A well-designed district hospital plays a crucial role in delivering efficient, safe, and patient-centered healthcare. These hospitals serve as the backbone of healthcare delivery in many regions, especially in rural and semi-urban areas, where they often represent the first point of contact for medical care.

Proper design ensures smoother workflows, minimizes the risk of infections, and enhances the overall patient experience. Additionally, a thoughtfully planned hospital supports staff efficiency, reduces operational costs, and improves response times during emergencies.

Role in Providing Accessible Healthcare Services

District hospitals bridge the gap between primary healthcare centers and specialized medical institutions, making healthcare more accessible to local communities. Strategic location and well-planned infrastructure ensure timely medical attention, particularly for emergencies, maternity care, and infectious diseases.

Furthermore, accessibility features such as ramps, elevators, clear signage, and proximity to public transport enhance inclusivity, ensuring that services cater to people of all abilities.

The term District Hospital is used here to mean a hospital at the secondary referral level responsible for a district of a defined geographical area containing a defined population.

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Grading of District Hospitals

The size of a district hospital is a function of the hospital bed requirement, which in turn is a function of the size of the population it serves. In India the population size of a district varies from 35,000 to 30,00,000 (Census 2001).

Based on the assumptions of the annual rate of admission as 1 per 50 populations and average length of stay in a hospital as 5 days, the number of beds required for a district having a population of 10 lakhs will be around 300 beds.

However, as the population of the district varies a lot, it would be prudent to prescribe norms by grading the size of the hospitals as per the number of beds.

• Grade i : District hospitals norms for 500 beds
• Grade ii : District Hospital norms for 400 beds
• Grade iii : District hospitals norms for 300 beds
• Grade iv : District hospitals norms for 200 beds
• Grade v : District hospitals norms for 100 beds

The disease prevalence in a district varies widely in type and complexities. It is not possible to treat all of them at district hospitals. Some may require the intervention of highly specialist services and use of sophisticated expensive medical equipment. Patients with such diseases can be transferred to tertiary and other specialized hospitals.

A district hospital should however be able to serve 85-95% of the medical needs in the districts. It is expected that the hospital bed occupancy rate should be at least 80%.

Physical Infrastructure for hospital below

1) Size of the hospital

The size of a district hospital is a function of the hospital bed requirement which in turn is a function of the size of the population it serves.

In India the population size of a district varies from 50,000 to 15,00,000. For the purpose of convenience the average size of the district is taken in this document as one million population.

Based on the assumptions of the annual rate of admission as 1 per 50 population and average length of stay in a hospital as 5 days, the number of beds required for a district having a population of 10 lakhs will be as follows:

The total number of admissions per year = 10,00,000 × 1/50 = 20,000
Bed days per year = 20,000 × 5 = 100,000
Total number of beds required when occupancy is 100% = 100000/365 = 275 beds
Total number of beds required when occupancy is 80% = 100000/365 × 80/100 = 220 beds

Requirement of beds in a District Hospital would also be determined by following factors:

• Urban and Rural demographics and likely burden of diseases
• Geographic terrain
• Communication network
• Location of FRUs and Sub-district Hospitals in the area
• Nearest Tertiary care hospital and its distance & travel time
• Facilities in Private and Not-for profit sectors
• Health care facilities for specialised population – Defence, Railways, etc.

2) Area and Space norms of the hospital

i) Land Area (Desirable)

Minimum Land area requirement are as follows:

• Upto 100 beds = 0.25 to 0.5 hectare
• Upto 101 to 200 beds = 0.5 hectare to 1 hectare
• 500 beds and above = 6.5 hectare (4.5 hectare for hospital and 2 hectare for residential)

ii) Size of hospital as per number of Beds

• General Hospital – 80 to 85 sqm per bed to calculate total plinth area. (Desirable).
• Teaching Hospital – 100 to 110 sqm per bed to calculate total plinth area.

The area will include the service areas such as waiting space, entrance hall, registration counter etc. In addition, Hospital Service buildings like Generators, Manifold Rooms, Boilers, Laundry, Kitchen and essential staff residences are required in the Hospital premises. In case of specific requirement of a hospital, flexibility in altering the area be kept.

Following facilities / area may also be considered while planning hospital. (Desirable)

a) Operation Theatre

• One OT for every 50 general in-patient beds
• One OT for every 25 surgical beds.

b) ICU beds = 5 to 10 % of total beds

c) Floor space for each ICU bed = 25 to 30 sq m (this includes support services)

d) Floor space for Paediatric ICU beds = 10 to 12 sq m per bed

e) Floor space for High Dependency Unit (HDU) = 20 to 24 sq m per bed

f) Floor space Hospital beds (General) = 15 to 18 sq m per bed

g) Beds space = 7 sq m per bed.

h) Minimum distance between centres of two beds = 2.5 m (minimum)

i) Clearance at foot end of each bed = 1.2 m (minimum)

j) Minimum area for apertures (windows / Ventilators opening in fresh air) = 20% of the floor area (if on same wall) or 15% of the floor area (if on opposite walls).

3) Site selection criteria

In the case of either site selection or evaluation of adaptability, the following items must be considered:

Physical description of the area which should include bearings, boundaries, topography, surface area, land used in adjoining areas, drainage, soil conditions, limitation of the site that would affect planning, maps of vicinity and landmarks or centers, existing utilities, nearest city, port, airport, railway station, major bus stand, rain fall and data on weather and climate.

Factors to be considered in locating a district hospital

• The location may be near the residential area.
• Too old building may be demolished and new construction done in its place
• It should be free from dangers of flooding; it must not, therefore, be sited at the lowest point of the district.
• It should be in an area free of pollution of any kind including air, noise, water and land pollution.
• It must be serviced by public utilities: water, sewage and storm-water disposal, electricity and telephone. In areas where such utilities are not available, substitutes must be found, such as a deep well for water, generators for electricity and radio communication for telephone.
• Necessary environmental clearance will be taken.

4) Site selection Process

A rational, step-by-step process of site selection occurs only in ideal circumstances. In some cases, the availability of a site outweighs other rational reasons for its selection, and planners and architects are confronted with the job of assessing whether a piece of land is suitable for building a hospital.

In the already existing structures of a district hospital

• It should be examined whether they fit into the design of the recommended structure and if the existing parts can be converted into functional spaces to fit in to the recommended standards.
• If the existing structures are too old to become part of the new hospital, could they be converted to a motor pool, laundry, store or workshop or for any other use of the district hospital.
• If they are too old and dilapidated then they must be demolished. And new construction should be put in place.

5) Hospital Building – Planning and Lay out

Hospital Management Policy should emphasize on hospital buildings with earthquake proof, flood proof and fire protection features.

Infrastructure should be eco-friendly and disabled (physically and visually handicapped) friendly. Local agency Guidelines and By- laws should strictly be followed.

i) Appearance and upkeep

• The hospital should have a high boundary wall with at least two exit gates.
• Building shall be plastered and painted with uniform colour scheme.
• There shall be no unwanted/outdated posters pasted on the walls of building and boundary of the hospital.
• There shall be no outdated/unwanted hoardings in hospital premises.
• There shall be provision of adequate light in the night so hospital is visible from approach road.
• Proper landscaping and maintenance of trees, gardens etc. should be ensured.
• There shall be no encroachment in and around the hospital.

ii) Signage

• The building should have a prominent board displaying the name of the Centre in the local language at the gate and on the building. Signage indicating access to various facilities at strategic points in the Hospital for guidance of the public should be provided. For showing the directions, colour coding may be used.
• Citizen charter shall be displayed at OPD and Entrance in local language including patient rights and responsibilities.
• Hospital lay out with location and name of the facility shall be displayed at the entrance.
• Directional signages for Emergency, all the Departments and utilities shall be displayed appropriately, so that they can be accessed easily.
• Florescent Fire Exit plan shall be displayed at each floor.
• Safety, Hazard and caution signs displayed prominently at relevant places.
• Display of important contacts like higher medical centres, blood banks, fire department, police, and ambulance services available in nearby area.
• Display of mandatory information (under RTI Act, PNDT Act, MTP Act etc.).

iii) General Maintenance

Building should be well maintained with no seepage, cracks in the walls, no broken windows and glass panes.

There should be no growth of algae and mosses on walls etc. Hospital should have anti-skid and non-slippery floors.

iv) Condition of roads, pathways and drains

• Approach road to hospital emergency shall be all weather motorable road.
• Roads shall be illuminated in the nights.
• There shall be dedicated parking space separately for ambulances, Hospital staff and visitors.
• There shall be no stagnation/over flow of drains.
• There shall be no water logging/marsh in or around the hospital premises.
• There shall be no open sewage/ditches in the hospital.

v) Environmental friendly features

The Hospital should be, as far as possible, environment friendly and energy efficient. Rain-Water harvesting, solar energy use and use of energy-efficient bulbs/ equipment should be encouraged.

Provision should be made for horticulture services including herbal garden. A room to store garden implements, seeds etc. will be made available.

vi) Barrier free access

For easy access to non-ambulant (wheel-chair, stretcher), semi-ambulant, visually disabled and elderly persons infrastructure as per “Guidelines and Space Standards for barrier-free built environment for Disabled and Elderly Persons” of Government of India, is to be provided.

This will ensure safety and utilization of space by disabled and elderly people fully and their full integration into the society. Provisions as per „Persons with Disability Act‟ should be implemented.

vii) Administrative Block

Administrative block attached to main hospital along with provision of MS Office and other staff will be provided.

Block should have independent access and connectivity to the main hospital building, wherever feasible.

viii) Circulation Areas

Circulation areas comprise corridors, lifts, ramps, staircase and other common spaces etc. The flooring should be anti-skid and non-slippery.

Corridors – Corridors shall be at least 3 m Wide to accommodate the daily traffic. Size of the corridors, ramps, and stairs shall be conducive for manoeuvrability of wheeled equipment. Corridors shall be wide enough to accommodate two passing trolley, one of which may have a drip attached to it.

Ramps shall have a slope of 1:15 to 1:18. It must be checked for manoeuvrability of beds and trolleys at any turning point.

ix) Roof Height

The roof height should not be less than approximately 3.6 m measured at any point from floor to roof.

x) Entrance Area

Barrier free access environment for easy access to non- ambulant (wheel-chair, stretcher), semi-ambulant, visually disabled and elderly persons as per “Guidelines and Space Standards for barrier-free built environment for Disabled and Elderly Persons” of CPWD/Min of Social Welfare, GOI.

Ramp as per specification, Hand – railing, proper lightning etc. must be provided in all health facilities and retrofitted in older one which lacks the same.

The various types of traffic shall be grouped for entry into the hospital premises according to their nature. An important consideration is that traffic moving at extremely different paces (e.g. a patient on foot and an ambulance) shall be separated.

There can be four access points to the site, in order to segregate the traffic.

1. Emergency: for patients in ambulances and other vehicles for emergency department.
2. Service: for delivering supplies and collecting waste.
3. Service: for removal of dead
4. Main: for all others

xi) Residential Quarters

All the essential medical and para-medical staff will be provided with residential accommodation. If the accommodation cannot be provided due to any reason, then the staff may be paid house rent allowance, but in that case they should be staying in near vicinity, so that essential staff is available 24 x 7.

6) Disaster Prevention Measures

(For all new upcoming facilities in seismic zone 5 or other disaster prone areas)

Desirable

Building structure and the internal structure of Hospital should be made disaster proof especially earthquake proof, flood proof and equipped with fire protection measures.

Earthquake proof measures – structural and non- structural should be built in to withstand quake as per geographical / state Govt. guidelines. Non-structural features like fastening the shelves, almirahs, equipment etc. are even more essential than structural changes in the buildings.

Since it is likely to increase the cost substantially, these measures may especially be taken on priority in known earthquake prone areas.

Fire fighting equipment – fire extinguishers, sand buckets, etc. should be available and maintained to be readily available when there is a problem.

Every district hospital shall have a dedicated disaster management plan in line with state disaster management plan. Disaster plan clearly defines the authority and responsibility of all cadres of staff and mechanism of mobilization resources.
All health staff should be trained and well conversant with disaster prevention and management aspects.

Regular mock drill should be conducted. After each drill the efficacy of disaster plan, preparedness of hospital and competence of staff shall be evaluated followed by appropriate changes to make plan more robust.

7) Hospital communication

24×7 working telephone shall be available for hospital. Additional telephone lines with restricted access for priority messages should be installed especially with ISD facilities.

All messages should be written down in the log book in details for follow up especially in case of disaster situations. Wireless Services with police assistance and hotline with the collector can be used in emergency.

Fax should be used for communication of information like quantity of drugs, specification of equipment etc so as to avoid errors.

Internal communication system for connecting important areas of hospitals like Emergency, Wards, OT, Kitchen, Laundry, CSSD, administration etc. should be established.

Central Information booth should be functional and competent person shall be available for answering the enquiries. The anxious excited friends and relatives want to know the welfare of their kith and kin and hospital authorities should calm them down, console them and provide them with detail information from time to time from information booth. List of patients may be displayed with their bed/ward location.

Crowds should be controlled and only the authorized attendants/relatives with passes should be allowed entry

8) Departmental Lay-Out for hospital

Clinical Services

i) Outdoor Patient Department (OPD)

The facility shall be planned keeping in mind the maximum peak hour patient load and shall have the scope for future expansion. OPD shall have approach from main road with signage visible from a distance.

Reception and Enquiry

• Enquiry/May I Help desk shall be available with competent staff fluent in local language. The service may be outsourced.
• Services available at the hospital displayed at the enquiry.
• Name and contacts of responsible persons like Medical superintendent, Hospital Manager, Causality Medical officer, Public Information Officer etc. shall be displayed.

Waiting Spaces

Waiting area with adequate seating arrangement shall be provided.

Main entrance, general waiting and subsidiary waiting spaces are required adjacent to each consultation and treatment room in all the clinics.

Waiting area at the scale of 1 sq ft / per average daily patient with minimum 400 sq ft of area is to be provided.

Layout of OPD

Layout of OPD shall follow functional flow of the patients, e.g.:

Enquiry → Registration → Waiting → Sub-waiting → Clinic → Dressing room / Injection Room → Billing → Diagnostics (lab/x-ray) → Pharmacy → exit

Patient amenities

• Potable drinking water.
• Functional and clean toilets with running water and flush.
• Fans/Coolers.
• Seating arrangement as per load of patient.

Clinics

The clinics should include general, medical, surgical, ophthalmic, ENT, dental, obsetetric and gynaecology, Post Partum Unit, paediatrics, dermatology and venereology, psychiatry, neonatology, orthopaedic and social service department.

Doctor chamber should have ample space to sit for 4-5 people.

Chamber size of 12.0 sq meters is adequate.

The clinics for infectious and communicable diseases should be located in isolation, preferably, in remote corner, provided with independent access.

For National Health Programme, adequate space be made available.

Immunization Clinic with waiting Room having an area of 3 m × 4 m in PP centre/Maternity centre/Pediatric Clinic should be provided.

1 Room for HIV/STI counseling is to be provided.

Pharmacy shall be in close proximity of OPD.

All clinics shall be provided with examination table, X-ray- View box, Screens and hand wishing facility. Adequate number of wheelchairs and stretcher shall be provided.

Nursing Services

Various clinics under Ambulatory Care Area require nursing facilities in common which include dressing room, side laboratory, injection room, social service and treatment rooms etc.

Nursing Station: Need based space required for Nursing Station in OPD for dispensing nursing services. (Based on OPD load of patient)

Quality Assurances in Clinics

• Work load at OPD shall be studied and measures shall be taken to reduce the Waiting Time for registration, consultation, Diagnostics and pharmacy.
• Punctuality of staff shall be ensured.
• Cleanliness of OPD area shall be monitored on regular basis.
• There shall be provision of complaints/ suggestion box. There shall be a mechanism to redress the complaints.
• Hospital shall develop standard operating procedures for OPD management, train the staff and implement it accordingly.
• Assessment of each patient shall be done in standard format.
• To avoid overcrowding hospital shall have patient calling systems (manual/Digital).

Desirable Services

• Air-cooling
• Patient calling system with electronic display
• Specimen collection centre
• Television in waiting area
• Computerized Registration
• Public Telephone booth
• Provision of OPD manager

II) Imaging (Radiology) Department

The department shall be located at a place which is accessible to both OPD and wards and also to operation theatre department.

The size of the room shall depend on the type and size of equipment installed.

The room shall have a sub-waiting area with toilet facility and a change room facility.

Film developing and processing (dark room) shall be provided in the department for loading, unloading, developing and processing of x- ray films.

Room shall be completely cut of from direct light.

Exhaust fan, ventilators shall be provided.

Room shall have a loading bench (with acid and alkali resistant top), processing tank, washing tank and a sink.

Separate Reporting Room for doctors shall be there.

Ultrasound room shall contain a patient couch, a chair and adequate space for the equipment.

The lighting must be dim for proper examination.

Hand-washing facility and toilet shall be attached with ultrasound room.

Process requirement and Quality Assurance in Radiology

• Lay out and construction of x-Ray shall follow the AERB guidelines.
• Lead Aprons and Thermo Luminescent Dosimeters (TLD) badges shall be available with all the staff working in x-ray room. TLD badges should be sent to BARC on regular bases for assessment.
• Cycle Time for reporting shall not be more than 24 hours. Same day reporting would be more desirable.
• Hospital shall ensure availability of adequate number of x-ray films at all the times.
• Fixer solution used in film processing shall not be disposed in drains. It shall be auctioned.
• Mandatory information as per PNDT act shall be displayed at ultrasonography centre. Records shall also be maintained as per PNDT Act.
• Service provided by the department with schedule of charges shall be displayed at the entrance of department.
• Department shall develop standard operating procedures for safe transportation of the patient to the department, handling and safe disposal of radioactive material and efficient operation of the department.
• Department shall have a system of preventive maintenance, breakdown repairs and periodic calibration of equipment.

III) Clinical Laboratory Department

The department shall be situated such that it has easy access to IPD as well as OPD patients. The Laboratory shall have adequate space from the point of view of workload as well as maintenance of high level of hygiene to prevent the infection.

Storage space shall be adequate (10% of total floor space) with separate storage space for inflammable items.

The layout shall ensure logical flow of specimens from receipt to disposal.

There shall be separate and demarcated areas for sample collection, sample processing, hematology, biochemistry, clinical pathology and reporting. The table top shall be acid and alkali proof.

Quality Assurance in Laboratory Services

External validation of lab reports shall be done on regular basis.

Facility of emergency laboratory services shall be available.

Service provided by the department with schedule of charges shall be displayed at the entrance of department.

Timely reporting should be ensured.

iv) Blood Bank

Blood bank shall be in close proximity to pathology department and at an accessible distance to operation theatre department, intensive care units and emergency and accident department.

Blood Bank should follow all existing guidelines and fulfill all requirements as per the various Acts pertaining to setting up of the Blood Bank. Separate Reporting Room for doctors should be there.

Quality Assurance in blood bank

• Hospital should follow standard operating procedure for management of blood bank services including policy on rational use of blood and blood product promulgated by Central/State Government, selection of donors, counselling and examination of donors, consent for donation, issue and transport of blood, storage of blood, cross matching, blood transfusion, safety precaution.
• Blood bank shall validate the test results from external labs on regular basis.
• Service provided by the department with schedule of charges shall be displayed at the entrance of department.
• Availability of blood group shall be displayed prominently in the blood bank.
• Blood bank shall adhere to NACO guidelines and drug and cosmetic act strictly.
• Blood bank shall practice first in first out policy for reduction of waste. Adequate measures shall be taken to prevent expiry of blood or blood components.
• Use of blood component shall be encouraged.

v) Intermediate Care Area (Indoor Patient Department)

General IPD beds shall be categorized as following

• Male Medical ward
• Male surgical ward
• Female Medical ward
• Female surgical ward
• Maternity ward
• Paediatric ward
• Nursery
• Isolation ward

As per need and infrastructure hospital have following wards

• Emergency ward/trauma ward
• Burn Ward
• Orthopaedic ward
• Post operative ward
• Ophthalmology Ward
• Malaria Ward
• Infectious Disease Ward
• Private ward: Depending upon the requirement of the hospital and catchment area, appropriate beds may be allowed for private facility. 10% of the total bed strength is recommended as private wards beds.

Location

Location of the ward should be such to ensure quietness and to control number of visitors.

Ward unit

It is desirable that up to 20 % of the total beds may be earmarked for the day care facilities, as many procedures can be done on day care basis in modern times.

The basic aim in planning a ward unit should be to minimize the work of the nursing staff and provide basic amenities to the patients within the unit.

The distances to be traveled by a nurse from bed areas to treatment room, pantry etc. should be kept to the minimum.

Ward unit will include nursing station, doctors‟ duty room, pantry, isolation room, treatment room, nursing store along with wards and toilets as per the norms.

On an average one nursing station per ward will be provided.

It should be ensured that nursing station caters to around 40-45 beds, out of which half will be for acute patients and half for chronic patients.

The following quality parameters should be ensured:

• There shall be at least 2.5 metre between centres of two beds to prevent cross infection and allow bedside nursing care.
• Every bed shall be provided with IV stand, bed side locker and stool for attendant. Screen shall be available for privacy.
• Dedicated toilets with running water facility and flush shall be provide for each ward.
• Dirty utility room with sluicing facility and janitors rooms shall be provided with in ward.
• All wards shall be provided with positive ventilation (except isolation ward) and fans.

vi) Pharmacy (Dispensary)

The pharmacy should be located in an area conveniently accessible from all clinics. The size should be adequate to contain 5 percent of the total clinical visits to the OPD in one session.

For every 200 OPD patients daily there should be one dispensing counter.

Pharmacy should have component of medical store facility for indoor patients and separate pharmacy with accessibility for OPD patients.

Hospital shall have standard operating procedure for stocking, preventing stock out of essential drugs, receiving, inspecting, handing over, storage and retrieval of drugs, checking quality of drugs, inventory management (ABC & VED), storage of narcotic drugs, checking pilferage, date of expiry, pest and rodent control etc.

vii) Patient Conveniences

Number of toilets etc. to be provided as per number of beds of Hospital/OPD load.

viii) Dharamshala

It is a premises providing temporary accommodation for short duration. The area shall be minimum 0.25 hectares of land adjoining or within the Hospital premises.

ix) Intensive Care Unit (ICU) and High Dependency Wards

General

In this unit, critically ill patients requiring highly skilled life saving medical aid and nursing care are concentrated. These should include major surgical and medical cases, head injuries, severe haemorrhage, acute coronary occlusion, kidney and respiratory catastrophe, poisoning etc.

It should be the ultimate medicare the hospital can provide with highly specialized staff and equipment.

The number of patients requiring intensive care may be about 5 to 10 percent of total medical and surgical patients in a hospital.

The unit shall not have less than 4 beds nor more than 12 beds.

Number of beds may be restricted to 5% of the total bed strength initially but should be expanded to 10% gradually.

Out of these, they can be equally divided among ICU and High Dependency Wards.

For example, in a 500-bedded hospital, total of 25 beds will be for Critical Care. Out of these, 13 may be ICU beds and 12 will be allocated for High Dependency Wards. Changing room should be provided for.

Location

This unit should be located close to operation theatre department and other essential departments, such as, x-ray and pathology so that the staff and ancillaries could be shared.

Easy and convenient access from emergency and accident department is also essential.

This unit will also need all the specialized services, such as, piped suction and medical gases, uninterrupted electric supply, heating, ventilation, central air conditioning and efficient life services.

A good natural light and pleasant environment would also be of great help to the patients and staff as well.

Facilities Nurses Station Clean Utility Area equipment Room

x) Accident and Emergency Services

• 24 x 7 operational emergency with dedicated emergency room shall be available with adequate man power.
• It should preferably have a distinct entry independent of OPD main entry so that a very minimum time is lost in giving immediate treatment to casualities arriving in the hospital. There should be an easy ambulance approach with adequate space for free passage of vehicles and covered area for alighting patients.
• Lay out shall follow the functional flow.
• Signage of emergency shall be displayed at the entry of the hospital with directional signage at key points.
• Emergency shall have dedicated triage, resuscitation and observation area. Screens shall be available for privacy.
• Separate provision for examination of rape/ sexual assault victim should be made available in the emergency as per guidelines of the Supreme Court.
• Emergency should have mobile x-ray/ laboratory, side labs/plaster room/and minor OT facilities. Separate emergency beds may be provided. Duty rooms for Doctors/nurses/ paramedical staff and medico legal cases. Sufficient separate waiting areas and public amenities for patients and relatives and located in such a way which does not disturb functioning of emergency services.
• Emergency block to have ECG, Pulse Oxymeter, Cardiac Monitor with Defibrillator, Multiparameter Monitor, Ventilator also.
• Stretcher, wheelchair and trolley shall be available at the entrance of the emergency at designated area.

xi) Operation Theatre

Operation theatre usually have a team of surgeons anesthetists, nurses and sometime pathologist and radiologist operate upon or care for the patients.

The location of Operation theatre should be in a quite environment, free from noise and other disturbances, free from contamination and possible cross infection, maximum protection from solar radiation and convenient relationship with surgical ward, intensive care unit, radiology, pathology, blood bank and CSSD.

This unit also needs constant specialized services, such as piped suction and medical gases, electric supply, heating, air-conditioning, ventilation and efficient lift service, if the theatres are located on upper floors.

Zoning should be done to keep the theatres free from micro organisms.

There may be four well defined zones of varying degree of cleanliness/asepsis namely, Protective Zone, Clean Zone, Aspectic or Sterile Zone and Disposal or Dirty Zone.

Normally there are three types of traffic flow, namely, patients, staff and supplies.

All these should be properly channelized.

An Operation Theatre should also have Preparation Room, Pre-operative Room and Post Operative Resting Room.

Operating room should be made dust- proof and moisture proof.

There should also be a Scrub-up room where operating team washes and scrub-up their hands and arms, put on their sterile gown, gloves and other covers before entering the operation theatre.

The theatre should have sink/ photo sensors for water facility. Laminar flow of air be maintained in operation theatre.

It should have a single leaf door with self closing device and viewing window to communicate with the operation theatre.

A pair of surgeon‟s sinks and elbow or knee operated taps are essential.

Operation Theatre should also have a Sub-Sterilizing unit attached to the operation theatre limiting its role to operating instruments on an emergency basis only.

Theatre refuse, such as, dirty linen, used instruments and other disposable/non disposable items should be removed to a room after each operation.

Non-disposable instruments after initial wash are given back to instrument sterilization and rest of the disposable items are disposed off and destroyed.

Dirty linen is sent to laundry through a separate exit. The room should be provided with sink, slop sink, work bench and draining boards.

xii) Delivery Suite Unit

The delivery suit unit be located near to operation theatre & located preferably on the ground floor. The delivery Suit Unit should include the facilities of accommodation for various facilities as given below:

• Reception and admission
• Examination and Preparation Room
• Labour Room (clean and a septic room)
• Delivery Room
• Neo-natal Room
• Sterilizing Rooms sterile store Room scrubbing Room Dirty Utility
• Doctors Duty Room
• Nursing Station
• Nurses changing Room
• Group C & D Room
• eclampsia Room

xiii) Post Partum Unit

It is desirable that every District Hospital should have a Post Partum Unit with dedicated staff and infrastructure to provide Post natal services, all Family Planning Services, Safe Abortion services and immunization in an integrated manner.

The focus will be to promote Post Partum Sterilization and will be provided if the case load of the deliveries is more than 75 per month.

xiv) Physical Medicine and Rehabilitation (PMR)

The PMR department provides treatment facilities to patients suffering from crippling diseases and disabilities.

The department is more frequently visited by out-patients but should be located at a place which may be at convenient access to both outdoor and indoor patients with privacy.

It should also have a physical and electro-therapy rooms, gymnasium, office, store and toilets separate for male and female. Normative standards will be followed.

9) Hospital Administrative and Support Services

i) Management Information System (MIS)

Computer with Internet connection is to be provided for MIS purpose. Provision of flow of Information from PHC/CHC to district hospital and from there to district and state health organization should be established.

Relevant information with regards to emergency, outdoor and indoor patients be recorded and maintained for a sufficient duration of time as per state health policy.

ii) Hospital Kitchen (Dietary Service)

The dietary service of a hospital is an important therapeutic tool. It should easily be accessible from outside along with vehicular accessibility and separate room for dietician and special diet.

It should be located such that the noise and cooking odours emanating from the department do not cause any inconvenience to the other departments.

At the same time location should involve the shortest possible time in delivering food to the wards. Apart from normal diet diabetic, semi solid diets and liquid diet shall be available Food shall be distributed in covered container.

Quality and quantity of diet shall be checked by competent person on regular basis.

iii) Central Sterile Supply Department (CSSD)

As the operation theatre department is the major consumer of this service, it is recommended to locate the department at a position of easy access to operation theatre department. It should have a provision of hot water supply.

Department shall develop and implement the Standard Operating Procedures (SOPs) for transfer of unsterile and sterile items between CssD and departments, sterilization of different items, complete process cycle, validation of sterilization process, recall, labelling, first in first out, calibration and maintenance of instruments.

iv) Hospital Laundry

It should be provided with necessary facilities for drying, pressing and storage of soiled and cleaned linens. It may be outsourced.

v) Medical and General Stores

Medical and general stores should have vehicular accessibility and ventilation, security and fire fighting arrangements. Hospital shall have standard operating procedure for local purchase, indent management, storage preparation of monthly requirement plan and Inventory analysis.

For Storage of Vaccines and other logistics

Cold Chain Room : 3.5 m × 3 m in size
Vaccine & Logistics Room : 3.5 m × 3 m in size

Minimum and maximum Stock shall be 0.5 and 1.25 month respectively. Indent order and receipt of vaccines and logistics should be monthly. Timely receipt of required vaccines and Logistics from the District Stores, should be ensured.

vi) Mortuary

It provides facilities for keeping of dead bodies and conducting autopsy. The Mortuary shall be located in separate building near the Pathology on the Ground Floor, easily accessible from the wards, Accident and emergency Department and Operation Theatre. It shall be located away from general traffic routes used by public.

Post-mortem room shall have stainless steel autopsy table with sink, a sink with running water for specimen washing and cleaning and cup-board for keeping instruments. Proper illumination and air conditioning shall be provided in the post mortem room.

A separate room for body storage shall be provided with at least 2 deep freezers for preserving the body. There shall be a waiting area for relatives and a space for religious rites.

vii) Engineering Services

Electric Engineering Sub Station and Generation

Electrical load requirement per bed = 3 KW to 5 KW.

Electric sub station and standby generator room should be provided.

Illumination

The illumination and lightning in the hospital should be done as per the prescribed standards.

Emergency Lighting

Shadow less light in operation theatre and delivery rooms should be provided. Emergency portable light units should be provided in the wards and departments.

Call Bells

Call bells with switches for all beds should be provided in all types of wards with indicator lights and location indicator situated in the nurses duty room of the wards.

Ventilation

The ventilation in the hospital may be achieved by either natural supply or by mechanical exhaust of air.

Mechanical Engineering

Air-conditioning and Room Heating in operation theatre and neo-natal units should be provided. Air coolers or hot air convectors may be provided for the comfort of patients and staff depending on the local needs. Hospital should be provided with water coolers and refrigerator in wards and departments depending upon the local needs.

Water Supply

Arrangement should be made for round the clock piped water supply along with an overhead water storage tank with pumping and boosting arrangements.

Water requirement per bed per day = 450 to 500 litres (Excluding requirements for AC, Fire-fighting, Horticulture and steam).

Drainage and Sanitation

The construction and maintenance of drainage and sanitation system for waste water, surface water, sub- soil water and sewerage shall be in accordance with the prescribed standards. Prescribed standards and local guidelines shall be followed.

Other Amenities

Disabled friendly, WC with basins wash basins as specified by Guidelines for disabled friendly environment should be provided.

viii) Waste Disposal System

National Guidelines on Bio-Medical Waste Management.
Mercury waste management guidelines are placed.

ix) Housekeeping services

Hospital shall develop and implement standard operating procedure for cleaning techniques, pest control, frequency and supervision of housekeeping activities.

x) Medical Gas

All gases may preferably be supplied through manifold system.

xi) Cooking Gas

Liquefied petroleum gas (LPG) will be used for cooking.

xii) Building Maintenance

Provision for building maintenance staff and an office- cum store will be provided to handle day to day maintenance work.

XIII) Annual Maintenance Contract (AMC)

AMC should be taken for all equipment which need special care and preventive maintenance done to avoid break down and reduce down time of all essential and other equipment.

xiv) Record Maintenance (Medical Record Department)

Hospital shall have dedicated medical record department to store patient‟s record and other data pertaining to hospital.

xv) Committee Room

A meeting or a committee room for conferences, trainings with associated furniture.

xvi) Hospital Transport Services

• Hospital shall have well equipped Basic Life support (BLS) and desirably one Advanced Life Support (ALS) ambulance.
• Ambulances shall be provided with communication system.
• There shall be separate space near emergency for parking of ambulances.
• Serviceability and availability of equipment and drugs in ambulance shall be checked on daily basis.

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