Prasad Black Book.docx

MULTISPECIALITY HOSPITAL

REPORT

SUBMITTED BY PRASAD ANIL POWAR

UNDER GUIDENCE OF AR. VIJAY.B .SAMBREKAR

SHRI VASANTRAO BANDUJI PATIL TRUST’S APPASAHEB BIRNALE COLLEGE OF ARCHITECTURE SOUTH SHIVAJI NAGAR, SANGLI-416416z

CERTIFICATE This is to certify that

MR. PRASAD ANIL POWAR Has submitted a dissertation project in academic year 2016-2017 To “Appasaheb College Of Architecture, Sangli” Affiliated to Shivaji University, Kolhapur In partial requirement of degree of

BACHELOR OF ARCHITECTURE Title of project

MULTISPECIALITY HOSPITAL

AR. VIJAY SAMBERKAR

AR. VIJAY SAMBERKAR

INTERNAL GUIDE

PRINCIPAL

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ACKNOWLEDGEMENT

It has given me immmense pleasure to thanks all people contributing the completion of the architectural thesis on ‘MULTISPECIALITY HOSPITAL, under the great help and guidance by AR. VIJAY SAMBERKAR.

I express my gratitude to Ar. Vijay Sambrekar, principal of Appasaheb Birnale College of Architecture, Sangli for his encouragement and guidance. I specially thank AR.VIJAY SAMBREKAR, renowned architect for his great help. The credit for this work also goes to my friends and many others who directly or indirectly have been of great help in this work.

Mr. Prasad Anil Powar Final year 2016-2017

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INDEX

1. Introduction 2. Live Case Study-1 (Bharati Hospital,Sangli) 3. Live Case Study-1 (Niramaya hospital,Ichalkaranji) 4. Net Case Study-1 (Apollo Hospital,Delhi) 5. Net Case Study-1 (Delta Hospital,Canada) 6. Data Collection 7. Physical Requirements 8. Site Identification 9. Bibliography 10. Design Solutions

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INTRODUCTION: A hospital is a health care institution providing patient treatment with specialised staff and equipment. Hospitals are usually funded by the public sector, by health organisations (for profit or non-profit), health insurance companies, or charities, including direct charitable donations. Historically, hospitals were often founded and funded by religious orders or charitable individuals and leaders. Today, hospitals are largely staffed by professional physicians, surgeons, and nurses, whereas in the past, this work was usually performed by the founding religious orders or by volunteers. However, there are various Catholic religious orders, such as the Alexians and the Bon Secours Sisters, which still focus on hospital ministry today, as well as several Christian denominations, including the Methodists and Lutherans, which run hospitals. In accord with the original meaning of the word, hospitals were originally "places of hospitality".

ABSTRACT 

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Architects who are concerned in the planning of new buildings should find somethings of value here that link in the chain or medical building evolution and contribution in some measure to the growing efficiencies of medical facilities. They should be able to create and environment that is comfortable for both staff and patients,should make more positive contributions to successful treatment of human maladies. Man has been in search of knowledge for improvised standard of living and comfort.This means he must improvise physical conditions and environment around him.Thus hospitals are a link between the pure science of medicals and applications of its to the masses. It is in this context of social necessity of well designed hospitals that topic has been chosen foe the proposed thesis and to understand the complexities of hospitals design.

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AIM:   

To study the planning and orgnisation of health center. To suggest location,Infrastructure,Layout of various departments and services in a healthcare center, To study the potential of a therapeutic environment.

OBJECTIVES:  Physicians have viewed body and mind as separate and distinct components.However and increasing number of physicians now recognize that treating the whole person,not just the diseased organ is important.  How to design a healing environment which would complement and enhance the healing effects of drugs and medical technology.  Relationship between stress and illiness and influence of positive attitudes on healing,more emphasis is being placed on design of patient care environment.

SCOPE: Scope of hospital services is a structural measure that reflects whether a hospital has the resources—facilities, staff, and equipment—to provide care for the medical conditions it professes to treat or to care for the medical conditions affecting potential patients. There are several potential sources of information on the scope of a hospital’s services, including hospital advertising, media reports about the existence of special equipment or specially trained staff, consumer guidelines for selecting medical providers, and organizations that accredit or certify hospitals.1 Identifying whether a hospital complies with external standards such as those used for accreditation or certification by an external body, however, is likely to be the most valid means of ascertaining a hospital’s scope of services.

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HOSPITAL WILL COMPRISE OF:   

      

Hospital will have better space planning,circulation,infection,control and healing environment. Better services to avoid cross contamination. By understanding patients psychological needs providing home like environment,fresh air,daulight,views will help reduce recovery time of patients. Access to healing powers of nature. Separate all departments,yet keep them close Elimination of long corridors. Segregation of public traffic-casuality,OPD.IPD,Patients,Visitors,Doctors and staff. Residential apartments for doctors and staff quarters. Hospitals with adequate facilities to cater to every minor and major health hazards. Seminar hall and exhibition center for medical exhibitions and seminars.

CONCLUSION

Thus I want to achieve psychological well-being through my design by

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Functional Zoning-taking care of sterility,segretation of work flow,unobstructed emergency routes,nurse observation,patients and staff safety.infection control etc. Innovative-Innovation has became radial but not incremental.By modern construction,faster and more efficient forms of construction,constantly adapting to the changing needs coming mainly from technological development. Impact of new technologies on future-As pharmaceuticals relace precedures,decreased need of admission.minimal invasive surgeries,robot assisted or voice assited procedures. A design that would have positive impacts on work effectiveness and stress reductions.

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METHODOLOGY

SYNOPSIS

CASE STUDY

DATA COLLECTION

LITERATURE REVIEW

INTODUCTION

LIVE CASE STUDY 1

SURVEY

JOURNALS

NEED OF PROJECT

LIVE CASE STUDY 2

INTERVIEWS

BOOKS

AIM AND OBJECTIVE

NET CASE STUDY

BYE LAWS AND DC RULES

CONFFERNCES AND SEMINARS PROCEEDING

SCOPE OF THE PROJECT

COMPARITIVE STATEMENT

ANTHRO DATA

TECHNICLAL SUPPORT

LIMITATIONS

ANALYSIS, EVELUTION AND IDENTIFICATION OF ISSUES

METHODOLOGY

CONCLUSION (DERIVATIONS)

ANY OTHER DATA AS MAY BE REQUIRED

PERIODICALS

ANY OTHERS

CONCLUSION

REFERENCES

IDENTIFICATION OF PROJECT SITE AND PROBABLE CASESTUDIES

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REFFERENCES:

1. 2. 3. 4.

Hospital Planning and design management Hospital Design Guide Healthcare Spaces-4 Building Types basics for health care facilities-Richard .L.Kobus

LIST OF PROBABLE CASE STUDIES:

Live case studies: 1. Bharati Hospital,Sangli. 2. Niramaya Hospital,Ichalkaranji

Net case studies: 1. Indraprasth Apollo Hospital,Delhi 2. Delta Hospital,Canada.

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LIVE CASE STUDY 1 -

BHARATI VIDYAPEETH HOSPITAL SANGLI . LOCATION

LOCATION- CENTER OF SANGLI –MIRAJ CITY ESTABLISHED IN-2005 BUILT UP AREA-2.5 LAKH SQ.FT CAPACITY-500 BEDED MULTISPECIALITY AND TERTIARY CARE HOSPITAL.

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SITE PLAN  

The site is accessed by single main Sangli-Miraj road. It consist of Main hospital building,central library,lecture hall,dental college,nurse hostel,boys hostel.

Main building is near the main road heance easily accessed in case of emergency

PLANNING OF MAIN BUILDING          

Medical Superintendent’s Office - Size : 36 Sq. mt. Principal/Dean’s Office in the Hospital – Size :- 75 Sq. mt. Hospital Office space – Size :- 120 Sq.mt. Nursing Superintendent’s Office – Size :- 10 Sq. mt. Waiting space for visitors - Size Total 350 Sq. mt. Enquiry/office – Size :- Included in Administrative block Reception area – Size :- 100 Sq. mt. Store rooms – No. & Size :- 5 rooms, 500 Sq. mt. Over all Central Medical Record Section- Size :- 250 Sq. mt. Linen rooms – No. & Size :- 100 Sq. mt. over all Hospital & Staff Committee Room – Size :- 80 Sq. mt.

INDOOR FACILITIES (IN EACH WARD)   

Nurses duty time table is available in each ward. With having facility of Examination & Treatment Room ,Ward Pantry. Store Room for linen & equipment Resident doctor’s duty room, Student’s duty room are very near that of the wards

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DISTRIBUTION OF BEDS

INFORMATIONIn the Bharati medical college and hospital daily average 815 patient visit the OPD, out of which approx. 560 are old patient and 680 are the newer one. An average 18317 patients get admission in to the hospital annually, and the average teaching bed occupancy is nearly 70% to 80%.

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REGISTRATION, MEDICAL RECORDS & STATISTICS DEPARTMENT They have central registration, medical record & statistic department for the in- patent and for OPD, with full man power. The record section have the updated software facility. Like, they have internal disease coding ISD 10th classification. It also provide the computerized manual and follow up service.

CENTRAL CASUALTY SERVICES Hospital provides 24 hrs emergency services. There is a separate casualty department. All facilities for resuscitation are available with all time availability of doctors, nursing, staff, and Other paramedical staff. 20 number of emergency beds are available in the casualty ward. 5 medical officers provides services in rotation order. Consultants are also available in on call services. In casualty all the resuscitation facilities like oxygen supply, ventilator, defibrillator fully equipped disaster trolley, X ray and laboratory facility. The operation theatre is available adjacent to the casualty.

EQUIPMENT: (INCLUDING ANESTHESIA EQUIPMENT) Anaesthesia department has Boyls apparatus, Pulse Oxymeters, Monitors etc. OT table Hydrolics Motorized- 9+2 = 11 Manual-2 Surgical Cauterizes-6 Suction Machine -11 Central Oxygen and Nitrous oxide supply central suction available. Infusion syringes, etc are available. All the necessary equipments required for routine and emergency surgery are available.

OPERATION THEATRE UNIT

9 major OTs are currently available in this hospital. All are air conditioned in main OT complex + 2 Causality + 1 Septic + 1 Minor O.T.

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Arrangement & Distribution: A fixed schedule of unit-wise operating days Is followed. Routine working hours 9.00 am to 5.00 p. m. & Emergency as per above table.

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FACILITIES Following facilities available in each O.T. unit            

Waiting room for patients Soiled Linen room Sterilization room Nurses duty room Surgeons & Anesthetists room For Males - 1 For Females – 1 Assistants room Observation gallery for students Store room Washing room for surgeons & Assistants Students washing up and dressing up room

ARRANGEMENT OF ANESTHESIA Pre-anesthetic car : Yes Nature of anesthesia used : All types of Anesthesia, General, Epidural, Local Regional, etc. Post-anesthetic care : Yes Pre-operative ward (no. of beds) : beds in OT complex - 5 Post-operative ward (no. of beds) : beds in OT complex - 8 Resuscitation facilities and special equipment: Available. If any super specialty exists -Plastic Surgery (Neuro.,Uro.,Lepro. & Oncology) One Major OT dedicated to super Speciality surgery

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INTENSIVE CARE AREA NO. OF BEDS SPECIALIZED EQUIPMENT’S IN EACH

I.C.U. of Burn Unit : 3 Surgical intensive care area : 8

RADIOLOGICAL FACILITIES Radio Diagnosis

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WORKLOAD PER DAY NOS. PER DAY  

Radiographics OPD- 120 & IPD – 39 Special Radiographs (for example, Barium and Dye OPD- 2, IPD – 1, Approximately studies)

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Ultrasonographs OPD – 65 & IPD- 22 Any other like mammography etc Color doppler available

CENTRAL STERLISATION SERVICES DEPARTMENT : Exclusive or with substeriliation centres als        

03 Horizontal High vaccume Double with three presents programe Glove washer Glow Drayer Two drying cabinets – 275 liters Two water disinfectrs 275 liters Two ultra sonic cleaners – 30 liters Two packing table with drawer Two work tables with shelf One distilwater still 20 liters.

(d) They have facility for sterilization of mattresses & blankets with full of man power.

CENTRAL LAUNDRY: (a) Equipment: Boiler 400 liters Washing Machine 40 kg Hydro extractor Ironing table (I ) Mechanised : Bulk washing machine, Hydro extractor, Flat & Rolley Steam Press. two Iron table (b) Volume of work/day : 150kg per day

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Blood Bank: We have fully functional and well equipped blood bank & aphaeresis unit. From 1st Oct 08-30th Sep 09 -1424 donors have donated blood (at BVUMC&H,Sangli- 855 and 569 in camps at other places).

Central Clinical Laboratory :The CCL plays a central role in patient care and management and is rightly called the backbone of a hospital . We provide prompt and quality laboratory reports that help and guide the clinicians in proper and timely management of patients. The professor and HOD of Pathology is in charge of CCL and the day to day work is looked after by one Professor and two lectures of Pathology , one lecturer and one tutor of Biochemistry and one associate professor and one lecturer of Microbiology. The CCL comprises of three main departments – Pathology, Biochemistry & Microbiology . Our CCL is participating in internal quality control programme run by CMC, Vellore and consistently showing accuracy of >90% making it one of the first 15 Labs in India

The Pathology laboratory has sections like haematology, clinical pathology & cytopathology

A} CENTRAL SAMPLE COLLECTION AREA:The central patient sample collection is situated in the CCL which is on the ground floor. All the out patients report to this area for collection of blood, urine and fluid samples irrespective of the nature of the test. The place comprises of registration counter, blood collection room and a spacious waiting area. We use the vaccumised syringes (VACCUTAINER) for the blood collection .

B} HAEMATOLOGY :Routine hematology investigations (CBC/ Platelet count) are carried out with the equipments like 3 part haematology analyzer – Celtac X, Nikhon khoden, Japan and fully automated 5 part haematology anlyser .- Cell Dyn. 3200 , Abbott Diagnostics , Germany . ESR , Reticulocyte count , Absolute eosinophil count , P/S for M.P/ M.F and Bone marrow examination is also done. Special stains like MPO and PAS are done for diagnosis of leukemia. Bleeding time , clotting time , and other coagulation studies including prothrombin time and activated partial thromboplastin time ( APTT) are carried out on semi automated coagulometer KC 1 , Trinity, Biotech , USA .

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C} CLINICALPATHOLOGY : Routine physical, chemical and microscopic exam of urine and special tests like B.J. protein , pregnancy test etc. are also done . CSF, semen and other body fluids are examined .

D} CYTOPATHOLOGY :Cytopathology studies including fine needle aspiration cytology of palpable masses / lesions and exfoliative cytology including cervical smear (PAP) studies and fluid cytology ( Peritoneal fluid , pleural fluid , synovial fluid , Broncho alveolar lavage , semen , CSF ) are done in cytopathology department . FNACs of deep eated intraabdominal and retroperitoneal masses are done under USG guidance .

E} BIOCHEMISTRY :Clinical biochemistry :- All routine investigations like BSL, LFT, RFT, lipid profile, uric acid , calcium , amylase , electrolytes , LDH etc. are done. Special biochemistry includes CPKMB , CPK Nac , Glycosylated Hb, Urine microalbumin, Troponin, Blood gas etc.

F} MICROBIOLOGY:Bacteriology – Gram and ZN staining , Giemsa staining , slit smear examination Parasitology Routine examination of stool , modified ZN staining on stool , Mycology:KOH mount , India ink preparation for Cryptococci.

CANTEEN This is for In door patients and Out door Patients.

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INTERIORS

PASSAGE

COURTYARD

CSSD

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INQUIRY

WAITING

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EXTERIORS

MAIN ENTRANCE

MAIN BUILDING.

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INTERNAL SERVICE ROAD

CENTRAL LIBRARY

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LIVE CASE STUDY 1 -

NIRAMAYA HOSPITAL,ICHALKARANJI

Location : Locate Centrally In Ichalkaranji ,Near Bohra Market, Ring Road. •

Built over 1 Acre of Plot,

•

Contour site ,

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accessed by two ,

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Built up area 36000 sq.Feet

•

G+1 structure

It has a capacity of 111 beds under different heads, viz ICU, PICU, NICU, male/female ward, private room, special room, also has facilities like three operation theaters, OPD, pediatric, maternity, physiotherapy, burn & plastic surgery, opthalmology, neuro surgery, E.C.G.& E.E.G, dialysis, dental and dietics, obesity clinic, T.M.T., P.F.T, these all services run for 24 hrs and under one roof. It is aided fully by well equipped diagnostic facilities viz x-ray, ct scan, color doppler, ultrasonograpy and ultramodern laboratory, which are also available round the clock.

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BASEMENT FLOOR 

SANOGRAPHY ROOM ATTACHED WITH

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REORTING ROOM

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CITY SCAN , REPORTING ROOM

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X- RAY ROOM

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PATHOLOGY LAB – BLOOD SAMPLE

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COLLECTING AND TESTING ROOM

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PHYSIOTHERAPY

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 TOILETS  NURSE REST ROOM  TOILETS

GROUND FLOOR 

RECEPTION

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CHECKING ROOM

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ICU FOR 9 PATIENTS

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NICU FOR 10 CHILDREN

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DRESSING ROOM

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GYNOCOLOGY DEPARTMENT

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OPERATION THEATRE – DOCTORS’S ROOM – 3 STORE ROOMS

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3 OPERATION THEATRE - FOR MAJOR OPERATIONS

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FOR MINOR OPERATIONS

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OPHTHALMOLOGY

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MEDICAL STORE

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ACCOUNT DEPARTMENT - 3 ACCOUNTANT

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CONFFERENCE ROOM

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SUPORVISOR ROOM

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OPD

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CASH COUNTER

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MANANGER

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TOILETS

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FIRST FLOOR 

SPECIAL ROOMS – 4

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SEMI SPECIAL ROOM – 11

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GENERAL WARD -

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FOR MALE– 20 BEDS

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FOR FEMALE – 6 BEDS

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DOCTOR ROOM

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RECORD ROOM

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DIALYSIS ROOM – 3 BED

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DOCTORS REST ROOM

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WASHING AREA

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PANTRY

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NET CASE STUDY 1 -

INDRAPRASTH APOLLO HOSPITAL,DELHI

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AREA- 6,75,000 SQ. FT. COMPLETED, 1996 LARGEST CORPORATE HOSPITAL IN INDIA FOURTH LARGEST IN THE WORLD 652 BEDS INCLUDING 138 ICU BEDS 14 OPERATION THEATRES BUILT UP AREA OF 675,000 SQ. FT.

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• • •

Situated on oelhi-mathura highway Faces sw of the road 7 minutes drive from ashram chowk In proximity to the okhla and nizamuddin railway stations, so easily approachable by trains.

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SPECIALITY OF HOSPITAL • • • • • • • • • • • • • • •

General OPD services Emergency department General medicine General surgery Dentistry ENT Obstetrics and Gynaecology Orthopaedics Paediatrics Psychiatry Tuberculosis and respiratory diseases Eye care Physiotherapy Community medicine Forensic medicine

For the in-patient wards, several criteria had to be satisfied : provision of crossventilation in every room; every bed to have a view of the outside; a minimum walking distance from the nurses station to the rooms and also allowing a sense of visual check; flexibility for the future so that any floor could be converted from wards to rooms and vice-versa : as the floors progress, the configuration for the hierarchy of the rooms to get established.

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The in-patient wards are grouped reassuringly around a central nurse's station and are placed above the clinical zone in the podium. Throughout the complex the aim has been to de-institutionalize the spaces by the use of bold, vibrant colours and patterns , thereby, creating a cheerful atmosphere and a feeling of home away from home.

The concept for the OPD generated from the need to accommodate the people who would wait. while the departments have definite spaces for waiting, the general waiting area has an atrium with a directional visual communication.

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The less complex out-patient department is separated by a pedestrian atrium space from the complex acute care, diagnostic and in-patient areas. The large atrium serves to enliven the environment and provide a street-like atmosphere from within which the various facilities are accessed .

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For the medical facilities, the key-word was to have flexibility. Sandwiched between the in-patient wards and the clinical zone is an interstitial floor housing the engineering plants & services which support the complex medical facilities and the clinical zone below. The clinical zone consisting of the diagnostic and the 'acute-care' areas were placed with the operation theaters and housed within deep-spanned, podium floor, sitting atop a double basement housing the complex support zone consisting of the various services.

Entry of the hospital is through 3 gates namely Gate 1, Gate 2, and Gate 3. Gate 1 is the main entry leading to OPO and parking area whereas gate 2 is exit gate opening to the red lights. Gate 3 is service entry serving as doctors and staff entry leading to the main building block and finally to the service yard from the ramp to the base.

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POSITIVE  Grand atrium which acts as waiting hall gives street like appearance, hence a source of attraction.  Overall circulation is reduced with the help of atrium.  Proper care of the cross ventilation and outward view has been taken in designing of the wards  Proper services are laid out  Wards are designed in the towers to minimize services NEGATIVE  Gives hotel like appearance.  Tower like structure not recommended for area lying in earthquake zone 4

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NET CASE STUDY 2 -

DELTA HOSPITAL,CANADA Delta Hospital is a located in Ladner, BC on a 80,916 sm area site. It forms one of the several community hospitals in the LMFM network servicing over 101,000 people the Fraser Health catchment area. The overall location is unique as it is surrounded by other community related services such as:       

Elementary School Fire Hall School Board Office Medical Lab and Office Community Centre Civic and City Hall Delta Police

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In addition to neighbours listed above the site potential is staggering. It is located amongst low rise residential on a rural site with an abundance of available density and connectivity. To north of the hospital site is a community transit bus station, the Ladner Exchange that can connect residents and visitors to all areas of the lower mainland transit systems. A park and ride site has been designated at this exchange. In addition, the hospital is connected to major highway arteries such as Hwy 17 which connects the site south to the communities of Tsawwassen and Point Roberts, the ferries to Vancouver Island, and north is less than five miles to major arteries running between Seattle and Vancouver.

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Currently the Zoning dictates the following:       

Hospital Site: “ P” zone (Public use) Hospice Zone: “SI” Use (Personal Care) Minimum Setbacks: 7.5 M front/back 4.5 M side Maximum Height: 9.2 M or 3 Storeys Maximum Site Coverage (FSR): 0.71 Site Area: 91 935 SM, 989 580 SF, 22.7 Acres Parking: per 4 inpatient beds/1 per Dr/1 every 3 Staff

ZONNING

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The Corporation of Delta Planning Department denoted several areas of the site and surroundings that need to be retained and developed as part of a future project to include:        

The retention of the “Forest of the Future” area at the south west corner of the site. This area was recently developed by the DH Foundation and community partners as part of integrating future green zones into the Hospital site Maintenance and development of a boulevard tree planning program on Clarence Taylor Crescent Maintenance of the Existing Delta Hospital main entrance identity and character specifically if it is intended to remain. They discouraged the placement of an above ground parkade blocking this area Protection of the zone surrounding the Hospice by ensuring that the intended use of future additions are congruent and appropriate to this quiet zone Development of a cross site pedestrian route linking the bus loop and local residents with City Hall and possible Community Health Programs • Introduction of a community shuttle from the bus loop to the hospitals front door • Integration of the Hospital into the precincts plan for district energy Potential site opportunities at Patterson Park for Residential Care or Medical Clinic use Undertake a collaborative parking study between the Corporations; other community neighbours and Delta Hospital as to better assess the precincts parking needs.

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ORGANIZATIONAL PRINCIPLES THE EXISTING SITE WAS ASSESSED BY CLINICAL ZONES AS FOLLOWS: • 

Major Buildings Zone

- Which may include program such as the integration of a Community Health Centre, A replacement Residential Care Facility, Medical Beds - This may include repurposing or adaptive reuse of the existing residential care building for a CHC, offices or Seniors outpatient facility 

Minor Buildings Zone

- Which may include program such as the integration of an alternate Community Health Centre location 

Additions Zone

- Which may include program additions for Lab, OR, Emergency, or Medical Imaging.

As part of the High Level Concept Plan process a study of the existing program areas, clinical adjacencies and circulation was undertaken. This also included a room by room accounting of existing areas and program locations, included as an appendix to this document. Delta Hospital can be divided into two major zones- a residential (previously extended care) zone, and an acute zone. The total area of the hospital is 10,850 sm. Most of the facility is a one-story building. The existing medical beds, outpatient services and the Foundation offices are located in a two-story building – previously called the Nursing Tower.

In addition to the On Site potential, Off Site strategies were also explored, such as the old horse racing grounds to the north of the site, Patterson Park was flagged by both the Corporation of Delta and LMFM Executives as a potential development site with specific reference to an alternate offsite Residential Care Facility location. This would require land purchase and a developer partner. For purposes of the Delta Hospital High Level Concept Plan it was decided that all Options put forward include the Residential Care expansion as an On Site option.

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RESIDENTIAL CARE ZONE The residential care zone located on the west portion of the site includes provision for onsite care of the elderly and persons requiring continued living assistance. The building infrastructure and design no longer provides service levels to comply with complex care requirements and standards of safety and as a result has been flagged. A comprehensive study has been preformed by LMFM on the building and it has been recommended that a new Residential Care Facility replace it. This study is not part of the Delta Hospital Service Plan, which forms part of this report. For purposes of this study it considered that the existing Residential Care facility be repurposed to a lighter use such as Outpatient Services, the Community Health Centre, or Staff Services It is important to note that some program currently located in the existing Residential Care Zone includes some services that are accessed and integral to the entire hospital campus such as:  Kitchen facilities for patient meals  Staff room  Meeting areas and conference rooms  Diabetes clinic  Auxiliary offices  IT, Biomed and miscellaneous support services If the facility is removed then relocation of the above services into new development will need to be considered.

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ACUTE CARE ZONE The acute care zone is the heart of hospital and includes the following key program. Description of each area can be found in the Service Plan. Clinical Services        

Emergency Surgical Day Care and OR’s Medical Imaging - Radiology and CT Scan Medicine Beds Pharmacy Outpatient Services- Cardiology, Mental Heath, Home Health, Rapid Access Physiotherapy / Rehabilitation Social Work

SUPPORT DIAGNOSTICS SERVICES             

Laboratory Central/Sterile Processing Life Line and Stores Laundry and Linen Food Services Main Entry and Cafe Admitting, Medical Records, and Human Resources Gift Shop Foundation Offices Plant Maintenance Mechanical and Electrical Support Staff lockers and rooms Spiritual room

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DATA COLLECTION

INTRODUCTION: As the topic of Multispeciality hospital there are mainly services are which are to be taken care of.Also the spaces in hospital have to meet the requirements and the standards.Various circulation patterns are studied which helps to planning of hospital . The data collection in this section will helps in forming standards for various spaces for multispeciality hospital.

HOSPITAL SPACES:-

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SPACE REQUIREMENT AN ACCESS Barrier Free Environment is one which enables people with disabilities to move about safely and freely and to use the facilities within.the built environment. The goal of barrier free design is to provide an environment that supports the independent functioning of individuals so that they can get to, and participate without assistance, in every day activities such as procurement of goods and services, community living, employment, and leisure. The fundamental principles which have been followed in developing standards / norms for various facilities to meet disabled people’s standards for safety, convenience and usability. Barrier free design standards should satisfy anyone who is hampered in his mobility or functioning (as compared with a nondisabled person) as a result of obstacles put in his way by the design of a building, the choice of hardware and equipment, and the arrangement of outside space.

WALKS AND PATHS:

Walks should be smooth, hard level surface suitable for walking and wheeling. Irregular surfaces as cobble stones, coarsely exposed aggregate concrete, bricks etc. often cause bumpy rides.  The minimum walk way width would be 1200 mm and for moderate two way traffic it should be 1650 .mm - 1800 mm.  Longitudinal walk gradient should be 3 to 5% (30 mm - 50 mm in 1 meter)  When walks exceed 60 Meter in length it is desirable to provide rest area adjacent to the walk at convenient intervals with space for bench seats. For comfort the seat should be between 350 mm - 425 mm high but not over 450 mm.  Texture change in walk ways adjacent to seating will be desirable for blind persons.  Avoid grates and manholes in walks. If grates cannot be avoided then bearing bar should be perpendicular to the travel path and no opening between bearing bars greater than 12 mm in width.

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TYPICAL DETAIL OF WALKWAY

NOTE :

 Walkway should be constructed with a non-slip material & different from rest of the area.  The walkway should not cross vehicular traffic.  The manhole, tree or any other obstructions in the walkway should be avoided.  Guiding block at the starting of walkway & finishing of the walkway should be provided. MULTISPECIALITY HOSPITAL

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 Guiding block-can be of red chequered tile, smooth rubble finish, prima regina,  Naveen tiles or any other material with a different texture as compared to the rest of the area

LEVELS AND GROOVES Passing over different levels and grooves)  The casters on a wheelchair are about 180 mm in diameter. Therefore, a wheelchair can only get over a small level difference.  Use a method that can reduce the height of the level difference, in addition to themethods shown here.



It can be difficult to move a wheelchair if a caster is caught in a groove. A. It is desirable that there is no difference in level. (If a difference is unavoidable, limit it to 20 mm or less.) B. Round off or bevel the edge.

C. To prevent a wheelchair from getting its casters caught in a drainage ditch or other cover. a. Install grating with narrow slots in the direction of movement. b. Treat the grating with a non-slip finish. C. Reduce the gap between an elevator floor and the landing.

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PARKING Parking :- For parking of vehicles of handicapped people the following provisions shall be made: 

Surface parking for two care spaces shall be provided near entrance for the physically handicapped persons with maximum travel distance of 30 M from building entrance.  The width of parking bay shall be minimum 3.60 Meter.  The information stating that the space is reserved for wheel chair users shall be conspicuously displayed.  Guiding floor materials shall be provided or a device which guides visually impaired persons with audible signals or other devices which serves the same purpose shall be provided.

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APPROACH TO PLINTH LEVEL Approach to plinth level : Every building should have at least one entrance accessible to the handicapped and shall be indicated by proper signage. This entrance shall be approached through a ramp together with the stepped entry. Ramped Approach : Ramp shall be finished with non slip material to enter the building. Minimum width or ramp shall be 1800 mm. with maximum gradient 1:12, length of rarnp shall not exceed 9.0 M having double handrail at a might of 800 and 900 mm on both sides extending 300 mm. beyond top and bottom of the ramp. Minimum gap from the adjacent wall to the hand rail shall be 50 mm.

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RAMP DETAILS

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ENTRANCE LANDING

Entrance Landing :- Entrance landing shall be provided adjacent to ramp with the minimum dimension 1800 x 2000 mm. The entrance landing that adjoin the top end of a slope shall be provided with floor materials to attract the attention of visually impaired persons (limited to coloured floor material whose color and brightness is conspicuously different from that of the surrounding floor material or the material that emit different sound to guide visually impaired persons hereinafter referred to as “guiding floor material” (Annexure - I). Finishes shall have a non slip surface with a texture traversable by a wheel chair. Curbs wherever provided should blend to a common level.

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CORRIDOR

Corridor connecting the entrance/exit for the handicapped:- The corridor connecting the entrance/exit for handicapped leading directly outdoors to a place where information concerning the overall use of the specified building can be provided to visually impaired persons either by a person or by signs, shall be provided as follows:  ‘Guiding floor materials’ shall be provided or devices that emit sound to guide visually impaired persons.  The minimum width shall be 1500 mm.  In case there is a difference of level slope ways shall be provided with a slope of 1:12.  Hand rails shall be provided for ramps/slope ways.

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STEPS AND STAIRS

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LIFT

Lifts :- Wherever lift is required as per bye-laws, provision of at least one lift

shall be made for the wheel chair user with the following cage dimensions of lift recommended for passenger lift of 13 persons capacity by Bureau of Indian Standards. Clear internal depth : 1100mm. Clear internal width : 2000 mm. Entrance door width : 900 mm.  A hand rail not less than 600 mm. long at 800-1000 mm. above floor level shall be fixed adjacent to the control panel.  The lift lobby shall be of an inside measurement of 1800 x 1800 mm. or more.  The time of an automatically closing door should or minimum 5 seconds and the closing speed should not exceed 0.25 M/ Sec.  The interior of the cage shall be provided with a device that audibly indicates the floor the cage has reached and indicates that the door of the cage for entrance/exit is either open or closed. MULTISPECIALITY HOSPITAL

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TOILET

One special W.C. in a set of toilet shall be provided for the use of handicapped with essential provision of wash basin near the entrance for the handicapped.  The minimum size shall be 1500 x 1750 mm.  Minimum clear opening of the door shall be 900 mm. and the door shall swing out.  Suitable arrangement of vertical/horizontal handrails with 50 mm. clearance from wall shall be made in the toilet.  The W.C. seat shall be 500 mm. from the floor.

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SIGNAGES The main purpose of signs should be to provide a clear designation of places, warnings and routing information. A person in a wheel chair is less than 1200 mm high. A person who is partially sighted needs contrasting texture along side walkways and audible signs for dangerous areas,. Signs should be useful to everyone, easily seen from eye level, readable by moving the fingers and well lighted for night time identification.  Signs shall indicate the direction and name of the accessible facility and incorporate the symbol of access.  The size, type and layout of lettering on signs shall be clear and legible.

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Re re WATER SUPPLY FOR BUILDINGS OTHER THAN RESIDENCES Minimum requirements for water supply for buildings other than residences shall be in accordance.

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THE REQUIREMENTS FOR FITMENTS FOR DRAINAGE AND SANITATION IN THE CASE OF BUILDINGS OTHER THAN RESIDENTIAL.

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BIO-MEDICAL WASTE IN HOSPITAL INTRODUCATION ‘Bio-medical waste’ means any waste generated during diagnosis, treatment or immunization of human beings or animals. Management of healthcare waste is an integral part of infection control and hygiene programs in healthcare settings. These settings are a major contributor to community-acquired infection, as they produce large amounts of biomedical waste. Biomedical waste can be categorized based on the risk of causing injury and/or infection during handling and disposal. Wastes targeted for precautions during handling and disposal include sharps (needles or scalpel blades), pathological wastes (anatomical body parts, microbiology cultures and blood samples) and infectious wastes (items contaminated with body fluids and discharges such as dressing, catheters and I.V. lines). Other wastes generated in healthcare settings include radioactive wastes, mercury containing instruments and polyvinyl chloride (PVC) plastics. The management of bio-medical waste is still in its infancy all over the world. There is a lot of confusion with the problems among the generators, operators, decisionmakers and the general community about the safe management of bio-medical waste. The reason may be a lack of awareness. Hence resource material on the environment for hospital administrators, surgeons, doctors, nurses, paramedical staff and waste retrievers, is the need of the hour

SOURCES OF BIO-WASTE While urban solid waste has attracted the attention of town planners, environmental activists and civic administrators, there is yet lack of concern for some special sources of waste and its management. One such waste is bio-medical waste generated primarily from health care establishments, including hospitals, nursing homes, veterinary hospitals, clinics and general practitioners, dispensaries, blood banks, animal houses and research institutes. The other sources of biomedical waste are the following:     

Households, Industries, Education institutes and research centres, Blood banks and clinical laboratories, Health care establishments (for humans and animals).

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PRIMARY SOURCE      

Hospitals, Nursing homes, Veterinary hospitals, Clinics, Dispensaries, Blood

OTHER SOURCES   

Households, Industries, Education institutes and research centers

CATEGORIES OF BIOMEDICAL WASTE

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EFFECTS OF BIOMEDICAL WASTE

The improper management in bio-medical waste causes stern environmental problems that causes to air, water and land pollution. The pollutants that cause damage can be classified into biological, chemical and radioactive. Some of the effects of pollution on air, radio activities, land, health and hazards are discussed.

Air Pollution Air pollution can be caused in both indoors and outdoors atmosphere. Biomedical waste that generated by air pollution are been classified in three types namely-Biological, Chemical and radioactive

In-door Air Pollution Pathogens present in the waste can enter and remain in the air for a long period in the form of spores or as pathogens Segregation of waste, pre-treatment at source etc., can also reduce this problem to a great extent. Sterilizing the rooms will also help in checking the indoor air pollution due to biological (Askarian et al 2004b; Baveja et al 2000). The indoor air pollution caused due to the above chemicals from poor ventilation can cause diseases like Sick Building Syndrome (SBS). Proper building design and well-maintained air conditioners can reduce the SBS. Chemicals should be utilized as per prescribed norms. Over use of chemicals should be avoided.

Out-door air pollution Outdoor air pollution can be caused by pathogens. The biomedical waste without pretreatment if transported outside the institution, or if it is dumped in open areas, pathogens can enter into the atmosphere. Chemical pollutants that cause outdoor air pollution have two major sources-open burning and incinerators. Open burning of biomedical waste is the most harmful practice. When inhaled can cause respiratory diseases. Certain organic gases such as dioxins and furans are carcinogenic (Burd 2005). The design parameters and maintenance of such treatment and disposal technology should be as per the prescribed standards

Radioactive emissions Research and radio-immunoassay activities may generate small quantities of radioactive gas. Gaseous radioactive material should be evacuated directly to the outside. The use of such device requires maintenance of the trap and monitoring of the off-gas.

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Water Pollution The liquid waste generated when let into sewers can also lead to water pollution if not treated properly (Rao, 1995; Rao & Garg, 1994). Water pollution can alter parameters such as pH, BOD, DO, COD, etc. There are instances where dioxins are reported from water bodies near incinerator plants. Dioxins enter the water body from the air.

Radioactive effluent Radioactive waste in liquid form can come from chemical or biological research, from body organ imaging, from decontamination of radioactive spills, from patient’s urine and from scintillation liquids used in radioimmunoassay. Under normal circumstances, urine and faeces can be handled as no radioactive waste so long as the patient’s room is routinely monitored for radioactive contamination.

Land Pollution Soil pollution from bio-medical waste is caused due to infectious waste, discarded medicines, chemicals used in treatment and ash and other waste generated during treatment processes. Heavymetals such as cadmium, lead, mercury etc., which are present in the waste will get absorbed by plants and can then enter the food chain. Nitrates and phosphates present in leachates from landfills are also pollutants. Excessive amounts of trace nutrient elements and other elements including heavy metals in soil are harmful to crops and are also harmful to animals and human beings.

HEALTH HAZARDS According to the WHO, the global life expectancy is increasing year after year. However, deaths due to infectious disease are increasing. A study conducted by the WHO in 1996, reveals that more than 50,000 people die everyday from infectious diseases. One of major causes for the increase in infectious diseases is improper waste management. List of infections and diseases documented to have spread through biomedical waste. Occupational health hazards Occupational health concerns exist for janitorial and laundry workers, nurses, emergency medical personnel, and refuse workers. Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees in institutions generating bio-medical waste. Proper management of waste can solve the problem of occupational hazards to a large extent.

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Hazards to the general public The general public’s health can also be adversely affected by bio-medical waste. Improper practices such as dumping of bio-medical waste in municipal dustbins, open spaces, water bodies etc., leads to the spread of diseases. Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases.

ENVIRONMENTAL MANAGEMENT SYSTEM The EMS is a broad framework aimed at providing effective direction for an institution in response to the changing external and internal factors. Waste system of the hospital was studied by (Das et al, 2001; CPHEE 1998; Kelkar, 1998; Kela et al, 2000). Figure 2 shows the waste management flow chart and process flow chart of the existing indicated the sequence from generation of waste to its final disposal. Figure 3 shows the interference of the points and data (Jaswal & Jaswal 2000). Colour coding and type of container for disposal of biomedical wastes is given in Table 4 Biomedical waste solutions specialize are in three categories namelyWaste management flow chart-

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Type of container and colour code for collection of bio-medical waste-

Amount and composition of hospital waste generated 

Amount

Country

Quantity (kg/bed/day)

U. K.

2.5

U.S.A.

4.5

France

2.5

Spain

3.0

India

1.5

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A process flow chart of the existing waste system of the hospital management of the infectious waste is crucial in today’s health care arena. DISPOSAL METHODSDifferent methods are used for the disposal of bio medical waste and are discussed below: Incineration: It is a controlled combustion process where waste is completely oxidized and harmful microorganisms present in it are destroyed/denatured under high temperature. An article regarding plasma pyrolysis of medical waste was reported by Neema and Gareshprasad (2002). The authors stated that the operating cost of the system would be Indian Rupees 13 per kilogramme (kg), and the energy recovered would cost Indian Rupees 8 per kg; thus the net cost would be Rs 7 per kg. Amount and composition of hospital waste generated.

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Autoclaving: Autoclaving is a low-heat thermal process where steam is brought into direct contact with waste in a controlled manner and for sufficient duration to disinfect the wastes. For ease and safety in operation, the system should be horizontal type and exclusively designed for the treatment of bio-medical waste. For optimum results, pre-vacuum based system be preferred against the gravity type system. It shall have tamper-proof control panel with efficient display and recording devices for critical parameters such as time, temperature, pressure, date and batch number etc. Microwaving, microbial inactivation occurs as a result of the thermal effect of electromagnetic radiation spectrum lying between the frequencies 300 and 300,000 MHz. Microwave heating is an inter-molecular heating process. The heating occurs inside the waste material in the presence of steam. Hydroclaving is similar to that of autoclaving except that the waste is subjected to indirect heating by applying steam in the outer jacket. The waste is continuously tumbled in the chamber during the process. Shredder: Shredding is a process by which waste are deshaped or cut into smaller pieces so as to make the wastes unrecognizable. It helps in prevention of reuse of bio-medical waste and also acts as identifier that the wastes have been disinfected and are safe to dispose off. A shredder is to be used for shredding in bio-medical waste with minimum requirements.

PRESENT SCENARIO: Waste management is one of the important public health measures. If we go into the historical background, before discovery of bacteria as cause of disease, the principle focus of preventive medicine and public health has been on sanitation. The provision of potable water, disposal of odor from sewage and refuse were considered the important factors in Prevention of epidemics. The current status of practice in India is given in Figure 4. The vehicles transporting the wastes to the facility shall be designed exactly as per the standards of Bureau of Indian Standards (Anonymous, 2005). They should also be labelled with symbols meant for hazardous wastes. The common Treatment facilities should comply with all the emission and effluent standards of the pollution control Board.

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Current status of medical waste disposal in Lucknow, India.

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CONCLUSIONSProper management of Bio medical waste is a concern that has been recognized by both government agencies and the Non government organizations. Several hazards and toxic materials containing should be disposed off with proper take and care. Inadequate and inefficient segregation and transportation system may cause severe problem to the society hence implementing of protective measures, written policies all of these factors contribute to increased risk of exposure of staff, patients and the community to biomedical hazards. In order to accelerate the rate at which proper processing and management methods are designed, timely regulatory and legislative policies and procedures are needed. To properly separate, process and isolation of wastes, they must be well-characterized, which is challenging. Safe and effective management of bio medical waste is not only a legal necessity but also a social responsibility. Lack of concern in persons working in that area, less motivation, awareness and cost factor are some of the problems faced in the proper hospital waste management. Proper surveys of waste management procedures in various practices are needed. Clearly there is a need for education as to the hazards associated with improper waste disposal. An effective communication strategy is imperative keeping in view the low awareness level among different category of staff in the health care establishments regarding biomedical waste management. One important direction for future research would be to project the flows of bio medical waste worldwide and quantitatively and qualitatively assess.

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SITE SELECTION CRITERIA

LOCATION OF SITE-Behind ghodawat farm house ,khotwadi road,hatkanagle. distkolhapur. CLIMATE-Hot dry SITE CONDITIONS- Used for farming,little vegetation or existing trees. WIND DIRECTIONS- North-south throughout the year. NOISE LEVEL- Moderate NOISE SOURCE- Primery and source of traffic on state highway-passing trucks,cars,buses etc. and railway POLLUTANTS-Traffic on state highway-passing trucks,cars,bikes,etc. SERVICES AVAILABLE ON SITE-Electricity,telecommunication lines,water supply line. access to the site-through the main highway.

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Area of site-7.50 acre(28,237.00 sq.m)

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Strenght-main route of transport in neighboring area is in south-north accessible by public transport.

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Public bus stand and railway station in nearby to at a distance of 1.00km.

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Strong cultural context access limited to one side. Weakness-lack of landscape.

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OPPORTUNITIESThere are not any multispeciality hospital in the surrpunding areas.as per observation there is need of such kind of hospitals.

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