PLANNING AND

ORGANIZING ANCILLARY
SERVICES
BY- Ms. FARAH NAAZ
 The ancillary services are an essential part of
the hospital Its proper functioning contributes
to the success of providing quality patient care.
The critical hospital ancillary services include
the Central Sterile Supply Department (CSSD).
laundry, kitchen, laboratory, services operation
theater and so on. Each department in
particular norms for planning and organizing
its services
Aims and scope
 To provide sterile equipment available for the
use of caring patients through various activities
such as receiving, cleaning, assembling, packing,
disinfecting, sterilizing storing, and distributing
sterile supplies as per hospital protocol. The
CSSD has a significant role In preventing
hospital-acquired infection by supplying
adequate sterile supplies
OBJECTIVES
 The objectives of the CSSD services are to
 1. Provide a source of sterile equipment and material
 2. Recieve and supply sterile articles. equipment and
other materials
 3.Ensure proper sterilization, process procedures
according to the type of articles equipment and other
materials
 4.Monitor and enforce controls to prevent hospital
cross infection.
 5. Organize and maintain efficient services
 Space Requirement
 The space requirement for planning CSSD depends
on the size of the hospital, average number, type of
surgical procedures, and beds. According to
Bhattacharya, the space requirement to plan CSSD
is as follows
 75-99 beds 10sq ft/bed
 100-149 beds 9sq ft/bed
 150-199 beds 81/­
­ 2sq ft/bed

 200-249 beds 8sq ft/bed

 250-299 beds 7­1/­2sq ft/bed
 ≥300 7sq ft/bed
 Location
 The location of CSSD should be close to the
emergency department, Trauma centre,
operation theaters (OT), and wards. It is
preferred to construct in the ground floor near
to OT to easy access for transportation. It
should have the provision of proper ventilation,
light, and supply of both cold and hot water,
compressed air and electrical supply
 Physical layout and workflow
 Area for receiving used supplies / equipment / articles
 Unsterile bulk storage
 Cleaning , washing and drying area
 Assembling and packing/preparation area
 Glove processing unit
 Gauze cutting area
 packing area
 Area for storage of pack sets before sterilization
 Area for sterilization
 Sterile storage area
 Staffing
 Central Sterile Supply Department must staff with the
adequately qualified superintendent in-charge and
supervisor who is the chief of the department. There
should be trained CSSD attendants, technicians,
storekeeper, and safai karamcharies. The recommended
staffing for CSSD in a 500-bedded hospital is five
technicians, four technical assistance, four nursing aides,
and four CSSD attendants. The staffing strength also
depends on workload, method of collection, and delivery
of items, and hospital policy. The staff must undergo
regular refresher courses. They should Adhere
segregation, for hepatitis B and tetanus. adhere to wear
personal protective clothes and immunized

 Record Keeping
 Central Sterile Supply Department should have
proper record system for maintaining the record of
all items. There must be a record of quality
indicator . A logbook registers for the details
received including date, time, and type of
instruments packs, name of departinent, and
signature of obtaining of equipment as per
warranty.
 Monitoring
 There should be monitoring standard operating
protocols In CSSD to ensure quality standards.
There should be a provision of a mechanical,
chemical, biological quality indicators for as per
recommendation.
 Biomedical Waste Management
 There should be a policy for biomedical waste
management generated during the process of
cleaning, disinfection, and sterilization process
as per its guidelines. There should be color-
coding bins available in the department
LAUNDRY SERVICES
 Types of Hospital Laundry
 The linen may be infected, soiled, foul, and radioactive in use
. According to the category of linen, it is of four types:
 The linen of general use: This type of linen is used only the
general purpose such as curtains, and table cloths used in the
hospital.
 Linen used for patients: The linen used by the patients
during their stay in the hospital Ancillary Services
 Ward linen: This linen used as bed clothing for the patients
such as bed sheets and pillow covers
 Linen used in special departments/procedure: The linen used
in OTs, labor room, etc., and used by the staff working in
these departments
  
 Quantification of Hospital Laundry
 There should be a minimum of six sets of linen per bed
  
 Location
  
 The location of the department should be within the
premises of the hospital, usually on the ground floor, It
should have easy access to user areas, near to CSSD,
dietary services, garage, and maintenance department.
There should be a provision of a separate entrance and
exit with a unidirectional flow of linen:
 Design
 The laundry department may be straight, U-
shaped or gravitational designs. Usually, In high
building, the gravitational design is preferred.
 Space and Engineering Requirement
 The space requirement for planning laundry services
depends on size and type of hospital, average number.
and type of surgical procedures, weather conditions and
types of consumers. The estimated laundry workload as
a rule of thumb is 3.5 kg/bed/day as per Indian
Standards The minimum space requirement is 10 sq
ft/bed or 10 sq ft/2.5 kg of linen. The minimum space
requirement for planning the laundry department of
300-bedded hospitals is 3,240 sg ft. 600- -bedded hospital
is 4,068 sq ft, and 500-600-bedded hospital is 5,800 sq ft.
 The floor should be smooth, washable, and nonslippery.
The walls must be hard, soft, and washable The ceiling
must be high enough, and there should be a minimum 10
and maximum 20 air changes during hot weathet. There
should be proper lighting at least 300 lux and temperature
should be 20-30°c with humidity 30-50%.
  

 Water requirement for the linen department is 30 Lkg of

linen for hot water and 10 L/kg of linen for cold water. As
a rule of thumb, the laundry process requires
approximately 100 L/bed/day water. There should be
boiler supplying steam, water softening plant, and a 400
volts three phase connection with backup supply.
  
 Physical Layout and Workflow
 There are four major functional areas (1)
reception and sorting area. (2) processing area,
(3) clean storage area and (4) tailoring area.
There should be separate collecting receiving
areas for soiled and fresh linen. There should also
be the provision of negative air pressure in dirty
linen areas and positive air pressure/flow from
clean area to soiled linen area to outside vent
 Equipment
 There should be washing machine for 30-bed
line/load and 60 pillow cover/load, water
extractor with a capacity of 8 bed sheet and 30
pillow covers/load, flatwork iron (calendering),
hand iron box, and sewing machine.
  
 Staffing
 The department must staff with a chief manager (a
chemical engineer ), laundry superintendent and
technical staff.
  
 Linen identification
 There should be a system of identifying linen by using
barcoding or tranaducers for linen flow control,
management system, preventing pilfering etc.
 
 Monitoring and Control
 The should be monitoring standard operating protocols
in the department to ensure quality standards. The
department should keep record of the use of washing
formula as per recommendation. There should be the use
mechanical, chemical, biological quality indicators for
the adequate cleaning process and adherence policy. The
department must have regular audit and quality
assurance. There should be a proper record system of all
items received during date , time and type of linen, name
of department and signature of acquiring a person.
 Biomedical Waste Management
  
 There should be a policy for biomedical management
generated during the process of washing, disinfection,
drying, ironing, calendering its guidelines.

 There should be color coding for sorting me transporting

dirty and contaminated linen. Use of fabric bag for soiled
linen, clear white bag firstly for foiled linen, double bag
using the inner water-soluble bag then in a red plaster bag
labeled with yellow marking as "infected linen" Use a white
bag with a prominent or strip for heat liable linen. There
should be the use detergent mechanical movement for the
removal of dust
DIETARY SERVICES/LINEN
 The department of dietetics in the hospital is
vital carries multiple responsibilities related to
patients dul; intake of nutrition. It supplies diet
to indoor patients in main aim is to provide
clean, hygienic, and nutritious food to patients
as per their calorie requirements. It can be
division of hospital or by outsourcing.
  
 Types of Hospital Diets
  
 there are different types of food prepared in dietetic
department according to the kind of patients such
As balanced diet, liquid diet, semisolid diet, low-fat
diet. Cantiac diet, renal diet, high-protein diet,
diabetic diet. high carbohydrate, low protein diet,
salt-restricted, bland diet, fat-free diet, Ryles tube
diet, postoperative high carbohydrate, formula, and
jejunostomy feed
 Bases for Planning
  
 The dietary services planning is according to the
number of hospital beds, type of patients,
number of meals per day, policies for serving
visitors, students, staff, kind of dietary services,
purchasing strategies, type of food to be served,
and turnover of the patients
  
 Location
  
 The location must be on the ground floor with easy access to
the transportation of food to nursing units. Its location is close
to material management departments/stores. The cafeteria and
dining room must be near to the food preparation area.
  
 Space Requirement
  
 The space required for a 500 bedded hospital is 15 sq ft/bed and
for up to 200 beds, it should be 20 sq ft/bed.
 Physical Layout and Workflow
 divided into four major functional areas:(1) receiving
supplies area. (2) storage and refrigeration room. (3)
preparation, and (4) cooking area. It also has facilities
serving room, food delivery/tray assembly room, special diet
kitchen dishwashing and washing area, garbage disposal
facilities, housekeeping facilities, and LPG bank for cooking.
There should be the provision of food service manager
office, office space for chief dietitian, and other Staff, dining
hall with adequate facilities, and cafeteria code shop.
  
Physical layout and workflow
 Dietary procurement
 Inspection and storage
 Pre preparation and preparation
 Equipment accessories
 Accounts and records
 Staffing
 For 500-bedded hospitals, there should he I
dietician who should be assisted by 5 assistant
dietician. IN steward, 2 storekeeper, 1 for ration
and other general store keeper I clerk, 2 head
cooks, and 2 therapeutic cooks 10 cnoks 28
bearers, 8 masalchi, 2 store attendants, and safai
karamcharis
 Monitoring and Control
 There should be monitoring standard operating
protocol in the department to ensure quality standards
The cleanliness hygiene, and sanitation of all the areas
must be monitored daily. The dietician must monitor the
diet quantity and quality. Ensure that the hygienic
measures are in practice during the preparation and
distribution of diets. There should be a policy for a
periodic checkup for the staff working in the kitchen.
The orientation programs regarding food safety and
personal hygiene for the kitchen
Laboratory services
 The laboratory services in the hospital are an
essential pan of the hospital. Different types of
laboratories order sprite lab tests to help
medical staff in making and continuing the
diagnosis it was a significant role in the patent
and prevention of diseases. The tests performed
by the last of mute and specialized levels
 Classification of Labs
 According to the tests performed by labs- there
are hematology and blood banking, microbiology
and Clinical pathology, clinical biochemistry,
histopathology, cytology. molecular biology, and
molecular pathology.
 According to the level of labs.
 Primary-level labs: These are routine or simple labs at primary and
urban health center These labs perform hematological, urine examination,
microscopy tests for detecting malaria and sputum for acid-fast bacilli
and have cold chain systems.
 Secondary-level labs: These types of labs are available at the district
hospital level. These Labs perform various tests such as pathological,
dinical pathology, biochemistry, serology, and microbiological tests.
 Tertiary-level labs: These labs are available in teaching and nonteaching
large hospitals. These labs perform sophisticated diagnostics and
Investigations. These labs usually receive referral specimens.
 Reference/research/specific disease reference - These types of labs
operationalize in medical colleges, research institutes, and private
Institutes. These are of high-standard labs.
 Location
 The labs must locate on the ground floor for easy access
patient, emergency, and inpatient departments It d be near to
surgical, Intensive care, radiology, and obstetrical departments
 Space Requirement
 The primary Health Center (PHC) having lab load 10-20 the
minimum area is 10 m with a total area of 115 mlor
Community health center (CHO) with lab d 39-50 patients, the
minimum space required is 90 m dr district hospital of 100-
500 bed capacity, it should Ham' with lab load 100 collections
  
 Workflow and Physical Layout
 The workflow must follow a unidirectional path to
have infection control and work efficiency. Thusly,
that are three paths: (1) sample path (2) reagent
path, and (3) report path. The personnel must go
along with all three tracks
 a. Sample path: It should be in black lines This path has areas for
sampling registration, room for receiving/collection of samples:
accession (tecend of all specimens obtained by the lab for analysis
preparing, analyzing with washing and autoclave room, facility for
sample storage and sample disposal. The labs must have the provision
of cold, hot, distilled and deionized water in individual sections, and
uninterrupted power supply
 b. Reagent path: The red line denotes the reagent path This path has
area/facilities for receiving, storage. Indenting, using and disposal of
reagent and materials.
 c. Report path: The blue line denotes the report path. This path
follows in pathology, microbiology, and biochemistry labs: it has the
provision of offices and reporting window
  
 2. Corridors: The inside lab corridor must be minimum 2,550 mm
without any obstruction in the passageway and the passage of exit.
 3. Ceilings: The minimum heights of the roof should be 3,000 mm
 4. Doors: The minimum width of entries should be 1.200 mm in all
analytic areas with double shutters. There should be panels for
indicating preanalytic and analytic domains
 5. Entry to lab: There should be a lobby at each exit point to have
demarcation between lab and non lab space and to have hygienic,
safe, and secure lab spaces. There should also be the facility for
hand washing and coat pegs for hangings lab protective clothing and
space for storing dirty protective clothing in the lobby.
 6. Workbenches: The area for analytic and testing sample should be 10 ft
x 20 with workbenches 750 mm long and 720 mm high.. It should have the
provision of safe long and 720 m cable management and minimum counter
to counter clearance should be 2.150 mm. There should be space at the
back for for the equipment and air circulation be enough
 7.Other facilities: Other facilities include a separate mom room for
reporting and recording facility of cleaning glassware sterilizers, and waste
disposal facilities for disposing of liquid reagents by products and waste
There should be adequate ventilation with mechanical ventilation systems,
climate control and lighting arrangement It should be equipped with hand
washing, eating storing food, etc. facilities. The labs must have adequate
communication facilities facilities for transportation of samples, etc. There
should also be a room for meeting ,doctors rooms and administrative
offices There should be a staff room with adequate facilities
 Staffing
 The lab must have Head of the department who
should be in-charge of the lab and have
administrative control. The requirement of staffing
depends on the level of the facility. Roles and
responsibilities must be defined. The department
must conduct training programs for the staff and
evaluate them annually based on performance
 Safety and Infection Control
 There should be a documentation of lab safety policies and procedures. The
labs must have general safety and must adhere to bio safety precautions as
per the level of Biosafety Laboratories (BSLI, BSL2, BSL3, and BSL4). The
staff must follow safe, hygienic practices such as hand washing, wearing
protective clothing, gloves, eye protection, etc.
 There should be proper segregation, storage, transport, and disinfection as
per Biomedical Waste Management Rules 2016, and first aid rooms with
lifesaving drugs. The lab must equip with decontamination of lab wastes
such as autoclaves, chemical disinfectants, etc. Label all biohazards material
with the biohazards symbol. The fire/emergency exits must consider in
planning that must lead to open space. The fire extinguishers and fire
blankets should be available. The staff must be aware of their ethical
responsibilities and follow a moral code of conduct
 Security
 For security purpose, the location of the lab must be in a secure area.
Only the authorized personnel have access to the lab.
 Monitoring and quality control
 For equipment: There should be a list of consumable and
nonconsumable items, and these should be suitable located, in functional
order with warranty cards, periodically inspected for cleaning and
maintenance The labs must have standing operative procedures and
logbooks for equipment. Equipment must be verified for Its reliability
and should have checked through both Internal and external quality
audits. The labs must have calibration certificates for all analytical I
equipment by National Accreditation Board of Testing and Calibration
Laboratories (NABL), which is ISO 15189.2007 standard in India.
 BIBLIOGRAPHY
 I clement, “Management of Nursing Services and Education” 2 nd
­
edition published by Elsevier.
  
 Deepak k, Sarath Chandran C, Mithun Kumar.B.P. “A comprehensive
Textbook on Nursing Management”, 2 nd edition, published by
Emmess.
  
  
 Jogindra Vati, “Principles and Practice of Nursing Management and
Administration”, 2nd edition , published by Jaypee.
  
Assignment
 Write short note on ‘CSSD’
THANK YOU