History of Hospitals:

Medicine and surgery date back to the beginning of civilization because diseases preceded humans on earth. Early medical treatment was always
identified with religious services and ceremonies. Priests were also physicians or medicine men, ministering to spirits, mind and body, Priests/doctors
were part of the ruling class with great political influences and the temple/hospital was also a meeting place.

Medicine as an organized entity first appeared 4000 years ago in the ancient region of Southwest Asia known as Mesopotamia. Between the Tigris and
Euphrates rivers, which have their origin in Asia Minor and merge to flow into the Persian Gulf.

The first recorded doctors prescription came from Sumer in ancient Babylon under the rule of the dynasty of Hammurabi (1728-1686BC). Hummurabis
code of law provides the first record of the regulation of doctors practice, as well as the regulation of their fees. The Mesopotamian civilization made
political, educational, and medical contributions to the later development of the Egyptian, Hebrew, Persian and even Indian cultures.

Indian Hospitals: Historical records show that efficient hospitals were constructed in India by 600 BC. During the splendid reign of King Asoka (273-232
BC), Indian hospitals started to look like modern hospitals. They followed principles of sanitation and cesarean sections were performed with close
attention to technique in order to save both mother and child. Physicians were appointed one for every ten villages-to serve the health care needs of the
populations and regional hospitals for the infirm and destitute were built by Buddha.

Ownership models
As seen in the earlier section, different hospital models developed over the years. Predominantly classified into for-profit and non profit. Or recent
classifications like for-profit, private nonprofit and public.

Unlike, most other sectors, for- profit organizations constituted a minority of firms supplying hospital care in the United States and in all developed
countries. In the US, such hospitals constitute only 15% of all nonfederal short term general hospitals in 1996(American Hospital Association 1998). By
contrast, 59 percent of hospitals were private nonprofit and the rest were operated by government, primarily local governments or special government
authorities. Another stylized fact is that growth of for profit hospitals market share has been moderate .Although for profit chains have grown both
numerically and in influence since they first appeared in the late 1960s,the share of small independent for profit hospitals has declined.

A recent study in India indicates that healthcare is delivered by a multitude of public and private providers. The government infrastructure is large in both
rural and urban India. In rural areas, the government has a vast base of primary healthcare centers, community health centers and sub centers. The
public infrastructure in urban India consists of tertiary medical colleges, district and taluk hospitals and urban health posts. The private healthcare
delivery sector consists of a large number of private practitioners, for profit hospitals and nursing homes and charitable institution.

The average size of such hospitals is less than 22 beds-much lower than developed countries.

The purpose of for profit, investor owned hospitals was primarily to increase the value of invested capital. Prior research finds that for profit hospitals tend
to locate in more profitable areas and are smaller than nonprofit hospitals. For profit hospitals obtain fewer donations and are not tax subsidized and so
rely primarily on patient fees. Church hospitals are owned and governed by religious organizations; they were originally organized to provide services for
church members, to restrict procedures that are contrary to religious beliefs and to permit patients to follow the tenets of the religion for last rites and
other ceremonies. These hospitals rely on both patient fees and donations. Government hospitals are owned and governed by governments, State or

Central. These hospitals rely on subsidies and grants for part of their operations and perform more charity than other hospitals. Because these hospitals
are tax

supported, government agencies are likely to monitor operations and have the authority to increase or decrease funding through budgeting processes.
Other nonprofit hospitals are privately owned and usually community hospitals or physician group hospitals. Physician influence tends to be stronger in
these hospitals. These hospitals rely also on patient fees and public donation.

Non profit firms may earn profits. In fact, many, including hospitals, do. Rather nonprofit firms are precluded from distributing profits to persons who
exercise control over the firm. Although such firms can pay reasonable compensation to suppliers of inputs, resulting earnings cannot be distributed. Such
earnings must be retained and used by the firm. Because of the non distribution constraint, nonprofit firms have no owners, that is, persons who control
and share residual earnings.

Ownership form and hospital behavior: The social welfare implications of for-profit versus nonprofit ownership, and private versus public ownership, have
been of interest to economists for decades. In stylized microeconomic models of organizations, theory predicts that the for profit organizational form is
efficient ,because of the high powered incentives that arise from the presence of a well defined residual claimant with legally enforceable property rights.
Researchers exploring the effects of for profit, private nonprofit and public hospital ownership on productivity have reported a wide range of empirical
results. On one hand, some researchers report that the for-profit form achieves greater productive efficiency, on the other hand, many studies find that
for-profit hospitals have higher costs or markups than do nonprofits. And a substantial literature argues that nonprofit hospitals have costs and /or quality
similar to that of for profits, concluding that hospitals are socially indistinguishable on the basis of ownership status.
In India too, the above conclusion stands true. There are hospitals both in the private and public who extend service quality par excellence. Due to the
unregulated system, there are also the extreme cases of poor quality healthcare provided by hospitals, many operating with unskilled medical staff and in
substandard facilities

Albert Einstein said We cannot solve operating problems by using the same kind of thinking we used when we created them,

HOSPITAL

A hospital is a health care institution providing patient treatment with specialized staff and equipment. Hospitals are usually funded by the public sector, by health
organizations (for profit or nonprofit), health insurance companies, or charities, including direct charitable donations. Historically, hospitals were often founded and funded
by religious orders or charitable individuals and leaders. Today, hospitals are largely staffed by professional physicians, surgeons, and nurses, whereas in the past, this work
was usually performed by the founding religious orders or by volunteers.
CATEGORIES OF HOSPITALS: Hospitals are classified depending on the nature of the healthcare facilities other on the type of ownership. with respect to. To healthcare
facilities :

HOSPITAL

GENERAL

SPECIALIZ
ED

DISTRICT

TEACHING

SPECIALTY HOSPITALS:
Specialty hospitals, owned and operated by physicians with an expertise in a particular medical condition, offer the opportunity to design a utopian care environment for optimal
delivery of care. In fact, the concept of specialty heart hospitals dates back to the mid-19th century in England, with the opening in 1857 of Londons National Hospital for
Diseases of the Heart and Paralysis.
A heart hospital is a hospital that specializes in the diagnosis and treatment of heart disease. It can be a free-standing hospital or it can be a section of a large hospital that is
designated as a heart hospital. Whether it is free-standing or incorporated into a section If the larger hospital it specializes only in the diagnosis and treatment of heart disease.

The nurses and doctors that work in these areas receive special training in the diagnosis and treatment of heart cardiac services function more effectively and efficiently when
they are integrated into a full-service hospital. Faced with the option of moving cardiac services to a freestanding facility or integrating them into a full-service hospital, health
systems and facilities typically choose integration for a number of important reasons. These include continuity of care, cost-effective integration of support services, shared
support spaces, and more integration in the delivery of healthcare services. At the same time, many cardiac specialists seek an environment that is exclusively designed to
meet their needs. A heart hospital within a hospital often offers the best of both worldsthe separate identity physicians and hospitals oftenisease. Seek for a key service line,
and the efficiencies of integrated
Clinical and admiistrnative support services.

DESIGNING A HOSPITAL :

Modern hospital buildings are designed to minimize the effort of medical personnel and the possibility of contamination while maximizing the efficiency of the whole system.
Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimized. The building also should be built to accommodate
heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design. However, the reality
is that many hospitals, even those considered 'modern', are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new
sections added on as needs and finances dictate. As a result, Dutch architectural historian Cor Wagenaar has called many hospitals:

"... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly
ever functional, and
instead of making patients feel at home, they produce stress and anxiety

Some newer hospitals now try to re-establish design that takes the patient's psychological needs into account, such as providing more fresh air, better views and more pleasant
color schemes. These ideas harken back to the late eighteenth century, when the concept of providing fresh air and access to the 'healing powers of nature' were first
employed by hospital architects in improving their buildings. The research of British Medical Association is showing that good hospital design can reduce patient's recovery
time. Exposure to daylight is effective in reducing depression. Single sex accommodation help ensure that patients are treated in privacy and with dignity. Exposure to nature
and hospital gardens is also important looking out windows improves patients' moods and reduces blood pressure and stress level. Eliminating long corridors can reduce
nurses' fatigue and stress. Another ongoing major development is the change from a ward-based system (where patients are accommodated in communal rooms, separated
by movable partitions) to one in which they are accommodated in individual rooms. The ward-based system has been described as very efficient, especially for the medical
staff, but is considered to be more stressful for patients and detrimental to their privacy. A major constraint on providing all patients with their own rooms is however found in the
higher cost of building and operating such a hospital; this causes some hospitals to charge for private rooms.

REQUIREMENTS:
AREA
1 hectare for every 25 beds is recommended.
SITE
Sites with high degree of sensitivity to outside noise should be avoided.
Sensitive areas like wards, consulting and treatment rooms and operation theatres to be placed away from the outdoor sources of noise.
The importance of landscape elements such as open areas, horticulture increase the comfort conditions inside the building and also in the surrounding environment.
REQUIREMENTS FOR PROPER HOSPITAL PLANNING. Hospital requirements are worked out primarily through functional planning. for the purpose of hospital planning
various components and departments are taken into consideration . Each department is an independent entity and specific peculiarities.
FLOOR HEIGHT

The height of all the rooms in the hospital should not be less than 3.00 m measured at any point from the surface of the floor to the lowest point of the ceiling. The
minimum head-room, such as, under the button of beams. fans and lights shall be 2.50 m measured vertical under such beam, fan or light.
DOOR OPENINGS:

Minimum dimensions of clear door openings of patients bedrooms 1500mm wide and 2100mm high.

Clear door opening to room that may be accessed by stretchers, wheeled bed stretchers, wheel chairs or handicapped persons should be 900mm.

Doors, except those to spaces such as ducts (which are not subject to constant patient or staff occupancy), shall not swing into corridors in a manner that might
obstruct traffic flow or reduce the required corridor width.
CORRIDORS:
Corridor widths in which there is frequent bed stretcher and trolley movement, e,g inpatients units, OTs, ICUs, - 2100 to 2400mm.
Corridor widths where infrequent trolley or bed movement is expected 1800mm
Corridor width where no patient transportation is required and where corridor rooms are no longer than 12meters (such as offices) 1200mm.
Major inter departmental arterial corridors and public corridors 2100mm.

CEILING HEIGHTS:

The minimum ceiling height in occupied areas shall be 2400mm, but consideration should be given to the size (Aesthetic consideration) and use of the room. 2700mm
is Considered a more appropriate ceiling height in work areas.

The minimum ceiling height in corridors, passages, recesses, etc. shall also be 2400mm. In portions of remodeled existing facilities, the corridor ceiling height may
be reduced to 2250mm, but only over limited areas, e.g., where a mechanical duct passes over a corridor, a reduced ceiling height for no greater corridor length than 3000mm
is acceptable.

In areas where access is restricted, e.g., drinking fountain recess etc., a minimum ceiling height of 2250mm is acceptable.

RAMPS:

Most
than
m.
area.
when

common provision made for wheelchairs is a ramp. However, ramps are mostly
difficult to use, both in mounting and in descending. They should be no steeper
8 per cent (preferably 6 per cent) and unbroken lengths of ramp no longer than 10
For a rise of only 650 mm, therefore, a good ramp would take up a considerable
The use of a chair lift or of ordinary lifts is therefore often preferable to a ramp,
although these suffer from the need for adequate maintenance, and problems arise
they break down.

PROVISION FOR THE HANDICAPPED:

CORRIDORS

Should be at least 7 ft wide to allow enough room both for two-way traffic of persons using crutches or wheelchairs.

Handrails of a bright color or material in bold contrast to the walls should be provided on corridor walls. Such handrails are especially helpful to people with poor vision
end to blind persons.

Provision for blind people needs to be made in the design of signs, raised letters being preferable to Braille, particularly in lifts.
WIDTH AND DESIGN OF CORRIDORS AND DOORWAYS :

The width of a corridor should not be less than 900 mm for a self-propelled wheelchair, or 1.8 m if two wheelchairs are likely to want to pass each other, no columns,
radiators, drinking fountains, telephone booths, pipes, or other projections should protrude into public corridors.
TURNING SPACE

Most wheelchairs require a space 1.4 m square to turn around. Crutch users often find ramps more of a problem than steps.
Ideally, all wheelchair ramps should be adjacent to supplementary steps.

AMBULANCE:
TURNING THROUGH 90 DEGREES :DIMENSIONS FOR DIFFERENT VEHICLES
Length=5885mm
Width= 2000mm
Height=2540mm
Round clearance=190mm
Turning circle=6.5m
EXTERNAL DIMENSIONS OF A CAR

LIFT DIMENSIONS:

Lifts transport people ,medicines, laundry, meals and hospital beds between two floor in buildings in which care, examination or treatment areas are accommodated
on upper floor at least two lifts suitable for transporting beds must be provided. One multipurpose lift should be provided for 100 beds, with a minimum of two for
smaller hospitals. In addition there should be a minimum of two smaller lift for portable equipments, staff and visitor Clear dimensions of the lift car: 0.90X1.20 m Clear
dimensions of the shaft: 1.25x1.50 m

Passenger lifts should be within a reasonable walking distance from the furthest part of the floor areas served (70 m maximum)
The location of goods and service lifts will depend on their function, but they should not open into passenger lift lobbies or public areas.
Bed lifts shall be necessarily provided in the emergency areas.

HOSPITAL DEPARTMENTS & ITS CIRCULATION:

OUT PATIENT DEPARTMENT (OPD) :

The OPD should be ideally located on the ground floor with separate entrance and adequate parking facilities.
Reception area and waiting space should be immediately apparent and welcoming.
Attention should be paid to circulation transversing department.
There should be easy access to labs , pharmacy , and pathology lab.

Treatment rooms for minor procedures and cast work be easily accessible from main waiting spaces and consultation rooms.

DESIGN CONSIDERATION FOR OPD

The storage areas for wheel chairs and stretchers should be neatly alcove and easily accessible from main traffic line.

Elevators should be accessible to the lobby and especially important for cardiac and obestric patients who require immediate care.

To improve the atmosphere, patients should be dispersed to sub waiting areas.

There should be proper link between the emergency services and outpatient department.

There should be provision of public telephones , toilets , water , cafeteria

RADIOLOGY:

The department receives inpatients, outpatient, and casualties. Its function is to photograph, process the film and provide facilities for its interpretation and storage.
X RAY rooms are equipped with photograph machinery of considerable sophistication .the x-ray rooms need dark rooms nearby for the processing of the films and a
room for viewing.
The location of the department should be convenient for trolley access from the wards and close to the outpatients department unless the accident and emergency
department has its own x-ray facilities, it is essential that there should be easy access to the x-ray department.
The radiology department comprises of mri room, ultrasound room, changing room, sub waiting area, xray general , radiography room , control room , change room ,
film store , reporting room.
Structural shielding from radiation can be achieved by using lead inserts or with thick concrete walls . The thickness of walls constructed in concrete only should be
3.00 m for treatment and examination rooms in the primary radiation area and 1.5m for rooms in the secondary radiation area , according to the type of equipment.
The huge weight of the equipment and the required structural radiation protection measures make it necessary for radiotherapy departments to be located in
basement or ground floor.

WARDS:
AREAS
General ward 3978sqft
Semiprivate + deluxe 8437sqft
Private+deluxe 8437sqft
Clear space around the bed
Total area wards 45378 sqft. 43% of the total floor
Clear space around the bed
Bed spaces + clinical support + two en- suites + circulation added In between.

GENERAL
WARD:
LINEAR WARD
20-30 beds
sluices and wc at
COURTYARD
Reduces internal working room.
Success depends on amount of daylight and degree of privacy

supported by nurse working room at end,

other.
PLAN

DEEP WARD OR RACE TRACK

it neglects spaces where spaces can be neglected.
Background noise reduced but as result audio-privacy for consultations is not so good.
Walls laced on outside wall, naturally lit and ventilated
Nurses workstation being centrally located needs artificial light and ventilation

OPERATION THEATER( OT) :

OT is that specialized facility of the hospital where life saving or life improving procedures are carried out on the human body by invasive methods under strict aseptic
conditions in a controlled environment by specially trained personnel to promote healing and cure with maximum safety, comfort and economy.

LOCATION:

The OTs can be grouped together in a centralized form to have an entire OT complex or they can be decentralized. However,

Centralized OTs are preferred normally as there is greater economy of staff and equipment, better professional supervision and greater efficiency.

There will be 3 OTs- 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 also 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.

An
sq ft.
The
a waste
Each
should
foot

of

operating room for general surgery will have an area of 450

operation suite will consist of an operating room a scrub room
disposal room an exit room.
stretcher station should be of 80 sq. feet (7.43 sqm) and
have a
Clearance of 4 feet (1.22m) on the sides of the stretcher and
the stretcher.

POST ANESTHETIC CARE UNITS :

omedication station
hand washing station
nurse station
storage space for stretchers

supplies and equipment

Additionally 80 sq feet (7.43 sqm) for each patient Bed clearance of 5 feet (1.5 m) between beds and 4 feet should
be (1.22m) between patient bed sides and adjacent walls.

INTENSIVE CARE UNIT:

The intensive care includes monitoring and treatment as well as care of patients.
ARRANGEMENT
The intensive care department must be a separate area and only accessible through lobbies.

Each intensive care unit be a separate fire compartment.

Apart from the patient and staff lobbies visitors should only access the unit through a visitors lobby

( waiting room).
The central point of an intensive care unit must be an open nurses workstation from which it is possible to oversee every room.

The recovery room of the operating department is often located in icu so the patients can
economically be cared for by the same staff.
The number of patients per unit should be between six and ten in order to avoid overloading.
One nurses duty station a sterilize work station , one material room and one equipment room per unit
should be included in plan.

ICU INTERDEPARTMENTAL RELATIONSHIP

EIGHT-BED INTENSIVE CARE SUBGROUP: GLAZED INDIVIDUAL ROOMS
PHARMACY :
A dispensary is needed, close to the out-patient department and with a comfortable waiting area.

Area

The

If the main hospital pharmacy cannot be so located,

pneumatic tubes from it to the dispensary and some
other user areas may be justified. Pharmacy store - Area
= 520 sqft.
Pharmacy outlet- Area = 260 sqft.
required for pharmacy per bed bed is 7.8 sqft.

PATHOLOGY :
four main laboratory disciplines in hospitals are
histology

 microbiology
haematology
biochemistry.
The whole department will generally have a shared receiving area for specimens and records.

MORTUARY :

LAUNDRY:

It is desirable, but not essential, for the mortuary to be near the pathology department, as the histologist
is responsible for post-mortems.
The main elements are the body store, post-mortem rooms, and facilities for visitors.
The access route into the mortuary for bodies from the hospital should be separate from that taken by
visitors, although mortuary trolleys are discreet enough that separate lifts and circulation routes through
the hospital are not needed.
Particular care is needed for the furnishing and outlook of the visitors waiting and visiting areas; a toilet
and kitchenette unit is required.
Access by hearses should be out of sight from windows of wards and other patients areas.

In India a common thing is lack of emphasis given to support services like kitchen, laundry, CSSD, back-up electricity and so
on.
AREA = 1918 sqft.
The area required for laundry per bed is 19.18 sqft.
The dirty utility opens into the dirty corridor from where the things are removed via the dumbwaiter to the CSSD or the
Laundry.
Figures for the amount of dirty dry washing defer from 0.8 kg to 3.0 kg. The following sequence of work is preferred

KITCHEN:
The compartment has no direct link with the patient. It gives secondary services to the patient, but without this department the whole hospital is paralyzed.
Food has to be supplied both to the patients and staff, and in modern hospitals the nos.of staff may be roughly equal to the nos. Of beds. One central kitchen usually supplies
all the food because it simplifies service, the staff dining rooms are generally sited adjacent to the kitchen.

CSSD:
A hospital consumes a large quantity of new material that need sterilization before use. it also processes other material that has to be clean and sterilized before it can be
used. this sterilization used to be carried out where and when the material was wanted, for instance in the ward or the operating suite. nowadays item can be supplied by
manufacturers in sterilized packs appropriate for particular purposes and an increasing no. of them are disposable. However, the hospital still needs to sterilize most items and
also to control the supply of properly sterilized material to wherever it is needed. the purpose of cssd is to concentrate the skill and the responsibility for the supply of material
and to reduce the risk of error. The department also enables nursing staff to do their work with patients more effectively. Where there are several hospitals in fairly close
proximity one department may provide this service for them all.
ADMINISTRATION:

The extent of offices provided in the hospital depends on whether they are also the headquarters of the Trust.
Main functions include Trust Board and Secretariat, finance, personnel, supplies, and senior nursing and other professional staff.
Ancillary spaces include computer facilities, stationery and other stores.
The post room and telephone exchange are often associated with the main entrance.
Other administrative functions do not need priority locations, and may be on an upper floor. Clinical Directorates offices are generally near their clinical areas.

Offices for consultants (shared if not full-time) may be centralized or near clinical areas.

NURSING UNIT:
Nursing unit or the nurse work station should be situated in the central position and require a size of about 25-30 sq.mts. The nursing unit comprises of :
Bed control (within patient s reach, with nurse controller cut off feature) CEILING

Nurses call micro-speakers.

radio speakers (for private room only) HIGH ON WALL( 60 inches or higher)

over bed light fixtures(direct and in-direct)

oxygen outlet . LOW ON WALL( approx malty 24 inches0

Double duplex receptacle (bed, oxygen-tent ,portable x-ray heating pad etc.)

remote recording instrument receptacles(temprature,pulse,respiratory)

This nursing unit layout permits a close relationship between the patient bedrooms and the nursing station and other service areas.

76

Operation Theatre
Instruments for General Surgery & (Maternity) Obstetrics/Gynaecology.
The aim of the following list of instruments is to provide an exhaustive checklist of instruments
that may be required. It is recognised that surgeons have preferences for types and number of
instruments and this list need not be considered as restrictive.
Instruments Quantity Size
General Instruments
Sponge forceps (Rampley) 4 2.5cms
Towel clips 6 11cms
Artery forceps, straight 6 16cms
(crile) curved 6 16cms
Artery forceps (mosquito) straight 6 13cms
curved 6 13cms
Curved artery forceps (Mayo or Kelly) 6 20cms
Straight artery forceps (spencerwells) 6 20cms
Tissue forceps (Allis) 4 15cms
Standard dissecting forceps toothed 2 14.5cms
non-toothed 2
14.5cms
Long dissecting
forceps (toothed) 1 25cms
Long dissecting
forceps (non-toothed) 1 25cms

Straight dissecting scissors (Mayo) 2 17cms

Curved dissecting scissors (Mayo) 1 23cms
Dissecting scissors (Metzenbaum) 1 18cms
Skin grafting (Humby's) handle 1
Skin grafting blades
Stitch scissors with blunt ends 2 15cms
Abdominal wall C-shaped retractors (narrow, medium)
Retractors (Deaver) medium, blade 1 25mm
large blade 1 75mm
Needle holders (Mayo) medium 2 15cms
large 2 17.5cms
Scalpel handles No.3 (Bard Parker) 12
No.4 (Bard Parker) 12
No.5 (Bard Parker) 4