At Connexxity, we offer comprehensive information to assist building designers and end-users, with a particular focus on MEPF (Mechanical, Electrical, Plumbing, Fire Safety) systems in India.

We provide insights on key infrastructure requirements, including details on service providers, material suppliers, and installation and repair services. Additionally, we cover mandatory codes, standards, and government approvals, outlining the necessary procedures and who can assist with obtaining these approvals.

Our resources are tailored to specific building types, detailing infrastructure needs and all relevant support information. Our team strives to identify the right resources for preliminary and detailed assessments, as well as certification of verifications, helping users make informed decisions.

Running a hospital in India involves obtaining various certifications, accreditations, approvals, and authorizations to ensure compliance with regulatory standards and to provide quality healthcare services. Here are the key requirements:

 Certifications and Registrations:

1. Certificate of Registration under Clinical Establishments (Registration and Regulation) Act, 2010:

   – Mandatory registration with the appropriate State Government authority to operate a clinical establishment, including hospitals.

2. Drug License:

   – Obtain a drug license from the State Drug Control Authority to procure, store, and dispense medications.

3. Bio-Medical Waste Management Authorization:

   – Obtain authorization from the State Pollution Control Board (SPCB) for the safe handling, treatment, and disposal of bio-medical waste generated by the hospital.

Accreditations and Standards:

1. National Accreditation Board for Hospitals & Healthcare Providers (NABH):

   – Accreditation by NABH signifies that the hospital meets national standards for quality healthcare delivery, patient safety, and management practices.

2. National Accreditation Board for Testing and Calibration Laboratories (NABL):

   – NABL accreditation is required for hospital laboratories to ensure they meet international standards for testing and calibration services.

Approvals and Permissions:

1. Fire Safety Certificate:

   – Obtain a fire safety certificate from the local Fire Department confirming compliance with fire safety regulations, including installation of fire safety systems and adherence to evacuation protocols.

2. Building Plan Approval:

   – Obtain approval from the local municipal authority for the hospital building plan, ensuring compliance with building codes, zoning regulations, and structural safety norms.

3. Occupancy Certificate:

   – Obtain an occupancy certificate from the local municipal authority upon completion of construction, confirming compliance with building and safety regulations for occupancy.

Authorizations and Licenses:

1. Clinical Establishment License:

   – In some states, a separate license specifically for clinical establishments (including hospitals) may be required in addition to registration under the Clinical Establishments Act.

2. Radiation Safety License:

   – Hospitals with diagnostic imaging facilities (like X-ray, CT scan, MRI) need a radiation safety license from the Atomic Energy Regulatory Board (AERB) to ensure safe handling and operation of radiation-emitting equipment.

3. Narcotics License:

   – If the hospital administers and dispenses narcotic drugs for pain management or anesthesia, a narcotics license from the State Drug Controller is required.

Other Requirements:

1. Insurance and Liability Coverage:

   – Adequate insurance coverage including professional indemnity insurance for healthcare providers, and liability insurance for the hospital.

2. Labor Law Compliance:

   – Compliance with labor laws related to employment, working conditions, and employee benefits.

3. Environmental Clearances (if applicable):

   – Hospitals located in environmentally sensitive areas may require specific clearances related to environmental impact and sustainability practices.

Conclusion:

Obtaining these certifications, accreditations, approvals, and authorizations is crucial for hospitals in India to ensure compliance with regulatory standards, provide quality healthcare services, and operate legally. Requirements may vary slightly between states, so it’s important to consult local authorities and regulatory bodies for specific guidelines applicable to the location of the hospital.

1. Mechanical Systems (HVAC):

   – Air Quality: Install HVAC systems equipped with HEPA filters in critical areas to maintain high Indoor Air Quality (IAQ) and mitigate hospital-acquired infections.

   – Temperature and Humidity Control: Ensure precise control of environmental conditions in patient rooms, ICUs, theaters, and laboratories to optimize patient comfort and equipment reliability.

   – Energy Efficiency: Implement energy-efficient HVAC systems and zoning strategies to minimize energy consumption while meeting ventilation and climate control requirements.

2. Electrical Systems:

   – Power Backup: Provide reliable backup power solutions such as generators and UPS to ensure uninterrupted operation of essential medical equipment and lighting.

   – Dedicated Circuits: Install dedicated electrical circuits for medical equipment to safeguard against power disruptions and ensure continuous functionality.

3. Plumbing and Sanitary Systems:

   – Water Supply: Ensure consistent water pressure, quality, and compliance with health standards throughout the facility.

   – Sanitation: Implement effective waste management systems to uphold cleanliness standards and prevent cross-contamination.

4. Fire Safety Systems:

   – Detection and Alarm: Deploy advanced fire detection and alarm systems integrated with central monitoring for swift identification and response to fire incidents.

   – Suppression: Install automatic fire suppression systems such as sprinklers and extinguishers in adherence to regulatory requirements for enhanced fire safety.

5. Public Address and Talkback Systems:

   – Communication: Install Public Address (PA) systems strategically to facilitate emergency alerts, general announcements, and information dissemination across the hospital.

   – Talkback: Implement two-way communication systems in critical areas like operating theaters and ICUs to enable effective communication during emergencies and critical situations.

6. Emergency Lighting and Signage:

   – Emergency Lighting: Ensure adequate emergency lighting in corridors, stairwells, and critical areas to facilitate safe evacuation during power outages or emergencies.

   – Signages: Install clear and visible fire exit signs, evacuation route maps, and instructions in multiple languages to guide occupants to safety effectively.

7. Nurse Call System:

   – Patient Communication: Implement nurse call systems with bedside units to enable patients to request assistance promptly.

   – Emergency Response: Integrate nurse call systems with hospital emergency protocols to ensure rapid response and efficient coordination during patient emergencies.

8. Oxygen and Medical Gas Systems:

   – Oxygen Pipeline: Design and install dedicated oxygen pipeline systems with centralized distribution points to deliver uninterrupted oxygen supply to patient care areas and operating theaters.

   – Medical Gas: Ensure the installation and monitoring of medical gas systems (e.g., oxygen, nitrogen) with stringent safety measures such as pressure regulators and alarms to ensure continuous supply and prevent hazards.

9. Integration and Compliance:

   – Regulatory Compliance: Ensure all MEPF systems comply with local building codes, health regulations, and accreditation standards such as NABH (National Accreditation Board for Hospitals & Healthcare Providers).

   – System Integration: Integrate MEPF systems seamlessly to optimize operational efficiency, safety, and functionality across the hospital infrastructure.

10. Maintenance and Training:

   – Regular Maintenance: Establish routine maintenance schedules for all MEPF systems to ensure optimal performance, longevity, and reliability.

   – Staff Training: Provide comprehensive training programs to hospital staff on the operation, maintenance, and emergency procedures related to MEPF systems to enhance safety awareness and preparedness.

Adhering to these comprehensive MEPF requirements ensures hospital facilities are equipped to deliver safe, efficient, and high-quality healthcare services while meeting regulatory standards and accreditation requirements.

Designing a hospital building requires meticulous attention to key requirements across mechanical, electrical, plumbing, and fire safety (MEPF) systems to ensure operational effectiveness, safety, and regulatory compliance. Here’s how an MEPF design consultant contributes to each system:

Mechanical Systems (HVAC):

1. Air Quality: Specify HVAC systems with HEPA filters in critical areas like patient rooms, ICUs, and operation theaters to maintain superior indoor air quality (IAQ) and mitigate infection risks.

2. Temperature and Humidity Control: Design precise control systems for temperature and humidity levels throughout the facility to enhance patient comfort and ensure optimal operation of medical equipment.

3. Ventilation: Engineer ventilation solutions that provide adequate fresh air circulation to minimize airborne contaminants and support patient recovery.

4. Energy Efficiency: Implement energy-efficient HVAC designs to reduce operational costs while meeting stringent ventilation and temperature control requirements.

Electrical Systems:

1. Power Backup: Design robust backup systems such as generators and UPS to ensure uninterrupted power supply for critical medical equipment and emergency lighting during power outages.

2. Dedicated Circuits: Specify dedicated electrical circuits for medical equipment to prevent disruptions and ensure reliable power distribution.

3. Lighting: Develop lighting plans that ensure sufficient illumination in patient areas, corridors, and emergency zones, including provisions for backup lighting to maintain safety during power failures.

Plumbing and Sanitary Systems:

1. Water Supply: Engineer systems for reliable water supply with adequate pressure and quality, adhering to health standards and infection control protocols.

2. Sanitation: Design effective waste management systems for the safe disposal of medical waste and sewage to prevent contamination and ensure hospital cleanliness.

3. Medical Gas Systems: Specify and install medical gas systems (e.g., oxygen, nitrogen) with centralized distribution points, incorporating safety features like pressure regulators and alarms for continuous supply and safety.

Fire Safety Systems:

1. Detection and Alarm: Integrate advanced fire detection systems (e.g., smoke and heat detectors) with central monitoring for early warning and rapid response to fires.

2. Suppression: Design automatic fire suppression systems including sprinklers and extinguishers to meet local fire codes and minimize fire risks.

3. Evacuation Planning: Develop comprehensive fire evacuation plans with clearly marked exits, routes, and assembly points to ensure swift and safe evacuation of patients, staff, and visitors during emergencies.

Integration and Compliance:

1. Regulatory Compliance: Ensure all MEPF systems comply with local building codes, health regulations, and accreditation standards such as NABH to guarantee safety and quality of care.

2. System Integration: Coordinate seamless integration of MEPF systems to optimize efficiency, functionality, and safety across the hospital infrastructure.

Maintenance and Training:

1. Regular Maintenance: Establish schedules for routine maintenance of all MEPF systems to uphold operational efficiency, reliability, and longevity, minimizing operational disruptions.

2. Staff Training: Provide comprehensive training to hospital personnel on the operation, maintenance, and emergency protocols related to MEPF systems to enhance safety awareness and preparedness.

By addressing these critical aspects comprehensively, an MEPF design consultant plays a pivotal role in creating a hospital environment that is safe, efficient, and conducive to high-quality healthcare delivery, meeting and exceeding regulatory standards and patient expectations.

NABH (National Accreditation Board for Hospitals & Healthcare Providers) audit involves assessing various aspects of hospital operations to ensure compliance with established standards for quality and patient safety. Here’s a checklist to guide you through a NABH audit:

Leadership and Management

1. Organizational Structure:

   – Verify the hospital’s organizational chart and ensure clear delineation of roles and responsibilities.

2. Governance:

   – Review governance structure to ensure accountability and transparency in decision-making.

3. Leadership Commitment:

   – Assess commitment of hospital leadership to quality improvement and patient safety.

4. Policy and Procedures:

   – Review and update policies and procedures related to patient care, safety, and operational processes.

Patient-Centered Standards

1. Patient Rights and Education:

   – Ensure patients are informed about their rights and responsibilities.

2. Patient Assessment and Care:

   – Verify adherence to protocols for patient assessment, care planning, and documentation.

3. Informed Consent:

   – Confirm procedures for obtaining informed consent from patients or their representatives.

4. Patient Feedback:

   – Evaluate mechanisms for capturing patient feedback and complaints, and actions taken based on feedback.

Facility Standards

1. Infrastructure and Safety:

   – Inspect physical infrastructure, including building layout, cleanliness, and infection control measures.

2. Medical Equipment:

   – Ensure proper maintenance and calibration of medical equipment, including records of service and performance checks.

3. Pharmacy Services:

   – Verify procedures for procurement, storage, dispensing, and disposal of medications.

Human Resource Management

1. Staffing Levels and Competency:

   – Review staffing ratios and ensure staff are competent and trained for their roles.

2. Staff Health and Safety:

   – Check policies and procedures for occupational health and safety of hospital staff.

3. Training and Development:

   – Assess training programs to ensure staff are trained in relevant areas including patient care, infection control, and emergency response.

Patient Safety

1. Infection Control:

   – Review infection control policies, practices, and surveillance measures.

2. Medication Safety:

   – Evaluate medication management processes to prevent errors in prescribing, dispensing, and administration.

3. Clinical Protocols and Guidelines:

   – Verify implementation of clinical protocols and guidelines for standardization of care practices.

Continuous Quality Improvement

1. Quality Indicators:

   – Monitor and analyze clinical outcomes and patient satisfaction indicators.

2. Internal Audits:

   – Confirm regular internal audits to identify areas for improvement.

3. Risk Management:

   – Review risk management processes including incident reporting and investigation.

Documentation and Records

1. Medical Records:

   – Ensure completeness, accuracy, and confidentiality of medical records.

2. Data Management:

   – Verify systems for data collection, analysis, and reporting for quality improvement initiatives.

Ethical Practices

1. Ethical Review Committee:

   – Ensure existence and functioning of an ethical review committee for ethical practices in patient care and research.

2. Confidentiality and Privacy:

   – Confirm policies and procedures for patient confidentiality and privacy protection.

Emergency Preparedness

1. Disaster Management Plan:

   – Assess readiness and response protocols for emergencies and disasters.

2. Emergency Equipment:

   – Verify availability and functionality of emergency equipment and supplies.

Environmental Management

1. Waste Management:

   – Review procedures for safe handling, segregation, and disposal of biomedical and hazardous waste.

2. Energy Conservation:

   – Evaluate initiatives for energy conservation and environmental sustainability.

Conclusion

– Compliance Report: Prepare a detailed report highlighting compliance status, areas of improvement, and recommendations.

– Action Plan: Develop an action plan based on audit findings to address deficiencies and enhance compliance with NABH standards.

This checklist provides a structured approach to conducting a NABH audit, ensuring thorough evaluation across all critical areas of hospital operations to maintain and improve quality of care and patient safety.

Fire Safety is one of the most essential aspect of any building and it has more severe implications in Hospital Buildings. In India, Fire and Life safety regulations are laid down in National Building Code 2016 – Vol 1, Part 4.

“This Code (Part 4) covers the requirements for fire prevention, life safety in relation to fire and fire protection of buildings. This Code (Part 4) specifies occupancy-wise classification, constructional aspects, egress requirements and protection features that are necessary to minimise danger to life and property from fire

Subsequent topics like definitions, classifications, regulations and explanations extends to 116 pages, which emphasise the importance of this topic.

“Subdivision C-1 Hospitals and sanatoria — This subdivision shall include any building or a group of buildings under single management, which is used for housing persons suffering from physical limitations because of health or age and those incapable of self-preservation, for example, hospitals, infirmaries, sanatoria and nursing homes”

It is further demarcated to Fire Zone 1, meaning Highest risk for fire.

Detailed specifications and explanations are given in the Code with clear statement that these are the minimum requirements and enhanced protection is always desirable.

Table 7 of this Code gives the Minimum Requirements of Fire Fighting Installation. Snapshots of the parts of the table related to Hospitals is pasted on top of the article for the purpose giving general awareness. However a detailed study of the table and the notes are necessary for proper understanding of the requirements.

There are many more instructions in this Code, specifying regulations connecting to Patient Safety. Restrictions in usage of Basements, terraces etc are also specified in the code. However, the maximum permissible height of hospital building is a major a concern during design or expansion stages. Hence the same is quoted below:-

3) All critical patients and those incapable of self-preservation and having physical impairment shall be housed within 30 m height.

4) Other types of patients and occupancies incidental to the hospitals such as consultation rooms, nurses’ stations, medical shops, canteens, etc may be housed at heights beyond 30 m but not more than 45 m.

Hospital management in general, and hospital Fire Safety officials in particular, needs to have awareness of regulations applicable to their hospitals.  Hence it is strongly suggested that a copy of the Code may be downloaded and made readily available for reference in Hospital.

Hospitals accredited by NABH, JCI, NQAS or such other accreditation will have established procedures and detailed Fire Safety instructions. They also conduct periodic trainings in Firefighting and Patient evacuation. Such practices help in keeping all the employees prepared for unforeseen situations. Hence it is strongly suggested that Hospitals without such accreditation shall also establish procedures and conduct periodic trainings for preparedness.

Fire safety in hospital buildings is not just a regulatory requirement but a fundamental aspect of ensuring the safety of patients, staff, and visitors. As highlighted by the National Building Code 2016, adhering to stringent fire prevention and protection measures is crucial. By implementing robust fire safety protocols, conducting regular training, and staying updated, hospitals can significantly mitigate risks and enhance their preparedness for emergency situations. At Vital Impakt, we are committed to supporting hospitals in their journey towards achieving the highest standards of fire safety, providing expert guidance and innovative solutions tailored to meet the unique challenges of healthcare facilities. Let’s work together to create safer environments and protect what matters most.