Monitoring Tools for Setting up The Hospital Project: Department-wise Planning 9789819966639, 9819966639

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Monitoring Tools for Setting up The Hospital Project Department-wise Planning Ajay Garg

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Monitoring Tools for Setting up The Hospital Project

Ajay Garg

Monitoring Tools for Setting up The Hospital Project Department-wise Planning

Ajay Garg Hospi-Care Consultants Ghaziabad, Uttar Pradesh, India

ISBN 978-981-99-6662-2    ISBN 978-981-99-6663-9 (eBook) https://doi.org/10.1007/978-981-99-6663-9 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Paper in this product is recyclable.

My wife, Mohini Garg, who was the main person by my corner, pushing me to share my experience by writing this book. You are my love and inspiration! Thanks for not just believing but knowing that I could do this! I love you always and forever! To my children, Dr. Megha Garg and Parth Garg, and my son-in-law, Samarth Bachkheti, for the hard work that you put into this book, and all the suggestions and improvements that you made to it have not just made this book better but also strengthened our bond. I wish the three of you all the happiness and success in this world. —Ajay Garg

Preface

In the complex world of healthcare, hospitals play a pivotal role in providing critical medical services to individuals and communities. As the demand for quality healthcare continues to grow, hospitals face the constant challenge of planning and designing their departments to meet the evolving needs of patients, healthcare professionals, and the broader healthcare landscape. The planning and designing of hospital departments are a multifaceted endeavour that requires a deep understanding of the complex interplay between clinical, operational, and architectural elements. It is a constant quest to create environments that promote healing, efficiency, and patient-centred care. By considering the diverse perspectives of healthcare professionals, leveraging innovative technologies, and embracing a culture of continuous improvement, hospitals can design departments that support the delivery of exceptional healthcare services for generations to come. The planning and designing of departments within a hospital require careful consideration and foresight. It involves a multidisciplinary approach, bringing together expertise from healthcare professionals, architects, engineers, administrators, and other stakeholders to create functional, efficient, and patient-centred spaces. This book aims to explore the fundamental principles and considerations involved in the planning and designing of hospital departments in terms of infrastructure and equipment/instruments/tools, highlighting their significance in enhancing patient care and overall hospital performance. Also, the need for alignment with local and national healthcare policies, regulations, and standards should be emphasized, ensuring that departments are designed to deliver safe and effective care. The book focuses on the architectural aspects of department design. It explores the principles of space utilization, workflow optimization, and patient and staff safety. It also delves into the integration of advanced technologies and state-of-the-­ art infrastructure to support efficient clinical operations while fostering a healing and comfortable environment for patients. Apart from the infrastructure, the book also highlights the requirements of the furniture, fittings, fixtures, medical equipment, instruments, tools, consumables, etc. required in each and every department to render the services to patients and family members effectively and efficiently.

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Preface

For each and every department of the functionality, the planning needs to be done. Once the hospital building is under planning or has been designed and is ready for implementation, the day-to-day monitoring of the project is extremely important. If anything goes wrong due to inadequate monitoring, redesigning or modifications in the building are generally difficult and not feasible. As hospital projects involve huge investments, from day one onwards, all the minute issues involved in setting up the project must be monitored on a daily basis, so that all the issues are addressed well in time. Furthermore, it is also equally true that efficient monitoring of the project during the implementation stage contributes a lot to reducing errors, scheduling the tasks, and completing the project well in time. Hence, to monitor the setting up of various departments of the hospital, in the last few years after planning, designing, and monitoring many hospital projects, right from small nursing homes to large corporate hospitals, I have worked out a series of monitoring tools in the shape of checklists, which are given in the 22 chapters of this book. These tools cover almost all the issues involved in implementing and constructing various departments of the hospital project. Being in the healthcare industry for about 30 years, I felt that I shall share my experiences of planning, designing, and monitoring the hospital projects. Therefore, this book is written to ease the monitoring of the hospital project. Please note that these chapters are written purely based on the practicality of the working conditions as per my personal experience. Though I have tried to highlight the norms of various accreditation agencies like JCI and NABH, the promoters are advised to go through the norms of the agencies/government applicable in their respective countries. If you feel that any of the details given in these chapters are not correct, it may be true for you or your country but may not be true for other countries. The requirement of the spaces and facilities varies from user to user or from country to country. Hence, you may consider those issues that you may feel to be beneficial to you, and the rest of the issues may be ignored. I have tried to write this book in a very easily understandable English language. This book may be a great help to medical administrators, architects, planners, project managers, and site engineers. Ghaziabad, Uttar Pradesh, India

Ajay Garg

Highlights of the Book

The checklists in the form of tables given in the book help in: • Considering the issues involved in actual construction inside the building • Considering the issues involved during the planning of the medical and non-­ medical equipment and procurement of the same • Considering the issues of setting up individual units/departments like: –– Entrance lobby –– Emergency –– Outpatient department (OPD) –– Intensive care unit (ICU) –– Intermediate care area (IPD) –– Operation theatre –– Delivery suite –– Radiology –– Clinical laboratory –– Blood bank –– Other investigating departments like cath lab and dialysis –– Pharmacy unit (OPD and IPD) –– Central Sterile Supply Department (CSSD) –– Hospital kitchen –– Laundry –– Medical record department (MRD) –– Mortuary –– Stores –– Maintenance areas –– Administrative department

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How to Use the Tables (Checklists) Given in the Book

• This book is basically a checklist to help the promoters and designers with self-­ assessment and monitoring of the ongoing project on a day-to-day basis. • This book shall be used by the promoter, planner, designer, chief engineer, or site in-charge. • The chief engineer or site in-charges shall judiciously maintain the checklists, fill them up daily, make corrections, fix the new targets, review the previous day’s work, and update the checklist. • Once you start filling these checklists and using the monitoring tools, a lot of your energy will be saved as it will reduce the quantum of rounds. It is not humanly possible to remember all the activities all the time, but if it is in a written form, just by glancing at it, you will remember the task or activity. • Chief engineer or site engineer shall summarize the checklist daily and submit the progress report to the top management. • Please be clear that these checklists are designed for a full-fledged multi-­ speciality hospital set-up. All the activities may or may not be related to you. The activities that are not related to your set-up may please be ignored. • Initially, the promoter, planner, and designer shall access the ideal time frame required for the completion of the entire project. • This time frame shall then be divided into different phases, like the planning phase, designing phase, approval phase, construction phase, equipment installation phase, manpower requirement phase, and testing and commissioning phase. • The designers shall then assess the period required for each phase. Keep in mind the phases which can run simultaneously with another phase. Also, the designers shall estimate the time required for each construction activity, like excavation, foundation, column and beam casting, slab casting, brick/block work, plaster, and electrical and plumbing works. • It is advised to start filling up the checklists phase-wise. Initially, the checklist of construction activities shall be considered. • Based on the period required for each activity, start filling up the start date and end date of the particular activity. • You are advised to fill up these lists with the lead pencil so that they can be modified as and when required just by erasing the same.

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Acknowledgements

I am thankful to the Chancellor and Vice Chairman of Teerthanker Mahaveer University, Moradabad, India, for providing us with the platform for learning and gaining experiences in the field of healthcare. Without your support and input, it would have been difficult to write this book and share my experiences. Here, I would also like to thank Mr. Abhishek Kapoor for providing me with all the help to write this book. Extending my gratitude towards Dr. Rohit Varshney, I would like to thank him for his constant support towards the vision, his regular discussions and brainstorming sessions during the compilation of this book, and his guidance on many small tasks. I would also like to thank him for helping me in compiling and sharing his experiences in a few chapters of this book. I would like to appreciate Ms. Himanshi for her invaluable assistance in the compilation of this book. Lastly, I would like to thank each one who believed in my vision and supported me throughout this amazing journey. I hope that this book helps everyone in some way, and collectively I can make the medical society achieve great heights. Thank you! Ajay Garg

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Introduction

The backbone behind proper functioning of hospitals is their departments and support services. The support services in liaison with medical departments result in best patient care within a hospital. This book provides a detailed layout, services, and staffing of all medical departments (including diagnostic, clinical, operating room, and emergency) together with their supporting. We understand that each and every department of a hospital has its peculiar requirements, and this book will help the planners and designers to plan and execute to function them in their best possible way. The site engineers would have the proper architecture set-up of each and every department, and they would have the idea to finish the construction activity in a timely fashion. The key feature of the book is the tabular format of each department, which will help the designer or planner in having an idea about the start and end dates of work. The guidance for timely completion of all the set-up and construction of a hospital in an easily understandable English language would provide the best help to the students of hospital management, paramedical sciences, and architecture; site engineers; site supervisors; and hospital promoters, planners, and designers. Ajay Garg

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Contents

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Entrance Lobby������������������������������������������������������������������������������������������   1 1.1 Location of the Entrance Lobby ��������������������������������������������������������   2 1.2 Infrastructure��������������������������������������������������������������������������������������   2 1.2.1 Entrance Hall��������������������������������������������������������������������������   2 1.2.2 Outside Entrance Lobby ��������������������������������������������������������   6 1.2.3 General Issues Related to the Entrance Lobby ����������������������   8 1.3 Services, Facilities, Equipment, Tools, and Instruments��������������������   8 1.3.1 Reception��������������������������������������������������������������������������������   8 1.3.2 Help Desk/Registration/Billing/Admission and Discharge Counters����������������������������������������������������������  10 1.3.3 Cash Counter��������������������������������������������������������������������������  11 1.3.4 Waiting Lobby������������������������������������������������������������������������  12 1.3.5 Pharmacy��������������������������������������������������������������������������������  14 1.3.6 Back Office for Administrative Support ��������������������������������  14 1.3.7 Cafeteria����������������������������������������������������������������������������������  15 1.3.8 Public Utilities������������������������������������������������������������������������  17 1.3.9 Prayer Room/Meditation Spaces��������������������������������������������  17 1.3.10 Shops in the Entrance Lobby��������������������������������������������������  17 1.3.11 Inside Entrance Lobby������������������������������������������������������������  17 1.3.12 General Issues Related to the Entrance Lobby ����������������������  19 Further Reading ������������������������������������������������������������������������������������������  19

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Emergency Department����������������������������������������������������������������������������  21 2.1 Level of Emergency Department��������������������������������������������������������  22 2.2 Location of Emergency Department and/or Trauma Centre��������������  23 2.3 Rooms in the Emergency Department������������������������������������������������  24 2.4 Infrastructure��������������������������������������������������������������������������������������  25 2.4.1 Emergency Entrance Area������������������������������������������������������  25 2.4.2 Outside Emergency Department ��������������������������������������������  26 2.4.3 Diagnostic Rooms������������������������������������������������������������������  27 2.4.4 Triage��������������������������������������������������������������������������������������  29 2.4.5 Procedure/Treatment Rooms and Utilities������������������������������  31 2.4.6 Minor Operating Suite������������������������������������������������������������  32 2.4.7 Emergency Operation Theatre Complex��������������������������������  33 xvii

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2.4.8 Day Care Observation Ward ��������������������������������������������������  34 2.5 Services, Facilities, Equipment, Tools, and Instruments��������������������  36 2.5.1 Outside Emergency Department ��������������������������������������������  36 2.5.2 Inside Emergency Department������������������������������������������������  37 2.5.3 Reception��������������������������������������������������������������������������������  39 2.5.4 Diagnostic Rooms������������������������������������������������������������������  40 2.5.5 Procedure/Treatment Rooms and Utilities������������������������������  41 2.5.6 Triage��������������������������������������������������������������������������������������  46 2.5.7 Minor Operating Suite������������������������������������������������������������  50 2.5.8 Day Care Observation Ward ��������������������������������������������������  51 2.5.9 Other Issues����������������������������������������������������������������������������  53 Further Reading ������������������������������������������������������������������������������������������  54 3

Outpatient Department (OPD) ����������������������������������������������������������������  57 3.1 Location of Outpatient Department����������������������������������������������������  58 3.2 Room Requirement in OPD����������������������������������������������������������������  59 3.3 Infrastructure��������������������������������������������������������������������������������������  60 3.3.1 Reception/Registration/Billing/Admission and Discharge/Cash Counters����������������������������������������������������������������������������������  60 3.3.2 Waiting and Sub-waiting Areas����������������������������������������������  61 3.3.3 Consultation Rooms����������������������������������������������������������������  61 3.3.4 Supporting Rooms������������������������������������������������������������������  62 3.3.5 Procedure/Treatment Rooms��������������������������������������������������  64 3.4 Services, Facilities, Equipment, Tools, and Instruments��������������������  71 3.4.1 Reception/Help Desk��������������������������������������������������������������  71 3.4.2 Registration/Billing/Admission and Discharge Counters ������  72 3.4.3 Cash Counter��������������������������������������������������������������������������  73 3.4.4 Waiting and Sub-waiting Lobbies������������������������������������������  75 3.4.5 Consultation Rooms����������������������������������������������������������������  76 3.4.6 Supporting Rooms������������������������������������������������������������������  79 3.4.7 Treatment/Procedure Room/Minor OT����������������������������������  83 3.4.8 Other Issues Relating to OPDs ����������������������������������������������  87 Further Reading ������������������������������������������������������������������������������������������  88

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 Intensive Care Units (ICUs)����������������������������������������������������������������������  89 4.1 Location of Intensive Care Units��������������������������������������������������������  90 4.2 Type of ICUs��������������������������������������������������������������������������������������  91 4.3 Zones of ICUs ������������������������������������������������������������������������������������  93 4.4 Infrastructure��������������������������������������������������������������������������������������  94 4.4.1 Patient Care Zone��������������������������������������������������������������������  94 4.4.2 Clinical Support Zone ������������������������������������������������������������  95 4.4.3 Unit Support Zone������������������������������������������������������������������  98 4.4.4 Family Support Zone�������������������������������������������������������������� 100 4.5 Services, Facilities, Equipment, Tools, and Instruments�������������������� 102 4.5.1 Patient Care Zone�������������������������������������������������������������������� 102 4.5.2 Clinical Support Zone ������������������������������������������������������������ 113

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4.5.3 Unit Support Zone������������������������������������������������������������������ 116 4.5.4 Family Support Zone�������������������������������������������������������������� 120 4.5.5 Neonatal ICU�������������������������������������������������������������������������� 122 Further Reading ������������������������������������������������������������������������������������������ 125 5

Operation Theatre Suite (OT)������������������������������������������������������������������ 127 5.1 Location of Operating Theatre (OT) Complex ���������������������������������� 128 5.2 Zones in OT Complex������������������������������������������������������������������������ 128 5.3 Infrastructure�������������������������������������������������������������������������������������� 129 5.3.1 OT Space Requirement ���������������������������������������������������������� 129 5.3.2 Types of Operating Rooms ���������������������������������������������������� 136 5.4 Services, Facilities, Equipment, Tools, and Instruments�������������������� 142 5.4.1 Unsterile Zone������������������������������������������������������������������������ 142 5.4.2 Protective Zone ���������������������������������������������������������������������� 145 5.4.3 Clean Zone������������������������������������������������������������������������������ 148 5.4.4 Sterile Zone���������������������������������������������������������������������������� 158 Further Reading ������������������������������������������������������������������������������������������ 170

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 Labour Delivery Room (LDR)������������������������������������������������������������������ 173 6.1 Location of LDR Complex ���������������������������������������������������������������� 174 6.2 Zones in LDR Complex���������������������������������������������������������������������� 174 6.3 Infrastructure�������������������������������������������������������������������������������������� 174 6.3.1 LDR Space Requirement�������������������������������������������������������� 174 6.4 Services, Facilities, Equipment, Tools, and Instruments�������������������� 182 6.4.1 Unsterile Zone������������������������������������������������������������������������ 182 6.4.2 Protective Zone ���������������������������������������������������������������������� 184 6.4.3 Delivery Zone ������������������������������������������������������������������������ 196 Further Reading ������������������������������������������������������������������������������������������ 203

7

Intermediate Care Area (IPD)������������������������������������������������������������������ 205 7.1 Location of the Indoor Patient Areas�������������������������������������������������� 206 7.2 Types of Patient Rooms in the Hospital���������������������������������������������� 207 7.2.1 Single-Bed Occupancy������������������������������������������������������������ 207 7.2.2 Sharing Rooms������������������������������������������������������������������������ 208 7.2.3 General Wards������������������������������������������������������������������������ 208 7.2.4 Isolation Ward/Rooms������������������������������������������������������������ 208 7.3 Infrastructure�������������������������������������������������������������������������������������� 208 7.3.1 Space Requirement for Intermediate Care Area (IPD) ���������� 208 7.4 Services, Facilities, Equipment, Tools, and Instruments�������������������� 225 7.4.1 Patient Units���������������������������������������������������������������������������� 225 7.4.2 Supporting Room/Units for Indoor Patient Service���������������� 246 7.4.3 Amenities for Patient’s Family ���������������������������������������������� 259 Further Reading ������������������������������������������������������������������������������������������ 262

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Radio Diagnosis������������������������������������������������������������������������������������������ 265 8.1 Location of the Radiology Department���������������������������������������������� 266 8.2 Infrastructure�������������������������������������������������������������������������������������� 266

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8.2.1 Space Requirement for Radio Diagnosis�������������������������������� 266 8.3 Services, Facilities, Equipment, Tools, and Instruments�������������������� 282 8.3.1 Utility Area����������������������������������������������������������������������������� 282 8.3.2 X-Ray Zone���������������������������������������������������������������������������� 288 8.3.3 Ultrasound Zone��������������������������������������������������������������������� 292 8.3.4 CT Scan Zone ������������������������������������������������������������������������ 294 8.3.5 MRI Zone�������������������������������������������������������������������������������� 298 8.3.6 Mammography Zone�������������������������������������������������������������� 304 8.3.7 DEXA Scan Zone ������������������������������������������������������������������ 307 8.3.8 PET/CT Scan/SPECT/CT Zone���������������������������������������������� 309 8.3.9 PET/MRI Zone����������������������������������������������������������������������� 311 8.3.10 Low-Risk Areas or Cold Areas ���������������������������������������������� 314 8.3.11 High-Risk Areas or Radiation Exposure Hot Areas���������������� 322 8.3.12 Miscellaneous Items in the Radiology Department���������������� 325 Further Reading ������������������������������������������������������������������������������������������ 325 9

Clinical Laboratory ���������������������������������������������������������������������������������� 327 9.1 Sub-branches of Clinical Pathology���������������������������������������������������� 327 9.2 Sub-branches of Biochemistry������������������������������������������������������������ 328 9.3 Sub-branches of Microbiology ���������������������������������������������������������� 329 9.4 Location of the Clinical Laboratories ������������������������������������������������ 330 9.5 Layout of the Clinical Laboratory������������������������������������������������������ 330 9.6 Open-Lab Designs������������������������������������������������������������������������������ 331 9.7 Biosafety �������������������������������������������������������������������������������������������� 331 9.8 Infrastructure�������������������������������������������������������������������������������������� 332 9.8.1 Laboratories’ Area������������������������������������������������������������������ 332 9.8.2 Support Services �������������������������������������������������������������������� 336 9.8.3 Utility Area����������������������������������������������������������������������������� 339 9.8.4 Outpatient Phlebotomy ���������������������������������������������������������� 339 9.8.5 Employee Support������������������������������������������������������������������ 340 9.9 Services, Facilities, Equipment, Tools, and Instruments�������������������� 341 9.9.1 Laboratories���������������������������������������������������������������������������� 341 9.9.2 Support Services �������������������������������������������������������������������� 348 9.9.3 Utility Area����������������������������������������������������������������������������� 354 9.9.4 OPD Phlebotomy Room �������������������������������������������������������� 356 9.9.5 Employee Support������������������������������������������������������������������ 358 Further Reading ������������������������������������������������������������������������������������������ 359

10 Blood Bank ������������������������������������������������������������������������������������������������ 361 10.1 Location of the Blood Bank in the Hospital ������������������������������������ 361 10.2 Controlling Authority of Blood Bank ���������������������������������������������� 361 10.3 Functions of Blood Bank������������������������������������������������������������������ 362 10.3.1 Receiving������������������������������������������������������������������������������ 362 10.3.2 Storage���������������������������������������������������������������������������������� 362 10.3.3 Testing���������������������������������������������������������������������������������� 362 10.3.4 Distribution �������������������������������������������������������������������������� 362

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10.4 Area of Blood Bank�������������������������������������������������������������������������� 362 10.5 Infrastructure������������������������������������������������������������������������������������ 363 10.5.1 Space Requirement for Blood Bank ������������������������������������ 363 10.6 Services, Facilities, Equipment, Tools, and Instruments������������������ 369 10.6.1 Receiving Area���������������������������������������������������������������������� 369 10.6.2 Testing Area�������������������������������������������������������������������������� 377 10.6.3 Storage and Processing Area������������������������������������������������ 380 10.6.4 Blood Component Room������������������������������������������������������ 381 10.6.5 Distribution Area/Delivery Room ���������������������������������������� 383 10.6.6 Utility Area��������������������������������������������������������������������������� 383 Further Reading ������������������������������������������������������������������������������������������ 387 11 Other  Investigations and Procedures ������������������������������������������������������ 389 11.1 Coronary Catheterization (Cath Lab)������������������������������������������������ 390 11.1.1 Infrastructure������������������������������������������������������������������������ 390 11.1.2 Services, Facilities, Equipment, Tools, and Instruments������ 393 11.2 Audiometry �������������������������������������������������������������������������������������� 404 11.2.1 Location of the Audiometry Room �������������������������������������� 404 11.2.2 Infrastructure������������������������������������������������������������������������ 404 11.2.3 Services, Facilities, Equipment, Tools, and Instruments������ 405 11.3 Polysomnography (Sleep Lab)���������������������������������������������������������� 406 11.3.1 Location of the Sleep Lab ���������������������������������������������������� 406 11.3.2 Infrastructure������������������������������������������������������������������������ 406 11.3.3 Services, Facilities, Equipment, Tools, and Instruments������ 407 11.4 Dialysis �������������������������������������������������������������������������������������������� 408 11.4.1 Location of the Dialysis Unit������������������������������������������������ 409 11.4.2 Infrastructure������������������������������������������������������������������������ 409 11.4.3 Services, Facilities, Equipment, Tools, and Instruments������ 411 Further Reading ������������������������������������������������������������������������������������������ 421 12 Radiation Therapy ������������������������������������������������������������������������������������ 423 12.1 Location of Radiotherapy Unit �������������������������������������������������������� 423 12.2 Infrastructure������������������������������������������������������������������������������������ 424 12.2.1 Utility Area��������������������������������������������������������������������������� 424 12.2.2 Treatment and Planning Area������������������������������������������������ 428 12.2.3 Chemotherapy Ward/Radiotherapy Ward ���������������������������� 434 12.3 Services, Facilities, Equipment, Tools, and Instruments������������������ 437 12.3.1 Reception/Registration/Cash Counters �������������������������������� 437 12.3.2 Record Room������������������������������������������������������������������������ 440 12.3.3 General Stores���������������������������������������������������������������������� 440 12.3.4 Consultation Rooms�������������������������������������������������������������� 441 12.3.5 Waiting and Sub-waiting Lobbies���������������������������������������� 444 12.3.6 External Beam Radiation Therapy (LINAC)������������������������ 445 12.3.7 Control Room for LINAC���������������������������������������������������� 447 12.3.8 Internal Beam Radiation Therapy (Brachytherapy)�������������� 448

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12.3.9 Operating Room for Surgeries Near the Brachytherapy Room������������������������������������������������������������������������������������ 449 12.3.10 Mould Room ������������������������������������������������������������������������ 453 12.3.11 Mould Workshop������������������������������������������������������������������ 454 12.3.12 Medical Physics Room �������������������������������������������������������� 455 12.3.13 CT Simulator������������������������������������������������������������������������ 456 12.3.14 Clean Utility�������������������������������������������������������������������������� 460 12.3.15 Dirty Utility/Sluice Room���������������������������������������������������� 460 12.3.16 Trolley Park Area������������������������������������������������������������������ 460 12.3.17 Equipment Park/Store ���������������������������������������������������������� 461 12.3.18 Store for Medicines, Consumables, and Disposables ���������� 461 12.3.19 Scrub Station������������������������������������������������������������������������ 462 12.3.20 Chemotherapy Ward/Radiotherapy Ward ���������������������������� 462 12.3.21 Administrative Rooms���������������������������������������������������������� 466 Further Reading ������������������������������������������������������������������������������������������ 466 13 Rehabilitation and Allied Health Therapies�������������������������������������������� 469 13.1 Location of Physiotherapy Department�������������������������������������������� 470 13.2 Infrastructure������������������������������������������������������������������������������������ 470 13.2.1 Space Requirement for Physiotherapy and Allied Departments�������������������������������������������������������������������������� 470 13.3 Services, Facilities, Equipment, Tools, and Instruments������������������ 475 13.3.1 Reception/Registration/Cash Counters �������������������������������� 475 13.3.2 Waiting and Sub-waiting Lobbies���������������������������������������� 478 13.3.3 Examination Rooms�������������������������������������������������������������� 479 13.3.4 Administrative Rooms���������������������������������������������������������� 481 13.3.5 General Stores���������������������������������������������������������������������� 482 13.3.6 Record Room������������������������������������������������������������������������ 482 13.3.7 Equipment Park/Store ���������������������������������������������������������� 483 13.3.8 Trolley Park Area������������������������������������������������������������������ 483 13.3.9 Clean Utility�������������������������������������������������������������������������� 484 13.3.10 Dirty Utility/Sluice Room���������������������������������������������������� 484 13.3.11 Change Rooms���������������������������������������������������������������������� 484 13.3.12 Physiotherapy Rooms/Cabins ���������������������������������������������� 485 13.3.13 Occupational Therapy Rooms/Cabins���������������������������������� 488 Further Reading ������������������������������������������������������������������������������������������ 489 14 Pharmacy Unit ������������������������������������������������������������������������������������������ 491 14.1 Location of the Pharmacy ���������������������������������������������������������������� 492 14.2 Size of the Pharmacy������������������������������������������������������������������������ 492 14.3 Infrastructure������������������������������������������������������������������������������������ 492 14.3.1 Spaces Required for the Pharmacy Unit ������������������������������ 492 14.4 Services, Facilities, Equipment, Tools, and Instruments������������������ 495 14.4.1 Drug Receiving Area������������������������������������������������������������ 495 14.4.2 Storage and Dispensing Hall������������������������������������������������ 496 14.4.3 Bulk Storage Room�������������������������������������������������������������� 499

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14.4.4 Cold Store ���������������������������������������������������������������������������� 499 14.4.5 Expiry Drug Room���������������������������������������������������������������� 500 14.4.6 Costly Drug Room���������������������������������������������������������������� 501 14.4.7 Drug Sorting Room�������������������������������������������������������������� 501 14.4.8 Narcotics and Controlled Drug Room���������������������������������� 502 14.4.9 Pharmacist Office������������������������������������������������������������������ 502 Further Reading ������������������������������������������������������������������������������������������ 503 15 Central  Sterile Services Department (CSSD)������������������������������������������ 505 15.1 Methods of Sterilization Processes �������������������������������������������������� 506 15.2 Location of CSSD ���������������������������������������������������������������������������� 506 15.3 Area Required for CSSD Department���������������������������������������������� 506 15.4 Zones of CSSD �������������������������������������������������������������������������������� 507 15.4.1 Functional Zones of CSSD �������������������������������������������������� 507 15.5 Infrastructure������������������������������������������������������������������������������������ 507 15.5.1 Space Requirement for CSSD���������������������������������������������� 507 15.5.2 Finishing Details of the CSSD���������������������������������������������� 511 15.6 Services, Facilities, Equipment, Tools, and Instruments������������������ 512 15.6.1 Receiving Zone (Unclean Area)�������������������������������������������� 512 15.6.2 Decontaminating, Washing, and Disinfecting Zone ������������ 513 15.6.3 Packing Zone������������������������������������������������������������������������ 515 15.6.4 Sterilization Zone������������������������������������������������������������������ 516 15.6.5 Clean Storage Zone�������������������������������������������������������������� 519 15.6.6 Delivery Zone ���������������������������������������������������������������������� 520 15.6.7 Administrative Rooms���������������������������������������������������������� 521 15.6.8 Staff Changing Rooms���������������������������������������������������������� 521 15.6.9 Shoe-Changing Areas����������������������������������������������������������� 522 15.6.10 General Store������������������������������������������������������������������������ 523 15.6.11 Restroom for Staff: Males and Females�������������������������������� 523 15.6.12 Trolley Bay �������������������������������������������������������������������������� 523 15.6.13 Electrical Points�������������������������������������������������������������������� 524 15.6.14 Lighting�������������������������������������������������������������������������������� 524 15.6.15 Air Conditioning ������������������������������������������������������������������ 524 Further Reading ������������������������������������������������������������������������������������������ 525 16 Hospital Kitchen���������������������������������������������������������������������������������������� 527 16.1 Location of Hospital Kitchen������������������������������������������������������������ 527 16.2 Size of the Kitchen���������������������������������������������������������������������������� 528 16.3 Infrastructure������������������������������������������������������������������������������������ 528 16.3.1 Space Requirement for Hospital Kitchen ���������������������������� 528 16.4 Services, Facilities, Equipment, Tools, and Instruments������������������ 534 16.4.1 Entry�������������������������������������������������������������������������������������� 534 16.4.2 Change Rooms Cum Hand Wash Area �������������������������������� 535 16.4.3 Storage Area�������������������������������������������������������������������������� 536 16.4.4 Preparation Area������������������������������������������������������������������� 537 16.4.5 Cooking Area������������������������������������������������������������������������ 538

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16.4.6 Reheating Area���������������������������������������������������������������������� 539 16.4.7 Packing/Plating �������������������������������������������������������������������� 540 16.4.8 Meal Trolley/Cart Parking���������������������������������������������������� 541 16.4.9 Trolley Return/Strapping������������������������������������������������������ 542 16.4.10 Trolley/Cart Wash ���������������������������������������������������������������� 542 16.4.11 Dishwashing�������������������������������������������������������������������������� 543 16.4.12 Pot Washing�������������������������������������������������������������������������� 544 16.4.13 Waste Disposal���������������������������������������������������������������������� 545 16.4.14 Gas Storage Closet���������������������������������������������������������������� 546 16.4.15 Staff Accommodation ���������������������������������������������������������� 546 16.4.16 General Issues About Infrastructure Requirements�������������� 547 Further Reading ������������������������������������������������������������������������������������������ 548 17 Hospital Laundry �������������������������������������������������������������������������������������� 551 17.1 Location of the Laundry�������������������������������������������������������������������� 552 17.2 Size of the Laundry�������������������������������������������������������������������������� 552 17.3 Infrastructure������������������������������������������������������������������������������������ 552 17.3.1 Spaces Required for Hospital Laundry �������������������������������� 552 17.4 Services, Facilities, Equipment, Tools, and Instruments������������������ 556 17.4.1 Central Storage Area ������������������������������������������������������������ 556 17.4.2 Dirty Receipts ���������������������������������������������������������������������� 557 17.4.3 Sorting and Weighing Area �������������������������������������������������� 557 17.4.4 Washing Area������������������������������������������������������������������������ 557 17.4.5 Inspection and Repairing������������������������������������������������������ 561 17.4.6 Packing and Storage�������������������������������������������������������������� 562 17.4.7 Dispatch Room��������������������������������������������������������������������� 563 17.4.8 Trolley Washing�������������������������������������������������������������������� 563 17.4.9 Store for Consumables���������������������������������������������������������� 564 17.4.10 Staff Accommodation ���������������������������������������������������������� 564 17.4.11 General Issues About Infrastructure Requirements�������������� 565 Further Reading ������������������������������������������������������������������������������������������ 568 18 Medical  Record Department (MRD) ������������������������������������������������������ 569 18.1 Location of MRD������������������������������������������������������������������������������ 570 18.2 Infrastructure������������������������������������������������������������������������������������ 570 18.2.1 Space Requirement for MRD����������������������������������������������� 570 18.3 Services, Facilities, Equipment, Tools, and Instruments������������������ 573 18.3.1 Entry and Reception�������������������������������������������������������������� 573 18.3.2 Medical Record Receipt Room�������������������������������������������� 574 18.3.3 Compilation Desk ���������������������������������������������������������������� 575 18.3.4 Indexing and Coding������������������������������������������������������������ 576 18.3.5 Statistical Analysis���������������������������������������������������������������� 576 18.3.6 Computer Lab ���������������������������������������������������������������������� 577 18.3.7 Medical Record Storage Room�������������������������������������������� 577 18.3.8 Dictation Room/Cubicles������������������������������������������������������ 578 18.3.9 Transcription Room�������������������������������������������������������������� 579

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18.3.10 Photocopying/Printing Room����������������������������������������������� 579 18.3.11 Record Scanning Room�������������������������������������������������������� 579 18.3.12 Binding Room���������������������������������������������������������������������� 580 18.3.13 Waste Holding Room������������������������������������������������������������ 581 18.3.14 Store�������������������������������������������������������������������������������������� 581 18.3.15 Staff Accommodation ���������������������������������������������������������� 581 18.3.16 General Issues About Infrastructure Requirements�������������� 583 Further Reading ������������������������������������������������������������������������������������������ 583 19 Mortuary���������������������������������������������������������������������������������������������������� 585 19.1 Location of the Mortuary������������������������������������������������������������������ 585 19.2 Infrastructure������������������������������������������������������������������������������������ 586 19.2.1 Mortuary ������������������������������������������������������������������������������ 586 19.2.2 Autopsy Area������������������������������������������������������������������������ 588 19.3 Services, Facilities, Equipment, Tools, and Instruments������������������ 590 19.3.1 Mortuary ������������������������������������������������������������������������������ 590 19.3.2 Autopsy Area������������������������������������������������������������������������ 594 19.3.3 Other Infrastructural Issues�������������������������������������������������� 600 Further Reading ������������������������������������������������������������������������������������������ 601 20 Administration Area���������������������������������������������������������������������������������� 603 20.1 Location of the Administrative Area������������������������������������������������ 603 20.2 Infrastructure������������������������������������������������������������������������������������ 604 20.2.1 Infrastructure of the Administrative Area ���������������������������� 604 20.2.2 Reception������������������������������������������������������������������������������ 604 20.2.3 Waiting Lobbies/Sub-Waiting Lobbies�������������������������������� 604 20.2.4 Senior Level Management’s Office�������������������������������������� 605 20.2.5 Senior Executive Level Management’s Office���������������������� 607 20.2.6 Executive Level Management’s Office �������������������������������� 608 20.2.7 Junior Level Management’s Office �������������������������������������� 609 20.2.8 Personnel Office�������������������������������������������������������������������� 609 20.2.9 Accounts/Finance Office������������������������������������������������������ 610 20.2.10 Marketing Office������������������������������������������������������������������ 611 20.2.11 Purchase Office �������������������������������������������������������������������� 612 20.2.12 Hospital Information������������������������������������������������������������ 612 20.2.13 Support Room/Facilities ������������������������������������������������������ 613 20.2.14 Meeting Rooms�������������������������������������������������������������������� 614 20.3 Services, Facilities, Equipment, Tools, and Instruments������������������ 615 20.3.1 Reception������������������������������������������������������������������������������ 615 20.3.2 Waiting Lobbies/Sub-waiting Lobbies/VIP Waiting Lobbies���������������������������������������������������������������������������������� 616 20.3.3 Offices of Senior Management �������������������������������������������� 618 20.3.4 Offices of Senior Executive Level Management������������������ 621 20.3.5 Offices of Executive Level Management������������������������������ 623 20.3.6 Offices of Junior Level Management������������������������������������ 624 20.3.7 Personal Assistant Office (Table 20.18)�������������������������������� 626

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20.3.8 Secretarial Staff Office���������������������������������������������������������� 627 20.3.9 Kitchen���������������������������������������������������������������������������������� 627 20.3.10 Dining Area�������������������������������������������������������������������������� 629 20.3.11 Store�������������������������������������������������������������������������������������� 629 20.3.12 Notice Boards����������������������������������������������������������������������� 629 20.3.13 Meeting Rooms/Conference Room�������������������������������������� 630 Further Reading ������������������������������������������������������������������������������������������ 632 21 Stores ���������������������������������������������������������������������������������������������������������� 635 21.1 Location of the Stores ���������������������������������������������������������������������� 635 21.2 Types of Hospital Stores ������������������������������������������������������������������ 636 21.3 Infrastructure������������������������������������������������������������������������������������ 637 21.3.1 Stores������������������������������������������������������������������������������������ 637 21.3.2 Utility Areas�������������������������������������������������������������������������� 638 21.4 Services, Facilities, Equipment, Tools, and Instruments������������������ 639 21.4.1 Store�������������������������������������������������������������������������������������� 639 21.4.2 Special Store Room�������������������������������������������������������������� 642 21.4.3 Cold Room���������������������������������������������������������������������������� 642 21.4.4 Store Keeper Office�������������������������������������������������������������� 643 21.4.5 Store Secretarial Staff Room������������������������������������������������ 644 21.4.6 Kitchen���������������������������������������������������������������������������������� 644 21.4.7 Receiving Area���������������������������������������������������������������������� 644 Further Reading ������������������������������������������������������������������������������������������ 646 22 Engineering  and Maintenance Unit �������������������������������������������������������� 647 22.1 Location of the Workshops �������������������������������������������������������������� 647 22.2 Types of Maintenance Workshops���������������������������������������������������� 648 22.3 Infrastructure������������������������������������������������������������������������������������ 649 22.3.1 Engineering and Maintenance Unit�������������������������������������� 649 22.3.2 Utility Areas�������������������������������������������������������������������������� 650 22.4 Services, Facilities, Equipment, Tools, and Instruments������������������ 651 22.4.1 Workshops���������������������������������������������������������������������������� 651 22.4.2 Workshop In-charge Room �������������������������������������������������� 653 22.4.3 Workshop Engineer Room���������������������������������������������������� 653 22.4.4 Receiving Area/Issue Counter���������������������������������������������� 654 Further Reading ������������������������������������������������������������������������������������������ 655 Glossary�������������������������������������������������������������������������������������������������������������� 657

List of Tables

Table 1.1 Table 1.2 Table 1.3 Table 1.4 Table 1.5 Table 1.6 Table 1.7 Table 1.8 Table 1.9 Table 1.10 Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 2.11 Table 2.12 Table 2.13 Table 2.14 Table 2.15 Table 2.16 Table 2.17 Table 2.18 Table 3.1 Table 3.2

Entrance hall����������������������������������������������������������������������������������   2 Outside entrance lobby������������������������������������������������������������������   7 Reception/help desk counters in the entrance lobby����������������������   9 Registration/billing/admission and discharge counters in the entrance lobby������������������������������������������������������������������������   10 Cash counter in the entrance lobby����������������������������������������������   11 Waiting lobby in the entrance lobby��������������������������������������������   13 Pharmacy in the entrance lobby ��������������������������������������������������   14 Back office for administrative support in the entrance lobby������   15 Cafeteria in the entrance lobby����������������������������������������������������   15 Inside entrance lobby ������������������������������������������������������������������   18 Entrance hall of emergency department��������������������������������������   23 Emergency entrance area ������������������������������������������������������������   25 Outside emergency department����������������������������������������������������   27 Diagnostic rooms of emergency department ������������������������������   28 Triage of emergency department ������������������������������������������������   29 Procedure/treatment rooms and utilities of emergency department������������������������������������������������������������������������������������   31 Minor operating room of emergency department������������������������   32 Emergency operation theatre complex of emergency department  33 Day care observation ward of emergency department ����������������   34 Outside emergency department����������������������������������������������������   37 Inside emergency department������������������������������������������������������   38 Reception of emergency department��������������������������������������������   39 Diagnostic rooms of emergency department ������������������������������   40 Procedure/treatment rooms and utilities of emergency department������������������������������������������������������������������������������������   42 Triage of emergency department ������������������������������������������������   47 Minor operating suite of emergency department ������������������������   50 Day care observation ward of emergency department ����������������   52 Other issues relating to emergency department ��������������������������   54 Location of the outpatient department ����������������������������������������   58 Reception/registration/billing/admission and discharge/ cash counters in the OPD������������������������������������������������������������   60 xxvii

xxviii

Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 Table 3.11 Table 3.12 Table 3.13 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 4.17 Table 4.18 Table 4.19 Table 4.20 Table 4.21 Table 4.22 Table 4.23 Table 4.24 Table 4.25 Table 4.26 Table 4.27 Table 4.28 Table 4.29 Table 4.30 Table 4.31 Table 4.32 Table 4.33

List of Tables

Consultation rooms in the OPD ��������������������������������������������������   61 Supporting rooms in the OPD������������������������������������������������������   63 Procedure/treatment rooms in the OPD ��������������������������������������   64 Reception/help desk in the OPD��������������������������������������������������   71 Registration/billing/admission and discharge counters in the OPD����������������������������������������������������������������������������������������   72 Cash counter in the OPD��������������������������������������������������������������   74 Waiting and sub-waiting lobbies in the OPD������������������������������   75 Consultation room in the OPD����������������������������������������������������   77 Supporting rooms in the OPD������������������������������������������������������   80 Treatment/procedure rooms/minor OT in the OPD ��������������������   84 Other issues relating to OPDs������������������������������������������������������   87 Location of intensive care units ��������������������������������������������������   91 Type of ICUs��������������������������������������������������������������������������������   92 Patient units/rooms/cubicles in ICUs������������������������������������������   94 Examination and treatment room in ICUs ����������������������������������   95 Clinical support zone in ICUs������������������������������������������������������   96 Unit support zone in ICUs ����������������������������������������������������������   98 Family support zone in ICUs ������������������������������������������������������  101 Services in ICU����������������������������������������������������������������������������  102 Patient unit furniture in ICUs������������������������������������������������������  105 Patient unit furnishing in ICUs����������������������������������������������������  106 General furniture in ICUs������������������������������������������������������������  107 Equipment in ICU������������������������������������������������������������������������  108 Tools and instruments in ICU������������������������������������������������������  110 Examination and treatment rooms in ICUs����������������������������������  111 Furniture in examination and treatment rooms in ICUs��������������  112 Equipment in the examination and treatment rooms in ICUs������  113 Radiology in ICU������������������������������������������������������������������������  114 Clinical laboratory in ICU ����������������������������������������������������������  114 Medication room in ICU��������������������������������������������������������������  115 Clean utility in ICUs��������������������������������������������������������������������  115 Dirty utility/sluice room in ICUs ������������������������������������������������  116 Staff change room in ICUs����������������������������������������������������������  116 Doctors duty room in ICUs����������������������������������������������������������  117 Nurse’s duty room in ICUs����������������������������������������������������������  117 Staff lounge in ICUs��������������������������������������������������������������������  118 Ward pantry in ICUs��������������������������������������������������������������������  118 Administrative offices in ICUs����������������������������������������������������  119 Multipurpose conference room in ICUs��������������������������������������  119 Family lounge in ICUs����������������������������������������������������������������  120 Counselling room in ICUs ����������������������������������������������������������  121 Family cafeteria near ICUs����������������������������������������������������������  121 Family sleep rooms/guest house near ICUs��������������������������������  122 Infrastructure of neonatal ICU ����������������������������������������������������  123

List of Tables

xxix

Table 4.34 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9 Table 5.10 Table 5.11 Table 5.12

Equipment in neonatal ICU ��������������������������������������������������������  125 OT space requirement������������������������������������������������������������������  129 Types of operating rooms������������������������������������������������������������  137 Administrative rooms in OT complex������������������������������������������  142 Frozen section laboratory in OT complex������������������������������������  142 Tolley bay in OT complex������������������������������������������������������������  143 Shoe changing areas in OT complex��������������������������������������������  143 Linen pre-wash room in OT complex������������������������������������������  144 Instrument wash room in OT complex����������������������������������������  144 Attendant waiting area in OT complex����������������������������������������  144 Staff change rooms in OT complex���������������������������������������������  145 Unsterilized store for equipment in OT complex������������������������  146 Store for medicines, disposables, and consumables in OT complex����������������������������������������������������������������������������������������  147 Pantry in OT complex������������������������������������������������������������������  148 Preoperative ward in OT complex�����������������������������������������������  149 Surgeons’ restroom in OT complex ��������������������������������������������  150 Restroom for staff in OT complex ����������������������������������������������  151 Dirty utility in OT complex���������������������������������������������������������  152 Pre-anaesthetic check-up room (PAC) in OT complex����������������  152 Preparation room in OT complex������������������������������������������������  154 Post-operative ward in OT complex��������������������������������������������  155 Operating rooms (ORs)����������������������������������������������������������������  158 Endoscopic unit in OT complex��������������������������������������������������  166 Scrub station in OT complex��������������������������������������������������������  168 Instrument trolley lay-up in OT complex������������������������������������  169 Clean supply room in OT complex����������������������������������������������  169 Theatre sterilization supply room (TSSU) in OT complex����������  170 LDR space requirement ��������������������������������������������������������������  175 Administrative rooms in LDR������������������������������������������������������  182 Trolley bay in LDR����������������������������������������������������������������������  182 Shoe-changing areas in LDR ������������������������������������������������������  183 Linen pre-wash room in LDR������������������������������������������������������  183 Instrument wash room in LDR����������������������������������������������������  183 Attendant waiting area in LDR����������������������������������������������������  184 Pre-labour room/ward and eclampsia room in LDR��������������������  185 Examination/preparation room in LDR ��������������������������������������  188 Post-labour ward/room in LDR ��������������������������������������������������  189 Staff change room in LDR ����������������������������������������������������������  192 Unsterile store for equipment storage in LDR����������������������������  192 Store for medicines, disposables, and consumables in LDR ������  193 Doctors’ night duty room in LDR������������������������������������������������  194 Surgeons’ lounge/restroom in LDR ��������������������������������������������  194 Restroom for staff in LDR ����������������������������������������������������������  195 Pantry in LDR������������������������������������������������������������������������������  195

Table 5.13 Table 5.14 Table 5.15 Table 5.16 Table 5.17 Table 5.18 Table 5.19 Table 5.20 Table 5.21 Table 5.22 Table 5.23 Table 5.24 Table 5.25 Table 5.26 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 6.9 Table 6.10 Table 6.11 Table 6.12 Table 6.13 Table 6.14 Table 6.15 Table 6.16 Table 6.17

xxx

Table 6.18 Table 6.19 Table 6.20 Table 6.21 Table 6.22 Table 6.23 Table 6.24 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 7.5 Table 7.6 Table 7.7 Table 7.8 Table 7.9 Table 7.10 Table 7.11 Table 7.12 Table 7.13 Table 7.14 Table 7.15 Table 7.16 Table 7.17 Table 7.18 Table 7.19 Table 7.20 Table 7.21 Table 7.22 Table 7.23 Table 7.24 Table 7.25 Table 7.26 Table 7.27 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8.9 Table 8.10

List of Tables

Delivery rooms in LDR����������������������������������������������������������������  196 Baby resuscitation area in LDR ��������������������������������������������������  199 Scrub station in LDR ������������������������������������������������������������������  201 Clean supply room in LDR����������������������������������������������������������  201 Dirty utility in LDR ��������������������������������������������������������������������  202 Instrument trolley lay-up in LDR������������������������������������������������  202 Sterilization room in LDR ����������������������������������������������������������  203 Multiple-bed general ward����������������������������������������������������������  209 Semiprivate sharing rooms����������������������������������������������������������  212 Single-bed private room��������������������������������������������������������������  215 Single-bed deluxe rooms��������������������������������������������������������������  218 Single-bed family suites��������������������������������������������������������������  221 Isolation rooms/wards������������������������������������������������������������������  223 Multiple-bed general ward����������������������������������������������������������  225 Semiprivate sharing rooms����������������������������������������������������������  229 Single-bed private room��������������������������������������������������������������  232 Single-bed deluxe room ��������������������������������������������������������������  237 Single-bed family suites��������������������������������������������������������������  241 Nurse station/desk in IPD������������������������������������������������������������  247 Nurse’s duty rooms in IPD����������������������������������������������������������  252 Store for medicines, consumables, and disposables in IPD��������  252 Equipment park/store in IPD ������������������������������������������������������  253 Dirty utility/sluice room in IPD ��������������������������������������������������  253 Clean utility in IPD����������������������������������������������������������������������  254 Procedure and treatment room in IPD ����������������������������������������  254 Ward pantry in IPD����������������������������������������������������������������������  257 Medication area in IPD����������������������������������������������������������������  258 Doctors’ duty rooms in IPD��������������������������������������������������������  258 Trolley park area in IPD��������������������������������������������������������������  259 Visitors’ bay/family lounge in IPD����������������������������������������������  260 Consultation room in IPD������������������������������������������������������������  261 Meditation space in IPD��������������������������������������������������������������  261 Family cafeteria near IPD������������������������������������������������������������  261 Family sleep rooms near IPD������������������������������������������������������  262 Utility area of the radiology department��������������������������������������  267 X-ray zone������������������������������������������������������������������������������������  269 Ultrasound zone ��������������������������������������������������������������������������  270 Computerized tomography (CT scan) zone ��������������������������������  271 Magnetic resonance imaging (MRI) zone������������������������������������  273 Mammography zone��������������������������������������������������������������������  275 DEXA scan zone��������������������������������������������������������������������������  277 PET/CT scan/PET/MRI scan/SPECT/CT zone ��������������������������  278 Other new investigation ��������������������������������������������������������������  281 Staff accommodation in radio diagnosis��������������������������������������  281

List of Tables

xxxi

Table 8.11

Reception/help desk/cash counter of utility area in radio diagnosis��������������������������������������������������������������������������������������  282 Waiting and sub-waiting lobbies of utility area in radio diagnosis��������������������������������������������������������������������������������������  284 Reporting room in radio diagnosis����������������������������������������������  285 Stores for films and consumables in radio diagnosis ������������������  286 Report delivery counter in radio diagnosis����������������������������������  287 Radiography rooms����������������������������������������������������������������������  288 Change room of X-ray ����������������������������������������������������������������  290 Patient preparation room of X-ray ����������������������������������������������  291 Computerized radiography (CR) room of X-ray ������������������������  292 Ultrasound room��������������������������������������������������������������������������  293 Change rooms of ultrasound��������������������������������������������������������  294 CT scan machine room����������������������������������������������������������������  295 CT control room��������������������������������������������������������������������������  297 UPS room for CT scan����������������������������������������������������������������  298 Change rooms for CT scan����������������������������������������������������������  299 MRI machine room����������������������������������������������������������������������  299 MRI control room������������������������������������������������������������������������  302 UPS room for MRI����������������������������������������������������������������������  303 Chiller for MRI����������������������������������������������������������������������������  303 Change rooms for MRI����������������������������������������������������������������  304 Mammography room ������������������������������������������������������������������  305 Change room for mammography ������������������������������������������������  306 Computerized radiography room for mammography������������������  306 DEXA scan room������������������������������������������������������������������������  307 Change room for DEXA scan������������������������������������������������������  308 PET/CT scan/SPECT/CT machine room������������������������������������  309 PET/CT scan/SPECT/CT control room ��������������������������������������  310 PET/CT scan/SPECT UPS room ������������������������������������������������  310 PET/CT scan/SPECT/CT change rooms ������������������������������������  311 PET/MRI machine room��������������������������������������������������������������  312 PET/MRI control room����������������������������������������������������������������  312 PET/MRI UPS room��������������������������������������������������������������������  313 PET/MRI chiller��������������������������������������������������������������������������  313 PET/MRI change room����������������������������������������������������������������  313 Reception/cash counter in cold areas������������������������������������������  315 Waiting areas in cold area������������������������������������������������������������  317 Physicians’ consulting room in cold area������������������������������������  318 Store for films and consumables in cold area������������������������������  320 Technologist room in cold area����������������������������������������������������  321 Hot lab cum radio pharmacy room����������������������������������������������  323 Isotope injection room ����������������������������������������������������������������  323 Post-dose waiting areas����������������������������������������������������������������  324 Active toilet����������������������������������������������������������������������������������  324

Table 8.12 Table 8.13 Table 8.14 Table 8.15 Table 8.16 Table 8.17 Table 8.18 Table 8.19 Table 8.20 Table 8.21 Table 8.22 Table 8.23 Table 8.24 Table 8.25 Table 8.26 Table 8.27 Table 8.28 Table 8.29 Table 8.30 Table 8.31 Table 8.32 Table 8.33 Table 8.34 Table 8.35 Table 8.36 Table 8.37 Table 8.38 Table 8.39 Table 8.40 Table 8.41 Table 8.42 Table 8.43 Table 8.44 Table 8.45 Table 8.46 Table 8.47 Table 8.48 Table 8.49 Table 8.50 Table 8.51 Table 8.52 Table 8.53

xxxii

Table 8.54 Table 8.55 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 9.6 Table 9.7 Table 9.8 Table 9.9 Table 9.10 Table 9.11 Table 9.12 Table 9.13 Table 9.14 Table 9.15 Table 9.16 Table 9.17 Table 9.18 Table 9.19 Table 9.20 Table 9.21 Table 9.22 Table 9.23 Table 9.24 Table 9.25 Table 9.26 Table 9.27 Table 9.28 Table 9.29 Table 9.30 Table 9.31 Table 9.32 Table 9.33 Table 9.34 Table 9.35 Table 9.36 Table 9.37 Table 9.38 Table 9.39 Table 9.40 Table 9.41

List of Tables

Post-examination waiting areas ��������������������������������������������������  325 Miscellaneous items in the radiology department ����������������������  325 Sub-branches of clinical pathology����������������������������������������������  328 Sub-branches of biochemistry������������������������������������������������������  329 Sub-branches of microbiology����������������������������������������������������  330 Testing areas of the laboratories��������������������������������������������������  332 Specimen receiving room/space in the laboratories��������������������  334 Report preparation room/space in the laboratories����������������������  334 Report dispatch room/space in the laboratories ��������������������������  335 Storeroom for glassware, chemicals, and reagents in the laboratories����������������������������������������������������������������������������������  335 Equipment park/store in the laboratories ������������������������������������  336 Clean utility in the laboratories����������������������������������������������������  336 Emergency eyewash station in the laboratories ��������������������������  337 Support services in the laboratories ��������������������������������������������  337 Utility area in the laboratories������������������������������������������������������  339 Outpatient phlebotomy����������������������������������������������������������������  340 Employee support in the laboratories������������������������������������������  341 Laboratories ��������������������������������������������������������������������������������  342 Furniture in the laboratories��������������������������������������������������������  343 Main equipment in the clinical laboratories��������������������������������  344 Specimen receiving room/space in the laboratories��������������������  345 Report preparation room in the laboratories��������������������������������  346 Report dispatch room in the laboratories ������������������������������������  347 Storeroom for glassware, chemicals, and reagents in the laboratories����������������������������������������������������������������������������������  347 Equipment park/store in the laboratories ������������������������������������  348 Clean utility in the laboratories����������������������������������������������������  348 Emergency eyewash station in the laboratories ��������������������������  349 Bulk storage room in the laboratories������������������������������������������  349 Autoclave room in the laboratories����������������������������������������������  349 Cold storage room in the laboratories������������������������������������������  350 Flammable storage in the laboratories ����������������������������������������  350 Biohazard/trash/recycle room in the laboratories������������������������  351 Gas storage closet in the laboratories������������������������������������������  351 RO water closet in the laboratories����������������������������������������������  352 Record/file/copy room in the laboratories������������������������������������  352 Penta head/deca head microscope room in the laboratories��������  353 Block and slide storage room in the laboratories������������������������  353 Specimen storage/recycle room in the laboratories ��������������������  354 Doctors’ room in the laboratories������������������������������������������������  354 Laboratory manager room in the laboratories������������������������������  355 Technicians’ room in the laboratories������������������������������������������  355 OPD phlebotomy room����������������������������������������������������������������  356 Fine needle aspiration room��������������������������������������������������������  357

List of Tables

Table 9.42 Table 9.43 Table 9.44 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 Table 10.6 Table 10.7 Table 10.8 Table 10.9 Table 10.10 Table 10.11 Table 10.12 Table 10.13 Table 10.14 Table 10.15 Table 10.16 Table 10.17 Table 10.18 Table 10.19 Table 10.20 Table 10.21 Table 10.22 Table 10.23 Table 11.1 Table 11.2 Table 11.3 Table 11.4 Table 11.5 Table 11.6 Table 11.7 Table 11.8 Table 11.9 Table 11.10 Table 11.11 Table 11.12 Table 11.13 Table 11.14 Table 11.15 Table 11.16 Table 11.17 Table 11.18 Table 11.19

xxxiii

Waiting area near phlebotomy room��������������������������������������������  358 Staff lounge in the laboratories����������������������������������������������������  358 Shower with water closet in the laboratories ������������������������������  359 Receiving area of the blood bank������������������������������������������������  363 Testing area of the blood bank ����������������������������������������������������  365 Storage and processing area of the blood bank����������������������������  366 Distribution area of the blood bank���������������������������������������������  367 Utility areas of the blood bank����������������������������������������������������  368 Entrance of the blood bank����������������������������������������������������������  369 Reception, registration, and cash counter of the blood bank ������  370 Waiting lobby of the blood bank��������������������������������������������������  371 Medical examination room of the blood bank ����������������������������  373 Bleeding room of the blood bank������������������������������������������������  375 Refreshment/recovery/restroom of the blood bank����������������������  376 Apheresis room of the blood bank ����������������������������������������������  377 Testing area of the blood bank ����������������������������������������������������  378 Storage and processing area of the blood bank����������������������������  380 Blood component room of the blood bank����������������������������������  381 Distribution area/delivery room of the blood bank����������������������  383 Change room of the blood bank��������������������������������������������������  384 Doctors’ restroom of the blood bank ������������������������������������������  384 Store of the blood bank����������������������������������������������������������������  385 Record room of the blood bank ��������������������������������������������������  385 Medical officer room of the blood bank��������������������������������������  386 Sterilization cum washing room of the blood bank ��������������������  387 Waste management and disposal of the blood bank��������������������  387 Room designing of cath lab ��������������������������������������������������������  390 Cath lab procedure room��������������������������������������������������������������  394 Cath lab control room������������������������������������������������������������������  396 UPS room cath lab ����������������������������������������������������������������������  397 Change room for patients in cath lab ������������������������������������������  398 Change rooms for staff in cath lab ����������������������������������������������  399 Waiting area for cath lab��������������������������������������������������������������  400 Store for unused disposables and consumables in cath lab����������  401 Store for records and DVDs in cath lab ��������������������������������������  401 Consultation room in cath lab������������������������������������������������������  402 Designing of audiometry room����������������������������������������������������  404 Patient room of audiometry unit��������������������������������������������������  405 Technician room of audiometry unit��������������������������������������������  406 Designing the room for the sleep lab ������������������������������������������  407 Patient sleeping room of sleep lab ����������������������������������������������  407 Technician room of sleep lab ������������������������������������������������������  408 Designing the dialysis unit����������������������������������������������������������  409 Dialysis procedure room��������������������������������������������������������������  412 Room for dialyser wash ��������������������������������������������������������������  415

xxxiv

List of Tables

Table 11.20 Stores for unused disposables and consumables for dialysis unit����������������������������������������������������������������������������������  416 Table 11.21 Change rooms for patients in the dialysis unit����������������������������  416 Table 11.22 Change room for staff in the dialysis unit������������������������������������  417 Table 11.23 Waiting lobby of the dialysis unit������������������������������������������������  418 Table 11.24 Consultation rooms of dialysis unit ��������������������������������������������  420 Table 12.1 Utility area of radiation therapy��������������������������������������������������  425 Table 12.2 Treatment and planning area of radiation therapy ����������������������  429 Table 12.3 Chemotherapy ward/radiotherapy ward��������������������������������������  435 Table 12.4 Reception/registration/cash counters for radiation therapy department������������������������������������������������������������������������������������  438 Table 12.5 Record room of radiation therapy department ����������������������������  440 Table 12.6 General stores of radiation therapy department ��������������������������  440 Table 12.7 Consultation rooms of radiation therapy department������������������  442 Table 12.8 Waiting and sub-waiting lobbies of the radiation therapy department������������������������������������������������������������������������������������  444 Table 12.9 External beam radiation therapy (LINAC)����������������������������������  446 Table 12.10 Control room for LINAC ������������������������������������������������������������  447 Table 12.11 Internal beam radiation therapy (brachytherapy)������������������������  449 Table 12.12 Operating room for surgeries near the brachytherapy room��������  450 Table 12.13 Mould room of radiation therapy department������������������������������  453 Table 12.14 Mould workshop of radiation therapy department����������������������  454 Table 12.15 Medical physics room of radiation therapy department��������������  455 Table 12.16 CT scan machine room of radiation therapy department������������  456 Table 12.17 CT control room of radiation therapy department ����������������������  458 Table 12.18 UPS room for CT scanner of radiation therapy department��������  459 Table 12.19 Change rooms of radiation therapy department��������������������������  459 Table 12.20 Clean room of radiation therapy department ������������������������������  460 Table 12.21 Dirty utility/sluice room of radiation therapy department ����������  460 Table 12.22 Trolley park area of radiation therapy department����������������������  461 Table 12.23 Equipment park/store of radiation therapy department ��������������  461 Table 12.24 Store for medicines, consumables, and disposables of radiation therapy department ������������������������������������������������������  462 Table 12.25 Scrub station of radiation therapy department ����������������������������  462 Table 12.26 Chemotherapy ward/radiotherapy ward��������������������������������������  463 Table 12.27 Administrative rooms of radiation therapy department ��������������  466 Table 13.1 Utility area of rehabilitation department��������������������������������������  470 Table 13.2 Therapy and treatment area of rehabilitation department������������  474 Table 13.3 Reception/registration/cash counters of rehabilitation department������������������������������������������������������������������������������������  476 Table 13.4 Waiting and sub-waiting lobbies of the rehabilitation department������������������������������������������������������������������������������������  478 Table 13.5 Examination rooms of rehabilitation department������������������������  480 Table 13.6 Administrative rooms of rehabilitation department ��������������������  482 Table 13.7 General stores of rehabilitation department��������������������������������  482

List of Tables

Table 13.8 Table 13.9 Table 13.10 Table 13.11 Table 13.12 Table 13.13 Table 13.14 Table 13.15 Table 14.1 Table 14.2 Table 14.3 Table 14.4 Table 14.5 Table 14.6 Table 14.7 Table 14.8 Table 14.9 Table 14.10 Table 15.1 Table 15.2 Table 15.3 Table 15.4 Table 15.5 Table 15.6 Table 15.7 Table 15.8 Table 15.9 Table 15.10 Table 15.11 Table 15.12 Table 15.13 Table 16.1 Table 16.2 Table 16.3 Table 16.4 Table 16.5 Table 16.6 Table 16.7 Table 16.8 Table 16.9 Table 16.10 Table 16.11 Table 16.12 Table 16.13 Table 16.14

xxxv

Record room of rehabilitation department����������������������������������  483 Equipment park/store of rehabilitation department ��������������������  483 Trolley park area of rehabilitation department����������������������������  484 Clean utility room of rehabilitation department��������������������������  484 Dirty utility/sluice room of rehabilitation department ����������������  485 Change rooms of rehabilitation department��������������������������������  485 Physiotherapy rooms/cabins of rehabilitation department����������  486 Occupational therapy rooms/cabins of rehabilitation department 488 Spaces required for pharmacy unit����������������������������������������������  493 Drug receiving area of pharmacy unit������������������������������������������  496 Storage and dispensing hall of pharmacy unit ����������������������������  497 Bulk storage room of pharmacy unit ������������������������������������������  499 Cold store of pharmacy unit��������������������������������������������������������  500 Expiry drug room of pharmacy unit��������������������������������������������  500 Costly drug room of pharmacy unit ��������������������������������������������  501 Drug sorting room of pharmacy unit ������������������������������������������  501 Narcotics and controlled drug room of pharmacy unit����������������  502 Pharmacist office of pharmacy unit ��������������������������������������������  503 Spaces required for CSSD ����������������������������������������������������������  508 Receiving zone of CSSD�������������������������������������������������������������  513 Decontaminating, washing, and disinfecting zone of CSSD ������  514 Packing zone of CSSD����������������������������������������������������������������  516 Sterilization zone of CSSD����������������������������������������������������������  517 Clean storage zone of CSSD��������������������������������������������������������  519 Delivery zone of CSSD����������������������������������������������������������������  520 Administrative rooms of CSSD ��������������������������������������������������  521 Staff changing rooms of CSSD����������������������������������������������������  522 Shoe-changing areas of CSSD ����������������������������������������������������  523 General store of CSSD����������������������������������������������������������������  523 Restroom for staff of CSSD ��������������������������������������������������������  524 Trolley bay of CSSD��������������������������������������������������������������������  524 Spaces required for hospital kitchen��������������������������������������������  529 Entry to the hospital kitchen��������������������������������������������������������  534 Change rooms cum hand wash area of hospital kitchen��������������  535 Storage area of hospital kitchen��������������������������������������������������  536 Preparation area of hospital kitchen��������������������������������������������  537 Cooking area of hospital kitchen ������������������������������������������������  538 Reheating area of hospital kitchen����������������������������������������������  540 Packing/plating area of hospital kitchen��������������������������������������  541 Meal trolley/cart parking of hospital kitchen������������������������������  541 Trolley return/strapping area of hospital kitchen ������������������������  542 Trolley/cart washing area of hospital kitchen������������������������������  543 Dish washing area of hospital kitchen ����������������������������������������  544 Pot-washing area of hospital kitchen ������������������������������������������  545 Waste disposal from hospital kitchen������������������������������������������  545

xxxvi

Table 16.15 Table 16.16 Table 17.1 Table 17.2 Table 17.3 Table 17.4 Table 17.5 Table 17.6 Table 17.7 Table 17.8 Table 17.9 Table 17.10 Table 17.11 Table 17.12 Table 18.1 Table 18.2 Table 18.3 Table 18.4 Table 18.5 Table 18.6 Table 18.7 Table 18.8 Table 18.9 Table 18.10 Table 18.11 Table 18.12 Table 18.13 Table 18.14 Table 18.15 Table 18.16 Table 19.1 Table 19.2 Table 19.3 Table 19.4 Table 19.5 Table 19.6 Table 19.7 Table 19.8 Table 19.9 Table 19.10 Table 19.11

List of Tables

Gas storage closet of hospital kitchen������������������������������������������  546 Staff accommodation for hospital kitchen ����������������������������������  547 Spaces required for hospital laundry��������������������������������������������  552 Central storage area of hospital laundry��������������������������������������  556 Dirty receipt area of hospital laundry������������������������������������������  557 Sorting and weighing area of hospital laundry����������������������������  558 Washing area of hospital laundry������������������������������������������������  558 Inspection and repairing area of hospital laundry������������������������  562 Packing and storage area of hospital laundry������������������������������  562 Dispatch room of hospital laundry����������������������������������������������  563 Trolley washing area of hospital laundry������������������������������������  564 Store for consumables of hospital laundry����������������������������������  564 Staff accommodation in hospital laundry������������������������������������  565 General issues about hospital laundry infrastructure ������������������  566 Spaces required for Medical Record Department (MRD) ����������  571 Entry and reception of medical record department (MRD) ��������  574 Medical record receipt room of Medical Record Department (MRD)��������������������������������������������������������������������������������  575 Compilation desk of Medical Record Department (MRD)����������  575 Indexing and coding room of Medical Record Department (MRD)��������������������������������������������������������������������������������  576 Statistical analysis of Medical Record Department (MRD)��������  576 Computer lab of Medical Record Department (MRD)����������������  577 Medical record storage room of Medical Record Department (MRD)��������������������������������������������������������������������������������  578 Dictation room of Medical Record Department (MRD)��������������  578 Transcription room of Medical Record Department (MRD) ������  579 Photocopying/printing room of Medical Record Department (MRD)��������������������������������������������������������������������������������  580 Record scanning room of Medical Record Department (MRD)��  580 Binding room of Medical Record Department (MRD)����������������  581 Waste holding room of Medical Record Department (MRD)������  581 Store of Medical Record Department (MRD) ����������������������������  582 Staff accommodation for Medical Record Department (MRD)��  582 Spaces required for mortuary������������������������������������������������������  586 Spaces required for autopsy area ������������������������������������������������  588 Entrance lobby and reception of mortuary����������������������������������  590 Body wash area of mortuary��������������������������������������������������������  591 Body holding area of mortuary����������������������������������������������������  592 Waiting/viewing area of mortuary ����������������������������������������������  593 Store of mortuary ������������������������������������������������������������������������  593 Staff accommodation of mortuary ����������������������������������������������  594 Exit lobby of mortuary����������������������������������������������������������������  594 Pre-autopsy room of autopsy area������������������������������������������������  595 Autopsy room (indoor) of autopsy area ��������������������������������������  596

List of Tables

Table 19.12 Table 19.13 Table 19.14 Table 19.15 Table 19.16 Table 19.17 Table 19.18 Table 20.1 Table 20.2 Table 20.3 Table 20.4 Table 20.5 Table 20.6 Table 20.7 Table 20.8 Table 20.9 Table 20.10 Table 20.11 Table 20.12 Table 20.13 Table 20.14 Table 20.15 Table 20.16 Table 20.17 Table 20.18 Table 20.19 Table 20.20 Table 20.21 Table 20.22 Table 20.23 Table 20.24 Table 21.1 Table 21.2 Table 21.3 Table 21.4 Table 21.5 Table 21.6 Table 21.7 Table 21.8

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Autopsy room (outdoor) of autopsy area ������������������������������������  597 Post-autopsy room of autopsy area����������������������������������������������  598 Autopsy surgeon’s room of autopsy area������������������������������������  598 Instrument wash room of autopsy area����������������������������������������  599 Viscera preparation room of autopsy area ����������������������������������  599 Viscera store of autopsy area ������������������������������������������������������  600 Surgeons change room of autopsy area���������������������������������������  600 Reception of hospital administration ������������������������������������������  604 Waiting lobbies of hospital administration����������������������������������  605 Senior level management offices ������������������������������������������������  606 Senior executive level management’s office��������������������������������  607 Executive level management’s office������������������������������������������  608 Junior executive level management’s office��������������������������������  609 Office of the personnel department����������������������������������������������  610 Office of the accounts and finance department����������������������������  611 Office of the marketing department ��������������������������������������������  611 Office of the purchase department ����������������������������������������������  612 Office of the information technology department������������������������  613 Reception of the administrative department��������������������������������  615 Waiting lobbies of the administrative department ����������������������  617 Offices of the senior management of the administrative department������������������������������������������������������������������������������������  619 Offices of the senior executive level management of the administrative department������������������������������������������������������������  621 Offices of the executive level management of the administrative department����������������������������������������������������������������������  623 Offices of the junior level management of the administrative department����������������������������������������������������������������������������  625 Offices of the personal assistant of the administrative department������������������������������������������������������������������������������������  626 Offices of the secretarial staff of the administrative department  628 Kitchen of the administrative department������������������������������������  628 Dining area of the administrative department������������������������������  629 Store of the administrative department����������������������������������������  629 Notice boards of the administrative department��������������������������  630 Meeting rooms/conference room of the administrative department������������������������������������������������������������������������������������  630 Type of stores in the hospital ������������������������������������������������������  637 Utility in the stores area of the hospital ��������������������������������������  638 Stores of the hospital��������������������������������������������������������������������  640 Special store room of the hospital������������������������������������������������  642 Cold store room of the hospital����������������������������������������������������  643 Store keeper office of the hospital ����������������������������������������������  643 Store secretarial staff room of the hospital����������������������������������  644 Kitchen in the store area��������������������������������������������������������������  645

xxxviii

Table 21.9 Table 22.1 Table 22.2 Table 22.3 Table 22.4 Table 22.5 Table 22.6

List of Tables

Receiving area in stores of the hospital ��������������������������������������  645 Engineering and maintenance units of the hospital ��������������������  649 Utility areas in engineering and maintenance units of the hospital����������������������������������������������������������������������������������������  650 Engineering and maintenance workshops of the hospital������������  651 Workshop in-charge room in engineering and maintenance units ����������������������������������������������������������������������������������  653 Workshop engineer room in engineering and maintenance units 654 Receiving/issue counter in engineering and maintenance units��  654

About the Author

Ajay  Garg  FCA, DHA, SAP(FI), has been in the field of healthcare planning, designing, and administration for the last three decades. He has worked for about 28  years with various hospitals, like Narinder Mohan Hospital & Heart Centre, Ghaziabad; Jeevan Rekha Hospital, Kashipur; and Teerthanker Mahaveer Medical College, Moradabad. He has also completed various hospital projects like Krishna Hospital (Kashipur), Narayan Hospital (Rudrapur), Le-Crest Hospital (Vasundhara, Ghaziabad), and TSM Medical College and Hospital (Lucknow) as a hospital consultant. He had already authored a book titled ‘Manual of Hospital Planning and Designing’ published by Springer Nature.

xxxix

1

Entrance Lobby

As soon as the patients, staff members, and visitors arrive at the hospital, the first place he/she lands is the entrance lobby. Hospital entrance lobbies serve as more than just a passageway connecting the outside and the inside of the building. This is where a hospital’s efforts to deliver high-quality medical treatment begin. According to the phrase ‘the first impression is the last impression’, the hospital lobby functions as the first impression of the facility. From this point onwards, segregation, separation, and infection control all start. The entrance lobby typically houses services like the reception desk, help desk, inquiry desk, registration desk, cash counter, admission desk, and discharge desk, among others. There are a few issues which need to be ensured before declaring the entrance lobby complete and operational, such as the following: the required infrastructure is provided; the layout of the entrance lobby is perfect; required services are available; proper furniture and fixtures are in place; required electrical points and communication ports have been provided; public utilities have been provided; signage, wayfinding, and display mechanisms are in place; required instrument/equipment/ gadgets are available; other required facilities are available; patient/staff/visitor safety mechanisms are available; proper lighting is ensured; proper environmental control with heating and air conditioning is available; security devices and mechanisms are provided; announcement systems are in place; and wall, ceiling, and interior decoration are up to the mark and appealing. This set of checklist shall help the planner and designer to remember all such issues relating to the entrance lobby and guide him/her to complete the test and commission all works/activities well in time. This will help him/her to ensure himself/herself that all the works/activities are carried out, complete, and working before the actual operations of the hospital begin.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_1

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1.1

1  Entrance Lobby

Location of the Entrance Lobby

The entrance lobby shall be located on the ground floor of the building, near the main hospital building entrance. As soon as the patient/visitor approaches the main hospital building, it shall directly lead to the entrance lobby. Hence, the entrance lobby shall be placed in a place which is prominently visible from the outside. The approach path to the lobby shall be clearly marked with signage so that visitors/ patients can easily reach the entrance lobby.

1.2 Infrastructure Now we will define each portion of the entrance lobby.

1.2.1 Entrance Hall See Table 1.1. Table 1.1  Entrance hall

Activity Has the spaces for the following been provided in entrance lobby Information centre and a small waiting area Reception Inquiry desk Help desk Registration Registration counter for empanelled and insured patients Admission and discharge desk Cash counter Strong room for cashier Store for the use of the reception and registration Pharmacy Back office for administrative support Cafeteria Public toilets separate for males and females

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::-

::::-

::::-

1.1 Infrastructure

3

Table 1.1 (continued)

Activity Public toilets separate for disabled and elderly Facility for drinking water Parenting/baby change facilities Prayer rooms/ meditation room Banking facilities ATM of bank Florist Gift shop Book shop Newspaper reading deck Entrance gates Signage and wayfinding system

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::::::::::-

While setting up the entrance lobby, the planner shall ensure that the spaces have been provided for: 1. Information centre: The information centre includes the spaces for a kiosk display and display of the signboard containing information about the departments of the hospital and doctors’ details including the day and time of consultation. The main signage and wayfindings are also displayed in the information centre. 2. Small waiting area: Waiting areas are provided in the entrance lobbies for a very limited person. Basically, the waiting shall be provided for senior citizens and physically compromised persons. 3. Reception: A reception counter shall be provided just in front of the entrance gate of the lobby so that it is visible as soon as the person enters the entrance lobby. Hence, these counters shall be located directly opposite the lobby’s main entrance gate. Furthermore, the reception desk shall have a clear view of the main entrance and waiting areas. The size of the reception counter shall be determined by the expected number of patients/visitors who will use the reception services. It is recommended that there shall be enough space for two receptionists to sit. 4. Inquiry desk: Enquiry counter is to help the person landing in the hospital to provide information about the hospital set-up, services available, indoor patient information, etc. and to resolve the inquiries of the patients, visitors, and relatives of the patient. As in the case of reception, the inquiry desk

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1  Entrance Lobby

shall also be visible as soon as the person enters the entrance lobby. Hence, these counters shall be located directly opposite the lobby’s main entrance gate. Furthermore, the inquiry counter shall have a clear view of the main entrance and waiting areas. The size of the inquiry counter shall be determined by the expected number of patients/visitors who will use the services of this counter. It is recommended that there shall be enough space for two clerks to sit. 5. Help desk: The help desk is to help the persons in the entrance lobby to solve the problems of the attendants and patients. However, the purpose of the help desk and enquiry counter is more or less the same. Hence, if there is any ­shortage of space in the entrance lobby, the help desk and inquiry counter can be clubbed together. If separately provided, the help desk shall be placed at such a location so that it is visible as soon as the person enters the entrance lobby. Hence, these counters shall be located directly opposite the lobby’s main entrance gate. Furthermore, the help desk shall have a clear view of the main entrance and waiting areas. The size of the help desk counter shall be determined by the expected number of patients/visitors who will use the services of this counter. It is recommended that there shall be enough space for two clerks to sit. 6. Registration: The registration counters are provided to register the patient with the hospital and also to register the patient for OPD consultation. The number of such counters is dependent on the patient load of the hospital. The more the patient, the more shall be registration counters. The best method to determine the number of counters is that the waiting time for registration shall not be more than 10 min. 7. Registration counter for insured and empanelled patients: The registration counters shall also be provided for patients who are covered with any type of empanelled organizations, patients who are insured with the insurance company, corporate patients, and patients from government organizations. The number of such counters is dependent on the patient load of the hospital. The more the patient, the more shall be registration counters. The best method to determine the number of counters is that the waiting time for registration shall not be more than 10 min. 8. Admission and discharge desk: Generally, hospitals prefer to provide a separate counter for admission and discharge of the patient. Preferably, there shall be two counters: one for admission and the other for discharge. However, if the size of the hospital is small, the combined admission and discharge counter can be provided. The number of such counters is dependent on the patient load of the hospital. The more the admission and discharge rate of the hospital, the more shall be the counters. 9. Cash counter: If a registration and admission/discharge counter is provided in the lobby, a cash counter shall also be provided because these two counters provide services related to financial transactions simultaneously. Hence, having a cash counter nearby will make it easier for patients/visitors to deposit cash. The cash counter shall be separate from the other counters and not close to the

1.1 Infrastructure

10.

11.

12.

13.

14.

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other service counters. The size of the cash counter shall be determined by the anticipated number of patients/visitors who will use cash deposit services. Nonetheless, seating for two cashiers shall be provided. Strong room for cashier: A small substantial room attached to the cash counter shall also be provided, where the cashier can keep safe, and the cash can be kept in the safe as and when required. The size of the room shall be about 3048 mm × 3048 mm. The room shall have only one door, which shall open to the cash counter. The door shall not be less than 914 mm. However, if the hospital has a system of collecting cash regularly (say, at least twice a day), this room may not be necessary. Store for the use of reception and the registration counter: Behind the reception, a storeroom shall be provided for the receptionist to keep general items such as stationery, forms, documents, and discharged files. The size of the room shall be about 3658 mm × 3658 mm. This room shall only have one door, which shall open into the reception area. The door shall not be less than 1000 mm. Pharmacy: Since most outpatients prefer to buy their medications from the hospital pharmacy counter, the pharmacy shall ideally only be located in the lobby. The pharmacy shall be easily accessible from the outpatient department’s exit. To help the consumer understand the dosage and adverse effects of the prescribed drug, a prescription explanation desk shall be provided. The pharmacy shall have serving windows. Attached to the pharmacy shall be the rooms like medicine receiving areas, bulk store, expiry medicine room, cold store, pharmacist office, and staff toilets. For more details on the pharmacy unit, please refer to chapter number 14 of this book. Back office for administrative support: Behind the reception counter, the back office for administrative support shall be provided. This room is used to provide special help to the patient/visitors for queries that cannot be attended to at the counter and requires a separate place. At times, if the patient, visitors, or relatives of the patient like to meet the senior officials of the hospital, may seek specialized help, or may become furious, this room shall be used. The room can also be used for counselling the patient. This room shall be just like a manager’s room of any other department. This room’s dimensions shall be 4572 mm × 4267 mm. A toilet shall be attached to this room. The room can also have a PA room attached to it if required. Cafeteria: Due to the large number of visitors arriving at the hospital, a cafeteria shall be provided in one of the corners of the lobby, where visitors can refresh themselves. It shall be visible inside the lobby and have a separate entrance door. The cafeteria shall be large enough to accommodate at least 30 people. Therefore, the cafeteria shall be at least 9144 mm × 6096 mm in size.

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15. Public utility for patients/visitors: Along with the entrance lobby, the toilet facility shall be provided. The toilets shall be separate for males and females. They shall have the provision for hand washing, and proper sanitary fittings shall be provided. The size of the toilet shall be about 6096 mm × 4572 mm. Further, at least one accessible toilet shall be provided with the main toilet block to be used by the physically disabled or elderly patients/visitors. This toilet shall have a proper provision of handrails and grab bars. Along with the toilet, on one corner, a parenting/baby change facility shall be provided with a space for the disposal of the baby’s soiled diapers. Also, at some distance from the toilets, the facility of drinking water shall be provided. It will still be better if the tea/coffee vending machine is also placed in this area. 16. Prayer room/meditation spaces: Disturbed family members of the patient usually are in fear and often seek blessings from the Almighty. Therefore, it is advised to provide prayer rooms on one side of the entrance lobby for prayer, meditation, reflection, and spiritual contemplation. Particular attention should be paid while designing the space, especially considering that adequate space is available for all/different religions. 17. Other service counters in the entrance lobby: Depending on the space, and the need of the patient/visitors, space may also be allocated for the services like banking facilities, general shops, florist, gift shop, book shop, ATMs, and newspaper reading deck. The size of these spaces shall be decided depending on the requirement and space availability. As far as the electrical points and other connectivity points are concerned, it shall be the concerned shop’s demand. 18. Entrance gates to the lobby: Two sets of doors shall be provided in the lobby, one for entry and the other for the exit. Each set of doors shall be at least 2438  mm wide and have twin doors, which shall open on either side. The sensor-­operated glass doors are another option for automation. The external and internal sections must be connected through an airlock space. This can be accomplished by setting up two sets of doors, say, six feet apart from each other. The goal is to reduce the rate of infection while maintaining temperature, air pressure, and air conditioning from internal to external locations. 19. Signage and wayfinding in the lobby: The layout of the lobby shall be made clear to visitors with the use of appropriate signage. Provide simple and clear directions. This can be achieved via appropriate signage or creative use of materials, such as accent lighting or colour-coordinated walkways.

1.2.2 Outside Entrance Lobby See Table 1.2.

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1.1 Infrastructure Table 1.2  Outside entrance lobby

Activity Landing bay Covered porch Trolley bay Screening areas Hand wash/sanitizer station Face mask/shoe cover dispensers A security checkpoint near the entrance

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:::::::-

1. Landing bay: Outside of the entrance lobby, there shall be a landing bay for dropping off and picking up the visitors. This landing bay shall preferably be provided with a porch at the entrance gate as a shelter from inclement weather. The porch shall be wide enough to allow two vehicles to pass easily at a time. The height of the porch shall be at least 4572 mm from the road level. There shall be a clear traffic pattern outside the lobby. The emergency department’s entrance lobby has to be separate and shall not conflict with the main entrance lobby. 2. Trolley bay: The trolley bay shall be provided outside the lobby for parking wheelchairs and stretcher trollies so that the patients dropped on the porch can use them. 3. Screening areas: It is recommended to provide a screening area at the hospital entrance and any other main public entry to perform screening through questionnaires and measurement of body temperature and other basic vitals. For this, isolated screening cabins can be used. It is a closed chamber with a provision of negative pressure and UV sterilization with a glass partition on the front side. There are two holes in the glass to fix the long elbow gloves. A healthcare worker sitting in the cabin can examine the patient standing on the other side of the glass through the gloves. This can help to sort out infectious patients at the entry point. This allows hospital workers to easily trace out infectious and contagious patients and isolate them or restrict their access to the hospital. 4. Hand wash/sanitizer stations: Hospitals should place hand wash stations or hand sanitizer dispensers at doors and entrances and encourage staff, patients, and visitors to use them more frequently. Before placing the hand wash stations or sanitizer stations, an analysis of the building’s layout for other accessible locations should be done.

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5. Face mask/shoe cover dispensers: Hospitals should also make arrangements for placing the face mask/shoe cover dispensers at the hospital’s doors and entrances. Any staff, patients, and visitors entering the hospital shall be encouraged to use them regularly. 6. Security checkpoint: A security checkpoint shall be located near the lobby’s entrance. A security barrier that can be locked in the event of an emergency shall be provided.

1.2.3 General Issues Related to the Entrance Lobby • The spaces within the lobby shall be clearly demarcated into visual zones and visual pathways. • The size of the lobby shall be determined by the number of service counters to be provided, the size of the counters, the number of waiting spaces to be provided, the number of visitors expected in the lobby, and other factors. • Security features such as CCTV shall be installed in this area but shall not be visible or noticeable to visitors. • Hooters and alarms shall be provided as security features. • Unauthorized access behind counter areas shall be prevented at the reception desk. • A suitable barrier for safety shall also be provided for the cashier. • Proper heating and air conditioning shall be provided. • For disabled patients, a wheelchair-accessible reception booth shall be provided.

1.3 Services, Facilities, Equipment, Tools, and Instruments 1.3.1 Reception See Table 1.3. The ideal size of the reception and/or help desk shall be about 3048–4572 mm long. The counter can be made out of civil work with an aesthetic look or granite or other material can be used to make it look appealing. Alternately, a counter made out of wood can also be provided. The front side of the counter shall be about 1524 mm in height so that the person can easily stand and talk to the receptionist. On the other side of the counter, the working top shall be provided, which shall be about 610 mm in width and 762 mm in height. Two reception chairs shall be provided for the receptionists. If need be, high-­ raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided to each receptionist or the help desk assistant. If required, the scanner can also be provided at reception.

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1.2  Services, Facilities, Equipment, Tools, and Instruments Table 1.3  Reception/help desk counters in the entrance lobby

Activity Provide the following at reception Reception chairs Computers with printers Scanner Microphone for public announcement system Intercom and telephone line Required electrical points at reception and help desk Other communication ports at reception and help desk Record room with reception

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::::-

:-

:-

The microphone for the announcement shall be provided at the reception. The intercom line and the telephone lines shall also be provided at the reception. Even one spare mobile phone shall also be placed at the reception to make emergency calls. The reception counter shall have the following electrical points: • At least six 5 Amp switch/sockets on the counter wall, about 152 mm above the working surface, shall be provided. These points shall be used to connect computers and printers. • For other appliances, two 15 Amp switch/sockets shall be provided on the wall behind the reception counter. The reception counter shall have the following communication ports: • • • •

Two RJ 45 connectors shall be provided for computer networking. Two RJ 11 connectors for intercom and extension line. Two USB ports for charging phones or other devices. The record room near the reception and/or help desk shall have steel cupboards and open racks for storage.

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1.3.2 Help Desk/Registration/Billing/Admission and Discharge Counters See Table 1.4. The ideal size of the counter shall be about 2438–3658 mm long. The counters can be made out of civil work with an aesthetic look and granite or other material can be used to make them look appealing. Alternatively, counters made out of wood can also be provided. The front side of each counter shall be about 1524  mm in height so that the person can easily stand and talk to the staff. On the other side of the counter, the working top shall be provided, which shall be about 610  mm in width and 762 mm in height. Two office chairs shall be provided at each registration/billing/admission and discharge counter. If need be, high-raised chairs can also be provided. Computer with UPS and printer (if needed for printing) shall be provided to each registration/billing/admission and discharge counter worker. If required, the scanner can also be provided at the registration/billing/admission and discharge counters. Also, the biometric scanners shall be provided at the registration counter to fetch the biometric data of the patient at the time of registration. Additionally, the barcode scanner and barcode printer shall be provided at the billing counter for scanning the barcodes for billing. The intercom line and the telephone lines shall also be provided at each registration/billing/admission and discharge counter. Table 1.4  Registration/billing/admission and discharge counters in the entrance lobby

Activity Provide the following at the registration and billing counter Office chairs Computers with printers Scanner Biometric scanner Intercom and telephone line Required electrical points at registration/ billing/admission and discharge counter Other communication ports at the registration/ billing/admission and discharge counter Record room with registration/billing/ admission and discharge counter

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::-

:-

:-

1.2  Services, Facilities, Equipment, Tools, and Instruments

11

Each registration/billing/admission and discharge counter shall have the following electrical points: • At least six 5 Amp switch/sockets on the counter wall, about 152 mm above the working surface, shall be provided. These points shall be used to connect computers and printers. • For other appliances, two 15 Amp switch/sockets shall be provided on the wall behind the counter. Each registration/billing/admission and discharge counter shall have the following communication ports: • Two RJ 45 connectors shall be provided for computer networking. • Two RJ 11 connectors for intercom and extension line. • Two USB ports for charging phones or other devices.

1.3.3 Cash Counter See Table 1.5. The size of the cash counter shall ideally be between 2438 and 3658 mm. The counter can be made of civil work with an appealing appearance, or it can be made of granite or another material. A wooden counter can also be provided as an alternative. The front side of each counter shall be about 1524 mm in height so that the person can easily stand and talk to the staff. On the other side of the counter, the working top shall be provided which shall be about 610 mm in width and 762 mm in height. Table 1.5  Cash counter in the entrance lobby

Activity Provide the following at cash counter Office chairs Computers with printers Scanner Barcode scanner Intercom and telephone line Required electrical points at the cash counter Other communication ports at cash counter Strong room with cash counter

Status of works Start End In Not date date Complete progress started

::::::-

::-

Responsible person

Remarks

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As the safety of the cash is necessary at the cash counters, above the counter, there shall be a glass partition up to the height of about 1219 mm from the top of the counter with a cut window on the lower side of the glass. Two office chairs shall be provided at each cash counter. If need be, high-raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided for each cashier separately. If required, the scanner can also be provided at the cash counter. Additionally, the barcode scanner shall be provided at the cash counter for scanning the barcodes for billing and receiving cash. The intercom line and the telephone lines shall also be provided at the cash counters. Each cash counter shall have the following electrical points: • At least six 5 Amp switch/sockets on the counter wall, about 6 inches above the working surface, shall be provided. These points shall be used to connect computers and printers. • For other appliances, two 15 Amp switch/sockets shall be provided on the wall behind the cash counter. Each cash counter shall have the following communication ports: • Two RJ 45 connectors shall be provided for computer networking. • Two RJ 11 connectors for intercom and extension line. • Two USB ports for charging phones or other devices. The strong room attached to the cash counter shall have a safe, which shall be properly grouted with the fasteners either to the working slab or to the floor of the room. The gates of the strong room shall be lockable and shall be operated by double keys.

1.3.4 Waiting Lobby See Table 1.6. The waiting lobby of the entrance hall shall be fully air-conditioned with a provision for cooling and heating. Waiting lobbies shall be properly guarded, and security measures like fire hooters and CCTV cameras shall be provided. Waiting lobbies shall have adequate speakers with a clear voice to hear the announcements. The proper comfortable chairs having backrests shall be provided in the waiting areas. Please avoid the backless benches, as it is not comfortable to sit on such benches. If sofa sets are provided, it will be better. However, the waiting areas of VIPs shall definitely have the sofa set along with the centre tables. The waiting areas shall have suitable seating provisions for bariatric patients.

1.2  Services, Facilities, Equipment, Tools, and Instruments

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Table 1.6  Waiting lobby in the entrance lobby

Activity Proper heating and air conditioning Security features like CCTV and fire hooters Announcement systems Waiting chairs/sofa set Wall, ceiling, and interior decoration Television, fish tanks, magazines, newspaper racks, kiosks, etc. Food and drink vending machines Signage and wayfinding system Spaces for indoor plants Mobile charging points in the lobby Free internet or Wi-Fi facility Handrails at the staircase and other areas

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::-

::::::-

For an aesthetic look of the waiting areas, the interiors shall be well decorated. The wall decoration shall be done by using mirrors, murals, texturized paints, or wallpapers. Similarly, the ceiling shall also be decorative. Light fittings shall also be decorative. For interior decor, colour, textures, surface finishes, fixtures, fittings, furnishings, and artworks shall be used. The waiting areas shall also have televisions, fish tanks, magazine holders, newspaper racks, kiosks, etc. for patients and visitors to spend time. For refreshment of the visitors and the patients, vending machines shall be provided in the waiting areas. The wayfinding and signages shall be very clear and glowable so that the visitors and the patients can easily identify the passages and the routes. For beautification, indoor plants can also be planned to be placed in waiting areas. Mobile charging points shall also be provided in the waiting area. Apart from this, if possible, the facility of Wi-Fi of the free internet can be provided. For the safety of the patients and visitors, provide necessary safety measures like handrails and non-slippery surfaces, avoid steep slopes, provide handicapped toilets and wheelchair accessibility, etc.

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Table 1.7  Pharmacy in the entrance lobby

Activity Storage racks Cupboards Drawers Office tables Chairs Refrigerators Vaccine storage fridge Computers with printers as required

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::::::-

1.3.5 Pharmacy See Table 1.7. The pharmacy shall be provided with sufficient racks, cupboards, and drawers for storing the medicines. In the bulk storage room, heavy-duty and deep racks shall be provided. Apart from this, a sufficient number of tables and chairs shall also be provided in the pharmacy. The pharmacy shall have refrigerators and a vaccine fridge. For billing and receiving cash from the sale of drugs and medicines, a sufficient number of computers with UPS and printers shall be provided at each serving window of the pharmacy. If required, the scanner can also be provided at the counters. Additionally, the barcode scanner shall be provided at the counter for scanning the barcodes of the drugs for billing. For more details about the pharmacy, please refer to Chapter No. 14 titled ‘Pharmacy Unit’ of this book.

1.3.6 Back Office for Administrative Support See Table 1.8. The back office administrative room shall be provided with an office chair along with the office table. At least two visitors’ chairs or a sofa set shall also be provided in the room. The computer system along with the UPS shall also be provided in the room. If needed, the printer and scanner shall also be provided. Most importantly, the room shall have the provision of audio-video recording, so the conversation between the hospital staff and the visitors can be recorded. This recording can act as proof in a court of law if required. Provide all the required electrical points and communication ports.

1.2  Services, Facilities, Equipment, Tools, and Instruments

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Table 1.8  Back office for administrative support in the entrance lobby

Activity Office table Office chair Two attendants’ chairs CCTV camera Required electrical points Required communication ports

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::::-

Table 1.9  Cafeteria in the entrance lobby

Activity Billing and serving counter Two chairs for the cafeteria staff Dining tables with chairs Standing dining tables Hand washing station Working top for placing kitchen equipment Refrigerator Deep freezers if required Microwave OTG Induction plate Gas burner Coffee/tea maker Computers with printers as required Electrical and other communication points

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::::-

:::::::::-

1.3.7 Cafeteria See Table 1.9. There shall be a proper billing and serving counter in the cafeteria, and it shall be on one side of the cafeteria. The counter shall have granite tops and be constructed with masonry work. The front side of the billing and serving counter shall be about

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1524 mm high so that customers can stand at it comfortably to place orders and accept deliveries of food. On the other side of the counter, the working top shall be provided, which shall be about 610 mm in width and 762 mm in height. The working surface top shall be provided on the wall behind the billing and serving counter to store appliances such as the microwave, induction plate, and tea/ coffee maker. The width of this working top shall be about 610 mm with a height of about 762 mm. For the café workers, two chairs shall be provided behind the billing and serving counter. The cafeteria shall have a suitable seating arrangement with chairs and tables. It will be better if some standing tables are also provided in addition to the chairs. In the cafeteria, there shall be a suitable hand washing station with the required water supply and drain lines. To prevent the smell of food from entering the lobby, adequate ventilation shall be provided. Trash containers shall be placed in every corner and other necessary locations in the cafeteria to enable efficient disposal of leftover food, disposables, and other waste. The cafeteria shall be provided with the appliances like refrigerator, deep freezer, microwave, OTG, induction plate, gas burner, and tea/coffee maker. A computer with UPS and printer (if needed for printing) shall be provided at the cafeteria’s service counter. If required, the scanner can also be provided at the counter. Additionally, the barcode scanner shall be provided at the counter for scanning the barcodes for billing and receiving cash. The intercom line and the telephone lines shall also be provided at the cafeteria’s billing and serving counter. The cafeteria shall have the following electrical points: • The cafeteria’s main switchboard, which controls the fan and lighting in the space as well as one 5 Amp switch/socket air conditioning control button with temperature adjustment, shall be provided on the wall opposite the wall on which the door will open. • At least six 15 Amp switch/sockets shall be provided on the rear wall, about one foot above the working surface. The cooking appliances shall be connected to these points. • At least six 5 Amp switch/sockets shall be provided on the billing and serving counter wall, about 6 inches above the working surface. These connector points must be utilized to connect PCs and printers. • On the wall behind the billing and serving counter, there must be two 15 Amp switch/sockets for supplying power to other appliances. The cafeteria shall have the following communication ports: • For computer networking, two RJ 45 points need to be provided. • For the intercom and extension line, provide two RJ 11 ports. • Enough power outlets and USB ports for charging smartphones.

1.2  Services, Facilities, Equipment, Tools, and Instruments

17

1.3.8 Public Utilities Proper ventilation must be ensured to facilitate exhaust of the toilet air to keep the lobby odour free. Further, the accessible toilet shall have a proper provision of handrails and grab bars. The parenting/baby change facility shall have a provision for a foldable baby change counter made out of either wood or stainless steel. For drinking water, sources like the water cooler, taps, or drinking fountains shall be provided, and the supply of drinking water shall be from the RO plant. It will still be better if the tea/coffee vending machine is also placed in this area.

1.3.9 Prayer Room/Meditation Spaces Prayer and meditation room shall have provision for hanging the pictures of the Almighty. Similarly, the raised platform shall be provided for placing the idols of the Almighty. The wall of the room shall be soundproof so that the outer noise does not enter the prayer room. The room shall be properly air-conditioned. The light shall be dim, and no bright light shall be provided.

1.3.10 Shops in the Entrance Lobby As far as the furniture of the shops is concerned, leave it up to the demand of individual shop, because the requirement of the furniture may differ from one to another. Similarly, as far as the electrical points and other connectivity points are concerned, it shall be the concerned shop’s demand.

1.3.11 Inside Entrance Lobby See Table 1.10. Inside the entrance lobby, all the interiors shall be excellent and shall give an appealing look. Some of the issues that can be taken care of or provided are as follows: • • • •

Enliven the area by the creation of art galleries or exhibition spaces. To make it appealing, a variety of materials, colours, and textures shall be used. Adequate window provision to bring in natural light and offer views of nature. Place natural and artificial plants inside the lobby.

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Table 1.10  Inside entrance lobby

Activity Spaces for art galleries or exhibition Adequate window provision for natural light and a view of nature Spaces for indoor plants Play areas for children, if possible Interactive displays Designated area for working on laptops with the provision of charging points Mobile charging points in the lobby Free internet or Wi-Fi facility Sound-absorbing materials on the walls, floors, and ceilings Handrails at the staircase and other areas Good internal lighting Television, fish tanks, magazines, movies/ DVDs, etc. Food and drink vending machines Airlock space connecting the external areas with internal areas Signage and wayfinding system Acrylic or glass partitions on all the counters Proper heating and air conditioning Security features like CCTV Announcement systems Waiting chairs Wall, ceiling, and interior decoration

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::-

::::-

:::-

:::-

::-

::-

:::::-

Further Reading

19

• Private room/space for visitors to discuss the issues like their health and payment, with officials and other personnel at the counters. • Provide interactive displays. • If possible, a small play area for children. • Designated area for working on laptops with the provision of charging points. • Free internet or Wi-Fi. • Mobile charging points in the lobby. • The walls and ceilings shall have sound-absorbing materials. • Floor material shall be able to reduce the risk of slips and falls of visitors, patients, and staff. • Staircases and other such areas shall have a provision of proper handrails. • Good internal lighting. • The lobby shall be provided with a television, fish tanks, magazines, movies/ DVDs, etc. • Food and drink vending machines. • The layout of the lobby shall be made clear to visitors with the use of appropriate signage. Provide simple and clear directions. This can be achieved via appropriate signage or creative use of materials, such as accent lighting or colour-­ coordinated walkways. • All the serving counters in the entrance hall shall be provided with a sturdy 1219 mm high acrylic or glass partition wall at the top of the counter or desk to save the workers from unwanted infection.

1.3.12 General Issues Related to the Entrance Lobby • Security features such as CCTV shall be installed in this area but shall not be visible or noticeable to visitors. • Hooters and alarms shall be provided as security features. • A suitable barrier for safety shall also be provided for the cashier.

Further Reading Adams A, Theodore D, Goldenberg E, McLaren C, McKeever P. Kids in the atrium: comparing architectural intentions and children’s experiences in a pediatric hospital lobby. Soc Sci Med. 2010;70(5):658–67. Building for Everyone: A Universal Design Approach. p. 88. Cho Y.  Wellness design evaluation criteria for the main entry lobby in a healthcare facility. 2017 Nov 30. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 113–21. Chapter 15, Designing of the Entrance Lobby of the Hospital

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1  Entrance Lobby

Healthcare Waiting Room Designs & Patient Research [Internet]. Steelcase. [cited 2021 Jun 18]. Available from: https://www.steelcase.com/spaces-­inspiration/ health-­spaces-­transition-­waiting/. Hospital Lobby Design Trends and Their Place in Design | Thought Leadership [Internet]. HMC Architects. 2020 [cited 2021 Jun 18]. Available from: https://hmcarchitects.com/news/ hospital-­lobby-­design-­trends-­and-­their-­place-­in-­design-­2020-­05-­06/.

2

Emergency Department

An emergency department (ED) is a department in the hospital to provide immediate and urgent medical treatment facilities to the patient by persons specialized in emergency medicine. Hence, emergency department plays an important role in providing the public with access to urgent and acute healthcare facilities apart from extending support to primary healthcare and community services. The emergency department is also addressed as accident and emergency department (A&E), emergency room (ER), or casualty department in different hospitals of different countries. The emergency department of the hospital is the window or can say door of the hospital from where the patients enter the hospital. Therefore, an emergency department creates the first impression on the patients, relatives, and friends who come along with the patient. If the patients in the emergency department are handled quickly and efficiently in a friendliness environment, it leads to a positive impact on the patients or their relatives and friends, who in turn can form their opinion about the care they will receive. The quicker and more efficient the care, the more the chances to save lives and also reduce the severity and duration of illness. The patients landing in the emergency department are of varied types like major trauma patients, elderly patients, patients with physical and mental disabilities, patients with mental health issues, patients with infectious diseases or who are immunocompromised, children and adolescents, sexual assault patients, domestic violence cases, custodial patients, victims of child abuse, and patients affected by chemical, biological, or radiological contaminants. The staff in the emergency department should be professional experts in their field who can effectively manage the patients, provide immediate critical care, resuscitate the patient, relieve the patient from pain, and save the life of the patient. The assistance of the support departments like radiology and pathology is also crucial for the emergency department to perform. Hence, the set-up of these supporting departments should be excellent and shall maintain good communication with an emergency department. The emergency department needs to establish a close © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_2

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2  Emergency Department

relationship with all these support departments as well as with the other departments and units of the hospital. The objective of the emergency department is to provide effective and immediate treatment to the patients, provide first aid to the patients, and save the life of the patient and relieve him/her of pain. Also, the department has to attend to medico-­ legal cases and coordinate with the local police for the same, screening patients for admission and providing care during non-OPD hours or on holidays. While planning and designing any emergency department in the hospital, it has to be ensured that all the works are complete and operational. Similarly, all the services shall be operational before the emergency department starts taking patients. On the other side, the emergency departments of the hospitals shall be operative 24 h a day for all weekdays. Hence, it becomes very easy for the patient with acute illness or accidents to land in this department without a prior appointment, but who requires immediate medical attention. There are a few issues which need to be ensured before the emergency department is in operation, such as the following: the required infrastructure is provided; the layout of the department is perfect; required services are available; proper furniture and fixtures are in place; required electrical points and communication ports have been provided; public utilities have been provided; signage, wayfinding, and display mechanisms are in place; required instrument/equipment/gadgets are available; required facilities are available; patient/staff/visitor safety mechanisms are available; proper lighting is ensured; proper environmental control with heating and air conditioning is available; security devices and mechanisms are provided; announcement systems are in place; and wall, ceiling, and interior decoration are up to the mark and appealing.

2.1 Level of Emergency Department An emergency department can be of different levels depending on various factors. Some of these factors are: 1. Number of beds in the hospital 2. Available space for emergency department 3. Expected number of patients to land in the department 4. Nature of diseases of patients landing in the emergency department 5. Availability of medical professionals in the department 6. Type and level of equipment provided in the department 7. Strength of the support departments and services like radiology, laboratory, and CSSD The set-up and the facilities to be provided in the emergency may vary according to the level of the emergency department. This set of monitoring tools shall help the planner and designer to remember all such issues relating to the emergency department and guide him/her to complete the test and commission all works/activities well in time. This will help him/her to ensure himself/herself that all the works/activities are carried out, complete, and working before the actual operations of the emergency department begin.

2.2  Location of Emergency Department and/or Trauma Centre

23

2.2 Location of Emergency Department and/or Trauma Centre See Table 2.1. Table 2.1  Entrance hall of emergency department

Activity Have the spaces for the location of the emergency department been identified? Is the required land available? Is the emergency located in a unitary building of the main hospital? If the emergency department is in a separate building, how much is the distance from the main hospital building? Distance from support departments like radiology Distance from support departments like pathology How much is the distance of the emergency department from the main gate? Is the road from the main gate directly approachable to the emergency department? Is the blood bank easily approachable from the emergency department? How much is the distance of the emergency department from the intensive care units (ICUs)? Are support services like CSSD and MGPS easily assessable?

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::-

:-

:-

:-

:-

:-

:-

:-

:-

24

2  Emergency Department

The emergency department of the hospital should be located on the ground floor, in the front portion of the hospital, and just at the entrance of the hospital, preferably with a separate and dedicated approachable entry. If the emergency department is planned within the unitary hospital building, a separate entry shall be planned. Similarly, a separate approach road and separate entrance along with the landing porch shall be planned. If the emergency department is located in a separate building, it shall be ensured that sufficient land is available. The size of the land shall be calculated keeping in view the area required for the emergency department, by-laws of the building regulatory authorities in terms of FAR, land coverage, setback areas, building height, etc. The main entrance gate of the emergency department shall be separate, and there shall be no general movement on this road. The main gate and the approach road shall be easily accessible to emergency vehicles entering the hospital. The department should be near other investigative departments like radiology and clinical laboratory and shall also not be far off from the other support departments like CSSD and MGPS. The emergency shall be properly displayed with adequate glowing signboards for easy identification by the patients and the vehicles entering the hospital. Preferably, an emergency department shall have a separate entry and exit. The road shall reach the entrance of the emergency department, making it accessible to the ambulance. The road shall also have a provision for an easy U-turn for the ambulance. The emergency department shall have separate entrances for a patient arriving by ambulances and walking patients. If there is a provision for air ambulances in the hospital, there shall be a separate entrance for such patients and shall not be clubbed with any other entrance. While deciding the location of the emergency department/trauma centre, it shall be ensured that the department shall be readily accessible to other critical areas and diagnostic facilities. The areas accessible to the emergency department can be the inpatient ward of the emergency department or the so-called observation ward or emergency ward; intensive care units (ICUs)/high dependency units (HDUs); clinical laboratory, radiology, or the so-called imaging department; operating rooms (ORs); interventional cardiology (if any); pharmacy, etc.

2.3 Rooms in the Emergency Department First of all, the overall size of the emergency department depends on factors such as the volume of patients expected to land in the emergency department and secondly the scope of services to be provided in the department. It is not that important that the size of the emergency has to be big, but important is that the space allotted for the services shall be sufficient to function efficiently. Also, the size of the emergency department depends on various other factors such as the location of the hospital and the type of patients expected to be landing in the emergency department; academic activities being undertaken in the department; pattern of diseases for which the patient lands in the emergency department; overall length of patient’s stay

2.4 Infrastructure

25

in the emergency department; indoor admission rates from the hospital; number of accident/trauma patients expected in the emergency; number of patients with an acute emergency; management of medico-legal cases; and turnaround time of the support departments like radiology, pathology, and other related investigations. While designing the room spaces of the emergency department, care shall be given to provide sufficient space for the movement of the stretcher trolleys and wheelchairs for wheeling the patient to and from the emergency department; waiting areas and reception; amenities like toilets and drinking water to be used by patients and attendants; accommodation of the operating areas in terms of major and minor operation theatre complex; triage and day care observation ward; and handling of mass casualties due to disasters like earthquake, train/bus accident, and fire. As the emergency department has different zones and areas, the following are the requirements of rooms for each such zone or area.

2.4 Infrastructure 2.4.1 Emergency Entrance Area See Table 2.2. The reception area shall be provided just at the entrance of the emergency department. It shall be ensured that the reception area for the emergency department, including other rooms required along with the reception, shall be separate. Under no circumstances the emergency reception shall be mixed or combined with the general reception of the hospital. Emergency reception shall be a dedicated reception serving only the emergency department and shall receive, help, and take care of the patients or the attendants/ Table 2.2  Emergency entrance area

Activity Has the spaces for the following been provided in the emergency department? Enquiry counter Registration counter Queuing tracks Record room Admission counter Cash counter General waiting Public utilities

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::::-

26

2  Emergency Department

visitors entering the emergency department. The reception usually acts as both enquiry and registration counter. Sufficient spaces shall be left in front of the emergency department for queuing of the patients, attendants, and visitors to the department. A small record room shall be provided attached or near to the reception, to be used by the reception staff to store the records and other printing and stationary items required for day-to-day working of the reception. This room can also be used by other counter staff like the cash counter and the registration counter. In the entrance area, the cash counter shall also be provided so that during non-­ working hours, when main cash deposit counters are closed, the payments can be deposited for availing the services of the emergency department. Along with the cash counter, a small strong room shall be provided to enable the cashier to safely keep the cash collected from the counter. However, if the hospital has a system of collecting cash from the cash counter more frequently, this may not be required. Along with the reception, the registration counter shall also be planned, to register, admit, and discharge the patient to/from the emergency department. However, if it is expected that the patient load in the emergency department will be less, then the registration counter can be clubbed with the reception counter or the cash counter.

2.4.2 Outside Emergency Department See Table 2.3. A landing bay for ambulances shall be provided outside of the entrance lobby to drop off the patients arriving in the emergency department. This landing bay shall preferably be a covered porch just outside the entrance gate of the emergency and shall act as a shelter from inclement weather. A separate walk-in entrance should also be provided so that the hindrance to the arrival of the ambulance can be avoided. The traffic pattern outside the emergency entrance shall be very clear and well defined. Apart from the landing bay, space is required for ambulance parking and ambulance washing. Preferably, these areas shall not be far off from the emergency department. As there shall be a backup facility of equipment to be used in an ambulance, a room shall be provided where this backup equipment can be stored, charged, and checked regularly. Hence, for efficient controlling of the ambulances, ambulance control or say transport office room can be provided. As drivers may be required in an emergency at any time, the availability of the ambulance driver shall be very quick. At times, it may also happen that the ambulance drivers arrive at odd times when he cannot go home. Hence, a small driver’s restroom shall be provided near the emergency department. If required, the hospital can also plan for the facility of the air ambulance. If planned, the helipad has to be provided, which can be either a rooftop helipad or otherwise on the ground, if the open spaces permit and fulfil the by-laws of the Aviation Regulatory Authorities of the country.

27

2.4 Infrastructure Table 2.3  Outside emergency department

Activity Ambulance landing bay Ambulance parking Ambulance equipment storage Drivers’ rest room Ambulance control room Decontamination area Entrance for patients Separate entrance for walking patients/ visitors Separate walk-in entrance Security checkpoint close to the emergency entrance Covered porch Trolley bay outside the lobby for wheelchairs/ stretchers

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::::-

::-

::-

The security at the entrance of the emergency shall be very effective; hence, a security check post shall be provided in proximity to the entrance. Outside the emergency, a small decontamination room shall be provided to clean the patient and make him/her hygienic before being shifted to the triage. If possible, a space shall be provided near the emergency department for cleansing and washing the ambulances.

2.4.3 Diagnostic Rooms See Table 2.4. For quick and effective resuscitation and treatment of the patients arriving in the emergency, the emergency departments shall have their own facility and set up for basic investigations. The investigations can be like pathology, radiology, and a few others which may be crucial. Depending on the size of the emergency, the investigation facilities that can be provided in the department can be like ECG, sample collection of blood and body fluids, X-ray, CT scan, MRI, and ultrasound.

28

2  Emergency Department

Table 2.4  Diagnostic rooms of emergency department

Activity ECG room Dressing rooms X-ray room CT scan  CT control room  CT panel room  CT UPS room  Change room MRI room  MRI control room  MRI panel room  MRI UPS room  Change room Ultrasound room Medico-legal specimen and record Portable X-ray room Disaster storage room

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::::::::::::-

::-

What all investigation facilities have to be provided in the emergency department itself will depend on the size of the emergency and the type and number of patients received and served in the emergency department. However, it is not always necessary that all investigation facilities are to be provided in the emergency department. This decision may depend on the factors like size of the emergency department, patient load, or investigation load in the department. Suppose that the emergency department is located in the same complex and very near to the radiology department; then there shall be no need for a separate radiological set-up in the emergency department; the facilities of the main radiology department can be used. There is no need to locate these investigation rooms on the front side of the emergency department. These can be located somewhere in the backside of the emergency department but shall be connected through a proper corridor for easy working. Further, the corridors shall be wide enough to easily move the stretcher or the patient bed without any interruption. Plaster room, clean utility, dirty linen, ECG room, dressing rooms, store, and portable X-ray room are simple rooms of different sizes. The sizes of the rooms shall depend on the planners and designers considering various factors.

29

2.4 Infrastructure

The CT scan and MRI rooms shall have spaces for the control room, panel room, UPS room, change rooms, etc. Medico-legal specimens and records shall be planned in the emergency department, which shall be properly secured and lockable. In the emergency department, a separate area shall be planned as a disaster storage room, which shall serve in the case of any major disaster, wherein a lot of patients may land in the emergency department in case of any major disaster, accident, or mishappening. As far as the sizes of the diagnostic rooms are concerned, it shall depend on the requirement, patient load, type of diseases normally attended in the department, availability of space, etc. However, there are a few diagnostic departments like X-ray and CT scan, where the norms and sizes of rooms are defined by the prescribed rules, regulations, and norms. Hence, the sizes of these rooms shall be according to these rules, regulations, and norms.

2.4.4 Triage See Table 2.5. Triage is an important area in the emergency department and can be termed the heart of the emergency department. A triage is a place where the patient lands into, Table 2.5  Triage of emergency department

Activity Triage Resuscitation Waiting Examination cubicles Isolation room/ chamber with negative pressure EMO duty room Doctors’ duty rooms Sub-waiting area Counselling/ interaction room for explaining attendants Public utility for faculty Public utility for patients and attendants Nurse station Disaster management area

Status of works Start End In Not date date Complete progress started :::::-

::::-

::::-

Responsible person

Remarks

30

2  Emergency Department

and this area acts as the first evaluation area, where the patient’s condition and degree of urgency to provide treatment are assessed. Depending on the outcome of this assessment, the patient will be resuscitated or treated. In case it is not possible to treat the patient in the emergency department and it is felt that the patient is sick and requires intensive care, the patient shall be shifted to the intensive care unit after resuscitation. If there is a separate treatment cum resuscitation room attached to the emergency department, the patient is shifted there for further management. If the condition of the patient is not critical but requires indoor admission, he/she shall be sent to the indoor ward for further treatment. If the patient is stable and does not require indoor admission, he/she shall be given first aid and discharged. The triage shall be located just near the entrance and reception so that the patient can be immediately wheeled to the triage. The triage shall also be near the other support services like radiology and operating room. Triage shall have an uninterrupted and a single corridor from the entrance to triage. The size of triage depends on various factors such as the number and type of patients expected per day; the number of patients that may require immediate attention; the number of accidental cases likely to be received; other separate resuscitation/treatment areas provided in the department; the average time the patients stay in triage; time taken to perform the required investigations; the number of medico-legal cases landing per day; and turnaround time for radiological, pathological, and other investigations. However, per bed area in the triage shall not be less than 120 sq. ft. Apart from this, the size of the triage also depends on the number of beds to be made available in the triage and the number of divisions to be done in the triage to create specialized spaces like isolation rooms. However, if the patient load in a single triage is more, providing more than one triage area shall be considered. Preferably, the triage shall be in a single hall. However, separate triage can be considered for infectious patients with a separate entry door. Attached to triage shall be the room of the emergency duty doctor. The door of the doctor’s duty room shall be connected to the triage. As far as possible, the support services like X-ray, ultrasound, and minor OT shall be attached to or very near to the triage. The toilet, plaster room, treatment room, dirty utility, clean utility, medicine store, equipment store, and the general store shall be attached or near to the triage. The sizes of these ancillary rooms shall be decided depending on the requirement and the availability of spaces. The nursing station along with the nurse duty room shall also be provided in the triage. Triage shall have the provision to allot a few beds, out of all, for infected patients called an isolation cabin. This area shall be used to accommodate infected patients arriving in the triage and shall be separated from the non-infected patients. Depending on the size of the triage, the level of the emergency department, and the patient load in the emergency department, the required physicians should be placed in the emergency department itself. Hence, while planning the emergency department, consider this issue and provide spaces for the physician’s duty room in or near the emergency department.

2.4 Infrastructure

31

2.4.5 Procedure/Treatment Rooms and Utilities See Table 2.6. Out of the patients landing in the emergency department, some may require minor procedures like catheterization, suturing of small wounds, dressing, and bandaging. At times, it becomes difficult to do these procedures in the triage due to the chances of getting infected, the privacy of the patient, or the procedure requiring anaesthesia. Therefore, a separate room must be dedicated to this purpose. One can call such room as ‘treatment room’, ‘procedure room’, or ‘minor OT’. The only difference between the three is that administration of anaesthesia is easier in a minor OT, and thus it is recommended to have one attached to the triage. Sample collection room and ultrasound room should have an attached toilet. Apart from this, the clean utility shall also be provided to store the sterilized instruments, linen, tools, consumables, and disposables. Similarly, the dirty utility shall be provided for dumping the dirty and soiled linen, and from there, it shall be sent to the laundry for a wash. Attached to the triage, a general store shall also be provided to store the items like stationery, registers, equipment, and unsterilized linen. As the record room is used for keeping the patient’s records along with the other records, a record room shall also be provided. In the emergency department, an equipment storage room shall be provided to store the un-utilized medical equipment and instruments. As the emergency department requires a lot of medicines and drugs to manage the patients in the department, the medicine and drug storeroom shall be provided within the emergency department. This room is just like a small pharmacy.

Table 2.6  Procedure/treatment rooms and utilities of emergency department

Activity Procedure rooms Sample collection room Plaster room Clean utility Dirty linen General store Record room Equipment storage room Medicine and drug Storeroom

Start date :::::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

32

2  Emergency Department

2.4.6 Minor Operating Suite See Table 2.7. Out of the total patients landing in an emergency, some may require minor procedures to be performed under the administration of anaesthesia, such as suturing of small wounds and minor surgeries. Therefore, a separate room called ‘minor OT’ must be dedicated for this purpose in the department of emergency. The minor OT is a place where minor procedures or surgeries shall be carried out. This room must be the cleanest and most sterile area. The size of each change room shall be approximately 4267 mm × 4572 mm. No one shall be allowed to enter the OR without wearing protective clothes, including caps, shoe covers, masks, eye shields, and other coverings to stop the spread of germs. The shoe change area shall be provided attached to the minor OT. The personnel must take off their outside shoes before changing into the sleepers and shoes that are reserved for use in the OT complex. Attached to the minor OT shall be the changing rooms so that the doctors and personnel can change into their OT clothes after removing their outer clothing. Preferably, the toilet shall be attached to the change rooms. These toilets shall be separate for men and women. The size of each change room shall be approximately 3658 mm × 3658 mm. Before performing surgery or any other intervention in the operating room, the surgeons and assisting staff shall scrub and wash up. Hence, the scrub station is provided adjacent to the operating room. OT is a very sensitive area; hence, extra tools and equipment need to be stored there. Although they are not frequently utilized, these are kept on standby to serve as a backup for essential tools and equipment. The equipment store shall be at least 4572 mm × 6096 mm in size. A dirty utility room near the minor OT shall be provided to keep items such as used and soiled linen, instruments, disposable item covers, soiled drapes, cotton, and gauze. The room shall be approximately 3048 mm × 3048 mm in size. Table 2.7  Minor operating room of emergency department

Activity Minor OT Shoe changing area Change room separate for males and females Scrub Store Dirty utility Clean supply room Equipment store

Status of works Start End In Not date date Complete progress started :::-

:::::-

Responsible person Remarks

2.4 Infrastructure

33

Similarly, the clean store shall also be provided attached to the minor OT to store the instruments and linen received from CSSD, and after proper sterilization, these are primarily kept in this room for storage. Additionally, sterile supplies and disposables typically used in operating rooms are kept here. The dimensions of this room shall be approximately 3658 mm × 3658 mm, with only one access, and the door shall be swing-type openable on both sides.

2.4.7 Emergency Operation Theatre Complex See Table 2.8. At times, it happens that some patients arriving in the emergency department may require immediate surgery. Hence, the operating theatre complex shall be provided in or near the emergency department. Depending on the size of the emergency department, the patient load in the department, and the number of patients that may require major surgeries, the planner shall consider providing a major OT complex in the emergency department. Table 2.8  Emergency operation theatre complex of emergency department

Activity Operation theatre Pre-op room Post-op recovery Sterilization Clean storage Toilet Sluice room Instrument/linen wash Store Sub-waiting area Change room doctors—male Change room doctors—female Change room nurses—male Change room nurses—female Change room staff—male Change room staff—female

Start date ::::::::::::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

34

2  Emergency Department

In the major OT complex, if established in the emergency department, all the spaces required in any OT complex shall be provided. The OT complex shall have the main operating rooms, the preoperative room, and the post-operative recovery room. The spaces shall also be provided for a sterilization room; clean storage; change rooms for doctors, staff, and technicians (separate for males and females); toilet; sluice room; instrument/linen wash; general store; sub-waiting area; administrative rooms, etc. as per the requirement. For more details about the operation theatre suite, please refer to Chapter No. 5 titled ‘Operation Theatre Suite (OT)’ of this book.

2.4.8 Day Care Observation Ward See Table 2.9. A day care ward or so-called observation ward shall be provided in or near the emergency department to admit patients who need to be kept under observation for Table 2.9  Day care observation ward of emergency department

Activity Day care observation Store Examination and Treatment room Nurses duty room Ward pantry Dirty utility/sluice room Clean supply room Equipment store Medicine store Night duty room for doctors Extra rooms for future expansion Resident doctors and student duty room Waiting Public utility for faculty Public utility for patients and attendants Visitor bay with attached toilets

Status of works Start End In Not date date Complete progress started :::::::::::::::-

:-

Responsible person

Remarks

2.4 Infrastructure

35

a small period. For example, after giving necessary treatment to an asthmatic patient in the emergency department, he/she may need to be kept under observation for a few hours in a day care ward. Usually at the discretion of the attending physician in the triage, if the patient needs to be kept under observation, he/she is shifted to the observation ward; if the patient is fit to be discharged from triage, he/she is directly discharged from the triage; otherwise, the patient may be sent to the wards of ICU. The size of the day care observation ward can be decided depending on the number of patients that are expected to be shifted to the day care ward per day. The number of beds that shall be placed in the day care observation ward is not governed by any set standards. A single ward used to have between 30 and 40 beds in the past. These days, a six-bed arrangement for a day care observation ward is quite common. There shall be spaces for patient beds in the day care observation ward. Each patient bed shall have an area of between 100 and 150 square feet. Accordingly, the ward’s size shall be determined. If a ward has 4 beds, the per-bed area must be at least 150 square feet, making the ward 9144 mm × 6096 mm in size. However, if a 30-bed ward is being considered, each bed’s space must be at least 100 square feet, making the ward’s dimensions approximately 22,860 mm by 12,192 mm. Attached to the day care observation ward shall be the set of toilets and a bathroom with a hand washing station. Male and female toilets shall be separate. As a general rule, one toilet shall be provided for every four patients and one bathroom for every eight patients. The nursing desk shall be provided along with the day care observation ward. If the ward is bigger, say 30 beds, the nursing desk shall be provided within the ward itself. The location of the nursing desk shall be in such a fashion so that the nursing staff while sitting at the nursing desk can have a clear view of all the patients in the ward. On the other hand, if there are multiple wards of small size, the common nursing desk shall be provided outside the ward. However, this nursing desk shall be easily approachable from all the wards for which it has been provided. Along with the nurse’s desk, a small nursing duty room shall be provided, for the nurses to keep their belongings, take rest after long duty hours, and take meals. The room size shall be approximately 3658 mm × 3658 mm. Attached to the nursing stations shall be a general store to keep enough medicines, consumables, and disposables on hand. The room’s dimensions must be at least 4572 mm × 3658 mm. There shall be a place for storing equipment at the nursing station so that the less important items can be kept there. A small room that is attached to the nursing station shall be 2438 mm by 2438 mm in size. Additionally, the nursing station shall have a dirty utility that is used to store the soiled linen. Generally, the size of the room shall be 3658 mm × 3658 mm, although the size of the room may be altered depending on the requirements. Two doors of about 915 mm shall be provided for this room. Out of the two doors, one shall open in the wards itself and the second one in the corridors for workers to collect the linen without having to go to the ward/nursing station.

36

2  Emergency Department

The nursing station shall have a clean utility attached to it for the storage of clean linen. This area is also utilized to store sterile materials such as a drum and drapes, and sterile supplies and disposables that are commonly used in the ward. This room shall be roughly 3048  mm  ×  3048  mm. The size of the room, however, can be altered based on the needs. This room shall have only one 915 mm door. The room shall be windowless. There must be a place for diet storage and further distribution for patients who are admitted to the day care observation ward. Ward pantry is the name of this area. The ward pantry shall be roughly 3658 mm × 3658 mm in size and have a single door that opens to the outside in the corridor. While designing the nursing station, a space in the form of a room or a cabinet shall be provided to store patient drugs in transparent plastic boxes. As the doctor must be posted on duty day and night in the day care observation ward, the duty room shall be provided for them. The room must be 3658 mm × 4268 mm in size and have a toilet attached to it. In the running hospital, no one can anticipate the future requirement of the room. The requirement of the room may increase due to excessive patient load, norms or regulations of the regulatory authorities, increased staff and doctors, and induction of new equipment, procedure, or investigation. Hence, while designing a day care observation ward, the spaces shall be provided for future expansion. The staff including the nursing, technicians, ward assistants, and housekeeping are supposed to be working round the clock; separate toilets shall be provided for them as they may be hesitant to use the toilets that have been allocated for the patients. Please remember to provide these toilets separately for male and female workers. It is but natural that the anxious and curious family members, friends, and relatives of the patient would like to visit the hospital to meet the patient. It is not always advisable to make all the visitors be seated in the ward. Hence, a separate space shall be provided near the ward, where these visitors can be made seated. This area is called visitor bay. The visitor bay shall have a toilet attached to it.

2.5 Services, Facilities, Equipment, Tools, and Instruments 2.5.1 Outside Emergency Department See Table 2.10. The trolley bay shall be provided outside the emergency lobby for the parking of stretcher trollies and wheelchairs to be used for wheeling the patients dropped in the porch. The security post at the entrance of the emergency shall have the security features such as alarms, hooters, and CCTV cameras for security. This area shall be used for screening the patients arriving in the emergency department through questionnaires, recording of the body temperature, and other

37

2.5  Services, Facilities, Equipment, Tools, and Instruments Table 2.10  Outside emergency department

Activity Security features such as hooters and alarms Trolley bay outside the lobby for wheelchairs/stretchers Screening areas Hand wash/sanitizer stations Face mask/shoe cover dispensers Space for cleaning and washing ambulances

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::-

::::-

basic vitals. For this, isolated screening cabins can also be used. This exercise will make it easy for hospital workers to identify infected and contagious patients and isolate them or restrict their entry to the hospital. Outside the emergency entrance, space shall be provided for hand wash stations or hand sanitizer dispensers. At the entrance gate, a provision shall be made to dispense face masks and shoe covers.

2.5.2 Inside Emergency Department See Table 2.11. The emergency department shall have an interactive display system, free internet or Wi-Fi, mobile charging points, a television facility, proper handrails at the staircase and other such areas, and private rooms or space for visitors to discuss their payment and health issues with the front desk officers or the receptionists. The whole of the emergency department shall have good internal lighting systems in place, and proper lumens of lights shall be available. An airlock space connecting external areas with internal areas shall be provided. This can be done by providing two doors at a distance of say 1829 mm from each other. The purpose is to decrease the infection rate and maintain air conditioning, temperature, and air pressurization from internal to external areas. The signage system of the emergency shall be very effective, and proper colour coding and backlit signboards shall be used in the department. The signage shall be bilingual, out of which one language shall be the local language. It is believed that despite automation, some patients/visitors will be using the counters and service desks. Under such circumstances, there are chances of the staff getting infected. To overcome this issue, it is advised to make a good 1219 mm high

38

2  Emergency Department

Table 2.11  Inside emergency department

Activity Adequate window provision for natural light and a view of nature Interactive displays Free internet or Wi-Fi facility Handrails at the staircase and other areas Good internal lighting Provision for television Airlock space connecting the external areas with internal areas Signage and wayfinding system Acrylic or glass partitions on all the counters Proper heating and air conditioning Security features like CCTV Announcement systems Waiting chairs Providing air curtains to prevent outside air contaminants from entering the department

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

::::::-

::-

:::::-

acrylic or glass partition at the top of the counter or desk so that the staff is always on the other side of the partition. The emergency department shall be well air-conditioned or heated as per the requirement of the weather. Security barriers that can be locked in case of emergencies and other security features like CCTV shall be provided in this area and shall not be visible and noticeable to the visitors. Security features such as hooters, alarms, and CCTV cameras shall be provided. The public announcement system shall be provided in the entire emergency department to make an announcement in the case of an emergency or to trace out the wanted physician, staff, or attendant of the patient. Waiting spaces in the entrance lobby of the emergency shall be provided with comfortable chairs. At the entrance gate of the emergency lobby, an air curtain can be provided to prevent outside contaminants from entering the emergency department.

2.5  Services, Facilities, Equipment, Tools, and Instruments

39

Table 2.12  Reception of emergency department

Activity Provide the following at reception Reception chairs Computers with printers Scanner Microphone for public announcement system Intercom and telephone line Required electrical points at reception and help desk Other communication ports at reception and help desk Record room with reception

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::::-

:-

:-

2.5.3 Reception See Table 2.12. The ideal size of the reception and/or help desk shall be about 3048–4572 mm long. The counter can be made out of civil work with an aesthetic look or granite or other material can be used to make it look appealing. Alternately, a counter made out of wood can also be provided. The front side of the counter shall be about 1524 mm in height so that the person can easily stand and talk to the receptionist. On the other side of the counter, the working top shall be provided, which shall be about 610 mm in width and 762 mm in height. Two reception chairs shall be provided for the receptionists. If need be, high-­ raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided to each receptionist or the help desk assistant. If required, the scanner can also be provided at reception. The microphone for the announcement shall be provided at the reception. The intercom line and the telephone lines shall also be provided at the reception. Even one spare mobile phone shall also be placed at the reception to make emergency calls. The reception counter shall have the following electrical points: • At least six 5 Amp switch/sockets on the counter wall, about 152 mm above the working surface, shall be provided. These points shall be used to connect computers and printers.

40

2  Emergency Department

• For other appliances, two 15 Amp switch/sockets shall be provided on the wall behind the reception counter. The reception counter shall have the following communication ports: • • • •

Two RJ 45 connectors shall be provided for computer networking. Two RJ 11 connectors for intercom and extension line. Two USB ports for charging phones or other devices. The record room near the reception and/or help desk shall have steel cupboards and open racks for storage.

2.5.4 Diagnostic Rooms See Table 2.13. Depending on the size of the emergency, the investigation facilities that can be provided in the department can be like ECG, sample collection of blood and body fluids, X-ray, CT scan, MRI, and ultrasound.

Table 2.13  Diagnostic rooms of emergency department

Activity ECG room Dressing rooms X-ray room CT scan  CT control room  CT panel room  CT UPS room  Change room MRI room  MRI control room  MRI panel room  MRI UPS room  Change room Ultrasound room Portable X-ray room Medico-legal specimen and record Disaster storage room

Start date ::::::::::::::::-

:-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

2.5  Services, Facilities, Equipment, Tools, and Instruments

41

The ECG room shall be provided with a wooden examination couch, step stool, instrument trolley to place the ECG machine, chair for staff, and a small office table. Apart from the light and fan, the room shall be provided with an electric switch/ socket near the examination couch to connect the ECG machine to power. The room shall be adequately air-conditioned. The dressing room shall be provided with an examination couch for dressing, a step stool, an instrument trolley, dressing trollies, an almirah to store dressing consumables, dustbins, a chair for staff, and a small office table. Apart from the light and fan, the room shall be provided with a sufficient number of electric switches/ sockets to connect the required devices. The room shall be adequately air-conditioned. As far as the X-ray room, CT scan unit, MRI unit, ultrasound room, and portable X-ray room are concerned, apart from the machines, few other instruments, tools, and gadgets shall also be provided. For more details on the set-up of the X-ray, CT scan, MRI unit, ultrasound room, and portable X-ray room, please refer to Chapter Number 8 titled ‘Radio Diagnosis’. Medico-legal specimens and records shall be planned in the emergency department, which shall be properly secured and lockable. The room shall have a cupboard for specimens, an almirah for records, an office table, and a chair. In the emergency department, a separate area shall be planned as a disaster storage room, which shall serve in the case of any major disaster, wherein a lot of patients may land in the emergency department in case of any major disaster, accident, or mishappening. The size of the room shall be such that it can easily accommodate the consumables and disposables for any type of disaster management.

2.5.5 Procedure/Treatment Rooms and Utilities See Table 2.14. As different specialities in the hospital have different types of procedure/treatment rooms, the requirement of the equipment, instruments, and tools may vary from one speciality to another. Furthermore, it may also vary from one physician to another. Hence, it is very difficult to describe each and every procedure and treatment room in detail. But generally, most of the treatment and procedure rooms have some item in common that needs to be provided in these rooms. We have tried to describe those items which are common to all. As far as the specialized items for various specialities are concerned, the same shall be provided as per the requirements of the speciality or the physician.

2.5.5.1 Procedure/Treatment Room The procedure/treatment rooms shall have furniture like examination/procedure couch, crash cart, instrument trollies, dressing trollies, IV stand, IV rod, step stool, stretcher trolley, wheelchairs, and oxygen cylinder trolley. The procedure/treatment rooms shall have equipment like an operating light single or double dome, operating loupe, multi-para vital sign monitor, infusion

2  Emergency Department

42

Table 2.14  Procedure/treatment rooms and utilities of emergency department

Activity Provide the following furniture in the treatment/procedure room Examination/procedure table Stretcher trollies Wheelchairs Dressing trolley Instrument trolley Step stool IV stand IV rod Crash cart, if required Oxygen cylinder trolley Provide the following equipment in the treatment/procedure room Operating light single or double dome Operating loupe Multi-para vital sign monitor Infusion pump Defibrillator ECG machine Suction machine Surgical cautery Laryngoscope Oxygen cylinders with masks View boxes, etc. MGPS supply of oxygen, air, suction, and nitrous oxide Hanging panels for MGPS Required electrical points Other communication points Sample collection room

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::::::-

::::::::::::-

:::-

2.5  Services, Facilities, Equipment, Tools, and Instruments

43

Table 2.14 (continued)

Activity Phlebotomy chair Office chairs Office table Blood shaker Examination couch Refrigerator Working top Sink Curtain partitions for couch Consumables like needles, vacutainer tubes, holders, cotton, and spirit Cupboards, shelves, and racks Computer with UPS and printer Barcode scanner Outlet station for pneumatic tube system (PTS) Interview/meeting/ counselling room Doctors’ table Doctors’ chair Two attendant chairs Sofa set Computer with UPS and printer Audiovisual recording system Clean utility Cabinet Drawers Cupboards Dirty utility Covered linen collection hampers Exhaust fan General store Cabinet Drawers

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::::::::-

::::-

::::::-

:::::::(continued)

44

2  Emergency Department

Table 2.14 (continued)

Activity Cupboards Record room Cabinet Drawers Cupboards Equipment storage room Working slab Cupboards Racks Electrical outlets Medicine and drug storeroom Cabinets Drawers Racks Refrigerator Intercom Automatic medicine dispensing machine Office table Office chairs Station of pneumatic tube system (PTS)

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::-

::::-

:::::::::-

pump, defibrillator, ECG machine, suction machine, surgical cautery, laryngoscope, oxygen cylinders with masks, and view boxes. The procedure/treatment rooms shall have the instruments and tools like sterilizing drums, instrument boxes, examination light, torches, forceps of all styles and sizes, scissors of all styles and sizes, Cheatle Forceps, needle holders, tray of all styles and sizes, extension cord and boxes, and all other required instruments. For the procedure room or the treatment room, a washbasin can be provided with a provision of soap dispenser and a towel hanger or paper napkin dispenser. As surgical interventions may have to be done in the treatment and procedure rooms, the outlets for the following piped medical gases shall be provided: • • • •

Oxygen Compressed air Suction Nitrous oxide

2.5  Services, Facilities, Equipment, Tools, and Instruments

45

The following electrical points shall be provided in the procedure/treatment rooms: • One 5 Amp switch/socket and the primary switchboard for the room’s fan and lighting shall be placed at the entry wall. • Temperature-adjustable air conditioning control button. • A pair of two 5/15 Amp switches/sockets shall be installed at a height of 457 mm from the floor level in the middle of each of the three walls of the procedure/ treatment room (except for the wall on which a door is provided). One pair of these two shall have the power backup through UPS. The following communication points shall be provided in the procedure/treatment room at the convenient place/wall: • RJ 45 port for networking of computer • RJ 11 port for intercom and extension line • HDMI port for the display of videos and images at other locations

2.5.5.2 Sample Collection Room The emergency department shall preferably have a sample collection room, commonly known as a phlebotomy room, in a convenient location. One phlebotomy chair and one examination sofa shall be provided in the sample collecting room. A working top with a sink shall be provided in the room for placing the specimens that have been drawn. For the patient’s privacy, a curtain partition shall be provided on the couch. To have an adequate supply of needles, vacutainer tubes, holders, etc., in this specimen collection room, suitable cabinets, shelves, and racks shall be provided. There shall be enough electrical outlets on the working surface. The provision of a refrigerator shall be kept. A sufficient number of office tables, chairs, computers with printers, and barcode printers shall be provided to execute tasks like processing the specimens, barcoding the specimens, and consent gathering. The phlebotomy room shall have a PTS outlet point so that samples and requisition forms can be sent directly to the laboratories without delay. For more details on the sample collection room, please refer to chapter number 9, titled ‘Clinical Laboratories’ of this book. 2.5.5.3 Interview/Meeting/Counselling Rooms The interview/meeting/counselling rooms in the OPD complex shall have the doctors’ chair along with the doctors’ table. At least two visitors’ chairs or a sofa set shall also be provided in the room. The doctor shall be provided with the computer system along with the UPS.  If needed, the printer shall also be provided. Most importantly, the entire interview/meeting/counselling room shall have the provision of audio-video recording, so the conversation between the doctors and the visitors is recorded. This recording can act as proof in a court of law if required.

46

2  Emergency Department

2.5.5.4 Clean Storeroom The clean utility shall be provided with sufficient numbers of closed cabinets, drawers, and racks in the room. 2.5.5.5 Dirty Utility Covered hampers or other receptacles for collecting soiled laundry shall be provided in the room. Exhaust fans shall be provided since the air in this room needs to be vented. 2.5.5.6 General Store General store shall have the cupboards, rack, working slab, drawers, etc. 2.5.5.7 Record Room The storeroom shall have the cupboards, rack, working slab, drawers, etc. 2.5.5.8 Equipment Storage Room The equipment store shall be a closed room. The room shall have working slabs to place the small equipment and clear floor space to store large equipment. Besides this, the cupboards and the racks shall also be provided. The room shall have a sufficient number of electrical charging points duly grounded for medical equipment charging that are not frequently used and are stored here. 2.5.5.9 Medicine and Drug Storeroom The medication room shall have the ability to store medications in cabinets, drawers, and racks. A large countertop shall be provided in the room for dispensing medications. Additionally, a refrigerator shall be provided in the room. Similarly, an intercom and telephone line shall be provided. Medicines can also be disbursed using automated drug dispensing machines. The employees working in the pharmacy shall be provided with the required number of office tables and chairs. The medicines and drugs shall preferably have a pneumatic tube system (PTS).

2.5.6 Triage See Table 2.15. Triage shall have the provision for normal beds and a few isolation cabins beds for infected patients. Single triage hall shall not have more than 10 beds, and at least 25% of the total beds in triage shall be dedicated to isolation beds. Triage shall have sufficient patient furniture like a patient bed (multi-positional ICU bed with bedside safety rails and lockable wheels), bedside locker, over-bed table, IV stand, IV rod, examination table, crash cart, instrument trollies, dressing trollies, stretcher trolley, wheelchair, step stool, scrub station, oxygen cylinder trolley, backrest, and patient transfer system.

2.5  Services, Facilities, Equipment, Tools, and Instruments

47

Table 2.15  Triage of emergency department

Activity Patient furniture in triage Patient bed (should be multi-positional ICU bed) Bedside locker Over-bed table Examination table Wheelchair Stretcher trolley Dressing trollies Instrument trollies Step stool Scrub station IV stand IV rod Crash cart Oxygen cylinder Trolley Backrest, etc. Office furniture in triage Office furniture Nursing counter Office chairs Almirah/cupboard Filing cabinet Visitor chairs, etc. Equipment in triage Portable OT light Portable ventilators Multi-para vital sign monitor Invasive mechanical ventilator Non-invasive ventilator High-flow nasal cannula Infusion pump Nebulizer Defibrillator Pulse oximeter

Status of works In Not Start End date date Complete progress started

Responsible person Remarks

:-

::::::::::::::-

::::::::::::::::(continued)

48

2  Emergency Department

Table 2.15 (continued)

Activity ECG machine Suction machine Portable X-ray machine Blood gas analyser Cardiac marker analyser BP apparatus Glucometer Laryngoscope Ambu bag Oxygen cylinders with masks View boxes, etc. Patient warming system Washbasin for hand wash Provide windows if possible MGPS supply of oxygen, air, suction Bed head panels of hanging panels for MGPS Required electrical points at reception Other communication points at reception Curtain partitions for all the beds Central nursing station in triage Doctors’ duty rooms in triage Attached toilet Office table, chair, bed, and cupboard Computer with an internet connection and intercom Air-conditioned

Status of works In Not Start End date date Complete progress started ::::::::::::::::-

::::-

:::-

:-

Responsible person Remarks

2.5  Services, Facilities, Equipment, Tools, and Instruments

49

Layout of beds in the triage shall be in such a fashion that it allows easy and smooth working all around the bed. The inter-bed spaces shall not be less than 1829 mm so that the patient can be easily transferred from/to bed. Sufficient inter-­ bed distance also helps in reducing the cross-infection rate. The head end of the bed shall be at least 610  mm away from the wall, and a clear space shall be about 1524 mm on the foot end so that the stretcher trolley can be easily turned around. The head support panel of the bed shall be removable. Triage shall have general furniture like a nursing counter, office chairs, visitor chairs, filing cabinet, almirah/cupboard, and stools. If the resuscitation area has been created, it shall contain a single bed and shall be equipped with gadgets for extensive monitoring of parameters like ECG, NIBP, oxygen saturation, core temperature, invasive monitoring, and CO2 monitoring. Emergency management tools and equipment like a defibrillator shall always be present. The resuscitation area shall have a facility for invasive and non-invasive ventilation, a patient warming system, an emergency crash cart equipped with medicines, portable OT light, material for intubation, catheters, cannulas, and external pacing. A separate washbasin for hand wash shall also be provided. All the required medical equipment, gadgets, tools, instruments, disposables, and consumables shall be provided in the triage in sufficient quantities. The door of the triage room or hall shall be openable on both the sides in and out and shall be at least 1829 mm wide, unobstructed. The windows shall be preferred in the triage, but direct sunlight shall be avoided. For the reason that the bed head panels have to be fixed on the wall above the patients, the window’s bottom shall be at least 1829 mm from floor level. The window glass can be tinted, or the curtains/blinds shall be provided. For hand washing, a single-bay scrub shall be provided, which shall be operational with sensors and feet. As critical patients arrive in the triage, they usually need oxygen. For some patients, invasive or non-invasive ventilation may be required. Hence, piped centralized medical supply shall be provided to deliver oxygen, compressed air, wall-­ mounted suction, and nitrous oxide (for OT and minor OT). These supply lines shall be provided on each bed. In some hospitals, the outlets of these gases are fixed on the wall itself or otherwise the bed head panels or the ceiling-suspended pendant can be used. On each bed of the triage, suitable electrical and communication points and ports shall be provided on the bed head panel or the pendant as the case may be. For general lighting, sufficient electrical outlets shall also be provided. Some of the points shall also be provided with power backup with the help of UPS.  The points for central nursing station shall also be provided on each bed of the triage. The communication points like nurse call devices, computer networking, intercom and extension line, and monitor display shall be provided at each bed of the triage. Similarly, at the nursing station, the required communication points shall be provided. All the beds in the triage shall be provided with hanging curtain partitions.

2  Emergency Department

50

Ideally, the triage shall provide one room for the physicians of each department. Rooms shall have a provision for an attached toilet. Furniture-wise, the room shall have one office table, chair, bed, and cupboard. The room shall have points for a computer with an internet connection and an intercom point apart from the light and fan. The room shall be air-conditioned, and the control button with temperature adjustment shall be provided in the room.

2.5.7 Minor Operating Suite See Table 2.16. The minor OT shall be either attached to or near the triage. Table 2.16  Minor operating suite of emergency department

Activity Patient furniture in minor OR Patient furniture OT table Stretcher trolley Dressing trollies Instrument trollies Step stool Scrub station IV stand IV rod Crash cart Oxygen cylinder Trolley Equipment in minor OR Basic Boyle’s machine/ anaesthesia workstation with a vaporizer Operating light single or double dome Operating loupe Multi-para vital sign monitor Infusion pump Defibrillator ECG machine Suction machine Surgical cautery Laryngoscope

Status of works Start end In Not Responsible date date Complete progress started person Remarks

:::::::::::-

:-

:::::::::-

2.5  Services, Facilities, Equipment, Tools, and Instruments

51

Table 2.16 (continued)

Activity Oxygen cylinders with masks View boxes, etc. Scrub station MGPS supply of oxygen, air, suction, and nitrous oxide Hanging panels for MGPS Required electrical points Other communication points

Status of works Responsible In Not Start end Remarks date date Complete progress started person ::::-

:::-

Minor OT shall have patient furniture like an OT table, IV stand, IV rod, scrub station, stretcher trolley, wheelchair, patient transfer system, crash cart, dressing trollies, instrument trollies, step stool, and oxygen cylinder trolley. Minor OT shall have equipment like a basic Boyle’s machine with a vaporizer (alternately, anaesthesia workstation can be provided, if necessary), operating light single or double dome, operating loupe, surgical cautery, multi-para vital sign monitor, suction machine, laryngoscope, infusion pump, oxygen cylinders with masks, defibrillator, Ambu bag, ECG machine, and view boxes. Minor OT shall have sufficient tools, instruments, gadgets, consumables, disposables, etc. For hand washing, a double-bay scrub shall be provided, which shall be operational with sensors and feet. Minor OT shall have a supply of medical gases like oxygen, suction, nitrous oxide, and compressed air. Nitrous oxide need not be provided in the treatment room and the procedure room. The outlets for these gases can be fixed in the ceiling-­ suspended pendant. On this pendant, both communication and electrical outlets and ports shall also be provided. All these rooms shall have a sufficient number of electrical and communication points as designed by the designer.

2.5.8 Day Care Observation Ward See Table 2.17. Layout of beds in the observation ward shall be in such a fashion that it allows easy and smooth working all around the bed. The inter-bed spaces shall not be less than 92 mm so that the patient can be easily transferred from/to bed. Sufficient inter-­ bed distance also helps in reducing the cross-infection rate. The head end of the bed

52

2  Emergency Department

Table 2.17  Day care observation ward of emergency department

Activity Patient furniture in observation ward: Patient bed (multi-­ positional ICU bed) Bedside locker Over-bed table Wheelchair Stretcher trolley Dressing trollies Instrument trollies Step stool IV stand IV rod Crash cart Oxygen cylinder trolley Backrest, etc. Furniture in observation ward: Nursing counter Office chairs Almirah/cupboard Filing cabinet Visitor chairs, etc. Equipment in observation ward: Multi-para vital sign monitor Non-invasive ventilator Infusion pump Nebulizer Defibrillator ECG machine Suction machine BP apparatus Glucometer Ambu bag Oxygen cylinders with masks View boxes, etc. MGPS supply of oxygen, air, suction

Status of works Start End In Not date date Complete progress started

:::::::::::::-

:::::-

:::::::::::::-

Responsible person

Remarks

53

2.5  Services, Facilities, Equipment, Tools, and Instruments Table 2.17 (continued)

Activity Bed head panels of hanging panels for MGPS Required electrical points at reception Other communication points at reception Curtain partitions for all the beds

Status of works In Not Start End date date Complete progress started

Responsible person

Remarks

:-

:::-

shall be at least 305  mm away from the wall, and a clear space shall be about 1524 mm on the foot end so that the stretcher trolley can be easily turned around. The head support panel of the bed shall be removable. Observation wards shall be fully equipped with the required patient furniture like a patient bed (multi-positional ICU bed), bedside locker, over-bed table, wheelchair, stretcher trolley, step stool, dressing trollies, instrument trollies, IV stand, IV rod, crash cart, oxygen trollies with cylinders, and backrest. The ward shall be provided with general furniture like a nurse counter, office chairs, almirah, cupboards, filing cabinets, and visitor chairs. The ward shall have the equipment, tool, gadgets, instruments, disposables, and consumables like multi-para vital sign monitor, non-invasive ventilator, infusion pump, nebulizer, defibrillator, ECG machine, suction machine, BP apparatus, glucometer, Ambu bag, oxygen cylinders with masks, and view boxes. A washbasin shall be provided near the nurse station. Piped centralized medical gases like oxygen and wall-mounted suction shall be provided on each bed. The observation ward and the ancillary rooms shall have a sufficient number of electrical outlets and communication points as designed by the designer. All beds in the observation ward shall be provided with hanging curtain partitions.

2.5.9 Other Issues See Table 2.18. The emergency department shall always have a strong provision for power backup at all the required places preferably with the help of auto-start generators or UPS of adequate capacity. Provision for battery-operated emergency lights shall be made for all the rooms and corridors of the emergency department. Promote the use of natural light as much as possible. All the rooms and the corridors of the emergency department shall be well-lit with proper overlapping of the lights. Fancy lights are however not recommended.

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2  Emergency Department

Table 2.18  Other issues relating to emergency department

Activity Continuous backup of power supply Provision of battery-operated emergency light Cross ventilation must Space for a patient brought dead

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::-

::-

As far as the air conditioning is concerned, the emergency department shall preferably be centrally air-conditioned with temperature and humidity to make the environment comfortable for the patients, visitors, and attendants. If central air conditioning is provided, particular care shall be taken that there shall be no mixing of the return air, and proper zoning of the return air needs to be provided. Air conditioning temperature control system shall be provided in all rooms. Cross ventilation shall be encouraged without mixing return air. The flooring of the department shall be non-slippery to prevent any accidents. All the floors of the emergency department shall be at the same level, which means at zero for all the rooms and corridors. Tiles used on the floor shall be jointless, and no spacers shall be used for fixing the tiles.

Further Reading Abdelsamad Y, Rushdi M, Tawfik B.  Functional and Spatial design of emergency departments using quality function deployment. J Healthc Eng. 2018;2018:e9281396. Designing the Future, Engineering Reality: Prototyping in the Emergency Department. [cited 2021 Jun 18]. Available from: https://iris.unimore.it/handle/11380/1169020#.YMxhe2hKg2x. Door Gasketing for Hospitals-Challenges Expectations and Innovations. p. 5. Emergency Department Design. Huddy HealthCare Solutions. [cited 2021 Jun 18]. Available from: https://huddyhealthcare.com/service/emergency-­department-­design/. Emergency Department Design for a More Efficient and Safe ER | Thought Leadership. HMC Architects. 2019 [cited 2021 Jun 18]. Available from: https://hmcarchitects.com/news/ emergency-­department-­design-­for-­a-­more-­efficient-­and-­safe-­er-­2019-­02-­27/. Emergency Department Infrastructure and Design. [cited 2021 Jun 18]. Available from: https:// dialremedy.com/blog/emergency-­department-­infrastructure-­and-­design. Finefrock SC. Designing and building a new emergency department: the experience of one chest pain, stroke, and trauma center in Columbus, Ohio. J Emerg Nurs. 2006;32(2):24–8. Garg A, Dewan A.  Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 16, Emergency Services. p. 123–2. Hospital Planning: Emergency Departments—Design Collaborative [Internet]. [cited 2021 Jun 18]. Available from: http://www.designcollaborative.com/design-­blog/ hospital-­planning-­emergency-­departments/.

Further Reading

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Hospital Swinging-Door Requirements [Internet]. [cited 2021 Jun 18]. Available from: https:// www.hfmmagazine.com/articles/3401-­hospital-­swinging-­door-­policy. In and Out of the Emergency Room | Streamlined design of patient flow [Internet]. [cited 2021 Jun 18]. Available from: https://www.asianhhm.com/facilities-­operations/ emergency-­department-­streamlining. Marsh RH, Chalmers KD, Checkett KA, Ansara J, Rimpel L, Edmond MC, et  al. Emergency department design in low- and middle-income settings: lessons from a University Hospital in Haiti. Ann Glob Health. 2020;86(1):6. New Strategies in ED Design [Internet]. [cited 2021 Jun 18]. Available from: https://www.hfmmagazine.com/articles/251-­new-­strategies-­in-­ed-­design. Wang T, Zhang S, Bai X. Study on the design of emergency entrances for hospitals evidence from extremely cold regions—Urban healing transition space. 2017, pp. 1–6. What’s the Future of Emergency Department Design? [Internet]. DuvaSawko. 2018 [cited 2021 Jun 18]. Available from: https://www.duvasawko.com/emergency-­department-­design/.

3

Outpatient Department (OPD)

The department in a hospital where ambulatory patients receive consultation from specialists or super-specialists is known as the outpatient department (OPD) unit, also known as the ambulatory care unit. The OPD treats patients who do not need to stay in the hospital overnight. The primary goal of OPD is to avoid crowding in the indoor department and to provide follow-up care for indoor patients after discharge. This is a win-win situation for everyone involved, including the doctor, the patient, society, and the hospital. The OPD services in the hospital support the patient by providing consultation with medical specialists and super-specialists; offering physical examination and investigations; referring the patient for admission to a hospital for inpatient services; providing follow-up consultation and ongoing case management; providing treatment on a day care basis; offering preoperative screening of the patient; performing minor procedures; referring the patients to other specialities or super-­ specialities for a second opinion or ongoing care and treatment; providing health education and counselling of patients and families; establishing a centre for providing training and education to students, etc. There are a few issues which need to be ensured before the hospital is operational, such as the following: required infrastructure has been provided; the layout of the department is perfect; required services are available; proper furniture and fixtures are in place; required electrical points and communication ports have been provided; public utilities have been provided; signage, wayfinding, and display mechanisms are in place; required instrument/equipment/gadgets are available; required facilities are available; patient/staff/visitor safety mechanisms are available; proper lighting is ensured; proper environmental control with heating and air conditioning is available; security devices and mechanisms are provided; announcement systems are in place; and wall, ceiling, and interior decoration are up to the mark and appealing.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_3

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While planning and designing any OPD in the hospital, it has to be ensured that all the works are complete and operational. Similarly, all the services shall be operational before the OPD starts taking patients. This set of checklist shall help the planner and designer to remember all such issues relating to the OPD and guide him/her to complete the test and commission all works/activities well in time. This will help him/her to ensure himself/herself that all the works/activities are carried out, complete, and working before the actual operations of the OPD start.

3.1 Location of Outpatient Department See Table 3.1. Table 3.1  Location of the outpatient department

Activity Are the OPDs located on the ground floor? Are the OPDs approachable easily? Does the OPD block has a separate entry? Are the OPDs located near each other? Has the main waiting hall been provided? Are the facilities for investigation near the OPD? Are the facilities for the supply of medicine near the OPD? Are the diagnostic services like pathology, radiology, injection room, dressing room, and minor operation theatre near the OPD block? Are the services of commercial sections like registration, help desk, billing, admission, and discharge near the OPD block? Is the OPD away from the inpatient area?

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::-

:-

:-

:-

:-

3.2  Room Requirement in OPD

59

The OPD shall be located on the ground floor and easily accessible and preferably have a separate entrance. In some cases, due to a lack of space, it is evident that the upper floors are also used for OPD.  In such cases, the upper floors shall be reserved for consultation and examination rooms, while the ground floor shall be preferred for reception, registration, and waiting, among other things. Furthermore, all OPDs shall be located close to one another so that patients can be easily referred to other doctors for cross-reference. Ideally, a separate OPD block shall be provided, but this is not always possible. A good OPD layout includes a main waiting hall in the centre and OPDs arranged around it; otherwise, there shall be a main corridor running through the centre of the OPD section, with side corridors providing access to and separating the various OPDs. All facilities for investigation and medicine supply shall be available in outpatient departments. Furthermore, the hospital’s outpatient department shall be designed in such a way that all specialists and super-specialists including other outpatient services are available in the OPD itself. Diagnostic services and the commercial section shall be accessible from the OPD. Pathology, radiology, injection/dressing room, minor operation theatre, and medical record section are the most common diagnostic and commercial services. Outpatients shall be discouraged from entering the inpatient area as much as possible to avoid disturbing the inpatients who are more seriously ill. Uncontrolled outpatient traffic in wards and departments of the inpatient block is undesirable from all perspectives. Even if it is necessary, the common gate between the OPD and the inpatient department shall be provided, which shall be guarded in such a way that the movement of OPD patients to the inpatient area is kept to a minimum. OPD can be located in either centralized outpatient services, decentralized outpatient services, or a separate block of OPD. Generally, the layout of the OPDs can be single-corridor OPD, double-­corridor OPD, or clustered OPD block.

3.2 Room Requirement in OPD As far as the number of OPDs is concerned, it depends on various factors like the following: • • • • •

The population served by the unit, as well as demographic trends. Number of patients expected to attend OPD. The number of transfers and referrals from other regions or hospitals. The number of physicians who will be performing OPD at any given time. The OPD’s timing: If the OPDs are conducted throughout the day, the chamber-­ sharing system can be used, resulting in a lower number of OPD chambers being required. • The average time is taken for the consultation. • Whether the OPD is a combined consultation room or a separate consultation room: Naturally, if management chooses the single consultation room concept, the need for OPD consultation rooms will increase.

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3.3 Infrastructure 3.3.1 Reception/Registration/Billing/Admission and Discharge/ Cash Counters See Table 3.2. The reception area is the first point of contact for patients and visitors after they arrive in the outpatient department. The receptionist’s role is to provide patients and visitors with the necessary information, guide them to the appropriate location, book appointments, and so on. As a result, the reception desk shall be situated right at the entrance to the OPD block. The OPD’s reception shall be at an easily accessible location. If required along with the reception, the help desk shall be provided for helping the patients and visitors to settle their quarries and guide them. The registration counter shall be located next to the reception desk. The registration counter registers the patient for OPD, prepares the OPD consultation form, accepts payment for the OPD consultation, and issues the token number, among other things. Case records are retained and stored with the registration department in some hospitals, and patients are given a small card containing their registration number. In this arrangement, the case record shall be taken out and sent to the physician for consultation every time the patient visits the hospital. The registration counter is responsible for this task. The registration counter shall be separate and shall not be mixed up with the reception. However, if the hospital set-up is very small, the job of reception and registration can be done on the same counter. As the reception and the registration counter may have a lot of documents to be stored including fresh unused stationery, a small record room cum storage room shall be provided near the reception and registration counter. Preferably, this room Table 3.2  Reception/registration/billing/admission and discharge/cash counters in the OPD

Activity Reception counter Help desk Registration counter Record room Billing counter Cash counter Strong room for storage of cash Queuing tracks General waiting Public utilities

Start date ::::::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

3.3 Infrastructure

61

shall be on the back side of the counters. The size of the record room can be 3658 mm × 3658 mm with a single door having a width of about 1000 mm. For billing of the OPD patients and the IPD patients, the billing counter shall be provided. If the size of the hospital is big, the registration, billing, and cash counters shall be separate. However, for medium- and small-sized hospitals, the counters can be clubbed depending on the requirement. As far as the cash counter is concerned, the same shall be separate and shall be properly enclosed for the safety of the cash and the cashier. Along with the cash counter, a small strong room shall be provided, where the cashier can keep the excess cash. However, if the hospital has a policy of collecting cash from the counter, very frequently, the strong room can be avoided. The size of the strong room shall be approximately 3048 mm × 3048 mm, with a single door having a width of about 1000 mm, and shall open at the cash counter. There shall be sufficient open space for queuing of the patients and visitors who are waiting for the services of the reception, registration, billing, and cash payment. The spaces for queuing shall be separate for every counter.

3.3.2 Waiting and Sub-waiting Areas Patients must wait for their turn for consultation after registering for an OPD consultation. It is recommended that hospitals be designed for small and sub-waiting lobbies rather than large waiting lobbies. For instance, a smaller sub-waiting lobby with about 30 seats that serves one or two OPD rooms shall be created instead of the OPD block’s main lobby with a seating capacity of 200. However, these measures might not always be feasible, particularly for smaller clinics, hospitals, and nursing homes. With the waiting area, the facilities of public utilities shall be provided. There shall be the facility of toilets (separate for males and females), drinking water, a small snacks bar, etc. Some hospitals may like to have a temple or meditation room in the waiting hall.

3.3.3 Consultation Rooms See Table 3.3. Table 3.3  Consultation rooms in the OPD

Activity Consultation chambers for doctors Attached are examination rooms wherever required Vital sign examination room

Status of works Start End In Not date date Complete progress started ::-

:-

Responsible person

Remarks

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3  Outpatient Department (OPD)

The examination/consultation rooms are the rooms where the physicians attend to the patients, take the history, examine the patient, diagnose the disease, give advice to the patient, prescribe the medication, prescribe the investigations to be done, and clarify the doubts of the patient or the visitors along with the patient. During routine working hours, the consultation chamber or room is the first place where the patient comes in contact with the physician. There are two types of consultation rooms: one is called a “combined multidisciplinary consultation room,” where several doctors from different disciplines share it at various times throughout the day, and the other is called a “separate consultation room,” where a specific room is designated for one speciality only and cannot be used by any other specialities. Both systems have their advantages and disadvantages. It is up to the requirement and the design of the hospital as to which system shall be adopted. Some of the specialities like surgery, orthopaedic, gynaecology, and medicine may require a detailed examination by the physician before concluding his/her decision. Apart from this, some of the specialities may require small procedures like the removal of stitches to be done in the OPD itself. Hence, a separate examination cum procedure room attached to these main consultation rooms may be required with such specialities. Within the OPD block, some supporting rooms are also required. Although these rooms do not offer direct consultation, they do offer support and backup to the doctors conducting the OPD. It is a practice to take the vitals of the patients like blood pressure, SPO2, pulse, weight, and height, before the patient moves to the consultation chamber of the physician. Hence, the vital sign examination room shall be given near the registration counter. As far as the size of the consultation room is concerned, the exact size of the room depends on factors like expected visitors, policy of the hospital, furniture to be placed in the consultation room, etc. But the ideal size shall not be less than 4267 mm × 3658 mm. The door of the OPD room shall not be less than 1219 mm wide, unobstructed. The door shall be on the other side of the examination couch to avoid patient exposure in consultation and treatment rooms. The windows shall be preferred in the room, but direct sunlight shall be avoided. The window glass can be tinted or curtains/blinds shall be provided.

3.3.4 Supporting Rooms See Table 3.4. The sample collection room shall be located inside or close to the OPD block so that patients’ blood and other specimens can be collected for clinical laboratory testing. Some of the patients may require an interview/meeting/counselling to explain to them in detail about their disease, prognosis of the disease, and precautions and at

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Table 3.4  Supporting rooms in the OPD

Activity Sample collection room Interview/meeting/ counselling rooms Clean storeroom Dirty utility General store Record room Equipment storage room Medicine and drug storeroom Staff room with beverage and food facilities Public toilets Drinking water facility

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::::::-

::-

the time of admission may require counselling. Hence, within the OPD block, an interview/meeting/counselling room shall be provided. A clean storeroom shall be provided near the OPD block to store clean items like sterilized linen, instruments, and disposables. A dirty utility room shall also be provided in the OPD block to store the soiled linen and other waste generated from the OPDs. General store which is used to store the items like stationery, forms, records, and files shall also be provided in the OPD block. Preferably, one such storeroom shall be provided for about four OPD consultation chambers. It is also advised that if the size of the hospital is large, separate record rooms shall be provided. However, if the hospital is medium or small, the general store and the record room can be clubbed. In the OPD block, an equipment storage room shall be provided to store the unutilized medical equipment and instruments. In the case of sharing OPD, the equipment of any particular speciality may have to be removed from the consultation chamber as the same chamber has to be shared by the other speciality. Hence, this room is used for storing such equipment and instruments. In case the medicines and drugs are distributed from the OPD, the medicine and drug storeroom shall be provided within the OPD block. This room is just like a small pharmacy. Staffroom with beverage and food storage facilities shall also be provided in the OPD block. Due to long hours of working, the staff may require some break and also need to freshen up. Hence, this room shall be provided. Preferably, the staff room shall have an attached toilet for staff.

3  Outpatient Department (OPD)

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Inside the OPD block, public toilets shall be provided for the patients and visitors. Please remember to provide separate toilets for males and females. A drinking water facility shall also be provided in the OPD block. As far as the number of such support rooms is concerned, it will purely depend on the requirement and the number of patients that may be requiring the services of such support rooms.

3.3.5 Procedure/Treatment Rooms See Table 3.5. Table 3.5  Procedure/treatment rooms in the OPD

Activity Procedure rooms General surgery Minor OT for surgery Dressing room female Dressing room male Paediatrics Immunization room for paediatric Play area Counselling room Child guidance clinic Child welfare clinic Child rehabilitation clinic including facilities for speech therapy and occupational therapy Cardiology ECG room TMT rooms Echocardiography room ABP rooms Tilt test room Holter rooms Electrophysiology lab Dobutamine stress echocardiography (DSE) Thallium scan Nuclear heart scan camera (gamma camera)

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::::::-

::::::::::-

3.3 Infrastructure

65

Table 3.5 (continued)

Activity Neurology Transcranial Doppler room Neuro-physiotherapy room NVC/EMG room Speech and swallowing clinic EEG room Pulmonology Spirometer rooms Diffusion DLCO room Bronchoscopy room with recovery room and endoscope washroom Body box diffusion room Pulmonary rehabilitation room TBNA room ICTC centre DOT centre Urology Urodynamics study room Uroflow meter room Gastroenterology Endoscopy room Gynaecology and obstetrics Colposcopy room Ultrasound room Family planning room D&C room Antenatal clinic Infertility clinic Cancer detection clinic Orthopaedic Infiltration room male Infiltration room female Plaster rooms Minor OT Bone bank Stem cell centre

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::::::-

::::::::-

:::::::::::::(continued)

66

3  Outpatient Department (OPD)

Table 3.5 (continued)

Activity Medicine Injection room male Injection room female Ophthalmology Refraction room Orthoptic room Treatment room Dark room OCT room ND YAG laser room Green laser room A-scan and B-scan room Otorhinolaryngology Audiometry room ENG lab Speech therapy room Temporal bone lab Minor OT Endoscopic room Dermatology and cosmetology Skin lab Treatment room Laser room General rooms attached to procedure and treatment rooms Clean utility Dirty linen Store

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::::::::::::::-

:::-

:::-

Along with the consultation chamber, some of the specialities may require attached procedures or treatment rooms. Ophthalmology requires refraction, orthoptic, darkroom, and dressing room. Surgery OPD requires minor OT, gynae Obs. D&C room, antenatal clinic, family welfare clinic, cancer detection clinic and colposcopy room. ENT requires audiometry, ENG lab speech therapy rooms, and so on. The list given in the above table is not exhaustive and may vary from one hospital to another. The requirement of these attached rooms shall solely depend on factors like the size of the hospital, the services that are to be provided, the medical equipment that has to be installed, the number of patients attending the OPD, the type of disease prevalent in the area, and the availability of the space in the OPD block.

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These procedures or treatment areas shall ideally be located close to the relevant OPD. It is not advised to place them in a cluster at any other location than the OPD block, because doing so wastes the time of the doctors and requires the patients to walk about unnecessarily. Size-wise, the exact size of the procedure/treatment room shall depend on factors like equipment to be placed in the room, number of persons required in the room, and movement spaces required to perform the procedure. But the ideal size shall not be less than 4267 mm × 3658 mm. However, the size may be increased as per the requirement. The door of the procedure/treatment room shall not be less than 324 mm wide, unobstructed for easy movement of the wheelchair/stretcher trolley. The door shall be on the other side of the procedure table to avoid patient exposure in procedure and treatment rooms. The windows can be avoided to maintain the privacy of the patients until and unless essentially required. If provided, direct sunlight shall be avoided. The window glass can be tinted or the curtains/blinds shall be provided. For the departments of general surgery, orthopaedic, and other surgical specialities, the minor operation theatre shall be provided which shall be used for small surgical interventions which may not require general anaesthesia and are generally performed under local anaesthesia. Apart from this, the dressing rooms (separate for males and females) shall also be provided in or near the OPD block. This room is generally used for the dressing of wounds or post-surgical dressings. Near the OPD of paediatrics, an immunization room shall be provided which shall be used to vaccinate the neonatal. However, the same can also be used for vaccination of the children and adults. Similarly, play area in the paediatric OPD is to entertain the children by playing games, etc. The child welfare room shall be provided which shall be used for welfare food distribution, regular medical and dental checkups, counselling for mental health issues, immunizations, and teaching on all areas of motherhood. Children of normal and abnormal intelligence who display a variety of behavioural and psychological issues that are together referred to as maladjustments are dealt with in the child guidance room. Child rehabilitation clinic shall be provided, which shall be used to provide rehabilitation support for children aged 0–18. This clinic includes the provision of speech therapy and occupational therapy. Similarly, a counselling room shall be provided, which shall cater to young children, teens, and adolescents suffering from one or more mental illnesses. It also assists youths who have experienced trauma and/or are living in a dysfunctional or stressful home environment. Along with the OPD of cardiology, an electrocardiogram (ECG) room shall be provided at a convenient place, so that patients from all the OPDs, who require ECG, can easily approach and get the investigation done. Similarly, an echocardiogram (echo) room shall be provided in the cardiology OPD complex, which shall be used for a diagnostic cardiac ultrasound to make pictures of the anatomy of the heart. Also, a TMT room shall be provided which shall be used to perform the treadmill test (TMT), also known as the cardiovascular stress test, to check the efficacy of the heart while facing any sort of physical stress. Similarly, a few other

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3  Outpatient Department (OPD)

investigation rooms shall be provided with the cardiology OPD.  These include Holter rooms for Holter analysis to detect or determine the risk of irregular heartbeats (arrhythmias) and ambulatory blood pressure (ABP) room to monitor and record the 24-h blood pressure at regular intervals and to assess the blood pressure during different times of the day while performing various activities during the day. Tilt test room for tilt table study is to diagnose the cause of unexplained dizziness, light headedness, fainting spells, and falls. Thallium scan for thallium stress test, a type of nuclear scan, is to diagnose conditions involving the heart by gathering data on the rate at which blood is pumped into the organ, damage to the area around the heart, obstruction of blood flow through the heart’s arteries, size of the organ’s chambers, areas of the organ lacking blood and oxygen, history of potential heart attacks and the area of their occurrence, and monitoring of heart treatment. Nuclear heart scan room (gamma camera) is used to take the images of the heart to help diagnose coronary artery disease, cardiomyopathy, and many other heart conditions. An electrophysiology lab is used for electrophysiological investigations (EPS), which are used to diagnose and treat issues with heart rhythm (arrhythmias). Attached to the OPD of neurology, transcranial Doppler room shall be provided which shall be used to perform functional transcranial Doppler sonography (fTCD), a type of neuroimaging technique that measures changes in cerebral blood flow velocity brought on by neural activation during cognitive tasks. The neuro-­ physiotherapy room attached to OPD shall be used for exercise, movement, and manual therapy to treat a wide range of physical problems caused by illness, accident, or ageing. Similarly, EMG/NCV room shall be provided to be used for performing electromyography (EMG) and nerve conduction velocity (NCV). Combine this nerve injury exam to look for issues including carpal tunnel syndrome, pinched nerves in the neck or back, generalized nerve injuries, or disorders of the muscles. The OPD shall also have a speech and swallowing clinic for rehabilitation therapy to evaluate and treat articulation, language, stuttering, voice, cognition, and swallowing disorders. Apart from all these, EEG room shall be provided to be used for an electroencephalogram (EEG) test, which uses tiny metal discs (electrodes) connected to the scalp to assess electrical activity in the brain. Coming to the OPD of pulmonology, the OPD shall be provided with rooms like spirometry room to measure how quickly and how much air a patient exhales in order to determine how effectively their lungs are functioning; body box diffusion room to measure lung volumes, total lung capacity (TLC), and functional residual capacity (FRC); 6-min walk test room to assess aerobic capacity and endurance; DLCO room for diffusion test to determine how good the lungs are at getting oxygen (O2) from the air inhaled into the blood system of the patient for accessing the capacity of grape-like structures called alveoli, which are tiny air exchange units of oxygen; pulmonary rehabilitation room to provide regular medical care and manage the patients with chronic respiratory diseases who are still symptomatic or continue to have decreased function; bronchoscopy room to perform bronchoscopy test to see the endoscopic images of the trachea and the lungs, which helps in diagnosing the lung disorders; TBNA room to collect samples of the masses found in the mediastinum through a needle inserted during the bronchoscopy; ICTC centre for

3.3 Infrastructure

69

counselling and testing the HIV patients; and directly observed therapy (DOT) centre to manage patients with difficult or drug-resistant TB cases, to track down treatment defaulters, and to evaluate and treat TB patients. For urology, provide urodynamics study room to determine how well the bladder, sphincters, and urethra are storing and releasing urine. The bladder’s capacity to store urine and empty it consistently and completely is the main focus of the majority of urodynamic testing. Apart from this, a uroflow meter room shall be provided to be used for measuring and computing the patient’s flow rate in millilitres per second, the volume of urine passed, and the amount of time needed to empty the bladder. Along with the gastroenterology OPD, the endoscopic room shall be provided to perform the upper gastrointestinal endoscopy and the colonoscopy. The unit shall have a recovery room for the post-endoscopy recovery of the patient. The toilet shall also be provided with the endoscopic unit. A small washing station for washing the endoscopes shall also be provided. Coming to the OPD of gynaecology, the rooms to be attached are like the colposcopy room for performing colposcopy to look at the lower part of the womb at the top of the vagina, called the cervix, for detecting abnormal cells in the cervix; the ultrasound room for an ultrasound of the pregnant patients with any gynaecological problems instead of sending them to the department of radiology; family planning room for counselling and guiding the couple regarding the planning for pregnancy, process of pregnancy, fertile window and best days for conceiving, problems generally faced during pregnancy, precautions to be taken during pregnancy, etc.; and dilapidation and curettage (D&C) room where the cervix is dilated during a quick surgical procedure to scrape the uterine lining. During or after a miscarriage or abortion or to remove small fragments of the placenta after birthing, a D&C procedure is performed to remove tissue from the uterus. Additionally, it is used to identify or treat growths like uterine cancer, polyps, fibroids, and hormone abnormalities. Cancer detection clinic is used to detect cancer of the uterine, cervix, ovaries, vulva, vagina, and gestational trophoblastic tumour. Apart from this, antenatal clinic shall be attached to help the pregnant lady by regularly examining her during pregnancy, helping out and solving her problems during pregnancy, and guiding the pregnant woman about the precautions to be taken during her pregnancy period. Providing an infertility clinic along with the gynaecology OPD is also important. This clinic shall be a complete set-up for diagnosing and treating the diseases of the male’s and female’s reproductive organs due to which they are unable to conceive. The infertility clinics also help couples in conceiving by artificial methods like intrauterine insemination or in vitro fertilization (IVF). The infertility centre shall include IUI clinic, semen collection room, IVF laboratory, and a small operating theatre. Coming to the OPD of orthopaedic, infiltration room shall be provided for introducing injections, generally corticosteroids, in the musculoskeletal joints. Infiltration is usually guided by X-ray or ultrasound. The benefit of the infiltration room is that it saves the utilization time of the operating room. The infiltration room shall

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preferably be separate for males and females. Provide bone bank for providing biological material for orthopaedic procedures. There is a growing need for musculoskeletal tissues for transplantation. Similarly, stem cell centre shall be provided to use the bone marrow that the body produces to help damaged cells heal. The bone marrow is drawn from the own healthy bones of the patient and then injected into the joint or a bone that has been damaged. Also, for giving an injection to OPD patients, the injection rooms (separate for males and females) shall be provided in or near the OPD block. Attached to the OPD of ophthalmology shall be rooms like refraction room for routine eye examination, also called as vision test to assess the vision and requirement of the glasses or contact lenses that the patient needs; orthoptic room for diagnosing and treating binocular vision, which is a defect in eye movement as to how the eyes work together; treatment room to perform small procedures like foreign body removal; darkroom to preliminarily examine the eye at 1 m and for distant direct ophthalmoscopy, indirect ophthalmoscopy, direct ophthalmoscopy, etc; optical coherence tomography (OCT) room to examine the distinct layers of the retina to help the ophthalmologist to map and measure the thickness of the pupils in order to diagnose the disease; ND:YAG laser room for treatment of opacification of the posterior capsule with the help of the laser; green laser room for treating retinal diseases; and A-scan and B-scan room to determine the length of the eye through ultrasound technology by A-scan, while B-scan is to diagnose other issues by comparing different parts of the eye, such as the lens, sclera, retina, and more. The OPD of otorhinolaryngology (ENT) shall have rooms attached like audiometry room to examine how well the hearing of the patient functions. It tests both the intensity and the tone of sounds, balance issues, and other issues related to the function of the inner ear. Also, provide ENG lab to detect disorders of the peripheral vestibular system or the nerves that connect the vestibular system to the brain and the muscles of the eye; speech therapy room to treat the problems with speaking, language, and swallowing; temporal bone lab to drill the temporal bone to learn temporal bone anatomy; minor OT of ENT to perform the minor surgical interventional procedure of ear, nose, and throat; and endoscopic room for visualizing the interior of the head and neck in a way that is not obtainable through a routine examination. As far as the OPD of dermatology is concerned, provide a room like skin lab for treatment of skin problems like laser hair removal services, hair transplants, and best skin care; a treatment room for small surgical procedures of derma like cauterization; and a laser room to install the lasers like argon and carbon dioxide (CO2), which are used to treat diseases like benign vascular birthmarks, congenital defects, and skin conditions, including vascular and pigmented lesions and removal of scars, tattoos, and wrinkles. Common to all the OPDs, there should be clean storerooms to store clean items like sterilized linen, instruments, and disposables; dirty utility room to store the soiled linen and other waste generated from the OPDs; and general store for storage of the items like instruments, consumables, disposables, drugs, and medicines.

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3.4  Services, Facilities, Equipment, Tools, and Instruments

3.4 Services, Facilities, Equipment, Tools, and Instruments 3.4.1 Reception/Help Desk See Table 3.6. The number of patients or visitors who are anticipated to use the reception or help desk services determines the size of the counter and/or help desk. It is advised that enough room be made so that two receptionists or assistants can be seated. Therefore, the appropriate length for the reception and/or help desk shall be between 3048 mm and 4572 mm. To make the counter appealing, it can be constructed with either civil work with an artistic appearance and granite or another material. A counter constructed of wood can also be offered as an alternative. The front side of the counter shall be approximately 324 mm high so that a person may stand and speak with the receptionist without difficulty. The working top, which shall be around 610  mm wide and 762  mm tall, shall be provided on the opposite side of the counter. For the receptionists, two chairs shall be provided. The high-raised chairs can also be provided, if necessary. Each receptionist or help desk assistant shall be provided with a computer with UPS and printer (if printing is required). The scanner can also be provided at the reception desk if necessary. The microphone for the announcement shall be provided at the reception. The intercom line and the telephone lines shall also be provided at the reception. Even one spare mobile phone shall also be placed at the reception to make emergency calls. Table 3.6  Reception/help desk in the OPD

Activity Provide the following at reception Reception chairs Computers with printers Scanner Microphone for public announcement system Intercom and telephone line Required electrical points at reception and help desk Other communication ports at reception and help desk Record room with reception

Status of works Start End In Not date date Complete progress started

::::::-

:-

:-

Responsible person Remarks

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3  Outpatient Department (OPD)

The reception counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be placed on the counter’s inner wall, around 6 inches above the working surface. Computers, printers, and other similar devices shall be connected to these points. • Additionally, there shall be two 3  Amp switch/sockets on the wall behind the reception desk for other appliances. The reception counter shall have the following communication ports: • RJ 45, two ports for networking of computers • RJ 11, two ports for the intercom and extension line • USB, two ports for additional devices or charging mobile phones The record room near the reception and/or help desk shall have steel cupboards and open racks for storage.

3.4.2 Registration/Billing/Admission and Discharge Counters See Table 3.7. Again, the size of the admission, discharge, billing, and registration counters shall be determined by the anticipated number of patients or visitors who are Table 3.7  Registration/billing/admission and discharge counters in the OPD

Activity Provide the following at the registration and billing counter Office chairs Computers with printers Scanner Biometric scanner Intercom and telephone line Required electrical points at registration/ billing/admission and discharge counter Other communication ports at the registration/ billing/admission and discharge counter Record room with registration/billing/ admission and discharge counter

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::-

:-

:-

3.4  Services, Facilities, Equipment, Tools, and Instruments

73

anticipated to use these counters’ services. However, there shall be room for two employees to sit at each counter. Therefore, the optimal length can range from 2438 mm to 3658 mm. Granite or another material can be utilized to give the counters an aesthetically pleasing appearance and shall be constructed by civil work. Counters made of wood can also be provided as an alternative. The front side of the counter shall be approximately 324 mm high so that a person may stand and speak with the receptionist without difficulty. The working top, which shall be around 610  mm wide and 762  mm tall, shall be provided on the opposite side of the counter. Two office chairs shall be provided at each registration/billing/admission and discharge counter. If need be, high-raised chairs can also be provided. Computer with UPS and printer (if needed for printing) shall be provided to each registration/billing/admission and discharge counter worker. If required, the scanner can also be provided at the registration/billing/admission and discharge counters. Also, the biometric scanners shall be provided at the registration counter to fetch the biometric data of the patient at the time of registration. Additionally, the barcode scanner and barcode printer shall be provided at the billing counter for scanning the barcodes for billing. The intercom line and the telephone lines shall also be provided at each registration/billing/admission and discharge counter. Each registration, billing, admission, and discharge counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be placed on the counter’s inner wall, around 6 inches above the working surface. Computers, printers, and other similar devices shall be connected to these points. • Additionally, there shall be two 3  Amp switch/sockets on the wall behind the counter for other appliances. Each registration, billing, admission, and discharge counter shall have the following communication ports: • RJ 45, two ports for networking of computers • RJ 11, two ports for the intercom and extension line • USB, two ports for additional devices or charging mobile phones The record room near the registration, billing, admission, and discharge counter shall have steel cupboards and open racks for storage.

3.4.3 Cash Counter See Table 3.8. Again, the size of the cash counters shall be determined by the anticipated number of patients or visitors who are anticipated to use these counters’ services. However, there shall be room for two employees to sit at each counter. Therefore, the optimal

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Table 3.8  Cash counter in the OPD

Activity Provide the following at cash counter Office chairs Computers with printers Scanner Barcode scanner Intercom and telephone line Required electrical points at the cash counter Other communication ports at cash counter Strong room with cash counter

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::-

::-

length can range from 2438 mm to 3658 mm. Granite or another material can be utilized to give the counters an aesthetically pleasing appearance and shall be constructed by civil work. Counters made of wood can also be provided as an alternative. The front side of the cash counter shall be approximately 324 mm high so that a person may stand and speak with the cashier without difficulty. The working top, which shall be around 610  mm wide and 762  mm tall, shall be provided on the opposite side of the counter. As the safety of the cash is essential at the cash counters, there shall be a glass barrier above the counter that rises to a height of approximately 1219 mm from the top of the counter and shall have a cut window on the lower side. Two office chairs shall be provided at each cash counter. If need be, high-raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided for each cashier separately. If required, the scanner can also be provided at the cash counter. Additionally, the barcode scanner shall be provided at the cash counter for scanning the barcodes for billing and receiving cash. The intercom line and the telephone lines shall also be provided at the cash counters. Each cash counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be placed on the counter’s inner wall, around 6 inches above the working surface. Computers, printers, and other similar devices shall be connected to these points. • Additionally, there shall be two 3  Amp switch/sockets on the wall behind the cash counter for other appliances.

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Each cash counter shall have the following communication ports: • RJ 45, two ports for networking of computers • RJ 11, two ports for the intercom and extension line • USB, two ports for additional devices or charging mobile phones The strong room attached to the cash counter shall have a safe, which shall be properly grouted with the fasteners either to the working slab or to the floor of the room. The gates of the strong room shall be lockable and shall be operated by double keys.

3.4.4 Waiting and Sub-waiting Lobbies See Table 3.9. The waiting and sub-waiting lobbies of the OPD blocks shall be fully air-­ conditioned with a provision of cooling and heating. Waiting lobbies shall be properly guarded, and security measures like fire hooters and CCTV cameras shall be provided in the waiting areas. Table 3.9  Waiting and sub-waiting lobbies in the OPD

Activity Proper heating and air conditioning Security features like CCTV and fire hooters Announcement systems Display board for token system Waiting chairs/sofa set Wall, ceiling, and interior decoration Television, magazines, newspapers racks, fish tanks, kiosks, etc. Food and drink vending machines Signage and wayfinding system Spaces for indoor plants Mobile charging points in the lobby Free internet or Wi-Fi facility Handrails at the staircase and other areas

Status of works Start End In Not Responsible date date Complete progress started person Remarks :::::::-

::::::-

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Waiting lobbies shall have adequate speakers with a clear voice to hear the announcements. Along with the audio system, the visual display system including the display boards shall be provided, where the token number can be displayed. The proper comfortable chair having backrests shall be provided in the waiting areas. Please avoid backless benches, as it is not comfortable to sit on such benches. If sofa sets are provided, it will be better. However, the waiting areas of VIPs shall have the sofa set along with the centre tables. The waiting areas shall have suitable seating and provisions for bariatric patients. For an aesthetic look of the waiting areas, the interiors shall be well decorated. The wall decoration shall be done by using mirrors, murals, texturized paints, or wallpapers. Similarly, the ceiling shall also be decorative. Light fittings shall also be decorative. For interior decor, colour, textures, surface finishes, fixtures, fittings, furnishings, and artworks shall be used. The waiting areas shall also have a provision for televisions, fish tanks, magazine holders, newspaper racks, kiosks, etc. for patients and visitors to spend time. A small cafeteria or vending machines shall be provided in the waiting areas. The wayfinding and signages shall be very clear and glowable so that the visitors and the patients can easily identify the passages and the routes. For beautification, indoor plants can also be planned to be placed in waiting areas. Mobile charging points shall also be provided in the waiting area. Apart from this, if possible, the facility of Wi-Fi or free internet can be provided. For the safety of the patients and visitors, provide necessary safety measures, like handrails, non-slippery surfaces, non-steep slopes, handicapped toilets, and wheelchair accessibility.

3.4.5 Consultation Rooms See Table 3.10. The following furniture shall be placed in the consultation room: • • • • • • •

Doctors’ table Side rack for doctor Doctors’ chair Two attendants’ chairs Examination couch Height adjustment revolving stool for patient Step stool All the necessary equipment, gadgets, and instruments shall be provided like:

• • • •

BP instrument Stethoscope View box Torch

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Table 3.10  Consultation room in the OPD

Activity Provide the following furniture in consultation rooms Doctors’ table Side rack for doctor Doctors’ chair  Examination couch  Two attendants’ chairs  Height adjustment revolving stool for patient Step stool Provide the following equipment/gadgets in OPD BP instrument Stethoscope Torch Knee hammer Tongue depressor Weighing machine Finger pulse oximeter View box Specialized equipment required for different types of OPDs Intercom Computer with a printer and UPS Washbasin for hand wash Curtain partitions for the examination couch Provide windows if possible MGPS supply of oxygen, air, and suction if required Required electrical points in OPD Other communication points in OPD

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::-

:-

:::::::::-

::::::-

::-

78

• • • • •

3  Outpatient Department (OPD)

Weighing machine Knee hammer (if required) Tongue depressor Finger pulse oximeter Special equipment required for different types of OPDs

However, apart from the above list of equipment, gadgets, and instruments, some of the items may vary from one speciality to another. For example, the eye consultation rooms may need the slit lamp and refraction unit; ENT consultation rooms may require an endoscopic chair; and medicine consultation rooms may require an ECG machine. Hence, depending on the speciality and the requirements of individual consultation rooms, the equipment, gadgets, and instruments shall be provided. All the consultation rooms shall be provided with an intercom for inter-hospital communication. The consultation rooms shall be provided with a computer along with the UPS. If printing is also required to be done in the consultation rooms, the printer shall also be provided. Each consultation room must have a hand basin along with the soap dispenser and towel hanger. A hanging curtain partition covering each of the examination table’s three sides shall be provided in the consultation rooms. The curtains shall be hung from a ceiling-­mounted curtain track that is fixed 2134  mm above the ground. A space should be left clear at the bottom of the curtain that shall approximately be 457 mm above the ground so that the floor can be cleaned easily. Biomedical waste management shall be introduced in all consultation rooms. Although direct sunlight shall be avoided, windows in consultation rooms are preferred. The window glass can be tinted and shall be covered with blinds or drapes. The following electrical points shall be provided in the consultation rooms: • The main switchboard for controlling the fan and lighting of the room shall be located at the entrance wall (other than the wall on which the door will open), coupled with one 5 Amp switch/socket. • Temperature-adjustable air conditioning control button. • The switch and one socket for the examination light shall be provided at 610 mm above the examination table on the wall. • Two 5 Amp switch/sockets shall be provided at 305 mm above the doctor’s table on the wall. Besides this, one 3 Amp switch/socket shall also be provided. • Above the doctor’s side rack at the height of about 305 mm, three 5 Amp switch/ sockets for the computer and printer shall be provided. Additionally, one 3 Amp switch/socket shall be provided adjacent to this for additional equipment or a heater.

3.4  Services, Facilities, Equipment, Tools, and Instruments

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The following communication points shall be provided in the consultation chamber: • RJ 45, for networking of computers • RJ 11, for the intercom and extension line • USB, for additional devices or charging mobile phones The examination room attached to the consultation rooms shall have the following: • • • • • • • • • • • • • •

Examination couch Step stool Examination lamp Torch Stainless steel trays Stainless steel bowls Dressing drums Speculums Knee hammer (if required) Tongue depressor Weighing machine Multi-para monitor (if required) View box Special equipment required for different types of examination rooms

The vital sign examination area attached outside the consultation rooms shall have the following: • • • • • • • • • •

BP apparatus Stethoscope Torch Stainless steel trays Stainless steel bowls Weighing machine Finger pulse oximeter Weighing machine Height scale Special equipment required for different types of vital sign examination rooms

3.4.6 Supporting Rooms See Table 3.11.

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Table 3.11  Supporting rooms in the OPD

Activity Sample collection room Phlebotomy chair Office chairs Office table Blood shaker Examination couch Refrigerator Working top Sink Curtain partitions for couch Consumables like needles, vacutainer tubes, holders, cotton, spirit Cupboards, shelves, and racks Computer with UPS and printer Barcode scanner Outlet station for pneumatic tube system (PTS) Interview/meeting/ counselling rooms Doctors’ chair Office table Visitors’ chairs or sofa set Audio-video recording camera system Computer with UPS and printer Clean storeroom Cabinet Drawers Cupboards Dirty utility Covered linen collection hampers Exhaust fan General store

Status of works Start End In Not date date Complete progress started

::::::::::-

::::-

:::::-

:::::-

Responsible person Remarks

3.4  Services, Facilities, Equipment, Tools, and Instruments

81

Table 3.11 (continued)

Activity Cabinet Drawers Cupboards Record room Cabinet Drawers Cupboards Equipment storage room Working slab Cupboards Racks Electrical outlets Medicine and drug storeroom Cabinets Drawers Racks Refrigerator Intercom Automatic medicine dispensing machine Office table Office chairs Station of pneumatic tube system (PTS) Staff room with beverage and food facilities Sofa sets Centre table Tea/coffee vending machine Refrigerator Cupboard Sink with draining board Gas burners or induction stove Microwave Sufficient electrical outlets

Status of works In Not Start End date date Complete progress started ::::::-

::::-

:::::::::-

:::::::::-

Responsible person Remarks

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3  Outpatient Department (OPD)

3.4.6.1 Sample Collection Room The sample collection rooms, commonly known as phlebotomy rooms, shall be provided with a phlebotomy chair and one examination sofa. A working top with a sink shall be provided in the room for placing the specimens that have been drawn. For the patient’s privacy, a curtain partition shall be on the couch. To have an adequate supply of needles, vacutainer tubes, holders, etc., in this specimen collection room, suitable cabinets, shelves, and racks shall be provided. There shall be enough electrical outlets on the working surface. The provision of a refrigerator shall be kept. A sufficient number of office tables, chairs, computers with printers, and barcode printers shall be provided to execute tasks like processing the specimens, barcoding the specimens, and consent gathering. The phlebotomy room shall have a PTS outlet point so that samples and requisition forms can be sent directly to the laboratories without delay. For more details on the sample collection room, please refer to Chapter number 9, titled ‘Clinical Laboratories’ of this book. 3.4.6.2 Interview/Meeting/Counselling Rooms The interview/meeting/counselling rooms in the OPD complex shall have the doctors’ chair along with the doctors’ table. At least two visitors’ chairs or a sofa set shall also be provided in the room. The doctor shall be provided with the computer system along with the UPS.  If needed, the printer shall also be provided. Most importantly, the entire interview/meeting/counselling room shall have the provision of audio-video recording, so the conversation between the doctors and the visitors is recorded. This recording can act as proof in a court of law if required. 3.4.6.3 Clean Storeroom The clean utility is used for storage of the clean linen, consumables, and sterilized disposables. Also, the materials like drums and drapes are stored in this room. One single door shall be provided to the room, which shall be about 914 mm tall. There shall be sufficient numbers of closed cabinets, drawers, and racks in the room. 3.4.6.4 Dirty Utility Before being sent to the laundry, the soiled linen is stored in the dirty utility. From here, the linen is relocated for a pre-wash or to the laundry. Covered hampers or other receptacles for collecting soiled laundry shall be provided in the room. Exhaust fans shall be provided since the air in this room needs to be vented. 3.4.6.5 General Store General store is used for storage of miscellaneous items like stationery, instruments, files, and unused linen. The storeroom shall have the cupboards, rack, working slab, drawers, etc.

3.4  Services, Facilities, Equipment, Tools, and Instruments

83

3.4.6.6 Record Room As the record room is used for keeping the patient’s records along with the other records, the storeroom shall have the cupboards, rack, working slab, drawers, etc. 3.4.6.7 Equipment Storage Room As mentioned earlier, the equipment storage room is used to store unused medical equipment or equipment that is used very rarely but has to be ready at all times to be used whenever required. The equipment store shall be a closed room. The room shall have working slabs to place the small equipment and clear floor space to store large equipment. Besides this, cupboards and racks shall also be provided. The room shall have a sufficient number of electrical charging points duly grounded for medical equipment charging that are not frequently used and are stored here. 3.4.6.8 Medicine and Drug Storeroom The medication room is used to store medications and disburse them to patients in the OPD complex. The room shall have the ability to store medications in cabinets, drawers, and racks. A large countertop shall be provided in the room for dispensing medications. Additionally, a refrigerator shall be provided in the room. Similarly, an intercom and telephone line shall be provided. Medicines can also be disbursed using automated drug dispensing machines. The employees working in the pharmacy shall be provided with the required number of office tables and chairs. The medicine and drugs shall preferably have a pneumatic tube system (PTS). 3.4.6.9 Staff Room with Beverage and Food Facilities Staff restroom is provided for staff to relax after long working hours in the OPD. A sofa set and a centre table shall be provided in the staff restroom. On request, a single bed can also be provided in the staff room so that the staff can rest there for a while. The pantry duly equipped to serve tea and coffee shall be connected to the staff restroom. In addition to tea and coffee, the pantry shall offer pre-made light snacks and cookies. The pantry shall have a countertop slab to place induction or gas burners for cooking. For washing utensils, a sink with a draining board shall be provided. In the pantry, a microwave and a refrigerator shall also be provided. There must be enough electric points available to operate these machines.

3.4.7 Treatment/Procedure Room/Minor OT See Table 3.12. As mentioned earlier, the ‘procedure rooms, ‘treatment rooms’, and ‘minor operating rooms’ are provided in the OPD complex to perform minor procedures and surgeries within the OPD complex itself.

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Table 3.12  Treatment/procedure rooms/minor OT in the OPD

Activity Provide the following furniture in the treatment/procedure room and minor operating room Examination/procedure table OT table for minor OT Stretcher trollies Wheelchairs Dressing trolley Instrument trolley Step stool Scrub station IV stand IV rod Small writing table Doctors’ chair Height adjustment revolving stool for a doctor Crash cart, if required Oxygen cylinder trolley Provide the following equipment in the treatment/procedure room and minor operating room Basic Boyle’s machine with a vaporizer for minor OT Alternately if required, anaesthesia workstation can be provided Operating light single or double dome Operating loupe Multi-para vital sign monitor Infusion pump Defibrillator ECG machine Suction machine Surgical cautery

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::::::::::::-

::-

:-

:-

::::::::-

3.4  Services, Facilities, Equipment, Tools, and Instruments

85

Table 3.12 (continued)

Activity Laryngoscope Oxygen cylinders with masks View boxes, etc. Scrub station/washbasin for hand wash MGPS supply of oxygen, air, suction, and nitrous oxide Hanging panels for MGPS Required electrical points Other communication points

Status of works In Not Responsible Start End Remarks date date Complete progress started person :::::-

:::-

Here, we shall discuss some important features of a minor OT as the other two (treatment rooms and procedure rooms) are almost similar. As different specialities in the hospital have different types of procedure/treatment rooms, the requirement of the equipment, instruments, and tools may vary from one speciality to another. Furthermore, it may also vary from one physician to another. Hence, it is very difficult to describe every procedure and treatment room in detail. But generally, most of the treatment and procedure rooms have some items in common that need to be provided in these rooms. We have tried to describe those items which are common to all. As far as the specialized items for various specialities are concerned, the same shall be provided as per the requirements of the speciality or the physician. The procedure/treatment rooms and the minor OT shall have the following furniture: • • • • • • • • • • •

OT table for minor OT Examination/procedure couch Crash cart Scrub station Instrument trollies Dressing trollies IV stand IV rod Step stool Stretcher trolley Oxygen cylinder trolley

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3  Outpatient Department (OPD)

The procedure/treatment rooms and the minor OT shall have the following equipment: • • • • • • • • • • • • •

Basic Boyle’s machine with a vaporizer for minor OT Alternately if required, anaesthesia workstation can be provided Operating light single or double dome Operating loupe Multi-para vital sign monitor Infusion pump Defibrillator ECG machine Suction machine Surgical cautery Laryngoscope Oxygen cylinders with masks View boxes, etc.

The procedure/treatment rooms and the minor OT shall have the following instruments and tools: • • • • • • • • • • •

Sterilizing drums Instrument boxes Examination light Torches Forceps of all styles and sizes Scissors of all styles and sizes Cheatle forceps Needle holders Tray of all styles and sizes Extension cords and boxes All other required instruments

For hand washing, in case of minor OT, a double-bay scrub shall be provided, which shall be operational with sensors and foot along with the soap dispenser and paper napkin holder. However, for the procedure room or the treatment room, a wash basin can be provided with a provision of soap dispenser and a towel hanger or paper napkin dispenser. As surgical interventions may have to be done in the minor OT/treatment and procedure rooms, the outlets for the following piped medical gases shall be provided: • • • •

Oxygen Compressed air Suction Nitrous oxide

3.4  Services, Facilities, Equipment, Tools, and Instruments

87

The following electrical points shall be provided in the procedure/treatment rooms and the minor OT: • One 5 Amp switch/socket and the primary switchboard for the room’s fan and lighting shall be placed at the entry wall. • Temperature-adjustable air conditioning control button. • If a hanging pendant is installed, at least 3 pairs of 5/3 Amp switch/sockets shall be provided on the pendant. All these points shall have a power backup through UPS. • A pair of two 5/3  Amp switch/sockets shall be installed at a height of 457 mm from the floor level in the middle of each of the three walls of the procedure/treatment room and the minor OT (except the wall on which a door is provided). One pair of these two shall have the power backup through UPS. The following communication points shall be provided in the procedure/treatment room and minor OT at any convenient place/wall: • RJ 45 port for networking of computer • RJ 11 port for intercom and extension line • HDMI port for the display of videos and images at other locations

3.4.8 Other Issues Relating to OPDs See Table 3.13. The provisions shall be made to have a continuous backup of power in the OPD complex, particularly for the treatment rooms, procedure room, and minor OT. To avoid total darkness in the OPD complex, battery-operated emergency lights shall be provided in the OPD complex. As far as possible, design the OPD complex in such a fashion which encourages cross ventilation in the OPD complex. Table 3.13  Other issues relating to OPDs

Activity Continuous backup of power supply Provision of battery-operated emergency light Cross ventilation

Status of works Start End In Not date date Complete progress started ::-

:-

Responsible person

Remarks

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Further Reading Anon. Design and application of a new doctor workstation system in the outpatient department-《Information of Medical Equipment》2006年09期 [Internet]. [cited 2021 Jun 18]. Available from: https://en.cnki.com.cn/Article_en/CJFDTotal-­YLSX200609011.htm. Anon. The patient-centred new outpatient building process design. J Med Postgraduates 2009年04期 [Internet]. [cited 2021 Jun 18]. Available from: https://en.cnki.com.cn/Article_en/ CJFDTotal-­JLYB200904022.htm. Athula WAK, Takakuwa S. Designing outpatient appointment systems with patient characteristics: a case study. Int J Healthc Technol Manag. 2012;13(1–3):37–69. Broberg O, Edwards K. User-driven innovation of an outpatient department. Work. 2012;41(Suppl. 1):101–6. Contributor G.  Healthcare Facilities Design After COVID-19. Facility Executive—Creating Intelligent Buildings. 2020 [cited 2021 Jun 18]. Available from: https://facilityexecutive. com/2020/06/healthcare-­facilities-­design-­after-­covid-­19/. COVID-19: Smart OPDs To Help Keep Our Doctors Safe [Internet]. Moneylife NEWS & VIEWS. [cited 2021 Jun 18]. Available from: https://www.moneylife.in/article/covid-­19-­ smart-­opds-­to-­help-­keep-­our-­doctors-­safe/60092.html. Donnellan F, Hussain T, Aftab AR, McGurk C. Reducing unnecessary outpatient attendances. Int J Health Care Qual Assur. 2010;23(5):527–31. Fleming RW. Outpatient care: design of outpatient areas. Hosp Top. 1973;51(10):45–9. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 17, Outpatient Department. p. 143–34. Health Care Radius. 10 hospital design changes, post COVID.  Health Care Radius. [cited 2021 Jun 18]. Available from: https://www.healthcareradius.in/ projects/26279-­10-­hospital-­design-­changes-­post-­covid. Madsen NB. Framework for Layout Design Supporting Patient Flow in Outpatient Departments. n.d. p. 44. Tabish SA. Outpatient Services in a Hospital. In 2011. Vahdatzad V, Griffin J. Outpatient clinic layout design accounting for flexible policies. In 2016. p. 3668–9. Zhao Y, Mourshed M.  Patients’ Perspectives on the Design of Hospital Outpatient Areas. Buildings. 2017;7(4):117.

4

Intensive Care Units (ICUs)

The intensive care unit (ICU) is a self-contained area of a hospital, dedicated to the management of patients with critical and life-threatening illnesses. This is a specially designed, equipped, staffed, furnished unit with the necessary tools, gadgets, equipment, and other materials required to manage the critically sick patient. Appropriate provisions are made for continuous, close, and rigorous monitoring and observation of critically sick patients. ICUs provide specialized expert care by using the skills of medical, nursing, and other personnel experienced in the management of patients and who support the vital functions of the patient. Designing an intensive care unit (ICU) is a difficult job as the patients to be handled in the ICUs are critically ill. Before beginning the planning and designing of ICUs, first of all, the designers need to understand the requirements in terms of the number of ICUs, beds in each ICU, and type of ICUs including the specialized and advanced ICUs. The main ICUs that are generally provided are medical ICU, surgical ICU, paediatric ICU, and neonatal ICU.  Apart from this, advanced and specialized ICUs like neurology ICU, cardiac ICU, and cardiothoracic ICU are also provided in hospitals. ICUs can be planned depending on the severity of the illness to be treated or otherwise ICUs can be designed department-wise. The ICU can be separate for each clinical department or otherwise a common ICU can be provided for two or more clinical departments. However, not all hospital set-ups need to have all these ICUs. Before planning the type, the number of ICUs, or the number of beds in each ICU, the answer shall be given to the words like what, why, and how many. The answers to these questions have to be collected by the management before planning the ICUs. Based on the answers to these questions, the decision about the type and number of ICUs has to be made. Also, a decision has to be taken about the number of beds in each ICU. Another important issue of planning is to decide about the facilities, amenities, and equipment that have to be provided in each ICU.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_4

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At times, the designers may also have to decide about the levels of the ICUs. It can be of different levels, i.e. level 1, level 2, and level 3. These levels are decided based on the factors like the number of beds in the ICU, the equipment facility, and the staffing pattern of the respective ICU. Before ICUs are operational and ready to take the patient, please ensure that the required infrastructure is provided; the layout of the department is perfect; required services are available; proper furniture and fixtures are in place; required electrical points and communication ports have been provided; public utilities have been provided; signage, wayfinding, and display mechanisms are in place; required instrument/equipment/gadgets are available; required facilities are available; patient/staff/ visitor safety mechanisms are available; proper lighting is ensured; proper environmental control with heating and air conditioning is available; security devices and mechanisms are provided; announcement systems are in place; and wall, ceiling, and interior decoration are up to the mark and appealing. This set of monitoring tools shall help the planner and designer to remember all such issues relating to the ICU and guide him/her to complete the test and commission all works/activities well in time. This shall help him/her to ensure himself/ herself that all the works/activities are carried out, complete, and working before the actual operations of the ICU start.

4.1 Location of Intensive Care Units See Table 4.1. As far as the location of the ICUs is concerned, there are two schools of thought. As per the first school of thought, the ICUs shall be located in a central area of the building for easy access to all the ICUs. The reason is that if the patient suddenly develops any complications, the specially trained staff and equipment are immediately available to patients from other ICUs. Additionally, hygiene can be maintained much more effectively, and visitor control shall be more effective. According to the second school of thinking, the placement of such intensive units shall be determined by the patient’s kind of disease. To promote simple follow-up for progressive treatment, the medical ICU shall be near the medical ward, whereas the surgical ICU shall be close to the operating room. Given that each thought has advantages and disadvantages, we can concur with both of them. However, if more than one set of ICUs is needed in the hospital, we advocate for placing all these ICUs at a central location on one floor, known as the ‘intensive care floor’. Whatever the location of ICUs, there shall be effective infection control measures in place and traffic shall be restricted. The location of ICUs and their accessibility to the general public and visitors shall be handled with special care. ICUs shall be considered as a restricted area, so access for guests and the general public shall be severely limited. Again, there are differing views about the floor where the ICU shall be situated. Some people favour having ICUs on the building’s top floor. This idea is supported

91

4.2 Type of ICUs Table 4.1  Location of intensive care units

Activity Have the spaces for the location of the intensive care units been identified? Are the ICUs located in a unitary building of the main hospital? Distance from support departments like radiology Distance from support departments like pathology How much is the distance of ICUs from the emergency department? Is the blood bank easily approachable from the emergency department? Are support services like CSSD and MGPS easily accessible from ICUs?

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:-

:-

:-

:-

:-

:-

by the claim that it is possible to successfully control traffic while lowering the risk of infection. Another idea is to sandwich the ICUs between two floors, perhaps in between the buildings. The top level has significant thermal losses, necessitating more efficient air conditioning at a higher running cost. When choosing a location for the ICUs, it is also important to keep in mind that they shall be close to other facilities such as the emergency room, operating room, radiology department, and blood bank. It shall also be ensured that support services like CSSD and MGPS are easily accessible from the ICUs.

4.2 Type of ICUs See Table 4.2. Note: The spaces for all these ICUs are not necessary. However, spaces shall be provided for those ICUs which have been planned to be built in your hospital. ICUs are normally designed depending on the type of disease. Generally, ICUs are planned for departments like medicine, surgery, interventional cardiology, cardiac surgery, pulmonology, neurology, neurosurgery, psychiatry, transplant surgery,

4  Intensive Care Units (ICUs)

92 Table 4.2  Type of ICUs

Activity Have the spaces been provided for the following ICUs? Bariatric surgery ICU Burn ICU CTVS ICU Derma ICU Endocrine surgery ICU Endocrinology ICU ENT ICU Gastro ICU Gastro surgery ICU Geriatrics ICU Gynae ICU Intensive coronary care unit (ICCU) Interventional cardiac ICU Medical ICU Neonatal ICU Nephrology ICU Neuro ICU Neurosurgery ICU Oncology ICU Ophthalmology ICU Ortho ICU Paedia ICU Paedia Surg. ICU Psychiatry ICU Pulmonology ICU Respiratory ICU Robotic Surg. ICU Surgical ICU Transplant ICU Urology ICU Vascular surgery ICU

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::::::::::::::::::::::::::::::-

nephrology, urology, robotic surgery, endocrinology, endocrine surgery, gastroenterology, GI surgery, bariatric surgery, burn, vascular surgery, gynaecology, orthopaedics, paediatrics, paediatric surgery, neonatology, ophthalmology, ENT, dermatology geriatrics, and oncology.

4.3 Zones of ICUs

93

Certain specialized ICUs are created to provide care for a specific disease or discipline in addition to the generalized ICUs like the medical and surgical ICUs. For instance, cardiac patients primarily get care at the intensive coronary care unit (ICCU). ICCU is another name for this ICU. The ICCU shall be designed in such a fashion so that it has all the facilities to handle emergencies and has the facilities and equipment like pacemakers and echocardiography machines, which are easily accessible. The ICU for respiratory care is intended to treat patients with respiratory illnesses. This ICU shall have top-notch ventilation support provisions. As a result, the design shall provide enough backup for the delivery of medical gases. Neurosurgical intensive care unit is for neurosurgical (operative and conservative) patients. The purpose of the burn unit is to provide treatment to patients with burns which require intensive care. All the beds of this ICU shall be isolation beds with negative air pressure. Along with this ICU, a shower room and a sterile dressing room shall also be provided. Hyperbaric chambers shall also be available in the burn ICUs if necessary. Elderly patients are treated in geriatric intensive care units. The design shall minimize excessive noise in the ICU and create a system that the patient can easily understand because the elderly has diminished eyesight and hearing. Because of the reduced vision, the illumination needs to be glare-free. Additionally, suitable railings shall be installed in the walking area to prevent patient falls. The toilets shall have sufficient support and handrails for people with disabilities.

4.3 Zones of ICUs The ICU is primarily divided into four distinct zones, each of which houses a different function or a group of linked functions. The zones are as follows: 1. Patient care zone The only purpose of this zone is direct patient care, and this zone includes patient rooms, isolation rooms, and ancillary rooms. 2. Clinical support zone This zone includes tasks that are closely related to delivering direct patient care. 3. Unit support zone The administrative, resource management, and employee support functions shall be carried out from this zone. 4. Family support zone This area is intended to support and facilitate families and visitors.

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4.4 Infrastructure 4.4.1 Patient Care Zone 4.4.1.1 Patient Units/Rooms/Cubicles See Table 4.3. Patient units/rooms/cubicles are part of the patient care zone, where direct patient care is provided. It also encompasses sections that are adjacent to patient units, such as the treatment/procedure room and the nursing counter. ICUs shall include space for standard beds as well as a few numbers of isolation cabins/units/cubicles for infected patients. These isolation units, cabins, and cubicles shall preferably be airtight and under negative pressure. These units shall have a different entrance than the ICU’s typical entrance. It is advised that around 25% of the ICU’s beds be set aside as isolation beds/rooms/units. Separate connecting toilets shall be provided with the isolation rooms. Per bed area of any ICU shall be somewhere between 13.94 and 16.26 sq. m. This figure is always subjected to variation depending on the criticality of the patient. If very sick patients are to be treated, where more equipment, material, and manpower will be required, the area can go up to 18.58 sq. m. If it is felt that the patients in any ICU will not be very sick and the requirement of equipment will be less, the area can be reduced to 13.0–13.94 sq. m. If instead of open ICU, a closed cubical with a single bed is planned, the area shall not be less than 23.23 sq. m. per bed. The same is the case with the isolation chamber/room. In an intensive care unit, nursing is essential to the patient’s care. The majority of the time, the nurse is available to patients. Therefore, the nurse shall maintain a constant eye on the patient in the unit or room. Because the nurse shall maintain a close eye on the patient and carefully monitor their vital signs, the nursing station’s position is quite important. The location of the nursing station shall allow the nursing staff to continuously monitor all of the unit’s patients. Hence, the nursing station shall ideally be in the middle of the room and Table 4.3  Patient units/rooms/cubicles in ICUs

Activity Have the following patient care spaces been provided individually for all ICUs? Intensive care beds Isolation rooms Nursing station Public utility for patients

Status of works Start End In Not Responsible date date Complete progress started person Remarks

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have a counter with a ‘U’-shape design. The nursing station shall be elevated so that the nurse can easily observe the patient, for example, on a platform that is about 305 mm from the ground level. To store the instruments, tools, patient files, stationery, etc., there shall be enough space at nursing stations. There shall be enough electrical and communication points. Additionally, a view box needs to be mounted on a wall close to the nursing station. Because ICU patients are severely ill and immobile, they seldom ever use regular toilets. As a result, the ICU unit has combined toilets. Bed pots and bedpans can also be cleaned on this toilet. The usage of a mobile commode chair is preferred for immobile patients. The handicapped toilets shall include the appropriate supports and handrails for bariatric and disabled patients.

4.4.1.2 Examination and Treatment Room See Table 4.4. At times, some of the patients in the ICU may require minor procedures like catheterization, suturing of small wounds, dressing, bandaging, and bronchoscopy. Sometimes, it becomes difficult to do these procedures in the ICU due to the chances of getting infected and the privacy of the patient or the procedure requiring anaesthesia. Therefore, a treatment room or procedure room is attached to the ICU. Location-wise, the treatment/procedure room shall be either attached to ICU or very near to ICU. The treatment/procedure room shall not be far off from the other support services like radiology and other necessary support services. The size of the treatment/procedure room shall not be less than 4572 mm × 4572 mm. The door of the treatment/procedure room shall not be less than 1524 mm wide, unobstructed. The door shall be openable on both the sides in and out. Windows need not be provided in the treatment/procedure room.

4.4.2 Clinical Support Zone See Table 4.5. The clinical support zone is concerned with all processes involved in patient diagnosis and treatment. Some of these activities might happen inside the ICU Table 4.4  Examination and treatment room in ICUs

Activity Has the space for an examination and treatment room been provided?

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Table 4.5  Clinical support zone in ICUs

Activity Have the following clinical support spaces been provided individually for all ICUs or common for more than one ICU? Clean utility Dirty utility/sluice room Equipment park/store Janitor Medication rooms Radiology Sample collection room

Status of works Start End In Not Responsible date date Complete progress started person Remarks

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complex, in nearby locations, elsewhere in the hospital, or occasionally even outside the hospital’s boundaries. The design shall be in such a fashion that the patient shall have access to various clinical support services and service rooms as quickly as possible. In the clinical support zone, the following are the primary diagnostic and treatment support services: Radiology: The radiology department’s services, such as X-rays, CT scans, MRIs, ultrasound mammography, PET CT, and PET MRIs, among others, shall be easily accessible from the ICUs as they aid in diagnosing patients and monitoring their progress throughout treatment. Similarly, the availability of the DSA is crucial for peripheral interventions involving ICU patients. A portable X-ray machine shall be installed in the ICU. Similarly, an ultrasound/ echocardiography machine shall be installed in the ICU. These machines shall only be used by ICUs and shall be parked in the ICU’s equipment area. For all other services relating to imaging, the radiology department shall be located at a place in the hospital premises, which has easy and quick access to the patients of the ICU. Laboratory: Access to clinical laboratory services shall be available around the clock to the ICUs. It hardly matters if the laboratory is not located in the ICU complex because the equipment for the central clinical laboratory is put in the department at a location other than the ICU and the patient does not need to be brought to the laboratory. However, a full-fledged sample collection room shall be provided near the ICU, with facilities for specimen collection, short-term storage, and pre-processing of the specimen, before being sent to the laboratory for investigation. A few lab tests, like arterial blood gas analysis and mixed venous blood gas analysis, need to be performed in the ICU itself in addition to the routine specimens that shall be transported to the lab. Therefore, a convenient location in the ICU itself

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shall be set aside for the placement of such machines. This area shall meet all installation criteria, including having an electrical outlet, a water supply and drain, and the proper temperature to operate the machine. Rapid transfer of samples to and from the lab is preferable with pneumatic tube systems (PTS); hence, consider installing the PTS. Medication rooms: The medication room shall be close to the intensive care unit and shall be utilized for both storing medications and dispensing them to patients. The pharmacy services shall be easily accessible and available 24/7, given that the majority of patients are unwell and in ICUs. The room with an approx. size of 3658 mm × 3658 mm shall be placed near the ICU. However, the size of the room can be increased depending on the requirement. A spacious countertop shall be provided in the room for dispensing medications. If the ICU and the medication room are connected, a window that opens in the ICU can be provided for easy communication. Similar to this, an intercom and telephone line shall be provided in the medication room. The medication room shall have sufficient space to accommodate at least two employees, a nurse and a pharmacist, who shall disburse the medications that have to be administered after double-checking the accuracy. For easy transfer of medicine and drugs from the main pharmacy store, the pneumatic tube systems (PTS) can be used. Clean utility: The clean utility is a room connected to ICUs or any other service unit where clean linen is kept. Also kept in this area are items like drums, drapes, and other sterile materials. Normally, the room shall not be less than 3658 mm × 3658 mm. But depending on the requirements, the size of the room can be changed. This room shall have only one door of about 914 mm. Dirty utility/sluice room: A space connected to ICUs for collection of the soiled linen is called the dirty utility. Dirty linen before being sent to the laundry is relocated from this location to the pre-wash area. Normally, the room shall not be less than 3658 mm × 3658 mm, but depending on the requirements, the size of the room can be changed. This room shall have two doors of about 914 mm. One door shall open in the ICU and the other in the corridor from where the laundry staff can collect the linen, and he/she need not come to the ICU for collection of linen. Instead of a door on the ICU side, an openable window can be provided. Janitor room: The janitor room is attached to the ICU, the door of which shall open in the hallway. The janitor room is used for maintaining the cleaning supplies, such as brooms and wipers, needed to clean the ICU and the spaces around it. Equipment park/store: Generally, in ICU, there are few pieces of medical equipment which are not always in use but have to be ready at all times to be used whenever required. Hence, these equipment have to be stored at a separate place in the ICU so that the floor space of the ICU is not unnecessarily occupied. Therefore, the equipment storage room/area is provided in the ICU. Normally, it is a room of size not less than 4267 mm × 4267 mm. However, depending on the requirements, the size of the room can be changed.

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This area can be a closed room with a door or an otherwise open area attached to ICU. The room shall have the provision of grounded electrical charging points for charging the unused medical equipment.

4.4.3 Unit Support Zone See Table 4.6. A unit support zone is an area from where the administrative, logistic, and staff support functions are performed. These spaces can be common to more than one ICU. However, it shall be better if these spaces can be created individually for every ICU separately. Change room—male/female in ICU: Since the ICU shall have a very hygienic and clean environment, outside clothing shall not be permitted inside. Therefore, the workers shall change their outside clothes. There shall be separate changing areas for males and females. The changing area shall ideally have a toilet that is attached to it. The room shall be of the size 4572 mm × 4267 mm.

Table 4.6  Unit support zone in ICUs

Activity Have the following unit support spaces been provided and are they common for more than one ICU? Administrative offices Change room—female Change room—male Corridors Multipurpose conference room Night duty room for on-call junior residents Nurses’ night duty room Reception Resident doctors and student duty room Security and access control Signage and wayfinding system Staff lounge Staff restrooms Ward pantry

Status of works Start End In Not Responsible date date Complete progress started person Remarks

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99

Resident doctors’ and students’ duty rooms in ICU: The placement of doctors from various specialities in the ICU to give prompt care to the patients shall usually depend on the size of the ICU and the number of beds in each ICU. In that scenario, the ICU complex shall have one or more doctor duty rooms available. There shall be one or more rooms set aside for each department’s doctors. Each room shall ideally have a toilet that is attached. The room shall be of the size 4267 mm × 3658 mm. Nurse’s night duty rooms in ICU: The nurses can feel exhausted due to the intense workload in the ICU or from overworking themselves. Otherwise, they might be required to perform more than one duty simultaneously, because of the scarcity of nursing staff. Both of these situations require giving rest to nurses. Hence the nurse’s night duty room shall be planned depending on the size of the ICU and the number of beds in each ICU. Each ICU shall have at least one room like this. There shall ideally be an attached toilet in each room. The room shall be of the size 3658 mm × 3658 mm. Night duty room for on-call junior doctors: Junior doctors are assigned to care for patients overnight, and they are expected to be on duty in the intensive care unit or close by. Therefore, a room shall be allotted for them so that they can relax. Hence, one or more rooms shall be provided for junior doctors. Each room shall ideally have a toilet attached to it. The room shall be of the size 4267 mm × 3658 mm. Staff lounge: The team working in the intensive care units needs some rest and replenishment after long days of extremely hard work. Therefore, a staff lounge shall be provided near the ICU complex. The number of ICUs and the number of employees shall determine the capacity of the staff lounge. An ideal lounge shall be having a seating of about 25–30 persons. The lounge shall be well ventilated to remove food smells from the ICU complex. The lounge shall ideally have an adjoining toilet. The staff lounge needs to be connected to the ICU by telephone or intercom so that they may be notified right away in an emergency. Staff rest rooms: The staff may occasionally feel worn out as a result of the tremendous workload in the ICU or from overworking themselves. At times, they may have to work simultaneously for two or more shifts due to a staff shortage. Both of these situations require the employees to rest. The staff restroom shall typically be planned depending on the size of the ICU and the number of beds in each ICU.  Each ICU shall have at least one room like this. There shall ideally be an attached toilet in each room. The room shall be of the size 3658 mm × 3658 mm. Ward pantry: There shall be a place for diet storage and further distribution because patients admitted to the ICU shall be provided with a full day’s meals. The ward pantry is the name of this area. The diet is made in the kitchen and then delivered to the ward pantry for further distribution; the diet does not need to be cooked on the ICU premises. The size of the ward pantry shall be about 3658 mm × 3658 mm, with a single door opening outside the corridor. The ward pantry shall only be one door that opens to the outside in the hallway. There shall be a countertop in the ward pantry where the food shall be packed. In addition to the countertop, a sink with both hot and cold water shall be provided. Reception area: A reception area shall be provided in the ICUs to manage visitor access. The reception shall ideally be placed at such a location so that guests

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shall pass through it to access the ICU complex. Telephone and/or other intercommunication systems shall be used to connect the receptionist with the ICUs. Corridors in ICU complex: The entrance and movement of visitors shall be through a separate corridor and shall not be from the corridor that is being utilized by healthcare personnel. Patients and healthcare professionals may use the same corridor for entrance and movement. For supplying and servicing each ICU, a separate perimeter corridor with an easy entrance and exit shall be provided. This corridor shall also be used for the removal of trash and soiled goods. Administrative offices: It is desirable to have a place for administrative offices close to the ICU(s) for medical and nursing management and administrative staff. To allow for meetings and consultations with the ICU team and/or patients’ relatives, office rooms shall be large enough to accommodate the essential equipment, comfortable furnishings, and other amenities. Multipurpose conference room: A multipurpose conference room that can host educational/training conferences and multidisciplinary staff meetings can also be considered. Signage and wayfinding system: Visitors shall be able to see all signage inside the ICU complex. It is recommended to use the multilingual signboard with arrow markers. A different colour coding scheme can be used on the ICU floor. The designer can opt for floor patterns, art, and landmarks. Public notifications, rules and regulations for the general public, visitor amenities, etc. shall also be displayed in the family lounge. The patient’s room number or bed number shall be prominently displayed in the lounge. Signage for directions shall be simple to read, understand, and follow. Security and access control: The entrance to the ICU complex shall be confined and designated, and it shall be securely monitored with CCTV surveillance. Entry into the ICU complex shall be allowed only to authorized visitors with proper entry passes. To enable communication between the ICU personnel, the entrance shall be equipped with the appropriate communication technologies, such as an intercom or a mobile phone. Even the entry from the visitor’s lounge to the ICUs shall be guarded to prevent unwanted visitor movement to and from the ICUs. A solution is to provide visitors with a card key to access the door if it becomes difficult to place around-the-clock guards owing to financial constraints.

4.4.4 Family Support Zone See Table 4.7. In addition to the patients, anxious friends or family members frequently visit the hospital. It is not advisable to let these family members or acquaintances visit patients while they are in the intensive care unit (ICU). Therefore, family support has been identified as a critical aspect of a patient’s rehabilitation and decreased morbidity. Hence, a family support zone, consisting of spaces and amenities necessary for the comfort of the visitors and family members, shall be provided outside

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4.4 Infrastructure Table 4.7  Family support zone in ICUs

Activity Have the following family support spaces been provided and are they common for more than one ICU? Consultation cum counselling rooms Family cafeteria Family laundry Family lounge Family sleep rooms Meditation spaces Public utility for attendants

Status of works Start End In Not Responsible date date Complete progress started person Remarks

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of the patient room but is situated at a reasonable distance from the main ICU complex. Family lounge: There shall be a family and visitors’ lounge provided next to or close to the ICU complex. Each ICU shall have its lounge if the ICUs are scattered throughout the hospital complex. The placement of lounges shall be in such a fashion that it shall not interfere with the hospital’s patient, employee, and supply flow systems. Separate male and female toilets shall be provided close to or as a part of the lounge. Consultation cum counselling rooms: To get an update on the patient’s status and where things stand, family members and friends need to visit and speak with the treating physician. The consultation/counselling rooms shall therefore be provided for this purpose. This room shall be about 4572 mm × 4267 mm. Meditation spaces: Family members of the patient who are distressed typically experience fear and frequently pray to the Almighty for blessings. Therefore, it is recommended that a meditation room shall be made available close to the intensive care unit for purposes of contemplation, meditation, and spirituality. While planning the space, it shall be especially noted that there shall be space for various religions, not just one in particular. Family cafeteria: The hospital shall have an adequate size of the cafeteria for the convenience of the family members. Typically, the hospital’s ground floor shall be utilized for the cafeteria, so that they can purchase refreshments easily. The cafeteria and lounge shall have accessible drinking fountains or another source of fresh drinking water. Family laundry: This may be an additional service offered to the patient’s family, especially if the patient has to stay in the hospital for an extended period. A dedicated counter can be arranged for such a facility where the clothing can be dropped off and picked up. The unclean clothing can be collected from the counter and taken

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to the hospital’s central laundry for washing before being brought back. The guests shall be responsible for paying for this service. Family sleep rooms: It has been seen that some patients shall remain in the ICU or other hospital units for an extended period, sometimes weeks or months. Even for some disorders, the patient might need to spend a few hours in the hospital for a procedure like a radiotherapy or chemotherapy. In such cases, it is advised that depending on land availability, a separate guest home be provided and made available to family members on a paid basis. If there is no enough room for a guest house, the hospital may make arrangements with a nearby hotel to host out-of-town guests and their families; nevertheless, the family member shall be responsible for paying the hotel’s rent.

4.5 Services, Facilities, Equipment, Tools, and Instruments 4.5.1 Patient Care Zone 4.5.1.1 Services in ICU See Table 4.8. Table 4.8  Services in ICU

Activity Has the following patient care facilities/ set-up been provided individually in ICU? Air conditioning/heating system Alcohol gel/sanitizer dispensers Centralized medical gas pipeline supply communication ports Curtain partitions Electrical points Emergency eyewash station Lighting in ICU Monitoring system Power backup RO water supply for dialysis Scrub station

Status of works Start End In Not Responsible date date Complete progress started person Remarks

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103

Scrub station: Near the ICU entrance, two-way scrub stations (sensor controlled and/or foot operated) shall be provided for hand hygiene. There shall be paper towels and soap dispensers close to the scrub station. There shall be hot and cold water available at the scrub station. Alcohol gel/sanitizer dispensers: Dispensers for alcohol gel/sanitizer shall be placed in the patient’s room and also at other staff locations around the unit. This can be placed in a holder in the patient room that can be hung from the bed at the foot end of the bed. Air conditioning/heating system: ICUs shall have a complete air conditioning system, allowing for the control of temperature, humidity, and airflow. At all times, adequate and secure air quality shall be maintained. There are various options for air conditioning in the ICUs like chilled water pipelines with air handling units (AHUs), ductable split systems, and VRV systems. Each system has advantages and problems of its own. If heating is required, hot water generators shall be used instead of water chillers. The use of room heaters is usually not recommended. The direction, flow, and exchange of air shall all comply with industry standards. Centralized medical gas pipeline supply: The system for centralized medical piped supply is essential because critical patients in the ICU need invasive or non-­ invasive ventilation. Compressed air, oxygen, and wall-mounted suction are the gases that are provided. Therefore, oxygen, air, and suction shall be available at all times in all ICU beds. Gas outlets are required for the supply of oxygen, air, and suction in every patient bed. These gas outlets can be mounted on a panel that is provided above the patient’s bed or on a pendant that hangs from the ceiling. Electrical and communication ports shall be provided, and these points and ports shall be placed on the bed head panel or pendent, as applicable. Each bed in the ICU shall have one of the following outlets: 1. Two oxygen outlets 2. One compressed air outlet 3. Two suction outlets Electrical points: For electric supply in the ICU, the following electrical outlets shall be provided: 1. The ICU’s main switchboard, which controls the fan and lights, shall be placed at the entrance wall. It shall also have one 6 Amp switch or socket. 2. An air conditioning control button for controlling the temperature and humidity. 3. There shall be at least four pairs of 6/4 Amp switch/sockets on each bed head panel or hanging pendant as the case may be, i.e. eight electrical outlets shall be provided. These outlets shall be connected to the UPS for power backup. 4. In the centre between two beds, three pairs of 6/4 Amp. A switch/socket shall be provided on the back wall, i.e. six outlets. Out of these, two pairs shall be on UPS supply. 5. Five 6/4 Amp switch/sockets shall be installed on the wall behind or close to the nursing station for view box or charging medical devices, among other things.

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6. The nursing counter shall have two 6 Amp switch/sockets. Communication ports: On every bed in the ICU, communication ports shall be provided. These ports include the nurse call point, the RJ 45 point for computer networking, the RJ 11 point for the intercom and extension line, and the outlet for connecting the patient’s reading light. The nurse station shall have a power outlet for connecting the nurse call control console, RJ 45 port for computer networking, RJ 11 port for intercom and extension lines, and an HDMI port for computer display. Curtain partitions: If the ICU does not have a cubicle system, hanging curtain partitions shall be provided on all the beds in the ICU, on all three sides of the bed except the wall side. Curtains shall be movable and collapsible and hung on the curtain tracks hanging from the ceiling. Emergency eyewash station: Splashes of chemicals or bodily fluids are possible due to the staff’s exposure to numerous dangerous fluids while working in ICUs. Therefore, close to the ICU scrub station, an eyewash station shall be provided. Monitoring system: The multi-parameter bedside monitor shall be placed close to the patient in the intensive care unit for rigorous patient monitoring. Therefore, a place and tools shall be made available for mounting the monitor at the patient’s bedside. A monitor tray can be installed on the bed head panel or the hanging pendant to accomplish this. In case this is not possible, the monitor tray may be mounted on the wall using bolts. Sometimes, medical professionals choose centralized monitoring via central nursing station (CNS). To do this, Cat 6 cabling shall be laid down from each bed separately, with all cables terminating at the nursing station, where the CNS is installed. Remote monitoring has been possible through constantly evolving technology. With this technology, the live data parameters are transmitted to the doctors online for ongoing supervision and delivery of the appropriate instructions. To make this possible, cabling shall be laid down from each bed to the computer placed at the nursing station, from which the information shall be sent to the doctor. Lighting in the ICU: Lighting needs to be properly managed both for general illumination and specialized operations. Both too bright and too dim lighting are discouraged. The right lumens of light shall be planned according to the requirements. Because of their extended lifespan and low energy usage, LED lighting is usually advised. The unit or space shall have an even distribution of lights. Lights that are surface-exposed shall be avoided. It is recommended to use flush-mounted ceiling lights. Avoid wall lights as they are not that effective. No usage of fancy lighting is permitted. To avoid burns, halogen and incandescent light sources shall not be used. Flexible arms, if used with the light source, shall be mechanically controlled to prevent the lamp from contacting linen. A reading light that can be adjusted and is readily operated by the patient shall be put on the patient’s bed. Directly above the patient on each bed, there shall be a separate source of lighting for emergencies and procedures. Low-level night lighting shall be placed close to the patient’s bed. There shall be an emergency

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battery-operated light in the patient unit and the hallways. It shall be better if users operate variable-control dimmers to control the lights. Dialysis equipment: Usually, some ICU patients need haemodialysis for continuous renal replacement therapy or bedside renal dialysis. For this, at least two beds in each ICU shall have the supply of RO/de-iodinated water supply and drain facilities. Power backup: In the event of a power failure, the ICU shall have its own backup power system that shall begin operating immediately. All the important electrical outlets on the beds shall be connected to a UPS. It is not advised to use a single UPS for all the ICUs; rather, each ICU shall have its own UPS. If all the ICUs are connected to a single UPS, then every ICU shall be affected if the UPS malfunctions.

4.5.1.2 Patient Unit Furniture See Table 4.9. All the required patient furniture shall be provided for all the beds in the ICU. These furniture items include patient bed (multi-positional ICU bed on lockable wheels with bedside safety rails), bedside locker, over-bed table, step stool, IV rod, IV stand, etc. Table 4.9  Patient unit furniture in ICUs

Activity Each patient unit or ICU hall shall have the following patient furniture: Patient bed (shall be ICU bed having multi-positional facilities) Backrest, etc. Bedside locker Crash cart Dressing trolley Examination table Instrument trolley IV rod IV stand Over-bed table Oxygen cylinder trolley Scrub station Step stool Stretcher trolley Wheelchair

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:-

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Apart from this, some other patient furniture items shall be provided in the ICUs but shall be used commonly for all the patients such as examination table, dressing trollies, instrument trollies, scrub stations, crash cart, oxygen cylinder trolley, patient transfer system, stretcher trolley, and wheelchair.

4.5.1.3 Patient Unit Furnishing See Table 4.10. Patient room furnishings: ICU rooms or units shall be finished and decorated acceptably and attractively. It greatly aids in the patient’s quick recovery and has a long-lasting impact on the patient’s perception of the level and quality of care Table 4.10  Patient unit furnishing in ICUs

Activity The following furnishing shall be provided in the patient unit/room A television, if it is a room but not in an ICU hall A wall clock on the foot end of the patient Cabinet for storage of personal belongings Calendar Horizontal surfaces to keep greeting cards, photos Intercom with the facility with outside call Internet connection/ Wi-Fi Mobile/laptop charging points Pictures, paintings, murals, and artwork Secure storage space for patients’ and family’s clothing and limited personal effects Soiled linen collection hamper Tack boards The waste collection bins Whiteboards

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

::::-

:::::-

::::-

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provided. Therefore, the patient room or unit’s furnishings need to be properly planned. In addition to the furniture mentioned above, the room/unit shall be furnished with a soiled linen collection hamper, waste collection in accordance with biomedical waste management standards, a wall clock at the patient’s foot end, a calendar, tack boards to track the patient’s progress, whiteboards to write important treatment instructions, horizontal surfaces to store greeting cards and photos, mobile/laptop charging ports, and internet/Wi-Fi access, a television, an intercom with the ability to make an outside call, a cabinet for storing personal items, and secure storage for the patient’s and family’s clothing and a few other personal items. Room decor: Results are improved when patients are in comfortable and aesthetically pleasing circumstances. Good colour combinations consequently influence mood and stress levels. The stress levels of patients are particularly lowered by the colours like light green and blue. With waterproof washable paints, wall furnishings shall be excellent. For the benefit of patients/families/caregivers, pictures, paintings, murals, and other artwork shall be presented appropriately. The ceiling is usually what the bedridden can view; hence, pictures and sceneries can be painted on the ceiling. One can also choose 3D laminated ceilings.

4.5.1.4 General Furniture See Table 4.11. Usually, in ICU, the attendants, visitors, or outsiders are not allowed except for a very short time; hence, general furniture is not required in the ICU except in the nursing station. At the nursing station, the nursing counter shall be provided. The size of the nursing station shall be sufficient to accommodate about 2–4 nursing staff (depending on the number of beds in the ICU, the size of the nursing counter may vary). Along with the nursing counter, office chairs with wheels shall be provided. The chairs shall have the provision of height adjustment. A few visitor’s chairs shall also be provided at the nursing station for doctors to be seated and to write notes if required. Table 4.11  General furniture in ICUs

Activity Each ICU shall have the following furniture: Almirah/cupboard Filing cabinet Nursing counter Office chairs Visitor chairs, etc.

Status of works Start End In Not date date Complete progress started

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Responsible person

Remarks

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A sufficient number of filing cabinets and cupboards shall be planned at the nursing station to store the stationary, forms, files, or other such items that are essentially required to perform their nursing duties.

4.5.1.5 Equipment in ICU See Table 4.12. Table 4.12  Equipment in ICU

Activity Each ICU shall have the following equipment: Air mattress Ambu bag Ambu mask of different sizes BP apparatus Blood gas analyser with electrolytes Cardiac marker analysers Chest drainage equipment Computers CRRT Defibrillator Dialysis machines DVT pumps ECG machine End-tidal CO2 monitor—capnography ETO sterilization Fibre-optic bronchoscope Glucometer High-flow nasal cannula Intra-aortic balloon pulsation (IABP) Infusion pump Intubating videoscope Invasive BP, SPO2, NIBP, ECG, RR, temp probes with trays Invasive mechanical ventilator

Status of Works Start End In Not date date Complete progress started

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:-

Responsible person Remarks

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Table 4.12 (continued)

Activity Laryngoscope Multi-para vital sign monitor Nebulizer Non-invasive ventilator Oxygen cylinders with masks Pacemaker Portable X-ray machine Pulse oximeter Spinal board Suction machine Syringe pumps Transport ventilator Ultrasound and echo machine View boxes, etc.

Status of Works In Not Start End date date Complete progress started

Responsible person Remarks

::::::::::::::-

Medical equipment pertains to the instruments and techniques that make it easier for healthcare professionals to conduct diagnostic tests to identify diseases and aid in their treatment. True hospital equipment, as opposed to fixtures and fittings, refers to the mechanical, electronic, and medical devices utilized for diagnosis and treatment. Since the medical equipment in the ICUs is the most essential component, hospital planners shall carefully plan and coordinate, as well as evaluate the clinical needs and equipment needs in the ICU. While it is impossible to include every piece of medical equipment needed in an intensive care unit, we have attempted to do so by highlighting a select handful. Table  4.12 lists the equipment that are typically needed in ICUs. This list is not exhaustive, and different ICUs may have different needs. Therefore, after conducting interviews with the ICU departmental heads, the planner shall understand equipment preferences, concerns, and priorities. Ensure that every element of the building complies with the specifications necessary for the equipment to operate efficiently. The planner and designer shall also review the architectural drawing and details to assess the spaces and infrastructure to install the said medical equipment.

4.5.1.6 Tools and Instruments in ICU See Table 4.13.

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Table 4.13  Tools and instruments in ICU

Activity Each ICU shall have the following tools/ instruments: Cheatle forceps Examination light Extension cords and boxes Forceps of all styles and sizes Instrument boxes Needle holders Operating light Proctoscope Refrigerator Scissors of all styles and sizes Splints Sterilizing drums Torches Tray of all styles and sizes Walkers/crutches Weighing machine All other required instruments

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::::::::::::::-

The tools and instruments generally required in the ICUs are as given in the table. This list is not a complete list in itself, and the requirements of various ICUs may differ. However, most of the items given in the table are required in each ICU. Therefore, while planning, the planner needs to assess the requirement of tools and instruments, their preferences, priorities, and concerns after conducting interviews with the ICU departmental heads before procurement.

4.5.1.7 Examination and Treatment Room See Table 4.14. Scrub station: For hand hygiene, two-way scrub stations (sensor controlled and/ or foot operated) shall be provided near the entrance of the treatment/procedure room of the ICU. There shall be paper towel dispensers and soap dispensers close to the scrub station. There shall be hot and cold water available at the scrub station. Air conditioning/heating system: The treatment or procedure room shall be fully air-conditioned, allowing for the adjustment of temperature, humidity, and air exchanges. At all times, adequate and secure air quality shall be maintained. The temperature of the treatment/procedure room shall be between 20 and 22 °C with a relative humidity of 50–60%.

4.5 Services, Facilities, Equipment, Tools, and Instruments

111

Table 4.14  Examination and treatment rooms in ICUs

Activity Has the following facilities/set-up been provided in the treatment/procedure room? Scrub station Air conditioning/heating system Centralized medical gas pipeline supply Communication ports Electrical points Scrub station

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::-

Centralized medical gas pipeline supply: Treatment or procedure rooms shall be equipped with a central piped system of medical gas supply. Compressed air, oxygen, and wall-mounted suction are the gases that are usually provided. However, if the procedures are to be done under anaesthesia, the supply of nitrous oxide shall be required. For the supply of oxygen/air/suction, gas outlets are required, which can be fixed on ceiling-suspended pendant. The ceiling pendant shall have electrical outlets and communication ports. Treatment/procedure room shall have the following outlets: 1. Oxygen—two outlets 2. Compressed air—two outlets 3. Suction—two outlets 4. Nitrous oxide—two outlets (if procedures are to be carried out under anaesthesia) Electrical points: The following electrical points shall be provided for the electric supply in the ICU: 1. The main switchboard, together with one 6  Amp switch or socket, shall be located at the entry wall to control the room’s fan and lighting. 2. For temperature adjustment, the air conditioning control button shall be provided. 3. There shall be electrical outlets on hanging pendant. On the back wall of the pendant, there shall be a minimum of three pairs of 6/4 Amp switches and sockets. These points shall be backed up by a UPS power supply. 4. A pair of two 6/4 Amp switches/sockets shall be installed in the middle of each of the three walls of the treatment/procedure room, excluding the wall on which a door is installed. One pair of these two shall be backed up by the UPS power supply.

4  Intensive Care Units (ICUs)

112

Table 4.15  Furniture in examination and treatment rooms in ICUs

Activity Provide the following patient furniture in the treatment/ procedure room: Crash cart Dressing trollies Instrument trollies IV rod IV stand OT table Oxygen cylinder trolley Patient furniture Step stool Stretcher trolley

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::::::-

Communication ports: The treatment/procedure room shall have communication points like RJ 11 for intercom and extension line and RJ 45 point for computer networking.

4.5.1.8 Furniture in Treatment/Procedure Room See Table 4.15. All the required patient furniture shall be provided in the treatment/procedure rooms. The main patient furniture items that are commonly used are examination/ OT table, dressing trollies, instrument trollies, scrub stations, crash cart, oxygen cylinder trolley, patient transfer systems, stretcher trolley, wheelchair, etc. 4.5.1.9 Equipment in Examination and Treatment Room See Table 4.16. For any treatment/procedure room, the medical equipment is the most essential component; hospital planners shall carefully plan and coordinate as well as evaluate the clinical needs and equipment needs in the treatment/procedure rooms. While it is impossible to include every piece of medical equipment needed in the treatment/procedure rooms, we have attempted to do so by highlighting a select handful. Table 4.16 lists the equipment that are typically needed in treatment/procedure rooms. This list is not exhaustive, and different treatment/procedure rooms may have different needs. Therefore, after conducting interviews with the treatment/procedure rooms’ departmental heads, the planner shall understand equipment preferences, concerns, and priorities. Ensure that every element of the building complies with the specifications necessary for the equipment to operate efficiently. The planner and designer shall also review the architectural drawing and details to assess the spaces and infrastructure to install the said medical equipment.

4.5 Services, Facilities, Equipment, Tools, and Instruments

113

Table 4.16  Equipment in the examination and treatment rooms in ICUs

Activity Provide the following equipment in treatment/procedure rooms: Defibrillator Infusion pump Laryngoscope Multi-para vital sign monitor Operating light single dome Oxygen cylinders with masks Scrub station Suction machine View boxes, etc. Bed head panel/ hanging pendants for MGPS Defibrillator

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::::::-

:-

4.5.2 Clinical Support Zone 4.5.2.1 Radiology See Table 4.17. ICU shall be equipped with a portable X-ray machine. Along with the X-ray machine, the computerized radiography (CR) system and the thermal printer shall be provided. The accessories like X-ray cassettes and protective devices like an apron and gloves shall be provided. Because the printing and delivery of the film take time, the answer is to use the method of online picture transmission. The images from the radiology department can be simply sent to the computer screen installed in the ICU by using PACS (software). Similarly, try to provide the ultrasound cum echocardiography machine in the ICU complex. In the ultrasound room, apart from the ultrasound cum echocardiography machine, the ultrasound table, doctor’s chair, and step stool shall also be provided. For quick reporting of ultrasound or echocardiogram, the computer shall be provided in the ultrasound room with a printer attached to it. 4.5.2.2 Clinical Laboratory See Table 4.18.

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Table 4.17  Radiology in ICU

Activity Computer with printer CR system with a camera (printer), if required Doctors’ chair for ultrasound Lead aprons and other protective devices PACS Portable X-ray machine Step stool Ultrasound cum echocardiography machine Ultrasound table X-ray cassettes

Status of works Start End In Not Date date Complete progress started

Responsible person Remarks

::-

::::::-

::-

Table 4.18  Clinical laboratory in ICU

Activity A table in sample collection room Almirah/cupboard Phlebotomy chair SS table for arterial blood gas analysis (ABG) machine

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::-

As the central laboratory is at some other place in the hospital, the sample from the ICUs needs to be collected from the ICU itself and sent to the central laboratory for testing. As far as sampling from ICU is concerned, as most of the patients are immobile, the sample needs to be collected from the bedside of the patient. However, to process the sample and make them ready for sending to the central laboratory, a sample collection room shall be provided in the ICU. The sample collection shall be provided with an office table, almirah/cupboards, and phlebotomy chair. For other details about the sample collection room, please refer to Chapter number 9 titled ‘Clinical Laboratories’ of this book.

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For installation of the ABG machine in the ICU complex, an SS table shall be provided, and this table shall be well balanced and vibration free; otherwise, the machine may be dis-levelled and may produce artefacts and give wrong results.

4.5.2.3 Medication Room in ICU See Table 4.19. The room shall have the capacity to store medications in cabinets, drawers, and racks provided in the room. Also, the required office tables and chairs shall be provided in the room. Additionally, a refrigerator shall be provided in the room. These days, medicines are being distributed using automated drug dispensing machines and the same can be installed if required. The room shall have the necessary electrical outlets, as well as points for an intercom and an internet connection. The room shall be air-conditioned, and there shall be a control button in the room that allows for temperature adjustment. 4.5.2.4 Clean Utility See Table 4.20. The clean utility room shall be provided with drawers, closed cabinets, and racks for storing clean items like linen and ward consumables.

Table 4.19  Medication room in ICU

Activity Almirah/cupboard Automated dispensing machine, if required Cabinets Counter Drawers Office chairs Racks Refrigerator

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::-

::::::-

Table 4.20  Clean utility in ICUs

Activity Almirah/ cupboard Cabinets Drawers Racks

Start date ::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

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4.5.2.5 Dirty Utility/Sluice Room See Table 4.21. The dirty utility room shall have a linen collection hamper which shall be properly covered or containers to collect the dirty linen shall be provided.

4.5.3 Unit Support Zone 4.5.3.1 Staff Change Room See Table 4.22. Staff lockers shall be provided in the changing area so that the staff can store their personal belongings. A typical locker size shall be 610 mm × 305 mm. The locker almirah can be created by combining these individual lockers. Each locker shall be individually lockable and secured. Each employee on duty shall be allotted one such locker. The room shall be furnished with a single chair and cabinet. There shall be a place to hang garments in the almirah. The necessary electrical outlets and intercom points shall be provided in the room. The room shall have air conditioning, and there shall be a control button in the room that allows for temperature modification. 4.5.3.2 All Types of Doctors’ Duty Room See Table 4.23. Table 4.21  Dirty utility/sluice room in ICUs

Activity Linen collection hampers Waste bins as per norms of biomedical waste management

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

::-

Table 4.22  Staff change room in ICUs

Activity Almirah for hanging clothes One chair and cupboards Staff lockers to keep their personal belongings

Status of works Start End In Not date date Complete progress started :::-

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4.5 Services, Facilities, Equipment, Tools, and Instruments Table 4.23  Doctors duty room in ICUs Status of works Start End In Not date date Complete progress started

Activity Computer table, if required One office table, chair, bed, and cupboard

Responsible person

Remarks

::-

Table 4.24  Nurse’s duty room in ICUs

Activity One bed and cupboard in the room

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:-

The room shall be furnished with an office table, office chair, bed with mattress, cabinet, and computer desk (if required). The room shall have the necessary electrical outlets, as well as points for an intercom and an internet connection. The room shall be air conditioned, and there shall be a control button in the room that allows for temperature adjustment.

4.5.3.3 Nurse’s Duty Room See Table 4.24. The nurses’ duty room shall have a bed and almirah. The necessary electrical points and intercom points shall be installed in the room. The room shall be air conditioned, and there shall be a control button in the room that allows for temperature adjustment. 4.5.3.4 Staff Lounge See Table 4.25. The lounge shall offer a quiet, cosy, roomy, and peaceful environment. The lounge ought to include a cosy sitting arrangement, a dining table and chairs, food storage appliances such as a refrigerator, microwave, and coffee maker or dispenser. A television and a computer with an internet connection are optional extras. A notice board shall be placed in the lounge because it is the ideal location to post any information important to the staff. The room shall have a bed in case the staff requires to lie down for a short time. The necessary electrical outlets and intercom points shall be provided in the room. The room shall be air conditioned, and there shall be a control button in the room that allows for temperature adjustment.

4  Intensive Care Units (ICUs)

118 Table 4.25  Staff lounge in ICUs

Status of works Start End In Not date date Complete progress started

Activity Coffee/tea maker and dispenser Computer with internet access Dining chairs Dining table Food storage facilities Microwave oven Notice board One bed and cupboard in the room Refrigerator Seating arrangements like sofa sets or recliner chairs Television

Responsible person

Remarks

::::::::::-

:-

Table 4.26  Ward pantry in ICUs

Activity Food storage facilities Microwave oven Refrigerator Trolley for collecting soiled utensils Waste bin

Start date

Status of works End In Not date Complete progress started

Responsible person

Remarks

::::-

:-

4.5.3.5 Ward Pantry See Table 4.26. The pantry shall have food storage facilities. The pantry shall have a working top to store the food. Additionally, the refrigerator and a microwave oven may also be helpful. For disposal of the waste, the trash can(s) shall be provided. For the collection of the dirty utensil, a cart shall be kept in the ward pantry. 4.5.3.6 Administrative Offices See Table 4.27. The room shall be provided with the office table, office chairs, and visitors’ chairs. An adequate arrangement shall be made for cabinets, drawers, and racks for smooth working.

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4.5 Services, Facilities, Equipment, Tools, and Instruments Table 4.27  Administrative offices in ICUs

Activity CCTV surveillance Office chairs Office table Sofa sets Visitors’ chairs

Start date

End date

Status of works In Not Complete progress started

Responsible person Remarks

:::::-

Table 4.28  Multipurpose conference room in ICUs

Activity Audiovisual equipment CCTV surveillance Computer with internet Conference table Intercom Office chairs PACS Projection screen Projector

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::::::-

The room shall also have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning.

4.5.3.7 Multipurpose Conference Room See Table 4.28. The room shall be provided with a conference table and conference chairs. The number of chairs to be provided shall be decided based on the size of the room and the persons likely to attend the meeting at any moment. High-speed internet access and audiovisual equipment shall be provided in this conference room. Projectors, screens, and other interactive display equipment shall be available. Connected to the ICU, the following shall be available: telephone or other intercommunication systems, access to hospital/health information systems, picture archiving and communication system (PACS), monitors, emergency cardiac arrest alarms, etc.

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4.5.4 Family Support Zone 4.5.4.1 Family Lounge See Table 4.29. A lounge shall have a comfortable waiting area, sofa sets or recliners for relaxation, centre tables, space for discussion in privacy, a telephone, and an intercom system. Additionally, the lounge shall contain the essentials like a small snack bar, television, newspaper and magazine stand, and a small kid-sized play area. Also, there shall be vending machines for coffee and tea. Access for visitors shall be managed from a separate reception area situated inside the lounge. The availability of drinking water shall be guaranteed. There shall be mobile charging stations available. To prevent personal possessions from being scattered throughout the lounge, shelves, closets, and lockable lockers shall be provided. The whole of the family lounge shall be under CCTV surveillance. The lounge shall have the necessary electrical outlets, as well as provision of internet connection or Wi-Fi. The lounge shall be air conditioned, and there shall be a control button in the lounge that allows for temperature adjustment. 4.5.4.2 Counselling Room See Table 4.30. Table 4.29  Family lounge in ICUs

Activity CCTV surveillance Centre tables Chairs/recliners Children play area Counter for receiving/giving laundry of attendant Drinking water facility Lockable shelves/ closets or lockers Mobile charging points Newspaper and magazine stand Small snacks bar Sofa sets Tea/coffee vending machine Television

Status of works Start End In Not date date Complete progress started :::::-

::::::::-

Responsible person

Remarks

121

4.5 Services, Facilities, Equipment, Tools, and Instruments

The counselling rooms shall have the provision for an office table, office chairs, visitor’s chairs, and a sofa set. There may occasionally be heated exchanges between the doctors and the patient’s visitors. Consequently, a few security guards shall be stationed outside the room. Additionally, this space shall be covered by internal CCTV with audio-video recording. The room shall have the necessary electrical outlets, as well as points for an intercom and an internet connection. The room shall be air conditioned, and there shall be a control button in the room that allows for temperature adjustment.

4.5.4.3 Family Cafeteria See Table 4.31. At mealtimes, some hospitals offer meals to families and visitors. Hence, a separate area or dining hall shall be made available, where the meals can be served to these family members and visitors. The cafeteria shall have a sufficient number of dining tables and dining chairs. Even some standing tables can also be provided. Table 4.30  Counselling room in ICUs

Activity CCTV surveillance Office chairs Office table Sofa sets Visitors’ chairs

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

Table 4.31  Family cafeteria near ICUs

Activity Dining chairs Dining table Drinking water facility Proper ventilation to remove the smell of food from the cafeteria Small snacks bar Snack vending machines Tea/coffee vending machine Waste bins

Status of works Start End In Not date date Complete progress started ::::-

::::-

Responsible person

Remarks

4  Intensive Care Units (ICUs)

122

Additionally, vending machines can be useful, especially late at night when hospital coffee shops or food services might not be available. The cafeteria shall have a proper wash basin for hand washing and trash bins for the disposal of soiled and dirty utensils. The set-up shall have a proper exhaust system to prevent the food’s odour from spreading throughout the hospital building.

4.5.4.4 Family Sleep Rooms/Guest House See Table 4.32. These rooms in the guest houses may have facilities like beds, side tables, chairs, centre tables, toilet, television, refrigerator, drinking water, mess for meals, laundry washing, and bedding.

4.5.5 Neonatal ICU As compared to any other ICU, the neonatal intensive care unit (NICU) has a different set-up altogether. As this ICU is exclusively used for newborn children, there are no beds in this ICU. Instead of the bed, bassinets are provided. Nowadays, bassinets have been replaced by the servo-controlled radiant heat warmers.

4.5.5.1 Location of NICU Preferably, NICU shall be located near the department where births occur like the Department of Obs. and Gynae, so that after the delivery, the baby can be shifted to NICU without much exposure to the infected atmosphere. 4.5.5.2 Infrastructure of NICU See Table 4.33. Table 4.32  Family sleep rooms/guest house near ICUs

Activity Bedding Beds Centre table Chairs Laundry wash facility Drinking water facility Lockable shelves/ closets or lockers Mess for meals Refrigerator Side tables Television

Start date :::::::::::-

Status of works End In Not date Complete progress started

Responsible person

Remarks

123

4.5 Services, Facilities, Equipment, Tools, and Instruments Table 4.33  Infrastructure of neonatal ICU

Activity NICU shall have the following rooms/areas: Clean NICU for in-house-delivered babies Unclean NICU for outside-delivered babies Ventilation room Step-down NICU Change room Clean supply room Dirty linen/sluice room Doctors’ duty room Formula room Medication room Mothers’ feeding room Nappy wash area Nurse station Nurses’ duty room Scrub station Staff toilet Store

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

:-

:::::::::::::::-

The set-up of the NICU shall have spaces/rooms for the following: Baby treatment spaces: Babies that are born in the same hospital and are thought to be free of any kind of infection are placed in the clean baby NICU. An infant born outside the same hospital, who arrives from outside, who is supposed to be infected, or for whom the situation regarding infection is unknown is placed in the infected baby NICU. The baby who needs to be closely monitored and put on mechanical ventilation is placed in the ventilation room, where the babies are offered invasive ventilation facilities. Babies that are stable or recovering from ICUs but still need to be kept under observation are kept in step-down NICUs. Similar to any other ICU, each of these spaces has been carefully planned and designed. Mothers’ feeding room: A separate space where the mother can breastfeed the child shall be provided in the NICU. Please ensure the privacy of this room, and do not let anyone else enter it while it is in use. This room shall have easy chairs

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(preferably without a handle), a wash basin for hand washing, and a crib. The room shall also have a baby nappy change platform. Nappy wash area: This is used to wash the babies’ soiled napkins. Due to the widespread usage of disposable, absorbent baby napkins, this is no longer used frequently. If provided, the room shall contain a sink for washing nappies, as well as a place and wash line for drying them. Formula room: This room is provided to prepare the milk and diet of the babies. The room shall have a hand washing facility and a countertop for preparing the diet. The room shall have a cooking gas connection or otherwise an electric kettle for preparing the diet. Also, the sink shall be provided to wash the soiled utensils. Nurse station, scrub station, change room, medication room, clean supply room, store, dirty linen/sluice room, nurse’s duty room, doctors’ duty room, and staff toilet shall be designed and planned exactly similar to other ICUs. The area shall also have the same facilities and set-up as in the case of any other ICU.

4.5.5.3 Equipment in NICU See Table 4.34. While it is impossible to identify every piece of medical equipment needed in the NICU, we have tried to do so by outlining a select handful. However, Table 4.34 lists the equipment that are commonly needed in the NICU. The requirements of NICU may differ from those on this list, which is not an exhaustive list in and of itself. Therefore, after conducting interviews with paediatricians, the planner shall understand equipment preferences, concerns, and priorities. To make sure that all of the building’s elements meet the specifications needed for the equipment to operate effectively, the designer shall also review the architectural drawing and its features. Similarly, all the support services like radiology, laboratory, MGPS, HVAC, scrubbing, electrical outlets, and communication ports shall be the same as in the case of any other ICU.

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Further Reading Table 4.34  Equipment in neonatal ICU

Activity Following equipment/ instruments/tools shall be provided in NICU: Servo-controlled radiant heat warmer with the baby trolley Phototherapy unit on the stand—upper surface Phototherapy unit on the stand—under surface Neonatal mechanical ventilator Humidifiers Transport incubator Oxygen hood Vein finder Bilirubin meter Electronic weighing machine basket type Skin sensor thermometer Other small tools and instruments Scrub station MGPS supply of oxygen, air, suction and nitrous oxide with each radiant warmer Bed head panel/hanging pendants for MGPS Required electrical points Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:-

:::::::::::::-

:::-

Further Reading Bartley J, Streifel AJ. Design of the environment of care for the safety of patients and personnel: does form follow function or vice versa in the intensive care unit? Crit Care Med. 2010;38:S388. Bazuin D, Cardon K. Creating healing intensive care unit environments: physical and psychological considerations in designing critical care areas. Crit Care Nurs Q. 2011;34:259–67. Chen H-L, Chen C-H, Wu C-C, Huang H-J, Wang T-M, Hsu C-C. The influence of neonatal intensive care unit design on sound level. Pediatr Neonatol. 2009;50(6):270–4. Ferri M, Zygun DA, Harrison A, Stelfox HT. Evidence-based design in an intensive care unit: end-­ user perceptions. BMC Anesthesiol. 2015;15(1):57.

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Garg A, Dewan A.  Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 18, Intensive care Units. p. 155–79. HealthManagement.org. Radiology Management, ICU Management, Healthcare IT, Cardiology Management, and Executive Management. Health Management. [cited 2021 Jun 18]. Available from: https://healthmanagement.org/c/icu/issuearticle/ future-­icu-­design-­return-­to-­high-­visibility. Katirci Y, Şafak T, Aydemir S. A review of design features of intensive care unit in general terms. Eur J Crit Care. 2018;1(2):51–8. Kesecioglu J.  Improving the patient’s environment: the ideal intensive care unit. Réanimation. 2015;24(2):341–3. Narayan S, Setlur R, Jahan N, Chatterjee K, Kanitkar M. Planning a modular intensive care unit for patients of the COVID-19 pandemic. J Mar Med Soc. 2020;22(Suppl. 1):S51–6. [cited 2021 Jun 18]. Available from: https://www.marinemedicalsociety.in/downloadpdf.asp?issn=0975-­ 3605;year=2020;volume=22;issue=3;spage=51;epage=56;aulast=Narayan;type=2. Nursing Center. Technology and the future of intensive care unit design. [cited 2021 Jun 18]. Available from: http://www.nursingcenter.com/ journalarticle?Article_ID=1236265&Journal_ID=54003&Issue_ID=1236032. Rashid M. A decade of adult intensive care unit design: a study of the physical design features of the best-practice examples. Crit Care Nurs Q. 2006;29(4):282–311. Rashid M.  Environmental design for patient families in intensive care units. J Healthc Eng. 2010;1(3):367–98. Robinson J. The design and function of an intensive care unit. Br J Anaesth. 1966;38(2):132–42. Rungta DN, Govil DD, Nainan DS, Munjal DM. ICU planning and designing in India—Guidelines. ISCCM Guidelines Committee; 2010. p. 1–26. Rungta N, Zirpe KG, Dixit SB, Mehta Y, Chaudhry D, Govil D, et al. Indian Society of Critical Care Medicine Experts Committee Consensus Statement on ICU Planning and Designing, 2020. Indian J Crit Care Med Peer-Rev Off Publ Indian Soc Crit Care Med. 2020;24(Suppl. 1):S43–60. SALUS  – Article—Critical care design of tomorrow: how technology fits in [Internet]. [cited 2021 Jun 18]. Available from: https://www.salus.global/journal/view/article/ critical-­care-­design-­of-­tomorrow-­how-­technology-­fits-­in-­1 Sessler CN. Evolution of ICU Design: smarter is better. Chest. 2014;145(2):205–6. Thompson DR, Hamilton DK, Cadenhead CD, Swoboda SM, Schwindel SM, Anderson DC, et al. Guidelines for intensive care unit design*. Crit Care Med. 2012;40(5):1586–600. Tripathy S, Acharya SP, Sahoo AK, Mitra JK, Goel K, Ahmad SR, et al. Intensive care unit (ICU) diaries and the experiences of patients’ families: a grounded theory approach in a lower middle-­ income country (LMIC). J Patient-Rep Outcomes. 2020;4(1):63. Valentin A, Ferdinande P, ESICM Working Group on Quality Improvement. Recommendations on basic requirements for intensive care units: structural and organizational aspects. Intensive Care Med. 2011;37(10):1575. White RD, Smith JA, Shepley MM. Recommended standards for newborn ICU design, 8th edition. J Perinatol. 2013;33(1):S2–16.

5

Operation Theatre Suite (OT)

An operating room (OT) is a room used for performing operations, surgeries, and other invasive interventions. All employees entering the OT complex are required to wear protective apparel such as shoe covers, masks, caps, eye shields, and other coverings to stop the spread of germs and microorganisms, creating a sterile atmosphere. The area is well lit, and the humidity and temperature are kept within acceptable ranges. The phrase ‘operating theatre suite/complex’ cannot be fully defined by the operating theatre alone. It represents a bundle of distinct rooms located around the entire complex. It must be verified that before the beginning of the surgeries in the operating room, all construction work is finished and services are operational. Before the operating complex can be used to operate, a few things need to be addressed like the following: the necessary infrastructure has been provided; the necessary services are available; the proper furniture and fixtures are in place; the necessary electrical points and communication ports have been installed; the required public utilities have been installed; the essential signage, wayfinding, and display mechanisms are in place; the relevant instrument/equipment/gadgets are available; the necessary facilities are available; and the appropriate patient/staff/visitor safety mechanisms are available. This set of checklists shall help the planner and designer to remember all such issues relating to the OT complex and guide him/her to complete, test, and commission all works/activities well in time. This will help him/her to ensure himself/herself that all the works/activities are carried out, complete, and working before the surgeries start in the OTs.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_5

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5  Operation Theatre Suite (OT)

5.1 Location of Operating Theatre (OT) Complex Some concerns to be considered while choosing the location of the OT complex include the following: The OT complex shall be in a restricted area where free mobility is prohibited. Additionally, the OT complex must be located at the same place in a cluster, ideally on the same floor. Avoid scattering it into different areas. Preferably, the OT complex shall be somewhere in the middle of the building and shall be sandwiched between two floors. The OT complex is frequently argued to be located on the hospital’s top floor. In case the OT complex is located on the top floors of the hospital building, because of the thermal losses brought on by the high summer temperatures, the air conditioning system must be significantly more powerful, which raises the cost of operation. Additionally, being on the top level means that the OT complex will be isolated from other support services like pathology, radiology, and the blood bank, which is another disadvantage. Dual corridors shall be present in OT complex. One of the two shall be utilized as an entrance to the OT complex, and the other shall be used as an exit. Near the OT complex, elevators and lifts shall be available. Similarly, the OT complex shall be next to the intensive care units (ICUs). As much as possible, diagnostic services like radiology shall be located close to the OT complex. The OT complex must have separate entry and exit doors connected to corridors, which is a significant challenge. The OT complex must only go in one direction; in other words, moving backwards is never permitted. Depending on the design, the movement can be either clockwise or anticlockwise.

5.2 Zones in OT Complex Normally, the OT complex is divided into four zones: • Unsterile zone: This area is often non-sterile, and movement is permitted here without change. • Protective zone: This zone is more sterile, and movement is restricted, but not always. Only by changing shoes can the area be accessed. • Clean zone: This more sterile area is used mostly for the change room’s exit, the supply of goods and services, and the spaces for wards like the preoperative ward and post-operative ward. • Sterile zone: This area is designated for the actual surgeries and interventions and shall be highly sterile and aseptic. No one should be permitted inside unless they are directly involved in performing or assisting in the surgery.

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5.3 Infrastructure 5.3.1 OT Space Requirement See Table 5.1. Coming to the infrastructural requirement of the OT complex, the rooms are designed and provided based on the zoning of the complex. We have tried to give details of such rooms zone-wise.

Table 5.1  OT space requirement

Activity Has the spaces for the following been provided in OT complex? Unsterile zone Administrative area In-charge/manager of operation theatre Head of the anaesthesia department Surgeons’ room for office work Frozen section biopsy laboratory Entry door for changing room Trolley bay Shoe changing area Linen pre-wash room Instrument washroom Waiting area for attendants Public utility for attendants Protective zone Staff changing technicians with toilet—males Staff changing technicians with toilet—females Staff changing class IV with toilet—males

Status of works In Not Responsible Start End Remarks date date Complete progress started person

::::::::::::-

:-

:-

:(continued)

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Table 5.1 (continued)

Activity Staff changing class IV with toilet—females Students changing with toilet—males Students changing with toilet—females Doctors’ change room with toilet—male Doctors’ change room with toilet—female Lockers Entry gate of the preoperative ward Unsterile store for equipment storage Store for medicines, consumables, and disposables Pantry Clean zone Preoperative room Exit gate of the preoperative ward Surgeons’ restroom Restroom for staff—males Restroom for staff—females Exit doors of all changing rooms Dirty utility Pre-anaesthetic checkup room (PAC) Preparation room Post-operative recovery ward Public utility for patients Sterile zone Main operating theatres Septic operation theatre Endoscopy room Scrub station Instrument trolley lay-up Clean supply room Sterilization room

Status of works In Not Responsible Start End Remarks date date Complete progress started person :::::::::-

::::::::::::-

:::::::-

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5.3.1.1 Unsterile Zone This section of the OT complex is unsterile and is open to everyone who has to provide goods or services or who needs to communicate with OT personnel. The unsterile zone shall be located at the OT complex’s entry corridor and shall be situated near the entrance gate. This area shall have the following rooms: Administrative area: This area is for the administrative and support workers who are responsible for the management of the OT complex. The personnel may be from the department of nursing, purchasing, stores, sterilization, housekeeping, etc. This space must be roughly 4572 mm × 6096 mm in size, although it may be smaller or larger depending on the need and the likelihood that people will sit in it. The toilet shall preferably be attached to the administrative room. If required, room for the personal assistant or the secretary shall also be provided. A separate store may be attached to this room if necessary. If required and long working hours are anticipated, this room can also be provided with a small restroom/lounge. In-charge or manager of operation theatre: This chamber, which is for the OT complex in-charge, shall also be situated at the entrance to the OT complex. As he/ she is responsible to oversee all of the complex’s non-medical functions, he/she will inevitably have a large number of guests and employees. This space shall be roughly 4572 mm × 4267 mm in size. The toilet shall preferably be attached to the room. If required, room for the personal assistant or the secretary shall also be provided. A separate store may be attached to this room if necessary. If required and long working hours are anticipated, this room can also be provided with a small restroom/lounge. Room for head of anaesthesia: The anaesthetist, who is the designated medical professional, is generally the in-charge of the OT complex. However, his/her area of responsibility is only medical administration. This room shall be adjoining the manager’s chamber. The size of this room shall be roughly 4572 mm × 4267 mm. The toilet shall preferably be attached to the administrative room. If required, room for the personal assistant or the secretary shall also be provided. A separate store may be attached to this room if necessary. If required and long working hours are anticipated, this room can also be provided with a small restroom/lounge. Surgeons’ room for office work: The surgeons and their helpers use this room to complete the administrative tasks associated with the surgeries they undertake, such as writing surgical notes. For daily entry, an OT register is typically kept here. This space must be close to the anaesthetist’s room. This space will be roughly 4572 mm × 4267 mm in size. The toilet shall preferably be attached to the administrative room. If required, room for the personal assistant or the secretary shall also be provided. A separate store may be attached to this room if necessary. If required and long working hours are anticipated, this room can also be provided with a small restroom/lounge. Frozen section biopsy laboratory: Sometimes, when executing the procedure, the surgeon may not be certain about the disease and may seek a second opinion on the diagnosis. Hence, the surgeon prefers to get a quick biopsy done by using the frozen section. Due to the frozen section, the surgeon can make the final decision after receiving the verified report by frozen section biopsy. The sample is not

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forwarded to the central lab since an instantaneous report is necessary in such cases, saving time. Entry door for changing room: For doctors, nurses, technicians, and class IV workers who are needed to work in the complex’s sterile zone, various types of change rooms shall be provided in the OT complex. Ideally, the change room ought to have two doors—one for entrance and the other for exit. The idea behind this is that the employees do not enter the unsterile zone after the change. Consequently, a change room’s entrance door is provided in this area. Trolley bay: The wheelchairs and stretcher trollies assigned to the OT complex shall have a designated space in this zone. After surgery, these stretcher trollies are typically used to transport the patient from the OT complex to the wards. Wheelchairs and stretcher trollies are typically not needed at the OT complex entrance. As a result, the trolley bay shall be situated in the non-sterile area at the exit of the OT complex. Shoe change area: This area must have room for shoe changing. The personnel must take off their outside shoes before changing into the sleepers and shoes that are reserved for use in the OT complex. Linen pre-wash room: Before sending the dirty linen from the OT to the laundry, the pre-wash room is used to waah the linen. As was previously stated, used linen must escape the OT complex through the exit gate or the corridor that runs behind the OT complex. This room must be located close to the exit gate of the OT complex. Instrument wash room: Before sending the soiled surgical instruments, used in the OT, to the CSSD for sterilization, this room is utilized to pre-wash them. The used instruments must be removed through the exit gate because back movement inside the OT complex is not permitted. This room must therefore be situated close to the OT complex’s exit gate. Waiting area for attendants: Family members and friends, of the patient who is undergoing surgery or other OT intervention, are seated in this area. The highly curious family members always want to sit close to the OT complex and do not prefer to be located in a remote location. As a result, a waiting room must be set up outside the OT complex’s main entrance. Public utility for attendants: In addition to the family members’ waiting space, toilets should be available. If at all possible, separate toilets for men and women must be provided. Additionally, a drinking water facility must be provided.

5.3.1.2 Protective Zone Movement is sometimes restricted in this zone, and it is slightly more sterile than an unsterile zone. Only by taking off shoes or wearing shoe covers can this area be assessed. For visiting this location, no change of clothes is necessary. This section shall be isolated from the unsterile zone by a door that shall be secured and situated immediately after the unsterile zone. Details of the rooms in this area are listed below: Changing rooms: The OT complex has changing rooms so that the doctors and personnel can change into their OT clothes after removing their outer clothing. Preferably, the toilet shall be attached to the change rooms. These toilets shall be

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separate for men and women. Regarding the number of change rooms, it shall depend on the number of employees needed in the OT complex. For each group of staff workers, different changing rooms shall be provided. Men and women shall have separate changing rooms. The size of each change room shall be approximately 4267 mm × 4572 mm. In the OT complex, typically, the following change rooms shall be provided: • • • • • • • • • •

Doctors’ change room—females Doctors’ change room—males Nurses’ change room—females Nurses’ change room—males Technicians’ change room—females Technicians’ change room—males Class IV staff change room—females Class IV staff change room—males Students’ change room—females Students’ change room—males

Entry gate of the preoperative ward: It is suggested that the preoperative ward shall have two gates to maintain the sterility of the OT complex. One gate shall be for the patient’s entry, and the other gate shall be for their exit. The entry gate shall be provided in this protective zone. Unsterile store for equipment storage: OT is a very sensitive area; hence, extra tools and equipment need to be stored here. Although they are not frequently utilized, these are kept on standby to serve as a backup for essential tools and equipment. The equipment store shall be at least 4572 mm × 6096 mm in size. Store for medicines, consumables, and disposables: Depending on the patient’s condition, a surgeon may raise the need for medications, disposables, and consumables during surgery. The surgeon’s request must be met right away because he/she will not be in a waiting position. Generally, all necessary medications, consumables, and disposables are kept on hand at the OT complex to prevent any untoward incidents. Such items shall be stored in the OT complex’s protective zone in a separate room. The room shall be at least 4572 mm × 6096 mm in size. Pantry: To enable the employees to enjoy tea or coffee whenever there is a break from surgery, a pantry shall be provided in the OT complex. The needs of the staff lounge or the doctor’s lounge can also be met by this pantry. In addition to tea and coffee, it may offer precooked light snacks and cookies. The pantry shall measure around 3658 mm × 3658 mm in size.

5.3.1.3 Clean Zone Because it is a cleaner zone than the protected zone, entry into this zone shall be strictly regulated. Once outside clothing has been changed, entry to this zone shall be permitted. This area shall be located immediately after the protective zone and shall be separated from it by a guarded door. The following are details about the rooms in this area:

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Preoperative ward: The patient is detained in the preoperative ward to keep under observation before being sent to the operating room. This ward shall accommodate beds, depending on the requirements. No need to provide a greater number of beds in this ward, as the patients stay in this ward for a very short period. Typically, one to two beds per operating room shall be provided in this ward. As far as the size of the ward is concerned, it will vary depending on the number of beds to be placed in the ward. Typically, 80–100 square feet of area is enough for each bed. A toilet attached to the preoperative ward shall be provided, and preferably, a changing room shall be provided in the ward for patients to change into the OT dress. Surgeons’ restroom: The ‘surgeons’ lounge’ is another name for this area. Surgery in a functioning hospital is typically scheduled by the same or different surgeons in a series that can range from 2 to 5 in a single OT. While waiting for the OT to prepare for the next surgery, the surgeon can relax in the surgeon lounge and work on the patient file, operative notes, and post-surgical prescription. The lounge shall have an attached toilet and a supply of tea/coffee that can be served from the pantry. The lounge shall be approximately 6096 mm × 4572 mm in size. Restroom for staff—males and females: The staff must have access to a lounge just like the surgeons do. But there shall be separate lounges for men and women. Additionally, these restrooms shall have attached toilets. Exit doors of all change rooms: All change rooms’ exits must be in the clean zone. From this point forward, the staff and surgeon either move ahead to the sterile zone or remain in this zone only. The exit doors must be 914 mm wide and swing type to close automatically. Dirty utility: A dirty utility room at the exit end of the OT complex stores items such as used and soiled linen, instruments, disposable item covers, soiled drapes, cotton, and gauze. The room shall be approximately 3048 mm × 3048 mm in size. Pre-anaesthetic check-up room (PAC): A patient is given a PAC by the anaesthetist to make sure that they are fit enough to administer anaesthesia. This space should be roughly 3658 mm × 3658 mm in size. Preparation room: Although the wards are instructed to prepare a patient before sending him/her to the operating room, it is occasionally found that the patient has not been adequately prepared for surgery. To fulfil the requirements before transferring the patient to the OT, a preparation room is provided in this area. This space should be roughly 3658 mm × 3658 mm in size. Post-operative recovery ward: Once the surgery is completed, the patient is transferred to the post-operative recovery ward. In this ward, the patient receives specialized care until the effects of anaesthesia go off. The post-operative recovery ward shall be located at the OT complex’s exit. After the patient has recovered completely, he/she is transferred to the appropriate ward or ICU. The number of beds in the post-operative recovery ward shall be proportionate to the size of the operating room. There shall be at least two recovery beds for each OT.

5.3.1.4 Sterile Zone The sterile zone is the OT complex’s most sensitive area. This area has to be sterile and aseptic. A swing-type door that must be at least 6 feet wide must separate it

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from the clean zone. These doors must be sealed completely to prevent any unwanted organisms from getting inside the sterile area. Similar doors must also be available on the exit side of this zone. Only authorized individuals, who have properly changed and are wearing caps and masks, shall be permitted in this zone, and movement shall be strictly prohibited. The details about the rooms in this area are as follows: Operating theatres/rooms (OR): The real surgeries and interventions take place in this room. This room must be the cleanest and most sterile in the entire hospital. No one shall be allowed to enter the OR without wearing protective clothes, including caps, OR shoes, masks, eye shields, and other coverings to stop the spread of germs. Further details about the types of operating rooms are discussed below in this chapter. Septic operation theatre: The septic OR is a place to operate on infected patients. This OR has the same specifications, design, and construction, as any other operating room. Endoscopy suite: It is used for colonoscopies, upper gastrointestinal endoscopies, and associated procedures like ERCP. A complete endoscopy suite must have an endoscopy room where the endoscopic procedures are carried out. The endoscopic suite must also include the endoscope washroom, a store, changing rooms, a recovery room for patients to recover post-endoscopy, as well as a consultation area for patients’ families. Scrub station: Before performing surgery or any other intervention in the operating room, the surgeons and assisting staff shall scrub and wash up. Hence, the scrub station is provided adjacent to the operating room. The scrub station could be in an enclosed or open space. If it is in a closed room, the doors shall be able to swing in either direction just with a tap of the foot and shall have a see-through glass in the middle. Instrument trolley lay-up: This room is used to set up the trolley for surgeries depending on the type of surgery. The room makes it easier to prepare the trolley because the requirements for the linen and instruments vary depending on the type of surgery. The material is transported into this room from the clean supply room, which is then placed on a trolley, and trolley in turn is taken to the appropriate OR. This room shall be around 3658 mm × 3658 mm feet in size and shall have just one entry and a swinging door that can be opened on both sides. Clean supply room: This space is also known as the clean store. The instruments and linen received from CSSD after proper sterilization are primarily kept in this room for storage. Additionally, sterile supplies and disposables typically used in operating rooms are kept here. This room must be close to the operating room (OR) to successfully meet the requirements. Better if it is positioned in the centre of all ORs. This room’s access shall be very limited. The dimensions of this room shall be approximately 4572 mm × 3658 mm, with only one access, and the door shall be swing-type openable on both sides. Sterilization room: The sterilization department deserves special attention because it is the backbone of any OT complex. The central sterile supply department (CSSD), which is located near the OT complex, performs the majority of the

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sterilization work. To meet the needs of the OT complex and other hospital departments, bulk sterilization is done in CSSD. However, the surgeon may occasionally need an instrument during surgery, or if an instrument drops and becomes contaminated accidentally, it must be promptly disinfected and given back to the surgeon. Hence, the OT complex’s sterile zone has a small sterilization facility that is commonly named the theatre sterile supply unit (TSSU). The room shall be roughly 3658 mm × 3658 mm in size.

5.3.2 Types of Operating Rooms Over time, there has been a significant improvement in the construction of OR based on requirements and technical advancement. The modern ORs are supposed to be sterile and have proper environmental conditions inside the OR. Following are the types of OR: 1. Simple room OR 2. Prefabricated modular OR 3. Semi-modular OR 4. Modular OR 5. Hybrid OR Let us now discuss these types in a little more detail. See Table 5.2.

5.3.2.1 Simple Room OR These kinds of OR were frequently built in the past. Even now, some small hospital set-ups choose to use these kinds of operating rooms. These are the most basic types of operating rooms, with no special sterility provisions, environmental considerations, or air exchanges. These types of ORs do not have any specific size. In these ORs, the walls are simply plastered and painted with washable paint or glazed tiles are affixed. Similarly, the ceiling is also plastered and painted or at the most POP false ceiling is provided. Flooring can be of normal marble stone or glazed tiles; doors can be normal wooden doors or aluminium doors. For air conditioning, split air conditioners are used. The OT light is fixed at the ceiling in the centre of the room, and the OT table is just placed in the centre of the room. A proper pipeline for medical gases is not laid down. 5.3.2.2 Prefabricated OR These are the most popular kinds of ORs. They are developed in a room having concrete walls and a ceiling. The majority of the requirements for an ideal OR, including sterility, environment, temperature, humidity, air exchanges, cleanliness, airflow, and internal pressure, are fulfilled by these ORs. These OR specifics are as follows:

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5.3 Infrastructure Table 5.2  Types of operating rooms

Activity Simple OR Simply plastered walls and ceiling Washable paint or glazed tiles on walls Washable paint on the ceiling Marble stone or glazed tile flooring Wooden or aluminium door Split air conditioners OT light OT table Pipelines and outlets for medical gases Prefabricated modular OR Prefabricated puff panel walls Prefabricated puff panel ceiling Prefabricated puff slanting panel Plenum in the ceiling for HEPA filter Motor-driven hermitical doors are operated and controlled with the sensors Window with double-­ glazed glass with a vacuum in between Control panel recessed in the panelled wall LED view box recessed in the panelled wall White magnetic writing board recessed in the panelled wall Pressure relief damper (PRD) Peripheral lights Plenum lights

Status of works In Not Responsible Start End Remarks date date Complete progress started person :::::::::-

:::::-

:-

:::-

:::(continued)

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Table 5.2 (continued)

Activity Pass-through windows/ hatch boxes Required electrical points Anaesthetist pendant Surgeon pendant Anti-static flooring Washable antibacterial and anti-fungal paint Chilled water air conditioning system with pipeline and AHUs Air supply aluminium ducts Vertical return air ducts

Status of works In Not Responsible Start End Remarks date date Complete progress started person :::::::-

::-

Size of the OR: The standard size of these ORs shall be 6096 mm × 6096 mm, or say 37.16 sq. m. However, the space must be about 46.45 sq. m. for surgeries like cardiac, neurological, robotic, and other specialized surgeries. Further, for transplant surgeries, approximately, 74.32 sq. m. shall be provided. Walls of the OR: In front of the brick walls that have already been built, these walls are created artificially. In the process, the prefabricated puff panels are mounted on the walls and fastened with rod fasteners about 146–244 mm away from the wall. This creates a vacuum between the wall and the panel, which helps in reducing the temperature in the OR. The panels are now fully joined together by welding, leaving no gaps between them. To make the panel surface smoother, the surplus welding spots are grounded. As no corners are allowed in these panels, the bends are welded at a 45-degree angle rather than a 90-degree angle. Ceiling of the OR: These ORs’ ceiling is made with puff panels as well. First, using screw rod fasteners, the plenum is hung from the ceiling in the middle of the OR. High-efficiency particulate air (HEPA) filters for air conditioning are placed in this plenum. A circular cut-out is provided right in the middle of the plenum so that the OT light can be suspended from the ceiling. Cut-outs are made on the plenum’s outer sides so that the supply ducts for the air conditioning can be fixed there. As no sharp corners are allowed in the ceiling, slanted panels are provided on the vertical panels to join the same with the ceiling panels. The slanted panels which are about 630 mm wide are fixed at the angle of 45° on the top of wall panels fixed earlier to avoid corners. Then all these slanted panels are welded to each other and also welded to the wall panel. The required grinding is done. The space left in between the slanting panel and the plenum is filled up with the straight puff panel by hanging these panels from the ceiling using screw rods. These

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panels are welded to each other. Also, the welding of these straight panels is done with the slanting panel and the plenum. Corners of OR: All four corners of the OR shall be properly covered. The return air duct, which is a vertical duct made out of the aluminium sheet, is first secured to the wall using clamps that are screwed into each of its four corners. Above the duct, the corners shall be covered with the same puff panel that was used to cover the wall, and all of the panels are joined together using welding. To avoid sharp corners, these corner panels must also be fixed at a 45-degree angle. The door of the OR: Prefabricated puff doors shall be provided in the OR. The door’s width ranges from 1524 to 1829 mm. This door shall be hermetically sealed. These doors either can be moved manually using a handle or are operated automatically using micro-motors and control device. The door slides on the railing that is fixed above the door. A view window with sealed glass is also provided in the door at eye level to see inside the OR. Window in OR: If a window is provided in the OR, it must be fixed on the exterior wall of the OR. The window can vary in size from 600 to 1000 mm wide and roughly 600 mm high. The windows must be of the fixed type and not openable. Windows shall have a double-glazed glass with a vacuum in between the two layers of glass. Vanishing blinds that are motorized and operated by a switch button or remote control can be positioned in the vacuum area between two layers of glass. Control panel: In the panelled wall next to the OR entrance, the control panel is recessed to install the control panel. The operation of the entire OR is managed by this control panel. The control panel can accommodate six or nine tiles. Here, the term ‘tiles’ refers to a module that can be utilized to control a particular function. Normally, the control panel can control functions like: • • • • • • • • • •

OT light Plenum lights Peripheral lights Clock Time elapsed Medical gas pressure Temperature meter Hand-free intercom Humidity meter Music system

View box: In front of the surgeon, the recessed LED view box is provided on the panelled wall. Use of a dual-film view box with a dimmable LED white light shall be preferred. Writing board: In addition, a magnetic white writing board is recessed in the panelled wall adjacent to the view box. Pressure relief damper (PRD): PRD is provided in the OR to reduce the air pressures in the OR by pushing the excess air out of the OR. PRD as such is made up of a group of stainless steel fins connected at a specific distance. A stainless steel

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weight is welded to one of these fins. PRD is installed at the bottom of the OR in a wall cut-out. Peripheral lights: Peripheral lights are basically 610 mm LED lights that are recessed into the OR’s straight panel ceiling. These are integrated into a single unit and have a dimmer. Eight of these lights are generally provided in the OR. Two such lights are fixed on either side of the OR. The control panel installed in the OR is used to control these lights. Plenum: Plenum is an overhead box-shaped structure. Fixing HEPA filters for air filtration and creating a unidirectional airflow are the primary functions of the plenum. The plenum is covered from the bottom by either fastening a silken fabric with a frame or a stainless steel sheet with several holes for air passage. Plenum lights: These 1219  mm long LED tubes are mounted in the plenum. About 32 of these tube lights are mounted in an aluminium frame that is fixed at the lower end of the plenum but above the silken fabric or a stainless steel sheet. These lights can be dimmed or turned off during the procedure, at the surgeon’s discretion. The control panel located in the OR is used to regulate these lights. Pass-through windows/hatch boxes: To move clean supplies and materials without opening the doors, these are provided in the OR. In terms of design, this window features two doors that open from each side. One distinctive feature of this window is that only one door can be opened at once. Anaesthetist pendant: An anaesthetist pendant hangs from the ceiling on the patient’s left side. A box-like structure known as the body of the pendant is placed at the lower end of the pendant. Medical gas outlets are attached to the back wall of the pendant body. Electric and communication ports are provided on both sidewalls of the pendant’s body. There are drawers and a service tray on the front wall of the pendant body. Surgeon pendant: If necessary, a surgeon pendant can be placed on the patient’s right side. Typically, this pendant has a fixed arm and can only rotate around its axis. The power outlets and a few trays are located on the sidewalls of this pendant, which is mostly utilized by the surgeon. Flooring: These ORs shall incorporate adequate earthing qualities and anti-­ static flooring. The flooring is made of PVC and has a carbon coating on the bottom. A copper strip is applied to the corners of the flooring during the fixing of the floor, and this copper strip is ultimately attached to the earthing wire. After the tile or roll has been bonded on the floor, any gaps in the flooring are filled by thermo-welding the joints using a PVC cord. Painting: All surfaces (walls and ceiling) of the OR are painted by applying a coat of primer, followed by one or two coats of metal putty to fill any gaps. Once the putty dries up, the surfaces are scrubbed with sandpaper. This is followed with at least two coats of washable antibacterial and anti-fungal paint. Air conditioning and environment of ORs: The OR should be fully air-­ conditioned, allowing control of temperature, humidity, and air exchanges. Suitable and safe air quality must always be maintained in the OR. The temperature should

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be maintained at 21  ±  3  °C (except for joint replacement where it should be 18 ± 2 °C) with corresponding relative humidity between 20 and 60%, though the ideal relative humidity is considered to be 55%. OR shall have a minimum of 20 total air changes based on biological load and location. The minimum fresh air component of the air change shall be a minimum of 4 out of 20 air changes. The airflow shall be unidirectional and downwards on the OR table. The air face velocity of 25–35 FPM (feet per minute) from a non-aspirating unidirectional laminar flow diffuser/ceiling array is recommended. The minimum positive pressure recommended is 2.5 Pascal (0.01 in. of water). For air purification and filtration, the AHU shall have two sets of washable flange-type filters of efficiency 90% down to 10 μm and 99% down to 5 μm with aluminium/stainless steel 304 frames within the AHU.

5.3.2.3 Semi-modular OR At times, due to some financial constraints, it may not be possible to provide a full-­ fledged prefabricated OR. Under such circumstances, the semi-modular OR can be designed. In these ORs, the modular wall structure, along with other fittings like a control panel, reassessed view box, whiteboard, PRD, window, and hermitical door, is avoided. Only the ceiling structure with the proper plenum and HEPA filters with proper AHU are provided so that the unidirectional flow of the air can be achieved. 5.3.2.4 Modular OR These kinds of ORs are made in the empty hall. An entire construction comprised of channels, angles, and other specific sections made of either mild steel or stainless steel is created for these ORs. The shape of a structure resembling a room is created by assembling these prefabricated structures. After that, the ceiling and wall panels are fastened in place to turn the framework into a room. For these ORs, all additional design criteria and requirements as in the case of prefabricated modular ORs shall be followed. 5.3.2.5 Hybrid OR In this type of operating room (OR), multidisciplinary integration is executed by fusing modern imaging diagnostics with surgery. This enables surgeons, radiologists, and other medical professionals to use real-time images for guidance and assessment during complex operations. A hybrid OR can be integrated with any one of the wide range of imaging devices such as magnetic resonance imaging (MRI), computed tomography (CT) scanners, angiography equipment (cath lab), scanners, digital subtraction angiography system (DSA), C-arm, and X-ray. The primary equipment that has to be integrated into the OR must be identified while developing these kinds of facilities. The type of equipment that has to be integrated shall determine the size of the OR. The hybrid OR shall be built following similar standards to a prefabricated modular OR, including those for walls, ceilings, doors, windows, air conditioning, control panels, etc.

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5.4 Services, Facilities, Equipment, Tools, and Instruments 5.4.1 Unsterile Zone 5.4.1.1 Administrative Rooms See Table 5.3. The room shall be provided with the office table, office chairs, and visitors’ chairs. An adequate arrangement shall be made for cabinets, drawers, and racks for smooth working. The room shall also have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning. 5.4.1.2 Frozen Section Laboratory See Table 5.4. Table 5.3  Administrative rooms in OT complex

Activity These rooms shall be provided with Office table Office chairs Visitors’ chairs Side rack Cabinets, drawers, and racks Required electrical points Intercom connection IT network CCTV surveillance Air conditioning

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::::::-

Table 5.4  Frozen section laboratory in OT complex

Activity A countertop for working and placing the equipment Lab sink Required electric points Other required communication points

Status of works Start End In Not date date Complete progress started :-

:::-

Responsible person Remarks

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143

The laboratory shall be provided with a countertop for working and placing the equipment and shall have an arrangement for a lab sink and sufficient electric outlets and communication ports.

5.4.1.3 Trolley Bay See Table 5.5. The trolley bay shall have sufficient provision to hold the trollies in place. Hence, a sufficient number of hooks and chains shall be provided on the walls. 5.4.1.4 Shoe Changing Areas See Table 5.6. Shoe changing area shall be provided with a chair for sitting while removing or wearing shoes and a sufficient number of shoe racks. 5.4.1.5 Linen Pre-wash Room See Table 5.7. A room shall be provided with a sink, draining board, and a low-height water tap to wash the clothes. Special care shall be taken about the slope in this room so that the water does not spill outside the room. Additionally, a wash line shall also be provided to dry the linen. 5.4.1.6 Instrument Wash Room See Table 5.8. The room shall be provided with a large-size sink, draining board, and a countertop for drying up the instruments. It is recommended that the instrument room shall be provided with a hot air dryer to dry the instruments. 5.4.1.7 Attendant Waiting Area See Table 5.9. Table 5.5  Tolley bay in OT complex

Activity Chains and hooks to hold the trollies in place

Start date

Status of works End In Not date Complete progress started

Responsible person

Remarks

:-

Table 5.6  Shoe changing areas in OT complex

Activity Shoe racks Chair

Start date ::-

End date

Status of works In Complete progress

Responsible Not started person

Remarks

144

5  Operation Theatre Suite (OT)

Table 5.7  Linen pre-wash room in OT complex

Activity Sink Draining board Low-height water tap Wash line

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

Table 5.8  Instrument wash room in OT complex

Activity Large-size sink Draining board Countertop for drying up the instruments Provision for hot air dryer

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

:::-

:-

Table 5.9  Attendant waiting area in OT complex

Activity Sofa sets Chairs/recliners Speakers of the PA system Separate toilets for males and females Small cafeteria Drinking water facility Mobile charging points Wi-Fi and internet facility CCTV surveillance

Status of works Start End In Not date date Complete progress started :::::::-

:-

5.4 Services, Facilities, Equipment, Tools, and Instruments

145

The waiting area shall be provided with sofa sets or chairs/recliners for comfortable sitting of the family members. The waiting area shall have a toilet block attached to it. Preferably, the toilets shall be separate for men and women. Along with this, a facility for drinking water shall be provided. For water supply, either water coolers or water drinking fountains can be provided. If possible, a small cafeteria shall be provided from where the precooked snacks and cookies can be served. Along with this, the tea/coffee vending machine shall also be provided. For listening to the announcements made from the OT, this area shall have a speaker system in place. To facilitate the OT staff to contact the family members in case of requirement, this area shall also have an intercom facility. Try providing Wi-Fi and an internet facility. The waiting area shall also have the facility for mobile charging points near the seating areas. This area shall be guarded by security to control the unnecessary movement of family members in the OT complex and shall be under CCTV surveillance.

5.4.2 Protective Zone 5.4.2.1 Staff Change Rooms See Table 5.10. Table 5.10  Staff change rooms in OT complex

Activity Staff lockers to keep their personal belongings One chair Hooks on the wall to hang clothes Almirah for hanging clothes Hanger rods Cabinet to keep the sterilized OT dresses Table to place boxes of masks and caps Bin for dirty linen Bin for used face masks, caps, and shoe covers Intercom point

Status of works Start End In Not date date Complete progress started :-

:::::-

::-

:-

Responsible person

Remarks

146

5  Operation Theatre Suite (OT)

The change room shall be provided with an adequate number of personal lockers to keep the personal belongings. Each staff member shall preferably be allotted one such locker. One chair shall be provided in the room, which the staff can use while changing their clothes. For hanging the outside clothes, an adequate number of hooks shall be provided on the wall. Apart from this, the almirah and hanger rods with the hangers shall also be provided to hang the cloths. There shall be a closed cabinet to keep the sterilized OT dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. One table shall be provided in the room to keep the containers of fresh unused masks and caps. A large bin for dirty linen shall also be provided in the change room. Also, a separate bin shall be provided for disposal of the used masks, caps, and shoe covers. The room shall have the provision of an intercom and shall have adequate air conditioning.

5.4.2.2 Unsterile Store for Equipment See Table 5.11. The equipment store shall have a sufficient number of working counters to place the countertop equipment and instruments. For bulk equipment, sufficient floor space shall be available. The store shall have adequate lockable cupboards, racks, and drawers to store the equipment and instruments. The store shall also have multiple electric points to charge the equipment when not in use. The store shall have proper air conditioning and controlled humidity levels to prevent the electronic equipment and metallic instruments from excessive heat and moisture. Table 5.11  Unsterilized store for equipment in OT complex

Activity Lockable cupboards, racks, and drawers Working counter Multiple electric points to charge equipment when not in use Air conditioning with controlled humidity level

Status of works Start End In Not date date Complete progress started :::-

:-

Responsible person Remarks

5.4 Services, Facilities, Equipment, Tools, and Instruments

147

5.4.2.3 Store for Medicines, Disposables, and Consumables See Table 5.12. The medicine, consumable, and disposable store in the OT complex shall have adequate lockable cupboards, racks, and drawers to store the material. The working countertop shall be provided to prepare the drugs if required. Furniture-wise, the office chairs and the table shall be provided for the staff to sit and perform duties. For storing the drugs requiring low temperature, the refrigerator shall be provided. A waste bin for disposal of the covers, empty boxes, and wrappers shall be provided. The store shall have the computer, UPS, printer, and barcode scanner installed on the office table. The service window shall be provided on the corridor side of the room to serve and dispense with the material. This is required to restrict the entry of unwanted staff into the store. The room shall have proper air conditioning and controlled humidity levels. 5.4.2.4 Pantry See Table 5.13. The pantry shall be provided with a countertop slab for cooking. The provision of a sink with a draining board shall be made for washing utensils. A microwave, refrigerator, gas burner, and/or induction heater shall be provided in the pantry. A dedicated place shall be provided to place the cooking gas cylinder. A sufficient number of electric points shall be provided to operate these machines. If cooking has to be done in the pantry, a chimney shall be provided to exhaust the fumes generated while cooking. Table 5.12  Store for medicines, disposables, and consumables in OT complex

Activity Lockable cupboards, racks, and drawers Countertop to prepare the drugs Refrigerator Waste bin Office chairs Office table Computer with UPS, printer, and barcode scanner Service window Air conditioning with a controlled humidity level

Status of works Start End In Not date date Complete progress started :::::::-

::-

Responsible person

Remarks

148

5  Operation Theatre Suite (OT)

Table 5.13  Pantry in OT complex

Activity Countertop slab for cooking and placing gas burners or inductions Sink with draining board Microwave Refrigerator Gas stove burner and place for keeping the gas cylinder Induction heater Required electric points

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:-

::::-

::-

5.4.3 Clean Zone 5.4.3.1 Preoperative Ward See Table 5.14. The preoperative ward shall have a sufficient number of patient beds. The number of beds shall depend on the number of ORs. The beds shall preferably be Fowler type with the facility of head up and shall have swivelling wheels. Furniture-wise, the preoperative shall have bedside lockers and over-bed tables with all the beds. Other than this, the ward shall be provided with wheelchairs, stretches, instrument trollies, step stools, IV stands, IV rods, and oxygen cylinder trollies. For nursing stations, the nursing counter, office chair, almirah/cabinets/cupboards, filing cabinets, and visitors’ chairs shall be provided. As far as the equipment is concerned, the ward shall have multi-para vital sign monitor, syringe pumps, infusion pump, defibrillator, suction machine, BP apparatus, stethoscopes, view boxes, oxygen cylinders with masks, Ambu mask of different sizes, etc. In addition to this, the ward shall have tools like sterilizing drums, trays, extension cord boxes, torches, and most importantly emergency medicines. Not all but a few beds shall have the provision for the supply of a medical gas pipeline mounted on the bed head panel. The medical gases shall be oxygen and suction. Each bed shall be provided with at least two electrical points to connect the medical devices. Other than this, sufficient electrical outlets and communication ports shall be provided in the ward.

5.4 Services, Facilities, Equipment, Tools, and Instruments

149

Table 5.14  Preoperative ward in OT complex

Activity Preoperative ward shall have the following furniture: Patient beds Bedside locker Over-bed table Stretcher trolley Wheelchair Step stool Instrument trolley Crash cart IV stand IV rod Oxygen cylinder trolley Nursing counter Office chairs Visitor chairs, etc. Filing cabinet Almirah/cupboard Preoperative ward shall have the following equipment: Multi-para vital sign monitor Syringe pumps Infusion pump Defibrillator Suction machine View box BP apparatus Stethoscopes Oxygen cylinders with masks Ambu mask of different sizes Preoperative ward shall have the following tools/ instruments: Sterilizing drums Trays Extension cords and boxes

Status of works In Not Responsible Start End Remarks date date Complete progress started person

::::::::::::::::-

::::::::::-

:::(continued)

5  Operation Theatre Suite (OT)

150 Table 5.14 (continued)

Activity Torches Emergency medicines MGPS outlets for oxygen and vacuum Bed head panel Two electrical outlets on each bed Other facilities in the ward Required electrical points for preoperative ward Required other communication points Curtain partitions on all the beds

Status of works In Not Responsible Start End Remarks date date Complete progress started person :::::-

:-

::-

Table 5.15  Surgeons’ restroom in OT complex

Activity Sofa set and a centre table Single bed for resting Dining table with chairs Computer, UPS, and internet connection Provision of tea/ coffee

Status of works In Not Start End date date Complete progress started

Responsible person

Remarks

::::-

:-

Preferably, all the beds in the wards shall be provided with the curtain partition to maintain the privacy of the patient.

5.4.3.2 Surgeons’ Restroom See Table 5.15. The surgeons’ lounge shall be provided with a few sofa sets/chairs/recliners and centre tables. If required, the dining table with chairs can also be provided in the room. On request, a single bed can also be placed in the lounge for surgeons to lie down for some time.

5.4 Services, Facilities, Equipment, Tools, and Instruments

151

The room shall preferably be provided with a computer with UPS and an internet connection so that the surgeons can surf the internet in their spare time. The lounge shall have the facility of tea/coffee, which can be served either from the pantry or through the vending machine.

5.4.3.3 Restroom for Staff See Table 5.16. The staff restrooms shall be provided with a few chairs and centre tables. On request, a single bed can also be placed in the lounge for staff to lie down for some time. The restrooms shall have the facility of tea/coffee, which can be served either from the pantry or through the vending machine. 5.4.3.4 Dirty Utility See Table 5.17. Dirty utility shall be provided with waste bins to dispose of the waste as per the biomedical waste management rules. Special attention shall be paid to biomedical waste. The room shall also have a hamper with a lid to collect the soiled linen that has to be sent to the laundry for a wash. 5.4.3.5 Pre-anaesthetic Check-Up Room (PAC) See Table 5.18. The pre-anaesthetic check-up (PAC) room shall have an examination couch with a step stool, instrument trollies, IV stands, and oxygen cylinder trollies. For general working, the room shall have office table, office chair, almirah/cupboards, and filing cabinets. As far as the equipment is concerned, the room shall be provided with portable OT light, multi-para vital sign monitor, ECG machine, BP apparatus, stethoscopes, view box, oxygen cylinders with masks, Ambu mask of different sizes, etc. In addition to this, the PAC room shall have tools like sterilizing drums, trays, extension cord boxes, torches, and most importantly emergency medicines. Near the examination table, the supply of medical gas pipeline, i.e. oxygen and suction, shall be provided. Table 5.16  Restroom for staff in OT complex

Activity Chairs and centre tables Single bed for resting Provision of tea/coffee

Start date :::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

152

5  Operation Theatre Suite (OT)

Table 5.17  Dirty utility in OT complex

Activity Waste bins for disposal of waste as per the biomedical waste norms Hamper with lid for soiled linen Exhaust fan

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:-

::-

Table 5.18  Pre-anaesthetic check-up room (PAC) in OT complex

Activity PAC room shall have the following furniture: Examination couch Step stool Instrument trolley IV stand Oxygen cylinder trolley Office table Office chairs Almirah/cupboard Filing cabinet PAC room shall have the following equipment: Portable OT light Multi-para vital sign monitor ECG machine BP apparatus Stethoscopes Oxygen cylinders with masks View box Ambu mask of different sizes PAC room shall have the following tools/ instruments: Sterilizing drums Trays

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::::::::-

::::::::-

::-

5.4 Services, Facilities, Equipment, Tools, and Instruments

153

Table 5.18 (continued)

Activity Extension cords and boxes Torches Emergency medicines MGPS outlets for oxygen and vacuum Other facilities in the ward Required electrical points Required other communication points Washbasin for hand wash

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::-

:::-

Other than this, sufficient electrical outlets and communication ports shall be provided in the room. For hand washing, the washbasin shall be provided in the room, with the provision of running hot and cold water.

5.4.3.6 Preparation Room See Table 5.19. The preparation room shall have an examination couch with a step stool, instrument trollies, IV stands, and oxygen cylinder trollies. For general working, the room shall have office table, office chair, almirah/cupboards, and filing cabinets. As far as the equipment is concerned, the room shall be provided with portable OT light, multi-para vital sign monitor, BP apparatus, stethoscopes, oxygen cylinders with masks, view box, Ambu mask of different sizes, etc. In addition to this, the preparation room shall have tools like sterilizing drums, trays, extension cord boxes, and torches. Near the examination couch, the supply of medical gas pipeline, i.e. oxygen and suction, shall be provided. Other than this, sufficient electrical outlets and communication ports shall be provided in the room. For hand washing, the washbasin shall be provided in the room, with the provision of running hot and cold water. 5.4.3.7 Post-operative Ward See Table 5.20. The post-operative ward is another critical unit in the hospital and shall be provided with all the facilities that are being provided in the intensive care units.

154

5  Operation Theatre Suite (OT)

Table 5.19  Preparation room in OT complex

Activity The preparation room shall have the following furniture: Examination couch Step stool Instrument trolley IV stand Office table Office chairs Almirah/cupboard Filing Cabinet The preparation room shall have the following equipment Portable OT light Multi-para vital sign monitor BP apparatus Stethoscopes Oxygen cylinders with masks View box Ambu mask of different sizes The preparation room shall have the following tools/ instruments: Sterilizing drums Trays Extension cords and boxes Torches MGPS outlets for oxygen and vacuum Other facilities in the room Required electrical points Required other communication points Washbasin for hand wash

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::::-

:::::::-

:::::-

:::-

5.4 Services, Facilities, Equipment, Tools, and Instruments

155

Table 5.20  Post-operative ward in OT complex

Activity Post-operative ward shall have the following patient furniture: Patient bed (should be multi-positional ICU bed) Bedside locker Over-bed table Stretcher trolley Wheelchair Step stool Instrument trolley Dressing trolley Crash cart IV rod IV stand Oxygen cylinder trolley Backrest, etc. Post-operative ward shall have the following furniture: Nursing counter Almirah/cupboard Filing cabinet Office chairs Visitor chairs, etc. Post-operative ward shall have the following equipment: Invasive mechanical ventilator Multi-para vital sign monitor Syringe pumps Infusion pump Defibrillator Non-invasive ventilator ECG machine Portable X-ray machine BP apparatus Stethoscope Suction machine

Status of works In Not Responsible Start End Remarks date date Complete progress started person

:-

::::::::::::-

:::::-

:::::::::::(continued)

5  Operation Theatre Suite (OT)

156 Table 5.20 (continued)

Activity Intra-aortic balloon pulsation (IABP) Intubating videoscope Invasive BP, SPO2, NIBP, ECG, RR, temp probes with trays ABG machine for ABG and electrolytes Ultrasound cum echo machine Laryngoscope Transport ventilator Spinal board Glucometer View boxes, etc. Oxygen cylinders with masks Ambu mask of different sizes Chest drainage equipment Post-operative ward shall have the following tools/instruments: Sterilizing drums Portable operating light Instrument boxes Extension cords and boxes Tray of all styles and sizes Refrigerator Torches All other required instruments Provide two-bay scrub stations for hand hygiene MGPS outlets for each bed Two outlets for oxygen One outlet for compressed air Two outlets for suction

Status of works In Not Responsible Start End Remarks date date Complete progress started person :::-

::::::::::-

:::::::::-

:::-

5.4 Services, Facilities, Equipment, Tools, and Instruments

157

Table 5.20 (continued)

Activity Bed head panels/ ceiling-suspended pendants for medical gas outlets and electrical points Required electrical points Required other communication points Curtain partitions on all the beds of the post-operative ward

Status of works In Not Responsible Start End Remarks date date Complete progress started person :-

:::-

The post-operative ward shall have a sufficient number of patient beds. The number of beds shall depend on the number of ORs. The beds shall preferably be multi-­ positional (preferably motorized) ICU beds with the facility of bedside railing, high-low, head up, Trendelenburg, and reverse Trendelenburg, and swivelling wheels. Furniture-wise, the post-operative ward shall have bedside lockers and over-bed tables with all the beds. Other than this, the ward shall be provided with wheelchairs, stretches, instrument trollies, dressing trollies, crash carts, IV stands, IV rods, step stools, scrub stations, oxygen cylinder trollies, backrests, etc. For nursing stations, the nursing counter, office chair, almirah/cabinets/cupboards, filing cabinets, and visitors’ chairs shall be provided. As far as the equipment is concerned, the ward shall have an invasive mechanical ventilator; non-invasive ventilator; multi-para vital sign monitor; syringe pumps; infusion pump; ECG machine; defibrillator; suction machine; portable X-ray; BP apparatus; stethoscopes; intubating videoscope; ABG machine for arterial blood gases and electrolytes; intra-aortic balloon pump (IABP); invasive having BP, SPO2, NIBP, ECG, RR, and temp probes with trays; spinal board; transport ventilator; ultrasound cum echocardiograph machine; laryngoscope; glucometer; oxygen cylinders with masks; view boxes; and Ambu mask of different sizes. In addition to this, the ward shall have tools like sterilizing drums, trays of various styles and sizes, portable operating light, extension cord and boxes, torches, refrigerator, instrument boxes, two-bay scrub station, and most importantly emergency medicines in crash cart. All the beds shall have the provision for the supply of a medical gas pipeline mounted on the bed head panel. The medical gases shall be oxygen and suction. At least two electrical ports for connecting the medical devices shall be provided on each bed.

158

5  Operation Theatre Suite (OT)

Other than this, sufficient electrical outlets and communication ports shall be provided in the ward. Preferably, all the beds in the wards shall be provided with the curtain partition to maintain the privacy of the patient. The ward shall be properly air-conditioned with controlled humidity levels.

5.4.4 Sterile Zone 5.4.4.1 Operating Rooms (ORs) See Table 5.21. Talking about the operating room, in the hospital, there are many surgical specialities. Out of them, some are more specific and specialized, like neurosurgery, urology, robotic surgery, and cardiac surgery. Table 5.21  Operating rooms (ORs)

Activity The following equipment shall be placed in the OR (common for all ORs): Anaesthesia workstations/Boyle’s machine Anaesthesia ventilator Blood pressure apparatus Camera HD Defibrillator Electro-surgical cautery with pencils Head light Image intensifier (C-arm) Insufflator Laparoscope set LED monitor medical grade Light source with fibre-optic cable Microprocessor controlled electrosurgical unit Mobile ultrasound Morcellator Multi-para monitor with ET Co2

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:-

::::::::::::-

:::-

5.4 Services, Facilities, Equipment, Tools, and Instruments

159

Table 5.21 (continued)

Activity Operating light head mounting Operating table attachments Portable OT light OT light double dome OT table Recording system Electrical suction machine Surgical loupe Telescopes UPS 10 Kva Vaporizer Operative room CTVS Cardiopulmonary bypass blood pump (heart-lung machine) Hyperthermia device (blanket, plumbing, and heat exchanger) Intra-aortic balloon pump Patient warming system Sternum saw Sternum saw battery Sternum saw battery charger Sternum saw blade guard Octopus vacuum stabilizer system Surgical instruments for cardiac, thoracic, and vascular surgeries Operating room ENT ENT drill and saw system ENT operating microscope Endoscopes Surgical instruments for all types of ENT surgeries

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::::::::::-

:-

::::::::-

::::-

(continued)

5  Operation Theatre Suite (OT)

160 Table 5.21 (continued)

Activity Operating room eye Cryo-ophthalmic unit Ophthalmic operating loupe Ophthalmic operating microscope for cataract Ophthalmic operating microscope for vitrectomy Ophthalmic lasers Photofragmentation unit Surgical instruments for all types of ophthalmic surgeries Vitreous aspiration and cutting Operating room gynaecology Culdoscope Foetal Doppler Hysteroscope Hysteroscopy pump Surgical instruments for all types of Gynae and Obs. surgeries Operating room neurosurgery CUSA Drill and saw system Neuro-endoscopes Neurosurgical operating O-arm navigation—spine Spine drill Stereotactic frame Surgical instruments for all types of neurosurgeries Operating room urology Cysto-ureteroscope Holmium/thulium laser Flexible fibre uretero-­ renoscope 270 Deg. Lithotripter

Status of works In Not Responsible Start End Remarks date date Complete progress started person

:::-

:::-

:-

:::::-

:::::::-

::::-

5.4 Services, Facilities, Equipment, Tools, and Instruments

161

Table 5.21 (continued)

Activity Nephoscope Paediatric cystoscope Resectoscope Surgical instruments for all types of urology surgeries Urethrotome Operating rooms orthopaedic Arthroscope set with accessories for knee, shoulder, and other joints Bit, drill, micro-motors, saw reamers, etc. Navigator for hip replacement Navigator for knee replacement Electrical pneumatic tourniquet Surgical instruments for all types of orthopaedic surgeries The following furniture shall be placed in the OR: Instrument trollies Crash cart Dressing trollies Mayo stand Swab rack Steel bucket with lid and footstool Doctor stool IV stand OR shall have the following tools/gadgets: Sterilization drums Trays of all types and sizes Kidney tray of all sizes Bowls of all sizes Disinfection and sterilization trays

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::-

:-

:-

:::::-

::::::::-

:::::(continued)

162

5  Operation Theatre Suite (OT)

Table 5.21 (continued)

Activity Formalin chamber OT linen OR shall have the following drugs: Emergency drugs Anaesthesia and analgesia drugs Antibiotics Fluids OR shall have the following consumables and disposables: All types of catheters All types of infusion sets Cotton, bandage, and gauze All types of sutures Implants as required Spare bulbs, batteries for equipment

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::-

::::-

::::::-

To equip the OR, there are a few equipment, instruments, and tools which are common to all ORs. However, for specialized surgeries, the equipment may increase. Though it is not possible to mention all the equipment that is required in the ORs, we have tried to mention the important ones. The requirement may vary from hospital to hospital, department to department, and surgeon to surgeon. Following are the equipment that are common to all the ORs and shall be provided in every OR: • • • • • • • • • • • • •

Anaesthesia ventilator Anaesthesia workstations/Boyle’s machine Blood pressure apparatus Camera HD for laparoscopic surgeries Defibrillator Electro-surgical cautery Head light Image intensifier (C-arm) Insufflator for laparoscopic surgeries Laparoscope set for laparoscopic surgeries LED monitor medical grade for laparoscopic surgeries Light source with fibre-optic cable for laparoscopic surgeries Mobile ultrasound

5.4 Services, Facilities, Equipment, Tools, and Instruments

• • • • • • • • • • • •

Morcellator Multi-para monitor with ETCo2 Operating light head mounting Operating table attachments Portable OT light OT light double dome OT table Electrical suction machine Surgical loupe Telescopes for laparoscopic surgeries UPS 10 Kva Vaporizer

Equipment Required for Cardiothoracic Vascular Surgery (CTVS) • Cardiopulmonary bypass blood pump (heart-lung machine) • Hyperthermia device (blanket, plumbing, and heat exchanger) • Intra-aortic balloon pump • Patient warming system • Sternum saw • Sternum saw battery • Sternum saw battery charger • Sternum saw blade guard • Surgical instruments for cardiac, thoracic, and vascular surgeries • Octopus vacuum stabilizer system Equipment Required for ENT • ENT operating microscope • ENT drill and saw system • Endoscopes • Surgical instruments for ENT Equipment Required for Ophthalmology • Cryo-ophthalmic unit • Ophthalmic operating loupe • Ophthalmic operating microscope for cataract • Ophthalmic operating microscope for vitrectomy • Ophthalmic lasers • Surgical instruments for all types of ophthalmic surgeries • Vitreous aspiration and cutting Equipment Required for Gynaecology • Culdoscope • Foetal Doppler • Hysteroscope • Hysteroscopy pump • Surgical instruments for all types of Gynae and Obs. surgeries

163

164

5  Operation Theatre Suite (OT)

Equipment Required for Neurosurgery • CUSA • Drill and saw system • Neuro-endoscopes • Neurosurgical operating microscope and spine drill • O-arm navigation—spine • Stereotactic frame • Surgical instruments for all types of neurosurgeries Equipment Required for Urology • Cysto-ureteroscope • Holmium/thulium laser • Flexible fibre uretero-renoscope 270 Deg • Lithotripter • Nephoscope • Paediatric cystoscope • Resectoscope • Surgical instruments for all types of urology surgeries • Urethrotome Equipment Required for Orthopaedic Surgeries • Arthroscope set with accessories for knee and shoulder • Bit, drill, micro-motors, saw reamers, etc. • Navigator for hip replacement • Navigator for knee replacement • Pneumatic tourniquet electrical • Surgical instruments for all types of orthopaedic surgeries The following furniture shall be placed in the OR: • • • • • • •

Instrument trollies Dressing trollies Mayo stand Swab rack Steel bucket with lid and footstool Doctor stool IV stand The following accessories, tools, and gadgets shall be placed in the OR:

• • • • •

Sterilization drums Trays of all types and sizes Kidney trays of all sizes Bowls of all sizes Disinfection and sterilization trays and sets

5.4 Services, Facilities, Equipment, Tools, and Instruments

165

• Formalin chambers • OT line including the doctor’s dress, patient dress, draw sheets, big sheets, cut sheets, eye hole sheets, aprons, gowns, absorption pads, etc. The following drugs shall be placed in the OR: • All the emergency drugs • Anaesthesia and analgesia drugs like analgesics, anxiolytics, local anaesthetics, general anaesthetics, inhalational gases, and paralytics • Antibiotics • Body fluids like intravascular biological fluids, interstitial biological fluids, and intracellular biological fluids The following consumables and disposables shall be placed in the OR: • All types of catheters including straight intermittent catheters, hydrophilic catheters, closed system catheters, etc. • All types of infusion sets • Cotton, bandage, and gauze • All types of sutures including (A) absorbable sutures like catgut suture, polydioxanone suture, poliglecaprone suture, and polyglactin suture and (B) nonabsorbable sutures like nylon, polypropylene, silk, and polyester • Implants as required • Spare bulbs, batteries for equipment

5.4.4.2 Endoscopic Unit See Table 5.22. The endoscopy unit of the hospital shall have medical equipment like 24-h pH impedance; breath analyser; capsule endoscopy; C-arm image intensifier; cholangioscope/choledochoscope, flexible or rigid; colonoscope; duodenoscope; endoscopic ultrasound (EUS); electro-surgical cautery with argon; enteroscope; multi-para monitor; manometry unit; upper gastrointestinal endoscope unit; paediatric upper GI endoscope unit; and video processor. The endoscopy unit shall have patient beds in the recovery unit. The beds shall preferably be multi-positional (preferably motorized) ICU beds with the facility of bedside railing, high-low, head up, Trendelenburg and reverse Trendelenburg, and swivelling wheels. Furniture-wise, the endoscopy unit shall have bedside lockers and over-bed tables with all the beds. Other than this, the unit shall be provided with the examination table wheelchairs, stretches, instrument trollies, dressing trollies, step stools, IV stands, IV rods, crash cart, oxygen cylinder trollies, etc. For nursing stations, the nursing counter, office chair, almirah/cabinets/cupboards, filing cabinets, and visitors’ chairs shall be provided. In addition to this, the unit shall have accessories and tools like sterilizing drums, trays of various styles and sizes, extension cords and boxes, portable operating light,

5  Operation Theatre Suite (OT)

166 Table 5.22  Endoscopic unit in OT complex

Activity Endoscopic unit shall have the following equipment: 24-h pH impedance Breath analyser Capsule endoscopy C-arm image intensifier Cholangioscope/ choledochoscope, flexible or rigid Colonoscope Duodenoscope Electro-surgical cautery with argon Endoscopic ultrasound (EUS) Enteroscope Multi-para monitor Manometry unit Upper gastrointestinal endoscope unit Upper GI endoscope Paedia unit Video processor Endoscopic unit shall have the following patient furniture: Examination table Patient bed (should be multi-­positional ICU bed) Bedside locker Over-bed table Wheelchair Stretcher trolley Dressing trolley Instrument trolley Step stool IV stand IV rod Crash cart Oxygen cylinder trolley

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::::-

::::::::::-

:::::::::::::-

5.4 Services, Facilities, Equipment, Tools, and Instruments

167

Table 5.22 (continued)

Activity Endoscopic unit shall have the following furniture: Nursing counter Office chairs Almirah/cupboard Filing cabinet Visitor chairs, etc. Post-operative ward shall have the following tools/instruments: Sterilizing drums Extension cords and boxes Portable operating light Instrument boxes Torches Tray of all styles and sizes All other required instruments Provide two-bay scrub stations for hand hygiene MGPS outlets for each bed Two outlets for oxygen One outlet for compressed air Two outlets for suction Bed head panels/ ceiling-suspended pendants for medical gas outlets and electrical points Required electrical points Required other communication points Curtain partitions on all the beds of the endoscopic unit

Status of works In Not Responsible Start End Remarks date date Complete progress started person

:::::-

:::::::::::::-

:::-

instrument boxes, torches, a refrigerator, two-bay scrub station, and most importantly emergency medicines in crash cart. The main endoscopic unit and the recovery beds shall have the provision for the supply of a medical gas pipeline mounted on the bed head panel. The medical gases shall be oxygen and suction.

5  Operation Theatre Suite (OT)

168

At least two electrical ports for connecting the medical devices shall be provided on each bed. Other than this, sufficient electrical outlets and communication ports shall be provided in the unit. Preferably, all the beds in the unit shall be provided with a curtain partition to maintain the privacy of the patient. The unit shall be adequately air-conditioned with controlled humidity levels.

5.4.4.3 Scrub Station See Table 5.23. The ORs shall be provided with a stainless steel scrub station, which could be operated by foot and/or sensors. Hand-operated taps are not allowed in the scrub station. It shall have a minimum of two bays, with the provision of both hot and cold water to wash hands. The scrub station shall be designed to allow the water to fall in the centre of the scrub and not spill around. Proper drain points shall also be provided for each scrub station. There shall be a provision for dispensing the soap using a wall-hanging soap dispenser, which shall be elbow operated. Similarly, an elbow-operated wall-hung antiseptic solution dispenser shall be provided with the scrub station. A nail brush should be provided, along with a nail cutter and a nail file. 5.4.4.4 Instrument Trolley Lay-Up See Table 5.24. The trolley layout room shall have racks, bins, an almirah, cupboards, and drawers for storage of the sterilized material. Also, a working countertop shall be provided to place the material. Waste bins shall be provided for disposal of items like caps, masks, and shoe covers. Table 5.23  Scrub station in OT complex

Activity Stainless steel scrub station Provision for hot and cold water Wall-hanging soap dispenser Wall-hanging antiseptic solution dispenser Nail brush, nail cutter, and nail file

Status of works Start End In Not date date Complete progress started ::::-

:-

Responsible person

Remarks

5.4 Services, Facilities, Equipment, Tools, and Instruments

169

5.4.4.5 Clean Supply Room See Table 5.25. This room shall have a hermetically sealed door operational with sensors. The room shall have stainless steel racks divided into bins to store the sterilized material stacked set-wise or surgery-wise or OR-wise. 5.4.4.6 Theatre Sterilization Supply Unit (TSSU) See Table 5.26. A quick steam sterilizer, a hot-air oven, and a formalin chamber shall be provided in the OT complex’s sterilization room. The room shall have a sufficient supply of soft water for the sterilizer and the necessary drain. There shall be sufficient ventilation and exhaust systems in the room. It shall also have the necessary electrical point to connect the machines. Additionally, a compressed air outlet shall be provided to clean the instruments’ detritus if necessary. Table 5.24  Instrument trolley lay-up in OT complex

Activity Bins/racks/ almirahs/ cupboards/drawers, etc. Working countertop Waste bins

Start date

Status of works End In Not Responsible date Complete progress started person Remarks

:-

::-

Table 5.25  Clean supply room in OT complex

Activity Hermetically sealed door operational with sensors Stainless steel racks divided into bins

Status of works Start End In Not date date Complete progress started :-

:-

Responsible person

Remarks

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5  Operation Theatre Suite (OT)

Table 5.26  Theatre sterilization supply room (TSSU) in OT complex

Activity Quick steam sterilizer Hot-air oven Formalin chamber Supply of soft water Adequate arrangement for exhaust and air exchanges Required electrical point to connect the machines Compressed air outlet

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

:-

:-

Further Reading Agnew GH. Designing the operative suite. Can Med Assoc J. 1965;93(20):1071–9. Blowers R, Crew B. Ventilation of operating-theatres. Epidemiol Infect. 1960;58(4):427–48. BRAINLAB.  Different types of operating rooms: hybrid, integrated, digital O.R.  Brainlab. [cited 2021 Jun 21]. Available from: https://www.brainlab.com/journal/ hybrid-­integrated-­digital-­o-­r-­differences-­similarities/. Chow TT, Kwan A, Lin Z, Bai W. Conversion of operating theatre from positive to negative pressure environment. J Hosp Infect. 2006;64(4):371–8. Essex-Lopresti M. Operating theatre design. Lancet. 1999;353(9157):1007–10. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p.  181–201. Chapter 19, Operation Theatre Suite Gupta S, Bharti AA. Interior designing for general operation theater (an architectural approach). Int Res J Eng Technol. 2018;5(11):6. Harry. General operating theatre design. Hospital Design Tips. [cited 2021 Jun 21]. Available from: https://hospitaldesigntips.com/2017/12/07/general-­operating-­theatre-­design/. Harsoor SS, Bhaskar SB.  Designing an ideal operating room complex. Indian J Anaesth. 2007;51(3):193. HCD Mag. [cited 2021 Jun 21]. Available from: https://healthcaredesignmagazine.com/ architecture/integrated-­operating-­room/. Healthcare Facilities. Planning and constructing a hybrid operating room: Lessons learned. Building Design + Construction. [cited 2021 Jun 21]. Available from: https://www.bdcnetwork.com/blog/planning-­and-­constructing-­hybrid-­operating-­room-­lessons-­learned. Humphreys H. Infection control and the design of a new operating theatre suite. J Hosp Infect. 1993;23(1):61–70. Indmedica. J Acad Hosp Admin. [cited 2021 Jun 21]. Available from: https://www.indmedica.com/ journals.php?journalid=6&issueid=72&articleid=907&action=article. Kameel R, Khalil E. Energy efficient and hygienic operating theatres’ Hvac airside design: architectural and engineering consideration. In: 1st International Energy Conversion Engineering Conference (IECEC). American Institute of Aeronautics and Astronautics; [cited 2021 Jun 21]; 2003. https://doi.org/10.2514/6.2003-­5997. Kavic MS. Operating room design: “The Devil is in the Details”. JSLS. 2001;5(4):297–8.

Further Reading

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Krupka D, Sandberg W. Operating room design and its impact on operating room economics. Curr Opin Anaesthesiol. 2006;19:185–91. Kumar S. Designing an ideal operating room complex. [cited 2021 Jun 21];Available from: https://www. academia.edu/29223685/DESIGNING_AN_IDEAL_OPERATING_ROOM_COMPLEX. Mayes BT. Installations in operating theatres. Archit Sci Rev. 1961;4(1):2–5. Ng I. Integrated Intra-operative room design. In: Pamir MN, Seifert V, Kiris T, editors. Intraoperative imaging. Vienna: Springer; 2011. p. 199–205. https://doi.org/10.1007/978-­3-­211-­99651-­5_31. [cited 2021 Jun 21] (Acta Neurochirurgica Supplementum). Sánchez-Barroso G, García S-CJ.  Evaluation of HVAC design parameters in high-performance hospital operating theatres. Sustainability. 2019;11(5):1493. Smylie HG, Dudley HAF.  X Some principles in operating theatre design. Scott Med J. 1961;6(12):588–96. Weldon S-M, Korkiakangas T, Bezemer J, Kneebone R. Music and communication in the operating theatre. J Adv Nurs. 2015;71(12):2763–74.

6

Labour Delivery Room (LDR)

Childbirth takes place in the labour room, often known as the delivery suite. It also goes by the name ‘birthing unit’. The facilities offered by this unit are to provide secure prenatal care, delivery, and immediate post-partum care for women and babies. This shall be referred to as ‘LDR’ in this chapter (labour, delivery, and resuscitation). To assess the LDR, the staff is required to wear protective apparel such as shoe covers, masks, caps, eye shields, and other coverings to stop the spread of germs and microorganisms, creating a sterile atmosphere. The area shall be well lit, and the temperature and humidity kept within acceptable ranges. Delivery suites, on the other hand, are more like a collection of various rooms dispersed around the complex’s many zones, such as the unsterile zone, protective zone, and delivery zone. While planning and designing the delivery suite in the hospital, it has to be ensured that all the works are complete and operational. Similarly, all the services shall be operational before the delivery starts in the delivery suite. Just like the operating complex, delivery suite also has a few issues that need to be ensured before the hospital is in operation, such as the following: the required infrastructure is provided; layout of the department is perfect; required services are available; proper furniture and fixtures are in place; required electrical points and communication ports have been provided; public utilities have been provided; signage, wayfinding, and display mechanisms are in place; required instrument/equipment/gadgets are available; required facilities are available; patient/staff/visitor safety mechanisms are available; proper lighting is ensured; proper environmental control with heating and air conditioning is available; security devices and mechanisms are provided; announcement systems are in place; and wall, ceiling, and interior decoration are up to the mark and appealing. This set of checklists shall help the planner and designer to remember all such issues relating to the delivery suite and guide him/her to complete, test, and

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_6

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commission all works/activities well in time. This will help him/her to ensure ­himself/herself that all the works/activities are carried out, completed, and working before the deliveries start in the delivery suite.

6.1 Location of LDR Complex While choosing the location of the LDR complex, it shall be ensured that LDR shall be located in a restricted area with limited access. The LDR complex shall also be situated in a cluster at the same location and ideally on the same floor. Avoid scattering it into different areas. LDR shall be situated close to the obstetric department because it is a section of the maternity unit or obstetric unit. The LDR shall also be close to the neonatal intensive care unit (NICU).

6.2 Zones in LDR Complex The LDR complex is divided into the following three zones: • Unsterile zone: This zone is generally not sterile, and normal movement is permitted without change. • Protective zone: Movement is sometimes restricted in this zone, which is somewhat more sterile. The only way to assess the area is to change shoes. Change rooms, supply of goods and services, as well as areas for pre- and post-labour wards are primarily located in this area. • Delivery zone: This room which is extremely sterile and aseptic is designated for the actual birth and resuscitation of babies.

6.3 Infrastructure 6.3.1 LDR Space Requirement See Table 6.1. Regarding the LDR complex’s infrastructure needs, the zoning of the complex is considered to design and provide the rooms. We have made an effort to provide information about these rooms zone-wise.

6.3.1.1 Unsterile Zone All people who need to offer services or materials, or who need to communicate with the LDR staff, are allowed to move around this zone of the LDR complex because it is not sterile. This area is connected to the entry corridor through the LDR complex’s entrance gate. Details of the rooms in this area include the following:

175

6.3 Infrastructure Table 6.1  LDR space requirement

Activity Following spaces shall be provided in LDR complex: Unsterile zone Administrative area Labour room in-charge Gynaecologist room for office work Entry door for changing room Trolley bay Shoe-changing area Linen pre-wash room Instrument wash room Waiting area for attendants Public utility for attendants Protective zone Pre-labour patient beds Eclampsia beds Examination/ preparation room Postnatal recovery Nurses’ change room with toilet—males Nurses’ change room with toilet—females Class IV change room with toilet—males Class IV change room with toilet—females Doctors’ change room with toilet—male Doctors’ change room with toilet—female Unsterile store for equipment storage Store for medicine, consumables, and disposables Doctors’ night duty room—males

Status of works In Not Start End date date Complete progress started

Responsible person Remarks

::::::::::-

::::::::::::-

:(continued)

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Table 6.1 (continued)

Activity Doctors’ night duty room—females Surgeons’ restroom Staff restrooms for males Staff restrooms for females Pantry Delivery zone Delivery room Baby bath and resuscitation area Exit doors of change rooms Scrub station Clean supply room Dirty utility Instrument trolley lay-up Quick sterilization room

Status of works In Not Start End date date Complete progress started

Responsible person Remarks

:::::::::::::-

Administrative area: The staff members in-charge of managing the LDR complex are the administrative and support personnel who work in this area. The staff may come from the nursing, purchasing, stores, sterilization, and housekeeping departments, among others. The size of this room shall be about 3658 mm × 4572 mm, though it may be smaller or larger based on the necessity and the number of persons expected to be sited in the room. Preferably, the administrative room shall have an attached toilet. If necessary, a room for the secretary or personal assistant can also be provided. If necessary, this room shall be provided with a separate store. If necessary and lengthy workdays are anticipated, a small restroom or lounge might be provided alongside this room. Labour room in-charge: This room, which belongs to the person in charge of the LDR complex, shall also be located at the entrance to the LDR complex. He/she will unavoidably have a lot of visitors and staff because it is their job to monitor all of the complex’s non-medical operations. This area shall be approximately 4572 mm × 4267 mm in size. It is preferable if the room has a connected toilet. The secretary’s or personal assistant’s room can also be provided if necessary. If necessary, this space shall have an adjacent store. A small restroom or lounge might be provided in this area if necessary and lengthy working hours are anticipated.

6.3 Infrastructure

177

Gynaecologist room for office work: This room is used by the gynaecologist and her assistants to accomplish the administrative duties related to the deliveries they carry out, such as drafting delivery notes. The birth register is usually kept here for daily entry. The dimensions of this room shall be around 3658 mm × 4267 mm. Preferably, the room shall have an attached toilet. If necessary, a room for the secretary or personal assistant shall be provided. If required, this room shall have a connected separate store. If lengthy workdays are anticipated, a small restroom and lounge area might be provided alongside this room. Entry door for changing room: The LDR complex shall have several types of change rooms for gynaecologists, technicians, nurses, and class IV workers who are required to work in the complex’s sterile zone. The changing room shall ideally have two doors: one for entry and another for the exit. The intention is to prevent personnel from entering the non-sterile area following the change. Therefore, a door for entrance to the changing room shall be provided in this zone. Trolley bay: The space designated for the wheelchairs and stretcher trollies assigned to the LDR complex shall be located here. After birth, these stretcher trollies are generally used to transport the patient out from the LDR complex. Shoe change area: This area shall have space for shoe changing. The staff must take off their outer shoes before changing into the sleepers or shoes that have been provided for this purpose. Linen pre-wash room: This room is used to pre-wash the dirty linen before sending it from the LDR to the laundry. This room shall be located close to the LDR complex exit gate or the exit of the corridor leading to the LDR. Instrument wash room: This room is used to pre-wash the surgical instruments used in the LDR before sending them to the CSSD for sterilization. Therefore, this room shall be located close to the LDR complex’s exit gate. Waiting area for attendants: The family and friends of the patient undergoing a delivery in LDR should stay in this area. The family members, who are quite curious, prefer to sit close to the LDR complex rather than in a distant location. Therefore, a waiting area shall be provided outside the LDR complex’s main entrance. Public utility for attendants: Along with the family members’ waiting area, toilets shall be provided. If possible, separate toilets for men and women shall be offered. Additionally, a drinking water facility shall be provided.

6.3.1.2 Protective Zone It is somewhat more sterile than an unsterile zone, and sometimes movement is restricted in this zone. Only after removing the shoes or wearing shoe covers can this zone be assessed. No change of clothing is required to visit this place. This area must be separated from the unsterile zone by a secure door that is placed right after the unsterile zone. Details of the rooms in this zone are listed below: Pre-labour room/ward: Pregnant women are held in the pre-labour room or ward during the painful stages of labour until the cervix has dilated and the patient

178

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is prepared for delivery. There should be enough beds in the ward/room because it is quite difficult to determine how long the patient will be staying there. Four beds per labour table are advised based on experience. However, it is advised not to keep more than four beds in one ward, and if more beds are required, an additional ward/ room shall be provided. Sometimes, a patient may want a single room since they do not want to stay in the same ward with other labour patients. Further, the patient shall be placed in a single room if she is restless and disturbing the other patients. Therefore, it will be better to provide a three-bed ward and a single room for each labour table. Size-wise, if there are three beds in a ward, 80–100 square feet per bed, or a 4572 mm × 6096 mm room, is typically enough. The size of the single room shall be roughly 4267 mm × 3658 mm. An adjoining toilet and bathroom with a bath and shower facility shall be provided. There must be sufficient space for patients to move around the room with support. The designated areas shall be provided for the mother’s belongings, gifts, and flowers. Eclampsia room: The LRD must provide a room designated for pre-labour eclampsia patients. Some architects favour having a single ward with two to three eclampsia beds. It is advised to have a single-bed eclampsia room rather than a single ward with many beds because the condition makes the patient quite disturbed. For every labour table, there shall be one eclampsia room. The room shall be roughly 4267 mm × 3658 mm in size. Examination/preparation room: While the patient is in labour pain, this room is utilized to check for cervix dilation and bleeding. Before transferring her to the labour room, this room shall serve as a preparation room to complete the necessary formalities. There shall be an examination couch in this room, and the size of the room shall be roughly 3658 mm × 3658 mm. Postnatal recovery ward: After delivery, the mother and child shall be removed from the delivery room, and the mother is generally transferred to the post-labour ward or room. This ward/room is used to provide specialized care to the mother until she is stable. Per the labour table, two beds are generally sufficient. But sometimes, a patient may prefer to stay in a private room rather than in a ward with other patients. As a result, a post-labour room with a single bed shall be provided. Size-wise, if we consider three beds in one ward, generally, 80–100 sq ft. space per bed is sufficient, i.e. the room size can be 4572 mm × 6096 mm. For a single bedroom, the size shall be about 4267 mm × 3658 mm. The nursing station shall be provided in the centre of the post-labour recovery ward or outside the rooms in case of the single bedroom. Changing rooms: The LDR complex shall be provided with changing rooms where the employees and doctors can change into their LDR clothing after taking off their outerwear. The changing areas should ideally have a toilet attached to them. These toilets shall be separate for males and females. The number of changing rooms shall vary, depending on how many staff members are required at the LDR complex. There must be a different changing area available for each category of the staff member. Men and women shall have separate changing areas. Each changing

6.3 Infrastructure

179

area must be at least 4267 mm × 4572 mm in size. Typically, the OT complex shall provide the following change rooms: • • • • • •

Doctors’ change room—males Doctors’ change room—females Nurses’ change room—males Nurses’ change room—females Class IV staff change room—males Class IV staff change room—females

Unsterile store for equipment storage: Due to the LDR’s high level of sensitivity, additional tools and equipment must be kept there. These are maintained on hand, even though they are not commonly used, to act as a backup for the necessary tools and equipment. The dimensions of the equipment store must be at least 4572 mm × 6096 mm. Store for medicines, consumables, and disposables: A gynaecologist may raise a need for drugs, consumables, and disposables during delivery depending on the patient’s condition. The gynaecologist’s demand should be fulfilled straight away because they will not be able to wait. To avoid any unfortunate incidents, all necessary medications, consumables, and disposables are often kept on hand at the OT complex. Such goods shall be kept in a separate room within the protected zone of the LDR complex. The space must be at least 3658 mm × 3658 mm. Doctors’ night duty rooms: A doctor must be posted on duty day and night since LDR must be operational 24/7. Hence, the LDR complex needs doctor duty rooms. Male and female night duty rooms shall be separate. The room must be 3658 mm × 4267 mm in size and have a toilet attached to it. Surgeons’ restroom: The ‘surgeons’ lounge’ is another name for this space. Gynaecologists use this room to relax, finish patient files, write labour notes, and prepare post-labour prescriptions. The lounge shall have an attached toilet with a provision for serving tea and coffee from the pantry. The lounge shall be roughly 4267 mm × 4572 mm in size. Restroom for staff—males and females: The staff must have access to a lounge just like the surgeons do. But there shall be separate lounges for men and women. Additionally, these restrooms shall have attached toilets. Pantry: To enable the employees to enjoy tea or coffee whenever there is a break from deliveries, a small pantry is provided in the LDR complex. The needs of the staff lounge or the doctor’s lounge can also be met by this pantry. In addition to tea and coffee, it may offer precooked light snacks and cookies. The pantry shall measure around 3658 mm × 3658 mm in size.

6.3.1.3 Delivery Zone It is in this zone where the actual vaginal birth takes place. The LDR complex’s most vulnerable area is this one. Aseptic practices shall be strictly followed in this area. Swing-type doors that shall be at least 629 mm wide shall be provided to divide the delivery zone from the protection zone. These doors must be sealed to prevent the

180

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entry of any unwanted organisms into this sterile area. Similar doors are provided on the exit side of this zone. The movement in this zone shall be strictly restricted, and only authorized persons shall be allowed, that too after the proper change, with caps and masks. Just at the entry of this zone, a shoe rack is placed which contains sterilized shoes or slippers to be worn before entering this zone. A double door with an airlock must be provided at the zone’s exit end to transfer the patient out of the recovery area. Details of the rooms located in this zone are as follows: Delivery rooms: This is the room where the actual vaginal deliveries are carried out. This room has to be the most sterile and aseptic area in the whole of the LDR complex. No person is allowed in the LDR without wearing protective clothing, including sterilized shoes or slippers, masks, caps, eye shields, and other coverings to prevent the spread of germs. As far as the number of delivery rooms is concerned, there is no thumb rule to decide the number of delivery rooms to be provided. However, there are a variety of factors that will affect the decision on the number of delivery rooms. These factors include the following: How many delivery patients are anticipated each month? How many women seeking obstetric care are generally referred to this hospital each day? In the LDR complex, the delivery rooms shall be located in the most sterile and restricted zone. Separate septic delivery suites shall be provided in the LDR complex for infectious deliveries. This delivery room shall be built to the same standards and specifications as all others. The furniture and equipment in this delivery room, however, shall be separate and shall not be used in the regular delivery room. When designing the delivery suite, some concerns need to be taken into consideration, such as the necessity for dimmable lighting in labour rooms for patient comfort. The foot end of the labour table should be facing away from the door or the access point, and the walls should include a sound-deadening material to prevent noise transfer between rooms. Avoid direct views into the room from the outside, through the windows and doors, i.e. do not provide door-viewing panels and a privacy curtain shall be provided. Types of delivery rooms: The design of delivery rooms has advanced significantly over time based on requirements and technological advancement. Modern delivery rooms are expected to be completely sterile and to have ideal environmental conditions. Different types of delivery rooms are as follows: 1. Simple delivery rooms 2. Prefabricated modular delivery rooms 3. Semi-modular delivery rooms 4. Modular delivery rooms The construction and design of all types of delivery rooms are exactly as per OR. Thus, for further detail on this topic, please refer to Chap. 5 titled ‘Operation Theatre Suite’ of this book. Baby bath and resuscitation area: Delivery rooms shall have a space for stabilizing and resuscitating infants. Often, a partition separates the baby resuscitation section

6.3 Infrastructure

181

within the delivery room. In such cases, windows and doors shall be designed to provide visual and acoustic privacy while also allowing for the easy exchange of an infant between staff. When an operative delivery room is provided with a pass-through window or door, it shall have a positive pressure so that when the window or door is opened, air flows out to the infant room. Each delivery and resuscitation room’s ventilation system shall be designed to keep the ambient temperature between 72 and 78  °F (22–26 °C) during the delivery, resuscitation, and stabilization of the newborn. For infant space, there must be a minimum of 80 square feet of free floor space. This area can be utilized for a variety of things, such as infant needs, stabilization, observation, examination, sleep, or other needs. Exit doors of all change rooms: All change rooms’ exits shall be in the clean zone. From here, the staff and gynaecologists shall proceed to the delivery zone. The exit doors shall be 914 mm wide and swing type, closing automatically. Scrub station: Before going into the delivery room, one utilizes the scrub station to wash up. Everyone who is a part of the delivery process must be washed up in this area. It should be just next to the labour room. The scrub station can be in an enclosed space or an open area. If it is in a closed room, the door shall be able to effortlessly swing open and shut with a simple foot touch and have a clear glass panel in the centre. Clean supply room: This room is also known as clean store. The tools and linen that were obtained from CSSD and properly sterilized are primarily kept in this room. Additionally, it is utilized to store sterile supplies and disposables that are generally used in the labour room. To efficiently meet the needs, this room shall be close to the labour room. This room shall be approximately 4572 mm × 3658 mm in size, have just one access, and have a swing-type door that can be opened on both sides. Even so, it is preferable if the door has sensors and is hermetically sealed. The room shall be windowless, but if a window cannot be avoided, it must be sealed with double-glazing glass. This space shall not have a water supply or drain. Dirty utility: Many used objects, including linen, instruments, disposable item covers, soiled drapes, cotton, gauze, etc., need to be removed after delivery. From the labour room, the instruments go to the instrument washroom, while the linen is sent to the linen pre-wash section. As a result, the exit side of the LDR complex shall have this dirty utility room. It shall be roughly 3048 mm × 3048 mm. Instrument trolley lay-up: This room is used to prepare the trolley for delivery. From the clean supply room, the material is brought into this room and placed on a trolley, which will then be taken to the relevant labour room. This room shall be roughly 3658 mm × mm in size, have just one access, and have a swing-type door that can be opened on both sides. The door has to be sealed. The room shall be windowless, but if a window cannot be avoided, it shall be sealed with double-glass glazing. There shall be no drain or water supply in the room. Quick sterilization room: The gynaecologist may sometimes need an instrument during delivery, or if an instrument accidentally falls and becomes contaminated, it must be rapidly sterilized and given back to the gynaecologist. Hence, the sterile zone of the LDR complex shall have a small sterilization room that is typically referred to as the theatre sterile supply unit. The room should be roughly 3658 mm × 3658 mm in size.

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6  Labour Delivery Room (LDR)

6.4 Services, Facilities, Equipment, Tools, and Instruments 6.4.1 Unsterile Zone 6.4.1.1 Administrative Rooms See Table 6.2. All the administrative rooms including the LDR in-charge and gynaecologists’ room shall be provided with the office table, side racks, office chairs, and visitors’ chairs. An adequate arrangement shall be made for cabinets, drawers, and racks for smooth working. The room shall also have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning. 6.4.1.2 Trolley Bay See Table 6.3. The trolley bay shall have sufficient provision to hold the trollies in place. Hence, a sufficient number of hooks and chains shall be provided on the walls. Table 6.2  Administrative rooms in LDR

Activity These rooms shall be provided with Office table Office chairs Visitors’ chairs Side rack Cabinets, drawers, and racks Required electrical points Intercom connection IT network CCTV surveillance Air conditioning

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

::::::::::-

Table 6.3  Trolley bay in LDR

Activity Chains and hooks to hold the trollies in place

Start date :-

Status of works End In Not date Complete progress started

183

6.4  Services, Facilities, Equipment, Tools, and Instruments

6.4.1.3 Shoe-Changing Areas See Table 6.4. A sufficient number of shoe racks and a chair for sitting while removing or wearing shoes shall be provided in the shoe-changing area. 6.4.1.4 Linen Pre-Wash Room See Table 6.5. A room shall be provided with a sink, draining board, and a low-height water tap to wash the clothes. Special care shall be taken about the slope in this room so that the water does not spill outside the room. If required, the wash line can also be provided to dry the linen. 6.4.1.5 Instrument Wash Room See Table 6.6. The room shall be provided with a large-size sink, draining board, and a countertop for drying up the instruments. It is recommended that the instrument room shall be provided with a hot air dryer to dry the instruments. Table 6.4  Shoe-changing areas in LDR

Activity Shoe racks Chair

Start date

End date

Status of works In Complete progress

Responsible Not started person

Remarks

::-

Table 6.5  Linen pre-wash room in LDR

Activity Sink Draining board Low-height water tap

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::-

Table 6.6  Instrument wash room in LDR

Activity Large-size sink Draining board Countertop for drying up the instruments

Status of works Start End In Not date date Complete progress started :::-

Responsible person

Remarks

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6  Labour Delivery Room (LDR)

Table 6.7  Attendant waiting area in LDR

Activity Sofa sets Chairs/recliners Speakers of the PA system Separate toilets for males and females Small cafeteria Drinking water facility Mobile charging points Wi-Fi and internet facility CCTV surveillance

Status of works Start End In Not Responsible date date Complete progress started person Remarks :::::::-

:-

6.4.1.6 Attendant Waiting Area See Table 6.7. The waiting area shall have comfortable sofa sets or chairs/recliners for the sitting of the visitors and family members of the patient. The waiting area shall have a toilet block attached to it. Preferably, the toilets shall be separate for men and women. Along with this, a facility for drinking water shall be provided. For water supply, either water coolers or water drinking fountains can be provided. If possible, a small cafeteria shall be provided from where the precooked snacks and cookies can be served. Along with this, the tea coffee vending machine shall also be provided. To hear announcements issued from the LDR, there shall be a speaker in this area that is connected to the mike system installed in the LDR complex. The LDR staff shall have access to an intercom placed in this area so that the staff may reach the family members in case of emergency. Try providing Wi-Fi and an internet facility. The waiting area shall also have the facility for mobile charging points near the seating areas. To prevent unwanted family member mobility within the LDR complex, this area shall be watched over by security personnel and shall always be under CCTV surveillance.

6.4.2 Protective Zone 6.4.2.1 Pre-labour Room/Ward and Eclampsia Room See Table 6.8. The pre-labour ward/room shall have a sufficient number of patient beds. The number of beds shall depend on the number of LDRs. The beds shall preferably be Fowler type with the facility of head up and shall have swivelling wheels.

6.4  Services, Facilities, Equipment, Tools, and Instruments

185

Table 6.8  Pre-labour room/ward and eclampsia room in LDR

Activity Pre-labour ward shall have the following furniture: Patient beds Bedside locker Over-bed table Wheelchair Stretcher trolley Instrument trolley Step stool IV stand IV rod Oxygen cylinder trolley Nursing counter Office chairs Almirah/cupboard Filing cabinet Visitor chairs, etc. Pre-labour ward shall have the following equipment: Multi-para vital sign monitor Facility of foetal monitoring such as cardiotocograph (CTG) Infusion pump Syringe pumps Defibrillator Suction machine BP apparatus Stethoscopes Oxygen cylinders with masks View box Ambu mask of different sizes Pre-labour ward shall have the following tools/ instruments: Sterilizing drums Trays

Status of works In Not Responsible Start End Remarks date date Complete progress started person

:::::::::::::::-

::-

:::::::::-

::(continued)

186

6  Labour Delivery Room (LDR)

Table 6.8 (continued)

Activity Extension cords and boxes Torches Emergency medicines MGPS outlets for oxygen and vacuum Bed head panel Nurse call button on each bed Two electrical outlets on each bed Other facilities in the ward Pain relief methods such as bean bags, alternative seating areas, and shelves for patients to lean on at standing and sitting heights Space for patients to walk around the room with sufficient support Space for the mother’s belongings, gifts, and flowers Provision of soothing music or aromas Grab rails for patients Required electrical points for preoperative ward Required other communication points Curtain partitions on all the beds

Status of works In Not Responsible Start End Remarks date date Complete progress started person :::::::-

:-

:-

:-

:::::-

Furniture-wise, the pre-labour ward/room shall have bedside lockers and over-­ bed tables with all the beds. Other than this, the ward/room shall be provided with wheelchairs, stretches, instrument trollies, step stools, IV stands, IV rods, and oxygen cylinder trollies. For nursing stations, the nursing counter, office chair, almirah/cabinets/cupboards, filing cabinets, and visitors’ chairs shall be provided.

6.4  Services, Facilities, Equipment, Tools, and Instruments

187

As far as the equipment is concerned, the ward/room shall have multi-para vital sign monitor, cardiotocograph to monitor the heartbeats of the baby, infusion pump, syringe pumps, defibrillator, suction machine, BP apparatus, stethoscopes, oxygen cylinders with masks, view boxes, and Ambu mask of different sizes. In addition to this, the ward/room shall have tools like sterilizing drums, trays, extension cord boxes, torches, and most importantly emergency medicines. Medical gas pipeline mounted on the bed head panel shall be provided on all the beds. The medical gases shall be oxygen and suction. Individual nurse call buttons shall be provided on all the beds in the ward. Each bed shall be provided with at least two electrical points to connect the medical devices. The ward/room shall have provisions to support a variety of pain relief methods such as bean bags, alternative seating areas, and shelves for patients to lean on at standing and sitting heights. In the ward/room, space shall be provided for the patients to walk around in the room with sufficient support. Similarly, the spaces shall be provided for the mother’s belongings, gifts, and flowers. It is further recommended that the ward/room shall have the provision of soothing music or aromas. Other than this, sufficient electrical outlets and communication ports shall be provided in the ward. Preferably, all the beds in the wards/room shall be provided with the curtain partition to maintain the privacy of the patient. All the facilities mentioned above for the wards shall also be provided in the individual pre-labour room and the eclampsia room.

6.4.2.2 Examination/Preparation Room See Table 6.9. The preparation room shall have an examination couch with a step stool, instrument trollies, IV stands, and oxygen cylinder trollies. For general work, the room shall have an office table, office chair, almirah/cupboards, and filing cabinets. As far as the equipment is concerned, the room shall be provided with portable OT light, multi-para vital sign monitor, BP apparatus, stethoscopes, oxygen cylinders with masks, view box, and Ambu mask of different sizes. In addition to this, the preparation room shall have tools like sterilizing drums, trays, extension cord boxes, and torches. Near the examination couch, the supply of medical gas pipeline, i.e. oxygen and suction, shall be provided. Other than this, sufficient electrical outlets and communication ports shall be provided in the room. For hand washing, the washbasin shall be provided in the room, with the provision of running hot and cold water.

188

6  Labour Delivery Room (LDR)

Table 6.9  Examination/preparation room in LDR

Activity Examination/ preparation room shall have the following furniture: Examination couch Step stool Instrument trolley IV stand Office table Office chairs Almirah/cupboard Filing cabinet Examination/ preparation room shall have the following equipment: Portable OT light Multi-para vital sign monitor BP apparatus Stethoscopes Oxygen cylinders with masks View box Ambu mask of different sizes Examination/ preparation room shall have the following tools/instruments: Sterilizing drums Trays Extension cords and boxes Torches MGPS outlets for oxygen and vacuum Other facilities in the room Required electrical points Required other communication points Washbasin for hand wash

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::::-

:::::::-

:::::-

:::-

6.4  Services, Facilities, Equipment, Tools, and Instruments

189

6.4.2.3 Post-labour Ward/Room See Table 6.10. The post-labour ward/room shall have a sufficient number of patient beds. The number of beds shall depend on the number of LDR. The beds shall preferably be Table 6.10  Post-labour ward/room in LDR

Activity Post-labour ward/room shall have the following patient furniture: Patient bed (should be multi-positional ICU bed) Bedside locker Over-bed table Bassinets Wheelchair Stretcher trolley Dressing trolley Instrument trolley Step stool Scrub station IV stand IV rod Crash cart Oxygen cylinder trolley Backrest, etc. Post-labour ward/room shall have the following furniture: Nursing counter Office chairs Almirah/cupboard Filing cabinet Visitor chairs, etc. Post-labour ward/room shall have the following equipment: Multi-para vital sign monitor Non-invasive ventilator Infusion pump Syringe pumps Defibrillator ECG machine

Status of works In Not Responsible Start End Remarks date date Complete progress started person

:-

::::::::::::::-

:::::-

::::::(continued)

190

6  Labour Delivery Room (LDR)

Table 6.10 (continued)

Activity Suction machine BP apparatus Stethoscope Ultrasound machine Glucometer Oxygen cylinders with masks View boxes, etc. Ambu mask of different sizes Post-labour ward/room shall have the following tools/instruments: Sterilization drums Extension cords and boxes Portable operating light Refrigerator Instrument boxes Torches Tray of all styles and sizes All other required instruments Other issues Provide two-way scrub stations for hand hygiene MGPS outlets for each bed Two outlets for oxygen One outlet for compressed air Two outlets for suction Bed head panels/ ceiling-suspended pendants for medical gas outlets and electrical points Required electrical points Required other communication points Curtain partitions on all the beds

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::::::-

::::::::-

::::::-

:::-

6.4  Services, Facilities, Equipment, Tools, and Instruments

191

multi-positional (preferably motorized) intensive care beds with the facility of bedside railing, high-low, head up, Trendelenburg, and reverse Trendelenburg and shall have swivelling wheels. Furniture-wise, the post-labour ward/room shall have bedside lockers and over-­ bed tables with all the beds. The wards or rooms shall have the required number of bassinets for the newborn baby to be laid down alongside the mother. Other than this, the ward shall be provided with wheelchairs, stretches, crash carts, instrument trollies, dressing trollies, step stools, IV stands, IV rods, oxygen cylinder trollies, scrub stations, backrests, etc. For nursing stations, the nursing counter, office chair, almirah/cabinets/cupboards, filing cabinets, and visitors’ chairs shall be provided. As far as the equipment is concerned, the ward shall have multi-para vital sign monitor, infusion pump, non-invasive ventilator, syringe pumps, ECG machine, defibrillator, suction machine, BP apparatus, stethoscopes, ultrasound machine, glucometer, oxygen cylinders with masks, view boxes, and Ambu mask of different sizes. In addition to this, the ward shall have tools like sterilization drums, trays of various styles and sizes, extension cords and boxes, portable operating lights, instrument boxes, torches, refrigerator, two-bay scrub station, and most importantly emergency medicines in crash cart. Medical gas pipeline mounted on the bed head panel shall be provided on all the beds. The medical gases shall be oxygen, suction, and compressed air. Each bed shall be provided with at least two electrical points to connect the medical devices. Other than this, sufficient electrical outlets and communication ports shall be provided in the ward. Preferably, all the beds in the wards shall be provided with the curtain partition to maintain the privacy of the patient.

6.4.2.4 Staff Change Room See Table 6.11. Adequate personal lockers shall be provided in the room, to enable the staff to keep their personal belongings. Each staff member shall preferably be allotted one such locker. One chair shall be provided in the room, which the staff can use while changing their clothes. For hanging the outside clothes, an adequate number of hooks shall be provided on the wall. Apart from this, the almirah and hanger rods with the hangers shall also be provided to hang the clothes. There shall be a closed cabinet to keep the sterilized LDR dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. One table shall be provided in the room to keep the containers of fresh unused masks and caps.

192

6  Labour Delivery Room (LDR)

Table 6.11  Staff change room in LDR

Activity Staff lockers to keep their personal belongings One chair and cupboards Hooks on the wall to hang clothes Hanger rods Almirah for hanging clothes Cabinet to keep the sterilized LDR dresses Bin for dirty linen Intercom point Air-conditioned

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

:::::-

:::-

Table 6.12  Unsterile store for equipment storage in LDR

Activity Lockable cupboards, racks, and drawers Working counter Multiple electric points to charge equipment when not in use Air conditioning with controlled humidity level

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:::-

:-

A large bin for dirty linen shall also be provided in the changing room. Also, a separate bin shall be provided for disposal of the used masks, caps, and shoe covers. The room shall have the provision of an intercom and shall have adequate air conditioning.

6.4.2.5 Unsterile Store for Equipment Storage See Table 6.12. The equipment store shall have a sufficient number of working countertops to place the countertop equipment and instruments. For bulk equipment, sufficient floor space shall be available.

193

6.4  Services, Facilities, Equipment, Tools, and Instruments

The store shall have adequate lockable cupboards, racks, and drawers to store the equipment and instruments. The store shall also have multiple electric points to charge the equipment when not in use. The store shall have proper air conditioning and controlled humidity levels to prevent the electronic equipment from excessive heat and moisture.

6.4.2.6 Store for Medicines, Disposables, and Consumables See Table 6.13. For storage of medicines, consumables, and disposables in the LDR complex, the storeroom shall have adequate lockable cupboards, racks, and drawers to stock the material. The working countertop shall be provided to prepare the drugs if required. Furniture-wise, the office chairs and the table shall be provided for the staff to sit and perform duties. For storing the drugs requiring low temperatures, a refrigerator shall be provided. A waste bin for disposal of the covers, empty boxes, and wrappers shall be provided. The store shall have the computer, UPS, printer, and barcode scanner installed on the office table. The service window shall be provided on the corridor side of the room to serve and dispense with the material. This is required to restrict the entry of unwanted staff into the store. The room shall have proper air conditioning and controlled humidity levels. Table 6.13  Store for medicines, disposables, and consumables in LDR

Activity Lockable cupboards, racks, and drawers Countertop to prepare the drugs Refrigerator Waste bin Office chairs Office table Computer with UPS, printer, and barcode scanner Service window Air conditioning with a controlled humidity level

Status of works Start End In Not date date Complete progress started :::::::-

::-

Responsible person

Remarks

194

6  Labour Delivery Room (LDR)

6.4.2.7 Doctors’ Night Duty Room See Table 6.14. Furniture-wise, the room shall have one office table, chair, cupboard, and bed. Apart from the light and fan, the room shall have points for a computer with an internet connection and intercom. Also, the room shall be air-conditioned with a control button with temperature adjustment in the room. 6.4.2.8 Surgeons’ Lounge/Restroom See Table 6.15. The surgeons’ lounge/restroom shall be provided with a few sofa sets/chairs/ recliners and centre tables. If required, the dining table with chairs can also be provided in the room. On request, a single bed can also be placed in the lounge for surgeons to lie down for some time. The room shall preferably be provided with a computer with UPS and an internet connection so that the surgeons can surf the internet in their spare time. The lounge shall have the facility of tea/coffee, which can be either served from the pantry or provided through the vending machine. Table 6.14  Doctors’ night duty room in LDR Status of works Start End In Not date date Complete progress started

Activity Office table, chair, bed, and cupboard Computer with an internet connection and intercom Air-conditioned

Responsible person

Remarks

Responsible person

Remarks

::-

:-

Table 6.15  Surgeons’ lounge/restroom in LDR

Activity Sofa set and a centre table Single bed for resting Dining table with chairs Computer, UPS, and internet connection Provision of tea/ coffee

Status of works Start End In Not date date Complete progress started ::-

:-

:-

6.4  Services, Facilities, Equipment, Tools, and Instruments

195

6.4.2.9 Restroom for Staff See Table 6.16. The staff restrooms shall be provided with a few chairs and centre tables. If required, a single bed shall be provided in the lounge for staff to lie down for some time. The restrooms shall have the facility of tea/coffee, which can be either served from the pantry or provided through the vending machine. 6.4.2.10 Pantry See Table 6.17. The pantry shall be provided with a countertop slab for cooking. The provision of a sink with a draining board shall be made for washing utensils. A microwave, refrigerator, gas burner, and/or induction heater shall be provided in the pantry. A dedicated place shall be provided to place the cooking gas cylinder. A sufficient number of electric points shall be provided to operate these machines.

Table 6.16  Restroom for staff in LDR

Activity Chairs and centre tables Single bed for resting Provision of tea/coffee

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::-

Table 6.17  Pantry in LDR

Activity Countertop slab for cooking and placing gas burners or inductions Sink with draining board Microwave Refrigerator Gas stove burner and place for keeping the gas cylinder Induction heater Required electric points

Status of works Start End In Not date date Complete progress started :-

::::-

::-

Responsible person Remarks

196

6  Labour Delivery Room (LDR)

6.4.3 Delivery Zone 6.4.3.1 Delivery Rooms See Table 6.18. Though it is not possible to mention all the equipment that is required in the LDRs, we have tried to mention the important ones. The requirement may vary from hospital to hospital, department to department, and gynaecologist to gynaecologist. Table 6.18  Delivery rooms in LDR

Activity Following equipment shall be placed in the delivery room: Anaesthesia Boyle’s machine Blood pressure apparatus Electro-surgical cautery with pencils Electrical suction machine Defibrillator Mobile ultrasound Multi-para monitor with ET Co2 Portable OT light OT light double dome Tools for assisted deliveries Foetal Doppler Labour table Emergency light Surgical instruments UPS 10 KVA A clock with seconds hand on the wall Following furniture shall be placed in the delivery room: Instrument trolleys Crash cart Dressing trollies Mayo stand Swab rack

Status of works Start End In Not date date Complete progress started :-

::::::::::::::::-

:::::-

Responsible person Remarks

197

6.4  Services, Facilities, Equipment, Tools, and Instruments Table 6.18 (continued)

Activity Steel bucket with lid footstool Doctor stool IV stand LDR shall have the following tools/ gadgets: Sterilization drums Trays of all types and sizes Kidney tray of all sizes Bowls of all sizes Disinfection and sterilization trays Formalin chamber OT linen LDR shall have the following drugs: Emergency drugs Anaesthesia and analgesia drugs Antibiotics Fluids LDR shall have the following consumables and disposables: All types of catheters that may be required for delivery All types of infusion sets Cotton, bandage, and gauze Sutures (as required) Spare bulbs, batteries for equipment

Status of works In Not Start End date date Complete progress started

Responsible person Remarks

:::-

:::::::-

::::-

:-

::::-

Following are the equipment that shall be provided in the delivery room: • • • •

Anaesthesia Boyle’s machine Blood pressure apparatus Electro-surgical cautery with pencils Multi-para monitor with ET Co2

198

• • • • • • • • • • • • •

6  Labour Delivery Room (LDR)

Electrical suction machine Defibrillator Mobile ultrasound Portable OT light Labour table OT light double dome Operating headlight Tools for assisted deliveries Foetal doppler Emergency light Surgical instruments UPS 10 KVA A clock with seconds hand on the wall

The labour table shall have adjustable side rails, facilities for height adjustment (hydraulic pump or electric), Trendelenburg/reverse positions, and swivelling castor wheels and brakes; mattress should be washable, waterproof, seamless, and divided into three parts and have thin cushioning at the joints, detachable at the perineal end; steel basin attachments; and calf support, handgrip, and leg support. The following furniture shall be provided in the delivery room: • • • • • • • • •

Instrument trollies Crash cart Dressing trollies Mayo stand Doctor stool Swab rack IV stand Steel bucket with lid Footstool

The following accessories, tools, and gadgets shall be placed in the delivery room: • • • • • • •

Sterilization drums Trays of all types and sizes Kidney trays of all sizes Bowls of all sizes Disinfection and sterilization trays and sets Formalin chambers OT line including the doctor’s dress, patient dress, draw sheets, big sheets, cut sheets, eye hole sheets, aprons, gowns, absorption pads, etc.

6.4  Services, Facilities, Equipment, Tools, and Instruments

199

The following drugs shall be placed in the delivery room: • All the emergency drugs • Anaesthesia and analgesia drugs like analgesics, anxiolytics, local anaesthetics, general anaesthetics, inhalational gases, and paralytics • Antibiotics • Body fluids like intravascular biological fluids, interstitial biological fluids, and intracellular biological fluids The following consumables and disposables shall be placed in the delivery room: • • • • •

All types of catheters required during the delivery and baby birth All types of infusion sets Cotton, bandage, and gauze Type of sutures that may be required during the delivery Spare bulbs, batteries for equipment

6.4.3.2 Baby Resuscitation Area See Table 6.19. The baby resuscitation area shall be connected to the delivery room through a pass-through window or door. The equipment that shall normally be provided within the baby resuscitation area are: • • • • • • •

Radiant warmer Mucus extractor Resuscitation kit with functional bag and mask Paediatric stethoscope An oxygen cylinder Pre-warmed baby receiving towels Shoulder roll

Table 6.19  Baby resuscitation area in LDR

Activity Provide a pass-through window or door, between delivery room and baby resuscitation area Equipment placed in the baby resuscitation area: Radiant warmer

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

6  Labour Delivery Room (LDR)

200 Table 6.19 (continued)

Activity Resuscitation kit with functional bag and mask Mucus extractor Pre-warmed baby receiving towels Shoulder roll Paediatric stethoscope An oxygen cylinder Provide two-way scrub stations for hand hygiene Running hot water MGPS outlets for each bed Two outlets for oxygen One outlet for compressed air Two outlets for suction Bed head panels/ ceiling-suspended pendants for medical gas outlets and electrical points Required electrical points Required other communication points

Status of works In Not Responsible Start End Remarks date date Complete progress started person :::::::::::::-

::-

In the baby resuscitation area, a two-way scrub station shall be provided, for hand washing. The unit shall have a provision of running hot water, for the baby bath. The baby resuscitation area shall have outlets for the piped medical gases. A total of two oxygen, two air, and two vacuum outlets shall be provided for the resuscitation of the baby. These outlets shall be fixed either on the bed head panel or on the ceiling-hanging pendant. The unit shall have a sufficient number of electrical outlets. Out of all the electrical outlets, few shall be backed by the UPS supply. Additionally, the required communication ports shall also be provided.

6.4.3.3 Scrub Station See Table 6.20. The LDR complex shall be provided with a stainless steel scrub station, which could be operated by foot and/or sensors. Hand-operated taps are not allowed in the

201

6.4  Services, Facilities, Equipment, Tools, and Instruments Table 6.20  Scrub station in LDR

Activity Stainless steel scrub station Provision for hot and cold water Wall-hanging soap dispenser Wall-hanging antiseptic solution dispenser Nail brush, nail cutter, and nail file

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

::::-

:-

Table 6.21  Clean supply room in LDR

Activity Hermetically sealed door operational with sensors Stainless steel racks divided into bins

Status of works Start End In Not date date Complete progress started :-

:-

scrub station. It shall have a minimum of two bays, with the provision of both hot and cold water to wash hands. The water outlet of the scrub station shall be designed to allow the water to fall in the centre of the scrub and not spill around. The drain points shall also be provided for each of the scrub stations to drain out the water. There shall be a provision for dispensing the soap using a wall-hanging soap dispenser, which shall be elbow operated. Similarly, an elbow-operated wall-hung antiseptic solution dispenser shall be provided with the scrub station. A nail brush should be provided, along with a nail cutter and a nail file. The number of scrub stations depends on the number of labour rooms in the complex. It is better if each labour room has its scrub station. No more than two labour rooms shall share one scrub station.

6.4.3.4 Clean Supply Room See Table 6.21. This room shall have a hermetically sealed door operational with sensors. To store the sterilized materials stacked set-wise, surgery-wise, or LDR-wise, the room shall have stainless steel racks divided into bins. This space should not have a water supply or drain.

202

6  Labour Delivery Room (LDR)

6.4.3.5 Dirty Utility See Table 6.22. Dirty utility shall be provided with waste bins to dispose of the waste as per the biomedical waste management rules. Special attention shall be paid to biomedical waste. The room shall also have a hamper with a lid to collect the soiled linen that has to be sent to the laundry for a wash. 6.4.3.6 Instrument Trolley Lay-Up See Table 6.23. The trolley layout room shall have racks, bins, an almirah, cupboards, and drawers for storage of the sterilized material. Also, a working countertop shall be provided to place the material. Waste bins for disposal of the items like caps, masks, and shoe covers. 6.4.3.7 Sterilization Room See Table 6.24. There shall be a rapid steam sterilizer, a hot-air oven, and a formalin chamber in the LDR complex’s sterilization room. Table 6.22  Dirty utility in LDR Status of works Start End In Not date date Complete progress started

Activity Waste bins for disposal of waste as per the biomedical waste norms Hamper with lid for soiled linen Exhaust fan

Responsible person Remarks

:-

::-

Table 6.23  Instrument trolley lay-up in LDR

Activity Bins/racks/almirahs/ cupboards/drawers, etc. Working countertop Waste bins

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

::-

203

Further Reading Table 6.24  Sterilization room in LDR

Activity Quick steam sterilizer Hot-air oven Formalin chamber Supply of soft water Adequate arrangement for exhaust and air exchanges Required electrical point to connect the machines Compressed air point

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

:-

:-

The space shall have the necessary drain and an adequate supply of soft water for the sterilizer. The space shall have sufficient air exchanges and exhaust systems. Additionally, the necessary electrical point for connecting the machines shall be provided. If necessary, a compressed air outlet can be provided to remove the debris from the instruments.

Further Reading Atmaca H. Patient centered approaches in labor and delivery room design in hospitals: case study in Dokuz Eylül University Hospital. İzmir Ekonomi Üniversitesi; 2013. p. 130. Austin N, Kristensen-Cabrera A, Sherman J, Schwandt D, McDonald A, Hedli L, et al. Analyzing the heterogeneity of labor and delivery units: a quantitative analysis of space and design. PLoS ONE. 2018;13(12):e0209339. ECG | Obstetrics Unit Labor and Delivery Design: LDR Vs. LDRP [Internet]. [cited 2021 Jun 22]. Available from: https://www.ecgmc.com/thought-­leadership/articles/ obstetrics-­unit-­labor-­and-­delivery-­design-­ldr-­vs-­ldrp Esfeh B, Kazemi A, Shamsaie A.  Designing architecture of soothing labor–delivery–recovery– postpartum unit: a study protocol. Reprod Health. 2020;17(1):1–4. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 203–12. Chapter 20, Delivery Room/ Labor Room Jullien JM. Planning the Labor-delivery Unit in the General Hospital. U.S. Department of Health, Education, and Welfare, Public Health Service, Division of Hospital and Medical Facilities, Architectural and Engineering Branch; 1964. 28 p. LIS. 12VAC5-410-442. Obstetric service design and equipment criteria. [Internet]. [cited 2021 Jun 22]. Available from: https://law.lis.virginia.gov/admincode/title12/agency5/chapter410/ section442/. Wrønding T, Argyraki A, Petersen JF, Topsøe MF, Petersen PM, Løkkegaard ECL. The aesthetic nature of the birthing room environment may alter the need for obstetrical interventions—an observational retrospective cohort study. Sci Rep. 2019;9(1):303.

7

Intermediate Care Area (IPD)

The significance and usefulness of the patient rooms are important issues and shall not be ignored in any hospital set-up. It is a place where the patients are kept while undergoing the necessary treatment and recovering. This is one of the places where the patient or family members can observe the standard of care given to the patient, along with other hospital services and treatments. Patients depend on professionals to act immediately in an emergency, check on them frequently, and ensure a good recovery. However, the staff can only provide patients with appropriate care when they fulfil their responsibilities quickly and have access to sufficient tools and materials that may be required for the treatment and comfort of the patient. Therefore, the key aspects influencing patient satisfaction are the room’s layout, furnishings, comfort, cleanliness, and safety as well as the nursing staff’s attentiveness and care. The following three crucial functions shall all be accommodated when designing a hospital room, which is one of the biggest obstacles faced by designers. The patient’s room shall first be relaxing and pleasant. Second, health professionals need to be able to move rapidly and effectively navigate the area. Finally, there needs to be a place where family members and other visitors can sit comfortably or sleep without interfering with the work of the staff or the patient’s recovery. Small hospitals might not always be able to do this, but the designer shall always make an effort to incorporate such areas. In a hospital, there are various ward types, including family suites, deluxe rooms, single-bed (private) rooms, sharing-bed (semiprivate) rooms, general ward (multiple beds), isolation ward, post-operative ward, ICU, ICCU, nursery, etc. According to the patient’s ability to pay and/or the severity of their illness, the patients in each of these wards shall be kept. Some of the factors which shall be considered while designing these wards are the following:

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_7

205

206

7  Intermediate Care Area (IPD)

The safety of the workers and patients shall come first while creating the patient rooms. There shall be no hiding places; CCTV can be utilized for surveillance, and every corner of the room shall be visible from the exterior corridor, among other precautions. There shall not be any sharp-edged furniture, equipment, or accessories in the space that could be used as a weapon against other people or oneself. The space shall have as few curved angles, hidden, and pull-out items as possible; glass shall be avoided in the room; tempered glass shall be used in place of regular glass; plastic silver-coated mirrors shall be used in place of glass mirrors; the lowest height of the windows shall be higher so that the patient cannot leap out; all windows shall have double glazing or grills installed. Additionally, ceiling fans, curtain rods, or cloth hanging rods shall be avoided. The flooring in the bathroom and the room shall be non-slippery and at zero level, and the bathroom shall have the appropriate grab bars. The degree of patient satisfaction, which contributes to a rise in the business, is one of the most crucial elements in a hospital setting. The degree of employee satisfaction is above this. There are a few factors that can help patients and employees feel more satisfied, such as having outstanding facilities and attractive surroundings, maintaining average humidity levels, and keeping the room’s temperature which shall not be either too high or too low. Rooms shall also have adequate natural lighting, be odourless, be silent and free from disturbing sounds and noises, be constructed to allow cross-ventilation, and have windows that provide views of the outdoors such as trees and gardens. Similar to this, the room shall have space for the patient’s family and friends to sit comfortably, be designed to be easily cleaned, and have entertainment options like television or small indoor/board games like ludo, playing cards, and chess, as well as attractive wall paintings, wall arts, and scenery. Additionally, patients shall have access to free Wi-Fi so they can use their smartphones or laptops to access the internet. Ensure the family’s comfort and convenience. Anxious family members and friends frequently accompany patients to hospitals. Additionally, the support of the family helps the patient to recover and lowers morbidity. Hence, a family support zone shall be provided and shall be situated close to the patient rooms. Facilities including a family lounge, consultation rooms, meditation areas, a family cafeteria, family sleep rooms, family laundry, etc. shall be available in this area. This set of checklists shall help the planner and designer to remember all such issues relating to the intermediate care units and guide him/her to complete, test, and commission all works/activities well in time. This shall help him/her to ensure himself/herself that all the works/activities are carried out, complete, and working before the patients are admitted to the wards.

7.1 Location of the Indoor Patient Areas The hospital’s indoor zoning needs to be carefully planned. It shall be remembered that the indoor area is a ‘limited movement zone’ and that only the patient and their family members are permitted to enter this zone. Therefore, it is advisable to designate this area on the upper levels of the building.

7.2  Types of Patient Rooms in the Hospital

207

Because numerous types of indoor rooms and wards have to be placed in the building, there are two options. The first option is to arrange all single room types collectively on a single floor. For instance, one floor might include all of the private, deluxe, and suite single bedrooms, while another might hold all of the semiprivate rooms, etc. The second option is to mix up the wards and rooms on each floor. For instance, each level might have a few private rooms, semiprivate rooms, and one or more general wards. Both methods have advantages and disadvantages. However, choosing the first choice is often preferable because the rooms shall ideally be the same size. As a result, the room design can be better planned for family lounges, nursing station, and toilets that are planned wall to wall and the same length, and the staff and visitor movement can be more effective. Zoning of the isolation areas: A separate zone shall be provided for infected patients. Only in this zone shall all wards and rooms for infected patients be built. A separate set of general wards, semiprivate rooms, private rooms, deluxe rooms, suites, etc. shall be provided within this isolation zone. If necessary, or for patients who are infected, a separate intensive care unit shall be provided in this zone only. It is advised that all types of isolated indoor units in a given zone be grouped (perhaps on the same floor, block, or building, or perhaps on adjacent floors, blocks, or buildings).

7.2 Types of Patient Rooms in the Hospital In a hospital, there are different types of  wards, including family suites, deluxe rooms, single-bed (private) rooms, sharing-bed (semiprivate) rooms, general wards (multiple beds), isolation wards, post-operative ward, ICU, ICCU, nursery, etc. According to the patient’s ability to pay and/or the severity of their illness, the patients in each of these wards shall be kept. Let us now discuss some other room types:

7.2.1 Single-Bed Occupancy These rooms, which also go by the name ‘single-bed private ward’, have a patient bed in addition to other facilities. They fall under the following subcategories: • • • •

Normal private room Deluxe room Super deluxe room Suites

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7.2.2 Sharing Rooms These are often referred to as ‘semiprivate sharing rooms’ and typically house 2–4 patient beds in one room.

7.2.3 General Wards These are the wards with several beds, typically 6–30 in a single hall.

7.2.4 Isolation Ward/Rooms These areas are specifically designated for the housing of infectious patients. Under the isolation category also, there can be a separate set of private rooms, semiprivate sharing rooms, and multiple-bed general wards.

7.3 Infrastructure 7.3.1 Space Requirement for Intermediate Care Area (IPD) 7.3.1.1 Multiple-Bed General Ward See Table 7.1. Patients usually choose this ward since it offers very affordable medical care, and they do not mind giving up privacy. As compared to paid wards, charitable hospitals and free hospitals generally prefer a larger number of multiple-bed general wards. Except for the isolation ward, which shall be situated in the hospital’s isolation zone, these multiple-bed general wards shall be grouped, in a certain zone, on a specific floor. Number of beds in the multiple-bed general ward: The number of beds that shall be placed in multiple-bed general wards is not governed by any set standards. A single ward used to have between 30 and 40 beds in the past. These days, a six-­ bed arrangement for a multiple-bed general ward is quite common. The management’s requirements and the designer’s preferences shall determine how many beds shall be placed in a given ward. However, it is advised that a single ward with multiple beds shall not have less than 6 or more than 30 beds. There shall be sufficient spaces for patient beds in the multiple-bed general wards. Each patient bed shall have an area of between 100 and 150 sq. ft. Accordingly, the ward’s size shall be determined. If a ward has 4 beds, the per-bed area shall be at least 150 sq. ft, making the ward 9144 mm × 6096 mm in size. However, if a 30-bed ward is being considered, each bed’s space shall be at least 100 sq. ft., making the ward’s dimensions approximately 22,860 mm by 1272 mm. Toilets: A separate set of toilets and a bathroom with a hand washing station and bath facilities shall be provided for each multiple-bed general ward. Male and

209

7.3 Infrastructure Table 7.1  Multiple-bed general ward

Activity Have the spaces for the following been provided for? Area patient beds Toilets Support rooms Nurse counter/desk Nurses’ duty room Store for medicines, consumables, and disposables Equipment park/store Dirty utility/sluice room Clean supply room Examination and treatment room Ward pantry Medication room Resident doctors/ student duty room Extra rooms for future expansion Public utility for staff Visitors’ bay with attached toilet

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

::::::::::-

female toilets shall be separate. The number of toilets in the ward shall be determined by the number of beds in the ward. As a general rule, one toilet shall be provided for every four patients and one bathroom for every eight patients. This set of toilets shall be connected to the ward. If the four-bed design is chosen, each cubicle shall have its own set of toilets and bathrooms. Apart from the main patient area, i.e. the ward, there are a few support rooms which are essential and shall be provided along with the ward. These areas are as follows: Nursing desk: The nursing desk shall be provided along with the multiple-bed general wards. If the ward is bigger, say 30 beds, the nursing desk shall be provided within the ward itself. The location of the nursing desk shall be in such a fashion so that the nursing staff while sitting at the nursing desk can have a clear view of all the patients in the ward. On the other hand, if there are multiple wards of small size, the common nursing desk shall be provided outside the ward. However, this nursing desk shall be easily approachable from all the wards for which it has been provided.

210

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Nurses’ duty room: Along with the nurse’s desk, a small nursing duty room shall be provided, for the nurses to keep their belongings, take rest between long duty hours, and take meals. The room size shall be approximately 3658 mm × 3658 mm. Store for medicines, consumables, and disposables: Attached to the nursing stations shall be a general store to keep enough medicines, consumables, and disposables on hand. The room’s dimensions shall be at least 4572 mm × 3658 mm. Equipment park/store: There shall be a place for storing equipment at each nursing station so that the less important items can be kept there. A small room that is attached to the nursing station and has a minimum dimension of 3658 mm × 3658 mm shall be provided for this purpose. This space could be an open area connected to the nursing station or a closed room with a door. Dirty utility/sluice room: Additionally, each nursing station shall have a dirty utility that is used to store the soiled linen. Generally, the size of the room shall be 3048 mm × 3048 mm, although the size of the room may be altered depending on the requirements. Two doors of about 914 mm shall be provided for this room. Out of the two doors, one shall open in the wards itself and the second one in the corridors for workers to collect the linen without having to go to the ward/nursing station. Clean utility: Each nursing station in the indoor spaces shall have a clean utility attached to it for the storage of clean linen. This area is also utilized to store sterile materials such as a drum and drapes, and sterile supplies and disposables that are commonly used in the ward. This room shall be roughly 3048 mm × 3048 mm. The size of the room, however, can be altered based on the needs. This room shall have only one 915 mm door. The room shall be windowless, but if one has to be provided, it shall be sealed with double-glazing glass. There shall be no water supply or drain in this area. Examination and treatment room: Patients who are admitted to the ward sometimes need minor treatments or procedures like stitch removal, catheterization, dressing, and bandaging, among others. Due to the risk of infection and the patient’s privacy, or if the procedure requires anaesthesia, it can usually be difficult to perform these procedures in the ward itself. Therefore, an examination/treatment room which is separate from the ward shall be provided. The room shall be roughly 4572 mm × 3658 mm in size. Ward pantry: There shall be a place for diet storage and further distribution since patients who are admitted to rooms or wards shall be provided meals for the full day. Ward pantry is the name of this area. A duly packed diet is shipped in bulk from the kitchen for direct distribution. At times, the unwrapped diet is also sent to the pantry, leaving it up to the pantry to pack and distribute to the patient. The ward pantry shall be roughly 3658 mm × 3658 mm in size and have a single door that opens to the outside in the corridor. Medication areas: While designing the nursing station, a space in the form of a room or a cabinet shall be provided to store patient drugs in transparent plastic boxes. The name of the patient and the patient’s room or bed number are written on these boxes. It is advisable that for each patient, a separate box is allotted. The medication room or the cupboard shall be lockable.

7.3 Infrastructure

211

Resident doctors and student duty rooms: As the doctor is posted on duty day and night in the indoor patient areas and the wards, the duty room shall be provided for them. The doctors usually stay in the wards but can take rest during long duty hours. Hence, attached to each ward shall be the duty room for the doctors. Please remember to provide separate duty rooms for male and female doctors. The room shall be 3658 mm × 4268 mm in size and have a toilet attached to it. Extra rooms for future expansion: In the running hospital, no one can anticipate the future requirement of the room. The requirement of the room may increase due to excessive patient load, norms or regulations of regulatory authorities, increased staff and doctors, and induction of new equipment, procedure, or investigation. Hence, while designing a hospital, the spaces shall be provided to accommodate more of multiple-bed general wards in future. Public utility for staff: The staff including nurses, technicians, ward assistants, and housekeeping personnel are supposed to be working round the clock, so separate toilets shall be provided for them as they may be hesitant to use the toilets that have been allocated for the patients. Please remember to provide these toilets separately for male and female workers. Visitors’ bay with attached toilet: It is but natural that the anxious and curious family members, friends, and relatives of the patient would like to visit the hospital to meet the patient. It is not always advisable to make all the visitors be seated in the patient room. Hence, a separate space shall be provided near the ward, where these visitors can be made seated. This area is called visitors’ bay. The visitor bay shall have a toilet attached to it.

7.3.1.2 Semiprivate Sharing Rooms See Table 7.2. Due to economical constraints, patients may decide to share a room, sacrificing privacy. The number of patients in such rooms ranges from two to four. Ideally, no more than two patients shall share a room; otherwise, it seems to be identical to a general ward. Based on the recommendations above, we strongly suggest that the following issues be considered while designing semiprivate sharing rooms: There shall be 2–4 patient beds in the semiprivate sharing room, and all these beds shall be housed in a single room. All the beds in this room shall be properly partitioned temporarily with curtains or permanently with wooden or metal partitions. The semiprivate sharing room shall be divided into three zones: a staff zone at the entrance to the room to enable employees to perform their duties effectively, a patient zone where the beds are placed, and a family zone where the guest is seated. Depending on the number of patient beds in the room, the family zones have to be provided separately. This means that a family zone has to be provided for each patient. If two beds are to be placed in the room, the total area of the room shall be about 350 sq ft., including family spaces and a toilet.

212

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Table 7.2  Semiprivate sharing rooms

Activity Have the spaces for the following been provided for? Room for patient beds Toilet attached to the patient’s room Support rooms Nurse counter/desk Nurses’ duty room Store for medicines, consumables, and disposables Equipment park/store Dirty utility/sluice room Clean supply room Examination and treatment room Ward pantry Medication room Resident doctors/ student duty room Extra rooms for future expansion Public utility for staff Visitors’ bay with attached toilet

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::-

:::-

::::::::::-

Toilets: Both patients in the room shall have access to the same toilet cum bath with a hand washing station. It is suggested that the mid-board concept for toilets be applied. Apart from the main patient rooms, there are a few support rooms which are essential and shall be provided along with the semiprivate sharing rooms. It is not necessary that all these support rooms shall be provided for all the individual semiprivate sharing rooms separately but shall be provided for a group of rooms which can be 5–10 rooms. Nursing desk: The common nursing desk shall be provided for a group of semiprivate sharing rooms. However, this nursing desk shall be provided at such a place so that it is easily approachable from all the semiprivate sharing rooms for which it has been provided. Nurses’ duty room: Along with the nurse’s desk, a small nursing duty room shall be provided, for the nurses to keep their belongings, take rest between long duty hours, and take meals. The room shall be about 3658 mm × 3658 mm in size.

7.3 Infrastructure

213

Store for medicines, consumables, and disposables: All nursing stations shall have a general store to preserve a sufficient supply of the necessary supplies, including consumables, disposables, and medications. The size of the  room shall be at least 4572 mm × 3658 mm. Equipment park/store: There shall be a place for storing equipment at each nursing station so that less important items can be kept there. A small room that is attached to the nursing station and has a minimum dimension of 3658 mm × 3658 mm shall be provided for this purpose. This space could be an open area connected to the nursing station or a closed room with a door. Dirty utility/sluice room: Additionally, each nursing station shall have a dirty utility that is used to store the soiled linen. Ideally, the room shall be about 3048 mm × 3048 mm, although the size of the room may be altered depending on the requirements. Clean utility: Each nursing station in the indoor spaces shall have a clean utility attached to it for the storage of clean linen. This area is also utilized to store sterile materials such as a drum and drapes, and sterile supplies and disposables that are commonly used in the ward. This room shall be roughly 3048 mm × 3048 mm. The size of the room, however, can be altered based on the needs. This room shall have only one 915 mm door. The room shall be windowless, but if one has to be provided, it shall be sealed with double-glazing glass. There shall be no water supply or drain in this area. Examination and treatment room: Patients who are admitted to the semiprivate sharing room sometimes need minor treatments or procedures like stitch removal, catheterization, dressing, and bandaging, among others. Due to the risk of infection and the patient’s privacy, or if the procedure requires anaesthesia, it can usually be difficult to perform these types of procedures in the patient room itself. Therefore, an examination/treatment room shall be provided. The room shall be roughly 4572 mm × 3658 mm in size. Ward pantry: There shall be a place for diet storage and further distribution since patients who are admitted in the semiprivate rooms shall be provided meals for the full day. Ward pantry is the name of this area. A duly packed diet is shipped in bulk from the kitchen for direct distribution. At times, the unwrapped diet is also sent to the pantry, leaving it up to the pantry to pack and distribute to the patient. The ward pantry shall be roughly 3658 mm × 3658 mm in size and have a single door that opens to the outside in the corridor. Medication areas: While designing the nursing station, a space in the form of a room or a cabinet shall be provided to store patient drugs in transparent plastic boxes. The name of the patient and the patient’s room or bed number are written on these boxes. It is advisable that for each patient, a separate box is allotted. The medication room or the cupboard shall be lockable. Resident doctors and student duty rooms: As the doctor is posted on duty day and night in the indoor patient areas and the semiprivate sharing rooms, the duty room shall be provided for them. The doctors usually stay in the IPD area but can take rest after duty hours. Hence, attached to a group of semiprivate sharing rooms shall be the duty room for doctors. Please remember to provide separate duty rooms

214

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for male and female doctors. The room shall be 3658 mm × 4268 mm in size and have a toilet attached to it. Extra rooms for future expansion: In the running hospital, no one can anticipate the future requirement of the room. The requirement of the room may increase due to excessive patient load, norms or regulations of regulatory authorities, increased staff and doctors, and induction of new equipment, procedure, or investigation. Hence, while designing a hospital, the spaces shall be provided to accommodate more of semiprivate sharing rooms in future. Public utility for staff: The staff including nurses, technicians, ward assistants, and housekeeping personnel are supposed to be working round the clock, so separate toilets shall be provided for them as they may be hesitant to use the toilets that have been allocated for the patients. Please remember to provide these toilets separately for male and female workers. Visitors’ bay with attached toilet: It is but natural that the anxious and curious family members, friends, and relatives of the patient would like to visit the hospital to meet the patient. It is not always advisable to make all the visitors be seated in the patient room. Hence, a separate space shall be provided near the patient rooms, where these visitors can be made seated. This area is called visitors’ bay. The visitor bay shall have a toilet attached to it.

7.3.1.3 Single-Bed Private Room See Table 7.3. Multiple-occupancy rooms are being phased away. Most patients currently want a single-occupancy room to get privacy, comfort, and accessibility to family members. Furthermore, patients, regardless of expense, prefer to receive better care and treatment. Any patient who can afford it prefers a single-occupancy private room over multiple occupancies. Because the rates for single-occupancy rooms are higher than for other low-category wards/rooms, the hospital’s revenue improves. As a result, hospital owners shall opt to have more numbers of single-bed units. Single-­ bed private rooms significantly help in the control of infections such as Covid-7, methicillin-resistant Staphylococcus aureus, gram-negative bacteraemia in burn patients, and respiratory and intestinal diseases necessitating contact isolation in wards. For the single-bed private rooms, there shall be just one patient bed per room. The single-bed private rooms shall be divided into three zones: a staff zone at the entrance to the room to enable employees to carry out their duties effectively, a patient zone containing patient beds, and a family zone with guest chairs. A single-bed private room shall be around 250 sq. ft. in size, including the toilet and family area. Toilets: All single-bed private rooms shall have a private toilet cum bath with a hand washing station. Shared or common toilets are not allowed in single-­occupancy units. It is proposed that the mid-board concept for toilets be adopted when deciding where to locate the toilet. Apart from the main patient rooms, there are a few support rooms which are essential and shall be provided along with the single-bed private rooms. It

215

7.3 Infrastructure Table 7.3  Single-bed private room

Activity Have the spaces for the following been provided for? Patient beds (single bed) Toilet attached to the patient’s room Support rooms Nurse counter/desk Nurses’ duty room Store for medicines, consumables, and disposables Equipment park/store Dirty utility/sluice room Clean supply room Examination and treatment room Ward pantry Medication room Resident doctors/ student duty room Extra rooms for future expansion Public utility for staff Visitors’ bay with attached toilet

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::-

:::-

::::::::::-

is not necessary that all these support rooms shall be provided for all the individual single-bed private rooms separately but shall be provided for a group of rooms which can be 5–10 rooms. Nursing desk: The common nursing desk shall be provided for a group of single-­bed private rooms. However, this nursing desk shall be provided at such a place so that it is easily approachable from all the single-bed private rooms for which it has been provided. Nurses’ duty room: Along with the nurse’s desk, a small nursing duty room shall be provided, for the nurses to keep their belongings, take rest between long duty hours, and take meals. The size of the room shall be about 3658 mm × 3658 mm. Store for medicines, consumables, and disposables: All nursing stations shall have a general store to preserve a sufficient supply of the necessary supplies, including consumables, disposables, and medications. The size of the room shall be at least 4572 × 3658 mm.

216

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Equipment park/store: There shall be a place for storing equipment at each nursing station so that less important items can be kept there. A small room that is attached to the nursing station and has a minimum dimension of 3658 mm × 3658 mm shall be provided for this purpose. This space could be an open area connected to the nursing station or a closed room with a door. Dirty utility/sluice room: Additionally, each nursing station shall have a dirty utility that is used to store the soiled linen. Normally, the room shall not be less than 3048 mm × 3048 mm, although the size of the room may be altered depending on the requirements. Clean utility: Each nursing station in the indoor spaces shall have a clean utility attached to it for the storage of clean linen. This area is also utilized to store sterile materials such as a drum and drapes, and sterile supplies and disposables that are commonly used in the ward. This room shall be roughly 3048 mm × 3048 mm. The size of the room, however, can be altered based on the needs. This room shall have only one 915 mm door. The room shall be windowless, but if one has to be provided, it shall be sealed with double-glazing glass. There shall be no water supply or drain in this area. Examination and treatment room: Patients who are admitted to the singlebed private rooms sometimes need minor treatments or procedures like stitch removal, catheterization, dressing, and bandaging, among others. Due to the risk of infection and the patient’s privacy, or if the procedure requires anaesthesia, it can usually be difficult to perform these procedures in the rooms itself. Therefore, an examination/treatment room shall be provided. The room shall be roughly 4572 mm × 3658 mm in size. Ward pantry: There shall be a place for diet storage and further distribution since patients who are admitted in the private rooms shall be provided meals for the full day. Ward pantry is the name of this area. A duly packed diet is shipped in bulk from the kitchen for direct distribution. At times, the unwrapped diet is also sent to the pantry, leaving it up to the pantry to pack and distribute to the patient. The ward pantry shall be roughly 3658 mm × 3658 mm in size and have a single door that opens to the outside in the corridor. Medication areas: While designing the nursing station, a space in the form of a room or a cabinet shall be provided to store patient drugs in transparent plastic boxes. The name of the patient and the patient’s room or bed number are written on these boxes. It is advisable that for each patient, a separate box is allotted. The medication room or the cupboard shall be lockable. Resident doctors and student duty rooms: As the doctor is posted on duty day and night in the indoor patient areas and the single-bed private rooms, the duty room shall be provided for them. The doctors usually stay in the IPD area but can take rest after duty hours. Hence, attached to the group of single-bed private rooms shall be the duty room for the doctors. Please remember to provide separate duty rooms for male and female doctors. The room shall be 3658 mm × 4268 mm in size and have a toilet attached to it. Extra rooms for future expansion: In the running hospital, no one can anticipate the future requirement of a room. The requirement of the room may increase

7.3 Infrastructure

217

due to excessive patient load, norms or regulations of regulatory authorities, increased staff and doctors, and induction of new equipment, procedure, or investigation. Hence, while designing a hospital, spaces shall be provided to accommodate more single-bed private rooms in future. Public utility for staff: The staff including nurses, technicians, ward assistants, and housekeeping personnel are supposed to be working round the clock, so separate toilets shall be provided for them as they may be hesitant to use the toilets that have been allocated for the patients. Please remember to provide these toilets separately for male and female workers. Visitors’ bay with attached toilet: It is but natural that the anxious and curious family members, friends, and relatives of the patient would like to visit the hospital to meet the patient. It is not always advisable to make all the visitors be seated in the patient room. Hence, a separate space shall be provided near the patient rooms, where these visitors can be made seated. This area is called visitors’ bay. The visitor bay shall have a toilet attached to it.

7.3.1.4 Single-Bed Deluxe Room See Table 7.4. The single-bed deluxe room is basically the same as a single-bed patient room, but it offers a few more conveniences. For example, the room may be larger (up to around 300 sq. ft.); larger toilet sizes and more attractive designs shall be considered; a small kitchenette with an electric kettle and a microwave can be given for brewing tea, coffee, snacks, etc.; the ceiling finishes could be nicer; the refrigerator’s size might be upgraded; for guests, a sturdy pull-out bed or sofa set shall be provided; more room can be made available for family and guests, dining table and chairs can be of better quality; larger and more attractive cabinets can be built and so on. As compared to any single-bed private room, the single-bed deluxe room is more costly, and the patient who can afford prefers such rooms. For the single-bed deluxe rooms, there shall be just one patient bed per room. The single-bed deluxe rooms shall be divided into three zones: a staff zone at the entrance to the room to enable employees to carry out their duties effectively, a patient zone containing patient beds, and a family zone with guest chairs. A single-bed deluxe room shall be around 300 sq. ft. in size, including the toilet and family area. Toilets: All single-bed deluxe rooms shall have a private toilet cum bath with a hand washing station. Shared or common toilets are not allowed in single-­occupancy units. It is proposed that the mid-board concept for toilets be adopted when deciding where to locate the toilet. Apart from the main patient rooms, there are a few support rooms which are essential and shall be provided along with the single-bed deluxe room. It is not necessary that all these support rooms shall be provided for all the individual single-bed deluxe rooms separately but shall be provided for a group of rooms which can be 3–5 rooms. Nursing desk: The common nursing desk shall be provided for a group of single-­bed deluxe rooms. However, this nursing desk shall be provided at such a

218

7  Intermediate Care Area (IPD)

Table 7.4  Single-bed deluxe rooms

Activity Have the spaces for the following been provided for? Patient beds (single bed) Toilet attached to the patient’s room Support rooms Nurse counter/desk Nurses’ duty room Store for medicines, consumables, and disposables Equipment park/store Dirty utility/sluice room Clean supply room Examination and treatment room Ward pantry Medication room Resident doctors/ student duty room Extra rooms for future expansion Public utility for staff Visitors’ bay

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::-

:::-

::::::::::-

place so that it is easily approachable from all the single-bed deluxe rooms for which it has been provided. Nurses’ duty room: Along with the nurse’s desk, a small nursing duty room shall be provided, for the nurses to keep their belongings, take rest between long duty hours, and take meals. The size of the room shall be about 3658 mm × 3658 mm. Store for medicines, consumables, and disposables: All nursing stations shall have a general store to preserve a sufficient supply of the necessary supplies, including consumables, disposables, and medications. The size of the room shall be at least 4572 mm × 3658 mm. Equipment park/store: There shall be a place for storing equipment at each nursing station so that less important items can be kept there. A small room that is attached to the nursing station and has a minimum dimension of 3658 mm × 3658 mm shall be provided for this purpose. This space could be an open area connected to the nursing station or a closed room with a door.

7.3 Infrastructure

219

Dirty utility/sluice room: Additionally, each nursing station shall have a dirty utility that is used to store soiled linen. Normally, the room shall not be less than 3048 mm × 3048 mm, although the size of the room may be altered depending on the requirements. Clean utility: Each nursing station in the indoor spaces shall have a clean utility attached to it for the storage of clean linen. This area is also utilized to store sterile materials such as a drum and drapes, and sterile supplies and disposables that are commonly used in the ward. This room shall be roughly 3048 mm × 3048 mm. The size of the room, however, can be altered based on the needs. This room shall have only one 915 mm door. The room shall be windowless, but if one has to be provided, it shall be sealed with double-glazing glass. There shall be no water supply or drain in this area. Examination and treatment room: Patients who are admitted to the single-bed deluxe rooms sometimes need minor treatments or procedures like stitch removal, catheterization, dressing, and bandaging, among others. Due to the risk of infection and the patient’s privacy, or if the procedure requires anaesthesia, it can usually be difficult to perform these procedures in the room itself. Therefore, an examination/ treatment room shall be provided. The room shall be roughly 4572 mm × 3658 mm in size. Ward pantry: There shall be a place for diet storage and further distribution since patients who are admitted in the single-bed deluxe rooms shall be provided meals for the full day. Ward pantry is the name of this area. A duly packed diet is shipped in bulk from the kitchen for direct distribution. At times, the unwrapped diet is also sent to the pantry, leaving it up to the pantry to pack and distribute to the patient. The ward pantry shall be roughly 3658 mm × 3658 mm in size and have a single door that opens to the outside in the corridor. Medication areas: While designing the nursing station, a space in the form of a room or a cabinet shall be provided to store patient drugs in transparent plastic boxes. The name of the patient and the patient’s room or bed number are written on these boxes. It is advisable that for each patient, a separate box is allotted. The medication room or the cupboard shall be lockable. Resident doctors and student duty rooms: As the doctor is posted on duty day and night in the indoor patient areas and the single-bed deluxe room, the duty room shall be provided for them. The doctors usually stay in the IPD area but can take rest after duty hours. Hence, attached to each single-bed deluxe room shall be the duty room for doctors. Please remember to provide separate duty rooms for male and female doctors. The room shall be 3658 mm × 4268 mm in size and have a toilet attached to it. Extra rooms for future expansion: In the running hospital, no one can anticipate the future requirement of a room. The requirement of the room may increase due to excessive patient load, norms or regulations of regulatory authorities, increased staff and doctors, and induction of new equipment, procedure, or investigation. Hence, while designing a hospital, the spaces shall be provided to accommodate more single-bed deluxe rooms in future.

220

7  Intermediate Care Area (IPD)

Public utility for staff: The staff including nurses, technicians, ward assistants, and housekeeping personnel are supposed to be working round the clock, so separate toilets shall be provided for them as they may be hesitant to use the toilets that have been allocated for the patients. Please remember to provide these toilets separately for male and female workers. Visitors’ bay with attached toilet: It is but natural that the anxious and curious family members, friends, and relatives of the patient would like to visit the hospital to meet the patient. It is not always advisable to make all the visitors be seated in the patient room. Hence, a separate space shall be provided near the patient rooms, where these visitors can be made seated. This area is called visitors’ bay. The visitor bay shall have a toilet attached to it.

7.3.1.5 Single-Bed Family Suites See Table 7.5. Single-bed family suites are distinct from regular single-bed patient rooms in that they include an additional family room that is adjacent to the patient room. Apart from that, it has a few additional amenities such as increased room size, which can be around 400 sq. ft.; larger toilets that can be designed to look more appealing; better ceiling finishes; a small kitchenette equipped with an electric kettle and a microwave to make tea/coffee, snacks, etc.; larger refrigerator; and a high-­ quality pull-out bed or sofa set for visitors. More space can be made available for family and visitors; the dining table and chairs’ quality can be upgraded; the cupboards can be made larger and more stylish; and higher quality artwork and scenery can be offered. A family room is also available in the single-patient bed family suite in addition to the patient unit. In addition to the patient space, the space for the family room shall be roughly 200 sq. ft. The patient room shall be adjacent to or close to the family room. A solid wall or a glass partition can be used to divide the patient room from the family area. For the family room or space, a separate toilet shall be provided. To prepare tea, coffee, snacks, etc., the single-bed family suite shall also have a small kitchenette with an electric kettle and a microwave. The kitchenette shall contain a working surface and a sink with a draining board for washing dishes. Toilets: Each single-bed family suite shall include a separate toilet cum bath with a hand washing station. Shared or common toilets are not permitted in these sorts of accommodations. There shall be a separate toilet with a shower available for the family room or area in addition to the patient unit’s toilet. Apart from the main patient rooms, there are a few support rooms which are essential and shall be provided along with the single-bed family suite. It is not necessary that all these support rooms shall be provided for all the individual single-bed family suites separately but shall be provided for a group of rooms which can be 2–5 rooms. Nursing desk: The common nursing desk shall be provided for a group of single-­bed family suite. However, this nursing desk shall be provided at such a place

221

7.3 Infrastructure Table 7.5  Single-bed family suites

Activity Have the spaces for the following been provided for? Patient beds (single bed) The toilet attached to the patient unit Family room The toilet attached to the family unit Small kitchenet Support rooms Nurse counter/desk Nurses’ duty room Store for medicines, consumables, and disposables Equipment park/store Dirty utility/sluice room Clean supply room Examination and treatment room Ward pantry Medication room Resident doctors/ student duty room Extra rooms for future expansion Public utility for staff Visitors’ bay

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::::-

::::::::::-

so that it is easily approachable from all the single-bed family suites for which it has been provided. Nurses’ duty room: Along with the nurse’s desk, a small nursing duty room shall be provided for the nurses to keep their belongings, take rest after long duty hours, and take meals. The size of the room shall be about 3658 mm × 3658 mm. Store for medicines, consumables, and disposables: All nursing stations shall have a general store to preserve a sufficient supply of the necessary supplies, including consumables, disposables, and medications. The size of the room shall be at least 4572 mm × 3658 mm. Equipment park/store: There shall be a place for storing equipment at each nursing station so that less important items can be kept there. A small room that is

222

7  Intermediate Care Area (IPD)

attached to the nursing station and has a minimum dimension of 3658 mm × 3658 mm shall be provided for this purpose. This space could be an open area connected to the nursing station or a closed room with a door. Dirty utility/sluice room: Additionally, each nursing station shall have a dirty utility that is used to store soiled linen. Normally, the room shall not be less than 3048 mm × 3048 mm, although the size of the room may be altered depending on the requirements. Clean utility: Each nursing station in the indoor spaces shall have a clean utility attached to it for the storage of clean linen. This area is also utilized to store sterile materials such as a drum and drapes, and sterile supplies and disposables that are commonly used in the ward. This room shall be roughly 3048 mm × 3048 mm. The size of the room, however, can be altered based on the needs. This room shall have only one 915 mm door. The room shall be windowless, but if one has to be provided, it shall be sealed with double-glazing glass. There shall be no water supply or drain in this area. Examination and treatment room: Patients who are admitted to the single-bed family suite sometimes need minor treatments or procedures like stitch removal, catheterization, dressing, and bandaging, among others. Due to the risk of infection and the patient’s privacy, or if the procedure requires anaesthesia, it can usually be difficult to perform these procedures in the room itself. Therefore, an examination/ treatment room shall be provided. The room shall be roughly 4572 mm × 3658 mm in size. Ward pantry: There shall be a place for diet storage and further distribution since patients who are admitted in the single-bed family suite shall be provided meals for the full day. Ward pantry is the name of this area. A duly packed diet is shipped in bulk from the kitchen for direct distribution. At times, the unwrapped diet is also sent to the pantry, leaving it up to the pantry to pack and distribute to the patient. The ward pantry shall be roughly 3658 mm × 3658 mm in size and have a single door that opens to the outside in the corridor. Medication areas: While designing the nursing station, a space in the form of a room or a cabinet shall be provided to store patient drugs in transparent plastic boxes. The name of the patient and the patient’s room or bed number are written on these boxes. It is advisable that for each patient, a separate box is allotted. The medication room or the cupboard shall be lockable. Resident doctors and student duty rooms: As the doctor shall be posted on duty day and night in the indoor patient areas and the single-bed family suite, the duty room shall be provided for them. The doctors usually stay in the IPD area but can take rest after duty hours. Hence, attached to each single-bed family suite shall be the duty room for the doctors. Please remember to provide separate duty rooms for male and female doctors. The room shall be 3658 mm × 4268 mm in size and have a toilet attached to it. Extra rooms for future expansion: In the running hospital, no one can anticipate the future requirement of the room. The requirement of the room may increase due to excessive patient load, norms or regulations of regulatory authorities, increased staff and doctors, and induction of new equipment, procedure, or

7.3 Infrastructure

223

investigation. Hence, while designing a hospital, the spaces shall be provided to accommodate more of single-bed family suites in future. Public utility for staff: The staff including nurses, technicians, ward assistants, and housekeeping personnel are supposed to be working round the clock, so separate toilets shall be provided for them as they may be hesitant to use the toilets that have been allocated for the patients. Please remember to provide these toilets separately for male and female workers. Visitors’ bay with attached toilet: It is but natural that the anxious and curious family members, friends, and relatives of the patient would like to visit the hospital to meet the patient. It is not always advisable to make all the visitors be seated in the patient room. Though, the space for the family has been provided with the single bed family suite, but as all the visitors shall not be allowed in the family room, a separate space shall be provided near to the suite, where these visitors can be made seated. This area is called visitors’ bay. The visitor bay shall have a toilet attached to it.

7.3.1.6 Isolation Rooms/Wards See Table 7.6. Table 7.6  Isolation rooms/wards

Activity In addition to the facilities provided in a different category of wards/rooms, the following has been provided: Space for downing and doffing of PPE kits Space for storage of soiled and clean materials Separate toilet with a hand washing sink Properly sealed room to prevent excess air leakage Are the doors of the room self-closing? Has the room been positively/negatively pressurized? Has the air pressure monitoring device been installed?

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::-

::-

::-

:-

:-

224

7  Intermediate Care Area (IPD)

For the sake of the patients, staff, and visitors, controlling the spread of airborne infectious diseases in hospitals is a critical problem. The Covid-7 virus serves as a recent illustration of this. Due to the scarcity of isolation beds, hospitals around the world have experienced challenges. Certain hospital rooms shall be constructed as airborne infection isolation rooms with negative pressure or protective environment rooms with positive pressure to reduce the transmission of airborne infections. As already mentioned, there shall be an area designated as isolation zone in the hospital. This section may be located on any floor or building unit. It shall be controlled by security, have limited access, and be properly barricaded. This region shall only be accessible to authorized personnel. There shall be air curtains at the entry. Services like the pantry, gas supply, and laundry in this section shall be distinct from those of other areas. All isolation patient units, such as single-occupancy rooms and shared wards (which are typically not advised), shall be kept apart and situated in this specific isolation zone only. No other portion of the hospital may have these isolation wards or rooms. The isolation ICU shall also be situated here, if at all possible. While the isolation rooms/wards shall comply with all of the general standards for a regular room/ward as described previously in this chapter, they shall also meet the following particular standards: • Only one patient bed shall be permitted in patient isolation rooms. • There shall be room for downing and doffing the PPE kits and any personal safety devices. • Directly outside or inside the entry door, space shall be made available for the storage of clean and dirty materials. • There shall be a separate toilet and hand washing sink in every room. • To stop excessive air leakage into or out of the isolation chamber, the room shall be tightly sealed. • The air pressure differential can be maintained more effectively if the space is more tightly built. • To stop air leakage, walls, floors, and ceilings shall be sealed. • Use only self-closing doors. • Airflow can be monitored by installing suitable devices. • The isolation rooms shall adhere to the accepted standards for pressurization. Both negative and positive pressurization is possible. For more technical details about the pressurization and air conditioning of the isolation room, please refer to Chapter number 38 titled ‘HVAC (Air Conditioning) System’ and chapter number 21 titled ‘Intermediate Care Area (Patient Rooms)’ of the book ‘Manual of Hospital Planning and Designing’ authored by Ajay Garg and Anil Dewan, published by Springer, ISBN no. 978-981-16-8455-5 and ISBN 978-981-16-8456-2 (eBook).

7.4  Services, Facilities, Equipment, Tools, and Instruments

225

7.4 Services, Facilities, Equipment, Tools, and Instruments 7.4.1 Patient Units 7.4.1.1 Multiple-Bed General Ward See Table 7.7. The multiple-bed general wards shall have the following furniture in the wards: Table 7.7  Multiple-bed general ward

Activity General ward shall have the following patient furniture: Patient bed (Fowler bed with bedside railing) Bedside locker Over-bed table Step stool IV stand IV rod Backrest Dressing trollies Wheelchair Stretcher trolley Oxygen cylinder trolley General ward shall have the following furniture: Reclining chairs or stool for attendants Cupboard separate for each patient General ward shall have the following equipment/ instruments/tools: Multi-para vital sign monitor Air mattress Walkers Nebulizer Electrical suction machine Other required instruments

Status of works In Not Responsible Start End Remarks date date Complete progress started person

:::::::::::-

::-

::::::(continued)

226

7  Intermediate Care Area (IPD)

Table 7.7 (continued)

Activity Air conditioning system as per design Bed head panel separate for each patient MGPS gas for oxygen on each patient’s bed Wall-mounted suction on each patient’s bed Required electrical points Required communications points/ ports Curtain partitions for each bed IV track for each bed Wi-Fi

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::::-

:::-

• Patient furniture –– Patient bed (shall preferably be Fowler bed with bedside railing; alternatively, a plain patient bed can also be used) –– Bedside locker –– Step stool –– Over-bed table –– IV rod –– IV stand –– Backrest –– Dressing trollies –– Wheelchairs –– Stretcher trollies –– Oxygen cylinder trolley • Other furniture: –– Reclining chair or stool for attendants of the patient –– Cupboards if possible The multiple-bed general wards shall have the following equipment/instruments/ tools in the wards: • Multi-para vital sign monitor (not necessary on all beds, but a few beds shall be provided with the monitors) • Pulse oximeter (in case the multi-para monitor is not provided)

7.4  Services, Facilities, Equipment, Tools, and Instruments

• • • • •

227

Air mattress Walkers Nebulizer Electrical suction machine Any other required equipment or instrument

Air conditioning system of ward: The multiple-bed general ward shall be provided with the air conditioning system and shall have complete climate control, including the ability to regulate temperature, humidity, and air exchanges. Wards can be cooled using a chilled water pipeline with an air handling unit (AHU), a ductable split system, or a VRV system. There shall be separate return air arrangements for each ward. No ward’s return shall be mixed with air from other wards, rooms, units, or areas. For heating the wards, hot-water generators shall be used coupled with the AHUs. Otherwise, room heaters are an option, though they are typically not advised. The temperature shall range from 21 to 24 °C. Central piped medical gas supply: All the patient beds in the multiple-bed general ward shall have a supply of centralized piped medical gases to handle any emergencies. The following gases shall be supplied: • Oxygen (O2) • Wall-mounted suction The outlets for these gases are fixed directly on  the wall. Otherwise, this is achieved via the bed head panel. It is a 4-foot panel constructed of aluminium extruded sections. The gas outlets and electrical points can be fixed using this panel. Additionally, the IV rod, monitor tray, and utility basket can all be mounted to the panel’s service railing. This panel is fixed just on the wall above the head of the patient. The multiple-bed general wards shall have the following electrical points in the ward: • The main switchboard, along with one 5 Amp switch/socket, shall be located at the entry wall to control the hall’s fan and lighting. • Temperature-adjustable air conditioning control button. • There shall be at least two pairs of 5/15 Amp switch/sockets (four points, on each bed head panel). Half of these points shall be backed up and supplied by UPS. • Two sets of 5/15 Amp switch/sockets shall be installed on the wall at a height of 457 mm above the floor, in the middle of two beds. One pair of these shall be the UPS backup. • There shall be a provision to charge mobile/laptop next to each bed. Other communication points in ward: All the patient beds in the multiple-bed general ward shall have a provision of the following: • Point for attaching the call button of the nurse call device

228

7  Intermediate Care Area (IPD)

• RJ 45 port for computer networking • Point for reading light for patients Curtain partitions: The patient bed in the ward shall be provided with hanging curtain partitions. The bed shall have a curtain on all other three sides. The ceiling-­ suspended curtain track is fixed at 2134 mm above the floor level. Curtains shall be hung on these tracks and shall be moveable and collapsible. The bottom of the curtain shall have a clear area of about 457 mm from the floor to allow easy cleaning of the floor. IV track: The patient bed in the ward shall be provided with a ceiling-suspended IV track. In the centre of the bed, the track shall be mounted lengthwise. The track is mounted and screwed to the ceiling/false ceiling of the room. The IV hanger shall be fixed in the track, which shall be moveable in the track. The IV hanger can be with the provision of three, four, or five hooks. It is recommended that each ward shall have a provision providing Wi-Fi to enable the patient to surf the internet.

7.4.1.2 Semiprivate Sharing Rooms See Table 7.8. Each room of the semiprivate sharing rooms shall have the following furniture: • Patient furniture –– Patient bed (preferably the multi-positional ICU bed shall be provided; otherwise, semi-Fowler bed with bedside railing can be provided) –– Bedside locker –– Step stool –– Over-bed table –– IV stand –– IV rod –– Backrest –– Dressing trollies (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms) –– Wheelchairs (not necessary for every room, but they can be for a group of rooms, say 2–5 rooms) –– Stretcher trollies (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms) –– Oxygen cylinder trolley (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms) • Other furniture: –– Plain sofa set or pull-out bed for families of each patient. This shall be separate for each patient’s family. –– Attendant bed (if pull-out bed is not provided, separate for families of each patient) –– Two cupboards (separate for each patient)

7.4  Services, Facilities, Equipment, Tools, and Instruments

229

Table 7.8  Semiprivate sharing rooms

Activity Sharing patient room shall have the following patient furniture: Patient bed (preferably multi-positional ICU bed, or Fowler bed with bedside railing) Bedside locker Over-bed table Step stool IV stand IV rod Backrest Dressing trollies Wheelchair Stretcher trolley Oxygen cylinder trolley Sharing patient bedroom shall have the following furniture: Pull-out bed or plain sofa or attendant bed separate for each patient Cupboard separate for each patient Sharing patient room shall have the following equipment/instruments/ tools: The below equipment/ instruments do not need to be provided for each room separately. However, the same shall be provided for a group of rooms, say 2–5 rooms Multi-para vital sign monitor Pulse oximeter Air mattress Walkers Refrigerator Nebulizer Suction machine electrical

Status of works In Not Responsible Start End Remarks date date Complete progress started person

:-

::::::::::-

:-

:-

:::::::(continued)

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7  Intermediate Care Area (IPD)

Table 7.8 (continued)

Activity Other required instruments Air conditioning system as per design Bed head panel separate for each patient MGPS gas for oxygen on each patient’s bed Wall-mounted suction on each patient’s bed Required electrical points Required communications points/ports Curtain partitions for each bed IV track for each bed Internet connection/Wi-Fi

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::::::::-

The semiprivate sharing rooms shall have the following equipment/instruments/ tools in the rooms. The below equipment/instruments/tools do not need to be provided for every room, but the same shall be provided for a group of rooms, say 2–5 rooms. • • • • • • • •

Multi-para vital sign monitor Pulse oximeter (in case the multi-para monitor is not provided) Air mattress Walkers Refrigerator Nebulizer Electrical suction machine Any other required equipment or instrument

Air conditioning system of patient rooms: The semiprivate sharing rooms shall each have a complete air conditioning system with controls for temperature, humidity, and air exchanges. Either the chilled water pipeline with a fan coil unit (FCU), the ductable split, or the VRV system can be used for room air conditioning. There shall be a separate return air supply in each room. No room, unit, or area’s return air shall be mixed with any other room’s return air. For heating, FCUs connected with hotwater generators can be used. Otherwise, room heaters are an option, though they are typically not advised. The temperature shall range from 21 to 24 °C. Central piped medical gas supply: All the patient beds in the semiprivate sharing rooms shall have a supply of centralized piped medical gases to handle any emergencies. The following gases are supplied:

7.4  Services, Facilities, Equipment, Tools, and Instruments

231

• Oxygen (O2) • Wall-mounted suction The outlets for these gases are fixed directly on the wall. Otherwise, this can also be achieved via the bed head panel. It is a 4-foot panel constructed of aluminium extruded sections. The gas outlets and electrical points can be fixed using this panel. Additionally, the IV rod, monitor tray, and utility basket can all be mounted to the panel’s service railing. This panel is fixed just on the wall above the head of the patient. The semiprivate sharing rooms shall have the following electrical points in the rooms: • The main switchboard, along with one 5 Amp switch/socket, shall be located at the entry wall to control the hall’s fan and lighting. • Temperature-adjustable air conditioning control button. • There shall be at least two pairs of 5/15 Amp switch/sockets (four points, on each bed head panel). Half of these points shall be backed up and supplied by UPS. • Two sets of 5/15 Amp switch/sockets shall be installed on the wall at a height of 457 mm above the floor, in the middle of two beds. One pair of these shall be the UPS backup. • There shall be a provision to charge mobile/laptop next to each bed. Other communication points in patient room: All the patient beds in the semiprivate sharing rooms shall have a provision of the following: • • • •

Point for attaching the call button of the nurse call device RJ 45 port for computer networking RJ 11 for intercom and extension line Point for reading light for patients

Curtain partitions: The patient bed in the rooms shall be provided with hanging curtain partitions. The bed shall have a curtain on all other three sides. The ceiling-­ suspended curtain track is fixed at 2134 mm above the floor level. Curtains shall be hung on these tracks and shall be moveable and collapsible. The bottom of the curtain shall have a clear area of about 457 mm from the floor to allow easy cleaning of the floor. IV track: The patient bed in the room shall be provided with a ceiling-suspended IV track. In the centre of the bed, the track shall be mounted lengthwise. The track is mounted and screwed to the ceiling/false ceiling of the room. The IV hanger shall be fixed in the track, which shall be moveable in the track. The IV hanger can be with the provision of three, four, or five hooks. It is recommended that each room shall have a provision of Wi-Fi to enable the patient to surf the internet.

7.4.1.3 Single-Bed Private Room See Table 7.9.

232

7  Intermediate Care Area (IPD)

Table 7.9  Single-bed private room

Activity Single-bed private room shall have the following patient furniture: Patient bed (preferably multi-positional ICU bed, or Fowler bed with bedside railing) Bedside locker Over-bed table Step stool IV stand IV rod Backrest Dressing trollies Wheelchair Stretcher trolley Oxygen cylinder trolley Single-bed private room shall have the following furniture: Plain sofa set or pull-out attendant bed Small dining table, if space is available Dining chairs Centre table Easy chairs Cupboard Refrigerator Single-bed private room shall have the following facilities: Soiled linen collection hamper The waste collection as per the norms of bio-=medical waste management Television with cable TV connection A wall clock on the foot end of the patient Whiteboard Calendar

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:-

::::::::::-

:::::::-

::-

::::-

7.4  Services, Facilities, Equipment, Tools, and Instruments

233

Table 7.9 (continued)

Activity Tack board Horizontal surfaces to keep greeting cards/ photos Provision of both hot and cold water in the toilets Pictures, paintings, murals, and artwork shall be provided Single-bed private room shall have the following equipment/instruments/ tools: The below equipment/ instruments do not need to be provided for all the rooms separately. However, the same shall be provided for a group of rooms, say 2–5 rooms Multi-para vital sign monitor Air mattress Walkers Weighing machine Nebulizer Electrical suction machine Other required instruments Air conditioning system as per design Bed head panel MGPS gas for oxygen Wall-mounted suction Required electrical points Required communications points/ports Curtain partitions for each bed IV track for each bed Internet connection/Wi-Fi

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::-

::-

::::::::::::::::-

234

7  Intermediate Care Area (IPD)

Each room of the single-bed private rooms shall have the following furniture in the wards: • Patient furniture: –– Patient bed (preferably the multi-positional ICU bed shall be provided; otherwise, semi-Fowler bed with bedside railing can be provided) –– Bedside locker –– Step stool –– Over-bed table –– IV stand –– IV rod –– Backrest –– Dressing trollies (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms) –– Wheelchairs (not necessary for every room, but they can be for a group of rooms, say 2–5 rooms) –– Stretcher trollies (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms) –– Oxygen cylinder trolley (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms) • Other furniture: –– Plain sofa set or pull-out bed –– Attendant bed (if pull-out bed is not provided) –– Small dining table, if the space in the room permits –– Dining chairs –– Centre table –– Easy chairs –– Cupboards –– Refrigerator The single-bed private rooms shall have the following facilities in the room: • • • • • • • • • •

The waste collection as per the norms of biomedical waste management Soiled linen collection hamper Television Calendar A wall clock on the wall at the foot end of the patient Whiteboard Tack board Charging points for mobile/laptop Horizontal surfaces to keep greeting cards/photos Photographs, paintings, murals, and other works of art positioned appropriately for patients, caretakers, and families

7.4  Services, Facilities, Equipment, Tools, and Instruments

235

The single-bed private rooms shall have the following equipment/instruments/ tools in the rooms. The below equipment/instruments/tools do not need to be provided for every room separately. However, the same shall be provided with a group of rooms (say 2–5 rooms). • • • • • • • •

Multi-para vital sign monitor Pulse oximeter (in case the multi-para monitor is not provided) Air mattress Walkers Weighing machine Nebulizer Electrical suction machine Any other required equipment or instrument

Air conditioning system of patient rooms: The single-bed private rooms shall each have a complete air conditioning system with controls for temperature, humidity, and air exchanges. Either the chilled water pipeline with a fan coil unit (FCU), the ductable split, or the VRV system can be used for room air conditioning. There shall be a separate return air supply in each room. No room, unit, or area’s return air shall be mixed with any other room’s return air. For heating, FCUs connected with hot water generators can be used. Otherwise, room heaters are an option, though they are typically not advised. The temperature shall range from 21 to 24 °C. Central piped medical gas supply: All the patient beds in the single-bed private rooms shall have a supply of centralized piped medical gases to handle any emergencies. The following gases are supplied: • Oxygen (O2) • Wall-mounted suction The outlets for these gases are fixed directly on the wall. However, this can also be achieved via the bed head panel. It is a 4-foot panel constructed of aluminium extruded sections. The gas outlets and electrical points can be fixed using this panel. Additionally, the IV rod, monitor tray, and utility basket can all be mounted to the panel’s service railing. This panel is fixed just on the wall above the head of the patient. The single-bed private rooms shall have the following electrical points inward: • The main switchboard, along with one 5 Amp switch/socket, shall be located at the entry wall to control the hall’s fan and lighting. • Temperature-adjustable air conditioning control button. • There shall be at least three pairs of 5/15 Amp switch/sockets (six points, on each bed head panel). Half of these points shall be backed up and supplied by UPS. • Two sets of 5/15 Amp switch/sockets shall be installed on the wall at a height of 457 mm above the floor just adjoining the patient bed. One pair of these shall be the UPS backup.

236

7  Intermediate Care Area (IPD)

• There shall be a provision to charge the mobile/laptop next to the bed. Other communication points in patient room: All the patient beds in the single-­bed private rooms shall have a provision of the following: • • • •

Point for attaching the call button of the nurse call device RJ 45 port for computer networking RJ 11 for intercom and extension line Point for reading light for patients

Curtain partitions: The patient bed in the rooms shall be provided with hanging curtain partitions. The bed shall have a curtain on all other three sides. The ceiling-­ suspended curtain track is fixed at 2134 mm above the floor level. Curtains shall be hung on these tracks and shall be moveable and collapsible. The bottom of the curtain shall have a clear area of about 457 mm from the floor to allow easy cleaning of the floor. IV track: The patient bed in the room shall be provided with a ceiling-suspended IV track. In the centre of the bed, the track shall be mounted lengthwise. The track is mounted and screwed to the ceiling/false ceiling of the room. The IV hanger shall be fixed in the track, which shall be moveable in the track. The IV hanger can be with the provision of 3, 4, or 5 hooks. It is recommended that each room shall have a provision providing Wi-Fi to enable the patient to surf the internet.

7.4.1.4 Single-Bed Deluxe Room See Table 7.10. Each room of the single-bed deluxe rooms shall have the following furniture in the wards: • Patient furniture: –– Patient bed (preferably the multi-positional ICU bed shall be provided) –– Bedside locker –– Step stool –– Over-bed table –– IV stand –– IV rod –– Backrest –– Dressing trollies (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms) –– Wheelchairs (not necessary for every room, but they can be for a group of rooms, say 2–5 rooms) –– Stretcher trollies (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms) –– Oxygen cylinder trolley (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms)

7.4  Services, Facilities, Equipment, Tools, and Instruments

237

Table 7.10  Single-bed deluxe room

Activity Single-bed deluxe room shall have the following patient furniture: Patient bed (multi-­ positional ICU bed) Bedside locker Over-bed table Step stool IV stand IV rod Backrest Dressing trollies Wheelchair Stretcher trolley Oxygen cylinder trolley Single-bed deluxe room shall have the following furniture: Plain sofa set or pull-out bed or attendant bed Small dining table, if space is available Dining chairs Centre table Easy chairs Cupboard Refrigerator Single-bed deluxe room shall have the following facilities: Soiled linen collection hamper The waste collection as per the norms of biomedical waste management Television with cable TV connection Whiteboard A wall clock on the foot end of the patient Tack board Calendar

Status of works In Not Responsible Start End Remarks date date Complete progress started person

:::::::_ ::::-

:::::::-

::-

:::::(continued)

238

7  Intermediate Care Area (IPD)

Table 7.10 (continued)

Activity Provision of both hot and cold water in the toilets Horizontal surfaces to keep greeting cards/ photos Pictures, paintings, murals, and artwork shall be provided Single-bed deluxe room shall have the following equipment/ instruments/tools: Multi-para vital sign monitor Air mattress Walkers Weighing machine Electrical suction machine Other required instruments Air conditioning system as per design Bed head panel MGPS gas for oxygen Wall-mounted suction Required electrical points Required communications points/ ports Curtain partitions for patient bed IV track for patient bed Internet connection/ Wi-Fi

Status of works In Not Responsible Start End Remarks date date Complete progress started person :-

:-

:-

::::::::::::-

:::-

• Other furniture: –– Plain sofa set or pull-out bed –– Attendant bed (if pull-out bed is not provided) –– Small dining table, if the space in the room permits –– Dining chairs –– Centre table –– Easy chairs

7.4  Services, Facilities, Equipment, Tools, and Instruments

239

–– Cupboards –– Refrigerator The single-bed deluxe rooms shall have the following facilities in the room: • • • • • • • • • •

The waste collection as per the norms of biomedical waste management Soiled linen collection hamper Television A wall clock on the foot end of the patient Mobile/laptop charging points Calendar on the wall on the foot end of the patient Tack board Whiteboard Horizontal surfaces to keep greeting cards/photos Photographs, paintings, murals, and other works of art positioned appropriately for patients, caretakers, and families

The single-bed deluxe rooms shall have the following equipment/instruments/ tools in the rooms. The below equipment/instruments/tools do not need to be provided for every room separately. However, the same shall be provided with a group of rooms (say 2–5 rooms): • • • • • • • •

Multi-para vital sign monitor Pulse oximeter (in case the multi-para monitor is not provided) Air mattress Walkers Weighing machine Nebulizer Electrical suction machine Any other required equipment or instrument

Air conditioning system of patient rooms: The single-bed deluxe rooms shall each have a complete air conditioning system with controls for temperature, humidity, and air exchanges. Either the chilled water pipeline with a fan coil unit (FCU), the ductable split, or the VRV system can be used for room air conditioning. There shall be a separate return air supply in each room. No room, unit, or area’s return air shall be mixed with any other room’s return air. For heating, FCUs connected with hot-water generators can be used. Otherwise, room heaters are an option, though they are typically not advised. The temperature shall range from 21 to 24 °C. Central piped medical gas supply: All the patient beds in the single-bed deluxe rooms shall have a supply of centralized piped medical gases to handle any emergencies. The following gases are supplied: • Oxygen (O2) • Wall-mounted suction

240

7  Intermediate Care Area (IPD)

The outlets for these gases are fixed directly on the wall. Otherwise, this can also be achieved via the bed head panel. It is a 4-foot panel constructed of aluminium extruded sections. The gas outlets and electrical points can be fixed using this panel. Additionally, the IV rod, monitor tray, and utility basket can all be mounted to the panel’s service railing. This panel is fixed just on the wall above the head of the patient. The single-bed deluxe rooms shall have the following electrical points in the rooms: • The main switchboard, along with one 5 Amp switch/socket, shall be located at the entry wall to control the hall’s fan and lighting. • Temperature-adjustable air conditioning control button. • There shall be at least three pairs of 5/15 Amp switch/sockets (six points, on each bed head panel). Half of these points shall be backed up and supplied by UPS. • Two sets of 5/15 Amp switch/sockets shall be installed on the wall at a height of 457 mm above the floor just adjoining the patient bed. One pair of these shall be the UPS backup. • There shall be a provision to charge the mobile/laptop next to the bed. Other communication points in patient room: All the patient beds in the single-­bed deluxe rooms shall have a provision of the following: • • • •

Point for attaching the call button of the nurse call device RJ 45 port for computer networking RJ 11 for intercom and extension line Point for reading light for patients

Curtain partitions: The patient bed in the rooms shall be provided with hanging curtain partitions. The bed shall have a curtain on all other three sides. The ceiling-­ suspended curtain track is fixed at 2134 mm above the floor level. Curtains shall be hung on these tracks and shall be moveable and collapsible. The bottom of the curtain shall have a clear area of about 457 mm from the floor to allow easy cleaning of the floor. IV track: The patient bed in the room shall be provided with a ceiling-suspended IV track. In the centre of the bed, the track shall be mounted lengthwise. The track is mounted and screwed to the ceiling/false ceiling of the room. The IV hanger shall be fixed in the track, which shall be moveable in the track. The IV hanger can be with the provision of 3, 4, or 5 hooks. It is recommended that each room shall have a provision of Wi-Fi to enable the patient to surf the internet.

7.4.1.5 Single-Bed Family Suites See Table 7.11. Each room of the single-bed family suites shall have the following furniture in the wards:

7.4  Services, Facilities, Equipment, Tools, and Instruments

241

Table 7.11  Single-bed family suites

Activity Patient room of the suite shall have the following patient furniture: Patient bed (multi-­ positional ICU bed) Bedside locker Over-bed table Step stool IV stand IV rod Backrest Dressing trollies Wheelchair Stretcher trolley Oxygen cylinder trolley Patient room shall have the following furniture: Plain sofa set or plain sofa set attendant bed Small dining table Dining chairs Centre table Easy chairs Cupboard Refrigerator The family room of the suite shall have the following facilities: Family room attached to the patient room Separate attached toilet Small kitchenette Electric kettle and microwave shall be provided Working slab with a washing sink and draining board in the kitchenette Sofa set for seating of 5–7 people Centre table

Status of works In Not Responsible Start End Remarks date date Complete progress started person

:::::::::::-

:::::::-

::::-

:-

::(continued)

7  Intermediate Care Area (IPD)

242 Table 7.11 (continued)

Activity Dining table and chairs Separate refrigerator Separate cupboard Separate television Separate computer with internet connection Reading table with chair can be provided Patient room shall have the following facilities: Soiled linen collection hamper Television with cable TV connection A wall clock on the foot end of the patient Whiteboard The waste collection as per the norms of biomedical waste management Tack board Calendar Provision of both hot and cold water in the toilets Horizontal surfaces to keep greeting cards/ photos Pictures, paintings, murals, and artwork shall be provided Patient room shall have the following equipment/ instruments/tools: Multi-para vital sign monitor Air mattress Walkers Weighing machine Electrical suction machine

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::::-

:::::-

:::-

:-

:-

:::::-

7.4  Services, Facilities, Equipment, Tools, and Instruments

243

Table 7.11 (continued)

Activity Other required instruments Air conditioning system as per design for the patient room and family room Bed head panel for patient room MGPS gas for oxygen in the patient room Wall-mounted suction Required electrical points for patient room and family room Required communications points/ ports for patient room and family room Curtain partitions for patient bed IV track for patient bed Internet connection/ Wi-Fi

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::-

::::-

:-

:::-

• Patient furniture: –– Patient bed (preferably the multi-positional ICU bed shall be provided) –– Bedside locker –– Step stool –– Over-bed table –– IV stand –– IV rod –– Backrest –– Dressing trollies (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms) –– Wheelchairs (not necessary for every room, but they can be for a group of rooms, say 2–5 rooms) –– Stretcher trollies (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms) –– Oxygen cylinder trolley (not necessary for every room, but it can be for a group of rooms, say 2–5 rooms)

244

7  Intermediate Care Area (IPD)

• Other furniture: –– Plain sofa set or pull-out bed –– Attendant bed (if pull-out bed is not provided) –– Centre table –– Easy chairs –– Cupboards –– Refrigerator Along with the patient unit in the single-bed family suites, a family room/unit shall be provided. The family unit shall have the following facilities: • There shall be a small kitchenette with a microwave and an electric kettle for making tea, coffee, and other snacks. • A working slab, a washing sink, and a draining board shall all be provided in the kitchenette. • The family room shall contain a sofa set that can accommodate 5–7 people and also a centre table. • In the family room, a dining table and chairs shall be provided. • The family room shall have an additional refrigerator. • The family area shall have a dedicated cabinet. • For the family, a separate television shall be given. • If possible, offer a separate computer with an internet connection. • If necessary, a chair and reading table can be provided. The single-bed family suites shall have the following facilities in the room: • • • • • • • • • •

Soiled linen collection hamper The waste collection as per the norms of biomedical waste management A wall clock on the foot end of the patient Calendar Tack board Whiteboard Horizontal surfaces to keep greeting cards/photos Mobile/laptop charging points Television (not applicable for ICU) Pictures, paintings, murals, and artwork placed appropriately for patients, families, and caregivers

The single-bed family suites shall have the following equipment/instruments/ tools in the rooms. The below equipment/instruments/tools do not need to be provided for all the rooms separately. However, the same shall be provided with a group of rooms (say 2–5 rooms): • Multi-para vital sign monitor • Pulse oximeter (in case the multi-para monitor is not provided)

7.4  Services, Facilities, Equipment, Tools, and Instruments

• • • • • •

245

Air mattress Walkers Weighing machine Nebulizer Electrical suction machine Any other required equipment or instrument

Air conditioning system of patient rooms: The single-bed family suites (both the patient unit and the family unit) shall each have a complete air conditioning system with controls for temperature, humidity, and air exchanges. Either the chilled water pipeline with a fan coil unit (FCU), the ductable split, or the VRV system can be used for room air conditioning. There shall be a separate return air supply in each room. No room, unit, or area’s return air shall be mixed with any other room’s return air. For heating, FCUs connected with hot-water generators can be used. Otherwise, room heaters are an option, though they are typically not advised. The temperature shall range from 21 to 24 °C. Central piped medical gas supply: All the patient beds in the single-bed family suites shall have a supply of centralized piped medical gases to handle any emergencies. The following gases are supplied: • Oxygen • Wall-mounted suction The outlets for these gases are fixed directly on the wall. However, this can also be achieved via the bed head panel. It is a 4-foot panel constructed of aluminium extruded sections. The gas outlets and electrical points can be fixed using this panel. Additionally, the IV rod, monitor tray, and utility basket can all be mounted to the panel’s service railing. This panel is fixed just on the wall above the head of the patient. Electrical points: The patient unit of the single-bed family suites shall have the following electrical points in the rooms: • The main switchboard, along with one 5 Amp switch/socket, shall be located at the entry wall to control the hall’s fan and lighting. • Temperature-adjustable air conditioning control button. • There shall be at least three pairs of 5/15 Amp switch/sockets (six points, on each bed head panel). Half of these points shall be backed up and supplied by UPS. • Two sets of 5/15 Amp switch/sockets shall be installed on the wall at a height of 457 mm above the floor just adjoining the patient bed. One pair of these shall be the UPS backup. • There shall be a provision to charge the mobile/laptop next to the bed. The family unit of the single-bed family suites shall have the following electrical points in the room:

246

7  Intermediate Care Area (IPD)

• The main switchboard, along with one 5 Amp switch/socket, shall be located at the entry wall to control the hall’s fan and lighting. • Temperature-adjustable air conditioning control button. • There shall be a provision to charge the mobile/laptop. • At least two numbers of 5/15 Amp switch/socket, for general use. Other communication points in the patient room: All the patient beds in the single-bed family suites shall have a provision of the following: • • • •

Point for attaching the call button of the nurse call device RJ 45 port for computer networking RJ 11 for intercom and extension line Point for reading light for patients

All the family units of the single-bed family suites shall have a provision of the following: • RJ 45 point for computer networking • RJ 11 for intercom and extension line with facility for outside calls Curtain partitions: The patient bed in the rooms shall be provided with hanging curtain partitions. The bed shall have a curtain on all other three sides. The ceiling-­ suspended curtain track is fixed at 2134 mm above the floor level. Curtains shall be hung on these tracks and shall be moveable and collapsible. The bottom of the curtain shall have a clear area of about 457 mm from the floor to allow easy cleaning of the floor. IV track: The patient bed in the room shall be provided with a ceiling-suspended IV track. In the centre of the bed, the track shall be mounted lengthwise. The track is mounted and screwed to the ceiling/false ceiling of the room. The IV hanger shall be fixed in the track, which shall be moveable in the track. The IV hanger can be with the provision of 3, 4, or 5 hooks. It is recommended that each room shall have a provision of Wi-Fi to enable the patient to surf the internet.

7.4.2 Supporting Room/Units for Indoor Patient Service 7.4.2.1 Nurse Station/Desk See Table 7.12. For treatment of the patient as an indoor patient, the nursing stations shall be provided with wards and rooms. The infrastructure part of the nursing stations/ desks has been described above in this chapter. Now we shall describe the equipment, furniture, tools, instruments, drugs, and consumables that have to be kept at the nursing counters/desks.

7.4  Services, Facilities, Equipment, Tools, and Instruments

247

Table 7.12  Nurse station/desk in IPD

Activity The nursing station shall have the following furniture: Nursing counter Instead of open nurse station, it can be enclosed in a glass bubble Office chairs Filing cabinet Almirah/cupboard Visitor chairs, etc. The nursing station shall have the following patient furniture (to be used for all wards and rooms in their charge): Wheelchair Stretcher trolley Dressing trolley Instrument trolley Crash cart Oxygen cylinder trollies The nursing station shall have the following equipment (to be used for all wards and rooms in their charge): Multi-para vital sign monitor Non-invasive ventilator Infusion pump Syringe pumps ECG machine Suction machine BP apparatus Stethoscope Spinal board Transport ventilator Glucometer Laryngoscope View boxes, etc. Ambu mask of different sizes

Status of works In Not Responsible Start End Remarks date date Complete progress started person :-

::-

::::-

::::::-

::::::::::::::(continued)

7  Intermediate Care Area (IPD)

248 Table 7.12 (continued)

Activity The nursing station shall have the following tools/instruments (to be used for all wards and rooms in their charge): Sterilizing drums Extension cords and boxes Refrigerator Instrument boxes Torches Trays of all styles and sizes Kidney tray of all sizes Bowls of all sizes Cheatle forceps Forceps of all styles and sizes Needle holders Scissors of all styles and sizes All types of required linen Alcohol gel/sanitizer dispensers All other required instruments The nursing station shall have the following drugs (to be used for all wards and rooms in their charge): Emergency drugs Analgesia drugs Antibiotics The nursing station shall have the following consumables/ disposables (to be used for all wards and rooms in their charge): All types of catheters All types of infusion sets

Status of works In Not Responsible Start End Remarks date date Complete progress started person

:::::::::::::::-

:::-

::-

7.4  Services, Facilities, Equipment, Tools, and Instruments

249

Table 7.12 (continued)

Activity Cotton, bandage, and gauze General ward consumables like Betadine, Savion, spirit, Cidex, and creams For hand hygiene, single-bay scrub station Soap dispensers and paper towel dispensers Required electrical points Required communication points/ports

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::-

::::-

It is not always possible to provide all equipment, tools, instruments, drugs, and consumables to all the patients or patient beds in the ward or rooms. Hence, these items are kept at the nursing counter/desk in the charge of the duty nurse to be used as and when required for any patient. Hence, we can say that these items are common to all the patients in the ward/rooms. Let us describe the nursing counters. All the nursing stations shall have a nursing counter. The nursing station shall be positioned at a reasonable height in general wards with multiple beds so that the nurse can easily see the patients. For this, a platform that is approximately 305 mm high shall be provided on which the nursing counter shall be placed. The design of the nurse station shall allow the nurses to keep a safe adequate distance from the patient. Hospitals typically have an open type of nurse counter where patients and visitors can speak with the nurse. Because there is no barrier in between, this kind of counter might be more likely to spread infection. Instead of an open counter type of nurse station, consider enclosing the nurse station in ‘glass bubbles’ as a solution to this problem. The staff shall always be on the other side of the partition when speaking with the patient or visitor; hence, it is recommended to build a proper 1828 mm high acrylic or glass divider at the top of the nursing counter. Technology like the audio-video controlled nurse call system is another option. The nursing counter shall have the following furniture: • Office chairs • Filing cabinet, almirah and cupboard for a storage facility for patient files, instruments, tools, and stationery • Visitor chairs, etc.

250

7  Intermediate Care Area (IPD)

For common use, the nursing counter shall be provided with the following patient furniture: • • • • • •

Stretcher trolley Wheelchair Instrument trolley Dressing trolley Crash cart Oxygen cylinder trollies

Similarly, for common use, the nursing counter shall be provided with the following medical equipment: • • • • • • • • • • • • • •

Multi-para vital sign monitor Non-invasive ventilator Infusion pump Syringe pumps ECG machine Suction machine BP apparatus Stethoscope Spinal board Transport ventilator Glucometer Laryngoscope View boxes, etc. Ambu mask of different sizes

Along with this, the nursing counter shall be provided with the following tools and instruments for common use: • • • • • • • • • • • • • •

Sterilizing drums Extension cords and boxes Refrigerator Instrument boxes Torches Trays of all styles and sizes Kidney tray of all sizes Bowls of all sizes Cheatle forceps Forceps of all styles and sizes Needle holders Scissors of all styles and sizes All types of required linen Alcohol gel/sanitizer dispensers

7.4  Services, Facilities, Equipment, Tools, and Instruments

251

• All other required instruments For emergencies, the nursing counter shall be provided with the following drugs for common use: • Emergency drugs • Analgesia drugs • Antibiotics At times, disposables and consumables may also be required in the ward/room; hence, the nursing counter shall be provided with the following consumables and disposables for common use: • All types of catheters • All types of infusion sets • General ward consumables like Betadine, Savion, spirit, Cidex, and creams Single-bay scrub stations, located near the nursing stations, shall be used for hand hygiene in the indoor patient area. Soap dispensers, paper towel dispensers, and trash receptacles shall all be located near the scrub station. The scrub station shall allow for hands-free operation. Scrub stations that are sensor controlled and/or foot operated shall be used. It shall have a connection both for hot and cold water. The following electrical and communications points shall be provided at the nursing station: • At least six 5 Amp switch/sockets on the counter wall, approximately 146 mm above the working surface. These connectors shall be used to connect computers and printers. • For other appliances, two 15 Amp switch/sockets shall be provided on the wall behind the nursing counter. • A 5 Amp switch/socket shall be provided on the wall behind the nursing counter for fixing the view box. • Port for installing the control console of the nurse call system. • RJ 45 port for computer networking. • RJ 11 connector for intercom and extension line. • HDMI port for sharing computer display at other locations.

7.4.2.2 Nurses’ Duty Rooms See Table 7.13. As these rooms are for the nurse to take rest/breaks and store their personal belongings, while on duty, the following shall be provided: • Single bed. • Cupboard or almirah.

252

7  Intermediate Care Area (IPD)

Table 7.13  Nurse’s duty rooms in IPD Start date

Activity Bed for rest Cupboard Points for computer with internet Intercom facility Air-conditioned

Status of works In Not Complete progress started

End date

Responsible person

Remarks

:::-

::-

Table 7.14  Store for medicines, consumables, and disposables in IPD

Activity Lockable cupboards Racks Drawers Refrigerator Countertop

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::-

• Besides the light and fan, the room shall have computer points with internet access and an intercom system. • The room shall be air-conditioned, and a temperature control button shall be provided in the room.

7.4.2.3 Store for Medicines, Consumables, and Disposables See Table 7.14. As this room is for the storage of required medicines, consumables, and disposables, it shall be provided with: • • • • •

Racks Adequate lockable cupboards Drawers Refrigerator A countertop for easy working

7.4.2.4 Equipment Park/Store See Table 7.15. The equipment park/store shall have a sufficient number of working counters to place the countertop equipment and instruments. For bulky equipment, sufficient floor space shall be available.

7.4  Services, Facilities, Equipment, Tools, and Instruments

253

Table 7.15  Equipment park/store in IPD

Activity Lockable cupboards, racks, and drawers Working counter Multiple electric points to charge equipment when not in use Air conditioning with controlled humidity level

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:::-

:-

Table 7.16  Dirty utility/sluice room in IPD

Activity Waste bins for disposal of waste as per the biomedical waste norms Covered linen collection hampers or containers Exhaust fans to exhaust the contaminated air

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

:-

The store shall have adequate lockable cupboards, racks, and drawers to store the equipment and instruments. The store shall also have multiple electric points to charge the equipment when not in use. The store shall have proper air conditioning and controlled humidity levels to prevent the electronic equipment from excessive heat and moisture.

7.4.2.5 Dirty Utility/Sluice Room See Table 7.16. Dirty utility shall be provided with waste bins to dispose of the waste as per the biomedical waste management rules. Special attention shall be paid to biomedical waste. The room shall also have a hamper with a lid to collect the soiled linen that has to be sent to the laundry for the wash. Exhaust fans are essential since the air in this space needs to be evacuated.

7  Intermediate Care Area (IPD)

254

7.4.2.6 Clean Utility See Table 7.17. To store the clean linen and sterilized material, the room shall have a sufficient number of racks, cupboards, drawers, or stainless steel racks divided into bins. 7.4.2.7 Procedure and Treatment Room See Table 7.18. The treatment/procedure room attached to the wards and other indoor units shall have the following patient furniture: • Patient furniture: –– Examination table –– Instrument trollies –– Dressing trollies –– Crash cart Table 7.17  Clean utility in IPD

Activity Racks Drawers Closed cabinets

Start date

End date

Status of works In Complete progress

Not started

Responsible person

Remarks

:::-

Table 7.18  Procedure and treatment room in IPD

Activity Following patient furniture shall be placed in the procedure/treatment room: Examination table Instrument trollies Dressing trollies Step stool IV rod Crash cart IV stand Stretcher trolley Oxygen cylinder trolley Scrub station

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::::::-

7.4  Services, Facilities, Equipment, Tools, and Instruments

255

Table 7.18 (continued)

Activity Following equipment shall be placed in the procedure/treatment room: Portable operating light single dome Multi-para vital sign monitor Defibrillator Suction machine Infusion pump Laryngoscope Oxygen cylinders with masks View boxes Following tools and instruments shall be placed in the procedure/treatment room: Sterilizing drums Examination light Scissors of all styles and sizes Needle holders Forceps of all styles and sizes Cheatle forceps Extension cords and boxes Instrument boxes Torches Tray of all styles and sizes All other required instruments MGPS gas outlets:  Oxygen two outlets  Compressed air two outlets  Suction oxygen two outlets Single-bay scrub station Required electrical points Required communication points/ ports

Status of works In Not Responsible Start End Remarks date date Complete progress started person

::::::::-

:::::::::::-

::::::-

256

–– –– –– –– –– ––

7  Intermediate Care Area (IPD)

IV rod IV stand Step stool Stretcher trolley Scrub station Oxygen cylinder trolley

The treatment/procedure room shall also have the following patient equipment: • • • • • • • •

Portable operating light single dome Multi-para vital sign monitor Defibrillator Infusion pump Suction machine Laryngoscope Oxygen cylinders with masks View boxes

Other tools and instruments that shall be provided in the treatment/procedure room: • • • • • • • • • • •

Sterilizing drums Examination light Instrument boxes Forceps of all styles and sizes Scissors of all styles and sizes Needle holders Cheatle forceps Tray of all styles and sizes Torches Extension cords and boxes All other required instruments

As surgical interventions may have to be performed in the treatment/procedure room, the outlets of the medical piped gas shall be provided duly mounted on the ceiling-suspended pendant. The following outlets shall be provided: • Two outlets for oxygen • Two outlets for compressed air • Two outlets for suction oxygen Electrical points in treatment/procedure room: the room shall have the following: • The main switchboard, having one 5 Amp switch/socket, shall be located near the entry wall to control the hall’s fan and lighting.

7.4  Services, Facilities, Equipment, Tools, and Instruments

257

• A temperature-controlled air conditioning control button. • The electrical points shall be provided on hanging pendants. On the back wall of the pendant, there shall be a minimum of three pairs of 5/15 Amp switches and sockets. These points shall be provided with power backup through UPS. • A pair of two 5/15  Amp switches/sockets shall be provided with the power backup at a height of 457 mm from the floor on each of the three walls of the treatment/procedure room, excluding the wall on which a door is present. One pair of these two shall be power backed up through UPS. Other communication points in the treatment/procedure room shall be: • RJ 45 port for computer networking • RJ 11 port for intercom and extension line • HDMI point for computer image display at other locations

7.4.2.8 Ward Pantry See Table 7.19. The pantry shall be provided with a countertop slab for cooking or for keeping and processing the precooked food that has to be served to the patient in the ward/rooms. The provision of a sink with a draining board shall be made for washing utensils. The sink shall have a provision for hot and cold water. Table 7.19  Ward pantry in IPD

Activity Countertop slab for cooking and placing gas burners and induction or for keeping and processing the diet Sink with draining board and hot and cold water supply Microwave oven may be useful Induction heater Refrigerator Gas stove burner and place for keeping the gas cylinder Waste bin Trolley for collecting the soiled utensils Required electric points

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

:::-

7  Intermediate Care Area (IPD)

258

A microwave, refrigerator, gas burner, and/or induction heater shall be provided in the pantry. A dedicated place shall be provided to place the cooking gas cylinder. The waste bin shall also be provided in the pantry for disposal of the leftover food. The place shall be provided near the panty to park the food trolley. A sufficient number of electric points shall be provided to operate these kitchen appliances.

7.4.2.9 Medication Area See Table 7.20. The medication area is provided adjoining the nurse stations, which is basically used for keeping the patient’s medications in clear plastic boxes. Hence, the space shall have a lockable cupboard, racks, and drawers. If the medication room is separate, the working countertop shall be provided in the room. Apart from this, a refrigerator shall also be provided for this medication room. 7.4.2.10 Doctors’ Duty Rooms See Table 7.21. The doctors’ duty room of the indoor areas shall have: • One office table, chair, cupboard, and a single bed. Table 7.20  Medication area in IPD

Activity Lockable cupboards Racks Drawers Countertop Refrigerator

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::-

Table 7.21  Doctors’ duty rooms in IPD

Activity Office table Office chair Bed for rest Cupboard Points for computer with internet Intercom facility Air-conditioned

Start date :::::-

::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

7.4  Services, Facilities, Equipment, Tools, and Instruments

259

Table 7.22  Trolley park area in IPD

Activity Chains and hooks to hold the wheelchairs and stretcher trollies in place

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

• The room shall be provided with points for a computer with an internet connection and an intercom system in addition to lights and fan. • It shall have air conditioning, and within the room itself, the control button for adjusting the temperature shall be provided.

7.4.2.11 Trolley Park Area See Table 7.22. The trolley bay shall have sufficient provision to hold the trollies in place. Hence, a sufficient number of hooks and chains shall be provided on the walls.

7.4.3 Amenities for Patient’s Family Often, anxious family members/friends visit a hospital with the patient. Moreover, the family’s support plays a significant role in the patient’s recovery and reduces morbidity. Therefore, a family support zone shall be placed near the patient rooms. This zone shall have the following facilities:

7.4.3.1 Visitors’ Bay/Family Lounge See Table 7.23. The visitors’ bay/family lounge near the wards and other indoor areas shall be provided with sofa sets or chairs/recliners for comfortable sitting of the visitors and family members of the patient. The area shall have a toilet block attached to it. Preferably, the toilets shall be separate for men and women. Along with this, a facility for drinking water shall be provided. For water supply, either water coolers or water drinking fountains can be provided. If possible, a small cafeteria shall be provided from where the precooked snacks and cookies can be served. Along with this, the tea/coffee vending machine shall also be provided. Try providing Wi-Fi and an internet facility. The waiting area shall also have the facility for mobile charging points near the seating areas. This area shall be guarded by security to control the unnecessary movement of family members in the indoor patient areas and shall be under CCTV surveillance. The visitors’ bay/family lounge shall also be provided with a few shelves, closets, and secure lockers where the visitors can safely keep their personal belongings.

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Table 7.23  Visitors’ bay/family lounge in IPD

Activity Sofa sets Chairs/recliners Separate toilets for males and females Drinking water facility Small cafeteria or snacks, tea and coffee vending machines Wi-Fi facility with internet Mobile charging points Controlled access CCTV surveillance Shelves, closets, and secure lockers Television, newspaper and magazine stand Small play area for children

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

:::::::-

The area shall also have a provision for a television, newspaper and magazine stand, and a small place dedicated as a play area for children.

7.4.3.2 Consultation Rooms See Table 7.24. A consultation room shall be provided in the patient room area for concerned family members who want to meet with the treating physician to get an update on the patient’s condition or recovery. This room shall include the following: • Office table, doctors’ chair, visitors’ chairs, and a sofa set. • A security guard shall be stationed outside the room because there may occasionally be heated arguments inside. • Furthermore, CCTV with an audiovisual recording facility shall be installed in this room.

7.4.3.3 Meditation Space See Table 7.25. Disturbed family members of the patient are often in fear and seek blessings from the Almighty. Hence, a room near the patient rooms for meditation, reflection, and spiritual contemplation shall be provided. The area shall have a place for placing or hanging the idols or pictures.

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7.4  Services, Facilities, Equipment, Tools, and Instruments Table 7.24  Consultation room in IPD

Activity Office table Chairs Sofa set Under CCTV surveillance

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

Status of works In Not Complete progress started

Responsible person

Remarks

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

Table 7.25  Meditation space in IPD

Activity Space for putting statues and pictures

Start date

End date

:-

Table 7.26  Family cafeteria near IPD

Activity Small cafeteria Drinking water fountains Separate space or dining hall Vending machines

Start date

End date

::::-

7.4.3.4 Family Cafeteria See Table 7.26. Typically, the hospital’s ground level shall have a café where the patient’s family members can have refreshments. The café and lounge shall contain or be close to freshwater supply facilities, such as drinking water fountains. There shall be a designated area or dining hall where the meals can be served to the family members. Additionally, vending machines can be useful, especially late at night when hospital coffee shops or food services might not be open. To maintain hygienic standards, sufficient measures shall be taken for the proper disposal of discarded utensils or disposables. 7.4.3.5 Family Sleep Rooms See Table 7.27.

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Table 7.27  Family sleep rooms near IPD

Activity Space in the patient room or a separate room in the hospital building Separate guest house shall be arranged Guest houses shall have a bed, bedding, toilet, TV, fridge, and mess

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

::-

If a family member needs to stay with the patient to provide specialized care, it is advised that each patient’s room have space for them to do so. Alternatively, if the space is not available within the patient room, any other alternate space within the hospital premises can be allocated for this purpose. If that is also not possible, a different guest house shall be arranged and made available to the family members in exchange for money. These guest houses shall have the required amenities like toilet, bed, bedding, TV, fridge, and dining.

Further Reading Anon. Design, Construction and Regulation of the Negative Pressure Isolation Room--《Chinese Medical Equipment Journal》2004年01期 [Internet]. [cited 2021 Jun 22]. Available from: https://en.cnki.com.cn/Article_en/CJFDTotal-­YNWS200401023.htm. Brown KK, Gallant D. Impacting patient outcomes through design: acuity adaptable care/universal room design. Crit Care Nurs Q. 2006;29(4):326–41. Choi J-H, Beltran LO, Kim H-S.  Impacts of indoor daylight environments on patient average length of stay (ALOS) in a healthcare facility. Build Environ. 2012;50:65–75. Cullinan K, Wolf M. The patient room: what is the ideal solution. Healthcare Design, n.d. p. 60. Eijkelenboom A, Bluyssen PM.  Comfort and health of patients and staff, related to the physical environment of different departments in hospitals: a literature review. Intell Build Int. 2019:1–19. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 21, Intermediate Care Area (Patient Rooms);. p. 213–39. Griffin CH, Joint Commission, Joint Commission Resources, Inc, Joint Commission International, AIA Academy of Architecture for Health, editors. Planning, design, and construction of health care facilities: addressing Joint Commission and JCI standards and other considerations--from planning to commissioning. Third edition. Oak Brook, IL: Joint Commission Resources; 2015. 138 p. Hendrich AL, Fay J, Sorrells AK. Effects of acuity-adaptable rooms on flow of patients and delivery of care. Am J Crit Care. 2004;13(1):35–45.

Further Reading

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Hyttinen M, Rautio A, Pasanen P, Reponen T, Earnest GS, Streifel A, et  al. Airborne infection isolation rooms—a review of experimental studies. Indoor Built Environ. 2011;20(6):584–94. Lee JK, Jeong HW. Rapid expansion of temporary, reliable airborne-infection isolation rooms with negative air machines for critical COVID-19 patients. Am J Infect Control. 2020;48(7):822–4. Plate JDJ, Leenen LPH, Houwert M, Hietbrink F. Utilisation of intermediate care units: a systematic review. Crit Care Res Pract. 2017;2017:8038460. Science News. New treatment room design model for future hospitals. ScienceDaily. [cited 2021 Jun 22]. Available from: https://www.sciencedaily.com/releases/2016/05/160526092743.htm. Smith TJ. Occupancy and patient care quality benefits of private room relative to multi-bed patient room designs for five different children’s hospital intensive and intermediate care units. Work. 2016;54(4):853–72. Stichler JF. The new standard: single family room design. JONA J Nurs Adm. 2012;42(10):447–50. Tsao T, Chang CP, Chuang C-Y, Juang Y-J, Lin S-J, Dai Y-T. The effect of doorway size on the negative pressure in airborne infection isolation room the effect of doorway size on the negative pressure in airborne infection isolation room. J Occup Saf Health. 2010;18:307–19. Waydhas C, Herting E, Kluge S, Markewitz A, Marx G, Muhl E, et al. Intermediate care units: recommendations on facilities and structure. Med Klin Intensivmed Notfallmedizin. 2017:113. Weng C-L, Kau L-J. Planning and design of a full-outer-air-intake natural air-conditioning system for medical negative pressure isolation wards. J Healthc Eng. 2021;2021:e8872167. Xie Y. Design and management of negative pressure isolation room for infectious Disease. Chinese J Nosocomiol 2007年12期 [Internet]. [cited 2021 Jun 22]. Available from: https://en.cnki.com. cn/Article_en/CJFDTotal-­ZHYY200712041.htm. Zhang Y, Han O, Li A, Hou L, Olofsson T, Zhang L, et al. Adaptive wall-based attachment ventilation: a comparative study on its effectiveness in airborne infection isolation rooms with negative pressure. Engineering. 2021 Jan 23 [cited 2021 Jun 22]; Available from: https://www. sciencedirect.com/science/article/pii/S2095809921000059.

8

Radio Diagnosis

The department of radiology is responsible for using medical imaging to diagnose and treat illnesses. Imaging modalities can be based on a variety of imaging techniques. X-rays, ultrasound waves, magnetic fields, and nuclear medicine are the main techniques. X-ray radiography, ultrasound equipment, computed tomography (CT), magnetic resonance imaging (MRI), mammography imaging, nuclear positron emission computed tomography (PET/CT), nuclear positron emission magnetic resonance imaging (PET/MRI), SPECT/CT, cyclotron/radio pharmacy, densitometer, bone scan, and digital subtraction angiography (DSA), among other imaging modalities, are examples of various imaging devices. Diagnostic vs. therapeutic: Diagnostic radiology is a science that uses a variety of imaging techniques to diagnose diseases, leaving doctors to manage the actual treatment. In this case, diagnostic imaging aids doctors in correctly diagnosing an illness. On the other hand, therapeutic radiology includes both diagnosis and treatment, such as peripheral shunting. Therapeutic radiology, including interventional radiology, enables the performing of (usually minimally invasive) medical procedures under the guidance of imaging technologies. It is important to highlight that the department of radio diagnosis is at the correct location in the hospital premises, shall have sufficient resources to ensure radiation exposure protection, and shall not obstruct the operation of other departments. This set of checklists shall help the planner and designer to remember all such issues relating to the radiology department and guide him/her to complete, test, and commission all works/activities well in time before the radiological investigations begin. Radiology is the department that uses various types of imaging techniques based on which imaging modalities are worked out. These techniques include X-ray, ultrasound waves, magnetic fields, and nuclear medicine.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_8

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Imaging modalities based on these above four techniques are: • • • • • • • • • • •

X-ray radiography Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasound machines Mammography imaging Nuclear positron emission computed tomography (PET/CT) Nuclear positron emission magnetic resonance imaging (PET/MRI) SPECT/CT Cyclotron/radio pharmacy Densitometer, bone Digital subtraction angiography (DSA)

8.1 Location of the Radiology Department It is a well-known fact that the service of radiology is often used by most of the departments of the hospital like the emergency department, outpatient department, ICUs, and indoor patient department. The department of radio diagnosis shall preferably be located on the ground floor of the hospital to make access easy for the patient, and secondly, it has to be in a fast-moving zone because of the heavy flow of patients in this department. The radiology department shall be near the main departments like OPD, emergency, and intensive care units. The general people must be provided with proper protection because X-rays are dangerous and the majority of equipment rely on this technology. The degree of protection must be such that the rays will not pass through the machine room’s walls. When it comes to CT scans, PET scans, DSA, and radiotherapy, the radiation dosage rate is significantly higher and dangerous to the general population. Therefore, it makes sense to situate the radiology department in the basement, as any penetrating rays will be absorbed by the soil beyond the exterior wall, protecting against outside radiation. The width of corridor of the radio diagnosis department shall be wide enough to permit the movement and installation of all pieces of equipment. If the size of the corridors and the corners are not well planned, it will create a big problem to transport the equipment to the respective point of installation.

8.2 Infrastructure 8.2.1 Space Requirement for Radio Diagnosis As far as the infrastructure of the radio diagnosis department is concerned, it shall be ensured that the spaces for the following had been provided for:

267

8.2 Infrastructure

8.2.1.1 Utility Area See Table 8.1. The radio diagnostic department’s utility area, also known as the patient zone, is for the patients’ convenience and comfort. The following are a few of the main spaces that shall be provided in this area: 1. Reception and enquiry: When a patient initially enters the department, they will make contact with the receptionist. The reception shall be accessible to provide visitors and patients with all the information they need, make appointments, guide them through the registration process, describe how to gather reports, and direct them to the investigation room. The reception shall be located at a place, which can be easily accessed. 2. Registration and cash counter: The registration/cash counter shall be placed next to the reception counter. The registration counter shall examine the doctor’s requisition form for the investigation, register the patient for the investigation, accept payment for the investigation (if applicable), issue a token number, etc., and help the patient to take a seat. If the patient’s footfall is greater, it is advised to provide a separate cash counter, which shall ideally be placed about 1829 mm away from the registration counter. 3. Waiting lobby: The patient must wait for their turn till they are taken for the investigation. Therefore, the waiting area shall be made available for them to Table 8.1  Utility area of the radiology department

Activity Reception and enquiry Registration Waiting areas and sub-waiting areas Record room Reporting room Store for unused films and related material Store for used films Report delivery room Public utility for faculty Public utility for patients and attendants Extra rooms for future expansion

Status of works Start End In Not date date Complete progress started ::::::-

::::-

:-

Responsible person

Remarks

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8  Radio Diagnosis

wait. The number of patients and the typical length of the investigation shall be taken into account when determining the waiting area’s size. After COVID-19, smaller waiting areas are preferred over larger ones. The social distance design principle must be followed while designing the waiting areas. Sub-waiting lobbies shall also be planned for and designed. Each imaging modality’s sub-waiting areas shall be provided separately. For instance, the sub-­ waiting room for an MRI shall be different than the one for a CT scan. Such measures might not always be possible, especially for smaller hospitals, nursing homes, clinics, etc. 4. Record room: To store the records utilized by the department, such as files, registers, and stationery, a record room shall be provided. The record room shall be about 3658 mm × 3658 mm in size. 5. Reporting room: Generally, hospitals have a centralized reporting room where reporting of all the modalities is completed. The size of the room shall depend on how many people will be using it at any given time, but it shall ideally be at least 6096 mm × 4572 mm. There shall be space in the reporting room for a typist to sit. 6. Stores for unused consumables and films: The department needs a store often known as the store for unused consumables and films because it shall always have an adequate quantity of consumables and films on hand to be prepared for round-the-clock investigations. This store’s dimensions shall be 3658 mm × 3658 mm, though they may change depending on the number of items that are to be stored. There shall be no windows or other sources of direct sunshine in the room. 7. Stores for used films and general items: The department sometimes needs to save exposed films, especially those with medico-legal cases or interesting cases for research and references. In addition, it is necessary to store waste films and various other materials, such as machine accessories. There shall therefore be a dedicated special place set aside for storing these things. This store’s dimensions shall be 3658  mm  ×  3658  mm, though they may change depending on the number of items to be stored. There shall be no windows or other sources of direct sunshine in the room. 8. Report delivery counter: For delivery of the reports, a report delivery counter shall be established in the hospital. However, this is required only if the hospital has the policy to deliver such reports directly from the radiology department. This counter can be either an open counter or in a closed room. However, it is recommended that an open counter shall be preferred, as it looks more elegant. 9. Public utilities for staff, patients, and attendants: Toilet facilities shall be provided in the utility area. The toilets shall be separate for males and females. Additionally, the drinking water facility shall also be provided. 10. Extra room for future expansion: One never knows about the requirement of rooms in future for expansions. Hence, it is recommended that the provision for one to two rooms shall be kept while designing the department. The size of these rooms can be about 3658 mm × 3658 mm.

8.2 Infrastructure

269

8.2.1.2 X-Ray See Table 8.2. X-ray zone: This zone of the radiology department deals with X-ray-related investigations and/or procedures including fluoroscopy and others. Special care shall be exercised while designing the investigation rooms because X-rays are harmful. The following are included in this zone: 1. Radiography rooms: These are the real rooms where the X-ray machine is installed and the patient receives X-ray exposure. The number of radiography rooms that are needed shall depend on how many machines need to be installed presently and how many more machines are planned to be added in future. From traditional X-ray machines to digital radiography (DR) machines, there are many different varieties of X-ray equipment. The rules and regulations of the nation’s controlling authorities shall be considered before designing the radiography rooms. Baba Atomic Research Institute publishes all such regulations in India. Preferably, a rectangle room with a minimum area of 25 sq. m, or 270 sq. ft, shall be provided. The room’s walls shall be at least 230 mm thick and plastered on both sides. If RCC walls are planned, for plain radiography, the primary wall of an X-ray room shall be at least 150 mm thick and made of 150 mm thick cement or concrete. Hollow bricks if used shall be covered up to 2.2 m from the floor level by a layer of 6 mm barium plaster. The X-ray room shall not have any wall dimensions smaller than 4 m in length. Table 8.2  X-ray zone

Activity Radiography rooms for X-ray machines or digital radiography (DR) Radiography room with IITV system and fluoroscopy (if separately required) Room for 60 mA mobile X-ray system Change rooms Preparation room for patient Computerized radiography (CR) room Sub-waiting area

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

:::::-

8  Radio Diagnosis

270

2.

3. 4. 5.

6.

The only door in the room shall be roughly 1500 mm wide and 800 mm high. Lead lining that is 2 mm thick shall cover both the door and its frame. When closed, doors shall have at least 100 mm overlap on either side. The windows are not permitted in the radiography room. A small, independent control room that is adjacent to the DR room shall be provided if a machine of the DR type is planned. A lead glass with a 2 mm lead lining shall be provided in a wooden frame between the two rooms. Room for mobile X-ray system: If the mobile X-ray units are going to be strategically positioned in the radiology department, the department needs to have a store where they can be kept. The store shall be 3658 mm × 3658 mm in size, but depending on how many machines are to be parked, the room size can be increased. Change rooms: To allow the patient to change into a hospital gown and remove any outside clothing, the department shall have changing rooms available. The room shall be about 3048 mm × 3048 mm in size. Patient preparation room: A room, in addition to the radiography unit, shall be provided for patients to prepare before specific imaging procedures such as barium swallow. The room shall be 3658 mm × 3658 mm in size. Computerized radiography (CR) room: The CR room shall be located adjacent to the radiography room to accommodate a computerized radiography system. After exposure, the cassette is placed in this room’s CR machine, which reads the captured image. The PC that is hooked to the CR receives the image that it has captured. The picture parameters can then be changed by the radiographer, and the image is subsequently printed on a film. The CR room shall be around 4267 mm × 3658 mm in size. The room temperature shall be between 18 and 21 °C, with a relative humidity of 40–50%. Sub-waiting for radiography: Shall be the same as described in the utility area above.

8.2.1.3 Ultrasound See Table 8.3. Ultrasound zone: Ultrasound is an imaging method that makes use of MHz-­ measured high-intensity sound waves. With the use of transduces, sound waves are penetrated in a particular area of the body using this technique. The transducer picks Table 8.3  Ultrasound zone

Activity Ultrasound room change room Toilets Sub-waiting area

Start date ::::-

End date

Status of works In Complete progress

Not started

Responsible person

Remarks

271

8.2 Infrastructure

up the returning waves, which have a varied intensity and distinct period when these sound waves strike different body tissues at different times separated by milliseconds and reflect the surface. The device creates an image by reading these returning waves. Included in this zone are the following: 1. Ultrasound room: This is the room where the patient’s ultrasound is performed. There are no particular guidelines for this room’s layout. It can be a 150–80 square foot square or rectangular room. 2. Change rooms: Occasionally, a patient’s clothing makes it challenging to do an ultrasound. As a result, the department shall have change rooms where the patient can change into a hospital gown and remove all of their outerwear. The room’s dimensions shall roughly be 3048 mm × 3048 mm. 3. Toilets: An adjacent toilet shall be provided in each ultrasound room. This is necessary because some tests, like the ultrasound of the lower abdomen, must be performed after a void. A WC, urinal, and washbasin shall be provided in the toilet. Exhaust shall be provided in the toilet. 4. Sub-waiting area for ultrasound: Shall be the same as described in the utility area above.

8.2.1.4 Computerized Tomography (CT Scan) See Table 8.4. CT scan zone: Computerized tomography is related to this zone of the radiology department. This technology also uses X-rays, and when exposure is given, a very high dose of X-rays is produced. Therefore, the CT room shall be designed with special consideration. Included in this area are the following: 1. CT scan machine room (examination room): The number of CT rooms relies on the number of machines that shall be installed presently, as well as any future intentions to add more machines.

Table 8.4  Computerized tomography (CT scan) zone

Activity Examination room Control room UPS room CT panel room Change room Store Sub-waiting area

Start date :::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

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8  Radio Diagnosis

The rules and regulations of the nation’s governing body shall be considered while designing the CT scan room. Baba Atomic Research Institute publishes all such regulations in India. It is necessary to build a rectangular room if the machine is to be installed horizontally. It would be better to design the room squarely if the machine is to be installed diagonally. However, in a rectangular room, we advise positioning the machine horizontally. In this case, the room dimension shall be 9144 mm × 4572 mm, and the room space shall not be less than 42 sq. m or 450 sq. ft. The room’s walls shall all be at least 230  mm thick and plastered on both sides. A solid baked clay brick primary wall shall be at least 250 mm thick, while walls made of mortar or concrete shall be at least 150 mm thick. If hollow bricks are used, they shall be covered up to 2.2 m from the floor level by a layer of 6 mm barium plaster. An additional door shall be placed in front of the CT room door to serve as an air interlock. To facilitate the mobility of trollies, the CT room shall have a single entrance with a width of approximately 1500 mm. The door shall be 800 mm high and at least 1500 mm wide. It is required that the door have an appropriate 2 mm thick lead lining. Even on the door frame, the lining is required. There shall be no radiation leakage from any part of the door. When closed, doors shall overlap by no less than 100 mm on either side. No windows are permitted in the radiography room. It is advisable to verify the weight-bearing capacity of the floor because the machine is heavier and moves faster. If necessary, construct a foundation for the machine following the manufacturer’s recommendations. 2. CT control room: There shall be a control room available, attached to the CT scan room. The only place from where the machine may be controlled is the control room. This room shall be 3658 mm by 3658 mm in size. To prevent radiation leaks, a lead glass measuring approximately 180  mm by 1000  mm that comes with the machine shall be installed in a wooden frame with 2 mm lead lining between the CT room and the control room. 3. UPS room: A CT scan requires a constant power source because it is an electronic device. If that is not given, the machine will crash, increasing the possibility of software failure or perhaps component failure. It is therefore preferred to install an online UPS together with the machine. Given that UPS often has high ratings (over 100 KVA), a separate room shall be provided because several batteries will be needed along with the UPS. This room shall be attached to either the machine room or the CT control room. This room shall be around 3658 mm × 3658 mm in size. 4. CT panel room: Other electrical components that are provided with the CT scanner shall be placed in the panels attached to the machine, which are in addition to the gantry of the machine where the X-ray tube and detectors are fixed. The CT scan room does not require these panels, but they do govern how the scanner operates. It is suggested to install these panels in a different room or enclosure that is connected to the CT scan room to better protect them. Therefore, such space shall be planned in consultation with the equipment m ­ anufacturer.

273

8.2 Infrastructure

Confirmation of the room’s size, temperature, and other factors shall come from the manufacturer. 5. Change rooms: The department shall have change rooms where patients can remove their outerwear and change into hospital gowns. The room shall approximately be 3048 mm × 3048 mm in size. 6. Sub-waiting area for CT scan: Shall be the same as described in the utility area above.

8.2.1.5 Magnetic Resonance Imaging (MRI) See Table 8.5. MRI zone: Magnetic resonance imaging is a technique that is covered in this area of the radiology department. Special consideration shall be given while designing the MRI rooms because this machine has a high magnetic field. Included in this area are the following: 1. MRI machine room: The number of MRI machine rooms shall vary depending on the number of machines that shall be installed presently, as well as any plans to add more machines in future. The design and size of the room shall be determined based on the configuration of the MRI scanner, which comes in a variety of configurations. For instance, a 0.25 T MRI room will be smaller than a 1.5 T MRI room, and a 3 T MRI room will be even larger. The following are some key factors for the design of MRI rooms: RF shielding: Radio frequencies are very sensitive for MRI machines. As a result, an RF shield surrounds the MRI machine. The ‘Faraday cage’ is a six-­ sided copper-lined enclosure that surrounds the room and shields the MRI system from outside radio frequencies to ensure a clear scan. Galvanized steel and aluminium are other materials that can be used for RF shielding.

Table 8.5  Magnetic resonance imaging (MRI) zone

Activity Examination room Control room UPS room Machine panel room Space for chiller Change room Store Sub-waiting area

Start date ::::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

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8  Radio Diagnosis

The parent wall, RF shield wall, and interior finishing wall are usually the three layers of walls needed for RF shields. Parent wall refers to the existing brick or concrete wall. The inner finish is the artificial decorative inside, while RF shield is the actual metallic sheet. Wallpaper, wooden or PVC panels, or both can be used to decorate the interior. A structural subfloor, RF shielding, a protective layer, and other finishing materials are usually needed for the floor in an MRI exam room. Subfloor refers to the first floor that was built, followed by the metallic cage and the protective covering. Given that it does not affect the magnetic field, this layer can be made out of wood. It is common to practise suspending an RF shield from the RCC ceiling above. Any ductwork, pipe, or other services that have to be placed below the ceiling shall pass through the plenum that is above the RF shield ceiling. To keep the shield’s integrity, objects that penetrate the RF shield enclosure will need special fittings and materials. At the feed-through points for shielding, materials like RF filters and waveguides are frequently utilized. LED lights or 3D luminated sceneries can be used to decorate the bottom of the ceiling. RF shielding is usually required for the window between the magnet room and the control/console room, which calls for two layers of copper screens or perforated sheets. The public’s safety from a strong magnetic field is the main concern. The magnet’s isocentre needs to be identified first. The Gauss field can be calculated from this isocentre. For anyone wearing ferrous metal or for any metal objects, the distance from the isocentre to the 5-gauss line is hazardous. Any metal that falls under the 5-gauss line will practically merge with the magnet. Therefore, there shall be barricades to prevent people from coming too close. Before going into the MRI room, it is recommended to supply interlocks. Another door can be placed in front of the MRI room door to accomplish this. The size of the RF cage shall determine the size of the MRI room. The entire room shall have walls that are at least 28 mm thick and plastered on both sides. The room shall have a single sealed door that is made of a material that does not interfere with the magnetic field. The machine vendor shall be contacted to confirm the door’s size. The MRI room is not permitted to have windows. It is essential to evaluate the floor’s ability to support weight due to the machine’s increased weight. If necessary, construct a foundation for the equipment following the manufacturer’s recommendations. 2. MRI control room: There shall be a control room available, attached to the MRI scan room. Only the control room shall be used for all controls. A copper screen or perforated sheet window (supplied with the machine) measuring approximately 180 mm by 1000 mm shall be installed in a wooden frame with 2 mm lead lining between the MRI room and the control room to ensure no radiation leakage.

8.2 Infrastructure

275

3. UPS room: Since MRI is an electronic device, it needs a constant power source. It is even more crucial since the machine’s cold head must always be working; otherwise, the helium gas that fills the magnet will boil off and perhaps leak. Given that UPS often has high ratings (over 150 KVA), a separate room shall be provided because several batteries will be needed. This room shall be connected to either the machine room or the MRI control room. This room shall be approximately 3658 mm × 3658 mm in size. 4. Machine panel room: Apart from the gantry of the main MRI machine, other electronic parts are provided in the panels connected to the machine. These panels control the working of the machine but are not directly needed in the MRI room. For better protection of these panels, it is advised to install these panels in a different room or enclosure, which is attached to the MRI room. Hence, such an area shall be designed after consulting the equipment manufacturer. The size and temperature shall be confirmed by the manufacturer of the machine. 5. Space for chiller: To keep the gradient coil and liquid helium compressor cool, the MRI machine shall have a water chiller in conjunction with the main machine. Three components make up the entire refrigeration system for MRI: a chiller, a helium compressor, and a cold head. Together, they keep the magnet’s internal temperature at −269 °C, preserving the coil’s superconducting state. Generally, the chiller shall be placed outside the hospital building to keep it cool. It shall have a water tank from which the water is drawn, cooled, and then sent to the machine via a connected conduit by the chiller. Through a different pipeline, this water cools the machine and then returns to the chiller to cool it once more. 6. Change rooms: To allow the patient to change into a hospital gown and remove any outside clothing, the department shall have changing rooms available. The size of the room shall be roughly 3048 mm × 3048 mm. 7. Sub-waiting area for MRI: This shall be the same as described in the utility area above.

8.2.1.6 Mammography See Table 8.6. Mammography zone: This area of the radiology department deals with the imaging of the female breast. The mammography room shall be carefully designed because this equipment also uses X-rays. Included in this area are the following: Table 8.6  Mammography zone

Activity Examination room Change room Computerized CR room Sub-waiting area

Start date ::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

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1. Mammography rooms: In terms of the number of mammography rooms, one is typically enough, but the designer shall also consider future ambitions. The following are some key considerations for the design of mammography rooms: The rules and regulations of the nation’s controlling authorities shall be considered when designing the radiography rooms. Baba Atomic Research Institute publishes all such regulations in India. The room may be square or rectangular, depending on the designer’s vision, and it shall not be less than 10 sq. m. or 108 sq. ft. The room’s walls shall be at least 28 mm thick and plastered on both sides. The ideal thickness for the primary wall of the mammography room shall be at least 250 mm solid baked clay bricks or 150 mm mortar/concrete walls. Hollow bricks if used shall be plastered with a thickness of 6 mm barium plaster and shall be protected up to 280 mm from the floor level. The mammography room cannot have any wall dimensions that are less than 3 m. At least 1000  mm wide and 2100  mm tall doors shall be provided for the room. Lead lining that is 2 mm thick shall cover both the door and its frame. When closed, doors shall have at least 100 mm overlap on either side. Windows are not permitted in the mammography room. A small, independent control room that is adjacent to the mammography room shall be provided if the digital mammography machine is planned. A lead glass with a 2 mm lead lining shall be installed in a wooden frame between the mammography room and the control room. 2. Change rooms: Typically, upper body clothing for mammography has to be changed into a simple cotton robe. As a result, the department shall have to change rooms where the patient can change into a hospital gown and remove all of their outerwear. The size of the room shall be approximately 3048  mm by 3048 mm. 3. Computerized radiography (CR) room: CR system of the main radiology department can be used for mammography. Just the cassette needs to be carried from the mammography room to the radiology CR room. Other processes shall remain the same. 4. Sub-waiting area for mammography: Shall be the same as described in the utility area above.

8.2.1.7 DEXA Scan See Table 8.7. DEXA scan zone: This section of the radiology department is concerned with high-precision X-rays used to assess the bone mineral density and bone loss. Because this machine uses X-rays, the DEXA scan room shall be carefully designed. Included in this area are the following: 1. DEXA scan machine room: In terms of the number of rooms, one is usually enough, but the designer shall also consider future plans.

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8.2 Infrastructure Table 8.7  DEXA scan zone

Activity Examination room Sub-waiting area

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::-

The following are some key elements to consider while designing DEXA scan rooms: The rules and regulations of the nation’s controlling authorities shall be considered when designing the radiography rooms. Baba Atomic Research Institute publishes all of these standards and regulations in India. The room’s shape can be either rectangular or square, as designed by the designer, and it shall be at least 10 sq. m or 108 sq. ft. The room’s walls shall be at least 28 mm thick and plastered on both sides. The ideal thickness for the primary wall of the DEXA scan room shall be at least 250  mm solid baked clay bricks and 150  mm mortar/concrete walls. Hollow bricks, if used, shall be plastered with a thickness of 6 mm barium plaster and shall be protected up to 280 mm from the floor level. At least 1000 mm wide and 2100 mm tall doors shall be provided for this room. Lead lining that is 2 mm thick shall be affixed to cover the door and its frame. When closed, doors shall have at least 100 mm overlap on either side. The DEXA scan room shall not have any windows. A small, separate control room that is adjacent to the DEXA scan room shall be provided if a machine of the digital type. A lead glass with a 2 mm lead lining shall be installed in a wooden frame between the two rooms. 2. Sub-waiting area for DEXA scan: This shall be the same as described in the utility area above.

8.2.1.8 PET/CT Scan/PET/MRI Scan/SPECT/CT See Table 8.8. PET/CT/MRI zone: This zone of the radiology department combines morphological imaging, such as CT or MRI, with positron emission tomography (PET) scanners. PET/CT and PET/MRI are the two names for this combined method. Therefore, we shall construct the infrastructure to include the fundamental components of CT and MRI, as well as the specifications and rules of the PET scanner, which uses radioactive isotopes. It is advised that both the PET/CT and PET/MRI shall be installed in the common area, which is also known as the hot area. The hot areas also include the cyclotron and the radio pharmacy areas. With this layout, the department would save a lot of space. Location of the zone in the hospital: Given that the PET area emits a lot of positrons, it is crucial to install enough shielding and safety measures, such as

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Table 8.8  PET/CT scan/PET/MRI scan/SPECT/CT zone

Activity PET/CT room PET/MRI room SPECT/CT room Console rooms for all machines UPS rooms Machine panel rooms Low-risk areas or cold areas Reception Secretarial room Sub-waiting area Physician consultation room Technologist room General store Change room High-risk areas or radiation exposure hot areas Hot lab cum radio pharmacy room Dose administration room Post-drug administration holding cubicles Active toilet Post-examination waiting room Radioactive waste room

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::-

:::::::-

:::-

:::-

reinforced cement concrete (RCC) walls. Because the room will be surrounded by soil, it is recommended to place this zone in the basements of the building, because the risk of emission outside the zone will be reduced. 1. PET/CT scan machine room: The machine room shall have the same infrastructure as in the case of normal CT scan machine room. The wall shall be constructed of RCC that is 300 mm thick as the only difference. 2. PET/MRI machine room: The machine room’s infrastructure shall be identical to that of a normal MRI machine room. The wall shall be constructed of RCC that is 300 mm thick as the only difference.

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279

All norms and specifications of other attached areas like the console room, UPS room, and machine panel room shall also be the same as CT scan and MRI rooms. 3. SPECT/CT machine room: Images are captured by SPECT while cutting slices of the parts to be investigated. The infrastructure of the machine room shall be identical to that of a standard CT or PET/CT machine room. 4. Operating console rooms: There shall be a separate console room available for each PET imaging modality. As a result, there shall be a wall between the console room and the rooms for the PET/CT scanner, PET/MRI, and SPECT/ CT. This wall shall be made of 300 mm thick RCC and include a 4 mm thick lead glass window. 5. UPS room: PET/CT and PET/MRI are electronic devices; hence, a constant power source is needed. It is much more crucial in the case of PET/MRI since the machine’s cold head must always be operative or the helium gas inside the magnet may boil off and perhaps leak. Since UPS often has high ratings (over 150 KVA), several batteries will be needed; hence, separate rooms shall be provided. These rooms shall be connected to the appropriate CT and MRI control rooms. The room sizes shall be roughly 3658 mm × 3658 mm. 6. Machine panel room: In addition to the gantry of the main PET/CT and PET/ MRI machine, other electronic components are installed in the panels attached to the machine. Despite not being physically required in the machine rooms, these panels regulate how the machines operate. Installing these panels in a different room or enclosure that is connected to the PET/CT/MRI rooms is advised for better protection of the panels. Confirmation of the machine’s size, temperature, and other factors shall come from the manufacturer. 7. Low-risk areas or cold areas (a) Reception: The reception shall be located towards the front, typically at the zone’s entrance. The reception area shall also have a secretarial room for administrative tasks like accounts. For both of these utilities, roughly a space of around 15–8 sq. m shall be sufficient, although the area may be altered depending on the workload. (b) Sub-waiting room: Shall be the same as described in the utility area above. (c) Physicians’ consulting room: Before bringing the patient in for an investigation, this room is used for analysis, interviews, and physical examinations of the patient. The type of specific examination the patient is going to get is explained to them. This room shall be near the waiting area and measure approximately 4267 mm × 4572 mm. (d) Technologist room: To arrange resources for the department and plan the investigation, a technologist room or office shall be placed next to or across from the physician consultation room. This room shall be approximately 4267 mm × 4572 mm in size. (e) Store: For storage of goods such as QC phantoms, consumables, and disposables, a small store shall be provided; size-wise, it shall be approximately 3658 mm × 3658 mm.

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(f) Change rooms: The department shall have change rooms available for PET/ CT/MRI patients so they can change into hospital gowns and remove all of their outerwear before the procedure. The size of the room shall be roughly 3048 mm × 3048 mm. 8. High-risk areas or radiation exposure hot areas (a) Hot lab cum radio pharmacy room: When the department has its own radiochemistry lab and cyclotron production unit, this room is necessary. This enables the delivery of lead containers containing mono-dose syringes to each injecting room. The room’s walls shall be made from 300  mm thick RCC. (b) Dose administration room: This area, sometimes referred to as the injection room, has walls made of RCC that are 28 mm thick. This room has a window that opens into the radio pharmacy. While the patients are made to sit in the injection room, the staff prepares the injection in the nearby radio pharmacy room. For each installed PET/CT, PET/MRI, or SPECT/CT, this room shall be provided which shall be about 12–16 sq. m. (c) Post-dose waiting area: After injecting the radioisotopes, the patient is directed to go to the post-dose waiting area, where he/she can relax comfortably during the uptake period. The walls of the post-dose waiting area shall be 300 mm thick RCC. (d) Active toilet: Patients are instructed to evacuate their bladders before beginning the actual PET scan procedure following injection and, depending on the protocol, an uptake period. Therefore, a toilet shall be provided close to the preparation rooms. The waste from this toilet shall be dumped into a separate settlement tank, where it can settle the effects of isotopes and neutralize, before being discharged into the main sewerage line. (e) Post-examination waiting room: While their scans are being reviewed, patients shall wait in the post-scan waiting area. If they are dressed in a hospital gown, they will also need to change. It is suggested that a separate exit gate be provided so that these individuals do not interact with other patients. (f) Waste disposal room: To allow the radioactivity to degrade before disposal, the supplies used to administer FDG and anything that might be contaminated (clothing, linen, etc.) shall be kept in a dedicated area.

8.2.1.9 Other New Investigation See Table 8.9. As the advancement in imaging technologies is growing very fast, it is quite possible that in the near future, some other modality may be introduced. If the hospital wants to be in the race and provide the services with the latest technology, the machine of the new technology has to be installed. In the running hospital, it is very difficult to find spaces for the installation of the new machine. Yes, it can be done in a separate building or block or floor. But it is not advisable. Preferably, it shall be in the same department and not far off from the existing department.

281

8.2 Infrastructure Table 8.9  Other new investigation

Activity Examination room Control room UPS room Machine room Change room Store Sub-waiting area

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

Responsible person

Remarks

:::::::-

Table 8.10  Staff accommodation in radio diagnosis

Activity Doctors’ rooms with toilet Personal secretary room Senior resident room

Start date

End date

Status of works In Not Complete progress started

:::-

Then why not design a space well in advance while designing the hospital? Till the time the new machine is installed, this space can be used for other purposes. Therefore, it is advised to design a full set of spaces including a machine room, control room, UPS rooms, store, change room, and sub-waiting area. The sizes and dimensions can be kept the same as in the case of a CT scan.

8.2.1.10 Staff Accommodation See Table 8.10. The doctor’s room shall be provided at some convenient location in the department of radiology, as he/she is responsible to oversee the entire functioning of the department. This space shall be roughly 4572 mm × 4267 mm in size. The room shall preferably have an attached toilet. If required, room for the personal assistant or the secretary shall also be provided. If necessary, this room shall be provided with a separate store. A small restroom or lounge can be provided in this space if necessary and extended working hours are anticipated. Similarly, rooms smaller than the doctor’s room can also be provided for junior doctors, if required.

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8.3 Services, Facilities, Equipment, Tools, and Instruments 8.3.1 Utility Area 8.3.1.1 Reception/Help Desk/Cash Counter See Table 8.11. The number of patients or visitors who are anticipated to use the reception or help desk services determines the size of the counter and/or help desk. It is advised that enough room be made so that two receptionists or helpers can be seated. Therefore, the appropriate length for the reception and/or help desk shall be between 3048 mm and 4572 mm. The counter can be built of granite or other materials, or it can be built up by civil construction with an elegant appearance. A wooden counter can also be provided as an alternative. For a person to comfortably stand and speak with the receptionist, the front side of the counter shall be roughly 1524 mm high. The working top, which shall be provided on the other side of the counter, shall be approximately 610 mm wide and 762 mm in height. Two reception chairs shall be provided for the receptionists. If need be, high-­ raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided to each receptionist or help desk assistant. If required, the scanner can also be provided at reception. Table 8.11  Reception/help desk/cash counter of utility area in radio diagnosis

Activity Provide the following at reception: Reception counter Reception chairs Computers with printers Scanner Public announcement system Cash collection box screwed to the counter Intercom and telephone line Required electrical points at reception Other communication points at reception Acrylic or glass partitions on all the counters

Status of works Start End In Not date date Complete progress started

::::::::::-

Responsible person

Remarks

8.3  Services, Facilities, Equipment, Tools, and Instruments

283

The microphone for the announcement shall be provided at the reception. The intercom and telephone lines shall also be provided at the reception. Even one spare mobile phone shall also be placed at the reception to make emergency calls. The reception counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points. • In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances. The reception counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for computer networking • Two RJ 11 points for intercom and extension lines Cash Counter The size of this counter shall depend on how many patients or visitors are anticipated to use its services. However, there shall be room for two employees to sit down at each cash counter. Therefore, the optimal length can range from 2438 to 3658 mm. Granite or another material can be utilized to give the counters an aesthetically pleasing appearance, or they can be formed of civil work. Counters constructed of wood can also be offered as an alternative. Each counter’s front side shall be roughly 1524 mm high so that people can stand at them and easily interact with the staff. The working top, which shall be provided on the other side of the counter, shall approximately be 610  mm wide and 762 mm high. As the safety of the cash is required at the cash counters, above the counter, there shall be a glass partition with a cut window on the lower side of the glass, rising to a height of about 1219 mm from the top of the counter. Two office chairs shall be provided at each cash counter. If need be, high-raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided for each cashier separately. If required, the scanner can also be provided at the cash counter. Additionally, the barcode scanner shall be provided at the cash counter for scanning the barcodes for billing and receiving cash. The cash counter shall be provided with a safe screwed to the counter, for the safe custody of the cash. The intercom and telephone lines shall also be provided at the cash counters. Each cash counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points.

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• In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances. Each cash counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for computer networking • Two RJ 11 points for intercom and extension lines

8.3.1.2 Waiting and Sub-waiting Lobbies See Table 8.12. The waiting and sub-waiting lobbies of the radiology department shall be fully air-conditioned with a provision of cooling and heating. Proper comfortable chairs having backrests shall be provided in the waiting areas. Please avoid the backless benches, as it is not comfortable to sit on such benches. If sofa sets are provided, it will be better. However, the waiting areas of Table 8.12  Waiting and sub-waiting lobbies of utility area in radio diagnosis

Activity Proper heating and air conditioning Security features like CCTV Announcement systems Waiting chairs/sofa set Wall, ceiling, and interior decoration Television, fish tanks, magazines, movies/ DVDs, etc. Food and drink vending machines Signage and wayfinding system Spaces for indoor plants Interactive displays Mobile charging points in the lobby Free internet or Wi-Fi facility Handrails at the staircase and other areas Other communication points

Status of works Start End In Not date date Complete progress started ::::::-

:::::::-

:-

Responsible person Remarks

8.3  Services, Facilities, Equipment, Tools, and Instruments

285

VIPs shall definitely have the sofa set along with the centre tables. For bariatric patients, the provision shall be made for specialized seating. Waiting lobbies shall be properly guarded, and security measurement like fire hooters and CCTV cameras shall be provided in the waiting areas. Waiting lobbies shall have adequate speakers with a clear voice to hear the announcements. Along with the audio system, the visual display system including the display boards shall be provided, where the token number can be displayed. For an aesthetic look of the waiting areas, the interiors shall be well decorated. The wall decoration shall be done by using mirrors, murals, texturized paints, or wallpapers. Similarly, the ceiling shall also be decorative. Light fittings shall also be decorative. Use of colour, textures, surface treatments, fixtures, fittings, furniture, and artwork shall be considered for interior decor. The waiting areas shall also have televisions, fish tanks, magazine holders, newspaper racks, kiosks, etc. for patients and visitors to spend time. A small cafeteria or vending machines shall be provided in the waiting areas. The wayfinding and signages shall be very clear and glowing so that the visitors and the patients can easily identify the passages and the routes. For beautification, indoor plants can also be planned to be placed in waiting areas. Mobile charging points shall also be provided in the waiting area. Apart from this, if possible, the facility of Wi-Fi or free internet can be provided. For the safety of the patients and visitors, provide necessary safety measures, like handrails, non-slippery surfaces, non-steep slopes, handicapped toilets, and wheelchair accessibility.

8.3.1.3 Reporting Room See Table 8.13. As the reporting room is to be used for reporting all the modalities of the radiology department, the room shall have all the necessary furniture, tools, and gadgets. Table 8.13  Reporting room in radio diagnosis

Activity Required counters for reporting Computers and printers with scanners Office tables Office chairs Basic facilities like telephones, intercom Wall-mounted big-size view boxes Required electrical points Other communication points

Status of works Start End In Not date date Complete progress started ::::::::-

Responsible person

Remarks

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286

Apart from this, the room shall have necessary electrical outlets and communication ports. When it comes to furniture, the room shall have comfortable revolving chairs, the number of which shall be determined by the number of people who will be seated in the room. Along with this, working desks/tables shall be provided. The table shall have space for placing the computer, printer, and scanner. There shall also be a space for placing the keyboard. To examine the films, a series of wall-mounted large-size view boxes (possibly holding up to four films) shall be provided in the room. It would be preferable if these view boxes could be dimmable. Most importantly, all computers shall be linked to picture archiving and communication system (PACS) via a secured network. PACS is a medical imaging software that communicates and transfers images via a closed network or the internet. All radiology images (except ultrasound) are archived and stored on a separate server known as the PACS server. When necessary, the images can be retrieved from any location for reporting by radiologists or diagnosis by physicians. The intercom and telephone lines shall also be provided at the reporting desks. Each desk shall have the following electrical points: At least six 5 Amp switches/sockets shall be provided near the working desk/ table These connectors are intended to connect computers, printers, and other similar devices. Additionally, two 15 Amp switch/sockets shall be provided on the wall behind the working desk/table for other appliances. Each desk shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for computer networking • Two RJ 11 points for intercom and extension lines

8.3.1.4 Stores for Films and Consumables See Table 8.14. Table 8.14  Stores for films and consumables in radio diagnosis

Activity Separate stores for used and unused films/consumables A sufficient number of countertops Fireproof cabinet for X-ray films Cupboards Drawers Racks

Status of works Start End In Not date date Complete progress started :-

:::::-

Responsible person

Remarks

8.3  Services, Facilities, Equipment, Tools, and Instruments

287

The stores used for storing the used and unused films and consumables shall have a sufficient number of countertops, cupboards, racks, and drawers. It is highly recommended that for storage of films (as films are highly inflammable), a fireproof cabinet is provided. The light switch of such a store shall be given outside the room, and a single light shall be provided, to avoid the chances of fire caused by sparks. The room shall be properly air-conditioned, and the temperature of the room shall be between 17 and 21 °C.

8.3.1.5 Report Delivery Counter See Table 8.15. The ideal length for the report delivery counter shall be between 3048 mm and 4572 mm. The counter can be made of civil work with an attractive appearance, or it can be made of granite or another material. A wooden counter can also be provided as an alternative. The front side of the counter shall be approximately 1524 mm high so that the person can easily stand and converse with the delivery staff. On the opposite side of the counter, a working top of approximately 610 mm wide and 762 mm high shall be provided. Two revolving chairs shall be provided for the staff. If need be, high-raised chairs can also be provided. Computer with UPS and printer (if needed for printing) shall be provided to each staff at the counter. If required, the scanner can also be provided at the counter. The microphone for announcement shall be provided at the counter. The intercom and telephone lines shall also be provided at the delivery counter. Behind the delivery counter, pre-numbered bins shall be provided, where the reports along with the films can be kept number-wise, for easy delivery to the patient. A lockable cupboard with bins can be a better solution. Table 8.15  Report delivery counter in radio diagnosis

Activity Required counter with countertop Computers and printers with scanners Chairs Pre-numbered bins near counter Required electrical points Other communication points

Status of works Start End In Not date date Complete progress started ::-

::::-

Responsible person

Remarks

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288

The delivery counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points. • In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances. The delivery counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for computer networking • Two RJ 11 points for intercom and extension lines

8.3.2 X-Ray Zone 8.3.2.1 Radiography Rooms See Table 8.16. As a main machine, the radiography room shall have X-ray machine. Presently, there are many different varieties of X-ray machines starting from conventional Table 8.16  Radiography rooms

Activity X-ray machine DR systems 800/500/300 MA with fluoroscopy Portable X-ray machine DR Warning light Lead apron, gloves, collars, etc. Chest stands or chest frame Shielded barrier Main switch and cable Lead glass wooden if DR is installed frame Ground earthing Heavy-duty hangers Cabinet for devices like lead gloves, lead goggles, groin guards, lead collar

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

::::::::::-

8.3  Services, Facilities, Equipment, Tools, and Instruments

289

X-ray machines to digital radiography (DR) machines. If we talk about the rating of the machines, it starts from 30 MA up to 1000 MA. Depending on the load of the patient and the type of investigations to be done, the rating of the machine is chosen. Similar is the case with digital radiography (DR) machines. They are also available in different ratings. The difference between the conventional X-ray machine and the DR is that the image in the conventional machine is captured on the preloaded X-ray cassette. In the case of DR, the cassette is not required, and the image is captured on the flat panel provided by the machine. Along with the machine, X-ray tables are also provided. These tables are available in a wide variety starting from fixed tables to multi-positional motorized tables. Above we have discussed the static machine, which is usually fixed in the room and cannot be moved. Apart from this, there is also the portable X-ray machine with a rating generally from 30 MA to 100 MA, which is generally used for immobile patients. These portable machines are placed either in the department of radiology or in the concerned department where it has to be used. It depends on the policy of the hospital, as to where the machine has to be placed. A warning light with a red bulb shall be installed outside the X-ray room’s door. This light must be linked to the X-ray generator so that it only illuminates when the X-ray tube is turned on for exposure. Inside the X-ray room, the X-ray radiation protection devices like lead aprons, gloves, lead glasses, thyroid collars, and gonad shields shall be provided with the protection of the staff from unwanted radiation exposure. On the wall opposite the entrance door and the control console, the chest stand or the chest frame can be fixed. A shielded barrier shall be placed in front of the X-ray control console and serve as a barrier between the control panel and the X-ray tube to protect the staff from unintentional radiation exposure while performing the process. The main switch and cable shall be terminated separately in each radiography room, and the power load needed by the machine shall be estimated based on its capacity. A small, independent control room that is adjacent to the DR room shall be provided if a machine of the DR type is planned. A lead glass with a 2 mm lead lining shall be provided to be installed in a wooden frame between the two rooms. Lighting shall be provided using regular LEDs that have enough brightness. There is no need for additional lighting in the space. Every machine shall have the appropriate ground earthing features. Each room shall have a stand with sturdy hangers where the lead apron can be hung. A cabinet shall be provided in each room to keep the radiation protection and safety devices like lead gloves, lead goggles, groin guards, and lead collars. Nowadays, due to advancements, the X-ray machine is remotely connected to the service centres of the machine manufacturers, for online monitoring and repairing minor defects. Hence, a dedicated internet line with a separate IP address shall be provided near the X-ray machine.

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Table 8.17  Change room of X-ray

Activity Lockers to keep the personal belongings of the patient One chair Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep the sterilized dresses Hanger rods with hangers Bin for dirty linen

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

::::::-

The room shall be adequately air-conditioned, and the temperature of the room shall be between 18 and 21 °C, and the humidity not more than 60%.

8.3.2.2 Change Room See Table 8.17. The changing room shall have adequate provisions for personal lockers wherein the patients can keep their personal belongings. One chair shall be provided in the room, which the patient can use while changing clothes. For hanging the outside clothes, an adequate number of hooks shall be provided on the wall. Apart from this, the almirah and hanger rods with the hangers shall also be provided to hang the clothes. There shall be a closed cabinet to keep the sterilized patient dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. The room shall be adequately air-conditioned, and the temperature of the room shall be between 18 and 21 °C. A large bin for dirty linen shall also be provided in the changing room. 8.3.2.3 Patient Preparation Room See Table 8.18. Furniture-wise, the preparation room shall have an examination couch with a step stool and instrument trollies, apart from the furniture like almirah/cupboards and filing cabinets. For hand washing, the washbasin shall be provided in the room, with the provision of running hot and cold water. As far as the equipment is concerned, the room shall be provided with portable OT light, BP apparatus, stethoscopes, etc.

8.3  Services, Facilities, Equipment, Tools, and Instruments

291

Table 8.18  Patient preparation room of X-ray

Activity Examination couch Step stool Instrument trolley Almirah/cupboard Sink Preparation room shall have the following equipment: Portable OT light BP apparatus Stethoscopes Preparation room shall have the following tools/ instruments: Sterilizing drums Trays Extension cords and boxes Torches Other facilities in the room Required electrical points Required other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks :::::-

:::-

::::-

::-

In addition to this, the preparation room shall have tools like sterilizing drums, trays, extension cords and boxes, and torches. Other than this, sufficient electrical outlets and communication ports shall be provided in the room. The room shall be adequately air-conditioned, and the temperature of the room shall be between 18 and 21 °C, and the humidity not more than 60%.

8.3.2.4 Computerized Radiography (CR) Room See Table 8.19. CR is a type of machine to process the image captured after exposure. In the process, the X-ray exposure is taken on a special X-ray cassette. This cassette has a screen inside it on which the image is collected post-exposure. The cassette is then loaded in a machine called CR, where the screen inside the cassette comes out and the CR reads the image. After reading, the image on the screen is washed out by the CR, and the cassette is ready for next use. The image captured by CR is then sent to

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Table 8.19  Computerized radiography (CR) room of X-ray

Activity Countertop for placing CR system Small foundation for camera (film printer) Computer with printer Chairs Office table

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

a PC attached to it. Radiographer can then modify the image parameters, followed by printing the image on a film. The CR room shall have a countertop or table to keep the CR system or alternately it can be placed on a wooden table. However, a countertop is better as the unit can generate vibrations on a wooden table. If the CR is a floor-mounted type, it can be placed on the floor just after providing the stand underneath. For placing the computer, printer, and UPS, either a simple table or otherwise a computer table can be provided. One office revolving chair shall also required. The laser image camera (film printer) can be either a tabletop model or a floor model. If it is a tabletop model, it can be placed on both the countertop and the table. But if it is a floor model, a small foundation shall be required. Lighting shall be normal as in other rooms. Nowadays, due to the advancements, the CR system is remotely connected to the service centres of the CR manufacturers, for online monitoring and repairing minor defects. Hence, a dedicated internet line with a separate IP address shall be provided near the CR system. The room shall be adequately air-conditioned, and the temperature of the room shall be between 18 and 21 °C, and the humidity not more than 60%.

8.3.3 Ultrasound Zone 8.3.3.1 Ultrasound Room See Table 8.20. Equipment-wise, an ultrasound machine along with the required transducers shall be placed in the room. If required, the vascular Doppler shall also be provided. The ultrasound room shall have one couch preferably made out of wood. The size of the couch shall be about 762 mm wide and 1829 mm long and about 833 mm in height. The rubber mattress shall be placed on the couch. Curtain partitions shall be provided on the couch. Curtain partitions shall be installed by hanging these curtains from ceiling-mounted curtain rails.

293

8.3  Services, Facilities, Equipment, Tools, and Instruments Table 8.20  Ultrasound room

Activity Ultrasound machine Vascular Doppler Wooden table for ultrasound Step stool Curtain partition Computer, UPS, and printer Computer table Office chair Paper napkin holder Required electrical points Other communication points Attached toilet

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::::::::-

:-

Usually, the reports of the ultrasound are prepared in the ultrasound room itself. Hence the computer, printer, and UPS shall be provided in the ultrasound room. For placing the computer, printer, and UPS, either the PC, a table can be provided or otherwise a computer table can be provided. One office revolving chair is also required. The light that has been provided shall be dimmable. To plug in the ultrasound machine, behind the ultrasound machine, 6/16 Amp. A switch/socket shall be provided. To wipe off the jelly after the procedure, the paper napkin holder shall be provided near the couch. Other than this, sufficient electrical outlets and communication ports shall be provided in the room. Each ultrasound room shall have an attached toilet. This is required as some of the scans need to be done post-void, particularly the ultrasound of the lower abdomen. The toilet shall have a WC, urinal, and washbasin. Exhaust must be given in the toilet. Nowadays, due to the advancements, the ultrasound machine is remotely connected to the service centres of the machine manufacturers, for online monitoring and repairing minor defects. Hence, a dedicated internet line with a separate IP address shall be provided near the ultrasound machine. The temperature of the room shall be between 18 and 22 °C with 50% relative humidity. Dimmable lighting is required in the room.

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Table 8.21  Change rooms of ultrasound

Activity Lockers to keep the personal belongings of the patient One chair Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep the sterilized dresses Hanger rods with hangers Bin for dirty linen

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

::::::-

8.3.3.2 Change Rooms See Table 8.21. The changing room shall have adequate provisions for personal lockers wherein the patients can keep their personal belongings. One chair shall be provided in the room, which the patient can use while changing clothes. For hanging the outside clothes, an adequate number of hooks shall be provided on the wall. Apart from this, the almirah and hanger rods with the hangers shall also be provided to hang the clothes. There shall be a closed cabinet to keep the sterilized patient dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. The room shall be adequately air-conditioned, and the temperature of the room shall be between 18 and 21 °C. A large bin for dirty linen shall also be provided in the changing room.

8.3.4 CT Scan Zone 8.3.4.1 CT Scan Machine Room See Table 8.22. As the main equipment, the room shall have a computed tomography machine (CT). The CT scan machine is supplied along with a specialized motorized patient table. The pressure die injector shall also be proved in the room to inject the contract media for performing the investigation. The machine can be installed either horizontally or diagonally in the room.

8.3  Services, Facilities, Equipment, Tools, and Instruments

295

Table 8.22  CT scan machine room

Activity Computed tomography (CT) with table Pressure die injector Warning light Lead apron, gloves, collars, etc. Required main switch and cable Lead glass between the machine room and control room Proper ground earthing Heavy-duty hangers MGPS outlets for oxygen, vacuum, air Two-way audio communication between CT machine room and console room Heavy-duty hangers for lead aprons Cabinet for devices like lead gloves, lead goggles, groin guards, lead collar Required electrical points Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::-

::::-

::-

::-

For flooring, tiles, marble, or granite can be chosen. But the flooring shall not be slippery to avoid accidents and injury to the patient. When installing the machine, ensure that there is at least 1829  mm of space behind the machine for the gantry of the machine to tilt and for easy maintenance. The machine shall be installed in the centre of the room’s width. Place the gantry and couch so that the patient is fully visible from the control console during scanning. The gantry room entrance door from the control console room shall meet the same requirements as the patient entrance door. A warning light with a red bulb shall be installed outside the CT scan room’s door. This light must be linked to the X-ray generator so that it only illuminates when the X-ray tube is turned on for exposure.

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Inside the CT scan room, X-ray radiation protection devices like lead aprons, gloves, lead glasses, thyroid collars, and gonad shields shall be provided with the protection of the staff from unwanted radiation exposure. The main switch and cable shall be terminated separately in each CT scan room, and the machine’s power load shall be estimated based on its capacity. Because the machine’s weight is greater and its movement is more rapid, it is recommended that the weight-bearing capacity of the floor be checked. Provide a foundation for the machine if necessary. For installation of the machine, follow the manufacturer’s recommendations. The CT scan machine shall be mounted on a base plate (usually supplied by the vendor) only with good-quality anchor fasteners as recommended by the manufacturer of the machine. Any shortcuts will cause the unit to vibrate during operation and cause compression artefacts in the image, resulting in poor image quality and the need to repeat diagnostic tests, leading to the eventual reinstallation of the machine. Lighting shall be provided using regular LEDs that have enough brightness. There is no need for additional lighting in the space. CT scan machine shall have the appropriate ground earthing features. Inside the CT scan room, outlets for medical gas supply shall be given. There shall be one outlet for oxygen, one for vacuum, and one for air. The proper two-way audio system shall be provided in the CT room, so that the patient can be directed by the technician sitting in the control room, without entering the CT room. Each room shall have a stand with sturdy hangers where the lead apron can be hung. A cabinet shall be provided in each room to keep the radiation protection and safety devices like lead gloves, lead goggles, groin guards, and lead collars. Other than this, sufficient electrical outlets and communication ports shall be provided in the room. Nowadays, due to the advancements, the CT scan machine is remotely connected to the service centres of the machine manufacturers, for online monitoring and repairing minor defects. Hence, a dedicated internet line with a separate IP address shall be provided near the CT scanner. The CT scan room shall be adequately air-conditioned, and the room’s temperature shall be between 18 and 21  °C, with the humidity not to be more than 60%. As far as the CT panel room is concerned, the room shall have sufficient electrical outlets and the communication ports shall be provided in the room.

8.3.4.2 CT Control Room See Table 8.23. The control unit of the CT scanner shall be installed on a table in the CT scan control room. The computer, keyboard, control command units, and control unit of the die injector are all components of the control unit. Typically, this table shall be supplied along with the machine.

297

8.3  Services, Facilities, Equipment, Tools, and Instruments Table 8.23  CT control room

Activity Computer tables Office tables Chairs Lead glass window Computers with printers and UPS View box Required electrical points Other communication points

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::::-

Apart from this, there shall be the provision of a secondary computer for transferring the CT images and for preparing reports. Hence, the computer, UPS, and printer shall be provided. To place this secondary computer unit, a separate table shall also be provided. Sufficient revolving chairs shall be provided in the room. A view box shall also be provided in the room to view the films of the old investigations for comparison purposes. A lead glass (provided with the machine) of about 180 mm × 1000 mm shall be fixed in a wooden frame with 2 mm lead lining between the CT machine room and the control room. Please ensure that there is no leakage of radiation from the CT machine room. If required, a laser image camera (printer) shall also be provided in the control room to print CT scan films. The room shall have sufficient electrical outlets to connect the equipment, devices, and computers to the electric supply. Other than this, the necessary communication ports shall also be provided in the room.

8.3.4.3 UPS Room See Table 8.24. There shall be a sufficient number of battery installation racks in the UPS room. There may occasionally be fumes in the room due to the acid in the batteries, so the UPS room shall have an exhaust system. Ground earthing of the UPS is necessary. The main supply cables shall terminate in the UPS room, which is then connected to the UPS. The output cables from UPS are connected to the main CT scan machine.

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Table 8.24  UPS room for CT scan

Activity Racks to install batteries Exhaust fans Required electrical points Required main switch and cable

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

The room shall have sufficient electrical outlets to connect the UPS and other devices to the electric supply. Other than this, the necessary communication ports shall also be provided in the room. Nowadays, due to the advancements, the UPS is remotely connected to the service centres of the UPS manufacturers, for monitoring and repairing minor defects online. Hence, a dedicated internet line with a separate IP address shall be provided near the UPS. As the UPS produces a lot of heat, the space shall be properly air-conditioned, and the temperature shall be between 17 and 8 °C with an RH of no more than 40%.

8.3.4.4 Change Rooms See Table 8.25. To keep the personal belongings of patients, provision of an adequate number of personal lockers shall be made in the changing room. One chair shall also be provided in the changing room, which the patient can use while changing clothes. For hanging the outside clothes, an adequate number of hooks shall be fixed on the wall. Apart from this, the almirah and hanger rods with hangers shall also be provided to hang clothes. There shall be a closed cabinet to keep sterilized patient dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. A large receptacle for the collection of the used linen shall also be provided in the changing room.

8.3.5 MRI Zone 8.3.5.1 MRI Machine Room See Table 8.26. The magnetic resonance imaging machine with spectroscopy is the primary part of MRI equipment. The MRI exam room shall have this device installed. A lengthy sliding table which is a part of the machine is also supplied with the MRI machine.

299

8.3  Services, Facilities, Equipment, Tools, and Instruments Table 8.25  Change rooms for CT scan

Activity Lockers to keep the personal belongings of the patient One chair Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep sterilized dresses Hanger rods with hangers Bin for dirty linen

Status of works In Not Start End date date Complete progress started

Responsible person

Remarks

:-

::::::-

Table 8.26  MRI machine room

Activity Magnetic resonance imaging (MRI) with spectroscopy MR-compatible fibre-optic pulse oximeter MR-compatible die injector MR scanner coils Phantoms Metal detector MR-compatible stretcher trollies MR-compatible wheelchair MR-­compatible plastic chair MR-­compatible drip stand MR-­compatible instrument trolley MR-­compatible emergency cart Window between the magnet room and control/console room

Status of works In Not Responsible Start End Remarks date date Complete progress started person :-

:-

:::::::::::-

(continued)

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8  Radio Diagnosis

Table 8.26 (continued)

Activity Check the weight-­ bearing capacity of the floor LED lights made of non-ferrous material Proper ground earthing Required main switch and cable Cabinet made out of wood or non-ferrous material for devices and coils MGPS outlets for oxygen, vacuum, and air outside RF shielding Two-way audio communication between MRI machine room and console room Required electrical points Other communication points

Status of works In Not Responsible Start End Remarks date date Complete progress started person :-

::::-

:-

:-

::-

Apart from this, the MR-compatible fibre-optic pulse oximeter/multi-para monitor shall be provided for monitoring the vitals of the patient. Also, die injectors shall be provided for injecting the contrast media. The MR scanner coils, dummies, and phantoms, that come along with the machine, shall also be placed in the room. The metal detector shall be installed just near the entry gate of the MRI room, so that all the persons entering the room shall be scanned for any metallic object. Also, the MRI shall be provided with MR-compatible accessories and tools like stretcher trollies, wheelchairs, plastic chairs, drip stands, instrument trolleys, and emergency carts. RF shielding is usually required for the window between the magnet room and the control/console room, which is usually two layers of copper screens or perforated sheets. When installing the machine, make sure to leave at least 1829  mm of space behind it for the MRI table to move behind and for easy machine maintenance. The machine shall be installed in the centre of the room’s width. Because the weight of the machine is greater, it is recommended that the weight-­ bearing capacity of the floor be checked. Provide a foundation for the machine if necessary, following the manufacturer’s recommendations.

8.3  Services, Facilities, Equipment, Tools, and Instruments

301

Only the desired mounting anchor fasteners as specified by the equipment’s manufacturer shall be used to install the machine on the base frame, which is usually supplied by the vendor. Any shortcuts will result in vibrations of the unit during operation and compression artefacts in an image, resulting in poor image quality and repetition of diagnostic tests, eventually leading to the machine’s reinstallation. Lighting shall be provided using normal LED, with the sufficient lumen. However, ordinary light fittings are not allowed. There are special lights made of non-ferrous material for the MRI room. All machines shall have proper ground earthing provisions. Inside the room, a cabinet made of wood, polycarbonate, or other non-ferrous material has to be provided. This is required to store the MRI coils and any other non-ferrous material. The MRI room needs the following outlets for medical gas supply: one outlet for oxygen, one for vacuum, and one for air. However, these outlets cannot be given directly in the room; instead, they are given outside the RF cage, from where a rubber tube is provided inside the MRI room up to the patient’s table. The proper two-way audio system shall be provided in the MRI room, so that the patient can be directed by the technician sitting in the control room, without entering the MRI room. The room shall have sufficient electrical outlets to connect the equipment and other electronic/electric devices and tools to the electric supply. Other than this, the necessary communication ports shall also be provided in the room. Nowadays, due to the advancements, the MRI machine is remotely connected to the service centres of the machine manufacturers, for online monitoring and repairing minor defects. Hence, a dedicated internet line with a separate IP address shall be provided near the MRI machine. As far as the MRI panel room is concerned, the room shall have sufficient electrical outlets and communication ports. The MRI room shall be adequately air-conditioned, and the room’s temperature shall be between 17 and 8 °C, and the humidity not more than 40%.

8.3.5.2 MRI Control Room See Table 8.27. The MRI control room shall be provided with a table to install the control unit of the MRI machine. The control unit consists of the computer, keyboard, control command units, and control unit of the die injector. This table is usually supplied along with the machine. Apart from this, there shall be provision of a secondary computer for transferring the MRI images and for preparing reports. Hence, the computer, UPS, and printer shall be provided. To place this secondary computer unit, a separate table shall also be provided. Sufficient revolving chairs shall be provided in the room. A view box shall also be provided in the room, to view the films of the old investigations for comparison purposes.

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Table 8.27  MRI control room

Activity Computer tables Office tables Chairs Perforated copper screen window Computers with printers and UPS View box Required electrical points Other communication points

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::::-

The window, which is often two layers of copper screens or perforated sheets, shall be provided between the magnet room and the control or console room. If required, a laser image camera (printer) shall also be provided in the control room to print MRI films. The room shall have sufficient electrical outlets to connect the equipment, devices, and computers to the electric supply. Other than this, the necessary communication ports shall also be provided in the room.

8.3.5.3 UPS Room See Table 8.28. As MRI is an electronic machine, it requires a continuous power supply. It is more essential, as the cold head of the machine shall always be on, failing which the helium gas filled in the magnet will boil and potentially be lost. If that is not provided, the machine will stop, increasing the chances of software corruption or even failure of different parts of the machine. To avoid this, mostly all users of the machine prefer to install an online UPS with the machine. The UPS room shall be provided with several racks to install batteries. Because of the acid in the batteries, sometimes fumes are formed in the room; thus, the UPS room shall have an exhaust. Ground earthing of the UPS is necessary. The main supply cables shall terminate in the UPS room, which is then connected to the UPS.  The output cables from UPS are connected to the main MRI machine and other panels of the machine. The room shall have sufficient electrical outlets to connect the UPS and other devices to the electric supply. Other than this, the necessary communication ports shall also be provided in the room. Nowadays, due to the advancements, the UPS is remotely connected to the service centres of UPS manufacturers, for online monitoring and repairing minor

303

8.3  Services, Facilities, Equipment, Tools, and Instruments Table 8.28  UPS room for MRI

Activity Racks to install batteries Exhaust fans Required electrical points Required main switch and cable

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

Table 8.29  Chiller for MRI

Activity Chiller outside the building Provide water make-up tank Required electrical cables and switches

Start date

End date

:::-

defects. Hence, a dedicated internet line with a separate IP address shall be provided near the UPS. As the UPS produces a lot of heat, the room shall be adequately air-conditioned, and the temperature shall be between 17 and 8 °C with an RH of no more than 40%.

8.3.5.4 Chiller See Table 8.29. The space shall be provided outside the hospital building for the chiller. The provision for a make-up water tank shall be provided, from where the chiller takes the water, cools it, and then sends it to the machine through a connected pipeline. The space shall have sufficient electrical outlets to connect the chiller and its accessories and other devices to the electric supply. 8.3.5.5 Change Rooms See Table 8.30. To keep the personal belongings of patients, provision of an adequate number of personal lockers shall be made in the changing room. One chair shall also be provided in the changing room, which the patient can use while changing clothes. For hanging the outside clothes, an adequate number of hooks shall be fixed on the wall.

304

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Table 8.30  Change rooms for MRI

Activity Lockers to keep the personal belongings of the patient One chair Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep sterilized dresses Hanger rods with hangers Bin for dirty linen

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

::::::-

Apart from this, the almirah and hanger rods with hangers shall also be provided to hang clothes. There shall be a closed cabinet to keep sterilized patient dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. A large receptacle for the collection of the used linen shall also be provided in the changing room.

8.3.6 Mammography Zone 8.3.6.1 Mammography Rooms See Table 8.31. The physical room where the mammography machine is installed and the patient is exposed to X-rays is called a mammography room. For flooring, tiles, marble, or granite can be chosen. But the flooring shall not be slippery to avoid accidents and injury to the patient. Windows are not allowed in the mammography room. A warning light with a red bulb shall be installed outside the mammography room’s door. This light must be linked to the X-ray generator so that it only illuminates when the X-ray tube is turned on for exposure. A cabinet shall be provided in the room to keep radiation protection and safety devices like lead gloves, lead goggles, groin guards, and lead collars. A shielded barrier shall be placed in front of the mammography control console and serve as a barrier between the control panel and the X-ray tube to protect the staff from unintentional radiation exposure while performing the process. The main switch and cable shall be terminated separately in each mammography room, and the power load needed by the machine shall be estimated based on its capacity.

8.3  Services, Facilities, Equipment, Tools, and Instruments

305

Table 8.31  Mammography room

Activity Mammographic machine digital Warning light Shielded barrier Main switch and cable Lead glass wooden if DR is installed frame Ground earthing Heavy-duty hangers Cabinet for devices like lead gloves, lead goggles, groin guards, lead collar

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::::-

A small, independent control room that is adjacent to the digital mammography machine room shall be provided if the digital type of mammography machine is planned. A lead glass with a 2 mm lead lining shall be installed in a wooden frame between the two rooms. Lighting shall be provided using regular LEDs that have enough brightness. There is no need for additional lighting in the space. Every machine shall have the appropriate ground earthing features. Each room shall have a stand with sturdy hangers where the lead apron can be hung. A cabinet shall be provided in each room to keep radiation protection and safety devices like lead gloves, lead goggles, groin guards, and lead collars. The room shall be air-conditioned, and the room’s temperature shall be between 18 and 21 °C, and the humidity shall not be more than 60%.

8.3.6.2 Change Rooms See Table 8.32. To keep the personal belongings of patients, provision of an adequate number of personal lockers shall be made in the changing room. One chair shall also be provided in the changing room, which the patient can use while changing clothes. For hanging the outside clothes, an adequate number of hooks shall be fixed on the wall. Apart from this, the almirah and hanger rods with hangers shall also be provided to hang clothes. There shall be a closed cabinet to keep sterilized patient dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. A large receptacle for the collection of the used linen shall also be provided in the changing room.

306

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Table 8.32  Change room for mammography

Activity Lockers to keep the personal belongings of the patient One chair Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep sterilized dresses Hanger rods with hangers Bin for dirty linen

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

:-

::::::-

Table 8.33  Computerized radiography room for mammography

Activity Countertop for placing CR system Small foundation for camera (film printer) Computer with printer Chairs Office table

Status of works Start End In Not date date Complete progress started :::::-

8.3.6.3 Computerized Radiography (CR) Room See Table 8.33. CR is a machine that processes images captured after exposure. The X-ray exposure is recorded on a special X-ray cassette during the procedure. This cassette contains a screen on which the image is collected after exposure. The cassette is then loaded into a machine known as a CR, where the screen inside the cassette is removed and the image is read by the CR. The image on the screen is washed out by the CR after reading, and the cassette is ready for the next use. The image captured by CR is then sent to a PC connected to it. The radiographer can then alter the image parameters before printing the image on film. The CR room shall have a countertop or table to keep the CR system or alternately it can be placed on a wooden table. However, a countertop is better as the unit can generate vibrations on a wooden table. If the CR is a floor-mounted type, it can be placed on the floor just after providing the stand underneath.

8.3  Services, Facilities, Equipment, Tools, and Instruments

307

For placing the computer, printer, and UPS, either the PC, a table can be provided or otherwise a computer table can be provided. One office revolving chair is also required. The laser image camera (film printer) can be either a tabletop model or a floor model. If it is a tabletop model, it can be placed on both the countertop and the table. But if it is a floor model, a small foundation shall be required. Lighting shall be normal as in other rooms. Nowadays, due to the advancements, the CR system is remotely connected to the service centres of the machine manufacturers, for online monitoring and repairing minor defects. Hence, a dedicated internet line with a separate IP address shall be provided near the CR system.

8.3.7 DEXA Scan Zone 8.3.7.1 DEXA Scan Room See Table 8.34. DEXA scan is a room used for bone scans and where the patient is exposed to X-rays. For the flooring of the room, tiles, marble, or granite can be chosen. But the flooring shall not be slippery to avoid accidents and injury to the patient. DEXA scan room shall not have any windows. A warning light with a red bulb shall be installed outside the DEXA scan room’s door. This light must be linked to the X-ray generator so that it only illuminates when the X-ray tube is turned on for exposure. Inside the DEXA scan room, the X-ray radiation protection devices like lead aprons, gloves, lead glasses, thyroid collars, and gonad shields shall be provided for the protection of the staff from unwanted radiation exposure. Table 8.34  DEXA scan room

Activity Densitometer, bone Warning light Shielded barrier Main switch and cable Lead glass wooden if DR is installed frame Ground earthing Heavy-duty hangers Cabinet for devices like lead gloves, lead goggles, groin guards, and lead collar

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::::-

8  Radio Diagnosis

308

To safeguard the staff from unintended radiation exposure while performing the procedure, a shielded barrier shall be positioned in front of the DEXA scan control console, which shall act as a barrier between the control panel and the X-ray tube. The main switch and cable shall be terminated separately in each DEXA scan room, and the power load needed by the machine shall be estimated based on its capacity. A small, independent control room that is adjacent to the DEXA scan room shall be provided if a machine of digital type. A lead glass with a 2 mm lead lining shall be installed in a wooden frame between the two rooms. Lighting shall be provided using regular LEDs that have enough brightness. There is no need for additional lighting in the space. Every machine shall have the appropriate ground earthing features. Each room shall have a stand with sturdy hangers where the lead apron can be hung. Each room shall have a cabinet to store radiation safety and protection devices, such as lead gloves, lead goggles, groin guards, and lead collars. The temperature of the room shall be between 18 and 21 °C, and the humidity not more than 60%.

8.3.7.2 Change Rooms See Table 8.35. The changing room shall have adequate provisions for personal lockers wherein the patients can keep their personal belongings. One chair shall be provided in the room, which the patient can use while changing clothes. For hanging the outside clothes, an adequate number of hooks shall be provided on the wall. Table 8.35  Change room for DEXA scan

Activity Lockers to keep the personal belongings of the patient One chair Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep sterilized dresses Hanger rods with hangers Bin for dirty linen

Status of works Start End In Not date date Complete progress started :-

::::::-

Responsible person

Remarks

8.3  Services, Facilities, Equipment, Tools, and Instruments

309

Apart from this, the almirah and hanger rods with hangers shall also be provided to hang clothes. There shall be a closed cabinet to keep sterilized patient dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. A large bin for dirty linen shall also be provided in the changing room.

8.3.8 PET/CT Scan/SPECT/CT Zone 8.3.8.1 PET/CT Scan/SPECT/CT Machine Room See Table 8.36. PET/CT scan machine room: The infrastructure of the machine room shall be the same as a normal CT scan machine room. The only difference is that the wall shall be made out of 300 mm thick RCC. SPECT/CT machine room: Earlier, a nuclear bone scan was done with the help of a gamma camera. It was able to capture an image just like X-ray, after inducing isotopes. As technology changed, SPECT came into the picture. It can capture images by cutting slices of the parts to be investigated. The infrastructure of the machine room shall be the same as a normal CT or PET/CT machine room. Table 8.36  PET/CT scan/SPECT/CT machine room

Activity Nuclear computed tomography (PET/CT) Warning light Required main switch and cable Proper ground earthing MGPS outlets for oxygen, vacuum, air Two-way audio communication between CT machine room and console room Heavy-duty hangers for lead aprons Cabinet for devices like lead gloves, lead goggles, groin guards, lead collar Required electrical points Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::-

::-

::-

310

8  Radio Diagnosis

8.3.8.2 PET/CT Scan/SPECT/CT Control Room See Table 8.37. There shall be a distinct console room for each imaging modality. As a result, a wall dividing the console room from the SPECT/CT and PET/CT rooms shall be provided. This wall shall be made of RCC and be 300 mm thick, with 4 mm lead-­ equivalent glass windows. The same standards and requirements apply to the PET/CT console room as to the CT scan. 8.3.8.3 PET/CT Scan/SPECT/CT, UPS Room See Table 8.38. All norms and specifications of the UPS room and machine panel room shall also be the same as CT scan room. Table 8.37  PET/CT scan/SPECT/CT control room Status of works Start End In Not date date Complete progress started

Activity Computer tables Office tables Chairs Lead glass window Computers with printers and UPS View box Required electrical points Other communication points

Responsible person

Remarks

::::::::-

Table 8.38  PET/CT scan/SPECT UPS room

Activity Racks to install batteries Exhaust fans Required electrical points Required main switch and cable

Start date ::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

311

8.3  Services, Facilities, Equipment, Tools, and Instruments Table 8.39  PET/CT scan/SPECT/CT change rooms

Activity Lockers to keep the personal belongings of the patient One chair Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep sterilized dresses Hanger rods with hangers Bin for dirty linen

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

::::::-

8.3.8.4 PET/CT Scan/SPECT/CT Change Rooms See Table 8.39. All norms and specifications of the change room shall also be the same as CT scan room.

8.3.9 PET/MRI Zone 8.3.9.1 PET/MRI Machine Room See Table 8.40. The infrastructure of the machine room shall be the same as a normal MRI machine room. The only difference is that the wall shall be made out of 300 mm thick RCC. 8.3.9.2 PET/MRI Control Room See Table 8.41. There shall be a distinct console room for each imaging modality. As a result, there shall be a partition between the console room and the PET/MRI room. This wall shall be made of RCC and be 300 mm thick, with 4 mm lead-equivalent glass windows. Every additional standard and requirement for the console room shall match those of the MRI room.

312

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Table 8.40  PET/MRI machine room

Activity Nuclear magnetic resonance imaging system (PET/MRI) Window between the magnet room and control/console room Required main switch and cable Proper ground earthing MGPS outlets for oxygen, vacuum, air outside RF shielding Two-way audio communication between MRI machine room and console room LED lights made of non-ferrous material Cabinet made out of wood or non-ferrous material for devices and coils Required electrical points Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

:::-

:-

::-

::-

Table 8.41  PET/MRI control room

Activity Computer tables Office tables Chairs Perforated copper screen window Computers with printers and UPS View box Required electrical points Other communication points

Status of works Start End In Not date date Complete progress started ::::::::-

Responsible person

Remarks

8.3  Services, Facilities, Equipment, Tools, and Instruments

313

8.3.9.3 PET/MRI UPS Room See Table 8.42. All norms and specifications of the UPS room shall also be the same as MRI room. 8.3.9.4 PET/MRI Chiller See Table 8.43. All norms and specifications of PER/MRI chiller space shall also be the same as MRI room. 8.3.9.5 Change Rooms See Table 8.44. All norms and specifications of the change room shall also be the same as MRI room. Table 8.42  PET/MRI UPS room

Activity Racks to install batteries Exhaust fans Required electrical points Required main switch and cable

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

Status of works In Not Complete progress started

Responsible person

Remarks

Responsible person

Remarks

::::-

Table 8.43  PET/MRI chiller

Activity Chiller outside the building Provide water make-up tank Required electrical cables and switches

Start date

End date

:::-

Table 8.44  PET/MRI change room

Activity Lockers to keep the personal belongings of the patient One chair

Status of works In Not Start End date date Complete progress started :-

:(continued)

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314 Table 8.44 (continued)

Activity Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep sterilized dresses Hanger rods with hangers Bin for dirty linen

Status of works In Not Start End date date Complete progress started

Responsible person

Remarks

:::::-

8.3.10 Low-Risk Areas or Cold Areas 8.3.10.1 Reception/Cash Counter See Table 8.45. The number of patients or visitors who are anticipated to use the reception or help desk services determines the size of the counter and/or help desk. It is advised that enough room be made so that two receptionists or helpers can be seated. Therefore, the appropriate length for the reception and/or help desk shall be between 3048 mm and 4572 mm. The counter can be built of granite or other materials, or it can be built up by civil construction with an elegant appearance. A wooden counter can also be provided as an alternative. For a person to comfortably stand and speak with the receptionist, the front side of the counter shall be roughly 1524 mm high. The working top, which shall be provided on the other side of the counter, shall be approximately 610 mm wide and 762 mm high. Two reception chairs shall be provided for the receptionists. If need be, high-­ raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided to each receptionist or help desk assistant. If required, the scanner can also be provided at reception. Microphone for announcement shall be provided at the reception. The intercom and telephone lines shall also be provided at the reception. Even one spare mobile phone shall also be placed at the reception to make emergency calls. The reception counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points. • In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances.

315

8.3  Services, Facilities, Equipment, Tools, and Instruments Table 8.45  Reception/cash counter in cold areas

Activity Provide the following at reception: Reception counter Reception chairs Computers with printers Scanner Public announcement system Cash collection box screwed to the counter Intercom and telephone line Required electrical points at reception Other communication points at reception Acrylic or glass partitions on all the counters

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::::::-

The reception counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for computer networking • Two RJ 11 points for intercom and extension lines Cash Counter The size of this counter shall depend on how many patients or visitors are anticipated to use its services. However, there shall be room for two employees to sit down at each cash counter. Therefore, the optimal length can range from 2438 to 3658 mm. Granite or another material can be utilized to give the counters an aesthetically pleasing appearance, or they can be formed of civil work. Counters constructed of wood can also be offered as an alternative. Each counter’s front side shall be roughly 1524 mm high so that people can stand at them and easily interact with the staff. The working top, which shall be provided on the other side of the counter, shall approximately be 610  mm wide and 762 mm high. As the safety of the cash is required at the cash counters, above the counter, there shall be a glass partition with a cut window on the lower side of the glass, rising to a height of about 1219 mm from the top of the counter.

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Two office chairs shall be provided at each cash counter. If need be, high-raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided for each cashier separately. If required, the scanner can also be provided at the cash counter. Additionally, the barcode scanner shall be provided at the cash counter for scanning the barcodes for billing and receiving cash. The cash counter shall be provided with a safe screwed to the counter, for the safe custody of the cash. The intercom and telephone lines shall also be provided at the cash counters. Each cash counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points. • In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances. Each cash counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for computer networking • Two RJ 11 points for intercom and extension lines

8.3.10.2 Waiting Room See Table 8.46. The waiting and sub-waiting lobbies of the radiology department shall be fully air-conditioned with a provision of cooling and heating. Waiting lobbies shall be properly guarded, and security measurement like fire hooters and CCTV cameras shall be provided in the waiting areas. Waiting lobbies shall have adequate speakers with a clear voice to hear the announcements. Along with the audio system, the visual display system including the display boards shall be provided, where the token number can be displayed. Proper comfortable chairs having backrests shall be provided in the waiting areas. Please avoid the backless benches, as it is not comfortable to sit on such benches. If sofa sets are provided, it will be better. However, the waiting areas of VIPs shall definitely have the sofa set along with the centre tables. For bariatric patients, arrangements shall be made for specialized seating. For an aesthetic look of the waiting areas, the interiors shall be well decorated. The wall decoration shall be done by using mirrors, murals, texturized paints, or wallpapers. Similarly, the ceiling shall also be decorative. Light fittings shall also be decorative. For interior decor, colour, textures, surface finishes, fixtures, fittings, furnishings, and artworks shall be used. The waiting areas shall also have televisions, fish tanks, magazine holders, newspaper racks, kiosks, etc. for patients and visitors to spend time. A small cafeteria or vending machines shall be provided in the waiting areas.

317

8.3  Services, Facilities, Equipment, Tools, and Instruments Table 8.46  Waiting areas in cold area

Activity Proper heating and air conditioning Security features like CCTV Announcement systems Waiting chairs/sofa set Wall, ceiling, and interior decoration Television, fish tanks, magazines, movies/ DVDs, etc. Food and drink vending machines Signage and wayfinding system Spaces for indoor plants Interactive displays Mobile charging points in the lobby Free internet or Wi-Fi facility Handrails at the staircase and other areas Other communication points

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::::-

:::::::-

:-

The wayfinding and signages shall be very clear and glowable, so that visitors and patients can easily identify the passages and routes. For beautification, indoor plants can also be planned to be placed in waiting areas. Mobile charging points shall also be provided in the waiting area. Apart from this, if possible, the facility of Wi-Fi or free internet can be provided. For the safety of the patients and visitors, provide necessary safety measures, like handrails, non-slippery surfaces, non-steep slopes, handicapped toilets, and wheelchair accessibility.

8.3.10.3 Physicians’ Consulting Room See Table 8.47. The following furniture shall be placed in the consultation room: • Doctors’ table • Doctors’ chair

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Table 8.47  Physicians’ consulting room in cold area

Activity Provide the following furniture in consultation rooms: Doctors’ table Doctors’ chair Height adjustment revolving stool for patient Two attendants’ chairs Examination couch Step stool Side rack for doctor Provide the following equipment/gadgets in consultation rooms: BP instrument Stethoscope Torch Weighing machine View box Intercom Computer with a printer and UPS Washbasin for hand wash Curtain partitions for the examination couch Provide windows if possible MGPS supply of oxygen, air, and suction if required Required electrical points Other communication points

• • • • •

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::-

::::-

:::::::::::-

::-

Two attendants’ chairs Height adjustment revolving stool for patient Examination couch Step stool Side rack for doctor

8.3  Services, Facilities, Equipment, Tools, and Instruments

319

All the necessary equipment, gadgets, and instruments shall be provided like: • • • • • • • •

BP instrument Stethoscope Torch Knee hammer (if required) Weighing machine Tongue depressor Finger pulse oximeter View box

All the consultation rooms shall have an intercom for inter-hospital communication. The consultation rooms shall have a computer along with the UPS. If printing is also required to be done in the consultation rooms, the printer shall also be provided. Each consultation room must have a hand basin along with soap dispenser and towel hanger. A hanging curtain partition covering each of the examination table’s three sides shall be provided in the consultation rooms. The curtains shall be hung from a ceiling-­mounted curtain track that is fixed 2134 mm above the ground. A space shall be left clear at the bottom of the curtain that is approximately 457 mm above ground so that the floor can be cleaned. All consultation rooms shall have a provision for biomedical waste management. Although direct sunlight shall be avoided, windows in consultation rooms are desirable. The window glass can be tinted, and there shall be blinds or drapes. The following electrical points shall be provided in the consultation rooms: • The main switchboard for controlling the fan and lighting of the room shall be located at the entrance wall (other than the wall on which the door will open), coupled with one 5 Amp switch/socket. • Temperature-adjustable air conditioning control button. • The switch and one point for the examination light shall be provided at about two feet above the examination table on the wall. • Two 5 Amp switch/sockets shall be provided at 305 mm above the doctor’s table on the wall. Alongside this, one 15 Amp switch/socket shall be provided. • Three 5 Amp switch/socket shall be provided on the wall at about 305 mm above the doctor’s side rack to power up the computer and printer. Additionally, for other equipment or heater, one 15 Amp switch/socket shall be provided adjoining to this. The following communication points shall be provided in the consultation chamber: • RJ 45 port for computer networking • RJ 11 port intercom and extension lines • HDMI port for displaying the computer output at other locations

8  Radio Diagnosis

320

The examination room (if attached to the consultation room) shall have: • • • • • • • • • • • • • •

Examination couch Step stool Examination lamp Torch Stainless steel trays Stainless steel bowls Dressing drums Speculums Knee hammer (if required) Tongue depressor Weighing machine Multi-para monitor (if required) View box Special equipment required for different types of examination rooms

The vital sign examination area attached outside the consultation rooms (if provided) shall have: • • • • • • • • • •

BP apparatus Stethoscope Torch Stainless steel trays Stainless steel bowls Weighing machine Finger pulse oximeter Weighing machine Height scale Special equipment required for different types of vital sign examination rooms

8.3.10.4 Store for Films and Consumables See Table 8.48. Table 8.48  Store for films and consumables in cold area

Activity Separate stores for used and unused films/consumables A sufficient number of countertops Cupboards Drawers

Status of works Start End In Not date date Complete progress started :-

:::-

Responsible person

Remarks

321

8.3  Services, Facilities, Equipment, Tools, and Instruments

The stores used for storing the used and unused films and consumables shall have a sufficient number of countertops, cupboards, and drawers. It is highly recommended that for storage of films (as films are highly inflammable), a fireproof cabinet is provided. The light switch of such a store shall be given outside the room, and a single light shall be provided, to avoid the chances of fire caused by sparks.

8.3.10.5 Technologist Room See Table 8.49. The following furniture shall be placed in the technologist’s room: • • • • • • •

Doctors’ table Doctors’ chair Two attendants’ chairs Examination couch Height adjustment revolving stool for patient Step stool Side rack for doctor

Table 8.49  Technologist room in cold area

Activity Office table Office chair Height adjustment revolving stool for patient Two attendants’ chairs Examination couch Step stool Intercom Computer with a printer and UPS Washbasin for hand wash Curtain partitions for the examination couch Provide windows if possible Required electrical points in OPD Other communication points in OPD

Status of works Start End In Not date date Complete progress started :::-

:::::::-

:::-

Responsible person

Remarks

322

8  Radio Diagnosis

The technologist room shall be provided with an intercom for inter-hospital communication. The technologist room shall be provided with the computer along with the UPS. If printing is also required to be done in the technologist’s room, the printer shall also be provided. Each technologist room must have a hand basin along with soap dispenser and towel hanger. A hanging curtain partition covering each of the examination table’s three sides shall be provided in the consultation rooms. The curtains shall be hung from a ceiling-­mounted curtain track that is fixed 2134 mm above the ground. A space shall be left clear at the bottom of the curtain that is approximately 457 mm above ground so that the floor can be cleaned. All technologist rooms shall have a provision for biomedical waste management. Although direct sunlight shall be avoided, windows in consultation rooms are desirable. The window glass can be tinted, and there shall be blinds or drapes. The following electrical points shall be provided in the technologist rooms: • The main switchboard for controlling the fan, and lighting of the room shall be located at the entrance wall (other than the wall on which the door will open), coupled with one 5 Amp switch/socket. • Temperature-adjustable air conditioning control button. • The switch and one point for the examination light shall be provided at about two feet above the examination table on the wall. • Two 5 Amp switch/sockets shall be provided at 305 mm above the doctor’s table on the wall. Alongside this, one 15 Amp switch/socket shall be provided. • Three 5 Amp switch/socket shall be provided on the wall at about 305 mm above the doctor’s side rack to power up the computer and printer. Additionally, for other equipment or heater, one 15 Amp switch/socket shall be provided adjoining to this. The following communication points shall be provided in the technologist chamber: • RJ 45 port for computer networking • RJ 11 port intercom and extension lines • HDMI port for displaying the computer output at other locations

8.3.11 High-Risk Areas or Radiation Exposure Hot Areas 8.3.11.1 Hot Lab Cum Radio Pharmacy Room See Table 8.50. Hot lab cum radio pharmacy room: This room is required when the department has its production unit (cyclotron and radiochemistry lab). The unit shall have the main machines like cyclotron/radio pharmacy. The office table and chair shall be provided in the hot lab.

323

8.3  Services, Facilities, Equipment, Tools, and Instruments Table 8.50  Hot lab cum radio pharmacy room

Activity Cyclotron/radio pharmacy Working top counter Chairs Office table

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

Responsible person

Remarks

::::-

Table 8.51  Isotope injection room

Activity Working top counter Chairs Examination table Office table Step stool Cabinet and drawers

Start date

End date

Status of works In Not Complete progress started

::::::-

Flooring can be of tiles/marble/granite, but it shall not be slippery to avoid accidents and injury to the patient. Windows are not allowed in the hot lab. Inside the hot lab, nuclear radiation protection devices shall be provided for protection of the staff from unwanted radiation exposure. The main switch and cable shall be terminated separately in each hot lab, and the power load needed by the machine shall be estimated based on its capacity. Lighting shall be provided using regular LEDs that have enough brightness. There is no need for additional lighting in the space. Every machine shall have the appropriate ground earthing features. A cabinet shall be provided in each room to keep the nuclear radiation protection and safety devices.

8.3.11.2 Isotope Injection Room See Table 8.51. An injection room shall be provided with a countertop for keeping the drugs and other consumables. The furniture like an examination table, step stool, chairs, and office table shall be provided in the room. Apart from this, a cabinet and drawers shall be provided to store the consumables.

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8.3.11.3 Post-Dose Waiting Area See Table 8.52. The post-dose waiting area shall be provided with recliners or easy chairs for the patient to rest. Instead of chairs, resting couches can also be provided. For entertainment, books or magazines can also be provided. If possible, television can also be provided in each of the waiting chambers. 8.3.11.4 Active Toilet See Table 8.53. The facilities in the toilet have to be the same as any other toilets of the hospital, with the only difference that the discharge of this toilet is taken in a separate settlement tank where it is allowed to settle down and the effects of isotopes are neutralized before dropping the discharge in the main sewerage line. 8.3.11.5 Post-Examination Waiting Area See Table 8.54. Patients should wait in the post-scan waiting room that shall be provided with chairs or a sofa set for resting. For entertainment, books or magazines can also be provided. If possible, television can also be provided in the waiting area. Table 8.52  Post-dose waiting areas

Activity Recliners/ chairs Resting couches Books/ magazine Television

Start date

End date

Status of works In Complete progress

Not started

Responsible person

Remarks

::::-

Table 8.53  Active toilet

Activity Separate settlement tank

Start date :-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

325

Further Reading Table 8.54  Post-examination waiting areas Start date

Activity Chairs Sofa set Books/ magazines Television

End date

Status of works In Not Complete progress started

Responsible person

Remarks

Responsible person

Remarks

::::-

Table 8.55  Miscellaneous items in the radiology department

Activity Leakage tester PACS

Start date

End date

Status of works In Complete progress

Not started

::-

8.3.12 Miscellaneous Items in the Radiology Department See Table 8.55. The radiology department shall have the leakage tester. This tester is used for testing the radiation leakage from the doors, windows, etc. of the radiation rooms like X-rays, CT scan, DEXA scan, and mammography room. The picture archiving and communication system (PACS) software shall be available in the radiology department. The computers linked to the machine and those in the reporting rooms shall all be connected to a secured network and have PACS.  A closed network or the internet can be used to communicate and share images using PACS, a software programme for medical imaging. Except for ultrasound, all radiological imaging is saved and kept on a separate server called the PACS server. The photos can be retrieved anywhere, when necessary, either for radiologists to report on or for doctors to diagnose. As the PACS is a software and is loaded in the server, and there is no separate room for PACS, no particular furniture or set-up is required.

Further Reading Avanttec. CT Scan room layout | CT Scan room layout and design. Avanttec. 2019 [cited 2021 Jun 22]. Available from: http://www.avanttec.net/ct-­scan-­room-­layout/. Block Imaging. 1.5T MRI suite size requirements. [cited 2021 Jun 22]. Available from: https:// info.blockimaging.com/1.5t-­mri-­suite-­size-­requirements. Carestream. Radiology Room Requirements for Medical Imaging. Everything Rad. 2017 [cited 2021 Jun 22]. Available from: https://www.carestream.com/blog/2017/02/14/radiology-­ room-­requirements/.

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CT Machine Site Plan Checklist | Amber Diagnostics. 2021 [cited 2021 Jun 22]. Available from: https://www.amberusa.com/blog/ct-­machine-­site-­plan-­checklist/. CT Scan Room Design Guidelines—CT Scan Machine. CT Scan room design guidelines—CT scan machine. [cited 2021 Jun 22]. Available from: https://ctscanmachines.blogspot.com/2018/11/ ct-­scan-­room-­design-­guidelines.html. Dwiyanto A, Hardiman G, Budi WS. Human safety design space in the CT-scan service unit a case study in an Indonesian public hospital. Int J Sci Technol Res. 2020;9(1):6. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 241–61. Chapter 22, Radiology Hawnaur J. Diagnostic radiology. BMJ. 1999;319(7203):168–71. HealthManagement.org. Radiology Management, ICU Management, Healthcare IT, Cardiology Management, Executive Management. Health Management. [cited 2021 Jun 22]. Available from: https://healthmanagement.org/c/imaging/issuearticle/safety-­factors-­in-­planning-­and-­design-­ of-­the-­imaging-­department. HFM Magazine. Design standards for imaging areas are changing. [cited 2021 Jun 22]. Available from: https://www.hfmmagazine.com/articles/1426-­design-­standards-­for-­imaging-­ areas-­are-­changing. HGA. Designing MRI suites: navigating structural design considerations for success. HGA. 2017 [cited 2021 Jun 22]. Available from: https://hga.com/designing-­mri-­suites-­navigating-­structural-­ design-­considerations-­for-­success/. Imaging Technology News. New trends and technology in radiology. Imaging Technology News. 2012 [cited 2021 Jun 22]. Available from: https://www.itnonline.com/article/ new-­trends-­and-­technology-­radiology. Jha AK, Singh AM, Mithun S, Shah S, Agrawal A, Purandare NC, et al. Designing of high-volume PET/CT facility with optimal reduction of radiation exposure to the staff: implementation and optimization in a tertiary health care facility in India. World J Nucl Med. 2015;14(3):189–96. Malone J. The design of diagnostic medical facilities where ionising radiation is used. Radiological Protection Institute of Irelan; 2009. Niu Y, Xian J, Lei Z, Liu X, Sun Q. Management of infection control and radiological protection in diagnostic radiology examination of COVID-19 cases. Radiat Med Prot. 2020;1(2):75–80. Psm JL. Safety guide for radiation protection in nuclear medicine. Australian Radiation Protection and Nuclear Safety Agency; 2008. p. 111. Skam J, Gloria I, Ibrahim Z, Zira D.  Radiographic room design and layout for radiation protection in some radio-diagnostic facilities in Katsina State, Nigeria. J Radiogr Radiat Sci. 2017;31(1):16–23. Tandon P.  Regulatory requirements for designing PET-CT facility in India. Indian J Nucl Med IJNM Off J Soc Nucl Med India. 2010;25(2):39–43. White MJ, Thornton JS, Hawkes DJ, Hill DLG, Kitchen N, Mancini L, et al. Design, operation, and safety of single-room interventional MRI suites: practical experience from two centers. J Magn Reson Imaging. 2015;41(1):34–43.

9

Clinical Laboratory

Clinical laboratory tests are conducted on clinical specimens in a ‘clinical laboratory’ to learn more about a patient’s health and to help with illness diagnosis, treatment, and prevention. The timeliness and correctness of the pathological investigation report heavily influence the hospital’s efficiency. One of the hospital’s primary investigative services is the clinical laboratory, which should give the clinical services its wholehearted support. It is also known as the ‘lab’ in hospitals. The laboratory offers the tools necessary to use scientific methods in the diagnosis, treatment, and investigation of clinical phenomena related to a disease. To ensure that this department is being utilized to its fullest potential, it should be carefully planned and managed. Pathology laboratory tests are invaluable for confirming and enhancing clinical findings, but a laboratory diagnosis which only addresses a few bodily processes must never take the place of a clinical diagnosis based on an evaluation of the patient as a whole. This set of checklists shall help the planner and designer to remember all such factors relating to the clinical laboratories and guide him/her to complete, test, and commission all works/activities well in time. This will help him/her to ensure himself/herself that all the works/activities are carried out, complete, and working before the investigations begin. Broadly, laboratories are divided into three main branches, i.e. pathology; biochemistry, and microbiology. Further, all these three branches are divided into different sub-branches.

9.1 Sub-branches of Clinical Pathology See Table 9.1. General pathology is performed by specialists in the field and focuses on analysing known clinical abnormalities that are precursors or markers for both infectious © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_9

327

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Table 9.1  Sub-branches of clinical pathology

Activity Have the spaces in the pathology laboratory been provided for: Anatomical pathology Clinical pathology Cytopathology Derma pathology Forensic pathology Hematopathology Histopathology Molecular pathology Neuropathology Oral and maxillofacial pathology Pulmonary pathology Renal pathology Surgical pathology Toxicology

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::::::::::-

and non-infectious diseases. Clinical pathology and anatomical pathology are the two main specializations. There are other specializations based on sample types (such as cytopathology, histopathology, and hematopathology), organs (such as renal pathology), physiological systems (such as oral pathology), and examination focus (such as forensic pathology). Promoters are responsible for determining which pathology branches and sub-­ branches need to be provided at the hospital and how much space is needed for each.

9.2 Sub-branches of Biochemistry See Table 9.2. The study of chemical reactions that take place inside and around living things is known as biochemistry. The sciences of structural biology, enzymology, and metabolism might be considered subfields of biochemistry, a branch of both chemistry and biology. Biochemistry has excelled in explaining life processes through these three disciplines over the past few decades of the twentieth century. Biochemical methods and research are revealing and developing almost all aspects of the biological sciences. Understanding the chemical basis of biological molecules and the interactions between and within live cells is the focus of biochemistry.

9.3  Sub-branches of Microbiology

329

Table 9.2  Sub-branches of biochemistry

Activity Have the spaces in the biochemistry laboratory been provided for: Cell biology Clinical biochemistry Enzymology Genetics Immunology Metabolism Molecular biochemistry

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::::::-

There are many sub-branches of biochemistry, and it is up to the promoters to select which branches and sub-branches should be provided at the hospital and how much space should be allocated as a result.

9.3 Sub-branches of Microbiology See Table 9.3. Bacteriology (the study of bacteria), phycology (the study of algae), mycology (the study of fungi), virology (the study of viruses and how they function inside cells), and parasitology (the study of parasites) are some of the sub-disciplines that make up the field of microbiology. In addition to these main branches, microbiology has numerous sub-branches. It is up to the promoters to select which microbiology branches and sub-branches should be offered in the hospital and how much room will be needed for each.

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Table 9.3  Sub-branches of microbiology

Activity Have the spaces in the microbiology laboratory been provided for: Bacteriology Cellular microbiology Generation microbiology Immunology Microbial cytology Microbial ecology Microbial genetics Microbial physiology Microbial systematics Microbial taxonomy Molecular microbiology Mycology Nano-microbiology Nematology Parasitology Phycology Phylogeny Protozoology Systems microbiology Virology

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::::::::::::::::-

9.4 Location of the Clinical Laboratories The clinical laboratories can be situated anywhere that is practical within the hospital because patients rarely visit the laboratories. However, only a few services, such as specimen collection and report delivery, that are directly related to the patient, shall be provided in the OPD or indoor patient area.

9.5 Layout of the Clinical Laboratory Some of the typical issues described below shall be considered while developing the lab. It is not advised to combine the labs in one location. For instance, the microbiology section of the lab should be in a different room from the pathology section and the biochemistry section of the lab.

9.7 Biosafety

331

If there is not enough room for a clinical lab or if the lab is small, biochemistry and pathology can be merged at most. Microbiology, however, must be kept apart from other laboratories. There shall be collection counters scattered around the wards and outpatient area. To avoid reporting delays, it is preferable to create a separate section for emergency investigations.

9.6 Open-Lab Designs More lab equipment are becoming automated in the modern day, moving away from the traditional bench-working approach. The concept of open-lab designs is favoured since automated systems are small and do not require a lot of manual intervention. What is open lab concept? This is basically an open hall or big room concept, where all the equipment are installed in the same hall. For each branch, pathology, biochemistry, and microbiology, such halls can be built depending on the size of the laboratory and the requirements. Because there are no inner walls in these halls, the layout can be reconfigured as needed. The equipment is installed in these halls in a row or in any other configuration that is required. Obviously, this method allows for the placement of additional equipment and treatment modalities as needed. The power, data, and gas points in these open labs are located overhead rather than through the floor or walls. Wheeled furniture, such as modular cabinets, is preferable. Sinks and floor drains should be installed in areas that are unlikely to change, such as near the walls.

9.7 Biosafety Employee safety is a concern for hospitals these days, as there is a growing concern about infectious diseases as a result of Covid-19, severe acute respiratory syndrome, swine flu, bird flu, Ebola, and Middle East respiratory syndrome outbreaks, as well as a growing concern about bioterrorism. As a result, the concept of BSL-3 labs will be implemented, particularly in sections such as microbiology. BSL-3 shall be carefully planned, taking into account factors like pathogen proliferation. The specimens must be handled safely by using the appropriate partitions. All room penetrations must be sealed, and working surfaces must be made of non-porous materials like stainless steel or hardened epoxy. Plumbing and vacuum lines must be equipped with multiple vacuum breakers. By taking these precautions, the likelihood of a virus spreading and infecting others will be decreased.

9  Clinical Laboratory

332

9.8 Infrastructure 9.8.1 Laboratories’ Area 9.8.1.1 Testing Areas of the Laboratory See Table 9.4. Except for a few characteristics that may vary from laboratory to laboratory, all laboratories (including the subdivisions of these labs) in the fields of biochemistry, microbiology, and pathology share the same design and construction standards. The actual design shall be worked out once the lab’s size has been decided. The following are some of the crucial concerns regarding the design of clinical laboratories: The rules and regulations of the nation’s governing body must be considered when designing laboratory spaces, similar to how the standards for clinical laboratories in India are set by NABL (a laboratory accreditation organization). The benefits of an open-plan laboratory design have been explained above. The open design is the best, there can be no doubt about it. However, it is advised that a Table 9.4  Testing areas of the laboratories

Activity Separate halls for each lab as far as possible Microbiology shall be separate from other labs Concept of BSL-3 labs to be adopted Proper partitions for handling the specimens safely Multiple vacuum breakers shall be fitted on plumbing and vacuum lines Space requirement for each laboratory Actual space for carrying out tests Flooring of tiles or granite (no marble) shall be jointless Hardened epoxy-coated or protected walls Seal all the penetrations of the room

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::-

::-

:-

:::-

::-

9.8 Infrastructure

333

close sort of laboratory be established for some specific divisions that deal with contagious or dangerous studies. This means that both open-type and closed-type laboratories shall be taken into consideration while designing the lab. Planning must take into account the need for different rooms if there is a need for a specific division of the laboratories. The spaces needed for personnel movement and the placement of equipment shall be considered while designing the laboratories. Some of the equipment manufacturers may prefer a separate enclosure for automated and complex machines, even if the equipment is located in an open hall, to ensure a dust-free environment. In such cases, glass or aluminium walls/partitions can be built. Regardless of the hall’s size, the laboratory shall have adequate areas for preparing and conducting testing. There shall be plenty of room for placing equipment and moving people and materials. While designing the laboratory’s workspace, the potential for expansion shall also be taken into consideration. The walls of the laboratory room must be at least 230 mm thick and plastered on both sides. The wall must be adequately painted with antibacterial, washable epoxy paint. No organism or microorganism shall pass from inside to outside or vice versa, so all openings and penetrations from the outside must be adequately sealed. Flooring: Non-porous and stain-resistant flooring shall be provided. It is recommended to use large floor tiles, such as those measuring 600 mm × 600 mm. The only stipulation is that there shall be no gaps between the tiles, implying that the tiles have fewer joints. As an alternative, granite can be used because it is a hard stone. Marble is not recommended because it is fragile, porous, and easily discoloured. Some designers prefer hot-welded vinyl flooring or epoxy-coated concrete slabs, for example. The drawback of these flooring options is that if chemicals and contaminated water infiltrate underneath the vinyl flooring, the entire floor may eventually get ruined and fall out. Doors: Each laboratory should ideally have a single door with a width of around 1829 mm so that personnel and materials can be moved with ease and equipment can be transported in and out of the lab. The laboratory doors shall automatically close. Following the building’s design and elevation, windows can be installed in the lab.

9.8.1.2 Specimen Receiving Room/Space in the Lab See Table 9.5. In addition to the working areas, a separate enclosure shall be provided for the collection of the specimens that have been withdrawn from the OPD and IPD before being sent to the lab for testing. The area shall contain a functional counter as well as arrangements for sample storage and sorting. There shall be two windows in this collection area. One window shall open outside the lab from where samples can be received, and the other shall open within the lab from where samples can be

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Table 9.5  Specimen receiving room/space in the laboratories

Activity Working slabs Spaces for storing the samples Spaces for segregation of the samples Window opening in the space outside the laboratory to receive samples Window opening inside the laboratory to deliver received samples for testing

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::-

:-

Table 9.6  Report preparation room/space in the laboratories

Activity The room shall be connected to the laboratory working space Connectivity to the machines

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:-

:-

delivered inside the lab for testing. The room should be roughly 3658 mm × 3658 mm in size. However, depending on the requirement, the size may be increased or decreased.

9.8.1.3 Report Preparation Room/Space See Table 9.6. Attached to the laboratory shall be the report preparation room. This room is used to prepare and print the final reports of the investigations performed in the laboratory. The room shall have provision for the setting of at least two clerks. If more clerks are required to sit in the room, the size of the room may be increased. This room shall be connected to the report dispatch area through the common window between the two. The room should be roughly 3658 mm × 3658 mm in size. However, depending on the requirement, the size may be increased or decreased. 9.8.1.4 Report Dispatch Room/Space See Table 9.7. Finally, there is the report dispatch room. A separate room or space in the laboratory shall be provided to dispatch the reports to the appropriate locations. The report

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9.8 Infrastructure Table 9.7  Report dispatch room/space in the laboratories

Activity The room shall be connected to the report preparation room A window between the report preparation room and report dispatch room

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

Table 9.8  Storeroom for glassware, chemicals, and reagents in the laboratories

Activity Provide separate room Single door No windows

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::-

dispatch room shall ideally be connected to the report preparation room for easy movement of printed reports. A window can be provided between the report preparation room and the dispatch room. The room shall be approximately 3658 mm × 3658 mm in size. However, depending on the situation, the size can be increased or decreased.

9.8.1.5 Storeroom for Glassware, Chemicals, and Reagents See Table 9.8. Each laboratory shall have a store for the storage of glassware, chemicals, unused reagents, and consumables. To be ready for around-the-clock investigations, laboratories shall always have an adequate supply of consumables on hand, such as glassware, kits, chemicals, and reagents. The dimensions of this store shall be 3658  mm  ×  3658  mm, but they may vary depending on the number of items to be stored. The room shall not have any windows or other direct sunlight sources. 9.8.1.6 Equipment Park/Store See Table 9.9. Generally, in laboratories, there can be equipment which is not always in use but has to be ready all the time to be used whenever required. Hence, storage of this equipment shall be done at a separate place in the laboratories so that the floor space of the laboratory is not unnecessarily occupied with this equipment. Therefore, the equipment storage room/area is provided in the laboratories.

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Table 9.9  Equipment park/store in the laboratories

Activity Separate room or open space Single door No windows

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::-

Table 9.10  Clean utility in the laboratories

Activity Separate room Single door

Start date

End date

Status of works In Complete progress

Not started

Responsible person

Remarks

::-

Normally, a room of size not less than 4267 mm × 4267 mm shall be provided attached to each laboratory. This area can be a closed room with a door or an otherwise open area attached to a laboratory.

9.8.1.7 Clean Utility See Table 9.10. The clean utility is a room attached to laboratories that are used for clean material storage. This room also houses sterile materials such as drums and drapes. Normally, the room shall not be smaller than 3658 mm × 3658 mm, but this can be increased depending on the requirement. This room shall have only one 914 mm door. 9.8.1.8 Emergency Eyewash Station See Table 9.11. Workers in the laboratory are exposed to a variety of hazardous fluids and chemicals. Despite universal precautions, chemical/body fluid splashes can occur. Therefore, each laboratory shall have an eyewash station in a suitable location.

9.8.2 Support Services See Table 9.12. Bulk storage room: This storage facility is required for the storage of laboratory chemicals, reagents, kits, consumables, glassware, and disposables that are received in bulk quantity. In general, one such store shall be provided for all labs combined. However, if the amount of material to be stored is greater, each laboratory can have its store. The room’s dimensions shall be 4572 mm × 4572 mm. The room’s size can also be increased or decreased as needed.

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9.8 Infrastructure Table 9.11  Emergency eyewash station in the laboratories

Activity Eyewash station (may be closed room) If room, single door shall be provided

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

Responsible person

Remarks

:-

:-

Table 9.12  Support services in the laboratories

Activity Bulk storage room Autoclave room Cold storage room Flammable storage room Biohazard/trash/ recycle room Gas storage closet RO water closet Record/file/copy room Penta head/deca head microscope room Block and slide storage Specimen storage/ recycle room

Status of works Start End In Not date date Complete progress started :::::::::-

::-

Autoclave: The microbiology lab shall feature an autoclave area where researchers can prepare media and sterilize lab glassware. The microbiology lab shall be fairly close to this room. The size of the space shall be 3658 mm by 3658 mm. Cold storage room: Because some laboratory reagents or kits are temperature sensitive, they cannot be stored at room temperature. As a result, a cold room might be necessary. All laboratories could use this cold room. It is also referred to as the refrigerated room. The room’s dimensions shall be 3048 mm × 3048 mm. The walls and ceiling of the room shall be made of puff panels, which will act as a thermal barrier. The room shall be air-conditioned, with a temperature range of 5–12 °C that can be adjusted as needed. Typically, the flooring shall be made of wood planks. The room’s door shall be lockable and no less than 1200 mm in width. The door shall also be hermetically sealed and made of a puff panel.

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Flammable storage: This room is for storing flammable and hazardous materials like acids, spirits, and alcohol. The room shall be separated from the general movement area. The room’s dimensions shall be 3658 mm × 3658 mm, with glazed acid-proof tiles on the walls and flooring. Biohazard/trash/recycle room: The biohazard/trash/recycle room is connected to the laboratories and is where soiled material is stored. The room shall not be smaller than 3658 mm × 3658 mm. However, the size of the room can be adjusted to meet your needs. The room shall have two 914 mm doors in this room. One door shall open in the laboratory and another in the corridor, from which the staff can collect the material without having to enter the laboratory. Gas storage closet: Cooking gas is required for burners in the majority of laboratories. It is preferable to supply the gas via pipelines rather than keeping gas cylinders at each point. As a result, to install the manifold, a small gas manifold room in a convenient location in the laboratories shall be provided. This area shall be open to the sky and not enclosed. RO water closet: RO water is required for the operation of some machines, such as the auto biochemistry analyser. Other machines may also require it. As a result, a separate closet in the laboratories area is required, where an RO plant can be installed and water supplied to the machinery via pipelines. The room’s dimensions shall be 3658 mm × 3658 mm. However, the size may be increased or decreased depending on the size of the RO plant. Record/file/copy room: This store, among other things, stores files, records, stationery, requisition sheets, etc. This storage facility could be used by all laboratories. However, if more such space is required, each laboratory may be given its store. The dimensions of the room shall be 3658 mm × 3658 mm. The room shall have no windows, no water outlets, and no moisture. Penta head/deca head microscope room: This room is required in teaching institutes or hospitals where more than one person examines the same slide. The penta head microscope has five different binocular outlets that are linked together by a pipe with prisms and a mirror in between. Each head is fixed on the common platform, which holds the object. The deca head microscope has ten of these outlets. Both microscopes shall be housed in separate rooms. The space shall be square. The size of the room shall be decided based on the dimensions of the microscope and as recommended by the manufacturer of the microscope. Block and slide storage: This room is used to store blocks and slides that have been prepared for processing and investigation. These blocks and slides, like specimens, are stored for a few days because a repeat test may be required at times. Adequate arrangements shall be made for the temperature and humidity of the environment. The size of the room shall be determined by the number of samples that have to be stored. In general, a room of 4267 mm × 3658 mm in size should suffice. Specimen storage/recycle: This room is used for storing specimens collected from patients. Normally, the specimens are kept for a few days because a repeat test may be required. The specimens can be blood, urine, stool, body fluids, sperm, and any other specimens. Each specimen may require different environment and storage

339

9.8 Infrastructure Table 9.13  Utility area in the laboratories

Activity Doctors’ room Laboratory manager Technicians’ room

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::-

methods. The size of the room shall be determined by the number of samples that have to be stored. In general, a room of 4267 mm × 3658 mm in size should suffice.

9.8.3 Utility Area See Table 9.13.

9.8.3.1 Doctors’ Room Pathologists, biochemists, and microbiologists, as well as other doctors, work in this room to carry out the laboratories’ official work. The dimensions of this room shall be 4572 mm × 4267 mm. A toilet shall be provided in this room. The room can also have a PA room attached to it. 9.8.3.2 Laboratory Manager This room is for the laboratory manager and shall be located on the laboratory premises. This room’s dimensions shall be 4572 mm × 4267 mm. A toilet shall be attached to this room. The room can also have a PA room attached to it. If necessary and long working hours are anticipated, a small restroom can also be provided with this room. 9.8.3.3 Technicians’ Room This room is used by the technicians who work in the laboratories to carry out their official duties. This room’s dimensions shall be 4572 mm × 4267 mm.

9.8.4 Outpatient Phlebotomy See Table 9.14. Outpatient phlebotomy: The collection of patient specimens for examination is known as phlebotomy. Typically, specimens are collected in hospital settings such as the OPD, emergency department, ICU, IPD, and OR, among others. In the case of indoor specimens, the samples are collected at a specific time.

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Table 9.14  Outpatient phlebotomy

Activity Phlebotomy room Fine needle procedure room Toilet room Waiting area

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

Single or multiple phlebotomy rooms are typically provided in a convenient location within the OPD complex. The dimensions of the room shall be 4572 mm × 4267 mm. The phlebotomy room shall be a standard room with a working top and sinks. The sample collection room/space, which is attached to the phlebotomy room, shall be provided where the patient is seated or laid down and the specimens are drawn. This area shall approximately be 2438 mm × 2438 mm in size. Fine needle aspiration room: This room is provided to be used for drawing specimens using fine needle aspiration. It is also known as the biopsy sample room. Typically, one such room is provided in a convenient location within the OPD complex. The room’s dimensions shall be 4572 mm × 4267 mm. It is a type of intervention because the specimen is collected with a fine needle. As a result, the environment in the room shall be sterile. A changing room for the patient and staff shall be attached to this room. A small storeroom attached to the room shall also be provided to keep sufficient stock of needles, vacutainer tubes, holders, and so on. Toilets: Some specimens, such as urine, stool, and sperm, must be collected in the toilet. Hence, a toilet adjacent to the phlebotomy room shall be provided. Separate toilets for men and women shall be provided, if possible. The toilet shall have a shelf with raised edges so that the patient can keep the sample while preparing to exit the toilet. Waiting area: A waiting area near the phlebotomy room shall be provided for the patients to wait till their turn comes to give the specimens.

9.8.5 Employee Support See Table 9.15. Staff lounge: The lounge in the laboratory area is provided for the staff to sit and relax in their spare time. Shower with water closet: Because laboratory personnel are more susceptible to infection as a result of chemical and reagent spillage, a shower facility shall be provided in the laboratories. As a result, the staff area shall include a shower room with a water closet for each gender of staff. If possible, provide a shower with water closet rooms separately for males and females.

341

9.9  Services, Facilities, Equipment, Tools, and Instruments Table 9.15  Employee support in the laboratories

Activity Staff lounge Female shower with water closet Male shower with water closet Unisex toilet

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

9.9 Services, Facilities, Equipment, Tools, and Instruments 9.9.1 Laboratories See Table 9.16. The lighting in the space shall be standard LED lights with a sufficient lumen output. The room does not require any additional lighting. Every machine shall have adequate grounding and earthing provisions. Working slabs: The importance of working slabs for effective laboratory work cannot be overstated. These work surfaces are used to set up small tabletop equipment, prepare chemicals and reagents, prepare slides or blocks, and so on. It implies that the working slabs can be used for a variety of purposes. If the open type is being designed, working slabs shall be provided alongside the laboratory walls. The top level of the working slab shall be typically 914–965 mm above ground level. The width of the slab shall be around 762 mm, but this can vary depending on the requirements. Granite stone with full-round or half-round edges can be affixed to the top surface of the slab. The vertical stone, like the horizontal stone, shall be attached to the wall starting at the top of the slab. The height of this vertical stone shall be between 305 and 610 mm. This vertical stone protects the wall from damage and stains. A platform must be constructed on the floor beneath the working slab. The platform must have a thickness of roughly 183 mm. Tiles or stone shall be affixed to the upper surface and the platform’s entire thickness. There will now be a space between the platform’s upper surface and the slab’s bottom surface. Cabinets shall be provided for this area. More than any other area, these cabinets are the most frequently used. Reagents, chemicals, consumables, office supplies, and other items can all be stored in these cabinets. For greater storage space and the material’s security, even some shelves and drawers can be given in the cabinets. Sinks: A sink for cleaning must be present in every laboratory. Hand-to-mouth transmission can expose people to potentially harmful substances and/or pathogenic organisms. The importance of washing hands before leaving the lab cannot be neglected. Consequently, the sink ought to be placed close to the egress.

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Table 9.16 Laboratories

Activity LED light fittings shall be provided Provision for grounding and earthing Sufficient working slabs with the top surface of granite stone Vertical stone on the wall above the top of the slab Cabinets under the working slabs Working slab sinks at appropriate places Proper air conditioning

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::-

:-

:-

:::-

Sinks shall be strategically placed on the working slab itself. A deep laboratory sink, approximately 610 mm long × 457 mm wide, shall be provided. China clay shall be used for the sink because metal sinks are not recommended for laboratories. The sink shall be recessed on the working slab. The drain of the sink shall be located on the floor platform, and the tap must be located 305 mm above the sink level. The sink shall have collars to prevent spills, and sink collars or brims shall be a minimum of 6 mm wide to keep the lab bench completely free of the sink drain. Air conditioning system of laboratories: All laboratories shall have complete climate control, including temperature, humidity, and air exchanges. At all times, the air quality shall be adequate and secure. Chiller water pipelines with AHUs, ductable split systems, and VRV systems are all practical choices for air conditioning. Every lab needs its own individual return air system. Never mix the return air from one laboratory with the return air from another. The temperature in the room shall be between 18 and 22 °C, with a humidity level no higher than 40%. It is critical to confirm the environmental requirements from the equipment manufacturer before deciding on the RH level or temperature because different machines may have different environmental requirements.

9.9.1.1 Furniture in the Laboratories See Table 9.17. The laboratories do not have much furniture. The laboratories only have a few office tables, chairs, and laboratory stools, among other things. All work surfaces (such as benchtops and counters) must be chemically resistant.

343

9.9  Services, Facilities, Equipment, Tools, and Instruments Table 9.17  Furniture in the laboratories

Activity Office tables Office chairs High-raised stools Normal laboratory stools

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

9.9.1.2 Main Equipment in the Clinical Laboratories See Table 9.18. The laboratories shall have the following medical equipment: 9.9.1.3 Electrical Points in Laboratories Because most laboratory equipment are electric powered, and because the equipment is dispersed throughout the laboratory, electrical points shall be carefully designed. The following electrical outlets shall be provided in the laboratory: 1. The main switchboard, which will control the hall’s fans and lights, shall be located at the entrance wall, along with one or more 6 Amp switch/sockets. 2. Air conditioning control button with temperature adjustment. 3. At least two 6/16 Amp switches/sockets shall be installed on the wall above the working slab. Such points shall be provided in series at 3048 mm intervals. The UPS should be connected to half of these. 4. 5 Amp switch/sockets shall be provided at the appropriate location for refrigerators and deep freezers. 5. A power supply shall be provided because the equipment will be dispersed throughout the laboratory hall. First and foremost, the power requirement specification and machine dimensions shall be obtained from the manufacturer of the machine. The location for the machine’s installation shall then be determined. The necessary power supply shall be provided through the floor. For this, the floor shall be chased, and conduit shall be installed in the chase. The wiring will then be completed, and the power shall be turned on. These outlets shall be powered by a UPS. Power can also be supplied from the ceiling using a suspended conduit. 6. Microscopes may also necessitate the use of a power supply on the office table. This can also be obtained through the floor supply.

9.9.1.4 Other Communication Points in Laboratories Nowadays, most laboratory equipment include communication ports for interfacing with hospital management software, allowing reports to be generated and machine identification via barcoding. Wireless connectivity may or may not be available on

9  Clinical Laboratory

344 Table 9.18  Main equipment in the clinical laboratories Pathology Automated platelet counting Binocular research microscope Cell counter, normal and abnormal Cell-freezing apparatus and reagents Chromatography Chromatography (GAS), clinical use Chromatography for bacterial identification Chromatography, ion exchange Chromatography, thin layer, methadone Clinitek status analyser Coagulation, automated Column supports, gas-liquid chromatography Columns, liquid chromatography Counter, automated cell Cytocentrifuge Cytospin Enzyme immunoassay Fibrometer Glassware Haematology analyser Haemoglobinometer Microbiology Automated clinical immunodiagnostic systems Bact alert system Bio-safety cabinet BOD incubator BSL-3 CD4 counter Cell cultures for isolation of viruses Deep freezer Elisa reader with washer Gene expert High-performance liquid chromatography (HPLC) Immunofluorescent microscope Biochemistry Automated clinical chemistry systems Automated urinalysis system Bichromatic photometric analyser Carbon dioxide analyser Card Reader Nyco II Chemistry (photometric, discrete) analyser

Laminar airflow horizontal Lamps, slide warming Mass spectrometer Micrometres, microscope Microscope fluorescence/UV Microscope inverted stage, tissue culture Microscope phase contrast Microtome Multipurpose system in vitro coagulation studies Platelet aggregation automated system Platelet aggregometer Processor, tissue automated Radioimmunoassay Rotary microtome Slide stainer, immersion type Spectrophotometer digital Stereoscopic microscopes Suspension system, cell culture Trinocular microscope with phase-contrast attachment Turbidity meter Vacuum oven Laminar airflow LIPA (line probe assays) MGIT 960 Microscope fluorescence/UV QBC microscope (malaria) Refrigerated centrifuge RT-PCR TB culture Bact/alert 3D Thermocycler Ultracentrifuge Vitek Vitek 2 Compact 60 Gamma counter Gas, oxygen analyser Glassware Microscope fluorescence/UV Monochromator Nephelometer

9.9  Services, Facilities, Equipment, Tools, and Instruments

345

Table 9.18 (continued) Chemistry (sequential multiple, continuous flow) analyser Chemistry, micro-analyser Colorimeter, photometer, spectrophotometer Densitometric, protein fractionation Freezer Fully auto analyser (immunoassay)

Osmometers Pipetting station Plasma viscometer Radioimmunoassay Refractometer Semi-auto analyser

Table 9.19  Specimen receiving room/space in the laboratories

Activity Working slabs Spaces for storing the samples Spaces for segregation of the samples Window opening in the space outside the laboratory to receive samples Window opening inside the laboratory to deliver received samples for testing

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::-

:-

some of these machines. If the machine does not have wireless connectivity, it shall be provided with a networking cable. As was done with the electrical wiring, these communication cables can also be provided through the floor. The network cable can also be supplied from the ceiling via the suspended conduit. The following communication points shall be provided: 1. RJ 45 points for computer networking 2. RJ 11 for intercom and extension line

9.9.1.5 Specimen Receiving Room/Space in the Lab See Table 9.19. There shall be two windows in this sample receiving room/space in the laboratory. One window shall open outside the lab from where samples can be received, and the other shall open within the lab from where samples can be delivered inside the lab for testing. The room shall have sufficient working tops to store, sort, or segregate the samples till they are sent to the lab for investigations. The electrical points shall be provided on the wall above the working top to supply power to the equipment like shaker.

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Table 9.20  Report preparation room in the laboratories

Activity Office table Office chair Side rack for doctor Computers with UPS Printers and scanners Barcode scanner Networking connected to the server of the hospital Required electrical points Required communication ports

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:::::::-

::-

9.9.1.6 Report Preparation Room See Table 9.20. The report preparation room shall have office tables, chairs, and side racks for the staff. The room shall be provided with a computer with UPS, printers, scanners, and barcode scanners. The computers shall be networked to the hospital’s server to retrieve data from the automated laboratory equipment. All necessary electrical points shall be provided to connect computers and other appliances to the power supply. The required communication ports shall be provided for system communication. 9.9.1.7 Reports Dispatch Room See Table 9.21. The report dispatch room shall have office tables, chairs, and side racks for the staff. The room shall have pre-numbered bins where reports can be kept number-wise for easy delivery to the patient. A lockable cabinet with bins might be a better option. Provide a computer with UPS, printers, scanners, and barcode scanners. If it is customary to send the report to the patient via digital media, the computers shall be networked to the hospital’s server and the appropriate digital media software installed. All necessary electrical points shall be provided to connect computers and other appliances to the power supply. The required communication ports shall be provided for system communication.

9.9  Services, Facilities, Equipment, Tools, and Instruments

347

Table 9.21  Report dispatch room in the laboratories

Activity Office table Office chair Side rack for doctor Computers with UPS Printers and scanners Barcode scanner Networking connected to the server of the hospital Required electrical points Required communication ports

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:::::::-

::-

Table 9.22  Storeroom for glassware, chemicals, and reagents in the laboratories

Activity Racks Cabinets Drawers Lockable cabinets Air conditioning

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::-

9.9.1.8 Storeroom for Glassware, Chemicals, and Reagents See Table 9.22. Storeroom for glassware, chemicals, unused reagents, and consumables shall be provided with sufficient numbers of racks, cabinets, and cupboards. The drawers shall also be provided for the small items. To store the costly items safely, a lockable cabinet shall also be provided in the room. The store shall be adequately air-conditioned, and the temperature shall be between 17 and 9 °C. 9.9.1.9 Equipment Park/Store See Table 9.23. The equipment store shall be a closed room. The room shall have working slabs to place the small equipment and clear floor space to store large equipment. Besides

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Table 9.23  Equipment park/store in the laboratories

Activity Racks Cabinets Working top Ground earthing Required electrical outlets for charging equipment

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

Table 9.24  Clean utility in the laboratories

Activity Racks Cabinets Drawers Working top

Start date

End date

Status of works In Complete progress

Not started

Responsible person

Remarks

::::-

this, cupboards and racks shall also be provided. The room shall have a sufficient number of electrical charging points duly grounded for medical equipment charging that are not frequently used and are stored here.

9.9.1.10 Clean Utility See Table 9.24. The clean utility shall be provided with sufficient numbers of closed cabinets, drawers, and racks in the room. 9.9.1.11 Emergency Eyewash Station See Table 9.25. The eyewash station shall be provided with the eyewash system. To operate the system, an electrical point shall be provided near the station. Also, the provision shall be made to supply hot and cold water. A proper drain point shall also be provided.

9.9.2 Support Services 9.9.2.1 Bulk Storage Room See Table 9.26. The store shall have enough lockable cupboards, racks, and drawers. If necessary, the store shall also include a countertop for preparing reagents.

349

9.9  Services, Facilities, Equipment, Tools, and Instruments Table 9.25  Emergency eyewash station in the laboratories

Activity Eyewash station shower system Electrical point to supply power to the station Hot and cold water supply Drainage

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

::-

::-

Table 9.26  Bulk storage room in the laboratories

Activity Adequate lockable cupboards Racks Drawers Countertop for reagent preparation

Start date

End date

Status of works In Not Complete progress started

::::-

Table 9.27  Autoclave room in the laboratories

Activity Hot-air oven/quick steam sterilizer Soft water plant Exhaust and air exchange arrangements Necessary electrical outlets for connecting the machines Sink/water tap for water supply Water drain point

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::-

:-

::-

9.9.2.2 Autoclave Room See Table 9.27. A quick steam sterilizer and a hot-air oven are required in the room. The room shall have a sufficient supply of soft water to be used in the sterilizer as well as the necessary drain.

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The room shall have adequate exhaust and air exchange arrangements. A sink for hand washing, as well as a drainage system, shall be provided. The room shall have the necessary electrical outlets to connect the machines.

9.9.2.3 Cold Storage Room See Table 9.28. The room’s walls and ceiling shall be made of puff panel, which acts as a thermal barrier. The room is air-conditioned, and the temperature shall be between 5 and 12 °C, adjustable as needed. Wooden planks shall be used for the flooring. The room’s door shall be lockable and no less than 1200 mm wide. It shall also be made of a puff panel and hermetically sealed. Open racks made of stainless steel shall be provided along the room’s walls for storage. 9.9.2.4 Flammable Storage See Table 9.29. This room is used to store flammable and hazardous materials such as acids, spirits, and alcohol. The room’s walls must be made of glazed acid-resistant tiles. In the room, only one electric light point shall be provided. The racks shall be made of metal, preferably stainless steel, and shall not be made of wood. Table 9.28  Cold storage room in the laboratories Status of works Start End In Not date date Complete progress started

Activity Air conditioning room with temperature between 5 and 12 °C Wooden flooring Stainless steel open racks

Responsible person Remarks

:-

::-

Table 9.29  Flammable storage in the laboratories

Activity Glazed acid-proof tiles on the floor and walls Racks made out of metal and not wood Single electrical point

Status of works Start End In Not date date Complete progress started :-

::-

Responsible person

Remarks

351

9.9  Services, Facilities, Equipment, Tools, and Instruments

9.9.2.5 Biohazard/Trash/Recycle Room See Table 9.30. Dirty utility shall be provided with waste bins to dispose of the waste following biomedical waste management regulations. Biomedical waste shall be given special consideration. The room shall also include a hamper with a lid to collect soiled linen that has to be sent to the laundry for washing. Exhaust fans are required because the air in this space shall be evacuated. 9.9.2.6 Gas Storage Closet See Table 9.31. The manifold shall be capable of holding 2–5 cylinders at once. A copper pipeline is laid down from the manifold to the burner, with a ball valve at the end. A rubber pipe connects the burner to this manifold outlet. Table 9.30  Biohazard/trash/recycle room in the laboratories

Activity Two doors are to be provided Waste bin as per the norms of biomedical waste rules Covered containers or linen collection hampers Exhaust fans to exhaust the contaminated air

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

::-

:-

:-

Table 9.31  Gas storage closet in the laboratories

Activity Gas manifold outside the building Copper pipeline from the manifold to the burner Ball valve near the burner Connecting burner with a rubber pipe

Status of works Start End In Not date date Complete progress started ::-

::-

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9.9.2.7 RO Water Closet See Table 9.32. The first step is to determine the capacity of the RO plant, which has to be determined by the amount of water required. Accordingly, the RO plant shall be installed in a convenient location in the laboratory. The electrical point shall be located near the RO plant. For storage of the treated water, a storage tank (with a pump, if necessary) shall be installed near the plant. We recommend that this tank be a double-layered stainless steel tank. The booster pump can also be installed on the tank, if necessary. The water supply line from the source to the RO plant shall be laid down. Similarly, the pipeline from the RO plant to the storage tank shall be laid and connected. A line from the storage tank shall be laid down to supply the RO water to the required location. 9.9.2.8 Record/File/Copy Room See Table 9.33. Table 9.32  RO water closet in the laboratories Status of works Start End In Not date date Complete progress started

Activity Proper electrical points Supply line for water to the plant Tank for storing treated water Required pipeline for connections Required electrical point for RO plant

Responsible person

Remarks

Responsible person

Remarks

:::::-

Table 9.33  Record/file/copy room in the laboratories

Activity Adequate lockable cupboards Racks Drawers Cupboards Cabinets Required electric points

Start date :-

:::::-

End date

Status of works In Not Complete progress started

353

9.9  Services, Facilities, Equipment, Tools, and Instruments

The storeroom shall have racks, drawers, cabinets, and cupboards to store records, files, requisition sheets, and stationery, among other things. There shall be no windows, no water outlets, and no moisture in the room. The room shall have an electrical outlet.

9.9.2.9 Penta Head/Deca Head Microscope Room See Table 9.34. A table large enough to accommodate the microscope shall be placed in the centre of the room. Laboratory stools shall be placed in front of the outlet on all five or ten eyepieces, as the case may be so that they can sit and use the microscope. On the table where the microscope is placed, proper electric points shall be provided. 9.9.2.10 Block and Slide Storage Room See Table 9.35. This room shall be equipped with adequate temperature and humidity controls. The room shall have adequate block storage cabinets for the storage of blocks. Similarly, slide storage cabinets shall be provided in the room for slide storage. The room shall have adequate working surfaces and sinks. Table 9.34  Penta head/deca head microscope room in the laboratories

Activity A big table in the centre of the room Sufficient laboratory stools Proper electric points

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::-

Table 9.35  Block and slide storage room in the laboratories

Activity Slide storage cabinets Block storage cabinets Proper bins Racks Cabinets

Start date :::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

354

9  Clinical Laboratory

9.9.2.11 Specimen Storage/Recycle Room See Table 9.36. This room shall have adequate refrigeration and humidity controls. Similarly, appropriate racks, bins, or cabinets shall be provided in the room for specimen storage. It is preferable to use pre-numbered bins for storage. Each bin shall have a place to insert the slip with the sample number, patient ID, and patient name, among other things. The room shall also have a working surface and sinks.

9.9.3 Utility Area 9.9.3.1 Doctors’ Room See Table 9.37. The room shall have an office table, office chairs, and visitors’ chairs. For smooth operation, cabinets, drawers, and racks shall be adequately provided. The room shall also have adequate electrical outlets, an intercom connection, an IT network, CCTV surveillance, and air conditioning. Table 9.36  Specimen storage/recycle room in the laboratories

Activity Proper bins Racks Cabinets Working top with sinks

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

Table 9.37  Doctors’ room in the laboratories

Activity Doctors’ table Doctors’ chair Two attendants’ chairs Side rack for doctor CCTV camera Required electrical points Required communication ports

Status of works Start End In Not date date Complete progress started :::::::-

Responsible person

Remarks

355

9.9  Services, Facilities, Equipment, Tools, and Instruments

9.9.3.2 Laboratory Manager Room See Table 9.38. The room shall have an office table, office chairs, and visitors’ chairs. For smooth operation, cabinets, drawers, and racks shall be adequately provided. The room shall also have adequate electrical outlets, an intercom connection, an IT network, CCTV surveillance, and air conditioning. 9.9.3.3 Technicians’ Room See Table 9.39. The room shall have an office table, office chairs, and visitors’ chairs. For smooth operation, cabinets, drawers, and racks shall be adequately provided. The room shall also have adequate electrical outlets, an intercom connection, an IT network, CCTV surveillance, and air conditioning.

Table 9.38  Laboratory manager room in the laboratories

Activity Office table Office chair Two attendants’ chairs CCTV camera Required electrical points Required communication ports

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

::::::-

Table 9.39  Technicians’ room in the laboratories

Activity Office table Office chair Two attendants’ chairs CCTV camera Required electrical points Required communication ports

Status of works Start End In Not date date Complete progress started ::::::-

9  Clinical Laboratory

356

9.9.4 OPD Phlebotomy Room See Table 9.40. One phlebotomy chair and one examination couch are required in the phlebotomy room/space. To handle any type of emergency, provide the crash cart duly filled up with emergency medicines, consumables, and disposables. There shall be a working surface top with a sink for storing the drawn specimens. For the patient’s privacy, the couch shall be provided with a curtain partition. The specimen collection room shall keep sufficient stock of needles, vacutainer tubes, holders, and so on. Hence, proper cupboards, shelves, and racks shall be provided. On the working surface top, there shall be enough electrical outlets. The provision of a refrigerator shall be considered. To complete the work such as barcode fixing and consent taking, an office table, chairs, computer with printer, and barcode printer shall be provided. The PTS outlet point shall be provided in the phlebotomy room so that the specimens and requisition forms can be sent to the laboratories as soon as possible. Table 9.40  OPD phlebotomy room

Activity Phlebotomy chair Examination couch Crash cart with emergency medicines Working top with the sink Curtain partition Cupboards, shelves, and racks Sufficient electrical points Refrigerator Outlet point of the PTS Office table Chairs Computer with printer and barcode printer

Status of works Start End In Not date date Complete progress started :::-

:::::::::-

Responsible person

Remarks

357

9.9  Services, Facilities, Equipment, Tools, and Instruments Table 9.41  Fine needle aspiration room

Activity Scrub station Shoe rack Examination table Hanging curtain partitions Crash cart containing emergency medicines Small storeroom

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

:-

9.9.4.1 Fine Needle Aspiration Room See Table 9.41. Outside the room, a scrub station shall be provided. Outside the room, a shoe rack shall be provided. The examination table shall be covered with hanging curtain partitions inside the room. Because this is an intervention procedure, the crash cart and emergency medications must be kept in the room. A small storeroom attached to the room shall also be provided to keep sufficient stock of needles, vacutainer tubes, holders, and so on. 9.9.4.2 Waiting Area Near Phlebotomy Room See Table 9.42. The waiting area shall be equipped with sofa sets or chairs/recliners so that family members can sit comfortably. A toilet block shall be attached to the waiting area. Toilets shall ideally be separate for men and women. Along with this, a drinking water facility shall be provided. Water coolers or water drinking fountains can be provided for water supply. This area shall have a speaker connected to the mike system installed in the waiting room for listening to the phlebotomist’s announcements. Try offering Wi-Fi and internet access. The waiting area shall also have mobile charging stations near the seating areas. This area shall be guarded by security to prevent unnecessary movement of family members in the laboratory and shall be monitored by CCTV.

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Table 9.42  Waiting area near phlebotomy room Status of works Start End In Not date date Complete progress started

Activity Security features like CCTV Announcement systems Waiting chairs/sofa set Signage and wayfinding system Interactive displays Mobile charging points Free internet or Wi-Fi facility Handrails at the staircase and other areas Required electrical outlets Other communication points

Responsible person

Remarks

Responsible person

Remarks

::::::::-

::-

Table 9.43  Staff lounge in the laboratories

Activity Attached toilet Chairs Resting bed if required Provision of tea/ coffee Staff lockers (separate for each worker)

start date

End date

Status of works In Not Complete progress started

:::::-

9.9.5 Employee Support 9.9.5.1 Staff Lounge See Table 9.43. A few chairs and centre tables shall be provided in the staff lounge. On request, a single bed can be placed in the lounge for staff to rest for a while. Tea/coffee shall be available in the restrooms, either from the pantry or by providing a vending machine.

359

Further Reading Table 9.44  Shower with water closet in the laboratories

Activity Bathroom with the provision of a shower Water closet Soap dispenser Towel hanger

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

:::-

Lockers shall be provided in the staff area to allow employees to keep their personal belongings secure and under lock and key. Each member of staff shall have a separate locker.

9.9.5.2 Shower with Water Closet See Table 9.44. The staff area shall include a shower room with a water closet separately for both male and female employees. The room shall be equipped with a shower and hot water supply. Soap dispensers and towel hangers shall also be provided.

Further Reading Aulbach A, Provencher A, Tripathi N. Influence of study design variables on clinical pathology data. Toxicol Pathol. 2017;45(2):288–95. Blanckaert N. Clinical pathology services: remapping our strategic itinerary. Clin Chem Lab Med. 2010;48(7):919–25. Clinical Lab Manager. Emerging Practices in Clinical Laboratory Design [Internet]. Clinical Lab Manager. [cited 2021 Jun 28]. Available from: https://www.clinicallabmanager.com/features/ emerging-­practices-­in-­clinical-­laboratory-­design-­341. Dark Daily. Technological Revolution in Hospital Design and Care Delivery Will Bring Changes for Clinical Pathologists and Medical Laboratories [Internet]. Dark Daily. 2017 [cited 2021 Jun 28]. Available from: https://www.darkdaily.com/2017/07/12/technological-­revolution-­in-­ hospital-­design-­and-­care-­delivery-­will-­bring-­changes-­for-­clinical-­pathologists-­and-­medical-­ laboratories/. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 263–75. Chapter 23, Clinical Laboratories GJRA.  Planning Premises and Design Considerations For Hospital Laboratory, GJRA—Global Journal For Research Analysis (GJRA), GJRA | World Wide Journals [Internet]. [cited 2021 Jun 28]. Available from: https://www.worldwidejournals.com/global-­journal-­for-­research-­ analysis-­GJRA/article/planning-­premises-­and-­design-­considerations-­for-­hospital-­laboratory/ MTA5MjQ=/?is=1. Health Facilities Management. Designing clinical labs [Internet]. [cited 2021 Jun 28]. Available from: https://www.hfmmagazine.com/articles/1703-­designing-­clinical-­labs. MedicalLab. Clinical Laboratory Design Concepts  : March 2018—MedicalLab Management Magazine [Internet]. [cited 2021 Jun 28]. Available from: https://www.medlabmag.com/ article/1454/.

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MLO.  Medical laboratory safety management [Internet]. Medical Laboratory Observer. 2018 [cited 2021 Jun 28]. Available from: https://www.mlo-­online.com/management/lab-­safety/ article/13017071/medical-­laboratory-­safety-­management. Race GJ, Tillery GW, Dysert PA.  A history of pathology and laboratory medicine at Baylor University Medical Center. Proc Bayl Univ Med Cent. 2004;17(1):42–55. Singh M. Planning premises and design considerations for hospital laboratory. Glob J Health Sci. 2019;8:1–6. Tan SS, Yan B, Saw S, Lee CK, Chong AT, Jureen R, et al. Practical laboratory considerations amidst the COVID-19 outbreak: early experience from Singapore. J Clin Pathol. 2021;74(4):257–60. Yoong NW.  Transforming the 24/7 Clinical Laboratories—Design Considerations, Workflow and Relocation to New Diagnostics Building. [cited 2021 Jun 28]; Available from: https:// clinmedjournals.org/articles/ijpcr/international-­journal-­of-­pathology-­and-­clinical-­research-­ ijpcr-­2-­024.php?jid=ijpcr.

Blood Bank

10

A blood bank is a facility that collects and tests donated blood, separates it into components, stores it, and prepares it for transfusion to recipients. Because the blood bank is a regulated department in the hospital, it is recommended that the rules, regulations, and norms of the blood bank, as well as the controlling authority of the respective country, be considered before planning and designing the blood bank. This set of checklists will assist the planner and designer in remembering all such issues relating to the blood bank and will guide him/her in completing, testing, and commissioning all works/activities on time. This will assist him/her in ensuring that all work/activities are completed and operational before the blood bank starts.

10.1 Location of the Blood Bank in the Hospital The blood bank shall be located in the most easily accessible area of the hospital, especially the emergency. It shall be close to the emergency, intensive care, and operating theatre complexes. The blood bank should ideally be on the ground floor. The blood bank shall be a unified complex, with no blood bank rooms scattered across different areas.

10.2 Controlling Authority of Blood Bank Generally, blood banks are controlled by an authorized controlling authority under a specific act in all countries. India, for example, is governed by the Drug Act. It is the controlling authority that establishes the norms, rules, and regulations.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_10

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Because the blood bank is a regulated department in the hospital, it is recommended that the rules, regulations, norms, and guidelines of the controlling authority of the respective country shall be considered before planning and designing the blood bank.

10.3 Functions of Blood Bank Blood banks have four major function areas: 1. 2. 3. 4.

Receiving Storage Testing Distribution

10.3.1 Receiving The blood bank’s receiving section is used to collect blood from donors and to give them facilities for recovering after bleeding.

10.3.2 Storage The storage area is used for storing untested blood, tested blood, and blood components.

10.3.3 Testing A testing area is set aside for screening the blood donated for ruling out the presence of infectious diseases in the blood.

10.3.4 Distribution This area is designated to distribute the tested blood to the patients for transfusion.

10.4 Area of Blood Bank Normally, the area is described in the norms set forth by the blood bank’s governing body. So, those regional rules must be followed when designing the blood bank, e.g. the Drug Act of India describes the area as follows:

10.5 Infrastructure

363

(a) For whole blood (b) For components (c) For apheresis

100 Sq. Mtr. Additional 50 Sq. Mtr. Additional 15 Sq. Mtr.

Consequently, the space must be at least 165 square metres. The overall area must not be less than 200 square metres after the movement area has been added.

10.5 Infrastructure 10.5.1 Space Requirement for Blood Bank The blood bank shall have the following infrastructure:

10.5.1.1 Receiving Area See Table 10.1. The donor’s registration, examination, and bleeding take place in the receiving area. The apheresis room and a refreshment room shall both be included in this area. The details for each room are as follows: Entrance The term ‘entrance’ refers to the main entrance to the blood bank. The blood bank’s entrance door should be about 1524 mm wide so that wheelchairs can easily enter. The door should ideally close automatically and be openable from both sides.

Table 10.1  Receiving area of the blood bank

Activity Following spaces shall be provided for: Entrance Reception area Registration and cash counter Waiting areas Medical examination room Bleeding room Recovery/ refreshment/ restroom Apheresis room

Status of works Start End In Not date date Complete progress started

:::::::-

:-

Responsible person

Remarks

364

10  Blood Bank

Reception The reception shall be located near the blood bank’s entrance. When a patient first arrives at the blood bank, they will speak with the receptionist. The reception desk shall be open to provide visitors and patients with all necessary information, make appointments, guide them through the registration process, describe how to donate blood, and obtain blood issues for transfusion. The reception may be kept open type and not a closed cabin type. Registration and Cash Counter Next to the reception desk shall be the registration/cash counter. The registration counter serves in both capacities. The first is registering as a donor, and the second is completing the necessary paperwork to deliver blood. When it comes to registering the donor, the registration counter shall complete the donor form and obtain the donor’s consent. The registration counter shall also review the doctor’s blood requirement request form and complete the necessary paperwork before issuing blood. The registration clerk shall then register the patient for the investigation and accept payment for it (if applicable). If the patient footfall is high, it is recommended that a separate cash counter be provided, ideally about 1829 mm away from the registration counter. Waiting The waiting area is for donors who are waiting for their turn or the donor’s family. Additionally, it is utilized for family members who visit the blood bank to receive blood. There shall be seats available in the waiting area for between 15 and 20 people. The area shall approximately be 4572 mm × 3048 mm in size. Medical Examination The donor’s pre-bleeding examination takes place in this room. The doctor shall measure the donor’s height and weight and check for any underlying illnesses. The donor is shifted to the bleeding room after the doctors determine that he/she is healthy enough to donate blood. The size of the examination room shall be approximately 3658 mm × 3658 mm. Bleeding Room This is the room where the donor is bled. Typically, a space of 4572 mm × 4267 mm shall be sufficient. There shall, however, be enough space in the room to accommodate at least two blood bank couches. If the donor load for bleeding is higher and more bleeding couches are required, the room’s size can be increased. In the room, there shall be two doors. The donor shall enter the bleeding room through one door, and the room’s second door shall lead to the refreshment/recovery/restroom area. Couches for blood donors shall be located near the room’s wall. Refreshment/Recovery/Restroom The donor is required to stay in this room for 15–30 min once the blood donation is finished. This time is utilized to finish the paperwork and keep an eye on the donor

10.5 Infrastructure

365

for any untoward effects, such as dizziness, bleeding from the puncture site, or any other complaints. Refreshments shall also be available in this room. The ideal room size shall be approximately 4572 mm × 3658 mm. It is preferable to attach the toilet to the refreshment room. Apheresis Room Through the process of apheresis, a specific component of blood is separated from the donor’s blood in this room. The apheresis machine is an equipment to separate the components. The room shall be approximately 4572 mm × 3658 mm in size.

10.5.1.2 Testing Area See Table 10.2. This area is designated for the testing of donated blood. There are two sections of the laboratory. One is the serology lab, which is a division for blood group serology, and the second is the TT lab for testing blood for hepatitis B antigens, HIV antibodies, etc. While designing and planning the laboratories, the following issues shall be kept in mind: 1. The testing area of the blood bank shall have two separate rooms, one for each laboratory. 2. The size of each room shall be approximately 3658 x 42,667. However, the size can be altered depending on the requirement. 3. The wall of the laboratory room shall all be 109 mm thick and plastered on both sides. The laboratories shall be built as clean rooms because the blood bank in itself is a clean environment. It is suggested that the wall be constructed using a puff panel with no corners or edges. With the aid of a puff panel or GI sheet, the edges shall be rounded off. Paint that is washable and antibacterial and antifungal shall be used to finish the walls and ceiling. 4. Flooring: The floor shall be impenetrable and stain-resistant. It is recommended to select floor tiles with large dimensions, such as 600 mm × 600 mm. The only requirement is that there shall be no gaps between the tiles, which means that the fixing of tiles shall be jointless. As an alternative, granite can be used as it is a hard stone. Marble is not recommended because it is a porous, soft stone that is easily stained. Hot-welded vinyl flooring or epoxy-coated concrete slabs are also Table 10.2  Testing area of the blood bank

Activity Following spaces shall be provided for: Serology lab Transferable disease lab

Status of works Start End In Not date date Complete progress started

::-

Responsible person

Remarks

10  Blood Bank

366

popular among designers. The disadvantage of these flooring options is that if water or a chemical penetrates the vinyl, the entire floor may be destroyed and may fall out. 5. Doors: Each laboratory shall ideally have a single door with a width of around 1219 mm to provide control over activities such as people and object movement while bringing equipment into and out of the lab. The laboratory doors shall be self-closing and automated.

10.5.1.3 Storage and Processing Area See Table 10.3. This area shall be used for storing the blood that has still to be screened. Also, the post-screened blood is stored in these areas. If the blood that has to be stored is excessively high, the option of chilled rooms shall be considered. Otherwise, the blood can be stored in specially designed blood bank refrigerators. In this area, the blood is also processed to separate the component of the blood. Blood storage rooms: Blood that has not been analysed yet (and needs to be screened) is usually kept in the bleeding chamber or another specially designed enclosure. The bleeding room, or enclosure as the case may be, shall have a blood bank refrigerator. Blood that has been tested and is prepared for delivery is stored separately from untested blood. Either the delivery room or a separate enclosure close to the delivery counter is provided as a space for this blood. There shall be a blood bank refrigerator in the delivery room, or enclosure, depending on the situation. Blood component room: To separate the components from whole blood and store them as separated components, a component room shall be provided. The component room shall be approximately 7620 mm × 7620 mm in size. The component room’s walls shall be at least 109 mm thick and plastered on both sides. It is suggested to use a puff panel to create the wall because the component room is a clean area. GI sheet or puff panel shall be used to round out the edges. Paint that is washable and antibacterial and antifungal shall be used to finish the walls and ceiling.

Table 10.3  Storage and processing area of the blood bank

Activity Following spaces shall be provided for: Refrigerated room for blood storage (if the volume of blood bags to be stored is excessively high) Blood component room

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:-

:-

10.5 Infrastructure

367

Flooring: The floor needs to be impenetrable and stain proof. Large floor tiles, such as those measuring 600 mm by 600 mm, are advised for use. The only requirement is that there shall be no gaps between the tiles, which entails that they must not have any joints. Otherwise, granite can be utilized as an alternative because it is a hard stone. Marble is not advised because it is a soft, porous stone that is readily stained. Some designers also favour using hot-welded vinyl flooring or concrete slabs that have been covered with epoxy. The drawback of these flooring options is that if water or a chemical penetrates through the vinyl, the entire floor may eventually get ruined and fall out. Doors: The storage areas and the component room shall ideally have a single door having a width of around 1524 mm to provide control over activities like the movement of people and objects while bringing equipment into and out of the lab. The lab doors shall be self-closing and automated.

10.5.1.4 Distribution Area See Table 10.4. The screened blood shall be distributed from here for the patient to receive a transfusion. It is usually a room with an exterior service window. The room’s dimensions shall be roughly 3048 mm × 3048 mm, and the window opening in the reception area can be up to 610 mm × 610 mm. This room shall be close to the screened blood storage area. Additionally, this area can also be used to store the screened blood. 10.5.1.5 Utility Areas See Table 10.5. These are the areas that facilitate the blood bank’s operation. Some of them are given below: Change Room No one shall be permitted to enter these rooms without changing, as some sections of the blood bank, such as laboratories and the component room, are essentially clean areas. Hence, the workers shall change their outdoor clothing into clean clothing. The room shall be approximately 2438 mm × 2438 mm in size. The changing room shall provide facilities for hand washing and changing.

Table 10.4  Distribution area of the blood bank

Activity Following spaces shall be provided for: Issue counter

Start date

:-

Status of works End In Not date Complete progress started

Responsible person

Remarks

368

10  Blood Bank

Table 10.5  Utility areas of the blood bank

Activity Following spaces shall be provided for: Change room Doctors’ restroom Store Record Medical officer room Sterilization room Washing room Toilet

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::::-

Doctors’ Restrooms Normally, a doctor is assigned duties in shifts as round-the-clock availability of doctors is required in the blood bank. Consequently, the blood bank shall have a small doctor’s restroom to help the on-call doctor. The room shall be 2438 mm × 3048 mm in size. The space shall be air-conditioned. Store For storage of equipment, supplies, consumables, medical disposables, and other objects, the blood bank shall be provided with a store. The store shall be about 3658 mm × 3658 mm in size. While designing the storage area, the designer shall also take future needs into account. The storage shall, to the greatest extent feasible, be secure, dry, termite-proof, and fire-resistant. Record Room The blood bank shall have an adequate separately allocated space for the storing of records. The room shall be approximately 2438 mm × 2438 mm in size. The storage shall, to the greatest extent feasible, be secure, dry, termite-proof, and fire-resistant. Medical Officer Room It shall ideally have a place from where the blood bank’s administration could be carried out. Hence, medical officer room shall be provided in the blood bank because the medical officer is in charge of it. The room shall be approximately 4267 mm × 3658 mm in size. Sterilization Room Cum Washing Room With the blood bank, a small washing and sterilization room shall be provided. The space shall be approximately 3048 mm × 3048 mm in size and have only one door.

10.6  Services, Facilities, Equipment, Tools, and Instruments

369

Waste Management and Disposal Blood banks generate a variety of waste products, including general trash, trade waste (chemical waste discharged into sewage), biological waste, and waste radiation materials. Some waste can be disposed of on-site, while others must be collected and disposed of off-site by specialized contractors following regional biomedical waste disposal laws.

10.6 Services, Facilities, Equipment, Tools, and Instruments 10.6.1 Receiving Area 10.6.1.1 Entrance See Table 10.6. A shoe rack shall be provided outside the entrance so that no one enters the blood bank premises wearing outside shoes. Either the shoe covers shall be provided or a separate set of slippers shall be provided. An air curtain can be installed on the blood bank’s door, but it is not necessary. 10.6.1.2 Reception, Registration, and Cash Counter See Table 10.7. The number of patients or visitors who are anticipated to use the reception or help desk services determines the size of the counter and/or help desk. It is advised that enough room be made so that at least one receptionist or helper can be seated. Therefore, the appropriate length for the reception and/or help desk shall be between 1829 mm and 2438 mm. The counter can be built of granite or other materials, or it can be built up with masonry work with an elegant appearance. A wooden counter can also be provided as an alternative. For a person to comfortably stand and speak with the receptionist, the counter’s front side shall be roughly 1524 mm high. The working surface on the other side of the counter shall be approximately 610 mm wide and 762 mm high.

Table 10.6  Entrance of the blood bank

Activity Shoe rack Bins for unused shoe covers Waste shoe cover bin Air curtain can also be provided

Start date ::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

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10  Blood Bank

Table 10.7  Reception, registration, and cash counter of the blood bank

Activity Acrylic or glass partitions at the counter Basic facilities like telephones, public address system Separate toilets for males and females Drinking water facility Provide the following at reception: Reception counter Reception chairs Computers with printers Scanner Intercom and telephone line Cash collection box on the cash counter Required electrical points on counters Other communication points on counters

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:-

:-

::-

::::::::-

One reception chair shall be provided for the receptionists. If need be, high-­ raised chairs can also be provided. Similarly, chairs shall be provided for the registration and cash counters also. A computer with UPS and printer (if needed for printing) shall be provided to each receptionist or help desk assistant. If required, the scanner can also be provided at reception. The intercom and telephone lines shall also be provided at the reception. Even one spare mobile phone shall also be placed at the reception to make emergency calls. The reception counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points. • In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances.

371

10.6  Services, Facilities, Equipment, Tools, and Instruments

The reception counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for networking of the computer • Two RJ 11 points for intercom and extension lines As far as the registration and cash counters are concerned, the set-up shall be the same. However, for the cash counter, additional care needs to be taken such as the following: Because cash counters must be secure, there shall be a glass partition above the counter with a cut window on the lower side of the glass, rising to a height of about 1219 mm from the top of the counter. The cash counter shall be provided with a safe screwed to the counter, for the safe custody of the cash.

10.6.1.3 Waiting Lobby See Table 10.8. Table 10.8  Waiting lobby of the blood bank

Activity Proper heating and air conditioning Security features like CCTV Announcement systems Waiting chairs/sofa set Wall, ceiling, and interior decoration Television, magazines, movies/ DVDs, etc. Signage and wayfinding system Mobile charging points Free internet or Wi-Fi facility Handrails at the staircase and other areas Required electrical points Other communication points

Status of works Start End In Not date date Complete progress started ::::::-

::::-

::-

Responsible person

Remarks

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Waiting lobbies shall be properly guarded, and security measures such as fire hooters and CCTV cameras shall be provided. Proper comfortable chairs having backrests shall be provided in the waiting areas. Please avoid backless benches, as it is not comfortable to sit on such benches. If sofa sets are provided, it will be better. For bariatric patients, the provision shall be made for specialized seating. For an aesthetic look of the waiting areas, the interiors shall be well decorated. The wall decoration shall be done by using mirrors, murals, texturized paints, or wallpapers. Similarly, the ceiling shall also be decorative. Light fittings shall also be decorative. Use of colour, textures, surface treatments, fixtures, fittings, furniture, and artwork shall be considered for interior decor. The waiting areas shall also have televisions, magazine holders, newspaper racks, etc. for patients and visitors to spend time. The wayfinding and signages shall be very clear and glowable so that visitors and patients can easily identify passages and routes. Mobile charging points shall also be provided in the waiting area. Apart from this, if possible, the facility of Wi-Fi or free internet can be provided. For the safety of patients and visitors, provide necessary safety measures, like handrails, non-slippery surfaces, non-steep slopes, handicapped toilets, and wheelchair accessibility.

10.6.1.4 Medical Examination See Table 10.9. The following furniture shall be placed in the examination room: • • • • • • •

Doctors’ table Side rack for doctor Doctors’ chair Two attendants’ chairs Examination couch Revolving stool with height adjustment for patient Step stool All the necessary equipment, gadgets, and instruments shall be provided like:

• • • • • • • • •

BP instrument Stethoscope View box Torch Weighing machine Tongue depressor Finger pulse oximeter Height scale BT/CT (bleeding time/clotting time) set

10.6  Services, Facilities, Equipment, Tools, and Instruments

373

Table 10.9  Medical examination room of the blood bank

Activity Provide the following furniture in consultation rooms: Doctors’ table Side rack for doctor Doctors’ chair Examination couch Two attendants’ chairs Revolving stool with height adjustment for patient Step stool Provide the following equipment/gadgets in OPD: BP instrument Stethoscope Torch Tongue depressor Weighing machine Finger pulse oximeter View box BT/CT set Height scale Intercom Computer with a printer and UPS Washbasin for hand wash Curtain partitions for the examination couch Provide windows if possible Emergency lights Required electrical outlets Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::-

:-

:::::::::::::::::-

The examination rooms shall have an intercom for inter-hospital communication. The examination room shall be equipped with a computer and UPS. If printing is required in the examination room, a printer shall also be provided. For hand washing, the examination room shall be provided with a wash basin, as well as a soap dispenser and a towel hanger.

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In the examination room, a hanging curtain partition shall be provided on each of the three sides of the examination table. The curtains shall be hung from a curtain track that hangs from the ceiling and is set 2134 mm above the floor. To make it simple to clean the floor, a space of 457 mm or so above the ground shall be left open at the bottom of the curtain. In the examination room, biomedical waste management shall be implemented. Even though direct sunlight shall be avoided, examining rooms shall ideally have windows. Shades or curtains shall be used to cover the window glass, or tinted glass can be used instead. The following electrical outlets/points shall be provided in the examination room: • The main switchboard for the room, as well as one 5 Amp switch/socket, shall be located at the entrance wall (a wall other than the wall on which the door opens). • Button for controlling the air conditioner’s temperature. • On the wall above the examination table, at 610 mm, there shall be a switch and one point for the examination light. • On the wall 305 mm above the doctor’s office table, two 5 Amp switch/sockets shall be installed. One 15 Amp switch/socket shall also be provided in addition to this. • There shall be three 5 Amp switch/sockets for the computer and printer installed above the doctor’s side rack at a height of around 305 mm. There shall also be one 15 Amp switch/socket next to this for additional equipment or a heater. The following communication points shall be provided in the examination chamber: • RJ 45 port for networking of the computer • RJ 11 for the extension line and intercom • USB which can be used to charge extra devices or cell phones

10.6.1.5 Bleeding Room See Table 10.10. The bleeding room shall have the following medical equipment: • • • • • • • • • • • •

Blood bag tube sealer Blood collection monitor Blood donor couch (mobile) Blood mixing and blood weighing device Blood collection system, vacuum-assisted Blood bank refrigerator Dielectric sealer BP apparatus Stethoscope Tongue depressor Crash cart with emergency medicines Oxygen cylinder with masks

10.6  Services, Facilities, Equipment, Tools, and Instruments

375

Table 10.10  Bleeding room of the blood bank

Activity Following equipment is provided in the bleeding room: Blood bag tube sealer Blood collection monitor Blood donor couch (mobile) Blood mixing and blood weighing device Blood collection system, vacuum-assisted Blood bank refrigerator Dielectric sealer BP apparatus Stethoscope Tongue depressor Crash cart with emergency medicines Central MGPS oxygen point Oxygen cylinder with masks Following furniture provided in the bleeding room: Chair for staff Working top Television Required electrical points Other communication points Emergency lights

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:::::-

::::::::-

::::::-

Couches for blood donors shall be placed next to the room’s wall. On the backside wall (the back of the couch), 457 mm wide working top shall be provided so that the tube sealer or blood collection monitor can be placed there. A cart with emergency medication containers shall also be provided in the room. The space shall be furnished with chairs so that staff members may watch the donor while they bleed. Near the donor’s couch, the oxygen point with the required outlet and the flowmeter from the central medical pipeline shall be provided.

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There shall be a television installed on the couch’s front wall. The following electrical outlets shall be provided in the bleeding room: • For the supply to the couch, two sets of 6/16 Amp switch/sockets shall be provided below the working top. There shall be two switches/sockets in each set. • To connect the medical equipment, there shall be enough 6/16 Amp switch/sockets on the wall above the working surface, spaced 1219 mm apart. • For the television, the electrical point shall also be provided. • There shall be a place for emergency lighting in the room.

10.6.1.6 Refreshment/Recovery/Restroom See Table 10.11. All of the amenities needed for the donor’s refreshments shall be provided in the restroom/recovery/refreshment room. The room shall be furnished with a sofa set for the donor to relax on and a bed for the donor to rest on. For the donor’s refreshments, there shall be a refrigerator and a vending machine for tea and coffee. Additionally, a television shall be provided on the wall in front of the sofa. There shall be sufficient electrical outlets for the refrigerator, television, and coffee vending machine. 10.6.1.7 Apheresis Room See Table 10.12. The apheresis room shall have the apheresis machine along with the apheresis kit stand. For the donor, the donor couch shall be provided. Apart from this for emergencies, the crash cart duly filled up with emergency medicines shall also be placed in the room. Table 10.11  Refreshment/recovery/restroom of the blood bank

Activity Sofa set for the donor Bed for resting of the donor Refrigerator Tea/coffee vending machine Television Required electrical points Other communication points

Start date :::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

377

10.6  Services, Facilities, Equipment, Tools, and Instruments Table 10.12  Apheresis room of the blood bank

Activity Apheresis machine Apheresis kit stand Donor chair Crash cart with emergency medicines Television Office chair Required electrical points Other communication points Power backup

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::-

::::-

:-

In front of the donor couch, there shall be a television. The apheresis device shall be positioned on the right-hand side of the donor couch. Additionally, for the technician, a standard office chair shall be provided to sit in while the procedure is being performed. Two pairs of electrical points shall be provided at a height of 457 mm above the floor to supply power to the apheresis machine and the donor couch. These electrical points shall be backed up by the UPS power supply. For televisions, an electrical outlet shall also be provided.

10.6.2 Testing Area See Table 10.13. The laboratories of the blood bank shall have the following equipment: • • • • • • • • • •

ELISA Reader with washer Mechanical shaker Oven universal/incubator ID centrifuge HB meter VDRL shaker Water bath serological RH view box Centrifuge machine Pipette set

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Table 10.13  Testing area of the blood bank

Activity Following equipment is provided in the laboratories ELISA reader with washer Mechanical shaker Oven universal/ incubator ID centrifuge HB meter VDRL shaker Water bath serological RH view box Centrifuge machine Pipette set Sufficient working slabs with the top surface of granite stone Vertical stone on the wall starting from the top of the slab Cabinets under the working slabs Sinks in the working slab at appropriate places SS notice boards and SOP document pockets Required electrical points Other communication points All electrical fittings shall be recessed in the ceiling Furniture in the laboratories: SS office tables Office chairs SS high-raised stools SS normal laboratory stools

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::::::::::-

:-

::-

::::-

::::-

10.6  Services, Facilities, Equipment, Tools, and Instruments

379

Working slabs shall be available for the laboratory’s effective operation so that they can be used to set up tiny tabletop machines, prepare chemicals and reagents, prepare slides or blocks, etc. Working slabs must be installed adjacent to the laboratory’s walls. The working slab’s top level shall typically be 915 mm above ground level. The slab’s width shall be around 762 mm, but it can vary depending on the situation. Granite stone edges that are round or half-round can be affixed to the slab’s top surface. The vertical stone, like the horizontal stone, shall be fixed to the wall starting from the slab. The height of this vertical stone shall be between 305 and 610 mm. This vertical stone protects the wall from getting damaged. On the floor beneath the working slab, a platform shall be built. The platform’s thickness shall be 152 mm. The upper surface and the entire thickness of the platform shall be covered with stone or tiles. There will now be a void between the platform’s upper surface and the slab’s bottom surface. Cabinets can be provided for this area. More than any other area, these cabinets are the most frequently used area. Reagents, chemicals, consumables, office supplies, and other items can all be stored in these cabinets. To increase storage capacity and ensure the safety of the item, shelves and doors shall also be provided. Every laboratory shall have a sink for cleaning. Sinks shall be strategically placed on the working slab itself. A deep laboratory sink measuring approximately 610  mm long by 457  mm wide is required. Because metal sinks are not recommended for laboratories, China clay sinks shall be used in the laboratories. The sink shall be set back from the working slab and recessed. The drain shall be located on the floor platform, and the tap shall be located 305 mm or so above the sink level. Since wood is never preferred in the laboratories of the blood bank, all notice boards must be made of stainless steel. Every machine shall have adequate grounding and earthing provisions.

10.6.2.1 Electrical Points in Laboratories The laboratories shall have the following electrical outlets: 1. The main switchboard, along with one or more 6 Amp switch/sockets, shall be placed at the entrance wall to operate the room’s fan and lighting. 2. Temperature-adjustable air conditioning control button. 3. The wall above the working top shall have a minimum of two 6/16 Amp switches/ sockets. These points shall be placed in a series and separated by 1524 mm. At least half of them shall be supplied by UPS. 4. On the office table, the power supply shall also be provided for the microscopes.

10.6.2.2 Other Communication Points in Laboratories The following communication points shall be provided: 1. RJ 45 points for networking of the computer 2. RJ 11 for intercom and extension line

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380

There is not much furniture utilized in the laboratory. The laboratories only have one office desk, one chair, one stool, etc. It is prohibited to use wood in the blood bank. Therefore, stainless steel shall be used for all objects, including tables, cabinets, racks, notice boards, etc. There shall be no fixtures of any kind, such as fans, boards, lights, or stitching, on the surface of the walls or ceiling. Everything shall be recessed into the ceiling or walls. Normal LED lighting with enough lumens shall be used for the room’s lighting. There is no need for additional lighting in the room. Air conditioning system of laboratories: Fully air-conditioned laboratories shall enable for control of temperature, humidity, and air exchanges. The room’s temperature shall be between 18 and 10 °C, and the humidity more than 40%. For air conditioning of the laboratory, either chilled water pipelines with air handling units (AHUs) or ductable split or VRV systems can be chosen. Each system has advantages and disadvantages of its own. For each laboratory, a separate return air system shall be designed. Any laboratory’s return air shall never be mixed with that of another laboratory. Air exchanges, flow, and direction shall adhere to industry standards.

10.6.3 Storage and Processing Area See Table 10.14. For storage of tested blood, the storage room shall be provided with blood bank refrigerators (BBRs). For power supply to the BBR, the required electrical point shall be provided near the location of the BBR. As far as the numbers and capacity of blood bank refrigerators are concerned, it shall depend on the quantum of blood bags to be stored. Table 10.14  Storage and processing area of the blood bank

Activity Following equipment is provided in the storage area Blood bank refrigerators for tested blood in the delivery room Required electrical points

Status of works Start End In Not date date Complete progress started

:-

:-

Responsible person Remarks

10.6  Services, Facilities, Equipment, Tools, and Instruments

381

10.6.4 Blood Component Room See Table 10.15. Equipment-wise, the component room shall have the following: • • • • • •

Deep freezer, −80 °C Deep freezer, −40 °C Refrigerated centrifuge Laminar airflow cabinet Platelet agitator with incubator Double-pan balance

Table 10.15  Blood component room of the blood bank

Activity Following equipment is provided in the component room Deep freezer, −80 Deg. C Deep freezer, −40 Deg. C Refrigerated centrifuge Laminar airflow cabinet Platelet agitator with incubator Double-pan balance Plasma extractor Thawing bath Cryo bath Temperature thermometer and hygrometer Connecting device for blood transfer to other bags Chair Laboratory stool Working countertops Stainless steel tables Lab sinks Required electrical points Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::::::::-

:-

:::::::-

382

• • • • •

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Plasma extractor Thawing bath Cryo bath Temperature thermometer and hygrometer Connecting device for blood transfer to other bags

The component room does not require a lot of furnishings. There shall only be one office desk, laboratory stool, chair, etc. available in the component room. In the component room, instead of the working tops, stainless steel tables shall be provided to place the equipment or for other uses. These SS tables shall include lab sinks as well, so additional sinks in the component room are not necessary. In the component room, the following electrical outlets shall be provided: 1. The main switchboard, along with one or more 6 Amp switch/sockets, shall be located at the entrance wall to operate the room’s fan and lighting. 2. Temperature-adjustable air conditioning control button. 3. On each wall of the component room, there shall be at least two 6/16  Amp switches/sockets. These points shall be located at a height of 457 mm above the ground. These points shall be in pairs, and each of the pairs shall be 1524 mm apart from the other. At least half of them shall be backed up by power through the UPS. The following communication points shall be provided: 1. RJ 45 points for networking of the computer 2. RJ 11 for intercom and extension line It is prohibited to use wood in the blood bank. Therefore, stainless steel shall be used for all objects, including tables, cabinets, racks, notice boards, etc. There shall be no fixtures of any kind, such as fans, boards, lights, or stitching, on the surface of the walls or ceiling. Everything shall be recessed into the ceiling or walls. Normal LED lighting with enough lumens shall be used for the room’s lighting. There is no need for additional lighting in the room. Air conditioning system of storage areas and component room: Fully air-­ conditioned areas shall enable for control of temperature, humidity, and air exchanges. The room’s temperature shall be between 18 and 10 °C, and the humidity more than 40%. For air conditioning of the storage areas and component room, either chilled water pipelines with air handling units (AHUs) or ductable split or VRV systems can be chosen. Each system has advantages and disadvantages of its own. The component room shall have a separate return air system and shall not be mixed up with the return air of any other room/area. Air exchanges, flow, and direction shall adhere to industry standards.

383

10.6  Services, Facilities, Equipment, Tools, and Instruments Table 10.16  Distribution area/delivery room of the blood bank

Activity Blood bank refrigerator (BBR) Office table Chairs Computer, printer, UPS PTS station

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::-

10.6.5 Distribution Area/Delivery Room See Table 10.16. The distribution room shall be provided with blood bank refrigerators (BBRs) for storing the tested blood. The room shall have a computer with UPS and a printer. The necessary electrical points for the power supply for the BBR and the computer shall be provided in the room. Also, the required communication port for computer networking and the intercom shall be provided. Pneumatic tube systems (PTSs): There shall be a PTS outlet in the distribution room. With PTS, the blood bank will find it easy to collect the patient’s blood samples along with the request form for cross-matching and to send the blood bag to the specified location.

10.6.6 Utility Area 10.6.6.1 Change Room See Table 10.17. The room shall be provided with an adequate number of personal lockers to keep the personal belongings. Each staff member shall preferably be allotted one such locker. One chair shall be provided in the room, which the staff can use while changing their clothes. For hanging the outside clothes, an adequate number of hooks shall be provided on the wall. Apart from this, the almirah and hanger rods with hangers shall also be provided to hang clothes. There shall be a closed cabinet to keep sterilized dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. One table shall be provided in the room to keep the containers of fresh unused masks and caps. A large bin for dirty linen shall also be provided in the changing room. Also, a separate bin shall be provided for disposal of the used masks, caps, and shoe covers.

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384 Table 10.17  Change room of the blood bank

Activity Staff lockers for keeping personal belongings One chair Hooks on the wall for hanging clothes Almirah for hanging clothes Hanger rods Cabinet to keep sterilized dresses Table to place boxes of masks and caps Bin for dirty linen Bin for used face masks, caps, and shoe covers Intercom point Air-conditioned

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

:-

::::::::-

::-

Table 10.18  Doctors’ restroom of the blood bank

Activity Office table Chair Resting bed Sofa set and a centre table (if necessary) Computer, UPS, and internet connection Provision of tea/ coffee

Status of works Start End In Not date date Complete progress started ::::-

:-

:-

The room shall have the provision of an intercom and shall have adequate air conditioning.

10.6.6.2 Doctors’ Restroom See Table 10.18. The doctors’ restroom shall have an office table, chair, bed, and cupboard. If required, the sofa set can also be provided in the room.

10.6  Services, Facilities, Equipment, Tools, and Instruments

385

Furthermore, the room shall be air-conditioned, and the temperature control button shall be placed in the room itself. The room shall preferably be provided with a computer with UPS and an internet connection so that the doctor can surf the internet in their spare time. There shall be a provision for serving tea/coffee, maybe by installing a vending machine.

10.6.6.3 Store See Table 10.19. As this room is for storage of required medicines, consumables, disposables, and general items, the room shall be provided with: • • • • •

Racks Cabinets Adequate lockable cupboards Drawers If required, the working countertop can also be provided

10.6.6.4 Record Room See Table 10.20. The record room shall be provided with a sufficient number of: • Shelves • File cabinets • Cupboards Table 10.19  Store of the blood bank Start date

Activity Racks Cabinets Cupboards Drawers for storage

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

Table 10.20  Record room of the blood bank

Activity Shelves Cupboards Cabinets Drawers Racks

Start date :::::-

End date

Status of works In Complete progress

Not started

Responsible person

Remarks

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Table 10.21  Medical officer room of the blood bank

Activity Doctors’ table Doctors’ chair Two attendants’ chairs Side rack for doctor Cupboard Sofa set Centre table Required electrical outlets Required communication ports

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::::::-

• Racks • Drawers

10.6.6.5 Medical Officer Room See Table 10.21. The medical officer room shall be provided with: • • • • • •

Office table Doctor’s chairs Two visitors’ chairs Side rack for doctor Cupboards Sofa set along with the centre table

Electricity points shall be placed close to the doctor’s table for a computer and view box. Computer and intercom communication interfaces shall be provided.

10.6.6.6 Sterilization Cum Washing Room See Table 10.22. The sterilization room shall be provided with a countertop with a deep sink for washing the instruments. The supply of hot and cold water shall be ensured. For sterilization, a single vertical autoclave with a capacity of two drums shall be provided. Please ensure that the sterilizer shall have a provision for monitoring the pressure and temperature of the sterilizer. Apart from this, the hot-air oven, if required, shall also be provided.

387

Further Reading Table 10.22  Sterilization cum washing room of the blood bank

Activity Quick steam sterilizer with pressure-­ monitoring system Hot-air oven Supply of soft water Exhaust fan for air exchanges Required electrical outlets for machines

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

::::-

Table 10.23  Waste management and disposal of the blood bank

Activity Waste bins as per the guidelines of the biomedical waste management norms

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

Provide necessary electric points for supplying power to the sterilizer and the hot-air oven. The room shall have proper provision for exhaust of the air; hence, the exhaust fan shall be provided in the room.

10.6.6.7 Waste Management and Disposal See Table 10.23. For disposal of the waste, the waste bins shall be provided keeping in mind the rules and regulations of biomedical waste management as defined by the respective government of the state of the country.

Further Reading Choudhury N, Desai P. Blood bank regulations in India. Clin Lab Med. 2012;32(2):293–9. DrugsControl Media Services. Drugs control, regulatory, pharma news, research news, NPPA [Internet]. [cited 2021 Jul 7]. Available from: https://drugscontrol.org/blood-­banks.php. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 24, Blood Bank. p. 277–86. 1. Health Services Department, Michael Okpara University of Agriculture, Umudike, Abia State, Nigeria. 2. Family Health International (FHI 360) Country Office, Garki Abuja Nigeria 3. Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Awka, Nigeria. Current concept of blood bank organisation and planning: a Review. Int J Curr Res Biol Med. 2016;1(7):19–26.

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Ltd TIS.  JPAC—Transfusion Guidelines [Internet]. [cited 2021 Jul 7]. Available from: https:// transfusionguidelines.org.uk/. Planning and Designing a Hospital Transfusion Service: September 2016—MedicalLab Management Magazine [Internet]. [cited 2021 Jul 7]. Available from: https://www.medlabmag. com/article/1305. World Health Organization. Design guidelines for blood centres. Manila, Philippines: World Health Organization, Western Pacific Region; 2010. 104 p

Other Investigations and Procedures

11

Apart from the clinical laboratories and radiology, the hospital conducts a variety of other investigations, examinations, and procedures. These investigations, testing, and processes may differ between departments. Coronary catheterization (cath lab), thallium scan, bronchoscopy, audiometry, colonoscopy, capsule endoscopy, cholangioscopy, endoscopic ultrasound, duodenoscopy, upper gastrointestinal endoscopy, etc. are some of the investigations that are frequently performed. Other investigations include neuropsychological tests, electromyography (EMG), NCV/EP studies, polysomnography (sleep lab), transcranial magnetic stimulation (TMS), ESW lithotripter of urology and dialysis, etc. The hospital might or might not need specific areas for all the unique investigations, testing, and treatments. Therefore, it shall be decided well in advance which of them the hospital intends to establish right away or possibly in the future. To ensure that the hospital does not encounter issues when introducing them in the future, the designer shall plan for the provision of areas for them. The majority of these specialized examinations, tests, and procedures often call for only a little extra space with standard amenities like enough space in the room, electricity outlets, and air conditioning. However, there are some of them, which may need specifically constructed rooms or complexes. Out of all the ones, those that need unique spaces or infrastructure are included in the section below. These include dialysis, polysomnography (sleep lab), cath lab, and audiometry. As far as the endoscopic procedures are concerned, the same has been discussed in Chap. 17 titled ‘Operation Theatre Suite’. Other processes essentially do not call for additional infrastructure. A maximum of one additional room with sufficient power outlets and air conditioning may be needed. This set of checklists shall help the planner and designer to remember all such issues relating to the space requirement and guide him/her to complete, test, and commission all works/activities well in time. This shall help him/her to ensure himself/herself that all the works/activities are carried out, complete, and working before the investigations are carried out. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_11

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11.1 Coronary Catheterization (Cath Lab) The cath lab is an X-ray-based imaging device, which is used for interventional cardiology. When exposure is given by the cath lab, a very high dosage of radiation is created. As a result, it needs to be designed with the regulating authority’s standards in mind. To prevent radiation leaks, the proper design shall be implemented.

11.1.1 Infrastructure 11.1.1.1 Room Designing See Table 11.1. Cath Lab Procedure Room The cath lab shall be in a sterile, clean place, ideally close to the intensive care unit (ICU). The number of cath lab rooms depends on the number of machines that shall be placed right once as well as any plans for additional machine additions in the future. The cath lab room’s design shall take into account the laws and ordinances of the country. All of these rules are published in India by the Baba Atomic Research Institute. If the machine has to be positioned horizontally, a rectangular chamber shall be built. If the equipment is going to be put diagonally, it would be best to design the space squarely. However, it is recommended to place the machine in a horizontal Table 11.1  Room designing of cath lab

Activity Procedure room Cath lab panel room Cath lab control room UPS room Change room for patients Change room for staff Cath lab waiting lobby Store for unused disposables and consumables Store for records and DVDs Consultation room

Status of works Start End In Not date date Complete progress started ::::::::-

::-

Responsible person

Remarks

11.1  Coronary Catheterization (Cath Lab)

391

direction in a rectangular room. In this instance, the room’s dimensions shall be 9144 mm × 4572 mm, and it shall have a minimum floor area of 42 sq. m (450 sq. ft). The wall of the room shall be at least 110 mm thick and shall be plaster on both sides. While walls composed of mortar or concrete shall be at least 150 mm thick, solid baked clay brick primary walls shall be at least 250 mm thick. If hollow bricks are utilized, a layer of 6 mm barium plaster shall be applied up to 2.2 m from the floor level. To act as an air interlock, another door shall be put in front of the cath lab procedure room door. The cath lab room shall have a single entrance door with a width of approximately 1829 mm to allow for the mobility of trollies. A suitable 2 mm thick lead lining is required for the door. The lining is required even on the door frame. No radiation shall leak from any portion of the door. Doors shall overlap by no less than 100 mm on either side when closed. The flooring shall be tile, marble, or granite. However, avoid slippery flooring to avoid mishaps that could cause injury to the patient. The cath lab procedure room is not permitted to have any windows. Because the machine is heavier and moves faster, it is recommended that the weight-bearing capacity of the floor be verified. Build up the machine’s foundation, if necessary, following the manufacturer’s instructions. Cath Lab Panel Room In addition to the main machine which consists of the X-ray tube and detectors, other electrical components supplied by the cath lab are generally placed in separate panels connected to the main machine. These panels are not required to be necessarily placed in the cath lab procedure room, but they do control the functioning of the cath lab. To properly safeguard them, it is advised to instal these panels in a separate space that is connected to the cath lab procedure room. While designing this room, they shall be taken from the equipment manufacturer. The manufacturer shall confirm the machine’s dimensions, temperature, and other details. The size of the room shall be confirmed by the manufacturer of the machine. Cath Lab Control Room A control room shall be accessible and attached to the cath lab procedure room. The dimensions of this room shall be 3658 mm by 3658 mm. Between the cath lab procedure room and the control room, a lead glass measuring approximately 1200 mm by 1000 mm that is included with the machine shall be installed by fixing it in a wooden frame with a 2 mm lead lining to minimize radiation leaks. UPS Room Being an electronic equipment, a cath lab machine needs a steady power source. If it is not provided, the system shall crash, perhaps leading to software or component failure. Therefore, it is preferable to instal an online UPS together with the device. A separate room shall be built since UPS will have high ratings (above 100 KVA), and multiple batteries shall be required in addition to the UPS. The control room or

392

11  Other Investigations and Procedures

the machine room shall be connected to this room. This space shall be about 3658 mm by 3658 mm in size. Change Rooms for Patients Sometimes, it is challenging to do the procedure because of the patient’s clothing. To allow the patient to change into hospital clothing and remove outside clothing, change rooms are provided close to the cath lab. This changing area shall be 3048 mm × 3048 mm in size and air-conditioned. Change Rooms for Staff To help the doctors and personnel change into sterile hospital clothes, certain changing rooms shall be provided in the cath lab. For various staff member categories, different changing facilities shall be offered. Additionally, there shall be separate male and female changing areas. The following change rooms are generally provided in the cath lab: 1. Doctors’ change room—males 2. Doctors’ change room—females 3. Nurses/technicians’ change room—males 4. Nurses/technicians’ change room—females 5. Class IV staff change room—males 6. Class IV staff change room—females The room’s dimensions, from an infrastructure perspective, shall be roughly 4267 × 4572 mm. Preferably, the changing area shall be air-conditioned. A toilet facility with an associated bath facility shall be provided in addition to the changing area. Waiting Lobby for Cath Lab For the sake of the patient’s family, the cath lab shall have a separate waiting area next to the lab. With enough room between the seats, the number of people who can wait in this lobby may be restricted. The size of the waiting lobby shall be determined depending on the persons likely to be occupying the seats in the waiting lobby. Stores for Unused Disposables and Consumables Catheters, guidewires, fluid, and other consumables are used often during cath lab procedures. Therefore, there shall be a sufficient stock of these consumables in the lab. Hence, the department requires a store to stock these items. The size of the store shall be approximately 3658 mm × 3658 mm. However, the size may differ according to the number and quantity of items. Stores for Records and DVDs The images are often burned to a CD or DVD after the procedure. These CDs and DVDs are labelled with the patient’s name and identification number, and they are stored along with other records and reports of the patient. Therefore, the department

11.1  Coronary Catheterization (Cath Lab)

393

needs a store to stock these CDs and DVDs. The size of the store shall be 3658 mm × 3658 mm. However, the size may differ according to the quantity and number of goods. Consultation Rooms Families and friends of the patient are anxious, and they would want to meet and speak with the treating cardiologist to learn more about the patient’s illness and its progression. Consultation rooms shall thus be provided near the cath lab. The cardiologist enters that room, calls the patient’s relatives, and speaks with them there. This space shall be approximately 4572 mm × 4267 mm.

11.1.2 Services, Facilities, Equipment, Tools, and Instruments 11.1.2.1 Cath Lab Procedure Room See Table 11.2. The cath lab machine being the primary equipment shall be placed in the cath lab procedure room along with a customized motorized patient table that is supplied with the machine. The machine can be positioned in the room either horizontally or diagonally. For the machine’s arm to move freely without colliding with the walls, there shall be at least 1829 mm of space behind the machine when it is installed. Installation of the machine shall be done in the middle of the room’s breadth. Place the machine and patient table in such a fashion so that during the intervention, the patient may be seen clearly from the control room. The room’s entrance door from the control room shall adhere to the same standards as the patient entrance door. Ceramic tiles, marble, or granite can be used for floor tiles. However, the flooring shall not be slippery to prevent mishaps and patient injuries. In each cath lab room, the main switch and cable shall be terminated separately, and the machine’s power consumption shall be predicted depending on its specifications. It is advised to evaluate the floor’s capacity to support weight due to the machine’s heavier weight and faster movement. If required, give the machine a foundation. Follow the manufacturer’s instructions for machine installation. The cath lab machine shall only be mounted on a base plate (often provided by the vendor) using high-quality anchor fasteners, as instructed by the machine’s manufacturer. Any shortcuts shall result in poor image quality and the necessity to repeat diagnostic tests. If this problem is continuous, there is no other option but to reinstall the equipment. The procedure room shall have medical equipment such as • Multi-parameter vital sign monitor • Syringe pump

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Table 11.2  Cath lab procedure room

Activity Cath lab machine with table Multi-parameter vital sign monitor Syringe pump Defibrillator BP apparatus Stethoscope ECG machine Glucometer Oxygen cylinders with masks Ambu mask of different sizes Lead apron, gloves, collars, etc. Oxygen cylinder trolley Warning light Lead glass mounted on a wooden frame between the machine room and the control room Cath lab shall have the following tools/ instruments: Sterilizing drums Instrument boxes Extension cords and boxes Tray of all styles and sizes Refrigerator Torches All other required instruments Other issues Provide two-bay scrub stations for hand hygiene Required main switch and cable Proper ground earthing for cath lab and UPS Heavy-duty hangers for lead aprons

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::::::::::-

:::::::-

::::-

11.1  Coronary Catheterization (Cath Lab)

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Table 11.2 (continued)

Activity MGPS outlets for oxygen, vacuum, air Bed head panels for MGPS and electrical points Two-way audio communication between cath lab machine room and console room Cabinet for storing devices like a lead apron, lead goggles, gloves, lead collar, groin guards, etc. Cupboards for storing consumables and medicines Required electrical outlets Other communication points

• • • • • • • •

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::-

:-

:-

:-

::-

Defibrillator BP apparatus Stethoscope ECG machine Glucometer Oxygen cylinders with masks Ambu mask of different sizes Oxygen cylinder trolley

It is required to put a red-bulb warning light outside the procedure room entrance. This light shall be connected to the X-ray generator so that it only switches on during exposure when the X-ray tube is turned on. To safeguard the employees from unintentional radiation exposure, the procedure room shall have X-ray radiation protection equipment such as lead aprons, gloves, lead glasses, thyroid collars, and gonad shields, among other items. The cath lab procedure room shall also have the required tools and instruments like: • Sterilizing drums • Instrument boxes • Extension boxes and cord

396

• • • •

11  Other Investigations and Procedures

Tray of all styles and sizes Refrigerator Torches All other required instruments

The double-bay hands-free scrub station shall be provided outside the procedure room for hand hygiene. Regular LEDs with sufficient brightness shall be used for lighting. The area does not require any additional lights. Cath lab machine shall have the proper grounding features. The cath lab procedure room shall have outlets for medical gas supply. There shall be one outlet each for air, vacuum, and oxygen. If space permits, these outlets and electrical points can be placed with a bed head panel if necessary. The cath lab procedure room shall include the appropriate two-way audio system so that the technician can direct the patient from the control room without leaving the room. Each room shall have a stand with sturdy hangers where the lead apron can be hung. Each room shall have a cabinet to keep radiation safety and protection devices, such as lead gloves, lead goggles, groin guards, and lead collars. The cath lab procedure room shall have sufficient power outlets and communication ports. In addition to this, the space shall have sufficient power outlets and communication ports in the cath lab panel room. The temperature in the room shall be between 17 and 21 °C, and the humidity shall be between 40% and 50%.

11.1.2.2 Cath Lab Control Room See Table 11.3. Table 11.3  Cath lab control room

Activity Computer tables Office tables Chairs Lead glass window Computers with printers Required electrical points Other communication points

Start date :::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

11.1  Coronary Catheterization (Cath Lab)

397

Though the cath lab is operated within the procedure room only, the control unit of the cath lab shall be installed on a table in the cath lab control room. The computer, keyboard, and control command units are all components of the control unit. Typically, this table is supplied with the machine. In addition, a secondary computer shall be provided for transferring the images and videos that were taken throughout the procedure. Finally, a computer, UPS, and printer shall be given to generate the report and the procedure notes. There shall be a separate table available to accommodate this computer unit. There shall be enough revolving chairs in the room. The room shall have enough electrical outlets to connect the computers, devices, and other equipment to the power source. Other than this, the room shall have the required communication ports.

11.1.2.3 UPS Room See Table 11.4. The UPS room shall have a sufficient number of battery installation racks. The UPS room shall be provided with an exhaust system since the acid in the batteries could occasionally produce fumes. It is important to earth the UPS to the ground. The main power supply cables shall terminate and be connected to the UPS in the UPS room. The output cables from UPS are in turn connected to the main cath lab machine. There shall be enough electrical outlets in the room to connect the UPS and other devices to the power source. Other than this, the room shall have the required communication ports. The room shall be properly air-conditioned, with a temperature between 17 and 20 °C and the RH of no more than 40% due to the high heat output of the UPS. 11.1.2.4 Change Rooms for Patients See Table 11.5. A sufficient number of personal lockers shall be provided in the changing area for patients to store their items. Table 11.4  UPS room cath lab

Activity Racks to install batteries Exhaust fans Air-conditioned Required electrical points Required main switch and cable

Start date :::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

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11  Other Investigations and Procedures

Table 11.5  Change room for patients in cath lab

Activity Separate change rooms for males and females Lockers to keep the personal belongings of patients One chair and cupboards Hooks on the wall to hang clothes Cabinet to keep sterilized dresses Hanger rods Bin to collect dirty linen

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

:-

:::::-

Additionally, a chair shall be provided in the changing room so that the patient can use it while changing clothes. The wall shall have a sufficient number of hooks installed for hanging outdoor clothing. In addition, an almirah and hanger rods with hooks shall be available for hanging clothing. The sterilized patient gowns shall be kept in a locked cabinet. The cabinet shall include shelves on which various types and sizes of clothing can be arranged. There shall also be a sizable container for collecting used linen in the change room.

11.1.2.5 Change Rooms for Staff See Table 11.6. There shall be enough personal lockers in the room for people to store their possessions. Preferably, one of these lockers shall be assigned to each employee. The personnel shall have access to one chair in the room to utilize while changing clothes. There shall be enough hooks on the wall to hang outdoor clothing. In addition, an almirah and hanger rods with hooks shall be available for hanging clothing. The sterilized garments shall be kept in a locked cabinet. The cabinet shall include shelves on which various types and sizes of clothing can be arranged. A single table shall be placed in the space to house the containers of unused masks and caps. The changing area shall have a large bin for dirty clothes. Additionally, a separate bin shall be provided for the disposal of discarded masks, caps, and shoe covers. The room shall be equipped with an intercom and have sufficient air conditioning.

11.1  Coronary Catheterization (Cath Lab)

399

Table 11.6  Change rooms for staff in cath lab

Activity Separate change rooms for males and females Attached toilet shall have the provision of a bath with each changing room Staff lockers to keep the personal belongings One chair and cupboards Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep sterilized dresses Hanger rods Bin to collect dirty linen Intercom point Air-conditioned

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::-

:::::::::-

11.1.2.6 Cath Lab Waiting Lobby See Table 11.7. The cath lab’s waiting area shall be fully air-conditioned with a heating and cooling system. The waiting lobby needs to be properly guarded, and CCTV cameras and fire alarms shall be provided for security purposes. There shall be enough speakers in the waiting area with clear voices so that people can hear the announcements. In the waiting area, proper, comfortable seats with backrests shall be available. Please stay away from backless benches; they are uncomfortable to sit on. It shall be preferable if sofa sets are given. However, the VIP waiting rooms shall certainly contain a sofa set and centre tables. Specialized seats shall be made available for bariatric patients. The furnishings of the waiting spaces shall be attractively designed for an appealing appearance. Mirrors, murals, painted textures, or wall coverings shall be used to decorate the walls. The ceiling shall be ornamental as well. Decorative lighting fixtures are also required. The interior design shall take into account the use of colour, textures, surface treatments, fixtures, fittings, furniture, and artwork. Televisions, magazine racks, newspaper racks, and other entertainment options shall be provided in the waiting areas for patients and visitors to use.

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11  Other Investigations and Procedures

Table 11.7  Waiting area for cath lab

Activity Proper heating and air conditioning Security features like CCTV Announcement systems Waiting chairs/sofa set Television Signage and wayfinding system Interactive displays Mobile charging points Free internet or Wi-Fi facility Handrails at the staircase and other areas Required electrical outlets Other communication points

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::::::-

::-

Wayfinding and signage shall be highly visible and glowable so that visitors and patients can readily recognize the passages and routes. Additionally, there shall be mobile charging points in the waiting area. Furthermore, if it is possible, free internet or Wi-Fi service can be provided. Provide the appropriate safety precautions for the patients’ and visitors’ safety, such as handrails, non-slip surfaces, non-steep slopes, handicapped bathrooms, and wheelchair accessibility.

11.1.2.7 Stores for Unused Disposables and Consumables See Table 11.8. The cath lab complex’s medicines, consumables, and disposables store shall have enough lockable cabinets, racks, and drawers to accommodate the material. A refrigerator shall be provided to store low-temperature-requiring medications. There shall be a trash can available for the disposal of the covers, empty boxes, and wrappers. The space shall have adequate air conditioning and humidity levels that are under control. The room’s temperature shall be between 17 and 21 °C.

401

11.1  Coronary Catheterization (Cath Lab) Table 11.8  Store for unused disposables and consumables in cath lab

Activity Lockable cupboards Racks Drawers Refrigerator Waste bin

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::-

Table 11.9  Store for records and DVDs in cath lab

Activity Lockable fireproof cabinet Lockable cupboards Racks Drawers

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

11.1.2.8 Store for Records and DVDs See Table 11.9. The department requires a store to keep the CDs and DVDs in addition to the patient’s other records and reports. The store shall have an adequate number of counters, cabinets, and drawers. It is preferable to offer a fireproof cabinet that can be locked to safeguard the DVDs from harm caused by fire. To reduce the risk of a fire started by sparking, such a store shall have a light switch outside the room and only one light shall be provided in the store. The store shall be air-conditioned, and the room’s temperature shall be between 17 and 21 °C. 11.1.2.9 Consultation Rooms See Table 11.10. The following furniture shall be placed in the consultation room: • • • • • • •

Doctors’ table Side rack for doctor Doctors’ chair Two attendants’ chairs Examination couch Revolving patient stool with height adjustment Step stool

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11  Other Investigations and Procedures

Table 11.10  Consultation room in cath lab

Activity Provide the following furniture in the consultation room: Doctors’ table Doctors’ chair Revolving patient stool with height adjustment Two attendants’ chairs Examination couch Step stool Side rack for doctor Provide the following equipment/gadgets in the consultation room: BP instrument Stethoscope Torch Tongue depressor Weighing machine Finger pulse oximeter View box Intercom Computer with a printer and UPS Washbasin for hand wash Curtain partitions for the examination couch Provide windows if possible MGPS supply of oxygen, air, and suction if required Required electrical points Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::::::-

:::::::::::::-

::-

11.1  Coronary Catheterization (Cath Lab)

403

All the necessary equipment, gadgets, and instruments shall be provided like: • • • • • • •

BP instrument Stethoscope View box Torch Weighing machine Tongue depressor Finger pulse oximeter

An intercom shall be provided in the consultation room for inter-hospital communication. The computer and UPS shall all be available in the consultation room. The printer shall also be available if printing is necessary for the consultation room. Hand basins, soap dispensers, and towel racks shall all be present in the consultation room. The examination table shall have a hanging curtain separation on each of its three sides in the consultation room. The curtains shall be hung from a curtain track that hangs from the ceiling and is set 2134 mm above the floor. The curtain’s bottom shall have a clear area of 457 mm or so above the ground so that the floor can be easily cleaned. Biomedical waste management rules shall be introduced in the consultation room. Windows in the consultation room are preferred. However, direct sunlight shall be avoided. The glass of the window can be tinted or shall have blinds or drapes. The consultation room shall have the following electrical outlets: • The room’s main switchboard, along with one 5  Amp switch/socket, shall be placed at the entrance wall (a wall other than the wall on which the door shall open). • Button for controlling the air conditioner’s temperature. • On the wall above the examination table at 610 mm, there shall be one point of switch/socket for the examination light. • Two 5 Amp switch/sockets shall be installed on the wall 305 mm above the doctor’s examination table. Additionally, one 15 Amp switch/socket shall be supplied for other appliances. • There shall be three 5 Amp switch/sockets for the computer and printer installed above the doctor’s side rack at a height of around 305 mm. There shall also be one 15 Amp switch/socket next to this for additional equipment or a heater. The consultation room shall have the following communication points: • RJ 45 to be used for computer networking • RJ 11 for the intercom and extension lines • USB for extra devices or charging mobile phones

404

11  Other Investigations and Procedures

11.2 Audiometry Hearing functions are accessed through audiometry examinations. It evaluates difficulties with balancing, sound intensity, and tone, as well as other inner ear-related issues. It is necessary to use the specially constructed chamber for the audiometry test.

11.2.1 Location of the Audiometry Room This room shall be in the general movement area and close to the ENT OPD. No need for sterile or clean environments for this.

11.2.2 Infrastructure 11.2.2.1 Designing of Audiometry Room See Table 11.11. There shall be two partitions in the audiometry room. One shall be the patient room and the other the technician room. Both divisions shall be accommodated in the room, which shall be roughly 4267 mm × 4572 mm in size. A separate partition from this total room area shall be set aside for the technician’s room. A glass wall shall be placed between the technician’s room and the patient’s room. Alternatively, a brick wall can also be provided, which shall be plastered from both sides. Immediately upon entering the room, first shall be the technician room. And after that, the patient’s room shall be located. In between the technician’s room and the patient’s room, a glass window shall be provided, so that the technician can see through the patient while the procedure is in progress. Table 11.11  Designing of audiometry room

Activity Patient room Technician room Completely soundproof room Walls and ceiling with acoustic treatment Flooring with wooden planks Airtight room, so that outer sound can be avoided in the patient room

Status of works Start End In Not date date Complete progress started ::::::-

Responsible person Remarks

11.2 Audiometry

405

Wooden boards shall be used for the flooring. There shall be a main door which shall be about 1220 wide. Additionally, the entry door of the patient room shall be about 1000 mm wide. The door of the patient room shall be airtight to prevent outside noise from entering the patient room.

11.2.3 Services, Facilities, Equipment, Tools, and Instruments 11.2.3.1 Patient Room of Audiometry Unit See Table 11.12. A table shall be positioned directly beneath the glass pane that separates the patient room from the technician room in the audiometry patient room. The patient shall have a chair in the room. The patient room shall be totally echo- and soundproof. The walls and ceiling shall have acoustic treatment to make the space echo- and soundproof. On the wall and ceiling, a glass wool-filled wooden frame can be installed for acoustics. A fireproof fabric shall be fastened to the top. Another option is to instal wall panelling on the wall using panels that are specifically made to absorb sound and echoes. The space shall have enough electrical outlets for appliances. A call bell shall be placed close to the patient’s chair so that, in the event of any problems, the patient can use it to seek assistance. Additionally, the space shall be suitably air-conditioned. 11.2.3.2 Technician Room of Audiometry Unit See Table 11.13. Equipment-wise, the audiometry or impedance audiometer machines shall be installed in the technician’s room just below the glass window so that the technician can see the patient in the other room while the procedure is being performed. A chair for the technician shall be provided. Table 11.12  Patient room of audiometry unit

Activity Table just below the window that has been provided between the technician room and the patient room Chair Adequate electrical points Air conditioning Call bell

Status of works Start End In Not Responsible date date Complete Progress started person Remarks :-

::::-

406

11  Other Investigations and Procedures

Table 11.13  Technician room of audiometry unit

Activity Audiometer Impedance audiometer Working top below the partition window Chair Required electrical outlets Other communication points

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::-

The room shall have a sufficient number of electrical points to install the equipment, along with the required communication ports like RJ 45, RJ 11, and USB. The room shall also be adequately air-conditioned.

11.3 Polysomnography (Sleep Lab) Polysomnography (sleep study) is a test used to diagnose sleep problems. Throughout the study, it monitors eye and leg movements as well as the heart rate, blood oxygen level, and respiration. The room shall be in a quiet location where the patient will not be disturbed by outside sound or light because this study will be conducted when they are asleep.

11.3.1 Location of the Sleep Lab This room shall be located close to the IPD area of the hospital. No need for sterile or clean environments for this.

11.3.2 Infrastructure 11.3.2.1 Designing Room for Sleep Lab See Table 11.14. The sleep lab room shall have two different divisions. The patient sleep room shall be in one, while the technician room shall be in the other. Both divisions shall be roughly 4267 mm × 4572 mm in size overall. A separate partition shall be set aside from this total room area for the technician room. A glass divider shall be placed between the technician’s room and the patient’s sleeping area. Alternatively, a brick wall can also be provided, which shall be plastered from both sides.

407

11.3  Polysomnography (Sleep Lab) Table 11.14  Designing the room for the sleep lab

Activity Patient sleeping room Technician room Completely soundproof room Walls and ceiling with acoustic treatment Flooring with wooden planks Airtight room, so that no outer sound can enter the patient room

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::::-

Table 11.15  Patient sleeping room of sleep lab

Activity Table just below the window that has been provided between the patient room and the technician room Patient bed Adequate electrical points Air conditioning Call bell

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

::::-

Immediately upon entering the room, first shall be the technician room. And after that, the patient’s sleeping room shall be located. The main door shall be about 1220 wide, whereas the entry door of the patient room shall be about 1000 mm wide. The door of the patient room shall be airtight to prevent outside noise from entering the patient room. Some hospitals prefer to carry out this procedure in a private, single-occupancy room because this machine is typically movable. If setting up a separate room is not possible, this alternative can be used.

11.3.3 Services, Facilities, Equipment, Tools, and Instruments 11.3.3.1 Patient’s Sleeping Room See Table 11.15.

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11  Other Investigations and Procedures

Table 11.16  Technician room of sleep lab

Activity Polysomnography machine Working top below the glass window Chair Required electrical points Other communication points

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

The technician shall be able to readily see the patient from the glass window that has been given between the patient’s sleep room and the technician’s room. The patient’s sleep room shall also contain a comfortable bed for the patient to sleep on. The patient’s room shall be absolutely soundproof and have a modest amount of darkness because the patient is anticipated to sleep well throughout the procedure. The space shall have enough electrical outlets for appliances. A call bell shall be placed next to the patient’s bed so that they can seek assistance, if necessary, in the event of an emergency. Additionally, the space shall have functioning air conditioning and dimmable lighting.

11.3.3.2 Technician Room See Table 11.16. The polysomnography machine shall be installed in the patient’s room on the working slab provided right below the glass window so that the technician can observe the patient in the other room while the process is going on. The technician’s chair shall be provided. The room shall have a sufficient number of electrical points to install the equipment, along with the required communication ports like RJ 45, RJ 11, and USB. The room shall also be adequately air-conditioned.

11.4 Dialysis The dialysis procedure with the help of an artificial kidney or so-called dialyser filters out metabolic waste products and removes excess water from the blood, hence reducing the creatinine and urea levels in the body.

409

11.4 Dialysis Table 11.17  Designing the dialysis unit

Activity Dialysis procedure room Room for dialyser wash Store for unused disposables and consumables Change rooms for patients Change rooms for staff Dialysis waiting lobby Consultation room RO plant room

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::-

:::::-

11.4.1 Location of the Dialysis Unit A separate location in the hospital is required for haemodialysis. The following considerations shall be made when planning the room for dialysis. Dialysis units shall be sterile and hygienic, ideally close to the department of nephrology.

11.4.2 Infrastructure 11.4.2.1 Designing of Dialysis Unit See Table 11.17. Dialysis Procedure Room The number of dialysis machines that are to be currently installed, as well as any future plans to add more machines, shall determine the size of the dialysis room. The dialysis of the positive patients shall be performed in a separate room and under no circumstances shall they be combined with ordinary patients. Additionally, the equipment shall be separate for patients who are detected positive. Each dialysis equipment shall have a minimum of 13.94 sq. m of area. For flooring, ceramic tiles, marble, or granite can be used. However, the flooring shall not be slippery to avoid mishaps and injury to the patient or visitors. Dialyser’s Wash Room A dialyser wash room attached to the dialysis room is a place where the dialyser washer shall be installed. The wash room for the dialyser shall have a working top and a sink. The size of the room shall be about 3048 mm × 3048 mm.

410

11  Other Investigations and Procedures

Store for Unused Disposables and Consumables Dialysis procedures necessitate the use of numerous consumable materials such as dialysers and dialysis fluid part A and part B. As a result, a sufficient supply of these consumables shall be kept in stock in the dialysis unit. The department requires a store to stock these items. This store shall be 4267 mm × 3658 mm in size. However, the size may vary depending on the number and quantity of products. Change Rooms for Patients It can be difficult to perform the procedure on occasion due to the patient’s clothing. As a result, change rooms shall be provided near the dialysis procedure room to let patients remove their outer clothing and change into hospital clothing. The size of the change room shall be approximately 3658 mm × 3658 mm. Change Rooms for Staff To help the doctors and personnel change into sterile hospital clothing, several changing rooms shall be provided in the dialysis unit. For various staff member categories, different changing facilities shall be provided. Additionally, the male and female changing rooms shall be separate. Change rooms shall be provided in the dialysis unit for the following: 1. Doctors’ change room—males 2. Doctors’ change room—females 3. Nurses/technicians’ change room—males 4. Nurses/technicians’ change room—females 5. Class IV staff change room—males 6. Class IV staff change room—females Infrastructure-wise, the room’s dimensions shall be roughly 3658 mm × 3658 mm. A toilet facility with an attached bathing area shall be provided in addition to the changing area. Waiting Lobby of Dialysis Families of patients undergoing dialysis procedures shall have a private waiting area near the dialysis procedure room in the dialysis unit. The number of people who can wait in this lobby may be limited, and there shall be enough space between the seats. The size of the waiting lobby shall be determined by the number of people who are most likely to be seated there. Consultation Room Anxious families and friends of the patient always want to meet and speak with the treating nephrologist to learn more about the patient’s illness and its progression. Consultation rooms shall thus be provided near the dialysis procedure room. The nephrologist enters that room, calls the patient’s relatives, and speaks with them there. This space shall be approximately 4572 mm × 4267 mm.

11.4 Dialysis

411

RO Plant Room RO water is an essential element to perform the dialysis procedure. Hence, near all dialysis machines, the RO water supply shall be provided. To supply water, the RO plant needs to be installed. The RO plant can be installed either on the roof of the hospital or within the dialysis unit. If it has to be installed in the dialysis unit, a separate room shall be provided to install the RO plant and also storage tank for the treated water. The room’s size shall be approximately 3658 mm  ×  3658  mm. However, depending on the size of the RO plant, the size of the room can be altered as per the recommendations of the manufacturer of the RO plant.

11.4.3 Services, Facilities, Equipment, Tools, and Instruments 11.4.3.1 Dialysis Procedure Room See Table 11.18. All dialysis machines are installed in this area as primary equipment. These machines are typically arranged in a row with at least 1829 mm between the two dialysis units. Between the two machines are dialysis chairs. Dialysis chairs shall be at least 610 mm ahead of the wall. The dialysis procedure room shall have medical equipment such as: • • • • • • • • • • • • • •

BN ProSpec and BN II nephelometer system Multi-parameter vital sign monitor Syringe pump Defibrillator BP apparatus Stethoscope Colorimeter Dialysis chairs Self-illuminating microscope ECG machine Glucometer Oxygen cylinders with masks Ambu mask of different sizes Oxygen cylinder trolley Similarly, the room shall have the following furniture:

• • • • • •

Bedside locker Stretcher trolley Wheelchair Instrument trolley Crash cart with emergency medicines, consumables, and disposables IV rod

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Table 11.18  Dialysis procedure room

Activity Dialysis machines BN ProSpec and BN II nephelometer system Multi-parameter vital sign monitor Syringe pump Defibrillator BP apparatus Stethoscope Colorimeter Dialysis chairs Self-illuminating microscope ECG machine Glucometer Oxygen cylinders with masks Ambu mask of different sizes Shall have the furniture like: Bedside locker Stretcher trolley Wheelchair Instrument trolley Crash cart with emergency medicines, consumables, and disposables IV rod IV stand Oxygen cylinder trolley Dialysis unit shall have the following tools/instruments: Sterilizing drums Instrument boxes Extension cords and boxes Tray of all styles and sizes Refrigerator Torches All other required instruments

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::::::::::-

:::::-

:::-

:::::::-

413

11.4 Dialysis Table 11.18 (continued)

Activity Other issues Required electrical points Proper ground earthing for each machine Other communication points On the backside of each dialysis machine, point for RO water supply Drain points on the floor for each dialysis machine Provide two-bay scrub stations for hand hygiene MGPS outlets for oxygen, vacuum, and air Bed head panels for MGPS and electrical points Brackets for mounting multi-parameter monitor Provision for nurse call system on each bed Curtain partitions on all the beds of the post-operative ward Nursing station in the dialysis unit shall have: Nursing counter Almirah/cupboard Filing cabinet Office chairs

Status of works In Not Responsible Start End Remarks date date Complete progress started person ::::-

:-

:-

:-

:-

:-

::-

::::-

• IV stand • Oxygen cylinder trolley The dialysis procedure room shall also have the required tools and instruments like: • Sterilizing drums • Instrument boxes

414

• • • • •

11  Other Investigations and Procedures

Extension boxes and cord Tray of all styles and sizes Refrigerator Torches All other required instruments

There shall be separate power outlets available for each dialysis machine. These points shall be on the wall behind the machine, 457 mm high from the ground. All of these outlets shall have UPS power as a backup. Dialysis equipment shall have the proper grounding features. Similarly, the room shall also have the necessary communication ports. As mentioned earlier, each machine shall have an individual supply line of RO water. This line shall terminate on the wall behind the dialysis machine and shall be at a height of about 610 mm from the floor level. Please remember to make a distance between the electrical point and the RO water outlet. A suitable gate valve shall also be provided on the RO water outlet. The water drain points shall be provided for all the machines separately. This drain point shall be behind the machine and can be provided on the floor just below the RO water supply outlet. The drain point shall be duly covered with the drain grating. Outside the procedure room, a double-bay hands-free scrub station shall be provided for hand hygiene. Regular LEDs with sufficient brightness shall be used for lighting. There is no requirement for extra lighting in the area. The dialysis procedure room shall be adequately air-conditioned, and the temperature of the room shall be between 17 and 21 °C, with a maximum humidity limit of 40%. The environmental requirements shall be confirmed with the equipment supplier before the RH level or temperature is set, as some machines may need different environmental standards. Medical gas supply ports shall be provided within the dialysis procedure room. There shall be one oxygen outlet, one vacuum outlet, and one air outlet for each dialysis machine. These outlets and electrical ports can be installed using either the bed head panel or, if space allows, the hanging pendant. A bracket shall be put on the wall above the dialysis chair to mount the multi-­ parameter vital sign monitor. A nurse call system point shall be installed near each dialysis chair, which the patient can use if he/she requires assistance. In the dialysis room, a hanging curtain partition covering each of the dialysis chair’s three sides shall be provided. Curtains shall be hung from a ceiling-mounted curtain track 2134 mm above the ground. A space shall be left clear at the bottom of the curtain, approximately 457 mm above the ground, so that the floor may be readily cleaned. Biomedical waste management shall be introduced in the dialysis room. The nursing station (if provided) in the dialysis room shall have the following:

11.4 Dialysis

• • • • • •

415

Nursing counter Office chairs Filing cabinets Racks Computer with UPS Printer

11.4.3.2 Room for Dialyser Wash See Table 11.19. A dialyser wash room, where the dialyser washer is installed, shall have sufficient space for the installation of the washer. Before designing the space, the specification of the machine shall be taken from the original manufacturer of the washer. Stainless steel bins shall be provided on one of the walls to store the washed dialysers until they are dry. The bins shall be 160 mm H × 150 mm W × 400 mm D in dimension. A total of 25–40 dialysers shall be required. The proper electrical outlet shall be provided to power the dialyser washer. Similarly, the washer’s water supply and drain shall be given following the manufacturer’s recommendations. Additionally, a point of RO water supply shall be provided to clean dialysers. 11.4.3.3 Stores for Unused Disposables and Consumables See Table 11.20. The store shall have enough worktops, cupboards, and drawers. Lockable stainless steel containers shall be supplied on one of the walls for storing used dialysers for reuse. The bins shall be 160 mm H × 150 mm W × 400 mm D in dimension. Provisions shall be made for 40–60 dialysers. The space shall have a granite-topped work surface. This worktop shall be used to prepare the solution as well as for other purposes. A refrigerator shall be supplied for the storage of low-temperature medications. Table 11.19  Room for dialyser wash

Activity Space for dialyser washer Required electrical points in OPD Stainless steel bins mounted on the wall for placing dialysers after wash Water outlet for dialyser wash Water drains for dialyser washer

Status of works Start End In Not date date Complete progress started :::-

::-

Responsible person Remarks

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Table 11.20  Stores for unused disposables and consumables for dialysis unit Status of works Start End In Not Responsible date date Complete progress started person Remarks

Activity Lockable cupboards Racks Drawers Working countertops Lockable stainless steel bins on walls for keeping the used dialysers for reuse Refrigerator Waste bin

:::::-

::-

Table 11.21  Change rooms for patients in the dialysis unit

Activity Separate change rooms for males and females Lockers to keep the personal belongings of patients One chair and cupboards Hooks on the wall to hang clothes Cabinet to keep sterilized dresses Hanger rods Bin to collect dirty linen

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

:-

:::::-

A waste bin shall be provided for the disposal of the covers, empty boxes, and wrappers. The room shall have proper air conditioning with a temperature range of 17–21 °C and humidity levels that are controlled.

11.4.3.4 Change Rooms for Patients See Table 11.21. A sufficient number of personal lockers shall be provided in the changing area for patients to store their items. Additionally, a chair shall be provided in the changing room so that the patient can use it while changing clothes. The wall shall have a sufficient number of hooks installed for hanging outdoor clothing.

417

11.4 Dialysis

In addition, an almirah and hanger rods with hooks shall be available for hanging clothing. The sterilized patient gowns shall be kept in a locked cabinet. The cabinet shall include shelves on which various types and sizes of clothing can be arranged. There shall also be a sizable container for collecting used linen in the change room. The changing room shall also be air-conditioned.

11.4.3.5 Change Rooms for Staff See Table 11.22. There shall be enough personal lockers in the room for people to store their possessions. Preferably, one of these lockers shall be assigned to each employee. The personnel shall have access to one chair in the room to utilize while changing clothes. There shall be enough hooks on the wall to hang the outdoor clothing. In addition, an almirah and hanger rods with hooks shall be available for hanging clothing. The sterilized garments shall be kept in a locked cabinet. The cabinet shall include shelves on which various types and sizes of clothing can be arranged. A single table shall be placed in the space to house the containers of unused masks and caps. Table 11.22  Change room for staff in the dialysis unit

Activity Separate change rooms for males and females Attached toilet shall have the provision of a bath with each changing room Staff lockers to keep their personal belongings One chair and cupboards Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep sterilized dresses Hanger rods Bin to collect dirty linen Intercom point Air-conditioned

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::-

:-

::::::::-

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11  Other Investigations and Procedures

The changing area shall have a large bin for dirty clothes. Additionally, a separate bin shall be provided for the disposal of discarded masks, caps, and shoe covers. The room shall be equipped with an intercom and have sufficient air conditioning.

11.4.3.6 Dialysis Waiting Lobby See Table 11.23. The waiting area of the dialysis unit shall be fully air-conditioned with a heating and cooling system. The waiting lobby shall be properly guarded, and CCTV cameras and fire alarms shall be provided for security purposes. There shall be enough speakers in the waiting area with clear voices so that people can hear the announcements. In the waiting area, proper, comfortable seats with backrests shall be available. Please stay away from backless benches, as they are uncomfortable to sit on. It shall be preferable if sofa sets are given. However, the VIP waiting rooms shall certainly contain a sofa set and centre tables. Specialized seats shall be made available for bariatric patients. The furnishings of the waiting spaces shall be attractively designed for an appealing appearance. Mirrors, murals, painted textures, or wall coverings shall be used to Table 11.23  Waiting lobby of the dialysis unit

Activity Proper heating and air conditioning Security features like CCTV Announcement systems Waiting chairs/sofa set Television Signage and wayfinding system Interactive displays Mobile charging points Free internet or Wi-Fi facility Handrails at the staircase and other areas Required electrical ports Other communication points

Status of works Start End In Not date date Complete progress started ::::::::::-

::-

Responsible person

Remarks

11.4 Dialysis

419

decorate the walls. The ceiling shall be ornamental as well. Decorative lighting fixtures are also required. The interior design shall take into account the use of colour, textures, surface treatments, fixtures, fittings, furniture, and artwork. Televisions, magazine racks, newspaper racks, and other entertainment options shall be provided in the waiting areas for patients and visitors to use. Wayfinding and signage shall be highly visible and glowable so that visitors and patients can readily recognize the passages and routes. Additionally, there shall be mobile charging points in the waiting area. Furthermore, if it is possible, free internet or Wi-Fi service can be provided. Provide the appropriate safety precautions for the patients’ and visitors’ safety, such as handrails, non-slip surfaces, non-steep slopes, handicapped bathrooms, and wheelchair accessibility.

11.4.3.7 Consultation Rooms See Table 11.24. The following furniture shall be placed in the consultation room: • • • • • • •

Doctors’ table Side rack for doctor Doctors’ chair Two attendants’ chairs Examination couch Revolving stool with height adjustment for patient Step stool All the necessary equipment, gadgets, and instruments shall be provided like:

• • • • • •

BP instrument Stethoscope View box Torch Weighing machine Finger pulse oximeter

An intercom shall be provided in the consultation room for inter-hospital communication. The computer, printer, and UPS shall all be available in the consultation room. The printer shall also be available if printing is necessary for the consultation room. Hand basins, soap dispensers, and towel racks shall all be present in the consultation room. The examination table shall have a hanging curtain separation on each of its three sides in the consultation room. The curtains shall be hung from a curtain track that hangs from the ceiling and is set 2134 mm above the floor. The curtain’s bottom shall have a clear area of 457 mm or so above the ground so that the floor can be easily cleaned.

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Table 11.24  Consultation rooms of dialysis unit

Activity Provide the following furniture in the consultation room: Doctors’ table Doctors’ chair Revolving stool with height adjustment for patient Two attendants’ chairs Examination couch Step stool Side rack for doctor Provide the following equipment/gadgets in the consultation room: BP instrument Stethoscope Torch Weighing machine Finger pulse oximeter View box Other issues Intercom Computer with a printer and UPS Washbasin for hand wash Curtain partitions for the examination couch Provide windows if possible Required electrical points Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::-

::::-

:::::::::::::-

Biomedical waste management shall be implemented in the consultation room. Windows are preferred in consultation rooms. Direct sunlight, on the other hand, shall be avoided. The window glass can be tinted or have blinds or drapes installed. Electrical points that shall be provided in the consultation room: • The main switchboard for the room, as well as one 5 Amp switch/socket, shall be installed on the room’s entrance wall (a wall other than the wall on which the door shall open).

Further Reading

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• Button for adjusting the temperature of the air conditioner. • One point of switch/socket for the examination light shall be located on the wall 610 mm above the examination table. • Two 5 Amp switch/sockets shall be installed on the wall 305 mm above the doctor’s examination table on the wall. In addition, one 15 Amp switch/socket shall be provided for other appliances. • Three 5 Amp switch/sockets for the computer and printer shall be installed above the doctor’s side rack at a height of approximately 305 mm. There shall also be one 15 Amp switch/socket nearby for additional equipment or power. The following communication points shall be provided in the consultation room: • RJ 45 for computer networking • RJ 11 for the intercom and extension lines • USB for extra devices or charging mobile phones All other investigation/procedure rooms (not specifically described in this chapter) shall be the standard rooms. However, the rooms shall be adequate in size and designed based on the manufacturer’s recommendation and the number of such machines to be installed, as well as the number of people occupying the room. The room must be dust-free and clean; proper electrical and communication points shall be provided for the machines; and proper environmental conditions shall be maintained following the equipment manufacturer’s specifications. All other infrastructure requirements specified by the machine’s manufacturers shall be met.

Further Reading Anon. Setting up of hemodialysis unit. Indian J Nephrol. 2020;30(7):1. Bower SB. Dialysis facility design—part I: Developing a strategic and financial plan. Dial Transplant. 2006;35(8):532–43. Cardiovascular Business. Planning for the ideal cath lab requires the multidisciplinary approach [Internet]. [cited 2021 Jul 7]. Available from: https://www.cardiovascularbusiness.com/topics/ coronary-­intervention-­surgery/planning-­ideal-­cath-­lab-­requires-­multidisciplinary-­approach. Cath Lab Digest Cardiac Catheterization Laboratory Facility Design and Equipment Selection [Internet]. HMP Global Learning Network. [cited 2021 Jul 7]. Available from: https://www. hmpgloballearningnetwork.com/site/cathlab/articles/Cardiac-­Catheterization-­Laboratory-­ Facility-­Design-­and-­Equipment-­Selection. DAIC. Predicting the cath lab of the future. DAIC. 2012 [cited 2021 Jul 7]. Available from: https:// www.dicardiology.com/article/predicting-­cath-­lab-­future. Garg A, Dewan A. Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. Chapter 25, Other investigations & procedures. p. 287–96.

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Hendry C, Rashid R. Catheter laboratory design, staffing and training. In: Watson TJ, Ong PJ, Tcheng JE, editors. Primary angioplasty: a practical guide. Singapore: Springer; 2018. p. 69–81. https://doi.org/10.1007/978-­981-­13-­1114-­7_6. [cited 2021 Jul 7]. McGeary D. Catheterization laboratories. Biomed Instrum Technol. 2008;42(1):49–52. Pontoriero G, Tetta C, Wratten ML, Locatelli F.  Design and quality assurance of new dialysis centers. Saudi J Kidney Dis Transplant. 2001;12(3):413. Rajhans N, Sardar V, Sajgure A. Design of wearable dialysis unit. In 2017.

Radiation Therapy

12

Radiation therapy (RT) is an oncology department speciality that treats cancer with radioactive rays generated by a linear accelerator (LINAC). External beams of radioactive waves cause damage to specific malignant cells. High-energy waves, such as gamma rays, electron beams, X-rays, or protons, are accelerated in the LINAC resulting in destroying or damaging the cancer cells. The radiation therapy unit consists of equipment for radiotherapy treatment. In the radiation oncology unit, the areas are allocated for patient consultation, treatment simulation and planning, and treatment administration. Treatment areas for external and internal radiotherapy (brachytherapy) are typically found in the radiation oncology unit. The main issue with establishing the radiation unit is building bunkers to house the machines. Bunkers shall effectively limit the spread of radiation beams outside of the bunker. This checklist shall assist the planner and designer in remembering all such issues relating to bunker design as well as other space requirements and shall guide him/her to complete, test, and commission all works/activities on time. This shall assist him/her in ensuring that all work/activities are executed, complete, and operational before operationalizing the radiation therapy department.

12.1 Location of Radiotherapy Unit There are two main machines in the radiotherapy department. The first is the linear accelerator (LINAC), and the second is brachytherapy. These machines shall be installed in bunkers due to the high radiation levels. What is a bunker, exactly? A bunker is made of high-density RCC materials like concrete or steel. The wall thickness of the bunker is generally 1200  mm. Similarly, the roof is 1200  mm thick. Another significant issue is that the LINAC is a massive machine, weighing between

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_12

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8 and 9 tonnes. As a result, to withstand such a load, the flooring shall be extremely strong. The bunker usually takes up 1.5 floors all the way to the top. Given the aforementioned considerations, the bunkers shall not be provided on any upper floors. It shall be on the building’s ground floor. It is preferable, however, if the bunkers are located in the basement. Because of the soil filled along the bunker walls, the basement has the added benefit of reducing the wall thickness. As radiations penetrate the filled-up soil, the thickness of the bunker’s outer walls decreases as they are exposed to the outside surface, where the soil is backfilled. As a result, the radiotherapy department, particularly the bunkers, shall be on the ground floor or in the basement. If basements are chosen, proper access and road connectivity to the bunker site are required because the machine has to be transported to the bunker for installation. Outpatients, including those with disabilities, as well as those arriving by patient transfer services and ambulances, and inpatients in wheelchairs and on beds or trolleys shall have easy access to the unit.

12.2 Infrastructure When planning the layout of the radiation therapy facilities, factors such as equipment requirements, water and electrical utilities, room shielding (including dosimetry ports), and climate control shall be considered. The patient flow in the treatment facility shall be closely monitored. The layout shall be designed in collaboration with the radiation oncologist, physicist, and equipment manufacturer following internationally recognized radiation safety standards. The appropriate drawings can be prepared in consultation with the original equipment manufacturer and with advice on room construction and shielding.

12.2.1 Utility Area See Table 12.1.

12.2.1.1 Entrance to the Department The radiation department shall ideally have its entrance separate from the main hospital. If not, the entrance to this department shall be secured, and no unauthorized person shall be permitted to enter. This department’s entrance doors shall be at least 1829 mm wide, having two doors that open on both sides. Sensor-controlled glass doors are another option for automation. An airlock connecting external and internal areas shall be provided. This can be accomplished by placing a set of two doors at a distance of 1829 mm apart. The goal is to reduce infection rates while maintaining air conditioning temperature and air pressure from internal to external areas. Air curtains can be provided if necessary to prevent outside air contaminants such as dust from entering the building.

425

12.2 Infrastructure Table 12.1  Utility area of radiation therapy

Activity Has the spaces for the following been provided for? Entrance to the department Reception and enquiry Registration Billing/cash counters Waiting and sub-waiting Record room General store room Clean store Consultation rooms Sample collection room Interview/meeting/ counselling rooms Dirty utility Equipment storage room Medicine and drug storeroom Public utility for faculty Public utility for patients and attendants Drinking water facility

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::::::::::::-

:-

A disembarkation area for ambulances shall be provided outside the radiotherapy department’s entrance. A porch, preferably, shall be provided at the entrance gate to provide shelter from inclement weather. The porch shall be at least 4572 mm above the road level and wide enough to allow two vehicles to pass at the same time. A trolley bay shall be provided outside the lobby for the parking of wheelchairs and stretcher trolleys so that patients arriving on the porch can use them.

12.2.1.2 Reception and Enquiry As soon as the patient initially enters the radiotherapy department, they shall come into contact with the receptionist. The receptionist shall be available to provide

426

12  Radiation Therapy

visitors and patients with all necessary information, make appointments, guide them through the registration process, describe how to consult the physicians, gather reports, and direct them to the appropriate consultation/investigation/treatment section. The reception area shall be in an easily accessible location. If necessary, a help desk shall be provided in addition to the reception area to assist patients and visitors in resolving their questions and guiding them.

12.2.1.3 Registration and Cash Counter The registration counter shall be next to the reception desk. The patient is registered for a consultation or radiotherapy treatment at the registration counter. Prepare the consultation form, accept payment, issue the token number, and assist the patient in taking a seat. Case records are kept in the registration department of some hospitals, and patients are given a small card with their registration number. Each time the patient visits the hospital, the case record shall be taken out and sent to the physician for consultation. This is the responsibility of the registration counter. If patient traffic is high, a separate cash counter shall be provided, ideally 1829 mm away from the registration counter. Because the reception and registration counters may have a large number of documents to store, including fresh unused stationery, a small record room or storage room shall be located near the reception and registration counters. This room shall ideally be on the opposite side of these counters. A billing counter shall be provided for patients undergoing consultation, investigation, or treatment. If the hospital is large, the registration, billing, and cash counters shall be separate. However, depending on the need, the counters in medium- and small-sized hospitals can be combined. In terms of the cash counter, it shall be separate and properly enclosed for the safety of the cash and the cashier. Along with the cash register, a small safe room where the cashier can keep excess cash shall be provided. However, if the hospital has a policy of collecting cash from the counter, the strong room can be avoided very frequently. There shall be enough open space for patients and visitors to queue while they wait for reception, registration, billing, and cash payment services. Queuing areas shall be separate for each counter. 12.2.1.4 Waiting Lobby The patient shall wait for their turn before being taken up for the consultation/investigation/treatment. As a result, a waiting area shall be provided for them to wait. While determining the size of the waiting area, the number of patients and the typical length of the investigation shall be considered. Smaller waiting areas are preferred over larger ones after COVID-19. When designing waiting areas, the social distance design principle shall be followed. Sub-waiting areas shall also be planned for and designed. Separate sub-waiting areas are preferred for consultation. Similarly, separate sub-waiting areas shall be provided for investigation and treatment. Such measures may not always be feasible, particularly in smaller hospitals, nursing homes, clinics, and so on.

12.2 Infrastructure

427

12.2.1.5 Record Room A record room in the radiotherapy department shall be provided to store the records, such as files, registers, and stationery. The record room shall be approximately 3658 mm × 3658 mm in size. 12.2.1.6 Store All current equipment, supplies, consumable materials, medical disposables, and other items shall be adequately stored in the department. Storage for personal items belonging to staff, patients, and visitors shall also be provided. Equipment and supplies shall be stored as close to the point of use as possible. The store shall be as secure as possible, free of moisture, termite-proof, and fire-resistant. If the hospital is medium to small in size, the general store and the record room can be combined. The size of the storeroom shall typically depend on the requirement and the number of items to be stored. 12.2.1.7 Clean Store The department requires a storage facility for clean and sterilized items such as lines, consumables, and disposables. As a result, the radiotherapy department shall have a clean store. The dimensions of this store shall be 3658  mm  ×  3658  mm, though this can be adjusted depending on the number and quantity of items to be stored. The room shall have no windows or other sources of direct sunlight, and the temperature shall be between 17 and 21 °C. 12.2.1.8 Consultation Room The radiotherapy department shall have the necessary consultation rooms where patients can consult with doctors about their future treatments and treatment protocols. This is the room where the physicians attend to the patients, take histories, examine the patient, diagnose the disease, give advice to the patient, prescribe medication, order investigations, and clear any doubts of the patient or visitors. During normal working hours, the consultation chamber or room is the first point of contact between the patient and the physician. The size of the consultation department shall be approximately 4572  mm  ×  4267  mm. However, the size of the room can be altered depending on the requirement and the availability of the space. Some specialities, such as surgical oncology, may necessitate a thorough examination by the physician before making a decision. With such specialities, a separate examination and procedure room attached to the main consultation room may be required. The examination shall be approximately 3048 mm × 3048 mm in size. Some supporting rooms are also required in addition to the consultation rooms. Although these rooms do not provide direct consultation, they do provide assistance and backup to the doctors performing the OPD. Before the patient enters the physician’s consultation chamber, it is common to take vitals such as blood pressure, SPO2, pulse, weight, and height. As a result, near the registration counter, the vital sign examination room shall be located.

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12.2.1.9 Sample Collection Room The sample collection room shall be located within or near the radiation therapy department for patients’ blood and other specimens to be collected for clinical laboratory testing. The size of the room shall be determined by the number of samples to be drawn as well as the type of investigations usually performed at the hospital. However, the dimensions shall not be less than 3048 mm × 3048 mm. 12.2.1.10 Interview/Meeting/Counselling Room Some patients may require an interview/meeting/counselling to explain their disease, the prognosis of the disease, and precautions and may require counselling at the time of admission. As a result, interview/meeting/counselling rooms shall be provided within the radiation therapy department. The room shall be 4267 mm × 3658 mm in size. 12.2.1.11 Dirty Utility This room shall also be provided in the radiation therapy department’s consultation and treatment blocks to store soiled linen and other waste generated from the consultation chambers, investigation rooms, and treatment rooms. The room’s dimensions shall be approximately 1238 mm × 1238 mm. 12.2.1.12 Equipment Storage Room An equipment storeroom shall be provided in the radiation therapy department to store unutilized medical equipment and instruments. The room’s dimensions shall be 4572  mm  ×  4267  mm. However, depending on the situation, the size can be adjusted. 12.2.1.13 Medicine and Drug Storeroom If the medicines and drugs are distributed from the radiation therapy department, this room is required. This room shall resemble a small pharmacy. The dimensions could be 3048 mm × 3048 mm. However, the size can be adjusted if necessary. 12.2.1.14 Public Utilities for Staff, Patients, and Attendants Toilet facilities shall be available in the utility area. There shall be separate male and female toilets. Additionally, a drinking water facility shall be provided.

12.2.2 Treatment and Planning Area See Table 12.2. Radiation Therapy Treatment Area External beam radiation therapy (LINAC) or internal beam radiation therapy (brachytherapy) shall be used for radiation treatment. The national regulatory authority shall licence the radiotherapy installation. Because a radiotherapy

429

12.2 Infrastructure Table 12.2  Treatment and planning area of radiation therapy

Activity Has the spaces for the following been provided for? Radiation bunkers for external beam radiation therapy (LINAC) LINAC control room Bunker for internal beam radiation therapy (brachytherapy) Brachytherapy control room Operating room attached to or near the brachytherapy bunker Metalling treatment planning equipment, mould room Mould workshop Medical physics laboratory Dosimetry planning room CT simulation Teletherapy unit Intracavitary treatment room Interstitial, endo-­ cavitary, surface mould therapy room Trolley bay Patient change room Doctors’ change Staff change Store Patient holding bay or waiting area Clean utility Dirty utility/sluice room Hand scrub station Toilet

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:-

::-

::-

:-

:::::::-

::::::::::-

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12  Radiation Therapy

installation necessitates extensive construction, regulatory authorities in the respective country or state shall provide authorization before construction can begin. As a result, the application for a licence shall be prepared at an early stage so that the construction is not delayed because of the approvals. It shall include all pertinent information to reassure the regulatory authority that the proposed facility shall be safe for the patients, health workers, and visitors.

12.2.2.1 Bunker for External Beam Radiation Therapy External beam radiation therapy is performed using the LINAC. LINAC typically generates an electron beam that is used to deliver radiation to cancer-affected tissues while sparing surrounding healthy tissue. These high-energy electron (particle) beam accelerators can kill malignant cells and tumours of various sizes and shapes. The external beam radiation therapy machine (LINAC) is installed in the bunkers. Bunkers are made of high-density RCC materials like concrete and steel. The wall thickness of the bunker is typically 1200 mm at the primary barriers. Similarly, the roof is 1200 mm thick at the primary barrier. The bunkers shall be built in the shape of a maze. The size of the bunkers shall be 7000 mm × 7000 mm, with the isocentre roughly in the centre of the room. The bunkers shall accommodate both the structure of the LINAC unit and the maximum longitudinal extension of a typical patient treatment table. The gantry and patient treatment table shall rotate around an isocentre. The width of the bunker shall allow for comfortable access around the gantry and the patient at all rotational angles. The plane of rotation of the gantry shall be parallel to the area of the treatment control panel. When designing the bunker orientation, high-occupancy areas shall be considered. The structural room height, including the maze, shall be at least 4 m. This height is required for equipment delivery ease; design of the air conditioning, heating, exhaust, and ventilation system; and installation of additional electrical supply cabling. The width of the maze shall be between 2000 and 2200  mm to allow for an adequate turning circle for equipment delivery. LINAC is a massive machine weighing 8–9 tonnes. As a result, the flooring shall be extremely durable to withstand such a load. When installing LINAC for the first time, make provisions for the base frame. This base frame shall have a 6000 mm × 2000 mm × 610 mm excavation from the centre to the back. To save money by sharing the primary shielding structures, two or more bunkers shall be built next to each other. To prevent accidental entry into the bunkers while the radiation is active, a door at the end of the maze, i.e. entry into the bunkers, shall be provided. This door does not require shielding because its purpose is to provide a physical barrier and limit access to bunkers rather than to protect against radiation. During radiation, access shall be restricted using a combination of light sensors and/or push gates or barriers that are interlocked to the control panel.

12.2 Infrastructure

431

The bunker usually takes up 1.5 floors all the way to the top. The bunker roof’s access shall be restricted and cordoned off, with a security entrance interlocked to the treatment machine. Water chillers and air conditioning plants, on the other hand, are installed on the roof because they require controlled access. A certified physicist or an appropriate agency shall evaluate the unit’s radiation protection requirements. This assessment shall specify the type, location, and amount of protection that shall be installed following the final approved department layout and equipment selection. Radiation protection requirements shall be incorporated into final plans and specifications. It is recommended that you consult with radiotherapy equipment manufacturers as soon as possible. With a maximum energy of 10 MV, no neutron shielding is required. When specifying radiation shielding, the lifespan of the facility and the need to upgrade technology shall be considered. The machines shall almost certainly be upgraded, and the newer machines may or may not emit more radiation. As a result, it is prudent to plan for the most powerful machine and the broadest beam that shall most likely be used in the future.

12.2.2.2 LINAC Control Room Each bunker shall include a control area. These areas shall be outside of the bunker’s maze. The control room’s dimensions shall be 4572 mm × 4267 mm, but this can be changed if necessary. 12.2.2.3 Internal Beam Radiation Therapy Internal beam radiation therapy utilizes brachytherapy. Brachytherapy is a type of radiation therapy in which radioactive sources are placed inside or near tumour tissue. A radiation source is delivered via a tube or applicator implanted during surgery in the brachytherapy treatment room. The infrastructure of the brachytherapy room is almost similar to that of LINAC. A bunker shall be provided for brachytherapy. As a result, all of the bunker-­ related issues raised in LINAC shall also be addressed in brachytherapy. However, the wall and ceiling thicknesses of the brachytherapy bunker shall be at least 1000 mm. To facilitate access, the maze shall be 1800 mm wide. To accommodate a C-arm and a procedure trolley if the patient is prepared in the treatment room, the inside dimensions of the room shall be 4000 mm × 4000 mm × 3600 mm height (ceiling height of 3000 mm). Because the source emits radiation isotopically, a shielded roof is required. All other LINAC bunker issues shall be addressed when designing the brachytherapy bunkers, except for wall thickness and dimensions. 12.2.2.4 Operating Room with Brachytherapy Bunker Along with the brachytherapy unit, an equipped operating room and other services such as an anaesthetic induction room, scrub area, patient recovery room, and clean room, among others, shall be provided.

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For more details about the operating rooms, please refer the chapter no. 5 titled ‘Operation Theatre Suite (OT)’ of this book.

12.2.2.5 Metalling Treatment Planning Equipment, Mould Room The mould is a type of shielding that is prepared to protect the patient from radiation exposure photons and electrons in areas other than those areas which require the radiation treatment. The mould shall be prepared for each patient, and the design and size vary from one to the next. The dimensions of the room shall be 4267 mm × 3658 mm. 12.2.2.6 Mould Workshop A mould workshop is a place where the moulds are physically prepared. Because the mould is made of molten metal, as well as foam cutters and vacuum formers, among other things, the mould workshop shall have a well-ventilated system. Because the use of types of machinery such as drills and cutters can generate a lot of noise, the mould workshop shall have proper acoustic treatment. A separate storage area shall be provided for storing the raw material used to prepare mould. A storage facility for the moulds that are currently being used for the patient’s treatment shall be provided. Such moulds are required to be stored throughout the duration of the treatment of that particular patient. 12.2.2.7 Medical Physics Laboratory The physical aspects of radiation therapy, as well as the radiation safety of staff, patients, and visitors, are overseen by medical physicists. They provide scientific support for all types of treatment machines, including CT simulators, LINAC, brachytherapy, computer planning systems, and equipment, as well as dosimetry, quality assurance, and radiation safety. Physicists shall have an office and workstation space. The dimensions of the room shall be 4267 mm × 3658 mm. A physics laboratory shall be provided to fabricate equipment for patient treatment that is not commercially available, such as the installation of rigid attachments for patient hoists, physics calibration jigs, and mask creation appliances. Storage of medical physics equipment, including bulky water tanks and phantoms, shall be provided. 12.2.2.8 Dosimetry Planning Room The dosimetry planning room is where telegraphy fields and radiation treatment plans are created. The preferred room dimensions are 4267 mm × 3658 mm. 12.2.2.9 CT Simulation Simulation is the process by which radiation oncologists and physicians acquire images of the body to develop an appropriate treatment plan. As a result, the CT simulator shall be installed in the treatment area. The CT simulator is set up almost identically to the CT scanner in the radiology department. For more details on the CT simulator, please refer to chapter no. 8 titled ‘Radio Diagnosis’ of this book.

12.2 Infrastructure

433

12.2.2.10 Trolley Bay Radiation therapy shall include a designated area for stretcher trolleys and wheelchairs for the patient’s convenience. The area shall be large enough to accommodate at least two wheelchairs and two stretcher trollies. The trolley park area shall be located in a corner of the department so that it does not interfere with the department’s normal operations. 12.2.2.11 Change Rooms for Patients It may be difficult to perform the procedure with the patient’s clothes on at times, so change rooms shall be provided in the radiation therapy department to allow the patient to remove the outside clothes and change into hospital clothing. The room shall be approximately 3048 mm × 3048 mm in size. 12.2.2.12 Change Room for Doctors and Staff The radiation therapy department shall have changing rooms so that the doctors and staff who work there can change into sterile clothing after removing their outer clothing. The toilet shall ideally be connected to the changing rooms. There shall be separate toilets for men and women. The number of change rooms required shall be determined by the number of employees required in the radiation therapy department. A separate changing area shall be provided for each group of staff workers. Separate locker rooms shall be provided for men and women. Each change room shall be approximately 4267 mm × 4572 mm in size. Typically, the change rooms shall be provided for doctors, nurses, technicians, and class IV staff and may be for students also. 12.2.2.13 Store Near the treatment units, a small storeroom of at least 3658 mm × 3658 mm shall be provided for storing the major dosimetry equipment as well as all current equipment, supplies, consumable materials, medical disposables, and other items. The designer shall consider future needs when designing the storage space. Equipment and supplies shall be stored as close to the point of use as possible. The storage shall be as lockable as possible, free of humidity, termite-proof, and fire-resistant as much as possible. 12.2.2.14 Patient Holding Bay or Sub-waiting Lobbies Instead of a large waiting lobby, sub-waiting lobbies for each departmental modality are recommended. The number of people who can wait in hospital lobbies may be limited to a maximum with a minimum distance between their seats. 12.2.2.15 Clean Utility A clean utility room shall be provided in the department for the storage of clean linen. The room shall also be used to store sterile materials such as drums and drapes. The room shall ideally be no smaller than 3658 mm × 3658 mm. However, depending on the requirements, the room’s size can be adjusted.

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12.2.2.16 Dirty Utility/Sluice Room In the department, a dirty utility shall be provided for the storage of soiled linen. The linen is then brought here to be pre-washed before being delivered to the laundry. The room shall ideally be no smaller than 3658 mm × 3658 mm. However, the size of the room can be adjusted to meet your needs. There shall be two 914 mm doors in this room. One door in the department and one in the corridor are open, allowing the linen to be collected by the laundry staff. 12.2.2.17 Hand Scrub Station Consultation rooms, treatment areas, procedure rooms, and imaging rooms shall all have a scrub station for hand washing. Scrub stations shall be conveniently located near simulator rooms and staff stations, or in other locations as required.

12.2.3 Chemotherapy Ward/Radiotherapy Ward See Table 12.3. As the chemotherapy treatment is a day care procedure, the patients usually have to be admitted for a short duration. Hence, a ward shall be provided where the patients can be admitted and discharged immediately after the treatment. This ward is generally a day care ward. However, in some chemotherapy treatments, the patient may have to stay overnight also. It is preferred that this ward shall have all the infrastructure to manage the patients who are admitted overnight also. In addition, the hospital may require the radiotherapy ward. This ward is required for frail patients, those who live too far away to be seen as outpatients, and the rare patient who has severe reactions to any of the treatments administered. These are required because radiation therapy almost always consists of a series of radiation administrations, usually daily over a 5–35-day treatment period (1–7 weeks). If they live close to the department, the majority of patients are healthy enough to commute every day. Number of beds in the chemotherapy ward: The number of beds that shall be placed in the chemotherapy ward is not governed by any set standards. It is suggested that the chemotherapy ward shall not have more than 15 beds. However, if the patient load is large, more than one such ward can be provided. There shall be spaces for patient beds in the chemotherapy wards. Each patient bed shall have an area of between 100 and 150 sq. ft. Accordingly, the ward’s size shall be determined. If a ward has four beds, the per-bed area shall be at least 150 sq. ft, making the ward 9144 mm × 6096 mm in size. However, if a 15-bed ward is being considered, each bed’s space shall be at least 100 sq. ft, making the ward’s dimensions approximately 15,120 mm × 9144 mm.

12.2.3.1 Toilets The chemotherapy ward shall have its own set of toilets and a bathroom with a hand washing station. Toilets for men and women shall be separate. The number of toilets

435

12.2 Infrastructure Table 12.3  Chemotherapy ward/radiotherapy ward

Activity Has the spaces for the following been provided for? Area for patient beds Toilets Support rooms Nurse counter/desk Nurses duty room Store for medicines, consumables, and disposables Equipment park/store Dirty utility/sluice room Clean utility Examination and treatment room Ward pantry Medication room Resident doctors and student duty room Extra rooms for future expansion Public utility for staff Visitors’ bay with attached toilet

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

::::::::::-

in the ward is determined by the ward’s bed count. In general, one toilet shall be provided for every four patients, and one bathroom shall be provided for every eight patients. This set of toilets shall be linked to the ward. If the four-bed layout is selected, each cubicle shall have its own set of toilets. Apart from the main patient area, i.e. the ward, there are a few support rooms which are essential and shall be provided along with the ward.

12.2.3.2 Nursing Desk The nursing desk shall be provided along with the chemotherapy ward. If the ward is bigger, say 15 beds, the nursing desk shall be provided within the ward itself. The location of the nursing desk shall be in such a fashion so that the nursing staff while sitting at the nursing desk can have a clear view of all the patients in the ward. On the other hand, if there are multiple wards of small size, the common nursing desk shall be provided outside the ward. However, this nursing desk shall be easily approachable from all the wards for which it has been provided.

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12.2.3.3 Nurses’ Duty Room Along with the nurse’s desk, a small nursing duty room shall be provided, for the nurses to keep their belongings, take rest after long duty hours, and take meals. The room size shall be approximately 3658 mm × 3658 mm. 12.2.3.4 Store for Medicines, Consumables, and Disposables Attached to the nursing station shall be a general store to keep enough medicines, consumables, and disposables on hand. The room’s dimensions shall be at least 4572 mm × 3658 mm. 12.2.3.5 Equipment Park/Store There shall be a place for storing equipment at the nursing station so that less important items can be kept there. A small room that is attached to the nursing station and has a minimum dimension of 1238 mm by 1238 mm shall be provided for this purpose. This space could be an open area connected to the nursing station or a closed room with a door. 12.2.3.6 Dirty Utility/Sluice Room Additionally, the nursing station shall have a dirty utility that is used to store the soiled linen. Generally, the size of the room shall be 3658 mm × 3658 mm, although the size of the room may be altered depending on the requirements. Two doors of about 915 mm shall be provided for this room. Out of the two doors, one shall open in the ward itself and the second one in the corridors for workers to collect the linen without having to go to the ward/nursing station. 12.2.3.7 Clean Utility Attached to the nursing station, a clean utility shall be provided for the storage of clean linen. This area is also utilized to store sterile materials such as a drum and drapes, and sterile supplies and disposables that are commonly used in the ward. This room shall be roughly 3048 mm × 3048 mm. The size of the room, however, can be altered based on the needs. This room shall have only one 915 mm door. The room shall be windowless, but if one has to be provided, it shall be sealed with double-glazing glass. There shall be no water supply or drain in this area. 12.2.3.8 Examination and Treatment Room Patients who are admitted to the ward sometimes need minor treatments or procedures like stitch removal, catheterization, dressing, and bandaging, among others. Due to the risk of infection, the patient’s privacy, or if the procedure requires anaesthesia, it can usually be difficult to perform these procedures in the ward itself. Therefore, an examination/treatment room which is separate from the ward shall be provided. The room shall be roughly 4572 mm × 3658 mm in size. 12.2.3.9 Ward Pantry There shall be a place for diet storage and further distribution of meals for the full day to patients in the ward. Ward pantry is the name of this area. A duly packed diet is shipped in bulk from the kitchen for direct distribution. At times, the unwrapped

12.3  Services, Facilities, Equipment, Tools, and Instruments

437

diet is also sent to the pantry, leaving it up to the pantry to pack and distribute to the patient. The ward pantry shall be roughly 3658 mm × 3658 mm in size and have a single door that opens to the outside in the corridor.

12.2.3.10 Medication Areas While designing the nursing station, a space in the form of a room or a cabinet shall be provided to store patient drugs in transparent plastic boxes. The name of the patient and the patient’s room or bed number are written on these boxes. It is advisable that for each patient, a separate box is allotted. The medication room or the cupboard shall be lockable. 12.2.3.11 Resident Doctors’ and Students’ Duty Rooms As the doctor shall be posted on duty day and night for the chemotherapy ward, the duty room shall be provided for them. The doctors usually stay in the ward but can take rest after duty hours. Hence, attached to each ward shall be the duty room for the doctors. Please remember to provide separate duty rooms for male and female doctors. The room shall be 3658 mm × 4268 mm in size and have a toilet attached to it. 12.2.3.12 Extra Rooms for Future Expansion In the running hospital, no one can anticipate the future requirement of a room. The requirement of the room may increase due to excessive patient load, norms or regulations of regulatory authorities, increased staff and doctors, and induction of new equipment, procedure, or investigation. Hence, while designing a hospital, spaces shall be provided for future expansion. 12.2.3.13 Public Utility for Staff The staff including the nursing, technicians, ward assistants, and housekeeping are supposed to be working round the clock, so separate toilets shall be provided for them as they may be hesitant to use the toilets that have been allocated for patients. Please remember to provide these toilets separately for male and female workers. 12.2.3.14 Visitors’ Bay with Attached Toilet It is but natural that the anxious and curious family members, friends, and relatives of the patient would like to visit the hospital to meet the patient. It is not always advisable to make all the visitors be seated in the patient room. Hence, a separate space shall be provided near the ward, where these visitors can be made seated. This area is called visitors’ bay. The visitor bay shall have a toilet attached to it.

12.3 Services, Facilities, Equipment, Tools, and Instruments 12.3.1 Reception/Registration/Cash Counters See Table 12.4. The number of patients or visitors who are anticipated to use the reception or help desk services determines the size of the counter and/or help desk. It is advised

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Table 12.4  Reception/registration/cash counters for radiation therapy department

Activity Provide the following at reception: Reception counter Reception chairs Computers with printers Scanner Public announcement system Cash collection box screwed to the counter Intercom and telephone line Required electrical points at reception Other communication points at reception Acrylic or glass partitions on all the counters Basic facilities like telephones, public address system Separate toilets for males and females Drinking water facility Mobile charging points

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::::::::-

:-

:::-

that enough room be made so that two receptionists or helpers can be seated. Therefore, the appropriate length for the reception and/or help desk shall be between 3048 mm and 4572 mm. The counter can be built of granite or other materials, or it can be built up by masonry construction with an elegant appearance. A wooden counter can also be provided as an alternative. For a person to comfortably stand and speak with the receptionist, the front side of the counter shall be roughly 1512 mm high. The working top, which shall be provided on the other side of the counter, shall be approximately 610 mm wide and 762 mm in height. Two reception chairs shall be provided for the receptionists. If need be, high-­ raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided to each receptionist or help desk assistant. If required, the scanner can also be provided at reception. Microphone for announcement shall be provided at the reception.

12.3  Services, Facilities, Equipment, Tools, and Instruments

439

The intercom and telephone lines shall also be provided at the reception. Even one spare mobile phone shall also be placed at the reception to make emergency calls. The reception counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points. • In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances. The reception counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for computer networking • Two RJ 11 points for intercom and extension lines Cash Counter The size of this counter shall depend on how many patients or visitors are anticipated to use its services. However, there shall be room for two employees to sit down at each cash counter. Therefore, the optimal length can range from 1238 to 3658 mm. Granite or another material can be utilized to give the counters an aesthetically pleasing appearance, or they can be formed of masonry work. Counters constructed of wood can also be offered as an alternative. Each counter’s front side shall be roughly 1512 mm high so that people can stand against them and easily interact with the staff. The working top, which shall be provided on the other side of the counter, shall be approximately 610 mm wide and 762 mm high. Because cash counters shall be secure, there shall be a glass/acrylic partition above the counter with a cut window on the lower side of the glass, rising to a height of about 1219 mm from the top of the counter. Two office chairs shall be provided at each cash counter. If need be, high-raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided for each cashier separately. If required, the scanner can also be provided at the cash counter. Additionally, the barcode scanner shall be provided at the cash counter for scanning the barcodes for billing and receiving cash. The cash counter shall be provided with a safe screwed to the counter, for the safe custody of the cash. The intercom and telephone lines shall also be provided at the cash counters. Each cash counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points.

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• In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances. Each cash counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for computer networking • Two RJ 11 points for intercom and extension lines

12.3.2 Record Room See Table 12.5. As the record room is used for keeping the patient’s records along with the other records, the storeroom shall have sufficient numbers of cupboards, racks, working slab, drawers, etc.

12.3.3 General Stores See Table 12.6. General store is used for storage of miscellaneous items like stationery, instruments, files, and unused linen. The store shall have sufficient working tops duly finished with granite top. The storeroom shall have a sufficient number of cupboards, racks, working slabs, drawers, etc. Table 12.5  Record room of radiation therapy department

Activity Cabinet Drawers Cupboards

Start date

End date

Status of works In Complete progress

Not started

Responsible person

Remarks

:::-

Table 12.6  General stores of radiation therapy department

Activity A sufficient number of countertops Cupboards Drawers Racks

Start date :-

:::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

12.3  Services, Facilities, Equipment, Tools, and Instruments

441

12.3.4 Consultation Rooms See Table 12.7. The following furniture shall be placed in the consultation room: • • • • • • • •

Doctors’ table Doctors’ chair Two attendants’ chairs Revolving stool with height adjustment for patient Examination couch including the facility for gynaecological examinations Head and neck examination chair Step stool Side rack for doctor All the necessary equipment, gadgets, and instruments shall be provided like:

• • • • • • • • •

BP instrument Stethoscope Torch Knee hammer (if required) Tongue depressor Weighing machine Tongue depressor Finger pulse oximeter View box

All the consultation rooms shall have an intercom for inter-hospital communication. The consultation rooms shall have a computer along with the UPS. If printing is also required to be done in the consultation rooms, the printer shall also be provided. Each consultation room shall have a hand basin along with the soap dispenser and towel hanger. A hanging curtain partition covering each of the examination table’s three sides shall be provided in the consultation rooms. The curtains shall be hung from a ceiling-­mounted curtain track that is fixed 2134 mm above the ground. A space shall be left clear at the bottom of the curtain that is approximately 457 mm above ground so that the floor can be cleaned. All consultation rooms shall have a provision for biomedical waste management. Although direct sunlight shall be avoided, windows in consultation rooms are desirable. The window glass can be tinted, and there shall be blinds or drapes. Consultation rooms shall have the following electrical points: • The main switchboard for controlling the room’s fan and lighting shall be located at the entrance wall (other than the wall on which the door shall open) and shall be connected to one 5 Amp switch/socket. • Temperature-adjustable air conditioning control button.

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Table 12.7  Consultation rooms of radiation therapy department

Activity Provide the following furniture in consultation rooms: Doctors’ table Doctors’ chair Revolving stool with height adjustment for patient Two attendants’ chairs Examination couch including the facility for gynaecological examination Head and neck examination chair Step stool Side rack for doctor Provide the following equipment/gadgets in the consultation room: BP instrument Stethoscope Torch Knee hammer Tongue depressor Weighing machine Finger pulse oximeter View box Intercom Computer with a printer and UPS Washbasin for hand wash Curtain partitions for the examination couch Provide windows if possible MGPS supply of oxygen, air, and suction if required Required electrical points in OPD Other communication points in OPD

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::-

::-

:::-

::::::::::::::-

::-

12.3  Services, Facilities, Equipment, Tools, and Instruments

443

• The switch and one point for the examination light shall be provided at about 2 ft above the examination table on the wall. • Two 5 Amp switch/sockets shall be provided at 305 mm above the doctor’s table on the wall. Alongside this, one 15 Amp switch/socket shall be provided. • Three 5 Amp switch/socket shall be provided on the wall at about 305 mm above the doctor’s side rack to power up the computer and printer. Additionally, for other equipment or heater, one 15 Amp switch/socket shall be provided adjoining to this. The consultation chamber shall have the following communication points: • RJ 45 port for computer networking • RJ 11 port intercom and extension lines • HDMI port for displaying the computer output at other locations The examination room (if attached to the consultation room) shall have: • • • • • • • • • • • • • •

Examination couch Step stool Examination lamp Torch Stainless steel trays Stainless steel bowls Dressing drums Speculums Knee hammer (if required) Tongue depressor Weighing machine Multi-para monitor (if required) View box Special equipment required for different types of examination rooms

The vital sign examination area attached outside the consultation rooms (if provided) shall have: • • • • • • • • • •

BP apparatus Stethoscope Torch Stainless steel trays Stainless steel bowls Weighing machine Finger pulse oximeter Weighing machine Height scale Special equipment required for different types of vital sign examination rooms

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12.3.5 Waiting and Sub-waiting Lobbies See Table 12.8. The waiting and sub-waiting lobbies of the radiation therapy shall be fully air-­ conditioned with a provision of cooling and heating. Waiting lobbies shall be properly guarded, and security measures like fire hooters and CCTV cameras shall be provided in the waiting areas. Waiting lobbies shall have adequate speakers with a clear voice to hear the announcements. Along with the audio system, the visual display system including display boards shall be provided, where the token number can be displayed. Proper comfortable chairs having backrests shall be provided in the waiting areas. Please avoid backless benches, as it is not comfortable to sit on such benches. If the sofa sets are provided, it shall be better. However, the waiting areas of VIPs shall have the sofa set along with centre tables. For bariatric patients, the provision shall be made for specialized seating. Table 12.8  Waiting and sub-waiting lobbies of the radiation therapy department

Activity Proper heating and air conditioning Security features like CCTV Announcement systems Waiting chairs/sofa set Wall, ceiling, and interior decoration Television Food and drink vending machines Signage and wayfinding system Spaces for indoor plants Interactive displays Mobile charging points in the lobby Free internet or Wi-Fi facility Handrails at the staircase and other areas Required electrical points Other communication points

Status of works Start End In Not date date Complete progress started :::::::::::::-

::-

Responsible person

Remarks

12.3  Services, Facilities, Equipment, Tools, and Instruments

445

For an aesthetic look of the waiting areas, the interiors shall be well decorated. The wall decoration shall be done by using mirrors, murals, texturized paints, or wallpapers. Similarly, the ceiling shall also be decorative. Light fittings shall also be decorative. Use of colour, textures, surface treatments, fixtures, fittings, furniture, and artwork shall be considered for interior decor. The waiting areas shall also have televisions, magazine holders, newspaper racks, kiosks, etc. for patients and visitors to spend time. The wayfinding and signages shall be very clear and glowable so that the visitors and patients can easily identify the passages and routes. For beautification, indoor plants can also be planned to be placed in waiting areas. Mobile charging points shall also be provided in the waiting area. Apart from this, if possible, the facility of Wi-Fi or free internet can be provided. For the safety of the patients and visitors, provide necessary safety measures, like handrails, non-slippery surfaces, non-steep slopes, handicapped toilets, and wheelchair accessibility.

12.3.6 External Beam Radiation Therapy (LINAC) See Table 12.9. The LINAC for treatment shall be installed in the bunker, taking into account the machine’s weight. To mount the machine, base frame shall be used. The LINAC shall have proper ground earthing. The bunker shall have the necessary electrical and plumbing provisions. The underground conduits for these utilities shall be angulated at a 45° angle rather than straight. Power supply to the LINAC shall be provided in the bunker following the machine’s requirements. As a result, the manufacturer of the equipment shall be consulted ahead of time when designing the bunkers. These cables and wires shall connect directly to the LINAC’s UPS and, ultimately, to the LINAC machine. Mechanical, electrical, and safety issues, such as providing dimmable lights in the room, emergency switches, and standby lighting, shall all be considered. The bunker shall have ducting provision for connecting the gantry structure to the treatment control panel. Isolated ducts shall also be provided for dosimeter cables and connection to the chiller system. After the machine is installed, false ceilings shall be installed in the bunkers. Because LINAC is an electronic machine, it requires constant power. If this is not provided, the machine shall stop, increasing the chances of software corruption or even failure of various machine components. To avoid this, almost all machine users prefer to include an online UPS with the machine. The UPS room shall have several racks for installing batteries. Because of the acid in batteries, fumes are occasionally formed in the room; thus, the UPS room shall have an exhaust system. Ground earthing of the UPS is necessary. The main supply cables shall terminate in the UPS room, which is then connected to the UPS. The output cables from UPS are connected to the main LINAC machine and other panels of the machine.

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Table 12.9  External beam radiation therapy (LINAC)

Activity Installation of the LINAC UPS of the required capacity Ground earthing of the LINAC Required electrical and plumbing conduits Providing sufficient cables and wires for power supply to the LINAC Dimmable lights in the bunker Provision for emergency switches Provision of standby lighting Ducting in the bunker for connection between the gantry structure and the treatment control panel Isolated ducts for dosimeter cables and connectivity to the chiller system False ceilings in the bunkers MGPS points for oxygen, suction, and air Cabinet to store treatment devices and daily used quality assurance equipment Hand wash sink Air conditioning and humidity control Required electrical points Other communication points Power backup

Status of works Start End In Not Responsible date date Complete progress started person Remarks :::::-

::::-

:-

:::-

:::::-

Inside the bunker, the outlets for the central medical gas supply shall be provided. The outlets shall be for the oxygen and suction. A lockable cabinet of suitable size shall be provided in the bunkers for storing the treatment devices and daily used quality assurance equipment.

12.3  Services, Facilities, Equipment, Tools, and Instruments

447

The hand wash sink with water supply and drain shall be provided. A suitable power backup shall be provided to the LINAC. Radiation protection is required for linear accelerator bunkers, which may include lead shielding and thick concrete walls, floors, and ceilings. A neutron door may be required depending on the type of linear accelerator used. Joints, ducting, and sleeves shall not diverge with the primary beam, which is easily accomplished by placing them in secondary shielding and using a curved path.

12.3.7 Control Room for LINAC See Table 12.10. The control room shall have an intercommunication device and at least two closed-circuit television monitors to communicate with the patient while therapy is being administered. Table 12.10  Control room for LINAC

Activity Patient intercommunication device with two closed-circuit television monitors Working top in the control area of adequate length Electrical power points along the whole length of the worktop allow multiple devices to be powered X-ray viewing box with ambient lighting Networked imager or printer and plotter Treatment planning computer with its video monitor Digitizer tablet and other required computer equipment Required electrical points Other communication points Proper signage and wayfinding systems

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

:-

:::-

:-

:::-

448

12  Radiation Therapy

A working top in the control area shall be provided. The working top can be made of masonry work and finished with a granite type of stone. Alternatively, the countertop could be made of wood. The length of the working surface shall be sufficient to allow for the installation of all monitors and other control equipment, as well as patient information files, sheets, and images to be used while therapy is in progress. It is recommended that the working top measure between 1238 mm and 3048 mm. The working top/table shall be approximately 762 mm in height and 610 mm in width. To view the X-ray/CT/MRI films, an X-ray viewing box with ambient dimmable lighting shall be provided in the control area. Space shall be provided along with the control room area for the networked imager or printer. This facility is also available for brachytherapy. Electrical power points shall be installed along the entire length of the worktop to power multiple devices, including additional emergency switches. Similarly, intercom, IT networking, and audio-video display communication points shall be provided. Proper signage and radiation hazard signboards shall be provided.

12.3.8 Internal Beam Radiation Therapy (Brachytherapy) See Table 12.11. A C-arm shall be provided in the brachytherapy for applicator placement and shall be installed in the appropriate room, either the procedure room or the treatment room, depending on local practice. An X-ray viewing box with ambient dimmable lighting shall be provided in the control area to view the X-ray/CT/MRI films. Along with the control room area, space shall be made available for a networked imager or printer. The bunker shall include a provision for the supply of central piped medical gases such as oxygen, suction, and air. To power multiple devices, including additional emergency switches, electrical power points shall be installed along the entire length of the worktop. Intercom, IT networking, and audio-video display communication points are also required. The control room shall have an intercommunication device and at least two closed-circuit television monitors to communicate with the patient while therapy is being administered. In the control area, a working top shall be provided. The working top can be made of masonry work and finished with granite stone. The working top could also be made of wood. The length of the working top shall be sufficient to allow for the installation of all machine control equipment and monitors, as well as patient information files, sheets, and images that are required to be used while therapy is in progress. It is recommended that the working top measure between 1238 mm and 3048 mm. The working top/table shall have a height of approximately 762  mm and a width of approximately 610 mm. Proper signage and radiation hazard signboards shall be provided.

12.3  Services, Facilities, Equipment, Tools, and Instruments

449

Table 12.11  Internal beam radiation therapy (brachytherapy)

Activity C-arm in the brachytherapy Networked imager or printer MGPS points for oxygen, suction, and air Required electrical points Other communication points Power backup Working top in the control area of adequate length Electrical power points along the whole length of the worktop allow multiple devices to be powered X-ray viewing box with ambient lighting Proper signage and wayfinding systems

Status of works Start End In Not Responsible date date Complete progress started person Remarks :::::::-

:-

::-

12.3.9 Operating Room for Surgeries Near the Brachytherapy Room See Table 12.12. The operating room attached to the brachytherapy shall have all the required equipment, tools, instruments, and gadgets to perform the interventional procedures for brachytherapy. Though it is not possible to mention all the equipment that are required in the ORs, we have tried to mention the important ones. The requirement may vary from hospital to hospital and surgeon to surgeon. Following are the equipment that are common to all the ORs and shall be provided in every OR: • • • • • •

Anaesthesia ventilator Anaesthesia workstations/Boyle’s machine Blood pressure apparatus Defibrillator Electro-surgical cautery Head light

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Table 12.12  Operating room for surgeries near the brachytherapy room

Activity The following equipment shall be placed in the OR (common for all ORs): Anaesthesia workstations/Boyle’s machine Anaesthesia ventilator Blood pressure apparatus Defibrillator Electro-surgical cautery with pencils Head light Image intensifier (C-arm) Microprocessor controlled electrosurgical unit Mobile ultrasound Morcellator Multi-para monitor with ET Co2 Operating light head mounting Operating table attachments Portable OT light OT light double dome OT table Suction machine electrical Surgical loupe Telescopes UPS 10 Kva Vaporizer Surgical instruments for various types of surgeries Drill and saw system for ENT and orthopaedic Operating microscope

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:-

:::::::-

::::::::::::::-

::-

12.3  Services, Facilities, Equipment, Tools, and Instruments

451

Table 12.12 (continued)

Activity The following furniture shall be placed in the OR: Instrument trollies Crash cart Dressing trollies Mayo stand Swab rack Steel bucket with lid footstool Doctor stool IV stand OR shall have the following tools/ gadgets: Sterilization drums Trays of all types and sizes Kidney tray of all sizes Bowls of all sizes Disinfection and sterilization trays Formalin chamber OT linen OR shall have the following drugs: Emergency drugs Anaesthesia and analgesia drugs Antibiotics Fluids OR shall have the following consumables and disposables: All types of catheters All types of infusion sets Cotton, bandage, and gauze All types of sutures Implants as required Spare bulbs, batteries for equipment

Status of works In Not Responsible Start End Remarks date date Complete progress started person

::::::::-

:::::::-

::::-

::::::-

452

• • • • • • • • • • • • • • • •

12  Radiation Therapy

Image intensifier (C-arm) Mobile ultrasound Morcellator Multi-para monitor with ET Co2 Operating light head mounting Operating table attachments Portable OT light OT light double dome OT table Suction machine electrical Surgical loupe UPS 10 Kva Vaporizer Operating microscope Drill and saw system for ENT and orthopaedic Surgical instruments for various types of surgeries The following furniture shall be placed in the OR:

• • • • • • • •

Instrument trollies Crash cart Dressing trollies Mayo stand Swab rack Steel bucket with lid footstool Doctor stool IV stand The following accessories, tools, and gadgets shall be placed in the OR:

• • • • • • •

Sterilization drums Trays of all types and sizes Kidney trays of all sizes Bowls of all sizes Disinfection and sterilization trays and sets Formalin chambers OT line including the doctor’s dress, patient dress, draw sheets, big sheets, cut sheets, eye hole sheets, aprons, gowns, absorption pads, etc. The following drugs shall be placed in the OR:

• All the emergency drugs. • Anaesthesia and analgesia drugs like analgesics, anxiolytics, local anaesthetics, general anaesthetics, inhalational gases, and paralytics • Antibiotics

453

12.3  Services, Facilities, Equipment, Tools, and Instruments

• Body fluids like intravascular biological fluids, interstitial biological fluids, and intracellular biological fluids The following consumables and disposables shall be placed in the OR: • All types of catheters include straight intermittent catheters, hydrophilic catheters, closed system catheters, etc. • All types of infusion sets • Cotton, bandage, and gauze • All types of sutures including A) absorbable sutures like catgut suture, polydioxanone suture, poliglecaprone suture, and polyglactin suture and B) nonabsorbable sutures like nylon, polypropylene, silk, and polyester • Implants as required • Spare bulbs, batteries for equipment For more details about the operating room for brachytherapy, please refer to Chap. 17 titled ‘Operation Theatre Suite (OT)’ of this book.

12.3.10 Mould Room See Table 12.13. The room shall be provided with an office table, chairs, and an examination couch. The room shall also be provided with computer workstations connected to the hospital network. The connection to the PACS shall also be done. All the required electrical outlets and communication ports shall be provided.

Table 12.13  Mould room of radiation therapy department

Activity Office table Chairs Examination couch Computer workstations with printer Connection to the PACS Required electrical points Other communication points

Status of works Start End In Not date date Complete progress started ::::-

:::-

Responsible person

Remarks

454

12  Radiation Therapy

12.3.11 Mould Workshop See Table 12.14. The moulding workshop shall have all of the necessary machinery to prepare the moulds. Drills, cutters, welding machines, lathe machines, blowers, melting furnaces, grinders, and so on are examples of machines. Because the moulds are made of molten metal, foam cutters, and vacuum formers, among other things, a lot of dust and raw material particles are produced and spread in the air, so a special exhaust system shall be installed in the workshop. Proper acoustic treatment is required because the use of machineries such as drills and cutters can generate a lot of noise. To prepare the moulds, the workshop shall have the necessary number of tables, chairs, and working counters.

Table 12.14  Mould workshop of radiation therapy department

Activity The required machinery to prepare the moulds like drills, cutters, lathe machines, blowers, welding machines Office table Chairs Computer workstations with printer Special exhaust Proper acoustic treatment Countertop for pouring and mounting the blocks Racks or space for tools Sink with a refuse trap for disposal of plaster of Paris Separate store to have countertops, almirah, cupboard, and racks to store the raw material like Styrofoam, trays, and shielding material for custom blocking Store for storing moulds that are being presently used, which shall have countertops, almirah, cupboard, and racks

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

::::::::-

:-

:-

12.3  Services, Facilities, Equipment, Tools, and Instruments

455

The working counter shall be equipped with a sink for pouring and mounting the blocks. Racks or cabinets for storing tools used in mould preparation should be provided. In the mound room, a sink with a refuse trap shall be provided for the disposal of plaster of Paris, which is commonly used to prepare moulds. The raw material store in the workshop shall have a sufficient number of almirahs, cupboards, and racks to stock raw materials for moulds such as Styrofoam, trays, and shielding material for custom blocking. Similarly, the store used for storing the moulds that are currently being used for the patient’s treatment shall have an adequate number of almirahs, cupboards, and racks. Such moulds are kept for the duration of the treatment.

12.3.12 Medical Physics Room See Table 12.15. An office table, chairs, and an examination couch shall be provided in the medical physics room. The room shall also have computer workstations that are linked to the hospital network. A physics laboratory shall be provided to manufacture equipment for patient treatment that is not commercially available, such as the installation of rigid attachments for patient hoists, physics calibration jigs, and mask creation appliances. The medical physics room shall have enough racks, almirahs, and cabinets to store medical physics equipment such as bulky water tanks, phantoms, ionization chambers, electrometers, cables, and films.

Table 12.15  Medical physics room of radiation therapy department

Activity Office table Chairs Examination couch Computer workstations with printer Space to manufacture equipment Space for storage of equipment including bulky water tanks, ionization chambers, electrometers, cables, films, and phantoms

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::-

456

12  Radiation Therapy

12.3.13 CT Simulator 12.3.13.1 CT Scan Machine Room See Table 12.16. As the main equipment, the room shall have a computed tomography machine (CT). The machine shall be supplied along with a specialized motorized patient table. The pressure die injector shall also be provided in the room to inject the contract media for performing the investigation. The machine can be installed either horizontally or diagonally in the room. Marble or granite can be used for flooring tiles. However, the flooring shall not be slippery to prevent accidents and injury to the patient. When installing the machine, leave at least 1829 mm of space behind the machine for the gantry to tilt and for easy maintenance. The machine shall be installed in the centre of the width of the room. Table 12.16  CT scan machine room of radiation therapy department

Activity Computed tomography (CT) with table Pressure die injector Warning light Lead apron, gloves, collars, etc. Required main switch and cable Lead glass with a wooden frame between the machine room and the control room Proper ground earthing Heavy-duty hangers MGPS outlets for oxygen, vacuum, air Two-way audio communication between CT machine room and console room Heavy-duty hangers for lead aprons Cabinet for devices like lead gloves, lead goggles, groin guards, lead collar Required electrical points Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::-

::::-

::-

::-

12.3  Services, Facilities, Equipment, Tools, and Instruments

457

During scanning, position the gantry and couch so that the patient is fully visible from the control console. The gantry room entrance door from the control console room shall comply with the same standards as the patient entrance door. A warning light with a red bulb shall be installed outside the CT scan room’s door. This light shall be linked to the X-ray generator of the CT scanner so that it only illuminates when the X-ray tube is turned on for exposure. Inside the CT scan room, the X-ray radiation protection devices like lead aprons, gloves, lead glasses, thyroid collars, and gonad shields shall be provided for the protection of the staff from unwanted radiation exposure. The main cable and switch shall be terminated separately in each CT scan room, and the machine’s power load shall be estimated based on its capacity. Because the machine’s weight is greater and its movement is more rapid, it is recommended that the weight-bearing capacity of the floor be checked. Provide a foundation for the machine if necessary. For installation of the machine, follow the manufacturer’s recommendations. The CT scan machine shall be mounted on a base plate (usually supplied by the vendor) only with good-quality anchor fasteners as recommended by the manufacturer of the machine. Any shortcuts shall cause the unit to vibrate during operation and cause compression artefacts in the image, resulting in poor image quality and the need to repeat diagnostic tests, leading to the eventual reinstallation of the machine. Lighting shall be provided using regular LEDs that have enough brightness. There is no need for additional lighting in the space. CT scan machine shall have the appropriate ground earthing features. Inside the CT scan room, outlets for medical gas supply shall be given. There shall be one outlet for oxygen, one for vacuum, and one for air. The proper two-way audio system shall be provided in the CT room, so that the patient can be directed by the technician sitting in the control room, without entering the CT room. Each room shall have a stand with sturdy hangers where the lead apron can be hung. A cabinet shall be provided in each room to keep radiation protection and safety devices like lead gloves, lead goggles, groin guards, and lead collars. Other than this, sufficient electrical outlets and communication ports shall be provided in the room. As far as the CT panel room is concerned, the room shall have sufficient electrical outlets, and the communication ports shall be provided in the room.

12.3.13.2 CT Control Room See Table 12.17. The control unit of the CT scanner shall be installed on a table in the CT scan control room. The computer, keyboard, control command units, and control unit of the die injector are all components of the control unit. Typically, this table is supplied with the machine.

458

12  Radiation Therapy

Table 12.17  CT control room of radiation therapy department

Activity Computer tables Office tables Chairs Lead glass window Computers with printers and UPS View box Required electrical points Other communication points

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::::::-

Apart from this, there shall be the provision of a secondary computer for transferring the CT images and for preparing reports. Hence, the computer, UPS, and printer shall be provided. To place this computer unit, a separate table shall also be provided. Sufficient revolving chairs shall be provided in the room. A view box shall also be provided in the room, to view the films of the old investigations for comparison purposes. A lead glass (provided with the machine) of about 1200 mm × 1000 mm shall be fixed in a wooden frame with 2 mm lead lining between the CT room and the control room to ensure no leakage of the radiation. If required, a laser image camera (printer) shall also be provided in the control room to print CT films. The room shall have sufficient electrical outlets to connect the equipment, devices, and computers to the electric supply. Other than this, the necessary communication ports shall also be provided in the room.

12.3.13.3 UPS Room See Table 12.18. There shall be a sufficient number of battery installation racks in the UPS room. There may occasionally be fumes in the room due to the acid in batteries, so the UPS room shall have an exhaust system. Ground earthing of the UPS is necessary. The main supply cables shall terminate in the UPS room, which is then connected to the UPS. The output cables from UPS are connected to the main CT scan machine. The room shall have sufficient electrical outlets to connect the UPS and other devices to the electric supply. Other than this, the necessary communication ports shall also be provided in the room.

459

12.3  Services, Facilities, Equipment, Tools, and Instruments Table 12.18  UPS room for CT scanner of radiation therapy department

Activity Racks to install batteries Exhaust fans Required electrical points Required main switch and cable

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

Table 12.19  Change rooms of radiation therapy department

Activity Lockers to keep the personal belongings of the patient One chair Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep sterilized dresses Hanger rods with hangers Bin for dirty linen

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

::::::-

12.3.13.4 Change Rooms See Table 12.19. To keep the personal belongings of patients, provision of an adequate number of personal lockers shall be made in the changing room. One chair shall also be provided in the changing room, which the patient can use while changing clothes. For hanging the outside clothes, an adequate number of hooks shall be fixed on the wall. Apart from this, the almirah and hanger rods with hangers shall also be provided to hang clothes. There shall be a closed cabinet to keep sterilized patient dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. A large receptacle for the collection of the used linen shall also be provided in the changing room.

460

12  Radiation Therapy

12.3.14 Clean Utility See Table 12.20. To store the clean linen and sterilized material, the room shall have a sufficient number of racks, cupboards, drawers, or stainless steel racks divided into bins.

12.3.15 Dirty Utility/Sluice Room See Table 12.21. Dirty utility shall be provided with waste bins to dispose of the waste as per the biomedical waste management rules. Special attention shall be paid to biomedical waste. The room shall also have a hamper with a lid to collect the soiled linen that has to be sent to the laundry for the wash.

12.3.16 Trolley Park Area See Table 12.22. The trolley bay shall have sufficient provision to hold the trollies in place. Hence, a sufficient number of hooks and chains shall be provided on the walls. Table 12.20  Clean room of radiation therapy department

Activity Racks Drawers Closed cabinets

Start date

End date

Status of works In Complete progress

Not started

Responsible person

Remarks

:::-

Table 12.21  Dirty utility/sluice room of radiation therapy department

Activity Waste bins for disposal of waste as per the biomedical waste norms Covered linen collection hampers or containers Exhaust fans to exhaust the contaminated air

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

:-

461

12.3  Services, Facilities, Equipment, Tools, and Instruments Table 12.22  Trolley park area of radiation therapy department

Activity Chains and hooks to hold the wheelchairs and stretcher trollies in place

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

Table 12.23  Equipment park/store of radiation therapy department

Activity Lockable cupboards, racks, and drawers Working counter Multiple electric points to charge equipment when not in use Air conditioning with controlled humidity level

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:::-

:-

12.3.17 Equipment Park/Store See Table 12.23. The equipment park/store shall have a sufficient number of working counters to place the countertop equipment and instruments. For bulky equipment, sufficient floor space shall be available. The store shall have adequate lockable cupboards, racks, and drawers to store the equipment and instruments. The store shall also have multiple power outlets to charge the equipment when it is not in use. The store shall have proper air conditioning and controlled humidity levels to prevent the electronic equipment from excessive heat and moisture.

12.3.18 Store for Medicines, Consumables, and Disposables See Table 12.24. As this room is for the storage of required medicines, consumables, and disposables, it shall be provided with: • Racks • Adequate lockable cupboards

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12  Radiation Therapy

Table 12.24  Store for medicines, consumables, and disposables of radiation therapy department

Activity Lockable cupboards Racks Drawers Refrigerator Countertop

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::-

Table 12.25  Scrub station of radiation therapy department

Activity Stainless steel scrub station Provision for hot and cold water Wall-hanging soap dispenser Wall-hanging antiseptic solution dispenser Nail brush, nail cutter, and nail file

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::-

:-

• Drawers • Refrigerator • Countertop for easy working

12.3.19 Scrub Station See Table 12.25. For hand hygiene, two-way scrub stations (sensor controlled and/or foot operated) shall be provided near the entrance of the radiation treatment rooms. There shall be paper towels and soap dispensers close to the scrub station. There shall be hot and cold water available at the scrub station.

12.3.20 Chemotherapy Ward/Radiotherapy Ward See Table 12.26. The chemotherapy/radiotherapy wards shall have the following furniture:

12.3  Services, Facilities, Equipment, Tools, and Instruments

463

Table 12.26  Chemotherapy ward/radiotherapy ward

Activity The chemotherapy/ radiotherapy ward shall have the following patient furniture: Patient bed (Fowler bed with bedside railing) Bedside locker Over-bed table Step stool IV stand IV rod Backrest Dressing trollies Wheelchair Stretcher trolley Oxygen cylinder trolley Ward shall have the following furniture: Reclining chairs or stool for attendants Cupboard separate for each patient Ward shall have the following equipment/ instruments/tools: Multi-para vital sign monitor Air mattress Walkers Nebulizer Electrical suction machine Other required instruments Air conditioning system as per design Bed head panel separate for each patient MGPS gas for oxygen on each patient’s bed Wall-mounted suction on each patient’s bed Required electrical points

Status of works In Not Responsible Start End Remarks date date Complete progress started person

:::::::::::-

::-

:::::::::::(continued)

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12  Radiation Therapy

Table 12.26 (continued)

Activity Required communications points/ ports Curtain partitions for each bed IV track for each bed Wi-Fi

Status of works In Not Responsible Start End Remarks date date Complete progress started person :-

:::-

• Patient furniture –– Patient bed (shall preferably be semi-Fowler bed with bedside railing; alternatively, the plain patient bed can also be used) –– Bedside locker –– Step stool –– Over-bed table –– IV rod –– IV stand –– Backrest –– Dressing trollies –– Wheelchairs –– Stretcher trollies –– Oxygen cylinder trolley • Other furniture: –– Reclining chair or stool for attendants of the patient –– Cupboards if possible The wards shall have the following equipment/instruments/tools: • • • • • • •

Multi-para vital sign monitor Pulse oximeter (in case the multi-para monitor is not provided) Air mattress Walkers Nebulizer Electrical suction machine Any other required equipment or instrument

Air conditioning system of ward: The chemotherapy/radiotherapy ward shall be provided with an air conditioning system and shall have complete climate control, including the ability to regulate temperature, humidity, and air exchanges. Wards can be cooled using a chilled water pipeline with an air handling unit (AHU), a ductable split system, or a VRV system. There shall be separate return air arrangements for each ward. No ward’s return shall be mixed with air from other wards,

12.3  Services, Facilities, Equipment, Tools, and Instruments

465

rooms, units, or areas. For heating the wards, hot-water generators shall be used coupled with AHUs. Otherwise, room heaters are an option, though they are typically not advised. The temperature shall range from 21 to 12 °C. Central piped medical gas supply: All the patient beds in the chemotherapy/ radiotherapy ward shall have a supply of centralized piped medical gases to handle any emergencies. The following gases are supplied: • Oxygen (O2) • Wall-mounted suction In some hospitals, the outlets for these gases are mounted directly on the wall. Currently, this is accomplished through the use of the bedhead panel. It is a panel made of aluminium extruded sections. This panel is used to install gas outlets and electrical outlets. The IV rod, monitor tray, and utility basket can also be attached to the panel’s service railing. This panel is mounted just above the patient’s head on the wall. The ward shall have the following electrical points in the ward: • The main switchboard, along with one 5 Amp switch/socket, shall be located at the entry wall to control the hall’s fan and lighting. • Temperature-adjustable air conditioning control button. • There shall be at least two pairs of 5/15 Amp switch/sockets (four points, on each bed head panel). Half of these points shall be backed up and supplied by UPS. • Two sets of 5/15 Amp switches/sockets shall be installed on the wall at a height of 457 mm above the floor in the middle of the room, between two beds. One pair of these shall be the UPS backup. • There shall be a provision to charge mobile/laptop next to each bed. Other communication points in the ward: All the patient beds in the ward shall have the provision of: • Point for attaching the call button of the nurse call device • RJ 45 port for computer networking • Point for reading light for the patient Curtain partitions: The patient bed in the ward shall be provided with hanging curtain partitions. The bed shall have a curtain on all other three sides. The ceiling-­ suspended curtain track is fixed at 2134 mm above the floor level. Curtains shall be hung on these tracks and shall be moveable and collapsible. The bottom of the curtain shall have a clear area of about 457 mm from the floor to allow easy cleaning of the floor. IV track: The patient bed in the ward shall be provided with a ceiling-suspended IV track. In the centre of the bed, the track shall be mounted length-wise. The track is mounted and screwed to the ceiling/false ceiling of the room. The IV hanger shall

466

12  Radiation Therapy

Table 12.27  Administrative rooms of radiation therapy department

Activity These rooms shall be provided with: Office table Office chairs Visitors’ chairs Cabinets, drawers, and racks Required electrical points Intercom connection IT network CCTV surveillance Air conditioning

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::::::-

be fixed in the track, which shall be moveable in the track. The IV hanger can be with the provision of three, four, or five hooks. It is recommended that each ward shall have a provision providing Wi-Fi to enable the patient to surf the internet.

12.3.21 Administrative Rooms See Table 12.27. Offices for the clinical director of the unit, radiation oncologists, and radiation therapy managers shall be equipped with office tables, executive chairs, visitor chairs, and a side rack, among other things. Electrical outlets, IT networks, intercom connections, and air conditioning shall be properly provided in the rooms. Nursing managers, allied health professionals, cancer care coordinators, and specialist nurses shall also have offices with office tables, chairs, visitor chairs, and a side rack, among other things. The room shall have adequate electrical outlets, an intercom connection, an IT network, and air conditioning.

Further Reading Acosta R, Brick W, Hanna A, Holder A, Lara D, McQuilen G, et al. Radiotherapy optimal design: an academic radiotherapy treatment design system. Math Fac Res. 2009:47. Ashby D, Peterson F, Atterbury D. Designing chemotherapy and radiation therapy facilities. Health Care Strateg Manage. 1986;4(10):9–16. Baskar R, Lee KA, Yeo R, Yeoh K-W. Cancer and radiation therapy: current advances and future directions. Int J Med Sci. 2012;9(3):193–9.

Further Reading

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Bonett J. Ceiling art in a radiation therapy department: its effect on patient treatment experience. J Med Radiat Sci. 2015;62(3):192–7. Designing the New-Age Oncology Radiation Therapy Department. Healthcare Executive. 2021. https://www.healthcareexecutive.in/blog/tdesigning-­the-­new-­age-­oncology-­radiation-­therapy-­ department. Garg A, Dewan A. Chapter 26, Radiation therapy. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 297–307. Horton P, Eaton D. Design and shielding of radiotherapy treatment facilities: IPEM report 75. 2nd ed. IOP Publishing; 2017. https://iopscience.iop.org/book/978-­0-­7503-­1440-­4. Internationale Atomenergie-Organisation. Radiotherapy facilities: master planning and concept design considerations. Vienna: IAEA; 2014. 31p. (IAEA humane health reports). McMorrow A. Radiation shielding and bunker design. Biomed J Sci Tech Res. 2019;18(1). https:// biomedres.us/fulltexts/BJSTR.MS.ID.003106.php. Mohan G, Ayisha Hamna TP, Jijo AJ, Saradha Devi KM, Narayanasamy A, Vellingiri B. Recent advances in radiotherapy and its associated side effects in cancer—a review. J Basic Appl Zool. 2019;80(1):14. Spencer K, Jones CM, Girdler R, Roe C, Sharpe M, Lawton S, et al. The impact of the COVID-19 pandemic on radiotherapy services in England, UK: a population-based study. Lancet Oncol. 2021;22(3):309–20. van der Merwe D. Planning a radiotherapy department. Clin Oncol. 2017;29(2):105–9. Wu S, Zheng D, Liu Y, Hu D, Wei W, Han G. Radiation therapy care during a major outbreak of COVID-19 in Wuhan. Adv Radiat Oncol. 2020;5(4):531–3.

Rehabilitation and Allied Health Therapies

13

Patients who are impaired, disabled, or handicapped can get multidisciplinary rehabilitation services and therapies from the rehabilitation-allied health unit. The allied health treatments for rehabilitation include, but are not limited to: 1. 2. 3. 4. 5. 6.

Physiotherapy, including: (a) Electrotherapy (b) Laser therapies (c) Manual therapy (d) Gait analysis (e) Hydrotherapy (f) Electromyography Occupational therapy Audiology Speech therapy Orthotics Podiatry

Both inpatients and outpatients use the services provided by these departments. In addition, long-term patients with a slow rate of recuperation make use of this department’s services. The great majority of patients come to this section daily. This department shall provide services to patients both within the department and in the indoor patient wards/rooms. Physiotherapy and its allied services are the most important. As a result, in this chapter, we will go over the department of physiotherapy and occupational therapy in greater detail. This checklist will assist the planner and designer in remembering all such issues relating to the space requirement and will guide him/her in completing, testing, and commissioning all works/activities on time. This will assist him/her in ensuring that all work/activities are completed and working before the rehabilitation services are provided. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_13

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13.1 Location of Physiotherapy Department Reaching a building’s top floors may be challenging for patients with a variety of impairments. The ground floor is hence the optimal location for this department. A location that is convenient for both inpatients and outpatients shall be preferred because the department has to serve both groups.

13.2 Infrastructure 13.2.1 Space Requirement for Physiotherapy and Allied Departments 13.2.1.1 Utility Areas See Table 13.1.

Table 13.1  Utility area of rehabilitation department

Activity Has the spaces for the following been provided for? Entrance Reception and enquiry Registration and cash counter Waiting area Examination room with examination cubicle Administrative rooms Store Record room Equipment storage room Trolley bay Clean utility Dirty utility Change rooms Public utility for staff Public utility for patients and attendants

Status of works Start End In date date Complete progress

:::::-

::::::::::-

Not started

Responsible person

Remarks

13.2 Infrastructure

471

Entrance Lobby Ideally, the rehabilitation department shall have a separate entrance from the main hospital. The entrance doors for this department shall be at least 1829 mm wide and have two doors that open in opposite directions. Glass doors with sensors are an additional automation option. Preferably, there shall be an airlock connecting the inside and exterior spaces. Two doors shall be placed 1829 mm apart to achieve this. The objective is to keep the temperature and air pressure of the air conditioners consistent from inside to outside. Ambulances shall be able to disembark outside the entrance to the rehabilitation section. At the entrance gate, there shall be a porch to provide cover from bad weather. The porch shall be at least 4572 mm above the road level and big enough for two vehicles to pass through simultaneously. Patients arriving on the porch shall be able to utilize wheelchairs and stretcher trolleys by parking them in a trolley bay outside the lobby. Reception As soon as the patient initially enters the rehabilitation department, they shall come into contact with the receptionist. The receptionist shall be available to provide visitors and patients with all necessary information, make appointments, guide them through the registration process, describe how to consult the physiotherapist, gather reports, and direct them to the appropriate consultation/investigation/treatment section. The reception area shall be in an easily accessible location. If necessary, a help desk shall be provided in addition to the reception area to assist patients and visitors in resolving their questions and guiding them. Registration and Cash Counter The registration counter shall be located next to the reception counter. The patient is registered at the registration counter for consultation or rehabilitation treatment. Prepare the consultation form, accept payment for the consultation, issue the token number, and assist the patient in taking a seat. In some hospitals, case records are kept in the registration department, and patients are given a small card with their registration number. The case record shall be taken out and sent to the physiotherapist or other rehabilitation consultants for consultation each time the patient visits the hospital. The registration counter is responsible for this task. If the patient footfall is high, it is recommended that a separate cash counter be provided, ideally 1829 mm away from the registration counter. Because the reception and registration counters may have a large number of documents to store, including fresh unused stationery, a small record room or storage room shall be located near the reception and registration counters. This room shall ideally be on the opposite side of these counters. A billing counter shall be provided for patients undergoing consultation or treatment. If the hospital is large, the registration, billing, and cash counters shall be separate. However, depending on the need, the counters in medium- and small-sized hospitals can be combined.

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In terms of the cash counter, it shall be separate and properly enclosed for the safety of the cash and the cashier. Along with the cash register, a small safe room where the cashier can keep excess cash shall be provided. However, if the hospital has a policy of collecting cash from the counter very frequently, the strong room can be avoided. There shall be enough open space for patients and visitors to queue while they wait for reception, registration, billing, and cash payment services. Queuing areas shall be separate for each counter. Waiting and Sub-waiting Lobbies The patient shall wait for their turn before being taken up for the consultation or treatment. As a result, a waiting area shall be established for them to wait. While determining the size of the waiting area, the number of patients and the typical length of the treatment shall be considered. Smaller waiting areas are preferred over larger ones after COVID-19. When designing waiting areas, the social distance design principle shall be followed. Sub-waiting areas shall also be planned for and designed. Separate sub-waiting areas are preferred for consultation. Similarly, separate sub-waiting areas shall be provided for treatment. Such measures may not always be feasible, particularly in smaller hospitals, nursing homes, clinics, and so on. Examination Room with Examination Cubicles The rehabilitation department shall have the necessary consultation rooms where patients can consult the physiotherapists or other rehabilitation consultants about their future treatments and treatment protocols. This is the room where the physiotherapists or the rehabilitation consultants attend to the patients, take histories, examine the patient, diagnose the disease, give advice to the patient, plan for the treatment protocols, and clear any doubts of the patient or visitors. During normal working hours, the consultation chamber or room is the first point of contact between the patient and the physiotherapist and/or other rehabilitation consultants. The consultation room shall be about 4572 mm by 4267 mm in size. However, the size of the room can be altered based on the need and the space’s availability. Administrative Area The rooms for the general administrator, managers, and administrative support staff shall be located in the rehabilitation department. The space shall be made available for the following: 1. In-charge rehabilitation department 2. Secretarial staff The size of the administrative rooms shall be approximately 4572 mm × 4267 mm. The room shall ideally have an attached toilet. A separate store may be attached to this room if necessary.

13.2 Infrastructure

473

A secretarial room shall be approximately 6096  mm  ×  4572  mm in size. The room shall ideally have an attached toilet. A separate store may be attached to this room if necessary. Store In the rehabilitation department, a store shall be provided for the storage of medical disposables, consumable materials, general items, stationery, supplies, old equipment that is no longer in use, and other daily-use items. The store shall be at least 3048  mm  ×  3048  mm in size, but this can be increased or decreased as needed. Storage space for personal items belonging to staff, patients, and visitors shall also be provided. The store shall be as secure as possible, termite-proof, free of moisture, and fire-resistant. The general store and the record room can be combined if the hospital is medium to small in size. Record Room The record room is to be provided to store the rehabilitation department’s records, such as files, registers, and stationery. The size of the record room shall be approximately 3658 mm × 3658 mm. Equipment Storage Room An equipment storeroom is provided in the rehabilitation department to store unutilized medical equipment and instruments. The room’s dimensions shall be 4572 mm × 4267 mm. However, depending on the situation, the size can be adjusted. Trolley Bay Parking for stretcher trollies and wheelchairs shall be provided for the rehabilitation department. This area shall be located near the department’s entrance. Clean Utility The rehabilitation department requires a storage facility for clean and sterilized items such as lines, consumables, and disposables. As a result, the rehabilitation department shall have a clean store. The dimensions of this store shall be 3048 mm × 3048 mm, though this can be adjusted depending on the number and quantity of items to be stored. The room shall have no windows or other sources of direct sunlight. Dirty Utility/Sluice Room The dirty utility is a room attached to the department where soiled linen is stored. The linen is then moved here for pre-washing before being sent to the laundry. Normally, the room shall be at least 3048 mm × 3048 mm in size. However, the size of the room can be changed depending on the needs. This room shall have two 914 mm doors. One door opens in the department, and the other in the corridor or outside the building, from which the laundry staff can collect the linen without having to come to the department.

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474

Change Rooms It can be difficult to provide therapy when the patient is dressed in inappropriate clothing. Therefore, change rooms shall be provided in the department for patients to remove their outside clothes and change into hospital attire. The room shall be approximately 3048 mm × 3048 mm in size. Public Utilities for Staff, Patients, and Attendants Toilet facilities shall be available in the utility area. The toilets for the staff shall be separate from the toilets of the patients. There shall be separate male and female toilets in both cases. Additionally, a drinking water facility shall be provided near the toilet block.

13.2.1.2 Therapy and Treatment Areas See Table 13.2. Physiotherapy The physiotherapy area shall be provided with the following zones: 1. Electrotherapy 2. Thermotherapy 3. Laser therapy 4. Physical exercise zone 5. Massage therapy 6. Gymnasium 7. Traction therapy

Table 13.2  Therapy and treatment area of rehabilitation department

Activity Has the spaces for the following been provided for? Electrotherapy Laser therapy Gymnasium Massage therapy Thermotherapy Traction Audiology Occupational therapy Speech therapy Orthotics Podiatry

Status of works Start End In Not date date Complete progress started

:::::::::::-

Responsible person Remarks

13.3  Services, Facilities, Equipment, Tools, and Instruments

475

First and foremost, the total physiotherapy department shall be divided into various zones as mentioned above. Each of these zones shall have individual cabins for each modality to ensure the patient’s privacy. These cabins can be constructed with either civil work walls or material partitions such as aluminium or board. The exercise zone shall be provided in a designated hall and does not need any cabins. Each modality of treatment shall have its own cabin. Traction, for example, shall have a separate cabin; similarly, wax baths and ultrasound therapy shall also have separate cabins. The size of each cabin shall be approximately 2743 mm × 1829 mm, with a single door of 762–914 mm in width. The exercise zone can be accommodated in a single hall with enough space to install all of the exercise equipment and modalities. All exercise modalities that are wall-mounted shall be securely fastened to the wall. Occupational Therapy The occupational therapy area shall be adjacent to the physiotherapy area and have easy access to the waiting and amenity areas. Larger spaces in the occupational therapy rooms and workshop shall be provided to allow for a variety of static and dynamic activities. Rooms shall have space for the installation of tables for training table-based activities like sewing machines, toy preparation, and woodwork. The number of patients to be accommodated, the activities to be performed, and so on shall determine the size of the rooms.

13.3 Services, Facilities, Equipment, Tools, and Instruments 13.3.1 Reception/Registration/Cash Counters See Table 13.3. The number of patients or visitors who are anticipated to use the reception or help desk services determines the size of the counter and/or help desk. It is advised that enough room be made so that two receptionists or helpers can be seated. Therefore, the appropriate length for the reception and/or help desk shall be between 3048 mm and 4572 mm. The counter can be built of granite or other materials, or it can be built up by masonry construction with an elegant appearance. A wooden counter can also be provided as an alternative. For a person to comfortably stand and speak with the receptionist, the height of the front side of the counter shall be roughly 1524 mm. The working top, which shall be provided on the inner side of the counter, shall be approximately 610 mm wide and 762 mm high. Two reception chairs shall be provided for the receptionists. If need be, high-­ raised chairs can also be provided.

476

13  Rehabilitation and Allied Health Therapies

Table 13.3  Reception/registration/cash counters of rehabilitation department

Activity Provide the following at reception: Reception counter Reception chairs Computers with printers Scanner Public announcement system Cash collection box screwed to the counter Intercom and telephone line Required electrical points at reception Other communication points at reception Acrylic or glass partitions on all the counters Basic facilities like telephones, public address system Separate toilets for males and females Drinking water facility Mobile charging points

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::::::::-

:-

:::-

A computer with UPS and printer (if needed for printing) shall be provided to each receptionist or help desk assistant. If required, the scanner can also be provided at reception. Microphone for announcement shall be provided at the reception. The intercom and telephone lines shall also be provided at the reception. Even one spare mobile phone shall also be placed at the reception to make emergency calls. The reception counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points. • In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances.

13.3  Services, Facilities, Equipment, Tools, and Instruments

477

The reception counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for computer networking • Two RJ 11 points for intercom and extension lines Cash Counter The counter’s size shall depend on how many patients or visitors are anticipated to use its services. However, there shall be room for two employees to be seated at each cash counter. Therefore, the optimal length can range from 2438 to 3658 mm. Granite or another material can be utilized to give the counters an aesthetically pleasing appearance, or they can be formed of masonry work. Counters constructed of wood can also be offered as an alternative. Each counter’s front-side height shall be roughly 1524 mm so that people can stand at them and easily interact with the staff. The working top, which shall be provided on the inner side of the counter, shall be approximately 610 mm wide and 762 mm high. Because cash counters must be secure, there shall be a glass/acrylic partition above the counter with a cut window on the lower side of the glass, rising to a height of about 1219 mm from the top of the counter. Two office chairs shall be provided at each cash counter. If need be, high-raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided for each cashier separately. If required, the scanner can also be provided at the cash counter. Additionally, the barcode scanner shall be provided at the cash counter for scanning the barcodes for billing and receiving cash. The cash counter shall be provided with a safe screwed to the counter, for the safe custody of the cash. The intercom and telephone lines shall also be provided at the cash counters. Each cash counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points. • In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances. Each cash counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for computer networking • Two RJ 11 points for intercom and extension lines

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13  Rehabilitation and Allied Health Therapies

13.3.2 Waiting and Sub-waiting Lobbies See Table 13.4. The waiting and sub-waiting lobbies of the rehabilitation department shall fully be air-conditioned with a provision of cooling and heating. Waiting lobbies shall be properly guarded with security measures like fire hooters and CCTV cameras. Waiting lobbies shall have adequate speakers with a clear voice to hear the announcements. Along with the audio system, the visual display system including display boards shall be provided, where the token number can be displayed. Proper comfortable chairs having backrests shall be provided in the waiting areas. Please avoid backless benches, as it is not comfortable to sit on such benches. If the sofa sets are provided, it shall be better. However, the waiting areas of VIPs Table 13.4  Waiting and sub-waiting lobbies of the rehabilitation department

Activity Proper heating and air conditioning Security features like CCTV Announcement systems Waiting chairs/sofa set Wall, ceiling, and interior decoration Television Food and drink vending machines Signage and wayfinding system Spaces for indoor plants Interactive displays Mobile charging points Free internet or Wi-Fi facility Handrails at the staircase and other areas Required electrical outlets Other communication points

Status of works Start End In Not date date Complete progress started :::::::::::::-

::-

Responsible person

Remarks

13.3  Services, Facilities, Equipment, Tools, and Instruments

479

shall definitely have the sofa set along with the centre tables. For bariatric patients, the provision shall be made for specialized seating. For an aesthetic look of the waiting areas, the interiors shall be well decorated. The wall decoration shall be done by using mirrors, murals, texturized paints, or wallpapers. Similarly, the ceiling shall also be decorative. Light fittings shall also be decorative. Use of colour, textures, surface treatments, fixtures, fittings, furniture, and artwork shall be considered for interior decor. The waiting areas shall also have televisions, magazine holders, newspaper racks, kiosks, etc. for patients and visitors to spend time. The wayfinding and signages shall be very clear and glowable so that the visitors and patients can easily identify the passages and routes. For beautification, indoor plants can also be planned to be placed in waiting areas. In the waiting area, mobile charging points shall also be provided. Apart from this, if possible, the facility of Wi-Fi or free internet can be provided. For the safety of the patients and visitors, provide necessary safety measures, like handrails, non-slippery surfaces, non-steep slopes, handicapped toilets, and wheelchair accessibility.

13.3.3 Examination Rooms See Table 13.5. The following furniture shall be placed in the consultation room: • • • • • • •

Doctors’ table Doctors’ chair Two attendants’ chairs Revolving stool with height adjustment for patient Examination couch Step stool Side rack for doctor All the necessary equipment, gadgets, and instruments shall be provided like:

• • • • • •

BP instrument Stethoscope Torch Knee hammer (if required) Weighing machine View box

All the consultation rooms shall have an intercom for inter-hospital communication. The consultation rooms shall have a computer along with the UPS. If printing is also required to be done in the consultation rooms, the printer shall also be provided.

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13  Rehabilitation and Allied Health Therapies

Table 13.5  Examination rooms of rehabilitation department

Activity Provide the following furniture in consultation rooms: Doctors’ table Doctors’ chair Revolving stool with height adjustment for patient Two attendants’ chairs Examination couch Step stool Side rack for doctor Provide the following equipment/gadgets in the consultation room: BP instrument Stethoscope Torch Knee hammer Weighing machine View box Intercom Computer with a printer and UPS Washbasin for hand wash Curtain partitions for the examination couch Provide windows if possible MGPS supply of oxygen, air, and suction if required Required electrical points Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::-

::::-

::::::::::::-

::-

Each consultation room shall have a hand basin along with the soap dispenser and towel hanger. A hanging curtain partition covering each of the examination table’s three sides shall be provided in the consultation rooms. The curtains shall be hung from a ceiling-­mounted curtain track that is fixed 2134 mm above the ground. A space shall

13.3  Services, Facilities, Equipment, Tools, and Instruments

481

be left clear at the bottom of the curtain that is approximately 457 mm above ground so that the floor can be easily cleaned. All consultation rooms shall adhere to all the biomedical waste management rules. Although direct sunlight shall be avoided, windows in consultation rooms are desirable. The window glass can be tinted, and there shall be blinds or drapes. Consultation rooms shall be provided with the following electrical points: • The main switchboard for controlling the room’s fan and lighting shall be located at the entrance wall (other than the wall on which the door shall open) and shall be connected to one 5 Amp switch/socket. • Air conditioning control button with temperature adjustment. • The switch and one examination light point shall be located on the wall about 2 ft above the examination table. • Two 5 Amp switch/sockets shall be installed on the wall 305 mm above the doctor’s table. In addition, one 15 Amp switch/socket shall be provided. • To power the computer and printer, three 5 Amp switch/sockets shall be installed on the wall approximately 305 mm above the doctor’s side rack. In addition, one 15 Amp switch/socket adjacent to this shall be provided for other equipment or heaters. The following communication points shall be provided in the consultation chamber: • RJ 45 port for computer networking • RJ 11 port for intercom and extension lines • HDMI port for displaying the computer output at other locations

13.3.4 Administrative Rooms See Table 13.6. The office of the in-charge rehabilitation department shall have an arrangement for office tables, side racks, executive chairs, visitor chairs, drawers, cabinets, storage racks, etc. for smooth working. The room shall have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning. Similarly, for the secretarial rooms, the room shall have an adequate arrangement of cabinets, drawers, and racks for smooth working. Required office tables and chairs shall also be provided. The room shall also have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning.

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13  Rehabilitation and Allied Health Therapies

Table 13.6  Administrative rooms of rehabilitation department

Activity These rooms shall be provided with: Office table Office chairs Visitors’ chairs Cabinets, drawers, and racks IT network Intercom connection Required electrical points CCTV surveillance Air conditioning

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

:::::::::-

Table 13.7  General stores of rehabilitation department

Activity A sufficient number of countertops Cupboards Drawers Racks

Start date

End date

Status of works In Not Complete progress started

:-

:::-

13.3.5 General Stores See Table 13.7. The store shall have sufficient working countertops duly finished with granite tops. The storeroom shall have adequate lockable cupboards, rack, working countertop, drawers, etc.

13.3.6 Record Room See Table 13.8. As the record room is used for keeping the patient’s records along with the other records, the storeroom shall have the cupboards, rack, working countertop, drawers, etc.

483

13.3  Services, Facilities, Equipment, Tools, and Instruments Table 13.8  Record room of rehabilitation department

Activity Cabinet Drawers Cupboards

Start date

End date

Status of works In Complete progress

Not started

Responsible person

Remarks

:::-

Table 13.9  Equipment park/store of rehabilitation department

Activity Lockable cupboards, racks, and drawers Working counter Sufficient electric points to charge equipment when not in use Air conditioning with controlled humidity level

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:::-

:-

13.3.7 Equipment Park/Store See Table 13.9. The equipment park/store shall have a sufficient number of working countertops to place the countertop equipment and instruments. For bulky equipment, sufficient floor space shall be available. The store shall have adequate lockable cupboards, racks, and drawers to store the equipment and instruments. The store shall also have multiple electric points to charge the equipment when not in use. The store shall have proper air conditioning and controlled humidity levels to prevent the electronic equipment from excessive heat and moisture.

13.3.8 Trolley Park Area See Table 13.10. The trolley bay shall have sufficient provision to hold the trollies in place. Hence, a sufficient number of hooks and chains shall be provided on the walls. Apart from this, the parking area shall have power outlets for recharging electric wheelchairs and scooters when they are not in use.

484

13  Rehabilitation and Allied Health Therapies

Table 13.10  Trolley park area of rehabilitation department

Activity Chains and hooks to hold the wheelchairs and stretcher trollies in place

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

Table 13.11  Clean utility room of rehabilitation department

Activity Racks Drawers Closed cabinets

Start date

End date

Status of works In Complete progress

Not started

Responsible person

Remarks

:::-

13.3.9 Clean Utility See Table 13.11. To store the clean linen and sterilized material, the room shall have a sufficient number of stainless steel racks divided into bins, drawers, cupboards, etc. The room shall be adequately air-conditioned, and the temperature shall be between 17 and 21 °C.

13.3.10 Dirty Utility/Sluice Room See Table 13.12. Dirty utility shall be provided with waste bins to dispose of the waste as per the biomedical waste management rules. Special attention shall be paid to biomedical waste. The room is provided with covered linen collection hampers or containers to collect the dirty linen that has to be sent to the laundry for the wash. Air from this room shall be exhausted; hence, exhaust fans are a must.

13.3.11 Change Rooms See Table 13.13. To keep the personal belongings of patients, provision of an adequate number of personal lockers shall be made in the changing room. One chair shall also be provided in the changing room, which the patient or staff can use while changing clothes.

485

13.3  Services, Facilities, Equipment, Tools, and Instruments Table 13.12  Dirty utility/sluice room of rehabilitation department

Status of works Start End In Not Responsible date date Complete progress started person Remarks

Activity Waste bins for disposal of waste as per the biomedical waste norms Covered hampers or containers to collect linen Exhaust fans to exhaust the contaminated air

:-

:-

Table 13.13  Change rooms of rehabilitation department

Activity Lockers to keep the personal belongings of the patient One chair Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep sterilized dresses Hanger rods with hangers Bin for dirty linen

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

::::::-

For hanging the outside clothes, an adequate number of hooks shall be fixed on the wall. Apart from this, the almirah and hanger rods with hangers shall also be provided to hang clothes. There shall be a closed cabinet to keep sterilized patient dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. A large receptacle for the collection of the used linen shall also be provided in the changing room.

13.3.12 Physiotherapy Rooms/Cabins See Table 13.14. Each therapy cabin shall have a treatment couch measuring 1829 mm × 762 mm.

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13  Rehabilitation and Allied Health Therapies

Table 13.14  Physiotherapy rooms/cabins of rehabilitation department

Activity Each cabin shall be provided with Treatment couch Instrument trolley One small cupboard Chair or stool (if the modality does not require a couch) Mirror is required Required hooks for thera belts Refrigerator for ice pack therapy Monitor stands in each cabin for multi-­ parameter monitor Nurse call systems MGPS supply of oxygen and suction if required Properly air-conditioned Hand washing facility with soap and paper dispensers Resuscitation trollies with emergency medicines Provide handrails, grab bars, and other safety devices Wall guards and corner guards Required electrical points in therapy room Other communication points in the therapy room

Status of works Start End In Not Responsible date date Complete progress started person Remarks :::::-

::::-

::-

::-

:-

:-

:::-

The necessary Z-trollies or the instrument trolley shall be provided inside the cabin to accommodate the modality equipment. In the cabin, one small cupboard shall be provided to store equipment accessories and/or other items such as linen.

13.3  Services, Facilities, Equipment, Tools, and Instruments

487

At times, a chair or stool may be required instead of a couch for some modalities. The same shall be provided. A mirror shall be provided in the cabin if one is required to assist the patient. Hooks for thera belts as required shall be provided. Refrigerators for ice pack therapy shall be provided in the cabin. Monitor stands shall be provided in the cabins to install the multi-parameter monitor if necessary. All individual cabins, including the exercise area, shall have the nurse call systems installed so that the patient can raise an alarm if necessary. The cabins shall have oxygen and suction outlets connected to the hospital’s MGPS lines. The outlets shall be wall-mounted or built into the bed head panel. If the building is located far enough away from the main hospital building that the MGPS pipeline cannot be brought to the rehabilitation department, a small manifold can be constructed in the rehabilitation department itself. Similarly, a small suction pump can be provided for suction. Every cabin shall have a controlled environment in terms of temperature, humidity, and ventilation. The department shall be air-conditioned, with a temperature between 18 and 23 °C. Each treatment space shall have hand washing facilities, including liquid soap and paper towel dispensers. In the event of an emergency, the department shall be provided with resuscitation trollies (crash carts) equipped with emergency tools and medications. The trollies shall be placed in a convenient location so that they can be easily and quickly wheeled to the required location in the event of an emergency. Natural light shall be used as much as possible to facilitate the work of the staff. Handrails, grab bars, and other support mechanisms shall be provided in the department for the safety of the patients. Wall guards and corner guards shall be provided in the department. Each cabin shall have sufficient electrical points: (a) Cabin’s light and fan. (b) The medical equipment shall be provided with a pair of 6/16 Amp switches/ sockets. If required, provide more than one such pair of power supplies. Besides this, for connecting the electronic devices, a pair of 6/16 Amp switch/ socket points shall be provided at all required locations. Further, all the computer points shall be backed up by a UPS supply. Intercom lines shall be provided at all the necessary locations throughout the department. In addition, computer networking points shall be provided in examination cubicles and cabins where machines are connected to computers. For connecting the computers to the networking, RJ 45 jacks shall be provided.

13  Rehabilitation and Allied Health Therapies

488

13.3.13 Occupational Therapy Rooms/Cabins See Table 13.15. In occupational therapy rooms, spaces shall be provided for the installation of training table-based activities such as sewing machines, woodwork, and toy preparation. Please keep in mind that the tables and chairs in the room shall be height adjustable to meet the needs of the patient. Benches shall be equipped with sinks and be wheelchair accessible. For the storage of equipment or tools, proper cupboards and shelves shall be provided. A hand washing basin along with liquid soap and paper towel dispensers shall be provided. Displays shall include a pinboard and a whiteboard. To supply power to the therapy’s tools and machinery, a sufficient number of electrical outlets shall be provided. Workshops must have a suitable air extraction and supply system in place. Preference shall be given to air exchange provisions. Table 13.15  Occupational therapy rooms/cabins of rehabilitation department

Activity Spaces for installing tables for training Table-based activities like the sewing machine, toy preparation, woodwork Tables and chairs with adjustable height Benches fixed with sinks and accessible by wheelchair Required shelves and cupboards Hand washing basin with liquid soap and paper towel fittings Pinboard and whiteboard for displays Required electrical points Other communication points Proper air conditioning and air exchanges

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::-

::-

::-

::::-

Further Reading

489

Further Reading Garg A, Dewan A. Chapter 27, rehabilitation and allied health therapies. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 309–14. PRIME PubMed | Planning a new physiotherapy department—a personal experience. 2021. https://www.unboundmedicine.com/medline/citation/7323205/Planning_a_new_physiotherapy_department__a_personal_experience_.

Pharmacy Unit

14

The pharmacy plays an important role in the hospital because it is the centre for dispensing medicines, injectables, cotton and bandages, and surgical disposables such as catheters to all inpatients and outpatients. In most hospitals, there are two pharmacy units from which drugs shall be disbursed. One unit is responsible for dispensing medications to inpatients, while the other is responsible for dispensing medications to outpatients. For inpatients, medications are typically given directly from the pharmacy to the appropriate wards, eliminating the need for a separate drug dispensing counter. Nonetheless, a retail pharmacy counter shall be available for patients who are outsiders. The pharmacy counter or store is essentially a licenced establishment, and both the inpatient pharmacy and the retail pharmacy counter need their own licenses. It shall be necessary to obtain a separate wholesale pharmacy license if the hospital distributes medications wholesale. Similar to this, additional licenses shall be needed to deal with narcotic medications like ketamine and other similar substances. In the hospital, pharmacy services are provided in a variety of ways. These can be self-owned pharmacies for both inpatients and outpatients; outsourced retail pharmacies for both inpatients and outpatients; or self-owned pharmacies for inpatients and outsourced retail pharmacies for outpatients. In any case, the hospital shall have dual pharmacies, one dealing with the inpatients and the other with the outpatients. This set of checklists shall assist the planner and designer in remembering all such issues relating to pharmacy design as well as other space requirements and shall guide him/her to complete, test, and commission all works/activities on time. This shall assist him/her in ensuring that all work/activities are completed, completed, and working before the pharmacy is stocked and operational.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_14

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14  Pharmacy Unit

14.1 Location of the Pharmacy The pharmacy shall provide an easily accessible retail counter for outpatients close to the OPD block. The OPD block exit point might be the ideal spot. Any area of the hospital where access is difficult shall have a pharmacy for inpatients. It might be on one of the service floors or in the basement.

14.2 Size of the Pharmacy The number of patients to be served, the number of formulations to be prescribed, the number of items to be stored, and a few other factors shall be taken into consideration while determining the pharmacy’s size. What is more crucial is that the stores have adequate space to hold enough supplies of medications and disposables that can last for at least 1 month.

14.3 Infrastructure The criteria for inpatient and outpatient pharmacies are essentially the same, with a few minor exceptions. The pharmacy shall generally have the following features:

14.3.1 Spaces Required for the Pharmacy Unit See Table 14.1. The pharmacy unit in the hospital shall be centralized (all spaces in one complex). While the inpatient pharmacy shall be placed away from the public areas and have limited access to this, the outpatient pharmacy shall have good connections to important hospital departments including the OPDs and emergencies. The pharmacies shall have the following infrastructure:

14.3.1.1 Entrance The pharmacy unit shall have a single entrance. The entrance shall have a lockable single door measuring approximately 1829 mm in width. The door shall be able to be opened from both sides. 14.3.1.2 Drug Receiving Zone The pharmacy shall have a location or enclosure for the storage of medications received from suppliers. The drugs shall be moved to the appropriate store for shelving after proper counting of the material received and quality verification. The size of this enclosure shall be at least 3658 mm × 3658 mm. The enclosure or space shall be secured, and employee access shall be limited.

493

14.3 Infrastructure Table 14.1  Spaces required for pharmacy unit

Activity Has the spaces for the following been provided for? Entrance Drug receiving zone Storage and dispensing hall Bulk storage Cooled storage Expiry drug room Costly drug room Drug sorting room Narcotics drug store Pharmacist office Public utilities for staff

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::::::::-

14.3.1.3 Storage and Dispensing Hall The storage and dispensing hall is the key area where routine drugs and disposables are stored and dispensed to patients. The number of patients served, the volume and variety of medicine formularies to be stored and dispensed, as well as the size of the storage and dispensing hall shall all be taken into consideration. The inpatient pharmacy shall have the same design, except that the dispensing counters or windows are not necessary in the dispensing hall because medicines and drugs are withdrawn from racks/bins and dispensed from a single window or through the pneumatic tube system to the inpatient wards. 14.3.1.4 Bulk Storage For items that move quickly, such as fluids, pharmacies place an order in bulk quantity. When the stock is delivered, it becomes difficult to keep the whole batch in the dispensing hall and may need to be kept somewhere else. Hence, a bulk store shall be provided. This bulk storage facility may be situated in the pharmacy complex or any other practical area inside or close to the hospital building. The size of the bulk storage shall be decided based on the requirements. A single door with a width of approximately 1219 mm shall be provided for the room. The storage space shall be waterproof and lockable. Electrical outlets shall be provided outside the store to ensure that the establishment is fire-resistant. Windows are not necessary for this store.

494

14  Pharmacy Unit

14.3.1.5 Cold Store A cold walk-in store shall be provided at the pharmacy for the storage of particular medications that need to be kept in a cold chain or a cool environment. This cold store shall be near the dispensing hall. The door of the cold room shall open in the dispensing hall. This space is also known as a refrigerated space. The room’s dimensions shall be 3048 mm × 3048 mm. The puff panelling room’s walls and ceiling serve as a thermal barrier. The room shall have air conditioning, and the temperature that can be adjusted shall be between 5 and 12 °C. The door to the room shall be hermetically sealed and made of a puff panel. Wooden planks are frequently used for flooring. The entry doors to this room shall be lockable. 14.3.1.6 Expiry Drug Room Drug expiration is typically the biggest problem in any pharmacy, and if it is not effectively regulated, significant losses may result. Drug expiration dates are always closely monitored by effective management. Because most drug manufacturers have a policy of replenishing near-expiry drugs, the pharmacist shall return the near-­ expiry drugs on time. To maintain track of expired and near-expired pharmaceuticals, most pharmacy software applications have a provision to keep track of expiry dates and issue timely warnings. The pharmaceuticals that the pharmacist has identified as being close to expiration shall be taken off the shelf and kept in a different location. Hence, a separate room shall be provided to store such medicines. Expiry drug store is another name for this space. The dimensions of the store shall be 3658 mm × 3658 mm. The dispensing hall shall be close to this store. A single door with a width of approximately 1067 mm shall be provided for this room. The storage space shall be waterproof and lockable. Electrical outlets shall be provided outside the store to ensure that the establishment is fire-resistant. Windows are not necessary for this store. Avoid direct sunlight inside the store. 14.3.1.7 Costly Drug Room There are some really expensive pharmaceuticals in every pharmacy, and there is a danger of being stolen, which could cause enormous losses if not well monitored. The expensive medications shall be constantly under the management’s watchful observation. As a result, such pharmaceuticals shall always be stored under lock and key in a separate area. The room may only be entered by authorized people. The expensive drug room is another name for this space. The room’s dimensions shall be roughly 3048 mm × 3048 mm. The dispensing hall shall be connected to this chamber. A single door with a width of approximately 1067 mm shall be provided for the room. The storage facility shall be moisture-free and lockable. This store does not require any windows. Avoid direct sunlight in this store. 14.3.1.8 Drug Sorting Room The cut strips are occasionally overlooked when administering the stripped medications in retail. Second, the drugs that were returned need to be refilled as a result of the returns. These chopped strips shall be sorted before being restocked with

14.4  Services, Facilities, Equipment, Tools, and Instruments

495

medications and replenishing the shelves. Hence, a separate room shall be made available for sorting such medications and strips. The drug sorting room shall be the name of this space. The room’s dimensions shall be roughly 3048 mm × 3048 mm. The dispensing hall shall be connected to this chamber. A single door with a width of approximately 1067 mm shall be provided for the room.

14.3.1.9 Narcotics and Controlled Drug Store When procuring, distributing, and keeping narcotics and controlled drugs, the pharmacist shall constantly be cautioned. Hence, such pharmaceuticals shall always be stored under lock and key in a separate area. Only those with permission shall be allowed in the room. The narcotic drug room shall be the name of this space. The room’s dimensions shall be roughly 3048 mm × 3048 mm. The dispensing hall shall be connected to this room. A single door with a width of approximately 1067 mm shall be provided for the room. The storage area shall be lockable and free of moisture. This store does not require any windows. Avoid direct sunlight in this store. 14.3.1.10 Pharmacist Offices Office space for the pharmacist shall be made available, either nearby or inside the drugstore unit. Pharmacy facilities for inpatients and outpatients shall have their own offices. The dimensions of these offices shall be roughly 4572  ×  4147  mm. There shall be an associated toilet in every office. If required, the personal assistant room shall be attached to the office. If extended working hours are expected, a small restroom shall be added to this workplace.

14.4 Services, Facilities, Equipment, Tools, and Instruments 14.4.1 Drug Receiving Area See Table 14.2. Furniture-wise, the drug receiving areas shall be provided with a sufficient number of racks and shelves for storage of the drugs, medicines, and consumables that have been received from the suppliers and vendors. For official work, an office table and office chairs shall be provided. The area or enclosure shall be lockable with restricted access for the staff. The receiving area shall be provided with a workstation duly connected to the networking and preloaded software of pharmacy management for recording the initial receiving/validation of medication orders. The computer shall be connected to the UPS supply. Apart from this, the computer accessories like printers, scanners, and barcode scanners and barcode printers shall be provided. The receiving area of the pharmacy shall be fully air-conditioned and have fully controlled temperature, humidity, and air exchanges. Air quality shall be adequate and secure at all times. The temperature of the pharmacy shall be between 18 and 22 °C.

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14  Pharmacy Unit

Table 14.2  Drug receiving area of pharmacy unit

Activity Separate lockable enclosure Racks and shelves Office table Chairs Working counter top Computer workstation connected to hospital network with UPS Printers and scanners Barcode scanner and barcode printer

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::::-

::-

14.4.2 Storage and Dispensing Hall See Table 14.3. To store the pharmaceuticals, medicines, disposables, and consumables, there shall be a sufficient number of racks divided into shelves in the dispensing hall. The racks shall be made of stainless steel or wood. The height of the racks shall not exceed 2134 mm, the depth of the shelf shall be around 305 mm, and the height between shelves shall be approximately 305 mm. Built-in cupboards with separated shelves can be installed on the hall walls as an alternative to racks. The shelves shall be able to withhold the weight of the pharmaceuticals that are kept on them. Space can be made available above the rack above the height of 2134 mm for bulky materials like cotton, pads, splints, and walkers. A double-stand stepladder may be used to operate this. Lockable drawers and cupboards shall be available for small and expensive medications. There shall be transaction/pass-through windows on the pharmacy’s front wall. For every 50 patients served in a day, at least one of these windows shall be available. A working countertop shall be placed below these transaction/pass-through windows so that the person can work there. For billing, computer systems with UPS and printers shall be provided. If needed, the barcode scanner shall also be provided. For storing some of the money collected, the counter shall have lockable drawers. On the working counter, suitable electrical points shall be installed to power the computers and printers. A display case can be given to show the common items being sold in the pharmacy and can be placed above the transaction windows/pass or on the sides of such windows.

14.4  Services, Facilities, Equipment, Tools, and Instruments

497

Table 14.3  Storage and dispensing hall of pharmacy unit

Activity Wooden or stainless steel racks divided into shelves for storage of drugs Built-in cupboards divided into shelves (if required) Lockable drawers and cabinets for small and costly drugs Transaction/pass-through windows for the sale of drugs Working countertop below transaction/ pass-through windows Working counter to have lockable drawers for cash Computers on the working counter for billing Display case facing outside for display of general items Office table and chair for pharmacist Computer system is connected to the hospital network and preloaded with the pharmacy management software with UPS Printers and scanners Barcode scanner Refrigerators for cold chain medicines Required electrical points Other communication points PTS station for IPD pharmacy distribution room

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

:-

:-

:-

::-

:-

::-

::::::-

498

14  Pharmacy Unit

Along with the working countertop for dispensing pharmaceuticals, chairs shall be made available for the staff members who are expected to work at the countertop. In addition, a desk and chair shall be set up in the hallway for the pharmacist, who shall monitor the operation of the pharmacy. The pharmacist shall be furnished with a computer system connected to the hospital network and preloaded with the pharmacy administration software. The UPS shall be linked to every PC. Moreover, the provision of computer accessories like printers, scanners, and barcode readers is required. Entry to this location shall be restricted, and it shall be guarded. A sufficient number of refrigerators shall be available in the hall to keep medications that need to be kept in cold chains, depending on the situation. The pharmacy’s dispensing hall shall have complete climate control, including temperature, humidity, and air exchanges. At all times, the air quality shall be sufficient and safe. For air conditioning, chilled water pipelines with AHUs, ductable split systems, and VRV systems are all possible solutions. The pharmacy shall be between 18 and 22 °C in temperature. The following electrical outlets shall be provided in the dispensing hall of the pharmacy: 1. The primary switchboard along with a 6 Amp switch/sockets, which manages the fans and lights in the hall, shall be placed near the entry wall. 2. Temperature-adjustable air conditioner control button. 3. There shall be at least two 6/16/Amp switches/sockets on the wall above the working counter slab. These points shall be placed in a series and separated by 3048 mm. The UPS shall be linked to half of these. 4. For refrigerators and deep freezers, 5 Amp switch/sockets shall be provided at the suitable location. The pharmacy dispensing hall shall have the following communication port: 1. RJ 45 point for computer networking 2. RJ 11 for intercom and extension line Pneumatic tube systems (PTSs): The inpatient pharmacy shall have PTS systems to give quick and effective service. The air pump for the PTS is connected to the control station, and the system is air-operated. This system is utilized for the transportation of paperwork, supplies, and medications. For records, specimens, materials, and medications, this is the most reliable, efficient, and rapid form of transportation. The outlet of this system and the control unit are situated at all the significant hospital locations (referred to as stations) where the medications shall be delivered or picked up. ICUs, emergency rooms, operating rooms, indoor wards, etc. are examples of these areas. The carrier box (capsule) transports the user department’s prescription to the pharmacy and in turn delivers medication to the user department.

14.4  Services, Facilities, Equipment, Tools, and Instruments

499

It is incredibly simple to use. Simply insert the medicine indent into the capsule and send it to the pharmacy from the user department. The pharmacy shall properly pack the medications and return them to the original user. The item or document is delivered in a matter of seconds to the desired destination. Automation of the pharmacy: A lot of automation is taking place in pharmacies, including the employment of robots to fill and dispense prescriptions and automated drug dispensers. The designer shall take into account all automation-related needs and concerns when creating the pharmacy. Before planning, if necessary, the automation equipment manufacturer shall be contacted.

14.4.3 Bulk Storage Room See Table 14.4. The bulk storage room shall have heavy-duty racks to store the cartons of the material. Accordingly, racks shall be designed. If required, the store shall also be provided with cupboards, an almirah, and drawers. Special care shall be taken that the store is fire-resistant; hence, electrical points shall be provided outside the store. In the store, only one or two light fittings shall be provided.

14.4.4 Cold Store See Table 14.5. A puff panel that serves as a thermal barrier shall be used for the cold room’s walls and ceiling. The room shall be air conditioning, which keeps the temperature adjustable between 5 and 12 °C. A temperature-monitoring system shall be installed in the room, and it shall be connected to a centralized alarm and warning system. The door of the room shall also be made out of the puff panel and shall be hermetically sealed. Table 14.4  Bulk storage room of pharmacy unit

Activity Heavy-duty racks Cupboards, almirah, drawers Electrical points shall be provided outside the store Windows are not required

Status of works Start End In Not date date Complete progress started :::-

:-

Responsible person

Remarks

500

14  Pharmacy Unit

Table 14.5  Cold store of pharmacy unit

Activity Refrigerated room Walls and ceiling made out of a puff panel Hermetically sealed door made out of the puff panel Wooden plank flooring Open racks Temperature-­ monitoring system connected to a centralized alarm/ warning system

Status of works Start End In Not Responsible date date Complete progress started person Remarks :::-

:::-

Table 14.6  Expiry drug room of pharmacy unit

Activity Racks and shelves Locking provision

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::-

The flooring shall be generally made out of wooden planks. For storage, open racks shall be provided along the walls. All access doors to this room shall be lockable.

14.4.5 Expiry Drug Room See Table 14.6. The expiry drug store shall be provided with a sufficient number of racks and shelves to store the drugs. Special care shall be taken that the store is fire-protected; hence, electrical points shall be provided outside the store. In the store, only one or two light fittings shall be provided. The expiry drug room of the pharmacy shall be fully air-conditioned and have fully controlled temperature, humidity, and air exchanges. Air quality shall be adequate and secure at all times. The temperature of the pharmacy shall be between 18 and 22 °C.

501

14.4  Services, Facilities, Equipment, Tools, and Instruments

14.4.6 Costly Drug Room See Table 14.7. The costly drug room shall be provided with a sufficient number of racks and shelves to store the drugs. This room shall also have lockable cupboards, an almirah, and drawers for storing the costly drugs. Special care shall be taken that the store is fire-protected; hence, electrical points shall be provided outside the store. In the store, only one or two light fittings shall be provided. The costly drug room of the pharmacy shall be fully air-conditioned and have fully controlled temperature, humidity, and air exchanges. Air quality shall be adequate and secure at all times. The temperature of the pharmacy shall be between 18 and 22 °C.

14.4.7 Drug Sorting Room See Table 14.8. The drug sorting shall be provided with shelves and racks for storage of the drugs. The racks and shelves shall be divided into bins to place the sorted cut-strip medicines item-wise and category-wise. Table 14.7  Costly drug room of pharmacy unit

Activity Racks and shelves Lockable cupboards, almirah, and drawers Locking provision

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

::-

:-

Table 14.8  Drug sorting room of pharmacy unit

Activity Racks and shelves divided into bins Working countertops along with the high-raised chair Trays Chairs Office tables

Status of works Start End In Not date date Complete progress started ::-

:::-

14  Pharmacy Unit

502

Also, the working countertop shall be provided along with the high-raised chairs. In case the countertop is not provided, ordinary office tables shall be provided with office chairs where the staff can be seated for sorting out the drugs. The drug sorting room of the pharmacy shall be fully air-conditioned and have fully controlled temperature, humidity, and air exchanges. Air quality shall be adequate and secure at all times. The temperature of the pharmacy shall be between 18 and 22 °C.

14.4.8 Narcotics and Controlled Drug Room See Table 14.9. The narcotic drug room shall be provided with racks and shelves to store the drugs. For better control and pilferage of narcotic drugs, instead of the open racks and shelves, it is better to provide lockable cupboards, almirah, and drawers. The room shall be lockable and free from any kind of moisture. Special care shall be taken that the store is fire-protected; hence, electrical points shall be provided outside the store. In the store, only one or two light fittings shall be provided. The narcotic drug storage room of the pharmacy shall be fully air-conditioned and have fully controlled temperature, humidity, and air exchanges. Air quality shall be adequate and secure at all times. The temperature of the pharmacy shall be between 18 and 22 °C.

14.4.9 Pharmacist Office See Table 14.10. The pharmacist’s office shall have an office table, office chairs, and visitors’ chairs. For smooth operation, cabinets, drawers, and racks shall be adequately provided. Along with enough electrical outlets, the room shall also have an intercom connection, an IT network, video surveillance, and air conditioning. Table 14.9  Narcotics and controlled drug room of pharmacy unit

Activity Racks and shelves Lockable cupboards, almirah, and drawers

Status of works Start End In Not date date Complete progress started ::-

Responsible person

Remarks

503

Further Reading Table 14.10  Pharmacist office of pharmacy unit

Activity These rooms shall be provided with: Attached toilet PA room Office table Office chairs Visitors’ chairs Cabinets, drawers, and racks IT network Intercom connection Required electrical points CCTV surveillance Air conditioning

Start date

Status of works End In Not date Complete progress started

Responsible person

Remarks

:::::::::::-

Further Reading ADVANCES IN HOSPITAL PHARMACY SERVICES: AN OVERVIEW.  PharmaTutor. 2021; https://www.pharmatutor.org/articles/advances-­in-­hospital-­pharmacy-­services-­an-­overview Augusto V, Xie X.  Redesigning pharmacy delivery processes of a health care complex. Health Care Manag Sci. 2009;12(2):166–78. Blum A, Merino GSAD, Merino EAD. Design strategies in hospital pharmacy department: mapping a medication system. Strateg Des Res J. 2018;11(1):15–20. Carroll N, Richardson I. Enablers and barriers for hospital pharmacy information systems. Health Informatics J. 2020;26(1):406–19. Coblio NA. The impact of pharmacy work design on pharmacist productivity. 2011;176. Five pharmacy automation trends. 2021. https://www.hfmmagazine.com/articles/2345-­five-­ pharmacy-­automation-­trends. Garg A, Dewan A. Chapter 28, Pharmacy unit. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 315–9. Gones V.  HOSPITAL PHARMACY MANAGEMENT: AUSTRALIAN AND INDONESIAN PERSPECTIVES. 2016;196. Kay BG, Boyar RL, Raspante PS.  Designing a modern hospital pharmacy. Am J Hosp Pharm. 1986;43(2):339–43. Pharmacy Design, Design a pharmacy. 2021. https://www.pharmacydesign.org/Articles-­ PharmacyDesignTrends-­0608.htm. Pharmacy design can streamline patient care—architecture. Healthcare Facilities Today 2021. https://www.healthcarefacilitiestoday.com/posts/Pharmacy-­design-­can-­streamline-­patient-­ care%2D%2D2720. Sabzghabaee AM, Badri S, Ashari HE, Hosseini SM. The design and equipments of hospital pharmacies in Isfahan. Iran J Res Med Sci Off J Isfahan Univ Med Sci. 2010;15(4):219–24. Swensson ES.  An innovative Design in Hospital Pharmacy Facilities. Am J Hosp Pharm. 1971;28(6):440–6. Taylor EN. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293(4):455.

Central Sterile Services Department (CSSD)

15

In any hospital, the importance of sterilization cannot be overemphasized. Sterilization is a process that removes microorganisms from hospital instruments, linen, operating rooms, and other areas, ensuring infection prevention in the hospital. The sterilization process kills all microorganisms, whether they are disease-­ producing or not. As a result, proper sterilization procedures shall be followed. The central sterile services department (CSSD) in hospitals is a centralized location that sterilizes medical devices, instruments, linen, and consumables. This is a department that assists other hospital departments. This department’s primary functions include cleaning, preparing, disinfecting, packing, and sterilizing reusable medical devices, linen, and surgical instruments. To provide sterile dressings and sets to the wards and departments, including the operating room, the hospital shall establish a central sterile supply department (CSSD). The CSSD shall be centrally located and furnished with the necessary sterilization tools. The sterilization process can be broadly divided into the following categories: 1. Before preparing for sterilization, cleaning the instruments and linen 2. Packing for sterilization 3. Sterilization 4. Storage after sterilization 5. Distribution of sterilized material to the end users Typically, the CSSD sterilizes the following items: 1. Surgical instruments 2. The linen of OT and emergency 3. Disposables 4. Dressing drums 5. Ward linen © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_15

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15  Central Sterile Services Department (CSSD)

This set of checklists shall assist the planner and designer in remembering all such issues relating to the designing of CSSD departments as well as other space requirements and shall guide him/her in completing, testing, and commissioning all works/activities on time. This shall assist him/her in ensuring that all work/activities are completed and operational before sterilization.

15.1 Methods of Sterilization Processes The effectiveness of sterilization shall depend upon the type of sterilization that has been used. Some of the sterilization methods are: 1. Steam sterilization 2. Gas sterilization 3. Chemical sterilization 4. Dry heat sterilization 5. Radiation sterilization 6. Formaldehyde sterilization 7. Fumigation 8. Boiling sterilization 9. Filtration sterilization

15.2 Location of CSSD The CSSD shall be situated as near as feasible to the primary user, such as operating rooms and intensive care units. As a result, CSSD shall be situated on the same floor as the intensive care unit or operating floor, or directly above or below it. The CSSD might not always be offered close to the OT due to a lack of space and might have to be offered at a separate location or floor. In these circumstances, a specialized sterile material elevator with doors opening in the user’s area, such as the OT complex and ICU complex, shall be provided.

15.3 Area Required for CSSD Department The area’s requirement is primarily determined by the following: 1. The workload of the CSSD department shall be determined by the number of operating rooms and ICUs. 2. The number of sterilization cycles that shall be performed per day. 3. Working hours of the CSSD (whether operative 24 h or only for limited hours). 4. Number of sterilizers to be installed in the department. 5. The type of sterilization to be performed, such as steam sterilization, ETO, hot-­ air sterilization, and chemical sterilization.

15.5 Infrastructure

507

6. The installation of equipment such as an ultrasonic cleaner and instrument washer. 7. Packing load of the CSSD department. 8. The number of instrument sets prepared per day.

15.4 Zones of CSSD 15.4.1 Functional Zones of CSSD The CSSD shall have the following zones: 1. Receiving zone (unclean area) 2. Decontaminating, washing, and disinfecting zone 3. Packing zone 4. Sterilization zone 5. Clean storage zone 6. Clean supply zone 7. Support zone

15.5 Infrastructure It is critical to remember when designing the CSSD that the material flow in the CSSD shall be unidirectional (one way), with no backward movement permitted. It means that unsterile material shall enter from one end of the CSSD and exit from the other end after sterilization.

15.5.1 Space Requirement for CSSD The following spaces shall be provided in the CSSD department (Table 15.1).

15.5.1.1 Receiving Zone (Unclean Area) Materials that need to be sterilized are sent to this section from a variety of user departments, including the OT complex and linen from the laundry. The receiving area shall be the first zone and be situated right at the entrance of the CSSD department. The reception space shall be a room with a minimum dimension of 3048 mm by 3048 mm. Nonetheless, the size can be altered according to the circumstance. To receive the material, a window or a door shall be provided in the receiving room. A glass partition with a lockable sliding hatch can also be installed between this area and the corridor outside CSSD. The width of the entrance door to the receiving area shall be 915 mm. If a separate door is provided for receiving the material, its size shall be around 1220 mm to allow the trolley to enter the room easily (if required). If a window is provided for

508

15  Central Sterile Services Department (CSSD)

Table 15.1  Spaces required for CSSD

Activity The following spaces shall be provided for: Dirty receipt Washing/disinfection Assembly/packing Sterilization Sterile storage Delivery room ETO room CSSD supervisor administration room Staff change for males Staff change for females Shoe changing area General store Staff restroom Trolley bay Public utility for staff

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::::::::::::-

receiving the material, it shall be approximately 1220 mm wide and 915 mm high. The window shall be installed at a height of 915 mm above the ground. Trolleys are typically used to transport the material to the receiving area. As a result, enough space shall be provided outside the room to park the trolleys engaged in transporting the material. If the trollies are to be brought into the receiving room, adequate space shall be made available to accommodate the trollies. In that case, the receiving room’s size shall be increased to meet the requirements.

15.5.1.2 Decontaminating, Washing, and Disinfecting Zone In the decontamination area, instruments are rinsed, ultrasonically cleaned (if required), washed/decontaminated, and dried. Decontamination is the process of removing dangerous bloodborne germs from instrument surfaces using both automated and manual cleaning techniques. Contaminated items are sorted, dismantled, pre-rinsed, and cleaned in this decontamination/dirty section. To ensure proper disposal, waste is separated into suitable containers. If the objects are very dirty, automatic instrument washers or ultrasonic disinfectors are used to clean them. This area shall be used for manual cleaning of instruments, linen, and other items that are not suitable for automated cleaning; rinsing of tools and equipment; disassembly and inspection of contaminated materials; and sorting and loading of tools and equipment into trays, washer-disinfectors, and other automated cleaning equipment.

15.5 Infrastructure

509

The appropriate dimensions for the washing and disinfection areas shall be 4267 mm × 3658 mm. However, the size of the room can be altered depending on how many washing machines are to be placed in it or how many objects would need to be cleaned and disinfected. The washing and decontamination room shall have a single-door entrance measuring 1220 mm in width. For the transfer of hand-washed items to the packing area and the return of empty trays, a hatch window between the washing room and the packing room shall be provided. The window shall be about 915 mm in height and 1220 mm in width. The window shall be mounted 915 mm above the ground.

15.5.1.3 Packaging Zone The instruments are sent to the packaging section to be put together into predetermined sets or trays after being cleaned and decontaminated. Sterilized instruments and other goods shall be packaged to retain their sterility up until the point of usage. With a one-way flow from the contaminated region to the clean areas, the packaging area shall be situated between the washing/decontamination area and the sterilization area. The appropriate packaging room dimension shall be 4572 mm × 4267 mm. Yet, the size can be altered as necessary. The packaging area shall have a single entrance door. This door shall directly open in the CSSD’s entrance area and not be connected to the receiving room or the washing/decontamination room. The door shall be 1220 mm wide. Another door in the packaging room shall open into the sterilization room. The width of this door shall also be 1220 mm. For the transfer of packed sets and trays to the sterilizing area, a hatch window between the packaging room and the sterilization room shall be provided. The window shall be about 915 mm in height and 1220 mm in width. The window shall be mounted 915 mm above the ground. To prevent cross-contamination, the packaging room shall be separated from the washing and decontamination rooms by a hard barrier. 15.5.1.4 Sterilization Zone Sterilization is the process where packed materials such as instruments, linen, and consumables are made free of any unwanted organisms that could harm the patient. This procedure may include steam sterilization, dry heat sterilization, or low-­ temperature sterilization depending on the product. The sterilization area includes sterilizer storage as well as a sterilizer and trolley parking. Specialized sterilizers such as ethylene oxide sterilizer require separate spaces and norms for installation. Sterilizers operated at low temperatures shall be installed separately following the manufacturer’s recommendations. Between the packing and clean storage facilities shall be the sterilizing and cooling space. The size shall depend on how many and what kind of sterilizers are placed, as well as whether the sterilizer has a single door or double door. However, depending

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on the requirement, the sizes can be altered. But on average, sterilizer area shall not be less than 9.29 sq. m. Sterilizer trolleys shall be able to be moved freely and without obstruction, as well as loaded and unloaded, in the circulation space. The ETO sterilizer needs to be set up in a separate space. The ETO sterilizer’s size and model shall be taken into consideration while determining the room’s size (tabletop or floor model).

15.5.1.5 Clean Storage Zone Items shall be kept in a sterile environment after being sterilized. To store processed sterile material such as trays and drums, a room shall be provided. The sterile storage area shall be close to the sterilization area, preferably in a dedicated, regulated, enclosed space with limited access where only sterile materials are kept. The amount of material to be stored and the length of time that the item is typically kept in the storage shall determine the size of the storage. The room shall not have any windows. Avoid direct sunlight in the room. The clean storage area shall have restricted entry, and people shall only be allowed in after they have washed and changed their clothes. The clean storage area shall have a single door that opens into the changing room. The door shall be 915 mm wide. The door shall be lockable and, if possible, hermetically sealed. A hatch window between the clean storage room and the delivery room shall be provided to transfer sterilized articles to the delivery room. The window shall be approximately 1220 mm wide and 915 mm high. The window shall be installed at a height of 915 mm above the ground. 15.5.1.6 Delivery Zone The sterile material shall be provided to users from the delivery counter, which shall be at the far end of the CSSD. The delivery room’s size shall be determined by the number of items delivered per day. The size of the room shall ideally be 3658  mm  ×  3658  mm. However, depending on the situation, the size can be altered. To provide the material to the user, a hatch window shall be placed in the delivery chamber. This window shall open to the exterior of the CSSD building. The window shall be approximately 1220  mm wide and 915  mm tall. The window shall be installed 915 mm above the ground. There shall be enough room outside the delivery windows for the trolleys to park when they arrive to retrieve the material. 15.5.1.7 Support Zone The CSSD support areas are those that are not directly concerned with the sterilization process but indirectly assist the CSSD department. The following are the spaces: Administrative area: The CSSD shall have space for its general administrator and administrative support workers. This space shall be roughly 4572 mm × 4267 mm

15.5 Infrastructure

511

in size. However, the size can be changed according to the need and number of people who shall probably sit. The room shall ideally have a connected toilet. If necessary, this space shall be connected to a separate store. Staff changing rooms: CSSD shall be provided with two different changing rooms. One shall be for the staff working in an unclean area, and another for the staff placed in the package and sterile areas. In terms of changing rooms for the unclean area, the unclean area shall have two pass-through changing rooms for males and females. The CSSD’s change room could be right at the entrance of the CSSD.  Each changing room shall have its own toilet. A separate set of changing rooms for packaging and sterile areas shall be provided at the entrance of the clean storage room; these change rooms shall be separate for males and females. Each changing room shall ideally have its own toilet. The changing room shall be 3048 mm × 3048 mm in size and shall include an attached toilet. Shoe change area: Inside the CSSD complex, shoe changing shall be provided. The personnel entering the CSSD shall take off their outside shoes before changing into the sleepers and shoes that are reserved for use in the CSSD. General store: CSSD complex shall have a store for the storage of CSSD consumables like sterilization agents, indicators, ETO cartridges, and packing papers. This store is also used for storing unused tools and equipment like sealing machines. The dimensions of this store shall be approximately 3658 mm × 3658 mm but can be altered depending on the number of items to be stored. The room shall not have any windows or other direct sunlight sources. Restroom for staff—males and females: The staff shall have access to a restroom where the CSSD staff can take a rest for short time after long duty hours. The size of the room shall be approximately 3658 mm × 3658 mm. Preferably, these restrooms shall have attached toilets. Trolley bay: Adequate trolley area shall be provided outside the receiving zone and delivery zone of the CSSD to park the trollies coming to the CSSD for delivery of the unsterilized material and to collect the sterilized material.

15.5.2 Finishing Details of the CSSD 15.5.2.1 Walls 1. Washable, antifungal, and antibacterial paints shall be used on the walls. Vinyl-­ coated walls are also an option. 2. Buffer rails and corner guards shall be used to protect walls from damage caused by loose equipment and wheeled traffic. 15.5.2.2 Ceilings 1. A ceiling height from the floor level shall be at least 2800 mm. 2. The ceiling shall be impermeable, washable, and non-porous.

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15.5.2.3 Floors 1. Avoid using carpet or another soft flooring. 2. The use of impermeable, non-slip floor coverings shall be preferred. If tiles are used, they shall not have gaps between them and be jointless. PVC-welded sheet vinyl coved up the walls can also be used. 15.5.2.4 Doors 1. Doors shall be wide enough to enable moving trolleys, and corridors shall have adequate space for trolley turning circles and protruding trolley fittings. 2. Door frames and door leaves shall be built with protection cladding and bumper rails to withstand the unavoidable trolley bumps. 3. Doors shall be big enough to let equipment, both present and potential, pass through without obstruction. 4. The doors shall have vision panes attached. 15.5.2.5 Sound/Noise Controlled noise shall be used, and the threshold shall not exceed 60 dBA (decibels). To prevent sound reflection, absorbent materials shall be used to construct the walls and ceilings. Sterilizer and washer-disinfector insulation shall be taken into account. 15.5.2.6 Natural Light Where possible, natural illumination shall be used, especially in cleaning and packaging rooms, where it is highly beneficial. On the other hand, direct sunshine shall be avoided in the workplace.

15.6 Services, Facilities, Equipment, Tools, and Instruments 15.6.1 Receiving Zone (Unclean Area) See Table 15.2. The space shall have enough work surfaces for sorting and unpacking the material that has been received for sterilizing. The working slab’s upper level shall be 914–965 mm above the ground. The slab shall be about 762 mm wide, but this can change depending on the specifications. On the slab’s top surface, granite stone with full- or half-round edges can be fitted. Similar to the horizontal stone, the vertical stone shall be fixed on the wall beginning at the top of the slab. This vertical stone shall have a height of 305–610 mm. This vertical stone shields the wall from stains and damage. The room shall be provided with stainless steel racks, and cabinets shall be provided to hold the material until it is treated further. Red lines shall be drawn at the receiving area to mark the path of any material or trolleys entering the CSSD through this entry.

15.6  Services, Facilities, Equipment, Tools, and Instruments

513

Table 15.2  Receiving zone of CSSD

Activity Provide working tops for unpacking and sorting SS racks and cupboards for stocking material till further processing Red lines to demarcate the movement of men and material Lockable hatch for trolleys Material elevators can be used Computer connection for recording the receipt of material Hand washing facilities with liquid soap dispenser and paper towel dispenser Required electrical points Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

:-

:::-

:-

::-

There shall be a lockable hatch in the trolley park area to hold the trollies. The room shall have hand washing sinks with a liquid soap dispenser and a paper towel dispenser. The receiving area shall have a sufficient number of: (a) Intercom outlets (b) RJ 45 for data points (c) Electrical outlets for computers and printers

15.6.2 Decontaminating, Washing, and Disinfecting Zone See Table 15.3. The washing and decontamination room shall be equipped with an automatic instrument washer (single or double door) on the foundation specified. Before installing the washer, the necessary electrical points shall be provided. Moreover, the machine’s earthing shall be finished. A water supply line and any necessary drains shall also be provided.

15  Central Sterile Services Department (CSSD)

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Table 15.3  Decontaminating, washing, and disinfecting zone of CSSD

Activity Automatic instrument washer (single door or double door) Ultrasonic cleaner Provision of the water supply Provision of the required drain Foundation for machine Electrical cables and outlet for machine Ground earthing of the machine Double-bay sink (for cleaning and rinsing) along with the draining board fixed in the benches Hot and cold water supply and drain All benches shall be made out of stainless steel Outlet of compressed air Room shall be under ‘negative pressure’ Hand washing facility with liquid soap dispenser and paper towel dispenser Air exhaust system in the area Wall-mounted brackets for hanging brushes Deionized, distilled, or reverse osmosis (RO) water Drying rack for drying manually cleaned instruments

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:::::::-

::-

:::-

:::-

:-

If an ultrasonic cleaner has to be provided in the room, similar preparations shall be made as in the case of an automatic instrument washer. For manual cleaning, there shall be a double-bay sink (one for cleaning and another for rinsing) and a draining board mounted to the benches. The sink needs to

15.6  Services, Facilities, Equipment, Tools, and Instruments

515

be at least 1 ft deep and manufactured of stainless steel grade 304. The size of the sink shall be roughly 457 mm by 610 mm. The supply and drainage of hot and cold water shall be properly set up. The benches shall also be made of stainless steel. A compressed air outlet shall also be provided in the washing area (can be supplied from the piped medical pipeline) for operating the blowguns. If necessary, a pre-treatment area can be provided, where pollutants are removed using an automatic cycle. This area shall be under ‘negative pressure’ in comparison to the surrounding environment to reduce the risk of contamination of the other treatment areas. A hand washing station with a liquid soap dispenser and a paper towel dispenser shall be provided. In this area, an air exhaust system shall be installed. There shall be enough wall-mounted brackets to hang cleaning instruments and brushes. Similarly, wall-mounted shelves shall be provided to keep the cleaning chemicals and reagents. For final rinsing, deionized, distilled, or reverse osmosis (RO) water shall be provided. Drying rack—A space shall be provided for drying the instruments that have been manually cleaned.

15.6.3 Packing Zone See Table 15.4. The packaging area shall include packing tables that are roughly 2438  mm  ×  1524  mm in size. Along its length, the table shall be split into two halves. A rack (914 mm height) with shelves shall be mounted in the centre. Hence, a provision for four employees to sit shall be created so that all four can pack the items simultaneously. Stainless steel shall be used to construct this table. One or more stainless steel counters shall be provided so that the trays and drums can be packed as well as the cotton rolls’ gauze cut into pieces. The size of this packaging table(s) shall be approximately 2000 mm by 700 mm by 800 mm high. Below the top surface of this table, a shelf shall be provided to place the SS basket, which can be used to store the unpacked materials. It is advised to set up storage space for fresh surgical instruments. These brand new instruments shall act as a backup in case any instruments delivered to CSSD are damaged and need to be replaced. The packaging room needs to be clean and positively pressurized. The pressurization system shall be the same as was in the case of operating rooms. To learn more, please refer to the chapter on operating rooms. The windows, if any, of the packing zone shall be properly sealed. There shall be enough wall-mounted brackets to place the tools and cleaning devices such as cutters and scissors. Power and electrical outlets shall be provided on the packaging tables to be used to connect the computers and instrument scanners.

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Table 15.4  Packing zone of CSSD

Activity Stainless steel packing tables Stainless steel countertops Shelf below packing tables and SS basket above table Storage area for new surgical instruments Positively pressurized area Sealed windows can be provided Wall-mounted brackets for equipment Electrical points on packing tables Hand washing facility with liquid soap dispenser and paper towel dispenser Sealing machine Cloth cutters Heavy-duty scissors Surgical trays and drums

Status of works Start End In Not Responsible date date Complete progress started person Remarks :::-

::::::-

::::-

A hand washing basin with a liquid soap dispenser and paper towel dispenser shall be provided at the room’s perimeter for hand wash. The room shall be equipped with a sealing machine, cloth cutters, heavy-duty scissors, surgical trays, drums, and so on.

15.6.4 Sterilization Zone See Table 15.5. The sterilizers shall be the most important component in the room for sterilizing the articles. There are several types of sterilizers available. It could be a steam sterilizer, a dry heat sterilizer, an ETO sterilizer, or something else. The most commonly used are steam sterilizers. In terms of the ETO sterilizer, it is specifically used for sterilizing articles that cannot be sterilized in the steam sterilizer. In terms of the steam sterilizer, this sterilization is accomplished through the use of steam under pressure that is greater than atmospheric pressure, which raises the

15.6  Services, Facilities, Equipment, Tools, and Instruments

517

Table 15.5  Sterilization zone of CSSD

Activity Steam sterilizers—as per requirement Foundation for sterilizer Exhaust duct from sterilizer terminating outside the room Required electrical outlets RO water line Drain for each sterilizer Hand washing facility with liquid soap dispenser and paper towel dispenser Proper ventilation system with positive pressure Ethylene oxide gas sterilizer (ETO) Separate room for ETO sterilizer Exhaust copper/SS pipe from ETO terminating outside above building height Required electrical outlets Proper waste disposal system for ETO cartage Dry heat sterilizer Hydrogen peroxide plasma sterilizer Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::-

::::-

:-

:::-

:::::-

temperature of the steam to destroy the microbial life. Vertical or horizontal steam sterilizers are available. Again, horizontal sterilizers can be rectangular or cylindrical. The rectangular shape is preferred for more efficient use of space in the sterilizer. Tough vertical sterilizers are not recommended these days because the steam inside the sterilizer when hits the lid of the sterilizer forms water vapours, which ultimately fall on the articles to make them wet. These wet articles when taken out of the sterilizer and exposed to air again get contaminated. Horizontal sterilizers are the best choice. The size of the sterilizer to be chosen shall depend on the requirement of the hospital considering the sterilization load of

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15  Central Sterile Services Department (CSSD)

the hospital. Another factor that needs to be decided is the number of doors of the horizontal sterilizer. There are two types of doors for these sterilizers, that is, a single door or double door. In the case of a double door, one door opens directly into the clean storage area. Out of the two, a double-door sterilizer is the better choice as the chances of contamination are reduced because the sterilized articles are directly moved to the clean store from the sterilizer itself. Anhydrous oils, petroleum products, and bulk powders that are impervious to steam and ethylene oxide gas can be sterilized using hot air in dry heat sterilizers. Dry heat destroys microbial life by physically oxidizing it or by slow-burning protein coagulation in cells. A reactive plasma or vapour is created when hydrogen peroxide is activated. It can be produced by a powerful magnetic or electric field. The cloud’s hydrogen peroxide free radicals interact with cell membranes, enzymes, and nucleic acids to interfere with the life processes of microorganisms. A single-door sterilizer shall be placed next to the room’s exterior wall if one is to be fitted. Nonetheless, there shall always be a gap between the sterilizer and the wall of around 914 mm. The unloading door shall open in the clean storage area if the sterilizer has two doors. After making a hole in the shared wall between the sterilization chamber and the clean storage, the sterilizer shall be placed. The sterilizer shall be installed on a foundation that has been prepared for this purpose. The size and other technical details of the foundation shall be decided in consultation with the sterilizer’s original manufacturer. The sterilizer shall be bolted to the foundation using fasteners. The sterilizer shall be attached to an exhaust duct, which shall traverse the room’s wall to open outside the space. This is crucial to let the surplus steam escape into the air. The sterilizers shall have the necessary electrical outlets. The supply shall come from a separate MCB installed in the distribution box (DB). The electrical power load for the sterilizer shall be determined following the recommendations of the sterilizer’s original manufacturer. A proper RO water line near each sterilizer shall be provided. Each sterilizer shall be provided with a separate drain on the floor just below the sterilizer. A free space of approximately 2438 mm shall be provided on the front side of the sterilizer to load the articles into the sterilizer. If more than one sterilizer is installed, they shall be at least 1829 mm away from one another. Around the room’s perimeter, there shall be a sink for hand washing along with a dispenser for liquid soap and paper towels. Air shall be designed to leave the sterilizing area through the ventilation system (via positive pressure). Sterilizer trolleys shall be able to be moved freely and without obstruction, as well as loaded and unloaded, in the circulation space.

15.6  Services, Facilities, Equipment, Tools, and Instruments

519

If a vertical steam sterilizer is installed, nothing particular needs to be done, but it shall be set down on the floor. Nonetheless, sufficient access to water, drainage, and electrical outlets shall be given. The installation of the ETO sterilizer requires a separate room. The ETO sterilizer’s size and model shall be taken into consideration while determining the room’s size (tabletop or floor model). Place the ETO sterilizer up against the room’s exterior wall. However, there shall be a gap between the sterilizer and the wall of around 914 mm. The sterilizer shall be equipped with an exhaust pipe for the drain of ethylene oxide gas that exits outside the room, crosses the room’s wall, and rises above the height of the building. Copper or stainless steel pipe is suggested for this use. The ETO sterilizers shall have the necessary electrical outlets. The supply shall come from a separate MCB installed in the distribution box (DB). The electrical power load for the sterilizer shall be determined following the recommendations of the sterilizer’s original manufacturer. To load the products into the sterilizer, a free space of approximately 1524 mm shall be provided on the front side. If more than one ETO sterilizer is installed, they shall be at least 1829 mm away from one another. A suitable waste disposal system shall be provided if ETO cartage is used. While using ETO cylinders, the correct connection between the cylinder and the sterilizer shall be made.

15.6.5 Clean Storage Zone See Table 15.6. The storage room shall be provided with stainless steel racks and/or alternately lockable cupboards made out of stainless steel. Some of these racks or the cupboards, as the case may be, shall be divided with the bins. Others can have open Table 15.6  Clean storage zone of CSSD

Activity Stainless steel racks and/or lockable cupboard Air conditioning Positively pressurized area with filtration Facility for washing the room and fumigation

Status of works Start End In Not date date Complete progress started :-

::-

:-

Responsible person

Remarks

15  Central Sterile Services Department (CSSD)

520

shelves. These racks shall be adjoining the walls of the storage room. The height of the racks can be about 1829 mm, and the width shall be according to the space in the room. Better is if the width is kept to 914 mm each. Then multiple racks of 914 mm in width can be placed side by side. The shelves shall be 375 mm deep and easily cleaned and allow air to circulate around the stored packs. Free-standing or mobile shelving provides a practical solution for handling the flow of products in and out of storage and cleaning. If the room size is bigger, the racks can be placed in the centre of the room to allow access from all sides of the racks. Open shelving is more commonly used as it allows dust to pass through making them easier to clean than solid shelves. For bins, the size of bins can be 305 mm × 305 mm × 305 mm each. Sterilized packs shall not be kept near or under sinks, on the floor, or anywhere else where they could get wet or damaged. They shall also be kept out of direct sunlight and water. Sterile packs shall be stored at least 450 mm below the ceiling or sprinkler heads, at least 50 mm from side walls, and at least 250 mm above the floor to allow for air circulation in the space and prevent contamination during floor cleaning. There shall be facilities for room cleaning and fumigation in the sterile area. The clean storage area shall be fully air-conditioned, allowing for temperature, humidity, and air exchange control. The clean storage room shall always have suitable and safe air quality. Temperatures shall be kept at 21 °C and ±3 °C, with relative humidity ranging from 20 to 60%, though 55% is considered ideal. Based on the biological load and location, a clean storage room shall have at least 20 total air changes. The fresh air component of the air change shall be at least 4 out of every 20 air changes. The recommended minimum positive pressure is 2.5 Pa (0.01 inches of water). Within the AHU, two sets of washable flange-type filters with efficiency of 90% down to 10 μm and 99% down to 5 μm shall be installed for air purification and filtration.

15.6.6 Delivery Zone See Table 15.7. Table 15.7  Delivery zone of CSSD

Activity Delivery counter Computer system with printer, UPS, scanner, and barcode scanner Outside the delivery windows, sufficient space for trolley parking

Status of works Start End In Not date date Complete progress started ::-

:-

Responsible person

Remarks

15.6  Services, Facilities, Equipment, Tools, and Instruments

521

The delivery room shall have an adequate number of working tops for the delivery of sterilized articles, packs, sets, and drums, among other things. The top level of the working slab shall be 914–965 mm above ground level. The width of the slab shall be around 762  mm, but this can vary depending on the requirements. The working countertop shall preferably be made of stainless steel. The delivery room shall be equipped with a computer system connected to the UPS, as well as other accessories such as a printer, scanner, and barcode scanner for managing material deliveries and transport documentation. On or near the delivery counter, the required number of electrical and computer networking outlets shall be provided to connect the computer.

15.6.7 Administrative Rooms See Table 15.8. The room shall be provided with the office table, office chairs, and visitors’ chairs. An adequate arrangement shall be made for cabinets, drawers, and racks for smooth working. The room shall also have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning.

15.6.8 Staff Changing Rooms See Table 15.9.

Table 15.8  Administrative rooms of CSSD

Activity These rooms shall be provided with: Office table Office chairs Visitors’ chairs Side rack Cabinets, drawers, and racks IT network Intercom connection Required electrical points CCTV surveillance Air conditioning

Status of works Start End In Not date date Complete progress started

::::::::::-

Responsible person

Remarks

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15  Central Sterile Services Department (CSSD)

Table 15.9  Staff changing rooms of CSSD

Activity Staff lockers to keep their personal belongings One chair Hooks on the wall to hang clothes Almirah for hanging clothes Hanger rods Cabinet to keep sterilized OT dresses Table to place boxes of masks and caps Bin for dirty linen Bin for used face masks, caps, and shoe covers Intercom point Air-conditioned

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

::::::::-

::-

The staff change rooms shall have an adequate number of personal lockers to keep the staff’s personal belongings. Each staff member shall preferably be allotted one such locker. One chair shall be provided in the room, which the staff can use while changing their clothes. For hanging the outside clothes, an adequate number of hooks shall be provided on the wall. Apart from this, the almirah and hanger rods with hangers shall also be provided to hang clothes. There shall be a closed cabinet to keep sterilized OT dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. One table shall be provided in the room to keep the containers of fresh unused masks and caps. A large bin for dirty linen shall also be provided in the changing room. Also, a separate bin shall be provided for disposal of the used masks, caps, and shoe covers. The room shall have a provision for intercom and shall have adequate air conditioning.

15.6.9 Shoe-Changing Areas See Table 15.10. The shoe-changing area shall be provided with a chair for sitting while removing or wearing shoes and a sufficient number of shoe racks.

523

15.6  Services, Facilities, Equipment, Tools, and Instruments Table 15.10  Shoe-changing areas of CSSD

Activity Shoe racks Chair

Start date

Status of works In Complete progress

End date

Responsible Not started person

Remarks

::-

Table 15.11  General store of CSSD

Activity Lockable cupboards Racks Drawers Working countertop

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

15.6.10 General Store See Table 15.11. The general store shall have adequate lockable cupboards, racks, and drawers to store the material. If required, the working countertop shall be provided to place the material on the countertop.

15.6.11 Restroom for Staff: Males and Females See Table 15.12. The staff restrooms shall be provided with a few chairs and centre tables. On request, a single bed can also be placed in the room for staff to lie down for a short time. The restrooms shall have the provision for serving tea/coffee, which can be either served from the pantry or provided through the vending machine.

15.6.12 Trolley Bay See Table 15.13. The trolley bay shall have sufficient provision to hold the trollies in place. Hence, a sufficient number of hooks and chains shall be provided on the walls.

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Table 15.12  Restroom for staff of CSSD

Activity Chairs and centre tables Single bed for resting Provision of tea/coffee

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::-

Table 15.13  Trolley bay of CSSD

Activity Chains and hooks to hold the trollies in place

Start date

Status of works End In Not date Complete progress started

Responsible person

Remarks

:-

15.6.13 Electrical Points 1. There shall be enough 6/16 Amp electrical outlets available to run all equipment. 2. For higher load appliances, the connection shall be made directly with the appropriately rated MCB or utilizing the starters.

15.6.14 Lighting 1. Lighting fixtures shall be adequately recessed and chosen to keep bugs and dust out. 2. Light levels shall be at least 400 lux and shall be provided by LED light fixtures.

15.6.15 Air Conditioning The CSSD’s ventilation and air conditioning systems are crucial in the bacterial contamination of the air. The following issues shall receive special consideration during the design and implementation process: 1. The administrative spaces and changing rooms shall have the same type of air conditioning as the rest of the hospital. 2. In clean locations like decontamination areas, packaging areas, sterilization areas, and clean storage spaces, air exchanges shall be made available. These spaces shall be created in the same manner as clean rooms.

Further Reading

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3. To achieve proper air exchanges, a dedicated air handling device with main air heating, cooling, humidification, dehumidification, and filtration shall be employed. 4. Between 18 and 22  °C shall be the CSSD temperature, and 40% shall be the RH factor. 5. Positive pressure shall be used in the airflow design so that air moves from clean parts into unclean ones. To stop air from moving from the ‘dirty’ regions of the unit into the ‘clean’ areas, positive air pressure is necessary for those areas.

Further Reading Allison VD. Hospital central sterile supply departments. Br Med J. 1960;2(5201):772–8. Banu A. Central Sterile Supply Department—need of the hour. n.d. 5. Basu D, Bhattacharya S, Mahajan A, Ramanan VR, Chandy M.  The importance of the central sterile supply Department in Infection Prevention and Control. Infect Control Hosp Epidemiol. 2014;35(10):1312–4. By JZ, Cao Y, Zhao H, Liran, HJ, Zhu L, et  al. MODERN CENTRAL STERILE SUPPLY DEPARTMENT ARCHITECTURAL DESIGN CONCEPT AND PRACTICE-NAVY GENERAL HOSPITAL CSSD DESIGN PRACTICE. Chin Hosp Archit Equip. 2014;(7):79–81. CENTRAL STERILE SUPPLY DEPARTMENT: Planning Considerations | Healthcare Architecture. 2021. https://healthcarearchitecture.in/central-­sterile-­supply-­department-­planning-­ considerations/. Design considerations for sterile processing departments. HALYARD. 2021. https://www.halyardhealth.com/articles/sterilization/3-­design-­considerations-­for-­sterile-­processing-­departments/. Garg A, Dewan A. Chapter 29, CSSD. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 321–31. Gonzalez P, Jacob MO. CENTRAL SERVICE: a systematic approach to design of efficient facilities layout. Hosp Top. 1969;47(4):119–26. Hospaccx. Central Sterile Services Department Planning and Designing. hospital and healthcare consultancy in India. 2019. https://hhbc.in/central-­sterile-­services-­department-­planning-­ designing/. Sen DJ, Saha DM. Central Sterile Supply Department: a concept. n.d. 2. Swenson D. Designing and developing a central sterile supply department. Biomed Instrum Technol. 2013;47(3):259–65. The Leaflet Article. 2021. https://www.hcarefacilities.com/newsletter/article.asp?id=1596.

Hospital Kitchen

16

Cooking and serving healthy meals to patients are the responsibilities of kitchen services, a crucial hospital support service. The kitchen may also provide food to hospital workers and guests, depending on hospital policy. The food service may also involve catering for events and meetings such as board meetings, seminars, conferences, and special occasions. Patients of all ages, from all religious, ethnic, and social backgrounds, as well as those who are nutritionally susceptible due to sickness, shall be able to recognize, enjoy, and enjoy the food. The hospital kitchen shall be configured and furnished to accommodate a variety of dietary requirements. The kitchen must be able to provide all prescribed diets because hospital patients are given diets based on their diseases. This checklist shall assist the planner and designer in remembering all such issues relating to the kitchen design as well as other space requirements and shall guide him/her to complete, test, and commission all works/activities on time. This shall assist him/her in ensuring that all work/activities are completed before the kitchen is operational and food is prepared.

16.1 Location of Hospital Kitchen The kitchen (also known as the catering unit) may be located on-site within the hospital or off-site, away from the hospital. If it is on-site, the hospital kitchen shall be located away from the patient area and clinical departments. Furthermore, the kitchen shall not be located on the floors, as the smell of the kitchen shall permeate the entire hospital. As a result, if the bylaws permit, the kitchen shall be located on the hospital building’s rooftop; otherwise, it shall be located outside the hospital building. The kitchen can also be located in the basement if proper ventilation and water supply and drainage are available. Furthermore, the kitchen shall be located in such a way that the noise does not disrupt the other departments. At the same time, the location shall ensure that food is delivered to the wards in the shortest time possible. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_16

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16.2 Size of the Kitchen The size of the kitchen is determined by the number of beds in the hospital, the number of people for whom the meals are to be prepared, and whether the kitchen serves meals in the hospital cafeteria as well as for visitors and staff. Aside from the dining area, the kitchen shall have an area of about 0.16 sq. m per prepared meal. If 500 meals have to be prepared per day, the area shall be approximately 140 sq. m. This area shall be further subdivided into various utility areas. However, if the hospital is small, the area shall not be less than 50 sq. m. In terms of dining space, it shall be approximately 0.16 sq. m per person.

16.3 Infrastructure 16.3.1 Space Requirement for Hospital Kitchen See Table 16.1.

16.3.1.1 Entry The kitchen shall have a single main entrance through which the staff shall enter. The kitchen shall also have an emergency exit just near the cooking area to enable quick exit from the kitchen in case of an accident. For materials, a separate entry door that opens into the storage room shall be installed, enabling the material to be transported there without interfering with the main kitchen entry. The main kitchen entrance shall be about 1524 mm wide and has a door on both sides. An airlock entry is required to keep outside air, insects, or contaminants like dust out of the catering unit and to control access to the unit. The length of the airlock shall be between 1524 and 1829 mm. Following the airlock, a second entry gate shall be installed. This door shall also be 1524 mm wide and open on both sides. The emergency exit near the cooking area shall be about 1219  mm wide for emergency evacuation out of the kitchen. For materials, a separate entry door can be provided that opens in the storage area, allowing the material to be sent directly to the storage without disturbing the main kitchen entry. This entry shall be 1524–1829 mm wide. 16.3.1.2 Change Rooms Cum Wash Areas A set of changing rooms shall be made available right away so that the workers can change into kitchen clothing after taking off their outerwear. These restrooms shall have separate male and female facilities. The change room shall be 3048 mm × 3048 mm in size. The toilet with a bathing facility shall be provided next to the changing room. There shall be a handwashing station right outside the changing rooms.

529

16.3 Infrastructure Table 16.1  Spaces required for hospital kitchen

Activity The following spaces shall be provided for Entry of staff Change rooms cum hand wash Receipt area for supplies Bulk storage for tableware, linen, crockery, and utensils Fruit/vegetable storage Refrigerator/s, cool rooms, and freezers Storage areas for dry ration/goods Pre-preparation Cooking/baking Reheating facilities Packing/plating areas Trolley parking area Loading/distribution Trolley/cart washing area Pot wash Dishwashing Waste disposal area Manifold room and cylinder storage Staff accommodation Kitchen manager Dietician Dietetics staff Public utility for staff

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::::-

:::::::::::::::::::-

16.3.1.3 Receipt Area for Supplies The goods receiving area shall be provided for receiving purchased goods, rations, and vegetables, among other things, that have to be used in the kitchen for cooking. Utensils and other items such as detergent powders, cooking gas, and so on are also included. The receiving area shall have a separate entrance from the main entrance and be close to the storage area. Materials/goods are received, handled, and quality/ quantity checked here. The material is then delivered to the appropriate storage location after stock register entries are made.

530

16  Hospital Kitchen

An area of about 3658 mm × 3658 mm shall be sufficient for this receiving area to do. There shall be two entrances in this space, one for bringing materials or commodities in and the other for transferring them to the proper storage. This area shall have two doors, one for entering materials/goods and the other for sending materials/goods to the appropriate storage. The width of the doors shall be around 1220 mm.

16.3.1.4 Storage Area Depending on the characteristics of the item—for example, dairy items may need a cold climate, and vegetables may need sufficient ventilation, hence different storage rooms shall be made accessible. In general, the following storages are required: Bulk storage Fruit/vegetable storage Refrigerator/s, cool rooms, and freezers Storage areas for dry ration/goods

Used to store cooking accessories and utensils, etc. Used to store vegetables, fruits, etc. Used to store meat and fish; milk and dairy products, etc. Used to store dry ration

The size of the storage rooms shall be determined by the size of the kitchen, the volume of meals, the frequency with which raw materials are delivered, the period for which the material shall be stored, and the type of storage (refrigerated, frozen, or dry), among other factors. Bulk Storage: Typically, bulk items like cooking utensils, cutlery, glassware, crockery, napkins, linen, outdated appliances (like microwaves, grinders, gas stoves, and toasters among others), cleaning tools, and cleaning agents and chemicals used in dishwashing equipment, such as detergents, are kept in this store. The minimum recommended size of this store shall be 3658  mm  ×  3658  mm, but this can be increased or decreased as required. Fruit and Vegetable Store: Perishable items, such as fruits and vegetables, are kept in this room. To ensure that the vegetables and fruits endure as long as possible, it is crucial to maintain control over the temperature and humidity levels during storage. The store shall have enough inventory on hand to last at least 4 days. The minimum recommended size requirement of this store shall be 3658 mm × 3658 mm, but this can be increased or decreased as necessary. Refrigeration, Cool rooms, and Freezers: For dairy items such as milk, butter, cheese, ice cream, and cream, as well as for fish, meat, and frozen vegetables like peas and corn, freezers and cool rooms are needed. Another name for it is the refrigerated room. The store shall have a cold room with an adjustable temperature between −20  °C and 2  °C.  The cold chamber shall measure roughly 3048 mm × 3048 mm. The walls and ceiling of the chamber shall be constructed of thermally effective puff panels. Wood planks are generally used for flooring. The door to the cold chamber shall likewise be hermetically sealed and made of puff panel.

16.3 Infrastructure

531

Storage areas for dry ration/goods: Dry products like pulses, wheat, flour, spices, dry ingredients, and cooking condiments are among the items kept at this storage facility. The store shall be able to hold enough supplies for at least 15 days of consumption. The minimum size requirement for the store is 4572 mm × 3658 mm, but this can be increased or decreased as per demand.

16.3.1.5 Preparation Areas Before starting the cooking process, ingredients are prepared in food preparation sections. Areas used for food preparation and those used for cooking shall be kept apart. In processing zones, common tasks include prepping meat, fish, and poultry, making pastries and desserts, meshing cooked vegetables, peeling and cutting vegetables, grinding condiments, mixing ingredients, kneading flour, etc. To have easy access to vegetable/ration storage areas and a refrigerated room for supplies, food preparation areas shall be positioned near the cooking section. Also, it shall be close to the kitchens, boiling water heaters, and ice makers. The preparation section shall generally be an open space, though partitions can be provided. As a result, there is no need to provide separate rooms. However, if the designer wishes to provide separate preparation rooms, he/she can plan for it. In that case, at least five rooms shall be planned. One for peeling and cutting vegetables, another for grinding condiments, a third for meshing boiled vegetables and mixing the items, a fourth for kneading the flour dome, and a fifth for preparing meat, fish, and poultry. The room’s dimensions shall be 3658 mm × 3658 mm. However, depending on the situation, the size can be altered. 16.3.1.6 Cooking Areas The cooking section is the most important area in the kitchen and shall be given the maximum space possible because there are various methods of cooking food such as boiling, frying, pan cooking, and so on. Depending on the menu, different cooking methods are used, including convection and conduction heating. The cooking section shall be close to the food preparation section and shall have easy access to the plating section. Different sections of the kitchen shall be set aside for different types of cooking. For instance, a separate area shall be made available for the installation of the boiling boilers. Similar to this, a separate area shall be made available for a flat pan (Tawa) for preparing chapatis and other products, an electric deep-frying machine or a gas burner for deep frying, and a gas stove area for preparing vegetables and other items. The walls adjacent to the cooking areas shall be cleanable and smooth. Hence, affixing glazed tiles on the walls up to a height of 1524 mm to 2134 mm shall be preferred. Similarly, the cooking section’s floors shall not be slippery, especially after grease spills, and shall be easily washable. Matt finish tiles can be the best option for flooring.

532

16  Hospital Kitchen

16.3.1.7 Reheating Areas Reheating is the process of reheating cooked food before serving it in dining areas. Heating can be done with gas burners or with devices like microwaves, induction plates, grills, and so on. If using gas burners, the same burners that were used for cooking can be used. If other devices are used, a separate area shall be provided. In general, the reheating area is open. As a result, there is no need to provide separate rooms. However, if the designer desires, separate rooms for reheating, the same can be provided. The room’s dimensions shall be 4267  mm  ×  3658  mm. However, depending on the situation, the size can be altered. 16.3.1.8 Packing/Plating After the meals have been cooked and heated, they are packed or laid out on plates, to make them ready to be served to patients, staff, or visitors. A separate section in the kitchen shall be provided for such packing/plating. The packing area is generally an open space, though partitions can be provided for different types of diets. As a result, there is no need to provide a separate room. However, if the designer wishes to provide separate preparation rooms, he/she can plan for it. The room’s dimensions shall be 6096 mm × 4572 mm. However, the size can be modified depending on the requirement. 16.3.1.9 Meal Trolley/Cart Parking Food shall be served in the appropriate wards, rooms, and dining rooms. To accomplish this, trolleys shall be used to transport the food to the desired location. A trolley/cart parking area is also required because the food shall be loaded from the packing/plating area. As a result, a trolley/cart parking area adjacent to the plating/ packing area shall be provided for temporarily parking the meal trolley that shall transport the food to the appropriate location. After that, the food is loaded into trolleys/carts. For the plates/trays to be loaded into the trolleys, service windows shall be provided between the plating/packing area and the trolley parking area. The number of trolleys to be accommodated shall determine the size of the area. 16.3.1.10 Trolley Return/Stripping Trolleys/carts filled with unwashed utensils that have returned from the wards/ rooms/dining areas after serving food shall be brought to the trolley return area. Trolleys are then taken to the trolley stripping area, where dishes, trays, plates, crockery, and waste are removed before returning to the trolley/cart washing area. The trolley return/stripping area shall be located close to the dishwashing and trolley/cart washing areas. The waste disposal area shall also be easily accessible. 16.3.1.11 Trolley/Cart Wash After unloading, the trolleys/carts shall be moved to the trolley washing area. This area shall be set aside for washing/disinfecting and drying trolleys and carts before

16.3 Infrastructure

533

returning them to the loading zone. A clear flow from dirty to clean is required to prevent cross-contamination of dirty and clean items. The trolley wash area shall be separated from the food preparation and storage areas, and it shall be easily accessible from the trolley return/stripping area.

16.3.1.12 Dishwashing Trays/plates/crockery/cutlery returned after use shall be washed. Hence, a dishwashing area in the kitchen shall be provided. This area shall be located near the trolley stripping area. After washing and draining, space shall be made available for sorting the utensils. After the utensils have been sorted, there shall be room to stack them. The size of the dishwashing area shall be determined by the number of utensils to be washed. It shall also be determined by the type of machinery used to wash utensils. If automated dishwashers are to be installed, the size of the area shall meet the requirements specified by the machine’s original manufacturer. Washing facilities shall be designed in such a fashion as to prevent cross-­ contamination of clean and soiled wares. 16.3.1.13 Pot Washing The kitchen shall also be provided with a pot-washing area where pots and large utensils used for cooking can be washed and cleaned. A separate enclosure near the cooking area shall be provided for this purpose. If there are a lot of pots and manual cleaning isn’t an option, an automatic pot-­ washing machine can be provided. The number and size of pots to be washed in the area shall determine the size of the pot-washing area. It shall also be determined by the type of machinery used to wash pots. If automated pot washers are to be installed, the size of the area shall meet the requirements specified by the machine’s original manufacturer. 16.3.1.14 Waste Disposal In the kitchen, the cutting/peeling areas and leftover food in the utensils generate a lot of waste. Wet and dry waste are both acceptable. As a result, proper provisions shall be made for the regular removal and disposal of such waste following the waste management guidelines and policies. A separate waste disposal area near and adjacent to the kitchen shall be provided for handling and disposal of such waste. This room shall be approximately 3048 mm × 3048 mm in size and shall have a door which shall open outside the kitchen. A window on the kitchen side shall be provided through which waste can be thrown into the waste disposal room’s bin. 16.3.1.15 Gas Storage Closet Cooking gas is required in the majority of kitchens. Pipelines are the best way to supply gas to these burners instead of keeping gas cylinders at each point. As a result, a gas manifold room in a convenient location outside the kitchen shall be provided. This area shall be open to the sky and not enclosed. The manifold shall be

16  Hospital Kitchen

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able to hold six to ten cylinders simultaneously. After the copper pipeline is laid down on the wall from the manifold, the flexible gas pipe connects it to the burner. A separate enclosure near the manifold room shall be provided for the storage of the stock of filled and empty cylinders. Both of these areas, the manifold room and the gas cylinder store, shall be surrounded by a wire mesh structure. There shall be no construction of a wall in these areas. Be extremely cautious when designing these areas, and ensure that they are completely protected from any nearby fires. The number of cylinders determines the size of the manifold. However, the average room size for a manifold with ten cylinders is 3658 mm × 3658 mm. Likewise, the gas store shall be 3658 mm × 3658 mm in size.

16.3.1.16 Staff and Support Areas A small administrative area shall be provided to control and monitor the operation of the kitchen. As a result, the kitchen shall have the following rooms. Offices shall be provided for the following personnel: 1. Kitchen manager 2. Dietician 3. Dietetics staff These rooms are for the kitchen’s general administrators and clerical staff. Managers, dieticians, assistant dieticians, and other professionals may be on the team. The dimensions of these rooms shall be 4572 mm × 3658 mm. However, the size can be increased or decreased depending on the need and number of people expected to sit. A toilet shall ideally be attached to the room. If necessary, a separate room for the staff shall also be provided.

16.4 Services, Facilities, Equipment, Tools, and Instruments 16.4.1 Entry See Table 16.2. The main kitchen entrance shall have an air curtain to keep insects out of the kitchen.

Table 16.2  Entry to the hospital kitchen

Activity Air curtain outside the main door

Start date :-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

16.4  Services, Facilities, Equipment, Tools, and Instruments

535

16.4.2 Change Rooms Cum Hand Wash Area See Table 16.3. The room shall have an adequate number of personal lockers to store personal belongings. Each member of staff shall ideally have one of these lockers. Individual lockers shall be approximately 305 mm × 305 mm in size. Individual lockers are combined, and the locker almirah is built. Each locker shall be individually lockable. One such locker shall be assigned to each member of staff. One chair shall be provided in the room, which the staff can use while changing their clothes. For hanging the outside clothes, an adequate number of hooks shall be provided on the wall. Apart from this, the almirah and hanger rods with the hangers shall also be provided to hang the clothes. There shall be a closed cabinet to keep the sterilized dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. One table shall be provided in the room to keep the containers of fresh unused masks and caps. A large bin for dirty linen shall also be provided in the changing room. Also, a separate bin shall be provided for disposal of the used masks, caps, and shoe covers. Immediately at the exit of the change rooms, the handwashing area shall be provided. For hand washing, the sinks shall be provided with a provision running hot and cold water. The drains shall be immediately below the wash sink. On average one sink per 10, workers shall be provided. Table 16.3  Change rooms cum hand wash area of hospital kitchen

Activity Lockers to keep the personal belongings of the patient One chair and cupboards Hooks on the wall to hang clothes Cabinet to keep the sterilized dresses. Hanger rods Bin for dirty linen Hand washing facility with liquid soap dispenser and paper towel dispenser

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

::::::-

536

16  Hospital Kitchen

16.4.3 Storage Area See Table 16.4. Bulk Storage: This store shall have an adequate number of lockable cupboards, racks, and drawers. In addition, the store shall have a working countertop where the material can be stored. The working slab’s top level shall be 914–965 mm above ground level. The slab’s width shall be around 762 mm, but this can vary depending on the requirements. Granite stone with full-round or half-round edges can be attached to the slab’s top surface. The vertical stone, like the horizontal stone, shall be fixed on the wall starting from the top of the slab downward. This vertical stone’s height shall be between 305 and 610 mm. Fruit and Vegetable Store: Baskets or bins made of stainless steel wire mesh shall be provided for this store. These wire mesh baskets if used shall be hung on the racks. The racks shall be arranged in such a way that air circulation is easy all around the racks. Wire mesh bin baskets shall not be overloaded, and sufficient space shall be left for proper air circulation. Table 16.4  Storage area of hospital kitchen

Activity Bulk storage Lockable cupboards, racks, and drawers Countertop Fruit and vegetable store SS racks, counter tops Bins or baskets made out of the stainless steel wire mesh Refrigeration, cool rooms, freezers Open racks Temperature monitoring system connected to a centralized alarm/ warning system. Storage areas for dry ration/goods Racks Bins Shelves Drawers

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::-

::-

::-

::::-

16.4  Services, Facilities, Equipment, Tools, and Instruments

537

Refrigeration, Cool rooms, Freezers: Open racks along the walls of this refrigerated room shall be provided for storage. The material shall be stored either on the rack’s shelves or in baskets made of stainless steel wire mesh. If necessary, a top-loading deep freezer may also be provided. Storage areas for dry ration/goods: This store shall have stainless steel racks, bins, shelves, and drawers, among other things. The racks shall be arranged in such a way that air circulation is easy all around the racks. Temperature and humidity levels shall be monitored carefully. Also, precautions shall be taken to keep rodents out of the store; for this, door brushes can be used. Food, raw materials, and vegetables, for example, shall be stored clear of the floor in all storage areas. The lowest shelf shall be at least 305 mm above the floor or closed in and sealed tight for easy cleaning. The storage area shall be outfitted with devices such as deep freezers, refrigerators, and so on.

16.4.4 Preparation Area See Table 16.5. Working counters shall be provided in the preparation area. The working slab’s top level shall be 914–965 mm above ground level. The slab’s width shall be around Table 16.5  Preparation area of hospital kitchen

Activity Working counters (with granite stone on top) Shelving and mobile trolleys for utensils Gadgets like food processors, slicers, mixers, grinders, and cutters Required electrical points for gadgets Important equipment connected through the UPS Single sink per station for washing the food and ration Hand washing facility with liquid soap dispenser and paper towel dispenser Big-sized waste bin

Status of works Start End In Not Responsible date date Complete progress started person Remarks :::-

::-

:-

:-

:-

16  Hospital Kitchen

538

610 mm, but this can vary depending on the requirements. Granite stone with full-­ round or half-round edges can be attached to the slab’s top surface. The vertical stone, like the horizontal stone, shall be fixed on the wall starting from the top of the slab downwards. This vertical stone’s height shall be between 305 and 610 mm. Sinks, shelving, and mobile trolleys for utensils shall also be provided in the rooms/area. Food processors, slicers, mixers, grinders and cutters, blenders, juicers, kitchen knives, nutcrackers, shredders, vegetable cutters/choppers, and other equipment shall be provided. The required electrical points for the operation of this equipment shall be provided on the wall above the working top. The 6/16 Amp switch/sockets shall be provided at a height of 305 mm from the top of the working counter for this. All equipment shall be installed following the manufacturer’s instructions. In the event of a power outage, a few critical pieces of equipment shall be connected via UPS. Each preparation area shall have one sink per station for washing food and rations. Hand basins with paper towels and soap dispensers shall also be provided in these areas. The peeling and cutting station shall also have a large waste bin.

16.4.5 Cooking Area See Table 16.6. Table 16.6  Cooking area of hospital kitchen

Activity Provision of power and gas or other fuel Water or steam supply Necessary drainage Gas stoves of other such cooking apparatus Chapatti making machine Boilers Exhaust hood Exhaust ducts terminating out of the kitchen Glazed tiles on the walls up to the height of 5–7 ft

Status of works Start End In Not date date Complete progress started ::::-

::::-

:-

Responsible person

Remarks

16.4  Services, Facilities, Equipment, Tools, and Instruments

539

Cooking equipment shall be of commercial quality and shall be installed according to the manufacturer’s specifications, with special attention paid to services such as power, gas, water, steam supply, and drainage. To avoid mixing up and obstructing the work of others, each section shall have proper low-height partitions. Working tables (made of stainless steel) shall be provided on the backside of these areas to keep the unprocessed material. Gas stoves and other similar cooking apparatus shall be kept at least 1 ft away from the wall. Each such apparatus shall have an area of at least 3.72 sq. m. Chapattis can be made on a flat plate designed for this purpose, or an automatic chapati-making machine can be installed if the quantity of chapattis is large. Cooking areas shall be ventilated properly, with an exhaust hood covering the entire area. Exhaust hoods shall be designed and installed in such a way that grease or condensation does not collect on walls or ceilings and does not drip into food or onto food-contact surfaces. These hoods’ exhaust ducts shall be opened out of the kitchen area. The walls of the cooking areas shall be smooth and washable. As a result, it is preferable to install glazed tiles on the walls up to a height of 1524–2134 mm. Similarly, the cooking area’s floors shall not be slippery, especially after grease spills, and shall be washable. Tiles with a matt finish can be used for this. The cooking area shall be provided with the equipment, tools like boilers, burners, chapatti makers, cookers and steamers, cooking ranges, flat cooking pans, fryers, grills, ovens, and cooking utensils like pots, griddles, ladles, pans and cooking spoons, and spatulas.

16.4.6 Reheating Area See Table 16.7. Heating can be accomplished using gas burners or other devices such as microwaves, induction plates, and grills. If it shall be done with gas burners, the same burners that are being used for cooking can be used. However, if other devices are to be used, a separate space shall be provided. This area shall include a working counter where the tabletop devices shall be placed. The working slab’s top level shall be 914–965 mm above ground level. The slab’s width shall be around 762 mm, but this can vary depending on the specifications. Granite stone with full-round or half-round edges can be attached to the slab’s top surface. The vertical stone, like the horizontal stone, shall be fixed on the wall starting from the top of the slab downward. This vertical stone’s height shall be between 305 and 610 mm. The required electrical points for the operation of these devices shall be provided on the wall above the working countertop. Hence, 6/16 Amp switch/sockets shall be installed at a height of 305 mm from the top of the working counter. All devices shall be installed in consultation with the original manufacturer of the machine. In

540

16  Hospital Kitchen

Table 16.7  Reheating area of hospital kitchen

Activity Devices like gas burners or microwaves/induction plates/grills Working counter for the tabletop devices Required electrical points Important devices connected through UPS Foundations for floor-mounted devices Countertop to keep the pre-heated and post-heated food items

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:-

:::-

::-

the event of a power outage, a few critical devices shall be backed up by a power supply from UPS. If any of these devices are mounted on the floor, adequate foundations and electrical points shall be provided. If necessary, a saperate working counter shall be provided to store pre-heated and post-heated food items. The working slab’s top level shall be 914–965 mm above ground level. The slab’s width shall be around 610 mm, but this can vary depending on the specifications. Granite stone with full-round or half-­round edges can be attached to the slab’s top surface. The vertical stone, like the horizontal stone, shall be fixed on the wall starting from the top of the slab downward. This vertical stone’s height shall be between 305 and 610 mm. Heating areas shall be outfitted with items such as induction stoves, kettles, microwave ovens, and air fryers, among other things.

16.4.7 Packing/Plating See Table 16.8. Depending on the type of diet to be packed (normal diet, diabetic diet, salt-free diet, oil-free diet, semi-solid diet or liquid diet, etc.), a different working counter shall be provided for packing/plating. The working slab’s top level shall be 914–965  mm above ground level. The slab’s width shall be around 610 mm, but this can vary depending on the specifications. Granite stone with full-round or half-round edges can be attached to the slab’s top surface. The vertical stone, like the horizontal stone, shall be fixed on the wall

16.4  Services, Facilities, Equipment, Tools, and Instruments

541

Table 16.8  Packing/plating area of hospital kitchen

Activity Different working counters (depending on the type of meal) with granite top Automated plating conveyor systems if a high number of plates have to be prepared

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

Table 16.9  Meal trolley/cart parking of hospital kitchen

Activity A sufficient number of heated trollies Service windows between the plating/ packing and trolley parking area Automatic loading conveyor if the number of trays to be loaded is large Electrical power point for plugging in the trolleys/carts to keep them warm/cold Chains or hooks to hold the trolleys

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::-

:-

:-

:-

from the top of the slab downward. This vertical stone’s height shall be between 305 and 610 mm. This vertical stone shields the wall from damage and stains. If an automated plating conveyor system is installed, the original manufacturer’s installation specifications shall be followed. Electrical outlets, as well as water supply and drain points, shall be provided during the process.

16.4.8 Meal Trolley/Cart Parking See Table 16.9. There shall be an adequate number of trollies to distribute meals to patients in the wards. There may be trolleys that keep the food warm, as well as refrigerated trolleys that keep the food cold and can be used for desserts. Hence, these trollies shall

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have the option of being heated or refrigerated. The trollies shall be insulated to keep the thermal temperature inside the trolley constant. The trollies shall be equipped with slots for storing meal trays. The trollies shall preferably be made of stainless steel and be easily washable. Service windows shall be provided between the plating/packing area and the trolley parking area for the plates/trays to be loaded into the trolleys. If there are a large number of trays to be loaded, an automatic loading conveyor can be used to quickly load the trolleys. If the automatic loading conveyor is installed, the original manufacturer’s installation specifications shall be followed. Electrical outlets, as well as water supply and drain points, shall be provided during the process. Power is required to keep the trolleys/carts hot and cold. As a result, the trolley/ cart parking area shall include an electrical power point for plugging in the trolleys/ carts so that they are ready for loading. The trolley shall also be provided with chains or other mechanisms such as hooks to hold the trolleys in place so that they do not move unnecessarily.

16.4.9 Trolley Return/Strapping See Table 16.10. The trolley return/stripping area shall have proper wall guards and corner guards in place to prevent the edges of the walls from being damaged by the impact of the trolleys hitting the walls. Handwashing facilities shall also be provided in the trolley stripping area. This area shall also have a sufficient number of waste bins for the disposal of leftover food items and peels.

16.4.10 Trolley/Cart Wash See Table 16.11.

Table 16.10  Trolley return/strapping area of hospital kitchen

Activity Proper wall guards and corner guards Hand washing facility with liquid soap dispenser and paper towel dispenser Waste disposal bins

Status of works Start End In Not date date Complete progress started ::-

:-

Responsible person Remarks

16.4  Services, Facilities, Equipment, Tools, and Instruments

543

Table 16.11  Trolley/cart washing area of hospital kitchen

Activity Proper wall guards and corner guards Running hot and cold water Proper drainage system Compressor system to pressure clean the trolleys Hot air-blowing system for drying trollies Automated trolley/cart washing equipment, if trollies are more

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::-

:-

:-

The trolley return/stripping area shall have proper wall guards and corner guards in place to prevent the edges of the walls from being damaged by the impact of the trolleys hitting the walls. There shall be running hot and cold water in the trolley wash area. A proper drainage system shall be installed in the area to allow for the easy and quick removal of the water used to wash the trollies. A compressor system shall also be provided to pressure clean the trolleys and remove dirt or greasy components. Similarly, the area shall include a provision for a hot air-blowing system to dry the trollies. If the number of trolleys to be washed increases, an automated trolley/cart washing machine may be provided. If installed, the original manufacturer’s installation specifications shall be followed. Electrical outlets, as well as water supply and drain points, shall be provided during the process.

16.4.11 Dishwashing See Table 16.12. Separate stainless steel sinks and drainers shall be provided for washing and shall be installed on the working counter. Sinks shall be deep, long, and wide enough to accommodate washing utensils. Along with the sink, a drain board is required to drain any excess water. The sinks shall have running hot and cold water with a flexible hose spray. A water drainage system shall be beneath the sink for the easy and quick disposal of the water used to wash the utensils.

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Table 16.12  Dish washing area of hospital kitchen

Activity Stainless steel sinks and drainers fixed in the working counter Running hot and cold water with a flexible hose spray Proper drainage system Provision of detergent dispensers and sponge holders on walls Space for stacking the utensils Wooden stripped cupboard on the wall or racks to dry the utensils Automatic dishwashers if the number of utensils to be washed is more

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

::-

::-

:-

In addition, detergent dispensers and sponge holders shall be installed on the wall. A wooden stripped cupboard can be fixed to the wall for stacking washed utensils, or racks can be provided. Automatic dishwashers can be used if there are a lot of utensils to wash. If the automatic dishwashers are installed, the original manufacturer’s installation specifications shall be followed. Electrical outlets, as well as water supply and drain points, shall be provided during the process. The glass washer and dish warmer shall also be provided in the washing area.

16.4.12 Pot Washing See Table 16.13. Low-level taps shall be provided in this area at a height of approximately 610–914 mm from the floor level, allowing sufficient space to rotate and move the pots beneath the taps. Hot and cold water shall be available from the taps. A water drainage system shall be provided for the easy and quick disposal of the water used to wash the pots. If necessary, a pressure cleaning arrangement can be made. The area shall have enough shelves to store detergents and cleaning tools such as scrubbers and sponge holders, among other things.

545

16.4  Services, Facilities, Equipment, Tools, and Instruments Table 16.13  Pot-washing area of hospital kitchen

Activity Low-level taps Running hot and cold water Proper drainage system Pressure cleaning if required Stripped stainless steel rack for draining excess water Automatic pot-­ washing machine, if required

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

:-

Table 16.14  Waste disposal from hospital kitchen

Activity Big-sized waste bins with a disposable biodegradable polythene bag Window on the kitchen side to throw waste in the waste bin Tap for washing waste disposal room and waste bins

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

:-

A stripped stainless steel rack shall be provided on the backside to serve as a drain board for the excess water from the pots. The pots shall be returned to the cooking area once they have dried. If there are a lot of pots and manual cleaning isn’t an option, an automatic pot-­ washing machine can be provided. If installed, the original manufacturer’s installation specifications shall be followed. Electrical outlets, as well as water supply and drain points, shall be provided during the process.

16.4.13 Waste Disposal See Table 16.14. The waste disposal room shall have large waste bins with disposable biodegradable polythene bags.

16  Hospital Kitchen

546

All garbage, especially wet waste, shall be stored in sealed bins. The removal and cleaning of these waste bins shall be scheduled regularly. There shall be enough space inside the room to wash the bins before the next use. A tap in the waste disposal area shall be provided for this purpose.

16.4.14 Gas Storage Closet See Table 16.15. The gas storage shall have a gas manifold that can connect at least ten gas cylinders at once. The gas manifold shall have a common outlet, and the copper pipe shall be connected to it. The copper pipe comes to an end near the gas stoves or gas burners in the kitchen. The stopcock shall be installed at the terminal point. The flexible gas pipe shall be used to connect the stopcock to the gas stoves or burners. However, if a piped gas supply is used, no gas storage unit is required, and the gas-supplying pipeline shall be terminated directly near the gas stoves or gas burners inside the kitchen. The stopcock shall be installed at the terminal point. The flexible gas pipe shall be used from the stopcock onwards to connect it to the gas stoves or burners.

16.4.15 Staff Accommodation See Table 16.16. The administrative and the dietician rooms shall be provided with the office table, office chairs, and visitors chairs. An adequate arrangement shall be made for cabinets, drawers, and racks for smooth working. The room shall also have adequate electrical outlets, an IT network, an intercom connection and CCTV surveillance, and shall have adequate air conditioning. Table 16.15  Gas storage closet of hospital kitchen

Activity Manifold with the provision of six to ten cylinders Copper pipeline up to near the burner by the flexible gas pipe The burner is connected to the copper line by the flexible gas pipe

Status of works Start End In Not date date Complete progress started :-

:-

:-

Responsible person

Remarks

16.4  Services, Facilities, Equipment, Tools, and Instruments

547

Table 16.16  Staff accommodation for hospital kitchen

Activity Kitchen manager These rooms shall be provided with Attached toilet PA room Office table Office chairs Visitors chairs Cabinets, drawers and racks Required electrical points Intercom connection I.T. Network CCTV surveillance Air conditioning Dietician room These rooms shall be provided with Attached toilet PA room Office table Office chairs Visitors chairs Cabinets, drawers and racks Required electrical points Intercom connection I.T. Network CCTV surveillance Air conditioning Hall for dietician staff with proper office table, chairs, racks, filing cabinets, cupboards, etc.

Status of works Start End In Not Responsible date date Complete progress started person Remarks

:::::::::::-

::::::::::::-

16.4.16 General Issues About Infrastructure Requirements 1. Doors shall be wide enough to allow trolleys/carts to pass through. The doors can be semi-automatic/automatic or manually operated. 2. Storage shelves, sinks, and countertops in the preparation sections shall be at an appropriate working height. If possible, height-adjustable equipment can be used.

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16  Hospital Kitchen

3. For lifting and handling heavy equipment or supplies, lifting devices can be provided. 4. To prevent overheating, all electrical equipment shall contain emergency shut-­ off switches. 5. Mobile food trolleys and caster-mounted catering equipment shall have provision of locking brakes. 6. All benches, tables, and other surfaces which are used for preparing and handling food, shall be covered in an impervious smooth material. Preferably, all furniture, tables, benches, and so on, shall be made of 304-grade stainless steel. 7. Ceilings in food preparation or storage areas shall be finished to make them easily cleanable. Any dust fallout could be a problem during food preparation. 8. The floors in the kitchen shall be water-resistant, non-slippery, and greaseproof. The floor finish shall be easily cleanable and free of joints. 9. Gaps/spaces in the floor and wall finishes that can harbour rodents and insects shall be avoided. 10. Wall finishes shall be smooth, easily cleanable, moisture-resistant, and able to withstand repeated washing. Hence, glazed tiles shall be fixed on the walls in the kitchen up to a height of 1524–2134 mm from the floor level. 11. All clean-up, preparation, cooking, and serving areas of the unit shall have an adequate number of handwashing basins. Employees working in food preparation and serving areas shall not be at a distance of more than 6000 mm from a hand washing basin. Hands-free basins with soap and paper towel dispensers shall be provided. Mirrors shall not be installed over sinks in food preparation areas where hair contact may cause contamination. 12. Grease traps in the kitchen area shall be installed to keep food, oil, and grease out of the drainage system. These grease tanks shall have odour-tight, airtight lids to keep airborne bacteria from contaminating preparation/cooking surfaces.

Further Reading Andersen BM.  Hospital kitchen. In: Andersen BM, editor. Prevention and control of infections in hospitals: practice and theory. Cham: Springer International Publishing; 2019. p.  995–9. https://doi.org/10.1007/978-­3-­319-­99921-­0_77. Benzu JK.  Cafeteria Design guide | Architectural Design. Architecture Student Chronicles. 2012. http://www.architecture-­student.com/design-­guide/cafeteria-­design-­guide-­ architectural-­design/. Garg A, Dewan A. Chapter 31, Hospital kitchen. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 349–58. Hospital Kitchen Design for Optimal Foodservice | LaBel. LaBel Foodservice Equipment and Design 2021. https://labelfoodservice.com/blog/hospital-­kitchen-­design-­planning. Hospital kitchen design—Hospital kitchen layout | Food Strategy. Commercial Kitchen Designers Brisbane | Food Strategy Australia. 2021. https://www.foodstrategy.com.au/projects/hospital-­ kitchen-­design-­ideas/. Hospitals take a fresh look on cafeteria design. 2021. https://www.hfmmagazine.com/articles/3181-­ hospitals-­take-­a-­fresh-­look-­on-­cafeteria-­design.

Further Reading

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Kitchen Design: Intermountain Hospital’s efficient kitchen and bistro. Foodservice Equipment Reports, Articles and News | FER Magazine. 2019. https://www.fermag.com/articles/9541-­ kitchen-­design-­intermountain-­hospitals-­efficient-­kitchen-­and-­bistro/. Moatari Kazerouni A, Chinniah Y, Agard B. Integration of occupational health and safety in the facility layout planning, part II: Design of the kitchen of a hospital. Int J Prod Res. 2014;53:1–15. Principles of commercial kitchen Design. WebstaurantStore. 2021; https://www.webstaurantstore. com/article/6/commercial-­kitchen-­design.html

Hospital Laundry

17

The laundry service is to ensure that all users have an adequate supply of clean, sterile, and consistent linen. Their primary responsibilities include sorting, washing, extracting, drying, ironing, folding, mending, and delivering. This department’s primary goal is to provide clean materials to patients while also maintaining hygiene throughout the process. In hospitals, laundry can be set up in three ways: To begin, the hospital can buy laundry equipment and hire employees to run the laundry on hospital grounds. Second, the hospital can provide laundry space and hire a contractor to set it up and run it. Third, the hospital can hire a local laundry service to transport dirty linen to an off-site/local laundry and return it after washing and processing. During routine hospital operations, soiled linen is generated from various departments such as indoor patient wards/rooms, operation theatre complexes, OPDs, and so on. This soiled linen shall be replaced with washed and sterile linen for the next use. Bedsheets, draw sheets, blankets, towels, patient gowns, pillow covers, doctors’ aprons, doctors’ OR gowns, theatre drapes, napkins, kitchen cloths, curtains, staff uniforms, screens cloths, and staff aprons are all examples of linen that are commonly used and washed in the hospital laundry. If the hospital establishes its own laundry, this checklist shall assist the planner and designer in remembering all such issues relating to the design of laundry as well as other space requirements and shall guide him/her to complete, test, and commission all works/activities on time. This shall assist him/her in ensuring that all work/activities are completed and operational before the laundry is operational.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_17

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17.1 Location of the Laundry The laundry shall be located in the service area of the hospital, with easy access to the clean and dirty loading dock areas. There shall be plenty of natural light and ventilation in the surrounding area. It shall ideally be located on the ground floor of a separate structure connected to or adjacent to the water and power source.

17.2 Size of the Laundry The size of the laundry area shall be determined by the size of the hospital, the total load of linen to be washed per day, and the number and type of laundry equipment to be installed. Factors such as the amount of storage required under normal conditions, the allowance for reserving clean linen and dirty holding in emergencies, and the frequency and dependability of linen supply and collection services shall all influence the size.

17.3 Infrastructure 17.3.1 Spaces Required for Hospital Laundry See Table 17.1. Table 17.1  Spaces required for hospital laundry

Activity The following spaces shall be provided for Dirty and soiled interim storage spaces Central storage area Dirty receipt Mending and tailoring Sorting/weighing Washing Ironing Packing Clean storage General storage Public utility for staff

Status of works Start End In Not date date Complete progress started

:-

::::::::::-

Responsible person

Remarks

17.3 Infrastructure

553

17.3.1.1 Dirty and Soiled Linen Interim Storage At the point of use, the process of sorting dirty and soiled linen begins. Hence, dirty utility rooms shall be provided at a different locations in the hospital, and each shall be duly equipped with a hamper to collect all dirty linen. In these rooms only, the contaminated linen is separated and placed in colour-coded plastic bags. These plastic bags containing linen are then transported to the central storage area using a trolley. Other details about the dirty utility rooms are mentioned in this book at appropriate places. 17.3.1.2 Central Storage Area This is the location where soiled linen is exchanged for clean linen. This area can be conveniently located either inside or outside the hospital. The amount of linen received daily and the frequency with which soiled linen is transported to the laundry shall determine the size of the rooms. Both dirty and washed linen are temporarily stored in the central storage area. The central storage area shall have two distinct rooms or enclosures separated by either a wall or hard patriations. One room/enclosure shall be designated for the storage of soiled linen collected from the hospital’s various interim storages. The second room/enclosure shall only be used for storing clean linen. Please avoid mixing clean and soiled linen as this may result in cross-contamination. Both of these rooms’ entrances shall be completely separate and managed by separate staff. 17.3.1.3 Dirty Receipt This area in the laundry shall receive soiled/dirty linen from the hospital’s central storage. This room shall be located near the laundry entrance and shall have a separate entrance. The amount of dirty linen received daily and the average time the linen stays in the room shall determine the size of the room. A 3658 mm × 4267 mm space, on the other hand, shall suffice. The room shall have two doors: one for receiving linen and the other for entry to the sorting and weighing area. Because the linen is delivered on trolleys, there shall be enough room outside the room for the trolleys to park. 17.3.1.4 Sorting and Weighing As previously stated, the soiled linen is initially sorted in the hospital’s central storage area. Furthermore, different items that require different washing conditions, such as temperature, detergent type, and wash cycle length, are sorted here. Items that need to be repaired or stained shall be separated so that they can be handled properly. Soiled linen shall be pre-washed in a suitable sluicing machine or stainless steel tubs provided in this area, depending on the size and type of facility. To fit the capacity of the washer extractors, the linen is also sorted by fabric type, item, colour, degree and type of soiling, and load size. For this purpose, stainless steel tables shall be provided in the room. Following sorting, items shall be placed in trolleys compatible with the loads permitted in washer extractors.

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17  Hospital Laundry

The size of the room shall be determined by the amount of linen. A 3658 mm × 4267 mm space, on the other hand, shall suffice. The room shall have two doors, one leading to the receiving area and the other to the washing area.

17.3.1.5 Washing Area It is the main area in the laundry’s infrastructure, where linen is washed. This group further comprises extraction, drying, and ironing. The primary areas required for the operation of various machines are as follows: Loading and Washing Once the linen has been sorted, weighed, and arrived in the washing area, it shall be loaded into the washers for the washing process. In most cases, there shall be enough space in the laundry for two washers. However, space for more than two washers shall be planned when designing the laundry, depending on the linen load and future expansion plans. The space to be allotted for the washer shall be determined following the specifications provided by the original manufacturer of the washer. Extractors Excess water shall be drained from the linen after washing. The extractor is used to accomplish this. Previously, hydro extractors were used as a separate machine, with linen being removed from the washer and loaded into the extractor to drain water. However, most washers now include an extractor. However, if separate extractors are to be used, the planning shall be done for two extractors. However, space for more than two extractors shall be planned when designing the laundry, depending on the load of the linen and future expansion plans. The space to be allotted for the extractors shall be determined following the specifications provided by the extractors’ original manufacturer. Tumbler Drying This method involves reducing the moisture content of washed linen to make it suitable for ironing. Linen that has to be processed in the tumbler dryers is loaded from the front and is then heated to dry. Dryers use gas, steam, or electricity to operate and heat. Previously, the dryers were used as a separate machine, with linen being removed from the washer/extractor and loaded into the dryer to dry the linen. However, nowadays most washers/extractors include dryers. If separate dryers are to be used, there shall be enough space in the laundry for two tumbler dryers. However, space for more than two tumbler dryers shall be planned when designing the laundry, depending on the load of the linen and future expansion plans. The space to be allotted for tumbler dryers shall be determined following the specifications provided by the tumbler dryers’ original manufacturer.

17.3 Infrastructure

555

Ironing This is the final stage of the washing process, and a separate ironing area in the laundry is required. Depending on the type of linen to be ironed, various types of ironing machines are installed in this zone. Pressing Machines: The pressing machine is used to iron clothing such as shirts, pants, uniforms, and curtains. In the laundry, one machine is usually sufficient. However, space for more than two pressing machines shall be planned ahead of time, depending on the linen load and future expansion plans. The space to be allotted for the pressing machine shall be determined following the specifications provided by the original manufacturer of the pressing machines. Calendar dryer irons: The calendar ironing machine is primarily used to iron bed linens. In the laundry, one machine is usually sufficient. However, depending on the load of the linen and future expansion plans, space for more than two calendar irons shall be planned ahead of time. The space to be allotted for the calendar irons shall be determined following the specifications provided by the original manufacturer of the calendar irons. Flat irons: This is a standard household iron for small clothes. This iron requires a space for a wooden table that can be installed in any convenient location adjacent to the wall in the ironing area. The total amount of space allotted for ironing shall be determined by the number of ironing tables installed in the ironing area.

17.3.1.6 Inspection and Repairing The laundry department performs an important function in mending and repairing torn linen. Mending is usually done after washing because handling soiled linen poses a high risk of infection. As a result, the laundry requires a separate mending room. The mending room’s dimensions shall be 4267 mm × 3658 mm. 17.3.1.7 Packaging and Storage This area is for packing linen in fluid-resistant, securely sealed plastic bags or placing it unwrapped in fluid-resistant covered carts or hampers. An open hall or a specially designated room can be used for packing; a separate room measuring 4267 mm × 3658 mm is recommended for packing. After wrapping, linen shall be stored in a clean storage area. The amount of linen to be stored and the number of days the linen shall be stored determine the size of the room. A room measuring 6096 mm × 4572 mm shall suffice. The size, however, can be adjusted depending on the situation. The storage room shall have two sealable doors, one to open the packing room from where linen is brought in and the other to open the dispatch room. 17.3.1.8 Dispatch Room The laundry shall also have a dispatch room from which linen is sent to either the user department or the hospital’s central storage. This room’s dimensions shall be 3658 mm × 3658 mm. It shall have two doors, one to open in the clean storage room

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17  Hospital Laundry

and the other to open outside the dispatch room, through which the linen is delivered. Because linen is delivered on trolleys, there shall be enough room outside the room for the trolleys to park.

17.3.1.9 Trolley Washing Trolleys transporting soiled linen are prone to contamination and shall be washed before reuse. This area shall be used for manually washing, disinfecting, and drying trolleys and carts before their next use. This area shall be kept separate from the clean storage room and easily accessible from the linen receiving area. 17.3.1.10 Store for Consumables Chemicals, detergents, and solution preparation materials are typically stored in this location. The storeroom shall have enough space to store supplies for at least 1  month. It shall be near the washer-extractor area. The store shall be at least 3658 mm × 3658 mm in size, but this can be adjusted as needed. 17.3.1.11 Staff and Support Areas To control and monitor the operation of the laundry, an administrative room shall be provided. The rooms shall be approximately 4572 mm × 3658 mm in size, but this can be adjusted based on the need and number of people who shall be sitting. The room shall have a toilet. A separate room for the staff shall be provided if necessary.

17.4 Services, Facilities, Equipment, Tools, and Instruments 17.4.1 Central Storage Area See Table 17.2. Table 17.2  Central storage area of hospital laundry

Activity Dirty linen Racks to store dirty linen Transport trolleys for transporting soiled linen to the laundry Washed linen Racks, cupboard to store clean and washed linen Transport trolleys for transporting clean linen from the laundry

Status of works Start End In Not date date Complete progress started ::-

:-

:-

Responsible person Remarks

17.4  Services, Facilities, Equipment, Tools, and Instruments

557

Racks for storing sorted and packed linen shall be provided in the hospital building’s dirty receipt room. The room shall also have transport trolleys to transport soiled linen to the laundry. Similarly, the hospital’s laundry room shall have racks, cupboards, almirahs, and other storage for washed linen. The room shall also have transport trolleys for delivering linen to the user department. Please keep the trolleys to be used for supplying washed linen separate from the trolleys to be used for shifting soiled linen to laundry. It is preferable to use closed trolleys for this purpose.

17.4.2 Dirty Receipts See Table 17.3. Racks or shelves shall be provided if needed to store the linen. After that, the linen shall be transferred to the sorting and weighing room for further processing.

17.4.3 Sorting and Weighing Area See Table 17.4. The room shall be provided with stainless steel tables for sorting the dirty linen. The size of the table shall approximately be 2438 mm × 1219 mm. The room shall also have its dedicated trollies which are compatible to handle loads of linen to be taken for the wash. Preferably, the trollies shall be made of stainless steel. To weigh the linen, the room shall have a provision for an electronic platform-­ type weighing machine.

17.4.4 Washing Area See Table 17.5. Table 17.3  Dirty receipt area of hospital laundry

Activity Sufficient space for parking trolleys If required, racks or shelves to be provided to store linen

Status of works Start End In Not date date Complete progress started ::-

Responsible person

Remarks

17  Hospital Laundry

558 Table 17.4  Sorting and weighing area of hospital laundry

Activity Stainless steel tables for sorting Trolleys to take a load to the washing area Weighing scale

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::-

:-

Table 17.5  Washing area of hospital laundry

Activity Washer Washers shall be provided duly installed on a pre-constructed foundation Connection with separate hot and cold water supply For hot water, systems like steam heating, gas-fired burners, or electric heaters Washer connection to water heating system Adequate power supply for washer Common drain pipe on the back of the washers Extractors If separate extractors are used, provide extractors Extractors shall be installed on a pre-­ constructed foundation with appropriate anti-vibration pads Adequate power supply for extractor Common drain pipe on the back of the washers

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:-

:-

:::-

::-

::-

17.4  Services, Facilities, Equipment, Tools, and Instruments

559

Table 17.5 (continued)

Activity Tumble drying Dryers shall be installed on a pre-constructed foundation with appropriate anti-­ vibration pads Adequate power supply for dryer Dryers vented directly outside of the building Hot air relayed outside Ironing Pressing machines Supply of compressed air to rotate and lift the bucks Connection to the electric supply, if electrically operated Connection to the boiler or steam generator if steam operated Calendar dryer irons Connection to the electric supply if electrically operated Connection to the boiler or steam generator if steam operated Flat irons Electric power point Wooden table

Status of works In Not Responsible Start End Remarks date date Complete progress started person :-

:::-

:-

:-

:-

:-

:-

::-

Washer: The washing area shall have the necessary number of washers. The washers are typically front-loading machines. Machines of various capacities are available and shall be selected based on the requirements. Washers shall be installed on a pre-built foundation and fastened with fasteners. The foundation’s specifications shall be taken from the original washer manufacturers. Furthermore, vibrations occur during washer operation; therefore, suitable anti-­ vibration pads shall be used to protect the machine. The washer shall have separate cold and hot water supplies. There are several options for heating the water that is needed for washing. Some of the options can be steam heating, gas-fired burners, and electric heaters. If steam has to be used for heating, the washer shall be connected to the boiler; if gas-fired burners are to be

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17  Hospital Laundry

used, the washer shall be connected to the gas supply system; and if an electric heater is to be used, the washer shall be supplied with an adequate power supply. Washers are typically installed against the laundry wall, with the floor drain on the back side, to discharge the water. For better laundry cleaning, the washers shall be installed approximately 610 mm away from the wall. On the back of the washers, a common drain pipe of approximately 146 mm in diameter shall be provided, to which all drain pipes of the washers shall be connected. A clear space of 1817 mm shall be provided in front of the washer for easy loading and unloading of the linen. In most cases, the laundry shall have at least two of these washers. However, depending on the load of the linen and future expansion plans, space for more than two washers shall be planned ahead of time. If two or more washers are installed, the inter-distance between the two washers shall be about 1817 mm. Extractors: Extractors are used to extract excess water from linen. Previously, hydro extractors were used as separate machines, but most washers now include an extractor. If separate extractors are to be used, they shall be installed on a pre-built foundation and fastened with fasteners. The specifications for the foundations shall be obtained from the extractors’ original manufacturers. Furthermore, vibrations occur during washer operation; therefore, suitable anti-vibration pads shall be provided to protect the machine. Because balancing and levelling are important considerations when installing an extractor, the extractor’s alignment shall be precise. A sufficient power supply is required to operate the extractor. Drain pipes terminating in a common drain shall be provided to drain the water from the extractor. Extractors, like washers, shall be installed at a distance of about 610 mm away from the wall to improve laundry cleaning. On the back of the washers, a common drain pipe of approximately 146 mm diameter shall be provided, to which all drain pipes of all the extractors shall be connected. A clear space of 1817 mm shall be provided in front of the extractors for easy loading and unloading of the linen. In most cases, at least two such extractors shall be provided in the laundry. However, depending on the load of the linen and future expansion plans, space for more than two washers shall be planned ahead of time. If two or more extractors are installed, the inter-distance between the two extractors shall be about 1817 mm. Tumble drying: This method involves reducing the moisture content of washed linen to make it suitable for ironing. Tumbler dryers are usually front-loaded, and the linen that has been processed in the extractor is then heated to get it dry. The dryers shall be screwed into the pre-built foundation and secured with fasteners. The foundation specifications shall be taken from the original dryer manufacturers. Dryers, like washers, are installed at a distance of about 610 mm from the wall to improve laundry cleaning. A clear space of 1817 mm shall be provided in front of the dryer for easy loading and unloading of the linen. Dryers shall have ventilation which shall terminate outside the building and shall ideally be located near an external wall. They can be placed next to each other or in

17.4  Services, Facilities, Equipment, Tools, and Instruments

561

a separate room at the back that is well ventilated. Dryers generate the most heat of any piece of laundry equipment, and all hot air shall be vented outside. Dryers can be powered by gas, steam, or electricity. As a result, the necessary preparations shall be made. In most cases, at least two such dryers shall be provided in the laundry. However, depending on the load of the linen and future expansion plans, space for more than two washers shall be planned ahead of time. If two or more dryers are installed, the inter-distance between the two dryers shall be about 1817 mm. Ironing: This is the final stage of the washing process, and a separate ironing area in the laundry is required. Depending on the type of linen to be ironed, various types of ironing machines are installed in this zone. Pressing machines: These are used to iron clothing such as shirts, pants, uniforms, and curtains. This machine is available with either single or double-heated bucks and can heat the bucks with either electricity or steam. Because compressed air is used to rotate and lift the bucks as well as for the pressing operation, a compressed air point near the pressing machine shall be provided in the laundry. The pressing machine is a floor mounting model that shall be screwed to the floor with fasteners. It shall be installed about 610 mm from the wall to allow for better laundry cleaning. A clear space of 1817 mm shall be provided in front of the machine for easy working of personnel. In the laundry, one machine is usually sufficient. However, depending on the linen load and future expansion plans, space for more than two pressing machines shall be planned ahead of time. If two or more pressing machines are installed, the inter-distance between the two pressing machines shall be about 1817 mm. Calendar dryer irons: The calendar ironing machine primarily serves to iron bed sheets. To save space, flatwork irons with a single large diameter heated roller shall be placed against a wall. The bed and chest heating calendars shall be placed near the perimeter wall, but the multi-roller heated-bed irons are free-standing and take up a lot more room. A clear space of 1817 mm shall be provided in front for easy working of personnel. In the laundry, one machine is usually sufficient. However, depending on the linen load and future expansion plans, space for more than two washers shall be planned ahead of time. If two or more calendar iron machines are installed, suitable inter-distance between the two shall be provided. Flat irons: This is a standard domestic iron that is used for small clothes. This iron requires an electric power outlet and a wooden table measuring 1219 mm × 914 mm, which can be installed in any convenient location in the ironing area adjacent to the wall. The number of such units to be installed shall depend on the requirement.

17.4.5 Inspection and Repairing See Table 17.6.

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Table 17.6  Inspection and repairing area of hospital laundry Start date

Activity Stainless steel working counter Racks/cupboards Foot-operated sewing machine Patching machine Adequate electric points

Status of works In Not Complete progress started

End date

Responsible person

Remarks

Responsible person

Remarks

:::::-

Table 17.7  Packing and storage area of hospital laundry

Activity Working tops Stainless steel racks Stainless steel shelves Stainless steel bins Positively pressurized

Start date

End date

Status of works In Not Complete progress started

:::::-

The laundry department performs an important function in mending and repairing torn linen. A stainless steel working counter, a foot-operated sewing machine, and a patching machine shall be provided in the mending room. To operate sewing machines or cutters, adequate electric points shall be provided. Needles, threads, repair fabrics, and other supplies required for mending the linen shall be provided for storage.

17.4.6 Packing and Storage See Table 17.7. Storing racks, shelves, bins, and other storage items, as well as packing tables or work surfaces, shall be provided in the packaging area. The storage room shall have stainless steel racks, shelves, or bins for storage. To maintain the hygiene of the linen, it is also recommended that the clean storage room be positively pressurized with proper air exchanges.

17.4  Services, Facilities, Equipment, Tools, and Instruments

563

17.4.7 Dispatch Room See Table 17.8. The dispatch room shall have a dispatch counter or an office table with a chair. For administrative purposes and documentation, a computer with UPS shall be provided in the room. If required, the printer and the barcode scanner can also be provided. Because linen is delivered via trolleys, there shall be an adequate number of trollies in the laundry to deliver the material to the hospital.

17.4.8 Trolley Washing See Table 17.9. The trolley wash area shall have proper wall guards and corner guards in place to prevent the edges of the walls from being damaged by the impact of the trolleys hitting the walls. There shall be running hot and cold water in the trolley wash area. A proper drainage system shall be installed in the area to allow for the easy and quick removal of the water used to wash the trollies. A compressor system shall also be provided to pressure clean the trolleys and remove dirt or greasy components. Similarly, the area shall include a provision for a hot air-blowing system to dry the trollies. If the number of trolleys to be washed increases, an automated trolley/cart washing machine may be provided. If installed, the original manufacturer’s installation specifications shall be followed. Electrical outlets, as well as water supply and drain points, shall be provided during the process. Table 17.8  Dispatch room of hospital laundry

Activity Dispatch counter Office table Chair Computer with printer Trolleys for delivery

Start date :::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

564

17  Hospital Laundry

Table 17.9  Trolley washing area of hospital laundry

Activity Proper wall guards and corner guards Running hot and cold water Proper drainage system Compressor system to pressure clean the trolleys Hot air-blowing system for drying trollies Automated trolley/cart washing equipment if trollies are more

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::-

:-

:-

Table 17.10  Store for consumables of hospital laundry

Activity Sufficient number of countertops Cupboards Drawers Racks

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

17.4.9 Store for Consumables See Table 17.10. Racks, drawers, lockable cupboards, and a countertop are required in the store. The environment in this store shall be dry. Because cleaning materials in dry form are supplied in heavy bags or containers, they shall be stored on pallets. If required, a storage space shall be provided with a countertop for solution preparation.

17.4.10 Staff Accommodation See Table 17.11. The administrative rooms shall be provided with an office table, office chairs, and visitors chairs.

17.4  Services, Facilities, Equipment, Tools, and Instruments

565

Table 17.11  Staff accommodation in hospital laundry

Activity Laundry manager These rooms shall be provided with Attached toilet PA room Office table Office chairs Visitors chairs Cabinets, drawers and racks Required electrical points Intercom connection IT network CCTV surveillance Air conditioning

Start date

Status of works End In Not date Complete progress started

Responsible person

Remarks

:::::::::::-

An adequate arrangement shall be made for cabinets, drawers, and racks for smooth working. The room shall also have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning.

17.4.11 General Issues About Infrastructure Requirements See Table 17.12.

17.4.11.1 Infection Control Hand washing stations shall be available in the clean linen storage room, soiled linen receiving room, sorting room, and so on. In addition, the following points shall be addressed: 1. The workflow of the laundry shall be unidirectional, i.e. progressing from dirty to clean areas. 2. Adequate cleaning and waste management facilities.

17.4.11.2 Airflow Positive airflow in the laundry shall flow from clean to dirty, which shall subsequently be venting the outside. This barrier is intended to keep microbe-laden lint and other particle contaminants from entering the clean linen processing area and settling on shelves, carts, or packed and delivered clean linen.

566

17  Hospital Laundry

Table 17.12  General issues about hospital laundry infrastructure

Activity Infection control measures Air flow Flooring Walls Natural lightning Mechanical ventilation Hot air extraction Compressors for compressed air with storage tank Steam Booster pumps and water storage tanks Air-to-water heat pumps coupled with large-volume hot-water storage tanks Water-softening plant Fire protection

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::::-

:::-

::-

17.4.11.3 Floors The laundry’s floors shall be non-slip in wet areas, impervious, easily cleaned, and robust enough shall allow equipment to be moved over them without lifting or getting damaged. Floors in the washing area and other areas where water release is unavoidable shall be adequately drained. 17.4.11.4 Walls To prevent trolley damage, wall surfaces shall be easily washable and equipped with wall guards and corner protection guards. 17.4.11.5 Natural Lighting Natural lighting is preferable and shall be used whenever possible, particularly in cleaning and packing areas. Direct sunlight and solar glare shall be avoided in the workplace. 17.4.11.6 Mechanical Ventilation Because laundry is warm due to the hot working environment of tumble drying, ironing, and so on, providing relatively cool and comfortable working conditions becomes more important. Adequate ventilation shall be provided by removing stale

17.4  Services, Facilities, Equipment, Tools, and Instruments

567

air at a high level and bringing in the fresh air at a low level. High-speed exhausts or centrifugal fans shall be used to exhaust the air. Similarly, blower fans shall be used for air supply.

17.4.11.7 Hot Air Extraction Hot air shall be extracted directly from the heat-emitting equipment if possible and according to the recommendations of the equipment manufacturers. Tumble drying is one of them, and dryers shall ideally be kept in a separate section. 17.4.11.8 Compressors Certain laundry washer extractors require compressed air to operate. Instead of medical compressed air, a separate compressed air supply shall be used for this purpose. Compressed air shall be dried as specified by the equipment suppliers. Moisture-trapping provisions shall be included in the system design. 17.4.11.9 Steam A suitable steam supply system shall be installed in the laundry. To generate steam, a boiler shall be installed outside the laundry premises if necessary. Depending on the type of boiler, a supply of gas/coal/wood/electricity shall be arranged near the boiler. 17.4.11.10 Water Supply, Heating, and Water Treatment Equipment Water shall be supplied to the laundry at the manufacturer’s recommended pressure. Booster pumps and water storage tanks are required for this. Hot water shall be generated and stored in sufficient quantities to ensure that the correct temperature in the washer extractors can be achieved without compromising machine output. Air-­ to-­water heat pumps in conjunction with large-volume hot-water storage tanks shall be considered. Because hard water can cause serious problems in the laundry, a water-softening plant shall be installed if necessary. 17.4.11.11 Fire Prevention and Detection Proper fire protection devices, such as a smoke detector, sprinkler system, hydrant supply, and fire extinguishers, shall be installed in the laundry. 17.4.11.12 Communications The linen handling unit may include the following IT/communications systems: 1. Telephones in linen holding areas, linen inspection and mending rooms, offices, and workstations. 2. Offices, workstations, and delivery rooms have data outlets for computers and internet access. 3. Systems for scanning the linen received in the laundry and dispatched from the laundry.

568

17  Hospital Laundry

Further Reading Beggs B. HSHS Shared Laundry Services consolidates laundry for 10 hospitals. 2010;10. Garg A, Dewan A. Chapter 32, Laundry. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 359–67. Kumar MS, Goud BR, Joseph B. A study of occupational health and safety measures in the laundry department of a private tertiary care teaching hospital, Bengaluru. Indian J Occup Environ Med. 2014;18(1):13. Lopes C, Scavarda A, Nunes M, Carvalho M, Vaccaro G, Korzenowski A. Analysis of sustainability in hospital laundry: the social, environmental, and economic (cost) risks. Resources. 2019;8. National Health Services Estates, editor. Laundry. London: HMSO Publications Centre; 1994. 118 p. (Health building note). OPL 101: designing an on-premises laundry room. American Laundry News. 2013; https://americanlaundrynews.com/articles/opl-­101-­designing-­premises-­laundry-­room Planning, designing and maintaining hospital laundry to reduce carbon foot prints and to make it energy efficient and cost competitive. Int J Sci Res. 2021. https://www.worldwidejournals.com/international-­journal-­of-­scientific-­research-­(IJSR)/article/planning-­designing-­and-­ maintaining-­hospital-­laundry-­to-­reduce-­carbon-­foot-­prints-­and-­to-­make-­it-­energy-­efficient-­ and-­cost-­competitive/MTA3ODE=/?is=1. Quality Assurance Hospital Linen and Laundry Services. 2015;6(3):4. Sehulster LM. Healthcare laundry and textiles in the United States: review and commentary on contemporary infection prevention issues. Infect Control Hosp Epidemiol. 2015;36(9):1073–88. Time to relook at infection control practices for hospital laundry. Clean India J. 2020. https://www. cleanindiajournal.com/time-­to-­relook-­at-­infection-­control-­practices-­for-­hospital-­linen/. Woodson S. Design and construction of a healthcare laundry. NLM J. 2007;5(3):6.

Medical Record Department (MRD)

18

A Medical Record Department (MRD) is responsible for maintaining systematic documentation of a patient’s medical history as well as current treatment and care. The medical record serves as a foundation for future patient care planning, documentation of communication between the hospital and any other health professionals involved in patient care, and aids in the protection of both the patient’s and the hospital’s legal interests in patient care. Previously, the majority of medical records were stored in hard copies. As a result, a lot of space was needed to keep the hard copies of the records. However, most of the records are now being converted to electronic and digital formats as information technology advances. However, not all records can be kept digitally, and some have to be kept in hard copies. As a result, to effectively preserve medical records, the MRD shall have an excellent information technology infrastructure in place. Electronic Medical Records (EMR): It is a computerized recording system that tracks and records data about hospitalized patients and their care. The EMR also enables authorized clinicians to access patient records at any time and from any online location for assessments and further treatment of the patient. An EMR system also necessitates the scanning of various paper records, which can come from outside the facility or be brought in by the patient. This set of checklists shall assist the planner and designer in remembering all such issues relating to the design of MRD as well as other space requirements and shall guide him/her in completing all works/activities on time. This shall assist him/ her in ensuring that all work/activities are completed and operational before the MRD becomes operational.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_18

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570

18  Medical Record Department (MRD)

18.1 Location of MRD Because several departments may need to refer to or visit the MRD regularly, it shall be located within the hospital building in a low-traffic area. The location does not have to be directly accessible to the patient. If the hospital has a basement, the MRD can be located there, or on floors that are not in a high-traffic area. Due to space constraints, the department may be located in a different building but close to the hospital. To ensure that staff can easily refer files and retrieve records in an emergency, the MRD shall be located within easy walking distance of the admitting or outpatient department.

18.2 Infrastructure 18.2.1 Space Requirement for MRD See Table 18.1.

18.2.1.1 Entry and Reception Reception shall be available at the MRD’s entrance. If necessary, near the reception, a small waiting area shall be provided. The reception area shall be approximately 1829 mm × 2438 mm in size. 18.2.1.2 Medical Record Receipt Room It shall be located at the main entrance to the MRD. This is the room where medical records are received for recording from the IPD, OPD, emergency, and diagnostic departments, among others. The receipt room shall measure 3658 mm × 3658 mm. The room shall have a single door that leads to the MRD. To receive the records, the outside wall shall have an openable window measuring approximately 914 mm × 914 mm. 18.2.1.3 Compilation Desk Records received at the receipt counter are routed to the compilation desk for further sorting and compilation. During the compilation process, all documents in the records are checked for accuracy and completeness. As a result, the MRD shall have a separate room. For the record to be easily transferred to the compilation room, this room shall be adjacent to the medical record receipt room. The dimensions of this room shall be 4267 mm × 3658 mm. The room shall have one door. 18.2.1.4 Indexing and Coding This desk shall be used to process the medical records by coding and compiling disease and operative indexes. As a result, a separate room shall be provided in the

571

18.2 Infrastructure Table 18.1  Spaces required for Medical Record Department (MRD)

Activity The following spaces shall be provided for Entry and reception Receipt Compilation desk/ sorting room Indexing/coding Statistical analysis Computer lab Storage for files/ register Dictation room/ cubicles Transcription room Photocopy/printing room Record scanning room Binding room Waste holding area Store Administrative area including: Staff accommodation for manager, coders Medical record officer Secretarial staff Public utility for staff

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::::::::::::::::-

MRD. This room shall be adjacent to the compilation room for the record to be easily transferred from there. The room’s dimensions shall be 4267 mm × 3658 mm. The room shall have one door.

18.2.1.5 Statistical Analysis In the MRD, a room shall be provided for statistical analysis of medical record data. As a result, a separate room measuring 3658 mm × 3658 mm shall be provided. 18.2.1.6 Computer Lab Because most records are on electronic digital media, the data of medical records shall be fed into workstations. As a result, a separate room of approximately 4572 mm × 3658 mm shall be provided for use as a computer lab.

572

18  Medical Record Department (MRD)

18.2.1.7 Medical Record Storage Room Medical records shall be kept for a long time, which can range from 7 to 15 years after the last attendance, depending on the country’s local statutory requirements/ guidelines, whereas medico-legal records may need to be kept for a longer time. As a result, records shall be kept in a fire-rated structure that meets local building codes. The size of the storage room shall be determined by the number of patients and beds in the hospital. However, for a 180-bed hospital, the recommended size is approximately 93 sq. m. The size shall be adjusted based on the number of beds in the hospital. A separate room shall be provided for the storage of CDs and DVDs. To prevent rodents from entering the room, the room’s doors shall be properly sealed and equipped with door brushes. 18.2.1.8 Dictation Room/Cubicles The medical staff and others use this area to view and research medical records, as well as dictate and complete discharge summaries. The cubicles shall be placed around the perimeter of the unit, near but not in the reception area. The number of cubicles shall be determined by usage. The size of each cubical shall be about 1848 mm × 1848 mm. 18.2.1.9 Transcription Room A section of the MRD shall be designated for medical record transcription. The room shall be 4267 mm × 3658 mm in size and noise and echo proof so that the transcription machines can be heard by the staff. This room shall be located somewhere between the entry and sorting areas. 18.2.1.10 Photocopying/Printing Room The MRD shall include a photocopying and printing room. The room shall be 3658 mm × 3658 mm. This area can also be used to generate barcode labels and store stationery. 18.2.1.11 Scanning Room Some documents, particularly those brought from outside by patients or those created in the hospital, need to be scanned to be recorded in electronic digital records. As a result, the MRD shall include a scanning room. This room shall be 3658 mm × 3658 mm in size. 18.2.1.12 Binding Room Because medical records shall be stored for an extended period, they shall be properly indexed and bound before storage. As a result, the MRD shall include a binding room. The room shall be 3658 mm × 3658 mm in size. 18.2.1.13 Waste Holding Room The documents that need to be discarded in the MRD shall be destroyed here in this room by shredding them. The size of the room shall be about 3658 mm × 3658 mm.

18.3  Services, Facilities, Equipment, Tools, and Instruments

573

18.2.1.14 Store The MRD shall include a store for the storage of general items, stationery, unused old equipment, and other daily used items. The store size shall be 1848 mm × 1848 mm, which may be increased or decreased as needed. 18.2.1.15 Administrative Area Separate rooms shall be provided for the MRD’s general administrator, managers, and clerical staff. The rooms shall be provided for: 1. In-charge MRD 2. Medical record officer 3. Coders 4. Data analyst 5. Secretarial staff The size of the room shall be determined by the staff’s designation. The in-­ charge and medical record officer’s rooms shall be 4572 mm × 4267 mm. A toilet is required in the room. A separate store may be attached to this room if necessary. Smaller rooms measuring 3658 mm × 3658 mm shall be provided for other staff members. The secretarial room shall measure 6096 mm × 4572 mm. A toilet is required in the room. A separate store may be attached to this room if necessary.

18.3 Services, Facilities, Equipment, Tools, and Instruments 18.3.1 Entry and Reception See Table 18.2. Reception shall be provided with a reception counter, the size of which shall be between 1219 and 1828 mm. The counter can be built of granite or other materials, or it can be built up with masonry work with an elegant appearance. A wooden counter can also be provided as an alternative. For a person to comfortably stand and speak with the receptionist, the front side of the counter shall be roughly 1524 mm high. The working top, which shall be provided on the other side of the counter, shall approximately be 610 mm wide and 762 mm in height. One reception chair shall be provided for the receptionists. If need be, high-­ raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided to the receptionist. If required, the scanner can also be provided at reception. The intercom line and the telephone lines shall also be provided at the reception. The reception counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points.

574

18  Medical Record Department (MRD)

Table 18.2  Entry and reception of medical record department (MRD)

Activity Provide a small waiting area Reception counter Chair Computer with UPS and printer connected to the hospital network Scanner Intercom and telephone line Necessary electrical outlets Required communication ports Entrance doors with a key card or electronic access

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::-

:::::-

• In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances. The reception counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices • Two RJ 45 connectors for computer networking • Two RJ 11 points for intercom and extension lines.

18.3.2 Medical Record Receipt Room See Table 18.3. Inside the room, a receipt counter made of wood, and stainless steel, or a fixed counter with a granite top shall be provided. On the backside, closed racks shall be provided to temporarily store the received records. A high-raised chair shall also be provided in the room. The room shall have a computer with a printer that is linked to the hospital’s computer network. In the MRD, one PTS station shall be provided for receiving documents and records from various hospital locations.

575

18.3  Services, Facilities, Equipment, Tools, and Instruments Table 18.3  Medical record receipt room of Medical Record Department (MRD)

Activity Receipt counter made out of either wood, stainless steel, or fixed counter with granite top Closed racks High-raised chair Computer with a printer connected to the hospital network Pneumatic tube systems (PTS)

Status of works Start End In Not Responsible date date Complete progress started person Remarks :-

:::-

:-

Table 18.4  Compilation desk of Medical Record Department (MRD)

Activity Compilation and sorting desk made out of wood or stainless steel Chairs Computer with a printer connected to the hospital network Separate partition for storing sorted and unsorted files

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:-

::-

:-

18.3.3 Compilation Desk See Table 18.4. The room shall have a compilation and sorting desk that shall approximately be 1829 mm × 1219 mm in size and made of either wood or stainless steel, as well as chairs. A filing rack shall be provided to store the records temporarily until they are sent for further processing. The room shall have a computer with a printer that is linked to the hospital’s computer network. A communication port and electrical outlets shall be provided for connecting the computers. The room shall have a separate partition for storing sorted and unsorted files.

576

18  Medical Record Department (MRD)

18.3.4 Indexing and Coding See Table 18.5. Because the majority of the indexing and coding work is done on a computer, the room shall have a computer with a printer that is connected to the hospital’s computer network. Following sorting and compilation, the record is indexed and coded using ICD codes. A communication port and electrical outlets are required for connecting the computers. Office tables and chairs shall also be provided in the room. A filing rack shall be provided in the room to store the records temporarily until they are sent for further processing.

18.3.5 Statistical Analysis See Table 18.6. Because the majority of the records are on electronic digital media, the analysis is performed on and from workstations. As a result, the room shall also include workstations that are linked to the hospital network. A communication port and electrical outlets are required for connecting the computers. An office table and chairs shall also be provided in the room. The room shall have a storage cupboard to temporarily store the files used for statistical analysis. Table 18.5  Indexing and coding room of Medical Record Department (MRD)

Activity Computer with a printer connected to the hospital network Office tables Chairs Filing rack

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

:-

:::-

Table 18.6  Statistical analysis of Medical Record Department (MRD)

Activity Office tables Chairs Computer with a printer connected to the hospital network Storage cupboard

Status of works Start End In Not date date Complete progress started :::-

:-

18.3  Services, Facilities, Equipment, Tools, and Instruments

577

18.3.6 Computer Lab See Table 18.7. The computer lab shall be equipped with workstations that are connected to the hospital network and used for data feeding and retrieval. The necessary number of computer workstations, as well as the UPS, shall be provided. The computers shall be linked to the hospital’s computer network. If required, the printers and the scanners can also be provided. The number of computers to be provided shall be determined by the hospital’s record load. A communication port and electrical outlets are required for connecting the computers. There shall be enough chairs and tables in the room for everyone to sit. In the same way, sufficient storage closets shall be placed in the space to temporarily house the files needed for data feeding or data retrieval.

18.3.7 Medical Record Storage Room See Table 18.8. To allow for simple access, open metal shelving units shall be used to hold active medical records that are always in use. Compact slidable devices may be utilized to store medical records. Records storage in open shelves or racks is not permitted, and storage cabinets shall be locked. There shall be seven shelves in the system. If the shelf is 1219 mm long and suitable movable dividers are provided, it can typically hold roughly 1000 records and files. In total, it can hold roughly 7000 record files if there are seven such shelves. A library step stool can be used by personnel to access the highest shelf, which shall not be higher than 2134 mm. Without a step stool, the tallest shelf that staff members can reach shall not be higher than 1829 mm. The aisle between shelving bays shall be 762 mm wide at a minimum, but 914 mm is recommended to allow for records trolleys, library stools, and staff transit. If the hospital’s management does not want to use the compacted slidable system, the open file rack system shall be used; however, adequate arrangements shall be made to protect the records from fire, termite, and pilferage. Table 18.7  Computer lab of Medical Record Department (MRD)

Activity Working tops Computer with a printer connected to the hospital network Chairs Storage cupboards

Status of works Start End In Not date date Complete progress started ::-

::-

Responsible person

Remarks

578

18  Medical Record Department (MRD)

Table 18.8  Medical record storage room of Medical Record Department (MRD)

Activity Compact slidable filing system Open file rack system Properly air-­ conditioned room for storage of CDs/DVDs and hard disks Properly sealed, fireproof cabinet to keep these items. Step stools Chairs Working tops made out of stainless steel. Door brushes to prevent rodents

Status of works Start End In Not Responsible date date Complete progress started person Remarks :::-

:-

::::-

Table 18.9  Dictation room of Medical Record Department (MRD)

Activity Office table Computer with a printer connected to the hospital network Chairs Storage cupboards

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::-

::-

A properly sealed, fireproof cabinet shall be provided in the CD/DVD storage area to keep these items. Step stools, chairs, and stainless steel worktops shall also be provided in the room. To prevent short-circuiting, all the electric cables shall be properly covered. Fire sprinklers are not permitted in the storage area. Records storage areas shall be temperature and humidity controlled for records to be preserved.

18.3.8 Dictation Room/Cubicles See Table 18.9. Workstations connected to the hospital network shall be provided in the dictation room. To operate the computers, the necessary power and data provisions shall be

18.3  Services, Facilities, Equipment, Tools, and Instruments

579

provided. A communication port and electrical outlets are required for connecting the computers. An office table and chairs shall be provided in the room. The room shall have a storage cupboard to temporarily store the files used for dictation work. Extraneous noise shall distract the person dictating, so auditory separation of personnel is preferred.

18.3.9 Transcription Room See Table 18.10. The transaction machines shall be installed in the transcription room. The number of machines to be installed shall be determined by the department’s workload. The room shall also have an office table, chair, and computer, as well as the UPS, printer, and scanner. A communication port and electrical outlets are required for connecting the computers.

18.3.10 Photocopying/Printing Room See Table 18.11. A photocopy machine shall be provided in the photocopying and printing room. In addition to this computer workstation with UPS, the room shall have a printer and scanner. A communication port and electrical outlets are required for connecting the computers. The office table and chairs shall be present in the room. This area can also be used to generate barcode labels and store stationery. The room shall also have cupboards for storing stationery to be used for photocopying and printing.

18.3.11 Record Scanning Room See Table 18.12. Table 18.10  Transcription room of Medical Record Department (MRD)

Activity Office table Chair Computer with a printer connected to the hospital network Transcription machine

Status of works Start End In Not date date Complete progress started :::-

:-

Responsible person Remarks

580

18  Medical Record Department (MRD)

Table 18.11  Photocopying/printing room of Medical Record Department (MRD)

Activity Photocopy machine Computer with UPSS and printer connected to the hospital network Office table Chairs Cupboards for stationery

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::-

:::-

Table 18.12  Record scanning room of Medical Record Department (MRD)

Activity Office table Chairs Computer with a printer connected to the hospital network Multi-sheet high-­ resolution scanner

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::-

:-

Some documents, particularly those brought from outside by patients or those created in the hospital, shall be scanned to be recorded in electronic digital records. A good quality multi-sheet high-resolution scanner shall be provided in the room. Workstations connected to the hospital network shall also be provided in the room. A communication port and electrical outlets are required for connecting the computers. The scanning room shall also have an office table and chairs. The room shall have a storage cabinet to temporarily store the documents and files used for scanning.

18.3.12 Binding Room See Table 18.13. The binding room shall have at least one office table, chair, and working surface for record binding. Hard discs, CDs, or DVDs for electronic digital records shall be placed in the binding room and kept ready for storage. A storage cupboard shall also be provided in the room to temporarily store files, registers, or any other paper-based records that shall be bound.

581

18.3  Services, Facilities, Equipment, Tools, and Instruments Table 18.13  Binding room of Medical Record Department (MRD)

Activity Office table Chair Working countertop for binding Storage cupboard Automatic binding machine, if required

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

Table 18.14  Waste holding room of Medical Record Department (MRD)

Activity Office table Chairs High-capacity paper shredding machine Waste holding bins

Start date

Status of works End In Not date Complete progress started

Responsible person

Remarks

:::-

:-

18.3.13 Waste Holding Room See Table 18.14. The documents discarded in the MRD shall be shredded in this room. A high-capacity shredding machine and waste holding bins shall be provided in the room for shredding the documents. The room shall also include an office table and chairs.

18.3.14 Store See Table 18.15. The store shall have lockable cupboards, racks, drawers, and a countertop. This store’s environment shall be dry.

18.3.15 Staff Accommodation See Table 18.16. The administrative rooms shall be provided with an office table, office chairs, and visitors chairs.

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Table 18.15  Store of Medical Record Department (MRD)

Activity Lockable cupboards Racks Drawers Working countertop

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

Table 18.16  Staff accommodation for Medical Record Department (MRD)

Activity In-charge MRD Medical record officer Coders Data analyst Secretarial staff Each room shall be provided with Attached toilet, if possible PA room, if required Office table Office chairs Visitors chairs Cabinets, drawers, and racks Required electrical points Intercom connection IT network CCTV surveillance Air conditioning

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

:::::::::::-

An adequate arrangement shall be made for cabinets, drawers, and racks for smooth working. The rooms shall also have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning.

Further Reading

583

18.3.16 General Issues About Infrastructure Requirements 18.3.16.1 Temperature, Colour, and Lighting Environmental factors such as temperature, humidity, and ventilation shall be considered. These variables have a direct impact on the MRD records. 18.3.16.2 Protection from Fire Fire extinguishers and smoke detectors shall be installed throughout the MRD, particularly in the filing area for records and X-ray films. Important documents, such as medico-legal cases, shall be stored in fire-resistant cabinets. To avoid short-­ circuiting, all electrical lines shall be covered. 18.3.16.3 Protection from Rodents and Termite The MRD section shall be designed to keep vermin, silverfish, and other insects from attacking and destroying the records. Proper wire mesh or door brushes shall be provided. MRD shall also have a sealed ceiling with no air gaps or leaks. Regular pest control treatment is required in the MRD. 18.3.16.4 Natural Light/Lighting Natural light shall be used as much as possible to facilitate staff work. However, natural light shall not be allowed into storage areas because it can accelerate the deterioration of paper records. 18.3.16.5 Safety and Security Because MRD records are confidential, their security shall be carefully considered to avoid loss or damage. MRD entry and exit points shall be restricted, with either manual or electronic access control. 18.3.16.6 Information Technology/Communications MRD sections shall have intercom lines, computer networking points connected to the hospital’s central server, and RJ45 jacks in all required locations. 18.3.16.7 Electrical Services At all required locations in the MRD, a pair of 6/16 Amp switch/sockets shall be provided, and all computer points shall be backed up by a UPS supply.

Further Reading Dugar D. Future of electronic medical records 2021 | EMR trends. 2021. https://www.selecthub. com/medical-­software/emr/electronic-­medical-­records-­future-­emr-­trends/. Garg A, Dewan A.  Chapter 33, Medical Record Department (MRD). In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 369–74. He X, Cai L, Huang S, Ma X, Zhou X. The design of electronic medical records for patients of continuous care. J Infect Public Health. 2021;14(1):117–22.

584

18  Medical Record Department (MRD)

Moghaddasi H, Hosseini A, Sheikhtaheri A. A new model for the organizational structure of medical record departments in hospitals in Iran. Perspect Health Inf Manag AHIMA Am Health Inf Manag Assoc. 2006;3:4. Publication I.  MEDICAL RECORD DEPARTMENT: AN ANALYTICAL STUDY. 2021. https://www.academia.edu/19864782/ MEDICAL_RECORD_DEPARTMENT_AN_ANALYTICAL_STUDY. Vlayen A, Marquet K, Schrooten W, Vleugels A, Hellings J, De Troy E, et al. Design of a medical record review study on the incidence and preventability of adverse events requiring a higher level of care in Belgian hospitals. BMC Res Notes. 2012;5:468. Wadhwa M. Electronic Health Records in India. 2020;23.

Mortuary

19

A hospital mortuary, also known as a morgue, is a place where dead bodies are temporarily kept under specific climatic conditions until a post-mortem is performed, the body is handed over to the police or family, or it is finally disposed of. A hospital mortuary can be used solely for body storage and disposal, or as a post-­ mortem facility with adequate provisions. Mortuary Unit: Its primary purpose is to store the body. The unit includes a refrigerated body storage facility as well as a body viewing and body preparation room. Autopsy Unit: It is a mortuary facility that is used to investigate the cause of death by performing a post-mortem. It has an autopsy room, a changing room, and an observation area. Autopsy services may not be required in all hospitals, but some hospitals may be required to have them following national guidelines. The size of the mortuary shall be determined by the number of cabinets/body storage spaces required as well as the hospital’s death rate. Space for four bodies per 300 beds is generally adequate, excluding isolation storage, which shall be separated. This set of checklists shall assist the planner and designer in remembering all such issues relating to the design of the mortuary as well as other space requirements and shall guide him/her in completing all works/activities on time. This shall assist him/her in ensuring that all work/activities are completed and operational before the mortuary opens.

19.1 Location of the Mortuary The mortuary/autopsy unit of the hospital shall be separated from the main clinical areas. It could be the same hospital building or an annexe to the main hospital. Furthermore, the mortuary shall have a separate route that neither patients nor staff can use. The best solution would be to have a separate back door from the hospital where bodies could be transported to the mortuary. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_19

585

19 Mortuary

586

The mortuary shall ideally be located on the hospital’s ground floor or basement to allow ambulances, police, and funeral vehicles easy and discrete access to deliver and/or remove bodies through an exit door.

19.2 Infrastructure 19.2.1 Mortuary See Table 19.1.

19.2.1.1 Entrance Lobby The mortuary shall have an entrance gate followed by a small lobby. The mortuary’s main gate shall be at least 1829 mm wide and shall be openable on both sides. The reception/waiting area shall be approximately 6096 mm × 4267 mm in size. The entrance lobby shall have easy access to the body wash and body holding area. Ample space shall be provided outside the entrance for parking the ambulances and trolleys transporting the body to the mortuary. There shall also be a trolley bay outside the entrance where stretcher trolleys can be parked and to be used to unload bodies from ambulances. 19.2.1.2 Body Wash It is quite possible that the bodies may be dirty or soiled as a result of a roadside accident, a stabbing death, or other causes. In such cases, the body shall be thoroughly washed before being transported to the body holding area. The body wash room shall be 4572  mm  ×  3658  mm to accommodate at least two body wash platforms. Table 19.1  Spaces required for mortuary

Activity The following spaces shall be provided for Entrance lobby Body wash Body holding area Waiting/viewing area Administration Exit lobby Staff area

Status of works Start End In Not date date Complete progress started

:::::::-

Responsible person

Remarks

19.2 Infrastructure

587

19.2.1.3 Body Holding Area This is the area where bodies are temporarily stored in a refrigerated space. The body holding area shall measure 6096 mm × 4877 mm. However, the area can be altered depending on the need. The following options are available for storing bodies in a refrigerated environment: Walk-in Cool Room The walk-in refrigerated chamber is provided in this concept. The chamber’s size shall be determined by the number of bodies that are expected to be placed at any moment as well as the average holding time of bodies. In a cool room, the bodies are placed on a loose tray or trolley, which requires approximately 3 sq. m of space per body. Refrigerated Cabinets This system includes refrigerated body storage cabinets with built-in slidable drawers for storing the body. In front of refrigerated cabinets, there shall be enough room to pull and push the drawers.

19.2.1.4 Waiting/Viewing Area In the mortuary and autopsy room, a waiting area for police and relatives of the deceased shall be provided. This area shall be located near the mortuary’s entrance and shall seat 20–30 people. However, capacity can be increased or decreased depending on the situation. There shall also be a toilet near the waiting area. Because the mortuary and autopsy rooms are not accessible to the general public, the waiting area shall include a viewing area with a window or partition that is revealed when a curtain is drawn. 19.2.1.5 Store Clean linen, aprons, gowns, towels, gumboots, plastic body bags, cleaning materials, and other items shall be kept in the mortuary and autopsy room. A lockable storage area for the deceased’s belongings shall also be provided. This store’s dimensions shall be 3658 mm × 3048 mm. 19.2.1.6 Administration Area Depending on the size of the mortuary, a staff area shall be provided. Pathologists, mortuary staff, and police officers shall use the area for a variety of administrative tasks and confidential phone calls. At least 2–3 such rooms shall be provided: one for the manager with dimensions of 3658 mm × 3658 mm, one for class IV staff with dimensions of 3048 mm × 3048 mm, and one for police officials with dimensions of 3048 mm × 3048 mm. These rooms shall preferably have an attached toilet. 19.2.1.7 Exit Lobby The mortuary shall have an exit lobby as well as an exit door. When the body is to be delivered to relatives or the police, it shall be removed from this door. The door

19 Mortuary

588

shall be at least 1829 mm wide and open on both sides. Direct access to the body holding area shall be provided from the exit lobby. Ample space shall be provided outside the exit lobby for ambulances and vehicles transporting the body.

19.2.2 Autopsy Area See Table 19.2.

19.2.2.1 Surgeon Change Room The autopsy room shall be equipped with changing rooms so that doctors and staff working in the autopsy room can change clothes after removing their outer clothing. The toilet shall ideally be connected to the changing rooms. Each change room shall be approximately 3048 mm × 3658 mm in size. 19.2.2.2 Pre-autopsy Room This room is required to store bodies before the post-mortem process. This can be a walking cool room or refrigerated cabinets; however, this space shall be separate from the mortuary. The body shall be kept in this room with complete identification as soon as the police arrive at the mortuary. The size of the pre-autopsy room shall be 4267 mm × 3658 mm. Table 19.2  Spaces required for autopsy area

Activity The following spaces shall be provided for Surgeon/staff change rooms Pre-autopsy room Autopsy room indoor Autopsy room outdoor Post autopsy room Autopsy surgeon’s room Instrument wash room Viscera preparation room Viscera store Staff toilet

Status of works Start End In Not date date Complete progress started

::::::::::-

Responsible person

Remarks

19.2 Infrastructure

589

19.2.2.3 Autopsy Room (Indoor) The room shall be 6096 mm × 6096 mm in size. The room shall have large windows to allow for maximum sunlight. The room’s flooring shall be either washable tiles or granite, with an adequate slope to the drain side for easy cleaning. The walls of the room shall be washable, so either tiles or washable epoxy paints can be applied up to a height of 2134 mm. 19.2.2.4 Autopsy Room (Outdoor) This room is required for post-mortem examinations of bodies that are infected or decomposed and cannot be handled in the main autopsy room. Except for the roof, which is usually covered with a net, the room shall have all of the same amenities as an indoor autopsy room. 19.2.2.5 Post-autopsy Room This room is required for moving bodies following the post-mortem examination. The body is kept here until it is given to the investigating officer, who then gives it to the relatives for final disposition. The dimensions of the room shall be 4267 mm × 4572 mm, and it shall include a platform for laying down the bodies. 19.2.2.6 Autopsy Surgeon’s Room This space shall be made available so that the autopsy surgeon/medical officer can discuss the details of the case with police and family members, as well as write reports. The dimensions of the room shall be 3658 mm × 4267 mm. However, the size can be increased or decreased depending on the need and number of people expected to sit. There shall also be a toilet attached to it. If necessary, a separate store can be attached to this room. Along with the surgeon’s room, a small room for the surgeon’s staff office shall be provided. The dimensions of this room shall be 3658 mm × 3048 mm. 19.2.2.7 Instrument Wash Room The used instruments shall be thoroughly cleaned after each post-mortem before the next use. As a result, an instrument washroom shall be provided. The room’s dimensions shall be approximately 2438 mm × 3048 mm. 19.2.2.8 Viscera Preparation Room This room is required for the preparation of post-mortem viscera. This room’s dimensions shall be 3658 mm × 3048 mm. 19.2.2.9 Viscera Stores The viscera store shall be a lockable room 3658 mm × 3048 mm in size. This is used to store and preserve viscera and visceral packing material. There shall be no windows in the store and direct sunlight shall be avoided.

590

19 Mortuary

19.3 Services, Facilities, Equipment, Tools, and Instruments 19.3.1 Mortuary 19.3.1.1 Entrance Lobby and Reception See Table 19.3. A small counter in the mortuary lobby shall be provided to receive the body and identify and tag the received body. The reception and/or help desk shall be approximately 1220–1829 mm long. The counter can be made of either civil work or wood. The front side of the counter shall be approximately 1524 mm high so that the person can easily stand and converse with the receptionist. On the opposite side of the counter, a working top of approximately 610 mm width and 762 mm height shall be provided. A reception chair shall be provided for the receptionist. If need be, the high-­ raised chair can also be provided. Computer with UPS and printer (if needed for printing) shall be provided at each reception. If required, the scanner can also be provided at reception. The microphone for the announcement shall be provided at the reception. The intercom line and the telephone lines shall also be provided at the reception. The reception counter shall have the required electrical outlets and communication ports. The record room near the reception and/or help desk shall have steel cupboards, and open racks for storage. The lobby shall be provided with a hand wash basin with soap dispensers and towels. Outside the entrance, the stretcher trolleys can be placed to unload bodies from the ambulances. Table 19.3  Entrance lobby and reception of mortuary

Activity Entry gate Provide a small waiting area Reception counter Chair Computer with a printer connected to the hospital network Necessary electrical outlets Stretcher trollies outside the entrance

Status of works Start End In Not date date Complete progress started :::::-

::-

Responsible person

Remarks

19.3  Services, Facilities, Equipment, Tools, and Instruments

591

19.3.1.2 Body Wash See Table 19.4. The body wash area shall have a platform measuring 2134 mm (L) × 914 mm (W) × 914 mm (H) (H). The platform’s top shall be slightly curved. The platform shall also have an appropriate drainage system to drain the water after the wash of the bodies. Glazed tiles shall be installed throughout the platform to allow for easy water drainage and proper platform cleaning. Showers shall be provided on top of the platform for washing the bodies. In addition, a tap with a hose pipe shall be provided in the body wash area. The drain shall be connected to the Effluent Treatment Plant (ETP) and shall not be directly connected to the main sewerage line. 19.3.1.3 Body Holding Area See Table 19.5. In the case of the Walk-In Cool Room, a refrigerated chamber is constructed. The walls and ceiling of this refrigerated chamber shall be made of insulated panels, and the flooring shall also be wooden for thermal control. The chamber door shall also be insulated and sealed to prevent outside air from entering. The chamber’s size shall be determined by the expected number of bodies to be placed at once and the average holding time of bodies. In a cool room, a loose tray or trolley shall be provided to place the bodies. The temperature in the chambers shall be kept between 2 and 4 °C. If Refrigerated Cabinets are chosen, refrigerated body storage cabinets with inbuilt slidable drawers to place the body shall be provided. A cabinet typically has two such drawers in one row, one above the other, and an unlimited number of such cabinets can be installed. It becomes difficult to lift the bodies at height if more than two are provided. However, the cabinets can be stacked vertically to maximize space utilization. In such a case, appropriate lifting equipment and adequate Table 19.4  Body wash area of mortuary

Activity Platform for body wash Proper drain from platform Platform shall have glazed tiles or granite top Showers on top of the platform Tap with a hose pipe

Status of works Start End In Not date date Complete progress started :::-

::-

Responsible person

Remarks

592

19 Mortuary

Table 19.5  Body holding area of mortuary

Activity Walk-in cool room Refrigerated room Walls and the ceiling made out of a puff panel Door made out of a puff panel and hermetically sealed Flooring made out of wooden planks Temperature monitoring system connected to a centralized alarm/ warning system Refrigerated cabinets Refrigerated body storage cabinets Suitable body lifting device Power backup system for refrigerated cabinet

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::-

::-

::::-

equipment turning circles shall be provided. This method of storage, however, is not suitable for bariatric (obese) bodies. There shall be enough room in front of refrigerated cabinets to pull and push drawers. The temperature of the cabinets shall be kept between 2 and 4 °C. Please keep in mind that isolation bodies and bariatric bodies shall have separate spaces/ cabinets for storage.

19.3.1.4 Waiting/Viewing Area See Table 19.6. The waiting area shall be furnished with sofa sets or chairs so that family members can sit comfortably. A toilet block shall be attached to the waiting area. Toilets shall ideally be separate for men and women. Along with this, a drinking water facility shall be provided. Water coolers or water drinking fountains can be provided for water supply. This area shall have a speaker system to hear announcements. An intercom system shall also be provided. Try offering Wi-Fi and internet access. The waiting area shall also have mobile charging stations near the seating areas. The waiting area shall also include a viewing area with a window or partition that is revealed when a curtain is drawn. 19.3.1.5 Store See Table 19.7.

593

19.3  Services, Facilities, Equipment, Tools, and Instruments Table 19.6  Waiting/viewing area of mortuary

Activity Chairs or sofa sets Drinking water Speaker and announcement system Intercom Internet/Wi-Fi Mobile charging points Viewing window of the door with view window Provision to draw the curtain

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::::-

:-

Table 19.7  Store of mortuary

Activity Lockable cupboards Racks Drawers Working countertop

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

The store shall have lockable cupboards, racks, drawers, and a countertop. This store’s environment shall be dry.

19.3.1.6 Staff Accommodation See Table 19.8. The administrative rooms shall be provided with an office table, office chairs, and visitors chairs. An adequate arrangement shall be made for cabinets, drawers, and racks for smooth working. The rooms shall also have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning. 19.3.1.7 Exit Lobby See Table 19.9. The exit lobby shall be provided with a hand wash basin with soap dispensers and a paper towel dispenser.

594

19 Mortuary

Table 19.8  Staff accommodation of mortuary

Activity Attached toilet PA room, if required Office table Office chairs Visitors chairs Cabinets, drawers, and racks Required electrical points Intercom connection I.T. Network CCTV surveillance Air conditioning

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::::::::-

Table 19.9  Exit lobby of mortuary

Activity Hand wash basin Soap dispensers Paper towel dispenser

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::-

19.3.2 Autopsy Area 19.3.2.1 Pre-autopsy Room See Table 19.10. This can be a walking cool room or refrigerated cabinets can be provided, however, this space shall be separate from that used in the mortuary. In the case of Walk-In Cool Room, a refrigerated chamber is constructed. The walls and ceiling of this refrigerated chamber shall be made of insulated panels, and the flooring shall also be wooden for thermal control. The chamber door shall also be insulated and sealed to prevent outside air from entering. The chamber’s size shall be determined by the expected number of bodies to be placed at once and the average holding time of bodies. In a cool room, the loose tray and trolley shall be provided to place the bodies. The temperature in the chambers shall be kept between 2 and 4 °C.

19.3  Services, Facilities, Equipment, Tools, and Instruments

595

Table 19.10  Pre-autopsy room of autopsy area

Activity Walk-in cool room Refrigerated room Walls and the ceiling made out of a puff panel Door made out of a puff panel and hermetically sealed. Flooring made out of wooden planks Temperature monitoring system connected to a centralized alarm/ warning system Refrigerated cabinets Refrigerated body storage cabinets Suitable body lifting device Power backup system for refrigerated cabinet

Status of works Start End In Not Responsible date date Complete progress started person Remarks :::-

::-

:::-

If Refrigerated Cabinets are chosen, refrigerated body storage cabinets with inbuilt slidable drawers to place the body shall be provided. A cabinet typically has two such drawers in one row, one above the other, and an unlimited number of such cabinets can be installed. It becomes difficult to lift the bodies at height if more than two are provided. However, if cabinets are stacked vertically to maximize space utilization, appropriate lifting equipment, and consideration of equipment turning circles shall be provided.

19.3.2.2 Autopsy Room (Indoor) See Table 19.11. The room shall have two dissection tables, preferably made of 304-grade stainless steel, with free drainage of a constant water flow from top to bottom. Proper ventilation and a ducting system shall be installed to allow foul odours and gases to exit the room. Provision shall also be made for the intake of fresh air and air exchanges. The room shall have large windows to allow for maximum sunlight. The room’s flooring shall be either washable tiles or granite, with an adequate slope to drain out the water for easy cleaning. The walls of the room shall be washable, so either tiles or washable epoxy paints can be applied up to a height of 2134 mm. The necessary tool, gadgets, and instruments such as OT lights, drills, saws, cutters, and surgical instruments shall be provided in the autopsy room.

596

19 Mortuary

Table 19.11  Autopsy room (indoor) of autopsy area

Activity Dissection tables made out of 304-grade stainless steel Free drainage of water flow from top to bottom Ventilation and the ducting system Provision of an inlet of fresh air and air exchanges Big-sized windows to allow maximum sunlight Flooring of the room with washable tiles or granite Tiles or washable epoxy paints on the walls to 2134 mm Portable X-ray machine X-ray view boxes Surgical instruments for autopsy All the required tools like drills, cutters, saws and reamers, etc. Required electric points Provision of photography CCTV surveillance Hot and cold water supply Arrangement for disposal of wastes as per the guidelines

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

:-

:-

::-

:-

:-

:-

::::-

:::::-

The room shall have X-ray view boxes, a portable X-ray machine, and the necessary electric points for the X-ray machine to operate. A portable OT light shall also have an electrical outlet near the autopsy table. A photography supply shall also be provided in the room.

19.3  Services, Facilities, Equipment, Tools, and Instruments

597

19.3.2.3 Autopsy Room (Outdoor) See Table 19.12. This room is needed for post-mortem examinations of infected or decomposed bodies that cannot be handled in the main autopsy room. The room shall have all of the same amenities as an indoor autopsy room, except for the roof, which is usually covered with a net. 19.3.2.4 Post-autopsy Room See Table 19.13. The room shall have a platform of about 914  mm  ×  2134  mm to lay down the bodies. Table 19.12  Autopsy room (outdoor) of autopsy area

Activity Roof covered with net Dissection tables made out of 304-grade stainless steel Free drainage of water flow from top to bottom Flooring of the room with washable tiles or granite Tiles or washable epoxy paints on the walls to 2134 mm Portable X-ray machine X-ray view boxes Surgical instruments for autopsy All the required tools like drills, cutters, saws, and reamers Required electric points Provision of photography CCTV surveillance Hot and cold water supply Arrangement for disposal of wastes as per the guidelines

Status of works Start End In Not date date Complete progress started ::-

:-

:-

:-

::::-

:::::-

Responsible person Remarks

598

19 Mortuary

Table 19.13  Post-autopsy room of autopsy area

Activity Platform for keeping the bodies

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

Responsible person

Remarks

:-

Table 19.14  Autopsy surgeon’s room of autopsy area

Activity Attached toilet PA room, if required Office table Office chairs Visitors chairs Cabinets, drawers, and racks Required electrical points Intercom connection IT network CCTV surveillance Air conditioning

Start date

End date

Status of works In Not Complete progress started

:::::::::::-

19.3.2.5 Autopsy Surgeon’s Room See Table 19.14. The room shall be provided with an office table, office chairs, and visitor’s chairs. An adequate arrangement shall be made for cabinets, drawers, and racks for smooth working. The room shall also have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning. 19.3.2.6 Instrument Wash Room See Table 19.15. The room shall have a large sink, drainboard, and a countertop for drying the instruments. It is recommended that the instrument wash room has a hot air dryer to dry the instruments. 19.3.2.7 Viscera Preparation Room See Table 19.16. The room shall be provided with a countertop, handwash basin, soap dispenser, and towel hanger.

599

19.3  Services, Facilities, Equipment, Tools, and Instruments Table 19.15  Instrument wash room of autopsy area Status of works Start End In Not date date Complete progress started

Activity Large size sink Drainboard Countertop for drying up the instruments.

Responsible person

Remarks

:::-

Table 19.16  Viscera preparation room of autopsy area

Activity Countertop Hand wash basin Soap dispenser Towel hanger

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::-

19.3.2.8 Viscera Stores See Table 19.17. The store needs to have sufficient countertops, cupboards, and drawers. The temperature of the room shall be between 17 and 21 °C. 19.3.2.9 Surgeons Change Room See Table 19.18. The room shall be provided with an adequate number of personal lockers to keep the personal belongings. Each staff member shall preferably be allotted one such locker. One chair shall be provided in the room, which the staff can use while changing their clothes. For hanging the outside clothes, an adequate number of hooks shall be provided on the wall. Apart from this, the almirah and hanger rods with the hangers shall also be provided to hang the clothes. There shall be a closed cabinet to keep the sterilized dresses. The cabinet shall have shelves, where different types and sizes of dresses can be placed. One table shall be provided in the room to keep the containers of fresh unused masks and caps. A large bin for dirty linen shall also be provided in the changing room. Also, a separate bin shall be provided for disposal of the used masks, caps, and shoe covers. The room shall have a provision intercom and shall have adequate air conditioning. Separate locker rooms shall be provided for men and women.

600

19 Mortuary

Table 19.17  Viscera store of autopsy area

Activity Countertops Cupboards for storing viscera Drawers

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::-

Table 19.18  Surgeons change room of autopsy area

Activity Staff lockers to keep their personal belongings One chair and cupboards Hooks on the wall to hang clothes Almirah for hanging clothes Cabinet to keep the sterilized dresses. Hanger rods Table to place boxes of masks and caps Bin for dirty linen Bin for used face masks, caps, and shoe covers Intercom point Air-conditioned

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:-

::::::::-

::-

19.3.3 Other Infrastructural Issues While designing the mortuary/autopsy room, the following issues shall be considered: 1. All handwashing basins shall have both hot and cold water. 2. To prevent foul air from permeating the rest of the area, the entire complex shall be air-conditioned, with a separate system for the autopsy rooms. To ensure a clean air environment, no air shall be recirculated in the mortuary.

Further Reading

601

3. The complex shall have adequate fire detection and firefighting equipment, such as fire sprinklers, smoke/thermal detectors in all rooms, and a fire alarm system. 4. The mortuary complex shall have all necessary arrangements in place for the disposal of various types of waste products following the country’s waste disposal rules and regulations.

Further Reading 3 ways to maximize postmortem spaces in medical facilities. 2021. https://www.hfmmagazine. com/articles/2114-­3-­ways-­to-­maximize-­postmortem-­spaces-­in-­medical-­facilities. Brassil KE, Zillman MA. Design for a hospital mortuary. Pathology (Phila). 1993;25(4):333–7. Chawla H, Sirohiwal B, PK P, Sharma L. Design and layout of mortuary complex for a medical college and peripheral hospitals. J Forensic Res. 2011;2:4. Garg A, Dewan A. Chapter 34, Mortuary. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 375–80. Hospital Mortuary/Autopsy Unit. Part B 2015;29. Malik AR, Rizvi IH, Ibrahim S. Design and layout of standard autopsy suite. Ann King Edw Med Univ. 2019;25(3). https://annalskemu.org/journal/index.php/annals/article/view/3042. Sirohiwal BL, Pk P, Sharma L, Chawla H. Design and Layout of Mortuary Complex for a Medical College and Peripheral Hospitals. 2011;2(6):4.

Administration Area

20

In any hospital, there is a group of people who manages the hospital’s day-to-day operations. This group of people is known as the ‘administrative team’, and they report to the organization’s management or owners. Because this team is responsible for the hospital’s daily operations, they shall be present daily. As a result, space in the hospital shall be set aside for their offices. This area is referred to as the ‘Administrative Area’. This area includes support staff of both clinical and non-clinical departments and provides spaces for offices, workspaces, and associated facilities to support hospital management. The size, number, and level of offices shall be determined by the hospital’s size. This checklist shall assist the planner and designer in remembering all such issues relating to the design of administration spaces and shall guide him/her in completing all works/activities on time. This shall assist him/her in ensuring that all tasks/activities are completed.

20.1 Location of the Administrative Area The administrative area shall be located either within the hospital or in a separate annex to the main hospital. It shall be kept distinct from the clinical departments if it is housed in the main hospital building. However, because many visitors and hospital personnel rely on the services of the administrative areas daily, it shall be easily accessible.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_20

603

20  Administration Area

604

20.2 Infrastructure 20.2.1 Infrastructure of the Administrative Area The administration unit may include the following spaces: 1. Main reception and enquiries 2. Offices for senior management and their support staff 3. Offices for senior executive management and support staff 4. Offices for executive management 5. Nursing office 6. Human resources and payroll office 7. Finance and accounting office 8. Facility management office 9. Public relations office 10. Legal services office 11. Quality management office 12. Training, education and research, this may be a separate area in large healthcare facilities

20.2.2 Reception See Table 20.1. The reception of the administration department shall be located at the department’s entrance so that as soon as visitors/patients enter the administrative areas, they shall come into contact with the receptionist. The receptionist shall be responsible for providing visitors and patients with all necessary information, scheduling appointments, and so on. If necessary, in addition to the reception area, a help desk shall be provided to assist patients and visitors in resolving their questions and guiding them.

20.2.3 Waiting Lobbies/Sub-Waiting Lobbies See Table 20.2. Table 20.1  Reception of hospital administration

Activity Provide the following at reception Reception area Store

Start date

::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

605

20.2 Infrastructure Table 20.2  Waiting lobbies of hospital administration

Activity Provide the following at waiting lobbies Main entrance lobby VIP waiting lobby Pantry for VIP lobby Sub-waiting lobbies Public utilities

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::::-

Visitors shall wait their turn at the reception desk before meeting with the appropriate person in the administrative area. In the pre-Covid era, the waiting lobbies were designed to be more comfortable and to accommodate a large number of chairs for seating. Following Covid-19, however, public spaces, such as waiting areas, need to be carefully planned and designed to create a greater physical separation between people through appropriate queuing. VIP Waiting Areas A VIP waiting area with seating for approximately 8–10 people shall be created for important visitors. A toilet shall be provided in the waiting room. A small pantry can even be attached to serve tea/coffee to visitors. Sub-waiting Lobbies It is recommended that hospitals design small sub-waiting lobbies instead of large waiting lobbies. For example, instead of providing a large lobby at the reception, a separate sub-waiting lobby for different administrative offices shall be created. However, such measures may not be feasible in all circumstances, particularly for small healthcare facilities, nursing homes, clinics, and so on. In such cases, the number of people permitted to wait in hospital lobbies may be limited to a specific maximum, with a specific minimum distance between their seats. As a result, future waiting lobbies may be smaller, but in dispersed clusters.

20.2.4 Senior Level Management’s Office The senior level management shall consist of the following: Senior level management

Directors Chief Executive Officer (CEO) or (COO) Medical superintendent Nursing superintendent

606

20  Administration Area

For each office of the senior level management, the following space shall be provided (Table 20.3). Given the senior level management’s status, the office setup shall be larger than in any other office. These offices shall be approximately 7620 mm × 6096 mm in size. However, the size of the room can be altered depending on the need. These offices shall have an attached toilet. A separate store can be attached to these offices if necessary. The size of the store can be determined based on the needs. A room for personal assistants shall also be attached to the offices of senior management. Similarly, each senior level management shall be provided with a small personal conference room with seating for approximately 8–10 people. However, if all of the offices of senior management are adjacent to each other, the conference room can be shared, reducing the number of such rooms. The secretarial staff shall have their own space or room. The secretarial staff room can either be provided separately for all senior level management or shared by all officers. The size of the room shall be determined by the number of people who shall be seated in it. If necessary and long working hours are anticipated, these offices can also include a small restroom. The office doors shall be flush doors type, preferably made of wood. The width of the doors shall not be less than 1219 mm and shall be unobstructed. A door closer and stopper shall be installed on the door. The door shall be able to be locked from both the inside and outside. The window shall be as large as possible and equipped with tinted glass, possibly with a double vacuum glass. The office flooring shall be visually appealing, and clean, and provide a positive and welcoming environment. The offices’ floors can be laid with either Italian marble or another stone. Carpet is another option. Table 20.3  Senior level management offices

Activity Office Toilet Store P.A room Conference room Small rest room Secretarial staff Waiting area for visitors

Start date ::::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

607

20.2 Infrastructure

20.2.5 Senior Executive Level Management’s Office The senior executive level management shall consist of the following: Senior executive level management

Dy. Medical superintendent Dy. Nursing superintendent Finance manager Personnel manager Marketing manager Training and skill development manager Purchase manager Electrical engineer Bio-medical manager IT manager HVAC engineer Civil engineer Stores manager

For each office of the senior executive level management, the following space shall be provided (Table 20.4). Each senior executive level management office shall be 4572 mm × 4572 mm in size. However, the size of the room can be altered depending on the requirement. These offices shall have an attached toilet. A separate store can be attached to these offices if necessary. The size of the store can be determined based on the needs. A room for personal assistants shall also be attached to the offices of senior executive level management. The secretarial staff room can either be provided separately for all senior executive level management officers or a common to be shared by all officers. The size of the room shall be determined based on the expected number of people to sit in it. The office doors shall preferably be flush doors made of wood. The width of the doors shall be at least 1219 mm. A door closer and stopper shall be installed on the door. The door shall be able to be locked from both the inside and outside. Table 20.4  Senior executive level management’s office

Activity The following spaces shall be provided for Office Toilet P.A room Secretarial staff Waiting area for visitors

Status of works Start End In Not date date Complete progress started

:::::-

Responsible person

Remarks

20  Administration Area

608

The window shall be as large as possible and equipped with tinted glass, possibly double vacuum glass. The office flooring shall be visually appealing, and clean, and provide a positive and welcoming environment. The offices’ floors can be laid with either Italian marble or another stone. Carpet is another option.

20.2.6 Executive Level Management’s Office The executive level management shall consist of the following: Executive level management

Chief cashier Marketing executives Accounts officers Purchase officer IT officers Design officer Store officers

For each office of the executive level management, the following space shall be provided (Table 20.5). For executive level management officers, a single room can either be allotted to one such officer or at the maximum two can be seated in the same room. If two people are to be seated in the same room, the room shall be 4572 mm × 4267 mm in size. If a single person is to be seated, the dimensions shall be 3658 mm × 3658 mm. However, depending on the designation, the room’s size can be altered. These offices shall have an attached toilet. The office doors shall preferably be flush doors made of wood. The unobstructed width of the doors shall be at least 1067 mm. A door closer and stopper shall be installed on the door. The door shall be able to be locked from both the inside and outside. If windows are provided, they shall be as large as possible and equipped with tinted glass, possibly double vacuum glass. The offices’ flooring can be laid with simple marble or any other similar stone. Table 20.5  Executive level management’s office

Activity The following spaces shall be provided for Office Toilet

Status of works Start End In Not date date Complete progress started

::-

Responsible person

Remarks

20.2 Infrastructure

609

20.2.7 Junior Level Management’s Office The junior level management shall consist of the following: Junior level management

Personal assistants Accounts clerks Store keepers Electrical line man Purchasers Bio-medical assistants

For each office of the junior level management, the following space shall be provided (Table 20.6). Rooms are not required for junior level management officers, but they shall have a hall with multiple desks/workstations. The size of the hall shall be determined based on the number of employees to be seated in the room. The office doors shall preferably be flush doors made of wood. The unobstructed width of the doors shall be at least 1067 mm. The door shall be able to be locked from both inside and outside. The common toilet block shall be provided with these halls. The window shall be as large as possible and equipped with tinted glass, possibly double vacuum glass. The flooring in the offices can be simple marble or another similar stone, or tiles.

20.2.8 Personnel Office See Table 20.7. The hospital’s personnel department shall have enough space to accommodate the department’s staff, including support rooms. Managers such as the personnel manager and the skill development manager can be accommodated in the chambers based on their designation. Table 20.6  Junior executive level management’s office

Activity The following spaces shall be provided for Hall with multiple desks Common toilet

Status of works Start End In Not date date Complete progress started

::-

Responsible person

Remarks

610

20  Administration Area

Table 20.7  Office of the personnel department

Activity The following spaces shall be provided for Personnel manager Attendance management Training and skill development manager Room for training and skill development Leaves record Clerks Public utility for staff

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::-

:-

:::-

The hall shall be provided to accommodate the rest of the department’s staff. The hall shall ideally be 7620  mm  ×  6096  mm in size. However, depending on the requirement, the size can be adjusted. There shall be enough space in the hall for attendance management, leave records management, personnel files storage, and records of the department. In the personnel department, a separate room or hall shall be provided for training and skill development of new joining staff as well as refresher training of existing staff. Further, some cabins shall also be provided in the hall for placing the mannequins for training. The room shall ideally be 7620 mm × 7620 mm in size. However, depending on the situation, the size can be adjusted.

20.2.9 Accounts/Finance Office See Table 20.8. The accounting department of the hospital shall have sufficient spaces to accommodate the staff of the department including the support rooms. As far as the managers like the finance manager, chief cashier and accounts officers are concerned, they can be accommodated in the chambers according to their designation. To accommodate the rest of the staff of the department, the hall shall be provided. Preferably, the hall shall be about 7620 mm × 6096 mm. However, the size can be altered depending on the requirement. In the hall, ample space shall be available for accounting management, accounting vouchers and other records. If required, a separate store can be provided.

611

20.2 Infrastructure Table 20.8  Office of the accounts and finance department

Activity The following spaces shall be provided for Finance manager Accounts officers Chief cashier Clerks Stores Sub waiting Public utility for staff

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

Responsible person

Remarks

:::::::-

Table 20.9  Office of the marketing department

Activity The following spaces shall be provided for Marketing manager Meeting room Design room Marketing staff Conference/meeting room Stores Sub waiting Public utility for staff

Status of works Start End In Not date date Complete progress started

::::::::-

20.2.10 Marketing Office See Table 20.9. The marketing department of the hospital shall have sufficient spaces to accommodate the staff of the department including the support rooms. As far as the managers like marketing managers and digital marketing managers are concerned, they can be accommodated in the chambers according to their designation. To accommodate the rest of the staff of the department, the hall shall be provided. Preferably, the hall shall be about 7620 mm × 6096 mm. However, the size can be altered depending on the requirement.

612

20  Administration Area

In the hall, ample space shall be available for accommodating the design room, digital marketing room, etc. A separate conference or meeting room shall also be provided in the department. This conference room shall have enough space to accommodate at least 10–15 people. The room shall ideally be 4572 mm × 4572 mm in size. However, depending on the situation, the size can be adjusted.

20.2.11 Purchase Office See Table 20.10. The purchase department of the hospital shall have sufficient spaces to accommodate the staff of the department including the support rooms. As far as the managers like purchase managers, and purchase officers are concerned, they can be accommodated in the chambers according to their designation. To accommodate the rest of the staff of the department, the hall shall be provided. Preferably, the hall shall be about 7620 mm × 6096 mm. However, the size can be altered depending on the requirement. A separate meeting room shall also be provided in the department where the purchase department officers can interact with the vendors and contractors. This meeting room shall have enough space to accommodate at least 10–15 people. The room shall ideally be 4572 mm × 4572 mm in size. However, depending on the situation, the size can be adjusted.

20.2.12 Hospital Information See Table 20.11. Table 20.10  Office of the purchase department

Activity The following spaces shall be provided for Purchase manager Purchase officer Meeting room Stores Sub waiting Public utility for staff

Status of works Start End In Not date date Complete progress started

::::::-

Responsible person

Remarks

613

20.2 Infrastructure Table 20.11  Office of the information technology department

Activity The following spaces shall be provided for IT manager IT control room Server room Public utility for staff

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::::-

The Information Technology (IT) department of the hospital shall have sufficient spaces to accommodate the staff of the department including the support rooms. As far as the IT manager is concerned, he/she can be accommodated in the chamber according to his/her designation. The department shall have a separate server room, to place all the servers. The flooring of the room shall be modular and raised above the base floor. The size of the server room shall be about 4572 mm × 4572 mm. Attached to the server room shall be the UPS room, to place the UPS system. The size of the room can be about 3048 mm × 3048 mm. A separate store can be provided with the room, to store the IT accessories. To accommodate the rest of the IT staff, the hall shall be provided. Preferably, the size of the hall shall be about 4572 mm × 6096 mm. However, the size can be altered depending on the requirement.

20.2.13 Support Room/Facilities The following support rooms/facilities are generally required in the administration area:

20.2.13.1 Senior Management’s PA Room For senior management staff, a PA room shall be provided. This room shall be attached to or near the officer’s room. This room’s dimensions shall be roughly 3658 mm × 3658 mm, however, they can be extended or decreased depending on the needs. The room shall have an additional door that leads into the officer’s chambers. 20.2.13.2 Kitchen A small kitchenette in the administrative area shall be provided for preparing and serving tea/coffee for guests and workers. This kitchenette shall also include space for reheating meals brought from home by staff members for lunch. The kitchenette’s dimensions shall be 3658 mm × 4267 mm.

614

20  Administration Area

20.2.13.3 Dining Area A dining room with a dining table and chairs for 10–15 people shall be provided near the kitchenette. The room’s dimensions shall be 4572 mm × 3658 mm. 20.2.13.4 Staff Toilets They shall be divided into male and female sections. Toilets, urinals, and washbasins are required in the restrooms. If necessary, a bathing facility can also be provided. 20.2.13.5 Store Stores shall be conveniently located to store all necessary files and stationery. Its dimensions shall be 3658 mm × 3658 mm. However, the sizes can be altered depending on the number and quantity of items to be stored. 20.2.13.6 Notice Boards A notice board shall be placed in the reception area, where all guests can see it. To simplify the usage of board pegs, the board shall be composed of cork. To improve visibility, a light shall be positioned above the notice board if possible.

20.2.14 Meeting Rooms In the administrative area, a single large meeting room or multiple small meeting rooms shall be provided. Before designing these rooms, the designer shall consider the needs of the hospital’s various administrative departments. The small meeting room shall be designed to accommodate ten people and shall be 6096 mm × 4572 mm in size. If a large meeting/conference room is planned, its dimensions shall be approximately 15,240 mm × 6096 mm, with seating for 50 people. The meeting room door shall preferably be made of wood, or flush doors shall be used. The unobstructed width of the doors shall not be less than 1829 mm. A door closer and stopper shall be installed on the door. The door shall be able to be locked from both the inside and outside. The window shall be as large as possible and equipped with tinted glass, possibly double vacuum glass. Curtains or vanishing blinds shall be used to cover the windows. The room’s flooring shall be visually appealing, and clean, and provide a positive and welcoming atmosphere. The meeting room’s flooring can be either Italian marble or another equivalent stone. However, the carpet shall be used to eliminate echo sounds in the room. The room’s walls and ceiling shall be acoustically treated to absorb echo sounds.

615

20.3  Services, Facilities, Equipment, Tools, and Instruments

20.3 Services, Facilities, Equipment, Tools, and Instruments 20.3.1 Reception See Table 20.12. The number of patients or visitors who are anticipated to use the reception or help desk services determines the size of the counter and/or help desk. It is advised that enough room be made so that two receptionists or helpers can be seated. Therefore, the appropriate length for the reception and/or help desk shall be between 3048 mm and 4572 mm. The counter can be built of granite or other materials, or it can be built up with masonry work with an elegant appearance. A wooden counter can also be provided as an alternative. For a person to comfortably stand and speak with the receptionist, the front side of the counter shall be roughly 1524 mm high. Table 20.12  Reception of the administrative department

Activity Provide the following at reception Reception counter Reception chairs Computers with printers Scanner Public announcement system Cash collection box screwed to the counter Intercom and telephone line Required electrical points at reception Other communication points at reception Acrylic or glass partitions on all the counters Basic facilities like telephones, public address system Separate toilets for males and females Drinking water facility Mobile charging points shall

Status of works Start End In Not date date Complete progress started

::::::::::-

:-

:::-

Responsible person Remarks

616

20  Administration Area

The working top, which shall be provided on the other side of the counter, shall approximately be 610 mm wide and 762 mm in height. Two reception chairs shall be provided for the receptionists. If needed, high-­ raised chairs can also be provided. A computer with UPS and printer (if needed for printing) shall be provided to each receptionist or the help desk assistant. If required, the scanner can also be provided at reception. The microphone for the announcement shall be provided at the reception. The intercom line and the telephone lines shall also be provided at the reception. Even one spare mobile phone shall also be placed at the reception, to make emergency calls. The reception counter shall have the following electrical points: • At least six 5 Amp switch/sockets shall be mounted on the counter’s wall at a distance of 146 mm or less from the working surface. Computers, printers, and other similar devices may be connected to these points. • In addition, there shall be two 15  Amp switch/sockets on the wall behind the reception desk to be used for other appliances. The reception counter shall have the following communication ports: • Two USB ports for charging mobile devices or other devices. • Two RJ 45 connectors for networking of computer. • Two RJ 11 points for intercom and extension lines.

20.3.2 Waiting Lobbies/Sub-waiting Lobbies/VIP Waiting Lobbies See Table 20.13. The waiting and sub-waiting lobbies of the administrative department shall be fully air-conditioned with a provision of cooling and heating. Waiting lobbies shall be properly guarded and the security measures such as fire hooters and CCTV cameras shall be provided in the waiting areas. Waiting lobbies shall have adequate speakers with a clear voice to hear the announcements. Along with the audio system, the visual display system including the display boards shall be provided, where the token number can be displayed. The proper comfortable chair having backrests shall be provided in the waiting areas. Please avoid the backless benches, as it is not comfortable to sit on such benches. If the sofa sets are provided, it shall be better. However, the waiting areas of VIPs shall definitely have the sofa set along with the centre tables. The waiting areas shall have suitable seating and provisions for bariatric patients. For an aesthetic look of the waiting areas, the interiors shall be well decorated. The wall decoration shall be done by using mirrors, murals, texturized paints, or wallpapers. Similarly, the ceiling shall also be decorative. Light fittings shall also be

20.3  Services, Facilities, Equipment, Tools, and Instruments

617

Table 20.13  Waiting lobbies of the administrative department

Activity Spaces for art galleries or exhibition Adequate windows provision for natural light and a view of nature Spaces for indoor plants Interactive displays Designated area for working on laptops with the provision of charging points Mobile charging points in the lobby Free internet or Wi-Fi facility Sound-absorbing materials on the walls, floors, and ceilings Good internal lighting Television, fish tanks, magazines, movies/ DVDs, etc. Food and drinks vending machines Signage and wayfinding system Proper heating and air conditioning Security features like CCTV Announcement systems Waiting chairs Wall, ceiling, and interior decoration

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::-

:::-

:::-

::-

:::::::-

decorative. For interior decor surface finishes, fixtures, fittings, colour, textures, furnishings, and artworks shall be used. The waiting areas shall also have televisions, fish tanks, magazine holders, newspaper racks, kiosks, etc. for patients and visitors to spend time. A small cafeteria or vending machines shall be provided in the waiting areas. The wayfinding and signages shall be very clear and glow able so that the visitors and the patients can easily identify the passages and the routes. For beautification, indoor plants can also be planned to be placed in waiting areas.

618

20  Administration Area

Mobile charging points shall also be provided in the waiting area. Apart from this, if possible, the facility of Wi-Fi of the free internet can be provided. For the safety of the patients, and visitors, provide necessary safety measures, like handrails, non-slippery surfaces, avoiding steep slopes, handicapped toilets, and wheelchair accessibility.

20.3.3 Offices of Senior Management See Table 20.14. Furniture-wise, each office of senior management shall have 1. 2. 3.

Offices (a) Executive office table (b) Side rack (c) Back rack (d) Executive chair (e) Executive visitors chair (f) Sofa set (g) Centre table (h) Coat hanger (i) Refrigerator (j) Television (k) Cabinets (l) Drawers (m) Racks (n) Filing Cabinet Conference room (a) Conference table (b) Conference chairs (c) Projector (d) Projector screen or multi-media television Rest room (a) Resting bed (b) Study table (c) Chair

Curtains or vanishing blinds shall be used on all of the room’s windows. The room’s walls shall be decorated with paintings, pictures, murals, and artwork. The room shall also have adequate electrical outlets, an intercom connection, an IT network, and CCTV surveillance. Air Conditioning The office shall have air conditioners installed. The system shall be linked to the central HVAC system, but administrative AHUs shall be kept separate. Individual

20.3  Services, Facilities, Equipment, Tools, and Instruments

619

Table 20.14  Offices of the senior management of the administrative department

Activity Each room shall have Executive office table Side rack Back rack Executive chair Executive visitors chair Sofa set Centre table Cabinets Drawers Racks Filing cabinet Coat hanger Refrigerator Television Curtains or vanishing blinds Pictures, paintings, murals, and artwork Air conditioning Required electrical points Intercom connection IT Network CCTV surveillance Each conference room shall have Acoustic treatment in conference rooms to reduce the noise Conference table Conference chairs Projector Projector screen or multi-media television Required electrical points Intercom connection IT network CCTV surveillance

Status of works In Not Start End date date Complete progress started

Responsible person

Remarks

:::::::::::::::::::::-

:-

::::::::(continued)

620

20  Administration Area

Table 20.14 (continued)

Activity Each rest room shall have Resting bed Study table Chair Required electrical points Intercom connection IT network CCTV surveillance

Status of works In Not Start End date date Complete progress started

Responsible person

Remarks

:::::::-

fan coil units can also be provided in the room. The office temperature shall be between 18 and 24 °C, with a relative humidity of 45–50%. Electrical Points 1. The main switchboard shall be provided at the entrance wall (other than the wall on which the door shall open) which controls the room’s fan and lights, including one 5 Amp switch/socket. 2. The air conditioning control button allows the control of the temperature. 3. On the wall next to the office table, three 6/16 Amp switch/sockets shall be provided. If the table is to be put in the centre of the room, an underground cable and electrical outlets shall be constructed. 4. Two 5 Amp switch/sockets shall be provided 305 mm above the office table on the wall. In addition, one 15 Amp switch/socket shall be provided nearby. 5. USB charging stations shall be installed on the table and near the sofa set. Other Communication Points in the Room The following ports shall be provided in the executive office at any convenient place/wall 1. RJ 45 point for networking of the computer. 2. RJ 11 for intercom and extension line. 3. HDMI point for computer displays at other locations Lighting in the Offices The lights shall not be too bright or too dim. Proper lumens shall be planned following the standards. LED lighting is always recommended due to its long life and low energy consumption. Surface exposed lights shall be replaced with ceiling

20.3  Services, Facilities, Equipment, Tools, and Instruments

621

flush-mounted lights. Fancy lights can be used. It is preferable if light controls are performed at the user end using variable-control dimmers.

20.3.4 Offices of Senior Executive Level Management See Table 20.15. Furniture-wise, each office of senior executive level management shall have (a) Executive office table (b) Side rack (c) Back rack (d) Executive chair (e) Executive visitors chair (f) Refrigerator (g) Television (h) Cabinets Table 20.15  Offices of the senior executive level management of the administrative department

Activity Each room shall have Executive office table Side rack Back rack Executive chair Executive visitors chair Refrigerator Television Cabinets Drawers Racks Filing cabinet Windows with tinted glass, maybe with a double vacuum glass Curtains or vanishing blinds Required electrical points Intercom connection IT Network CCTV surveillance Air conditioning

Status of works Start End In Not date date Complete progress started ::::::::::::-

::::::-

Responsible person Remarks

622

20  Administration Area

(i) Drawers (j) Racks (k) Filing cabinet Curtains or vanishing blinds shall be used on all of the room’s windows. The room’s walls shall be decorated with paintings, pictures, murals, and artwork. The room shall also have adequate electrical outlets, an intercom connection, an IT network, CCTV surveillance, and air conditioning. Air Conditioning Air conditioners shall be installed in the office. The system shall be linked to the central HVAC system, with administrative AHUs separate. Ducts can be installed in rooms which are ultimately connected to the AHU. Alternatively, individual fan coil units can be provided in the room. The temperature in the offices shall be between 18 and 24 °C, with a relative humidity of 45–50%. Electrical Points 1. The main switchboard at the entrance wall (other than the wall on which the door shall open) which controls the room’s fan and lights, as well as one 5  Amp switch/socket. 2. The air conditioning control button allows you to control the temperature. 3. On the wall next to the office table, three 6/16 Amp switch/sockets are attached. If the table is to be put in the centre of the room, an underground cable and electrical outlets shall be constructed. 4. Two 5  Amp switch/sockets are located 305  mm above the office table on the wall. In addition, one 15 Amp switch/socket shall be provided nearby. 5. USB charging stations shall be installed on the table and near the sofa set. Other Communication Points in the Room The following ports shall be provided in the executive office at any convenient place/wall. 1. RJ 45 point for networking of computer. 2. RJ 11 for intercom and extension line. 3. HDMI point for computer displays at other locations. Lighting in the Offices The lights shall not be too bright or too dim. Proper lumens shall be planned following the standards. LED lighting is always recommended due to its long life and low energy consumption. Surface exposed lights shall be replaced with ceiling flush-­ mounted lights. It is preferable if light controls are performed at the user end using variable-control dimmers.

20.3  Services, Facilities, Equipment, Tools, and Instruments

623

20.3.5 Offices of Executive Level Management See Table 20.16. Furniture-wise, each office of executive level management shall have (a) Office table (b) Side rack (c) Chair (d) Visitors chair (e) Cabinets (f) Drawers (g) Racks (h) Filing cabinet Curtains or vanishing blinds shall be used on all of the room’s windows. The room shall also have adequate electrical outlets, an intercom connection, an IT network, CCTV surveillance, and air conditioning. Table 20.16  Offices of the executive level management of the administrative department

Activity Each room shall have Office table Side rack Chair Visitors chair Cabinets Drawers Racks Filing cabinet Windows with tinted glass Curtains Required electrical points Intercom connection IT Network CCTV surveillance Air conditioning

Start date

:::::::::::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

624

20  Administration Area

Air Conditioning Air conditioners shall be installed in the office. The system shall be linked to the central HVAC system, with administrative AHUs separate. Ducts can be installed in rooms which are ultimately connected to the AHU. Alternatively, individual fan coil units can be provided in the room. The temperature in the offices shall be between 18 and 24 °C, with a relative humidity of 45–50%. Electrical Points 1. The main switchboard at the entrance wall (other than the wall on which the door shall open) which controls the room’s fan and lights, as well as one 5  Amp switch/socket. 2. The air conditioning control button that controls allows you to control the temperature. 3. On the wall next to the office table, three 6/16 Amp switch/sockets are attached. If the table is to be put in the centre of the room, an underground cable and electrical outlets shall be constructed. 4. Two 5  Amp switch/sockets are located 305  mm above the office table on the wall. In addition, one 15 Amp switch/socket shall be provided nearby. Other Communication Points in the Room The following ports shall be provided in the executive office at any convenient place/wall 1. RJ 45 point for networking of computer. 2. RJ 11 for intercom and extension line. 3. HDMI point for computer displays at other locations. Lighting in the Offices The lights shall not be too bright or too dim. Proper lumens shall be planned following the standards. LED lighting is always recommended due to its long life and low energy consumption. Surface exposed lights shall be replaced with ceiling flush-­ mounted lights. It is preferable if light controls are performed at the user end using variable-control dimmers.

20.3.6 Offices of Junior Level Management See Table 20.17. Furniture-wise, each office of junior level management shall have (a) Office table (b) Side rack

625

20.3  Services, Facilities, Equipment, Tools, and Instruments Table 20.17  Offices of the junior level management of the administrative department

Activity Each room shall have Office table Chair Visitors chair Cabinets Drawers Racks Filing cabinet Windows with tinted glass Curtains Required electrical points Intercom connection IT Network CCTV surveillance Air conditioning

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::::::::::::::-

(c) Chair (d) Visitors chair (e) Cabinets (f) Drawers (g) Racks (h) Filing cabinet Curtains or vanishing blinds shall be used on all of the room’s windows. The room shall also have adequate electrical outlets, an intercom connection, an IT network, CCTV surveillance, and air conditioning. Air Conditioning Air conditioners shall be installed in the office. The system shall be linked to the central HVAC system, with administrative AHUs separate. Ducts can be installed in rooms which are ultimately connected to the AHU. The temperature in the offices shall be between 18 and 24 °C, with a relative humidity of 45–50%. Electrical Points 1. The main switchboard at the entrance wall (other than the wall on which the door shall open) which controls the room’s fan and lights, as well as one 5  Amp switch/socket.

20  Administration Area

626

2. The air conditioning control button that controls allows you to control the temperature. 3. On the wall of the modular desk, each station shall have two 6/16 Amp switches/ sockets. Other Communication Points in the Room The following ports shall be provided in the executive office at any convenient place/wall 1. RJ 45 point for networking of computer 2. RJ 11 for intercom and extension line 3. HDMI point for computer displays at other locations Lighting in the Offices The lights shall not be too bright or too dim. Proper lumens shall be planned following the standards. LED lighting is always recommended due to its long life and low energy consumption. Surface exposed lights shall be replaced with ceiling flush-­ mounted lights.

20.3.7 Personal Assistant Office (Table 20.18) Furniture-wise, each office of personal assistant shall have (a) Office table (b) Chair Table 20.18  Offices of the personal assistant of the administrative department

Activity Office table Side rack Chair Visitors chair Cabinets Drawers Racks Extra door which shall open in the officer’s room Required electrical points Required other communication points Air conditioning

Status of works Start End In Not date date Complete progress started ::::::::-

:::-

Responsible person

Remarks

20.3  Services, Facilities, Equipment, Tools, and Instruments

627

(c) Visitors chair (d) Cabinets (e) Drawers (f) Racks (g) Filing cabinet All of the room’s windows shall have tinted glass and may be draped. The room shall also have adequate electrical outlets, an intercom connection, an IT network, CCTV surveillance, and air conditioning. Air Conditioning The office shall have adequate air conditioning. Electrical Points 1. The main switchboard at the entrance wall (other than the wall on which the door shall open) which controls the room’s fan and lights, as well as one 5  Amp switch/socket. 2. The air conditioning control button that controls allows you to control the temperature. 3. On the wall of the modular desk, each station shall have two 6/16 Amp switches/ sockets. Other Communication Points in the Room The following ports shall be provided in the executive office at any convenient place/wall 1. RJ 45 point for networking of computer 2. RJ 11 for intercom and extension line 3. HDMI point for computer displays at other locations

20.3.8 Secretarial Staff Office See Table 20.19. For a smooth working environment, each workstation in the secretarial hall shall have an adequate arrangement of chairs, tables, visitors’ chairs, cabinets, drawers, and racks. Each workstation shall have electricity and communication points, and the hall shall have air conditioning.

20.3.9 Kitchen See Table 20.20.

628

20  Administration Area

Table 20.19  Offices of the secretarial staff of the administrative department Status of works Start End Not Responsible date date Complete In-progress started person Remarks

Activity Hall with multiple desks/workstations Office tables Chairs Visitors chairs Each workstation shall have an adequate arrangement of cabinets, drawers, and racks Required electrical points Required other communication points Air conditioning

:::::-

:::-

Table 20.20  Kitchen of the administrative department

Activity Countertop Deep stainless steel sink with a drain board Gas burner with connection to a gas cylinder Refrigerator Microwave oven Induction heating pad OTG Required utensils, crockery, and cutlery Mixer/juicer

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::-

:-

::::::-

It shall have a working surface for cooking and storing kitchen appliances. A deep stainless steel sink with a drainboard for washing utensils shall be installed on the countertop. A gas burner shall also be installed within a gas cylinder connection. The kitchenette shall include a refrigerator, microwave oven, induction heating pad, OTG, utensils, and other necessary items such as a mixer and juicer.

20.3  Services, Facilities, Equipment, Tools, and Instruments

629

20.3.10 Dining Area See Table 20.21. A dining table and chairs are required in the dining room. It shall have a hand washing station with a soap dispenser and paper towels. The room shall be air-conditioned, and the temperature shall be between 17 and 21 °C.

20.3.11 Store See Table 20.22. The store shall have an adequate number of counters, cabinets, and drawers. The room temperature shall be between 17 and 21 °C. It shall be lockable and secure to protect confidential administrative, financial, and human resource records.

20.3.12 Notice Boards See Table 20.23. A notice board shall be planned near the reception area, where it shall be visible to all visitors. The board shall be made of cork to facilitate the use of board pins. Table 20.21  Dining area of the administrative department

Activity Dining table Dining chairs Hand washing facility with soap dispenser and paper towel

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::-

Table 20.22  Store of the administrative department

Activity Lockable cupboards Racks Drawers Working countertop

Start date ::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

630

20  Administration Area

Table 20.23  Notice boards of the administrative department

Activity Framed board made out of cork Light above the notice board

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

::-

Table 20.24  Meeting rooms/conference room of the administrative department

Activity Conference table Conference chairs Projector Projector screen or multi-media television If possible, a smart board Stage or podium with audio system connection Teleconference or videoconference facilities At all seats, the conference audio system Speakers connected to the audio system in the ceiling Required electrical points Required other communication points Acoustic treatment on the walls and the ceiling

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::::-

:-

:-

:-

:::-

The size of the board shall be determined depending on the number of notices to be displayed on the notice board. If possible, a light shall be installed above the notice board to improve visibility.

20.3.13 Meeting Rooms/Conference Room See Table 20.24.

20.3  Services, Facilities, Equipment, Tools, and Instruments

631

Furniture in the Meeting/Conference Room The following furniture shall be provided in the meeting rooms: 1. Conference table 2. Conference chairs 3. Projector 4. Projector screen or multi-media television 5. Smart board (If possible) The meeting room shall have a teleconference or videoconference capabilities. All seats shall have a conference audio system with two-way communication. Ceiling speakers connected to the audio system shall be installed. However nowadays, the ceiling speakers are not used and headphones with mike are provided on each seat of the conference table. There shall be a stage or podium with an audio system connection. Electrical Points 1. The main switchboard at the entrance wall (other than the wall on which the door shall open) for control of the room’s fan and lights, as well as one 6  Amp switch/socket. 2. Temperature adjustment is available via the air conditioning control button. 3. A module of electrical points shall be provided on the conference table. The module shall include three 6/16 Amp switch/sockets, one USB charging port, one RJ 45 port, and one HDMI port. 4. At the podium, one projector electrical outlet shall be provided. 5. If a smartboard is used, an electrical outlet shall be installed near the board. Other Communication Points in the Room The following communication points shall be provided in the room at any convenient place/wall: 1. RJ 45 point for networking of computer 2. RJ 11 for intercom and extension line 3. Connection to the CCTV surveillance system Lighting Lighting shall be carefully planned for both general illumination and specific tasks. When it comes to meeting room lighting, the following factors shall be taken into account: 1. The lights shall not be too bright or too dim. Proper lumens shall be planned following the standards. 2. LED lighting is always recommended due to its long life and low energy consumption. 3. The lights in the room shall be distributed evenly.

632

20  Administration Area

4. Surface exposed lights shall be replaced with ceiling flush-mounted lights. 5. Avoid using wall lights because they are ineffective. 6. Incandescent and halogen light sources shall be avoided to avoid burns. 7. The room shall have an emergency battery-powered light. 8. It is preferable if light controls are performed at the user end using variable-­ control dimmers. Air Conditioning Air conditioners shall be provided in the conference/meeting room. The system shall be linked to the central HVAC system, with administrative AHUs separate. Ducts can be installed in rooms which are ultimately connected to the AHU. Alternatively, if the room size is small, individual fan coil units can be provided in the room. The temperature in the offices shall be between 18 and 24 °C, with a relative humidity of 45–50%. Room Decor Pleasant and appealing surroundings shall be created, and the following concerns shall be considered when creating the room: 1. A decent colour scheme, particularly bright green and blue, shall be utilized on the walls. 2. Waterproof washable paints shall be wonderful for wall décor. 3. Appropriate pictures, paintings, murals, and artwork shall be provided. Acoustics Acoustic treatment shall be provided in meeting and conference rooms to curtail noise between rooms, especially if they are used for teleconferencing, videoconferencing, or large meetings. Similarly, on the windows black-out curtains shall be provided to darken the room, for projection on the screen. Privacy Where confidential conversations are likely to take place, visual privacy shall be taken care of when designing meetings and conference rooms.

Further Reading Garg A, Dewan A. Chapter 35, Administration area. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 381–92. GmbH E. Lighting for offices and administrative buildings | ERCO. 2021. https://www.erco.com/ en/designing-­with-­light/work/work-­6443/.

Further Reading

633

Jose D, Rajan D, Jitha KR, Mathew P, Treesa Varghese M, M A College of Engineering. Functional planning of an administrative building. Int J Eng Res. 2015;V4(03):IJERTV4IS030897. Lakshmi EV, Kumar PD. Planning, analysis and design of an administrative building at NBKRIST 2019;7(1):5. Mohammad K, Ranjan R, Singh A, Siddharth V, Sharma D.  Hospital administration control room—an effective concept for managing hospital operation issues: a study in tertiary care public sector hospital. Int J Res Foundation Hosp Healthcare Admin. 2018;6:82–90.

Stores

21

Stores are an essential component of any hospital. It is the hub of activity where materials used in the hospital are managed. The store’s primary goals are to ensure (1) the availability of a balanced and timely flow of all materials such as consumables, medical disposables, spare parts and components, tools and equipment, and other general supplies, (2) the receipt, inspection, and issue of the aforementioned supplies/stores to the hospital, and (3) the acceptance, storage, and disposal of scrap and unwanted supplies/stores. Consumable stores, non-consumable stores, general stores, medical and pharmacy stores, equipment stores, surgical stores, stationery stores, linen stores, engineering and maintenance stores, dietary stores, and condemnation stores are the stores that a hospital requires. This set of checklists shall assist the planner and designer in remembering all such issues relating to the design of stores and shall guide him/her in completing all works/activities on time. This shall assist him/her in ensuring that all works/activities are completed.

21.1 Location of the Stores Stores shall be located away from the general circulation and clinical areas of the hospital. Unauthorized individuals shall be denied access to this area. Stores can be located in areas that would otherwise be inaccessible to clinical departments, such as the basement. If the main building hospital does not allow to accommodate the stores due to a shortage of space, they can be taken in the main hospital’s annexure building. The issues relating to the safety of materials from unnecessary pilferage, theft, and fire shall be considered carefully while deciding the location of the stores. The placement shall allow for easy material transfer and small vehicle access. In the stores, vertical lifts shall be installed. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_21

635

636

21 Stores

The store’s location shall be close to where the materials are required. When selecting an appropriate location for a store, temperature, humidity, lighting arrangements, and future development plans shall all be taken into account.

21.2 Types of Hospital Stores Depending on the nature of the items dealt with, hospitals can provide different types of stores. Generally, hospitals shall have the following stores: 1. Medical and drug stores This store deals with medicines, general drugs, special drugs, emergency drugs, chemicals, formulary and medical gases, etc. 2. Surgical stores This store deals with items like surgical instruments, sutures, gauze, cotton, bandages, rubber goods, glass items, and general surgical items. 3. General stores This store deals with cleaning materials like soaps and detergents, ward/general furniture, small electrical items, enamel wares, etc. 4. Equipment stores This store deals with medical equipment, tools, devices, spares of the equipment, and consumables of equipment. 5. Linen stores This store deals with textiles, doctors’ dresses, patient dresses, staff dresses, ward linen, woollen articles, synthetic fabric, pillows, curtains, blankets, bedsheets, and furnishings. 6. Stationery stores This store deals with medical forms and formats, for medical documentation stationery, office stationery, registers, etc. 7. Dietary stores This store is typically linked to kitchens and manages the commodities such as dry ration vegetables, fruits, and canned goods. 8. Engineering and maintenance This store manages items needed for hospital maintenance such as civil maintenance, electrical maintenance, HVAC maintenance, plumbing maintenance, mechanical and electronic maintenance, IT maintenance, and wooden and steel maintenance among other things. Depending on the material load, a single store can be provided for all such maintenance departments, or each department can have its own store. 9. Condemnation store This store deals with the acquisition and disposal of hospital-condemned items.

21.3 Infrastructure

637

21.3 Infrastructure 21.3.1 Stores Hospital setup requires different types of stores as has been mentioned in para 21.2 above. Hence the spaces shall be provided for Table 21.1. The number of stores, the nature of the material to be handled, the workload, the number of things to be dealt with, and the cost of the material to be handled shall all decide the size of the store. There are no set standards for the size of the stores, but the size is determined by the user. According to our experience, we recommend the following store sizes: Store type Medical and drug stores Surgical stores General stores Equipment stores Linen stores Stationery stores Engineering and maintenance Condemnation store

Size of the store room 9144 mm × 9144 mm 9144 mm × 9144 mm 12,192 mm × 9144 mm 12,192 mm × 12,192 mm 9144 mm × 9144 mm 6096 mm × 9144 mm 30,480 mm × 15,240 mm 30,480 mm × 15,240 mm

An individual store can be divided into different sections to improve working efficiency and control over the movement and storage of material in the stores. Medical stores, for example, can be divided into item-specific sections such as one for medicines, emergency drugs, special drugs, formulary, general drugs, chemicals, medical gases, and so on. Store doors shall preferably be flush doors made of wood. As an alternative, aluminium doors can be used. MS steel doors, on the other hand, are not Table 21.1  Type of stores in the hospital

Activity Medical and drug stores Surgical stores General stores Equipment stores Linen stores Stationery stores Dietary stores Engineering and maintenance Condemnation store

Start date :::::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

638

21 Stores

recommended because they rust and look bad. The unobstructed width of the doors shall be at least 1829 mm. A door closer and stopper shall be installed on the door. The door shall be able to be locked from both the inside and outside. The window shall be as large as possible and equipped with tinted glass, possibly double vacuum glass. Curtains or vanishing blinds shall be used to cover the windows. The store’s flooring shall be stable enough to withstand a heavy load of material. On the other hand, it shall be visually appealing, and clean. The flooring options include marble, hard stone, or heavy-duty tiles.

21.3.2 Utility Areas See Table 21.2.

21.3.2.1 Special Store Room Within the stores, a specific locked area shall be created for the storage of valuable products and confidential store records. This storage shall be located in a convenient place yet shall be visible from the storekeeper’s room. The store’s dimensions shall be 3658 mm × 3658 mm, although this can vary based on the number and quantity of items to be stored. To emphasize, this type of store shall preferably be made of reinforced concrete (RCC). 21.3.2.2 Cold Room A cold walk-in store/refrigerated area shall be provided in the medical and drug store for storing special drugs that require a cold chain or shall be stored at a cool temperature. The room’s dimensions shall be 3048 mm × 3048 mm. The room’s walls and ceiling shall be made up of puff panels, which shall act as a heat barrier. Table 21.2  Utility in the stores area of the hospital

Activity Special store room Cold room Storekeeper room Store secretarial staff Kitchen Staff toilets Issue counter Receiving area

Start date ::::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

21.4  Services, Facilities, Equipment, Tools, and Instruments

639

The door to the room shall likewise be made of puff panel and hermetically sealed. Wood planks shall be used for flooring.

21.3.2.3 Storekeeper Office The storekeeper shall have his/her own office. This office shall be either attached to the store premises or close to the store. Depending on the needs, there may be one or more offices for various storekeepers. The dimensions of this office room shall be approximately 4267 mm × 3658 mm, but they can be increased or decreased depending on the requirements. 21.3.2.4 Store Secretarial Staff Secretarial personnel aren’t required to have rooms, but they shall have an access to a hall with many desks/workstations. 21.3.2.5 Kitchen A modest kitchenette near the businesses shall be provided to prepare tea and coffee for guests and staff. This kitchenette shall also include space for reheating meals brought from home by staff members for lunch. The kitchenette’s dimensions shall be 3658 mm × 3658 mm. 21.3.2.6 Staff Toilets There shall be separate toilets for men and women. Bathing facilities can be provided if needed. The toilet shall be approximately 1829 mm × 1219 mm in size. 21.3.2.7 Issue Counter The store shall have an issue counter near the front door. The user shall remain at the issue counter while the material is being taken out and issued to him/her. There shall be enough room outside the issue counter for the user to sit, as well as enough space for material-carrying trolleys to park. 21.3.2.8 Receiving Area Materials obtained from outside, whether from a vendor or from within the hospital, shall be kept in a separate enclosure in the store. This room is needed to store materials until their quality and quantity have been confirmed. When everything has been concluded, it is transferred to the store, and this area is cleared out. The receiving area’s size shall be decided by the number and quantity of things received in that area daily. However, the size of 3658 mm × 3658 mm shall suffice.

21.4 Services, Facilities, Equipment, Tools, and Instruments 21.4.1 Store See Table 21.3.

640

21 Stores

Table 21.3  Stores of the hospital

Activity Each store shall have Slotted angle racks Heavy-duty racks made out of stainless steel or mild steel with shelves Bins for storing small items Wall-fixed cupboard with locking facility Office table Office chairs Visitor chair Countertops, cupboards, and drawers Plastic or wooden pallets for stocking material on the floor Twin-leg ladder for climbing to the rack height Material handling fork lifters, if required Required electrical points Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::-

:::::::-

:-

:::-

Furniture in the Stores The following furniture shall be provided in the storerooms: 1. Racks with slotted angles. 2. Heavy-duty racks with proper shelves made of stainless steel or mild steel. To accommodate all types of materials, the shelves shall be of varying heights. Depending on the requirements, it can range in height from 229 to 610 mm. 3. Bins for storing small items such as bolts, sanitary items such as elbows, tees, and plugs, electrical materials such as connectors, PVC tape, switches, and plugs. The size of the bins shall be determined by the requirements. It can be as small as 152 mm × 152 mm or as large as 305 mm × 305 mm. 4. Wall-mounted cabinet with locking mechanism. 5. Storekeeper’s office desk. 6. Visitor chairs in the office. 7. Pallets made of plastic or wood for stocking materials on the floor.

21.4  Services, Facilities, Equipment, Tools, and Instruments

641

8. Twin-leg ladder for reaching rack height. 9. If necessary, material handling fork lifters. The store shall have the provision of CCTV surveillance and adequate firefighting and detection system shall be provided. Electrical Points Following electric outlets and points shall be provided in the stores: 1. The main switchboard at the entrance wall (other than the wall on which the door shall open) controls the room’s fan and lights, in addition to one 6  Amp switch/socket. 2. The air conditioning control button allows for controlling the temperature. 3. An appropriate electrical point with a 6 Amp switch/sockets shall be placed on the vacant walls of the stores to aid in the testing of equipment, machinery, charging of machines, and other miscellaneous uses. If necessary, 16  Amp switches/sockets can be provided. Other Communication Points in the Room The following communication points shall be provided near the office table of the storekeeper: 1 0. RJ 45 point for networking of computer. 11. RJ 11 for intercom and extension line. Lighting in the Stores The following points shall be considered while finalizing the lighting for general illumination: 1. The lights shall not be too bright or too dim. Proper lumens shall be planned following the standards. 2. LED lighting is always recommended due to its long life and low energy consumption. 3. The lights in the store shall be distributed evenly. 4. If the store has a false ceiling, ceiling flush-mounted lights shall be used. However, surface-mounted ceiling lights can be used if a false ceiling is not provided. 5. Avoid using wall lights because they are ineffective. 6. Incandescent and halogen light sources shall be avoided to avoid burns. 7. Stores shall have an emergency battery-powered light. Air Conditioning Stores shall be equipped with air conditioners if necessary. The system shall be linked to the main HVAC system, with separate AHUs for the storage area. Ducts

642

21 Stores

can be installed in the stores and connected to the AHU.  The temperature in the stores shall be between 18 and 24 °C, with a relative humidity of 45–50%.

21.4.2 Special Store Room See Table 21.4. Slotted angle racks, heavy-duty racks made of stainless steel or mild steel with proper shelves, bins for storing small items, wall-mounted cupboard with locking facility, office table for storekeeper, and office chairs shall be provided for the special store room. The store shall have enough countertops, cupboards, and drawers. The room temperature shall be between 17 and 21 °C. All the required electrical outlets and communication ports shall be provided.

21.4.3 Cold Room See Table 21.5. Open racks along the walls shall be provided for storage. Bins or stainless steel baskets can also be provided for the storage of small items. Air conditioning shall be installed inside the room, and the temperature shall be kept between 5 and 12 °C, which can be adjusted as needed. The room shall have a temperature monitoring system that is linked to a centralized alarm/warning system. This room’s access doors shall all be lockable. Table 21.4  Special store room of the hospital

Activity Store shall have Slotted angle racks. Bins for storing small items Wall-fixed cupboard with locking facility Office table Office chairs Countertops, cupboards, and drawers Required electrical points: Other communication points

Status of works Start End In Not date date Complete progress started ::::::-

::-

Responsible person

Remarks

643

21.4  Services, Facilities, Equipment, Tools, and Instruments Table 21.5  Cold store room of the hospital

Activity Store shall have Slotted angle open type of racks Bins for storing small items Perforated SS baskets Temperature monitoring system connected to a centralized alarm/ warning system

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::::-

Table 21.6  Store keeper office of the hospital

Activity Office table Office chairs Visitors chairs Cabinets, drawers and racks Required electrical points Intercom connection IT network CCTV surveillance Air conditioning

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::::::-

21.4.4 Store Keeper Office See Table 21.6. The office of the storekeeper shall be provided with the office table, office chairs, and the visitor’s chairs. An adequate arrangement shall be made for cabinets, drawers, and racks for smooth working. The rooms shall also have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning.

21 Stores

644

21.4.5 Store Secretarial Staff Room See Table 21.7. Secretarial personnel shall be provided with a hall with multiple desks/ workstations. For a smooth working environment, each workstation shall have an adequate arrangement of cabinets, drawers, and racks. Each workstation shall have adequate electrical and communication connections, and the hall shall have air conditioning.

21.4.6 Kitchen See Table 21.8. The kitchen shall have a working surface for cooking and storing kitchen appliances. A deep stainless steel sink with a drainboard for washing utensils shall be installed on the countertop. A gas burner shall also be installed and connected to the gas cylinder/piped cooking gas system. The kitchenette shall include a refrigerator, microwave oven, induction heating pad, utensils, and other necessary items.

21.4.7 Receiving Area See Table 21.9. Furniture-wise, the receiving areas shall be provided with a sufficient number of racks and shelves for storage of the material that has been received from the suppliers and vendors. For official work, an office table and office chairs shall be provided. Table 21.7  Store secretarial staff room of the hospital

Activity Hall with multiple desks/workstations Each workstation shall have an adequate arrangement of cabinets, drawers, and racks Required electrical points Required other communication points Air conditioning

Status of works Start End In Not Responsible date date Complete progress started person Remarks ::-

:::-

645

21.4  Services, Facilities, Equipment, Tools, and Instruments Table 21.8  Kitchen in the store area

Activity Countertop Deep stainless steel sink with a drain board Gas burner with connection to a gas cylinder Refrigerator Microwave oven Induction heating pad Required utensils, crockery, and cutlery

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

::-

:-

::::-

Table 21.9  Receiving area in stores of the hospital

Activity Separate lockable enclosure Racks and shelves Office table Chairs Working counter top Computer workstation connected to hospital network with UPS Printers and scanners Barcode scanner ad barcode printer

Status of works Start End In Not date date Complete progress started

Responsible person Remarks

::::::-

::-

The area or enclosure shall be secured with personnel access controlled. A workstation shall be provided in the receiving area. The PC shall be linked to the UPS power supply. Aside from that, computer equipment such as scanners, barcode scanners, and printers shall be given. The receiving area shall be fully air-conditioned and have a fully controlled temperature, and humidity. Air quality shall be adequate and secure at all times. The temperature of the pharmacy shall be between 18 and 22 °C.

646

21 Stores

Further Reading Facility Layout and Material Management in the Healthcare Industry | Thought Leadership. HMC Architects. 2019. https://hmcarchitects.com/news/facility-layout-and-material-managementin-the-healthcare-industry-2019-09-13/. Garg A, Dewan A. Chapter 36, Stores in the hospital. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 393–8. Kent AM, Kirby AE. The design of the store environment and its implications for retail image. Int Rev. Retail Distrib Consum Res. 2009;19(4):457–68. Material Handling. 2021. https://www.mhi.org/fundamentals/material-­handling. Material Handling and Storage Safety Topics. SafetyInfo. 2021. https://www.safetyinfo.com/ material-­handling-­and-­storage-­safety-­index/. Supply Chain: Health care reform. 2021. https://www.mmh.com/article/supply_chain_health_ care_reform. What works for storeroom, warehouse design Healthcare Purchasing News 2017; https:// www.hpnonline.com/sourcing-­l ogistics/article/13000939/what-­w orks-­f or-­s toreroom-­ warehouse-­design.

Engineering and Maintenance Unit

22

Any asset you develop shall, by definition, require repairs and maintenance. All medical equipment and hospital buildings require repairs and maintenance. This can be outsourced, or in-house repair and maintenance facilities can be built. Outsourcing, on the other hand, raises the expense of repair and maintenance, and it sometimes takes longer to fix an asset. As a result, it is recommended that hospitals build up in-house repair and maintenance facilities. For the upkeep and maintenance of the hospital assets, the hospital generally requires workshops such as biomedical workshops, electrical workshops, HVAC workshops, MGPS workshops, low voltage workshops, building maintenance, mechanical workshops, firefighting workshops, and automobile workshops, among others. This set of checklists shall assist the planner and designer in remembering all such issues relating to the design of workshop spaces and shall guide him/her in completing all works/activities on time. This shall assist him/her in ensuring that all tasks/activities are completed.

22.1 Location of the Workshops Workshops shall be located away from the hospital’s general circulation and clinical areas. Unauthorized individuals shall be denied access to this area. Areas such as the basement, which would otherwise be unavailable to clinical departments, shall be used for workshops. The location of the workshops shall allow for easy material shifting and the approachability of small vehicles. Vertical lifts shall be installed in the workshops. All other workshops, except for the biomedical workshop and the low voltage workshop, can be placed outside the main hospital building. This can be done in temporary construction or the main hospital’s annexure building.

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9_22

647

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22  Engineering and Maintenance Unit

22.2 Types of Maintenance Workshops To carry out the aforementioned repairs and maintenance, several workshops are required. Different workshops are created and planned based on the volume of work or the frequency of repairs and maintenance. In all the hospital setups, it is not necessary to provide all the workshops separately. But depending on the burden on the workshops, few of them can be grouped. The following are some of the workshops that shall be provided: 1. Biomedical Workshop This is used at the hospital for the repair and maintenance of biomedical equipment such as ventilators, X-ray machines, lab instruments, vital monitors, ultrasounds, defibrillators, and other medical equipment. 2. Electrical Workshop This is used to repair and maintain electrical supplies, switches, sockets, electric motors, MCB & DB boxes, UPS, and other electrical equipment. This workshop shall also assist the biomedical workshop in repairing and maintaining the electrical components of biomedical equipment. 3. HVAC Workshop This is utilized to repair and maintain the air conditioning, cold rooms, and refrigerated devices such as the mortuary cabinet, refrigerators, and deep freezers. 4. MGPS Workshop This is where the hospital’s medical gases, including the manifold room, pump room, and liquid oxygen plant, are repaired and maintained. 5. Low Voltage Workshop This is utilized to repair and maintain the building’s low voltage services, such as CCTV, IT network, computer systems, audio-visual systems, and internet and Wi-Fi services. 6. Building Maintenance This is used for civil construction, plumbing, painting, woodworking, steel and aluminium construction, welding, and mild steel construction. A unified building workshop or separate workshops might be designed depending on the workload and size of the project. As previously indicated, if only one workshop is intended, different divisions for each service can be developed. 7. Mechanical Workshop This is used for the repair and maintenance of mechanical machineries such as elevators, generators, pumps, and mechanical medical equipment. 8. Firefighting Workshop This is used to repair and maintain the hospital’s firefighting services. Depending on the size of the hospital, either a separate workshop or one combined with the building maintenance workshop can be designed. 9. Automobile Workshop If the hospital has a vehicle fleet, an automobile workshop can be provided in-house.

649

22.3 Infrastructure

22.3 Infrastructure 22.3.1 Engineering and Maintenance Unit See Table 22.1. The size of the workshop shall be determined by the number of workshops, the nature of the services provided, and the workload. There is no set standard for the size of these workshops, but the size of the workshop shall be determined by the user. Based on our experience, we recommend the following store sizes: Workshop type Biomedical workshop Electrical workshop HVAC workshop MGPS workshop Low voltage workshop Building maintenance Mechanical workshop Firefighting workshop Automobile workshop

Size of the workshop room 9144 mm × 6096 mm 6096 mm × 6096 mm 9144 mm × 6096 mm 6096 mm × 4572 mm 6096 mm × 4572 mm 30,480 mm × 15,240 mm 12,192 mm × 6096 mm 6096 mm × 4572 mm 30,480 mm × 15,240 mm with service duct

Table 22.1  Engineering and maintenance units of the hospital

Activity The following spaces shall be provided for workshops of Medical equipment Electrical services Plumbing services HVAC services MGPS services IT/CCTV/low voltage services Firefighting services Mechanical equipment Building including Civil repairs Painting Wooden works Steel works Aluminium works Landscape works Automobile workshop

Status of works Start End In Not date date Complete progress started

::::::::::::::::-

Responsible person

Remarks

650

22  Engineering and Maintenance Unit

The workshop door shall preferably be flush doors made of wood. As an alternative, aluminium doors can be used. MS steel doors, on the other hand, are not recommended because they rust and look bad. The unobstructed width of the doors shall not be less than 1829 mm. A door closer and stopper shall be installed on the door. The door shall be able to be locked from both the inside and outside. The window shall be as large as possible and equipped with tinted glass, possibly double vacuum glass. Curtains or vanishing blinds shall be used to cover the windows. The workshop flooring shall be stable enough to withstand a heavy load of material. On the other hand, it shall be visually appealing, and clean. The flooring options include marble, hard stone, or heavy-duty tiles.

22.3.2 Utility Areas See Table 22.2.

22.3.2.1 Workshop In-charge Room The workshop manager shall have his/her own chamber. This chamber shall be either attached to the workshop premises or close to the workshop. Depending on the needs, one or more rooms may be provided for various workshops-in-charge. Some hospitals choose to separate each sort of workshop. This room’s measurements shall be roughly 4267 mm × 3658 mm, although they can be expanded or decreased depending on the needs. 22.3.2.2 Workshop Engineers Room Rooms are not required for engineers and assistant engineers, but they shall have access to a hall with multiple desks/workstations. Table 22.2  Utility areas in engineering and maintenance units of the hospital

Activity The following spaces shall be provided for workshops of Workshop in-charge room Workshop engineers room Staff toilet Receiving counter Issuing counter

Status of works Start End In Not date date Complete progress started

:::::-

Responsible person

Remarks

22.4  Services, Facilities, Equipment, Tools, and Instruments

651

22.3.2.3 Staff Toilets There shall be separate toilets for men and women. Toilets, urinals, and washbasins are required in the restrooms. A bathing facility can also be provided if necessary. 22.3.2.4 Receiving/Issue Counter A receiving and issuing counter shall be placed near the workshop’s front door. The user shall submit the item to be fixed at this counter, and the item shall be returned to the user at the same counter following repairs. There shall be ample room outside the counter for the user to sit and for parking trolleys carrying items.

22.4 Services, Facilities, Equipment, Tools, and Instruments 22.4.1 Workshops See Table 22.3. Furniture in the Workshop The following furniture shall be provided in the workshop rooms: 1. Racks with slotted angles. Table 22.3  Engineering and maintenance workshops of the hospital

Activity Each workshop shall have Slotted angle racks. Heavy-duty racks made out of stainless steel or mild steel with proper shelves Wall-fixed cupboard with locking facility High-raised chairs for countertop working Office table Office chairs Visitor chair Countertops, cupboards, and drawers Required electrical points: Other communication points

Status of works Start End In Not Responsible date date Complete progress started person Remarks

::-

::::::::-

652

22  Engineering and Maintenance Unit

2. Heavy-duty racks with proper shelves made of stainless steel or mild steel. The shelves shall be of varying heights to accommodate a variety of materials. Depending on the requirements, it can range in height from 229 to 610 mm. 3. Wall-mounted cabinet with locking mechanism. 4. For working at a counter, use high-rise chairs. 5. The workshop keeper’s office table. 6. Chairs for the workplace. 7. Chair for visitors. Electrical Points 1. The main switchboard at the entrance wall (other than the wall on which the door shall open) controls the room’s fan and lights, in addition to one 5  Amp switch/socket. 2. The air conditioning control button controls the temperature. 3. To aid in the testing of things, charging of machinery, and other miscellaneous applications, a sufficient electrical point with 6  Amp switch sockets shall be placed on the walls above the workshop’s working counter. If required, 16 Amp switches/sockets can be provided. The workshops shall also have proper arrangements for the IT network, CCTV surveillance, and air conditioning. Other Communication Points in the Room The following communication points shall be provided near the office table of the workshop in-charge: 1. RJ 45 point for networking of computer 2. RJ 11 for intercom and extension line Lighting in the Workshops Lighting shall be carefully planned for both general illumination and specific tasks. The following factors shall be considered when finalizing the lighting plan for the workshops. 1. The lights shall not be too bright or too dim. Proper lumens shall be planned following the standards. 2. LED lighting is always recommended due to its long life and low energy consumption. 3. The lights in the hall, particularly the working countertop, shall be distributed evenly. 4. Ceiling flush-mounted lights shall be fitted if the workshop has a false ceiling. However, if the false ceiling is not available, surface-mounted ceiling lights can be used. 5. Avoid using wall lights because they are ineffective.

22.4  Services, Facilities, Equipment, Tools, and Instruments

653

6. Incandescent and halogen light sources shall be avoided to avoid burns. 7. The workshop shall have an emergency battery-powered light. Air Conditioning Workshops shall be equipped with air conditioners if necessary. The system shall be linked to the central HVAC system, with separate AHUs for the workshops. Ducts can be installed in the stores and connected to the AHU.  The temperature in the workshops shall be between 18 and 24 °C, with a relative humidity of 45–50%.

22.4.2 Workshop In-charge Room See Table 22.4. The workshop in-charge rooms shall be provided with the office table, office chairs, and visitors chairs. An adequate arrangement shall be made for cabinets, drawers, and racks for smooth working. The rooms shall also have proper arrangements for electrical points, intercom connection, IT network, CCTV surveillance, and air conditioning.

22.4.3 Workshop Engineer Room See Table 22.5. Workshop engineers shall be provided with a hall with multiple desks/ workstations. Table 22.4  Workshop in-charge room in engineering and maintenance units

Activity Office table Office chairs Visitors chairs Cabinets, drawers, and racks Required electrical points Intercom connection IT network CCTV surveillance Air conditioning

Start date :::::::::-

End date

Status of works In Not Complete progress started

Responsible person

Remarks

654

22  Engineering and Maintenance Unit

Table 22.5  Workshop engineer room in engineering and maintenance units

Activity Office table Office chairs Visitors chairs Cabinets, drawers, and racks Required electrical points Intercom connection IT Network CCTV surveillance Air conditioning

Start date

End date

Status of works In Not Complete progress started

Responsible person

Remarks

:::::::::-

Table 22.6  Receiving/issue counter in engineering and maintenance units

Activity Counter at the entry of the store Separate enclosure for receiving goods Computer with printer connected to the network of the hospital

Status of works Start End In Not date date Complete progress started

Responsible person

Remarks

:::-

For a smooth working environment, each workstation shall have an adequate arrangement of cabinets, drawers, and racks. Each workstation shall have adequate electrical and communication connections, and the hall shall have air conditioning.

22.4.4 Receiving Area/Issue Counter See Table 22.6. Furniture-wise, the receiving and issuing areas shall be provided with enough racks and shelves for storage of the material that has been received from the hospital for repairs and also the material which is ready for issuing to the hospital. For official work, an office table and office chairs shall be provided. The area or enclosure shall be locked, with personnel access restricted. The receiving area shall have a workstation that is properly connected to the network.

Further Reading

655

The PC shall be linked to the UPS power supply. Apart from this, the computer accessories like printers, scanners, and barcode scanners and barcode printers shall be provided. The receiving and issuing areas shall be fully air-conditioned and have fully controlled temperature, humidity, and air exchanges. Air quality shall be always adequate and secure. The temperature of the pharmacy shall be between 18 and 22 °C.

Further Reading Bronzino JD, editor. Chapter 6: facilities management and design. In: Management of Medical Technology. Butterworth-Heinemann; 1992. p.  187–242. https://www.sciencedirect.com/ science/article/pii/B9780750692526500138 Garg A, Dewan A. Chapter 37, Engineering and maintenance unit. In: Manual of hospital planning and designing for medical administrators, architects, and planners. India: Springer Singapore; 2022. p. 399–403. Olanrewaju A, Fang WW, Tan SY. Hospital building maintenance management model. Int. J Eng Technol. 2018;7(2.29):747–53 Singh M, Patnaik S, Srivastava P, Satia H, Singh M. Planning and designing of clinical engineering Department in a Hospital. Int J Res Found Hosp Healthc Adm. 2015;3:129–34. WBDG | WBDG - Whole Building Design Guide. 2021. https://www.wbdg.org/.

Glossary

°F  Degrees Fahrenheit 3D  3 Dimensional ABP  Ambulatory blood pressure AC  Air conditioning ACH OA  Air changes per hour—outdoor air ACH SA  Air changes per hour—smart air ACT  Activated clotting time ADT  Admission, transfer, discharge AEP  Auditory evoked potential AHU  Air handling unit AMC  Annual maintenance contract Amp  Amperes APC  Argon plasma coagulation ARD  Automatic rescue device ATM  Automated teller machine AV  Audio-video BEP  Break-even point BAC  Blood alcohol concentration BOD  Bio-oxygen demand BP  Blood pressure BSC  Bio-safety cabinet BSL  Bio-safety lab Cat  Category Cath Lab  Coronary catheterization laboratory CAV  Constant air volume CCTV  Closed circuit television system CD  Compact disk cd/m2  Candela per square metre CEO  Chief executive officer CFM  Cubic feet per minute CIC  Circulating immune complexes

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 A. Garg, Monitoring Tools for Setting up The Hospital Project, https://doi.org/10.1007/978-981-99-6663-9

657

658

CMC  Comprehensive maintenance contract CNS  Central nursing station CO2  Carbon dioxide COPD  Chronic obstructive pulmonary disease CPAP  Continuous positive airway pressure CR  Computerized radiography CRRT  Continuous renal replacement therapy CSSD  Central Sterile Services Department CT  Computerized tomography CTG  Cardiotocograph CTVS  Cardiothoracic and vascular surgery CUSA  Cavitron ultrasonic surgical aspirator D&C  Dilation and curettage DG  Diesel generator DSCR  Debt service coverage ratio dBA  Decibel Derma  Dermatology DEXA  Dual-energy X-ray absorptiometry dia  Diameter DICOM  Digital imaging and communications DLCO  Diffusing capacity of the lungs for carbon monoxide DNA  Deoxyribonucleic acid DOT  Directly observed treatment DPR  Detailed project report DR  Digital radiography DSA  Digital subtraction angiography DSE  Dobutamine stress echocardiography DVD  Digital video disc or digital versatile disc DVR  Digital video recorder DVT  Deep vein thrombosis DX  Direct expansion e.g.  For example EBB  Earth bonding bar EBUS  Endobronchial ultrasound ECG  Electrocardiograph ECHS  Ex-Servicemen Contributory Health Scheme ECI  Extracorporeal immunoadsorption ECM  Electronically commutated motors ECT  Electroconvulsive therapy EDA  Electrodermal activity EEG  Electroencephalogram EGG  Electroglottograph ELISA  Enzyme-linked immunosorbent assay ELV  Extra-low voltage

Glossary

Glossary

EMG  Electromyography EMO  Emergency medical officer EMR  Electronic medical record ENG  Electronystagmography ENT  Ear, nose, throat EP  Electrophysiology EPABX  Electronic Private Automatic Branch Exchange Epm  Unverricht–Lundborg disease EPS  Electrophysiology studies EPS  Earnings per share ERCP  Endoscopic retrograde cholangiopancreatography ESI  Employees’ State Insurance ESU  Electrosurgical unit ESW  Extracorporeal shock wave ESWL  Extracorporeal shock wave lithotripsy ETO  Ethylene oxide ETP  Effluent treatment plant EUS  Endoscopic ultrasound FAME  Fatty acid methyl ester FAR  Floor area ratio FCC  Fire command centre FCU  Fan coil unit FeNO  Fractional exhaled nitric oxide FFP  Fresh frozen plasma FPI  Fins per inch FPM  Feet per minute FRLS  Fire-retard low smoke FRP  Fibre-reinforced plastic FSI  Floor space index ft.  Feet GI  Galvanized iron GI  Gastrointestinal Gastro  Gastroenterology GC  Gas chromatograph GC-VUV  Gas chromatography-vacuum ultraviolet spectroscopy GERD  Gastroesophageal reflux disease GRN  Goods received note Gynae  Gynaecology HR  Human resources HDD  Hard disk drive HDMI  High-definition multimedia interface HDU  High-dependency unit HEPA  High-efficiency particulate air HFNC  High-flow nasal cannula

659

660

HIS  Health information system HIV  Human immunodeficiency virus HL7  Health Level Seven HMS  Hospital management system HOD  Head of department HP  High pressure HRC  High rupture capacity HRUS  High-resolution ultrasonography HT  High tension HVAC  Heating ventilation and air conditioning IABP  Intra-aortic balloon pump IBMS  Integrated building management system ICCU  Intensive cardiac care unit ICD  International Classification of Diseases ICRA  Investment Information and Credit Rating Agency ICT  Information and communication technologies ICTC  Integrated Counselling and Testing Centres ICU  Intensive care unit ID  Inner diameter ID  Identity document IEEE  Institute of Electrical and Electronics Engineers IETF  Internet Engineering Task Force IgG  Immunoglobulin IITV  Image-intensifying television IOL  Intraocular lens IOP  Intraocular pressure IP  Internet protocol IPD  Inpatient department IPL  Intense pulsed light IPS  Isolated power supply IPTV  Internet protocol television IRDS  Infant respiratory distress syndrome IRR  Internal rate of return ISMS  Integrated security management system IT  Information technology IUP  Intrauterine pressure IV  Intravenous IVF  In vitro fertilization JCI  Joint Commission International kPa  Kilopascal KV  Kilovolt KVA  Kilovolt ampere kW  Kilowatt L/min  Litres per minute

Glossary

Glossary

LCD  Liquid crystal display LDB  Lighting distribution board LDR  Labour, delivery, and resuscitation LINAC  Linear accelerator LIPA  Line probe assay LT  Low tension Ltr.  Litre Lux  Unit of illumination mA  Mill ampere MA  Medical air MCB  Miniature circuit breaker MCCB  Moulded case circuit breaker MDB  Main distribution board MEP  Mechanical, electrical, and plumbing MEP  Maximal expiratory pressure MERV  Minimum efficiency reporting value MGIT 960  Mycobacteria growth indicator tube MGPS  Medical gas pipeline system MHz  Megahertz MICU  Medical intensive care unit MIP  Maximal inspiratory pressure MIS  Management information system MLC  Medico-legal cases mm  Millimetre MRD  Medical record department MRI  Magnetic resonance imaging MRL  Machine room less MS  Mild steel NPBT  Net profit before tax N2  Nitrogen N2o  Nitrous oxide NABH  National Accreditation Board for Hospitals NCV  Nerve conduction velocity NFPA  National Fire Protection Association NIBP  Non-invasive blood pressure Ni-Cd  Nickel-cadmium NICU  Neonatal intensive care unit OT  Operation theatre O2  Oxygen OAE  Otoacoustic emissions OBS  Obstetrics OCT  Optical coherence tomography OD  Outer diameter OLTC  On-load tap changer

661

662

Onco  Oncology OPD  Outpatient department OPG  Orthopantomogram OR  Operating room Ortho  Orthopaedic PA  Personal assistant PA  Public address PAC  Pre-anaesthetic check-up PACS  Picture archiving and communication system PC  Personal computer PCNL  Percutaneous nephrolithotomy PDB  Power distribution board PE  Premature ejaculation Paedia  Paediatrics PERT  Program evaluation review technique PET/CT  Nuclear positron emission computed tomography PET/MRI  Nuclear positron emission magnetic resonance imaging PF  Provident fund PFT  Pulmonary function test PICU  Paediatric intensive care unit PLC  Programmable logic control PNS  Peripheral nerve stimulation POP  Plaster of Paris PPE  Personal protective equipment PPM  Parts per million PPS  Primary power supply PRD  Pressure relief damper PSG  Polysomnography PTS  Pneumatic tube system PTZ  Pan tilt zoom PUVA  Psoralen and ultraviolet A PVC  Polyvinyl chloride PVR  Profit volume ratio PWS  Patient warming system RCC  Reinforced cement concrete RCCB  Residual current circuit breaker RF  Radio frequency RFID  Radio frequency identification RH  Relative humidity RNA  Ribonucleic acid RO  Reverse osmosis ROI  Return on investment RONW  Return on net worth RR  Respiration rate

Glossary

Glossary

RT  Radiation therapy RT-PCR  Real-time polymerase chain reaction SS  Stainless steel SEP  Somatosensory evoked potential SICU  Surgical intensive care unit SMDB  Sub-main distribution board SMS  Short message service SOP  Standard operating procedure SOW  Scope of work SPD  Surge protection device SPECT/CT  Single photon emission computerized tomography SPO2  Unit of measuring oxygen saturation SPR  Skin potential response SPS  Secondary power supply Sq. Ft.  Square feet Sq. Mtr  Square meter SRS  Stereotactic radio surgery STP  Sewerage treatment plant TB  Tuberculosis TBNA  Transbronchial needle aspiration TCFR  Techno-Commercial Feasibility Report TDS  Tax deducted at source TDS  Total dissolved solid TEE  Transesophageal echocardiography TMS  Transcranial magnetic stimulation TMT  Treadmill test TPA  Third-party administrator TPN  Triple pole and neutral TPS  Tertiary power supply TSSU  Theatre sterile supply unit TT lab  Transmissible tests TV  Television UGI  Upper gastrointestinal UHID  Unique Health Identification UPS  Uninterrupted power supply UPVC  Unplasticized polyvinyl chloride USB  Universal serial bus UV  Ultraviolet VAV  Variable air volume VCB  Vacuum circuit breaker VCD  Vacuum constriction device VED  Vital, essential, desirable VEEG  Video electroencephalography VFD  Variable frequency device

663

664

VIE  Vacuum insulated evaporator VIP  Very important person VLC  Visible light communications VNG  Videonystagmography VRLA  Valve-regulated sealed lead acid WC  Water closet WC  Water column WDV  Written-down value WTP  Water treatment plant XLPE  Cross-linked polyethylene

Glossary