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2 Library Study HOSPITALS NATIONAL INSTITUTE OF TECHNOLOGY, HAMIRPURLibrary Study HOSPITALS
3 Functional Planning Norms by Medical Council of India HospitalA hospital is an institution for providing health care treatment to the patients with specialized staff and equipments.A general hospital is divided into operational areas of administration, examination, treatment, supply, disposal, residential areas, and support areas for service operation.1CATEGORY A : (25-50 BEDS)2CATEGORY B : ( BEDS)Functional Planning Norms by Medical Council of India3CATEGORY C : ( BEDS)4CATEGORY D : ( BEDS)5CATEGORY E : ( BEDS)
4 Selection of Site for Hospital Quite PlaceTreatment roomsAlmost sq. areaAligned along North-West and North-East directionLocationNursing WardsFuture Expansion areaAligned along South to South-West directionNo loss of amenitySpecial roomsAligned along North directionNo contaminated land
10 Out Patient Department (OPD) The Examination Room should be close to the nurses station and the consultation room.Consultation Room is mostly used when lengthy conversation is involved between the doctor and the patient.Clinical Department of OPD includes clinics which can use standard accommodation, general medicine, surgery, etc.The OPD has facilities for screening, counseling, clinical examination, treatment and referral.It consists of the following:Types of clinics: surgical, orthopedic, medical, pediatric,skin, ophthalmic, ENT, dental, chest, psychiatric, cardiology clinic.OPD for the surgical department should be located on the ground floor and near the emergency with direct access to it.Minor Surgery Room may be used as a cast room, ECG room, minor operations. It should have a separate entrance.Support services includes clinics which can use standard accommodation, general medicine, surgery, etc.
11 In Patient Department (IPD) Isolation unit- An area of 14m2 for such rooms to contain a bed, beside locker, etc and separate toilet facilities.Wards for the particular specialties, should be located closer to their respective department, self contained centers.Ward unit shall comprise beds. Isolation rooms should be present for 15% of the patients in a hospital.Inpatient- means that the procedure requires the patient to be admitted to the hospital so that he can be closely monitored during the procedure and afterwards for recovery.Aim is to minimize the works of the nursing staff and provide basic amenities to the patients with in the unit.Orientation of rooms should face south-east or south for the adequate day lighting in the wardsSize- Width of the doors > 1.2 m, dado to a height of 1.2 m. Effective corridor width of 2.40 m up to 3.10 m.Size- Area of 7 m2 per bed is recommended, arranged with a minimum distance of 2.25 m between centers of two beds.
12 EmergencyRenders services right from the elementary first aid to sophisticated management of surgical and medical emergencies and full scale trauma care.1Should be located on the ground floor with separate access for the patients and ambulances, away from the outpatient entrance2Should be well marked with proper lighting and signs and should be easily visible and accessible from the street3Raised platform for ambulance discharge, ramps provided for wheelchair and pedestrian access4Close to admission, medical records, cashier’s booth, laboratory services, and the blood bank5Proximity to elevators is also important in order to proceed to surgery without loss of time.
13 RadiologyRadiology includes the specialist areas which use ionizing radiation for diagnostic and therapeutic purposes. This includes X-Ray diagnosis, radiotherapy and nuclear medicine.1Should always be close to the ambulance entrance and because of the great weight of the equipment should be on ground floor.2A connecting corridor which can be used simultaneously as a store, dictating room and switch room for staff is desirable.3Sonography, mammography and jaw X-ray require about sqm. Whereas standard X-ray and admission rooms need to be sqm.4The access route for the patients should be through 2 changing cubical.5WC’s should be installed in the X-ray room used for stomach/intestinal inspection.
14 Flow Chart of X-Ray Department X-Ray RoomDark RoomToiletReading & Interpretation(Radiologist)ICUOTChangingRoomDoctor’s ViewingWaitingFile Collection&StorageReceptionControl
15 RadiotherapyIn radiotherapy, conditions diagnosed in the radiography department (e.g. tumors) are treated.1It comprises of reception, waiting area, doctor’s room (18 sqm.), switch room (15 sqm.), localization room (20-25 sqm.), service room (20 sqm.), film developing room (10 sqm.), stores and cleaner’s room.2Each treatment room requires a changing cubicle for patients.3If the department includes a linear accelerator, a workshop (15 sqm.) and at least one physics laboratory (15-18 sqm.)4The clear height of the radiation rooms must be 4.3m.5For hygiene reasons the patient waiting area , examination, localization, preparation and radiation rooms must be well ventilated.
16 PhysiotherapyThis department contains a wet area consisting of an exercise pool (4X6m), a four cell bath, a butterfly bath, inhalation rooms, a massage bath, hand and foot baths as well as necessary subsidiary rooms. Slip resistant tiles to be used.1Should be accessed through the main reception area.2Additional rooms – changing rooms, WCs, rest rooms, linen stores, waiting areas, cleaner’s room and service room.3A gymnasium to be included in it.4Because of the high internal temperatures (28-30 degree) construction physics problems should be anticipated.5Should be arranged on basement floor where natural lighting can be admitted through roof lights and light shafts.
18 Operation Theatre OT Freedom from noise and disturbances. Freedom from contamination and possible cross infection.Independent of general traffic movement from rest of the hospital.Correct & convenient relationship with ICU, CSSD, Radiology & Pathology Lab.Adequate glare free natural light is required which has psychological impact. Hence north light is desirable.Most present day operations use artificial light, but good light and ventilation are of added advantage.OTFreedom from noise and disturbances.Temperature range should be between 23 to 24 deg C.
19 Operation Theatre Attach-ments Washroom Sterile goods room Min. width – 1.8m. For each OT there should be 3 non-splash wash basins with foot controls.Size of room – 3.8x3.8m. Electric sliding door of clear width 1.4m. Room should be equipped with a refrigerator, draining sink, rinsing line, cupboards, connections for anesthesia equipments and emergency power.WashroomSize of roughly 10 sqm. Must be directly accessed by the OT.Sterile goods roomAnesthetics roomAttach-mentsPlaster roomEquipment roomFor hygiene reasons this is not located in the surgical zone but in the outpatient area. In emergencies the patient must be channeled through lobbies in order to get to the OT.Sub-sterilisation roomSize of approximately 20 sqm. Should be as close as possible to the OT.It contains a non-clean area for non-sterile material and a clean area for prepared sterile items. Should be equipped with a sink, storage surface, work surface and steam sterilizer.
20 Ward Facilities Nursing station Workroom for nursing staff Room for the staff nurseCloakroomSanitaryRoom for the Head nurseSluice roomStorage for the stretcherExamination & Treatment roomLaboratoryWard storeLinen roomPantry
21 Intensive Care Unit (ICU) Description of ICUThe task of intensive care is to prevent life-threatning disruption of the vital bodily functions. The services of ICU include monitoring and treatment as well as care of the patient.Must be a separate area and only accessed through lobbies.For economical care of OT patients, recovery room is located in ICU.Number of patients/unit should be 6 to 10The beds may be placed in an open, closed or combined arrangement.Beds in clear view of central nurses’ station.It should have an OT for minor interventions (25-30 sqm.), Laboratory spaces, Kitchenette, Substerilisation (20 sqm.), clean material room, non-clean workroom, cleaning room, lounge for relatives, Duty doctor’s room, Documentation room, Consulting room and Sanitary facilities.Arrangement of Bed SpacesAuxiliary FunctionsArrangement
23 One-bed room with service panel Section of 3-bed room set Patient’s RoomOne-bed room with service panelSection of the roomSection of 3-bed room setPatient’s cupboardSide view
24 Nursing ServicesNursing station is given in a ward in such a way that nurse keeps an eye on all patients. Nurse work room is used to sterilise the instruments along with storage of necessary instruments and machinery.1Double corridor nursing floor provides closer relationship between beds, nursing stations and other service areas.2Clean utility is designed to accommodate carts for storing linens, utensils and other supplies .3Elevators are located outside the nursing unit to cut down noise.4Nursing services can be integrated into the same module which includes the typical patient room.5Greater flexibility in segregation of patients for various medical reasons.
25 detail of nursing station and utility Nursing ServicesFlow chartward typedepthwidth1 bedroom3.4m3.15m2 bedroom3.3m3.5m3 bedroom7m4 bedroom5.3m6.4m6 bedroom8 bedroom5.55m2x6.4mdetail of nursing station and utilitySizes of Nursing rooms
26 Admitting DepartmentFunctions of the admitting department revolve around admitting, transfer and discharge of patients. This department coordinates patient’s arrival, registration, medical records and initial tests.1Maintain bed index showing current occupancy status. Prepare admission and discharge lists and midnight census.2It should be situated on the same level as hospital’s main entrance, be readily identifiable, and provided with a sign(easily seen).3Admitting patients’ waiting area, large enough to accommodate patients and relatives accompanying.4Clerical work area for maintaining hospital occupancy directories, records, forms,, notices, etc.5Wheelchair and stretcher alcove. Space for computers and office equipment.
28 Medical DepartmentThe medical records department maintains records and documents relating to patient care.1Maintaining proper facilities and services for accurate and timely production, processing,checking,filing and retrieval of medical records.2It should be close to or on the corridor leading to doctors’ lounge so that they can stop by and complete their records and study.3It should be so designed with the best possible means of transportation of medical records thorough all stages of their use.4Reception-cum-registration area, space for copier. Work area for record processing, assembling, numbering, indexing, etc.5Storage area for medical carts. Staff facilities.
29 Medical Flowchart Flowchart of medical records on discharge of patient Flowchart of medical records on admission of patient
30 Central Sterilisation and Supply Department (CSSD) Despite of the advancement, hospital acquired infection remains the hospital’s single most serious concern that negated some of its otherwise good work.1This method basically involves cleaning, disinfecting and sterilizing before use all instruments, materials and equipment utilized in patient care..2Is performed by heating them with pressurized steam of by gas sterilization.3Carrying out the process of decontamination or disinfection prior to sterilizing4Packing all materials for sterilizing,Sterilizing,Labelling and dating materials,Storing and controlling inventory,Issuing and distributing.5Accessiblity to elevators, dumbwaiters and stairs is of utmost importance..
31 Food Service Department Good food is important in the treatment of the patient and is a part of his total care. The food service department in today’s modern hospitals ranks one of the major departments.1Provide best possible food at a cost consistent with the policy of the hospital..2The department should be close to the materials management department.3In general the important factor to be borne in mind is the logical workflow.4Plan and implement patient therapy, education and counselling. .5A ground floor location is preferable, and is also convenient to deliver supplies..
33 Delhi Bye-Laws For 500-200 bedded hospital The Medical Facilities In Delhi are provided by various agencies operating at various hospitals, dispensaries, clinics and nursing homes. These agencies includes Delhi government, Central Government, Local bodies, Statuary Bodies, Voluntary Organizations and Private Sectors. A six Tier system of health facilities has been proposed in MPD-2001 as given below:S.No.CategoryPopulationCoveredCapacityArea OfHospitalResidentialAreaTotal Area1Gen. Hospital2.5 lakh500 Beds4 Ha.2 Ha.6 Ha.2IntermediateHospitals (A)1 lakh200 Beds2.7 Ha.1 Ha.3.7 Ha.3Hospitals (B)80 Beds0.6 Ha.0.4 Ha.4Polyclinics0.2 – 0.3 Ha.-5Nursing HomeChild Welfareand Maternity25-30 Beds6Dispensary0.15 lakh0.08 – 0.12 Ha.For bedded hospitalMaximum Ground Coverage : 35%Maximum Far : 200Maximum Height: 33M
34 Case Study: Bhagwan Mahavir Hospital INTRODUCTION:Bhagwan Mahavir Hospital is located in Madhuban Chowk near Pitampura Metro Station, Delhi. It is a two side open site. There is 60m wide road in front and 5m wide road on the side.As the name suggests Bhagwan Mahavir Hospital is dedicated to Bhagwan Mahavir and it runs under Maha Sati Devi Jain Educational Trust. The Hospital was inaugurated by the President Of India Giani Zail Singh on the 23 October It is a 40 Bedded Hospital.CLIMATE:Delhi is in the group of composite climateMaximum Temperature : 41̊CMinimum Temperature : 7 ̊CRainfall : 1.73MIn comparison, Delhi has high rainfall and less air movement, which in turn gives rise to high humidity round the year.
35 Case Study: Bhagwan Mahavir Hospital FACILITIES AVAILABLE:Ground Floor:OPD ChambersLaboratoryUltrasoundICUReceptionChemistX-RayAREA STATEMENT :Total Site Area: 3000 SQ.M.Total Covered Area : 990 SQ.M.F.A.R. = 100First Floor:Operation TheatreStaff RoomWardsStoreNursery roomThe total area of site is 3000SQ.M. . The front set back is 10M., rear set back is 5M., side set back is 3M. and the other side is 18M. left for future extension.SITE PLANTecniaInstituteSaroj HospitalR.S. InstituteOf AdvancedStudies
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