CHEMO

THERAPHY
&

LABORATORY
SERVICES
SUBMITTED BY-
SHAHAAB, DANISH & SAAD
INTRODUCTION
1. The treatment of cancer is complex, often involving a combination of treatment
methods to be effective.
2. The following methods may be provided, alone or in combination, as part of an
individual’s management plan:
o Surgical intervention
o Chemotherapy
o Radiation Therapy
o Hormone Therapy

CHEMOTHERAPY
1. Chemotherapy is prescribed for the treatment of diseases, especially cancers, using
specific cytotoxic agents or drugs that are destructive to malignant cells and tissues.
2. The Medical Oncology (Chemotherapy) Unit provides for the clinical treatment and
management of patients undergoing Chemotherapy treatment for cancer.
3. The function of the Unit may include:
o Chemotherapy Administration
o Administration of blood products and/or other supportive therapies
o Blood collection
o Clinical procedures and examination
o Patient and family education and support
o Clinical trial management
o Coordination of care.
CHEMOTHERAPY PROCESS MAP
HOURS OF OPERATION
• The hours and days of operation will depend on the level of service being provided.
• Units operate on a 5 to 7 day week, with 8 – 12 hour working days.
• Chemotherapy infusions administered in an outpatient facility may take from 15
minutes to 12 hours.
• Intensive and complex chemotherapy infusions that may take 1-4 days, often
involving the sequential infusion of a variety of drugs, will require a short stay in an
inpatient facility.

SUPPORT SERVICES
1. Support services that are associated with the chemotherapy service may include:
• Physiotherapy (including lymph oedema management)
• Occupational therapy
• Dietetic / Nutrition services
• Clinical Psychology
• Social work services
• Community and outreach cancer services
• Palliative Care Complementary therapies (e.g. relaxation, stress management and
massage)
• Wig and prosthesis services.
FUNCTIONAL AREAS
The Chemotherapy Unit may include the following Functional Areas:
Entry / Reception including:
• Waiting areas with amenities such as beverage making facilities, telephones, vending
machines, play area for children and toilets
• Interview room for patient/ family discussions and treatment planning
• Storage for files, stationery, wheelchairs
Chemotherapy Treatment Areas including:
• Treatment chair or bed bays
As per AUSTRALIAN GUIDELINES
• Isolation rooms as required
• Ensuites, Patient Toilets
• Treatment Room
• Cytotoxic room
Support Areas including:
• Bays for linen, resuscitation trolley, mobile equipment
• Clean and Dirty Utilities
• Cleaner’s and Disposal rooms
• IT/ Communications room
• Staff Station
• Store Rooms for equipment, general supplies
• Property bay for patients
Administration/ Office Areas with:
• Meeting Rooms
• Offices and workstations according to the service plan
FUNCTIONAL AREAS (CONTD.)
Staff Areas including:
• Staff Room
• Toilets, Shower and locker areas

Medical Imaging (optional) including key imaging modalities required for patient
treatment:
• CT Scanning rooms with control and computer equipment
• General X-ray with processing and reporting areas
• MRI with control and equipment rooms, preparation and set-up room
• Patient waiting, holding bays, change rooms and toilets

Additional considerations for chemotherapy ward as per Australasian Guidelines.

• Medication stores will need to include separated refrigerated storage of cytotoxics, blood
and medications.

• An emergency shower including eye wash is required.

• The dirty utility room will need to also accommodate a cytotoxic waste bin.

• Ideally, the chemotherapy service should be closely accessible to the oncology pharmacy
for ease of access for patients to cancer related discharge medications and for pharmacists
to provide education to patients.
FUNCTIONAL RELATIONSHIPS
Planning should address the following key issues:

External
• Ease of access to the unit where the majority of people will arrive by car on a daily basis.
• separation of walking and stretcher/ambulance patient arrivals
• Safe access to the units storerooms for the delivery of bulk items e.g. Bulk fluids which
may arrive or be stored on a palette requiring mechanical lifting, moving and storage
• Safe access for the delivery of food, clean linen, pharmacy, consumables, disposable
items and the removal of bulk cytotoxic chemotherapy waste and soiled linen etc.

Internal
1. The internal planning of the Chemotherapy Unit should be planned by considering the
units functional areas/zones.
2. Some of the critical relationships to be considered include:
• Staff station/s require an unobtrusive view of all patient treatment areas. The inclusion of
decentralized staff stations may be considered in larger units that have multiple treatment
spaces
• Providing a number of treatment spaces and/or individual cubicles in groups or clusters
• Inclusion of working spaces for visiting multidisciplinary team members.
• Location of Reception to provide a clear view of entry and exit/egress points of the Unit
• Easy access from the Waiting area to the patient treatment area for the convenient arrival
and departure of patients and families
WORKFLOW AND TIME TAKEN IN A
CHEMOTHERAPY WARD
LAYOUT OF A
CHEMO
THERPAPY
WARD
CHEMOTHERAPY UNIT IN A HOSPITAL
CHEMOTHERAPY UNIT IN A HOSPITAL
SPACES WITH SIZES (AS PER IHFG)
SPACES WITH SIZES
DESIGN CONSIDERATIONS
General
Design of the Unit should consider the following:
• Ease of access for patients and their families, who may arrive either walking, using
mobility equipment, by ambulance stretcher or patient transport trolley
• Convenient access to public parking for frail patients, particularly those undergoing a
scheduled period of chemotherapy on a regular basis
• Service access for delivery of large amounts of intravenous fluids to the unit on a regular
basis and suitably sized storage areas to hold supplies
• Appropriate floor finishes for constant staff movement to/ from and between patients
during chemotherapy treatments, such as cushioned vinyl.

Patient Treatment Areas

• Patients should be situated so that healthcare providers have good visual access to ensure
safety and quality care. This approach enhances staff monitoring of patient condition
during treatment. The optimal design is to allow a direct line of vision between the patient
and staff.
• Provision for dedicated chemotherapy areas for children and young people is
recommended. Where facilities are shared, patient pathways should be kept as separate
as possible. Cancers that develop in children and young people are complex and differ
from those that develop in adults. Early diagnosis is challenging because cancers are rare
and more diverse.
DESIGN CONSIDERATIONS (environmental)
Acoustics
Acoustic privacy is required for many functions in the Unit including:
• Family/ case conference/ interview rooms
• Isolation of noisy areas such as waiting rooms from clinical areas e.g. clean and dirty
utilities
• Staff discussions regarding confidential matters in meeting rooms
Solutions to be considered include:
• Location of the unit away from noisy hospital areas
• Use of sound isolating construction and selection of sound absorbing materials.
• Planning to separate quiet areas from noisy areas
• Review of operational management and patient/client flows; this may include separate
areas for patients with special needs
• Provision of television systems with headphones to reduce ambient noise levels.
Privacy
Confidentiality and privacy when requested for persons receiving treatment and the area
design should be considered as a critical element during the design process.
The Unit should be designed to:
• Ensure confidentiality of personal discussions and medical records;
• Provide an adequate number of rooms for discreet discussions and treatments to occur
when required
• Provide suitably sized treatment spaces that permit screen curtains to be easily closed
whenever required
• Appropriately locate windows and doors to enhance visual and acoustic privacy.
DESIGN CONSIDERATIONS (environmental)
Lighting
• Natural light and views should be available from the Unit for the benefit of staff and
patients.
• Every effort should be made to provide a view to all treatment areas either by locating
treatment bays/ cubicles/ bedrooms adjacent to a window or by locating chairs and beds
to have an external view from each patient space.
• High quality task lighting is essential to ensure complex medical and pharmacological
tasks can be safely achieved.
• Colour corrected lighting is also essential to ensure patient assessment can be conducted
effectively.

Interior Design/ Décor

Interior decor includes furnishings, style, colour, textures and ambience, and is influenced by
perception and culture. The décor of the Unit should provide an inviting and comfortable
space with a non-institutional atmosphere.
Suggestions to achieve this balance include the following:
• Use of design features such as colours and artworks to distract the sight from clinical areas
• Inclusion of soft furnishings that act as a design feature such as screening, lounges in
waiting areas and window treatments
• Provision of a beverage bay for people to use while waiting.
 VISUALS OF A CHEMOTHERAPY WARD AND
SUPPORTS

CHEMO WARD SHOWING INTERACTIVE SPACES PREPRATION OF DOSAGE IN CR

EQUIPEMENTS FOR A CHEMO WARD (WHO)

RESUS TROLLEY

SPHYGMOMANOMETER

INFUSION PUMP
 EQUIPEMENTS FOR A CHEMO WARD (WHO)

RECLINING CHAIRS
PATHOLOGY
1. The word pathology is derived from Greek word ‘patho’ which means diseases
and ‘logy’ with means study. Therefore, pathology is the study and diagnosis of
diseases. Pathology involves two types of branches, basic medical science and
clinical practice to investigate the cause and mechanism of diseases.

2. To understand basic pathology, we have to understand what a pathologist does.

Pathologists are experts in disease. Pathologists work in laboratories, in clinics
and on hospital wards. Every blood test, allergy diagnosis or search for infection
will involve a pathology team. People who work in pathology services specialize
in particular areas. Bridging science and medicine, pathologists underpin every
aspect of patient care. Diagnosing, treating and preventing disease, they are a
key part of the healthcare team.
DIVISION IN PATHOLGY DEPARTMENT
In hospitals and other patient-care settings, laboratory medicine is provided by the
Department of Pathology, and generally divided into two sections, each of which will
be subdivided into multiple specialty areas. The two sections are:
• General Pathology - involves a mixture of anatomical and clinical pathology
specialties in the one Unit.
• Anatomic pathology: - areas included here are histopathology, cytopathology, and
electron microscopy.
Layouts of clinical laboratories in health institutions vary greatly from one facility to
another. For instance, some health facilities have a single laboratory for the
microbiology section, while others have a separate lab for each specialty area.
Clinical laboratories: Which typically includes the following areas:
• Clinical Microbiology: This encompasses several different sciences, including
bacteriology, virology, parasitology, immunology, and mycology.
• Clinical Chemistry: This area typically includes automated analysis of blood
specimens, including tests related to enzymology, toxicology and endocrinology.
• Hematology: This area includes automated and manual analysis of blood cells. It
also often includes coagulation.
• Blood Bank: The testing of blood specimens is done here in order to provide blood
transfusion and related services.
• Molecular diagnostics DNA Testing: May be done here, along with a subspecialty
known as cytogenetics.
• Reproductive biology testing: Available in some laboratories, including Semen
analysis, Sperm bank and assisted reproductive technology.
Classification of Pathology Department
• Based on in-house or outsource
In most developed countries, there are two main types of lab processing the majority
of medical specimens.
1. Hospital Labs: Almost all hospitals contain a laboratory to support the clinical
services offered at the hospital. The specific pathology services would include
both anatomic (surgical pathology, cytopathology, autopsy) and clinical
(laboratory medicine) pathology at most hospitals. Most, if not all, inpatient and
many outpatients seen by hospital-affiliated physicians require tests performed
by hospital labs.
2. Reference Labs: Reference labs are usually private, commercial facilities that do
both high volume and specialty (high complexity and/or rare) laboratory testing.
Most of these tests are referred from physician’s offices, hospital facilities and
other patient care facilities such as nursing homes. Reference labs, typically
located at a site other than the healthcare facilities, are often used for tests that
involve specimens sent between different labs for uncommon tests. For
example, in some cases it may be more cost effective if a particular laboratory
specializes in a less common tests, receiving specimens (and payment) from
other labs, while sending other specimens to other labs for those tests they do
not perform.
3. Public health labs: Public health laboratories are typically run by state and local
health departments to diagnosis and protect the public from health threats such
as outbreaks of infectious disease.
Classification of Pathology Department
• Based on NABL classification
A. Small sized: A laboratory receiving samples of up to 100 subjects per day
B. Medium sized: A laboratory receiving samples of up to 101- 400 subjects per day
C. Large sized: A laboratory receiving samples of more than 401-1000 subjects per
day
D. Very large sized: A laboratory receiving more than 1000 subjects per day
E. Multiple location: A laboratory with more than one location in the same district
with same legal identity

• Based on Biosafety Levels

Risk Biosafety level (BSL) Laboratory type
Group
1 BSL 1 Basic teaching, research
2 BSL 2 Primary health services; diagnostic
services; research
3 BSL 3 Special diagnostic services, research
4 BSL 4 Dangerous pathogen units
Organizational structure
The staff of clinical laboratories may include:
•A pathologist is generally charge of the laboratory.
•Assistant pathologists, in larger hospitals
•Chief of Microbiology (M.Sc. in microbiology)
•Chief of Biochemistry (M.Sc. in clinical biochemistry)
In larger hospitals, microbiology may be organized as independent under a medical
doctor not reporting to the pathologist.
At lower level
•Chief of medical technologist (reports to chief of laboratory)
•Medical technicians (histology etc.)
•Biochemists
•Microbiologists
•Phlebotomist (PBT)
Location of the Pathology department
Functional Areas

The functional areas of a Pathology department are dependent on the nature and prime
function of the hospital and also the available financial support. Regardless a pathology
department may consist of the following:15
•Entry/ Reception area with patient waiting areas.
•Specimen Reception including:
i.Specimen registration, data entry
ii.Specimen sorting and preliminary processing prior to delivery/dispatch to
various specialty laboratories
•Laboratories, which may include:
i.Automated laboratories that perform a range of tests across a variety of
specialties
ii.Specialist laboratories such as Clinical Chemistry, Anatomical Pathology,
Microbiology, Hematology, Immunology.
Functional Areas
•Blood Bank including:
i.Storage of blood and blood products in refrigerators and freezers
ii.Testing laboratory
•Support areas may be centralized to serve all sub specialty laboratories and may
include:
i.Clean-up room/s
ii.Sterilization area
iii.Storage areas for reagents, appropriate storage for flammable liquids, supplies,
refrigerated storage for slides and reagents
iv.Disposal facilities for contaminated waste
•Specimen Collection area (this may be located remotely to the Laboratory Unit or in
Outpatient areas):
i. Reception and Waiting area
ii. Patient toilets
iii. Specimen collection cubicles with a workbench, space for patient seating and
hand washing facilities
•Staff Areas including:
i.Offices and workstations
ii.Meeting Rooms - Staff Room
iii. Change Rooms with Toilets, Shower and Lockers.
Functional Relationship
• External
1. Access from Outpatients and Day Patient units to Specimen Collection through a
public corridor
2. Specimen Collection area may be located adjacent to Laboratories or in a remote
location
3. Indirect relationships between Laboratory Unit all Inpatient and Critical Care
areas through public corridors; specimen transit may be automated.
4. Access through a staff/ service corridor for Supplies and Housekeeping including
waste.
• Internal
1. Internally, the Laboratory unit will be arranged in zones with a clear flow of
processing from Specimen Reception to the various Laboratories. The preferred
internal relationships are demonstrated and include:
2. Specimen Reception at the Entry
3. Controlled access at entry points to staff and Laboratory areas
4. A specimen work flow from Specimen Reception, to Sorting/ Initial Processing,
then to Laboratories
5. Support areas located centrally to Laboratories at the point of use, and also at
the perimeter for supplies and shared areas
6. Staff areas including Offices and Meeting Room located in a staff zone
accessible without traversing laboratory areas.
7. Staff Change Areas located closer to the entry to the Unit for staff to put on
protective attire on entry and remove on exit.
Flow of Sample
• Unidirectional workflow is important in view of productivity Management and
infection control. Three paths should be kept in mind.
o Sample Path
o Reagent Path
o Report Path
• The movement of personnel will be along all three and good planning will optimize
this movement.
Functional Relationship
An Example Layout
As per IPHS,

Area for laboratories are divided in three parts

a) Layout for PHC: An average lab load of 10-

20 patients and a limited scope of testing
exist for PHC labs. A minimum area of 10
sqm. is defined for this.

b) Layout for CHC: An average lab load of

30- 50 patients per day is defined for CHCs
and a minimum area of 90 sqm. is suggested
for this.

c) Layout for District Hospitals: The bed

strength and hence IPD strength is variable
from 100- 500 plus. OPD load also varies
likewise. An average lab load of 100 upwards
can be expected. A minimum area of 150
sqm. is suggested for a lab load with 100
collections. This may be scaled up as
per requirement.
Designing for Biosafety Levels

Source: NCDC -BIOSAFETY MANUAL FOR PUBLIC HEALTH LABORATORIES

 Architectural Considerations
Corridors Width
Internal Corridor width should be not less than 2550 mm.
Corridors and passages to exits should be clear of obstructions.

Ceiling Height
The minimum clear ceiling height in laboratory should be 3000 mm.

Interstitial space
The provision of services to a single-storey laboratory poses few problems but multi-storey
laboratory buildings need very careful planning unless a peristitial space (below the floor) or
interstitial space is designed.
Use of interstitial spaces to create additional floors for mechanical systems is a design strategy that
can facilitate both the construction and operation of laboratories.
By providing additional space and easier access to mechanical systems, interstitial designs facilitate
maintenance and reconfiguration of laboratories, thus reducing life cycle costs. Despite these and
other advantages, the use of interstitial space is often eliminated as a laboratory design option due
to perceptions of high first costs
 Architectural Considerations
Work station
Work counters with space for equipment, microscopes, incubators, centrifuge and overhead
cabinets. They should be equipped with vacuum gas, electrical services, sinks and water supply.

Entry to the laboratory

A lobby (buffer space) at each laboratory exit should form the boundary between the laboratory
and non- laboratory space. This will allow for the hygienic, safe and secure laboratory spaces.
Provision of hand- washing facilities and coat pegs for hanging laboratory protective clothing should
be provided in the lobby. Provision of storage space for linen bags for storing dirty protective
clothing.

Safety and Infection control

• Proper segregation between laboratories and non-laboratories.
• First-aid areas or rooms near laboratory suitably equipped and readily accessible should be
available. An emergency tray to be available 24x7 with lifesaving drugs.

Lighting
• The laboratory should be illuminated to optimal level (300 lux) for safe working. Glare should be
minimized.
• Emergency lighting should be provided for corridors/exit pathways.
• Power back-up
Schedule of accommodation
EQUIPMENTS
Biosafety Cabinet Fume Hoods

A biosafety cabinet —also called a biological safety These are particularly required in
cabinet or microbiological safety cabinet—is an laboratories where radioactive
enclosed, ventilated laboratory workspace for substances are used. Forced
safely working with materials contaminated with ventilation should be accompanied by
pathogens requiring a defined biosafety level. an extraction system.
The fume hood should be located
away from traffic areas and doorways.
Depending on the anticipated usage,
central/ individual stills should be
provided for the supply of distilled and
de-ionized water supplies.
EQUIPMENTS AND WASTE MANGAGEMENT

Autoclave

Sterilization autoclaves are widely

used in microbiology. typical loads
include laboratory glassware, other
equipment and waste, surgical
instruments, and medical waste.
THANKS