Guidelines For Implementation Of “KAYAKALP” Initiative PDF

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MINISTRY OF HEALTH AND FAMILY WELFARE

GOVERNMENT OF INDIAGUIDELINES FOR

IMPLEMENTATION OF

"KAYAKALP"

INITIATIVE

Guidelines For Implementation Of "KAYAKALP" Initiative 2 Introduction:- ------------------------------------------------------------------------ A.

Improving Hospital/Facility Upkeep ------------------------------------------------------------------------

-----8 Infrastructure Maintenance ------------------------------------------------------------------------ ---------------------8

Hospital/Facility Appearance ------------------------------------------------------------------------

-----------------11 Maintenance of Open Areas ------------------------------------------------------------------------ -------------------15 Landscaping and Gardening ------------------------------------------------------------------------ ------------------15 Pest and Animal Control ------------------------------------------------------------------------ -----------------------18

Illumination and Lighting in Hospital ------------------------------------------------------------------------

-------19

Maintenance of Furniture and Fixtures ------------------------------------------------------------------------

-----23 Removal of Hospital Junks ------------------------------------------------------------------------ ---------------------23 Water Conservation ------------------------------------------------------------------------ -----------------------------25 Work Place Management ------------------------------------------------------------------------ ----------------------28 B.

Improving Sanitation and Hygiene ------------------------------------------------------------------------

------23

General Approach to Environmental Cleaning --------------------------------------------------------------------23

Material and Equipment for Cleaning ------------------------------------------------------------------------

-------41 Standard Method of Cleaning ------------------------------------------------------------------------ -----------------50

Monitoring of Cleanliness Activities ------------------------------------------------------------------------

---------51

Drainage and Sewage Management ------------------------------------------------------------------------

---------51 C. Improving Waste Management ------------------------------------------------------------------------ -----------55

Implementation Of Bio Medical Waste Rules, 2016 & 2018 (Amendment) ---------------------------------55

Storage of Bio Medical Waste ------------------------------------------------------------------------

-----------------59

Disposal of Bio Medical Waste ------------------------------------------------------------------------

----------------60 Handling of Metal Sharps ------------------------------------------------------------------------ ----------------------61 Handling of Glassware ------------------------------------------------------------------------ -------------------------62 Sharp Management ------------------------------------------------------------------------ -----------------------------62

Post Exposure Prophylaxis (PEP) ------------------------------------------------------------------------

------------62

Steps for Managing Accidental Exposure ------------------------------------------------------------------------

---63

Management of Hazardous Waste ------------------------------------------------------------------------

-----------67

Solid General Waste Management ------------------------------------------------------------------------

-----------71 Liquid Waste Management ------------------------------------------------------------------------ --------------------73

Equipment and Supplies for BMW Management -----------------------------------------------------------------77

Statutory Compliances ------------------------------------------------------------------------ -------------------------77 D. Infection Control ------------------------------------------------------------------------ -----------------------------80

Standard and Additional Precautions ------------------------------------------------------------------------

-------81 Spill Management ------------------------------------------------------------------------ ------------------------------111

Isolation and Barrier Nursing ------------------------------------------------------------------------

---------------116

Guidelines For Implementation Of "KAYAKALP" Initiative 4

Hospital Infection Control Programme ------------------------------------------------------------------------

----118

Hospital Acquired Infection Surveillance ------------------------------------------------------------------------

-122 Environment Control ------------------------------------------------------------------------ --------------------------128 E. Hospital Support Services ------------------------------------------------------------------------ ---------------134

Laundry Services and Linen Management ------------------------------------------------------------------------

134
Water Sanitation------------------------------------------------------------------------ --------------------------------141 Kitchen Services ------------------------------------------------------------------------ --------------------------------145 Hospital Security Services ------------------------------------------------------------------------ --------------------151

Out-Sourced Services Management ------------------------------------------------------------------------

--------152 F. Hygiene Promotion ------------------------------------------------------------------------ ------------------------155

Community Monitoring andPatient Participation ---------------------------------------------------------------155

Information, Education and Communication ---------------------------------------------------------------------157

Leadership and Teamwork ------------------------------------------------------------------------ -------------------159

Staff Hygiene and Dress Code ------------------------------------------------------------------------

----------------161 Annexure I: Characteristics of the Main Disinfectant Groups Annexure II: Standard Operating Procedures for Cleaning

Cleaning of Patient Care Area/Room

------------164 Cleaning Operating Rooms ------------------------------------------------------------------------ ------------------------166

Cleaning of Sterile Areas

---------------------------170 Cleaning of Labour Rooms ------------------------------------------------------------------------ -------------------------170

Cleaning of Toilets

-----------------------------------172 Cleaning of Isolation Wards ------------------------------------------------------------------------ -----------------------173

Cleaning of Equipment

-----------------------------175 Cleaning of Ambulance ------------------------------------------------------------------------ -----------------------------177 Cleaning of Water Coolers: ------------------------------------------------------------------------ -------------------------178

Cleaning of Air Conditioners (Ac)

----------------178

Annexure III: Sample Checklist ------------------------------------------------------------------------

-------------------179 Annexure IV: Schedule I: BMW Categories and their Segregation, Collection,

Treatment, Processing and Disposal Options ------------------------------------------------------------------------

--181

Annexure V: Logo for BMW Containers and Bags ---------------------------------------------------------------------186

Annexure VI: Needle Stick Injury Reporting Format

Annexure VII: Surgical Site Infection Reporting Format

Annexure VIII: Inspection Checklist (CPWD) ------------------------------------------------------------------------

--190

Annexure IX: IECfor Swachh Bharat Abhiyan andKayakalp ---------------------------------------------------------194

Annexure X: Glossary of Terms ------------------------------------------------------------------------

-------------------199

List of Abbreviations

--------------------------------206 References ------------------------------------------------------------------------ List of Contributors ------------------------------------------------------------------------ ---------------------------------212 Guidelines For Implementation Of "KAYAKALP" Initiative 5

INTRODUCTION

After the launch of ''Swachh Bharat Abhiyan (SBA)'' on 2nd October 2014, ''Kayakalp'' initiative was launched by the Ministry of Health & Family Welfare on 15 th

May 2015 to complement these efforts.

The objectives of the ''Kayakalp'' Scheme are

to promote cleanliness, hygiene and infection control practices in public healthcare facilities, through

incentivising and recognising such public healthcare facilities that show exemplary performance in adhering to standard protocols of cleanliness and infection control;

to inculcate a culture of ongoing assessment and peer review of performance related to hygiene, cleanliness and sanitation;

to create and share sustainable practices related to improved cleanliness in public health facilities linked to positive health outcomes.

All the states have been enthusiastically participating in this scheme since its launch. As evident, the Scheme promoted cleanliness and hygiene in public health facilities. However, it was

observed, through peer review and external assessment process, that awareness levels with regard to the

closure of gaps as per the thematic area of the Kayakalp Scheme have been found to be inadequate at the

facility level. "Guidelines for Implementing Kayakalp" have been developed as an implementation tool and enabler public hospitals meeting the Indian Public Health Standards (IPHS) guidelines, though with some discretion they may be used for primary healthcare facilities and as well tertiary care hospitals.

These guidelines have been developed after a detailed literature review of the existing best practices in

and support services etc.; and relevant extracts from the same were adapted with suitable changes as

per the needs of public health systems. These guidelines are generic in nature and can be adopted by the

healthcare facilities judiciously as per their scope of services.

While framing these guidelines actual logistics, staff and other constraints in the public healthcare

facilities have also been kept under consideration. This handbook would serve as a practical guide to follow standard protocols and practices to achieve

highest level of standards related to cleanliness, hygiene and infection control at public healthcare

facilities. These guidelines are divided into six thematic areas as per the "Kayakalp"Scheme (Figure-1):

Hospital Upkeep

Sanitation and Hygiene

Waste Management

Infection Control

Hospital Support Services

Hygiene Promotion

Guidelines For Implementation Of "KAYAKALP" Initiative 6

Figure 1: Six thematic areas of "Kayakalp"

Each thematic area is further detailed as per the criteria and check points included in the guidelines.

These guidelines focus on strengthening and streamlining maintenance of infrastructure, development of

suitable policies for housekeeping services, pest control measures, water sanitation, selection & training

of manpower, development and implementation of suitable cleaning methods in the form of protocols/ Standard Operating Procedures (SOPs), effective supervision and monitoring by the staff and in-built mechanisms in the contracts coupled with an organisational structure which puts a premium on good housekeeping and sanitation. The guidelines also describe waste management protocols to be followed

in hospitals, along with infection control measures and monitoring of infection rates and activities, the

function and role of support services and measures which can be undertaken by hospitals for hygiene promotion both within the hospitals and in community as well. Guidelines For Implementation Of "KAYAKALP" Initiative 7 D

ISCLAIMERS

In addition to the prescribed guidelines, healthcare facilities must comply with any statutory or legal

obligations from time to time. Many photographs in these guidelines have been provided to illustrate best practices. These photographs were shared by States/UTs with National Health Systems Resource Centre (NHSRC), and NHSRC does not authenticate these photographs and name of the facilities. These are given just to illustrate texts in pictorial form. Recommendations in these guidelines are provided after considering various national and

international guidelines (CDC, WHO), constraints of public health facilities in India, best practices

For ease of service providers, somewhere brand names of products are provided only as an illustrative example. NHSRC does not endorse any commercially available products.

Purpose

These guidelines have been developed to provide comprehensive information to healthcare workers for implementation of 'Kayakalp'' in their facilities. facilities, equipment, and procedures necessary to implement ''Swachhata'' and standards precautions for control of infections

development of suitable policies for housekeeping services, training of manpower, development and implementation of suitable cleaning methods in the form of protocols/SOPs, equipment details for manual cleaning, chemicals & cleaning agents to be used, etc

cleaning, disinfecting and reprocessing of reusable equipment waste management practices standard precaution and protection of healthcare workers.

Use of the guidelines

These guidelines are expected to serve the following purpose: As an implementation guidebook containing practical guidelines and protocols for attaining high score on "Kayakalp" assessments. Reference books for "SBA training'' under "Kayakalp".

Help assessors to get acquaintance with various aspects of "Kayakalp" tools viz. rain water harvesting, 5S'', three bucket system, composting, herbal garden, illuminations, etc.

Guidelines For Implementation Of "KAYAKALP" Initiative 8

Design characteristics of the hospital such as lighting, ventilation, supportive workplaces, proper layout,

and maintenance of the exteriors and interiors can help to reduce errors and stress, and improve outcomes.

Activities which are directed for proper maintenance of hospital upkeep enable health facilities to carry

out the functions in a safe and secure environment. Under the "Kayakalp" Scheme the key components of hospital upkeep are included under following criteria:

Infrastructure Maintenance

Hospital/Facility Appearance

Pest and Animal Control

Landscaping & Gardening

Maintenance of Open Areas

Maintenance of Furniture and Fixtures

Illumination and Lighting

Removal of Junk Material

Water Conversation

Work Place Management

INFRASTRUCTURE MAINTENANCE

All buildings, however well designed and conscientiously built, require maintenance and repair as they get

older. Proper maintenance of the infrastructure is required to be carried out to maintain safe environment

inside these buildings. This is a continuous process and includes immediate remedial action for any fault

besides preventive maintenance.

MAINTENANCE OF GENERAL PHYSICAL STRUCTURE

Maintenance of general hospital infrastructure includes the following activities: 1.

Day to day repairs: Day to day repairs should be carried out by hospital authorities through directly

employed labour. The work which is to be attended such as removing choked drainage pipes,

restoration of water supply, replacement of blown fuses, repair of faulty switches, watering of plants,

lawn mowing, hedge cutting, sweeping of leaf falls etc. should be done on day to day basis. This ensures satisfactory continuous functioning of various services in the buildings. A

IMPROVING HOSPITAL/

FACILITY UPKEEP

Guidelines For Implementation Of "KAYAKALP" Initiative 9 2. Annual Repairs: Works of periodical nature like white washing, colour washing. distempering, painting etc. are called annual repair works and these are generally undertaken through a system of contracts. The periodicity of two years for white washing and colour washing and three years for painting has been laid down by the Central Public Works Department (CPWD). However, facility staff is required to take a decision on the basis of directive received from their respective state governments.

Works such as patch repair to plaster, minor repairs to various items of work, replacement of glass panes,

hedges, replacement/replanting of trees, shrubs, painting of tree guards, and trimming of plants etc.,

which are not emergent works and are considered to be of routine type, can be done during any particular

also. 3. Special repairs: As the building ages, there is deteriorationof various parts of the building and services. Major repairs and replacement of elements become inevitable. It becomes necessary to

prevent the structure from deterioration and undue wear and tear as well as to restore it back to its

original condition to the extent possible. The following types of works in general are undertaken under special repairs: preparing the surface afresh

Painting after removing the existing old paint

Repairs of internal roads and pavements

Replacement of water supply and sanitary installation like water tanks, WC cistern, wash basins, kitchen sinks, pipes etc.

Re-grassing of lawns/grass plots within 5-10 years

Renovation of lawn in 5-6 years

Replanting of hedges in 8-10 years.

expected to last for 20-25 years. Thereafter, it may be necessary to replace them after detailed inspection.

The expected economic life of the building under normal occupancy and maintenance conditions is considered to be as below:

Monumental buildings - 100 years

RCC framed construction - 75 years

Load bearing construction - 55 years

Semi-permanent structures - 30 years

Purely temporary structures - 5 years

The life of the building mentioned above is only indicative and it depends on other factors like location,

Guidelines For Implementation Of "KAYAKALP" Initiative 10

All the three categories i.e. day to day, annual and special repairs/services are interrelated. Neglect of

routine maintenance and preventive measures may lead to more extensive periodical maintenance and in the long run major repair or restoration which could have been avoided or postponed. Hospital authorities may use Inspection Checklists of CPWD for maintenance, as provided in Annexure VIII

All three plans are to be carried out under the direct supervision and should ensure following in the

health facility: There are no broken windows and glass panes and all the windows are guarded There are no loose and hanging electrical wirings in the facilitiesquotesdbs_dbs14.pdfusesText_20

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