Professional Documents
Culture Documents
TABLE OF CONTENTS
1. Introduction.2
2. Need and Scope of the Study..2
3. Justification of the Study3
4. Aims and Objectives3
5. Methodology.3
6. Areas Requiring Distinct Services..4
7. Factors Impacting on the Services..5
8. Electrical Services....6
9. Water Supply and Sanitary Services12
10. Communication System16
11. Environmental Control.21
12. Biomedical Engineering23
13. Transportation...25
14. Case Study-Apollo Hospital, Ranchi.30
15. Inferences33
Bibliography.34
FACLTY OF ARCHITECTURE & EKISTICS (JAMIA MILLIA ISLAMIA)
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1. INTRODUCTION
Water Supply & Sanitary and Electrical Services is a very important aspect to be taken into
consideration while designing a Hospital. The Administration of any hospital always makes it a
point to keep these services in mind before planning of making a hospital.
Electrical energy is an essential source of power, the pivot around which almost every services in
a hospital revolves, and the system is becoming increasingly more demanding, complex and
crucial.
Water is one of the critical utilities in a hospital, yet is often taken for granted. Much of the
hospitals engineering services is concerned with installing, repairing the systems that delivers
utilities and services water being one of them in a functional continuing and safe manner.
Major services required in a Hospital Building are:
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Aims
To the study the planning, function, location etc. of Electrical, Water Supply and Other
Services in a Hospital Building.
Objectives
5. METHODOLOGY
Study and identification of Electrical, Water Supply and Other such Services in a Hospital
Building.
Study of functions of these areas by discussions with experts of the field and if possible users
of such areas with its proper planning and design in the Hospital.
Case Studies of some hospitals in order to find out numbers of these services provided in
them their location, planning, space requirements etc.
Compilation of the data collected by the above studies.
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Nuclear medicine
Laboratories
Mortuary
Laundry
Incinerator
AHU rooms
Electrical substation
Boiler room
Fuel storage
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Site Location, Locality, Available Resources and their Conservation. Examples: Use of
natural topography facilitates drainage system and water recycling. Rainwater can be
harnessed by making use of rainwater harvesting. Site contours can help the drainage
and sewerage system. Local weather conditions like rainfall, humidity and prevailing
wind direction can help reduce the running cost.
Technology. Intelligence Building Management System (IBMS) provides live data and
reports that can be used to refine operation, check system performance review and
planning of maintenance. It can be used in energy savings. Security can be integrated
into this system.
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8. ELECTRICAL SERVICES
Overview
Electrical energy is an essential source of power, the pivot around which almost every function
of the hospital revolves, and the system is becoming increasingly more demanding, complex and
crucial. This is partly because of the specialized medical and electronic equipment used for
diagnosis, treatment and rehabilitation of patients and partly because of the large load of power
needed in today's hospitals. In the electrical system, the main concern of the design team and the
hospital engineer is the power distribution system - the electrical lifeline of the hospital. There
are also other concerns like an adequate and dependable supply. No less important, which many
owners do not take seriously, are the electrical equipment and fixtures which should be of high
quality. They should conform to safety codes and regulations.
There is a need to create an awareness of the energy costs and the need for preservation both
within and outside the hospital largely because of sharply increasing prices and scarcity of
energy resources. Both are a global phenomenon. A two-fold message seems to have evolved
from this. It is important not only to conserve present resources but also to develop and use
alternative sources.
In essence, the hospital's use of electricity is similar in purpose to that of residential homes and
other facilities. However, some special applications exist. The basic functions that consume
electricity and resources are:
Environmental control including heating, ventilating and air-conditioning.
Heating and cooling water.
Lighting
Cooking, refrigerating and freezing food
Operating all types of medical, sterilization, incineration, laundry, etc. equipment.
The high dependability of electrical service is made possible by using high quality
equipment, careful design, good construction and efficient operation by quality engineers.
Emphasis should be on the design of a system that will operate economically and provide
for easy maintenance rather than the least possible installation cost.
The electrical system is one of the major costs of operation and many hospitals find
themselves saddled with a heavy financial burden due to an inefficient system.
There should be an emergency generator to supply power to essential and critical areas of
the hospital immediately if normal electrical service is interrupted. Under certain
circumstances, power interruption of even 10 seconds may not be permissible. In such
cases, an uninterruptible power supply (UPS) is the only answer.
Design
In designing a hospital electrical power system, the major elements that should receive
serious consideration are safety, reliability, cost, voltage quality and ease of maintenance.
FACLTY OF ARCHITECTURE & EKISTICS (JAMIA MILLIA ISLAMIA)
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Safety
Safety encompasses protection of life and property, and continuity of hospital services.
Protection of human life of patients, visitors and personnel-is of paramount importance.
Safety of equipment is also essential. A faulty electrical system devoid of adequate
safeguards may cause extensive damage to essential equipment and machinery. This in
turn may cause loss of service and a delayed return to normal operation because of repairs.
Economics
It is necessary to consider the cost of the total system and not just the components. Cost of
installation and cost of operation must be balanced. So also, cost and reliability. Cost of
equipment is a major percentage of the initial cost of installation. Cost of operation is
frequently not given adequate consideration with all attention focused on equipment and
installation.
Voltage
Stability of voltage is very important in the hospital power supply. It reflects the quality of
electric power. With the increasing use of automated and electronic equipment in the
hospital, voltage regulation under normal operation and abnormal changes in load merit
special attention. Hospitals will do well to consider additional investment in special
devices for critical areas vulnerable to voltage fluctuations. This may prove more
economical in the long run.
Maintenance
A proper maintenance of the electrical system is necessary for its safety and reliability.
The system should be designed and streamlined to make maintenance easy and safe, and to
enable routine maintenance and inspection without shutting down the essential hospital
supply. For this, use of a circuit arrangement providing an alternate source of power
should be arranged.
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Planning
The hospital electrical system calls for careful planning. Consideration should be
given to immediate as well as future needs both in terms of expansion and increased
workload. Early in the planning stage, the engineer, the consultant or whoever is in
charge of planning should closely work with the architect on the one hand and the
hospital administrator, medical and other hospital staff on the other. Electric load
estimates for a 200-bed state-of-the-art hospital is given at the end of this section.
The views of the hospital staff should be given due consideration because they are the
ones who operate and maintain equipment and facilities of the system. The medical
staff should be consulted on crucial, specialized medical areas and the administrative
staff, on the other areas such as vertical transportation and computer network. A third
group whose view should be considered is the engineering and maintenance staff
charged with keeping the system going.
The power distribution system should be adequate to meet the service reliability
requirements of the hospital and yet it should be made as economical as possible. This
requires the power system engineer to plan the distribution system on an all-inclusive
basis. To do this effectively, he must constantly search for facts on which to base his
decisions.
The right decisions on setting up the substation, electrical H.T. and L.T. panels, diesel
generator room, load centres, etc. save not only installation but also operational costs.
Finally, the engineer should be conversant with various statutory regulations, codes and
standards applicable to hospitals.
Design Procedures
In planning and designing an electrical system, the engineer should observe the following
basic steps and procedures:
Work out the actual connected load and the demand load for the present and future
Develop a site plan of the hospital plant showing the size and location of present and
future loads
Work out the essential loads and then determine the capacity of diesel generator (D.G.)
sets
Establish voltage levels throughout the hospital plant
Determine the size, number and location of power centres
Determine the service reliability, select circuit arrangements required in each hospital
area, and design the circuits to provide reliability
Provide adequate power supply points to the various pieces of equipment
Provide protection against lightning, earth leakage current, short circuit current, under
voltage and overvoltage
Observe special precautions required for hospital safety
Consider special lighting design for patient rooms and other areas
Provide necessary specifications. Specifications supplement the working drawing and
furnish the information not shown in them by describing equipment and its functions.
They also prescribe quality of materials and workmanship required under the contract.
They tie the entire job together.
FACLTY OF ARCHITECTURE & EKISTICS (JAMIA MILLIA ISLAMIA)
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Emergency Generators
Given the erratic record of public utility supply companies in our country, hospitals must
expect to go without normal source of power frequently. However, hospitals are especially
vulnerable to even a short-term loss of electrical current because patient care depends on an
uninterrupted power supply. Recognizing this, hospitals do provide for an alternate
(emergency) source of power to serve essential portions of the hospital's distribution
system. This emergency power should be reliable and is generally used for lighting and
operating essential equipment.
The usual source of power used in hospital for emergencies is the generator that is driven by an
internal combustion engine operating on diesel oil.
The components of the alternate electrical system are the same as those in the normal distribution
system except for the alternate source of supply and transfer switches. The engineer must
determine the load to be placed on the system.
The load can be transferred from the normal source of power to the emergency source either
manually or automatically. The automatic transfer switch should be capable of transferring the
load within 10 seconds of the power failure.
However, in normal practice it may take longer. Manual operation may take a few minutes
depending on where the operator is and how long it takes for him to reach the generator site.
At the planning and design stage, the engineer should specify which loads have to be transferred
automatically and which manually, depending on the urgency or criticality of the function. For
example, all lights may be connected to the automatic transfer load because patients and visitors
often panic in the dark.
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Page 10
1200 KW
General Lighting
320 KW
350 KW
300 KW
175 KW
150 KW
CSSD
200 KW
Surgical Suites (4 to 5)
150 KW
Servers, PCs
100 KW
125 KW
250 KW
180 KW
Miscellaneous
100 KW
Total
3600 KW
4500 KVA at 0.8 power factor
The total connected load is approximately 3600 KW (4500 KVA) and maximum demand 2400
KW or 3000 KVA.
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Bore wells
Tanker supply
Recycled water. The treated waste water from basin, shower, laundry, etc. can be used
in W.C. flushing, landscaping, etc.
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=
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Design Elements
In designing the hospital water supply system, the major elements that merit
attention are:
Continuous and reliable supply of water
Quality of water
Proper distribution network
Cost
Ease of maintenance and operation
Quality of Water
The quality of water supplied to the hospital affects virtually every aspect of
operation. It is, therefore, essential that suitable water of microbiological quality is
provided for drinking, laboratory procedures and solutions used in medical and
surgical treatment. Chemically acceptable water is essential for the operation of
equipment, laboratory tests and dietary purposes. A regular surveillance
programme
should be instituted. This normally includes evaluating the source of supply,
equipment and distribution system, and routine microbial and chemical analyses of
water. The engineer should have samples of water collected routinely and have
them sent for analysis. In addition to potability, water should be tested for
hardness and iron. Hard water is detrimental to equipment and increases operating
costs.
Routine water processing programmes carried out in hospitals include chemical
treatment of water, deionization, distillation, filtration and sterilization. The
engineer should be familiar with hospital operations and know where specially
treated, deionised or distilled water is used and when it is necessary to provide it.
He should realize that deionising process removes only the ionisable contaminants
and not the bacteria or other organics and in organics, and that the deionised water
often becomes
heavily contaminated with bacteria that grow on the resins. Distillation provides
water of the highest purity. However, distilled water is not sterile. Sterile water is
produced by processing water in sterilizers or autoclaves. Hemodialysis requires
specially treated water.
The quality of water depends largely on two factors:
Quality of raw water supplied to the hospital, and
Level of quality required for various purposes.
Since there are varied sources of raw water, it is generally not possible to control its
quality. It is thus essential to first analyse the quality of water obtained from various
FACLTY OF ARCHITECTURE & EKISTICS (JAMIA MILLIA ISLAMIA)
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Distribution Network
For the proper utilization of water, the distribution system should be designed taking
into consideration the pressure and quantum of water required at various outlets. Due
care must be taken while selecting distribution equipment and pipes because of the risk
of contamination and corrosion. The water supply distribution system is often designed
using the hydro pneumatic system for achieving a uniform pressure at all the outlet
points.
Great care should be exercised in protecting the hospital's potable water against
contamination that can result from a poorly designed and installed plumbing system.
The potable water supply system should not be connected with other piping systems,
nor should it be connected with fixtures having submerged inlets. This could cause
contamination.
Planning
The hospital water supply and sanitary system calls for a high degree of planning. The
design should take into consideration not only the present needs but also future
requirements.
There should be adequate provision for future expansion. The location and size of plant
rooms, service ducts, etc. play a very important role in designing an economical and
convenient system. Attention should be paid to the maintenance and operation of the
system. In large hospitals, the service floor concept may be considered for running all
sanitary and water supply lines horizontally below the toilets and terminate them in a
common vertical duct. Careful interaction with the architect and other service engineers
is necessary before finalizing the layout for the water supply and sanitary system.
Steam
Steam is required in the kitchen, laundry, CSSD and other sterilization areas. It is
generated at 8-10 kg/sq. cm pressure using oil-fired steam boilers. Various areas will
FACLTY OF ARCHITECTURE & EKISTICS (JAMIA MILLIA ISLAMIA)
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require steam at different pressures. Therefore, pressure reducing stations with headers
should be provided to tap the required steam. Provision has to be made to recover the
condensate and conserve waste heat. The steam boilers should be located next to the
hot water boilers. If the steam requirement is not much, it is possible to have only one
combined steam boiler supplying both steam and hot water.
Drainage System
The drainage system of the hospital should be simple, effective, economical and
serviceable. It should be designed keeping in view the kind of septic and toxic waste
that needs to be effectively disposed of. It is advisable to adopt a double stack system
in which separate stacks are provided to collect waste and soil from the toilets and
'other areas. Pipelines should run with sufficient slopes so that sewage could be
conveyed to inspection chambers by gravity.
Provision should also be made to terminate the collected sewage in the municipal sewer
line via a battery of inspection chambers or manholes. Where it is not possible to do so,
alternate arrangements like sewage treatment plants should be made. It should be
ensured that the effluents from the treatment plants are further treated to acceptable
standards before their utilization in landscaping or recirculation.
For sewage disposal, it is preferable to use PVC pipes as they are easy to install and
repair, and also allow for smooth flow of sewage.
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Telephone System
Advanced telecommunication technology today offers vastly improved and
sophisticated telephone equipment with never-before features and capabilities.
Advanced systems are now available in which a single instrument acts as a multibutton phone. Most telephone systems have flexible circuits that allow telephone calls
to be transferred to another area as, for example, to the admitting office. In smaller
hospitals, this eliminates the need for a telephone operator during the night. Some other
new features are: Touchtone dialling, call pick up, call forwarding, conference
capability, transferability of incoming and outgoing calls and direct dialling.
Car telephone, which hasn't made a big foray into the Indian scene yet, is expected to
have a major impact on communications for hospitals. Made accessible by use of
cellular technology, car telephone will play a big role in contacting doctors who are on
the move particularly because the use of a mobile phone is prohibited while driving.
Within the hospital, interconnecting telephone should be provided for all departments
and sections including operating rooms, ICUs, nurses' stations, offices, maintenance,
housekeeping and elevators. A telephone service outlet should be provided midway in
the elevator shaft to connect the telephone in the elevator. All intercom telephones
FACLTY OF ARCHITECTURE & EKISTICS (JAMIA MILLIA ISLAMIA)
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should be dial type that permits intercommunication without calling the hospital
switchboard.
Many hospitals provide telephones in patient rooms. Patients can make long-distance
calls directly with the facility of remote metering or transmission to a computer so that
automatic charging of the concerned patient is accomplished. As far as possible,
telephones should be installed in patient rooms, especially in private and special rooms.
The practice of installing jacks in all patient rooms for use of plug-in telephones is now
considered obsolete. However, jacks may be provided in multi-bed general wards
(where generally phones are not provided) for the use of sick patients who cannot come
to the nursing station to receive or make a call. Public (pay) telephones should be
provided at convenient locations for outpatients, visitors and staff, particularly in the
outpatient area, inpatient areas, emergency department, near the labour-delivery suites
and in the fathers' waiting room, if there is one. Pay phones leave hospital switchboard
free for patient care and official use. In addition to public telephones, there should be a
convenient room where visitors, outpatients and hospital personnel can make assisted
STD and ISD calls. At the construction stage, conduits should be provided to facilitate
installation of telephones wherever necessary, keeping future needs in mind.
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Telephone Nigam Limited of New Delhi were responsible for providing the set-up and
back-up services.
The reason why one needs an ISDN line is because video images cannot be transmitted
over a normal telephone line. The images must be first converted into digital data- bits
and bytes- before they are transmitted. With the introduction of private basic telephone
networks across the country and the country itself going fibre-optic in a big way, the
application of telemedicine, telediagnosis and tele consulting opens up vast new frontiers
in the medical field. This augurs well for this country where superior medical talents
abound.
Narayana Hrudayalaya, a famous heart hospital in Bangalore, has set up a telecardiology
unit that extends teleconsultation in cardiology to far corners of the country, largely in
rural areas, where facilities have been set up. Cardiologists are available at the hospital
round-the-clock for any doctor in these remote centres to call them up for expert advice.
It is live telemed/video-audio conferencing in which reports, images and documents
relating to the treatment of the patient in question can be transferred, seen and discussed.
The hospital is in the process of setting up more centres.
Another doctor, a radiologist in Whitefield near Bangalore, started teleconsulting for
some American hospitals in what is called consultancy through teleradiology, also called
"Offshore Teleradiology"-said to be the first of its kind in India. His job is to read the
scans sent by these hospitals via internet by fax or e-rnail through a common server in
America and send his interpretations/reports back. His reports are dictated using voice
recognition software installed on his computer-another device that is becoming
increasingly popular. Verbal messages are communicated to doctors by a combination of
telephony and instant messaging. A high-speed internet line, modem, server, alternative
line, heavy duty UPS and Local Area. Network (LAN) form his infrastructure.
An added facility is net telephony. The government of India has now allowed Internet
Service Providers-to offer the net telephony that had hitherto been banned. What this
means is that personal computers (PCs) can now be used to call up phones abroad.
Without going into the technicalities, it may be mentioned that net telephony costs
substantially less because it is based on what is called "packet switching" as opposed to
"circuit-switching" of the traditional telephone network. All these advances augur well
for health care and will bring about sweeping changes in the way health care is practised
and delivered - on-line.
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director's office.
The following are the features of the advanced computerized nurse call system:
The call is registered by the patient.
The call is acknowledged by the nurse.
The call is attended to by the nurse. (Nurse switches off the call signal in the
room)
In the event of delay as programmed by the response time, the signal light
flashes.
When the delay becomes longer, the flash rate increases progressively.
The signal is both audible and visible.
There is provision for two-way voice communication between the patient and the
nurse station. This can be programmed in such a way that only the nurse can
initiate the voice communication and not the patient.
The system has the following components:
Panel in the patient room
Patient room door panel
Main nurse station panel
Monitoring panel
Computer interface
Software
Alert panel
Computer voice interface
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In the patient room panel, there is a red push button to register the call, a red indicator
light to show the call-is registered, a green indicator light to show that the nurse has
acknowledged the patient's call, and a-switch to cancel the call.
In the panel outside the patient's room, there is a red indicator to show that the patient
requires attention and a green indicator to show that the call has been acknowledged by
the nurse. When only the green indicator is lit up, it shows that the nurse is attending the
patient. This eliminates the need for more than one nurse responding to the call. The
panel is provided with a green switch for the nurse
to acknowledge the call at the door, if necessary.
At the nurses' station, the panel has a layout plan of the ward and the beds with bed
numbers, a red indicator, a green indicator and an acknowledgement switch. The panel
clearly shows which bed requires attention. The digital indicator can be added to show
the sequence of call registration. An audio beeper is provided to attract the nurse's
attention. Delay in attending to the patient results in the signal light flashing and the
beeper sound becoming faster. The monitoring panel is intended for the supervisory
staff to monitor response and improve efficiency. The management information support
software monitors the response pattern of nurses throughout the hospital during the day,
week and month.
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Infection Control
Environment control is based primarily on the science of engineering, microbiology
and sanitation. All those who are concerned with environmental control-from the chief
executive officer to the hospital engineer down to the housekeeping personnel-should
be familiar with the basic facts about microbial growth and death and the transmission
of disease.
Every hospital must establish an infection control committee to administer a hospitalwide infection control programme, and formulate and enforce polities and procedures
for infection control. These policies and procedures should cover the following:
Personnel. This includes employee health, dress code, in-service education, etc.
Isolation procedures.
Environment specimens like trash, garbage storage and collection, infectious waste, etc.
Water supply.
Maintenance of buildings, etc.
Ventilation system including air intake and outlet, air filters on air-conditioner units, etc.
Preventive maintenance.
Rodent control.
Systems control, including evaluation of systems, etc.
Radiological Health
Radiation control and safety practices in hospitals come under the mandatory
regulations of the Division of Radiological Protection (DRP) of the Bhabha Atomic
Research Centre (BARC). Radiation sources are generally of two categories: Ionizing
and non-ionizing. Examples of hospital ionizing radiation are X-rays and radioactive
FACLTY OF ARCHITECTURE & EKISTICS (JAMIA MILLIA ISLAMIA)
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isotopes." The most common non-ionizing sources are microwave and laser; the latter
is used in hospitals for diagnosis and treatment.
Radiation control measures are based on the factors of time, distance, shielding,
containment, personnel protective and monitoring devices and ventilation. Hospitals
must appreciate the problems concerning radioactive waste disposal, both liquid and
solid, and should strictly comply with the regulations.
Occupational Health
Every employee has the right to work in a safe environment. Frequently, the work place
is hazardous in spite of the mandatory safety regulations and requirements under relevant
laws. Dangers lurk in unsuspected places: While walking, on working surfaces, in the
means of egress, hazardous materials, compressed gas and air equipment, materials
handling and storage-the list is endless. It is incumbent on hospitals to do everything
reasonably possible to make the hospital environment a safe place. However, safety is
everybody's business. All employees should be made aware of it.
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Evaluating equipment and machinery. Evaluation must include, among other things,
not only the initial cost of the equipment but also its operating cost.
Organizing in-service training programmes and training for personnel in the clinical
engineering department as well as other user departments to use equipment properly.
Evaluating the need for new or replacement equipment and major repairs.
Active involvement in the activities of the hospital's safety committee and checking
safety hazards.
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productivity of its employees. When facilities are inadequate or poorly designed, much
time is wasted in extra steps and in making makeshift arrangements. A congenial
working environment influences the efficiency of employees. A pleasant and
comfortable work area creates a favourable attitude and enhances productivity.
It is difficult to establish a standard space layout for a clinical engineering laboratory for
all the hospitals. It depends on a number of factors like the size of the hospital, the
sophistication of equipment, the size and training of personnel and the extent of contract
service. Each hospital should tailor its structure and design to meet its individual
functional needs. Generally, in a small hospital where there is only one biomedical
technician, one room of 13.95 sq.metres (150 sq. ft.) = 4.57 metres x 3.71 metres (15
ft. x 10 ft.) is adequate to perform the basic functions. In a typically large layout, on one
side of the room, there is a desk with wall-mounted cabinets or bookcases above it for
reference books and catalogues. Beside it is a file cabinet for manuals and records. Next
to the cabinet are a lockable cabinet, shelves and drawers for storing test instruments,
spare parts and smaller instruments awaiting repairs. Large instruments that have come
for repair are stored at the end of the room on one side.
On the other side of the room, there are workbenches with storage drawers underneath
for tools and more spare parts. This is the main work area. The bench is 3.65 metres (12
ft.) long so that the technician can work on more than one item at a time. A large
laboratory type sink is provided at the end of the row for cleaning instruments. The
repairs area is divided into the mechanical repair area and electronics repair area. The
two are separated and provided with more cabinets for storage. There is a small secured
storeroom as well.
Irrespective of their size, all laboratories require the same facilities. The lab should be
air-conditioned because electronic instruments and spare parts are temperature-sensitive
and if they are not kept and repaired in an air-conditioned room, their operation may be
affected. The lab also requires good lighting.
There should be adequate power supply for several pieces of equipment and instruments
to be tested and operated at the same time. Both single and three-phase outlets are
required for testing various types of instruments.
Provision must be made for both hot and cold water for cleaning equipment. Some
equipment on the mechanical side may require water for operation. Besides these
facilities, the lab requires compressed air and a vacuum system-either piped or
furnished by a compressor and a vacuum pump-for cleaning equipment. Some types of
equipment require compressed air and others vacuum for operation. Certain instruments
and equipment require moisture-free cleaning which is done by using nitrogen.
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13. TRANSPORTATION
Overview
Transportation is an essential function in every hospital regardless of its size,
sophistication and means of transportation. It encompasses a wide range of activities
and areas in any hospital. Some of them are:
Inpatient escort service upon admission and discharge. Some hospitals make it
mandatory for every discharged patient to be escorted in a wheelchair to the main
entrance.
Movement of patient food, generally in trolleys or carts and through the elevators,
from the food service department to patient floors and return of used trays, dishes,
etc. to washing areas.
Some hospitals may have a transport department to operate and maintain ambulances,
vans and other vehicles. Some may have, in addition, what is called the patient
transportation or escort service. Where there is no such centralized patient escort
service, individual departments may arrange it for their patients.
The usual means of transportation of people and materials include ambulance, elevators,
wheel chairs, lifts, dumbwaiters, stairways and ramps.
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At least one hospital-type elevator should be installed when up to 59 patient beds are
located on any floor other than the main entrance floor; at least two hospital-type
elevators are needed when 60 to 200 patient beds are located on floors other than the
main entrance floor and at the least three are needed when 201 to 350 patient beds are
on floors other than the entrance floor.
Specifications
Hospital-type elevator cars should have inside dimensions that will accommodate a
patient bed, attendants and necessary equipment. It should be at least 1.52m (5'0")
wide by 2.29m (7'6") deep. The car door should have a clear opening of not less than
1.22m (4'0") wide and 2.l3m (7'0") high.
Additional elevators meant for visitors, personnel and materials handling can be of
smaller size
Every elevator should be equipped with a telephone and an alarm for use in an
emergency.
If there is a bank of elevators, at least one elevator should have dual control to
obviate the
necessity for an operator during the night or when traffic is light. This is particularly
useful in smaller hospitals.
Elevator call button and controls should be of the type that will not be activated by
heat or smoke.
As a rule, hospital elevators are slow. And there is a misconception that they should
be so. This is not true. There is no reason why they should not move as fast as those
in hotels or in commercial buildings.
Elevators are one place where people panic in case of power failure. To obviate this,
electric service and switching facilities should be arranged to permit operation of
elevators from alternate (emergency) power source in case of interruption in normal
electrical service. If it is not possible to connect all elevators to the alternate source
of power, at least one in each bank of elevators should be powered by an alternate
source.
For their proper and efficient functioning, elevators require routine maintenance and
inspection by skilled elevator mechanics with special training and experience in this field.
Elevator inspection and maintenance service should be contracted to the manufacturer or
his authorized agent, and not undertaken by in-house personnel as it is normally
considered beyond their capabilities.
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Lift
An elevator that is primarily used to move materials one or two floors is called a lift. In India,
however, the term lift is used synonymously with elevator. In this context, lifts (elevators)
are used to move all kinds of traffic and materials.
Dumbwaiters
Dumbwaiters are small lifts or elevators that are used to deliver food trays, medicines and
supplies: Before installing a: dumbwaiter, on~ should decide the purpose for its use. -One
purpose for which it is used is to deliver sterile supplies and instruments from the CSSD to
the operating rooms when these two departments are located in different floors but directly
one below the other so that the dumbwaiters open directly into the departments.
There are two types of dumbwaiters: The conventional waist-loading type and the floor
loading type. The latter permits a greater variety of use including transportation of small carts
between upper and lower floors. The cart can be rolled directly onto the platform. This
eliminates manual handling of materials. This is not possible in the waist-loading type.
Dumbwaiters can be equipped with automatic loading and unloading devices. They are
available in various sizes and capacities. One popular size is 0.836 sq. metres (9 sq. feet) of
floor size and 1.21 metres (4 feet) in height.
Large dumbwaiters can be used to transport bulky equipment like food trucks or trolleys and
laundry trucks.
When used for transporting sterile supplies from CSSD to the upper floor operating rooms,
generally twin dumbwaiters are used-one sterile and the other soiled. The sterile dumbwaiter
transports sterile instruments and supplies from the sterile area of the CSSD to the sterile
area of the surgical suite. The soiled dumbwaiter brings back soiled instruments and supplies
from the surgical suite to CSSD for reprocessing.
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This hospital has a very good electrical power back up system as it has two generators of
1000 KVA each and addition to it they also has a generator of 50 KVA as emergency
back up to be used in worst circumstances.
Electric cable has been provided from Electric Sub Station in addition to normal and
emergency one as a back up.
All critical areas like Cath Lab, MRI etc. has a direct connection from Electric Sub
Station and has not been connected with any other area.
Dedicated earthing has been provided for costly equipments separately and is not
connected to any other equipment.
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Separate M.C.B. has been provided for each department on each floor.
There is only one transformer and they do not have any back up of transformer and are
dependant on generator or D.G. set for power back up when transformer breaks down.
The electrical panels are controlled by motor instead of manual control and if the motors
burns or break down generator has to be used.
There is no back up for electrical panels, hence the power of the whole department or the
whole hospital has to be cut for servicing and the critical areas are provided a back up by
generator which is not good and is very troublesome.
There is different water supply line for each floor and this has been done to maintain the
same pressure of water in pipes everywhere and this has been done by making a ring of
the water supply line from over head water tank at terrace level and then providing
separate outlets of water supply for each floor.
They have their own bore well of sufficient capacity capoacity in the hospital and do not
depend on municipal water supply.
There is an underground water reservoir of 1.5 lacs litres of which 50 thousand litres are
always reserved for fire fighting.
An Ion exchange water filter plant has been made and all the water from the reservoir has
to pass through it before getting transferred to the over head water tank for use.
The water supply line is of G.I. which gets choked quiet often due to choking as
Jharkhand is a hilly plateau and the water is very rich in iron. Iron remover should have
been installed instead to remove the iron from the water and to prevent the pupes from
getting choked time and again or P.V.C. pipe could have been used.
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The over head water tank is of very low capacity i.e. 30 thousand liters which is very less
for a 300 bedded hospital. The reason for it is that initially it started as a 100 bedded
hospital but after gradual expansion it has become a 300 bedded now.
The drainage facility is not very proper and all the waste water whether black water or
grey water is transferred to the septic tank and from there to soak pit. This also leads to
overflowing of tanks at times. Instead only black water i.e. water from toilet should be
transferred to septic tank and water from washing and other areas i.e. grey water should
have been used for gardening and flushing after treatment.
There is no Sewage Treatment Plant in the hospital which is very unhealthy and wrong
practice but now after heavy penalties by the pollution control board and their strict
norms they have started the process of installing a Sewage Treatment Plant.
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15. INFERENCES
We should have arrangements for proper power back up like two numbers of
generators and U.P.S which will provide us with the option of double power back
up.
Separate distribution board for each department and each floor must be provided so
that there is no power disturbance in other areas if some repair work is going on in
one area.
There should be two lines of main cable so that if one blasts of breaks down we
have the other as stand by to be used in emergency.
There should be separate electrical panels for Air Conditioning, Street Light etc.
Bed head panels must be provided in critical areas like I.C.U., C.C.U, ventilator etc.
with sufficient number of plug points in order to connect any life saving or
treatment equipment as and when needed.
The sewer line must be properly covered and should never be exposed as it may
lead to the cause of some infection.
The calculation for the capacity of over head water tank must be done properly
which is 340 litres per bed per day for a hospital of up to 100 beds and 450 litres
per bed per day for hospitals with more than 100 beds.
The quality of water must be tested from time to time so that we can be aware of
the water type and we get to know immediately if there is some infection in the
water.
One third capacity of the water tank should always remain full and the over flown
water from fire tank must be filled up in the daily usage tank so that the fire tanks
always remain full for fire fighting purposes in case of any fire emergency.
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Bibliography
Website of Agency of Healthcare Research and Quality http://www.ahrq.gov/
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