So basically, a hospital is a place for people who are ill that looked after by nurses and doctors inside. They treat patients according to your budget or to your financial status. Like this quote by Gary Miller, “Hospitals must provide emergency treatment to all who walk through the door, regardless of their citizenship status or ability to pay”. In ancient cultures, religion and medicine were linked. The earliest documented institutions aiming to provide cures were ancient Egyptiantemples.
In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia, functioned as centers of medical advice, prognosis, and healing. The earliest surviving encyclopedia of medicine in Sanskrit is the Carakasamhita (Compendium of Caraka). This text, which describes the building of a hospital is dated by Dominik Wujastyk of the University College London from the period between 100 BCE and CE150. The Romans constructed buildings called valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 B. C., and many were identified by later archeology.
Following First Council of Nicaea in 325 A. D. construction of a hospital in every cathedral town was begun. Called the “Basilias”, the latter resembled a city and included housing for doctors and nurses and separate buildings for various classes of patients. Byzantine hospital staff included the Chief Physician (archiatroi), professional nurses (hypourgoi) and the orderlies (hyperetai). By the twelfth century, Constantinople had two well-organized hospitals, staffed by doctors who were both male and female.
One source indicates the first prominent Islamic hospital was founded inDamascus, Syria in around 707 with assistance from Christians. The public hospital in Baghdad was opened during the Abbasid Caliphate of Harun al-Rashid in the 8th century. The Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 and was simple, but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. The first hospital in Egypt was opened in 872 and thereafter public hospitals sprang up all over the empire from Islamic Spain and the Maghrib to Persia.
The first Islamic psychiatric hospital was built in Baghdad in 705. Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. The first Spanish hospital, founded by the CatholicVisigoth bishop Masona in 580AD at Merida, was a xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia of Merida) as well as a hospital for citizens and local farmers. The hospital’s endowment consisted of farms to feed its patients and guests.
The Ospedale Maggiore, traditionally named Ca’ Granda (i. e. Big House), in Milan, northern Italy, was constructed to house one of the first community hospitals, the largest such undertaking of the fifteenth century. Commissioned by Francesco Sforza in 1456 and designed by Antonio Filarete it is among the first examples of Renaissance architecture in Lombardy. The Normans brought their hospital system along when they conquered England in 1066. The first hospital founded in the Americas was the Hospital San Nicolas de Bari [Calle Hostos] in Santo Domingo, Distrito Nacional Dominican Republic.
Fray Nicolas de Ovando, Spanish governor and colonial administrator from 1502–1509, authorized its construction on December 29, 1503. This hospital apparently incorporated a church. The first phase of its construction was completed in 1519, and it was rebuilt in 1552.  Abandoned in the mid-eighteenth century, the hospital now lies in ruins near the Cathedral in Santo Domingo. Conquistador Hernan Cortes founded the two earliest hospitals in North America: the Immaculate Conception Hospital and the Saint Lazarus Hospital.
The oldest was the Immaculate Conception, now the Hospital de Jesus Nazareno in Mexico City, founded in 1524 to care for the poor. The first hospital north of Mexico was the Hotel-Dieu de Quebec. It was established in New France in 1639 by three Augustinians from l’Hotel-Dieu de Dieppe in France. The project, begun by the niece of Cardinal de Richelieu was granted a royal charter by King Louis XIII and staffed by a colonial physician, Robert Giffard de Moncel. Guy’s Hospital was founded in London in 1724 from a bequest by the wealthy merchant, Thomas Guy.
Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. In the British American colonies the Pennsylvania General Hospital was chartered in Philadelphia in 1751. When the Vienna General Hospital opened in 1784 (instantly becoming the world’s largest hospital), physicians acquired a new facility that gradually developed into the most important research center. During the nineteenth century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef Skoda, Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis.
Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded inVienna, being considered as the birth of specialized medicine. In early 19th century, the Americans gave birth and endured the pain and even the surgery at their home only. Since they belonged to a large rural society, few among them would ever have occasion to visit hospital. Hospitals in United States only exist in institution, especially in almshouses. This was charity’s tradition that the public hospitals first seen in developed cities and in community who’s concerned for the poor who are ill, deprived and disabled.
That day, the numbers of beds are only six in the ward which was founded in 1736 in New York City Almshouse. Today, there were places where the care of strangers grew larger that turned out to be found in municipal instituitions. By the mid-nineteenth century most of Europe and the United States had established a variety of public and private hospital systems. In continental Europe the new hospitals generally were built and run from public funds. The National Health Service, the principle provider of health care in the United Kingdom, was founded in 1948.
II. Presentation of Data A. Safe from Disasters Building Guidelines Mitigation is defined as any sustained action taken to reduce or eliminate long-term risk to life and property from hazard events. The goal is to save lives and reduce property damage in ways that are cost-effective and environmentally sound. Hazard mitigation measures should be integrated into the process of planning and design because they reduce casualties and damage resulting from building failures during hazard events.
The effects of a disaster on a hospital, however, are never restricted to the physical damage or the distress among the staff and patients as a result of such damage. Consequences frequently include partial or total loss of the ability to provide services and meet the demand for health care when it is most needed. Incorporating mitigation measures in the design of hospitals is therefore especially important because they minimize the disruption of hospital operations and protect the uninterrupted provision of critical health services.
Most hospitals plan to “shelter in place” and weather the storms, rather than evacuate. In order to do this, they must take care of their existing patients, many of whom are critically ill, and in addition, be prepared to accommodate the casualties as well as the increased number of outpatients. In order to accomplish this, there are a wide variety of services that must remain functional. Often municipal utility services will be cut off during a disaster, so alternative power, water, and waste disposal services need to be provided onsite whenever possible.
Communication systems are often cut off, so redundancy is a key factor in maintaining links to the outside world as well as internal communications within the hospital. Sheltering in place can be challenging, but in most cases it is the preferred option for most acutely ill patients. * Architectural Components Nonstructural vulnerabilities that can affect hospital functions and the safety of occupants include the potential failures of architectural components, both on the exterior and the interior of buildings.
Damage to roof coverings, facades, or windows can make way for water penetration that can damage sensitive equipment and shut down many hospital functions. When roofing material is disturbed by wind, the roof may start to leak and the moisture can knock out vital equipment, disrupt patient care, and penetrate walls and other concealed spaces, allowing mold to build up over time. Window breakage resulting from high winds, earthquakes, and even flooding frequently requires patient evacuation from affected areas.
Patients in critical care and acute care units are particularly vulnerable because the move separates them from medical gas outlets, monitors, lighting, and other essential support services. Non-load bearing and partition walls and ceilings, for instance, are rarely designed and constructed to the same standards of hazard resistance as the structural elements. Collapse of these components has caused a number of evacuations and closures of hospitals following a hazard event. B. Space requirements 1. Lobby/Entrance/Exit * Hospital facility requires three to four major entrances.
It is determined by adjacencies and traffic flow inside the facility, and in turn will determine traffic flow outside and location of parking lots. By and large the major entrances are: * Main hospital entrance * Outpatient entrance * Emergency and ambulance entrance * Service entrance * Each entrance to the facility will be appropriately identified. * Emergency room entrance signs will be illuminated. * Every exit will be clearly visible or the route to it conspicuously identified, so that every occupant of the building readily knows the direction of escape from all points.
* Main entrance and lobby should be attractive. Should be designed elaborately and elegantly. * Provide four separate entrances to hospital through smaller hospitals: the main hospital entrance, outpatient entrance, emergency entrance and service entrance. This is to control visitors. The main entrance for patients and visitors can also be used by the staff while a separate entrance may be designed for them in larger hospitals. * The service entrance should be adjacent to the kitchen and storage areas which receive bulk of the supplies and possible to service elevator.
There should also be a platform and scale provided in that area. The garbage and other solid wastes are removed from this area also the removal of dead bodies; it should be protected from patients and visitors’ view. Other hospital combined this exit point with emergency entrance for better control. * Separate public door from patient and staff corridors as far as possible. It reduces the staff and patients’ transit time; also it will be in order. Hospitals should be designed in a way that the staffs were patients and visitors can easily orient themselves within the building and go where they want to.
* Staff should pass from the entrance to locker rooms, and then to the place where they punch time cards/swipe i. d cards or signs their attendance before entering their respective work areas. 2. Elevator – Elevators should be located where there is maximum concentration of traffic. Elevator doors should not open to the main lobby, instead to an alcove or side corridor. Two elevators are minimum for any multi-storeyed building, hospitals with more than 250-300 beds are required for three or more. Separate passenger and service elevators is recommended.
The size of the hospital type elevator car should be preferably be 1. 52×2. 28 meters and the door at least 1. 22 meters wide to allow handling of beds and stretchers together with attendants. Facilities classified as healthcare or ambulatory occupancy in which patients are housed on floors other than ground level will have at least one elevator that will accommodate at least one adult size bed. Elevators will be equipped with a telephone or intercommunication system. 3. Stairs/Stairways and Corridors * Bulletin boards or other similar distractions will not be located in or near stairways.
* Corridors and stairways will be kept free of unnecessary obstructions and will not be used as storage space. Nothing should be located in exit corridors. * Corridor widths in outpatient suites and in areas not used for patient transportation on trolleys or stretchers may be reduced to 1. 500m. * Corridor widths of 1. 200m are acceptable where there is no patient transportation requirement and where corridor runs are no longer than 3. 00m, e. g. , corridor spur to a group of offices. * Normally stairways may not be used in handling traffic when there are elevators. At least two stairways leading from the top floor to a ground level.
Located in separate areas of the building and provided with lighted exit signs. A minimum width of 3 feet 8 inches is necessary for handling stretchers in an emergency, as in the evacuation of patients in cases of fire or bomb threat. Stairways should have wide landings for the same purpose. Railings with a height of 3 feet are required for safety of patients. 4. Zoning: The different areas of a hospital shall be grouped according to zones as follows: I. Outer Zone – areas that are immediately accessible to the public: emergency service, outpatient service, and administrative service.
They shall be located near the entrance of the hospital. * Administration Department – The administrative service, particularly admitting office and business office, shall be located near the main entrance of the hospital. Offices for hospital management can be located in private areas. This service should be provided, where possible, in reasonable proximity to the main entrance of the facility and in association with the following functions or activities: * reception, direction and provision of information to visitors and patients; * public waiting area(s);
* public toilet facilities; and * public telephone. In addition, facilities shall be provided to accommodate the following administrative activities: * admission of patients; * private interview space which may include admission procedures; * storage space for wheelchairs, out of the path of normal traffic, but near the entry point; * general and/or individual office accommodation for * appropriate clerical, administrative, medical and nursing * personnel, if required; * storage of office equipment, stationery and supplies; and * multi-purpose conference room.
* Public relations’ major responsibilities in the departments are interpreting, advising, marketing and communicating. To carry out all of these, the director should be fully informed of everything that goes on in the hospital. In short, he should be in the inner circle so that he has direct access to information as to what goes on there. He should be a member of the top management team and should attend meetings of the governing board. * Office of the public relations director should be located in close proximity to the office of the CEO.
Proximity to the CEO’s office is necessary because generally everything that is of significance emanating from the public relations office requires the CEO’s approval. It also helps the public relations director to have personal consultations with the CEO and accomplish things speedily. * General accounting – general and patient accounting functions are integrated with the general ledger.
It gives online access to the hospital’s date and timely reporting. Generates a wide range of financial reports, including balance sheet, operating statements and budget projection. * Medical Records – authorized personnel can have access to all current and historical date.
Medical reporting gives optimal access to information in the desired format. It can stored and sequenced in a variety of ways. They can be generated on a daily, monthly, quarterly, semi-annual and annual basis. Facilities shall be provided for the secure storage and retrieval of patient records. The following functions shall be allowed for: * secure storage of all patient records, including secondary and * clerical and administrative activity associated with medical records management; * review of medical records and report preparation; and * storage of Ledgers, account forms, vouchers etc.
* Toilet and dining – The Administrative and Clerical staff shall have access to toilet and dining facilities which may be shared with other hospital staff. * Clerical – Separate room, or space within the Workroom, shall be provided for routine clerical/administrative procedures. * General and Individual Offices – General and individual offices shall be provided as required for business transactions, records and administrative and professional staff. These shall be separate from public and patient areas with provision for confidentiality of records. Provide enclosed office spaces for administration and consultation.
* Staff Toilet/Lunch Room – A toilet and lunch room shall be provided for staff working outside the operating suite, i. e. Administrative/reception/ pre-operative staff. This may be a shared facility with the remainder of the hospital, if attached. * Payroll – online enquiry access to payroll and related information and management reports. Payroll automation significantly decreases manual work. In addition to standard payroll function, other capabilities are automatically calculating benefit accruals with the ability to post them to the general ledger, integration of payroll and personal data.
* Human resources – information can be used for managing and utilizing personnel more productively and cost effectively. Total enquiry access to employee’s data. * Helps to plan career development and professional growth of employees, to see skills and proficiency levels of employees, levels of formal education, degrees, study leave programmes, in service training etc. * Information on employee’s current and previous jobs with details like salary, experience, etc. * Details of performance evaluations – dates, performance ratings, deficiencies, development programme arranged, etc.
* Salary expense analysis with automatically updated historical payroll data. * Human resource department generated relatively light to moderate traffic within the hospital with respect to the hospital personnel. However, there is heavy traffic from the job applicants. A street level entrance to the department is recommended so that the department is easily accessible to job applicants. Such an arrangement will also eliminate the stream of these applicants merging with and interfering with the regular hospital traffic.
Because of the close working relationship between the director of the human resource department and the CEO under whose direction the former functions, the department should be in the close proximity to the executive suite. It should also be centered in the administrative block with convenient access to payroll records of the financial service unit but adjacent to a waiting area directly accessible from the outside to accommodate job applicants. * Human resources department must be carefully planned and designed since it is here that prospective employees get the first impression of the hospital.
The offices, reception and waiting area, their decor and furnishing should be pleasing. They should project a positive image of the hospital and its philosophy. * Emergency Department – The emergency service shall be located in the ground floor to ensure immediate access. A separate entrance to the emergency room shall be provided. * Out-Patient Department – care was once on the sidelines, and having been originally designed with a limited scope, it offered only basic, minor services. In a significant move all over the world, outpatient care has
changed as a major service encompassing a wide range of treatment, diagnostic tests and minor surgeries, some of which required hospitalization earlier. Some facets of the outpatient department are maintained separately from the inpatient services. Nevertheless, the two should be integrated physically, functionally and from the clinical and administrative points of view. This is because in most cases the patient is studied and given treatment in the outpatient department till he is hospitalized. He is then admitted and cared for as an inpatient until he is referred back to the outpatient department where treatment continues.
Besides, as an outpatient he has his diagnostic tests and procedures In the ancillary and adjunct services, which are integral parts of the hospital. The advantage of treating the patient in the outpatient department is that it eliminates the need for or reduces the length of hospitalization and consequently the cost to the patient. Outpatients may be routed from the registration and medical records to sub-waiting areas and from there to the laboratory, x-ray, pharmacy, special therapeutic and other service areas. Never be routed to pass through inpatient areas.
* Entrance and Reception – This may be a shared facility with the hospital or other specialty departments. * Waiting – May also be shared. * Nurses Office – The need for this space is dependent upon the size of the outpatient service. * Consultation – The type and size of this service is so variable, dependent upon the level of specialization. * Medical Laboratory/Utility Room – The size and type of this facility will be determined by the size of the outpatient service and whether or not shared facilities are available within the hospital proper.
* Staff Room – May be shared with the hospital. * Toilets and Change rooms – May be shared with the hospital. II. Second Zone – areas that receive workload from the outer zone: laboratory, pharmacy, and radiology. They shall be located near the outer zone. * Radiology Department – the width of the corridor in this area can be reduced from 1. 80m where trolley or bed movement is irregular. The ceiling height is 3. 00m. * X-ray room – must be large enough for the equipment. * Must have sufficient space for patient transport (wheel chair, gurney or trolley, etc.
) and for staff to transfer patient to x-ray examination table. * Should have at least one patient change cubicle accessible from outside the room * Must locate the operator’s console where the primary beam will never be directed towards it, but where the patient can be easily observed. * Pharmacy – The size and type of service to be provided in the pharmacy will depend upon the type of drug distribution system used, number of patients to be served, and extent of shared or purchased services. The pharmacy room or suite shall be located for convenient access, staff control, and security.
* Dispensing – Area for review and recording of orders. * Manufacturing – Bulk compounding area. Quality control area. * Storage – In the form of cabinets, shelves, and/or separate rooms or closets. * Administration – Separate room or area for office function including desk, filing, communication, and reference. * Cabinet or shelf storage for the drug information retrieval system. * Provisions for patient counseling and instruction (may be in room separate from the pharmacy). * Hand washing facilities shall be provided within each separate room where open medication is handled.
* Laboratory – Specific areas of laboratories have the potential to contaminate air supply systems and these facilities shall be examined for the requirements of controlled air flow and areas from which air should not be re-circulated, or require a high level of filtration before recirculation. Laboratories shall be held at negative pressure with respect to adjacent areas so as to contain odors etc. in the case of spills. It should be conveniently located on the ground floor to serve the outpatient, emergency and admitting departments. It should be close to or easily accessible to surgery, intensive care, radiology and obstetrics.
In the larger hospitals which have a large number of outpatients or when the main laboratory is not within walking distance, there may be a laboratory sub-station in the outpatient department. Similarly. There may be a sub-lab in the operation theatre complex for preparation and examination of frozen sections. * In designing laboratory, the use of modules is recommended both for workstations and for piping layout for essential utility services. For workstations, the modules may be 10 feet by 20 feet with workbenches 12 feet long and 30 inches high. Equipment by and large requires space at the back for air circulation.
This should be borne in mind when determining the depth of workbenches, particularly if there is a wall behind. Modules should be open within sub-divisions and closed between them. Open areas include haematology, urinalyses, bacteriology, serology, pathology-histopathology, sterilization, glass washing, blood bank and offices, chemistry and haematology are usually the largest areas. * The laboratory needs cold, hot, ditilled and deinized water in certain sections. However, it is recommended that distilled water be piped to all sections of the laboratories where water is used. * Organization workflow of laboratory:
* One in procuring specimens and delivering to the laboratory. The outpatients generally go to the laboratory and deliver the specimens themselves. In the case of inpatients, technicians collect blood samples at the bedside and take them to the laboratory. The second aspect is that the tests are performed according to established procedures on the basis of several factors such as the number and types of test ordered, the time they are ordered, the extent of automation of the laboratory, etc. III. Inner Zone – areas that provide nursing care and management of patients: nursing service.
They shall be located in private areas but accessible to guests. * Central Sterilizing Supply Unit – The sterilization process may be carried out entirely or partially on site, the latter relying on an external supply source to regularly restock the hospital sterile goods store. Infection control and good manufacturing principles are to be observed when designing the unit/department. * Receiving and Decontamination – A room shall be provided which shall contain work space and equipment for sorting, decontamination and cleaning medical and surgical equipment and for disposal of used/soiled material.
It shall include hand washing facilities. * Clean Workroom – A room shall be provided which will contain hand washing facilities, work space and equipment for terminal sterilizing of medical and surgical equipment and supplies. Linen folding shall be carried out in a separate room. * Clerical – A separate room, or space within the Workroom, shall be provided for routine clerical/administrative procedures. * Storage (a) A room shall be provided for the storage of processed sterile packs etc. Ventilation, humidity and temperature control is required.
(b) A separate room shall be provided for the storage of ‘clean’ stock (not sterile). (c) Space shall also be provided for the storage of distribution trolleys as required. (d) Facilities shall also be provided in the change room for the storage of caps, overalls and footwear protection. ‘Barrier’ principles are observed when entering the unit. * Nursing Ward * Nurses Station – A nurse’s station shall be provided. The nurses’ station, with space for charting and central monitoring, shall be located so that nurses will be in visual contact with each patient.
In larger units, more than one nurse’s station may be needed to provide for direct observation of all patients. The nurses’ station as a raised dais is recommended. * Nursing service – shall be segregated from public areas. The nurse station shall be located to permit visual observation of patients. Nurse stations shall be provided in all inpatient units of the hospital with a ratio of at least one (1) nurse station for every thirty-five (35) beds. Rooms and wards shall be of sufficient size to allow for work flow and patient movement. Toilets shall be immediately accessible from rooms and wards.
IV. Deep Zone – areas that require asepsis to perform the prescribed services: surgical service, delivery service, nursery, and intensive care. They shall be segregated from the public areas but accessible to the outer, second and inner zones. * Surgery/Maternity Department * Surgical service – shall be located and arranged to prevent non-related traffic. The operating room shall be as remote as practicable from the entrance to provide asepsis. The dressing room shall be located to avoid exposure to dirty areas after changing to surgical garments.
The nurse station shall be located to permit visual observation of patient movement. * Nursery – A room is to be provided for the medical and nursing care of newborn infants where a dedicated maternity or multi-function Nursing Unit is to be established. The following functions are to be allowed for: – resuscitation (oxygen); – ultra violet treatment; – sleeping of babies; – bathing of babies (controlled temperature water); – changing, cleaning and drying of babies; – storage (nappies, towels, creams, powders etc. ); – weighing of babies; – waste disposal (refuse and dirty linen);
– hand washing (separate basin); – bottle feeding of baby (a chair); The room shall be located near to the Nurses Station to enable regular observation by duty staff. A corridor observation window shall be provided. Partial blackout for day-time sleeping shall also be provided. The size and number of the Nursery(s) will be determined by the maximum number of beds in the Nursing Unit(s) to be set aside for maternity use. If the nursing unit is dedicated maternity, with say 30 beds, and a “rooming-in” policy exists, then space for a minimum of 10 basinets shall be provided.
Allow 2. 3m? of floor area per basinet for a general nursery. * Formula Preparation Room – A room is to be provided for preparation and bottling of formula for bottle feeding of infants. The following functions are to be allowed for: – bench level activities involving chemical sterilization of bottles and teats, preparation of milk formulas, demonstrations to mothers on formula preparation and washing of equipment; – storage of sanitized bottles and teats, dry goods and cutlery; – water boiling;
– refrigerated storage of prepared milk acute formula, service areas; and – staff hand washing. The room should be near the Nursery, although where large scale production is necessary, a centralized Formula Preparation Room is acceptable. The Formula Preparation Room cannot form part of the Nursery. The size of the room shall be determined by the size and number of Nurseries. * Observation Windows – To assist staff observation of patients in cubicles or single patient rooms, observation windows, conveniently placed to ensure unobstructed vision from the nurses’ station, shall be provided.
* Patient Privacy – Each patient bed area shall have provision for visual privacy from casual observation by the other patients and visitors. * Nurse Call – A patient activated nurse call facility shall be provided at each bed for summoning assistance. * Staff Assistance – A staff assistance call facility shall be provided at each bed for summoning staff assistance. * Clinical Hand washing – Clinical hand washing facilities, convenient to nurse’s station and patient bed areas, shall be provided.
The ratio of provision shall be one (1) facility for every three (3) patient beds in open plan areas and one (1) in each patient room or cubicle. * Cleaner’s Room – A dedicated cleaner’s room shall be provided. * Bathroom/Mobile Bath – The need to provide a bathroom or a mobile bath should be considered in relation to the policy adopted for the care of burns or other special cases at the particular hospital.
* Visitors’ Gowning Area – An area off the main traffic route may be provided for visitors to gown up prior to accessing the Intensive Care area. Storage provision for gowns, hanging space and disposal facilities are required. The inclusion of the gowning area is dependent upon hospital policy regarding the need for visitors to gown up. * Staff Lounge – A staff lounge shall be provided within the unit for staff relaxation and beverage preparation. Inclusion of a window to the outside is desirabl