GUIDELINES FOR IMPLEMENTATION OF “KAYAKALP”

1 MINISTRY OF HEALTH AND FAMILY WELFAREGOVERNMENT OF INDIAGUIDELINES FOR IMPLEMENTATION OF kayakalp INITIATIVEG uidelines For IMPLEMENTATION Of kayakalp Initiative2 Introduction:- ---------------------------------------- ---------------------------------------- --------------------------------5A. 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

2 Hospital ---------------------------------------- ---------------------------------------1 9 Maintenance of Furniture and Fixtures ---------------------------------------- -------------------------------------23 Removal of Hospital Junks ---------------------------------------- ---------------------------------------- -------------23 Water Conservation ---------------------------------------- ---------------------------------------- ---------------------25 Work Place Management ---------------------------------------- ---------------------------------------- --------------28B. Improving Sanitation and Hygiene ---------------------------------------- --------------------------------------23 General Approach to Environmental Cleaning ---------------------------------------- ----------------------------23 Material and Equipment for Cleaning ---------------------------------------- ---------------------------------------4 1 Standard Method of Cleaning ---------------------------------------- ---------------------------------------- ---------50 Monitoring of Cleanliness Activities ---------------------------------------- ---------------------------------------- -51 Drainage and Sewage Management ---------------------------------------- ---------------------------------------- -51C.

3 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)

4 ---------------------------------------- ---------------------------------------- ----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 ---------------------------------------- ---------------------------------------- -----------------77D.

5 Infection Control ---------------------------------------- ---------------------------------------- ---------------------80 Standard and Additional Precautions ---------------------------------------- ---------------------------------------8 1 Spill Management ---------------------------------------- ---------------------------------------- ----------------------111 Isolation and Barrier Nursing ---------------------------------------- ---------------------------------------- -------116 CONTENTSG uidelines For IMPLEMENTATION Of kayakalp Initiative4 Hospital Infection Control Programme ---------------------------------------- ------------------------------------118 Hospital Acquired Infection Surveillance ---------------------------------------- ---------------------------------122 Environment Control ---------------------------------------- ---------------------------------------- ------------------128E.

6 Hospital Support Services ---------------------------------------- ---------------------------------------- -------134 Laundry Services and Linen Management ---------------------------------------- --------------------------------134 Water Sanitation------------------------------ ---------------------------------------- ----------------------------------141 Kitchen Services ---------------------------------------- ---------------------------------------- ------------------------145 Hospital Security Services ---------------------------------------- ---------------------------------------- ------------151 Out-Sourced Services Management ---------------------------------------- ---------------------------------------- 152F. 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 ---------------------------------------- ---------------162 Annexure II.

7 Standard Operating Procedures for Cleaning ---------------------------------------- -----------------164 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.

8 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 ---------------------------------------- -------------------------187 Annexure VII: Surgical Site Infection Reporting Format ---------------------------------------- ---------------------189 Annexure VIII: Inspection Checklist (CPWD) ---------------------------------------- ----------------------------------190 Annexure IX: IECfor Swachh Bharat Abhiyan andKayakalp ---------------------------------------- -----------------194 Annexure X.

9 Glossary of Terms ---------------------------------------- ---------------------------------------- -----------199 List of Abbreviations ---------------------------------------- ---------------------------------------- ------------------------206 References ---------------------------------------- ---------------------------------------- ------------------------------------208 List of Contributors ---------------------------------------- ---------------------------------------- -------------------------212 GUIDELINES For IMPLEMENTATION Of kayakalp Initiative5 INTRODUCTIONA fter the launch of Swachh Bharat Abhiyan (SBA) on 2nd October 2014, kayakalp initiative was launched by the Ministry of Health & Family Welfare on 15th May 2015 to complement these 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.

10 To create and share sustainable practices related to improved cleanliness in public health facilities linked to positive health the states have been enthusiastically participating in this scheme since its 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 document to find solutions to the identified problems, These GUIDELINES are meant for secondary care 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 GUIDELINES have been developed after a detailed literature review of the existing best practices in the field of hospital sanitation, housekeeping, infection control, general maintenance, waste management, and support services etc.