Ajay Walia

DISSERTATION
Year: 2017-18
Batch No. 15
HYGIENE IN HOSPITAL DESIGN
Undertaken by:
AJAY WALIA
Enrollment No.: 13E1AAARF4XP009
V Year B. Arch (A)
Prof. PUSHPAK BHAGWATI Prof. N.S.RATHORE

GUIDE COORDINATOR
Aayojan School of Architecture

ISI-4, RIICO Institutional Block,
Sitapura, Jaipur-302022
APPROVAL
The study titled “HYGIENE IN HOSPITAL DESIGN” is hereby approved as an original work
of AJAY WALIA, enrolment no 13E1AAARF4XP009 on the approved subject carried out
and presented in manner satisfactory to warrant its acceptance as per the standard laid
down by the university. This report has been submitted in the partial fulfillment for the award
of Bachelor of Architecture degree from Rajasthan Technical University, Kota.
It is to be understood that the undersigned does not necessarily endorse or approve any
statement made, any opinion expressed or conclusion drawn therein, but approves the
study only for the purpose it has been submitted.
December 2017
Jaipur
Prof. K.S. MAHAJANI

EXTERNAL EXAMINER 1 PRINCIPAL
Prof. N.S. RATHORE

EXTERNAL EXAMINER 2 COORDINATOR
i
DECLARATION
I, AJAY WALIA here by solemnly declare that the research work undertaken by me, titled
“HYGIENE IN HOSPITAL DESIGN” is my original work and wherever I have incorporated
any information in the form of photographs, text, data, maps, drawings, etc. from different
sources, has been duly acknowledged in my report.
This dissertation has been completed under the supervision of the guide allotted to me by
the school. Further, whenever and wherever my work shall be presented or published it will
be jointly authored with my guide.
AJAY WALIA
V Year B.Arch. (A)
Aayojan School of Architecture, Jaipur
CERTIFICATE
This is to certify that the research titled, “HYGIENE IN HOSPITAL DESIGN” is a bonafide
work by AJAY WALIA of Aayojan School of Architecture, Jaipur. This research work has
been completed under my guidance and supervision in a satisfactory manner. This report
has been submitted in partial fulfillment of award of BACHELOR OF ARCHITECTURE
degree from Rajasthan Technical University, Kota.
This research work fulfills the requirements relating to the nature and standard laid down by
the Rajasthan Technical University.
Prof. Pushpak Bhagwati

Guide
Aayojan School of Architecture
ii
ACKNOWLEDGEMENT
I feel indebted to have the opportunity to express my gratitude to

All those who have lent a helping hand during this endeavor.
I owe immensely to PROFESSOR PUSHPAK BHAGWATI for guiding
Me throughout my research project.
I extend my gratitude to PROFESSOR ARCHANA RATHORE for her invaluable guidance

and encouragement given to me during the entire project.
I acknowledge and with utmost respect thank my parents and my brother for their
encouragement, love and faith in me
AJAY WALIA
V Year B.Arch. (A)
Aayojan School of Architecture, Jaipur
iii
CONTENTS
Page No.
Approval i
Declaration ii
Acknowledgement iii
Contents iv-v
List of illustrations vi
CHAPTER 1: INTRODUCTION 1-5

1.1 Background of the study
1.2 Criteria of selection
1.3 Hypothesis
1.4 Objectives
1.5 Scope
1.6 Methodology
CHAPTER 2: HOSPITAL HYGIENE 6-9
2.1 Introduction to hospital hygiene
2.2 Mode of transmission of infection
2.3 General measures of infection control
CHAPTER 3: INTRODUCTION TO HOSPITAL DESIGN 10-13
3.1 Introduction to hospital zones
3.2 Study of hospital zones and there subzones
CHAPTER 4: PARAMETERS TO CONTROL HYGIENE 14-23

4.1 Parameters to control hygiene
4.2 Study of different zones on the basis of parameters
CHAPTER 5: HOSPITAL DESIGN CASE STUDIES 24-35
5.1 EHCC (Eternal heart care center)
5.2 Tagore hospital and research Centre
5.3 Mahila chikitsalya
iv
CHAPTER 6: ANALYSIS 36-40
6.1 Analysis chart of case study parameters.
6.1.1 On the basis of architectural zoning.
6.1.2 On the basis of circulation.
6.1.3 On the basis of architectural detail, waste disposal and
air circulation system.
CHAPTER 7: CONCLUSIONS & RECOMMENDATIONS 41-43
Bibliography vii
v
LIST OF ILLUSTRATIONS
Figure Description of figure Source Page no.
number
Figure 1 Mode of transmission of infection Indian public health standard 2
Figure 2 Measures of hygiene control Indian public health standard 3
Figure 3 Transmission of infection WHO(world health 7
organization)
Figure 4 Hospital zones By Author (ref. - IPHS) 11
Figure 5 Hospital major zones and Indian public health standard 13
subzones
Figure 6 Parameters to control hygiene By Author 15
Figure 7 Hygiene zoning (WHO standards) By Author (ref. - WHO) 15
Figure 8 User zoning By Author (ref. - WHO) 16
Figure 9 Hospital floor and walls tiles http://www.dupont.co.in 17
Figure 10 Incineration Plant http://www.vezzaniforni.it 17
Figure 11 HVAC Plant http://www.eforenergy.com 17
Figure 12 Laminar air filtration system http://www.airepure.com.au 17
Figure 13 OPD Layout By Author (ref. - IPHS) 18
Figure 14 Diagnostic Layout By Author (ref. - IPHS) 19
Figure 15 IPD Layout By Author (ref. - IPHS) 20
Figure 16 Operation Theatre Layout By Author (ref. - IPHS) 22
Figure 17 EHCC By Author 25
Figure 18 Emergency By Author 25
Figure 19 Waste disposal ( service floor ) By Author 26
Figure 20 Ground Floor Hospital administration 27

Figure 21 Section Hospital administration 27
Figure 22 Service Floor Hospital administration 27
Figure 23 Service Floor Hospital administration 27
Figure 24 Mezzanine floor Hospital administration 28
Figure 25 First floor Hospital administration 28
Figure 26 Second floor Hospital administration 28
Figure 27 Third floor Hospital administration 28
Figure 28 Tagore Hospital By Author 29
vi
Figure 29 Basement floor Hospital administration 29
Figure 30 Ground floor Hospital administration 30
Figure 31 First floor Hospital administration 30
Figure 32 Second floor Hospital administration 30
Figure 33 Third and Fourth floor Hospital administration 31
Figure 34 IPD wards By Author 32
Figure 35 Operation Theatre By Author 32
Figure 36 Mahila chikitsalaya By Author 33
Figure 37 Site plan Hospital administration 33
Figure 38 Free medicine store By Author 33
Figure 39 Emergency By Author 34
Figure 40 vertical zoning By Author 34
Figure 41 OPD By Author 34
Figure 42 Critical care unit By Author 35
Figure 43 Waiting lounge By Author 35
Figure 44 Conclusion By Author 43
vii
AAYOJAN SCHOOL OF ARCHITECTURE
CHAPTER 1 - INTRODUCTION
 BACKGROUNG OF THE STUDY
 NEED AND CRITERIA OF SELECTION
 HYPOTHESIS
 OBJECTIVES
 SCOPE AND LIMITATION
 METHODOLOGY
HYGIENE IN HOSPITAL DESIGN 1

1.1 BACKGROUND OF THE STUDY
Nosocomial infection — also called “hospital acquired infection” can be defined as: An
infection acquired in hospital by a patient who was admitted for a reason other than that
infection.
An infection occurring in a patient in hospital or other health care facility in whom the
infection was not present or incubating at the time of admission, but after the admission
he suffers from any such infection which was adopted by in because of hospital
environment or appearing after the discharge of the patient.
An infection in a hospital which leads to improper hygiene generally occur through -
Figure 1 :Mode of transmission of infection
WHAT IS HYGIENE?
Hygiene is a set of practices which is performed for the preservation of health .According
to the world health organisation (WHO), Hygiene refers to the conditions and practices
that helps to maintain the health and prevent the spread of any diseases or infection.

The fundamental of hygiene control depends on the various measures, in which hierarchy
is:
Figure 2: Measures of hygiene control
1.2 NEED AND CRITERIA OF SELECTION
There is a list of fact which emphasis the need for the study of hospital hygiene-
 At any given time, about 1 in every 20 inpatients has an infection which is related
to hospital care.
 Hospital Acquired Infections kill more people than breast cancer, AIDS, and
automobile accidents and other diseases combined.
 It is well established that the hands of HCWs are the principal cause of
transmission of the infection from patient to patient and HCW to patients.
 According to a study done by JAMA Internal Medicine in 2012, an estimated $9.8
billion is spent annually in order to treat the five most common infections picked up
in the hospital.
 One study showed that when a nurse walks into a room occupied by a patient with
MRSA and has no patient contact, but touches objects in the room, the nurse's
gloves are contaminated 42 percent of the time when leaving the room and
transfer the infection to the outside world .
 In 2010, the U.S. Bureau of Labour Statistics estimated that 72 percent of
physicians use smartphones. Nurses aren't far behind, with 71 percent using
smartphones on the job, this can also be the resulting in nosocomial infection.
 In the US, approximately 18,650 persons die during a hospital stay related to
serious MRSA infections annually, which is a very higher ratio.

 The Centres for Disease Control and Prevention estimates that there are 1.7
million infections resulting in approximately 99,000 deaths annually in the United
States, making healthcare-associated infections the fourth leading cause of death.
1.3 HYPOTHESIS
Hygiene can be maintained in the hospital through architectural design and detail.
1.4 OBJECTIVES
1.4.1 To study the concept of hygiene.

1.4.2 To study introduction to hospitals architectural design.
1.4.3 To study the different architectural details in the hospital.
1.4.4 To study the parameters to control hygiene in the hospital.
1.4.5 To study and analyse the case examples on the basis of the derived parameters
1.5 SCOPE AND LIMITATION

 The research lays emphasis on the study of hygiene maintenance in more than
100 bedded hospitals.
 The study will be limited to only two controlling measures which are environmental
control and respiratory protection measures (i.e. Architectural design and Detail).

1.6 METHODOLOGY
Selection of topic
Need to study Introduction to topic
Formulation of aims and objectives
Scope and Limitations

Objectives and Scope
To study the concept of hygiene
- Personal - Book
Observations
Data Collection
- Case Studies -- Online Data
Data Identification and Collection
Synthesis of data
Analysis of data and case studies

Data synthesis and analysis
Conclusions and Recommendations

CHAPTER 2 - HOSPITAL HYGIENE
 INTRODUCTION TO THE HOSPITAL HYGIENE

 MODE OF TRANSMISSION OF INFECTION
 GENERAL MEASURES OF INFECTION CONTROL

2.1 HOSPITAL HYGIENE

Hospital acquired infections (HAIs) is a major safety concern for both health care
providers and the patients. Management of health-care and waste disposal is an integral
part of hospital hygiene and infection control. Health-care waste should be considered as
a reservoir of pathogenic microorganisms and bacteria, which can cause contamination
and give rise to infection. If waste is inadequately managed or proper measure are
avoided, then these microorganisms can be transmitted by direct contact, in the air, or by
a variety of vectors. Infectious waste contributes in this way to the risk of nosocomial
infections, putting the health of hospital personnel, and patients, at risk.
The principles of the grading of recommendations assessment, development and

evaluation (GRADE) system is used to guide assessment of quality of evidence from high
(A) to very low (C) and to determine the strength of recommendations. Each
recommendation is categorized on the basis of existing scientific data, theoretical
rationale, applicability and economic impact. The grade system classifies the distribution
of hygiene level on the basis GRADE 1 (Strong ) and GRADE 2( Weak ).
2.2 MODE OF TRANSMISSION OF INFECTION

 Microorganisms can be
transmitted from their source of
origin to a new host through direct
or indirect contact, in the air, or by
vectors.
Figure 3 Transmission of infection
 In Vector-borne transmission is typical in which insects, arthropods, and other

parasites are widespread. These become contaminated by contact with excreta
or secretions from an infected patient and transmit the infection to other patients.

 Airborne transmission occurs only with microorganisms that are dispersed into
the air and characterized as a result of low minimal infective dose. These are
dispersed in large numbers only as a result of sneezing or coughing.
 Direct contact between patients does not usually occur in health-care facilities,
but the infection can be transferred from an infected health care worker directly
transmit a large number of microorganisms to the new host.
 The most frequent route of transmission, however, is indirect contact (when a
infected patient touches a surface air a equipment and if that medium comes in
contact with the another individuals who may then develop an infection.)
 During general care and/or medical treatment, the hands of health-care workers
often come into close contact with patients, which can also be the reason for the
transfer of the infection.
2.3 GENERAL MEASURES OF INFECTION CONTROL

2.3.1 ISOLATION
 The first essential measure in preventing the spread of nosocomial infections is
isolation of infected patients.
 Isolation of any degree labour-intensive, and usually inconvenient or
uncomfortable for both patients and health-care personnel as this can result in
transmission of infection.
2.3.2 PRINCIPLE
Two basic principles that govern the main measures that should be taken in order to
prevent the spread of nosocomial infections in health-care facilities are :
 Separate the infection source from the rest of the hospital;
 Cut off any route of transmission.
The separation of the source has to be interpreted in a broad sense. It includes not only
the isolation of infected patients but also all “aseptic techniques”—the measures that are
intended to create a barrier between the different users by dividing and connecting the
zones in the most adaptable situation.
2.3.3 CLEANING
 One of the most basic measures for the maintenance of hygiene, and one that is
particularly important in the hospital environment, is cleaning. It is essentially a
mechanical process, which includes the removal of visible dirt physically.

 Soaps and detergents act as solubility promoting agents. The microbiological

effect of cleaning is also essentially mechanical: bacteria and other
microorganisms are suspended in the cleaning fluid and removed from the
surface. The efficacy of the cleaning process depends completely on this
mechanical action, since neither soap nor detergents possess any antimicrobial
activity. Thorough cleaning will remove more than 90% of microorganisms.
 The careless and superficial cleaning is much less effective; it is even possible
that it has a negative effect, by dispersing the microorganisms over a greater
surface and increasing the chance that they may contaminate other objects.
2.3.4 STERILIZATION
 An object should be sterile, i.e. free of microorganisms, after sterilization.

However, sterilization is never absolute, it effects a reduction in the number of
microorganisms by a factor of more than 106 (i.e. more than 99.9999% are killed).
 It is therefore important to minimize the level of contamination of the material to be
sterilized. This is done by sterilizing only objects that are clean (free of visible dirt)
and applying the principles of good manufacturing practice.
 Sterilization can be achieved by both physical and chemical means. Physical
methods are based on the action of heat (autoclaving, dry thermal or wet thermal
sterilization), on irradiation (g-irradiation), or on mechanical separation by filtration.

CHAPTER 3 - INTRODUCTION TO
HOSPITAL DESIGN
 INTRODUCTION TO THE HOSPITAL ZONES

 STUDY OF HOSPITAL ZONES AND THEIR SUBZONES

3.1 INTRODUCTION TO HOSPITAL DESIGN
Hospital is the most complex of building types. Each hospital is comprised of a wide
range of services and functional units. These include diagnostics, treatment rooms and
surgical areas, hospitals functions such as food services and housekeeping and
fundamentals impatient care or bed related functions.
The health services - including public and private hospital services- must meet quality
standards (ISO 9000 and ISO 14000 series). So in order to meet the needs for a well
maintained hygiene controlled environment for a hospital building one need to follow
these standards.
Some considerations which will usually be included in order to plan a hygienic
environment for hospitals are –
 Traffic flow to minimize exposure of high risk patients and facilitate patient
transport.
 Materials that can be adequately cleaned.
 Adequate spatial separation of patients. Adequate number and type of isolation
rooms.
 Appropriate access to handwashing facilities.
 Appropriate ventilation for isolation rooms and special patient care areas
(operating theatres, transplant units).
 Preventing patient exposures to fungal spores with renovations.
Now we will be discussing on the different zones of the hospitals -
Figure 4 : Hospital zones

Zone Functions
Main Entrance
o Entrance lobby
 Trolley park
 General waiting
 Public utilities
o Reception
o pharmacy
OPD/Emergency Entrance
o Entrance Lobby( Trolley bay,General waiting, Public utilities
Entrance o Reception
Zone  Enquiry counter
 Admission/discharge
 Cash counter
 Queuing track
 Staff accommodation
o Arcade ( Gift, book shop, Snack counter)
o Security & Ambulance station
Service/Staff Entrance
o Central receipt/inspection
o Staff Utilities
 Lockers
 Change rooms
 Time keeping
o Consultation rooms (general clinics-2, medical-2, surgical-2,
ophthalmic, ENT, dental, OBS and gynac-2, paediatric,
orthopaedics, dermatologist)
o (consultation room with attached Toilets and examination room,
sub waiting)
Ambulatory o Nursing station
care area o (Nurses desk, clean utility, dirty utility)
o Treatment rooms, injection & dressing room, emergency O.T.
o Casualty/ Emergency
o (reception and record, emergency lab, nurses desk, emergency
beds-3, observation beds-3)
o Public utilities
o Pathology laboratory
(sample collection, record, pathologist room, bleeding room,
Diagnostic storage, sub waiting,)
Zone o Imaging
(radiology, ultrasound),
Preparation room ,change room, toilet, control, dark room,
o Sub waiting, public utilities
o Blood bank( sub waiting, bleeding room, refreshment / donor’s
rest room)

Zone Functions
o Nursing station
Intermediate o (Nurse desk, clean utility, dirty utility, pantry, store, trolly bay)
Zone o General ward-3, maternity ward-1, paediatric ward-1, 10
(inpatient private rooms
Nursing units) o Ancillary rooms (Doctor’s rest room, Nurses duty room)
o Visitors rest room
o Patient area (preparation, pre anaesthesia, post-operative ,

Critical zone ICU -4)
(operational o Staff area (changing resting)
Theatres/labour o Supplies area (trolley bay, equipment storage, sterile storage)
room o OT/ LR area
o (operating/labour room, scrub, instrument sterilization,
disposal)
o C.S.S.D, laundry, building maintenance, kitchen, medical and

Service zone general store, water supply, drainage and sanitation, space for
other services like medical gases, fire protection, waste
disposal, electrical, mechanical
o Administration (general, hospital, nursing, security, transport,

Administrative housekeeping, conference room, record room).
zone
Figure 5 Hospital major zones and subzones

CHAPTER 4 – PARAMETERS TO CONTROL

HYGIENE
 PARAMETERS TO CONTROL HYGIENE

 ARCHITECTURAL SEGREGATION
 CIRCULATION /TRAFFIC CONTROL
 ARCHITECTURAL DETAIL
 STUDY OF DIFFERENT ZONES ON THE BASIS OF

PARAMETERS.

4.1 PARAMETERS TO CONTROL

HYGIENE
In order to maintain to the hygiene in the
hospital three major parameter this helps to
maintain the areas germ free and hygienic
are-
 Architectural segregation
 Circulation
 Architectural details
Figure 6 Parameters to control hygiene
4.1.1 ARCHITECTURAL ZONING
It is useful to stratify patient care areas by risk of the patient population for acquisition of
infection for some unit, including oncology neonatology, intensive care unit special
ventilation and other facilities is required. Accordingly each area shares its own hygiene
level and that is needed to be maintained according to its requirement.
There are five degree of risk according to which hygiene level can be distributed –
Figure 7 Hygiene zoning (WHO standards)

4.2.2 TRAFFIC FLOW /CIRCULATION
A room or space, whatever its purpose, is never completely separate. A distinction can
be made between high traffic and low traffic areas. One ca consider general services (
food and laundry , sterile equipment , and pharmaceutical distribution ), specialized
services and other areas .a hospital with well-defined areas for specific activities can be
described using flowcharts depicting the flow of in - and out patients ,visitors , health care
workers , supplies , as well as the flow of air , liquid and waste . Some other traffic
patterns can also be identified.
Figure 8 : User zoning

4.2.3 ARCHITECTURAL DETAIL AND MATERIAL
The choice of construction material - especially those considered in the covering of

internal surfaces is very important. Floor coverings must be easy to clean and resistant to
disinfection procedure This also applies to all item in the patient environment. Some of
the features in the hospital that includes details are –
 Walls and ceiling should be fire proof

stain resistant and joint less to avoid the
dust particles to be settled.
 Floors should be smooth and non-slip.
They should be easy to clean and
resistant to disinfection procedure
Figure 9 Hospital floor and walls tiles
Figure4. 1

 Incineration plants for the waste
disposal (to dispose of the infected organs
and body part generated after surgeries and
operation.)
Figure 10 Incineration Plant
 Separately designed HVAC and air

circulation system for different zones,
according to their rate of air change
and temperature requirement.
Figure 11: HVAC Plant
 The operation theatres is the most sterile

zone in the hospital and even most prone to
bacteria’s and infection growth ,hence in order
to keep the air clean and hygienic new system
of air filtration are used which have greater rate
of air exchange and transfer the most filtered air
inside the zone.( laminar air filtration systems ).
Figure 12 Laminar air filtration system

4.3 STUDY OF ZONES ON THE BASIS OF PARAMETERS
4.3.1 OPD AND ENTRANCE ZONE
An outpatient department provided primary as well as comprehensive healthcare for

patients who come for diagnostics, treatment or follow up care. It is the first contact
between a hospital and the patients. An OPD is therefore appropriately called the ‘shop
window’ of a hospital.
Figure 13 : OPD Layout
1. ARCHITECTURAL SEGREGATION
The OPD includes three zones that is public zone, joint use zones and staff
zones–
 Public zones are basically includes the main entrance ,foyer ,bays ,public
conveniences ,cash counter , registration counter and other spaces where
the relation with public is set by the hospital staff.
 Joint use zones are the areas which are jointly used by the staff and the
patients such as consultation and examination rooms. A set of minimum
time is prepared for the contact between the staff and the patient, in order
to avoid any kind of infection in the hospital, adopted by the visitor from
outside environment.
2. CIRCULATION AND TRAFFIC FLOW

 The circulation for OPD and emergency should always be different; the two
users should never coincide with each other during their function.

3. ARCHITECTURAL DETAILS
 Floor tile should and stain proof and resistant to any disinfectant applied to
its surface.
 The pressure built inside the toilets is high, so to avoid the flow of air into
other zone.
 Examination rooms are provided with sinks for washing hands.
4.3.2 DIAGNOSTICS
Figure 14 : Diagnostic Layout
 The diagnostic zone should be in connection with all three major zones which are
OPD, IPD and critical zone.
 Areas for public waiting and diagnosis should be properly segregated with barriers
to control the hygiene levels .


 The movement for the OPD,IPD and emergency patient should be separate and
they should set a direct connectivity with diagnostic zones.
 Its traffic comprises of patient and staff.
 The laboratory and diagnostic area should be air lock.
 Chemical resistant and stain resistant material should be used for laboratory
worktops and work station.
 Mechanical ventilation system is required with 10 -15 air changes per hour in
areas where fumes is expected , and 8-10 in other areas.
4.3.3 IPD AND INTERMEDIATE ZONE
Intensive care unit is a dedicated facility for critically ill patients who require invasive life
support, high levels of medical and nursing care and complex treatment . These
speciality units are designed, equipped and staffed to treat critically ill patients those
requiring specialized care and equipment .it has capability of continuous observations of
vital functions of patients and can support these functions more promptly and efficiently.
Figure 15 : IPD Layout

 Proper isolation wards should be provided with ICU for the patients suffering
from any infection.
 IPD area should be placed in minimum distance with the CSSD unit for successful
transferring of sterile equipment to ICU.

 Patient and doctors corridor should be different from hospital corridor (visitor
movement), to control hygiene.
 Visitors should not be allowed inside the IPD area, to maintain its sterility any
inflow of any infection.
 Conventional operating rooms are ventilated with 20 to 25 changes per hour of

high efficiency filtered air delivered in a vertical flow .
 The operating room is usually under positive pressure relative to the surrounding
corridors, to minimize inflow of air into the room.
 Doors should be sliding in OT as they area more user friendly and prevent air
turbulences.
 Walls and ceiling should be non-porous, stain proof and easy to clean, with round
off corners and joints.
 Floors should be smooth, non-slip either inset mosaic with the least possible
number of joints.
4.3.4 CRITICAL ZONE/OT
An OT is that specialized facility of the hospital where lifesaving or life improving

procedures are carried out on the human body by invasive methods under strict aseptic
conditions in a controlled environment by specially trained personnel to promote healing
and cure with maximum safety, comfort and economy.
 The critical zones and OT are the most sterile zone of the hospitals, as it is
functioned with surgical activities .the OT should be in connection with the CSSD

ICU, and have a dirty corridor in order to transfer the waste and dirty equipment
without contaminating the outside environment of hospital corridor.

 The traffic flow for doctor, HCW, and patients are generally planned with barriers
to maintain the sterile environment for OT. After entering the from hospital corridor
there is preparation and changing for doctors and patients, then there is scrub are
to remove the bacteria to enter OT.
Figure 16 Operation Theatre Layout

3. ARCHITECTURAL DETAIL
 Conventional operating rooms are ventilated with 20 to 25 changes per hour of
high efficiency filtered air delivered in a vertical flow.
 The operating rooms are usually under positive pressure relative to the
surrounding corridors, to minimize inflow of air into the room.
 Doors should be sliding in OT as they area more user friendly and prevent air
turbulences.
 Walls and ceiling should be non-porous, stain proof and easy to clean, with round
off corners and joints.
 Floors should be smooth, non-slip either inset mosaic with the least possible
number of joints.

CHAPTER 5 - HOSPITAL CASE STUDIES

 EHCC (ETERNAL HEART CARE CENTRE)
 TAGORE HOSPITAL AND RESEARCH CENTRE
 MAHILA CHIKITSALYA

PARAMETERS OF STUDY
 To study the architectural zoning and segregation of spaces in the hospital.

 To study the traffic flow and the circulation of doctors ,visitors ,patients and HCW
in the hospital
 To study the various detail and architectural features in the hospital used in order
to maintain the hygiene level of different zones.
 To study the system of air circulation in different zones.
 To study the system of waste disposal and its movement.
5.1 ETERNAL HEALTHCARE CENTRE (EHCC)
LOCATION
3A, Near Jawahar circle, Jagatpura road,
Jaipur ,Rajasthan, 302020
Eternal heart care centre is a multi-

specialist hospital which also serves
emergency services and complete
treatment to the critical cases along with
this hospital has a specialized class of
team dealing with cardiology cases .It is a
Figure 17 : EHCC
250 bedded hospital.
ANALYSIS
 The building have separate entrances for the

emergency and the OPD patients, which helps to
divide the traffic and maintain hygiene level of the
zone.
 The laboratory and diagnosis zone is set in direct
connectivity with the OPD users, hence this
restricts their movement to the particular zone.
 Separate zones and corridors area designed for
Figure 18: Emergency
the movement of patients, HCW, Doctors to their
auxiliary and visitors which helps to maintain the hygiene level in the intermediate
zone.
 Patients inside the IPD wards are kept in closed environment. There is no source
of natural light provided inside the wards.
 Walls of IPD are coated with plastic paint (bacteria resistant), which is stain proof
and easy to clean.
 IPD have uniform and smooth tile flooring which is easy to clean and resistant to
any disinfectant.
 Dustbins were placed for any kind of waste disposal inside the ward
WASTE DISPOSAL
Figure 19: Waste disposal ( service floor )
Dustbin were placed in the public zones(cafeteria and waiting areas) .In OPD ,OT , and
IPD a set of three dustbins are placed with three different colours which represents
biological waste , surgical waste ,and dry waste .To maintain the hygiene level in OT the
waste generated after the surgery is transferred through the dirty corridor to the back
station of the hospital where the waste is kept in the separate room according to their
category , and later they are taken to the incineration plant to dispose off.

 The vertical zoning of the building

compliments its ground floor
planning ,and sets a proper
connection with the required
zone.
 The administrative zone has its

separate circulation in the
mezzanine floor which avoids the
collision of the two user groups
throughout the building.
Figure 20 : Ground Floor
AIR CIRCULATION
 The air in each zone of the hospital is controlled by an

air handling unit, which helps to keep the air clean and
germ free.
 In a regular interval of time the rate of air exchange is
different for both the zones ,as the requirement for the
quality of hygiene to be maintained for all the zones is
Figure 22: Service Floor
different. Figure 21: Section
 The water generated from the pump house travels to the

filtration system, which is later send to the air handling
unit , the unit decreases the temperature of the water
and this water travels through the pipes in the IPD and
OPD zones by the help of which cooler air is supplied .
 Fresh air unit are set up for OPD and IPD department to
have a faster system of air exchange in the zones. It is
not a continuous process ,this cycle of air exchange is
practice at a regular interval of time.
Figure 23: Service Floor

OPERATION THEATRE /CRITICAL CARE UNIT
 The floor for the OT was antiskid mating which was resistant to dust
and the liquid compound generated during the surgery process ,and was
resistant to any disinfectants and chemicals .
 The walls are cladded with the aluminium panels which are non-porous
and also we can easily provide the rounded corners along the edge of the
rooms using aluminium.
Figure 24: Mezzanine floor
LAMINAR FLOW HEPA FILTER

 Ventilation and air conditioning systems must ensure that the protection
area near the operating table and the instrument trolley are dynamically
shielded. Filtered and conditioned ultra clean air reduces the number of
airborne micro-organisms and consequently lowers the risk
Of wound contamination.
Figure 25: First floor
 A constant laminar flow ensures that the air above the protection area,
which has been 'contaminated' by the patient and the surgical team, is
displaced. Operating theatres must only be accessed via airlocks; positive
pressure must be maintained such that no pathogens from adjoining areas can
enter. The way to maintain the pressure conditions in the operating theatre is a
laminar flow that causes very little turbulence.
Figure 26: Second floor
Figure 27 : Third floor

5.2 TAGORE HOSPITAL AND RESEARCH CENTRE
LOCATION
Tagore Lane, Sector 7, Shipra Path,

Mansarovar, Jaipur, Rajasthan, 302020
Tagore Hospital & Research Institute is

a State of the art proposed 300 bedded,
super specialty hospital located at
Mansarovar ,Jaipur, India, spread over
more than 12,500 Sq. meter area with
an aim to provide best possible
healthcare solutions. Figure 28: Tagore Hospital
The hospital building has been divided

into four blocks. The central block has a
double height main reception area.
Hospital has four entrances. Main
entrance in the north to reception.
Emergency entrance in the south.
Entrance to path labs is from east.
Entrance to reception is from the west.
ANALYSIS
CSSD block is placed in the basement ,

so in order to transfer the equipment one
need to go floor to floor.
Locker room and dining for HCW is

provided in the lower ground so it affects
the hygiene in hospital.
Figure 29: Basement floor

ANALYSIS
Each level of zone has its separate block

and different entrance, hence dividing its
user and their functions and helps to
maintain the hygiene of a particular zone.
Figure 30: Ground floor
OPD and administration zones are placed at the

same level of floor, which results in interaction of
their users and affects the hygiene level for both the
zones.
Figure 31: First floor
In IPD section, according to the category of

the patients, different blocks are developed
which helps to maintain the hygiene.
Figure 32: Second floor

Operation theatre are placed in direct connection with the IPD ,hence there is direct
movement of patients from OT to IPD after surgery ,without having a movement from a
unhygienic environment and this helps to prevent nosocomial infection in users.
Figure 33: Third and Fourth floor
AIR CIRCULATION
 Fresh air unit are set up for OPD and IPD department to have a faster system of
air exchange in the zones. It is not a continuous process, this cycle of air
exchange is practice at a regular interval of time.
 In operation theatre the three layered laminar flow hepo filter system is used for
cleaner and filtered air to maintain the level of hygiene. A constant laminar flow
ensures that the air above the protection area, which has been 'contaminated' by
the patient and the surgical team, is displaced. Operating theatres must only be
accessed via airlocks; positive pressure must be maintained such that no
pathogens from adjoining areas can enter. The way to maintain the pressure
conditions in the operating theatre is a laminar flow that causes very little
turbulence.

Dustbins were placed in the public zones

(cafeteria and waiting areas) .In OPD, OT, and
IPD a set of three dustbins are placed with
three different colours which represents
biological waste, surgical waste, and dry
waste, which is later send to incineration plant
for disposal.
Figure 34: IPD wards

OPERATION THEATRE
 OT have uniform and smooth tile flooring which was easy to clean .Outer zones of
critical care have marble flooring.
 OT has a lower skirting, due to which there is the possibility of settlement of
bacteria and dust particles.
 OT was provided with the provision to source of natural light as a window which is
generally not required.
Figure 35: Operation Theatre

5.3 MAHILA CHIKITSALAYA
LOCATION
Opposite Sanganeri Gate, Jaipur,
Rajasthan 302004.
Mahila Chikitsalaya is an educational

government hospital established on 1st
March 1987 that provides medical
facilities & create awareness of the
hazards, problems & preventions of
diseases or ailments in women.
Figure 36: Mahila chikitsalaya
Figure 37: Site plan
BLOCK -1 OLD BUILDING
 Old building block includes administration and

record area, general wards (normal delivery
patients), 24 hour free medical store, It even
consist of service area which include oxygen
plant.
Figure 38: Free medicine store

BLOCK 2 – EMERGENCY
 This block consist of emergency and

OPD. On the first floor there is NICU,
medical store, and operation theatre. On
second floor there is caesarean ward.
Figure 39: Emergency
BLOCK 3 -(NEW 100 BED BUILDING BLOCK)
New building block caters 100 bed.

The block is connected with the older
building block .below we describes its
zoning -
The basement of the building is

designed for the parking facility.
On the ground floor the facility for

labour room is provided, the zone is
separately designed for the labour
patients, within the zone u have
consultation service and diagnostic
check-up. Connected to this you
Figure 40: vertical zoning have medical store service.
On the second floor operation theatre is set up which created the direct connectivity with
the IPD zone which is present on the same floor.
On the third floor separate IPD wards for other

patients and private rooms are provided.
ANALYSIS
 OPD and emergency have the same

entrance due to which, the users for the
two zones have to share the same
corridor and the hygiene level is
disturbed.
Figure 41:OPD

 CSSD unit was set up near the critical care

zone and the dirty laundry in transferred from
the lift vertically to the service zone without
degrading the quality of hygiene in public
corridors.
 Their no direct connectivity of OPD patients

from laboratory and diagnosis zone they have
to travel into different block for the services. Figure 42:Critical care unit
 The isolation wards provided for the patients

are placed open to the public corridors.
 In OPD and IPD marble tile flooring is used.

While in OT smooth tile flooring is used which
was easy to clean and stain proof.
Figure 43: Waiting lounge

CHAPTER 6 – ANALYSIS
 ANALYSIS CHARTS OF CASE STUDY PARAMETERS
 ON THE BASIS OF ARCHITECTURAL ZONING

 ON THE BASIS OF CIRCULATION
 ON THE BASIS OF DETAIL,WASTE DISPOSAL AND
AIR CIRCULATION





CHAPTER 7 - CONCLUSION AND

RECOMMENDATIONS

7.1 CONCLUSION
On the basis of the parameters derived for the maintenance of hygiene in the hospital,
each parameters provides us with the following conclusion -
PARAMETERS CONCLUSION
 Architectural segregation Each area is segregated on the level of risk of

the patient’s population of acquisition of infection,
and this segregation helps to maintain the level of
hygiene in different zones.
 Circulation / Traffic Flow Each zone can never be placed completely

separate; it is always accompanied by the
circulation of people. Therefore to avoid the
transmission of infection from user of one zone to
other, control on the traffic flow is required.
 Architectural Details Architectural details in different zones help to

maintain the quality of hygiene, and prevents in
creating any living conditions for bacteria which
can results in transmission of any kind of
nosocomial infection.
 Waste Disposal The disposal and the process of transferring the

waste, affects the quality of air in the
environment, and the quality of hygiene.
 Air Circulation With the continuous operations and activities in

different zones , the quality of air gets degrades
and requires a durational change in order to
maintain the level of hygiene.
Figure 44: Conclusion
Hence, all these parameters are required to be taken into the consideration, as they
affect and helps to maintain the level of hygiene in the hospital.

7.2 RECOMMENDATIONS
 At the stage of planning one should consider the placement of zones and the
circulation of users for the maintenance of the quality of hygiene levels.
 At the time of planning a particular zone different architectural detail should be
taken into the consideration as per the zone requirement to maintain the quality of
hygiene.
 Proper provision for the system of waste disposal should be proposed.
 In order to maintain the quality of air, the provision for a air filtration system should
be given as it is a more adaptable method for a clean and germ free air in a
building .

BIBLIOGRAPHY
Books
IPHD ( indian public health standard )
Step by Step hospital design and planning ,(narendra manhotra )
Modern trends in hospital design , ( jp publication )
Web References
http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf
http://www.who.int/water_sanitation_health/medicalwaste/148to158.pdf
http://clinicalestablishments.nic.in/WriteReadData/776.pdf
http://www.airepure.com.au
http://www.vezzaniforni.it
http://www.eforenergy.com

Ajay Walia

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DISSERTATION

HYGIENE IN HOSPITAL DESIGN

Prof. PUSHPAK BHAGWATI Prof. N.S.RATHORE

Aayojan School of Architecture

Prof. K.S. MAHAJANI

Prof. N.S. RATHORE

Prof. Pushpak Bhagwati

I feel indebted to have the opportunity to express my gratitude to

I extend my gratitude to PROFESSOR ARCHANA RATHORE for her invaluable guidance

CHAPTER 1: INTRODUCTION 1-5

CHAPTER 4: PARAMETERS TO CONTROL HYGIENE 14-23

CHAPTER 7: CONCLUSIONS & RECOMMENDATIONS 41-43

Figure 20 Ground Floor Hospital administration 27

 NEED AND CRITERIA OF SELECTION

 SCOPE AND LIMITATION

HYGIENE IN HOSPITAL DESIGN 1

1.1 BACKGROUND OF THE STUDY

An infection in a hospital which leads to improper hygiene generally occur through -

Figure 1 :Mode of transmission of infection

HYGIENE IN HOSPITAL DESIGN 2

Figure 2: Measures of hygiene control

1.2 NEED AND CRITERIA OF SELECTION

HYGIENE IN HOSPITAL DESIGN 3

1.4.1 To study the concept of hygiene.

1.5 SCOPE AND LIMITATION

HYGIENE IN HOSPITAL DESIGN 4

Need to study Introduction to topic

Formulation of aims and objectives

Scope and Limitations

To study the concept of hygiene

Data Identification and Collection

Analysis of data and case studies

Conclusions and Recommendations

HYGIENE IN HOSPITAL DESIGN 5

CHAPTER 2 - HOSPITAL HYGIENE

 INTRODUCTION TO THE HOSPITAL HYGIENE

HYGIENE IN HOSPITAL DESIGN 6

2.1 HOSPITAL HYGIENE

The principles of the grading of recommendations assessment, development and

2.2 MODE OF TRANSMISSION OF INFECTION

Figure 3 Transmission of infection

 In Vector-borne transmission is typical in which insects, arthropods, and other

HYGIENE IN HOSPITAL DESIGN 7

2.3 GENERAL MEASURES OF INFECTION CONTROL

HYGIENE IN HOSPITAL DESIGN 8

 Soaps and detergents act as solubility promoting agents. The microbiological

 An object should be sterile, i.e. free of microorganisms, after sterilization.

HYGIENE IN HOSPITAL DESIGN 9

 INTRODUCTION TO THE HOSPITAL ZONES

HYGIENE IN HOSPITAL DESIGN 10

3.1 INTRODUCTION TO HOSPITAL DESIGN

Now we will be discussing on the different zones of the hospitals -

Figure 4 : Hospital zones

HYGIENE IN HOSPITAL DESIGN 11

HYGIENE IN HOSPITAL DESIGN 12

o Patient area (preparation, pre anaesthesia, post-operative ,

o C.S.S.D, laundry, building maintenance, kitchen, medical and

o Administration (general, hospital, nursing, security, transport,

Figure 5 Hospital major zones and subzones

HYGIENE IN HOSPITAL DESIGN 13

CHAPTER 4 – PARAMETERS TO CONTROL

 PARAMETERS TO CONTROL HYGIENE

 STUDY OF DIFFERENT ZONES ON THE BASIS OF

HYGIENE IN HOSPITAL DESIGN 14