Hospital Design for Infection Control in Pakistan: Zoning, Finishes and Flow

Healthcare-associated infections are infections that patients pick up while receiving care. Many are prevented by clinical practice such as hand hygiene, sterilisation and antibiotic stewardship, but the building has a large influence too. Hospital design for infection control in Pakistan is about planning layouts, airflow, surfaces and services so that the right behaviour is easy and the wrong one is difficult. A hand-wash basin in the wrong place goes unused; a shared corridor for clean linen and waste invites contamination; a porous floor cannot be disinfected. This guide explains the design measures that matter most, from master planning down to finishes.

Why Design Matters for Infection Control

Infections spread through a limited number of routes: contact (hands, surfaces, equipment), droplets, airborne particles, water and contaminated supplies. Each route has a design response. WHO lists the built environment, including materials, equipment and water and sanitation, among the core components of infection prevention and control programmes.

In Pakistan, many hospitals operate in converted or extended buildings where corridors are shared, isolation rooms are improvised and hand-wash basins are few. Retrofitting infection control into such buildings is difficult and expensive. Building it into the design from the start is far more effective.

1. Zoning the Hospital by Infection Risk

The first step is to group departments by risk so that controls can be concentrated where they are needed.

High-risk departments are best grouped together with controlled entry, while dirty functions are placed where they can be reached by service routes without crossing clinical areas.

2. Separating Clean and Dirty Flows

Clean supplies, sterile instruments, food and linen should not share routes with used instruments, soiled linen and clinical waste. Ways to achieve this include:

• Separate service corridors or service lifts for dirty items
• A CSSD laid out in one direction: dirty receipt, wash and decontamination, pack, sterilise, sterile store, with physical separation between dirty and clean sides
• Dedicated clean and dirty utility rooms on every ward
• Waste holding rooms near service exits, with a route to the central waste store that avoids patient areas
• Time-separated movements where the building cannot provide separate routes

Our guide to patient flow in hospital design covers people movements; the same discipline applies to materials.

3. Isolation Rooms

Airborne infection isolation rooms

Patients with infections such as tuberculosis or measles need rooms kept at negative pressure relative to the corridor, so air flows into the room rather than out. ASHRAE 170 sets ventilation rates and pressure relationships for these rooms. An anteroom between the corridor and the room helps maintain pressure and gives staff space to put on and remove protective equipment.

Protective isolation

Patients with weak immune systems, such as those undergoing chemotherapy or transplant care, need the opposite: positive-pressure rooms with highly filtered air that keep contaminants out.

How many isolation rooms?

The number depends on the hospital’s specialties and catchment. Emergency, ICU and medical wards usually need at least some isolation capability. The COVID-19 pandemic showed that hospitals with no isolation capacity had to improvise under pressure, so many owners now plan some convertible rooms. For dedicated facilities, see our infectious disease hospital design guide.

4. Hand Hygiene by Design

Hand hygiene is the single most important infection-control practice, and design determines whether it happens. Good practice includes:

• Clinical hand-wash basins at the entrance to every ward, ICU and procedure area, and within or immediately outside patient rooms
• Alcohol hand-rub dispensers at the point of care, close to each bed
• Hands-free or elbow-operated taps, and basins without overflows to reduce bacterial growth
• Basins positioned so splashing does not reach clean supplies or medication preparation areas

5. Surfaces and Finishes

Every surface in a clinical area must withstand frequent cleaning with disinfectants without deteriorating.

• Floors: seamless welded vinyl or suitable epoxy with coved skirting, so there is no joint between floor and wall where dirt collects
• Walls: hygienic wall cladding or high-quality washable coatings in theatres, ICUs and isolation rooms
• Ceilings: sealed, flush ceilings in theatres and clean areas; cleanable tiles elsewhere
• Doors and frames: smooth, impact-resistant surfaces, with vision panels and hands-free operation where possible
• Furniture and fixtures: minimal ledges, wipeable upholstery and sealed joints

Our detailed guides to hygienic materials for OT and ICU and hospital finishing works compare the options.

6. Ventilation and Air Pressure

Ventilation controls airborne spread. Operation theatres are kept at positive pressure with high-efficiency filtration so air flows from the cleanest zone outwards. Isolation rooms are controlled as described above. Corridors, toilets and dirty utility rooms are exhausted so that odours and contaminants do not spread. Pressure relationships only work if doors are kept closed and walls and ceilings are well sealed, so architecture and HVAC must be designed together.

7. Water Systems and Drainage

Hospital water systems can harbour bacteria such as Legionella and Pseudomonas if water stagnates or sits at the wrong temperature. Designers should avoid dead legs in pipework, keep hot and cold water at safe temperatures, provide adequate storage and treatment, and locate drains and traps so they can be cleaned. Water storage tanks, common in Pakistani buildings because of intermittent supply, need access for cleaning and secure covers.

8. Healthcare Waste Routes and Storage

Hospitals produce infectious waste, sharps, pathological waste and general waste, and each stream must be segregated at the point of generation and stored safely until collection or treatment. Design should provide:

• Space for colour-coded bins in every clinical room and utility room
• Local waste holding rooms on each floor, ventilated and easy to wash down
• A central waste store near the service exit, secured from public access and animals, with a washable floor and drainage
• A collection route for waste carts that does not pass through wards, kitchens or public waiting areas
• Space for on-site treatment equipment if the hospital will treat waste itself rather than use a licensed contractor

Provincial healthcare waste rules apply, and the waste management plan should be agreed with the infection-control team before the layout is finalised.

Infection-Control Design: Good vs Poor Practice

How Infection Control Is Built Into a Project

Infection Control During Construction and Renovation

Construction itself can create risk when work takes place in or next to an operating hospital. Dust from demolition can carry fungal spores that are dangerous to vulnerable patients. Renovation projects should include dust barriers, negative pressure in the work zone, sealed openings, separate routes for workers and debris, and agreement with the hospital’s infection-control team before work starts. This is especially important for hospital renovation and upgrade projects.

Frequently Asked Questions

Conclusion

Hospital design for infection control in Pakistan works best when it starts at the master plan and continues through every detail: risk zoning, clean and dirty routes, isolation rooms, hand-hygiene stations, ventilation, water systems and finishes. These choices make safe practice easier for staff every day. For planning and construction, see ACCO’s hospital construction services.