Kayakalp Toolkit DH, SDH & CHC_19 July 2024-N (1).xlsx

	A	B	D	E	F	H	L
1		Ver: KK/DH-SDH-CHC/0724
2	APS	Kayakalp Clean Hospitals
3		Checklist for Assessment( DH, SDH and CHC)
4
5
6		The Cleanliness Score Card
7		Name of Facility	Kayakalp Scorecard		Eco- Friendly Scorcard	State & District
8					0
9		Date	0			Level of Assessment
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12		Thematic Scores
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14
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17		A. Hospital Upkeep		B. Sanitation & Hygiene		E. Support Services
18		0		0		0
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20
21
22
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27		C. Waste Management		D. Infection Prevention & Control		F. Hygiene Promotion
28		0		0		0
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30
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32
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36		G. Beyond Hospital Boundary		H. Eco-Friendly Facility		WASH
37		0		0		0
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39
40
49
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51	S.No	Criteria	Assessment Method	Means of Verification		Compliance	Remarks
52	A	Hospital/Facility Upkeep				0
53	A1	Pest & Animal Control				0
54	A1.1	No stray animals within the facility premises	OB/SI	Observe for the presence of stray animals such as dogs, cats, cattle, pigs, monkey etc. within the premises. Also discuss with the facility staff.
55	A1.2	Cattle-trap is installed at the entrance	OB	Check at the entrance of facility that cattle trap has been provided. Also look at the breach, if any, in the boundary wall and ensure that there is some mechanism for passage of wheel chairs and trolleys.			One gate
56	A1.3	Integrated Pest Control Management is implemented in the facility	SI/RR	Ask the facility administration about pest control measures to control rodents and insect. Check records of engaging a professional agency for the same
57	A1.4	Anti-termite Treatment of the wooden furniture and fixtures is undertaken periodically	RR/SI	Check if the facility has a scheduled programme for anti-termite treatment at least once in a year
58	A1.5	Measures for Mosquito free environment are in place	OB/SI /PI	Check for 1. Usage of insectiside treated (LLIN) Mosquito nets by the patients. 2. Availability of adequate stock of Mosquito nets. 3. Wire Mesh in windows. 4. Desert Coolers (if in use) are cleaned regularly/ oil is sprinkled 5. No water collection for mosquito breeding within and outside the premises
59	A2	Landscaping & Gardening
60	A2.1	Facility’s front area is landscaped (Both hardscaping and soft-scaping)	OB	Check for the following: 1.Hardscaping: look for driveways/retaining walls/pavers / fountains are maintained adequately 2.Soft-scaping :Front of the facility has been maintained with grass beds, trees, Garden, etc. and it has an aesthetic appearance
61	A2.2	Green Areas/ 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.
62	A2.3	Internal Roads, Pathways, waiting area, etc. are even and clean	OB	Check that pathways, corridors, courtyards, waiting area, etc. are clean and land landscaped.
63	A2.4	Gardens/ green area are secured with fence	OB	Check the barricades, fence, wire mesh, railings, gates, etc. have been provided for the green area.
64	A2.5	Provision of Herbal Garden	OB/SI	Check if the facility maintains a herbal garden for the medicinal plants Check for:- 1. Its accessibility to the patients 2.Trees & Plants generating more oxygen (E.g.. Neem, Peepal, Aloe Vera, Tulsi etc.)
65	A3	Maintenance of Open Areas
66	A3.1	There is no abandoned / dilapidated building within the premises	OB	Check for the presence of any ‘abandoned building’ within the facility premises. Note: give full compliance if the existing abandoned building is identified and marked and not in use
67	A3.2	No water logging in open areas and the facility buildings are vector- breeding proof	OB	Check for water accumulation in open areas because of faulty drainage, leakage from the pipes, rainwater etc. Look for tyres, flower pots etc., for accumulation of stagnant water.
68	A3.3	No thoroughfare/general traffic in hospital premises	OB/ SI	Check that the facility premises are not being used as ‘thoroughfare’ by the general public
69	A3.4	Open areas are well maintained	OB/RR	Check that: 1- there is no over grown shrubs, weeds, grass, potholes, bumps etc. in open areas 2-Retaining natural topography (and/ or) design vegetated spaces on the ground, for at least 15% of the site area 3-Preservation of existing trees & plantation of new trees
70	A3.5	There is no unauthorised occupation within the facility, nor there is encroachment on Hospital land	OB/SI	Check for hospital premises and access road have not been encroached by the vendors, unauthorized shops/ occupants, etc.
71	A4	Hospital / Facility Appearance
72	A4.1	Walls are well-plastered and painted	OB	Check that wall plaster is not chipped-off and the building is painted/ whitewashed in uniform colour and paint has not faded away.
73	A4.2	Interior of patient care areas are plastered & painted	OB	Interior walls and roof of the outdoor and indoor area are plastered and painted in soothing colour. The Paint has not faded away.
74	A4.3	Name of the hospital is prominently displayed at the entrance	OB	Name of the Hospital is prominently displayed as per state’s policy and convenience of beneficiaries. The name board of the facility is well illuminated in night
75	A4.4	Uniform and signage system in the Hospital	OB	Check for: 1. All signage's (directional & departmental) and information displayed in local language 2. All signages follow uniform colour scheme.
76	A4.5	No unwanted/Outdated posters	OB	Check, that facility’s external and internal walls are not studded with irrelevant and out dated posters, slogans, wall writings, graffiti, etc.
77	A5	Infrastructure Maintenance
78	A5.1	Hospital Infrastructure is well maintained	OB	No major cracks, seepage, chipped plaster & floors in the hospital
79	A5.2	Hospital has a system for periodic maintenance of infrastructure at pre-defined interval	SI/RR	Check the records for preventive maintenance of the building. It should be done at least annually.
80	A5.3	Electric wiring and Fittings are maintained	OB	Check to ensure that there are no loose hanging wires, open or broken electricity panels
81	A5.4	Hospital has intact boundary wall and functional gates at entry	OB	Check that there is a proper boundary wall of adequate height without any 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.
82	A.5.5	Hospital 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
83	A6	Illumination
84	A6.1	Adequate illumination in Circulation Area	OB	Check for adequate lighting arrangements in the waiting area, lobby, corridors, lift landing area, staircase, etc., through Natural Light or Electric Bulbs. Minimum illumination should be 100-150 Lux.
85	A6.2	Adequate illumination in outdoor and Indoor patient care areas	OB	Check for adequate lighting arrangements through Natural Light or Electric Bulbs. The illumination should be 150-300 Lux at the Nursing station and 100-150 Lux in the wards.
86	A6.3	Adequate illumination in Procedure Areas	OB	Check for adequate lighting arrangements in OT, Labour Room, Laboratory, other clinical departments, etc., as applicable.
87	A6.4	Adequate illumination in front of hospital and access road	OB	Check that hospital front, entry gate, parking and access road are well illuminated specially at night
88	A6.5	Adequate illumination in auxiliary area	OB	Check that auxiliary area of the facility like Pharmacy, Kitchen, Laundry, Mortuary, Administrative offices, Toilets, Bathing area, etc. are well illuminated
89	A7	Maintenance of Furniture & Fixture
90	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
91	A7.2	Patient Beds & Mattresses are in good condition	OB	Check that Patient beds are not rusted and are painted. Mattresses are clean and not torn
92	A7.3	Trolleys, Stretchers, Wheel Chairs, etc. are well maintained	OB	Check that Trolleys, Stretcher, wheel chairs are intact, painted and clean. Wheels of stretcher and wheel chair are aligned and properly lubricated
93	A7.4	Furniture at the nursing station, staff room, administrative office are maintained	OB	Check the condition of furniture at nursing station, duty room, office, etc. The furniture is not broken, painted/polished and clean.
94	A7.5	There is a system of preventive maintenance of furniture and fixtures	SI/RR	Check if hospital has an annual preventive maintenance programme for furniture and fixtures, at least once in a year.
95	A8	Removal of Junk Material
96	A8.1	No junk material in patient care areas	OB	Check if unused/ condemned articles, and outdated records are kept in the Nursing stations, OPD clinics, wards, etc.
97	A8.2	No junk material in Open Areas and corridors	OB	Check, if unused/ condemned equipment, vehicles, etc. are kept in the corridors, pathways, under the stairs, open areas, roof tops, balcony, etc.
98	A8.3	No junk material in critical service area	OB	Check if unused articles and old records are kept in the Labour room, OT, Injection room, Dressing room, emergency room, etc.
99	A8.4	Hospital 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
100	A8.5	Hospital has documented and implemented Condemnation policy	SI/RR	Check that: 1. Hospital has drafted its condemnation policy or has got one from the state. 2. They are complying with it 3. Old ambulances, vehicles, broken furniture, etc., not lying inside the hospital premises
101	A9	Water Conservation
102	A9.1	Piped water supply is adequate in Quantity & Quality	OB/SI	Check for:- 1. Quantity of water including reservoir and record of its for judicious use of water 2. Installation of main water meter/sub-meter
103	A9.2	Water supply system is maintained in the hospital and periodical inspection for water wastage is done	OB/SI	Check for:- 1. staff have been assigned duty for periodical inspection of leaking taps, pipes and dysfunctional cisterns etc. 2. use of low-flow faucets; dual flush toilets
104	A9.3	Hospital promotes water conservation	SI/OB/RR	Check :- 1. IEC material is displayed for water conservation, and staff & users are made aware of its importance 2. The facility conducts educational program that highlights the need to conserve and use water efficiently
105	A 9.4	Hospital has a functional rain water harvesting system	OB/SI	Check :- Hospital Infrastructure and drain system are fitted with rain water harvesting system with sufficient storage capacity
106	A.9.5	The hospital has innovative practices for water Conservation		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.Usage of grey water for irrigation and toilet flushing etc. 3. Installation of Sensor based/auto stop taps at washbasins 4. Recycling of waste water 5. Installation of dual flush in toilets
107	A10	5S for Work Place Management
108	A10.1	Staff periodically sort 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, workstation, dispensing counter in Pharmacy, etc. Check for presence of unnecessary articles.