Janish final pdf

60 bedded Maternity and Childcare Hospital at Shajahanpur U.P. A DESIGN THESIS

Submitted in partial fulfillment of the requirements for the award of the degree of

BACHELOR OF ARCHITECTURE

By Janish Kumar 2013BARC064

Under the Guidance of

Prof. Sushil Kumar Solanki

SCHOOL OF PLANNING AND ARCHITECTURE, BHOPAL NEELBAD ROAD, BHAURI, BHOPAL (MP)-462030 MAY 2018

Declaration I Janish Kumar Scholar No 2013BARC064 hereby declare that the thesis entitled 60 bedded Maternity and Childcare Hospital at Shajahanpur U.P. by me in partial fulfilment for the award of degree of Bachelor of Architecture, in School of Planning and Architecture Bhopal, India, is a record of bonafide work carried out by me. The matter embodied in this thesis has not been submitted to any other University or Institute for the award of any degree or diploma.

[15 May 2018]

[Janish Kumar]

Certificate This is to certify that the declaration of Janish Kumar is true to the best of my knowledge and that the student has worked for one semester in preparing this thesis.

RECOMMENDED

Prof. Sushil Kumar Solanki Thesis Guide

ACCEPTED ___________________ Prof. Sanjeev Singh Head, Department of Architecture May, 2018, Bhopal

Acknowledgement My name appears on the cover of this dissertation, a great many people have contributed to its production. This Architectural thesis project was one of the most significant academic tasks which I have underwent in my last 5 years of graduation and came out with a wide experience. I want to express my sincere gratitude to the people who made this dissertation possible and because of whom my graduation experience has been one that I will cherish forever.

My deepest gratitude to my thesis guide Ar. Sushil Kumar Solanki. I have been amazingly fortunate to have a mentor who gave me the freedom to explore on my own and at the same time the guidance to recover when my steps faltered. This work would not have been possible without his expert guidance, support and encouragement. His patience and support helped me overcome many crises situations and finish this dissertation.

I would also like to credit a heartiest thanks to Dr. Sanjeev Singh, Dr. A.K. Vinodia and Ar. Ankit Kumar, our Thesis Coordinators, for their constant guidance and support. This helped us to improve our work day by day, with their valuable suggestions and encouragement.

I am also very thankful to the Hospital staff of The Cradle Hospital Calicut, staff of Chirayu Medical College and Hospital for allowing the tour of their managed Hospital. I would also like to thank LT Durga Prasad Gupta, Ar. Venkatesh Kanisetti for their unconditional help and support in making me strong all the time during my thesis and before. Furthermore, I would like to thank my fellow batch mates Kaushal Kumar, Kundan, Lokesh, Gourav Kumar Besra, Rakesh Soren, Vishal Kumar, Anurag Upadhyay, Priyanka Karn for their constant support as family and juniors; Sahil Kulshrestha, Ronit Kumar, Aditya Narayan, Yasho Aditya, Wasim Khan, Sumit Sangam for their immense support and references under the topic. Their infinite help and support has helped me throughout my Thesis work. I would also like to owe my sincere gratitude to my special friend Jatinder Kaur who stood behind me in all circumstances and didn’t let my moral down and supported me unconditionally throughout the semester. I would like to acknowledge my other friends for their moral support and motivation, which drives me to give my best. Chandana, Isha, Jyotikishan, Lakshmi, Kasturi, Nitin, Gaurav Kumar, Vijay Yadav ‌the list is endless‌thanks to one and all.

My special gratitude to Muskan for being with me in thicks and thins of thesis journey, I find myself lucky to have friends like them in my life.

I would like to thank the Almighty for giving me the strength and patience to work through all these years so that today I can stand proud with my head held high.

Most Importantly, I would like to owe a big thank to my family for their unconditional support, infinite love and blessings at all times of the day. I also thank them for providing me financial and all the more the moral support. I would like to express my heart felt gratitude to my parents who aided and encouraged me throughout this endeavor.

School of Planning and Architecture Bhopal May 2018

Janish Kumar

ABSTRACT Maternity care in India is not meeting the needs of rural and remote women as evidenced by poor access and outcomes. Rural communities have experienced substantial and ongoing loss of maternity services for more than a decade. Consequently, rural women have to leave their community Hospital Services does not operate in isolation but the co-operation and the integration of several disciplines to provide the ultimate patient’s experience. The whole objective of this thesis is to explore and to design the various hospital services’ areas essential for the small scale bedded hospitals in India.

This study mainly focus on the design of maternity hospital in rural area with having all new facility of privatized hospital.

The hospital services play major role in the functioning of the hospital system, easement of the patients and provides all necessary areas for the equipment and the other departments.

The demand of the hospital services increases as the need of the patients rapidly increases, for that purpose the suitable areas for the all services must be provided to ensure the well function of hospitals. The requirements of areas should be defined as per the crowd which is to be catered in a particular building. The purpose of study is to define the areas of non- ambulatory services in small scale hospital which can be implemented for similar kind of project through comparative analysis of case studies.

In summary, this study makes a contribution to the enhancement of maternity care and services in rural Shahjahanpur and will improve the delivery & hospital quality so that rural women can have the same experience and emotions about the hospitals which urban have.

Keyword: - Hospital, Patient Experience, Services.

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CONTENT ACKNOWLEDGEMENT ............................................................................................................................................. I ABSTRACT .............................................................................................................................................................. II CONTENT .............................................................................................................................................................. III LIST OF TABLES ..................................................................................................................................................... VI LIST OF FIGURES................................................................................................................................................... VII CHAPTER 1. INTRODUCTION .................................................................................................................................. 1 1.1 HOSPITAL ...............................................................................................................................................................1 1.2 TYPES OF HOSPITALS ................................................................................................................................................1 1.3 INTRODUCTION .......................................................................................................................................................2 1.4 AIM ......................................................................................................................................................................2 1.5 OBJECTIVE ..............................................................................................................................................................2 1.6 SCOPE AND LIMITATION ............................................................................................................................................2 1.7 METHODOLOGY ......................................................................................................................................................3 CHAPTER 2. LITERATURE STUDY ............................................................................................................................. 4 2.1 HOSPITAL BUILDING PLANNING AND LAYOUT ................................................................................................................4 2.1.1 Appearance ............................................................................................................................................4 2.1.2 Signage ..................................................................................................................................................4 2.1.3 GENERAL MAINTENANCE..................................................................................................................................5 2.1.4 Condition of roads Pathways, Drains. ....................................................................................................5 2.1.5 Environment Friendly Features. ............................................................................................................5 2.1.6 Barriers free Access. ...............................................................................................................................5 2.1.7 Roof height............................................................................................................................................. 6 2.1.8 Circulation areas. ...................................................................................................................................6 2.2 DEPARTMENT LAYOUT..............................................................................................................................................6 2.3 Clinical Services. .....................................................................................................................................7 2.3.1 Outdoor Patient Department (OPD) ...................................................................................................... 7 2.3.2 Pharmacy ............................................................................................................................................... 7 2.3.3 Intensive care units (ICU’s) .....................................................................................................................8 2.3.4 Delivery Suit units ..................................................................................................................................9 2.3.5 In Patients Department (IPD) .................................................................................................................9 2.4 HOSPITAL ADMINISTRATIVE AND SUPPORT SERVICES....................................................................................................10 2.4.1 Hospital Kitchen (dietary Services).........................................................................................................10 2.4.2 Central Sterile Store Department (CSSD) ...................................................................................................10 2.4.3 Hospital Laundry. ......................................................................................................................................11 2.4.4 Medical and general Store. ....................................................................................................................... 11 2.4.5 Engineering Services. .................................................................................................................................11 2.4.6 Medical Gas and cooking Gas ...................................................................................................................12 2.4.7 Record Department. (Information Cell) .....................................................................................................12 2.4.8 Committee Rooms .....................................................................................................................................12 CHAPTER 3. SITE ANALYSIS .................................................................................................................................. 13 3.1 BASIC INFORMATION..............................................................................................................................................13

3.2 SHAHJAHANPUR CITY .............................................................................................................................................13 3.3 SITES OF INTEREST. ................................................................................................................................................13 3.4 CONNECTIVITY TO SITE. ..........................................................................................................................................13 3.5 SITE DETAILS......................................................................................................................................................... 14 3.6 BYELAWS. ............................................................................................................................................................16 3.7 CLIMATIC CONSIDERATIONS. ...................................................................................................................................17 3.7.1 SUN............................................................................................................................................................17 3.7.2 WIND ......................................................................................................................................................... 17 3.7.3 SITE ORIENTATION .................................................................................................................................... 18 3.7.4 SITE CONTOUR ..........................................................................................................................................19 3.6.5 DRAINAGE ................................................................................................................................................. 19 3.7.6 SWOT ...................................................................................................................................................20 3.8 INFERENCES..................................................................................................................................................20 CHAPTER 4. CASE STUDIES ................................................................................................................................... 22 4.1 4.1.1 4.1.2 4.1.3 4.1.4 4.2 4.2.1 4.2.2 4.2.3 4.3 4.3.1 4.3.2

THE CRADLE HOSPITAL, CALICUT (KERALA) (LIVE CASE STUDY) .............................................................................22 Site Context ..........................................................................................................................................22 Planning and Design ............................................................................................................................22 Horizontal Zoning.................................................................................................................................23 Other Design Aspects. ..........................................................................................................................25 CHIRAYU HOSPITAL, BHOPAL (LIVE CASE STUDY) ............................................................................................... 27 Plan Layout and Circulation .................................................................................................................28 OT Block ...............................................................................................................................................30 CSSD and other Services .......................................................................................................................31 MOTHER BABY CENTER, MINNESOTA, USA (LITERATURE STUDY) .........................................................................32 VERTICAL ZONING .........................................................................................................................................33 Material and specification. ..................................................................................................................34

CHAPTER 5. AREA STATEMENT ............................................................................................................................ 38 CHAPTER 6. DESIGN PROPOSAL ........................................................................................................................... 43 6.1 6.1.1 6.2 6.2.1 6.3 6.3.1 6.3.2 6.3.3 6.3.4 6.3.5 6.3.7

CONCEPT DEVELOPMENT ................................................................................................................................43 EVIDENCE BASED THEORY/DESIGN .........................................................................................................43 SPACE AND FORM ANALYSIS. ..........................................................................................................................45 Form Development ..............................................................................................................................45 DESIGN DEVELOPMENT ..................................................................................................................................46 Site Plan ...............................................................................................................................................46 Circulation and Courtyard ....................................................................................................................48 Services ................................................................................................................................................49 OPD’s....................................................................................................................................................50 Administrative Department .................................................................................................................51 Internal Patient Department (IPD’s) ....................................................................................................52

CHAPTER 7. ADVANCE OBJECTIVE ........................................................................................................................ 53 7.1 INTRODUCTION.............................................................................................................................................53 7.1.1 AIM ......................................................................................................................................................53 7.1.2 SCOPE AND LIMITATION ...................................................................................................................... 53 7.1.3 OBJECTIVES ..........................................................................................................................................53

7.1.4 EXPECTED FINDINGS ............................................................................................................................54 7.2.1 Background Study: - ..................................................................................................................................55 7.2.1.1

Hospital ...................................................................................................................................................... 55

7.2.2 Classification .............................................................................................................................................55 7.2.2.2 Central Sterile Store/Supply Department (CSSD) ................................................................................................ 57 7.2.2.3 Hospital Laundry ........................................................................................................................................ 58 7.2.2.4 Engineering Services .................................................................................................................................. 59 7.2.2.5 Sanitary Services. ....................................................................................................................................... 60 7.2.2.6 Gas Supply Services .................................................................................................................................... 61

7.2.3 Parameter .................................................................................................................................................62 7.2.4 INFERENCE: - ................................................................................................................................................63 7.2.5 FINAL PROPOSAL OF AREA PROGRAM...............................................................................................................65 7.2.6 CONCLUSION AND RESULT ..............................................................................................................................66 BIBLIOGRAPHY ..................................................................................................................................................... 67

LIST OF TABLES Table 1 Merits and demerits of Hospital(Cradle) ......................................................................... 26 Table 2 Showing Bed Distribution of Chirayu Hospital ............................................................... 28 Table 3 Showing Characteristics of EBD ..................................................................................... 43 Table 4 Showing Services. ............................................................................................................ 55 Table 5 Areas of Services ............................................................................................................. 56 Table 6 Kitchen Services Areas .................................................................................................... 57 Table 7 CSSD various Areas ........................................................................................................ 58 Table 8 Laundry Areas.................................................................................................................. 59 Table 9 Engineering Services in Hospitals ................................................................................... 60 Table 10 Sanitary Services in Hospitals ....................................................................................... 60 Table 11 Gas Manifold in Hospitals. ............................................................................................ 61 Table 12 Standard For all Services with areas and type of rooms [5]. ......................................... 63 Table 13 Final Area Program for 60-100 Bedded Maternity Hospitals........................................ 64

LIST OF FIGURES Fig. 1 Methodology......................................................................................................................... 3 Fig. 2 Opd Layout ........................................................................................................................... 6 Fig. 3 Pharmacy Layout .................................................................................................................. 8 Fig. 4 ICU Connectivity.................................................................................................................. 8 Fig. 5 IPD connectivity ................................................................................................................... 9 Fig. 6 Connectivity Kitchen .......................................................................................................... 10 Fig. 7 Connectivity CSSD............................................................................................................. 10 Fig. 8 Connectivity of Medical Records ....................................................................................... 12 Fig. 9 Land use Map ..................................................................................................................... 14 Fig. 10 Site and it surroundings .................................................................................................... 14 Fig. 11 Trees on site ...................................................................................................................... 15 Fig. 12 Existing vegetation on site ................................................................................................ 15 Fig. 13 Existing site image............................................................................................................ 16 Fig. 14 Sun Path of site ................................................................................................................. 17 Fig. 15 Maximum heat gain by West facade ................................................................................ 17 Fig. 16 Wind Movements in the site ............................................................................................. 17 Fig. 17 Showing air passing through Trees .................................................................................. 18 Fig. 18 Showing stack effect [6] ................................................................................................... 18 Fig. 19 Shape of the abstract not desirable for the site ................................................................. 18 Fig. 20 Shape of the abstract Suitable for the site......................................................................... 18 Fig. 21 Site contour ....................................................................................................................... 19 Fig. 22 Site Section ....................................................................................................................... 19 Fig. 23 Schematic section of the site Showing building envelope ............................................... 19 Fig. 24 Site Drainage pattern ........................................................................................................ 19 Fig. 25 Hospital location ............................................................................................................... 22 Fig. 26 Typical Section ................................................................................................................. 22 Fig. 27 Ground Floor plan (Cradle) .............................................................................................. 23 Fig. 28 Pharmacy from outside ..................................................................................................... 23 Fig. 29 Me and Mom Shop ........................................................................................................... 23 Fig. 30 Hospital Reception [7] ...................................................................................................... 23 Fig. 31 First Floor Plan(Cradle) .................................................................................................... 23 Fig. 32 Waiting hall with play area ............................................................................................... 24 Fig. 33 Area Distribution in First floor ......................................................................................... 24 Fig. 34 Diagnostics. ...................................................................................................................... 24 Fig. 35 Examination room ............................................................................................................ 24 Fig. 36 Second floor plan (Cradle) ............................................................................................... 24 Fig. 37 Operation Theatre ............................................................................................................. 24 Fig. 38 showing NICU ................................................................................................................. 24 Fig. 39 Suit room of hospital ........................................................................................................ 24 Fig. 40 Third Floor Plan(Cradle) .................................................................................................. 25

Fig. 41 Showing Area Distribution ............................................................................................... 25 Fig. 42 IPD Rooms ...................................................................................................................... 25 Fig. 43 Showing Lighting, Mechanical area and Material used. .................................................. 26 Fig. 44 Chirayu Medical College and Hospital ............................................................................ 27 Fig. 45 Elevation of Chirayu Building .......................................................................................... 27 Fig. 46 Site plan of Chirayu .......................................................................................................... 27 Fig. 47 Floor plan (left- Ground Floor) (Right- First Floor)......................................................... 28 Fig. 48 Area Distribution (Left - Ground Floor, Right- First Floor) ............................................ 29 Fig. 49 Second Floor (Left) Third Floor (Right) .......................................................................... 29 Fig. 50 Maternity Department Layout (Chirayu) .......................................................................... 30 Fig. 51 Operation Theatre Layout ................................................................................................. 30 Fig. 52 CSSD Floor Plan Chirayu................................................................................................. 31 Fig. 53 autoclave steam sterilization machine (left), Ethylene oxide sterilizer(Right) ................ 31 Fig. 54 Plan of Gas manifold (Chirayu)........................................................................................ 31 Fig. 55 Section showing Connection of gas pipes to the building. ............................................... 31 Fig. 56 Site View of Hospital ....................................................................................................... 32 Fig. 57 Site Plan ............................................................................................................................ 32 Fig. 58 Plans Mother baby Center ................................................................................................ 33 Fig. 59 Lighting Render Mother Baby Center .............................................................................. 34 Fig. 60 Color Scheme of Mother baby Center .............................................................................. 34 Fig. 61 Material used Mother baby center .................................................................................... 35 Fig. 62 Form of mother baby center ............................................................................................. 35 Fig. 63 Chart Showing the process of EBD .................................................................................. 43 Fig. 64 Circulation Linked With EBD .......................................................................................... 44 Fig. 65 Zoning of site on Evidence base design ........................................................................... 44 Fig. 66 Concept Development ...................................................................................................... 45 Fig. 67 Build form Development .................................................................................................. 45 Fig. 68 Conceptual Layout Site Plan ............................................................................................ 46 Fig. 69 Site Plan stage 2 ................................................................................................................ 46 Fig. 70 Site Plan Stage 3 ............................................................................................................... 47 Fig. 71 View from the Hospital Building ..................................................................................... 47 Fig. 72 Night View from the Entrance.......................................................................................... 47 Fig. 73 Flow Diagram Showing Methodology ............................................................................. 54 Fig. 74 Typical Kitchen Layout for 100 Bedded Hospital [5] ...................................................... 56 Fig. 75 Kitchen Layout (The Cradle, Calicut) .............................................................................. 56 Fig. 76 CSSD Unit (CMCH) ......................................................................................................... 57 Fig. 77 CSSD Unit (THE CRADLE, CALICUT) ........................................................................ 57 Fig. 78 Typical Hospital Laundry Plan [6] ................................................................................... 58 Fig. 79 Sanitary Layout (The Cradle, Calicut) ............................................................................. 60 Fig. 80 Gas Manifold Room (CMCH) .......................................................................................... 61 Fig. 81 Section Showing Height .................................................................................................. 62

Fig. 82. Section of Kitchen ........................................................................................................... 65 Fig. 83 Final Layout of Kitchen .................................................................................................... 65 Fig. 84 Section of CSSD Department ........................................................................................... 65 Fig. 85 Proposed plan for CSSD Department ............................................................................... 65

CHAPTER 1. INTRODUCTION

1.1 Hospital In Medical terms institutions which have capability to treat ill person known as patients with having specialized staff and equipment considered to be hospital. The Hospital plays a major role towards the integral part of the social and medical groups which have all necessary functions to provide a complete health care facility to the people which may be in form of curative and preventive. The all functioning of hospitals is funded by public sector, by health organizations which may be in form of profit or nonprofit, all health-related insurance companies or charities which may include direct charitable donations. Nowadays hospitals are fully furnished with staff of professional physicians, surgeons and nurses, but as we see the past of hospitals this work was usually done by the religious orders or by volunteers. Hospitals have only one mission which is to help patients to get well and to stay well. Hospitals full fill two major need of mankind: I. II.

The treatment and cure of patients physical and mental ills.

And to Satisfying patients by physical, emotional and aesthetical needs.

1.2 Types of Hospitals As Human body have many different organs, functions and needs hence to overcome the health care facility to human body there are different types of hospitals which may be as per the functioning of it.

Typically, hospitals have few processes which are common in all the types of hospitals those are diagnosis, treatment, or therapy and out-patient without staying overnight, and few of others are admitted and stay overnight or may be for several days or weeks or months known as in-patients.

Hospitals are differentiated with their types which may include: 





General hospitals: - The very best-known type of hospitals, which is set up to deal with many kinds of disease and injury, and normally it has emergency department to deal with all immediate and very urgent threats to health. Larger states have variants in sizes of hospitals according to bed size but have same functioning.

District Hospitals: - District hospitals are those major health facilities in a region which having large numbers if beds for intensive Care and long-term care. District Hospitals have all high major equipment and have all other high medical facilities which may or may not be in General Hospitals.

Specialized Hospitals: - Hospitals having specialization in one field which deals with proper care of one particularly medical field. Types of specialized hospitals include trauma centers, rehabilitation hospitals, Maternity Hospitals, Children’s hospitals, seniors (geriatric) hospital, also many hospitals deal with certain disease categories such as cardiac, oncology, or

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Introduction  



orthopedic problems. Also, in such case of hospitals it may be single module of building or having cluster of buildings linked together, which makes a campus of hospitals.

Teaching: - it is that kind of hospitals linked with the education in the field of medical and student get chance to learn from the hospitals as the hospitals treats and provide all necessary facilities to patients.

Clinics:-In the present world there are many Doctors who provide their facility to the world without being appointed in hospitals. They open their own clinic and provide the treatment which may be specialized in their field.

1.3 Introduction Thesis Project as the overall concept of ‘Healing Architecture’, this has been in my interest since I encountered the emerging concept before. With Healing caring architecture as the topic, this will help in architecture and planning aspects in India for making new healthcare units like Super Hospitals, Nursing Homes etc.

Hospitals is in terms of it basic necessity has more complexity in its design as it has many services systems which leads to proper functioning of building. The basic service system of any hospital is its emergency and casualty unit, OPD services, IPD services and Operation theatre.

There are other services such as administrative services supportive services and Utility services.

There are few major aspects which create lots of impact on the psychology of patients and the users such as the movement of Doctors, patients and other facilities in the hospital precinct, circulation of wastes from the sources point to end or to disposing area like incinerators.

Maternity hospital providing care for pregnant women and newborn infants and facilities for childbirth, with architectural design. There are few major things which effects maternity hospital 1. NICU, 2. Access to Blood Bank, 3. Level of Hygiene in hospital, 4. Proper ambulance services and 5. Power backup needed.

1.4 Aim To design a 60 bed Maternity and Childcare Hospital in the Shahjahanpur District of Uttar Pradesh, which will cater the needs of the females of the region.

1.5 Objective o o o

To Provide circulation, easy movement to the patients and the users.

To provide aesthetically pleasant and safe healthy environment for the in-patients for their speedy relief.

To Study the various typologies and design aspects], which are essential to the hospital building in terms of circulation and services.

1.6 Scope and Limitation The Study is limited to the Specialized area of Maternity and childcare for the rural people and which will reflect the services provided by the government for rural betterment.

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Introduction

1.7 Methodology Topic: - Maternity and Childcare Hospital

Case Study The Cradle Chirayu Medical college and hospital

Literature Study

Site

Medical Council of India

Analysis

Indian Public Health Guidelines

The Mother baby Centre

Inferences

Concept

Design Development

Final Design Fig. 1 Methodology Source: Author

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CHAPTER 2. LITERATURE STUDY The whole study pattern is shown and how will whole study will be going to take place:

2.1 Hospital building Planning and layout 2.1.1 Appearance o o o

o o o o

The Hospital should have a high boundary wall with having proper Exit gates. So that a proper maintenance of environment can be acquire pleasant and soothing environment to the patients.

The building should be colored with proper and uniform Scheme and having nice and acceptance plaster.

Hospital is always placed as building which makes healthy environment to the patients, so in order to that hospital shall avoid unwanted/outdated posters on the walls of building and boundary walls of the site.

The site of hospital shall be free from outdated/unwanted hoardings.

The visibility of hospitals such that it can be visible from the outside approach road.

Hospital always requires proper maintenance, which may in form of building cleaning or in terms of landscape.

Hospital site must be free from any illegal encroachment.

2.1.2 Signage The Signage’s are the most prominent feature of any public building, which helps the user and patients to identify and locate the part of use in the building. o Accordingly building should have prominent boards displaying the name of the Hospital, in local language at the gate and on the building. o Display of mandatory information (Under RTI act, PNDT act, MTP act etc.) o Signage indicates access to the various facilities at strategic points in the hospital for proper guidance of the public. It may be in form showing directions for that color coding may be used. o Majorly all hospitals have good quality of fire exit plan, but it must be florescent, so that it can be readable at each floor. o All kind of necessary information which includes Citizen’s charter shall be displayed at OPD and entrance in local language, including patient’s rights and responsibilities. o Proper layout of the hospital building should be indicated at each floor at prominent distance so that it can guide all patients who so ever want to access it. o Directional signage at every point for major departments shall be marked or indicated properly so that they can easily access. o All kind s of required contact numbers should be displayed in hospital. Like (medical centers, Blood banks, Fire Stations, Police and Ambulance services which are available nearby) Safety, hazard and precautions sign should be displayed at relevant places.

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Literature Study

2.1.3 General Maintenance.

Hospital is a place where large number of users get interact daily and variety of patients get their medical treatment, so this place requires proper maintenance at regular interval so that building can perform properly. So, in order to maintain the building there will be no seepage, no cracks in the walls, any broken windows and glass panes. Also building should be free from the growth of algae and mosses on walls etc.

Hospital Building should have anti-skid and non-slippery floors.

2.1.4 Condition of roads Pathways, Drains.

The hospital should have proper road network and have barrier free movement up to emergency department. There are following things to be considered while designing roads and pathway of hospital: o o o o o

2.1.5

Approach roads to the hospital emergency shall be all weather motor able road.

All the roads near and in the site of hospitals shall be having proper illumination during night time.

There shall be proper dedicated spaces for parking which includes Ambulance, staff and doctors parking.

There should be proper dedicated spaces for drainage of the roads and site.

Hospital

Environment Friendly Features.

The Hospital should be environment friendly and high energy efficient. By Using rain water harvesting from the building, solar energy use and use of energy efficient equipment should be encouraged. To promote the greenery near the building there should be green garden provided where mother can get better and visual effects.

2.1.6 Barriers free Access.

As per the medical council guidelines there must be free access to each part of the hospital by each and every user of it. In terms of category of patients having problems with physical disabilities, few of visually disable and elderly person. For this proper guideline which are followed in India is provided. This will ensure the safety of differently abled and elderly people fully and their full scope of integration with the society. Also, provision of ‘Person disability act’ should be implemented.

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Literature Study 2.1.7 Roof height.

The Roof Height should not be less than approximately 3.6 meter measured at any point from floor to roof.

2.1.8 Circulation areas.

Circulation areas comprise corridors, lifts, staircases, ramp and other common spaces etc. The flooring of the building should be non-slippery and anti-skid.

Corridors should be at least 2.8 meters minimum or 3 meters above to accommodate daily traffic.

Size of corridors, staircase, lifts must be such that they can carry the requirement of wheeled equipment.

Corridors must such wide that they can cater two passing trolley at once. Ramp should have slope of at least 1:15 or 1:18. It must be checked that the ramp have proper turning point so that each moving bed or trolley can move easily.

2.2 Department Layout As hospital is a complex service building having different building components which perform different functions at their point of level. Basically, Maternity hospitals are divided into following components: -

Consultant rooms OUT PATIENT

Supporting Facilities Blood bank Pharmacy

Medical Services

OT/Diagnostics/casulty

Pathlogy/Radiology Operation Theatre

Emergency General Wards Private Wards IN PATIENT Intensive care Unit Fig. 2 Opd Layout Source: Author Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

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Literature Study 2.3 Clinical Services.

Hospitals have their need in terms of administration and other services, but medical clinics and their requirement is most important thing, which is going to have OPD, IPD, Maternity Suits, Pharmacy, ICU’s etc.

2.3.1 Outdoor Patient Department (OPD) This is the department which cater the maximum load during peak hours as all the patients will go to the consultant for their problems.

The major OPD Department for maternity hospitals are Pediatrics and gynecology. OPD Should have proper approach and have direct access to the patients with the help of signages. The major component of OPD Department is Reception, waiting.

RECEPTION This facility must be provided to the patients and the receptionist must be well educated and familiar to the local language of the place. At this point all the major facilities provided by the hospital must be displayed. Name and contact of the responsible person should be displayed.

WAITING SPACE Waiting area should be provided at the main entrance, general OPD and subsidiary to all necessary facilities such as treatment room in all the clinics. Waiting area at the scale of 0.1 sqm/per average daily patient with a minimum of 38 sqm of area is to be provided.

LAYOUT OF OPD The layout of OPD Department must follow the function flow of the Patients: Enquiry  Registration/Reception  Waiting/Sub-waiting  Clinic  Inspection Room  Billing  Diagnostics Pharmacy  Exit.

PATIENTS AMENITIES A good hospital must have these patient’s amenities according to the norms: 1. Portable Drinking Water.

2. Functional and Clean toilets with running water and flush.

3. Fans/Cooler.

4. Seating Arrangements as per Loads of patients.

2.3.2 Pharmacy The Pharmacy should be located at such place which is conveniently accessible from all clinics and the size is to be adequate to contain 5% of the total clinical visits to the OPD in a session.

Pharmacy should have special dispensary for In-Patients for receiving of medicines.

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Literature Study

Dispensing Area

Toilet woth JAnior

Store

PHARMACY

Farmacist room

Preparation Area

Queuing Area

Fig. 3 Pharmacy Layout Source: Author

2.3.3 Intensive care units (ICU’s) In this Unit critically, ill patients get highly skilled lifesaving medical aid and nursing care. this should include major C-Sections, Operations etc. This is the major department of any hospital building where ill patient get highly specialized staff and equipment for the treatment. In this Number of beds restricted to the 5% of the total bed of the Hospital building.

This Unit should be located close to operation theater department and another essential department. It should have easy and convenient access from emergency. This unit needs all the emergency services which include all gas, heating ventilation and air conditioning. A good pleasant light and environment is also help for the patients and the staff.

Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

Fig. 4 ICU Connectivity Source: Author

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Literature Study 2.3.4 Delivery Suit units The delivery suit unit preferably located near operation theatre. The Delivery suit unit should cater following facilities listed: Examination and Preparation room.

Labour Room Delivery Room Neo-Natal Room

Sterilizing Room Sterile Store Scrubbing Room Dirty Utility Nursing Station

Nurse Changing Room Eclampsia Room

2.3.5 In Patients Department (IPD) The patient Admit zone in the hospital where patients are required to admit in case of their treatment required observation under the Doctors.

The location of the Ward is such that they can avoid noises and have peaceful environment through out that day.

Private beds are also the part of in patient area, and according to MCI 10% of the total beds is allocated for private. there are following things in consideration while designing beds and their distance from another bed: o o o o o

There shall be 2.5 Meter distance from each other so that infection can be avoided.

Every bed must provide IV stand, bed side locker and stool for attendant.

Dedicated toilet with running water facility must be provide to each ward.

Dirty utility should be provided to each ward and having a nursing station for proper attention.

Every ward must have proper ventilation except isolation ward.

Fig. 5 IPD connectivity Source: Author Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

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2.4 Hospital Administrative and support services 2.4.1 Hospital Kitchen (dietary Services).

The dietetic department mainly serves the patient needs in terms of therapeutic diets, diet counselling and special feeds. The dietary service is one of the most supporting services of the hospital unlike any other support service. The Dietary Department does procurement of food so it requires storage areas, for cooking purpose cooking areas, sanitary spaces such like washing and cleaning of trolleys and garbage collection areas.

Area Requirement for Kitchen Dietary Services: a. b. c. d. e.

Cooking Area.

Washing Area.

Dry Ration Store Area.

Garbage Collection Area.

Cold Store (if Needed).

Fig. 6 Connectivity Kitchen Source: Design Studio (2015-16)

2.4.2 Central Sterile Store Department (CSSD) The Central Sterile Store/Supply Department is the area responsible for receiving, storing, processing, Controlling and Distributing all the professional supplies and Equipment which may sterile and non-sterile for Hospital in every part of ambulatory areas, through which safety of patients get under control.

As per the case study it is easy to identify various spaces in CSSD department, which includes a. b. c. d.

Receive Area: Through all Collection and supply will take place.

Sterile Store: After method of sterilization all equipment get stored.

Cutting Zone: The zone where sterile Cotton gauge and other things were cut.

Autoclave Unit: The Room where electrical or chemically Treated Machine are stored for Disinfecting materials. e. Changing Room: Toilets and staff changing room. f. Non-Sterile Store: After Receiving Infected Equipment They get stored.

ISSUING STERILE ZONE CSSD NON STERILE ZONE Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

CHANGING ROOM RECIEIVING

Fig. 7 Connectivity CSSD Source: Author

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Literature Study 2.4.3 Hospital Laundry.

The hospital is the area that receives all the linen material from different areas such as department, OT, OPD and the office area where there are subjected to classification washing extraction, Drying ironing bending, repair and delivery. To Control the hospital infection, continually provide the clothing supply to the user department to improve the image of the hospital 2.4.4 Medical and general Store.

Medical and general store should have vehicular accessibility and should have fire safety arrangements. For storage of Vaccines and other logistics medicines should have cold store.

Medical store should have stock of at least 1 month or half of month.

2.4.5 Engineering Services.

The major non- ambulatory services of hospitals are Engineering Services which includes: Electrical, Sub-station and Generators, illumination, Emergency Lighting, Ventilations.

Electrical Engineering Services Mainly Focuses on building: a. b. c. d.

Building Power.

Alternate Source of Energy.

Air Conditioning.

Lifts and Fire Control.

The Above mention areas are the part of Electrical Room in which all the things were control and have separate areas for operation.

Sanitary Services The Hospital is most Sterile area and always require Proper hygienic conditions. Sanitary Services of Hospitals Provides a Happy, Healthy, Safe and Pollution free environment to the users. The Sanitary Services must be available for all floors and have minimum distance to travel and each floor have its own Store location and from where all the equipment can be assessed.

The Cradle, Calicut is having 30 Sqm Area for Sanitary Service in each floor, so that sanitation can be controlled throughout the day.

The task Should be performed by the Sanitary Department are: Dust Moping 6 minutes for 280 sqm.

Wet Moping for 12 Minutes for 280 Sqm and Machine Scrubbing for 2 hours. [6]

Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

Source: Author

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Literature Study 2.4.6 Medical Gas and cooking Gas Medical Gas Distribution System is a system of centralized for medical gas (O2, N2O, N2), medical air and medical vacuum comfortably to each ward and Convenient through a Central Piping system to all the sources where the Gas is needed.

Gas manifold room consist of: a. Supply Room. b. Gas Cylinder Store c. Gas Cylinder Holding. d. Electrical Panel for Gas Supply.

The Location of Gas manifold is also Matters for hospitals as the supply will be for whole hospitals and to all parts of the building. Gas Supply having separate rooms are very easy to handle out because they have their own Pump, electrical panel and control, with supervisor and also having separate space for Dropping and collecting cylinder.

2.4.7 Record Department. (Information Cell) Hospital shall have medical records department to store patients records and other data pertaining to hospital.

Medical Records Store General Store

Doctors Report Completion Room

Medical Records Officer

Medical Records Department

Medical Records Processing Are

Fig. 8 Connectivity of Medical Records Source: Author

2.4.8 Committee Rooms A Meeting Room or a committee room for is to be provided for conferences and trainings, with associated furniture.

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CHAPTER 3. SITE ANALYSIS 3.1 Basic Information Latitude: Time Zone: Country: Elevation:

27.88°N 79.91°E IST (UTC+5:30) India (Uttar Pradesh) 194 m (636 ft)

3.2 Shahjahanpur City The city Shahjahanpur was established by two brothers Dilir Khan and Bahadur Khan, sons of Dariya Khan, a soldier in army of the Mughal emperor Jahangir. Shahjahanpur district is one of the historical districts of Pilibhit in the Republic of India. It is a part of Bareilly division which is situated in south-east of Rohilkhand division. It was established in 1813 by the British Government. The District headquarters is still known as Shahjahanpur, popularly known as Shahjahanpur shahar which have its separate Municipality.

The nearest International Airport is Chaudhary Charan Singh International Airport, Lucknow, roughly five-hour drive from Shahjahanpur.

The major tourism spots in Shahjahanpur is Hanumat dham located at the bank of khanaut river.

There is a statue with an image of Ram-Sita at heart, heavily feeling the orange colored statue of human towering overhead. The statue is located at Virast ghat, which is only 4-5 km drive from Shahjahanpur Railway station and Bus stand.

3.3 Sites of Interest.

Shahjahanpur is popularly known for birthplace for great freedom fighter of India like Ram Prasad Bismil, Shaheed Ashfaqullah Khan and many more and also the city is famous for holding a home for third tallest statue of Shree Hanuman.

The city have rich culture, heritage and history.

3.4 Connectivity to Site.

The site is located Powayan Tehsil 30 kms from Shahjahanpur district. there is local bus transport system from Shahjahanpur Bus stand to Powayan bus stand, Shahjahanpur bus stand is around 3 kms from Shahjahanpur railway station.

There is state highway 74 running along the site with arterial roads, and provides suitable connectivity to the site.

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Site Analysis

Fig. 9 Land use Map

Source: Author

3.5 Site Details.

Fig. 10 Site and it surroundings

Source: Author

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Site Analysis Area: Site Area includes area of Community Healthcare Centre and maternity hospital that is 27345 Sqm. Maternity and Childcare Hospital site Area is 9715 sqm.

Site is 27 km from main railway station (Shahjahanpur) Nearest Bus stop: - 400 Meter 22 Kilometer from Tehsil of Powayan.

Nearest Petrol Pump: - 1.2 Km from site.

Fig. 11 Trees on site Source: Author

Fig. 12 Existing vegetation on site Source: Author

Relatively flat site as site have 3 Meter. contour difference. Rain water will runoff towards the drainage of CHC canal. Soil type is RED SOIL. The site is surrounded by agriculture land and mix use of buildings, as the site is nearest to the school property and have future construction of housing which may leads to the very affective growth of the Hospital.

In Site the view has been great impact of natural trees which provide a suitable barrier to the site.

As entrance of the site is not defined by existing conditions hence the site have only entrance from the Community health center.

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Site Analysis

Fig. 13 Existing site image Source: Author

3.6 Byelaws.

Land use: Agriculture land FAR: 1.25 Ground coverage: 30 % of Maternity Site.

Maximum height: 24 Meters Setbacks: 8-meter front and 6-meter sides.

Landscaping bye Law: - one tree for 20 square meters of open space out of which minimum 50 percent to be in the category of evergreen trees, having height of 40 feet or more.

Minimum space to be kept for landscaping is around 50 percent of open area.

Site is having electric substation from Community health Center which is off 33KV and is fulfilling the demand of the hospital required.

Parking Bye Law: - One parking space per 50 square meters of covered area.

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Site Analysis 3.7 Climatic Considerations.

The Climatic conditions of Shahjahanpur city is warm and moderate. There is much more rainfall in Shahjahanpur in winter as compare to summer.

June is the warmest month of the year. The temperature in June averages 32.9 °C. In January, the average temperature is 15.3 °C. It is the coldest month of the year.

The average rainfall here averages 1105 mm.

3.7.1 SUN With the help of an abstract form, the areas that receive maximum sun light and areas with permanent shade are shown for two sets times in hourly fashion Fig. 14 Sun Path of site Source: Author

Inference (SUN): -

The facade that receives the maximum sun must have projection or chajjas. Shade will have to be created by design solutions.

Area that are under permanent shade can be turned into open seating areas.

Fig. 15 Maximum heat gain by West facade Source: Author

3.7.2 WIND WESTERLIES During hot weather months of April and May, carry cold pool of air. Also helps to activate monsoon.

Wind catches are needed to capture such desirable air in facades facing the west Fig. 16 Wind Movements in the site Source: Author

EASTERIES Span around the months of October to March. The winds are coming from the existing CHC and can be capture by wind catchers.

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Site Analysis Inference (Wind): WIND Methods adopted to take the desirable winds into the built for better ventilation and cross circulation.

Fig. 18 Showing stack effect [6]

STACK EFFECT Movement of air into and out of buildings, chimneys, or other containers, resulting from air buoyancy due to temperature differences.

WIND and NOISE BARRIERS Methods adopted to cut off understand air flow, such as the winds and Fig. 17 Showing air passing through Trees noise coming from Source: Author surroundings.

3.7.3 SITE ORIENTATION Shape and the size of the site plays an important role in deciding the orientation and shape of the building. The shape of site similar to rectangle. AN abstract form has been designed for checking site orientation with the building.

Fig. 19 Shape of the abstract not desirable for the site Source: Author

Fig. 20 Shape of the abstract Suitable for the site Source: Author

The shape and size of the site can significantly affect on its suitability for potential development.

Site shape and size helps to play the role of deciding the location of the built form with the sun orientation and wind direction. Site shape slightly makes the design in the individual project like hotels and hospitals. According to the site shape the services and other infrastructure is also decided. As this site is flat and nearly similar to the shape of rectangle so it can be obtained that the shape of building may be go with the pattern of the site.

Site Shape is always crucial for the designing the building foot print as there are some legal constraints to follow which allows to design the building in suitable limit.

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Site Analysis 3.7.4 SITE CONTOUR The site has gradual slope of 3 over 142 meters.

Fig. 23 Schematic section of the site Showing building envelope Source: Author

Fig. 22 Site Section Source: Author

Fig. 21 Site contour Source: Author

3.6.5 DRAINAGE Minimum slope required for drainage is 2.0 %, therefore the site has perfect slope for drainage site has uniform slope of 3.0 % across it is considered ideal if the drainage lines are placed in high to low direction.

But site the municipal sewer lines are along with road hence it will be easy to transfer sewer along road.

Fig. 24 Site Drainage pattern Source: Author

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Site Analysis 3.7.6 SWOT STRENGTH o o

The site ideal for Maternity and childcare Hospital as it is within accessibility yet is cut off from the Traffic and noise.

The site is flat and also have attached to the CHC and can transfer all service with it.

WEAKNESS o

The site has short side facing the road, which is weak point for providing entrances.

OPPORTUNITY o o

The adjacent high-end apartment project may bring more clients to the luxury birthing center.

The shape of site provides opportunity to build building along with slope.

THREAT o o

3.8

The adjacent may also to be cause of disturbance to the peace and tranquility presently found in the site.

The site is very far away from main city area, which will cause delay in construction and to technology.

Inferences. a. Climatic analysis o o o o

The site is under composite climatic zone. It has high humidity throughout the year.

Humidity level even rises in monsoon.

Proper ventilation has to be required and sun shades/chajjas must be provide to avoid direct heating to the building surface.

A large opening and open courtyard must be provided to make building more ventilated and also pleasant for the patients.

Vegetative buffer can be provided near building to reduce the shine effect of the sun.

b. Services Analysis. o o o o o

Sever line has to be laid throughout the site as there is no existing sever line in the site.

Electric city can be brought to the site through the existing substation of the Community health center that is of 33KV. Entrance can be provided through the arterial road going along the north side of the site.

Water supply can be drawn from the existing CMC and can be supply to the whole building through Underground and overhead tanks.

Rain water harvesting can be done in the underground water tanks and can be used for cleaning and gardening purpose.

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Site Analysis c. Vegetation Analysis o o o o o o

Unshaded pavements should be avoided as far as possible and air should not be allowed to pass over such hot surfaces before reaching to the building.

Trees having large crowns and have height can be used to protect building from direct radiation of the sun and can be incorporated in the landscaping planning.

Parking should be of such material which can be treated as landscaping not heat generating materials.

Hardscape should be avoided as much as so that heat radiation from those can be neglected.

Green garden should be provided with small heighted green tress which may increase the microclimate of the place by the presence of themselves.

As the ground of site can grow any kind of tree hence according to the requirement of the space the planting must be done.

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CHAPTER 4. CASE STUDIES

4.1 The Cradle hospital, Calicut (Kerala) (Live Case Study) The Cradle Calicut is a women & child Specialty hospital located in Kozhikode (Calicut) Kerala.

The Hospital was established in 2011.

4.1.1 Site Context It is located along the NH 17 bypass, Calicut. It is easily accessible by road and is situated in an area that is less prone to traffic jams. The Hospital has separate entry and exit.

Fig. 25 Hospital location

4.1.2 Planning and Design It is built on 65 cents of land.

Site is sloping at approx. 1:12 gradient.

It provides for parking for visitors at the ground level in front of the hospital. Basement parking is provided for inpatients and staff as well as service cars.

The Hospital Follows a vertical growth pattern due to lack of area in site. future expansion is possible in above floors.

Fig. 26 Typical Section

SITE SURROUNDINGS: - The site surrounding include national highway.

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Case Study 4.1.3 Horizontal Zoning Ground Floor Plan:   

Access to Commercial areas.

Large waiting hall with reception.

There is one common entry for doctors and patients.

Fig. 27 Ground Floor plan (Cradle)

Fig. 28 Pharmacy from outside

Pharmacy is ideally located in the ground floor with direct access from the exterior as well as from inside.

Fig. 29 Me and Mom Shop

Mom & Me Retail Showroom inside the Hospital. (240 sqm.)

Fig. 30 Hospital Reception [7]

The Reception is intrusive to the lobby space yet holds good view to the waiting area and entrance.

In this case study it was found the hospital is highly commercialized which is not suitable for any such hospital building as the user/patient first meet such kind of commercial activities in the ground floor.

Ideally any hospital building must have their emergency department at the very first approach of the building.

First Floor Plan:  

This provides access to the all consultant rooms with large waiting hall.

This floor has administrative department.

Fig. 31 First Floor Plan(Cradle)

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Case Study

waiting 15%

Admin 30%

Circulation 30% Consultant 25%

Admin Fig. 32 Waiting hall with play area

Consultant

Circulation

waiting

Fig. 33 Area Distribution in First floor

Source: Author

The examination rooms are designed to provide privacy to the patient.

The ultrasound scanning is located in the OPD which is to Both out patients and inpatients. (70 sqm) Fig. 34 Diagnostics.

Fig. 35 Examination room

Second Floor Plan:   

There are two operation theatre in the Second floor Also, the suit room is located.

The second floor is highly sterile zone of the building.

 

Fig. 36 Second floor plan (Cradle)

The NICU is spacious and well connected to the operation suit. It has capacity of 15 infants with area of 48 sqm.

Nurse station area provided in every floor which decreases the travel time to enhance the efficiency.

Fig. 38 showing NICU

Fig. 37 Operation Theatre

Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

Fig. 39 Suit room of hospital

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Case Study Third/fourth/fifth Floor Plan: -

Rooms

Circualation

Sterile

Fig. 41 Showing Area Distribution

Admin

Fig. 40 Third Floor Plan(Cradle)

The Deluxe suite is 20 sqm (4m X 5m) in Area. The Semi suite is having slightly larger area that is 35 sqm as to accommodate an extra space for visitors.

Fig. 42 IPD Rooms

4.1.4 Other Design Aspects.

WAYFINDING The cradle Calicut is very legible. The public area and opd’s are well defined and marked at the entrance of the building for easy accessibility. Also, the Building is used vertically more as compared to horizontal circulation so it is very easy to understand the segregation.

LIGHTING Soft yellow lighting has been used throughout the hospital to render a feeling of warmth and comfort.

SERVICES Laundry: - The soiled linen is autoclaved within OT. The Linen from other ward are given to washer men.

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Case Study MECHANICAL PLANT: The plant room is located in the exterior to reduce vibration. The generator is also placed in the exterior.

CENTRAL STERILE STORE DEPARTMENT(CSSD) The CSSD is located with nursing and is also in sterile zone, which access to the all department easily and major access to the operation theater as it is located at second floor near OT Block.

FORM The form of the building is imposing. It does not render the image of a homelike intimate space for birthing. it is formal and lack character.

Fig. 43 Showing Lighting, Mechanical area and Material used.

MATERIAL SELECTION The materials used are marble for flooring and feature walls, dark wood for furniture. The natural materials used render a homely atmosphere.

Provided Site is very low in scale

Required Vertical Stacking is done.

No Ramp is Provided No Laundry is provided

Ramp should be provided of at least 1:15. For patients Should be provided

No Blood bank is provided

Should be provided

No Service lift has direct connection to the IPD department

Should be provided to connect pantry at least.

Table 1 Merits and demerits of Hospital(Cradle) Source: Author

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4.2 Chirayu Hospital, Bhopal (Live Case Study) Chirayu Medical College and Hospital, Bhopal Project Chirayu Medical College and Hospital Architect Ar. Ajay Kataria (ARCONS, Bhopal) Construction Year 2005 No. of Beds 502 No. of Beds Maternity 37 Parking Capacity 300 Cars

Fig. 44 Chirayu Medical College and Hospital

Intention of case study: This case study was done to understand the scale of the hospital building. it was also helpful to understand the circulation and distribution of services among all the different departments. The Hospital have nearly 37 beds for maternity department which helps to understand the service for maternity department.

Fig. 46 Site plan of Chirayu Source: Thesis Report Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

Fig. 45 Elevation of Chirayu Building

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Case Study

Table 2 Showing Bed Distribution of Chirayu Hospital

From the above data it was found that Chirayu medical college and hospital has 37 beds for maternity.

4.2.1 Plan Layout and Circulation

Fig. 47 Floor plan (left- Ground Floor) (Right- First Floor) Source: Author

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Ground Floor 17% 31% 11% 3% 4% 4%

4% 9% 3% 5% 5% 4%

Emergency Blcok Radiology Block Radiology Dept.

Admintstration Pharmacy Obstretics & Gynea Physeiotherapy Orthodpedics Genral Surgery Pediatrics Pscyhiatry Circulation

Pathology

First Floor

General Med. Dental

30%

24%

23%

Opthalmic Respiratory

5% 2% 3% 4% 3% 3% 3%

ENT Orthopaedics Dermatology IPD Circulation

Fig. 48 Area Distribution (Left - Ground Floor, Right- First Floor) Source: Author

Fig. 49 Second Floor (Left) Third Floor (Right) Source: Author

GYNAECOLOGISTS DEPARTMENT: There is no direct access to lift for the maternity Department. Also, the department has no segregation between the patients’ corridors and the doctors’ corridors.

Sterilization process was Same as OT. Proper waiting area designed for 50 people.

Separated circulation for minor and major OT’s. There is no direct connection between Blood bank and the Department. It has integrated NICU. Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

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Fig. 50 Maternity Department Layout (Chirayu)

4.2.2 OT Block OPERATION THEATRE BLOCK: Total Number 6 OTs. No direct access to lift for OT. Strong connectivity of OT--IPD. CSSD Situated on the same floor with OT complex.

Dirty Utility is first washed and semi sterilized in autoclave and then transferred CSSD. No Separate Blood Bank is present.

OT Block has direct connection to ICU. Same Entrance for staff and patients, no separation between clean, dirty and sterile corridor.

All OTs are placed in order to receive diffused light Fig. 51 Operation Theatre Layout

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Case Study 4.2.3 CSSD and other Services Location: - Third floor One Machine req.: - 2 x 3 sqm.

Types of sterilization: - 1. steam (135 degree) 2. gas (55 degree) Number of person working: - 06.

Reception: - 2.90 x 3.00 m

Fig. 52 CSSD Floor Plan Chirayu

Fig. 53 autoclave steam sterilization machine (left), Ethylene oxide sterilizer(Right)

GAS MANIFOLD: -

Chirayu Hospital has separate building for supply of gas to the hospital.as shown in

Fig. 54 Plan of Gas manifold (Chirayu) Source: Author

Fig. 55 Section showing Connection of gas pipes to the building. Source: Author

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Case Study

4.3 Mother Baby Center, Minnesota, USA (Literature Study) Mother Baby Center, Minnesota, Project Mother Baby Center, (Maternity Hospital) Architect HDR Architects Construction Year February 2013 Site Area 8918.168 Square Meter SITE VIEW The site is basically residual space between existing hospital buildings. It connects to the existing buildings and functions at multiple levels and interface with the complex geometry of existing building faces.

The Center has its own entrance at Chicago Avenue and 26th street in Minneapolis. The Main entrance has a circle driveway for easy drop-off CONCEPT The overall goal was to create a center where the mother will receive the very best care, while maintaining the appearance of a luxury hotel and spa, “explained Michael Rodriguez, the lead project designer for the Center.” Every detail was thought out” Fig. 56 Site View of Hospital

From the outside, the Mother Baby Centre looks four stories high. But, Because of an existing parking structure underneath the site, and a 100,00 square foot size limitation for the entire project, the first-floor entrance is smaller than the floors above it. Visitors entering at the ground floor will find a reception area, information kiosks and elevators.

Future plans for the first floor include a conference center and education spaces,

Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

Fig. 57 Site Plan

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Case Study

4.3.1 Vertical Zoning Special care nursery and ante-partum /postpartum unit are located at second floor of the building, from where easy connection of the departments is done.

- 24 Rooms, 31 beds with special care nursery (Allows for triplet and twins) - 20 beds ante-partum/post-partum unit - 3 family sleep rooms.

- Skyway connection between Midtown doctors building and the Piper Building.

DESIGN CONSIDERATIONS Each Spacious private room has a family sleep space, Breast feeding Support space, large screen TV, large bathroom and luggage cart with a personal safe. In addition to a dedicated water birth room, each labor and delivery room is large enough to accommodate a portable water birth tub. It thereby broadens the patients birthing options.

WAYFINDING The building is organized by “neighborhoods,� each in a different color, including yellow, orange, green and purple. Patients will find their way around the center with the color-coded system which is also mirrored on the outside of the building with tinted windows.

Fig. 58 Plans Mother baby Center

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4.3.2 Material and specification.

LIGHTING Lighting can help stimulate staff and help to provide a cheery atmosphere in as place that is not always happy place for patients.

The corridor is dimly lit by floral light plane panels which is very artful illumination and the problem of bright light during the night can be avoided.

Fig. 59 Lighting Render Mother Baby Center

COLOR PALETTE According to project architect Jim Thomson of HDR Architecture, the colorful building is meant to compliment the design of the adjacent Children’s Hospital, which was substantially remodeled in 2010.

“The colors for the Mother Baby Center were vetted out by a team to create a healing environment for the mom.” It’s the same palette on both campuses but muted down. You won’t see bright and brash colors.”

Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

Fig. 60 Color Scheme of Mother baby Center

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MATERIALS Rooms are designed with materials that evoke a sense of warmth, comfort and beauty in a stressfree environment.

Fig. 61 Material used Mother baby center

FORMS The exterior of the building not only breaks down into four pods, it also twists from floor to floor. The twist gives visual interest to the contemporary design as well as creates a constant change with shadow and the sun’s reflection.

The Design infuses hallways with freeflowing curves that lead to labor and delivery and patient rooms embraced with curved off its reminiscent of the shape of an egg. These graceful curved ceiling elements may be the first thing a baby sees.

Fig. 62 Form of mother baby center

THE HEALING ENVIRONMENT A welcoming environment designed to ensure that their entire childbirth process is as safe, relaxing and enjoyable as possible.

The Environment embraces both evidence-based design innovations and patients- centered care models. The Design of the Mother Baby Centre was based on interviews of past and future mothers to find out what they like and don’t like about birthing centers.

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4.4

Inference from the case studies

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CHAPTER 5. AREA STATEMENT

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AREA PROGRAM

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AREA PROGRAM

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AREA PROGRAM

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AREA PROGRAM

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CHAPTER 6. DESIGN PROPOSAL

6.1 Concept Development 6.1.1 EVIDENCE BASED THEORY/DESIGN Evidence Based Design. or EBD, is a field of study emphasizing credible evidence to influence design or “a process for the conscientious, explicit, and judicious use of current best evidence from research and practice in making critical decisions, together with an informed client, about the design of each individual project. This approach has popular in healthcare to improve patient and staff well-being, patient healing, stress reduction and safety.

Fig. 63 Chart Showing the process of EBD Source: Author

Table 3 Showing Characteristics of EBD Source: Author

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Design Proposal

Fig. 64 Circulation Linked With EBD Source: Author

ZONING Zoning of the site is done on the basis of site analysis.

Fig. 65 Zoning of site on Evidence base design Source: Author

Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

1. Entrance of the site is provided through the arterial road.

2. Along the entrance parking is proposed as hospital is for females and for mothers so the drop off is required at the entrance of the building.

3. OPD should be linked with the main entrance of the building.

4. From the OPD In-Patient department is located and both IPD and OPD have major link through RAMPS and Lifts.

5. Emergency is provided at the beginning of the building as the case of casualty may occur any time and they require much more attention than anything.

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Design Proposal 6. All circulation and major services should be provided through separate vehicular road movement so that hospital can run smoothly in load hours.

7. Green garden space is also provided for females and children so that In patients can have proper green environment, and can have relaxing time there.

6.2 Space and Form Analysis.

Basic form generation through massing space and using concept of cross ventilation among two parts of the buildings.

BREAKING MASS

Fig. 66 Concept Development Source: Author

6.2.1 Form Development

The building form is generated through the massing of the square in terms of courtyard concept. Which will lead to get impact of climatic variations, such as extreme heat during summers, harsh winters as well as torrential rains. It will also help in the utilization of Natural light and benefiting in terms of air circulation. Also, in public spaces the courtyard will be most interactive space for all the patients.

The spitting the building in two parts and providing the proper circulation to air is good for patients and other users health

v

Fig. 67 Build form Development Source: Author Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

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Design Proposal

6.3 Design Development 6.3.1 Site Plan

Fig. 68 Conceptual Layout Site Plan Source: Author

Site Plan is divided into two zones: Front Zone is vehicular zone where all kind of vehicular allowed including doctor’s cars, Ambulance and patients’ vehicles and public transport.

From the Entrance there should be a guard room with solid entrance gate which should provide a good view to the hospital but proper enclosed environment.

Fig. 69 Site Plan stage 2

After entrance A good quality parking with landscaping pavement which will allow patients and the user to walk and provide proper access to the site.

Source: Author

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Design Proposal From the previous stage of the drawing development the site plan has been improved to provide necessary garden layout for the inpatient department patients.

Building Orientation is decided on the basis of the sun orientation and wind direction as done in site analysis part.

The Building entrance is west facing which means the building front portion will get maximum heat during mid-day or in evening time

Fig. 70 Site Plan Stage 3 Source: Author

The IPD and OPD has been kept together by stacking up hence in order to have fast and easy circulation and connectivity to the patients and as well as the doctors.

Emergency Department is having it own position in the building which is directly connected to the visibility to outside of the site.

Fig. 71 View from the Hospital Building Source: Author

Fig. 72 Night View from the Entrance Source: Author

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Design Proposal 6.3.2 Circulation and Courtyard

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Design Proposal 6.3.3 Services

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Design Proposal 6.3.4 OPD’s

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Design Proposal 6.3.5 Administrative Department

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Design Proposal 6.3.7 Internal Patient Department (IPD’s)

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CHAPTER 7. ADVANCE OBJECTIVE

7.1

INTRODUCTION

Services are major integral part of the Hospital Buildings, that shall be designed and planned to observe appropriate services in terms of medical, administration, electrical, sanitary, ventilation & Cooling and Dietary.

It has been observed that government of India is strongly focuses on improving hospital services in terms of availability, accessible health services to the people. In order to improve healthcare facilities, the services which supports the base of hospital are following listed as follows: 1. Hospital Kitchen (Dietary Service) 2. Central Sterile and Supply Department (CSSD) 3. Hospital Laundry 4. Medical and General Stores (Pharmacy/Dispensary).

5. Engineering Services (Electrical, ventilation & Cooling)6. Public Health Engineering (Water Supply) 7. Sanitary Service.

8. Waste Disposal System. (Stores sterile and non- sterile) 9. Gas Supply Services. (Kitchen Gas, Medical Gas and laboratory Gas) The above-mentioned services have different areas for different categories of hospitals, and specific area requirement of the services changes as per the size of the hospital, also according to the frequently use of it. This study will provide appropriate area for the services mentioned and will be use in the thesis also.

7.1.1 AIM The Aim of this study to examine, the areas for different services in a hospital building.

7.1.2 SCOPE AND LIMITATION This study is mainly focuses on the area assessment of non-ambulatory services in hospitals which are significant to the small-scale hospitals such as 50-60 bedded.

The study is limited to the service areas of 50 to 60 bedded hospitals only. The study will not focus on the latest new models of new equipment used in hospital services areas.

7.1.3 OBJECTIVES The brief objective of this research is: 2. Identify the various hospital services.

3. Identify the area requirement for the various services in a hospital building through Literature survey.

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Advanced Objective 4. Live case study to identify areas for Vertical and Horizontal services for 50-60 Bedded hospital.

5. Analyze the areas requirement by comparing both literature and live study.

6. To propose suitable area recommendation for the horizontal and vertical services areas.

7.1.4 EXPECTED FINDINGS Height of building can be defined by the research. This will be going to have all the final areas of services required for 60 bedded hospital 7.2

METHODOLOGY

The whole study pattern is shown and how will whole study will be going to take place:

Fig. 73 Flow Diagram Showing Methodology Source: Author

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Advanced Objective 7.2.1 Background Study: 7.2.1.1 Hospital A building which provides medical and surgical treatment for sick or injured peoples. It also carries medical staff with other services of care. Hospitals have many departments and services in terms of Medical/ Ambulatory services or in terms of non-ambulatory services.

On the basis of Ambulatory services, the Hospitals are categorized in different specialization and its fields such as: - Orthopedics, Maternity, Pediatrics, Geriatrics, Oncology etc.

These types of hospitals are limit to their services, but whereas the one thing is in common for all such hospitals are their non-ambulatory services, these all services as also termed as support services for hospitals.

7.2.2 Classification Classification of Hospital Non-ambulatory services: 1. Hospital Kitchen (Dietary Service) 2. Central Sterile and Supply Department (CSSD) 3. Hospital Laundry 4. Engineering Services (Electrical, ventilation & Cooling) 5. Sanitary Service.

6. Gas Supply Services. (Kitchen Gas, Medical Gas and laboratory Gas).

On the basis of case studies, the area and the requirement of above mentioned services is there or not being get clarified.

Case Study 1

Case Study 2

Case Study 3

The Cradle Hospital, Calicut

Chirayu Medical College and Hospital

The Motherhood Boutique Birthing Centre, Bengaluru

1 Services)

Y

Y

N

Y

2 CSSD 3 Hospital Laundry

Y N

Y Y

Y N

Y Y

Engineering Services

Y

Y

Y

Y

5 Sanitary Services

N

Y

Y

Y

6 Gas Supply Services 7

Y

Y

Y

Y

S.no

Services

Kitchen (Dietary

4

Design 60 Bedded Maternity & Childcare, Shajahanpur, U.P.

Table 4 Showing Services.

Source: Author

Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

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Advanced Objective In India Hospitals are designed as per the Guidelines provided by MCI (Medical Council of India) and with National Building Codes in which the services areas have their own space requirement as per the basis of beds and users.

Case Study 1

Case Study 2

Case Study 3

S.no

Services

The Cradle Hospital, Calicut (36 Bedded)

Chirayu Medical College and Hospital (500 Bedded)

The Motherhood Boutique Birthing Centre, Bengaluru (30 bedded)

1

Kitchen (Dietary Services)

31 sqm

650 sqm

-

2 3 4

CSSD Hospital Laundry Engineering Services

24 sqm.

40 sqm 40 sqm

335 sqm 200 sqm 150 sqm

30 sqm.

40 sqm 30 sqm

5

Sanitary Services

-

100 sqm

25 sqm

6

Gas Supply Services

20 sqm

76 sqm

16 sqm

Table 5 Areas of Services

Source: Author

7.2.2.1 Kitchen (Dietary Services) The dietetic department mainly serves the patient needs in terms of therapeutic diets, diet counselling and special feeds. The dietary service is one of the most supporting services of the hospital unlike any other support service. The Dietary Department does procurement of food so it requires storage areas, for cooking purpose cooking areas, sanitary spaces such like washing and cleaning of trolleys and garbage collection areas.

Area Requirement for Kitchen Dietary Services: a. b. c. d. e.

Cooking Area.

Washing Area.

Dry Ration Store Area.

Garbage Collection Area.

Cold Store (if Needed).

Fig. 74 Typical Kitchen Layout for 100 Bedded Hospital [5]

Fig. 75 Kitchen Layout (The Cradle, Calicut)Author Source:

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Advanced Objective Kitchen Services Areas S.no

Services

1 2 3 4 5

Case Study 1

Case Study 2

Case Study 3

The Cradle Hospital, Calicut (36 Bedded)

Chirayu Medical College and Hospital (500 Bedded)

The Motherhood Boutique Birthing Centre, Bengaluru (30 bedded)

4.5 sqm 4.0 sqm 3.5 sqm

110 sqm 95 sqm 80 sqm 65 sqm 300 sqm

-

Cooking Area.

Washing Area.

Dry Ration Store Area.

Garbage Collection Area.

Total area (Including Circulation)

3 sqm 16 sqm

Table 6 Kitchen Services Areas Source: Author

The finishes of all exposed ceilings and ceiling structures in areas normally occupied by patients or staff, and those in food preparation or food storage areas shall be readily cleanable with routine housekeeping equipment.

Fig. 77 CSSD Unit (THE CRADLE, CALICUT) Fig. 76 CSSD Unit (CMCH)

7.2.2.2 Central Sterile Store/Supply Department (CSSD) The Central Sterile Store/Supply Department is the area responsible for receiving, storing, processing, Controlling and Distributing all the professional supplies and Equipment which may sterile and non-sterile for Hospital in every part of ambulatory areas, through which safety of patients get under control.

As per the case study it is easy to identify various spaces in CSSD department, which includes g. h. i. j.

Receive Area: Through all Collection and supply will take place.

Sterile Store: After method of sterilization all equipment get stored.

Cutting Zone: The zone where sterile Cotton gauge and other things were cut.

Autoclave Unit: The Room where electrical or chemically Treated Machine are stored for Disinfecting materials.

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Advanced Objective k. Changing Room: Toilets and staff changing room. l. Non-Sterile Store: After Receiving Infected Equipment They get stored.

CSSD Service Areas S.no 1 2 3 4 5 6 7

Services Receive Section Sterile Store Cutting Zone Autoclave Unit Changing Room Non- Sterile Store Circulation

Case Study 1

Case Study 2

Case Study 3

The Cradle Hospital, Calicut (36 Bedded)

Chirayu Medical College and Hospital (500 Bedded)

The Motherhood Boutique Birthing Centre, Bengaluru (30 bedded)

4.5 sqm 3.4 sqm 1.2 sqm 3.6 sqm 6.5 sqm 4.8 sqm

12 sqm 45 sqm 100 sqm 50 sqm 30 sqm 20 sqm 78 sqm

4 sqm 3.2 sqm 1.2 sqm 4 sqm 8 sqm 4 sqm 5.6 sqm

Table 7 CSSD various Areas Source: Author

As the operation theatre department is the major consumer of this service, it is recommended to locate the department at a position of easy access to operation theatre department. It should have a provision of hot water supply. [1] 7.2.2.3 Hospital Laundry The hospital is the area that receives all the linen material from different areas such as department, OT, OPD and the office area where there are subjected to classification washing extraction, Drying ironing bending, repair and delivery. To Control the hospital infection, continually provide the clothing supply to the user department to improve the image of the hospital

Fig. 78 Typical Hospital Laundry Plan [6]

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Advanced Objective Laundry Service Areas

S.no

1 2 3 4 5 6 7 8 9 10 11 12

Services

Receiving and Sorting Sluicing Pre-Wash Washing Trolley wash Tumbler Wash Store Calendaring Inspection/Packing Mending Clean Storage and distribution Circulation

Case Study 1

Case Study 2

Case Study 3

The Cradle Hospital, Calicut (36 Bedded)

Chirayu Medical College and Hospital (500 Bedded)

The Motherhood Boutique Birthing Centre, Bengaluru (30 bedded)

3 sqm 3 sqm 10 sqm 6 sqm 8 sqm 3 sqm 7 sqm

15 sqm 5 sqm 10 sqm 15 sqm 10 sqm 10 sqm 10 sqm 30 sqm 10 sqm 5 sqm 50 sqm 45 sqm

4 sqm 4 sqm 8 sqm 4 sqm 10 sqm 10 sqm

Table 8 Laundry Areas.

Source: Author

The process of Laundry cleaning is based on the proper segregation of Dirty linen and transfer to washing area. It is most preferred while designing Laundry Services in hospital that it must be kept in Ground floor as all Dirty Linen can easily collected at one place and can be transfer smoothly to one location at a time. As per the equipment sizes the room dimension can be varies and also, type of linen generating through hospital which may include Clothes of Patients, Bedsheets, Blankets and Pillows, Mattresses etc.

7.2.2.4 Engineering Services The major non- ambulatory services of hospitals are Engineering Services which includes: Electrical, Sub-station and Generators, illumination, Emergency Lighting, Ventilations.

Electrical Engineering Services Mainly Focuses on building: a. b. c. d.

Building Power.

Alternate Source of Energy.

Air Conditioning.

Lifts and Fire Control.

The Above mention areas are the part of Electrical Room in which all the things were control and have separate areas for operation.

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Advanced Objective Engineering Service Areas S.no

Services

Case Study 1

Case Study 2

Case Study 3

The Cradle Hospital, Calicut (36 Bedded)

Chirayu Medical College and Hospital (500 Bedded)

The Motherhood Boutique Birthing Centre, Bengaluru (30 bedded)

1 Building Power Alternate Source 2 (Generator) Air Conditioning 3 (Special Wards) 4 Lifts 5 Fire control Table 9 Engineering Services in Hospitals Source: Author

7.2.2.5 Sanitary Services.

The Hospital is most Sterile area and always require Proper hygienic conditions. Sanitary Services of Hospitals Provides a Happy, Healthy, Safe and Pollution free environment to the users. The Sanitary Services must be available for all floors and have minimum distance to travel and each floor have its own Store location and from where all the equipment can be assessed.

The Cradle, Calicut is having 30 Sqm Area for Sanitary Service in each floor, so that sanitation can be controlled throughout the day.

The task Should be performed by the Sanitary Department Fig. 79 Sanitary Layout (The Cradle, Calicut) Source: Author are: Dust Moping 6 minutes for 280 sqm.

Wet Moping for 12 Minutes for 280 Sqm and Machine Scrubbing for 2 hours. [6]

Sanitary Service Areas S.no

Services

1 Sanitary Supply Store 2 Sanitary Controller 3 Sanitary Control Room

Case Study 1

Case Study 2

Case Study 3

The Cradle Hospital, Calicut

Chirayu Medical College and Hospital

The Motherhood Boutique Birthing Centre, Bengaluru

12 sqm 10 sqm 8 sqm

30 sqm 40 sqm 30 sqm

10 sqm 8 sqm 8 sqm

Table 10 Sanitary Services in Hospitals Source: Author Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

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Advanced Objective 7.2.2.6 Gas Supply Services Medical Gas Distribution System is a system of centralized for medical gas (O2, N2O, N2), medical air and medical vacuum comfortably to each ward and Convenient through a Central Piping system to all the sources where the Gas is needed.

Gas manifold room consist of: a. Supply Room. b. Gas Cylinder Store c. Gas Cylinder Holding. d. Electrical Panel for Gas Supply.

Image showing gas manifold room plan of Chirayu Medical College and Hospital having area of 77 sqm.

The Location of Gas manifold is also Matters for hospitals as the supply will be for whole hospitals and to all parts of the building. Gas Supply having separate rooms are very easy to handle out because they have their own Pump, electrical panel and control, with supervisor and also having separate space for Dropping and collecting cylinder.

Fig. 80 Gas Manifold Room (CMCH) Source: Author

Note: - All the buildings have standard height for all services which include false ceiling and clear height of the building.

Gas Manifold S.no

1 2 3 4

Services

Supply Room Gas Cylinder Store Gas Cylinder Holding Electrical Panel

Case Study 1

Case Study 2

Case Study 3

The Cradle Hospital, Calicut

Chirayu Medical College and Hospital

The Motherhood Boutique Birthing Centre, Bengaluru

20 sqm

20 sqm 20 sqm 30 sqm 7 sqm

16 sqm

Table 11 Gas Manifold in Hospitals.

Source: Author

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Advanced Objective

Fig. 81 Section Showing Height Source: Author

7.2.3 Parameter Comparison between All spaces with the standards and the minimum Requirement as per bed in the above-mentioned Hospitals and calculating its space area as per the size of the Hospital Proposed.

The Height of Hospital building is also defined as per the height of the services areas required and will be calculated with the ceilings and other services going through it Such as electrical and Gas Service.

The standards for all the services as per bed:

S.no

Services

A 1 2 3 4

Kitchen (Dietary Services) Cooking Area.

Washing Area.

Dry Ration Store Area.

Garbage Collection Area.

5 Circulation Total area B Central Sterile Supply Department (CSSD) 1 2 3 4 5

Receive Section Sterile Store Cutting Zone Autoclave Unit Changing Room

Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

Area Requirement (Sqm)

Type of Area

14 7 7 10.5

Area Space Room Area

11.55 50

-

5 7 5 7 6

Area Room Area room Room

Remark

For 30 Bedded Hospitals

For 30 Bedded Hospitals

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Advanced Objective 6 Non- Sterile Store 7 Circulation C 1 2 3 4 5 6 7

Room -

Total area

8 11.4 49

Area Space Space Space Area Room -

Total area

6 8 10 8 6 7 13.5 45

Total area

10 5 5 6 20

Laundry Services Receipt and Sorting Sluice and Washing Calendaring Drying Press Clean Storage and issue Circulation

D 1 2 3 4

Sanitary Services Sanitary Supply Store Sanitary Controller Sanitary Control Room Circulation

E 1 2 3 4 5

Gas Manifold Supply Room Gas Cylinder Store Gas Cylinder Holding Electrical Panel Circulation

10 6 6 3 Total area

7.5 33

For 30 Bedded Hospitals

Room Room Room -

For 30 Bedded Hospitals

Room Room Space Space -

For 30 Bedded Hospitals

Table 12 Standard For all Services with areas and type of rooms [5].

7.2.4 Inference: From the above steps the final areas for the all major non- ambulatory services will be calculated and new area program for the 60-bedded hospital will be proposed.

As the comparison between surveyed data and the standard from norms and medical council of India, the list has been prepared of all the areas of services and their respective height according to the equipment measurement and layout in the space.

S.no

Services

Area Requirement (Sqm)

Type of Area

Remark

20 10 10 15

Area Space Room Area

16

-

For 60 to 100 bedded maternit y hospital

A Kitchen (Dietary Services) 1 2 3 4

Cooking Area.

Washing Area.

Dry Ration Store Area.

Garbage Collection Area.

5 Circulation Maternity and Childcare hospital (60 Beds), Shahjahanpur U.P.

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Advanced Objective 6 Eating space included B 1 2 3 4 5 6 7 C 1 2 3 4 5 6

Total area Central Sterile Supply Department (CSSD) Receive Section Sterile Store Cutting Zone Autoclave Unit Changing Room Non- Sterile Store Circulation Total area Laundry Services Receipt and Sorting Sluice and Washing Calendaring Drying Press Clean Storage and issue

7 Circulation Total area D 1 2 3 4

Sanitary Services Sanitary Supply Store Sanitary Controller Sanitary Control Room Circulation

Space

8 12 16 18 16 8 22 100

Area Room Area room Room Room -

8 30

Area Space Space Space Area Room

60 18 34 150

Gas Manifold Supply Room Gas Cylinder Store Gas Cylinder Holding Electrical Panel Circulation

For 60 100 Bedded Hospital

Room Room Room -

For 60 100 Bedded Hospital

Room Room Space Space -

For 60 100 Bedded Hospital

50 10 6 6 3

Total area

For 60 100 Bedded Hospital

-

20 10 10 10 Total area

E 1 2 3 4 5

160 230

7.5 33

Table 13 Final Area Program for 60-100 Bedded Maternity Hospitals Source: Author

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Advanced Objective

7.2.5 Final Proposal of Area Program

Fig. 82. Section of Kitchen Source: Author

All necessary kitchen facility which is required to have proper functioning in the hospitals is prepared, on the basis of all data and final area sheet preparation.

The areas of kitchen are around 70 sqm which i s to be provide for 60-100 bedded maternity hospitals.

Source: Author Fig. 83 Final Layout of Kitchen

These all drawings are typically made to show how can be the utilization of the area can be done.

Fig. 84 Section of CSSD Department Source: Author

Fig. 85 Proposed plan for CSSD Department Source: Author

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Advanced Objective CSSD is department which carry autoclave unit with changing rooms, Gauge cutting and store area which have been designed accordingly.

According to whole data and inference from the data the good design must carry the circulation area and all spaces have been properly allocated.

According to the study the typically design has been proposed for central sterile store department which have 70 sqm area for the space and around 30 sqm area for proper circulation for both sterile and non-sterile equipment.

For All the services the area and their circulation must be taken in consideration, and according to their service requirement they must be design or allocate their designation in the building.

7.2.6 Conclusion and Result The study shows there are some important considerations in Hospital Design which has significant role on non-ambulatory services. It was found in all the cases that some services are having different areas for different number of beds and the user types.

The problem has been identified and tried to solve by the same standards and some changes in room dimensions. The new proposal for the services areas which may be vertical or horizontal in type needs proper areas and location in the hospital building plans. However, some compromises have been taken in the areas of few of the services such as to provide suitable comfort and for the user of service.

The major problem identified is height of the non-ambulatory services and their circulation, in hospital building the engineering services includes ventilation system, which may be taken care of through the height of the buildings.

The Data extracted in the paper is for about 60-100 bedded hospital with extra services area and can be feasible to both government or privatized hospital.

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Bibliography [1] Indian Public Health standards for 100 Bedded Hospitals (2007), [2] Ministry of health & Family welfare.

[3] A. Balaras, Elena Dascalaki, Athina Gaglia, “HVAC and indoor thermal hospital operating rooms (2007)”. www.sciencedirect.com

conditions in

[4] Guidelines in the planning and design of a Hospital and othert health facilities (2004).

Department of Health.

[5] Area Data for maternity Hospital Available from: http://www.bis.org.in/sf/mhd/MHR14(0131).pdf (Accessed – 27 March 2018)

[6] Plan for Laundry Services From http://vikaspedia.in/health/sanitation-and-hygiene/swachhta_abhiyaan_guidelines/laundryservices (Accessed- 27 March 2018).

[7] Agency for Healthcare Research and Quality. National health care quality report.

Washington, DC: Department of Health and Human Services; 2006.

[8] Centers for Medicare and Medicaid Services. Medicare demonstration shows hospital quality of care improves with payments tied to quality. CMS Office of Public Affairs.

Available at: http://www.cms.gov/apps/media/press/release.asp?Counter=1729.

(Accessed November 29 March, 2018).

[9] Medical council of India guidelines, 2012.

[10] Indian Public Health standards,2014.

[11] Kunders, G. (2004) Hospital: facilities, Planning and Management. Tata McGraw-Hill Education.

[12] Department of Health (Nov, 2004), Guidelines in the planning and design of a hospital and other health facilities.

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Bibliography [13] E. Marcon, S. Kharraja, G. Simonnet, The Operation theater planning by the follow-up of the risk of no realization, International Journal of Production Economics 85 (1) (2003).

[14] District Health Facilities, Guidelines for Development and Operations; WHO; 1998.

[15] Indian Standard Basic Requirement for Hospital Planning; Part 2 Up to 50 to 100 Bedded Hospital, Bureau of Indian Standards, New Delhi, January, 2013.

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