Presentation 1

2/6/17
1
PLANNING AND ORGANIZATION
PLANNING AND
ORGANIZATION
PRESENTED BY
MS PUJA GUPTA
ND
ND
INTRODUCTION
2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

4

GUIDING PRINCIPLES IN
PLANNING
Patient care of high quality.
Effective community
orientation.
Economic viability.
Orderly planning.
Sound architectural planning.
Medical technology and

planning.

CLASSIFICATION OF HOSPITALS
Government or
public hospitals
Private hospitals 6

CONT.
Public charitable trust/
nursing homes
Voluntary hospitals
&
Corporate hospitals
7

8

OUT-PATIENT DEPARTMENT

PLANNING AND
ORGANIZATION OF THE OPD
Location:
It should be attached to the

hospital accessible from the main
entrance to the hospital with the
direct approach from the main road.
Space
The space requirement will

depend on upon the land available
and location of the hospital.
Generally, 0.66-1 sq. ft. area per
10
annual outpatient attendance should
be provided for OPD.
CONT.
Size
The size of OPD depends
upon the volume of attendance,
clinics provided and extent of
facilities like blood bank,
emergency department.
Consultation room
Each department should

have a separate consultation room
where the chief and assistant
doctor, and two nurses will
perform their duties to analyses
11
the diagnosis of the patient.
FUNCTIONAL
MANAGEMENT
It receives the patient, writes the data about the patient, collects
the history and does the physical examination in the room
specified as per the patients disease condition.
Patient will be enrolled in the OPD register, and the patient will
be guided by the nurse to meet the doctor concerned.

After consultation, the doctor decides whether the patients needs
to be admitted for bedside care or not.

If admissions required, OPD nurse commits the IPD nurse to get
the patient admitted.

OPD nurse also receives patients transferred from other hospitals,
emergency department after first aid or from other ward transfers.

Nurse maintains outpatients register and staff register, and issues12
outpatient chits or cards to patients.

PLANNING AND
ORGANIZATION OF
WARDS
General wards:
Patients with non-

specific aliments.
No life saving care.
Nurse patient ratio 1:5
in big wards.
13

CONT.
SPECIFIC WARDS:
Emergency ward
Intensive care unit
UNITS WITH
Intensive coronary SPECIALIST
care unit NURSING,
TREATMENT
Nursery AND
EQUIPMENT:
Special septic
Burn ward,
nursery transplant ward
Burns ward functions at
Post-operative wardnational or
regional
Post natal ward centers. 14
.

WARD PLANNING
Physical facilities : It includes
Size of the ward depends on types of patient and requirement of ward staff.
Size of rooms
Single bed room 125 sq ft/ bed
Two bed room 160 sq ft/ bed
Four bed room 320 sq ft/ bed
Six 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
Treatment room
Clean work room

15
Pantry
Unit store Sanitary area

TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP
WARD DESIGN
Open ward
Riggs ward
16

CONT.
Unilateral riggs ward
Bilateral ward:
T-shaped ward
17

STE ENT C
RIL RA L
DE ES
PAR UP
T M PLY
(CS EN 18
SD T
2/6/17
) TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP
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 the OT complex. Above 500 beds , TSSU is
established in addition to the CSSD in service area.
The following areas are to be provided in CSSD
Equipment storage room.
Receiving counter and clean up room.
Needles and syringe processing room.
Gloves assembling room with rubber goods processing room.
Clean work area including sterilizers.

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Sterile storage area and issue counter.
Gauze and dressing assembly area.

DISTRIBUTION OF THE
SPACE
Clean area including
sterilization- 40%
Sterile storage area-15%
Equipment storage-14%
Fluids, needles & syringes-
14%
Receiving & clean up area-
12%
Glove processing area-5 - 7%
Additional 25% space

located for future expansion 20

AREA REQUIREMENTS
FACILITIES IN SQ. METER
Entrance 10.50

Lockers 7.00
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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 bag 10.50

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Bulk store 17.50

Duty room 3.50

STAFFING REQUIREMENT
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 hospital is
Supervisor-1 ( senior most and
trained technician)
Asst supervisor-1 of the senior
technician
Technicians- 6 ( Promoted
attendants)
Sweepers- 15
22
Clerk-1

EQUIPMENT AND
MATERIALS REQUIRED
Hot and cold running water.
Cleaning brushes and jet water gadgets.
Ultrasonic washers.
Hot air oven for drying instruments and sterilization.
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 sink, taps.
Trolley for supply of sterilized items and separate trolleys for 23
collection of used items are needed.

METHODS FOR
STERILIZATION
2/6/17
r i l i z a t i o n
Steam
Ste
t e r i l i za tion i za t i o n
Hot a i r S re ste r i l
ic p r es s u
o s p h e r
Sub atm
th f o r m alin
wi za ti on
a l ste r i l i
Ch e m i c
er i l i z a t ion
d i a t i on st
a ir r a z t i o n.
Gamm m ste r i l i a
e s t e a
r m a l d e hyd
Fo
24

INVENTORY MANAGEMENT
2/6/17
Stock
Issue of materials
Distribution of sterile
items.
Grocery system
CSSD is open for
limited 24 hours
Quality control
methods
25

2/6/17
LAUNDR
Y
SERVIC
ES
26

FUNCTIONS OF LAUNDRY
Control of cross infections.

Patient satisfactions.
Public relations.
27

Rental
system
Co-operative
TYPES system
OF
LAUNDR
Y
Contr
a ct
system
In-plant o
r
in-house
laundry
28
TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

LAUNDRY MANAGEMENT
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 is done for foul linen in
sluice machine and then the linen 29
put in washer for cleaning.

CONT.
Hydro- extractor means put the
linen in extractor for removing
extra water.
In drier tumbler put the linens
for drying.
The linens are pressed.
In mending, the torn linen is

sent for repair and replacement.
Repaired linen is again washed
in washer and washing cycle
after that is to be completed. 30

CONT.
LINEN DISTRIBUTION SYSTEM
:
Clean for dirty exchange
Exchange trolley system
POLICIES AND PROCEDURES

Collection and distribution
system of linens with periodicity
to each ward and department.
Detailed instruction about
handling infected and foul linen.
Operation of laundry machines. 31

CONT.
Maintenance and service contracts of machines.
Provision of detergents.
Procedure for condemnation of linen and procurement of

new linen and training schedule of staffs.
Fire safety drills and fire extinguishing measures.
Record of distribution, collection, inventory of detergents

and linen procured and condemned.
Security arrangements for laundry.
Regular physical verification of linen and fixing

responsibility of any type of loss.
32

2/6/17
KITCHEN
SERVICES
33
FUNCTIONS OF DIETARY
SERVICES
Therapeutic diet
In-patient catering
Diet counseling
Education and training
34

STAFF REQUIREMENTS
Chief dietician
Senior Dietician
Dietician
Head clock
Asst. Dietician Therapeutic cooks
Cooks
Steward Asst. cook
Cleaners, waiters
Storekeeper (ratio)
Store attendants
Storekeeper (general) Sweepers
Clerk/typist
35

LOCATION AND SPACE
REQUIREMENT
Location
The dietary service area should ideally
be in 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
200-400 beds - 16 sq ft/ bed
500 and above - 15 sq ft/ bed 36

PHYSICAL
FACILITIE
S
PERIPHERAL CENTRAL
COMPONENT COMPONENT
37

DISTRIBUTION OF DIET
Centralized service:
The food is set in
individual trays centrally at
dietary department including
therapeutic diet of patients and
transferred to wards in trolleys
and served to the patients.
Decentralized diet:
The food is sent to wards
and served as per the need of the
patient.
38

DIETARY STORAGE
MANAGEMENT
Storage of food items:
For dry storage, the temperature should be 70 0C and 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 AGMARK or IDI.
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
To control the labor cost.
Menu planning should be done in such a way that selection of items
39
common to many areas of patient care, reduced wastage, use of automation
for an effective financial control.
LABORATORY
SERVICES
40

Confirm
diagnosis
CROSS MATCH
BLOOD DIAGNOSTIC
SAMPLES TESTS
BASIC
FUNCTONS
IMMUNOLOGI OF
IDENTIFY
CAL TESTS LABORATORY
ORGANISMS
SERVICES
DIAGNOSTIC BLOOD
EQUIPMENT CELLS 41

FUNCTIONAL
DIVISIONS
Hematology MICROBIOLOGY
BLOOD
Serology BANK
Clinical
Urinalysis
Chemistry
42

FUNCTIONAL PLANNING
Determining services to be provided for
inpatients/outpatients, for other departments, smaller
hospitals and private practitioners
Determining area and space requirement to accommodate
equipment, furniture and personnel in technical,
administrative and auxiliary functions
Dividing the area into functional units, hematology,
biochemistry, microbiology, histopathology, urinalysis etc
Determining the major equipment and appliances in each
unit 43

ORGANIZATION
Location
Easily accessible from all wards
Hospital laboratory planned on the ground floor.
Area/ Space
The requirement of space for the laboratory consists of:
PRIMARY SPACE
Technical staff for the primary task of carrying professional

work utilize this space.
SECONDARY SPACE
It is utilized for all supportive activities.

ADMINISTRATIVE SPACE 44
It is utilized for pathologists and others, staff toilets etc.

CONT.
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
It is a module of space and some auxiliary areas based on

laboratory space unit.
Administrative and auxiliary areas
Administrative area:-
Office of pathologist
Record room
Administration Office
Patient Waiting Area

45
Seminar room
CONT.
Auxillary Area:-
Glass washing room
Cleaning of Instrument
Equipment sterilization
Reception and sample collection
Bar- coding system for samples
Specimen toilet
Pathologist office
Glass washing and sterilizing unit
Report issue
46
Utility services

INTERNAL DESIGN AND FITMENTS
Work benches
The height of the work benches is 75-90 cm depending upon the height of the workers.
Lighting
Fluorescent fixtures that give uniform illumination and minimize heat.
Storage
Storage space provided under the bench drawers and cupboards etc.
Storage space for reagents, chemicals, glass wares, and other items.
Partitions
It may be required between some laboratory spaces.
Air conditioning
Whole or at least histopathology section of the laboratory should be air conditioned due to
accumulation of formalin vapors.

Working surface/ flooring
Floor should be easy to clean, and not slippery.
47
Flexible vinyl flooring is preferred for laboratory floor coverings.

STAFFING
Qualifications are Doctorate

degree in a pathology or PG
degree in laboratory
medicine.
Staff requirement of laboratory
technicians can be worked out
empirically based on generally
accepted norm, which are about
30 tests per day per technician.
48

EQUIPMENT
Auto analyzers
Cell counter
Centrifuge
Refrigerators
Pressure sterilizers
Pipette washers
Analytical balance
Semi auto analyzer
ELISA reader
Blood gas analyzer
PCR instrument
49
Flow cytometer

50
PLANNING AND ORGANIZATIONAL
CONSIDERATIONS
1. Location:
It must be located on ground floor and easily accessible to both
ambulatory and ambulance patients.

The emergency department must be have in the acute patient care areas,
e.g., operation theatre, ICU, blood bank etc.

2. Stretcher, trolley and wheelchair should be stored adjacent to the
entrance.
3. Ambulance attendants, police, mass media room should be placed near
the entrance hall with attached toilet serves the needs of above personnel.
4. The working area should be equipped with enough room for personnel
and patients.
51
5. Waiting area for emergency department patients.
CONT.
6. Waiting area for relatives.
7. Visitors toilet should be provided near the main waiting
space.
8. Nurses station should be placed infront of the entrance and
manned on 24 hour basis and it should be provided with
multiple telephones, bulletin board with duty roaster of doctors
on call.
9. Nurses work room should be well stocked with drugs and IV
fluids.
10. Examination and treatment area should be ready always to
receive patients at all times and should be consist of large room52
and separate smaller rooms for examination and treatment.
CONT.
11. Equipment
Stretchers
On- the wall oxygen unit
On- the wall suction unit
BP apparatus, otoscope, stethoscope, ophthalmoscope etc.
Spot lights
Utility table.
Airways and resuscitation bags
12. Resuscitation room should be well equipped with

resuscitation equipment, ECG machine, X-ray machine and
facility for performing minor operative procedures.
53
13. Operation room for minor surgery or who are critically ill etc.
CONT.
14. Plaster room for treatment of fractures and application
plasters.
15. A separated room with 20 m2 area should be reserved for
immediate care of burn patients.
16.Isolation room for obstetric patients and pediatric patients.
17. Other rooms:
Room for dead bodies
Pantry
Storage space
Utility or soiled linen room
Cleaners room- housekeepers room
Changing room
54
Conference room and reference library

STAFING PATTERN
Physicians especially trained

in emergency medicine.
A well-staffed emergency
department need 8 nurse
shifts of 8 hours.
Clerks-3
Security
Public relation and social

worker should be available to
take care of the anxious and
disturbed patients and their 55
relatives.
MEDICO-LEGAL ASPECTS OF
EMERGENCY DEPOARTMENTS
According to the recent supreme court decision, no doctor can
refuse giving first aid treatment to accident victims or any
other patients.
A written consent must be obtained from the patient to treat
him, with the patients knowledge regarding procedures.
Keeping the medical records is high priority in any hospital.
All medico-legal cases e.g., Assualt and battery, child abuse

and accidents etc. should be reported to proper authorities e.g.,
police.
The cases of AIDS and venereal diseases should be reported to56
health authorities.
2/6/17
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2/6/17
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2/6/17

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

Sound architectural planning.

Medical technology and

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

It should be attached to the

The space requirement will

Each department should

be guided by the nurse to meet the doctor concerned.

to be admitted for bedside care or not.

the patient admitted.

emergency department after first aid or from other ward transfers.

outpatient chits or cards to patients.

Patients with non-

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

Two bed room 160 sq ft/ bed

Four bed room 320 sq ft/ bed

Six 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

Clean work room

Unit store Sanitary area

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

Unilateral riggs ward

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

Receiving counter and clean up room.

Needles and syringe processing room.

Gloves assembling room with rubber goods processing room.

Clean work area including sterilizers.

Gauze and dressing assembly area.

Fluids, needles & syringes-

Additional 25% space

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

Staff change room 7.00

Dirty receipt and disassembly 7.00

Washing, disinfection, and decontamination 17.50

Linen processing 10.50

Sterile storage 21.00

Trolley wash 7.00

Trolley bag 10.50

Duty room 3.50

10-15 persons. Staff for 1000

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

Hot air oven for drying instruments and sterilization.

Instrument sharpener like needle sharpening machines.

Stem sterilizers and boiler for steam.

Autoclaves of various sizes including gas autoclave.

Chemicals to clean materials.

Wall fixtures like sink, taps.

Trolley for supply of sterilized items and separate trolleys for 23

collection of used items are needed.

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

CSSD is open for

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP

Control of cross infections.

2/6/17 TEERTHANKER MAHAVEER COLLEGE OF NURSING, MORADABAD,UP