2. Inpatient wards are for those patient who need treatment under healthcare
personal supervision. Patients are admitted in Inpatient ward for short or long
term depending on severity of their disease.
3. • Nursing station
• ICU, CCU, HDU, OT, Post-operative care & Burns unit
• Pharmacy
• Radiology, Laboratory service
• Beds
• Sanitary Area
• Sluice Room
• Pantry
• Unit store
• Treatment room
• Dinning & Daycare/Recreation
INPATIENT DEPARTMENT CONSIST
4. • To provide highest possible quality of medical & nursing care
• To make a provision for essential equipment, drugs and other materials required for
patient care.
• To provide comfortable and desirable environment to patient as substitution of home.
• To provide facilities for visitors
• To provide opportunity for education, training and research
• To provide highest possible satisfaction to patient.
FUNCTIONS OF INPATIENT DEPARTMENT
5. FEATURES OF IPD
The IPD forms 33%-50% of the structure of hospital construction and most of the
equipment and staff are in this department with maximum amount of patient care,
training, medical teaching and research concentrated in the department.
6. FORMS OF INPATIENT WARDS
Nightingale
Rig’s pattern
Modified Rig’s pattern
Racing track ward
‘T’ and ‘Y’ shaped ward
Single straight corridor ward
‘L’ shaped plan
Cruciform plan
‘H’ shaped plan
‘E’ shaped plan
Box plan
Central corridor multiple rib pattern
7. NIGHTINGALE WARD
Beds in two rows at right angle to the longitudinal walls
Nursing station, doctor’s room, other facilities at other end
Bathroom and WC at one end
Length of the ward 96 feet to home 30-35 patients
It may have side room if isolation room required for privacy and improve condition
It provides good visibility, economical and plenty of fresh air ventilation
8. Disadvantages of Nightingale ward(open ward)
Noise pollution
No privacy for patient
Risk of cross infection
Fatigue of nurses
Less space between bed
Constant glare of patient
9. Modified Nightingale ward
Nursing station is in center of the ward
Ancillary and Auxiliary services are at one end of the ward
Utility and bathroom are at other end of the ward
Nurses travel is reduced
Supervision over patient condition is easy
10. RIG’ S PATTERN WARD
Ward is divided into small compartments separated from each other.
Each compartment has 4-6 beds
Beds may be on one side or parallel to each other
1-2 Isolation room can be kept
11. ADVANTAGE OF RIGG’S PATTERN
Privacy to the patient
Risk of cross infection minimizes
Less noisy
Isolation of infectious case can be easier
Enhancing flexibility of utilization
12. DISADVANTAGE OF RIG’S PATTERN WARD
Communication between patient & nurse is more difficult
Direct observation of patient is difficult
More staffing required
More nurses required, Costly and difficult to maintain than open ward
13. COMPONENTS OF WARD UNIT
PRIMARY ACCOMMODATION: It consist of single bedroom or multiple bedroom for
patient and nursing station
ANCILLARY ACCOMMODATION: Service for direct support of treatment. Example.
Portable X-ray, side lab, Pantry, Dietary, Mobile Pharmacy
AUXILIARY ACCOMMODATION: Service in indirect support of treatment. Example.
Store, Housekeeping, Doctor’s room, Nurse’s room, Seminar- Teaching room.
SANITARY ACCOMMODATION: Consist of WC, Bathroom, Janitor’s room, Sluice
room
14. COMPONENTS OF NURSING UNIT
Primary; 1 bed-14 sq. meters; 2 bed 21; 3bed 28; 4 bed 42 sq. meters
Ancillary-nursing room (20’ * 20’), MOs room, clean utility room9100-120sq. Feet),
Treatment room, kitchen ( 100sq. Feet), Day care room, stores
Auxiliary
Sanitary- dirty utility room, bathroom and WC
Urinal 1 for 6 beds
WC 1 for 8 beds
Bathroom 1 for 12 beds
Washroom 1 for 10 beds
Janitor room
15. ANCILLARY SERVICES
Nursing station
Ward kitchen/ pantry
Treatment room
Clean and utility area
Doctors duty room
Seminar room
Attendant’s room
Side room laboratory
Locker room
Wheelchair room/ Trolley bay
16. Physical Facilities related requirement
Sufficient space for carrying out patient care activities with adequate circulation space
Facility should be non-slippery floor, safe electrical fittings, no accidental spot etc to avoid injury
chances
Inter bed distance should be around 6feet
Hand washing area easily accessible to healthcare staff
Accessibility of fire fighting equipment
Crash cart should be kept from where it is easily accessible to healthcare staff.
Patient washroom should have anti skid mats, emergency call button, grab bars, door opening from
outside
Adequate privacy arrangement especially in multi-bed ward
Availability of all necessary patient care equipment
Biomedical waste bins as per BMW rules
Segregated storage area for clean and dirty supplies
Emergency exit route should be displayed
17. Staffing related requirement
Categories of nurses required to be identified (depending upon the type of ward)
Nurse: Patient ratio to be defined for the ward in each shift
Duty roster to serve as an evidence of nurse patient ratio
Doctor should be available round the clock
Other support staff as required
18. Ward management related requirement
Linen on patient bed to be changed daily
Periodic cleaning of mattresses pillow and other bed items
Temperature of the refrigerator in which medicine should be checked at-least once in each shift
Crash cart should have life- saving drug and equipment it should be replenished if used
All emergency medicine should be available as per defined quantity
Mechanism for replenishing emergency medicine to be followed
High risk medicine to be identified and stored separately
If the narcotic drugs and psychotropic substance act are temporarily stored it should be under lock and
key. NDPS regulation should be followed.
Reporting adverse patient
List of hazardous material in the ward to be identified material safety data sheet(MSDS).
Bio- medical waste should be segregated as per regulation
Area of ward washroom should be kept neat and clean
Clean supplies and dirty used items should be stored separately
Medical records should be stored as per hospital policy
Security and confidentiality of medical records to be maintained as per hospital’s policy
Maintenance of admission discharge, stock, laundry, adverse incident register is necessary.
19. Staff awareness related requirements.
Components and time- frame for initial assessment of admitted patients.
Uniform care policy and patient care processes that fall under it
Patient’s rights
Dealing with HIV+ve patients and manufacturing confidentiality
Provision of basic cardiac support
Code blue policy and procedure
Other emergency code(pink code, yellow code, red code etc.)
Identification and care of vulnerable patients
Care of surgical patient/ paediatric patients/ obstetric patient
Proper identification of patient
Safe medication practices(things to check before administration monitoring, verbal orders
administering high risk medicine etc.)
Safe blood transfusion practices
Policy and procedure of patient’s restraint
Pain management policy and protocol
Standard precaution for infection control (hand hygiene, use PPE etc.)
20. Safe injection practices
Patient safety incidents, its types and reporting(such as near miss, sentinel, adverse drug reaction
etc.)
Emergency evacuation plan
Their role during any disastrous situation
Basic fire safety measures
21. Quality indicators of wards
Average time for initial assessment of admitted patient and percentage outliner
Incidence of medical errors
Percentage of admission with adverse drug reaction
Percentage of patients receiving high risk medicine and developing adverse drug reaction
Percentage of transfusion reaction
Incidence of bed sore after admissions
Incidence of patient right violation
Incidence of needle stick injuries
Incidence of missing medical records
Percentage of non-compliance observed related to infection control practice
Patient satisfaction rate of the ward
Time taken for discharge
Average Patient : Nurse ratio in each shift
Percentage of current medical record that are incomplete as per hospital policy.
23. Operation theatre is a facility within the hospital in which surgical procedures are carried out in aseptic
environment.
Operating rooms are spacious, easy to clean, and well-lit, typically with overhead surgical lights, and may
have viewing screens and monitors. Operating rooms are generally windowless and feature controlled
temperature and humidity. Special air handlers filter the air and maintain a slightly elevated pressure.
Electricity support has backup systems in case of a black-out. Rooms are supplied with wall suction,
oxygen, and possibly other anesthetic gases. Key equipment consists of the operating table and
the anesthesia cart. In addition, there are tables to set up instruments. There is storage space for common
surgical supplies. There are containers for disposables. Outside the operating room is a dedicated
scrubbing area that is used by surgeons, anesthetists, operating department practitioners, and nurses prior
to surgery. An operating room has a map to enable the terminal cleaning staff to realign the operating table
and equipment to the desired layout during cleaning.
24. Functions of OT
Perform surgery in safe, aseptic environment
Ascertain patients comfort, both physical and emotional
Maintain high standards of performance
Acquire, maintain, suitably utilize equipment
Maintain theatre discipline by following prescribed procedures, up dating time to
time
Attempt maximum utilization of theatre by proper scheduling
Prevent iatrogenic complications
Prevent health hazards-environmental, radiological, anesthetic and infecting
agents
Minimize postponement of surgery
25. OBJECTIVE OF PLANNING
To promote highest standards of asepsis
To ensure maximum safety for patient and staff from installation hazards
Optimum use of OT staffing time
Smooth and effective functioning of OT
Good working environment for Doctors and staff
Allow flexibility by use of multiple operating suits
26. Functional consideration of OT
Location:
Maximum six suits in one OT complex, preferably ground floor
Easy access to CSSD, sterilization unit emergency and surgical ward
Maximum protection from sun, sounds, heat and wind
Independent of general traffic flow
Easy access to other area of OT
Size:
General OT unit 18’x18’ or 40sq meter
Super specialty OT unit 60sq meter
Additional room for heart lung machine, C-arm etc.
Paired OTs help in proper utilization of instruments and equipment.
27. Factors Influencing Number of OT
Factors
Type of Hospital
Staff & strength
& capacity of
sterile supply
Hospital policy
No of Hospital
bed
Type of surgery
Average length
of stay
Turn over rate in
OT
Time for OT
maintenance
Projected
emergency
surgical case
Average No. of
operations
28. PLANNING CRITERIA FOR
FUNCTIONS ERGOMETRIC or
WORK FLOW
LOCATION
SIZE
NO. OF OTS
GROUPING OF OTS
ZONING
EQUIPMENT
INSTALLATION
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PLANNING
CRITEREA
TECHNICHAL ENVIRONMENT
Space free movement of staff,
patients, supplies
• OT Staff
• Functional Area
• Preparation of
Patient
• Sterilization unit
• Scrub station
• Designing &
finishing
• Lighting
• Air conditioning
• Ventilation
• Water supply
• Fire safety
• Plumbing
• Clothing
29. NUMBER OF OTS
No. of OTs= One OT unit for 50 surgical beds
No. of Operation/day= No. of Surgical bed
Average length of stay surgical patient
No. of operations/day= No. of surgical beds x % bed occupancy x 365
ALS x 100 x No. of working OT day
The number of operation per suit should not exceed 06 per day or 8 to 10hr
per day
31. ZONING OF OPERATION THEATRE
CLEAN ZONE
• Preparation of patient
• Recovery room
• Theatre work room
• X-ray plaster room
• Sister room
• Anesthetist roomPROTECTIVE ZONE
• Patient waiting area &
reception
• Trolley bay
• Lift
• Stairs
• Switch
• Pre anesthesia room
• Changing room
• Store room
STERILE ZONE
• Operating suit
• Scrub room
• Anesthesia room
• Instrument trolley
area
DISPOSAL ZONE
• Dirty room
• Disposal room
• Janitor corridor
ZONING of OT
32. PROTECTIVE ZONE
Reception, patient identification & case sheet check
Waiting area for relatives
Changing room for OT staff & surgeon
Pre-anesthesia room
Store room, trolley boy
Autoclaves
Record & controller room
OT in charge, electricity control
Seminar & meeting room
Entrance to observation gallery
34. STERILIZATION OF OPERATION THEATRE
Special air flow pattern-filtered & purified air
Standard cleaning- disinfection with appropriate chemical agents
Fumigation with Formaldehyde, Phosphine, Methyl Bromide etc.
Infection control committee, restricted entry, through washing & carbonization,
regular training
Operation theatre discipline surveillance bacterial counts
Keeping floor dry, vacuum cleaning
35. ADVANTAGE OF GROUPING
Easy expansion in future
Maximum flexibility of use
Better staffing, organization & control
Great efficiency in resource utilization
Easy to maintain
Minimize cross infection
Increases utilization of OT
Minimization of cancellation of OT list
Size : General: 40 sq. m
CVTS/Neurology/ Orthopedics: 60sq. m
Endoscopy suite procedure room: 20sq.m
36. CRITERIA OF PLANNING
Environmental criteria: provide complete environment control for safely of Patient/staff
Economic criteria: Optimization of interrelationship between various financial areas and Operating
department.
Workflow: the flow of staff, patient & supplies in OT to be well planned
Function criteria: design follows function: No. of surgical bed x % of bed occupancy rate X365
Average length of stay x 10 x No. of working day
37. Environmental factors
Electricity
ensure round the clock electric supply
Standby generation system
UPS for all equipment and gazettes
Central field illumination
Floor round table illumination
Minimum glares, four power outlet on each wall at height of 1.5m
Separate copper earthing
Avoid extension cord
Operating light
Shadow less, mobile, hanging pendent easily maintainable OT light
Intensity should be 4000lux at incision & 8000lux at 9 cm deep
Air-conditioning
Control asepsis, controlled air flow, positive pressure
Maintenance of temperature 220c
Humidity 55% + 5 percent
100% fresh air
Ventilation
There should be +ve pressure ventilation with lower pressure
All anesthesia gases should be vented out to exhaust
Flow of air 2 to 3 cu m/min
Air removal from floor level through weight lever
Plumbing
Sewerage shaft should not pass through operating room
Toilet should be provide in the changing area
gas pipeline system should be ensured
All fire safety measure to be taken
38. Water supply
Adequate & running fresh water supply to be ensured
Ensure self water flow after de salination
Autoclave Room
Provision of steam supply
Proper maintenance of autoclave
Linen supply should be regular & adequate
Attached to theatres
Equipment to be kept in cupboards
Diagnostic and operating instrument should be disinfected in Lysol
39. Equipment's for OT
Operation Table Surgical Ceiling Lights Pulse Oximetry
Blood Sugar Meter ECG Monitor Anaesthesia
Machine
40. OT FACILITIES AND EQUIPMENT
Regulated entry to clean zone and beyond
Facility should be safe, for eg. Non- slippery, safe electrical fillings, no accidental
spot
Separate storage area for clean and dirty items
Accessibility of fire- fighting equipment, in all area of OT
Arrangement for quick availability of sterilized items
Space for changing shower and personal storage of staff and doctors
All equipment in OT should be calibrate having label of calibration date and status
OT should have an emergency evacuating route to be used in case of any
emergency.
41. Pre- Operative and Post- Operative area
Easy accessibility of crash cart to these area.
Use of a define criteria to decide shifting of patient from post-operative ward
Immediate pre- operative checkup before wheeling in patient in operation room from pre-
operative ward.
Availability of anaesthesiologist whenever required
All staff to be trained in Basic Cardiac Life Support(BCLS)
42. Process for Patient Safety
Use of OT attire by all staff.
Having pre-operative assessment and provisional diagnosis before surgery
Use of WHO surgical safety checklist for each patient
Compliance of blood and blood product transfusion practices
Monitoring of patient during surgical procedure:
Heart rate
Cardiac rhythm
Respiratory rate
Blood pressure
Oxygen saturation
Level sedation
Documentation of types anaesthesia and anaesthetic medication in patient medical record.
All staff must be aware standard precaution and OT specific infection control practice:
Scrubbing
Sterility maintenance
Use PPE(Personal Protective Equipment)
43. Medicines/ consumable supplies
Narcotic to be stored as per regulation (under lock and key, record maintenance etc.)
Look alike, sound alike medicine to be stored separately as per hospital policy
Multi- use open vials to have a label of date of opening and expiry
High risk medicine must be stored separately
Spirit should be stored under lock
All high risk materials should be identified listed and material safety data sheet(MSDS) for
each of them should be kept easily available for the staff.
45. Patient relating activity
Reception & preoperative preparation
Identification of patient & part to be operated
Shifting patient of OT table
Administration of anesthesia
Intubation of positioning
Preparation of surgical area & draping
Intubation after operation, recovery from anesthesia
Supporting Activity
OT dressing
Scrubbing & hand washing
Gowning, putting gloves
Checking of equipment & instruments
Administrative Activities
Preparation of operation schedule
Preparation of OT list
Requisition of patient
Identification of patient, parts and records
Shifting patient to OT
Preparation for doctors and assistant staff
Clerical activities
Operation note
Transfusion record
Consent to patient for operation
Post of operative advise
46. House keeping
Collection of soiled linen
Counting and collection of soiled instrument disposables
Counting of abdominal sponges
Cleaning of OT table & area
Preparation of receive next patient
Store keeping
Ensure required medicine & instruments are ready
Indent & stocking of essential drugs & injections
Different king of fluid & blood
Internal design
Wall
• Melanin facing wall for easy cleaning
• Height should be 3 - 3 1/2m
• Pale colour to be used
• Resistant to minor damage or impact
• Free crevices and flaking
• All corners to be smoothly carved
• Door should be 1.5m wide swinging & 7feet height
47. Roof
o Same as well, but can take load of OT lights, X-ray unit, TV camera, gas & electric panel
Floor
o Easily washable no staining impressive
o Moderately electro conductive
o Vinyl conductive flooring is best
Fixtures & installation
o Minimum equipment in OT suite
o Adequate free area around the table for free movement
o Table connected to gas pipeline
o No loose over head beams or pipes
48. Environmental Process
Each operation room should be monitored for humidity and temperature on daily basis
Each OT should monitor for pressure different at least once a month
Each OT should be monitored for filter integrity, at least month
All area in OT should be kept clean from dust all the time
Regular environmental surveillance for microbes to be done in each OT and other area to
identify forming of any colonies of bacteria.
Regular cleaning with antiseptic solution of all surface in OT fumigation, if followed by
the hospital can be done.
Segregation of route of biomedical waste movement if this is not possible time of BMW
should be different from time of staff and clean supplied movement.
49. Awareness of OT Staff
Prevent needle injuries
Patient rights
Dealing with HIV+ve patient
Isolation requirement of patient
Various emergency coloures codes followed in hospital
Safe injection practices
Patient safety incidents its types and reporting (such as near miss, sentinel, adverse drug
reaction)
Emergency evacuation plan
Their role during any disastrous situation
Quality indicators of OT
50. Quality Indicators for OT and Surgeries
Compliance percentage to environmental norms( temperature, humidity)
Percentage compliance to WHO surgical safety checklist
Percentage of unplanned returns to OT
Percentage of re-scheduling of surgeries
Percentage of re- exploration of surgical site
Percentage of unplanned ventilation following anaesthesia
Percentage of modification of anaesthesia plan
Percentage of adverse anaesthesia events
Anaesthesia related mortality rate
51. OT ADMINISTRATION
Operation theatre committee
Each unit must have from 4-7 OT staff
i. Chief Surgeon
ii. OT. Assistant
iii. Chief Anesthetist
iv. Anesthesia assistant
v. Scrub nurse
vi. Anesthesia nurse
vii. Circulating nurse
viii. OT Nurse for assisting
ix. Attendant, House keeping, OT technicians
52. STAFF
Theatre superintendent
Maintain cleanliness
Asepsis
Equipment in working order
Adequate stock of consumables & instruments
Finalize operation schedules
Trained nurses
Two nurses per table
Special training for pediatric, cardiac, neuro surgery
Recovery room nurse patient ratio 1:1
Theatre assistant
Preparation of trolley
Packing instruments, gloves, gowns
Coordinating supply of sterilized item from CSSD
Arrange for transportation of patient from ward to theatre & back
Labour staff
Cleaning segregation
Taking blood/biopsy sample to laboratory
53. ADMINISTRATION OF OT
Monitoring of OT asepsis
Once a week maintenance
Swab for microbiological growth
AC checked including filter
HEPA filter(high efficiency particulate air)
Environment control temperature, humidity, ventilation, air change
Adequate pressure maintenance
Dis infection of equipment, OT table, other articles
Fumigation at regular intervals with standard equipment & standard procedure
Staff with infection, should not be allowed to enter OT
54. COMMON PROBLEMS WITH OT MANAGEMENT
Poorly designed process
Lack of motivation
Dodging responsibilities/ placing blame
Lack of discipline