APS

Kayakalp Clean Hospital

Checklist for Assessment PHC (With beds)

The Cleanliness Score Card

Name of Facility

90.7%
Grading

Thematic Scores

A. PHC Upkeep B. Sanitation & Hygiene

56 57

D. Infection Prevention &Control E. Support Services

54 34

G. Beyond Hospital Boundary WASH

43 92.0454545454546
 Ref. Criteria Assessment Means of Verification
No. Method
A. PHC/AAM-PHC UPKEEP
A1 Pest & Animal Control
A1.1 No stray animals within the facility premises OB/SI 1. Observe for the presence of stray animals, such as dogs, cats, cattle, pigs,
etc., within the premises.
2. Check at the entrance of the facility that a cattle trap has been provided.
3. Look for the breach in the boundary wall, if any

A1.2 Integrated Pest Control Measures are implemented in SI/RR/ OB Check for the evidence at the facility (Presence of Pests, Record of Purchase
the facility of Pesticides and availability of the rat trap) and Interview the staff about
its usage

A1.3 Measures for Mosquito free environment are in place OB/SI /PI Check for
a. Wire Mesh in Windows b. Desert Coolers (if in use) are cleaned regularly/
oil is sprinkled. c. No water collection to prevent
mosquito breeding within and outside the premises
d. Gambusia fish cultivation
e. Usage of insecticide-treated (LLIN) Mosquito nets by the admitted
patients
f. Availability of adequate stock of Mosquito nets( If Applicable)

A2 Landscaping & Gardening

A2.1 Front area/ Parks/ Open spaces are well maintained OB Check that wild vegetation does not exist. Shrubs and Trees are well
maintained. Over grown branches of plants/ tree have been trimmed
regularly. Dry leaves and green waste are removed
on daily basis.
Gardens/ green area are secured with fence

A2.2 Internal Roads, Pathways, etc. are even and clean OB Check that pathways, corridors, courtyards, etc. are clean and landscaped.

A 2.3 Provision of Herbal Garden OB/SI 1. Check if the facility maintains a herbal garden for the medicinal plants
2. Check that trees & plants generating more oxygen (E.g. Neem, Peepal,
Aloe Vera, Tulsi etc.) are cultivated

A3 Maintenance of Open Areas

A3.1 There is no abandoned / dilapidated building within the OB Check for presence of any ‘abandoned building’ within the facility premises.
premises Give full compliance if the existing abandoned building is identified and
marked and not in use.

A3.2 No water logging in open areas and the facility buildings OB 1. Check for water accumulation in open areas because of faulty drainage,
are vector- breeding proof leakage from the pipes, rainwater etc
2. Look for tyres, flower pots etc., for accumulation of stagnant water.

A3.3 There is no unauthorised occupation within the facility, OB/SI Check for PHC premises and access road have not been encroached by the
nor there is encroachment on PHC land vendors, unauthorized shops/ occupants,
No thoroughfare / general traffic in PHC premises etc.

A4 PHC Appearance
A4.1 Name of the PHC is prominently displayed at the OB Name of the PHC is prominently displayed as per state’s policy.
entrance The name board of the facility is well illuminated / florescent to have
visibility in night

A4.2 Walls are well-plastered and painted OB Check that wall (Internal and External) plaster is not chipped-off and the
building is painted/ whitewashed in uniform approved colour and Paint has
not faded away.
Check for presence of any outdated Posters, IEC material & boards etc
A4.3 Uniform signage system in the PHC OB Check for:
1. All signage's (directional & departmental) and information displayed in
local language
2. All signages follow uniform colour scheme.

A5 Infrastructure Maintenance
A5.1 PHC Infrastructure is well maintained OB/ RR/ SI No major cracks, seepage, chipped plaster & floors is seen within the
building.
The Building is periodically maintained

A5.2 PHC has intact boundary wall and functional gates at OB Check that there is a proper boundary wall of adequate height without any
entry breach. The Wall is painted in uniform colour.
Check that there is no rusting of the gates.
All the gates (entry, exit or any other gates) are painted and functional.

A.5.3 PHC has adequate facility for parking of vehicles OB (a) Check there is a demarcated fringe parking space for the ambulances,
patients, visitors and staff vehicles.
(b) Check vehicles are parked systematically
A6 Illumination
A6.1 Adequate illumination inside the building OB Check for Adequate lighting arrangements through Natural Light and
Electric Bulbs inside PHC (OPDs, procedure areas, circulation areas, IPD,
toilets etc)

A6.2 Adequate illumination in Outside of the PHC OB Check that PHC front, entry gate, parking and access road are well
illuminated specially at night

A6.3 Use of energy efficient bulbs OB Check that PHC uses energy efficient bulb like CFL or LED for lighting
purpose within the PHC Premises

A7 Maintenance of Furniture & Fixture

A7.1 Window and doors are maintained OB Check, if Window panes are intact, and provided with Grill/ Wire Mesh.
Doors are intact and painted /varnished

A7.2 Patients' furniture are in good condition OB Check that Patient beds are not rusted and are painted. Mattresses are
clean and not torn
Trolleys, Stretchers, Wheel Chairs, etc. are well maintained( As applicable)

A7.3 Furniture at the nursing station, staff room, OB Check the condition of furniture at nursing station, duty room, office, etc.
administrative office are maintained The furniture is not broken, painted/polished and clean.

A8 Removal of Junk Material

A8.1 PHC has documented and implemented States' SI/RR Check that:
Condemnation policy 1. Hospital has a condemnation policy, or have got one from the state.
2. They are complying with it

A8.2 No junk material within the PHC premises OB Check if unused/ condemned articles, and outdated records are kept in the
Nursing stations, OPD clinics, Labour Room, Injection Room, Dressing
Room, Wards, stairs, open areas, roof tops, balcony etc.
Old vehicles, broken furniture, etc. not lying inside the hospital premises

A8.3 PHC has demarcated space for keeping condemned junk OB/SI Check for availability of a demarcated & secured space for collecting and
material storing the junk material before its disposal

A9 Water Conservation
A9.1 Piped Water supply system is maintained in the PHC OB Check for leaking taps, pipes, over-flowing tanks and dysfunctional cisterns.
Over-head tank has functional float-valve

A9.2 Preventive measures are taken to reduce wastage and SI/OB Check any innovative practices such as :
reuse of water
1. Landscaped area is planted with drought-tolerant plants (e.g. Cactus,
Palm, Bougainvillea, snake plant, lavender etc.)

2. Installation of self-closing taps

3. Recycling and reusing waste water for activities like gardening, toilet
flushing, etc.
4. Installation of dual flush in toilets
A 9.3 PHC has a functional rain water harvesting system OB/SI If the such system is available, please check its functionality

A10 Work Place Management

A10.1 The Staff periodically sorts useful and unnecessary SI/OB Ask the staff about the frequency of sorting and removal of unnecessary
articles at work stations articles from their work place like Nursing stations, work bench, dispensing
counter in Pharmacy, etc.
Check for presence of unnecessary articles.

A10.2 Useful articles, records, drugs, etc. are arranged SI/OB Check if drugs, instruments, records, have been kept systematically near
systematically their usage points in demarcated areas. They are not lying in haphazard
manner.

A10.3 Articles are labelled for easy recognition and easy SI/OB Check that drugs, instruments, records, etc. are labelled for facilitating easy
retrieval. identification.

B Sanitation & Hygiene

B1 Cleanliness of Circulation Area
B1.1 No dirt/Grease/Stains/ Cobwebs/Bird Nest/ Dust/ OB (1) Check that floors and walls of Corridors, Waiting area, stairs, roof top
vegetation on the walls and roofs and circulation area in for any visible or tangible dirt, grease, stains, etc.
PHCs (2) Check that roof, walls, corners of Corridors, Waiting area, stairs, roof top
for any Cobweb, Bird Nest, etc.

B1.2 Corridors are cleaned at least twice in a day with wet SI/RR Ask cleaning staff about frequency of cleaning in a day. Verify with
mop Housekeeping records.
Corridors are rigorously cleaned with scrubbing / flooding once in a month

B1.3 Surfaces are conducive for effective cleaning OB Check if surfaces are smooth for cleaning
Check the floors and walls for cracks, uneven or any other defects which
may adversely impact the cleaning procedure
B2 Cleanliness of Wards
B2.1 No dirt/Grease/Stains/ Cobwebs/Bird Nest/ Dust/ OB Check the floors and walls of wards for any visible or tangible dirt, grease,
vegetation on the walls and roof in the PHC's ward stains, etc.
Check the roof, walls, corners of wards for any Cobweb, Bird Nest, etc.

B2.2 Wards are cleaned at least thrice in a day with wet mop SI/RR Ask cleaning staff about frequency of cleaning in a day. Verify with the
Housekeeping records

B2.3 Surfaces are conducive for effective cleaning OB Check if surfaces are smooth for cleaning
Check the floors and walls for cracks, uneven or any other defects which
may adversely impact the cleaning procedure

B3 Cleanliness of Procedure Areas

B3.1 No dirt/Grease/Stains/ Cobwebs/Bird Nest/ Dust/ OB Check that floors and walls of Procedure area like Labour Room, OT,
vegetation on the walls and roof in the procedure area. Dressing Room, Immunization Room etc. (As Applicable) for any visible or
tangible dirt, grease, stains, etc.
Check that roof, walls, corners of these area for any Cobweb, Bird-nest,
vegetation, etc.

B3.2 Procedure area are cleaned at least twice in a day/ after SI/RR Ask cleaning staff about frequency of cleaning in a day. Verify with
every procedure (as applicable) Housekeeping records.
Areas are rigorously cleaned with scrubbing / flooding once in a week

B3.3 Surfaces are conducive for effective cleaning OB Check if surfaces are smooth for ensuring cleaning Check the floors and
walls for cracks, uneven or any other defects which may affect cleaning
procedure

B4 Cleanliness of Ambulatory & Diagnostic Areas

B4.1 No dirt/Grease/Stains and Cobwebs/Bird Nest/ Dust on OB Check that floors and walls of OPD, Lab, X-ray etc. (If available) for any
walls and roof in Ambulatory & Diagnostic area visible or tangible dirt, grease, stains, etc.
Check that roof, walls, corners of these area for any Cobweb, Bird Nest, etc.

B4.2 Ambulatory and Diagnostic areas are cleaned at least SI/RR Ask cleaning staff about frequency of cleaning in a day. Verify with
twice in a day with wet mop Housekeeping records

B4.3 Surfaces are conducive of effective cleaning OB Check if surfaces are smooth for ensuring cleaning
Check the floors and walls for cracks, uneven or any other defects which
may affect cleaning procedure

B5 Cleanliness of Auxiliary Areas

B5.1 No dirt/Grease/Stains and Cobwebs/Bird Nest/ OB 1. Check that floors and walls of Pharmacy, Stores, Cold chain Room,
Vegetation/ Dust on walls and roof in Auxiliary area Meeting Room etc. (As applicable) for any visible or tangible dirt, grease,
stains, etc.
2. Check that roof, walls, corners of these area for any Cobweb, Bird Nest,
etc.
3. Parking area is visibly clean
B5.2 Auxiliary areas are cleaned at least twice in a day with SI/RR Ask cleaning staff about frequency of cleaning in a day. Verify with
wet mop Housekeeping records
Areas are rigorously cleaned with scrubbing / flooding once in a month

B5.3 Surfaces are conducive of effective cleaning OB Check if surfaces are smooth enough for cleaning check floors and walls for
cracks, uneven or any other defects which may affect cleaning procedure

B6 Cleanliness of Toilets
B6.1 No dirt/Grease/Stains/ Garbage in Toilets OB Check some of the toilets randomly in indoor and outdoor areas for any
visible dirt, grease, stains, water accumulation in toilets
B6.2 No foul smell in the Toilets and its dry OB 1. Check the toilets in indoor and outdoor areas for the foul smell, dryness
of the floor and absence of cracks and residue water accumulation
2. At least one toilet provides the means to manage menstrual hygiene
needs

B6.3 Toilets have running water and functional cistern OB/SI Please operate cistern and water taps

B7 Use of standards materials and Equipment for Cleaning

B7.1 Availability of Detergent Disinfectant solution / Hospital SI/OB/RR 1. Check for good quality, eco-friendly PHC cleaning solution, preferably an
Grade Phenyl for Cleaning purpose ISI mark. The composition and concentration of the solution are written on
the label.
2. Check with cleaning staff if they are getting an adequate supply. Verify
the consumption records.
3. Check if the cleaning staff is aware of the correct concentration and
dilution method for preparing the cleaning solution.

B7.2 Availability of carbolic Acid/ aldehyde & other chemicals SI/RR 1. Availability of carbolic Acid/ Aldehyde & other chemicals e.g. Bacillocid
for surface cleaning in procedure areas. for surface cleaning in procedure areas-(Labour Room)
2.Check for adequacy of the supply. Verify with the records for stock-outs, if
any

B7.3 Availability of Cleaning Equipment SI/OB Check the:

1. Availability of mops, brooms, collection buckets etc. as per requirement.
2. Storage area/Janitor room for cleaning equipment is clean and dry

B8 Use of Standard Methods for Cleaning

B8.1 Use of Three bucket system for cleaning SI/OB 1. Check if cleaning staff uses three bucket system for cleaning.
First mop the area with the warm water and detergent solution.
• After mopping clean the mop in plain water and squeeze it.
• Repeat this procedure for the remaining area.
• Mop area again using sodium hypochlorite 1% after drying the area.
Ask the cleaning staff about the process.

B8.2 Use unidirectional method and outward mopping SI/OB Ask the cleaning staff to demonstrate, how they apply mop on floors. It
should be in one direction without returning to the starting point. The mop
should move from inner area to outer area of the room. Separate mop is
used for the Procedure area.

B8.3 No use of brooms in patient care areas SI/OB Check if brooms are stored in patient care areas. Ask cleaning staff if they
use brooms for sweeping in wards, OT, Labour room. Brooms should not be
used in patient care areas.

B9 Monitoring of Cleanliness Activities

B9.1 Use of Housekeeping Checklist OB/RR Check for:
1. Housekeeping Checklist is displayed in Toilet and updated daily (check
records for at least one month)
2. Cleaning schedule for each area has been prepared, approved and
disseminated to the concerned persons

B9.2 Periodic Monitoring of Housekeeping and Bio medical SI/RR Periodic Monitoring is done by MOIC or trained designated person. Please
waste management activities check record of such monitoring

B9.3 Monitoring of adequacy and quality of material used for SI/RR Check if there is any system of monitoring that adequate concentration of
cleaning disinfectant solution is used for cleaning. PHC administration take feedback
from cleaning staff about efficacy of the solution and take corrective action
if required.

B10. Drainage and Sewage Management

B10.1 Availability of closed drainage system with adequate OB/SI Check, PHC should have a closed drainage system or else drains should be
gradient properly covered.
B10.2 Availability of connection with Municipal Sewage OB/SI Check if PHC sewage has a connection with municipal system. If there is no
System/ soak pit/ septic tank access to municipal system, there should be septic tank. Check condition of
septic tank e. g. Periodicity of cleaning, mosquito proofing of manhole, etc.

B10.3 No blocked/ over-flowing drains in the facility OB/SI Observe that the drains are not overflowing or blocked
All the drains are cleaned once in a week

C Waste Management
C1 Segregation of Biomedical Waste
C1.1 Segregation of BMW is done as per BMW management OB/SI Anatomical waste and soiled dressing material are segregated in Yellow Bin
rule, 2016* General and infectious waste are not mixed

C1.2 Display of work instructions for segregation and OB Check for instructions for segregation of waste in different colour coded
handling of Biomedical waste bins are displayed at point of use.
C1.3 Check if the staff is aware of segregation protocol SI/OB Ask staff about the segregation protocol. (Red bag for re-cyclable,
Glassware into puncture proof and leak proof boxes and container with
blue marking, etc.)
C2 Collection and Transportation of Biomedical Waste
C2.1 The facility has linkage with a CBWTF Operator or has OB/ RR/ SI Check record for functional linkage with a CBWTF
deep burial pit (with prior approval of the prescribed In absence of such linkage, check existence of deep burial pit, which has
authority) approval of the prescribed authority.

C2.2 Biomedical waste bins are covered OB Check that bins meant for bio medical waste are covered with a lid

C2.3 Transportation of biomedical waste is done in closed OB/SI Check if transportation of waste from clinical areas to storage areas is done
container/trolley in covered trolleys / Bins. Trolleys used for patient shifting should not be
used for transportation of waste.

C3 Sharp Management
C3.1 Disinfection of Broken/Discarded Glassware is done as OB/SI/ RR Check such waste is pre-treated either with 1-2% Sodium Hypochlorite for
per recommended procedure 30 minutes or by autoclaving/ microwave/ hydroclave and sent for
recycling

C3.2 Sharp Waste is stored in Puncture proof containers OB/SI Check availability of Puncture & leak proof container (White Translucent)
at point of use for storing needles, syringes with fixed needles, needles from
cutter/burner, scalpel blade, etc.

C3.3 Staff is aware of needle stick injury Protocol SI/RR Ask staff immediate management of exposure site; and Medical Officer
knows criteria for PEP.
There should be functional linkage to DH / SDH/ CHC for PEP follow-up and
check records of such referrals and follow-up

C4 Storage of Biomedical Waste

C4.1 Dedicated Storage facility is available for biomedical OB Check if PHC has dedicated room for storage of Biomedical waste before
waste disposal/handing over to Common Bio wasteTreatment Facility.

C4.2 No Biomedical waste is stored for more than 48 Hours SI/RR Verify that the waste is being disposed / handed over to CBWTF within 48
hour of generation. Check the record especially during holidays

C4.3 Access to waste storage facility is secured OB Observe the display of Biohazard symbol at storage areas
Check that the BMW storage is situated away from the main building and is
kept under lock and key

C5 Disposal of Biomedical waste

C5.1 PHC has adequate facility for disposal of Biomedical RR/OB/SI The Health facility within 75 KM of CTF shall have a valid contract with a
waste Common Treatment facility for disposal of Bio medical waste. Or else
facility should have Deep Burial Pit and Sharp Pit within premises of Health
facility. Such deep burial pit should have approval of the Prescribed
Authority

C5.2 Recyclable waste is disposed as per procedure given in OB/SI Check management of IV Bottles (Plastic), IV tubes, Urine Bags, Syringes,
the Bio-Medical Waste Management Rules, 2016* Catheter, etc.
(Autoclaving/ Microwaving/ Hydroclaving followed by shredding or a
combination of sterilisation and shredding. Later treated waste is handed
over to registered vendors.)

C5.3 Deep Burial Pit is constructed as per norms given in the OB/RR Located away from the main PHC building and water source, A pit or trench
Biomedical Waste Management Rules 2016* should be dug about two meters deep. It should be half filled with waste,
then covered with lime within 50 cm of the surface, before filling the rest of
the pit with soil.
Secured from animals . If waste disposed through CBWTF, then a deep
burial pit is not required. (Give Full Compliance)
C6 Management Hazardous Waste
C6.1 Availability of Mercury Spill Management Kit and Staff is SI/OB Check for Mercury Spill Management Kit and ask staff what he/she would
aware of Mercury Spill management do in case of Mercury spill. (If facility is mercury free give full compliance)

C6.2 Disposal of used Disinfectant solution like SI Check for:

Glutaraldehyde, Lab reagents and liquid laboratory 1.Used disinfectants are collected separately and pre-treated prior to
waste mixing with rest of the wastewater from HCF.
2.Liquid from laboratories are collected separately and pre-
treated prior to mixing with rest of the wastewater from HCF

C6.3 Disposal of Expired or discarded medicine SI/RR Returned back to manufacturer or supplier
Alternatively handed over to CBWTF Operator for incineration at
temperature > 12000C

C7 Solid General Waste Management

C7.1 Availability of Compost pit as per specification OB/SI Availability of compost pit for Bio degradable general waste.

C7.2 Disposal of General Waste OB/SI There is a mechanism of removal of general waste from the facility and its
disposal.

C7.3 Innovations in managing general waste OB/SI/ RR Look for efforts of the health facility in managing General Waste, such as
Recycling of paper waste, vermicomposting, waste to energy initiative, etc.

C8 Liquid Waste Management

C8.1 The laboratory has a functional protocol for managing OB/SI/ RR A copy of such protocol should be available and staff should be aware of the
discarded samples same.

C8.2 Liquid waste is made safe before mixing with other OB/SI/RR Check for the procedure - staff interview and direct observation
waste water

C8.3 The facility has treatment facility for managing OB/SI Check the availability of effluent treatment system.
infectious liquid waste

C9 Equipment and Supplies for Bio Medical Waste Management

C9.1 Availability of Bins and non-chlorinated liners for OB/SI 1. Check for availability foot operated bins and non-chlorinated plastic
segregated collection of waste at point of use bags/liners of appropriate size at each point of generation for Biomedical
waste
2. Check for adequate availability of bins and liners

C9.2 Availability of Needle cutter and puncture proof boxes OB/SI At each point of generation of sharp waste

C9.3 Availability and supply of personal protective OB/SI 1. Check the availability of PPE (cap, mask, gloves, boots, goggles) for
equipment cleaning and waste handlers and its supply record
2. Check there is no stockout of PPE

C10 Statuary Compliances

C10.1 PHC has a valid authorization for Bio Medical waste RR Check for the validity of authorization certificate
Management from the prescribed authority

C10.2 PHC submits Annual report to pollution control board RR Check the records that reports have been submitted to the prescribed
authority on or before 30th June every year.

C10.3 PHC maintains records, as required under the RR Check following records -
Biomedical Waste Management Rules 2016* a. Yearly Health Check-up record of all handlers
b. BMW training records of all staff (once in year training)
c. Immunisation records of all waste handlers

D Infection Prevention & Control

D1 Hand Hygiene

D1.1 Availability of Sink and running water at point of use OB Check for washbasin with functional tap, soap and running water at all
points of use

D1.2 Display of Hand washing Instructions OB Check that Hand washing instructions are displayed preferably at all points
of use
D1.3 Staff is aware of standard hand washing protocol SI 1. Ask facility staff to demonstrate steps of hand wash
2. Check staff is aware of 5 moments of hand washing (before touching a
patient, before a procedure, after a procedure or body fluid exposure risk,
after touching a patient, after touching a patient's surroundings)

D2 Personal Protective Equipment (PPE)

D2.1 Use of Gloves during procedures and examination SI/OB Check, if the staff uses gloves during examination, and while conducting
procedures

D2.2 Use of Masks ,Head cap and Lab coat, Apron etc. SI/OB Check, if staff uses mask head caps , Lab coat and aprons in patient care and
procedure areas

D2.3 Use of Heavy Duty Gloves and gumboot by waste SI/OB Check, if the housekeeping staff and waste handlers are using heavy duty
handlers gloves and gum boots
D3 Personal Protective Practices
D3.1 The staff is aware of use of gloves, when to use SI/OB Check with the staff when do they wear gloves, and when gloves are not
(occasion) and its type required. The Staff should also know difference between clean & sterilized
gloves and when to use

D3.2 Correct method of wearing and removing PPEs SI/OB Ask the staff to demonstrate correct method of wearing and removing
Gloves, caps and masks etc.

D3.4 No re-use of disposable personal protective equipment SI/OB Check that disposable gloves and mask are not re-used. Reusable Gloves
and mask are used after adequate sterilization.

D4 Decontamination and Cleaning of Instruments

D4.1 Staff knows how to make Chlorine solution SI Ask the staff how to make 1% chlorine solution from Bleaching powder and
Hypochlorite solution & its frequency.

D4.2 Decontamination of operating and Surface examination SI/OB Ask staff when and how they clean the operating surfaces either by
table, dressing tables etc. after every procedures chlorine solution or Disinfectant like carbolic acid

D4.3 Decontamination and cleaning of instruments after use SI/OB Check whether instruments are decontaminated with 0.5% chlorine
solution for 10 minutes. Check instruments are cleaned thoroughly with
water and soap before sterilization

D5 Disinfection & Sterilization of Instruments

D5.1 Adherence to Protocols for sterilization SI/OB/RR 1. Check about awareness of recommended temperature, duration and
pressure for autoclaving instruments - 121 degree C, 15 Pound Pressure for
20 Minutes (30 Minutes if wrapped)
2. Linen - 121 C, 15 Pounds for 30 Minutes.
3. Check if the staff know the protocol for sterilization of the laparoscope
soaking it in 2% Glutaraldehyde solution for 10 Hours or as per
manufacturer instructions

D5.2 Adherence to Protocol for High Level disinfection SI/OB 1. Check with the staff process about of High Level disinfection using Boiling
for 20 minutes with lid on,
OR soaking in 2% Glutaraldehyde/Chlorine solution for 20 minutes.

D5.3 Use of autoclave tape for monitoring of sterilization OB/RR Check autoclaving records for use of sterilization indicators (signal Lock)

D6 Spill Management
D6.1 Staff is aware of management of small spills SI Check for adherence to protocols

D6.2 Availability of spill management Kit SI/OB Check availability of kits

D6.3 Spill management protocols are displayed at points if SI/OB Check for display
use

D7 Isolation and Barrier Nursing

D7.1 Infectious patients are not mixed for general patients OB/SI Check infectious patients are separated from other patients

D7.2 Maintenance of adequate bed to bed distance in wards OB Check for:

1. A distance of 3.5 Foot is maintained between two beds in isolation wards
2. Each bed has only one patient

D7.3 Restriction of external foot wear in critical areas OB/SI External foot wear are not allowed in labour room, OT etc.( As Applicable)

D8 Infection Control Program

D8.1 Infection Control Committee is constituted and RR/SI Check for the enabling order and minutes of the meeting
functional in the PHC

D8.2 Antibiotic Policy is implemented at the facility RR/SI Check if the PHC has documented Anti biotic policy and doctors are aware
of it.
D8.3 Immunization and medical check-up of Service RR/SI PHC staff has been immunized against Td, Hepatitis B
Providers Check for the records and lab investigations of staff

D9 Hospital Acquired Infection Surveillance

D9.1 Facility measures the Health care associated infections RR/SI Check for monitoring of Healthcare Associated Infection that may occur in a
Primary healthcare setting like Injection abscess, Postpartum sepsis,
infection at dressing and suturing sites etc.

D9.2 Facility reports all notifiable diseases and events RR/SI Check that the facility has list of all notifiable disease needs
immediate/periodic reporting to higher authority.
Check records that notifiable disease have been reported in program such
as IDSP/IHIP and AEFI Surveillance.

D9.3 Regular Monitoring of infection control practices RR/SI Check, if there is any practice of daily monitoring of infection control
practice like hand hygiene and personal protection

D10 Environment Control

D10.1 Cross-ventilation at Patient Care areas (ward, labour OB/SI Check availability of Fans/ air conditioning/ Heating/ exhaust/ Ventilators
room and dressing room) as per environment condition and requirement

D10.2 Preventive measures for air borne infections has been OB/SI Check staff is aware, adhere and promote respiratory hygiene and cough
taken etiquettes

D10.3 Adequate number of Air-exchange in Laboratory OB/SI Please check availability and serviceability of exhaust fan in the laboratory

E SUPPORT SERVICES
E1 Laundry Services & Linen Management
E1.1 The facility has adequate stock (including reserve) of RR/SI Check the stock position and its turn-over during last one year in term of
linen demand and availability

E1.2 Hygiene and quality of linen is maintained OB/SI 1. Bed-sheets and pillow cover are stain free and clean in the wards, Labour
Room, etc.
2. Linen is not torn or damaged

E1.3 Bed-sheets and linen are changed daily OB/SI/PI Check, if the bedsheets and pillow cover have been changed daily or
between each patient. Please interview the patients as well.

E2 Water Sanitation
E2.1 The facility receives adequate quantity of water as per RR/SI/PI Check for:
requirement 1. At least 200-250 litres of water per bed per day is available (if municipal
supply)
2. Water is available on 24x7 basis at all points of usage
3. Hospital has pumping or boosting arrangements

E2.2 There is storage tank for the water and tank is cleaned RR 1. The hospital should have capacity to store at least three days of water
periodically requirement Water tank is cleaned at three monthly interval and records
are maintained.
2. Check the area around water tap is fenced making the tap stand area
inaccessible by the animals

E2.3 Drinking Water is tested and chlorinated RR Presence of free chlorine at 0.2 ppm is tested in the samples drawn at the
consumer's end.

E3 Pharmacy and Stores

E3.1 Medicines are arranged systematically OB/SI Check all the shelves/racks containing medicines are labelled in pharmacy
and drug store
Heavy items are stored at lower shelves/racks
Fragile items are not stored at the edges of the shelves
Medicines and consumables are stored away from water and sources of
heat, direct sunlight etc.
Medicines are not stored at floor and adjacent to wall

E3.2 Cold storage equipment's are clean and managed OB Check ILR, Deep freezers and Ice packs are clean
properly Check there is a practice of regular cleaning.
Check vaccines are kept in sequence
Check work instruction for storage of vaccines are displayed at point of use

E3.3 Cold storage equipment are not used for storing other OB/SI Check eatables are not kept in ILR/Deep Freezers
items, than vaccine .

E4 Security Services
E4.1 One Security Guard per shift OB Check for the presence of one security personnel at PHC every shift
E4.2 Departments are locked after working hours OB/SI Departments like OPD, Lab, Administrative office etc. are locked after
working hours.
E4.3 Security personal reprimands attendants, who found OB/SI Check, if security personnel watch behaviour of patients and their
indulging into unhygienic behaviour - spitting, open field attendants, particularly in respect of hygiene, sanitation, etc. and take
urination & defecation, etc. appropriate actions, as deemed.

E5 Outreach Services

E5.1 Biomedical waste generated during outreach session are RR/SI Check the records and ask staff
transported to the PHC on the same day

E5.2 ASHA's are promoting cleanliness and hygiene practices SI Check for ASHA's counsel mothers for hand hygiene, toilets, water
sanitation etc.

E5.3 Medical officers monitor cleanliness and hygiene of RR/ SI Check with medical officers and records of monthly meeting ''Swachh
outreach sessions and HWC-sub centres. Baharat Abhiyan'' has been followed up during monthly meetings with
extension workers like MPW, ASHA, ANM etc.

E6 Patient Convienances

1. Check for 2 or more toilets in the outpatient setting & one toilet per 6
beds in IPD.
2. Look for separate toilets for staff in proximity to the duty area.
E6.1 Availability of adequate number of toilets SI/RR

Check for availability of functional hand hygiene area within 5 meter of the
E6.2 Availability of hand hygiene stations near the toilets OB toilets

At least one toilet has provision for sanitary napkins to ensure menstrual
E6.3 Menstrual hygiene needs are addressed OB/SI hygiene needs
F Hygiene Promotion
F1 Community Monitoring & Patient Participation
F1.1 Local community and organisations are involved in SI/RR Members of RKS and Local Governance bodies monitor the cleanliness of
monitoring and promoting cleanliness the PHC at pre-defined intervals
Local NGO/ Civil Society Organizations/Panchayati Raj Institution are
involved in cleanliness of the PHC

F1.2 Patients are made aware of their responsibility of PI/OB Ask patients about their roles& responsibilities with regards to cleanliness.
keeping the health facility clean Patient’s responsibilities should be prominently displayed

F1.3 The Health facility has a system to take feed-back from SI/RR 1. Check if there is a feedback system for the patients.
patients and visitors for maintaining the cleanliness of 2. Verify the records that analysis of patient feedback received is done &
the facility action are taken in lowst performing attributes.
3. Look for the records of action plan closure & its status

F2 Information Education and Communication

F2.1 IEC regarding importance of maintaining hand hygiene OB Should be displayed prominently in local language
is displayed in PHC premises

F2.2 IEC regarding Swachhata Abhiyan/water OB Should be displayed prominently in local language
pollution/reuse of water etc.is displayed within the
facilities’ premises
F2.3 IEC regarding use of toilets is displayed within PHC OB Should be displayed prominently in local language
premises

F3 Leadership and Team work

F3.1 Cleanliness and infection control committee has RR/SI (1) Verify the Constitution of the committee and its functioning from the
representation of all cadre of staff including Group ‘D’ records
and cleanings staff (2) Roles and responsibilities of different members are assigned and
communicated
(3) Checkt members are aware of their roles and responsibilities
F3.2 PHC has a system of reviewing and improving the gaps SI/RR 1) The committee check the cleanliness and Biomedical Waste
identified for cleanliness and Biomedical waste management compliance regularly
management including WASH (2) All the non-compliance are enumerated, and improvement plans are
prepared and action is taken

F3.3 PHC leadership review the progress of the cleanliness SI/RR Check about regularity of meetings and monitoring activities regarding
drive on weekly basis cleanliness drive

F4 Training and Capacity Building and Standardization

F4.1 Bio medical waste Management training has been SI/RR Verify with the training records.
provided to the staff Check staff are trained at the time of induction and at least once in every
year
F4.2 Infection control Training has been provided to the staff SI/RR Verify with the training records.
Check staff are trained at the time of induction and at least once in every
year

F4.3 PHC has documented Standard Operating procedures RR Check availability of SOP with respective users
for Cleanliness, Bio-Medical waste management,
Infection Control and procurement of PPE

F5 Staff Hygiene and Dress Code

F5.1 Check PHC have adequate staff for maintaining cleaning SI/RR Check facility has adequate staff for maintaining cleanliness, hygiene and
activities bio-medical waste management activities

F5.2 Check the dress code policy is defined and mechainism BO/RR (1) Check dress code policy is available and adhered to.
in place to check regular monitoring of the hygiene of (2) Check about personal hygiene and clean dress of staff
staff

F5.3 Identity cards and name plates have been provided to all OB Check staff uses I Card and name plate
staff

G Beyond Hospital Boundary

G1 Promotion of Swachhata & Coordination with Local bodies
G1.1 Local community actively participates during Swachhata RR/SI Local community is actively involved in administration of ''Swachhata
Pakhwara(Fortnight) Pledge'' and distribution of caps/T-shirts/ badge with cleanliness message
and logos of ''Water Conservation'', "Air & Noise Pollution" and ''Kayakalp''.

G1.2 Implementation of IEC activities related to ' Swachh OB/RR/SI Advertisement in news-papers/electronic media, distribution of booklets/
Bharat Abhiyan' pamphlets, posters/wall writing-promoting use of toilets, hand washing,
safe drinking water and tree plantation, etc.

G1.3 Community awareness by organising cultural RR/SI Like rally/marathon/ Swachhata walk/human chain, street plays, essay/
programme and competitions poem/slogan/painting competition, etc.

G1.4 The Facility coordinates with local Gram RR/SI Look for evidence of collective action such as cleaning of drains,
Panchayat/Urban local bodies and NGOs for improving maintenance of parking space, orderly arrangement of hawkers (outside
Swachhata in vicinity of the health facility the facility), rickshaw, auto, taxi, construction & maintenance of public
toilets, improving street-lighting, removing cattle nuisance, etc.

G1.5 Facility coordinates with other departments for RR/SI Look for evidence of coordination with departments such as Education
improving Swachhata (school programs on hygiene promotions), Water sanitation , PWD (Repair
& Maintenance), Forest Department (Plantation Drive) etc., which
contributes strengthening towards of hygiene & sanitation

G2 Leadership & tapping alternative source of funding for Swachhata

G2.1 The Facility has undertaken initiative for community SI/RR Check for any mobilization activities in line with VISHWAS campaign
mobilization in the surrounding for improving initiated by MoHFW, involving VHSNC/MAS/RKS/JAS
Swachhata
G2.2 The Facility endeavours to attract financial support from RR/SI Look for evidence that the health facility has been supported by other
other organisations organisations such as Industry, Business houses, NGOs, Rotary & Lions
clubs, market associations, welfare associations etc. for improving the
cleanliness in the surroundings

G2.3 Facility endeavours to attract financial support from RR/SI Look for evidence that local MPs/MLAs/Municipal Councillors/Panchayat
local support Members/Zila Parisad/ individual donations have supported health facility
in its cleanliness efforts.

G2.4 Facility support the local school/ college in improving RR/SI Look for evidence that local School/College has implemented ‘Swachh
their cleanliness Bharat-Swachh Vidyalaya’ initiative through coordinated efforts

G2.5 The facility engages the local Community for reducing RR/SI Look for evidence that the facility has engaged in reducing household level
household pollutions in the vicinity pollution in near vicinity of the health facility – Presence of community bins
for segregated collection of general (biodegradable & recyclable), Compost-
pits, Roll-out of PM Ujjwala Scheme in nearby slum, etc.

G3 Cleanliness of approach road and surrounding area

G3.1 Area around the facility is clean, neat and tidy OB Check for:
1. Any litter/garbage/outgrown weeds/moss in the surrounding area,
footpaths and pavements
2. No water logging in the surrounding area
3. Access, directional signage, and name of facility in approach road to PHCs
is available

G3.2 Exterior of hospital boundary wall is painted and OB/SI (1) The exterior of the boundary wall is clean, free from solid waste,
maintained stagnant water, no animal and human faeces in and around the boundary
wall
(2) It is of uniform colour—no unwanted posters on the exterior of the
boundary wall.
(3) Exterior of the boundary walls are painted innovatively, displaying
messages of cleanliness, hygiene & Go Green concept etc
G3.3 Approach road are even and free from pot-holes OB/SI Check that approach roads are clean and free from pot-holes and water
stagnation

G3.4 All drains/sewer are covered. OB Check for open manhole and overflowing drains.

G3.5 Functional street lights are available on the approach OB/SI Check for street lights and their functionality. Trees or other buildings
road should not be blocking the lights.

G4 Public Amenities in Surrounding Area

G4.1 Availability of Public toilets/ Urinal in surrounding Area OB Check for availability separate toilets/ Urinal for male and female. Check
that no foul smell come from the toilets

G4.2 Such toilets/Urinal are neat & clean OB Check availability of water and level of cleanliness

G4.3 Presence of Safe Drinking Water facility outside the OB Check for its presence and functionality
boundary wall
G4.4 Availability of adequate parking facilities for Public OB Check signage & parking space: Also check that such transports are parked
Transport such as Cycle Rickshaw, Tanga, Auto, Taxi haphazardly

G4.5 Vendors & hawkers have designated place outside the OB/SI Check for the availability of designated place for vendors & hawkers and
facility cleanliness

G5 Aesthetics of Surrounding area

G5.1 Parks and green areas in the surrounding area are well OB/SI Check that there no wild vegetation & growth in the surroundings. Shrubs
maintained and trees are well maintained. Dry leaves and green waste are removed
regularly.

G5.2 There are no stray animals in surrounding area OB/SI Observe for the presence of stray animals such as pigs, dogs cattle, etc.

G5.3 Illumination in surrounding area OB Check that hospital front, approach road and surrounding area are well
illuminated with street lights
G5.4 No unwanted/broken/torn/ loose hanging OB Check that hospital surrounding are not studded with irrelevant and out
posters/billboards. dated posters, slogans, wall writings, graffiti, etc.

G5.5 No loose hanging wires in and around bill boards, OB Check for any loose hanging wires
electrical polls etc.

G6 Maintenance of surrounding area and Waste Management

G6.1 Availability of bins for General recyclable and OB Check availability adequate number of bins for Biodegradable and
biodegradable wastes recyclable general waste in the nearby market

G6.2 Availability of garbage storage area/ compost pit OB Garbage storage area is away from residential/commercial areas and is
covered/ fenced. It is not causing public nuisance. In rural set-up there
should be a compost pit.

G6.3 Innovations in managing waste OB/SI Check, if certain innovative practices have been introduced for managing
waste e.g. Vermicomposting/Re-cycling of papers/Waste to
energy/Compost Activators, etc.

G6.4 Surrounding areas are well maintained OB Check that there is no over grown shrubs, weeds, grass, potholes, bumps
etc. in surrounding areas. Vector control measures like Regular fogging,
DDT Spray, Gambusia (mosquito fish) in ponds and other water bodies
done for disease prevention.

G6.5 Regular repairs and maintainance of roads, footpaths OB/SI/RR Check when was the last repair done and current condition of the road- pot-
and pavements holes, broken footpath etc.
ital

s)

Level of Assessment

Improvement

C. Waste Management

58

F. Hygiene Promotion

30
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