An Architectural Brief For A Proposed 100-Bedded Hospital: HOSMAC (India) Pvt. LTD

AN ARCHITECTURAL BRIEF FOR A PROPOSED

100-BEDDED HOSPITAL

DISSERTATION WORK DONE BY

Dr. Preet Matani
AT
HOSMAC (India) Pvt. Ltd
AN ARCHITECTURAL BRIEF FOR A PROPOSED 100 BEDDED HOSPITAL
ACKNOWLEDGEMENT
The dissertation period gave me an opportunity to explore the field which has always
intrigued me and where my interest was- that of facility planning.
I am indebted to Dr. Vivek Desai – Director HOSMAC (India) Pvt. Ltd. for giving me an
opportunity to work in his organization as there are but a handful of such organizations where
I could have pursued such a study.
I am extremely grateful to Mr. Hussain Varawalla- Sr. Architect HOSMAC (India) Pvt. Ltd., my
guide who took a lot of efforts for my sake.
I am also extremely grateful for the support provided by my seniors Mr. Sameer Mehta and
Mr. Kapil Rawal who were a constant source of encouragement at HOSMAC.
I would like to thank Brig. S.K. Puri, my guide, for having faith in me and I hope that I would
be able to live up to his expectations.
I am also indebted to my teachers Dr. S.G. Kabra and Dr. Hari Singh for their guidance
throughout my academic career.
Lastly but not the least I would like to thank my friends - Shekhar, Rupesh, Gaurav Tripathi
and Benjamin for always being with me throughout my stay at IIHMR.
PREET MATANI
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TABLE OF CONTENTS
CHPT TOPIC PAGE

NO NO.
1 STUDY DESIGN
1.1 INTODUCTION AND BACKGROUND INFROMATION 1
1.2 RATIONALE FOR THE STUDY 3
1.3 OBJECTIVE 4
1.4 SPECIFIC OBJECTIVES 4
1.5 METHODOLOGY 4
1.6 LIMITATIONS OF THE STUDY 5
1.7 TIME PERIOD AND PLACE 5
2 ABOUT THE ORGANIZATION 6
3 LITERATURE REVIEW 15
4 SPACE PROGRAM 23
5 OPERATION THEATRE 38
6 INTENSIVE CARE UNITS 50
7 RADIOLOGY 61
8 LABORATORY 72
9 CENTRAL STERILE PROCESSING DEPARTMENT 80
10 PATIENT ROOM 87
BIBLIOGRAPHY 89
ANNEXURES
1 LIST OF LICENCES, REGISTRTIONS AND APPROVALS 90
2 AERB SPECIFICATIONS FOR MEDICAL DIAGNOSTIC 91

EQUIPMENT (X-Rays)
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EXECUTIVE SUMMARY
This study was carried out at HOSMAC (India) Pvt. Ltd, a consultancy firm of
repute. HOSMAC has experience of building several hospitals with many new
projects in the pipeline. This study is about a brief for a proposed 100-bed
hospital. It is both exploratory and descriptive in nature.
Once a decision to build the hospital has been taken the next step is its
architectural design. A detailed architects brief has to be first prepared to enable
the architect in drawing up his plans. The landscape, facility mix, bed mix,
availability of utilities in the vicinity will have to be considered. Considerable
inputs from other agencies like air-conditioning, electrical, plumbing, etc. will be
required to finalize the working plan for the building. Inputs from the equipment
vendors especially in specialty areas like Cath-labs, CT-scanners, MRI, linear
accelerators, operation theatres etc. will be essential. In India a common thing is
lack of emphasis given to support services like kitchen, laundry, CSSD, back-up
electricity and so on. Not only are these services vital, but these also have high
capital cost and recurrent expense and hence should be properly planned. Just to
illustrate the standards for healthcare design in India, we are still designing
facilities where total area per bed is hardly 600 sq. ft. whereas western standards
are close to 1,400 – 2,000 sq.ft. per bed and WHO recommends an area of 800-
1200 sq. ft per bed. While it may not be prudent to follow the western concepts
blindly, one needs to pick up the good things from the modern methods. Some of
the issues that could be adapted from developed countries are flexibility for
future expansion, larger secondary areas for better patient comfort, proper
utilities for wait areas, nurse stations, storage, changing rooms, alcoves for
stretchers/ wheelchairs, adequate transport facilities, parking facilities, proper
light and ventilation etc.
In the case of hospitals functional complexities far outweigh physical complexities
and demand an addition to the planning and design team of persons who
understand not only the work process of individual departments but those of the
hospital operating system as a whole.
The study will help in formulating a functional brief or an architects brief that will
have an analysis of functional needs, interrelationship of departments, area
requirements, major equipment, the grouping of accommodation and the main
outline of traffic flow.
This document would help the architect in understanding the complex needs of
hospital functioning and enable him to build a hospital that is functional, efficient,
and yet economical without compromising on the design aspect.
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1.1 INTRODUCTION AND BACKGROUND INFORMATION:
Planning can be defined as ' The specification of the means necessary for the
accomplishment of goals and objectives before action towards these goals has
begun'
What are the various things that must be addressed to during healthcare
programming and design process?
1. Provide a functional design that ensures efficient, safe and appropriate work
spaces.
2. Accommodate technical requirements for highly sophisticated equipment.
3. Create clear, segregated paths for movement of people and material within
the building.
4. Create a humane environment for patients and staff.
5. Develop building systems that can accommodate rapid change.
6. Blend technical and functional requirements into a design that brings delight
to those who use the building and those who pass by it.
Architects and construction-oriented professionals acting alone may provide a

building that operates efficiently as a physical structure, however, it is equally
possible that they may entirely miss the mark in terms of operational
functionality.
And Functionality as a prime determinant of operational efficiency is a major
factor in the total life cycle cost of all hospital structures. There is also little doubt
that quality of care and treatment is also affected by the degree to which design
accommodates both inter and intra-departmental functions. Hence a new
discipline called functional planning has emerged over the past few years, which
augurs well for the future of hospital design. Individuals possessing adequate
training and experience in this field have made and are making substantial
contributions to the planning and design process. Usually such planners have
backgrounds in hospital management. They could also be architects who have
specialized in hospital architecture or trained personnel of consulting firms.
Responsibilities of a functional planner:
1. Physical evaluation of existing facilities (along with architect)

2. Functional evaluation of existing facilities.
3. Preparation of workload projections.
4. Functional programming.
5. Space programming (along with architect).
6. Master site planning (along with architect).
Although functional planning of hospitals has not reached its maturity and
indeed may never do so, concepts springing from its practice are burgeoning
yearly as intense study is made of alternative operational and building systems.
There are even more innovative changes in operational methods and procedures
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on the horizon as demands for greater employee productivity are considered. All
this will directly depend upon architectural design for implementation and few
can be brought into being without direct input to the design process by
functional planners.
Determination of the services to be provided in quantitative terms requires

consideration of the following:
Ø Functions
Ø Locations
Ø Relationship
Ø Utilization
Ø Staffing pattern
Ø Space requirements
Ø Work flow.
Before an architect can develop a hospital design that will best serve its
functions he has to be provided a written programme explaining these
requirements. This is the architects brief from the interpretation of which he
prepares schematic drawings and sketch plans.
The brief would contain the permission required from various regulatory bodies,
spatial needs of various departments, manpower required, special requirements
of various departments, inter and intra departmental relationships.
1.2 RATIONALE FOR THE STUDY:
The future will see a continued demand for the construction of healthcare
facilities including completely new or replacement facilities and projects involving
major additions and modernization. The annual value of healthcare construction
projects will see an uptrend in the immediate years ahead owing to various
factors like opening up of the insurance sector and privatization initiatives.
Therefore planning and design will continue to merit prime emphasis amongst
other responsibilities of healthcare officials. In the case of hospitals functional
complexities far outweigh physical complexities and demand an addition to the
planning and design team of persons who understand not only the work process
of individual departments but those of the hospital operating as a single
functional system. Functional planning is the responsibility of a trained hospital
administrator who should be capable of interpreting complex relationships,
internal traffic flows (personnel and supplies),
Technological requirements and operational procedures to the extent a product of
beauty, reasonable cost and optimal utility will result. A functional design can
promote skill, economy, conveniences and comforts whereas a nonfunctional
design can impede activities of all types, detract from the quality of care and
raise costs. A non-functional building is the nemesis of any hospital striving to
compete in the current climate of competition and emphasis on productivity. Thus
this stage consisting of preparation of the architects brief is important as the
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design of the hospital will become crystallized during this phase. Time and
trouble spent during this stage will be well repaid and will enable the whole
project to proceed smoothly with a minimum of subsequent revision.
In undertaking any complex activity it is well to examine the experiences of

others in similar situations if such information can easily be found and properly
interpreted.
1.3 OBJECTIVE:
To prepare an architectural brief that would help the architect to build a

functional, economical, and efficient hospital.
1.4 SPECIFIC OBJECTIVES:
1. To study/understand the issues involved in functional planning of a hospital.
2. To determine the recent trends and changes in the healthcare facility needs
and to evolve a document that can incorporate these changes so as to enable
the architects to build hospitals in tune with modern requirements.
3. To draw up a space plan for the proposed hospital.
4. To study certain departments in greater detail and to provide a brief that may
be used as a basis for detailed programming later on.
1.5 METHODOLOGY:
§ Both primary and secondary research was carried out with more emphasis on
the latter.
§ Primary research will involve in-depth interviews with hospital consultants and
architects experienced in building healthcare facilities.
§ Secondary research will involve descriptive studies of the functional planning
carried out while building hospitals in the recent past. This will also involve
literature review by going through different books and journals.
Thus the study design is both exploratory and descriptive in nature.
1.6 LIMITATIONS OF THE STUDY:

Ø Considering the time factor all the departments of the hospital were not
dealt with, only certain key departments were covered.
Ø The study could provide only a preliminary brief for the architect. It would
be the basis for the development of a more detailed brief.
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1.7 TIME PERIOD AND PLACE:
The study was carried out at HOSMAC (India) Pvt. Limited, Mumbai from 24th
January till 17th April 2003.
Chpt. 2 ABOUT THE ORGANIZATION:

HOSMAC India Private Limited is a pioneering name in the field of Hospital
Planning & Management consultancy in India. Since its inception in 1996,
HOSMAC has grown rapidly to become a Unique hub of skill sets which cuts
across various facets of a health care facility be it architecture, engineering,
management, or information technology.
In a short span of 6 years, HOSMAC has notched up an impressive string of more

than 80 projects in India and abroad. HOSMAC provides the entire range of
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services that any health care service provider, may require: undertaking market
research, feasibility studies, detailed architectural design, project co-ordination,
equipment procurement, commissioning assistance, conducting an operational
audit for existing hospitals.
To provide such wide-ranging services HOSMAC has a motivated team of highly

qualified and experienced professionals (doctors, MBAs, architects, engineers and
project managers). On a cumulative basis these professionals have more than
245 man years of experience and have rendered more than 60,000 hours of
management consulting services, designed 1.4 million sq feet of hospital space,
and are coordinating hospital projects worth more than 3.34 billion INR.
Unlike other industries, the health care industry is extremely complex in terms of
the wide spectrum of specialties, technologies, and the skilled/unskilled
manpower. The smooth interplay of these factors only will lead to a successful
health care organization. The alarming rise in cost for providing quality health
care will drive hospitals to cut costs rather than only enhancing revenue.
Some of HOSMAC’s services

OSPITAL PLANNING & PROJECT MANAGEMENT
Market Research For Project Conceptualization
A comprehensive market research is undertaken to ascertain the needs in the
local health care market. HOSMAC's field workers are specifically trained to
conduct surveys and gather secondary data from various governmental and non-
governmental agencies.
The survey could include –
§ households
§ medical professionals
§ diagnostic centres
§ nursing homes
§ hospitals.
§ relevant data from census report, demographic surveys,

government/media publications, and various other sources is also
searched
Such a market study is essential:
§ to primarily know the deficiencies in the health care market, thereby

assisting us arriving at a proper facility & bed mix.
§ to helps us finalizing the project size
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§ for existing hospitals to undertake benchmarking in areas like tariff

rationalization, compensation policies, utilization reviews for various
services etc.
Feasibility Reports
Having decided on the facility mix, the next value added service provided by
HOSMAC includes a very detailed and comprehensive feasibility study of the
project. This has been our major strength and we have to credit more than 30
such studies. We are proud to mention here that many of our reports have been
accepted by leading Financial Institutions in the country like IDBI, ICICI, IL&FS
and multilateral agencies like the World Bank, Kfw etc.
The feasibility report would essentially contain the following vital information:
§ Brief description on the major findings of the market research
§ Proposed facilities plan
§ Detailed project cost inclusive of land & building, medical equipment, non-
medical equipment, furniture & fixtures, utilities, pr-operative costs,
contingencies, and working capital requirement, and the means of finance
§ Income and expenditure projections based on the feedback from the

market research and form HOSMAC's exhaustive database
§ Profit and Loss/ Balance sheet/Cash flow statements
§ Break even analysis
§ Sensitivity analysis
Architectural Designing
It is a known fact that Hospital Architecture in India is a neglected specialty.
HOSMAC's aim is to bridge this gap by providing modern yet practical cost-
effective solutions to the health care industry.
Healthcare architecture differs from that of other building types in the complexity
of the functional relationships between the various parts of the hospital. In the
residential and commercial building types the design brief is relatively easy to
understand and cater to. Healthcare architecture, however, requires specialized
knowledge on the part of the architect and the supporting engineering team. The
lack of such trained professionals results in many of the hospitals in India today
being ill conceived and costing their promoters much more in construction and in
inefficient operation than they need to. Eventually it is the patient who bears the
brunt of this incompetence through lack of quality in the medical care provided,
physical and mental discomfort and increased cost of hospitalization.
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Specialized healthcare architecture is a field that is still in its infancy in India. As

pioneers in the field, HOSMAC is uniquely positioned to advise its' clients. This
advice is based on the combination of the skills and knowledge of our varied
team of professionals, which consists of doctors, architects, engineers and
hospital management graduates and the resource of an extensive database of
information compiled over the years.
However, this specialized field is not only about satisfying the stringent functional
demands that the hospital makes on its designer. The emphasis of healthcare
architecture is also on improving the quality of the environment for patient and
caregivers alike. It must meet the needs of people who use such facilities in
times of uncertainty, stress, and dependency on doctors and nurses. It must
recognize and support patients' families and friends by providing pleasant spaces.
At the same time the building should project an underlying reassurance that the
patient is in the hands of competent medical staff and in a technically sound
healthcare facility.
In the future patients will be increasingly demanding of healthcare organizations.

Those facilities that are designed to be most responsive to patients in terms of
convenience, caring encounters, service orientation and the quality of care will do
best in meeting these new demands.
Architects are regarded as talented problem solvers. The problem here is to find
a way to deliver a high quality of care and access in a setting that is also highly
supportive of human relationships during times of great anxiety and fear. The
particular skills of HOSMAC's design team are well suited to meeting this
challenge.
We invite you to proceed to learn more about how HOSMAC (India) can help you
design and construct your proposed healthcare facility.
Project Management
Apart from providing Architectural Designing solutions, HOSMAC also provides
the most vital project management services. An ardent need was felt for this as
most hospital projects in India suffer from lack of co-ordination between various
agencies like the promoters, architects, contractors, consulting agencies, doctors,
equipment vendors etc. HOSMAC thus identified this as a vital growth area and
has been rendering such services to help our clients in combating TIME/COST
overrun apart from giving functionally sound infrastructure solutions.
This service includes important activities
§ Liaison with all Agencies - Architects/contractors/equipment

vendors/utility service consultants and suppliers
§ Monitoring Project with PERT/CPM
§ Managing Change in Project Plans - most vital and complicated component

due to the various fall outs from the change in project design
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§ Managing equipment planning schedule including cost-feature analysis,

procurement process, installation etc.
MANEMENT CONSULTANCY
Management Consultancy Services
Turn Around Strategies
Such assignments include studying the historical trends of the hospital in terms
of its income/expenditure patterns, identifying cost/profit centers, identifying the
key success criteria for improving the bottomline. Having done this we provide a
strategic business plan with definite milestones to implement our
recommendations and monitor the same.
Operational Audits
This is again a niche service provided by HOSMAC for health care institutions
requiring specific departments to be studied for improvement which may be
qualitative and/or efficiency related. An example of studies could include:
§ improvement of the lab services
§ operation theatre utilization reviews
§ manpower audits
§ medical audits
§ infection control programs
§ reorganization of profit centres
§ support service audits etc.

Costing of Services
This is a highly specialized service which we provide. It is a well known fact that
hospitals in India set their tariffs in comparison to the market rates. This leads to
skewed rate setting and the customer is the looser. HOSMAC has conducted
several costing exercises for our clients to help them understand the real cost of
providing services by virtue of which our clients have an advantage over their
competitors. In many cases we found that hospitals were under pricing their
services hoping that volumes will cover up the cost, whilst they were actually
increasing their losses. We have developed an in-house format for costing of
various services on a department wise basis which enables us to conduct our
studies in a systematic manner within a short span of time.
Systems Study & Re-design
Though HOSMAC does not provide computerization solutions, we are thorough in
system analysis and provide vital interface solution with the agency providing the
computer solutions. Also such assignments are essential for hospitals which do
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not have computerized systems for various activities. The activities involved
include 'walking through' the processes, identifying the stumbling blocks, finding
solutions, redesigning the systems/processes/forms/reports/records,
implementing the 'changed' processes and providing online correctional
interventions. Many of our clients have found our association to be invaluable
whilst implementing the computerization modules.
Manpower Audit & Training
Hospitals are labour intensive institutions and salary expenditure forms the major
head of expenditure. Therefore it is of paramount importance that a proper
manpower plan is formed and implemented. Also notable feature is that in
hospital setting the interaction between the highly skilled and unskilled workforce
is of a very high magnitude leading to IR problems. Whilst conducting such study,
we undertake an exhaustive manpower audit of all departments and benchmark
it with the industry standards to ascertain the deficiencies. Wherever required re-
distribution of manpower, job enlargement, and job enrichment solutions are
recommended. Customized training programs are conducted targeting specific
needs like attitudinal change, team building, grooming in etiquettes, etc.
Marketing Strategies
This has been one of our most popular services and we have devised and
implemented successfully our marketing plans. We begin our assignment by
benchmarking the services against the best hospitals in the client's service
segment and conducting a customer satisfaction survey to understand the
drawbacks in our services and products to be marketed. This followed by a
proper product development for marketing, which includes improvement in the
service delivery mechanisms, proper pricing, identification of target audience,
preparation of brochures/mailers, and setting milestones for productivity
enhancement. We help our clients in implementation of the strategy by making
visits to the corporates and monitoring the overall process of marketing.
L EQUIPMENT PLANNING
Biomedical Equipment - Planning & Procurement Norms
Advances in Engineering and Information Technology in the recent years have
brought about several changes in the field of Medical Science. Medical Equipment
play a very significant role in the field of medicine and healthcare delivery
system. Sophisticated biomedical equipment requires a host of utilities like the air
conditioning and refrigeration, stabilized power supply systems etc. The design
criteria of these support systems are of paramount importance.
Hospital equipment fall into an extremely wide spectrum ranging right from a hi-
tech MRI and CT scanner to a simple patient trolley. These all account for a major
part of any hospital project cost, which could go upto almost 60%. Of this,
biomedical equipment could account for nearly 50% of the cost. Keeping this in
view it is essential to ensure maximum utilization of the equipment with
minimum downtime.
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The health care industry is experiencing a new era in cost containment. In the
past, little attention was given to the financial impact of equipment related
decisions. Today, however, times have changed. In this new environment, "state-
of-the-art" is no longer sufficient as planning criteria for selecting new
technology. Today, for a technology to be appropriate, it must address the needs
for efficiency, cost-effectiveness, and productivity and at the same time, improve
or maintain the quality of patient care. In addition, hospitals are finding
themselves in an extremely competitive arena, which puts an additional emphasis
on a technology's marketability. The challenge faced by hospital executives today
is to gain the management and control required to make effective equipment
planning decisions.
Whilst medical devices can be broadly categorized into diagnostic and therapeutic
equipment, the selection criteria for procurement would need to take into account
several factors viz. type of hospital & level of services provided; services
available in the neighbourhood and technology employed; background of the staff
that would operate the equipment; proposed tariff for the services employing
medical devoices; etc. Having addressed these issues one would need to carry
out a separate financial feasibility for the major and critical equipment and then
set out to prepare the specifications and features of the medical devices that
would be considered most appropriate for the hospital. After having undergone
this exercise too there are multiple products that one can choose from. For this
one would need to apply further criteria and do a detailed analysis of factors
related to the technology and design base of the equipment; the maintenance
convenience and available service support; forthcoming technology and
interchangeability with the current generation; presence of the manufacturer /
vendor in the existing market place; and once again the factors are several!
Product Development Assistance
§ Provide benchmarking data regarding market expectation from a hospital

management system
§ Details hospital best practices
§ Undertake detailed reviews of newer modules and upgrade versions and

provide recommendation of any enhancements/modification
§ Periodic comprehensive review and study of the existing modules to update

and upgrade continuously
Implementation Assistance
§ Jointly prepare implementation plan with solution provider
§ Undertake a comprehensive system study
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§ Gap analysis
§ Preparing specification for customization
§ Site monitoring assistance
§ Undertake audits of the sites where software is already installed to identify

areas of problem
Business Development Assistance

§ Provide business development assistance in terms of identifying new leads,
represent and recommend the business partner during presentation to key
clients as hospital consultants.
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LITERATURE REVIEW:
Since Henri Fayol's pioneering treatise on management in 1916, planning has

involved two considerations, i) Assessing the future and ii) making provisions for
it.
According to Robert M. Fuller "Planning is of course decision Making because it
involves selecting from among established alternatives" Certainly the adoption of
a systematic planning process is imperative in any hospital facility. Failure to
adopt and to adhere to a specific methodology almost invariably results in a
deterioration of the quality of planning. Architectural design represents the most
definitive act of planning any building project. Although representing a new
discipline, functional planning already has achieved recognition through its
contribution to operational functionality and has become a key factor in hospital
design. Future research in this area of planning and design process may further
enhance productivity in the healthcare field.
In terms of broad categories of activities the process of hospital project planning
can be a multistep process.
The steps are as follows:
1. Perception of need for a building program.
2. Strategic Planning and feasibility assessments.
3. Organizing for planning, design and construction.
4. Determining the planning, design and construction approach.
5. Scheduling planning, design and construction.
6. Opening the completed project.
The role of the Functional planner is most important in steps 3 and 4.
Selection of the professional planning team
A complete team should possess capabilities in

• Financial Feasibility Consulting.
• Functional Planning.
• Architectural and Engineering services
• Construction Management.
Selection Timing:
The Functional Planner, the architect and the construction manager can all
make valuable contributions in the early stages of a project and should be
contracted at approximately the same time. Because the functional planner has
the most intense involvement in the very first stages, he might be brought in
first, but the other two must closely follow.
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The possibility to influence a project and its cost is reduced during the course of
its development after the client has decided to establish the requirements of the
user and started to investigate the problems. The largest reduction of possibilities
to influence the design occurs at point 1, which marks the clients decision
concerning implementation. The figure is based on a study by Stig Nordquist.
Responsibilities of a Functional Planner:
1. Physical evaluation of existing facilities (along with architect)

2. Functional evaluation of existing facilities.
3. Preparation of workload projections.
4. Functional Programming.
5. Space programming (along with architect)
6. Master site planning (along with architect)
1. Physical evaluation of existing facilities:
This is a study to determine the degree of physical obsolescence of existing

facilities and to identify major code violations and physical problems and to
project future usability.
2. Functional evaluation of existing facilities:
This is a study to define functional problems that detract from operational

efficiency, quality of patient care, and convenience of building inhabitants to
evaluate traffic flows and physical relationships, to determine space
insufficiencies in terms of current requirements to study the need for
modernization, alterations and expansion, according to strategic plan findings
and to note possible alternative future uses of the structure as a whole as well
as of various departmental areas.
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3. Preparation of workload projections:
The functional planner can determine and formulate concepts of operation for
the proposed project according to previous study findings. These concepts will
be incorporated in the functional program. These projections form the basis
for functional programming, revenue projections and staffing estimates.
4. Functional programming:
Using approved recommendations and findings of the strategic plan, findings

of physical and functional evaluations and workload projections, the functional
planner formulates recommendations for operational concepts, the detailed
room composition of the project, required phasing, alterations, internal and
external traffic flows, interdepartmental relationships and operating systems.
5. Space programming:
Based on the functional program, as amended and approved by the hospital a

room-by-room listing is made of all areas in the proposed project. Net square
footage is assigned to each space, and totals accumulated for every
department or functional entity. using the net figures, appropriate calculations
are then made to set gross totals for each department or functional entity as
well as the total for the entire project.
Some pointers to successful hospital planning
Good planning is critical to the hospitals success:

If a hospital has to be successful it must be built on the bedrock of three sound
principles, namely good planning, good design and construction and good
management. The absence of the first two of the equally important but closely
related triad, good planning and good design and construction means failure to
design the facilities for the optimum utilization of staff and services. This in turn
results in a mediocre hospital that fails to realize its economic goals.
Efficient, Functional and economical hospital:

The real test of any hospital is the quality of healthcare it provides. If the hospital
has to pass this test- a truly rugged test-planning and design must result in a
functional, efficient and economical hospital. It should be remembered that even
minor defects in designing could make the operation of a hospital inefficient. The
corollary of this is that an inefficient hospital costs significantly more to operate,
staff and maintain, not to mention the fact that the patients within it get less
health services for the money they pay.
It should be borne in mind that economy of operation and maintenance over the
life of the building as well as the quality care to patients depends in a large
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measure on the proper planning and designing of the hospital and is more
important than the economy of construction. The initial cost of building a hospital
is insignificant when compared to the cost of running and maintaining it over the
years- by one reckoning eighteen to twenty times over a period of say twenty
years. Another study says that the running cost of a hospital over 4 to 5 years
from the date of completion is about the same as the capital cost. and if the
facilities are not planned and designed properly this intangible cost can be
enormous. the efficiency with which the physicians and their assistants can
function has been greatly handicapped by obsolete design. Patient comfort and
provision for expansion have often been overlooked. Growing efficiency and
innovative ideas have revolutionized hospital building construction to meet
among other things, the special needs of patients. It is believed that a pleasant
environment that makes for an enthusiastic and more productive staff also
benefits the patients albeit indirectly.
Promoters and hospital planners often overlook to include in the facilities design
what helps to preserve the patients' dignity and status as a human being or
details that would make the hospital more livable. Many patients complain that
hospitals as institutions reduce privacy, individuality and more importantly
human dignity. Many of these details and facilities can be incorporated with little
or no extra cost.
While planning and designing a hospital the patients needs and expectations
should be kept uppermost in mind and any design should aim at his satisfaction
and comfort.
Today's healthcare facility is by its very nature a complicated entity and planning
and designing such a facility to serve the increasingly complex needs of its
patients, staff and management team is difficult and complicated. The problem is
compounded by rapid changes and advances that are taking place in the fields of
technology and medicine and the constant need to modernize, renovate, replace
and expand healthcare facilities.
Process of planning:
A common understanding should be established between the architect and the

engineers on one hand and the promoters, doctors, administrators and planners
on the other. A wide variety of professionals need to be integrated into a
planning team that is responsible for the implementation of this complex process.
Initial planning encompasses the general physical facilities that are being
considered, the space requirements, cost constraints, time schedules, standards
that must be included.
In the next step details of the operational plan for each department should be
considered- location of each department, requirement of floor space,
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intradepartmental and interdepartmental relationships, circulation, traffic flow

and requirements in relation to equipment, personnel and patients.
Operational and Functional planning first:
Before any plans can be drawn by the architect an understanding of the

requirements of the hospital in terms of services it is going to provide, number of
beds, departmental functions, departmental needs, major equipment, space
requirements, required personnel, relationships and adjacencies must be agreed
upon. All this must form a written document. This is called operational planning-
a written programme needed for any architectural project.
Operational planning establishes a dept-by dept description of needed space by

outlining for example, the no. and type of surgeries, X ray rooms, outpatient
services, laboratory services etc. the exercise thus determines current and
projected needs within the facility. A consultant or an administrator who is
knowledgeable and has experience in the operation of the hospital is by far the
best person to develop this document. Normally there is either no briefing of the
architect or the brief given to him is inadequate. The promoters must clearly tell
the architect the requirements of the hospital and not the other way round. The
architect should not dictate to them, nor should he guess what the requirements
are or what he should design. Often there is no written brief or operational
program and to know what is needed the architect must fend for himself.
Sometimes he is asked to prepare his building schedules with the help of doctors,
at other times he is asked to observe other hospitals and take guidelines from
them. Both these are unsatisfactory methods.
Key to Functional planning:
The proper sequence is the development of operational planning that defines the
major requirements and needs first. The operational plan is then developed into a
functional plan. Planning of the hospital on a functional basis-that lists every
room and suggests net sizes for major functional rooms and the total size of the
department. The key to functional planning is not just a room list but
understanding that travel and adjacencies will affect operational cost for the life
of the facility says David R. Porter the renowned hospital architect.
Mistakes in planning may prove costly:
Instances are aplenty of hospitals that were not planned with these critical
factors in mind-within five to ten years they found that the cost of construction
had been equaled or surpassed by operating expenses.
Functional grouping of high traffic areas such as X-ray, laboratories, surgical and
delivery suites, physical therapy and clinics on two floors is desirable. It permits
concentration of hospital activities in a manageable unit. When future expansion
20
or changes becomes necessary, they can be accomplished without disturbing the

nursing areas.
Operational Plan and Functional Plan must precede Architectural Plans:
Planning and Building a hospital to serve the increasingly complex needs of

modern healthcare is an intricate job. The architect though competent in his
profession may not be competent in the technical aspects of hospital architecture
and may lack knowledge of some of the specialized clinical and administrative
areas and matters. This document called the operational plan and functional plan
developed from it form the basis and are necessary prerequisites for the architect
to prepare the architectural plans.
Hospitals must be planned for the future:
A fundamental rule that promoters should remember is that the hospital should
be planned for at least 10 to 15 years ahead or else experts say plans will be
obsolete when they come to the drawing board. With the rapid development and
advances in technological, medical and administrative sciences and innovative
techniques and therapies, space requirements of every department has increased
markedly. New departments come to be needed, and more space is required to
some specialties. In addition to space needs, technology is imposing a host of
physical demands on our hospitals. Well planned systems must be built into them
to keep pace with the changes. Said one design expert ' We have got to design
`Smart` hospitals that respond to present needs while anticipating future
change.
Within the building all departments must be planned in such a way that they can
stand individually. This can be done by freely locating each department with
space around for expansion. Further care should be taken that expensive
permanent fixtures and fixed equipment such as plants and elevators are not
located at the free ends of the departments as they would permanently block
expansion plans. Future expansion is rendered easy with free ended buildings
with extendable corridors.
21
Space Program:
The space plan is made based on personal interviews with hospital administrators
experienced in building hospitals and also with the help of literature review and
would help the architect in finalizing his plans. Hospitals are a difficult planning
subject as explained earlier. The maxim ‘Design follows function’ must be kept in
mind while allocating space details. The area specifications may be taken as
indicative as suitable alterations would have to be made by the architect to
conform to the grid matrix.
The total space area including the parking space, HVAC and water is 1,05,319 sq
ft which works out to be 1053.19 sq ft. This is in concurrence with modern
standards of constructing hospitals which provide for an area of 800-1200 sq ft
per bed.
Ground Floor:
Key Departments like OPD, Emergency, Radiology, Laboratory would be situated
on the ground floor. The Radiology dept. would be situated near the Emergency
dept.(According to a study nearly 40% of cases coming to Emergency require X
rays)
The administration department would be located on the 1st floor along with the
Blood bank and General and Paediatric wards.
The Labour room, Obstetric ward and NICU would be located on the 2nd floor
along with the semi-private ward.
The CSSD would also be located on the 2nd floor just below the operation theatre
with provision for dumb waiters between the CSSD and the OT.
The OT’s will not be located on the top floor to avoid the excess heating nor will
they be located near the major traffic areas.
The ICU’s and private wards will also be located on the 3rd floor.
The residential area will be located on the 4th floor just above the ICU’s and the
OT’s. So a doctor can easily attend to the patient when called.
30% of the area is kept for circulation.
22
Department wise area allocation
Department Area sq.ft
General ward 3978

Semiprivate + deluxe 8437
Private+deluxe 8437
Obstetric Ward 3679
Paediatric Ward 2847
NICU 4921
ICU 7235
OT 5844
OPD 4940
Physiotherapy dept 975
Radiology 5005
Other diagnostic Facilities (ECG, 3380
EEG, Stress test, Endoscopy)
Laboratory 2425
Blood Bank 1840
Pharmacy Outlet 260
Pharmacy Store 520
MRD 1430
CSSD 1957
Laundry 1918
Kitchen 2300
Restaurant 2860
Housekeeping 325
Telecommunication 390
PR Department 260
Security 195
Auditorium 1950
Prayer Room 260
Mortuary 975
Library 390
Manifold Room 390
Administration 2314
A/c Department 780
Stores 2405
EDP 780
Emergency Room 1937
Ambulance 325
Telephone Booth 260
Shoppe 130
Executive health checkup 1300
Residents 15000
23
Total Space for 100 beds 105319

Area per bed 1053.19
(Current standards 800-1200 sq ft)
Parking Space 46875

Electrical+HVAC+Water 4550
Distribution of floor space by wards and departments
Wards 45378 43%

Diagnostic Facilities 12650 12.01%
OPD+ Emergency+ Related Areas 10117 9.60%
Administrative Area 11349 10.78%
Service departments 10790 10.25%
Residential Areas 15000 14.25%
100%
Breakdown of Space Requirements of key departments

Area Sq ft per bed
Nursing Units 273.78
ICUs 121.56
Operation Theatres 58.44
Radiology 50.05
Laboratory 24.25
Pharmacy 7.8
CSSD 19.57
Dietary 23
MRD 14.3
Housekeeping Dept 3.25
Laundry 19.18
Mechanical Installations 49.4
Stores 24.05
Administration 30.94
Distribution of Beds
General 16
Semi- Private (two in one) 26
Private 13
Deluxe 6
ICU 10
NICU 9
Obstetric Ward 10
Paediatric 10
Total 100
Other Beds
24
Pre -op 4
Post op 6
Emergency 4
Allocation of Departments floor wise

G+0
OPD 4940
Emergency 1937
Radiology 5005
Laundry 1918
Kitchen 2300
Physiotherapy 975
Pharmacy outlet 260
PR Dept 260
Manifold room 390
Shoppe 130
Telecommunications 390
Prayer Hall 260
Ambulance 325
Telephone booth 260
Mortuary 975
Laboratory 2425
Total space 22750
G+1
Restaurant 2860
Housekeeping 250
Administration 2314
Security 195
Accounts Department 780
Executive Health Check Up 1300
Blood Bank 1840
MRD 1430
General Ward 3978
Paediatric 2847
Other Diagnostic Facilities 3380
Pharmacy Stores 520
EDP Dept 780
Total space 22474
G+2
CSSD 1957
Semiprivate ward + Deluxe beds 8437
25
Stores 2405
Obstetric ward 3679
NICU 4921
Total Space 21399
G+3
OT 5844
ICU 7235
Private + Deluxe 8437
Total space 21516
G+4
Residential Area 15000
Library 390
Auditorium 1950
Total space 17180
Department Wise Space Plan

General Ward
Beds 16 120 1920

Nursing Station 1 200 200
Doctors room 1 100 100
Nurses room 1 100 100
Treatment room 1 100 100
Staff toilet 1 50 50
Store 1 60 60
Pantry 1 60 60
Clean utility room 1 60 60
Dirty utility room 1 60 60
Toilets General 3 50 150
Waiting Area 1 200 200
3060
Add 30% circulation space 918
Total space 3978
Semi private (2 in 1)
26
Beds 26 175 4550

Beds deluxe 3 350 1050
Nursing station 1 200 200
Dr's room 1 100 100
Nurses rest room 1 100 100

Store 1 60 60
Pantry 1 60 60
Toilet 1 50 50
Waiting area 1 200 200
6490
Total Space 8437
Single Room\ Private
Beds 13 350 4550

Beds deluxe 3 350 1050
Dr's room 1 100 100
Store 1 60 60
Pantry 1 60 60
Toilet 1 50 50
6490
add 30% circulation space 1947
Total Space 8437
ICU
Beds 8 225 1800
Beds - Isolation room 2 250 500
Equipment Room 1 250 250
Stat Lab 1 50 50
Doctors Room 1 100 100
Nurses Rest room 1 100 100
Toilet (staff) 1 50 50
Toilets -General 2 50 100
27
Store 1 60 60
Pantry 1 60 60
Clean Utility Room 1 60 60
Dirty utility Room 1 60 60
Beds For Relatives 10 150 1500
Toilets cum Bath 3 75 225
5565
Total space 7235
NICU
Open Care units 9 125 1125

Equipment store room 1 200 200
Toilets staff 2 50 100
Component milk formula room 1 50 50
Feeding room 1 60 60
Nursing room 1 100 100
Toilets - General 3 50 150
Waiting Room 1 250 250
Beds for relatives 9 150 1350
3785
Total space 4921
Obstetric Ward
Beds 10 120 1200
Clean utility 1 60 60
Dirty utility 1 60 60
Pantry 1 60 60
Staff toilet 1 50 50
General toilets 2 50 100
Store 1 100 100
Labour rooms 2 300 600
28
2830
Total space 3679
Paediatric Ward
Beds 10 120 1200

Clean utility 1 60 60
Dirty utility 1 60 60
Pantry 1 60 60
Store 1 60 60
Toilet- Staff 1 50 50
Toilet- General 2 50 100
2190
Add 30% circulation Space 657
Total space 2847
Operation Theatre
OT rooms
General OT Room 2 450 900
Specialty OT Room 1 625 625
Scrub room 2 100 200
Instrument room 2 100 200
Wash room/ Dirty utility 2 60 120
Store room 1 200 200
Chief anaesthetist room 1 100 100
Dr's room 1 150 150
OT incharge room 1 60 60
Nurse room 1 60 60
Dumbwaiters 2 20 40
Pantry 1 40 40
Equipment room 1 200 200
Trolley bay 1 150 150
Toilet 2 40 80
Change rooms 3 50 150
Reception 1 60 60
Waiting room 1 100 100
Pre operation room 4 beds 350
Post operation room 6 beds 600
4495
29

Total 5844
OPD
May I help you desk 1 50 50
Registration/billing 1 200 200
Waiting area-- Reception 1 500 500
Toilets (M&F) 8 25 200
Reception and Records room 1 250 250
OPD waiting area 1 400 400
Consultants rooms (Medicine, 5 150 750
Surgery, Gyn obs, Paed & Ortho)

Sub Waiting Areas 5 50 250
Staff toilets 2 50 100
Doctors toilets 1 75 75
Trolley/ Wheelchair bay 1 200 200
Collection room 1 50 50
Minor OT 1 300 300
OPD Store 1 75 75
Staff room 1 250 250
Administrators office 1 150 150
3800
Total 4940
Other Diagnostic Facilities

ECG Room 1 300 300
EEG Room 1 350 350
2 D echo room 1 500 500
Stress Test Room 1 750 750
Endoscopy Dept
Reception 1 50 50
Waiting 1 200 200
Consultation 1 100 100
Endoscopy room 1 350 350
2600
Add 30% circulation Space 780
Total 3380
Physiotherapy Department 1 750 750

add 30% circulation space 225
total 975
30
Radiology
MRI 1 750 750
Ultrasound 1 350 350
Ultrasound Room
Change room
Sub Waiting
X ray- General 1 650 650
Radiography room
Control room
Change room
Sub waiting
Special X ray 1 900 900
Radiography room
Control room
Change room
Toilet
Barium Preparation
Sub- Waiting

Radiologist room 1 100 100
Reception 1 100 100
Technicians room 1 100 100
Records room 1 150 150
Film Store 1 150 150
Reporting room 1 100 100
3850
5005
Laboratory
Reception 1 75 75
Biochemistry 1 300 300
Haematology & clinical pathology 1 200 200
Histopathology 1 200 200
Microbiology 1 200 200
Serology 1 200 200
Sample collection 1 150 150
Toilet 1 40 40
Toilets (staff) 2 50 100
Waiting 1 100 100
Report dispatch area 1 100 100
31

Technicians 1 100 100
1865
Total 2425
Blood Bank
Examination room 1 75 75
Recovery& refreshment room 1 150 150
Bleeding room 1 150 150
Staff room 1 60 60
Blood bank in charge room 1 100 100
Component separation room 1 400 400
Toilet (staff/visitors) 2 40 80
Issue counter 1 50 50
1415
Total 1840
Pharmacy
Store area 1 400 400
Retail area 1 200 200
600
Total 780
MRD
Process room 1 500 500
Office room 1 100 100
Record cum store room 1 500 500
1100
Total 1430
CSSD
Receipt area 1 100 100
Wash room 1 200 200
Gloves sterilizing room 1 75 75
Change room 1 50 50
CSSD Supervisor room 1 100 100
Clean area for packing 1 100 100
32
Actual sterilizing room 1 450 450

Sterile store room 1 200 200
Trolley Park 1 150 150
Dumb Waiters 2 20 40
1505
Total 1957
Laundry
Dirty area 1 150 150
Ironing/ wash area 1 400 400
Laundry incharge room 1 150 150
Toilet 1 50 50
Mending room 1 100 100
Delivery/ Distribution 1 100 100

Trolley Park 1 100 100
1350
Total 1918
Kitchen
Dietician room 1 100 100
Utensils area for storage 1 100 100
Dry area 1 150 150
Cold area 1 100 100
Preparation area 1 150 150
Cooking Area 1 350 350
Washing area 1 150 150
Trolley park 1 150 150
Change area 1 50 50
Toilet 1 40 40
Dining room 1 200 200
Garbage room 1 50 50
1770
Total 2301
Restaurant
Sitting area 1 1500 1500
33
Preparation 1 500 500

Store 1 200 200
2200
Total 2860
Housekeeping
Office 1 50 50
Store 1 200 200
250
Total 325
Telecommunication
Office 1 50 50
Cable area 1 250 250
300
Total 390
Personnel Relation department

Office 1 200 200
Total 260
Security
Office 1 150 150
Total 195
Mortuary 1 750 750

Total Space 975
Auditorium 1 1500 1500

Total 1950
Prayer room 1 200 200

Total 260
Library 1 300 300
34

Total 390
Electrical HVAC +Water+Boiler 1 3500 3500

Compressor air & Vacuum
Total 4550
Manifold room
Area 1 250 250
Office 1 50 50
300
Total 390
Administration
MD/CEOs office 1 250 250
MS office 1 200 200
Office (secretary) 2 50 100

Manager administration 1 150 150
Clerical office 1 350 350
Nursing superintendent 1 200 200
Staff for nursing superintendent 1 200 200
Toilets
MD/CEO/MS 1 50 50
Clerical staff 2 40 80
1780
Total 2314
A/C department
Office 1 200 200
Process area 2 200 400
600
Total 780
Stores
Storage area 1 1500 1500
35
Office 1 250 250

1850
Total 2405
EDP
Office 1 100 100
Server room 1 500 500
600
Total 780
Emergency room
Triage 4 beds 500 500
Med. Officer 1 100 100
Dr change room 1 75 75
Nurse change room 1 75 75
Toilet 1 40 40
Minor OT 1 250 250
Reception 1 100 100
1490

Total 1937
Ambulance
Control room 1 250 250
Telephone Booth 2 50 100
Shoppe 1 100 100
450
Total 585
Residential Area 15000
Executive Health Check Up

Reception 1 100 100
Doctors rooms 3 150 450
Collection room 1 50 50
Records & Storage 1 100 100
Toilets 2 50 100
1000
36

Total 1300
Parking space
Area for 1 car = 275 sq.ft
Area for parking 150 cars 41250
30 staff, 120 general
Area for I scooter = 75

Area for 75 scooters 5625
25 staff, 50 general
Total 46875
Operation Theatre
Function:
The function of this department is to receive patients after diagnosis, to
anaesthetize them, to operate upon them and to supervise their post-operative
condition before returning them to their wards. The surgical patients account for
30% to 40% of the in-patient admissions.
Location:
The OTs can be grouped together in a centralized form to have an entire OT
complex, or they can be decentralized. However, for having decentralized OTs
e.g. like those for gynecology, ophthalmology and ENT the quantum of work
should justify the need for them. Centralized OTs are preferred normally as there
is greater economy of staff and equipment, better professional supervision, and
greater efficiency.
There will be 3 OT’s- 2 General and 1 Specialty OT. They will be located on the
3rd floor. The location will be such that they will be away from major traffic areas
and not on the top floor. This will avoid overheating. They will be located close to
the ICUs for the easy transport of patients. They will also be located close to
vertical transport and above the CSSD. There will be 2 dumbwaiters- one for
clean linen and one for soiled linen.
Key Factors influencing OT complex Planning:

The total volume of expected operations along with the anticipated work period is
used to calculate the no. of operating rooms needed. Around 1 operating suite is
recommended for every 50 beds. The number of operating rooms has also been
indicated to be 5 per cent of the total number of surgical beds. In larger hospitals
a thumb rule 0.1 operations per bed per day has been used. For Indian theatres
conducting general surgeries it is estimated that the average time taken for each
surgery will be around 75 minutes per operation. Hence one OT can perform
37
around 5 general surgeries daily. A separate emergency OT would be justified

when 50 or more cases are reported in the casualty. The other factors that would
influence the planning are the case mix and the type of operations to be
performed and the ALOS of surgical patients.
The no. of operating rooms forms the basis for determining the number of pre-op
beds and the post-op beds.
Number of operations per day = No. of surgical beds

ALOS of surgical patients
Number of OT rooms = Total no. of operations in hospitals

Capacity of 1 OT
Basic Functions:
Ø Reception and identification of the patient.
Ø Pre- op supervision of the patient.
Ø Depilation of the patient if not done in the ward.
Ø Transfer of patient to the operating table.
Ø Induction/ Intubation/ Positioning
Ø Preparation of the operative area and surrounding skin.
Ø Draping of patient
Ø SURGERY
Ø Sewing up/ Removing drapes/ Extubating
Ø Transfer of patient to post- anesthetic recovery area.
Ø Post- operative supervision of the patient/ Step down.
Layout:
The OT will be independent of the general traffic and movements of the rest of
the hospital. The rooms should be arranged in a manner that allows continuous
progression from the entrance through the various zones that become
increasingly clean. The various zones in the OT are
Ø Protective Zone
Ø Restricted Zone
Ø Clean zone
Ø Super clean Zone
Ø Ultra clean Zone.
The protective zone is the area where the entry is restricted to the patients, the
staff, and their relatives. It is till the waiting areas for the relatives.
The entry to the restricted zone is limited to the patients and the staff. This
area includes the patient reception area, the staff changing rooms.
The clean zone, which is the next zone, consists of the pre and post op areas,
the administrative areas, the stores, laboratory, space for equipment storage.
The superclean zone consists of the operating theatre and its ancillary rooms
like the scrub room, the instrument room and wash room.
38
The ultraclean zone consists of an area of 1 metre on either side of the

operating table.
An operating room for general surgery will have an area of 450 sq ft. However
operating room for specialty surgeries like orthopedic and Neurosurgery will be
around 625 sq ft. The operation suite will consist of an operating room, a scrub
room, a waste disposal room, and an exit room. The waste disposal room will
lead into the dirty corridor so that waste can be disposed of without it being
allowed to renter the clean zones. There will be a service lift to carry away the
waste and a dumb waiter to carry the soiled linen to the CSSD.
In older times it was believed that it was desirable to have a separate induction
room. However, while such a room reduces the operating rooms occupancy time
as the patients can receive pre-operative anesthesia while other patients are on
the operating table. The disadvantages however outweigh the benefits. The main
disadvantage may be the huge increase in capital as well as running costs
incurred in such a room. Also, there will be the cost of additional equipment and
the utilization of the room will be low.
Ø The preop holding area and post op recovery room should have piped and
medical gas outlets.
Ø Provisions should also be made for flash sterilizers.
If the operating room has windows this will increase the heat load inside and
provision should be made for it. Windows provide for visual relaxation but
whether operating rooms should have them or not is a debatable question as
they may cause distraction if provided.
Ø The temperature inside the OTs will be maintained at 21 degrees. The airflow
is laminar airflow i.e., positive pressure is created such that air flows from the
clean zones to the dirty zones. The laminar airflow is created through a plenum in
the ceiling. The velocity of air flowing through this plenum is 60 ft/min. The size
of the plenum will be around 6 by 6 feet. This will be enough to cover the patient
on the operating table and the entire operating team. The air moves outwards
through outlets, piped gas, suction and nitrous oxide are provided through
pendants in the OT.
Ø HEPA filters which can filter air up to 0.3 microns will be used.
Ø Between 20- 100% fresh air is used. The rest is recycled.
Ø Humidity levels will be 55% plus or minus 5%
Ø The floor of the OT will be granite with brass strips. This helps in earthing
purposes for the electrostatic current. The walls can be of stainless steel or
marble whereas the ceiling can be of stainless steel or Plaster of Paris. The
theatre corridors will preferably be 3.2 metres and not less than 2.85
metres wide.
39
Circulation within the department:

Patient flow:
In-patient nursing units Holding area Operating room
Pt rooms Post op recovery
Staff:
Entrance Changing rooms Working area Rest

room/changing
room
Exit
Equipment & supplies:
Clean Entrance Supply area Theatre area User Area
Sterile:
CSSD Theatre Preparation area User Area
Dirty linen and instruments:
Theatre Disposal room CSSD
Laundry
Relationships with other departments:
- Patient areas
- Support areas
The surgery dept will be related to patient areas like the emergency dept, the
ICU, patient rooms. They should have direct horizontal or vertical access to
surgery. Support areas such as pharmacy, laboratory, CSSD and housekeeping
40
services should have access to surgery through nonpublic and non-sterile

corridors.
CSSD will have vertical adjacency to surgery and will be connected by
dumbwaiters with the Operation Theatre.
Equipment required:
Movable Equipment
Surgical tables
C arm machines
Anaesthesia machines
Heart lung Machines
Flash sterilizers
Fixed Equipment:
Medical gas
Surgery lights
Laminar flow
Functional Areas:
Control Station: The control station is primarily a clerical area located in a

position to control traffic into the surgery department. A control station differs
from a nurse station in that less people work out of this area. Surgeries are
scheduled; records and administrative functions are maintained. Space is
provided for requisite items to be delivered or picked up by other departments.
Casework and furniture required:
¨ Computer support components
¨ File drawers
¨ Form trays to organize the large volume of paper and forms.
¨ Marker board for posting daily surgery schedule.
Pre-Operative Holding:
Patients arriving for surgical operations will be held in this area until the
operating room is ready. Here patients may be given medications or intravenous
fluids under close observation of the nursing staff.

¨ A small workstation for filling out forms and paperwork.
¨ Locker to hold patient care supplies.
¨ Sink unit.
¨ Medicine prep/ Storage
¨ Specialty procedure carts.
Scrub Area:
They are placed with access to the operating rooms. Surgical scrub sinks are
generally ceramic or stainless steel with foot or knee controls. Shelves will be
placed above the sink to hold scrub brushes and masks.
41

¨ Overhead storage of 2 feet per sink is required.
Operating room:
It is the area where surgical procedures are performed under sterile techniques.
Operating room will have positive pressure ventilation systems, with controlled
temperature and humidity, to prevent corridor air from entering.
The work surface for the circulating nurse will be placed near the entrance door
and the movable modular casework on the wall at the foot end of the table
depending on the head orientation of the patient.
Modular casework applications:
Procedure/supply carts used for
¨ Anaesthesia supplies and equipment
¨ Suction and cautery equipment
¨ Monitoring equipment
¨ Prep and dressing
¨ Anaesthesia carts.
Lockers used for

¨ General supply storage
¨ Backup supplies
¨ Specialty procedure carts.
Dirty utility:
Used linens, instrument sets and equipment are placed in soiled utility
immediately after surgery. This room may hold soiled linen and instruments until
they are returned to central supply.
This opens outside to the dirty corridor from where the things are removed via
the dumbwaiter to the CSSD or to the laundry via the service lift.
Movable modular caseworks:

¨ Process tables or work surfaces for receiving soiled items.
¨ Sink unit.
Staff lounge:
A staff lounge is used primarily for coffee breaks, snacks and as a place for staff
to rest from the pressures of patient care. Space should be provided for a
refrigerator, microwave oven and large coffee maker.
Staff change rooms usually adjacent to staff lounge are provided for male and
female staff to change from street clothing to surgery attire. Clothing lockers,
toilet facilities and showers are provided.
Movable modular caseworks and furniture:

¨ Tables and seating
¨ Base cabinets for storage
42
¨ Overhead storage for coffee maker and supplies.
Administrative office:
The following positions will require an administrative office
Ø Director/ Head of Anaesthesiology
Ø OT in charge
Ø Operating room materials manager/ Store room
Movable Modular Casework and furniture systems:

¨ Cantilevered work surfaces
¨ Work surfaces for keyboard drawers or trays to accommodate computers and
printers
¨ Overhead storage and marker boards for displaying information.
¨ Task lights and personal lights.
Lighting:
Intensity:
At the plane of the incision, it would be desirable to achieve an all-round intensity
of about 40,000 lux.
Luminance:
Normal luminance brightness for the central field during an operation should be
2,000 to 3,000 cd/sq.m The floor around the surgical table should have a
luminance of 200 to 300 cd/sq m, the walls 300 to 500 cd/sq m and the ceiling
lights 1,000 cd/sq m at most.
Operation lamp characteristics:
§ The intensity of light be variable, but generally at least 40,000 lux at the
working plane, and at least 8,000 lux at the bottom of a 13 cm deep and
5 cm wide incision.
§ The operation lamp should with no part hang lower than 2.0 m above the
floor.
General Lighting in operation room:

General lighting in the operation room should attain a minimum of 400 lux. In the
U.S. general illumination capability of 2,000 lux uniformly distributed throughout
the room with provision for reducing this level has been recommended.
Lighting in Operation room:

A reasonable level of illumination at washbasins is 300 to 500 lux. In the U.S. for
scrub rooms the illumination level of 2000 lux has been recommended as
members of the surgical team will encounter in the operating room.
Lighting in post anaesthetic recovery room:

Patients are disoriented and aware of bright lights during the awakening period.
Therefore light fittings must be placed where they will not disturb the patient.
43
A lighting intensity of about 300 lux is recommended. A mounted wall or ceiling

source of higher intensity spot illumination about 10,000 lux must be available
for performing procedures if required.
Colour in surgical department:

Generally in the UK pale blue, grey and green have found to be most suitable.
Blues and yellows should be avoided. A light grey colour for the operating room
floor has been recommended.
For the scrub up room yellowish or red shades may be used.
For the anaesthetic room the reflections on the patients face would not obstruct
the anaesthesiologists judgement of the patients condition. The colour scheme in
the anaesthetic room may be the same as that for the operating room, possibly
softer and warmer.
Noise levels
In operating room:
The noise level in operation rooms should be below 50 decibels.
In anaesthetic rooms as well as in the labour and delivery rooms the noise levels
should be below 45 decibels.
In recovery room:
A special sensitivity to noise and need for protection from it is found in newly
operated persons whose autonomic nervous system is in disorder. One of the
patients greatest irritations in the recovery area is the laughter and other noises
of the staff.
In recovery rooms sound absorbent ceiling materials and wall finishes with a
reflection factor of about 50 per cent should be used.
Temperature in the operating room:

The temperature in the operating room will be maintained between 21 to 23
degrees.
Humidity:
The acceptable limits for relative humidity as regards static electricity and
comfort are 45 to 60 per cent. Low relative humidity has been reported to be an
optimal condition for Kleibsiella pneumoniae Type A while high humidity in the
hospital enhances the danger of growth of Ps. Aeruginosa.
Humidity in the operation room is believed to contribute to the prevention of

dehydration of exposed tissues.
At a relative humidity of about 50 per cent a very thin invisible film of moisture
forms on operation equipment and other surfaces. The film of moisture conducts
static to earth before a spark producing potential is built up.
44
A standard of relative humidity between 40 to 65 per cent has been fixed for
operating rooms. (55 % + or – 5%)
Flooring in operation room and anaesthetic room:

The rooms flooring in the operation rooms and the anaesthetic rooms should be
Non slippery when wet.
Withstand intensive application of water and disinfectants
Not absorb physically foreign molecules
Be elastic and recover after the removal of heavy objects.
Have a high resistance to breakdown.
Be fire resistant.
Be colourfast.
PVC flooring is the floor finishing that satisfies the majority of the requirement
of the operating room flooring.
Walls:
Suitable surface materials include laminated polyesters with an epoxy finish
and hard vinyl coverings which can be heat sealed.
Semi matt wall surfaces reflect less light than high gloss finishes and are less
tiring to the staff.
The corners in the operating room should be rounded with the wall surfaces to
make cleaning routines easier.
Doors:
Door hardware should be designed with single lever action and should require
no more than 4 kg of pressure to open the door.
In the operation department, staff dressed in sterilized garments require a
minimum door opening width of 90 cm. A clearance of about 10 cm on either
side of the bed including special equipment is required to move it through an
opening.
A width of 150 cm for two leaf door openings can be recommended.
A device that holds the door open must be provided to simplify equipment
moving.
The sound insulation properties of the doors should be good.
Operating rooms and anaesthetic rooms should be provided with safety
glazed openings with blinds to save unnecessary opening.
In the postoperative recovery area the doorways should pass beds easily. A
door width of about 145 cm is recommended.
Electrical outlets and switches:

Electrical outlets should not be placed so that the power cords between the
wall outlets and the junction boxes and apparatus hinder the staff.
In operating rooms about 20 outlets are needed for advanced operations.
Electrical outlets in the vicinity of the operating table should be combined in a
control panel comprising switches, fuses and plug outlets for main voltage
45
and low voltage for electronic appliances. It is preferred to have the control
panel hanging from the ceiling from the pendant.
In post anaesthetic units upto 8 electrical points are necessary for each bed.
Medical gases, piped air, vacuum.

Oxygen, compressed air, nitrous oxide and vacuum are supplied via gas pipes
identified by colours according to international standards.
To maintain homeostasis the inspired gases should be warm and humidified.
Heated humidifiers which supply gases at 35 degrees centigrade and at 100
per cent relative humidity. The temperature of gases should be monitored to
prevent tracheobronchial burn.
Gas outlet points shall be at least 20 cm from electrical components to avoid

generation of sparks.
For preoperative areas oxygen, suction and compressed air are required.
For the operation theatre and postoperative areas oxygen, compressed air,
nitrous oxide and suction are required.
46
Intensive Care Units:
Function:
ICUs are specialty nursing units designed, equipped and staffed with specially
skilled personnel for treating very critical patients or those requiring specialized
care and equipments.
Location:
The ICU’s should be located in a geographically distinct area within the hospital
with controlled access. No through traffic to other departments should occur.
Location should be chosen so that the unit is adjacent to or within direct elevator
travel to and from the Emergency Department, operating room, Intermediate
care units and Radiology department.
There are 2 schools of thought-
One suggests that ICUs should be in a centralized place and be contiguous with
or readily accessible to one another. Having intensive care facilities in a
centralized place allows the specially trained professionals and equipment an
almost instant access to patients in all clinical services when an emergency
develops. Such an arrangement also eliminates the need for duplication of costly
equipment and personnel.
The second school of thought favors that the location should be dependent on the
type of patients eq.-The surgical ICU should be close to the operating rooms.
- The Medical ICU should be in close proximity to the medical wards.
- The NICU should be close to the obstetrics ward.
- The Neurosurgical ICU can be located close to the emergency department
Layout:
12 to 16 beds per unit are considered best from a functional perspective. There
will be 10 beds in the ICU. There will also be 2 isolation rooms within the ICU to
accommodate increasing incidence of contagious and immunocompromised
patients. Supply corridors should be separated from public/patient corridors.
The ICU consists of the following areas

§ Patient rooms.
§ Central/ Nursing Station
§ X ray viewing areas/ Storage areas
§ Clean and dirty utility rooms
§ Equipment storage
§ Food prep area/ Pantry
§ Staff areas/ Doctors Room/ Nurses rest room
§ Supply and service corridors.
§ Stat lab
§ Visitors waiting room.
§ Doctors room.
47
Patient rooms:
Patient rooms must be designed to support all necessary healthcare functions.
There will be at least 225 square feet area per bed.
An emergency alarm button must be present at every bedside within the ICU.
The alarm must sound automatically in the central nursing station and the origin
of these alarms must be discernible.
The patient bed should be located permanently away from the wall to give staff a
360 degree access to the patient. There is generally a headwall behind each
patients bed for a freestanding utility column to mount monitors and equipment
and to supply suction, air, oxygen and regular electrical and emergency electrical
services. Space for computer terminals and patient charting should be
incorporated in the design. Storage for computer terminals and patient charting
should be incorporated in the design. Storage for patients personal belongings,
patient care supplies and pharmaceuticals should be provided at the bedside. An
ICU design should consider natural illumination and view. Windows are an
important aspect of sensory orientation and every room should have the patient
facing the windows to reinforce day/ night orientation if possible.
The patients must be situated so that direct visualization by healthcare providers

is possible at all times. This approach permits the monitoring of patient status
under both routine and emergency situations.
Movable Modular Casework:

¨ Bedside supplies placed in an L cart with drawers or in a storage unit.
¨ Locker within or adjacent to the patient room to house immediate necessary
supplies and linen.
¨ Cantilevered work surface or mobile table with a keyboard tray as a station
for nurse charting done on a bedside computer.
Isolation rooms:
There will be 2 isolation rooms in the ICU.
Isolation rooms are used by patients with highly communicable diseases or those
who are unusually susceptible to infection. Cleanliness and contamination are key
concerns in these rooms. Each isolation room will contain at least 250 square
feet of floor space with an anteroom. Each anteroom should contain at least 20
square feet to accommodate hand washing, gowning and storage. An attached
toilet must be provided in the isolation rooms.

Same as that required for patient rooms.
48
Central station:
A central nursing station should provide a comfortable area of sufficient size to
accommodate all necessary staff functions. Within the nurses station the staff
manages patient records and charts, communicates regarding the patients
conditions, views patient monitors, orders tests and treatments and dispenses
medications. Adequate space for computer terminals and printers is essential.
Patient records should be easily accessible and adequate space must be provided
for them. Adequate surface space and seating for medical charting by both
physicians and nurses should be provided. Shelving file cabinets and other
storage for medical record forms must be located so that they are readily
accessible by all personnel requiring their use.
A refrigerator for pharmaceuticals and a sink with hot and cold running water
must be provided.
Behind the nursing station a small area may be provided as a rest room for
nurses. This area can contain a bed, which can be utilized by pregnant nurses to
rest in between work.
Doctors Dictation:
An area should be provided for physicians to review patients charts, dictate
progress notes and write patients orders. It should have access to telephones.
Charting:
A stand up or sit down area should be provided with access to patients charts by
nurses and physicians. This area is generally maintained by the unit clerk or the
unit secretary.
Cart Storage:
An area must be provided to store and quickly access crash carts and procedure
carts. This area should be accessible to supplies for restocking carts and have
electrical access to maintain rechargeable equipment.
Movable Modular Casework and Furniture:

¨ Cantilevered work surfaces
¨ Monitor shelves
¨ Computer tools and keyboard trays.
¨ Lateral filing components.
¨ Procedure and crash carts.
X ray viewing area

A separate area at the nursing station or near each cluster of ICUs must be
provided for the view of the patient radiographs.
49
Storage areas:
Provision should be made for storage of crash carts and portable monitors/
defibrillators near each set of ICUs.
Stat Lab/Equipment storage:

A separate storage area behind the nursing station for storage of large patient
care items not in active use such as mobile X ray must be provided. Space should
be adequate enough to provide for easy access, easy location and easy retrieval.
Much of the equipment must be accessible to electrical outlets to maintain
battery charges.

They can be used to store small and large equipment and may include
¨ Modular Shelving units
¨ Bulk supply carts.
Space for Laboratory equipment:

Since many patients in the ICU require Arterial blood gas analysis and electrolyte
analysis space must be provided for an ABG analyzer and an electrolyte analyzer.
Clean and dirty utility rooms:

They must be separate rooms that are not interconnected.
Clean utility room:

It should be used for the storage of all clean and sterile supplies and also for the
storage of clean linen. It requires space for supplies, linen, procedure trays and
procedure carts.
¨ Cantilevered work surfaces with drawers
¨ Extra- deep modular shelving units
¨ Lockers for medical supplies and linen
¨ Bulk supply carts
¨ Procedure carts.
Dirty Utility room:

It must be provided with a sink. Separate covered containers must be provided
for soiled linen and waste materials. Special containers should be provided for the
disposal of needles and other sharp objects. Air supply from the dirty utility room
must be exhausted. This room typically has a sink.
¨ Cantilevered work surfaces with drawers
¨ Cantilevered sink unit.
If a special procedures room is desired it could be located between the clean and
dirty utility rooms. A separate hatch can be provided from the clean utility room
50
to the special procedure room and from the special procedures room to the dirty
utility room.
Food preparation area/Pantry:

An area where food can be brought from the kitchen in food trolley and
heated/prepared before it can be distributed to the patients.
Staff change rooms and toilets:

Rooms must be provided for staff to change and there should be lockers to keep
their belongings. Separate toilets should be provided for the staff.
Patient and supply corridors:

The patient and supply and service corridors should be separate from each other
so as to facilitate easy movement.
Reception area/Visitors lounge/Waiting room.

The reception area should be located such that all visitors should pass this area
before entering. This area should contain information about the patients admitted
and should also be of help to the attendants of the patient.
Waiting room:
One to one and a half seats per critical bed is recommended here. Public
telephones( preferably with privacy enclosures) must be provided. Television
and/ or music should be provided. Tea/coffee vending machines, public toilet
facilities and a drinking fountain should be located in the lounge area.
One bed per patient admitted must be provided for the patients’ attendants. This
room must have adequate toilet and bathing facilities.
A separate family consultation room can be provided. This will help if the treating
physician wants to talk with the family/ relatives of the patient.
Interdepartmental Relationships:
ICUs should be located close to or be easily accessible from
Ø Emergency Department
Ø Operation Theatre
Ø Laboratory
Ø Radiology
Ø General Nursing units/ Wards
Most admissions are through OT or emergency.

Also they should be close to vertical transport cores.
An intermediate area should have twice the number of intensive care beds in an
ICU
51
Patient/material flow.
Patients will come to the unit from in-patient admitting, emergency/trauma
department, other patient care units, surgical departments or cardiac cath
departments.
From here the patients may go to other patient care units like intermediate care/
general nursing units, surgical OT, diagnostic departments like radiology,
laboratory, Endoscopy or the patient can be discharged home
Patient/Material flow in ICU:
Support Services
Dietary
Admitting Materials Management
Services CSSD
Housekeeping
Emergen Triage
cy room Observat ICU Discharge Home
ion
Trauma unit
Other Patient units Diagnostics

Radiology
Laboratory
Cath Lab
Endoscopy
OT/Surgery/Recovery
EEG/EMG
52
Lighting:
While considering optimal lighting, attention must be given to the reflectance
value of walls, ceilings, and floor. The reflectance value is dependent upon their
texture and colour. Some recommended reflectance values are ceilings 80 to
95%, upper walls 40 to 60%, lower walls 15 to 20%, floors 15 to 30%, furniture
25 to 40%.
General overhead illumination plus light from the surroundings should be

adequate for routine nursing tasks including charting, yet create a soft light
environment for patient comfort. The intensity of 300 lux has been
recommended. Total luminance should not exceed 30 foot candles (fc). It is
preferable to place lighting controls on variable control dimmers located just
outside the room. This approach permits changes in lighting at night outside the
room, allowing a minimum disruption of sleep during patient observation. Night
lighting should not exceed 6.5 fc for continuous use or 19 fc for short periods.
Separate lighting for emergencies and procedures should be located in the ceiling
directly above the patient and should fully illuminate the patient with at least 150
fc shadow free. A patient reading light is desirable and should be mounted so
that it will not interfere with the operation of the bed or monitoring equipment.
The luminance of the reading lamp should not exceed 30 fc.
Colour in intensive care units:

Blues and greens should be avoided in the intensive treatment rooms as about 50
% of the light reflects from the walls the green and blue colours and may appear
to make the patient cyanotic. Gray colour is preferred.
Blue or blue green shades should be used in waiting and holding areas where
they are calming.
Noise levels:
The international noise council has recommended that noise levels in hospitals
acute care areas should not exceed 45 db in daytime, 40 db in evening and 20 db
at night. Normally noise levels in most hospitals are between 50 to 70 dB with
occasional episodes above this range. For these reasons floor coverings that
absorb sound should be used. Walls and ceilings should be constructed of
materials with high sound absorption capabilities.
Temperature and humidity in ICUs:

A temperature of 22 to 23 degree centigrade and humidity at 50 to 60 percent
have been found appropriate in the intensive care and treatment units as well as
in isolation rooms.
53
Doors:
In the ICU handles can be omitted from doors which can be pushed open. Also
the door width should be about 145 cm. In neonatal intensive care units the door
units the door widths of 90 cm are accepted.
Utilities:
Each ICU must have electrical power, water, oxygen. Compressed air, vacuum,
lighting and environmental control systems that support the needs of patients
and critical care team under normal and emergency situations. A utility column
(free standing, ceiling mounted or floor mounted) is the preferred source of
bedside electrical power, oxygen, compressed air and vacuum and should contain
the controls for temperature and lighting. When appropriately placed, utility
columns permit easy access to patients head to facilitate emergency airway
management if needed. If utility columns are not feasible utility services may be
supplied on the head wall.
Electrical Power:
Electrical service to each ICU should be provided by a separate feeder connected
to the main circuit breaker panel that serves the branch circuits in the ICU. The
main panel should also be connected to an emergency power source that will
quickly resupply power in the event of power interruption. Each outlet or outlet
cluster within an ICU should be serviced by its own circuit breaker in the main
panel. It is critical that the ICU staff have easy access to the main panel in case
power must be interrupted for an electrical emergency.
Grounded 110 volt electrical outlets with 30 amp circuit breakers should be
located within a few feet of each patients bed. Outlets at the head of the bed
should be placed approximately 36 inches above the floor to facilitate connection
and to discourage disconnection by pulling the power cord rather than the plug.
Outlets at the sides and foot of the bed should be placed close to the floor to
avoid tripping over electrical cords.
In intensive care and treatment units 10 electrical outlets per bed are required.
In neonatal intensive care units 10 to 12 outlets per bed are required.
Water Supply:
The water supply must be from a certified source, especially if haemodialysis is to
be performed. Zone stop valves must be installed on pipes entering each ICU to
allow service to be turned off should line breaks occur. Hand washing sinks deep
and wide enough to prevent splashing, preferably equipped with elbow, knee,
foot or sonar operated faucets must be available near the entrances to patient
modules or between two patients in ward type units. This is a critical component
of general infection control measures. When a toilet is included in a patient
module, it should be equipped with bedpan cleaning equipment, including hot and
54
cold water supplies and a spray head with foot control. In addition when toilets
are present, environmental control systems must be modified.
Oxygen, Compressed Air and Vacuum.

Centrally supplied oxygen and compressed air must be provided at 50 to 55 psi
from main and reserve tanks. At least 2 oxygen outlets per patient are required.
One compressed air outlet per bed is required two are desirable. Connections for
oxygen and compressed air outlets must occur by keyed plugs to prevent the
accidental exchange of gases. Audible and visible low and high pressure alarms
must be installed both in each ICU and in hospital engineering. Manual shut off
valves must be located and identified in both areas to permit interruption of the
supplies in case of fire, excessive pressure or for repair purposes.
At least three vacuum outlets per bed are required. The vacuum system must
maintain a vacuum of at least 290 mm hg at the outlet farthest away from the
vacuum pump. Audible and visual alarms must indicate a decrease in vacuum
below 194 mm hg.
Environmental Control systems:

Suitable and safe air quality must be maintained at all times. A minimum of six
total air changes/ room/ hr are required, with two air changes/ hr composed of
outside air. For rooms having toilets, the required toilet exhaust of 75 cubic
ft/min must be composed of outside air. Central air-conditioning systems and
recirculated air must pass through appropriate filters.
Radiology Department:
Function
The term radiology now incorporates:
Ø Radiodiagnosis—
• X Ray
• Sonography
• CT Scan
• Magnetic Resonance Imaging (MRI)
• Digital Subtraction Angiography (DSA)
Ø Radiotherapy
Ø Nuclear Medicine
Ø Interventional radiology
The functions of the radiology department are;
¨ Receiving the patient.
¨ Exposing the film using the appropriate modality
¨ Developing and checking the quality of the film image.
¨ Viewing and interpretation by a radiologist.
¨ Dictation and transcription of the interpretation and forwarding the report to
the requesting physician or surgeon.
¨ Filing both the film and the written report.
55
Location:
The department should be easily accessible to the OPD, casualty and the
inpatient wards.
The location of the department will be on the ground floor.
It should have some scope for expansion at a later date.
Layout:
Planning for a good design for the X ray department is a complex process.
Equipment for Radiodiagnosis department is expensive, requires a great deal of
care and maintenance and appropriate space central to the users
WHO has recommended the standard size of the X ray room at 20 sq. mts
Approximate requirement of space for hospitals of different sizes is
750 beds --- 800 sq m
500 beds --- 650 sq m
300 beds --- 370 sq m
200 beds --- 175 sq m
100 beds --- 65 sq m.
Generally the space distribution in an X ray department is as follows:
11% control rooms and cubicles
16.5% X ray rooms.
9.0% Film processing and interpretation.
20.5% Administrative
8.5% Teaching
5.0% Waiting and Recovery
29.5% Circulation and wall area.
Patient and work flow:

According to experience 3 percent of the patients are taken directly to the X Ray
rooms. 17 percent are bed or stretcher cases. 80 percent are ambulant or use
wheel chairs or are minors. Around 5 to 10 percent of the departments patients
are children.
Patients
Receptionist
Waiting
Undressing/Enema
X ray Procedure
Film Processing
Wet film examination
56
Viewing by Radiologist
Interpretation
Report to the patient
Functional areas:
Waiting:
From the main reception area the patients are directed to sub-waiting areas.
A floor area of about 1.3 sq m should be allowed for each waiting patient.
Parking areas for beds and trolleys should be provided. The corridors must be 2.8
m wide for bed traffic.
Lavatories:
Lavatories should be easily accessible to waiting patients. Some should be larger
so that an attendant could assist. Handgrips on the wall for the patient are
recommended. Doors to lavatory compartments should open outwards.
All lavatories must have a wash basin.
Changing cubicles:
The patients who are to be X rayed require undressing or stripping to the waist.
Each X ray room requires about 2 well lit and ventilated cubicles of about 1.3 sq
mts size.
Each cubicle should have a chair, clothes hook and a mirror.
Contrast media preparation room/Barium Preparation:
In the vicinity of the undressing cubicles and X ray rooms there should be a room
where contrast media, frequently barium powder is mixed for investigations.
X ray screening room:
A standard size of 40 sq mts has been recommended. The depth of the screening
room should not be less than 5.8 m. In the room a working height of about 3.3 m
is recommended.
In all X ray rooms a stainless steel unit with a sink and a washbasin is needed
because of the microbial cross-contamination and infection potential.
Door openings should be at least 1.3 m wide.
Radiodiagnostic rooms should have natural lighting and ventilation whenever
possible. All artificial lighting in the screening room should be wall mounted. The
ceiling has to be free from air ducts, pipes etc and should be weight bearing in all
directions for the installation of ceiling mounted equipment.
All rooms will have a control, tube (an X ray emitting device), tube stand or
support and cabling.
Important design considerations:
57
• The space should be configured to allow a stretcher to be manoevered

with minimum turns by placing the axis of the X ray table perpendicular to
the wall with the door by which the patient will enter the room.
• The control console will be opposite the door with direct access to the
vertical core.
• Minimum size of a room should not be less than 20 sq mts/ideal is 40sq.
mts.
• An overhead type tube support facilitates X raying a patient in bed or on a
stretcher.
• The X ray tube should never point towards the control unit, darkroom or
window.
• Control panel should be as far away as possible from X ray table.
• Radiation hazard to the occupants of the X ray room is inversely
proportional to the square of the distance between the tube and the
individuals.
• The passage of film cassettes from the radiography room to the darkroom
takes place through the hatch window opening into the darkroom. The
hatch must be adequately lead lined to prevent the entry of radiation
scatter into the darkrooms.
• Also the doors and windows of the radiography room have to be lead lined
to prevent radiation scatter from the room.
• A door on the control booth is required to protect the technician in the
booth from scattered radiation.
• The control panel should be wired to a signal outside each X ray room to
indicate when the machine is on, to prevent other personnel from
inadvertently entering the room. A red light bulb will be satisfactory as a
signal.
Special equipment:
¨ Table and tube.
¨ Wall bucky (a device that holds film in a position during exposure)
¨ Control console
¨ Sink and casework
¨ Transformer and power cabinet.
Fluoroscopy room:
Fluoroscopy makes use of radio- opaque media that may be introduced into the
body to create images of tissue that would not otherwise show up well on X ray.
Because the radio- opaque material is typically barium introduced through the
mouth or the rectum, it is important to have a toilet room directly accessible from
the procedure room.
Apart from the design considerations for X ray rooms other considerations
peculiar for fluoroscopy room are:
• The toilet room will be directly attached to the fluoroscopy room.
• Barium will be prepared in a procedure room.
58
• Floors should be designed keeping in mind that loads upto 2,000 kg/m will
be borne by the floor.
Special equipment;
¨ Fluoroscopic X - Ray tube and table.
¨ Image intensifier.
¨ Spot film camera
¨ Video monitor.
¨ Wall bucky
¨ Control Console
¨ Sink and casework.
¨ Transformer and Power cabinet.
X ray machines :
Machines which operate at a higher milliampereage are better for taking X rays of
thicker part of the body with less exposure time, but they are more expensive.
For chest X rays and X ray of the extremities better films of these parts are
obtained with 100 or 200 mA machines. However Examination of the skull,
abdomen and special investigations are best carried out with machines working
at 500 mA and above.
Image intensifiers:
Special investigations and fluoroscopy together form about 14 percent of all
investigations.
Image intensifiers greatly enhance the brightness of the normal fluoroscopic
images reducing the dose to the patient. Image intensifier systems are
distinguished by a C arm suspended from an overhead support clamped between
the floor and ceiling on an upright metal column.
Some details on X-ray machines available and prices.
Portable X ray- 60 mA ---- Rs.1,25,000
300 mA X ray -----Rs. 7,50,000
500 mA X ray ----- Rs.9,00,000
1,000 mA X ray with IITV—Rs.32,00,000
Film processor tank ---- Rs. 3,00,000
X ray viewer (8 film panel)-- Rs. 9,000.
Power requirements:
1. Mains
• 220 volts AC, three phase.
• 50-60 cycles
• 25 Amps
• Mains impedance should not be greater than 0.5 ohms.
2. For a steady current with least impedance, a separate power line
exclusively for the radiology department is essential.
3. Frequent voltage fluctuations give unsatisfactory results. Voltage stabilizer
is necessary for each machine.
59
Radiation Protection:
If radiology rooms are isolated and built so that people cannot come within one
metre of its outside walls then no protection to the walls is required. However as
this is not always possible the walls of the rooms where radiographic machines
are located have to be adequately reinforced.
AERB guidelines (also see annexure)

PROTECTIVE The protective barrier for positioning between the
BARRER! operator/control panel and the X-ray tube/patient must
be of appropriate size and design so as to shield the
operator adequately against leakage and scattered
radiation. The protective barrier must have a minimum
lead equivalence of 1.5 mm. A viewing window having
1.5 mm lead equivalence must be provided in the barrier.
The lead equivalence must be indicated on the barrier as
well as on viewing window.
FLUOROSCOPY
The fluoroscopy chair must have a minimum of 1.5 mm
CHAIR! lead equivalence and its design must ensure adequate
protection to the radiologist against stray radiation.
PROTECTIVE The protective aprons must have a minimum lead

APRONS! equivalence of 0.25 mm and their size/design must
ensure adequate protection to the torso and gonads of
the user against stray radiation.
PROTECTIVE Protective gloves must have a minimum lead equivalence

GLOVES! of 0.25 mm and the design must ensure adequate
protection against stray radiation reaching the hands and
the wrists and must permit easy movements of the
hand/fingers.
GONAD SHELD! The gonad shields must have a minimum lead

equivalence of 0.5 mm.
PASS BOX! The cassette pass box intended for installation in the X-
ray room wall must have a shielding of 2.0 mm lead
equivalence. The design must be such that the pass box
60
can be opened from one side at a time.
FILM STORAGE!
The box intended for temporary storage of undeveloped
films must not have less than 2.0 mm lead equivalence
all around.
VEHICLE X-ray units installed in a mobile van or vehicle e.g. for

MOUNTED X-
medical surveys/clinics in remote areas, must be
RAY provided with an appropriate shielding enclosure so as to
EQUIPMENT!
ensure adequate built in protection for persons likely to
be present in and around the vehicle.
SHIELDING
Appropriate overlap of shielding materials must be
CONTINUITY!
provided at the joints or discontinuities so as to ensure
minimum prescribed shielding all over the surface of all
radiation protection devices. Care must be taken to
ensure that lead or any other shielding material does not
creep or flow, resulting in reduction of shielding in any
location.
MARKINGS!
The lead equivalence of shielding incorporated in
radiation protection devices must be marked
conspicuously and indelibly on them.
CONVENTIONAL Facilities for immobilization of patients, specially children,

SAFETY! should be provided so as to minimize holding of patients
during X-ray examinations.
CONVENTIONAL
Appropriate equipment must be available to
SAFETY!
prevent/manage conventional hazards such as fire,
flooding and electrical emergencies.
SAFETY
Additional radiation protection devices which would be
ACCESSORIES! necessary for specialized radiological investigations must
have a minimum of 0.5 mm lead equivalence
SERIAL Automatic serial changers should be used where the

CHANGERS! volume of work demands such specialized equipment.
• For a 100 mA machine a wall thickness equivalent to 1 mm of lead is

required.
• 1 mm of lead thickness = 12 cm of poured concrete
61
= 10 cm of sheet glass
= 5 mm of steel.
• The appropriate wall thickness using different materials can be calculated
using the following equation:
Thickness of concrete x 2.35 gm/ cu. Cm = Thickness of other material x
Density of other material.
• As per the recommendations of the radiation protection division of the
BARC, Mumbai the walls of the radiography rooms have to be 9 inches
thick concrete walls or 14 inches thick brick masonry walls which are
sufficient for primary as well as secondary radiation. Where they are thin,
lead shielding of walls is advisable.
• The places which need special protection are
i. The wall behind the chest stand in the radiology room.
ii. Wall between radiology room and the adjoining room.
• Personal protective measures like wearing the lead-rubber apron while
working and lead rubber gloves while doing fluoroscopy work provide
adequate protection.
• Use of dosimeters to measure the level of radiation.
Dark room/ Film processing room:

The darkroom should preferably be air-conditioned. Where the volume of work is
high, automatic film developing and fixing can be done wherein the exposed film
is fed at one end and comes out automatically developed, fixed and dried at the
other end. If the daily workload in the department exceeds 50 films, a small
automatic film processor should be installed.
The darkroom is conveniently located between two X ray rooms to facilitate
handling of films, a film transfer cabinet between the two X ray rooms to
facilitate handling of the films.
A utility sink is provided in the darkroom for handwashing.
The passage into the darkroom should be zigzag to serve as a lightlock between
the darkroom and outside.
The size of the darkroom depends on the number of staff working in it. For the
first person about 8 sq m. is required and for every additional person 2 sq m is
required.
Dark colours, especially black should be avoided. Citrus fruit colour and pastel
shades are suitable for the walls and the ceiling of the darkroom.
Ten air changes per hour are recommended.
Radiologists office:
The office has a series of viewing boxes where the radiologists examine
radiologists examine radiographic plates and dictates reports.
A single radiologist can report upto 50 to 60 cases in a month.
Manpower required:
Radiologists
X ray technicians
62
Darkroom assistants
Staff Nurse
Attendants
Record clerk
Receptionists.
Temperature in Radiodiagnostic department:

Some heating design temperatures for Radiodiagnostic departments.
Room Temperature in degrees centigrade
Waiting area 19
Patients changing room 22
Lavage room 21
Diagnostic X ray room 22
Processing area 19
Viewing area 19
Records 19
Office 19
Chemical and film stores 16
Flooring in Radiology Department:

In radiology units loads of 2,000 kg/sq m are installed which must be kept in
mind while designing the flooring of the radiology department.
Walls:
Permanent wall radiation screening in the X ray department rooms where the
working capacity does not exceed 150 kV and radiation is undirected should
comprise of a 2 mm thick sheet of lead and equivalent material.
In the X ray department shielded floors will be necessary if there are rooms
below the X ray rooms, particularly if tubes pointing downwards are used.
When under couch tubes are used ceiling shielding will be necessary for the
rooms above.
Windows:
Unshielded openings, if provided in am X-ray room for ventilation or natural light
etc., must be located above a height of 2 meters from the ground/floor level
outside the X-ray room.
Ultrasound room:
Ultrasound or sonography operates on the principles of sonar and records size
and shape by tracking reflected sound waves. A hand held transducer emits
regular pulses of high frequency sound and translates received echoes into
images.
Space requirements:
• Space requirement for a sonography room is about 25 sq mts.
• Space for staff, for storage of material and patient reception, waiting and
toilets which admit a wheelchair also are needed.
63
• A changing cubicle of about 2 sq mts in size should be made available for

the ultrasound room. It should be equipped with hooks, mirrors and
means for locking up the patients valuables.
• A toilet attached to the room is desirable.
Special equipment:
¨ An ultrasound unit with the console placed on the right side of the patient.
¨ Examination bed
¨ Film illuminators.
MRI room:
MRI is performed by placing the patient in a powerful magnetic filed that aligns
the magnetic spin of the atomic nuclei. Radio frequency energy is introduced
which disturbs the alignment of the nuclei. Different atoms respond at different
radio frequencies thus providing a distinction between tissue types. MRI does not
utilize ionizing rays and can create detailed two and three dimensional images of
both hard and soft tissue.
Since MRIs use radio frequencies to generate imaging they are susceptible to
electro magnetic interference from outside sources. The room is wrapped with a
copper fabric to shield it.
Special equipment:
¨ MRI unit
¨ Patient couch
¨ Operators console and video monitor in the control room.
Clinical laboratories:
Function:
Basic lab services provide information regarding the bodies chemical make up
and balance, the presence, numbers, performance and general activity of cells,
inherent genetic characteristics and the presence and level of bacteria and viral
organisms. In addition analyses of body tissue and cellular condition are assessed
through anatomical pathology studies. Clinicians use laboratory tests to make
decisions about patient care.
Location:
Generally laboratories are centralized for optimum efficiency in staffing,
management, quality control and equipment utilization. There may be a collection
center located in the outpatient department and a frozen section component
located in the surgical suite for immediate access during procedures. Blood gas
analyzers may be located either in the ICUs or in the laboratory depending on the
necessity. Stat labs may be located in those departments where necessary.
The laboratories will be located on the ground floor.
Interdepartmental relationships:
The labs should be easily accessible from the emergency department, the ICUs,
the OT’s, the OPD’s and the inpatient wards.
Key Determinants:
64
The majority of tests performed in labs today are automated, requiring relatively
little handling by technologists (except to initiate the testing process or to
calibrate and verify properly functioning equipment). Therefore the types and
numbers of testing machines within each lab section determine the capacity of
the lab and amount of space needed.
Flow of test orders and specimens:

Outpatient Inpatient
Patient visits Physician records

physician request for testing
on patient chart
Fills out
request for testing Specimen is collected
From patient
Outpatient comes
to lab for testing
Specimen is sent to Specimen is logged and

Specimen receiving decision is made on which dept
To send the specimen based on
Tests required
Specimen may be split into

Several containers
Departments receive sample
Departments test sample
Departments log results
Results are sent to the Results are received

Outside lab
Outpatient department at nurses station and
65
Attached to patients chart
Patient collects the

Results Physician reviews chart
And makes decision
Inpatient
Key design considerations:

Ø Biochemistry and haematology are most frequently located closest to the
specimen reception area due to the high volume of work. Microbiology
may be located farthest from the reception area because of the lower
volume of testing to be performed and to isolate these biohazardous
activities from other procedures.
Ø Chemical resistant and stain resistant materials should be used for
laboratory worktops and casework finishes. Bacteria resistant, cleanable
building finishes should be used in all areas. In areas of gross tissue
handling, such as gross tissue stations and the frozen section lab,
stainless steel is often used to enhance cleanability and durability.
Ø Casework used today is modular and easily movable to facilitate quick,
economical rearrangement. Casework 36 inch high is standard.
Functional areas:
Rooms
Specimen Control/ receiving – 75 sq. ft
Phlebotomy/ Blood drawing area – 150 sq. ft
Biochemistry – 300 sq ft.
Haematology –200 sq ft.
Blood Bank – 1840 sq ft
Microbiology –200 sq ft.
Histology –200 sq ft.
Administrative areas-
Pathologists office – 100 sq ft
Secretarial/ Transcription area/Reception – 100 sq ft.
Specimen receiving: All orders by physicians for tests and specimens to be

examined are received and logged in here. Specimens are then distributed to the
appropriate areas within the lab. Record keeping, generating computer reports
takes place here. Specimen receiving is usually located near the entrance of the
laboratory for easy access to traffic coming into the lab. Specimen receiving
should be located in close proximity to chemistry, haematology, urinalysis and
blood bank as most of the specimens go to these areas.
66
Casework and furniture:

¨ Stand up work surfaces to receive and hold specimens.
¨ Process tables for centrifuges
¨ Administrative work surfaces for seated work and computer use.
¨ Work surfaces at stand up height for specimen preparation.
¨ Locker with tray/ shelves to store blood drawing supplies used by
phlebotomists.
Phlebotomy area:
Area designated for drawing of blood samples from outpatients. Space is
provided for phlebotomists trays containing supplies necessary for drawing blood
samples from inpatients.
Casework :
¨ Modular shelving or lockers used for storage of phlebotomists trays and
supplies.
Biochemistry:
Blood, urine and other body fluids and tissues are analyzed in the biochemistry
lab for their chemical constituents. It will have the largest workload and the
number of technicians. It contains a large number of expensive highly specialized
testing equipment. It requires workstations with running tap water, distilled
water and many electrical outlets, some with dedicated lines for specific
equipment. Space must be provided for disposable supplies, reagents and
instrumentation.
¨ Workstations with modules and access panels for air and vacuum outlets,
running tap water, distilled water, drainage.
¨ Casework cabinets may be used for storage below work surfaces.
¨ Overhead flipper and shelf storage or below work surface drawers and shelves
for disposable supplies.
¨ Shelves below work surfaces towards the bottom of lockers as storage for
reagent containers.
¨ Chem- surf or resin work surfaces for staining areas.
¨ Cantilevered work surfaces, file drawers for administrative work space for
supervisors.
¨ Process tables for vibrating equipment, microscopes or large instrumentation
that may need easy access from all sides for use or repair.
Haematology:
It is the area of the lab in which blood samples are analyzed to determine the no.
and type of RBC’s, WBC’s and platelets. Complete blood counts (CBC) are
performed using large automated counters. Haematology performs approximately
50% of the procedures of the lab. Hence it should be in close proximity to
specimen control, have a specimen preparation area, room for several large
automated instruments, storage for reagents and many supplies and areas for
microscopes.
67
Casework and furniture:

¨ Stand-up and sit down workstations with chem-surf or resin work surfaces for
receiving and preparing specimens and for staining.
¨ A large number of workstations using modules and support panels.
¨ Casework cabinets for storage below work surfaces.
¨ Process tables for vibrating equipment such as a centrifuge.
¨ Lockers on terminal panels
Microbiology:
It is a study of specimens to isolate and identify disease causing organisms e.g.
Bacteria, fungi, viruses and parasites.
Ø Ideal location of microbiology is away from the main entrance of the lab.
Ø Separate area for media preparation and media inoculation requiring long
work surfaces.
Ø Ventilation and exhaust systems are key requirements.
Ø Subspecialties- Bacteriology (bacteria)
Mycology (Fungi)
Virology (viruses)
Parasitology (parasites)
They should be isolated from general lab and have negative air pressure to
guard against contamination of other lab areas from the substance under
examination.

¨ Heavy- duty work surface with drawers.
¨ Drawers under work surfaces to hold inoculation loops, slides, cover slips,
petri dishes, test tubes, pipettes etc.
¨ Casework cabinets for storage below work surfaces.
¨ Modular shelving units, C frame storage units with different sized drawers
or lockers to store stains and reagents for immediate accessibility.
¨ Resin work surfaces which are stain and heat-resistant for working with
stains, reagents and flames.
¨ Modules with water, electrical outlets and vacuum.
¨ Cantilevered sink unit.
Histology:
Function:
Histology prepares microscopic slides of tissues removed from patients during
surgery or autopsy.
After examination of the specimen by the naked eye in gross pathology,
pathologists examine prepared slides under the microscope to determine or
confirm the diagnosis.
The important thing to be kept in mind is the considerable cleaning problem
caused by the large amount of paraffin used – often in the melted state.
68
Pathologists office:
The chief pathologist will be provided with an office with room for meeting
people. He will have a microscope in the office.
Movable Modular Casework and Furnitures:
¨ Chair for chief pathologist
¨ Chairs for visitors.
¨ Work Surface
¨ Overhead storage
Secretarial/ Waiting:
There will be an administrative area for secretaries and receptionists. Waiting
areas are provided for patients waiting to have testing done. These areas will be
located towards the front of the laboratory to discourage traffic in the clinical
areas.
Movable Modular Casework and Furniture systems:
¨ Work surfaces with keyboard trays or drawers to accommodate computers

and printers.
¨ Flipper storage, display shelves and open shelves for storage of manuals and
books.
¨ Task lights and personal lights.
Lighting in laboratories:
When precision instruments are involved or colours have to be judged the
illumination level should be about 1,000 lux and when regular instruments 500 to
600 lux. The reasonable level of illumination at work with microscopes is about
3,000 lux.
Lighting in laboratories must not cause reflectance, glare and shadows.
Temperature and humidity:

In laboratories a fairly stable temperature of between 21 to 22 degrees
centigrade and a relative humidity between 40 and 60 percent should be
maintained.
Flooring in laboratories:
For laboratories special building adaptions, such as deep inserts in the floor, must
be taken in planning considerations early on.
All materials used should be tested with strong acids, alkalis, water, solvents,
and histological stains. The floors should be of non- slip quality also when wet,
easy to clean, hard wearing and fire resistant. Linoleum and tiles are widely used
in laboratories.
69
Asbestos vinyl tiles are hard wearing and not so slippery when wet. They are
however attacked by some alkalis and acids. Flexible vinyl is preferred for
laboratory floor covering because it is more impervious and therefore a little
more resistant to chemical attack. Flexible vinyl is resistant to acids but not to all
solvents. Vinyl sheets should not be laid where it would be subjected to abrasive
materials or to heavy point loads.
Doors in laboratories:
In laboratories 120 cm is considered to be the minimum acceptable door width.
For easy exit door widths should swing out from the laboratory.
Central Sterile Processing Department (CSSD/CSPD):
Functioning:
Central Sterile Processing is a service whereby medical/surgical supplies and
equipment-both sterile and non-sterile are cleaned, prepared, processed, stored
and issued for patient care. Its primary function is the sterilization of instruments
for surgery, labour and delivery and other departments. It is also responsible for
the distribution of sterile and clean disposable items.
Objective:
The objective of the CSSD is to provide a centralized and standardized
sterilization facility with a view to reducing the incidence of infection in a
healthcare setting.
Location:
Since around 40% of the load on CSPD is from the surgical department the ideal
location of the CSPD would be next to the surgery or either above or below
surgery. Vertical transport is important if the location is either above or below the
surgical department. This is usually through dumbwaiters that provide direct
access for both clean as well as soiled materials.
Interdepartmental relationships:
The CSSD is located such that it is easily accessible from the surgical
department, the wards and the ICUs.
Key factors to be kept in mind while planning CSSD:
Ø While designing the CSSD care should be taken that the flow of traffic is
continuous from receiving where the soiled items commence their journey
to issuing where sterilized items are issued, without retracting steps.
Ø The CSSD is located on a lower floor then 2 dedicated dumbwaiters
should be provided-one sterile and the other soiled-which connect the
CSSD floor with the surgical suite. Dumbwaiters are small elevators that
are used to deliver supplies. The sterile dumbwaiter opens into the sterile
area of the surgical suite and transports all sterile items without being
contaminated in transit. The second dumbwaiter which opens from the
disposal zone of the surgical suite, brings down the soiled items to the
soiled area of the CSSD for reprocessing.
70
Work Flow:
IN
Soiled returns from Soiled returns from

theatres wards and departments
SORT/WASH/DISINFECT/DRY
Make up packs
SET Trays
Sterilize Sterilize
Hold in processed goods

Despatch to theatres store
Despatch to
wards/departments
OUT
71
The department is divided into three zones to accomplish the functions of

decontamination, assembly and sterile processing and sterile storage and
distribution. These zones are a follows
1. Decontamination zone.
2. Sterilization zone
3. Storage and distribution zone.
A distinct separation must be maintained between the soiled and sterile areas.
The staff works on either side and cannot cross from one side to the other.
1. Decontamination zone:
The reusable equipment and soiled instruments and supplies are received from
departments for initial or gross cleaning. These items are cleaned and
decontaminated by means of manual or mechanical processes and chemical
disinfection.
Equipments used are:
Ø Washer Decontaminator: Used to clean heat intolerant items.
Ø Ultrasonic washer: Used to remove fine soil from surgical instruments
after manual cleaning and before sterilization
2. Sterilization zone:
After the instruments have been cleaned and inspected, they are assembled
into sets and trays. Each set or tray is wrapped or packaged for terminal or final
sterilization. Then the sets are prepared for issue, storage or further processing.
Equipment most commonly used are:
• High/Low pressure sterile processing systems.
• Ethylene oxide gas sterilizers.
• Chemical sterilization systems.
• Microwave sterilization systems.
3.Storage and distribution zone:

Following sterilization instruments are stored in sterile storage or sent to the
appropriate department.
Space requirements:
The space requirements for CSSD are around 10 –15 sq. ft per bed.
Primary areas:
1. Entrance area.
2. Soiled returns hold.
3. Washing area.
4. Gowning area.
5. Packing room.
6. Linen preparation room.
7. Sterilizer loading area.
8. Sterilizer plant room.
9. Cooling area.
72
10. Processed goods store.

11. Dispatch area.
Offices and staff facilities:
12. Staff changing room.
13.Staff toilets.
14. Office of the manager/in charge of dept/CSSD supervisor room.
Functions of each area:

1. Entrance area: There may be one or more entrance areas to the CSPD. One
may be for the staff and visitors and the return of soiled goods whereas the other
may be for the delivery of sterile supplies.
2. Soiled returns hold: The primary function is receiving collection trolleys

containing soiled returns from users in the hospital. Adequate parking space is
required for the no. of trolleys expected to be held at any time.
3.Washing area: Its function is to offload soiled returns from trolleys, to sort,
clean and dry all reprocessable items returned. Most items including trays and
containers will be cleaned and dried using an automated process. Items not
suitable for the automatic process will be cleaned at a hand-washing and drying
systems facility.
4.Gowning area: Before entering the packing room all staff and visitors must
conform to the changing procedure policy.
5.Packing room: Here all items are inspected and assembled in preset trays and
procedure packs and then transferred as packaged goods to the sterilizer loading
area.
6.Linen preparation room: The function is to receive clean linen from the
materials store and to transfer prepared linen into the packing room.
7.Sterilizer loading area: This is located next to the packing room. Trays and
packs will be received from the packing room and loaded onto carriers and
pallets. The carrier or pallet will be loaded onto the appropriate sterilizer chamber
using a sterilizer loading trolley.
8.Sterilizer plant room: Its primary function is accommodating steam and hot air
sterilization machines if required.
9.Cooling area: The function is cooling trays and packs. To achieve a good and
safe practice, loads should remain on the carrier or pallet until cooled.
10.Processed goods store: Here goods that have been processed by the
department are stored.
73
11.Despatch area: Its function is to receive trays and packs from the processed
goods store and to load distribution trolleys with goods for dispatch.
12.Staff changing room: Full changing facilities for male and female staff are
required if suitable central staff change is not available nearby. An individual
locker may be allocated to each full-time and part-time, member of staff.
13.Staff toilets: Toilets should be provided for the staff with WCs and
washbasins.
14.Office of the manager/incharge of the dept : The requisites for this room are
computer facilities, a desk with telephone and a document storage cabinet. There
should be enough space for the manager and visitors.
Equipment and accessories:

1. SS work table with wastage bin.
2. Worktable with undershelf.
3. Vertical sliding door
4. Two door instrument washer-disinfector.
5. Single free standing basket rack.
6. Storage shelf.
7. Storage shelf
8. Work table with single sink
9. Work table with 2 sinks
10. Ultrasonic cleaner.
11. Glove washer
12. Glove dryer
13. Glove powderer.
14. Glove storing bin.
15. E.T.O. sterilizer.
16. Preparation & packing table.
17. Rectangular sterilizer.
18. Trolley with carriage.
19. Storage tank
20. Water still
21. Double free standing basket rack.
Finishes:
Ø In the processing areas finishes should be suitable for frequent washing down
and tolerant to disinfectants. Joints should be avoided as they can hold moisture,
encouraging the growth of organisms. Worktops, sinks, etc should be built up to
walls and any gaps sealed. Where gaps are unavoidable they should be wide
enough for easy cleaning. Movable worktops adjacent to machines permit easy
cleaning and maintenance.
74
Ø Ledges trap dust particles and should be avoided. This is particularly

important in the packing room and linen preparation room which as clean rooms
require finishes which are easily cleaned and low in maintenance.
Ø Finishes must be suitable to cope with heavily loaded trolleys which are used
in many spaces. Buffering on trolleys and mobile equipment is one of the most
effective ways of reducing damage.
Flooring in the CSPD:

Ø Throughout the processing areas, stores and circulation spaces a uniform
floor level must be maintained. The finish must be suitable for heavy trolley
traffic. The flooring should be turned up at walls in an integral covered skirting
which should be continuous with the floor and be finished flush with the wall so
that the junction between the skirting and the wall does not provide a ledge for
the collection of dust.
Ø The finish must be hardwearing and easy to clean. Appropriate finishes would
be PVC sheet with welded joints or resin based flooring. A non slip surface should
be considered for wet areas.
Walls in the CSPD:

Ø In the storage and processing areas hollow wall construction should not be
used because of possible infestation risk and liability to trolley damage. Walls
should be of solid construction, rendered to a hard smooth finish to withstand
heavy treatment. Epoxy coating would be appropriate in processing areas.
Emulsion paint is appropriate in stores, circulation areas and staff areas.
Ceilings:
The minimum height from floor level to ceiling is 2.8 metres.
Doors:
Doors should be adequately sized to allow clear passage of trolleys and wheeled
medical equipment.
Patient room:
The patient room should be planned to provide the maximum amount of patient
comfort while allowing for the greatest quality of patient care. The room should
be designed to provide enough space for the patient and family or visitors as well
as equipment.
Spatial Requirements:
It is recommended that the area for one bed room should be less than 120 sq
feet in the general ward. The two bed rooms should be of 350 sq feet in size
with a minimum of 175 sq ft allotted to each bed and provided with curtains for
visual privacy. The private and deluxe rooms should have a area of 350 sq. ft.
There should not be less than four feet of space between the beds, and sufficient
space to allow the nurse to pass between the bed and the wall.
75

Ø The patients beds should be placed parallel to the exterior wall so that
patients can avoid facing the window and the outside glare.
Ø The doors of the patient rooms should not open outward into the corridor.
Ø The toilet in the patient room should be provided with a grab bar and an
emergency call button within easy reach. 30 to 35 mm diameter of the grab bar
will provide most people with a safe grip.
Ø The door of the toilet should open outwards towards the patient room.
Ø Electrical outlets for a reading light, nurses call and television should be at
the head of the bed and so also the telephone.
Ø An additional electrical outlet for cleaning equipment like vacuum cleaner
and portable X ray is needed on the opposite wall.
Ø The television may be ceiling hung or wall hung and should be in direct
sight from the bed.
Ø Windows should be provided for orientation of the patient to the outside
world. The height of the window sill should not exceed three feet to allow the
patient the outside view.
Ø The door width of all patient rooms should not be less than 1.2 m so that
a standard hospital bed can be wheeled in without obstruction. A standard
hospital bed measures 1.0 m in breadth and 2.15 m in length.
Ø Suitable width of corridors is 2.4 m to facilitate movement of stretcher
trolleys.
Ø The floor of ceiling height of the ward unit should not be less than 3.00 m.
Ø A comfortable working height while standing is usually 91.5 cm at the
wash basin rim. Wash basins used by wheelchair patients should have a
maximum height of 80 cm.
Movable Modular Casework and furniture:

¨ L carts or supply carts for general medical supplies.
¨ C frame storage units with drawers for general patient supplies.
¨ Cantilevered work surfaces for nurse charting.
¨ Patient bed
¨ Chair for the patient
¨ Visitors chair.
Lighting requirements:
In the patient room the level of illumination of 100 lux is quite satisfactory for
general lighting of the patient areas which will also meet the needs of the nursing
staff.
For examination purposes an examination light capable of providing 500 to 1000
lux will be required.
Noise in ward units:

Acceptable noise levels in wards range between 30 to 40 decibels.
76
BIBLIOGRAPHY:
1. Hospitals: The Planning and Design Process – Owen Hardy and Lawrence
Lammers.
2. Designing for total Quality in Healthcare- Kunders G. D.
3. Principles of Hospital Planning and Administration – B.M. Sakharkar.
4. Hospital Planning and Administration –MacCaulay and Llewelyn-Davies.
5. The Frontline Hospital- by Philip Mein. An article in a WHO offset
publication.
6. Planning, building and operation of healthcare facilities – B. M.
Kleczkowski. Also an article in a WHO offset publication.
7. Modern Hospital – International Planning Practices – Ervin Putsep.
8. Hospital Planning Module – Dr. Vivek Desai.
9. Herman Miller – Graphic Standards Programming and Schematic Design.
10. Building Type Basics For Healthcare Facilities – Stephen A. Kliment.
11. Sterile Services Department – Scottish Hospital Planning Note.
12. Hospital Planning Design & Management – G.D. Kunders.
13. Hospital Architecture – Guidelines for design & renovation – David R.
Porter.
14. www.aerb.gov.in - Safety code on medical, diagnostic X- ray equipment
and installations.
77
ANNEXURE 1
List of Licenses, Registrations and Approvals required.
License Agency
Food inspector license (storage of Municipal Authority
kitchen items)
Storage of spirit Municipal Authority
Storage of acids, alcohols, acetone, X Municipal Authority
ray films, oxygen cylinders
LPG cylinders Central Govt.
Drug license form 12(permission to Prohibition and excise dept.
import)
License for spirit Prohibition and excise dept.
License for alcohol Prohibition and excise dept.
Registration Agency
Reg. Under Shops and establishment Municipal Authority
Act
FDA for blood bank Central Govt.
FDA for Pharmacy Central Govt.
Reg of vehicles(ambulances) RTO
Approval list of items Agency

Imaging dept (X ray, MRI, CT scan, BARC, Central govt.
Gamma camera, RIA, Mammography)
Chimney for incinerator Pollution board
Electrical installations PWD, municipal authority
Lifts Municipal Authority
Fire Fighting Chief fire Officer
Incinerator Pollution Board
Sewage treatment plant Pollution board
78
Annexure 2
AERB SPECIFICATIONS FOR MEDICAL DIAGNOSTIC X-RAY
EQUIPMENT
PURPOSE! This Code is intended to govern radiation safety in the

design, installation and operation of medical diagnostic X- ray
equipment in order to:-
(a) ensure that workers occupationally exposed to

radiation/members of the public are not exposed to radiation
in excess of the operational limits specified under the
Radiation Protection Rules, 1971;
(b) do whatever is reasonably achievable to reduce radiation

exposures below these limits;
(c) ensure availability of appropriate equipment, personnel

and expertise for patient protection; and
(d) ensure timely detection and prompt rectification of

radiation safety related defects or malfunctioning of the
equipment.
SCOPE!
Radiation safety in the use of radiation generating plants is
governed by section 17 of the Atomic Energy Act, 1962.
Pursuant to the provisions of the Act, the Central
Government had promulgated the Radiation Protection Rules,
1971 Which stipulate basic safety standards for all types of
radiation applications in medicine, industry, research etc.
Appropriate radiation surveillance procedures have been
issued under rule 15 for ensuring radiation protection in
various types of applications. Radiation Surveillance
Procedures for Medical Applications of Radiation are
applicable to medical X- ray equipment and installations. This
Code elaborates the safety requirements contained in the
Atomic Energy Act, 1962 and the Radiation Surveillance
Procedures, relevant to medical diagnostic X-ray equipment
and installations and their use. Practical aspects of
implementing these requirements will be further elaborated
in the various guides to be issued under this Code.
In this Code, unless the context otherwise requires:-
(i)! "adequate protection" means protection against radiation so
79
provided that the levels of radiation are kept as low as

reasonably achievable and in no case exceed the prescribed
operational limits;
(ii)!
"appropriate" means appropriate in the opinion of the
competent authority to ensure adequate protection;
(iii)! "collimator" or "field limiting diaphragm" means the

mechanism for defining the useful beam;
(iv)! "commissioning" means starting the use of a diagnostic X-

ray equipment subsequent to performing such tests and
measurement as are necessary to confirm the safety and
performance of the equipment as per the design intent;
(v)!
"competent authority" means any officer or authority
appointed by the Central Government by notification. At
present atomic Energy Regulatory Board is the competent
authority;
(vi)! "cone" means a device by which the X- ray beam is confined

to a specified area;!
(vii)!
"decommissioning" means discontinuation of the use of a
diagnostic X-ray equipment on a permanent basis, with or
without dismantling the equipment;
(viii)! "dose" means energy absorbed in matter from ionising

radiation per unit mass of the matter. The S.I. Unit of dose
is gray (Gy). The special unit of dose is the rad and 1 rad =
1 centigray (cGy);
(ix)! "dose equivalent" means the quantity obtained on

multiplying the absorbed dose in tissue by appropriate
weighting factors to correct and normalize for variation in
the degree of biological effect produced by the same dose
of different ionising radiations or under different irradiation
conditions. The dose equivalent is used for radiation
protection purposes only. The unit of dose equivalent is
sievert (Sv) when the absorbed dose is expressed in gray. 1
sievert = 100 rem
(Appendix-IV) ;
80
(x)! "dosimetry" means operations and measurements performed

in connection with (a) the determination of rediation
dose;(b) dose distributions in the irradiated volume; and (c)
measurements related to operational limits;
(xi)! "employer" means any person who employs radiation

workers or who is self-employed as the only radiation worker
in a radiation installation;
(xii)! "filter" means a layer of radiation attenuating material

incorporated in the tube housing to preferentially absorb the
less penetrating components of the useful beam;
"permanent filter" means the filter which is an integral part
of the tube housing and which cannot be removed by the
user, unlike the "added filter";
(xiii)! "fluoroscopic screen" means a card-board or plastic base

upon which a layer of fluorescent salt is evenly spread which
emits visible radiation on being subjected to X- rays;
(xiv)!
"focus" means that area of the anode in an X-ray tube on
which X- ray producing electrons are incident. The area from
which the useful beam appears to originate, relative to the
film is called "apparent focus".
(xv)! "grid" means a device composed of alternate strips of lead

and radiolucent material encased suitably to be placed
between the patient and X- ray film to absorb scatter.
"potter bucky grid" or "bucky" means a device containing a
grid and a mechanism to impart motion to the grid during
radiography exposure;
(xvi)! "handle" means manufacture, possess,store,use, transfer by

sale or otherwise, import, transport or dispose of;
(xvii) !
"kerma" means the energy transferred (per unit mass) by
gamma rays, X-rays, or neutrons in the form of kinetic
energy of secondary charged particles at the point of
interest in an irradiated medium. If the irradiated medium is
air,the corresponding kerma is called air kerma. The SI unit
of kerma is gray
81
( Appendix-IV);
(xviii)!
"lead equivalence" means the thickness of lead, which,
under specified conditions of irradiation, affords the same
attenuation as the material under consideration;
(xix)! "leakage radiation" means radiation coming out of the tube

housing out side the useful beam area.
(xx)! "light beam collimator" or "light beam diaphragm" means

the mechanism to collimate and indicate the radiation field
by an optical equipment;
(xxi)!
"mobile equipment" or "portable equipment" means
equipment intended to be moved or carried from carried
from one location to another between periods of use;
(xxii)! "operational limits" means limits on levels of radiation as the

competent authority may by notification specify from time to
time;!
(xxiii)! "person" includes-

(I) any individual, corporation, association of persons
whether incorporated or not, partnership, estate, trust,
private or public institution, group, government agency, or
any state or any political sub-division thereof or any political
entity;
(ii) any legal successor, representative or agent of each of
the foregoing;
(xxiv)!
"protective barrier" or "shielding" means a barrier of
radiation attenuating material used to reduce radiation
levels;
(xxv)! "quality assurance tests" means tests performed to ensure

the performance and reliability of the X-ray equipment as
per the design specifications;!
(xxvi)! "radiation" in the context of diagnostic X- ray equipment

means X- rays originating from the X-ray tube or its high
voltage components/accessories, It also includes the
scattered radiation;
82
(xxvii)! "radiation protection survey" means an evaluation of

radiation safety in and around a radiation installation using
appropriate radiation measuring instruments;!
(xxviii) ! "radiation surveillance" means measure that may be

specified by the competent authority to provide adequate
protection either generally or in any individual case;
(xxix)! "radiation worker" means any person who is occupationally

exposed to radiation and who in the opinion of the
competent authority should be subject to radiation
surveillance;!
(xxx)!
"radiograph" means a permanent record of a transmission
image, produced by a beam of X-rays after passing through
the subject;
(xxxi)! "radiological safety officer" means any person who is so

designated by the employer and who in the opinion of the
competent authority is qualified to discharge the functions
outlined in the Radiation Protection Rules, 1971;!
(xxxii)!
"safety" means radiation safety and does not include
electrical/mechanical and other safety considerations;
(xxxiii)!
"scatter" or "scattered radiation" means radiation scattered
by the medium on which the primary beams is incident;
(xxxiv)!
"stationary equipment" means either fixed equipment or
equipment which is not intended to be moved from one
place to another,
(xxxv)!
"tube housing" means a shielding enclosure provided around
an X- ray tube, in order to-
(I) define the useful beam; and
(ii) limit the radiation levels outside of the useful beam such
as not to exceed the radiation leakage levels as specified in
section 3 of this Code;
(xxxvi)!
"useful beam" or "primary beam" means that part of the
emergent radiation from an X-ray tube housing which is
capable of being used for the purpose for which the X-ray
equipment is intended; and
83
(xxxvii)! "X-ray equipment" or "x-ray unit" means the integrated

assembly consisting of X-ray tube along with its housing,
support structure, associated accessories necessary for
proper operation and inclusive of built-in-radiation safety
devices as provided in section 3 of this Code.
In this Code-
(i) "shall" indicates a mandatory requirement as per provisions in the Radiation

Protection Rules, 1971;
(ii) "must" indicates a recommendation that is essential to meet the currently

accepted standards of radiation protection; and
(iii) "should" indicates an advisory recommendation that is highly desirable and

that is to be implemented where feasible.
BUILT- IN SAFETY SPECIFICATIONS FOR MEDICAL DIAGNOSTIC X-RAY

EQUIPMENT
Specifications for Radiography Equipment
TUBE HOUSING!
Every tube housing for medical diagnostic X-ray
equipment shall be so constructed that the leakage
radiation through the protective tube housing in any
direction, averaged over an area not larger than
100 cm2 shall not exceed an air kerma of 1 mGy in
one hour approximately 115 mR in one hour) at a
distance of 1.0 meter from the X-ray source when
the tube is operating at each of the ratings specified
by the manufacturer. There must be a distinctly
visible mark on the tube housing to indicate the
plane of the focus.
CONES &/
The X-ray tube housing must be provided with light
DIAPHRAGMS!
beam collimators for all general purpose stationary
diagnostic X-ray machines. For mobile units, a light
beam collimator should be preferred over cones
wherever possible. Field limiting diaphragms or
cones shall comply with the leakage radiation level
requirements prescribed for the tube housing. Each
84
cone should be indelibly marked with field size at

the specified focus to film distance.
BEAM FILTER! The useful beam portal of an X-ray tube housing

with maximum rated operating potential above 100
kV must have a total filter equivalent to at least 2.5
mm aluminum of which 1.5 mm should be
permanent. The X-ray tube housing must have a
total filter equivalent to at least 2.0 mm aluminum (
of which 1.5 mm should be permanent) for units
operating upto 100 kV except mammography and
dental units. Mammography units must have a
permanent filter equivalent to at least 0.5 mm
aluminum in the useful beam. The total permanent
filtration in the useful beam for conventional dental
radiography equipment with a maximum tube
voltage not exceeding 70 kV must be equivalent to
not less than 1.5 mm aluminum.
The inherent\permanent filter incorporated
must be indicated in the housing. The added filters
must have their equivalent filtration clearly marked
on them.
TUBE The X-ray unit must have appropriate features and

POSITIONING !
display aids for tube positioning, target to film
distance selection, useful beam centering and
angulation, positioning of the patient and for the X-
ray film exposure in the desired manner.
LOCKING DEVICES!
The tube housing and the tube stand must have
appropriate locking devices to immobilize` the tube
in the desired location and orientation.
BUCKY ALIGNMENT!
The X-ray table must have provisions for correct
positioning of the grid, the bucky tray and the film
cassette in proper alignment with the useful beam
and for their locking in the desired position.
CABLE LENGTH! The X-ray unit must have electrical cables of

sufficient length so that the control panel/operation
switch can be located and operated from a
minimum distance of 3 metres from the nearest
position of the X-ray tube. For dental radiography
85
units and mobile/portable X-ray equipment the

cable must not be less than 2 metres.
CONTROL PANEL! The control panel must be provided with means to

indicate the exposure parameters and conditions
including the tube potential, tube current, time of
exposure, integral exposure in milliampere seconds
(mAs), technique selection and the engagement of
the buck mechanism. A Clearly marked and
identifiable indicator must be provided at the
control panel to show whether the X-ray beam is
'ON' or 'OFF' for portable/mobile/dental units
appropriate exposure parameters should be
provided.
COMMON STATION !
When more than one tube can be operated from a
single control panel, there must be indication at or
near the tube housing and on the control panel
showing which of the tubes is being operated.
EXPOSURE SWITCH! The control panel must have provision to terminate

the X-ray exposure automatically after a preset
time or manually at any moment before this time by
removing pressure from it , When mechanical
timers are provided, repeated exposures must not
be possible without resetting the timer. The timer
must be so arranged that inadvertent exposure is
not possible.
RADIATION LEAKAGE The radiation level at 5 cm from the transformer

FROM surface of the X-ray unit shall not exceed 5 mGy in
TRANSFORMER!
one hour (approximately 0.6 mR in one hour).
SPECIAL CONES! The field defining cone-cum-spacer of dental

radiography and mammography units must be such
that they will ensure a focus to skin distance of at
least 20 cm for equipment operating at more than
60 kV and at least 10 cm for dental radiography
must limit the field diameter at these distance to
less than 7.5 cm at the cone end.
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Specifications for Fluroscopy Equipment
FLUOROSCOPY The tube housing shall conform to the leakage radiation

TUBE levels prescribed for radiography equipment in 3.1.1 The
HOUSING AND useful beam must aluminum for general fluoroscopy and
FILTRATION! not less than 2.5 mm for cardiovascular studies.
PROTECTIVE The protective lead glass covering of the fluorescent

LEAD GLASS!
screen must have a lead equivalent thickness of 2.0 mm
for units operating upto 100 kV. For units operating at
higher kilovoltages the lead equivalence must be
increased at the rate of 0.01 mm per kV.
LEAD RUBBER The X-ray table and the fluoroscopy stand must be
FLAPS!
provided with means of adequate protection for the
radiologist and other staff against the scattered X-rays.
Lead rubber flaps having lead equivalence of not less than
0.5 mm and sufficient dimensions to protect the
radiologist must be so provided that they are suspended
(a) from the bottom of the screen such that the flaps
overlap the fluoroscopic chair in vertical fluoroscopy and
(b) from the edge of the screen, nearest to the radiologist,
such that the flaps extend down to the table top in case of
horizontal fluoroscopy. The 'bucky-slot' must be provided
with a cover of 0.5 mm lead equivalence on the
radiologist's side.
TUBE SCREEN The X-ray tube and the fluoroscopic screen must be rigidly
ALIGNMENT! coupled and aligned so that both move together
synchronously and the axis of the X-ray beam passes
through the centre of the screen in all positions of the
tube and screen.
FIELD The field limiting diaphragm control mechanism must be

LIMITING so mechanically restricted that even when the diaphragm
DIAPHRAGM! is fully opened and the screen is at the maximum distance
from the table there is still an unilluminated margin of at
least 1 cm all along the edges of the screen.
FOCUS TO
The focus to table top distance must be so adjusted
TABLETTOP
mechanically that it shall not in any case be less than
DISTANCE! 30cm for fluoroscopy units and should preferably be (a)
45 cm for general fluoroscopy units. And (b) 60 cm for
87
units used exclusively for chest screening.
DIAPHRAGM
The diaphragm control knobs must be located on the
CONTROL ! frame of fluorescent screen and provided with local
shielding, if necessary, so as to offer adequate protection
for the hands of the radiologist.
FOOT-SWITCH
foot operated pressure switch must be provided for
& VISUAL conduction fluoroscopy examinations. There must be a
INDICATOR!
visual indication on the control panel when the beam is
'ON'.
FLUOROSCORY The unit must have a cumulative timer and its maximum
TIMER!
range shall not exceed 5 minutes. There should also be
provision for an audible signal at the end of the preset
time.
TABLE-TOP
The air kerma rate measured at the table top for the
DOSE!
minimum focus to table top distance should be as low as
possible and in any case must not exceed 5 cGy per
minute (approximately 5.75 R per minute).
AUTOMATIC When automatic brightness control is used to adjust kV or

BRIGHTNESS!
mA of the X-ray tube to maintain constant luminescence
at the viewing screen, appropriated monitoring equipment
must be incorporated to check the Tube potential and tube
current
SPECIFICATIONS FOR RADIATION PROTECTION DEVICES
PROTECTIVE
The protective barrier for positioning between the
BARRER!
operator/control panel and the X-ray tube/patient must
be of appropriate size and design so as to shield the
operator adequately against leakage and scattered
radiation. The protective barrier must have a minimum
lead equivalence of 1.5 mm. A viewing window having
1.5 mm lead equivalence must be provided in the barrier.
The lead equivalence must be indicated on the barrier as
well as on viewing window.
88
FLUOROSCOPY The fluoroscopy chair must have a minimum of 1.5 mm

CHAIR! lead equivalence and its design must ensure adequate
protection to the radiologist against stray radiation.
PROTECTIVE
The protective aprons must have a minimum lead
APRONS! equivalence of 0.25 mm and their size/design must
ensure adequate protection to the torso and gonads of
the user against stray radiation.
PROTECTIVE Protective gloves must have a minimum lead equivalence

GLOVES! of 0.25 mm and the design must ensure adequate
protection against stray radiation reaching the hands and
the wrists and must permit easy movements of the
hand/fingers.
GONAD SHELD!
The gonad shields must have a minimum lead
equivalence of 0.5 mm.
PASS BOX! The cassette pass box intended for installation in the X-
ray room wall must have a shielding of 2.0 mm lead
equivalence. The design must be such that the pass box
can be opened from one side at a time.
FILM STORAGE!
The box intended for temporary storage of undeveloped
films must not have less than 2.0 mm lead equivalence
all around.
VEHICLE
X-ray units installed in a mobile van or vehicle e.g. for
MOUNTED X- medical surveys/clinics in remote areas, must be
RAY provided with an appropriate shielding enclosure so as to
EQUIPMENT! ensure adequate built in protection for persons likely to
be present in and around the vehicle.
SHIELDING Appropriate overlap of shielding materials must be

CONTINUITY! provided at the joints or discontinuities so as to ensure
minimum prescribed shielding all over the surface of all
radiation protection devices. Care must be taken to
ensure that lead or any other shielding material does not
creep or flow, resulting in reduction of shielding in any
location.
89
MARKINGS! The lead equivalence of shielding incorporated in

radiation protection devices must be marked
conspicuously and indelibly on them.
CONVENTIONAL
Facilities for immobilization of patients, specially children,
SAFETY! should be provided so as to minimize holding of patients
during X-ray examinations.
CONVENTIONAL Appropriate equipment must be available to

SAFETY! prevent/manage conventional hazards such as fire,
flooding and electrical emergencies.
SAFETY
Additional radiation protection devices which would be
ACCESSORIES! necessary for specialized radiological investigations must
have a minimum of 0.5 mm lead equivalence
SERIAL
Automatic serial changers should be used where the
CHANGERS!
volume of work demands such specialized equipment.
LOCATION OF The rooms housing diagnostic X-ray units and related

X-RAY
equipment should be located as far away as feasible from
INSTALLATIO areas of high occupancy and general traffic, such as
N!
maternity and paediatric wards and other departments of
the hospital that are not directly related to radiation and
its use.
LAYOUT!
The layout of rooms in an X-ray department should aim at
providing integrated facilities so that handling of X-ray
equipment and related operations can be conveniently
performed with adequate protection. The number of doors
for entry to the X-ray room should be kept to the
minimum. The doors and passages leading to the X-ray
installation should permit safe and easy transport of
equipment and non-ambulatory patients. The dark room
should be so located that the primary X-ray beam cannot
be directed on it.
90
ROOM SIZE! The room housing an X-ray equipment must be spacious

enough to permit installation, use and servicing of the
equipment with safety and convenience for the operating
personnel, the servicing personnel and the patient. The
room size must not be less than 25 sq.m. for a general
purpose X-ray machine.
SHIELDING!
Appropriate structural shielding shall be provided for the
walls, the ceiling and the floor of the X-ray room so that
the doses received by workers occupationally exposed to
radiation and the members of the public are kept to a
minimum and shall not exceed the annual effective dose
equivalent limits of 50 mSv and 1 mSv respectively. The
doors of an X-ray room shall provide the same shielding as
that of the adjacent walls, in case persons are likely to be
present in front of them when the X-ray unit is energized.
Appropriate shielding must be provided for the dark room
to ensure that undeveloped X-ray films stored in it will not
be exposed to more than an air kerma rate of 10mGy per
week (approximately 1.13 m R per week).
OPENING & Unshielded openings, if provided in am X-ray room for

VENTILATION! ventilation or natural light etc., must be located above a
height of 2 meters from the ground/floor level outside the
X-ray room.
ILLUMINATIO
Rooms housing fluoroscopy equipment must be so
N CONTROL! designed that adequate darkness can be achieved
conveniently when desired in the room. For the use of
radiologist after dark adaptation.
EQUIPMENT The X-ray equipment must be installed in such a way that

LAYOUT!
in normal use the useful beam is not directed towards
control panel, doors, windows or areas of high occupancy.
The useful beam should preferably be directed towards
unoccupied area should be left all around the X-ray table
for safe and free movements of equipment-trolley,
radiology staff and service personnel.
CONTROL In the case of diagnostic X-ray equipment operating at

PANEL! 125 kV or above the control panel must be installed in a
separate control room located outside but contiguous to
the X-ray room and provided with appropriate shielding,
91
direct viewing and oral communication facilities between

the operator and the patient.
WAITING Patient waiting areas must be provided outside the X-ray

AREAS! room.
WARNING A suitable warning signal such as a red light must be

LIGHT &
provided at a conspicuous place outside the X-ray room
PLACARD! and kept 'ON' when the X-ray unit is in use, to prevent
inadvertent entry of persons not connected with the
examination. An appropriate warning placard, as indicated
in Appendix-III, must also be outside the X-ray room.
OPERATIONAL SAFETY
COMMISSIONING! When a diagnostic X-ray equipment is newly

installed/reinstalled in a new location/the equipment is
subjected to major repairs or structural modifications
are carried out in the existing installation, the
installation shall not be commissioned unless a
radiological protection survey conducted by the R.S.O.
or any other person duly authorized by the competent
authority has confirmed adequate protection and
operational safety in the X-ray installation. Records of
all such surveys shall be maintained for inspection of
the competent authority.
PERIODIC
Periodic inspection of the X-ray equipment, the lead
INSPECTION! rubber protective clothing and the safety/shielding
features of the X-ray room must be conducted to assure
replacement of defective components/items affecting
radiation safety. Records of all such inspections must be
maintained.
OPERATION OF
The X-ray equipment should be so operated that the
X-RAY primary beam is directed towards the areas of the
EQUIPMENT!
primary beam is directed towards the areas of minimum
occupancy. Installation of more than one X-ray unit in
the same room should therefore be discouraged. Only
92
the patient whose radiological examination is to be

carried out shall be allowed in the room except under
conditions specified under
CONTROL PANEL! When the control panel is in the X-ray room itself, the
panel must be located as far away from the X-ray
unit/chest stand as possible and duly shielded by a
protective barrier.
FURNISHING &
When the control panel is in the X-ray room itself, the
FIXTURES ! panel must be located as far away form the X-ray
unit/chest stand as possible and duly shielded by a
protective barrier.
BEAM Under no circumstances must the X-ray beam be

RESTRICTION! directed towards the control panel and other similar
areas where the shielding is adequate for secondary
radiation only.
ASSISTANCE TO Holding of children or infirm patients for X-ray

PATIENTS! examinations must be done only by an adult relative or
escort of the patient and not by a staff member.
Protective aprons and gloves must be provided to
persons rendering such help. Innobiliasation devices
should be used to prevent movement of children during
exposure. In no case shall the film or the X-ray tube be
held by hand.
SAFETY OF All efforts must be made to conduct the X-ray

STAFF! examination in such a way as to achieve the desired
result with minimum of exposure to the patient/staff.
Measures such as use of protective clothing, optimum
exposure setting, minimization of retakes and optimum
film processing techniques must be employed for this
purpose.
OPERATIONAL No persons other than those specifically concerned with

STAFF! a particular X-ray examination shall stay in the X-ray
room during radiological examination. The X-ray unit
must not be operated by any unauthorized person.
MOBILE A mobile X-ray unit shall be used with appropriate

EQUIPMENT!
93
safety measures to protect the public in the vicinity.

Minimum occupancy, maximum distance from occupied
areas and temporary shields shall be employed for the
purpose.
SERVICING OF
Servicing X-ray equipment must be undertaken only by
UNIT! such technologists who have been authorized by the
competent authority on the basis of their expertise and
radiation protection background to undertake this job
safety. In addition to the personnel monitoring devices,
the service personnel must use appropriate radiation
survey meters and direct reading dosimeters for on the
spot verification of their working conditions.
PATIENT PROTECTION
EXAMINATION Any X-ray examination should be prescribed only after

REQUIRMENT a critical evaluation of the patient’s condition in order
to avoid unnecessary exposures. In the event of doubt
on the advisability of an X-ray examination the matter
should be resolved by the radiologist in consultation
with the referring physician. Clinical indications,
provisional diagnosis and information required form X-
ray examination should be stated by the referring
physician. The practice of conducting mass radiological
surveys for the detection of tuberculosis, mass
mammography for occult carcinoma and chest
examinations should be undertaken with caution.
TRANSFER OF Transfer of radiographs from one institution to another

RECORDS should be encouraged to avoid repeat examinations.
QUALITY A new diagnosis X-ray equipment must not be used

ASSURANCE unless all the appropriate quality assurance tests have
been performed satisfactorily. Quality assurance tests
must be repeated periodically to ensure continued
good performance. Any defects noticed must be
corrected before recommisioning the unit.
FLUOROSCOPY No fluoroscopic examination should be conducted if the

required information can be obtained form
94
REQUIREMENT radiography. Wherever possible image intensifiers of

high gain, coupled with a TV monitor should be used
for fluoroscopy. No fluoroscopic work shall be done on
equipment not designed for fluoroscopy.
PATIENT DOSE All efforts shall be made to keep the patient dose as
REDUCTION low as technically achievable. Appropriate techniques
such as use of high efficiency filmscreen combinations,
minimum field size, minimum fluoroscopic time and
tube current, good dark adaptation and room
darkening must be employed for this purpose in day–
to-day practice of radiology.
ELECTIVE Elective radiological examinations of the lower

RADIOLOGICAL abdomen and pelvis of women in the reproductive age
EXAMINATIONS should be carried out. Preferably within the first 10
OF FEMALES days from the onset of menstruation. However the
examination may be performed if the clinical condition
of the patient needs immediate X-ray examination.
FOETAL Radiological examination of the lower abdomen and

PROTECTION pelvis of a pregnant woman must be conducted that
the foetus receives minimum possible radiation dose.
In all other X-ray examinations of the pregnant women
the lower abdomen and the pelvis must be covered
with a protective shield.
ORGAN SHIELD Gonad shields must be employed to shield the

reproductive organs of the patient unless it would
interfere with the information desired. Eye shields
should be provided to protect the eyes of the patients
undergoing some special examinations like carotid
angiography. Thyroid shields should be used where
necessary.
EXAMINATIONS Photoflurography and radiography of the chest should

OF CHEST be performed with a focus to receptor distance of at
least 120 cm.
RECORDS Records of all radiological examinations should be

maintained by the radiologist for follow-up and future
reference. Reports, and if possible radiographs, should
95
be given to the patient for future reference.
RADIATION PROTECTION PROGRAMME
FUNCTIONS OF R.S.O. The radiological safety officer (RSO) shall

implement all radiation surveillance
measures, conduct periodical radiation
protection surveys, maintain proper records
of personnel doses, instruct all radiation
workers on relevant safety measures,
educate and train new entrants and take
appropriate local measures including the
issuance of clear administrative instructions
in writing to deal with radiation emergencies.
The RSO shall ensure that all radiation
measuring and monitoring instruments in his
custody are properly calibrated and
maintained in good condition. Suitable
records of such surveys, including the layout
drawing, dose mappings, deficiencies noticed
and the remedial actions taken shall be
maintained for future follow-up.
PERSONNEL MONITORING Appropriate personnel monitoring devices

shall be used by all radiation workers.
PREGNANT WORKERS Once pregnancy of a radiation worker is

established, she shall not receive more than
10 mSv (1 rem) at a uniform rate during the
remaining period of her pregnancy .
TRAINNES Medical students/trainees must not operate

an X-ray equipment except under the direct
supervision of authorized operating
personnel.
STORAGE OF RADIATION Storage of undeveloped X-ray films and

SENSITIVE MATERIALS personnel monitoring devices must be done
appropriately in areas protected form X-rays
and other radiation sources in the installation.
96
PERSONNEL REQUIREMENTS AND RESPONSIBILITIES
SAFETY Every X-ray installation shall have a radiological safety

PERSONNEL officer. The radiological safety officer may be employer
himself or a consultant or a full/part time employee to
whom the employer will delegate the responsibility of
ensuring compliance with the appropriate radiation
safety/regulatory requirements applicable to his X-ray
installation. The minimum qualification and experience
currently prescribed for an R.S.O. are indicated in
Appendix-I
RADIOLOGIST All diagnostic radiology installations should be manned

as far as possible by qualified radiologists. However,
the services of a qualified radiologist must be made
available in (i) all installations having more than two X-
ray units or even single X-ray unit having fluoroscopy
facility and (ii) all establishments performing special
procedures such as cardiac catheterization,
angiography procedures, genito-uro-radiological
procedures such as cardiac catheterization,
angiography procedures, C.T. scans and all other
sophisticated imaging devices and procedures. The
minimum qualifications and experience currently
prescribed for a radiologist are given in Appendix-I.
Other installations having a single X-ray unit without
fluoroscopy may be manned by a physician without
radiology qualifications but having a degree recognized
by the Medical Council of India, provided a qualified/
certified X-ray technologist is available. A dental X-ray
equipment may be manned by a dentist damentals of
radiographic techniques and radiation protection.
! Only qualified X-ray technologists will be allowed

handle X-ray equipment. The minimum qualifications
and experience for X-ray technologists in Appendix-I.
However, the competent authority may consider
relaxation of qualifications for certification of
97
radiography technologists in case of experienced

personnel where only the X-ray unit without
fluoroscopy facility installed.
RESPONSIBILITES In any diagnostic X-ray installation, the ultimate

OF THE responsibility of ensuring radiation safety, availability
EMPLOYER of RSO and qualified personnel for handling of X-ray
equipment and providing them requisite equipment
and facilities to discharge their duties and functions
shall rest with the employer. He shall inform the
competent authority of any change in equipment or
staff including the RSO.
RESPONSIBILITES The radiologist shall undertake an X-ray examination

OF THE on the basis of a medical requirement. He shall so
RADIOLOGIST conduct the examination as to achieve maximum
reduction in radiation dose to the patient while
retaining all clinically important information.
RESPONSIBILITES The X-ray technologist and other attending staff shall

OF X-RAY ensure appropriate patient protection, public protection
TECHNOLOGIST and operational safety in handling the X-ray equipment
and other associated facilities.
RESPONSIBILITES The RSO shall assist the employer in meeting the

OF THE R.S.O. relevant regulatory requirements applicable to his X-
ray installation.
RESPONSIBILITES The manufacturer of X-ray equipment must make

OF THE available to the actual user detailed procedures for
MANUFACTURER routine quality assurance tests, exposure charts,
operating manuals and a copy of safety/regulatory
documents as may be issued by the competent
authority from time to time. The manufacturer must
provide appropriate servicing and maintenance
facilities during the useful life time of the X-ray
equipment.
REGULATORY CONTROLS
DESIGN Every medical X-ray diagnostic equipment shall meet
98
CERTIFICATION the design safety specifications stipulated in this code.

The manufacturer/vendor shall obtain design
certification from the competent authority prior to
marketing the X-ray equipment.
REGISTRATION OF The sale, transfer, gift, leasing or loan of X-ray

X-RAY EQUIPMENT equipment must be registered with the competent
authority by the seller or the person transferring such
equipment.
REPORT ON Persons undertaking servicing of X-ray equipment

UNSAFE must immediately report to the competent authority
EQUIPMENT any equipment no longer safe for use according to this
equipment, its locations/address, the name and
address of the employer/owner and nature of defects
that equipment hazardous.
INSPECTION The diagnostic X-ray installation shall be made

available by the employer for inspection, at all
reasonable times, by the competent authority or his
representative, to assure compliance of this code.
DECOMMISIONING Decommissioning of an X-ray equipment shall be

registered with the competent authority by the
employer immediately.
GUIDE & ORDERS The employer shall ensure that persons handling
medical x-ray diagnosis equipment duly addible by the
previsions of this Code and their further elaboration in
the various Guides issued by the competent authority.
He shall also ensure that these documents are made
available to them and further that any other measures
of safety as the competent authority may stipulate at
any time in each individual case are duly implemented
without delay.
CERTIFICATION Any consultant undertaking contract(s) to discharge

OF RSO the duties and functions of RSO in diagnostic X-ray
installations shall do only after obtaining certification
from the competent authority for the purpose. Such
certification shall be granted on the basis of his
qualification, experience and the
testing/survey/dosimetry equipment available with
99
him.
CERTIFICATION Servicing of X-ray equipment shall be undertaken only

OF SERVICE by persons holding a valid servicing safety certification
ENGINEERS from the competent authority. The certification shall
be granted on the basis of his qualification ,training,
experience, safety record and the servicing facilities
of such person.
REVOCATION OF The competent authority may revoke the

CERTIFICATION license/certification of an RSO/Service Engineer in the
event of persistent negligence in the discharge of his
duties.
PENALTIES Any person who contravenes the provisions of the

Radiation Protection Rules, 1971 elaborated in this
code or any other terms or conditions of certification
granted to him by the competent authority, is
punishable under section 24, section 25 and section
26 of the Atomic Energy Act, 1962. The punishment
may include imprisonment or fine or both.
Source:www.areb.gov.in -Safety code on medical, diagnostic X- ray equipment and

installations.
100

An Architectural Brief For A Proposed 100-Bedded Hospital: HOSMAC (India) Pvt. LTD

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AN ARCHITECTURAL BRIEF FOR A PROPOSED

DISSERTATION WORK DONE BY

CHPT TOPIC PAGE

1.1 INTODUCTION AND BACKGROUND INFROMATION 1

1.2 RATIONALE FOR THE STUDY 3

1.4 SPECIFIC OBJECTIVES 4

1.6 LIMITATIONS OF THE STUDY 5

1.7 TIME PERIOD AND PLACE 5

2 ABOUT THE ORGANIZATION 6

6 INTENSIVE CARE UNITS 50

9 CENTRAL STERILE PROCESSING DEPARTMENT 80

1 LIST OF LICENCES, REGISTRTIONS AND APPROVALS 90

2 AERB SPECIFICATIONS FOR MEDICAL DIAGNOSTIC 91

1.1 INTRODUCTION AND BACKGROUND INFORMATION:

Architects and construction-oriented professionals acting alone may provide a

Responsibilities of a functional planner:

1. Physical evaluation of existing facilities (along with architect)

Determination of the services to be provided in quantitative terms requires

1.2 RATIONALE FOR THE STUDY:

In undertaking any complex activity it is well to examine the experiences of

To prepare an architectural brief that would help the architect to build a

1.4 SPECIFIC OBJECTIVES:

1. To study/understand the issues involved in functional planning of a hospital.

3. To draw up a space plan for the proposed hospital.

Thus the study design is both exploratory and descriptive in nature.

1.6 LIMITATIONS OF THE STUDY:

1.7 TIME PERIOD AND PLACE:

Chpt. 2 ABOUT THE ORGANIZATION:

In a short span of 6 years, HOSMAC has notched up an impressive string of more

To provide such wide-ranging services HOSMAC has a motivated team of highly

Some of HOSMAC’s services

§ relevant data from census report, demographic surveys,

Such a market study is essential:

§ to primarily know the deficiencies in the health care market, thereby

§ to helps us finalizing the project size

§ for existing hospitals to undertake benchmarking in areas like tariff

§ Brief description on the major findings of the market research

§ Proposed facilities plan

§ Income and expenditure projections based on the feedback from the

§ Profit and Loss/ Balance sheet/Cash flow statements

§ Break even analysis

Specialized healthcare architecture is a field that is still in its infancy in India. As

In the future patients will be increasingly demanding of healthcare organizations.

§ Liaison with all Agencies - Architects/contractors/equipment

§ Monitoring Project with PERT/CPM

§ Managing Change in Project Plans - most vital and complicated component

§ Managing equipment planning schedule including cost-feature analysis,

Turn Around Strategies

§ improvement of the lab services

§ operation theatre utilization reviews

§ infection control programs

§ reorganization of profit centres

§ support service audits etc.

Product Development Assistance

§ Provide benchmarking data regarding market expectation from a hospital

§ Details hospital best practices

§ Undertake detailed reviews of newer modules and upgrade versions and

§ Periodic comprehensive review and study of the existing modules to update

§ Undertake a comprehensive system study