[PDF] Guidelines For Implementation Of “KAYAKALP” Initiative

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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

CONTENTS

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

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