Technical and Environmental Services

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EPOS Health Management

Some areas of the building have been completed either through hospital operational needs or to take advantage of available funding. At times funding constraints - both the amount of funds and the time limitations for spending the funds - have meant that the building procurement process is rushed, smaller contractors are employed and time to complete the work is too short.

On level 1 of the building, which corresponds to street level at the front, the Emergency Department is complete and operational (although only operational to a limited degree due to lack of equipment). On levels 3,4,5 and 6 the ward block on the south side is complete but not operational. The lifts have not been installed to transport patients between floors and sewer drainage has not been connected.

Extensive areas of building façade treatment have been installed, some with windows incorporated, some without. From the outside this gives the impression that the building is more complete than it really is. Installed façade includes levels 1,2 and 3 at the front and levels 3,4,5 and 6 at the rear. Some of the façade treatment has deteriorated and will require rectification.

Currently works are underway to finish approximately half of level 1 which includes Medical Imaging, Laboratory, Clinical Pharmacy and the Neuro Cebero Vascular Unit.

The work is valued at about IDR 15 billion. It is unlikely that it will be finished before the end of the financial year (end December).

A more detailed Functional Overview of the buildings is given in Annex 18.

4.3 Technical and Environmental

Buildings and Construction

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some distance from the building. It contains one 1000kVA transformer with another planned, and some switchgear.

The power house for Building B,C,D has not been constructed in the location recom-mended by the building consultants. It is in a less than satisfactory location beneath high voltage PLN power lines. The distance from the building means that cable diame-ter will need to be greatly increased and it may be a more economical option in the long term to re-build the power house in its designed location. The power house is not well built, there are leaks, the acoustic treatment is insufficient and there is inadequate ven-tilation.

4.3.2 Emergency Power Supply

Although Building A has a room constructed to take an emergency generator it was not installed. There is a small semi-portable generator (about 50 kVA) located outside the main entrance to the building. It serves the Ophthalmology operating theatres. There is no central UPS (uninterruptable power supply) each computer is connected to its own UPS.

Building E,F is supplied emergency power from its power house where two 1000 kVA diesel generators are installed in well-designed conditions. The gensets have automatic switchgear for startup and load transfer. Also located in the power house are two 300kVA UPS with associated battery banks. Uninterrupted power is provided to the COT, ICU, Medical imaging, Radiotherapy and Laboratory.

Building B,C,D power house contains one 850kVA diesel generator and switchgear.

There is no UPS at present but there is a room planned for it in the basement of the building.

4.3.3 Water Supply

Water supply for the hospital comes from three different sources which are managed according to supply and available budget. The main water source is from the water authority (PDAM) supply which is considered to be of good quality and reliable. The two other water supplies are from the lake system on the university grounds via a water treatment plant to each building and from two deep wells near the hospital buildings.

Each of Building A (level 1) and Building E,F (basement) contain water storage tanks which provide domestic water supply and fire-fighting supply. Water is pumped to over-head tanks on the roofs of the buildings to provide constant pressure for domestic sup-ply. A similar system is designed for Building B,C,D. Water quality is tested monthly in accordance with Indonesian regulations. Hot water is produced by a boiler in Building E,F which is distributed to the Kitchen, Laundry and wards. A similar system is de-signed for Building B,C,D.

4.3.4 Waste Water Treatment

A new waste water treatment plant has recently been designed and constructed by the hospital's Environmental Services Dept. It is a multi-chamber mixed aerobic / anaerobic treatment plant contained in an underground tank. Treated water discharges to a near-by drainage channel.

Building A waste water is piped directly to the new underground waste water treatment plant. Building E,F has pre-treatment of Laboratory waste water to remove heavy met-als and neutralise chemicmet-als. Generally waste water is pumped to the original pack-aged wastewater treatment plant located just outside the building. Now, rather than being discharged the waste, after this initial treatment, is pumped to the new

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ground plant for further treatment. Waste water from Building B,C,D will be collected in pits and pumped to the underground plant.

4.3.5 Solid Waste Disposal

The hospital, through their Environmental Services Dept., have a policy in place for the collection of waste which is separated at source for domestic waste, sharps and clinical waste (health care waste). Containers are provided within each user area which meet Indonesian standards for health care waste management, staff are trained in the proper handling of waste and specific staff are allocated to the transport and treatment of the waste. These staff are provided with protective clothing.

Domestic waste is bagged, collected and transported to large waste collection bins at the periphery of the hospital site. From here it is collected by the municipality for dis-posal. The hospital has a syringe crusher and an incinerator for the treatment of clinical waste. The incinerator is a dual-chamber with smokeless (stach scrubber) technology.

It has a capacity of 150kg. Average daily clinical waste collected is 115kg. The hospital has a contract with a specialist sub-contractor for the collection and disposal of inciner-ator ash.

The hospital advise that they have a policy to minimize cytotoxic waste, it is stored and collected in dedicated containers, transported by trained staff and incinerated at their waste management facility. The hospital have also advised that they do not produce any radioactive waste. The hospital have confirmed that their waste management facili-ties and procedures comply fully with current Indonesian (both Ministry of the Environ-ment and Ministry of Health) regulations and standards

4.3.6 Fire Protection

Water storage in each building includes dedicated fire-fighting water storage. Each building contains fire hydrants and hose reels. Each building is sprinklered in accord-ance with Indonesian regulations (for buildings over 4 levels). Water for fire-fighting is kept under pressure through a system of jockey pumps, main booster pumps and standby diesel booster pumps. The systems are tested monthly. Each building also has a system of automatic fire detection sensors and manual fire alarms which relay to a central control room manned 24/7. Externally fire hydrants are located at regular inter-vals for use by the fire brigade.

The Environmental Services Dept. are responsible for fire safety and occupational health and safety. They undertake monthly inspections and testing of the buildings to ensure compliance and regularly train staff through fire awareness and evacuation drills.

4.3.7 Medical Gases

The operating theatres of Building A are provided with medical gases from bottled sup-ply via manifolds for nitrous oxide and oxygen. Suction is provided by portable suction machines.

There is a central medical gas plant located in the basement of Building E,F which produces medical compressed air and suction. Oxygen is provided from a bulk oxygen tank (capacity 5 cu.m.) located between Building B,C,D and Building E,F. Nitrous oxide is provided from bottled supply via an automatic manifold, also located in the basement of Building E,F. A standby oxygen supply from bottles on an automatic manifold ensure uninterrupted supply. The gases are piped to the main clinical areas and wards. The