Hospital Support and Utility

Services
Hospital Services are the collective activities of all
departments and all personnel of a hospital, which end-
up in satisfactory patients care.
 Clinical services

Clinical Services in a hospital, are the care which is directly related to patient-treatment.

1. Emergency Services
2. Outpatient Services
3. Inpatient Services (Ward)
4. Inpatient care Unit ( ICU)
5. Operation Theatre (OT)
 Support Service

Support Services in Hospital, are the services which are not directly related to
patient care but, indirectly contribute in patient management.

1. Laboratory Services
2. Radiological Services
3. Blood bank
4. CSSD
5. Pharmacy & transport
Laboratory Services & Radiological Services
Laboratory Services & Radiological Services

 Laboratory & Radiological department are one of the focal

point of any hospital or a medical centre and setting up such
facility requires a careful planning and vision for the
future.
 Scope of modern department setup is not only limited to
imaging studies but also has a therapeutic role in the form
of minimal invasive interventional radiology / laboratory
setup.
Layout

 Reception area
 Preprocedural and changing rooms
 Investigation room
 Reporting room
 Location

The radiology/LAB should be located such that, it should cater to the needs of both
outpatient and inpatient departments along with accident and emergency services.
 Preferably on the ground floor
 In addition to walk in patients, the department also caters to emergency patients who
may not able to walk or need urgent Investigation for establishing the diagnosis.
 Should be easily accessible to
 OPD Patient,
 Inpatients

 Emergency department
 Investigation Rooms (Radiology Department)

A modern radiological setup should have a minimum of

1. One digital X-ray unit
2. One fluoroscopic unit
3. One mammographic unit
4. One sonographic unit
5. One CT scan
6. One MRI unit
Special care is required for the construction of rooms b/c they ( emit ionising radiation)
 Classification of the laboratory services
The central laboratory services can be broadly classified into four heads each of which
can be further classified into units within the individual labs.
1. Biochemistry
2. Microbiology
3. Pathology
4. Haematology
 This is further classified as
 Blood morphology
 Urine stool
 Coagulation profile
 Immuno hematology
 Blood Bank
 Central Sterile Supply Department

 CSSD is the abbreviation of the Central Sterile Supply Department

 CSSD comprises that services within a hospital which receives stores,
processes, distributes, and controls professional supplies and
equipment, both sterile and non-sterile to and from all departments of
the hospital for the care and safety of patients.
Central Sterile Supply Department


Ideally CSSD is an independent department with
facilities to receive, clean, pack disinfect, sterilizes, store
and distribute instruments and supplies as per the
protocols
ORGANISATIONAL CHART
Location

 The central supplies department must be located centrally in the

relation to the departments which utilize its services the most. The
department should also be close to Labour, OT, and laundry, etc.
 The design of the department should help in fulfilling the fundamental
responsibility of this unit i.e. sterilization.
 Ideally, there should be three separate zones the
1. unclean and washing area
2. the assembly and packing area
3. the sterilization area other.
 Equipments:

 Equipment in the CSSD includes the following

 Dry oven
 Gauze cutter
 Ultrasound Washer
 Needle flushing Device
 Autoclave
 Ethylene oxide steriliser
 Work benches with marble or stainless steel top
 Storage cupboards and racks
 Linen folding table
 Soaking sinks
 High pressure water jets.
 Hospital Pharmacy

 The pharmacy department of the hospital deals with procurement,

storage, dispensing, manufacturing testing, packaging, and distribution
of medicine in the hospital.
 The practice of pharmacy within the hospital under the supervision of a
professional pharmacist is known as hospital pharmacy.
 Is one of the most revenue generated department
Objective

 Cost Containment
 Effective and efficient service
 Patient satisfaction
 Effective staff Utilization
 Function

 Forecast of demand
 Selection of reliable supplies
 Quality control of purchased product
 Distribution of medication in the ward
 Dispensing of medication to outpatient
 Drug information source in the hospital
 Implement recommendations of the pharmacy and therapeutic
committee.
Location

 Preferably in the ground floor

 Readily accessible to all departments
 OPD Unit to serve OPD Patient
 Few hospital have floor wise pharmacy.
 Storage of medicine

 General Drugs (arrange in alphabetically, as per-use, FIFO, etc)

 Cold storage: 8 to 15 Degree antibiotics and other drugs and 2 -8
degree vaccines.
 Narcotic Drugs : special arrangement ( lock and key )
 Inflammable Items ( spirit/ chemicals) separate enclosure
Drug and Therapeutic Committee

 MS / Director – chairman
 All HODs – Members
 Nursing Superintendent – Member
 Chief Pharmacist – Member Secretary
UTILITY SERVICES
Utility Services in hospitals are the services that provide supplementary or additional
help and support that are not directly related to patient care but, Service provided
in addition to the regular services.
1. Medical Record
2. Dietary Services
3. Engineering and Maintenance Services
4. Hospital Security
5. Linen and Laundry Services
6. Housekeeping
7. Hospital Waste Management
 27

Medical Records Department

 28
Definition

Medical Record is a clinical, scientific, and legal document relating

to patient care which record sufficient data written in the

sequence of events to justify diagnosis, treatment and end result

 Contents of Medical Records 29

Cover Page: Name, Gender, Age, Date of Birth, ID Number, Work Place, the Address
and Telephone Number of the Patient's Home and Workplace, Details of Next of Kin

Case Details:-
Clinical Monitoring Legal Documents
•Complaints,
Records:- like referral letter,
Histories •Temperature, Pulse
•Physical request for
•Respiration, BP and Information etc
Examination
Weight Recording
Findings, Treatment

Discharge Summary, Operation report if Investigation reports

referral slip operation has been like, X-ray,
performed pathology etc
 30
FUNCTIONAL ACTIVITIES IN MRD

Numbering : Medical record numbering systems are how we give a number to medical records.

 SERIAL NUMBERING: In this method, the patient receives a new number

on each admission.
 UNIT NUMBER SYSTEM: the patient is given a number on his / her first
admission to the in-patient or out-patient or out-patient department of the
hospital. He / she retains that number on all subsequent admissions

UID Number is permanent but OPD Visit

number/ IPD number may change
 FUNCTIONAL ACTIVITIES IN MRD
Color Coding

Different colors are used for different years for easy identification and retrieval.
 32

Staffing

 Staffing will Depend on the Extent of Use

of Computer Technology
 Staffing Norms for 500 Bedded Hospital
 Medical Record Officer 1
 Medical Records Technician 4
 Clerks 3
 Peon 1
 Statistician 1 Part Time
 Dietary services

 Dietary services is to make provision for clean,

hygienic and nutritious diet for the indoor
patient as per their caloric requirement.

 The dietary service can be provided by in

house provision or by out sourcing.
EQUIPMENTS

 Cooking Utensils
Cooking Ovens
 Distribution Trolleys
 Refrigerators
 Micro wave
 Cold storage
Cutting Equipment's
 Dish washers
Mixing Machines
 Cutlery
Chapati Making Machine
Grinding & Weighing
 STAFFING OF DIETARY SERVICES

MEDICAL SUPERINTENDANT

CHIEF DIETICIAN

DIETICIAN

SUPERVISOR

HEAD COOK SERVICE BEARER

ASSTT. COOK BEARER

 Location & Size

 The dietary services area should ideally be on the ground floor

 away from normal traffic flow
 Access to lorries coming for unloading supplies
SIZE
 the area requirement for kitchen varies as per the type and size of the hospital
 Up to 200 beds - 20 sq ft.bed
 200 to 400 beds -16 sq ft/bed
 500 and above - 15 sq ft / bed
 Hospital Engineering Services

 Engineering Services are perhaps the most vital of the

utility services in the hospital.

 The efficiency of entire patient care delivery system of the

hospital depends on their efficiency.
 Even the slightest breakdown of power supply system, information
system communication system or malfunctioning of vital
equipment can have catastrophic effects.
Engineering Specialties

 Civil Engineering – Building, Roads, Grounds

 Mechanical Engineering – Equipment's, Air conditioning, Medical

gas, Steam plant

 Electrical Engineering – Electrical equipments, Generator sets, UPS,

and Lighting
Engineering Specialties

 Public Health Engineering – Water supply, Sewage and

Waste disposal
 Electronics Engineering – Computers, Communication
equipment.
 Functional Aspects

 Maintenance of assets including periodical services.

 Repair and renovation of equipment and systems
STAFFING
 Chief Engineer (In charge of the department).
 Engineer(clinical, electrical, mechanical , plant operation, civil)
 Supervisor
 Electrician
 Technician
 Carpenter
 Boiler operator
 Plumber
 Helper
LOCATION

Ground floor in a non-prime area.

Away from patient care area.
Convenient movement of machines & equipment.
3 important functional areas(Administrative area, shop area, &
mechanical equipment area).
 Housekeeping - Definition

Housekeeping is defined as “The provision of a clean,

comfortable and safe environment for the patients and
public in a hospital setup”.
 Acid Alkaline Solvent
Detergents
Cleaners Cleaners Cleaners

Abrasives Disinfectants
TYPES OF
CLEANING AGENTS

Floor seal Laundry

Polishes Deodorants
Aids
 Organization Chart

Executive
Housekeeper

HK Laundry Linen Room

Supervisors Supervisor Supervisor

Desk Floor Linen Room

Washer men Iron men
Attendants Attendants Attendants

Helpers Helpers
 Manpower

 The cost of housekeeping services in hospital amount to 3% of the total cost.

 Recommended

1 Sanitary attendant for 10 beds OR for a work area of 1200 to 1500 sq.ft.

1 supervisor for every 10 sanitary attendants.

 Scheduling of housekeeping staff done as per the work loads.

 Linen and laundry services are one of the most
important utility services in the present day
hospitals.

Linen and The clean bedding, clean clothes gives

psychological confidence to patients and enhances
Laundry their faith in the services rendered by the hospital.
Services
An adequate supply of clean linen becomes
essential for Hospital .
  The laundry should be located in an area that has ample
daylight and natural ventilation.
 Ideally, it should be on the ground floor of an isolated
building connected or adjacent to the water and power
plant.
The following considerations are important:

Location  1. Space for heavy equipment like washing machine,

squeezer etc.
 2. Provision for supply of water and power.
 3. Storage place for cleaning agents.
 4. Space is also needed for sorting the soiled linen
 5. Place for ironing
Staffing pattern

 Four category of workers are required in laundry;

 Supervisor
 Operational
 Semi-skilled
 Unskilled
 Training in infection control and basic hygiene should be given to all
workers. There are various formula for calculating staffs in laundry:
Staffing pattern cont..

 A-one washer man for each 60-75 kg of linen

 As per recommendation of US department of health
 Approx. personnel excluding mangers are :
 50 -75 bed 7 personnel
 100-175 bed 12 personnel
 200-300 bed 15 personnel
 Mortuary Services

 Mortuary is the place where dead bodies are kept before

burial/cremation.
 Morgue is a place where dead bodies are kept in the
refrigerated body store and examined in the post mortem
room.
 PLANNING CONSIDERATIONS
Separate lockers for cloths,
gowns, aprons etc.

Pathologists room-3 Changing room -4

Fulfill report,
discussion 3 stores Clean,
equipment, chemical

Body store-2 Stores-5

Refrigerated body store, Rooms required
deep freezer

Autopsy room-1 Technicians room-6

Autopsy table, sink,

cupboard, tile wall, etc Waiting area-7
Veranda, soberly
furnished, prayers
 STAFFING

 The requirement of staff in the mortuary differs from place to place

and depends on the type of work undertaken, the quantum of work and
the type of institute whether teaching or non teaching hospitals.
 STAFFING

 2 pathologists or forensic experts for 150 autopsies

 5 morgue attendants posted round the clock
 At least 2 mortuary technicians
 3 workers for cleaning and maintaining
 X-ray technicians for X-ray in case of MLC
 A record assistant
Equipments

Cold Chamber
Autopsy Table
Table ,Chair, Stools, File cabinets, Lockers
Computer with printers
Sterilizer
Instrument cabinet
Portable xray machine
Spectrophotometer
Fume chamber
 Location

 Mortuary complex must be located in a

separate building in vicinity of hospital.
What is bio-medical waste?

 BIOMEDICAL WASTE” :- Means any waste which is

generated during the Diagnosis, Treatment, or Immunization
of human beings or animals or in Research Activities
pertaining there to or in the production of testing of
biologicals (Preparation from organisms, micro-organisms /
Product of Metabolism for Diagnosis treatment or research).
Amount and composition

Waste

Non hazardous Hazardous

85% 15%

Hazardous but infective 10% Hazardous but not infective 5%

 Non Sharp  Radioactive waste
 Sharps  Discarded Glass
 Plastic Disposal  Chemical waste
 Liquid Waste  Cytotoxic Waste
STATUTORY MANDATE

 BIOMEDICAL WASTE (HANDLING & MANAGEMENT)

 RULES 1998 under powers conferred by sections 6,8

& 25 of environment (protection) act 1986 publicized under gazzete
July 27, 1998.

BIO-MEDICAL WASTE MANAGEMENT (AMENDMENT) RULES -

2018
Bio-medical waste (BMW) management?

Hospital Waste

• Generation
• Segregation
• Collection
• Storage
• Treatment
• Transportation

Disposal
 Waste Storage

 Untreated human anatomical waste, animal anatomical waste, soiled waste and, biotechnology waste

shall not be stored beyond a period of 48 (forty –eight) hours.

 If required to store beyond 48 hours, the occupier shall ensure that it does not affect human health

and inform the SPCC (State pollution control committee)with reason.

 Administrative Services

 CEO, Vice President (S),

 Executive Assistants,
 Departmental Heads,
 Business people who run the hospital,
 Oversee budgeting and finance,
 Establish hospital policies and procedures,
 Often perform public relation duties