Principles Of Hospital Design And Equipment (Part 3)

Principles Of Hospital Design And Equipment (Part 3)


Standards, per capita and introduction of different wards of the hospital

Engineer Sadegh Pourbakht, project manager of Espo Company

Surgery and operating rooms:

To meet the standard environmental conditions in operating rooms, the zoning of operating rooms is divided into the following 4 parts:

1- Free

2- Clean

3- Sterile

4- Dirty

1.Free zone.

This area is the outermost area of ​​operating rooms. Entry and exit to the operating rooms and control of people and equipment entering the operating rooms in this area are done.

The locker room of the operating room staff is located in this area. After changing shoes and clothes, the operating room staff is allowed to enter clean and sterile areas.

The free zone includes pre-entrances, Vanshan and Vampai substitutes, bed and delivery facilities, toilets and staff bathrooms, waiting for patient companions, admission, patient transportation, examination, and electrical room and facilities.

2.Clean area.

The degree of protection of the clean area is between free and sterile areas. It is important to note that this area should never be considered negligible in the same free zone or, conversely, should be considered strictly equal to the sterile area, both of which will increase the risk of nosocomial infections.

Areas located in the clean area include nursing and reporting station, secretary's desk or room, nurse's headroom, recovery, pre-operative preparation room, doctors' rooms, sterile and anesthesia warehouse, restrooms, storage space Clean workbench, medicine room, and warehouse, juicer and other support spaces.

3.Sterile area:

The sterile area is the area where the patient's surgery is performed.

 - It should be separated from other spaces by a red line.

- All equipment and devices in this area must be sterilized.

- This area can be a large and independent hall that opens the doors of all operating rooms.

- The air pressure in the sterile area is positive for cleanliness.

- The air pressure of the clean area is positive compared to the dirty and free areas.

 - The traffic route between clean and sterile areas is done without replacements and shovels, but hand washing and scrubbing must be done.

- The spaces in the sterile area are:

- Surgical rooms, scrubbers, sub-sterile rooms, access corridors, and anesthesia rooms.

4.Dirty area:

- A dirty area is also called a defecation corridor.

- This corridor extends directly from the operating room outlet to the washing section of the CSSD.

- The dirty area is usually designed as a corridor that is located around the operating rooms. From this corridor, the surgical equipment used in the operating rooms is transferred directly to the central sterilization department.

- Contaminated areas of operating rooms, such as suction drains, dirty workrooms, storage of infectious and non-infectious waste, T-washrooms, and storage of used appliances are located in this area.

- The traffic route between sterile and dirty areas is completely one-way and no one is allowed to enter the sterile area from the dirty area.

Infrastructure and per capita operating rooms:

The minimum useful infrastructure of an operating room for small surgeries is 25 square meters. And the length of each side should not be less than 4.5 meters.

The minimum useful infrastructure of an operating room for average surgeries is 38 square meters. And the length of each side should not be less than 5.5 meters.

The minimum useful infrastructure of an operating room for major surgeries such as open-heart surgery and organ transplantation is 55 square meters. And the length of each side should not be less than 6.5 meters.

The minimum useful height of operating rooms for small and medium surgeries is 3 meters and for large surgeries is 3.20 meters

Infrastructure and per capita operating rooms

The total infrastructure of the operating room hall will be at least 150 square meters for each operating room for up to 5 operating rooms and at least 130 square meters for each operating room for more than 5 operating rooms.

For each operating room bed, a minimum of 1.5 beds is required. The required area for each recovery bed is at least 7.5 square meters.

For each person working in the operating room, including the physician, technician, nurse, secretary, and crew, at least 75 /. There is a square meter of dressing room space.

The location of the operating room ward in the hospital should be such that it provides easy and effective access to other related departments such as emergency, CSR central sterilization, ICU intensive care unit, hospitalization, psychiatry, etc.

Suitable space for waiting for companions in the vicinity or other place is preferably close to the operating rooms with a capacity of at least 2 seats per operating room.

Operating Room Installation Infrastructure:
The air pressure in the sterile area is positive for clean and dirty areas and the clean area is positive for dirty and free areas.
At least 12 air-to-air shifts are required for the interior of operating rooms.
The best ambient temperature for operating rooms is between 22 and 23 degrees Celsius.
Operating room air conditioning should be such that the fresh air and airflow are well felt.
The maximum allowable humidity in the operating room hall is 50%
Because the infrastructure of the operating rooms plays the most important role in the operation of the operating rooms, the height of the false ceilings of this section must be suitable for the passage of the installation infrastructure.
Electricity in the main area of ​​operating rooms needs to be insulated from urban electricity by isolated transformers (one by one).
In addition to being equipped with an emergency generator to the power system, the operating room hall must also be equipped with a UPS (Uninterrupted Power Supply). Also, in the design of electrical installations, it is necessary to allocate 100% of the electrical room electricity distribution to emergency electricity.
The following spaces are essential in the emergency department:
Clear and visible visual input, patient triage, cardiopulmonary resuscitation room, examination rooms, operating room, spaces under the supervision of men and women, pharmacy, treatment, nursing station, patient stabilization space equipped with essential equipment, support spaces such as doctors' locker rooms and Nurses, Watershed and Dining Room, Clean and Dirty Work Room, Isolated Infectious Diseases Room, Admission and Clearance, Patient Waiting Space, Plastering, Sampling, Separate Sanitary Services for Patients and Staff and Spaces Related to Specialized Emergencies And hospital missions such as burns, poisoning, trauma, chemical, microbial, radioactive and the like.
Emergency infrastructure:
The area of ​​the emergency department should not be less than 5% of the total hospital infrastructure. In any case, this area should not be less than 350 square meters.
Patient triage space is located at the main entrance of the emergency room and it is necessary to have one triage bed for every 100 hospital beds. In any case, the area of ​​this space should not be less than 9 square meters.
The number of beds under observation and the stabilization of patients in the emergency department should be at least 7% of the total number of hospital beds.
The net area of ​​each bed under emergency supervision is at least 7 square meters with dimensions of 3 * 4/2, which need to be separated with a special partition or curtain to protect the patient's privacy.
The location of the emergency nursing home should preferably be in the middle of the hall under the supervision and in such a way that it dominates all the beds and isolated rooms. The area of ​​the station depends on the number of beds and the number of nurses. But in any case, it should not be less than 10 square meters.
The location of the emergency department and its entrance should not be in the shadow of the demolition or collapse of adjacent buildings and facilities.
The emergency department should be located in such a way that access to other parts of the hospital, including operating rooms, is easily possible.
The location of the emergency department should be such that it has an independent communication path to the main street, without visible obstruction and direct visual vision from a distance of 150 meters.
 The emergency department should have easy access to ambulances, vehicles, and pedestrians.
The entrance to the emergency department must be roofed and protected from wind, rain, and storms.
The entrance area of ​​the emergency department should be such that ambulances and other vehicles can evacuate the patient easily and in the shortest possible time, and leave the area after bypassing.
All emergency room and other hospital wards should have guidelines and signs to guide patients.
All emergency department routes must be safe for wheelchair users or even pedestrians. If there is a difference in level, it is necessary to use ramps and sloping surfaces with a gentle slope.
It is mandatory to use cheerful and soothing colors and sound-absorbing materials in the emergency department and other parts of the hospital.
Materials used in medical spaces should be such as to prevent the accumulation of contaminants.
The lights used in therapeutic spaces should not be such as to cause errors and mistakes in recognizing the true color of people and objects.
It is recommended that the emergency department have a burning room or similar space for primary care to burn patients.
It is recommended that the emergency department be built on the ground floor.