Designing Hospital for better Infection Control: an Experience.

The physical design of hospital is an essential component of a hospital's infection control strategy, incorporating infection control issues to minimise the risk of infection transmission. Hospital design therefore, needs to consider the separation of dirty and clean areas, adequate ventilation, lighting and storage facilities and design of patient accommodation areas, including adequate number of wash hand basins and single bed facilities. A 250 bed general hospital was planned keeping in view structural and design elements necessary for success of a good infection control programme. Various National and International Standards like BSI recommendations, JCAHO, IC Standards, DHSS, ASHRAE, AIA and OSHA were studied and compared with our planning parameters. Planning of ward unit, ICU, Operation theatre and Isolation wards were especially reviewed in the light of recent knowledge available in the field of hospital acquired infection and modifications were carried out. Need for effective identification of potential infections, risks in the design of a hospital were stressed. Engineering controls required to reduce the concentration of infectious droplet nuclei in the air and prevention of transmission of disease were highlighted.

Biomedical Waste Management : An Infrastructural Survey of Hospitals.

BACKGROUND: The Ministry of Environment & Forests notified the Biomedical Waste (management & handling) Rules, 1998" (BMW Mgt) in July 1998. In accordance with the rules, every hospital generating BMW needs to set up requisite BMW treatment facilities on site or ensure requisite treatment of waste at common treatment facility. No untreated BMW shall be kept stored beyond a period of 48 hours. The cost of construction, operation and maintenance of system for managing BMW represents a significant part of overall budget of a hospital if the BMW rules have to be implemented in their true spirit. Two types of costs are required to be incurred by hospitals for BMW Mgt, internal and external. Internal cost is the cost for segregation, mutilation, disinfection, internal storage and transportation including hidden cost of protective equipment. External costs are off site transportation, treatment and final disposal. METHODS: A study of hospitals was carried out from various sectors like Govt, Private, Charitable institutions etc. to assess the infrastructural requirement for BMW Mgt. Cost was worked out for a hospital where all the infrastructure as per each and every requirement of BMW rules had been implemented and then it was compared with other hospitals where hospitals have made compromises on each stage of BMW Mgt. RESULTS: Capital cost incurred by benchmarked hospital of 1047 beds was Rs.3 lakh 59 thousand excluding cost of incinerator and hospital is incurring Rs. 656/- per day as recurring expenditure. Pune city has common regional facility for BMW final disposal. Facility is charging Rs.20 per kg of infectious waste. As on Dec 2001 there were 400 institutions including nursing homes, labs and blood banks which were registered. CONCLUSION: After analyzing the results of study it was felt that there is an urgent need to standardize the infrastructural requirement so that hospitals following BMW rules strictly do not suffer additional costs.