Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Structure
Objectives
lntroduction
Civil Assets
I 2.1
1.2.2
1.2.3
1.2.4
1.2.5
1.2.6
1.2.7
1.2.8
1.2.9
1.2.10
1.2.1 1
1.2. I2
Electricity Supply
Sources of Supply and Standard Voltage
1.3.1
1.3.2
Electric Sub-station
1.3.3
Switchboards and Power Distribution
1.3.4
Load Segregation
1.3.5
Spot Power lmprovement
1.3.6
Stand-by Power Supplies
1.3.7
Stand-by DG Sets
1.3.8 Uninterrupted Power Supply (UPS)
1.3.9
Earthing
1.3.10 Electrical Inspection
1.3.1 1 Future Expansion
Water Supply
1.4.1
1.4.2
1.4.3
1.4.4
1.4.5
1.4.6
1.4.7
1.4.8
1.4.9
1.4.1 0
1.4.1 1
Steam Supply
1.5.1
1 5.2
15 . 3
1.5.4
Let Us Sum Up
Answers to Check Your Progress
F u h e r Readings
1.0 OBJECTIVES
After going through this unit, you should be able to:
explain the rudiments of hospital engineering services;
describe the important components and areas needing attention; and
contribute towards better performance ofthe facilities.
1 . INTRODUCTION
The primary duty of any hospital as you know is to care for the sick and suffering so that
they regain their health speedily. This fbnction can be carried out with greater effect with the
assistance of certain facilities, the foremost of which are the building, water and electricity
supplies, sanitation and an excellent environment alround. You would have noticed that
state of the art equipment are playing an ever increasing vital role in quick and painless
diagnosis and appropriate treatment of the ailment and all of them need engineering services
to function at optimum level. The Engineering and Allied Services comprise ofthe following:
Civil assets
Electricity supply
Water supply
Steam supply
Central medical gases, air, and clinical vacuum delivery system
Air-conditioning and refrigeration
Non-conventional energy devices
Workshop facilities
Engineering services department
Hospital laundry, incinerator and fire protection have been dealt separately.
In this unit, you will learn about the basic engineering services that facilitate efficient
functioning of the hospital, such as civil assets, supply of water, electricity, s@gnk.centrat
medical gases, air and vaccum delivery system. Other areas listed above yifl.becovered in
the next unit.
1.2.1
A large piece of land will provide the best possible clean enGronment for a hospital.
Presently, economy considerations have promoted maximum utilisation of every bit of land
space permitted by laws for building construction leaving least open spaces that do not
permit good ventilation. Even Indian Standard states that the total area to be provided for a
hospital complex shall depend on the availability of land and recommends for guidance an
area of one hectare (1 0,000 sq. m) for every 25 beds.
Hospitals should be easily accessible to the public and the staff, to supply lorries and fire
fighting vehicles. So also, civil amenities like roads, water and electricity supplies, central
sewerage system, communication and banking services etc. should be available reasonably
close to tlie site. A well thought out layout and orientation of the buiidings will reduce airconditioning and ventilation loads.
I
1
Hospital Buildings are generally huge in size and are multi-storeyed. Toilet facilities, which
have to be provided as per norliis, sliould be judiciously located at several points in all floors
and sonie of them are bound to be in the interior portions. To take out tlie soil and waste
water pipes, vertical shafts should be provided wherein these pipes, as also others like water
pipes, are fixed vertically to tlie inner faces of tlie shaft walls. Pipes draining rain water from
the roof top also run through these shafts.
1
I
Drainage piping should not be run liiddeh qbove tlie false ceiling as far as possible. I{is best
to avoid drainage piping in operation a n d d e ~ j y e rooms,
r~
nurseries, central services
areas, food preparation or serving or storage a5eas. sensitive areas like costly equipment
roonis or electronic data processing room (computer rooms) etc. Floor drains should never
be present in operating, delivery and cystoscopic rooms. Drain systems of autopsy tables
sliould be carefully planned to prevent splatter and splzshing and overflow at all costs.
Only a we~l\~lanned,
executed &d maintainedhospital will have no fear o f cross infection
taking place in its premises.
Provision for future expansion and renovation should not be overlooked at the initial
planning stages as these are inevitable in the long run.
Illumination levels for some nursing facilities as per international practice are indicated in the
table given on next page.
In places like anaesthesia store, the electrical fittings should be of flameproof category which
are strong enough to withstand internal explosions. It is better not to have socket outlets
and the like in such a place and to locate all switches outside the hazardous enc1osul.e.
1.2.4
Ventilation
--A CA....-A
..---:I-*:--
---
L- -A--a-.I
:- I----:*-#-
1-
--L
-->
Illumination Level
lllumination Values
AreaIActivity
Lux
Foot candles
500
50
200
300
20
30
200
300
20
30
100
Resident room:
General
Readingibed
Toilet
Resident lounge:
General
Reading
Resident dining
300
300
Nursing station:
General
Desk
.Med~cationarea
300
500
500
Corridors - day
Corridors- night
1
--
I
I
200
100
-
Storage. General
200
20
300
30
Dietary
500
50
Exanlination room
500
50
I
I
Physical therapy
Stairways
300
- - --
30
150
-
---
500
natural exhaust, natural supply and forced exhaust, forced supply and natural exhaust or
forced supply and forced exhaust. If no products of combustion or anaesthesia gases or
other contaminants are involved, then the following air changes recommended in Indian
Standard can be adopted:
Air Changes
space
Operation theatre
Wards
13athrooms, toilets
Kitchen
L;iundry
1.2.5
All hospitals invariably comprise of multi-storeyed blocks and water tanks are placed at
judicious locations on top of the roofs to supply water under pressure to assigned locations.
These tanks are filled by pumping water into them. Like all storage appliances, these tanks
also need periodical cleaning and upkeep. They should have sufic!ent storage capacity to
ensure water supply throughout the day. No tank should exist in unused condition which
will lead to water stagnation and deterioration in storage. Distribution pipelines convey water
from these terrace-mounted tanks to the water taps and other pre-determined points. They
are designed and laid so that water at the right pressure issues forth from the taps. A
defective system will cause innumerable hardships like continuously low pressure, low
pressure when another tap is opened for use, airlocks, etc. The entire system should be wellbalanced so that water at the right pressure is available round the clock on all the floors at all
points of use.
A major problem with pressure pipelines is leaks. These are to be considered as serious in
case of hospitals. When the pipeline is empty, outside contamination can easily slip into the
pipeline and cause havoc. A leaky pipeline inside the hospital building will cause dampness
and unhygienic conditions. Moreover, wet floors can give rise to slippery conditions. A
pipeline leak should be detected at the earliest and promptly attended to. Pipes showing
signs of corrosion should also be changed.
Other problems which give rise to complaints are as follows:
a)
.Dry tap: Inadequacy of water is a major cause that is difficult to overcome. Water
conservation, stoppage of leaks and misuse could be of some help.
b)
Low pressure at tap outlet: A bucket takes an irritatingly long time to fill. A partial
pipeline block or a partially open valve could be the reason.
c)
Low pressure at tap outlet when another tap is opened: This indicates an inadequacy
of pipeline carrying capacity and is difficult to overcome without carrying out changes
in the distribution system.
d)
High pressure at tap outlet: Water splashes all over and wastage results. A pressure
reducing valve or restriction should be intentionally introduced into the pipeline to
reduce the pressure.
e)
Muddy water issues from tap: A common occurrence during monsoon period and if
the storage tanks are dirty, this condition calls for effective filtration ofwater. On-line
filters could be incorporated in the pumping mains. Pipelines should also be
investigated for leaks through which outside water is probably entering the system.
f)
g)
Leaky tap: The drip-drip tapping noise could be most annoying especially to the sick.
This condition should never occur if the maintenance staff is alert.
Hot water is essentially required in. patient areas like wards, operation theatres, intensive care
units, laboratories, kitchen, laundry and such other departments. Basically a hospital
requires hot water at two temperature levels - the lower level not exceeding 43C ( I 10F) for
patient washrooms with about 38C to 40C (1 00F to 104F) for showers, and the higher
level of not less than 7 1C (160F) for physiotherapy, kitchen, cafeteria and laundry. Dietary
requirement could be hot water at a minimum temperature of 49C (120F), and surgical and
similar department may need it at about 40C to 43C (104F to 109.4"F).
Electric storage type water heaters (generally called geysers) can be provided at required
places for spot heating and supply of hot water. The thermostat temperature control could
be set to obtain hot water at the desired temperature. But the sheer number of such units in a
hospital places a heavy demand on maintenance and they could prove to be dangerous in
case of failure of the safety devices when they may even burst spewing steam and hot water
all around. Since the quantity of hot water requirement is considerable in most hospitals, a
centralised hot water generator systeni would prove to be convenient, safe and beneficial. It
couldaperate on electricity or hels and could be riiounted on the roof top of the liospit,al
building. Hot water could be distributed through down take vertical pipes with tee off
arrangement at every floor. The entire hot water system should be well-insulated throughout.
A peculiar situation occurs which invariably leads to a huge wastage of water. The vertical
pipes hold a good amount of hot water which will cool offduring the night time stagnation
condition. A person requiring hot water later on in the night will get cold water first which
will need to be run to waste till hot water reaches the outlet. This wastage has to be avoided
by installing a small pump at ground level which will continuously return a small quantity of
hot water back to the hot water storage tank. This will ensure presence of hot water in the
pipelines at all times so that wastage can be avoided.
It is difficult to assess the requirement of hot water in case of hospitals, because hot water is
mixed with cold water before use. The mixing proportion depends on the particular desire of
the actual user.
However the information provided in the table given below could be useful:
Possible Hot Water Requirements
Patients
Operation theatre
Physiotherapy
Laboratories
Kitchen
Laundry
As required basis, depending on equipments requirement to be decided with equipment supplier. It could
be 50 litres per bed per day
Attendants and
visitors of patients
It may be noted here that the quantity of hot water is not an additional requirement, but is
drawn from the total quantity of water used daily by the hospital which is covered in subsequent sub-section 4.10 of this unit.
Cold water supply is needed for processing tanks in film developing room and perhaps by
some machines which may have their own water chilling units. Cold drinking water is also
essentially required and could be obtained by the use of storage type water coolers. Their
installation should serve maximum number of people conveniently and be such as not to
create wet floor alround. Wastewater from the water coolers need to be drained. Notice
should be displayed prominently that the water is for drinking purposes only and not for
washing or brushing teeth. Spitting into the waste drain in the.cooler should be discouraged.
It is advisable to install a spot water purification unit on the inlet water pipeline of water
coolers. Water coolers must not be placed against walls which will deny adequate ventilation
to the chilling equipment, and also not near a toilet for hygienic reasons and to prevent the
misuse for washing purposes after toilet.
allpwed to occur. This occurs more frequently in monsoon periods. The load on toilets is
always increasing. With time more people coming to the hospital and original line size may
prove to be. inadequate to handle the increased sewage. This aspect needs careful attention
and planning.
Sewer line blockage is a frequent occurrence and a major problem in a hospital. The clogging
process occurs gradually and is difficult to detect till the blockage is complete and the toilet
gets flooded causing the greatest inconvenience. Locating the point of blockage is as
difficult as it is to clear it and make the line functional. Clearing operation is a nuisance
whether it is inside or outside the building. Organised energetic regular maintenance of the
entire system is the only practical answer to this malady.
Most urban hospitals discharge the waste into the municipal lines without checking the
bacteria level which is likely to be high. This situation is one that is fraught with danger. In
case of danger signs, hospital sewage should be pre-treated to make it safe and to conform
to the general standards notified under the Environment Protection Act as applicable for
discharging into the municipal system having terminal treatment plant. Rural hospitals may
not have the benefit of municipal sewage lines in which case they will need septic tanks and
soakage pits. These require a large area and are messy to maintain. Greater attention will be
needed in this case. Hospital effluents which are discharged into sewers without terminal
sewage treatment facilities or are not connected to public sewers should conform to the
following norms:
1I
PH
6.5 to 9.0
BOD
Suspended solids1 100 mg / litre / / C O D
I0 lng / litre
1 30 rng / litre
( 250 rng/ litre
I
I
This may necessitate sewage treatment by the hospital itself to comply with the regi~lations.
I
Travel
NO. of storeys
2 or 3
.I
0.25
Medium Travel l i f t
4 or 5
0 50
6 and over
1.00
--
Passengei lifts should be easily accessible and preferably located near staircases. Hospital
lifts should be placed near the wards and operation theatre department entrances.
1
1
Lilts should have power supply frolii mains and froill stand-by generating sets. The normal
practice is that, in case of fire, only one lift is to be in operation for use exclusively by fire
personnel and all other occupants have to use staircases. This would not be acceptable in
case of hospitals and therefore suitable understanding will have to be arrived at with the fire
authorities. Controls, alarm push buttons and telephones in lifts should be so placed as to
be withi" reach of wheelchair patients. Alarm system and emergency light are battery
operated. All lifts, except the goods lifts, should be equipped with a special two-way switch
to be used by the hospital staff to by-pass all landing buttons and travel directly to any
desired floor. To prevent the lift doors from closing automatically even as a passenger is
entering or exiting, an infra-red sensing device is fitted which keeps the door open. The lift
should never move unless the doors are properly closed. Many accidents can take place due
to unexpected movement of the lift with the doors open. Doors should never be forced open.
The general practice is to have a lift attendant operating the lift during hospital working
hours and then to put the lift on manual operation during the night.
Lifts should be subjected to load tests and a thorough inspection, and certified to be in
conformity with safety regulations and codes before it is taken into service. Thereafter they
should be maintained at the highest degree of perfection and got inspected at regular
intervals.
Dumbwaiters are small box type elevators used for transporting stores from one floor to
another. Separate dumbwaiters should be eannarked for verticalmovenient of sterile items
and non-sterile items. These are electrically operated with the machinery suspended from the
roof and have a travel speed of about 0.25 metre per second. Load carrying capacity is about
250 kg. The car size could be I000 mm x 1000 mm x 1200 mm. "In Use" and "Car Here"
indication lights are provided at all floors.
Today an). hospital needs a formidable co~iilnunicationnetwork with more and more users
sharing peripherals. This is essential to accomplish critical and complicated tasks for which
faster access to information of a varied type is another requirement. It is therefore necessary
that communication cabling be capable of supporting and sustaining a variety of
Basic E n g i n e e r i n g Ser'ices
Unshielded twisted pair (UTP), which is a 4-pair, 24 gauge, 100 ohm copper cable. This
resembles the telephone cable, but its performance is enhanced.
Shielded twisted pair (STP), which is a 2-pair 22 gauge, 150'ohm copper cable.
Shielding gives the capability to perform well.
Single-mode and multi-mode optical fibre cable, which is a thin glass transparent strand
of material for transmission of modulated light to carry signals. The cable is flex~bleand
consists of three distinct regions - a core, a cladding and a sheath. This gives a very
high performance structured cabling system and a single pair of fibre cable can handle
the same amount of voice traffic as 1400 pairs of copper structured cabling emanates
from the telecommunication centre and extends to each outlet location passing through
walls, floors and ceilings on the way. Any number of outlet points can be provided and
only the necessary ones used at any time. This is very much similar to socket outlet
points in internal electric supply wiring.
--
~ o d e r nhospitals are concerned with global telemedicine applications. Simply stated, this is
a means of providing the highest class of medical services to remote locations worldwide
through highly sophisticated telecommunications technology. Physicians at leading
hospitals all over the world can deliver a range of most modern medical specialities to
virtually every city in the world. Teleniedicine holds the chance of revolutionising the
provision of health care services by assuring medical access to remote locations and by
enhancing medical dialogue. The telemedicine workstation provides a desktop system
interactive or asynchronous multi-site multimedia (audio, video and data) medical information
trans~nissionwith particular attention to clinics, hospitals and remote medical facilities. This
system can conduct and manage remote consultations. Some of the capabilities are:
a
The structured cabling system can fully integrate all wiring Systems that are concerned with
information traffic, voice, data videos, building controls and security systems. This is a
stepping stone to intelligent buildings.
Switch on or off lights, start or stop fans and air-conditioners depending on the
.presence or absence of the user.
Balance artificial lighting level withnatural light infiltrating into a space to provide the
desired illumination level.
Operate and monitor security systems like closed circuit cameras and activate motion
detection systeni only at night.
Number of lights and fans in one electrical circuit should not exceed: ..............................
2)
'"sdita~
Engineering Services
3)
- ..
-
,
,
. .....................................................................................................................................
Upto 100
0.4 1 5
6.6 or l 1
II
22
33
One side
Two sides
Three sides
Four sides
0.50m
0.75 m
1.00in
1.35m
Good ventilation enables the transformer to dissipate heat and thereby perform better.
Substation is the electric power receipt and dispersal point which keeps the hospital ticking
at all times. Hospitals need a distribution sub-station for stepping down the supply voltage.
to the level of 415 V and for distributing the power to the various departments of the
hospital. Electric sub-station should be a protected place.
This sub-station generally houses the incoming and outgoing HT switch gear, incoming and
outgoing LT panels and the stand-by generating sets. Hospital power consuming
equipment degrade the power sector substantially leading to power problems and higher
energy bills. Therefore power factor improvement with a bank of capacitors is also carried out
in the sub-station. lmprovement to 0.95 pf level is ideal.
Sub-stations can be of the totally outdoor type, or be of the totally indoor type. Even partial
indoor-outdoor design is possible. Totally outdoor sub-station is adopted for voltages
higher than 33 kV. While transformers can be of outdoor type, it would be desirable to house
their controlling and metering switchgears properly in a building where they can perform
better under shaded and dust protected conditions. Excellent lighting and ventilation
should be provided in the sub-station with adequate space for the operators to work and
keep the maintenance items safely. It is always wise to have extra space for future
expansion.
Hospital sub-stations distribute considerable amount of electric power and for this purpose
distribution cables or solid bus bars are used. Electric cables are the common choice because
they are relatively easy to lay and are cheap. But their numbers multiply with increasing
loads and management becomes problematic. Moreover, having a good content of PVC
material, the fire hazard potential also increases which is undesirable in case of hospitals.
A siHgle bus bar trunking system can convey any amount of power without enhancing the
fire rise. This system is costly to install and consists of aluminium strips which are the
conductors placed inside a metal enclosure. Insulating separators ensure that the strips are
spaced correctly. The enclosure can be made dust and waterproof.
Fire-alarmcontrol panel
Fire lift
Security lighting
Obstruction lights
Lighting in common areas such as lift lobbies, stair-cases, entrance hall, common toilets,
corridors etc.
Stand-by sets are generally installed in the sub-station so that power distribution can be
done easily. These sets can be made to start automatically by using an automatic rnains
failure (AMF) panel. With the provision o f AMF panel, the set will come on load within a
few seconds o f mains supply interruption. Two or more sets are installed to collectikely take
care o f the load and also meet the eventuality of one set failing to start. They need fuel
supply for which a fuel tank o f adequate capacity will have to be installed. Diesel en', "rlles
make considerable noise and emit pollutants in the exhaust. Effective silencing and e~n~ssiorl
control measures will have to be adopted. The generating sets should have ample 5pace all
around and more roof height to pernlit installation o f exhaust piping and to reduce the noise
Basic Engi~leeringServices
Moreover, good ventilation is necessary to dissipate the heat from the engines. A few
details of the larger capacity sets are as follows:
Diesel Engine Generating Sets
Capacity, kVA Current. A
(kw)
Engine
HP
Approx. fuel
consumption
litreslhr
Size,
L x W x H mm
Weight
kg
500 (400)
695
614
108
4510x 1460x2400
6200
600 (480)
834
700
129
4510x 1460x2400
6300
750 (600)
1042
890
154
8800
I000 (800)
1390
1180
203
11500
1250 (1000)
1737
1470
225
1244
Generating sets need permission and approval from SEB for installation and use. After
installation, the Electrical Inspector will inspect the installation and check the kwh meter
which will then be sealed. Certificate will be issued by him and the hospital will be charged
for the units of power generated by themselves.
~e
~ e c a u s of
e frequent interruptions in power supply, many homes have gone in for an
"inverter". You can easily make out that this is actually a "off-line UPS" apparatus, but of
small capacity sufficient to power a tube light or two with one or two fans. Sometimes it is
referred to as an "electronic generator". This can be conveniently used for isolated loads in
a hospital which cannot be connected to a central UPS system and therefore a few details are
given in the table below:
Load Calculation
Load
Equipment
Capacity
Back up time at
60% load
'Battery
Tube light
50 to 60 V A
300
1 2 V / 120AH
4 hrs
Fan
60 to 90 VA
500
12 V 190 AH
Lamp
Watt rating
500
24 V / 120 AH
6 hrs
TV
60 to 80 V A
750
24 V / 180 A H
6 Iirs
Computer
500 VA
1000
24V/180AH
Telex
150 to 250 VA
1000
4 8 V / 180AH
8 hrs
Fax
50 to l 0 0 V A
2000
4 8 V / 180AH
4 hrs
Desert cooler
300 to 500 V A
5000
48 V / 180 A H
I hr
hrs
4 hrs
1.3.9 Earthing
You would have noticed that some plugs used at home have-three pins. The top pin is for
connecting to the earth wire. This is to protect persons from receiving a shock from the
body of the apparatus being used. Equipment earthing is the connection of non-current
carrying metallic parts of the equipment with the Inass of the earth using a metallic conductor
of negligible resistance. f h i s path will ensure an immediate discharge of energy to earth
without causing harm or posing a danger to persons at any time. The parts which are not
supposed to carry any current under normal working conditions could be the body o f a
motor, switch, metal enclosure. conduits used in wiring, steel structures, electric poles.
portable equipment such as electric iron, grinders, mixes and so on. It would be better if
~ n d i c a equipment
l
such as X-ray machines, MRI and so on are provided with earthing by the
suppliers themselves. Provision of double earthing enhances safety. Earthing is a requirement as per Indian Electricity Rules, 1956, and have to be tested at specific intervals and
resu Its recorded.
Earthing of electric supply systenl should be totally independent of and separate fro111the
earthing of lightning protection system.
2)
3)
State the necessity for dividing the hospital eleciric loads into essential and nonessential categories.
......................................................................................................................................
4)
hardness not exceeding 200 ppm. Salts commonly found in natural water and their effects are
given belo&
lngredien t
SI.No.
I I
--
Sodium bicarbonate,
I
1
1
I
1
1
1
4
5
Magnesiumchloride, MgCI,
II
Potassium salts
I
1
Calcium sulphate (Gypsum), CaSO, Causes permanent hardness. corrosion of iron and steel.
I
I
SiIica,SiO,
~ oharmfi~~.
t
Nitrites
12
113
1 1
14
Nitrates
Ammonia freeand saline
~ a n n ~ ebut
s s make origin of water ruspiciuus.
Presence indicates serious pollution.
1
-
~ i ~ ~ or
i l l Good
~ d for boiler
neutral water feed water
Strong
acid
-ore
-4
hydrogen ions-b
~orrosivkwater
-4
Strong
alkali
In water treatment, acidic water (pH value less than 7) will not permit alum to form "floc" and
sodium carbonate may have to be added to increase the pH value to 7 or more. Boiler feed
water should be neutralised if acidic and be made alkaline with a pH value between 8 and 9.
The pH value of water decreases as water temperature increases. Water for human
consumption should have a pH value between 7.0 and 8.5, and is not fit for human use if pH
value is less than 6.5 or more than 9.2.
An abridged tabulation is given below. Figures under column "acceptable" are limits up to
which water is generally acceptable to consumers. Figures under column "cause for
rejectionmarelimits beyond which water has to be rejected. Figures in excess o f those under
column "acceptable" render the water not acceptable. but still may be tolerated in the
absence o f alternative and better sources but upto the limits indicated under column "cause
for rejection".
Amptable
Unobjectionable
Unohjec~ionahle
7.0 to 8.5
500
l500
200
600
200
100
200
400
1.O
1.5
45
45
75
200
30 or less
I50
0.1
1.O
0.05
0.5
C ~ P F( ~
m g ) (as Cu)
0.05
l.S
5.0
15.0
0.01
0.3
0.05
0.05
0.0 1
0.01
0.05
0.05
0.05
0.05
(mgn)(as Pb)
0.1
0.1
0.0 1
0.0 1
0.00 1
0.00 1
PH
Mineral oil ( m g )
TOXIC MATERIALS
Chromium ( m g )
'
..
b)
ii)
iii)
iv)
v)
Ammonia (albuminoid)-ppm
vi)
vii) Nitratesppm
viii) Chlorine as chloridesppm
k)
x)
mi
c)
d)
Finally a statement that the water is or is not fit for drinking without further treatment.
If treatment is required, it would help if the nature and type of treatment required is
indicated.
ii)
iii)
450
Hostels
c)
d)
Day SchoolslCollge
.Vote:
'
'
M r Ervin pulsep, an eminent cspert on hospitals, in his book titled ..Modern tlospitals.. has
stated that the general estiiiiate ol'\cater supply requirement is about 400 to 650 litres per bed
per day which is a significant increase from the age old scale of 300 litres per day.
Basic E n g i n e e r i n g Scrvircs
The provisioti shown above for hospitals does not include tlie water requirement for
attendants, relatives and casual visitors o f tlie patients, and a suitable allowance has to be
made to tliis inescapable necessity based on the social and climatic conditions.
Air-conditioning plant is another huge consumer o f water. Once the plant capacity is
assessed on reasonably accurate data and working hours are known, water requirement can
be estimated. A provision o f 200 litres per day per ton o f plant capacity should suffice for
this purpose. Stand-by generating sets and some bio-medical equipments also need water
for cooling purposes, but their requirements are not likely to be large.
Water for horticulture, arboriculture and beauty spots like fountains is another unavoidable
necessity, but the requirement has to be anticipated on case to case basis. Need o f water for
lawns will be considerable.
Other water allowances pertain to evaporation and leakage losses, fire fighting practice drills
and the like. An enhancement o f 3% to 5% should be adequate for these purposes.
Accurate assessnient o f water requirement for a hospital is a difficult task, but should be
done with utmost care to ensure that the hospital does not suffer from inadequacy o f water
and tlie projected requirement is not outside the capacity o f the supplying agency.
External water supply distribution system is likely to be limited in a hospital unless tlie
hospital has teaching and training facilities, hostels and residential accommodation. Pumps
draw water fro111the storage sumps and pump it through delivery or rising main into elevated
storage reservoirs or service tanks on top o f the buildings. The distribution then takes place
by gravity.
Mostly cast iron (CI) or galvanised iron (GI) pipes are used in external water supply as they
are strong and are able to sustain pumping pressure as well as any vehicular load combing
over them. While laying, it is best to keep these pipes away from sewer mains and places o f
l.
line should be well above any sewer line at
contamination which could prove h a r ~ n f i ~Water
least by a metre at the crossing point. It would be prudent to avoid a water pipe joint at this
crossing point. Anchorage o f pipes at bends is essential to prevent the joints from opening
up. A proper up-to-date record should be kept of all the pipe routes to assist in easy
location for maintenance and repair purposes.
Check Your Progress 3
I)
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3)
Witliout looking at tlie pH value chart, state whether a pH value o f 8 indicates that
water is acidic or alka'line.
3)
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4)
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Hospital kitchen and laundry need supply of steam. Even the Central Sterilisation and
Supply Department (CSSD) needs steam for sterilisation purposes. ,
Engineering Services
H+tal
Esgiaecring Services
Centralised medical gas supply and pipeline distribution system has proven merits as an
effective tool towards better patient care in hospitals. The system as a whole is efficient,
economical and a highly dependable life support service that conveys oxygen. nitrous oxide,
compressed air and vacuum facility to patient spots in wards and operation theatres. The
service provided by the system is uninterrupted and uncontaminated with reliability doubly
assured by the use of safety and alarm devices.
1.6.1
Benefits to Patients
Supply is uninterrupted,
uncontaminated md reliable
Supply is aseptic and safe
- no apprehensions
Benefits to Administration
Rationalization ot'ordering.
storing and transporting prc~edurt:
No irksome i~oisrsfinm
movclnent oCcylindets nearby
Implementation of centralised system depends mainly on the size of the hospital and may
not be viable if bed strength is below 50 unless it is a super-speciality hospital.
contents o#the "reserve" bank will automatically commence feeding the pipeline. Visual
warning signals are also activated to indicate that one cylinder bank is empty. As soon as
bank of cylinders becomes empty, it should be replaced with a set o f fully-filled cylinders.
Normally a change-over two or three times a week is acceptable. More frequent replacement
may indicate the need for a bigger inmifold or leakage o f gas. First stage high pressure, high
flow regulator connects to a common second stage regulator controlling the line pressure to
4.22 kgsq cm (about 61 lWsq in). A l l manifold units are sealed by authorized personnel.
Nitrous oxide control panel incorporates a heating system to avoid freezing or condensation
ofthe liquefied gas. Drop in pressure o f nitrous oxide is extremely rapid as the cylinders near
exhaustion level. A 64-oxygen cylinders and 8-n'itrous oxide cylinders installation requires a
manifold room o f about 12 m x 5 m size. The room should have excellent ventilation and
.
lighting, and should never be usdd to house the compressed air or vacuum unit. Empty
cylinders and cylinders which a q filled (full) should be stored separately in places earmarked
for this purpose and should never be mixed up.
'
used to l u n the ventilators and operate dental and orthopaedic drills and other pneumatic
tools. Air must be both o i l free and clean. Compressed air unit consists o f an electrically
driven air compressor possessing an after-cooler, air drier, air receiver (storage vessel which
could be 3 metres in height) and other adjuncts for delivering the highest quality medical air.
The unit is duplicated for reliability of service. Water is required for cooling the compressor
in a high capacity unit. A 15-hp compressor o f a 500-bedded hospital may require 40 to 50
litres ofwater per minute and a cooling tower to cool this water. A i r pressure could be about
7 to 8.33 kg/sq cm (about 100 to 1 18 Ib/sq in) at the compressor and this is reduced to about
4.1 to 4.33 kgtsq cm (58 to 61 Ib/sq in) for use at the patient's end. The permissible pressure
drop is about 0.35 kglsq cm (5 Ibkq in). The compressor unit starts and stops automatically
to maintain the pressure in the air vessel.
Vwuumunit: Vacuum is extensively used in most patient treatment areas, OTs and surgeries
and in laboratories. I n the surgical. recovery and intensive care areas, i t serves to remove
fluids h m incisions and bpdy cavities and is used in post-operative drainage. Its use in
laboratories is for filtering,cleaning delicate apparatus and transporting fluids from one
container to other. The vacuum unit consists of an electrically-driven vacuum pump to create
a pressure much lower than atmospheric air pressure i n a reservoir tank which could be 3
metres in height. This vacuum creates a "suction" effect at the patient's end. The unit
operates automatically starting or stopping as required by means o f a negative pressure
switch and the vacuum pump can create quite a high vacuunl. The unlt is duplicated to
ensure reliability o f service. The reservoir tank stabilizes the vacuum pressure in the pipeline
system somewhere between 305 mm to 635 mm o f mercury at all outlet points. Care should be
taken to ensure that vacuum (or suction) unit i s not used in case o f flammable anaesthetic
agents (for scavenging and such-like purposes) which are soluble in vacuum pump oils. This
is especially the case with OTs and surgery areas. Vacuum system is susceptible to misuse
and abuse as it i s temptingly convenient to get rid of pollutants etc. Therefore, this system
should preferably be over-sized to ensure reliability. Vacuum pump room should be clean,
especially the floor which should not have even oil stains.
1.6.4
Distribution System
The distribution system consists o f pipelines. pipeline fittings and valves. Cleaned and
degreased, non-arsenical, deoxidized, seamless solid drawn, half hard copper pipe o f
appropriate grade and standard are used in the delivery systenl. The pipelines ace
surface-mounted on walls at a height not less than 2.13 metres (7 ft.) or underside o f roof
slabs for ease o f inspection and defect detection. and extend to various tloors and wings o f
the hospital. Where they cross over to other floors, they should be covered by metal or
plastic sleeves for protection. A l l piping (except maybe control line piping) should be
identified by painting, tagging or by painted sign-boards. It is best to lay the pipeline away
from all electric cables and wires, and avoid long vertical runs. Jointing is done with extreme
care using fluxless silver brazing to obtain a leak-proof condition. Branch lines are generally
provided with stop valves to enable them to be isolated from the main system for repairs. A l l
valves should carry identification tags and a valve schedule should be prepared for ready
information of all concerned and for permanent record purposes. After erection, the pipelines
are purged and tested for pressure drop at a high pressure o f one and a half times the normal
Hospital
Engineering Services
line pressure, i.e. 6 kglsq cm using an inert clean gas. The sizes o f the pipes used range from
I 0 mm to 76.1 mm outer diameter. A l l pipes are to be colour coded by painting as given
below:
Medical Gas Pipeline CDlour Code
Medical gas
Ground colour
Air
Sky blue
White
Oxygen
Canary yellow
White
Nitrous oxide
Canary yellow
French blue
Vacuu~ii
Sky blue
Black
Canary yallow
Black
IS : 2379- 1963
It is important to note that copper pipes are reactive to cement mortar. Prior treatment will
become necessary if they are to be embedded. The supports should be o f copper or brass,
but never o f steel. The pipes can be epoxy coated. They may be taped if insulation effect is
to be obtained.
Alarm devices,are invariably introduced into the medical gases delivery system at judicious
points in different zones o f the pipeline network. These monitor pressure o f gases and
generate audio-visual alarm in case o f abnormal pressures. An abnormal situation i s
indicated when the green light goes off and red light comes on. Audio alarm is effective in
catching the attention of the maintenance man and i s mutable. Its location should however
be such as not to alarm the patients.
Equipment
Cylinders and
manifold room
-
'
If units are duplicated. operate units alternately (say, after every 300
hours). Do not tamper with the vacuum switch. Check the vacuum
levels at which the unit starts up or stops automatically. All ad.justmerits / repairs should be carried out by authorized personnel I supplier.
Never spill oil or drop grease onto the floor. If it happens. remove it
immediately. Air compressor should not be located in the vacuum
pump room. Prohibit smoking and naked lights or fire in the vacuum
pump room.
Air compressor
If units are duplicated, operate units alternatively (say. after every 300
hours). Keep inlet air filter clean. Compressor should suck in only
fresh. clean air free from pollutants and odour. Never tamper with the
air governor unit. All adjustments and repairs should be carried out by
authorized personnel /supplier. Maintain the cooling towel. in clean
condition. Ensure adequate water supply. Do not spill oil or drop
grease onto the floor. lf it happens. remove it immediately. Vacuum
pump unit should not be located in the air compressor room. Prohibit
materials that exude smell (e.g. paints, oil, grease, kerosene. petrol and
diesel, even food and eatables etc.) from being brought into this room.
Prohibit smoking and naked lights or fire in the compressor room.
Terminal units
Chech for leakages. Coordinate with all users so that they observe due
care in using this service.
Documentation
2)
a)
b)
Vacuum system.....................................................................................................................
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10
2) a)
Poor efficiency
b) Short life
c) Gets stolen
3)
Having a small pump at ground level to return the water in the down-take pipe to the
storage tank and thereby keep up hot water circulation.
3)
Essential load is supplied with electricity generated by the stand-by generating set and
by segregating it from the total load the generating set capacity is reduced with savings
in expenses. Non-essential load is connected only to the mains supply.
b)
4)
Basic
Services