Migration plan for District Trishuli Hospital Nuwakot 2016

2016
Migration Plan for District
(Trishuli) Hospital, Nuwakot
From Tents to the Pre-Fabricated Cement Structure
Prepared by:
TIMSNA DEEPAK
for
District (Trishuli) Hospital Development Committee, Nuwakot

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CHAPTER 1: Current Situation of District Hospital
Background
The District (Trishuli) Hospital often called Trishuli Hospital is a 50-beded autonomous hospital situated
in the District Headquarter- Bidur of Nuwakot. It is managed by a Hospital Development Committee. It
started its services as a health center in 2032 initially to the employees of Nepal Electricity Authority and
gradually extended its services to the public.
Before the mega-earthquake of 25th
April, 2015, there were 19 blocks for providing the preventive and
curative services to the public. Among the services offered by it were: Emergency Maternal and child
health clinic (MCH clinic), Out-patient services, In-patient services, DOTS, ART, HIV/AIDS counselling,
vaccination and health education. Out of the nineteen blocks 14 were fully damaged by the earthquake
and among the remaining five, three blocks viz. Operation Theatre, MCH clinic, the then DoTS centre
needed minor repair while the other two blocks were partially damaged but standing. Hence, majority
of the hospital services were resumed through 11 different tents supported by External Development
Partners.
The service offered by the Trishuli Hospital has been summarized in the table below:
Table 1 Service Offered by the Trishuli Hospital for the Earthquake Victims.
Categories Male Female
Total death (during treatment in hospital) 44
Injuries 1274 1874
Treatment 3469 4878
Hospital admission 785 993
Referral 120 156
Major operation 27 46
Minor operation 60 66
Source: Nuwakot District Recovery Plan 2015

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Human Resource Situation and Currently Offered Services in the Hospital
Majority of the positions of the specialists and consultants remains unfulfilled (Table 2) in the hospital.
At present it runs through 11 tents and the blocks (Table 3 and 4) that survived the earthquake.
Table 2 Human Resource Situation as of June, 2016
Organogram of District (Trishuli) Hospital
Fulfilled Posts
Departments Level Sanctioned
Posts
GoN Hired by
HDCPermanent Contract
HEAD/CHIEF- Medical
Superintendent (Chief Consultant
Medical Generalist)
11 1 1* - -
Emergency department
Consultant Medical Generalist 9 or 10 1 - - -
Medical Officer 8 3 - 6** -
HA 5 3 - - -
AHW 4 3 2 - 2
ANM 4 4 2 - 5
General Medicine Department
Consultant General Physician 9 or 10 1 - - -
Medical Officer 8 1 - - -
Surgery Department
Consultant General Surgeon 9 or 10 1 - - -
Pediatric Department
Consultant pediatrician 9 or 10 1 - - -
OBGYN Department
Consultant Obstetrician
/Gynecologist
9 or 10 1 - - -
Orthopedic Department
Consultant Orthopedic Surgeon 9 or 10 1 - - -
Radiology Department
Consultant Radiologist 9 or 10 1 - - -
Dark room Assistant 4 1 - - -
Radiographer 5 1 1 - -
Dental Department
Dental Surgeon 8 or 9 1 1 - -
Dental Supervisor 5 1 - - -
Lab

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Lab Technologist 7 1 - 1 -
Lab technician 5 1 - - 1
Lab Assistant 4 1 - - 4
Nursing Department
Senior Sister 7 1 - - -
Staff Nurse 5 12 8 - 1
Pharmacy Department
Pharmacy Supervisor 5 1 1 - -
Medical Record Department
Medical Recorder 5 1 - - -
Administration Section
Nayab Subba (Na. Su.) Ra. Pa. An. First 1 1 - -
Computer Operator Ra. Pa. An. First 1 1 - -
Light Vehicle Driver Ra. Pa. An.
Second
1 - - -
Light Vehicle Driver Shreni Bihin 1 - - -
Kharidar Shreni Bihin 1 - - -
Office assistant Shreni Bihin 15 7 - 11
Finance and Admin Department
Accountant Ra. Pa. An. First 1 - - -
Sub Accountant Ra. Pa. An.
Second
1 - - -
Total 70 24 1 24
*Acting Medical Superintendent, Dr. Surya Bhusal
** Deployed by MoH but yet to report to District Trishuli Hospital
Table 3 Use of Standing Blocks for Service Delivery
Blocks before the Earthquake Now serving for:
DOTS clinic (3 rooms) Waiting and Labor
Operation theatre Operation Theatre
MCH clinic MCH Clinic
Store (5 rooms) Registration, Dispensary, Medical Record Desk and
Administrative room
Table 4 Services Currently Offered Through Tents
Name of the services Services are offered through
Emergency Service Tents
Dressing and Injections, Routine Procedures Tents
Clinical laboratory Red-cross block (permanent type)
Maternity Services Own block of the hospital (permanent type)
Diagnostic Services- X-ray, ECG, USG Damaged x-ray block
Dental Services Tents

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Nursing/Inpatient Services Tents
Dispensary Admin block (permanent type)
General Medicine (through multi-purpose OPD services) Tents
Additional services offered
Physiotherapy Tents
Outpatient Therapeutic Program (OTP) Tents

Exit
Entry
Color Code:
Yellow color: Doing good at the current location
Red color: Will migrate to a better location.
Figure 1: Location of Currently Offered Services
Pre Fab Building-
PHCC type – newly constructed
Sajha
Pharmac
y
Lab Services
/Blood Bank
Services
OT Building
MCH Clinic
Storage for equipment
recovered from
Earthquake
Water
Storage
Tank
Tent
ART
Center
Water
Tank
Secu
rity
Post
Tent
Physiotherapy OPD
General OPD
Generator (2)
Dressing Room
Emergency (4 Bed)
OTP Tent
Nursing Station
IPD General 12 BedsPediatric Ward
(6 Beds)
Isolation Ward (6
Bed)
Mortuary
Storage for
equipment
Placenta
Pit
Waste disposal Pit
Toilet
(5)
Bathro
om
(1)
Cante
enLabor&
Delivery
Room
PNC
Room
Admin Block/Billing counter /Medical
Record Desk/ Dispensary
Water Tap
North

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CHAPTER 2: Migration Plan of Tent Hospital to Pre-Fabricated Structure
(Migration) Process:
The tent hospital will be shifted to the newly constructed pre-fabricated cement building with 427 sq.
meter of plinth space. Currently, all departments other than operation theatre, waiting/labor room,
MCH, administrative unit, registration and dispensary are functioning through the partially damaged
blocks. However, the services of the three latter ones are compromised with the lack of adequate space.
Hence, the migration processes will be complete in 4 different phases.
The preparatory phase:
Most of the activities of this phase starts by 3rd
week of June and will be complete by the next week.
However, the involvement of consultants in S.N.4, 5 and 6 depends upon the contractual procedures
from the Country Office. Some of the major activities of this phase include.
a. Ensuring the appropriateness of the pre-conditions in the pre-fab building
b. Installing newly received equipment in the pre-fab structure and repair and maintenance of
equipments
c. Draft migration plan from tent to pre-fab structure and endorsement from HDC meeting
d. Planning and preparation for orienting hospital staffs on the rationale use of available space for
service delivery
e. Assessment of existing equipment and prepare/update the inventory of the hospital
f. Assessment on Hospital waste management
g. Orient staffs on use of space and equipment utilization
The transfer phases:
During this phase the different departments will move from current locations (tents and building) to
more suitable location (pre-fabricated structure or existing building). This involves the movement of 11
different departments of the hospital. However, a few departments and hospital will continue from their
existing location, while the majority of hospital support services will remain less affected with the
migration plan. The migration of the departments and services will however be carried out in a phase
wise manner so as to minimize the discontinuation of service provision and based on their urgency.
Shiftment of each phase will take place in 2 days (total of 8 working days).
Phase 1:
In this phase, the radiology service (x-ray), emergency including the ECG service, indoor service and
nursing station would be moved from their current location to the pre-fabricated building as these
services are more affected in the tent with the upcoming rainy season. This phase will be completed in
the 3 days.

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Phase 2:
This phase will be successive to the 1st
phase where labour, delivery and PNC services and CSSD
department will be shifted from the current building to the pre-fabricated structure.
Phase 3:
In this phase, the remaining departments i.e. administration, HDC office, medical record desk, finance
department and social service unit would be relocated in the existing building where currently the
labour and delivery services are being provided. Similarly, the outpatient services (including dressing and
injection), dental services would be relocated to the existing administrative building.
Phase 4:
This is the final phase where the laboratory service will shift to the pre-fab building.
Table 5: Overview of shifting plan in phases
Services/
Departme
nts
Phase 1 Phase 2 Phase 3 Phase 4
Radiology (X-ray) Labour Admin with HDC
office, finance
Laboratory
Emergency including
ECG service
Delivery Medical Record desk
and SSU
Indoor PNC Outpatient
(including dressing
& injection)
Nursing CSSD Dental
Table 6: Services that will continue from existing locations
Services from tents Services from existing buildings
ART Center USG service from MCH building
Isolation ward Registration
OTP tent Dispensary
Physiotherapy
Other hospital support services
Canteen
Temporary toilets
Placenta pit
Mortuary
Note: The time chart for the shiftment of these phases is shown in the annex.

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Other Processes Involved in the Migration of District Hospital
1. Ensure the appropriateness of the pre-conditions in the pre-fab building: The hospital
management and the S2HSP technical team would access and ensure the appropriateness of the
preconditions in the pre-fab building like the conditions of taps, water supply, electrical and
communication system, waste collection bins and cleanliness etc., using the checklist (annex-2).
2. Orientation to staffs on the use of space: With the technical assistance of S2HSP, the district
hospital staffs will be oriented on the basic space utilization plan. It will be conducted in 3
batches in order not to interrupt the hospital services.
3. Orient staffs on the use of equipment: The BMET will facilitate one day orientation to support
staffs and the department heads on the proper handling of equipment.
4. Transfer of equipment: The department/unit head will be responsible for the transfer of
equipment in their current wards (at tents)- annex- 3. The fragile and heavy equipment will be
handed carefully with appropriate packaging. S2HSP will provide assistance through its
consultant/s on need base.
The current x-ray machine lying in the pre-fab will be replaced with the new one which can be
digitalized. Due attention will be paid to the remaining equipment which needs proper storage
like old x-ray machine, beds etc.
5. Repair and maintenance of hospital equipment: He would prepare the inventory of equipment
and fix the repairable ones.
6. Orient staffs on hospital waste management: The overall goal of the consultant's job although
a separate activity will contribute indirectly to the interim hospital waste management advices.
(TBD- if it is feasible with the consultant for an hour lecture/demonstration session)
7. Water supply for hospital: Follow-up will be made with the HDC and Me.Su. regarding the
progresses of last advices from the consultant for the regular supply of 24-hrs running water to
the hospital.
8. Enhanced hospital management: All of the efforts shall contribute to the interim enhancement
of hospital management and will be further strengthened in the near future.

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Figure 1: Undecided Space for Services
Space Utilization Plan
District (Trishuli) Hospital has a total of 6 standing buildings at present including 5 small blocks that
survived the earthquake a year ago. The currently constructed pre-fab building offers services to
majority of the departments in the hospital like- emergency, in-patient services, laboratory services,
labor, delivery, post-natal care, neonatal stabilization services, CSSD, Procedures and x-ray (Fig. 2)
Similarly, the existing blocks will be chiefly used to provide administrative services, OPD services,
Cesarean Section (OT), MCH services and services through Social Service Unit (as per Fig. 3).
Things to be discussed and finalized
1. There are 6-8 deliveries in the maternity unit. The currently allocated space for PNC might not
be sufficient enough to accommodate 8 beds. Hence, the currently proposed ANC room or the
post-operative ward (in OT Block) might be used as a PNC room until a permanent structure
replaces the pre-fab. Currently only Cesarean Section is performed in the Operation Theatre.
(The previously planned ECG and USG room (in pre-fab) might be used for other purposes upon
discussion with Me.Su.
2. Dr. Jitendra plans for the extension of dental department in the hospital. However,
Identification of its location is under discussion and not decided yet.

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Figure 2 Use of space in pre-fab building

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Space Utilization Plan in District Trishuli Hospital
Exit
Entrance
Color Code:
Green colour: The final location of service units.
Yellow color: TBD where to shift.
Figure 3 Services through pre-fab and tents
FutureKOICAsupported50-bededhospital
Pre Fab Building
In-patient services, Emergency (with ECG), Dressing
and injection, Labor & delivery, Neonatal stabilization
services, PNC services, Laboratory services, Nursing
station, CSSD, Radiology services (x-ray)
Sajha
Pharmacy
Blood Bank (NRCS)
OT Building
& PNC services
MCH Clinic With USG
Parking space for car/motorbikes
And
future KOICA supported 50-beded hospital
KOICA hospital (part)
Storage for equipment
recovered from Earthquake
Water
Storage
Tank
ART Center
Water Tank
(tbd)
Multipurpose
Tent (tbd)
Physiotherapy OPD
Gener
ator
(2)
OTP Tent
Mort
uary Storage for
equipment
Placent
a Pit
Waste
disposal
Pit
Toilet
(5)
Bathro
om
(1)
Canteen
Admin,HDC,SSU,
Financeand
Medical
Recorder'sRoom
Water Tap (tbd)
(tbc
Registration, Out Patient Services and
Dispensary

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Annex 1: Action Plan for the migration of District Trishuli Hospital
Table 7: The migration action plan for District (Trishuli) Hospital
S.N. Activities/Department/Services June (week) July Remarks Phases of
Migration
1st
2nd
3rd
4th
1st
2nd
3r
d
4th
1. Ensure the appropriateness of the pre-
conditions in the pre-fab building
2. Install newly received equipment in the pre-fab
structure
- Supplied by ADRA
-On progress through
RPN
Preparatory
phase
3. Prepare a draft plan of the migration of the
tents to hospital with the HDC and Me.Su. and
endorse it through HDC meeting
Consultation is
ongoing as of 09.06
4. Plan for orienting hospital staffs on use of space
and equipment handling (date, venue,
participants etc.) with Me.Su./HDC
5. Assessment of existing equipment and
prepare/update the inventory
GIZ consultant
(Santosh)
6. Monitor and calculate the hospital waste and
prepare a brief report
GIZ consultant (Kapil)
7. Fix the equipment that needs minor repair and
segregate the other for further repair or
auctioning
GIZ consultant
(Santosh)
8. Update the inventory of District Hospital (with
newly received equipment)
DT/PP
9. Technical preparation for orienting on space
utilization (contents to discuss)
DT/SB (Schedule of
SB)
10. Orient hospital staffs on use of space and DT/SB/PP and

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equipment RPN Engineer
Migration of Services and Departments
Radiology (x-ray) old x-ray machine to
be replaced by a new
X-ray machine
PHASE 1Emergency (including ECG) These three units with high
patient load are currently
operating through tents and
the hospital admin has
pressure to shift these units
first
Inpatient services
Nursing Station
Labor, Delivery and PNC services Labor and PNC services are
offered though the earlier
DOTS Centre (block) will be
shifted to the pre-fab.
PHASE 2
CSSD
Admin, HDC office, Medical Record Desk,
Finance, Social service unit
These units will move from
current location to the earlier
DoTS Centre Block.
PHASE 3Outpatient services
Dressing and injection
Dental services
Laboratory services PHASE 4

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Annex 2: Checklist for preconditions in the pre-fabricated building
Checklist of preconditions for District (Trishuli) Hospital, Nuwakot
Department [……………………………………….] Date: ……/………/……..
Condition of Plumbing system
1. Tap installed in all places in the prefab structure
a. Yes
b. No
2. Connection of water supply to pre fab
a. Yes
b. No
3. Water leakage (joints in water supply system)
a. Yes
b. No
4. Connection of solar water to prefab and OT
a. Yes
b. No
5. Shower tap and wash basin/sink fitted as per requirement
a. Yes
b. No
6. Connection of grey-water (from bathrooms) from pre fab to sewage system
a. Yes
b. No
Condition of Electrical and Communication System
1. Electrical wiring in the pre fab building is completed
a. Yes
b. No
2. Appropriate lighting is installed
a. Yes
b. No
3. Electric fans are installed in appropriate places and are adequate
a. Yes
b. No
4. Electrical connections are well provided in all the departments to operate the equipments.
a. Yes
b. No
5. Alternative backup (Generator) is in place and ready
a. Yes
b. No

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6. Telephones sockets are set at appropriate places
a. Yes
b. No
Status of waste management
1. Color coded waste collection bins placed at each departments
a. Yes
b. No
2. Appropriate number of sinks are installed in the right place
a. Yes
b. No
3. The sinks are properly fitted in all necessary departments/units
a. Yes
b. No
4. The construction and finishing of toilets is satisfactory as per design and drawing
a. Yes
b. No
5. Provisions made for transportation of the hazardous waste through the shortest possible routes.
c. Yes
d. No
Completion of construction works:
1. The construction works are complete:
a. Yes
b. No
2. The finishing of the departments is satisfactory:
a. Yes
b. No
3. Paintings of the buildings is complete and acceptable:
a. Yes
b. No
4. The laboratory slab(where procedures are carried out) is fitted with non-erosive tiles:
a. Yes
b. No
5. The laboratory sink is non-erosive and non-reactive to the common solutions used during
diagnosis and cultures:
a. Yes
b. No
6. There is good cooling system in the server room, labor room and post-natal room.:
a. Yes
b. No

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7. The general construction works are all complete and acceptable:
a. Yes
b. No

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Annex- 3: Inventory of equipment in the District Trishuli Hospital
A. Equipm
ent/Furniture
in Operation
Theatre (Will
NOT move)
B.. Equipment /furniture in Labor Room (moves to pre-fab)
SN Equipment Qty. Remarks SN Equipment Qty. Remarks
1. Delivery Beds 2 1. Delivery set 9
2. Cupboards (steel) 3 2. LSCS set 2
3. Steel racks (open) 2+1 3. VH set 2
4. Refrigerator 1 4. Spinal Set 4
5. Wooden Table 2+1 5. Dressing
Set
11
SN Equipment in OT Qty. Remarks
1. OT bed 1
2. OT light 2
3. Emergency Trollery 1
4. Steel Racks 3+1
5. Suction Machine 2+1 1 not functioning
6. Newborn resus table 1
7. Weighing machine 1+1 1 not functioning
8. Cystoscopy 1
9. Cantry machine 1
10. Steel trollery 4
11. AC 1+1
12. Patient Trolley 1
13. Nursing Desk 1
14. IV Stands 5
15. Mayo trolley / tray 1
16. Stools 2 OT room
17. ECG Monitor 1
18. DC Machine 1
19. Room warmer / heater 1+1+2 2- not functioning
20. Bata Stand 1
21. O2 cylinders (Big + Small) 1+1
22. Washing machine 1
23. Locker (cap / mark) 1
24. Shoe rack 2
25. Bed side lockers 5
26. Wooden bench 1
27. Chairs 2
28. Fire extinguisher 2
29. Portable light 2 Non functioning

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6. Wooden rack 1 6. Suture Set 4
7. Chairs 4+1+1 7. Cheatle
Forceps
4
8. Wooden Bench 2 8. CAC / PAC
set
4
9. Steel Trolley 8 9. Episiotomy
Set
9
10. Suction Machine 1
11. Resuscitation table 1
12. Infant Warmer 1
13. Footsteps 2
14. Stools 2+1
15. Autoclave Machine 2
16. USG machine 1
17. O2 cylinder 1
18. Keys box 1
19. Weighing Machine 1
20. Steel beds Mattress 26
21. O2 Head box 1
22. Fans (Wall + stand) 1+2
23. IV stands 4
24. Patient side lockers 1+1
25. Delivery light 1
26. Peri- light 1
27. Notice board 1
C. Equipment/furniture in In-patient ward (moves to pre-fab)
SN Equipment Qty. Remarks
1. O2 Concentrator 1
2. Nebulizer 1
3. Refrigerator 1
4. Fan 3
5. Electric Kettle 1
6. Table 2
7. Chair 2
8. Cupboard (metal) 2
9. Patient bed 17
10. Staff bed 1
11. Bedside locker 14
12. Chart Trolley 2
13. Stethoscope 1
14. BP set 2
15. Punching machine 1

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16. Stapler 1
17. Cheatle Forcep 1
18. Scale 1
19. Waste Buckets 3
20. Low bed (blue) 3
D. Equipment/furniture in Emergency (moves to pre-fab)
1 Wheel chair 1
2 Chair 2
3 Table (with drawer) 1
4 Plain Table 2
5 Weighing machine 1
6 Drum for Gauge piece 1
7 Cheatle Forcep Swing 1
8 Focus light 1
9 Foot step 1
10 Patient Bed 4
11 Shoping Bed 1
12 Cupboard 1
13 Rack 3
14 Suction Machine 1 Non functioning
15 IV Stand 4
16 Trolley 1
17 ECH Machine 1
18 Oxygen Cylinder 1
19 Screen 1
20 Monitor 1
21 Telephone set 1
22 ENT Set 1
23 ENT set 1
24 BP set 2
25 Torch light 1
26 Weighing machine (adult and child) 2
27 Dental chair 1 out of order
28 Compressor 1 out of order
29 Suction machine 1 out of order
30 Dental instruments 1
31 Autoclave 1 out of order
32 Table 4
33 Examination bed 1
34 Chairs 4
35 Stool 2
36 Stand fan 3 1 broken stand

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E. Equipment/furniture in Administration Room (moves to existing labor block)
1. Table 3
2. Revolving chair 2
3. Arm chair 2
4. Chair 1
5. Stool 1
6. Sofa Set 2
7. Water Filter 1
8. Steel Cupboard 1
9. Wall Clock 1
10. Computer CPU 1
11. Dell Printer 1
12. LCD monitor 1
13. Ceiling fan 1
14. UPS 1
15. Photocopy machine 1 out of order
16. Dustbin 1
F. Equipment supported by ADRA (will remain in pre-fab; does not move)
S.N. Name of Equipment QTY Remarks
1 Episiotomy set 2
2 Normal delivery set 1
3 Implant Insertion and Removal Set 3
4 Dental set 1
5 IUCD Insertion and removal set 3
6 Cidex tray with lid 1
7 Resucitation seet (Adult) 1
8 Cheattle forceps with jar 2
9 Bed cover 8
10 Suction catheter 2
11 Dressing tray 3
12 dressing drum 2
13 Dressing set 3
14 Bed pan (female fam) 2
15 Urinal 1
16 Suture set 3
17 Suture removal set 2

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18 Wall clock with battery 1
19 Chart holder 2
20 BP instrument adult 1
21 BP instrument paediatric 1
22 Plaster cutting scissors 1
23 Newborn weighing machine 1
24 Douche can set 2
25 ENT Dx set 1
26 Tongue depressor 2
27 Measuring tape 2
28 Sputum mug 2
29 Instrument tray 1
30 Kidney tray 4
31 Fetoscope 2
32 Salter scale 3
33 Rechargeable light 2
34 Paediatric resucitation set 1
35 Infra-light (peri-light) 1
36 Steam sterilizer 1
37 Portable standing spot light 1
38 Bandage cutting scissors 2
39 Pillow 4
40 Torch light with battery 2
41 Four burner stove 1
42 Autoclave 1
43 Perineal/Vaginal/Cervical repair pack 4
44 Foreign body removal set 1
45 Metal catheter 3
46 Pillow cover 8
47 Digital thermometer 3
48 Container for sharp disposal 1
49 peri light with battery 1
50 Bedside locker 2
51 Bedside stool revolving stool 2
52 Dressing trolley 1
53 Examination table 1
54 Foot step 2
55 Hospital bed 2
56 IV stand 2
57 Medicine rack 1
58 Medicine trolley 1
59 Patient trolley 1
60 Stretcher without wheel 1

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61 Suction machine foot operated 1
62 Threefold screen stand 2
63 Waterproof covered machine 4
64 Birth stripping bed 1
65 Instrument trolley 1
66 Wheel chair 1
67 Waste receptable 2
68 Bowel (zolit) 2
69 Mackintosh 1

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Annex- 4: Orientation Schedule and Plan
Orientation of Hospital and HDC staffs
The orientation training to the hospital staffs would be completed in 3 batches with 20 members in each batch. Each batch will be
representative of staffs from all departments and services of hospital. The orientation will be conducted in District Trishuli Hospital and will be a
single day orientation session.
S.N. Departments and Services No. of Staffs Remarks
Batch 1 Batch 2 Batch 3
1 Emergency 2-MO, 2-AHW, 2-ANM 2-MO, 1-AHW, 2-ANM 2-MO, 1-AHW, 3-ANM
2 General Medicine 1-Con. Gene. Physician - -
3 Orthopaedic - 1-Orth. Surgeon -
4 Radiology - - 1-Radiographer
5 Dental 1-Dental Surgeon - -
6 Laboratory 1-Lab assistant 1-Lab technologist, 2-lab
assistant
1-Lab technician, 1-lab
assistant
7 Nursing 3-Staff Nurse 3-Staff Nurse 3-Staff Nurse
8 Pharmacy 1-Pharmacy Supervisor - -
9 Administrative 6-Office Assistant 1-Nayak Subba, 6-Office
Assistant
1-Computer Operator, 6-
office assistant
10 Others Hospital Me.Su HDC Chairperson Office assistant
(*electrician)
Total 20 20 20
*Changes can be made based on the field situation

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The orientation will be particularly focused on the following topics
a. Proper utilization of available space (pre-fab structure, buildings and tents)
b. Proper handling of equipments
c. Waste Management (segregation, transportation, storage and disposal)
The tentative schedule for the orientation is as follows
Venue: District Trishuli Hospital, Nuwakot
Time: 1:00 – 5:00 pm
Date:
Time Activity Responsible Person
12:00 – 1:00 pm -Registration
-Welcome
-Objectives of the orientation session
-Expected Outcomes
Dal Bahadur/Suraj
1:00 – 2:30 pm Pre-fab building space utilization
-Introduction to pre-fab building
-Use of available space in emergency, indoor, labor, delivery and
laboratory
-Use of space in procedure room, sterilization room and PNC
Saurav Bhattarai

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02:30 – 3:00 pm Joint observation in the pre-fab structure Saurav Bhattarai/Deepak Timsina
3:00 – 3:45 pm Proper handling and maintenance of equipment
-Identification of biomedical equipment
-Proper utilization
-Maintenance and repair
Santosh Sapkota
3:45 – 4:15 pm Joint observation of biomedical equipment Santosh/Suraj
04:15 – 05:00 pm Health care waste management
-Importance of waste management
-Segregation of waste
-Waste transportation
-Storage and disposal
-Infection prevention
Kapil Gyawali/Deepak Timsina
05:00 – 5:30 pm Discussion and observation All
5:30 onwards Remarks and Closing
Annex-5:
Basic standards to be followed for hospital services and departments:

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Some basis standards for a 50-beded Hospital like District (Trishuli) Hospital:
About 85 per cent bed occupancy is considered optimum.
Distances, Parking and Landscaping
Distances
Distances must be minimized for all movements of patients, medical, nursing and other staff and for supplies, aiming at minimum of time and
motion. Similarly, the routes which the patients will have to take on stretchers, wheelchairs or on foot from their wards to the radiography
department, laboratory and physiotherapy require careful thought to minimize the length of these routes.
Parking
For each inpatient bed there is likely to be at least one visitor a day traveling on a motorbike or four wheelers. For two-wheelers, one parking
space for a bed is desirable for the hospital.
Additional parking for four-wheelers should also be considered.
Employees and staff parking areas are preferably separated from public parking.
Landscaping
The site should permit orientation of the structure in such a way that most of patients' rooms will derive maximum benefit from natural light,
and maximum advantage should be taken of the prevailing wind for natural ventilation.
Zonal Distribution and Inter-relationships of Departments
The departments which come in close contact with the public should be isolated from the main inpatient areas and allotted areas closer to the
main entrance to the site. Such departments are OPD and emergency. The supportive service departments, viz. the X-ray and laboratory services
are extensively used by outpatients and need to be located as near the OPD as possible, at the same time integrated with the main inpatient

TIMSINA D., 2016
wards. Therefore, these departments need to be located in such a way that they are approachable by separate entrances by outpatients as well
as through inpatient areas, but preferably closer to the outpatient department.
CSSD
Central Sterile Supply Department (CSSD) mostly serves the operation theatres, but its other users include the emergency, the wards and the
maternity ward and should be so sited as to be central to all these.
Hospital Kitchen
It will have to be located taking into consideration the prevailing wind direction so that smoke and kitchen odors are not constantly wafted to
the patient care areas.
Hospital Workshop
A large number of various types of mechanical and electrical equipment is installed in a hospital and requires repair and preventive
maintenance. Some equipment requires time to time repair or servicing in-house by an in-house or a contracted maintenance staff. So, a
hospital can only function satisfactorily with a workshop.
Laundry
Used linen from wards, operation theatres and the delivery rooms may be infected, and therefore needs careful handling at an area remote
from all other clinical and supportive service departments. So, appropriate laundry arrangement, stores, drying sheds have to be catered for at
an appropriate area, preferably at a remote corner of the site with plentiful supply of water.
Space Requirements
Space requirements might vary from place to place based on the exploitation of medical sciences for better patient care. In a general District
Hospital, the following space distribution is recommended:
Wards: 37-45%
OPD: 12-18%
Diagnostic and therapeutic: 18-22%

TIMSINA D., 2016
Administrative: 8-12%
Service departments: 15-20%
Five functional areas need to be given special attention in respect of siting and space requirements. These departments are:
i) outpatient department
ii) inpatient wards
iii) laboratory
iv) operation theatre
v) radiology department
It is desirable to group all inpatient accommodation together. Exceting for pediatric, maternity, infectious diseases and psuchiatric service whose
needs have special characteristics, all other types of patients can be cared for in accommodation basically similar in its plan and equipment.
Bed distribution: Generally, about 165 out of every thousand population will be hospitalized for an average of about seven days each. The
number of beds necessary to care for this number will be 3 to 4 per thousand population.
Beds per 1000 population required for a given population in a given region is calculated by the following formula:
Bed : Population =( A x S x 100)/(PO x 365)
where, A = number of inpatient admissions per thousand population per year
S= average lengh of stay (ALS)
PO= percentage occupancy.

TIMSINA D., 2016
OPD:
Current global statistics indicate that per hospital bed, 1.5 to 3 patients attend the outpatient department of a large government hospital per
day. In case of District Trishuli Hospital, Nuwakot, …… patients visit the OPD per day (DHO Annual Report 2071/2072). Out of these cases seeking
attention in a hospital, uoto 65 percent are for minor ailments and only 35 per cent are for major conditions. Of these 35, 10 percent may be
with acute and 25 per cent non-acute problems
Flow of patients:
On outpatient visits, patients flow is in a predictable manner usually from Enquiry to Registration to Waiting to Examination room to
Investigation facilities, although there are many exceptions to this. It is highly recommended that a hospital draws a flowchart of activities and
movements in the OPD to guide the planning process for location of various facilities and their relationship with one another.
The area required for the OPD should be adequate to accommodate the reception and waiting hall, waiting rooms, registration and outpatient
medical records, clinics, toilet facilities and the injection and dressing room, pharmacy, procedure room and circulation routes.
Reception and Enquiry:
A reception and enquiry counter in the outpatient department is necessary at the entrance lobby from where patients seek information about
the location of various clinics, registration procedures and so on. This should be located at a prominent place at the entrance of the department
and also in close proximity to the emergency and casualty department. The entrance lobby should connect with public facilities and with a tea
and snack bar.
To isolate it from the noise that usually prevails in such a place, reception and enquiry can be enclosed in a see-through cubicle. A small room
with glass paneled wall above a height of 1.10 metre and a swinging door /s has been found to be very suitable.
The reception and enquiry should be prominently signposted. It should be staffed during the working hours of OPD by an experienced and
competent person. S/he should have complete knowledge of the location of every single facility and activity of the OPD. S/he should be well-
mannered and cool-tempered with infinite patience to hear patients' innumerable queries and answer them.

TIMSINA D., 2016
Reception and enquiry should have good communication through telephone and intercom sets with all clinics and other important areas in the
OPD. A well-illustrated, easily understandable guide map showing locations of all clinics and adjunct services units can be prominently displayed
in this location.
Waiting area:
There should be a main entrance hall where people first arrive and get registered. On entering an outpatient department, the patient should
find himself in the entrance hall faced by the reception and enquiry counter. At least one square foot per outpatient attendance per day is
recommended irrespective of the size of hospital. In Nuwakot hospital, each outpatient is usually accompanied by one or two relatives or
friends.
Apart from the main waiting area, subsidiary waiting areas for a small numbers of patients will be needed at each clinic and at the diagnostic and
therapy rooms. Space required for subsidiary area is 0.75 m2
for one-third of the attendance at each department.
An acoustical ceiling is desirable in the main reception and waiting hall to absorb the high level of noise that prevails there. The main waiting hall
should be well-ventilated and easy to clean. The halls should be furnished with comfortable benches or chairs. If needed the waiting hall can be
used for health education lectures and screening of health education films. Adequate number of toilets should be provided separately for males
and females. Arrangement of drinking water should also be made in the waiting space.
The waiting area or entrance lobby should display boards for information of the patients and public regarding names of doctors and nursing staff
on duty during a clinic session.
A place to park trolley should be provided at the very entrance to the OPD.
The Nursing Unit:
One of the traditional nursing unit was based on the ward concept established by Florence Nightingale, which centered around the head nurse
called 'nightingale ward'. It is a pavilion type of ward and consists of patient beds in two rows at right angles to the longitudinal walls, with toilets
and bathrooms at one end, and the nurse's table, and other technical facilities at the other end. Although it lacks privacy to patients, not-so-

TIMSINA D., 2016
quiet atmosphere and has danger of nosocomial infection, District Trishuli Hospital will adopt this type of nursing unit to adjust to the local
context and space availability. There will be 11 beds in the In-patient Department.
A few considerations for an ideal nursing unit:
Ceiling height: between 3.00 m and 3.60 m
Width of corridors: 2.40 m to facilitate the movement of stretcher trolleys.
Windows: Window openings for admitting light and air should not be less than 15% of the floor areas of the rooms.
Doors: height not less than 1.2 m. The doors must not open towards the corridor. Doors which open towards the patients' bed give greater
privacy. Door closers to prevent the doors slamming are necessary.
Bed: A standard hospital bed measures 1.0 m in breadth and 2.15 m in length.
Ceiling: Acoustical structure for ceiling in corridors is preferable to minimize transmission of noise.
Bedside locker: One locker per bed is must.
Chair: One chair per bed
Dado: From the standpoint of hospital hygiene, it is imperative to have the dado extended at least up to 1.20 m high in all rooms and corridors.
Nursing station: The location of the nurse's station should be as close to the patients but as central as practicable.
Lighting: Illumination of 100 lux is quite satisfactory for general lighting of the patient areas which will also meet the general needs of the
nursing staff.
Laboratory:
Fig.

TIMSINA D., 2016
Hospital laboratory should be easily accessibnle to the wards. In a smaller hospital like District Trishuli Hospital, where there is significant
outpatient load on the laboratory, it should be situation in between the OPD and the wards.
Considerations for a hospital laboratory:
 Space for laboratory: A small District Hospital like Nuwakot needs a Laboratory Space Unit (LSU)1
measuring 10'x20' (200 sq. ft. or 18.5
m2
).
 Reception and sample collection:It should be with a good and pleasing atmosphere, well-ventillated and well-lighted. Similarly it should
have space for a chair (for patient) during sample collection.
 Specimen Toilet: The lab has to be equipped with a specimen toilet in the close proximity.
 Dust: Laboratories should have a dust-free atmosphere.
 Working surface: The surface of workbenches should be resistant to heat and chemicals, stain proof, and easy to clean and
decontaminate.
 Flooring: Flooring materials in the laboratory should be tested with acids, strong alkalis, solvents and histological stains. They should be
easy to clean and not slippery. Flexible vinyl flooring is preferred for laboratory floor covering.
Central Sterile Supply Department (CSSD)
The location of CSSD should be convenient to tis principal consumers. These are the nursing units, labor suites and operation theatre. It
should be so located that supplies and equipment are brought to and taken away by the shortest route.
A minimum of 100 sq ft for a small hospital like Trishuli Hospital is considered essential for planning a CSSD with scope for future expansion
and growth.
Major activities performed in the CSSD include:
a. Receipt of used supplies
b. Washing, cleaning and drying
c. Sorting
d. Gauze cutting and assembling
1
LSU is the basic unit of planning space for hospital laboratories.

TIMSINA D., 2016
e. Sterilization
f. Sterile storage
g. Issue (of supplies)
Special space requirements of a hospital
Activities Remarks
1 Receipt of used supplies Reception counter for small
items, parking place for trolley
load
2 Cleaning and washing Series of sinks with running
hot and cold water
2 Sorting Table space, next to washing
area
4 Drying area Table space, wires for hanging
gloves
5 Gauze cutting area Table space
6 Glove processing area Table space, room for glove
processing unit
7 Packing area Table space
8 Storage area for items awaiting sterilization Shelves
9 Sterilization Autoclave room
10 Sterile storage Storage room with shelves
11 Issue counter
12 Change room with toilet for workers
13 CSSD Supervisors' room
Fig. Flow Chart of CSSD

TIMSINA D., 2016
There should be a properly qualified supervisor in-charge of the department. The chief of CSSD also called the CSSD supervisor, has
traditionally been a senior nurse.

TIMSINA D., 2016
Annex-6:
Table Status of Logistics of District Hospitals - Furniture
Name of Logistics Total #
of
logistic
s
Status due to earthquake Repairable
items (#)Damaged
by
earthquake
Missin
g
Non
functional
Office table 17 0 0 3 3
Metal Table 2 0 0 0 0
Simple Table 10 3 0 4 4
Patient bed 35 27 0 0 8
Trolley (Medicine) 6 0 0 1 1
Patient Trolley 2 0 0 1 0
Panel rack 9 0 0 0 0
Delivery Bed 1 0 0 0 0
Metal Chair (no arm) 8 0 0 0 0
Large Daraz (Wooden) 4 0 0 0 0
Italian folding bed 21 0 0 0 0
Sofa 4 0 0 0 0
stretcher 3 0 0 0 0
Computer Table 1 0 0 0 0
Italian folding tool 7 0 0 0 0
Panel Rack 1 0 0 0 0
Wheel Chair 3 0 0 0 0
Foot Step 15 1 0 0 0
Metal Chair 12 0 0 0 0
Examination table (wooden) 7 1 0 0 0
Steel Cupboard 6 0 0 2 1
Table 4 1 0 1 0
Steel Daraz 9 0 0 2 2
Revolving Chair 12 0 0 2 2

TIMSINA D., 2016
Name of Logistics Total #
of
logistic
s
Status due to earthquake Repairable
items (#)Damaged
by
earthquake
Missin
g
Non
functional
Patient Screen 6 0 0 1 1
Hydraulic dental chair 1 0 0 1 1
Wooden chair 18 0 0 4 4
Wooden tool 2 0 0 0 0
Metal tool 2 0 0 1 1
Bedside locker 18 7 0 10 10
Baby Bed 2 1 0 0 0
OT table 2 0 0 0 0
Patient Examination table (metal) 9 0 0 1 1
Patient examination table (metal) Italian 4 0 0 0 0
Sofa (3- piece) red 1 0 0 0 0
Sofa with rec check (1- piece) 1 0 0 0 0
Sofa with Synthetic Leather (3+1+1) black 1 0 0 0 0
Tea table wooden round 1 0 0 0 0
Plastic Chair 3 0 0 0 0
Metal Tool 1 0 0 0 0
Footstep wooden 1 0 0 0 0
Patient waiting metal bench (green) 4 0 0 0 0
Patient waiting bench wooden 2 0 0 0 0
Patient waiting bench metal blue (three in
one)
5 0 0 0 0
Patient waiting bench metal black 7 1 0 6 6
Wooden rack 2 0 0 0 0
Steel locker (daraz) 1 0 0 0 0
Steel glass rack 1 0 0 0 0
Wooden cupboard 1 0 0 1 1
Total 295 42 0 41 46
Source: Nuwakot District Recovery Plan 2015

TIMSINA D., 2016
Status of District Trisuli Hospital
Name of medical equipment Available # of equipment’s
X ray machine 300 MA 2
Computer set 6 (1 laptop and 6 desktop)
Printer 4
Hydraulic dental chair 1
Steam autoclave machine 5
Compressor machine (oil free) 1
Weighing machine 2
Instrument box 3
Suction machine (dental) 1
Fridge 8
Semi auto analyzer (Bio chem) 1
Colori meter 1
Microscope 3
Electrolyte analyzer 1
Hot air oven 3
Celling fan 39
Centrifuge 3
D/C counter 1
Micropipettes 9
Stand light 3
Foot step 12
Suction machine 1
Examination table (metal) 4
Patient bed 54
I/V Stand 30
Medicine trolley 6
ECG machine 3
Screen 3
Stricture 3
Mattresses 34
Electric O2 Concentration 3

TIMSINA D., 2016
Nebulizer 5
Dark room tank 1
Drying machine (x-ray) 1
Film assets (x ray) 6
OT table 2
OT light 2
Peri light 4
Ventilator 1
Suction machine 4
Cutlery machine 1
Patient trolley 3
Baby table/bed 2
Fax machine 1
UPS 4
Delivery bed 1
O2 bottle (Italian) 20
EKG (ECG machine) 1
Cardio monitor (Italian) 3
Electric portable aspirator 2
Visiting bed 4
Large pallet 600 1
Modular tents ferrino 2
Tents 4 arches 2 doors 1
Tower light 3
Generator 3
Electrical panel 1
Compressor 1
Drill and tools 1
Electric oven 1
Induction plate 1

TIMSINA D., 2016
Vacuum cleaner 1
Boxes different size (vaccine) 67
Italian patient examination bed 104
Otoscopy 2
Pulse oximeter 3
Cardio monitor and defibrillator manual 1
Modular tent (450 X 300) 2
Halogen heater 4
Wi-max 1
Cordless Panasonic 1
Artery forceps 22
Water motor 5
O2 cylinder medium size/big size 25
Tray SS for abdomen 1
Dental forceps 1
Retractor general open 4
Speculum 20
USG machine 3 (one nonfunctional)
Sponge holder 12
Bowel S/S 2
Needle holder 11
Suture set 15 set
Ring forceps 1
Fenaculum forceps 1
Stitch cutting scissor 4
Obstetric forceps 1
Tongue depressor (metal) 6
Ophthalmoscope 2 set
Ambu bag 2 set
Dental instruments 1 set
ICD bed 2
Weighing machine electrical/digital 1

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Dressing drum 2
Ultra-sono scale 1
C shape table 1
Laryngoscope 1
Washing machine 2
Infant warmer 2
Solar heater with tank 1
Thumb forceps 10
Non troth forceps 10
Tuning forceps 1
Foreign body remover 4
Vacuum set 3
Food suction 1
Nasal speculum 1
Scissor 3
Doppler FHS set 3
Autos copy instruments 1
Proto scope 1
Battery 12 V 1
Inverter 1
X ray dark room accessories 1
Kidney tray 10
A.C 4
Water bag (reserve tank 500o liter) 2
Source District hospital logistic department
Table 15 Resuming Health care services through the district hospital
Status of Regular Services Services being given [Yes or No]
Emergency and Trauma Care Services Yes
Surgery Care (Emergency and C-section) No
Inpatient Services Yes

TIMSINA D., 2016
CAC/PAC Yes
Immunization Services Yes
ANC, PNC Yes
Normal Delivery Services Yes
Family Planning - Short Term Methods Yes
FP: Long-term family planning Yes
Newborn Services Yes
Case management of diarrhea and pneumonia (for
<5 years)
Yes
Continuity of HIV treatment Yes
Continuity of TB treatment Yes
Communicable Diseases (Sexual Health, malaria,
etc.)
Yes
Surveillance System No
Response Readiness Yes
Nutrition for mothers and children <5 years Yes
Outpatient Services Yes
Mobile Clinic Services based on IDP No
Physiotherapy yes
Rehabilitation Services No
WASH monitoring No
Status of distribution of Reproductive Health Kit
(RH Kit) & Sanitary Kit
No
Psychosocial Counseling Yes
Mental Health Yes

TIMSINA D., 2016
Some basic statistics of the hospital services:
Hospital Name
Received
Reports
Average
Length of
Stay (days)
Bed
Occupancy
Rate (%)
% of
Inpatients
% of OPD
% of
Emergency
2013/2014 12 2.03 49.58 14.94 70.25 14.81
2014/2015 12 2.22 36.40
Source: HMIS 2013/2014
Fiscal Year
Hospital Name
Totalnoof
Inpatient
TotalInpatients
Stay(Days)
TotalInpatient
Discharged
TotalOPD
TotalEmergency
TotalPreventive
Others
Total(OPD+
Emergency+
Others)
Services Provided in hospital
NeonatalServices
Provided
X-Ray
UltraSound
ECG
Safe
Motherhood
service
provided
Examinedin
Laboratory
2013/2014 Trisuli Hospital Nuwakot 4666 9049 4453 20945 4416 5238 0 35052 3193 821 2 1481 17549 1448

Migration plan for District Trishuli Hospital Nuwakot 2016

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