Hygienic Requirements for Lay-out of Hospital Site

· The hospital site should be of a rectangular form with a ratio of sides as 1:2 or 3:4 for convenience of functional zones.

· The density of building at hospital site should not exceed 15 %. Green plants should occupy not less than 60 % of the site area. Along the perimeter a protective green hedge not less than 15 meters wide is planted.

 

The functional zones of hospital site are as follows:

· Zone of medical buildings (infectious and non-infectious). The infectious department is located in depth of the site.

· The gardening zone - includes green plantings along the perimeter of site, among buildings.

· Zone of pathoanatomical department should be located beyond the sight from windows of medical buildings.

· Zone of polyclinic. The polyclinic should be located at a distance of 30-50 m from medical buildings and have a separate entrance, or be as close as possible to the main entrance to the hospital site (prevention of visitors to polyclinic from intrahospital infections).

· The economic zone is located at a distance of 30-40 meters from other zones. Here the central boiler-house, laundry with desinfection chamber, warehouse premises, garage, kitchen are placed.

 

 

Plan of hospital plot

 

Green zone

Pathoanatomical zone

     

Economic zone (garage)

                                                                                                                                   

 

 

Hospital section (25 beds)

balcony	bbuffet	W        A            R            D           S								physician room
		3-4 beds	3-4 beds	3-4 beds	3-4 beds	3-4 beds	3-4 beds	1-2 beds	1-2 beds

Post of nurse on duty

                                                  corridor

               

Material room

Bath-room

Hostess nurse room

Treatment room

nurses room

isolation ward

           

 

 

Narcosis room 20 м^2

2, 8 м                                         corridor

Preoperative room 15 м^2

sterilizating room 10 м^2

Operating room                       36м^2

surgical block’s   scheme

 

 

Nurses’ assistants Room 10 м^2	Nurses Room 10 м^2	Room for manager of surgical block’s 10 м^2	Cloakroom for patients 10 м^2	Cloakroom for doctors 10 м^2	Material room 10 м^2	Toilet 10 м^2
- exit

 

    Box (22 m²⁾  for 1 patient and half-box.

	corridor

Sanitary room

sluice

Hospital ward

Sanitary room

sluice

Hospital ward

                                                                                                                                             

 

                                                          5

 

 

1 - bed; 2 - table; 3-chair; 4- rack for doctor’s overall; 5-wash-hand-stand;

6-bath, 7-toilet

- ventilation          

 

        window for food        

            

          exit                                    

 

The Systems of Hospital Construction

Historical types of hospital construction are as follows:

· In the 17-18th centuries a barrack type of hospital construction was applied (one big room for all patients), then a corridor-barrack type was used when big wards are connected by corridor – the conditions for patients and personnel were very bad.

· A hutment type was for the first time in the world applied by N. I. Pirogov in the Crimea in 1855-1856 during the Russia-England-France-Turkey war. After operations patients stayed in one wooden barrack for a while, then they were moved to another barrack, and the former one was burnt. It gave the possibility to decrease the number of postoperative infectious complications.

· A pavilion type was applied at the end of 19th-beginning of 20th century. It consisted in construction of separate premises in a park with wards having good airing and illumination.

 

The modern types of hospital construction have the following features:

v The decentralized system is characterized by presence of several, usually one- or two-storey buildings, each of them being used for one type of department, e.g. surgical, therapeutic, etc. In some hospital buildings the general diagnostic, economic and additional services, hospital authorities, polyclinic are located.

The advantages of this system are: good conditions for prevention of intrahospital infections (isolation of each department of hospital in separate building), easy access for patients to hospital garden, where they can be in the open air in good weather and get a daily dose of UV irradiation.

Disadvantages of this system are as follows: it requires a very big area for hospital site, the construction of lots of one-floor buildings is very expensive, it is difficult for personnel to transport patients to different diagnostic departments (especially in bad weather), to supply departments with medicaments, food, etc.

This system is now applied at construction of sanatoria and while building hospitals in mountain districts.

v The centralized system is characterized by location of all medical departments, polyclinic, administrative offices (apart from pathological anatomical and economic departments) in one multi-storey building. For example, for a 900-cot hospital a 15-storey building is necessary. The advantages and disadvantages of this system as compared to decentralized system are: in such hospitals there is a high level of intrahospital infection and it is very difficult to fight against it at such system of hospital building).

v The mixed system of building is characterized by tendency to decrease the number of medical buildings up to 2-4, centralization of hospital medical-diagnostic and additional services. The infectious, children's, radiological departments and polyclinic are placed in separate buildings. Thus, on hospital site there are some low and multi-storey buildings.

v The centralized-block system in modern conditions is the most appropriate to large hospitals. The basic feature of centralized-block system is division of all premises of hospital complex into two groups for the best maintenance of medical-protective regimen in hospital:

Ø premises for long-term, stable operation, including medical buildings with ward sections of any structure.

Ø premises which functional purpose demands regular updating of equipment, reconstruction or decoration which realization should not stop the work of hospital complex as a whole, namely the surgery block, premises for functional diagnostics, diagnostic laboratories, physiotherapeutic departments, polyclinic, etc.

Hygienic Requirements to the Ward Section

The basic functional unit of any hospital department is a ward section for 25–30 cots, in some specialized departments (resuscitation unit) it is less. The number of ward sections in the department is determined by number of cots in it. If a department is planned for 30 cots, it has one ward section.

The basic premises of ward section are: wards, doctor’s consulting room, room for patients’ examination, buffet, lavatory, dining-hall, material facilities. There should be two 1-bedded wards (an isolation ward - for infectious patients and a ward for agonizing patients).

Hygienic Requirements to a Hospital Ward

The capacity of ward for adults and children elder than one year in hospitals should be not more than 4 cots. This parameter is optimal both in technological and in hygienic relations.

The area of ward should be 7 m2 per cot, the area in the ward of intensive therapy - 13 m2 per cot.

The microclimate in a ward should correspond to the main standards for living quarters: temperature is 18-22ºC, relative humidity - 40-60%, speed of air movement – 0.2-0.4 m/sec.

Ventilation: СО2 content – 0.1 %, frequency rate of ventilation - 2-3, volume of ventilation - 20-80 m3/hour/cot.

Natural illumination: light coefficient (LC) 1:5 – 1:6, coefficient of natural illumination (CNI) -1%. Artificial illumination: general illumination in a ward is not less than 50 lux, local -100 lux, tell-tale light (at night at exit) - 3 lux.

The distance between beds is not less than 0.8-1m, and between beds and external walls is not closer than 0.9-1 m.

The maximal permissible level of noise in a ward is 25 decibel.

Hygienic Requirements to a Surgery Unit

At designing large modern multifield hospitals it is expedient to unite several operating rooms in a uniform complex, which should have two departments: septic and aseptic with operational, auxiliary and office rooms.

The structure of a surgery unit should include an operational, preoperational, sterilization, anesthetic room, premises for storing blood and portable equipment, rooms for surgeons and scrub nurses.

A surgery unit is divided into 4 zones according to degree of sterility:

· sterile (operational) zone;

· zone of strict regimen (sanitary inspection room for personnel, sterilization room);

· zone of limited regimen (washing chamber, rooms for personnel);

· zone of common hospital regimen (office of a surgery unit head, etc.).

Hygienic Requirements to an Operating Room