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HOUSEKEEPING SERVICES MANUAL Quality Assurance Division Haryana State Health Resource Centre, Government of Haryana
HOUSEKEEPING SERVICES MANUAL Quality Assurance Division Haryana State Health Resource Centre, Government of Haryana

HOUSEKEEPING SERVICES MANUAL

HOUSEKEEPING SERVICES MANUAL Quality Assurance Division Haryana State Health Resource Centre, Government of Haryana

Quality Assurance Division Haryana State Health Resource Centre, Government of Haryana

CONTENTS

1.0

INTRODUCTION………………………………………………………………………………….….…4

2.0

OBJECTIVES AND PURPOSE OF MANUAL……………………………………………………5

3.0

DEFINITIONS……………………………………………………………………………………….…5

4.0

DEPARTMENTAL STRUCTURE……………………………………………………………….….6

5.0

HOUSEKEEPING PROTOCOLS FOR A DISTRICT HOSPITAL………………………….7

PART-1 CLEANING AND DISINFECTION OF PATIENT CARE AREAS

6.0 ENVIRONMENTAL CLEANING AND DISINFECTION IN HIGH RISK AREAS….9

6.1 CLEANING AND DISINFECTION IN OPERATION THEATRE ENVIRONMENT….9

6.2 DISINFECTANTS TO BE USED ………………………………………………………………….… 9

6.3 PREPARATION AND CONCENTRATION OF DISINFECTANTS……………………… 10

6.4 SUGGESTIVE CLEANING SCHEDULE FOR OPERATION THEATRE…………………10

7.0

CLEANING AND DISINFECTION IN LABOUR ROOM………………………………….12

8.0

CLEANING AND DISINFECTION IN ISOLATION ROOMS……………….….12

9.0

CLEANING AND DISINFECTION OF EMERGENCY ROOMS AND THE INTENSIVE CARE UNITS………………………………………… ………13

10.0

DISINFECTION OF PATIENT CARE UTILITIES……………………………………….14

11.0

CLEANING AND DISINFECTION OF LABORATORY ………………………………

15

12.0 CLEANING AND DISINFECTION OF OUT PATIENT DEPARTMENT…………15

13.0

CLEANING AND DISINFECTION OF DRESSING ROOM………………………… 16

14.0

CLEANING AND DISINFECTION OF INPATIENT WARDS

…………………… 16

2

PART -2 CLEANING AND DISINFECTION OF NON -PATIENT CARE AREAS

1.0

CLEANING AND DISINFECTION OF CORRIDORS……………………………………… 20

2.0

CLEANING DISINFECTION OF TOILETS…………………………………………………….20

3.0

CLEANING AND DISINFECTION OF LIFT…………………………….…………………….21

PART-3 SPILL MANAGEMENT, BIOMEDICAL WASTE MANAGEMENT

AND OTHER PROTOCOLS

1.0 GUIDELINES FOR SPILL MANAGEMENT: SPILL MANAGEMENT OF BLOOD & BODY FLUID ……………………………………………………………………………………………….23

2.0 BIO-MEDICAL WASTE MANAGEMENT………………………………………………26

2.1 BIOMEDICAL WASTE SEGGREGATION CHART………………………………26

2.2 BIO MEDICAL WASTE MANAGEMENT HANDLING RULES 199827

3.0

MANAGEMENT OF LOST AND FOUND ITEMS ………………………………………….31

4.0

MANANGEMENT OF PEST CONTROL……………………………………………………….31

5.0

RECORDS TO BE MAINTAINED BY THE HOUSEKEEPING SUPERVISOR…… 31

6.0

SUGGESTIVE LIST OF EQUIPMENT/GADGETS/MACHINERY FOR HOUSEKEEPING DEPARTMENT……………………………………………….…… 33

3

1.0 INTRODUCTION “It is said that the first impression lasts till the end” Hospital cleanliness
1.0 INTRODUCTION
“It is said that the first impression lasts till the
end”
Hospital cleanliness is the first impression that any patient
or relative makes while entering a hospital.
A clean and hygienic environment has a tremendous
psychological impact on the patients and the family members,
and speaks volumes about the quality of service the hospital
provides. Since it is difficult for people to judge the clinical
services in a hospital due to lack of medical knowledge, opinion
about a hospital is often formed on the basis of its appearance
and cleanliness.
Tardiness and
Cleanliness are the basic
tenets of maintaining a
healthy, environment.
In Government
Hospitals it becomes
absolutely essential to
maintain hygiene despite
high volumes of patients
visiting the Out Patient
Departments.
Housekeeping services in a hospital has a major role in
controlling
the
infection
rate
as
well
as
minimizing
the
Hospital
acquired
infections
to
the
patients.
Effective
housekeeping prevents diseases and spread of infections
reducing medical costs and the amount of sickness among
patients and other visitors.
4
2.0 OBJECTIVES AND PURPOSE OF MANUAL In government hospitals regular cleaning and disinfection is essential
2.0 OBJECTIVES AND PURPOSE OF MANUAL
In government hospitals regular cleaning and disinfection is essential because of the
high turnover of patients, Standardization of cleaning methods, materials, checklists is
essential. Some of the Objectives of the manual are:
1. Standardized protocols for housekeeping services would ensure that cleaning,
disinfection is adequately done
2. The types of solutions, type of material to be used for cleaning/ disinfection
purposes would be identified.
3. Manual would provide the hospital with standard document for training protocols
for various housekeeping procedures. Checklists to be used for cleaning,
disinfection purposes and daily monitoring of various activities would be available
and can be used for references.
4. It would help in maintaining the hospital clean, orderly and infection free.
5. Establish and maintain procedures to ensure standards of quality. This would
include cleaning of windows, walls, floors, furniture and equipments.
6. Standardize various processes for waste segregation and disposal in coordination
with the infection control team.
3.0 DEFINITIONS 1
There are various types of methods used in maintaining sanitation in the hospitals.
Some of the Definitions are given below:
1) CLEANING: Cleaning is the removal of visible soil (e.g., organic and inorganic material)
from objects and surfaces and normally is accomplished manually or mechanically using
water with detergents.
2) DISINFECTION: Disinfection describes a process that eliminates many or all pathogenic
microorganisms, except bacterial spores, on inanimate objects.
3) DISINFECTANT: Disinfectants are antimicrobials applied only to inanimate objects
4) DECONTAMINATION: Decontamination removes pathogenic microorganisms from
objects so they are safe to handle, use, or discard.
5) DAMP DUSTING : A process of cleaning which involves the use of wet cloth
1 CDC-Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008
5
4.0 DEPARTMENTAL STRUCTURE The Housekeeping department in Government hospitals/ health care facilities is usually
4.0 DEPARTMENTAL STRUCTURE
The Housekeeping department in Government hospitals/ health care
facilities is usually outsourced to an external agency, an MOU / Agreement is
developed between the Hospital management and the external agency. The terms of
reference should be clearly defined in the MOU, in order to define the Key
Performance Indicators upon which the work is measured.
A
suggestive
organization
Structure
of
Housekeeping
department
for
a
district hospital is given below:
HOUSEKEEPING DEPARTMENT
Principal Medical Officer / Medical Superintendent/
Senior Medical Officer I/c
Hospital Administrator/Deputy Medical Superintendent
Housekeeping Supervisor
General Duty Attendants / Class IV/
Sweeper / Group –D Staff
6

5.0 HOUSEKEEPING PROTOCOLS FOR A DISTRICT HOSPITAL

According to Cleaning and Disinfection purposes, hospital is categorically divided into different areas according to the risk of various Hospital Acquired infections. The different areas are classified into: Patient Care Areas and Non Patient Care Areas.

INPATIENT CARE AREAS:

The patient care areas are divided into 3 types- High risk, Medium risk and Low risk. The risk of hospital infections is high in High risk patient care areas because of high content of microbial load as in isolation rooms or due to susceptibility of the bacteria to invade open tissues.

The various patient care areas are given below:

A. Patient Care Areas

(1)

High risk areas :

Operation Theatre

Labor Room

Isolation Rooms

(2)

Medium Risk Areas :

Patient Inpatient wards

Emergency Department

Laboratory

Radiology

Dirty Utility Area

Mortuary

(3)

Low Risk areas :

OPD / Consultation Rooms

B. Non Patient care areas

Corridors

Toilets

Lifts

Waiting halls / Waiting Rooms

Stores (Medicine Store, Linen Store)

Pharmacy

7

PART-1

CLEANING AND DISINFECTION OF PATIENT CARE AREAS

8

(A) PATIENT CARE AREAS

6.0 ENVIRONMENTAL CLEANING AND DISINFECTION IN HIGH RISK AREAS

6.1 CLEANING AND DISINFECTION IN OPERATION THEATRE ENVIRONMENT AND LABOUR ROOM

A) CLEANING/ DISINFECTION BEFORE SURGERY

All horizontal surfaces with in the OT are damp dusted before the first scheduled surgical procedure of the day with a clean cloth moistened in the approved disinfectant solution.

Visual inspection of OT area, equipments, OT Table before commencement of the first surgical case.

B) CLEANING/ DISINFECTION DURING SURGICAL PROCEDURE

Accidental spillage (Blood and Body Fluids) in the area outside the surgical field should be promptly cleaned by placing tissue papers over it then pouring 1% sodium hypochlorite over it.

Leave it for 15 minutes then collect it, then mop with a disinfectant.

Discard the contaminated disposable items in yellow bag meant for Biomedical Waste.

C)

CLEANING/ DISINFECTION IN BETWEEN SURGICAL PROCEDURE

Conduct a visual check to inspect cleanliness of the operation theatre

Reusable Suction bottles are emptied and cleaned under the running water and tubing is replaced.

Respiratory tubing is cleaned under running water and sent for autoclaving.

Floor cleaning is done in area around the sterile field with sodium hypochlorite.

D)

CLEANING IN OT AT THE END OF THE DAY

Terminal cleaning (End of the day) to be done with 2% Gluteraldehyde (Cidex) and formaldehyde (Formalin) or 5% hydrogen peroxide.

6.2 DISINFECTANTS TO BE USED

Formaldehyde (Formalin) and Gluteraldehyde (Cidex)

Hydrogen peroxide (11%) and Silver nitrate (0.1%)

Sodium Hypochlorite

9

6.3 PREPARATION AND CONCENTRATION OF DISINFECTANTS Formaldehyde and gluteraldehyde  For surface cleaning: 200ml in
6.3 PREPARATION AND CONCENTRATION OF DISINFECTANTS
Formaldehyde and gluteraldehyde
 For surface cleaning: 200ml in 10 liters (2%)
 For fogging: 2%
Hydrogen peroxide and silver nitrate
 For surface cleaning make 5% of the solution: add 250ml in 5 liters of water.
 For Fogging: make 20% concentration of solution (200ml in 1000 ml)
Sodium Hypochlorite
 75 ml in 12 liters of water (1%)
6.4 SUGGESTIVE CLEANING SCHEDULE FOR OPERATION THEATRE AND
LABOUR ROOM
CLEANING
MATERIAL USED
RESPONSIBILITY
DAILY
WEEKLY
MONTHLY
AREAS
OT Table
1% Sodium
OT Housekeeper
hypochlorite Sol.
At least once or as
per requirement
between each
surgery in a day
Delivery Table
1% Sodium
Housekeeper
hypochlorite Sol.
At least once or as
per requirement
between each
delivery in a day
OT light
1% Sodium
OT Housekeeper
hypochlorite Sol.
At least once or as
per requirement
Crash Cart
1% Sodium
OT Housekeeper
hypochlorite Sol.
At least Once or as
per requirement
Ventilator
1% Sodium
OT Housekeeper
hypochlorite Sol.
At least Once or as
per requirement
Scrub Trolleys
1% Sodium
OT Housekeeper
hypochlorite Sol.
At least Once as per
requirement
Drums
Wet mop
OT Housekeeper
Once
Racks
Disinfectant sol.
OT Housekeeper
Once
10
Glass Wall Disinfectant sol. OT Housekeeper Once Wall Disinfectant sol. OT Housekeeper Once Floor Disinfectant
Glass Wall
Disinfectant sol.
OT Housekeeper
Once
Wall
Disinfectant sol.
OT Housekeeper
Once
Floor
Disinfectant sol.
OT Housekeeper
Twice or as per
requirement
TV
Disinfectant sol.
OT Housekeeper
Once
C- arm
Disinfectant sol.
OT Technician
Once
Suction
Detergent &
OT Housekeeper
SAVLON SOL
Twice or as per
requirement
Sink
Disinfectant sol.
OT Housekeeper
Twice or as per
requirement
Fridge
Internal- Detergent
OT Housekeeper
Once
AC ducts
Vacuum cleaning,
HK SUPERVISOR
ONCE
Disinfectant sol.
Frequently
Disinfectant sol.
House Keeper
Twice
touched
surfaces- Door
knobs, switch,
tap(INSIDE OT)
Frequently
Disinfectant sol.
House Keeper
touched
3 times a day (Before
each shift)
surfaces- Door
knobs, switch,
tap(OUTSIDE
OT)
Floor
Disinfectant sol.
House Keeper
Thrice or as per
requirement
Lockers
Disinfectant sol.
House Keeper
Once
Shoe rack
Wet mop
House Keeper
Once
Dust bins
Detergent
House Keeper
Once
Buckets, Dust
Detergent
House Keeper
Twice
pans
Mop
1% Sodium
House Keeper
Twice
Hypochloride sol.
11
All furniture, wall surfaces, fixed and ceiling mounted equipments, anaesthesia equipments and accessories, soap
All furniture, wall surfaces, fixed and ceiling mounted equipments, anaesthesia
equipments and accessories, soap dispensers, handles of cabinet are to be disinfected
with either formaldehyde and gluteraldehyde or hydrogen peroxide.
1. Scrub sinks are cleaned with detergent solution under water.
2. Floor cleaning is done with 1% Sodium Hypochlorite.
3. Bathrooms and toilets are cleaned with detergent powder.
4. Suction bottles are to be emptied, cleaned and disinfected by immersing
into 1% sodium hypochlorite solution for 20mts and in case they are
infected then for 1hr.
5. Transport vehicles (trolleys and wheelchairs), including straps and
attachments are cleaned with 2% formaldehyde and gluteraldehyde or
5% hydrogen peroxide.
Weekly Cleaning
Remove all movable equipments and furniture from the O.T.
1.
Clean with wet mopping with disinfectant solution
2.
Floor cleaning to be done with scrub and vacuum.
3.
Ceiling and walls are cleaned with disinfectant/ Cidex solution.
4.
Fumigation is done at night
Mops:
1. Mops used should be cleaned with detergent periodically.
2. Post usage keep it for drying.
8.0 CLEANING AND DISINFECTION IN ISOLATION ROOMS
Isolation Rooms are specifically designed for patients requiring isolation
due to contagious diseases from being spread from a patient to other
patients, staff, and visitors, or from others to a particular patient. Another
type of patients requiring isolation is immuno-compromised patients, which
have chances of acquiring secondary infections.
12
So single bed isolation rooms are made for immune compromised whereas muti-bedded isolation wards are
So single bed isolation rooms are made for immune compromised whereas
muti-bedded isolation wards are made and ward for patients with similar
diagnosis like TB.
1. Change curtains after the discharge of all patients in case of a ward or every 15
days whichever is earlier.
2. Fogging to be carried out with 20% hydrogen peroxide disinfectant after
discharge of each patient.
3. Terminal cleaning with 5% hydrogen peroxide to be done at the end of each shift.
4. Special transmission based precautions i.e. blood born pathogen isolation (BBP),
airborne isolation (AI), droplet isolation (DI) and contact isolation (CI) have to be
followed for patients having specific diseases.
9.0 CLEANING AND DISINFECTION OF EMERGENCY ROOMS
AND THE INTENSIVE CARE UNITS
1. All examination tables to be cleaned daily.
2. Washable walls will be spot washed daily and as necessary, using specified
disinfectant.
3. Sinks, soap dishes, and paper towel dispensers will be cleaned daily and
replenished.
4. All stretchers /trolleys will be cleaned weekly.
5. Toilets to be washed and cleaned at least thrice daily using germicidal
solution, including both sides of toilet seats in case of English toilets.
6. Emergency Department is to be cleaned on a 24-hour basis, 7 days per week
and thoroughly cleaned, as necessary.
7. For cleaning spray the entire area with a mixture of 20% hydrogen peroxide,
formaldehyde and Gluteraldehyde (cidex) before a new patient is admitted.
8. Change the curtains once in 7 days or as and when required.
13
10.0 DISINFECTION OF PATIENT CARE UTILITIES CLEANING / DISINFECTION ITEMS TIME REMARKS Nebulizer set Soap
10.0 DISINFECTION OF PATIENT CARE UTILITIES
CLEANING / DISINFECTION
ITEMS
TIME
REMARKS
Nebulizer set
Soap and water
N.A
Individual preferred
Stethoscope
Alcohol swab
N.A
After each use
Thermometer
Isopropyl alcohol swab or soap and
water
N.A
Preferably Individual for
each patient.
Clean after each use.
Laryngoscope
Blade – with soap & water
Handle & bulb - isopropyl alcohol.
N.A
Nasal prongs
Tap water only if dirty
N.A
Preferably Individual
for each patient.
Oxygen masks
Isopropyl alcohol swab
N.A
Preferably Individual
for each patient.
Ambu bag
If uninfected patient -isopropyl
swab,
Infected patient – cidex dipped for
1 hr.
N.A
For 1hr
20mts to
Sputum mug
Soap and water, Immerse in 1%
sodium hypochlorite
1hr
Keep a minimal amount of
water in the mugs prior to
giving to patient.
Transducer
Alcohol swab
N.A
20mts to
Bed Side
Urinal
Soap and water immerse in 1%
sodium hypochlorite
1hr
Emesis basin
Soap and water
N.A
Measuring cup
Soap and water
N.A
Medicine
Soap and water
N.A
container
Soap and water
Bed pan
N.A
14

11.0 CLEANING AND DISINFECTION OF LABORATORY

1. Laboratory area requires specific cleaning in different sections of the Laboratory, Hematology, and Biochemistry section table tops should be cleaned with 1% Sodium Hypochlorite in the morning. Microbiology sections and Histopathology sections should be disinfected after each shift so that microbial culture built up does not occur.

2. Laboratory areas should be free from any blood spills, they should be scraped off

3. All the dustbins shall be washed and lined with color coded bags in the morning. Change the waste bag when it is 2/3 filled with laboratory waste.

4. Clean the walls thoroughly by using a specialized soap/disinfectant solution in the morning.

5. The floor shall be thoroughly mopped with a disinfectant solution.

6. The common areas shall be swept and mopped in the morning and at regular intervals to keep them clean.

7. Contaminated clothing must be decontaminated before laundering

8. Replace soap, hand towel, alcohol based hand rub when required.

12.0 CLEANING AND DISINFECTION OF OUT PATIENT DEPARTMENT

1. Use 1% sodium hypochlorite for floor mopping.

2. Wipe all the table tops, examination table, dressing trolleys with 5% hydrogen peroxide.

3. Spray the Dental department with 20% hydrogen peroxide.

4. Change all curtains once in a week.

5. Change linen on examination table every day or as and when required.

6. Remove trash from dustbins and change the trash liner every evening before closing hours.

7. The offices shall be dry dusted and swept after the closing hours.

8. The worktables to be cleaned with soap solution in the morning.

9. The office shall be mopped with soap solution in the morning.

10. Staff rest rooms/toilets to be cleaned using soap solution and kept odor free using deodorizer.

15

11. Change doctor coat and replace with new coat. 13.0 CLEANING AND DISINFECTION OF DRESSING
11. Change doctor coat and replace with new coat.
13.0 CLEANING AND DISINFECTION OF DRESSING ROOM
1. Spray the entire room with 20% hydrogen peroxide daily in the evening.
2. Clean all the table tops with 5% hydrogen peroxide twice in each shift.
3. Trolley to be kept clean at all times.
4. Wipe the top of dressing trolley with 5% hydrogen peroxide.
14.0 CLEANING AND DISINFECTION OF INPATIENT WARDS
1. The cleaning of a patient's wards will be performed once during each shift.
Housekeeping staff with emphasis on patient touch areas such as bed, bed rails, door
knobs, handles, monitoring equipment, buttons/controls, cables.
2. After a patient is discharged all used disposable items like IV bags and tubing’s,
suction catheters and tubings will be discarded by nurses.
3. Soiled linen is removed by Housekeeping Staff.
4. Clean the bed surface including under the mattress with disinfectant.
5. Toilet cleaning, bathrooms, sinks, showers should be cleaned every six hourly or as
when required. Soap and clean towel would be provided and will be refilled as
needed.
CLEANING SCHEDULE IN WARDS
Cleaning
Material
Responsibility
Daily
Weekly
Monthly
Areas
Used
Beds / bed
rails
2% Sodium
2
times
Hypochlorite
Housekeepers/General
Duty Attendants
Bed side
2% Sodium
Housekeepers/General
Duty Attendants
2
times
trolleys
Hypochlorite
Dressing
2% Sodium
Housekeepers/General
Duty Attendants
2
times or
trolleys
Hypochlorite
as per
reqrmnt
Crash carts
2% Sodium
Housekeepers/General
Duty Attendants
2
times or
Hypochlorite
as per
requirement
Cardiac
2% Sodium
2
times or
Table
Hypochlorite
Housekeepers/General
Duty Attendants
as per
requirement
ECG trolley
2% Sodium
Housekeepers/General
Duty Attendants
Once
Hypochlorite
16
Defibrillator 2% Sodium Housekeepers/General Duty Attendants Once Trolley Hypochlorite IV Stands 2% Sodium
Defibrillator
2% Sodium
Housekeepers/General
Duty Attendants
Once
Trolley
Hypochlorite
IV Stands
2% Sodium
Housekeepers/General
Duty Attendants
2
times
Hypochlorite
Nursing
2% Sodium
2
times
Stations
Hypochlorite
Housekeepers/General
Duty Attendants
Chairs
2% Sodium
Housekeepers/General
Duty Attendants
Once
Hypochlorite
Mops
2% Hypo
Housekeepers/General
Duty Attendants
3
times
bleach
Fans
Wet mop
Housekeepers/General
Duty Attendants
once
Mirrors
Soap Water
Daily
Sol.
Housekeepers/General
Duty Attendants
Cleaning Areas
Material Used
Responsibility
Daily
Weekly
Monthly
Frequent touch
area :-
Disinfectant
Switches,
solution
Housekeepers/General
Duty Attendants
sockets, Door
Three times
a day after
each shift
Knobs, Taps
Vacuum
Housekeeping
Monthly
AC Ducts
Cleaning+Disin
supervisor
once
fectant
Twice a
day(morning
Disinfectant
Dust Bins
solution
Housekeepers/General
Duty Attendants
+night) at
the end of
shift
Buckets, Dust
With detergent
3 times a
pans
powder
day
Housekeepers/General
Duty Attendants
Bed side
Formalin
Urinals/ Bed
Once a day
tablet
pans
Disinfectant
3 times per
Floor
solution
Disinfectant
Housekeepers/General
Duty Attendants
shift
Chairs
Once a day
solution
Disinfectant
Lockers
Once a day
solution
Housekeepers/General
Duty Attendants
2 times per
Sink
Detergent
shift
17
Detergent(insi de), ONCE Fridge once INSIDE Disinfectant OUTSIDE (outside) Housekeepers/General Duty Attendants
Detergent(insi
de),
ONCE
Fridge
once INSIDE
Disinfectant
OUTSIDE
(outside)
Housekeepers/General
Duty Attendants
Shoe Rack
Wet mop
Once
PRIVATE WARDS SPRAYING
1. On discharge of patient clear all the furniture from the room.
2. Remove the bed linen, curtains early morning disinfectant for spraying use in sprayer
all over the room.
3. Let it dry.
4. Clean all the table tops, window ledges, all fixtures, phones, chairs and other
furniture in the room with clean duster and 5% disinfectant solution.
5. Floors to be mopped with 1% sodium hypochlorite.
6. Once all the surfaces in the room are dry replace all the furniture back.
IMPORTANT ASPECTS
1. Do not vigorously shake the cloth to remove the dust while dusting or sweeping.
2. Change curtains once every week.
3. Avoid using the patient’s linen for dusting.
4. Avoid cleaning mops and dusters in the sinks.
5. Use clean mops for cleaning.
18

PART -2

CLEANING AND DISINFECTION OF NON -PATIENT CARE AREAS

19

(B) NON-PATIENT CARE AREAS

1.0 CLEANING AND DISINFECTION OF CORRIDORS

1. Place “wet floor” caution signs at both ends of corridor to alert staff and visitors to a potential risk.

2. Wet mop all corridor, covering only half of the width at time. This allows safe foot traffic at all times. The patients can walk through the other half of the width and patient/ relative/ staff falls can be avoided.

3. Wet mop the remaining half of the corridor only when the first half has dried completely.

2.0 CLEANING DISINFECTION OF TOILETS

1. Wash hands and put on gloves

2. Ventilate the area (for example, open a window), and prepare the cleaning solution in a well-ventilated area (refer to manufacturers’ instructions)

3. Flush the toilet with the seat lid down

4. The toilets should be thoroughly cleaned at least once every shift and mopped dry. The floor should be made non-slippery and all deposits removed.

5. Apply the cleaning agent to the inside of bowl, including under the rims and allow to soak and clean the bowl after wards Flush the toilet, rinsing the brush in flushing water (leave the toilet brush in the bowl)

6. Remove any splashes or marks from the wall

7. Wipe the toilet seat and flush handle with the cloth, and then close the lid.

8. Dispose of the cloth when the task is completed

9. Remove gloves and wash hands

10. In addition to the stipulated timings, sweeper shall also undertake such sweeping / cleaning /mopping operation as and when required or as directed by Housekeeping Supervisor /nursing staff on duty, or such personnel as may be authorized in this regard by the superintendent at any time of the day and night.

11. The outlets and drain pipes of the urinals should be kept clog free and fixed in proper place.

20

12. The clogged drain pipes are to be de clogged immediately and drain chambers cleaned
12. The clogged drain pipes are to be de clogged immediately and drain chambers
cleaned thoroughly once a week as part of preventive maintenance and also one
register to be maintained for all the drainages of the hospital.
13. Regular monitoring to be done by the housekeeping supervisor for the cleaning
by maintaining and filling the checklist.
14. In-case of Indian Toilets: Apply the cleaning agent to the inside of bowl,
including under the rims and allow to soak and clean the bowl after wards Flush
the toilet, rinsing the brush in flushing water. Then clean the foot pedals with
disinfectant and let dry. Cleaning steps would be similar except for the cleaning
of the foot pedals.
2.1 RECORD FOR TOILET CLEANING
DATE
TIME
CLEANING DONE BY
SIGNATURE OF SUPERVISOR
REMARKS
3.0 CLEANING AND DISINFECTION OF LIFT
1. Take the Lift to a non-patient, non-public floor for cleaning and turn off with key.
2. Mix disinfectant detergent in bucket.
3. Clean with damp cloth soaked in disinfectant detergent. Wipe dry to prevent
streaking and replace.
4. Dust mop the floor.
21

PART-3

SPILL MANAGEMENT,

BIOMEDICAL WASTE MANAGEMENT AND

OTHER PROTOCOLS

22

1.0 GUIDELINES FOR SPILL MANAGEMENT 1.0 SPILL MANAGEMENT OF BLOOD & BODY FLUID The factors
1.0
GUIDELINES FOR SPILL MANAGEMENT
1.0
SPILL MANAGEMENT OF BLOOD & BODY FLUID
The factors involved in Spill Management are given below:
 The nature (type) of the spill (e.g. Sputum, vomit, faeces, urine, blood or
laboratory culture)
 The pathogens most likely to be involved in these different types of spills (e.g.
Stool samples may contain viruses, bacteria or protozoan pathogens whereas
sputum may contain mycobacterium tuberculosis)
 The size of the spill (e.g. Spot [few drops], small [<10cm] or large [>10cm])
 Volume of spill ( less than 30 ml, more than 30 ml)
 The type of surface (e.g. Carpet or flooring)
 The location involved i.e. whether the spill occurs in a contained area such as a
microbiology laboratory or in a waiting area or wards, OPDS.
HAZMAT KIT LIST (HAZARDOUS MATERIAL KIT)
1. Gloves
2. Mask
3. Goggles
4. Disposable Gown
5. Tissue roll
6. Sodium hypochlorite 2%
7. Gum boots
8. Cap
9. Chalk
10. Two Cardboard pieces
11. Syringe
12. Cotton
13. Sulphur Powder
14. Small Glass Jar
15. Instruction Sheet
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PROCEDURE FOR SPILL MANAGEMENT

1. Wear Personal Protective Equipment (Gloves only in case of minor spill, apron, mask for major spill, to avoid before cleaning the spillage

2. Cover the area with 1 % hypochlorite and bleaching power, chalk powder to sock the spillage

3. Leave it for 20 minutes

4. Collect the residue with newspaper or cardboard.

5. Wipe and discard all the waste in disposable bag

6. Disinfect the entire spill area with a hospital-grade disinfectant and allow it to stand for the amount of time recommended by the manufacturer.

7. Mop the spillage using disposable cloth or wipes until the area is visibly clean

8. Remove the gloves and discard in the same bag ,tie the bag properly and put label with the type of spillage

9. Wash the hands properly.

10. Fill incident form and submit

NOTE: If spill contain broken glass and there is a risk of sharps injury, first disinfect the spill with 1% sodium hypochlorite solution and after 20 minutes, put broken glass pieces in the sharps container and then proceed further to wipe the spill

Steps to follow in case of Mercury spill :

1) Remove all items nearby the mercury spill. Switch off the exhaust fan if on. 2) Wear face mask to prevent inhalation of mercury. 3) Remove the clothes if spoiled with mercury. 4) Remove the ornaments. Wear gloves. 5) In case of sharps of the glass wrap it in the paper and put in the zip bag. This should be labelled with “Contaminated with mercury.” 6) If spilled in the wood or tiles can be cleaned easily, but if spilled on linen the portion is to be cut and removed. 7) Collect the tiny mercury particles with cardboard. Tiny particles can be seen with torch. For this after switching off the lights in room the torch light is focused along the floor. Observe the room with such precautions. 8) Collect the particles of mercury with dropper or syringe and then placed in bottle filled with water. Bottle is to be closed airtight. Place the bottle in the zip lock bag and is to be

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labelled “Contaminated with mercury”. After collecting the larger particles if the tiny particles are not seen then sulphur powder is sprinkled to visualize the tiny particles which makes the mercury particles darker and can be seen easily. Then small particles are collected with syringe and placed in bottle. The precautions are taken to prevent the powder inhalation, which is poisonous. 9) All the equipment used for cleaning including gloves are placed in zip lock bag and labelled. 10) The zip lock bag is deposited to staff nurse and disposed off as per Biological waste management rules. 11) The doors and windows of the room where the mercury spilled are to be kept open for 24 hours. In case of mercury side effects immediate medical treatment is provided.

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2.0 BIO-MEDICAL WASTE MANAGEMENT 2.1 BIOMEDICAL WASTE SEGGREGATION CHART The housekeeping Supervisor has the
2.0 BIO-MEDICAL WASTE MANAGEMENT
2.1 BIOMEDICAL WASTE SEGGREGATION CHART
The housekeeping Supervisor has the responsibility of training on BMW.
COLOUR OF BIN
TYPE OF WASTE
ACTION/ ATTENTION
Blood or Body Fluid infected tubings, Blood and Urine
RED
Bags, I/V Sets, Syringes, Catheters,
Cannula, Drains, Plastic I/V Bottles, Discarded Plastic
Sheets & McIntosh for patient care, Gloves after
disinfection
Disfigure and disinfect by
soaking in 1% Sodium
Hypochlorite Solution
YELLOW
Human Tissue, Dressings, Gauge, Bandages, POP
Plaster, Cotton Swabs, Dressing Tapes, Discarded
House-Keeping Mops/ Clothes, Bed- sheets &
Blankets (Blood Soaked)
Disfigure before disposing
BLUE
Sharps, Needles after destruction, Broken Glass,
Unbroken Glass Vials/ Bottles/ Ampoules
Disfigure before disposing
BLACK
Kitchen Waste, Paper, Polythene, Card board,
Aluminum Foil, Disposable Glasses/ Bottles/ Plates,
Vegetable & Fruit Peel & Left Over Food
Do not litter the place
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2.2 BIO MEDICAL WASTE MANAGEMENT HANDLING RULES 1998. Bio Medical waste management is done by
2.2 BIO MEDICAL WASTE MANAGEMENT HANDLING RULES 1998.
Bio Medical waste management is done by appropriate authorities and rules and
regulations are followed regarding Bio Medical Waste Management handling rules
1998.
SCHEDULE A
CATEGORIES OF BIOMEDICAL WASTES:-
Option
Waste Category
Treatment & Disposal
Category No. 1
Human Anatomical Waste( human tissues organs, body
parts )
Incineration @ deep
burial*
Category No. 2
Animal Waste(animal tissues, organs body parts carcasses
bleeding parts fluid blood and experimental animals used in
Incineration @ deep
burial*
research)
Category No. 3
Microbiology & Biotechnology Waste(wastes from
laboratory cultures, stocks or micro-organisms live or
vaccines, human and animal cell culture used in research and
infectious agents from research and industrial laboratories,
wastes from production of biological, toxins, dishes and
devices used for transfer of cultures)
Local autoclaving /
micro waving
Category No. 4
Waste sharps (needles syringes scalpels blades, glass, etc
may cause puncture and cuts)
Disinfection(chemical
treatment) / autoclaving
/ micro waving
Category No. 5
Discarded Medicines and Cytotoxic drugs ( wastes
comprising of outdated contaminated and discarded
medicines )
incineration@
/
destruction And drugs
disposal in secured
landfills
Category No. 6
Solid waste ( Items contaminated with blood and body fluids
including cotton dressings soiled plaster casts, lines beddings
other material contaminated with blood )
Incineration@
Autoclaving
/
micro
waving
Category No. 7
( Wastes generated from disposable items other than the
waste sharps such as tubing’s, catheters, intravenous sets etc
)
Disinfection by chemical
treatment @ autoclaving
/ micro waving and
Mutilation
/
shredding##
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Category No. 8 Liquid waste( waste generated from laboratory and washing cleaning housekeeping and disinfecting
Category No. 8
Liquid waste( waste generated from laboratory and washing
cleaning housekeeping and disinfecting activities )
Disinfection by chemical
Treatment @@ and
discharge into drains
Category No. 9
Incineration Ash( ash from incineration of any bio medical
waste )
Disposal
in
municipal
landfill
Category No. 10
Chemical waste( Chemical used in production biological,
chemicals used disinfection as insecticides etc )
Chemical treatment @@
and discharge into
drains for liquids landfill
for solids
Chemical treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It must
be ensured that chemical treatment ensures disinfection.
* Mutilation/Shredding must be such so as to prevent unauthorized use.
SCHEDULE B
COLOR CODING AND TYPE OF CONTAINER
FOR DISPOSAL OF BIOMEDICAL WASTE
Color Coding
Type of Container
Waste Category
Treatment as per Schedule I
Yellow
Plastic Bag
Cat.1, Cat. 2, and
Cat.3 Cat 6
Incineration/deep Burial
Red
Disinfected
Container/plas
Cat.3 Cat.6, Cat.7
bag
Autoclaving Microwaving/Chemical
Treatment
Blue/
White
Plastic bag/ puncture
Proof container
Cat.4, Cat.7
Autoclaving / Microwaving/
Chemical Treatment and
Translucent
Black
Plastic bag
Cat.5, and Cat.9
and cat.10
( Solid)
Disposal in secured landfill
Notes:
1.
Color coding of waste categories with multiple treatment options as defined in Schedule I,
shall be selected depending on treatment option chosen, which shall be as specified in Schedule I.
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2. Waste Collection bags for waste types needing incineration shall not be made of chlorinated
2. Waste Collection bags for waste types needing incineration shall not be made of
chlorinated plastics.
3. Categories 8 & 10 (liquid) do not require container/bags
4. Category 3 if disinfected locally need not be put in container bags
SCHEDULE-III
LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS
BIOHAZARD SYMBOL
CYTOTOXIC HAZARD SYMBOL
BIOHAZARD
CYTOTOXIC
HANDLE WITH CARE
Note : Label shall be non-washable and prominently visible.
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2.3 RECORD FOR MAINTENANCE OF BIOMEDICAL WASTE MANAGEMENT SR. DATE BMW QUANTITY SIGNATURE NO. Yellow
2.3 RECORD FOR MAINTENANCE OF BIOMEDICAL WASTE MANAGEMENT
SR.
DATE
BMW QUANTITY
SIGNATURE
NO.
Yellow
Red
Blue
Total quantity
Housekeeping
kgs.
supervisor
Quantity in
Quantity
Quantity in
kgs
in kgs
kgs
Monthly collection
Annual collection
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3.0 MANAGEMENT OF LOST AND FOUND ITEMS

In order to protect any article inadvertently left or lost by a patient, visitor to the hospital and it can be deposited safely so that it can be handed back by the housekeeping supervisor a procedure for Lost and Found is very essential.

DESCRIPTION:

1. When an article is found, finder to immediately report to housekeeping supervisor.

2. The housekeeping supervisor to enter details in his lost & found register

3. A unique S No. Generated form is attached to the item with details of date, name of the ward room no, location, patient name if found in the room & name of finder.

4. Forwarding address is obtained from IP admission.

5. The housekeeping supervisor may contact the patient to either claim it or for further instructions.

6. When claim is made, detailed description of the article is verified before handing over. The claimant’s signature is taken as acknowledgement on the receipt generated through lost & found module.

7. If not claimed the article is kept under custody of matron for 6 month. After which time it is disposed off as decided by hospital authorities.

4.0 MANANGEMENT OF PEST CONTROL

Management of pest Control is vital to eradicate pests like rats, flies, mosquitoes, lizard, ant, silver fish and termites from hospital premises.

DESCRIPTION:

Pest control is an activity, which is given out on contract to a company specializing in this field. Their scope of work is as follows

1. “Pest control services including all related and connected services such as fly control, household disinfestations, rodent control measures, vector control, fogging, fumigation in respect of all the areas as specified by the company meeting best cleanliness standards and maintaining it at all times. Area covered includes entire premises and precincts thereof and any other area indicated by the management as per agreed schedule and specifications.”

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2. Starting from one side, all areas have to be sprayed as per terms and
2. Starting from one side, all areas have to be sprayed as per terms and conditions
mentioned in the contract (As per MOU).
3. Every evening pest control book to be checked by the pest control in
charge/housekeeping supervisor as per pest control daily schedule.
4. Equipments & chemicals are to be provided by the contractor (As per MOU).
5. Clearance of bill is subject to the pest free premises of entire building as per quality
standards and as per schedule.
6. Any complaint received from area in lodged in a complaint format (as below)
PEST COMPLAINT FORMAT
DATE:
Type of complaint
……………………………………………………………………………………
Area
……………………… ………………………………………………………………………………
Complaint given by…………
Given to………………………
Received time ……………
Time complaint attended…….……
Measures taken…………………………………………………………………………………………
Housekeeping Supervisor/Pest control supervisor sign…………………………
Company supervising…………………………………………………………………………….
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5.0 RECORDS TO BE MAINTAINED BY THE HOUSEKEEPING SUPERVISOR

(As per MOU with respective District Hospital)

1)

Monthly Indent Register For Disinfectants And Consumables

2)

Stock Register For Disinfectants And Consumables

3)

Floor Wise/ Area Wise Cleaning And Disinfection Schedule

4)

Biomedical Waste Segregation Record

5)

Fumigation Record (Separate For Operation Theatre And Wards

6)

Incident Record (For Spill Management)

7)

(With Corrective and Preventive Actions) Attendance Register/ Duty Roaster

8)

Record Of Housekeepers For Needle Stick Injuries (Duplicate Copy)

9)

Training Record

10) Lost And Found Record

6.0 SUGGESTIVE LIST OF EQUIPMENT/GADGETS/MACHINERY FOR HOUSEKEEPING DEPARTMENT

Indicative list of Equipments/ Gadgets/ Machinery to be used cleaning etc:

1)

Dry Vacuum Cleaners

2)

Floor Scrubbers cum wet Drier (Walk Behind Type)

3)

Biomedical Waste Transportation trolley with Covers

4)

Wet Jet Washers

5)

Cob Web Remover

6)

Floor Mopper (Trolley Mounted)

7)

Floor Wiper

8)

Glass Clearing Roller

9)

Aluminium Ladder for Cleaning Purpose

10) Wheel Barrows

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