This question es very interesting. Does it not also include the kind of air-regulation in the hospital? If windows may be opened or not (clima-regulation)? Perhaps your question should describe the kind of hospital building more exactly.

In my opinion, the best would be a separate building and separate personel for those patients with higher intensive watch of personel and tools by a clincal hygienician.

Hi Dr Dietrich.... Thanks for your answer... and yes... my question is more related to the building design itself.... what i mean is that the location of highly infectious patients in the uppermost floors would prevent their contaminated exhausted air from re-entering to the upper floors due to buoyancy (stack) effect. and this case is very well known and happened in a hospital in Meschede, West Germany in 1970  where an outbreak of chickenpox occurred due to this fact. the stairwell served effectively as a chimney and provided access to the upper units of the hospital building . of course it is preferred to put infectious patients in a separate facility... but what is this was not available due t design constrains??

Airborne infection prevention and control in multi-story building is not that simple.If separate building can not be constructed,there are some options: stated from simple to more complex methods,they include: maximizing natural ventilation through open windows and doors on opposite side,Hybrid ventilation(augmentation of natural ventilation by using window extractor fans or by installing wind driven roof turbine), upper room UVGI installation or use of closed mechanical ventilation system.For airborne precaution rooms, it is essential to ensure that they have at least 12 air changes per hour.

I will re-emphasize the hospital surroundings rather than the distribution of patients to wards at various floors in a building.

We live where no town planing exists or is respected, multipurpose buildings erupt from the ground at competitive speed, the land owner is the king, poorer people (over half of the community) build modest structures, richer people ( the privileged few) erect impressive structures for various purposes.

Some hospitals in Africa harbour vectors of infectious diseases such that a visitor or a patient who stays within the hospital premises for 24 hours must subsequently present with a high parasitemia for example without any body associating the increase in parasitemia to hospital visits.

Permits to create a hospital are not genuinely awarded who you are, the people you know and how much you can spear gives you a building permit where no sensible person should have imagine any building. Meanwhile we all know that a building permit should be given bearing in mind such hazard like air-borne infectious diseases that can spread through wind and closeness, vector-borne diseases and the high risk environmental conditions that favour the spread of any disease.

Unfortunately, Private hospitals in many Developing Countries are sandwiched among residential quarters, sometimes without any distance from the ward to the neighbour's house due to no urban planning strategy. The reason is simple, some people build residential quarters and later convert them at will to health facilities without any prior permit to open a health facility on that plot. The public health department sometimes is not  aware that there is a health center in people's own homes.

Hospital Management of certain tertiary institutions (Teaching hospitals) is not bothered about the surroundings of the wards either because there is no public/environmental health knowledge or because workers and patients are regarded as passive tenants of offices/wards. Maintaining the hospital environment clean and disease free is hampered under the disguise of no funds.

Health systems in Africa are more a public health threats than some epidemics.

The attached publication may offer some assistance, although it is written specifically for Scotland with all the associated resources available here. At the very least it is a great cure for insomnia.

http://www.his.org.uk/files/4713/7907/0658/HTM_03-01_Part_A_Specialised_Ventilation_for_Healthcare_Premises.pdf

One of the ancient scientists decided to build hospital, he was confused where is the most suitable area for his project, he brought 4 peaces of meat and put each in one direction of the city and return after few days to execute his hospital project in the least infected peace of meat.

Dear Dr. Hegazy,

The 2009 WHO guidelines entitled "WHO policy on Tuberculosis infection control in health-care facilities, congregate settings and households"  described all the different components on this topic  (http://www.who.int/tb/publications/2009/infection_control/en/). In addition, you can find specific recommendations related to building design in the following document: "TBCTA. IMPLEMENTING the WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households. A framework to plan, implement and scale-up TB infection control activities at country, facility and community level. November 2010. (http://www.tbcta.org)."

All the best,

Dr. Daniel Chemtob (Former WHO Medical Officer in charge at the Geneva WHO/HQ  of TB infection control worlwide)

Article Relationship between hospital ward design and healthcare-ass...

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