The engineering services in a hospital include the civil assets, electricity supply, water supply including plumbing and fittings, steam supply, piped medical gases, air and clinical vacuum delivery system, air conditioning and refrigeration, lifts and dumb waiters, public health services, lightening protection, communication system (public address system, telephones, paging system), TV and piped music system, non conventional energy devices, horticulture, arboriculture and landscaping and last but not the least workshop facilities for repairs and maintenance.
They are an extremely vital service on whose efficiency depends the efficiency of the entire patient care delivery system of the hospital.
They are responsible for the inspection, repair and maintenance of all the facilities and services mentioned above to ensure their optimum operational reliability and reduction/elimination of any risks associated with them.
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Any break in any of the services may spell serious trouble of some or the other kind as listed below.
1. Prevention of Engineering Related Safety Hazards:
1. To manage the engineering services, with full efficiency and effectiveness, the hospital requires a full department of engineering services with adequate fully trained staff including a qualified Biomedical engineer, a well equipped workshop for electrical, mechanical, biomedical repairs.
The department should be headed by a senior well qualified electrical engineer with exposure of air conditioning, refrigeration, communication technology, and some idea of mechanical/biomedical equipment, besides, of course, the knowledge of civil works.
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Adequate supervisory and other staff in all branches, including the civil, mechanical, electrical and plumbing section, should be available to attend to problems round the clock.
2. Availability of a documented Quality manual with clearly defined role and scope of services of the engineering department and the policies and procedures covering every aspect of their activities.
3. A procedure for detection/reporting of defects and their repair/maintenance with the minimum possible downtime and fixed minimum time frame for restoring the facility to operational state.
4. A check list of all the legal compliances and a mechanism for ensuring regular updating of the licenses/registrations/certifications.
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5. A comprehensive equipment management program and a system of equipment audit. The records of proceedings including the audit points and corrective actions are to be maintained.
6. An updated inventory of all the equipment and a comprehensive history sheet in respect of each and every equipment unit.
7. A standardized system and format for registering complaints giving the details of:
i. Ward/ department
ii. Details of the equipment
iii. Details of the defects
iv. Urgency involved (routine/urgent/immediate)
v. Date and time of complaint
vi. Authentication by the complainant.
8. A record of breakdown complaints and the response time for attending to complaints (restoration of operational status) is to be maintained and monitored.
9. Regular periodic inspection and recalibration of the equipment by the authorized agencies.
10. Adequate potable water supply round the clock with 3 days reserve and a system of regular periodic testing of water samples at the source as well as the user end.
11. Planned periodic cleaning of AC ducting and cleaning/replacement of filters.
12. Availability of a Fire safety Manual with a check list of actions to be taken by the 1 staff during fire/other emergencies.
It is ensured that up to date floor plans along with the escape routes are available, the escape routes are kept free of any obstacles and there is a documented plan for safe escape of patients, public and staff during fire or other emergencies.
Operational readiness of the equipment is ensured by regular periodic inspection and planned preventive (and breakdown) maintenance of all fire safety equipment.
13. Hospital safety committee is to regularly inspect the facilities at least twice a year and after a detailed exercise in Hazard identification and Risk Analysis (HIRA) submit their findings and recommendations in writing. A record, including the actions taken, is to be maintained.
14 There is a documented system of periodic inspection and planned preventive (and breakdown) maintenance and risk reduction in respect of each of the following facilities/services.
a. Buildings and environment for loose stones/ plaster/ slates, bricks.
b. Electric supply and distribution system including the diesel generator (DG) sets UPS systems and stabilizers. No loose hanging wires or temporary connections to be allowed.
c. Water supply and distribution system including the supply of hot, cold, potable, ultra pure water and steam supply. There should be no dripping taps, leaking pipes or blocked sewage lines.
d. Air conditioning and refrigeration facilities.
e. Centralized gas and vacuum supply service.
f. Communication system.
g. Traction/transportation system.
h. Lightening Protection- Periodic testing of patency of earthing.
i. Public health engineering system (waste storage/disposal, effluent treatment plant).
j. Proper earthing of all electric equipments.
k. Periodic checking of all switches/ sockets to ensure their adequacy and hazard free functioning.
2. Prevention of Hazards Related to Construction/Maintenance Activities:
Construction and maintenance activities are activities that temporarily throw the system out of gear and disrupt the normal functioning for a variable period.
Any demolition/new construction may mean temporary change of entry/exit routes, spread of debris or building materials here and there, disconnection of electric cabling, shutting down the power supply or water supply or communication lines.
It also has the hazards of accidental fall of construction materials on the patients, public or staff nearby, leading to serious injuries.
In order to prevent any disruption of normal functioning and its adverse effects on the health and safety of people, the management and the engineering services must make the following arrangements.
1. Plan the activities in advance in a phased manner to ensure minimum disturbance of the normal functioning of the services.
2. Put in place and test the alternate arrangements before actually starting the activities.
3. Inform all concerned about the activities and their timings well in advance and the changes necessary in the system of functioning.
4. Ensure that the people are fully protected from any possible/accidental injurious effects of demolition/ construction activities by creating barriers to dust, noise, falling materials.
5. Ensuring that the maintenance activities are started only after making all spares/ equipment/tools available, so that they can be completed as per the schedule.
6. Timings for such activities may be adjusted so that they have minimal disruptive effect on the patient care activities.
7. If necessary, suspending some of the services or shifting locations/timings, as an interim measure.
8. Placing warning signs and directional signs wherever indicated.
9. Any other measures necessary to ensure safety of patients and their safe/uncompromised treatment.
Construction and maintenance activities do have an impact on the life safety systems in the hospital. The JCAHO (USA) have developed certain health and safety measures called “Interim Life safety Measures (ILSM)” to protect the safety and health of patients, visitors and staff.