Infrastructure maintenance

All buildings, however well designed and conscientiously built, require maintenance and repair as they get older. Proper maintenance of the infrastructure is required to be carried out to maintain safe environment inside these buildings. This is a continuous process and includes immediate remedial action for any fault besides preventive maintenance.

Maintenance of General Physical Structure

Maintenance of general hospital infrastructure includes the following activities:

1. Day to day repairs: Day to day repairs should be carried out by hospital authorities through directly employed labour. The work which is to be attended such as removing choked drainage pipes, restoration of water supply, replacement of blown fuses, repair of faulty switches, watering of plants, lawn mowing, hedge cutting, sweeping of leaf falls etc. should be done on day to day basis. This ensures satisfactory continuous functioning of various services in the buildings.
2. Annual Repairs: Works of periodical nature like white washing, colour washing. distempering, painting etc. are called annual repair works and these are generally undertaken through a system of contracts. The periodicity of two years for white washing and colour washing and three years for painting has been laid down by the Central Public Works Department (CPWD). However, facility staff is required to take a decision on the basis of directive received from their respective state governments.

Works such as patch repair to plaster, minor repairs to various items of work, replacement of glass panes, replacement of wiring damaged due to accident, replacement of switches, sockets, tiles, gap filling of hedges, replacement/replanting of trees, shrubs, painting of tree guards, and trimming of plants etc., which are not emergent works and are considered to be of routine type, can be done during any particular period of the financial year, depending upon the exigency. Such works can be done under day to day repair also.

Special repairs: As the building ages, there is deteriorationof various parts of the building and services. Major repairs and replacement of elements become inevitable. It becomes necessary to prevent the structure from deterioration and undue wear and tear as well as to restore it back to its original condition to the extent possible.

The following types of works in general are undertaken under special repairs:

• White washing, colour washing, distempers etc. after completely scrapping the existing finish and preparing the surface afresh
• Painting after removing the existing old paint
• Provision of water proofing treatment to the roof. All the existing treatments known are supposed to last satisfactorily only for a period of about ten years
• Repairs of internal roads and pavements
• Repairs/replacement of flooring, skirting, dado and plaster
• Replacement of doors, window frames and shutters.
• Replacement of door and window fittings
• Replacement of water supply and sanitary installation like water tanks, WC cistern, wash basins, kitchen sinks, pipes etc.
• Re-grassing of lawns/grass plots within 5-10 years
• Renovation of lawn in 5-6 years
• Replanting of hedges in 8-10 years.

The building services fixtures including internal wiring, water supply distribution systems etc. are expected to last for 20-25 years.Thereafter, it may be necessary to replace them after detailed inspection.

The expected economic life of the building under normal occupancy and maintenance conditions is considered to be as below:

• Monumental buildings - 100 years
• RCC framed construction - 75 years
• Load bearing construction - 55 years
• Semi-permanent structures - 30 years
• Purely temporary structures - 5 years

The life of the building mentioned above is only indicative and it depends on other factors like location, utilisation, specifications, maintenance and upkeep and caretaking.

All the three categories i.e. day to day, annual and special repairs/ services are interrelated. Neglect of routine maintenance and preventive measures may lead to more extensive periodical maintenance and in the long run major repair or restoration which could have been avoided or postponed. Hospital authorities may use Inspection Checklists of CPWD for maintenance.

All three plans are to be carried out under the direct supervision and should ensure following in the health facility:

• There are no cracks, seepage, chipped plasters and broken floors in the HCF
• There are no broken windows and glass panes and all the windows are guarded
• There are no loose and hanging electrical wirings in the facilities
• All the electrical panels are placed inside closed cabinet and there are no broken electrical panels in the facility
• The health facility has an intact boundary wall with an adequate height to prevent unauthorised entry
• The health facility does not have any growth of algae, mosses or any vegetation on the roof and walls
• The health facility including boundary walls are painted in a uniform colour scheme.

The  following precautions are needed to be taken while framing, scheduling or performing periodic maintenance of the health facility:

• Maintenance work is needed to be carried out at times which minimise any adverse effect on output or function of hospital
• Programme should be planned in a way to carry out comprehensive work to obviate multiple works at one site at different times
• Maintenance work, completed or being carried out should comply with all statutory and other legal requirements.

All All the activities carried out under the periodic maintenance programme need to be recorded and all such records need to be kept by the health facility. These records include details of work done, details of person performing the activities, time frame of the activity and person responsible for validating the satisfactory completion of the work done.

Maintenance of Hospital Parking

The health facility should ensure that there is provision of sufficient space for parking of vehicles of the staff, patients, visitors and ambulances.

The following aspects are needed to be considered for maintenance of parking spaces of the health facility:

• The porch parking space at the entrance of the hospital should be covered with a shed to protect from all weather conditions
• The porch parking should be designed in a way to enable singular way of movement and enough space for parking of at least two ambulances, for better disaster management
• The parking facilities for ambulances and other vehicles are properly demarcated
• The demarcated parking area for ambulances should be covered with a shed and should be kept free of normal traffic to ease the movement of the ambulance
• Parking for patients, especially those with disabilities should be as close as possible to the entrance of the building
• A reserved parking space for persons with disabilities should be created in public and staff parking
• The directional signage should also be in place for proper identification of the parking spaces Guidelines For Implementation Of “KAYAKALP” Initiative 11
• Parking areas need to be proper illuminated • Parking space for employees should ideally be located separately.

Maintenance of Furniture and Fixtures

Hospitals need to ensure that all the furniture and fixtures installed in the hospital are well maintained to provide safe environment in the hospital. These minimum requirements need to be met by the hospital for maintenance of furniture and fixtures.

• All the doors are needed to be intact and are painted and varnished.
• All the window panes need to be intact and should be provided with safeguard grill and meshes.
• All the patient beds are well maintained with no broken parts and no temporary arrangements made for maintaining stability of the beds.
• All the patient beds should be checked for deposition of rust and should be painted on regular basis.
• All trolleys, stretchers, wheel chairs etc. are provided with safety belts.
• All trolleys, stretchers and wheel chairs should be intact, painted and cleaned on regular basis.
• Wheels of stretchers, wheel chairs and trolleys need to be properly aligned and well lubricated.
• All furniture installed in the hospital needs to be checked for any broken parts, withered paint etc. and should be repaired accordingly.
• Preventive maintenance programme of the hospital should also include preventive maintenance of furniture and fixtures.
• The facility should ensure that it carries out anti-termite treatment for all the furniture and fixtures at least once in a year as described in the pest and animal control section above.

Source: Guidelines For Implementation Of "KAYAKALP" Initiative