NIGHTINGALE INSTITUTE OF

NURSING

ASSIGNMENT
ON
LAYOUT PLANNING IN COLLEGE ,
HOSPITAL, COMMUNITY
(SUBJECT: NURSING MANAGEMENT)

SUBMITTED TO SUBMITTED BY
MS. ANN GLADIS MS. DHAIRYA ARORA
ASSOCIATE PROFESSOR M.Sc. NURSING 2nd YEAR
N I N, NOIDA N I N, NOIDA
 LAY OUT PLANNING IN HOSPITAL

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 serve. 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 populations. 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 as
follows:

The total number of admissions per year = 10,00,000 x 1/50 = 20,000

Bed days per year = 20,000 x 5 = 100,000

Total number of beds required when occupancy is 100% = 100000/365 = 275

Total number of beds required when occupancy is 80% = 100000/365 x 80/100

Bed: Population = A x S x 100

365 x PO

A= number of inpatient admissions/1000 population/year

S= average length of stay

PO= percentage occupancy

AREA OF THE HOSPITAL:

An area of 65-85 m2 per bed has been considered to be reasonable. The area will
include the service areas such as waiting space, entrance hall, registration counter, etc. In case
of specific requirement of a hospital, flexibility in altering the area be kept.

SITE INFORMATION:

Physical description of the area which should include bearings, boundaries, topography,
surface area, land used in adjoining areas, 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. Hospital Management
Policy should emphasize on quake proof, fire proof and flood proof buildings. Infrastructure
should be eco-friendly and disabled (physically and visually handicapped) friendly. Provision
should be made for water harvesting, generating back-up, solar energy / power back-up, and
horticulture services including herbal garden. Local agency Guidelines and By-laws should
strictly be followed. A room for horticulture to store garden implements, seeds etc will be
made available.
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, gas 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. Disability Act will be followed.

SITE SELECTION CRITERIA

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 arid architects are confronted with the job of assessing whether apiece of land is
suitable for building a hospital. In the case of either site selection or evaluation of
adaptability, the following items must be, considered: size, topography, drainage, soil
conditions, utilities available, natural features and limitations.

DATA REQUIRED IN PLANNING THE HOSPITAL

 Geographic Data
 Morbidity & Mortality Status
 Need & Demand
 Details of existing Facilities
 Financial Feasibility
 Demographic details
 Population Strength
 Sex & Age Ration
 Social Status
 Educational level

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.

BUILDING AND SPACE REQUIREMENTS

Administrative Block:

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

Circulation Areas

Circulation areas like corridors, toilets, lifts, ramps, staircase and other common spaces
etc. in the hospital should not be more than 55% of the total floor area of the building.

Floor Height

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

Entrance Area

Physical Facilities

AMBULATORY CARE AREA/ OUT- PATIENT DEPARTMENT (OPD)

Waiting Spaces

Registration, assistance and enquiry counter facility be made available in all the clinics.
Main entrance, general waiting and subsidiary waiting spaces are required adjacent to each
consultation and treatment room in all the clinics.

Clinics

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

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: On an average, one nursing station per ward will be provided.
However, it should be ensured that nursing station caters to about 40-45 beds. Out of these
half will be for acute and chronic patients.
Diagnostic Services

Imaging

Role of imaging department should be radiodiagnosis and ultrasound along with hire
facilities depending on the bed strength. The department should be located at a place which is
accessible to both OPD and wards and also to operation theatre department. The size of the
room should depend on the type of instrument installed. The room should have a sub-waiting
area with toilet facility and a change room facility, if required. Film developing and
processing (dark room) shall be provided in the department for loading, unloading,
developing and processing of X-ray films. Separate Reporting Room for doctors should be
there.

Clinical Laboratory

For quick diagnosis of blood, urine, etc., a small sample collection room facility shall
be provided. Separate Reporting Room for doctors should be there.

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 fulfil all requirements as
per the various Acts pertaining to setting up of the Blood Bank. Separate Reporting Room for
doctors should be there.

INTERMEDIATE CARE AREA (INPATIENT NURSING UNITS)

General

Nursing care should fall under following categories:

General Wards: Male / Female

Private Wards:

Wards for Specialities 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

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 ensure that nursing station caters to above 40-
45 beds, out of which half will be for acute and chronic patients.

Private ward:

Depending upon the requirement of the hospital and catchment area appropriate beds
may be allocated for private facilities. However, 10% of the total bed strength is
recommended as private wards beds.

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

INTENSIVE CARE UNIT 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 2 to 5 percent 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 will be restricted to 5% of the total
bed strength. 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. Number of beds for both the units will be restricted to 5% of the
total bed strength. 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.
Facilities

Nurses Station

Clean Utility Area

Equipment Room

CRITICAL CARE AREA (EMERGENCY SERVICES)

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.

THERAPEUTIC SERVICES

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 need constant specialized services, such as, piped suction and medical
gases, electric supply, heating, air-conditioning, ventilation and efficient life 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 namely,
Protective Zone, Clean Zone, Aseptic 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 central air
conditioning facility. 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.

Delivery Suite Unit

The delivery suit unit be located near to operation theatre. 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

Physiotherapy

The physiotherapy 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 electrotherapy rooms,
gymnasium, office, store and toilets separate for male and female. Normative standards will
be followed.

HOSPITAL SERVICES

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.

Central Sterile and 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.

Hospital Laundry

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

Medical and General Stores

There are of medical and general store should have vehicular accessibility and ventilation,
security and fire fighting arrangements.

Mortuary

It provides facilities for keeping of dead bodies and conducting autopsy. It should be so
located that the dead bodies can be transported unnoticed by the general public and patients.

ENGINEERING SERVICES

Electric Engineering

Sub Station and Generation Electric sub station and standby generator room should be
provided.

Public Health Engineering

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. Approximately 10000 litres of
potable water per day is required for a 100 beded hospital. Separate provision for fire fighting
and water softening plants be made available.

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.
 LAY OUT PLANNING IN COLLEGE

Building

The College of Nursing should have a separate building. The college of Nursing should be
near to its parent hospital having space for expansion in an institutional area. For a College
with an annual admission capacity of 40-60 students, the constructed area of the college
should be 23720 square feet. Adequate hostel/residential accommodation for students and
staff should be available in addition to the above mentioned built up area of the Nursing
College respectively. The details of the constructed area is given below for admission
capacity of 40-60 students.

Teaching Block

S. No. Teaching Block Area (Figures in Sq

feet)
Lecture Hall 4 @ 1080 = 4320
1.

(i) Nursing foundation 1500

2. lab

(ii) CHN 900

(iii) Nutrition 900
(iv) OBG and Paediatrics lab 900
(v) Pre-clinical science lab 900
(vi) Computer Lab 1500
Multipurpose Hall 3000
3.

Common Room (Male 1100

4. & Female)

Staff Room 1000

5.

Principal Room 300

6.

Vice Principal Room 200

7.

Library 2400
8.

A.V. Aids Room 600

 9.

One room for each 800

10. Head of Departments

Faculty Room 2400

11.

Provisions for Toilets 1000

12.

Total 23720 Sqr. Ft.

1. Class rooms

There should be at least four classrooms with the capacity of accommodating the
number of students admitted in each class. The rooms should be well ventilated with
proper lighting system. There should be built in Black/Green/White Boards. Also
there should be a desk/ dais/a big table and a chair for the teacher and racks/cupboards
for keeping teaching aids or any other equipment needed for the conduct of classes
also should be there.

Departments: College should have following departments

1. Fundamentals of Nursing including Nutrition

2. Medical Surgical Nursing

3. Community Health Nursing

4. Obstetric and Gynecological Nursing

5. Child Health Nursing

6. Psychiatry and Mental Health Nursing

2. Laboratories

There should be at least Seven laboratories as listed below:

Nursing Foundations and Medical Surgical
Community Health Nursing
OBG and Peadiatracs
Nutrition
Computer with 10 computers
Pre Clinical Science Lab. (Biochemistry, Microbiology,
 Biophysics, Anatomy & Physiology)
3. Auditorium

Auditorium should be spacious enough to accommodate at least double the sanctioned/actual

strength of students, so that it can be utilised for hosting functions of the college, educational
conferences/ workshops, examinations etc. It should have proper stage with green room
facilities. It should be well –ventilated and have proper lighting system. There should be
arrangements for the use of all kinds of basic and advanced audio-visual aids.

4. Multipurpose Hall

College of Nursing should have multipurpose hall, if there is no auditorium.

5. Library

There should be a separate library for the college. The size of the Library should be of
minimum 2400 sqr. ft. It should be easily accessible to the teaching faculty and the students.
Library should have seating arrangements for at least 60 students for reading and having good
lighting and ventilation and space for stocking and displaying of books and journals. The
library should have at least 3000 books. In a new College of Nursing the total number of
books should be proportionately divided on yearly basis in four years. At least 10 sets of
books in each subject to facilitate for the students to refer the books. The number of journals
should 15 out of which one- third shall be foreign journals and subscribed on continuous
basis. There should be sufficient number of cupboards, book shelves and racks with glass
doors for proper and safe storage of books, magazines, journals, newspapers and other
literature.

In the library there should be provision for:

- Staff reading room for 10 persons.

- Rooms for librarian and other staff with intercom phone facility

- Video and cassette / CD room (desirable)

- Internet facility

6. Offices Requirements

(a) Principal’s Office

There should be a separate office for the Principal with attached toilet and provision for
visitor’s room. Independent telephone facility is a must for the Principal’s office with
intercom facility connected/linked to the hospital and hostel and a computer with internet
facility. The size of the office should be 300 sqr. ft.

(b) Office for Vice-Principal

There should be a separate office for the Vice-Principal with attached toilet and provision for
visitor’s room. Independent telephone facility is a must for Vice-principal’s office with
intercom facility connected/linked to the hospital and hostel and a computer with internet
facility. The size of the office should be 200 sqr. ft.

(c) Office for Faculty Members

There should be adequate number of office rooms in proportion to the number of teaching
faculty. One office room should accommodate 2 teachers only. Separate toilet facility should
be provided for the teaching faculty with hand washing facility. There should be a separate
toilet for male teachers. The size of the room should be 200 sqr. ft. Separate chambers for
heads of the department should be there.

(d) Office room: One separate office room for the office should be provided with adequate
toilet facility. This office should be spacious enough to accommodate the entire office staff
with separate cabin for each official. Each office room should be adequately furnished with
items like tables, chairs, cupboards, built –in racks and shelves, filing cabinets and book
cases. Also there should be provision for typewriters, computers and telephone.

7. Common Rooms

A minimum of 3 common rooms should be provided. One for the teaching faculty, one for
the student and one for the office staff. Sufficient space with adequate seating
arrangements,cupboards, lockers, cabinets, built-in-shelves and racks should be provided in
all the common rooms. Toilet and hand washing facilities should be made available in each
room.

8. Record Room

There should be a separate record room with steel racks, built-in shelves and racks, cupboards
and filing cabinets for proper storage of records and other important papers/ documents
belonging to the college.

9. Store room

A separate store room should be provided to accommodate the equipments and other
inventory articles which are required in the laboratories of the college. This room should have
the facilities for proper and safe storage of these articles and equipments like cupboards,
built-in-shelves, racks, cabinets, furniture items like tables and chairs. This room should be
properly lighted and well-ventilated.

10. Room for Audio-Visual Aids

This room should be provided for the proper and safe storage of size 600 sq. ft. for all the
Audio- Visual Aids.
11. Other Facilities

Students’ welfare hall of size 400 sqr. ft. Indoor games hall of size 4000 ft. Safe drinking
water and adequate sanitary/toilet facilities should be available for both men and women
separately in the college in each floor common toilets for teachers (separate for male and
female) i.e 4 toilets with Wash basins. Common toilets for students (separate for male and
female) 12 with Wash Basins for 60 students.

12. Garage

Garage should accommodate a 60 seater vehicle.

13. Fire Extinguisher

Adequate provision for extinguishing fire should be available as per the local bye-laws.

14. Playground

Playground should be spacious for outdoor sports like Volleyball, football, badminton and for
Athletics.

Hostel Block (60

Students):
S. No. Hostel Block Area (Figures in Sq
feet)

1. Single Room/ 24000

Double Room

2. Sanitary One latrine & One Bath

room (for 5 students) –
500

3. Visitor Room 500

Reading Room 250

4.

Store 500
5.

Recreation Room 500

6.

7. Dining Hall 3000

 8. Kitchen & Store 1500

Total 30750 Sqr. Ft.

Grand Total : 23720 + 30750 = 54470 Sqr. Ft.

HOSTEL FACILITIES:

There should be a separate hostel for the male and female students. It should have the
following facilities.

1. Hostel Room

It should be ideal for 2 students with the minimum 100 sq. ft. carpet area. The furniture
provided should include a cot, a table, a chair, a book rack, a cupboard and a cloth rack for
each student.

2. Toilet and Bathroom

Toilet and bathroom facilities should be provided on each floor of the students hostel at the
rate of one toilet and one bathroom for 2-6 students. Geysers in bathroom and wash basins
should also be provided

3. Recreation

There should be facilities for indoor and outdoor games. There should be provision for T.V.,
radio and video cassette player.

4. Visitor’s Room

There should be a visitor room in the hostel with comfortable seating, lighting and toilet
facilities.

5. Kitchen & Dining Hall

There should be a hygienic kitchen and dining hall to seat at least 80% of the total students
strength at one time with adequate tables, chairs, water coolers, refrigerators and heating
facilities. Hand washing facilities must be provided.

6. Pantry

One pantry on each floor should be provided. It should have water cooler and heating
arrangements.

7. Washing & Ironing Room

Facility for drying and ironing clothes should be provided in each floor.

8. Sick Room
A sick room should have a comfortable bed, linen, furniture and attached toilet. Minimum of
5 beds should be provided.

9. Room for Night Duty Nurses

Should be in a quiet area.

10. Guest Room

A guest room should be made available.

11. Warden’s Room

Warden should be provided with a separate office room besides her residential
accommodation.

12. Canteen

There should be provision for a canteen for the students, their guests, and all other staff
members.

13. Transport

College should have separate transport facility under the control of the Principal. 50 seater
bus is preferable.

Residential Accommodation:

Residential family accommodation for faculty, should be provided, according to their marital
status. Telephone facility for the Principal at her residence must be provided. Residential
accommodation with all facilities is to be provided to the Hostel Warden.

Crèche

There should be a crèche in the college campus.

STAFF FOR THE HOSTEL:

1. Warden (Female) -3 : Qualification- B.Sc. Home Science or Diploma in House

keeping/ Catering. Minimum three wardens must be there in every hostel for morning,
evening and night shifts. If number of students s more than 150, one more warden/ Asst.
Warden/ House keeper for every additional 50 students.

2. Cook-1: For every 20 students for each shift.

3. Kitchen & Dining Room helper- 1 : For every 20 students for each shift.

4. Sweeper-3

5. Gardener-2
6. Security Guard/ Chowkidar-3

LAY OUT PLANNING IN COMMUNITY

CONCLUSION

Layout planning is important because it can significantly affect the productivity and service

quality. Some consequences of poor layout are increased costs, confused and frustrated
customers, and poor communication and information flows. Explain the importance of layout
planning for everyday life.

REFERENCES:

1)  Basavanthapa BT, Nursing administration, 2nd ed. New Delhi: Jaypee brothers
publications; 2009.p.-306-17.
2) Vati Jogindra . Principles & practice of nursing management and administration, Ist
ed., New Delhi: Jaypee Brothers Medical publisher; 2013.p.139-40.
3) Robert Dredge. Hospital global budgeting. [cited 2004 Sep]:
4) Available from: URL:http://www.who.int/management/facility/hospital