Guidelines for Design and Construction of Hospital & Healthcare Facilities

Hospitals are governed by more rules than almost any other building type, and those rules come from several places at once: national building codes, provincial healthcare regulators and international technical standards. This guide brings the main hospital design and construction guidelines together in one place for owners, doctors and investors in Pakistan. It explains what each set of guidelines covers, how they apply at each stage of a project, and the practical design rules that make a healthcare facility safe, efficient and ready for licensing.

How the Different Guidelines Fit Together

No single document tells you everything needed to design a hospital in Pakistan. In practice, design teams use a layered approach:

• Legal minimums come from the Building Code of Pakistan, local building regulations and the provincial healthcare commission. These must be met.
• Clinical planning guidance such as the FGI Guidelines and UK Health Building Notes gives room sizes, adjacencies and departmental layouts that are widely used where local rules are silent.
• Engineering standards such as ASHRAE 170, NFPA 99 and HTM 02-01 define how ventilation, electrical and medical gas systems should perform.
• Infection-control guidance from WHO and national programmes shapes finishes, hand hygiene, isolation and waste handling.

The design brief should state which references the project will follow, so that architects, engineers and contractors all work to the same standard.

Guideline 1: Start with a Clinical Brief and Master Plan

Every good hospital design begins with a written clinical brief listing the services, bed numbers, theatres, imaging and support departments. For larger sites, a master plan shows how the hospital can grow over time without blocking future expansion. A hospital feasibility study tests the brief against demand, site and budget before design starts.

Guideline 2: Plan Departments Around Clinical Adjacencies

Some departments must be close to each other because patients move between them quickly or often. Key adjacencies include:

For a full list of departments, see the complete list of hospital departments and services.

Guideline 3: Separate Circulation Routes

Hospitals work best when different flows do not cross. Design for separate or time-separated routes for outpatients and visitors, inpatients on beds, staff, clean supplies and sterile goods, and waste and soiled linen. At minimum, provide a dedicated bed lift, a service lift where possible, and corridors wide enough for two beds or trolleys to pass in inpatient areas.

Guideline 4: Room Standards for Clinical Spaces

Room sizes should allow staff to work around the patient with the necessary equipment. The figures below are typical planning considerations drawn from international guidance, not legal requirements, and the final sizes should be confirmed against the standard the project adopts and the licensing body’s requirements.

Guideline 5: Engineer the Building Services Properly

Ventilation

Healthcare ventilation is about controlling infection as much as comfort. ASHRAE 170 sets air change rates, filtration and pressure relationships for spaces such as theatres, isolation rooms, laboratories and sterile stores. Split units alone cannot meet these requirements in critical areas.

Electrical systems

NFPA 99 and similar standards classify spaces by risk and require essential power, automatic transfer to generators, UPS for life-support loads and isolated power systems in some locations. Reliable earthing and segregated circuits are essential.

Medical gases

Oxygen, medical air, vacuum and other gases should be designed, installed and tested to a recognised standard such as HTM 02-01 or NFPA 99, with zone valves, alarms and full commissioning. See ACCO’s guide to medical gas pipeline systems.

Water and drainage

Adequate storage, safe drinking water, hot water at controlled temperatures, treated water for dialysis and sterilisation, and separate handling of laboratory waste are standard requirements.

Guideline 6: Fire and Life Safety

Because many patients cannot evacuate themselves, hospitals use a defend-in-place strategy. Floors are divided into fire compartments so patients can be moved horizontally to safety. Fire-rated construction, protected stairs, smoke control, detection, alarms and sprinklers where required are designed together, following NFPA 101 principles and local fire regulations.

Guideline 7: Infection-Control Finishes and Details

• Seamless, coved flooring in clinical areas
• Smooth, cleanable and impact-resistant walls
• Sealed, flush ceilings in theatres, ICUs and isolation rooms
• Hand-wash basins at the point of care with hands-free taps
• Separate clean and dirty utility rooms and secure clinical waste storage

These details follow WHO infection prevention principles and are checked during licensing inspections.

Guideline 8: Structural Safety and Resilience

Hospitals are essential facilities and should remain usable after an earthquake or other disaster. Structural design should follow the Building Code of Pakistan seismic provisions with the importance factor for essential facilities, and non-structural elements such as ceilings, pipes and equipment should be braced.

Guideline 9: Accessibility, Dignity and Wayfinding

A hospital is used by people who are ill, injured, elderly or disabled, often accompanied by anxious relatives. Good guidelines therefore go beyond technical systems and cover how people experience the building.

• Step-free access: ramps with gentle gradients and handrails, level thresholds, and lifts serving every patient floor
• Accessible toilets: on every floor used by patients and visitors, with grab rails and space for a wheelchair and an assistant
• Privacy: curtains or partitions between beds, private consultation rooms and separate areas for female patients where culturally expected
• Wayfinding: clear signage in Urdu and English, colour coding of departments and simple, legible floor layouts
• Attendants: waiting areas, prayer spaces and refreshment facilities for families who stay with patients

Common Mistakes to Avoid

• Starting design without agreeing which standards the project will follow
• Using split air conditioners in theatres, ICUs and isolation rooms
• Leaving too little floor-to-floor height for ducts and medical gas pipes
• Designing to the building code but ignoring healthcare licensing requirements until the end
• Skipping commissioning and testing of ventilation, power and gas systems before opening

How Guidelines Apply Through a Project

Frequently Asked Questions

Conclusion

Hospital design and construction guidelines exist to protect patients and staff. By agreeing the standards at the start, planning departments around clinical adjacencies, engineering ventilation, power and medical gases properly, and building in fire safety, infection control and seismic resilience, owners can create facilities that pass licensing and serve their communities well. For more answers, see ACCO’s hospital design and construction FAQs.