Presented by: Ms. Blessy Abraham M.Sc. Nursing 2 nd Year

1. Seminar on:Planning and Organizing Hospital Units and Ancillary Services (specifically CSSD, Laundry, Kitchen, Laboratory services, Emergency department) Presented by: Ms. Blessy Abraham M.Sc. Nursing 2nd Year

2. Introduction

3. Terminologies: • Ancillary: helping in a subsidiary way. • Viability: practicability • Corporate: shared by members of a group or united in a group. • Conceptualization: forming a concept about something.

4. Meteorological: conditions related to atmosphere and weather. • Proximity: nearness • Catchment area: an area from which a hospital draws patients. • Auxiliary: services that provides support or help. • Strategy: the planning and directing of the whole operation, a plan or policy.

5. Procurement: obtain or acquire things with effort. • Sluicing: a channel carrying off water. • Entrepreneur: persons who organizes a commercial undertaking especially involving risk.

6. PLANNING AND ORGANIZATION OF HOSPITAL UNITS

7. 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 • Modernization of the already existing facilities • To reduce the cost of operations and maximize efficiency of services.

8. Guiding principles in planning: • Patient care of high quality: • Provision of appropriate technical equipments and supplies. • An organizational structure that assigns responsibility and requires accountability for various functions within the organization. • A continuous review of adequacy of care provided by physicians, nursing staffs and paramedical personnel.

9. Effective community orientation: • A governing board made up of persons who have demonstrated concerns for community and leadership ability. • Policies that assure availability of services to all people. • Participation of the hospital in community programmes to provide preventive care.

10. Economic viability: • A corporate organization that accepts responsibility for sound financial management in keeping with desirable quality of care. • A planned programme of expansion based solely on demonstrated community need. • An annual budget plan that will permit the hospital to keep pace with times. • Orderly planning • Selection of a site large enough to provide for future expansion and accessibility of population. • Recognition of the need of uncluttered traffic patterns within for movement of staff, patients and visitors and efficient transportation of supplies.

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.

12. Classification of hospitals: On the basis of agencies that finance them: • Government or public hospitals • Non-government hospitals On the basis of ownership: • Private (personal) • Partnership • Private (family) trust • Public charitable trust • Cooperative society • Private limited company • Public limited company

13. Hospital planning process: • Conceptualization of hospital • Support groups • Temporary organization and securing funds • Geographical, environmental and miscellaneous factors: • Meteorological information • Geographical information • Miscellaneous availability

14. Hospital design: • Bed planning • Hospital size • Land requirements • Public utilities: the national building code of ISI suggests 455 liters of water per consumer per day (LPCD) for hospitals up to 100 beds and 340 LPCD for hospitals of 100 beds and over.

15. Circulation routes: • Internal circulation: 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. • External circulation: only one entrance to the hospital for vehicular traffic from the main road is desirable.

16. 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, by constructing multistoried as they are convenient due to compactness as compared to horizontal development of hospital. • Separate parking for 3-wheelers and scooters, employees and staff parking areas separate from public parking should be considered.

17. Zonal distribution and inter-relationship of departments: • The departments (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.

18. Gross space requirements: gross total area (building gross)-780-1005 sq ft, add walls, partitions: 95-125 sq ft. The bed distribution is calculated as: Bed : population= A x S x 100 365 x PO A= number of in-patient admissions per thousand population per year S= average length of stay (ALS) PO= percentage occupancy

19. Medical: 30-40% • Surgical: 25-30% • Obstetrical: 15-18% • Pediatric: 10-12% • Miscellaneous: 10-15% (including eye and ENT)

20. Climatic consideration in design • Equipping a hospital: • Physical plant • Hospital furniture and appliances • General purpose furniture and appliances • Therapeutic and diagnostic equipments • Cost evaluation of construction of hospital

21. Planning and organization of the OPD: • Location • Space: Generally 0.66-1 sq ft area per annual outpatient attendance should be provided for OPD. • Size • Zones: • Functional zone • Administrative zone • Diagnostic and supportive zone • Ambulatory zone • Staff zone

22. Functional management: • OPD timings • Records • Public relations • Facilities in OPD: • Staffing of OPD: 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 worker.

23. Planning and organization of Wards: Types of wards: • General wards • Specific wards • Units with specialist nursing, treatment and equipment

24. Ward planning: • Physical facilities: • Size of ward: 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. • Patient housing area: • The area per bed within the ward is 80 sq 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 31/2 to 4 ft.

25. Clearance between wall and side of bed is 2ft. • Length of bed is 6’6”, width of the bed is 3’. • Size of rooms: • 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

26. support service area: • Nursing station/duty room • Treatment room • Clean work room • Pantry • Unit store • Sanitary area • Auxillary areas

27. Ward design: • Open ward • Rigg’s ward • Unilateral rigg’s ward • Bilateral ward • T-shaped ward

28. NS • OPEN WARD • RIGG’S WARD NS

29. NS • RIGG’S UNILATERAL WARD RIGG’S BILATERAL WARD WARD NS

30. Ward management: • Strategic management • Operational management

31. Planning and organizational consideration of CSSD

32. Central Sterile Supply Department (CSSD): 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.

33. Planning 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.

35. Areas are to be provided in CSSD: • Equipment storage room • Receiving counter and clean up room • Needles and syringes processing room • Gloves assembling room with rubber goods processing room • Clean work area including sterilizers • Sterile storage area and issue counter • Gauze and dressing assembly area

36. Percentage distribution of the space : • 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 expansion

37. Layout: • 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.

38. 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.

39. Layout of CSSD: Separation of sterilized items by a partition or corridor Counter of receipt of used items Decontamination and cleaning area Processing Packing of items Sterilization Distribution point Sterilized items store

40. Area requirements: 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.

43. Staffing pattern: 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

44. Equipments and materials required: • 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

45. 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

46. Methods of sterilization: • Steam sterilization • Hot air sterilization • Gas sterilization with ethylene oxide • Sub atmospheric pressure sterilization with formalin • Chemical sterilization with activated glutaraldehyde • Gamma irradiation sterilization • Formaldehyde steam sterilization

47. Inventory management: • Stock: • Issue of materials • Distribution of sterile items • Grocery system • CSSD is open for limited hours: • Clean for dirty exchange system • Milk round system • Basket system

48. Quality control methods: • 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.