Planning and Design 115

1.8 ENGINEERING SERVICES

1.8.1 Mechanical engineering

The significance of the combined mechanical-electrical components of a

hospital can be deduced from the fact that the cost of installing the equipment is
normally about one -third of the total cost of the building. The operation and
maintenance costs are also more than the combined expenses for all other parts
of the building. Furthermore, their expected life may be only one-half or even one-
third that of the buildings.

The primary objective of the designer of the system, therefore, is to bring

down the initial cost and evolve a design that has a reasonable maintenance cost.
This can be done by providing the simplest mechanical devices possible while
using high-quality materials; thus, the number of repairs will be reduced as will
costs for labour, fuel and power. It will also ensure that. the maintenance is within
the capability of local resources. The design should also include adequate
protection of the health and safety of staff, public and patients.

The following is a checklist of the components to be considered in the

mechanical design of a hospital. Engineering consultants should be brought in at
a very early stage of the designing process; consultation should also take place
with the necessary government authorities.

General provisions

General description of installations

Fuel

Proposed fuel, with justification

Estimated monthly and maximum daily fuel consumption

Storage of fuel, when applicable

Primary source of energy

Type of heating, temperatures and pressures

Preliminary load and breakdown of main components

Provision for future expansion

Number and capacity of boilers or heat exchangers

Description of boiler and auxiliaries, control and stand-by

Schematic diagram

Sketch of major operational features and maintenance access

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Primary distribution system

General description

Domestic heating

Internal design criteria

External design criteria, frequency of use

Infiltration rate assumed

Heating media, temperature, pressures

Preliminary heat load, allowance for future expansion

Scheme of circuitry

Types of heat emitters in different areas

Type of control operation

Piping materials, types of pump

Area to be heated for each type of heating (m2)

Means of absorbing thermal expansion of pipes

Feed and expansion provisions

Domestic hot water

Means of heating

Design criteria, storage, maximum demand with time

Preliminary storage and heat-up capacity

Size of generators, allowance for future expansion

Type of piping

Type and capacity of cold feed system

Steam services (other than for heat or hot water)

Locations (e.g., kitchen, laundry, central sterile supply department)

Required pressure

Criteria for load calculations

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Preliminary heat load

Allowance for extension

Ventilation and air-conditioning systems

Description of systems (central or split type)

Types of fan

Areas served by each system

Typical circuitry schemes

Internal design criteria

External design conditions

Design criteria for assessing air volumes:

- supply air temperatures;

- ventilation to remove heat, moisture, odours, fume~;

- minimum rates of air change per hour;

- fresh air and recirculation requirements

Number and capacity of fans and air-handling plants

Sound levels

Control operation and energy conservation

Filter types and efficiencies

Type of cooling and heat rejection system

Type of humidification

Design criteria for cooling equipment:

- ambient conditions for cooling towers, etc. (including frequency if

these are exceeded)

- chilled water temperature

- condenser water temperatures

Preliminary cooling load

Allowance for expansion

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Numbers and capacity of cooling and heat rejection plants

Air-conditioned area (m2 )

Ratio of design cooling load: air-conditioned area (W/m2)

Medical gas services (when piped)

Gases used (e.g., vacuum, compressed air, oxygen)

General description of system

Allowance for extension

Types and capacities of compressors and vacuum pumps

Proportion of stand -by plant used

Fire protection system

Type of system, coverage and classification

Location of control and indicator panels

Manual call points, general locations of alerting devices, type and

sequence of operation

Details of water supply for fire-fighting

Dry/wet riser system

Special service systems

Description and justification of any other service

Instrumentation, alarms, monitors and controls

General description of scope and philosophy

Type, of equipment proposed

(1) Heating, air-conditioning and ventilation

Maintaining a pleasant temperature, about 22°C, is the design target for

heating and air-conditioning systems in cold and warm countries. Higher or lower
temperatures may be attained in specific areas through independent units to suit
individual requirements.

Heating and air-conditioning and ventilation systems are related both in

physical installation and in their function in the hospital departments. Air-
conditioning differs from ventilation in that the temperature and humidity of the air
are controlled in the former. It is expensive to provide, operate and maintain,
however, and it should be installed only in areas
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where it is essential, such as in operating theatres. Wherever possible, therefore,

hospital design should minimize or eliminate the need for air-conditioning and
mechanical ventilation by providing occupied spaces with adequate windows,
cross-ventilated where possible, and by using internal areas for specific purposes,
such as operating theatres, darkrooms and storerooms. Careful attention to siting
and design to take advantage of any cooling breezes and the use of trees to
shade the building can help in optimizing natural conditions.

The ventilation of a hospital is dictated by health, comfort and safety

standards. In areas where excessive heat or moisture is generated, or where
objectionable odours, dust or toxic gases are present in the atmosphere, afresh
air supply and exhaust system must be provided. Electric fans can be used to
augment the system as and where necessary.

Ventilation associated with kitchen, laundry and refrigeration equipment must

be designed by qualified engineers in coordination with the users. Special care
must be taken in designing extraction systems over cooking installations to avoid
any fire hazard due to build-up of fat in exhaust ducts. Filters to trap fat carried in
the exhaust fumes should be accessible and should be cleaned regularly.

(2) Technical requirements

Heating, ventilating and air-conditioning systems should meet the following

guidelines:

(a) They should provide the temperatures shown in Table 3 and a relative
humidity of 50-60%.

Table 3. Temperatures to be provided in a district hospital

Area Temperature (oC)

Operating theatre 21-25

Delivery room 21-25

Recovery room 24

Nursery 24-26

Intensive care 24-26

(b) All air supply and air exhaust systems must be operated mechanically.
Fans serving exhaust systems should be located at the discharge end
of the system. Minimal acceptable ventilation rates in the major areas
should be as shown in Table 4.

(c) The ventilation system should be designed and balanced to provide the
pressure relationships shown in Table 4.

(d) The ventilation systems serving sensitive areas, like operating theatres,
delivery rooms, nurseries and sterile rooms, must be equipped with at
least two filter beds.
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The exhaust from all laboratory hoods in which infections or radioactive

materials are handled must have filters with 99% efficiency.

Table 4. Ventilation system

(e) All filter frames must be durable

and provide an airtight fit with the
enclosing ducts. All joints between
segments and the enclosing ducts
should be gasketed or sealed to
provide a positive seal against air
leakage.

(f) Ducts that penetrate structures

to protect against X-ray radiation
should not impair its effectiveness.
Ducts that pass through fire walls
must be provided with automatic fire
doors on both sides of the wall.
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(g) Duct linings, coverings, vapour barriers and the adhesives used for applying
them must have a flame-spread classification of not more than 25 and a smoke-
developed rating of not more than 50. Acoustic lining materials should not be used
inside duct systems serving sensitive areas, such as operating theatres, nurseries
and isolation rooms.
(h) Cold-air ducts should be insulated wherever necessary to maintain the
efficiency of the system and to minimize condensation.

(i) Duct systems serving hoods should be made of corrosion-resistant materials.

1.8.2 Electric and electronic engineering

Power is supplied to hospitals in most countries by public or private utility

companies. In either case, the hospital must have a back-up gasoline- or diesel-
driven generator for use in the case of breakdown, at least for emergency,
delivery and operating rooms, selected corridors and exits, and stairs. In addition,
battery or automatic generators may be used.

(1) Components in the electrical design

The following is a checklist of those electrical components that should be

considered in designing a district hospital. Engineering consultants should be
brought in at a very early stage of the designing process. Consultation should also
take place with the local electricity supply company and with any necessary
government authorities regarding the mode and system of supplying high- and
low-tension electricity to the hospital.

Electricity supply

Point of mains supply

Maximum capacity
Supply and incoming voltage
Tariffs and meterjng
Agreements with supplying authority
Alterations to existing supply

General description

General description of any existing system (mains and essential

services)
Technical data on existing installation (maximum capacity, assessed
connected loads and measured maximum site demand, cable
types, protection methods and discrimination)
General description of new system (with load estimates for both
essential and non-essential supplies)

Local distribution

General description of sub-main and sub-circuit system (routes, board

locations and area of coverage )
Cable types and sub-main load estimates
Installation and wiring methods
Protection methods and discrimination

Earthing

Method adopted for each continuity and electrode system

 Planning and Design 122

Sub-stations

Type and accessibility

Transformer and switch-gear ratings and type
Capacity for increased load, provision for expansion

Stand-by plant

Type and ratings

Capacity for increased load
Controls and alarms
Sensory circuits and starting
Fuel type and stored quantity
Provisions for maintenance, including access

Distribution boards

General description
Sub-main or sub-circuit protection
Fault rating
Capacity for increased load
Services supplied (assessed loads and area covered)

Special safety and earthing

Area, location and classifications

Medical procedures carried out and equipment used
Type of protection chosen, with justification

General power

Known major equipment, with assessed loads (e.g., kitchen and laundry
equipment, autoclaves, mechanical services plant, medical
equipment)
Typical location and numbers of plug sockets, including number per
circuit
Connections to essential supply, with load estimate
Hazardous areas and provisions proposed

Interior lighting

Area classifications
Illumination levels
Anti-glare design
Types of fittings (surface, suspended, concealed)
Lamp type and colour
System data: mounting height, hours in use, reflectance
Estimated connected load and load per circuit
Connections to essential services with estimated loads

Exterior lighting

Areas served and purpose

Type of fitting
Control and wiring method, including routes

Lightning protection

Need
Design criteria
Description of proposed design
 Planning and Design 123

Communications

Justification for each type of area

Type of system
Areas served
Wiring method

Other features and safety considerations, like call systems,

intercommunication systems, fire alarm systems and other special installations
may be included as required in the design and computations for the total electric
power requirements.

(2) Lighting

Guidelines for hospital illumination are shown in Table 5.

 Planning and Design 124

(3) Emergency electrical services

As mentioned above, the district hospital should have a reliable alternative

source of power, in addition to the normal electrical service, for emergency
lighting, for operation of essential equipment, and for the safety of its occupants.
The alternative source should be from:

• a generator, when the normal service is supplied from one or more

central transmission lines, or
 Planning and Design 125

• an emergency generating set or a central transmission line, when the

normal supply is generated on the premises.

The emergency generating set, including the prime mover, should be located
on the premises, away from the operating department and the ward block. It
should be reserved exclusively for supplying electricity in an emergency. The
recommended circuits to which power should be provided are:

Lighting:

• all exits, including exit signs, stairways and corridors

• surgical, obstetrical and emergency room operating lights

• nursery, laboratory, recovery room, intensive care unit, nursing station,

labour room and pharmacy

• generator set location, electrical switch-gear location and boiler room

• one or two lifts, if needed for emergency

• telephone operator's room

• computer room, when available

Equipment

• nurses' call system

• alarm system, including fire alarm

• fire pump and pump for central suction system

• blood bank refrigerator

• sewerage or sump lift pump, if installed

• equipment necessary for maintaining telephone service

• equipment in operating, recovery, intensive care and delivery rooms

• one electrical sterilizer, if installed

Heating, cooling and ventilation system

• operating, delivery, labour, recovery, intensive care unit, nurseries and

patient rooms.

The capacity of the emergency generating set should be 50-60% of the

normal electrical load of the hospital, to maintain the minimum level of services.
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The emergency electrical system should be so controlled that, after

interruption of the normal electric power supply, the generator brings full voltage
and frequency within 10 seconds to all the emergency lighting and equipment
listed above. Lights powered by storage batteries can be provided to augment the
emergency lighting during the period of transfer switching, immediately following
the interruption of normal service; however, these should not be used to substitute
for the generator set. A typical diagram of an incoming electricity supply and of
how the generator is relayed is given in Figure 77.

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