DESIGN OF A DIAGNOSTIC CENTRE
TOPIC: Design of a diagnostic centre A THESIS Submitted in partial fulfillment of the requirements of Post Graduate Diploma in Interior Design and Business Management by R. SANJANA
DEPARTMENT OF INTERIOR DESIGN 30 Hosur Road, Opposite Adugodi Police Station, Koramangala, Bengaluru, Karnataka 560030 JULY 2020
CREO VALLEY 30 Hosur Road, Opposite Adugodi Police Station, Koramangala, Bengaluru, Karnataka 560030
DEPARTMENT OF INTERIOR DESIGN BONAFIDE CERTIFICATE This is to certify that this Thesis Report is the bonafide work of R. Sanjana who carried out the Thesis work entitled Design of a Diagnostic centre under our supervision from Jan to June 2020
COORDINATOR PRIEYA ARUN
Submitted for Viva voce Examination held on 21/07/2020
Internal Examiner PRIEYA ARUN
External Examiner DHARMA TEJA
DECLARATION I, R. Sanjana hereby declare that the Thesis Report entitled Design of a diagnostic centre done by me under the guidance of Ar.PRIEYA ARUN (Internal) and Ar. DHARMA TEJA (External) is submitted in partial fulfillment of the requirements for the award of POST GRADATE DIPLOMA IN INTEIROR DESIGN MANAGEMENT DATE:
21/07/2020
PLACE: BANGALORE
SIGNATURE OF THE CANDIDATE
ACKNOWLEDGEMENT I offer my sincere appreciation for the learning opportunities provided by the Directors Ms. Avi Keswani, Mr. Girish Keswani and Mr. Devaraj, Principal, CREO Valley, Bangalore. I would like to thank Ar. Prieya Arun, B. Arch, M. Arch, for her able guidance and support towards the completion of this project. Besides my guide, I would also like to thank Mr. Sunil Karthik, department of Interior Design, CREO Valley, Bangalore. I owe my gratitude to the faculty of Genetics and Biochemistry department from Jyoti Nivas College, Autonomous, Bangalore for their encouragement and help along with my fellow classmates of batch, 2018. I would like to extend my gratitude to Dr. Narendra, Vascular surgeon, Columbia Asia Hospital, Whitefield; Ebisu Diagnostics, HSR Layout and Anand Diagnostic Laboratory, Bowring Tower for giving me the opportunity to carry out my case studies. A special mention to my friends Anupa Ann Joshy and Aman Sharma, for helping me out with this project constantly. I couldn’t have accomplished this without the support from my family. Specially acknowledging my little sister for helping me out during quarantine with her not- so valuable inputs. This surely wouldn’t have been possible without you all. Thank you R. Sanjana
ABSTRACT A growing awareness has developed in recent years in the healthcare community of the need to create functionally efficient and hygienic environments that also have pleasant, stress reducing characteristics. Increased insurance penetration, expanded access to diagnostics services have propelled the overall growth of the healthcare sector in India. The aim of this thesis was to design a diagnostic space from the viewpoint of planning, design and end users. The purpose was to generate knowledge about the work done in projects that can be utilized in healthcare sector design. The same knowledge was imparted in designing a diagnostic space that prioritised traditional concerns such as infection risk exposure and work efficiency along with the emotional needs of staff and consumers. Social support must be an essential consideration in creating new healthcare. Green design has been incorporated in order to create a stress reducing and healthy working environment. Today laboratory is an important component in healthcare and is widely acknowledged as the seat of medicine. Good quality diagnostic tests are of prime importance in effective disease control and reducing the burden of infectious diseases. And this is facilitated by good design. Apart from skilled technicians, a well designed space also plays a role in work productivity. Therefore, the drivers of my design are understanding the flow and needs of each specialty, functionality, ergonomics, comfort, patient privacy, visual/spatial appeal, environments which look good on day one and for many years to follow, ability to be maintained, and healthy as well as healing environments. This is achieved through thorough study of materials, equipment specifications, and practice of standard laboratory guidelines.
TABLE OF CONTENTS 9
Introduction
Mood board
18
10
Site Analysis
Product and Material specifications
20
12
Case study
Layouts
25
14
Concept
Views
38
16
Zoning
Bibliography
52
INTRODUCTION Role of Diagnostic Laboratories in Healthcare Diagnostic tests improve patient care, contribute to the protection of consumer health, and help to limit healthcare spending by finding potential problems sooner.
Today, laboratory is an important component in healthcare and is widely acknowledged as the seat of medicine. Most critical treatment decisions are based on laboratory results and with the advent of Information Technology and computers, people are becoming more health conscious.
In the developing world, where infectious diseases are the major causes of death and which account for more than half of all deaths in children, an important contributing factor to the enormous burden of ill health is the lack of access to diagnostic testing. Accurate diagnosis usually requires a specific diagnostic test, often involving access to a diagnostic laboratory.
Good quality diagnostic tests are of prime importance in effective disease control and reducing the burden of infectious diseases. Diagnostic tests are also often used in epidemiological studies and drug resistance surveillance. A well-designed work-place can drastically improve employee performance, satisfaction and well-being. The many parameters of a successful healthcare project, are the drivers of the design: understanding the macro and micro needs of the entire lab in detail; understanding and creating an efficient infrastructure for the flow of products and staff in and out of the facility as well as between different parts of the facility, flexible environments which allow for growth and change, comfort, ergonomics, and visual/spatial appeal, environments which look good on day one and for many years to follow, ability to be maintained, and healthy as well as healing environments A well-defined established set of criteria in terms of qualification, infrastructure or equipment for setting up a laboratory must be practiced.
AIM To design a diagnostic centre OBJECTIVES • Implement laboratory standards and follow design guidelines. • Ideal and specific material usage. • Architectural considerations and specifications - lab layout and path of workflow; ergonomic features in furniture /workstation /counters; spatial provision for equipment. • Study lab equipment specifications that affect designing. • Accommodation requirements and general guidelines – support spaces, service areas. • Include garden design OUTCOME A functional working space that ensures staff, patients, community benefit from green design, perfomance and efficiency.
SITE ANALYSIS
LEGEND Residential
Mercantile
PGs, Apartments Educational
Shops, showroom Industrial
Schools Institutional
Factory Business
Hospitals
Banks
BBMP Office
Office
Assembly Bus stops Places of worship Restuarants
Plot
LOCATION 3, Varthur Main Road, Ayyappa Layout, Chandra Layout, Marathahalli, Bengaluru, Karnataka - 560037
Vegetation
Accesibility
Accesibility is a crucial factor. This plot is one such area that is accessible to a large influx of patients (ease of access). And an added advantage is that there are no such diagnostics around this plot.
Solar and wind analysis
CASE STUDY COLUMBIA ASIA HOSPITAL Whitefield, Bengaluru
ANAND DIAGNOSTIC LABORATORY
Shivaji nagar, Bengaluru
Drive- through blood collection service The whole idea is to enhance the convenience for customers and help them save time and effort. Extensive planning and layout modifications have been done to allow for smooth flow of the vehicles and to ensure privacy while the tests are done. The service allows customers to drive through to the sample collection station in their cars without having to park the cars in a different location and then walk up to the facility to get their tests done. Customers are attended by technicians while they are seated in their cars.
An observation of the mechanical and electrical systems in the hospital along with a detailed analysis of laboratory layout and workflow. Inquired design specificatiosn in the radiology derpartment.
EBISU DIAGNOSTICS AND EYE CARE CENTRE
HSR Layout, Bengaluru
Study of the phlebotomy section and the fully automated laboratory.
CONCEPT ZONING
CONCEPT
CIRCULATORY SYSTEM
The movement of blood and nutrients around the human body. The essential components of the human cardiovascular system are the heart, lungs, blood and blood vessels. It includes the pulmonary circulation, a "loop" through the lungs where blood is oxygenated; and the systemic circulation, a "loop" through the rest of the body to provide oxygenated blood.
In architecture, the concept of circulation isn't so different - it refers to the way people, the blood of our buildings, move through space. In particular, circulation routes are the pathways people take through and around buildings or urban places. Circulation is often thought of as the 'space between the spaces', having a connective function, but it can be much more than that. It is the concept that captures the experience of moving our bodies around a building, three-dimensionally and through time.
Clinical pathology is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids. Therefore, a concept related to this was considered ideal. Planning and zoning will reflect the functioning of the human circulatory system.
Supply - Circulation of samples/ walk- ins to different sections from the reception. Return - Convergence of reports to one area from their respective sections. Exchange of data and reports to support the functioning of the office space. Major supporting areas such as -services, admin, waste management and staff lounge.
ZONING GROUND FLOOR
Lab access Sample circulation Report circulation Office, technical space Common access path
FIRST FLOOR
Lab access Sample circulation Report circulation Office, technical space Common access path
MOOD BOARD Mood board for the entire project space Colours that elicit high levels of pleasure with low levels of arousal are most likely to induce a state of calm, whereas those causing displeasure and high levels of arousal may provoke anxiety. The short wavelength blues and greens generally elicited more pleasure than the longer wavelength reds and yellows in the comprehensive study by Valdez and Mehrabian, while no consistent patterns were observed between hue and arousal.
Beneficial effects of visual art on health are due to positive distraction. Positive distraction is a term used to describe the belief that environmental features can elicit positive feelings, hold attention and interest and, therefore, reduce stressful thoughts.
Laboratory and radiology section
PRODUCT AND MATERIAL SPECIFICATIONS CEILING
FLOORING
Laboratory and radiology section
Laboratory and office space
Suspended Ceiling Grid Ceiling tile - Mineral Fiber
Quartz Flooring System description: Heavy-duty, decorative epoxy trowel quartz mortar, chemically resistant seamless mortar base resinous flooring with integral cove base
Flexible ceiling tile that is fire resistant (A1 Class), waterproof, asbestos-free, highly light reflective (necessary for a lab working space). It is also effective in noise control (sound absoprtion), heat isolation and they are impact resistant (can be readily removed and replaced). 30-Year Limited System Warranty against visible sag, mold/mildew, and bacterial growth
Brand: Armstrong ceilings ULTIMA health zone
Radiology section
Office space Open Ceiling With Fiberglass baffle Material - Fiberglass core encapsulated in Sailcloth. Architecturally decorative, light-weight panels that have high acoustical performance and are moisture, chemical resistant. Custom enginered and manufactured.
These floors possess superior impact and abrasion resistance, and also maintain nonslip properties throughout the years. They are usually accompanied with an integral cove base for easy clean-ability and maintenance. The lack of seams in these floors make for a naturally anti-microbial surface.
Brand: Acoustical services pvt ltd. Bengaluru
Antistatic vinyl flooring Rooms intended to support image-guided or minimally-invasive procedures should be welded seam sheet vinyl flooring with an integral base. Skirting- aluminium Washroom Ceramic tile with a ceramic tile base.
Brand: Hanwha Corona Premium
SURFACE FINISH
RADIATION SHEILDING
Laboratory and radiology section Countertop Max Resistance Panels - FunderMax Double cured urethane acrylic coating, chemical and highly mechanical resistant, easy to clean, silicone-free. Certification SEFA 3 approved, FSC, PEFC, Greenguard, EPD, EN348, ASTM, contributes to LEED, Recycling and green manufacturing (green electricity and district heating)
Brand: FunderMax Code: 0074 Pastel grey
X-ray equipment must be installed in adequately shielded rooms to ensure that public in the vicinity of the x-ray installations are not unduly exposed to x-ray radiation. The adequacy of shielding depends on the material and thickness used for this purpose. Different materials can be used for shielding. However, brick or concrete are considered the best materials, as they are easily available, economical, and have good structural strength. While lead is a suitable shielding option for energies encountered in diagnostic x-rays, it is a weak structural material with tendency to lose uniformity and needs periodic radiation survey to ensure its continued adequacy. Also, Lead poses a serious environmental hazard and the use of it is being discouraged the world over. Guidelines for sheilding of X-ray installations
Shelving HPL- High Presure Laminates • Tough and easy to look after surfaces with Anti-Bacterial protection for everyday use Brand: Greenlam Laminates Code: 297 Blue Galaxy Cabinets Fire retardant laminate For locations demanding extra fire retardancy from surfaces • Meeting international standards for fire retardant grade laminate finishes Suede Finish
Brand: Greenlam Laminates
Office space Anti-fingerprint laminate Makes the surface impression free This laminate makes the surface non-porous and hydro-repellant making it easy to clean of impurities and grease mark. It is anti-bacterial too.
Brand: Greenlam Laminates Code: 9851 White X
9” brick wall Lead-lined glass in console room 1’ thick RCC floor and roof slab Lead lined AC ducts in radiology section
AVT- Anti- vibration table
Anti- microbial shield
Ergonomically styled, the AVT offers a solid and stable surface specifically for vibration free requirement during measurement. When used in tandem with a balance, the table allows the balance to perform with marked precision, despite air currents or movements that might cause readings to fluctuate. Our AVTs offer excellent protection from vibrations and oscillations, which would otherwise distort the weighing result. Solid framed base can be levelled easily, along with Polished granite slab that provides solid support, and combined with specially designed rubber vibration reducing pads, it makes for an anti vibration table that gives user the vibration relief needed for precision weighing. The table comprises two separate parts: An internal working surface consisting of a thick granite slab mounted on adjustable rubber shock absorbing mounts along with Heavy duty Scew Supported Mounts having Rotational Axis. All our tables are manufactured with rugged construction for durability, easy setup, adjustable levelling feet to compensate for uneven floors, and scratch proof top granite slab to prevent surface damage.
This shield works on advanced Lysis technology, creates a colorless invisible barrier on any surface which lasts up to 12 months, even after repeated cleaning. All kinds of viruses, bacteria, mold, mildew, pathogens can be sealed with one use. This Smart Shield can be used on a variety of hard or porous surface. • Eliminates viruses, airborne germs and bacteria • Comes with 99.99% instant germ-killing technology • Stops mould and mildew build up • Is non-toxic and hypo-allergenic • Helps eliminate bad odours • Provides long term protection As it is applied via fogging, there is no chance of any oil stain. Also, it eliminates bad odour. It comes with 99.99% germ-killing technology, which not only sanitizes your surroundings but also gives overall protection from germs and viruses. As it is non-toxic and doesn’t use any alcohol, dehydration process, or poison, it is safe for children and pets.
Company: Space Design India, a modular lab furniture company Location: Laboratory
Track curtain Type: Brand : Material: Cover Strip: Mounted:
Cubicle Window Techs Pvt Ltd. Aluminium PVC Wall Or ceiling Mounted
Antimicrobial Shield is a Made in Australia product, by Permagard Group, imported & sold here by Permagard India. Application: On handrails, door handles
Blood donor couch
Illuminator
Brand : Diagnovision Size : 1880*830*1300 mm Color: Variable Material: MS Adjustable Seat
X-ray film illuminator approximately 1'4” H x 1’10” W x 6'' D. This is a wall mounted type unit with a continuous viewing surface (acrylic sheet). The unit's balanced-light viewing is assured by the 32W circular fluorescent lamp. It provides 500 feet candles of cool operation across the entire viewing surface.
Specification: · Comfortable upholstery with good density · All metal sections are pre-treated and epoxy powder coated. · Equipped with 2 blood test splints.
Paints
Plants
Royale Health Shield Luxury Emulsion is equipped with Silver Ion Technology which kills 99% of infection-causing bacteria on the painted surface, thus, providing a more hygienic environment at home. This healthy paint has low VOC, and it also improves indoor air quality by reducing formaldehyde, a harmful pollutant.
Sansevieria trifasciata, Snake Plant (var. laurentii) It is a popular houseplant with leaves having dark green centers that are surrounded by light yellow to gold edges. • Best plant for AC rooms, office desk, etc. • Zero maintenance plant. • Best indoor plant for low light condition • Popular houseplant with wavy cross stripes. Chlorophytum, Spider Plant produces oxygen whilst purifying the air in your home and office by absorbing carbon monoxide, formaldehyde and xylene. Additionally, Spider Plants are non-toxic and are in fact edible, making them safe for pets and young children.
Ficus robusta, rubber plants improve indoor air quality. Their large leaves can absorb airborne chemicals and break them down, rendering them harmless. Rubber plants also eliminate bacteria and mold spores in the air.
Wash Basin Location: Washrooms, Radiology section Brand: CERA
Ceramic WB Location: Pathology laboratory Impervious to chiping and cracking, heat and stain resistant.
Rectangular SS WB
Indoor hanging vine Hedera Helix, Ivy It can easily adapt to many light conditions. This fast-growing vine has evergreen foliage that remains green even in winters. Requires indirect sunlight. English ivies can remove toxins like: benzene,formaldehyde,xylene,toulene. These toxins can cause sick building syndrome. Sick building syndrome is when people feel ill when spending time in a particular building or room.
LAYOUTS
Stucco Ramp MCM travertine cladding Collapsible shutter door basement parking
WEST ELEVATION
RCC Slab - 1’ RCC beam AC duct Grid ceiling Gypsum ceiling 4” Door lintel lvl. - 7’ Bucky- xray standing wall unit
Countertop ht. - 28” Switch board lvl - 24” 4” aluminium skirting FFL GL
RCC Slab - 1’ RCC beam AC duct Grid ceiling Gypsum ceiling 4” Window sill lvl. - 8’6”
Cabinet Countertop ht. - 36” Switch board lvl - 24” 4” aluminium skirting FFL GL
VIEWS
BASEMENT • Drive - through Sample collection area, cabin space Inspired by the drive- through at Anand Diagnostics (Bowring tower branch). It is convenient, saves time and effort. Designed in such a manner to ensure privacy and comfort. • Lift, staircase access
GROUND FLOOR RECEPTION
ULTRASOUND ROOM 1 • Vinyl flooring has been used, complying with the Indian health facility guidelines std components • 11/2 leaf door, with framed view window
XRAY ROOM • Enough space is provided in order to allow the change in bed orientation (vertical/ horizontal) • Provision of changing room with a track curtain • Some radiation-producing equipment and radioactive materials require the use of special shielding. Generally, cobalt and cesium irradiators should be placed in separate, small rooms that are lead lined or constructed with dense concrete walls, floors, and ceilings to shield the source. These facilities and the equipment used in them add many tons of extra weight to the structure and require special consideration during structural design. Hence, the floor and roof slab are made of RCC - 1’ thk. And walls are 9” thk brick walls. • chest stand must be placed in suc a way that it is on the opposite wall of the entrance door and the control console. • Control console should be positioned as far away as possible from the x-ray tube.
MAMMOGRAPHY General setup includes a Control console, equipment and protective barrier in the same room. • Inorder to provide better radiation sheilding, the console is placed in the console room unlike the general setup. • Positioning of equipment should be as far as possible from the door and the control console. • Mobile protective barrier with lead equivalent glass viewing window should be positioned in such a manner that the operator is completely shielded during the exposure.
FIRST FLOOR Phlebotomy and Reception area Each collection station has adequate space to accommodate a phlebotomy chair for the patient, shelves to hold supplies (lockable), access to computer. All reports of pathological examinations conducted on one site will be dispatched through a central administrative office. The office has a dedicated area for housing printers and one computer workstation per desk and stoeage space for records.
PATHOLOGY • Direct and unobstructed paths to exits. • Modifiable to provide reasonable accommodations to workers with disabilities. • Adequate amount of separate break area(s) to discourage eating and drinking in labs - staff lounge. • Glass panels or viewing ports to facilitate interior observation in event of accident.
• Optimum door width for all analytical/pre-analytical spaces are considered. • Self-closing doors are recommended to aid in infection control.
MICROBIOLOGY • Lab coat hangers are located near the en- • Preparation and sterilization of culture media - LAF/ culture room. trance to the lab. • Wall surfaces are free from cracks, un- • Solar protection should be provided to minimise solar gain and control glare. sealed penetrations, and imperfect junctions with ceiling and floors. This may include the use of sun shades, • Materials are washable with strong desunlight reduction glazing and window blinds. tergents and disinfectants and be capable of withstanding the impact of normal • A sluice will also be required where urine samples are handled. traffic. • Automatic fire suppression is required for all new laboratory installations where flammable materials are used and/ or stored.
HISTOPATHOLOGY • Shelving has chemical resistant finish surfaces. • Workbenches are organised according to the type of analysis that is performed, with adequate space for bench-tops equipment and enough space to place SOP while in use and display job aids. • Open spaces between and under benches, cabinets and equipment are accessible for cleaning. • Worktops are monolithic or have a minimal number of joints between them which can sometimes harbor contaminating microorganisms.
• Wastewater from clinical laboratories may contain trace amounts of metals (lead, mercury, zinc, etc.), volatile organic compounds (formaldehyde, etc.), and other chemicals prohibited by the local wastewater authority. Therefore, a filter is provided under the sink encolsed in cabinet. SS sinks are used in the laboratory. Stainless steel is an alloy, that has elements that impart useful properties such as enhanced formability and increased corrosion resistance.
Chemical storage - vented Lower section for light sensitive chemicals
SS ssink with eye wash station
• At least one emergency eyewash station at a sink must be installed in the laboratory where hazardous materials may be used. Eyewash station is provided adjacent to clinical hand-wash basins. • Workstations have provision for safe cable management like provision of an open tray under the work surface.
Anti- vibration table
• Flammable cabinets are vented. All cabinets used to store chemicals that are toxic by inhalation or have a very low odor threshold are required to be vented. • Storage space must be adequate enough to hold supplies for immediate use and thus prevent clutter on bench tops and in aisles. • Provision of adequate number of rated flammable storage cabinets.
• Storage of spare parts Facilities for storing aprons and personal items is provided outside the laboratory working areas - Staff lounge. Service rooms to accommodate autoclaves - sluice room. Sinks for cleaning glassware.
GROUND FLOOR LOUNGE AREA VIEW Walkthrough https://drive.google.com/file/d/1m4H9XyBgLQJAigK88BUWjlrLtDZ5VpoD/view?usp=sharing https://drive.google.com/file/d/1pF05W634Puv4_kytTQxjmo9scDr7fJBi/ view?usp=sharing https://drive.google.com/file/d/1tmeY9Ti42eEsPYAvvNPUuosxkTvyL2Eo/ view?usp=sharing
During the coarse of the last six months of this research, I was able to enhance my knowledge in the field of healthcare design. It surely has been favourable in advancing my career in the same field.
BIBLIOGRAPHY Websites
Books/pdfs
1. @suzanne__cherian (Instagram handle)- wall art 2. hhbc.in/diagnostic-care-centre-planning-and-designing/ 3. www.sciencedaily.com 4. maiinspiration.wordpress.com/2016/11/09/understanding-mailab-chem-ebc/ 5. www.greenlam.com/india 6. www.archdaily.com/catalog/us/products/7322/max-resistance-fundermax 7. www.fundermax.at/en/interior/surfaces/detail/resistance.html 8. www.spav.ac.in/arch-thesis.html 9. spacedesignlabs.com/fume-hoods/ 10. e hs.stanford.edu/manual/laboratory-standard-design-guidelines/laboratory-design-considerations 11. cleanhandle.se/ 12. www.citymetric.com 13. permagardindia.com/product/antimicrobial-shield/ 14. design-milk.com 15. www.engadget.com 16. www.exportersindia.com/acoustical-surfaces-private-limited 17. www.researchgate.net/publication/252307449_Health_Benefits_of_Gardens_in_ Hospitals 18. uk.fraster.dk/addhome/paint-book-for-felt-carpets/ 19. www.coatings2go.com/pages/instructions-for-use 20. www.ncbi.nlm.nih.gov/pmc/articles/PMC2996524/ 21. https://www.youtube.com/watch?v=e7ZNEhGRlm8 22. https://www.youtube.com/watch?v=sEn9v-WLO30 23. https://www.youtube.com/watch?v=yOBIcNRl93A 24. www.certainteed.com/
• Indian health facility guidelines standard components • US Dept of Veteran Affairs – Construction & Facilities Management • GUIDELINES FOR LABORATORY DESIGN- Health, Safety, and Environmental Considerations- Fourth Edition Louis J. Diberardinis, Janet S. Baum, Melvin W. First, Gari T. Gatwood, Anand K. Seth • Guidelines for shielding of x-ray installations • yale university -guidelines for safe laboratory design, Prepared by Yale University, Environmental health & safety; Revised june 2016 • International Journal of Pathology and Clinical Research; Ng and Yeo. Int J Pathol Clin Res 2016, 2:024,ISSN: 2469-5807,Volume 2 | Issue 1 • Guideline Document For Design Of Bsl 2 Labs (District Hospitals, Chc And Phc) Level