PLANNING EQUIPMENTS AND SUPPLIES FOR NURSING CARE IN HOSPITAL

April 15, 2013  Nursing Path  No comments

INTRODUCTION
Hospital supplies and equipments are dealt with under material management. Supplies are those items that are used up or consumed; hence the term consumable is used for supplies. The supplies in hospital include drugs, surgical goods (disposables, glass wares), chemicals, antiseptics, food materials, stationeries, the linen supply etc. The term equipment is used for more permanent type of article and may be classified as fixed and movables. Fixed equipment is not a structure of the building, but it is attached to the walls or floors (egg; steriliser,) Movable equipment includes furniture, instruments etc.  

PURCHASE OF SUPPLIES AND EQUIPMENT
The purchase of supplies and equipments in a hospital is carried out through;
  1. General store
  2. Dietary department and
  3. Pharmacy department
When planning for the purchase of articles , budgeting is done not only for the actual price of articles  but also for the additional costs that are involved such as ;
  • Transport charges ( local delivery reduce the transport charge)
  • Incidental costs
  • Cost of chemicals and other consumable  to be used with the equipment (eg; ECG paper   for an ECG machine )
  • Operating cost (hiring a technician )
  • Cost of maintenance service; 10-20% of hospital equipment may remain idle if serving is not done periodically.
  • Cost of technology obsolesces: when a better quality appears in market there is tendency to discard the old model.
  • Replacement cost of equipment
Selection of article- while buying articles it has to meet the standards. Indian Standards Institution is the national agency set up to bring standardisation of articles in India. Articles that meet the criteria specified by the Indian Standard Institution will be marked by ISI markings. The articles bought should provide safety to the patient and personnel. Faulty instruments and equipments cause not only inconvenience in the patient care, but also it may cause the loss of life.

Purchasing article:
  • The material used for any equipment should be durable, non-corroding, non toxic and safe for use.
  • Should have standard shapes and dimensions to fit into  various situations
  • Reparability and spare part availability of the article
  • Interchangability of the article
  • All surgical instruments used in  a hospital should be sterilisable  and they should stand the tests for leakage , hydraulic pressure tests for bursting etc
  • Should have accuracy in measurements
  • Should have ease of operation
The central supply service
Most hospitals have a central department where equipments and supplies are stored and from which they are distributed to the units. The type of materials that is kept in the central supply room varies from hospital to hospital. In some hospital the central soppy room deals with only the sterile supplies and ward trays. In other hospitals all types of equipment such as oxygen, suction, ward trays, catheters, syringes etc are stored here.
Linen supply:  Methods of handling linen supply include;
a) Departmentalised system: Here the supply of linen for each department of the hospital is marked for that department. The head of the department is responsible for making a linen standard for his own department.
b) Centralised linen supply: Under centralised system, linen is issued on exchange basis, that is clean linen is exchanged for soiled linen.
FACTORS TO BE CONSIDERED
  1. Type of service provided by the hospital: a maternity hospital requires more equipment related to gynaecologic procedures than a cardiac hospital.
  2. Age of patients: children need different type and amount of equipments than adults.
  3. Sex- men and women sometime require different type of equipment.
  4. Degree and type of illness- neurologic patients sometimes require more bedsides, rubber mattress and linen than patients with other type of illness.
  5. Cost of items- cost of items will limit the purchase of number of equipment.
 GENERAL UTILITY SERVICES IN THE HOSPITAL
  1. Electric supply and  installations
A hospital must have a steady electrical supply at a stable voltage. Voltage fluctuations play havoc with sophisticated electronic equipment, endoscope, sterilisers, X-ray equipments etc. While planning hospital departments, provision should be made for voltage stabilisation in areas with heavy concentration of electrical and electronic equipment. This is preferred over using voltage stabilisers with individual equipment. There should be an emergency generator capable of supplying power to all emergency areas of the hospital. This generator should be of right capacity and kept in working order by periodic test runs.
  1. Water supply
Since safe water supply is not always assured, hospitals must have their own purification system. Also there should be plumbing system.
  1. Disposal of waste –liquids and solids.
Disposal of waste both solid and liquid is a totally neglected area. A hospital incinarator good for the waste management.
  1. Refrigeration, air conditioning, ventilation and environment control.
Air conditioning is required for protection of sophisticated electronic equipment, X ray, machines etc.
  1. Transport
Lifts are needed for vertical transport. There should be separate lifts for patients, visitors, staff and supply. Patients lift should accommodate a standard hospital bed. Sides of the lift must be protected to prevent damage by trolleys. Lift surfaces and flooring should be capable of easy cleaning and disinfection. Ventilation, communication and emergency escape system should be provided on all lifts. As for horizontal transport also trolleys and ramps with gentle gradient are useful.
  1. Supply of medical gases , compressed air, hot water, vacuum suction  and gas plants
Piped supply of medical gases , compressed air, vacuum suction , hot water, steam, necessitates thoughtful planning at all stages to consider problems of –
    • Easy uninterrupted safe supply
    • Fire and explosion hazards
    • Easy of servicing and maintenance without disrupting hospital services.
  1. Laundry- A hospital laundry has 2 separate areas, with provision for decontamination and sterilising of soiled linen.
  2. Fire hazard- there should be consideration of ventilation, exhaust systems and adequate earthing of all electrical installation.
  3. Communication- public telephone and internal telephones are required in each hospital.
  4. Repairs workshop
There should be provision for repair and maintenance of necessary equipments used in the hospital .
MATERIALS USED IN HOSPITALS
Hospital material medical side Hospital material management side
  • Perfusion materials
  • Surgical disposables
  • Instruments
  • Drugs, medicine, oxygen, linen
  • Biomedical equipment
  • Disinfecting items
  • Computers, telephone and fax
  • Food and beverage materials
  • Anaesthetic equipment
  • Electro medical  equipment
  • Glass ware, dental machines
  • Surgical dressing utensils
  • Artificial limbs ,bandages, cots for patient, furniture
  • Engineering items and many others
  • Computer, fax, telephone, stationary items
  • Public address items overhead projector
  • Audiovisual systems
ESSENTIAL EQUIPMENTS FOR A 50 BEDDED DISTRICT HOSPITAL (WHO)
1) Scope of services
  • Essential clinical services- medicine, surgery, paediatrics., OBG,  and acute psychiatry (when necessary)
  • Optional clinical services – oral surgery, orthopaedic surgery, otolaryngology, neurology and psychiatry.
  • Essential clinical support- anaesthesia, radiology and clinical laboratory
  • Optional clinical support services- pathology and rehabilitation including physiotherapy.
2) Essential medical equipment
  • Diagnostic imaging equipment –it include x-ray and ultrasound equipment. X-ray equipment can be stationary in one room or mobile
  • laboratory equipment –
    • microscope
    • blood counter
    • analytical balance
    • calorimeter( spectrophotometer)
    • Centrifuge – a small centrifuge that can accommodate six 15ml tubes should be available.
    • Water bath – used for stabilising temperature at 25, 37, 42, or 56degree Celsius.
    • Incubator/oven- a small hot air oven to carry out standard cultivations and sensitisations.
  • Refrigerator – an ordinary household refrigerator with a freezer unit, for storing preparations, vaccines, blood etc.
  • istillation and purification apparatus - it should be made of metal that resists acid, and alkali and should be free standing.
3) Electrical medical equipment.
  • Portable electrocardiograph
  • Defibrillator( external)
  • Portable anaesthetic unit – 2 small aesthetic units should be obtained, complete with a range of masks.
  • Respirator – it should be applicable for prolonged administration during post operative care.
  • Dental chair unit- a complete unit should be available to carry out standard dental operations.
  • Suction pump –one portable and one other suction pump are required.
  • Operating theatre lamp- one main lamp with at least 8 shadows lamp and an auxiliary of 4 lamp units.
  • Delivery table- it should be standard and manually operated.
  • Diathermy unit – a standard coagulating unit which is operated by hand or foot switch, with variable poor control.
4) Other equipment
  • autoclave – for general stabilisation
  • Small sterilisers- for specific services- eg. Stabiliser
  • cold chain and other preventive medical equipment
  • ambulance
5) Small , inexpensive equipment and instruments
  • Equipment and instrument, such as BP apparatus, oxygen manifolds, stethoscope, diagnostic sets and spotlights.
CONCLUSION
Health care services are the result of a number of materials used in the process. As hospital administrators  nurses should also know about the materials .Medical items such as perfusion materials, surgical disposables, instruments,  electrical, civil and engineering items for maintenance , house keeping materials, linen, biomedical equipment . drugs, food items etc pay an effective role in improving the quality of health care services.

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