CONTINUING MEDICAL EDUCATION

-Consists of educational activities which serve to maintain, develop, or increase

the knowledge, skills and professional performance and relationships that a
physician uses to provide services for patients, the public or the profession. The
content of CME is the body of knowledge and skills generally recognized and
accepted by the profession as within the basic medical sciences, the discipline of
clinical medicine and the provision of health care to the public.

-CME activities may describe or explain complementary and alternative health

care practices. As with any CME activity, these need to include discussion of the
existing level of scientific evidence that supports such practices.

- credit may not be claimed for learning which is incidental to the regular
professional activities or practice of a physician, such as learning that occurs
from:

·0 Clinical experience

·1 Charity or mission work

·2 Mentoring

·3 Surveying

·4 Serving on a committee, council, task force, board, house of delegates or

other professional workgroup

·5 Passing examinations that are not integrated with a certified activity

SPACES:

·6 AUDITORIUM-it should be located for convenient use by faculty and

 students/professional from the clinical departments, the teaching hospital,
the basic science facilities, and by outside groups. Most authorities prefer
fixed seats with dropleat tablet arms, arranged in theater fashion with a
sloping floor . The auditorium should have a low stage to facilitate the
demonstration of patients end should be equipped for the installation of
closed-circuit television. Projection facilities for sound films and slides,
lighting controls, chalkboards, public-address systems, and closed-circuit
television for doctors' paging should be provided.

·7 LECTURE ROOM- A minimum of three lecture rooms should be provided

in the basic science facilities as follows: two sloping or stepped-floor
lecture rooms of 120-150 seats and one sloping or stepped-floor lecture
room of 80 seats for other programs. Two 150-seat lecture rooms of
sloping or step-floor type should be provided as part of the clinical
department facilities and the teaching hospital.

·8 CONVENTIONAL AND MULTIDISCIPLINE LABORATORIES

-Two types of laboratories are in use in medical schools today:

conventional laboratories, where each department has its own laboratories or
shares laboratorieswith another department requiring similar facilities and
students move from one laboratory to another; and multidiscipline laboratories
where students are assigned work spaces and all disciplines except gross
anatomy are taught in this laboratory.

·9 DEPARTMENTS

A. ANATOMY

-DISSECTING ROOM - one large room with stand-up height dissecting tables to
accommodate all the students. Convenience for faculty and students and
proximity of elevator service to be used for transporting cadavers are important
considerations in the location. Provisions should be made to prevent viewing of
dissection procedures by unauthorized persons.

-MICRONEURO ANATOMY LAB- usually requires a demonstration area with a

table, chalkboard, projection screen, and sitdown. Benches should seat four
students on the same side to face in the same direction for an unobstructed view
of the demonstration area.

-GROSS NEUROANATOMY ROOM- Usually the area serves also as a

departmental storage center for specimens, in which case adjustable shelving for
supporting a number of jars of formalin is required. The demonstration table,
located at the center of the room to accommodate students on each side, is
usually provided with a stainless-steel top with raised edge and an integral sink
at one end. Lighting should be designed for close observation at tabletop level .
Hand-washing facilities, an x-ray film illuminator, and a chalkboard should be
provided. Storage for formalin should be considered.

-TISSUE STAINING AND EMBEDDING- This unit may be subdivided into a head
technician's office, an embedding area, a sectioning and tissue-staining area,
and a slide storage-andissue area with access to the teaching laboratory,
preferably by way of a dutch door for issuing slides and materials.

-CADAVER PREPARATION AND STORAGE- The unit should be so located and

designed that no unauthorized persons may enter. Its location relative to the
dissecting and autopsy rooms should not require transportation through any
public areas. It should be located at grade with a receiving entrance accessible to
a low loading platform. Where design permits, the platform may also serve the
animal-receiving entrance.

-CREMATORY- if provided, should be located in the cadaver preparation and

storage unit. The department will require storage space for tissue embedments
and gross organs.

B. BIOCHEMISTRY

-LABORATORY-The conventional teaching laboratory is similar to those of other

basic sciences. Island-type laboratory benches approximately 16 feet long . The
bench should have a stone sink at one or preferably both ends and a continuous
drain trough or cup sinks ,a continuous reagent shelf, and individual service
outlets for each student. Services required are gas, air, vacuum, cold water, and
electricity. Bench tops should be stone or acid-resistant composition surfaces.

-PREPARATION ROOM- adjacent to the teaching laboratory is used for mixing

reagents and for storing chemicals and glassware. It may be divided by partitions
into alcoves for separating issue, storage, and preparation.

-GLASSWARE WASHING AND STORAGE- a large sink with drainboards is

required, with space for glassware carts, a worktable for glassware sorting, and
shelves for storage.

C. PHYSIOLOGY

- RESEARCH LABORATORY- Furniture and mechanical facilities may be similar

to those of a typical research laboratory.

-EQUIPMENT STORAGE- adjacent to the teaching laboratory, is needed, as is

desk space for a stock clerk and technician.

-SHIELD ROOM- If required by the program, a shielded room distant from

obvious electrostatic interference must be provided.

-AUDIO ROOM- it should consist of a test room and a control room with a triple-
glazed clear-glass observation window between and with acoustical treatment.
The test room should have a microphone and a speaker cabinet. The control
room should have a sit-down counter with cabinets located on the observation
window side.

-PHYSIO-OPTICS ROOM- a special room will be needed with 20-ft separation

between the subject and the vision chart. A sink for hand washing and a sit-down
counter for recording are necessary.

D. BICROBIOLOGY

- ELECTRON MISCROSCOPY- Facilities for this purpose would be similar to

those described for the department of anatomy.

-MEDIA PREPARATION- should be adjacent to teaching areas and designed to

eliminate through traffic to prevent drafts and the introduction of contaminating
organisms. A media kitchen requires a range, or portable hot plates on a counter
37 in. high, for cooking the material. Counter-top sinks and cabinets with drawers
ranging in width from 6 in. to 2 ft 6 in. and wall cabinets with shelves for storage
are desirable. Counters should have air, gas, vacuum, and electrical outlets.
Distilled water should be piped to one location over a sink and distributed in
carboys .

-LABORATORY

-GLASSWARE WASHING AND STORAGE

-CHEMICAL STORAGE-

E. PATHOLOGY

- CLINICAL PATHOLOGY PREPARATION UNIT- This unit usually has a head

technician's office and a preparation room with direct access to the teaching
laboratory, preferably by a dutch door. For preparing some types of specimens as
well as stains and reagents for direct issue, a stand-up counter 37 in. high is
desirable. For other types of specimens, particularly those such as blood and
bone marrow, a sit-down counter 31 in. high is more convenient. Both counters
should have reagent shelves, countertop sinks, air, gas, vacuum, and electrical
service outlets, knee spaces, cabinets for storing equipment and chemicals and
reagents .

-LABORATORY

- TISSUE STAINING AND EMBENDDING

- AUTOPSY ROOM- This should be located convenient both to the teaching

hospital and to the pathology department and arranged so as to prevent
unnecessary contact of unauthorized persons with autopsy procedures. If the
basic science building is separated from the teaching hospital, autopsy facilities
should be located in the hospital to avoid transporting bodies from one building to
another.

-X-RAY ROOM- A mobile x-ray machine should be provided. X-ray protection

should be in accordance with the recommendslions of the applicable handbooks
of the National Bureau of Standards.

-UTILITY AND CLEAN UP ROOM- This room should be located between two
autopsy rooms with direct access to each and to the corridor. Equipment for this
area includes a sink with drainboard; a flushing-rim service sink; provisions for
storage of glass jars, formalin, and alcohol; wall cabinets for fixed specimen
storage; and an instrument washer-sterilizer unless provided in each autopsy
room.

-PHOTO ROOM- should adjoin the autopsy room.

- DARK ROOM- Wet and dry areas of the darkroom should be separated. A
refrigerator for storing color film should be provided, and water supply at all
processing sinks is required.

-COLD ROOM- separate from the research cold room but adjacent to the
autopsy areas for holding tissue and organs for later study is required . A deep-
freeze unit and adjustable metal shelving may be provided for preservation of
fresh gross material for class use. Stand-up counters with sinks and air, vacuum,
and electrical service outlets are required. Floor surface should be smooth,
waterproof, and wear resistant.

-GROSS PANTHOLOGY CONFERENCE ROOMS- A stand-up table with sink at

one end and clowndraft top similar to that described for the gross neuroanstomy
room is appropriate. Other equipment includes adjustable shelving, x-ray film
illuminators, bulletin board, and scrub sink with knee or foot controls. Where
possible, this area should have direct access to the cold room.

-DRECORD STORAGE- Open-faced shelving with shelf dividers designed for

vertical stacking of the records with a reference table and chairs should be
provided. A storage room for records of less frequent reference should be
provided in basement storage.

F. PHARMACOLOGY
- ANESTHESIA STORAGE-should be provided with cylinder storage racks to lock
cylinders in an upright position and shelving for pressure gauges end other
anesthetic equipment. Space at ground level should be provided for bulk storage
of cylinders.

-LABORATORY

- SUPPLY ROOM-may be divided into two areas: one for instruments and
general supplies and the other for chemicals used in research.

-PREPARATION ROOM

-GLASSWARE WASHING AND STORAGE

·10 CLINICAL SCIENCE FACILITIES- The departments generally include

internal medicine, surgery, pediatrics, obstetrics and gynecology,
psychiatry, preventive medicine,end radiology.

-For convenience of operation,

clinical department facilities should be located between, and connecting
with, the basic science building and the teaching hospital. This allows for joint
use of teaching, research, and supporting facilities and makes it convenient
for the medical staff to take care of their hospital responsibilities. Departments
should be located on the some floors as the patient-care units they serve.
Research facilities in the form of laboratories should be provided for each
department member.

A. MEDICINE-The department consists of physicians specializing in

internal medicine and includes the subspecialties of allergy, cardiology,
dermatology, gastroenterology, hematology, infectious diseases end
immunology, metabolism, neurology, end pulmonary diseases.

B. SURGERY- consists of physicians specializing in general surgery or

in one of the surgical specialties, which include anesthesiology,
ophthalmology, otolaryngology, orthopedics, neurosurgery, plastic
 surgery, thoracic surgery, and urology. The emergency service of a
hospital is under the direction of the department of surgery, as may be
the professional aspects of disaster planning.

C.PEDIATRICS- consists of physicians specializing in the developmental

aspects of physiological processes and expressions of disease. They are as
concerned about the long-term health effects of early disease and with their
prevention, as with the immediate care of infants and children.

D. OBSTETRICS AND GYNECOLOGY OBSTETRICS- concerns with the

processes of conception, gestation, and delivery in women, whereas gynecology
deals with the specific diseases of the female reproductive tract. Requirements of
the department is for administrative office, teaching and research space are not
essentially different from those of any other clinical department.

E. PSYCHIATRY- consists of specialists concerned with the functions and

disfunctions of the mind and emotions. Offices for members of the department of
psychiatry may be used for somewhat different purposes than staff offices of
other clinical departments. Consultation rooms connected by a one-way viewing
screen or TV with an adjoining observation area.

F. PREVENTIVE MEDICINE- it comprises physicians who are concerned

with the natural history of disease and the factors in the environment which have
an effect upon morbidity and mortality. They are interested in reducing the
incidence of avoidable disease and premature death through control of those
factors which may contribute to disability and incapacity. There is usually a close
relationship between the staffs of pediatrics, medicine, obstetricsgynecology,
psychiatry, and preventive medicine, and this should be borne in mind in the
location and assignment of office space .

SUPPORT FACILITIES
1. MORTUARY- All medico-legal work including autopsies for the district is
carried out on behalf of the Civil Surgeon by Medical Officers posted
there. Complicated cases requiring re-examination are referred to the
Tertiary level hospitals, where autopsy work is conducted by the
department of Forensic Medicine. This hierarchy is prevalent throughout
the country except for a few anomalies here and there. Still any sort of
regularity and standardization eludes autopsy work as no standard design
or guidelines are outlined for construction of mortuary complexes.

·11 Forensic facility's comprehensive morgue and postmortem component

services are:

• Specimen handling area

• Administrative functions- documentation of incoming or

outgoing bodies report preparation

• Receiving, preparation and temporary storage of cadavers.

• Investigations into the cause of death- perform by a PM

examination of the body including forensic autopsies.

• The demonstration of PM findings in cases of clinical interest,

for teaching or forensic purposes.

• Mobile radiography

• Photography

• Family/police viewing and/or identification of the body.

·12 General guidelines- Every mortuary should have following minimum

facilities:

i) arrangements for receiving the dead bodies from the hospital

or from outside, with separate arrangements for keeping decomposed
and infectious bodies (known HIV/hepatitis death cases) etc.
 ii) for performing autopsies

iii) Handing over the dead bodies after postmortem examination

to the relatives/ undertakers through police

iv) postmortem viewing gallery for the students /IO /nominees as

per court orders etc.

v) other basic essential requirements like offices and related

rooms .

The mortuary complex must be located at a short distance from

the hospital, at a sight which is secluded but easily accessible. There
should be a direct link between the hospital and the mortuary to
facilitate easy delivery of the dead bodies for autopsy from the wards.
It should have adequate parking space. It should be preferably
centrally air conditioned.

The teaching mortuary complex must consist of the following :

1. Veranda should be in front of the faculty office, autopsy surgeon room in which
these should open and working windows for the reception room on both sides.

2. Faculty office with an attached toilet.

3. Autopsy surgeon's room (size 14×20 sq. ft.): where the Autopsy surgeon
/medical officer can discuss details of the case with police and relatives and write
reports peacefully without any disturbance.

4. Computer Room & Office (12×10 sq. ft): with furniture, computer, printer cum
scanner, photography instruments etc.

5. Stores-1 (12×10 sq. ft) for clean gowns, aprons, rubber gloves, gumboots,
towels etc.

6. Reception/ room for mortuary supervisor (12×14 sq. ft.): where inquest papers
are received and details are entered in a register. There should be a counter with
glass panel and working window on the sides with access to the doctor's room.

7. Toilet for general public.

8. Investigating officer /Police Room (10×10 sq. ft.) for the police personnel
accompanying the body who has to watch and take care of the dead bodies in
the mortuary complex.

9. Veranda/shade for trolley etc.

10. Class IV Rooms (8×10 sq. ft.); it has lockers etc. and used as changing place
for them.

11. Toilet for staff.

12. Walled enclosure with gate.

13. Pre Autopsy Room (16×20sq. ft): / the capacity of the cold storage room
should be depending upon the number of the dead bodies (for keeping 10-15
bodies) before the post-mortem examination. As soon as the police brought the
body in the mortuary it should be kept in this room with complete identity. This
should have cold storage facilities (cold chambers in the form of refrigerated
cabinets) with a temperature maintained between 4-6.5°C. Adequate space for
keeping the extras dead bodies on the trolleys, if needed, should be there.

14. Post Autopsy Room (14×18 sq. ft.): should have a central platform (4×8 sq.
ft.) for handing over the body to the investigating officer who subsequently
handover the body to the relatives for final disposal after competition of the post-
mortem examination.

15. Gate for open mortuary; the gate should be of sliding type.

16. Teaching Autopsy Room I: the size of the autopsy rooms should be
depending upon the intake of the students and at least it should be 400 Sq.
Meters or more. It should have at least two mortuary tables preferably of
stainless steel with arrangements for free drainage of a constant flow of water
from top to bottom. A proper vent and duct system needs to be installed for exit of
foul smelling gases and entry of fresh air. Each room should have mortuary work
station. This room should be constructed in such a way that they should have big
windows up to the level of roof with glasses, if, possible facing the east, south
and west, so that the maximum adequate sun light may remain in the rooms.
There should be large charts depicting weights and measurements of viscera,
bones etc. for quick reference for autopsy surgeon. There should be X-ray view
boxes in these rooms for seeing x-ray film etc. Portable x-ray machine should be
available. The floors should be constructed of materials like granite and walls
with epoxy which facilitate easy cleaning with a slope to a main drain. The
viewing gallery for the students shall be constructed around the autopsy tables
depending upon their strength in both teaching autopsy rooms. The doors should
be fly proof.

17. Teaching Autopsy Room II (of same specifications as above).

18. Space for open mortuary /maceration tanks/open research lab; (with roof
covered with net) for the decomposed bodies and other ancillary work. This
space should be all around both the teaching autopsy rooms so that public
cannot have an access to the ongoing postmortem in these rooms;

19. Instrument Room (8×10 sq. ft.): instrument cleaning room to be provided for
the thorough cleansing of all numbered instruments /equipments between the
two autopsy rooms;

20. Viscera Preparation Room (12×10 sq. ft.) where the technician /mortuary
attendant can do the assigned job under the supervision of the medical officer. It
should be near to the autopsy rooms;

21. Stores-II (12×10 sq. ft.) for reserve stocks of and chemical solutions for
preserving the viscera and packing materials etc.

22. Officer's toilet; (8×12 sq. Ft.) One separate male and female W.C. lavatory,
basin and a shower cubical are needed.
23. Doctors changing room: there must be two changing rooms (12×10 sq. ft.
each) having bath with shower for autopsy surgeons and with lockers for male
and female officers.

24. Green belt: this is required to make mortuary complex eco-friendly.

25. Corridors & Verandas' all around: these will help not only in free movement of
the functioning officials in the premises of mortuary but also in cases of
emergency of handling of mass disaster cases and will provide more space for
decomposed gases to spread and exit.

26. Waiting area for attendants of the relatives of the deceased with seating
arrangements and provisions of drinking water and toilets.

27. Main Gate; preferably it should be sliding type.

28. Open space for parking for vehicles bringing and carrying the dead body.

2. PARKING BUILDING -. The parking facility or lot must foremost deal with the
Functional/Operational, as in providing for safe and efficient passage of the
automobile and driver. This is a very complex challenge as automotive,
engineering and traffic issues relative to site locations must be integrated to
create the appropriate solution.

The parking standards have been formulated for new development areas,
including comprehensive redevelopment projects. However, the Authority will
need to have flexibility, within and beyond the standard ranges, to meet special
circumstances, such as redevelopment in the built-up urban areas. The Authority
will consider, inter alia, the following aspects of land use/transport interactions:

(a) proximity to and quality of pedestrian access linking railway stations and
other major public transport interchanges;
(b) availability of public transport services in the vicinity;

(c) availability of public car parks in the locality;

(d) projected road capacity and traffic volumes in both the immediate vicinity
and the wider district;

(e) feasibility of providing safe entry/exit points;

(f) existence of closed road permit policies (e.g. South Lantau Island);

(g) area and shape of specific site; and

(h) parking demand and supply condition in the vicinity.

PARKING REQUIREMENTS

-1 car parking space per 3 to 12 beds.

-In addition, 2 to 5 spaces should be allocated for disabled visitor parking.

-Additionally for hospitals with Accident and Emergency (A+E)

departments, 8 parking spaces (9m x 3m) for ambulances and for hospitals
without A+E departments, 3 parking spaces (9m x 3m) for ambulances.

-In determining the number of car parking spaces to be provided within the
range permitted, it should be noted that hospitals with A+E departments require
more parking spaces than other hospitals. Spaces are normally intended for
operational needs, but some spaces are recommended for visitors especially at
hospitals which provide emergency services. Adequacy of public transport
facilities, the availability of public parking in the vicinity, and the location of the
hospitals should be taken into account in assessing the overall parking
requirement and the need for visitor parking.

-If visitor parking is provided, a number of the most conveniently located

spaces should be reserved for emergency cases.

-Disabled visitor parking spaces should be located at the most convenient

places for disabled drivers visiting the out-patients departments and A+E
departments.

3. SEWAGE TREATMENT PLANT- Wastewater from hospitals can contain traces

of anything from viruses and multi-resistant bacteria to medical contrast agents
and chemicals for cancer treatment. Small amounts of hormone-disrupting
substances and other medicine residues are also part of the mix that passes
from patients through hospital toilets and into public sewer systems. Liquid waste
shall be discharged into an approved public sewerage system whenever
available, and solid waste shall be collected, treated and disposed of in
accordance with applicable codes, laws or ordinances.

4 WAREHOUSE- A hospital warehouse is a department in a hospital where

medical supplies are stored. Such supplies include intravenous (IV) solutions and
tubings, first aid products, protective equipment,personal care products/toiletries,
feeding tubes, foley catheters, respiratory supplies and orthopedic supplies.
Items in the warehouse may be distributed to various departments within the
hospital through a centralized requisition system which determines what
supplies are needed and the amount to each department. Hospital warehouses
are typically located near a loading dock, where deliveries from medical supply
companies are received. Medical supplies and other products get shipped, often
via delivery companies, and received at the warehouse, and then are delivered to
the recipient.

5 ENGINEERING AND MAINTENANCE DEPARTMENT

-The major responsibility of the department is to oversee the provision of

quality maintenance of hospital equipment, infrastructures, buildings, machinery,
and plant, to manage technical contracts in the hospital.

-Below are some of the activities performed by these sections:

·13 Installation and Repair of all medical equipment

·14 Electrical installations including cold rooms, air conditioners

·15 Repair of boilers, incinerators, water pumps, generators

·16 Installation and repair of autoclave machine

·17 Installation and Repair of heavy duty washing machines

·18 Perform civil work including painting , Carpentry works, Welding works and
fabrications

·19 Prepare and perform planned preventive maintenance for hospital plant
 and equipment

REFERENCES:

Smith GS, Dick A, Sissons HH (1961) Mortuary designs and hazards. J Clin
Pathol 14: 103-108.

http://www.pland.gov.hk/pland_en/tech_doc/hkpsg/full/ch8/ch8_tbl_11a.htm

http://www.mnh.or.tz/index.php/directorates/technical-services/engineering-and-
maintenance

https://cme.ucsd.edu/faq_accreditation.html