Kayakalp Toolkit_AAM _19 July 2024_0 (1).xlsx

	A	B	D	E	H	I
2	APS	Kayakalp Clean Hospital
3		Checklist for Assessment of Ayushman Arogya Mandir Sub Health Centre
4
5
6		The Cleanliness Score Card
7		Name of Facility	100		Level of Assessment
8
9		Grading			Improvement
10
11
12		Thematic Scores
13
14
15		A. PHC Upkeep		B. Sanitation & Hygiene	C. Waste Management
16		40		40	40
17		40		40	40
18
19
20
21		D. Infection Prevention & Control		E. Support Services	F. Hygiene Promotion
22		40		24	20
23		40		24	20
24
25
26		G. Beyond Hospital Boundary		WASH
27		40		100
28
35
36
37	Ref. No.	Criteria	Assessment Method	Means of Verification	Compliance	Remarks
38	A.	Sub Centre/Ayushmann Arogya Mandir Upkeep
39	A1	Pest & Animal Control			4
40	A1.1	No stray animals within the facility premises	OB/SI	Observe for the presence of stray animals such as dogs, cats, cattle, pigs, etc. within the premises. Also discuss with the facility staff. Also look at the breach, if any, in the boundary wall and presence of secured gate.	2
41	A1.2	Pest Control Measures are implemented in the facility	SI/RR/OB	Check for the evidence at the facility ( Presence of Pests ,Record of Purchase/availability of Pesticides and availability of the rat trap) and interview the staff.	2
42	A2	Landscaping, Gardening & Yoga			4
43	A2.1	Surrounding area/ 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.	2
44	A2.2	Demarcated place/room for Yoga is well maintained	OB	Check Yoga room/space is available and demarcated. Check space is adequate and clean.	2
45	A3	Maintenance of Open Areas			4
46	A3.1	Approach walkway from gate to the facility is even and clean	OB	Check that walkway is even and non-slippery and well maintained	2
47	A3.2	No water logging in open areas	OB	Check for water accumulation in open areas because of faulty drainage, pipe leakage, rainwater etc. Look for any stagnant water in tyres, flower pots, etc.	2
48	A4	Hospital/Facility –Appearance			4
49	A4.1	Walls are well-plastered, painted and name of the facility is displayed	OB	Check that the wall plaster (internal and External wall) is not chipped off and the building is painted with yellow colour wall & Brown colour windows. The paint has not faded away. The name of the Centre is prominently displayed.	2
50	A4.2	Branding of Ayushman Aarogaya Mandir has been under taken as per current guideline.	OB	Check for:- 1- Outer surface of the building is yellow with specified shade. 2- Windows & their frame in the brown specified shade. 3- Six illustrations drawn on the façade. 4- Logo of NHM and Ayushman Bharat.	2
51	A5	Infrastructure Maintenance			4
52	A5.1	Facility Infrastructure is well maintained	OB	No major cracks, seepage, chipped plaster & floors in the Centre. Periodic Maintenance is done.	2
53	A5.2	Centre has intact boundary wall/Fencing and functional gates at entry	OB	Check that there is a proper boundary wall/fencing of adequate height without any breach. Check that there is no rusting of the gates. All the gates (entry, exit or any other gates) are painted and functional.	2
54	A6	Illumination			4
55	A6.1	Adequate illumination in inside and outside of the Centre	OB	Check for Adequate lighting arrangements through natural light or electric bulbs(CFL/LED) inside Centre . Check that Centre front, entry gate and access road are well illuminated.	2
56	A6.2	Use of energy efficient bulbs	OB	Check thatCentre uses energy efficient bulb like CFL or LED for lighting purpose within the Centre Premises	2
57	A7	Maintenance of Furniture & Fixture			4
58	A7.1	Window and doors are maintained	OB	Check, if Window panes are intact, and provided with Grill/ Wire Meshwork. Doors are intact and painted /varnished.	2
59	A7.2	furniture and fixtures are in good condition.	OB	Check that the Examination table, foot Step, Table, Chair, stool, etc., are not rusted and are painted. The mattresses are clean and not torn Almirah, Fans, Tube lights etc., are well maintained( As applicable)	2
60	A8	Removal of Junk Material			4
61	A8.1	No junk material within centre premises	OB	Check if unused/ condemned articles, and outdated records are kept in the haphazard manner.	2
62	A8.2	Centre has system for removing junk materials	OB/SI	Check for any system of removing junk from Centre with support from PHC	2
63	A9	Water Conservation			4
64	A9.1	Piped water supply is adequate in Quantity & Quality	OB	(1) Check for leaking taps, pipes, over-flowing tanks and dysfunctional cisterns. (2) Over-head tank is covered.	2
65	A9.2	Check if the facility has rain-water harvesting system	SI/OB	Check for its functionality and storage system	2
66	A10	Work Place Management			4
67	A10.1	The Staff periodically sorts useful and unnecessary articles at work station	SI/OB	Ask the Staff, how frequently they sort and remove unnecessary articles from their work place.. Check for presence of unnecessary articles.	2
68	A10.2	The Staff arranges the useful articles, records in systematic manner and label them	SI/OB	Check if drugs, instruments, records are not lying in haphazard manner and kept near to point of use in systematic manner. The place has been demarcated for keeping different articles Check that drugs, instruments, records, etc. are labelled for facilitating easy identification.	2
69	B	Sanitation & Hygiene
70	B1	Cleanliness of Circulation Area (Corridors, Patient Waiting area)			4
71	B1.1	No dirt,grease,stains, cobwebs, bird nest, dust, vegetation on walls and roof in the circulation area	OB	Check that floors and walls of Corridors, Waiting area etc for any visible or tangible dirt, grease, stains, etc. Check that roof, walls, corners of Corridors, Waiting area for any Cobweb, Bird Nest, etc.	2
72	B1.2	Corridors are cleaned at least once in the day with wet mop	SI/OB	Ask the staff about frequency of cleaning in a day.	2
73	B2	Cleanliness of Clinic room			4
74	B2.1	No dirt,grease,stains, cobwebs, bird nest, dust, vegetation on walls and roof in the Clinic room	OB	Check floors and walls of the clinic room for any visible or tangible dirt, grease, stains, etc. Check that roof, walls, corners of clinic for any Cobweb, Bird Nest, vegetation, etc.	2
75	B2.2	Clinic room is cleaned at least once in a day with wet mop	OB/SI	Ask staff about frequency of cleaning in a day.	2
76	B3	Cleanliness of Procedure Areas (Laboratory/Diagnostic)			4
77	B3.1	No dirt,grease,stains, cobwebs, bird nest, dust, vegetation on walls and roof in the procedure area	OB	Check that floors and walls of storage for any visible or tangible dirt, grease, stains, etc. Check roof, walls, corners of these area for any cobweb, bird nest, vegetation, etc.	2
78	B3.2	Procedure area are cleaned at least once in a day and as required	OB/SI	Ask staff about frequency of cleaning in a day	2
79	B4	Cleanliness of Storage Space			4
80	B4.1	No dirt, grease, stains, cobwebs, bird nest, dust, vegetation on walls and roof in the storage space.	OB	Check that floors and walls of storage for any visible or tangible dirt, grease, stains, etc. Check roof, walls, corners of these area for any cobweb, bird nest, vegetation, etc.	2
81	B4.2	Storage space are cleaned at least once in the day with wet mop	OB/SI	Ask staff about frequency of cleaning in a day	2
82	B5	Cleanliness of Roof top			4
83	B5.1	No dirt, cobwebs, bird nest, junk articles on roof top	OB	Check roof top of the Centre for any dirt, Cobweb, Bird Nest, etc. Check for any junk articles on roof top	2
84	B5.2	Roof top are cleaned at least once in the month	SI/OB	Ask staff about frequency of cleaning	2
85	B6	Cleanliness of Toilets			4
86	B6.1	No dirt/Grease/Stains/ Garbage in Toilets	OB	Check the toilets randomly for any visible dirt, grease, stains, or water accumulation in the toilets Check for any foul smell in the Toilets Floors of Toilets are dry, crack free and without residue water accumulation	2
87	B6.2	Separate male & female toilets have running water and functional cistern	OB/SI	Check availability of separate male and female toilets Ask staff to operate cistern and water taps	2
88	B7	Use of standards materials and Equipment for Cleaning			4
89	B7.1	Availability of Detergent Disinfectant solution / Hospital Grade Phenyl for Cleaning purpose	SI/OB/RR	Check for good quality cleaning solution preferably an ISI mark. Composition and concentration of solution is written on label. Check with staff if they are getting adequate supply. Verify the consumption records. Check, if the cleaning staff is aware of correct concentration and dilution method for preparing cleaning solution.	2
90	B7.2	Availability of Cleaning equipment	SI/OB	Check the availability of mops, brooms, collection buckets etc. as per requirement.	2
91	B8	Use of Standard Methods for Cleaning			4
92	B8.1	Use of Two bucket system for cleaning	SI/OB	Check if cleaning staff uses two bucket system for cleaning. One bucket for Cleaning solution, second for wringing the mop. Ask the cleaning staff about the process, Disinfection and washing of mops after every cleaning cycle	2
93	B8.2	Use unidirectional method and out word mopping	SI/OB	Ask cleaning staff to demonstrate the 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.	2
94	B9	Monitoring of Cleanliness Activities			4
95	B9.1	Monitoring of cleanliness by Community Health officer (CHO) on daily basis	OB/RR	Ask Community Health officer (CHO) about monitoring mechanism of cleanliness. Check for records	2
96	B9.2	Periodic Monitoring of Housekeeping and Bio medical waste management activities	SI/RR	Periodic Monitoring is done by MOIC or trained designated person. Please check record of such monitoring	2
97	B10.	Drainage and Sewage Management			4
98	B10.1	Availability of drainage and sewage system	OB/SI	Centre has a functional septic tank and soak pit within the premises.	2
99	B10.2	No blocked/ over-flowing drains in the facility	OB/SI	Observe that the drains are not overflowing or blocked and they are covered.	2
100	C	Waste Management
101	C1	Segregation of Biomedical Waste			4
102	C1.1	Segregation of BMW is done as per BMW management rule 2016 including key changes as amendments	OB/SI	General & Biomedical Waste are not mixed together. Display of work instructions for segregation and handling of Biomedical waste	2
103	C1.2	Check if the staff is aware of segregation protocols	SI	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.)	2
104	C2	Collection and Transportation of Biomedical Waste			4
105	C2.1	Centre waste is collected and transported in safe manner	OB	Check for records of linkage with CWTF operator or has functional deep burial pits within the facility which has approval of the prescribed authority.	2
106	C2.2	The waste is transported in closed bag	OB	Check availability of bag for transportation of waste.	2
107	C3	Sharp Management			4