SDH 31 To 50 Bedded Revised Draft (India) PDF

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Modifications in the updated Sub Divisional Hospital (SDH)

31-50 bedded document


(Major changes have been highlighted in yellow colour)

A. The revised IPHS (SDH) has considered the services, infrastructure, manpower,
equipments and drugs in two categories of Essential (minimum assured services)
and Desirable (the ideal level services which the states and UT shall try to
achieve).

B. Services: Following services were included


Essential
i. Accidents and emergency services including poisoning and Trauma Care
ii. FP services like IUCD, NSV, Minilap, and lap sterilization
iii. Neonatology and Immunization
iv. DOT centre and Designated Microscopy centre
v. Integrated Counselling and Testing Centre
vi. Disability Certification (as per guidelines notified by state Government)

Desirable
i. Critical care / Intensive Care (ICU)
ii. Psychiatry
iii. Geriatric Services
iv. Tobacco Cessation Services
v. Physical Medicine and Rehabilitation services
vi. Public Health Management
C. Infrastructure: following were added.
i. Signage.
ii. Barrier free access.
iii. disaster prevention measures (desirable for new upcoming facilities),
iv. Functions and space requirements are updated.
v. New born stabilization unit added.
vi. Blood storage facility in place of Blood Bank
D. Manpower: the new IPHS recommends the changes in manpower at SDH
i. Dietician (Desirable)
ii. Dental Technician/ Assistant/ Hygienist/
iii. In place of physiotherapist two Multi Rehabilitation workers provided.
iv. Cold Chain & Vaccine Logistics Assistant
E. List of drugs and equipments updated: the drug list for obstetric care and sick
newborn & child care (for FRU / SDH) incorporated in these guidelines
F. Annexure added.
i. New born care corner and new born stabilization unit.
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ii. Seismic safety guidelines.
iii. National guidelines on hospital waste management.
iv. Guidelines to reduce environmental pollution due to mercury waste.
G. Annexure deleted
i. Central scheme for biomedical waste management (as it has been dropped
in the eleventh five year plan.)

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DRAFT

Indian Public Health Standards (IPHS)


For
31 to 50 Bedded
Sub-District/Sub-Divisional Hospitals

GUIDELINES
(Revised 2010)

Directorate General of Health Services


Ministry of Health & Family Welfare
Government of India

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Executive Summary
Sub-district (Sub-divisional) hospitals are below the district and above the block level
(CHC) hospitals and act as First Referral Units for the Tehsil /Taluk /block population in
which they are geographically located. They have an important role to play as First
Referral Units in providing emergency obstetrics care and neonatal care and help in
bringing down the Maternal Mortality and Infant Mortality. They form an important link
between SC, PHC and CHC on one end and District Hospitals on other end. It also saves
the travel time for the cases needing emergency care and reduces the workload of the
district hospital. A subdivision hospital caters to about 5-6 lakh people.

Service Delivery

Specialist services are provided through these sub-district hospitals and they receive
referred cases from neighboring CHCs and also PHCs and SCs. In this IPHS document,
Services that a Sub-District Hospital is expected to provide have been grouped as
Essential (Minimum Assured Services) and Desirable (which we should aspire to
achieve). Besides the basic specialty Services, due importance has been given to
Newborn Care (New Born Care Corner and New Born Stabilization Unit), Family
Planning, Psychiatric services, Physical Medicine and Rehabilitation services, Geriatric
Services, Accident and Trauma Services and Integrated Counseling and Testing Centre

Requirement for Delivery of the Above-mentioned Services

The requirements have been projected the basis of estimated case load for hospital of this
strength. The guidelines of hospital building, planning and layout, signage, disaster
prevention measures for new facilities, barrier free access and environmental friendly
features have been included. Manpower has been rationalized and new manpower has
been provided for Physical medicine and Rehabilitation Services, Dental and
Immunization services. National guidelines on hospital waste management, Guidelines to
reduce environmental pollution due to mercury waste, and Seismic safety guidelines have
been included.

A Charter of Patients’ Rights for appropriate information to the beneficiaries, grievance


redressal and constitution of Hospital Management Committee for better management
and improvement of hospital services with involvement of Panchayati Raj Institutions
(PRI) and NGOs has also been made as a part of the Indian Public Health Standards. The
monitoring process and quality assurance mechanism is also included.

Standards are the main driver for continuous improvements in quality. The performance
of District Hospital can be assessed against the set standards. This would help monitor
and improve the functioning of the District Hospitals in the country.

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1. Introduction

Sub-district (Sub-divisional) hospitals are below the district and above the block
level (CHC) hospitals and act as First Referral Units for the Tehsil /Taluk /block
population in which they are geographically located. Specialist services are provided
through these sub-district hospitals and they receive referred cases from neighboring
CHCs and also PHCs and SCs. They have an important role to play as First Referral
Units in providing emergency obstetrics care and neonatal care and help in bringing
down the Maternal Mortality and Infant Mortality. They form an important link between
SC, PHC and CHC on one end and District Hospitals on other end. It also saves the travel
time for the cases needing emergency care and reduces the workload of the district
hospital. In some of the states, each district is subdivided in to two or three sub divisions.
A subdivision hospital caters to about 5-6 lakhs people. In bigger districts the sub-district
hospitals fills the gap between the block level hospitals and the district hospitals. There
are about 1200 such hospitals in the country with a varying strength of number of beds
ranging from 50 to 100 beds or more.

The Government of India is strongly committed to strengthen the health sector for
improving the availability, accessibility of affordable quality health services to the
people. In order to improve the quality and accountability of health services a set of
standards need to be there for all health service institutions including sub-district
hospitals.

Standards are a means of describing the levels of quality that health care
organizations are expected to meet or aspire to. The key aim of standard is to underpin
the delivery of quality services which are fair and responsive to client’s needs, which
should be provided equitably and which deliver improvements in health and well being of
the population. Standards are the main driver for continuous improvements in quality.
The performance of Sub-district hospitals can be assessed against a set of standards.

The Bureau of Indian standards (BIS) has developed standards for hospitals
services for 30 bedded and 100 bedded hospitals. However, these standards are
considered very resource intensive and lack the processes to ensure community
involvement, accountability, the hospital management, and citizens’ charter etc peculiar
to the public hospitals.

Setting standards is a dynamic process. This document contains the standards to


bring the Sub-district/ Sub-divisional hospitals to a minimum acceptable functional grade
(indicated as Essential) with scope for further improvement (indicated as Desirable) in
it.

Most of the existing hospitals below district level (31-50 Bed category) are
located in older buildings in urbanized areas / towns as compared to most Primary Health
Centres / Sub-centres. The expansions already done have resulted in construction

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touching the boundaries walls with no scope of further expansions. As far as possible,
States should not dislocate the said hospitals to a new location (in case of dislocating to a
new location, the original client group will not be able to have same access to the desired
health facilities)

2. Objectives of Indian Public Health Standards (IPHS) for Sub-District


Hospitals:

The overall objective of IPHS is to provide health care that is quality oriented and
sensitive to the needs of the people of the district. The specific objectives of IPHS for
Sub District Hospitals are:

i. To provide comprehensive secondary health care (specialist and referral


services) to the community through the Sub District Hospital.
ii. To achieve and maintain an acceptable standard of quality of care.
iii. To make the services more responsive and sensitive to the needs of the people
of the district and act as the First Referral Unit (FRU) for the hospitals/centers
from which the cases are referred to the Sub District hospitals

3. Definition of Sub District hospitals

The term Sub District / Sub Divisional Hospital is used here to mean a hospital at
the secondary referral level responsible for the Sub District / Sub Division of a defined
geographical area containing a defined population.

4. Categorizing of Sub District hospitals

The size of a sub district hospital is a function of the hospital bed requirement,
which in turn is a function of the size of the population it serves. In India the population
size of a sub district varies from 1, 00,000 to 5, 00,000. Based on the assumptions of the
annual rate of admission as 1 per 50 populations and average length of stay in a hospital
as 5 days, the number of beds required for a sub district having a population of 5 lakhs
will be around 100-150 beds. However, as the population of the sub district varies a lot, it
would be prudent to prescribe norms by categorizing the size of the hospitals as per the
number of beds. For the purpose of classification, we have arbitrately leveled Sub-district
Hospitals as Category-I (31-50) and Category II (51-100). We presume that above 100
beds strength, health care facility will constitute District Hospital Group.

Category I: Sub District hospitals norms for 51-100 beds.


Category II: Sub District hospitals norms for 31 to 50 beds.

The minimum functional requirement of sub district hospitals (31-50 bedded) is


given as under.

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5. Functions

A sub district hospital has the following functions:

i. It provides effective, affordable healthcare services (curative including


specialist services, preventive and promotive) for a defined population,
with their full participation and in co-operation with agencies in the
district that have similar concern. It covers both urban population (sub
divisional headquarter town) and the rural population of the sub division.

ii. Function as a referral centre for the public health institutions below the
tehseel / taluka level such as Community Health Centres, Primary Health
Centres and Sub-centres.

iii. Provide education and training for primary health care staff.

6. Services

Services include OPD, indoor and emergency services. Secondary level health
care services, to be provided as given below. These can be grouped as Essential
Services (Minimum Assured Services) and Desirable Services

Essential

General Medicine
General Surgery
Accidents and emergency services including poisoning and Trauma Care
General Orthopaedics.
Obstetrics & Gynaecology
FP services like IUCD, NSV, Minilap, and lap sterilization
Paediatrics including Neonatalogy and Immunization
Anaesthesia
Ophthalmology
ENT
Dermatology & Venerology including RTI/STI,
Imaging services
Dental care
DOT centre
Designated Microscopy centre
AYUSH
Integrated Counseling and Testing Centre
Disability Certification (as per guidelines notified by state Government)
Services provided under other National Health Programmes including lifestyle
disorders

Diagnostic and other Para clinical services:

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Lab, X-ray, Ultrasound, ECG, Blood transfusion and storage1, and Basic Multi
Rehabilitation Services

Desirable

Critical care / Intensive Care (ICU)


Psychiatry
Geriatric Services
Tobacco Cessation Services
Physical Medicine and Rehabilitation services
Public Health Management

Support Services: Following ancillary services shall be ensured:

Essential

♦ Finance*
♦ Medico legal/postmortem
♦ Ambulance services
♦ Dietary services
♦ Laundry services
♦ Central sterile supply department
♦ Engineering and maintenance cell
♦ Security services including fire safety services
♦ Housekeeping and Sanitation
♦ Medical store and Inventory Management
♦ Waste management
♦ Medical record department including MIS
♦ Stand by Power back-up facility
♦ Office Management (Provision should be made for computerized medical records
with anti-virus facilities whereas alternate records should also be maintained)

Desirable
♦ Counseling services for domestic violence, gender violence, adolescents, etc.
Gender and socially sensitive service delivery be assured.

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Blood storage units should have atleast number of units equal to double of the average daily
requirement/consumption.

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* Financial accounting and auditing be carried out as per the rules along with timely
submission of SOEs/UCs.

Financial powers of Head of the Institution


Medical Superintendent to be authorized to incur and expenditure up to Rs.15.00 lakhs
for repair/upgrading of impaired equipments/instruments with the approval of executive
committee of RKS.

All the equipment/instruments should be under comprehensive Annual Maintenance


Contract after regular warranty period. No equipment/instrument should remain non-
functional for more than 30 days in a year. It will amount to suspension of status of IPHS
of the concerned institutions.

Outsourcing of services like laundry, ambulance, dietary, housekeeping and sanitation,


security, waste disposal etc. to be arranged by hospital itself. Manpower and outsourcing
work could be done through local tender mechanism.

Following services mix of procedures in medical and surgical specialties would be


available:

SERVICE MIX OF PROCEDURES IN MEDICAL AND SURGICAL


SPECIALITIES

MEDICAL
1 Pleural Aspiration
2 Lumbar Puncture
3 Skin scraping for fungus / AFB
4 Skin Biopsies
5 Abdominal tapping
6 FNAC
OPD Procedures (Including IPD)
1 Dressing (Small, Medium and Large)
2 Injection (I/M & I/V)
3 Catheterisation
4 Steam Inhalation
5 Cut down (Adult)
6 Enema
7 Stomach Wash
8 Douche
9 Sitz bath
10 Blood Transfusion
11 Hydrotherapy
12 Bowel Wash
Skin Procedures

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1 Chemical Cautery
2 Electro Cautery
3 Intra Lesional Injection
4 Biopsy
Paediatric Procedures
1 Immunization as per National Immunization Schedule / CH/ORT corner
Services related to new born care + All procedures as mentioned in
2
Medical
2.1 - only cradle
2.2 - Incubator Nebulization equipment
2.3 - Radiant Heat Warmer
2.4 - Phototherapy
2.5 - Gases (oxygen)
2.6 - Cut down
Cardiology Procedures and Diagnostic Tests
1 ECG
2 Defibrillator Shock
Physical Medicine and Rehabilitation (PMR) Services

1 With Electrical Equipments


1.1 - Short wave diathermy
1.2 - Ultra Sonic Therapy
1.3 - Infra Red Lamp (Therapy)
1.4 - Electric Vibrator
Non Electrical Equipments – Cervical/lumbar traction, wax bath, shoulder
2
wheel, weights etc.
Eye Specialist Services (Opthalmology)
1 OPD Procedures
Refraction (by using snellen’s chart)
1.1
Prescription for glasses using Trial frame.
1.2 - Syringing and Probing
1.3 - Foreign Body Removal (conjunctival)
1.4 - Foreign Body Removal (Corneal)
1.5 - Epilation
1.6 - Suture Removal
1.7 - Subconjunctival Injection
1.8 - Retrobular Injection (Alcohol etc.)
1.9 - Tonometry
1.10 - Pterygium Excision
1.11 - Syringing & Probing
1.12 - I & C of chalazion
1.13 - Stye
1.14 - Conjuctival Resuturing

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1.15 - Corneal Scraping
1.16 - I & D Lid Abscess
1.17 - Uncomplicated Lid Tear
1.18 - Indirect Opthalmoscopy
1.19 - Retinoscopy
Obstetric & Gynecology Specialist Services
1. Episiotomy
2. Forceps/vacuum delivery
3. Craniotomy-Dead Fetus/Hydrocephalus
4. Caesarean section
5. Female Sterilization ( Mini Laparotomy & Laparoscopic)
6. D&C
7. MTP/MVA
8. IUCD services
9. Bartholin Cyst Excision
10. Suturing Perineal Tears
11. Assisted Breech Delivery
12. Cervical Cautery
13. Normal Delivery
14. E U A
15. Retained Placenta & MRP
16. Suturing Cervical Tear
17. Assisted Twin Delivery
18. PAP smear
Dental Services
1 Dental Caries/Dental Abscess/Gingivitis
2 Minor Surgeries, Impaction, Flap
3 Trauma including Vehicular Accidents
4 Sub Mucus Fibrosis (SMF)
5 Scaling and Polishing
6 Root Canal Treatment
7 Extractions
8 Amalgum Filling (Silver)
9 Intra oral X-ray
10 Complicated Extractions (including suturing of gums)
SURGICAL
1 Abcess drainage including breast & perianal
2 Wound Debridement
3 Appendicectomy
4 Fissurotomy or fistulectomy
5 Hemorroidectomy
6 Circumcision
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7 Hydrocele surgery
8 Suprapubic Cystostomy
9 Vasectomy
10 Cysts and Benign Tumour
Breast
1 Excision fibroadenoma – Lump
Hernia
1 Ingunial Hernia repair reinforcement
2 Femoral Hernia repair
3 Strangulated Ventral or Incisional Hernia/Ingunial
Abdomen
1 Exploratory Laparotomy
2 Gastrostomy or Jejuncstomy
3 Simple Closure of Perforated Ulcer
Pancreas
1 Drainage of Pseudopancreatic Cyst
2 Retroperitoneal Drainage of Abscess
Appendix
1 Emergency Appendisectomy
2 Interval Appendisectomy
3 Appendicular Abscess Drainage
Small Intestine
1 Resection and Anastomosis
2 Multiple Resection and Anaestomosis
3 Intestinal Performation
Liver
1 Open Drainage of liver abscess
Colon, Rectum and Anus
1 Fistula in anus low level
2 Catheters
3 IV Sets
4 Colostomy Bags
5 Perianal Abscess
6 Ischiorectal Abscess
7 Ileostomy or colostomy alone
8 Haemorroidectomy

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9 Anal Sphincter Repair after injury
Penis, Testes, Scrotum
1 Circumcision
2 Partial amputation of Penis
3 Orchidopexy (Unilateral & Bilateral)
4 Hydrocele (Unilateral & Bilateral)
5 Excision of Multiple sebaceous cyst of scrotal skin
6 Reduction of Paraphimosis
Other Procedures
1 Suture of large laceration
2 Suturing of small wounds
3 Excision of sebaceous cyst
4 Small superficial tumour
5 Repair torn ear lobule
6 Incision and drainage of abscess
7 Injection Haemorrhoids/Ganglion/Keloids
8 Removal of foreign body (superficial)
9 Removal of foreign body (deep)
10 Excision Multiple Cysts
11 Tongue Tie
12 Debridment of wounds
13 Excision carbuncle
14 Ingroving Toe Nail
15 Diabetic Foot And carbuncle
Urology*
1 Cystolithotomy Superopubic
2 Dialatition of stricture urethra under GA
3 Dialation of stricture urethra without anaesthesia
4 Meatotomy
Plastic Surgery#
Burn Dressing Small, medium (10% to 30%), large 30% to 60%, extensive >
1
60%
2 Ear lobules repair one side
3 Simple wound
4 Complicated wound
5 Simple injury fingers

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6 Surgery concerning with TB
Orthopaedic Surgery
1 Fractures
1.1 Ext. fixation of hand & foot bones
Tarsals, Metatarsals, Phalanges carpals, Metacarples, excision head fibula,
1.2
lower and of Inia
1.3 Debridement & Secondary closure
1.4 Percutaneous Fixation (small and long bones)
2 Closed Reduction
2.1 Hand, Foot bone and cervicle
2.2 Forearm or Arm, Leg, Thigh, Wrist, Ankle
2.3 Dislocation elbow, shoulder, Hip, Knee
2.4 Closed Fixation of hand / foot bone
3 Open Reduction
3.1 Shoulder dislocation, knee dislocation
3.2 Acromiocalvicular or stemoclavicular Jt. Clavicle
3.3 Wrist dislocation on intercarpal joints
3.4 MP & IP Joints
3.5 Debridement of hand/foot
3.6 Fibula Radius Ulna (Clavicle) and Wrist, Ankle, Hand foot
3.7 Amputation (Thigh or arm, leg or forearm, feet or hand, digits)
POP Application (Hip Spica, Shoulde spica POP Jacket; A-K/A-E POP; B-
3.8
K/B-E POP)
3.9 Patellectomy

• To be provided by General Surgeon

# To be provided by specially trained General Surgeon

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RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) FOR DIFFERENT
ILLNESSES CONCERNING DIFFERENT SPECIALITIES:

Obstetric & Gynecology

S. NAME OF THE ILLNESS RECOMMENDED SERVICE MIX


No (SUGGESTED ACTIONS)
1 Bleeding during first trimester Diagnose ,Treat

2 Bleeding during second trimester Diagnose ,Treat

3 Bleeding during third trimester Diagnose ,Treat & refer

4 Normal Delivery Yes

5 Abnormal labour ( Mal presentation Refer


,prolonged labour, PROM, Obstructed
labour)
6 PPH Obstetric fisrt aid –IV line /oxytonic
Drip
SOS / Inj. Ergometrine
IV /Inj. Prostaglandin IM and refer
Mesopros
7 Puerperal Sepsis First Aid ,IV parentral antibiotics and
refer
8 Ectopic Pregnancy May refer

9 Hypertensive disorders Diagnose, treatment and refer if


necessary
10 Septic abortion Diagnose and IV parentral antibiotics
and refer
11 Medical disorders complicating Diagnose and refer
pregnancy ( heart disease ,diabetes
,hepatitis )
12 Bronchial asthma Diagnose , first aid and refer
Gynaecology

1 RTI / STI Treat and refer if necessary


2 DUB Refer D & C medical management

3 Benign disorders ( fibroid,prolapse Initial Investigations and refer


,ovarian masses)
Initial investigation at PHC / Gr III
level

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4 Cancer Cervix screening Initial Investigations, Collection of PAP
Initial investigation at PHC / Grade III SMEAR and refer
level
5 Cancer cervix /ovarian Initial Diagnose and refer
investigation at PHC / Gr III level
6 Infertility Basic Workout & Semen Analysis &
Refer
7 Prevention of MTCT Refer
8 MTP / MVA services MVA
9 Tubectomy Yes
10 PPTCT Counseling Yes

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GENERAL MEDICINE

S. RECOMMENDED SERVICE MIX


NAME OF THE ILLNESS
No (SUGGESTED ACTIONS)
1 Fever -a) Short duration (<1 week) Basic investigation and Treatment
Investigation and treatment
Fever -b) Long duration (>1 week)
Refer if necessary
Treat uncomplicated
c) Typhoid
Complicated cases refer to Gr-II - SDH
d) Malaria / Filaria Treat
Sputum +ve - Treat
e) Pulmonary Tuberculosis.
Sputum -ve - Ref to Gr-II-SDH
Mild icterus, Short duration - Treat/
f) Viral Hepatitis Long duration, Severe icterus- Refer to
Gr-II-SDH
g) Leptospirosis / Meningitis and
Diagnose and Treat refer if necessary
Haemorrhagic fever
Refer to nearest facility having
f) Malignancy
oncology services
2 COMMON RESP. ILLNESSES :
Bronchial Asthma / Pleural effusion /
Diagnose and Treat refer if necessary
Pneumonia / Allergic Bronchitis/COPD
3 COMMON CARDIAC PROBLEMS
a) Chest pain (IHD) Diagnose and refer to Gr-II Sub district

Diagnose and treat - Emergencies Refer


b) Giddiness (HT)
to Gr-IISDH
4 G I TRACT
G I Bleed / Portal hypertension / Gall Emergencies - Ref. To Gr-II / Gr-I -
a)
bladder disorder District Hospital
b) AGE / Dysentry / Diarrhorea Treat
5 NEUROLOGY
a) Chronic Headache Diagnose and Treat, refer if necessary

Chronic Vertigo/
b) Diagnose and Treat, refer if necessary
CVA/TIA/Hemiplegia/Paraplegia

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6 HAEMATOLOGY
Basic investigation and Treatment
a) Anaemia
Refer if necessary
Emergencies - Ref. to DH otherwise -
b) Bleeding disorder
Ref. To Tertiary
c) Malignancy Refer to nearest oncology facility
7 COMMUNICABLE DISEASES
Cholera, Measles, Mumps, and Chickenpox Treat
8 PSYCHOLOGICAL DISORDERS
Acute psychosis / Obsession / Anxiety Screening, emergency care and
neurosis referral

PAEDIATRICS

RECOMMENDED SERVICE
S. No NAME OF THE ILLNESS
MIX (SUGGESTED ACTIONS)
Diagnose, Treat & Refer if no
1 ARI/Asthmatic Bronchitis
improvement
Diagnose, Treat & Refer if no
2 Diarrohoeal Diseases
improvement
Protein Energy Malnutrition and Vitamin
3 Diagnose, Treat, & Refer
Deficiencies
Investigate, diagnose, treat & refer if
4 Pyrexia of unknown origin
no improvement
5 Bleeding Disorders Early Diagnosis and Refer
6 Diseases of Bones and Joints Early Diagnosis and Refer

NEONATOLOGY

RECOMMENDED SERVICE MIX


S. No Name of the Illness
(SUGGESTED ACTIONS)
Attention at birth (to prevent
1 Skilled Birth Attendant
illness)
2 Hypothermia Warm chain
3 Birth asphyxia Resuscitation/Refer if Necessary
4 Hypoglycemia Treat
5 Meconium aspiration syndrome Treat and Refer
6 Convulsions (seizures) Treat and Refer

18
7 Neonatal Sepsis Treat and refer in necessary
1800-1500 gms treat with kangaroo care
8 LBW
below that refer
9 Neonatal Jaundice Treat and refer if necessary

10 Preterm warm chain, feeding, kangaroo care and refer

11 Congenital malformations Examine and refer

12 R.D.S, ARI Manage and Refer

13 Dangerously ill baby Identify, first-aid and refer

14 Feeding Problems Identify and manage

15 Neonatal diarrhea Diagnosis and manage. Refer if necessary

16 Birth injury Minor -manage; major -refer


17 Neonatal Meningitis identify and refer
Renal problems/Congenital heart
18 Refer
disease/Surgical emergencies
19 HIV/AIDS Refer to ART Centre
20 Hypocalcemia Manage and Refer
21 Metabolic Disorders Identify & Refer
22 Hyaline Membrane diseases Diagnose & refer
23 Neonatal Malaria Manage/refer if needed
24 Blood disorders Manage and refer
25 Developmental Delays CBR
26 UTIs Manage &refer

27 Failure to Thrive Manage & Refer

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DERMATOLOGY

RECOMMENDED SERVICE MIX


S. No NAME OF THE ILLNESS
(SUGGESTED ACTIONS)
Infections
1 a) Viral - HIV - Verrucca Treat
Molluscum Contagiosa
Pityriasis Rosea, LGV, HIV Identify / Treat and refer
b) Bacteria
Pyoderma Treat
Chancroid
Gonorrhea, Leprosy, & Tuberculosis Treat & Refer
c) Fungal
Identify / Treat and refer
Sup. Mycosis, Subcut – Mycetoma
d) Parasitic Infestation
Scabies / Pediculosis/Larva Migrans Treat
e)Spirochaetes
Diagnosis and Treat
Syphilis
Papulosquamous
2 Psoriasis (classical)-uncomplicated/Lichen Treat
Planus
Pigmentary Disorder
3 Treat/Refer
Vitiligo
Keratinisation Disorder
4 Refer/Treat
Ichthyosis/Traumatic Fissures

Autoimmune
5 Treat / Refer
Collagen Vascular DLE, Morphea
Skin Tumors, Seb.Keratosis, Soft
6 Fibroma, Benign Surface,Tumors / Cysts, Refer
Appendageal Tumors
Miscellaneous
7 a.) Acne Vulgaris, Miliaria, Alopecia, Nail Treat
disorder,Toxin induced
b) Leprosy - Resistant/
Complications / reaction
Treat /
Allergy - EMF / SJS / TENP
Refer
soriasis/Collagen Vascular/Auto immune
Disorders
c) Deep Mycosis, STD Complications Treat / Refer

d) Genetically Determined Disorders Refer

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CHEST DISEASES

S. RECOMMENDED SERVICE MIX


NAME OF THE ILLNESS
No (SUGGESTED ACTIONS)
Investigation and Treatment Refer if
1 Fever
necessary
2 Cough with Expectoration / Blood Stained Treatment and refer if necessary

3 Hemoptysis Diagnose, Treat and refer if necessary

4 Chest Pain ECG Symptomatic treatment Refer


Investigation, Symptomatic treatment if
5 Wheezing
necessary
Investigation, Treatment and Refer if
6 Breathlessness
necessary, X-ray

PSYCHIATRY

S. RECOMMENDED SERVICE MIX


NAME OF THE ILLNESS
No. (SUGGESTED ACTIONS)
1 Schizophrenia Screening and Refer
2 Depression Screening and Refer
3 Mania Screening and Refer
4 Anxiety Disorders Screen, treat and Refer if necessary

5 Mental Retardation Screen, treat and Refer if necessary


6 Other Childhood Disorders Screen, treat and Refer if necessary
7 Alcohol and Drug Abuse Screening and Refer

8 Dementia Screening and Refer

DIABETOLOGY*

S. RECOMMENDED SERVICE MIX


NAME OF THE ILLNESS
No (SUGGESTED ACTIONS)
1 Screening for Diabetes Diagnose and Treat
2 Gestational Diabetes/DM with Pregnancy Diagnose and refer
3 DM with HT Diagnose, Treat and refer, if necessary

21
4 Nephropathy/Retinopathy Diagnose and Refer

5 Neuropathy with Foot Care Investigate, Diagnose & Treat

Emergency :-
i) Hypoglycemia
6 Diagnose, first aid and refer
ii)Ketosis
iii)Coma

* To be provided by General Physician

NEPHROLOGY

S. RECOMMENDED SERVICE MIX


NAME OF THE ILLNESS
No. (SUGGESTED ACTIONS)
1 Uncomplicated UTI Treat
Nephrotic Syndrome - Children/ Acute
2 Refer to District Hospital
Nephritis
3 Nephrotic Syndrome - Adults Refer to Tertiary Care
4 HT, DM Annual follow-up / refer to Gr-II-SD
5 Asymptomatic Urinary Abnormalities Refer to the District

6 Nephrolithiasis Refer to District Hospital

7 Acute renal Failure/ Chronic Renal Failure Diagnose and Refer to District level

8 Tumors Refer to Tertiary

* To be provided by General Physician

NEURO MEDICINE AND NEURO SURGERY

S. RECOMMENDED SERVICE MIX


NAME OF THE ILLNESS
No (SUGGESTED ACTIONS)
First Aid, Referral and Follow up of
1 Epilepsy
already diagnosed cases
2 C.V.A. First Aid and Referral
3 Infections Referral
4 Trauma First Aid and Referral
5 Chronic headache Referral
6 Chronic Progressive Neurological disorder Referral

22
* To be provided by General Physician and General Surgeon

GENERAL SURGERY

RECOMMENDED
S. NAME OF THE SURGICAL SERVICE MIX
No PROCEDURE/ILLNESSES (SUGGESTED
ACTIONS)
a. Minor Cases
under LA Abcess I&D/Suturing, Excision of
Treat
Lipoma / Ganglion / Lymph Node, Seb-Cyst /
Basic
1 Dermoid / Ear Lobe Repair / Circumcision
Techniques
b. Breast Lumps, Lymph nodes Swelling Diagnosis and Refer

a. Genitourinary tract Hydrocele, Hernia,


Treat
Circumcision, Supra pubic cystostomy
Elective
2
Surgeries b. Gastrointestinal disorder
Appendicitis/Anorectal abscesses Treat
/Hemorrhoids/Fistula

Emergency Injuries, Trauma, Burns, Accidents,


3 Diagnose, treat & refer
surgeries Perforation/Intestinal obstruction etc.

Benign/
Breast/Oral/GI tract/Genitourinary (Penis,
4 Malignant Diagnose & refer
Prostate, Testis)
Diseases

5 Others Thyroid, Varicose veins Diagnose & Refer

Burns First Aid, Treat and Refer,


6 Burns
if necessary
AR entry / Treat Refer if
7 Medico legal a) Assault / RTA
necessary
AR entry / Treat Refer if
b) Poisonings
necessary
AR entry / Treat Refer if
c) Rape
necessary
d) Postmortem Done

23
OPTHALMOLOGY

RECOMMENDED
S. No. NAME OF THE ILLNESS SERVICE MIX
(SUGGESTED ACTIONS)
1 Superficial Infection Treatment with drugs
2 Deep Infections First aid and refer
3 Refractive Error Treat
4 Glaucoma Diagnosis and refer
5 Eye problems following systemic disorders Refer
Screen, treat and refer
6 Cataract
complicated cases
7 Foreign Body and Injuries First aid and refer
Squint and Amblyopia/Corneal
8 Refer
Blindness(INF,INJ, Leucoma)/ Oculoplasty
9 Malignancy/Retina Disease Refer
10 Paediatric Opthalmology Refer

EAR, NOSE, THROAT

EAR
RECOMMENDED SERVICE MIX
S. No. NAME OF THE ILLNESS
(SUGGESTED ACTIONS)
1 ASOM/SOM/CSOM Treat
2 Otitis External / Wax Ears Treat
3 Polyps Diagnose and Refer
Treatment
4 Mastoiditis
(Medical)
5 Unsafe Ear Diagnose and Refer
THROAT

1 Tonsillitis/Pharyngitis/Laryngitis Treat
2 Quinsy Diagnose and Refer
3 Malignancy Larynx Diagnose and Refer
4 Foreign Body Esophagus Diagnose and Refer

24
NOSE
1 Epistaxis First aid & Refer
2 Foreign Body Treat(Removal)And refer if needed
3 Polyps Refer
4 Sinusitis Treat (Medical)
5 Septal Deviation Treat (Symptomatic)

ORTHOPADICS
RECOMMENDED SERVICE MIX
S. No. NAME OF THE ILLNESS
(SUGGESTED ACTIONS)

1 Osteomyelitis Diagnose, treat and refer if necessary


Detection/ Refer
2 Rickets /Nutritional Deficiencies Nutritional Mgt / Nutritional
Rehabilitation Centre
Prevention / Detection /
Poliomyelitis with residual
3 Antibiotics/Anti inflammatory for
Deformities/JRA/RA
JRA
4 RTA/Polytrauma Stabilize and Refer

UROLOGY
CHILDREN
RECOMMENDED SERVICE
S. No NAME OF THE ILLNESS
MIX (SUGGESTED ACTIONS)

1 Hydronephrosis Diagnose and refer


2 Urinary Tract Injuries Diagnose and refer
3 PUV/ Posterior Urethral Valve Diagnose and refer
4 Cystic Kidney Diagnose and refer
5 Urinary Obstruction Urethral Catheter Insertion Referral
6 Undesended Testis Diagnose and refer
7 Hypospadias and Epispadias Diagnose and refer
8 Mega Ureter Diagnose and refer
9 Extrophy Diagnose and refer
10 Tumours - Urinary Tact Diagnose and refer

25
ADULT
All above and
1 Stricture Urethra Diagnose and refer
2 Stone Diseases Diagnose and refer
3 Cancer - Urinary and Genital Tract Diagnose and refer

4 Trauma Urinary Tact Diagnose and refer


5 GUTB Diagnose and refer
OLD AGE
Prostate Enlargement and Urinary Urethral Catheter Insertion
1
Retention Referral
2 Stricture Urethra Diagnose and refer
3 Stone Diagnose and refer
Cancer
4 (Kidney, Bladder, Prostate, Testis, Penis Diagnose and refer
and Urethra)
5 Trauma Urinary Tract Diagnose and refer

DENTAL SURGERY
S. No NAME OF THE RECOMMENDED SERVICE MIX
ILLNESS (SUGGESTED ACTIONS)

1 Dental Caries/Dental Treatment


Abcess/Gingivitis Extraction and Filling

2 Cleaning Treat by Cleaning


Periodontitis
Surgery
3 Minor Surgeries, Treat and Refer if necessary
Impaction, Flap
4 Malocclusion Diagnose and Refer

5 Prosthodontia (Prosthetic Diagnose and Refer


Treatment)
6 Trauma Treated - First aid with drugs and refer

7 Maxillo Facial Surgeries Refer

8 Neoplasms Refer

26
HEALTH PROMOTION & COUNSELLING

S. No. NAME OF THE ILLNESS RECOMMENDED SERVICE


MIX (SUGGESTED ACTIONS)
1 CHD / M.I. Counseling / Diet advice Safe Style
changes
2 Diabetes Safe Style Changes / Physiotherapy
3 Substance Abuse Vocational Rehabilitation Safe
Style
4 HIV / AIDS HIV Counseling

COMMUNITY HEALTH SERVICES:

S. No. NAME OF THE ILLNESS RECOMMENDED SERVICE


MIX (SUGGESTED ACTIONS)
1 Communicable & Vaccine Preventable Health Promotional Activities like
Diseases ORT Canon, Immunization Camps
2 Non-communicable Diseases Epidemic Health Investigation,
Promotion & Counseling Activities
3 Adolescent & School Health Adolescent & school health
promotional activities
4 Family Planning Counseling services, camps, follow
up of contraceptive users
5 HIV / AIDS HIV Counseling and Testing; STI
testing; Blood safety; STI
syndromic treatment

27
7. Physical Infrastructure

7.1. Size of the hospital: the size of a district hospital is a function of the hospital bed
requirement which in turn is a function of the size of the population serve. In India the
population size of a district varies from 50,000 to 15,00,000. For the purpose of
convenience the average size of the district is taken in this document as one million
populations. Based on the assumptions of the annual rate of admission as 1 per 50
populations. And average length of stay in a hospital as 5 days. The number of beds
required for a district having a population of 10 lakhs will be as follows:

The total number of admissions per year = 10,00,000 x 1/50 = 20,000


Bed days per year = 20,000 x 5 = 100,000
Total number of beds required when occupancy is 100% = 100000/365 = 275
Total number of beds required when occupancy is 80% = 100000/365 x 80/100

7.2. Area of the hospital: An area of 65-85 m2 per bed has been considered to be
reasonable. The area will include the service areas such as waiting space, entrance hall,
registration counter, etc. In addition, Hospital Service buildings like Generators, HVAC
plant, Manifold Rooms, Boilers, Laundry, Kitchen and essential staff residences are
required in the Hospital premises. In case of specific requirement of a hospital, flexibility
in altering the area be kept.

7.3. Site information: Physical description of the area which should include bearings,
boundaries, topography, surface area, land used in adjoining areas, limitation of the site
that would affect planning, maps of vicinity and landmarks or centers, existing utilities,
nearest city, port, airport, railway station, major bus stand, rain fall and data on weather
and climate. Hospital Management Policy should emphasize on quake proof, fire
protected, flood proof buildings and should be away from overhead high tension wires..
Infrastructure should be eco-friendly and disabled (physically and visually handicapped)
friendly. Provision should be made for water harvesting, generator back-up, solar energy
/ power back-up, and horticulture services including herbal garden. Local agency
Guidelines and By-laws should strictly be followed. A room for horticulture to store
garden implements, seeds etc will be made available.

7.4. Factors to be considered in locating a Sub-district hospital


♦ The location may be near the residential area.
♦ Too old building may be demolished and new construction done in its place.
♦ It should be free from dangers of flooding; it must not, therefore, be sited at
the lowest point of the district.
♦ It should be in an area free of pollution of any kind, including air, noise, water
and land pollution.
♦ It must be serviced by public utilities: water, sewage and storm-water
disposal, electricity, gas and telephone. In areas where such utilities are not
available, substitutes must be found, such as a deep well for water, generators
for electricity and radio communication for telephone.
♦ Necessary environmental clearance will be taken.

28
♦ Disability Act will be followed. Barrier free access environment for easy
access to non-ambulant (wheel- chair, stretcher), semi-ambulant, visually
disabled and elderly persons as per “Guidelines and Space Standards for
barrier-free built environment for Disabled and Elderly Persons” of CPWD/
Min of Social Welfare, Government of India. This will ensure safety and
utilization of space by disabled and elderly people fully and full integration
into the society

7.5. Site selection criteria


A rational, step-by-step process of site selection occurs only in ideal
circumstances. In some cases, the availability of a site outweighs other rational
reasons for its selection, and planners arid architects are confronted with the job
of assessing whether apiece of land is suitable for building a hospital. In the case
of either site selection or evaluation of adaptability, the following items must be,
considered: size, topography, drainage, soil conditions, utilities available, natural
features and limitations.

7.6 In the already existing structures of a sub-district hospital


♦ It should be examined whether they fit into the design of the recommended
structure and if the existing parts can be converted into functional spaces to fit
in to the recommended standards.
♦ If the existing structures are too old to become part of the new hospital, could
they be converted to a motor pool, laundry, store or workshop or for any other
use of the district hospital.
♦ If they are too old and dilapidated then they must be demolished. And new
construction should be put in place.

7.7. Building and Space Requirements

The hospital building is to be designed as a barrier free facility and all facilities
for physically challenged persons required be incorporated in the design.

Signage:

The building should have a prominent board displaying the name of the Centre in
the local language at the gate and on the building. Colour coded guidelines and
signages indicating access to various facilities at strategic points in the Hospital
for guidance of the public should be provided.

• Disaster Prevention Measures: (For all new upcoming facilities in seismic zone
5 or other disaster prone areas )

Desirable
For prevention of

29
Earhquake,
Flood
and Fire

Building structure and the internal structure of Hospital should be made disaster
proof especially earthquake proof, flood proof and equipped with fire protection
measures.

Quake proof measures – structural and non-structural should be built in to


withstand quake as per geographical/ state govt. guidelines. Non-structural
features like fastening the shelves, almirahs, equipments etc are even more
essential than structural changes in the buildings. Since it is likely to increase the
cost substantially, these measures may especially be taken on priority in known
earthquake prone areas. (For more details refer to ‘Annexure VI: Seismic safety
of non-structural elements of Hospitals/Health facility’)

Hospital should not be located in low lying area to prevent flooding.

Fire fighting equipments – fire extinguishers, sand buckets, etc. should be


available and maintained to be readily available when there is a problem. There
should be regular drill of the staff for use of these equipments

All health staff should be trained and well conversant with disaster prevention and
management aspects

Environmental friendly features

The Hospital should be, as far as possible, environment friendly and energy
efficient. Rain-Water harvesting, solar energy use and use of energy-efficient
bulbs/equipments should be encouraged.

Administrative Block:

Administrative block attached to main hospital along with provision


of MS Office and other staff will be provided.

Circulation Areas

Circulation areas like corridors, toilets, lifts, ramps, staircase and other common
spaces etc. in the hospital should not be more than 55% of the total floor area of
the building.

Floor Height

30
The room height should not be less than approximately 3.6 m measured at any
point from floor to floor height.

Entrance Area

Physical Facilities: Barrier free access environment for easy access to non-
ambulant(wheel- chair, stretcher), semi-ambulant, visually disabled and elderly
persons as per “Guidelines and Space Standards for barrier-free built environment
for Disabled and Elderly Persons” of CPWD/ Min of Social Welfare, GOI.

Ramp as per specification, Hand- railing, proper lightning etc. must be provided
in all health facilities and retrofitted in older one which lack the same.

Ambulatory Care Area (OPD)

Waiting Spaces

Registration, assistance and enquiry counter facility be made available in all the
clinics alongwith proper sitting arrangements, drinking water, ceiling fans and
toilet facilities separate for male and female.

Main entrance, general waiting and subsidiary waiting spaces are required
adjacent to each consultation and treatment room in all the clinics.

Clinics

The clinics should include general, medical, surgical, ophthalmic, ENT, dental,
obsetetric and gynaecology, paediatrics, dermatology and venereology,
psychiatry, neonatology, orthopaedic and social service department. The clinics
for infectious and communicable diseases should be located in isolation,
preferably, in remote corner, provided with independent access. For National
Health Programme, adequate space be made available. Immunization Clinic with
waiting Room having an Area of 3m x 4m in PP centre/Maternity centre/
Pediatric Clinic should be provided. One room for HIV/STI Counseling is to be
provided.

Nursing Services

Various clinics under Ambulatory Care Area require nursing facilities in common
which include dressing room, side laboratory, injection room, social service and
treatment rooms, etc.

31
Nursing Station: Need based space required for Nursing Station in OPD for
dispensing nursing services. (Based on OPD load of patient)

Diagnostic Services

Provision for following Space be made

-Space for common collection area


-Separate room for doctors/consultants
-rooms for reporting
-space for technicians
-storage /records areas
-sufficient waiting areas

Imaging

Role of imaging department should be radio-diagnosis and ultrasound along with


hire facilities depending on the bed strength. The department should be located at
a place which is accessible to both OPD and wards and also to operation theatre
department. The size of the room should depend on the type of instrument
installed. The room should have a sub-waiting area with toilet facility and a
change room facility, if required. Film developing and processing (dark room)
shall be provided in the department for loading, unloading, developing and
processing of X-ray films. Separate Reporting Room for doctors should be there.

Clinical Laboratory

For quick diagnosis of blood, urine, etc., a small sample collection room facility
shall be provided.
Separate Reporting Room for doctors should be there.

Blood Storage Unit (annexure VII)

The area required for setting up the facility is only 10 square meters, well-lighted,
clean and preferably air-conditioned.

Intermediate Care Area (Inpatient Nursing Units)

General

Nursing care should fall under following categories:

General Wards: Male / Female


Private Wards
Wards for Specialities

32
Depending upon the requirement of the hospital and catchment area, appropriate
beds may be allowed for private facility. 10% of the total bed strength is
recommended as private wards beds.

Location

Location of the ward should be such to ensure quietness and to control number of
visitors.

Ward Unit

The basic aim in planning a ward unit should be to minimize the work of the
nursing staff and provide basic amenities to the patients within the unit. The
distances to be traveled by a nurse from bed areas to treatment room, pantry etc.
should be kept to the minimum. Ward unit will include nursing station, doctors’
duty room, pantry, isolation room, treatment room, nursing store along with wards
and toilets as per the norms. On an average one nursing station per ward will be
provided. It should be ensure that nursing station caters to around 40-45 beds, out
of which half will be for acute patients and rest for chronic patients.

Private ward: Depending upon the requirement of the hospital and catchment
area appropriate beds may be allocated for private facilities. However, 10% of the
total bed strength is recommended as private wards beds.

Patient Conveniences: It is to be as per local byelaws.

Pharmacy (Dispensary)

The pharmacy should be located in an area conveniently accessible from all


clinics. The size should be adequate to contain 5 percent of the total clinical visits
to the OPD in one session.

Pharmacy should have component of medical store facility for indoor patients and
separate pharmacy with accessibility for OPD patients.

Patient Conveniences: It is to be as per local byelaws.

Intensive Care Unit & High Dependency Wards (Desirable)

General

In this unit, critically ill patients requiring highly skilled life saving medical aid
and nursing care are concentrated. These should include major surgical and
medical cases, head injuries, severe haemorrhage, acute coronary occlusion,
kidney and respiratory catastrophe, poisoning etc. It should be the ultimate
medicare the hospital can provide with highly specialized staff and equipment.

33
The number of patients requiring intensive care may be about 2 to 5 percent of
total medical and surgical patients in a hospital. Number of beds will be restricted
to 5% of the total bed strength. However, the unit shall not have less than 4 beds.
Out of these, they can be equally divided among ICU and High Dependency
Wards. Changing room should be provided for. There should be clear cut
admission and discharge policy.

Location

This unit should be located close to operation theatre department and other
essential departments, such as, X-ray and pathology so that the staff and
ancillaries could be shared. Easy and convenient access from emergency and
accident department is also essential. This unit will also need all the specialized
services, such as, piped suction and medical gases, uninterrupted electric supply,
heating, ventilation, central air conditioning and efficient life services. A good
natural light and pleasant environment would also be of great help to the patients
and staff as well.

Accidents and emergency services

It should preferably have a distinct entry independent of OPD and main entry so
that a very minimum time is lost in giving immediate treatment to casualties
arriving in the hospital. There should be an easy ambulance approach with
adequate space for free passage of vehicles and covered area for alighting
patients.

Emergency should have separate mobile X-ray/ laboratory, side labs/plaster


room/and minor OT facilities. Separate emergency beds may be provided
consisting of 10% of the total bed strength of the hospital. Duty rooms for
Doctors/ nurses/paramedical staff and medico legal cases. Sufficient waiting area
for relatives and located in such a way which does not disturb functioning of
emergency services.

Therapeutic Services

Operation Theatre

Operation theatre usually have a team of surgeons anesthetists, nurses and


sometime pathologist and radiologist operate upon or care for the patients. The
location of Operation theatre should be in a quite environment, free from noise
and other disturbances, free from contamination and possible cross infection,
maximum protection from solar radiation and convenient relationship with
surgical ward, intensive care unit, radiology, pathology, blood bank and CSSD.
This unit also needs constant specialized services, such as, piped suction and
medical gases, electric supply, heating, air-conditioning, ventilation and efficient

34
life service, if the theatres are located on upper floors. Zoning should be done to
keep the theatres free from micro organisms. There may be four well defined
zones of varying degree of cleanliness namely, Protective Zone, Clean Zone,
Aspectic or Sterile Zone and Disposal or Dirty Zone. Normally there are three
types of traffic flow, namely, patients, staff and supplies. All these should be
properly channelized. An Operation Theatre should also have Preparation Room,
Pre-operative Room and Post Operative Resting Room. Operating room should be
made dust-proof and moisture proof. There should also be a Scrub-up room where
operating team washes and scrub-up their hands and arms, put on their sterile
gown, gloves and other covers before entering the operation theatre. The theatre
should have sink / photo sensors for water facility. Laminar flow of air be
maintained in operation theatre. It should have a central air conditioning facility.
It should have door with self closing device and viewing window to communicate
with the operation theatre. A pair of surgeon’s sinks and elbow or knee operated
taps are essential. Operation Theatre should also have a Sub-Sterilizing unit
attached to the operation theatre limiting its role to operating instruments on an
emergency basis only.

Theatre refuse, such as, dirty linen, used instruments and other disposable/ non
disposable items should be removed to a room after each operation. Non-
disposable instruments after initial wash are given back to instrument sterilization
and rest of the disposable items are disposed off and destroyed. Dirty linen is sent
to laundry through a separate exit. The room should be provided with sink, slop
sink, work bench and draining boards.

Delivery Suite Unit

The delivery suit unit be located near to operation theatre.


The delivery Suit Unit should include the facilities of accommodation for various
facilities as given below:

Reception and admission


Examination and Preparation Room
Labour Room (clean and a septic room)
Sterilizing Rooms
Sterile Store Room
Scrubbing Room
Dirty Utility Room
Newborn care corner in Labour room. (Annexure V)
Newborn care Stabilization Unit: Details at Annexure V A

Physical Medicine and Rehabilitation (PMR)

The PMR department provides treatment facilities to patients suffering from


crippling diseases and disabililties. The department is more frequently visited by
out-patients but should be located at a place which may be at convenient access to

35
both outdoor and indoor patients with privacy. It should also have a physical and
electro-therapy rooms, gymnasium, office, store and toilets separate for male and
female. Normative standards will be followed.

Hospital Services

Management Information System (MIS)

Computer with Internet connection is to be provided for MIS purpose. Provision


of flow of Information from PHC/CHC to district hospital and from there to
district and state health organization should be established. Relevant information
with regards to emergency, outdoor and indoor patients be recorded and
maintained for a sufficient duration of time as per state health policy.

Hospital Kitchen (Dietary Service)

The dietary service of a hospital is an important therapeutic tool. It should easily


be accessible from outside along with vehicular accessibility and separate room
for dietician and special diet. It should be located such that the noise and cooking
odours emanating from the department do not cause any inconvenience to the
other departments. At the same time location should involve the shortest possible
time in delivering food to the wards.

Central Sterile and Supply Department (CSSD)

As the operation theatre department is the major consumer of this service, it is


recommended to locate the department at a position of easy access to operation
theatre department. It should have a provision of hot water supply and steam.

Hospital Laundry

It should be in-plant mechanized laundry provided with necessary facilities for


drying, pressing and storage of soiled and cleaned linens.

Medical and General Stores

There are of medical and general store should have vehicular accessibility and
ventilation, security and fire fighting arrangements.

For Storage of Vaccines and other logistics

For Storage of Vaccines and other logistics


Cold Chain Room: 3.5m x 3m in size
Vaccine & Logistics Room: 3.5m x 3m in size

36
Minimum and maximum Stock (0.5 and 1.25 month respectively). Indent order
and receipt of vaccines and logistics should be monthly. CC & VL Assistant will
be responsible for timely reciept of required vaccines and Logistics from the
District Stores

Mortuary

It provides facilities for keeping of dead bodies and conducting autopsy. It should
be so located that the dead bodies can be transported unnoticed by the general
public and patients.

Engineering Services

Electric Engineering

Sub Station and Generation

Electric sub station and standby generator room should be provided.

Illumination

The illumination and lightning in the hospital should be done as per the prescribed
standards.

Emergency Lighting

Shadow less light in operation theatre and delivery rooms should be provided.
Emergency portable light units should be provided in the wards and departments.

Call Bells

Call bells with switches for all beds should be provided in all types of wards with
indicator lights and location indicator situated in the nurses duty room of the
wards.

Ventilation

The ventilation in the hospital may be achieved by either natural supply or by


mechanical exhaust of air.

Mechanical Engineering

Air-conditioning and Room Heating in operation theatre and neo-natal units


should be provided. Air coolers or hot air convectors may be provided for the
comfort of patients and staff depending on the local needs.

37
Hospital should be provided with water coolers and refrigerator in wards and
departments depending upon the local needs.

Generator- 5 KVA with POL for Immunization Cold Chain maintenance

Public Health Engineering

Water Supply

Arrangement should be made for round the clock piped water supply along with
water storage tank with a provision to store at least three days water requirement.
It should have pumping and boosting arrangements. Approximately 10000 litres
of potable water per day is required for a 100 bedded hospital. Separate provision
for fire fighting and water softening plants be made available.

Drainage and Sanitation

The construction and maintenance of drainage and sanitation system for waste
water, surface water, sub-soil water and sewerage shall be in accordance with the
prescribed standards. Prescribed standards and local guidelines shall be followed.

Other Amenities
Disabled friendly, WC with basins wash basins as specified by Guidelines for
disabled friendly environment should be provided.

Waste Disposal System

National guidelines on Bio-Medical Waste Management and a Notification of


Environment and Forests are at Annexure - I.

Trauma Centre

Guidelines to be followed

Fire Protection

Telephone and Intercom

Medical Gas

Cooking Gas: Liquefied petroleum gas (LPG)

Laboratory Gas: Liquefied petroleum gas (LPG) and other specified gases.

38
Building Maintenance: Provision for building maintenance staff and an office-
cum store will be provided to handle day to day maintenance work.

Annual Maintenance Contract (AMC)


AMC should be taken for all equipments which need special care and preventive
maintenance done to avoid break down and reduce down time of all essential and
other equipments.

Parking: Sufficient parking place as per the norms will be provided

Administrative Services: Two sections (i) General section to deal with overall
upkeep of the hospital and welfare of its staff and patients (ii) Medical Records
section.

Committee Room: A meeting or a committee room for conferences, trainings


with associated furniture.

Residential Quarters: All the essential medical and para-medical staff will be
provided with residential accommodation. If the accommodation can not be
provided due to any reason, then the staff may be paid house rent allowance, but
in that case they should be staying in near vicinity, so that essential staff is
available 24x7 in case of need.

39
8. MANPOWER REQUIREMENT

8.1. Man Power – Doctors

S. Sub District Hospital (31-50 bedded)


Staff
No Essential Desirable
1
1 Hospital Superintendent 1
2 Medical Specialist 1 +1
3 Surgery Specialists 1
4 O&G specialist 1 +1
Dermatologist /
5 1
Venereologist
6 Paediatrician 1
7 Anesthetist 1 +1
8 Opthalmologist 1
9 Orthopedician 1
10 Radiologist 1
Casualty Doctors / General
11 7 (3 lady MOs)
Duty Doctors
12 Dental Surgeon 1
13 Forensic Specialist 1
14 ENT Surgeon 1
15 AYUSH Physician2 2
Total 22 25
1
May be a Public Health Specialist or management specialist trained in public health
2
Provided there is no AYUSH hospital / dispensary in the district headquarter

40
8.2. Man Power – Para Medical

S. Sub District Hospital (31-50 bedded)


No Staff
Essential Desirable
1 Staff Nurse 18 +2
Hospital worker (OP/ward
2 +OT+ blood storage unit+ Cold 6
Chain handler#)
3 Sanitary Worker 5
Ophthalmic Assistant /
4 1
Refractionist
5 ECG Technician 1
Laboratory Technician* ( Lab +
6 4 +1
Blood Storage Unit)
Laboratory Attendant (Hospital
7 2
Worker)
8 Radiographer 2
Pharmacist1
9 4
10 Dietician 1
Dental Technician/ Assistant/
11 Hygienist/
1
Assistant Nursing
13 Superintendent 1

14 Multi Rehabilitation worker 2


15 Statistical Assistant 1
Medical Records Officer /
16 1
Technician
Cold Chain & Vaccine
17 1
Logistics Assistant
18 Electrician 1
19 Plumber 1
Total 52 56
* Must have MLT qualification.
1
One from AYUSH.
# One may be identified (& trained) from the existing staff for assisting cold chain
and vaccine logistic assistant.

41
General HR and Bed norms for Obstetric Cases

No of Deliveries Requirement of Requirement of HR requirement Staff


in a month Bed Labour table Nurses
100 deliveries 10 beds 2 Labour tables 4 for Labour Rooms

5 for ANC/PNC Wards

42
8.3. Manpower- Administrative Staff

S. Sub District Hospital (31-50 bedded)


Staff
No
Essential Desirable
1 Office Superintendent 1
2 Accountant 2
3 Computer Operator 4 +2
4 Driver 1 +2
5 Peon 2
6 Security Staff* 2
Total 12 16

Note: Driver will not be required if outsourced

* The number would vary as per requirement and to be outsourced.

8.4. Man Power – Operation Theatre

Sub District Headquarters Hospital


S.
Staff 31-50 Bedded
No.
Emergency / FW OT
1 Staff Nurse 2
3 OT Assistant 2
4 Sweeper 1
Total 5

8.5. Man Power – Blood Storage

S.
Staff Blood Storage
No
1 Staff Nurse 1
2 MNA / FNA 1
Blood Bank
3 1
Technician
4 Sweeper 1

43
9. EQUIPMENT (ESSENTIAL EXCEPT WHERE INDICATED)

I Imaging Equipment
S. 31 -50 bedded Sub
No. Name of the Equipment District Hospital
1 100 M.A. X-ray machine 1
2 Dental X ray machine 1
Ultra Sonogram (Obs & Gyne. department
should be having a separate ultra-sound
3 machine of its own) 1 + 1(Desirable)

II X Ray Room Accessories


S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
1 X-ray developing tank 1
2 Safe light X-ray dark room 1
3 Cassettes X-ray 4
4 X-ray lobby single 2
5 Lead Apron 1
6 Intensifying screen X-ray 1

III Cardiac Equipments


S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
1 ECG machine ordinary 1
2 Cardiac Monitor 1(Desirable 2)
3 Pulse Oximeter 1 (Desirable 2)
4 Infusion pump 1
5 B.P.apparatus table model 6 (Desirable 10)
6 B.P.apparatus stand model 4
7 Stethoscope 2(Desirable 12)

IV Labour ward & Neo Natal Equipments


S. 50 bedded Sub
No. Name of the Equipment District Hospital
1 Baby Incubators 1
2 Phototherapy Unit 1
3 Emergency Resuscitation Kit-Baby 2
1 each for the labour
4 Standard weighing scale
room & OT

44
Newborn Care Equipments 1 set each for labour
5 room & OT
Double–outlet Oxygen Concentrator 1 each for the labour
6 room & OT
7 Radiant Warmer 1
8 Room Warmer 2
9 Foetal Doppler 1(Desirable 2)
10 Delivery Kit 2
11 Episiotomy kit 1
12 Forceps Delivery Kit 1
13 Vacuum extractor metal 1
14 Silastic vacuum extractor 1
15 Pulse Oximeter baby & adult 1
16 Cardiac monitor baby 1(Desirable)
17 Nebulizer baby 1
18 Weighing machine adult 2
19 Weighing machine infant 2
20 CTG Machine 1(Desirable)
21 Arc 1(Desirable)

Equipments for Newborn care corner and new born care Stabilization Unit: Details at
Annexure V & V A respectively.

45
V Immunization Equipments
ILR(L)-1, & DF(L)-1 for
ILR & DF with Stabilizer immunization at hospital purpose
Spare ice pack box one from each equipment
Room Heater/Cooler for immunization clinic As per need
with electrical fittings
Waste disposal twin bucket, hypochlorite 2 per ILR bimonthly
solution/bleach
Freeze Tag Need Based
Thermometers Alcohol (stem) 2
Almirah for Vaccine logistics 2
Almirah for vaccine logistics 1
Immunization table 5
Chair for new staff proposed 3
Stools for immunization room 2
Bench for waiting area 1
Dustbin with lid one from each equipment
Water container 1
Hub cutters 2
5 KVA Generator with POL for 1 ( If hospital has other Generator
immunization purpose for general purpose this is not
needed.)
For Monitoring and Effective programme management for immunization
following are to be used

Registers Immunization register


Vaccine stock & issue register
AD syringes, Reconstitution syringes, other logistic
stock & issue register
Equipment, furniture & other accessories
register
Geneset Logbook
Tracking Bag and Tickler Box
Tally sheets
Monitoring
Immunization cards
Tools

Temperature Logbook
Microplans
Reports Monthly UIP reports
Weekly surveillance reports (AFP, Measles)
Serious AEFI reports
Outbreak reports
46
VI Eye Equipments
S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
1. Opthalmoscope - Direct 1
2. Slit Lamp 1
3. Retino scope 1
4. Perimeter 1
5. Binomags 1
6. Distant Vision Charts 1
7. Foreign Body spud and needle 1
8. Lacrimal cannula and probes 1
9. Lid retractors (Desmarres) 1
10. Near Vision charts 1
11. Punctum Dilator 1
12. Rotating Visual acuity drum 1
13. Torch 2
14. Trial Frame Adult/Children 1
15. Trial Lens Set 1
16. IOL Operation set 2
17. Laser Photocoagulometer* 1
18. Operating Microscope 1
19. A-Scan Biometer 1
20. Keratometer 1
21. Auto Refractometer 1
22. Flash Autoclave 1
23. Applanation Tonometer 1

VII EAR NOSE THROAT EQUIPMENT

District Headquarters
S. Hospital (201-300
No. Name of the Equipment bedded)
1. Indigenous Digital Audiometer 1
2. Impedance Audiometer 1(Desirable)
3. Operating Microscope (ENT) 1
4. Head light (ordinary) (Boyle Davis) 2
5. ENT Operation set including headlight,
Tonsils 1
6. Ear Surgery Instruments 2 sets
7. Mastoid Set 1
8. Micro Ear Set myringoplasty 1
9. Micro drill System 2 sets
10. Stapedotomy Set 1
11. Stapeidoplasty 1

47
12. ENT Nasal Set (SMR, Septoplasty, 1(Desirable)
Polypetcomy, DNS, Rhinoplasty)
13. Laryngoscope fibreoptic ENT 1(Desirable)
14. Laryngoscope indirect 2
15. Otoscope 2
16. Oesophagoscope Adult 1
17. Oesophagoscope Child 1
18. Head Light (cold light) 1
19. Tracheostomy Set 2
20. Tuning fork 1
21. OAE Analyzer 1(Desirable)
22. Sound Proof room 1(Desirable)

VIII Dental Equipments


S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
1 Air Rotor 1
2 Dental Unit with motor for dental OP 1
3 Dental Chair 1
4 Dental Kit 1

IX Operation Theatre Equipment


S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
1 Auto Clave HP Vertical (2 bin) 1
2 Operation Table Hydraulic Major 1
3 Operation table Hydraulic Minor 1
Operating table non-hydraulic field
4 type 1
5 Autoclave vertical single bin 1
6 Shadowless lamp ceiling type major* 1
7 Shadowless lamp ceiling type minor* 1
8 Shadowless Lamp stand model 1
9 Focus lamp Ordinary 1
10 Sterilizer big (Instrument) 1
11 Sterilizer Medium (Instrument) 2
12 Steriliser Small (Instruments) 2
13 Bowl Steriliser – big* 1
14 Bowl steriliser – Medium* 1
15 Diathermy Machine (Electric Cautery) 1
16 Suction Apparatus - Electrical 2
17 Suction Apparatus - Foot operated 1

48
IX Operation Theatre Equipment
S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
18 Ultra violet lamp philips model 4 feet 2

* To be provided as per need.

X Laboratory Equipments
S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
1. Binocular Microscope 2
2. Chemical Balances 1
3. Simple balances 1
4. Electric Colorimeter 1
5. Auto analyser * 1
6. Micro pipettes (10-100 ml), (200-1000
ml) 2 (1+1)
7. Water bath 1
8. Hot Air oven* 1
9. Lab Incubator* 1
10. Distilled water Plant 1
11. Electricentrifuge, table top 1
12. Cell Counter Electronic* 1
13. Hot plates 2
14. Rotor / Shaker 1
15. Counting chamber 2
16. PH meter 1
17. Glucometer 1
18. Haemoglobinometer 1
19. TCDC count apparatus 1
20. ESR stand with tubes 1
21. Test tube stands* 3
22. Test tube rack* 3
23. Test tube holders* 3
24. Spirit lamp* 4
25. Timer stop watch 1
26. Alarm clock 1
27. Refrigerator 1
28. Laboratory Auto Claves 2
Automatic Processing Unit for
29. Radiology
30. Tonometer for Ophthalmology
31. Automatic Blood Gas Analyzer 1(Desirable)
32. 2000 Nos Whole Blood Finger Prick HIV

49
X Laboratory Equipments
S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
Rapid Test and STI Screening Test each

* To be provided as per need

XI Surgical Equipment Sets


S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
1. P.S.set 1
2. MTP Set 1
3. Biopsy Cervical Set* 1
4. D & C Set 1
5. Electric Cautrey 1
6. I.U.C.D. Kit 1
7. LSCS set 1
8. MVA Kit 1
9. Vaginal Hysterectomy 1(Desirable)
10. Proctoscopy Set* 1(Desirable)
11. P.V. Tray* 1
12. Abdominal Hysterectomy set 1
13. Laparotomy Set 1
14. Formaline dispenser 1
15. Kick Bucket 4
16. General Surgical Instrument Set Piles, 1
Fistula, Fissure*
17. Knee hammer 1
18. Hernia, Hydrocele* 1
19. Vaginal Examination set* 2
20. Suturing Set* 2
21. MTP suction apparatus 1
22. Thomas Splint 3
23. Mini Surgery Set* 1
24. GI Operation Set* 1
25. Appendicectomy set * 1
26. L.P.Tray* 1
27. Uretheral Dilator Set 1
28. Amputation set 1
29. Crammer wire splints 6
30. IUCD -5 Nos 5
31. Minilap sets-3 3
32. NSV sets- 3 3

50
XI Surgical Equipment Sets
S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
33. Colposcope ** 1(Desirable)
34. Cryoprobe ** 1(Desirable)

* To be provided as per need.


** Optional

XII PMR Equipments (Desirable)


S. 31-50 bedded Sub
No. Name of the Equipment Distric Hospital
1. Skeleton traction set 1
2. Short Wave Diathermy 1
3. Hot packs & Hydro collator
4. Exercise Table
5. Static Cycle
6. Medicine ball
7. Quadricaps Exerciser
8. Coordination Board
9. Hand grip strength measurement Board
10. Kit for Neuro-development assessment.
11. CBR Manual
12. ADL Kit & hand exerciser
13. Multi Gym Exerciser
14. Self Help devices
15. Wheel chair
16. Crutches / Mobility device sets
17. Hot air oven
18. Hot air gun
19. Grinder
20. Sander
21. Router
22. Power Drill
23. Band saw
24. Vacuun forming apparatus
25. Lathe
26. Welding machine
27. Buffing & polishing machine
28. Work table – 2 nos
29. Tools and raw material

51
XIII Endoscopy Equipments
S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
Laparoscope diagnostic and for
1 sterilisation * 1+1(Desirable)

* To be provided as per need.

XIV Anaesthesia Equipments


S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
Anaesthetic - laryngoscope magills with four
1 blades 2
2 Endo tracheal tubes sets 1
3 Magills forceps (two sizes) 3
4 Connector set of six for E.T.T 3
5 Tubes connecting for ETT 4
6 Air way female* 4
7 Air way male* 8
8 Mouth prop* 6
9 Tongue depressors* 6
10 O2 cylyinder for Boyles 6
11 N2O Cylinder for Boyles 6
12 CO2 cylinder for laparoscope* 2
Boyles Apparatus with Fluotec and circle
13 absorber 1

* To be provided as per need.

XV Furniture & Hospital Accessories


S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
Doctor's chair for OP Ward, Blood Bank,
1 Lab etc. 12
2 Doctor's Table 3
3 Duty Table for Nurses 4
4 Table for Sterilisation use (medium) 4
5 Long Benches(6 1/2'x 1 1/2' ) 10
6 Stool Wooden 8
7 Stools Revolving 6
8 Steel Cup-board 8
9 Wooden Cup Board 4
10 Racks -Steel – Wooden 5

52
XV Furniture & Hospital Accessories
S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
11 Patients Waiting Chairs (Moulded)* 10
12 Office Chairs 4
13 Office Table 3
14 Foot Stools * 8
15 Filing Cabinets (for records) * 4
16 M.R.D.Requirements (record room use) * 1
17 Paediatric cots with railings 3
18 Cradle* 2
19 Hospital Cots (ISI Model ) 50
20 Hospital Cots Paediatric (ISI Model ) 5
21 Wooden Blocks (Set)* 1
22 Back rest* 2
23 Dressing Trolley (SS) 2
24 Medicine Almairah 1
25 Bin racks (wooden or steel)* 3
26 ICCU Cots 2
27 Bed Side Screen (SS-Godrej Model)^ As per requirement
28 Medicine Trolley(SS) 2
29 Case Sheet Holders with clip(S.S.)* 40
30 Examination Couch (SS) 2
31 Instrument Trolley (SS) 4
32 Instrument Trolley Mayos (SS) 2
33 Surgical Bin Assorted 15
34 Wheel Chair (SS) 3
35 Stretcher / Patience Trolley (SS) 2 each.
36 Instrument Tray (SS) Assorted 20
37 Kidney Tray (SS) - Assorted 20
38 Basin Assorted (SS) 20
39 Basin Stand Assorted (SS)
(2 basin type ) 3
( 1 basin type) 5
40 Delivery Table (SS Full) 4
41 O2 Cylinder Trolley(SS) 3
42 Saline Stand (SS) 10
43 Waste Bucket (SS) 20
44 Dispensing Table Wooden 1
45 Bed Pan (SS) 10
46 Urinal Male and Female 10
47 Name Board for cubicals 1
48 Waste Disposal - Bin / drums 5(Desirable+10)
49 Waste Disposal - Trolley (SS) 1(Desirable+1)

53
XV Furniture & Hospital Accessories
S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
50 Linen Almirah 2(Desirable+2)
51 Stores Almirah 2(Desirable+2)
52 Arm Board Adult 6
53 Arm Board Child 6
54 SS Bucket with Lid 4
55 Bucket Plastic 6
56 Ambu bags 3
57 O2 Cylinder with spanner ward type 6
58 Diet trolley - stainless steel 1
59 Needle cutter and melter 10
60 Thermometer clinical 10
61 Thermometer Rectal 3
62 Torch light 6
63 Cheatles forceps assorted 5
64 Stomach wash equipment 2
65 Infra Red lamp 3
66 Wax bath 1
67 Emergency Resuscitation Kit-Adult 2
68 Enema Set 2
69 Ceiling Fans$ As per requirement
* To be provided as per need.
^ At least one screen per five beds except female wards.
$ One fan per four beds in the ward.

XVI Post Mortem Equipments


(To be provided if facilities are available)
S. 31-50 bedded Sub
No. Name of the Equipment District Hospital
1 Mortuary table (Stainless steel)* 2
2 P.M. equipments (list) 3
3 Weighing machines (Organs) 1
4 Measuring glasses (liquids) 2
5 Aprons* 10
6 PM gloves ( Pairs )* 10
7 Rubber sheets* 4
8 Lens 1
9 Spot lights 1
10 Cold box for preserving dead body 1(Desirable+1)
* To be provided as per need.

54
XVII Linen
31-50 Bedded Sub
S. No. Name of the Equipment District Hospital
1 Bedsheets 200(Desirable+100)
2 Bedspreads 300
3 Blankets Red and blue 20(Desirable+80)
4 Patna towels 100
5 Table cloth 30
6 Draw sheet 30
7 Doctor's overcoat 20
8 Hospital worker OT coat 25
9 Patients house coat (for female) 150
10 Patients Pyjama (for male) Shirt 100(Desirable+50)
11 Over shoes pairs As per requirement
12 Pillows 60
13 Pillows covers 150
14 Mattress (foam) Adult 50
15 Paediatric Mattress 6
16 Abdominal sheets for OT 30
17 Pereneal sheets for OT 30
18 Leggings 20
19 Curtain cloth windows and doors As per requirement
20 Uniform / Apron As per requirement
21 Mortuary sheet 10
22 Mats (Nylon) 30
23 Mackin tosh sheet (in meters) 100
24 Apron for cook As per requirement

XVIII Teaching Equipments


S. Name of the Equipment 31-50 Bedded Sub
No. District Hospital
1 Slide Projector 1
2 Laptop* 1(Desirable)
3 O.H.P / LCD * 1
4 Screen 1
5 White / colour boards 1
6 Television colour 1
7 Tape Recorder ( 2 in 1 )* 1
8 VCD Player 1
9 Radio 1
10 1.Desk top computer( with color monitor, 1
CPU, UPS, laser printer & computer table)
11 Resuscitation Training Mannequins 1
12 Library with Books, Training CD and
Potocols

55
* To be provided as per need.
XIX Administration
S. 31-50 Bedded Sub
No. Name of the Equipment District Hospital
Computer with Modem with UPS,
1 Printer with Internet Connection 2
2 Xerox Machine 1
3 Intercom (15 lines)* 1
4 Fax Machine 1
5 Telephone 1
6 Public Address System* 1

* To be provided as per need.

XX Refrigeration & AC
S. 31-50 Bedded Sub
No. Name of the Equipment District Hospital
1. Refrigerator 165 litres 2
2. Blood Bank Refrigerator 1
3. ILR 1
4. Deep Freezer 1
5. Coolers* As per requirement
6. Air conditioners 3

* One cooler per 8 beds in the wards.

XXI Hospital Plants


S. 31-50 Bedded Sub District
No. Name of the Equipment Hospital
1 Generator 40 / 50 KV 1
4 Portable 2.5 KV 1

XXII Hospital Fittings & Necessities


S. Name of the Equipment 31-50 Bedded Sub District
No. Hospital
1 Ceiling Fans* 20
2 Exhaust Fan* 6
3 Pedestal Fan* 1
4 Wall Fan* 1

56
5 Hotwater geiser* 1
6 Fire extinguishers* 1
7 Sewing Machine* 1
8 Lawn Mover* 1
9 Aqua guard* 4
10 Emergency trauma set* 1
11 Tube lights* 30
12 Drinking Water Fountain* 1

* To be provided as per need.

XXIII Transport
S. 31-50 Bedded Sub District
No. Name of the Equipment Hospital
1 Ambulance 1
2 Pickup vehicles Maruti (Omni) 1

57
10. Laboratory Services: Following services will be ensured, for advanced
diagnostic tests, a list of National Reference Laboratories has been provided as
annexure:

S. No. Speciality Diagnostic Services / Tests

I. CLINICAL PATHOLOGY
a. Haematology Haemoglobin estimation
Total Leucocyte count
Differential Leucocyte count
Absolute Eosinophil count
Reticulocyte count
Total RBC count
E.S.R.
Bleeding time
Clotting time
Peripheral Blood Smear
Malaria/Filaria Parasite
Platelet count
Packed Cell volume
Blood grouping
Rh typing
Blood Cross matching

b. Urine Analysis Urine for Albumin, Sugar,


Deposits, bile salts, bile pigments,
acetone, specific gravity, Reaction
(pH)
c. Stool Analysis Stool for Ova cyst (Eh)
Hanging drop for V. Cholera
Occult blood
II. PATHOLOGY
b. Sputum Sputum cytology

58
S. No. Speciality Diagnostic Services / Tests

III. MICROBIOLOGY
Smear for AFB, KLB (Diphtheria)
Grams Stain for Throat swab, sputum etc.
KOH study for fungus
IV. SEROLOGY RPR Card test for syphillis
Pregnancy test (Urine gravindex)
WIDAL test
Rapid Test for HIV, HBs Ag, HCV

S. No. Speciality Diagnostic Services / Tests

V. BIOCHEMISTRY Blood Sugar


Blood urea
Serum bilirubin
Liver function tests
Kidney function tests
Blood Cholesterol
Blood uric acid

Sl. No. Speciality Diagnostic Services / Tests

VI. CARDIAC a) ECG


INVESTIGATIONS
VII. OPHTHALMOLOGY a) Refraction by using Snellen's chart
Retinoscopy
Ophthalmoscopy
Syringing
Tension
IX. RADIOLOGY a) Xray for Chest, Skull, Spine,
Abdomen, bones
e) Dental Xray
f) Ultrasonography*

* In consonance with PC and PNDT Act.

59
11. ALLOCATION OF BED STRENGTH AT VARIOUS LEVELS:

It should be done as per local needs.

REQUIREMENTS FOR OPERATION THEATRE

Sub District Hospital


S. No Item
31-50 Bedded
1 Emergency OT/FW OT 1
2 Ophthalmology /General Surgery 1

12. LIST OF MEDICINES / INSTRUMENTS / EQUIPMENTS /LAB


REAGENTS / OTHER CONSUMABLES AND DISPOSABLES FOR SUB-
DISTRICT/DISTRICT HOSPITALS.

Sr. No Name of the item


A) Analgesics/Antipyretics/Anti Inflamatory
1. Tab.Aspirin 300mg
2. Tab.Paracetamol 500mg
3. Inj.Diclofenac sodium
4. Tab.Diclofenac sod
5. Tab.Dolonex DT 20mg
6. Tab.Ibuprofen
B) Chemotherapeutics
7. Inj.Crystalline penicillin 5 lac unit
8. Inj. Benzathene Peniciline
9. Inj.Fortified procaine pen 4 lac
10. Inj.Ampicillin 500mg
11. Inj. Cloxacillin
12. Inj.Gentamycin 40mg/2ml vial
13. Inj.crystalline penicillin 10 lac unit
14. Cap.Ampicillin 250mg
15. Cap.Tetracycline 250mg
16. Tab.Trimethoprim+Sulphamethazol ss
17. Tab.Ciprofloxacin 250mg
18. Tab.Ciprofloxacin 500mg
19. Inj.Ciprofloxacin 100ml
20. Tab.Erythromycin 250mg
21. Tab.Erythromycin 500mg

60
22. Syrup Cotrimoxazole 50ml
23. Syrup Ampicillin 125mg/5ml 60ml
24. Inj.Cefoperazone 1Gm (Desirable)
25. Inj.cefotaxime 500mg (Desirable)
26. Tab.Norfloxacin 200mg
27. Inj Ceftriaxone
28. Diazepam Inj. IP
29. Dexamethasone Sodium Phosphate inj. IP
30. Aminophylline Inj. BP
31. Adrenaline Bitartrate Inj. IP
32. Ringer Lactate
33. Doxycycline Hydrochloride
34. Vit. K3 (Menadione Inj.) IP
35. Phenytoin
36. Inj. Gentamycin
37. Water for injection
38. Inj. Lasix
39. Inj. Phenobarbitone
40. Inj. Quinine
41. Inj. Chloramphenicol
42. Inj. Calcium Gluconate
43. Nebulisable Salbutamol nebusol solution (to be used with nebuliser)
44. Inj. Dopamine
45. Tab.Norfloxacin 400mg
46. Tab.Ofloxacin 200mg
47. Inj.Vionocef(Ceffixime)250mg (Desirable)
48. Inj.Amikacin sulphate 500mg
49. Inj.Amikacin sulphate 100mg
50. Cap.Cefodroxyl 250mg (Desirable)
51. Inj.Amoxycillin 500mg
C) Anti Diarrhoeal
52. Tab.Metronidazole 200mg
53. Tab. Metronidazole 400mg
54. Syrup. Metronidazole
55. Tab. Furazolidone 100mg
56. Tab. Diolaxanide Fuzate
57. Tab. Tinidazole 300mg
D) Dressing Material/Antiseptic lotion
58. Povidone Iodine solution 500ml
59. Phenyl 5litr jar(Black Phenyl)
60. Benzalkonium chloride 500ml bottle

61
61. Rolled Bandage a)6cm
b)10cm
c)15cm
62. Bandage cloth(100cmx20mm) in Than
63. Surgical Guaze (50cmx18m) in Than
64. Adhesive plaster 7.5cm x 5mtr
65. Absorbent cotton I.P 500gm Net
66. P.O.P Bandage a) 10cm
b)15cm
67. Framycetin skin oint 100 G tube
68. Silver Sulphadiazene Oint 500gm jar
69. Antiseptic lotion containing :
a) Dichlorometxylenol 100ml bot
b) Haffkinol 5litre jar
70. Sterilium lotion
71. Bacillocid lotion
72. Infusion fluids
73. Inj. Dextrose 5% 500ml
74. Inj. Dextrose 10% 500ml bottle
75. Inj. Dextrose in Normal saline 500ml bt
76. Inj. Normal saline (Sod chloride) 500ml
77. Inj.Ringer lactate 500ml
78. Inj.Mannitol 20% 300ml
79. Inj.Water for 5ml amp
80. Inj.Water for 10ml amp
81. Inj.Dextrose 25%100ml bot
82. I.V.Metronidazole 100ml
83. Inj.Plasma Substitute 500ml bot
84. Inj.Lomodex
F) Other Drugs & Material
85. Disposable Syringes 2ml
5ml
10ml
20ml
86. Hypodermic Needle (Pkt of 10 needle)
a)No.19
b)No.20
c)No.21
d)No.22
e)No.23
f)No.24

62
g)No.25
h)No.26
87. Scalp vein sets no a)19
b)20
c)21
d)22
e)23
f)24
g)25
h)26
88. Gelco all numbers
89. Tab.B.Complex NFI Therapeutic
90. Tab.Polyvitamin NFI Therapeutic
91. Inj.Dexamethasone 2mg/ml vial
92. Inj.Vitamin B Complex 10ml
93. Inj.B12 Folic acid
94. Surgical Gloves a)6 "
b)6.1/2"
c)7"
d)7.5"
95. Catgut Chromic a)1 No.
b)2 No.
c)1-0 No
d)2-0 N0
e)8-0
96. Vicryl No.1
97. Sutupak 1,1/0,2,2/0
98. Prolene
99. X Ray film 50 film packet(in Pkt) size
a)6.1/2x8.1/2"
b)8"x10"
c)10"x12'
d)12"x15"
100. Fixer
101. Developer
102. CT Scan film
103. Ultrasound scan film
104. Dental film
105. Oral Rehydration powder 27.5g
106. Ether Anaesthetic 500ml
107. Halothane

63
G) Eye Drops
108. Sulphacetamide eye drops 10% 5ml
109. Framycetin with steroid eye drops 5ml
110. Framycetin eye drops 5ml
111. Ciprofloxacin eye /ear drops
112. Gentamycin eye drops
113. Local antibiotic steroid drops
114. Pilocarpine Nitrate 2%
115. Timolol 0.5%
116. Homatropine 2%
117. Tropicamide !%
118. Cyclomide 1%
119. Wax dissolving ear drops
120. Antifungal (Clotrimazole) ear drops
Antiallergic+ Decongestant combination eg. Chlorphenarmine +Pseudoephederine
121. /Phenylephrine
122. Oxmetazoline/Xylometazoline nasal drops
H) Other Material
123. Rubber Mackintosch Sheet in mtr
124. Sterile Infusion sets(Plastic)
125. Antisera I) A 5ml
II)B 5ml
III)D 5ml
IV)AB 5ml
126. Inj.MethylErgometrine 0.2mg/amp
127. Inj.Streptokinase 7.5lac vial
128. Inj.Streptokinase 15lac vial
129. Inj.PAM(Desirable)
130. Tab.Antacid
131. ARS
132. Syp.Antacid
133. Inj.Rabipur
134. Inj.Ranitidine 2ML
135. Tab.Ranitidine
136. Tab.Omeprazole
137. Cough syrup 5litre Jar
138. Cough syrup with Noscapine 100ml
139. Coir Mattress
140. Inj.Lignocaine 1%
141. Inj.lignocaine 2%
142. Inj.Lignocaine 5%

64
143. Inj. Hylase (Hyaluronidase)
144. Inj.Marcaine
145. Inj. Diazepam
146. Inj. Salbactum+Cefoperazone2Gm
147. Inj. Amoxycillin with clavutanite acid 600mg
148. Cap.Amoxycillin250+cloxacillin 250
149. Inj. Cefuroxime 250/750 (Desirable)
150. Tab. Pefloxacin 400mg (Desirable)
151. Tab. Gattifloxacin 400mg (Desirable)
152. Tab. Valdecoxib 20mg (Desirable)
153. Tab. Atrovastatin 10mg
154. Sy. Himalt-X (Desirable)
155. Sy. Protein (Provita) (Desirable)

I) Antibiotics and Chemotherapeutics


1. Tab.Chloroquine phosphate 250mg
2. Inj.Chloroquine phosphate
3. Inj.Quinine
4. Tab.Erythromycine Esteararte 250mg
5. Syp.Erythromycine
6. Tab.Phenoxymethyl Penicillin125mg
7. Cap.Rifampicin
8. Tab.Isoniazid 100mg
9. Tab.Ethambutol 400mg
10. Cap.Neomycin
11. Inj.Benzathine penicillin 12lac
12. Cap. Amoxycilline 500 mg
13. Cap. Amoxycilline 250 mg
J) Antihistaminics/anti-allergic
14. Inj.Pheniramine maleate
15. Tab.Diphenhydramine (eqv.Benadryl)
16. Tab.Cetrizine
17. Tab.Chlorpheniramine maleate 4mg
18. Tab.Diethylcarbamazin
19. Tab. Beta-histidine 8 mg (Desirable)
20. Tab. Cinnarazine 25 mg
K) Drugs acting on Digestive system
21. Tab.Cyclopam
22. Inj.Cyclopam
23. Tab.Bisacodyl
24. Tab.Perinorm

65
25. Inj.Perinorm
26. syrup.Furazolidone
27. Inj.Prochlorperazine(Stemetil)
28. Tab.Piperazine citrate
29. Tab.Mebendazole 100mg
30. Syp.Mebendazole
31. Sy.Piperazine Citrate
32. Sy.Pyrantel Pamoate
33. Tab.Belladona
L) Drugs related to Hoemopoetic system
34. Tab.Ferrous sulphate200mg
35. Inj.Iron Dextran/Iron sorbitol
M) Eye oint
36. Chloramphenicol eye oint & applicaps
37. Chloramphenicol + Dexamethsone oint
38. Gentamycin eye/ear drops
39. Dexamethasone eye drops
40. Drosyn eye drops
41. Atropine eye oint
N) Drugs acting on Cardiac vascular system
42. Inj.adrenaline
43. Inj.atropine sulphate
44. Inj.Digoxine
45. Tab.Digoxine
46. Inj.Mephentine
47. Tab.Atenolol
48. Tab.Isoxuprine
49. Inj.Duvadilan
50. Tab.Methyldopa
51. Tab.Isosorbide Dinitrate(Sorbitrate)
52. Tab.Propranolol
53. Tab.Verapamil(Isoptin)
54. tab.Enalepril2.5/5mg
55. Tab.Metoprolol
56. Hydrochlorthiazide 12.5, 25 mg
57. Tab Captopril
58. Tab Clopidogrel
59. Glyceryl Trinitrate Inj
60. Carbamazepine tabs, syrup

O) Drugs acting on Central/peripheral Nervous system

66
61. Inj.Pentazocine (Fortwin)
62. Inj.Pavlon 2ml amp
63. Inj.Chlorpromazine 25mg(like Largactil)
64. Inj.Promethazine Hcl Phenergan
65. inj.Pethidine
66. Inj.Diazepam 5mg
67. Tab.Haloperidol
68. Inj.Haloperidol
69. Tab.Diazepam 5mg
70. Tab.Phenobarbitone 30mg
71. Tab.Phenobarbitone 60mg
72. Tab.Largactil 25mg
73. Tab.Pacitane
74. Tab.Surmontil
75. Tab. Chlorpromazine 100 mg
76. Tab. Risperidone2 mg
77. Inj. Promethazine 50 mg
78. Tab. Imipramine 75 mg
79. Inj. Fluphenazine 25 mg
80. Tab. Lorazepam 2 mg
81. Tab. Diphenylhydantoin 100 mg
82. Tab. Lithium Carbonate 300 mg
83. Tab. Carbamazepine 200 mg
84. Cap. Fluoxetine 20 mg
85. Tab. Olanzapine 5 mg
86. Syrup.Phenergan
87. Syrup Paracetamol
88. Ethyl chloride spray
89. Lignocaine oint
90. Gentamycin eye/ear drops
91. Betnesol-N/Efcorlin Nasal drops
P) Drugs acting on Respiratory system
92. Inj.Aminophylline
93. Tab.Aminophylline
94. Inj.Deriphylline
95. Tab.Deriphylline
96. Tab.Salbutamol 2mg
97. Syrup Tedral
98. Syrup.Salbutamol
Q) Antiseptic Ointment
99. Furacin skin oint

67
100. Framycetin skin oint
R) Drugs acting on UroGenital system
101. Tab.Frusemide 40mg
102. Inj.KCL
103. Liquid KCL
104. Tab.Pyridicil
105. Inj.Frusemide

S) Drugs acting on Uterus and Female Genital Tracts


106. Inj.Pitocin
107. Inj.Prostodin
108. Tab. Mesoprostol
109. Tab.Duvadilan
110. Inj. Duvadilan
111. Tab.Methyl Ergometrine
112. Tab.Primolut-N
113. Haymycin vaginal tab
114. Inj. Magnessium Sulphate
115. Inj.Ethacredin lact(Emcredyl)
T) Hormonal Preparation
116. Inj.Insulin Rapid
117. Insulin lente Besal
118. Inj. Cry Insulin
119. Inj. Mixtard
120. Inj. Testesterone plain 25mg
121. Testesterone Depot 50mg
122. Tab. Biguanide
123. Tab. Chlorpropamide 100mg
124. Tab. Prednisolone 5mg
125. Tab. Tolbutamide 500mg
126. Tab. Glibenclamide
127. Tab. Betamethasone
U) Vitamins
128. Inj.Vit "A"
129. Inj.Cholcalciferol16lac
130. Inj.Ascorbic acid
131. Inj.Pyridoxin 50mg
132. Inj.Vit K
133. Tab.Vit "A" & "D"
134. Tab.Ascorbic acid 100mg
V) Other drugs

68
135. Inj.Antirabies vaccine
136. Inj.Antisnake venom
137. Inj.AntiDiphtheria Serum (Desirable)
138. Inj.Cyclophosphamide
139. Inj.Sodabicarb
140. Inj.Calcium Gluconate
141. Tab.Calcium lactate
142. Tr.Iodine
143. Tr.Benzoin
144. Glcial acetic caid
145. Benedict solution
146. Caster oil
147. Liquid paraffin
148. Glycerine
149. Glycerine Suppositories
150. Turpentine oil
151. Potassium Permangnate
152. Formaldehyde
153. Dextrose Powder
154. Methylated spirit
155. Cotrimazole lotion
156. Cotrimazole cream
157. Tab.Theophylline
158. ECG Roll
159. Burnion Oint
160. Flemigel APC Ointment
161. Syp.Himobin
162. APDYL Cough & Noscopin
163. Tab. Septilin
164. Tab. Cystone
165. Tab. Gasex
166. Syp. Mentat (Desirable)
167. Oint. Pilex
168. Rumalaya Gel
169. Pinku Pedratic Cough Syp.

Vaccines Drugs and Logistics


170. Vaccines BCG, DPT, OPV, Measles, TT, Hep B*, JE* and other
vaccines if any as per GOI guidelines
171. AD syringes AD syringes (0.5 ml & 0.1 ml) - need based
172. Reconstitution syringes Reconstitution syringes(5ml) - need based
173. Red Bags Red Bags for waste management

69
174. Black bags
175. Vial Oppener Need Based
176. Vitamin A Vitamin A Syrup
177. Paracetamol Paracetamol Syrup
178. Emergency Drug Kit Inj. Adrenaline, Inj. Hydrocortisone, Inj.
Dexamethasone, Ambu bag (Paediatric), Disposable
2ml and 5ml syringes, Needles( Size 24, 22, 20)
* Hep B wherever implemented under UIP and JE in select districts
(W) Others
1. Tab.Liv52
2. Syrup Liv52
3. Cap. Doxycycline 100mg
4. Inj. Heparin sod.1000IU
5. Tab. Dipyridamol (Like Persentine)
6. Inj. Dopamine
7. Tab. Glyceryl Trinitrate
8. Tab.Amitryptilline
9. Tab.trifluoperazine(1mg)
10. Tab.Nitrofurantine
11. Inj.Valethemide Bromide(Epidosyn)
12. Inj.Isolyte-M
13. Inj.Isolyte-P
14. Inj.Isolyte-G
15. Cap.Cephalexin 250mg
16. Tab.Taxim
17. Inj.Metaclopramide
18. Tab.Folic acid
19. Inj.Lignocaine Hcl 2%
20. Inj.Nor adrenaline
21. Betadine lotion
22. Tab.stilboesteral
23. Inj.Pyridoxine
24. Hydrogen peroxide
25. Inj.magnesium sulphate
26. Benzyl Benzoate
27. GammaBenzene Hexachloride
28. Gum Paint
29. Inj.Tetglobe
30. Inj.Paracetamol
31. Pilocarpine eye drops 1%
32. Sy.Orciprenaline
33. Suturing needles (RB,Cutting)

70
34. Inj.Calcium pantothernate
35. Inj.Xylocaine 4% 30 ml
36. Halothane
37. Mixture Alkaline
38. Inj. Phenabarbitone 200mg
39. Inj. B12 (Cynacobalamine)
40. Neosporin, Nebasuef , Soframycin Pow
41. Magnasium Sulphate Powder
42. Furacin Cream
43. Xylocaine jelly
44. Formaldehyde Lotion
45. Cetrimide 100ml bott 3.5%, 1.5% 1
46. Bacitrium powder 10mg botts
47. Bleaching Powder 5 Kg Pkts(ISI Mark)
48. Ether Solvent
49. Sodium Hypochloride Sod. 5 ltrs/1 ltrs
50. Inj. Diphthoria antition ADS)10000I.U(Desirable)
51. Inj. Gas gangrene Antitoxin(AGGS)10000(Desirable)
52. Inj. Hydroxy Progesterone500mg/2ml
53. Inj. Methyl Prednisolon 500mg vial
54. Inj. Multivitamin I.V
55. Inj. Potassium chloride
56. Inj. Quinine Dihydrochloride
57. Tetanus Antitoxin 10000 I.U
58. Inj. Tetanus Toxoid 5ml vial
59. Inj. Theophylline Etophylline
60. Inj. Vitamin A
61. Tab. Ferrous sulphate200mg+Folic acid
62. Tab. Ferrous sulphate 300mg
63. Tab. Griseofulvin125mg
64. Tab. Phenobarbitone 30mg
65. Tab. Phenobarbitone 60mg
66. Tab. Pyridoxin 10mg
67. Tab. Thyroxine sod 0.1mg
68. Warfarin sod 5mg
69. Tab. Alprazolam 0.25mg
70. Tab. Amlodipine 5mg
71. Tab. Amlodipine 10mg
72. Tab. Nefidipine 20mg
73. Tab. Nefidipine 30mg
74. Tab. Riboflavin 10mg

71
75. Syp. Ferrous Gluconate 100ml bottle
76. Cream Fluconozole 15gm tube
77. Sus. Furazolidone
78. Oint. Hydrocortisone acetate
79. Syp. Isoniazid 100mg/5ml 100ml bot
80. Liquid paraffin
81. Linctus codein 500ml bot
82. Cream Miconozole 2% 15gm tube
83. Syp.Nalidixic acid
84. syp.Norfloxacin
85. Phenylepinephrine eye drops
86. Pilocarpine eye drops 2%
87. Syp.Pottassium chloride 400ml bot
88. Syp.Primaquine
89. Suspension Pyrantel pamoate
90. Sus Rifampicin
91. Syp.Salbutamol 100ml bot
92. Syp.Theophylline 100ml
93. Syp.Vitamin B.Complex
94. Vit D-3 Granules
95. Opthalmic & ear drops
96. Glycerine Mag sulphate ear drops
97. Pilocarpine eye drops 4%
98. Oint Acyclovir 3% 5gm tube
99. Benzyl Benzoate emulsion 50ml bot
100. Oint.Betamethasone
101. Cream Clotrimazole skin 1% 15gm
102. Oint Dexamethasone 1%+ Framycetin
103. oint contain clotrimazole+Genta+Flucon
104. Oint Flucanazole 10 mg
105. Cream Framyctin 1% 20gm tube/100gm
106. Lot.Gamabenzene hexachloride1% bt
107. Glycerine Suppository USP 3gm bott/10
108. Cream Nitrofurazone 0.2% jar of 500g
109. Oint Silversulpadiazene 1% 25g
110. AIDS Protective kit
111. STI syndromic drug kit
112. Chemotherapy Drugs
113. Hearing Aids (Behind the Ear Type) 200 per district per year
Surgical Accessories for Eye
114. Green Shades

72
115. Blades (Carbon Steel)
116. Opsite surgical gauze (10x14 cm.)
8-0 & 10-0 double needle suture
Visco elastics from reputed firms
Spectacles
For operated Cataract Cases (after refraction)
For Poor school age children with refractive errors
117. EAR DROP
118. Wax Solvent Eardrops
119. Antifungal 2 Anti biotic Ear Drops (Clohoaimazole PMB)
120. Stewed & AB Ear Drops

LIST OF ESSENTIAL DRUGS FOR FRU/CHC

DRUG KIT FOR SICK NEW BORN & CHILD CARE - FRU/CHC

1. Diazepam Inj. IP 5 mg per ml Inj. 2 ml Ampoule 60 Ampoules


For per rectally use
only.
2. Inj. Cefotaxime 1 gm Vial 100 Vial
3. Inj. Cloxacillin 1 gm Vial 100 Vial
4. Dexamethasone 4 mg per ml Inj. 2 ml ampoule 300 Ampoules
Sodium
Phosphate inj. IP
5. Aminophylline 25 mg per ml Inj. 10 ml Ampoule 60 Ampoules
Inj. BP
6. Adrenaline 1 mg per ml Inj. 1 ml Ampoule 60mpoules
Bitartrate Inj. IP (1:1000
dilution)
7. Ringer Lactate 500 ml 500 ml plastic pouch 300 Pouches
8. Doxycycline dispersible Tablets 300 Tablets
Hydrochloride
9. Vit. K3 Inj. 10 mg per Inj. 1 ml ampoule 100Ampoules
(Menadione Inj.) ml
IP
10. Phenytoin 50 mg per ml Inj. 2 ml Ampoule 60 Ampoules
11. Dextrose Inj. IP 5% Inj. 500 ml plastic pouch 60 Plastic pouches
I.V. Solution
12. Inj. Gentamycin 10 mg/ml Ampoule 150Ampoules
13. Water for 2 ml/ 5 ml Ampoule 300Ampoules
injection
14. Inj. Lasix 20 mg/2ml 2 ml Ampoule 300Ampoule
15. Inj. 100mg/ml 2 ml Ampoule 60Ampoule

73
Phenobarbitone
16. Inj. Quinine 150 mg/ml 2 ml Ampoule 60 Ampoule
17. Normal Saline 500 ml 500 mg Plastic pouch 60 Plastic pouches
18. Inj. Ampicillin 500mg/ 5ml Vial 150 Vial
19. Inj. 1 gm/10 ml Vial 150 Vial
Chloramphenicol
20. Inj. Calcium 10% 10 ml Ampoule 60 Ampoules
Gluconate
21 Ciprofloxacin 100mg Tablet 500 tablets
dispersible
22 Nebulisable 15 ml 100 Nebuliser
Salbutamol equipment to be
nebusol solution provided with
(to be used with Nubulisable
nebuliser) Salbutamol
23. Inj. Dopamine 200 mg/5 ml Ampoule 20 Ampoule
24. Needles 23G 750
25. Disposable 1ml/2ml/5 ml 1ml-200
Syringe 2ml-500
5ml-500

13. Capacity Building

74
Training of all cadres of workers at periodic intervals is an essential component
of the IPHS for sub district hospitals. Both medical and paramedical staff should
undergo continuing medical education (CME) at intervals.

Sub District hospitals also should provide the opportunity for the training of
medical and paramedical staff working in the institutions below sub district level such as
skill birth attendant training and other skill development / management training.

14. Quality Assurance in Service Delivery


Quality of service should be maintained at all levels. Standard treatment
protocols for locally common diseases and diseases covered under all national
programmes should be made available at all sub district hospitals. All the efforts that are
being made to improve hardware i.e. infrastructure and software i.e. human resources
are necessary but not sufficient. These need to be guided by standard treatment protocols
and Quality Assurance in Service Delivery.

Quality Control

Internal Monitoring

Social audit through Rogi Kalyan Samities / Panchayati Raj Institutions

Medical Audit, Hospital Infection Control,Technical Audit, Financial Audit,


Disaster Preparedness Audit, Monitoring of Accessibility and equity issues, information
exchange.

External Monitoring

Monitoring by PRI / Rogi Kalyan Samities

Service / performance evaluation by independent agencies

District Monitoring Committees formed under NRHM shall monitor the


upgradation of Hospitals to IPHS. Annual Jansamvad may also be held as a
mechanism of monitoring.

Monitoring of laboratory

Internal Quality Assessment Scheme


External Quality Assessment Scheme

Record Maintenance

Computers have to be used for accurate record maintenance and with


connectivity to the District Health Systems, State and National Level.

75
15. Rogi Kalyan Samities (RKS) / Hospital Management Committee
(HMC)
Each sub district hospital should have a Rogi Kalyan Samiti / Hospital
Management Committee with involvement of PRIs and other stakeholders as per
the guidelines issued by the Government of India. These RKS should be
registered bodies with an account for itself in the local bank. The RKS / HMC
will have authority to raise their own resources by charging user fees and by any
other means and utilized the same for the improvement of service rendered by
the Sub District Hospital.

16. Citizen’s Charter


Each Sub District hospital should display a citizen’s charter for the sub
district hospital indicating the services available, user fees charged, if any, and a
grievance redressal system. A modal citizen’s charter is given in Annexure I

Annexure I

OUR MOTTO - SERVICE WITH SMILE

CITIZENS CHARTER

This charter seeks to provide a framework which enables our users to know:

• What services are available in this hospital;


• The quality of services they are entitled to;
• The means through which complaints regarding denial or poor quality of services
will be redressed.

Standards of Service:

• This is a Sub-district hospital;


• It provides medical care to all patients who come to the hospital;
• Standards are influenced by patients load and availability of resources;
• Yet we insist that all our users receive courteous and prompt attention.

Locations:

It is located on ………. road in front of …………

76
This hospital has-

Doctors: ………………… (including residents ………).


Nurses: …………………. (including supervisory staff).
Beds: …………………….

Doctors wear white aprons and nurses are in uniform.

All Staff member wear identity cards.

General Information

Enquiry, Reception and Registration Services:

This counter is functioning round the clock.


Location guide maps have been put up at various places in this hospital.
Colour coded guidelines and directional signboards are fixed at strategic points for
guidance.
Telephone enquiries can be made over telephone numbers:
……………………., & ……………………, Fax: ………………………..

Casualty & Emergency Services:

All Casualty Services are available round the clock.

• Duty Doctor is available round the clock.


• Specialist doctors are available on call from resident doctors.
• Emergency services are available for all specialities as listed in the OPD
Services.
• Emergency Operations are done in-

OT located on ………….. floor of ………… building.

Maternity OT
Orthopaedic Emergency OT
Burns and plastic OT
Main OT for Neurosurgery cases

Emergency Operation Theatre is functioned round the clock.

In serious cases, treatment/management gets priority over paper work like registration
and medico-legal requirements. The decision rests with the treating doctor.

OPD Services:

Various outpatient services available in the hospital are detailed below (as available):

77
OPD Place Time of Registration Time of OPD

General Medicine

Paediatrics

General Surgery

Obstetric & Gynec.

Eye

ENT

Skin

Psychiatry
Orthopaedics

Burns & plastics

Dental OPD

ISM Services:

Homeopathic

Ayurvedic

Any other

In OPDs specialists are available for consultation.

OPD services are available on all working days excluding Sundays and Gazetted
Holidays.

On Saturdays, the hospital functions from ……………. AM to …………….. PM.

Medical Facilities Not Available:

Organ Transplantation

………………………..

………………………..

78
………………………

Some specialities do not have indoor patients services:

Psychiatry

D-addiction

Dental

Geriatrics

Laboratory Services:

Routine: Laboratory Services are provided in the field of (as available):

• Bio-chemistry
• Microbiology
• Haematology
• Cytology
• Histopathology including FNAC

There is a Central Collection Centre for receiving and collecting various specimens for
testing. The timings for receiving specimens are 9:00 AM to 11:30 AM.

Emergency: Emergency Laboratory Services are available 24 hours for limited tests
relating to clinical pathology and bio-chemistry.

Radio Diagnostic Services:

Routine: These services include:

X-Rays

Ultrasound

Routine X-Rays are done from 9:00 AM to 1:00 PM. Registration is done from 9:00 AM
to 11:30 AM.

Ultrasound examination is done from 9:00 AM to 4:00 PM.

Emergency: Emergency X-Ray services are also available round the clock. CAT Scan
services are also available round the clock.

Indoor Patient Services:

79
There are total of ………. Wards providing free indoor patient care.

Emergency ward A admits emergency cases for medical problems.

Emergency ward B admits emergency cases for surgical problems.

There is a ------------- bedded Intensive Care Unit for care of seriously ill patients.

A --------------- bedded Intensive Coronary Care Unit takes care of heart patients
requiring intensive treatment.

In the Burns Department, there are ----------- bedded Intensive Care Unit to treat seriously
injured burns patients.

There are --------------- labour rooms for conducting deliveries round the clock.

------------------ nurseries provide necessary care to the newborns – normal as well those
born with disease.

All indoor patients receive treatment under the guidance and supervision during office
hours i.e. 9:00 AM to 4:00 PM.

Outside office hours, treatment is given by doctor on duty and specialists are available on
call.

Free diet is provided to all patients in the General Wards.

Every patient is given one attendant pass.

Visitors are allowed only between 5:00 PM to 7:00 PM.

Investigations like CAT Scan, Ultra Sound, Barium-meal, ECHO, TMT etc. are charged
for as per Government approved rates.

For poor patients, these charges can be waived partially or fully on the recommendation
of the H.O.D. by the Additional Medical Superintendent. In case of emergency CMO (on
duty) may waive off these charges.

A Staff Nurse is on duty round the clock in the ward.

Admitted patients should contact the Staff Nurse for any medical assistance they need.

Other Facilities:

80
Other facilities available include:

Cold Drinking Water

Wheel chairs and trolleys are available in the OPD and casualty.

----------- Ambulances are available to pick up patients from their places (on payment of
nominal charges) and also for discharged patients.

Mortuary Van is available on payment between 9:00 AM to 4:00 PM.

Public Telephone Booths are provided at various locations.

Stand-by Electricity Generators have been provided. Chemist Shops are available outside
the hospital. Canteen for patients and their attendants is available.

Lifts are available for access to higher floors.

Adequate toilet Facilities for use of patients and their attendants are available.

Complaints & Grievances:

There will be occasions when our services will not be upto your expectations.

Please do not hesitate to register your complaints. It will only help us serve you better.

Every grievance will be duly acknowledged.

We aim to settle your genuine complaints within 10 working days of its receipt.

Suggestions/Complaint boxes are also provided at various locations in the hospital.

If we cannot, we will explain the reasons and the time we will take to resolve.

Name, designation and telephone number of the nodal officer concerned is duly displayed
at the Reception.

Dr. …………………….
Designation…………….
Tele (O)……………… (R)………………….. (M)…………………..
Meeting Hours…………… to ……………………

Responsibilities of the Users:

The success of this charter depends on the support we receive from our uses.

81
Please try to appreciate the various constraints under which the hospital is functioning.

On an average more than --------- lacs patients attend the OPD annually and more than ---
---------- lacs patients are attended annually in the casualty and emergency wards.

Please do not inconvenience other patients.

Please help us in keeping the hospital and its surroundings neat and clean.

Please use the facilities of this hospital with care. Beware of Touts.

The Hospital is a “No Smoking Zone” and smoking is a Punishable Offence.

Please refrain from demanding undue favours from the staff and officials as it encourages
corruption.

Please provide useful feedback & constructed suggestions. These may be addressed to the
Medical Superintendent of the Hospital.

♦ “No Smoking Please”

♦ Don’t split here & there


♦ Use Dustbin
♦ Keep Hospital Clean
♦ Give regards to Ladies and Senior Citizens

82
Annexure – II

NATIONAL GUIDELINES ON HOSPITAL WASTE MANAGEMENT BASED


UPON THE BIO-MEDICAL WASTE (MANAGEMENT & HANDLING) RULES,
1998

The Bio-Medical Waste (Management & Handling) Rules, 1998 were notified
under the Environment Protection Act, 1986 (29 of 1986) by the Ministry of Environment
and Forest, Govt. Of India on 20th July, 1998. The guidelines have been prepared to
enable each hospital to implement the said Rules, by developing comprehensive plan for
hospital waste management, in term of segregation, collection, treatment, transportation
and disposal of the hospital waste.

1. POLICY ON HOSPITAL WASTE MANAGEMENT

The policy statement aims “to provide for a system for management of all
potentially infectious and hazardous waste in accordance with the Bio-Medical
Waste (Management & Handling) Rules, 1998 (BMW, 1998).

2. DEFINITION OF BIO-MEDICAL WASTE

Bio-Medical waste means any waste, which is generated during the diagnosis,
treatment or immunisation of human beings or animal or in research activities
pertaining thereto or in the production or testing of biological, including
categories mentioned in the Schedule of the Bio-Medical Waste (Management &
Handling) Rules, 1998.

3. CATEGORIES OF BIO-MEDICAL WASTE

Hazardous, toxic and Bio-Medical waste has been separated into following
categories for the purpose of its safe transportation to a specific site for specific
treatment. Certain categories of infectious waste require specific treatment
(disinfection/decontamination) before transportation for disposal. These
categories of bio-medical waste are mentioned as below:-

83
Category No.1- Human Anatomical Waste
This includes human tissues, organs, and body parts.
Category No.2- Animal Waste
This includes animal tissues, organs, body parts, carcasses, bleeding parts, fluid,
blood and experimental animal used in research; waste generated by veterinary
hospitals and colleges: discharge from hospital and animal houses.

Category No.3- Microbiology & Biotechnology Waste


This includes waste from laboratory cultures, stocks or specimens of
microorganism live or attenuated 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.

Category No.4- Waste sharps


This comprises of needles, syringes, scalpels, blades, glass, etc, that may cause
puncture and cuts. This includes both used and unusable sharps.

Category No.5- Discarded Medicines and Cytotoxic drugs


This includes wastes comprising of outdated, contaminated and discarded
medicines.

Category No.6- Soiled Waste


It comprises of item contaminated with blood, and body fluids including cotton,
dressings, soiled plaster casts, linens, beddings, other material contaminated with
blood.

Category No.7- Solid Waste


This includes wastes generated from disposable items, other than the waste
sharps, such as tunings, catheters, intravenous sets, etc.

84
Category No.8- Liquid Waste
This includes waste generated form laboratory and washing, cleaning,
housekeeping and disinfecting activities.

Category No.9- Incineration Ash


This consists of ash form incineration of any bio-medical waste.

Category No.10- Chemical Waste


This contains chemical used in production of biological and chemical used in
disinfection, insecticides, etc.

4.1 SEGREGATION OF WASTE

4.1 It should be done at the site of generation of bio-medical waste, e.g. all
patient care activity areas, diagnostic services areas, operation theatre
labour rooms, treatment rooms etc.

4.2 The responsibility of segregation should be with the generator of bio-


medical waste i.e. Doctors, Nurses, Technicians, etc.

4.3 The Bio-medical waste should be segregated as per categories applicable.

5. COLLECTION OF BIO-MEDICAL WASTE:

Collection of Bio-Medical Waste should be done as per Bio-Medical Waste


(Management & Handling) Rules, 1099 (Rule 6-Schedule II). The collection
bags and the containers should be labelled as per guidelines of Schedule III, i.e.,
symbols for bio-hazard and cytotoxic. A separate container shall be placed at
every pointy of generation for general waste to be disposed of through Municipal
Authority.

85
The trolleys which are used to collect hospital waste should be designed in such a
way that there should be no leakage or spillage of bio-medical waste while
transporting to designated site.

5.1 Type of container and colour for collection of Bio-medical waste:

Category Type of container Colour Coding


1. Human Anatomical Waste Plastic Bag Yellow
2. Animal Waste Plastic Bag Yellow
3. Microbiology & Bio-
Technology Waste Plastic Bag Yellow/Red
4. Waste sharp plastic bag, Puncture Proof Blue/White/Translucent
Container
5. Discarded Medicines Plastic Bag Black
& Cytotoxic Waste
6. Solid waste (plastic) Plastic Bag Yellow/Red
7. Solid Waste( Plastic) plastic Bag Blue/White
8. Liquid waste --------- --------
9. Incineration ash Plastic Bag Black
10. Chemical waste(solid) Plastic Bag Black

• Those plastics bags which contain liquid like blood, urine, pus, etc., should be put
into red colour bag for microwaving and autoclaving and other items should be
put into blue or white bag after chemical treatment and mutilation/shredding.

5.2 All the items sent to incinerator/deep burial (Cat. 1, 2, 3, 6) should be


placed in Yellow coloured bags.

5.3 All the Bio-medical waste to be sent for Microwave/Autoclave treatment


should be placed in Red coloured bags. (Cat. 3, 6 & &)

5.4 Any waste which is sent to shredder after


Autoclaving/Microwaving/Chemical treatment is to be packed in Blue/White
translucent bag.

86
5.5 Location of Containers:
All containers having different coloured plastic bags should be located at
the point of generation waste, i.e., near OT tables, injection rooms,
diagnostic service areas, dressing trolleys, injection trolleys, etc.

5.6 Labelling: All the bags/containers must be labelled bio-hazard or


cytotoxic with symbols according to the rules (Schedule III of Bio-
Medical Waste Rules, 1998)

5.7 Bags: It should be ensured that waste bags are filled up to three-fourth
capacity, tied securely and removed from the site of the generation to the
storage area regularly and timely.

5.8 The categories of waste (Cat. 4, 7, 8, & 10) which require pre-treatment
(decontamination/disinfection) at the site of generation such as plastic and
sharp materials, etc.. should be removed from the site of generation only
after pre-treatment.

5.9 The quantity of collection should be documented in a register. The colour


plastic bags should be replaced and the garbage bin should be cleaned
with disinfectant regularly.

6. STORAGE OF WASTE
Storage refers to the holding of Bio-medical waste for a certain period of
time at the site of generation till its transit for treatment and final disposal.

6.1 No untreated bio-medical waste shall be kept stored beyond a period of


48 hours.

87
6.2 The authorised person must take the permission of the prescribed
authority, if for any reason it becomes necessary to store the waste
beyond 48 hours.
6.3 The authorised person should take measures to ensure that the waste does
not adversely affect human health and the environment in case it is kept
beyond the prescribed limit.

7. TRANSPORTATION

7.1 TRANSPORTATION OF WASTE WITHIN THE HOSPITALS:


7.1.1 Within the hospital, waste routed must be designated to avoid the passage
of waste through patient care areas as far as possible.
7.1.2 Separate time schedules are prepared for transportation of Bio-medical
waste and general waste. It will reduce chances of their mix up.
7.1.3 Dedicated wheeled containers, trolleys or carts with proper label (as per
Schedule IV of Rule 6) should be used to transport the waste from the site
of storage to the site of treatment.
7.1.4 Trolleys or carts should be thoroughly cleansed and disinfected in the
event of any spillage.
7.1.5 The wheeled containers should be designed in such a manner that the
waste can be easily loaded, remains secured during transportation, does
not have any sharp edges and easy to cleanse and disinfect.

7.2 TRANSPORTATION OF WASTE FOR DISPOSAL OUTSIDE THE


HOSPTITAL.

7.2.1 Notwithstanding anything contained in the Motor Vehicles Act, 1988 or


rules there under. Bio-medical waste shall be transported only in such
vehicles as may be authorised for the purpose by the Competent
Authority.

88
7.2.2 The containers for transportation must be labelled as given in Schedule III
and IV of BMW, 1998.

8. TREATMENT OF HOSPITAL WASTE (Please see Rule 5. Schedule


V & VI)
8.1 General waste (Non-hazardous, non-toxic, non-infectious). The safe
disposal of this waste should be ensured by the occupier through Local
Municipal Authority.

8.2 Bio-Medical Waste

Monitoring of incinerator/autoclave/microwave shall be carried out once


in a month to check the performance of the equipment. One should ensure:
The proper operation & Maintenance of the incinerators/autoclave/
microwave.
Attainment of prescribed temperatures in both the chambers of
incineration while incinerating the waste.
Not to incinerate PVC plastic materials.
Only skilled persons operate the equipment.
Proper record book shall be maintained for the incinerator/autoclave/
microwave/shredder. Such record book shall have the entries of period of
operation, temperature/pressure attained while treating the waste quantity
for waste treated etc.
The scavengers shall not be allowed to sort out the waste.
Proper hygiene shall be maintained at, both, the waste treatment plant site
as well as the waste storage area.
Categories 4,7,8 & 10 should be treated with chemical disinfectant like 1%
hypochlorite solution or any other equivalent chemical reagent to ensure
disinfection.

8.2.1 Incineration: The incinerator should be installed and made operational as per
specifications under the BMW Rules, 1998 (schedule V) and an authorization
shall be taken from the prescribed authority for the management and handling of
bio-medical waste including installation and operation of treatment facility as per
Rule 8 of Bio-Medical Waste (Management & Handling) Rules 1998. Specific
requirement regarding the incinerator and norms of combustion efficiency and

89
emission levels etc. have been defined in the Bio-Medical Waste (Management &
Handling) Rules 1998. In case of small hospitals, Joint facilities for incineration
can be developed depending upon the local policies of the Hospital and feasibility.
The plastic Bags made of Chlorinated plastics should not be incinerated.

8.2.2 Deep burial: Standard for deep burial are also mentioned in the Bio-medical
waste (Management & handling) Rules 1998 (Schedule V). The cities having less
than 5 lakhs population can opt for deep burial for wastes under categories 1 &2.

8.2.3 Autoclave and Microwave Treatment: Standards for the autoclaving and
Microwaving are also mentioned in the Bio-medical Waste (Management &
Handling) Rules 1998 (Schedule-V). All equipments installed/ shared should meet
these specifications. The waste under category 3,4,6 & 7 can be treated by these
techniques.

8.2.4 Shredding: The plastics (IV bottle IV sets syringes, catheters, etc.) sharps
(needles, blades, glass, etc.) should be shredded but only after chemical
treatment/Microwaving/Autoclaving, ensuring disinfection.

8.2.5 Needles destroyers can be used for disposal of needles directly without chemical
treatment.

8.2.6 Secured landfill: The incinerator ash, discarded medicines, cytotoxic substances
and solid chemical waste should be treated by this option (cat. 5,9 & 10).

8.2.7 It may be noted there are multiple options available for disposal of certain
category of waste. The individual hospital can choose the best option depending
upon treatment facilities available.

8.2.8 Radioactive Waste: The management of the radioactive waste should be


undertaken as per the guidelines of BARC.

8.2.9 Liquid (Cat.8)& Chemical Waste (Cat.10):

Chemical waste & liquid waste from Laboratory: Suitable treatment,


dilution or 1% hypochlorite solution as required shall be given before
disposal.

90
The affluent generated from the hospital should conform to limits as laid
down in the Bio-medical Waste (Management & Handling) Rules, 1998
(Schedule V).
The liquid and chemical waste should not be used for any other purpose.
For discharge into public sewers with terminal facilities the prescribed
standard limits should be ensured.

9. SAFETY MEASURES
9.1 Personal Protection:
Hospital and health care authorities have to ensure that the following personal
protective equipment are provided.
i) Gloves
a) Disposable gloves
b) Latex surgical gloves
c) Heavy duty rubber gloves (uptil elbows) for cleaners.
ii) Masks: Simple and cheap mask to prevent health care workers against:
aerosols splashes and dust.
iii) Protective glasses.
iv) Plastic Aprons.
v) Special Foot wear, e.g., gum boots for Hospital waste Handler.

9.2 Immunization against Hepatitis B and Tetanus shall be given to all hospital staff.

9.3 All the generators of bio-medical waste should adopt universal precautions and
appropriate safety measures while doing therapeutic and diagnostic activities and
also while handling the Bio-Medical waste.

9.4 All the sanitation workers engaged in the handling and transporting should be
made aware of the risks involved in handling the bio-medical waste.
9.5 Any worker reporting with an accident/injury due to handling of biomedical waste
should be given prompt first aid. Necessary investigations and follow up action as
per requirement may be carried out.

9.2 Reporting Accident & Spillages

The procedure for reporting accidents (as per Form III of BMW Rules. 1998)
should be followed and the records should be kept. The report should include the
nature of accidents, when and where it occurred and which staffs were directly

91
involved. It should also show type of waste involved and emergency measures
taken.

10 TRAINING
10.1 All the medical professional must be made aware of Bio-medical waste
(Management & Handling) Rules, 1998.
10.2 Each and every hospital must have well planned awareness and training
programme for all categories of personnel including administrators to make them
aware about safe hospital waste management practices.
10.3 Training should be conducted category wise and more emphasis should be given
in training modules as per category of personnel.
10.4 Training should be conducted in appropriate language/medium and in an
acceptable manner.
10.5 Wherever possible audio-visual material and experienced trainers should be used.
Hand on training about colour coded bags, categorization and chemical
disinfections can be given to concerned employees.
10.6 Training should be interactive and should include, demonstration sessions,
Behavioural science approach should be adopted with emphasis on establishing
proper practices. Training is a continuous process and will need constant
reinforcement.

11. MANAGEMENT & ADMINISTRATION


11.1 The Head of the Hospital shall form a waste Management Committee under his
Chairmanship. The Waste Management Committee shall meet regularly to review
the performance of the waste disposal. This Committee should be responsible for
making hospital specific action plan for hospital waste management and for its
supervision, monitoring implementation and looking after the safety of the bio-
medical waste handlers.
11.2 The Heads of each hospital will have to take authorization for generation of waste
from appropriate authorities well in time as notified by the concerned State/U.T.
Government and get it renewed as per time schedule laid in the rules. The
application is to be made as per format given in form I for grant of authorization.
(Please See page 18 of notifies BMW Rules)
11.3 The annual reports accident reporting, as required under BMW rules should be
submitted to the concerned authorities as per BMW rules format ( Form II and
Form III respectively) (Please see pages 19 & 20 of BMW Rules).

92
Annexure III

Guidelines to Reduce Environmental Pollution due to Mercury waste

1. following guidelines will be used for management of Mercury waste

a. As mercury waste is a hazardous waste, the storage, handling, treatment


and disposal practices should be in line with the requirements of
Government of India’s Hazardous Waste (Management, Handling and
Trans-boundary Movement) Rules 2008, which may be seen at website
www.cpcb.nic.in.
b. Mercury-contaminated waste should not be mixed with other biomedical
waste or with general waste. It should not be swept down the drain and
wherever possible, it should be disposed off at a hazardous waste facility
or given to a mercury-based equipment manufacturer.
c. Precaution should be taken not to handle mercury with bare hands and as
far as possible; jewellery should be removed at the time of handling
mercury. After handling mercury, hands must be carefully washed before
eating or drinking. Appropriate personal protective equipment (rubber
gloves, goggles / face shields and clothing) should be used while handling
mercury.
d. Mercury-containing thermometers should be kept in a container that does
not have a hard bottom. Prefer a plastic container to a glass container, as
the possibility of breakage will be less.
e. In case of breakage, cardboard sheets should be used to push the spilled
beads of mercury together. A syringe should be used to suck the beads of
mercury. Mercury should be placed carefully in a container with some
water. Any remaining beads of mercury will be picked up with a sticky
tape and placed in a plastic bag, properly labeled.

2. Reporting formats must be used to report and register any mercury spills /
leakages.
3. Hospitals and health centres should work to create awareness among health
workers and other stakeholders regarding the health and safety hazards of
mercury.

93
Annexure - IV
REFERRAL LABORATORY NETWORKS

Referral Laboratory Network for Advanced diagnostic facilities

IDSP Level - 4 Labs


IDSP
Level – 5
Central South North South
East Zone Labs
Zone Zone Zone Zone

Advance Diagnostic Facilities

Bacterial diagnosis

Enteric CMC PGIMER RMRC KEM NICED &


bacteria: Vellore Chandigarh Dibrugarh, Mumbai, NICD
Vibrio Trivandrum AIIMS Cuttack AFMC
cholerae,
Medical Delhi Medical Pune
Shigella, College CRI College
Salmonella
Kasauli

Streptococcus Indore St. John VP. Chest - BJ MC CMC


pyogenes and S Medical Medical University Vellore
pneumoniae College College, of Delhi
Bangalore

C.diphtheriae BHU CMC, NICD, STM, AFMC, VP Chest


Vellore Delhi Kolkata Pune Institute,
Delhi

Neisseria SN State PH PGIMER - Surat CMC


meningitidIs Medical Lab Chandigarh Medical Vellore &
and N. College, Trivandrum College PGIMER
gonorrheae Agra Chandigarh

Staphylococcus BHU MGR Maulana STM, AFMC, NICD,


Medical Azad Kolkata Pune Delhi
University Medical
College,
Delhi

94
Tuberculosis State TB Demonstration & Training Centre (for all zones) NTI, TRC
ICGEB, Delhi

Leptospirosis DRDE Virology AIIMS RMRC, BJMC RMRC


Institute, IVRI Bubaneswar Port Blair
Allepey &
Tamil Nadu Dibrugarh
University,
Chennai
VCRC,
Pondicherry

Viral Diagnosis

Enteric viruses DRDE CMC, AIIMS & NICED - EVRC,


Vellore Villupuram Kolkata Mumbai,
Chest NIV & NICD
Institute

Arboviruses DRDE CMC, AIIMS & NICED - NIV


Vellore NICD Delhi Kolkata
Chest
Institute

Myxoviruses DRDE CMC, AIIMS & NICED - NIV, HSADL


Vellore NICD Delhi Kolkata Bhopal
Chest
Institute

Hepatitis viruses DRDE CMC, AIIMS NICED - NIV


Vellore ICGEB, Kolkata
Delhi

Neurotropic viruses DRDE CMC, AIIMS & - - NIV


Vellore NICD Delhi NIMHANS

HIV DRDE CMC, AIIMS - - NARI, NICD


Vellore & NACO
ICGEB,
Delhi

95
Parasitic Diagnosis

Malaria All State Public Health Laboratories MRC, Delhi


ICGEB, Delhi

Filaria All State Public Health Laboratories NVBDCP,


Delhi VCRC
Pondicherry

Zoonoses

Dengue DRDE VCRC, AIIMS NICED NIV NIV


Pondicherry
ICGEB,
Institute of Delhi
Virology,
Aleppey

JE DRDE CRME, AIIMS NICED NIV NIV /NICD


Madurai &
NIMHANS
VCRC,
Pondicherry

Plague DRDE NICD NICD, - Haffikins NICD,


Bangalore Delhi Institute Delhi

Rickettsial diseases DRDE CMC, - - AFMC NICD


Vellore
IVRI

Others of Public Health Importance

Anthrax DRDE CMC, IGIB NICED, BJMC NICD


Vellore Calcutta
IVRI

96
Microbial water NEERI, CMC PGIMER RMRC, KEM NICED &
quality Nagpur Vellore, Chandigarh Dibrugarh, Mumbai, NICD
monitoring Trivandrum AIIMS Cuttack HAFFKIN'
s,
Medical Delhi Medical
Mumbai
College College
CRI AFMC Pune
Kasauli

Unknown pathogens Other laboratories to perform support NIV, NICD,


functions HSADL

Outbreak investigation Medical Colleges and state public NICD, NIV,


support health laboratories as L3/ L4 NICED,
VCRC

Laboratory data Medical Colleges, state public health NIV, NICD


management laboratories and all the L4 & L5
laboratories (in their area of expertise)

Capacity building All the L4 & L5 laboratories (in their NIV, NICD
area of expertise)

Quality assurance All the L4 & L5 laboratories (in their CMC, TRC,
area of expertise) NTI, AFMC,
NARI,
RMRC,Port
Blair NIV,
NICD

Quality control of All the L4 & L5 laboratories (in their CMC, TRC,
reagents & kits area of expertise) NARI,
evaluation RMRC,Port
Blair NIV,
NICD, BJMC,

97
NICED

Production & supply of - DRDE, NIV,


reagents/ kits/ biological/ IVRI, NICED,
standard reference NICD,MRC,Delhi
materials AFMC, Pune
NARI
TRC, Chennai
RMRC, Port Blair

Biosafety & bio- Other laboratories to perform support HSADL,


containment function NIV/MCC,
DRDE,
NICD

98
Annexure V

New Born Care Facilities at SDH

Newborn Corner in OT/ Labour Room

Delivery rooms in Operation Theatres (OT) and in Labour rooms are required to have
separate resuscitation space and outlets for newborns. Some term infants and most
preterm infants are at greater thermal risk and often require additional personnel,
equipment and time to optimize resuscitation. An appropriate resuscitation/stabilization
environment should be provided as provision of appropriate temperature for delivery
room resuscitation of high-risk preterm infants is vital to their stabilization.

Services at the Corner

This space provides an acceptable environment for most uncomplicated term infants, but
may not support the optimal management of newborns who may require referral to
SNCU. Services provided in the Newborn Care Corner are;

• Care at birth
• Resuscitation
• Provision of warmth
• Early initiation of breastfeeding
• Weighing the neonate

Configuration of the corner

• Clear floor area shall be provided for in the room for newborn corner. It is a space
within the labour room, 20-30 sq ft in size, where a radiant warmer will be kept.

• Oxygen, suction machine and simultaneously-accessible electrical outlets shall be


provided for the newborn infant in addition to the facilities required for the
mother. Clinical procedures: administration of oxygen, airway suctioning.

• Resuscitation kit should be placed in the radiant warmer.

• Provision of hand washing and containment of infection control if it is not a part


of the delivery room

• The area should be away from draught of air, and should have power connection
for plugging in the radiant warmer.

Equipments and Renewable required for the Corner

99
Item Item Description Quantit

Mechanica
Installatio
No y

Electrical
Desirable
Essential

Training

Civil
n

l
Open care system: radiant warmer, fixed height, with
1. E 1 X X X X X
trolley, drawers, O2-bottles
Resuscitator (silicone resuscitation bag and mask
2. E 1 X
with reservoir) hand-operated, neonate, 500ml
3. Weighing Scale, spring E 1 X
4. Pump suction, foot operated E 1 X
5. Thermometer, clinical, digital, 32-34 0C E 2
6. Light examination, mobile, 220-12 V E 1 X X
7. Hub Cutter, syringe E 1 X
Renewable consumables
8. I / V Cannula 24 G, 26 G E
9. Extractor,mucus,20ml,ster,disp Dee Lee E
10. Tube,feeding,CH07,L40cm,ster,disp E
11. Oxygen catheter 8 F, Oxygen Cylinder E
12. Sterile Gloves E

100
Annexure V A

NEWBORN CARE STABILIZATION UNIT

Setting of Stabilization Unit at First Referral Units

Every first referral unit, whether or not care of sick babies is undertaken, must have
clearly established arrangements for the prompt, safe and effective resuscitation of babies
and for the care of babies till stabilized, either in the maternity ward or by safe transfer
elsewhere.

Services at the Stabilization Unit

FRUs are not intended to provide any intensive care, a newborn that has problems
identified immediately after birth, or who becomes ill subsequently, may have a
requirement for one or more of the following services. These should therefore be
available to ensure safe care of the baby prior to appropriate transfer:

• Provision of warmth
• Resuscitation
• Supportive care including oxygen,drugs,IV fluids
• Monitoring of vital signs, including blood pressure
• Breast feeding/ feeding support
• Referral Services

Configuration of the Stabilization Unit

• Stabilization unit should be located within or in close proximity of the emergency


ward where sick and low birth weight newborns and children can be cared .

• Space of approximately 40-50 sq ft per bed is needed, where 4 radiant warmers


will be kept.

• Provision of hand washing and containment of infection control

101
Equipments and Renewable required for the Stabilization Unit

Item Item Description Quantit

Mechanica
Installatio
No y

Electrical
Desirable
Essential

Training

Civil
n

l
Open care system: radiant warmer, fixed height, with
1. E 4 X X X X X
trolley, drawers, O2-bottles
Resuscitator, hand-operated, neonate and child,
2. E 2 X
500ml
3. Laryngoscope set E 2 X
4. Scale, baby, electronic, 10 kg <5kg> E 1 X
5. Pump suction, foot operated E 1 X
6. Thermometer, clinical, digital, 32-34C E 4
7. Light examination, mobile, 220-12 V E 4 X X
8. Hub Cutter, syringe E 1 X
Renewable consumables
9. I / V Cannula 24 G, 26 G E
10. Extractor,mucus,20ml,ster,disp Dee Lee E
11. Tube,feeding,CH07,L40cm,ster,disp E
12. Oxygen cylinder 8 F E
13. Sterile Gloves E
14. Tube, suction, CH 10, L50 cm, ster, disp E
15. Cotton wool, 500g, roll, non-ster E
16. Disinfectant, chlorhexidine, 20% E

Human Resource:
Staffing:
ONE STAFF NURSE SHOULD PROVIDE COVER FOR NEONATES AND
CHILDREN ROUND THE CLOCK Additional nursing staff may be required for
newborn care at the Stabilization Unit. Pediatrician posted at FRU will be in charge of the
Stabilization Unit.

Training:
Doctors and Nurses posted at Stabilization Unit will undergo Facility based care training.

Referral Services
Each Unit accepting neonatal and sick child referrals should have, or have access to, an
appropriately staffed and equipped transport service.

102
Annexure VI

Seismic Safety Guidelines

Seismic safety of non-structural elements in Hospitals/Health facility.

• Health Facility/Hospital should remain intact and functional after an


earthquake to carry on routine and emergency medical care.
• There may be increased demand for its services after an earthquake.
• Hospital accommodates large number of patients who cannot be evacuated in
the event of earthquake.
• Hospitals have complex network of equipment specialised furniture, ducting,
wiring, electrical, mechanical fittings which are vulnerable due to earthquake.
• The Non-structural element may value very high from 80% to 90% incase of
Hospital unlike office buildings due to specialized medical equipments.
• Even if building remains intact, it may be rendered non-functional due to
damage to equipments, pipelines, fall of partitions and store material, etc.
• While the safety of building structure is the duty of PWD and designers of the
building, the risk of non-structural component has to be dealt by staff and
authorities of the health facility.
• This non-structural Mitigation & reduction of risk can be achieved through
series of steps:

i) Sensitization (understanding earthquakes and safety requirements)


ii) Earthquake Hazard Identification in the hospital
iii) Hazard survey and prioritization.
iv) Reducing non-structural hazards.

Step I : Understanding Earthquakes and Safety requirements

• Awareness and sensitization about safety


• The structural elements of a building carry the weight of the building like
columns, beams, slabs, walls, etc.
• The Non-structural elements do not carry weight of the building, but include
windows, doors, stairs, partition and the building contents: furniture, water tank,
hospital equipment, medical equipment, pharmacy items and basic installation
like water tanks, medical gases, pipelines, air conditioning, telecommunications,
electricity etc.
Step II : Earthquakes hazard identification in the hospital

• Tall, narrow furniture like cupboards can fall on people, block doors/
passages/exits
• Items on wheels or smooth surfaces can roll and crash
• Large and small things on shelves, etc. can knock, fall, crash and damage
severely.

103
• Hangings objects can fall
• Shelves/almirahs, storage cabinets can topple and block exits and obstruct
evacuation.
• Pipes can break and disrupt water supply

Step III : Reducing non-structural hazard

a) To relocate furniture and other contents


b) To secure non-structural building elements with the help of structural
engineers
c) To secure the furnishings and equipments to the walls, columns or the floors
with help of engineers and technicians.

Step IV: Hazard Survey and Prioritization

All the non-structural hazard should be identified systematically and prioritise for
as high, medium or low priority and action taken immediately or in due course. This
involves systematic survey and categorisation of all hazards in each area of the hospital
and action thereof. Hospital/health facility should have a Committee dedicated to
undertake this task and monitor on continuous ongoing basis.

104
Annexure VII

Extracts from National Guidelines on Blood Storage Facilities at FRUs

1. Requirements
Space: The area required for setting up the facility is only 10 square meters, well-lighted,
clean and preferably air-conditioned.

Manpower: One of the existing doctors and technicians should be designated for this
purpose. They should be trained in the operation of blood storage centers and other basic
procedures like storage, grouping, cross- matching and release of blood.

The medical officer designated for this purpose will be responsible for overall working
of the storage center.

Electricity: 24 hours supply is essential. Provision of back-up generator is required.

Equipment: Each FRU should have the following:

1. Blood bag refrigerators having a storage capacity of 50 units of blood.

1. Deep freezers for freezing ice packs required for transportation. The deep freezers
available in the FRUs under the Immunization Programme can be utilized for this
purpose.
2. Insulated carrier boxes with ice packs for maintaining the cold chain during
transportation of blood bags.
3. Microscope and centrifuge: since these are an integral part of any existing
laboratory, these would already be available at the FRUs. These should be
supplied only if they are not already available.

Consumables: There should be adequate provision for consumables and blood grouping
reagents. The following quantities would suffice the annual requirement of an FRU with
up to 50 beds.

105
Consumables Quantity:
Pasteur pipette 12 dozens / year
Glass tubes 7.5 to 10 mm - 100 dozens / year
Glass slides 1" x 2" boxes of 20 or 25 each / year
Test tube racks 6 racks, each for 24 tables
Rubber teats 6 dozens / year
Gloves Disposable rubber gloves 500 pairs per year

Blotting tissue paper As required Marker pencil ( alcohol based) As required


Tooth picks As required
Reagents: All the reagents should come from the Mother Blood Bank.
Anti-A 2-vials each per month
Anti-B 2-vials each per month
Anti-AB 2-vials each per month
Anti-D (Blend of IgM & IgG) 2 vials each per month
Antihuman Globulin 1 vial per month
(Polyclonal IgG & Complement)

Since quality of the reagents is an important issue, the supplies of these should be made
from the same blood bank/center from where blood is obtained. For this purpose, State
Governments/Union Territories should provide the additional budgetary requirements to
the mother blood bank/center.

Disinfectants: Bleach & Hypochlorite Solution - As required

2. Suggested quantities of Whole Blood Units to he available at a Blood Storage


Unit

5 units each of A, B, O (Positive)


2 units of AB (Positive)
1 units each of A, B & O (Negative)
This can be modified according to the actual requirement, and minimum should be 2
times the average daily consumption of Blood

106
3. Storage & transportation

Cold chain: It is necessary to maintain the cold chain at all levels i.e. from the mother
center to the blood storage center to the issue of blood. This can be achieved by using
insulated carrier boxes. During transportation, the blood should be properly packed into
cold boxes surrounded by the ice packs. Ice, if used should be clean and should not come
in direct contact with the blood bags. The blood should be kept in blood bank refrigerator
at 4°-6°c ± 2°c. The temperature of the blood should be monitored continuously.

Storage: The storage center should check the condition of blood on receipt from the
mother center and also during the period of storage. The responsibility of any problem
arising from storage, cross matching, issue and transfusion will be of the storage center.
Any unit of blood showing hemolysis, turbidity or change in colour should not be taken
on stock for transfusion. Due care should be taken to maintain sterility of blood by
keeping all storage areas clean. The
expiry of the blood is normally 35/42 days depending on the type of blood bags used.
The Medical Officer in-charge should ensure that unused blood bags should be returned
to the mother center at least 10 days before the expiry of the blood and fresh blood
obtained in its place. The blood storage centers are designed to ensure rapid and safe
delivery cf whole blood in an emergency. The detail of storage of packed cells, fresh
frozen plasma and platelets concentrate are therefore not given in these guidelines. In
case, however, these are required to be stored, the storage procedures of the mother
blood bank should be followed.

4. Issue of blood s

Patients blood grouping and cross matching should invariably be carried out before issue
of blood. A proper record of this should be kept.

First In and First Out (FIFO) policy, whereby blood closer to expiry date is used first,
should be followed.

5. Disposal

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Since all the blood bags will already be tested by the mother center, disposal of empty
blood bags should be done by landfill. Gloves should be cut and put in bleach for at least
one hour and then disposed as normal waste.

6. Documentation & records

The center should maintain proper records for procurement, cross matching and issue of
blood and blood components. These records should be kept for at least 5 years.

7. Training

Training of doctors and technicians, who will be responsible for the Blood Storage
Center, should be carried out for 3 days in an identified center as per the guidelines.
Training will include:

Pre-transfusion checking. i.e. patient identity and grouping


Cross matching
Compatibility
Problems in grouping and cross matching
Troubleshooting
Issue of blood
Transfusion reactions and its management
Disposal of blood bags

The states will have to identify the institutions where training of the staff responsible for
running the blood bank is to be held. These could be the blood banks at Medical
Colleges, Regional Blood Banks, Indian Red Cross Blood Banks, or any other well
setup, licensed Blood Bank, provided they have the necessary infrastructure for
undertaking training.

The training will be for three-days duration during which the Medical Officer and the
technician from the identified FRUs will be posted at the training institution.

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A "Standard Operating Procedures Manual" (SOPM) has been developed and is par
t of these guidelines. This SOPM will be used as the training material. A copy of this
SOPM will be made available to the Medical Officer for use in his Blood Storage Center
for undertaking storage, grouping, cross matching and transfusion.

In addition to the training of the above Medical Staff, it is considered necessary that the
clinicians who will be responsible for prescribing the use of blood are also sensitized on
the various parameters of blood transfusion. For this the "Clinician'
s Guide to
Appropriate Use of Blood" has been developed. It is suggested that one-day sensitization
programme for the clinicians may be organized at the District Hospital/Medical College.

Government of India will make the expenditure for the above-mentioned trainings,
available as per the norms of training under the RCH Programme. This training will,
however, be coordinated by the Training Division of Department of Family Welfare. The
states are required to include training as part of the overall State Action Plan for
establishing Blood Storage Centers.

Equipments for Laboratory Tests & Blood Transfusion

Rod, flint-glass, 1000 x 10 mm dia, set of two 2


Cylinder, measuring, graduated W/pouring lip, glass, 50 ml 2
Bottle, wash, polyethylene W/angled delivery tube, 250 ml 1
Timer, clock, interval, spring wound, 60 minutes x 1 minute 1
Rack, slide drying nickel/silver, 30 slide capacity 1
Tray, staining, stainless steel 450 x 350 x 25 mm 1
Chamber, counting, glass, double neubauer ruling 2
Pipette, serological glass, 0.05 ml x 0.0125 ml 6
Pipette, serological glass, 1.0 ml x 0.10 ml 6
Counter, differential, blood cells, 6 unit 1
Centrifuge, micro-hematocrit, 6 tubes, 240v 1
Cover glass for counting chamber (item 7), Box of 12 1
Tube, capillary, heparinized, 75 mm x 1.5 mm, vial of 100 10

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Lamp, spirit W/screw cap. Metal 60 ml 1
Lancet, blood (Hadgedorn needle) 75 mm pack of 10 ss 10
Benedict'
s reagent qualitative dry components for soln 1
Pipette measuring glass, set of two sizes 10 ml, 20 ml 2
Test tube, w/o rim, heat resistant glass, 100 x 13 mm 24
Clamp, test-tube, nickel plated spring wire, standard type 3
Beaker, HRG glass, low form, set of two sizes, 50 ml, 150 ml 2
Rack, test-tube wooden with 12 x 22 mm dia holes 1

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Annexure VIII

LIST OF ABBREVIATIONS

BJMC BJ Medical College


CHC Community Health Centre
CME Continuing Medical Education
CSSD Central Sterile and Supply Department
CRI Central Research Institute
CRME Centre for Research in Medical Entomology
DRDE Defense Research and Development Establishment
ICGEB International Centre for Genetic Engineering and
Bio-technology
EVRC Enterovirus Research Centre
FRU First Referral Unit
HSADL High Security Animal Diseases Laboratory
IGIB Institute of Genomics and Integrative Biology
IPHS Indian Public Health Standards
IVRI Indian Veterinary Research Institute
KEM King Edmund Memorial Hospital
MRC Malaria Research Centre
NARI National AIDS Research Institute
NEERI National Environmental Engineering Institute
NICED National Institute of Cholera and Endemic Diseases
NIV National Institute of Virology
NRHM National Rural Health Mission
PRI Panchayati Raj Institution
RKS/HMC Rogi Kalyan Samiti / Hospital Management
Committee
RMRC Regional Medical Research Centre
STM School of Tropical Medicines
VCRC Vector Control Research Centre

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References

1. Indian Standard Basic Requirement for Hospital Planning; Part 2 Upto 100
Bedded Hospital, Bureau of Indian Standards, New Delhi, January, 2001

2. Rationalisation of Service Norms for Secondary Care Hospitals, Health & Family
Welfare Department, Govt. of Tamil Nadu. (Unpublished)

3. District Health Facilities, Guidelines for Development and Operations; WHO;


1998.

4. Indian Public Health Standards (IPHS) for Community Health Centres;


Directorate General of Health Services, Ministry of Health & Family Welfare,
Govt. of India.

5. Population Census of India, 2001; Office of the Registrar General, India.

6. Prof. Anand S.Arya, under the GOI- Disaster Risk Management Programme,
Natiional Disaster Management Division, MHA, New Delhi.

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