Kayakalp Toolkit PHC without beds-19 July 2024_0.xlsx

	A	B	D	E	H	I	J
2	APS	Kayakalp Clean Hospital				ver
3		Checklist for Assessment UPHC/APHC (without bed)
4
5
6		The Cleanliness Score Card
7		Name of Facility	100.0%		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
40	Ref. No.	Criteria	Assessment Method	Means of Verification	Compliance	Remarks	Wash Point
41	A.	APHC/UPHC UPKEEP
42	A1	Pest & Animal Control			4
43	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. Also discuss with the facility staff. 2. Check at the entrance of facility that cattle trap has been provided. 3. Look for the breach in the boundary wall, if any	2
44	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 of Pesticides and availability of the rat trap) and interview the staff about its usage	2
45	A2	Landscaping & Gardening			4
46	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	2
47	A2.2	Internal Roads and pathways are even and clean	OB	Check that pathways, corridors, courtyards, etc. are clean and landscaped.	2
48	A3	Maintenance of Open Areas			4
49	A3.1	There is no abandoned / dilapidated building / unused structure within the premises	OB	Check for presence of any ‘abandoned building’ and unused temporary structure within the premises. Give full compliance if the existing abandoned building is identified and marked and not in use.	2
50	A3.2	No water logging in open areas and the facility buildings are vector- breeding proof	OB	1. Check for water accumulation in open areas because of faulty drainage, leakage from the pipes, rainwater etc 2. Look for tyres, flower pots etc., for accumulation of stagnant water.	2
51	A4	APHC/UPHC Appearance			4
52	A4.1	Walls are well-plastered and painted	OB	Check that wall (Internal and External) plaster is not chipped-off and that the building is painted/ whitewashed in a uniform approved colour scheme. The paint has not faded away. Check for the presence of any outdated posters, IEC material & boards etc	2		Hygiene
53	A4.2	Name of the PHC is prominently displayed at the entrance and have uniform signage system	OB	1. Name of the PHC is prominently displayed as per the state’s policy. 2. The name board of the facility is well-illuminated at night. 3. Check that all signages (directional & departmental)and information is displayed in the local language. 4. Uniform colour scheme id followed	2
54	A5	Infrastructure Maintenance			4
55	A5.1	PHC Infrastructure is well maintained	OB	No major cracks, seepage, chipped plaster & floors in the PHC. Periodic Maintenance is done.	2
56	A5.2	PHC has intact boundary wall and functional gates at entry	OB	Check that there is a proper boundary wall of adequate height without any breach. 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.	2		Hygiene
57	A6	Illumination			4
58	A6.1	Adequate illumination in inside and outside of the PHC area	OB	Check for adequate lighting arrangements through Natural Light or Electric Bulbs inside PHC Check that the PHC front, entry gate and access road are well-illuminated	2		Hygiene
59	A6.2	Use of energy efficient bulbs	OB	Check that PHC uses energy efficient bulb like CFL or LED for lighting purpose within the PHC Premises	2
60	A7	Maintenance of Furniture & Fixture			4
61	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
62	A7.2	Patients' & staff furniture is in good condition	OB	1. Check that Patient beds, examination couches, stools, etc., are not rusted and are painted. 2. Mattresses are clean and not torn 3. Trolleys, Stretchers, Wheel Chairs, etc., are well maintained( As applicable) 4. Check the furniture at the nursing station, duty room, offices, etc. painted/polished and clean. Check, the furniture is not broken & rusted	2
63	A8	Removal of Junk Material			4
64	A8.1	No junk material within APHC/UPHC premises	OB	Check if unused/ condemned articles and outdated records/ broken furniture are kept in the Nursing stations, OPD clinics, Injection rooms, Dressing Rooms, stairs, open areas, rooftops, balconies etc.	2
65	A8.2	PHC has demarcated space for keeping condemned junk material	OB/SI	Check for availability of a demarcated & secured space for collecting and storing the junk material before its disposal	2
66	A9	Water Conservation			4
67	A9.1	Piped Water supply system is maintained in the PHC	OB	(1) Check for leaking taps, pipes, over-flowing tanks and dysfunctional cisterns. (2) Over-head tank has functional float-valve.	2		Water
68	A9.2	Preventive measures are taken to reduce wastage and reuse of water	SI/OB	Check any innovative practices such as : 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 wastewater for gardening, toilet flushing, etc. 4. Installation of dual flush toilets 5. Availability of rainwater harvesting system	2
69	A10	Work Place Management			4
70	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 like Nursing stations, work bench, dispensing counter in Pharmacy, etc. Check for presence of unnecessary articles.	2
71	A10.2	The Staff arranges the useful articles, records in a systematic manner and labelled	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
72	B	Sanitation & Hygiene
73	B1	Cleanliness of Circulation Area (Corridors, Waiting area, Lobby, Stairs)			4
74	B1.1	No dirt/Grease/Stains and Cobwebs/Bird Nest/ Vegetation/ Dust on the walls and roof in the Circulation area	OB	Check that floors and walls of Corridors, Waiting area, stairs, roof top for any visible or tangible dirt, grease, stains, etc. Check that roof, walls, corners of Corridors, Waiting area, stairs, roof top for any Cobweb, Bird Nest, etc.	2		Hygiene
75	B1.2	Corridors are cleaned at least once in the day with wet mop	SI/OB	Ask cleaning staff about the frequency of cleaning in a day. Verify with Housekeeping records. Corridors are rigorously cleaned with scrubbing/flooding once a month	2
76	B2	Cleanliness of OPD Clinic			4
77	B2.1	No dirt/Grease/Stains and Cobwebs/Bird Nest/ Dust/ Vegetation's on walls and roof in OPD	OB	Check floors and walls of the OPD for any visible or tangible dirt, grease, stains, etc. Check that roof, walls, corners of OPD for any Cobweb, Bird Nest, vegetation, etc.	2		Hygiene
78	B2.2	OPD are cleaned at least twice in a day with wet mop	OB/SI	Ask cleaning staff about the frequency of cleaning in a day. Verify with Housekeeping records. Clinics are rigorously cleaned with scrubbing/flooding once a month	2
79	B3	Cleanliness of Procedure Areas(Dressing Room, Immunization, Injection Room, Labour Room (if available))			4
80	B3.1	No dirt/Grease/Stains and Cobwebs/Bird Nest/ Dust/ vegetation's on walls and roof in Procedure area	OB	Check that floors and walls of Procedure area like Labour Room, 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.	2		Hygiene
81	B3.2	Procedure area are cleaned at least twice in a day	OB/SI	Ask cleaning staff about frequency of cleaning in a day and also verify with check-list. Check if surfaces are smooth for ensuring cleaning Check the floors and walls for cracks, uneven or any other defects which may affect the cleaning procedure	2
82	B4	Cleanliness of Lab and Pharmacy			4
83	B4.1	No dirt/Grease/Stains and Cobwebs/Bird Nest/ Dust/ Vegetation on walls and roof in lab and pharmacy area	OB	Check that floors and walls of Lab and Pharmacy for any visible or tangible dirt, grease, stains, etc. Check roof, walls, corners of these area for any Cobweb, Bird Nest, Vegetation, etc.	2		Hygiene
84	B4.2	Lab and Pharmacy area are cleaned at least once in the day with wet mop	OB/SI	Ask cleaning staff about the frequency of cleaning in a day and also verify with check-list & housekeeping records	2
85	B5	Cleanliness of Auxiliary Areas( Office, Meeting Room, Staff Room, Record Room)			4
86	B5.1	No dirt/Grease/Stains and Cobwebs/Bird Nest/ Dust/ vegetation on walls and roof in Auxiliary area	OB	Check that floors and walls of office, Meeting Room, Staff Room Record room etc. (As applicable) for any visible or tangible dirt, grease, stains, etc. Check roof, walls, corners of these area for any Cobweb, Bird Nest, Vegetation, etc.	2		Hygiene
87	B5.2	Ambulatory and auxiliary areas are cleaned at least once in a day with a wet mop	SI/RR	Ask cleaning staff about the frequency of cleaning in a day. Verify with Housekeeping records	2
88	B6	Cleanliness of Toilets			4
89	B6.1	No dirt/Grease/Stains/ Garbage in Toilets	OB	Check the toilets randomly for any visible dirt, grease, stains, water accumulation in the toilets Check for any foul smell in the toilets	2		Hygiene
90	B6.2	Toilets have running water and functional cistern	OB/SI	Ask cleaning staff to operate cistern and water taps	2		Water
91	B7	Use of standards materials and Equipment for Cleaning			4
92	B7.1	Availability of Detergent Disinfectant solution / Hospital Grade Phenyl for Cleaning purpose	SI/OB/RR	1. Check for good quality, eco-friendly PHC cleaning solution, preferably an 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.	2		Hygiene
93	B7.2	Availability of Cleaning Equipment	SI/OB	1. Check the availability of mops, brooms, collection buckets etc. as per requirement. 2. Storage area/Janitor room for cleaning equipment is clean and dry	2		Hygiene
94	B8	Use of Standard Methods for Cleaning			4
95	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.	2
96	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. Separate mop is used in the procedure area.	2		Hygiene
97	B9	Monitoring of Cleanliness Activities			4
98	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	2
99	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		Sanitation and Healthcare Waste
100	B10.	Drainage and Sewage Management			4
101	B10.1	Availability of connection with Municipal Sewage System/ or Soak Pit	OB/SI	Check if PHC sewage has a proper connection with a municipal drainage system. If there is no access to the municipal system, there should be a septic tank. Check the condition of the septic tank e. g. Periodicity of cleaning, mosquito proofing of the manhole, etc.	2
102	B10.2	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	2
103	C	Waste Management
104	C1	Segregation of Biomedical Waste			4
105	C1.1	Segregation of BMW is done as per BMW management rules 2016*	OB/SI	Check that Soiled Waste is collected in the yellow bin & bag. General & Biomedical Waste are not mixed together. Display of work instructions for segregation and handling of Biomedical waste	2		Sanitation and Healthcare Waste
106	C1.2	Check if the staff is aware of segregation protocols	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.)	2
107	C2	Collection and Transportation of Biomedical Waste			4
108	C2.1	The PHC's waste is collected and transported by CBWTF operator	OB	Check for records of linkage with CBWTF operator or has functional deep burial pits within the facility.	2		Sanitation and Healthcare Waste
109	C2.2	The waste is transported in closed bag & trolley	OB	Check availability of trolley for transportation to collection point.	2
110	C3	Sharp Management			4
111	C3.1	Disinfection of Broken / Discarded Glassware is done as per recommended procedure	OB/SI/ RR	Check such waste is pre-treated either with 1-2% Sodium Hypochlorite for 30 minutes or by autoclaving/ microwave/ hydroclave and sent for recycling	2
112	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.	2