheet of about 914  mm in height should protect staff from infectious

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diseases. Proper pre-numbered bins on the back wall can organize reports for delivery.

18.4 X-Ray Zone This section of the radiology department is dedicated to X-ray investigations, including fluoroscopy. Due to the potential harm of X-rays, the meticulous design of investigation rooms is crucial. The X-ray zone comprises the following areas:

18.4.1 Radiography Rooms This area houses the X-ray machines and facilities for X-ray-related procedures. The number of radiography rooms depends on the required machine capacity and future expansion plans. Different machine types and tables are available, ranging from conventional X-ray to Digital Radiography (DR) machines. Key design considerations for radiography rooms are as follows: 1. Comply with guidelines and norms of the country’s controlling authority, like the ones issued by the Baba Atomic Research Institute in India. 2. Provide a separate room for each machine. 3. Radiography room size remains consistent irrespective of machine or table type and should not be less than 25 sq. meters with rectangular dimensions. 4. Walls should be at least 229 mm thick, with plaster on both sides and primary walls of X-ray rooms require ideal thicknesses for radiation protection. 5. Ensure no single wall dimension should be less than 4 mtr. 6. Choose non-slippery flooring materials to avoid accidents. 7. Install a single door with lead lining, a width of about 1524 mm, and a height of 2000 mm. 8. Prohibit windows in the radiography rooms for radiation safety. 9. Provide a warning light outside the door connected to the generator, illuminating only during tube activation. 10. Fix the chest stand or frame on the wall opposite the entrance door and control console. 11. Install a shielded barrier at the X-ray control console to protect staff from radiation exposure. 12. Determine the power load required by the machine and separately terminate the main switch and cable in each radiography room. 13. If using a DR machine, provide a separate control room adjoining the DR room with a lead glass barrier. 14. Ensure adequate lighting with normal LEDs and maintain a temperature between 18 and 21 °C and a humidity level not exceeding 60%.

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15. Ground all machines properly and provide stands with heavy-duty hangers to hang lead aprons. 16. Equip each room with a cabinet for storing radiation safety devices such as lead gloves, goggles, groin guards, and collars. 17. Provide a store in the department for storing mobile X-ray units, and the size may vary based on the number of machines. 18. Install change rooms to enable patients to change into hospital attire before entering the X-Ray room. 19. Accommodate a patient preparation room with an examination couch and chair. 20. Design a Computerized Radiography (CR) room with specific dimensions, countertops, and a table or foundation for the camera. 21. The sub-waiting area for radiography follows the same principles as the utility area.

18.5 UltraSound Zone Ultrasound is an imaging technique using high-intensity sound waves (measured in MHz). Sound waves are induced into the body using a transducer, and when they hit different body tissues, they are reflected to the surface. The transducer picks up these waves, which have varying intensity and time periods, and the machine forms an image. This zone includes:

18.5.1 Ultrasound Room This room is used for performing ultrasound scans on patients. The design requirements are flexible, and it can be a square or rectangular room with a size of about 13.94 – 18.58 Sq. Mtr. A couch should be placed next to the Ultrasound machine, and curtain partitions installed using ceiling-mounted curtain rails. The room temperature should be around 18–22 °C with relative humidity (RH) of 50%. The lighting in the room should be dimmable.

18.5.2 Change Rooms Change rooms should be provided to allow patients to change into hospital attire if necessary for the ultrasound scan. The room size should be approximately 3048 mm × 3048 mm and equipped with personal lockers, hooks, hanger rods, and hangers for patient belongings. Additionally, a cabinet for storing sterilized dresses should be included.

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18.5.3 Toilets Each Ultrasound room should be equipped with an attached toilet to accommodate post-void scans, particularly for the ultrasound of the lower abdomen. The toilet should be furnished with a WC, urinal, and washbasin, with proper exhaust provision.

18.5.4 Sub Waiting for Ultrasound Should be the same as for the Utility area.

18.6 CT Scan Zone This section of the radiology department is dedicated to Computerised Tomography (CT). CT is an X-ray-based imaging technique that involves a high dose of X-rays during exposure. Therefore, the design of the CT Room requires special attention. This zone includes the following:

18.6.1 CT Scan Machine Room The CT Scan machine room should be designed based on the number of machines to be installed and future expansion plans. CT Scan machines come in different configurations, but the room design and size remain consistent. Important points for designing CT rooms include: 1. Follow guidelines and norms issued by the country’s controlling authority, such as Baba Atomic Research Institute in India. 2. Each machine requires a separate room. 3. Design the room either as a rectangular room (9144 mm × 4572 mm) for horizontal machine installation or a square room for diagonal installation. 4. Walls should be at least 229 mm thick with plaster on both sides, with recommended wall thickness for primary walls being 250 mm solid baked clay bricks and 150 mm mortar/concrete walls for plain radiography. 5. Flooring options can be tiles/marble/granite, ensuring non-slippery surfaces for patient safety. 6. Consider installing Air Interlocks with an additional door before the CT room door. 7. Provide a single door with a width of about 1524 mm for easy movement of trollies.

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8. The door should have a 2 mm thick lead lining on both door and frame to prevent radiation leakage and overlap by 100 mm on each side when closed. 9. Windows are not allowed in the CT room. 10. Install a warning light (red colour bulb) outside the door, illuminating during tube activation. 11. Leave at least 1829 mm space behind the machine for the Gantry to tilt and for easy maintenance. 12. Calculate the power load required for the machine and provide separate termination for the main switch and cable in each room. 13. Check the weight-bearing capacity of the floor, providing a foundation if needed. 14. Mount the equipment on a base plate using desired anchor fasteners specified by the equipment manufacturer. 15. Avoid shortcuts to prevent vibrations during operation and maintain image quality. 16. Provide normal LED lighting with sufficient lumen; no extra illumination is required. 17. Maintain a room temperature of 18–21 °C and humidity level below 60%, following equipment supplier recommendations. 18. Ensure proper ground earthing provisions for all machines. 19. Install medical gas supply outlets in the CT room for Oxygen, Vacuum, and Air. 20. Incorporate a two-way audio system in the CT room for communication with the patient during scanning. 21. Position the gantry and couch to enable complete visibility of the patient from the control console during scanning. 22. The entrance door to the gantry room from the control console should meet similar requirements as the patient entrance door. 23. Provide a stand with heavy-duty hangers outside the rooms to hang lead aprons. 24. Install a cabinet in each room to store radiation safety devices like lead gloves, lead goggles, etc.

18.6.2 CT Control Room An attached control room should be provided for CT Scan procedures, equipped with a table for the Control Unit and a secondary computer if required. Lead glass with lead lining separates the CT room and control room to prevent radiation leakage. A camera (printer) should also be provided in the Control Room to print CT films.

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18.6.3 UPS Room An online UPS is essential for continuous power supply to the CT Scan machine. A separate room with proper ventilation and air conditioning should be provided to house the UPS and batteries. The size of this room should be about 3658 mm × 3658 mm with several racks to install batteries.

18.6.4 CT Panel Room Electronic panels controlling the machine but not directly required in the CT room can be housed in a separate attached room or enclosure.

18.6.5 Change Rooms Patients may need to change into a hospital dress before entering the CT room; hence, change rooms with lockers, hooks, and hangers should be provided. The room should be approximately 3048 mm × 3048 mm in size.

18.6.6 Sub Waiting for CT Scan Should be the same as for the Utility area.

18.7 MRI Zone MRI rooms require special design considerations due to the machine’s strong magnetic field. This zone includes the following:

18.7.1 MRI Machine Room The design of MRI rooms is critical due to the strong magnetic field. This zone includes the following key points: 1. A separate room for each MRI machine is required. 2. Magnetic field safety is vital, and the MRI machine is enclosed in an RF shield (6-sided copper-lined box) to protect it from external radio frequencies.

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3. Room size varies based on the MRI machine’s configuration, with considerations for shielding, flooring, and construction materials. 4. Barriers are designed to protect the public from the powerful magnetic field, and the 5-gauss line is marked to prevent magnetic interference. 5. Clearances must be maintained to prevent objects from being pulled toward the magnet. 6. Provision of interlocks is advised before entering the MRI room. 7. All walls should be at least 229 mm thick with plaster on both sides. 8. A single sealed door, free of magnetic interference, is required, and windows are not allowed. 9. Sufficient space should be provided behind the machine for the MRI table’s movement and maintenance. 10. Weight-bearing capacity of the floor should be checked, and a foundation may be required for heavy machines. 11. Lighting with sufficient lumens is essential, using non-ferrous materials for MRI room lights. 12. The temperature in the room should be between 18 and 21 °C, and humidity should not exceed 40%. 13. Proper grounding provisions are required for all machines. 14. A non-ferrous cabinet inside the room is needed to store MRI coils and other non-ferrous materials. 15. Medical gas outlets for Oxygen, Vacuum, and Air should be provided in the RF cage. 16. A two-way audio system facilitates communication between the technician in the control room and the patient in the MRI room.

18.7.2 MRI Control Room A control room is attached to the MRI Scan room, where all controls are operated, and no entry is allowed during the procedure. The size of the control room should be 3658 mm × 3658 mm. It includes a table for the Control Unit of the machine, and optionally, a secondary computer for MRI image transfer and report preparation. A 2 mm lead-lined meshed glass separates the MRI room from the control room to prevent radiation leakage. A camera (printer) should be provided in the control room for printing MRI films.

18.7.3 UPS Room An online UPS is required for continuous power supply to the MRI machine, as a power failure can cause helium gas loss and potential machine failure. The UPS is usually of high rating (above 150 KVA) and requires a separate room attached to the

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MRI Control Room or machine room. The UPS room should have exhaust and air conditioning to control temperature (17–20 °C) and maintain humidity below 40%. Proper earthing is necessary. The size of this room should be about 3658 mm × 3658 mm with several racks to install batteries.

18.7.4 MRI Panel Room Electronic panels that control the MRI machine, apart from the main gantry, are located in a separate enclosure attached to the MRI room. Consultation with the equipment manufacturer is recommended for designing this area.

18.7.5 Chiller An external water chiller is required to cool down the gradient coil and liquid helium compressor of the MRI. It maintains the temperature inside the magnet at −269 °C for superconducting coil operation. The chiller is connected to the UPS for continuous functioning and is installed outside the hospital building. It cools water in a tank and circulates it through a pipeline to cool the MRI machine.

18.7.6 Change Rooms Patients should be provided with change rooms to switch to hospital attire before entering the MRI room to avoid interference with imaging due to metal in regular clothes. The room size should be approximately 3048 mm × 3048 mm, equipped with lockers, hooks, hanger rods, hangers, and a cabinet for sterilized dresses.

18.7.7 Sub Waiting for MRI Should be the same as for the Utility area.

18.8 Mammography Zone This zone in the radiology department is dedicated to breast X-rays for females, also known as mammography. Special care is taken while designing the mammography room.

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The zone includes:

18.8.1 Mammography Rooms This zone in the radiology department is dedicated to mammography rooms where X-rays are used for breast imaging in females. Important points related to the designing of these rooms include. 1. Consider guidelines and norms of the controlling authority while designing the rooms, such as those issued by the Baba Atomic Research Institute in India. 2. Provide a separate room for each mammography machine. 3. The room can be rectangular or square, but its size should not be less than 10 sq. mtr. 4. Ensure walls are at least 229 mm thick with plaster on both sides. 5. Ensure no single wall dimension is less than 3000 mm. 6. Use non-slip flooring like tiles, marble, or granite to prevent accidents and injuries to patients. 7. Install a single door with a width of about 1000 mm and 2000 mm high, with 2 mm thick lead lining on the door and its frame to prevent radiation leakage. Overlap doors by at least 100 mm on each side when closed. Provide handles and locks inside and outside for controlled access. 8. Avoid windows in the mammography room. 9. Install a warning light (red bulb) outside the door connected to the generator, illuminating only during tube activation. 10. Place a shielded barrier at the mammography control console to protect staff from radiation exposure. 11. Calculate power load based on machine capacity and ensure separate termination of the main switch and cable in each mammography room. 12. For DR-type machines, provide a separate small control room adjoining the DR room with a lead glass fixed in a wooden frame with 2 mm lead lining between the two rooms. 13. Install normal LED lighting with sufficient lumen; no extra illumination is required. 14. Maintain the room temperature between 18 and 21  °C and humidity below 60%. Confirm environmental requirements with the equipment supplier for machine-specific variations. 15. Ensure proper ground earthing provisions for all machines. 16. Provide a stand with heavy-duty hangers outside each room to hang lead aprons. 17. Include a cabinet in each room to store other radiation safety devices such as lead gloves, lead goggles, groin guards, lead collars, etc.

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18.8.2 Change Rooms For mammography, change rooms are provided where patients can change into a simple cotton gown. The room size should be approximately 3025 mm × 3025 mm and include personal lockers, hooks, hanger rods, and hangers for patient belongings. A cabinet for storing sterilized dresses should also be included.

18.8.3 Computerised Radiography (CR) Room The CR System in the main radiology department can be used for mammography. Only the cassette needs to be carried from the mammography room to the radiology CR room. Other processes remain the same.

18.8.4 Sub Waiting for Mammography Should be the same as for the Utility area.

18.9 DEXA Scan Zone This zone of the radiology department is dedicated to DEXA Scan, a high-precision X-ray that measures bone mineral density and bone loss. It helps detect the risk of osteoporosis and bone fractures. Careful design considerations are essential for the DEXA Scan room. This zone includes the following:

18.9.1 DEXA Scan Machine Room This area houses the DEXA Scan machine for X-ray exposure to patients. Generally, one room is sufficient, but future plans should be considered: 1. Comply with guidelines and norms of the country’s controlling authority (e.g., Baba Atomic Research Institute in India) during room design. 2. Allocate a separate room for each DEXA Scan machine. 3. The room can be rectangular or square with a minimum size of 10 sq. mtr. 4. Walls must be at least 9 inches thick, with plaster on both sides. 5. Use non-slip flooring materials like tiles, marble, or granite to prevent accidents and injuries to patients.

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6. Install a single door with a width of about 1000 mm and 2000 mm high, with a 2 mm thick lead lining on the frame to prevent radiation leakage. Overlapping doors by at least 100 mm on each side, when closed, is essential. 7. Exclude windows in the DEXA Scan room. 8. Provide a warning light (red bulb) outside the door, connected to the generator for illumination only during tube activation. 9. Shield the DEXA scan control console to protect staff from radiation exposure. 10. Terminate the main switch and cable separately in each DEXA scan room based on machine capacity. 11. If a DR machine is planned, include a separate small control room adjoining the DR room with a lead glass fixed in a wooden frame with 2  mm lead lining between the rooms. 12. Use normal LED lighting with sufficient lumen, no extra illumination is required. 13. Maintain the room temperature between 18 and 21  °C, and humidity level below 60%. Confirm environmental requirements with the equipment supplier for variations. 14. Ensure proper ground earthing provisions for all machines. 15. Provide a stand with heavy-duty hangers outside each room for hanging lead aprons. 16. Install a cabinet in each room to store radiation safety devices like lead gloves, lead goggles, groin guards

18.9.2 Sub Waiting for DEXA Scan Should be the same as for the Utility area.

18.10 PET CT/MRI Zone This radiology zone involves integrated PET scanners (PET CT and PET MRI) that combine morphological imaging (CT or MRI) with nuclear isotopes. Designing the facility requires accommodating the basic infrastructure of CT and MRI, along with PET Scanner requirements and regulations, where nuclear isotopes are used. To optimize space, it’s advisable to install both PET CT and PET MRI in the same area since the hot area containing the cyclotron and radiopharmacy is common to both. This setup can help save valuable department space. Typically, one machine each of PET CT and PET MRI is installed, but the designer must also consider the hospital’s future expansion plans.

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18.10.1 Location of the Zone in the Hospital To ensure proper shielding and safety, the PET area, being a high positron emitter, should ideally be located in the basement. The surrounding soil acts as a barrier, reducing the risk of emission outside the zone.

18.10.2 PET CT Scan Machine Room The infrastructure of the machine room should be the same as a normal CT Scan machine room. The only difference is that the wall should be made out of 300 mm thick RCC.

18.10.3 PET MRI Machine Room The PET CT machine room’s infrastructure is similar to a normal CT Scan machine room, except for 300 mm thick RCC walls for enhanced shielding.

18.10.4 Other Attached Areas All norms and specifications for attached areas, such as the console room, UPS room, and machine panel room, should be the same as those for CT Scan and MRI.

18.10.5 SPECT CT Machine Room The SPECT CT machine room’s infrastructure is similar to a normal CT or PET CT machine room.

18.10.6 Operating Console Rooms Each imaging modality requires a separate console room. These rooms should have a 300-mm-thick RCC wall with a 4-mm lead equivalent glass window, separating them from the PET CT scanner, PET MRI, and SPECT CT room. Before planning rooms for PET CT, PET MRI, and SPECT CT, it is crucial to meet the requirements and room specifications, including weight-bearing capacity,

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temperature stability, adequate power supply, and radiation safety measures, as advised by the machine manufacturer.

18.10.7 Low-Risk Areas or Cold Areas 18.10.7.1 Reception It should be located at the entrance of the zone, the reception area also includes a secretarial room for administrative tasks like accounts. Approximately 15–20 sq. mtr. Space is sufficient, but it can be adjusted based on workload. Lighting, temperature, and furniture will follow standard reception and administrative room standards. 18.10.7.2 Sub Waiting Room Should be the same as for Utility rooms. 18.10.7.3 Physicians Consulting Room This room is for patient analysis, interviews, and physical examinations before conducting investigations. It should be close to the waiting room and equipped adequately, including outlets for oxygen and vacuum supply. Room size: about 4267 mm × 4572 mm. 18.10.7.4 Store A small store (3658 mm × 3658 mm) should be provided to store materials like QC phantoms, consumables, disposables, etc. Equipped with worktops, cabinets, and drawers for storage. 18.10.7.5 Technologist Room The technologist room cum office should be located near or opposite the physician consultation room for investigation planning and resource management.

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18.10.8 High-Risk Areas or Radiation Exposure Hot Areas 18.10.8.1 Hot Lab Cum Radiopharmacy Room This room is required when the department has its own production unit (cyclotron and radiochemistry lab) for delivering mono-dose syringes in lead containers to each injecting room. Walls should be 300 mm thick RCC. 18.10.8.2 Injection Room An injection room should be constructed with 220-mm-thick RCC walls, the injection room should have an aperture opening to the radiopharmacy. Patients sit in the injection room while the staff prepares the injection in the adjoining radiopharmacy. Room size: roughly 12–16 sq mtr. for each PET CT/ PET MRI/ SPECT CT installed. Patients after injection emit radiation (approx. 30–50 μSv/h per patient at 1000 mm just after administration). 18.10.8.3 Post-Dose Waiting Area After injection, patients rest in the post-dose waiting area during the uptake period. Walls made of 300-mm-thick RCC result in an exposure rate of about 1.22 uSv/h (for a patient injected with 300 MBq of 18F radiopharmaceutical at a distance of about 1000 mm). Proper positioning and shielding of the uptake rooms are crucial to manage the radiation protection concern when several patients assemble in the area.

18.10.9 Toilet Adjacent to the preparation rooms, a toilet should be provided for patients to void their bladder before the PET scan. The discharge from this toilet should be directed to a separate settlement tank where isotopes are neutralized before disposal into the main sewerage line.

Further Reading

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18.10.10 Control and Scanning Room The core of the facility is easily accessible from preparation rooms and the toilet. Vendors’ prerequisites and installation guidelines are considered during planning. Sufficient space and appropriate angles in corridors are ensured to accommodate the heavy gantry of multi-modality scanners.

18.10.11 Post-Examination Waiting Room Patients wait in this room while their scans are checked, and they change clothes if needed. A separate exit gate should be provided for these patients to avoid mixing with others, ensuring faster patient throughput.

18.10.12 Waste Disposal Room Used materials like FDG dispensing items and potentially contaminated items are stored in this dedicated area for the safe decay of radioactivity before proper disposal.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 22, Radiology. p. 241–61.

Chapter 19

Clinical Laboratories

A ‘Clinical Laboratory’ is a crucial facility for conducting clinical pathology tests on patient specimens to obtain health information aiding diagnosis, treatment, and disease prevention. The efficiency of a hospital largely relies on prompt and accurate reports from pathological investigations. Referred to as the ‘LAB,’ it is a significant investigative service supporting clinical services. The laboratory applies scientific techniques to disease diagnosis and control and investigates clinical phenomena associated with diseases. It must be well-designed and supervised to maximize its benefits. While pathology exams supplement clinical findings, they should never replace the comprehensive clinical diagnosis based on studying the patient as a whole.

19.1 Infrastructure of Clinical Lab For infrastructures of the Clinical Laboratories, please refer to “Table 1 – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

19.1.1 Planning & Designing of Laboratory While designing the clinical lab the issues to be considered are:

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_19

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19.2 Size of the Lab The lab size varies based on factors like patient load, number of specimen collection, and types and quantity of tests required to be performed. Hospitals may choose outside labs for certain investigations due to cost constraints, and how many of these tests will be outsourced. The size of the lab differs from hospital to hospital.

19.3 Layout Different lab sections should be in separate rooms. In small spaces, Biochemistry and Pathology can be combined, while Microbiology needs a separate space. Collection counters should be available at various locations in the hospital like OPD, Emergency, ICU etc.

19.4 Spaces The lab requires areas for conducting tests, collecting specimens, dispatching reports, equipment storage, and administrative work.

19.5 Location & Arrangement of Areas Clinical labs can be conveniently placed within hospitals since patients rarely visit them. Specimen collection and report delivery are handled in inpatient areas.

19.6 Open- Lab Designs Traditional lab designs with separate compartments are shifting to open-plan concepts due to advancements in technology and automation. Open labs offer flexibility in reconfiguring layouts and adding equipment as needed. Equipment is arranged in rows, and utilities like power, data, and gas points are overhead. Modular furniture with wheeled cabinets is preferred, while fixed elements like sinks and floor drains are strategically placed.

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19.7 Biosafety In light of infectious disease concerns like Covid-19 and others, hospitals adopt BSL-3 labs, especially for sections like Microbiology. BSL-3 labs require careful design to prevent pathogen multiplication. Safety measures include hardened epoxy-coated walls, sealed penetrations, and non-porous working tops like Stainless Steel. These precautions minimize the risk of pathogen spread.

19.8 Molecular Testing Molecular diagnostics is a rapidly growing area in clinical labs, replacing traditional microbiology. It allows direct testing of patient blood for DNA markers, providing quicker results without lengthy incubation. Technicians can identify specific organisms and genetic markers, aiding in personalized treatment decisions.

19.9 Laboratories Biochemistry, Microbiology, and Pathology labs share common design norms, with minor variations based on lab-specific requirements. Once the lab size is determined, the final design is worked out accordingly. Some of the important issues relating to the design of the Clinical Laboratories are as follows: 1. Consider country-specific guidelines and standards, such as NABL, while designing laboratory rooms in hospitals. 2. Opt for open-type laboratory designs for most divisions, but include closed-­ type designs for sections dealing with infectious or hazardous investigations. 3. Plan separate rooms for specific laboratory divisions, taking equipment and staff movement into account. 4. For equipment requiring a dust-free environment, provide separate enclosures using glass or aluminium partitions. 5. Walls in the laboratory rooms should be at least 9-inch-thick with plaster on both sides. 6. Choose non-porous, stain-proof flooring, such as large-sized floor tiles, hot welded vinyl flooring, or epoxy-coated concrete slabs. 7. Install single doors, around 1829 mm wide, for each laboratory, and ensure they are automatically self-closing. 8. Include windows in the laboratory design based on the building’s elevation. 9. Illuminate the room with normal LED lights, providing sufficient lumens without requiring additional illumination.

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10. Maintain the room temperature between 18 and 22  °C and humidity below 40%. Confirm the environmental requirements with equipment suppliers. 11. Ensure proper ground earthing provisions for all machines in the laboratory. 12. Optimize working slabs for efficient laboratory operations, with granite top surfaces and cabinets for storage. 13. Include deep laboratory sinks, made of china clay, at appropriate places in the working slab for washing hands. 14. Allocate a separate Equipment Park/Store room in the laboratory for storing equipment not in constant use. 15. Provide an Emergency Eyewash Station in each laboratory to address accidental chemical or fluid splashes. 16. Design a Clean Utility room for storing sterilized materials and clean items, equipped with cabinets, drawers, and racks. 17. Include a Biohazard/Trash/Recycle room for storing soiled materials, with two doors—one opening to the laboratory and the other to the corridor for staff’s convenience during material collection.

19.10 Pneumatic Tube Systems (PTS) Each laboratory shall have one PTS station for receiving specimens and requisition forms from different hospital locations and sending reports to respective places.

19.11 Clear Floor Space Maximize clear floor space in laboratories to accommodate equipment and technicians efficiently.

19.12 Electrical Points in Laboratories Design electrical points carefully to meet equipment needs. Provide main switchboard at the entrance, air conditioning controls, multiple 6/16 Amp switches/sockets above the working slab (some on UPS supply), and 5 Amp switches/sockets for refrigerators and freezers. Power supply for scattered equipment can be given through the floor or suspended conduit from the ceiling.

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19.13 Other Communication Points in Laboratories Equip laboratories with communication ports for interfacing the equipment with Hospital Management Software. Provide RJ 45 points for computer networking and RJ 11 for intercom and extension lines.

19.14 Air Conditioning System of Laboratories Opt for fully air-conditioned laboratories with controlled temperature, humidity, and air exchanges. Separate return air for each lab, maintain airflow as per industry norms and set the temperature between 18 and 22  °C unless specific equipment requires different temperatures. Consider either Chilled Water Pipe Line with AHUs or Ductable Split/VRV systems for air conditioning.

19.15 Furniture in the Laboratories Lab furniture is minimal, with office tables, chairs, and laboratory stools being the primary pieces. Work surfaces like benchtops and counters must be impervious to chemicals.

19.16 Main Equipment in the Clinical Laboratories Pathology Automated platelet counting

Chromatography (GAS), clinical use Column supports, gas-liquid Chromatography for Chromography bacterial identification Micrometres, microscope Binocular research microscope Clinitek status analyser Coagulation, automated Chromatography Microscope fluorescence/ UV Chromatography, thin-layer, Microscope inverted stage, methadone tissue culture Cytocentrifuge Cytospin Microscope phase contrast Microtome Multipurpose system in Vintro Platelet aggregation coagulation studies automated system Platelet Aggregometer Processor, tissue automated

Cell counter, normal and abnormal Cell-freezing apparatus and reagents Mass spectrometer Chromatography, ion-exchange Counter, automated cell Columns, liquid chromatography Laminar air flow horizontal Lamps, slide warming Trinocular microscope with phase contrast attachment Radioimmunoassay

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Slide Stainer, immersion type Stereoscopic microscopes Haematology analyser Suspension system, cell culture

Enzyme immunoassay Glass ware Vacuum oven

Microbiology Automated clinical BOD incubator Cell cultures for isolation of viruses Deep freezer

Bact alert system BSL 3 High-performance liquid chromatography (HPLC) Elisa reader with washer

Gene expert

QBC microscope (malaria)

Laminar air flow Refrigerated centrifuge Thermocycler Vitek 2 compact 60

LIPA (line probe assays) RT- PCR T.B. Culture Bact/alert 3D

Biochemistry Automated clinical chemistry systems Automated urinalysis system Chemistry (sequential multiple, continuous flow) analyzer Card reader Nyco II Freezer Fully auto. Analyzer (immunoassay) Osmometers Radioimmunoassay

Spectrophotometer digital Fibrometer Hemoglobinometer Turbidity meter

Bichromatic photometric analyzer Chemistry, micro analyzer Colorimeter, photometer, spectrophotometer Gamma counter Gas, oxygen analyzer

Bio-safety cabinet CD4 counter Immunofluorescent microscope Immunodiagnostic systems Microscope fluorescence/ UV MGIT 960 Ultracentrifuge Vitek

Nephelometer

Chemistry (photometric, discrete) Analyzer Carbon-dioxide analyzer Densitometric, protein fractionation Glass ware Microscope fluorescence/ UV Monochromator

Pipetting station Refractometer

Plasma viscometer Semi-auto analyser

19.17 Support Services These are the areas which support the laboratories at the back end to perform efficient work in the lab. Some of the areas are like;

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19.17.1 Autoclave A room near the microbiology lab houses an autoclave for media preparation and glassware sterilization. The room should be about 3658 mm × 3658 mm, equipped with a quick steam sterilizer and a hot air oven. It should have a soft water supply, drain, and proper exhaust and air exchange arrangements.

19.17.2 Bulk Storage Room Used for storing reagents, chemicals, kits, glassware, and disposables, the size of the room should be at least 4572 mm × 4572 mm. Lockable cupboards, racks, and drawers should be provided, with a countertop for reagent preparation. The storekeeper should be responsible for this room.

19.17.3 Cold Storage Room For temperature-sensitive materials, a common refrigerated room of about 3048 mm × 3048 mm in size should be available. Use puff panel walls and air conditioning, maintaining a temperature between 5 and 12 °C. Stainless steel racks line the walls.

19.17.4 RO Water Closet A separate room, approximately 3658 mm × 3658 mm, houses the RO plant to supply water to machines like Auto biochemistry analyzers. A treated water tank should be provided for water storage.

19.17.5 Gas Storage Closet A small open gas manifold room should conveniently be located in the laboratories to supply cooking gas through pipelines. It should hold 2–5 cylinders at a time and be connected to burners via copper pipelines and ball valves.

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19.17.6 Record/File/Copy Room This store, approximately 3658 mm × 3658 mm, is used to store records, files, requisition sheets, and stationery. It should be windowless, moisture-free, and have an electric point for light and a fan.

19.17.7 Flammable Storage This room, measuring 3658 mm × 3658 mm, stores hazardous materials like acids, spirits, and alcohol. It should be located away from general movement areas, have glazed acid-proof tiled walls, and only one electric point for lighting.

19.17.8 Specimen Storage/Recycle This room stores collected specimens like blood, urine, stool, body fluids, and semen, requiring different environmental conditions for refrigeration and humidity. Proper bins, racks, and cabinets should be provided, along with working tops and sinks. A room size of 4267 mm × 3658 mm should be sufficient.

19.17.9 Block and Slide Storage Used for storing processed blocks and slides, this room requires suitable temperature and humidity arrangements. Block storage cabinets and slide storage cabinets should be provided. A room size of 4267 mm × 3658 mm is usually sufficient.

19.17.10 Penta Head/Deca Head Microscope Room Required in teaching institutes or hospitals, this room accommodates a Penta Head or Deca Head Microscope. The square-shaped room contains a table with outlets for multiple users. Proper electric points should be provided on the table. .

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19.18 Utility Area This is the administrative area for controlling and coordinating the working of the laboratories. Some of the spaces are:

19.18.1 Doctors Room This room, approximately 4572 mm × 4267 mm, is for pathologists, biochemists, microbiologists, and other doctors to conduct official work. It should include office tables, executive chairs, visitor chairs, side racks, and an attached toilet. Proper arrangements should be made for electrical points, intercom connections, IT networks, and air conditioning.

19.18.2 Laboratory Manager The manager’s room, about 4572 mm × 4267 mm in size, should be located within the laboratory premises. It should include office tables, executive chairs, visitor chairs, side racks, and an attached toilet. If required, a small restroom may be provided. Proper arrangements should be made for electrical points, intercom connections, IT networks, and air conditioning.

19.18.3 Technicians Room This room, approximately 4572 mm × 4267 mm, is for laboratory technicians to carry out their official work. It should include office tables, office chairs, visitor chairs, and side racks. Proper arrangements should be made for electrical points, intercom connections, IT networks, and air conditioning.

19.19 Outpatient Phlebotomy Phlebotomy is the collection of patient specimens for investigation, conducted by a professional called a Phlebotomist. Specimens are collected in various hospital locations, including OPD, IPD, ICU, OR, and Emergency areas. The phlebotomy process may involve dedicated phlebotomists, nurses, or technicians, depending on the hospital’s practices.

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Phlebotomy rooms should typically be planned in the OPD complex of the hospital. The following rooms should be provided for phlebotomy in the OPD:

19.19.1 OPD Phlebotomy Room One or more phlebotomy rooms should be provided in the OPD complex. The room should be about 4572  mm  ×  4267  mm in size and equipped with working tops, sinks, and electrical points. It should include an office table, chairs, computer, printer, and barcode printer for completing administrative tasks. The room should also have a refrigerator for storing specimens temporarily. A Sample Collection Room/Space should be attached to the phlebotomy room, containing a phlebotomy chair and examination couch. Cupboards, shelves, and racks store necessary supplies. The room should be connected to the Pneumatic Tube System (PTS) for sending specimens to the laboratories promptly.

19.19.2 Fine Needle Aspiration Room This room, about 4572 mm × 4267 mm in size, is used for fine needle aspiration or biopsy procedures. It should be maintained under sterile conditions and include an examination table with hanging curtain partitions. A changing room for patients and staff should be attached, along with a scrub station and shoe rack outside. Emergency equipment and medicines should be available in the room. A small storeroom should be provided for necessary supplies.

19.19.3 Toilets Toilets should be provided, attached to the phlebotomy room, for collecting specific specimens like urine, stool, and semen. Separate toilets for males and females are preferable. The toilet should have a shelf with raised edges for patient convenience.

19.19.4 Waiting Area A waiting area near the phlebotomy room allows patients to wait for their turn to give specimens. The hospital may introduce a token system or use speakers connected to a microphone in the phlebotomy room for patient announcements.

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19.20 Employee Support The area for the facility of the staff. This area includes:

19.20.1 Staff Lounge A lounge in the laboratory area for staff to relax in their spare time, with an attached toilet and provision for tea/coffee from the pantry.

19.20.2 Lockers Lockers should be provided in the staff area for safely storing personal belongings, with each staff member allotted a separate locker.

19.20.3 Shower with Water Closet Separate shower rooms with water closets should be provided for male and female staff to maintain hygiene and safety from potential chemical exposure.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 23, Clinical laboratories. p. 263–75.

Chapter 20

Blood Bank

20.1 Location of the Blood Bank in the Hospital The Blood Bank should be strategically located for easy accessibility, particularly during emergencies, and should be in close proximity to the Emergency, Operating Theatre Complex, and Intensive Care Units. Ground floor placement is preferred for convenience. The Blood Bank must be a cohesive unit, with all its rooms located together and not scattered throughout the hospital.

20.2 Controlling Authority Blood Banks are regulated by specific controlling authorities under relevant acts in most countries, such as India’s Drug Act. Designers should carefully adhere to the rules, regulations, and norms set forth by the controlling authority when planning and designing the Blood Bank, given its regulated status within the hospital.

20.3 Functions of Blood Bank Blood banks have four major functions area.

20.3.1 Receiving The area designated for the collection of blood from the donor and providing facilities to the donor after bleeding. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_20

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20.3.2 Storage Storage is for storing the untested blood, tested blood and blood components.

20.3.3 Testing The area designated for the screening of the donated blood for ruling out any infectious diseases in the blood.

20.3.4 Distribution Area for distributing the blood for transfusion.

20.4 Infrastructure of the Blood Bank For infrastructures of the Blood Bank, please refer to “Table 1  – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

20.5 Area of Blood Bank Generally, the area is specified in the norms issued by the controlling authority of the blood bank. So while designing the blood bank, those area norms have to be adhered to. e.g. In India, the Drug Act prescribes the area as. a) For Whole Blood b) For Components c) For Apheresis

- 100 Sq. Mtr. - Additional 50 Sq. Mtr. - Additional 15 Sq. Mtr.

Hence the area should not be less than 165 Sq. Mtr. After adding the movement area, the total area should not be less than 200 Sq. Mtr.

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20.6 Equipment in the Blood Bank Normally the following equipment is provided in the blood bank: Apheresis machine Blood collection monitor Blood donor couch (Mobile) Cryo bath unit Dielectric sealer Mechanical shaker Platelet incubator Thawing Bath

Blood bag tube sealer Blood collection system, vacuum-assisted Deep freezer −40 °C

Blood Bank refrigerator Blood mixing and blood weighing device Deep freezer −80 °C

Double pan balance HB meter Oven universal Platelet agitator Processing system for frozen blood

Elisa reader with washer ID centrifuge Plasma extractor Refrigerated centrifuge Water bath serological

20.7 Receiving Area This area covers donor registration, examination, and bleeding, along with spaces like a refreshment room and apheresis Room. Detailed room information includes:

20.7.1 Entrance The main entrance of the blood bank should be wheelchair-accessible with a door width of 1219 mm. A shoe rack outside prevents outside shoes from entering. An optional air curtain on the door helps as an air barrier.

20.7.2 Reception Located near the entrance, the reception counter should have chairs for the receptionist. It should be equipped with electric points, computer networking jacks, an intercom, and an emergency telephone line. Adequate storage space can be provided in cabinets or side racks. The area should be around 3658 mm × 3658 mm.

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20.7.3 Registration The registration counter, where donor forms are provided and consent is taken, can be combined with the reception if needed. An area of 2438 mm × 2438 mm is sufficient.

20.7.4 Waiting This area accommodates 10–15 people, including donors and their family members. The waiting area should be around 4572 mm × 3048 mm.

20.7.5 Medical Examination The room is for pre-bleeding donor examination. It should measure 3658 mm × 3658 mm and include a doctor’s table, chair, examination couch, view box, and electrical points for lamps and devices. Intercom and networking points should be provided, along with a fixed height scale on the wall.

20.7.6 Bleeding Room This room accommodates the bleeding of donors. A size of approximately 4572 mm × 4267 mm should be adequate for two blood bank couches. Additional space may be added for more couches. The room should have two doors, emergency medicines on a working top, and a television provision. Ample electrical points are essential for medical equipment, and the room should have emergency lighting.

20.7.7 Refreshment/Recovery/Rest Room The refreshment/Recovery room for the donors after the donation should be provided. The room should be approximately 4572 mm × 658 mm, and have a sofa set, couch, refrigerator, tea/coffee vending machine, and television. Electrical points should be provided for these amenities.

20.7.8 Apheresis Room Used for apheresis, the room should measure about 4572 mm × 3658 mm. It houses an apheresis chair, a television, an apheresis machine, and an office chair for the technician. Electrical points should be given at 457  mm from the floor level and supplied through UPS. A television point should be also available.

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20.8 Testing Area This area involves donated blood screening, with two sections: the Serology Lab for blood group serology and the TT Lab for screening HIV antibodies and hepatitis B antigens. The Lab’s structure details are as:

20.8.1 Laboratories Two rooms, one for each lab should be provided in the blood bank.

20.8.2 Wall The laboratory walls should be at least 229 mm thick with plaster on both sides. Walls and ceilings should be finished with anti-bacterial and anti-fungal washable paint. Puff panels or GI sheets should be used to eliminate corners and edges.

20.8.3 Flooring The flooring must be non-pervious and stain-proof. Recommended options include jointless floor tiles of size 600 mm × 600 mm or hard stone like granite. Marble is not recommended due to its porous nature.

20.8.4 Doors Preferably, each laboratory should have a single automatic and self-closing door with a width of about 1219  mm to facilitate the movement of personnel and equipment.

20.8.5 Lightning Normal LED lights with sufficient lumens should be sufficient for lighting in the room.

20.8.6 Earthing All the machines should have proper ground earthing provisions.

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20.8.7 Working Slabs Working slabs are essential for efficient laboratory work, placed on the walls at 915 mm in height. Slab width can be adjusted based on needs, topped with round or half-round edged granite. Vertical stones are fixed from the slab to prevent wall damage. Below the slab, a 152 mm thick platform should be provided, fixed with stone or tiles. This space should house the cabinets for storing reagents and consumables, with shelves and doors for safety.

20.8.8 Sinks Each laboratory should have a deep laboratory sink (610 mm × 457 mm) for washing, recessed in the working slab. China clay sinks are recommended over metal sinks. The tap height should be 305  mm above the sink level, with a floor platform drain.

20.8.9 Electrical Points in Laboratories The main issues to be considered while designing the electric points are as follows: 1. Main Switchboard should be at the entrance wall for controlling the fan and lights of the hall along with one or more 6 Amp Switch/Socket 2. Air Conditioning Control button with temperature adjustment 3. At least a pair of two 6/16/Amp switch/sockets, on the wall above the working slab, at a distance of 1524 mm from each other. Out of them, at least half should be on UPS supply. 4. The power supply on the Office table for Microscopes.

20.8.10 Other Communication Points in Laboratories The following communication points should be provided 1. RJ 45 points for Computer networking 2. RJ 11 for Intercom and extension line

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20.8.11 Air Conditioning System of Laboratories Air conditioning for laboratories is crucial for controlling temperature, humidity, and air quality. Maintaining separate return air for each laboratory is essential. Airflow, direction, and exchanges must adhere to industry norms, and the temperature should be maintained between 18 and 22 °C, considering specific machine requirements.

20.8.12 Furniture in the Laboratories Due to restrictions on wood usage in the blood bank, all items like tables, cabinets, racks, and notice boards must be made of stainless steel.

20.8.13 Fittings and Fixtures No fittings like lights, fans, boards, or stitches are allowed on the walls or ceiling surface. Everything must be recessed in the walls or ceiling for a clean and organized appearance.

20.9 Storage & Processing Area This area is for blood storage before and after screening. Blood is stored in blood bank refrigerators, with refrigerated rooms used for large quantities. This area also processes blood to separate its components.

20.9.1 Storage of Untested Blood Untested blood storage should be kept in the bleeding room or a separate enclosure with a blood bank refrigerator, requiring an electrical point.

20.9.2 Storage of Tested Blood Tested blood storage should be separate from untested blood, located in the delivery room or a nearby enclosure with a blood bank refrigerator, needing an electrical point.

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20.9.3 Blood Bank Refrigerators The numbers and capacity of blood bank refrigerators should depend on the quantum of blood bags to be stored.

20.9.4 Blood Component Room The component room is for separating and storing components from whole blood, sized at about 7620 mm × 7620 mm. The component room’s walls should be 229 mm thick with a puff panel, rounded corners, and finished with anti-bacterial and anti-fungal washable paint. 20.9.4.1 Flooring The floor should be non-pervious and stain-proof, preferably using joint-less 600 mm × 600 mm floor tiles or optionally granite. Avoid using porous marble, hot-­ welded vinyl, or epoxy-coated concrete flooring. 20.9.4.2 Doors Preferably, the component room should have a single automatic and self-closing door, about 1219 mm wide, to facilitate easy movement of men and materials. 20.9.4.3  Electrical Requirements The room should have normal LED lights with sufficient lumens, eliminating the need for extra illumination. All the machines should have proper ground earthing provisions. 20.9.4.4 Furniture in the Component Room Furniture should include an office table, chair, and laboratory stool. Stainless steel tables with sinks can serve as working tops, eliminating the need for extra sinks. 20.9.4.5 Electrical Points in the Component Room The main issues to be considered while designing the electric points are as follows; 1. Main Switchboard at the entrance wall for fan and light control, along with one or more 6 Amp Switch/Socket.

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2. Air Conditioning Control button with temperature adjustment. 3. At least one pair of 6/16 Amp switch/sockets on each wall, 18 inches from the floor level, spaced 1524 mm apart. At least half of them are on UPS supply. 20.9.4.6 Other Communication Points in Laboratories The following communication points should be provided: 1. RJ 45 points for Computer networking 2. RJ 11 for Intercom and extension line 20.9.4.7 Air Conditioning System of Component Room Air conditioning for laboratories is crucial for controlling temperature, humidity, and air quality. Maintaining separate return air for each laboratory is essential. Airflow, direction, and exchanges must adhere to industry norms, and the temperature should be maintained between 18 and 22 °C, with humidity level not exceeding 40% considering specific machine requirements.

20.9.5 Use of Wood The use of wood in the blood bank is restricted. Therefore, all the items like tables, cabinets, racks, notice boards etc. should be made out of stainless steel.

20.9.6 Fitting and Fixtures No surface fittings allowed for lights, fans, boards, etc. Everything must be recessed in the walls or the ceiling.

20.10 Distribution Area This area is used for distributing screened blood to patients through a room with a service window opening outside. The room size should be approximately 3048 mm × 3048 mm, with a window opening of about 610 mm × 610 mm in the reception area. It’s recommended to locate this room near the storage of screened blood or use it as a storage area itself. The room should be equipped with a computer for entering issue details, along with necessary electrical and data points. An intercom communication port should also be provided.

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20.10.1 Pneumatic Tube Systems (PTS) The distribution room should have a PTS outlet for efficient specimen reception and blood bag delivery. PTS allows the blood bank to receive patient blood specimens and requisition forms for cross-matching and deliver the blood bag to the required location.

20.11 Utility Area These are the areas which support the functioning of the blood bank. Some of them are:

20.11.1 Change Room The change room, with a size of 2438 mm × 2438 mm, is essential for clean areas like laboratories and the component room. It must accommodate sterilized clothes, hangers, and staff lockers (305 mm × 305 mm) with individual locks. Hand washing and gowning facilities should be provided.

20.11.2 Doctors Rest Rooms To facilitate round-the-clock availability, a small doctor’s rest room (2438 mm × 3048 mm) should be provided with furniture, including an office table, chair, bed, and cupboard. It should be equipped with a light, fan, computer points, internet connection, intercom, and an air conditioning system with temperature control.

20.11.3 Store The blood bank requires a storage area for equipment, supplies, and medical disposables. The store should be designed considering future needs, be lockable, termite-­ proof, fire-resistant, and free from humidity. Medicines and injectables must be carefully stored and controlled.

20.11.4 Record Room Adequate storage space (2438  mm  ×  2438  mm) should be allocated for medical records. Lockable storage, free from humidity, termite-proof, and fire-resistant is essential. The room should be equipped with shelving, file cabinets, and storage for both current (2–5 years) and archival donor records (up to 20 years).

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20.11.5 Medical Officer Room A space for administrative control of the blood bank should be provided for the Medical Officer. The room (4267 mm × 3658 mm) should include an office table, chairs, a cupboard, and electrical points for the view box and computer. Communication ports for computers and intercom should also be provided.

20.11.6 Sterilization Room Cum Washing Room A small room (3048 mm × 3048 mm) for washing and sterilization purposes should be included. It should have a countertop with a deep sink for washing instruments and a vertical autoclave (2 drums capacity) for sterilization. Necessary electrical points should be provided for the sterilizer.

20.11.7 Waste Management and Disposal A comprehensive waste management and disposal plan must be implemented to handle various types of waste generated by the blood bank. Policies and protocols are developed for the proper handling, storage, and disposal of general, chemical, biological, and radioactive waste following local regulations.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 24, Blood bank. p. 277–86.

Chapter 21

Other Investigation & Procedures

Apart from Clinical Laboratories and Radiology, hospitals conduct various investigations, tests, and procedures that vary across departments. Planning in advance is crucial to determine which of these services the hospital wants to establish immediately or in the future. Designers must ensure adequate space, electrical outlets, and air-conditioning for most special investigations, tests, and procedures. However, some may require specially designed rooms or complexes, as described below. Careful consideration of these needs will help avoid future implementation challenges. For infrastructures of the Other Investigations, please refer to “Table 1 – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

21.1 Coronary Catheterization (Cath Lab) The Cath lab, utilized for interventional cardiology, employs X-ray-based imaging, producing a high dose of rays during exposure. Therefore, it necessitates meticulous design adhering to regulatory norms to prevent radiation leakages. Key considerations for Cath Lab design are:

21.1.1 Location of the Cath Lab Ideally located near the ICCU, the Cath Lab must be a sterilized and clean area.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_21

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21.1.2 Number of Cath Lab Procedure Rooms The number of Cath Labs depends on current and future machine requirements, with one machine per room.

21.1.3 Other Issues Related to Cath Lab Guidelines and norms of the country’s controlling authority, like the Bhabha Atomic Research Institute in India, must be considered during design. •  Each Cath Lab must have a separate room, not allowing multiple machines in one room. • F  or horizontal machine installation, a rectangular room (minimum 42 sq. mtr, approx. 9144 mm × 4572 mm) is recommended. •  Walls should be at least 229 mm thick, using solid baked clay bricks (250 mm) or plastered hollow bricks (150 mm) for X-ray protection. •  Non-slippery tiles, marble, or granite flooring should be provided to prevent accidents and patient injuries. •  The room should have a single door with a width of about 1829 mm, to ease the movement of trollies. •  Doors and frames must have 2 mm thick lead lining to prevent radiation leakage, with handles and locks on both sides. •  It is advised to provide air interlock spaces by providing an additional door before the Cath Lab room door. •  Windows are not allowed in the Cath Lab. •  A red bulb outside the Cath Lab door, connected to the generator, illuminates only during tube activation. • Leave 1829  mm space behind the machine for C-Arm movement; install the machine centrally in the room. • Calculate power load based on machine capacity and terminate the main switch and cable separately for each cath lab room. •  Check the weight-bearing capacity of the floor and ceiling for the machine’s weight and movement; reinforce if needed. • Normal LED lights with sufficient lumens are adequate; no extra illumination is required. •  Maintain room temperature between 17 and 21 °C with humidity not exceeding 40%; confirm environmental requirements from equipment supplier. •  All the machines should have proper ground earthing provisions. •  Inside the Cath Lab room, outlets for medical supplies shall be given. The outlets shall be 1 for Oxygen, 1 for Vacuum and 1 for Air. •  The proper two-way audio system should be provided in the Cath Lab, from here the patient can be directed by the technician from the control room.

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•  Position the gantry and couch such that the patient is completely visible from the control console during the procedure. •  Stand with heavy-duty hangers shall be provided outside the Cath Lab to hang the lead apron. •  Also, a cabinet shall be provided, for keeping other radiation safety devices like lead gloves, lead goggles, groin guards, lead collars etc.

21.1.4 Cath Lab Console Room Attached to the Cath Lab, the console room should m be provided having a minimum size of 3658 mm × 3658 mm. It should include a Secondary Computer for image transfer and reporting.

21.1.5 UPS Room Install an Online UPS near the Cath Lab machine to ensure continuous power supply. The room size should be about 3658 mm × 3658 mm with racks for batteries. Provide exhaust for battery fumes and air-conditioning to maintain a temperature of 17–20 °C and RH below 40%.

21.1.6 Cath Lab Panel Room Electronic panels controlling the machine can be placed in a separate enclosure attached to the Cath Lab room for better protection. Size and temperature specifications should be confirmed with the equipment manufacturer.

21.1.7 Change Rooms for Patients Near the Cath Lab, provide change rooms (3658 mm × 3658 mm) to enable patients to change into hospital dress for procedures, equipped with hanger rods and shelves.

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21.1.8 Change Rooms for Staff Cath Lab requires separate changing rooms for doctors, nurses/technicians, and Class IV staff, with male and female facilities. Each room (approximately 4267 mm × 4572 mm) should include an attached toilet with bath, personal lockers, hooks, hanger rods, a cabinet for sterilized dresses, and a hamper for dirty lines.

21.1.9 Waiting for Cath Lab Provide a separate waiting area near the Cath Lab for patient family members with limited seating and proper spacing.

21.1.10 Stores for Unused Consumable A store of size 3658  mm  ×  3658  mm should be provided for stocking catheters, guide wires, fluids, etc. Also, provide sufficient countertops, cupboards, and drawers required, with a temperature of 17–21 °C.

21.1.11 Stores for Records and CDs Another store of size 3658  mm  ×  3658  mm should be provided to stock patient images on CDs/DVDs, along with registers and reports. Sufficient storage should be available with temperatures between 17 and 21 °C.

21.1.12 Consultation Rooms Rooms of approximately 4572 mm × 4267 mm should be provided for patient families to interact with treating cardiologists. The room should be equipped with a doctor’s table, chairs, and sofa set, and monitored with CCTV and audio-video recording.

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21.2 Thallium Scan Thallium Scan, being a high positron emitter, requires proper shielding and safety mechanisms such as RCC walls. It is advisable to club this investigation with the PET CT/MRI area. For details, please refer to the chapter on ‘Radiology’.

21.3 Audiometry Audiometry tests evaluate hearing functions, including sound intensity, tone, balance, and inner ear issues. These tests necessitate a specially designed room.

21.3.1 Location of the Audiometry Room The audiometry room, located near the ENT OPD and in a general movement area, does not require a clean and sterilized environment.

21.3.2 Room Designing The room should be approximately 4267  mm  ×  4572  mm with a glass partition, creating a patient room and a technician room. The patient room must be soundproof and echo-proof, achieved through acoustic treatment with a wooden frame, glass wool filling, and fireproof cloth on the ceiling. Wall panelling with specially designed sound absorption panels can also be considered. Wooden plank flooring and an airtight door ensure no external sounds enter the patient’s room. The technician’s room, separated by a glass window, should have a working top below the window for observing the patient during the procedure.

21.4 Bronchoscopy Bronchoscopy, an invasive procedure used to assess lung abnormalities, is preferably performed in the OT Complex. However, if done outside the OT complex, a setup with a sterilized bronchoscopy room, change rooms for staff and patients, store, bronchoscope wash area, and patient recovery room is required. The design of the rooms shall be exactly as described in the chapter of ‘OT Complex’.

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21.5 Capsule Endoscopy, Cholangioscopy, Colonoscopy, Duodenoscopy, Endoscopic Ultrasound & Upper Gastrointestinal Endoscopy Etc. All these procedures are other invasive procedures that should be performed in a sterilized and clean area, preferably in the OT Complex. The details of the Endoscopy room have been described in the chapter on ‘OT Complex’.

21.6 Neurology Neurology investigations like EMG, Neuropsychological Tests, NCV/EP Studies, and TMS are conducted in the OPD complex’s Neuro Lab, with separate cabins for each investigation and space of 3658 mm × 3658 mm for each machine. Waiting area, reception, and toilet facilities should also be provided.

21.7 Polysomnography (Sleep Lab) For Polysomnography (sleep study), a silent and disturbance-free room is needed as the patient is asleep during the study.

21.7.1 Location of the Sleep Lab The Sleep Lab should be located near the IPD area of the hospital and does not require a clean and sterilized environment.

21.7.2 Room Designing The room size should be about 4267 mm × 4572 mm with a glass partition separating the patient and technician rooms. The patient room should be soundproof and dimly lit to ensure patient comfort and sleep. An airtight door should prevent outside sounds from entering the room, and a bed should be provided for the patient. Alternatively, a private single-occupancy room can be used for this procedure if a separate room is not available. The Technician’s room will have a glass window allowing the technician to observe the patient during the procedure and record the findings.

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Proper electric and communication points should be provided for the machines.

21.8 Ophthalmology In the Ophthalmology department, specialized dust-proof rooms are required for lasers, located near the Eye OPD with no general movement. Each laser room should have an area of about 3658 mm × 3658 mm with proper environmental conditions such as temperature (18–22 °C) and humidity (40–45%). Adequate electric and communication points should be provided for the machines.

21.9 ESW Lithotripter of Urology For the ESW Lithotripter of Urology, a separate room of approximately 4572 mm × 4267 mm is needed. The machine and C-arm are placed on one side of the table, with the temperature and humidity in the room meeting specific equipment requirements. Proper electric and communication points should be provided, and the machine and table properly earthed for safety.

21.10 Dialysis In the Dialysis area, the following factors need to be considered while designing the room.

21.10.1 Location of the Dialysis Room Ideally near the Nephrology department, ensuring a sterile and clean environment.

21.10.2 Dialysis Procedure Room The size of the room should be determined based on the current and future number of Dialysis machines.

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21.10.3 Other Issues of Dialysis Unit •  Provide dedicated rooms for positive patients, not mixed with general patients, with separate machines. •  The space for each dialysis machine should not be less than 13.94 Sq. Mtr. •  At least 1829  mm distance between two Dialysis beds/couches for proper machine placement. •   Backside of each machine should have supply points for RO water and floor drains. •  Sufficient LED lighting, no need for extra illumination. •  Maintain room temperature at 17–21  °C with humidity not exceeding 40%. Confirm environmental requirements with the equipment supplier. •  All the machines should have proper ground earthing provisions. •  For each of the Dialysis beds/couches, the outlets for medical supplies should be given. The outlets should be 1 for Oxygen, 1 for Vacuum and 1 for Air.

21.10.4 Wash Room for Dialysers Attached to the Dialysis room should be the dialyser washroom. This room houses the dialyser washer and stainless steel bins (160 mm H × 150 mm W × 400 mm D) to store washed dialysers having the capacity to store 25–40 dialysers.

21.10.5 Store To stock consumables like dialysers, and dialysis fluid Part A and Part B, a store of size 4267 mm × 3658 mm (or as needed) with sufficient countertops, cupboards, and drawers should be provided. Lockable stainless steel bins (160  mm H × 150 mm W × 400 mm D) should be provided to store used dialysers (40–60). The room temperature should be maintained at 17–21 °C.

21.10.6 Change Rooms for Patients Provide change rooms for patients near the Dialysis area (3658 mm × 3658 mm) with hanger rods and shelves for hospital dresses.

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21.10.7 Change Rooms for Staff Separate change rooms for male and female staff (3658 mm × 3658 mm) with personal lockers, hooks, hanger rods, and cabinets for sterilized dresses should be provided. A dirty linen hamper should also be provided.

21.10.8 Waiting for Dialysis Dialysis should have a separate waiting area near the Dialysis room for patients’ family members with appropriate spacing between seats.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 25, Other investigations and procedures. p. 287–96.

Chapter 22

Radiation Therapy

Radiation Therapy (RT) is a specialized cancer treatment using radioactive rays from a Linear Accelerator (LINAC) to damage specific malignant cells. High-­ energy waves like x-rays, gamma rays, electron beams, or protons are accelerated in the LINAC to destroy cancer cells. The Radiation Therapy Unit provides facilities and equipment for radiotherapy treatment, including patient consultation, treatment simulation and planning, and treatment administration. This unit typically includes both external and internal radiotherapy (brachytherapy) treatment areas.

22.1 Location of Radiotherapy Unit The Radiotherapy department houses two main machines: LINAC and Brachytherapy, which require installation in Bunkers made of High-density RCC materials. The bunker wall and roof thickness is typically 2400  mm. Considering these factors, Bunkers cannot be placed on upper floors, only on the ground floor or preferably in the basement, where soil backfilling reduces wall thickness. The Radiotherapy department, particularly the bunkers, should have proper access and road connectivity for LINAC transport. The Unit should provide easy access for outpatients, including people with disabilities, using patient transfer services, ambulances, wheelchairs, or beds.

22.2 Infrastructure of the Radiotherapy Department For the infrastructure of the Radiation Therapy Department. please refer to “Table 1  – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_22

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22.3 Utility Areas The utility areas shall have;

22.3.1 Entrance to the Department 1. Doors should be at least 1829 mm wide and openable on both sides. 2. Sensor-operated glass doors can be chosen for automation. 3. An airlock connecting external and internal areas will help decrease infection rates and maintain air-conditioning temperature and air pressurization. 4. Prevent outside air contaminants by using an air curtain. 5. Thermal scanning of all patients, attendants, and visitors entering the emergency department should be mandatory. 6. Provide masks, gloves, and shoe covers at the entry gate. 7. Sanitization provision should also be made at the gate

22.3.2 Outside Entrance If this department has a separate entrance, provide: 1. Provide an ambulance disembarkation area near the entrance gate. 2. Preferably a wide porch for shelter from inclement weather, accommodating two vehicles. 3. Porch height should be at least 4572 mm from the road level. 4. Outside the lobby, place a trolley bay for parking wheelchairs and stretcher trolleys.

22.3.3 Reception & Enquiry Counter Place the reception counter just at the entry of the radiotherapy department for easy access.

22.3.4 Registration Counter Next to the reception, place the registration counter for patient registration, consultation form preparation, and payment.

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22.3.5 General Waiting 1. Allow one accompanying attendant per patient in the waiting area just outside the treatment area. 2. Ensure appropriate distancing between chairs. 3. Provide facilities like telephones, public address systems, toilets (separate for males and females), and cold drinking water. 4. Install mobile charging points.

22.3.6 Store Provide adequate storage for equipment, supplies, and disposables, close to the point of use. Ensure storage should be lockable, humidity-free, termite-proof, and fire-resistant, with proper control over medicines.

22.3.7 Consultation Room Include consultation rooms in the radiotherapy department for patient-doctor interactions and treatment protocols. For other details on Consultation Rooms, Furniture, Equipment, Instruments & Tools, Doors, Windows, Central Medical Gas Supply, Electrical Points and Other Communication Points etc., please refer to the chapter ‘Out-­ Patient Department’ in this book.

22.4 Treatment & Planning Area This area includes;

22.4.1 Mould Room The mould room is used to prepare custom photon and electron shielding for patients undergoing radiation treatment. It should measure about 4267 mm × 3658 mm and includes an office table, chairs, examination couch, and computer workstations connected to the hospital network, including PACS.

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22.4.2 Mould Workshop The mould workshop physically creates the moulds and features: 1. Special exhaust for molten metal, foam cutters, and vacuum formers. 2. Proper acoustic treatment to reduce machinery noise. 3. Separate storage for raw materials for moulds. 4. A store for storing moulds currently in use for patient treatment.

22.4.3 Medical Physics Medical physicists oversee radiation treatment and safety, providing scientific support for treatment machines, dosimetry, and quality assurance. The space should include an office with workstations, sized approximately 4267  mm  ×  3658  mm, equipped with an office table, chairs, examination couches, and computer workstations connected to the hospital network. A physics laboratory manufactures non-­ commercial patient treatment equipment and storage for medical physics equipment.

22.4.4 CT Simulators The CT simulator aids in planning radiation treatment by acquiring body images. A CT simulator should be set up in the treatment area, similar to a CT scan in the Radiology department. For other details about Furniture, Equipment, Instruments & Tools, Doors, Windows, Central Medical Gas Supply, Electrical Points and Other Communication Points etc. and CT Simulation, please refer to the chapter on ‘Radiology’ in this book.

22.5 Radiation Therapy Treatment Area The radiation treatment can be either External Beam Radiation Therapy (LINAC) or Internal Beam Radiation Therapy (Brachytherapy).

22.5.1 External Beam Radiation Therapy External Beam Radiation Therapy Bunker Design Considerations;

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1. LINAC is installed in high-density RCC bunkers made of concrete and steel. 2. Bunker wall and roof thickness: 2400 mm. 3. Maze-type design for the bunkers. 4. Bunker size: 7000 mm × 7000 mm with iso-centre at the centre. 5. Space for LINAC unit and patient treatment table. 6. Gantry and table engineered to rotate around iso-centre. 7. Sufficient width for access around the gantry and patient. 8. Gantry rotation plane parallel to treatment control panel area. 9. Consideration of high occupancy areas during bunker orientation. 10. Minimum room height: 4 mtr, for access and utility installations. 11. Maze width: 2000–2200 mm for equipment delivery. 12. Strong flooring to support LINAC’s weight (8–9 tonnes). 13. Provision for base frame during installation (6000 mm × 2000 mm × 610 mm deep excavation). 14. Designing adjacent bunkers to reduce costs by sharing shielding. 15. Door at maze entry for safety, not radiation shielding. 16. Access during radiation is prevented by light sensors and/or push gates. 17. Roof access is restricted with a security entrance. 18. Controlled access to the roof for equipment installation. 19. Radiation protection with lead shielding and concrete walls/floors/ceilings. 20. Certified physicist assesses radiation protection needs. 21. Neutron shielding is not required for LINAC with 10 MV energy. 22. Consider facility lifespan and potential upgrades for radiation shielding. 23. Angulated plumbing and electrical conduits in the bunker. 24. Contact the manufacturer for LINAC’s power supply requirements. 25. Curved paths for joints, ducting, and sleeves to avoid primary beam divergence. 26. Consider mechanical, electrical, and safety aspects (dimmable lights, emergency switches). 27. Provision for ducting between the gantry structure and control panel. 28. Isolated ducts for dosimeter cables and connectivity to the chillier system. 29. Install false ceilings in bunkers after machine installation. 30. Control Areas located outside the bunker maze. 31. Patient intercommunication devices and CCTV monitors in bunkers. 32. Adequate length working top in control area for equipment and patient files. 33. Electrical power points along the worktop for multiple devices. 34. X-ray viewing box with ambient lighting in the control area. 35. Space for networked imager or printer in the control room area.

22.5.2 Internal Beam Radiation Therapy Design Considerations for Brachytherapy Unit: 1. Brachytherapy uses radiation sources placed within or near the tumour tissue.

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2. Similar to External Radiation therapy, Brachytherapy requires a bunker with specific considerations. 3. Equipped operating room and other services like anaesthetic induction room provided. 4. C-arm used for applicator placement, installed in the appropriate room. 5. Brachytherapy bunker requires wall and ceiling thicknesses of at least 1000 mm. 6. 1800 mm wide maze for emergency access, no door shown in the design. 7. Room dimensions: 4000 mm × 4000 mm × 3600 mm (ceiling height of 3000 mm) for manoeuvring equipment. 8. Shielded roof is required due to isotropic radiation emission from the source. 9. All other issues from LINAC bunkers are to be considered for Brachytherapy bunker design.

22.6 Radiotherapy Ward Radiotherapy departments usually don’t require wards, but some hospitals prefer a small setup (2–4 beds) for emergencies. The ward’s setup should be similar to the Intermediate Care Area (Patient Rooms) chapter in the book. For other details about Radiotherapy Ward about construction details, Furniture, Equipment, Instruments & Tools, Doors, Windows, Central Medical Gas Supply, Electrical Points and Other Communication Points etc. please refer to the chapter ‘Intermediate Care Area (Patient Rooms)’ in this book.

22.7 Trolley Bay A designated area for stretcher trolleys and wheelchairs, located at a corner of the department for patient convenience without hindering routine work.

22.8 Change Rooms Provided for patients to change into hospital dress, approximately 3048 mm × 3048 mm in size. Should include personal lockers, hooks, hanger rods, and cabinets for sterilized dresses.

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22.9 Store A small storeroom (at least 3658 mm × 3658 mm) should be provided near treatment units for dosimetry equipment and supplies. Should be designed for current and future requirements, lockable, humidity-free, termite-proof, and fire-resistant.

22.10 Signage and Wayfinding Clear signage and wayfinding solutions should be provided for easy department navigation, such as colour-coordinated paths or accent lighting.

22.11 Sub Waiting Lobbies Instead of a large waiting lobby, sub-waiting lobbies should be provided for each modality with limited seating and spacing between seats.

22.12 Clean Utility Room for clean linen and sterilized material storage (normally 3658 mm × 3658 mm) with closed cabinets and one door should be provided.

22.13 Dirty Utility/Sluice Room Provide room for soiled linen storage and pre-washing before laundry, with covered linen collection hampers and two doors for easy access and exhaust fans.

22.14 Hand Washing Hand basins with soap dispensers and disposable paper towels should be provided in consult rooms, procedure rooms, imaging rooms, and other necessary places.

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22.15 Administration/Offices Provide offices for Clinical Director, Radiation Oncologists, and Radiation Therapy Managers (approximately 4572  mm  ×  4572  mm) with essential amenities and attached toilet and P.A room. Additional offices should be provided for other professionals (approximately 3658 mm × 3658 mm) with the necessary facilities.

22.16 Other Communication Points in the Radiation Department 1. RJ 45 points for Computer networking 2. RJ 11 for Intercom and extension line 3. HDMI point for computer display at other locations 4. Voice/data outlets and wireless networks 5. Telephone and video conferencing capacity for meeting rooms 6. PACS imaging system, electronic records, and radiotherapy information management systems

22.17 Heating Ventilation and Air Conditioning General air conditioning for the entire department, maintaining a comfortable temperature range of 18–24 °C. Treatment room temperature is to be kept between 17 and 20 °C with humidity not exceeding 40%. Environment requirements may vary based on equipment specifications.

22.18 Central Piped Medical Gas Supply Treatment rooms and planning rooms should be equipped with Piped Centralised Medical Supply system supplying Oxygen, Compressed Air, and Wall-mounted Suction.

22.19 Electrical Points in the Radiation Therapy Department Specific electrical points should be provided in the consultation chamber, administration rooms, planning rooms, and other areas except for treatment rooms.

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Power requirements in treatment rooms and LINAC/Brachytherapy machines are to be confirmed with the equipment supplier.

22.20 Power Backup Treatment rooms with machines have their own automatic power backup, preferably connected to UPS. The department should have its own backup with an Auto Start Diesel Generator and there should be a provision for voltage regulation in the department.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 26, Radiation therapy. p. 297–307.

Chapter 23

Rehabilitation and Allied Health Therapies

The Rehabilitation-Allied Health Unit offers multi-disciplinary therapies for patients with impairments, disabilities, or handicaps. Therapies include Physiotherapy (e.g., Gait Analysist, Hydrotherapy, Manual Therapy, Electrotherapy, Electromyography, Laser Therapies), Occupational Therapy, Speech Therapy, Podiatry, Audiology, and Orthotics. The department, mainly focusing on Physiotherapy, serves inpatients, outpatients, and long-term patients with slow recovery. Patients receive daily services within the department or in indoor patient wards/rooms.

23.1 Location of Physiotherapy Department Due to patient difficulties with mobility, the department is best situated on the ground floor for accessibility. This location benefits both out-patients and in-­ patients, ensuring convenience for all.

23.2 Infrastructure of the Physiotherapy Department For infrastructures of the Physiotherapy Department, please refer to “Table 1  – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

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23.3 Entrance/Entrance Lobby If the department is in a separate building, it should have its own entrance. Reception-­ related details are available in the ‘Entrance Lobby’ chapter.

23.4 Reception The department’s reception should be located at the entrance. Refer to the ‘Entrance Lobby’ and ‘Out-Patient Department’ chapters for reception details.

23.5 Waiting Areas Waiting areas should be situated in the entrance lobby. More information on waiting areas can be found in the ‘Entrance Lobby’ and ‘Out-Patient Department’ chapters.

23.6 Examination Room with Exam Cubicles An examination room should be provided in the department. For details, see the ‘Out-Patient Department’ chapter.

23.7 Patient Therapy Areas 23.7.1 Physiotherapy Physiotherapy area should have zones for Physical Exercise, Electrotherapy, Laser Therapy, Thermotherapy, Massage Therapy, Traction, and Gymnasium. Each modality should have. 1. Individual cabins to maintain patient privacy. 2. Cabins can be made out of civil work walls or partitioned with materials like aluminium or board. 3. A separate cabin for each modality (e.g., Traction, Wax bath, Ultrasound therapy). 4. Cabin size: about 2743 mm × 1829 mm, with a single door (762 mm–914 mm wide).

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5. Cabins should include a treatment couch (1829 mm × 762 mm) and an instrument trolley. 6. Sufficient electrical points for light, fan, and a pair of 6/16 Amp switch/sockets for medical equipment. 7. Properly air-conditioned (temperature: 18–23 °C). 8. Small cupboard for equipment/accessory storage and provision for chairs/stools if needed. 9. Mirror if required to assist the patient, hooks for thera belts, and provision for refrigerators for ice pack therapy. 10. Cabins equipped with Oxygen and Suction outlets through MGPS lines or using a small manifold/pump in the department if required. 11. Provision for monitor stands in cabins, and wall-mounted stands in all rooms. 12. Nurse call systems in all individual cabins and Exercise area The Exercise zone can be in a single hall with proper equipment installation and wall-mounted exercise modalities.

23.7.2 Occupational Therapy Occupational Therapy area to be adjacent to Physiotherapy with access to waiting and amenities areas. Main issues: 1. Should have larger spaces for Occupational Therapy rooms and Workshops to accommodate various activities. 2. Tables for table-based activities like sewing machines, woodwork, and toy preparation should be provided. 3. Room size should be based on patient capacity and activities. 4. Provided benches with sinks, and wheelchair accessibility. 5. Storage shelves and cupboards for equipment/tools should be provided. 6. Prefer adjustable-height tables and chairs. 7. Hand-washing basin with liquid soap and paper towel fittings should be provided. 8. Pinboard and whiteboard for displays should be provided. 9. Should have adequate electrical outlets for tools/machinery. 10. Workshop areas to have suitable air extraction and supply for air exchanges.

23.8 Administrative Area The Rehabilitation department should have rooms for the In-charge and Secretarial staff. In-charge’s room size is about 4572 mm × 4267 mm, with cabinets, tables, chairs, an attached toilet, and storage. Proper arrangements for electrical points, intercom, IT network, CCTV, and air conditioning should be made. A secretarial

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room size of about 6096  mm  ×  4572  mm, with similar amenities should also be provided.

23.9 Store A store for general items, stationery, old equipment, etc. Size at least 3048 mm × 3048 mm, with lockable cupboards, racks, drawers, and countertops should be provided.

23.10 Trolley Bay Provided space for parking stretcher trollies and wheelchairs near the department entrance. Also, provide power outlets for recharging electric wheelchairs and scooters.

23.11 Clean Utility Room for clean linen and sterilized materials, size about 3048 mm × 3048 mm, with cabinets, drawers, racks, and one door should be provided.

23.12 Dirty Utility/Sluice Room Room for soiled linen storage, size about 3048 mm × 3048 mm, with covered linen collection hampers or containers, two doors for easy access, and exhaust fans should be provided.

23.13 Change Rooms Provided rooms for patients to change clothes, size approximately 3048 mm × 3048 mm. Includes personal lockers, hooks, hanger rods with hangers, and a cabinet for sterilized dresses.

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23.14 Other Issues About the Infrastructure of the Rehabilitation Department 1. Hand-washing facilities near each treatment space with liquid soap and paper towel provision. 2. Resuscitation trollies with emergency tools and medicines to be conveniently placed for quick access during emergencies. 3. Careful consideration of temperature, humidity, and ventilation; air-conditioning to maintain 18–23 °C temperature. 4. Maximize the use of natural light wherever possible for staff convenience. 5. Intercom lines and computer networking points are to be provided at required locations, along with RJ45 jacks. 6. Pair of 6/16 Amp switch/socket points to be added in addition to regular electrical points, and computer points to have UPS backup. 7. Installation of handrails, grab bars and support mechanisms for patient safety. 8. Wall guards and corner guards for additional safety in the department.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 27, Rehabilitation and allied health therapies. p. 309–14.

Chapter 24

Pharmacy Unit

In the hospital, the Pharmacy plays a vital role in dispensing medicines, injectables, and surgical disposables to both inpatients and outpatients. For inpatients, drugs are directly disbursed from the pharmacy store to respective wards without a separate distribution counter. Outpatients are served through a retail pharmacy counter. The Pharmacy must have separate licenses for inpatient and outpatient facilities, and additional licenses for wholesale distribution or handling scheduled Narcotics drugs. Hospital Pharmacy services can be provided in different ways: self-owned pharmacies for both inpatients and outpatients, private retail pharmacies for both, or a combination of self-owned inpatient pharmacies and private retail shops for outpatients. Two separate pharmacies are required in any case.

24.1 Location of the Pharmacy For Outpatients, a retail counter should be provided near the OPD block, preferably at the OPD block exit, and should be easily accessible to patients. For inpatients, the pharmacy can be located in the basement or on service floors, providing restricted access.

24.2 Size of the Pharmacy Depends on patient numbers, formulations, and storage needs. Stores should be large enough to accommodate drugs and disposables for at least 1  month’s consumption.

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24.3 Infrastructure of Pharmacy Inpatient and outpatient pharmacies have similar requirements with a few differences. For infrastructures of the Pharmacy Units, please refer to “Table 1 – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

24.4 Pharmacy for Outpatients The hospital’s Outpatient Pharmacy should be centralized and connected to key departments like OPD and emergency. It should include the following infrastructural facilities;

24.4.1 Entrance A single entrance to the pharmacy with an 1829 mm wide, double-sided openable door, monitored 24/7.

24.4.2 Drug Receiving Area A space within the pharmacy for receiving drugs from suppliers, approximately 3658 mm × 3658 mm. It should include racks, shelves, office tables, chairs, and a workstation for recording medication orders. The area should be lockable with restricted staff access.

24.4.3 Disbursing Hall This is the main area for storing and dispensing routine drugs and disposables to patients: 1. Hall size should be based on patients served and drug formularies disbursed. 2. Provision of racks divided into shelves for drug storage, not exceeding 2134 mm in height, shelf depth of about 305 mm, and shelf-to-shelf height of 305 mm should be made. 3. Provide built-in cupboards with shelves as an alternative to racks. 4. Shelves should be designed to bear the load of stored drugs.

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5. Space above racks (above 2134 mm) can be used for bulky items with a double-­ stand step ladder for access. 6. Provide lockable drawers and cabinets for small and costly drugs. 7. Transaction/pass-through windows on the front wall should be provided, at least one for every 50 patients served daily. 8. Provided working counter below windows for staff with lockable drawers for cash collection. 9. Provided proper electrical points on the working counter for computers and printers. 10. Display cases near transaction windows for showcasing general items shall be thought of. 11. Provided office table and chair for the pharmacist to oversee pharmacy operations. 12. Pharmacists should be equipped with a computer system connected to the hospital network. 13. Restricted entry and security measures are in place. 14. Provision of refrigerators to store drugs requiring cold chains.

24.4.4 Bulk Storage A separate bulk store shall be provided for fast-moving items like fluids, located within or near the pharmacy complex. It should have heavy-duty racks for carton storage, a single door (1219  mm wide), and be lockable, moisture-free, and fire-resistant.

24.4.5 Cold Store A cold walk-in store for drugs requiring cold storage should be located near the disbursement hall, with a size of about 3048 mm × 3048 mm. The room should have thermal barriers, adjustable temperature between 5 and 12 °C, a temperature monitoring system, lockable access doors, and racks for storage.

24.4.6 Expiry Drug Room An Expiry Drug Store to track near-expiry drugs should be located near the disbursement hall, with a size of about 3658 mm × 3658 mm. It should have racks, be lockable, moisture-free, fire-protected, and equipped with minimal light fittings.

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24.4.7 Costly Drug Room A separate room to store expensive drugs under lock and key should be provided attached to the disbursement hall, with a size of about 3048 mm × 3048 mm. The room should be lockable, moisture-free, fire-protected, and avoid direct sunlight.

24.4.8 Drug Sorting Room A room to sort cut strips and returned drugs is to be provided, attached to the disbursement hall, with a size of about 3048 mm × 3048 mm. It should have racks, shelves, a working counter, and chairs for staff to sort drugs.

24.4.9 Narcotics and Controlled Drug Store A room to store narcotics and controlled drugs should be provided attached to the disbursement hall, with a size of about 3048 mm × 3048 mm. It should be lockable, fire-protected, and avoid direct sunlight. Only authorized personnel are allowed access.

24.5 Pharmacy for Inpatients The centralized Inpatient Pharmacy should connect to key hospital departments like ICU, Emergency, Operating Unit, and IPD. It should have the same design as the outpatient pharmacy, excluding disbursing counters and windows in the disbursing hall.

24.6 Pneumatic Tube Systems (PTS) To ensure fast and efficient service, the Inpatient Pharmacy should be equipped with a Pneumatic Tube System (PTS). This air-operated system transports documents, materials, and medicines between important hospital stations such as ICU, Emergency, Operating Room, and Indoor wards. It offers quick and accurate transportation, improving pharmacy operations.

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24.7 Pharmacist Offices Separate offices for inpatient and outpatient pharmacists should be provided near or inside the pharmacy complex, each sized about 4572 mm × 4267 mm. These rooms should be furnished with office tables, chairs, racks, and an attached toilet. Proper electrical points, intercom, IT network, and air conditioning should be arranged.

24.8 Automation in the Pharmacy Consideration of automation, such as drug-dispensing robots and machines, should be made during pharmacy design. Collaboration with automation equipment manufacturers may be necessary for planning.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 28, Pharmacy unit. p. 315–9.

Chapter 25

CSSD

Sterilization is vital in hospitals to eradicate microorganisms and prevent infections. The Central Sterile Services Department (CSSD) is responsible for sterilizing medical devices, instruments, linen, and consumables. The sterilization process involves cleaning, preparing, pre-sterilization packing, sterilization, storing, and distributing sterilized materials. Items commonly sterilized in CSSD include surgical instruments, dressing drums, OT and emergency linen, disposables, bedding, and equipment.

25.1 Infrastructure of CSSD For infrastructures of the CSSD, please refer to “Table 1 - ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

25.2 Location Ideally, CSSD should be located close to operation theatres and intensive care areas on the same floor or adjacent floors. However, if space limitations occur, CSSD may be placed on different floors. In such cases, a dedicated sterile material elevator should be installed, providing easy access to user areas like OT Complex and ICU Complex.

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25.3 Area Required for CSSD Department The required area for the CSSD depends on several factors, such as the number of operation theatres (OTs) and intensive care units (ICUs), daily sterilization cycles, operation hours (24 h or limited), number of sterilizers, type of sterilization (e.g., Steam, ETO, Hot Air, Chemical), and the equipment installed (e.g., instrument washer, ultrasonic cleaner). Additionally, the packing load and the number of instrument sets prepared per day play a role in determining the area. Standards recommend a minimum area of 1.39 sq. mtr. per bed or a minimum of 25–30 sq. mtr. for small hospitals.

25.4 Material Flows Unidirectional flow is crucial in the design of CSSD to ensure that materials move in one direction only, preventing any backward movement. This means unsterile materials enter from one end of the CSSD and exit after sterilization from the opposite end.

25.5 Functional Zones of CSSD The CSSD shall have the following Zones:

25.5.1 Receiving Zone (Unclean Area) The Receiving Zone (Unclean Area) is where materials to be sterilized from different user departments are received, such as surgical instruments from the OT Complex and linen from the laundry. It serves as the CSSD’s reception area and must address several important issues: 1. The size of this area should be approximately 3048 mm × 3048 mm. 2. Visual access from inside to the main entrance door of the CSSD should be available. 3. The room should have suitable working tops for unpacking and sorting. 4. Racks and cupboards should be provided in the room to store material until further processing. 5. All entrances should be secured to prevent unauthorized access. 6. A window or door can be used for material intake, with a lockable sliding hatch or a glass partition with the corridor.

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7. Red lines can be marked to guide the movement of material and trolleys entering the CSSD through this entrance. 8. Adequate space for parking trolleys used to bring in materials is essential, along with a lockable hatch for trolleys. 9. Dedicated material elevators are recommended for trolley movement. 10. A computer connection is required for material entry records. 11. Hand-washing facilities with soap and paper towel dispensers should be available in the receiving area. 12. Intercom outlets, RJ45 data points, and electrical outlets for computers and printers are necessary

25.5.2 Decontaminating, Washing and Disinfecting Zone The Decontaminating, Washing, and Disinfecting Zone is where instruments undergo rinsing, ultrasonic cleaning (if needed), washing, and drying to remove harmful pathogens. It involves both automated and manual cleaning processes, with waste items sorted for proper disposal. The area serves the following purposes: 1. Disassembly and inspection of contaminated materials. 2. Sorting and loading of medical instruments into washer-disinfectors and other automated cleaning equipment. The area should be equipped with: 1. Space for Automatic Instrument washer and Ultrasonic cleaner, with necessary water supply and drainage. 2. Double bay sink for manual cleaning, made of stainless steel and equipped with hot/cold water supply. 3. Outlet of compressed air for blowguns. 4. Provision for a pre-treatment area if required, with negative pressure to avoid contamination. 5. Handwashing facility with soap and paper towel dispenser. 6. Air exhaust system. 7. Wall-mounted brackets for cleaning chemicals and brushes. 8. Parking space for trolleys. 9. Hatch window for transferring hand-washed items. 10. Deionized, distilled, or RO water for final rinsing. 11. Drying rack for manually cleaned instruments.

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25.6 Packaging Area Following decontamination and washing, instruments proceed to the packing area where they are assembled into predefined sets or trays. Proper packaging is crucial to maintain their sterility until they are used.

25.6.1 Location The packing area should be strategically located between the Decontamination and Sterilization areas, following a one-way workflow from contaminated to clean zones.

25.6.2 Role of the Packing Room Shall Be The role of the Packing room includes inspecting, testing, assembling, and packing cleaned medical devices to prepare them for sterilization. Packs are thoroughly checked, reassembled, double-wrapped, and labelled before being delivered to the sterilizer loading area, with racks returned to the decontamination area.

25.6.3 Contents of Packing Room The ideal size of the packing room should be 4572  mm  ×  4267  mm but can be adjusted based on requirements. It should be equipped with stainless steel packing tables, each accommodating four staff members. Additional countertops are provided for specific tasks such as cutting gauze or cotton rolls. The room should be clearly marked for different packing purposes and should have a storage area for new surgical instruments as backup. The packing room should be designed to be a sterile area with positive pressurization and may include sealed windows. Proper equipment, including sealing machines, cloth cutters, and surgical trays, should be available. Handwashing facilities, electrical connections, and hatch windows or doors for material transfer to the sterilization room should also be provided.

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25.7 Sterilization Area Sterilization is a crucial process that ensures packed materials like instruments, linen, and consumables are free from harmful organisms that may harm patients. It involves various methods such as steam sterilization, dry heat sterilization, and low-­ temperature sterilization processes, depending on the product. The Sterilization area also serves for cooling the sterilized material before transferring it to the clean storage room. This area accommodates sterilizers and provides parking space for sterilizers and cooling trolleys. Specialized sterilizers like ethylene oxide require separate installations and accommodation. Low-temperature specialized sterilizers should be installed as per the manufacturer’s recommendations.

25.7.1 Location and Relationships The Sterilizing and Cooling area should ideally be located between the Packing area and the Clean Storage area.

25.7.2 Main Activities of the Sterilization Process Main activities in the Sterilization room include parking and loading trolleys, loading and unloading sterilizers, and cooling sterilized packs.

25.7.3 Size of the Sterilization Room The size of the Sterilization room varies depending on the number and type of sterilizers installed, with an average area of 9.29 sq. mtr. per sterilizer.

25.7.4 Methods and Types of Sterilizers Sterilizers are selected based on the method and load of material to be sterilized and can include various types;

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25.7.4.1 Steam Sterilizers Steam sterilizers use pressurized steam to destroy microbial life through denaturation and coagulation of proteins. Depending on the type (Single Door or Double Door), specific requirements are considered during installation: 1. Single door sterilizer should be installed adjoining the outer wall. 2. Allow about 914 mm of space between the sterilizer and the wall. 3. For double-door units, the unloading door opens into the clean storage room after puncturing the common wall. 4. Install the sterilizer on a prepared foundation and securely bolt it with fasteners. 5. Connect an exhaust duct to the sterilizer, opening outside the room through the wall. 6. Provide required electrical outlets and proper RO water line. 7. Ensure drainage on the floor below the sterilizer. 8. Allocate about 2438 mm of free space in front for loading the sterilizer. 9. Maintain at least 1829 mm distance between multiple sterilizers. 10. Preferably locate sterilizers in a restricted access area. 11. Install a hand washing basin with liquid soap and a paper towel dispenser at the perimeter. 12. Design ventilation for positive pressure air outflow from the sterilization area. 13. Ensure sufficient circulation space for unhindered trolley manoeuvring during loading and unloading. 14. For vertical steam sterilizers, provide necessary electrical, water supply, and drain points. 25.7.4.2 Ethylene Oxide Gas Sterilizer (ETO) Ethylene oxide (EO) sterilizes heat or moisture-sensitive items by interfering with microbial metabolism, resulting in cell death. ETO is used in the gaseous state and requires direct contact with microorganisms on or in the items to be sterilized. Requirements for ETO Sterilizer infrastructure: 1. ETO sterilizer should be installed in a separate room. 2. Room size depends on ETO sterilizer size and model (Tabletop or floor model). 3. Keep about 914 mm space between the sterilizer and the wall. 4. Provide an exhaust pipe for the ethylene oxide gas drain, crossing the room wall and terminating above building height using copper or stainless steel. 5. Ensure the required electrical outlets for the sterilizer supply. 6. Allocate about 1524 mm of free space in front for loading the sterilizer. 7. If installing multiple sterilizers, keep a minimum distance of 1829  mm between them. 8. Preferably place sterilizers in a restricted access area. 9. For ETO cartridges, provide a proper waste disposal system. For ETO cylinders, ensure the correct sterilizer connection.

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25.7.4.3 Dry Heat Sterilizer Dry heat sterilization uses hot air to sterilize anhydrous oils, petroleum products, and bulk powders, which cannot be penetrated by steam and ethylene oxide gas. Microbial death occurs through physical oxidation and slow-burning coagulation of proteins within cells. 25.7.4.4 Hydrogen Peroxide Plasma Sterilizer Hydrogen peroxide is activated to create reactive plasma or vapour using a strong electric or magnetic field. Free radicals of hydrogen peroxide in the cloud disrupt the life functions of microorganisms by interacting with cell membranes, enzymes, or nucleic acids.

25.8 Clean Storage Area After sterilization, processed sterile materials, including trays and drums, should be stored in a dedicated sterile area. Thus, a storage room should be provided for this purpose.

25.8.1 Location of the Clean Storage Room The sterile storage area should be located adjacent to the sterilization area, preferably in a separate, controlled, enclosed, limited-access area dedicated solely to storing sterile supplies.

25.8.2 Designing of the Storage Shelves The storage room should be equipped with stainless steel racks and/or lockable cupboards made out of stainless steel. Some racks or cupboards may have bins for organization, while others can have open shelves. The racks should be placed along the walls of the storage room. Rack height can be about 1829 mm, and the width should be adjusted to the available space, preferably around 914 mm each. Multiple racks of 914 mm width can be placed side by side. The shelves shall be 375 mm deep, easily cleaned, and allow air circulation around stored packs. Freestanding or mobile shelving can facilitate the flow of products in and out of storage. For bins, the size can be 305 mm × 305 mm × 305 mm each.

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Sterile packs should be stored away from direct sunlight, water, sinks, or the floor to avoid damage or contamination. They should be stored at least 250  mm above the floor and 450 mm below the ceiling or sprinkler heads, leaving at least 50 mm of space from side walls to ensure proper air circulation and prevent contamination during cleaning. Considerations for Designing the Clean Storage Room: 1. The storage size should depend on the quantity of materials to be stored and the expected storage duration. 2. Avoid providing windows in the room. 3. Prevent direct sunlight from entering the room. 4. Restrict entry to authorized personnel who have washed up and changed clothes. 5. Use racks of various sizes to store sterilized materials for easy access. 6. Clearly mark sets with the sterilization date to track their sterilization life and facilitate re-sterilization if needed. 7. Ensure proper ventilation, humidity, and temperature control, maintaining a temperature between 18–22 °C and an RH of around 40%. 8. Maintain positive pressurization in the room with filtration, similar to operating rooms. 9. Install lockable doors for security. 10. Connect the storage room to the delivery counter for convenient material transfer. 11. Plan for room washing and fumigation in the sterile area

25.9 Delivery Counter The delivery counter, located at the far end of the CSSD, serves as the point of distributing sterile materials to users. Staff members bring the required materials from the sterile store, place them on the delivery counter, record the necessary information, and complete the delivery process. The counter features a delivery window with dimensions ranging from 914 mm to 1219 mm in length and 914 mm in height. Sufficient space should be provided outside the delivery windows for parking trolleys that arrive to collect materials. A computer station should be available for managing material delivery and transport documentation.

25.10 Support Areas Support areas in the CSSD are those not directly involved in the sterilization process but play a crucial role in assisting the department. These areas include;

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25.10.1 Staff Changing Rooms Two separate changing areas should be provided in the CSSD: one for staff in the unclean area and another for staff in the packaging and sterile areas. The changing rooms for the unclean area should be located at the entrance of the CSSD and include attached toilets. Considerations for designing the changing rooms: 1. Provide separate rooms for males and females, each measuring 3048 mm × 3048 mm. 2. Include furniture such as chairs and cupboards. 3. Install an almirah with hanging provisions for clothes. 4. The rooms should be air-conditioned with a temperature control button. 5. Staff lockers should be provided in the changing rooms for personal belongings. Each locker should measure about 305  mm  ×  305  mm and be individually lockable.

25.10.2 Administrative Area The CSSD requires an administrative area for general administrative and clerical staff managing the department. The size of this room should be approximately 4572 mm × 4267 mm, which can be adjusted based on the staff capacity. The room should be equipped with cabinets, drawers, racks, office tables and chairs. If possible, an attached toilet and a store can be included. Adequate arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning should be made.

25.11 Electrical Points 1. Provide an adequate number of 6/16  Amp electrical outlets to power all appliances. 2. Higher-load appliances should be connected using starters or properly rated MCBs.

25.12 Air Conditioning The air conditioning and ventilation systems in the CSSD are crucial for controlling air bacterial contamination. Pay careful attention to the following during design and implementation:

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1. Areas like changing rooms and administrative areas should have air conditioning without air recirculation, following standard hospital practices. 2. Clean areas such as decontamination, packing, sterilization, and clean storage areas should have provisions for required air exchanges, designed similarly to clean rooms. 3. Use dedicated air-handling units with primary air heating, cooling, humidification, dehumidification, and filtration to ensure proper air exchanges. 4. Maintain the temperature in the CSSD between 18–22  °C and the Relative Humidity (RH) around 40%. 5. Ensure positive air pressure in clean areas to prevent air movement from dirty areas to clean areas.

Further Reading Garg A, Dewan A. Chap. 29, CSSD. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 321–31. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 26

Piped Medical Gas Supply System (MGPS)

Medical gases play a vital role in hospitals, used for various medical applications. Commonly used medical gases include: 1. Oxygen (O2): Essential for respiration, anaesthesia machines, and ventilators. Sourced from Liquefied oxygen tanks, Gas Cylinders, or Oxygen Concentrator systems, coded in white. 2. Nitrous Oxide (N2o): Administered via anaesthesia machines, mixed with oxygen and anaesthetic agents. Used in operating rooms, supplied through manifold systems, with blue cylinders and pipelines. 3. Compressed Medical Air 4  bar: Used for respiratory purposes, supplied from centralized medical compressor plants, coded in black. 4. Compressed Medical air 7 bar: Known as surgical air, used for surgical equipment like drills and tourniquets. Supplied through compressor plants. 5. Carbon Dioxide (CO2): Used for laparoscopy procedures, sourced from portable cylinders with grey coding. 6. Nitrogen N2: Utilized for surgical power tools in sites with synthetic air production. 7. Medical Vacuum: Provided by a vacuum central plant for suctioning patients and anaesthetic gas scavenging systems. Identified by yellow pipes

26.1 System Components Medical Gas Pipeline Systems (MGPS) consist of various system components that supply specific gases to patient beds. Each gas must have a separate system to avoid cross-connections.

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26.2 Sources There are different sources of medical gases: 1. Bulky systems: These may include cryogenic vessels or high-pressure manifolds, and are used for gases like oxygen, nitrous oxide, and carbon dioxide in large hospitals. 2. Manifold systems: A set of gas cylinders connected in series, with two banks, one operational and the other as a backup. A control panel manages primary and secondary regulators. 3. Central Plants: Produce gases like Medical Air and Vacuum supply through compressor and vacuum pumps installed in pairs. Pumps switch automatically between operations. 4. Generators: Oxygen concentrators separate oxygen from the atmosphere and fill tanks, supplying it to the pipeline.

26.3 Piping Networks Medical gases and vacuum are distributed in hospitals through high-quality copper pipes, protected against damage and corrosion, and colour-coded for gas identification. The pipes come in various sizes with different outer diameters and thicknesses, ranging from 76 mm to 12 mm.

26.3.1 Pipeline Installation 1. Pipes must be non-arsenical, phosphorus-deoxidised copper. 2. Fittings like valves and control panel fittings can be made of copper, brass, gunmetal, or bronze. 3. Pipes should be thoroughly cleaned and degreased for oxygen service, capped, and identified as medical gas pipes during delivery. 4. Jointing fittings should also be cleaned, degreased, and sealed in bags or boxes for oxygen service. 5. Copper-to-copper joints made with brazing filler rods and oxygen-free nitrogen are permitted to prevent oxide formation. Purging is needed to remove any internal shield gas and particles. 6. For copper joints to brass or gunmetal fittings, flux is used, followed by cleaning to remove residues. 7. Brazing heating should be done using oxygen/acetylene, acetylene, hydrogen, or liquid petroleum gas/ambient air torches. 8. To maintain pipeline cleanliness and prevent verdigris formation, the system should remain charged with medical air until final commissioning.

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9. Mechanical joints may be used for valves and control equipment, but not for general pipework installation except for vacuum pipelines of 76 mm diameter and above. 10. Allow joints, especially gunmetal fittings, to cool naturally to prevent cracking from rapid cooling. 11. Adequate support with PVC saddles is needed to prevent sagging or distortion of the pipeline. Surface-mounted pipework supports should allow painting clearance. 12. Pipes should be painted and colour-coded for easy identification, with colour bands applied near valves, junctions, walls, etc. A 150 mm wide band is used for identification.

26.3.2 Valves In the MGPS system, valves control gas flow, including two types: zone valves and service valves. Zone valves isolate large areas like halls or floors, mainly used during maintenance or repairs. Service valves isolate smaller sections, like individual rooms, for modification or repair. Valve Boxes are available based on the number of gases required, like 5 Services, 4 Services, 3 Services, and 1 Service.

26.3.3 Warning and Alarm Systems The warning and alarm systems serve to alert in case of system failure or inadequate gas pressure. Two types of alarms are used: Master Alarm for monitoring main gas lines and sources, and Area alarms for specific smaller areas. Pressure switches for high and low pressure are installed for each gas service. The alarm system provides a common audiovisual alarm, with permanently labelled visual signal panels indicating areas, rooms, or departments served. Flashing signals have alternating on-off modes. After a fault condition, the system automatically resets to normal, resounding after 15 min if the fault persists. Area Line Pressure Alarm Boxes are available for different gas capacities like Area Line Pressure Alarm up to 5 gases, up to 4 gases, up to 3 gases and up to 2 gases.

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26.3.4 Outlets and Inlets Outlets serve as the final points of gas delivery to patients in the MGPS. These terminal units can be wall-mounted or pendant-mounted, and connectors are used to connect them to the delivery pipes, ensuring gas delivery. Outlets are colour-coded and gas-specific according to standards.

26.3.5 Secondary Equipment Includes hoses, gas flow meters, gauges, and vacuum regulators. While not part of the pipeline system, these components significantly contribute to gas and vacuum consumption.

26.4 Designing the MGPS System Before installing the MGPS system, crucial factors must be considered for the system’s design, accounting for current requirements and future expansion. Designing the system should adhere to country-specific norms issued by competent authorities. Key considerations include.

26.4.1 Analysis of the Area of the Hospital First of all, the area where the outlets have to be provided should be analyzed concerning 1. Bed count, identifying the beds requiring MGPS supply and the location of such beds. 2. Determining the purpose of each area (ICU or normal patient room) and the medical equipment dependent on gas supplies. 3. Selecting the type of gases to be supplied (e.g., Oxygen, Air, or Vacuum) based on equipment usage. 4. Deciding the number and type of outlets for each bed, whether push type or sliding type. 5. Planning outlet installation, considering bed head panels, walls, or ceiling hanging pendants. 6. Anticipating hospital expansion plans and determining the location for gas source installations. 7. Assessing the availability and capacity of gas cylinder refilling and maintaining adequate stock.

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8. Estimating gas consumption based on patient types, critical units, and expected surgeries. 9. Preparing schematic drawings for piping layout, zone valves, area valves, master alarms, and area alarms. 10. Designing technical details of plant and machinery, considering pipeline length and delivery point pressure.

26.5 Infrastructure for MGPS For infrastructures of the MGPS, please refer to “Table 1 – ROOMS REQUIRED FOR VARIOUS ZONES / UNITS / DEPARTMENTS” given in Chap.  7 of this book.

26.6 Manifold Room The manifold room is designed for installing the manifold system to supply oxygen and nitrous oxide gases in the hospital. The manifold connects multiple cylinders in a series to a common outlet, forming a bank. The number of cylinders in each bank is decided based on the design and gas consumption requirements. A copper pipe with sockets is fixed on the wall, providing one socket for each cylinder. The copper tailpipe is connected to these sockets and further to the cylinder regulator. To ensure continuous gas supply, two banks are installed in the manifold room – a “Duty Bank” and a “Standby Bank.” A control panel, either automatic or semi-­ auto, switches between the banks based on pressure. A non-return valve is fitted to prevent discharge in case of pig tail-pipe rupture. An emergency manifold with two to four cylinders is provided to tackle potential failures. The emergency manifold is directly connected to the main supply line, ensuring continuous flow in case of primary source failure. The number of cylinders in the manifold system varies based on the number of outlet points and gas requirements. Recommended patterns for oxygen and nitrous oxide supplies are provided.

26.6.1 Location of the Manifold The manifold room should have an approach road for easy transportation of jumbo cylinders. It should be located near the hospital building’s shaft for pipeline distribution. A wooden plank should be inserted at the cylinder unloading point to protect the floor from damage when the cylinder is unloaded from the vehicle.

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26.6.2 Size of the Manifold Room The size of the manifold room depends on the number of cylinders and the space required for storage. Roughly, 0.28 sq. mtr. Area per cylinder should be allotted.

26.6.3 Fixing the Manifold Systems in the Hall/Room The manifold systems are fixed on three walls of the room/hall, with one wall for oxygen, the opposite for nitrous oxide, and the third for emergency manifolds of both gases. The arrangement can be adjusted depending on wall sizes.

26.7 Compressed Medical Air Medical air serves various purposes in hospitals, such as operating invasive ventilators, nebulizers, and dental chairs, and powering medical equipment like drill machines and surgical saws. It is required at two different pressures: 400 kPa for respiratory applications and 700 kPa for driving surgical tools

26.7.1 Compressor Air Plant The air compression plant consists of electric motors, air compressors, air reservoirs, control panels, bacteria filters, air dryers, and other necessary components. It is important to use oil-free compressors to avoid traces of harmful oil in the produced air. Two units of compressors are set up to work reciprocally. The air is stored in the reservoir, passed through filters to remove contaminants, and dried using twin air dryer systems. The capacity of the compressors and motors shall depend on the air required and the number of outlets. It is measured in cfm. Compressed air connects to the main supply. Automatic/Semi-Automatic control panels manage compressors, ensuring continuous operation in case of failure.

26.7.2 Air Filtration Medical air may contain impurities from the atmosphere, compressor, and pipeline distribution. Filtration equipment like pre-filters, coalescing filters, carbon filters, and particulate filters ensure air quality. A 5 μm intake filter prevents blockage. The

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filtration system ranges from single-stage to four-stage. Air Dryers remove moisture, with a twin system on standby.

26.7.3 Medical Air 400 kPa The medical air with a pressure of 400 kPa is primarily used for operating invasive ventilators and other medical equipment. Flow rates for ventilators can vary up to 80 L/min, while other equipment may require up to 10 L/min.

26.7.4 Surgical Air 700 kPa Surgical air at 700 kPa is used for surgical tools, with pressure requirements between 600 and 700 kPa and flows between 200 and 350 L/min. The pipeline systems are designed to provide a flow of 350 L/min at 700 kPa at the terminal units. Overall, the system is designed to ensure a continuous and reliable supply of medical air, considering diverse factors and safety measures.

26.8 Vacuum The medical vacuum pipeline system, essential for operation theatres and ICUs, relies on vacuum pumps for its operation.

26.8.1 Vacuum Plant The system includes Electric Motors, Vacuum pumps, Vacuum Reservoir, and an Automatic/Semi-Automatic Control Panel with Bacteria Filter. The plant is designed for easy maintenance, and two units of pumps work alternately. The Vacuum Reservoir, made of thick MS steel, is connected to the vacuum pumps and the filtration system. Its capacity varies based on requirements, from 1000 l to 5000 l, and it is installed on a raised foundation.

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26.8.2 Filtration System The vacuum system incorporates Bacteria Filters to ensure suction air passes through the filtration system. Filtration can range from single-stage to four-stage. Automatic/Semi-Automatic control panels govern vacuum pumps, switching between units at intervals, ensuring continuous operation. The medical vacuum pipeline maintains a vacuum of at least 300 mm Hg (40 kPa) at each terminal unit. Diversified flow is considered for ward areas with multiple terminal units. Outlets connect to Ward vacuum units with regulators and collection bottles. HP tubes transport medical gases. Operating Rooms use theatre suction units instead of ward vacuum units.

26.9 Issues While Designing the Plant Room and the Manifold Room The following issues shall be taken care of: 1. Manifold room should have two doors, one large enough for cylinder handling, opening outwards on an outside wall, and another 914 mm door opening inside or outside. Doors must be obstruction-free and locked to prevent unauthorized access. 2. Internal walls and doors of the manifold room must be non-combustible 2-h fire-­ resistant material, with heat detectors installed. Avoid unnecessary internal doors. 3. Ventilation louvres at high and low levels in manifold room for proper air circulation. 4. Plant rooms with motors and pumps generating heat require natural ventilation. Maintain ambient temperature between 18 °C to 30 °C. 5. Mechanical ventilation may be needed for some plant rooms, using direct air coolers facing compressors and pumps. 6. Plant rooms should be designed with acoustic linings for noise control, especially during the simultaneous operation of multiple vacuum pumps or compressors.

26.10 Medical Gases Outlet Terminals The gas outlets are the endpoint of the MGPS system, where pipelines carrying gases terminate and are connected to the probe to provide gases to patients. Medical gas outlets are installed based on gas type (O2, N2O, Air, Vacuum) and are properly marked for identification.

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Outlets are typically placed at patient beds directly on the wall or using either Bedhead panels or Ceiling suspended pendants. Bedhead panels are aluminium panels fixed at 1524 mm height with provisions for gas outlets, electrical points, and a service railing for IV rods and utility attachments. Ceiling suspended pendants offer similar features, suspended from the ceiling at 1524 mm above the floor, with gas outlets on the back wall, electrical points on the side walls, and utility tray and basket on the front wall. Pendants can be single or dual-arm and can rotate up to 270° for broader bed coverage.

26.11 Bulk Liquid Oxygen Gas System In hospitals with high oxygen consumption, cylinder handling and availability becomes challenging. Installing a bulk liquid oxygen tank is the best solution. This cryogenic pressure vessel made of stainless steel stores cryogenic liquids like oxygen, nitrogen, and nitrous oxide.

26.11.1 Liquid Oxygen Vessel The vessel is a vacuum flask-type capsule made of stainless steel and comes in various capacities from 500 l to 20,000 l. Installed on a pre-constructed foundation is enclosed by the fence. The vessel area, about 18 m × 9 m, must be outside the hospital building in an open area. A 6 m door is provided on the front for vehicle entry, usually kept locked until the vehicle arrives. A smaller 914 mm wide door on the side allows regular monitoring. Local authority planning constraints and approvals from departments like the Explosive Department are necessary before installation, and an inspection is done before issuing the operating license.

Further Reading Garg A, Dewan A. Chapter 30, piped medical gas supply system (MGPS). In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 333–48. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 27

Hospital Kitchen

Hospital kitchen services are essential for providing high-quality food to patients, staff, and visitors. Additionally, the kitchen may cater to meetings and special occasions. Food must cater to the diverse dietary needs, cultural backgrounds, and nutritional requirements of patients. The kitchen should be designed and equipped accordingly to fulfil these needs and provide prescribed diets for patients based on their illnesses.

27.1 Infrastructure of Hospital Kitchen For infrastructures of the Hospital Kitchen, please refer to “Table 1  - ROOMS REQUIRED FOR VARIOUS ZONES / UNITS / DEPARTMENTS” given in Chap. 7 of this book.

27.2 Location of Hospital Kitchen The hospital kitchen, or catering unit, can be situated on-site within the health facility or off-site, away from the hospital. If on-site, it should be distant from patient areas and clinical departments to avoid spreading kitchen odours. The preferable location is on the hospital rooftop, subject to bylaws, or outside the building. Alternatively, if proper ventilation and drainage are ensured, the kitchen can be in the basement. Noise should be minimized to avoid disturbing other departments. The kitchen’s location should prioritize efficient food delivery to the wards.

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27.3 Size of the Kitchen The kitchen size depends on factors such as hospital bed count, the number of meals cooked, supplying meals to visitors and staff, and cafeteria service. Generally, excluding the dining area, the kitchen should be around 0.28 sq. mtr. per meal. For example, for 500 meals prepared daily, the area should be approximately 140 sq. mtr. Smaller hospital setups should have a minimum area of 50 sq. mtr. The dining space should also be about 0.28 sq. mtr. per person.

27.4 Entry The kitchen must have a main entry and an emergency exit. The main entry should be approximately 1524 mm wide with a door opening on both sides and equipped with an Air Curtain to prevent insects from entering. An airlock of about 1524–1829 mm in length should be provided immediately after the main entry to control access and prevent external contaminants. Another entry gate, also 1524 mm wide and openable on both sides, should follow the airlock. Additionally, there should be an emergency exit near the cooking area, about 1219 mm wide, for quick evacuation. A separate entry door for materials can be provided to directly access storage without disturbing the main entry, sized around 1524–1829 mm wide.

27.5 Change Rooms Cum Wash Areas After the main entry, separate change rooms for male and female staff should be provided, each sized at approximately 3048 mm × 3048 mm. The rooms should have an attached toilet with a bath facility and cupboards. Staff lockers of about 305 mm × 305 mm should be allotted to each employee and should be locked individually. The exit of the changing rooms should lead to the handwashing area with sinks equipped with running hot and cold water. On average, one sink per 10 workers should be provided, and drains should be placed below the wash sinks for proper drainage.

27.6 Receipt Area for Supplies The receipt area for supplies includes receiving purchased goods, ration, vegetables, utensils, and other items for the kitchen. It should have a separate entrance from the main entry and should be located near the storage area. Materials are received, checked, and entries are made in stock registers before sending them to the respective storage. The area should be about 3658 mm × 3658 mm with two doors for entry and sending of materials.

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27.7 Storage Area There are different storage rooms based on item properties of the material like:

27.7.1 Bulk Storage This storage area is used for bulk items like cooking utensils, crockery, cutlery, linen, cleaning machines, and chemicals. It should not mix with food storage. Size should be about 3658 mm × 3658 mm with lockable cupboards, racks, and a countertop, managed by the Kitchen Manager.

27.7.2 Fruit and Vegetable Store For perishable food storage, it must control temperature and humidity. The room size should be about 3658 mm × 3658 mm with wire mesh bins on racks for proper air circulation.

27.7.3 Refrigeration, Cool Rooms, Freezers For dairy, meat, and frozen items, a cold room of size about 3048 mm × 3048 mm with adjustable -20 °C to 2 °C temperature should be provided. Top-loading deep freezer may also be provided.

27.7.4 Storage Areas for Dry Ration/Goods For dry goods, the store size of about 3658 mm × 3658 mm with stainless steel racks or bins/shelves/drawers should be provided. Temperature and humidity control is essential, and door brushes can prevent rodents. Food should be stored off the floor, at least 305 mm above or sealed tight for cleaning.

27.8 Preparation Areas Food Preparation areas are distinct zones separate from the cooking area. Tasks such as peeling, cutting, grinding, mixing, and meat/fish/poultry preparation are conducted here. These areas should be conveniently located near vegetable/ration

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storage, refrigeration, cooking, boiling water units, and ice dispensing machines. Equipped with working counters, sinks, shelving, and trolleys, they also house food processors, slicers, mixers, and grinders. Electrical points (6/16 Amp) should be provided at a height of 305  mm above the working counter. Each station should have a sink, hand basins, and waste bins. Special considerations should be made for vegetarian, vegan, and allergy-specific food preparation. Adherence to religious and cultural practices is also essential.

27.9 Cooking Areas The cooking area is crucial and should have ample space for various cooking methods like boiling, frying, and pan cooking. Each cooking method requires designated sections, with low-height partitions to avoid mixing. Gas stoves and other apparatus must be placed 305 mm away from the wall and provided with a minimum area of 3.72 sq. mtr. Automatic chapatti (Indian bread) making machines can be used for large quantities. Proper ventilation with exhaust hoods should be provided to prevent grease buildup. Smooth, washable walls with glazed tiles up to 1524–2134 mm in height and non-slip, washable floors are recommended.

27.10 Reheating Areas Reheating is done using gas burners, microwaves, or induction plates/grills. A separate area with working counters should be provided for non-gas devices. Electrical points at 305 mm height should be installed, and critical devices may connect to UPS. Floor-mounted devices require proper foundations and electrical points. Additional working counters can hold pre-heated and post-heated food items.

27.11 Packing/Plating In the kitchen, a separate area is designated for packing or plating the meals, following specific diets prescribed by physicians. Each plate or tray is marked with patient details and diet type. The plating area equipment can include automated plating conveyor systems for efficient service. Plates/trays are covered with silver foil or wrapping slings and tagged before loading onto trolleys for distribution.

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27.12 Meal Trolley/Cart Parking The trolley/cart parking area adjoins the plating/packing area, facilitating the temporary parking of meal trolleys for distribution. Service windows allow easy transfer of plates/trays to the trolleys. Power points should be available for keeping trolleys hot or cold as needed. Chains or hooks secure trolleys in place to prevent unnecessary movement.

27.13 Food Distribution Trolleys/carts loaded with meals are delivered to respective wards/rooms or dining areas to ensure hot or cold food as required. After meals, the trolleys/carts return to the kitchen for unloading and are later wheeled back to the trolley wash area.

27.14 Trolley Return/Stripping Trolleys/carts returning from service have dishes and waste removed in the trolley stripping area. This area, adjacent to dishwashing and trolley wash areas, has wall and corner guards for protection and handwashing provision.

27.15 Trolley/Cart Wash Trolleys are moved to the trolley washing area for washing, disinfecting, and drying, ensuring a clear flow from dirty to clean items. This area should have provision for hot and cold water, a compressor system, or optional automated equipment for washing multiple trolleys.

27.16 Dishwashing In the kitchen, a dishwashing area near the trolley stripping area is provided. It includes stainless steel sinks with drainers, detergent dispensers, and sponge holders. Utensils are sorted, stacked, and should be washed manually or using automatic dishwashers.

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27.17 Pot Washing A separate enclosure near the cooking area serves as a pot-washing area. Low-level taps with hot and cold water should be provided for washing pots, with a stripped stainless steel rack for drainage. Automatic pot washing machines can be used if required.

27.18 Waste Disposal A separate waste disposal area adjoining the kitchen is provided for regular removal and disposal of wet and dry waste following Waste Management guidelines. The room (approx. 3048  mm  ×  3048  mm) should have a door opening outside the kitchen and contains big waste bins with disposable biodegradable polythene bags. Waste is thrown into the bins through a window from the kitchen side. Garbage, especially wet waste, should be stored in sealed bins and provision should be made for bin removal and cleaning inside the waste disposal area.

27.19 Gas Storage Closet Instead of keeping gas cylinders at each point, a gas manifold room should be provided outside the kitchen for supplying cooking gas through pipelines. The manifold should hold 6 to 10 cylinders at a time, connected to the burners via flexible gas pipes. An enclosure near the manifold stores should be provided for filled and empty cylinders. However, both areas should be enclosed with wire mesh for safety. The manifold room and gas store shouldn’t have walls but should be carefully designed to prevent fire hazards. The size of the manifold and gas store varies based on the number of cylinders; for 10 cylinders, each area should be approximately 3658 mm × 3658 mm.

27.20 Staff and Support Areas A small administrative area is provided in the kitchen to control and monitor its functioning. The following rooms are included: • Kitchen Manager’s Office • Dietician’s Office • Dietetics Staff Office

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These rooms are for general administrators and clerical staff managing the kitchen, such as Managers, Dieticians, and Asstt. Dieticians. The size of each room should be approximately 4572 mm × 3658 mm, but it can be adjusted based on the number of occupants. The rooms should have cabinets, drawers, and racks for smooth operations, along with office tables, chairs, and an optional attached toilet. Adequate electrical points, intercom, IT network, CCTV surveillance, and air conditioning should be provided.

27.21 Fixtures, Fittings and Equipment Some of the equipment, devices and cookware required for the kitchen are; Blenders Chapati maker Cooking utensils Dish washer Fryer Grill Juicer Ladles Nutcracker Refrigerators Spatulas Waste bins large size

Boilers Cookers and steamers Deep freezers Fire extinguisher Glass washer Grinders Kettles Microwave ovens Ovens Rubber floor mats Stainless steel tables, benches

Burners Cooking ranges Dish warmer Flat cooking pan Griddles Induction stove Kitchen knives Mixers Pans and cooking spoons Shredders Vegetable cutters/choppers

Further Reading Garg A, Dewan A. Chapter 31, hospital kitchen. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 349–58. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 28

Laundry

The Laundry service ensures a constant supply of clean and sterilized linen to all users, including patients, to maintain hygiene. Basic tasks include sorting, washing, drying, ironing, folding, mending, and delivery. Hospitals can establish laundry in three ways: internal setup with equipment and staff, providing space to a contractor, or outsourcing to a local laundry service.

28.1 Infrastructure of Laundry For infrastructures of the Laundry, please refer to “Table 1 - ROOMS REQUIRED FOR VARIOUS ZONES / UNITS / DEPARTMENTS” given in Chap. 7 of this book.

28.2 Location of the Laundry The Laundry should be located in the hospital's service area with easy access to clean and dirty loading docks. Ample daylight and natural ventilation are preferred, and an isolated building near a water and power plant is ideal.

28.3 Size of the Unit The size of the Laundry area depends on the hospital’s size, daily linen load, and laundry equipment. Considerations include storage needs, reserve clean linen and reliable linen supply services. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_28

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28.4 Dirty and Soiled Linen Generation Soiled linen is generated from different hospital departments and replaced with washed and sterilized linen for reuse. Types of linen washed in the hospital laundry include: Bedsheets Curtains Kitchen cloths Patient gowns Towels Uniform of the staff

Blankets Doctors apron Napkins Pillow covers Screens cloths

Draw Sheets Doctors OT dress & gowns Patient dress Theatre drapes Staff apron

28.5 Dirty and Soiled Linen Interim Storage Dirty linen sorting begins at the point of use, with designated Dirty Utility areas in the hospital equipped with hampers for collection. Contaminated linen should be initially separated and placed in colour-coded plastic bags. A trolley then transports the linen to the Central Storage Area.

28.6 Central Storage Area This area facilitates the exchange of soiled linen with washed linen. Part of the Central Storage Area should be designated for soiled linen collected from various interim storages in the hospital. It can be located inside or outside the hospital building, with room size depending on daily linen quantity and transport frequency to the laundry. The room should be equipped with racks and transport trolleys for soiled linen. A separate room should store clean linen to prevent cross-contamination. Room size depends on daily washed linen quantity and issue frequency to departments. It should include racks and transport trolleys, with a separate trolley parking bay for clean linen.

28.7 Dirty Receipt This area at the laundry entrance receives soiled/dirty linen from the hospital’s Central Storage under a receipt. The room size depends on daily linen quantity and the average time for dirty linen storage, with 3658 mm × 4267 mm being sufficient. It should have two doors, one for receiving linen and another opening to the sorting

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and weighing area. Adequate space should be provided outside the room that accommodates trolley parking. Optional racks or shelves should be provided to store linen before transferring it to the sorting and weighing room for further processing.

28.8 Sorting and Weighing Soiled linen is initially sorted in the storing and weighing area. Here, items requiring specific washing conditions are sorted based on fabric type, colour, soiling degree, and load sizes for washer-extractors. Items needing mending or stain removal are separated. Pre-sluicing can be done in suitable machines or stainless steel tubs provided in this area. Stainless steel tables should be used for sorting. The room size depends on linen quantity, with 3658 mm × 4267 mm being sufficient, and it should have two doors, one connected to the receiving room and another opening to the washing area.

28.9 Washing Area This main area of the laundry is where linen is washed, extracted, dried, and ironed, preparing it for delivery. The area accommodates different machines and processes, ensuring effective laundry operations:

28.9.1 Loading and Washing Once sorted and weighed, linen is loaded into front-opening washing machines installed on a foundation. Anti-vibration pads protect machines from vibrations during operation. Washers are connected to separate hot and cold water supplies, with options for heating water using steam, gas-fired burners, or electric heaters. Washers should be arranged against the laundry wall, with drain-off discharged into a floor drain channel. Adequate space of 1829  mm should be provided in front of the washer allowing easy loading and unloading. Typically, at least two washers should be provided, with room for expansion based on linen load and future plans.

28.9.2 Extractors After washing, excess water is drained using extractors, either as a separate machine or inbuilt with the washer. If separate extractors are used, they should be installed on a foundation and protected with anti-vibration pads. Extractors require an

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accurate alignment for balancing and levelling. Adequate power supply and drain pipes should be provided for their operation. Similar to washers, extractors should be installed at a distance of about 610 mm from the wall and typically two or more should be provided based on linen load and future expansion plans.

28.9.3 Tumble Drying Tumble drying reduces moisture content in washed linen for ironing. Dryers, powered by gas, steam, or electricity, should be installed on a foundation at a distance of about 610  mm from the wall. Adequate space of 1829  mm in front of the dryer allows easy loading and unloading. Dryers must be vented outside the building and can be placed side by side or in a well-ventilated separate room. Typically, at least two dryers should be provided, with space for future expansion based on linen load.

28.9.4 Ironing A separate area should be dedicated to ironing in the laundry. Various types of ironing machines are installed based on the type of linen to be ironed. Examples of ironing machines include: 28.9.4.1 Pressing Machines Used to iron clothes like shirts, pants, uniforms, and curtains, these machines can be single or double-heated bucks operated with electricity or steam. Compressed air is used for the rotation and lifting of the buck. One machine is typically sufficient for the laundry, with space for future expansion. 28.9.4.2 Calendar Dryer Irons Calendar ironing machines are used for ironing bed sheets. They can have a single large heated roller or bed and chest heating with up to four large rollers. Machines can be positioned against a wall or be free-standing. Automatic folding processes can be fitted. Space planning should consider linen load and future expansion.

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28.9.4.3 Flat Irons Domestic irons for small clothes require an electric power point and a wooden table of size 1219 mm × 914 mm. They can be installed conveniently in the ironing area adjoining the wall.

28.10 Inspection and Repairing The laundry department mends and repairs torn linen in a separate room equipped with a stainless steel working counter, foot-operated sewing machine, and patching machine. The room size should be about 4267 mm × 3658 mm with adequate electric points for operation. It should store supplies such as threads, needles, repair fabrics, and haberdashery requirements.

28.11 Packaging and Storage Linen is packed in fluid-resistant, securely sealed plastic bags or covered carts. The packing area can be an open hall or a dedicated room, with a recommended size of 4267  mm  ×  3658  mm. It should have sorting racks, shelves, bins, and packing tables. After wrapping, linen should be stored in a clean storage room of size 6096 mm × 4572 mm with stainless steel racks, shelves, or bins. The storage room should be positively pressurized for hygiene.

28.12 Dispatch Room Linen is dispatched to user departments or the central storage from this room, which should be about 3658 mm × 3658 mm in size. It should have a dispatch counter or office table with a chair and two doors for easy access. Sufficient space for parking trolleys should be provided outside the room.

28.13 Trolley Washing This area is for washing, disinfecting, and drying trolleys carrying soiled linen before reuse. It should be located remotely from the clean storage room, with easy access from the linen receiving area. The trolley wash area should have proper wall and corner guards to prevent damage. It should have running hot and cold water, a

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compressor system for pressure cleaning, and a hot air-blowing system for drying trolleys.

28.14 Store This store is for chemicals, detergents, and solution preparation. It should have storage space for at least 1 month’s supply, located near the washer-extractor area. The store size should be at least 3658 mm × 3658 mm, with lockable cupboards, racks, drawers, and a countertop. Dry-washing materials should be stored on pallets, and environmental conditions should be dry. If needed, a solution preparation and storage area may be provided.

28.15 Staff and Support Areas The laundry should have an administrative room for controlling and monitoring laundry operations. The room size should be about 4572 mm × 3658 mm, with cabinets, drawers, and racks for organization. Office tables, chairs, and an attached toilet should be provided. Additional rooms for staff may be considered. Proper arrangements for electrical points, intercom, IT network, CCTV, and air conditioning should be included.

28.16 Other Issues Relating to the Infrastructure of the Laundry The following issues shall be considered while designing the laundry:

28.16.1 Infection Control Laundry should have sufficient hand washing stations in clean and soiled linen areas, along with restricted/controlled access and uni-directional workflow from dirty to clean areas.

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28.16.2 Airflow Ensure positive airflow from clean to dirty areas, venting directly outside to prevent contamination of clean linen.

28.16.3 Mechanical Ventilation Provide adequate ventilation for a comfortable working environment, with exhaust systems using high-speed exhausts or centrifugal fans.

28.16.4 Hot-Air Extraction Extract hot air directly from heat-emitting equipment, and consider a separate section for tumble-drying.

28.16.5 Compressors Use a separate compressed air supply for washer-extractors, ensuring proper moisture-­trapping arrangements.

28.16.6 Steam Provide a sufficient steam supply with a boiler installed outside the laundry premises, considering gas/coal/wood/electricity provision.

28.16.7 Water Supply, Heating, and Water Treatment Equipment Ensure adequate water supply and heating with booster pumps and storage tanks, and address hard water issues with water-softening plants.

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28.16.8 Fire Prevention and Detection Install fire protection devices like sprinkler systems, hydrants, smoke detectors, and fire extinguishers in the laundry.

28.16.9 Communications Provide telephones, data outlets for computers/internet access, and scanning systems for efficient communication within the Linen Handling Unit.

Further Reading Garg A, Dewan A. Chapter 32, Laundry. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 359–66. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 29

Medical Record Department (MRD)

Medical Records are systematic documentation of a patient’s medical history, treatment, and care, serving as a basis for planning future patient care, communication with healthcare professionals, and protecting legal interests. They also aid in medical education, internal auditing, quality assurance, and medical research. While electronic storage is increasingly used, some records still require hard copies. Hence, the MRD should have a robust information technology setup for effective record preservation.

29.1 Electronic Medical Records (EMR) Electronic Medical Records (EMR) is a computerized system that tracks patient details and allows authorized clinicians to access records online for assessments and treatment. It involves scanning paper records brought in by patients or from outside sources.

29.2 Location of MRD The MRD should be located within the hospital building in a low-activity area, accessible to various departments for referrals. It can be situated in the basement or other less busy floors, or in a nearby building due to space constraints. Easy walking distance from the admitting or outpatient department ensures quick access to records during emergencies.

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29.3 Infrastructure of MRD For infrastructures of the MRD, please refer to “Table 1 - ROOMS REQUIRED FOR VARIOUS ZONES / UNITS / DEPARTMENTS” given in Chap.  7 of this book.

29.4 Entry and Reception The reception at the MRD entrance should have a reception counter, chair, and a computer with the necessary electrical outlets. Authorized staff should have a key card or electronic access. Non-authorized visitors should not be allowed.

29.5 Medical Record Receipt Room Located at the MRD entrance, this room receives medical records from various departments. It should measure about 3658 mm × 3658 mm with one door and an openable window of 914 mm × 914 mm. The room should contain a receipt counter (wood/stainless steel/granite top), closed racks for temporary storage, and a high-­ raised chair. A computer should have a printer and be connected to the hospital network.

29.6 Compilation Desk A separate room in the MRD for sorting and compilation, sized about 4267 mm × 3658 mm, adjacent to the receipt room should be provided. It should house a compilation and sorting desk (wood/stainless steel) of approximately 1829 mm × 1219 mm with chairs. A filing rack should be provided for temporary storage. The room should have a computer with a printer connected to the hospital network. The record keeper should check records against a checklist provided in the system. Proper partitioning should be provided to allow for the storage of sorted and unsorted files. This room should have access to the dictation room, photocopy, and scanning area.

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29.7 Indexing and Coding A separate room for indexing and coding medical records should be provided. The room should measure about 4267 mm × 3658 mm with one door opening in the MRD. It should contain office tables, chairs, and a filing rack for temporary record storage. A room should have computers with a printer, connected to the hospital network, which facilitates indexing and coding as per ICD codes.

29.8 Statistical Analysis A room of about 3658 mm × 3658 mm should be designated for statistical analysis of medical record data. Workstations connected to the hospital network should be available for analysis. The room should also include an office table, chairs, and a storage cupboard for files used in the analysis.

29.9 Computer Lab A separate room of about 4572 mm × 3658 mm should be provided to function as the computer lab for data feeding and retrieval. It should be equipped with workstations connected to the hospital network, along with chairs and storage cupboards for file organization.

29.10 Medical Record Storage Room Medical records must be stored in a fire-rated construction adhering to local building bylaws. Active records in constant use can be stored in open metal shelving units for easy access. The size of the storage room depends on the hospital’s patient load, and for a 300-bed hospital, the recommended size is about 93 sq. mtr. Storage cabinets should be lockable, and the use of open shelves is not permitted. The room features compact slidable units with 7 shelves, accommodating around 7000 record files. Adequate arrangements must be made to prevent fire, termite, and pilferage risks. An air-conditioned area measuring about 3048  mm  ×  3048  mm should be provided to store CD/DVD/hard disks with electronic data backup in a properly sealed, fireproof cabinet. The room should be equipped with step stools, chairs, and stainless steel working tops. Doors should be sealed and fitted with brushes to prevent rodents from entering. Proper cable management should be ensured, and fire sprinklers should not be installed to preserve records’ integrity. Temperature and humidity control maintain optimal preservation conditions.

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29.11 Dictation Room/Cubicles Cubicles for medical staff and others to view, research medical records, dictate, and complete discharge summaries should be located on the perimeter of the MRD, adjacent to the reception area. The number of cubicles depends on usage. Auditory separation should be preferred to reduce distractions. Adequate power and data provisions should be provided.

29.12 Transcription Room A noise and echo-proof room of size 4267 mm × 3658 mm designated for medical record transcription should be provided. It should be located between the entry area and the sorting room. The room should be equipped with an office table, chair, computer, and transcription machine. Power and data provisions should be available.

29.13 Photocopying/Printing Room A room of about 3658 mm × 3658 mm serves for photocopying, printing, generating barcode labels, and stationary storage. It should contain a photocopy machine, computer workstation, office table, chairs, and storage cupboards for stationery.

29.14 Scanning Room A room of approximately 3658 mm × 3658 mm should be dedicated for scanning documents brought from outside or created in the hospital, to record them in electronic digital format. The room features an office table, chairs, a workstation, and a high resolution.

29.15 Binding Room A room of about 3658 mm × 3658 mm should be provided for binding paper-based medical records before storage. It should include at least one office table, chair, and working top for binding. Electronic digital records should be packed and prepared for storage in this room as well. A storage cupboard should be available for temporarily storing records to be bound.

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29.16 Waste Holding Room This room, measuring about 3658 mm × 3658 mm should, be provided to be used for destroying, discarded documents in the MRD through shredding. It should contain an office table, chairs, a high-capacity shredding machine, and waste-­ holding bins.

29.17 Store The MRD should include a store of size 3048 mm × 3048 mm for general items, stationery, unused old equipment, and daily used items. Lockable cupboards, racks, drawers, and a countertop should be provided in the store.

29.18 Administrative Area The MRD shall have separate rooms for the following staff: In-charge MRD and Medical Record Officer: Rooms of about 4572 mm × 4267 mm size with cabinets, drawers, racks, office tables, and chairs should be provided. An attached toilet and optional store should be provided. Proper arrangements for electrical points, intercom, IT network, CCTV surveillance, and air conditioning should be included. Coders, Data Analyst, and Secretarial Staff: Smaller rooms of approximately 3658 mm × 3658 mm size with cabinets, drawers, racks, office tables, and chairs should be provided. Proper arrangements for electrical points, intercom, IT network, CCTV surveillance, and air conditioning should be included. Secretarial Room: A room of about 6096 mm × 4572 mm in size with cabinets, drawers, racks, office tables, and chairs should be provided. An attached toilet and optional store are provided. Proper arrangements for electrical points, intercom, IT network, CCTV surveillance, and air conditioning should be included.

29.19 Other Issues About the Infrastructure of MRD 1. Protection from fire Install fire extinguishers and smoke detectors in the MRD, especially the filing area and X-ray section. Medico-legal cases should be stored in fire-proof cabinets. Cover electrical lines to prevent short-circuiting. 2. Protection from rodents and termites

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Ensure the MRD is designed to prevent vermin and insects from damaging records. Use wire mesh or door brushes and maintain a sealed ceiling. Regular pest control treatments should be carried out. Safety & Security Implement strict security measures to safeguard confidential records. Limit entry and exit points and consider manual or electronic access control. Information Technology/Communications Provide intercom lines, computer networking points connected to the hospital’s central server, and RJ45 jacks as needed in the MRD section. Electrical Services Install 6/16 Amp switch/socket pairs at required locations and ensure all computer points are backed up by UPS supply. Pneumatic Tube Systems (PTS) Include one PTS station in the MRD to facilitate quick and accurate transportation of documents, specimens, materials, and medicines from different areas of the hospital.

Further Reading Garg A, Dewan A. Chapter 33, medical record department (MRD). In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 369–74. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023.

Chapter 30

Mortuary

Hospital Mortuary serves as temporary storage for dead bodies until post-mortem, handover to authorities or family, or final disposal. It can be used for storage/disposal or as a post-mortem facility.

30.1 Mortuary It is primarily used for the storage of bodies and includes a refrigerated body storage facility and may include a body viewing and preparation room.

30.2 Autopsy Unit Autopsy Unit, attached to the mortuary, investigates the cause of death and consists of an autopsy room, change room, and observation area. The mortuary size depends on the cabinets/storage needed and the death rate. Typically, space for four bodies per 300 beds works well, excluding isolation storage. Additional autopsy functions may be available in large hospitals or as per local guidelines.

30.3 Location of the Mortuary The Mortuary/Autopsy Unit should be situated away from the main clinical areas, either in the same building or an annexure building. It must have a separate route not commonly used by patients or staff. An ideal solution is to have a separate back door © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_30

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from the hospital for moving bodies to the mortuary. The ground floor or basement location is preferred for easy and discreet access by ambulances, police, and funeral vehicles through an exit door.

30.4 Infrastructure of Mortuary For infrastructures of the Mortuary, please refer to “Table 1 - ROOMS REQUIRED FOR VARIOUS ZONES / UNITS / DEPARTMENTS” given in Chap.  7 of this book.

30.5 Mortuary 30.5.1 Entrance Lobby The Mortuary’s entrance lobby should include a gate and a small counter for receiving, identifying, and tagging bodies. Records related to body reception and disposal should be maintained here. The main gate should be at least 1829 mm wide and openable on both sides. The reception/waiting hall’s size should be approximately 6096 mm × 4267 mm and has direct access to the Body Wash and Body Holding Area. Adequate space for ambulance and trolley parking, along with a trolley bay for unloading bodies, should be provided outside the entrance.

30.5.2 Body Wash The Body Wash area allows thorough cleaning of bodies, especially in cases of accidents or soiling. It features a curved platform with dimensions 2134  mm (L) × 914 mm (W) × 914 mm (H) and glazed tiles for easy drainage. Showers and a tap with a hose pipe should be provided, and body bags provided to pack the body if needed.

30.5.3 Body Holding Area This area offers refrigerated storage for bodies. For this, the following options are available: 1. Provide a walk-in Cool Room for individual trolleys 2. Install refrigerated cabinets

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30.5.3.1 Walk-in Cool Room This concept involves a chamber with insulated panels for walls, ceiling, and an insulated, sealed door to prevent outside air from entering. The chamber size depends on the expected number of bodies and average holding time. Generally, 3 sq. m. space is needed for a body on a tray or trolley. The temperature is maintained between 2–4 °C. 30.5.3.2 Refrigerated Cabinets This system uses cabinets with slidable drawers for body storage. Each cabinet typically has two drawers in one row, and multiple cabinets can be installed. Vertical stacking should be avoided for ease of handling. Adequate space is provided to manoeuvre and access the drawers. The temperature should be maintained between 2–4 °C. Separate spaces/cabinets should be allocated for isolation and bariatric bodies, with consideration for their storage and handling. The body holding area should be approximately 6096 mm × 4877 mm, adjustable as needed. It must have a power backup system, either a self-start generator or UPS.

30.5.4 Waiting/Viewing Area The mortuary and autopsy room should have a waiting area for police and relatives (capacity 20–30, adjustable) with an accessible toilet nearby. A viewing area with a curtain-revealed window/partition should be provided.

30.5.5 Storage A store in the mortuary and autopsy room should store clean linen, gowns, aprons, gumboots, towels, cleaning materials, and plastic body bags. A lockable storage area (3658 mm × 3048 mm) for the deceased’s belongings should be provided. An area for collecting used linen and gowns should also be allocated.

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30.5.6 Administration Area Staff areas for administrative tasks, workstations, toilets, etc., should be provided based on mortuary size. 2–3 rooms should be given: one (3658 mm × 3658 mm) for the manager, one (3048  mm  ×  3048  mm) for class IV staff, and one (3048 mm × 3048 mm) for police officials.

30.5.7 Exit Lobby The mortuary should have an exit lobby with a wide door (at least 1829 mm), providing direct access to the Body Holding Area. It should have a hand wash basin, soap dispensers, and towels. Adequate space outside for parking ambulances and vehicles should be provided for body transportation.

30.6 Autopsy Area 30.6.1 Pre Autopsy Room Separate from the mortuary, this room stores bodies before the post-mortem. Size: 4267 mm × 3658 mm. Temperature: 4–6.5 °C.

30.6.2 Autopsy Room (Indoor) Size: 6096  mm  ×  6096  mm. Equipped with two stainless steel dissection tables, proper ventilation, and ducting for foul smell removal. Washable flooring and walls. X-ray view boxes, portable X-ray machines, and electrical points are included. Provision for photography.

30.6.3 Autopsy Room (Outdoor) For infected or decomposed bodies. Facilities such as indoor room, but with net-­ covered roof.

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30.6.4 Post Autopsy Room After post-mortem, bodies are kept here until handed over to the investigating officer. Size: 4267 mm × 4572 mm, with a 914 mm × 2134 mm platform.

30.6.5 Autopsy surgeon’s room For discussing cases with police and relatives, and writing reports a room should be provided. Size: 3658 mm × 4267 mm. Furniture, attached toilet, and optional store. Equipped with electrical points, intercom, IT network, CCTV, and AC. Additionally, a Staff office (3658 mm × 3048 mm) should be included.

30.6.6 Instrument Wash Room For washing used instruments after post-mortem. Size: 2438  mm  ×  3048  mm. Equipped with a large sink and countertop for drying.

30.6.7 Viscera Preparation Room Size: 3658 mm × 3048 mm. Provide a countertop, handwash basin, soap dispenser, and towel hanger.

30.6.8 Viscera Stores Lockable room, size: 3658 mm × 3048 mm. Storage of viscera and packing material. Countertops, cupboards, and drawers should be provided. Temperature: 17–21 °C.

30.6.9 Surgeon Change Room Separate rooms for male and female surgeons. Size: 3048 mm × 3658 mm. Equipped with cupboards, cloth hangers, and staff lockers for personal belongings.

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30.7 Other Infrastructural Issues Relating to the Mortuary/ Autopsy Room Considerations for designing the mortuary/autopsy room: 1. Ensure hot and cold water supply in all handwash basins. 2. Implement a separate air-conditioning system for autopsy rooms to maintain clean air without foul odours. 3. Install fire detection and firefighting systems, including fire sprinklers, smoke/ thermal detectors, and fire alarms throughout the complex. 4. Provide proper waste disposal arrangements in compliance with the country’s waste disposal regulations.

Further Reading Garg A, Dewan A. Chapter 34, Mortuary. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 375–80. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 31

Administration Area

In any organization, there is an “administrative team” managing day-to-day affairs, reporting to management or owners. They require a dedicated “Administrative Area” within the hospital, providing offices and workspaces for supporting both clinical and non-clinical staff involved in hospital management. The size and number of offices depend on the hospital's size.

31.1 Levels of Administrative Staff Different administrative staff levels in the hospital include Senior Management, Senior Executive Level Management, Executive Level Management, and Junior level Management. Senior Level Management

Directors Chief Executive Officer (CEO) or (COO) Medical Superintendent Dy. Medical Superintendent Nursing Superintendent

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Executive Level Management

Junior Level Management

31  Administration Area Dy. Medical Superintendent Dy. Nursing Superintendent Personnel Manager Training & Skill Development Manager Finance Manager Marketing Manager Purchase Manager HVAC Engineer Civil Engineer Electrical Engineer Bio-Medical Manager IT Manager Stores Manager Chief Cashier Accounts Officers Design Officer Marketing Executives Purchase Officer Store Officers IT Officers Personal Assistants Accounts Clerks Store Keepers Electrical Line Man Purchasers Bio-Medical Assistants

The above list is not exhaustive, but just an example. The actual grading shall depend on hospital policies.

31.2 Infrastructure of the Administrative Area For infrastructures of the Administration Area, please refer to “Table 1 – ROOMS REQUIRED FOR VARIOUS ZONES/UNITS/DEPARTMENTS” given in Chap. 7 of this book.

31.3 Location of the Administrative Area The administrative area can be within the hospital building or in a separate annexure building. If in the main hospital building, it should be away from clinical departments but easily accessible due to frequent use by visitors and hospital staff.

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31.4 Reception The reception serves as the point of contact for visitors and staff before entering the administration office, also functioning as an Enquiry Counter. When designing the reception, the following considerations apply.

31.5 Infrastructure of Reception Reception infrastructure considerations include: 1. The reception counter should be positioned near the administrative area’s entrance. 2. The waiting area should be in front of the reception, maintaining social distancing. 3. The reception should be clearly visible and accessible without obstructing human traffic. 4. The size of the reception should be based on the number of visitors in the administrative area. 5. A record room should be provided alongside the reception for storing necessary files. 6. Furniture in the reception should include a reception counter and chair.

31.6 Waiting Lobby To accommodate social distancing, waiting lobbies in the post-Covid era should be designed with individual seats instead of clustered ones. Sub-waiting lobbies can be created for different administrative offices to maintain physical separation. Self-­ check-­in and smaller enclave waiting spaces can minimize interactions between visitors. Seating should be arranged in small clusters with partitions, and VIP waiting areas can be provided with comfortable amenities like sofas, a television, drinking water, and an attached toilet, along with a small pantry for serving refreshments.

31.7 Offices of the Senior Management Each senior officer of the management should have a separate office room, typically sized at 6096 mm × 6096 mm, but subject to adjustment based on their designation. The room should include cabinets, drawers, and racks for efficient work. An attached toilet is preferred, and if needed, a store can be attached as well. Additionally, a personal conference room can be provided, and for extended working hours, a small

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restroom may also be included. The room should be equipped with appropriate amenities to facilitate a conducive working environment:

31.7.1 Electrical Points Offices should have a main switchboard for fan and light control, air conditioning control, multiple switch/sockets near the office table, a 5 Amp Switch/Socket above the table, and USB charging points on the table and near the sofa set.

31.7.2 Other Communication Points in the Room Offices may have RJ 45 points for computer networking, RJ 11 for intercom, HDMI points for computer display, and connections to the CCTV surveillance system.

31.7.3 Lighting in the Offices Offices should consider proper lumens, LED lights, even distribution of lights, flush-mounted lights, avoidance of wall lights, and use of dimmers for control.

31.7.4 Doors Wooden or flush doors, minimum width of 1219 mm, door closer, stopper, and provision for locking from inside and outside.

31.7.5 Windows Wide windows with tinted glass, curtains, or vanishing blinds.

31.7.6 Flooring Italian marble, stone, or carpet can be used for flooring in executive rooms.

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31.7.7 Air-Conditioning Offices should have air-conditioning connected to the central HVAC system, with temperature and humidity levels maintained between 18–24  °C and 45–50%, respectively.

31.7.8 Room Décor Use light green and blue colour tones on the walls, excellent wall furnishings with waterproof washable paints, and appropriate placement of pictures, paintings, and artwork.

31.7.9 Furniture in the Executive Offices Furniture includes an executive office table, side rack, back rack, chairs, sofa set, centre table, coat hanger, refrigerator, and television. The Conference room of the Executive office should include Conference Table, Conference Chairs, Projector and Projector Screen or Multi-Media Television. The Rest room should include Resting Bed, Study Table and Chair.

31.7.10 Acoustics Acoustic treatment should be done in meeting and conference rooms to reduce noise transfer between rooms.

31.7.11 Privacy Consider visual privacy in areas where confidential conversations are likely to take place.

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31.8 Offices of the Senior Executive Level Management Each senior executive should have a separate office room, approximately sized 4572 mm × 4267 mm, adjustable based on their designation. The room should have cabinets, drawers, and racks for efficient work. An attached toilet is preferred. The room should be equipped with the necessary amenities for a conducive working environment:

31.8.1 Electrical Points Offices should have a main switchboard for fan and light control, air conditioning control, multiple switch/sockets near the office table, a 5 Amp Switch/Socket above the table, and USB charging points on the table.

31.8.2 Other Communication Points in the Room Offices may have RJ 45 points for computer networking, RJ 11 for intercom, and HDMI points for computer display.

31.8.3 Lighting in the Offices Offices should consider proper lumens, LED lights, even distribution of lights, flush-mounted lights, avoidance of wall lights, and use of dimmers for control.

31.8.4 Doors Wooden or flush doors, minimum width of 1219 mm, door closer, stopper, and provision for locking from inside and outside.

31.8.5 Windows Wide windows with tinted glass, maybe with double vacuum glass, and covered with curtains or vanishing blinds.

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31.8.6 Flooring Italian marble or other stone for an aesthetic and clean appearance, or carpet for executive rooms.

31.8.7 Air-Conditioning Offices should have air-conditioners connected to the central HVAC system, maintaining temperature and humidity levels between 18–24 °C and 45–50%, respectively.

31.8.8 Furniture in the Executive Offices Furniture should include an office table, side rack, officer chair, visitors chair, and television.

31.8.9 Acoustics Acoustic treatment should be done in rooms, providing acoustic separation to reduce noise transfer between rooms, especially for private conversations.

31.9 Offices of the Executive Level Management One or more executives should have a room as their office. If two persons share a room, it should be approximately 4572 mm × 4267 mm, and for a single person, the size is about 3658 mm × 3658 mm, which can be adjusted based on their designation. The room should be equipped with cabinets, drawers, and racks for smooth working. Proper arrangements should be made for the required amenities.

31.9.1 Electrical Points Offices should have a main switchboard for fan and light control, an air conditioning control button, three 6/16 Amp switch/sockets near the office table, two 5 Amp switch/sockets above the table, and one 15 Amp switch/socket adjoining.

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31.9.2 Other Communication Points in the Room Offices should have RJ 45 points for computer networking, RJ 11 for intercom, and HDMI points for computer display.

31.9.3 Lighting in the Offices LED ceiling-mounted lights should be provided in the rooms.

31.9.4 Doors Wooden or flush doors with a minimum width of 1067 mm, equipped with a door closer, stopper, and provision for locking from inside and outside.

31.9.5 Windows Wide windows with tinted glass, maybe with double vacuum glass.

31.9.6 Flooring The flooring of the offices can be simple marble or other stone.

31.9.7 Air-Conditioning Offices should have air-conditioners connected to the central HVAC system, maintaining temperature and humidity levels between 18–24 °C and 45–50%, respectively.

31.9.8 Furniture in the Executive Offices Furniture should include an office table, an officer chair, and a visitor’s chair.

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31.10 Offices of the Junior Level Management For junior-level staff, individual rooms are not necessary. Instead, a hall with multiple desks/workstations should be provided, each equipped with cabinets, drawers, and racks for smooth working. The hall’s size should depend on the number of staff members to be accommodated. Each administrative department in the hospital should have separate halls with multi-desk workstations, assigned for specific departments such as purchase, HR, and accounts. The room should have proper arrangements for.

31.10.1 Electrical Points Offices should have a main switchboard for fan and light control and an air conditioning control button, and each workstation should have two 6/16 Amp switches/ sockets on the modular wall of the desk.

31.10.2 Other Communication Points Each workstation should be equipped with RJ 45 points for computer networking, RJ 11 for intercom and extension lines, and HDMI points for computer display at other locations.

31.10.3 Lighting in the Offices LED ceiling-mounted lights should be provided in the rooms.

31.10.4 Doors Wooden or flush doors with a minimum width of 1067 mm, equipped with provision for locking from inside and outside.

31.10.5 Windows Wide windows with tinted glass, maybe with double vacuum glass.

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31.10.6 Flooring The flooring of the offices can be simple marble, other similar stone, or tiles.

31.10.7 Air-Conditioning Offices should have air-conditioners connected to the central HVAC system, maintaining temperature and humidity levels between 18–24 °C and 45–50%, respectively.

31.11 Support Room/Facilities The following support rooms/facilities are generally required in the administration area:

31.11.1 Senior Management’s PA Room A PA room for senior management personnel should be provided, sized at about 3658  mm  ×  3658  mm, adjustable based on requirements. The room should have cabinets, drawers, and racks for smooth working, an additional door opening into the officer’s room, and proper electricity, communication points, and air-conditioning.

31.11.2 Secretarial Staff Secretarial staff should have a hall with multiple desks/workstations, equipped with cabinets, drawers, racks, electricity, communication points, and common air-conditioning.

31.11.3 Kitchen An administrative area kitchenette, approximately 3658 mm × 4267 mm, should be provided for preparing tea/coffee and warming staff’s homemade lunches. It should include a cooking top, stainless steel sink, gas burner, refrigerator, microwave oven, induction heating pad, OTG, utensils, and other required items.

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31.11.4 Dining Area Close to the kitchenette, a dining room with a table and chairs to accommodate 10–15 people should be provided, sized around 4572  mm  ×  3658  mm. It should include a hand washing facility with a soap dispenser and paper towel.

31.11.5 Staff Toilets Separate toilets for males and females should have WCs, urinals, and washbasins. Optional bathing facilities may also be provided.

31.11.6 Store A conveniently accessible store for files and stationery should be provided 3658 mm × 3658 mm in size, with adequate countertops, cupboards, and drawers. The room’s temperature should be between 17–21 °C, and it should be lockable and secure for confidential records.

31.11.7 Notice Boards A cork noticeboard should be placed near the reception for visibility to visitors. Optional lighting can be provided above the noticeboard for better readability.

31.12 Meeting Rooms One or more meeting rooms should be provided in the administrative area, designed to accommodate different departmental requirements. Small meeting rooms should accommodate 10 people with a size of about 6096  mm  ×  4572  mm. For a large meeting/conference room, seating for 50 people should be available with a size of about 15,240 mm × 6096 mm. Considerations for both room types include teleconference or video-conference facilities, a conference audio system at all seats with ceiling speakers, a projector and screen, and optionally a smart board and a stage or podium with an audio system connection.

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31.12.1 Electrical Points 1. Main switchboard at the entrance wall for controlling fan and lights, along with one 6 Amp Switch/Socket. 2. Air Conditioning Control button with temperature adjustment. 3. On the conference table, a module of electrical points provided be provided with three 6/16  Amp Switch/Sockets, 1 USB charging point, RJ 45 point, and 1 HDMI point. 4. 1 electrical point for the projector shall be provided at the podium. 5. If a smartboard is used, the required electrical outlet shall be provided near the board.

31.12.2 Other Communication Points in the Room The following communication points should be provided in the room: 1. RJ 45 points for Computer networking. 2. RJ 11 for Intercom and extension line. 3. Connection to the CCTV surveillance system.

31.12.3 Lighting Lighting for general illumination and specific tasks should be carefully planned, considering the following: 1. LED Lights with proper lumens as per the standards. 2. Equally distributed ceiling flush-mounted lights should be used. 3. Avoid wall lights for better effectiveness. 4. Emergency battery-operated light should be provided. 5. Dimmers at the user end can control light intensity.

31.12.4 Doors Preferably use wooden or flush doors for the meeting room, with a width not less than 1829 mm. Doors should have a door closer, a stopper, and a provision for locking from inside and outside.

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31.12.5 Windows Wide windows with tinted glass, possibly double vacuum glass, should be installed. Windows can be covered with curtains or vanishing blinds.

31.12.6 Flooring Choose aesthetic flooring, such as Italian marble or other stone, or carpet for a welcoming atmosphere.

31.12.7 Air-Conditioning Provide air-conditioners connected to the central HVAC system with separate AHUs for meeting rooms. Alternatively, individual Fan Coil Units can be provided. Maintain a temperature of 18–24 °C and RH of about 45–50%.

31.12.8 Room Decor Use a good colour scheme with light green and blue colours on the walls. Utilize waterproof, washable paints, and decorate with appropriate pictures, paintings, murals, and artwork.

31.12.9 Furniture in the Meeting Room Furniture like Conference Tables, Conference Chairs, Projector, Projector Screen or Multi-Media Television, and Smart Board should be provided in the meeting rooms.

31.12.10 Acoustics Ensure proper acoustic treatment to reduce noise between rooms, especially for teleconferencing, video-conferencing, and large meetings.

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31.12.11 Privacy Consider visual privacy while designing spaces for confidential conversations in meeting and conference rooms.

Further Reading Garg A, Dewan A. Chapter 35, administration area. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 381–92. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 32

Stores in the Hospital

Stores are vital for hospitals and industries, controlling materials used in the hospital. The main objectives are a balanced flow of consumables, disposables, spare parts, tools, and general supplies. They receive, inspect, and issue supplies, and manage scrap disposal.

32.1 Functions of Stores The following functions need to be performed by the stores: 1. Identification codifies and describes required stocked items. 2. Receipt involves verifying and inspecting materials received by the purchasing department. 3. Inspection checks incoming materials for quality and quantity. 4. Storage involves keeping materials in warehouses or stockyards. 5. Stock control ensures consistent service with economic provisioning, and maintaining safe custody. 6. Issues and dispatch fulfil demands from hospital departments promptly. 7. Stock records maintain daily receipts, issues, and balances. 8. Store accounting tracks receipts, issues, and departmental expenses, including bill processing. 9. Stocktaking physically verifies materials and their condition periodically, comparing records. 10. Raise purchase demands for needed materials.

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32.2 Types of Hospital Stores The hospital stores can be divided into two broad categories: 1. Non-Consumable Stores Surgical instruments, patient furniture, general furniture, rubber goods, enamelware, electrical items, etc. 2. Consumable Stores Cotton, bandages, catheters, linen, stationery, lab reagents & chemicals, etc.

32.3 Planning of Hospital Stores Depending on the nature of the items dealt the hospital may have a different type of store. Generally, hospitals have the following stores: 1. Medical and Drug Stores Deals with medicines, emergency drugs, medical gases, and chemicals. 2. Surgical Stores Includes bandages, gauzes, sutures, instruments, and surgical items. 3. General Stores Contains cleaning materials, enamel wares, small electrical items, etc. 4. Equipment Stores Manages medical equipment, spares, and consumables. 5. Linen Stores Handles textiles, patient dresses, blankets, bedsheets, and furnishings. 6. Stationery Stores Stores medical forms, papers, and office stationery. 7. Dietary Stores Attached to kitchens, including vegetables, fruits, and dry ration. 8. Engineering and Maintenance Supplies materials for hospital maintenance, civil, electrical, HVAC, plumbing, IT, mechanical, and electronic. 9. Condemnation Store Deals with acquisition and disposal of condemned items.

32.4 Location of the Stores Stores should be located away from the general movement and clinical areas of the hospital, restricting access for unauthorized individuals. Basements or annexure buildings can be used if the main hospital lacks space. Safety from pilferage, theft, and fire is crucial. Easy material shifting and accessibility for small vehicles should

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be considered, and vertical lifts provided. The store’s proximity to areas requiring materials is essential. Site selection should account for temperature, humidity, lighting, and future expansion plans.

32.5 Infrastructure of Stores The following points should be considered while designing the stores:

32.5.1 Store Depending on the number of stores, nature of the material to be handled, workload, number of items to be dealt with, and the cost of material to be handled, the size of the store should be worked out. There is no fixed size, but it depends on the user to decide the size of the store. The following store size recommendations are given based on experience: Store type Medical and drug stores Surgical stores General stores Equipment stores Linen stores Stationery stores Engineering and maintenance Condemnation store

Size of the store room 9144 mm × 9144 mm 9144 mm × 9144 mm 12,192 mm × 9144 mm 12,192 mm × 12,192 mm 9144 mm × 9144 mm 6096 mm × 9144 mm 30,480 mm × 15,240 mm 30,480 mm × 15,240 mm

32.5.2 Storekeeper Room A separate room, about 4267 mm x 3658 mm, attached or in close vicinity to the store, with cabinets, drawers, and racks. Provision for electricity, communication, and air-conditioning.

32.5.3 Store Secretarial Staff A hall with multiple desks/workstations, each with cabinets and electricity. Common air-conditioning for the hall.

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32.5.4 Kitchen A small 3658 mm × 3658 mm kitchenette near the stores for tea/coffee and warming food. Equipped with a gas burner and stainless steel sink.

32.5.5 Staff Toilets Separate for males and females, with WCs, urinals, washbasins, and optional bathing facilities.

32.5.6 Special Store Room Locked room for expensive items and confidential documents. Size is 3658  mm  ×  3658  mm, with countertops, cupboards, and drawers. Temperature between 17–21 °C.

32.5.7 Cold Room A 3048 mm × 3048 mm cold walk-in store for specific drugs. Made of puff panel, hermetically sealed door, wooden plank flooring. Temperature maintained between 5–12 °C, with a monitoring system.

32.5.8 Issue Counter Located near the entrance with seating space for users and a trolley parking area.

32.5.9 Receiving Area Separate enclosure for material received from vendors or within the hospital, awaiting validation before shifting to the store.

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32.6 Other Infrastructure Issues While designing stores, the following should be considered:

32.6.1 Electrical Points Main switchboard with 6 Amp switch/socket and Air Conditioning Control button. Suitable 6  Amp and 16  Amp switch/sockets for testing, charging, and miscellaneous use.

32.6.2 Other Communication Points in the Room RJ 45 points for Computer networking, RJ 11 for Intercom, and CCTV connection near the storekeeper’s office table.

32.6.3 Lighting in the Stores Plan for proper lumens, use LED lights, distribute them equally, prefer ceiling flush-­ mounted lights, avoid wall lights, and provide emergency battery-operated lights.

32.6.4 Doors Prefer wood or flush doors, avoid MS steel doors. Doors should be at least 1829 mm wide, with a door closer and stopper, and lockable from inside and outside.

32.6.5 Windows Wide windows with tinted glass, maybe double vacuum glass, covered with curtains or vanishing blinds.

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32.6.6 Flooring Steady, aesthetic flooring with marble, Kota stone, or tiles.

32.6.7 Air-Conditioning Stores can have air-conditioners connected to the central HVAC system, maintaining temperature (18–24 °C) and RH (45–50%).

32.6.8 Furniture in the Stores Slotted angle racks, heavy-duty SS or MS racks with different height shelves, bins, cupboards, office tables, chairs, pallets, twin-leg stairs, and fork lifters if required.

32.6.9 Notice Boards Cork notice board near the storekeeper’s office table, with optional light for better readability.

Further Reading Garg A, Dewan A. Chapter 36, Stores in the hospital. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 393–7. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 33

Engineering and Maintenance Unit

In hospitals, all assets, including medical equipment and buildings, require repairs and maintenance. This can be outsourced, but it elevates costs and repair time. Developing in-house repair and maintenance facilities is recommended for efficiency. Types of required repairs in hospitals include medical equipment, electrical, plumbing, HVAC, MGPS, IT/CCTV/low voltage, fire fighting, and mechanical services. Building repairs encompass civil, painting, wooden, steel, and aluminium works. Additionally, landscape works and an automobile workshop may be needed. Establishing in-house facilities allows for quicker repairs and cost-effectiveness, ensuring smooth hospital operations.

33.1 Works Shops Workshops are essential for repairs and maintenance in hospitals, designed based on workload and frequency. Necessarily provided workshops are:

33.1.1 Biomedical Workshop Repairs medical equipment like X-Ray, Ventilators, Lab instruments, etc.

33.1.2 Electrical Workshop Maintains electrical supply, switches, motors, and assists Biomedical Workshop.

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33.1.3 HVAC Workshop Repairs air conditioning, cold rooms, refrigerators, and freezers.

33.1.4 MGPS Workshop Maintains medical gases supply, manifold room, and liquid oxygen plant.

33.1.5 Low Voltage Workshop Repairs CCTV, IT, computer systems, and internet services.

33.1.6 Building Maintenance Manages civil, plumbing, painting, wood, steel, and aluminium works.

33.1.7 Mechanical Workshop Repairs lifts, generators, pumps, and mechanical medical equipment.

33.1.8 Fire Fighting Workshop Maintains firefighting services, which can be combined with Building Maintenance.

33.1.9 Automobile Workshop For hospitals with a vehicle fleet.

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33.2 Location of the Workshops Workshops should be situated away from the general movement and clinical areas of the hospital to restrict access for unauthorized individuals. Basements, which are unusable for clinical departments, can be utilized for workshops. Easy material shifting and approachability for small vehicles should be ensured, with vertical lifts provided. Except for Biomedical and Low Voltage workshops, others can be located outside the main hospital building in temporary structures or the annexure building.

33.3 Infrastructure of Workshops The following points should be considered while designing the workshop:

33.3.1 Workshop Workshop size depends on the number, nature of service, and workload. No fixed size exists, allowing users to decide. Recommendations are based on experience. Workshop type Biomedical workshop Electrical workshop HVAC workshop MGPS workshop Low voltage workshop Building maintenance Mechanical workshop Fire fighting workshop Automobile workshop

Size of the workshop room 9144 mm × 6096 mm 6096 mm × 6096 mm 9144 mm × 6096 mm 6096 mm × 4572 mm 6096 mm × 4572 mm 30,480 mm × 15,240 mm 12,192 mm × 6096 mm 6096 mm × 4572 mm 30,480 mm × 15,240 mm with service duct

33.3.2 Workshop In-charge Room Separate room for workshop-in-charge, attached or in close vicinity to the workshop. Size: 4267 mm × 3658 mm (adjustable as needed). Adequate cabinets, drawers, and racks for smooth working, with electricity, communication points, and air-conditioning.

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33.3.3 Workshop Engineers Engineers and assistant engineers don’t need separate rooms. Instead, a hall with multiple desks/workstations, equipped with cabinets, drawers, racks, electricity, communication points, and common air-conditioning can be provided.

33.3.4 Staff Toilets Separate toilets for males and females with WCs, urinals, and washbasins. Optional bathing facility if needed.

33.3.5 Receiving/Issue Counter Workshop has a counter near the entrance for item submission and collection after repairs. Adequate space outside the counter for seating and parking trolleys carrying material.

33.4 Other Infrastructure Issues While designing the workshops, the following shall be considered:

33.4.1 Electrical Points 1. Main switchboard at entrance wall for fan and light control, with one 5 Amp Switch/Socket. 2. Air Conditioning Control button with temperature adjustment. 3. Suitable electrical points with 6 Amp Switch Sockets on walls above workshop working counters for testing, charging machinery, or other uses. 16 Amp switch/ sockets can be provided if needed

33.4.2 Other Communication Points in the Room Near the workshop in-charges office table, provide: 1. RJ 45 points for Computer networking.

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2. RJ 11 for Intercom and extension line. 3. Connection to CCTV surveillance system

33.4.3 Lighting in the Workshops Carefully plan general and task lighting: 1. Ensure proper lumens as per standards, avoiding overly bright or dull lights. 2. Use LED lights for longer life and energy efficiency. 3. Equally, distribute lights in the hall and working countertop. 4. False ceiling workshops use flush-mounted lights; otherwise, surface-mounted ceiling lights. 5. Avoid ineffective wall lights. 6. Prevent burns by avoiding incandescent and halogen light sources. 7. Provide emergency battery-operated lights

33.4.4 Doors Prefer wood or flush doors for workshops, or use aluminium as an alternative. Avoid MS steel doors due to rusting. Door width should be at least 1829 mm, with a door closer, stopper, and provisions for locking from inside and outside.

33.4.5 Windows Wide windows with tinted glass, possibly double vacuum glass. Curtains or vanishing blinds to cover windows.

33.4.6 Flooring Sturdy flooring to withstand heavy loads, providing a clean and welcoming atmosphere. Options: marble, kota stone, or tiles.

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33.4.7 Air-Conditioning Workshops can have air-conditioners connected to the central HVAC system. Separate AHUs for workshops with ducts connected to AHU. Maintain temperature between 18–24 °C and RH of about 45–50%.

33.4.8 Furniture in the Workshop Provide the following furniture: 1. Slotted angle racks. 2. Heavy-duty racks made of Stainless Steel or Mild Steel with adjustable shelves (229 mm to 610 mm high). 3. Wall-fixed cupboard with locking facility. 4. High-raised chairs for countertop working. 5. Office table for workshop keeper. 6. Office Chairs. 7. Visitor Chair.

33.4.9 Notice Boards Place a cork notice board near the workshop-in-charge for easy use of board pins. Optionally, provide light above the notice board for better visibility.

Further Reading Garg A, Dewan A. Chapter 37, engineering and maintenance unit. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 399–403. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Section III

MEP Planning & Designing

Chapter 34

HVAC (Air-Conditioning) System

HVAC in hospitals is highly intricate, more so than in commercial buildings. It must provide comfortable conditions for patients and staff while ensuring a germ-free environment to curb disease spread. Sensitive medical equipment requires precise air control to function accurately. Designers must be attentive to these aspects. Different hospital rooms have varying uses, adding complexity. Zones must be defined clearly to handle isolation and infection control. Proper air change rates, effective filtration, and UV germicidal lights can reduce airborne infection spread. Controlling temperature and humidity, exhausting air from high-risk areas, and well-distributed airflow aid in particle removal and pathogen prevention. There are two options for HVAC system in the hospitals: 1 . Central Water Chilled Plant 2. DX (Direct Expansion) Chilling

34.1 Central Water Chilled Plant For large hospital projects, it is recommended to opt for a Chilled Water Central Plant for the HVAC system. This choice reduces initial costs and improves overall efficiency. The system involves chilling water in central chillers, which then travels to AHU coils through insulated pipelines. Fans blow the cooled air through ducts and diffusers into the spaces. Calculating the central plant’s capacity considers space size, air-conditioning needs, simultaneous peak load, and diversity factors like machinery heat load, occupancy, lighting, and thermal losses due to sunlight. These considerations ensure an effective and appropriately sized central cooling plant.

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34.1.1 Chillers Chillers cool water for AHUs in the HVAC system. The chilled water plant should have at least two chillers to avoid overloading during continuous operation, with one acting as a standby. Chillers can be cooled by water (water-cooled chillers) or air (air-cooled chillers). For heating, hot water is supplied to the AHU through the Hot Water Generators, resulting in warm air delivery instead of cool air. Otherwise, the processes remain unchanged. 34.1.1.1 Water-Cooled Chillers Water-cooled chillers come in different types: centrifugal/screw and absorption chillers. Centrifugal chillers with single or dual compressors are commonly used for water-cooled chiller plants, depending on total tonnage. 34.1.1.2 Air-Cooled Chillers For air-cooled chillers, screw type is suitable for over 100 tons, while smaller installations can use scroll-type chillers. Reciprocating chillers are not recommended for hospital HVAC systems.

34.1.2 Cooling Towers Cooling towers are essential to cool the water before recirculation in operative chillers. Induced draft-type with counter-flow, only factory-fabricated and tested cooling towers are recommended. They should have a structure and basin made of stainless steel 304 grade, along with FRP removable louvres. Additionally, a basin cleaning system should be provided with the cooling towers.

34.1.3 Air Handling Systems 34.1.3.1 Air Handling Units (AHU) AHU is a box structure that cools/warms the air and sends it to diffusers for designated spaces. Provisions include fresh air intake controlled by dampers, separate return air connection, and no mixing of fresh and return air. A blower fan exhausts air, while chilled water cools air passing through coils. Each cooling coil should have a maximum of six rows and 10 fins per inch. Discharge face velocity limits for

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cooling and heating coils are 450  fpm and 800  fpm, respectively. AHU contains filters for air filtration, and UV light can be used for disinfection. AHU design depends on CFM and air-conditioning requirements, with a capacity limit of 50,000 m3/h. Separate AHUs are required for critical areas, and vertical stacking is not recommended. Individual return air fans are preferred, and VFDs are encouraged for energy efficiency. Access doors should open inside the AHU, and safety switch interlocks are recommended for personnel protection. 34.1.3.2 Fan Coil Units Fan Coil Units (FCUs) are an alternative to AHUs for smaller or specific areas like private patient rooms. Both systems function similarly, but AHUs supply air in larger quantities to larger areas, while FCUs provide less air to smaller spaces. FCUs are suitable for single patient rooms, computer rooms, offices, restrooms, and other areas. However, FCUs should not be used when adequate space for distribution ductwork is available or where distribution ductwork is.

34.1.4 Variable Air Volume (VAV) Ventilation VAV/DCV systems perform better in frequent part-load conditions of ventilation equipment. DCV adjusts ventilation based on room occupancy. VAV allows variable airflow, controllable manually or automatically. VAV systems offer energy savings and better temperature/humidity control, extending the life of air-conditioning equipment by reducing on/off cycles. VAV depends on dampers in VAV boxes and fan speed controls, often using VFDs for motors above 1 hp. and ECM for built-in speed control. VAV boxes automatically adjust air dampers based on space air temperature. VAV systems can save over 30% of energy compared to CAV systems in buildings with variable ventilation loads.

34.1.5 Diffusers, Registers and Grills 34.1.5.1 Grills Grills allow air to pass in and out and are suitable for both air intake and exhaust in indoor spaces. They require minimal maintenance, but airflow direction and quantity cannot be adjusted due to the absence of moving components or dampers.

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34.1.5.2 Registers Registers are similar to grills but include adjustable dampers. They are used for both air intake and release in indoor spaces and are installed with air supply outlets. Dampers in registers help control airflow direction and can shut off the flow. 34.1.5.3 Diffusers Diffusers have all-round dampers, allowing for variable airflow direction. They differ from registers in this aspect. Commonly found on ceilings, diffusers cover air-­ con or air-release outlets and come in square or circular shapes with vents facing different directions.

34.1.6 Ductwork 1 . Ducts carry cool air to terminal points and may also return air to AHUs. 2. Supply ducts connect AHUs to VAVs, grills, dampers, or diffusers, while return ducts connect to grills and link back to AHUs. 3. Clinical areas in hospitals require a fully ducted system. 4. Duct shapes can be rectangular, square, or round based on design and space availability. 5. Ducts are commonly made of galvanized steel, and for Operating Rooms, aluminium is used. 6. Duct systems should be accessible with access panels. 7. The internal surface of ducts should have an anti-microbial coating. 8. Ducts need insulation, preferably with a nitrile sheet applied using adhesive.

34.1.7 Air Intake and Exhaust 1. Position air intake and exhaust vents carefully to prevent undesired air recirculation. 2. Maintain adequate distances between intake and exhaust points. 3. In harsh climates, use sand trap louvres for outside air intake. 4. Install washable aluminium filters behind sand trap louvres with accessible cleaning options to avoid clogging and pressure drops.

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34.1.8 Filtration 1. Provide MERV 8/ePM10 60% first stage filtration and MERV 14/ePM1 70% final filters downstream of wet-air cooling coils and supply fan for AHUs. 2. Use UV-C for disinfection to inactivate micro-organisms, especially on cooling coil surfaces to prevent fungal growth. 3. Utilize filters like Pre-Filters, Sand Filters, Micro V filters, and HEPA filters based on HVAC design recommendations

34.2 Installation of Central Chilled Water Plant: 34.2.1 Chillers 1. Adequate spaces away from patient areas are needed for chiller installation (basements, rooftops, or outside). 2. Check the building structure’s capacity to handle HVAC equipment weight before finalizing the chiller location. 3. Always provide a set of two chillers for alternating operation and to have a backup in case of failure. Allow space for future expansion of chillers. 4. Chiller size varies with capacity. 5. Allot spaces for chiller pumps and supply pumps near the chiller. 6. Provide space for chiller water supply and chilled water pipeline to AHUs. 7. Allocate spaces for equipment removal and maintenance. 8. For air-cooled chillers, allow sufficient open space for fresh air cooling. 9. Provide space for Hot Water Generator installation. 10. Add an emergency chilled water pipeline system with blind flanges and isolation valves for future chiller installation. 11. Provide proper raw water pipelines to connect chillers and cooling towers. 12. Use higher delta T for energy-saving and reduced pumping cost. 13. Consider VFD-driven equipment for pumps consuming over 7.5 kW for additional energy savings. 14. Allocate space for the make-up tank of water for chilling and transporting to AHUs. 15. Provide space for electrical panels and main switches for the power supply

34.2.2 Cooling Towers 1 . Allot open space on the rooftop or an open area for cooling tower installation. 2. Connect cooling towers to water pipelines for chiller water supply and makeup water.

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3. Provide power supply for cooling tower operation.

34.2.3 Air Handling System 1 . Install AHUs near the area where the air is needed. 2. Provide a separate room with openings for air ducts and fresh air intake for AHU installation. 3. Alternatively, use ceiling-suspended AHUs if floor height and ceiling capacity permit. For Fan Coil Units, suspend them from the ceiling, preferably near the room entrance. 4. Ensure required electrical power supply points are available for AHU/FCU.

34.3 DX (Direct Expansion) Chilling DX (Direct Expansion) air-conditioning systems utilize refrigerant (gas) to directly chill the air used in indoor spaces, providing higher cooling efficiency. The system comprises three main compartments:

34.3.1 The Plant Room Contains refrigeration systems, compressors (open type or semi-hermetically sealed), and water-cooled condensers. Cooling towers placed at the top or elsewhere cool the condenser and compressor.

34.3.2 Air Handling Unit Room AHU, located separately, has a cooling coil, air filters, and a blower. Refrigerant from the condenser enters the cooling coil, cooling the air, which is then circulated through ducts to supply chilled air to rooms.

34.3.3 Air-Conditioned Room Ducts from AHU supply chilled air to the room, where it absorbs heat, returns through the return air grill, and is recirculated by the AHU.

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34.3.4 Benefits of DX Air-Conditioning Systems 1 . Flexible installation options inside or outside the building. 2. Easily expandable for increased capacity or adding new buildings. 3. Low maintenance requirements, reducing repair costs. 4. Space-efficient compared to other cooling systems. 5. Energy-saving, reducing electricity bills. 6. Provision for individual room control using DX valve to adjust the refrigerant flow

34.3.5 Disadvantages of the DX System 1. Suitable for small buildings or single-floor setups due to limitations in laying refrigerant piping over long distances. 2. Longer piping requires more refrigerant, making the system expensive. 3. Longer piping increases the risk of refrigerant leakage. 4. AHU and refrigerant piping should be nearby to maintain adequate refrigerant pressure and cooling efficiency.

34.4 Split Air Conditioning This is a wall-hung split air conditioning system, with a separate compressor and indoor unit connected by refrigerant copper pipes. The outdoor unit contains the compressor, while the indoor unit includes a blower fan and refrigerant coil. The system offers individual temperature control for each room, making it advantageous. It is commonly used for small areas or specific rooms.

34.5 HVAC- Room Side Design The key design elements of various spaces in the hospital are as follows: Area Operating rooms Intensive care units Patient rooms

Temperature Humidity 18–22 °C 20–60% RH 18–24 °C 30–60% RH 21–24 °C 60% RH

Ventilation system 20ACH SA / 4 ACH OA 6ACH SA / 2 ACH OA 6ACH SA / 2 ACH OA

34  HVAC (Air-Conditioning) System

324 Area Negative isolation room

Temperature Humidity 21–24 °C 60% RH

Positive isolation room

21–24 °C

60% RH

Recovery (post anesthesia care unit)

21–24 °C

Decontamination room

21–24 °C

30–60% RH 60% RH

Examination/treatment room Resuscitation room:

21–24 °C 21–24 °C

Triage:

21–24 °C

60% RH 20–60% RH 60% RH

Emergency department public waiting area: Burn units Procedure rooms

21–24 °C

60% RH

21–32 °C 21–24 °C

Gastrointestinal endoscopy procedure room Endoscopy/bronchoscopy:

21–23 °C

Endoscopy ERCP procedure room:

20–23 °C

Imaging rooms Central laboratories Pharmacy Mortuary & autopsy

18–21 °C 21–24 °C 21–24 °C 20–24 °C

40% RH 20–60% RH 20–60% RH 20–60% RH 20–60% RH 60% RH 60% RH 60% RH 60% RH

Dirty area of CSSD Clean area of CSSD Sterile store of CSSD Server room of CSSD

16–23 °C 20–23 °C 20–24 °C 19–22 °C

20–23 °C

60% RH 60% RH 60% RH 30–60% RH

Ventilation system 12ACH SA / 2 ACH OA 12ACH SA / 2 ACH OA 6ACH SA / 2 ACH OA 12ACH SA / 2 ACH OA 6ACH SA / 2 ACH OA 15ACH SA / 3 ACH OA 12ACH SA / 2 ACH OA 6ACH SA / 2 ACH OA 6ACH SA / 2 ACH OA 15ACH SA / 3 ACH OA 6ACH SA / 2 ACH OA 12ACH SA / 2 ACH OA 15ACH SA / 3 ACH OA 6ACH SA / 2 ACH OA 6ACH SA / 2 ACH OA 6ACH SA / 2 ACH OA 12ACH SA / 2 ACH OA 6ACH SA / 2 ACH OA 4ACH SA / 2 ACH OA 4ACH SA / 2 ACH OA 12ACH SA / 2 ACH OA

Further Reading Garg A, Dewan A. Chapter 38, HVAC (Air-Conditioning) system. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 407–22.

Further Reading

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Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 35

Electrical Services

In hospital projects, assessing power requirements for equipment, electrical outlets, air-conditioning, and lighting is crucial. Special areas like MRI, PET CT, and LINAC require specific power considerations. Power supply sources for hospitals can include different options such as:

35.1 Primary Power Supply (PPS) Primary Power Supply (PPS) is reliable power from the local distribution company. An application is made, and after calculating the power load and redundancy, the connection is sanctioned from either LT or HT lines.

35.2 Secondary Power Supply (SPS) It is the power generated on-site through Diesel Generator Sets.

35.3 Tertiary Power Supply (TPS) Tertiary Power Supply (TPS) provides immediate backup through Uninterruptible Power Supplies (UPS) for critical equipment.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_35

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35.4 Electrical Load Calculation Electrical Load Calculation considers equipment, air-conditioning, lifts, and lighting to design transformers, circuit breakers, and bus bars. The total connected load is calculated in KVA, determining the maximum demand with diversity factor, power factor, and sub-station design. Hospital technology advancements require spare capacity for future demand. The total connected load of the hospital shall be calculated in KVA. Based on this, the maximum demand is worked out with an overall diversity factor of 80% and a power factor of 0.8 (lagging). To meet this electrical load and assume 80% transformer loading and 97% efficiency of transformers, a sub-station should be designed.

35.5 HT Distribution System HT Distribution System receives power from the Electricity Supply Board/Company via LT or HT lines. If HT, it is an 11  KV single circuit feeder terminated at the metering panel room at the hospital entrance. The 11 KV supply then connects to the main HT VCB panel in the sub-station area. HT power is transmitted to transformers through an 11 KV XLPE (E) cable laid underground. The sub-station houses an 11 KV indoor type 630 Amp VCB (varies based on load) as incoming cum outgoing, and an oil-cooled OLTC type transformer, whose capacity depends on the hospital’s load calculation.

35.6 LT Power Distribution LT Power Distribution connects the power supply from the transformer or Diesel Generators to the main LT cum synchronization panel through a bus duct or LT Armored XLPE, aluminium cable. Capacitor Panels directly link to the main LT panel cum DG panel, improving Power Factor to 0.8 to 0.95 lagging. This main panel controls both Primary and Secondary supplies. This main LT panel cum DG panel shall feed the supply to different panels of HVAC, Imaging Department, Central Laboratory, Operating Theatre, Cathlab, LINAC, Different Floor, Fire-fighting, Utility panel, External lighting, and Lift. Power connections from the main panel to individual panels are established using LT Armored XLPE, aluminium cables, or Rising Main Bus-bar. Each floor has individual floor panels, terminating at separate LDB/PDB locations for lighting and power. These panels have incoming MCB cum ELCB and outgoing MCBs, rated based on load factors. Power distribution occurs from the MCBs to various locations and electrical outlets through underground LT copper cables. Cable trays

35.9  Uninterrupted Power Supply System (UPS)

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can be used instead of underground installation, typically travelling above false ceilings along corridors, avoiding placement in rooms.

35.7 Redundancy Due to Power Failure A contingency plan for power failure should be in place with redundancy in power sources to mitigate its impact. Areas like ICU and Emergency require more robust power infrastructure with secondary and tertiary power supplies to ensure patient safety. The designer must address the risks associated with power failure and minimize its impact on patient safety and hospital operations.

35.8 Emergency Power Generation System Are provided for 100% power backup. Multiple DG sets are installed based on peak and non-peak load requirements. They automatically supply power in the absence of primary electricity or during voltage drops. The DG sets are located near the substation and are controlled by PLC. They are fixed on a strong raised foundation with anti-vibration pads. An independent exhaust pipe from each DG set is connected to a 30-meter-high chimney for smoke dispersion. VRLA or Ni-Cd batteries are recommended for engine cranking. Adequate diesel storage is provided for at least 2 days of fuel consumption. Critical areas like OR, ICU, and emergency receive backup power. Dedicated main DB rooms segregate primary and secondary DBs from other spaces.

35.9 Uninterrupted Power Supply System (UPS) UPS is crucial for providing uninterrupted power supply in hospitals, including emergency lighting and for critical units with sophisticated machines like MRI, CT, and LINAC. Critical care units like ICU, NICU, and emergency are equipped with dedicated UPS systems, powering life-saving machines like monitors and ventilators. Three-­ phase online UPS with a rating of around 5–10 KVA for a 10-bed ICU is recommended. Operating rooms (ORs) have their own UPS systems, supplying power to lights and outlets during primary power failure. Three-phase online UPS with a rating of not less than 10 KVA for each OR is recommended. UPS units are also installed for servers, working nodes, and essential IT equipment. Separate UPS systems are provided for sensitive medical equipment, preventing damage and software corruption during power failures.

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Emergency lighting is connected to single or floor UPS, providing a 20–30 min battery backup with sealed maintenance-free batteries. Static, double-conversion type UPS units with VRLA batteries in a dual string arrangement are preferred for better performance. Keeping room temperature between 18–22 °C and installing alarm systems ensure longer battery life and temperature monitoring. UPS units have external bypass panels for continuous power supply during total UPS failure. While most UPS units can be kept together, those for special medical equipment should be placed near respective machines for optimized performance.

35.10 Switching Arrangement Switching arrangements will allow isolation for fault protection. ACBs are used in the LT panel for switching incoming circuits, while MCCBs are used for outgoing circuits up to 630 Amps and ACBs for circuits above 630 Amps. MCCBs are provided inside main DBs and sub-DBs, and final DBs have MCBs and RCCBs. Care is taken to prevent voltage drop exceeding 5 v in cables.

35.11 Emergency Lighting Emergency lighting designates 10% of common/parking area lights as emergency lights, individually connected to UPS/inverter for uninterrupted illumination during main supply shutdown until the DG set starts, avoiding complete blackout.

35.12 Earthing System Earthing is provided for the HT/LT distribution system through a maintenance-free earth station and bonding cables/equipment. An insulated copper earthing wire is used for light and power points, while separate chemical earthing is done for UPS system units, EPABX, server, lift, and low voltage systems using copper electrodes. Equipotential bonding is established for hospital equipment by connecting their metal bodies to the Earth Bonding Bar (EBB), which is linked to chemical earthing. ORs have a dedicated EBB, and other areas have EBBs in respective sub-electrical rooms. Major machines like MRI, CT, LINAC, chillers, etc. have supplementary earthing and bonding with dedicated EBBs. All electrical panels and sub-panels are bonded and earthed with a separate EBB.

35.16  Power Quality

331

35.13 System of Wiring and Cabling The wiring system involves PVC-insulated copper conductors in MS/PVC conduits throughout the hospital. The minimum conductor size for light points is 1.5 sq. mm, and for power points, it is 2.5/4 sq. mm. Colour coding is used for phases (Red, Yellow, Blue), neutral (Black), and earthing (Green) in the wiring. Ferruling with number coding is used for circuit identification. Localized switching/dimmers are provided for convenience and operations in each area. Power supply cables for life safety equipment are fireproof and connected to a separate power supply source. LS0H insulation is used for wires and cables in hospitals. Armoured cables are used for outdoor installations or underground burial with PVC outer sheaths. Separate cable trunking and conduits are used for Isolated Power Supply (IPS) final circuit.

35.14 Switches/Sockets and Boxes The hospital should use white/coloured rocker switches rated 6/16 Amp for primary power supply sockets. Faceplates made of plastic or metal should match the colour of the switch/socket for aesthetic purposes. Red-coloured sockets and switches should be used for DG set power supply, while blue-coloured ones will be used for the UPS power supply. To avoid sparking fires, switches/sockets in bed head panels or hanging pendants should be properly partitioned from medical gas outlets.

35.15 Lightning Protection Lightning protection for the entire hospital should involve suitable lightning arrestors connected to copper tape/cable. A protected zone should be established through a mast, connected to earthing stations via cable/copper tape. For safeguarding electronic devices and medical equipment from lightning strikes, Surge Protection Devices (SPDs) should be installed on sub-main electrical branch circuits that serve critical medical equipment.

35.16 Power Quality To ensure the safe operation of sophisticated medical equipment, the following precautions are taken to maintain a pure sine wave power supply and prevent electrical disturbances:

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1. Main equipment like CT, MRI, X-Ray, LINAC, etc., should directly receive power supply feeders from the main distribution board (MDB) instead of shared sub-distribution panels. 2. If direct supply from the MDB is not feasible, a dedicated and appropriately sized sub-main distribution board (SMDB) should be installed in the MDB room to serve a group of such equipment. 3. Surge protection devices should be provided to ensure a pure sine wave power supply. 4. Provisions for installing harmonic filters should be made in the main DBs. Spare breakers designated for these filters should be clearly labelled as “For Harmonic Filter Only.” Harmonic filters are essential to address overcurrent and overheating issues caused by power system harmonics of specific orders (e.g., third, fifth, seventh, ninth, 11th, and 15th). 5. Harmonics should be measured once a significant portion of medical equipment, and mechanical, and electrical appliances are operational to accurately assess and address any harmonic-related problems.

35.17 Power Factor Correction Capacitor banks, including reactors, should be installed in the main capacitor panels at the central power station to control the power factor and address harmonics. Regulatory requirements mandate all bulk users to maintain a power factor of 0.9 and above. Non-compliance may lead to stringent penalties imposed by power distribution companies.

35.18 Street Lighting System LED lamps with appropriate fixtures should be mounted on 7-m high GI poles for street lighting, ensuring an average lighting level of 18 lux with an illumination density of 1.5 cd/m2. Timer controls should be implemented to switch ON/OFF the street lights based on a predefined schedule.

35.19 Lighting Management System 35.19.1 Occupancy Sensor Based on a person’s presence in an area, lights would automatically switch on/off. The sensor would have a time delay before the lights are switched off.

Further Reading

333

Further Reading Garg A, Dewan A. Chapter 39, electrical services. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 425–32. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 36

ELV, ICT and IBMS Services

ICT (Information and Communication Technologies) focuses on processing information and connecting devices, while ELV (Extra Low Voltage) systems handle connectivity, security, safety, and automation. Both systems are crucial for hospital operations. The hospital’s LAN infrastructure ensures IP connectivity for various services, allowing data and commands to be shared across the network. Applications like CCTV, data, public address, voice, video, nurse call, queuing systems, HIS, and PACS rely on this integrated network for seamless functionality.

36.1 Data System All data cables shall be terminated at the floor patch panel and then data shall be transmitted to the server through a backbone fibre optic cable.

36.2 Nurse Call System The nurse call system facilitates communication between patients and nurses when assistance is needed. Important design considerations for the system are as follows:

36.2.1 Desktop Console This unit receives calls and alarms from patients and staff at different locations. When a patient activates the call, the console displays a unique ID (room or bed number) and starts beeping an alarm. Nurses can communicate with patients using © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_36

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bi-directional speech. To end the call, nurses must reset it at the patient's bed. The console should be placed at the nursing station within direct eye contact with the nurses.

36.2.2 Room Lights Colour-coded lights are installed at each area/room's main entrance with the nurse call device. The light turns on when the call is activated and switches off after attending and pressing the reset button.

36.2.3 Patient Call with Handset The Patient Hand Set has buttons for staff assistance and emergency call. It allows patients to communicate with staff and alert nurses for assistance, providing a sense of security. The device should be available at all locations where patients are admitted and not continuously attended by a nurse.

36.2.4 Patient Call – in Toilets These units initiate emergency alarm calls from inside the toilet. Fixed at a low height for easy reach, they have minimal buttons to avoid confusion. They are waterproof and suitable for wet locations.

36.2.5 Staff Assist Call Used by staff at the patient location to seek additional help. Pre-configured locations receive the activated call with a visual ID display and an audible alarm.

36.2.6 Emergency Call Staff can raise alarms in emergencies to alert others. The system generates an audible alarm with an alphanumeric display indicating the call’s location.

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36.2.7 Wireless Handset Patients use a wireless handset, connected via Bluetooth or infrared, to activate the call, similar to a wired handset.

36.2.8 Wireless Console Mobile wireless nurse call consoles use Bluetooth or Wi-Fi, allowing nurses to respond to calls from different patients and locations.

36.2.9 Audio-Video Nurse Call System An in-development device with audio-video communication. It includes a nurse console with a video screen, microphone, and speaker, a camera mounted at the patient's end, and a handset with video, microphone, and speaker. The nurse can see and talk to the patient, and the patient's mobile can be connected to the nurse console through a dedicated IP.

36.3 Electronic Security and Video Surveillance System 36.3.1 Closed Circuit Television System (CCTV) Hospitals, being large and complex institutions, face significant security concerns for both people and assets on their premises. With a high number of individuals and potential mental stress cases, there is a risk of self-harm or suicide incidents. Additionally, valuable equipment theft and medical data leaks are also possible. To address these challenges effectively, hospitals require comprehensive CCTV solutions. The Closed-Circuit Television System (CCTV system) allows real-time video display and recording, enabling future event tracking if necessary. However, while designing the CCTV and access control systems, certain critical issues must be considered: 1. Patient privacy is of utmost importance, and camera placement should avoid compromising it in sensitive areas such as toilets, procedure rooms, OR, and delivery suites. 2. CCTV and access control systems should be strategically placed in important, crowded, and sensitive locations throughout the hospital.

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3. Key areas to consider for CCTV coverage include, but are not limited to: Main entrances of the hospital Entrance lobbies Emergency & triage room Common corridors Billing & registration counters Waiting lobbies Staircases All exits of the hospital All receptions Pharmacy, medication dispensing areas Entrance door of medication rooms Inside the medication rooms Inside the laboratories Blood Bank

Cash counters NICU Nurse stations Staff rooms Body storage areas Fire exit stairs Main entrances of public toilet Hot labs MEP plant rooms Air-conditioning plant Lift lobbies Inside lifts Central sterile supply unit Parking lots and garages

4. IP megapixel cameras should be installed in the specified locations, including corridors, perimeters for protection, server rooms, UPS rooms, and hub rooms. Fixed cameras should serve as primary surveillance, while areas like the main entrance hall should have additional secondary surveillance using PTZ cameras. 5. CCTV system cameras should be connected to the DVR and PC to record live network video images, storing them on the PC’s hard disk. The HDD should have the capacity to retain footage for at least 2 months. Regular backups should be taken on an external hard disk to free up space for further recordings. 6. The entire system, including DVR, cameras, and PC, should have power backup through UPS to ensure continuous functioning. CCTV cameras should receive appropriate power with UPS backup. 7. To meet operational and security requirements, a separate and dedicated IT network should be provided for the IP CCTV network and access control.

36.4 Access Control System A network should be created on the campus to integrate various systems with the Integrated Security Management System (ISMS). In hospitals, patient anxiety and trauma can lead to aggression or violence from patients or their family members. Quick and efficient handling of quarantined patients is essential to prevent infection spread. Patient safety should be a top concern to avoid issues like abductions, harm, missing patients, or suicides. To address theft and abuse risks, especially concerning expensive equipment and pharmaceutical drugs, a robust access control system should be implemented. This

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36.4  Access Control System

comprehensive system will enhance overall security, minimize hospital losses, and ensure the safety of both patients and staff. Different access control systems are available, but only a few are suitable for hospital setups. They can effectively restrict access to sensitive areas like ICUs, OR, record rooms, and isolation areas to prevent disease spread, track and prevent theft of medical equipment and drugs, and protect staff and patients.

36.4.1 No-Touch Access Touchpoints in an access control system, such as door handles, push bars, and keypads, can spread infections in hospitals. It is advisable to reduce physical touch points and opt for touch-free devices like distance-reading door readers that authenticate credentials and open automatically. Below are the architectural and functional requirements of an integrated security alarm management system: 1. Access control system should use proximity readers for authorized entry to common doors, ensuring no unauthorized access. Implementation is ideal for main entry doors through the staircase and lifts lobbies, with exits planned through card readers. 2. Biometric face readers should secure important locations like server rooms, control rooms, and highly secured documentation areas. 3. Integration of access control system with IP CCTV and fire alarm system. 4. RFID cards/tags and reader-based access control systems should be employed. 5. Fingerprint biometric readers requiring physical contact should not be used in the hospital. 6. An ‘Infant Protection System’ should be used in NICU and pediatric wards. Trackable tags on the infant and mother’s forearms should interface with the access control system to prevent security breaches. 7. Discrete Panic Alarms should be provided at critical locations like emergency triage areas, cash counters, reception, ICU, etc. Electronic access control shall be provided at the following locations: Radiotherapy LINAC bunkers Server rooms or data centres CT scan/MRI room Pharmacy Cash counters Medical records Isolation rooms Neonatal units

Intensive care units Entrances to staff-only areas Clean storage of CSSD Dirty utility All entries and exits to the outside Entrances to back offices, insurance offices Staff only corridors

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36.5 Telecommunication System In hospitals, either a combined audio/video or audio intercom system should be provided for fast two-way communication, with a preference for IP-based solutions. Four pair of CAT 6 cables should connect telephone and data points from floor patch panels to the main patch panel in the LV rooms, using patch cords for patching between panels. The telecommunication system should be installed with a central intercom EPABX system. Then lay down CAT 5 or 6 cables throughout the hospital building. After that assign unique intercom numbers to each location connected to a cable/wire. Telecommunication also includes telemedicine and telemonitoring for remote healthcare. Radiofrequency (RF) technology was common but has security and interference issues. Visible Light Communications (VLC) using LEDs provides an effective and secure solution for hospital applications. A hybrid optical-radio network is recommended for high-performance, secure, and flexible communication.

36.6 Patient Entertainment and Information Systems Patients’ rooms should have smart TVs on the wall in front of them at an appropriate height. Patients should have an operating remote at their bedside. The television should be connected to the IPTV network and offer multiple channels through satellite dishes, while mobile phone usage may be restricted in critical areas like ICUs.

36.7 Queue Management System Waiting areas like registration, billing, OPD, etc., should have a queue management system with token dispensing machines. LED panel screens should display token numbers and the corresponding counter or room numbers for reporting. The calling station can be software-controlled from a computer workstation, eliminating the need for conventional hardware with a keypad.

36.8 Public Address System Effective communication is crucial in hospitals for providing better healthcare services and ensuring prompt responses. Hospital communication systems, such as intercom and public address (PA) systems, play a vital role in reaching medical professionals and making hospital-wide announcements, including emergencies.

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Advancements in technology have led to IP-based communication systems, offering greater flexibility, improved sound quality, and integration with video surveillance, access control, and nurse call systems. The PA system in the hospital should ensure clear and audible voice coverage without disturbances or echoes. Zoning should tailor the system to meet operational needs. PA equipment includes sensitive microphones, processing circuits, sound amplifiers, pre-mixers, ambient noise reduction, speakers, cabling, and other necessary components. Microphones with minimum noise distortion and low sensitivity to feedback should be connected to zone selection consoles, enabling operators to send announcements to specific audio zones based on selectable priorities. Distribution equipment should consist of line attenuators with line transformers and rotary/digital controls for selecting the output power of a line speaker. Speakers should vary in design based on the area’s requirements, such as column type for areas without false ceilings and concealed mounting type with a wide bandwidth for areas with false ceilings. A central announcement cell, operational round the clock, should have a microphone, amplifier, and zone controller to manage announcements effectively.

36.9 Integrated Building Management Systems (IBMS) IBMS is an advanced automation control system that optimizes electro-mechanical systems in buildings, focusing on energy efficiency and green building standards. It ensures efficient usage of HVAC, electrical, DG, sprinklers, hydrant, and security systems for energy conservation. Building Automation System (BAS) in IBMS conserves energy by executing energy conservation control schemes, reducing manpower requirements while maintaining service quality. It acts as a Management Information System (MIS) by providing critical operation data for analysis and energy conservation possibilities. IBMS is based on Micro Processor Control System with various Energy Management Programs, capable of the following functions: 1. HVAC System In a hospital setup, the HVAC system consumes maximum energy. If IBMS is used for HVAC, it can provide the opportunity to save a lot of energy. 2. Precision AC System The IBMS can monitor and control the actual on/off status of the precision AC and display it on the BMS screen. 3. Diesel Generator Set The IBMS can monitor the status of alarms like low lubricant oil pressure low, fuel level low, etc. for DG set. The status can also be displayed on the DG screen of the IBMS system.

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4. UPS System Through IBMS, the UPS can be monitored via serial interface and the user can view the input, output, and interface parameters. 5. Water management IBMS can control the water levels in the tanks through the automatic level sensors and can automatically switch on/off the water supply motors. 6. Lift Monitoring Through IBMS, the lifts can be easily controlled. It can control functions like floor position, alarm, and maintenance modes. 7. Firefighting system IBMS can easily monitor the pressure status in the hydrant and sprinkler line of the firefighting system. If the pressure goes down in the line, it can automatically switch on/off the fire pumps to recover the pressure. 8. If the IBMS is connected and integrated with the fire control panel, it can monitor the status of the firefighting system.

Further Reading Garg A, Dewan A.  Chapter 40, ELV, ICT and IBMS services. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 433–40. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 37

Information Technology and Computerization

The IT or computer network in the hospital needs to be efficient for implementing the Hospital Information System (HIS) across all departments and locations. The software is hosted on central servers, requiring connectivity throughout the hospital. Key considerations for designing the network and providing IT hardware are: 1. The main server should be located in a separate, restricted-access room away from patient areas. The room’s flooring should be raised, concealing all cables and wires underneath, while maintaining the manufacturer-recommended temperature and humidity. 2. Server cabinets should be installed in the server room to house and organize the servers securely. 3. A second mirror server should be implemented to continuously copy real-time data from the main server, serving as a precautionary backup. 4. Off-site backup servers should also be considered to ensure data safety in case of server breakdown, fire, or flooding. These backups can be stored in another hospital room or a different location. 5. Each server should be equipped with its own UPS power backup system with the required rating. 6. Additional backup arrangements should be made using external devices such as HDDs and DVDs to further protect crucial data. 7. A separate air-conditioned room with fireproof cabinets should be designated for storing these backup devices. 8. The network connectivity should be established using CAT 6 cables or optical fibre cables. Optical fibre cables should run from the main server to each floor’s switch boxes, terminating at RJ 45 connector jacks for user connections. 9. The network design should adhere to established standards, using only IEEE or IETF-certified protocols. Compatibility with other vendors’ systems should be ensured through the use of standards like HL7 and DICOM.

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10. The IT network should support multiple virtual IP addresses and enable multicast routed domains with complete traffic separation. 11. Security should be a top priority in the system’s design, with robust options in place to protect against hacking and IP exposure. 12. Bandwidth requirements should be carefully assessed based on the network and data storage needs. 13. Bandwidth and data storage requirements should be determined by the hospital’s software and the number of working nodes. Different software modules may necessitate varying bandwidth levels. 14. Data storage capacity should be planned to accommodate at least 6 years’ worth of hospital operation data. 15. If public WIFI access is provided, Captive Portals should be utilized to implement the system securely.

37.1 Health Information System (HIS) A Hospital Information System (HIS) is a comprehensive and integrated system for managing hospital activities, including Finance & Accounts, inpatient treatment, admissions, and discharges, Investigation departments (e.g., radiology and pathology), operation theatre, nursing care, outpatient management, procurements, asset management, materials management, pharmacy management, blood bank, and payroll management. Crucially, it includes reporting systems and data analysis to inform management decisions and improve hospital performance. HIS is also known as Hospital Management System (HMS) and serves as a secure electronic repository for a patient’s health history, enabling healthcare workers to access and retrieve essential information when needed. It helps healthcare professionals track a patient’s medical history, diseases, medications, surgeries, visits, and other relevant health information.

37.2 Modules of Hospital Information Software Modules of Hospital Information Software: The HIS is a software bundle consisting of integrated modules, each catering to a specific activity. These modules typically include:

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37.2.1 Information Desk Module The Information Desk Module caters to diverse inquiries concerning the hospital and registered or admitted patients, encompassing patient, appointment, investigation, consultant/doctor, in-patient, tariff, treatment estimates, package, investigation, and visitor pass inquiries, among others.

37.2.2 Patient Registration Module This module facilitates the registration of new patients before the consultation. Registration staff enters the personal, medical, family, and demographic details to generate a unique patient ID for record-keeping and easy tracking. The module prints consultation tokens, and case sheets with barcodes and photographs, and handles registration and consultation fee billing. It also checks physician availability for appointment bookings.

37.2.3 Outpatient Management Module The Out Patient Department module manages consultation bookings, prescriptions, and fee receipts. It maintains daily appointment lists, enables booking for laboratory and radiology tests, and sends SMS alerts to patients about appointments. This module records medical treatment details, diagnosis, and investigation reports, interfacing with other modules for data acquisition. It offers various reports on user, patient, and doctor activities, OPD billing, revenue, and patient registration.

37.2.4 Inpatient Management Module The In-Patient Department module oversees indoor patient activities from admission to discharge. It manages bed occupancy, allotment, and interdepartmental consultations. It links newborns’ medical records with maternal data. The module handles admissions, bed allotment, transfers, pharmacy requisitions, investigations, and patient charges. RFID wristbands are prepared for patient tracking. It generates reports on counts, revenue, and provides a patient access dashboard.

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37.2.5 Admission, Transfer, Discharge (ADT) Module This module handles patient admission, interdepartmental/inter-ward transfers, and discharge processes. It manages bed allotment, ward allocation, and billing. Medical notes, nursing records, vitals, special incidents, and medication details are recorded. It also manages insurance payments and generates discharge summaries.

37.2.6 Consulting Appointment Management Module This module facilitates advanced appointments for consultations, including rescheduling or cancelling appointments. It allows booking appointments for laboratory/ radiology services and handles registration and billing.

37.2.7 Bed Management Module This module maintains bed occupancy records, estimating waiting times to optimize bed turnover and revenue.

37.2.8 Ward Management Module Designed for nursing staff, this module supports nursing and clinical procedures, in-patient services, laboratory, blood banks, and pharmacy orders. It monitors patient health status, and vital parameters, and assists with material requisitions and roster management.

37.2.9 Nursing Management Module This module helps ward staff manage critical units like ICUs and OTs. It tracks patient services, vital charts, investigations, medications, surgeries, admissions, transfers, and communication with support departments. It also records adverse reactions or incidents.

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37.2.10 Operating Room Module This module tracks surgeries, pre-surgery, and post-surgery details. It manages OR bookings, surgical team coordination, preparation of surgical equipment, and coordinates with blood bank, laundry, and housekeeping. It records drugs, and consumables used, and maintains pre-operative and post-operative patient conditions.

37.2.11 Laboratory Module This module manages investigations for OPD and IPD patients, emailing results to patients and treating physicians. It handles test requisitions, result verification, billing, and sample processing, interfacing with laboratory equipment for online data capture. It also maintains an inventory of equipment, reagents, and kits.

37.2.12 Blood Bank Module This module manages blood bank activities, including donor registration, blood grouping, screening, component preparation, and cross-matching. It maintains records for statutory compliance.

37.2.13 Radiology Module This module manages radiology department operations, including billing, investigation requisitions, reporting, and storage of images in the PACS system. It supports speech-to-text typing for radiologists.

37.2.14 Picture Archiving and Communication System (PACS) Module PACS is an imaging software for storing medical images in DICOM format. It handles images from various imaging equipment and provides online delivery, image processing, 3D imaging, printing, labelling, and secure user access.

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37.2.15 Casualty & Emergency Management System This module handles the emergency department’s functioning, capturing patient data, alerting relevant departments, recording medico-legal cases, consulting details, and billing for emergency services.

37.2.16 Pharmacy Information System The Pharmacy module manages medicine inventory, suggesting alternatives, interfacing with drug databases, generating purchase orders, and providing alerts for stock levels and expiry dates. It also generates reports and utilizes barcode/RFID for item tracking.

37.2.17 Order Management System Module This module handles requests and orders for various services, including medicines, laboratory and radiology investigations, diet, blood, procedures, and nurse services.

37.2.18 The Birth/Death Registration Module This module facilitates birth and death registration, issuance of memos, reporting to government departments, printing certificates, and generating statistical reports.

37.2.19 Electronic Medical Records Module This module manages and stores patient records, treatment details, diagnosis reports, investigations, and billing electronically for easy retrieval. It aids in improving patient care and communication.

37.2.20 Billing and Finance Module This module manages patient billing, payment collection, refunds, and estimated billing, and generates financial reports for the hospital.

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37.2.21 Insurance and Medi-claim Module This module handles cashless and empanelled patient services, evaluating eligibility, reimbursement, and online bill settlement.

37.2.22 Human Resources Module The HR module manages hospital manpower, attendance, leave records, salary calculations, duty rosters, staffing needs, recruitment, training, and shift rotation.

37.2.23 Materials Management System (Stock, Purchasing and Fixed Asset Module) This module deals with purchasing, stocking, and issuing assets, medical equipment, and consumables used in the hospital.

37.2.24 Dietary Module/Catering Module This module allows dieticians to prescribe suitable diets for patients, calculate nutritional information, and manage meal preparation.

37.2.25 Statistics and Reporting Module (MIS) This crucial module provides various reports and dashboards for hospital management to measure and monitor performance, frame policies, and make informed decisions.

37.2.26 Hospital Analytics The Hospital Analytics module provides useful information and analysis of hospital data, aiding clinicians in patient care and improving healthcare services.

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37.2.27 Interface Module This module facilitates interfacing electronic equipment and external software used in the hospital, such as laboratory equipment and radiology machines, with the account’s module for finance management.

Further Reading Garg A, Dewan A. Chapter 41, information technology and computerization. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 441–50. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 38

Water Supply and Drainage System

Water is vital for human survival, particularly in hospitals where the water supply and drainage are crucial for treating patients. Clean and hygienic water is essential for infection control, medical equipment lifespan, and staff-patient hygiene. Hospital systems and operations rely on clean water, and some medical equipment’s performance depends on its quality. Proper wastewater treatment is equally important. Ensuring a reliable and uninterrupted water supply is vital for hospital buildings, but excessive water volume and tank stagnation should be avoided. Quality water supply and efficient drainage are indispensable for hospitals’ functioning, patient care, and overall well-being.

38.1 Source of Water Supply Water sources for hospitals can include: 1. Supply from the Water Network Supplier 2. Bore Hole 3. Underground Water Wells 4. Connection for Portable Water Trucks Considerations for the water source: 1. Treatment is necessary to maintain TDS/PPM levels between 0–150 PPM. 2. Hospitals should have at least two water sources for backup, and an emergency supply should also be arranged.

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3. Water supplied must be protected to prevent waterborne infections. 4. Designers should calculate daily water consumption, peak flow requirements, and pressure from the source. 5. Plan for future expansion with at least 25% spare water capacity. 6. Water temperature should be kept between 15–20 °C to avoid bacterial growth. 7. Water storage: Hospitals need to store water equivalent to 3 days’ consumption in concrete or GRP tanks, based on peak demand and available water quantity from the external source.

38.2 Water Storage Hospitals should have main storage tanks made of concrete or Glass-reinforced plastic (GRP) tanks. Water storage calculation should be based on the peak demand vis-à-vis the quantity of water available from the main external water source.

38.2.1 Water Storage Tank Locations Water storage tank locations include both roof level and floor level, with main storage in underground tanks. Water is pumped from the underground tanks to rooftop tanks, which should hold 6  h’ worth of consumption. A real-time filling system should be implemented for continuous replenishment. To ensure proper water pressure on all floors, booster pumps connected to emergency power are used, not solely relying on gravity-driven tanks. Tanks must be watertight to prevent contamination, and ample space should be provided for inspection and maintenance. Each tank should have (a) A drain valve at the bottom for full draining. (b) An overflow pipe connected to the drainage. (c) Internal and external access ladders. (d) An air vent pipe with corrosion-resistant mesh covering the air inlet.

38.3 Systems of Water Treatment Water treatment in hospitals is crucial to control microbiological growth. Treatment methods depend on the water’s specific purpose. Techniques to control microbiological growth involve regulating water temperature and chemical components. Some possible methods include:

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38.3.1 Pasteurization Flushing the system with hot water (70–75 °C) to eliminate growth in pipelines and fittings, but can be costly and cause system shutdown.

38.3.2 Chemical Treatment Using Chlorine Dioxide to oxidize organic substances and eliminate growth in the system.

38.3.3 Chlorine Water Treatment Utilizing Chloramine for long-lasting antibacterial effects, but unsuitable for procedures like dialysis.

38.3.4 Water Softener Plants Employed to remove Magnesium and Calcium from water to prevent scale deposition in pipelines and fittings for specific hospital areas.

38.3.5 Silver-Copper Ionization Releasing Copper-Silver ions to combat organisms in contaminated water.

38.3.6 Reverse Osmosis Treatment Commonly used for maximum contaminant removal using a semipermeable membrane, suitable for critical units and drinking water.

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38.3.7 Ultraviolet Treatment Deactivating or killing bacteria using UV light, especially with 254 nm wavelength for proper treatment.

38.3.8 Ozone Water Treatment Using unstable ozone gas to disinfect and reduce iron and manganese concentration in water.

38.3.9 Distilled Water Created from condensed steam after cooling and liquefaction.

38.4 Drinking Water For drinking water taps and fountains, some hospitals provide a separate water supply line. The following issues should be addressed for drinking water; 1. The quality of drinking water, even after Chemical treatment should be safe for human consumption. 2. To prevent the temperatures of drinking water from exceeding 20 °C and stagnation of the water, the water should be supplied from a central water storage tank that is made for drinking water only. 3. If a central drinking water system is not available, then provision should be made for bottled drinking water through water coolers.

38.5 Water Booster Pumps In hospitals high flow of water is essential for hygienic hand wash and cleaning. Therefore, the hospital should have a system for constant and high-flow water pressure to ensure a hygienic and clean infection-free environment. Hence the following should be provided; 1. The pressure at fixtures of the cold-water supply should be appropriate 2. The flow velocity of the cold water piping should be appropriate.

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3. A booster pump should be provided to ensure that an adequate pressure of water is available throughout the hospital. 4. Multi-stage booster pumps should be used instead of single-stage pumps. 5. An emergency power supply should be provided to the booster pumps.

38.6 Hot Water System In the hospital, hot water is needed for Hand Wash, Scrub Sinks, CSSD, Kitchen, Patient’s bathrooms, and Instrument washing. Different types of hot water systems can be provided in the hospitals:

38.6.1 Electrical Hot Water Generation A stainless steel cylindrical tank with insulated high-rated heating elements is used to heat water. The elements are controlled by a thermostat, switching on when the water temperature falls below the set level and off when it reaches the preset temperature.

38.6.2 Hot Water Generation from Boiler/Steam by Burning Fuel A steamer or boiler heats the water with a fire below the tank, burning fuels like Gas, Wood, Coal, or waste oil.

38.6.3 Solar Hot Water Generation Solar cells with conductive copper pipe capillary lines on rooftops heat water from sun exposure. A backup system is required for cloudy or rainy days when sunlight is insufficient.

38.6.4 Stand-Alone Hot Water Geysers Small hospitals use individual geysers at various locations with required power switch/socket and laid pipelines for hot water supply.

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1. Hospitals should have a backup plan for heating water using techniques mentioned earlier, with electrical heating elements considered the preferred option. 2. Hot water temperature should be maintained between 60–65  °C to prevent microorganism growth. 3. Water serving the hot water plant must undergo proper Ultraviolet treatment before connecting to the hot water system. 4. Hot water supply pipelines should be insulated with moulded insulation and flame-proof jackets to ensure temperature control.

38.7 Sanitary Fittings Compared to other commercial buildings, hospitals have unique sanitary fittings designed to maintain an infection-free, safe, and hygienic environment. Considerations for designing these fittings include: 1. Hospital sanitary system design should prioritize durability and allow for future maintenance. 2. Isolation valves must be installed at the main entrance of sanitary fixtures in toilets. 3. Sensor taps are preferred for hand-wash basins in hospitals. 4. Hospitals should avoid installing spray-type mixer taps. 5. Flow restrictors or aerators should not be used in taps and mixers to prevent bacterial growth and maintain water flow. 6. Adjustable spray options in shower heads should be avoided to prevent water stagnation issues.

38.8 Irrigation Water Supply Dedicated irrigation water tanks supply water exclusively for irrigation purposes, separate from other water supply lines. Irrigation can be for internal or external landscape areas.

38.9 WC Flushing Systems Treated water from showers, wash basins, floor drains, and RO rejection can be used in Non-Loitering Irrigation Areas and WC flushing systems in the hospital.

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38.10 Steam System Steam is needed in various hospital areas such as laundry, food & beverages, laboratories, sterile store, and CSSD. The steam’s quality depends on the application; ordinary plant steam is suitable for areas like laundry or food & beverages, clean steam for CSSD and critical areas, and pure & filtered steam for laboratories or pharmaceutical preparation. Important considerations when designing the steam system include: 1. Source of Steam System Hospitals can generate steam from Central Steam Boiler System or Local/ Central Electrical Steam Generator. 2. Plant Steam Normal steam is prepared with regular water, with added chemicals to control the steam’s pH level. 3. Clean Steam Generated using RO or DM water supplied to the steam generator. 4. Steam System Pipeline Stainless steel piping is used for its hardness, non-reactivity, and corrosion resistance. Proper insulation maintains steam temperature and prevents conversion back to liquid. 5. Central Steam Generation vs Local Steam Generation Hospitals can choose between a central plant (economical but less efficient) or localized plants at different locations. Operational costs, distance, and redundancy factors influence the decision, with some hospitals opting for a combination of both systems. Hospitals require an effective drainage system, especially considering the lower quality and quantity of effluent compared to other buildings. While designing the system, the following factors should be addressed: 1. Assess nearby drainage networks, main holes, and connection points based on the hospital’s location. 2. Consider level differences between hospital drains and the drainage network. 3. Evaluate the types of effluent that may be discharged, such as chemical, radiation, and grease. 4. Ensure external drainage network connection points meet municipality requirements.

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38.11 Drainage Strategy 1. Use gravity-driven drainage for general effluent and pressure drainage for areas like basements via sump and pump connection. 2. Prevent odours by addressing broken or dried floor traps. 3. Ensure sufficient drainage gradient for waste discharge into main sewer lines. 4. Directly connect sanitary fixtures to the drain line whenever possible, avoiding floor traps or other fixtures.

38.12 Types of Drainage Systems Various drainage systems in hospitals must be kept separate to control infections and optimize the system. The following are the drainage systems:

38.12.1 Wastewater Drainage General drainage from sources like wash basins, sinks, showers, scrub sinks, bathrooms, and floor drains. It typically does not contain human waste or contaminated water.

38.12.2 Soil Water Drainage Contains human waste and originates from WCs, urinals, and dirty linen washrooms.

38.12.3 Storm Water Drainage Collects rainwater or sprinkler water.

38.12.4 Chemical Drainage From laboratories, where effluent must be neutralized before discharge into the main system.

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38.12.5 Radiation Drainage Generated from areas like hot labs and settlement toilets.

38.13 Methods of Drainage 38.13.1 Vent Pipes Vent pipes are essential in drainage systems to prevent foul odours by venting the effluent outside.

38.13.2 Floor Drains Floor and clean-out drains should be equipped with traps to prevent odours. A primer valve connected to the water supply can refill the trap if it dries out.

38.13.3 Soil Water Drainage Toilet, urinal, and dirty utility drainage can use either S-Trap or P-Trap discharge systems, with the P-Trap system being recommended for easier maintenance. WC drainage connections should be at least 150 mm in diameter, increasing the size for more connections. Avoid using 90° bends to prevent blockage.

38.13.4 Rainwater Drainage System Design the hospital roof to collect rainwater through horizontal pipes and transfer it to vertical pipes connected to holding tanks or soak pits to increase underground water levels.

38.13.5 Infectious Contaminated Drainage Hospitals may have drainage containing biohazardous materials with living organisms, such as from isolation rooms. A “Kill Tank” connected to the concerned areas should be used to treat the hazardous material with chemicals before final drainage.

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38.13.6 Radiation Drainage Provide a radiation tank at a safe location. If local regulations prohibit direct radiation drainage, use a holding tank before dilution.

38.13.7 Kitchen Grease Drainage Kitchen drainage systems should include grease interceptors to treat the effluent before discharging it into the external drainage network. After completing the drainage system and connecting it to the main building holes, the drain water requires treatment before being discharged into the municipal sewerage network or soak pits. For water treatment, please refer to the chapter on Bio-­Medical Waste Management in this book.

Further Reading Garg A, Dewan A. Chapter 42, Water supply and drainage system. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 451–8. Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b.

Chapter 39

Vertical Transportation System

In multi-storey hospitals, vertical lifts are vital for the efficient transportation of patients, medical equipment, staff, and visitors between floors. They also serve as crucial fire-fighting and evacuation facilities during emergencies. Compliance with statutory regulations in each country is essential, ensuring lifts meet prescribed standards set by the municipality.

39.1 Lift Categories The lifts in hospital buildings can be categorized and provided based on the function below:

39.1.1 General Passenger Lifts 1. Used for staff, doctors, visitors, and patients in wheelchairs. Key points: 2. Internal dimensions: Width – 2000 mm, Depth – 1700 mm, Loading Capacity – 1250 kg, Door Opening – 1100 mm, Internal Height – 2100 mm. 3. Consider a separate lift for housekeeping services. 4. Passenger lifts should be separate from Bed, Service, and Goods lifts with separate lobbies.

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39.1.2 Bed Lifts 1. Designed to carry patients on beds or stretchers with necessary equipment and staff. Specifications: 2. Internal dimensions: Car Width  – 1800  mm, Depth  – 2700  mm, Loading Capacity – 2500 kg, Door Opening – 1400 mm, Internal Height – 2500 mm.

39.1.3 Service/Goods Lift 1. For moving furniture, equipment, maintenance supplies, building materials, hospital waste, food, and linen trolleys. Specifics: 2. Internal dimensions: Car Width  – 1600  mm, Depth  – 2200  mm, Loading Capacity – 2500 kg, Door Opening – 1200 mm, Internal Height – 2500 mm. 3. Smaller hospitals (up to 50 beds) can have smaller goods lifts. 4. Larger service/goods lift with wider door openings are recommended for hospitals with heavier equipment transportation needs.

39.2 Design Considerations 1. Optimize operational speed for efficiency and comfort. 2. Place lifts away from sensitive areas like MRI due to vibration and magnetic distortion. 3. Bed Lifts and Service Lifts should have identical designs and sizes for flexibility and interchangeability, providing backup options. 4. Categorize Service Lifts as Dirty and Clean, ensuring they are not exchanged. 5. Use Dirty Lifts for transporting items like dirty linen, waste, and infected patients. 6. Use Clean Lifts for transporting clean items, medication, and staff.

39.3 Engineering Guidelines Consider the following criteria for choosing lift size, capacity, speed, and drive system in hospital buildings: (a) Number of patients expected to use lifts. (b) Number of staff members expected to use lifts. (c) Hospital’s operation and visiting hours. (d) Zoning of the hospital building. (e) Number of lift wells in the building. (f) Floor location of critical units. (g) Location of service departments. (h) Location of support departments like kitchen and laundry. (i) Emergency evacuation system. (j) Location of the

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Emergency department. (k) Daily visitors in the hospital. (l) Number of attendants allowed with each patient. 1. Lift speed selection depends on building height, but modern technologies allow jerk-less lifts, making speed less significant. Speed should still comply with standards based on building height. 2. An average interval time of 30 s to 50 s for door opening to closing is generally acceptable in hospitals. 3. Centre-opening doors are preferred over side-opening doors for lifts used by patients and clinical staff. Side-opening lifts can be used for goods or service lifts, and either door type is acceptable for general passengers and visitors. 4. Prefer Machine Room Less (MRL) lifts as they don’t require a machine room on the top floor. 5. Install emergency lighting with 1-hour battery backup in lifts. 6. Provide hall buttons on each floor and lift indicators to know the car’s position. 7. Properly seal and paint lift shafts, including walls and ceilings, to reduce infection transmission risks. 8. Install Infrared Curtain Door Sensor on lift car doors for contact-free detection of obstructions to prevent accidents. 9. Provide intercom lines in lifts for passenger communication during emergencies. 10. Include a hooter in the lift for passengers to signal emergencies. 11. Install CCTV cameras inside the lifts for live image recording. 12. Equip lifts with Automatic Rescue Device (ARD) to bring the lift to the nearest lower floor and open doors in case of power failure. 13. Bed lifts should have a priority lift car call option for critical care patients. 14. Provide power backup through UPS or other alternate power sources for the lifts. 15. Power supply to lifts shall come directly from the MDB near the machine room. 16. Include handrails on at least two long sides of the lift car for patient safety. 17. Ensure non-slip and easily cleanable flooring in the lift car. 18. Prefer fire-rated doors for the lifts. 19. Include an Overload device to warn of lift overload. 20. Provide Emergency Firemen’s service in the lift. 21. Consider an automatic Belt Inspection device in the lift.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 43, Vertical transportation system. p. 459–61.

Chapter 40

Pneumatic Tube Systems (PTS)

Pneumatic Tube Systems (PTS) are efficient internal logistics and transport systems used within hospitals to quickly move small items or documents. The system operates by placing items in capsules and transporting them through an air-pressurized tube network. PTS is ideal for transporting documents, materials, and medicines, providing accurate and speedy delivery. Hospitals install PTS terminals, or stations, at crucial sending and receiving locations such as ICU, Emergency, Operating Room, Pharmacy, Laboratory, Blood Bank, and Billing Counter. Operating the system is simple: users place items in carriers, select the destination station, and capsules move swiftly to deliver the items within seconds. PTS can be single-zone or multi-zone, depending on the hospital’s needs.

40.1 Pneumatic Tube System Components The PTS system comprises components which when combined make a complete system. The following are the system components:

40.1.1 Blower & Air Reverse Valve The blower generates pressurized air to move PTS carriers through the piped network in the hospital. It is installed in the plant room, along with the system control unit and inter-zone/linear coupler.

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40.1.2 Carrier Carriers are reusable plastic containers used in pneumatic tube systems to transport various items within the hospital, such as medicines, consumables, lab specimens, blood, documents, etc. They come in different sizes to meet hospital requirements and are categorized as: 1. Standard carriers: For medicines, small instruments, and solid items. 2. Leak-proof carriers: Designed for transporting sensitive liquids like blood samples. 3. Special carriers: Rarely used carriers with specific features like lead lining or cooling for specific purposes.

40.1.3 Control Centre Software controlling carrier movement between stations and users, including real-­ time carrier tracking through the user interface.

40.1.4 Database Records carrier movements, date, time, and station details in the system repository for each PTS system.

40.1.5 Inter-zone Connection Tube network section linking different zones.

40.1.6 Station User interface for sending and receiving carriers, featuring a touch screen, dialling system, RFID scanner, and a platform for loading and unloading carriers.

40.1.7 Diverter Device in tube network, enabling carrier diversion at branching points.

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40.1.8 Tubing Used to create PTS network, available in sizes like 110 mm or 160 mm with different materials based on environmental conditions.

40.1.9 Zone Set of directly connected stations, e.g., one zone for a floor, capable of accommodating around 10 stations, while a Blower Group Zone can accommodate 60 stations.

40.1.10 Slow Speed Device For transporting sensitive items like lab samples and blood samples at reduced speed.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 44, Pneumatic tube system (PTS). p. 463–5.

Chapter 41

Signage System

Way-finding or Signage System in hospitals helps orient and navigate people through the space. Its purpose is to direct patients, visitors, and staff from entry points to their destinations. A well-designed system reduces inconvenience, confusion, stress, and worry. Inefficient systems cause stress, frustration, and disorientation, leading to wasted time and helplessness. Effective wayfinding makes using the space easier for everyone.

41.1 Categories Using Way-Finding The following categories generally use the wayfinding systems.

41.1.1 Patients and Visitors Wayfinding systems in hospitals are particularly helpful for patients and visitors who are often unfamiliar with the hospital’s layout. This includes various individuals, such as commercial service representatives, delivery personnel, medical representatives, and government officers like police and fire brigade officers.

41.1.2 Staff Hospital staff, being regular users, usually become familiar with the hospital’s layout over time. Wayfinding systems can assist staff in guiding lost individuals or those in need of help. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_41

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41.1.3 Users with Special Needs Wayfinding is crucial for people with sensory, physical, language, or intellectual disabilities. Universal signage systems are used to aid such users.

41.1.4 Sensory Impairment People with visual or hearing impairments face challenges in navigating hospital spaces. For those with limited vision, clear and colour-contrasted signboards are essential, while those with hearing impairments rely on written messages, lip-­ reading, and hand gestures for communication.

41.1.5 Language and Illiteracy Wayfinding systems should incorporate standardized symbols and pictographs along with alphabetical signage to assist functionally illiterate individuals.

41.2 Principles for Designing a Wayfinding System While designing the wayfinding system, the following principles shall be followed: 1. Create a unique identity for each location in the hospital. 2. Differentiate zones with colour schemes. 3. Use floor or wall strips for route indication. 4. Provide signboards from entry points onward. 5. Ensure clear visibility and legible fonts. 6. Use contrasting colours for better visibility. 7. Ensure well-lit indoor signboards. 8. Strategically place signboards for easy visibility. 9. Plan clear and concise routes. 10. Provide signs for the handicapped with text and symbols. 11. Use landmarks for orientation. 12. Provide well-lit fire exit plans. 13. Include hospital route plans in brochures. 14. Display detailed information at the main reception. 15. Install signboards from the parking lot onwards. 16. Ensure clear and well-lit entry and exit gate signboards. 17. Provide signboards at all major entrances and exits. 18. Use large-size signboards for emergency departments.

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1 9. Display room numbers and purposes at entrances. 20. Clearly, mark and number serving counters. 21. Use directional arrows on signboards when necessary. 22. Display vehicular signboards on roadsides. 23. Provide proper signboards in parking lots. 24. Keep signboards at a readable height, preferably within 1200–1800 mm. 25. Organize the directory based on user needs. 26. Choose legible and readable fonts for signage. 27. Ensure letter size is legible from a distance of 15 meters. 28. Use icons or symbols along with text for non-literate users. 29. Align messages left or use justified alignment. 30. Use simple and understandable terminology. 31. Make signboards bilingual, including English and the local language. 32. Display clear floor markings in lift lobbies and staircases. 33. Plan signboard sizes carefully for optimal visibility. 34. Maintain appropriate size proportions for signboards. 35. Keep sufficient distance and spacing between signboards. 36. Use notice signboards for specific messages. 37. Display general information signboards for prohibitions and guidelines

41.3 Types of Sign Boards Sign boards can be of different types like:

41.3.1 Classified by Function Based on the information required by users, the wayfinding sign boards installed in the interior or exterior of the building shall be classified based on the type of information provided by the signboard. Some are like: 1. Orientation Orientation sign boards provide an overview of the building, including locations like Waiting areas, IPD areas, visitors lounge, and cafeteria. They may also include maps, directories, and floor plans. 2. Directional Directional sign boards guide users to their destinations with clear messages and directional arrows. 3. Identification Identification sign boards display the identity or function of rooms, halls, departments, floors, and buildings with names and numbers. 4. Statutory

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Statutory sign boards are mandatory installations as required by regulations and statutes, such as fire evacuation plans, fire exits, and warnings for radiation areas or electrical dangers. 5 . Traffic and Parking Traffic and Parking sign boards control traffic and assist drivers, including signs like No Entry, One Way, Pedestrian Crossings, No Horn, and speed limits.

41.3.2 Signs Classified by Physical Characteristics This classification is based on the mounting methods with which the sign boards are displayed like: 1. Self-supporting The sign boards which are self-sustained, free hanging, mounted on a pole, fixed on the plinth, or self-weight bearing signboards are called self-supported signboards. 2. Wall mounted These are the signboards which are fixed on the walls. 3. Ceiling Suspended Sign boards that are hung or fixed from the ceiling.

41.3.3 Other Factors in the Classification of Sign Boards There are some other factors based on which the sign boards can be classified. Some of them are: 1. Single Sided Sign boards displaying information on one side, usually fixed on walls or counters. 2. Double Sided Sign boards displaying information on both sides are typically used as ceiling-­ suspended signs. 3. Illuminated sign boards Sign boards are illuminated internally or externally using bollards or spotlights, requiring natural or artificial light. 4. Dynamic or static Static sign boards show consistent information until physically replaced, while dynamic signs are used for frequently changing information like patient room allocations and token numbers.

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Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 45, Signage system. p. 467–71.

Chapter 42

Bio-Medical Waste Management

Bio-Medical Waste Management is regulated by country or state legislation, with specific rules. In India, the Ministry of Health & Family Welfare issued the “Biomedical Waste Management Rules, 2016.” This chapter presents a synopsis of these rules to understand the subject. Plagiarism is not intended, and the rules of other countries are not covered for practical reasons. Biomedical waste, also known as ‘Hospital waste,’ may contain infectious materials and includes waste from laboratories. It differs from normal trash, kitchen waste, and hazardous waste like chemical, radioactive, universal, or industrial waste. Biomedical waste can be solid, semi-solid, or liquid. Examples include discarded laboratory specimens, blood, body parts, tissues, bandages, surgical gloves, medical consumables, catheters, and sharps like needles, lancets, or blades, potentially contaminated with body fluids or blood.

42.1 Classification of Hospital Waste Hospitals have the primary responsibility for managing bio-medical waste, covering collection, segregation, storage, transportation, pre-treatment, and disposal. The waste generated from the hospitals is classified as: Bio-Medical Waste General Waste Other Wastes

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42.1.1 Bio-Medical Waste Bio-Medical Waste (BMW) refers to hospital waste that can harm health and the environment if not disposed of properly. It makes up about 15% to 20% of total hospital waste. BMW is segregated and placed in colour-coded bags, with each colour indicating the type of waste to be put inside. Bio-Medical Waste is disposed of in colour-coded bags, where each colour defines the type of waste to be put into it as follows: (a) Yellow Category – Includes human or animal anatomical waste, soiled waste, expired or discarded medicines, chemical waste, discarded linen, mattresses & beddings, routine mask & gown, and clinical laboratory waste. (b) Red Category  – Comprises disposable items like tubes, bottles, intravenous tubes and sets, catheters, urine bags, syringes without needles, vacutainers, and gloves. (c) White Category – Consists of needles, scalpels, blades, or any other contaminated sharp objects that may cause punctures and cuts. (d) Blue Category  – Designated for broken, discarded, and contaminated glass, including medicine vials and ampoules.Such wastes should be handled and disposed of as per the rules and regulations of the respected country and/ or state.

42.1.2 General Waste All waste excluding bio-medical waste, including paper, cardboard boxes, newspapers, food containers, plastic bottles, packaging materials, aluminium cans, organic/ biodegradable waste (e.g. leftover food), and construction and demolition waste. Disposal must adhere to country/state regulations.

42.1.3 Other Wastes This category comprises electronic waste, batteries, chemicals, and radioactive waste, which may or may not pose a threat to humans or the environment. Disposal must follow country/state regulations.

42.2 Steps Involved in Bio-Medical Waste Management Bio-Medical waste management involves five steps:

42.4  Bio-Medical Waste Collection

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Segregation Collection Pre-treatment Transportation Storage

42.3 Bio-Medical Waste Segregation 1 . Segregate waste at the point of generation. 2. Display posters depicting the segregation process. 3. Use colour-coded bins, bags, and containers at the point of segregation. 4. Provide staff with personal protective equipment (PPE).

42.4 Bio-Medical Waste Collection 42.4.1 Time of Collection 1 . General waste must not be collected with bio-medical waste. 2. Bio-medical waste should be collected daily from each ward at fixed intervals. 3. General waste collection is best done after visiting hours. 4. Collection time should align with waste generation; e.g., OR waste collected immediately after daily surgeries

42.4.2 Packing of Bio-Medical Waste & Labelling 1 . Bio-medical waste bags should not be overfilled (max three quarters). 2. Use cable ties, not staples, to seal the bags. 3. Keep empty bags available at collection points for replacement. 4. Print bio-hazard symbol on colour-coded waste bags. 5. Label filled bags with collection date, waste type, quantity, etc. 6. Barcoded stickers on bags enable tracking till final disposal.

42.4.3 Interim Storage 1. Use dirty utilities for interim storage; avoid storing waste inwards or in departments.

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2 . Avoid storing waste in patient care, clinical, procedural areas, or OR. 3. If no dirty utilities are available, store waste in low-traffic areas.

42.5 Transportation of Bio-Medical Waste in Hospital 42.5.1 Transportation Trolleys Transportation of such waste should be done using closed trolleys or containers.

42.5.2 Route of Transportation Choose routes with fewer patients and visitors for waste transportation.

42.5.3 Central Waste Collection Room for Bio-Medical Waste 1. Hospitals should have a central waste collection room on-site. 2. Waste should be stored there until final disposal. 3. The room should be distant from public spaces and restricted. 4. Sufficient capacity to store waste for at least 2 days is essential. 5. The room’s RCC roof should be lockable and guarded 24/7. 6. Provide a ramp for transporting trolleys. 7. Choose tiled or glazed flooring with a sloped design for easy cleaning. 8. Install exhaust fans for ventilation. 9. Fire extinguisher, smoke detector, and sprinkler system for fire prevention. 10. Provide tap water for room and container washing. 11. Display Bio-Medical Waste Hazard sign boards and logo.

42.6 Record Keeping 1. Maintain records of waste generation points, quantities, transportation details, and disposal date/time. 2. Record waste quantities category-wise in the Bio-Medical Waste Register/ logbook. 3. Provide a weighing machine at the central waste collection centre. 4. Prepare an annual report and submit it to authorities. 5. Keep records of training provided to waste handlers and segregators.

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6. Maintain annual health check-ups and immunization records of employees. 7. Record and keep minutes of Bio-Medical Waste Management committee meetings. 8. Maintain records of accidents and actions taken. 9. Keep records of biomedical treatment equipment operation, effluent testing, and recyclable waste management. 10. Retain all records for at least five years.

42.7 Updating Information on the Website Develop a webpage/website displaying biomedical waste-related information as per country/state rules.

42.8 Management of General Waste 1. Segregate general solid waste from biomedical waste and collect it in separate bins using non-chlorinated bags. 2. Separate dry waste from bio-degradable waste using green and blue bins, respectively. 3. Dispose of waste as per rules. 4. Preferably wrap items like sanitary pads and diapers before disposal. 5. Dispose of horticulture and garden waste according to the rules. 6. Avoid open public space dumping or burning, and prevent disposal in drains or water bodies.

42.9 Management of Other Wastes 42.9.1 Used Batteries Dispose of used batteries only through authorized dealers, recyclers, or agencies.

42.9.2 Management of Radioactive Wastes Re-export radioactive wastes to the manufacturer under an agreement with the hospital.

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42.9.3 Management of E-Wastes Hand over e-wastes to authorized E-Waste Recyclers/Dismantlers or approved agencies for disposal.

42.10 Effluent Treatment Plant (ETP/STP) Hospital wastewater must undergo proper treatment before disposal to avoid harmful environmental impacts and infectious diseases. An effluent treatment plant (ETP/STP) is essential for hospitals. Wastewater typically contains chemicals, biological waste (microbial pathogens, harmful bacteria, viruses), radioactive isotopes, pharmaceuticals, hazardous chemicals, and heavy metals. Various hospital units like pathology, OR, emergency, hot lab, ICU, radiology, kitchen, and laundry continuously generate wastewater. ETP/STP removes organic matter and suspended solids from the water before reuse or discharge. Stages involved in ETP/STP operation include:

42.10.1 Preliminary Stage Also called ‘pre-treatment’, it uses bar screens to remove larger suspended solids like debris, paper, rags, and plastic from raw wastewater. Sedimentation slows water flow in a grit chamber to remove sand and grit.

42.10.2 Primary Stage Physical and chemical methods improve wastewater quality. Skimming after sedimentation removes 60–65% of suspended solids. Sludge from the grit chamber is processed in a sludge digester.

42.10.3 Secondary Stage Biological treatment removes organic matter. Water in the secondary clarifier separates floatable matter and forms ‘active sludge’.

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42.10.4 Tertiary Stage The final disinfection stage removes the remaining suspended solids and other materials. This chapter presents highlights of Bio-Medical Waste Management, but actual waste management depends on country or state regulations. Designers and hospital management should refer to these rules and regulations before planning and designing Bio-Medical Waste Management facilities.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 46, Biomedical waste management. p. 473–7.

Chapter 43

Fire Safety

Fire safety, protection, and detection norms are subject to country or state regulations, each issuing its own set of rules. Internationally accepted codes and standards, like those by the National Fire Protection Association (NFPA), exist. In India, the “National Building Code of India 2016” provides relevant rules. Due to the diversity of regulations globally, this chapter focuses on the “National Building Code of India 2016” to aid understanding. The content of this chapter is the synopsis of the “National Building Code of India 2016” and should not be considered as Plagiarism. To ensure fire safety, hospital buildings should be designed to handle emergencies and prevent fire incidents. Considering the vulnerable patients, visitors, and staff, provisions should be made to minimize fire risks and aid evacuation. Early fire detection and suppression systems are essential to contain any fire promptly. Hospitals need comprehensive fire safety measures due to their unique challenges.

43.1 Planning for Fire Safety in Hospitals When designing a hospital building, the following fire detection and fighting aspects should be considered: 1. Compartmentalization of building 2. Provision of open spaces as per norms 3. Installation of fire-resistant doors 4. Pressurization of lift lobbies, lift wells, and staircases 5. Pressurization of vertical shafts 6. Provision of refuge areas 7. Installation of the smoke ventilation system © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_43

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8. Placement of fire dampers & hydrants 9. Implementation of automatic sprinkler system 10. Installation of fire alarm system 11. Provision of a public address system 12. Use of automatic detection system with smoke/heat detectors 13. Placement of manual call points 14. Availability of first aid kits 15. Provision of fire-fighting appliances like extinguishers 16. Implementation of alternate power supply 17. Placement of evacuation signage

43.2 Structural Elements for Fire Safety The following structural elements should be provided while designing a hospital building:

43.2.1 Compartmentalization Proper compartments and barriers should be designed as per country/state regulations. Key considerations include: 1. For bedridden patient areas over 280  sq. mtr., provisions to shift patients to smokeless compartments. 2. Sections larger than 500 sq. mtr. Should be compartmentalized with 2-hour fire resistance. 3. Each patient area floor should have at least two smoke compartments. 4. Floors with over 50 people should be divided into two smoke compartments.

43.2.2 Open Spaces Open spaces outside the building should meet country/state regulations. Focus on: 1 . Adequate space for emergency/fire vehicle movement. 2. Motorable and obstruction-free open spaces at all times. 3. Passage for emergency vehicle entry. 4. Road and entrance width compliance with regulations. 5. Outside storage/tanks covered with strong slabs, not used for parking. 6. Access roads around the building without dead ends.

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43.2.3 Basements Basement design should address fire issues and regulations: 1 . Concrete walls in basements. 2. Automatic sprinklers and smoke evacuation systems. 3. Dampers for fresh air. 4. Basement ceiling height as per regulations. 5. Separate staircase and/or ramp access. 6. At least two independent exits. 7. Fire-resistant doors for staircases. 8. No cutouts to the upper floors from the basement.

43.2.4 General Exit Requirements Exits should meet country/state regulations. Focus on: 1. Exits through staircases or ramps; no lifts during the fire. 2. Width, height, and number of exits as per regulations. 3. Exit doors opening outside for easy egress. 4. Exit doors opening into enclosed stairways. 5. Exit doors are openable without keys. 6. Fire-rated doors, assembly, and hardware with proper labelling. 7. Access-controlled doors with manual release devices if provided. 8. Automatic opening of boom barriers, access-controlled doors, etc., during the fire. 9. Compliance with walking surface regulations. 10. Exit access, corridor width, capacity, and travel distance per regulations. 11. Avoid obstructions in the exit access. 12. Properly lit exit access with floor or fluorescent strips. 13. Adequate exit signage and evacuation plans in the building. 14. Exit access should not pass through any room or hall. 15. Exit travel distance per regulations.

43.2.5 Corridors and Passageways 1 . Corridors and passageways’ width and height should comply with regulations. 2. The exit corridor width should not be less than the exit doorways width. 3. Corridors should be well-ventilated and free from obstructions. 4. Doors opening into corridors should open inside the room to allow smooth traffic flow.

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43.2.6 Staircases Staircases should meet the regulations: 1 . Internal staircases with external walls made of non-combustible materials. 2. Avoid using metal staircases due to fire heating. 3. No pipelines or ducts are allowed in the staircase. 4. Handrail on one side with regulated height. 5. Avoid lifts opening into staircases. 6. External stairs should open directly to the ground in an open area. 7. Avoid using spiral staircases.

43.2.7 Ramps 1 . Ramp width, minimum headroom, and inclination per regulations. 2. Non-slippery ramp flooring. 3. Ramps without sloped turnings. 4. Landings at both ends of the ramp. 5. Handrails on both sides of the ramp.

43.2.8 Electrical and Emergency Power Emergency power plan should meet the regulations: 1 . Provide emergency lighting with a standby generator or UPS. 2. Emergency power to critical fire and life safety systems and equipment. 3. Automatic activation of emergency power within one second of failure. 4. Use non-flammable materials for emergency power systems. 5. Locate fire and life safety equipment panels in fire-safe zones. 6. Use metal conduits for cables in fire detection and suppression systems.

43.2.9 Air Conditioning, Ventilation and Smoke Control Air conditioning and ventilation system should comply with regulations: 1 . Minimize fire spread risks from such systems. 2. Curb the spread of smoke to other floors and suppress smoke. 3. Provide separate AHUs for different floors or compartments. 4. Ducting should be separate for each floor or compartment and preferably made of metal.

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5 . AHUs should have proper non-combustible filters to curtail smoke. 6. Seal openings around ducts in walls properly.

43.2.10 Fire Barrier Provide proper fire barriers as per regulations, horizontally or vertically. Seal all shaft openings to prevent fire and smoke spread.

43.2.11 Glazing Take care of glazing design: 1 . Use tempered non-combustible glass for the glass façade. 2. Place sprinklers near the glass façade for full coverage. 3. Seal all gaps in the glass façade. 4. Provide sufficient fire-openable panels.

43.2.12 Surface Interior Finishes Use non-combustible walls and ceiling surface finishes as recommended per regulations.

43.2.13 Fire Command Center (FCC) Design FCC on the ground floor near the entrance with direct user access: 1 . Control room with fire alarm panel and public address system. 2. Controls and monitors fire detection and suppression systems, pressurization, and smoke management. 3. Provide CCTV monitoring station. 4. Detailed floor plan with marked escape routes and key locations.

43.3 Fire Detection and Alarm Adequate fire detection system provision as per regulations:

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1. Provide an intelligent, addressable fire detection system with smoke detectors, heat detectors, manual call points, hooters/strobes, etc., connected to a microprocessor-­based control panel. 2. Integrate fire detection and suppression systems for a coordinated response, activating alarms, sprinklers, fans, doors, etc. 3. Install smoke detectors, heat detectors, and other components as per regulations, using FRLS-insulated wires in MS conduits.

43.4 Fire Extinguishers/Fixed Fire Fighting Installations 1. Follow guidelines to protect the hospital building with various types of extinguishers, sprinklers, water spray systems, etc. 2. Wall-mount extinguishers for easy accessibility. 3. The number and specifications of fire-fighting equipment depend on regulations.

43.4.1 Static Water Storage Tanks Provide an underground/terrace static storage tank with the capacity according to regulations for supplying water to firefighting devices like hydrants, sprinklers, downcomers, and yard hydrants.

43.4.2 Fire-Fighting Pump House The pump house should be equipped with two auto-start main pumps, two jockey pumps, and one diesel engine-operated fire pump set, connected to the emergency power supply, to supply water to the hydrant, sprinklers, and yard hydrant.

43.4.3 Automatic Sprinkler Installation Install automatic sprinkler system as per regulations. 1 . Maintain appropriate distance between sprinklers as per regulations. 2. Avoid installing sprinkler systems in sensitive areas like OR, ICU, record room, CT, MRI, PET, or other such areas where water spray may damage medical equipmentThis chapter highlights Fire Safety Management, which is subject to the specific Rules and Regulations of the country or state.

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Designers and hospital management are advised to thoroughly review these rules before planning and designing Fire Detection, Suppression, and Safety Management infrastructure.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 47, Fire safety. p. 479–84.

Chapter 44

Green Hospitals

A green hospital is not globally defined but can be described as a building that optimizes natural resources efficiently and in an eco-friendly manner, aiming to enhance patient care and well-being. Hospitals rely on various resources, which contribute to their carbon footprint and impact the environment. The deteriorating state of the environment, with global warming and pollution, has heightened the importance of adopting sustainable practices. Green building concepts are being promoted worldwide, and different countries have designated agencies to frame policies, guidelines, and ratings for green buildings, including green hospitals. These green building frameworks categorize buildings based on their sustainability achievements.

44.1 What Is Green Hospital A Green Hospital enhances patient care by efficiently utilizing natural resources and adopting environment-friendly practices.

44.2 Elements of a Green Hospital During the planning and designing phase of a hospital building, the following elements should be considered to create a green hospital:

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44.2.1 Energy Conservation Hospitals are prone to more energy consumption as compared to other commercial buildings. The following issues can be addressed for energy conservation in the green hospital: 1. Switch to LED light bulbs for energy-efficient lighting. 2. Optimize HVAC thermostat settings for temperature control. 3. Use energy-efficient electrical fittings and appliances. 4. Raise awareness to reduce energy consumption hospital-wide. 5. Encourage turning off equipment when not in use. 6. Turn off AHUs or air-conditioning when rooms are vacant. 7. Maximize natural light during daylight hours. 8. Seal room leakages for effective air conditioning. 9. Regularly maintain electric motors and compressors. 10. Utilize light and occupancy sensors for efficient lighting. 11. Install in-row cooling with heat reclaim in data centres. 12. Implement controllers to reduce voltage for external lighting. 13. Use vestibules for temperature control between spaces. 14. Regularly check and maintain boilers. 15. Limit hot water usage to specific time periods. 16. Replace conventional doors and windows with thermal-resistant materials. 17. Properly insulate HVAC ducts and pipelines. 18. Insulate exterior walls, roof, and flooring. 19. Use photocell-controlled faucets for water conservation. 20. Employ heat recovery systems to capture wasted heat. 21. Implement an Energy Management System for monitoring usage. 22. Upgrade energy-consuming equipment with energy-efficient alternatives. 23. Focus on building envelope design for energy efficiency. 24. Consider cogeneration systems like combined heat and power (CHP). 25. Conduct periodic energy audits to identify inefficiencies. 26. Use variable-frequency drives (VFDs) for energy-saving. 27. Consider heat-recovery chillers for combined cooling and heating needs. 28. Encourage cold-rinse for kitchen and laundry cleaning. 29. Plant shaded trees or use shading devices to reduce heat transfer. 30. Replace magnetic ballasts with electronic ballasts for efficiency. 31. Super insulate roofs and walls are exposed to direct sunlight. 32. Apply light colours to reduce heat absorption in rooms.

44.2.2 Alternative Means of Energy Generation Hospitals should have their own sources of renewable energy:

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1. Utilize solar energy through photovoltaic (PV) panels for electric power, solar thermal for water heating, and concentrated solar power (CSP) for thermal applications. 2. Employ wind turbines to generate electricity from natural airflow, considering appropriate siting to minimize environmental impact. 3. Utilize hydropower by harnessing water flow in dams and rivers to rotate turbines and generate electricity. 4. Explore geothermal technology for heat or electricity generation from the earth’s energy. 5. Utilize biomass energy from organic plant material through anaerobic digestion to create biogas for electricity or heating hospitals. 6. Harness biogas is formed through organic material decomposition in an anaerobic environment for heating fuel or electricity production. 7. Consider Renewable Natural Gas (RNG) injection into the natural gas pipeline for heating or base-load electricity production.

44.2.3 Water Conservation The following issues need to be addressed for the conservation of water 1. Implement rainwater harvesting to collect and reuse rainwater for irrigation, cleaning, and cooling towers. 2. Install low-flow water-efficient fixtures in toilets, urinals, and showers to save water. 3. Use sensing devices in sinks to automatically turn off water when not needed. 4. Recycle drained water from the hospital using ETP and aerobic Sewage Treatment Plant (STP) for various non-potable purposes. 5. Regularly check plumbing and pipes to prevent water leakages. 6. Opt for drought-resistant plants and mulch landscaping to minimize water requirements for irrigation. 7. Incorporate rain gardens in landscaping to utilize stormwater runoff. 8. Consider drip irrigation and sprinkler systems for efficient water usage.

44.2.4 Indoor Environmental Quality and HVAC Optimization The following measures can be adopted to reduce the energy costs of the HVAC system. 1. Perform periodic preventive maintenance and calibration of HVAC equipment to ensure efficient operation. 2. Timely clean and replace air filters, valves, insulation, etc., to reduce energy consumption.

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3. Ensure quality water is used in HVAC chillers to increase their life and reduce energy costs. 4. Provide temperature control thermostats to patients for energy conservation. 5. Promote Variable Air Volume (VAV) systems for energy savings. 6. Optimize airflow demand based on the present scenario to save energy. 7. Install upgraded chillers like screw chillers to synchronize with the actual load and reduce energy costs. 8. Use Building Automation System (BAS) and Fault Detection and Diagnostics (FDD) software to control and identify potential faults in HVAC systems. 9. Implement energy-saving measures for operating rooms by switching off HVAC systems when not in use. 10. Replace refrigerant devices containing Chlorofluorocarbons (CFC) with eco-­ friendly alternatives with reduced global warming potentials (GWPs).

44.2.5 Chemical Management The following issues should be addressed to manage the chemicals effectively 1. Frame and implement a specific chemicals action plan with benchmarks and timelines to protect health and the environment. 2. Replace mercury thermometers and blood pressure devices with safer alternatives for a mercury-free hospital. 3. Monitor and manage the use of harmful chemicals, replacing them with safer alternatives if possible. 4. Prefer chemicals that have undergone basic toxicity testing. 5. Provide proper labelling and storage of all chemicals to avoid accidents or spills. 6. Train staff in handling, storing, and applying hazardous chemicals. 7. Strictly follow the national chemical management policy to reduce the use of hazardous chemicals.

44.2.6 Solid Waste Management Hospitals usually generate a lot of waste. The waste generated by the hospital can be biodegradable, recyclable, or hazardous. Proper segregation, storage and safe& effective disposal of such waste is essential to achieve the concept of a green hospital. It has been seen that about 10% to 15% of the total waste generated is from hospitals. The following issues need to be addressed for an excellent waste management 1. Strictly follow country norms and guidelines for handling and disposing of hazardous waste.

44.2  Elements of a Green Hospital

395

2. Reduce construction waste by using more sustainable construction materials and methods. 3. Avoid toxic materials like mercury, plastic, and PVC, as well as unnecessary disposable products. 4. Set up a waste management committee and allocate a budget for waste management. 5. Implement waste segregation at the source, with non-hazardous waste sent for recycling. 6. Conduct comprehensive waste management training and awareness campaigns. 7. Vaccinate and provide personal protective equipment to waste handlers. 8. Dispose of waste in an economical, safe, and environmentally friendly manner. 9. Establish policies and guidelines to achieve zero waste and align hospital operations accordingly. 10. Store waste in a secured and restricted space. 11. Compost biodegradable waste, and landfill-infected plastics after disinfection instead of incineration. 12. Reduce inhaled anaesthetic atmospheric waste by using low fresh gas flows and avoiding high-impact anaesthetics like Desflurane and Nitrous Oxide. 13. Minimize intra-venous pharmaceutical waste by using prefilled syringes and disposing of unused medications as per regulations. 14. Reduce anaesthesia equipment waste by using reusable or reprocessed equipment instead of disposable

44.2.7 Environmental Services A clean environment in and out of health care facilities is important to reduce and control infections, provide quality air, and reduce pests etc. Some of the measures that can be taken for a better environment are as below 1. Pay attention to the components of cleaning agents, pest control chemicals, and other materials used, discouraging the use of toxic and harmful substances. 2. Adopt Integrated Pest Management (IPM) to reduce the use of harmful chemicals and target specific pests. 3. Minimize the use of products containing harmful substances such as carcinogens, mutagens, and respiratory irritants. 4. Reduce atomizing chemicals to limit their spread in the environment. 5. Minimize the use of virgin paper in janitorial paper and opt for products containing recycled content. 6. Promote the use of microfiber-based cleaning equipment to cut chemical waste and increase performance. 7. Improve indoor air quality with the use of indoor plants and a well-designed ventilation system.

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8. Protect and restore natural habitats and minimize the environmental impact of buildings and infrastructure. 9. Avoid materials like lead and cadmium-containing paint and asbestos. 10. Implement natural ventilation systems and improve lighting and acoustical settings for better environmental quality. 11. Inspect and seal roof parapets and caps to prevent pests from entering. 12. Regularly inspect and remove bird nests and other potential breeding areas for pests. 13. Repair and seal orifices, cracks, and holes in walls to prevent pest entry. 14. Maintain proper distance between vegetation and the main building perimeter. 15. Use physical barriers to block the entry of pets and animals inside the hospital premises. 16. Prohibit smoking inside the hospital and provide designated smoking areas away from main entrances and air intakes. 17. Use natural ventilation whenever possible and consider mechanical systems for ventilation as needed. 18. Avoid foam furniture and opt for alternatives without harmful flame retardants.

44.2.8 Food Services Agriculture and food systems have a significant impact on the environment and human health. Hospitals can promote health by providing fresher, good-tasting, nutritious food choices for patients, healthcare workers and visitors by supporting food production that is local, humane, and protective of the environment and health. To achieve an environmentally-friendly food system, the hospital should keep in mind the following few issues: 1. Strive to eliminate the use of disposable food containers and bottled water, or opt for biodegradable/compostable alternatives. 2. Minimize the use of paper products like napkins, and opt for those with recycled content. 3. Implement food waste composting to reduce waste and create compost for sustainable agriculture. 4. Ensure that food products are sourced and prepared in an environmentally safe and sustainable manner. 5. Develop a sustainable food plan and policy, increasing procurement of locally and regionally produced foods. 6. Explore ways to reduce food waste through innovative food preparation and service methods. 7. Donate leftover food to food banks and community groups instead of disposing of it. 8. Consider starting an organic garden on-site if space permits.

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9. Eliminate fast food and sugar-based soft drinks in hospital cafeterias and vending machines. 10. Encourage vendors to supply food produced without synthetic pesticides and hormones or antibiotics for animals. 11. Promote nutritious, socially equitable, and ecologically sustainable food practices and procedures to patients, healthcare workers, visitors, and the community

44.2.9 Environmentally Preferable Purchasing During the normal course of operation, the hospitals have to necessarily purchase a lot of products such as pharmaceuticals, chemicals, reagents, disposables, consumables, equipment, fixtures, food, cleaning and other general supplies. If environmentally-­friendly products are purchased, it can have a significant impact to improve sustainability. For environmentally preferable purchasing, the following should be taken care of 1. Purchase products with minimal packaging to reduce waste and environmental impact. 2. Phase out instruments and equipment containing mercury and replace them with sustainable alternatives. 3. Prefer local vendors who supply third-party certified sustainable products and follow ethical practices. 4. Insist on suppliers disclosing chemical ingredients and safety testing data before purchasing products.

44.2.10 Sustainable Construction Materials Sustainable construction is creating a healthy environment that’s designed and constructed based on ecological principles. Sustainable construction focuses on principles like protecting nature; high quality; conserving; reusing; recycling/renewing, and creating non-toxic effects on the environment. For sustainable construction, the following issues should be addressed: 1. Choose new generation, stronger, lighter, and more sustainable building materials to reduce the environmental impact of construction. 2. Use precise cutting and reshaping methods to minimize material wastage during construction. 3. Opt for materials that produce less wastage, such as wooden flakes or dust from plyboard cutting. 4. Substitute wooden scaffolding with iron scaffolding to reduce the use of timber. 5. Consider constructing green buildings and adaptive reuse projects for old buildings to promote sustainability.

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6. Manage construction sites effectively to reduce environmental impact, including treating water on-site and recycling materials. 7. Focus on energy conservation during construction to minimize overall environmental footprint.

44.2.11 Pharmaceutical Minimization, Management and Disposal For a healthy environment, the procurement, management, and disposal of pharmaceuticals in a prescribed appropriate, safe manner are necessarily required. Hence the following measures should be adopted: 1. Prescribe small initial quantities of pharmaceuticals during new prescriptions to reduce waste. 2. Avoid providing samples of medications to patients, and instead, consider providing them to those who have difficulty purchasing medicines. 3. Provide necessary training to healthcare workers for safe and proper disposal of leftover expired pharmaceuticals. 4. Develop training programs for healthcare workers to optimize their medicine prescribing practices. 5. Introduce centralized procurement and distribution plans for pharmaceuticals to control purchased quantities and streamline distribution. 6. Establish contracts with suppliers to ensure the return of excess pharmaceuticals.

44.2.12 Reducing Transportation Cost The hospital can reduce its transportation emissions by effectively following a few of the following measures: 1. Encourage the use of public transportation by providing infrastructure near the hospital. 2. Promote the usage of alternate fuels like CNG and electric vehicles for hospital transport. 3. Encourage healthcare workers, patients, and visitors to use bicycles, public transportation, and carpools. 4. Prefer purchasing products from local suppliers or suppliers who use fuel-­ efficient transportation methods. 5. Promote telemedicine to reduce unnecessary travel and air pollution. 6. Consider providing off-site small healthcare facilities at different locations to reduce the need for unnecessary travel.

Further Reading

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7. Dispose of hospital waste near the point of generation to avoid unnecessary transportation of waste.

44.2.13 Greenery The below-mentioned measures can be adopted for increasing greenery inside and outside of the hospital: 1. Create courtyards and gardens for relaxation, treatment, and naturopathy procedures. 2. Implement green roofs, facades, and walls to improve insulation and reduce heating and cooling costs. 3. Incorporate indoor gardens in central areas, waiting rooms, and treatment areas to improve air quality and create a pleasant atmosphere. 4. Design attractive landscaping for hospital grounds, including green borders and trees. 5. Promote indoor plants to improve air quality and remove pollutants inside buildings. 6. Plant shaded trees in the car parking area to reduce heat stress for visitors and lower fuel consumption. 7. Utilize dense vegetation on the hospital boundary as a barrier for protection. 8. Design patient rooms with views of outside greenery. 9. Create green outdoor gardens for ambulatory patients to relax. 10. Provide easy access to indoor and outdoor green areas for patients, staff, and visitors.

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 48, Green hospitals. p. 485–98.

Section IV

Equipment Planning

Chapter 45

Equipment Planning

Equipment in hospitals refers to articles and implements for specific activities, aiding diagnostic investigations and treatment. It includes medical and mechanical machines, distinct from fixtures. Hospital equipment can be Fixed (e.g., MRI, CT Scan) or Loose & Mobile (e.g., monitors, surgical instruments). Detailed planning, coordination, and budgeting are crucial for procurement. The objective is to select suitable products within budget, procured, delivered, and commissioned timely. The planner assesses clinical needs, functionality, cost, frequency of use, income potential, and useful life of equipment, considering technological changes and reuse options. Understanding departmental preferences and architectural details is essential for efficient equipment functioning.

45.1 Choosing the Desired Equipment After finalizing the equipment list, the planner must select the desired equipment from the market. In a competitive market, numerous manufacturers offer various models of the same equipment, each with different costs based on specifications, configuration, capacity, size, and performance. The planner’s role is to determine the required specifications and choose the model that best fits the needs.

45.1.1 Quality of the Equipment When selecting medical equipment and devices, prioritize uncompromising quality and patient safety. Choose vendors with a quality mindset, emphasizing product excellence and compliance. Healthcare facilities employ a wide range of

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 A. Garg, Handbook on Hospital Planning & Designing, https://doi.org/10.1007/978-981-99-9001-6_45

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equipment, from simple tools to complex, technologically advanced machines. The main factors supporting quality assurance are: 1. Non-quality products risk patient harm, injuries, or even death due to defects or malfunctions. 2. Unstandard equipment lacks proper calibration, leading to incorrect results and misdiagnosis. 3. Quality products prioritize safety, minimizing risks to individuals, property, and the environment. 4. Medical equipment adheres to global rules and regulations, such as the U.S. Food and Drug Administration (FDA), (QSR) for product performance and safety, and Standard ISO 13485 complementing the Medical Device Directive. 5. Quality medical equipment tends to have a longer lifespan compared to substandard alternatives. 6. Maintenance and repair costs for quality equipment are lower compared to others.

45.2 Points to Be Considered While Purchasing the Medical Equipment 45.2.1 Equipment Specification and Configuration Finalize equipment specifications and configurations before selecting vendors. Opt for the latest technology while considering its financial feasibility. Compare the increased costs of the latest equipment with the hospital’s technology requirements.

45.2.2 Warranty Choose equipment with the maximum warranty period to reduce maintenance concerns.

45.2.3 Maintenance Contracts Equipment manufacturers offer Annual Maintenance Contracts (AMC) with or without spare parts (CMC – Comprehensive Maintenance Contract). It is advisable to opt for CMC, as it eases the hospital’s worries about the cost of replacing spares.

45.2  Points to Be Considered While Purchasing the Medical Equipment

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45.2.4 Availability of the Service Engineers and the Workshops Ensure vendors have nearby workshops and a team of engineers to attend breakdown calls promptly and conduct regular preventive maintenance. Adequate spare parts stock on-site prevents time delays and increases machine uptime.

45.2.5 Period of Spare Part Availability Before procurement, confirm with vendors the availability of spare parts for at least 10 years.

45.2.6 Cost of Consumables Check and compare consumable costs for equipment like laboratory analysers before purchasing. The open system technology is preferred over closed systems to avoid dependency on a single supplier and potential cost issues.

45.2.7 Life Expectancy of the Equipment Ensure the expected lifespan of the equipment and assess possible technology changes or improvements in design.

45.2.8 Plan for Space and Development Each hospital room (patient room, ICU, diagnostic lab, etc.) has unique equipment space demands. Before assigning spaces, ensure sufficient and efficient areas for desired equipment installation.

45.2.9 Vendors Evaluation Check the vendor’s track record in terms of after-sales service quality, efficiency, spare parts availability, and service infrastructure.

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45.2.10 Regulatory Compliance Identify and adhere to local building codes, accreditation agencies, controlling authorities, federal and state legislature norms, and industry standards relevant to the equipment during the planning phase.

45.2.11 Inspection and Testing Before the Transfer of Ownership Before transferring ownership and signing commissioning reports, the Biomedical Engineer should inspect and test the equipment. Conduct dummy tests to check equipment operation, electrical safety, radiation safety, and other essential factors before final affirmation.

45.3 Equipment Used in the Hospital Hospitals require a wide variety of equipment for efficient functioning, ranging from small and affordable to large and costly items that demand substantial space. While it’s not feasible to list all medical equipment available in the market, I have compiled a few with their respective purposes. List of medical equipment generally used in the hospital Emergency & Triage Air Bed

ECG Machine

LED Monitor Medical Grade for Laparoscopes Light Source with Fibre optic Cable for Laparoscopes Micro Processor Controlled Electrosurgical Unit Modular Operation Theatre with Pendants MRI

Anaesthesia Workstation

Echocardiogram

Analyser Blood Gas/ pH

Elec. Surgical Cautery

Bipap Machine

Electrolyte Analysers

Blood Warmer

Head Light

Boyles Machine C Arm (Image Intensifier)

Hemoglobinometer Multi-Para Monitor High Flow Nasal Cannula Multi Para Monitor with ETCO2

Portable OT Light

Recording System

Scrub Station two/three Bay Suction Machine Surgical Operating Instruments Syringe Pumps Telescopes of Laparoscope

407

45.3  Equipment Used in the Hospital Camera HD for Laproscopes CT Scan Defibrillator DVT Pump

Infusion Pumps

Muscle Stimulator

Ultra Sound Machines

Insufflator Invasive Ventilators Laparoscopic Set

OT Light OT Table Pneumatic Tourniquet Electric

UPS 10 KW Vaporizer X-Ray DR System Stationery/Portable

Infusion Pumps Multi Para Monitor

Suction Machine Syringe Pumps

Pulse Oximeter

X-Ray DR System Portable

Electrolyte Analysers High Flow Nasal Cannula Infusion Pumps Invasive Ventilators

Multi Para Monitor Syringe Pumps

Indoor Wards and Patient Rooms Air Bed Blood Warmer Analysers Blood Gas/ Defibrillator pH Bipap Machine ECG Machine Intensive Care Units (ICUs) Air Bed Defibrillator Analysers Blood Gas/ DVT Pump pH Bipap Machine ECG Machine Blood Warmer Echocardiogram

Ultra Sound Machine X-Ray DR System Portable

Robotic Surgery Surgical Robot with Master control, Magnified 3D HD vision, Slave Control, foot pedals for electro surgery, Clutch for camera and instrument control, Surgical manipulator; Endo wrist functionality etc. Cardiology & Interventional Cardiology ACT Machine Electro physiology Lab Hypothermia Device TEE Probe with (Blanket, Plumbing & Ultrasound Heat Exchanger) Ambulatory ABP Electrocardiograph Instruments for Cath Tilt Test Table Monitor (ECG) Lab Cath Lab Gamma Camera Intra-Aortic Balloon TMT Pump Defibrillator, High Holter Monitoring Pacemaker Temporary Energy, (Including System Paddles) Pulmonology Body Box Diffusion EBUS PC Based Spirometry Rigid Bronchoscope Broncho fiberscope Endobronchial PFT System with Video Broncho scope Adult Ultrasonography TBNA Diffusion, Ros Q MEP/ MIP Broncho fiberscope FENO (Fractional Polysomnography Video Thoracoscope Set Paediatric Exhaled Nitric Oxide) (Sleep Lab) Diffusion for DLCO Neurology Digital Video Ocular Plethysmograph Stimulator Transcranial magnetic Electroencephalograph Neuromuscular stimulation (TMS) (EEG) EMG Polysomnography (PSG) Stimulator Peripheral Video (electromyogram)/ Nerve Electroencephalography NCV/EP Machine (VEEG)

45  Equipment Planning

408 Gait and Balance Analysis Nystagmograph Neurosurgery Aversive Conditioning Device Biofeedback Device

Electroconvulsive Therapy Device

Stimulator Intracerebral/ Subcortical Stimulator Nerve

Stimulator Spinal-Cord VNG

Intracranial Pressure Monitoring Device Neurosurgical Fragmentation and Aspiration Device Ophthalmodynamometer

Radiofrequency Lesion Probe Skin Potential Measurement Device

Evoked Response Auditory System

Percussion Hammer

Hypothermia Device to Treat Spinal-Cord Injury Interferential Current Therapy Psychiatry ECT (Brief Pulse Constant) Nephrology BN ProSpec and BN II System Nephelometer System Colorimeter Urology Automatic device for monitoring and detecting kidney damage. Columns for Immunoadsorption in Extracorporeal Systems Cystoscope

Physiological Signal Amplifier

Stimulator Neuromuscular Stimulator Peripheral Nerve

Spectrum, Stimulator Spinal-Cord Electroencephalogram (EEG) Signal Analyzer Stimulator Stimulator Vegas Nerve Intracerebral/ Subcortical Stimulator Nerve Tilt Table Test

Pinwheel

EEG

Multi Behaviour Sex Therapy Machine

Dialysis Chairs

RO Plant

Self-Illuminating Microscope

Erectile Dysfunction Device

Holmium or Thulium Laser

Uro Dynamics cum Uroflometer

ESW Lithotripter

Hydraulic Cytometric Device

Ureteroscope

Green Light Laser

Nephoscope

Wearable, smartphonecontrolled device for treating premature ejaculation (PE)

Dialysis Machines

Gastroenterology, Hepatology & Pancreatology 24 hr. pH Impedance Cholangioscope/ Choledochoscope, Flexible or Rigid Breath Analyser Colonoscope Capsule Endoscopy

Stimulator Vegas Nerve

Duodenoscope

Endoscopic Ultrasound Upper Gastro Intestinal (EUS) scope Enteroscope Manometry Unit

Upper GI Endoscope PEDIA Video Processor

45.3  Equipment Used in the Hospital Electro Surgical Cautery with Argon Plastic, Cosmetic, Burn and Vascular Surgery CO2 Fractional Laser Electric Dermatome Cryosurgical Unit & Erbium Yag Laser Accessories Diode Laser Hair Growth Laser

409

C-Arm

Drill & Saw System Hyper Baric Oxygen for Micro Surgery Therapy Machine Gynaecology & Obstetrics Baby Resuscitation Equipment for Assisted Unit Delivery Colposcope (and Colpomicroscope) In Vitro Fertilization (IVF) CODA Extra Inline Integrated Vertical Filter Laminar Flow with TFT monitor and FCG Table Cryogenic Cans Inverted Research Microscope with Micromanipulator Doppler Ultrasound for Intrauterine Pressure Foetal Evaluation Recorder Heracell CO2 Incubator Paediatric (Neo-Natal ICU) Baby Incubator ICE lined Refrigerator Baby Resuscitation Infantometer Unit Baby Weight Machine Infusion Pumps Humidifier Multi Para Monitor Orthopaedic & Rheumatology Dynamometer Goniometer Gait Analysis Meter Ophthalmology Angio O.C.T

Dynamometer

KTP Laser ND Yag Laser Long Pulse ND Yag Laser Q Switch Osteotome

Pulse Diode Laser RF Cautery

Labour Table

Monitor Uterine Contraction

Makler Counting Chamber

Trinocular Stereo Zoom Microscope

Neodymium Yag Laser

Uterine Contraction Monitor

Spermfuge

Vertical Laminar Flow for Andrology

Neonatal CPAP (Bubble) Oxygen Hoods

Phototherapy Under Surface Phototherapy Upper Surface Radiant Warmer

Paediatric Ventilator

Pneumatic Tourniquet Electric Varicose Laser

Plaster Cutter

Sensory Evoked Potential (SEP)

Orb’s Scan

Applanation Tonometer A-Scan A-Scan with water immulsion Auto Keratometer

Exophthalmometer

NA Yag Laser (Long Pulse Yag Laser) O.C.T

Femto Lasix Fornixscope

Ocular Esthesiometer Ophthalmic Camera

Radiation Beta Unit Retinoscope

Fundus Camera

Slit-Lamp

Auto Refractometer

Humpry Automated

Ophthalmic Refraction Unit Ophthalmoscope

Pachymeter (NCT)

Synapthophare

45  Equipment Planning

410 B-Scan with UBM

Indirect Ophthalmoscope

C3R Machine

Kerato meter (KMS6)

Contrast Sensitivity Lensometer Chart Otorhinolaryngology (ENT) Audiometer ENT Examination Unit with Endoscope, Camera and Chair Bronchoscope ENT Microsurgical (Flexible or Rigid) Carbon-Dioxide Laser Bronchoscope, Filli Form Set, Eustachian Non-Rigid Electroglottograph Impedance Audio Meter Dermatology, Cosmetology, Venereology Cryotherapy unit Diode Laser Pulsed

Ophthalmic Laser (Green) Ophthalmic Trial Frame and Trial Box

Tonometer, Non-Contact (Pachymeter) Visual Acuity Chart

Laryngoscope

Otoscope

Nasopharyngoscope (Flexible) Oesophagoscope (Flexible or Rigid) Otodyamics Otoport (DP + TE) (OAE)

Speech Trainer Software

Liquid Nitrogen Cryogenic Tank MIPL Laser Phototherapy lamps

RF Cautery

Derma Abrader Derma Peel

Electro-Cautery machine Fractional CO2 Laser

Dermatological Ultraviolet Light Dermatoscopes

High Freq. Radio Surgery PUVA Chamber Unit Iontophoresis Unit Q Switched Nd-Yag Laser

Oncology Brachytherapy Cyber Knife 6MV General Items in All Operating Rooms Anaesthesia Heavy Duty OT Table Workstation Boyles Machine Hyperthermia System, Extracorporeal Camera HD Insufflator C-ARM

Laparoscopy Set

Cryogun

Laser scalpel

Defibrillator

LED Monitor Medical Grade Light Source with Fibreoptic Cable Micro Processor Controlled Electrosurgical Unit

EES Generator (Harmonic) Elec. Surgical Cautery

Head Light

Strobe Laryngoscope (Endoskope)KS Temporal Bone Lab Station

Skin biopsy punches Skin ultrasound imaging systems Woods lamp

CGT Planner

Linac linear accelerators

Mobile ultrasound system Modular Operation Theatre with Pendants Morcellator

Recording System

Multi Para Monitor with ETCO2 OT Light

Scrub Station Suction Machine Electrical Surgical Loupe

OT Table

Surgical Operating Instruments for all departments Telescopes

Pneumatic Tourniquet Electric Portable OT Light

Uninterrupted Power System (UPS) Vaporizer

45.3  Equipment Used in the Hospital Operative Room CTVS Cardiopulmonary Patient Warming System Bypass Blood Pump (Heart Lung Machine) Hyperthermia Device Sternum saw (Blanket, Plumbing & Heat Exchanger) Intra-Aortic Balloon Pump Operating Room ENT ENT Drill & Saw ENT Operating System Microscope Operating Room Eye Cryophthalmic Unit Ophthalmic Operating Loupe Famto Laser

Ophthalmic Operating Microscope for Cataract Operating Room Gynaecology Culdoscope Fetal Doppler Operating Room Neurosurgery CUSA Neuro Endoscopes Neuro Surgical Operating Microscope & Spine drill Operating Room Urology Cystourethroscope Holmium/Thulium Yag Laser Flexible Fibre Nephoscope Urotero- Renoscope 270 Deg Operating Rooms Orthopaedic Arthroscope Set with Bit, Drill, Micro Motors, Accessories for Knee Saw Reamers etc. and Shoulder Radiology Camera Scintillation Laser Imager Camera (Gamma) Computed Tomography Leakage Tester (CT)

411

Sternum saw Battery

Sternum Saw Blade Guard

Sternum saw Battery Charger

Vacuum Stabilizer System Octopus

Ophthalmic Operating Microscope for Vitrectomy Ophthalmic Laser (Green)

Photofragmentation Unit

Hysteroscope

Hysteroscopy Pump

O-Arm navigation – Spine

Stereotactic Frame

Paediatric Cystoscope

Urethrotome

Vitreous Aspiration and Cutting

Drill & Saw System

Cyclotron/Radio Pharmacy Densitometer, Bone Digital Subtraction Angiography (DSA)

Magnetic Resonance Imaging (MRI) with Spectroscopy Mammographic Machine Digital MRI Fibre optic Pulse Oximeter

Resectoscope

Navigator for Hip replacement

Navigator for Knee replacement

Nuclear Computed Tomography (PET CT) Nuclear Magnetic Resonance Imaging System (PET MRI) Picture Archiving and Communications System PACS Portable X-Ray Machine DR Pressure Die Injector

Rebreathing Systems, Radionuclide Ultrasound Machine

Vascular Doppler

X-Ray Machine DR systems 800/500/300 MA with Fluoroscopy

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412 Pathology Automated Blood Cell Diluting Apparatus Automated Cell Counter Automated Chromosome Analyzer Automated Coagulator Automated Platelet Counting Automated Tissue Processor Binocular Research Microscope Cell Counter, Normal and Abnormal Cell Culture Suspension System Cell-Freezing Apparatus and Reagents Centrifuge Machine High Speed Chromatograph Microbiology Bact Alert System Bacteriological Incubator Binocular Microscope

Chromatograph (GAS) Chromatograph for Bacterial Identification Clinitek Status Analyser Cytocentrifuge Cytospin Electrolyte Analyzer

Photo Calorimeter Digital

Haemocytometer

Fluorometer Gene Expert

Automated Urinalysis System Blender/Mixer

Rotary Microtome Serological Water Bath

Gas Solid/Liquid Chromatograph Column Supports Haematology Analyser

BOD Incubator CD4 Counter

Biochemistry Analytical Balance Automated Clinical Chemistry Systems

Mass Spectrometer Micrometres, Microscope Microscope Binocular Microscope Fluorescence/UV Microscope Inverted Stage, Tissue Culture

Bio Safety Cabinet

Distilled Water Plant

Projection Microscope

Electronic Precision Balance Electrophoretic Haemoglobin Analysis System Fibrometer

Egg Incubator Electronic Colony Counter Electrophoresis Instrumentation Elisa Reader with Washer

Deep Freezer

Ion-Exchange Chromatograph Laminar Air Flow Horizontal Magnetic Stirrer

Microtome

E.S.R Analyser

Refrigerated Centrifuge

Slide Strainer, Immersion Type Spectrophotometer Digital Stereoscopic Microscopes

Thin-Layer Methadone Chromatograph Vacuum Oven

Platelet Aggregation Automated System Platelet Aggregometer

Water Bath

Hot Air Oven Immunofluorescent Microscope Lab Incubator

Refrigerated Centrifuge RT- PCR

Laminar Air Flow

T.B. Culture Bact/Alert 3D Thermocycler Ultracentrifuge

MGIT 960 Microscope Binocular LED High-Performance Liquid Microscope Chromatograph (HPLC) Fluorescence/UV Homogenizer QBC Microscope (Malaria) Counter For Clinical Use Densitometer/Scanner (Integrating, Reflectance, TLC, Radio chromate.) Drying Unit

Radioimmunoassay

Shaking Water Bath

Vitek

General Use Balance Glass Ware

Nephelometer Osmometers

Liquid Scintillation Counter Membrane Filter Unit

Plasma Viscometer Polarimeter

45.3  Equipment Used in the Hospital

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Block Heating Carbon-Dioxide Analyzer Centrifugal Chemistry Analyzer Centrifuge

Electrolyte Analyser Enzyme Analyzer

Micro Mixer Micro Pipette

Radioimmunoassay Refractometer

Flame Photometer

Microplate Washer

Semi Auto Analyser

Freezer

Shaker/Stirrer

Chemistry Analyzer (Photometric, Discrete) Colorimeter, Photometer, Spectrophotometer Pain Clinic Manujet III Transtracheal Jet Blood Bank Apheresis Machine

Fully Auto. Analyzer (immunoassay) Gamma Counter

Microscope Binocular LED Microscope Fluorescence/UV Monochromator

Micro Surgical Bipolar Coagulator

Radio Frequency Generator

Spine Jet Discectomy Unit

Elisa Reader with Washer HB Meter ID Centrifuge

Platelet Agitator

Mechanical Shaker

Thawing Bath

Plasma Extractor

Water Bath Serological

Blood Mixing and Blood Weighting Device Blood Bag Tube Sealer Cryo Bath Unit Blood Bank Deep Freezer −40 Deg. C Refrigerator Blood Collection Deep Freezer −80 Deg. C Monitor Blood Donor Couch Dielectric Sealer (Mobile) CSSD Brushes for Cleaning Dry Heat Sterilizer Instrument Ethylene Oxide Gas Sterilizer

CBCT Cephalometer

Dental Intraoral Drill Dental Operative Unit

Dental Accessories

Electro Surgical Unit and Pantograph Accessories, Dental Electromagnetic Pulp Tester Bone-Growth Stimulator Fibreoptic Dental Light

Dental Burr Dental Chairs with Unit

Platelet Incubator Refrigerated Centrifuge

Infectious Waste burner Pressure Sterilizers (Incinerator) (Instruments, Dressings, Utensils, Etc.) Plasma Sterilizer Sterilizer (Autoclave)

Cleaner, Ultrasonic, Medical Instrument Dental AC-Powered Bone Saw

Dental Instruments

Water Purifier (Reverse Osmosis)

Jet Injector GasPowered/ Mechanical-Powered Operative Burnisher OPG

Surgical Haemostat

Surgical Headlight Ultraviolet Activator for Polymerization X-Ray Unit, Extraoral with Timer X-Ray Unit, Intraoral

45  Equipment Planning

414 Physiotherapy Ankle Exerciser Balance Trainer

CPM Device for Knee and Hip Cryotherapy system

Bath Sitz, Nonpowered Decompression Therapy System Bath Hydro-Massage Electromyograph Bath Paraffin Wax EMG Biofeedback System Bath Sitz Powered Ergometer, Treadmill Bed Air Flotation Therapy, Powered Bed Air Fluidized Cane Cold Pack

Finger Ladder Hand Exercise Table High Low Couches/ Bobath Tables High Power Laser Therapy Hot Pack

Combination Therapy System(Ultrasound+ Stimulation) Compression Therapy Hydro collator System Occupational Therapy Activity mattress Figure Eight Balance beam set Aluminium sheet Filler (different types) Ankle exercise Fingerboard

Infrared Lamp

Shortwave Diathermy

Iontophoresis Device, Other Uses Isokinetic Testing And Evaluation System Long wave Microwave Diathermy

Shoulder Wheel

Parallel Bars Physiotherapy Gun

Treadmill, Powered Ultra Violet Lamp

Pressure Applying Device Quadriceps table

Ultrasonic Diathermy

Shockwave Therapy System

Wireless Electrotherapy

Low-temperature plastic LTT sheet cutter Medicine ball

Sewing machine

Stimulator Muscle Therapy Device, Direct Current, Low Intensity NeuroRehablitation Traction Equipment, Robotics machine Powered Other Sensory products Transfer Aid

Armeo robotic hand

Finger climbing board

Audio-visual toys

Finger dexterity test(100 holes+tweezer) Finger extension remedial Ortho wheelchair Finger prehension device Overhead shoulder pulley Fluido therapy dry heat Paediatric gaiters therapy unit

Ball pool Bean bag Bed with therapy mats of different sizes from ground Bench grinder with stone Bench vice Bolster roller (different sizes) Box and blocks

Nirmal hand exerciser table Oral motor equipment

Foam adventure set, foam Parallel bar adult gymnasium Foot placement ladder Parallel bar paediatric Footprints Paediatric walker/ relater adjustable Foot roller

Static Cycle

Pegboards of different types and sizes

Unweighing Harness System

Shoulder pulley Shoulder wheel/ multipurpose wheel Sorting matching posting box set Sound discrimination set Standing frame Standing table with frame Static bicycle

Steel scissors Strong scissors Supinator and pronator (Rainbow and zig zag type) Supine sander

45.3  Equipment Used in the Hospital Building blocks Buttoning hook Carousel spinning chair Cerebral palsy chair

Footstool double step Full-length mirror Gel ball set

Pencil grips Pencil maze test board Percussion hammer

Tape measuring Target game Texture mat

Geometric puzzle board

Physic gym ball set (different sizes), peanut shape therapy ball Pinch tree

Therapeutic putty (Different colours according to hardness) Therapy mat/activity mattress Tilt table Trampoline

Cervical air traction

Goniometre (full circle, half circle, finger) Corner chair/floor sitter Grip exercises Counting and colour Gross motor skill sorting beads set development set Cosy caterpillar Gymnic multi-activity stone Crash pad Hammer Crawler for CP Hand dynamometer

Crawling tunnel Crutch Dendrite/fevicol Different types of peg boards Door latch frame set Dressing frame

Poly poplin sheet Power stretch band (different level) Prone crawling board Prone sander Puzzle program set

Hand exerciser power web combo Hand gym kit board Heat bath Heat gun

Pyramid round and pyramid square Quadriceps board Rainbow river stone Reached

Hilltops –set of 5 Hole punch

Rhythm instrument Rabbit

Dumbbells

HPEE synthetic leather occupational therapy tumble roller Eating aid with utensils Inclined and horizontal sandboard Electrical drill machine Inclined tapered balance beam Electro equipment Indoor and outdoor play frame set equipment like plastic balls, softballs in small and big sizes, basketball indoor kits for kids, and movable toys with light and sound. Envil Jigsaw

Equilibrium board/ balance board/wobble board

415

Keyhole test board

Rocking horse

Trimming knife Velcro Vestibular/swing system, on-the-go swing, air walker therapy swing, cocoon swing Vibrator machine or toys Vise group pliers Walker Wavy tactile path Wax bath Wedge (different sizes according to need) Weight cuff (different weights)

Rope ladder

Weighted blanket

Round nose pliers

Wheelchair detachable

Sanding unit reciprocal Wheelchair paediatric exert with incline

Sanding unit semi-circular table model Sensory brush/ vibrating brush

Wiggle seat

Wire cutter

45  Equipment Planning

416 Ergometer Exercise staircase

Fidget set Patient Furniture Attendants Stool Attendants Couch Bed Screens Bed Side Locker Deluxe Bed Side Locker General Beds Deluxe Civil Furniture Examination Table Wooden with a Mattress File Almirah (4 Drawers) File Racks Backup Services Ambulance Autoclaves

Linear motion steadiness test apparatus electrical Locomat

Long-handled brushes and comb

Wrist circumductor

Sensory motor/ Wrist rollator perceptual motoractivity indoor fun gym Sensory stimulation Wrist rotation activities kit rehabilitation

Beds General Beds ICU Motorised Beds Semi Fowler Motorised Cribs

I.V Stand I.V. Rod Instrument Trolley

Patient Stool Pillows Step Stool (Double)

Mattress

Stretcher Trolley

Cylinder Trollies

Over Bed Table

Wheel Chairs

Lockers Large

Office Chairs (Executive)

Steel Almirah Small

Office Chairs

OPD/Waiting Chairs

Visitors Chairs

Office Chairs (Deluxe)

Steel Almirah Large

Visitors Chairs (Executive)

Cleaning Equipment

Hospital Operating Software Oxygen Cylinders “A” Type Oxygen Cylinders “B” Type

Televisions

Automatic folding machines

Sewing machines

Nebulizer Heavy Duty Otoscopes

Suction Machine Baby Torch

Splints And Tourniquets Sponge Holder

Tongue Depressor

Syringe Needle Destroyer

Weight Machine Adult

Dressing Trollies

Bed Partitions

Computers with Printers & UPS Fridges

Hospital Laundry Washer cum dryer

Calendar for pressing

Hydro extractor Iron press Miscellaneous Small Instruments B.P Apparatus Fumigator 5 Ltr. Baby Weighing Hammer Small Machine Chetal Forceps Height Scale Cidex Trays 222 × 82 × 41 Cidex Trays 400 × 70 × 50

Sensory brushes

Humidifiers Laryngoscopes

Water Coolers

Trauma Packs and Kits

417

Further Reading Ear Specular Examination Lamps Formalin Chamber Medium

Mortuary Cabinets (Cooled) Nasal Forceps Needle Holder

Stethoscope Adult

X-Ray View Box Double

Stethoscope Paed.

X-Ray View Box Single

Further Reading Garg A. Monitoring tools for setting up the hospital project: initial planning, building and equipment. India: Springer Singapore; 2023a. Garg A. Monitoring tools for setting up the hospital project: department-wise planning. India: Springer Singapore; 2023b. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 49, Equipment planning. p. 501–27.