Facility, Infrastructure, and Disaster Preparedness in Hospitals

By Abdulla Israr & Simran Rani

Facility, Infrastructure, and Disaster Preparedness in Hospitals

Introduction

·        Hospitals are complex healthcare facilities that require robust infrastructure and preparedness mechanisms to ensure safe, efficient, and continuous service delivery.

·        Unlike other establishments, hospitals operate 24/7 and house vulnerable populations, including critically ill patients, children, and elderly individuals, who may not be able to evacuate quickly in emergencies.

·        Thus, hospital facility and infrastructure management must focus on safety, resilience, compliance with regulations, and disaster preparedness.

Fire Safety Plan & Protocols

·        Hospitals are high-risk zones for fire incidents due to the presence of oxygen cylinders, flammable chemicals, electrical equipment, and constant patient load.

·        Fire safety requires both preventive and responsive strategies.

Key Elements of Hospital Fire Safety

  • Risk Assessment
    • Identify fire-prone areas: ICUs, operation theatres, labs, storage rooms, kitchens, electrical panels.
    • Assess oxygen-rich environments and flammable material storage.
  • Fire Safety Plan
    • Written policies and Standard Operating Procedures (SOPs).
    • Clearly marked fire exits, escape routes, and assembly points.
    • Installation of fire detection and suppression systems (smoke detectors, sprinklers, alarms).
  • Fire Safety Equipment
    • Fire extinguishers (CO₂, foam, dry powder depending on hazard type).
    • Hydrant systems and automatic sprinklers.
    • Fire-resistant building materials for walls, doors, ceilings.
  • Protocols & Training
    • Regular fire drills for staff and mock evacuation exercises.
    • Staff training in the use of extinguishers and patient evacuation.
    • Special focus on evacuating immobile patients (using stretchers, evacuation chairs, and lifts designed for fire safety).
  • Compliance
    • Adherence to National Building Code of India (NBC) and NABH/JCI fire safety guidelines.

Electrical Safety

·        Electricity is critical for hospital functioning, but also a leading cause of fire, shock, and equipment failure.

Electrical Safety Measures

  • Design & Installation
    • Hospital electrical systems should comply with safety codes (e.g., Indian Electricity Rules, IEC standards).
    • Adequate grounding and circuit breakers to prevent overloads.
    • Isolated power supply systems for critical care areas (ICU, OT).
  • Maintenance
  • Backup Power
    • Diesel Generator (DG) sets with automatic transfer switches.
    • Redundant power lines for critical areas.
    • Battery backup for life-supporting equipment.
  • Safety Training
    • Staff trained in handling electric shocks (CPR & defibrillator use).
    • Awareness on safe equipment handling and reporting electrical hazards.

Hazardous Material Management

·        Hospitals generate biomedical waste, radioactive substances, chemicals, and sharps, which pose risks if mismanaged.

Categories of Hazardous Materials

  • Biomedical Waste (infectious, pathological, sharps, cytotoxic drugs).
  • Radioactive Waste (nuclear medicine, radiotherapy).
  • Chemical Waste (formalin, solvents, disinfectants).
  • Pharmaceutical Waste (expired drugs, vaccines).

Management Protocols

  • Segregation: At source using color-coded bins (as per BMW Rules 2016 & amendments).
  • Storage & Handling: Secure, labeled containers; sharps containers for needles.
  • Treatment & Disposal:
    • Incineration, autoclaving, or plasma pyrolysis for infectious waste.
    • Deep burial or return to manufacturers for pharmaceutical waste.
    • Special handling of radioactive waste as per AERB guidelines.
  • Staff Safety
    • Use of PPE (gloves, masks, aprons).
    • Training in spill management and exposure response.
    • Emergency showers and eyewash stations in labs.
  • Regulatory Compliance
    • Adherence to Biomedical Waste Management Rules (2016), Atomic Energy Regulatory Board (AERB) standards, and Pollution Control Board norms.

Building Safety & Maintenance

·        Hospital infrastructure should support safety, durability, and resilience against hazards.

Structural Safety

  • Compliance with National Building Code (NBC) and Seismic Zone Regulations.
  • Earthquake-resistant design for high-risk regions.
  • Fire-rated staircases, corridors, and exits.

Functional Safety

  • Adequate ventilation, air filtration (HVAC), and infection control.
  • Water supply safety (chlorination, testing for contamination).
  • Lifts for patient transport and emergency evacuation.

Preventive Maintenance

  • Routine checks of plumbing, HVAC, elevators, and medical gas pipelines.
  • Preventive maintenance schedule for physical infrastructure.
  • Use of computerized Facility Management Systems (FMS) for maintenance tracking.

Environmental Safety

  • Noise control in wards and ICUs.
  • Lighting levels suitable for patient care.
  • Green building initiatives for energy efficiency.

Emergency Preparedness & Disaster Management

·        Hospitals are expected to function as lifelines during disasters (natural or man-made).

Types of Disasters

  • Natural: Earthquakes, floods, cyclones, landslides.
  • Man-made: Fire, chemical leaks, nuclear accidents, terrorism, mass casualty incidents.
  • Epidemics/Pandemics: Influenza, COVID-19, etc.

Emergency Preparedness Elements

  • Disaster Management Plan (DMP): Written document outlining hospital’s response.
  • Hospital Disaster Management Committee (HDMC): Multidisciplinary team including administrators, clinicians, engineers, security, and logistics.
  • Command & Control: Incident Command System (ICS) for coordination.
  • Communication System: Public address systems, hotline, internal walkie-talkies.
  • Resource Management: Stockpiling of essential drugs, oxygen, PPE, emergency beds.
  • Triage & Patient Flow: Mass casualty triage protocols (color coding).
  • Training & Drills: Regular disaster mock drills, tabletop exercises.

Disaster Response Protocol

  1. Activation of Emergency Code (e.g., Code Red for Fire, Code Blue for Cardiac Arrest, Code Yellow for Disaster).
  2. Mobilization of Staff & Resources.
  3. Evacuation Procedures for vulnerable patients.
  4. Coordination with External Agencies (fire department, police, NGOs, blood banks).
  5. Post-Disaster Recovery: Restoring services, psychological support, and review of response effectiveness.

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