Académique Documents
Professionnel Documents
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2.0
2.1
22
Objectives
Introduction
Air-conditioning and Refrigeration
2.2.1
2.2.2
2.2.3
2.2.4
2.2.5
2.2.6
2.2.7
2.2.8
2.2.9
2.2.10
2.2.1 1
2.2.12
2.2.13
2.2.1 4
2.2.1 5
2.3
Maintenance Categories
Coinparison of Activities
Design Out Maintenance
Contract Maintcnancq
Requirements
Walk Around Inspection
Maintenance Spares and Stores
Requirement Analysis
Procurenlent
.Storage and Preservation
Workshop Facilities
2.6.1
2.6.2
2.6.3
2.6.4
2.6.5
2.7
2.6
Energy Conservation
2.4.1
2.4.2
2 3
2.4.4
2.4.5
2.4.6
2.4.7
2.5
Air-conditioning Plant
Central Chilled Water System
Testing of the I'lant
Powcr and Water Requirements
Fire Dampers
Air Filtration '
Air-conditioning of OT
Caution and Co~nmonMibtakes
Winter Heating
Desert Coolers
Refrigeration
2.4
Air-conditioning
Air-conditioned Areas
Temperature and Humidity
Air-conditioning Load. Factors and Design Parameters
Workshop Sectioils
Trades
Tradesmen Strength
Tools and Work Materials
Workshop Management
~ n ~ i n e e r Services
in~
Department
2.7.1
2.7.2
Types of Equipment
Engineering Services Department
2.7.3
2.7.4
2.7.5
2.7.6
2.7.7
Let Us Sum Up
Answers to Check Your Progress
Further Readings
2.8
2.9
2.10
Functional Aspects
Engineering Specialities
Structure o f the Department
Statling Pattern
Control and Responsibilities
2.0 OBJECTIVES
After studying this unit, you will be able to:
a
understand the need and the role of hospital engineering services department; and
2.1 INTRODUCTION
This unit is an extension of the previous Unit and you will learn about certain allied services
which are basically engineering in nature and factors governing them.
While going through the preceding Unit, you must have become aware of the basis of the
subject.
In this unit, you will learn about the engineering services department and how it can become
the hub activity of all Engineering Services. In the beginning of the unit you will learn about
the air-conditioning and refrigeration in a hospital. Thereafter you will learn about nonconventional energy devices for conservation of energy in a hospital set up. Further you will
learn about the maintenance operations and stores management including workshop facilities
and engineering service department.
2.2.1
Air-conditioning
Air-conditioning is the act of creating an artificial climate by making the airjust right for use
in a building by making it colder or warmer, by drying or moistening it and by cleaning it. Airconditioning therefore controls temperature, humidity,cleanliness and movement of air in
such a manner as to assist patients in recovering and equipment in functioning sgtisfactorily
with the desired accuracy. It is a common practice to refer to this activity as heating,
..
ventilating and air-conditioning, or HVAC for short.
Hospital Enginetri.g
Services
1-fi.K:
Temp. "C
(2 (o F)
(OF)
26.1 (79)
24.0
23.a(7i.s)
RH %,
21.3
Those with hyperthemia need a cool room with low humidity level
Dry conditions are not favourable to the ill and debilitated. It contributes to secondary
infection.
In case of air-conditioning for equipment areas, the inside conditions should be decided in
direct consultation with the suppliers of the medical equipment at the time of
procurement.These conditions differ as the examples in the following table show:
Temperature and RH Environment Examples for Medical Equipment
Equipment
Make
Temperature Range
RH
RadiographylFluoroscopy
Siemens
30 to 75 %
GE
20 to 80 %
Siemens
55 to 65 %
GE
10 to 2 1C (50 to 75F)
30 to 60 %
GE
22 to 25C (7 1 to 75F)
30 to 70 %
Varian
15to80%
Siemens
35 to 7 0 %
GE
40to70%
Picker
30 to 60 %
Linear Accelerator
CT Digital
Ambient conditions at numerous cities have been recorded for several years and have been
mderated to arrive at the values suitable for adoption in air-conditioningcalculations. The
following table is an illustrative example and highlights-thenecessity for air-conditioning
when co-related with the conditions for human comfort and equipment operation:
Ambient Conditions adopted in Air-conditioning Calculations
Location
Place
Monsoon
Summer
Winter
Calcutta
37.8 (100)
49
32.2 ( 90)
85
13.3 (56)
55
Chennai
16
39.4 (103)
41
28.3 ( 83)
88
18.3 (65)
60
2.2.4
Conducted load: Heat from outside in case ofsummer cooling and heat from inside in
case of winter heating is conducted by walls, floor and mof. This is greatest in case of
exposed roofs.
Occupancy load: Persons inside the air-conditioned space give off heat which depends
on the degree of their activity.
Lights and user equipment load: Lights emit heat and all equipment give off heat when
in use.
Ventilation load: All materials exude smell which should be expelled. Occupants need
oxygen and fresh air. Therefore hot outside air is internationally inducted into the
system which adds to the air-conditioning load. If a quantity of outside air whose
volume is equal to the room volume is inducted every hour, then the number of fresh air
changes would be one per hour. This is actually the practical minimum since opening
and closing of doors results in outside air leaking into the air-conditioned space. In case
of operating rooms, the number of fresh air changes could be 10 per hour or more. It
could even be "all fresh air system", also called "blow through system". This imposes
the greatest load on the plant.
Air-conditioning services design requires the following basic information at the very outset:
Inside temperature and humidity with permissible drift thereon
Number of fresh air changes per hour (or indoor air quality)
Occupancy and their activity level
Users equipment load and details thereof
Number, wattage and type of lights
Air purity level
Working hours per day
Necessity for warmth heating in winter
Further, the following additional information becomes essential in case of hospitals:
Whether positive or negative air pressure is to be maintained in any particular space
Whether re-circulation of air is permissible
Whether all fresh air conditions is inescapable
Whether inside air from a particular space needs to be exhausted to outside safely
Whether air is to move into or out of any specified space
Whether laminar flow conditions are required in any particular space.
Air-conditioning is vulnerable to too many factors having a direct and serious impact on its
performance. One common factor is a half bright - half brown condition about the ultimate
design burdens and the final resultant site realities including usage of space and equipment
therein. More often than not, only rough details of equipment will be available in the
beginning on which the air-conditioning design is finalized. Much later, the parameters get
altered when the actual equipment to be purchased is finalized. It is important that the first
step of defining the design parameters is taken with due care and finalized in great detail.
Based on the design parameters, heat load calculations are carried out for the summer and
monsoon seasons. The higher capacity out of the two is selected. Sometimes the monsoon
load is greater than the summer load.
Water System. In both cases, the cooling of air takes place in a part of the plant called air
handling unit (AHU). The AHU houses the air filter, cooling coil and air blower which
circulates the treated air through the air-conditioned space. Air ducts convey the air to and
from the AHU. For best performance, the air duct length should be limited to 30 m (100 ft).
The DX system plant can handle only one AHU whereas the chilled water system plantcan
have as many AHUs as necessary.
1
I
I
This limitation of the DX system plant to handle one AHU is a disadvantage in case of
hospitals as they will then need several plants working in different places with increased
plant operating manpower. On the other hand, one big central chilled water plant could serve
the whole hospital through several AHUs placed judiciously near to the load points. It
would be advantageous to place areas needing air-conditioning together in a group so that,
inside conditions permitting, one AHU can serve them all effectively.
The air-conditioning plant capacity is specified in tons (or tonnes) of refrigeration (TR). This
actually denotes the heat extraction capacity of the plant and has nothing to do with weight.
One ton of refrigeration is equal to a heat extraction rate of 12,000 BTU (British Thermal Unit)
per hour (3024 kilocalories per hour).
Room air-conditioners (generally called as window type air-conditioners) are a common sight
and come in several capacities starting from a fraction of a TR and extending upto 2.5 TR.
These are DX systems and give comfort cooling. A one TR unit can suffice for a room upto
12 sq m. Multiple units can be used for air-conditioning larger areas. They need electric
supply and a little quantity of water in a small tank to increase their cooling effect. They
condense out moisture from the air which has to be drained out properly. Latest units are
technologically advanced with energy saving devices and attractive looks. Any MCB used
in this electric circuit should be of "G series" with adequate rating. Packaged air-conditioners
are also DX systems with a capacity ranging from 3 to 15 TR. They need electricity and water
ifthe unit is water-cooled. Single units can air-condition much larger areas and multiple units
can be used to advantage.
2.2.6
Th,k is a versatile system and is best suited for hospital use. One single plant can serve the
entire needs of the hospital, thereby cutting down the manpower. Even a big plantcan work
efficiently on part loads as low as 10% and offer huge energy savings. Chilled water pipes ark
adequately insulated and appear huge in size. Each AHU can be specially designed and
selected to perform to meet the requirements of the spaces that it serves. In wards and
common areas, fan coil units can also be used. These are small cooling units upto 2 TR
capacity and are slung from the roof. Like room air-conditioners, these also condense out
moisture'from the air and the condensate will have to be drained out properly.
is effective down to particulate size of 5 microns, one micron being one-millionth of a metre or
one-thousadth of a millimeter. High efficiencyparticulate air filters (HEPA filters) can filter
down to 0.3 microns with 99.97% effiiency. These are very costly and have to be installed
with extreme care as even a pin point puncture will cause an air leak to upset its efficiency
and effectiveness. These are mostly used in operating roomi to eliminate bacteria carrying
particles. HEPA filters have to be replaced at frequent intervals which may not be longer
than six months.
2.2.1 1 Air-conditioning of OT
This is an intricate task the details of which are described in Unit 3 on Operation Theatre,
(Block 1, Course 4).
An oversized plant may not perform satisfactorily if the individual components are not
matched correctly.
Finish of the plant is not upto the mark. Duct and air grilles works areshabby.
.Adequate spares backing is not provisioned. Technical and operating manuals are not
provided.
Areas like OT, ICU, Nursery, Emergency, selected wards, selected areas of pathological
laboratory need heating in winter. This could be achieved by using a hot water generator
and a pump to circulate the hot water through the AHU concerned.
2.2.15 Refrigeration
Refrigeration produces cold, but is not primarily meant to circulate air like the airconditioning plant. So also, the temperatures attained are very much lower than in air.... .
.. . .
. , ,.
,
,
.
"
in pathology and cold storage plants in dietary department, pathology, medical stores and
mortuary. They are sometimes called as "reach-in", "walk-in" and "under-the-counter" units.
They work on electricity and some cold stores of bigger size may need water for condenser
cooling. All these items should be maintained in spotlessly clean condition without any
stains inside and outside. Bottle coolers also may be provided in kitchens and cafeterias. All
electricity consuming apparatus and equipment must have a clear space of at least 60 cm ( 2 ft
) all around to provide adequate ventilation and for ease of maintenance. Refrigerators and
water coolers are no exception. Placing them closer than 60 cm (2 ft) to walls or in a closefitting niches are not good practices and should be avoided. A walk-in cold room for storing
medicines, vegetables, bread, eggs, kitchen left-overs etc. could have a temperature of 4 to
10C (39t050F).
Check Your Progress 1
1)
......................................................................................................................................
2)
......................................................................................................................................
A l l i e d E ~ ~ g i ~ ~ e r r iSnefw! i c e s
Solar (thennal)
Solar (electrical)
Wind (electrical)
4
oriented to face the sun to best advantage throughout the day. Banks of flat plate collectors
connected in series and in parallel will have to be installed in case of hospitals and favoured
sizes are those in the output range of 100 to 160 litrcs per day of hot water each at about 60 to
70C (140 to 158F) during peak sunshine and 30 to 40C (86 to 104OF) during diffused
sunshine hours. Water storage tank supplies water to the collectors at the bottom end and
hot water is tapped off at the top end to be stored in a well-insulated tank. The flow of water
takes place automatically due to the temperature gradient created by the heating process.
Hot water storage tanks should have the capacity to store at least one day's requirements.
Water should not be hard otherwise scaling and clogging of collector passages will occur.
Perforniance of this system depends on the sun strength, rate of draw-off and quality of
~nai~~tetiance
of the collector. To ensure adequate quantity of hot water at the correct
temperature especially on cloudy days or excessive consuniption in early morning hours,
supplementary electric heating has to be incorporated into the system with ther~nostatically
controlled heating elements. All these are generally mounted on roof top of the building and
occupy considerable space. Hot water from the storage tank is brought down by vertical
down-take pipes with a tee off arrangement at each floor. Entire hot water piping is
adequately insulated. In one design, the heat collector-and storage tank are combined into
one nodular unit which saves space.
In the systern described above, water is directly heated in the flat plate collector. An
advanced system employs indirect heating in which a specially developed fluid like
propylene glycol, which is a food-grade, non-toxic heat transfer fluid, circulates in a closed
circuit through the multi-flow collector and becomes hot. This fluid possesses better heat
absorption qualities than water. This hot fluid then circulates through a jacket in the hot
water storage tank and heats the water contained in it. The fluid does not cause scaling of
the collector passages which water will do especially if it is hard. Two layers of protective
ceramic coating line the storage tank to prevent corrosion. This systeln is costlier, but
performs better.
You [nilst go through the infor~uationon hot water supply systeni given in sub-section 3.5.2
of Unit 3 of this block wherein the arrangement for avoiding wastage of hot water is
explained. The same is applicable to this case also.
Whilst their virtues of energy saving and causing no atmosplieric pollution or usage of
oxygen admit of no controversy, they still suffer from the disadvantage of greater
maintenance effort and large space requirement. The inescapable need for supple~nentary
electric heating is also a prominent minus point. Space heating can also be done with the hot
water from solar water heaters, but this would be effective at best for a few hours during day
time in small hospitals.
Allied E n g i n e e l i b p Services
H o s p i t a l E o g i ~ i e e r i ~ lSge r v i c c s
In urban liospitals, where space will be.a ma-jor problem and pollution constraints are severe,
it would appear that solar water heaters located on the terrace of tlie hospital building can
only be used. Power generation through pliotovoltaics will be costlier than with captive
generation and \vould therefore not be an attractive proposit'io~i.
All said and done, one has to accept tlie sad reality that alternative and renewable sources of
energy possessing treme~idouspotential liave not bee11able to make their presence felt for a
long, long time.
Check Your Progress 2
List the non-conventional energy sources that could be considered for use in the
following hospitals.
a)
Rural :
....................................................................................................................
b)
Urban:
....................................................................................................................
2.4.1
Energy saving i s the sure way to reduce expenditure and is essential for hospitals to be
economical and stay competitive. We cannot escape the fact that energy saving is very
much possible at every place and in every function ofthe hospital. Take a simple example to
start with.
~ k a k i tap
n ~is a familiar sight. Water is reaching the tap from the storage tank placed on the
building roof. I t reached the storage tank because a pump pumped it using energy. Thus it i s
energy that i s leaking to waste through the tap. Yet hardly anyone bothers to stop the flow
and loss o f energy even though it takes only a flick o f the wrist. Remember-"Little drops o f
water make the mighty ocean".
I s the temperature in the air-conditioned room too low forcing the use o f blanket?
Are the doors and windows o f the air-conditioned space properly closed? Any window
glass is broken?
Was it necessary to use the lift when the staircase could have been used?
Are high-energy consuming items like heaters, sterilizers, etc. being used optimally and
not unconcernedly?
Answers to these questions should prompt the person to take necessary action that is called
for to stop the energy drain and help the hospital.
Air-conrlitioning: The plant consumes huge amount o f electric power made worse by
prolonged duty hours. I n a system which i s well-designed and cared for, energy saving will
be difficult without compronlising on patient care. In this case, maintenance effort should not
only be i!i the plant room, but also in the air-conditioned spaces to ensure that no
unnecessary loss of treated air and no unaccounted heat gains occur.
Water Supply: Leakage at the tap end has been mentioned, but consider leakages from sumps,
reservoirs and storage tanks and delivery mains. Another common occurrence is the overflow
from the storage tanks. All these fall into the same category of energy loss.
Compressed air, vacuum andsteam: Leakages are generally overlooked or corrective action
delayed as the systems cannot be shut down. Losses are considerable and mount minute by
minute.
There are several serious areas of energy loss which should be tackled at the right time.
Most of them concern planning, design and equipmem selection. Simplest cases are the
following:
Building and environment: Hospitals have considerable areas air-conditioned for technical
and comfort reasons. Proper orientation of the building, use of materials having lower heat
conductivity properties, limiting sizes of glass windows and positioning them where the sun
is not incident on them and so on will reduce air-conditioning and ventilation loads. A good
horticulture and arboriculture effort will also achieve the same results.
Equipment selection: Installing oversized equipment to play safe results in energy loss.
Similarly economizing on pipe or cable sizes to reduce initial costs create eternal energy loss.
Modern technology has many energy efficient items and machines to offer which should be
taken cognizance of for deriving cost benefits.
Operation and maintet~ance:Machines should be operated as stipulated in their manuals by
the manufacturers or suppliers. Incorrect operation is ineff~cientoperation with resultant
energy loss. Unnecessary operation is another huge energy drain. Improper or infrequent
maintenance is an enemy of efficiency and should be avoided.
Life of equipment: Wear and tear is inevitable when an equipment is used. Depreciation is also
inevitable even when the equipment is not used. But an old equipment continues to be used
with a little extra expenditure on repair and maintenance because it is cheaper than the capital
cost of energy efficient niodern equipment. Specialist opinion is required in these cases as to
when a more efficient new one best replaces an existing old item.
Maintknance action
Equipment overload
Check for leakage in air-conditioned spaces, extra equipment load. cleanliness of cooling coils, closed danipers in
ducts, obstruction to air grilles
2.4.7 Caution
Hospitals can and have to reduce their energy consumption and thereby energy expenses
through forcefuI management procedures. But this economy action should not lower the
standards of health care delivery to the patients and should not compromise on comfort,
security and safety. The main theme-behind energy conservation is to reduce waste and
losses, but not to reduce the functional aspects of the hospital.
Check Your Progress 3
2.5.1
Maintenance Categories
.:
Consider the use of a scooter. The seat, handle bar and probably the body are wiped with a
cloth before first use of the scooter on any day. This is routine maintenance. The scooter is
handed over for servicing every month or so. This is planned maintenance. Before
embarking on a long trip, the scooter is subjected to a thorough check and suitable action
taken to replace weak and worn out parts to prevent a possible breakdown on the way. This
is preventive maintenance. A puncture on the way renders the scooter unusable till the
wheel is replaced. This is breakdown maintenance. Replacing of tyres after completion of a
certain mileage would be predictive maintenance. After a long use, the scooter engine is
opened up for de-carbonizing and cleaning of internal pa@. This is corrective maintenance.
Thus we can easily visualize several distinctive maintenancs actions.
Maintenance consists of those activities as are required to keep an asset in "as built"
condition so that it continues to possess its original characteristics. Maintenance results in
the asset being available for intended use at minimum cost, functioning at or near agreed
standards with minimum waste. Importance of maintenance operations have been recognized
as one of the main tools for eficient functioning of hospitals.
Maintenance functions can be considered as follows:
Routine maintenance: This is a procedure followed regularly or as a cyclic operation
recurring periodically. Defects that develop gradualIj1 will be discovered and eIiminated.
Plannedmaintetiance: This is a pre-planned maintenance action carried out with
forethought and with knowledge of the equipment. MostIy it will be based on the
recommendations of the equipment supplier. Periodical servicedike white-washing and
painting of building, cleaning of water storage tanks, touching up of road sign-boards and
the like come under this category. Planned maintenance involves administrative approval and
support, adequate budget and a systematic procedure for implementation.
Preventive maintenance: This pertains to critical system maintenance to reduce the possible
risk of failures to a minimum. Parts and sub-systems which are suspected to be unreliable are
replaced before they actually fail, thus ensuring high reliability but at extra cost.
Breakdown maintenance: This is also called as repair maintenance and the basic concept is
not to do anything until the equipment ceases'to function. No servicing is carried out and
the unit receives attention only after it has failed. The result is wastage of time, energy-and
money.
Predictive mainteriance: Keeping the unit under surveillance and continuously monitoring
its operation, the health of the unit is gauged. Based on how well the unit is performing, and
maintenance is carried out.
Corrective maintenance: A time will come when age catches up with the unit which affects
its performance. At this stage, maintenance is necessary to restore the capability of the unit
to perfonn satisfactory. Sometimes manufacturers recommend a major overhaul after a
stipulated working hours. This tantamounts to corrective maintenance.
Emergerrcy maintertance: This refers to work done on an equipment or facility that involves
personnel safety, extreme material or monetary loss or severe deterioration. This is an
unexpected and unplanned workload requiring prompt notification of occun-ence, rapid
response and immediate action. Subsequent action should be diverted towards ascertaining
the cause and taking effecitve steps to prevent a repetition. '
2.5.2
Comparison of Activities
The following table includes a few maintenance actions under planned and preventive
categories:
Illustrative Maintenance Actions
Preventive maintenance
Item
Planned maintenance
Exterior walls
Roof
Walls. floors,
ceilings
Doors.
windows
Storage tanks
Clean strainers. bottle traps,
and plumbing
filters. Repair leaky taps.
Adjust and halance water flows.
Check expansion tanks and
pressure vessels. Check storage
does not overflow. Stop pipeline
leaks and ensure fluid flows
..
Planned maintenance
Item
Preventive maintenance
Heatingand
cooling
Roads,
Pathways
Parking areas,
covered and
Open drains
Shatts inside
building
T h e maintenance activity o f paramount importance is the o n e carried out before the onset of
monsoon. This o n e action is a major contributor t o the smooth functioning of the hospital
d u r i n g t h e ~ o n ~ ' ~ e r of
i o wetness.
d
Function o f the pre-monsoon maintenance is to ensure
that all provisions incorporated in t h e hospital building and grounds function faultlessly a n d
that the equipment assets of t h e hospital are sufficiently protected t o withstand the ill effects
o f the wet and humid months. S o m e o f the basic deeds are given in the cage below:
Pre-monsoon Maintenance
Building
Roof
Shafts
Cilajas'
Windows and Doors
Rain water down pipes
Lightning protection
Roads, pathways
Drains
Signboards
Garden
Grounds
-1
Public Health
Manholes
Check and clean. replace missingor bmken covers. clear ground all around
to prevent rain water ingress
Clear ground all around and prevent rain water ingress into the sump
(pollution), ensure all covers are in place
Ensure covers are in place
Ensure sufticicnt stock ofche~nicalsand chlorine gas
All dewatering pumps to be checked for operation
Underground sumps
Water tanks
Treatment
Pumps
Electrical
Equipment
Earthing
Lights
Lifts
Mechanical
2.5.5
Requirements
~ a i n i e n a n c services
e
require technical literature which c~vexsthe following:
Equipment maintenance schedules and instructions
Equipment operating manuals
Trouble shooting and fault analysis charts
Drawings
Specificat ions
Provision of adequate and quality spare parts, appropriate and dependable tools,
instruments and gauges is also an essential requirement.
2.5.6
The four senses inspection tour will prove to be most revealing. See the table below:
Three Senses lnspection Points
Sightabserve
Sound-Hear
llnusual noise
.
Sense-Feel or Touch
liot-bearings. shafis
Deterioration,corrosion,
discolouration
Leaks - air. fluid. lubricani
Loose or missing parts
Loose or dtmaged helts .
Loose or dangling wires
Electric sparks.
Tree branches touching electric
wires
Missing gauges
.
Hissing -gas. steam or air leak Cold-no hot water or steam flow
Grinding - lack of maintenance Breeze - air leak from ducts
Silence- machinery not working Vibration-machine out ofbalanw
Dripping - fluid leaks, roof leaks Shaking-loose Fou~ldationbolts
Banging -door or window not Draught - open doors. broken
window panes.
secured
Ilu~nming-machinerynot
working properly
C n r h s m anA
~
rpfitcr cnllertinn
Sound-Hear
Sight-Observe
Allied E~~gineerme:
-services
Sense-Feel or Touch
Identify tli? fourth sense and tabulate on the ahove lines how it can enrich the inspection activity (sixth
sense excluded)
Inspection roun* provide an opportunity to have a systematic an&orderly look at the state
of the assets and status of maintenance as well. Special attention should be paid for a few
items as follows:
Areas or items biologically dangerous to humans. Check if security measures are
adequate and whether emergency procedures for accidental exposure exist and are
known to all concerned.
Equipment parts that are mechanically dangerous to humans. Moving parts like
flywheels, belt and chain drives need guards.
All tire detection alarm and fighting appliances. They should be functional and in place.
Standby and emergencypower equipment. Standard emergency procedures should be
laid down and make known to all concerned.
e.. .,'visuse of hospital groundsand premises. breach of security. Damaged security walls
and vacant security posts should be noted.
2.5.7
Any maintenance set-up must have the backing of basic material supply. Provision of spare
parts and stores is a service function to maintenance.
Spare parts, which are consu~iiedregularly, could be called as maintenance spare parts.
These spare parts are mostly required to replace worn out or damaged parts on the machine
or fitting. These are generally fast lnoving andrepetitive in nature.
It is conimon practice to procure fast moving spare parts at the time of purchasing the capital
equipment. In a few cases, the value of spares procured as initial provisioning could touch
30% of the equipment value. The temptation is strong to purchase more than the
requirenient so that subsequent non-availability will not be a hindrance. Original
~iianufacturersexploit this to dump non-moving expensive spares which gather dust on the
hospital premises.
Stocking policies and consumption norms can easily be established based on actual
withdrawals of spare parts. This exercise should take cognizance of ready availability of the
items in tlie open market.
Spares can be categorised as follows:
Maintenance
Overhaoling
Commissioning
Rotable
Insunnce
Maintenance spares are fast moving ones and are stocked in plenty. Overhauling spares are
needed during overhauling of the equipment to give it a new lease of life and need not be
stocked. They could be procured just before the overhauling operation. Commissioning
spares are required only at tlie time of installation; testing and commissioning of the
equipmetit. Thereafter their utility does not exist and these are declared as project surplus to
be disposed off. Rotable spares are full assemblies which replace tlie defective one and the
defective one is repaired and retained in store as ready stock. Insurance spares are vital
parts of th; equipment whose life expectancy is equal to the equipment itself. These are held
virtually as standby for use in case of a breakdown.
VED
Vital
Vital: if not readily available. complete closure of the plant for long
periods with on sequent loss would result. Ready example is a
spark plug of a car
Essential
l~nportirnt
Normal
Desirable: Non-availability will cause minor disruption and nuisance for
short period!
Spares cost a lot of money and represents the capital that is locked up. Their inventory level
should be kept at a minimum forwhich minimum working balance should be established
based on past experience.
2.5.9
Procurement
Right time
Right price
Right quality
Cloth and paper should be protected from moisture, rats, moths etc. by using insecticides.
1)
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2)
3)
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2.6.1
Workshop Sections
The first step is to identify the nature df work that the workshop is likely to be called upon to
do. Consider an adjustable hospital metal bed. It may need painting, replacement o f a
damaged bolt or bent linkage, repair o f castor wheels, welding o f a loose part. A hospital
trolley may also need similar treatment. The hospital will have'hundreds o f fans o f all types,
electric motors o f various sizes. heaters, refrigerators, water coolers and so on. Certainly
they w i l l need painting, motor rewinding or replacement o f bearings. Wooden items will need
carpentry work, painting and polishing, and may be upholstej repair. Caning o f furniture
may also be necessary. Vehicle maintenance and repair portion could be a convenient part OF
the workshop with necessary gadgets and tools. Cutlery may need plating. Thus we can
broadly list the following possible sections in the workshop:
Mechanical Section
Air-conditioning and refrigeration section
Sheet rnetal Section
Blacksmithy Section
Welding Section
Allied E ~ g i n r c r i n gSrrvires
Electrical Section
Electronic Section
instrumentation Section
Electroplating Section
Carpentry and cane weaving Section
Painting Section.
If the hospital has an artificial limbs department, then some more sections will also be
necessary.
Workshop is coverd in 1s:10905 (Part 1 )-I984 dealing with recommendations for basic
requirementsof General Hospital Building.
2.6.2 Trades
The trades involved are given below, but not all may be needed in every hospital:
Fitter
'
Electrician
Machinist (Lathe operator)
Electronic mechanic (Radio, TV etc.)
Refrigeration mechanic
Motor winder
Air-conditioning mechanic
instrument mechanic
Welder
Electroplater
Tinsmith
Painter
Blacksmith
Spray painter
Han~merman
-
Signboard painter
Carpenter
Vehicle mechanic
Cane weaver
Vehicle electrician
Upholsterer
Mates, muzdoors
Glass blower
I
I
Workshop supervisor/foreman
Blacksmith
Carpenter
Glass blower
Mechanic
Painter
Electrician
Khalasis
If teaching and training facilities, hostels and residential acco~nmodationare attached to the
hospital, then the above staffing pattern will need to be suitably augmented.
The workshop should be run on professional lines following the rules and regulations in
t
force and with regular checks and balances and frequent auditing. ~ o Gaccounting
procedures should be laid down and detailed records maintained.
Check Your Progress 5
2.7
Hospitals used to be the domain o f doctors and nurses long time back. Engineers had hardly
any role to play in the functioning o f the hospitals. With the advancements in the health care
delivery mechanism and concurrent technological achievements, facilities like better
buildings, electric and water supplies, centralized sewage disposal systems came into the
picture. Steam and hot water supplies entered to make sterilization possible. This was
followed by air-conditioning, comfort winter heating, laundry and kitchen mechanized
equipment, incinerators and so on. Technological advancements in the field o f electronics
niade its application to diagnostic, therapeutic, monitoring, and simple information and data
bank possible in numerous ways. Thus health carefacilit~eshave become a home for
engineering marvels which facilitate painless diagnosis and patients recovery and welfare to
a very great extent.
You have already recognized the need for Workshop Facilities and learnt about its functions
in the previous Section 2.6 o f this unit. This facility is a fragment o f the Engineering Services
Department with which it is closely associated.
2.7.1
Types of Equipment
In the context o f engineering services, the equipment in a hospital premises could be taken to
consist o f two types:
i) Bio-medical equipnlent in departnlents such as X-ray, CAT scan, Path lab. MRI, Linear
Accelerator, Cardiac Catheterization and so on. Even monitors and ventilators, and a
host o f computerized adjuncts could be included in this category. In fact, all equipment
and smdller items used in diagnostic and therapeutic fields o f activity connected with
health care delivery could be included in this group.
ii)
Thus, broadly speaking, we have two types of equipments - one closely associated with
patients care, and the other supporting this primary equipment and providing amenities to
every one inside and outside the hospital building. Bio-medical equipment are basically
electricity operated and could also be considered as electro-medical equipment.
We can therefore consider the following two types of equipment and assets:
i)
ii)
Information about Engineering Services Department is included in IS: 10905 (Part 31-1984
dealing with recommendationsfor basic requirements of General Hospital Buildings.
2.7.3
Functional Aspects
The growth of technology has increased the need for highly skilkd, trained and experienced
personnel to manage the intricate modem machinery and equipment. In advanced countries,
a new specialist group of bio-medical equipment engineers and technicians look qfter the
medical equipments which top class engineers who are not specifically trained can
undertake.
A comprehensive services department may have the following hnctional areas:
Maintenance and repair of bio-medical equipments
Civil assets up-keep, maintenance and repair
Electrical energy provisioning
Water supply and sewerage systems management
Management of air-conditioning and refrigeration services
Responsibility towards fire protection system
General safety and security systems
Maintenance and repair of equipments, vehicles and instruments etc.
Miscellaneous items as may exist in the hospital
Physical duties will broadly consist of the following:
Maintenance of assets including periodical services
Repair and renovation of equipment and systems
i Mechanical engineering - to deal with all mechanical equipments and vehicles, airconditioning and refrigeration, medical and cooking gas supplies, steam plant and so on.
Electrical engineering - to deal with all electrical equipment, sub-station and generating
sets, UPS systems, area lighting and so on.
Public health engineering - to deal with water supply, sewerage disposal, environment
.sustenance and so on.
Electronics tngineering - to deal with computers, communication equipment and
systems, entertainmentfacilities like TV and music systems, and so on.
Almost all major medical equipment will involve several ofthe above specialities. For
example, an MRI equipment needs electric supply and elaborate cooling arrangements which
may need watersupply, and has extensive electronic gadgetry.
2.7.5
The importance of ready availability of skilled and trained staff to attend quickly to
engineering tasks cannot be over-emphasised. Permanent engineering staff will become
familiar with all the equipments and systems over a period of time, and will know the likely
defects and the correct action to take in a crisis. They may even develop a sixth sense of
impending failures based on past experiences.
No hard and fast rule can exist for the structure and size of the department due to numerous
factors. The bed strength together with the speciality level of the hospital itself is a prime
factor. Needs of a hospital with attached training and teaching facilities is another one.
Availability of outside facilities nearby and readiness of dependable contractors of repute to
undertake works on behalf of the hospital will influence this aspect substantially. Services of
government agencies like the PWD, CPWD, Boards and Public Sector Undertakings could
possibly be availed of and they have a huge manpower bank to rush to the assistance of a
hospital in times of distress. Annual maintenance contracts are also entered into with
external agencies in case of several items like iifts. specialist and costly medical equipment,
computers and communication devices and others whose quantity is substantial.
A small hospital may have only a couple of mechanics, but not a department as such. Where
the investment in buildings or equipment is considerable, creation of a department is a sound
proposhion. There will be scores of technicians working and even their supervision and
control will be a big task. In case of super-speciality hospitals. creation of a department is
always worth serious consideration even with low bed strength, because of the costTy
equipment and intricacy of support services. The prime function of the engineering services
department is to provide a dependable base for rendering the best possible and economical
engineering services of all kinds without shortcomings and failures.
Towards this aim, it is best to have a senior engineer with experience in all specialities of
engineering heading the department. It could even be at chief engineer level and he should
be responsible to the administrator orhospital apex body. Executives could work under the
department head. A full-fledged, comprehensive and ideal set up for a hospital with training.
and teaching facilities and residential accommodation could be the following:
Hcnd
residential
Foreman
Workshop
Maintenance
Gcnset
hldical
Equipment
3laintenatn:
lieeper
Allied E n g i n e e r i n g Services
Hospital E n ~ i n e e r i n gServices
'The structure should be viewed more from a practical need-based standpoint than in a cost
effectiveness atmosphere. There should be close cooperation and coordination between the
sections, and working in water-tight compartments should be discouraged. Medical
equipment and electronics sections under Executive Bio-medical Equipment will be mostly
working on the equipment in the places where they are installed and hence will carry out
repair and maintenance also.
It would be prudent to associate the head of the engineering services in medical equipment
purchase committees so that the services required for the forthcoming equipment can be
appreciated and properly planned for execution.
Role and responsibilities of the engineering services department should be clearly laid down.
So also the responsibilities and duties of each and every person at all levels should be
defined. Division of responsibility should be clearly established with no overlap or
duplication between departments and the staff. A striking example is one where the
maintenance of batteries in an emergency system became a point of dispute between the
services department and the OTdepartment staff. The dispute was amicably settled with a
decision from the appropriate authority, but the batteries could not be saved as they were
already damaged. Check lists and repair codes should be prepared and made available to the
technicians. Safety measures and emergency procedures should be given prominence. All
these should be displayed in such a fashion as to attract the attention of the staff and be
available to them in any emergency. There should be a close interaction between the
services staff and the heads of all departments of the hospital at all levels.
2.8
--
LET US SUM UP
This topic of Engineering and Allied Services presented would have made you aware of the
diverse activities of the engineering services as are involved in modern and specialist
hospitals and with which an administrator is bound to be closely associated. You have
accordingly been kept in touch with all branches of engineering services in sufficient detail
to enable you to grasp the issues as they come up and take a positively active part in
discussions in a meaningful way. Certainly this information will stand you in good stead in
planning and progressing of new proposals, renovations and augmentation of hospital
facilities.
The invasion of electronics into the medical field has diversified the medico-technical
equipment to a very great extent. The need for an electronics engineer is now firmly
established to look after these equipment which are so very costly that their down time will
prove disastrous to the patients and the hospital.
The importance of maintenance and a workshop in the hospital are established facts. So
many trades and tradesmen are involved in the upkeep of the hospital and even then some
contracting with outside agencies is inescapable to keep the number of staff within
manageable limits.
The hospital will have to deal with several agencies to obtain water, electricity, fuel and gas
supplies. Payment for these will have to be made as per prior agreements and these
payments are high. You appreciate the dire need for energy conservation to reduce hospital
expenses and bring health care delivery systems within reach ofone and all. Affinity
between energy conservation and maintenance has been highlighted by examples of a cycle
and a household item to be identitied by you. .'
Al!ied
E r p i n e c r i l ~ c S e r \ ices
2.9
A'NSWERS
TO CHECK.YOUR PROGRESS
Bio-gas plant
Solar'water heater
Solar photovoltaic
Windmill
Wind turbine
c)
2)
3)
They should be put in plastic bags with a small sack containing silica gel. They should
be protected against effects of static electricity. Air-conditioned space would be ideal
for storing them.
c) Mechanical
d) Electronic
e) Public health