CLINICAL AND NON CLINICAL

DEPARTMENT

PRESENTED BY :
Shweta Saini
Subhomita Dutta
PEDIATRIC UNIT

PRESENTED BY :
Shweta Saini
Subhomita Dutta
Definition :

◦ The word pediatrics revolve around the care of neonates and children up to adolescence.

◦ The word, pediatrics, comes from the Greek words 'paedia' (child) and 'iatrike' (physician).

◦ Hospitalized children are usually segregated by care requirement or by age or by both.

◦ The unit provides supportive secure and child friendly, homely and cheerful environment for
comprehensive care for child and family

◦ Needs of hospitalized children are: adequate care, protection from physical danger and psychologically
threatening environment.

◦ Pediatric unit provides specialised care with a wide range of conditions for children from birth to 16.
 OVERVIEW OF Pediatric Nursing Care Areas :

◦ Emergency services (ETAT Area )

◦ Pediatric intensive care unit

◦ Pediatric Inpatient Facility

a) High Dependency Unit

b) Pediatric Ward

c) Diarrhoea Treatment Unit

d) Isolation Room
 o Emergency triage assessment and treatment [ETAT]

• Triage is the process of rapidly examining all sick children when they first arrive in hospital in order to
place them in one of the following categories:
 those with emergency signs who require immediate emergency treatment.
 those with priority signs, indicating that they should be given priority in the queue, so that they can
rapidly be assessed and treated without delay. SERVICES LOCATION

 those who have no emergency or priority signs

and therefore are non-urgent cases.
These children should be directed to a
registration area, after which they will
proceed to the OPD. can wait their turn in the
queue for assessment and treatment.
All children attending an emergency care setting should be visually assessed immediately upon arrival and
receive an initial triage assessment within 15 minutes of arrival or registration by a competent and
appropriately trained nurse or doctor.

• All children (older than 1 month) should be directed to paediatric triage assessment and emergency area.

• Patients triaged as EMERGENCY cases should remain in the emergency care area for treatment and
stabilization.

• Following institution of emergency treatment, children should be transferred to a High Dependency

Area/Unit established as a 4-6 bedded unit (depending on space and caseload) located either in the
emergency area or pediatric ward.

• Triage should preferably have a distinct entry independent of OPD main entry so that minimum time is lost in
giving immediate attention to emergency cases arriving in the DH. There should be easy ambulance
approach. It is best located on the ground floor, with directional signage (in white text on a red background).
o The pediatric emergency should have sufficient space for Triage, Resuscitation & emergency
management, Close monitoring/ Stabilisation, Reception and waiting area.

o A cubicle with a door, ensuring audio visual privacy and confidentiality for doctors & nurses during
consultation and counselling sessions with parents-attendants

should be available within this setup.

o It is assumed that general amenities like drinking water and

washrooms are available for use by attendants and ancillary

areas like doctors’ & nurses’ duty rooms and stores etc. are in

place in the emergency area.

Source: Strenghtening_Facility_Based_Paediatric_Care-
Operational_Guidelines.pdf
 List of equipments

Source: Strenghtening_Facility_Based_Paediatric_Care-Operational_Guidelines.pdf
STAFFING FOR ETAT
◦ It is recommended that pediatric emergency be staffed with at least 1 nurse (total 4 for round the clock
services) and 1 medical officer (total 4) trained in paediatric triage &emergency treatment.

◦ In addition one pediatrician should be on call every shift to provide specialist services for seriously ill
children.

◦ Based on the review of utilisation data, staffing may be increased to 2 staff nurses during busy hours,
when the patient load is high.

◦ In addition, the gatemen and pharmacist may be provided the responsibility for “directing traffic” within
the District Hospital/ Trauma Centre.
Pediatric inpatient services –HDU
◦ Paediatric High Dependency Care (HDC) is the provision of close observation, monitoring and intervention
to children who are, or have a significant potential to be, physiologically unstable.

◦ All children with emergency signs and unstable vital signs are to be admitted to HDU.

◦ Children are shifted out once their physiological condition stabilises to the point where they can be cared for
on a general ward or their condition deteriorates and they require care on a tertiary care unit (Paediatric
Intensive Care Unit; PICU).

◦ It acts as a ‘step up’ from the wards and a ‘step down’ from our Paediatric Intensive Care Unit

◦ HDU at District Hospital is envisaged as a specially staffed and equipped four to six bedded unit that
provides patients with expert medical and nursing care and monitoring facilities.

◦ Once the patient has made sufficient recovery, s/he can be shifted to paediatric ward.
Location and size

◦ HDU can be located within or adjoining emergency area so that the patients who have been instituted
emergency treatment can be placed here under direct supervision of trained health provider till the patient is
stabilised.

◦ Second option is to establish HDU within or adjacent to the paediatric ward. It is preferable to allocate a
separate room for HDU. However if it is located within the ward, it should be partitioned off from rest of
the ward area and located close to the nursing station.

◦ HDU will require 425-500 square feet of space in order to accommodate 4 beds, equipment, hand washing
and toilet facilities.

◦ Additional space will be required for nursing station, doctors and nurses rooms and toilet if these are not
available in the adjoining ward or emergency area.
 Proposed layout List of equipments

Source: Strenghtening_Facility_Based_Paediatric_Care-Operational_Guidelines.pdf
STAFFING FOR HDU

◦ This level of clinical care requires atleast one nurse per 3-4 beds (preferable nurse: bed ratio of 1:3) in
each of the three shifts and the presence of a doctor round the clock.

◦ One medical officer should be present in the HDU in each shift. This means that atleast 4 medical
officers should be allocated to HDU in addition to Paediatric Specialists.

◦ Medical officer must take at least one clinical round of paediatric ward during his/her shift and make
more frequent assessment of cases in the HDU.
PEDIATRIC WARD
◦ The Paediatric ward provides care for children from 1 month of age up to 12 years, who meet the criteria for admission. The
ward should have provision for one parent -attendant to stay (per patient) on the ward overnight.

◦ As per the IPHS 2012, 8-10% of hospital beds (depending on the total bed strength of the DH) are to be allocated topaediatric
ward

SIZE AND DESIGN

◦ The paediatric ward should be designed with the objective of facilitating the nursing staff to observe each patient and keep a
close watch on them. In the open ward arrangement, beds can be arranged perpendicular to the wall on either side of the nursing
station or with nursing station on one end.
◦ The other arrangement is that of 4-6 or more beds in cubicles separated by low partitions with nursing
station either on one side or in the centre. This arrangement may provide privacy to patients with less risk
of transmission of infection.

◦ The size of paediatric ward will depend on the availability of space but also whether the arrangement of
beds in open ward or cubicles and positioning of nursing station. The space between 2 rows of beds is 5
feet and space between two beds 3.5-4.00 feet. Clearance of bedhead from the wall is 1 feet and 2 feet
from the opposite bed.

◦ A 4 bedded cubicle requires about 320 square feet of space and 6 bedded 400 square feet. The nursing
station requires about 20 x 20 feet with sisters’ changing room and toilet, cupboards or lockers. The
procedure room,attached or adjoining to the ward, should include an examination couch, dressing trolley,
hand washing facilities and routine equipment such as spot light, BP instrument, stethoscope, etc.
AMBIENCE

◦ Colours play an important role in creating cheerful ambience of the paediatric wards.

◦ Colourful mural on the wall with cartoons, under water themes or jungle themes creates a soothing
environment and its helps children ease their anxiety and trauma.

◦ Natural lighting has a positive impact and benefits the child in the healing process.

SANITARY ARANGEMENTS

◦ Sanitary facilities for inpatients should be located in the area outside the ward.

◦ IPHS guideline for DH, revised 2012 recommends 1 WC (water closet) for every 6 indoor beds, two
washbasins for up to 24 persons; and one bath with shower for every 6 beds.

◦ For a 24 bed unit this would mean 4 WCs, 2-3 washbasins and 4 bathrooms.

◦ The fact that these facilities will be used by children should be kept in view and designed accordingly
(eg; low toilet seats).
◦ This is in addition to the dirty utility room (where soiled linen, bedpans etc. are stored); janitor’s room
(for used mops, brooms, buckets etc.) and handwashing facilities in the ward and treatment room. Bed
pan washing sinks (1 for every 6 beds) and Cleaners sink (one for the each ward) should also be in place.

AMENITIES

◦ There should be bedside lockers and call bells with switches for all beds with indicator lights and
location indicator in the nurses duty room.

◦ Water cooler and refrigerator should be provided in the ward or at a suitable but accessible location.

◦ Seating arrangement in the ward should be made as all children are accompanied by parent-attendant.

◦ Arrangements for rooming in with children should receive attention, otherwise, parents often end up
sleeping on the patient’s bed. The ward should preferably be air-cooled with temperature maintained in
the range of 28 +/- 2 degree centigrade.
CHIRAYU MEDICAL COLLEGE
AND HOSPITAL, BHOPAL MP

ZONING
 General ward

LAYOUT Semi Private ward

LIST OF EQUIPMENTS

STAFFING

• For care of inpatients, atleast one paediatrician assisted by a medical officer and one nurse for every 4-6
functional beds should be available in the ward during routine hours.
• For example, a minimum of 4 nurses in each shift and total of 15-16 nurses are required for 24 bedded
paediatric ward.
• Class IV employees (one Ayah/one ward boy and one sanitary worker) /shift should be available to assist in
cleaning and support services
DIARRHOEA TREATMENT UNIT

◦ In a large hospital where treatment of diarrhoea cases is a major activity, the Diarrhoea Treatment Unit
(DTU) should be assigned a permanent area in the health facility, close to the paediatric ward and with the
possibility of expansion in the high season for diarrhoea.

◦ The space in DTU is arranged such that there are three areas for management of diarrhoea cases.

Reception & triage area: where cases are assessed and classified for treatment.

ORT area, where benches with side tables (or other seats like chairs or mats) are provided, with space for
movement of staff and mothers.

Diarrhoea ward, where cases with severe dehydration and cases with complications are managed as
inpatients. They receive IV or nasogastric fluid initially and ORS is started as soon as appropriate. The
mother/parent can stay next to the patient’s bed.
STAFFING OF DTU

◦ A staff (such as ANM, nurse) who is trained in preparation of ORS solution and Zinc administration,
should be posted to manage the ORT area. The management of children in the ward should be supervised
by the doctor; one nurse should be available in each shift to administer the treatment, and provide
supportive care.

LIST OF EQUIPMENTS IN DTU

ISOLATION ROOMS

◦ An isolation room is a specially constructed area in a hospital designed for housing patients in order to
prevent patients with an infectious disease (eg; meningococcemia, rabies, H1N1 infection) from infecting
others (source isolation)and/or prevent susceptible patients from being infected (protective isolation).

GENERAL PRINCIPLES TO BE APPLIED FOR ISOLATION UNIT

◦ 1. The door of the room or cubicle should be kept closed at all times. An extraction fan may be fitted. Any
unnecessary furniture should be removed; room may be equipped with special items needed to nurse the
patient eg. pedal bins, plastic bags etc.

◦ 2. Hand washing before and after contact with the patient is the most important measure in preventing the
spread of infection. Either a non-medicated soap or a detergent antiseptic preparation should be adequate
for most purposes. 70% alcohol is more effective in removing transient as well as residual flora and
should be used in high risk situations.
◦ 3. Disposable or autoclavable equipment should be used whenever possible. Essential items of patient care
such as stethoscopes should be left in the room and disinfected when the patient is discharged or before
being used on another patient. Thermometers should be kept in the isolation room until the patient is
discharged.

◦ 4. Hard surfaces may be disinfected by wiping with a phenolic or hypochlorite solution. Other equipment
may be disinfected by wiping with 70% alcohol.

◦ 5. All clinical waste should be disposed of in a colour-coded bag for incineration.

◦ 6. Patients should be sent to other departments only if it is essential to do so. The department should be
notified in advance so that they may take suitable measures to prevent the spread of infection.

◦ 7. Personal protective gear: Although disposable aprons are preferable, non-disposable plastic aprons may
be used and should be disinfected by heat or alcohol. Gloves should be worn when handling infected
material and sites.
◦ 8. Masks if used they should be of the high efficiency filter type, which should provide protection for 10-
15 minutes.

◦ 9. Linen from infected patients should be placed in a colour-coded linen bag for transfer to the laundry.
Linen which may present a hazard to the laundry staff eg. hepatitis B, should first be sealed in labelled
bag.

◦ 10. When sending laboratory specimens, some warning should be given to the laboratory staff. Containers
should be placed in a biohazard bag.

◦ 11. Patient’s charts/records/case sheets should be kept outside the contaminated areas.
PEDIATRIC INTENSIVE CARE UNIT

◦ The PICU is the section of the hospital that provides sick children with the highest level of medical care.
In the PICU, kids get intensive nursing care and close monitoring of things like heart rate, breathing, and
blood pressure.

◦ No traffic to other departments should pass through the unit.

◦ The unit should be located near lift with easy access to emergency department and operation theatre,
laboratory and radiology department.

◦ The doctor duty room as well as intensivist duty room/office should be close to PICU with intercom
facility. Other facilities nearby should include a staff area with locker cabinets, a family waiting area to
provide for at least one (preferably two) person per admitted patient with bathroom, shower and telephone
facility, as feasible.
SIZE OF PICU

◦ The ideal PICU size can not be stated but six to ten beds is desirable.

◦ PICUs with less than 4 beds risk inefficiency and PICUs with greater than 16 beds may be difficult to
manage, if not properly divided.

ROOM LAYOUT AND BED AREA

◦ Room layout should allow actual visualization of all patients from central station.

◦ PICU cubicles should have sliding glass doors to allow full visibility.

◦ Patient area in open PICU should be 150 to 200 sq ft. In a cubicle, the minimum area should be 200 to 250

square feet with at least one wash basin for two beds. However, one for each bed is preferred .

◦ At least one, preferably two rooms should have an isolation capability with an area of 250 square feet with
an ante room (separate area at least 20 square feet for hand washing and wearing mask and gown)
 CHIRAYU MEDICAL COLLEGE
AND HOSPITAL, BHOPAL MP

ZONING
LAYOUT
and separate ventilation. The area around the bed should allow enough space for performing routine ICU
procedures such as central lines, chest tube placement, as well as for easy access for portable X-ray machine,
portable ultrasound, electrocardiograph and portable electroencephalograph machine.

◦ An easy access to head end of the patient for emergency airway management is a must on all beds.

◦ Wall and ceilings should be constructed of materials with high sound absorption capabilities.

◦ Wall oxygen outlets (two), air outlet (one), two suction outlets, and at least ten electrical outlets per bed
are recommended for various equipments.

◦ In rooms, windows are important to prevent a sense of isolation. Adequate lighting, child friendly wall
papering or paintings with soothing colors and curtains are desirable.
POWER SUPPLY AND TEMOPERATURE CONTROL

◦ Unit should preferably be centrally air conditioned and should have central heating for temperature
control.

◦ In case of lack of central heating system, over head warmers should be available.

◦ Unit should have an uninterrupted power supply by means of backup power sources such as invertors and
generators in accordance with load of various equipments.

BEDS

◦ Beds should have ability to manouver head end and foot end as well as availability of two or more
air/water mattresses to prevent bed sores. All beds must have a railing to prevent accidental fall of the
child.
Each bed should have an emergency alarm button to activate code system(3) in case of cardiac arrest or
other emergencies so that additional help can be immediately mobilized. An intercom at each bed is
desirable. A cart at the bedside is important to hold personal belongings and required patient items.

CRASH CART

A crash cart with emergency drugs and portable monitor/defibrillator should be readily accessible. Zones
should be provided for medication preparation and cabinets should be available for the storage of
medications and supplies.

CENTRAL STATION
◦ A central station should provide visibility to all patient areas.
◦ It should have ample area to have capacity for all necessary staff functions. Patient records should be
easily available.
◦ Adequate space for computer, printers and central monitor is essential.

◦ Ample space for doctors to write on patient files and space for unit secretarial staff is essential.
At least two telephone lines should be available.

◦ A cordless telephone instrument is desirable. If possible, a telephone line dedicated to incom-ing

calls only to facilitate critical care trans-port requests is desirable.

XRAY VIEWING AREA

◦ A distinctive area in PICU should be chosen for viewing and storage of patient X-ray. An illuminated

viewing box should allow viewing of several films.

STORAGE
◦ Storage for vital supplies should be located within or closely adjoining to PICU.
◦ A refri-gerator is essential for some pharmaceuticals. An area must be provided for storage of large patient
care equipment items not in active use. An area must be provided for stretchers and wheel chairs

CLEAN AND DIRTY UTILITY ROOM

◦ Clean and dirty utility rooms must be separate.
◦ The clean utility room should be used for the storage of clean linen. Dirty utility room must contain a
separate sink.
◦ Covered bins must be provided for soiled linen and waste materials.
◦ An area for emptying and cleaning bed pans and urine bottles is also necessary.
 LAYOUT PICU WARD

LAYOUT OF A PICU WARD IN ESI HOSPITAL, FARIDABAD

NURSNG STATION
NON CLINICAL – LAUNDRY UNIT

PRESENTED BY :
Shweta Saini
Subhomita Dutta
Definition :

◦ Laundry services constitute one of the most important supportive services in hospital.

◦ Globalisation, privatisation, need for quality assurance and healthcare institutions, increase in
knowledge, expectations, needs, demands and requirements of clientele and staff are some of the factors
which make laundry services of utmost importance in healthcare institutions.

◦ Depending on the policy of the hospital, processing for the cleaning of linen may be undertaken in-house
or it may be outsourced.

◦ The word laundry has been derived from the word launderer or laundress meaning washer man or
Washerwoman. The activities, services pertaining to the washing or cleaning of line and come under the
ambit of laundry services.
OBJECTIVE
The main objective of a laundry service is to provide an adequate quantity of the ride quality linen for the
indoor patients, OT is, OPD in other areas, and for the medical and paramedical personnel engaged in
providing healthcare.
IMPORTANCE
◦ It provide psychological satisfaction to the patient and improve the aesthetics.

◦ An efficient laundry service reflects a positive image of the hospital and is an important public relations
variable.

◦ It reduces the incidence of hospital associated infection by preventing infected laundry from becoming a
source of infection.

◦ It facilitates provision of quality healthcare services.

FUNCTIONS
◦ Collection and receipt of soiled and infected linen.

◦ Sorting, servicing, disinfecting, washing and ironing of the linen.

◦ Repair of damaged linen.

◦ Assembling and packing specialty items and linen packs for sterilisation.

◦ Distribution of linen to the user departments.

KEY PLANNING AND DESIGN PARAMETERS
LOCATION

◦ The location of a laundry should be convenient to the user units and close to the service elevator.

◦ Depending on the type of healthcare building, it may be located in the basement with proper drainage
system.

◦ If possible, it should be in close proximity to the CCSD and dietary services due to the common
requirement of steam and the boiler plant by these services.
PHYSICAL LAYOUT

◦ A mechanised laundry service is not only convenient but also safe and dependable as compare to the other methods.

◦ The design of the laundry should facilitate the following laundering processes:

-Reception of soiled laundry.

-Sorting.Servicing.Sluicing.

-Washing.

-Hydro extraction.

-Drying.

-Calendaring and pressing.

-Packing, storage and distribution of clean laundry.

◦ A separate room should be provided for receiving and holding soiled linen until it is ready for pick up or processing.

◦ As a planning guide, the quantity of Lenin should be cleaned may be taken as 4 KG per bed per day with 10 to 20% being infected linen. In
addition 8 KG of soiled linen for each surgical operation and delivery should be taken into consideration.

◦ There should be a barrier separating the soil in on an infected linen. The infected linen should be separately handled and washed. Infected linen
may be sent for servicing and disinfectant before being loaded into regular washer extractor machines.
◦ There should be a physical separation between the clean and soiled areas.
◦ Laundry should generally be separate entry and exit.
◦ The ceiling height should be approximately 4.5 m to facilitate the installation and repair of equipment.
◦ The floor should be smooth, washable, non-slippery and water impervious. The walls should have a smooth and
washable surface. They should not have any dust collecting projections. The door should be wide enough minimum
1500 MM to admit heavy machinery and Trolleys.
◦ The room should have effective ventilation. The recommended air changes are eight per hour the boiler room should
be appropriately located and there should be separate exhaust pipes, for letting off steam. The recommended water
supplies 15 L of hot water and 10 L of cold water for every kilogram of linen.
◦ Utilisation of solar thermal system in place is having good sunlight is recommended. If the water being utilised is
excessively hard a water Softening plant should be installed. Provision must be made for fire safety including the
installation of fire extinguishers.
◦ Trolley storage areas with separate storage of clean and soiled linen trolleys should be provided.
◦ The equipment installed should be able to process at least seven days supply within the regular scheduled work week.
◦ Appropriate placement and space should be available for the equipment in the laundry such as washing machines, hydro extractors,
drying tumblers, calendaring machines, steam presses, dry cleaning machines, boilers and ironing tables.
◦ The arrangement of equipment should permit and Orderly workflow with a minimum of cross traffic that might mix clean and soiled
operations.
◦ The following facilities should also be planned and designed for:

-Saving room
-Laundry managers office
-Toilet facilities, resting room and shower facilities for workers.
The drains specially in the sorting and washing area should have sediment and land trees. Laundry should be planned and designed for
the present with adequate capacity for future expansion
THANK YOU