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Toolkit for Setting Up Special Care Newborn Units, Stabilisation

1. be ALUMINIUM PARTITION Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Part B Guide for Equipment and Renewable Resources Medical devices and renewable resources should be planned on the basis of the functional services to be provided by the unit There must be access to equipment for e Providing radiant heat e Monitoring of vital signs including blood pressure and blood gases e Fluid and drug treatment e Providing venous access e Portable X ray facilities Some of the questions that the planners need answers on with respect to newborn care equipments are 1 What are the equipments required for Special Care Newborn Unit 2 What quantities are required for a 12 bedded unit These recommendations can be suitably modified to estimate requirements for units with larger number of beds 3 Whether these equipments are Essential or Desirable 4 Whether pre installation assessment and installation by the supplier is recommended 5 Does the installation of the equipment have implications for civil mechanical or electrical systems of the unit Tables B 1 to B 4 provide answers to the above questions in a tabular form Before proceeding to read the tables read the following comments and instructions Box 1 Instructions on reading Tables B 1 to B 4 1 Equipments listed in these tables are classified
2. 24 2 7 Cost of setting up a stabilisation 24 Section 111 Newborn Care Corner erre rrr Iren eren emere en ana tasa satu suma manua tasa sese sunas 25 3 1 Designation of newborn care corner in labour room emen 26 3 2 S rvices at the Comer clean REX otf an evade cane RD MER EE 26 3 3 Configuration Of the corner oce case tdeo Gea iena sU UE ena 26 Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 3 4 Equipment and renewables required for the corner 26 3 5 HUMAN resources vendi abated pepe dial elia 26 3 6 Cost of setting up newborn care corner 27 Sumay PP 27 AnfnBXIUE Is DR Ce FEF Fv cu Du CU Pp SEVEN OR 28 Annexure 1 Estimating number beds required for SCNU 29 Annexure 2 Generic specifications for the equipments 30 Annexure 3 Asepsis and housekeeping protocols eee eee eee eee nene 59 Annexure 4 Instructions for equipment and equipment 5 63 Abbreviations AMC Annual Maintenance Contract CFL Compact fluorescent lighting CRT Capillary refill time ET Endo tracheal tube FRU First Referral Unit IUGR Intrauterine
3. Cover photo credit Jorge Caravotta Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 5 3 2 y EJ N77 3 SZ Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Acknowledgements This toolkit is a result of significant contribution by large number of agencies and professionals National Neonatology Forum NNF led the initiative supported by UNICEF and the WHO Collaborative Center for Training and Research in Newborn Care All India Institute of Medical Sciences New Delhi Dr Anil Narang led the NNF accreditation committee that set standards for level Il newborn care in India The toolkit draws heavily from these standards We acknowledge that the idea as well as the initial draft was inspired by the work done by Society for Applied Studies in collaboration with UNICEF field office for West Bengal We sincerely acknowledge the contributions made by Dr Harish Chellani Dr Sidharth Ramji Dr Neelam Kler Dr Arvind Saili Dr Sushma Nangia Dr Satish Saluja Dr VK Paul and Dr Ashok Deorari in drafting and revising the draft Dr Kaninika Mitra Dr Pavitra Mohan Dr Gagan Gupta Dr Ajay Trakroo and Dr Harish Kumar provided useful inputs and field insights Special thanks to James Patterson who led the initiative to firm up the specifications of equipments and Dr Anju Puri who very patiently reviewed revised and fi
4. 0 6 metres away from any part of a newborn s bed to minimise radiant heat loss Placing newborns too close to external windows can cause serious problems with radiant heat loss or gain and glare Therefore provision of windows in the unit requires careful planning and design A 7 Ambient temperature and ventilation A 7 1 Temperature The unit should be designed to provide an air temperature of 78 8 F to 82 4 F 26 28 A 7 2 Ventilation Ventilation in the unit should inhibit particulate matter from moving freely in the space and to minimise drafts on or near the newborn beds General ventilation can be provided in two ways exhaust only and supply and exhaust Exhaust fans pull stale air out of the unit while drawing fresh air in through cracks windows or fresh air intakes Exhaust only ventilation is a good choice for units that do not have existing ductwork to distribute heated or cooled air Supply and exhaust ventilation is a good choice for units with heating or cooling ducts as it is an inexpensive way of providing fresh air A 8 Acoustic environment The acoustic conditions of the unit should favour speech intelligibility normal or relaxed vocal effort speech privacy for staff and parents and physiological stability uninterrupted sleep and freedom from acoustic distraction for the newborn and the staff Noise generating activities and gadgets such as telephone sounds staff areas and equipment should be ac
5. and should have appropriate power connection for plugging in the radiant warmer 3 4 Equipment and renewables required for the corner Item Item Description FL gt No 5 8 03 ual gc 1 Open care system radiant warmer fixed E 1 height with trolley drawers O2 bottles 2 Resuscitator hand operated neonate E 1 500ml 3 Weighing Scale spring E 1 4 Pump suction foot operated D 1 5 Room Thermometer E 1 6 Light examination mobile 220 12 V D 1 7 I V Cannula 24 G 26 E 8 Extractor mucus 20ml ster disp E Dee Lee 9 Towels for drying and wrapping E the baby 10 Sterile equipment for cutting and tying E the cord 11 Tube feeding CHO7 L40cm ster disp E 12 Oxygen cylinder 8 F D 13 Sterile Gloves E 3 5 Human resources Staffing One staff nurse or ANM is desirable in addition to the one conducting the delivery for providing appropriate care at birth Training All staff posted at the labour rooms should be trained in providing essential care at birth and basic resuscitation 7 Including Operation Theatres in facilities where Cesarean Sections are conducted 26 3 6 Cost of setting up newborn care corner The following costs are indicative Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners One time establishment cost Equipment and
6. hold the remaining tubes and lines in hand e Detach as many tubes equipment as possible prior to weighing Keep the naked baby on the towel and record the weight subtract the weight of the cloth if the scale has no facility to reset to zero e Read the weight to nearest 5 10 gms e Record weight on baby record and plot on growth chart Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Do s e Put the weighing scale on a flat stable surface e Record weight prior to feeding e f using pre weighed splint reduce the weight from baby s weight e Always look for and adjust zero error e Remove excessive clothing e Record weight only when display is stationary amp not fluctuating Don ts e Do not stack up line or other objects on the weighing pan when not in use e Do not pour water on the electronic display Cleaning and disinfection e Clean with soap and water use damp cloth to clean e Wipe with spirit swab between patient use Troubleshooting e Place on a flat firm surface e Check for power cord e Check for fuse e Calibrate using a known standard weight every two weeks e Record zero error if it cannot be corrected and account for it 69 Notes 70
7. requiring intensive care 12 Oxygen cylinder 8 F e Breast feeding and feeding support 13 Sterile Gloves Referral services 14 Tube suction CH 10 L50 cm ster disp T 15 Cotton wool 500g roll non ster 2 3 Configuration of a stabilisation unit 16 Disinfectant chlorhexidine 2096 e The stabilisation unit should be located within or in close proximity of the maternity ward e Space of approximately 40 50 sq ft per bed is needed where four radiant warmers can be kept e Provision of hand washing and containment of infection control should be there if it is not a part of the delivery room 23 2 5 Human resources Staffing One dedicated nursing staff needs to be available round the clock for newborn care in the stabilisation unit One Medical Officer skilled in newborn care or paediatrician is required for clinical care and oversight Training Doctors and nurses posted in the stabilisation unit must undergo skill based training for 3 4 days 2 6 Referral services Each unit accepting sick newborns and required to make neonatal referrals should have or have access to an appropriately staffed and equipped transport service 2 7 Cost of setting up a stabilisation unit The costs mentioned below are indicative and could vary widely One time establishment cost Renovations and civil works Rs 3 00 000 7 50 000 Highly variable depending on the state o
8. 12 It is universally felt that units providing special care should have a minimum of eight beds and a maximum of 16 beds A unit with fewer beds becomes unviable and with more than 16 beds becomes unwieldy However an on site assessment of needs and review of available resources is advisable to determine the size of the unit Annexure 1 For an optimum size one has to consider economic realities and sustainability Consideration of factors such as economies of scale management technology and maintenance of a minimum level clinical experience point towards a minimum capacity of 10 to 12 beds A 3 Minimum space requirements Each newborn space shall contain a minimum of 100 square feet 9 9 square metres of clear floor space excluding hand washing stations and columns This 100 sq ft per bed of space should be utilised as follows e Baby care area 50 sq ft per bed e General support and ancillary areas 50 sq ft per bed A 4 Configuration of the unit The SCNU design should be driven by a systematic plan of space utilisation projected bed space demand staffing requirements and other basic information related to the unit Opinions are too divergent on what is the best design for a unit that will satisfy all The ideal design should provide constant surveillance of each bed area from the nurses station with minimal walking distance for the staff The design should allow for flexibility and creativity to achieve
9. 28 Needle disp 22G ster BOX 100 E 29 Needle disp 24G ster BOX 100 E 30 Needle disp 26G ster BOX 100 E 31 Needle scalp vein 21G ster disp E 32 Needle scalp vein 25G ster disp E 33 Gloves exam latex medium disp BOX 100 E 34 Gloves surg 7 ster disp pair E 35 Infusion set pediatric with chamber 150ml ster disp with 22G needle E 36 Cotton wool 500g roll non ster E 37 Compress gauze 10x10cm n ster PAC 100 E 38 Compress gauze 10x10cm ster PAC 5 E 15 Table B 5 Cont Item Item Description Essential Desirable No 39 Tube connection 2 2mm length box of 100 E 40 Connector 3 way stop cock valve ster disp E 41 Disinfectant chlorhexidine 20 E 42 Disinfectant bleach percentage E 43 Disinfectant handsoap E 44 Antiseptic betadine E 45 Tape adhesive Z O 2 5cmx5m E 46 Scalpel blade ster disp no 22 box of 100 E 47 Umbilical Venous catheter No 5 6 E 48 Disinfectant Bacilloid D 49 Blood transfusion set D 50 Nasal prongs disposable set of 3 D 51 Endotracheal tubes D 52 Electrodes neonatal box of 200 sets of 3 electrodes for ECG recorder and monitoring D 53 Sterilization indicator TST control spots D 54 Paper sheets crepe for sterilization pack D 55 Tape adhesive for sterilization pack D 56 Slide microscope 76x26mm BOX 100 2x50 D 57 Cover glass microscope slides BOX 100 D 58 Jar staining D 59 Counting chamber glass Neubauer WBC
10. Growth Retardation LED Light Emitting Diodes OT Operation Theatre PVC Poly Vinyl Chloride ROP Retinopathy of Prematurity SCNU Special Care Newborn Unit USG Ultra Sonography vi Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Introduction India accounts for 30 per cent of the neonatal deaths globally In India the neonatal mortality rate is 37 1 000 live births Most of these deaths occur within the first days of life 46 2 per cent occurring in the first two days of life and 73 3 per cent taking place within the first week of Thus serious concerted efforts have to be made to address the needs of a newborn in its first days in order to reduce neonatal mortality in India While simple known preventive and promotive interventions within the home environment such as exclusive breastfeeding or keeping the baby warm remain the corner stone in tackling newborn mortality an effective link between healthcare facilities and community based newborn care is needed Provision and delivery of services for both essential newborn care and the care of sick newborns in the existing health facilities at the district and sub district levels is lacking The purpose of this toolkit is to support the efforts of state and district health administrators health care entrepreneurs and others involved in planning and managing Facility Based Care for Newborns at various levels It provides
11. SpO2 arterial blood oxygen saturation pulse rate and signal strength Measuring range SpO2 30 to 100 minimal graduation 1 Pulse rate 20 to 250 bpm minimal graduation 1 bpm Accuracy SpO2 50 to 69 396 70 to 10096 2 Display hows SpO2 96 HR bpm and signal strenght bar Large display readable from distance display cover durable plastic User preset of high low alarms on SpO2 and pulse rate monitoring e Audio visual alarm for SpO2 and pulse rate in case measurements are outside preset range e Silencing feature for audio alarm e Display reports system errors probe failure and built in battery status e Automatic switch from mains to batteries in case of power failure e Power requirements 220 V 50 Hz and internal re chargeable battery autonomy approx 6 hrs automatic recharge e Power consumption 50 W e Device is produced by ISO 9001 certified manufacturer e Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with e 2xreusable SpO2 sensors neonate clip on type including connection cable e 10x reusable SpO2 sensors neonate wrap around type including connection cable e 1 x spare rechargeable battery e 1 spare set of fuses e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English e 40 List of priced accessories List of priced spare parts List with name and address o
12. application of the device 9 All parts to be replaced those which are most likely to break down within the next 6 months The technical training should enable hospital 10 It includes working hours travel cost boarding technicians to undertake first line corrective interventions that do not require specific spare parts They should also be able to recognise and report correctly the technical malfunctions requiring on site services of the supplier Annual maintenance contract proposal ought to cover both preventive maintenance and on call corrective interventions and lodging if applicable of the service engineer s On call corrective intervention The objective is to intervene immediately and repair the device limiting the downtime to the minimum Hence it includes and covers 1 Oncsite visit of service engineer s with necessary spare parts within a specified Preventive maintenance period of notification of the malfunction 2 All necessary materials and spare parts to The objective is to ensure maximum uptime complete the repair of the medical equipment assuring accuracy 3 Availability of spare parts for the technical efficiency and clinical efficacy Preventive lifetime of the device approximately maintenance therefore consists of at least two seven years planned technical visits per year and includes 4 n case the device can not be repaired on site and covers and the device is to be evacuated a similar 1 Excha
13. controlled access and environment e The unit should be in close proximity to the area of the hospital where births occur The unit should preferably be situated close to the labour room e f obstetric and neonatal services are on separate floors of the hospital provision for quick access like a ramp or an elevator should be provided for service between the birthing unit and the care unit e Units receiving infants from other facilities should have ready access to the hospital s transport receiving area e Transport of newborns within the hospital should be possible without using public corridors It should provide effective circulation for staff family and equipment Passage for accessing other services should not be through the unit A 2 2 Size projected bed demand of the unit As a general guide for all deliveries occurring within the health facility three beds for every 1 000 annual deliveries may be dedicated to the newborn care unit This demand is for intramural deliveries those occurring within the district hospital Additionally for newborns delivered outside the hospital extramural and being brought to the hospital for special care an extra allowance of 30 per cent of the estimated beds should be considered For example if a hospital conducts 3 000 deliveries per year the number of beds required would be e For intramural 3 1000 X 3000 9 beds e For extramural 3096 9 3 beds e Total beds required
14. curtains or linen as slings so as to reflect back as much light as possible to the baby making sure not to cover top surface of unit which allows air flow for cooling the bulbs Encourage frequent breast feeding No need to supplement breastfeeding with any other type of feed or fluids Temporary interruptions for feeding or procedures are allowed But not for oro gastric feeding or for IV fluids If baby is on IV fluids or expressed breast milk increase the volume by 10 Monitor for and ensure urinary frequency 6 8 times day Monitor temperature 4 hourly and weight every 24 hours Estimate serum bilirubin frequently q 12 hourly Clinical or visual assessment of jaundice under lights becomes fallacious Change tube lights every 6 months or usage time gt 1000 hrs whichever is earlier or if tube ends blacken or if tubes flicker Monitor irradiance of the phototherapy machine once every week Use a flux meter to monitor irradiance Change light source if irradiance falls below 6 8 uw cm2 nm Do not place anything on the phototherapy unit this blocks air vents Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Caution e Do not use phototherapy unit under a warmer e Ensure eye patches do not obstruct nostrils e For babies below 2kg preferably use phototherapy over incubator e After switching on the unit check if all tubes bul
15. e 1x set of 3 matching sterilising drums e 1 x of sterilisation indicator TST control spots e 1 x box paper sheets crepe for sterilisation pack e 1x tape adhesive for sterilisation pack e 1 spare set of fuses e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English e List of priced accessories List of priced spare parts List with name and address of technical service providers in India Training and installation at end user site e Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel 57 37 Laundry washer dryer combo 5kg Stand alone automatic laundry washer Capacity approx 5kg Selection of five programmed wash cycles Temperature selection 30 to 90C Dry spinning approx 1200 rpm Integrated tumble dryer Various degrees of drying out selectable Electronic sensor monitors humidity and alarm at pre selected level Safety feature protect against over temperature Support feet are height adjustable levelling the device Power requirements 220 V 50 Hz single phase Power consumption 2000 W Device is produced by ISO 9001 certified manufacturer Supplied with 58 1 x set of connection tubing water supply 1 x set of connection tubing water drainage 1 x set of connection tubing water vapour exhaust 1
16. element 2 x empty 10 L oxygen cylinders 1 x spare set of fuses User manual with trouble shooting guidance in English Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India Training and installation at end user site Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel 2 Phototherapy unit single head high intensity Technical Specifications Heavy sturdy mobile stand phototherapy unit e Antistatic castors 2 with breaks e Single head surface size approx 0 50 x 0 75 m e Head height adjustable approx 1 40 to 1 75 m e Blue light 4 Compact Fluorescence Tubes CFL approx 20 W e White light 2 Compact Fluorescence Tubes CFL approx 20 W e Tubes are protected by grill e rradiance at skin level up to 40 uW cm2 nm e Wavelength 420 to 500 nm with highest intensity at 470 nm e Integrated cumulative hour timer e Power requirement 220 V 50 Hz e Power consumption 250 W e Device is produced by ISO 9001 certified manufacturer Certificate to be submitted further details see Technical Provisions e Device is safety certified according CE 93 42 FDA 51
17. height 22 cm diam 25 cm 3 x size medium approx height 18 cm diam 20 cm Made of autoclavable polycarbonate Trauma free silicone neck with adjustment flap With bilateral oxygen nozzle Oxygen tube of 2 m length must be provided with Device is produced by ISO 9001 certified manufacturer Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with e 1 x spare set of tubing e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English e List of priced accessories e List of priced spare parts e List with name and address of technical service providers in India 10 Oxygen concentrator elec 220V refer to material 50002047 Technical Specifications e Oxygen concentrator to provide oxygen from ambient air e Oxygen concentration measured at the flow meter by oxygen sensing device OSD e Sound level 15 dB e Superior grade of molecular sieve e Maintenance free rotary proppet valve e Oxygen purity approx 90 e Oxygen output approx O 5 LPM e Pressure approx 8 psi e Double outlet or flowsplitter for oxygen Delivery e Oxygen tube of 2 m length must be provided with e Facility for nebulization with tube amp mask e With two humidifier bottles and two cabinet filters Power requirements 220 V 50 Hz Power consumption 450 W Device is produced by ISO 9001 certified manufacturer e Device is sa
18. in labour rooms Neonatal Stabilisation Unit First Referral Unit and in operation theatres OT District Hospital Newborn care corner in labour room Special Care Newborn Unit and in operation theatre OT Section Special Care Newborn Unit Part A Setting up of a Special Care Newborn Unit a District Hospital The following principles are applicable for setting up an SCNU in a district hospital or in an equivalent facility While many of these specifications are minimums the intent is to optimise resources and facilitate quality health care for the newborns A 1 Services at the unit The configuration of the SCNU at the district level should be such that it supports delivery of necessary quality services and meets the potential need to expand in order to accommodate increased demand The SCNU at the district hospital is expected to provide the following services 1 Care at birth including resuscitation of asphyxiated newborns 2 Managing sick newborns except those requiring mechanical ventilation and major surgical interventions Post natal care Follow up of high risk newborns Referral services Immunisation services EO E In addition the unit should also provide training to medical officers and nurses in newborn care 2 Location and size of the unit A 2 1 Location within the district hospital The unit should be in a distinct area within the healthcare facility with
19. least 20 minutes prior to pre warm the linen and mattress so that the baby does not lie on a cold surface initially e Read temperature on display Adjust heater output to High If baby temperature is below 36 C Medium If baby temperature is between 36 36 5 C and to Low If baby temperature is between 36 5 37 59 e Once the baby s temperature is between 36 5 37 5 C switch on the servo mode skin mode e f baby is in supine position place the skin probe on the right hypochondrium When in prone position place the probe on the loin area To prevent skin injury place tegaderm and fix the probe on it with an adhesive e Ensure that the baby s head is covered with cap and feet secured in socks and the baby is clothed or covered unless it is necessary for the baby to be naked or partially undressed for observation or for a procedure e Place only one baby under each radiant warmer e Turn the baby frequently while under the warmer if possible e Check the temperature of the warmer and of the room every hour and adjust the temperature setting accordingly Record the heater output in each shift every 6 hours Any sudden increase in heater output is an early indicator of sickness Move the baby to be with the mother as soon as the baby no longer requires frequent procedures and treatment If in servo mode the heater output is lt 20 it is safe to shift the baby to mothers side Servo Mode Set tem
20. paper e 1 x box neonatal ECG electrodes 200 sets electrodes chest and or extremities diameter approx 22mm ultra soft gel self adhesive e 1 spare set of fuses e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India Training and installation at end user site Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel 31 Infantometer plexi 32 105 Portable baby infant length height measuring system Measures laying length of neonates and babies No need for calibration as all parts have prefixed position Reads in centimetres and inches Minimum graduation 1 mm Long lasting hard wearing ruler graduation is fully integrated with device Measuring slide wedge glides smoothly and close via ruler avoiding reading parallax e Measuring slide wedge wobbles max 2 mm over full length e No sharp edges or corners e Low stable board width ca 30 cm e Length measurement range approx 100 cm e Head footplate board and slide wedge made of quality laminated wood or plastic e Wood parts should be treated and finished protected with varnish to prevent chipping of edges and allow easy cleaning all connectio
21. recommendations on setting up Special Care Newborn Units SCNUs Stabilisation Units and Newborn Care Corners at different levels of healthcare organisation It dos not however provide guidelines on organising level Ill newborn care units The recommendations relate to the services design infrastructure equipments supplies and human resource requirements for providing newborn care at these levels The document also provides detailed specifications of the equipments and tips for maintenance and use of the equipments It is hoped the toolkit will serve as a ready reference and a one stop guide for the establishment of newborn care units However defining the exact scale and design of these units in a given situation is complex and would often require drawing in expertise from other sources and institutions Upon request National Neonatology Forum NNF provides handholding support to individuals and agencies in this process We hope that this kit will contribute to expansion of newborn care in India and ensure that the economic and technological advances of the country are adequately harnessed to ensure best possible start in lives for all children In the future we hope to update this toolkit on a regular basis incorporating new research findings experiences and suggestions Your suggestions are welcome 7 Multi centric Home based Intervention project of the Indian Council of Medical Research ICMR annual report 2005 06 Description
22. sec e Large LED display readable in low light working situations display cover durable plastic e With integrated printer e Power requirements 220 V 50 Hz with adapter e Power consumption 350 W e Device is produced by ISO 9001 certified manufacturer e Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with e 2xreference solution packages e 1 x box of micro capilary tubes inner diam 1mm length 7mm heparinzed e 1 x box of micro capilary tubes inner diam 1mm length 7mm plain e 1 x pack of sealing compound for micro capilary tubes e 1 x spare lamp e 1 x dust cover e 1 spare set of fuses e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English e List of priced accessories e List of priced spare parts e List with name and address of technical service providers in India e Training and installation at end user site Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel 55 35 Microscope binocular with illuminator refer to material 50957105 Basic binocular microscope with built in halogen illumination Rotable body 360 degrees inclined metal base Quadruple revolving nosepiece with distinct click stop Stage approx 140 x 130 mm with clamps for mounting object slide With fixed gra
23. should be about 40 50 sq ft per bed the space can be in the SCNU or in the vicinity or in the postnatal ward A 5 Electrical and mechanical needs Electrical and mechanical requirements of each newborn bed should be organised keeping in mind safety easy access and maintenance A 5 1 Electrical needs e Power supply The unit should have a 24 hour uninterrupted stabilised power supply Back up power supply is a must with one or two outlets To ensure this a generator with 25 50 KVA capacity and a servo stabiliser 3 phase of the Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners microorganisms Materials should permit cleaning without the use of chemicals At the same time floors should be highly durable to withstand frequent cleaning and heavy traffic Vitrified tiles are preferred Other flooring that may be used includes Kota Stone or chip flooring however such flooring needs to be well polished Walls As with floors the ease of cleaning durability and acoustical properties of wall surfaces must be considered Although commonly used vinyl wall covering contains PVC which degrades indoor air quality and thus should be avoided Walls should be glaze tiled up to a height of at least seven feet e Water Supply The unit should have 24 hour uninterrupted running water supply To ensure water supply it is useful to have a separate overhead tank with a capac
24. steel quenched magnetic steel stand mat SO726000 x Scalpel handle no 4 Bistoury handle for interchangeable blade The number indicates the characteristic of the distal end and therefore the choice of the blade Length approx 14 cm Austenitic steel non quenched non magnetic stand mat 50745500 x Forceps tissue 145 mm straight Straight tissue dissecting forceps Slightly springy flexible arms With 1 x 2 teeth Good adjustment of the teeth Good gripping of the jaws Martensitic steel quenched magnetic steel stand mat 50737000 x Probe double ended 145 mm Double ended probe dilator Bulbous shape at both ends Diameter 2 mm Austenitic steel non quenched non magnetic stand mat 50759820 e Device is produced by ISO 9001 certified manufacturer e Device is safety certified according CE 93 42 FDA 510k or equivalent 35 Supplied with Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India 8 Syringe pump 10 20 50 ml elec 220V e Digital and self regulating volume controlled portable syringe pump e Can be mounted on bed wall rail or mobile pole stand supplied with fixation e Suitable for all intravenous and intra arterial infusions e Continuous volumetric delivery with syringes 10 20 and 50 ml e Open system suitable for different bra
25. the stated objective A 4 1 Baby care area The baby care area 50 sq ft per bed may be divided into two interconnected rooms separated by transparent observation windows with the nurses work place in between This facilitates temporary closure of one section for disinfection A A 2 Space for ancillary supplementary services Distinct support space should be provided for all clinical services that are routinely performed in the SCNU The ancillary area should include space for the following e Gowning area at the entrance e Hand washing stations Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners e Examination area e Clean area for mixing intravenous fluids and medications e Mother s area for expression of breast milk breastfeeding and learning mother crafts e Side laboratory e Boiling and autoclaving 4 2 1 Gowning room The unit should provide clear floor space excluding entry work area for gowning e hands free elbow operated hand washing station for hand hygiene and areas for gowning and storage of clean and soiled materials should be provided near the entrance e The room should have self closing devices on all exits A 4 2 2 Hand washing stations Hand washing stations should be so positioned that every newborn bed is within 20 feet 6 metres Hand washing stations should be no closer than three feet 0 9 metres from a newborn bed or clean supply stor
26. x spare set of fuses User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India Training and installation at end user site Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Annexure 3 Asepsis and Housekeeping Protocols 1 Basics 1 1 Basic requirements for asepsis in a baby care area e Running water supply e Soap e Elbow or foot operated taps e Strict hand washing e Avoid overcrowding optimal number of nurses for care of more babies e Plenty of disposables e Rational antibiotic policy e Obsession with good housekeeping and asepsis routines Guidelines for ENTRY into the baby care are e Remove shoes socks woollens watch bangles and rings Roll up the sleeves up to elbow e Put on the earmarked slippers wash hands with soap and water for two minutes follow six steps of hand washing e Put on sterile half sleeve gown Policy regarding VISITORS e Only parents of the babies should be allowed entry into the nursery e Mothers are welcome at any time to be involved in care of their newborns e Parents should be trained on proper hand washing technique Personnel with active infection should not be allowed entry into the baby care area 1 2 Ster
27. 0k or equivalent Supplied with e 2 spare blue CFL tubes e 1 spare white CFL tube e 1 spare set of fuses e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English e List of priced accessories e List of priced spare parts e List with name and address of technical service providers in India e Training and installation at end user site Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances year ii on call technical interventions spare parts and travel 31 3 Resuscitator hand operated neonate 500 250ml Resuscitator for manual ventilation of neonates Ventilation can be done with ambient air or with oxygen Resuscitator can be totally disassembled is easy to clean disinfect and sterilize All parts can be autoclaved at 121 C except O2 reserve bag Manufactured from durable high strength synthetic not requiring special maintenance or storage Resuscitator is supplied as a complete set in a box Compressible self refilling ventilation bag capacity approx 500 250 ml With non rebreathing patient valve with pressure limitation Intake valve with nipple for O2 tubing 2 reserve bag complete capacity approx 2000 ml Set of 3 cushioned neonate size masks translucent Size O approx 50 mm Device is produced by ISO 9001 certified manufacturer Device is safet
28. 23 Indicator TST control spot PAC 300 D 1 24 Irradiance meter for phototherapy units D 2 25 Monitor vital sign 5 2 ECG RR Temp D 1 V IJV 26 ECG unit 3 channel portable SET D 12 27 Infantometer plexi 105 1 J 28 X Ray mobile 1 Viv 14 Vv 29 Transport incubator basic with battery and 02 w o ventilator 1 V IJV V 30 Autoclave steam bench top 20L electrical D 1 Vv V IJV 31 Laundry washer dryer combo 5kg D Viv iv VV 13 Table B 2 Equipment for disinfection 1 Drum sterilising 165mm diameter 4 2 Electric Steriliser D 1 Vv 3 Washing machine with dryer E 1 4 Gowns for staff and mothers E Adequate 5 Washable slippers E Adequate Vv Table B 3 Laboratory equipment 1 Centrifuge hematocrite benchtop to 12000 rpm including E 1 iv rotor 2 Microscope binocular with illuminator D 1 3 Bilirubinometer total bilirubin capillary based D 4 Glucometer with Dextrostix E 3 Vv Table B 4 General equipment E 1 AC 1 5 Tonne 1 X X X X 2 Generator set 25 50 KVA 1 x x 3 Refrigerator hot zone 110L 1 x X 4 Voltage Servo Stabiliser three phase 25 50 KVA E 1 X 5 Room Heater Oil D 4 x 6 Computer with printer D 1 X X X 7 Spot Lamps 2 X
29. 8 Wall Clock with second hand 2 X Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Table B 5 Renewable and consumables Item Item Description Essential Desirable No 1 Adaptor Meconium aspirator disposable for suction pump E 2 Line infusion pump sterile disposable E 3 Multistix urine 5 parameter Glu Prot Eryt Spc Grav pH E 4 Cuvettes Glu box of 200 E 5 Cuvettes Hb box of 200 E 6 Vacuum tube EDTA 3ml set of 100 E 7 Vacuum tube EDTA 6ml set of 100 E 8 Vacuum tube serum 3ml set of 100 E 9 Vacuum tube holder set of 100 E 10 Vacuum tube needle 22G set of 100 E 11 Lancet safety sterile single use PAC 200 1 8mm E 12 Capillary tubes box 1000 E 13 Sealing compound capillary tubes pck 500g E 14 Mask surgical disposable box 100 E 15 Cap surgical disposable box 100 E 16 Cord clamp disposable set of 10 E 17 Extractor mucus 20ml ster disp Dee Lee E 18 Tube suction CH10 L50cm ster disp E 19 Tube suction CH12 L50cm ster disp E 20 Tube feeding CH05 L40cm ster disp E 21 Tube feeding CH06 L40cm ster disp E 22 Tube feeding CH07 L40cm ster disp E 23 Syringe dispos 1ml ster BOX 100 E 24 Syringe dispos 2ml ster BOX 100 E 25 Syringe dispos 5ml ster BOX 100 E 26 Syringe dispos 10ml ster BOX 100 E 27 Syringe dispos 20ml sterile BOX 80 E
30. HR Respiration rate SpO2 NIBP and temperature Display colour TFT approx 7 inch 4 channel Soft touch keys durable and easy to clean Measurements ranges e ECG I II Ill e HR approx 30 to 250 bpm 3 bpm e NIBP approx 20 to 290 mmHg systolic 1 mmHg gt SpO2 approx 40 to 100 96 196 e ECG div respiration approx 6 to 180 bpm 1 bpm Temperature approx 10 to 45 degree Celsius 0 1 degree Celsius gt e NIBP oscillometric step deflation manual automatic initial inflation pressure user selectable e Sweep adjustable 12 5 25 or 50 mm s e Sensitivity amplitude of all signals user adjustable e Voltage marker 1 mV e User preset of high low alarms on all monitored parameters e Audio visual alarm in case measurements are outside preset range e Silencing feature for audio alarms e Trend display from 2 to 24 hours e RS232 serial data output provision peripheral printer or network analogue output for ECG e Defibrillator sync and protection e Pacemaker detection rejection e Display reports system errors leads and sensors failure and built in battery status e Unit can be mounted on bed wall rail or mobile pole stand e Automatic switch from mains to batteries in case of power failure e Monitor constructed of durable shock proof plastic e Power requirements 220 V 50 Hz with adapter or internal re chargeable batteries autonomy approx 3 hrs automatic recharge e Power consumption 350 W e Devi
31. UNIT D w O WASH ROOM 2 3 4 5 Ww O w R Figure 1 Sample design of SCNU 1 Adapted from design of SCNU at Satna District Hospital M P WT TABLE 318VL 1M LL EH CONTROL ROOM 5 6mx6m EH EH EH EH apa EH OUTBORN UNIT6mx6m EH nnum E amp ALUMINIUM SHED UNIT WASH PATHOLOGY PARTITION Licio 4 8 mX3 6m ROOM SOFA 5 STEPDOWN 3 0 LA 888 eL 14x2 OXYGEN ROOM 0 E O UNIT O 1 Lr SLEEPER 3 7mx7 6m HAND WASH A BATH O 0 ROOM 14X12 235 8 LI n O KIT MOTHER FEEDING ROOM O 3 9MX5M O O LI _ ALUMINIUM PARTITION SHOOE ROOM 2 35MX24M SHOOE RACK SLEEPER RACK O O SISTER ROOM STORE O 3 5MX3 9M O O Figure 2 Sample design of SCNU 2 Adapted from design of SCNU at Bhind District Hospital M P 10 i ALUMINIUM PARTITION 40 WAITING ROOM 2 35mX7m
32. aVF I Il and V1 6 pre cordials Automatic and manual printout mode e Internal memory for data storage e Splash resistant alphanumeric keyboard and direct function keys e Reset zeroing auto base line correction 0 5 Hz 1mV test e Electrode connection quality check e Filter setting for line frequency 50 or 60 Hz and tremor e Large back lit LCD 10x12cm displays recorded data and failure announcements ECG curves leads heart rate patient name and ID electrode control clock leads speed and filter setting e Integrated high resolution dpi thermal printer width 210 mm e Print out folded thermo reactive paper format A4 e Number of channels selectable 3 6 or 12 e combination of channels or manually selectable e Paper speed selectable 5 25 and 50 mm sec e Sensitivity automatic or selectable 5 10 and 20 mm mV e Copy function e Built in batteries and charging unit e When fully charged the battery gives approx 50 readings e Power requirements 220 V 50 Hz with adapter or internal re chargeable batteries autonomy approx 6 hrs automatic recharge Power consumption 30 W e Device is produced by ISO 9001 certified manufacturer e Device is safety certified according CE 93 42 FDA 510k or equivalent 51 Supplied with e 1 x patient cable e suction ball type chest electrodes reusable e 4 x extremity clamp electrodes reusable e 1 x bottle of gel for electrodes e 1 x box of recording
33. able resistant to cleaning with chlorine based solution and flame retardant Side boards transparent acryl drop down and lockable Under table 2 storage drawers Side rails allow for mounting of accessories Hood suspended above the table integrates heating element and overhead light Overhead light 2 x 50W halogen spot with dimming function Integrated support for two 10 L oxygen bottles Control unit has flow meter and displays pressure Heating element emitter with parabolic reflector and protected by metal grid Control unit allows air and skin temperature preset LED indicator and drives radiant heater output Servo and manual Integrated timer 1 to 59 min with count up and count down feature Temperature range skin 34 to 38 C user pre settable Monitoring of skin temperature by means of sensor range 30 to 42 C Heater output O to 100 in increments of 5 Control unit audiovisual alarms according to timer and temperature presets avoiding overheating Display reports systems errors sensor failure Power requirement 220 V 50 Hz Power consumption 800 W Device is produced by ISO 9001 certified manufacturer Certificate to be submitted further details see Technical Provisions Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with 30 1 x mattress 1 x skin temperature probe including connection cable 1 x spare skin temperature probe including connection cable 1 x spare heating
34. acility Equipment and furniture Rs 25 00 000 Sub Total Rs 41 00 000 Consumables Rs 3 50 000 Maintenance cost Rs 6 50 000 Sub Total Rs 10 00 000 21 Section Il Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 2 1 Setting up of stabilisation units in first 2 4 Equipment and renewables required for a referral units stabilisation unit Every first referral unit must have clearly Item Item Description Quantity established arrangements for the prompt safe and No effective resuscitation of babies and for the care 1 Open care system radiant warmer 4 of sick newborns Most sick newborns can be fixed height with trolley drawers stabilised at this level Sa 2 Resuscitator hand operated neonate 2 500ml 2 2 Services at a stabilisation unit Su ee 4 Scale baby electronic 10 kg lt 5kg gt 1 A Stabilisation Unit at an FRU or an equivalent 2 Li a facility provides the following services 6 Thermometer clinical digital 32 34C 4 e Care at birth 7 Light examination mobile 220 12 V 4 e Provision of warmth 8 Hub Cutter syringe 1 e Resuscitation Renewable Resources e Monitoring of vital signs 9 I V Cannula 24 G 26 G e Initial care and stabilisation of sick newborns 10 Extractor mucus 20ml ster disp Dee Lee Care of low birth weight newborns 11 Tube feeding CHO7 L40cm ster disp
35. age Protocols for asepsis and hand washing are in Annexure 2 e lt should be a hands free elbow operated hand washing station e Hand washing sinks should be large enough to control splashing and designed to prevent standing or retained water Preferably the hand washing sink should be 24 wide x 16 front to back x 10 deep The size of a sink is also a consideration in infection control Very deep sinks create big splashes as the water usually strikes from a distance The splashed water must be considered to be contaminated whether the sink is made of stainless steel or porcelain Very wide front to back sinks cause the hand washer to lean into the sink again contaminating clothing Countertops around sinks should also be avoided as staff and parents tend to put items on them These counters must also always be considered to be contaminated e Space for pictorial hand washing instructions should be provided above all sinks e Walls adjacent to hand washing sinks should be constructed non porous non absorbent material to prevent growth of moulds e Space should be provided for soap and towel dispensers and for appropriate trash receptacles A 4 2 3 Examination area This should include comfortable seating and allow complete visual and acoustic privacy 4 2 4 Mother s area Comfortable seating and privacy should be provided within the unit to allow mothers to breastfeed comfortably This area sho
36. as those required for individual care equipments required for disinfection laboratory equipments and general equipments 2 To accommodate differences in development and availability of supporting services such as laboratory central sterile supply and diagnostics the listed items are classified as essential these should be available and desirable items these could be available or could be drawn from shared resources within the hospital 3 For each of the items it has been identified whether installation by a supplier is recommended and if pre installation assessment amp training is necessary 4 Many equipments have potential implications on civil mechanical and electrical systems of the unit and should be taken into consideration while setting 11 Example reading Tables 1 to B 4 Item Item Description N 8 No t o o o o gt dz SEE 2 E S 5 cs t o A Sw 2 E gt iu 1 Open care system radiant warmer E 12 Vv J J NA NA fixed height with trolley drawers O2 bottles The table above depicts that 12 numbers of open care radiant warmers are essential for a 12 bedded unit It is recommended that installation is conducted by the supplier and that the staff is trained in its use The installation will have implications for civil mechanical and electrical syst
37. born through Meconium stained amniotic fluid D Decontamination i ii Washing and rinsing Dissemble as shown on the reverse e Wash in warm water using a detergent e Rinse in clean water Disinfection Sterilisation Except reservoir whole bag can be boiled autoclaved or soaked in disinfectant solution After soaking in disinfectant clean with distilled water or running water Dry the valves and then reassemble 66 Suction machine Foot operated Parts Suction catheter Suction tubing Suction bottles Using the foot suction 1 Connect suction catheter to patient end of silicone tubing of machine 2 Place the foot suction on floor across and in front of resuscitation trolley with bellows on right side if you use your right foot and fluid collection jar on left side 3 Ensure that foot suction is close to resuscitation trolley so that it can be operated while resuscitating the baby 4 Ensure that suction catheter is placed on baby mattress and tube length is not short Use 8Fr to 10Fr catheters for Oropharyngeal suction 5 Place right foot on bellows and press down ensuring that it slides down in contact with the central vertical metal plate This ensures that the bellows do not tilt outwards preventing slipping of foot 6 Foot pressure can be adjusted to ensure adequate suction pressure 7 Pinching the suction catheter end press bellows and check for suction pressure N B for safety of
38. bs are on Trouble shooting If Unit is not switching on check the following e Mains Socket change to another socket e Fuse e Loose contact in the plug or a damaged mains cord If any Tube is flickering Do the following and check e Change starter to the lamp e Change lamp After doing the above procedure s if the unit is still having problem call qualified technician to repair the unit Cleaningldisinfection e Use moist or dry cloth to clean unplugged unit e Ensure the reflectors remain dust free 65 Resuscitator ambu bag self inflating bag A Parts Valve assembly Patient outlet Air inlet Oxygen inlet Safety valve Body of the bag o ooo B Test function e Block patient outlet or mask by palm of your hand e Squeeze the bag i You should feel pressure against your hand ii Check opening of inspiratory valve iii With higher pressure one can open pop off safety valve e Procedure e Choose appropriate size of the bag and mask e Position the baby in a sniffing position Slight extension e Provide tight seal Use finger tips to generate enough pressure to move chest of baby Observe for improvement in heart rate colour and chest rise Follow the rhythm Squeeze two three ensure 40 to 60 breaths per minute For prolonged bag and mask insert an orogastric tube and then continue bag and mask Do not use bag and mask for suspected diaphragmatic hernia and babies
39. ce is produced by ISO 9001 certified manufacturer e Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with 50 3 x cuff hose infant 2 x sets of 5 neonate BP cuffs No 1 3 1 5 7 cm No 2 4 3 8 cm No 3 5 8 10 9 No 4 7 1 13 1 No 5 9 6 14 3 cm 1 x patient cable 1 x box neonatal ECG electrodes 200 sets of 3 electrodes chest and or extremities diameter approx 22mm ultra soft gel self adhesive 2 x skin temperature transducers 2 x reusable SpO2 sensors neonate clip on type including connection cable Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners e 10 x reusable SpO2 sensors neonate wrap around type including connection cable e 1 x spare rechargeable battery e 1 spare set of fuses e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English e List of priced accessories e List of priced spare parts e List with name and address of technical service providers in India e Training and installation at end user site e Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel 30 ECG unit channel portable SET refer to material 50002062 e Digital recorder of rest Electro Cardio Gram ECG Records 12 leads simultaneous aVR aVL and
40. cessories List of priced spare parts List with name and address of technical service providers in India Training and installation at end user site Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 36 Autoclave steam bench top 201 electrical e Stand alone bench top autoclave 20 L automatic e Single door self sealing with high quality silicone gasket e Chamber diameter ca 25 cm depth ca 45 cm e Pre set automatic cycles for unwrapped instruments wrapped instruments packs slow exhaust and drying cycles e Two automatic programmes approx 2 2 bar at 134 C and 1 1 bar at 121 C e Panel reports temperature pressure and time low water level as well as system errors f e door Fit with 5 L water reservoir manual fill autonomy for at least 10 cycles Power shut off upon completion of cycle With 3 removable shelves Double safety door locking device Safety feature protect against over pressure and over temperature Audible and visual alert upon cycle interruption or completion unwrapped cycle time cold 30 min hot 20 min Control panel with alpha numerical display and cycle indicators Complete with 3 instruments trays Power requirements 220 V 50 Hz single phase Power consumption 3000 W Device is produced by ISO 9001 certified manufacturer Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with e 1x set of matching instrument baskets
41. creasing lighting levels for other babies in the room Since intense light may be unpleasant and harmful to the developing retina every effort should be made to prevent direct light from reaching an infant s eyes Procedure lights with adjustable intensity field size and direction can help protect an infant s eyes from direct exposure and provide the best visual support to staff Procedure light that comes inbuilt with radiant warmers is often sufficient for procedures and no separate lights are required A 6 3 Illumination of support areas Illumination of support areas within the SCNU including the charting areas medication preparation area reception desk and hand washing areas should be adequate In locations where these functions overlap infant care areas such as close proximity of the staff charting area to infant beds the design should nevertheless permit separate light sources with independent controls so the very different needs of sleeping infants and working staff can be accommodated to the greatest possible extent Care must be taken however to ensure that bright light from these locations does not reach an infant s eyes A 6 4 Day lighting At least one source of daylight should be visible from baby care areas either from each room itself or from an adjacent staff work area When provided external windows in the rooms should be glazed to minimise heat gain or loss and should be situated at least two feet
42. d lenght approx 3 m Power requirements 220 50 Hz Power consumption 50 W Device is produced by ISO 9001 certified manufacturer e Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with e 1 spare halogen bulb e 1 spare set of fuses e User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India Assembly and installation at end user site Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 18 Centrifuge hematocrite bench top up to 12000 rpm including rotor Technical Specifications e Benchtop centrifuge for quick assessment of hematocrit e Rotation upto 12000 rpm adjustable in increments of 100 Timer settable in minutes maximum preset 99 minutes Safety lid lock feature and emergency lid release Motor overheating protection and imbalance shut off Digital display shows rpm and time Angle rotor 24 positions maximum approx 16000 rcf Power requirements 220 V 50 Hz Power consumption 200 W Device is produced by ISO 9001 certified manufacturer e Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with e 1 x box of micro capilary tubes inner diam 1mm length 7mm heparinzed 1 x pack of sea
43. daily if occupied Daily Incubator If unoccupied clean with 296 Bacilloid The following are the different colour drums with c Blue drums bags different colour polythene for different types of Infected plastic waste such as used disposable waste to be disposed of in a different way syringes needles first destroy the needle in the needle destroyer Used sharps blade and a Black drums bags broken glass should be discarded in puncture Left over food fruit feeds vegetables waste paper proof containers before discarding Patients packing material empty boxes bags etc This IV set BT set ET tube catheter urine bag waste is disposed of by routine municipal machinery etc should be cut into pieces and disposed of in blue bag This waste will be autoclaved to b Yellow drums bags make it non infectious This is then shredded Infected non plastic waste e g human anatomical and disposed of waste blood body fluids placenta etc This type of waste requires incineration 62 Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Annexure 4 Instructions for equipment and equipment use Radiant warmer e Ensure that the temperature of the room is 22 C e Place the warmer away from air currents e Clean the mattress and platform and cover the mattress with clean linen sheet e When it is known beforehand that a baby is to arrive in the newborn unit turn on the warmer at
44. duated mechanical stage travelling approx 50 x75 mm focusing object slide by moving the stage Adjustment system course and fine adjustment Magnification range 40X to 1600X binocular observation tube inclined Objectives minimum achromatic 4X 10X 40X spring loaded 100X spring loaded oil immersion field numbers Eyepieces pair Huyguenian or widefield 10X 16X field number inter pupillary distance and diopter adjustment Magnification optics anti fungus treated Illumination built in halogen bulb at least 6V 20W 2 pieces provided and detachable mirror Condenser type Abbe min 1 25 NA with centring and adjustment by rack and pinion including iris diaphragm lever and dark field stop Coloured filters daylight blue Power requirements 220 V 50 Hz complete with transformer Power consumption 50 W Device is produced by ISO 9001 certified manufacturer Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with 56 1 x detachable power cord 1 x cleaning kit brush non frying cloth non hazardous cleaning solution lens tissue paper 1 x bottle immersion oil 2 x eye shades 1 x pair of tube caps 2 x spare halogen bulbs 1 x airtight plastic cover to protect against dust and changing humidity 1 x spare set of fuses User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced ac
45. duced by ISO 9001 certified manufacturer Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with 1 x box of 100 cuvettes x box of 100 sterile lancets x cleaning set x calibration set x dust cover x storing case spare set of fuses User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India Training and installation at end user site Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel 1 1 1 1 1 1 20 Photometer Hb refer to material 50010112 Technical Specifications 44 Bench top point of care blood haemoglobin meter Direct reading photometery determining total amount of haemoglobin in whole blood On switch and auto off Automatic zero setting between measurements Dual wavelength measurement 570 and 880 nm Sample size 5 ul of whole blood on disposable cuvette Measuring time appprox 30 to 120 seconds Measuring range approx O to 20 mmol l or O to 250 mg dl Accuraccy equivalent to laboratory spectrophotometer Large LED display readable in low light working situations display cover durable plastic Display mmol l and mg dl easy switch between both Results p
46. e disinfected daily using soap detergent solution or disinfection solution Response Power alarm This alarms if the mains power fails Find alternative means for heating if power cannot be fixed KMC Check the fuse System alarm electrical electronic circuit This alarms if there is an error in the Change WARMER needs repair Skin Probe failure alarm This alarm sounds if the temperature probe sensor is not connected properly or if it is not functioning properly Try to re connect the sensor correctly If this does not work it requires changing Skin temperature alarm High or Low Heater Failure gt 0 5 C Indicates heater is not working This alarm operates in servo mode only It sounds when the patient temperature differs from the SET temperature by Change to manual mode with maximum output if baby is having low temperature and adjust the temperature to try and normalise the baby s temperature If baby is having fever shift to manual mode and set appropriate heater output Check for signs of infection Change warmer needs repair 64 Phototherapy unit Protect the eyes from light using eye patches once the lights are on Keep baby naked with a small nappy to cover the genitalia Change position supine to prone after each 3 hourly from feed Place the baby as close to the lights as the manufacturers instructions allow Use white
47. ectric Parts Do s e Motor e Suction gently e Vacuum gauge with precision regulator e Maintain asepsis during the suctioning e Suction bottles procedure e Suction catheter e Use only disposable suction catheters e Suction tubing e Check adequacy of suction pressure Working Don ts e Connect to mains e Do not do vigorous and deep suction e Switch on the unit and occlude distal end to check the pressure Ensure it does not exceed Troubleshooting 100cm of water e Check fuse e Take disposable suction catheter e Check cord e Connect to suction tubing e Check earthing e Perform suction gently e Check for leakages in the bottle tubing e Switch off the suction machine Maintenance Cleaning amp Disinfection e Check for adequacy of suction pressure e Wash suction bottle with soap amp water e Change tubing if leaky or broken e Change bottle solution every day 68 Weighing machine Electronic Parts e Pan or baby tray e Weight scale display e Machine proper Working e Put on a firm even surface Wipe clean the weighing pan e Plug on and wait till the display panel registers zero e Check for and adjust zero error e Place the clean cloth paper e Press the knob to reset the reading to zero or else you will have to subtract the weight of the cloth from the total weight when baby is weighed along with the sheet e Place the baby over the cloth paper e Keep baby in the middle of the weighing pan
48. ems of the unit 12 Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Table B 1 Equipments for individual care 1 Open care system radiant warmer fixed height with trolley drawers E 12 Viv Vv Vv O2 bottles 2 Phototherapy unit single head high intensity E 6 v 3 Resuscitator hand operated neonate 250 E 2 4 Resuscitator hand operated neonate 500ml E 4 Vv 5 Laryngoscope set neonate E 6 6 Pump suction portable 220V w access E 2 V IJV 7 Pump suction foot operated E 2 8 Surgical instrument suture SET E 2 9 Syringe pump 10 20 50 single phase E 3 IJV 10 Oxygen hood 5 set of 3 each including connecting tubes E 6 11 Oxygen concentrator E 4 J IJV 12 Thermometer clinical digital 32 43 C 12 13 Scale baby electronic 10 59 4 V v 14 Pulse oxymeter bedside neonatal E 6 V v J 15 Stethoscope binaural neonate E 12 16 Sphygmomanometer neonate electronic E 6 Vv 17 Light examination mobile 220 12V E 6 Vv 18 Hub cutter syringe E 2 19 Tape measure vinyl coated 1 5m E 2 20 Basin kidney stainless steel 825ml E 4 21 Tray dressing ss 300x200x30mm E 4 22 Stand infusion double hook on castors E 1
49. f technical service providers in India Training and installation at end user site Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 14 Stethoscope binaural neonate e Double cup neonatal stethoscope e Chest piece in stainless steel with non chill plastic rim e Diaphragm approx 20 mm Sensitivity approx 3 0 dB from 50 to 500 Hz cardio Sensitivity approx 8 0 dB from 600 Hz to 1500 Hz pneumo Y tube treated rubber with large diameter Arms stainless steel or chrome brass with treated spring for lasting elasticity and comfort Removable plastic ear pieces Device is produced by ISO 9001 certified manufacturer Supplied with e 1 spare set of earpiece e 1 x spare diaphram e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories e List of priced spare parts e List with name and address of technical service providers in India 15 Sphygmomanometer neonate electronic e Digital electronic sphygmomanometer suitable for neonate Composed of cloth cuff with inflatable bag quick connected via tube to main unit Cloth is washable strong and reinforced at both ends Tube length approx 60 cm Strip of Ve
50. f the health facility Equipment and furniture Rs 2 75 000 Capacity building Rs 25 000 Sub Total Rs 6 00 000 Civil and electrical work ahs been taken at an average of Rs 3 Lakh Recurring or running cost per year does not include the salaries of staff Consumables Rs 25 000 Maintenance cost Rs 1 50 000 Sub Total Rs 1 75 000 24 Section Ill Newborn Care Corner 3 1 Designation of newborn care corner labour room Labour rooms in every facility at every level are required to have appropriate facility for providing essential care to newborns and for resuscitating those who might require it Newborn care corner in this document refers to the space within the labour room for providing immediate newborn care to all newborns 3 2 Services at the corner Newborn care corner provides an acceptable environment for all infants at birth Services provided in the Newborn care corner include e Essential Care at birth e Resuscitation e Provision of warmth e Early initiation of breastfeeding e Weighing the neonate 3 3 Configuration of the corner e Clear floor area should be provided for in the room for newborn care corner It should be within the labour room 20 30 sq ft in size where a radiant warmer is kept e Resuscitation kit should be placed in the radiant warmer Availability of oxygen source is desirable but not essential e The area should be away from draughts of air
51. fety certified according CE 93 42 FDA 510k or equivalent 37 Supplied with e 1 x spare set of tubing e 1 spare set of internal and external filters baterial e 1 spare set of fuses e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English e List of priced accessories e List of priced spare parts e List with name and address of technical service providers in India e Training and installation at end user site e Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel 11 Thermometer clinical digital 32 43 C refer to material 0481053 Digital thermometer Celsius scale with switch to Fahrenheit Safe to use atraumatic no glass no mercury Measurement range 32 C to 43 C Accurate measurement 0 1 C between 35 C to 41 C Liquid crystal display easy to read Beep sound and switch off Water proof for ease of cleaning Battery powered Low battery indicator Power requirements 220 V 50 Hz Power consumption 450 W Device is produced by ISO 9001 certified manufacturer Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with e 1x NiCad battery e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructi
52. fied manufacturer 23 Basin kidney stainless steel 825ml refer to material 50211000 Stainless steel kidney basin Capacity approx 825 ml Austenitic stainless steel composition 8 to 10 nickel 18 to 20 chromium Thickness steel 0 8 mm Length approx 250 mm Width approx 140 mm Height approx 40 mm e Device is produced by ISO 9001 certified manufacturer 24 Tray dressing ss 300x200x30mm refer to material 50279000 e Stainless steel dressing tray Rectangular with rounded corners Austenitic stainless steel composition 8 to 10 nickel 18 to 20 chromium Thickness steel 0 8 mm Length approx 300 mm Width approx 200 mm Height approx 30 mm Device is produced by ISO 9001 certified manufacturer 25 Drum sterilizing 165mm diameter refer to material 50106000 e Stainless steel cylindrical sterilising drum Austenitic stainless steel composition 8 to 10 nickel 18 to 20 chromium Lateral air vents manually closed after sterilisation Thickness steel 0 8 mm Diameter approx 165 mm Height approx 100 mm Device is produced by ISO 9001 certified manufacturer Certificate to be submitted further details see Technical Provisions 26 Stand infusion double hook on castors refer to material 50150000 Technical Specifications e Infusion stand on castors variable height support column with telescoping upper pole e Safety double hook welded to the upper pole e Support column with
53. furniture Rs 75 000 Capacity building Rs 5 000 Sub Total Rs 80 000 Recurring or running cost per year Consumables Rs 5 000 Maintenance cost Rs 15 000 Sub Total Rs 20 000 Summary 1 This document provides specific guidance for setting up newborn care services for different level of health services e All health facilities where deliveries are conducted must have skilled staff and facilities for care at birth to all newborns and to provide resuscitation of those who require it e In addition FRUs should be equipped to provide initial care and stabilisation of sick newborns and care of most low birth weight newborns that do not require intensive care e Every district hospital or sub district hospitals that conducts more than 3000 deliveries should have a Special Care Newborn Unit that is equipped to provide special care to most sick newborns except those requiring mechanical ventilation or surgical interventions 2 There should be agreed procedures for transport of sick newborns from one level of facilities to another 3 SCNU within the district hospitals must have continuous availability of qualified medical and nursing staff and resources to meet the needs of all sick babies 4 Technical specification standards for the expected levels of equipment have been established and should be adhered to Local systems for procurement maintenance and replacement of equipment are necessary 5 All neonatal units sh
54. he unit 12 Biodegradable Polythene Bag Red Blue Black Yellow The container should comprise of an inner plastic bag of varied color depending on the type of waste according to the Schedule ll and labeled according to Schedule Ill of Bio Medical Waste Management amp Handling Rules 1998 It should be of a minimum gauge of 55 micron if of low density or 25 micron if of high density leak proof and should match the chosen outer container The outer container is a plastic bin with handles amp lids and of a size which will depend on the amount of waste generated The inner polythene bag should fit into the container with one fourth of the polythene bag turned over the rim The capacity of the bag should vary according to the quantity waste generated 13 Durability The performance and safety of the device shall not be compromised by Exposure to ambient conditions of 43C 90 relative humidity for one week Supplied with 1 Necessary tools for maintenance 2 Biodegradable Polythene Bag Red Blue Black Yellow as applicable 100 per unit 46 Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 22 Tape measure vinyl coated 1 5m e Vinyl coated fibreglass measuring tape e Metal tip finishing at both ends Reads both in cm and inch Length 1 5 m 5 ft Minimal graduation 0 5 cm 0 2 inch Width approx 1 3 cm Thickness 0 36 mm Device is produced by ISO 9001 certi
55. ications e Foot operated suction pump e High performance suction pump for pharyngeal and tracheal suction e Double acting piston pump provides a combination of large airflow and high vacuum e See saw movement of pedal generates suction every time one side of the pedal is depressed e Pump chassis complete with valve diaphragms manifold pipe bottom cover cylinder with draw link and valve diaphragm piston O ring pedal with retaining springs aspirating tube with angle connector and combination suction tip Pump can be totally disassembled is easy to clean and disinfect All parts can be autoclaved at 121 C Vacuum max 600 mmHg Free airflow at two pumping strokes per second approx 30 to 40 L min All parts made of high strength long life materials not requiring specific maintenance or storage Transparent polycarbonate collection container capacity approx 1 L Bottom cover thermoplastic rubber Manifold pipe polypropylene e Gasket O rings and valve diaphragm silicone rubber e Piston rings teflon e Foot pedal aluminium e Device is produced by ISO 9001 certified manufacturer Certificate to be submitted further details see Technical Provisions e Device is safety certified according CE 93 42 FDA 510k or equivalent Certificate to be submitted further details see Technical Provisions Supplied with e 1x set of silicone rubber suction tubing approx diam 10 mm length 1 5 m e 1 x angle connector and comb
56. ile gloves e Always use sterile gloves for invasive procedures like sampling starting intravenous lines giving intravenous injections etc e Wash gloved hands to remove the blood stains and secretions Remove gloves and put in the polar bleach bucket Wash hands again with soap and water Used gloves should be cleaned dried powdered and packed in a paper e g a piece of newspaper for re autoclaving Adequate number of pairs should be prepared every day Once can use disposable gloves if available 1 3 Full sleeve gowns and masks Use them for all invasive procedures e g lumbar puncture blood exchange transfusion etc 1 4 Other basics Keep separate spirit and betadine swab containers stethoscope tape measure and thermometer for each baby Change intravenous sets daily or as per set routine Feeding tubes as long as baby can keep Do not keep FOMITES e g files X ray films pens etc on the baby cot Change antiseptic solution in SUCTION BOTTLES and sterile water in oxygen humidification chambers everyday and sterilise the bottles chambers daily by dipping in 296 gluteraldehyde for 4 to 6 hours 1 5 Nursery environment Floor should be cleaned with diluted phenyl once in each nursing shift and as and when required No dry mopping only wet cleaning should be done Clean the walls with 296 of bacillocid once in each nursing shift Dustbin should be washed daily with soap and water Polythene shou
57. ination acetal suction tip e 1 x spare valve diaphragms e 1 x spare piston O ring e 1 x spare retaining springs e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English e List of priced accessories e List of priced spare parts e List with name and address of technical service providers in India e Assembly and installation at end user site 34 Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 7 Surgical instrument suture SET e Suture instruments set consisting of e 0 0 x Scissors Deaver 140 mm curved sharp blunt Surgical operating scissors model according Deaver Curved with one pointed and one blunt end blade Martensitic steel quenched magnetic steel stand mat 50773550 x Needle holder Mayo Hegar 180 mm straight Ratchet enables needle to be gripped with varying tightness model according Mayo Hegar Defined longitudinal groove to prevent deterioration of the needle Jaws with pronounced ridges Martensitic steel quenched magnetic steel stand mat 50743600 x Forceps artery Kocher 140 mm straight Haemostatic forceps model according Kocher Slightly springy flexible arms Variable setting of the ratchet Adjustment of the jaws Martensitic
58. ity of 1 000 to same rating is needed Monitors must have UPS e Electrical outlet for individual beds To handle equipment 6 8 central voltage stabilised outlets are required per bed 4 of them should be of 5 amperes and another 4 of 15 amperes Two alternate sockets for mobile bed side X ray equipment or USG machine need to be planned 2 000 litres e Lighting of the unit The unit should be well illuminated with adequate daylight Panel ni of lights with cool white fluorescent tubes A 6 Lighting preferably CFL or LED light emitting diodes will be required for adequate illumination A 6 1 Ambient lighting Perception of skin tones is critical in a SCNU light sources should provide accurate skin tone recognition Light sources should be as free as possible of glare or veiling reflections e II TTT A 5 2 Mechanical needs e Floor surfaces Floor surfaces should be easily cleanable and should minimise the growth of direct view the electric light source or sun shall be permitted in the newborn space this does not exclude direct procedure lighting as described below Any lighting used outside the baby area shall be located so as to prevent any newborn s direct line of sight to the fixture Lighting fixtures should be easily cleaned A 6 2 Procedure lighting in baby care areas Temporary increases in illumination necessary to evaluate a baby or to perform a procedure should be possible without in
59. lcro fastening length can be adjusted to fit around neonate upper arm Measuring range up to 300 mmHg Minimum graduation 1 mmHg Accuracy 5 Large LCD display readable in low light working situations display cover durable plastic Displays reports systolic diastolic and mean pressure and heart rate Power requirements 220 V 50 Hz with adapter internal re chargeable batteries or replaceable batteries autonomy approx 6 hrs automatic recharge e Power consumption 30 W e Device is produced by ISO 9001 certified manufacturer e Device is safety certified according CE 93 42 FDA 510k or equivalent 41 Supplied with 1x storage case 2 x spare cuffs User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India e Training and installation at end user site 16 Refrigerator hot zone 110L See WHO minimal performance specifications for refrigerators 17 Light examination mobile 220V 12V Mobile light for medical examination Stand with 5 anti static swivel castors Articulated arm 105 cm spring loaded with on off switch and integrated transformer Halogen bulb 12V 20W Light intensity approx 20 000 Lux at 40 cm Natural white light colour temperature 4000 K Reflector adjustable for positioning Power cor
60. ld be changed daily or whenever full Accessed from Essential Newborn Nursing newbornwhocc org essential newborn nursing training htm 59 2 Hand washing e It is the single MOST IMPORTANT means of preventing nosocomial infections e tis VERY SIMPLE and CHEAP 2 1 Hand washing norm e Two MINUTES hand washing 6 steps to be done before entering the unit e 20 second hand washing to be done before and after touching babies 2 2 Steps of effective hand washing e Roll sleeves above elbow e Remove wrist watch bangles rings etc e Using plain water and soap wash parts of the hand in the following sequence Palms and fingers and web spaces Back of hands Fingers and knuckles Thumbs Finger tips Wrists and forearm up to elbow DUI WH Once you have washed your hands do not touch anything e g hair pen or any fomite till you carry out the required job e Keep elbows always dependent i e lower than your hands e Close the tap with elbow e Dry hands using single use sterile napkin or autoclaved newspaper pieces e Discard napkin to the bin kept for the purpose If newspaper pieces discard in the black bucket e Do not keep long or polished nails Remember Rinsing hands with alcohol is NOT A SUBSTITUTE for proper hand washing Poster on hand washing should be displayed at all hand washing stations A Sample poster used in the Neonatal unit at Department of Pediatric All India In
61. ling compound for micro capilary tubes 1 x spare set of fuses User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India Training and installation at end user site e Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel 19 Photometer glucose refer to material 50010110 Technical Specifications e Bench top point of care blood glucose meter Direct reading photometry determining total amount of glucose in whole blood On switch and auto off Automatic zero setting between measurements Dual wavelength measurement 660 and 840 nm Sample size 5 ul of whole blood on disposable cuvette Measuring time appprox 30 to 120 seconds Measuring range approx to 20 mmol l or O to 400 mg dl Accuraccy equivalent to laboratory spectrophotometer Large LED display readable in low light working situations display cover durable plastic Display in mmol l and mg dl easy switch between both Results printable via external printer connecetd on RS232 or equivalent 43 Power requirements 220 V 50 Hz with adapter and internal re chargeable batteries autonomy approx 6 hrs automatic recharge Power consumption 30 W Device is pro
62. luids Do not use a single dextrose saline bottle for gt 24 hours e Label the bottle with date and time of opening e After seal is removed first clean with spirit swabs then use Betadine soaked sterile cotton to cover the stopper of the bottle e Change the burette set every 24 hours or as per policy of your unit e Use syrups within 1 week of opening write the opening date e Antibiotics vials to be changed after 24 hours E g injections Ampicillin and Cefotaxime e There is no need for flushing with heparinised saline to keep the IV line patent e Use separate IV line of giving antibiotics do not open the IV fluid line for giving injections Safe disposal of hospital waste Proper disposal of hospital waste is important to keep the environment clean The waste should be disposed of in a proper way All health professionals should be well conversant with their local hospital policies for waste disposal which may vary from place to place Name of equipment Disinfection method Baby linen blanket Wash and autoclave Blanket Cover Other considerations Use autoclaved linen each time Cotton gauze Autoclave as required Every time use autoclaved cotton Feeding utensils paladai spoon amp katoris etc then boil for 10 minutes Wash with soap and water before each use Swab container injection and medicine tray Sets for procedures Autoclave Wash with soap and water autoclave Daily morni
63. me and address of technical service providers in India Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 5 Pump suction portable 220V wiaccess Technical Specifications Portable suction pump with 1 litre plastic jar Dismantable for easy cleaning jar autoclavable Shock resistance protects from dropping Light easy to carry and keep clean Jar with plastic cover gasket and overflow valve With suction regulator vacuum gauge Size approx 260 x 180 x 220 H mm Suction power 17 L min Vacuum max 800 mmHg Power requirement 220 V 50 Hz Power consumption 100 W Device is produced by ISO 9001 certified manufacturer Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with 1x set of silicone rubber suction tubing approx diam 10 mm length 1 5 m 1 x spare jar with cover 1 x spare set of fuses User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India Training and installation at end user site Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel 33 6 Pump suction foot operated refer to material 50760640 Technical Specif
64. nalised the draft Dr Marzio Babille believed that quality healthcare is possible for newborns in India and engaged partners to translate the belief into reality This toolkit is a step in that direction The preparation of the toolkit was funded by UNICEF from a contribution by Norway India Partnership Initiative Contents Page No 5 INTRODUCTION eec THE 1 Description of newborn care facilities at different health setting levels 2 Section Special Care Newborn 3 Part A Setting up of a special care newborn unit in a district hospital 4 AN Services atthe A 4 A 2 Location and size of the Unit 4 Minimum space requirement eee meme emen mese enne en emen ese rese enne nnns 5 Configuration of Rien 5 Electrical and mechanical needs 7 A 6 Lighting 7 7 Ambient temperature and ventilation 8 8 ACOUSTIC 8 Part B Guide for equipmen
65. nds of syringes e Programmable user entry infusion volume and time or flow rate e Rate adjustable 1 to 999 ml h steps of 1 ml h e Accuracy ca 1 of total volume delivered e With occlusion detection and alarm e Display reports systems errors end of infusion and built in battery status e Audio visual alarm with silencing feature for audio alarm e Automatic switch from mains to batteries in case of power failure e Power requirements 220 V 50 Hz or internal re chargeable battery autonomy approx 6 hrs automatic recharge e Power consumption 50 W e Device is produced by ISO 9001 certified manufacturer e Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with e 1 x spare battery e 1 spare set of fuses e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English e List of priced accessories e List of priced spare parts e List with name and address of technical service providers in India e Training and installation at end user site e Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year 36 ii on call technical interventions spare parts and travel Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 9 Oxygen hood S and M set of 3 each including connecting tubes e Round shape 3 x size small approx
66. newborn maximum suction pressure is limited to 100mm Hg irrespective of foot pressure 8 In case thick mucous plug blocks the suction inlet switch suction tubing to alternate suction inlet provided on the rubber stopper Cleaning sterilisation 1 The foot suction must be cleaned immediately after use Empty the fluid collection jar Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 2 The fluid collection jar and silicone tubing can be autoclaved at 124 C This can also be washed with soap and water 3 Wash the rubber stopper with soap and water and rinse thoroughly 4 Re assemble when dry 5 Replace in carry case N B Rubber lid for fluid collection jar cannot be autoclaved Wash thoroughly with soap water rinse and dry 6 Empty fluid jar immediately when filled to more than half mark Do s e Suction gently e Maintain asepsis during the suctioning procedure e Use only disposable suction catheters e Check adequacy of suction pressure Don ts Do not do vigorous and deep suction Troubleshooting Check for leakage in the bottle tubing In case fluid jar cannot be emptied immediately when full to prevent overflow of fluid into the bellows open the alternate suction inlet No suction pressure will be created even if bellow is compressed Maintenance Check for adequacy of suction pressure Change tubing if leaky or broken 67 Suction machine El
67. ng shift Use separates swab containers for each baby After each use Every 72 hours if unused Cheattle forceps Autoclave Daily Put in sterile autoclaved bottle containing dry sterile cotton Stethoscope measuring tape thermometer swabs BP cuffs probes of Radiant warmer Incubator pulse oximeter Clean with spirit Daily Laryngoscope after each use Clean with spirit swab thoroughly daily and If used for an infected baby wash with soap and water Put the blade in 2 gluteraldehyde after removing from gluteraldehyde wrap in autoclaved cover and mark date on the cover 61 Disinfection protocols cont Name of equipment Disinfection method Oxygen hood Wash soap amp water Other Considerations Daily dry with clean linen Face mask Clean with soap and water immerse in Gluteraldehyde for 20 min rinse in distilled running water dry and wrap with autoclaved Daily and after each use linen Resuscitation bag and Clean with soap and water after dismantling Weekly for resuscitation bag and reservoir reservoirs oxygen tubing Immerse in gluteraldehyde for 4 6 hours Daily for others Use savlon for suction bottle and tubing of Rinse in distilled water Dry wrap in bottles Change daily suction machine autoclaved linen and put a date Weighing machine Wipe with 296 Bacillocid Daily in morning shift and when required Radiant warmer and Clean with soap water
68. nge of information with the end user and replacement model should be provided for the technical staff about the status of the device period of the repair 2 Function and performance check up of the 5 It includes working hours travel cost boarding device 3 Technical check up of device based on the manufacturer s technical checklist and lodging if applicable of the service engineer s Detailed instructions on use of Open care Radiant warmer Phototherapy units resuscitation bags foot operated suction machine electrically operated suction machine and weighing scale are provided in Annexure 3 4 Assessment of wear and tear of the device with notification if incorrect use of the device is noted 5 Cleaning parts beyond reach or capability of the end user 19 Part Human Resources Staffing Successful provision of quality services by an SCNU depends not on the equipped unit but on the availability of round the clock clinical expertise backed up by monitoring devices and equipment Well trained nurses and medical staff form the backbone of the service Thus the unit should have the required number of appropriately trained and qualified nurses There should be a designated consultant pediatrician responsible for the clinical standards of the care of newborn babies While the available manpower for SCNU will differ from state to state the basic principles are e At least two dedicated staff nurses per
69. ns should screwed nailed plus glued e Device is produced by ISO 9001 certified manufacturer Supplied with e User manual with trouble shooting guidance in English e List of priced accessories e List of priced spare parts e List with name and address of technical service providers in India e Assembly and installation at end user site 52 Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 32 X Ray mobile e Mobile x ray system for low volume setting at NICU department Heavy base on castors with 4 anti static swivel wheels 2 with breaks Rotation of arm approx and 120 degree e Output power 2 5 kW e kV range 40 to 100 kV e Coarse and Finer adjustment of Voltage kV e Output waveform high frequency max ripple 5 kV e mA range 1 6 to 63 mA e mAs range 0 32 to 200 mAs e Exposure time adjustable 20 ms to 5 sec e X ray tube BEL DSA7 stationary anode tube e Focal spot 1 4 x 1 4 mm e inherent filtration lt 1 5 mm AI e Unit dimensions 65 x 142 x 142 cm width x height x length e Adjustable Timer e Power requirements 220 V 50 Hz e Power consumption 3000 W e Device is produced by ISO 9001 certified manufacturer e Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with e 1x set of 3 empty cassettes e 1 x set of matching of films e 1x set of 2 aprons lead protection e 1 x set of 3 gonad shields neonates 2 mm lead equivalen
70. of newborn care facilities at different levels Special Care Newborn Unit SCNU The Special Care Newborn Unit SCNU is a neonatal unit in the vicinity of the labour room that provides care to all sick newborns except for those requiring assisted ventilation or major surgery Details of services provided and requirement for equipment supplies training and human resources are available in Section Neonatal Stabilisation Unit The Neonatal Stabilisation Unit is a facility within or in close proximity of the maternity ward where most sick and low birth weight newborns can be taken care of All First Referral Units FRUs need to have a Neonatal Stabilisation Unit in addition to a Newborn Care Corner Details of services provided and requirement for equipment supplies training and staffing are available in Section Newborn Care Corner This is a space within the delivery room where immediate care is provided to all newborns This area is MANDATORY for all health facilities where deliveries take place Details of services provided and requirement for training equipment and supplies are available in Section The following table summarises the required newborn care facilities at different levels Table 1 Newborn care facilities at different health care levels Health Facility All Newborns at Birth Sick Newborns Primary Health Centre Newborn care corner in labour rooms Prompt referral Community Health Center Newborn care corner
71. ons in English 38 Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 12 Scale baby electronic 10 kg lt 5g gt Electronic scale for weighing babies Measuring range O to approx 10 kg Minimum graduation 5 g With tare function On switch and auto off Auto calibration with each scwitch on Large LED display readable in low light working situations display cover durable plastic Display kg and 165 easy switch between kg and lbs Reading time max 5 seconds Zero weighing adjustment Freeze reading feature Smooth surface finishing allows for easy cleaning disinfection All vital parts made of rust proof materials Horizontal levelling with height adjustable feet Splash proof and shock resistant light weight body Power requirements 220 V 50 Hz Power consumption 150 W Device is produced by ISO 9001 certified manufacturer Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with 1 x spare set of fuses User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India Training and installation at end user site 39 13 Pulse oxymeter bedside neonatal Compact portable bedside pulse oximeter with LCD display Continuous monitoring of
72. ould comply fully with Clinical guidelines e Quality assurance Follow up of high risk survivors Monitoring service provision and access e Training and continuing education Mothers should be encouraged to be involved in care of their sick newborns at every level All units should provide the environment that supports mothers to be involved in the care of their newborns 27 Annexures Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Annexure 1 Estimating number of beds required for SCNU The number of beds that would be required for a particular hospital can be estimated based on factual information as below Average number of live births in last 2 years A No of live births requiring special care B 15 x A No of bed days required assuming an average stay of 7 days C Bx 7 No of special care beds required D C 365 An extra allowance of 30 per cent beds for extramural births E Dx 30 29 Annexure 2 Generic specifications for the equipments 1 Open care system on trolley with drawers with radiant warmer 02 provision Technical Specifications Mobile newborn resuscitation table with fixed height radiant warmer Antistatic castors 2 with breaks Table surface with mattress with infant head shoulder support Mattress padding foam density approx 21 25 kg m Mattress cover removable with zipper waterproof wash
73. oustically isolated Two sample designs of SCNUs are depicted as follows Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners D rh ALUMINIU BATH ROOM PARTITION DI 1 75X1 15 w TI 2 35 3 57 pane at w WAITING D il i STORE SISTER 6990 0 i d L Ww D TEN iii EI i PARTITION Sem mn w tr Cage rg cursors ALUMINIUM H UNIT amp PARTITION EH DI Vi 75 0677 S Ii f 0 waste 0 w D CONTROL 3 6MX4 8M E Z1 EH rH 2 9MX10 0M E L w Q w und D DG m pum Ten O HH unit E 6mX6m Jig Lj AI p Mee 0 T m DI A STEPDOWN m UNIT Eq E D WT 0 WAY TO NEW
74. perature at 36 5 C heater output will adjust automatically to keep baby at set temperature If baby temperature is below the set temperature the heater output will increase if baby is at set temperature or higher the heater output will become zero Look for probe displacement when the baby is in servo mode Check for and ensure proper probe placement every hour Manual Mode Once connected to mains heater output regulated by knob on front panel The output is displayed as or bars or bulbs Use maximum 100 output for rapid warming of bassinet in labor room 10 minutes before delivery Reduce output to 25 75 after 10 minutes depending on ambient temperature If left on with heater output gt 80 alarm is activated within 15 or 20 minutes later and there after the 63 Alarms the servo radiant warmer No alarms manual mode Alarm heater output goes to 40 if alarm is silenced the heater will kept on for another 15 to 20 minutes as per manufacturers recommendation For low birth weight or sick neonate adjust heater output depending on baby temperature Never use full 100 heater output unsupervised Record baby temperature every 2 4 hourly Problem Use this mode only for pre warming during resuscitation and initial stabilisation For disinfection For daily cleaning of front panel use damp cloth soaked in mild detergent soap water Don t use spirit or other chemical Bassinet cot should b
75. rintable via external printer connecetd on RS232 or equivalent Power requirements 220 V 50 Hz with adapter and internal re chargeable batteries autonomy approx 6 hrs automatic recharge Power consumption 30 W Device is produced by ISO 9001 certified manufacturer Device is safety certified according CE 93 42 FDA 510k or equivalent Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Supplied with x box of 100 cuvettes x box of 100 sterile lancets x cleaning set x calibration set x dust cover x storing case spare set of fuses User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India e Training and installation at end user site e Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel 21 Hub cutter syringe 1 Material used will have e The cutting blade of the cutter will be made of stainless steel IS 6911 of 1992 e The thickness of the blade will not be less than 0 5 mm with one side sharpen to cut minimum of 10 000 cuts All other metal if used in the hub cutter will be made of galvanized carbon steel which will withstand rusting even in rough weather
76. rovided Dedicated space can also be allocated for electronic medical record keeping e clerical area 12 bedded SCNU should be located near the entrance to the unit This will also enable personnel to supervise traffic into the unit e Newborns charts computer terminals and hospital forms may be located in this space e Design of the unit must anticipate use of electronic medical record devices such as computers so that their introduction does not significantly disrupt functions of the unit or impinge on the space designed for other purposes A 4 3 4 Linen washing laundry area f laundry facilities are not provided a separate laundry room can serve the functions of laundry Space should accommodate a washing machine with dryer Placement of an automatic washing machine with dryer promotes the efficiency and effectiveness of the aseptic cleaning process A 4 4 Staff support space Space should be provided within the unit to meet the professional personal and administrative needs of the staff e These areas include doctors duty room nurses changing room etc e Rooms should be sized and located to provide easy access to the SCNU A 4 5 Step down area rooming in facility An additional five bed step down area where recovering neonates can stay with their mothers before discharge is of added advantage to a SCNU This will relieve the pressure on the SCNU to some extent The additional space requirement
77. s D 60 Solution stain Gram 100ml D 16 Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Part C Technical Specifications of the Equipments Knowing the correct generic specifications of the medical devices supporting technical integrity and quality for equipment are critical to ensure that appropriate equipments of appropriate quality and safety are procured Detailed specifications of the newborn care equipments are provided in Annexure 2 17 Part D Asepsis and Housekeeping Protocols Maintenance of asepsis is extremely critical in newborn care units It requires laying down of clean housekeeping protocols of following them stringently Details of asepsis and housekeeping protocols are mentioned in Annexure 3 18 Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Part E Annual Maintenance Contract AMC Specific Coverage and Requirements for Critical Equipments After sales technical services in the context 6 Adjustment and calibration of the device of maintenance start right from the time of 7 All necessary materials to complete the installation of the equipment The training preventive maintenance and installation offered by suppliers ought to 8 Repetition of user and technical training for include i user training ii technical training and current and new hospital staff iii basics of the clinical
78. shift are necessary for a 12 bedded unit Thirty per cent extra staffing is recommended to account for nights off and leave vacancies e There should be an adequate number of doctors to be able to take a round of the newborns once in each shift every eight hours and to be on call round the clock 20 e Dedicated support staff should be there to clean the nursery at least once every shift and more often depending on the need For a 12 bed unit the recommended staffing is e Staff Nurses 10 e Physicians 3 e Support Staff 4 Training It is suggested that the medical and paramedical staff working in an SCNU should undergo e initial training program for 4 5 days e An observer ship at medical college or an equivalent facility for at least two weeks 12 working days National Neonatology Forum www nnfi org and WHO Collaborative Center for Training and Research in Newborn Care www newbornwhocc org supports training programs for physicians and nurses and could be contacted Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners Part G Cost Cost can be broken down into capital cost and recurrent cost While the cost will vary widely due to various factors indicative costs for a 12 bed unit is summarised below Renovations and civil works average of 16 lakhs Rs 12 00 000 20 00 000 Highly variable depending on the state of the health f
79. solid mechanism to fix upper pole at required height e Heavy base on castors with 5 anti static swivel wheels e Knock down construction e Must be resistant to corrosion and decontamination chlorine solution e Frame stainless steel 18 10 bright polished or satin finishing e Adjustable height approx 140 to 200 cm e Tubes approx diam 25 30 x 1 5 mm e Swivel castors approx diam 50 mm e To clean and disinfect e Device is produced by ISO 9001 certified manufacturer Certificate to be submitted further details see Technical Provisions Supplied with e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English e List of priced accessories e List of priced spare parts e List with name and address of technical service providers in India e Assembly and installation at end user site 48 Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 27 Indicator TST control spot PAC 300 e TST temperature steam time control indicator e Self adhesive coloured spot attachable to steam sterilizing containers e Operational range 121 C 15 minutes e Colour change irreversible when sterilised corrected from yellow to blue e Packed in box of 300 TST control spot plus 1 record sheet e Device is produced by ISO 9001 certified manufacturer Supplied with e User manual with trouble shooting g
80. stitute of Medical Science is shown bellow HAND WASHING A SIMPLE AND EFFECTIVE METHOD FOR PREVENTION OF NOSOCOMIAL SEPSIS Golden rules Remove all jewelry and watch before hand washing Roll the shirt to above elbow level Wet and apply soap on hands and forearm up to elbow level A normal non medicated soap is good enough Dry hands either in air or by single use sterile towel or sterile paper Multiple use cloth towels are not recommended Alcohol based hand rub solutions may be used as an alternative The 5 solution should be spread all parts of the hands follow Above steps rub hands to dry Wash hands for 2 complete minutes before entering NICU amp before any procedure Wash hands for at least 20 seconds before and after touching baby www newbornwhocc org Division of Neonatology Department of Pediatrics All India Institute of Medical Sciences 60 3 Skin preparation for venepuncture and other procedures Skin preparation is an import part of asepsis routines It should be performed meticulously to avoid entry of pathogens during insertion of IV cannula pricks or procedure Always wear sterile gloves after two minutes of thorough hand washing The procedure of skin preparation is given in the box below incture Disinfection protocols Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 4 Other recommendations e Never use stock IV f
81. t e 1x set of 10 lead numbers O to 9 e 1 x set of lead letters to Z b pcs of each e 1 spare set of fuses e User manual with trouble shooting guidance in English e Technical manual with maintenance and first line technical intervention instructions in English e List of priced accessories e List of priced spare parts List with and address of technical service providers in India Training and installation at end user site e Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel 53 33 Transport incubator basic with battery and 02 w o ventilator Double wall transparent canopy with mattress mount on stretcher Front and head access door slide out mattress tray With baby restraining straps Warm air circulation system Bacterial filter to remove air born particles Incubator air temperature monitoring and servo control 25 to 38 C increments 0 1C Digital displays outside shows air temperature Two 10 L integrated oxygen cylinders regulator and flow meter Audiovisual alarms high low air temperature temperature sensor failure power failure and low battery Construction dismantleable allows frequent washing and disinfection of the incubator Battery and AC supported Power requirements 220 V 50 Hz and internal re chargeable batteries autonomy approx 3 hrs automatic recharge Power consumption 200 W De
82. t and renewable 11 B 1 Equipments for individual care 0 13 B 2 Equipment for disinfection ee cline esate ty tenes dee same ees 14 B 3 Laboratory equipment iaia alal 14 4 General iii Rie dei IA ERE 14 B 5 Renewable and Consumables 15 Part C Technical specifications of 17 Part D Asepsis and Housekeeping Protocols 18 Part E Annual Maintenance Contract specific coverage and requirements for critical equipments ga A 2a 19 Part F HUMAN lesOUF C88 iiio tears tasca i Fa SPARE 20 Part Gi 21 Section Il cnr gj ee U 22 2 1 Setting up of stabilisation unit at first referral UNItS 23 2 2 Services at a stabilisation UNIt 23 2 3 Configuration of a stabilisation 23 2 4 Equipment and renewables required for a stabilisation UNIt 23 2 5 HUMAN TesourG8S 24 2 6 2 529
83. ted needles are being dropped into the containers it shall remain sufficiently sealed so as to prevent a hand from entering Needle should not protrude from the container when the box contains 500 needles with hub 6 Capacity of the container have sufficient capacity to hold 500 18 28 gauge 10 25 mm long needles with hub 7 Colour The container shall be translucent white in color and will allow visual inspection from outer surface to determine when the container is full 8 Technique The device shall be designed to facilitate the location and entry of the needles so that the AD syringe is cut from hub by having e a non critical angle of the needle relative to the entry point e entry target area which is recessed concave and diameter is such that it allows all type of AD syringe available in the market to cut from hub Handling Able to be carried in one hand and portable 10 Instructions Pictorial instructions in major Indian languages to be printed on the surfaces of the container to clearly describe e use of the hub cutter e Biohazard symbol as stipulated in schedule III of the Bio Medical Waste Management and Handling rules e Govt supply not for sale 11 Packaging Carton containing 20 hub cutters A separate sheet is to be provided with pictorial instructions on how to use Each carton will contain at least twenty sheets of instruction Each lot will have 1000 units and the lot number and manufacturer details outside t
84. uidance in English e List with name and address of technical service providers in India 28 Irradiance meter for phototherapy units e Handheld irradiance meter spectro radiometer for measurement the output of conventional phototherapy devices e Bandpass filter max transmission 425 to 475 nm Light detector range O to 2000 uW cm2 full bandwidth O to 40 uW cm2 nm Minimal graduation 1 uW cm2 nm Accuracy 10 Total block for IR and UV Large LED LCD or needle dial reports measurement On switch and auto off Automatic zero setting between measurements e Measuring time appprox 5 seconds e Power requirements 220 V 50 Hz with adapter or internal re chargeable batteries autonomy approx 6 hrs automatic recharge e Power consumption 30 W e Device is produced by ISO 9001 certified manufacturer e Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with e 1 x storing case e 1 x spare set of fuses e User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India Training and installation at end user site 49 29 Monitor vital sign 5 2 ECG RR Temp Compact portable suitable for all patient categories i e neonates and infants Parameters monitored ECG
85. uld have communication aides so that families can learn about newborn care practices 4 3 General support space Distinct facilities should be provided for clean and soiled utilities medical equipment storage and unit management services A 4 3 1 Clean utility holding area s Such areas should be there for storage of supplies frequently used in the care of newborns Routinely used supplies such as diapers linen cover gowns charts etc may be stored in this space Space should also be provided for storage of syringes needles intravenous infusion sets and sterile trays A 4 3 2 Soiled utility holding room This is essential for storing used and contaminated material before its removal from the care area e Unless used only as a holding room this room should contain a counter and a hands free hand washing station separate from any utility sinks e Ideally the ventilation system in the soiled utility holding room should be engineered to have negative air pressure with all air being exhausted to the outside a simple exhaust fan can also improve ventilation in the area e The soiled utility holding room should be so situated that it enables removal of soiled materials without passing through the baby care area A 4 3 3 Charting staff work areas Along with the provision of charting space on each bedside an additional separate area or desk for tasks such as compiling records completing requisitions etc should be p
86. vice is produced by ISO 9001 certified manufacturer Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with 54 1 x spare air temperature probe 1 x spare rechargeable battery 2 x empty 10 L oxygen cylinders 1 x spare set of fuses User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India Training and installation at end user site Proposal for full service AMC year 1 to 5 covering i 2 preventive maintenances per year ii on call technical interventions spare parts and travel Toolkit for Setting Up Special Care Newborn Units Stabilisation Units and Newborn Care Corners 34 Bilirubinometer total bilirubine capillary based Bench top point of care bilirubine meter Direct reading photometry determining Total Bilirubine in serum plasma On switch and auto off e Automatic calibration setting between measurements e Dual wavelength measurement 460nm and 550nm e Correcting for Hb at 550 nm e Sample size 1 capillary tube with serum plasma e Main light source 5 W tungsten lamp e Measuring range O to 700 umol or O to 40 mg 100 ml e Accuraccy equivalent to laboratory spectrophotometer approx 5 e Read out switchable between mg 100 ml of u mol l e Fast analysis time lt 5
87. with high humidity coastal region for a minimum of five year IS 277 of 2003 galvanized steel sheet specification e spring if used in the hub cutter will be made of steel wire for mechanical spring oil harden and tampered steel wire 151 4454 of 2001 revision part e sharp container should be made of Polypropylene PP of not less than 4 mm thick and should be white translucent The material should be autoclavable plastics puncture resistant high drop impact strength material should be non toxic and pyrogen free the material will not wear out with normal usage 2 Shape The shape of the container will be such that the lid is tightened with the body with a twist and cannot be opened by pulling the lid and the body in the opposite direction The container containing the cut hub along with needle of various size will be full when filled with 500 cut hub with needles 3 Capacity range Able to destroy from hub of AD syringe with needles from 18 28 gauge diameter and from 10 25 mm length and fitted with all types of needle fittings eg fixed luer lock luer ship of snap on 4 Resistance to piecing Container shall accept 500 cut needles along with the hub when it is th full filling line Needles shall not penetrate container walls when filled up to the filling line The average of forces needed to penetrate samples shall be not less than 15 N 45 5 Tamper proofing When contamina
88. y certified according CE 93 42 FDA 510k or equivalent Supplied with User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with name and address of technical service providers in India 4 Laryngoscope set neonate Laryngoscope set with neonate blades Constituted of large hollow cylindrical slightly ribbed handle and a set of depressors in stainless steel Handle is made of either chromium plated or stainless steel and can be opened at an extremity to insert two alkaline batteries LR14 size C 1 5 Volts The other end has a stud contact which fits the various sizes and types of depressors 2 x curved depressors Macintosh type No 1 approx 68 mm length with halogen bulb 2 x straight depressors Miller type No 0 approx 53 mm length with halogen bulb Presented in suitable protective plastic box Device is produced by ISO 9001 certified manufacturer Certificate to be submitted further details see Technical Provisions Device is safety certified according CE 93 42 FDA 510k or equivalent Supplied with 2 x spare halogen bulbs 1 for each depressor User manual with trouble shooting guidance in English Technical manual with maintenance and first line technical intervention instructions in English List of priced accessories List of priced spare parts List with na

Toolkit for Setting Up Special Care Newborn Units, Stabilisation

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