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ELECTRICAL, WATER SUPPLY & OTHER SERVICES IN A HOSPITAL

TABLE OF CONTENTS
1. Introduction.2
2. Need and Scope of the Study..2
3. Justification of the Study3
4. Aims and Objectives3
5. Methodology.3
6. Areas Requiring Distinct Services..4
7. Factors Impacting on the Services..5
8. Electrical Services....6
9. Water Supply and Sanitary Services12
10. Communication System16
11. Environmental Control.21
12. Biomedical Engineering23
13. Transportation...25
14. Case Study-Apollo Hospital, Ranchi.30
15. Inferences33
Bibliography.34
FACLTY OF ARCHITECTURE & EKISTICS (JAMIA MILLIA ISLAMIA)

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1. INTRODUCTION
Water Supply & Sanitary and Electrical Services is a very important aspect to be taken into
consideration while designing a Hospital. The Administration of any hospital always makes it a
point to keep these services in mind before planning of making a hospital.
Electrical energy is an essential source of power, the pivot around which almost every services in
a hospital revolves, and the system is becoming increasingly more demanding, complex and
crucial.
Water is one of the critical utilities in a hospital, yet is often taken for granted. Much of the
hospitals engineering services is concerned with installing, repairing the systems that delivers
utilities and services water being one of them in a functional continuing and safe manner.
Major services required in a Hospital Building are:

Heat, Ventilation and Air Conditioning (HVAC) Services


Medical Gas
Electrical Services
Water Supply and Sanitary Services
Fire Detection and Fire Fighting
Networking and Communications
Solid Waste Management
Environmental Control
Biomedical Engineering
Transportation etc.
In this report I have tried to discuss all the services mentioned in bold above with primary focus
on Electrical and Water Supply and Sanitation Services.

2. NEED AND SCOPE OF THE STUDY


In the earlier times it was found that these services and facilities were not taken care of by
hospitals excepting a few, but now these facilities have become very important in order to run a
hospital smoothly. There have also been some cases of mismanagement or health hygiene issues
which make these services quiet important in a hospital building.
So this study is going to help us in studying some of the important services which we need to
keep in mind while planning our hospital and it will also help us in understanding the functions,
location, design, distribution and other important parameters for such services.

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3. JUSTIFICATION OF THE STUDY


As I have discussed above that a Hospital Building a very critical area and therefore these
services play a very important role in the smooth running of a Hospital. Proper planning and
design of these services needs to be done to avoid any kind of issues like health and hygiene,
continuous power supply and back up for smooth running of hospital equipments and life support
equipments for the patients without any hiccups, proper treatment of waste and sewage from a
hospital building etc.

4. AIMS AND OBJECTIVES

Aims
To the study the planning, function, location etc. of Electrical, Water Supply and Other
Services in a Hospital Building.

Objectives

Identification of Water Supply distribution network in a Hospital.


Study of sewage disposal system in a Hospital.
Water requirement in a Hospital and sources of water supply.
To study the design of electrical services considering the safety, economy and voltage
quality.
Planning and design parameters of hospital electrical system.

5. METHODOLOGY

Study and identification of Electrical, Water Supply and Other such Services in a Hospital
Building.
Study of functions of these areas by discussions with experts of the field and if possible users
of such areas with its proper planning and design in the Hospital.
Case Studies of some hospitals in order to find out numbers of these services provided in
them their location, planning, space requirements etc.
Compilation of the data collected by the above studies.

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6. AREAS REQUIRING DISTINCT SERVICES


Hospitals are most service-intensive buildings and so warrant a lot of thought at the planning
and design stage. Integration of the basic building services like electrical, plumbing/sanitary, airconditioning, ventilation and fire protection into architectural designs is the basic and necessary
function.
Some of the major areas of the hospital that have distinct service Requirements

Surgical suites and their sterile zones

Intensive care, coronary care and critical care units

Nuclear medicine

Laboratories

Central sterile and supply department

Mortuary

Medical gas manifolds

Kitchen and cold storage

LPG gas banks

Laundry

Incinerator

HVAC plant room

AHU rooms

Electrical substation

Generator rooms and electrical panel room

Boiler room

Fuel storage

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7. FACTORS IMPACTING ON THE SERVICES

Architectural designs. Some examples: Use of glass in terms of structural glazing


increases the HVAC load. As a result, operational cost becomes high. Choice of false
ceiling material can contain or accelerate contamination in terms of allergic reactions to
fibers, fungus, bacteria and pest. Roof insulation has an impact on the maintenance cost
and overall heat load of the building.

Site Location, Locality, Available Resources and their Conservation. Examples: Use of
natural topography facilitates drainage system and water recycling. Rainwater can be
harnessed by making use of rainwater harvesting. Site contours can help the drainage
and sewerage system. Local weather conditions like rainfall, humidity and prevailing
wind direction can help reduce the running cost.

Regulations, Codes and Laws. Examples: National Building Code, National


Environmental Pollution Rules and Regulations, Local by-laws, BARC approval,
electrical, fire, sanitation and plumbing codes, boiler codes, ground water authority and
many more.

Technology. Intelligence Building Management System (IBMS) provides live data and
reports that can be used to refine operation, check system performance review and
planning of maintenance. It can be used in energy savings. Security can be integrated
into this system.

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8. ELECTRICAL SERVICES
Overview
Electrical energy is an essential source of power, the pivot around which almost every function
of the hospital revolves, and the system is becoming increasingly more demanding, complex and
crucial. This is partly because of the specialized medical and electronic equipment used for
diagnosis, treatment and rehabilitation of patients and partly because of the large load of power
needed in today's hospitals. In the electrical system, the main concern of the design team and the
hospital engineer is the power distribution system - the electrical lifeline of the hospital. There
are also other concerns like an adequate and dependable supply. No less important, which many
owners do not take seriously, are the electrical equipment and fixtures which should be of high
quality. They should conform to safety codes and regulations.
There is a need to create an awareness of the energy costs and the need for preservation both
within and outside the hospital largely because of sharply increasing prices and scarcity of
energy resources. Both are a global phenomenon. A two-fold message seems to have evolved
from this. It is important not only to conserve present resources but also to develop and use
alternative sources.
In essence, the hospital's use of electricity is similar in purpose to that of residential homes and
other facilities. However, some special applications exist. The basic functions that consume
electricity and resources are:
Environmental control including heating, ventilating and air-conditioning.
Heating and cooling water.
Lighting
Cooking, refrigerating and freezing food
Operating all types of medical, sterilization, incineration, laundry, etc. equipment.
The high dependability of electrical service is made possible by using high quality
equipment, careful design, good construction and efficient operation by quality engineers.
Emphasis should be on the design of a system that will operate economically and provide
for easy maintenance rather than the least possible installation cost.
The electrical system is one of the major costs of operation and many hospitals find
themselves saddled with a heavy financial burden due to an inefficient system.
There should be an emergency generator to supply power to essential and critical areas of
the hospital immediately if normal electrical service is interrupted. Under certain
circumstances, power interruption of even 10 seconds may not be permissible. In such
cases, an uninterruptible power supply (UPS) is the only answer.

Design
In designing a hospital electrical power system, the major elements that should receive
serious consideration are safety, reliability, cost, voltage quality and ease of maintenance.
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Safety
Safety encompasses protection of life and property, and continuity of hospital services.
Protection of human life of patients, visitors and personnel-is of paramount importance.
Safety of equipment is also essential. A faulty electrical system devoid of adequate
safeguards may cause extensive damage to essential equipment and machinery. This in
turn may cause loss of service and a delayed return to normal operation because of repairs.

Economics
It is necessary to consider the cost of the total system and not just the components. Cost of
installation and cost of operation must be balanced. So also, cost and reliability. Cost of
equipment is a major percentage of the initial cost of installation. Cost of operation is
frequently not given adequate consideration with all attention focused on equipment and
installation.

Voltage
Stability of voltage is very important in the hospital power supply. It reflects the quality of
electric power. With the increasing use of automated and electronic equipment in the
hospital, voltage regulation under normal operation and abnormal changes in load merit
special attention. Hospitals will do well to consider additional investment in special
devices for critical areas vulnerable to voltage fluctuations. This may prove more
economical in the long run.

Maintenance
A proper maintenance of the electrical system is necessary for its safety and reliability.
The system should be designed and streamlined to make maintenance easy and safe, and to
enable routine maintenance and inspection without shutting down the essential hospital
supply. For this, use of a circuit arrangement providing an alternate source of power
should be arranged.

Some Design Elements

Nature and magnitude of load


Source of power
Cost of electric power system
Voltage levels
Circuit arrangement, whether radial, ring main, etc.
Most economical size of substance.
Secondary distribution
Combined light and power systems (This is usually most economical, but flicker
problems must be watched)
Means of voltage regulation, if required
Short circuit protection
Grounding
Over current protection
Lightning protection
Proper metering of all circuits
Power factor correction
Anti-static electricity precautions
Isolation transformers for operation room complex.
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Planning
The hospital electrical system calls for careful planning. Consideration should be
given to immediate as well as future needs both in terms of expansion and increased
workload. Early in the planning stage, the engineer, the consultant or whoever is in
charge of planning should closely work with the architect on the one hand and the
hospital administrator, medical and other hospital staff on the other. Electric load
estimates for a 200-bed state-of-the-art hospital is given at the end of this section.
The views of the hospital staff should be given due consideration because they are the
ones who operate and maintain equipment and facilities of the system. The medical
staff should be consulted on crucial, specialized medical areas and the administrative
staff, on the other areas such as vertical transportation and computer network. A third
group whose view should be considered is the engineering and maintenance staff
charged with keeping the system going.
The power distribution system should be adequate to meet the service reliability
requirements of the hospital and yet it should be made as economical as possible. This
requires the power system engineer to plan the distribution system on an all-inclusive
basis. To do this effectively, he must constantly search for facts on which to base his
decisions.
The right decisions on setting up the substation, electrical H.T. and L.T. panels, diesel
generator room, load centres, etc. save not only installation but also operational costs.
Finally, the engineer should be conversant with various statutory regulations, codes and
standards applicable to hospitals.

Design Procedures
In planning and designing an electrical system, the engineer should observe the following
basic steps and procedures:
Work out the actual connected load and the demand load for the present and future
Develop a site plan of the hospital plant showing the size and location of present and
future loads
Work out the essential loads and then determine the capacity of diesel generator (D.G.)
sets
Establish voltage levels throughout the hospital plant
Determine the size, number and location of power centres
Determine the service reliability, select circuit arrangements required in each hospital
area, and design the circuits to provide reliability
Provide adequate power supply points to the various pieces of equipment
Provide protection against lightning, earth leakage current, short circuit current, under
voltage and overvoltage
Observe special precautions required for hospital safety
Consider special lighting design for patient rooms and other areas
Provide necessary specifications. Specifications supplement the working drawing and
furnish the information not shown in them by describing equipment and its functions.
They also prescribe quality of materials and workmanship required under the contract.
They tie the entire job together.
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Emergency Generators
Given the erratic record of public utility supply companies in our country, hospitals must
expect to go without normal source of power frequently. However, hospitals are especially
vulnerable to even a short-term loss of electrical current because patient care depends on an
uninterrupted power supply. Recognizing this, hospitals do provide for an alternate
(emergency) source of power to serve essential portions of the hospital's distribution
system. This emergency power should be reliable and is generally used for lighting and
operating essential equipment.
The usual source of power used in hospital for emergencies is the generator that is driven by an
internal combustion engine operating on diesel oil.
The components of the alternate electrical system are the same as those in the normal distribution
system except for the alternate source of supply and transfer switches. The engineer must
determine the load to be placed on the system.
The load can be transferred from the normal source of power to the emergency source either
manually or automatically. The automatic transfer switch should be capable of transferring the
load within 10 seconds of the power failure.
However, in normal practice it may take longer. Manual operation may take a few minutes
depending on where the operator is and how long it takes for him to reach the generator site.
At the planning and design stage, the engineer should specify which loads have to be transferred
automatically and which manually, depending on the urgency or criticality of the function. For
example, all lights may be connected to the automatic transfer load because patients and visitors
often panic in the dark.

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Uninterruptable Power Supply (UPS)


Under certain circumstances, even a 10-second interruption of power supply in hospitals
may prove life-threatening. In the operating rooms where an open heart surgery or kidney
transplant is in progress, or in the ICUs, cardiac catheterization lab or stress test laboratory,
such interruptions may be fatal. In the non-medical areas, all computers depend on an
uninterrupted supply of power. The engineer, with the assistance of administrative and
medical staff, should identify critical areas that should be hooked on to the UPS,
Large hospitals often use advanced clinical and diagnostic equipment, sophisticated
Medical instruments and voltage-sensitive computers, These demand clean, computer grade
power that is totally free from momentary interruptions, transients, sags, surges and
brownouts common to the utility power lines. With the actual and projected rapid
deterioration in commercial power, power conditioning is becoming a standard requirement
for reliable operation of electronic data processing and clinical equipment. It is no longer
viewed as a luxury in the same way as air-conditioning has become more of a necessity for
them now.
Several power conditioning alternatives are available ranging from isolation transformers to
the UPS. One of the choices is the motor-generator set that can protect the computer and
other medical equipment from many power problems. However, it suffers from an inability
to ride through longer commercial power outages.
UPS sets have established themselves as highly dependable pieces of equipment capable of
supplying an output voltage of high quality (that expresses a degree of stability) and of
harmonic neutralization (that implies total independence from the commercial supply
source) and having a high rate of reliability.
Voltage sensitive medical equipment, computers and perhaps a small percentage of
lighting are connected to UPS that typically has a battery back-up of 30 minutes,
Advanced models of some medical equipment have a built-in battery back-up that
provides uninterrupted power supply to keep the equipment operational for some time,
Technical considerations pertaining to the electrical system are beyond the scope of this
book, But as stated earlier, hospitals should utilize the expertise of design and specialist
engineers and consultants in the early stages of planning itself so as to provide optimum
electrical system facilities in their hospitals.

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Electric load for a 200 bed State of Art Hospital


HVAC

1200 KW

General Lighting

320 KW

General Lights and Power Plugs

350 KW

MRI, C.T. Scan & X-ray machines

300 KW

Angiography and Gamma Camera etc.

175 KW

Pathology and Microbiology Labs

150 KW

CSSD

200 KW

Surgical Suites (4 to 5)

150 KW

Servers, PCs

100 KW

Elevators and Dumbwaiters

125 KW

Laundry and Kitchen

250 KW

Water Supply and Treatment Plants

180 KW

Miscellaneous

100 KW

Total

3600 KW
4500 KVA at 0.8 power factor

The total connected load is approximately 3600 KW (4500 KVA) and maximum demand 2400
KW or 3000 KVA.

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9. WATER SUPPLY AND SANITARY SERVICES


Water Supply
Water is one of the critical utilities in a hospital, yet it is often taken for granted. Much of
the hospital's engineering service is concerned with installing, repairing and maintaining
the systems that deliver utilities and services - water being one of them-in a functional,
continuing and safe manner.
Hospitals require copious supply of water. While the nation's population and the demand
for water are increasing, its water supply is diminishing. This puts a tremendous pressure
on the ability of administrators and hospital engineers to supply pure water to hospitals.
Every effort should be made to conserve this precious but fast-diminishing resource.
Hospitals should, as far as possible, rely on the public water supply system for the
necessary quantity and quality of their water supply. This may be supplemented by their
own water supply. Some hospitals have private wells or bore wells that they can use to
augment their water supply.
Designing a water supply and sanitary system for a hospital is a complex task that calls for
the expertise of competent, experienced and specialist engineers. Since most of the service
lines are concealed, faulty design and installation or any compromise in the quality of
materials will lead to disastrous results that will be difficult to rectify later. Therefore,
planning and installation of this system are of the utmost importance. Defective
installation would affect not only the functioning of the hospital but also its hygienic
conditions.
Two important components of the system are:
Water supply distribution network, and
Sewage disposal
The design should allow flexibility to recycle waste water, if need be, for reuse as A.C.
cooling tower make-up water or for gardening and toilet flushing.

Sources of Water Supply


The primary source of water supply to hospitals is generally the public utility supply
system. Invariably, water is in short supply in most cities. To meet the ever-growing
demand for water, the following alternative sources of water supply may be considered:

Bore wells

Tanker supply

Recycled water. The treated waste water from basin, shower, laundry, etc. can be used
in W.C. flushing, landscaping, etc.

To ensure a continuous supply of water, adequate storage capacity of underground sumps


and over-head tanks should be provided.

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Water Requirement of Hospital


The minimum requirement of water supply for any hospital shall be in accordance with
the National Building Code (NBC):
Hospital (including laundry) per bed:
a. Number of beds not exceeding 100
=
340 litres per head per day
b. Number of beds exceeding 100
c. Nurses/medical staff quarters
d. Minimum hot water requirement

=
=
=

450 litres per head per day


135 litres per head per day
45 litres per head per day

Design Elements
In designing the hospital water supply system, the major elements that merit
attention are:
Continuous and reliable supply of water
Quality of water
Proper distribution network
Cost
Ease of maintenance and operation

Quality of Water
The quality of water supplied to the hospital affects virtually every aspect of
operation. It is, therefore, essential that suitable water of microbiological quality is
provided for drinking, laboratory procedures and solutions used in medical and
surgical treatment. Chemically acceptable water is essential for the operation of
equipment, laboratory tests and dietary purposes. A regular surveillance
programme
should be instituted. This normally includes evaluating the source of supply,
equipment and distribution system, and routine microbial and chemical analyses of
water. The engineer should have samples of water collected routinely and have
them sent for analysis. In addition to potability, water should be tested for
hardness and iron. Hard water is detrimental to equipment and increases operating
costs.
Routine water processing programmes carried out in hospitals include chemical
treatment of water, deionization, distillation, filtration and sterilization. The
engineer should be familiar with hospital operations and know where specially
treated, deionised or distilled water is used and when it is necessary to provide it.
He should realize that deionising process removes only the ionisable contaminants
and not the bacteria or other organics and in organics, and that the deionised water
often becomes
heavily contaminated with bacteria that grow on the resins. Distillation provides
water of the highest purity. However, distilled water is not sterile. Sterile water is
produced by processing water in sterilizers or autoclaves. Hemodialysis requires
specially treated water.
The quality of water depends largely on two factors:
Quality of raw water supplied to the hospital, and
Level of quality required for various purposes.
Since there are varied sources of raw water, it is generally not possible to control its
quality. It is thus essential to first analyse the quality of water obtained from various
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sources and then recommend the treatment process before use.

Distribution Network
For the proper utilization of water, the distribution system should be designed taking
into consideration the pressure and quantum of water required at various outlets. Due
care must be taken while selecting distribution equipment and pipes because of the risk
of contamination and corrosion. The water supply distribution system is often designed
using the hydro pneumatic system for achieving a uniform pressure at all the outlet
points.
Great care should be exercised in protecting the hospital's potable water against
contamination that can result from a poorly designed and installed plumbing system.
The potable water supply system should not be connected with other piping systems,
nor should it be connected with fixtures having submerged inlets. This could cause
contamination.

Planning
The hospital water supply and sanitary system calls for a high degree of planning. The
design should take into consideration not only the present needs but also future
requirements.
There should be adequate provision for future expansion. The location and size of plant
rooms, service ducts, etc. play a very important role in designing an economical and
convenient system. Attention should be paid to the maintenance and operation of the
system. In large hospitals, the service floor concept may be considered for running all
sanitary and water supply lines horizontally below the toilets and terminate them in a
common vertical duct. Careful interaction with the architect and other service engineers
is necessary before finalizing the layout for the water supply and sanitary system.

Hot Water System


Hot water supply is one of the prime requirements in any hospital. It is required in
patient bathrooms, kitchen, laboratory, laundry, CSSD, etc. If the hospital is located in
a cold climatic area, it is essential to provide hot water in all the toilets and washbasins.
Hot water is supplied through the central distribution system and is usually generated
using oil-fired hot water (HSD) generators. The temperature of water ranges between
55 C - 60 C and stored in an insulated, closed pressure hot water mixing tank.
The ideal location for boilers, mixing tank and associated pumps and equipment is
either the pump room or a separate room adjoining it. The exhaust flue gas from the hot
water boiler should be taken above the building as per statutory regulations and
discharged into the atmosphere. The complete hot water system should be distributed to
various utility outlets using insulated G.I. pipes. To eliminate wastage and get
immediate hot water when the tap is turned on, a hot water circulation pump may be
necessary. The hot water pressure in the pipeline should be maintained in the same way
as in the cold water supply line by connecting the hot water supply to hydro pneumatic
system.

Steam
Steam is required in the kitchen, laundry, CSSD and other sterilization areas. It is
generated at 8-10 kg/sq. cm pressure using oil-fired steam boilers. Various areas will
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require steam at different pressures. Therefore, pressure reducing stations with headers
should be provided to tap the required steam. Provision has to be made to recover the
condensate and conserve waste heat. The steam boilers should be located next to the
hot water boilers. If the steam requirement is not much, it is possible to have only one
combined steam boiler supplying both steam and hot water.

Drainage System
The drainage system of the hospital should be simple, effective, economical and
serviceable. It should be designed keeping in view the kind of septic and toxic waste
that needs to be effectively disposed of. It is advisable to adopt a double stack system
in which separate stacks are provided to collect waste and soil from the toilets and
'other areas. Pipelines should run with sufficient slopes so that sewage could be
conveyed to inspection chambers by gravity.
Provision should also be made to terminate the collected sewage in the municipal sewer
line via a battery of inspection chambers or manholes. Where it is not possible to do so,
alternate arrangements like sewage treatment plants should be made. It should be
ensured that the effluents from the treatment plants are further treated to acceptable
standards before their utilization in landscaping or recirculation.
For sewage disposal, it is preferable to use PVC pipes as they are easy to install and
repair, and also allow for smooth flow of sewage.

Sewage Treatment Plant


The objective of the sewage treatment plant is to stabilize the decomposable organic
matter present in sewage to produce effluents and sludge. These can then be disposed
of in the environment without causing any health hazards or nuisance. The treated
sewage water can also be reused for various purposes like gardening, landscaping,
flushing of WCs, A.C. cooling towers, etc.

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10. COMMUNICATION SYSTEM


Communication systems in hospitals encompass intra-departmental intercom,
telephone, paging (overhead and wireless), nurses' call, data communications,
computerized visual display terminals, television, cable television and closed circuit
television (CCTV), alarm system, central dictation, monitoring, and the more recent
telemedicine, tele consulting and so on. The demand to provide more and more
information at higher speeds is greater today than ever before. The field of
communications is being improved constantly to meet the complex demand of
communicating from person to person, person to machine and machine to machine.
With the advancement and sophistication of communication technology and the
development of new and complex systems of communication, hospitals increasingly
need persons who are knowledgeable in the management of communication systems
and skilled in handling them.
Planning adequately for communication services in these changing times is as
important as planning and designing the hospital itself and it~ services. The ability to
transmit messages voice, video, print and data-in a quick, accurate and economical
manner depends on the ready availability of the hospital's communications network
and facilities. A system that anticipates frequent changes and growth allows for the
control of rising costs and produces greater efficiency.
Instantaneous and reliable communication is crucial to hospitals. A slow response or
missed communication can be life threatening. For example, a delay in issuing a
cardiac emergency call or failure to reach a specialist on time may endanger life. Poor
communication can' result in overall organizational inefficiency. A tardy response or
unfriendly attitude' of the telephone operator may establish a negative image in the
minds of the public. Since the telephone operator is frequently the first contact of the
caller with the hospital, how she responds to his calls sets the .overall first impression
of the hospital for him.

Telephone System
Advanced telecommunication technology today offers vastly improved and
sophisticated telephone equipment with never-before features and capabilities.
Advanced systems are now available in which a single instrument acts as a multibutton phone. Most telephone systems have flexible circuits that allow telephone calls
to be transferred to another area as, for example, to the admitting office. In smaller
hospitals, this eliminates the need for a telephone operator during the night. Some other
new features are: Touchtone dialling, call pick up, call forwarding, conference
capability, transferability of incoming and outgoing calls and direct dialling.
Car telephone, which hasn't made a big foray into the Indian scene yet, is expected to
have a major impact on communications for hospitals. Made accessible by use of
cellular technology, car telephone will play a big role in contacting doctors who are on
the move particularly because the use of a mobile phone is prohibited while driving.
Within the hospital, interconnecting telephone should be provided for all departments
and sections including operating rooms, ICUs, nurses' stations, offices, maintenance,
housekeeping and elevators. A telephone service outlet should be provided midway in
the elevator shaft to connect the telephone in the elevator. All intercom telephones
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should be dial type that permits intercommunication without calling the hospital
switchboard.
Many hospitals provide telephones in patient rooms. Patients can make long-distance
calls directly with the facility of remote metering or transmission to a computer so that
automatic charging of the concerned patient is accomplished. As far as possible,
telephones should be installed in patient rooms, especially in private and special rooms.
The practice of installing jacks in all patient rooms for use of plug-in telephones is now
considered obsolete. However, jacks may be provided in multi-bed general wards
(where generally phones are not provided) for the use of sick patients who cannot come
to the nursing station to receive or make a call. Public (pay) telephones should be
provided at convenient locations for outpatients, visitors and staff, particularly in the
outpatient area, inpatient areas, emergency department, near the labour-delivery suites
and in the fathers' waiting room, if there is one. Pay phones leave hospital switchboard
free for patient care and official use. In addition to public telephones, there should be a
convenient room where visitors, outpatients and hospital personnel can make assisted
STD and ISD calls. At the construction stage, conduits should be provided to facilitate
installation of telephones wherever necessary, keeping future needs in mind.

Integrated Service Digital Network (ISDN)


The Integrated Service Digital Network (ISDN), which is poised to take the
communication world by storm, will revolutionize our communication systems and
with them our lives. Digital switching system, which is an advanced computer by itself,
will be able to handle voice, data, text and image transmission - all on the same
telephone line. In other words, telephone, computer, printer, fax and almost anything
else that is electronic can be plugged into a single telephone line to provide an
integrated communications system.

Telemedicine, Teleconsulting and Net Telephony


With internet fast becoming a way of life, web-enabled services are playing an
increasingly significant role in health care. With intern et technology moving at an
explosive rate, health care' operations and services are becoming web-enabled too.
Recently, the Escorts Heart Institute 111 New Delhi made medical history when it
beamed live pictures of patients being operated upon for cardiac ailments onto a giant
screen halfway round the globe in San Francisco. The event was watched by a large
group of cardiac specialists and other professionals in that part of the world. And what
is of significance was the simultaneous interaction between the two groups-the
observers asking questions on the various aspects of surgery and the surgeons
answering them. For the US surgeons and other professionals-they are specialists
themselves in their own right-this was nevertheless a great learning experience because
the heart ailments found in India are not the same as those found in Western countries.
The whole exercise is a precursor of what one expert said, "This may help diagnose
heart diseases at the outpatient department level." If hospitals in other towns and cities
are linked up with a centre like Escorts, doctors can obtain expert advice or a second
opinion over the phone. All that they need to do is hook up. Thus people all over the
world can benefit from the expertise of one person without actually visiting him.
This marvellous surgical feat was made possible thanks to Integrated Services Data
Network. The Medical Products Group of Hewlett-Packard (HP) and the Mahanagar
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Telephone Nigam Limited of New Delhi were responsible for providing the set-up and
back-up services.
The reason why one needs an ISDN line is because video images cannot be transmitted
over a normal telephone line. The images must be first converted into digital data- bits
and bytes- before they are transmitted. With the introduction of private basic telephone
networks across the country and the country itself going fibre-optic in a big way, the
application of telemedicine, telediagnosis and tele consulting opens up vast new frontiers
in the medical field. This augurs well for this country where superior medical talents
abound.
Narayana Hrudayalaya, a famous heart hospital in Bangalore, has set up a telecardiology
unit that extends teleconsultation in cardiology to far corners of the country, largely in
rural areas, where facilities have been set up. Cardiologists are available at the hospital
round-the-clock for any doctor in these remote centres to call them up for expert advice.
It is live telemed/video-audio conferencing in which reports, images and documents
relating to the treatment of the patient in question can be transferred, seen and discussed.
The hospital is in the process of setting up more centres.
Another doctor, a radiologist in Whitefield near Bangalore, started teleconsulting for
some American hospitals in what is called consultancy through teleradiology, also called
"Offshore Teleradiology"-said to be the first of its kind in India. His job is to read the
scans sent by these hospitals via internet by fax or e-rnail through a common server in
America and send his interpretations/reports back. His reports are dictated using voice
recognition software installed on his computer-another device that is becoming
increasingly popular. Verbal messages are communicated to doctors by a combination of
telephony and instant messaging. A high-speed internet line, modem, server, alternative
line, heavy duty UPS and Local Area. Network (LAN) form his infrastructure.
An added facility is net telephony. The government of India has now allowed Internet
Service Providers-to offer the net telephony that had hitherto been banned. What this
means is that personal computers (PCs) can now be used to call up phones abroad.
Without going into the technicalities, it may be mentioned that net telephony costs
substantially less because it is based on what is called "packet switching" as opposed to
"circuit-switching" of the traditional telephone network. All these advances augur well
for health care and will bring about sweeping changes in the way health care is practised
and delivered - on-line.

Nurse Call System


The nurse call system ranges from the simplest-a mere visual signal system-to the most
complex and sophisticated computer-controlled system with visual and audio indicators,
two-way voice communication and advanced facilities for management information. It
can be linked to the panic button in the patient's bathroom, code blue alarm system and
the fire alarm system.
The feature common to all the systems is the switch or button provided at the patient's
bedside which, when activated, registers the call at the nurses' station. In the traditional
system, a push button with a flexible cord is provided to each bed. The signal can be
switched off only at the bedside. A pilot light is placed over each bed if there are more
than one bed in the room. There is a pilot light over the door of the room and a central
light panel at the nurses' station. A central monitoring panel is provided in the nursing
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director's office.
The following are the features of the advanced computerized nurse call system:
The call is registered by the patient.
The call is acknowledged by the nurse.
The call is attended to by the nurse. (Nurse switches off the call signal in the
room)
In the event of delay as programmed by the response time, the signal light
flashes.
When the delay becomes longer, the flash rate increases progressively.
The signal is both audible and visible.
There is provision for two-way voice communication between the patient and the
nurse station. This can be programmed in such a way that only the nurse can
initiate the voice communication and not the patient.
The system has the following components:
Panel in the patient room
Patient room door panel
Main nurse station panel
Monitoring panel
Computer interface
Software
Alert panel
Computer voice interface

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In the patient room panel, there is a red push button to register the call, a red indicator
light to show the call-is registered, a green indicator light to show that the nurse has
acknowledged the patient's call, and a-switch to cancel the call.
In the panel outside the patient's room, there is a red indicator to show that the patient
requires attention and a green indicator to show that the call has been acknowledged by
the nurse. When only the green indicator is lit up, it shows that the nurse is attending the
patient. This eliminates the need for more than one nurse responding to the call. The
panel is provided with a green switch for the nurse
to acknowledge the call at the door, if necessary.
At the nurses' station, the panel has a layout plan of the ward and the beds with bed
numbers, a red indicator, a green indicator and an acknowledgement switch. The panel
clearly shows which bed requires attention. The digital indicator can be added to show
the sequence of call registration. An audio beeper is provided to attract the nurse's
attention. Delay in attending to the patient results in the signal light flashing and the
beeper sound becoming faster. The monitoring panel is intended for the supervisory
staff to monitor response and improve efficiency. The management information support
software monitors the response pattern of nurses throughout the hospital during the day,
week and month.

Dictation and Central Transcription System


Remote dictation service is set up to allow the doctors to dictate reports from any part of
the hospital where a dictation equipment is provided, usually from the operating rooms,
ICUs, patient floors, emergency room and the doctors' chart completion room in the
medical record department. Modern telephone systems can be used for dictation as they
can now be interconnected with centralized dictation where reports are recorded on tapes
and later transcribed by medical secretaries/transcribers. The system allows any phone in
the hospital to dial a code and dictate to the central room. It enables the doctor to start,
stop, play back and correct his dictation.

Public Address System and Piped Music


A public address system or wired or overhead paging is invaluable for making
announcements to a large number of people in assembly halls and other strategic
locations. The system should be designed for zone paging so that information can be
transmitted to selected places without disturbing patients and hospital staff in other
areas. Suitable background music can be piped throughout the hospital during selected
hours. Many Christian institutions broadcast devotional songs and worship programmes
over the public address system. Individual speakers in patient rooms give patients the
option to switch the transmission off.
Where piped music, the public address system and television system are bundled
together, a cut-in feature for announcements should be included. Announcements may be
made from several places depending on the nature of announcement.

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11. ENVIRONMENTAL CONTROL


Hospitals have always considered it their responsibility to control their environment.
This involves protection of the patients, staff, visitors and the surrounding comm unity.
The concept of environmental control is generally practised through
Infection control
General environmental hygiene and pollution control
Radiological health
Accident and accidental injury protection, and
Occupational health.
A detailed discussion of this vast subject is outside the scope of this book. However,
some of the important areas are highlighted here.
Since the days of yore when hospital-acquired infections took a heavy toll of human
life, efforts have been made to control infection through improved arid scientific
methods of disinfection and sterilization procedures, better housekeeping system, strict
application of basic environmental hygiene procedures, development of laminar
airflow, etc. Even then hospital-acquired infection continues to be a problem.

Infection Control
Environment control is based primarily on the science of engineering, microbiology
and sanitation. All those who are concerned with environmental control-from the chief
executive officer to the hospital engineer down to the housekeeping personnel-should
be familiar with the basic facts about microbial growth and death and the transmission
of disease.
Every hospital must establish an infection control committee to administer a hospitalwide infection control programme, and formulate and enforce polities and procedures
for infection control. These policies and procedures should cover the following:

Personnel. This includes employee health, dress code, in-service education, etc.
Isolation procedures.
Environment specimens like trash, garbage storage and collection, infectious waste, etc.
Water supply.
Maintenance of buildings, etc.
Ventilation system including air intake and outlet, air filters on air-conditioner units, etc.
Preventive maintenance.
Rodent control.
Systems control, including evaluation of systems, etc.

General Environmental Control


General environmental control covers areas like water supply, plumbing, liquid waste,
solid waste, air quality and air pollution control, sterilization (autoclave, use of
ethylene oxide), insect and rodent control, interior cleanliness and food service. Some
of these have been dealt with in detail elsewhere in this book.

Radiological Health
Radiation control and safety practices in hospitals come under the mandatory
regulations of the Division of Radiological Protection (DRP) of the Bhabha Atomic
Research Centre (BARC). Radiation sources are generally of two categories: Ionizing
and non-ionizing. Examples of hospital ionizing radiation are X-rays and radioactive
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isotopes." The most common non-ionizing sources are microwave and laser; the latter
is used in hospitals for diagnosis and treatment.
Radiation control measures are based on the factors of time, distance, shielding,
containment, personnel protective and monitoring devices and ventilation. Hospitals
must appreciate the problems concerning radioactive waste disposal, both liquid and
solid, and should strictly comply with the regulations.

Accidental Injury Prevention


Few people appreciate; much less concern themselves with, the problems arising from
accidental injuries in hospitals, largely among hospital patients, personnel and visitors,
and the resultant financial loss and suffering. Too preoccupied with fulfilling their
primary mission of patient care, hospital authorities and staff do not recognize the
hospital's responsibility in this regard and the fact that most accidental injuries can be
prevented.
Causative factors leading to accidents are "environmental" or "human." Control of
environmental factors through various means discussed earlier cannot by itself prevent
accidents. The human factors are the cause of most accidents. On the hospital's part,
such seemingly minor considerations as elimination of electrical shock situations,
provision of non-slip floor surfaces, handrails and grab bars, wherever necessary, and
provision of structurally and mechanically sound equipment and furniture, to mention
just a few, go a long way in making the hospital a safe place.

Occupational Health
Every employee has the right to work in a safe environment. Frequently, the work place
is hazardous in spite of the mandatory safety regulations and requirements under relevant
laws. Dangers lurk in unsuspected places: While walking, on working surfaces, in the
means of egress, hazardous materials, compressed gas and air equipment, materials
handling and storage-the list is endless. It is incumbent on hospitals to do everything
reasonably possible to make the hospital environment a safe place. However, safety is
everybody's business. All employees should be made aware of it.
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12. BIOMEDICAL ENGINEERING


Overview
Clinical or biomedical engineering is one of the latest and most dynamic
programmes in hospitals. In today's high technology environment with a
proliferation of advanced and complex medical hardware, clinical engineering has
assumed great significance. This section has been included in this study to provide
information about how to set-up and operate a clinical engineering programme as no
hospital, which has invested a small fortune on costly equipment, can afford to
remain without such a set-up.
The aim of a clinical engineering programme is to provide technical expertise and
management support to hospital administration, engineering department and medical
staff.
Functions
The following are some of the important functions of the unit:

Writing specifications for new equipment and machinery.

Evaluating equipment and machinery. Evaluation must include, among other things,
not only the initial cost of the equipment but also its operating cost.

Inspecting incoming equipment and machinery and performing pre-acceptance


checks before officially accepting equipment and payment.

Setting standards and ensuring their compliance.

Organizing in-service training programmes and training for personnel in the clinical
engineering department as well as other user departments to use equipment properly.

Evaluating the need for new or replacement equipment and major repairs.

Advising and providing expertise to medical staff and administration.

Organizing a planned maintenance programme for all equipment and attending to


emergency breakdowns and repairs.

Instituting an effective equipment control system.

Establishing an inventory of all existing and incoming equipment.

Maintaining work record and maintenance history record.

Active involvement in the activities of the hospital's safety committee and checking
safety hazards.

Design, Space, Facilities and Utilities


The quality of the facilities of the department has a direct effect on the efficiency and
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productivity of its employees. When facilities are inadequate or poorly designed, much
time is wasted in extra steps and in making makeshift arrangements. A congenial
working environment influences the efficiency of employees. A pleasant and
comfortable work area creates a favourable attitude and enhances productivity.
It is difficult to establish a standard space layout for a clinical engineering laboratory for
all the hospitals. It depends on a number of factors like the size of the hospital, the
sophistication of equipment, the size and training of personnel and the extent of contract
service. Each hospital should tailor its structure and design to meet its individual
functional needs. Generally, in a small hospital where there is only one biomedical
technician, one room of 13.95 sq.metres (150 sq. ft.) = 4.57 metres x 3.71 metres (15
ft. x 10 ft.) is adequate to perform the basic functions. In a typically large layout, on one
side of the room, there is a desk with wall-mounted cabinets or bookcases above it for
reference books and catalogues. Beside it is a file cabinet for manuals and records. Next
to the cabinet are a lockable cabinet, shelves and drawers for storing test instruments,
spare parts and smaller instruments awaiting repairs. Large instruments that have come
for repair are stored at the end of the room on one side.
On the other side of the room, there are workbenches with storage drawers underneath
for tools and more spare parts. This is the main work area. The bench is 3.65 metres (12
ft.) long so that the technician can work on more than one item at a time. A large
laboratory type sink is provided at the end of the row for cleaning instruments. The
repairs area is divided into the mechanical repair area and electronics repair area. The
two are separated and provided with more cabinets for storage. There is a small secured
storeroom as well.
Irrespective of their size, all laboratories require the same facilities. The lab should be
air-conditioned because electronic instruments and spare parts are temperature-sensitive
and if they are not kept and repaired in an air-conditioned room, their operation may be
affected. The lab also requires good lighting.
There should be adequate power supply for several pieces of equipment and instruments
to be tested and operated at the same time. Both single and three-phase outlets are
required for testing various types of instruments.
Provision must be made for both hot and cold water for cleaning equipment. Some
equipment on the mechanical side may require water for operation. Besides these
facilities, the lab requires compressed air and a vacuum system-either piped or
furnished by a compressor and a vacuum pump-for cleaning equipment. Some types of
equipment require compressed air and others vacuum for operation. Certain instruments
and equipment require moisture-free cleaning which is done by using nitrogen.

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13. TRANSPORTATION
Overview
Transportation is an essential function in every hospital regardless of its size,
sophistication and means of transportation. It encompasses a wide range of activities
and areas in any hospital. Some of them are:

Inpatient escort service upon admission and discharge. Some hospitals make it
mandatory for every discharged patient to be escorted in a wheelchair to the main
entrance.

Patient transportation to and from ancillary departments like X-ray, physical


therapy and pulmonary medicine besides operating rooms, delivery suite, etc. for
inpatients, emergency room patients and, on occasion, outpatients.

Movement of staff and visitors within the facility through elevators.

Movement of supplies, materials and equipment within the hospital.

Movement of patient food, generally in trolleys or carts and through the elevators,
from the food service department to patient floors and return of used trays, dishes,
etc. to washing areas.

Ambulance service. Movement of patients from their homes, scenes of accident,


etc. to the hospital, and discharged patients to their homes.

Some hospitals may have a transport department to operate and maintain ambulances,
vans and other vehicles. Some may have, in addition, what is called the patient
transportation or escort service. Where there is no such centralized patient escort
service, individual departments may arrange it for their patients.
The usual means of transportation of people and materials include ambulance, elevators,
wheel chairs, lifts, dumbwaiters, stairways and ramps.

Elevator, Lift and Dumbwaiter


Elevator
Elevators are an integral part of the hospital's transportation system. They handle four
types of traffic: Patients, visitors, personnel and service. Movement of patient and visitor
traffic should be quick. Patients may have to be moved quickly in an emergency,
sometimes in their beds and stretchers, to the emergency rooms, operating rooms, ICUs,
CCU or the labour-delivery suite. Patients are moved in wheelchairs to the ancillary
services and other therapeutic treatment areas. Ideally, patient traffic should be separated
from visitor and service traffic. Some hospitals have separate service elevators for service
personnel and equipment, for delivering supplies from outside and for internal deliveries
like food, linen and materials.
Hospitals elevators are of two types: (i) for passenger traffic including doctors, nurses,
personnel and visitors, and (ii) for vehicular traffic including beds, stretchers,
wheelchairs, portable machines, food carts and the accompanying personnel.
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At least one hospital-type elevator should be installed when up to 59 patient beds are
located on any floor other than the main entrance floor; at least two hospital-type
elevators are needed when 60 to 200 patient beds are located on floors other than the
main entrance floor and at the least three are needed when 201 to 350 patient beds are
on floors other than the entrance floor.
Specifications

Hospital-type elevator cars should have inside dimensions that will accommodate a
patient bed, attendants and necessary equipment. It should be at least 1.52m (5'0")
wide by 2.29m (7'6") deep. The car door should have a clear opening of not less than
1.22m (4'0") wide and 2.l3m (7'0") high.

Additional elevators meant for visitors, personnel and materials handling can be of
smaller size

All elevators should be equipped with automatic levelling devices.

Some hospitals equip the patient-transporting elevators with a two-way special


service switch to permit cars to bypass all landing button calls and be dispatched
directly to any floor.

Every elevator should be equipped with a telephone and an alarm for use in an
emergency.

If there is a bank of elevators, at least one elevator should have dual control to
obviate the
necessity for an operator during the night or when traffic is light. This is particularly
useful in smaller hospitals.

Elevator call button and controls should be of the type that will not be activated by
heat or smoke.

As a rule, hospital elevators are slow. And there is a misconception that they should
be so. This is not true. There is no reason why they should not move as fast as those
in hotels or in commercial buildings.

Elevators are one place where people panic in case of power failure. To obviate this,
electric service and switching facilities should be arranged to permit operation of
elevators from alternate (emergency) power source in case of interruption in normal
electrical service. If it is not possible to connect all elevators to the alternate source
of power, at least one in each bank of elevators should be powered by an alternate
source.

For their proper and efficient functioning, elevators require routine maintenance and
inspection by skilled elevator mechanics with special training and experience in this field.
Elevator inspection and maintenance service should be contracted to the manufacturer or
his authorized agent, and not undertaken by in-house personnel as it is normally
considered beyond their capabilities.

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Lift
An elevator that is primarily used to move materials one or two floors is called a lift. In India,
however, the term lift is used synonymously with elevator. In this context, lifts (elevators)
are used to move all kinds of traffic and materials.
Dumbwaiters
Dumbwaiters are small lifts or elevators that are used to deliver food trays, medicines and
supplies: Before installing a: dumbwaiter, on~ should decide the purpose for its use. -One
purpose for which it is used is to deliver sterile supplies and instruments from the CSSD to
the operating rooms when these two departments are located in different floors but directly
one below the other so that the dumbwaiters open directly into the departments.
There are two types of dumbwaiters: The conventional waist-loading type and the floor
loading type. The latter permits a greater variety of use including transportation of small carts
between upper and lower floors. The cart can be rolled directly onto the platform. This
eliminates manual handling of materials. This is not possible in the waist-loading type.
Dumbwaiters can be equipped with automatic loading and unloading devices. They are
available in various sizes and capacities. One popular size is 0.836 sq. metres (9 sq. feet) of
floor size and 1.21 metres (4 feet) in height.
Large dumbwaiters can be used to transport bulky equipment like food trucks or trolleys and
laundry trucks.
When used for transporting sterile supplies from CSSD to the upper floor operating rooms,
generally twin dumbwaiters are used-one sterile and the other soiled. The sterile dumbwaiter
transports sterile instruments and supplies from the sterile area of the CSSD to the sterile
area of the surgical suite. The soiled dumbwaiter brings back soiled instruments and supplies
from the surgical suite to CSSD for reprocessing.

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Stairways and Ramps


Stairways
Wherever there are elevators, stairways do not play a major role in handling normal
traffic. However, they are required if the elevators break down and as a means of egress
in case of fire. Therefore, they must be planned with considerable care. There should
always be at least two stairways-in larger facilities, more than two-leading from the top
floor to a ground level exit. It is also necessary to locate them in different areas of the
building. The fire department may require, as a measure of protection against fire, that
there should be a complete enclosure in the entry to the stairways with self-closing doors
and lighted exit signs over the door in the corridors. A minimum width of 1.11 metres (3
ft. 8 in.) and wide landings are necessary for handling stretchers in an emergency as, for
example, when patients have to be excavated during a fire. Continuous hand railings on
both sides at a height of approximately 0.9 metre (3 feet) are necessary for ease as well
as safety of patients and personnel. Treads with grooves should be provided to make the
surface of the steps non-slippery.
In smaller hospitals with only ground and first floors, there may not be any elevators. In
that case, stairway in combination with a ramp becomes the major means of handling
traffic of all kinds with ramps being used to transport patients on stretchers and
wheelchairs.
Ramps
Ramps are a common feature in many hospitals. They are used largely for transporting
stretcher patients. Ramps must have a gradient of 1: 10; the width should be 2.5 metres
(8 feet); width at landing at the U turn 3.0 metres (10 feet); concrete railings ata height
of 0.9 metres (3 feet) and at the top of the railings M. S. pipe or wooden railings with a
diameter of 75 mm.
The flooring of the ramp should have grooves perpendicular to the slope to avoid
skidding. The floor may be of tiles, stone slabs or ribbed vinyl. When ramps are located
in the periphery of the building, they should be sheltered from the weather.

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14. CASE STUDY APOLLO HOSPITAL, RANCHI


Introduction
Abdur Razzaque Ansari Memorial Hospital (ARAM) in Ranchi is the only super speciality
hospital in this area of the country. It was founded in 1996 by the Chotanagpur Regional
Handloom Weavers Co-operative Union Ltd and the members of the family of the late Abdur
Razzaque Ansari.
The hospital provides state-of-the-art medical facilities to the most backward regions of the
country thereby arresting the migration of needy patients to other metros for all their major
ailments. Today ARAM, Ranchi is comparable to any super-speciality hospital in the
country. It is a 300 bedded hospital with all the modern facilities in it.

Electrical and Water Supply and Sanitation Services in the Hospital

This hospital has a very good electrical power back up system as it has two generators of
1000 KVA each and addition to it they also has a generator of 50 KVA as emergency
back up to be used in worst circumstances.

Electric cable has been provided from Electric Sub Station in addition to normal and
emergency one as a back up.

All critical areas like Cath Lab, MRI etc. has a direct connection from Electric Sub
Station and has not been connected with any other area.

Dedicated earthing has been provided for costly equipments separately and is not
connected to any other equipment.

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Separate M.C.B. has been provided for each department on each floor.

There is only one transformer and they do not have any back up of transformer and are
dependant on generator or D.G. set for power back up when transformer breaks down.

The electrical panels are controlled by motor instead of manual control and if the motors
burns or break down generator has to be used.

There is no back up for electrical panels, hence the power of the whole department or the
whole hospital has to be cut for servicing and the critical areas are provided a back up by
generator which is not good and is very troublesome.

There is different water supply line for each floor and this has been done to maintain the
same pressure of water in pipes everywhere and this has been done by making a ring of
the water supply line from over head water tank at terrace level and then providing
separate outlets of water supply for each floor.

They have their own bore well of sufficient capacity capoacity in the hospital and do not
depend on municipal water supply.

There is an underground water reservoir of 1.5 lacs litres of which 50 thousand litres are
always reserved for fire fighting.

An Ion exchange water filter plant has been made and all the water from the reservoir has
to pass through it before getting transferred to the over head water tank for use.

The water supply line is of G.I. which gets choked quiet often due to choking as
Jharkhand is a hilly plateau and the water is very rich in iron. Iron remover should have
been installed instead to remove the iron from the water and to prevent the pupes from
getting choked time and again or P.V.C. pipe could have been used.

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The over head water tank is of very low capacity i.e. 30 thousand liters which is very less
for a 300 bedded hospital. The reason for it is that initially it started as a 100 bedded
hospital but after gradual expansion it has become a 300 bedded now.

The drainage facility is not very proper and all the waste water whether black water or
grey water is transferred to the septic tank and from there to soak pit. This also leads to
overflowing of tanks at times. Instead only black water i.e. water from toilet should be
transferred to septic tank and water from washing and other areas i.e. grey water should
have been used for gardening and flushing after treatment.

There is no Sewage Treatment Plant in the hospital which is very unhealthy and wrong
practice but now after heavy penalties by the pollution control board and their strict
norms they have started the process of installing a Sewage Treatment Plant.

FACLTY OF ARCHITECTURE & EKISTICS (JAMIA MILLIA ISLAMIA)

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ELECTRICAL, WATER SUPPLY & OTHER SERVICES IN A HOSPITAL

15. INFERENCES

We should have arrangements for proper power back up like two numbers of
generators and U.P.S which will provide us with the option of double power back
up.

Separate distribution board for each department and each floor must be provided so
that there is no power disturbance in other areas if some repair work is going on in
one area.

There should be two lines of main cable so that if one blasts of breaks down we
have the other as stand by to be used in emergency.

There should be separate electrical panels for Air Conditioning, Street Light etc.

Bed head panels must be provided in critical areas like I.C.U., C.C.U, ventilator etc.
with sufficient number of plug points in order to connect any life saving or
treatment equipment as and when needed.

The sewer line must be properly covered and should never be exposed as it may
lead to the cause of some infection.

There should be 24 hours water supply without fail.

The calculation for the capacity of over head water tank must be done properly
which is 340 litres per bed per day for a hospital of up to 100 beds and 450 litres
per bed per day for hospitals with more than 100 beds.

The quality of water must be tested from time to time so that we can be aware of
the water type and we get to know immediately if there is some infection in the
water.

One third capacity of the water tank should always remain full and the over flown
water from fire tank must be filled up in the daily usage tank so that the fire tanks
always remain full for fire fighting purposes in case of any fire emergency.

Sewage Treatment Plant (S.T.P) or Effluent Treatment Plant (E.T.P) must be


provided for treating the waste water before disposing it to the sewerage system or
using it for flushing and gardening purposes.

FACLTY OF ARCHITECTURE & EKISTICS (JAMIA MILLIA ISLAMIA)

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ELECTRICAL, WATER SUPPLY & OTHER SERVICES IN A HOSPITAL

Bibliography
Website of Agency of Healthcare Research and Quality http://www.ahrq.gov/

Hospital Facilities Planning and Management by G.D. Kunder.

Trends in Modern Hospital Planning by Dr. Chandrashekhar & Shakti Gupta

FACLTY OF ARCHITECTURE & EKISTICS (JAMIA MILLIA ISLAMIA)

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