Owner: Shenzhen Third People's Hospital

Architecture: TRO Jung Brannen

Associate Architects: AHS International Architectural Design Consulting and Shenzhen General Institute of Architects Design and Research

Interior Design: Shenzhen General Institute of Architects Design and Research

General Contracting: Shenzhen Construction Company

MEP Engineering: Shenzhen General Institute of Architects Design and Research

Civil Engineering: Shenzhen General Institute of Architects Design and Research

Renderings: Yuanjing Company, Beijing, China

Model: Nike Model Company, Beijing, China

Sketches: TRO Jung Brannen, Memphis, Tennessee

Total Building Area: 83,000 square meters (anticipated)

Total Construction Cost: 6,000 RMB/square meter (anticipated)

Construction start date: November 2007

Completion date: December 2009 (anticipated)

As the economy in China has improved, demand for better healthcare facilities has increased, resulting in a wave of new hospital construction. Living standards are improving and private health insurance is becoming available.

Before the recent hospital construction boom, typical Chinese hospitals included narrow buildings with low floor-to-floor heights that relied on natural ventilation. These building forms accommodated important aspects of traditional Chinese design by creating courtyard gardens and a predominance of south-facing patient rooms. However, they also resulted in facilities that were cold and damp in winter, hot and humid in summer. Contemporary western designs, which include large floor plates and high floor-to-floor heights, can accomplish highly regulated air temperature and humidity control, but their forms limit the opportunity to provide culturally appropriate elements valued in China.

Located in the wealthy province of Shenzhen, China, near Hong Kong, Shenzhen Third People's Infectious Disease Hospital is a specialty hospital which will include 500 inpatient beds, outpatient clinics serving 2,000 patients per day, research labs, and staff housing.

The design solution began by understanding site conditions and program requirements, then synthesizing them to find the optimal fit of traditional Chinese forms and Western technology. The design solution is a campus with a linear spine and a series of north-south fingers—narrow buildings that are curved to capture sunlight and channel the winds between them (figures 1, 2). Although the buildings will have internal mechanical systems consistent with those found in U.S. hospitals in order to effectively halt the spread of infections, the campus organization is consistent with a culturally understood arrangement of locating infectious patients downwind and offering them the natural healing power of sunlight and serene garden views. The site has prevailing southeasterly winds; therefore, the noninfectious zone is at the south end of the campus, with the semi-infectious zone in the center and the infectious zone at the north.

Patient and administrative services comprise three zones: infectious, semi-infectious, and noninfectious. The infectious zone (north) has four buildings for infectious diseases, including liver and hepatitis, viruses, tuberculosis, and severe respiratory diseases. The semi-infectious zone (middle) contains diagnostic treatment areas and outpatient clinic space, as well as a research building, while the noninfectious zone (south) includes administrative offices and staff housing. No internal connections exist between these three zones.

Inpatient buildings have their own entrances; they are disconnected from other structures by open-air walkways in order to minimize the opportunity for disease to spread among patients and staff (figure 3). Similar to the organization of the site, individual floors are divided into zones to prevent cross-contamination, with separate corridor access to each zone. Patient rooms themselves will have access from each end, with an outer (soiled) side and an inner (clean) side. The highest level of protection from respiratory diseases such as SARS and Bird Flu will be provided in the respiratory building at the northwestern corner of the site, which has an additional clean corridor along its west wall for service and staff access.

Protective gowns must be worn by all staff with patient contact. Visitors are not permitted in patient rooms; closed-circuit TV and shielded visiting rooms are located within the building.

The hospital will handle major outbreaks of infectious diseases, as well as provide ongoing general healthcare. In the event of a major disease outbreak, open areas of the hospital site will have underground utilities for field hospitals to accommodate the overflow of patients.

Outpatient and diagnostic facilities, as well as the research building, are located in the middle, semi-infected zone (figure 4), and are organized to keep medically required separation between infected and noninfected patients. Clinical space is located in the middle ring of the outpatient floor, while staff circulation is located in the center so staff can interact in the clean core. Soiled elevators, corridors, and services docks are separated from the clean zones as well as from the clinical areas.

The administration building, outpatient building, and inpatient building are visually joined by a high roof and central arrival courtyard to present a strong welcoming gesture. Actual connections between these buildings are by way of exterior bridges. The 900-occupant dormitory, where most Shenzhen Hospital employees live, is set apart from patient care areas.

The buildings are clean and modern, constructed with high-tech materials, and selected to give the hospital a modern international appearance, with durability and cost as factors influencing the choice of each building system. Glass is the predominant exterior material, exposing views, maximizing opportunities for light, and providing a transparency for patients whose diseases require them to be separated from others. A series of landscaped courtyards and roof gardens will provide visual focus for the staff and patients alike.

Feng shui applied to the design

Chinese feng shui involves topography, geography, Architecture, meteorology, philosophy, science, and art. It is the guiding principle and practical guideline in Chinese urban planning and Architecture. The main idea of Chinese feng shui in Chinese Architecture is finding the suitable site, orientation, design, and layout of buildings so as to achieve harmony with the natural environment, as well as human beings. Shenzhen Third Hospital used the following feng shui principles in planning and architectural design:

Core Principle 1: An Integrated and Holistic System. In the feng shui paradigm, our environment is considered to be an integral system as a whole. Each of the individual components does not stand alone; they are mutually connected, mutually restrained, mutually dependent, mutually opposing, and mutually transforming. Based on this principle, we put three separate functional zones into one hospital system integrated with its beautiful surroundings.

Core Principle 2: Carry the Yin and Embrace the Yang. A feng shui building should be protected from the cold wind and facing the warm sun. Both considerations are involved in finding an ideal feng shui location where the Yin and Yang are balanced and where the Sheng Qi is assembled. This principle is also called “Sitting on the North and Facing South.” Following this principle, we designed most of the patient rooms facing south to embrace the Yang Qi.

Core Principle 3: Take Advantage of the Sheng Qi. The basic principle of feng shui is Chi. It is the invisible form of energy which sustains all life forms on this earth. It relates to cosmic energy, life force, breath, and vapor. The flow of this energy affects all the areas of one's life and is affected by all the elements of the physical environment. There are two opposite Chi: Sheng Qi and Sha Qi. Sheng Qi is the life force that makes things grows and Sha Qi is the opposing force that halts the growth of life. Sheng Qi can be cultivated by adjusting the Yin and Yang balance of a situation so that they are in harmony and mutually support each other. The aim of feng shui is to locate a building in places where there is Sheng Qi so the occupants can take advantage of it. The Shenzhen Third Hospital's building shapes follow the prevailing wind in that particular location to form the Sheng Qi.

Air handling

The HVAC system of Shenzhen Third People's Hospital is designed according to China's national standard Architectural Design Code for Infectious Diseases Hospitals. Shenzhen Third Hospital's infectious diseases area has a mechanical ventilation system, with mechanical air supply and air exhaust systems provided separately in the clean area, semipollution area, and contaminated area. Ventilation systems in the Outpatient and Emergency Departments are also provided separately.

From the clean area, to the semicontaminated area, to the contaminated area, the air pressure provided by the mechanical air supply and air exhaust system falls gradually. The air pressure of the clean area is positive and in the contaminated area, negative. The pressure difference that ensures the air flow direction is determined by the difference of air flow provided by the air supply and air exhaust systems and by the airtight extent of the building enclosure structure. The minimum ventilation rate in rooms is six times per hour.

Air flow organization: locations of air inlets and air outlets ensure that the fresh air at first flows to the staff area, and then flows to the air outlet, bypassing the contamination source. Air inlets are located in the upside of the rooms, while air outlets in the contaminated area (within patient rooms) are located in the underside of the rooms. The distance from the end of the air outlet to the floor in patient rooms is greater than 100mm. Air exhaust ducts between patient rooms and the general air exhaust system are provided with check valves to prevent cross-contamination among rooms.

The operating rooms, ICU, and rooms housing high-precision equipment will be negative pressure. To ensure negative pressure in rooms of the contaminated area, the air exhaust volume will be at least 10% larger than the air supply volume (with the difference of air volume in these areas larger than 85m3/h [50CFM]). Toilet air exhaust in patient rooms will not go through the vertical shaft, but through the patient room air exhaust. The hospital also provides several negative pressure isolation rooms, which are used for acute respiratory disease patients (patients who have a fatal infectious disease that spreads by air).

The air supply and exhaust in negative-pressure isolation patient rooms, operating rooms, and the ICU will pass through low-, middle-, and high-rank efficient filters. Air filters will be installed on the air exhaust duct between rooms and the general air exhaust system to eliminate particulate-incurred diseases before the air flow reaches the general air exhaust system.

Rooms housing high-precision medical equipment will adopt an independent air-conditioner unit (or constant temperature and humidity unit), according to requirements of temperature and humidity of the equipment. A fan coil system is used for small spaces (such as consultation rooms) and staff offices. The condensation of air conditioners will be collected in a separate area and be processed with sewage and waste water of each area.

Healthcare Design 2008 November;():26-30