THE CENTRAL STERILIZATION & SUPPLY DEPARTMENT (CSSD) MISSION OF CSSD (CUSTOMER ORIENTED) Timely delivery of sterile goods Quality (according to European Standards – EN) Efficiency (line process) ACTIVITIES OF THE CSSD (SPAULDING) Cleaning Disinfection of semi- / non critical items (mucosa – non intact skin contact) Sterilization of critical items (high risk for infection) Supply of sterile materials

1. ALL YOU NEED
TO KNOW ABOUT
CENTRAL
STERILE SUPPLY
DEPARTMENT

2. HOSPITAL MANAGEMENT
- CSSD, OR, ICU
BY TALAL ALBUDAYRI

3. CENTRAL STERILE
SUPPLY DEPARTMENT
(CSSD)

4. THE CENTRAL STERILIZATION & SUPPLY
DEPARTMENT (CSSD)
MISSION OF CSSD (CUSTOMER ORIENTED)
Timely delivery of sterile goods
Quality (according to European Standards – EN)
Efficiency (line process)
ACTIVITIES OF THE CSSD (SPAULDING)
Cleaning
Disinfection of semi- / non critical items (mucosa – non intact
skin contact)
Sterilization of critical items (high risk for infection)
Supply of sterile materials
3

5. AIMS
TO PROVIDE STERILIZED MATERIAL FROM A
CENTRAL DEPARTMENT WHERE STERILIZING
PROCESS IS CARRIED OUT UNDER PROPERLY
CONTROLLED CONDITIONS
TO ALLEVIATE THE BURDEN OF WORK OF THE
NURSING PERSONNEL, THERE BY ENABLING
THEM TO DEVOTE MORE OF THEIR TIME TO
PATIENT CARE .
4

6. THE CENTRAL STERILIZATION & SUPPLY
DEPARTMENT (CSSD)
BUILDING BLOCKS
Well trained employees
Information System
Planning system: information available OR CSSD
Tracing: set level / instrument level
Standardization
Processes: SOP
Equipment and Instruments
Infrastructure
(External) Validation
“Just in time” delivery – pull from the OR
5

7. DECONTAMINATION LIFE CYCLE
6

8. FLOW PROCESS : CSSD
7

9. MAIN RESULTS OF THE ANALYSIS
8

10. DEFINITION OF CSSD
SERVICE, WITH IN THE HOSPITAL, CATERING FOR
THE STERILE SUPPLIES TO ALL DEPARTMENTS ,
BOTH TO SPECIALIZED UNITS AS WELL AS
GENERAL WARDS AND OPDS.
9

11. HISTORY
1928 – AMERICAN COLLEGE OF SURGEONS –
CSSD.
1942 – WORLD WAR II .CAIRO, BRITISH SDS
UNIT .
1955 – CAMBRIDGE MILITARY HOSPITAL –
REGULAR CSSD IN UK.
1965 – FIRST CSSD IN INDIA – SAFADARAJAN
HOSPITAL
10

12. ADVANTAGES
Bacteriological safe sterilization.
1.
Less expensive.
2.
Elimination of unsound practices & establishment of
standard procedures.
3.
Assurance of adequate supply of sterile products
immediately and constantly available for sometime as
well as emergency use.
4.
Conservation of trained staff.
5.
Better quality control
6.
Better good of material flow
7.
Prolonged life by proper care of equipment
8.
11

13. ITEMS COMMONLY HANDLED BY
CSSD STORES
Syringes
1.
Procedure Sets
2.
Lumbar puncture ; sternal puncture ;
venesection ; paracentesis ; aspiration ;
catheterization ; tracheotomy ; suturing ;
dressing ; biopsy ; incision & drainage ;
aortography ; cardiac resuscitation ; etc
3.
Needles
4.
Gloves
5.
12

14. ITEMS COMMONLY HANDLED BY
CSSD STORES-CONT.
I.V. FLUIDS.
1.
TREATMENT TRAYS.
2.
O.T INSTRUMENTS.
3.
O.T. LINEN
4.
INFUSION FLUIDS FOR RENAL DIALYSIS.
5.
AT TIMES LINEN. (OTHER THAN O.T)
6.
NB: DIET , DRUGS , BEDPANS & URINALS ARE
NOT INCLUDED BY CONVENTION .
13

15. PLANNING A CSSD DEPT
PHYSICAL PLANNING.
1.
FUNCTIONAL PLANNING.
2.
PERSONNEL PLANNING.
3.
EQUIPMENT PLANNING.
4.
FINANCIAL PLANNING.
5.
QUALITY CONTROL.
6.
PREVENTIVE MAINTENANCE.
7.
14

16. PHYSICAL PLNG
LOCATION & GROUPING .
1.
LAY OUT & SPACE REQTS.
2.
FIXTURTES & FURNITURE .
3.
15

17. ADM & STORAGE (UNSTERILE)
AREA
21² M
SCALES FOR
HOSPITALS > 700
BEDS
RECEPTION,CLEANING,CHECKING,A
SSEMBLY & PACKING AREA
35² M
AUTOCLAVING AREA 28 ² M
STERILE STORAGE & ISSUE AREA 28 ² M
TOTAL
1,320 ² ft
AREA REQUIREMENT
RULE OF THE THUMB-ROUGHLY – 10 SQFT / BED
16

18. EQUIPMENT'S IN CSSD
JET WATER CLEANING GADGETS.
1.
ULTRASONIC WASHERS
2.
GLOVE SHARPENER
3.
NEEDLE SHARPENER.
4.
GAS, CHEMICAL OR STEAM AUTOCLAVES.
5.
TESTING APPARATUS FOR EFFICIENCY OF
STERILIZATION
6.
17

19. OTHERS
MAINTENANCE & REPAIR EQUIPMENT
1.
ADEQUATE NUMBER OF CABINS & FURNITURE
2.
TELEPHONE OR INTERCOM.
3.
ADEQUATE NO OF SYRINGES & PROCEDURE
SETS.
4.
18

20. NUMBER OF SETS/SYRINGES
A - 1½ Daily requirement in use at wards / Departments
B - 1 Daily requirement in sterile state at CSSD, ready
for issue
C - 1 Daily requirement being processed at CSSD
D – 1to 1½ Daily requirement held in reserve – dome in
CSSD, some in medical stores
Total: 4.5 to 5 times of the daily requirement
19

21. TYPES OF STERILIZATION TECHNIQUES
Dry Heat
1.
Steam High Pressure-Autoclaves operated by Gas,
K.oil or Electricity ( Flash, Pulse)
2.
Ethylene Oxide Sterilization.
3.
Chemical Sterilization.
4.
Radiation Sterilization.
5.
Infra Red Radiation – Syringes
6.
Ultra Violet Radiation – Decontamination of Air
7.
Ionizing Radiation / Gamma Radiation
8.
20

22. 21

23. CHEMICAL
CIDEX
A Glutaraldehyde derivative is most effective as it destroys
spores too.
ETHYLENE OXIDE (ETO)
Quite effective against spores too.
Useful for delicate instruments and item which can’t be
immersed in liquids
- Low Boiling Point (10 degree C)
- Prolonged Aeration
- Highly Expensive / Explosive / Toxic
22

24. STERILISATION
IT IS A PROCESS OF FREEING AN ARTICLE
FROM ALL LIVING ORGANISMS INCLUDING
BACTERIA ,FUNGAL SPORES AND VIRUSES.
A MATERIAL IS PRONOUNCED STERILE IF IT
ACHIEVES 99.99% KILL OF BACTERIAL
SPORES.
23

25. STEAM STERILATION
- Water  Saturated  Wet vapor  Dry saturated Vapor 
Super Heated Vapor / Steam
- Steam with <0.95 Dryness Factor is not useful for
Sterilization.
- Superheated Steam acts like Dry Hot Air only . (
Strength Of Steam is its Latent Heat)
24

26. OPERATION OF POROUS LOAD STERILIZERS
The operating cycle of a porous load sterilizer normally
has five stages.
AIR REMOVAL
A.
STEAM ADMISSION
B.
HOLDING TIME
C.
DRYING
D.
AIR ADMISSION
E.
25

27. ADVANTAGES OF STEAM STERILISATION
RAPID HEATING & PENETRATION OF LOADS.
1.
DESTRUCTION OF ALL FORMS OF MICROBIAL
LIFE
2.
NO RESIDUAL TOXICITY.
3.
NO DAMAGE TO SUPPLIES BEING
STERILISED.
4.
EASY QUALITY CONTROL
5.
ECONOMICAL & RELIABLE
6.
THIS METHOD IS UNSUITABLE FOR HEAT
SENSITIVE AND NON- PERMEABLE MATERIAL
7.
26

28. MODE OF ACTION.
DRY HEAT  OXIDATION
STEAM  DENATURATION = COAGULATION OF PROTEINS
STERILIZATION TIME
(HOLDING TIME + SAFETY
TIME)
Pressure
(PSI)
Temperatur
e ( C° )
2' + 1′ = 3'
8' + 2' = 10'
12' + 3' = 15'
30
20
15
134
126
121
27

29. TYPES OF AUTO CLAVING MACHINES
Downward Displacement
1.
Vacuum Assisted.
2.
Pulsed Steam Dilution
3.
28

30. TESTS FOR EFFICENCY OF
STERILISATION
SPECIALLY TREATED PAPER STRIP.
1.
PRESSURE SENSITIVE TAPE TO BE FIXED TO THE
FINAL FOLD
2.
BROWN INDICATOR TUBES - (VERY EXPENSIVE)
3.
BIOLOGICAL. GREEN STRIP CONTAINING
BACTERIA (COLOR MUST CHANGE TO BLACK)
4.
29

31. TESTS FOR EFFICENCY OF STERILISATION
CELLOPHANE WRAPPED TABLET CONTAINING
1.
LACTOSE - 75%
2.
STARCH - 24%
3.
MAGNESIUM TRISILICATE – 1% (TABLET
TURNS BROWN DURING AUTOCLAVING)
4.
MICROBIOLOGICAL EXAMINATION OF
FINISHED PRODUCTS.
5.
THERMO - COUPLES .
6.
30

32. RADIATION STERILISATION
Dose - 2.5 Mega Rhontgen; Source – Cobalt-60
/Caesium – 137/ Electron Beam (generated by linear
accelerator)
1.
Reliable, can penetrate all types of packing. Large &
diverse shaped articles can be sterilised. No residual
radio activity at 2.5 mega rhontgens.
2.
Glass becomes dark, cotton looses tensile property,
food gets undesirable flavor. Not practicable in
hospitals
3.
31

33. STAFFING :CSSD
CENTRALISED SUPPLY (RULE OF THUMB 2 PER 100 BEDS)
SUPERVISORS (sister/male ward masters) 4
STAFF NURSES 5
TECHNICIANS (ORA) 6
ATTENDANTS 24
SWEEPER 4
CLERK 1
TOTAL 44
32

34. DISTRIBUTION SYSTEMS :
REGULAR ISSUE OF ONE DAY’S REQUIREMENT.
1.
CLEAN FOR DIRTY EXCHANGE.
2.
MILK ROUND SYSTEM (TOPPING UP
PREDETERMINED STOCK LEVEL)
3.
AS ON REQUIRED BASIS. (GROCERY SYSTEM)
4.
33

35. OPERATION OF DRY-HEAT STERILIZERS
A DRY-HEAT STERILIZER WILL TYPICALLY HAVE THE
FOLLOWING OPERATING CYCLE.
Heating-up. Hot air is heated electrically and circulated through the
chamber.
a.
The plateau period starts when the chamber temperature, recorded
by a sensor located in the part of the chamber known to be the
slowest to heat up, reaches the sterilization temperature.
b.
In the first part of this period, the equilibration time, all parts of the load
attain the sterilization temperature.
a.
The moment when the temperature in all parts of the load finally attains
the sterilization temperature marks the end of the equilibration time and
the start of the holding time.
b.
Cooling. The load is cooled by circulating cold, filtered air through
the chamber or through a jacket.
c.
34

36. SERVICE OBJECTIVES
Decontaminate to a level compatible with the intended use of
the product.
Minimize adventitious contamination through control of the
environment, personnel and materials.
Produce items that are fit for their intended purpose within the
specified life-time.
Within the constraints of the service, provide products in a
timely manner.
Ensure the location and facilities provide a high quality and
cost-effective service.
Provide adequate labelling and instructions for safe use.
Ensure the process is validated, controlled and monitored.
Hold appropriate documentation/records to demonstrate
compliance.
35

37. CSSD IS DIVIDE INTO 5 MAIN AREAS
Decontamination
Assembly and processing
Sterilization
Sterile storage and
Distribution
36

38. CSSD FUNCTIONING
37

39. CSSD LAYOUT:
SINGLE-DOOR
STERILIZER
CONFIGURATION
AND FLOW
CHART
38

40. CSSD LAYOUT:
DOUBLE-DOOR
STERILIZER
CONFIGURATION
AND FLOW
CHART
39

41. INDIVIDUAL SPACES WITHIN AN SSD
• Entrance areas
• Contaminated returns lobby
• Contaminated returns holding area
• Wash room: gowning room/area
• Wash room
• Wash room: domestic services room
• IAP gowning room
• Inspection, assembly and packing (IAP)
room
• IAP domestic services room
• Materials store
• Materials transfer room
• Packed product transfer facility
• Sterilizer loading area
• Sterilizer plant room
• Unloading/cooling area
• Processed products store
• Despatch area
• Manager’s office
• Deputy manager’s office
• Office(s): general
• Staff room
• Training room
• Staff changing/WC/shower room
• General areas: domestic services room
• General waste disposal/laundry returns
• Test equipment and data room.
40

42. 41

43. 42

44. OPERATION
THEATERS
(OR)

45. GENERAL PLANNING PRINCIPLES-OTS
THE INTERNAL LAYOUT BASED ON THE TRAFFIC FLOW WITHIN THE
DEPARTMENT
1.
A single corridor to carry patients, staff, clean and used equipment
(suitably bagged) to and from the operating theatres and out through a
separate theatre exit. OR
a.
Clean and dirty streams of traffic can be segregated.
b.
ROOMS ARRANGED IN CONTINUOUS PROGRESSION FROM THE
ENTRANCE THROUGH ZONES OF INCREASING STERILITY.
2.
STAFF WITHIN THE DEPARTMENT SHOULD BE ABLE TO MOVE FROM
ONE CLEAN AREA TO ANOTHER WITHOUT PASSING THROUGH
UNPROTECTED OR UNCLEAN AREAS.
3.
PATIENTS, STAFF AND SERVICES SHOULD ENTER THROUGH THE SAME
CONTROL POINT.
4.
AIR FOR AIR-CONDITIONING SHOULD MOVE FROM CLEANEST TO
LESS CLEAN AREAS.
5.
THE OPERATING THEATRE SHOULD BE AT POSITIVE PRESSURE IN
RELATION TO ADJACENT ROOMS.
6.
REDUCED AIR MOVEMENT – TO REDUCE AIRBORNE INFECTIONS
7. 44

46. CONSIDERATIONS AT THE INITIAL PLANNING
STAGE
Consider modular construction methods.
Infection control teams should be consulted from the
outset of any new-build or renovation project and
should remain integral planning team members
throughout.
45

47. CONSIDERATIONS AT THE INITIAL PLANNING
STAGE
Bench-top sterilizers in theatres are replaced by central
sterile service department (CSSD).
Operating departments should ensure that they have
adequate stocks of surgical instruments to overcome
issues associated with dropped instruments.
Some surgical operations necessitate exposing patients in
ways that they find distressing and embarrassing.
Protecting their dignity is therefore a critical function.
A number of measures can be taken to minimise the
invasion of privacy including the design and fitting of the
building.
46

48. CONSIDERATIONS AT THE INITIAL PLANNING
STAGE
An increasing number of patients undergo surgery
without a general anaesthetic, remaining conscious
throughout the entire procedure, and hence remain
aware of their surroundings even in the operating
theatre.
Designers should aim to create an environment that
is conducive to making patients feel at ease and
giving them confidence, thus aiding the healing
process. At the same time it should facilitate efficient
working, and contribute to staff morale.
47

49. NATURAL LIGHTING
Natural light is of particular importance to the wellbeing of
patients and staff. All surgical facilities, where possible, should
have natural daylight directly from windows, or by means of
borrowed light from windows across corridors. Lack of natural
light is one of the most common complaints made by staff about
their working environment.
Where natural light is not available through conventional means,
consideration should be given to using recently-developed
technology, which allows natural light to be ducted to internal
rooms even in multi-storey buildings.
Where possible, the following areas within the department
should have natural light:
operating theatres;
recovery unit;
staff rest room.
48

50. CAPACITY PLANNING- LATER
A separate sheet is provided to you to presents a
method of determining the number of operating
theatres that will be needed for a new, or for a
reconstructed, operating department for in-patients.
The method also provides an estimate of unused
capacity.
In the calculations, using the model of eight theatres,
it is assumed that at least one theatre will be
reserved for emergencies.
One session (half a day) per theatre each week
should be reserved for planned preventive
maintenance and cleaning. 49

51. OT ZONING
Outermost protective zone:
GENERALLY AT LEVEL OF HOSPITAL CLEANLINESS
Patient waiting,
OT reception,
Staff change rooms and toilets,
Trolley-bay,
Patient traffic area,
Cafeteria. Positive air-pressure relative to rest of hosp. maintained.
Clean zone: Higher Positive air-pressure level than outer zone.
Aseptic or sterile zone: Higher Positive air-pressure relative to
other areas so as to exclude entry of air from any other areas.
Communicate with dirty corridor or disposal area through inter-
lock hatch system.
Disposal zone: less air press than sterile zone. Instruments
temporary stored/collected before being sent for sterilization.
50

52. SITING CONSIDERATIONS
Ideally, all the operating theatres in the hospital should be
in one location with one recovery unit. This helps with
flexibility of operation, efficiency of staffing, clinical
governance and safe management of emergencies.
Operating theatre departments that admit patients for
emergency surgery should have the following services on
the hospital site as a minimum standard
• emergency care (A&E department);
• 24-hour access to imaging, including scanning;
• critical care;
• laboratory services (pathology);
• in-patient acute services; and
• orthopaedic/trauma services.
51

53. SITING CONSIDERATIONS
52

54. ANAESTHETIC ROOMS
In the UK it is common practice for each operating
theatre to have its own anaesthetic room.
It is common practice in the US, in some European
countries and Pakistan to exclude the traditional
anaesthetic room from the operating department
layout. Patients are prepared for their operation in
the operating theatre. This has been taken up in the
UK by a small number of trusts.
53

55. PREPARATION ROOMS
One preparation room for each theatre
Where the laying-up of trolleys is undertaken under
the protection of the ultra-clean ventilation canopy it
is imperative that the ultra-clean ventilation system is
operating at full duty
Under no circumstances should two or more
operating theatres share a single preparation room,
due to the potential risk of cross-infection via the
ventilation airflows.
54

56. RECOVERY UNITS OR PACU (POST
ANAESTHETIC CARE UNIT)
Most patients are transferred from the operating
theatre to the recovery unit.
This will affect the size of each space, as it should be
large enough to accommodate an adult bed with
additional space for the monitoring equipment and
to ensure immediate access for staff in case of
emergency
Provision is required for quiet dark spaces (using
adjustable lighting levels) in which patients can
recover from specific anaesthetics
The need to segregate male from female patients
should also be considered. 55

57. ACCOMMODATION IN AN EIGHT ROOM THEATER
INTEGRAL
communications base;
eight operating theatres
eight anaesthetic rooms;
patient support facilities (admissions lounge with changing
facilities, waiting area, interview room);
recovery unit with 16 bed spaces (with associated ancillary
accommodation);
staff support facilities (porters’ base, changing facilities, rest
rooms, reporting room);
storage areas (equipment, bulk store);
disposal areas (dirty utility, disposal hold, housekeeping
room).
INTEGRAL OR CO-LOCATED
education and training facilities;
anaesthetic department;
administrative offices. 56

58. FUNCTIONAL RELATIONSHIPS
57

59. TRAFFIC FLOW IN OPERATING DEPARTMENT
58

60. A LAPORSCOPY SETUP IN OT
59

61. SCRUB SINK WITH NON-TOUCH TAPS
60

62. RECOVERY AREA
61

63. THEATRE CONTROL PANEL
62

64. MEDICAL GAS AND EQUIPMENT
63
12 socket-outlets and
connection to the UPS/IPS
systems
PAS theatre record system
networked to hospital
mainframe;
1 oxygen outlet;
1 nitrous oxide outlet;
1 medical air outlet;
1 surgical air outlet;
2 medical vacuum points;
anaesthetic gas
scavenging points.
anaesthetic machine
located on anaesthetic
medical supply unit only;
flat-screen monitor and
recording system for
patient records;
2 infusion pumps;
3 syringe pumps;
blood warmer;
feeding pump

65. CEILING MOUNTED PENDANTS
64

66. MEDICAL GAS OUTLETS
65

67. DOORS WITHIN THE OPERATING SUITE
66
Doors through which beds or trolleys
will pass should be wide enough to
allow easy passage with attachments,
including sterile drapes. It should be
possible for them to stand in the open
position. All doors should be fitted with
vision panels capable of being obscured,
and have laser-proof blinds. All doors
should close quietly

68. EXIT BAY
67

69. STAFF ACCOMMODATION
THEATRE STAFF WORK IN STRESSFUL SITUATIONS EVERY
DAY. THE PROVISION OF WELL-DESIGNED FACILITIES WILL
BE A MORALE BOASTER.
THERE ARE FIVE MAIN CATEGORIES OF STAFF FACILITIES,
ALL OF WHICH SHOULD BE DESIGNATED CLEARLY AS NON-
CLINICAL AREAS:
rest facilities;
changing rooms and associated facilities;
office accommodation;
facilities for education and training;
storage.
AREAS 1 AND 2 SHOULD BE LOCATED WITHIN THE
OPERATING DEPARTMENT.
68

70. STORAGE ROOM FOR SUPPLIES AND EQUIPMENT
69

71. CEILING
A minimum clear height of 3000 mm between the finished
floor level and ceiling is required to allow unrestricted
adjustment of the operating luminaire and other ceiling-
mounted equipment.
The building structure should be capable of supporting the
loads generated when the ceiling mounted medical supply
unit is installed.
Modular ceilings are not acceptable in the operating theatre.
The ceiling in the operating theatre should also be able to
withstand an occasional wash and have a completely sealed
finish to maintain microbiological standards.
70

72. FLOOR
CARPETS ARE NOT ACCEPTABLE ANYWHERE IN AN OPERATING
DEPARTMENT. FLOORS SHOULD BE ABLE TO WITHSTAND HARSH
TREATMENT, INCLUDING:
the rolling loads of heavy mobile equipment;
frequent spillages with subsequent “mopping-up”; and
regular hard cleaning.
FLOORING SHOULD ALSO HAVE THE FOLLOWING
characteristics:
hygienic finishes;
slip-resistant;
continuous;
smooth;
impervious;
sealed joints;
easily cleanable;
wear-resistant 71

73. VENTILATION STRATEGY
72
THE VENTILATION SYSTEM IN THE OPERATING THEATRE SUITE HAS
FOUR MAIN FUNCTIONS:
• DILUTION OF BACTERIAL CONTAMINATION;
• CONTROL OF AIR MOVEMENT WITHIN THE THEATRE SUITE SUCH
THAT THE TRANSFER OF AIRBORNE BACTERIA FROM LESS CLEAN TO
CLEANER AREAS IS MINIMIZED;
• CONTROL OF SPACE TEMPERATURE AND HUMIDITY;
• TO ASSIST IN THE REMOVAL AND DILUTION OF WASTE
ANAESTHETIC GASES.
ROOM PRESSURE TO
Preparation room Positive Theater
Theater Positive excluding
i
Anesthetist room Positive Corridor
Disposal Negative Corridor
Corridors Neutral

74. AIR HANDLING UNIT
73

75. OT LAYOUT
74

76. INTENSIVE
CARE UNIT
(ICU)

77. ICU INTRODUCTION
The intensive care unit is for critically ill patients who need
constant medical attention and highly specialized equipment, to
control bleeding, to support breathing, to control toxaemia and
to prevent shock. They come either from the recovery room of
the operating theatre, from wards or from the admitting Section
of the hospital.
This unit requires many engineering services, in the form of
controlled environment, medical gases, compressed air and
power sources. As these requirements are very similar to those
in the operating department, it is advisable to locate the
intensive care unit adjacent to the recovery room of, the
operating department. If engineering provisions are to be
centralized for economy, the recovery room and the intensive
care unit should be on either side of the support area.
76

78. SHOULD EVERY HOSPITAL HAVE ICU?
The number of beds in ICU should correspond to approximately 1-2% of
the total beds in the hospital. In small hospital of 50-100 beds, this
would mean only one or two beds.
This number would not warrant the provision of an intensive care unit.
Such a unit should contain no fewer than six beds in order to justify the
highly sophisticated equipment and highly specialized manpower
involved.
If so what alternatives to considered?
A patient who requires long-term intensive care should be referred to a
higher-level hospital.
Intensive care beds can be provided within the recovery room of the
operating department.
Patients who are highly dependent on nursing can be given beds or
rooms very close to the nurses' station in the ward, sustained with a
portable oxygen tank and monitoring equipment.
77

79. DEPARTMENTAL RELATIONSHIPS
78

80. FUNCTIONAL RELATIONSHIPS
79

81. ENTRANCE
80

82. 81

83. 82

84. 83

85. 84

86. 85

87. BED SPACE LAY OUT PLAN
86

88. THANKS
HEAPS!
Talal Albudayri
https://t.me/tolioCSSD