SDH 31 To 50 Bedded Revised Draft (India) PDF
SDH 31 To 50 Bedded Revised Draft (India) PDF
SDH 31 To 50 Bedded Revised Draft (India) PDF
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).
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
GUIDELINES
(Revised 2010)
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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
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.
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.
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)
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:
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.
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.
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5. Functions
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
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Lab, X-ray, Ultrasound, ECG, Blood transfusion and storage1, and Basic Multi
Rehabilitation Services
Desirable
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.
1
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.
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
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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
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RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) FOR DIFFERENT
ILLNESSES CONCERNING DIFFERENT SPECIALITIES:
15
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
Chronic Vertigo/
b) Diagnose and Treat, refer if necessary
CVA/TIA/Hemiplegia/Paraplegia
17
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
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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
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DERMATOLOGY
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
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CHEST DISEASES
PSYCHIATRY
DIABETOLOGY*
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4 Nephropathy/Retinopathy Diagnose and Refer
Emergency :-
i) Hypoglycemia
6 Diagnose, first aid and refer
ii)Ketosis
iii)Coma
NEPHROLOGY
7 Acute renal Failure/ Chronic Renal Failure Diagnose and Refer to District level
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* 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
Benign/
Breast/Oral/GI tract/Genitourinary (Penis,
4 Malignant Diagnose & refer
Prostate, Testis)
Diseases
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
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
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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)
UROLOGY
CHILDREN
RECOMMENDED SERVICE
S. No NAME OF THE ILLNESS
MIX (SUGGESTED ACTIONS)
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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
DENTAL SURGERY
S. No NAME OF THE RECOMMENDED SERVICE MIX
ILLNESS (SUGGESTED ACTIONS)
8 Neoplasms Refer
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HEALTH PROMOTION & COUNSELLING
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:
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.
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♦ 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
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.
All health staff should be trained and well conversant with disaster prevention and
management aspects
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:
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
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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.
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
Imaging
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.
The area required for setting up the facility is only 10 square meters, well-lighted,
clean and preferably air-conditioned.
General
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.
Pharmacy (Dispensary)
Pharmacy should have component of medical store facility for indoor patients and
separate pharmacy with accessibility for OPD patients.
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.
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.
Therapeutic Services
Operation Theatre
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.
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
Hospital Laundry
There are of medical and general store should have vehicular accessibility and
ventilation, security and fire fighting arrangements.
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
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
Mechanical Engineering
37
Hospital should be provided with water coolers and refrigerator in wards and
departments depending upon the local needs.
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.
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.
Trauma Centre
Guidelines to be followed
Fire Protection
Medical Gas
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.
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.
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
40
8.2. Man Power – Para Medical
41
General HR and Bed norms for Obstetric Cases
42
8.3. Manpower- Administrative Staff
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)
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
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
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)
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
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
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)
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)
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.
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
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
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
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
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:
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
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
59
11. ALLOCATION OF BED STRENGTH AT VARIOUS LEVELS:
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)
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
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
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.
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
DRUG KIT FOR SICK NEW BORN & CHILD CARE - FRU/CHC
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
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.
Quality Control
Internal Monitoring
External Monitoring
Monitoring of laboratory
Record Maintenance
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.
Annexure I
CITIZENS CHARTER
This charter seeks to provide a framework which enables our users to know:
Standards of Service:
Locations:
76
This hospital has-
General Information
Maternity OT
Orthopaedic Emergency OT
Burns and plastic OT
Main OT for Neurosurgery cases
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
Eye
ENT
Skin
Psychiatry
Orthopaedics
Dental OPD
ISM Services:
Homeopathic
Ayurvedic
Any other
OPD services are available on all working days excluding Sundays and Gazetted
Holidays.
Organ Transplantation
………………………..
………………………..
78
………………………
Psychiatry
D-addiction
Dental
Geriatrics
Laboratory Services:
• 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.
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.
Emergency: Emergency X-Ray services are also available round the clock. CAT Scan
services are also available round the clock.
79
There are total of ………. Wards providing free indoor patient care.
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.
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.
Admitted patients should contact the Staff Nurse for any medical assistance they need.
Other Facilities:
80
Other facilities available include:
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.
Stand-by Electricity Generators have been provided. Chemist Shops are available outside
the hospital. Canteen for patients and their attendants is available.
Adequate toilet Facilities for use of patients and their attendants are available.
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.
We aim to settle your genuine complaints within 10 working days of its receipt.
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 ……………………
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 help us in keeping the hospital and its surroundings neat and clean.
Please use the facilities of this hospital with care. Beware of Touts.
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.
82
Annexure – II
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.
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).
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.
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.
84
Category No.8- Liquid Waste
This includes waste generated form laboratory and washing, cleaning,
housekeeping and disinfecting activities.
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.
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.
• 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.
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.
5.7 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.
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.
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
88
7.2.2 The containers for transportation must be labelled as given in Schedule III
and IV of BMW, 1998.
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.
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.
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.
92
Annexure III
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
Bacterial diagnosis
94
Tuberculosis State TB Demonstration & Training Centre (for all zones) NTI, TRC
ICGEB, Delhi
Viral Diagnosis
95
Parasitic Diagnosis
Zoonoses
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
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
98
Annexure V
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.
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
• 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.
• The area should be away from draught of air, and should have power connection
for plugging in the radiant warmer.
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
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.
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
101
Equipments and Renewable required for the Stabilization Unit
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
• 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
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
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.
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
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.
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
107
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.
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:
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.
108
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.
109
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
110
Annexure VIII
LIST OF ABBREVIATIONS
111
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)
6. Prof. Anand S.Arya, under the GOI- Disaster Risk Management Programme,
Natiional Disaster Management Division, MHA, New Delhi.
112
113