MULTI-SPECIALITY HOSPITAL

DESIGN@VIRUTHUNAGAR
DATA COLLECTION-BACKGROUND STUDY

-S.HARI PRASANNA
16AR12
Definition
Multi- Specialty Hospital is the hospital which has all the different branches of Medicine
and surgery under one roof. The term Multi-speciality Hospital at district level is used
here to mean a hospital at the secondary referral level responsible for a district of a
defined geographical area containing a defined population.
Grading of Multi-speciality Hospitals
Based on the assumptions of the annual rate of admission as 1 per 50 populations and
average length of stay in a hospital as 5 days, the number of beds required for a district
having a population of 10 lakhs will be around 300 beds.
Grade I: District hospitals norms for 500 beds
Grade II: District Hospital Norms for 400 beds
Grade III: District hospitals norms for 300 beds
Grade IV: District hospitals norms for 200 beds
Grade V: District hospitals norms for 100 beds.
The total number of admissions per year = 10,00,000 × 1/50 = 20,000
Bed days per year = 20,000 × 5 = 100,000
Total number of beds required when occupancy is 100% = 100000/365 = 275 beds
Total number of beds required when occupancy is 80% = 100000/365 × 80/100    = 220
beds
Physical Infrastructure
Area and Space norms of the hospital
Land Area
500 beds and above = 6.5 hectare (4.5 hectare for hospital and 2 hectare for residential)
Size of hospital as per number of Beds
General Hospital - 80 to 85 sqm per bed to calculate total plinth area.
Teaching Hospital - 100 to 110 sqm per bed to calculate total plinth area.
Following facilities/area may also be considered while planning hospital.
(i) Operation Theatre a. One OT for every 50 general in-patient beds
b. One OT for every 25 surgical beds.
(ii) ICU beds = 5 to 10 % of total beds
(iii) Floor space for each ICU bed = 25 to 30 sq m (this includes support services)
(iv) Floor space for Paediatric ICU beds = 10 to 12 sq m per bed
(v) Floor space for High Dependency Unit (HDU) = 20 to 24 sq m per bed
(vi) Floor space Hospital beds (General) = 15 to 18 sq m per bed
(vii) Beds space = 7 sq m per bed.
(viii) Minimum distance between centres of two beds = 2.5 m (minimum)
(ix) Clearance at foot end of each bed = 1.2 m (minimum)
(x) Minimum area for apertures (windows/ Ventilators opening in fresh air) = 20%
of the floor area (if on same wall) = 15% of the floor are
Site selection criteria
Physical description of the area which should include bearings, boundaries,
topography, surface area, land used in adjoining areas, drainage, soil conditions,
limitation of the site that would affect planning, maps of vicinity and landmarks or
centers, existing utilities, nearest city, port, airport, railway station, major bus stand,
rain fall and data on weather and climate.
• The location may be near the residential area.
• It should be in an area free of pollution of any kind including air, noise,
water and land pollution.
• It must be serviced by public utilities: water, sewage and storm-water
disposal, electricity and telephone. In areas where such utilities are not
available, substitutes must be found, such as a deep well for water,
generators for electricity and radio communication for telephone.
Hospital Building – Planning and Lay out
Appearance and upkeep
• The hospital should have a high boundary wall with at least two exit gates.
• Building shall be plastered and painted with uniform colour scheme.
• There shall be provision of adequate light in the night so hospital is visible from
approach road.
• Proper landscaping and maintenance of trees, gardens etc. should be ensured.
Signage
• The building should have a prominent board displaying the name of the Centre in
the local language at the gate and on the building. Signage indicating access to
various facilities at strategic points in the Hospital for guidance of the public should
be provided. For showing the directions, colour coding may be used.
• Hospital lay out with location and name of the facility shall be displayed at the
entrance.
• Directional signages for Emergency, all the Departments and utilities shall be
displayed appropriately, so that they can be accessed easily.
• Florescent Fire Exit plan shall be displayed at each floor.
• Safety, Hazard and caution signs displayed prominently at relevant places
Condition of roads, pathways and drains
• Approach road to hospital emergency shall be all weather motorable road.
• Roads shall be illuminated in the nights.
• There shall be dedicated parking space separately for ambulances, Hospital staff and
visitors. There shall be no stagnation/over flow of drains.
Environmental friendly features
• The Hospital should be, as far as possible, environment friendly and energy efficient.
Rain-Water harvesting, solar energy use and use of energy-efficient bulbs/
equipment should be encouraged. Provision should be made for horticulture
services including herbal garden. A room to store garden implements, seeds etc. will
be made available.
Barrier free access
For easy access to non-ambulant (wheel-chair, stretcher), semi-ambulant, visually
disabled and elderly persons infrastructure as per “Guidelines and Space Standards for
barrier-free built environment for Disabled and Elderly Persons” of Government of
India, is to be provided. Provisions as per ‘Persons with Disability Act’ should be
implemented.
Administrative Block
Administrative block attached to main hospital along with provision of MS Office and
other staff will be provided. Block should have independent access and connectivity to
the main hospital building, wherever feasible.
Circulation Areas
Corridors – Corridors shall be at least 3 m Wide to accommodate the daily traffic. Size
of the corridors, ramps, and stairs shall be conducive for manoeuvrability of wheeled
equipment. Corridors shall be wide enough to accommodate two passing trolley, one
of which may have a drip attached to it. Ramps shall have a slope of 1:15 to 1:18. It
must be checked for manoeuvrability of beds and trolleys at any turning point.
Roof Height
The roof height should not be less than approximately 3.6 m measured at any point
from floor to roof.
Entrance Area
• Barrier free access environment for easy access to nonambulant (wheel-chair,
stretcher), semi-ambulant, visually disabled and elderly persons.
• access points to the site, in order to segregate the traffic
Emergency: for patients in ambulances and other vehicles for
emergency department.
Service: for delivering supplies and collecting waste.
Service: for removal of dead
Main: for all others
Residential Quarters
All the essential medical and para-medical staff will be provided with residential
accommodation.
Departmental Lay Out Clinical Services
Outdoor Patient Department (OPD)

The facility shall be planned keeping in mind the maximum peak hour patient load
and shall have the scope for future expansion. OPD shall have approach from main
road with signage visible from a distance.
• Reception and Enquiry
• Waiting Spaces
Waiting area with adequate seating arrangement shall be provided. Main
entrance, general waiting and subsidiary waiting spaces are required adjacent to
each consultation and treatment room in all the clinics. Waiting area at the scale
of 1 sq ft/per average daily patient with minimum 400 sq ft of area is to be
provided.
• Layout of OPD
Enquiry→Registration→Waiting→Sub-waiting→ Clinic→Dressing room/Injection
Room→Billing→ Diagnostics (lab/X-ray)→Pharmacy→Exit

• Clinics
The clinics should include general, medical, surgical, ophthalmic, ENT, dental,
obsetetric and gynaecology, Post Partum Unit, paediatrics, dermatology and
venereology, psychiatry, neonatology, orthopaedic and social service
department. Doctor chamber should have ample space to sit for 4-5 people.
Chamber size of 12.0 sq meters is adequate.
The clinics for infectious and communicable diseases should be located in
isolation, preferably, in remote corner, provided with independent access.
Immunization Clinic with waiting Room having an area of 3 m × 4 m in PP
centre/Maternity centre/Pediatric Clinic should be provided.
1 Room for HIV/STI counseling is to be provided.
• Nursing Services
Dressing room, side laboratory, injection room, social service and treatment rooms etc.
Imaging
The department shall be located at a place which is accessible to both OPD and wards
and also to operation theatre department.
The room shall have a sub-waiting area with toilet facility and a change room facility.
Film developing and processing (dark room) shall be completely cut of from direct light.
Ultrasound room shall contain a patient couch, a chair and adequate space for the
equipment. The lighting must be dim for proper examination. Hand-washing facility and
toilet shall be attached with ultrasound room.
Clinical Laboratory
The department shall be situated such that it has easy access to IPD as well as OPD
patients.
Storage space shall be adequate (10% of total floor space) with separate storage space
for inflammable items.
There shall be separate and demarcated areas for sample collection, sample
processing, hematology, biochemistry, clinical pathology and reporting.
Blood Bank
Blood bank shall be in close proximity to pathology department and at an accessible
distance to operation theatre department, intensive care units and emergency and
accident department. Separate Reporting Room for doctors should be there.
Intermediate Care Area (Indoor Patient Department)
General IPD beds shall be categorized as following
• Male Medical ward
• Male surgical ward
• Female Medical ward
• Female surgical ward
• Maternity ward
• Paediatric ward
• Nursery
• Isolation ward
Wards in IPD
• Emergency ward/trauma ward
• Burn Ward
• Orthopaedic ward
• Post operative ward
• Ophthalmology Ward
• Malaria Ward
• Infectious Disease Ward
• Private ward: Depending upon the requirement of the hospital and
catchment area, appropriate beds may be allowed for private facility. 10% of
the total bed strength is recommended as private wards beds.
Ward Unit
The basic aim in planning a ward unit should be to minimize the work of the nursing
staff and provide basic amenities to the patients within the unit.
Ward unit will include nursing station, doctors’ duty room, pantry, isolation room,
treatment room, nursing store along with wards and toilets as per the norms.
• There shall be at least 2.5 metre between centres of two beds to prevent
cross infection and allow bedside nursing care.
• Every bed shall be provided with IV stand, bed side locker and stool for
attendant. Screen shall be available for privacy.
• Toilets with running water facility and flush shall be provide for each ward.
Pharmacy (Dispensary)
The pharmacy should be located in an area conveniently accessible from all clinics.
The size should be adequate to contain 5 percent of the total clinical visits to the OPD
in one session.
Pharmacy should have component of medical store facility for indoor patients and
separate pharmacy with accessibility for OPD patients.
Dharamshala
It is a premises providing temporary accommodation for short duration. The area shall
be minimum 0.25 hectares of land adjoining or within the Hospital premises.
Intensive Care Unit and High Dependency Wards
General
In this unit, critically ill patients requiring highly skilled life saving medical aid and nursing
care are concentrated.
The number of patients requiring intensive care may be about 5 to 10 percent of total
medical and surgical patients in a hospital.
The unit shall not have less than 4 beds nor more than 12 beds.
In a 500-bedded hospital, total of 25 beds will be for Critical Care. Out of these, 13 may be
ICU beds and 12 will be allocated for High Dependency Wards.
Changing room should be provided
Location
This unit should be located close to operation theatre department and other essential
departments, such as, X-ray and pathology so that the staff and ancillaries could be
shared.
Easy and convenient access from emergency and accident department is also essential.
This unit will also need all the specialized services, such as, piped suction and medical
gases, uninterrupted electric supply, heating, ventilation, central air conditioning and
efficient life services.
Accident and Emergency Services
• It should preferably have a distinct entry independent of OPD main entry so that
a very minimum time is lost in giving immediate treatment to casualities arriving
in the hospital.
• Signage of emergency shall be displayed at the entry of the hospital with
directional signage at key points.
• Emergency shall have dedicated triage, resuscitation and observation area.
Screens shall be available for privacy.
• Separate provision for examination of rape/ sexual assault victim should be
made available in the emergency as per guidelines of the Supreme Court.
• Emergency should have mobile X-ray/ laboratory, side labs/plaster room/and
minor OT facilities. Separate emergency beds may be provided. Duty rooms for
Doctors/nurses/ paramedical staff and medico legal cases. Sufficient separate
waiting areas and public amenities for patients and relatives and located in such
a way which does not disturb functioning of emergency services.
Operation Theatre
The location of Operation theatre should be in a quite environment, free from noise
and other disturbances, free from contamination and possible cross infection,
maximum protection from solar radiation and convenient relationship with surgical
ward, intensive care unit, radiology, pathology, blood bank and CSSD.
There may be four well defined zones of varying degree of cleanliness/asepsis namely,
-Protective Zone, Clean Zone, Aspectic or Sterile Zone and Disposal or Dirty Zone.
There are three types of traffic flow, namely,
-patients, staff and supplies.
An Operation Theatre should also have Preparation Room, Pre-operative Room and
Post Operative Resting Room.
There should also be a Scrub-up room where operating team washes and scrub-up
their hands and arms, put on their sterile gown, gloves and other covers before
entering the operation theatre.
Operation Theatre should also have a Sub-Sterilizing unit attached to the operation
theatre limiting its role to operating instruments on an emergency basis only.
Delivery Suite Unit
The delivery suit unit be located near to operation theatre & located preferably on the
ground floor.
• Reception and admission • Scrubbing Room
• Examination and Preparation Room • Dirty Utility
• Labour Room (clean and a septic room) • Doctors Duty Room
• Delivery Room • Nursing Station
• Neo-natal Room • Nurses changing Room
• Sterilizing Rooms • Group C & D Room
• Sterile Store Room • Eclampsia Room
Post Partum Unit
It is desirable that every District Hospital should have a Post Partum Unit with
infrastructure to provide Post natal services, all Family Planning Services, Safe Abortion
services and immunization in an integrated manner.
Physical Medicine and Rehabilitation (PMR)
The department is more frequently visited by out-patients but should be located at a
place which may be at convenient access to both outdoor and indoor patients with
privacy. It should also have a physical and electro-therapy rooms, gymnasium, office,
store and toilets separate for male and female.
Hospital Administrative and Support Services

• Management Information System (MIS)

• Hospital Kitchen (Dietary Service)
It should easily be accessible from outside along with vehicular accessibility and
separate room for dietician and special diet. It should be located such that the
noise and cooking odours emanating from the department do not cause any
inconvenience to the other departments. At the same time location should
involve the shortest possible time in delivering food to the wards.
• Central Sterile Supply Department (CSSD)
It should be easy access to operation theatre department. It should have a
provision of hot water supply.
• Hospital Laundry
It should be provided with necessary facilities for drying, pressing and storage of
soiled and cleaned linens. It may be outsourced.
• Medical and General Stores
Medical and general stores should have vehicular accessibility and ventilation,
security and fire fighting arrangements.
Cold Chain Room: 3.5 m × 3 m in size Vaccine &
Logistics Room: 3.5 m × 3 m in size
Mortuary
The Mortuary shall be located in separate building near the Pathology on the Ground
Floor, easily accessible from the wards, Accident and emergency Department and
Operation Theatre. It shall be located away from general traffic routes used by public.
A separate room for body storage shall be provided with at least 2 deep freezers for
preserving the body. There shall be a waiting area for relatives and a space for religious
rites.
Post-mortem room should have proper illumination and air conditioning.
Other Amenities
Disabled friendly, WC with basins wash basins as specified by Guidelines for disabled
friendly environment should be provided.
Committee Room
A meeting or a committee room for conferences, trainings with associated furniture.
RECOMMENDED
ALLOCATION OF
BED STRENGTH

REQUIREMENTS
OF OPERATION
THEATRE