Standards Guideline For Establishing, Equipping and Operating Renal Dialysis Centres

In The Name Of Allah The
Beneficent The Merciful
1
INDEX
N. STANDARDS page
Part-1 Chapter One: Structural Standard 10
INTRODUCTION 10
1-1 -Preamble 12
1-2 -Purpose 12
1-3 -The role of the Unit 12
1-4 -Policy statement 13
1-5 -Description of Unit 13
PLANNING 14
1-6 Models and charts of dialysis centers 14
1-6-1 Selecting the appropriate location 14
1-6-2 Planning for spaces 14
1-6-3 Allocation of space inside and outside the building 14
------- Spaces inside the building 14
1-7 Role of the associated hospital 17
1-8 Academic and teaching roles 17
1-9 Staff structure 17
1-10 Nature of patient acuity and complexity 17
1-11 Operational Policies 75
1-12 Access-External 18
1-13 Access-Internal 18
1-14 Adaptability and Flexibility 18
1-15 Amenities Patients 18
1-16 Amenities Staff 19
1-17 Amenities Visitors 19
1-18 Call system 19
1-19 Catering Services / Food Safety 19
1-20 Cleaning Requirements 20
1-21 Energy Efficiency 20
1-22 Infection Control 20
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N. STANDARDS page
1-23 Information Technology 21
1-24 Laundry Management 22
1-25 Maintenance 22
1-26 Medical Records Management 22
1-27 Medications Management 22
1-28 Operating Hours 22
1-29 Resuscitation 22
1-30 Safety 23
1-31 Security 23
1-32 Storage 24
1-33 Waste Management 24
1-34 Referral Policy 24
1-35 Deceased Person Management 24
1-36 Functional Areas(cluster spaces) 24
1-37 Key Internal Relationships 25
1-38 Key External Relationships 25
1-39 Signage / Path finding 25
1-40 Functional Relationships 25
1-41 Ideal requirements of hospital dialysis units 25
Design 26
1-42 General 26
1-43 Safer by Design 26
Environmental Considerations 26
1-44 Acoustic 26
1-45 Natural light and views 27
1-46 Privacy 27
1-47 Decor 27
Building Services Requirements 27
1-48 Clocks 27
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N. STANDARDS page
1-49 Communications 28
1-50 Electrical Services 28
1-51 Water Treatment Services 29
1-52 Drainage System 30
1-53 Duress Alarms 30
1-54 Recall Staff & Emergency 30
1-55 Lighting 30
1-56 Medical Gases 30
Components of The Unit 31
1-57 General 31
Standard Components 31
1-58 Compliance with the standard components 31
1-59 Public Area, Main Entry / Waiting Area 31
1-60 Treatment Area 32
1-61 Isolation Room 32
1-62 Training Room Optional 33
1-63 Examination Room Cleaning Area of Equipments 33
1-64 Nurse Station(s) 33
1-65 Equipment cleaning Area Main Store Room 33
1-66 Water Treatment Plant Room 34
1-67 Storage Areas 34
1-68 Schedule of Accommodation 35
- Public Areas: Main Entry / Reception Cluster 36
- Treatment areas 37
- Administrative and Staff areas 38
- Support Services and Store Areas 39
Chapter Two: MANPOWER STANDARDS 41
2-1 Doctors 42
2-2 Nurses 43
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N. STANDARDS page
2-3 Supporting Manpower 44
Chapter Three : INSTRUMENTS STANDARDS 45
3-1 Specifications of Hemodialysis Machines 46
3-2 Specifications of CRRT machine 50
3-3 Specifications of Water Treatment Plant 55
3-4 Specifications of Hemodialysis Chairs 61
3-5 Necessary Requirements for Operating Hemodialysis Unit 63
Chapter Four : ACCREDITATION STANDARDS & PATIENT RIGHTS 65
4-1 Accreditation Standards 66
4-2 Patient Rights 68
Chapter Five :REFERENCES & APPENDICES 71
REFERENCES 72
- Local References 72
- Foreign Reference 72
APPENDICES 73
5-1 Functional Diagram 73
5-2 Hemodialysis Center (20) chairs ( Ground & First Floor) 74
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SUPERVISOR
Dr. AQEEL BIN GAMAAN AL GHAMDI

Assistant Deputy Minister for Hospital Affairs
Head of the Supervisory Committee of the National Program for The Renal Failure Patients Care
PREPARED BY
Eng. Ahmed Bin Ali Al Baiz Dr. AQEEL BIN GAMAAN AL GHAMDI
Assistant Deputy Minister Assistant Deputy Minister for Hospital Affairs
for Engineering Affairs – MOH Consultant Paediatric Nephrologist
Dr. Ayman Karkar Dr. Adnan Alfi

Consultant Nephrologist Consultant Nephrologist
Director/Kanoo Kidney Center Director/Dialysis Center
Dammam Medical Complex King Abdulaziz hospital
Supervisor/Dialysis Centers Supervisor/Dialysis Centers
Jeddah, Western Province, MOH
Eastern Province, MOH
Dr. Ahmed Wasfy Hassan Eng. Saleh Bin Abdulrahman Al Obeilan

Technical Affairs, Assistant Deputy Minister Office Director of Studies and Designs
For Hospital Affairs, MOH MOH
Eng. Rashid Ibrahiem Al Juwair

Technical Affairs, Assistant Deputy Minister Office
For Hospital Affairs, MOH
REVISED BY
Dr. Abdulla A. Al-Sayyari

Dr. Soliman Al Mohaya
Consultant Nephrologist
Consultant Nephrologist
Professor of Medicine
Security Forces Hospital
Head, Division of Nephrology & Renal
The Ministry of Interior
Transplantation, King Abdulaziz Medical City
Dr. Lutfi Abdullah Al Korbi Dr. Abdel Kareem Al Suwaida

Consultant Nephrologist Consultant Nephrologist
Director/Hemodialysis Unit King Khaled University Hospital
King Faisal Specialist Hospital Ministry of Higher Education
Assistant Deputy Minister For General Supervisor of Legal Affairs

Private Health Sector Ibrahim Bin Sulaiman Al msaitir
Dr. Ali Bin Hussein Al Zawawi
Eng. Essam Bin Mohammad Al Mohandis
Executive Director of the Department of Control
and Biometrics sector Medical Devices and Products
Saudi FDA
6
7
The development and the fast progress of improvement
in health services in the Kingdom of Saudi Arabia have
continued in a distinguished and elegant style; thanks to
God, and then to the Guardians of this country (God bless
them) for their concern, guidance and patronage of these
services.
At the forefront of these services is the care
provided for patients with chronic renal failure through creation and maintenance
of successful modern and well equipped and staffed renal centers all over Saudi
Arabia.
The Ministry of Health, represented by The Deputy Ministry for Hospital
Affairs and Supervisory Committee of the National Program for care of patients with
chronic renal failure, has issued numerous policies and procedures and guidelines
to regulate and advance these services. These guidelines include information and
data about establishing and running dialysis units and centers according to the
international standards. The aim of these guidelines has been to unify implementation
and regulation of policies and procedures, and to ensure premium services are
provided for patients with renal failure.
We still have many hopes and aspirations to continue improving these, and
other, health services and we are very much looking forward for a promising future
by God willing, and hope that these guidelines will achieve the expected benefits.
At the end, I can only lift the palms of humility to Allah Almighty to
perpetuate this country’s precious blessings of security, stability and prosperity
under the wise leadership led by the Custodian of the Two Holy Mosques and the
Highness of the Crown Prince (God saved). And God the Source of strength.
Minister of Health

Minister of Health
Dr. Abdullah Bin Abdulaziz Al Rabiah
Eng. Essam Bin Mohammad Al Mohandis

Executive Director of the Department of Control
and Biometrics sector Medical Devices and Products
Saudi FDA
8
Renal failure is considered one of contemporary
health burden for several reasons including increasing
number of cases, particularly among elderly and
diabetics. Also due to multiplicity of causes at different
classes of society and its health, social and psychological
complications. In addition to the cost of management
either by dialysis or transplantation.
In response to the directions of His Excellency the Minister of Health, the

Assistant Deputy Minister of Hospital Affairs and the Supervisory Committee of
the National Program for Renal Failure Patients Care as well as the other relevant
departments in Saudi Arabia have been conducting a preventive plans and early
detection measurements aiming at development of the curative services as being
represented by the renal dialysis centers in all directorates of health nationwide.
These plans are implemented to assure the sustainability of providing the

medical services on regular and prompt manner.
The ministry of Health is striving to apply the best practices and up-to-date
technologies for renal dialysis centers in order to improve their performance.
These guidelines include the standards for establishment, equipping and

operating the renal dialysis centers of the MOH according to the updated international
standards. Which enable the health team to provide a high quality services that meet
the patient expectations and ameliorate their pains.
Assistant Deputy Minister of Hospital Affairs

Head of the Supervisory Committee of the National
Program for The Renal Failure Patients Care
Dr. Aqeel Bin Jamaan Al Ghamdi
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Introduction
The health sector in The Kingdom of Saudi Arabia enjoys with particular
interest and support from the Government of the Custodian of the Two Holy
Mosques, the development and provided health services to patients and in
particular patients with renal failure. These health services are competing with
their counterparts in the developed countries, and became a mirror that reflects
the extent of development of the comprehensive health care in the Kingdom of
Saudi Arabia.
Accordingly Assistance Deputy Ministry for Hospitals Affairs and The
supervisory committee of the National Program for the Care of Patients with
Chronic Renal Failure in the Kingdom has prepared this guide to improve
and standard of care in kidney centers and dialysis units in all health sectors
to ensure high performance level according to international standards.
These guidelines include standards for the establishment and equipping and
operating dialysis units/centers. The design of these units/centers are based on
scientific manner and according to the highest international standards of health in
terms of structural and architectural planning to provide interior spaces to facilitate
the movement of workers and patients in addition to entertainment facilities.
The first module includes an overview of the standards of construction and
design spaces, Module II focuses on the standards of the workforce necessary
and providers, Module III safe accurate requirements of technical specifications
of the devices and special needs aspect to operations, and module IV includes
accreditation standards, which have been approved by The Central Board for
Accreditation of Health care Institutes (CBAHI) and patients’ rights.
These Guidelines are only for the advancement of the health services
provided to patients with renal failure to provide medical care and therapeutic
excellence for patients in all regions of Saudi Arabia. These Guidelines will be
updated periodically.
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1- INTRODUCTION:
1-1 Preamble
(A) Dialysis Center : is an out-of-hospital out-patient dialysis unit that is a licensed facility
which provides services on an out-patient basis to stable patients requiring dialysis on
regular basis or training for home dialysis; or
(B) Dialysis Unit : is an in-hospital dialysis unit that is a special unit of a licensed hospital
designed, equipped and staffed to offer dialysis therapy for in-patients as well as for
stable out-patients on regular basis, and to provide training for home dialysis and renal
transplantation as appropriate.
-Renal Dialysis Units are used by persons requiring hemodialysis and peritoneal dialysis services
or preparation for transplantation.
-Hemodialysis is a treatment for end stage renal failure where the function of the kidneys to
remove harmful substances and excess fluids from the blood is replaced by a machine. Treatment
requires the patient to be attached to the machine for ≥4 hours per session on at least three days
weekly.
-This process may be undertaken in a satellite dialysis center or hospital, or at home (home
hemodialysis). Peritoneal dialysis is an alternative to hemodialysis.
-Peritoneal dialysis involves removal of harmful substances and excess fluids across peritoneal
cavity by using sterile solutions in the abdomen on several occasions each day either manually
or with the assistance of a machine.
-Peritoneal dialysis is usually performed at home but training in technique and problem solving
may take place at the satellite dialysis centre or in a hospital.
1-2 Purpose
1. These guidelines have been developed to ensure consistent approach to the design of efficient
units which meet all necessary statutory and regulatory requirements. It is accepted that
standards and requirements will change over time.
2. Licensing dialysis units or centers at the private sector.
3. Working by total quality improvement system in renal dialysis centers and access to
accreditation.
1-3 The role of the Unit

-The role of the unit is to provide an easily accessible, safe and serviced environment in which
people can undertake haemodialysis on a regular basis.
-The Unit must be able to provide a reliable service for regular attendees as well as people who
require unusual episodes while recovering from another illness.
-The Unit will also provide treatment to people with infectious diseases. Every aspect of the
design of the unit must pay attention to design for infection prevention and control.
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1-4 Policy Statement
-Provision of sufficient renal dialysis capacity to meet the current and future needs of the
population.
-These guidelines may require modification on regular basis.
-Reference should also be made to the directions of the Ministry of Health and Advisory Group.
1-5 Description of the Unit

Most units will treat adults only with some specific units designated to treat children. The
functions of the Unit are to:
• Receive and provide dialysis services to people who have been referred from the community
or a hospital inpatient unit;
• Provide training for people, family members in procedures related to haemodialysis and/or
peritoneal dialysis;
• Act as a resource to the community with regards to the requirements of renal health services.
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PLANNING
1-6 Operational Models
Models and charts of dialysis center:
The following issues should be considered in developing the model for the implementation of
the structure of dialysis unit/center:
1-6-1Selecting the appropriate location:
A- Independent center: B- A unit within a hospital:

- Easy access to center - Easy access to the unit

- Proximity to a hospital for the treatment of critical cases - Proximity to the emergency department
- Coverage most of needing patients for dialysis. - Availability of exits and entrances to gain access to
departments supporting services.
1-6-2Planning for Spaces:

According to the bed capacity of the unit/center, the following categories should be considered:
More than
5 10 20 30 40 50
Bed Capacity 50
Chairs Chairs Chairs Chairs Chairs Chairs
Chairs
1-6-3-Allocation of space inside and outside the building:

Spaces outside the building:
- Allocate space in front of the main entrance for drop off patients.
- Allocate space for parking commensurate with the number of Patients and staff.
- Allocate space for the external ramps for handicapped patients.
- Allocate space for the ambulance.
- Allocate space in front of the main store from the outside.
- Allocate space for the gardens which equals (5-10 meters)/chair.
Spaces inside the building:
first Public Area

N Site
1 The main entrance
2 The main entrance / Reception
3 (The main entrance /Waiting area (for men)
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4 The main entrance /Waiting area (for women(
5 Public toilet / bathroom
6 A public toilet with facilities for disabled
7 Prayer room
8 Elevator patients (1.4 m × 2.0 m2) elevators / floors
9 Elevator visitors (1.2 m × 2.0 m2) elevators / floors
10 A sub-waiting patients (men - women), buffet (for drinks(
11 Waiting chairs for disables
12 Allocated space for carts/trolley
13 Corridors
Second Treatment area
N Site
1 Treatment area (dialysis machine + bed or chair)
2 Isolation Room to isolate blood-borne diseases
3 Nursing station (Counter) 1st floor - 2nd floor
4 Hand washing basins (an area of the
basin 1 m2)
5 Consultation room / Examination room
6 Minor operation room
7 Antiseptic area for handling medications
8 Pharmacy
9 Laboratory
10 Subsidiary Nursing station
Third Area for staff and administration
N Site
1 Director office (+meeting room + small archive + Break)
2 Doctors room
3 Head nursing office
Administration (staff offices: - Secretarial - social worker –Accountants -Managing
4
Director)
5 Patients Affairs office
6 Dietician office
7 Filing room
8 Training room (for patients and relatives on peritoneal dialysis techniques)
9 Dining room for the operating staff
10 Health records room
11 Bathroom (staff)
12 Common room (staff)
13 Personal locker room
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Fourth Support services and Stores
N Site
1 Store for clean linen 1st floor - 2nd floor
2 Store for dirty linen 1st floor - 2nd floor
3 Water treatment plant (Minimum 9 m2 – based on bed capacity)
4 Daily store room (Warehouse)
5 Weekly store room
6 General store room
7 Waste disposal reservoir
8 Warehouse equipment (for the maintenance and sterilization of dialysis machines)
9 Warehouse for the supply of cleaning solutions
10 Warehouse to save & prepare dialysis solutions
11 Kitchenette
12 Water pump room
13 Pump room for fire resistance
14 Control room (with Tableau power + generator works automatically reserve)
15 Store room for medical gases
16 Repair shop for equipments and chairs
17 Support Room
18 Room Pantry supplies
19 Store (supplies of cleaning liquids and dry materials & tools)
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1-7 ROLE DELINEATION OF THE ASSOCIATED HOSPITAL
Although the basic nature of the services is the same, there are different requirements for
services providing a large tertiary service and those that may provide a satellite service. The
role delineation of the associated hospital will influence the level of service provided as will
the support systems able to be provided by the associated renal network to which the service
belongs.
1-8 ACADEMIC AND TEACHING ROLES

This factor will influence the requirements for meeting rooms, office space and general
administrative space.
1-9 STAFF STRUCTURE

-The staff structure of the unit will have an impact on the nature, size and location of the staff
station, office and administrative spaces, staff facilities such as staff rooms and toilets.
-The staffing structure of the proposed unit, should be developed prior to planning any new unit.
1-10 NATURE OF PATIENS

A clear understanding of the nature of the patient population to be served should be clearly
articulated prior to planning of a new unit. Factors that need to be taken into account are:
• The age mix and sex of the patient group.
• Mental and social aspects of patients.
• Severity of the illness of the proposed patient group (acuity).
• Any comorbidity that may be expected in the patient group.
• The rate of infectious diseases to be expected in the patient group.
1-11 OPERATIONAL POLICES:

Operational Policies have a major impact on facility requirements and the capital and recurrent
costs of the Unit. These policies should be clearly articulated prior to the commencement of
capital planning so that the facility design can reinforce the new practices proposed for the
service.
While it is not possible to anticipate the full range of operational policies required for all new
units, the following are offered as a guide for review and adaptation when a new service is
proposed or an existing service is to be redesigned.
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1-12 ACCESS EXTERNAL
-The unit should be easily accessible to the public. A majority of persons requiring regular
treatment will arrive at the unit by vehicle. Easy and convenient access should be provided
either horizontally or vertically (lifts, escalators).
-Designated parking and covered drop-off areas for persons close to the entry point must also
be considered.
-Ambulance services may drop off and collect persons in a routine or urgent manner. Adequate
covered space and parking needs to be designated for this purpose.
-There should be easy access for regular and large amounts of disposable products and supplies
to be delivered on palettes to the units main store room by a mechanized palette lifter.
-It should be easy and discreet to deliver food, laundry and other supplies to the unit and take
away general and medical waste as well as dirty laundry several times per day without disrupting
the operations of the unit.
1-13 ACCESS INTERNAL

The unit (if on a hospital site) should be located for easy access to other relevant hospital
departments such as inpatient units and clinical support services. Within the unit, functional
relationships should enable the easy execution of all tasks in a safe environment. This includes
the provision of two egress points from each consultation/ treatment room.
1-14 ADAPTABILITY AND FLEXIBILITY

While the functions of many of the core spaces within the unit are set, there should be a high
degree of flexibility to alter the function of support areas to meet changing demands. For
example, storage areas may become office spaces and vice versa. Consultation rooms may be
used for training, meeting and interview spaces.
1-15 AMENITIES PATIENTS

A full range of necessary amenities should be located within the unit or in close proximity for
the convenience of people receiving treatment. These should include:
•Toilet
•Shower
•Telephone
•Audio-visual entertainment
•Access to food and beverages
•Educational booklets and magazines
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1-16 AMENITIES STAFF
A range of amenities and services are required by staff so that they can perform their duties at
an optimal level. These may be provided within the unit or may be shared with another area
adjacent to the Unit:
• Toilet
• Food and beverage preparation area
• Proper bay for cost in a secure environment
• Meeting room
• Recording space
• Computer, facsimile and printer access
• Internet/intranet access
• Medical and scientific library.
1-17 AMENITIES VISITORS

Family and friends will need to be provided with amenities including:
• Toilet
• Beverage preparation area
• Consultation room access
• Comfortable waiting areas provided by educational and audiovisual means.
1-18 CALL SYSTEM

The following call systems are required in the unit:
• Patient call system back to staff station if all persons are not able to be in full view of staff at
all times.
• Call buttons in toilets, showers and other areas where patients may need to call for assistance.
• Emergency call at the staff station (if the unit is part of a hospital) to provide a prompt and
appropriate response.
• Alarm to the staff to provide a prompt and appropriate response.
1-19 CATERING SERVICES /FOOD SAFTY

providing a light meal to people receiving treatment and have beverages available. Food supply
and preparation must meet the requirements of the Food Safety Standards.
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1-20 CLEANING REQUIREMENTS
The unit requires a high standard of cleanliness to guard against infection:
• High levels of cleaning are conducted in the unit including daily thorough cleaning of the unit
and ‘terminal’ cleaning of isolation rooms at least twice per day.
• All surfaces should be easy to clean and be absent from seams and creases which may harbour
bacteria.
• Vinyl that requires a warm water wash and does not require daily polishing should be included
in all treatment areas.
• Skirting should be coved to prevent dirt congregating in corners.
• Washable paint should be applied coating anti-bacteria, washable for all walls and ceilings.
• The unit must be air conditioned and the system must be serviced regularly and filters cleaned
periodically.
• Air agitation devices such as vacuum cleaners and air hand dryers should be omitted or used
sparingly to prevent the production of air borne particles.
• Windows and other glass should be kept clean.
• The areas of toilets and bathrooms must be covered by ceramic until smooth walls to enable
easy cleaning.
• Kitchen areas should be kept clean including appliances such as microwaves and refrigerators.
1-21 ENERGY EFFICIENCY

The design of the unit and the engineering systems included to meet service needs must take into
consideration the need for efficient energy use to reduce consumption and minimise operating
costs.
1-22 )INFECTION CONTROL (CLEANING REQUIREMENTS

Infection prevention and control involves identification of transmissible agents and intervention
to minimise the spread of these infections. The design of all aspects of the unit should take into
account the need to ensure a high level of infection control in all aspects of practice. Key factors
that should be taken into consideration are:
• All surfaces and fixtures are to be designed to enable easy and thorough cleaning on a regular
and repeated basis.
• The design should support high levels of hand washing by staff and other persons by the
convenient and adequate placement of suitable hand wash basins at a rate of one per three (3)
treatment bays as well as in all separate treatment areas, utility areas, toilets and showers.
• Alcohol hand-rub dispensers should be at the entrance of each treatment room and within each
treatment bay for easy access by staff.
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• Isolation rooms should be provided at the rate of one isolation room to every five (5) treatment
bays (in hospital-based and satellite units) giving a cluster of six (6) treatment spaces. A
Class S room is a single room with a shower/toilet en suite that is not shared. There is no
special requirement for the air-conditioning system but a hand basin and a self-closing door
is recommended. A personal protective equipment (PPE) bay should be provided immediately
outside the room to hold gloves, goggles, face shield masks, gowns and a waterless alcohol-
based hand rub dispenser. A PPE Bay can be shared between two isolation rooms.
• Air-conditioning rather than natural ventilation should be provided to the unit. All air-
conditioning filters should be changed or cleaned at a rate consistent with the manufacturer’s
requirements.
• Floors: it must be covered by ceramic, easy to clean and resistant to disinfection procedures.
All treatment areas should not be carpeted. Floors in food preparation areas should be water
resistant and greaseproof.
• Skirting: wall bases in treatment areas, kitchens, clean and dirty utility rooms and toilets
should be made integral to the floor, tightly sealed against the wall and constructed without
voids. Skirting in showers should extend all the way up the wall to protect all potentially wet
areas from infiltration.
• Walls: wall finishes must be scrub able and should be smooth and water-resistant.
• Ceilings: all exposed ceilings and ceiling structures must be easy to clean. All areas where dust
fall out would present a potential problem must have finished ceilings that cover all conduits
and pipes.
• Window furnishings: washable blinds are preferable to curtains as they retain less dust and
are easier to clean and non-flammable.
1-23 INFORMATION TECHNOLOGY
The following systems should be provided in the unit:

• Telephone, facsimile and computer access.
• Intranet and internet access.
• Access to all ordering and recording systems currently utilised by the Area Health Service to
supply and collect data.
• Teleconferencing and videoconferencing amenities may be useful to either access information
or provide information.
• Closed circuit television (CCTV) may be required to ensure staff can oversee entry and egress
points.
• A decision about the need for other Tele-health technology (such as access to digital radiology
or pathology systems) should be made early in the planning process.
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1-24 LAUNDRY MANAGEMENT
Suitable areas are to be provided for storing clean linens and clothes in an orderly and easily
accessible manner.
-A holding area for bagged used linens and clothes is to be provided for safe storage prior to
collection.
-Ideally this holding area should be located on the external perimeter of the unit so that the
collector does not need to enter the unit.
1-25 MAINTENANCE
The unit must have a fully developed and documented maintenance plan in place to ensure
that replacements and upkeep are undertaken on a preventative basis for all equipment and
engineering systems. This plan should be part of a broad strategy in the hospital.
1-26 MEDICAL RECORDS MANAGEMENT

- Medical records for all persons receiving treatment in the Unit are to be kept in a central
location that can be appropriately secured.
-Where the Unit is part of a hospital the records should be integrated with other medical records
for each patient as part of an integrated medical record system.
- Once a person is no longer receiving treatment in the Unit , the medical records shall be
returned to the central records management department.
-Where an electronic medical records management system is in operation, the Unit’s information
management system shall be designed to participate in this system.
1-27 MEDICATIONS MANAGEMENT

-All medications will be held in the locked pharmacy store in the Clean utility room. Scheduled
drugs will be stored in the pharmacy store in accordance with the requirements of the poisons
regulations.
1-28 OPERATING HOURS

-Units commonly operate between 7am and 4.30 pm, per day, allowing two sessions per machine
per day.
There will be a wide range of variations to these operating hours depending on the needs of the
patient groups, staff availability, number of working machines and actual demands.
1-29 RESUSCITATION
All areas of the unit accessed by patients must enable the delivery of resuscitation in an appropriate
manner. This requires:
• Central location (adjacent to the centralised staff station) for the resuscitation trolley.
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• Adequate space in each treatment space/room for resuscitation procedures to be performed.
• Oxygen and suction sources either piped to each space and room or from mobile units.
• Emergency call system to gain a prompt response from extra support resources, as required.
1-30 SAFETY
All aspects of the unit must ensure the required standards of personal safety for people visiting
the unit and staff. Issues that need to be considered include:
• Application of occupational health and safety standards to all components of the unit.
• Sufficient space to enable the required activities to be undertaken in a safe manner.
• Recognition of the fact that people using the services may have varying degrees of physical and
sensory disability that require consideration during their stay.
• The unit must be fully accessible for persons in wheelchairs or on a patient trolley or patient
bed.
• Fittings and fixtures must be robust and of safe design to prevent injury.
• Large pieces of equipment (e.g. hemodialysis units) and furniture (e.g. patient chairs) must be
selected for their ease of movement by staff as well as their appropriate design features.
• Chemicals and concentrates utilized within the unit will be handled as per their ‘Material
Safety Data Sheets’.
1-31 SECURITY
A secure environment needs to be provided which complies with the requirements of the Ministry
of Health Safety and Civil Defence Regulations.
Key features that need to be included are:
• Unit design must facilitate good sight lines for staff to all key areas of the unit.
• Controlled access through the clustering of functional spaces or grouping of spaces, as required.
• Minimize entry and exit doors and ensure staff areas are optimally places to oversee entry/exit
points.
• Provide staff with emergency call capabilities and procedures.
• Procedures must be in place for management of persons who are aggressive or a threat to
patients and staff.
• Patient files must be kept in a secure environment that prevents access by unauthorized persons.
• Non-removable ‘Asset No.’ on all equipments in the unit.
• Dangerous drug safe in the clean utility room.
• Provision of lockers for staff personal effects in a secure environment.
• Closed circuit television may be required to provide an adequate view of external areas. This
should be considered during planning the design.
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1-32 STORAGE
Large quantities of liquid substances, disposable equipment and other supplies are delivered on
palettes to the unit on a regular basis. This activity requires the following:
• Provision of an adequately sized main storeroom with sufficient aisle width to enable access
by a palette lifter.
• Areas designated as wet and dry need to be provided to prevent the contamination of dry sterile
stores and meet the requirements.
• Location of the main storeroom on the external perimeter of the unit with a roller door to
facilitate palette lifter access.
• Easy access from a loading dock to the main storeroom.
• Heavy duty shelving to hold the large quantities of supplies in an orderly manner.
• Additional dispersed storage to enable the unit to be kept clear of collision obstacles.
• The stability of liquid concentrates (especially those which are glucose-based) is dependent on
air temperature. Consideration should be given to the need for air-conditioning in some storage
areas if the temperature cannot be maintained within required limits. Reference should be made
to the storage requirements of stored items to determine the need for this requirement.
1-33 WASTE MANAGEMENT

Substantial quantities of waste (both general and contaminated) are generated by the unit. Waste
management practices must include:
• Application of universal precaution standards in the management of waste.
• Provision of suitable receptacles for all waste categories that are convenient to use.
• Provision of adequate storage areas for waste (general, contaminated, sharps etc.) in an
appropriate manner.
• Provision of a disposal room on the external perimeter of the unit to enable collection of used
laundry and waste without intruding into the unit.
1-34 REFERRAL POLICY

Each unit / dialysis center should have a policy to refer to one or more of the hospitals, to provide
care within the hospital or other hospitals to provide services.
1-35 DECEASED PERSON MANAGEMENT

Any person becoming deceased in the unit will be moved to an enclosed space (e.g. consult
room, isolation room) until transferred discreetly to the mortuary or the hospital.
1-36 :FUNCTIONAL AREAS

• Reception/waiting
• Treatment
24
• Staff areas
• Support areas
There are various ways in which these components of the service can be configured to ensure
efficient and thoughtful management practices that make each day easier for people receiving
treatment, their relevant others and staff.
1-37 KEY INTERNAL RELATIONSHIPS

• Staff station requires an unobtrusive view of all patient treatment areas.
• Reception requires a clear view of entry and exit/egress points of the unit.
• Easy access from the waiting area to the patient treatment area for the convenient arrival of
patients.
• A functional relationship diagram which displays the above associations is included in the
appendices.
1-38 KEY EXTERNAL RELATIONSHIPS

• Easy access to the unit where a high percentage of people will arrive by car on a daily basis.
This should include convenient, designated parking spaces close to the entry point with direct
horizontal or vertical travel to the unit, providing explanatory signs on the location of the unit
and its entrance.
1-39 SIGNAGE / PATHFINDING

• Access to the unit should be identified from all site access points with clear directions to
parking areas and building entry.
• If the unit is not directly accessible from external areas, clear signage must provide direction
to the unit.
1-40 FUNCTIONAL RELATIONSHIP

• The satellite unit must be self-sufficient with easy access for walking persons and those arriving
by vehicle for treatment. There must be easy access for the delivery of food, clean laundry,
equipment, supplies and files and the removal of waste and dirty laundry.
1-41 • The hospital-based unit will ideally require the following:
Pathology. Easy access for staff to attend the unit to collect specimens. Inclusion in the pathology
results management system to access results in a timely manner.
Medical Imaging. Easy access to the Medical Imaging Department to allow portable equipment
to be brought to the unit and for persons to travel to the unit for procedures of imaging.
Medical Records. If a hard copy system is in use, there should be easy access to the Medical
25
Records Unit for the retrieval of files and the return of files after treatment is completed. If an
electronic system is in use, the unit must have the necessary workstations to permit staff the
required level of access to patient files.
Inpatient Units. The unit should be closely related to any inpatient unit which refers or accepts
patients from the unit.
Pharmacy. Easy access for staff to retrieve supplies and for pharmacy staff to provide inventory
and counselling services to the unit.
Mortuary. Easy and discreet access to the mortuary for the delivery of persons who may become
deceased in the unit.
Security. The hospital-based unit should enjoy the same level of scrutiny from Security Services
as all other sections of the hospital to maintain a high level of security integrity. For satellite units,
a standard of security should be in place commensurate with the requirements of the unit and any
untoward factors that may compromise security such as extended operating hours, location on a
busy road etc.
DESIGN
1-42 General
Reference should be made to the Ministry of Health Guidelines.
1-43 SAFER BY DESIGN

Many satellite units are not part of an integrated building and are therefore more susceptible to
security breaches. The Design Team should be mindful of this in planning the unit in a way that
promotes a secure environment.
Environmental Considerations
1-44 ACOUSTIC
Many functions undertaken in the unit require consideration of acoustic privacy including:
• Discussions/interviews with people and families.
• Isolation of noisy areas such as waiting rooms from treatment areas.
• Staff discussions regarding confidential matters.
Solutions to be considered include:
• Selection of sound absorbing materials and finishes.
• Use of sound isolating construction.
• Planning to separate quiet areas from noisy areas.
• Changes to operational management. This may include separate areas for patients with special
needs.
26
1-45 NATURAL LIGHT AND VIEWS
Natural light contributes to a sense of wellbeing, assists orientation to building locations and
improves service outcomes. The use of natural light should be maximized throughout the unit.
Natural light and a view to pleasant and interesting outdoor areas is of particular importance for
people who spend long periods of time sitting in dialysis chairs. Every effort should be made to
provide a view to all treatment areas either by locating treatment bays adjacent to a window or
enabling unobstructed sight lines through areas to an outdoor view.
1-46 PRIVACY
Confidentiality for persons receiving treatment is a highly important consideration to be
addressed. The unit should be designed to:
• Ensure confidentiality of personal discussions and medical records.
• Provide an adequate number of rooms for discreet discussions and treatments to occur whenever
required.
• Enable sufficient space within each treatment space to permit curtains to be easily drawn
whenever required.
• Appropriately locate windows and doors to ensure privacy.
1-47 DECOR
This includes style of design, furnishings, colour, textures, ambience, perceptions and taste. The
decor of the unit should be of a standard that meets the expectations of people using the services
and make every effort to reduce an institutional atmosphere. This is very difficult with the high
degree of equipment, services and infection control conditions that are required to deliver the
service. Suggestions to achieve this balance include:
• Use of design features such as colours and artworks to distract the sight from clinical areas.
• Inclusion of soft furnishings that act as a design feature such as screening, lounges in waiting
areas and window treatments.
• Elimination of corridors through good design wherever possible.
• Inclusion of corridors at the minimum required widths to meet the service need.
Wide corridors are a feature that potentiates institutional environments.
• Provision of a beverage bay for people to use while waiting.
• Background music through a piped system or a centralized unit.
• Television systems with head set access.
Building Service Requirements

1-48 Clocks
A wall clock should be located in the Reception/Waiting and Treatment Areas in clear view.
27
1-49 COMMUNICATIONS
The following communications systems will be included in the unit:
• Telephone (fixed and cordless for use by persons on dialysis)
• Paging system for staff if part of the hospital-wide communications system.
• Computer with internet and intranet access.
• Document Center including facsimile.
• Physical transfer systems such as pneumatic tubes and automated trolley systems for hospital-
based units if part of the hospital-wide communications system.
• Teleconferencing capability in the meeting room.
• Videoconferencing capability if there is an identified need as part of the area-wide strategy or
network.
• Some other telemedicine modalities may also be required especially in remote and rural sites.
The need for these modalities and how they are expected to operate should be confirmed prior to
the commencement of capital planning.
• Patient/nurse call system if all persons receiving treatment cannot be visualized at all times.
• Emergency and duress systems capability in line with area-wide policies to ensure patient and
staff safety.
• Early warning information system (EWIS) for evacuation warnings and public address alerts.
• Workspaces, bench design and suspension devices must permit the appropriate accommodation
of computer terminals, keyboards, drivers and printers. The centralization of printers, scanners,
facsimile machine and photocopier should facilitate shared use.
• Closed circuit television should be considered where the functional design of the unit does not
permit staff to oversee all necessary entry and egress points.
1-50 ELECTRICAL SERVICES

The following electrical requirements shall be provided in every Dialysis Unit:
1. Electric Source:
Due to the importance of medical equipments in general and the dialysis equipments in particular.
It is a must to provide 3 Nos. electrical sources which are as follows:
a) Main Source for the electric network is supplied either from the breaker of the hospital or
a breaker specifically used for the center.
b) A set of emergency electric generators with enough power to run the dialysis units, air
conditioning units which serves this division, water pumps and the filtration units.
c) Uninterrupted power supply (UPS) which are continuously feeding the units in such a
way there will not be an interruption of power supply during the transfer period between
the City Network to the electric generator when a black out occurs. The UPS unit shall
have enough power to run the equipments for at least a period of 20 minutes.
2. To provide water filtration plant specifically used for the dialysis units. It shall be independent
28
from the rest of hospital division.
3. Distribution of lighting units will correspond with the use of the area and the architectural shape
of the ceiling and will provide acceptable illumination according to the international standards.
In addition an emergency lightings and exit signs shall be provided.
4. Distribution of electric outlets network in all divisions which are fed from the main network
and another set of emergency electric outlets fed from the electric generator set.
1-51 WATER TREATMENT SERVICE
A key component of the renal dialysis unit is the need to treat water that will be used in the
hemodialysis process to remove any contaminants. Different commercial water treatment
systems may undertake the water treatment activities in slightly different ways but in general
the main phases of water treatment occur in the following sequence:
Phase 1: Particle filtration to 20 microns.
Phase 2: Water softening to remove calcium and magnesium carbonate.
Phase 3: Carbon filtration to remove chlorine. Chlorine is taken out as late as possible in the
process so that its disinfection properties are utilized.
Phase 4: Particle filtration to 5 or less preferably 1 micron.
Phase 5: Reverse Osmosis Process.
-Reverse osmosis (RO) is a process where water is dematerialized using a semipermeable
membrane to encourage mineral salts to pass out of the water to be used in dialysis. Industrial
RO uses spiral wound membranes mounted in high pressure containers to activate this process.
-The aim of all the above processes is to improve the purity of the water to be used by removal of
particulates, salts and bacteria before it comes into contact with the person receiving hemodialysis.
-Booster pumps may also be required to ensure a certain speed of water (at least 10 meters/
second) and a certain pressure of water (varies dependent on the concentration of the salt solution
on the reject side of the membrane) to enable these processes and to limit the ability of tubing
contamination by bacteria and moulds.
-These contamination processes are also reduced by the application of heat (85°C – 95°C),
eliminating any right angle bends, ensuring the internal surfaces of tubing have a high level of
smoothness and by keeping tubing runs as short as possible.
-The Plant Room for water treatment is ideally located as part of the renal dialysis unit to keep
tubing runs short and to make it easy for staff to monitor and service the water treatment systems.
1-52 DRAINAGE SYSTEM
- Services that facilitate the drainage of fluids from the hemodialysis machines must be ventilated
to prevent condensation and the subsequent growth of mould. This fact should be kept in mind
when designing covers or screens for the drainage systems. Commercial models which comply
29
with the relevant Saudi FDA Standards are available.
-It is necessary to secure the water network diameter 2.5 cm or more, as well as the sewer
network diameter is 10 cm, the level of sanitation is lower than the level of the water implant
prepared for hemodialysis.
1-53 DURESS ALARMS

Should be in accordance with the Ministry of Health and Civil Defence Regulations.
1-54 RECALL STAFF & EMERGENCY

- Systems should provide emergency appeal in all treatment areas, bathrooms and toilets for
patients and health team to perform the appropriate level of assistance.
- Emergency Stairs should be available for safety reasons (according to the standards of the
International Fire Fighting) and be completely isolated with the availability of panels to indicate
the emergency exits.
- Emergency exits should be provided which open directly outward, The maximum horizontal
distance between two adjacent exits is no more than 45 meters in accordance to criteria of the
National Fire Prevention Association.
-Provision of an emergency entrance for ambulances provided that:
- 2 Nos. leaves door ( Double Door) with no less of 2 meters clear opening.
- Door will open inside the corridor
- The width of the corridor leading from the door of the emergency to treatment room is at
least 2.4 meters
- The connection of the entrance to the ambulance should have a safe ramp.
- The emergency entrance should be located far from the main entrance and other entry
points.
1-55 LIGHTING
-The lighting design needs to provide for both comfort and function and should be inherently
flexible. There are different considerations for different areas within the unit.
- It should be possible to vary lighting conditions between individual treatment bays and
rooms.
1-56 MEDICAL GASES

Patient treatment spaces and treatment rooms require access to oxygen and suction.
Network for various medical gas systems to supply patients sites and treatment rooms, it must
be taken into account the following:
• piping must bear a pressure equal to 1.2 of the maximum possible pressure.
• Pipes must be connected to the earth electric connection of the place of the unit.
• Pipes must be protected from damage that may result from the collision devices such as
30
chairs and the Terolli carts.
• Pipes must be supported with pillars so as not to bend.
• Props must be made of corrosion-resistant material.
• Props for pipes must not be used for any other uses.
• Piping net for gases must be distinguished periodically by name of gas and / or symbol near
to gas valve and put an arrows to indicate the direction of gas flow.
COMPONENTS OF THE UNIT

1-57 General
As previously advised the key components or clusters of a unit are:

• Public reception
• Treatment
• Staff areas
• Support areas
Within each of these clusters there will be variable additions to meet the special needs of each
service depending on the outcomes of the needs analysis and the approved service plan, both of
which should be completed before commencing capital planning of the unit.
This section should be read with reference to the following sections of this guideline:
• Functional relationships diagram.
• Schedules of accommodation.
• Room data sheets.
Standard Components
1-58 The standard components in the unit must comply with Ministry of Health Facility Guidelines,
Advanced international standards and Ambulance Services.
1-59 PUBLIC AREA

This area must be inviting, have comfortable domestic furniture and a beverage pantry for the
use of people waiting. The entry doors should be observable from the Reception Area.
It includes :
- The main entrance
- The main entrance / Reception
- The main entrance / Waiting area (for men)
- The main entrance / Waiting area (for women)
- Public toilet / bathroom
- A public toilet with facilities for disabled
- Mosque
- Elevator patients (1.4 m × 2.0) elevators / floors
- Elevator visitors (1.2 m × 2.0 m) elevators / floors
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- A sub-waiting patients (men women) + buffet (for drinks)
- Waiting chairs with disabilities
- Wait for carts / trolley
- Corridors
* Wheelchair parking space, facilities that provide a significant number of services to aging
and disabled populations who utilize wheelchairs (should provide more than one space to park
wheelchairs)
1-60 TREATMENT AREA

-The treatment area shall be separate from administrative and waiting areas. The treatment
area shall be permitted to be an open area. Open treatment areas shall be designed to provide
privacy for each patient. This area should be designed with treatment bays adjacent to each
other in sight of a staff station. Each treatment bay is sized to take a chair or a bed. It is strongly
recommended that the treating area space should not be less than 9 m2. There shall be a clear
dimension of at least (1.22 meters) between beds and/or lounge chairs. Optimally an external
view should be provided for all persons participating in hemodialysis either through being
adjacent to a window or by keeping sight lines to further windows clear of obstruction. This
may require the slanting of chairs or beds away from the traditional vertical alignment. Instead
of the foot of the chair or bed pointing at a perpendicular angle to the staff station. For larger
units several clusters of treatment bays may be designed around smaller sub staff stations for
better management. It should be kept in mind that the usual management practice is for one
nurse to one critical patient, one junior nurse to manage two patients, and one professional and
experienced nurse to manage 3 hemodialysis patients at any one time.
*Treatment Bays
Bay size need to be 9 square meters with a clear width of 3 meters along the back of the bay to
ensure appropriate service placement, machine accommodation and curtain track placement.
Spaces of 12m2 will need to be considered where more than 50% of patients are receiving
dialysis in the unit inpatient beds rather than chairs or trolleys. This is of particular relevance
for Level 5 and Level 6 renal services located in tertiary referral hospitals.
* It is proposed that the unit may utilize chairs or beds, or a combination of both.
1-61 ISOLATION ROOM

Reference should be made to the Ministry of Health documents and guidelines for infection
control policies and procedures in dialysis units. These include cleaning, disinfection and
sterilizing reusable medical and surgical instruments and equipment, and maintenance of
associated environments in health care facilities. The increasing prevalence of infections such
as Vancomycin resistant E Coli (VRE) and others requires the inclusion of isolation rooms to
32
separate infected persons during treatment. Advice on the rates of infection demonstrates that
persons with a less acuity who will attend satellite renal hemodialysis units have lower rates of
infection than those persons of a higher acuity who will attend a hospital-based unit. It is the
norm to isolate patients with hepatitis B from those of hepatitis C and from negative patients,
where each group is segregated in separate rooms/halls.
Each isolation room must have access to a dedicated en suite. Each isolation rooms must be
preceded by a Personal Protective Equipment (PPE) Bay. One PPE bay can be shared between
two isolation rooms.
No special air-conditioning requirements are associated with Class S Isolation rooms. Self-
closing doors are preferred. Isolation rooms should be located close to open treatment bays.
1-62 TRAINING ROOM OPTIONAL

Units must be able to support people who are using all forms of dialysis. Likely future requirements
for services such as peritoneal dialysis training and home hemodialysis training for people and
their family and/or carers should be considered.
For larger units where significant numbers of people will require training and support in the unit
on a regular basis that cannot be undertaken in a spare treatment space or room, the inclusion of
training room should be considered. This space could also be used for minor procedures such as
the insertion of catheters, though a mini theatre is preferred.
Home Training Room:

The following requirements shall be met:
- A private treatment area of at least (11.15 m2) shall be provided for patients who are being
trained to use dialysis equipment at home.
- This room shall contain a counter, hand-washing stations, and a separate drain for fluid disposal.
1-63 EXAMINATION ROOM

-At least one examination room shall be provided.
-The examination room shall have a minimum clear floor area of 100 square feet (9.29 m2)
- The examination room shall have the following:
- Hand-washing station
- A counter or shelf space for writing or electronic documentation
1-64 NURSE STATION(S)

-Nursing stations shall be located within the dialysis treatment area and designed to provide
visual observation of all patient stations.
1-65 EQUIPMENT CLEANING AREA

This room is required for the cleaning and routine maintenance of hemodialysis machines and
33
other equipment. It must include:
• Cupboards for holding commonly used supplies and parts.
• A sink with a drainer.
• General staff hand basin.
1-66 WATER TREATMENT PLANT ROOM

This room must be located with easy access to the external perimeter of the unit while being
adjacent to the treatment area and requires the following specific attributes:
• Space for water treatment components which may include booster pumps (usually two which
alternate), particle filters (approximately two), water softener, carbon filter and reverse osmosis
system as well as products to keep these units operational.
• There must be workable space around all sides of the units (at least 0.5 meters) to enable
routine calibration, servicing and maintenance to be conducted in a safe and easy manner.
• Sufficient space to have soft curving of tubing to prevent right angle bends.
• Adequate ventilation, air-conditioning and/or exhausting to remove the heat load generated by
the equipment.
• Noise attenuation is important to prevent any sound disturbance to treatment and other areas.
1-67 STORAGE AREAS

Main Store Room:
• To hold general stores, fluids and equipment. Must be placed on the perimeter of the unit and
accessible by a palette lifter.
• Shelving must have 100 kg weight capacity and shelves need to be at least 400 mm apart and
adjustable.
• A benchmark of 1m2 for each treatment bay and isolation room has been determined by
assessing operational units.
Clean linen storage:
• This warehouse will be a separate room from soiled waste room and there is no direct contact
between the two chambers.
• If blankets or other linens are used, a clean linen storage area shall be provided.
(1) Location of the clean linen storage area within the clean workroom, a separate closet, or an
approved distribution system shall be permitted.
(2) If a closed cart system is used, storage in an alcove shall be permitted. It must be out of the
path of normal traffic and under staff control.
• If the room is used for preparing patient care items, it shall contain the following:
(1) Work counter
(2) Hand-washing station
34
(3) Storage facilities for clean and sterile supplies
Soiled waste room:

A soiled workroom shall be provided and shall contain the following:
• A flushing-rim sink • A hand-washing station
• A work counter • Storage cabinets
• Waste receptacles • A soiled linen receptacle
Disposal Area
• Area to hold receptacles for general and contaminated waste and dirty laundry.
• May be an open bay with receptacles or an enclosed room.
Bay - equipment holding
• May be subdivided to place in convenient locations to keep wheelchairs, trolleys etc. out of
corridors and work areas.
Cleaner’s Wet Store
• To hold cleaning liquids, mopping, scrubbing and other equipment. Will include a cleaner’s
sink.
Cleaner’s Dry Store
• Cupboard to hold paper supplies and other goods that must be kept dry to eliminate potential
water contamination.
Dialysis Fluid Bay
• To hold dialysis fluid in a convenient location close to treatment bays. May be subdivided
to enhance staff access.
1-68 Schedules of Accommodation

• The following schedules of accommodation (spaces) demonstrate the range of functional
areas required for units of 5, 10, 20, 30,40 and 50 treatment spaces.
• In each box the first number denoted the number of spaces and the second number the square
meters of each individual space.
• For e.g. “2 x 12” implies 2 spaces of 12 m2 each (a total of 24 m2).
35
Spaces in public areas (by square metres)
first Public Area 5 beds 10 beds 20 beds 30 beds 40 beds 50 beds
N Site M2 M2 M2 M2 M2 M2
1 The main entrance - - 50 60 60 75
2 The main entrance / Reception 10 15 20 20 20 25
3 The main entrance / Waiting area (for men) 6 6 9 9 9 10
4 The main entrance / Waiting area (for women) 6 6 9 9 9 10
5 Public toilet / bathroom 7 7 2 x 12 2 x 12 2 x 12 2 x 12
6 A public toilet with facilities for disabled 6 6 2 x 3.5 2 x 3.5 2 x 3.5 2 x 3.5
7 Mosque - - 28 28 28 35
8 Elevator patients (1.4 m × 2.0) # 2 elevators / floors - - 9 9 9 2x9
9 Elevator visitors (1.2 m × 1.5 m) elevators / floors - - 7 7 7 2x7
10 A sub-waiting patients (men women) + buffet (for drinks) 2x6 2x6 2x8 2x8 2x8 2 x 12
11 Waiting chairs with disabilities 6 6 9 9 9 9
12 Wait for carts / trolley 4 4 7 7 7 7
13 Corridors 25% 25% 25% 25% 25% 25%
36
)Spaces in treatment areas (by square metres
Second Treatment area 5 beds 10 beds 20 beds 30 beds 40 beds 50 beds
1 Total Treatment area (eatch area dialysis machine + bed or chair = 9m2 ) 4x9 8x9 18 x 9 26 x9 36 x 9 44 x 9
2 Isolation Room to isolate blood-borne diseases 1 x 15 2 x 15 2 x 15 4 x 17 4 x 17 6 x 17
1st floor 7 7 2x9 2x9 2 x 14 2 x 14

3 Nursing station (Counter)
2nd floor - - - 1 x 20 1 x 20 1 x 20
4 Hand washing basins (an area of the

basin 1 meter square) 3x1 5x1 8x1 13 x 1 16 x 1 21 x 1
5 Consultation room / Examination room 1 x 12 1 x 12 1 x 12 2 x 12 2 x 12 2x12
6 Minor operation room - - 27 27 27 27
7 Antiseptic area for hand - - 5 5 5 5
8 Pharmacy - - 32 32 32 32
9 Laboratory - - 36 36 36 36
10 Subsidiary Nursing station - - 7.5 7.5 7.5 7.5
37
Administrative and staff Areas (by square metres)
Third Area for staff and administrative 5 beds 10 beds 20 beds 30 beds 40 beds 50 beds
1 The Director›s office (+meeting room + small archive + Break) 25 25 25 25 25 25
2 Rooms for doctors 9 9 9 9 9 9
3 Head Nursing Office 9 9 9 9 9 9
Administration (staff offices: Secretarial social worker –
4 50 70 95 95 95 100
Accountants -Managing Director)
5 Office of the patients Affairs 16 16 18 18 18 18
6 Office of the dietitian 9 9 12 12 12 12
7 Filing room 7.5 7.5 7.5 7.5 7.5 10
Training room (for patients and relatives on peritoneal dialysis
8 - - 33 33 33 33
techniques)
9 Dining room for the operating staff 30 30 30 30 30 45
10 Room for Medical records 10 10 20 20 20 20
11 Bathroom for the health team 2 x10 2 x 10 4 x 10 4 x 10 4 x 10 4 x 10
12 Break room (for the health team) 16 16 18 18 18 20
13 The area to save your personal locker 2 x 18 2 x 18 2 x 24 2 x 24 2 x 24 2 x 24
38
Support services and store areas (by square metres)
Fourth Support services and Stores 5 beds 10 beds 20 beds 30 beds 40 beds 50 beds
1st floor 1x6 2x6 2x6 2x6 2x6 2x6
1 Store for clean linen 2nd floor - - - 1x9 1x8 1x8
1st floor 1x6 2x6 2x6 2x4 2x6 2x6
2 Store for dirty linen
2nd floor - - - 1x9 1x8 1x8
Water treatment plant (Minimum 9M2 increases with bed 12 12 16 16 20 20
3
capacity)
4 Daily Store Room (Warehouse) 2x5 2x5 2x5 2x7 2x7 2x9
5 Weekly Store Room 11 11 11 11 11 16
6 General store room 25 25 25 35 35 40
7 Waste disposal repositor 16 16 20 20 20 20
Warehouse equipment (for the maintenance and
8 5 5 7 7 7 9
sterilization of dialysis machines)
9 Warehouse for the supply of cleaning solutions 5 5 7 7 7 9
st
1 floor 2x4 2x4 2x4 1x6 1 x 12 1 x 12
10 Warehouse to save & prepare dialysis solutions.
2nd floor - - - 2x2 2x4 2x4
11 Kitchenette 1x8 1x8 2x8 2x8 2x8 2x9
12 Water pump room 25 25 25 25 25 35
13 Pump room for fire resistance 25 25 25 25 25 35
Control room (with Tableau power + generator works
14 9 9 9 9 9 9
automatically reserve)
15 Store room for medical gases 9.5 9.5 9.5 9.5 9.5 12
16 Repair shop for equipments and chairs 30 30 30 30 30 30
17 Support Room 1x5 1x5 2x5 2x5 2x5 2x7
18 Room Pantry supplies 7 7 9 9 10 10
Room for cleaning ( to supply cleaning liquids &dry materials&
39
19 4 4 4 6 6 2x6
tools)
40
Man Power
41
MAN POWER
Doctors ( staff) Requirements
Dialysis Doctors
Qualification Requirements
Position
1. Consultant Qualifications:
Nephrologist
Should hold a specialty certificate from the Saudi Commission for Health Specialties
as a Consultant Nephrologist
2. Specialist in Qualifications:
Nephrology
A specialty certificate approved by the Saudi Commission for Health Specialties as
a Nephrology Specialist.
3. Resident Qualifications:
in Nephrology
A) Should be a qualified medical doctor with a degree of medicine and approved
by the Saudi Commission for Health Specialties as a Nephrology Resident.
B) Should have a 3-5 years experience in nephrology and dialysis from a well
recognized dialysis center.
Requirements of doctors for the dialysis centers
The ratio of doctors for the dialysis centres is as following:
1 Consultant / 15 stations
1 Specialist / 10 stations Major Centers
1 Resident / 15 stations
For small centers, where the number of stations is less than what is shown above, the services should be
covered by one nephrology specialist and one nephrology resident. A consultant nephrologist can cover
other nearby dialysis centers, where he/she should complement the ratio of “1 consultant / 15 stations”.
42
Specifications for the nursing Staff
Requirements of Dialysis Nursing Position
Dialysis
Nursing Qualification Requirements
Position
1. Nursing Registered Nurse (RN) Bachelor or High Diploma Degree in Nursing
Supervisor Professional Experience , Minimum Skills &Specialized Knowledge:
*Minimum of 5 years experience in dialysis (preferable with about 10 year experience).
* Minimum of 3 years experience as Nurse Manager.
* Good communication skill preferably both in English and Arabic.
* Certified in BCLS and preferably in ACLS.
* Certified and registered with the Saudi Commission for Health Specialties.
* Computer Literate.
2. Unit Registered Nurse (RN) Bachelor or High Diploma Degree in Nursing
Head Professional Experience , Minimum Skills &Specialized Knowledge:
Nurse *Minimum of 5 years experience in dialysis
* Minimum of 2 years experience as Head Nurse Assistant.
3. Dialysis Registered Nurse (RN) Bachelor or High Diploma Degree in Nursing
Nurse Professional Experience , Minimum Skills &Specialized Knowledge:
*Successfully passed a Haemodialysis Training Program
* Minimum of 2 years experience in dialysis.
4. Infection Registered Nurse (RN) Bachelor or High Diploma Degree in Nursing
Control Professional Experience, Minimum Skills &Specialized Knowledge:
practitioner *Minimum of 5 years experience in Nursing.
* Trained and experienced in dialysis (Minimum of 2 years)
* Trained and experienced in infection control (Minimum of 2 years)
Note: Dialysis Nurse to patient ratio is ideally 1:3 for stable cases , and 1:1 for unstable and complicated dialysis
patients, The Nurse – patient ratio for stable cases can be stretched to 1:3 However , this ratio may compromise
the patient’s safety due to the high potential of staff nurse fatigue and lack of adequate time leading to inadequate
attention to proper patient management especially in times when intradialytic complications occur.
43
Other Supporting Manpower
For Dialysis Unit
Manpower Should provide support to unit / center of dialysis as follows:
1 Clinical Pharmacist
- A Dietician / unit
- A social worker / unit
- A psychologist / unit
- Technical maintenance of medical devices / unit
Administrators :
- Two (2) Medical secretaries
- Two (2) Workers (cleaners)
- One (1) Correspondent
44
Specifications of Instruments
45
3-1. Specifications of Hemodialysis Machines
‫المواصفات‬Specifications
GROUP NAME GROUP NO. ITEM NO ITEM DESCRIPTION

‫أسم المجموعة‬ ‫المجموعة‬ ‫رقم البند‬ ‫اسم البند‬
‫جهاز غسيل دموي‬
HEMODIALYSIS MACHINE
Model Country of Origin Manufacturer

‫الموديل‬ ‫بلد المنشأ‬ ‫الشركة الصانعة‬
Parameter Description Specified Offered

‫عنصــر المواصفـــة‬ ‫المطلـوب‬ ‫المعـروض‬
1 FDA or Saudi FDA APPROVED Provide certificate
2 EC Saudi FDA MARKED Provide certificate
3 DIALYSATE DELIVERY
1 Proportioning System Volumetric (Specify type)
2 Comfort control, °C 35-39
3 Temperature alarm limits, °C 34-40
4 Conductivity range, mS/cm 13-16
5 pH monitor preferred
Accepts dry bicarbonate concentrate

6 Bicarbonate cartilage
(cartridge).
At least up to 700 ml/min more is
7 Flow, ml/min
Better (adjustable, selectable)
8 Transmembrane pressure, mm Hg 0 to +450 or wider
9 Isolated Ultrafiltration Yes
10 Ultrafiltration Profiling Yes
11 Sodium Profiling Yes
12 Bicarbonate Profiling preferably
13 Ultrafiltration removal rate, L/hr 0.1-3 or wider
4 BYPASS INDICATOR Yes
5 BLOOD CIRCUIT Adult & Pediatric option
1 Arterial pressure, mm Hg -350 to +150 or wider
2 Venous pressure, mm Hg 0 to +390 or wider
3 Blood pump range, ml/min 50-500 or wider
4 Heparin pump range, ml/h 0.5-10 or wider
46
Specifications ‫المواصفات‬



Chemical & Thermal (heat up to 85-95°C
6 DISINFECTION Method – open system where internal tubing of HD machine should be
resistant to this high temperature)
7 DISPLAY TYPE TFT Color
1 Screen size 15” 17” or more
2 Resolution 1024 x 786
8 DISPLAYED PARAMETERS
1 Conductivity Yes
2 Temperature Yes
3 Flow rate Yes
4 Elapsed time Yes
5 Remaining time Yes
6 Prescribed time Yes
7 UF removal Yes
8 Arterial pressure Yes
9 Venous Pressure Yes
10 TMP Yes
11 Measured BP, Pulse & MAP Yes
9 AUTOMATED BLOOD PRESSURE MEASUREMENT Yes
10 ALARM ACTIONS
Stops blood pump, clamps line

1 Blood-leak detector
OTHER ACTION SPECIFY
2 Air/foam detector
3 Conductivity Bypass
47



4 Arterial/venous pressure
5 Temperature, high/low Bypass
6 Blood Pressure, high/low Yes
Yes, operates with battery back-up

7 Power Failure alarm
8 Loss-of-water alarm Yes
9 Prescribed Time reached Yes
11 POWER SUPPLY
1 Voltage 220V
2 Frequency 60 Hz
12 BATTERY BACK-UP Yes, at least 15 minutes
13 REGULATORY COMPLIANCES Saudi FDA or others (Specify in offer)
Saudi FDA or other

14 SAFETY STANDARD
International Standard(specify in offer)
All standard accessories NEEDED (specify in
15 ACCESSORIES
offer)
16 ALL OPTIONS NEEDED IN ITEMIZED PRICES
1 Clearance Monitor (Kt/V) must
2 Single Needle Dialysis Single Pump & Double Pump
3 Blood Volume Monitor Preferred
4 Access Flow Meter (AFM) Preferred
or Blood Temperature Module (BTM) Preferred
48



Preferred (online production of
5 Online HDF/HF
STERILE substitution fluid)
Compatible with hospital communication

Integrated network connectivity & serial
6 system &connectable to lab. / dialysis /
communication protocols
doctor›s clinic
1) The hemodialysis machine should

be easy to move, but should
resist tipping over during use or
in transportation. Therefore, it is
advised to be equipped/moved with
castors with at least two castors
have locks.
2) Controls should be sealed against
penetration of liquids.
3) Guarantee of STERILITY OF
SUBSTITUTION FLUID produced
online by the machine.
4) Able to make an actual
17 OTHER SPECIFICATIONS measurement of the maximum
substitution in HDF mode.
5) Simultaneous pre-dilution and post-
dilution is possible during HDF
therapy.
6) The machine can be connected to a
portable Reverse Osmosis Unit.
7) Capable of storing dialysis records.
Vendor shall conduct comprehensive
training for all operators; training shall
be conducted by application specialist
approved by manufacturer.
49
3-2. Specifications of CRRT Unit – ICU

‫جهاز الغسيل الكلوي المستمر لمرضى العناية‬
‫المركزة‬
CRRT Unit ICU


1 Saudi FDA APPROVED Provide certificate
2 Saudi FDA MARKED Provide certificate
3 RANGE OF THERAPIES ALL TREATMENT MODALITIES REQUIRED
1 CVVH (Continuous Hemofiltration) Yes
2 VHVHF (Very high volume hemofiltration) Preferred
3 CVVHDF (Continuous Hemodiafiltration) Yes
4 CVVHD (Continuous Hemodialysis) Yes
5 SCUF (Slow Continuous Ultrafiltration) Yes
6 TPE (Plasmapheresis) Preferred
7 HP (Hemoperfusion) Preferred
4 THERAPY OPTION BOTH OPTION REQUIRED
1 Paediatric Option Yes
2 Adult Option Yes
5 PUMP FLOW RATES SPECIFY
1 BLOOD PUMP
1a Paediatric Option 10 TO 200 mL/minute
1b Adult Option 30 to 300 mL/min. or wider
1c VHVHF 50 to 500 ml/min.
2 PRE-DILUTION (options should be available)
2a Paediatric Option Maximum 8,000 mL/hr.
2b Adult Option Must be preferred
50

CRRT Unit ICU


3 POST-DILUTION (options should be available)
3a Paediatric Option Maximum 8,000 mL/hr.
3b Adult Option Must be preferred
4 NET FLUID LOSS SPECIFY
4a Pediatric Option 0-10-1,000 mL/hr.
4b Adult Option 0-10-2,000 mL/hr.
5 FILTRATION SPECIFY
5a Paediatric Option Maximum up to 8,000 mL/hr.
5b Adult Option Wider is better
6 SCALES SPECIFY MAXIMUM LOAD
1 Substitution Scale Capacity 0-10 kgs., wider is preferable
2 Dialysate Scale Capacity 0-10 kgs., wider is preferable
3 Filtration Scale Capacity 0-12 kgs., wider is preferable
Guaranteed to be SAFE, EFFECTIVE&

7 INTEGRATED FLUID WARMER
CONVENIENT for use
1 Temperature Range Off or 35 to 39°Cwith flow compensation
2 Automatic Degassing Yes, SPECIFY
8 ANTICOAGULANT PUMP
1 Syringe Size 30 or 50 mL
2 Bolus Function 0.5 mL bolus increments
9 PRESSURE MONITORING Yes
1 Access Pressure -300 to +250 mmHg
2 Return Pressure -50 to +350 mmHg
51

CRRT Unit ICU


3 Prefilter Pressure -150 to +500 mmHg
4 TMP Yes
4a CRRT (upper & lower limit) -30 to 400 mmHg
4b TPE (upper & lower limit) -30 to 100 mmHg
5 Filtrate Pressure -500 to +500 mmHg
6 Pressure Drop Yes
10 DISPLAY TYPE TFT Color
1 Screen size At least10” or wider
11 DISPLAYED PARAMETERS
1 Therapy Mode Yes
2 Flow rates Yes
3 Temperature Yes
4 Treatment Time Yes
5 Net Fluid Loss Yes
6 Arterial pressure Yes
7 Venous Pressure Yes
8 Prefilter Pressure Yes
9 TMP Yes
10 Filtrate Pressure Yes
11 Pressure Drop Yes
12 Filtration Fraction Yes
12 ALARM ACTIONS

1 Blood-leak detector
2 Air/foam detector
52

CRRT Unit ICU


3 Arterial/venous pressure
4 TMP, high Yes, SPECIFY ACTION
5 Temperature, high/low Yes, SPECIFY ACTION
6 Fluid Balance Alarm Yes, SPECIFY ACTION
Yes, blood pump operates with battery back-

7 Power Failure alarm up.
13 POWER SUPPLY
1 Voltage 220V
2 Frequency 60 Hz
14 BATTERY BACK-UP Yes, at least 15minutes
ISO, Saudi FDA, CE, or others (Specify in

15 REGULATORY COMPLIANCES
offer)
Complies with Saudi FDA and International
16 SAFETY STANDARD Standards
(Specify in offer)
All standard accessories NEEDED (specify in
17 ACCESSORIES
offer)
18 OTHER OPTION
• Integrated in the machine.

• With software algorithm that adjust citrate
1 Regional Citrate Anticoagulation
and calcium infusion rate according to the
blood flow rate.
53

CRRT Unit ICU


1) Disposables (lines, filters,

substitution solutions, and other
accessory items) should be available at
MOH MEDICAL SUPPLY STORES.
2) Each unit should Specifications of
Hemodialysis Machines be supplied with
DISPOSABLE SETS and SOLUTION
BAGS sufficient for 1000 SESSIONS.
19 OTHER SPECIFICATIONS 3) Simultaneous pre-dilution & post-
dilution should be possible in HF and
HDF therapies, with maximum total
substitution flow rate of up to 10 Liters/
hour or higher.
54
3-3. Water treatment plant specification

Water Treatment Plant


Equipped on raw water tank (or
external), stainless steel, controlled from
1 RAW WATER FEEDING PUMP
local panel, pressure relief valves, non-
return valves
2 RAW WATER FILTER Backwash filter (50 – 200µm)
Cylindrical raw water tank for the pre-

treated water covered with special
layer / coat to avoid sun light, equipped
with pumps, manufactured from
polypropylene with tight fitting lid, inlet
ball valve, air gap inlet, outlet drain,
overflow connections, low level switch
3 RAW WATER TANK
for pump protection, capacity volume
depends on reverse osmosis capacity
and number of HD machines (500–1500
liter)
The base of the tank should be conical
to avoid stasis of water and bacterial
growth.
The size and volume capacity depend
on the reverse osmosis capacity
and number of HD machines, the
4 WATER CHILLER
temperature of chilled water must be
maintained <20°C preferably between
10 - 20°C
Built in the chiller, pumping between ( 20
5 WATER CHILLER PUMP
– 40 Liter/min )
Depending of the quality of water, the
6 2. PRE-TREATMENT UNIT: pre-treatment unit should be consisted of
one or more of the following:
Sand filter material consists of fine
grains of sand of uniform size with ability
7 SAND FILTERS, 3 LAYERS
to remove contaminant particles larger
than 20-30µm
Special layers of filters capable of
IRON REMOVAL FILTERS – if local raw water supply is removing iron automatically if iron
8
high in iron content. concentration is very high. These filters
can be added inside the sand filters
Automatic activated charcoal adsorption
9 CARBON FILTER / CHARCOAL ADSORPTION FILTER
filters with different multiple layers
Two softeners connected in parallel with
automatic and alternating regenerations,
10 TWIN SOFTENERS electronic control, the type depends on
reverse osmosis capacity and water
hardness
55



Manifold pre-filter cartridge equipped
with 20 inch filter housing of 20mm,
CARTRIDGE FILTER
11 and single or dual particle filters of 5µm
DOUBLE PRE-FILTER
or less preferably 1µm, all depends on
reverse osmosis capacity
Built in thermometer measures
temperature of water between 10°C –
12 THERMOMETER 60°C, which has electronic temperature
sensors in chiller and the reverse
osmosis unit
Should be accessible to maintenance.,
The length of piping system from reverse
13 * Piping System
osmosis to hemodialysis machines
should not excess 300 meters.
Two reverse osmosis (dual) units
are recommended for large referral
dialysis centres, which can operate
automatically in case of sudden failure
of the other unit
Portable small reverse osmosis
units are recommended for satellite
haemodialysis units
The productive capacity and supply of
the reverse osmosis unit(s) depends on
the number of HD machines in the HD
unit/center.
Operates continuously 24 hours from a
3. REVERSE computerized control panel; for simple
14 OSMOSIS UNIT handling, system information display
and alarm monitoring
Automatic flushing program when
system in not in use
Membranes can stand high temperature
(90°C) for automatic heat disinfection,
as well as the distribution system
Membranes stand and can perform
chemical cleaning and disinfection
Should have a compact design and very
low noise level
Certified as approved medical device
There should be no post-treatment tank
56



Complete installation requires high
quality materials:PEX pipes/tubes
15 INSTALLATION MATERIALS (certified as medical device) to avoid
biofilm and stand high heat disinfection
temperature.
Booster stainless steel pumps with
16 HIGH PRESSURE FEEDING PUMP controller should be integrated in the
system
Should be operated continuously from
and to the reverse osmosis by controlling
17 TREATED WATER RECYCLE valve with a yield control setting up to
85% but
Not less than 75 %.
Including chemical and heat disinfection
18 REVERSE OSMOSIS CLEANING UNIT
(heat disinfection for all dialysis canters)
Digital pressure sensors should be
available in the reverse osmosis system
and pressure meters on water inlet unit,
19 PRESSURE METERS
particle and fine filters; all should be
vibration durable and included in the
system
Should be included in the reverse
20 ONE WAY DIRECTION VALVES
osmosis unit
All pumps of the water treatment
plant should be heavy duty and non-
conductive to heat or electricity and high
and low pressure. The water bath of
21 PUMPS
all pumps should be made of medical
grade stainless steel. The water pump
itself should be made special for water
treatment unit.
Should reach up to 75% - 85% of its total
22 USABLE CAPACITY WATER TREATMENT PLANT
capacity
Air valves should be installed on
pre-filtration and reverse osmosis (to
23 AIR VALVE
withdraw air and should be installed in
water tanks and filters).
Pressure valves should be installed In
24 PRESSURE VALVES
reverse osmosis unit
Equipped on reverse osmosis, preferably
25 POWER CONTROL PANEL to Include: with two redundant power supply
systems
57



The reverse osmosis can work
independently in emergency mode
26 Ability
Can perform heat disinfection without using
chemicals
27 Microprocessor CX embedded PC technology / PLC system
28 Operating Display Touch screen high resolution LCD display
Temperature (permeate, feed water),

conductivity (permeate, feed water),
pressure (concentrate, permeate), flow
29 Alarm System
(feed water, concentrate); all should be
integrated in the system (visual and audible
in water treatment plant and control room)
30 PH-METER of the treated water It should be included in the system.
Digital conductivity meters should be

31 CONDUCTIVITY METER
included in the system.
32 WATER HARDNESS TEST KIT Should be included
Illustrative stickers on all parts of the

33 STICKERS & OPERATING MANUAL plant with an operating manual should be
included and provided.
PEX (polyethylene cross-linked) pipes/
tubes (certified as medical device) should
be installed to allow consistent pressure,
avoid biofilm formation and to stand high
heat (90°C) disinfection temperature
throughout the whole loop
Piping should be continuous with no or
4. WATER
34 minimal dead ends, including no fixations,
DISTRIBUTION
elbows, connectors, T-pieces
SYSTEM (Pipings)
Continuous loop configuration (not
interrupted)
Well insulated, especially for long
distant pipes, in order to avoid heat loss
and maintain consistent efficient heat
disinfection
Water outlets should be made of stainless
steel, resist high temperature, have
hygienic design with minimum stagnant
zones and with no dead space.
Chemical analysis of treated water results
should be according to international and
European Best Practice Guidelines (as
35 OUTPUT OR PRODUCT WATER
shown in the attached appendix).
Bacterial growth < 100 CFU/ml and
endotoxin level < 0.25 EU/ml for
conventional HD units (small HD units).
Bacterial growth < 0.1 CFU/ml and
endotoxin level < 0.03 EU/ml for online
hemodiafiltration treatment (is provided).
58
Daily monitoring of treated water in hemodialysis units
Normal
Target Saturday Sunday Monday Tuesday Wednesday Thursday Friday
Value
Chlorine Level
T.D.S. or Conductivity
Hardness
PH
1st
Week Technician sig.
Head Nurse sig.
General Director Sig.
Normal
Value
Chlorine Level
Hardness
2nd
Week PH
Technician sig.
Head Nurse sig.
59
Daily monitoring of treated water In hemodialysis unit
Normal
Value
Chlorine Level
Hardness
PH
3rd
Week Technician sig.
Head Nurse sig.
Normal
Value
Chlorine Level
Hardness
4th
PH
Week
Technician sig.
Head Nurse sig.
60
3-4 Specifications of Dialysis Chairs

DIALYSIS CHAIR


1 TYPE Micro-processor controlled
1 REMOTE CONTROL Yes
2 CPR Yes
2 FRAME MATERIAL Steel / Aluminum
1 Anti-Rust Yes
2 Paint Powder Coated
3 Easy to clean & sterilize Yes
SEAT: COMFORTABLE LEATHER WITH HEIGHT
3 Yes
ADJUSTMENT
4 MULTI-CHAIR ADJUSTMENT
1 Back rest adjustment independently Yes
2 Seat tilting adjustment independently Yes
3 Leg rest adjustment independently Yes
4 Foot rest adjustment independently Yes
5 Height adjustment independently Yes
5 PERFECT HORIZONTAL POSITION Yes
6 MOTORS Yes
1 Double insulated Yes
2 Frame grounded Yes
3 Isolated motor ground Yes
4 Non-conductive Yes
5 Isolated transformer Yes
6 Safety fuse Yes
7 Shock proof Yes
7 HAND SET CONTROL
1 Long life micro-switches Yes
2 Exchangeable key pad Yes
3 Trendelenburg position Yes
61

DIALYSIS CHAIR


8 INTELLIGENT CONTROL UNIT Yes
1 Additional safety Trendelenburg Yes
2 Equipotent Connection Pin (EPH Connector) Yes
3 Integrated reading lamp connector Yes
4 SSP motor control (Soft start-stop process) Yes

HEAD & FOOT SEGMENT MOVABLE BOTH TOGETHER
9 Yes
AND INDEPENDENTLY
Electrically /Manually /Battery (Preferred
10 OPERATION
battery operated back up)
11 ARM REST
1 Tilt up Yes
2 Height adjustable Yes
3 Distance Adjustable Yes
4 Multi-Layered soft cushion Yes
5 Arm rest more horizontally and vertically. Yes
6 Enough length for the whole arm Yes
12 DETACHABLE SOFT CUSHION Yes

1 Blood resistant to disinfectants Yes
13 WHEELS (CASTERS) Yes
14 IV POLE MOUNT 6
15 IV POLE STORAGE Yes
ELECTRICAL COMPONENT WITH WATER SPLASH
16 Yes
PROJECTION
17 WAIGHT LOAD NOT LESS THAN 200 Kg.
18 POWER SUPPLY 220Volt – 60 Hz.
IEC-601, 93 / 42, EEC, CE, SIO,
19 SAFETY STANDARD
EN60601-2-38, 60601-1-2 o Others.
20 ACCESSORIES All standard accessories
21 OTHER SPECIFICATIONS With weighing scale built in
62
Necessary Requirements for processing
a hemodialysis unit
1 Dialysis Unit 21 Portable Ultrasound

Device to determine the blood vessels
2 CRRT Unit ICU 22 by ultrasound for the installation of
hemodialysis catheters
3 Dialysis Bed With Scale 23 Portable Ventilator (Adult, Pediatric)
4 Dialysis Chair With Scale 24 Self fullness breathing balloon Ombobaj
5 Water Treatment Plant 25 Crash Cart ,with Defibrillator
6 Monitor Transport 26 Stethoscopes
mural oxygen Organizers or oxygen
7 Syringe Pumps 27
cylinders
8 Infusion Pump 28 Mobile Suction Pump, Electric
9 Vital Sign Monitor 29 Nebulizer, Ultrasonic
10 Heparin pump 30 Dressing Cart
11 Thermometer, Digital 31 Wheelchairs for Nursing
12 I.V STAND 32 Small Dressing tables
13 Wheelchairs for patients 33 Mobile food tables (for patients)
A device for measuring blood clotting,
14 34 Small and Medium sized transport tab
fast and easy to use
Ultrasonic device to measure blood
15 35 Large transport tables
flow to blood vessels.
16 Stretcher, Transport 36 ECG device with 12 channels
17 Blood gas Analyzer set 37 Glucometer
18 Chair with Scale 38 Blood Pressure Monitor
19 Hot air Oven 39 Pharmacy Refrigerator
20 Autoclave, 20 L 40 Hanged TV
63
64
1- Central Board for
Accreditation of Health care Institutes
(CBAHI)
Hemodialysis Centers (HM)
2- Patient Rights
65
Scoring
STANDARD
FM PM MM NM
NA
(3) (2) (1) (0)
The department head is a qualified
1.
nephrologist
Hemodialysis A qualified registered nurse with
2.
sufficient training as nurse manager
All nursing staff are registered nurses, qualified by
3.
experience and education
All nurses working in hemodialysis are
4.
certified in BCLS and preferably ACLS
There is a copy of certificate for
BCLS and if obtained, ACLS in
staff personal files
The nurses working in hemodialysis receive
continuous education and training with competency
5.
assessment (e.g. written test, return demonstration,
etc.) in the following areas:
Care of patients with AV fistula/AV Graft
Dialysis procedures
Care of tunneled/non-tunneled Catheters
Peritoneal dialysis
Assessment of patient’s volume Status
Management of anticoagulation
Management of clotted access
Hyperkalemia
Written admission and discharge
6.
criteria
Written polices and procertures in the dialysis unit
that include, but not limited to maintenance,
7.
inspection and disinfection of the medical
equipments.
Crash carts with defibrillators are in the
8.
vicinity
66
Scoring
STANDARD
FM PM MM NM
NA
(3) (2) (1) (0)
Water quality is checked according to
written policy with a charted standard of metal
9.
concentration. A complete chemical analysis is
done on initial set up and at least once per year
Microbiology testing of the water is done
10.
monthly
The microbiology test record is available in the
unit
Infection control guidelines are followed closely
11.
to include:
Wearing of gloves, gowns and masks
Separating the machines used for blood-borne
infectious diseases (such as Hepatitis B, Hepatitis
C and HIV/AIDS patients)
Proper disposal of needles and sharps
Cleaning up blood spills
Hand washing before and after contact
with each patient
Disinfecting the BP cuff and the machine control
panels after each use
The proper handling of supplies and equipment
Documented routine and yearly staff checkups for
Hepatitis B, Hepatitis C, and HIV/AIDS status
All equipment and machines in the unit are
12.
regularly maintained with PPM schedule
67
Patients’ rights:
4-1 Knowledge of rights for patients and their families:

Publishing a statement of patients’ rights and responsibilities at all levels.
Guidance of the patient’s and their families about the message of unit / center of dialysis and
their rights and responsibilities.
Developing a policy and a plan for the application of patients’ rights and responsibilities at the
facility.
Obtaining a copy of the document of patients’ rights when the patient is registering to admission.
The presence of posters in the departments for the reception and waiting areas.
Conducting periodic questionnaires to identify the degree of patient satisfaction and the quality
of the provided service.
4-2 Respect and appreciation (for the patient and his family):
The patient has the right to get the care with dignity at all times.
The patient has the right to respect his values and
beliefs.
Respect the right of the patient to express the intensity of pain.
4-3 Privacy and Confidentiality:
The right to discuss the program of treatment with the patient or his guardian through
confidentiality.
Covering the sins of patients during the examination or health care, and confidentiality of
information (diagnosis, investigations and medical records) after the consent of the patient
unless required by the judicial authorities.
Providing separate and suitable waiting areas for women and men.
4-4 Protection and safety:
Providing a safe and appropriate environment to the patient’s health status.
The patient is not isolated, only if that is necessary.
Protection of patient property from theft and damage.
Providing a policy to deal with people with special needs and the elderly.
Prevention of Smoking.
4-5 Access to care:
The right to access to care regardless of race or religion.
Access to care in cases of life-threatening and critical situations in each level of treatment,
according to EBM as much as possible and to ensure that the patient or his guardian has
information about all health situation.
4-6 Participate in the plan of care:
-The right to know the patient’s prescribed treatment plan and the size and potentials of the
health facility.
-The patient will know the names of the participants in provision of health services and their
specialties and the name of the doctor who is responsible for his treatment and follow-up
condition, except for emergency situations that require urgent medical intervention in accordance
with the followed laws and regulations.
-Explain the reasons for the transfer of the patient to another place or outside the health facility,
given the necessary instructions or reasons to transfer his care to another doctor.
68
4-7 Refuse treatment:
awareness of the patient or guardian for the possibility to refuse all planned treatment or part of
it with the commitment of the facility towards this right, including this right does not conflict
with the laws and regulations should be followed with necessary signing of the consent form,
and documentation of the dialogue and discussion in the patient’s file.
-The consequences of refusal to treatment are not related to any decisions or procedures to the
state of health of the patient, and service provider in the health facility is obliged to continue to
provide appropriate care to patient in accordance with the standards of medical practice.
-The patient or legal guardian is fully responsible for his decisions and actions in the event of
refusal of treatment or not following the instructions of treatment.
awareness of the patient or legal guardian with other alternative remedies in the event of rejection.
4-8 Provides policy for dealing with material costs and health insurance:
-To obtain approximate information about the expected cost before the start of treatment.
-Suspension of a Poster indicating who are eligible to treatment.
-Suspension of a Poster describing in a simple terms the services and costs.
4-9 Clarity and comprehensiveness of forms of consent report:
Identify who is responsible for signing the form.
Providing a list of interventions that needs a separate approval.
Awareness of the patient or legal guardian’s about the information contained in the consent form
with a clear manner.
Keep in recognition of the patient’s file.
providing the patient with an accurate complete medical report, and the complementary test
results.
4-10 The existence of policies and procedures for complaints and suggestions that include:
-Identifying those authorized to receive complaints
-The existence of flow charts which refers to the pathway of complaints
-Referring non-medical complaints to the relevant section and problem solving the complaint as
soon as possible and reporting solutions to the complainant.
-Directing the medical complaints to the responsible department and follow up the complaint on
an ongoing basis.
-Study and analysis of complaints and identify its causes and treatment.
4-11 The existence of policies and procedures for organs and tissues
donation:
-Medico-legal measures undertaken for of live donation.
-The criteria for organ donation from living non-relatives.
-Criteria for organ donation from brain death.
-Explaining the benefits and the importance of organ donation to patients and staff responsible
for that.
69
4-12 Participation in research programs and study:
- Ensure the rights of patient to participate or the post or not to participate or stop participating
at any time without affecting his right to treatment and continuity.
- The existence of clear and understandable information about research or study, medical
treatment and expected results.
- The existence of a special form to participate in any research or study, not allowed for the
patient to participate except after signing.
- The Presence of a committee or an official authority to permit and supervise the research or
study.
- The Presence of clear mechanisms for how to protect the patient and receive his complaint and
his views during the research or study.
70
REFERENCES & APPENDICES
71
References
Local References
1 Documents and Regulations of The Ministry of Health, 2012
Studies of Directorate of Studies and designsAssistant Deputy Ministry
2
for projects and Engineering AffairsMOH, 2012
3 Civil Defence Regulations
4 Saudi FDA
Standards and Guidelines for the Construction & Equipments of Dialysis Unit ,Prince Fahad
5
Bin Salman Charity Association For Renal Failure Patients Care (KELLANA), 1428 H
Document of the rights and responsibilities of patients ( General Directorate for the
6
program of patient relations) MOH, 2012
Foreign References:
Guidelines for Design and construction of Health Care Facilities
7
American Code The Facility Guidelines Institute 2010 edition
8 Best European practices, 2010
NSW-HEALTH , Health Facility Guidelines –The University of New South Wales ,
9
SYDNEYAUSTRALIA Part-B 2010
10 NKF Campaigns Dialysis-High-visibility version, 2010
Accreditation of Renal Dialysis Unit-Hong Kong College of Physicians & Central Renal
11
Committee
STANDARDS FOR END STAGE RENAL DIALYSIS CLINICS
12
Department of Health –USARevised May, 2010
19-13-D55a Licensure of out-patient dialysis units-standards for in-hospital dialysis units –
13
Department of Public Health-11/6/2007
Good Practice Guidelines For Renal Dialysis Transplantation Units
14
Prevention and control of bloodborne virus infection-September, 2002
15 New Zealand Dialysis Standards and Audit, 2006 (revised 2008)
Architectural and Engineering Guidelines for Submission, Approval and Inspection of
16
Occupancies Licensed by the Department of Health, 2006
72
APPENDICES
Diagram 3-1FUNCTIONAL RELATIONSHIP DIAGRAM–RENAL DIALYSIS UNIT
The following diagram sets out the relationships between zones in a Renal Dialysis Unit:
The main entrance (from the street and parking lot with a tray for disabled wheelchairs)
Entrance to the reception: (includes waiting area file room –information technology – Buffet to
provide drinks – restrooms
Treatment Areas : This includes the treatment rooms , isolation rooms, bathrooms and restrooms
Administrative area: the health team, administrators and restrooms
Areas of support: This includes warehouses water treatment plant
Training room: meeting room or room for interviews
Other Entrance to the unit : connects the unit to other hospital services
73

External View For A hemodialysis Center (20) chairs
Diagram
5-1
hemodialysis
Center (20)
chairs
A horizontal view to the ground floor-20 chairs

A horizontal view to the first floor20 chairs
74

Diagram
5-2
hemodialysis
Center (30)
chairs

A horizontal view to the ground floor-30 chairs

75

Diagram
5-3
hemodialysis
Center (40)
chairs

A horizontal view l to the ground floor40 chairs

76

Standards Guideline For Establishing, Equipping and Operating Renal Dialysis Centres

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Standards Guideline For Establishing, Equipping and Operating Renal Dialysis Centres

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In The Name Of Allah The

Beneficent The Merciful

1-3 -The role of the Unit 12

1-4 -Policy statement 13

1-5 -Description of Unit 13

1-6 Models and charts of dialysis centers 14

1-6-1 Selecting the appropriate location 14

1-6-2 Planning for spaces 14

1-6-3 Allocation of space inside and outside the building 14

------- Spaces inside the building 14

1-7 Role of the associated hospital 17

1-8 Academic and teaching roles 17

1-9 Staff structure 17

1-10 Nature of patient acuity and complexity 17

1-11 Operational Policies 75

1-14 Adaptability and Flexibility 18

1-15 Amenities Patients 18

1-16 Amenities Staff 19

1-17 Amenities Visitors 19

1-18 Call system 19

1-19 Catering Services / Food Safety 19

1-20 Cleaning Requirements 20

1-21 Energy Efficiency 20

1-22 Infection Control 20

1-24 Laundry Management 22

1-26 Medical Records Management 22

1-27 Medications Management 22

1-28 Operating Hours 22

1-33 Waste Management 24

1-34 Referral Policy 24

1-35 Deceased Person Management 24

1-36 Functional Areas(cluster spaces) 24

1-37 Key Internal Relationships 25

1-38 Key External Relationships 25

1-39 Signage / Path finding 25

1-40 Functional Relationships 25

1-41 Ideal requirements of hospital dialysis units 25

1-43 Safer by Design 26

1-45 Natural light and views 27

Building Services Requirements 27

1-50 Electrical Services 28

1-51 Water Treatment Services 29

1-52 Drainage System 30

1-53 Duress Alarms 30

1-54 Recall Staff & Emergency 30

1-56 Medical Gases 30

Components of The Unit 31

1-58 Compliance with the standard components 31

1-59 Public Area, Main Entry / Waiting Area 31

1-60 Treatment Area 32

1-61 Isolation Room 32

1-62 Training Room Optional 33

1-63 Examination Room Cleaning Area of Equipments 33

1-64 Nurse Station(s) 33

1-65 Equipment cleaning Area Main Store Room 33

1-66 Water Treatment Plant Room 34

1-67 Storage Areas 34

1-68 Schedule of Accommodation 35

- Public Areas: Main Entry / Reception Cluster 36

- Administrative and Staff areas 38

- Support Services and Store Areas 39

Chapter Two: MANPOWER STANDARDS 41

Chapter Three : INSTRUMENTS STANDARDS 45