CHITKARA SCHOOL OF HEALTH SCIENCES

ASSIGNMENT ON:
PLANNING AND ORGANISING HOSPITAL
UNITS AND ANCILLARY SERVICES

SUBMITTED TO: SUBMITTED BY:

MS. GAGANDEEP KAUR PRACHI GUPTA
ASSISTANT PROFESSOR [Link] NURSING 2ND YEAR
CSHS 2440982501
Introduction: Planning and Organization of Hospital Units
A hospital plays a vital role in delivering essential health services to the
community. To ensure efficient functioning, hospital planning must follow
universally accepted principles applicable at all levels — national, state, and
individual institutions.

Aims of Hospital Planning

Hospital planning aims to:
 Expand existing hospitals by adding new facilities.
 Increase the utilization and accessibility of hospital services.
 Broaden population coverage.
 Enhance hospital productivity.
 Modernize existing infrastructure and equipment.
 Reduce operational costs while maximizing efficiency and quality of care.

Guiding Principles in Hospital Planning

1. Patient-Centered High-Quality Care
High-quality care can be achieved through:
a. Provision of adequate technical equipment and medical supplies.
b. A defined organizational structure with clear roles, responsibilities, and
accountability.
c. Continuous evaluation of the care provided by physicians, nurses, and
paramedical staff.
2. Community Orientation
Hospitals should maintain strong links with the community by:
a. Forming a governing board with community leaders who demonstrate concern
and leadership.
b. Ensuring equitable access to services for all members of society.
c. Participating in preventive and community health programs.
3. Economic Viability
Financial sustainability can be ensured by:
a. Establishing sound corporate governance and financial management systems.
b. Planning expansions based solely on verified community needs.
c. Preparing annual budgets that accommodate modernization and operational
demands.
4. Orderly Planning
This involves:
a. The hospital administrator assuming primary responsibility for both short- and
long-term planning with expert advisory support.
b. Developing a functional program detailing objectives, required facilities,
equipment, and staffing plans.
5. Sound Architectural Design
An effective hospital design includes:
a. Selecting a site large enough for future expansion and easily accessible to the
population.
b. Ensuring smooth traffic flow within the hospital for patients, staff, and visitors,
along with efficient supply transport.
6. Integration of Medical Technology
Rapid advancements in medical technology significantly influence hospital design
and professional standards. Incorporating appropriate technology enhances
diagnostic and therapeutic efficiency.

Classification of Hospitals
Hospitals can be classified based on funding and ownership:
1. Government or Public Hospitals
Managed by central, state, municipal, or departmental authorities and financed
through public budgets.
2. Non-Government or Private Hospitals
Managed by individuals, charitable organizations, religious institutions, or private
enterprises.
Ownership sub-categories include:
 Private (individual) ownership
 Partnership
 Family or private trust
 Public charitable trust
 Cooperative society
 Private limited company
 Public limited company

Hospital Planning Process

i. Conceptualization
The initiator visualizes the hospital project, drawing inspiration from existing
models and adapting them to meet community needs.
ii. Formation of Support Groups
After conceptualization, the initiator gathers a group of collaborators and
stakeholders to develop and execute the project.
iii. Temporary Organization and Funding
A formal group or trust is registered under the Societies Act or Companies Act.
The initiator serves as chairperson, and members are assigned specific tasks,
including estimating capital requirements and identifying funding sources.
iv. Geographical, Environmental, and Miscellaneous Considerations
Planning must account for:
 Meteorological factors: temperature, rainfall, and humidity.
 Geographical aspects: accessibility, seismic or flood risks, and proximity
to airports affecting building height.
 Miscellaneous needs: availability of trained manpower, water supply, and
sewage disposal facilities.
v. Hospital Design
Bed Planning:
Hospitals serve both local and extended populations; hence, an 85% bed
occupancy rate is considered optimal.
Hospital Size:
Extremely large hospitals (over 1,000 beds) can be difficult to manage, whereas
very small hospitals (under 50 beds) may be economically unviable. Two 400-bed
hospitals are often more functional than a single 800-bed facility.
Land Requirements:
 In rural or semi-urban areas, hospitals may expand horizontally due to ample
land availability.
 In urban areas, limited land often necessitates vertical expansion.
No. of Beds Land (Acres) Building Type
50 beds 10 acres Single-storey
100 beds 15–20 acres Single-storey
200 beds 20–25 acres Double-storey
500 beds 55–70 acres 3–5 storeys
700 beds 80–90 acres 4–6 storeys
1,000 beds 90–100 acres 6–9 storeys
Public Utilities:
According to the National Building Code of India (ISI), hospitals require
approximately 455 liters per person per day (LPCD) for up to 100 beds, and 340
LPCD for hospitals exceeding 100 beds. Additional provisions must be made for
staff quarters and nursing hostels.
Hospitals should ideally connect to the public sewage system or develop in-house
treatment facilities if unavailable.
vi. Circulation Routes
Efficient hospital design depends heavily on internal and external circulation
routes.
 Internal circulation: Corridors, staircases, and lifts should allow smooth
movement; corridors should be at least 8 feet wide with protective corner
beading.
 External circulation: A single vehicular entrance from the main road is
preferred, with clearly marked entry and exit points for organized traffic
flow and administrative security.
vii. Distances, Compactness, Parking, and Landscaping
Hospital design should aim to minimize distances for the movement of patients,
staff, and supplies. Efficient layouts reduce time and effort, ensuring smooth
operation and quicker access to essential services. Adequate parking space must
be provided for patients, visitors, and staff, while landscaping should create a
calm and healing environment around the hospital.

viii. Zonal Distribution and Departmental Inter-Relationships

Efficient hospital functioning depends on the proper distribution and logical
arrangement of departments based on their functions and patient flow.
 Public contact areas such as the Outpatient Department (OPD),
Emergency, and Casualty should be located close to the main entrance,
isolated from inpatient areas to reduce congestion.
 Support services like the X-ray and Laboratory units should be near the
OPD for easy access.
 The inpatient zone should include wards, ICU, operation theatres (OT), and
delivery suites.
 Clinico-administrative and support departments such as stores, kitchen,
dietary, and pharmacy should be grouped around a centralized service core
for efficiency.

ix. Gross Space Requirements

The gross total hospital area typically ranges from 780–1005 sq. ft. per bed,
with an additional 95–125 sq. ft. for walls, partitions, corridors, and mechanical
spaces. This includes all internal circulation areas like stairs and service zones.
A reception and enquiry counter should be located in the main waiting area near
the OPD entrance for patient convenience.
Bed Requirement Formula:
A × S ×100
Beds per population=
365 × PO
Where:
 A = Number of inpatient admissions per thousand population per year
 S = Average length of stay (ALS)
 PO = Percentage occupancy
Suggested Bed Distribution by Specialty:
 Medical: 30–40%
 Surgical: 25–30%
 Obstetric: 15–18%
 Pediatric: 10–12%
 Miscellaneous (ENT, Eye, etc.): 10–15%

x. Climatic Considerations in Design

Hospital design must adapt to local climatic conditions.
 In hot climates, artificial cooling systems are necessary, but natural
ventilation and cooling can be enhanced through building orientation and
architectural design.
 In cold or humid regions, insulation and humidity control become essential
for patient comfort and equipment maintenance.

xi. Hospital Equipment and Furnishing

Hospitals require a broad range of equipment and furniture to support all
functions. These are classified as follows:
1. Physical Plant Equipment:
Includes lifts, boilers, incinerators, refrigeration and air-conditioning
systems, kitchen appliances, mechanical laundry, and central oxygen supply
units.
2. Hospital Furniture and Appliances:
Includes beds, stretchers, trolleys, bedside lockers, movable screens,
operation tables, and instrument trolleys.
3. General Purpose Furniture and Appliances:
Office machines (computers, typewriters, filing systems), office furniture,
crockery, and cutlery.
4. Therapeutic and Diagnostic Equipment:
Includes general-use equipment (BP apparatus, suction machines, glassware
washers) and specialized patient-interactive equipment (defibrillators, X-ray
machines, etc.).

xii. Cost Evaluation in Hospital Construction

The most common method of cost estimation is based on the per-bed cost,
which varies depending on hospital type, facilities provided, and inclusion of
teaching, training, or research units.
Factors influencing cost include:
 Quality of materials and technology used
 Level of automation and digital systems
 Inclusion of specialty and super-specialty units

Outpatient Department (OPD)

Definition
The Outpatient Department (OPD) serves all patients who do not require
emergency or inpatient care. It is the hospital’s primary contact point for
community health services.
Planning and Organization of OPD
Location:
The OPD should be located near the main hospital entrance and easily
accessible from the main road. Ideally, it should function as a separate wing to
prevent interference with inpatient services.
Space:
The area requirement depends on the hospital’s scale and expected attendance.
Approximately 0.66–1 sq. ft. per annual outpatient visit should be provided.
For instance, a hospital with 300,000 annual OPD visits would require 2–3 lakh
sq. ft. (4.5–6.8 acres) of space.
Size:
The OPD’s size is determined by the number of clinics, the volume of patient
attendance, and additional facilities such as blood banks or emergency units.

Zones of the OPD

1. Functional Zone:
Used by patients and attendants. Includes parking, entrance hall, waiting
area, enquiry and registration counters, and medical social services.
2. Administrative Zone:
Manages coordination and supervision of OPD activities. Includes:
o Office of the OPD In-Charge
o Nurses’ Control Station
o Cash Counters
o Medical Records Department (MRD)
3. Diagnostic and Supportive Zone:
Includes laboratory and imaging services essential for patient diagnosis.
4. Ambulatory Zone:
The area where patients directly interact with doctors and healthcare staff.
Includes:
o Consultation clinics (various specialties)
o Treatment rooms
o Minor operation theatre (OT)
o Pharmacy
5. Staff Zone:
Reserved for hospital staff. Includes duty rooms, storage areas,
housekeeping, and conference rooms.

Functional Management of OPD

Timings:
 OPD should function six days a week with morning (8 AM–12 PM) and
evening (3 PM–5 PM) sessions.
 Specialty clinics can operate between 2 PM–4 PM.
 Overcrowding and patient waiting times must be minimized through
efficient scheduling.
Records:
A unit record system is recommended to maintain continuity between
outpatient and inpatient records.
Public Relations:
All OPD staff act as public relations representatives. Proper communication,
clear signages, and courteous behavior help minimize complaints and enhance
patient satisfaction.

Facilities in OPD
 Adequate seating to avoid long standing queues.
 Display of general procedures and rules on notice boards or walls.
 Clearly identifiable and accessible registration counters.
  Health education through TVs, digital screens, or posters to inform and
engage patients during waiting time.

Staffing Pattern in OPD

 Medical Staff: Consultants, professors, senior lecturers, medical officers,
residents, and interns.
 Nursing Staff: Generally one nurse per OPD or clinic.
 Paramedical Staff: Personnel for injection rooms, dressing rooms,
registration, and MRD.
 Administrative Staff: Receptionists, cashiers, and record keepers.
 Medical Social Worker: Assists patients with social, financial, and
emotional support.

PLANNING AND ORGANIZATION OF WARDS:

A ward is the most important part of hospital where the sick persons are kept for
supervised treatment. It is also a nodal point for research in medicine and nursing
field, training and teaching of medical, nursing and paramedical personnel.
Types of wards:
a. General wards: in these wards, patients with non-specific ailments, requiring no
lifesaving care are admitted. The nurse patient ratio of 1:5 in big wards, and
catering to the patient‘s routine investigation, treatment and care needs.
b. Specific wards: these include patients admitted for specific care due to illness or
social reasons. It includes:
 Emergency ward
 Intensive care unit
 Intensive coronary care unit
 Nursery
 Special septic nursery
 Burns ward
 Post operative ward
 Post natal ward
a. Units with specialist nursing, treatment and equipment: wards like burn ward,
transplant ward functions at national or regional centers where particular
service skills are concentrated.

Ward planning:
Physical facilities: it includes:
Size of ward: size of the ward depends on- types of patient (an area of 100-120
sq ft/bed is required and smaller rooms of 2-4 beds are preferable), requirement
of ward staff (a small ward will have same requirement throughout the day,
helped by a head nurse and a clerk for administrative and clerical
responsibilities)

Patient housing area: this is an area where patients are kept for treatment.
 The area per bed within the ward is 80 sq ft/bed but in acute ward it is
100 sq ft/bed
 Space left between two rows of bed is 5 [Link] between two beds is
31/2 to 4 ft.
 Clearance between wall and side of bed is 2ft.
 Length of bed is 6‘6, width of the bed is 3‘.

Size of rooms:
 Single bed room should have a size of 125 sq ft/bed
 2 bed room 160 sq ft/bed
 4 bed room 320 sq ft/bed
 6 bed room 400 sq ft/bed
 ICU 120-150 sq ft/bed
 Obstetrics and orthopedics 120 sq ft/bed

Support service area: this section of ward includes:

Nursing station/duty room: it should be located at such a place that the time taken
by a nurse for moving from one place to another is limited. Centralize location is
desirable.
Treatment room: the room is meant for examination of patients and should be
equipped with examination table, spotlight, dressing material, hand washing
facility etc.
Clean work room: it is a working room for staff nurses in nursing unit, contains
work benches for preparation of trays, care of materials, equipments and supplies
etc.
Pantry: it is a place where the dishes are cleaned, washed and stored.
Unit store: it is meant for storing the supplies and linens.
Sanitary area: it includes baths and toilets, dirty utility room, store for sweepers
etc.
 Ward design: the primary objective of a ward design is to facilitate the nurse to
hear and see everything in the ward and to enable the patients to easily call the
nurse when need help.
[Link] ward: in an open hall, beds are placed in rows facing each other and
nursing station in the center of the hall.
II. Rigg‘s ward: in this design, 3-4 beds are placed parallel to the windows in open
bays separated from each other by low partition.
III. Unilateral rigg‘s ward: side beds are placed in each bay separated from nurse‘s
station with its standby services by a common corridor.
IV. Bilateral ward: it has been accepted as most suitable and workable conditions,
two unilateral rigg‘s wards are on either side of a central nursing station.
V. T-shaped ward: bed bays are placed in front of the nursing station and critical
patients bays are in front of nursing station. Isolation bays are at both sides and
ancillary and other service areas are behind the nursing station.
ANCILLARY SERVICES
INTRODUCTION
The ancillary services are an essential part of the hospital. It’s a proper functioning
contributes to the success of providing quality patient care. The critical hospital
ancillary services include central sterile supply department (CSSD), laundry,
kitchen, laboratory services, radiology, Operation Theater and so on.
CENTRAL STERILE SUPPLY DEPARTMENT (CSSD):
DEFINITION OF CSSD:
A CSSD is a department that furnishes all supplies required for the nursing units
and departments of a hospital- theatres, wards, out-patient and casualty
departments with complete, sterile equipment ready and available for immediate
treatment of patients.
These supplies include sterile linens, sterile kits, operating room packs, needles,
syringes and other medical surgical supplies.
AIMS AND SCOPE
To provide sterile equipment available for the use of caring patient through various
activities such as receiving, cleaning, assembling, packing, disinfecting, sterilizing
and storing and distributing sterile supplies as per hospital protocol.
OBJECTIVES
 Provide a source of sterile equipment ad material
 Receive and supply sterile articles equipment and other material
 Ensure proper sterilization process, procedure according to the type of
articles, equipment and other material
 Monitor and enforce control to prevent hospital cross infection
 Organize and maintain efficient services.
PLANNING AND ORGANIZATIONAL CONSIDERATION OF CSSD:
Planning of CSSD: the CSSD should be planned in all hospitals above 100 beds.
Theatre sterile supply unit (TSSU) is to meet emergent and large requirement of
OT and is established inside OT complex. In large hospitals like 500 beds and
above, TSSU is established in addition to the CSSD in service area.

The following areas are to be provided in CSSD:

i. Equipment storage room
ii. Receiving counter and clean up room
iii. Needles and syringes processing room
iv. Gloves assembling room with rubber goods processing room
v. Clean work area including sterilizers
 vi. Sterile storage area and issue counter
vii. gauze and dressing assembly area Percentage distribution of the space is
as follows:
 Clean area including sterilization- 40%
 Sterile storage area-15%
 Equipment storage-14%
 Fluids, needles and syringes- 14%
 Receiving and clean up area-12%
 Glove processing area-5 to 7%
 Additional 25% space located for future expansion
Layout:
 Location should be where the most rapid means of transportation of supplies
and equipment is possible.
 There should be avoidance of back tracking of sterile goods.
 There should be a continuous flow of equipment from the receiving counter
to the dispensing counter.
 The contamination of sterile goods should be avoided.
 Sterilizing area should be the last area before the sterile storage and
dispensing counter.
 The receipt and issue counters are separated by a corridor to avoid
contamination.
Area requirements:
It is recommended that the area of 1.64 sq.m/bed for a CSSD would be appropriate
up to 400 bedded hospitals, and for more than 400 beds an area of 1 sq.m/bed
would be sufficient.

Facilities
In [Link]
 entrance 10.50
 lockers 7.00
 Staff change room 7.00
 Dirty receipt and disassembly 7.00
  Washing, disinfection and decontamination 17.50
 assembly 10.50
 Linen processing 10.50
 sterilization 14.00
 Sterile storage 21.00
 distribution 10.50
 Trolley wash 7.00
 Trolley bay 10.50
 Bulk store 17.50
 Duty room 3.50
 toilet 3.50
 Total per 100 bed hospital 164.50

Staffing pattern:
 One CSSD worker per 30 beds plus one supervisor is recommended.
 In 200-300 beds hospital, you need 10-15 persons.
 Staff for 1000 bedded hospitals is:
 Supervisor – 1(senior most and trained technician)
 Asst. Supervisor- one of the senior technician
 Technicians – 6 (promoted attendants)
 Sweepers- 15
 Clerk- 1
Equipments and materials required:
 Hot and cold running water
 Cleaning brushes and jet water gadgets
 Ultrasonic washers
 Hot air oven for drying instruments and sterilization
 Globe processing unit
 Instrument sharpener like needle sharpening machines
 Stem sterilizers and boiler for steam
 Autoclaves of various sizes including gas autoclave
 Testing equipment
 Chemicals to clean materials
 Wall fixtures like sinks, taps
 Trolleys for supply of sterilized items and
  separate trolleys for collection of used items are needed
Methods of sterilization:
Sterilization is a process of freeing an article from all living organisms including
bacteria, fungus, using dry or wet heat, chemicals or irradiation.
a. Steam sterilization: autoclaving is the commonest method
b. Hot air sterilization: Vaseline and oils cannot be sterilized with steam. these
items are exposed to hot air to 160-1800c for 40 minutes.
c. Gas sterilization with ethylene oxide
d. Sub atmospheric pressure sterilization with formalin: it is meant to disinfect
instruments like endoscopes. the temperature required is 900c for 10-30 minutes.
e. Chemical sterilization with activated glutaraldehyde
f. Gamma irradiation sterilization: it is used for disposable goods but is a costly
method.
g. Formaldehyde steam sterilization Inventory management:
i. Stock: to ensure the availability of sterilized items to the hospital units, five
times the average daily requirements. The replacement and procurement of
condemned items should be laid out so that situation of stock out ‘can be avoided.
ii. Issue of materials: the principle of ‗first in- first out ‘ensures proper rotation of
supplies in CSSD and prevents any item from being kept for longer time so that its
sterilization date expires.
iii. Distribution of sterile items: the method that can be used for distribution of
sterile items are:
 Grocery system: in case CSSD is open 24 hrs, wards and departments can
send requisition to CSSD and stock is supplied accordingly.
 CSSD is open for limited hours:
 Clean for dirty exchange system: one clean item is provided for each item in
the ward used.
 Milk round system: it includes daily topping up of each ward/ department
stock level to a pre determined level decided by users.
  Basket system: a basket with daily requirement of ward is changed everyday
irrespective sterile items used or not, and the items of the whole basket is
sterilized every day.
 In case the items are to be stocked in wards, the date of sterilization is
written on each item so that the unused items are returned to CSSD for re-
sterilization after 72 hrs.
iv. Quality control methods:
 Routine temperature/pressure and holding time testing of each autoclave.
 Steam clox is also very handy and reliable. Changes color from brown to
green
 Heat/time, moisture sensitive tapes may be used in same way as that of
steam clox
 Random samplings of sterilized items are also tested in laboratory
 Culture of wall/floor and scrapings.
LAUNDRY SERVICES:.
Linen and laundry department is an important support service area and essential
component of the hospital. It provide clean and safe linen to the different
departments of the hospital and thus contributing towards the infection control
practice in the hospital

AIMS AND SCOPE

 To provide clean and safe linen required for the patients and the use of
caring patient.
 It includes various activities such as procuring/receiving, segregation,
disinfecting, washing, cleaning, drying, ironing and distributing clean linen
as per hospital protocol.
 It has a significant role in preventing hospital acquired infection by
supplying an adequate linen supplies.
OBJECTIVES
 Provide a source of n adequate supply of clean and safe linen to indoor and
outdoor patient departments
 Receive and supply fresh and clean linen regularly and timely to patient and
staff
  Ensure proper laundry process, procedure according to the type of linen
 Monitor and enforce controls to prevent hospital cross infection

Functions of laundry:
 Control of cross infection: it reduces the chances of cross infection.
 Patient satisfaction: the patient likes to have clean linen which is changed
and washed frequently and has a psychological effect on patient.
 Public relation: the image of hospital also depends on clean look of linen as
it instills confidence in patients and relatives.
Types of laundry:
a. In-plant or in-house laundry: in this system, the hospital has its own linen and
laundry and all activities of the hospital laundry services are done in hospital
premises. A hospital with more than 100 beds can run this type of laundry services.
b. Rental system: this system is used in advanced western countries. The owner of
the linen is also the supplier of linens to the hospitals and is also responsible for the
replacement as well as the laundering of patients and staff linen.
c. Contract system: in India, all hospitals have their own linen, majority of the
hospitals get the laundering done by contract dhobis. In some cases, a subsidized
contract type is prevalent and in some cases, the hospitals provide water and
washing area within the hospital premises.
d. Co-operative system: it is most beneficial to the smaller hospitals than the large
hospitals as they share the service of highly qualified laundry services.
PLANNING AND ORGANIZATION OF LAUNDRY SERVICES:
Location: if possible, the laundry should be in the same building as the hospital,
and should have separate entrance and exit areas. It is recommended to have a
mechanized laundry in the basement, with proper drainage arrangements.
Space requirements: The requirement for any laundry services has been worked
out to be approx. 10-15 [Link]./bed.
[Link] beds Space
200-300 beds 3750 [Link].
300-500 beds 5670 [Link].
500-600 beds 6460 [Link].
>650 beds 8210 [Link].

Physical layout:
1. Straight through flow: the planning of the building and installation of equipment
in a straight flow from the dirty end to the clean end.
2. U-flow: where the dirty and clean ends are in the same direction.
3. Gravity flow: this takes advantage of the underground, with dirty end at the top
and clean end at the bottom.
Laundry is divided into two distinct areas:
Dirty area: it comprises of
 Reception of solid linen
 Sorting of soiled linen into suitable quantities for processing
Clean area: it comprises of
Drying
Finishing
Discharge
a barrier wall between the clean and dirty area is desirable
ANCILLARIES:
 Laundry manager‘s office Stores
 Tailoring bay
 Worker‘s rest room
 Toilet Boiler room Material and decor:
 The route of soiled linen from the using points to the laundry and the flow of
 Sufficient space should be provided for the storage of one week‘s supply of
detergents, bleaches and others.
 The floor for the laundry should have smooth, slip resistant and water proof
surface, the walls should have a smooth washable surface free from all
corners, edges or projections which create maintenance problems.
  Utility services like piping, electrical wiring should be designed and sized
with appropriate consideration for future expansion.
 The steam supply system should be designed to deliver steam to the
equipment in right quantity at a desired temperature.
 Hot water should be available at 1800F by the pipeline to the laundry at the
required temperature from the boiler room.
 The power supply to the laundry is usually 220 or 440 volts in three phases ,
four wire alternative system and must be accessible
 Lighting should be free of glare and shadows.
 Fire extinguishers should be located in the laundry near the clean linen and
the processing areas.
 Ventilation system must be able to provide a comfortable environment for
the workers.
 Sewing and mending room should be located near to the clean linen and
pack preparation room.

LAUNDRY MANAGEMENT:
The management of laundry contributes to morale of the staff and patients with
fresh laundered linen:
a. Sequence of operation: Collection of laundry by laundry staffs in trolley
with clean and dirty linen separately and is sorted out as soiled, infected and
foul linen to avoid nosocomial infection.
Disinfection is done using disinfectants for infected linens. Sluicing and washing:
sluicing is done for foul linen in sluice machine and then the linen along with those
that are disinfected are put in washer for cleaning.
Drier tumbler: the linens are put for drying.
Pressing: the linens are pressed
Mending: the torn linen is sent for repair or condemnation and replacement.
Repaired linen is again washed in washer and washing cycle after that is to be
completed.
Distribution to ward is done by laundry staff after it is ready for use.
b. Linen distribution system:
Topping up: in this, the ward is given certain number of stock of linen based
on 24 hours requirement and shortfall of linen due to use is topped up by the
laundry staff every day and used ones are collected.

Clean for dirty exchange: the issue of clean linen to exchange number of
pieces of dirty linen.

Exchange trolley system: this is expensive and not used in India. In this,
total trolley is supplied which has 24 hours requirement and next day fresh
trolley is supplied with same number of pieces and old trolley is taken back
to laundry irrespective as how many pieces have been used and linen is
brought and washed.

c. Quality control of laundry services: the quality assurance of laundry should

be developed since laundry is important from where infection can be
transmitted to other patients, which should be seen by the hospital infection
control committee.

d. Policies and procedures:

 Collection and distribution system of linens with periodicity to each
ward and department.
 Detailed instruction about handling infected and foul linen.
 Charter of duty of each person handling laundry and training schedule
of staffs.
 Sluicing and disinfection procedures.
 Operation of laundry machines.
 Maintenance and service contracts of machines.
 Provision of detergents
 Procedure for condemnation of linen and procurement of new linen
 Fire safety drills and fire extinguishing measures
 Record of distribution, collection, inventory of detergents and linen
procured/condemned.
 Security arrangements for laundry.
 Regular physical verification of linen and fixing responsibility of any
type of loss.
KITCHEN SERVICES:
A hospital dietary service includes most importantly a production unit that converts
raw material into palatable food.
The preparation and distribution of food from store to spoon has many challenges
for the administration such as proper preparation, cost accounting, pilferage and
wastage.
OBJECTIVES
 Provide hygienic balanced and therapeutic diet to indoor patients
 Provide counseling and advice to patient suffering from different diseases
 Educate patients as per their requirements for the dietary needs and dietetic
preparation
 Supply special diets to indoor, diet clinics and private patients
 Provide training to dietetic interns nursing staff and other staff working in
department
Functions of dietary services: The dietary services cater for the following:
therapeutic diet in-patient catering diet counseling education and training
Location and space requirement:
Location: the dietary department should be located on the ground floor near wards
where the diets need to be taken and also accessible to road as supplies are to be
carried to storage area.
Space requirement: Hospital kitchen is divided into number of divisions which
have a particular activity.
The broad areas are supplies receiving area, storage area, cooking area, pots and
pan wash, garbage disposal, LPG stove and refrigeration facilities, housekeeping,
dietician, steward offices and circulation area.
Following space requirements are recommended for different size of hospitals:
1. 200 beds or less: 20 sq ft per bed
2. 200-400 beds: 16 sq ft per bed or 18 sq ft per bed
3. 500 beds and above: 15 sq ft per bed
Functional areas in department:
a. Recipient area: this is the place where all provisions are off loaded. These are
checked for right quality and quantity; hence area should have unloading points,
ramps, trolleys and weighing scales.
b. Storage area: this area where the provisions are categorized and stored in
separate areas. The areas should have enough shelves and bins:
 Dry provisions like flour, dal, sugar, oil etc.
 Fresh provisions like vegetables, milk, butter, meat etc.

 Office store keeper They are further divided based on temperature

requirements: items to be stored at room temperature like onion, potato etc
 Items require cool temperature (8-100c is maintained) for which walk-in
cooler can be provided to store milk, eggs, butter etc.
 Deep fridge where temperature is below 00c fish and meat should be stored.
c. Day store: it is an area where provisions for one days cooking issued to the
cooks are stored.
d. Preparation area: it is an area where provisions are cleaned, washed, soaked;
meat is chopped, cut and sliced etc. the items like kneader, weighing scale, slicer
etc. has to be provided.
e. Cooking area: it should have pressure cooker, cooking range oven etc.
f. Service area: the food is put in service pots in trolleys and if it is a centralized
distribution system, it is put in service trays, with specifying the name of patients.
g. Washing area: this is meant for washing cooking and service pots, hence
should have liberal hot and cold water.
h. Disposal area: the area where all garbage and left over food is collected for
disposal.
Distribution of diet:
a. Centralized service: the food is set in individual tray centrally at dietary
department including therapeutic diet of patients and are transferred to wards in
trolleys and served to the patients.
b. Decentralized service: the food is sent to wards and served as per the need of
the patient.
Dietary store management:
Storage of food items: for dry storage, the temperature should be 700c, with
adequate ventilation has to be insured. The storing shelves, bins should be placed
10 above the floor.
Purchase of food products: the items can be purchased from open market or
through calling tenders. The items to be purchased should have AG MARK OR
IDI. For this, an internal purchase committee may be constituted by the hospital
administration.
Equipment planning: equipment purchase depends on the objectives and basic
functions of the department, workload and availability of the personnel, and quality
standards.
Modern gadgets like mixer grinders, pressure cookers, dish washers etc. Should be
a part of hospital kitchen.
Financial control:
 The first thing to be done for an effective financial control is to control the
labor costs.
 Menu planning should be done in such a way that it reduces the inventory,
selection of items common to many areas of patient care, reduced handling,
wastage, use of automation or more equipment requiring less operational
staff are some measures that can be put to practice for an effective financial
control.
LABORATORY SERVICES:
The basic function of laboratory services is:
 To assist doctors in arriving at or confirm a diagnosis and to assist in the
treatment and follow-up of patients.
 The laboratory not only generates prompt and reliable reports, and also
functions as store house of reports for future references.
 It also assists in teaching programs for doctors, nurses and laboratory
technologists.
 It carries out urgent tests at any part of day or night.
Functional divisions: The hospital laboratory work generally falls under the
following five divisions:
a. Hematology
b. Microbiology
c. Clinical chemistry/ biochemistry
d. Histopathology
e. Urine and stool analysis
Functional planning: It covers the following activities:
 Determining approximate section wise workload.
 Determining the services to be provided.
 Determining the area and space requirement to accommodate equipment,
furniture and personnel in technical, administrative and auxiliary functions.
 Dividing the areas into functional units i.e. Hematology, biochemistry,
microbiology etc.
 Determining the number of work stations in each functional units.
 another, from the point of view of flow of work and technical work
considerations.
 Identifying the electrical and plumbing requirements for each area/ work
station.
 Considering utilities i.e. lighting, ventilation, isolation of equipments or
work stations.
 Working out the most suitable laboratory space unit, which is a standard
module for work areas.

Location:
it is preferable to have hospital laboratory planned on the ground floor and so
located that it is accessible to the wards.
In large hospitals, the entry of outpatients to the laboratory can be obviated by
opening a sample collection counter in the outpatient service area itself.
Outpatient sample collection: it should be located in the outpatient department
itself.
The design of this area should include waiting room for patients,
venepuncture area and specimen toilets separately for male and female patients,
along with provision of containers with appropriate preservatives and keeping
record of each patient.
Area/space: in a small hospital, the laboratory facility consists of a room in which
all the routine urinalysis, hematology and clinical chemistry investigations are
carried out.
As the hospital size increases, the requirement of technical and administrative
services also increases with the necessity for departmentalization of the laboratory.
The requirement of space for the laboratory consists of :-
Primary space: this space is utilized by technical staff for the primary task of
carrying professional work.
Secondary space: it is utilized for all supportive activities.
Administrative space, i.e. Offers for the pathologists and others, staff toilets etc.
Circulation space: it is the space required for uncluttered movement of personnel
and materials within the department between various technical work stations,
rooms, stores and other auxiliary and administrative areas.
Laboratory space unit (LSU): it is a module of space and all calculations for
technical work areas and some auxiliary area are based on LSU.
For allocation of primary space, one of the most suitable sizes of a LSU is one
measuring 10‘ x 20‘ giving a LSU module of 200 sq. ft. a rectangular module is
functionally more efficient because in the same overall space, it can accommodate
longer runs of benching due to its longer perimeter. \

Layout:
Structural flexibility should be achieved by use of movable or adjustable benching
systems in association with an installation of service mains that has been designed
to permit the repositioning of outlets.
Administrative and auxiliary areas: the administrative area (the area is the
central collection point for receiving specimens and is the reception and interaction
area for patients and hospital staffs) is separated from the technical work area so
that the non laboratory personnel need not enter the technical areas.
Reception and sample collection: this is the area should be well ventilated and
lighted, should have a chair where the patient can sit in comfort and where his arm
can be stretched for the phlebotomy, a bed where the patient can lie down for
pediatric collection or aspiration cytology.
Bar-coding system for samples: this system is used to trace the samples. The
sample is received and then bar coded, and then sent to processing area. This
protects patient identity.
Specimen toilet: it is provided for the collection of urine and stool specimens.
Pathologist office: it is so placed that the pathologist can have an easy access to the
technical areas particularly histopathology unit.
Glass washing and sterilizing unit: small labs collect blood in bottles that are
washed and reused. This is partitioned into washing and sterilizing area, containing
sterilizer, pipette washer and sinks.
Report issue: the reports should be issued in printed format. The hospital lab
software can be made as per the requirement of the hospitals.
Utility services: it includes water, gas and compressed air systems. Piping systems
should be easily accessible for maintenance and repairs with minimum disruption
of work. For safety purpose and to facilitate repairs, each individual piping system
should be identified by color, coding or labeling.
Internal design and fitments:
a. Work benches: the height of the work bench on which the technicians sit while
working (revolving stools) vary from 75-90 cm depending upon the height of the
workers.
b. Lighting: natural light should be used to the fullest. Each work bench should be
provided with adequate electric points especially fluorescent fixtures that give
uniform illumination and minimize heat.
c. Storage: each laboratory bench length should have storage space for reagents,
chemicals, glass wares and other items, provided in the form of under bench
drawers, cupboards etc.
d. Partitions: it may be required between some laboratory spaces.
e. Air conditioning: whole or at least histopathology section of the laboratory
should be air conditioned due to accumulation of formalin vapors or else a
powerful exhaust system should be installed.
f. Working surface/ flooring: the surface of work benches should be resistant to
heat, chemicals, stain proof and easy to clean. Floor should be easy to clean, and
not slippery. Flexible vinyl flooring is preferred for laboratory floor coverings.
Staffing:
The hospital laboratory services should be under the control and direction of a
doctor with qualifications in pathology or a PG degree in the new discipline of
laboratory medicine.
Number of personnel: staff requirement of laboratory technicians can be worked
out empirically on the basis of generally accepted norm which is about 30 tests per
day per technician.
Equipment: Some of the core instruments that are needed are:
 Colorimeters/ spectrophotometers: they were used in old days, are now
replaced by new auto-analyzers these days.
 Auto analyzers: it is used maximum in biochemistry works.
 Cell counter: it gives a more complete blood picture.
The principle of the instrument is to pass the cells through a thin capillary.
Centrifuge
 Refrigerators
 Pressure sterilizers
 Pipette washers
 Analytical balance
 Semi auto analyzer
 ELISA reader
 Blood gas analyzer
 PCR instrument
  Flow cytometer
Emergency services: An emergency department must be developed as a mini
hospital within a hospital i.e. Independent and self-sufficient in day to day
working.
PLANNING AND ORGANIZATIONAL CONSIDERATIONS:
1. Location: there are two essential location requirements:
 It must be on ground floor and easily accessible to both ambulatory and
ambulance patients, and there should be minimal separation between it and
radiology department.
 Secondly, the emergency department should have ready access to the acute
patient care areas, eg. Operation theatre, ICU, blood bank etc. Emergency
department must be designed; usually 1000 [Link] is required for daily patient
load of 100 patients.
2. Stretcher, trolley, wheelchair store: a store for stretcher, trolley and wheelchairs
should be located adjacent to the entrance.
3. Ambulance attendants, police, mass media room: an equipped room of about 10
m2 near the entrance hall with attached toilet serves the needs of above personnel.
4. Work area: it should be spacious with enough room for personnel and patients
5. Waiting area for emergency department patients: the main function of this is to
be the passageway to patient examination and treatment area.
6. Waiting area for relatives: patient relatives should not be allowed in the work
areas of emergency department. Waiting room with recreational facilities may be
provided.
7. Visitor‘s toilet: it should be provide near the main waiting space.
8. Nurse‘s station and administrative office: this should be next to the entrance and
manned on 24 hr. basis. It should be provided with multiple telephones, bulletin
board with duty roster of doctors on call and directive pertaining to the emergency
department should be displayed. Nurses work room should be well stocked with
drugs, IV fluids.
9. Examination and treatment area: this area should always be in readiness to
receive patients at all times, and should consist of a large room and number of
separate smaller rooms for examination and treatment.
It should be well illuminated space with oxygen supply, resuscitation equipment,
suction, portable X-ray, electrocardiographs, and Boyle‘s apparatus.
10. Equipment:
 Stretchers
 On-the wall oxygen unit
 On-the wall suction unit
 BP apparatus, otoscope, stethoscope, opthalmoscope etc.
 Spot lights
 Utility table
 Airways and resuscitation bags
11. Resuscitation room: the patient is to be stabilized in this room before shifting to
treatment or recovery room, or to ICU or nursing unit. It should be well equipped
with resuscitation equipment, ECG machine and X-ray viewing screening with
facility for performing minor operative procedures.
12. Operation room: a self-sufficient operation room to serve patients who need
minor surgery and no admission or who are critically ill etc. in emergency
department.
13. Fracture room: a separate fracture room equipped similar to OT and additional
facilities for reduction of closed fractures under local anesthesia can be planned
with hospitals with turnover of emergency patients in excess of 15,000 per annum.
14. Plaster room: it is needed for treatment of fractures and application plasters.
15. Care of burns: a separate room with 20 m2 area should be reserved for
immediate care of burn patients. An observation ward of about 6-8 beds for
patients to be kept under observation overnight or 24 hrs.
16. Isolation room: for obstetric patients, pediatric patients.
17. Other rooms: these should be planned based on the local needs:
 Room for dead bodies
 Pantry-7 m2
 Storage space
  Utility and soiled linen room-7 m2
 Cleaners room-house keepers room 4m2
 Change room duty rooms 9m2
 Conference room and reference library 8m2 Staffing pattern:
 Full time emergency physicians, especially trained in emergency medicine
 A well-staffed emergency department needs 8 nurse shifts of 8 hours each
per 100 daily patients visits. Additional staff nurses is required if there is
observation ward attached.
 For registration and records, usually 3 clerks work in day and afternoon
shift, and one during night.
 Security should be available round the clock
 Public relations and social worker should be available to take care of the
anxious and disturbed patients and their relatives.
Medico-legal aspects of emergency department:
a. Negligence: it is the breach of duty owed by a doctor to his patients to exercise
reasonable care/skills resulting in some bodily, mental or financial disability.
b. Duty to treat all: according to the recent supreme court decision, no doctor can
refuse giving first aid treatment to accident victims or any other patients.
c. Problem areas in emergency department: Consent to treatment: a written
consent must be obtained from the patient to treat him, with the patient‘s
knowledge regarding procedures.
Medical records: medical records and proper record keeping are high priority in
any hospital. Proper documentation of patient‘s case history with informed consent
is necessary.
Reporting to authorities: all medico-legal cases e.g. Assault and battery, child
abuse, accidents etc. Should be reported to proper authorities e.g. Police.
The cases of AIDS and venereal diseases should be reported to health authority
BIBLIOGRAPHY
Book:
 Jogidra, V. (n.d.). Textbook of principles and practice of nursing management
and administration (1st ed., pp. 221–228). Jaypee Brothers Medical Publishers
Pvt. Ltd.

Journals :

 Uyar, A., & Bilgin, N. (2011). Budgeting practices in the healthcare sector: An
empirical study. International Journal of Health Care Management, 4(3), 159–
168.
 Kumar, P., & Thomas, R. (2020). Leadership approaches in nursing
administration: A review. Journal of Nursing Management, 28(5), 1203–1210.
Websites:
 World Health Organization. (2023, June 12). Nursing and midwifery.
 American Nurses Association. (2022). Principles of nursing management
and leadership.