safety assessment & analysis of healthcare buildings · pdf filesafety assessment &...

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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3

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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4

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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5

Medical gases

Medical gases

Laminar air flow with air curtans


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6

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.


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