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SAFETY ASSESSMENT & ANALYSIS OF
HEALTHCARE BUILDINGS IN NEW DELHI
- Smita Rashmi,M.Arch.,B.Arch.
Introduction:
Today, the safest, most profitable hospitals are
run by those who have their finger on the pulse
of thei buildi gs’ e uip e t a d syste s,
identifying problems before they negatively
affect their hospital.
Critical equipment failure brings unexpected
costs and the possible loss of revenue-
generating services.
It can significantly impact patient
care/satisfaction and employee safety, while
increasing exposure to litigation and negative
public relations
Safety
Safety of humans in terms of reliability ,
availability & secured services are the backbone
for any of the hospital.
To accomplish this, a certain level of redundancy
is required in all the services employed in a
hospital.
Need of the study
Many patients in hospitals of India have died in
the recent past due to negligence in the safety
requirements or non availability of safety systems
in hospitals of India.
1
Over 5,000 children died at Safdarjung hospital
in 3 years (Press Trust Of India)
RTI query by Mumbai the hospital revealed that
in the past three years, starting from 2009, a
total of 24,924 people died while undergoing
treatment at the hospital.
Five infants Burnt Alive in Incubator Fire in
Patiala Hospital ( by Santosh Kumar
Agarwal for Global Village February 01, 2009).
Therefore ,the assessment of building services
in terms of safety in hospitals becomes the
utmost need of the hour
The Risk Hazard Grade is determined by the
combination of four equally
weighted factors ( rated on 1 to 5 scales ) ( 1 —
Low 2 — Med-Low 3 — Medium 4 — Med-High 5 —
High) i.e. Level of possible danger for each deficiency.
> The impact of the occurrence to patient care
> The safety hazard to electrical works
> The probability of an occurrence
The ability to respond quickly to correct the
negative effects of the occurrence.
SAFETY ASSESSMENT
ELECTRICAL SERVICES
REDUNDANCY IN GRID SOURCES
1 Power coming from
more than one grid 3/5 ( N/P )
TRANSFORMER REDUNDANCY
2 No.of transformers
(N+1) 4/5
3 Two no. of LT Panels
1/5
4 LT Panel room
Having CO2 total suppression
system - 2/5
5 Each area of hospital
served by two risers
1/5
100% POWER BACK UP SUPPLY
6
DG Set- 100%
power back up
supply
4/5
CENTRALIZED UPS
7
Heat produced by
UPS catered by
(cooling condition
of UPS )
2/5
THE ASSESSMENT – After visiting a no. of hospitals
in N ew Delhi,it was found out that majority of the
hospitals lack in the quality & monitoring of the
services commissioned .
P – Total no. of hospitals visited out of which N no. having the facility
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Electrical Safety for hospitals and
Other medical locations
2
EARTHING
8
Earthing
maintenance in
hospital
4/5
ISOLATED POWER DISTRIBUTION FOR WET
AREAS
9
Provision of
isolated
transformer
3/5
HVAC SERVICES
10
Pumps
configuration in
chilled water
circuit
Primary pump - constant – 5/5
& secondary pump –VFD -
4/5
11 Boiler Centralized Boiler –
2/5
12
Maintaining
temperature in
plant room
Air washers given - 3/5
only one small ventilator in
pump rm. - 1/5
13 Maintained
Cooling Tower
Maintained condition –
4/5
14 For all OT's
ACH > 25.Exhaust in between
15% to 30% - 5/5
1 OT -100% Fresh air for
cardiac,1 OT – 75% fresh air –
neuro ,ortho - 4/5
15 HRV IN AHU of OT 3/5
16 OT laminar air flow - 5/5
air curtain - 0/5
17 Smoke exhaust
system
Local smoke exhaust systems
with axial fans – 5/5
18 BMS
BMS – 2/5 ( only for HVAC,
AHU, FCU)
With security interface – 0/5
19 Working condition
of BMS
Constant monitoring with BMS
– 1/5
20 CSSD
Proper air conditioning in CSSD
having ACH -15
- 3/5
FIRE SERVICES
21
Proper Working
condition of fire
pump room
4/5
22 Fire pump room
cooling
Appropriate cooling for fire
pump room - 3/5
23 Alarm in fire pump
room
sprinkler burst, then sprinkler
alarm is present in the fire
pump room - 3/5
24 FIRE ALARM
CONTROL PANEL
Analog addressable system
- 1/5
intelligent addressable system
- 4/5.
Repeater panel - 4/5
25 Detection systems
Smoke, heat detectors, MCP,
Fire Alarm panel – 5/5.
For OT'S,MRI - aspiration
systems - 1/5
26 MRI ROOM
Non magnetic fire extinguisher
used in MRI,
no metal housing – 5/5
MEDICAL GASES
27 Zoning
For Proper Zoning ,plant room
near to the manifold room –
2/5
28 For Monitoring Dew Point Monitor ,CO
analyser present - 2/5
29
Temperature to be
maintained inside
plant 30 C to 35 C
(Air washers reqd. in plant
room) Temperature
maintained inside – 2/5.
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30
For maintenance
,Total 3 feet gap
between 2
machines in plant
room
Proper gaps present – 2/5
31 For safety
Alarm, Area alarms present in
the plant room for maintaining
the pressure - 3/5
CSSD SERVICES
32
outside delivered
things used for
surgery should first
come to CSSD
All the outside delivered things
– go to store then CSSD - 1/5
33 No. Of Sterlization
equipments
Sufficient in no. - 1/5
(depends on no. of beds in
hospital)
33 No. Of Sterlization
equipments
Sufficient in no. - 1/5
(depends on no. of beds in
hospital)
34 Zoning
Proper zoning.well connected
with OT through service lift -
2/5
35
Amount of space
for CSSD
Sufficient .As per European
standards - 2/5
36 AHU of CSSD Having HEPA filter - 3/5
37 Minimum
infiltration areas
Minimum infiltration areas in
between the zones - 2/5
38 water quality
Provision of DM plant (water
having impurities of < 50
microns is to be used for CSSD)
– 1/5
39 Linen packing store separate big exhaust present
in linen store - 1/5
40 Exhaust for each
machine Properly working - 3/5
41 Guidelines for CSSD No Indian guidelines. Only
european gudelines are there.
MEDICAL WASTE
42 Dirty corridor
Separate way for taking bags
- 1/5
KITCHEN
43 Supply & exhaust
system
Supply from air washer &
exhaust from air scrubber
on terrace – 3/5
Only exhaust fans with
chimney - 2/5
THE ASSESSMENT – After visiting a no. of
hospitals in New Delhi, it was found out that
most of the hospitals lack in safety in terms of
existing commissioned services in hospitals .
The reasons ( in terms of architecture ) - due to
less amount of space provision, improper zoning,
segregation in terms of clean & dirty corridors
etc. which ultimately effect the operation of
services which in turn affect the safety of human
beings, height restriction for hospitals 30m. as
per NBC.
In terms of Services
lack of redundancy levels required in Hospitals
lack of fresh air requirements ( owing to the
amount of pollution in New Delhi ),lack of
advanced safety systems owing to their high
capital cost & Very poor monitoring of services
( done only at the basic level )
Lack of stringent building codes
In terms of safety provisions in hospitals, safety
and special safety systems are just recommended
in Indian codes ( NEC 2011 India ) but not made
mandatory as compared to other countries.
RECOMMENDATIONS
ELECTRICAL SERVICES
REDUNDANCY LEVEL
• For reliable supply, two sources of supply
from two grids.
• Standby transformer to be there in case of
failure of one transformer
• For every area of hospital, each area served
by two risers.
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EARTHING LEVEL REQUIRED
In Operating rooms
100% power back up supply to be
there for hospitals
Centralized online UPS to be used for
whole of the hospital except for some
of the areas like MRI require individual
separate ups.
Proper cooling to be present in UPS
room ,LT Panel room.
• About 10 percent of all fires in
hospitals are related to faulty electrical
systems .
• One time chemical earthing
recommended owing to its low
maintenance.
HVAC
•Air Quality Issues:
• Filtration - Pre-filters, Microvee, HEPA
•HEPA - Three-Stage Filtration
–Operating Theatres –CSSD Sterile Stores
–Isolation Room (+ve / -ve)
• Laminar Air Flow
- Ultra Clean Surgeries ( Cardiac, Neuro- surgery,
Orthopaedic (Joint Replacement )
• Installing passive infrared light switching and
copper/silver surfaces to limit transmission of germs .
• Ventilation fan used of particular CFM are as /
required by NBC.
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Medical gases
Medical gases
Laminar air flow with air curtans
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CSSD
• Well connected to OT’s sterile area . 2nd route
to Service lifts should be there .
• Temperature required – sterile zone – 180c to
220c
• Clean zone – 240c , & not less than 1 mm hg air
exchange rate.
• Central boilers to CSSD , Hot water line.
Rounded corners should be there, tiles on wall s
& floors , space more required for the passage of
trolleys, utility rooms, washrooms, change
rooms, storage.
Minimum infiltration area from clean to sterile
zone.
FIRE SERVICES • Standby diesel electric pump to be given of
sufficient capacity with required amount of
diesel fuel in fire pump room
• Cooling required for fire pump room.
• Alarms to be present in the fire pump room.
• Flow switches on every floor to be given with
butterfly valve.
• Fire detection systems - OT'S,MRI to have
aspiration systems so as to avoid nuisance
alarms.
• MCP to be connected with fire indication
systems.
MEDICAL GASES
• The bulk tanks – typically located outside the facility.
• Zoning – Gas Manifold room – from where the
centralized supply is given to all the areas via rising
mains.
• The Manifold room should be adjacent to the plant
room.
• Shutoff valves must be strategically installed so that
their closing produces the least disruption to patient
care.
• Zone valves allow isolation of the system.
• Various types of monitors like CO & dew point
monitors to be in place.
• Passive systems - fire rated doors, fire
curtains for lifts, smoke management systems
to be implemented.
PLUMBING SERVICES Cold Water, Hot Water, Steam requirements
–W.T.P./S.T.P.
–Hydro-pneumatic system
–Fire-Fighting
–Rain Water Harvesting
–Toilet location (mechanical ventilation issue)
• Water Test to determine treatment.
•DM Plant – CSSD (Ultrasonic Washers etc.)
•DI Plant – Lab Medicine (Auto-analyzer etc.)
•RO Plant – AKD (Dialysis)
•UV Treatment – Scrub stations etc.
•STP – Recycling – Flushing, Landscaping, Cooling
Towers
• system maintains piping under a continuous negative
pressure - eliminates potential for the spread of infection
• Circulating temperatures, water velocities and water
age are key factors in maintaining a safe condition in a
hospital plumbing system .
• antimicrobial sinks & fixtures - kills 99.9 percent of the
following bacteria within two hours of exposure.
CONCLUSION – Many services such as
security, BMS ,monitoring crucial for hospitals
are either at a very basic level or does not exist
Many departments like CSSD ( Heart of any
hospital) are not at all functioning properly in
majority of hospitals in India, which immensely
affect the safety of the patients.
International Journal of Advancements in Research & Technology, Volume 4, Issue 11, November -2015 ISSN 2278-7763
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