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Literature Study
👷 Submitted By: Divyanshu Tiwari
Subject Code: AR 302 Architectural Design
A.) General Information
a.) Classification of healthcare buildings according to level of care
b.) Classification of healthcare buildings according to capacity
c.) Components of a hospital
B.) Physical Infrastructure
a.) Size of Hospital
b.) Land Area
c.) Floor Area
d.) Circulation
→ Corridors
→ Ramps
→ Roof Height
→ Elevators
→ Entrance Areas
→ Barrier free access
→ Proximity Diagram
C.) Ward Unit

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 a.) Planning
b.) Beds
c.) Windows
d.) Detailed Breakup
D.) Pharmacy
a.) Detailed Breakup
E.) Intensive Care Unit
a.) Beds
b.) Location
c.) Facilities
F.) Accident and Emergency Services
a.) Detailed Breakup
G.) Outdoor Patient Department
a.) Spaces inside OPD
b.) Location
H.) Indoor Patient Department
I.) Blood Bank
a.) Detailed Breakup
J.) Operation Theatre
a.) Number
b.) Location
c.) Zones
d.) Traffic Flow
e.) Detailed Breakup
K.) Delivery Suite Unit
a.) Detailed Breakup
L.) Physical Medicine and Rehabilitation(PMR
M.) Hospital Administrative and Support Services
a.) Hospital Kitchen
→ Detailed Breakup
b.) Central Sterile Supply Department
→ Detailed Breakup
c.) Hospital Laundry
→ Detailed Breakup
d.) Medical and General Stores
→ Storage room for Vaccines and other logistics
→ Detailed Breakup
e.) Mortuary
→ Detailed Breakup

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 N.) Engineering Services
a.) Electric Engineering Sub Station and Generation
b.) Illumination
c.) Ventilation
d.) Mechanical Engineering
e.) Water Supply and Sanitation
→ Detailed Breakup
f.) Committee Room
g.) Hospital Transport Services
O.) Fire Safety in Hospitals
a.) Elements of Fire Safety
→ Open Spaces
→ Basements
→ Internal Staircase
→ External Staircases
→ Horizontal Exits
→ Exit Doors
→ Corridors and Passageways
→ Ramps
→ Fire pump room
P.) Trends in Hospital Design
a.) Designing Around Modern Technology
→ Digital Kiosks
→ Virtual Reality
b.) Adaptable Spaces
→ Prefabricated Partitions
→ Shell Spaces
c.) Materials that Protect Against the Spread of Incfection
→ Photoactive Pigments
→ Indigo Lighting
d.) Biophilic Interior Design
→ Natural Light
→ Integrate Views of Nature
e.) Concierge Healthcare Services
→ Neutral-Colored Waiting and Exam Areas
→ Private Waiting Rooms
Q.) References

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 A.) General Information
a.) Classification of healthcare buildings according to
level of care
General healthcare buildings are generally graded according to their degree
of sophistication and level of care:
Primary care - This is where patients first come to when they enter the
healthcare system
Secondary care - Medical care that is provided by a specialist or facility
upon referral by a primary care physician.s
Tertiary care - Highly specialized medical care usually over an extended
period of time.
b.) Classification of healthcare buildings according to
capacity
Category A - 25 to 50 beds
Category B - 51 to 100 beds
Category C - 101 to 300 beds
Category D - 301 to 500 beds
Category E - 501 to 700 beds
c.) Components of a hospital
Medical services
Inpatient ward
Outpatient clinics
Short stay wards for accidents and emergency
Day units for psychiatric or geriatric patients
Departments

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 Diagnostic radiology
Physical Medicine
Dentistry
Radiotherapy
Renal Dialysis
The Operating Department
The Pathology Laboratories
Medical support services
Pharmacy
Central sterile supply
Central milk kitchen for maternity wards
Medical library
Storage space for central medical records
General support services
Central administration
General supply and disposal
Linen supply and disposal + Laundry
Mortuary
Engineering services
Transport services
Staff changing rooms and amneties + Residential accomodation(optional)

B.) Physical Infrastructure

a.) Size of Hospital

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 For the purpose of convenience, the average size of the district is taken as
one million population. Based on the assumptions of the annual rate of
admission as 1 per 50 population and the average length of stay in a hospital
as 5 days, the number of beds in a hospital is then calculated.
b.) Land Area
Minimum Land area requirement is as follows:
Upto 100 beds = 0.25 to 0.5 hectare
Upto 101 to 200 beds = 0.5 hectares to 1 hectare
500 beds and above = 6.5 hectares 4.5 hectares for hospital and 2
hectares for residential)
c.) Floor Area
700 - 900 sq. ft per bed
One bed requires 75 100 sq. ft
Total floor area required is 10 times this
Floor Area Allocation
OPD - 12% - 18%
Wards - 37% - 45%
Diagnostic & Therapeutic - 18% - 22%
Administration - 8% - 12%
Service Departments - 15% - 20%
d.) Circulation
Separate all departments, yet keep them close together; separate types of
traffic, yet keep steps for everybody.
→ Corridors

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 Corridors shall be at least 3m wide or wide enough to accommodate two
passing trolley.
It must be checked for manoeuvrability of beds and trolleys at any turning
point.
Segregate clean and dirty corridors.
→ Ramps
Ramps should have a slope of 1 15 to 1 18
→ Roof Height
Should not be less than approximately 3.6m
→ Elevators
Depending upon number of beds above the ground floor:
Upto 60 - 1
Upto 200 - 2
Upto 350 - 3
Size:
Dimensions: 2280 x 1600 x 2300 mm
Door size: 1300 x 2100 mm
→ Entrance Areas
Traffic moving at extremely different paces shall be seperated e.g. a patient
on foot and an ambulance
There can be four access points to the site, in order to segregate the traffic
Emergency: For patients in ambulances and other vehicles for emergency
department.
Service: For delivering supplies and collecting waste
Service: For removal of dead

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 Main: For all others
→ Barrier free access
Easy access to non-ambulant, semi-ambulant, visually disabled and elderly
persons.
Infrastructure should be as per "Guidelines and Space Standards for the
barrier-free built environment for Disabled and Elderly Persons".
→ Proximity Diagram

C.) Ward Unit

a.) Planning
Ward planning should be such that work of nursing staff is minimized and
patients get their basic amenities within the unit.
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 24 to 32 beded.
20% of the total beds should be earmarked for the daycare facilities.
Ward unit includes:
Nursing station
Doctor's duty room
Pantry
Isolation room
Treatment room
Nursing store
Sluice room
Broom closet
Nursing station should cater to around 40 45 beds, out of which half will be
for acute patients and half for chronic patients.
Atleast 2.5m between centers of two beds to prevent cross infection.
Dedicated toilet
Dirty utility room
b.) Beds
75 sq. ft are for each bed
Center to center distance between beds - 8ft
Edge to edge distance between bed rows 4ft
Wash basin - one between 10 beds
c.) Windows
Window area 20% of floor area if only on one wall.
Window area 15% of floor area if on opposite walls at same sill level.

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 d.) Detailed Breakup

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 D.) Pharmacy
Located in an area from where it's conviniently accessible from all clinics.
Adequate size to cater 5% of the total clinical visits to the OPD in one
session.
1 dispensing counter for every 200 OPD patients daily.
a.) Detailed Breakup

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 E.) Intensive Care Unit
The number of patients requiring intensive care may be about 5 to 10 per cent
of total medical and surgical patients in a hospital.
a.) Beds
Should not have less than 4 beds nor more than 12 beds i.e. 2% to 5% of total
beds
Not less than 5 or more than 15 in a unit.
Floor space for each ICU bed = 25 to 30 sq m (this includes support
services)
The number of beds may be restricted to 5% of the total bed's strength
initially but should be expanded to 10% gradually.
b.) Location
Should be located close to operation theatre department and other essential
departments such as X Ray and pathology.
Easy access and convinient access from emergency and accident
department.
A good natural light and pleasant environment.
c.) Facilities
Nurses Station
Clean Utility Area
Equipment Room

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 F.) Accident and Emergency Services
Distinct entry independent of OPD so that minimum time is lost in giving
immediate treatment to casualities.
Dedicated triage, resuscitation and observation area.
Separate provision for examination of rape/sexual assault victim.
Emergency should have mobile X-ray / Laboratory / Plaster Room / and minor
OT facilities.
a.) Detailed Breakup

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 G.) Outdoor Patient Department
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 The facility should be planned to keep the maximum peak hour patient load
and shall have scope for future expansion. OPD should have an approach
from the main road with signage visible from a distance.

a.) Spaces inside OPD:

Reception and Enquiry
Waiting Spaces
Adequate seating arrangement
Main entrance, general waiting and subsidiary waiting adjacent to each
consultation and treatment room in all clinics.
60% of area should be for waiting and corridors.
Waiting area at the scale of 1 sq ft/per average daily patient with minimum
400 sq ft of area is to be provided.
Layout of OPD
Shall follow the functional flow of the patients, e.g.:

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 Enquiry → Registration → Waiting → Sub-waiting → Clinic
Dressing/Injection Room → Billing → Diagnostics Pharmacy → Exit
Patient amenities
Portable drinking water
Functional and clean toilets
Fans and coolers
Seating arrangements
Clinics
Doctor chamber should have ample space to sit for 4 5 people. 150sq. ft
is adequate.
Attached examination room - 80 sq. ft
Pharmacy shall be in close proximity.
All clinics should be provided with:
Examination table
X Ray - View box
Screens and hand wishing facility
Adequate wheelchairs and stretchers
Clinics should include:
General
Medical
Surgical
Ophthalmic
ENT
Dental
Obstertrics
Gynaecology

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 Post-Partum
Paediatrics
Dermatology
Venereology
Psychiatry
Neonatology
Orthopaedic
Social Service
Nursing Services: Various clinics under Ambulatory Care Area require nursing
facilities in common which include:
Dressing Room
Side Laboratory
Injection Room
Treatment Room
Nursing Station
b.) Location
Location of the ward should be such to ensure quietness and to control number
of visitors.

H.) Indoor Patient Department

General IPD beds shall be categorized as following
Male Medical Ward
Male Surgical Ward
Female Medical Ward
Female Surgical Ward
Materity Ward
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 Paediatric Ward
Nursery
Isolation Ward
As per need and infrastructure hospital have following wards
Emergency Ward
Burn Ward
Orthopaedic Ward
Post-operative Ward
Ophthalmology Ward
Malaria Ward
Infectious Disease Ward
Private Ward: 10% of the total bed strength is recommended as private wards
beds.

I.) Blood Bank

Blood bank shall be in close proximity to the pathology department and at an
accessible distance to operation theatre department, intensive care units and
emergency and accident department.
a.) Detailed Breakup

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 J.) Operation Theatre
Minimum clear area of 360sqft 18' x 20') excluding cabinet and shelf.
a.) Number
One OT for every 50 general in-patient beds
One OT for every 25 surgical beds
No. of Operations per day
No. of OT =
Expected Output per day

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 b.) Location
The location of Operation theatre should be in a quiet environment, free from
noise and other disturbances, free from contamination and possible cross-
infection, maximum protection from solar radiation and convenient relationship
with surgical ward, intensive care unit, radiology, pathology, blood bank and
CSSD.

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 c.) Zones
There are four well defined zones of varying degree of cleanliness:
Protective Zone - Zone A
Clean Zone - Zone B
Sterile Zone - Zone C
Disposal Zone - Zone D
d.) Traffic Flow
Patients
Staff
Supplies
Normally there are three types of traffic flows:
Patients: Patients are bought from ward and they should not cross the
transfer area in the ward clothing, which is a source of infection.
Staff: The surgeon, nurse, sister, nursing elderly should enter through a
separate and through a set of changing rooms and through an airlock; they
should communicate with the surgical corridor.
Supplies: All sterile goods should have a different entry point reachig the
clean corridor independently.
e.) Detailed Breakup

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Literature Study 22
 K.) Delivery Suite Unit
It should be located near to the operation theatre and located preferably on the
ground floor. It should include the facilities of accommodation for various
facilities as given below:

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 Reception and admission
Examination and Preparation Room
Labour Room (clean and a septic room)
Delivery Room
Neo-natal Room
Sterile Store Room
Scrubbing Room
Dirty Utility
Doctors Duty Room
Nursing Station
Nurses changing Room
Group C & D Room
Eclampsia Room
a.) Detailed Breakup

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 L.) Physical Medicine and
Rehabilitation(PMR)
Provides treatment facilities to patients suffering from crippling diseases and
disabilities.
Mainly visited by out-patients
Should be located at a place which may be at a convenient access to both
outdoor and indoor patients with privacy.
It should also have a physical and electro-therapy room, gymnasium, office,
store and toilets separate for male and female.

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 M.) Hospital Administrative and Support
Services
a.) Hospital Kitchen
Easily accessible from outside along with vehicular accessibility and seperate
room for dietician and special diet.
Location should be such that the noise and cooking odours emanating from
the department do not cause any inconvinience to other departments.
Should involve shortest possible time in delivering food to the wards.
→ Detailed Breakup

b.) Central Sterile Supply Department

It is recommended to locate it at a position of easy access to operation
theatre department.
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 → Detailed Breakup

c.) Hospital Laundry

Should be equipped with necessary facilities for drying, pressing and storage
of soiled and cleaned linen.
→ Detailed Breakup

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 d.) Medical and General Stores
Should have vehicular accessibility and ventilation, security and firefighting
arrangements.
→ Storage room for Vaccines and other logistics
Cold Chain Room: 3.5m in size
Vaccine and Logistics Room: 3.5m x 3m in size
→ Detailed Breakup

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 e.) Mortuary
Should be located in seperate building near the Pathology on the ground
floor, easily accessible from the wards.
Post-Mortem room shall have stainless steel autopsy table with sink and
proper illumination and air conditioning shall be provided in the post mortem
room.
A separate room for body storage shall be provided with at least 2 deep
freezers for preserving the body.
Waiting area for relatives and space for religious rites.
→ Detailed Breakup

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 N.) Engineering Services
a.) Electric Engineering Sub Station and Generation
Electrical load requirement per bed = 3kW to 5kW
Electric substation and standby generator room should be provided
b.) Illumination

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 c.) Ventilation
Can be achieved either by natural supply or by mechanical exhaust.
d.) Mechanical Engineering
Air-conditioning and Room heating in operation theatre and neo-natal units
should be provided.
e.) Water Supply and Sanitation
Arrangement should be made for round the clock piped water supply along
with an overhead water storage tank.
Water requirement per bed per day = 450 to 500 litres.
→ Detailed Breakup

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 f.) Committee Room
A meeting or a committee room for conferences, training with associated
furniture.
g.) Hospital Transport Services
Hospital shall have well equipped Basic Life support BLS and desirably one
Advanced Life Support ALS ambulance.
There shall be separate space near emergency for parking of ambulances.

O.) Fire Safety in Hospitals

Hospitals shall provision for two levels of safety within their premises:
Comparative Safety - Protection against heat and smoke within the
hospital premises, where removal of the occupants outside the premises
is not feasible and/or possible.
Ultimate Safety - It is the complete removal of the occupants from the
affected area to an assembly point outside the hospital building.
a.) Elements of Fire Safety
→ Open Spaces
Sufficient open space in and around the hospital building to facilitate the free
movement of patients and emergency/fire vehicles. They should be kept free
of obstructions.
Adequate passage way and clearance for fire-fighting vehicles.
Width of entrance should not be less than 4.5m, with clear head room not less
than 5m.
The width of access road shall be a minimum of 6m.
Turning radius of 9m for fire tender movement.
Set back area shall be a minimum of 4.5m

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 Width of main road not less than 12m
→ Basements
Clear headroom of 2.4m
A minimum ceiling height of any basement shall be 0.9m and maximum 1.2m
above the average surrounding ground level.
The access to the basement shall be separate from the main and alternative
staircase providing access and exit from higher floors.
Lifts shall not normally communicate with the basements.COA
→ Internal Staircase
Should not be arranged around lift shaft.
Should have 2hrs fire resistance.
Minimum width of stairs shall be 2m
Width of tread shall not be less than 300mm
The height of riser shall not be less than 150 mm and the number of stairs per
flight shall not exceed 15.
Handrails shall be provided at a height og 1000mm
Minimum headroom in a passage under the landing and under the staircase
shall be 2.2m
→ External Staircases
Should be protected by a railing or a guard. The height shall not be less than
1200 mm.
Shall be continuous from ground floor to the terrace level.
Straight flight with a width not less than 2m.
Handrail shall have a height not less than 1000 mm and not exceeding 1200
mm.
→ Horizontal Exits
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 Refuge area of 15 sq. m or an area equivalent to 0.3 sq. m per person.
Doors shall be accessible at all times from both sides.
Where there is a difference in the level between areas connected by a
horizontal exit, ramps not more than 1 in 10 m in slope shall be provided.
Steps shall not be used.
→ Exit Doors
Minimum width 2 m
→ Corridors and Passageways
Minimum width and height of corridors and passageways shall be 2.4 m.
Adequate ventilation.
Barrier to limit the transfer of smoke, toxic gas, gases and heat.
→ Ramps
Should comply with the applicable requirements for stairways regarding
enclosure, capacity and limiting dimensions except in certain cases where
steeper slopes may be permitted with inclination less than 1 in 8.
Surfaced with approved non skid and non slippery material
→ Fire pump room
Centralized room to house the pumps that supply water to the various fire
fighting systems.

P.) Trends in Hospital Design

a.) Designing Around Modern Technology
→ Digital Kiosks
Touchscreen monitors that allow patients to easily check-in when they arrive at
the facility. Not only do these kiosks eliminate the need for a receptionist, but

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 also they benefit patients who might be anxious or who have auditory difficulties.
→ Virtual Reality
You can also use technology throughout the design process itself. Virtual reality
VR has greatly improved how we collaborate with clients. VR makes it possible
to create a digital 3D model of any healthcare facility. This technology helps us
and our clients make more informed decisions about a building’s design.
b.) Adaptable Spaces
→ Prefabricated Partitions
A prefabricated wall takes less time to install than a traditional wall and offers
flexibility. Breaking the walls down to adapt to a new patient or staff needs or
future renovations is simple. Wheeled partitions are even more flexible.
→ Shell Spaces
Shell spaces, or soft spaces, are areas that aren’t vital to the daily operations of a
facility but serve as temporary placeholders for future expansion. For example, a
current storage room or rarely used conference room can be replaced by
additional patient exam rooms, a pharmacy, or even an imaging lab when needed.
c.) Materials that Protect Against the Spread of
Incfection
→ Photoactive Pigments
Glass, ceramic, and steel surfaces coated in photoactive pigments kill microbes
when they are exposed to artificial or natural UV rays. These coatings are often
found on commercial and residential bathroom tiles to help them stay clean
longer.
→ Indigo Lighting
Installing indigo LED lighting can help kill bacteria. When bacteria absorb the light
emitted by indigo LED bulbs, a chemical reaction is caused, which destroys the
microbe’s cells.

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 d.) Biophilic Interior Design
→ Natural Light
To implement a biophilic design in your hospital, start by inviting more natural
light into the space. Floor-to-ceiling windows, glass curtain walls, and skylights
reduce the need for artificial lighting and help improve patient and staff moods.
→ Integrate Views of Nature
Visitors can enjoy these views of nature while they wait for their appointments.
Moreover, the atrium naturally helps with ventilation, which is especially
important in a hospital located in a humid climate.
e.) Concierge Healthcare Services
→ Neutral-Colored Waiting and Exam Areas
A neutral-colored palette makes spaces appear more sophisticated and helps
patients feel more at ease. Crisp white sheets and eggshell-colored walls remind
visitors of clean, luxurious spas. You can also add calming pops of pastel shades,
such as blue sky blue or mint green, without losing the room’s sense of serenity.
→ Private Waiting Rooms
Secluded rooms in which patients can enjoy complimentary fresh coffee, watch
TV, and surf the web on facility-provided mobile tablets will make them feel like
VIPs. Comfortable armchairs and sofas, as well as warm wall colours, will make
the space feel cosy.

Q.) References
IS 10905.1 1984 & IS 10905.2 1984
Compendium of Norms for Designing of Hospitals and Medical Institutions
Neuferts- Architects Data - 3rd Edition

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