IS 15461 (2004): Performance guidelines for quality ... · resources needed to implement the...

Disclosure to Promote the Right To Information

Whereas the Parliament of India has set out to provide a practical regime of right to information for citizens to secure access to information under the control of public authorities, in order to promote transparency and accountability in the working of every public authority, and whereas the attached publication of the Bureau of Indian Standards is of particular interest to the public, particularly disadvantaged communities and those engaged in the pursuit of education and knowledge, the attached public safety standard is made available to promote the timely dissemination of this information in an accurate manner to the public.

इंटरनेट मानक

“!ान $ एक न' भारत का +नम-ण”Satyanarayan Gangaram Pitroda

“Invent a New India Using Knowledge”

“प0रा1 को छोड न' 5 तरफ”Jawaharlal Nehru

“Step Out From the Old to the New”

“जान1 का अ+धकार, जी1 का अ+धकार”Mazdoor Kisan Shakti Sangathan

“The Right to Information, The Right to Live”

“!ान एक ऐसा खजाना > जो कभी च0राया नहB जा सकता है”Bhartṛhari—Nītiśatakam

“Knowledge is such a treasure which cannot be stolen”

“Invent a New India Using Knowledge”

है”ह”ह

IS 15461 (2004): Performance guidelines for qualityassurance in hospital services upto 100 bedded hospitals[MHD 14: Hospital Planning]

H

IS 15461:2004

Indian Standard

PERFORMANCE GUIDELINES FOR QUALITYASSURANCE IN HOSPITAL SERVICES UP TO

100-BEDDED HOSPITALS

ICS 03.120 .10;1 1.020

@ BIS 2004

BUREAU OF INDIAN STANDARDSMANAK BHAVAN, 9 BAHADUR SHAH ZAFAR MARG

NEW DELHI 110002

chdy 2004 Price Group 12

Hospital and Medical Care Services Sectional Committee, MSD 8

FOREWORD

This lndian Standard was adopted by the Bureau of Indian Standards, afier the draft finalized by the Hospital andMedical Care Services Sectional Committee had been approved by the Management and Systems Division Council.

Health and medical care delivery systems in our country have come under constantly increased pressure due toincreased utilization as a result of population explosion, increased awareness among common consumers, biomedicaladvancement resulting in the use of sophisticated and advanced technology in diagnosis and therapeutics, andconstantly rising expectation levels of the users of these services.

Also the Government’s commitment to the cause of the common consumer is amply reflected in the enactment ofConsumer Protection Act (COPRA), 1986. With the introduction of COPRA, the need for evaluating the care beingrendered in retrospect has firther gained strength. Until now, the quality of health care being provided by the healthcare organizations could not be subject to critical retrospective evaluation, as there were no checks or controls on thecare being rendered and there being no predetermined standards or guidelines in this area. Today, a common consumerexpects some sort of assurance that the services rendered should be of desired quality and cost effective.

There is an urgent need to provide guidance to those concerned with quality assurance in hospital services to ensureefficiency and effectiveness of the services rendered. In order to enable them to successfully manage the hospital tofulfil ever rising expectations of the consumers’ in the pr(!sent economic scenario, it is imperative that health careprofessionals should bring in certain standards in their respedive areas of work so that quality of health care providedcan be evaluated against laid-down norms or standards. Viwiousfbnetionaries, such as doctors, nursing and paramedicalstaff, hospital administrators, etc, should bear responsibility for any failure in the system, so as to make these servicesmore effective, economical and accountable.

*

In contrast with the case of products, where the expected performance is oflen in terms of measurable attributes, thedifficulty in case of services is that the customers’ needs and expectations are quite often abstract. Notwithstandingthis, a hospital keen to provide satisfactory service or to improve upon its present level of service, needs to evolve asuitable mechanism to identify the patient’s needs and expeetdms, even if they am imprecise or vague. This maybedone by communication with the users of the service, customer sarvey, etc. Such Attributes,wh~h are important forthe patient’s needs and requirements, may be identified These attributes maybe divided into two broad categories:

a) First relating to infrastructure, skills, procedures and aystetnsi ete, which will ensure a satisfactory service atoptimum cost. This is a prescription type of provision, adherence to which is expected to result in service ofdesired quality.

b) The second part comprises identification and quantification, wherever ~ossible, attributes of quality which isa performance based provision. Successfid achievement of these quality attributes is expected to providenecessary confidence to hospital management as well as users of these sakices.

.

At the district level, there is strong need felt, as to how a hospital up to 100 beds can provide better services to theconsumers at large. ,

●

In spite of great demand, presently there is no guidance readily available on those attributes of quality which areabsolutely performance based for hospital services. This standard is intended to fulfil this long-felt need. This \standard lays down necessary guidelines on the performance requirements of hospital services and the system fortheir evaluation. It maybe noted that these days many of the services like ambulance services, etc are being outsourced.[t is reiterated that, the onus of control over such services still lies with the hospital(s).

The Model Citizens’ Charter for Public Hospitals given in Annex C, has been provided by Voluntary Organization inInterest of Consumer Education (VOICE).

The composition of the Committee responsible for the formulation of this standard is given in Annex D.

< -T--- —

Indian Standard

PERFORMANCE GUIDELINES

IS 15461:2004

FOR QUALITY

ASSURANCE IN HOSPITAL SERVICES UP TO1OO-BEDDED HOSPITALS

1 SCOPE

This standard covers guidelines for performancerequirements for quality assurance in hospital servicesup to 100-bedded hospitals and the system for theirevaluation.

2 REFERENCES

The standards given below contain provisions, whichthrough reference in this text, constitute provision of thisstandard. At the time of publication, the editions indicatedwere valid. All standards are subject to revision and partiesto agreements based on this standard are encouraged toinvestigate the possibility of applying the most recentadditions of the standards indicated below:

IS No.

1474:19591475 (Part 1) :2001

1742:1983

2064:1993

2065:1983

~]89 :1999

2190:1992

2309:1989

2379:1990

2440:1975

4347: 1967

5329:1983

Title

Commercial refrigeratorsSelf-contained drinking watercoolers — SpecificationCode of practice for buildingdrainage (second revision)Code of practice for selection,installation and maintenance ofsanitary appliances (second

revision)

Code of practice for water supplyin buildingsSelection, installation andmaintenance of automatic firedetection and alarm system —Code of practice (third revision)

Selection, installation andmaintenance of first-aid fireextinguishers — Code of practice(second revision)Code of practice for protection ofbuildings and allied structuresagainst lightingPipelines — Identification —Colour code @st revision)

Guide for day lighting ofbuildings (second revision)

Code of practice for hospitallightingCode of practice for sanitary pipe

IS No. Title

work above ground for buildings~rst revision)

12377:1988 Classification and matrix forvarious categories of hospitals

12433 Basic requirements for hospitalplanning:

(Part 1): 1988 Up to 30-bedded hospitals(Part 2): 2001 Up to 100-bedded hospitals

13808 (Part 3) :1995 Quality management for hospitalservices up to 30-bedded hospi-tals — Guidelines

15195:2002 Performance guidelines for qualityassurance in hospital services upto 30-bedded hospitals

15280:2003 Quality fi.mction deployment15431:2004 Seven basic tools of quality

management

3 TERMINOLOGY

For the purpose of this standard, the following definitionsshall apply.

3.1 Customer — Organization or person that received aproduct.

Example: Consumer, client, end-user, retailer, beneficiaryand purchaser.

NOTE — A customer can be internal or external to the

organization.

3.2 Product/Service — Result of a Process

NOTE 1 — There are four gqmericproduct categories, as follows:

a) Services (for example, transport);

b) Software (for example, computer program, dictionary);

c) Hardware (for example, engine mechanical part); and

d) Processed materials (for example, lubricant).

Many products comprise elements belonging to differentgen$ric product categories. Whether the product is thencalled service, software, hardware or processed materialdepends on the dominant element. For example, theoffered product ‘automobile’ consists of hardware (forexample, tyres), processed materials (for example fuel,cooling liquid), software (for example, engine controlsoftware, driver’s manual), and service (for example,operating explanations given by the salesman).

1

1S 15461:2004

NOTE 2 — Service is the result of at least one activitynecessarily performed at the interface between the supplier andcustomer and is generally intangible. Provision of a service caninvolve, for example, the following:

— an activity perfomred on a customer-supplied tangible prod-

uct (for example, automobile to be repaired);

— an activity performed on a customer-supplied intangible

product (for example, the income statement needed to pre-

pare a tax return);

the delivery of an intangible product (for example, the

delivery of information in the context of knowledge trans-

mission);

the creation of ambience for the customer (for example, in

hotels and restaurants),

Software consists of information and is generally intangible

and can be intheform of approaches, transactions or procedures.

Hardware is generally tangible and its amount is a countablecharacteristic. Processed materials are generally tangible andtheir amount is a continuous characteristic. Hardware andprocessed materials often are referred to as goods.

NOTE 3— Quality assurance is mainly focused on intendedproduct.

NOTE 4 — Result generated by activities at the interface betweenthe hospital/health care organization and the customer and theinternal activities of the hospital/health care organization tomeet the customers’ needs and expectations.

4 GENERAL

4.1 In order to consistently provide the services of desiredquality at optimum cost for providing effective andefilcient patient-care services, a hospital managementshould develop, implement and continuously improvethe quality management system. Such a system consistsof organizational structure, procedures, processes andresources needed to implement the quality management.

4.2 The basic requirements up to 100-bedded generalhospitals have been clearly defined in terms ofinfrastructure, personnel, material, etc, in IS 12433(Part 2) which covers the physical facilities required fordelivery of service to the patients. Some of the aspects ofquality management system characteristics may notalways be observable by the customer, but directly affectservice performance.

4.3 The characteristics of hospital services in terms ofinfrastructure and systems form the starting point. Theother set relates to quality considerations, which shouldfollow thereafter. These may be quantitative (measurable)or qualitative (comparable). Hospital authorities againstdefined standards of acceptability should evaluate boththese types of characteristics. Quality is generallyexpressed in terms of the following attributes:

a)

b)

c)

d)

e)

t)

g)

h)

Availability — The services shall be available tothe patient whenever needed.Reliability — The services shall be accurate andreliable, for example, if a blood sample is testedin a pathological laboratory, the values obtainedshall be accurate and free from avoidable errors.Completeness — The services rendered shall becomplete in all respects. If a laboratory test isdone for an in-patient but report not sent to theward, it is not a satisfactory service because it isnot complete.Timeliness — Rendering the services in time is avery important consideration, which otherwise, mayeven cost a patient’s life. The medical service, inorder to be called as good quality or satisfactory,shall adhere to the time specified.Courtesy —A hospital service is a highly person-alized one and should be rendered with duecourtesy and pleasant behaviour to the customer.A patient, while suffering from a disease, heaves asigh of relief through courteous behaviour.Economy — A hospital service should beprovided to the patient at reasonable cost which isgenerally affordable.Consciousness —A strong will to redress griev-ances and make good losses arising out of lapsesin service is also an attribute of quality of servicesrendered.Other Considerations — These may includeconfidentiality, hygiene considerations responsive-ness, comfort, aesthetics of environment andeffective communication and transparencyparticularly in costs and communications.

5 COMMUNICATION WITH CUSTOMERS

5.1 One of the major indicators of quality of health careservices ,is the feedback received from patients. It isessential that such feedback percolates down the line toevery employee in the hospital. Another major elementin this service area is the concept of consideration.Usually, price is a very important concept in any industryand service. But in ,health care service area, price hasbeen replaced by the element of consideration.Consideration is price plus 10SSof dignity, waiting time,anxiety, etc. The latest concept in management is that ofcustomer delight. It has now become essential not onlyto ensure customer satisfaction but also to aspire forcustomer delight. Customer delight, for example, couldmean that a receptionist is not merely courteous, but iswarm, empathic and well trained in counseling.

5.2 Interface with Customers

5.2.1 Hospital management should establish and monitoreffectiveness of interaction between customers and

L

hospital person. This is crucial to achieve customersatisfaction.

5.2.2 Management can influence this perception bycreating an appropriate image based on the reality ofactions taken to meet customer needs. This imagepresented by personnel at all levels, has a primary effecton the hospital’s relationship with the customer.

5.2.3 Personnel having direct customer contact are animportant source of information for the ongoing qualityimprovementprocess. Managementshouldregularlyreviewthe methods used for promoting contacts with customers.

5.2.4 Since health service is mainly people-oriented,prevention and reduction of human errors at all levels areof vital importance. This means that top priority shall begiven to human resource development. Some commonexamples of waste, rework, negligence and error in patientcare in hospitals are:

a)b)c)d)e)

f)g)h)

j)k)m)

n)

P)

X-ray/investigation ordered but not done;Prolonged stay before and after the operation;Consultation indicated and not carried out;Wrong label on samples;Wrongly numbered reports;Missing requisitions, reports, etc; .

Inferior quality of drugs used;Delayed reports;Prescriptions not explained;Medicine prescribed but not given by the nurse;Incorrect patient identification; unnecessary and/or repetitive investigations;Wrong diagnosis and treatment; andUnnecessary and/or repetitive investigation.

5.3 Communication with customers involves listeningto them and keeping them informed. Difficulties incommunication or interaction with customers should begiven prompt attention. These difficulties provideimportant information on areas for improvements in theservice delivery process. Effective communication withcustomers involves:

a)

b)c)

d)

e)

f)

g)

Describing the service, its scope, its availabilityand timeliness of delivery;Stating how much the service will cost;Explaining the interrelationships between service,delivery and cost;Explaining to customers the effect of any problemand how it will be resolved, should it arise;Ensuring that customers are aware of the contribu-tion they can make to service quality;Providing adequate and readily accessible facili-ties for effective communication; andDetermining the relationship between the serviceoffered and the real needs of the customer.

IS 15461:2004

The customers’ perception of service quality is acquiredoften through communication with the serviceorganization’s personnel and facilities.

5.4 The control of service and service deliverycharacteristics should be achieved by controlling theprocess that delivers the service. Process performancemeasurement and control are, therefore, essential toachieve and maintain the required service quality.

5.5 In the delivery of health care services, a citizen’scharter for public hospitals may be made available at alltimes for better communication. A model citizen’s charteris given in Annex C.

6 IDENTIFYING RELEVANT INFORMATION ANDDATA

6.1 It is important to identi~ and analyze the relevantinformation data, which may involve:

a)

b)

c)

d)

Giving priority to those activities having the great-est adverse impact on service quality;Providing feedback of results of the analysis tooperational management with recommendationfor immediate service improvement;Reporting periodically to senior management for amanagement review of long-term quality improve-ment recommendations; andAdmission and discharge analysis of the patients(monthly statistical report).

6.2 Members from different parts of the serviceorganization working together may be able to offer fruitfulideas that could be directed towards improving qualityand reducing cost. Management should encouragepersonnel at all levels to contribute to programmed forquality improvement, with recognition for their effortsand participation.

7 PERFORMANCE REQUIREMENTS

7.1 Parameters have to be identified which describe theperformance of each activity of the work phase. Theseparameters should relate to the quality of patient careactivity and should be associated with the appropriatetype of service required.

7.2 In order to define standards of acceptable performance,the value of each parameter needs to be specified in termsof both the acceptable level and allowable tolerances.

7.3 Customer’s needs and expectations from variousactivities of hospital services should be kept in mindwhile laying down various quality parameters. Some ofthese customer satisfiers are given below:

a)b)

Patients should get cured;Curing should be done in the shortest possible time

3

IS 15461:2004

c)d)

e)

f)

g)h)

and at the optimum cost;Cure should be lasting;Psychologically the patients should feel that theyare cared for and being treated well;The hospital environment should be clean andappealing;The environment should prevent the spread of dis-eases to others including doctors, nurses and otherpatients;Emergencies should be attended to promptly; andLifesavingmeasuresshouldbe taken inminimumtime.

7.4 Parameters — General Performance

Some pertinent parameters include the following.

7.4.1

a)b)c)

7.4.2

a)b)c)

7.4.3

a)b)

c)

7.4.4

7.4.5

a)b)c)d)e)

7.4.6

a)b)c)d)e)

f)g)h)

j)

Yeception and Registration

:ourteous response,[formation provided, andGuidance need anticipated and provided.

Waff Service

Courtesy,Comfort, andPromptness.

House-Keeping and Sanitation

Cleanliness and hygiene,Safe and effective disposal of biomedical waste,andLinen and laundering.

Hospital Infection Control, Qualitative indicator,

Patient Management Team

Doctor,

Nurse,Allied health professionals and para medicals,Technicians, andAttendants.

Medical Facilities

ECG,EEG (Optional),X-Ray,Pathological services,Sonography,Blood bank,Physiotherapy and occupational therapy,Essential drugs, andOthers.

7.4.7 Other Facilities

a) Canteen,

b)c)d)e)

f)g)h)

j)k)m)n)

Laundry,Kitchen,Drinking water,Chemist shop,Waiting space for patient’s relatives,Public relation and social work,Horticulture and landscaping,Parking facility,Manifold services,Library,STD/ISD and internet facilities, and

P) Light music/Cable TV.

7.4.8 Follow-up Care

7.4.8.1 Hospital indices — quantitative

a) Bed occupancy rate,b) Average length of stay,c) Hospital death rate,d) Hospital acquired infection rate,e) Number of admissions,f) Number of discharge on non-medical grounds, and

g) Number of LAMAs (Left Against Medical Advice).

7.4.9 Functional Areas in a Hospital Up to 100 Beds.a)b)c)d)e)

f)!3)h)

j)

Entrance and Ambulatory Care Area,Critical care area (Emergency services),Diagnostic services,Intermediate care area,Intensive care area,Therapeutic services,Hospital services,Engineering services, andAdministrative/Ancillary services.

7.5 Entrance Area and Ambulatory Care Area

Ambulatory care is being provided in the Out PatientDepartment of the hospital. It is the first place where thesick and their relations come in direct contact with thehospital. It provides primary and comprehensive healthcare for ambulato~ patients who come for diagnosis,treatment and follow-up care.

7.5.1

a)

b)

In@@ructure with A4edicalEqu@ment andInstruments

Infrastructure for Ambulatory Care Area shouldbe in conformance with the norms given in IS 12433(Part 2), that is, 9.31 m2/bed and also as perAnnex A of IS 12433 (Part 2).Equipment, instruments and furniture required bythis department should be in conformance with thenorms given in Section 6 of IS 12433 (Part 2).However, the number of these shall be governed bythe actual local needs. In addition to the above, theitems required to be made available are as under:

lS 15461 :2004

1) ECGmachine,2) Nebulizer,3) Cardio pulmonary resuscitation kit (mobile

unit),4) Dark field microscope/ordinary microscope,5) Dermal curette,6) Electrocautery,7) Instruinents for micro graft,8) 4X to 10X lens with stand,9) Wood’s stand,

10) Skin biopsy punch (disposable) various sizes,11) Nail extractor and dissector,12) Molluscum curette extractor of various sizes,13) Thermometer,14) Knee hammer,15) Tape measure,16) ENT diagnostic set (complete),17) Bull’ eye Iarnp,18) Tuning forks,19) Head mirror,20) Clinical diagnostic pure tone audiometer,21) Laryngoscopic mirrors,22) Rhinoscopic mirrors,23) Suction cannula (different sizes),24) Weighing machine (Adult),25) Weighing machine digital (pediatric),26) Television with VCK27) Aversion therapy apparatus,28) Cot for hypnotherapy,29) Orthopedic fracture table,30) Spica table,31) Plaster cutters,32) Splints of various types,33) Traction kits of various types,34) Slit lampbimicroscopewithApplantiontonometer,35) Automated perimeter,36) Retinoscope,37) Refraction set,38) Dosimeter,39) PEFRmeters (Peak flow meter),40) Spirometry,41) Bronchoscope with accessories, and42) Gynecological examination table.

7.5.2 Physical Facilities

a) Out patient department (ambulatory care area)should be a separate wing segregated frominpatient department.

b) It should be easily accessible from the main entranceof the hospital and preferably in the ground floor.

c) It should also be easily approachable to thediagnostic and support services.

d) There should be adequate number of wheel chairsand stretchers in out patient department.

7.5.3 Five Main Parts of the Functional Zones of the

Ambulatory Care Area

7.5.3.1 Public zone or entrance zone

This zone is mainly used by patients and their attendants.The main functional areas of this zone areas under:

a) Parking Area:1) The parking area for the vehicles should be near

the main entrance of the hospital.2) A proper parking area should be earmarked so

that no encroachment shall take place near theentrance.

3) A separate area for physically challengedpersons should be earmarked at a convenientlocation.

b) Entrance Hall and Waiting Space:1) From the main entrance to the entrance hall

porch and slip proof ramps preferably with gra-dient of 1 :20 should be built for physicallychallenged patients/visitors.

2) Entrance hall serves as a waiting area for thepatients and their attendants before registration.

3) Waiting space must have proper sitting arrange-ments with ceiling fhns and provisions for drhk-ing water, telephone booth, snack bar, toiletsseparate for ladies and gents and any other asper the locaI need. One toilet each for males andfemales to be provided for first 200 patients and/or visitors followed by one each for every 100.

4) This waiting area should be adjacent to theregistration counter.

5) This area must have a display board indicatingabout the clinics provided, room numbers of theclinics and other services, days and timings ofthe various clinics, etc.

c) Reception, Enquiry and Registration:1) This area should be located near the entrance.2) Railings should be provided for separate queues,

that is, new patients and old patients, male andfemale.

3) Number of regis~ation desks will vary withpatient load but each desk should be able tohandle 12-30 patients per hour.

d) Room for Medico-social Worker:In meeting the problems of patients whose needsmay be aggravated by social factors, themedico-social service is an essential aspect ofthe hospital. A room should be allocated in theoutpatient area to the medico-social worker.

7.5.3.2 Ambulatory or joint use zone

This is the zone where patients and their attendants comein direct contact with the hospital staff. The various

5

IS 15461:2004

fictional areas of this zone areas under:

a) Clinics for Various Medical Disciplines:1)

2)

3)

4)

5)

6)

7)

8)

Clinics for various disciplines/specialtiesshould have sufficient number of consultation-cum-examination rooms.The clinicsfdisciplines provided in the outpa-tient area is as per IS 12377. These clinics are –medical, surgical, ophthalmology, oto-rhino-laryngology, obstetrics and gynecology, pedi-atric, orthopedic, family welfare, dermatologyand STD (optional), psychiatric (optional) andneonatology (optional).Pediatric clinic should be isolated from otherclinics.Orthopedic clinic should be in close proxi-mitj to the radiology and accident and emer-gency department, which shall help, in minimumcirculation and maximum use of equipment.Right from the registration counter patientsshould be guided to the required clinic with thehelp of proper signage system and for illiteratepersons the same is done by colour codes anddiagrams.Every clinic should have sub-waiting area forthe patients and their attendants.Every clinic should have a calling device forsummoning the next patient.Proper lighting and ventilation shouldbe provided in the examination room. Theillumination should not be less than 500 IUX.

b) Treatment Room:1)

2)

3)

4)

5)

This room should be provided for dressing andfor administering injections. These functionsshould be done in separate rooms if the workloadis high.There should be a separate treatment room forimmunization and should be located in thepediatric outpatient area.Treatment room for fractures should be bigenough to have dressing couch, spica table andmobile X-ray unit.Separate treatment room should be allocated tothe family welfare clinic for IUCD insertion andother diagnostic procedures.Treatment room for dermatology and STD clinicshould also be separate aid specially forleprosy cases.

c) Pharmacy:1)

2)

3)

The dispensary should be located in an areaeasily accessible fi-om the clinics and near theexit.For eveq 200 patients there should be one drug-dispensing counter with tracks,The dispensary should have enough space for

4)storage of drugs.Adequate stock of drugs should always beavailable in the drug store of the out patientdepartment.

d) Minor Operation Theater:Area for minor operation theater should beallocated near surgical clinic for minor surgicalprocedures.

e) Plaster Room:1) Plaster room should be adjacent to orthopedic

clinic.2) Plaster room should have space for plaster prepa-

ration, spica table and mobile X-ray unit.

7.5.3.3 Diagnostic and supportive zone

The various fictional areas of this zone are as under:a)

b)

c)

Central Specimen Collection Center:This is the area where all the specimens to beexamined are collected. After collecting thesespecimens they are further sorted out and sent tothe respective laboratories.Clinical Laboratory:There should be a provision for a small clinicallaboratory for providing support facilities to theclinics where immediate result is required fordiagnosis/treatment.Imaging Section:Area should be allocated for this facility, whichincludes X-ray and ultrasound thus providingsupport services to all the clinics.

7.5.3.4 Administrative zone

The out patient department requires an administratorfor planning, organizing, supervising, evaluating,coordinating and improving the services being provided.The various functional units of this zone are as under:

a)

b)

c)

d)

OffIce of theOPD In-charge:A senior person of the rank of Chief MedicalOftlcer should be the in-charge of the out patientdepartment arid shall look aflerthe day-to-day fi.mc-tioning of the OPD.Nurses Station for Administrative Control:This should oversee the general waiting area. Itshould have full inter-communication with theentire department and with other departments ofthe hospital.Cash Counte~Paymentsfor OPD tickets,consultation,variousinves-tigationsand other servicesmay be made at this place.Medical Record Room:1)

2)

The location of the record room should be incontinuation of the registration area, andMaintaining of records for medico-legal casesrelated to OPD is mandatory.

6

lS 15461 :2004

7.5.3.5 Staff zone

The staff members exclusively use this zone. The variousfunctional units of this zone are as unde~

a)

b)

c)

d)

Duty Rooms:

There should be separate duty rooms for doctorsand nurses. These rooms must have attached toi-lets and an area for preparing terdcoffee, etc.Stores:

There should be separate store for drugs, equip-ment and linen. This store should not be sharedwith any other department.House Keeping

Every floor should be provided with Janitor closetfor house keeping and cleaning materials.Conference/Seminar Room

7.5.3.6 Selection of patients

All patients coming to the out patient department shouldbe attended to but if the hospital/organization has itsown referral policy then action may be taken accordingly.

7.5.3.7 Medical care

a)

b)

c)

d)

e)

f)

Adequate number ofmedical staff should be postedin the outpatient clinics as per norms and standards.Medical staff preferably qualified in the specialtyconcerned should be posted in the outpatientclinics.Medical staff should be physically present in theirrespective clinics during the OPD hours.Medical records on diagnosis, investigationsadvised, outcome of various investigations and themanagement or treatment advised should be clearlymentioned on the OPD tickets.Medical staff must maintain punctuality.Behaviour of medical staff with patients and theirattendants must be empathetic and courteous.Patient’s satisfaction in this regard may be donethrough continuous evaluation and rectify thebottlenecks from time-to-time.

7.5.3.8 Nursing care

a)

b)

c)

d)

Nursing station should be tlmctional, efficient andeffective.All the nursing staff posted in the out patientdepartment should be physically present at theirrespective place of duty.Nursing in-charge should supervise, guide and con-trol the nursing and other supportive staff workingunder them.Supervise the housekeeping activities involvingmaintenance of clean, safe and comfortableenvironment in the outpatient area. ”

e)

o

g)

h)

j)

k)

Nursing in-chargeshould initiate the process of main-tenance and repair of various instruments and equip-ment used in the out patient department,Life saving drug trays should always be readilyavailable.Optimum stock of life saving drugs, dressings,linen, stationery items, house-keeping items,certain equipment like sphygmomanometer,stethoscope, torch, etc, should be available.Behaviour of nursing staff with patients and theirattendants must be empathetic and courteous.Patient’s satisfaction in this. regard may be donethrough continuous evaluation and rectify thebottlenecks from time-to-time.Maintenance of nursing record as per standardprotocol.Standard (Universal) precautions should bepracticed.

7.5.3.9 Ancillary care

a)

b)

c)

d)

Transportation of patients to any service areashould be safe, comfortable and timely.Security and safety of patients, their attendants andstaff should be ensured by the hospital administra-tion.Storage and serviceability of equipment, instru-ments, supplies and drugs should be as per laiddown procedures.Attitude of support care staff should be helpful,courteous and &npathetic towards the patien~ andtheir attendants.

7.5.4 Performance Parameters in Critical Care Area

(Emergen~ Services)

7.5.4.1 Infrastructure with medical equipment and

instruments

a) Infrastructure for critical care area should be in con-formance with the tiorms given in IS 12433 (Part2), that is, 4.69 mzibed and also as per Annex A ofIS 12433 (Part 2). As fhr as infrastructure param-eteti are concerned, ,)hefobving points are to beconsidered:1)

2)

3)

4)

5)

It should be near the main entrance of thehospital easily visible from a distance.Critical care area shouId have a distinct entryindependent of out patient department so thatminimum time is lost in giving treatment to thecasualties arriving in the hospital.It should be housed in the ground floor of thehospital.There has to be easy accessibility with outpatient department and radiology department.It should have ready access to the acute patient

7

.

IS 15461 :2004

b)

6)

7)

8)

9)

1o)

care areas Iike operation theater, intensive careunit and obstetrics unit.The blood bank, clinical laboratories, X-ray unit,record department and mortuary should benearby.Ambulance port should be of drive through type,covered and enclosed to protect patients duringtransfer from ambulance to the critical care area.Entrance for ambulant patients and those onstretchers should be separate and at least 1.6 mwide.It should have easy access to pedestrian andvehicular traffic.Directional signs to the critical care area shouldbe unmistakably marked and clearly visible dayand night.

Equipment, instruments and furniture required bythis department should be in conformance with thenorms given in Section 6 of IS 12433 (Part 2).However, the number of these shall be governed bythe actual local needs.

7.5.4.2 Physical facilities

a)

b)

c)

d)

e)

o

g)

The main entrance of the emergency departmentshould have porch and slip proof ramp.The entrance lobby should have a trolley, wheelchair and stretcher bay, general waiting area withpublic utilities.Patients’ relatives should not be allowed in the workareas of the emergency department.The general waiting area can be used for triage ofthe patients during mass casualties. It should beeasily accessible from the entrance. The hospitalshould have a sound policy to create space for ac-commodating the patients of mass casualties in thecritical care area.Reception area of the emergency departmentshould have an enquiry counter with queuingtracks.Near the entrance area there should be provisionfor a chemist shop and snack counter.There should be a control room of the size of10 mz near the entrance hall preferably with at-tached toilets for ambulance drivers/attendants,security, police and tire.

h) Nursing station and asdministrative oftlce shouldbe close to entrance area. Multiple telephones,bulletin board with roster of doctors and directivespertaining to the emergency department should bedisplayed.

j) Nursing station should be well stocked withemergency drugs and supplies.

k) Life saving drug tray should always be readilyavailable.

m)

n)

P)

d

r)

s)

t)

u)

v)

w)

Y)

Examination and treatment area should consist of alarge room and a number of smaller rooms for exami-nation and treatment. It must have provisions forresuscitative measures.Resuscitation room housed with all resuscitativeequipment must be made near the examination andtreatment area for stabilizing serious patients.The open emergency room should not be smallerthan 7.0 m x 13.5 m with door 1.3 m wide.An observation ward of about 6-8 beds where pa-tients should be kept under observation overnightbut not more than 24 h should be a part of criticalcare area. The observation ward should have a nurs-ing station and drugs/supply store.A separate room should be reserved for burnspatients.There should be provision for an operation theaterfor both major and minor surgeries depending uponthe situation.There should be an isolation room for infectiouspatients or patients who require reverse isolation(forHIV patients).Depending upon the local needs certain roomsshould be provided. These are rooms for doctor in-charge, storage space, utility and soiled linen room,cleaners room – house-keepers room, changingroom, duty/retiring rooms, room for dead bodiesand seminar room-cum-reference library.Provision of a locker room specially for keepingbelongings of unconscious or medico-legal cases.Critical care area should be provided with adequatelighting and power supply with standby genera-tors with capacity as per load.Communication system of this department withother areas of the hospital must be very sound andeffective.

7.5.4.3 Human resources

Manpower requirement in respect of doctors and othertechnical and supportive staff should be as per Section 5of IS 12433 (Part 2).

Requirement of nurs~ staff should be as per Annex C ofIS 12433 (Part 2).

7.5.4.4 Selection of patients

All casualties coming to emergency department must beattended immediately including all medico-legal cases.

7.5.4.5 Medical care

a)

b)

Medical personnel posted in the emergencydepartment should be available round the clock.All the doctors posted in this department shouldbe trained in emergency medicrne and resuscita-tion of patients.

8

._

,, !

c)

d)

e)

og)

Medical records on diagnosis, investigationsadvised, outcome of various investigations and themanagement or treatment advised should be clearlymentioned on the emergency tickets.Medial records in respect of medico-legal casesmust be ca.refidlymade and the MLC register shouldbe kept under lock and key.All the personnel working in the emergencydepartment must work as a team for managementof patients.Medical staff should maintain punctuality.Behaviour of medical staff with patients and theirattendants must be empathetic and courteous.Patient’s satisfaction in this regard may be donethrough continuous evaluation and rectify thebottlenecks from time-to-time.

7.5.4.6 Nursing care

a)

b)

c)

d)

e)

o

g)

h)

j)

Nursing station should be functional, efficient andeffective.All the nursing staff posted in the emergencydepartment should be available round the clockat their respective place of duty.Nursing in-charge should supervise, guide and con-trol the nursing and other supportive staff workingunder them.Supervise the house-keeping activities involvingmaintenance of clean, safe and comfortable envi-ronment in the critical care area.Nursing in-charge should initiate the process ofmaintenance and repair of various instruments andequipment used in the out patient department.Life saving drug trays should always be readilyavailable and should be checked on a daily basis.Optimum stock of life saving drugs, dressings,linen, stationery items, house-keeping items,certain equipment like sphygmomanometer,stethoscope, torch, etc, should be available.Behaviour of nursing staff with patients and theirattendants must be empathetic and courteous.Patient’s satisfaction in this regard may be donethrough continuous evaluation and rectificationof the bottlenecks from time-to-time.Maintenance of nursing record should be as perstandard protocol.

7.5.4.7 Ancillary care

a)

b)

c)

Transportation of patients to any service areashould be safe, comfortable and timely.Security and safety of patients, their attendants andstaff should be ensured by the hospital administra-tion.Storage and serviceability of equipment, instru-ments, supplies and drugs should be as per laiddown procedures.

d)

IS 15461:2004

Attitude of support care staff should be helpfid,courteous and ~ympathetic towards the patien< andtheir attendants.

7.6 Performance Parameters in Diagnostic Services

7,6.1

a)

b)

c)

d)

e)

o

g)

h)

k)m)

n)

P)

Laboratory Services

Information, registration and receipt of samples:

Information, Registration, receipt and Iabelling ofsamples should be done within 3-5 minutes.Storage and transportation of samples:Storage of samples should be at 4 to 80Croom tem-perature, depending upon type of samples (likeblood, urine, body fluids, tissue etc).Transportation of samples should be done in ap-propriate covered containers. The guidelines forstorage and transportation should be available inlaboratory.Processing of sample:

Time taken to process the sample should belimited to !4 to 2 h depending upon type ofinvestigations.Despatch of report:

Facilities for early despatch report of urgent andemergency cases should be made available.Despatch of routine reports should be done on thesame day. Provision of Computerized despatch andretrieval services is preferable.Number of samples/workload:

Laboratory should be able to handle at least 150routine tests apart from having arrangement forspecialized tests.Techniques used for investigations:

Availability of automated/semi-automatedequipment are preferred. Techniques used forinvestigation as well as reports should be displayedon working tables as far as possible.Quality control:

Internal and external quality control programmeshould be specified and practiced. Regular cali-bration and maintenance of the equipment shouldbe carried out and his$prysheet of equipment shouldbe maintained. Standardized reagent, kits andchemicals should be used.Reports recording, Indexing:

A proper legible record of all reports should bemaintained and indexed in specific registers.Availability of24 h Emergency lab services shouldbe ensured.General cleanliness of laboratory.General instructions of cleanliness should be fol-lowed.Laboratory waste disposal schedule should bestrictly followed as per guidelines of Government.Laboratory services should preferably be comput-

9

___

IS 15461: 2UU4

q)

7.6.2

a)

b)

c)

d)

e)

o

@

h)

7.6.3

a)

b)

c)

1

~rized providing accessibility of laboratory infor-mation to all the users.Standard (Universal) precautions should beprac-ticed with special references to blood and bodyfluids.

Imaging Diagnostic Service

Proper information should be displqved Informa-~ion receipt of requisition and registration : Re-

seipt of requisition and registration should be donepromptly and preferably in less than ten minutes.Vumber of radiographs/ultrasound : Availabilityof equipments (X-ray/USL) for handling 60-70number of X-ray/ the workload of ultrasoundinvestigations per day.Utilization of radiographic films : Proper recordof utilization of radiographic films should bemaintained. This should also include a record ofoverexposed/under-exposed or repeat films foreach case.Radiation protective devices : Proper use ofradiation protection measures and safety devicesshould be ensured for the staff as well as patients.Record of exposure counter reading for X-ray tube :

Record of exposure counter reading of X-ray tubeshould be properly monitored with a view to plan-ning preventive maintenance of the machine as permanufacturer’s instruction/manual. Further, recordof exposure of personnel to radiations should bemaintained (Dosimeter reading sent by BARC).Fixing and developing of X-ray films should bepreferably automatic and done according to laiddown procedure and guidelines.Ultrasound Norm – PNDT Act: Ultrasound facili-ties should address the provision of (pre-natal sexdetermination test) PNDT- Act guidelines. Appro-priate records of all Ultrasounds done should bemaintained.Reporting and dispatching of X-ray reports : Therequired time for reporting and dispatching ofX-ray reports should be less than one hour foremergency cases and on same day for routine cases.

ECG Services

Receipt of ECG demand and registration : Timerequired for receipt and registration of ECGdemand should be less than five minutes.Recording, reporting and despatch ofECG reportsECG Tracing should be taken in 10 minutes andhanded over to patient/dispatched immediately.Procedure should take less than ten minutes.Maintenance ofECG machine: Preferably mainte-nance should be carried out to ensure minimaldowntime.

d) A lady attendant for ECG should be provided.

7.6.4 Blood Transfusion Service

a)

b)

c)

d)

e)

o

g)

Information, receipt of demand and registration

for requisition of blood demand: Receipt andregistration of requisition for blood should be donewithin 10 min. Blood transfer should conform tothe provision of Blood Transfusion Act. Informat-ion regarding facilities and the broad policy ofthe blood bank together with general informationfor the patients/attendants should be readablyavailable and prominently displayed.Selection of donor : Selection of donor should bedone according to the notified criterion. Thesecriteria should be available. The entire selectionprocedure should take less than 30 min.Collection, grouping and cross matching of blood

This should be done within 45 min as per laid downprocedure.Mandatory screening of blood donor : Mandatoryscreening of blood donor for safety measures fortesting Hepatitis B and C, VDRL, HIV and Malariashould be completed in less than two hours.Blood Storage: Blood bank should have refrigera-tion capacity for a min of 25 bags with the facilityfor temperature control, humidity and alarm sys-tem.Issue procedure : Blood which has already beenscreened and stored should be issued within 20min after grouping and cross-matching. It shouldbe ensured that correct blood in good condition isissued. Proper record of requisition, blood collec-tion screening and issuing should be maintained.List of voluntary donors : Voluntary donors alongwith this addresses and telephone numbers andblood group should be readily available.

7.7 Intermediate Care Areas

The intermediate cafe Weas (more commonly known aswards) may be categorized into:/

a) General> wards .fThe traditional type of wards,where not so critically ill patients are attached forcontinuoits care or observation. “

b) Specialized wards : Wards for the patients whorequire some specificlspecialized type of care.

c) Private Warak: Most of these wards are pay wardswhere the patients enjoy more privacy with someextra facilities.

By and large, wards should be situated at a place awayfrom the general crowded places that ensures quietness.

7.7.1 Infrastructure

Infrastructure for the Intermediate care area should be in

10

.

:1F’.

IS 15461:2004

conformance with the norms of inpatient services as givenin IS 12433 (Part 2).


Patient holding area —Availability ofspace per bedshould be according to IS 12433 (Part 2). Generalcleanliness and maintenance should be according tosatisfactory level of acceptance so as to prevent anyhospital acquiredinfection. Also itshouldbeawayfiomgen~ral crowd of other busy areas of hospital.

The wards should be planned in such a way so as tominimize the nurse fatigue factor.

7.7.1.2 General ward facilities

Each

a)

b)

ward unit should have following functional areas:

Nursing station :

Itshould be positioned in such a way that the nursescan continuously monitor the patients. The roomshould contain a cupboard to hold materials, whichmight otherwise be placed in clean utility room, adrug cupboard, sink, chair, small table and spacefor all system points and records. Separate toiletfacilities for staff should be provided.Ward pant~ :

For collection and distribution of meals and

Item

Water closets

Ablution taps

UrinalsWash basinsBathsBed pan washing sinksCleaner’s sinks and sinkslslab for cleaning mackintoshKitchen sinks and dishwashers

c)

d)

e)

f)

g)

preparation of beverages, a ward pantry should beprovided. It should be fitted with a hot-watersupply geyser, refrigerator and hot case and shouldhave the facilities for storing cutlery, etc.Ward store :

A store should be provided for storing the weeklyrequirements of hospital linen and other ward equip-ments.Treatment room :Major dressing and complicated treatments shouldbe carried out in the treatment room to avoid therisk of cross-infection.Sluice room :A room, should be provided for emptying and clean-ing bed pans, urine bottles, sputum mugs, disposedof used dressing and similar material, storage ofstool and urine specimen, etc.Patient conveniences (Sanitary requirements) :

Toilet for an individual room (single or two bed-ded) in a ward unit shall be 3.5 m2to comprise abath, a WC in separate cubicle and a wash basin.For multiple beds of a ward unit, requirement offitments are given below.Ancillary room :

Ancillary room for doctors, nurses and supportingstaff should be well maintained and functional.

Numbers Required

1 for every 8 beds or part thereof (male)1 for every 6 beds or part thereof (female)1 for each water closets plus1 water tap with drainage arrangement in the vicinity ofwater closets1 for every 12 beds or part thereof (for male only)1 for every 12 beds or part thereof1 bath with shower for every 12 beds or part thereof1 for each ward in dirty utility and sluice room1 for each ward in dirty utility and sluice room1 for each ward in ward pantry

/

One toilet may be provided for the physically challenged persons.

7.7.1.3 Medical instruments and equipment staff, supporting staff and others according to IS 12433(Part 2) should be ensured,

Medical instruments and equipment should be availablein working condition. 7.7.3 Medical Care

i

r ‘

7.7.2 Human Resources a) The fmt medical examination and management ofevery admitted patient should be done as soon as

Availability of human resources ‘namely’ doctors, nursing possible but not exceeding one hour. However, the

11

IS 15461 :2004

b)

c)

d)

7.7.4

a)

b)

c)

d)

e)

f)

g)

admitting physician, particularly for emergency ad-missions, should always advise initial management.There should be comprehensive and accurate recordkeeping of every patient admitted indoor, particu-larly for the records of the provisional clinical diag-nosis, investigations requested and managementadvised and initiated at the time of first evaluation.Up-to-date medical record should be available atany given time [(see IS 13808 (Part 3)].Periodicity of visits of medical staff during the hos-pitalization of patient — should be at least once aday. It should be in accordance with the type ofsickness and its management. Each visit and ob-servations should be recorded in patient’s case sheetwith date and time.Behaviour of medical staff with patient andemployees shall be communicative, sympatheticand courteous. Continuous evaluation of patient’ssatisfaction, through exit opinion poll and employ-ees; interpersonal relationship should be carriedout (see Annex A).

Nursing Care

Reception ofpatient in the ward:Patient should be received with courtesy andwarmth. All documentation including patient’s con-sent shall be carried out as per hospital StandardOperating Procedures (SOP). Freshly prepared bedshall be made available to the patient immediatelyon arrival in the ward but not later than 15 minutes.The patient shall be made comfortable.Administration of oral/parental drugs :It should be administered as per schedule andprescription of medical staff and proper recordsshall be maintained.Organisation of diagnostic investigation :Timely and proper collection of samples for inves-tigation, their transportation to respective labora-tories, receiving and filing the reports in respec-tive patient’s medical record should be ensured.Monitoring of vitals :

Monitoring of vital parameters of the patient shouldbe done routinely, at least every 4 h or as per medi-cal advice. This should be recorded simulta-neously.A40nitoringfluid levels :

Record of I.V. fluid administration and, where ad-vised, intake and output charts shall be maintainedand available.Basic nursing procedures :

Itshall be ensured as per laid down standards (asper standard precautions).Supervision of support service staff:Support service staff attached to the ward shouldbe properly scheduled and supervised so as to meet

h)

j)

7.7.5

a)

b)

c)

d)

e)

o

g)

patient care needs in the ward. This should be moni-tored through duty rosters and staff movementrecords.Behaviour of nursing staff:

Nursing staff should be courteous, helpfi.dand sym-pathetic to the patients’ needs. Continuous evalu-ation of patient’s satisfaction through exit opinionpoll (see Annex A) and employees’ interpersonalrelationship should be carried out.Maintenance of nursing record:

It should be maintained as per standard protocol.

Ancillary Care

Personal assistance to the patient :

Need based assistance to the patient should be givenby appropriate staff and its evaluation should bedone in exit-poll analysis (see Annex A).Transportation ofpatient to other service areas :

Itshould be safe, comfortable and timely. The nurs-ing staff should monitor the patient’s movementrecords and services received.Provision of appropriate linen :

Linen should be changed at least thrice a week.Provision of diet :

Diet should be in accordance with therapeuticadvice, as per time schedule and served in a pleas-ant and courteous manner. Continuous evaluationof patient’s satisfaction through exit opinion poll(see Annex A) should be carried out.Security and safety :

Security and safety of patients and staff should beensured by hospital administration. The safety andsecurity implies physical safety and safety of prop-erty of patient and hospital and it should be en-sured as per laid down procedures.Storage and serviceabili~ :The provision for storage and serviceability of es-sential equipment and essential drug should bedone as per laid down procedures. It should bemonitored as per the patient drug administrationrecord and service record of equipmentiledgers.Attitudes of supporting care stafl:

It should be co@-teous,helpful and sympathetic tothe patient’s need.

7.8 Performance Parameters and Norms for IntensiveCare Unit (fCU)

7.8.1 Infrastructure with Medical Equipment andInstruments

Infhstructure for ICU should be in conformance with thenorms as given in IS-12433 (Part 2). Along with that thefollowing equipment and instrumentsavailable in proper working condition:

should also be

12

a)

b)c)d)e)

og)h)

j)k)m)n)

7.8.2

a)

b)

c)

d)

Basic resuscitation equipment including defibrilla-tor,Cardiac monitors and ECG machines,Ventilators (minimum of one for 2 beds),Adequate Ozcylinders/02 Concentrator,Medical gas supply with minimum number ofsimultaneously accessible gas outlets per bed foroxygen, air and vacuum,Suction apparatus (one for two beds),10-20 Electrical sockets,Back up generator of at least 1.5 kVAIUPS forcritical care equipment,Pulse oxymeter,Gas analyzer (optional),Isolation room (optional), andA/C with temperature 22-260C and humidity of40-60 percent.

Physical Facilities

Patient holding area for 2 to 6 beds with temporarypartitions. Availability of space per bed should beaccording to IS 12433 (Part 2), that is, 10.5 m2/bed.Fowler’s bed with low head end alongwith provi-sion for railing on either side.Strict measures should be taken to control I-Iospi-tal acquired infection, that is, strict adherence tostandard precaution procedures.Clean and properly disinfected urine pots and bed-pans for each bed.

e) Janitor closet and toilets should be kept absolutelyclean, hygienic and fictional.

f) Nursing Station should be strategically located sothat it can oversee all the beds simultaneously.1) It should be functional, efficient and in

effective condition.2) Life saving drug trays should always be readily

available.3) Optimum stock of all life saving drugs should

.!3)

h)

j)

7.8.3

a)

b)

be available in ICU.Ancillary room for doctors, nurses and supportingstaff should be well maintained and functional.Waitingarea for patient attendant and relatives withdrinking water and proper and clean toilet facili-ties.Essential information regarding patients to be puton display board outside I.CU.

Human Resources

Nursing stafl— Highly experienced and motivatednursing staff to be deployed as per the norms givenby Nursing Council, that is, one nurse per bedround the clock basis.Other human resources like doctors and support-ing staff should be according to IS 12433 (Part 2).

IS 15461:2004

7.8.4 Selection of Patient for Admission and Discharges

Hospital should have a sound policy for the selection ofpatient for ICU for the purpose of admission anddischarge.

7.8.5

a)

b)

c)

d)

e)

o

!3)

7.8.6

a)

b)

c)

d)

e)

Medical Care

Trained and qualified medical personnel shouldbe physically available in the ICU round the clock.Patient to be evaluated by the clinician as soon aspossible after admission.The admitting Clinician should always adviseinitial management.Medical records of provisional diagnosis, investi-gations requested and management advised andinitiated at the time of first evaluation should beprepared. Up-to-date medical record should beavailable at any given time [see IS 13808 (Part 3)].Medical staff should visit the patient at regular in-terval and all the salient observations to be recordedin the patient’s case sheet.Behaviour of medical staff with patient andemployees shall be communicative, sympatheticand courteous.Continuous evaluation of patient’s satisfaction,through exit opinion poll (see Annex A) andemployees’ interpersonal relationship shall becarried out.

Nursing Care

All the Nursing staff on duty should be physicallyavailable in the ICU round the clock.All documentation including patient’s consent shallbe carried out as per hospital standard operativeprocedure. Freshly prepared bed shall be made avail-able to the patient immediately on arrival in theward but not later than 15 min. The patient shall bemade comfortable.Patient’s clothing and the bed linen of the patientshould be changed at least once daily. It will alsobe changed immediately whenever soiled orstained. “All the drugs to be ‘given to the patient orally orparentally should be crosschecked and adminis-tered as per schedule and prescription of medicalstaff and proper record should be maintained.Organization of diagnostic procedures, that is,timely and proper collection of samples for inves-tigation, their transportation to respective labora-tories, receiving and filing the reports iri respec-tive patient’s medical record should be ensured.Monitoring of vital parameters of the patient shouldbe done routinely (that is at least 4 h) or as per medi-cal advice. This shall be recorded simultaneously.

13

1S 15461: 2(HJ4

g) Monitoring of fluids, that is, record of I.V. fluidadministration (wherever advised) and intake/out-put charts shall be maintained and properly recorded.

h) Basic nursing procedures should be ensured as perlaid down standards.

j) Support service staff attached to the ICU should beproperly scheduled and supervised. This shouldbe monitored through duty rosters and staff move-ment records.

k) Behaviour of nursing staff should be courteous,helpfbl and sympathetic to patients’ needs. Con-tinuous evaluation of patient’s satisfaction throughexit opinion poll and employees’ interpersonalrelationship should be carried out.

m) Maintenance of nursing record as per standardprotocol.

7.8.7 Ancilla~ Care

a] Personal assistance to the patient ; Need basedassistance to the patient should be given by appro-priate staff and its evaluation should be done inexit-poll analysis.

b) Transportation ofpatient to other service areas :Itshould be safe, comfortable and timely. The nurs-ing staff should monitor the patient’s movementrecords and services received.

c) Security and safety of patients and staff should beensured by hospital administration. The safety andsecurity implies physical safety and safety of prop-erty of patient and hospital and it should beensured as per laid down procedures.

d) Storage and serviceability : The provision forstorage and serviceability of essential equipmentand essential drugs should be done as per laid downprocedures. It should be monitored as per thepatient drug-administration record and service-record of equipment/ledgers.

e) Attitude of support care staff should be courteous,helpful and sympathetic to the patient’s need.

7.9 Performance Parameters and Norms forTherapeutic Services

The therapeutic services of the hospital consist offacilities provided by operation theatre suite, deliverysuite and physiotherapy. The performance parameters andnorms for these services should ensure that the relatedtechnical and art of care are delivered in an effective,efficient and acceptable way. Concurrently, it willfacilitate objectives of achieving quality patient and staffsatisfaction consistent with professional standards andethics. This will sequentially ensure provision of qualityassurance and continuous quality improvement in theseservices. Quality assessment necessitates using a widearray of criteria and undertaking analysis at individual,

departmental and organizational levels. Measurableperformance indicators should be incorporated formonitoring, evaluation and improvement of the services.

7.9.1 Operation Theatre Suite

7.9.1.1 Site planning

OT should be planned so as to ensure:

a) avoidance of unrelated hospital traffic flow in thearea.

b) convenient functional relationship and communi-cation with surgical ward, ICU, CSSD, blood bank,X-Ray and pathology lab.

c) avoidance of outdoor source of noise.d) provision for future expansion/alterations.e) other parameters for location of OT should be as

enumerated in IS 12433 (Part 2).

7.9.1.2 Area requirement and zoning

The areas for the different components of the operationtheatre suite, that is, the protective clean, sterile anddisposal zones should be in consonance with Section 2of IS 12433 (Part 1)and Section 3 of IS 12433 (Part 2). Inorder to ensure asepsis in surgical practice, OT suiteshould conform to the principles of zoning, namely, di~,protective, clean and sterile areas. The traffic flow ofpatients, staff and supplies should be appropriatelycanalized in and out of the operation theatre suite.Contaminated material should be removed withoutpassing through the protective, clean or sterile zones.

7.9.1.3 Human resource development

a) The manpower should be as recommended inIS 12433 (Part 2).

b) It must be ensured that the manpower has the requi-site educational qualifications and skill. Personnelshould be selected based on capability to satisQdefined job d@cription. The staff should be encour-aged to upgrade their knowledge and skill bytaking part in. seminars/workshops/con ferences/continued medj6a1 education programmed. Sched-uling of duties should be planned to ensure avail-ability of manpower for scheduled and emergencycontingencies. The work environment should fosterexcellence and a secure work relationship. The staffshould be motivated to provide focused qualitymedical care with a human touch. The staff serviceshould be communicative, courteous and prompt.


Preparation room, pre-operative room, post-operativerooms, operation theatre, scrub and instrument steriliza-tion rooms should be as per guidelines enlisted in

14

-...

1S12433(Part 2). The important parameters which shouldbe considered are as follows:

a)

b)

c)

d)

e)

f)

g)

h)

j)

k)

m)

n)

P)

Corridors should not be less than 2.85 m inwidth.Central air conditioning should ensuretemperature range of 21 to 25°C, with 50 to60 percent humidity levels. Positive pressureventilation, low turbulence displacement air flowwith minimum 15 to 20 air changes per hour andhigh efficiency particulate air (HEPA) filtersshould be incorporated.The operation theatre should have in-situ mo-saic tinish for full height of walls.The flooring should either be in-situ mosaic withleast possible joints and copper strips to carryaway any static electricity produced or of joint-less conductive tiles.The ceiling should be painted with washablepaint and comers of the rooms should be roundedoff to prevent collection of dirt and dust.Taps in the scrub room should be knee/elbowoperated.Electrical wiring should be in concealedconduit. Lighting, both natural and artificialshould be of appropriate illumination intensityand contrast. The OT table should haveshadowless flexible illumination system withcapability of providing 60000 to 150000 Iuxand should have an independent battery sys-tem. All electrical points should be of the nonsparking type and positioned above 6 feetheight. A minimum of 8 multipurpose socketelectric points should be available in each unit.Earthing facilities should be provided,Facilities should exist for uninterrupted powersupply(UPS) and voltage stabilization,power backup with provision of standby generating sets.Doors should be of double action two leaf typelsliding and of minimum 1.2 m width in areaswhere patient movement is anticipated like op-eration theatre, pre- and post-operative rooms.OT table and trolley to have facilities forTrendelenberg and reverse Trendelenbergposition with side railings.Auditory levels should be ensured in the rangeof25 to 35 dB.Communication system including patient infor-mation system. Facilities should exist for tele-phone communication within various rooms ofthe OT suite as well as with other departments ofthe hospital. Patients’ relatives should be peri-odically informed about the patients’ movement/progress in the OT suite.Fire safety measures should include smokedetectors and automatic water sprinklers.

@r)

s)

t)

u)

v)

w)

Y)

IS 15461:2004

OT should have facilities for sterilization.Essential pharmaceutical storage includingrefrigeration facilities should be available.Waste disposal facilities should be available es-pecially for bio-medical waste as per Bio-A4edi-

cal Waste (Management and Handlin@ Rules,

1998. There should be an external exit in thedisposal zone for conveyance of theatre refhge.There should be a waiting area separately forpre- and post-operative patients. There shouldbe a waiting room with toilet facilities for pa-tient attendants.Separate change rooms should be available fordoctors, nurses and technicians with arrange-ments of lockers and toilet facilities.There should be a minimum of 2 air, 2 oxygen, 2suction outlets of Medical Gas Supply in eachOT and also in pre- and post-operative areas.Patient should be shifled out ffom post-opera-tive room only on written instructions of Anes-thetist/Surgeon along with post-operative notes.There should be a Nurses Reception desk to over-look all entries and exit points as well as patientarea.

7.9.1.5 Equipment

a)

b)

c)

Equipment should be as per details given inIS 12433 (Part 2). In addition, provision of cardiacmonitors and defibrillator should be ensured.Annual maintenance contract (AMC) should bescientifically executed for all major equipment.NecessaW clauses for preventive maintenance,‘Down-Time’ specifications and penalty clauses fornon-adherence to terms and conditions should beincorporated in the AMC.The following indices should be calculatedand analyzed for ensuring optimal utilization ofequipment:1) Use-coefficient,2) Down-time index, and

d)

e)

3) Break-even analysis.The staff should be trained to properly handle andcarry out preventive maintenance of the equipment.There should be protocols and standing operativeprocedures (SOPS) to ensure availability, calibra-tion, fimctionality as well as effective preventiveand breakdown maintenance of equipment.

7.9.1.6 Protocols and standing operating procedures

There should be comprehensive and well-defined,specific and acceptable protocols for the operatingsystems. Standing operating procedures (SOPS) shouldbe available for facilitating and ensuring actions inaccordance with documented work instructions as perdefined standards. The SOPSshould be regularly reviewed

15

IS 15461:2004

and updated. The staff should be well versed with theSOPS. Comprehensive and up-to-date SOPS should beavailable for the following:

a)b)

c)

d)

e)

f)

g)

h)

j)k)

m)n)

P)

Operation theatre scheduling.Reception and identification of patients. Handingand taking over of patients to and from the opera-tion theatre.Pre- and post-operative monitoring and manage-ment of patients including record of dentalprosthetics, drug allergies, medication, bloodgrouping and transfusion.Checklist for correctness of swabs, instruments usedduring operation.Deaths in OT.Sterilization indices, Re-sterilization of unused andsterilized packs.Cleaning of OT, asepsis measures including fumi-gation.Surveillance of OT for pathogens.Equipment maintenance.Handling of bio-medical waste including segrega-tion, colIection, transportation, storage treatmentand disposal.Maintenance of records.Job specifications and responsibilities of variouspersonnel, andRole in disaster management.

7.9.1.7 Records

Records for the following must be meticulouslymaintained, analyzed and if required, remedial measuresinstituted for improvement.

a)

b)

c)d)

e)

0g)

h)

Jk)

m)

7.9.2

Death in OT, anesthesia related deaths. Detailed in-vestigativereports shouldbe maintainedfor each case.Workload, operation room utilization. Record ofoperations.Fumigation and laboratory reports.Records of temperature, pressure, holding time andrandom sampling of sterile items for culture.Post-operative Infection Rate.Staff absenteeism and turnover. Duty roster for staff.Scheduling and waiting list for operations. Post-ponement of scheduled operations.Patient and staff satisfaction. Complaints frompatients, visitors and staff.Pathology reports of surgical specimens.Bio-medical waste disposal.OT accident reporting.

Delivery Suite Unit


The labour and delivery suites should be in as isolate aplace in the hospital as practicable. This wi11ensure

avoidance of non-related and unnecessary traffic throughthe suites and provide privacy to the patients. The facilityshould be in close proximity to nursery, obstetricalnursing unit, operation theatre and blood bank.

7.9.2.2 Area requirement

The area requirement and number of maternity bedsshould be in consonance with Section 2 of IS 12433(Part 1) and Section 3 of IS 12433 (Part 2).

7.9.2.3 Human resources development

The medical and nursing manpower should be inconsonance with IS 12433 (Part 2).

7.9.2.4 For enhancement of knowledge and skill andoptimal utilization of manpower measures as enumeratedin 7.9.l.3(b) should be undertaken.


The delivery suite unit should have facilities for receptionand admission, examination and preparation room, labourroom, delivery room, sterilization room, sterile store room,scrubbing room, dirty utility room, change room fordoctorshmrses, pack preparation room, instrument andstorage, recovery and Isolation rooms. These should beas per guidelines prescribed in Section 7 of IS 12433(Part 2). The important parameters that should beconsidered are:

a)

b)

c)

d)

The registration counter should open into an en-trance lobby.The preparation room should have adequate facili-ties for bathing, enema and an examination table.Labour rooms should have Iabour delivery bed witharrangements of stirrups, adequate lighting facili-ties for clinical examination. R should be soundproofed, width of the doors should be minimum1.2 m to facilitate movement of stretchers. Thereshould be provision for medical oxygen. Thereshould also be an electronic foetal heart-recordingmachine, available.Delivery room should cater for normal deliveriesand caesareans. Sterility should be maintained asfor operation theatres. It should have a designatedarea for new born babies with requisite resuscita-tive and emergency medical drugs and equipmentlike Ambu bag, suction apparatus and oxygen cyl-inders. Provision for piped suction air and oxygensupply should be made. Sinks with elbow or kneeoperated taps are essential and there should also bean emergency call system. A labour room shouldpreferably be of 18 fi x 18 ft dimension. The floorshould be conductive as for operation theatres.Placenta and dead foetuses alongwith other

16

IS 15461:2004

e)

f)

g)

bio-medical waste should be disposed as per Bio-medical Waste Management and Handling Rules,1998. The delivery room for caesarean sectionsshould have facilities including sterility related asenumerated for that of Operation Theatres.Recovery room should have facilities for medicalgases and cabinets, as well as troIleys for medicinedispensing.Sterilizing rooms, scrub-up room, dirty utility roomand other facilities should be as enumerated in Sec-tion 7 of IS 12433 (Part 2) for delivery suite unit.A waiting room for patient’s attendants is alsodesirable.

7.9.2.6 Equipment

a) SOPS for optimal utilization of equipment, AMCand utilization indices should be as enumerated in7,9.1.5(b) to 7.9.l.5(e).

b) Equipment should be as per details given inIS 12433 (Part 2), In addition, provision should bemade for obstetric table, foetal heart monitor, cardiacmonitor, Ambu bag, ET tube. Resuscitation equip-ment for the new born should also be available.

7.9.2.7 SOP k

7.9.2.7.1 SOPS should be available as enumerated foroperation theatre suite. In addition, SOP should also beavailable for identification of babies including their sex.Use of wristbands and inedible ink should be made toavoid mix-ups and associated legal cases.

7.9.2.8 Records

Records for the followingmaintained and monitored:

must be meticulously

a)b)c)

d)e)

Workload, labour and delivery room utilization.Pre-term babies.Labour/delivery/anesthesia related deaths.Detailed investigative reports should be maintainedfor each case.Vehicle delivery cases.Other applicable records as enumerated for OT suite.

7.9.3 Physiotherapy Department

The main objective of physiotherapy services is tofacilitate patients achieve optimum functional physicalcapabilities by prevention, correction or alleviation ofphysical disabilities.


The physiotherapy department should be sited to beconveniently accessible to indoor as well as outpatients.Parameters such as natural light, fresh air and privacyshould be given due consideration.

The department should preferably be situated on theground floor.

7.9.3.2 Functional areas

a) These should include the reception area, hydro-therapy area (whirlpool/Hubbard tank), gymna-sium, cubicle treatment area for electrotherapy,thermotherapy and massage therapy, waiting room,storage room, staff toilets. Toilet facilities forpatients should be designed so as to be alsoaccessible and usable by wheel chaired patients.

b) The timctional areas should be in consonance asenumerated in Annex A of [S 12433 (Part 2).


The physiotherapy services should provide facilities forelectrotherapy, thermotherapy, hydrotherapy andgymnasium as per guidelines enumerated in IS 12433(Part 2). The important parameters which should beconsidered are:

a)

b)

c)

d)

e)

o

g)

h)

j)

k)

m)

The department should be well ventilated withappropriate lighting facilities and providingcheerful and a relaxed environment.The cubicles should provide privacy to patients.Provision of sliding doors/curtains should be suit-able. Suitable stepping steps for patients accessi-bility to treatment table.The cubicles should be spacious to provide enoughspace to physiotherapists to provide assistance topatients flom either side of the tables and also foreasy access for wheel chaired patients.Movement of patients using wheel chair, crutches,walking sticks should be facilitated by provisionof ramps, wall bars, appropriate toilet facilities andtreatment cubicles.Separate changing room for male and femalepatients,Gymnasium should have non-slip, preferablywooden flooring.Ceiling height should be minimum 12 feet tofacilitate equipment installation.Provision of wall mirrors should be made in thedressing cubicle and gymnasium area preferablyof size 60 cm x 45 cm and 200 cm x 50 cmrespectively.A place for parking wheel chairs, trolleys andstretchers should be available.Detailed record of patient’s history, plan of treat-ment, follow-up and improvement should be main-tained.The floor and the sidewalls of the hydrotherapypoolsshould be non-skid type and ridged or studded. Thereshould also be a provision for steps, hand rail andpipe rail above water level on long sides of tank.

17

IS 15461:2004

7.9.3.4 Human resource development

a)

b)

c)

The manpower should be in consonance with1S12433(Part 2).For enhancement of knowledge, skill and optimalutilization of manpower measures as enumeratedin 7.9.1.3(b) should be undertaken.The staff should be able to effectively manageindoor and outdoor patients. Bedside physio-therapy should also be provisioned for.

7.9.3.5 Equipment

a)

b)

7.10

Availability of equipment should be as per detailsgiven in IS 12433 (Part 2).SOPS,AMC, equipment utilization index and stafftraining should be as enumerated in 7.9.l.5(b) to7.901.5(e).

Performance Norms in Hospital Services

7.10.1 Kitchen (Dieta?y Services)

7.10.1.1 The kitchen or dietary service department of ahospital has the responsibility of preparing anddistributing nutritionally adequate meals for patients ata cost consistent with the policies of the hospitaI.

7.10.1,2 Infrastructure with equipment and instruments

a) Infrastructure for kitchen should be in conform-ance with the norms given in Annex A ofIS 12433 (Part 2), that is, 1.54 m2ibed. As far asinfrastructure pawneters are concerned, the follow-ing points are to be considered:1)

2)

3)

b)

The location should ensure that any noise orcooking odours emanating ffom the departmentdo not cause any inconvenience to the otherdepartments.Kitchen should preferably be located in theground floor of the hospital.All the units of kitchen should be so placed thattraftlc flows in a straight line, that is, receiving,storage, daily stores, preparation, distributionand dish washing.

Equipment, instruments and furniture required bythk department should be in conformance with thenorms given in Section 6 of IS 12433 (Part 2). Inaddition to the above equipment the followingequipment may also be made available:

1) Dish washer (optional);2) Doss plate;3) Dough kneading machine;4) Egg beaters;5) Electric geyser;6) Fly catcher;7) Food boiler;

8)9)

10)11)12)13)14)15)16)17)18)19)20)21)22)23)24)

25)

Food trays;Garbage trolley;Grillers;Hot plate;Iron racks;Milk/tea urns;Mixer, grinder and juicer;Pressure cookers;Rice colande~Rice cooker - bulk;Steel drums;S.S.top worktable withgmbagechuteand drawers;Thermos flask;Storage racks;Fly catcherWater filters;Weighing machines for weighing up to 300 kgand 1 to 5 kg; andWork table with double sink.


In physical planning of the kitchen, by and large, thefollowing areas are to be provided:

a) Receipt and storage of food and supplies:1) Receiving/Inspection area

i) Entrance of the receiving area should belocated where the noise of vehicles will notdisturb patients.

ii) A weighing scale (stringless dial-faced plat-form scale) is essential in the receiving area.

2) Storage areai) A dry, well-ventilated and secured storeroom

should be provided for non-perishable itemslike wheat, rice, pulses, sugar, oil, etc.

ii) This area should be big enough to hold bulkstocks ,for a fortnight to a month.

iii) An area for storing one or two day’s suppliesshould be located near the food preparationarea. TMs area can be used for storing veg-etables.

iv) Refrigerated storage is required for perish-able items”’likepoultry, meat, dairy products,eggs, fruits, vegetables, etc. It should be cen-trally located for easy supervision andcontrol.

v) Equipment store for vessels, utensils,machines, etc, that are not required for dailyuse.

b) Normal and special diet kitchens with separatepreparation and cooking areas:i)

2)

Preliminary preparation of food:This area should be located between the storagearea and the cook’s unit.Main food preparation uniti

18

lS 15461 :2004

3)

4)

i) The number of meals and the complexity ofthe menu can determine the type and capac-ity of equipment required for this unit.

ii) Equipment should be arranged in a directline of traffic from the receiving area, throughpreparation, to the point of service.

iii) Approximately 4 feet of worktable spaceshould be allowed for each preparation em-ployee.

Special diet area:This area should be located next to the dietitian’sroom for effective control.Formularoom:This may be part of a special diet kitchen,but should preferably be located adjacent to thenursery.

c) Wash-up area:i) The washing room requires a three-compart-

ment sink, one for pre-rinse and soaking, onefor washing, both with water at 49-60°C andone for rinsing with water at 82”C. The sinkshould have splash back and grease traps.

ii) Facilities for sterilizing the food containersof the trolleys should be provided.

iii) Food containers and trolleys shall be parkedin the trolley bay.

iv) Floor should be smooth, clean and in goodcondition preferably made of concrete, ter-razzo or tile.

v) Floor drains should be provided with propertraps and so constructed as to minimize clog-ging and properly graded for drainage.

d) Miscellaneous rooms:Rooms for dietitian, oflice of kitchen, change roomfor kitchen staff, trolley parking area, toilets, etc,should be included.

e) All doors and windows should be fly proof.~ All working surfaces should be provided with

sufficient light.


Manpower requirement in respect of kitchen staff shouldbe as per Section 5 of IS 12433 (Part 2). The various typesof staff to be provided in kitchen are dietitian, steward,storekeeper, clerldtypist, cooks, bearers, masalchi andhouse-keeping staff.

7.10.1.5 QuaIi@parameters in dietary care services

a)

b)

c)

Dietitian should be the overall in-charge of thedepartment.Food standards should be specified before makingany purchase.Dietitian must work closely with the medical staffin preparing the patient’s diet.

19

■

((

i1

d)

e)

o

.?3)

h)

j)

k)

m)

n)

P)

Dietitian should be solely responsible for requisi-tioning food and dietary supplies.There should be a clear cut laid down policy forpurchase of food and supplies.Responsible and reliable supervisory staff shouldbe in the kitchen throughout the working hoursthat should be about 16 hours a day.The service time should be fixed taking into con-sideration the traffic on floor and elevators.The dietitian should check the food in respect ofits presentation, palatability and nutritional ad-equacy.Responsibility should be fixed for the compila-tion of regular dietetic menus, modified or specialdiets and a therapeutic dietary manual.Periodic and adequate health examination shouldbe carried out of all the staff handling food andrelated goods at least once a year.Regular cleaning schedules and periodic inspec-tion of dietary equipment should be carried out.Staff working in this department should be inuniform.See also 7.8.3 of IS 15195.

7.10.2 Performance Parameters in Central Sterile Supply

9epartment (CSSD)

:entral sterile supply department is an organizeddepartmentwhere surgical equipment and allied materials,ncluding dressings and linen are sterilized centrallymder specific conditions and strict quality control.

7.10.2.1 Infrastructure with medical equipment and

instruments

a) Infrastructure for central sterile supply departmentshould be in conformance with the norms given inAnnex A of IS 12433 (Part 2), that is, 1.40 m2/bed.As far as infrastructure parameters are concerned,the following points are to be considered:

b)

1)

2)

3)

The location should be where the most rapidmeans of transportation of supplies and equip-ment is possible.This departmem should be located near themajor users of CSSD, such as the OperationTheater, delivery suites, emergency departmentand ward units for easy accessibility.CSSD should have adequate supply of water(both hot and cold), steam, compressed air andelectricity.

Equipment, ‘instruments and furniture required bythis department should be in conformance with thenorms given in Section 6 of IS 12433 (Part 2). Inaddition to the above, equipment required are asunder:1) Gauze cutting machine

IS 15461 :2004

2)

3)4)

5)

6)

7)

8)

9)1o)11)12)13)14)15)16)

Glove washing machineGlove drying machineGlove powdering machineHigh speed instrument sterilizerHot air ovenIncubatorArrangement for hot and cold water supplyRolled steel tubular trolleyStainless steel top worktable with under shelfStainless steel wire basketsStorage racksWasher disinfectorWater distillation unitlwater plantWater Sofiening PlantOther items like fhmiture, sink, cupboards, wasteunit, pack assembly bench, folding table, paperbags, containers, chairs, etc.


In physical planning of the CSSD the following areasmay to be provided:

a)

b)

c)

d)

e)

o

g)

h)

Receiving area — This is the area for receipt of theused/dirty stores. About 3 percent of the total spaceis required for this area.Clean up/wash room — This clean area is for clean-ing, washing and decontamination of stores. About7 percent of the total space is required for this area.Unsterile storage area — This clean area requiresabout 15 percent of the total area. It is used for un-sterile bulk storage of supplies, equipment andequipment inspection and maintenance.Miscellaneous rooms — Include gauze and dress-ing assembly area, area for linen, glove room, of-fice of CSSD, change room for CSSD staff, trolleypark are% toilets, etc. These rooms require about12percent of the total area. This is also a clean area.Area for syringe, needle and instrument processing

This section requires 12 percent of the total area. Itis a clean area.Glove processing area — requires about 5 percentof the total area. It is also a clean area.Clean work area — for sorting, testing, inspecting,packaging and sterilizing. This is the area whereautoclaves and sterilizers are housed. It requires30 percent of the total area.Sterile area – It includes sterile stores and issuecounters and constitutes about 16 per cent of thetotal area.


Manpower requirement in respect of technical and otherstaff should be as per Section 5 of IS 12433 (Part 2). Thevarious types of staff to be provided in CSSD are CSSDtechnicians, CSSD attendants and messengers for wards/

operation theaters/delivery suites, boiler attendant, clerksand house-keeping staff. As a rule of thumb one CSSDworker is required per 30 beds plus one supervisor.

7.10.2.4 Quali&parameters in CSSD

a)

b)

c)

d)

e)

o

g)

h)

j)

k)

m)

n)

P)

All materials must be subjected to proceduresensuring sterility.It is safe to consider all used articles as contamin-ated.It is impotiant that all steps are undertaken to avoidmixing up of contaminated and sterile articles ateach stage – collection, storage, issue and trans-portation.The system of packing sterile materials should besimple, easily understood by all users, clearlyindicating what is sterile and what is not.The pressure in the autoclaves must be steady allthe time during sterilization. There has to be aproper coordination between pressure, temperatureand holding time.In CSSD practice of prescribed norms of steriliza-tion is extremely essential. At a pressure of 32.5 lbsand temperature of 134”C, the holding time shouldbe 3-5 minutes and; at a pressure of 17-20 lbs and125°C of temperature, the holding time should be20-30 min.Clock record of every autoclave about time, tem-perature and holding time must be maintained ondaily basis.All items/packs/baskets are to be sterilized withproper numbering,Use of heat sensitive indicator tapes with everyload is essential.Periodical bacteriological test should beconducted by placing culture tubes of Bacillus

Stearothermophilus.Random testing of samples of sterilized items forinfection or contamination.Shelf life of sterilized items should not be morethan 72 h.See also 7.8.1 of IS 15195.

7.10.3 Performance ~arameters in HospitaI Laund~

7.10.3.1 Infrastructure with equipment and instruments

a) Intlastructure for hospital laundry should be in con-formance with the norms given in Annex A ofIS 12433 (Part 2), that is, 1.54 m2/bed. As far asintlastructure parameters are concerned, the fol)ow-ing points are to be considered:1) The location should be convenient to the user

units but preferably in the same building as thehospital.

2) This department should have separate entranceand exit areas.

20

lS 15461 :2004

b) Theequipment, instruments and furniture requiredby this department areas under:1)2)3)4)5)6)7)8)9)

1o)11)12)13)14)15)16)17)18)19)20)21)22)

Air compressorCalendaring machineDry linen trolleyDrying tumbler (electrically heated)Linen rack with shelvesFlat steam press pneumatic liftingFolding tableFurniture and trolleysHand iron with tableHeavy duty ironing tableHydro extractorWater extractorSluicing machineMS chimneyRolling shelf trolleyWashing machineSorting trolleySteam boilerWater Softening PlantWeighing machine of 250 kgWet iron trolleyStorage racks


a) In physical planning of the Laundry services thefollowing areas are to be provided:1) Reception2) Counting and weighing3) Sorting for repair and condemnation4) Sluicing of stained clothes5) Washing area6) Hydro extraction7) Drying8) Calendaring and pressing

b) Issues that need to be given due consideration whileplanning physical facilities are as under:1)

2)

3)

4)

5)

6)

7)

Flooring should be smooth, non-slippery andwater impervious.Walls should have smooth, washable surface andfree from all unnecessary comers.Ceiling should be smooth and washable andshould be high enough to allow for installationand repair of all equipment. The main laundrybuilding should have a clear headroom of 14feet.Doors should be wide enough to admit heavymachinery and trolleys.Ventilation should be adequate. Exhaust fansshould be provided adequately. Recommendedair changes are 10 per hour.Lighting should be adequate. Day light shouldbe used whenever possible.Power supply should be adequate, that is, 220or 440 volts, 3 phase and alternating current.

8)

9)

10)

11)

12)

The steam supply system must deliver steam tothe equipment in the quantity and at the desiredtemperature, that is, 170°C with 100 Psi. Allsteam lines should be properly insulated.Uninterrupted water supply round the clockinadequate quantity is a must. For every kilogramof linen 15 litres of hot water and 10 Iitres of coldwater is required. If hardness of water exists thenwater-softening plant should be installed.There should be provision of toilets, locker roomand shower facilities.Sewing room should be provided near the cleanlinen area.Room should be provided for laundry manager’soffice. This room should be centrally locatedfor effective supervision of the entire laundryoperation.


Manpower requirement should be as per Section 5 ofIS 12433 (Part 2). One washer man/dhobi for about60-75 kg of linen.

7.10.3.4 Quali@ parameters in laundry

a)

b)

c)

d)

e)

f)

g)

h)

j)

k)

All linen purchased for the hospitaI should be ofgood quality from approved firms only. Each typeof linen should be chosen with regard to weave,tensile strength and colour.Linen quality control : 1) any deficiency with re-gard to stains, holes, tears, dirty linen issued to wardsshould be brought to notice of laundry manager forremedial action; 2) ideally six sets of bed line perbed; minimum acceptable is four set per bed;frequency of change of linen has been omitted.Centralized control of laundry services generallyhave better control over the laundry services.It is important that all steps are undertaken to avoidmixing up of contaminated and sterile articles ateach stage – collection, storage, issue and trans-portation.The system of proper locking of stock room andrestriction of numbt% of persons having access tothem.The proper sealing of containers and bags duringtransit of linen ffom one area to another and systemof receipt at each stage should be adhered to.[n laundry responsibility should be fixed to thestaff holding the charge of Iinen.There should be constant and positive supervisionat all stages of linen circulation.There should be regular physical verification topinpoint the extent and type of loss with properpreventive action by the administration.There shouldbe reguhrcondemnation of linenarticles.

21

lS 15461 :2004

m)

n)

P)

Various records in respect of all inventories shouldbe properly maintained.There should be proper security arrangements atall exits and the number of exits should be mini-mal.See also 7.8.4 of IS 15195.

7.10.4 Performance Parameters in Stores

For an effective functioning of stores, the followingfunctions should be performed:

a)b)c)d)e)

f)!3)h)

Demand estimation,Procurement,Receipt and inspection,Storage,Issue and use – Pharmacy,Maintenance and repair,Disposal, andAccounting and information system.

7.10.4.1 Infrastructureparameters

The location of the Hospital supply system (Stores)should be such that it ensures an easy flow of supplies,has quick and easy access to the main road and promotesleast expensive transport of supplies tlom source to user.

The criteria for store site selection are:

a)b)c)

d)

e)

f)g)

Easy accessibility to transport links,Site well served by water and electricity,Surrounding area should not be subject toflooding,Unimpaired entry/exit for heavy load carryingvehicles with adequate parking,Ample unloading/receiving a~ea,Area well secured from outside intrusions, andWell connected communication facility.

7.10.4.1.1 Building

The store building should have:

a)b)

c)

d)

e)

og)h)

j)k)

Easy entry and exit points;Ramp at entrance for easy movements of heavyitems;Adequate ventilation and good interval air circu-lation;Optimum utilization of space by built-in shelvesat different heights;Easy maintenance of bulk supplies;Systematic arrangements of stocks;Provision of cold chain maintenance;Secure storage area for controlled stocks like nar-cotics etc;Protected fireproof storage area;Provision of tire prevention measures like alarms

m)n)

P)

@

r)

and fire-fighting equipmentRound the clock security by watchmen;Generator supply;Pest control measures should be undertaken atintervals;Medical stores should be filly insured separately;andTrolleys with wheels to be provided to transfer thestock to various departments.

7.10.4.2 Process parameters for quality assurance of

hospital supply system

a) T~es of stores items:Hospitals should have availability of the follow-ing three categories of stores:i) Medical stores — Drugs, vaccines and contra-

ceptives, laboratory chemicals and kitsii) Surgical stores (incIuding instruments) —

Expandable and Non - Expandable ~iii) General stores — Stationery, Furniture, Linen

b)

c)

and other itemsDemand estimation:Availability of a committee to look into matters ofpreparation and time to time updating of hospitalsdrugs formulary. This should be prepared basedupon review of the morbidity pattern and consump-tion rates of the items. Effort should be made toreduce variety of drugs limiting to the WHO list ofessential drugs. ‘This drug formulary should be readily available.Procurement1)

2)

3)

4)

5)

All the procurement procedure to be doneunder the supervision of a committee (StorePurchase.)One of the Medical Officers should be madeincharge of all the procurement procedures.All items to be procured should be from the for-mulary only.The demand for each item aIongwith its quan-tity should be initiated by the respective userdepartments.Procurement @the items should be done as perthe laid down rules of State/Central Gover-nment/concerned organization which may in-cludei) Rate contract (Running and Fixed)

ii) Tender systemiii) Authorized agencies (like Cooperative stores)iv) Local and emergency spot purchases

6) Maintenance of all the records and registers per-taining to procurement procedures

d) Receipt and inspection:Only &e author~ed person should receive the sup-ply. On receipt of each item it should be inspectedthoroughly, whether they are supplied as per the

22

lS 15461 :2004

specifications and having the mandatory QualityControl Certificate attached alongwith. The in-spection should be done on the following lines:i) Physical verification:

1) Quantity and strength as per specificationsof purchase order

2) Physical appearance (colour, shape, consis-tency etc)

3) Hardness and dispensability (for tablets)4) Turbidity or any suspended particles (for all

injectable)ii) Chemical analysis: for drugs

10 percent of all the store items to be picked upat random and to be sent for chemical analysisto Government registered and authorized firmsfor certification. Reports should be receivedwithin 15days. Drugs should be taken into stockafter receiving the verification report.

e) Storage:1)

2)

3)

4)

5)

6)

7)

St&e In-charge — Stores should be maintainedby proper authorized person(s) having sufficientexperience and knowledge of store functioning.Physical arrangements of stores — properguidelines of physical management of storesarea to be followed, that is, space, lighting, ven-tilation, arrangement of racks, storage areas ofitems, fire controls, seepage control, pest con-trol, temperature and humidity control (refer toBIS Guidelines for structural design). Gradedtemperature zone to be maintained for thermolabile and short life items.Maintenance of registers/records pertaining to

procurement, storage and distribution of items

As far as possible, records of the stores shouldbe computerized. These registers are to be main-tained very meticulously and supervised at aregular interval by the competent authorities.Out of these the following registers are must:i) Stock registers,

ii) Expiry drug register, andiii) Narcotic drug register.Conduction of physical verification ofitems — This is to be done at regular intervaland at least once in a year. Another officer whois not holding the charge of the store should doverification.Lead time should be known before hand and tobe followed strictly so that there should not beany stock outs.Reorder level of vital and essential items — tobe calculated properly so that it helps in timelyprocurement of these items.Bufler Stock — To be worked out properly forvital and essential items applying the InventoryControl techniques and to be followed strictly.

Issue and use:The items should be issued through indents prin-ciple of first in first out (FIFO). The stores shouldfix a schedule for its monthly indents to variousdepartments. Any other requirements to be askedunder supplementary indent.

The quantity issued should be noted in the stockregisters and available stock updated.

Communication of fresh stocks and out of stockitems to be sent to departments.Condemnation and disposal of items:1)

2)

3)

All non-consumable items including surgicaland other instruments to be condemned throughCondemnation Committee. This committeeshould meet at regular interval at least once in ayear. For the expensive bio-equipment, theinformation for condemnation should beobtained from the history sheet/log book ofrespective equipment.Disposal of surplus : to be done under the [supervision of the doctor in-charge and thesenior pharmacist.Disposal to be done throughi) Destruction, and

ii) Auction.

7.10.4.3 Accounting and information system

An assessment of functioning and quality control can becarried out by checking OE

a)

b)

c)

d)e)

o

g)

Percentage of time the items were available whenasked for — availability index.Delay on procurement of items, over and above thenormal lead-time.Number of items rejected after analysis or foundsub-standard.Delay in getting the results of chemical analysis.Amount of itemsldrugs wastedldamaged due to pil-ferage, spoiled etc.Number of timei the stores were physically veri-fied in a year.Number of supplementary indents in a month.

7.10.4.4 Manpower, furniture requirements and

functional areas, should be as per IS 12433 (Part 2).

7.10.5 Performance Parameters in Mortuary

Mortuary is the centralized agency to register all hospitaldeaths and to store all dead bodies before issue. R is herethat autopsy in medico-legal deaths and pathologicalautopsies in deaths to ascertain the exact diagnosis areconducted. Dead bodies are preserved before disposal.

7.10.5.1 Infrastructural facilities

It should be located preferably on the ground floor at the

23

IS 15461 :2004

rearend ofahospital preferably with atleastone autopsytable and Cold storage area having temperatures less than5°C and at least five cabinets for storing dead bodies.Adequate safety and security should be provided.Continuous running water is essential for mortuary henceprovision of storage of water.

7.10.5.2 Manpower requirements

A doctor qualified in forensic sciences/trained orexperienced in the area should man it.

7.10.5.3 Performance requirements

a)

b)

7.11

Written information to the mortuary should be sentas soon as possible but not later than 30 minutes ofdeath, after completion of prescribed documenta-tion like death certificate, death summary and iden-tification bond.Mortuary staff will report to ward immediatelywithin 5 to 10 min to collect dead body after get-ting registration done on the register to receive deadbody to mortuary.1)

2)

3)

4)

5)

The body is issued to relatives immediately ondemand for non-MLC cases or preserved inmortuary, if the relatives are not available. Thebody is preserved in mortuary for autopsy inMLC in appropriate cold storage cabinets.Autopsy is arranged within 30 min to 1 h on thesame day in working hours on availability/sub-mission of request papers by police and hand-ing over the body within 30 min to 1 h afterautopsy.Pathological autopsy should be conductedwithin 1 to 2 h of death in undiagnosed caseswhere death has occurred within 24 h of admis-sion after seeking the consent of relatives andhanding over the body to the relatives withinone hour of autopsy.Disposal of unclaimed bodies should be doneafter 72 h or if required, beyond a specified pe-riod or as per the guidelines of a given hospitai/directives of government.Receipt of all dead bodies should be obtainedon the prescribed records fi-omthe kith and kinof the deceased before body is issued to them innon-MLC cases and police in MLC casesrespectively.

Performance Parameters in Engineering Servicesand Allied Services

The engineering services are an essential constituent inalmost all facets of functioning of a hospital. Theeffectiveness and efficiency of the services are animportant parameter in ensuring delivery of qualitypatient care in a safe and comfortable environment forpatients, visitors, attendants and staff. The services are

varied and comprise all facilities listed in Section 1,Group4 of IS 12433 (Part 2). The design, construction,renovation, expansion and operational functionalityshould be in accordance with regulations/guidelines ofCentral Pollution Control Board, Indian National BuildingCode, Indian Standards and bye laws of local body.

7.11.1 Manpower Requirements

The manpower requirements should be in consonancewith those enumerated at Section 5, clause 9 of IS 12433(Part 2).

7.11.2 Instruments, Equipment and Furniture

Requirements

These should be as per details given in Section 6 andAnhex E of IS 12433 (Part 2).

7.11.3 Building Requirements

Hospkid buildings should have the various departmentspltiiit?d in a functiontilly correct and operationallyefficient mtier. The building requirements includingcirculation areas, height of rooms, apertures forfatYilitdiing proper ventilation and light and sanitarytittingk should be in consonance with Section 7 ofIS 12433 (Part 2). The area requirements should be‘in accordance with Section 6 of IS 12433 (Part 2).

7.11.4 Area Requirements for Electrical Services

These should be as perAnnexAand B of IS 12433(Part 2).

7.11.5 Maintenance

An office-cum-store should be provided to handleday-to-day maintenance of the hospital building inaccordancewith Section20, clause20.9 of IS 12433(Part2).

Preventive and breakdown maintenance of allengineering and allied services including furniture,fixtures, lifts, trolleys, etc, should be ensured.

7.1L6 Electrical Engineering

The following should be ensured:

a)

b)

c)

The sub-station and generating set should be inconsonance with Section 20 of IS 12433 (Part 2).Standby generators, voltage stabilizers and UPS(Uninterrupted power supply) should be appropri-ately provided to generate appropriate /additional/emergency power requirements for critical and es-sential areas of the hospital such as operation the-atre, labour room, radiology deparhient, bloodbank, cold/cool storage rooms of medical stores,Iiti (if present).Emergency portable lights units should be

24

lS 15461 :2004

d)

e)

0

g)

h)

j)k)

m)

n)

provied in wards and departments to serve asalternative source of light in case of power failure.Requirements for day lighting should be in accor-dance with IS 2440. Levels of illumination for vari-ous visual tasks should be in accordance withIs 4347.Shadowless light in OT, delivery rooms and minorOT should be provided.Call bells with switches for all beds and toilets withindicator lights and location indicator situated inthe nurses duty room should be available.Lightening protective system for hospital build-ings should be in accordance with IS 2309. It shouldbe totally independent and separate from the elec-tric supply and distribution system.Use of copper cables/FRLS (Fire Retardant LowSmoke), PVC cables, steel conduits, MCB (Minia-ture Circuit Breakers) are desirable.Earthing for major equipment should be provided.All electric installations should comply with theprovisions of Indian Electricip Rules, 1956.

Provision should be made to cater for futureexpansion of hospital and enhanced powerrequirements.Use of non-conventional energy devices such assolar energy must be explored.

7.11.7 Ventilation

The ventilation requirements including air changes perhour of various hospital areas should be in consonancewith Section 20, clauses, 20.1.7 and 20.1.8 of IS 12433(Part 2).

7.11.8 Mechanical Engineering

The following must be ensured.

7.11.8.1 Air conditioning

a)

b)

Air conditioning should at least be available forareas such as operation theatre, delivery rooms, ICU,blood bank, cold/cool storage of medical stores,and radiography/ultrasound rooms of Radio diag-nosis department.Periodical cleaning of air conditioning ducts andcleaningheplacements of filters must be done.

7.11.8.2 Refrigeration

a) Water coolers or hot air connectors may be pro-vided to patientslstaff depending upon local needs.

b) Water coolers and refi-igerators should be availableas per IS 1475 (Part 1) and 1474 respectively.

7.11.8.3 Lz@


a)

b)

c)

d)

e)

f)

All hospitals with more than one storey should havelifts for vertical transportation of patients, staff,visitors and supplies.Hospital should have passenger lifts, bed or stretcherlifts. These should have electric supply fromstandby’generators as well. Lifts for transportationof goods are also desirable.Lifis should be with automatic controls with safetydevices but should also be provided with manualcontrols, which should be so placed as to be withinreach of wheelchair borne patients.Alarm system and emergency light should be bat-tery operated. At least one lift in each separate sec-tion of the hospital should normally be connectedto the standby generator.Regular inspection should be done to conform tosafety regulations.Passenger lifts should be easily accessible andpreferably located near staircases. Bed/stretcherlifts should be placed near the wards and operationtheater department entrances.

7.11.9 Public Health Engineering

The following must be ensured.

7.11.9.1 Water supply

a)

b)

c)

d)

e)

f)

d

h)

k)

Water supply should be in accordance with clause20.3.1 of IS 12433 ( Part 2).Laying and distribution of water supply systemshould be in accordance with IS 2065.Design, construction and maintenance of drains forwaste water, surface water, sub-soil water and sew-erage should be in accordance with IS 1742.Selection, installation and maintenance of sanitaryappliances should be in accordance with IS 2064.Design and installation of soil, waste and ventilat-ing pipes should be as per IS 5329.Waste disposal system should be in consonancewith the guidelin~ of Central Pollution ControlBoard, Ministry of Environment and Forest.Water tanks should be periodically cleaned andmaintained. ‘,,Water pipelines shoidd be periodically checked forsigns of corrosions/leaks. Preventive/ breakdownmaintenance should be appropriately carried out.Provision of hot water requirements to wards, OT,delivery suites, ICU, laboratory, kitchen, laundryand other departments should be either by central-ized supply system or through electric storage typewater heaters (Geysers). Cold drinking water avail-ability should also be ensured specially duringsummer months.Incorporation of water harvesting methods andtechniques is desirable.

25

IS 15461 :2004

7.11.9.2 Public conveniences

a)

b)

c)

Public conveniences should be adequatelyprovided for staff, visitors and patients. Patientconvenience for inpatient nursing units should bein accordance with requirements enumerated inSection 15, clause 15.5.7 of IS 12433 (Part 2).Organized, regular maintenance and cleaning ofthe sewer line should be done to avoid blockage,leakage and spillage.Sewage discharge should be appropriatelydischarged into municipal lines/septic tanks. Ifrequired hospital sewage should be pre-treated tomake it safe and in confirmation with the standardsnotified by Environment Protection Act.

7.11.10 Waste Management

These should be as per guidelines stated by centralpollution control board (CPCB) and also 7.8.2.1 ofIS 15195.

7.11.11 Fire Protection


a)

b)

c)

d)

e)

o

Availability of fire protection, dampeners in ACducting and safety procedures and policies.Fire protection regulation should be prominentlydisplayed. Telephone numbers of those to becontacted in case of fwe should be displayed andavailable with all concerned including patients,visitors and staff.‘NO SMOKING’ signboards are adequately andprominently displayed.Proper upkeep of fire-fighting equipment, adequateFirst- Aid, fire-fighting equipment should be avail-able, installed and functional in accordance withIS 2190.Fire fighting drill should be carried out periocli-tally.Availability of manually operated fire alarmsystems. Availability of automatic fire system inaccordance with IS 2189 is also desirable.

7.11.12 Horticulture and Landscaping

A hospital should have pleasing surroundings, whichpresent a welcoming appearance. The following shouldbe ensured:

a)

b)

c)

Master plan for horticulture and landscaping shouldbe made;Adequate, scientific and aesthetic plantation oftrees and seasonal plants; andMaintenance of gardens, hedges and lawns.

7.11.13 Medical Gases


a)

b)

c)

d)

These should be provisioned in accordance withSection 20, clause 20.6 of IS 12433 (Part 2). Cen-tralized gas supply system along with air and clini-cal vacuum delivery systems is desirable.The centralized gas supply system pipeline shouldbe away from all electrical cables and wires. Colorcoding should be in accordance with IS 2379.Alarm devices should be present in the medicalgases delivery system to monitor pressure and gen-erate audiovisual alarms if required.SOPSfor operating, maintenance schedule, storage

e)

and change of cylinders should be formulated andimplemented. Proper records should also be main-tained.Preventive/breakdown maintenance should beensured timely.

7.11.14 Workshop

a)

b)

7.12

An electro-mechanical and bio-medical workshopshould be available to cater to the preventive andbreakdown maintenance of the equipment,fitments, furniture, machinery and instruments.Adequate spares should be available for ensuringtimely repair and maintenance.

Performance Parameters in Administrative/Ancillary Services

7.12.1 House-Keeping Services

The main function of the house-keeping department is tomaintain a hygienic clean, healthy environment ofpatients, visitors and staff. The services amongst othertlmctions play an important role as a public relationvariable and in preventing/controlling hospital acquiredinfection, Effective house-keeping services in a hospitalshould be ensured by:

a)

b)

c)

d)

e)

regular and scheduled cleaning of the various hos-pital areas.cleaning of the patient care and other areas ofthe hospital by appropriate methods, such asdusting, mopping, stain removing, scrubbing andvacuum cleaning.incorporation of mechanized cleaning includingmachine scrubbing and cleaning in the hospital isdesirable.provision of adequate water supply, cleaning ma-terials including brooms, mops, detergents, chemi-cals, stain removers, deodorants, etc.the house-keeping staff must be trained for the fol-lowing:1)

2)

Sci&titic maintenance of hygiene and sanita-tion in the hospitalRole of house-keeping in prevention andcontrol of Hospital Acquired Infection

26 I

lS 15461 :2004

f)

g)

3) Role of house-keeping in Public Relations. Thestaff must be polite and courteous to thepatients, their attendants and visitors.

Active supervision of the various activities ofhouse-keeping including documentation andrecord keeping.Appropriate protection and safety precautions forpersonnel handling the waste.

7.12.2 Safety and Security Function

The administration of the hospital should providesecurity to the staff, patients, visitors and attendants andalso protection to the property and assets of the hospitaland patients. The following should be ensured:

a)

b)

c)

d)e)

f)

g)

h)

Fire safety procedures and the duties and responsi-bilities of staff in the event of a fire should be knownto all concerned.Display boards for fire safety guidelines including‘NO SMOKING’ signs should be promptly put upat various places in the hospital.Maintenance of fire-fighting equipment should beensured.Fire-fighting drill should be carried out periodically.Measures for prevention of theft and pilferage.Measures for information losses, such as medicalrecords of patients. Computer information securityshould also be ensured.Measures to prevent workplace violence, such asassaults on staff, patients and visitors.Measures to avoid accidental/intentional swapptig(e.g. of new horns and dead bodies).

7.12.3 Ambulance Services

Scientifically designed, appropriately equipped andstaffed ambulances are an effective means oftransportation of the sick and injured. The followingshould be ensured inAmbulances Services of the hospital:

a)

b)

c)

Number of ambulances — The minimal desirablenumber of ambulances in a 100-bedded hospitalshould be 2 to 3.Manpower — Each ambulance should have traineddriver and stretcher bearer in all shifts of dutyto call for 24 h available and should be giventraining in First Aid besides both should be trainedin Cardio Pulmonary Resuscitation.Equipment — The following basic equipmentsshould be available ‘inall Ambulances:l) Portable suction apparatus with wide basic tub-

ing and rigid pharyngeal suction tip.2) Hand operated bag mask ventilation unit (Ambu

3)4)

5)6)7)

8)9)

10)11)12)13)I4)15)16)17)

d) It

bag) with mask of all sizes.Oropharyngeal airways – all sizes.Mouth to mouth artificial ventilation airways –adults and children.Portable oxygen equipment.Mouth gags.Sterile intravenous infisions (plastic bags withadministration kit).Universal dressings, sterile gauze packs.Bandages of all types.Sterile bum sheets (two).Traction splints.Padded splints assorted.Spine boards.Safety pins.Sterile obstetrical kit.BP instrument and stethoscope.Two-way communication system.is desirable to have appropriately trained man- 3s

power and equipment, such- as ECG monitoringequipment, defibrillator and portable respirator inthe ambulances.

7.12,4 Medical Recor&

Medical records section should Iimction for professionalwork in diagnosis, treatment and care of patients. Thearea requirements for this section should be as per AnnexA of IS 12433 (Part 2 ).

8 APPLICATION OF STATISTICAL METHODS

Modem statistical methods can assist in most aspects ofdata collection and application, whether it be to gain abetter understanding of customer needs, in-processcontrol, capability study, forecasting, measurement ofquality to assist in making decisions or continuousimprovement in quality of service.

Few examples are given below:

a)

b)

c)

Seven basic tools. of quality management (seeIS 15431) can be applied, for example, if a patientdoes not respond tqxi particular line of treatment, ateam of doctors could carry out a cause-and-effectanalysis of the problem and work out a moreeffective treatment instead of relying on experi-mentation or intuition or expertise of one doctor.Trend charts can be prepared for average timerequired to cure a disease to see any continuousimprovement; number of patients treated per month.Quality Function Deployment (see IS 15280) meth-odology can be used as a perfortnance measure-ment tool.

27

IS 15461 :2004

ANNEXA(Clauses 7.7.3,7 .7.4,7.7.5 and7.8.5)

EXTINTERWEWPROPORMA

You may kindly express your hank and honest opinionregarding the experience you had for availing servicesfrom this hospital.

Scale in : ExcelIent (5) Very Good (4) Good (3)Average (2) Poor (1)

1 Reception and Registration

a) Promptness in answering questionsb) Courtesy and politenessc) Well-informed/explained repliesd) Promptness in service

2 Waiting Area

a) General condition and cleanlinessb) Sitting arrangementc) Toiletsd) Drinkhg water

3 Doctors

a) Accessibilityb) Courteous and sympathetic attitudec) Listened and explained properlyd) Punctuality/availabilitye) Helpful with querries

4 Pharmacy Services

a) Promptness in serviceb) Explanation of prescriptionc) Helpfi.dand well informed repliesd) Availability/quality of medicines’

5 Diagnostic Services

a) Courtesy and politenessb) Explanation of proceduresc) Helpful in answering

6 Admission and Registration

a) Courtesy and politenessb) Explanation of procedures/formsc) Promptness in admission process

7 Indoor Services

a) Cleanliness of room

b)c)d)e)

f)

Cleanliness and maintenance of toiletsQuicknessCondition of bed and linenGeneral comfortAvailability of medicines

8 Nursing Sewices

a) Courtesy and sympathetic attitudeb) Smiling and pleasant when spoken toc) Promptness when calledd) Punctuality in giving medicine, injection, etce) Competence

9 Dietary Sewices

a) Timely servicesb) Palatability

10 Allied Health Professionals

a) Ward boyb) Dressersc) Physiotherapistd) Medico-social workere) Safai karamchari

11 Ancillary Services

a) House-keepingb) Securityc) Waterd) Electricitye) Maintenance

12 Discharge Procedures

a) Promptness in discharge processb) Directionii about home care

“13Additional Comments/Suggestions

14 Overall Rating

15 Identity of the Patient (Optional)

a) Name:b) Age/Sexc) C.R. No.:d) Address:e) Signature:

28

lS 15461 :2004

ANNEX B(Clauses 7.7.4,7.8.6 and 7.10.5.3)

INFORMEDANDSPECIALCONSENTFORM

C.R.NO./O.P.D. NO.

Name Sex Age

Son/Daughter/Wife of

Insured Consent

Authorization for Medical Treatment, Administration of Anesthesia and performance of Surgical Operation and/orDiagnostic/ Therapeutic Procedure.

1. I hereby authorize hospital to.——.—.——.—————— —— — perform uponthe following medical treatmen~surgic~~ operation and/or diagnostic/therapeutic

procedures

2. It has been explained to me that, during the course of the operation/procedure, unforeseen conditions may berevealed or encountered which necessitate surgical or other emergency procedures in addition to or different fi-omthose contemplated at the time of initial diagnosis. I therefore, further authorize the above designated medicalofficial to perform such additional surgical or other procedures as they deem necessary or desirable.

3. I consent to the administration of a anesthesia and to use such anesthetics asdesirable, except to the following exceptions:

(Indicate exception or ‘None’)

4. I state that I am/am not suffering from Hypertension/D iabetes/Bleeding

may be deemed necessary or

disorders/heart diseases or

5. 1also state that I am not suffering fi-omany known allergies or drug reactions.

6. 1further consent to the administration of such drugs, infisions, plasma or blood transfusions or any other treatmentor procedures deemed necessary.

7. The nature and purpose of the operation andlor procedures, the necessity, thereof, the possible alternative methods,treatment, prognosis, the risks involved and the possibility of complications in the investigative procedures/investigations and treatment of my condition.ldiagnosis have been filly explained to me and I understand the same.

8. I have been given an opportunity to ask all/any questions and I have also been given option to ask for any secondopinion.

9. I acknowledge that no guarantee and promises has been made to me concerning the result of any procedure/treatment.

10. I consent to the photographing or televising of the operations of procedures to be performed, including appropriateportions of my body, for medical, scientific or educational purposes, provided my identity is not revealed by thepictures or by descriptive texts accompanying them.

11. For the purposeoperating room.

of advancing medical education, I hereby give consent to the admittance of observers to the

29

IS 15461 :2004

12. I also give consent to the disposal by hospital authorities of any tissues or parts which maybe removed during thecourse of operative procedure/treatment.

I certi~ that the statements made in the above consent letter have been read over and explained to me in the language1 understand and 1 have fully understood the implications of the above consent and fiwther submit that statementstherein referred to were filled in and any inapplicable paragraphs stricken off before I signed/put my thumb impression.

Date

Signature, names and address of the witnesses:

Signature of patient/Thumb impression

Name

1. 2.

When patient is a minor or unable to affix signature due to mental or physical disability.

Signature/Thumb impression of naturalguardianlguardian

Name and relationship with patient

Signature, names and address of witnesses:

1.

I confirm that I have explained the nature and effects of theabove ccnsent form.

2.

operationhreatment to the person who has signed the

Signature of Doctor-in-Charge

Name

Date Designation

30

lS 15461 :2004

ANNEX C(Foreword, and Clause 5.5)

AMODELCITIZENS’ CHARTER FORPUBLICHOSPITALS

Name of Hospital

Address

Telephone No.

C-1 PREAMBLE

This charter is an expression of the commitment and resolve of this hospital to provide to its patients informationabout the services that are available, the quality and standards of service that they may expect, as also the machineryand procedure available for redressal of their grievances and complaint.

C-2 GENERAL INFORMATION

C-2.1 Hours of Work

Out Patient Deptt. :

Morning .. . ... . . . . .. A.M.to . .. .. ...

Evening ... ... .. . . . .. P.M.to .. . .. ...

Administrative OffIce

Weekdays ... .. . . .. A.M.to .. . . . . . . . ..

Lunch Break . .. .. .. A.M.to . . . . . ... P.M.

Saturdays ......... A.M.to . .. .. ... P.M.

Closed on Sundays and Gazetted Holidays

Causality/Emergency/Deptt. :Resident Medical OfficerDuty Doctor

Specialist

C-2.2 Other Facilities

Open throughout 24 h on all daysAvailable throughout 24 h on all daysEvery Department connected with Casualty/ Emergency will have aminimum of one duty doctor available for 24 hours.. .. .. .. A.M. to ... ..... P.Mon .. . . . . . . .Weekdays . .. . .. ... A.M. to . .. .. . . ..P.MLunch Break .. . .. .. A.M. to .. . . .. .. P.M.Saturdays . . .... ... A.M. to .. . . .... P.M.

Closed on Sundays and Gazetted Holidays

d)

a) The list of doctors on duty, the names of Resident e)Medical Ot%cer, Medical Supdt., Heads of Differ-ent Departments, along with their location and tele-phone numbers etc., is displayed at the Reception.

b) Wheel chairs and stretchers are available on requestat the gate/reception for facility of patients whoare not in a position to walk. Walkways/lifts are oalso available for access to higher floors.

c) A location map is on display at the Reception for g)easy access to various departments by the patients.

31

Every staff in this hospital can be identified by theiruniform and name badge.Information regarding the fees and other paymentsif any to be made for use of the various facilities/diagnostic and other machines and equipment andlor for specialists fees/medicines etc, are also dis-played at the Reception. For every payment a prop-erly authenticated oflicial receipt will be given.Adequate drinking water and toilet facilities areavailable for the convenience of the public.Adequate display boards are available at differentlocations for guidance of visitors and outpatients.

IS 15461 :2004

h)

j)

k)

m)

n)

P)

Ambulances/Mortuary Vans are available for useon payment throughout 24 h.There is a laboratory available in the hospital pre-mises for various tests.There is a standby generator to cater to Emergencyservices in case of general breakdown of electricity.Public telephone booths are available at variouslocations in the hospital.A canteen is available for catering to visitors andoutpatients during normal working hours.A chemist shop is located in the hospital premises,which is open 24 hours on all days.

C-3 SERVICE STANDARD

This hospital has.. .. .. .. . . . . . . ... Doctors. .. . ... . . . . . . . . ..Nurses

.. . ... .. . . . . . . . .. Beds

C-3. 1 Standards of service and adequate degree of patientcare can be provided to the extent proper and workableratio between doctor to patient, nurses to patient andbeds to patients are maintained, as also the extent ofavailability of resources and facilities. Consistent withthis every possible effort will be made by this hospital:

a)

b)

c)

d)

e)

to provide access to hospital and professional medi-cal care to all patients who visit the hospital.to prescribe a workable maximum waiting time foroutpatients, before they are attended to by a quali-fied doctor andlor specialists and continuouslystrive to improve upon it.to ensure that all equipment in the hospital aremaintained efficiently in proper working order.to ensure availability of beds and operationtheatres facilities as freely as possible.to ensure treatment of emergency cases withutmost promptitude and attention.

C-3.2 Every outpatient seeking treatment at the hospitalwill be registered and issued a card for recording variousdetails of the symptoms, diagnosis and treatment beingprovided. Efforts will be made to computerize the recordsystem in the hospital, to provide better service to thepatients.

C-3.3 The patients’ right to privacy, dignity, religiousand cultural beliefs, as also their right to be informed,right to consultation and choice shall be respected.

C-3.4 No patient shall be treated or examined withouthis/her consent or the consent of the guardian in the caseof minor and the consent of the legal heir in the case of apatient who is unconscious or otherwise unable to expresshimself. If a legal heir is not available, but a medical

intervention is urgently needed and delay is dangerous,the doctor shall be entitled to carry out necessarytreatment or operation without such consent.

C-3.5 No patient shall be used for any research orexperiment without a written consent and without beinginformed of the potential hazards or discomforts involved.

C-3.6 All patients and visitors to the hospital will receivecourteous and prompt attention tlom the staff and oi%cialsof the hospital in the use of its various services.

C-3.7 Qualified pharmacists shall handle drugs and ensureproper potency and quality of the drug. Every effort willbe made to ensure adequate availability of drugsespecially those which are life saving. The Pharmacy willdisplay information regarding non-availability of anydrug and how long they are likely to remain non-available.

C-3.8 Reliability and promptness of laboratory resultswill be ensured and whenever possible such reports willbe made available within 8 hours.

C-3.9 Operation theatre shall be maintained on a regularbasis to ensure that they are serviceable all the time andevery effort will be made to keep the hospital and itssurroundings, clean, infection-tlee and hygienic.

C-3.1OA regular system of obtaining feedback from theusers will also be initiated through, periodic surveys forconstantly improving the quality of service standards.

C-4 EQUIPMENT AND FACILITIES/SERVICESAVAILABLE

C-4.1 This hospital has the following services available:X-Ray machines, Testing laboratory, Ultra sound, Catscan, ECL, EEG and Oxygen pipe in every room inIntensive Care Unit, centralized air-conditioned timingin ICU, 24 hour duty nurses for ICU, Physiotherapyequipment . . . .. . . .. etc . . . . . . ...).

C-4.2 The hospital has its own Electrical and Mechanicalunits for ensuring pro~er maintenance and working ofthe various equipment~,

C-4.3 If any equipment is out of order, informationregarding the same shall be displayed suitably indicatingthe alternate arrangements, if any, as also the likely dateof recommissioning the equipment after repairs andreplacement.

C-5 WHEN THINGS GO WRONG OR FAIL

C-5. 1 Appropriate action will be taken on thoseresponsible for such failures and action taken to rectifithe deficiencies, Complainants will also be informed ofthe action taken.

C-5.2 In case of likely persistence of the deficiency, thereasons for the delay in recti&ing the deficiency and thetime likely to be taken for rectifying the same, will bedisplayed prominently for the information of the public.

C-5.3 Special directions would be given to the non-medical staff to deal with the patients and publiccourteously. Any breach in this regard when brought tothe notice of the hospital authorities shall be dealt withappropriately.

C-5.4 The hospital encourages the patients and the publicto inform the authorities when things go wrong.Suggestions/complaints boxes are provided at theReception, Canteen and the RMO’S Office. Alsocomplaint forms with serial numbers and tear off counterfoils are available at the Reception.

C-5.5 Weekly review meetings will be held of all Headsof Departments, to look into perform ante reports,grievances/complaints and their redress al, non-fimctioning of equipment, delays in repair, maintenance/replacement of equipment identification of deficienciesetc, and time bound action taken for improvingperformance.

C-6 GRIEVANCES/COMPLAINTS/REDRESSAL

C-6.1 There will be a designated Medical Officer whosename, location and telephone number is duly displayedat the Reception and elsewhere in the hospital forreceiving and attending to all grievances and complaints.Every grievance/complaint will be acknowledgedimmediately and dealt with finally within 7 working days.

C-6,2 Every patientivisitor shall have the right to be heardregarding his/her grievance/complaint.

C-6.3 If the complainant is not satisfied with the disposalof his grievance/complaint, he can approach to the Headof the Hospital and thereafter the Hospital AdvisoryCommittee.

IS 15461:2004

C-6.4 A Hospital Advisory Committee consisting of theHead of the Hospital, the Heads of Departments/Wings ofthe hospital, officials in-charge of the maintenance ofhospital building, electrical systems and variousequipment, representatives of consumers organizations,local MLAs/MPs etc, will be constituted to reviewperiodically the overall performance of the hospital interms of patient care and treatment as also redressal ofgrievances and complaints. The names, addresses andtelephone numbers of the members of the AdvisoryCommittee are displayed at the Reception.

C-7 RESPONSIBILITIES OF THE USERS

C-7. 1 Users of the hospital are entitled to demandadherence of all concerned to the Charter Principles asindicated above and bring any shortcomings ordeficiencies to the notice of the appropriate authorities.

C-7.2 Users should appreciate the various constraintsunder which the hospital is fi,mctioning and ensure itssmooth functioning without inconveniencing otherpatients and visitors.

C-7.3 They should help the hospital authorities in keepingthe hospital and its surroundings clean and in propersanitary condition.

C-7.4 Provide useful feedback and constructivesuggestions regarding the quality and extent of serviceavailable at the hospital.

C-7.5 Reftain from misusing the facilities available ordemanding an undue favour from the staff and officials.

C-8 SUGGESTION FOR IMPROVEMENT

Any suggestion for improvement of this charter documentwill be most welcome and may be addressed to:

.. .. ... . . . . . . . . . . . . . . . . . . . . . . . . . ..

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . ..

33

IS 15461:2004

ANNEX D(Foreword)

COMMllTEECOMFOSITION

Hospital and Medical Care Services Sectional Committee, MSD 8

Organizatiorr

Safdarjung Hospital, New Delhi

Academy of Hospital and Administration, Delhi

Air Headquarters, New Delhi

All India Institute of Medical Sciences, New Delhi

AN India Occupational Therapists’ Association, New Delhi

Armed Forces Medical College (Department of HospitalAdministration), Pune

Artificial Limbs Manufacturing Corporation of India, Kanpur

B.M. Birla Heart Research Centre, Kolkata

Batra Hospital & Medical Research Centre, NewDelhi

Cauvery Medical Centre, Bangalore

Christian Medical College and Hospital, Vellore

Commissionerate of Health, Medical Services and MedicalEducation, Gandhi Nagar

Department of Health & Family Welfare, Govt. of Sikkim,Gangtok

Representative(s)

DrrV.H. ‘f.m[a(Chairman)DRAswrrwTHEOGAONKAR(Alternate)

SusmCm (D@N. A.IWw

WG CDR S. K. TmwwWG CDRA. SH.UiMA(Alternate)

DRR. K. SWADR D. K. SHARUA(Alternate)

DR R. K. SHARMADRAN!LSRIVASTAVA(Alternate)

COLM. DAYANANOA

Sm R. P. SHARMASrnu M. C. DOBN (Alternate)

SHIUAMrTDE

DR M. P. VASDYASt-au V. N. Sm (Alternate)

DR G. D. KUNDERS

DR SELVAKUMARDrt ANANDJOB (Alternate)

M K. C. MEHTA

DRD. K, SUBBADR S. K. Psuossm (Alternate)

Department of Health & Family Welfare (Delhi Administration), DRV.P. VARSHNEYDelhi

DGAFMS. Ministry of Defence, New Delhi

Directorate General of Health Services, New Delhi

Directorate of Health Services, Chrmdigarh

Directorate of Health Services, Delhi

Directorate of Health Services, Gandhi Nagar

Directorate of Health Services, Mumbai

Employees State Insurance Corporation Ltd (ESIC), New Delhi

Engineer-in-Chief’s Branch, Army Headquarters, New Delhi

DR YOOESHCHOOIWRY (Alternate)

COLH. S. GULEIUALT COL S. C. ACUARAYA(Alternate)

SriruJ. CHOUDSSARY

hi5CtOR

DRR. N. BAISHYADR RAMESHCsmm (Alternate1)DRJ. N. Morrmm (Alternate11)

DlrUX?OR

DR Soarwr+R. SALONKEEDrrL. B. IGmmm (Alternate1)DR V. D. MALE (Alternate11)

W D. K. @OORDR (Sr@ NALINITANDON(Alternate)

StuuM. D. KrmuSm MALAMOHAN (Alternate)

34

lS 15461 :2004

Organization

ESrmtSwartMihrte&ReSedJcerrtre(EHJRc), NewDelhi

Health & Family Welfare Division, Planning Commission,New Delhi

Holy Family Hospital, New Delhi

Hospital ManagementPlanning Consultants,New Delhi

Hospital Services Consultancy Corporation (India) Ltd,Noida, New Delhi

Indira Gandhi National Open University, School of HealthSciences (IGNOU), New Delhi

In personal capacity (C S/38 VasantKunj, New Delhi-110070)

Indian Hospital Association, New Delhi

Indian Institute of Health Management & Research, Jaipur

Indian Medical Association, New Delhi

Indian Society of Health Administrators (ISHA), Bangalore

Institute of Nuclear Medicine & Allied Sciences, DRDO, Delhi

Institute of Public Health & Hygiene, New Delhi

JIPMER Medical College, Pondicherry

Medical Council of India, New Delhi

Metalbeds India Pvt Ltd, Mumbai

Ministry of Health and Family Welfae, New Delhi

NationalAcademyof Medical Sciences,New Delhi

National Institute of IHealth & Family Welfare (NIHFW),New Delhi

National Medical College and Hospital, Kolkata

NTPC, New Delhi

(’kdnance Factory Boardj Kolkata

PD. Hinduja National Hospital & Medical Research Centre,Mumbai

Post Graduate Institute of Medical Educatioo & Research (PGI),Cbmrdigarh

Railway Board, Ministry of Railways, New Delhi

Sanjay Gandhi Post-GraduateInstitute of Medical Sciences, Lucknow

School of Planning & Architecture, New Delhi

Representative(s)

DR (SMT)ANITAARORA

DR (SMT)AMBUJAMNAJRKAFQDR

SHRJEOWARODAVID

AR. LEKHRAJ LALLA

.$HRJSNUIVSGGDSHSUV. S. KRJSHNAN(Alternate)

PROFA. K. AGARWAL

LT COLS. K. MATHUR(RETD)

DR S. D. VOHRA

Drr S. D. GUPTA(M.D, Ph.D.)DRVIrNODK. ARORA(Alternate)

DR SANJWMALIK

DRASHOKSAHNJ

BFWJ, K, BANSALLTCOLG. KHOSHCHJ(Alternate)

DR SHVAMSUNDERJOSHIDR SEEMAYADAV(Alternate)

DIRSCTORHEADOFDEPTTOFANESTHESIOLOGY(Alternate)

DR K, K. ARORA

SHRJK. J. S. GULATISHRJGIRJSHSHETH(Alternate)

SHRJDIUPKLMAR

DRHARJGAIJWMDR P. K. KHOSLA(Alternate)

DRJ. K. DAS

Da SHVAMALKm-n BANsrosEDRDmrPKR.BARMAN(Alternate)

DRP. C, RAIDR (MRs)A. G, M]cmms’(Alternate)

DIRSCTGR(HEM-m+SERVICES)ADOLDIRECTOR(HEALTHSERVICES)(Alternate)

BJUGJOECURJAN(I&M)SHRIANUPAMVARMA(Alternate)

DRSONITsrrwn

DRKALYANGHOSH

DRA. K. SRIVASTAVADR HEMCHANDRA(Alternate)

SHRSANSLDEWAW

35

lS 15461 :2004

Organization

State Institute of Health and Family Welfare, Jaipur

Tata Engg & Locomotive Co Ltd, Jamshedpur

Tirathram Shah Charitable Hospital, Delhi

Top Syringe Mfg Company, Mumbai

University College of Medicai Sciences, Delhi

Director General. BIS

Representative(s)

DRRAMESHWARSHARMA

DRA. BANDYOPADHYAYDR MANITOSHRAY(Alternate)

DR A. K. DUBEY

SHRIJ. K. WAD

DR S. DWIVEDI

Smu P. K. GAMBHIR,DIRECTOR& HEAD(MSD)[Representing Director General (Ex-oflicio)]

Member SecretarySW LALrrKUMARMFHTA

Joint Director (MSD), BIS

Quality Assurance Standards for Hospital Services Subcommittee, MSD 8:3

IGNOU, New Delhi

AIIMS, New Delhi

Academy of Hospital & Administration, New Delhi

Chikitsa Hospital, New Delhi

DGMS (Army), Ministry of Defence, New Delhi

DHS, General Hospital, Chandigarh

DHS, New Delhi

EHIRC, New Delhi

ESIC, New Delhi

In personal capacity (C 5/38 Vasant Kunj, New Delhi-110 070)

In personal capacity (25, ESJ Calany, BasidarapucNew Delhi-1 10015)

institute of Nuclear Medicine & Allied Sciences, DRDO, Delhi

MCD, Delhi

Medical Council of India, New Delhi

NIHFW, New Delhi

PD. Hinduja National Hospital & Medical Research Centre,Mumbai

Safdarjung Hospital, New Delhi

Tirathram Shah Charitable Hospital, New Delhi

PROFA. K. AOARWAL(Convener)

DRSHAKTIGUPTA

DR SIDHARTHSATPATSSY(Alternate)

SURGCAPT(DR) N. A. KHAN

DR (SMT)MUKULJMN

LTCOLSONILK.NQT

DRK. K. GARG

DR SUREWSETHDR RA~Esri CHUGH(Alternate)

DR (SMT)ANITAARORA

DR S. K. JAIN

LT COLS. K. MATHUR

DR KAMLGOLDAR

BFOGJ. K. BANSALLT COLG KHOSHOO(Altervrate)

DRK. N. TIWARIDR N. C. SHARMA(Alternate)

DRK. K. ARORA

DRJ. K. DAS

BSUGJOECOIUAN(RET@SHRJANUPAMVW (Alternate)

DRV. H. TAUBDRAIWINDTHEGGAONUR(Alternate)

DRA. K. DUBEY

Member SecretaryMu LAIJTKWMEITA

Joint Director (MSD), BIS

36

.

Bureau of Indian Standards

B1S is a statutory institution established under the Bureau of Indian Standards Act, 1986 to promoteharmonious development of the activities of standardization, marking and quality certification of goodsand attending to connected matters in the country.

Copyright

BIS has the copyright of all its publications. No part of these publications may be reproduced in any formwithout the prior permission in writing of BIS. This does not preclude the free use, in the course ofimplementing the standard, of necessary details, such as symbols and sizes, type or grade designations.Enquiries relating to copyright be addressed to the Director (Publications), BIS.

Review of Indian Standards

Amendments are issued to standards as the need arises on the basis of comments. Standards are also reviewedperiodically; a standard along with amendments is reaffirmed when such review indicates that no changes areneeded; if the review indicates that changes are needed, it is taken up for revision. Users of Indian Standardsshould ascertain that they are in possession of the latest amendments or edition by referring to the latest issue of‘BIS Catalogue’ and ‘Standards: Monthly Additions’.

This Indian Standard has been developed from Doc : No. MSD 8 (293).

Amendments Issued Since Publication

Amend No. Date of Issue Text Affected

BUREAU OF INDIAN STANDARDS

Headquarters :

Manak Bhavan, 9 Bahadur Shah Zafar Marg, New Delhi 110002Telephones :23230131, 23233375,23239402

Regional Offices : /

Central : Manak Bhavan, 9 Bahadur Shah Zafar Marg .,

Eastern

Northern

Southern

Western

Branches :

NEW DELHI 110002

: 1/14 C.I.T. Scheme VII M, V. I. P. Road, Kankurgachi.;fi

KOLKATA 700054

: SCO 335-336, Sector 34-A, CHANDIGARH 160022

: C.I.T. Campus, IV Cross Road, CHENNAI 600113

Manakalaya, E9 MIDC, Marol, Andheri (East)MUMBAI 400093

Telegrams: Manaksanstha(Common to all offices) I

\Telephone t

{

2323761723233841

;

{

23378499,2337856123378626,23379120

{

603843609285

I

{

22541216,2254144222542519,22542315

{

28329295,28327858\

28327891,28327892

AHMEDABAD. BANGALORE. BHOPAL. BHUBANESHWAR. COIMBATORE. FARIDABAD.GHAZIABAD. GUWAHATI. HYDERABAD. JAIPUR. KANPUR. LUCKNOW. NAGPUR.NALAGARH. PATNA. PUNE. RAJKOT. THIRWANANTHAPURAM. VISAKHAPATNAM.

Printed at Prabhat Offset Press, New Delhi-2

Date post:	28-Feb-2021
Category:	Documents
Upload:	others
View:	5 times
Download:	1 times

IS 15461 (2004): Performance guidelines for quality ... · resources needed to implement the...

Documents