Ministry of Public Health, GDCM Minimum Standards for Private Hospital and Clinical Facilities
Minimum Standards for Private Hospital and Clinical Facilities
December 2010
Contents
1. Preamble 5
2. Definitions for a Private Hospital 6
2.1. Interpretation of definitions 6
3. Functional Programmes 7
3.1. Emergency/First Aid 7
3.2. General Medicine 8
3.3. General Surgery 8
3.4. Maternity facilities 9
3.5. Pathology 10
3.6. Radiology 10
3.7. ECG 10
3.8. Health Education 10
3.9. Ambulance 11
3.10. Medical Records 11
3.11. Diet 12
3.12. Universal Bio-Safety 12
3.13. Others 12
4. Human Resources 12
4.1. Qualifications 12
4.2. Availability of personnel 13
4.3. Minimum requirement of personnel 15
5. Instruments for various facility zones 15
5.1. Entrance Zone 15
5.1.1. Reception and Registration (with Cashier) 16
5.1.2. Waiting area 16
5.2. Ambulatory Zone 16
5.2.1. Nursing station 16
5.2.2. Treatment/Dressing room and Injection room 16
5.2.3. Examination and consultation rooms in OPDs and Casualty 18
5.2.4. Pharmacy 19
5.2.5. Diagnostic 19
5.3. Intermediate Zone 21
5.3.1. In Patients Wards 21
5.3.2. Nursing station 22
5.3.3. Treatment room 22
5.3.4. Trolley bay 23
5.3.5. Ward store 23
5.4. Operation Theatre Zone 23
5.4.1. General Instruments 23
5.4.2. Instruments for Abdominal Surgery 25
5.4.3. Instruments for Chest Surgery 25
5.4.4. Instruments for Orthopaedic Surgery 25
5.4.5. Instruments for Urogenital Surgery 26
5.4.6. Instruments for Vascular Surgery 26
5.4.7. Instruments for Gynaecological Surgery 27
5.4.8. Instruments for Obstetric Surgery 27
6. Equipments 30
6.1. For General and Obstetrics/Gynaecological Surgery 30
6.2. Equipment for Orthopaedic Surgery 33
6.3. Equipments for Anaesthetia 33
6.4. Equipment and Instruments for Delivery suite 34
6.4.1. Examination and preparation room 34
6.4.2. Labour room 34
6.4.3. Delivery rooms 35
6.5. Equipments for Services Zone 36
7. Space Requirements for minimum functions 37
7.1. Entrance Zone 38
7.2. Ambulatory Zone 38
7.2.1. Medical Clinic 38
7.2.2. Surgical Clinic 38
7.2.3. Casualty and Emergency Care 38
7.2.4. Obstetric and gynaecological Clinic 38
7.2.5. Nursing station for OPD 39
7.2.6. Janitor's closet 39
7.3. Diagnostic zone 39
7.3.1. Pathology 39
7.3.2. Radiology 39
7.3.3. Critical Zone 39
7.4. Intermediate zone 43
7.4.1. Inpatients nursing units 43
7.5. Service zone 45
7.5.1. Laundry 45
7.5.2. Dietary facilities 45
7.5.3. Space for storage of oxygen cylinders 45
7.5.4. Space for storage of Nitrous oxide cylinders 45
7.5.5. Space for Compressor 45
7.5.6. Space for Generator 45
7.5.7. Stores 46
7.5.8. Administration 46
8. Building Engineering Environmental Standards 46
8.1. Location 46
8.2. Ceilings 46
8.3. Floor Height 47
8.4. Floors and Walls 47
8.5. Doors 48
8.6. Windows 48
8.7. Corridors 48
8.8. Water Supply, Plumbing and other Piping Systems 49
8.8.1. Water Supply 49
8.8.2. Plumbing 49
8.8.3. Other Piping Systems 49
8.8.4. Medical Gas Outlet Specifications 50
8.9. Electrical Standards 51
8.9.1. Environmental factors 51
8.9.2. Power Supply 51
8.9.3. Switchboards and Power points 51
8.10. Access routes to various facilities 52
8.11. Communication system 52
8.12. Fire-fighting system 52
8.13. Heating ventilation and air conditioning (HVAC) affecting patient care 52
8.14. Requirements for sanitary fitments for patients 53
8.14.1. Inpatient Wards and Nursing Units 53
8.14.2. Outpatient Block 53
8.15. Waste Disposal 54
9. Appendix 54
9.1. Bio-Safety Guidelines 54
9.2. Minor Surgery 55
1. Preamble
Constitutionally the Government of the Islamic Republic of Afghanistan (GIRA) is obliged to support the development of private sector initiatives in the various fields including healthcare sector. It is the responsibility of Ministry of Public Health (MoPH) to guide the development of private health care services while ensuring patient’s safety and staff security and minimum standards of quality care. Therefore, in the regulatory framework, this document is intended to provide a model standard for planning and operating a private health care facilities and the operation of private health care services.
Private hospitals are envisaged as place where a patient is admitted for overnight medical and nursing care and it is a common practice that most of such clinical facilities provide various disciplines under one roof. If a hospital or clinical facility is intended to provide health care following standard norms and keeping patient safety and staff security on the highest level, provision of such establishment should normally not in requirement of any special infrastructural input beyond what available in any standard hospital or clinical facility. It is mainly a question of medical and professional skill passed on to the medical patients who are normally admitted to such facilities, which provide care in other disciplines.
This document lists out minimum standards for providing medical/surgical/maternity facilities in respect to functional program, human power, equipment, functional requirements of basic space allocation and a few essentials in building services; engineering and environmental requirements have also been covered.
Nothing in these standards should be construed as restrictive to a facility that chooses to do work as part of a long range plan for improvement of quality/level of services provided or safety of the facility. Such facilities should also be integrated with the community where it is situated and should participate or take lead in health education, nutrition and other needs of the community.
With the help of Allah, and based on the following minimum standards for private hospitals, Afghanistan will be able to provide effective and efficient health care services to its people.
2. Definitions for a Private Hospital
2.1. Interpretation of definitions
The basic definitions include the following:
(a) “Clinical Facility” means: hospitals, clinics, nursing and maternity homes, physical therapy centres, clinical laboratories and medical imaging centres, or any establishment as per the jurisdiction of the General Director of Health Services Provision (GDHSP), MoPH by notification in gazette from time to time specifies;
a. “Hospital” means any premises used for the reception of the sick and their treatment providing in- and outpatient services in various departments and disciplines that may require overnight stay;
b. “Clinics” means any premises used for the reception of the sick and their treatment providing mainly outpatient and day-care services in specific fields of medical care;
c. “Nursing home” means an establishment or premises used for the reception of, and providing nursing care to persons suffering from chronic sickness or infirmity, which may require overnight stay;
d. “Maternity home” means an establishment where women are received or accommodated for antenatal and postnatal care in connection with child-birth;
e. “Physical Therapy Centres” “means an establishment where persons are treated by physical means such as massage, electrotherapy, hydrotherapy, remedial gymnastics or the like;
f. “Clinical laboratory” means an establishment where (i) Biological, pathological, bacteriological, radiological, chemical, biochemical or other tests, examinations or analysis or (ii) Preparation of cultures, vaccines, serums or other biological or bacteriological products, in connection with the diagnosis or treatment of diseases, are carried out;
g. “Medical Imaging Centre” means an establishment where (i) X-Ray, (ii) CT and MRI Scans, (iii) Ultrasound, and any other kind of medical imaging and x-ray technologies are performed in connection with the diagnosis or treatment of diseases.
(b) “Qualified medical practitioner” means a medical practitioner registered under a law for the registration of medical practitioners;
(c) “Qualified Midwife” means a midwife registered under the law in force, for the registration of midwives or trained in a licensed hospital, nursing home, maternity home for at least two years and duly certified to have been properly trained in a hospital by that institution;
(d) “Qualified Nurse” means a nurse registered under the Nursing Council or trained in a licensed hospital, nursing home, maternity home for at least two years and duly certified to have been properly trained in a hospital by that institution.
(e) Other paramedical staffs mean a staff trained in a licensed hospital, nursing home, maternity home for at least two years and duly certified to have been properly trained in a hospital by that institution.
3. Functional Programmes
To ensure minimum standards of quality care, all clinical and clinical support services have to be provided by professional staff whose qualification is testified by valid national and international institutions, approved by the MoPH. All equipment used in the process of diagnosis and treatment has to comply with standards of good manufacturing practice and be regularly maintained in order to assure patient safety and staff security.
The basic minimum functions provided by a private hospital must include the following:
3.1. Emergency/First Aid
Emergency first aid is care provided initially to stabilize a victim’s condition and to minimize potential for further injury during transport to an appropriate service. At minimum each hospital shall have provisions for emergency first aid treatment for staff as well as for persons who may be unaware of or unable to immediately reach services in other facilities. This is not only for minor incidents that may require minimal care but also for persons with severe injuries or in grave condition who must receive immediate first aid and assistance for transport to other facilities.
Emergency first aid includes facilities for incubation, venesection, thorough cleaning/dressing of wounds, ligations of bleeding vessels, insertion of intercostal drainage tube, application of Thomas Traction, starting of nasal O2, bladder catheterisation, stomach wash, establishing an intravenous line in case of patients in shock, controlling of convulsions, controlling of acute attacks of breathlessness, etc. Emergency first aid services should be provided to all patients in need of them irrespective of their capacity to pay.
3.2. General Medicine
All private hospital providing medical facilities should be able to provide Clinical diagnosis for infectious diseases, diabetes, hypertension, auto-immune disorders, endocrine disorders, neurological disorders, renal disorders, skin diseases, gastro-intestinal disorders, etc. Treatment and follow-up care for a majority of these conditions would also be possible by a physician. Medical personnel manning such a facility should be able to take a decision regarding cases which require higher medical skills or which may eventually need transfer to a better equipped facility (intensive care, surgical facility, ventilators, haemodialysis machine, cardiac monitors etc.) and accordingly transfer such patients at the earliest.
In case a patient had been admitted in such a facility for more than 24 - 48 hours, it is expected that the patient will be transferred with a medical attendant accompanying the patient and all medical records (including X-rays, investigation reports and clinical notes) will be made available to the next doctor who will be treating the patient. It is also expected that the doctor who had treated the patient initially will keep in touch with the institution to which the patient has been transferred in order to remain aware of the patient’s condition.
If a private hospital is providing ‘Cardiology Consulting’ facilities only, this should be clearly stated in the functional programme as well as in any advertising material put up by the facility. This is to avoid confusion and misunderstanding in the minds of the populace seeking care. A facility which claims to provide Emergency Cardiology Services should possess permission to run intensive care facilities and registered as required by the MoPH.
3.3. General Surgery
A hospital with general surgical facility must be able to provide Elective General Surgery for the following conditions:
Benign and malignant soft tissue tumours, benign breast disease, carcinoma breast, thyroid surgery benign and malignant conditions of the gastrointestinal tract, benign anal conditions, inguinal hernia, hydrocoele, varicose veins, testicular tumours, abscesses, vasectomy etc.
In case a patient who has been operated upon or has been admitted in a surgical nursing home needs transfer to a better-equipped facility, it is expected that the patient will be transferred with a medical attendant accompanying the patient and all medical records (including X-rays, investigation reports, detailed indoor notes with operation and anaesthesia notes) will be made available to the next doctor who will be treating the patient. It is also expected that the doctor who had initially treated the patient will continue to keep in touch with the patient, his/her relatives and the next doctor. A purely general surgical nursing home need not have a delivery suite.
Elective surgery for uncomplicated urolithiasis, gall bladder conditions and closed reduction of fractures can be performed if portable X-ray facility is available. In case a private hospital provides emergency General Surgical facilities, this should be clearly mentioned in the functional programme and as well as in any advertising material put up by such facilities.
In such private hospitals, emergency care for cases of acute abdomen, strangulated hernia, torsion testis, etc. can be provided. For this X-ray facilities should be available within the facility and access to Blood Bank and Ultrasonography facilities should be available within half an hour.
Conditions like carcinoma oesophagus, acute abdomen with cardio-respiratory compromise, oral malignancies, pancreatic surgery for obstructive jaundice/malignancies/chronic pancreatitis, liver Surgery, biliary tract strictures and malignancies, surgery for portal hypertension, recurrent surgery in the abdomen for complications like G.I fistulae, repeated adhesions, associated serious medical conditions like severe diabetes, cardiac disease etc., and other conditions that will need critical management with ventilators/intensive care units should not be operated upon unless intensive care facilities can be made available.
3.4. Maternity facilities
All private hospital providing maternity facilities should provide basic obstetric and neonatal facilities including ability to carry out procedures like suction and evacuation, dilatation and curettage, Lower Segment Cesarean Section and Hysterectomy on an emergency basis. Blood transfusion and ultrasonography facilities should be available within half to one hour, which should be mentioned in the functional programme of the private hospital including availability of a nearest neonatal intensive care facility.
3.5. Pathology
The type and extent of laboratory facility to be available for a private hospital will depend on the functional programme but provisions shall be made for the following minimum procedures to be performed on site or at a nearby facility. Blood counts, urinalysis, blood glucose, blood urea and nitrogen, coagulation profile (bleeding time, clotting time, prothrombin time), Blood grouping, typing and cross-matching, serum electrolytes, serum amylase. Provision shall also be included for specimen collection and processing. A separate toilet facility should be provided for the pathology section.