Ajay Draftaa PDF

AAYOJAN SCHOOL OF ARCHITECTURE
CHAPTER 1 - INTRODUCTION
 BACKGROUNG OF THE STUDY
 NEED AND CRITERIA OF SELECTION
 HYPOTHESIS
 OBJECTIVES
 SCOPE AND LIMITATION
 METHODOLOGY
HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 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 a hospital or other health care facility in whom the
infection was not present or incubating at the time of admission. This includes infections
acquired in the hospital but appearing after discharge, and also occupational infections
among staff of the facility.
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 performed for the preservation of health .According to the
world health organisation (WHO), Hygiene refers to conditions and practices that helps to
maintain health and prevent the spread of diseases.

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 related to

hospital care.
 Hospital Acquired Infections kill more people than breast cancer, AIDS, and
automobile accidents combined.
 It is well established that the hands of HCWs are the principal cause of
transmission of infection from patient to patient.
 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.
 This death rate from nosocomial infections equals a 9/11 every eleven days.
 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.
 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.
 In the US, approximately 18,650 persons die during a hospital stay related to
serious MRSA infections annually.

 The Centres for Disease Control and Prevention estimates 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.
 There has been a 20 percent decrease in infections related to the 10 surgical
procedures tracked in the CDC Progress Report between 2008 and 2012.
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 hospital.
 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 parameters to control hygiene in hospital
- 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

CHAPTOR 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, 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
recommendations as strong (grade 1) or weak (grade 2).
2.2 MODE OF TRANSMISSION OF INFECTION

Microorganisms can be transmitted from their source to a new host through direct or
indirect contact, in the air, or by vectors.
Vector-borne transmission is typical of countries 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 infective organisms mechanically to
other patients.
Airborne transmission occurs only with microorganisms that are dispersed into the air
and that are characterized by a low minimal infective dose. Only a few bacteria and
viruses are present in expired air, and 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 an
infected health-care worker can touch a patient and directly transmit a large number of
microorganisms to the new host.

The most frequent route of transmission, however, is indirect contact. The infected
patient touches—and contaminates—an object, an instrument, or a surface. Subsequent
contact between that item and another patient is likely to contaminate the second
individual 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. The hands of the clinical personnel are thus the
most frequent vehicles for nosocomial infections. Transmission by this route is much
more common than vector borne or airborne transmission or other forms of direct or
indirect contact.
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. The term isolation covers a broad domain of measures. The strictest
form of isolation is applied in case of very infectious diseases (e.g. haemorrhagic fever,
diphtheria); less stringent precautions can be taken in case of diseases such as
tuberculosis, other respiratory infections, and infectious diarrhoea. Isolation of any degree
is expensive, labour-intensive, and usually inconvenient or uncomfortable for both
patients and health-care personnel; its implementation should therefore be adapted to the
severity of the disease and to the causative agent.
2.3.2 PRINCIPLE
Two basic principles govern the main measures that should be taken in order to prevent
the spread of nosocomial infections in health-care facilities:
 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 act as a barrier between infected or potentially contaminated tissue and the
environment, including other patients and personnel.

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. The principal aim of
cleaning is to remove visible dirt. It is essentially a mechanical process: the dirt is
dissolved by water, diluted until it is no longer visible, and rinsed off. 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. However, 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.
Cleaning has therefore to be carried out in a standardized manner or, better, by
automated means that will guarantee an adequate level of cleanliness.
2.3.4 STERILIZATION
Self-evidently, an object should be sterile, i.e. free of microorganisms, after sterilization.

However, sterilization is never absolute; by definition, it effects a reduction in the number
of microorganisms by a factor of more than 106 (i.e. more than 99.9999% are killed).
Standard reference works, such as pharmacopoeias, often state that no more than one
out of 1000000 sterilized items may still bear microorganisms. 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. Chemical means include gas sterilization with ethylene oxide or other gases,
and immersion in a disinfectant solution with sterilizing properties (e.g. glutaraldehyde).

2.3.5 DISINFECTION
The term disinfection is difficult to define, as the activity of a disinfectant process can vary
widely. The guidelines of the Canters for Disease Control (Garner & Favero, 1986) allow
the following distinction to be made: • High-level disinfection: can be expected to destroy
all microorganisms, with the exception of large numbers of bacterial spores. •
Intermediate disinfection: inactivates Mycobacterium tuberculosis, vegetative bacteria,
most viruses, and most fungi; does not necessarily kill bacterial spores. • Low-level
disinfection: can kill most bacteria, some viruses, and some fungi; cannot be relied on to
kill resistant microorganisms such as tubercle bacilli or bacterial spores. There is no ideal
disinfectant and the best compromise should be chosen according to the situation. A
disinfectant solution is considered appropriate when the compromise between the
antimicrobial activity and the toxicity of the product is satisfactory for the given
application. Another consideration may well be the cost. The more active disinfectants
are automatically the more toxic ones; potentially toxic products can be applied to
inanimate objects or surfaces, whereas for disinfection of human tissues only the less
toxic disinfectants can be considered. For antisepsis, different disinfectants are used for
application to the intact skin (e.g. alcoholic solutions) and to mucous membranes or
wounds (only aqueous solutions of non-toxic substances). Cost is a less important
consideration for an antiseptic than for a disinfectant. The principal requirements for a
good antiseptic are absence of toxicity and rapid and adequate activity on both the
natural flora and, especially, pathogenic bacteria and other microorganisms after a very
short exposure time. Essential requirements for a disinfectant are somewhat different:
there must be adequate activity against bacteria, fungi, and viruses that may be present
in large numbers and protected by dirt or organic matter. In addition, since disinfectants
are applied in large quantities, they should be of low ecotoxicity. In general, use of the
chosen disinfectant, at the appropriate concentration and for the appropriate time, should
kill pathogenic microorganisms, rendering an object safe for use in a patient, or human
tissue free of pathogens to exclude cross-contamination.

CHAPTOR 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 3. 1: Hospital zone

Source: Indian public health standards

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
Table 3. 1 Hospital major zones and sub zones

Source : Indian public health standards

CHAPTOR 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 4. 1: Parameters
4.1.1 ARCHITECTURAL ZONING Source : WHO
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 4. 2 Hygiene Zoning

Source : By Author

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 4. 3 User Zoning

Source : By Author

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
Figure4. 1

 Incineration plants for the waste
disposal (to dispose of the infected organs
and body part generated after surgeries and
operation.)
 Separately designed HVAC and air

circulation system for different zones,
according to their rate of air change
and temperature requirement.
 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 filteration systems ).

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 3. 4 : OPD Layout

Source : By Author
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 3. 5 Diagnostics Layout

Source: By Author
 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 3. 6 : IPD Layout

Source : By Author

 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 3. 7 Critical Zone Layout

Source : By Author
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.

CHAPTOR 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
250 bedded hospital.
Figure 4.1. 1 EHCC
Source : By Author
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 4.1. 1: Emergency
Source: By Author
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 4.1.2: 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.
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
different.
 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.

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.
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.
 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.

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.
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.

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.
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.
In IPD section, according to the category of the

patients, different blocks are developed which helps
to maintain the hygiene.

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.
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.
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.

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.
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.
To divide the building block and make barriers gates

were used to guide the circulation.

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.
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
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.

 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.
 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.

CHAPTOR 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





CHAPTOR 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
anosocomial 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.
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.

.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 .

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AAYOJAN SCHOOL OF ARCHITECTURE

 NEED AND CRITERIA OF SELECTION

 SCOPE AND LIMITATION

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 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 MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 2

Figure 2: Measures of hygiene control

1.2 NEED AND CRITERIA OF SELECTION

 At any given time, about 1 in every 20 inpatients has an infection related to

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 3

1.4.1 To study the concept of hygiene.

1.5 SCOPE AND LIMITATION

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 4

Need to study Introduction to topic

Formulation of aims and objectives

Scope and Limitations

To study the parameters to control hygiene in hospital

Data Identification and Collection

Analysis of data and case studies

Conclusions and Recommendations

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 5

CHAPTOR 2 - HOSPITAL HYGIENE

 INTRODUCTION TO THE HOSPITAL HYGIENE

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 6

2.1 HOSPITAL HYGIENE

The principles of the grading of recommendations assessment, development and

2.2 MODE OF TRANSMISSION OF INFECTION

Vector-borne transmission is typical of countries in which insects, arthropods, and other

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 7

2.3 GENERAL MEASURES OF INFECTION CONTROL

 Separate the infection source from the rest of the hospital;

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 8

Self-evidently, an object should be sterile, i.e. free of microorganisms, after sterilization.

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 9

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 10

 INTRODUCTION TO THE HOSPITAL ZONES

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 11

3.1 INTRODUCTION TO HOSPITAL DESIGN

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

Figure 3. 1: Hospital zone

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 12

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 13

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,

Table 3. 1 Hospital major zones and sub zones

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 14

CHAPTOR 4 – PARAMETERS TO CONTROL

 PARAMETERS TO CONTROL HYGIENE

 STUDY OF DIFFERENT ZONES ON THE BASIS OF

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 15

4.1 PARAMETERS TO CONTROL

Figure 4. 2 Hygiene Zoning

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 16

4.2.2 TRAFFIC FLOW /CIRCULATION

Figure 4. 3 User Zoning

HYGIENE MAINTAINENCE THROUGH ARCHITECTURAL DESIGN AND DETAIL 17

4.2.3 ARCHITECTURAL DETAIL AND MATERIAL

The choice of construction material - especially those considered in the covering of

 Walls and ceiling should be fire proof

 Separately designed HVAC and air