Engineering services are perhaps the most vital of the utility
services in the hospital. The efficiency of entire patient care
delivery system of the hospital depends on their efficiency. Even
the slightest breakdown of power supply system, information
system communication system or malfunctioning of vital
equipment can have catastrophic effects.
SCOPE OF ENGINEERING SERVICES
• Civil assets
• Electricity supply
• Water supply including plumbing and fittings
• Steam supply
• Central medical gases, air and clinical vacuum delivery system
• Air conditioning and refrigeration
• Lifts and dumb waiters
• Lightning protection, structured cabling
• Communication system (public address system, telephones)
• Non-conventional energy devices
• Workshop facilities for repairs and maintenance.
• Engineering service is one single department on which depends
the efficiency of each and every department and each and
every member of the hospital staff. Even though it is a
department that generally does not come in the lime light for
any credits, in view of its crucial role it would be more
appropriate to call it an “Enabling Service”.
• This is the department that is responsible for soundness and
integrity of the buildings, power and water supply, air
conditioning, communication, transportation, functioning of all
the equipment, and prevention of most of the hazards. Any
break in any of the services may spell a disaster of some kind or
• To manage the engineering services, with full efficiency and
effectiveness, the hospital requires a full department of
• FUNCTIONS OF MAINTENANCE
• Building operation and
• Mechanical & electrical
• Landscaping & ground
• Lift maintenance
• Plumbing, water supply & sanitary
• Carpentry, painting & signage
• Central medical gases
• Repair of non-medical equipments
• Fire prevention, fire detection &
• fire fighting methods and devices
• Electrical system including
• equipment,machinery, lighting,
• emergency generators
• Equipment and instrument
• Equipment control and pre-
• acceptance evaluation.
• Preventive and corrective
• CIVIL ASSETS
• • Indian Standard states that the total area to be provided for a hospital complex
• shall depend on the availability of land & recommends an area of 1
• hectare(10,000 sqm) for every 25 beds.
• • Total land area of MSRH is 40,8005 sq ft.
• • Civil assets of a hospital complex consists of the land on which the hospital
• premises stand, the hospital buildings and several others that serve it, the roads
• and pathways, and the general environment created around the buildings
• bounded by the compound wall.
• • Hospitals are planned in accordance with norms, standards and prevailing laws.
• • Circulation areas such as hospital streets, corridors and passages, entrance
• staircases and lift lobbies inside hospital buildings account for 30 % of total floor
• PHYSICAL ENVIRONMENT
• • LIGHT-Maximum availability of day light.
• -Light control in patient rest area.-Sufficient illumination in varied floor
• • COLOUR -Color should be soothing but bright.
• -Match with nature of activity -Should not reflect the light.
• • SOUND -Noise to be avoided -Soothing, low volume music system
• • TEMPERATURE -Temperature to be maintained within comfort level
• to 32◦c
• • HUMIDITY – acceptable limits as regard static electricity and comfort
• 45-50%. For new-born and premature infants 55-65% is desirable.
• ELECTRICAL SUPPLY
• • Electrical energy is an essential source of power, the
• around which almost all functions of a hospital revolves.
• • This system is used for environmental control including
• HVAC, heating & cooling water, lighting, cooking,
• refrigerating & operating all type of medical facilities.
• • Provides emergency services to supply power to
• critical areas of hospital.
• • Its proper maintenance necessary for safety & reliability.
• • Hospital loads are generally classified as essential & non-essential. Essential
• powered by standby generating sets.
• • in single phase 2 wire system, the standard voltage is 240 V.
• • When the supply voltage level is above 415V, the voltage will need to be stepped
• down before the electricity can be used. For this purpose
• Transformers are used.
• • A hospital distribution system is likely to have the following :
• o HT side of sub-station
• o LT side of sub-station
• o Main LT distribution panel
• o Distribution boards and Sub-Distribution boards
• o Points of consumption
• • Distribution cables are used to distribute electric power from hospital substations.
• • Additional power supplies :
• o Stand-by diesel engine-driven generating sets supply
• o Emergency batteries supply
• o Uninterrupted Power Supply system
• • The UPS system depends on a fully charged battery bank for instant power supply in
• case of mains failure. These batteries are on continuous charge from a powerful
• battery charger unit in UPS. When mains power disappears, these batteries supply
• DC power to an inverter in UPS which changes the DC voltage to AC voltage at the
• correct level.
• • Backup power period depends on the number & capacity of batteries.
• • Earthing is a requirement as per Indian Electricity Rules, 1956.
• • Equipment earthing is the connection of non-current carrying metallic parts of the
• eqmt with the mass of the earth using a metallic conductor of negligible resistance.
• This will ensure immediate discharge of energy to earth without causing any harms
• to persons at any time.
• ELECTRIC INSTALLATIONS
• • Avoid physical and mechanical pressure on cables. Cables to be laid on
• trays to avoid direct pressure.
• • Joints and terminals must be tightly secured and sealed to avoid heating
• and sparking.
• • Circuit breaker be used to avoid high voltage serge-Loose connections,
• plugs must be regularly repaired. Do not use bare wire into sockets.
• • Ensure proper earthing of all equipments.
• • Heating appliances, lights, fan & AC to be switched off when not in use.
• • Power grids, junction boxes, generators must be regularly inspected and
• • Use UPS/ voltage stabilizer to ensure constant supply to sensitive
• gadgets.-There should not be any loose or hanging wires.
• WATER SUPPLY
• • Hospitals need supply of cold water, hot water, soft water, distilled water &
• pure water for medical purposes.
• • Water is also required for the cooling systems of equipment, for steam
• generation, for plants & gardens & for fire fighting when it strikes.
• • Sources of water supply could be local civic body, borewells
• or dug wells.
• • Water hardness is an imp factor to be considered.
• • Soft water is preferable for use in sterilisers, CSSD, n others.
• • Disinfection of water normally achieved by Chlorination.
• • Hospital water requirements (301-750 bedded) – 450 liters/
• • Centralised water pumps used, located half a feet away from s
• • Centralised water pumps used, located half a feet away from
• • Pipes made of galvanised iron & PVC.
• • Water is also treated by RO plant which works on Reverse
• which is capable of of a high degree of filtration.
• o This process employs cellulosic polyamide & specialty polymer
membranes to rid
• water of dissolved salts, bacteria, pyrogens & organic.
• • Water storage :
• o underground storage pump
• o Overhead tanks
• o Pumps to pump stored water to overhead storage tanks.
• Hospitals have a multi-dimensional role of providing a safe &
• environment to the patients , visitors & staff. Various areas of the
• hospital require different air pressures, temperatures, humidity,
• filtration & circulation.
• Specified range of temperature & humidity is required for effective
• functioning of hospital equipment. It is thus essential that heating,
• ventilation & air conditioning(HVAC) is done scientifically.
• Need for HVAC :
• • Minimizes the risk of transmission of airborne pathogens.
• • Facilitates restriction of air movement through n btw various depts.
• • Provides different types of temperature & humidity
• • Facilitates ventilation & filtration to dilute & remove contamination
• Components of HVAC system :
• • Outside air inlet or intake filters
• • Humidity modification mechanism
• • Heating & cooling equipment
• • Fans
• • Ductwork
• • Air exhaust
• • Grills for proper distribution of air
• • Controls & switches
• • Electricity supply system with DG set backup.
• • The essential components of an air conditioning plant are the
• and AHU. It has air filters, cooling coils and air blowers.
• • Air ducts convey the air to and from AHU.
• • Cooled air produced in refrigeration unit is transferred either
• Directly to circulating air – DIRECT EXPANSION SYSTEM
• To circulating water – CHILLED WATER SYSTEM
• • The cooling of circulatory air occurs in the Air Handling Unit(AHU).
• • In MSRMTH Chilled water system is mainly used.
• • Direct expansion system ACs used mainly in administrative office.
• • 3 types of Air filters used
• Coarse filters – to prevent large particles; efficiency is 90% down to 5-
• Micro fine filters – filters upto 5 microns; 99.9% efficiency
• HEPA – filter upto 0.3 microns with 99.97% efficiency
• • The first HEPA filter was designed in 1940s by the research &
• development from Arther D Little under a classified government contract
• as part of the Manhattan project to prevent the spread of airborne
• radioactive contaminants.
• • It was commercialized in the 1950s,
• • HEPA (high efficiency particulate air) filter is defined as a throwaway, extended-
• media, dry type filter with a rigid casing enclosing the full depth of the accordion
• type pleats.
• • The diameter specification of 0.3 um corresponds to the most penetrating
• particle size (MPPS); it implies that particles smaller and larger than this, are
• trapped by the HEPA filter with greater efficiency.
• • HEPA is used mainly in OT maintained at a temperature of 22 °C.
• • In ICUs temperature is maintained at 23° C.
• • Only soft water is to be used.
• • Monthly maintenance done.
• • Quarterly preventive maintenance done.
• CENTRAL MEDICAL GASES
• INTRODUCTION :
• In modern hospitals,medical gases are a vital life supporting measures &
• there is no substitute for them in the hospitals. In the past, therapeutic
• gases were not recognised as an independent entity in majority of the
• They existed as a part of medical store dept but now it has become an
• indispensable part of the critical care & extensively used for advanced
• anesthesiology. This system has now acquired greater independence & is
• known as “Manifold Room”.
• Oxygen therapy was introduced in 1867.
• In 1935, the piped gas supply system was introduced in St. Mary
• • Medical gas services include :
• Medical Oxygen
• Nitrous Oxide
• Medical air
• Anaesthetic gas scavenging disposal system
• • Oxygen is extensively used throughout the hospital, but Nitrous Oxide is
• mostly required in OTs & surgeries.
• • The manifold system controls the duplexed banks of gas cylinders & has
• automatic changeover device which is set to function with both the banks
• of cylinders opened for use.
• One bank will be in “Running mode” feeding the pipeline while the
• bank is held in “Reserve mode”.
• • Centralized gas and vacuum supply service is a modern system of piped supply
• medical gases from a central storage area called manifold room to all delivery
• in hospital
• • It provides a very efficient, economical and highly dependable life support
• • Makes better patient care in all the areas of hospital.
• • Supply of right medical gases at right pressure
• • Supply of compressed air at right pressure
• • Supply of clinical vacuum at right pressure
• • Proper planned maintenance of all equipments, including distribution network
• • Optimum level of cleanliness and pollution free environment
• • Prevention of hazards such as fire, explosion or contamination of gases
• • Source of supply: Central supply room with control equipments and panels
• • Distribution system: piping
• • Point of use delivery connections: Suitable station outlet valves and pendants
• • Monitoring and control equipment and alarms.
• MANIFOLD ROOM
• • Consists of a cylinder manifold and a control panel.
• • Control panel: primary and secondary pressure regulators; warning lamp.
• • Vacuum Unit
• – Vacuum pump with an electric motor
• – Cylindrical reservoir tank: stabilizes the pressure of the pipeline system at all
• outlet points
• – Motor has switch for automatic start and stop
• Compressed air unit
• – Compressor with electric motor, after cooler, air receiver and air dryer
• – Instantly provides compressed air
• • Oxygen and nitrous oxide should be stored separately from flammable
• • Storage location should be free of combustible materials
• • If exceeding 2,000 cubic feet storage should be outside the building
• • Must have generator backup, adequate ventilation, lighting and
• Visual warning signals(alarm system) are present to indicate that 1
• cylinder bank is empty.
• COMPRESSED AIR UNIT
• • Primary use is for inhalation therapy in OTs, surgeries & ICUs.
• • Used to run ventilators,run orthopaedic drills & other pneumatic
• • Compressed air unit consists of
• an electrically driven compressor
• after cooler
• air drier
• air receiver
• VACUUM UNIT
• • Extensively used in most treatment areas,OTs,surgeries & in
• • It serves to remove fluids from incisions & body cavities & is used in
• operative drainage.
• • it consists of an electrically driven vacuum pump to create a pressure
• much lower than atmospheric air pressure in a reservoir tank. This
• vacuum creates a “suction ” effect at the patient’s end.
• • The unit operates automatically starting or stopping as required by
• means of a negative pressure switch & the vacuum pump can create a
• high vacuum.
• Liquid medical Oxygen supply system
• • A liquid oxygen supply system provides a centralised, convenient %
• reliable method of storing Liquid Medical Oxygen to supply gaseous
• oxygen to a hospital administration system.
• • Liquid oxygen vessels should be located in the open & surrounding
• should be so controlled that no combustible materials or naked lights are
• allowed within a distance of 6 metres.
• • It consists of
• Vacuum insulated evaporater
• Vaporiser system
• Oxygen delivery control panel assembly
• DISTRIBUTION SYSTEM
• • Consists of piplines, pipeline fittings & valves.
• • Pipes made of copper.
• • The pipelines are surface mounted at a height of 7 ft.
• • Jointing of pipelines done with silver brazing to obtain a
• • Branch lines provided with stop valves.
• • Colour codes :
• Oxygen – white
• nitrous oxide – navy blue
• vacuum – yellow
• air – white & black
• TERMINAL UNITS
• • Gas outlets / vacuum inlet units
• • Connected to source equipment through the distribution system
• • Located at actual usage point
• • Outlets should be gas specific and non-interchangeable
• • Fitted with locking system and non-return valves.
• • permit the supply of medical equipment with medical gases and
vacuum from the
• central gas supply system.
• ALARM SYSTEM
• • Audio-visual
• • Monitoring of pressure
• • Meant to warn maintenance dept
• FIRE SAFETY
• Main considerations for fire safety in hospitals are:
• • Prevention of fire through proper design and construction.
• • Provision of smoke/fire detection alarms, restriction of spread and extinguishment systems.
• • Life safety : transfer of occupants to areas of refuge or evacuation of the building.
• CLASSIFICATION :
• A – grade fire : caused by ordinary combustible material. Extinguished by soda acid, water, CO2, dry
• chemical powder etc,..
• B – grade fire : caused by inflammable liquids. Extinguishers like foam, halon and dry chemical
• powder should be used.
• C – grade fire : caused by electrical faults either in fittings or distribution points.
• D – grade fire : Fires involving combustible metals such as magnesium, sodium, potassium, titanium,
• and aluminum. Special dry powder
• extinguishing agents are required for this class of fire, and
• must be tailored to the specific hazardous metal.
• K – grade fire : Fires involving commercial cooking appliances with vegetable oils, animal oils, or fats
• at high temperaturesl
• Restriction of fire spread
• • Compartmentalisation of building must be ensured.
• • Air conditioning duct should be provided with dampers/stoppers. Dampers are
• installed to stop or to restrict the flow of hot gases/flames from 1 compartment to
• • Atleast two areas of refuge should be provided in each horizontal plane. The initial
• movement of patients for evacuation should be horizontal.
• • There should be atleast 2 approved exits on each floor with area more than 500m2.
• • Corridors should be atleast 2.4m wide clear of any obstruction & well lit with
• adequate sign boards.
• • The high fire hazard areas of the hospital like boiler room, laundry, gas supply should
• be located such that in case of a fire in any of these, it does not affect wards, OTs &
• other risk areas in the hospital.
• • For building more than 15 m high, mandatory fire protection guidelines should be
• complied with.
• Building Elements
• • Floor materials shall be easily cleanable and appropriately wear resistant for the
• • The floors should be non-slippery, when wet, withstand intensive application of water
• and disinfectants, not absorb physically foreign molecules, have a high resistance to
• • Conductive flooring in areas where electronic equipments are used.
• • Steps, stairs and handrails should not be made of slippery material. Hard, level, non-
• skid surfaces are essential.
• • Minimum ceiling height – 2.4m
• • Elevators be arranged in groups of 2 or 3. capacity of 544 kg for 8 passengers.
• clear door opening – 800mm(w) * 2000 m(ht)
• • Dumbwaiters – capacity of 50 kg.
• • Doorways – 86 cm clear opening width
• Sanitary equipment – wash basins at comfortable working height.
• there should be no water closet without a wash basin.
• Containers for paper seat protectors, soap, paper towel
• Grab bars next to water closet.
• • Communication system
• Public address sysstem to cover whole hospital
• Music system to provide piped music to selected areas
• staff calling system
• telephone and intercom
• Close circuit television and master antenna television.
• • Emergency exits – clearly labelled.
• Hospital safety
• • Fire – emergency exits. Escape routes fire protected and smoke free by means of
• horizontal and vertical passageways.
• • Flood – hospital building should be sited above the highest flood level with raised
• plinth for eventual safety from getting submerged.
• A lump at direct entrance to basement to prevent ingress of floodwater.
• Non fuctioning of sewage and storm water disposal system another factor.
• • High wind and earthquake
• All multi storeyed buildings are required to be designed to withstand the effect of
• strong gale and seismic forces as applicable.
• IS recommends the use of equivalent static method to arrive at wind force upto
• height of 40m. Height to width ratio of < 5.
• earthquake – length to width ratio of not exceeding 3.
• • Blast