Nursing Management, Easy Explanation

1. PLANNING AND ORGANIZING HOSPITAL
UNITS AND ANCILLARY SERVICES
(SPECIFICALLY CSSD, LAUNDRY,
KITCHEN, LABORATORY SERVICES,
EMERGENCY DEPARTMENT
MRS. POOJA GODIYAL

2. Introduction
• A hospital is a human invention, and as such can be reinvented at any time.
• Hospitals design has been subject to many changes over the past 100 years or so in
both layout and size.
• In the early 20thcentury hospitals were basically places where the very sick spent
their last days. But today, emerging concepts of a hospital are calling for
designs that promote wellness and wellbeing rather than merely the treatment
of diseases.
• Health care organization, medical and pharmaceutical advances and
medical technology developments and patient expectations are continuously
changing at a fast pace.
• The implications of these changes on the planning and design of health care
facilities are direct and evident and the design response to them manifests itself
in emerging planning concepts and ideas
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3. Planning and organization of hospital units
• A hospital is responsible to render an essential service.
• In fulfilling this responsibility, hospital planning should be guided
by certain universally acknowledged principles.
• The principles are usually irrespective of the level of planning,
i.e. whether at national level, state level or individual hospital
level.
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4. Aims of Hospital planning
To enlarge the existing hospital by introducing new facilities
To increase utilization of hospital facilities
To increase population coverage
To increase productivity of hospital
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5. Aims of Hospital planning
Modernizationof the already existing facilities
To reduce the cost of operations and maximize efficiency of
services
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6. High quality Patient care
It can be achieved by the hospital through adopting following
measures:
a.Provision of appropriate technical equipments and supplies.
b.An organizational structure that assigns responsibility and requires
accountability for various functions within the organization.
c.A continuous review of adequacy of care provided by physicians,
nursing staffs and paramedical personnel
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7. Effective community orientation
This should be achieved by the hospital by adopting following
measures:-
a.A governing board made up of persons who have demonstrated
concerns for community and leadership ability.
b.Policies that assure availability of services to all people.
c.Participation of the hospital in community programmes to
provide preventive care
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8. Economic viability
This is achieved by adopting measures like:-
a.A corporate organization that accepts responsibility for sound
financial management in keeping with desirable quality of care.
b.A planned programme of expansion based solely on
demonstrated community need.
c.An annual budget plan that will permit the hospital to keep pace with
times
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9. Orderly planning
Orderly planning should be achieved by the hospital by following:-
a.Acceptance by the hospital administrator of primary
responsibility for short and long-range planning with support and
assistance from competent financial, organizational and functional
advisors.
b.Preparation of a functional programme that describes the short
range objectives and facilities, equipments and staffing necessary to
achieve them.
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10. Sound architectural plan
• It is achieved by the following:-
a.Selection of a site large enough to provide for future expansion and
accessibility of population.
b.Recognition of the need of uncluttered traffic patterns within for
movement of staff, patients and visitors and efficient transportation of
supplies
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11. Medical technology and planning
• Development in medical technology is taking place so rapidly that
now the use of sophisticated technology determines the professional
status.
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12. Hospitals in general are classified into two categories depending
upon the agencies which finance them:
1.Government or public hospitals: they are managed by government
services, either central or state or public, municipal or departmental
bodies that are financed from the overall budget for publicservices.
2.Non-government hospitals: they are managed by individuals,
charitable organizations, religious groups, industrial undertakings etc.
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13. On the basis of ownership patterns, non-governmental
hospitals are classified as:
Private (personal)
Partnership
Private (family) trust
Public charitable trust
Cooperative society
Private limited company
Public limited company
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14. HOSPITAL PLANNING PROCESS
i.Conceptualization of hospital: Here the imagination or idea of the
originator takes into a practical shape, and compares his dreams with
the existing hospitals of country or outside world, tries to fit dreams
into any such project.
ii.Support groups: Once the idea is developed, the entrepreneur,
discuss project, and then finds support groups to join hands and
complete the project.
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15. iii.Temporary organization and securing funds: A group should be
formalized called as a hospital trust, which must be registered under
the society‟s act or companies act.
The originator is the chairman and others are members who are
assigned different tasks.
A detailed work out as to how much capital will be required for
establishing the hospital.
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16. iv.Geographical, environmental and miscellaneous factors:
Meteorological information: temperature, rainfall, humidity
Geographical information: existing road and rail communications,
susceptibility to quakes/floods, building height restrictions due to
proximity of airports.
Miscellaneous availability: trained manpower, water, sewage disposal
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17. v.Hospital design:
Bed planning: it should be realized that the hospitals are not
only utilized by the population in the vicinity but also will
constitute the indirect population in the larger catchment area.
About 85% bed occupancy is considered optimum.
Hospital size: as a very large hospital of 1000 beds or more becomes
extremely unwidely to operate, and a small hospital of 50 or less are
not profitable. From functional efficiency point of view, it is advisable
to plan two separate hospitals of 400 beds, each with a scope of
future expansion, rather than a single one of 800 beds
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18. Land requirements: in rural and semi-urban areas, plentiful land
may be available permitting the hospital to grow horizontally,
whereas in urban areas there will always be great premium on land
and only avenue will be a vertical growth.
No. of beds Land in acres Storey of building
50 beds 10 acres Single storey
100 beds 15 - 20 acres --do--
200 beds 20 - 25 acres Double storey
500 beds 55 - 70 acres 3 - 5 storey
700 beds 80 - 90 acres 4 - 6 storey
1000 beds 90 - 100 acres 6 - 9 storey
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19. Public utilities: the national building code of ISI suggests 455
liters of water per consumer per day (LPCD) for hospitals upto
100 beds and 340 LPCD for hospitals of 100 beds and over.
• Additional availability of water in case, staff quarters and nurse‟s
hostel are a part of hospital campus.
• The hospital sewage disposal is connected to the public sewage
disposal system, otherwise it needs to build and operate its own
sewage disposal plant.
• It is preferable that power supply should be available on a multi-grid
instead of uni-grid system in general use, to ensure a continuous
supply of electricity to hospital at all times. Electricity requirement is
1 KW per bed per day2.
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20. Approval of plan by the local
authorities: once the detailed
plan has been formulated, the
local bodies are consulted and
persuaded for approval of plans.
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21. vi.Circulation routes: the utility and success of hospital plans depend
on the circulation routes on hospital site and within building.
There are two types of circulation in the hospital :-
the circulation space involves corridors, stairways and
lifts.Corridors with less than 8 ft. Width are not desirable in hospitals and
protective corner beading is a necessity in hospital corridors.
only one entrance to the hospital for vehicular traffic from the
main road is desirable.The entrance and exit points should be wide enough to take
two lanes of traffic, one entry for clarity of all visiting traffic and one exit for
security from administrative viewpoint
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22. • vii.Distances, compactness, parking and landscaping: distances
must be minimized for all movements of patients, medical, nursing
and other staff, for supplies aiming at minimum of time and motion.
• Functional efficiency depends on the compactness of the hospital
which is achieved by constructing multistoriedas they are
convenient due to compactness as compared to horizontal
development of hospital which demands more land involving extra
costs and installation of services, roads, water supply, sewage etc
• One car parking space per 2 beds is desirable in metropolitan
towns, lesser in smaller urban areas while much less in semi-
urban and rural areas.Separate parking for 3-5wheelers and
scooters, employees and staff parking areas separate from public
parking should be considered.
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23. • viii.Zonal distribution and inter-relationship of departments: the
departments which come in close contact with the public (e.g.
outpatient department, emergency and casualty) should be isolated
from the main in patient areas and allotted areas closer to the main
entrance.
• The supportive services like X-ray and laboratory services need to
be located near the OPD‟s.
• From the main entrance should be main inpatient zone consisting of
ICU, wards, OT and delivery suit.
• The other supportive and clinico-administrative department in the
hospital consists of hospital stores, kitchen and dietary
department, pharmacy etc.these departments should be preferably
grouped around a service core area
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24. ix. Gross space requirements: gross total area (building gross)-
780-1005 sq ft, add walls, partitions: 95-125 sq ft. a building gross
square footage figure includes everything a building‟s perimeter viz.
stairs, corridors, wall thickness and mechanical areas.
On average, space will be required for a reception and enquiry
counter in the main waiting area near the OPD entrance
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25. The bed distribution is calculated as:
• Bed:population= A x S x 100 / 365 x
PO
Where, A= number of in-patient
admissions per thousand
population per year
S= average length of stay (ALS)
PO= percentage occupancy
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26. • Bed distribution among various specialties will vary from hospital
to hospital and conforms to following range:
Medical: 30-40%
Surgical: 25-30%
Obstetrical: 15-18%
Pediatric: 10-12%
Miscellaneous: 10-15% (including eye and ENT)
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27. x.Climatic consideration in design: In very hot climate buildings
need to be cooled in summer by artificial means. Some natural
cooling can be achieved by building orientation and design.
The building should be open, and oriented in such a way that even a
slight breeze can pass through the building to cool its insides.
Another way is to keep thick walls and small windows where the
thick walls absorb the heat during day and dissipates during night,
and small windows minimize the amount of radiated heat entering
the building.
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28. xi.Equipping a hospital: Hospital equipment covers a broad range
of items necessary for functioning of all services.
The universal application of equipment in the hospital can be classified
as:
It includes lifts, refrigeration and air-conditioning,
incinerators, boilers, kitchen equipments, mechanical laundry, central
oxygen etc.
Beds, stretchers, trolleys,
bedside lockers, movable screens, operation tables, instrument
trolleys etc.
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29. It includes office
machines (typewriters, calculators, filing system, and computers),
office furniture, crockery and cutlery.
It includes equipments
for general use (BP instruments, suction machines, glassware
washers etc.) and equipment interacting with patients during
diagnostic and therapeutic procedures ( defibrillators, X-ray
machines etc.)
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30. xii.Cost evaluation of
construction of hospital:
The most common method of
estimating the cost is on the
basis of per bed cost. It will also
vary in type of facilities the
hospital provides, like teaching,
training and research facilities.
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31. OUTPATIENT DEPARTMENT
• Outpatient department is the
one where all patients except
those who require emergency
treatment, come for service in the
hospital
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32. Planning and organization of the OPD
Location: It should be easily accessible to those who come for outside,
and should be a separate wing for OPD attached to the hospital
accessible from the main entrance to the hospital with direct
approach from the main road.
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33. Planning and organization of the OPD
Space: The space requirement will depend upon the land
available and location of the hospital.
• Generally 0.66-1 sq ft area per annual outpatient attendance should
be provided for OPD.
• If there are 3 lakhs visit in a year, the total space requirement for
OPD will be 2-3 lakh sq ft or 4.5-6.8 acres.
Size: The size of OPD depends upon the volume of attendance,
clinics provided and extent of facilities like bloodbank, emergency
department.
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34. ZONES OF OPD
• FUNCTIONAL ZONE: This zone is mainly used by the patients attending
the OPD, attendants and relatives.This area includes parking area,
entrance hall, waiting space, enquiry and registration, and medical social
services.
• ADMINISTRATIVE ZONE: This zone is required in a large hospital to plan,
organize, supervise, evaluate and co-ordinate the facilities being provided.
The various functional units of this zone are
Office of the OPD in-charge
Administrative control nurses station
Cash counters
Medical record room
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35. • DIAGNOSTIC AND SUPPORTIVE ZONE: The various functional units in
this area are:
Clinical laboratory
Imaging section
• AMBULATORY ZONE: This is a zone where the patients come in
direct contact with the doctors and paramedical staff for
consultancies, advice and treatment.
• It includes units like:
Clinics for various medical disciplines
Pharmacy
Treatment room
Minor OT
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36. • STAFF ZONE: This zone is used exclusively by the staff members only.
It includes duty rooms, stores, housekeeping and conference room
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37. Functional management of OPD
• OPD timings: It is recommended that OPD shall work 6 days in a week with
facilities of morning and evening clinics.The morning timings is usually from 8am-
12 pm, whereas the evening hours shall be from 3pm to 5 pm, and
specialty clinics from 2 pm to 4pm. overcrowding and waiting time of the
patients and relatives must be minimized.
• Records: A unit record system combining both in-patientsrecord and
continuousout patient record is recommended.
• Public relations: Public complaints can be minimized and defused through
public relations, the entire staff of OPD including public relations persons should
act as agents
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38. •Facilities in OPD:
The waiting lines should have enough furniture so that patients
don‟t have to stand in queues but can sit comfortably.
The general procedure and rules should be painted on boards
or walls for the public.
The registration area should be easily recognized and reachable.
Health education messages can be promoted through TV-VCR
system, closed circuit TV and also to reduce the boredom of the
waiting patients and their relatives in OPD
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39. • Staffing of OPD: It includes the
• medical staff (consultant, professor, senior lecturers, medical
officers, residents, junior and senior should be available),
• nursing staff (usually one nurse/OPD/clinic),
• paramedical staff (for injection room, dressing room, registration and
MRD),
• receptionists and
• medico social work
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40. Planning and oranization of Wards:
• A ward is the most important part of hospital where the sick
persons are kept for supervised treatment.
• It is also a nodal point for research in medicine and nursing
field, training and teaching of medical, nursing and paramedical
personnel.
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41. Types of wards
a. General wards: In these wards, patients with non-specific
ailments, requiring no life saving care are admitted. The nurse patient
ratio of 1:5 in big wards, and catering to the patient‟s routine
investigation, treatment and care needs.
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42. Types of wards
b.Specific wards: These include patients admitted for specific care due ti illness or
social reasons. It includes:
Emergency ward
Intensive care unit
Intensive coronary care unit
Nursery
Special septic nursery
Burns ward
Post operative ward
Post natal ward
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43. c.Units with specialist nursing,
treatment and equipment:
Wards like burn ward, transplant ward
functions at national or regional
centers where particular service
skills are concentrated.
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44. WARD PLANNING
Physical facilities: It includes
Size of the ward depends on-types of patient (an area of
100-120 sq ft/bed is required and smaller rooms of 2-4 beds are
preferable),
Requirement of ward staff (a small ward will have same
requirement throughout the day, helped by a head nurse and a clerk
for administrative and clerical responsibilities)
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45. WARD PLANNING
Physical facilities:
This is an area where patients are kept for
treatment.
The area per bed within the ward is 80sq ft/bed but in acute ward it
is 100 sq ft/bed
Space left between two rows of bed is 5 ft.
Distance between two beds is 3 1/2 To 4 ft.
Clearance between wall and side of bed is 2ft.
Length of bed is 6‟, width of the bed is 3‟.
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46. Single bed room should have a size of 125 sq ft/bed
2 bed room 160 sq ft/bed
4 bed room 320 sq ft/bed
6 bed room 400 sq ft/bed
ICU 120-150 sq ft/bed
Obstetrics and orthopedics 120 sq ft/bed
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47. This section of ward includes:
Nursing station/duty room: It should be located at such a place
that the time taken by a nurse for moving from one place to
another is limited.Centralizelocation is desirable.
Treatment room: The room is meant for examination of patients and
should be equipped with examination table, spotlight, dressing
material, hand washing facility etc.
Clean work room: It is a working room for staff nurses in
nursing unit, contains work benches for preparation of trays,
care of materials, equipments and supplies etc
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48. Pantry: It is a place where the dishes are cleaned, washed and
stored.
Unit store:it is meant for storing the supplies and linens.
Sanitary area:it includes baths and toilets, dirty utility room,
store for sweepers etc.
Auxillary areas:this section includes duty room for doctors,
clinical side room, seminar room, attendant room, locker room for
staff
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49. WARD DESIGN
• The primary objective of a ward design is to facilitate the nurse to
hear and see everything in the ward and to enable the patients
to easily call the nurse when need help.
In an open hall, beds are placed in rows facing each other
and nursing station in the center of the hall.
In this design, 3-4 beds are placed parallel to the
windows in open bays separated from each other by low partition.
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50. 8/1/2021 POOJA GODIYAL 50
OPEN WARD
RIGG’S WARD

51. Side beds are placed in each bay separated
from nurse‟s station with its standby services by a common corridor.
It has been accepted as most suitable and workable
conditions, two unilateral rigg’s wards are on either side of a central
nursing station.
Bed bays are placed in front of the nursing
station and critical patients bays are in front of nursing
station.Isolation bays are at both sides and ancillary and other
service areas are behind the nursing station
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52. 8/1/2021 POOJA GODIYAL 52
RIGG’S UNILATERAL
WARD
RIGG’S BILATERAL WARD

53. WARD MANAGEMENT
• It is the optimal utilization of the ward resources to produce
maximum output, namely care and comfort of patients. It includes:
Responsibility of giving a strategic direction to
a ward lies within the nursing unit set up in each ward.
Strategy formulation for ward has to be done in the context and
parameters defined by the strategy, direction, resources and
constraints of hospital.
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54. WARD MANAGEMENT
Where as strategic management gives an
anchor and direction, operational management works towards the
strategy.
The responsibility of operational management of a ward rests with the
ward head nurse/ nursing unit with the help of other ward
personnel like ward clerk.
It includes objectives of providing comfort and good care to the
patients and long term objective of improvement and establishment
of systems in functioning of the ward
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55. CENTRAL SUPPLY SERVICE DEPARTMENT
(CSSD)
• Definition of CSSD: A CSSD is a department that furnishes all supplies required
for the nursing units and departments of a hospital-theatres, wards,
out-patient and casualty departments with complete, sterile equipment
ready and available for immediate treatment of patients.
• These supplies include sterile linens, sterile kits, operating room packs,
needles, syringes and other medical surgical supplies. In addition, the
personnelin this department clean, inspect, repair, assemble, wrap and
sterilize special treatment trays for various nursing units
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56. Planning and organizational consideration of CSSD
The CSSD should be planned in all hospitals above
100 beds.
• Theatre sterile supply unit (TSSU) is to meet emergent and large
requirement of OT and is established inside OT complex.
• In large hospitals like 500 beds and above, TSSU is established in
addition to the CSSD in service area
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57. Bed size of the hospital Location of CSSD
Up to100 beds In operation theatre
100-500 beds CSSD centrally located in service area
Above 500 beds CSSD in service area and a separate unit for OT to
be called theatre sterile supply unit ( TSSU)
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58. The following areas are to be provided in CSSD:
i.Equipment storage room
ii.Receiving counter and clean up room
iii.Needles and syringes processing room
iv.Gloves assembling room with rubber goods processing room
v.Clean work area including sterilizers
vi.Sterile storage area and issue counter
vii.gauze and dressing assembly area
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59. Percentage distribution of the space is as follows:
• Clean area including sterilization-40%
• Sterile storage area-15%
• Equipment storage-14%
• Fluids, needles and syringes-14%
• Receiving and clean up area-12%
• Glove processing area-5 to 7%
• Additional 25% space located for future expansio
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60. Location should be where the most rapid means of
transportation of supplies and equipment is possible.
There should be avoidance of back tracking of sterile goods.
There should be a continuous flow of equipment from the
receiving counter to the dispensing counter.
The contamination of sterile goods should be avoided.
Sterilizing area should be the last area before the sterile storage and
dispensing counter.
The receipt and issue counters are separated by a corridor to avoid
contamination
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61. The receipt and issue counters are separated by a corridor to avoid
contamination
Counter of receipt of used
items
Processing and packing of
items
Distribution point Sterilized item store Sterilization
Decontamination and
cleaning area
Seperation of sterilized items by a partition or corridor
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62. It is recommended that the area of
1.64 sq.m/bed for a CSSD would be
appropriate up to 400 bedded
hospitals, and for more than 400 beds
an area of 1 sq.m/bed would be
sufficient.
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63. The manual of IGNOU has recommended following functional area
for a 100 bedded hospitals
Facilities in Sq metre Facilities in Sq metre
Entrance 10.50 Sterilization 14.00
Lockers 7.00 Sterile storage 21.00
Staff change room 7.00 Distribution 10.50
Dirty receipt & disassembly 7.00 Trolley wash 07.00
Washing Disinfection &
Decontamination
17.50 Trolley bay 10.50
Assembly 10.50 Bulk store 17.50
Linen processing 10.50 Duty room 03.50
Toilet 03.50
Total per 100 bed hospital 164.50
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64. Staffing pattern
• One CSSD worker per 30 beds plus one supervisor is
recommended. In 200-300 beds hospital, you need 10-15 persons.
Staff for 1000 bedded hospitals is:
Supervisor –1(senior most and trained technician)
Asst. Supervisor-one of the senior technician
Technicians –6 (promoted attendants)
Sweepers-15
Clerk-1
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65. Hot and cold running water
Cleaning brushes and jet water gadgets
Ultrasonic washers
Hot air oven for drying instruments and sterilization
Globe processing unit
Instrument sharpener like needle sharpening machines
Stem sterilizers and boiler for steam
Autoclaves of various sizes including gas autoclave
Testing equipment
Chemicals to clean materials
Wall fixtures like sinks, taps
Trolleys for supply of sterilized items and separate trolleys for collection
of used items are needed
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66. Methods of sterilization
• Sterilization is a process of freeing an article from all living organisms including
bacteria, fungus, using dry or wet heat, chemicals or irradiation.
a. Steam sterilization: autoclaving is the commonest method
b. Hot air sterilization: Vaseline and oils cannot be sterilized with steam. These items
are exposed to hot air to 160-1800c for 40 minutes.
c. Gas sterilization with ethylene oxide
d. Sub atmospheric pressure sterilization with formalin: it is meant to disinfect instruments
like endoscopes. The temperature required is 900c for 10-30 minutes.
e. Chemical sterilization with activated glutaraldehyde
f. Gamma irradiation sterilization: it is used for disposable goods but is a costly method.
g. Formaldehyde steam sterilization
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67. Inventory Management
To ensure the availability of sterilized items to the
hospital units, five times the average daily requirements. The
replacement and procurement of condemned items should be laid
out so that situation of „stock out‟ can be avoided.
The principle of „first in-first out‟ ensures proper
rotation of supplies in CSSD and prevents any item from being kept
for longer time so that its sterilization date expires
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68. The method that can be used for distribution of sterile
items are:
• Grocery system: in case CSSD is open 24 hrs, wards and departments can
send requisition to CSSD and stock is supplied accordingly.
• CSSD is open for limited hours:
Clean for dirty exchange system: one clean item is provided for each item in the
ward used.
Milk round system: it includes daily topping up of each ward/ department stock level
to a pre determined level decided by users.
Basket system: a basket with daily requirement of ward is changed everyday
irrespective sterile items used or not, and the items of the whole basket is sterilized
every day.
• In case the items are to be stocked in wards, the date of sterilization is written on
each item so that the unused items are returned to CSSD for re-sterilization after 72
hrs.
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69. • Routine temperature/pressure and holding time testing of each
autoclave.
• Steam clox is also very handy and reliable. Changes color from brown
to green
• Heat/time, moisture sensitive tapes may be used in same way as
that of steam clox
• Random samplings of sterilized items are also tested in laboratory
• Culture of wall/floor and scrapings.
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70. LAUNDRY SERVICES
Functions of laundry
• Control of cross infection: it reduces the chances of cross infection.
• Patient satisfaction: the patient likes to have clean linen which is
changed and washed frequently and has a psychological effect on
patient.
• Public relation: the image of hospital also depends on clean look
of linen as it instills confidence in patients and relatives
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71. Types of laundry
In this system, the hospital has its
own linen and laundry and all activities of the hospital laundry
services are done in hospital premises. A hospital with more than 100
beds can run this type of laundry services.
This system is used in advanced western countries.
The owner of the linen is also the supplier of linens to the hospitals and
is also responsible for the replacement as well as the laundering of
patients and staff linen.
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72. Types of laundry
In India, all hospitals have their own linen, majority
of the hospitals get the laundering done by contract dhobis. In
some cases, a subsidized contract type is prevalent and in some
cases, the hospitals provide water and washing area within the
hospital premises.
it is most beneficial to the smaller hospitals
than the large hospitals as they share the service of highly qualified
laundry services
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73. Planning and organization of laundry services
If possible, the laundry should be in the same building as
the hospital, and should have separate entrance and exit areas. It
is recommended to have a mechanized laundry in the basement,
with proper drainage arrangements
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74. The requirement for any laundry services has
been worked out to be approx. 10-15 sq.ft./bed
No. of beds Space
200-300 beds 3750 sq.ft
300-500 beds 5670 sq.ft
500-600 beds 6460 sq.ft
>650 beds 8210 sq.ft
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75. • According to Dr. Mc Gibony, the area for a laundry for a teaching
hospital in India should be at least 5800 sq.ft.
• Physical layout:
1.Straight through flow: the planning of the building and
installation of equipment in a straight flow from the dirty end to the
clean end.
2.U-flow: where the dirty and clean ends are in the same direction.
3.Gravity flow: this takes advantage of the underground, with dirty end
at the top and clean end at the bottom
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76. Laundry is divided into two distinct areas:
Dirty area: It comprises of
Reception of solid linen
Sorting of soiled linen into suitable quantities for processing
Clean area: It comprises of
drying
finishing
discharge
a barrier wall between the clean and dirty area is desirable
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77. Reception of dirty linen
and storage
Boiler room
Decontamination and
sluice room
Toilet Washer
Laundry Staff room Store of
detergent
Store of spare
linen
Hydroextractor
Linen mending
Issue area
Storage of clean
linen
Pressing and
laundering
Drier
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78. Ancillaries
• Laundry manager‟s office
• Stores
• Tailoring bay
• Worker‟s rest room
• Toilet
• Boiler room
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79. • The route of soiled linen from the using points to the laundry and the
flow of clean linen from laundry to the using points should be
planned as to minimize the possibility of contamination of clean
linen.
• The laundry should be grouped into specific separate areas.
• Laundry manager‟s office should be located as centrally as possible to
properly supervise the entire laundry operations.
• The walls should have large vision panels to allow full view of each
area
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80. • The walls should have large vision panels to allow full view of each
area.
• A toilet, locker and shower facilities should be provided in the
soiled linen receiving, sorting and washer loading room and clean
linen processing room.
• Supply storage room should be adjacent and connected to the
soiled linen receiving, sorting and washer loading room.
• Sufficient space should be provided for the storage of one week‟s
supply of detergents, bleaches and others.
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81. • The floor for the laundry should have smooth, slip resistant and water
proof surface, the walls should have a smooth washable surface free
from all corners, edges or projections which create maintenance
problems.
• Utility services like piping, electrical wiring should be
designed and sized with appropriate consideration for future
expansion.
• The steam supply system should be designed to deliver steam to
the equipment in right quantity at a desired temperature.
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82. • Hot water should be available at 1800F by the pipeline to the
laundry at the required temperature from the boiler room.
• The power supply to the laundry is usually 220 or 440 volts in
three phases , four wire alternative system and must be accessible
• Lighting should be free of glare and shadows.
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83. • Fire extinguishers should be located in the laundry near the clean
linen and the processing areas.
• There is a need for flow of drains in the sorting and washing areas.
• Ventilation system must be able to provide a comfortable
environment for the workers.
• Sewing and mending room should be located near to the clean linen
and pack preparation room
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84. The management of laundry contributes to morale of the staff and patients with fresh laundered linen:
Collection of laundry by laundry staffs in trolley with clean and dirty linen separately and is sorted
out as soiled, infected and foul linen to avoid nosocomial infection.
Disinfection is done using disinfectants for infected linens.
Sluicing and washing: sluicing is done for foul linen in sluice machine and then the linen along with those
that are disinfected are put in washer for cleaning.
Hydro-extractor: it is then put in extractor for removing extra water.
Drier tumbler: the linens are put for drying.
Pressing: the linens are pressed
Mending: the torn linen is sent for repair or condemnation and replacement.
Repaired linen is again washed in washer and washing cycle after that is to be completed.
Distribution to ward is done by laundry staff after it is ready for use.
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85. Topping up:In this, the ward is given certain number of stock of
linen based on 24 hours requirement and shortfall of linen due to use is
topped up by the laundry staff everyday and used ones are collected.
Clean for dirty‟ exchange: the issue of clean linen to exchange number
of pieces of dirty linen.
Exchange trolley system: this is expensive and not used in India. In
this, total trolley is supplied which has 24 hours requirement and
next day fresh trolley is supplied with same number of pieces and
old trolley istaken back to laundry irrespective as how many pieces
have been used and linen is brought and washed.
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86. The quality assurance of laundry
should be developed since laundry is important from where infection
can be transmitted to other patients, which should be seen by the
hospital infection control committee.
Collection and distribution system of linens with periodicity to each
ward and department.
Detailed instruction about handling infected andfoul linen.
Charter of duty of each person handling laundry and training schedule of
staffs
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87. Sluicing and disinfection procedures.
Operation of laundry machines.
Maintenance and service contracts of machines.
Provision of detergents
Procedure for condemnation of linen and procurement of new linen
Fire safety drills and fire extinguishing measures
Record of distribution, collection, inventory of detergents and
linen procured/condemned. Security arrangements for laundry.
Regular physical verificationof linen and fixing responsibility of any type of
loss.
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88. KITCHEN SERVICES
• A hospital dietary service includes most importantly a production unit
that converts raw material into palatable food.
• The preparation and distribution of food from store to spoon has
many challenges for the administration such as proper
preparation, cost accounting, pilferage and wastage.
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89. Functions of dietary services:
The dietary services cater for the
following:
• therapeutic diet
• in-patient catering
• diet counseling
• education and training
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90. Staff requirements:
Category of
employees
Beds
100 200 300 500 750
Chief dietician - - - - 1
Senior Dietician - - - - 1
Dietician - - - 1 1
Asst. Dietician 1 2 3 5 7
Steward - - 1 1 1
Storekeeper(ration) - - - 1 1
Storekeeper(general) - - - 1 1
Clerk/typist - - - 1 1
Head cook 1 1 1 2 2
Therapeutic cooks - - 2 2 3
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91. Staff requirements:
Category of
employees
Beds
100 200 300 500 750
Cooks 4 6 8 10 16
Asst. cook 6 14 20 28 32
Cleaners, waiters 4 4 6 8 10
Store attendants - 1 1 2 2
Sweepers 1 1 2 2 3
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92. Location and space requirement:
The dietary department should be located on the
ground floor near wards where the diets need to be taken and also
accessible to road as supplies are to be carried to storage area
Hospital kitchen is divided into number of
divisions which have a particular activity.
• The broad areas are supplies receiving area, storage area, cooking
area, pots and pan wash, garbage disposal, LPG stove and
refrigeration facilities, housekeeping, dietician, steward offices and
circulation area
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93. Following space requirements are recommended for different size of
hospitals:
200 beds or less: 20 sq ft per bed
200-400 beds: 16 sq ft per bed or 18 sq ft per bed
500 beds and above: 15 sq ft per bed
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94. Functional areas in department:
This is the place where all provisions are off loaded.
these are checked for right quality and quantity, hence area should
have unloading points, ramps, trolleys and weighing scales.
This area where the provisions are categorized and
stored in separate areas. the areas should have enough shelves and
bins:
• Dry provisions like flour, dal, sugar, oil etc.
• Fresh provisions like vegetables, milk, butter, meat etc
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95. They are further divided based on temperature requirements:
• Items to be stored at room temperature like onion, potato etc
• Items require cool temperature (8-100c is maintained) for which
walk-in cooler can be provided to store milk, eggs, butter etc.
• Deep fridge where temperature is below 00c fish and meat should be
stored
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96. It is an area where provisions for one days cooking
issued to the cooks are stored.
It is an area where provisions are cleaned,
washed, soaked; meat is chopped, cut and sliced etc. the items
like kneader, weighing scale, slicer etc has to be provided.
It should have pressure cooker, cooking range oven etc.
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97. The food is put in service pots in trolleys and if it is a
centralized distribution system, it is put in service trays, with specifying
the name of patients.
This is meant forwashing cooking and service
pots, hence should have liberal hot and cold water.
The area where all garbage and left over food is
collected for disposal.
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98. LAYOUT OF KITCHEN
Recipient area
of provisioning
Fresh store
Dry store
Walk - in cold
store
Office store
keeper
Dry store Preperation area
Trolley + Pot
wash area
Cooking area
Wards
Distribution area and
service
Dietician
Supervisor
Staff room
Staff toilet
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99. Distribution of diet
The food is set in individual tray
centrally at dietary department including therapeutic diet of
patients and are transferred to wards in trolleys and served to
the patients.
The food is sent to wards and served
as per the need of the patien
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100. Dietary store management
For dry storage, the temperature should
be 700c, with adequate ventilation has to be insured. The storing
shelves, bins should be placed 10” above the floor.
The items can be purchased from
open market or through calling tenders. The items to be purchased
should have AG MARK OR IDI. For this, an internal purchase
committee may be constituted by the hospital administration
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101. Equipment purchase depends on the
objectives and basic functions of the department, workload and
availability of the personnel, and quality standards. Modern
gadgets like mixer grinders, pressure cookers, dish washers etc.
Shouldbe a part of hospital kitchen.
The first thing to be done for an effective financial control is to
control the labor costs.
Menu planning should be done in such a way that it reduces
the inventory, selection of items common to many areas of
patient care, reduced handling, wastage, use of automation or more
equipment requiring less operational staff are some measures that
can be put to practice for an effective financial control.
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102. LABORATORY SERVICES
The basic function of laboratory services is:
• To assist doctors in arriving at or confirm a diagnosis and to
assist in the treatment and follow-up of patients.
• The laboratory not only generates prompt and reliable reports, and
also functions as store house of reports for future references.
• It also assists in teaching programmes for doctors, nurses and
laboratory technologists.
• It carriesout urgent tests at any part of day or night.
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103. The hospital laboratory work
generally falls under the following
five divisions:
a.Hematology
b.Microbiology
c.Clinical chemistry/ biochemistry
d.Histopathology
e.Urine and stool analysis
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104. It covers the following activities:
• Determining approximate section wise workload.
• Determining the services to be provided.
• Determining the area and space requirement to accommodate
equipment, furniture and personnel in technical, administrative and
auxiliary functions.
• Dividing the areas into functional units i.e.Hematology, biochemistry,
microbiology etc.
• Determining the number of work stations in each functional units.
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105. • Determining the major equipments and appliances in each unit.
• Determining the functional location of each section in relation to
one another, from the point of view of flow of work and technical
work considerations.
• Identifying the electrical and plumbing requirements for each area/
work station.
• Considering utilities i.e. lighting, ventilation, isolation of equipments
or work stations.
• Working out the most suitable laboratory space unit, which is a
standard module for work areas
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106. Organization
It is preferable to have hospital laboratory planned on the
ground floor and so located that it is accessible to the wards.
In large hospitals, the entry of outpatients to the laboratory can be
obviated by opening a sample collection counter in the outpatient
service area itself.
It should be located in the
outpatient department itself.
The design of this area should include waiting room for patients,
venipuncture area and specimen toilets separately for male and
female patients, along with provision of containers with appropriate
preservatives and keeping record of each patient.
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107. In a small hospital, the laboratory facility consists of a
room in which all the routine urinalysis, hematology and clinical
chemistry investigations are carried out. As the hospital size
increases, the requirement of technical and administrative
services also increases with the necessity for departmentalization of
the laboratory.
• The requirement of spacefor the laboratory consists of:-
Primary space: This space is utilized by technical staff for the
primary task of carrying professional work.
Secondary space: it is utilized for all supportive activities.
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108. Administrative space, i.e. Offers for the pathologists and others, staff
toilets etc.
Circulation space: It is the space required for uncluttered movement
of personnel and materials within the department between
various technical work stations, rooms, stores and other auxiliary
and administrative areas.
Laboratory space unit (LSU): It is a module of space and all
calculations for technical work areas and some auxiliary area are
based on LSU. For allocation of primary space, one of the most
suitable sizesof a LSU is one measuring 10‟ x 20‟ giving a LSU
module of 200 sq. ft. a rectangular module is functionally more
efficient because in the same overall space, it can accommodate
longer runs of benching due to its longer perimeter
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109. Structural flexibility should be achieved by use of
movable or adjustable benching systems in association with an
installation of service mains that has been designed to permit the
repositioning of outlets.
The administrative area(the
area is the central collection point for receiving specimens and is
the reception and interaction area for patients and hospital
staffs) is separated from the technical work area so that the
non-laboratory personnel need not enter the technical areas.
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110. This is the area should be well
ventilated and lighted, should have a chair where the patient can
sit in comfort and where his arm can be stretched for the
phlebotomy, a bed where the patient can lie down for pediatric
collection or aspiration cytology.
This systemis used to trace the
samples.The sample is received and then bar coded, and then
sent to processing area. This protects patient identity
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111. It is provided for the collection of urine and stool
specimens. Pathologist office: it is so placed that the pathologist
can have an easy access to the technical areas particularly
histopathology unit.
Small labscollect blood in bottles
that are washed and reused. This is partitioned into washing and
sterilizing area, containing sterilizer, pipette washer and sinks.
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112. The reports should be issued in printed format. The
hospital lab software can be made as per the requirement ofthe
hospitals.
It includeswater, gas and compressed air
systems.Piping systems should be easily accessible for maintenance
and repairs with minimum disruption of work.For safety purpose
and to facilitate repairs, each individual piping system should be
identified by color, coding or label.ing
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113. a. Work benches: The height of the work bench on which the
technicians sit while working (revolving stools) vary from 75-90 cm
depending upon the height of the workers.
b. Lighting: Natural light should be used to the fullest. Each work
bench should be provided with adequate electric points especially
fluorescentfixtures that give uniform illumination and minimize heat
c. Storage: Each laboratory bench length should have storage space
for reagents,chemicals, glass wares and other items, provided in
the form of under benchdrawers, cupboards etc.
d. Partitions: it may be required between some laboratory spaces.
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114. e. Air conditioning: Whole or at least histopathology section of the
laboratory should be air conditioned due to accumulation of
formalin vapors or else a powerful exhaust system should be
installed.
f. Working surface/ flooring: the surface of work benches should
be resistant to heat, chemicals, stain proof and easy to clean. Floor
should be easy to clean, and not slippery. Flexible vinyl flooring is
preferred for laboratory floor coverings.
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115. • Staffing: The hospital laboratory services should be under the control
and direction of a doctor with qualifications in pathology or a PG
degree in the new discipline of “laboratory medicine”.
• Number of personnel: Staff requirement of laboratory technicians
can be worked out empirically on the basis of generally accepted
norm which is about 30 tests per day per technician.
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116. Equipments: Some of the core instruments that are needed are:
 Colorimeters/ spectrophotometers: They were used in old days, are now replaced by new auto-analyzers these days.
 Auto analyzers: It is used maximum in biochemistry works.
 Cell counter: It gives a more complete blood picture. The principle of the instrument is to pass the cells through a thin
capillary.
 Centrifuge
 Refrigerators
 Pressure sterilizers
 Pipette washers
 Analytical balance
 Semi auto analyzer
 ELISA reader
 Blood gas analyzer
 PCR instrument
 Flow cytometer
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117. Policies and procedures
Samples to be examined falls in two categories:
Samples collected by nursing staffs in nursing units
Samples obtained by lab. personnel.
All requests for lab. Examinations must be in writing.
In the reception area, all samples of blood,
urine, body fluids etc should be received at the reception
counter.Sufficient racks and hand washing facility should be
provided in this area
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118. All request forms should be uniform in size and
contain only pertinent information.
A time schedule for accepting
certain types of specimen will facilitate the operations of the
laboratory.
All specimens sent should be in proper containers.
Instructions on the timeof taking specimens, minimum volume
required, type of container etc. Should be posted at the nurse‟s
station in wards.
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119. The lab. personnel should be responsible
for proper disposition of all specimens and requests within the
lab. to identify the specimen received, the specimen and request
form should be numbered with same numberand is also entered in
the request register.
Lab. personnel should give reports only to
authorized ward/ OPD personnel and never directly to patients.A
daily record register should be kept of all examinations performed
in the lab. In order to maintain a monthly and yearly account of the
work done.
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120. It should be controlled by the officer in
chargeand the technical supervisor, to ensure that all are aware
of the establishment of written procedures for identification of
blood samples, storage facility etc.
It is necessity in large hospitals where the
volume of workload from outpatient department is considerable.
Necessary safety precaution should be clearly understood by
all concerned while drawing blood samples from suspected HIV and
hepatitis patients.
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121. Differences between the patients lab. reports
as compared to their clinical status arises which should be discussed
in the medical audit committee.
The in charge should discuss
professional, technical and administrative matters concerning the
laboratory during periodical meetings with staff.
• The lab. policy must lie down that all staff is cross-trained to
work in all the different sections of the laboratory.
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122. Histopathology and microbiology laboratory waste
be considered as hazardous waste and should be disposed
accordingly.
To better utilize the
laboratory services, a constant emphasis is needed on ordering only
the appropriate tests required for diagnosis or prognosis based on
clinical judgmentand filling the required forms completely.
As a part of quality control function, standard
operating procedure should be laid down by the incharge pathologist
for each function and each functionary in the laboratory
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123. EMERGENCY SERVICES
• An emergency department must be developed as a mini
hospital within a hospital i.e. Independent and self sufficient in
day to day working
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124. Planning and organizational considerations
There are two essential location requirements:
It must be on ground floor and easily accessible to both
ambulatory and ambulance patients, and there should be minimal
separation between it and radiology department.
Secondly, the emergency department should have ready access
to the acute patient care areas, eg. Operation theatre, ICU, blood
bank etc
• Emergency department must be designed;usually 1000 sq.ft is
required for daily patient load of 100 patients
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125. A store for stretcher, trolley
and wheelchairs should be located adjacent to the entrance.
An equipped room
of about 10 m2 near the entrance hall with attached toilet serves the
needs of above personnel.
It should be spacious with enough room for personnel
and patients.
The main
function of this is to be the passageway to patient examination and
treatment area.
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126. Patient relatives should not be
allowed in the work areas of emergency department. Waiting
room with recreational facilities may be provided.
It should be provide near the main waiting space.
This should be next to the
entrance and manned on 24 hr. basis. It should be provided with
multiple telephones, bulletin board with duty roster of doctors on call
and directive pertaining to the emergency department should be
displayed.Nurses work room should be well stocked with drugs, IV
fluids.
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127. This area should always be in readiness to
receive patients at all times, and should consist of a large room and number of
separate smaller rooms for examination and treatment.It should be well
illuminated space with oxygen supply, resuscitation equipment, suction,
portable X-ray, electrocardiographs, and Boyle‟s apparatus.
Stretchers
On-the wall oxygen unit
On-the wall suction unit
BP apparatus, otoscope, stethoscope, opthalmoscope etc.
Spot lights
Utility table
Airways and resuscitation bag
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128. The patient is to be stabilized in this room before shifting to
treatment or recovery room, or to ICU or nursing unit.It should be well equipped
with resuscitation equipment, ECG machine and X-ray viewing screening with
facility for performing minor operative procedures.
A self sufficient operation room to serve patients who need
minor surgery and no admission or who are critically ill etc. in emergency
department.
A separate fracture room equipped similar to OT and additional
facilities for reduction of closed fractures under local anesthesia can be
planned with hospitals with turnover of emergency patientsin excess of 15,000 per
annum
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129. It is needed for treatment of fractures and application
plasters.
A separate room with 20 m2 area should be reserved
for immediate care of burn patients. An observation ward of about
6-8 beds for patients to be kept under observation overnight or
24 hrs.
For obstetric patients, pediatric patients
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130. These should be planned based on the local needs:
Room for dead bodies
Pantry-7 m2
Storage space
Utility and soiled linen room-7 m2
Cleaners room-house keepers room 4m2
Change room duty rooms 9m2
Conference room and reference library 8m2
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131. Staffing pattern
• Full time emergency physicians, especially trained in emergency
medicine
• A well staffed emergency department needs 8 nurse shiftsof 8 hours
each per 100 daily patients‟visits. Additional staff nurses is
required if there is observation ward attached.
• For registration and records, usually 3 clerks work in day and
afternoon shift, and one during night
• Security should be available round the clock
• Public relations and social worker should be available to take care of
the anxious and disturbed patients and their relatives
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132. Medico-legal aspects of emergency department
It is the breach of duty owed by a doctor to his
patients to exercise reasonable care/skills resulting in some bodily,
mental or financial disability.
According to the recent supreme court
decision, no doctor can refuse giving first aid treatment to accident
victims or any other patients.
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133. Medico-legal aspects of emergency department
A written consent must be obtained from the patient to
treat him, with the patient‟s knowledge regarding procedures.
Medical records and proper record keeping are high
priority in any hospital. Proper documentation of patient‟s case history
with informed consent is necessary.
All medico-legal cases e.g. Assault and battery,
child abuse, accidents etc. Should be reported to proper authorities e.g.
Police. The cases of AIDS and venereal diseases should be reported to health
authorities.
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134. BIBLIOGRAPHY
• A.G Chandorkar. Hospital administration and planning. 2ndedition.
Paras medical publisher. NewDelhi. 2009.pg no. 67-72,153-166,167-
179,181-195.
• B.M.Sakharkar. principles of hospital administration and planning.
2ndedition. jaypee brothers medical publishers ltd. 2009. pg.no-195-
207.
• D C Joshi, Mamta Joshi. Hopsital administration. Jaypee brothers
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