Healthcare Radius December 2017

WPP license no. MR/TECH/WPP-76/North/2017 License to post without prepayment Postal Registration No. MCN/242/2015-2017.

Published on 27th of every previous month. Posting date: 30th & 31st of every previous month. Posted at Patrika Channel Sorting Office, Mumbai-400001. Registered with Registrar of Newspapers under RNI No. MAHENG/2012/46040.

Aligning business and healthcare in India

INFRASTRUCTURE

December 2017 Vol 6 • Issue 3 • `50

PROJECT

• PREVENTING HAI • FIRE SAFETY MEASURES

SAHYADRI SUPER SPECIALTY HOSPITAL, HADAPSAR

BEST PRACTICES

HOW 3-D MODELLING, ADVANCED FIRE SAFETY GUIDELINES AND LATEST INFECTION CONTROL PRACTICES ARE SHAPING THE HEALTHCARE INDUSTRY

Published by ITP Media (India)

Total number of pages 54

Contents 16

44 BULLETIN 10 This month's important news updates.

PROJECT 16 The upcoming Sahyadri Super

22

Specialty Hospital at Hadapsar brings some of the features for the first time in Pune.

INFRASTRUCTURE SPECIAL 22 From following hand hygiene to having antibiotic stewardship, hospitals are following a slew of steps to control HAI.

34 The motive of fire protection systems is to ensure life safety, equipment/ property protection.

34

40 Healthcare facilities building design is complex and thus stands to gain immensely from BIM practices.

COMMENT 44 In the services industry, expectation mismatch is the norm and its prudent management a veritable art.

DIAGNOSTICS 48 Digital pathology breaks down

40 4

DECEMBER 2017 | HEALTHCARE RADIUS

geographical barriers and brings together experts via the virtual world.

Schiller’s Offerings in Imaging & Neurosurgery

ROSA BRAIN & ROSA SPINE TM

TM

Robotic Surgical Assistant

CereTom® 8 Slice Portable Head & Neck CT Scanner

Radius XP (CCD & Flat Panel)

BodyTom®

Mobile Lab for Neurosurgery Mobile Lab for Interventional Cardiology

32 Slice Portable Whole Body CT Scanner

For enquiries contact : sales@schillerindia.com | Website : www.schillerindia.com | Toll-Free No. : 1-800-2098998 Swiss H.Q.: Schiller AG, Altgasse 68, P. O. Box 1052, CH - 6341 Baar, Switzerland, Indian Corporate Office: Schiller Healthcare India Pvt Ltd., Advance House, Makwana Rd, Off. Andheri Kurla Road, Marol Naka Metro Station, Andheri (East), Mumbai - 400 059.

Tel.: + 91- 9833123910, +91-22 61523333/29209141 | Fax: +91-22-29209142 E-mail: sudipbagchi@schillerindia.com, sales@schillerindia.com, support@schillerindia.com Factory : No. 17, Balaji Nagar, Puducherry 605010 CIN : U33110MH1997PTC111307

All registered trademarks acknowledged

EDITOR'S NOTE

DECEMBER 2017 • VOL 6 • ISSUE 3

Infra talk

ITP MEDIA (INDIA) PVT. LTD

T

Bandra (West), Mumbai – 400050. India

he Indian healthcare delivery system faces severe shortage of beds and would need to add 3.6 million beds by the next 20 years.

With multiple hospitals being planned to serve the demand supply gap, the endeavour is to explore new methods that would ensure high-quality but costeffective and time-bound projects. Using Building Information Modelling (BIM)- based approach is one such step to streamline hospital projects by reducing wastage of talent, time and money and providing optimisation of the design process.

BIM has been made mandatory in many countries for all major projects. In the UK all centrally-procured construction projects are required to achieve BIM level. And in Germany, 90% of all project owners often or always demand BIM. Besides BIM, the complexity of hospital building is also understood when one wants to implement fire safety regulations. Hospital as an institution is more prone to fire because of the use of several heatdissipating equipment, combustible gases, the need for a lot of electrical and other factors. Read about the advanced technologies used by hospitals for fire safety plan aimed at saving lives and protection of equipment and property.

The special also highlights another alarming situation inside the hospital, where India has an abysmal score. Find out how hospitals are using strategies like hand hygiene, antibiotic stewardship, safe infusion policy, disinfectants and others to combat the menace of HAI, which varies from 11% to 83% for different kinds. Surely more rigorous training and implementation is required to contain this.

Rita Dutta Editor rita.dutta@itp.com

Notan Plaza, 3rd floor, 898 Turner Road

T +91 22 6154 6000

Deputy managing director: S Saikumar Group publishing director: Bibhor Srivastava

Editorial Editor: Rita Dutta T +91 9980 588199 rita.dutta@itp.com

ADVERTISING Director: Sanjay Bhan T +91 9845 722377 sanjay.bhan@itp.com Business head: Tushar Kanchan T + 91 9821 459592 tushar.kanchan@itp.com

STUDIO Head of design: Milind Patil Senior designer: Vinod Shinde Contributor: Sanjay Bandre

PRODUCTION Deputy production manager: Ramesh Kumar

CIRCULATION Distribution manager: James D’Souza T +91 22 6154 6006 james.dsouza@itp.com

The publishers regret that they cannot accept liability for error or omissions contained in this publication, however caused. The opinions and views contained in this publication are not necessarily those of the publishers. Readers are advised to seek specialist advice before acting on information contained in this publication, which is provided for general use and may not be appropriate for the readers’ particular circumstances. The ownership of trademarks is acknowledged. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing. An exemption is hereby granted for extracts used for the purpose of fair review.

Printed and Published by Sai Kumar Shanmugam, Flat no 903, Building 47, NRI Colony, Phase – 2, Part -1, Sector 54, 56, 58, Nerul, Navi Mumbai 400706, on behalf of ITP Media (India) Pvt. Ltd, printed at Indigo Press India Pvt. Ltd., Plot No. 1C / 716, Off Dadoji Konddeo Cross Road, Between Sussex and Retiwala Ind. Estate, Byculla (East), Mumbai-400 027, India and published at ITP Media (India) Pvt. Ltd, Notan Plaza, 3rd floor, 898 Turner Road, Bandra (West), Mumbai – 400050. India

Editor: Rita Dutta

WRITE TO THE EDITOR Please address your letters to: The Editor, Healthcare Radius, Notan Plaza Third Floor, 898 Turner Road, Bandra West, Mumbai - 400050. India or email rita.dutta@itp.com. Please provide your full name and address, stating clearly if you do not wish us to print them.

6

DECEMBER 2017 | HEALTHCARE RADIUS

Published by and © 2017 ITP Media (India) Pvt. Ltd Title verification no.

RNI No: MAHENG/2012/46040

A DV I S OR Y B O A R D OUR EDITORIAL BOARD HOLDS UP A MIRROR TO THE HEALTHCARE INDUSTRY, HELPING US UNDERSCORE THE KEY TRENDS AND DEVELOPMENTS OF THE INDUSTRY

DR ALOK ROY DR NAROTTAM PURI (HONY) BRIGADIER Chairman, Medica Advisor, Fortis Healthcare DR ARVIND LAL Chairman and managing Synergie director, Dr Lal PathLabs

DR PRANEET KUMAR Healthcare Consultant

DR GIRDHAR J GYANI Director general, Association of Healthcare Providers

DR RAVINDRA KARANJEKAR CEO, Jupiter Hospitals

DR G BAKTHAVATHSALAM DR MK KHANDUJA

Chairman, KG Hospital & Post Graduate Medical Institute

Chairman, BSR Healthcare

Subscription form

DR GUSTAD B DAVER Medical director, Sir HN Hospital

BRIGADIER JOE CURIAN Healthcare Consultant

DR DURU SHAH Director, Gynaecworld

DR NC BORAH Chairman, GNRC

SANDEEP SINHA Director, South Asia and Middle East, Healthcare & Life Sciences, Frost & Sullivan

DR SANJEEV SINGH Medical superintendent, Amrita Institute of Medical Science

Duration

You Pay

1 year (12 issues)

Rs1000/-

Please use BOLD / CAPITAL LETTERS ONLY Mr/Ms: _______________________________________________________________________________________________ (First name) (Middle name) (Last name) Designation ____________________________________________________________________________________________ Company ______________________________________________________________________________________________ Address1 ______________________________________________________________________________________________ Address2 ______________________________________________________________________________________________ Address3 ______________________________________________________________________________________________ City: ___________________________________Pin code: __________________State: ________________________________ Tel: ______________________________Fax: ______________________Mobile:_____________________________________ Email: _________________________________________________________________________________________________ Cheque/DD No. _____________________ Dated______________ Favouring ITP Media (India) Pvt. Ltd Drawn on __________________________________________________________________________________________Bank Please use bold & capital letters only l The mode of payment should be cheque/demand draft favouring ‘ITP Media (India) Pvt. Ltd’ Please write your name and address on the back of the cheque/demand draft l Orders once placed will not be terminated or transferred l Please allow a minimum of 4 weeks to process the order.

Subscribe to HEALTHCARE RADIUS by completing the form and sending it to: Subscription Department ITP Media (India) Pvt. Ltd, Turner Road, 898 Notan Plaza, 3rd Floor, Bandra (W), Mumbai-400 050.

For further queries write to: james.dsouza@itp.com | Tel:+91 22 6154 6006/6000 l l

8

DECEMBER 2017 | HEALTHCARE RADIUS

BULLETIN

Hinduja Hospital recognised as ‘Healthy Workplace’

Gautam Khanna receiving the award.

Mumbai’s PD Hinduja Hospital & Medical Research Centre has become one of 12 leading companies in India named by Arogya World as a 2017 Platinum Healthy Workplace, in recognition of its considerable efforts to quantitatively track employee health. This is the sec-

Siemens Healthineers completes Epocal acquisition Siemens Healthineers has completed the acquisition of Epocal Inc. from Abbott to complete its blood gas portfolio. The closing of the deal occurred October 31, 2017. In integrating Epocal Inc.’s offerings into its POC Ecosystem solution, Siemens Healthineers enables customised testing offerings based on individual facility needs— whether that is hand held testing, benchtop solutions or central lab applications—to help improve process efficiency.

"Health networks have varying needs for blood gas testing across physicians’ offices, clinics, emergency departments, laboratories and even in ambulances.

Having any one solution is limiting and may not meet all patient needs, which is why customised testing solutions are so important,” said Peter Koerte, President, Point of Care Diagnostics, Siemens Healthineers.

10

DECEMBER 2017 | HEALTHCARE RADIUS

ond time that the hospital has been chosen as healthy workplace. The first time the hospital won the award in the Gold category. The award was received by Gautam Khanna, CEO, PD Hinduja Hospital & MRC. Arogya World is a US-based global health non-profit working to prevent non-communicable diseases (NCDs) through health education and lifestyle changes. In India, the organisation has implemented diabetes prevention programmes in schools, workplaces and the community. The Arogya Healthy Workplace Initiative is a key programme to motivate companies in India to invest in workplace wellness through pioneering awards.

Receiving the award Gautam Khanna said, “We have initiated various programmes to maintain a healthy work environment and achieve work life balance and are happy to know that our endeavour to make PD Hinduja Hospital a healthy place to work has been duly acknowledged.”

Dr Geeta Bharadwaj, Head of Healthy Workplace programme, Arogya World India Trust, said, “By initiating a culture of metrics, these Platinum companies have made a great start. We commend them for their remarkable commitment to improving the health of their employees and communities.”

Bristol-Myers Squibb & Syngene International expand collaboration Syngene International, India’s largest contract research organisation, announced that it has expanded its ongoing collaboration with BristolMyers Squibb. The next phase of the partnership will see the addition of a new facility to support future Bristol-Myers Squibb research and development operations, an expansion of the team and the extension of the existing agreement through 2026.

The expansion will enable the two companies to undertake a greater range of scientific research and development for pharmaceuticals across a broader range of activities.

Syngene and Bristol-Myers Squibb have worked together since 1998. The research campus was established in 2007, and subsequently renewed through 2020 and now has been further extended through 2026.

PAS S I O N F O R LI F E

PAS S I O N F O R LI F E

BULLETIN

Carestream to unveil its new mobile X-ray system Carestream Health will unveil its new CARESTREAM DRX-Revolution Nano Mobile X-ray system at the upcoming Radiological Society of North America tradeshow. This system uses carbon nanotube technology to deliver significantly reduced size and weight when compared to existing mobile X-ray systems. It is scheduled for availability in 2018 and currently is not available for sale.

“We are showcasing our commitment to continued technological advances by demonstrating a new generation of mobile X-ray systems with carbon nanotube technology that offers important productivity and ergonomic advantages,” said Jianqing Bennett, Carestream’s President of Digital Medical Solutions.

The DRX-Revolution Nano system is a lighter weight, non-motorised system that is easier to move and position even in cramped critical care areas. The new system includes fully integrated digital workflow, carbon nanotube technology and an advanced lithium iron phosphate battery that contributes to longer life, a sleek design with enhanced visibility both over and around the system, a compact footprint and total weight of

CARESTREAM DRX-Revolution Nano Mobile X-ray System

about 200 pounds that make it easy to maneuver and position in tight spaces; and support for all Carestream DRX detectors.

New standard for ICUs across India The Association of Healthcare Providers- India (AHPI), in association with Bureau Veritas, introduced a new standard known as ‘ResCCU - Responsible Critical Care Units’ at PD Hinduja Hospital, Mahim. The new standard was co-developed by awareness and knowledge partner Cipla. This initiative was launched with the aim of amplifying the number of safety and infection control measures undertaken by hospitals in their respective ICU departments.

Chief Guest, Dr Deepak Sawant, Hon. Minister of Health & Family Affairs, Govt Of Maharashtra, said, “The Indian critical care industry is in dire need of uniformity, not just in infection control but also in providing quality care. Further, it is important to note that these new standards need to be implemented not just in private hospitals, but also in government hospitals, for which I will do my very best to implement. ” Joy Chakraborty, COO, PD Hinduja Hospital & MRC said “The initiative and the newly launched ResCCU standard will act as a benchmark for hospitals to compare themselves against and to improve their infection control measures in an effective manner.”

Clove Dental launches ‘Platinum Dental Membership Plan’ Clove Dental, the largest dental chain in India promoted by Star Dental Centre Pvt Ltd, has launched the first of its kind ‘Platinum Dental Membership Plan’, pan India. Platinum Dental Membership Plan is a complete annual dental health plan for the entire family that includes a complementary oral care kit, with required toothpaste, brushes, mouthwash, floss, etc., delivered to the doorstep every few months. Members get Clove vouchers up to Rs 5,000 for any treatment in Clove clinics. Also included are many preventive treatments at no cost and discounts on all other treatments.

Platinum Dental Membership Plan are offered to individuals, couples and families of four.

HEALTHCARE RADIUS | DECEMBER 2017

15

PROJECT

Design for comfort The upcoming Sahyadri Super Specialty Hospital at Hadapsar has been thoughtfully planned, focussing on patient well-being

BY TEAM HR

P 1. The hospital is spread over one lakh square feet.

16

une’s Sahyadri Hospitals is slated to commission a 137-bed Greenfield hospital at Hadapsar in Pune in the month of December.

The hospital, known as Sahyadri Super Specialty Hospital, will be the group’s eigth hospital in the state of Maharashtra. The hospital would offer excellence in oncology care right from chemotherapy, surgical oncology to radiation oncology; excellence in surgical care - neurosurgery, general surgery, orthopaedics, urology, ophthalmology, ENT and excellence in medical services such as gastroentrology, internal medicine, obstetrics and gynaecology, paediatrics and neurology.

The hospital, designed by Architects United, has been thoughtfully planned after detailed analysis and would be introduc-

DECEMBER 2017 | HEALTHCARE RADIUS

ing some of the features for the first time in Pune as well as ushering global standards.

Says Madhur Varma, Group CEO, Sahyadri Hospitals, “The designing and layout planning was done along with the hospital’s operations team after doing a need gap analysis of Pune’s healthcare scenario.

The overall aim was to make the design of hospital both welcoming and patient-driven without compromising on quality.” He added that patient care is not just about patient anymore- it’s about their families as well.

“That is why we have introduced many firsts in Pune for patients' families. It’s planned and made to be a facility that will be valued for its thoughtfulness,” he said.

The hospital will serve its surrounding residential areas such Magarpatta City, Amanora Township and densely populated areas of

PROJECT

2

1 Hadapsar, Kharadi and Wagholi. It will also cater to the commercial areas that make an important component of this neighbourhood. The hospital is located on the highway, providing an easy access to the patients from other towns, cities and states.

Design of various areas Lobby: Says Sachin Mujumdar, Partner, Architects United, "The entrance lobby is vast, decorated with simplicity in the shades of white and beige, and accentuated with stripes of blue to bring in positivity. " The corridors are designed to be broad to ensure easy movement. It offers enough space for wheelchairs to pass easily while not restricting movement of other people. It is also well lit and ventilated, setting the tone for a comforting experience.

OPD waiting area: The OPD is the first point of contact between a hospital and the patients. “The key to operational efficiency in the OPD is efficient patient flow. Hence the procedure room, lab, cardiac and neuro diagnostics are planned on the same floor.

The units are arranged in a manner that facilitates coordination of various procedures,” says Majumdar. This results in two fold benefits. Firstly, the patients need not waste time waiting. Secondly, the personnel can handle large number of cases with ease and efficiency.

Two entire floors are dedicated for the OPD with a huge waiting area. Space is an important ingredient in ensuring a great experience for patients and their families. Also, even while waiting, patients expect to be kept engaged and welcomed. "Hence we’ve made space for various interactive patient education, information dissemination points in the OPD area," says Varma. And taking care of kids has been made easy with a kids play area. A self-help kiosk for OPD is also part of the future plans.

Diagnostic wing: Being located on the ground floor of the hospital, the diagnostic wing gives easy access to walk-in patients as well as patients from the emergency room.

Complying to all technical and legal requirements, the diagnostic area includes MRI, PET CT, USG, X-ray and Mammography.

The design of the department meets several seemingly divergent needs. Firstly, it serves to accommodate large, heavy, noisy technical medical equipment with extensive infrastructure and shielding requirements.

Madhur Varma, Group CEO, Sahyadri Hospitals

Sachin Mujumdar, Partner, Architects United

2. The entrance lobby is vast, decorated with simplicity in the shades of white and beige, and accentuated with stripes of blue to bring in positivity.

HEALTHCARE RADIUS | DECEMBER 2017

17

PROJECT

3

4

3. Two entire floors are dedicated for the out patient department with a huge waiting area.

4. The diagnostic wing gives easy access to walk-in patients and from emergency room.

18

Secondly, it creates a safe, pleasant and efficient staff work environment. Thirdly, it ensures comfort to patients who are likely to be anxious or uncomfortable.

Consultation room: The consultation rooms have been designed, considering multiple aspects like ensuring proper space for doctor-patient interaction, complete privacy while physical examination, and enough space for movement of wheel chairs and stretchers. Keeping with the overall scheme of colours, the consultation rooms are also white, grey and blue to bring in positivity.

Types of rooms: For clinicians and nurses, the in-patient room is a workspace that has procedural environment. For patients, it’s a recovery place, bedroom and dining room.

And for family members, it’s a living room.

DECEMBER 2017 | HEALTHCARE RADIUS

“The aim was to design patient rooms that encourage healing, provides modern conveniences, give patients a quiet respite and the hospital staff convenience to deliver proper care,” says Varma.

The inpatient rooms offer options of general ward, semi private rooms, private rooms and suite room. There is a separate day care unit and LDR. The rooms are equipped for larger family groups, overnight stays or beyond basic levels of self-sufficiency.

The ICU wing: The hospital has 36- bed ICU with four isolation rooms. The glass panels on two sides ensure an abundance of natural light and the yellow interior gives a soothing feel to the serious area of the hospital. From bed side nurse workstations, counselling rooms ensuring privacy to lounge for attendants of ICU patients, every element has been well thought through to ensure efficiency and comfort.

NICU: Instead of drab colours, the NICU is painted in vibrant tones of blue. The walls and ceiling come with comic art work. The wing has special waiting area and accommodations for parents.

Attendant Lounge: "A hospital not only has to treat the patients but also take care of their family. Sahyadri Hospital has, therefore, created a lounge for the attendants of ICU patients," says Varma. The lounge is equipped with recliners, storage area and refreshment facilities. The lounge overlooks the mountains ranges and the lush greenery outside gives a spectacular view to the occupants.

The OTs: There are five well spaced out, state-of-the-art operating rooms. "Medical needs and modes of treatment will continue to change. Therefore, operation rooms are designed on modular concepts of space planning and layout, and are open-ended, with well-planned directions for future expansion," says Majumdar.

Cafeteria: The cafeteria would be serving patients, visitors and staff. It will offer a wide selection of healthy meal choices, desserts, snacks and beverages.

PROJECT

PROJECT DETAILS Name of the project: Sahyadri Super Specialty Hospital Approx cost of the project: Rs 70 crore Total bed strength: 137 Operational bed strength: 137 Duration of the project: 1 year, 5 months Date of commissioning of the project: December 2017 In built area: Aprrox 1 lakh square feet False Ceiling/Roofing with name of vendor: Saint Gobain Use of drywalls with name of vendor: Saint Gobain Paints with name of vendor: Asian Paints Architect: Architect United Interior designer: Architect United RCC Consultant: G A Bhilare Consultant Pvt. Ltd Electrical Consultant: Vidyutsallagar Pvt. Ltd Vendor(s) for HVAC system: Pentagon EL-Mech Sol. Pvt Ltd (Chilled Water System) b) Airmax (VRF System) Vendor for sanitary fittings: Jaquar Vendor for furniture: Space Solutions

5

6

5. The NICU is painted in vibrant tones of blue.

6. The design of patient rooms encourages healing, provides modern conveniences, and gives patients a quiet respite.

20

Flooring based on function It is important to choose a floor that performs well in all healthcare applications.

At the same time, it contributes greatly to the moods that can be influenced. In every area, the hospital has chosen shades to go along with the function of that space. For instance, in the entrance lobby, it has used beige shaded tiles to bring in coziness and comfort. The floor around the help desks is a warm brown, whereas the rooms have lightcoloured clean and clear tiles.

“From smooth and effortless wheelchair movement to handling the high footfall area, granite and vinyl flooring has been thoughtfully used in combination everywhere. The selection was based on the performance which should hold up for many years and ease of maintenance,” says Varma.

DECEMBER 2017 | HEALTHCARE RADIUS

Nature-themed paintings The large corridor walls and rooms are beautifully decorated with back-lit paintings. The theme of the painting across the hospital building used is ‘nature’. “Sub-consciously, nature keeps radiating positivity and we intend that keeps touching everyone, including the team, the doctors, the patients, and their families alike,” says Varma. Floor wise, various elements of nature have been selected with a description about the painting.

Colours ooze warmth The colour scheme in the various areas was well thought out- right from the external colours that ooze out warmth and yet reflect being contemporary to do justice to the occupation and relate to the audiences as well.

Maximum white in the entrance lobby brings in transparency, while the grey stripes make it comforting. The blue highlights lend itself to give a unlike hospital feeling. The helpdesks are done in deep browns to render the feeling of comfort and convenience.

A dash of nature in different forms everywhere has been used to bring in the natural colours.

INFRASTRUCTURE SPECIAL

Preventing HAI

1

From following hand hygiene to having antibiotic stewardship, hospitals are following a slew of steps to control HAI

BY RITA DUTTA

A

1. Hospitals should have a stringent antibiotic policy.

22

patient with fever and with an oozing pus at a wound visits the treating surgeon seven days post-surgery. A doctor in the ICU noticed patient under mechanical ventilator having high WBC count, brownish colour sputum and cloudy patches in chest X-Ray. These are examples of hospital acquired infections (HAI), infections which are acquired by patient when admitted for a reason other than that infection. For a HAI, the infection must occur in any of these conditions: up to 48 hours after hospital admission, up to three days after discharge, up to 30 days after an operation.

The WHO estimates about 7-12% HAI burden in hospitalised patients globally, and the figures from India are alarming, with an incidence rate varying from 11% to 83% for different kinds of HAIs. Most common type of nosocomial infections in India are catheter- associated urinary tract infections (CAUTI), ventilator-associated pneumonia/ events (VAP), central line-associated blood stream infections (CABSI) and surgical site

DECEMBER 2017 | HEALTHCARE RADIUS

infections (SSI). CAUTI is the most frequent (accounting for about 35 % of HAI) but carry the lowest death and lowest cost. SSI is second in frequency (about 20 %) and third in cost. CABSI and VAP are less common (about 15% each) but are associated with much higher death and costs. Moreover, Clostridium difficile diarrhoea due to misuse and overuse of antibiotics are also seen.

The high incidence of HAI is primarily because of lack of awareness and training among healthcare professionals. Says Dr Malathi A, Group Chief Quality Officer & Chief Medical Officer – GCG, Aster DM Healthcare, “Most healthcare associated infections are caused due to poor adherence to infection control practices like hand hygiene and use of outdated practices. For instance, fumigation is not an acceptable standard but used in many parts of India still. Also, there is poor adherence to bundle check lists required to prevent CAUTI and SSI.” Many rural hospitals do not have adequate staff and facilities to follow the best practices of infection control. Understaffed

INFRASTRUCTURE SPECIAL

HAND HYGIENE BY WHO World Health Organization's five moments for hand hygiene are: • Before touching a patient • Before aseptic procedures • After body fluid exposure • After touching the patient • After touching the patient's surrounding

healthcare professionals do not have time to wash their hands as patients’ other needs take priority. Moreover, government hospitals do not provide adequate hand rubs to practice hand hygiene.

Many hospitals in India do not get the necessary financial or administrative support required for implementation of rigid infection control programme. Says Dr Ranjeeta Adhikary, Infection Control Officer, Manipal Hospital, Bengaluru, "Many hospitals do not monitor their nosocomial infections. There is no microbiologists / infection control officer and a trained infection control nurse to do the surveillance of nosocomial infections."

Adds Dr Mustafa Afzal, Consultant Microbiologist and Infectious Diseases, CARE Hospitals, Nampally, Hyderabad, “There is no proper surveillance system, analysis and interpretation of nosocomial infections in India and thus there is no proper reporting and no national data available. In most hospitals, there is no separate department to take care of infection control issues. In the west, there are separate departments and one infection control nurse per 200 beds as per the regulation and they have to report their infection control data to the regulatory bodies.”

Government hospitals do not have funding for supporting and implementation of infection control programmes. Extremely low nurse to patient ratio is also another major concern leading to hospital overcrowding, cross infections in hospitals.

Medical student is never exposed to con-

2 cepts of infection control. The training happens much later- leading to poor knowledge about antibiotic stewardship and infection control practices amongst healthcare professionals. Moreover, injudicious use of antibiotics leads to infections by multidrug resistant bugs.

T

he last decade has seen a sea-change in infection control practices in India. Healthcare providers, nursing staff, hospitals are more sensitised towards the concepts of infection control. There are institutes that offer certificate training to nurses in infection control. This leads to greater awareness and sensitisation of nursing staff towards infection control.

"With increasing awareness and accreditation processes, nosocomial infection prevention has started in rural areas,” says Dr Adhikary.

The government of India has issued a strict advisory to curb the overuse, misuse and overuse of antibiotics and has advised each hospital to have an antibiotic stewardship programme. "So, the evolution of infection control has started a decade ago with the above changes and we expect that we would be evolved and more equipped with infection control standards in the years to come," says Dr Malathi.

Below are some of the practices followed by leading private hospitals to prevent HAI:

Dr Malathi A, Group Chief Quality Officer & Chief Medical Officer – GCG, Aster DM Healthcare

Dr Ranjeeta Adhikary, Infection Control Officer, Manipal Hospital, Bengaluru

2. Hands are the most common modes for transmission of organisms.

HEALTHCARE RADIUS | DECEMBER 2017

23

INFRASTRUCTURE SPECIAL

ASTER DM HEALTHCARE Steps taken to prevent HAI include: • There is a structured infection control team reporting to department of quality. The standards are laid out by the quality head and implemented by the infection control team.

Each hospital has a team consisting of representation from management, quality head, infection control officer- either a specialist or microbiologist, Infection control nurse- officer and link nurses.

• There is budget reserved for strict implementation of practices. The guidelines and standards laid down are as per standards set globally with modifications made to suit the local hospital environment.

• A strict antibiotic stewardship programme is followed.

• Training in the form of weekly training, CME programmes of doctors- including medical officers and residents help to sensitise healthcare providers and support staff towards safe infection control practices.

• There is practical training given to house-keeping staff to establish adequate disinfection before accepting patients.

• Availability of resources- Adequate number of hand –rubs/ disinfectants/ good CSSD facility- availability of plasma-sterilizers, isolation gowns/ N95 masks/ negative pressure rooms (a total at Aster CMI: 7 negative pressure isolation rooms). This helps in appropriate cohorting of patients.

• Patient education leaflets are available to also help visitors and patients to understand about prevention of infections.

• Ongoing audits done by the infection control team at local level help in improvising the practices.

• It has interim meetings between the CMS and treating surgical teams – when there has been an increase in the number of surgical site infections to understand the core concerns.

Design stage: One should incorporate HAI prevention in hospital design stage with infection prevention norms like airconditioning, isolation rooms, provision of water based hand wash in clinical area. Says Deepak Agarkhed, General Manager-clinical engineering and quality, Sakra World Hospital, "One should plan the hospital design with waste transportation that does not mix with clean material like chute system, dedicated lifts for clean and dirty material movement."

Hand hygiene: Hands are the most common modes for transmission of organisms.

“Hand hygiene is the single and simplest method of preventing the transmission of infections among patients,” says Dr Adhikary. All healthcare professionals should

24

DECEMBER 2017 | HEALTHCARE RADIUS

be trained to wash hands with soap and water when they are soiled or visibly dirty with blood or other body fluids. Otherwise, they should be advised to use an alcoholbased hand rub like 0.5% chlorhexidine with 70% w/v ethanol, if hands are not visibly dirty.

A combination of chlorhexidine and alcohol is ideal as they cover Gram-positive and Gram-negative organisms, viruses, mycobacteria and fungi. Chlorhexidine also has residual activity. Hand rub should be made available at the patient’s bedside for easy accessibility.

Isolation of infected patients: All infected patients should be isolated. “Healthcare professionals should wear appropriate personal protective equipment for caring these patients,” says Dr Adhikary.

Using disinfectants: Microorganisms are known to survive for prolonged period on inanimate objects in the vicinity of the patient. Therefore, cleaning and disinfecting horizontal surfaces and equipment should be done thoroughly with hospital approved disinfectant in each shift.

Antibiotic stewardship: Antimicrobial stewardship is a co-ordinated programme that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms. “A strict antibiotic stewardship programme is mandatory to avoid the development of multidrug resistant organisms in the hospital,” says Dr Malathi.

Nurse to staff ratio: The nurse- staff ratio in ICU is by far acceptable worldwide is 1:1 for ventilated patients in MICU/ SICU and Transplant ICU. 1: 3 in non ventilated patient. In wards, it is 1: 5 patients ( at times of high occupancy) which is as per standards.

This helps to reduce cross infection.

Vaccination: Vaccinating hospital staff is mandatory to build resistance to HAI and vaccinating soon after person gets needle stick injury.

BEST PROFESSIONALS

WITHIN 72 HO UR S OF MANDATE RECEIVING *T&C APPLY

*

INFRASTRUCTURE SPECIAL

Burden of various healthcare associated infections in different parts of India.

Deepak Agarkhed, General Managerclinical engineering and quality, Sakra World Hospital

Author (Reference no)

Period of study

Place of study

HAI incidence (%)

VAP*

CA-UTI*

CR-BSI*

Habibi s et al., [3]

2004-2005

New Delhi

34.1

31.4

11.2

3.4

Joseph NM et al., [5]

2006-2007

Puducherry

NA

30.6

NA

NA

Datta P et al., [6]

2010-2011

Chandigarh

29.1

6.0

9.08

13.8

Singh S et al., [7]

2009-2010

Pune

17.6

32

9

16

Mathai AS et al., [10]

2010-2011

Vellore

NA

40.1

NA

NA

Current study

2011-2013

Puducherry

50.2

72.5

12.4

3.9

Source :J ClinDiagn Res. 2017 Jan; 11(1): OC01–OC04.

Mustafa Afzal, Consultant, Microbiologist and Infectious Diseases, CARE Hospitals, Nampally

Audits: Infection control audits should be regularly conducted to monitor the practice of infection control protocols.

Safe infusion policy: This includes aseptic technique at all times like timely replacement of peripheral lines.

Biomedical waste management: Hospitals should follow biomedical waste management policy for proper segregation, transportation of hospital waste like anatomical waste, gloves, sharp items, etc.

Training: All healthcare professionals

should be sensitised about nosocomial infections and prevention protocols at the time of induction. Thereafter, they should be trained at regular interval. Regular CMEs would be conducted on this.

I

ndia has a long way to go in nosocomial infection prevention across the country.

If NABH accreditation processes are made mandatory in India across private and government hospitals, probably there will be an improvement in the trend in nosocomial

SAKRA WORLD HOSPITAL Steps taken to prevent HAI include: • Standard operating procedures for infection prevention and regular training including induction training to staff on its importance.

• Vaccinating hospital staff to build resistance to HAI and vaccinating soon after person gets needle stick injury.

• Dedicated resource i.e. clinician and nurses to drive infection prevention and control programme.

• Regular surveillance of clinical and other area to know the status on ground.

• Regular validation and verification of air and water samples.

• Internal audits on measurable elements wrto HAI and attempt improve the current practices wherever applicable.

• Monthly data capturing and presentation on KPI related to HAI like BSI, UTI, VAP, SSI and hand hygiene compliance. Doing root cause analysis to know the gaps and try to improve the same.

• Structured infection prevention committee headed by surgeon with representation of clinicians, nursing, CSSD, Engineering and management staff.

• Secured Safe-I, certification programme on prevention of HIA from NABH by adopting good practices of industry.

26

DECEMBER 2017 | HEALTHCARE RADIUS

INFRASTRUCTURE SPECIAL

MANIPAL HOSPITALS Steps taken to prevent HAI include: • All infected patients are isolated.

• Hand hygiene is strictly followed.

• Cleaning and disinfecting horizontal surfaces and equipment are done thoroughly with hospital approved disinfectant three times a day in each shift.

• Hospital antibiogram is reviewed every six months and antibiotic policy is reviewed every year. The usage of antibiotic is strictly monitored. This has helped to reduce injudicious use of antibiotics.

• Biomedical waste segregation as per the standard guidelines is practiced.

• Infection control audits are regularly done to monitor the practice of infection control protocols and re-training done if necessary.

CARE HOSPITALS Steps taken to prevent HAI include: • Active surveillance for monitoring nosocomial infections. Infection control nurse do regular rounds of all the ICUs, wards and microbiology department. She starts her day with the microbiology department and collects all the information related to positive bacterial cultures and visit the respective sections to document the hospital acquired infections in format and present them to the microbiologist to analyse and interpret the data.

• It has standardised definitions as per the CDC for VAE (VAC, IVAC, Possible & Probable VAP), CAUTI, CLABSI and SSI are documented.

• It has implemented standard universal precautions in the hospital and its training, given regularly with pre and post test evaluation of the staff.

• It conducts audits on hand hygiene practices, biomedical waste management segregation, effectiveness of infection control practices and safe infusion practices.

• It does surveillance of usage of high-end antibiotics and reserved antibiotics in the hospital in coordination with the antibiotic committee.

• It has initiated “Eye on I electronic surveillance programme”.

• It has special modular and hands on training for the nursing staff and immunisation and prophylaxis for healthcare workers. It has engineering control surveillance for high risk areas in the hospital (Operation Theaters, ICUs, CSSD and Isolation rooms).

• Implemented prophylactic antibiotic and empirical antibiotic policy to avoid miss use of antibiotics by initiating antibiotic audits by microbiologist.

28

DECEMBER 2017 | HEALTHCARE RADIUS

infection prevention in the years to come, point out analysts.

There should be formal training for infection control at the state and central level.

CARE Hospitals is one of the few hospitals in the country that runs a national training programme in infection control and have trained more than 3,000 doctors, nurses and administrators in the last five years.

According to experts, the government should establish an epidemiology centre and train epidemiologists to take care of outbreaks in the hospital. They should be standardised the surveillance definitions for infection control indicators as per the national /CDC guidelines.

“One should start reporting multidrug resistance organisms to the nodal centre in the country and strictly implement and audit hand hygiene, biomedical waste management and safe infusion practices guidelines in the hospital. One should standardise the cleaning and disinfectant protocols and disinfectants in the country for critical care equipments as per the standard norms," says Dr Afzal. Repeated training , awareness, implementation and analysis of the Infection control practices should be done religiously all the hospitals.

With strict implementation and adherence to hospital infection control policies, Indian hospitals should see a decline in HAI.

CONSUMER CONNECT

Setting new standards Getinge Assured product offers consumers a renewed sense of comfort.

G

etinge is a world leader in cleaning, disinfection and sterilisation equipment, with solutions for the healthcare and life science sectors. The company understands that people need their disinfection and sterilisation equipment to consistently perform to manufacturer’s specifications in full compliance with international and local standards as well as specified hospital requirements.

ASSURE QUALITY OF YOUR PRODUCTION The Getinge Assured product offering provides the tools for monitoring the complete decontamination process. It offers diagnostic controls for manual washing, washer-disinfectors, AERs and sterilisers. These are all part of the Getinge Assured portfolio.

INCREASE EFFICIENCY IN YOUR WORKFLOW Getinge Assured offers a comprehensive portfolio of wash monitoring and sterility assurance indicators to help check the effectiveness of instrument reprocessing. The technologically superior product line gives users the highest possible patient safety and care at the hospital.

IMPROVE PATIENT SAFETY Using products which monitor the success or failure of the entire decontamination process, at relatively little cost, will help one reduce hospital-acquired infections. Consequently, hospitals now have the means of effectively managing their sterile

30

DECEMBER 2017 | HEALTHCARE RADIUS

production, which in turn can reduce hospital expenses. This will manifest itself in fewer cancelled operations, just in time delivery of sterile instruments and contribute to optimisation of the patient’s experience REDUCE ENVIRONMENTAL FOOTPRINT By using best-in-class and unique technology, developed and owned by Getinge, it offers one a Getinge Assured product range with inks that are non-toxic and contain no toxic heavy metals in their base ingredients. The Getinge chemical indicators are sterilant specific to provide diagnostic results that will help one detect inadequacies with relevant parameters important for your instrument reprocessing. Getinge Assured is not only about wash monitoring and sterility assurance, it is also about having complete control in how you impact your local environment.

COMPLIANCE TO RELEVANT INTERNATIONAL AND LOCAL STANDARDS Getinge Assured products are all manufactured at ISO 9001 and ISO 13485 certified Getinge facilities and are tested against all relevant standards such as EN ISO 15883, EN ISO 11140 parts 1 & 4 and EN ISO 11138. We offer certificates of con¬formity for the complete product range, as well as 3rd party independent certificates for most products, to give you complete peace of mind about the accuracy and performance of our portfolio.

CONSUMER CONNECT

Child's play Instore Kids Corners have evolved interesting products that can turn any waiting room in hospitals fun for children.

What is the need to have children play area in a healthcare set-up?

As Instore Kids Corners, we have been able to use our expertise to assist healthcare organisations across the world.

Every day, children that have to visit these organisations have the opportunity to have some fun, despite the circumstances in which they find themselves. With a child-friendly environment, you only need focus on their treatment then. A great environment for a child is as important as technology and the medical faculty.

A fun, child friendly environment makes waiting more fun.

The play area provides a chance for children waiting to be examined by the doctor, or of course those children who accompany their parents, to feel comfortable.

What should be the key features of children play area?

The product should be safe enough that it should not require any adult supervision. Safety is our main priority when designing any concepts. Products in the play area should be easy to clean, without loose parts, with minimal maintenance requirement. If the modules/products involve much physical play then the flooring be done with a soft base. The colours used should be lead free. At IKC we don’t use a lot of plastic as it’s very difficult to trace the source as well as the integrity of the product.

IKC products are safe, TUV certified and designed for years of fun! Our products fixed on the wall cannot be moved/mishandled by a child and the modules kept on the floor are heavy for a child to move them around. This enhances the longevity of the play area, which is critical given the investment that goes into this.

After years of listening to children and clients, working in collaboration with health care institutions, we developed solutions to make fitting play concepts.

The play area is where children can be themselves because: • It brings a relaxing and stress relieving influence.

• For a brief moment they can enter their own world and be themselves.

• They can play safely, whether alone or socialising.

• Play stimulates a child's creativity.

Please share the names of healthcare facilities whose play area have been designed by your company.

Medanta Medicity-Gurgaon; HUG Geneva Hospital-Geneva; OLVG Hospital-Greater Amsterdam; SINT Franciscus HospitalRotterdam; Dental Clinic - Gouda, Netherlands; DentpointBudapest, Hungary; Ikazia Hospital-Rotterdam, Netherlands; Zhejiang Sian International Hospital-Jiaxing, China; Hofpoort Hospital -Woerden, Netherlands; Hirose Eye Hospital-Japan; Juliana Hospital-Hague, Netherlands; Hospital MC ZuiderzeeLelystad, Netherlands; Hospital VU Medical Centre- Amsterdam, Netherlands; New Abbot Hospital-United Kingdom; and Hospital MedInd-Russia.

Tushit Agarwal, CEO, IKCPlay India.

What services does the company provide in designing these areas?

A client shares the details/dimensions of the area with us and after understanding their requirements and budget, we design the place and share the 3D mockup with the client. Post that we can help the client with all aspects of the playarea beginning with flooring, wallpapers and, most importantly, our products.

For more details, contact india@ikcplay.com, and visit us at www.ikcplay.com

HEALTHCARE RADIUS | DECEMBER 2017

31

INFRASTRUCTURE SPECIAL

Hospital designing: A specialised subject Prashant Naidu, Head Healthcare Transformation Services & Infrastructure Advisory ( South Asia ), Philips India Limited, on the group’s unique integrated project delivery approach

1

1. Prashant Naidu

32

Can you brief us about Philips Healthcare Transformation Services & Infrastructure Advisory Division (HTSI) and areas of your activity?

Philips is well known in healthcare for its innovations and quality products. To bring better clinical outcome and productivity for the client, Philips has decided to engage with the client in long-term relationship on solution mode rather than just selling products. While Philips took multiple steps to move towards solution business, one of the steps is the setting up of HTS team globally across Philips including India. We at Philips Healthcare Transformation Services & Infrastructure Advisory Division provide end to end solution based on Integrated Project Delivery (IPD) approach to the customer by providing services across the following areas: • Healthcare Consultancy and Strategic Advisory: To help customer to narrow down the choice of location(s), what specialty etc based on demand-supply gap analysis, techno – economic viability study / feasibility study , operational & productivity improvement , pre-commissioning support, clinical process improvement, etc.

DECEMBER 2017 | HEALTHCARE RADIUS

• Hospital Design Services: To build high standard hospitals& help reduce the overall cost of the project by using latest tools such as BIM, etc. HTSI does master planning, co creates and clinical service modelling, hospital planning, complete hospital design & engineering, interior designing etc and also peer review.

• Project Management: To manage the quality of project delivered within time and budget and avoid any cost overrun.

HTSI does hospital project management advisory, project audit, planning and monitoring, quality & safety audits, design & project integration, etc.

• Equipment Procurement Advisory: To help procure appropriate medical and non-medical equipment.

• Financial Advisory: To help customers manage their financing - debt and equity - from local market and also help arrange long-term foreign currency funding.

How does the Integrated Project Delivery approach of Philips HTSI bring more value to the customer?

In India, traditionally, the hospital owner engages multiple

INFRASTRUCTURE SPECIAL

consultants and vendors to execute the hospital project. During the execution, the co-ordination becomes a major challenge and many hospital project runs in to trouble due to mismanagement of multiple stake holders and incur cost and time overrun.

By the time the client realises these issues, it is generally too late and also there are certain design and execution shortcomings which cannot be undone and the hospital then needs to continue with those inefficiencies and poor quality, thereafter.

Our HTSI team@ Philips works on IPD concept where HTSI handles the end-end consultancy and brings transparency into the system. This team monitors the quality / cost/ time at regular intervals and foresee the potential issues and addresses the same well in time to execute the project with in the agreed parameters. We provide sufficient knowledge/ inputs to the client, so that they always can take an informed decision. Needless to mention that this results in saving the cost of the project.

How are you leveraging technology to ensure that the hospital projects are designed & executed properly?

Right from beginning, we use Building Information modeling (BIM) which helps to improve the design efficiency and reduces the re-work during the execution by the way of 3D modelling and advance features like Auto Clash detection on the BIM platform. This helps for faster execution, timely and on budget completion of the project.

Also we at Philips HTSI, design all the hospitals complaint to green building standards. Now a days, many customers are keen to go for certification for green building to stand out in the competition as well for a savings on operational cost. We use our domain experience and simulation tools to design better facility and optimise space utilisation. Be it vertical transportation, waiting areas , requirement of number of OPD, OTs, phlebotomy /sample collection rooms etc and the analysis gives us a better configuration by considering the full capacity operation.

What in your opinion is the importance of having patient centric design?

Based on our experience and leveraging Philips Global expertise, we have now moved a step ahead from just patient centric design to People Centric Designs where all the stakeholders like patients, doctors, staff, patient relatives are equally considered while doing the holistic planning and designing. We work on design platforms and ambience designs where every occupant of the hospital gets the best environment which will help to provide better clinical outcomes and improved productivity.

How the market is responding to your new initiative?

We must say that the response is very positive. We are already

2 doing more than 1,500 beds in India and neighbouring countries.

The healthcare infrastructure market in India is maturing very fast since the customers (promoters /doctors/ patient / patient relatives / nurses and staff) are now more aware and demand a better hospital environment. Now even the client is seeing the value we bring to the table with our clinical service modelling resulting in better hospital planning due to which they are now ready to engage us for their hospital designing and project management.

Customers now realise that hospital designing is a specialised subject and requires domain expertise. Hospitals are built for the long term, keeping in mind uninterrupted continued operations.

Hence now customers appreciate that if the hospital is not designed and constructed properly then they will have to live with those inefficiencies which will hamper their clinical outcomes and productivity throughout the life of the hospital.

We also advise the hospital operator to conduct a proper market survey and have a techno economic viability report which can be a base document for the medical programme and help in design process. This reduces the changes during pre-commissioning stage and post commissioning.

And what are the trends in hospital infrastructure space?

Besides the tertiary care multi-specialty hospitals there is an increasing trend for single specialty hospitals in the field of oncology, mother and child care, eye care, etc. Customers are now looking at modular designs with provisions for expansions and expect hospital infra to be future ready. They are also looking at an infrastructure suitable for hub and spoke model and hence we see a traction happening even in tier II /III cities.

There is also an interest being shown on pre cast and pre fab structures for hospitals, as it may save the execution time.

2. The company uses people centric designs where all the stakeholders are equally considered while doing the holistic planning and designing.

HEALTHCARE RADIUS | DECEMBER 2017

33

INFRASTRUCTURE

Fire safety saves lives The motive of fire protection systems is to ensure life safety, equipment and property protection

BY TEAM HR

1

I Satyendar Khurana, Senior VP – Projects and Development, Columbia Asia Hospital

Sujayanti Dasgupta, Co-Founder and Managing Director W-ARD FOUR 1. For some hospital, the sprinkler systems are connected with BMS system.

34

n the recent past, several fire-safety related accidents have occurred in hospitals across the country which have highlighted the lack of a comprehensive fire safety plan for many hospitals. According to a survey by The Fire and Safety Association of India (FSAI), over 4,000 hospitals in Karnataka alone are not following the standard fire safety rules.

Fires can be devastating, especially in a hospital where a large number of people who need to be evacuated may be vulnerable – immuno compromised, on life support, and incapable of moving on their own. Says Satyendar Khurana, Senior Vice President – Projects and Development, Columbia Asia, "Hospital as an institution is more prone to fire because of the use of many heatdissipating equipment, combustible gases, the need for a lot of electrical wiring, presence of high power consuming equipment and electrical gadgets and the use of a large quantity of fire prone materials/articles such as cotton, linen, books, etc."

The vulnerability to fire is much higher in hospital due to physical condition of the

DECEMBER 2017 | HEALTHCARE RADIUS

occupants and inadequacy of knowledge of building infrastructure. Says D N Suresh, Senior VP- Infrastructure, Max Healthcare, “The vulnerability may lead to increased risk of fire-related casualties."

There are multiple challenges to following fire safety regulations in healthcare facilities. Firstly, most of the occupants will be ‘incapable of self-preservation’ due to age, physical/mental disabilities. Secondly, hospitals will have laboratories with significant quantity of flammable chemicals, hazardous chemical storage, sensitive equipment such as MRI, CT scan machines, LINAC rooms, etc. "Disconnecting the electrical power supply while responding to the hospital fire is complicated as power is critical to a hospital operations," says Khurana.

Hospitals require continual power supply even during a fire situation for operating the medical equipment in critical areas of the hospital like OTs, ICUs, etc.

Says Tarundeep Katyal, Group Head, Biomedical Services, AMRI Hospitals, “It is an uphill task to follow fire safety measures in a hospital building and the challenges become more if the building is an old one.

INFRASTRUCTURE

2 These buildings were designed at the time when the fire safety measures were not made compulsory or were not in the developed phase. To install a new fire safety/ fighting system in a operational hospital is a difficult task.”

After the devastating fire that broke out in AMRI Hospitals in 2011 that led to the death of 92 people, the authorities have laid out stringent guidelines for fire safety. In India, the national building code is followed for design of fire safety systems in buildings. And in the west, NFPA guidelines are strictly followed. "The fire safety code in Indian standard follows the American and European standards," says Suresh.

Leading hospitals have woken up to the threat posed by fire and follow a comprehensive fire safety plan. Hospitals use fire fighting systems like underground storage tank, fire pump, fire hydrant, delivery hose pipe, hose reel hose pipe, branch nozzle, as well as sprinklers, fire detection and alarm system like intelligent addressable smoke sensor with fire alarm panel, manual call

point, smoke management system, etc.

Recently, Max Hospital, Saket received Joint Commission International accreditation and safety leadership award from Frost and Sullivan on the basis of safety standards followed in the hospital.

D N Suresh, Senior VP- Infrastructure, Max Healthcare

T

he primary aim of fire safety in a hospital facility is to not evacuate patients unless it is absolutely necessary. "Hence, special attention should be towards proper prevention and suppression techniques to avoid this worst-case scenario," says Suresh.

According to Sujayanti Dasgupta, CoFounder and Managing Director - W-ARD FOUR, the three main pre-requisites for ensuring fire safety are structural integrity, smoke compartments and staff training and readiness.” Firstly, the structure itself is required to be of a construction grade that can withstand several hours of fire without giving way in order for patients and caregivers to remain in place safely. “In this type of construction, the structural elements consist of non-combustible materials, usu-

Tarundeep Katyal, Group Head, Biomedical Services, AMRI Hospitals

2. Most hospitals have mock fire drills to keep the staff active and alert about any fire exigency.

HEALTHCARE RADIUS | DECEMBER 2017

35

INFRASTRUCTURE

Case Study Max Healthcare

The fire safety measures used by the group are: ⊲ Fire fighting system like underground storage tank, fire pump, fire hydrant, delivery hose pipe, hose reel hose pipe, branch nozzle etc. ⊲ Coverage of sprinkler in whole building area. ⊲ Fire detection and alarm system like intelligent addressable smoke sensor with fire alarm panel, manual call point etc. ⊲ Compartmentalisation to prevent fire or smoke to spread form one fire zone to another area like fire resistant door, fire curtains, fire wall, fire retardant paint on electrical cables, etc. ⊲ Fire suppression system for electrical panels to control fire within the electrical panel during incipient stage. ⊲ Clean agent fire extinguisher installed in critical location of the hospital.

⊲ Fire suppression and PNG gas detection system provided in kitchen. ⊲ Smoke management system – Smoke exhaust and ventilation system provided in the hospital building. ⊲ Standalone emergency lights fixed in staircases, corridors, ICU, OT, safe passage in hospital building. ⊲ Special customised equipment placed in critical location in hospital for safe evacuation of patient vertically and horizontally such as evacuation chair, fire resistant field stretcher, fire smoke hood/ mask, fire blanket, etc. ⊲ Mock drill and fire safety training conducted for employee/staff. Dedicated fire safety manpower in the hospital for 24x7. ⊲ In the future, it is looking at fire water foam tender for fire fighting and fire hydraulic platform.

ally steel or concrete, that provides a given fire protection performance against the effects of fire,” she explains. It is particularly important to evaluate the fire resistivity of the structure if an existing structure is be-

36

DECEMBER 2017 | HEALTHCARE RADIUS

ing re-used as a hospital.

Secondly, for smoke compartments to be effective and safe the passive fire and life safety systems in the facility must be functioning flawlessly. With proper main-

INFRASTRUCTURE

Case Study Columbia Asia

The fire safety measures followed by the group are: ⊲ Hydrant system: • Landing hydrants with hose reel drum are proposed near all staircases across all floors. Yard hydrants are considered around the periphery of the development. ⊲ Automatic sprinkler system: • System is proposed to cover both ceiling and room voids. Upright and pendent sprinklers are proposed for above and below false ceiling area respectively.

• Sprinkler flow switch provided on the header main are integrated with fire alarm panel to alert the facility about system activation. ⊲ Fire detection and alarm system: • Multi sensor detectors are proposed to cover above and below false ceiling that can detect both heat and smoke.

• MCPs and hooter cum flashers are proposed across the floor at strategic locations.

• Third party services such as AHUs, fire damper, lifts, access control doors and electrical systems integrated with FA panel. ⊲ Public address system: • System proposed to convey clear and audible instructions to occupants in case of emergency.

• Integration of EPBAX with PA system to enable manual override. ⊲ Fire extinguishers: • Appropriate type of fire extinguishers are provided in lift lobby, corridors and other strategic locations ⊲ Gas suppression system: • NOVEC suppression system for server room protection with cross zoned detectors and agent release panel to control system activation. ⊲ Safety signages and passive fire protection system: • Photo luminescent type exit signage's on green background PVC board with white lettering for exit identification.

tenance, the goal is to limit smoke and fire to one compartment and not allow it to spread. "Smoke dampers, fire barriers, fire doors must be employed and inspected in the given timeframe for their effectiveness.

• Fire evacuation maps provided at all patient areas, • Fire stop sealant (minimum two hour fire rating) for shaft/wall penetrations to prevent spread of fire, smoke, toxic fumes. ⊲ In the newer hospitals, the group is following fire compartmentalisation within the floors to limit the smoke within the zone and avoid spreading to other areas.

This is done with the help of fire dampers, fire doors integrated with electromagnetic locks which are further connection to the fire detection system. It is also opting for the use of water curtains in the basement to limit the spread of smoke and fire. Also, it would explore the possibility of using CO2 flooding systems. ⊲ The group is exploring the use of fire/smoke curtains as an alternative to fire doors in the upper floors to achieve compartmentalisation.

And the occupants should be relocated to a safe location on the same floor rather than being evacuated. This would help buy valuable time and save lives of critically ill patients before a total evacuation may

HEALTHCARE RADIUS | DECEMBER 2017

37

INFRASTRUCTURE

Case Study AMRI Hospitals

The fire safety measures followed by the group are: ⊲ All hospitals are well equipped with fire detection and alarm systems. ⊲ The FAS are tested and monitored round the clock by specially designated fire operators, who are always on the foot and taking regular rounds in the premises. ⊲ It uses both fire hydrant and sprinkler systems and is connected with BMS system. ⊲ All fire pumps are connected to diesel generators directly to overcome the power cut situation during fire. ⊲ Regular fire training is an important part of daily routine. Mock fire drills are being organised to keep the staff active and alert anytime. ⊲ Practical fire trainings have been made compulsory for each and every staff. ⊲ Testing of fire pumps every week is compulsory.

⊲ It has worked on smoke management system and provided smoke extractor fans whereever possible. ⊲ It has a strong internal hospital safety team that does audit each quarter and submits the report to management to overcome the gaps. ⊲ All AC systems are connected with the fire alarm system to be tripped automatically when a fire alarm goes on. ⊲ In the upcoming hospital projects, it is using navigational tool for emergency responders. It displays critical information on the origin and progression of a fire, allowing firefighters to quickly locate and extinguish it.

Detailed information such as access routes, location of hazardous materials and areas of refuge are displayed on custom floor plans via a touch-screen display.

become necessary,” she adds.

Thirdly, safety officers at the helm must be entrusted to training, fine tuning procedures and communicating all procedures effectively. “Their ability to respond appropriately with a calm and confident de-

38

DECEMBER 2017 | HEALTHCARE RADIUS

meanour alone can be the deciding factor between life and death. Emphasis will need to be placed on training staff to sound an alarm, handle fire suppression equipment, be able to monitor patients and relocate if necessary, etc,” she adds.

CONSUMER CONNECT

Intelligent Technology Ventilator Model Flight 60 from Israel

O

n spending: "If you buy things you do not need, soon you will have to sell things you need." ~ Warren Buffet On saving: "Do not save what is left after spending, but spend what is left after saving." ~ Warren Buffet Operating ICU ventilators in critical care and emergency care environment is becoming a challenge for all size of hospitals, due to non-availability of trained & professional staff. With increase in patient turnover when a critical patient arrives into the emergency care area, patient stabilization & fixing of ventilator is time consuming and needs trained professionals to make the ventilator settings.

We are happy to introduce our low cost of ownership product that will suit your needs, a high-end intelligent technology Ventilator Model Flight 60 from Israel. It allows you to do the settings by just touching Adult/Pediatric or spontaneous (awake) patients displayed on screen with all pre-set parameters also allowing you to make changes if needed manually. This technology helps physicians and medical assistants ensure faster patient recovery and stabilization.

We have more than 400 hundred satisfied users of Flight 60 ventilators in India and around 2,500 worldwide including USA, Europe, Japan and Asia Pacific.

Remarkable performance and features in a portable and easy-to-use package, the Intelligent Ventilator Model Flight 60 is used in a range of hospital needs while improving patient comfort & independence, flow sensor interface technology allows patient friendly (Synchrony) and helps quick patients recovery. ⊲ Flight 60 Ventilator is supplied with advance modes as well as standard ICU Modes

Advance Modes • Volume / pressure and PRVC New volume guaranteed MVG mode Intelligent mode advance pressure control ventilation.

• Volume Guarantee ventilation : is a dual control mode of ventilation, combining two basic ventilation controls (Volume control and pressure control). When using the volume guarantee mode the patient is given pre-set volume of gas even though it is pressure control ventilated. Flight 60 will ventilate patients at lowest pressure possible while guaranteeing set volume of gas to reach patient's lungs.

• New Bi-Lev Mode : Bi-Phasic Ventilation is a time cycle pressure mode. In this mode the patient is allowed to breath spontaneously at both the high and low pressure baseline pressure support.

NIV Mode of Ventilation ⊲ Standard ICU Modes CMV-Pressure Control/Volume control, SIMV Pressure Control or Volume and Spontaneous/CPAP with pressure support with Apnea back up ventilation. Flight 60 ICU Ventilator is FDA certified for use in intra hospital transport with the help of 8 hours power back up and also provides high pressure, low flow oxygen port available for mobile and rugged design ensuring patient safety Ventilation on move.

For ICU Ventilators, Defibrillators, operation room equipments and Ambulance Fabrication, please contact us: Gensesis Healthcare email : gensesis_hcare@yahoo.co.in.

Phone : +91 040-27901151 / Mob : +91 9849742099.

HEALTHCARE RADIUS | DECEMBER 2017

39

INFRASTRUCTURE SPECIAL

BIM in Healthcare Healthcare facilities building design is complex and thus stands to gain immensely from BIM practices

BY ALPANA CHAUHAN

40

DECEMBER 2017 | HEALTHCARE RADIUS

INFRASTRUCTURE SPECIAL

tools and an actual picture of the site and surrounding which can then be incorporated in the model and accessed by all. Sharing the model has made it easier for different disciplines to coordinate and detect clashes in the very beginning of the projects, leading to time and money being saved in the latter part of the projects.

BIM collaboration and work-sharing such as Autodesk A360 has made it easier for different people to be able to work simultaneously on big projects from any part of the world providing better accessibility anywhere and on any device. Various simulation software such as Sefaira, Energy Plus, Autodesk Insight 360, Flow Design help designers in visualising sunlight during various times of day or different seasons or to quantify the calculation of building energy performances. The BIM model has much more information than a 2D drawings which leads to faster production of traditional plans, sections, elevations, schedules and sheets for the final construction documentation which saves valuable drafting time.

B

1

T

he architecture, engineering and construction industry is fast moving from 2D drawings to 3D models due to their increase in efficiency and coordinated project delivery. Building Information Modelling (BIM) saves both time and money for projects. It captures the wealth of information that we have access to in today’s world, using better mapping

IM has been made mandatory in many countries for all major projects. The US has mandated the use of BIM for all Public Building Service projects. In the UK all centrally-procured construction projects are required to achieve BIM level 2. The Scandinavian countries are some of the earliest countries that have pushed the use of BIM in their projects. In Germany, 90% of all project owners often or always demand BIM. In Singapore, BIM e-submissions have been mandated for all projects greater than 5,000 square metres and many other countries are moving to make BIM mandatory for big projects.

“BIM is a perfect fit for healthcare because of the complex nature of these buildings, the repetitiveness of the activity within the building, and the need to really nail process,” Dan Noble, FAIA, FACHA, President and CEO,HKS, Dallas once said. HKS has worked on Autodesk's Revit BIM software on a

1. BIM has been made mandatory in many countries for all major projects.

HEALTHCARE RADIUS | DECEMBER 2017

41

INFRASTRUCTURE SPECIAL

number of healthcare projects, including the Capital Health System replacement hospital and medical office building in Hopewell, NJ, and the new Boca Raton (Fla.) Community Hospital. “Having a fully integrated BIM model allows us to simulate process and material distribution, patient and staff flow, and M/E/P activities—and how all that interrelates.”

BIM in healthcare buildings Healthcare facilities building design is very complex and thus is one that stands to gain immensely from BIM practices as quality control can literally be a matter of life and death. As healthcare facilities are growing, in size and complexities, so has the acceptance and adoption of BIM.

2. Virtual construction of the project has led to more practical designs.

A. Uses of virtual construction: Virtual construction of the project has led to more practical designs. It has now become easier for architects to document what they visualise. Architects, engineers and contractors can agree upon the aesthetics and the constructability of the project and detail out everything exactly as per the architect’s visualisation as well as reduce on site errors before any construction. The use of virtual reality can be used for the mockup models which gives the contractors and the owners

2

42

DECEMBER 2017 | HEALTHCARE RADIUS

a sense of the room and its materials which can be shown in the form of a 360 Panorama of the space can lead to a better understanding of the clearance spaces and mobility.

B. Reducing onsite clashes: Softwares like Navisworks help in detecting clashes and identifying risks. When different discipline i.e. structure, architecture and MEP models are linked together in one environment all the clashes can be identified in the model itself as BIM models have each and every detail of a construction project which can be seen coexisting. Therefore, virtual construction can have an effect which flows into several steps of the construction project making it well-organised and efficient.

C. Coordination using BIM: BIM makes it easier to streamline projects reducing wastage of talent, time and money, providing optimisation of the design process. Production of construction documents by early stage expert planning and coordination between structure, architecture and MEP disciplines is made significantly simpler through BIM. D. Hospital layout and planning: In hospital design equipment layouts are just as important as spatial arrangements of several

INFRASTRUCTURE SPECIAL

types of diagnostic, testing and treatment areas. We can create a visual prototype of any room and take the input of the user i.e. the doctors, nurses and surgeons for better performance.

D. Material takeoff and project management: The Bill of Quantity (BOQ) can document precisely the number of equipment or the exact amount of material that needs to be used in a building. By using project management software, we can estimate the construction time accurately shorten schedules, reduce rework, produce lesser RFI’s and improve project quality. 4D simulations can better plan for construction sequencing, materials and equipment staging.

BIM being used by Indian hospitals In recent years, India has come a long way in adopting new technologies and implementing them in the field of design and construction. In the beginning of 2K, India started adopting BIM in the construction industry. Despite being new in India it has been shown strong acceptance potential here. BIM is a new and promising approach in healthcare facilities which is gradually gaining acceptance by the owners, architects, engineers, and builders. Cut sheets are a great example of all the information being incorporated in the documentation process of the building.

Perhaps, the biggest advantage of using BIM is its ability to isolate and group various 3D elements of the building system. In our recent experience, projects such as the IM Thapar Hospital which has undergone a plethora of changes over its design process, this ability of the software helped to perform design revisions with a lot more ease than it would be in a conventional 2D platform. This becomes all the more crucial in a building system as complex as a healthcare facility where changes to the design are inevitable owing to the complex medical planning as opposed to say a commercial building. The design team after compre-

3 hending a change can perform the changes taking lesser time as all the elements have a reference point and it’s easier to detect clashes as a result of any change.

Another obvious advantage is that different deliverable packages can be worked upon simultaneously, leading to better understanding and coordination amongst various services. As was the case with our Nagpur healthcare project, the architecture, interiors, facade and landscape packages were being worked upon simultaneously by different team members resulting in a coordinated and time-bound effort. The only source of delays were the services which were not executed on the BIM platform such as MEP and structures.

Having all the services in the same BIM platform will help us deliver full scope projects such as the one mentioned above in even lesser time frame.

Future use of BIM BIM is now focusing on use for post-construction facility management where it can help manage, plan and track ongoing maintenance of the facility. It has the potential to store what is inside the building as well as the building itself which can then be used to save data related to patients, treatments and operational performance. This will further lead to far greater advantages then just facilitating design.

Alpana Chauhan is designer with HKS India Design Consulting Private Limited.

3. The use of virtual reality can be used for the mockup models which gives the contractors and the owners a sense of the room.

HEALTHCARE RADIUS | DECEMBER 2017

43

COMMENT

1

Lessons from L’affaire Indigo Frontline staff needs to be trained in the critical nuances of customer handling

BY COL HEMRAJ SINGH PARMAR

L 1. Excellent quality of services will always be the winner.

44

et’s face it Indigo screwed up, and big time! How could a reputable airline such as Indigo with more than 38% of the market share, a Passenger Load Factor (PLF) of more than 80%, one of the lowest passenger related complaints at a negligible 0.2/10000 pax and a credible On-Time Performance (OTP) schedule screw it up so badly?

Needless to say, they sinned on the basic principle of customer delight! They have worked hard and consistently to reach the top echelons of the aviation industry, but perhaps that lulled them into complacency.

It’s natural to ask as to how did an airline

DECEMBER 2017 | HEALTHCARE RADIUS

known for its punctuality and good services land itself up in such a soup? The incident of manhandling has spawned a generation of memes and jokes, while the carrier suffers new business catastrophe of monumental proportions. What are the key lessons for the healthcare industry and for the senior honchos here?

Lessons for Healthcare Industry There are plenty of lessons I guess, not the least customer orientation and speedy ‘service recovery’ in case things do go wrong, as sometimes they will. Failure is not a choice here.

COMMENT

We encounter similar situations in our hospitals on a routine basis. Some of them are even graver in nature with potential for violence against doctors and hospital staff or even litigation. Many patients will not pay for the services availed of. Sometimes hospital bills raised are more than that the patient was counseled for, or there’s a clinical/ managerial mismanagement or a death case for whatever reasons. These are reasons enough for the patient or his dependents to go ballistic.

Media is always looking out for such opportunities and will often empathise with the patient or his family even without investigating. While the problem could lie with either the provider or the patient, it is in the interests of the provider to contain the damage to prevent loss of reputation and to retain its loyal clientele. A compromise is often reached to prevent escalation.

Smart hospital staff will read the deteriorating situation early and take steps to prevent escalation.

Indigo staff defaulted here and paid the price for it! I’m sure the carrier would not have been happy with the turn of events, as it horrifically unfolded much to its discomfiture. The escalation was rather too quick and if somebody had not captured the entire incident on camera, it might have even gone totally unnoticed.

Uber had undergone similar situation few years back and was almost on the verge of closure when one of its drivers was implicated in the rape of a hapless passenger.

The rookie, untrained staff at the functional level, can cause irreparable damage to the organisation, glossy high profile post event PR exercise notwithstanding. Frontline staff needs to be trained in the critical nuances of customer handling – most lack this skill. In fact, I’d even go a step further and state that most organisations do not invest enough on the training of their customer facing staff, as the ROI is not easily visible till such events come about, by which time it’s already too late!

2 Some of the questions that easily come to mind are: How do you prevent such explosive situations from occurring and how do you manage them in case we reach such a pass? What are the options available with our hospital staff to diffuse the situation? Are we trained enough to handle such situations?

Some of the key lessons for us all are as follows: • Customer delight and orientation is a constant work, don’t take it for granted.

Arrogance, indifference and apathy come at a cost. You cannot bask in the glory of a bigger market share alone. Your financial performance is incumbent on continued delivery of good services. Continuous customer orientation and training of staff is the key. Customer is the king and will dictate what s(he) wants, the reverse is not true. Many an airline has closed shop defaulting on this simple dictum. Before US Airways was purchased by America West in 2005, the airline had slashed its customer service budget, and outsourced many of those functions. Air India and United Airlines are counted amongst one of the worst service providers because they both lack gravely on quality parameters.

• You will be trolled, so be prepared for it with its consequent adverse impact on your reputation, credibility and top line.

Good PR machinery is therefore an abso-

2. Customer delight and orientation is a constant work.

HEALTHCARE RADIUS | DECEMBER 2017

45

COMMENT

fancy of common man who would capitalise on such opportunities to vent their feelings and pent up angst. You better be prepared for the verbal troll and ignominy. Organisations need to have a PR policy in place to meet such damaging situations. Unfortunately in the healthcare industry we face such situations with alarming alacrity, since lives are constantly at stake and any inadvertent mishap can take violent route pretty quickly, snowballing into a major media controversy, often hard to contain.

3 lute de riguer in case things do go wrong.

Indigo has to now launch a full media and PR blitzkrieg to regain confidence of its loyal clientele, while it will continue to lose revenue for a while.

• There is no replacement for good training of staff. Quality of recruitment is another important aspect. Employees with aggressive or abusive tendencies must be weeded out early. Regular staff evaluations can ensure continuity of good services, while weeding out bad heads.

• Being in a pole position doesn’t guarantee permanence unless you constantly work to maintain quality and persevere to uphold the industry values and norms. In fact, it puts more responsibilities on you.

Competition will Fish in Troubled Waters Indigo has become the proverbial butt of the joke. The incident did not prevent the competition from capitalizing on the godsend and launched an opportunistic campaign to take swipes at Indigo and wean away customers from them, while Indigo struggles to recuperate and limp back to normalcy.

3. Social media is unforgiving, especially in cases of misconduct and believes in instant trial.

46

The Power of the Social Media Social media has become too powerful with the explosion and democratisation of the IT industry. In this globalised and highly connected world, it is difficult to avoid constant scrutiny and rebuke. Social media is unforgiving, especially in cases of misconduct and believes in instant trial. Such incidents become viral within no time and catch the

DECEMBER 2017 | HEALTHCARE RADIUS

Consumer is the Undisputed King Like it or not, consumer is really the king and its collective power is unmatched, a voice that cannot be subdued. In this age of consumerism and breakneck competition, excellent quality of services will always be the winner. A customer is ready to pay whatever it takes, provided you can deliver the required quality of services. Some of the top airlines such as Singapore Airlines, Lufthansa and Emirates Airlines are a few examples that easily come to one’s mind while defining quality. Hospitals need to learn a lot from the airline industry and some of the best private banking industry on the delivery of quality services. Fisticuffs don’t do you good, quality and humility do!

The service industry contributed around 53.8% of its Gross Value Added in 2016-17 and employed 28.6% of the total population. This figure is likely to increase to 62% by 2020.

As India slowly waltzes into a full-fledged service economy, we are going to encounter more and more of such unforeseen fiascoes and the C-suite has to work hard to stay well ahead of the curve.

In the services industry, expectation mismatch is the norm and its prudent management a veritable art.

Col Hemraj Singh Parmar is Group COO with IVY Hospital.

EVENT

Showcasing latest in radiology Asian-Oceanian Congress of Radiology (AOCR 2018), The Renaissance, Mumbai, Jan 25-28, 2018 Tell us in brief about AOCR 2018 and its significance in the Radiology industry The Indian Radiology and Imaging Association (IRIA) is hosting AOCR 2018, the 17th Asian Oceanian Congress of Radiology and the 71st Annual Conference of the Indian Radiology and Imaging Association (IRIA) at Renaissance Mumbai Convention Centre Hotel, Powai, Mumbai from the 25th- 28th of Jan, 2018.

The radiology industry is rapidly growing with a significant penetration of advanced equipments now extending to tier II and tier III towns. With availability of such equipment though pan India distribution, people across all strata of India are likely to benefit.

The event is a perfect showcase for delegates to see the latest in machine advancement and technology in India.

What will be attraction of AOCR, as the event is happening in India after 25 years?

With four days of lectures spread across six halls, five halls for presentation of scientific papers, E posters on screens across the conference arena, more than 20,000 square feet of space for scientific exhibits, Mumbai Chaat Street, three consecutive nights of top-notch social events, and stay available at the venue itself for those taking the residential package, this event is packed with tremendous academics. Additionally, it provides enjoyment for all delegates.

A strong participation from AOSR group of countries is expected for this event, with a

heavy dose of international and national faculty that will make this a not-to-miss event in the annals of radiology conferences in India.

We have geared ourselves to showcase an academic and cultural extravaganza. We will leave no stone unturned to ensure a wonderful experience for the delegates. It is a great opportunity to meet friends, network, watch legends give cutting updates, see budding talent amongst Indian radiologists, be a part of exciting on site quiz contests, see new equipment showcased at the trade exhibit, and enjoy wonderful cultural events.

What sort of international participation is expected for the event?

The Asian- Oceanian region will be participating and that includes South Korea, Japan, China, Taiwan, Singapore and Thailand. Also delegates from Bangladesh and Nepal have registered for the event. Delegates from the UK have registered for this event. We expect a delegate strength of over 4,000.

Dr Shailendra Singh as Organising Secretary, AOCR 2018

Dr Sanjeev Mani, Organising Secretary, AOCR 2018

Which major radiology companies will be seen participating in AOCR event?

All major radiology players are participating, with a big number of technology and Make in India companies too participating in the scientific exhibit area. Special care has been taken to ensure good footfalls in the trade area, with pop up quizzes and prizes. Our platinum sponsors for this event are Philips Healthcare, Wipro GE Healthcare, Fujifilm India and Siemens.

HEALTHCARE RADIUS | DECEMBER 2017

47

DIAGNOSTICS

1

Opening new vistas Digital pathology breaks down geographical barriers and brings together experts via the virtual world

BY DR KIRTI CHADHA

U 1. Digital pathology eliminates some of the issues associated with sharing slides such as the degradation of samples and inability to share them.

48

ntil the advent of digital pathology in India, histological slides and photographs were the primary tools to share microscopic images with others. Which brings us to the question of what exactly is digital pathology and does India need it? From simply remotely viewing patient slides, to consulting specialists real time within India and other parts of the world – the applications of digital pathology are endless.

Digital pathology eliminates some of the issues associated with sharing slides such as the degradation of samples and inability to share them. In addition to preserving quality, specimen images can be transferred to colleagues with ease. It also plays a significant role in diagnostics as hospitals and laboratories can share images anywhere in the world, thereby significantly decreasing the time it takes to diagnose and treat a patient.

In addition, using networking tools, mul-

DECEMBER 2017 | HEALTHCARE RADIUS

tiple pathologists can assure that teams are discussing the same aspect of the sample.

Digital pathology breaks down geographical barriers and brings together experts via the virtual world and eliminates the need for expensive logistics to bridge that distance. In rural areas especially, this has opened new window as patients can now access experts sitting anywhere in the world.

In surgical pathology, biopsied tissue is dissected, fixated, embedded and cut into very thin slices, which are then stained and permanently mounted on glass slides. The slides are then examined by a pathologist under a light microscope to arrive at a diagnosis. WSI, on the other hand, refers to the digitisation of the stained tissue mounted on glass slides.

When using WSI, the tissue is prepared as it normally is for light microscopy. However, the slide is then converted into a digital whole slide image that the pathologist views on a computer monitor instead of through

DIAGNOSTICS

microscope oculars.

Digital slides can be reproduced an infinite number of times which has been a major limitation up till now. This has proven useful in cases of chronic and recurring diseases e.g. cancer. In essence, digital pathology extends the limits of microscopy, enabling students, educators, researchers, and clinicians to share tissue samples. Images sent or shared over the internet or through specific analysis software opens a path to new and exciting microscopy tools ensuring optimal patient treatment. It lends algorithmic objectivity to numerous tests that were otherwise subjective by nature and through image analysis software quantification is possible.

Pathology in the near future will provide digitally-enabled services as the norm to provide primary diagnosis of disease, facilitate personalised treatment, where therapies are tailored to the individual, extract and analyse data to understand the links between tests and therapy, to maximise positive outcomes. It will help pathologists access prior data from a spectrum of different sites quickly. It will also empower people to manage their own health through access to electronic health records.

In a major breakthrough, it has received regulatory clearance from the FDA (via De Novo classification), marking a significant leap forward for the pathology services industry in the US. De novo classification is the regulatory pathway for marketing clearance for novel, low to moderate risk medical devices that are the first of their kind. This news has implications not only for improving laboratory workflow and efficiencies, but also for quality and accuracy of cancer diagnostics through computational pathology— an approach to rendering disease diagnoses that incorporates multiple sources of data and uses mathematical models to generate clinically actionable inferences.

Just as PACS turned radiology on its head, the same is slated to happen with pathology. Digitised slides can reduce turnaround times, improve communication between

2 physicians, and are well-suited to computeraided detection, similar to the technology widely used in mammography.

Pathology occupies a similar role as radiology in hospital workflows, as a referral-based service. As many as 95% of clinical pathways pass through the pathology department, according to a 2013 NHS study, so increasing efficiency in the field will definitely improve hospital functioning as a whole.

With FDA approvals for digital pathology systems for narrow applications, it has also opened up several new avenues for treatment. To conclude, digital pathology is a dynamic, image-based environment that enables the acquisition, management and interpretation of pathology information generated from a digitised glass slide. Healthcare applications include primary and intraoperative diagnosis, consultation, medical student and resident training, manual and semi-quantitative review of immunohisto chemistry, clinical research, decision making support, peer review, and tumuor boards.

Dr Kirti Chadha is Head of Global Reference laboratory, Metropolis Healthcare Ltd.

2. Digital pathology systems have been used for primary diagnosis in Europe for several years.

HEALTHCARE RADIUS | DECEMBER 2017

49

CONSUMER CONNECT

NephroPlus conducts 2nd edition of World’s Only

Dialysis Olympiad in New Delhi More than 800 participants on dialysis from across the country attended the event

O

n, October 29th, 2017 in New Delhi, NephroPlus, India’s largest dialysis delivery network, hosted the second edition of the world’s only Dialysis Olympiad in Thyagaraj Sports Complex, New Delhi today. The Olympics style event conducted exclusively for those on dialysis was attended by more than 800 participants on dialysis from different parts of the country.

Driven by a guest-centric (at NephroPlus all patients are called guests) approach, NephroPlus strives to enable people on dialysis to lead lives as close to normal as possible, encouraging them to work, travel and have fun. Taking this vision further, the Dialysis Olympiad unrolled a series of events like Cricket, Running, Cycling, Basketball, Table Tennis, Badminton and Carom to further instill in them confidence to lead lives optimistically and happily. The winners of these respective events were awarded gold, silver and bronze medals.

NephroPlus has always designed innovative solutions to enhance the quality of lives of its guests. This year’s Dialysis Olympiad was therefore kicked off early this month, by conducting a record breaking bike expedition (400 km) from Jalandhar to New Delhi. Six people on dialysis, accompanied by a team of doctors and nurses, covered sectors of Ludhiana, Khanna, Ambala, Kurukshetra, Panipat, and Sonipat over four days – thus reinstating that with the backing of expert care, anybody can dare to dream big and achieve their dreams.

The first edition of the event which was held in 2015 in Hyderabad, witnessed participation from 600 champions across the country, who fought their illness to reveal their undying spirit. This event truly empowers the dialysis community to

50

DECEMBER 2017 | HEALTHCARE RADIUS

dream big and help achieve confidence to live life to the fullest.

Vikram Vuppala, Founder and CEO, NephroPlus said, “Two years back, when we had conducted the first edition of Dialysis Olympiad, it was considered a revolutionary moment in medical history. Convincing the dialysis community to indulge in physically challenging activities was a herculean task. But with our expertise, confidence in innovating with our services and reach across the length and bread of the country, this year we were able to increase the participation for the event.”

Adding to this, Rohit Singh, Vice President - Business Development NephroPlus said, “We at NephroPlus have always believed that those on dialysis can and should lead normal lives.

Our operational excellence and world-class dialysis quality and clinical care are reaching a large number of people on dialysis across the country. Several hospitals are now reaching out to us to help them enhance the quality of dialysis being offered at their hospitals and enabling their patients to also experience the NephroPlus difference. We are looking forward to touching more and more lives in this way.

About NephroPlus NephroPlus is India’s largest Dialysis Provider Network offering highest quality dialysis services. With a strong commitment to quality, it is spearheading a change in the way in which dialysis is done in India and beyond. NephroPlus has 126 centers currently across 18 states in India and is coming soon to other geographies. The goal of NephroPlus is to enable dialysis patients to live life normally, encouraging them to do things everyone does like work, travel and have fun.

CONSUMER CONNECT

Blood investigation technology Hematology in-vitro diagnostics are important parts of IVD market

BY NITIN SRIVASTAVA

I

n Vitro Diagnostics (IVD) are very different from other medical devices – they do not come in direct contact with patient, value of the knowledge and information they deliver and no therapeutic effect claimed. IVD products include not only the instruments, systems, and reagents used to perform the tests, but also the products intended for use in the collection, preparation, and examination of specimens taken from the human body. And these IVD medical devices are categorised into three classes by FDA, Class I – low-risk medical devices, Class II intermediate risk medical devices and class III high.

IVDs fulfill their role based on information that they provide and not on their direct action on the patient. This is of fundamental importance also related to matters dealing with product validation and testing. The validity of a medical device, or of a drug, is ultimately tested only by seeing how it performs on a patient while this approach will never be possible for an IVD. The quality of the information delivered by an IVD is assessed by measuring the analytical precision of the test or assay and by the clinical evidence of the information provided.

We all understand how important it is to be very precise specifically when testing blood for blood-typing (identifying blood type) or blood screening for HIV, Hepatitis C, etc. We all understand the clinical relevance of these assays. So while on one hand it is definitely correct to seek a high level of safety for both medical devices and IVDs, it is important to maintain the

52

DECEMBER 2017 | HEALTHCARE RADIUS

differences between these two categories of medical devices - one that comes in direct contact and the other that doesn’t.

Only in this way we will continue to have a well-balanced and effective regulatory system.

The Hematology In-Vitro Diagnostics, which includes hematology instruments and testing products as well as flow cytometry instrumentation and testing products, are the important parts of IVD market. Hematology tests are used to examine different parts of the blood, including tests to determine white blood cell counts, red blood cell counts, complete blood cell (CBC) counts, platelet counts, the amount of hemoglobin in the blood, a manual count is required due to the inability of automated CBC and differential analyzers to discriminate complex morphology, especially the shape of abnormal cells, such as immature white blood cells or the presence of diseased cells. It is important, though, to accurately detect the presence of immature white blood cells since they are often associated with conditions such as leukemia, infection, inflammation, or tissue injury.

Nitin Srivastava is National Sales Manager- In Vitro Diagnostics with Nihon Kohden India Pvt Ltd.

For more details, please contact: North region: Raju Gulati @ +91-9818071072 | South region: Sunil PV @ +91-9920907244 West region: Sachin Joshi @ +91-9833366843 | East region: Shivashish Ganguly @ +91-9831079296 Corporate & Registered Office: Carrier Airconditioning & Refrigeration Ltd., Kherki Daula Post, Narsinghpur, Gurgaon-122004 Tel: 0124-4825500 CIN: U74999HR1992FLC036104 | Website: www.carrierindia.com | Email: customersupport.inda@carrier.utc.com