Housekeeping Manual 2014

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HOUSEKEEPING SERVICES

MANUAL

Quality Assurance Division

Haryana State Health Resource Centre,

Government of Haryana


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CONTENTS

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

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

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

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

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

PART-1 CLEANING AND DISINFECTION OF PATIENT CARE AREAS

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

6.1 CLEANING AND DISINFECTION IN OPERATION THEATRE ENVIRONMENT….9

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

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

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

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

8.0

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

9.0 CLEANING AND DISINFECTION OF EMERGENCY ROOMS

AND THE INTENSIVE CARE UNITS…………………………………………..………13

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

11.0 CLEANING AND DISINFECTION OF LABORATORY ………………………………...15

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

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

14.0 CLEANING AND DISINFECTION OF INPATIENT WARDS ……………………..16


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

1.0 CLEANING AND DISINFECTION OF CORRIDORS………………………………………..20

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

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

PART-3 SPILL MANAGEMENT, BIOMEDICAL WASTE MANAGEMENT

AND OTHER PROTOCOLS

1.0 GUIDELINES FOR SPILL MANAGEMENT: SPILL MANAGEMENT OF BLOOD &

BODY FLUID ……………………………………………………………………………………………….23

2.0

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

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

2.2 BIO MEDICAL WASTE MANAGEMENT HANDLING RULES 1998…27

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

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

5.0

RECORDS TO BE MAINTAINED BY THE HOUSEKEEPING SUPERVISOR……..31

6.0

SUGGESTIVE LIST OF EQUIPMENT/GADGETS/MACHINERY

FOR HOUSEKEEPING DEPARTMENT……………………………………………….……..33


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1.0 INTRODUCTION

“It is said that the first impression lasts till the

end”

Hospital cleanliness is the first impression that any patient

or relative makes while entering a hospital.

A clean and hygienic environment has a tremendous

psychological impact on the patients and the family members,

and speaks volumes about the quality of service the hospital

provides. Since it is difficult for people to judge the clinical

services in a hospital due to lack of medical knowledge, opinion

about a hospital is often formed on the basis of its appearance

and cleanliness.

Housekeeping services in a hospital has a major role in

controlling the infection rate as well as minimizing the

Hospital acquired infections to the patients. Effective

housekeeping prevents diseases and spread of infections

reducing medical costs and the amount of sickness among

patients and other visitors.

Tardiness andCleanliness are the basic

tenets of maintaining a

healthy, environment.

In Government

Hospitals it becomes

absolutely essential to

maintain hygiene despite

high volumes of patients

visiting the Out PatientDepartments.


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2.0 OBJECTIVES AND PURPOSE OF MANUAL

In government hospitals regular cleaning and disinfection is essential because of the

high turnover of patients, Standardization of cleaning methods, materials, checklists is

essential. Some of the Objectives of the manual are:

1.

Standardized protocols for housekeeping services would ensure that cleaning,

disinfection is adequately done

2. The types of solutions, type of material to be used for cleaning/ disinfection

purposes would be identified.

3.

Manual would provide the hospital with standard document for training protocols

for various housekeeping procedures. Checklists to be used for cleaning,

disinfection purposes and daily monitoring of various activities would be available

and can be used for references.

4. It would help in maintaining the hospital clean, orderly and infection free.

5.

Establish and maintain procedures to ensure standards of quality. This would

include cleaning of windows, walls, floors, furniture and equipments.

6.

Standardize various processes for waste segregation and disposal in coordination

with the infection control team.

3.0 DEFINITIONS1

There are various types of methods used in maintaining sanitation in the hospitals.

Some of the Definitions are given below:

1 CDC-Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

1) CLEANING: Cleaning is the removal of visible soil (e.g., organic and inorganic material)

from objects and surfaces and normally is accomplished manually or mechanically using

water with detergents.

2) DISINFECTION: Disinfection describes a process that eliminates many or all pathogenic

microorganisms, except bacterial spores, on inanimate objects.

3) DISINFECTANT: Disinfectants are antimicrobials applied only to inanimate objects

4)

DECONTAMINATION: Decontamination removes pathogenic microorganisms from

objects so they are safe to handle, use, or discard.

5) DAMP DUSTING : A process of cleaning which involves the use of wet cloth


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4.0 DEPARTMENTAL STRUCTURE

The Housekeeping department in Government hospitals/ health care

facilities is usually outsourced to an external agency, an MOU / Agreement is

developed between the Hospital management and the external agency. The terms of

reference should be clearly defined in the MOU, in order to define the Key

Performance Indicators upon which the work is measured.

A suggestive organization Structure of Housekeeping department for a

district hospital is given below:

HOUSEKEEPING DEPARTMENT

Principal Medical Officer / Medical Superintendent/

Senior Medical Officer I/c

Hospital Administrator/Deputy Medical Superintendent

Housekeeping Supervisor

General Duty Attendants / Class IV/

Sweeper / Group –D Staff


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5.0 HOUSEKEEPING PROTOCOLS FOR A DISTRICT HOSPITAL

According to Cleaning and Disinfection purposes, hospital is categorically

divided into different areas according to the risk of various Hospital Acquired

infections. The different areas are classified into: Patient Care Areas and Non PatientCare Areas.

INPATIENT CARE AREAS:

The patient care areas are divided into 3 types- High risk, Medium risk and

Low risk. The risk of hospital infections is high in High risk patient care areas

because of high content of microbial load as in isolation rooms or due to

susceptibility of the bacteria to invade open tissues.

The various patient care areas are given below:

A.

Patient Care Areas

(1) High risk areas :

Operation Theatre

Labor Room

Isolation Rooms

(2) Medium Risk Areas :

Patient Inpatient wards

Emergency Department

Laboratory

Radiology

Dirty Utility Area

Mortuary

(3)

Low Risk areas :

OPD / Consultation Rooms

B.

Non Patient care areas

Corridors

Toilets

Lifts

Waiting halls / Waiting Rooms

Stores (Medicine Store, Linen Store)

Pharmacy


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PART-1

CLEANING AND DISINFECTIONOF

PATIENT CARE AREAS


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(A) PATIENT CARE AREAS

6.0 ENVIRONMENTAL CLEANING AND DISINFECTION IN HIGH RISK AREAS

6.1 CLEANING AND DISINFECTION IN OPERATION THEATRE ENVIRONMENT

AND LABOUR ROOM

A) CLEANING/ DISINFECTION BEFORE SURGERY

All horizontal surfaces with in the OT are damp dusted before the first scheduled

surgical procedure of the day with a clean cloth moistened in the approved

disinfectant solution.

Visual inspection of OT area, equipments, OT Table before commencement of the

first surgical case.

B) CLEANING/ DISINFECTION DURING SURGICAL PROCEDURE

Accidental spillage (Blood and Body Fluids) in the area outside the surgical field

should be promptly cleaned by placing tissue papers over it then pouring 1%

sodium hypochlorite over it.

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

Discard the contaminated disposable items in yellow bag meant for Biomedical

Waste.

C) CLEANING/ DISINFECTION IN BETWEEN SURGICAL PROCEDURE

Conduct a visual check to inspect cleanliness of the operation theatre

Reusable Suction bottles are emptied and cleaned under the running water and

tubing is replaced.

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

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

D) CLEANING IN OT AT THE END OF THE DAY

Terminal cleaning (End of the day) to be done with 2% Gluteraldehyde

(Cidex) and formaldehyde (Formalin) or 5% hydrogen peroxide.

6.2 DISINFECTANTS TO BE USED

Formaldehyde (Formalin) and Gluteraldehyde (Cidex)

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

Sodium Hypochlorite


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6.3 PREPARATION AND CONCENTRATION OF DISINFECTANTS

Formaldehyde and gluteraldehyde

For surface cleaning: 200ml in 10 liters (2%) For fogging: 2%

Hydrogen peroxide and silver nitrate

For surface cleaning make 5% of the solution: add 250ml in 5 liters of water.

For Fogging: make 20% concentration of solution (200ml in 1000 ml)

Sodium Hypochlorite

75 ml in 12 liters of water (1%)

6.4 SUGGESTIVE CLEANING SCHEDULE FOR OPERATION THEATRE AND

LABOUR ROOM

CLEANING

AREAS

MATERIAL USED RESPONSIBILITY DAILY WEEKLY MONTHLY

OT Table 1% Sodium

hypochlorite Sol.

OT Housekeeper At least once or as

per requirement

between each

surgery in a dayDelivery Table 1% Sodium

hypochlorite Sol.

Housekeeper At least once or as

per requirement

between each

delivery in a day

OT light 1% Sodium

hypochlorite Sol.

OT Housekeeper At least once or as

per requirement

Crash Cart 1% Sodium

hypochlorite Sol.

OT Housekeeper At least Once or as

per requirement

Ventilator 1% Sodium

hypochlorite Sol.

OT Housekeeper At least Once or as

per requirement

Scrub Trolleys 1% Sodium

hypochlorite Sol.

OT Housekeeper At least Once as per

requirement

Drums Wet mop OT Housekeeper Once

Racks Disinfectant sol. OT Housekeeper Once


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Glass Wall Disinfectant sol. OT Housekeeper Once

Wall Disinfectant sol. OT Housekeeper Once

Floor Disinfectant sol. OT Housekeeper Twice or as per

requirement

TV Disinfectant sol. OT Housekeeper Once

C- arm Disinfectant sol. OT Technician Once

Suction Detergent &

SAVLON SOL

OT Housekeeper Twice or as per

requirement

Sink Disinfectant sol. OT Housekeeper Twice or as per

requirement

Fridge Internal- Detergent OT Housekeeper Once

AC ducts Vacuum cleaning,

Disinfectant sol.

HK SUPERVISOR ONCE

Frequently

touched

surfaces- Door

knobs, switch,

tap(INSIDE OT)

Disinfectant sol. House Keeper Twice

Frequently

touched

surfaces- Door

knobs, switch,tap(OUTSIDE

OT)

Disinfectant sol. House Keeper 3 times a day (Before

each shift)

Floor Disinfectant sol. House Keeper Thrice or as per

requirement

Lockers Disinfectant sol. House Keeper Once

Shoe rack Wet mop House Keeper Once

Dust bins Detergent House Keeper Once

Buckets, Dust

pans

Detergent House Keeper Twice

Mop 1% Sodium

Hypochloride sol.

House Keeper Twice


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All furniture, wall surfaces, fixed and ceiling mounted equipments, anaesthesia

equipments and accessories, soap dispensers, handles of cabinet are to be disinfected

with either formaldehyde and gluteraldehyde or hydrogen peroxide.

1. Scrub sinks are cleaned with detergent solution under water.

2.

Floor cleaning is done with 1% Sodium Hypochlorite.3.

Bathrooms and toilets are cleaned with detergent powder.

4. Suction bottles are to be emptied, cleaned and disinfected by immersing

into 1% sodium hypochlorite solution for 20mts and in case they are

infected then for 1hr.

5. Transport vehicles (trolleys and wheelchairs), including straps and

attachments are cleaned with 2% formaldehyde and gluteraldehyde or

5% hydrogen peroxide.

Weekly Cleaning

Remove all movable equipments and furniture from the O.T.

1.

Clean with wet mopping with disinfectant solution

2. Floor cleaning to be done with scrub and vacuum.

3.

Ceiling and walls are cleaned with disinfectant/ Cidex solution.

4.

Fumigation is done at night

Mops:

1. Mops used should be cleaned with detergent periodically.

2.

Post usage keep it for drying.

8.0 CLEANING AND DISINFECTION IN ISOLATION ROOMS

Isolation Rooms are specifically designed for patients requiring isolation

due to contagious diseases from being spread from a patient to other

patients, staff, and visitors, or from others to a particular patient. Another

type of patients requiring isolation is immuno-compromised patients, which

have chances of acquiring secondary infections.

http://en.wikipedia.org/wiki/Contagious_diseasehttp://en.wikipedia.org/wiki/Patienthttp://en.wikipedia.org/wiki/Patienthttp://en.wikipedia.org/wiki/Contagious_disease


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So single bed isolation rooms are made for immune compromised whereas

muti-bedded isolation wards are made and ward for patients with similar

diagnosis like TB.

1.

Change curtains after the discharge of all patients in case of a ward or every 15days whichever is earlier.

2.

Fogging to be carried out with 20% hydrogen peroxide disinfectant after

discharge of each patient.

3.

Terminal cleaning with 5% hydrogen peroxide to be done at the end of each shift.

4.

Special transmission based precautions i.e. blood born pathogen isolation (BBP),

airborne isolation (AI), droplet isolation (DI) and contact isolation (CI) have to be

followed for patients having specific diseases.

9.0 CLEANING AND DISINFECTION OF EMERGENCY ROOMS

AND THE INTENSIVE CARE UNITS

1.

All examination tables to be cleaned daily.

2.

Washable walls will be spot washed daily and as necessary, using specified

disinfectant.

3.

Sinks, soap dishes, and paper towel dispensers will be cleaned daily and

replenished.

4. All stretchers /trolleys will be cleaned weekly.

5.

Toilets to be washed and cleaned at least thrice daily using germicidal

solution, including both sides of toilet seats in case of English toilets.

6.

Emergency Department is to be cleaned on a 24-hour basis, 7 days per week

and thoroughly cleaned, as necessary.

7. For cleaning spray the entire area with a mixture of 20% hydrogen peroxide,

formaldehyde and Gluteraldehyde (cidex) before a new patient is admitted.

8.

Change the curtains once in 7 days or as and when required.


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10.0 DISINFECTION OF PATIENT CARE UTILITIES

ITEMSCLEANING / DISINFECTION

TIME REMARKS

Nebulizer set Soap and water N.A Individual preferred

Stethoscope Alcohol swab N.A After each use

ThermometerIsopropyl alcohol swab or soap and

waterN.A

Preferably Individual for

each patient.

Clean after each use.

LaryngoscopeBlade – with soap & water

Handle & bulb - isopropyl alcohol.N.A

Nasal prongs Tap water only if dirty N.APreferably Individual

for each patient.

Oxygen masks Isopropyl alcohol swab N.APreferably Individual

for each patient.

Ambu bag

If uninfected patient -isopropyl

swab,

Infected patient – cidex dipped for

1 hr.

N.A

For 1hr

Sputum mugSoap and water, Immerse in 1%

sodium hypochlorite

20mts to

1hr

Keep a minimal amount of

water in the mugs prior to

giving to patient.

Transducer Alcohol swab N.A

Bed Side

Urinal

Soap and water immerse in 1%

sodium hypochlorite

20mts to

1hr

Emesis basin Soap and water N.A

Measuring cup Soap and water N.A

Medicine

containerSoap and water N.A

Bed panSoap and water

N.A


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11.0 CLEANING AND DISINFECTION OF LABORATORY

1.

Laboratory area requires specific cleaning in different sections of the Laboratory,

Hematology, and Biochemistry section table tops should be cleaned with 1% Sodium

Hypochlorite in the morning. Microbiology sections and Histopathology sections

should be disinfected after each shift so that microbial culture built up does not

occur.

2.

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

3. All the dustbins shall be washed and lined with color coded bags in the morning.

Change the waste bag when it is 2/3 filled with laboratory waste.

4.

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

morning.

5.

The floor shall be thoroughly mopped with a disinfectant solution.

6. The common areas shall be swept and mopped in the morning and at regular

intervals to keep them clean.

7.

Contaminated clothing must be decontaminated before laundering

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

12.0 CLEANING AND DISINFECTION OF OUT PATIENT

DEPARTMENT

1.

Use 1% sodium hypochlorite for floor mopping.

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

peroxide.

3.

Spray the Dental department with 20% hydrogen peroxide.

4.

Change all curtains once in a week.

5.

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

6.

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

hours.

7.

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

8.

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

9.

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

10.

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

deodorizer.


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11.

Change doctor coat and replace with new coat.

13.0 CLEANING AND DISINFECTION OF DRESSING ROOM

1.

Spray the entire room with 20% hydrogen peroxide daily in the evening.

2.

Clean all the table tops with 5% hydrogen peroxide twice in each shift.3.

Trolley to be kept clean at all times.

4.

Wipe the top of dressing trolley with 5% hydrogen peroxide.

14.0 CLEANING AND DISINFECTION OF INPATIENT WARDS

1.

The cleaning of a patient's wards will be performed once during each shift.

Housekeeping staff with emphasis on patient touch areas such as bed, bed rails, door

knobs, handles, monitoring equipment, buttons/controls, cables.

2.

After a patient is discharged all used disposable items like IV bags and tubing’s,

suction catheters and tubings will be discarded by nurses.

3.

Soiled linen is removed by Housekeeping Staff.

4.

Clean the bed surface including under the mattress with disinfectant.

5. Toilet cleaning, bathrooms, sinks, showers should be cleaned every six hourly or as

when required. Soap and clean towel would be provided and will be refilled as

needed.

CLEANING SCHEDULE IN WARDS

Cleaning

Areas

Material

Used

Responsibility Daily Weekly Monthly

Beds / bed

rails

2% Sodium

Hypochlorite

Housekeepers/General

Duty Attendants

2 times

Bed side

trolleys

2% Sodium

Hypochlorite


Duty Attendants

2 times

Dressing

trolleys

2% Sodium

Hypochlorite


Duty Attendants

2 times or

as per

reqrmntCrash carts 2% Sodium

Hypochlorite


Duty Attendants

2 times or

as per

requirement

Cardiac

Table

2% Sodium

Hypochlorite


Duty Attendants

2 times or

as per

requirement

ECG trolley 2% Sodium

Hypochlorite


Duty Attendants

Once


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Defibrillator

Trolley

2% Sodium

Hypochlorite


Duty Attendants

Once

IV Stands 2% Sodium

Hypochlorite


Duty Attendants

2 times

Nursing

Stations

2% Sodium

Hypochlorite


Duty Attendants

2 times

Chairs 2% Sodium

Hypochlorite


Duty Attendants

Once

Mops 2% Hypo

bleach


Duty Attendants

3 times

Fans Wet mop Housekeepers/General

Duty Attendants

once

Mirrors Soap Water

Sol.


Duty Attendants

Daily

Cleaning Areas Material Used Responsibility Daily Weekly Monthly

Frequent touch

area :-

Switches,

sockets, Door

Knobs, Taps

Disinfectant

solution


Duty Attendants

Three times

a day after

each shift

AC Ducts

Vacuum

Cleaning+Disin

fectant

Housekeeping

supervisor

Monthly

once

Dust BinsDisinfectant

solution


Duty Attendants

Twice a

day(morning

+night) at

the end of

shift

Buckets, Dust

pans

With detergent

powderHousekeepers/General

Duty Attendants

3 times a

day

Bed side

Urinals/ Bed

pans

Formalin

tabletOnce a day

FloorDisinfectant

solution Housekeepers/General

Duty Attendants

3 times per

shift

ChairsDisinfectant

solutionOnce a day

LockersDisinfectant

solution Housekeepers/General

Duty Attendants

Once a day

Sink Detergent2 times per

shift


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Fridge

Detergent(insi

de),

Disinfectant

(outside)Housekeepers/General

Duty Attendants

ONCE

OUTSIDEonce INSIDE

Shoe Rack Wet mop Once

PRIVATE WARDS SPRAYING

1.

On discharge of patient clear all the furniture from the room.

2.

Remove the bed linen, curtains early morning disinfectant for spraying use in sprayer

all over the room.

3.

Let it dry.

4.

Clean all the table tops, window ledges, all fixtures, phones, chairs and other

furniture in the room with clean duster and 5% disinfectant solution.

5.

Floors to be mopped with 1% sodium hypochlorite.6.

Once all the surfaces in the room are dry replace all the furniture back.

IMPORTANT ASPECTS

1.

Do not vigorously shake the cloth to remove the dust while dusting or sweeping.

2.

Change curtains once every week.

3. Avoid using the patient’s linen for dusting.

4.

Avoid cleaning mops and dusters in the sinks.

5.

Use clean mops for cleaning.


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PART -2

CLEANING AND DISINFECTIONOF

NON -PATIENT CARE AREAS


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(B) NON-PATIENT CARE AREAS

1.0 CLEANING AND DISINFECTION OF CORRIDORS

1.

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

2.

Wet mop all corridor, covering only half of the width at time. This allows safe foot

traffic at all times. The patients can walk through the other half of the width and

patient/ relative/ staff falls can be avoided.

3.

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

completely.

2.0 CLEANING DISINFECTION OF TOILETS

1. Wash hands and put on gloves

2.

Ventilate the area (for example, open a window), and prepare the cleaning

solution in a well-ventilated area (refer to manufacturers’ instructions)

3. Flush the toilet with the seat lid down

4.

The toilets should be thoroughly cleaned at least once every shift and mopped

dry. The floor should be made non-slippery and all deposits removed.

5.

Apply the cleaning agent to the inside of bowl, including under the rims and

allow to soak and clean the bowl after wards Flush the toilet, rinsing the brush in

flushing water (leave the toilet brush in the bowl)

6.

Remove any splashes or marks from the wall

7.

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

8. Dispose of the cloth when the task is completed

9.

Remove gloves and wash hands

10.

In addition to the stipulated timings, sweeper shall also undertake such

sweeping / cleaning /mopping operation as and when required or as directed by

Housekeeping Supervisor /nursing staff on duty, or such personnel as may be

authorized in this regard by the superintendent at any time of the day and night.

11.

The outlets and drain pipes of the urinals should be kept clog free and fixed in

proper place.


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12.

The clogged drain pipes are to be de clogged immediately and drain chambers

cleaned thoroughly once a week as part of preventive maintenance and also one

register to be maintained for all the drainages of the hospital.

13.

Regular monitoring to be done by the housekeeping supervisor for the cleaning

by maintaining and filling the checklist.

14.

In-case of Indian Toilets: Apply the cleaning agent to the inside of bowl,

including under the rims and allow to soak and clean the bowl after wards Flush

the toilet, rinsing the brush in flushing water. Then clean the foot pedals with

disinfectant and let dry. Cleaning steps would be similar except for the cleaning

of the foot pedals.

2.1 RECORD FOR TOILET CLEANING

DATE TIME CLEANING DONE BY SIGNATURE OF SUPERVISOR REMARKS

3.0 CLEANING AND DISINFECTION OF LIFT

1.

Take the Lift to a non-patient, non-public floor for cleaning and turn off with key.

2. Mix disinfectant detergent in bucket.

3.

Clean with damp cloth soaked in disinfectant detergent. Wipe dry to prevent

streaking and replace.

4. Dust mop the floor.


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PART-3

SPILL MANAGEMENT,

BIOMEDICAL WASTE MANAGEMENT

AND

OTHER PROTOCOLS


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1.0 GUIDELINES FOR SPILL MANAGEMENT

1.0 SPILL MANAGEMENT OF BLOOD & BODY FLUID

The factors involved in Spill Management are given below:

The nature (type) of the spill (e.g. Sputum, vomit, faeces, urine, blood or

laboratory culture)

The pathogens most likely to be involved in these different types of spills (e.g.

Stool samples may contain viruses, bacteria or protozoan pathogens whereas

sputum may contain mycobacterium tuberculosis)

The size of the spill (e.g. Spot [few drops], small [10cm])

Volume of spill ( less than 30 ml, more than 30 ml)

The type of surface (e.g. Carpet or flooring)

The location involved i.e. whether the spill occurs in a contained area such as a

microbiology laboratory or in a waiting area or wards, OPDS.

HAZMAT KIT LIST (HAZARDOUS MATERIAL KIT)

1. Gloves

2.

Mask

3.

Goggles

4. Disposable Gown

5. Tissue roll

6. Sodium hypochlorite 2%

7. Gum boots

8. Cap

9. Chalk

10. Two Cardboard pieces

11.

Syringe12. Cotton

13. Sulphur Powder

14. Small Glass Jar

15. Instruction Sheet


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PROCEDURE FOR SPILL MANAGEMENT

1. Wear Personal Protective Equipment (Gloves only in case of minor spill, apron,

mask for major spill, to avoid before cleaning the spillage

2.

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

the spillage

3.

Leave it for 20 minutes

4.

Collect the residue with newspaper or cardboard.

5. Wipe and discard all the waste in disposable bag

6.

Disinfect the entire spill area with a hospital-grade disinfectant and allow it to

stand for the amount of time recommended by the manufacturer.

7.

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

8.

Remove the gloves and discard in the same bag ,tie the bag properly and put label

with the type of spillage

9.

Wash the hands properly.

10.

Fill incident form and submit

NOTE: If spill contain broken glass and there is a risk of sharps injury, first disinfect the spill

with 1% sodium hypochlorite solution and after 20 minutes, put broken glass pieces in the

sharps container and then proceed further to wipe the spill

Steps to follow in case of Mercury spill :

1) Remove all items nearby the mercury spill. Switch off the exhaust fan if on.

2) Wear face mask to prevent inhalation of mercury.

3) Remove the clothes if spoiled with mercury.

4) Remove the ornaments. Wear gloves.

5) In case of sharps of the glass wrap it in the paper and put in the zip bag. This should be

labelled with “Contaminated with mercury.”

6) If spilled in the wood or tiles can be cleaned easily, but if spilled on linen the portion is to

be cut and removed.

7) Collect the tiny mercury particles with cardboard. Tiny particles can be seen with torch.

For this after switching off the lights in room the torch light is focused along the floor.

Observe the room with such precautions.

8) Collect the particles of mercury with dropper or syringe and then placed in bottle filled

with water. Bottle is to be closed airtight. Place the bottle in the zip lock bag and is to be


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labelled “Contaminated with mercury”. After collect ing the larger particles if the tiny

particles are not seen then sulphur powder is sprinkled to visualize the tiny particles which

makes the mercury particles darker and can be seen easily. Then small particles are collected

with syringe and placed in bottle.

The precautions are taken to prevent the powder inhalation, which is poisonous.

9) All the equipment used for cleaning including gloves are placed in zip lock bag and

labelled.

10) The zip lock bag is deposited to staff nurse and disposed off as per Biological waste

management rules.

11) The doors and windows of the room where the mercury spilled are to be kept open for

24 hours. In case of mercury side effects immediate medical treatment is provided.


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2.0 BIO-MEDICAL WASTE MANAGEMENT

2.1 BIOMEDICAL WASTE SEGGREGATION CHART

The housekeeping Supervisor has the responsibility of training on BMW.

YELLOW

Human Tissue, Dressings, Gauge, Bandages, POP

Plaster, Cotton Swabs, Dressing Tapes, Discarded

House-Keeping Mops/ Clothes, Bed- sheets &

Blankets (Blood Soaked)

Disfigure before disposing

BLUESharps, Needles after destruction, Broken Glass,

Unbroken Glass Vials/ Bottles/ Ampoules Disfigure before disposing

BLACK

Kitchen Waste, Paper, Polythene, Card board,

Aluminum Foil, Disposable Glasses/ Bottles/ Plates,

Vegetable & Fruit Peel & Left Over Food Do not litter the place

COLOUR OF BIN TYPE OF WASTE ACTION/ ATTENTION

RED

Blood or Body Fluid infected tubings, Blood and Urine

Bags, I/V Sets, Syringes, Catheters,

Cannula, Drains, Plastic I/V Bottles, Discarded Plastic

Sheets & McIntosh for patient care, Gloves after

disinfection

Disfigure and disinfect by

soaking in 1% Sodium

Hypochlorite Solution


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2.2 BIO MEDICAL WASTE MANAGEMENT HANDLING RULES 1998.

Bio Medical waste management is done by appropriate authorities and rules and

regulations are followed regarding Bio Medical Waste Management handling rules

1998.

SCHEDULE A

CATEGORIES OF BIOMEDICAL WASTES:-

Option Waste Category Treatment & Disposal

Category No. 1 Human Anatomical Waste( human tissues organs, body

parts )

Incineration @ deep

burial*

Category No. 2 Animal Waste(animal tissues, organs body parts carcasses

bleeding parts fluid blood and experimental animals used in

research)

Incineration @ deep

burial*

Category No. 3 Microbiology & Biotechnology Waste(wastes from

laboratory cultures, stocks or micro-organisms live or

vaccines, human and animal cell culture used in research and

infectious agents from research and industrial laboratories,

wastes from production of biological, toxins, dishes and

devices used for transfer of cultures)

Local autoclaving /

micro waving

Category No. 4 Waste sharps (needles syringes scalpels blades, glass, etc

may cause puncture and cuts)

Disinfection(chemical

treatment) / autoclaving

/ micro waving

Category No. 5 Discarded Medicines and Cytotoxic drugs ( wastes

comprising of outdated contaminated and discarded

medicines )

incineration@ /

destruction And drugs

disposal in secured

landfills

Category No. 6 Solid waste ( Items contaminated with blood and body fluids

including cotton dressings soiled plaster casts, lines beddings

other material contaminated with blood )

Incineration@

Autoclaving / micro

wavingCategory No. 7 ( Wastes generated from disposable items other than the

waste sharps such as tubing’s, catheters, intravenous sets etc

)

Disinfection by chemical

treatment @ autoclaving

/ micro waving and

Mutilation /

shredding##


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Category No. 8 Liquid waste( waste generated from laboratory and washing

cleaning housekeeping and disinfecting activities )

Disinfection by chemical

Treatment @@ and

discharge into drains

Category No. 9 Incineration Ash( ash from incineration of any bio medical

waste )

Disposal in municipal

landfill

Category No. 10 Chemical waste( Chemical used in production biological,

chemicals used disinfection as insecticides etc )

Chemical treatment @@

and discharge into

drains for liquids landfill

for solids

Chemical treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It must

be ensured that chemical treatment ensures disinfection.

* Mutilation/Shredding must be such so as to prevent unauthorized use.

SCHEDULE B

COLOR CODING AND TYPE OF CONTAINER

FOR DISPOSAL OF BIOMEDICAL WASTE

Color Coding Type of Container Waste Category Treatment as per Schedule I

Yellow Plastic Bag Cat.1, Cat. 2, and

Cat.3 Cat 6

Incineration/deep Burial

Red Disinfected Container/plas

bag

Cat.3 Cat.6, Cat.7 Autoclaving Microwaving/Chemical

Treatment

Blue/

White

Translucent

Plastic bag/ puncture

Proof container

Cat.4, Cat.7 Autoclaving / Microwaving/

Chemical Treatment and

Black Plastic bag Cat.5, and Cat.9and cat.10

( Solid)

Disposal in secured landfill

Notes:

1. Color coding of waste categories with multiple treatment options as defined in Schedule I,

shall be selected depending on treatment option chosen, which shall be as specified in Schedule I.


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2. Waste Collection bags for waste types needing incineration shall not be made of

chlorinated plastics.

3. Categories 8 & 10 (liquid) do not require container/bags

4. Category 3 if disinfected locally need not be put in container bags

SCHEDULE-III

LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS

BIOHAZARD SYMBOL CYTOTOXIC HAZARD SYMBOL

BIOHAZARD CYTOTOXIC

HANDLE WITH CARE

Note : Label shall be non-washable and prominently visible.


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2.3 RECORD FOR MAINTENANCE OF BIOMEDICAL WASTE MANAGEMENT

SR.

NO.

DATE BMW QUANTITY SIGNATURE

Yellow Red Blue Total quantity

kgs.

Housekeeping

supervisor

Quantity in

kgs

Quantity

in kgs

Quantity in

kgs

Monthly collection

Annual collection


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3.0 MANAGEMENT OF LOST AND FOUND ITEMS

In order to protect any article inadvertently left or lost by a patient, visitor to the hospital

and it can be deposited safely so that it can be handed back by the housekeeping supervisor a

procedure for Lost and Found is very essential.

DESCRIPTION:

1.

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

2.

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

3. A unique S No. Generated form is attached to the item with details of date, name of the

ward room no, location, patient name if found in the room & name of finder.

4.

Forwarding address is obtained from IP admission.

5.

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

instructions.

6. When claim is made, detailed description of the article is verified before handing over.

The claimant’s signature is taken as acknowledgement on the receipt generated through

lost & found module.

7. If not claimed the article is kept under custody of matron for 6 month. After which time it

is disposed off as decided by hospital authorities.

4.0 MANANGEMENT OF PEST CONTROL

Management of pest Control is vital to eradicate pests like rats, flies, mosquitoes, lizard, ant,

silver fish and termites from hospital premises.

DESCRIPTION:

Pest control is an activity, which is given out on contract to a company specializing in

this field. Their scope of work is as follows –

1.

“Pest control services including all related and connected services such as fly control,

household disinfestations, rodent control measures, vector control, fogging,

fumigation in respect of all the areas as specified by the company meeting best

cleanliness standards and maintaining it at all times. Area covered includes entire

premises and precincts thereof and any other area indicated by the management as

per agreed schedule and specifications.”


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2.

Starting from one side, all areas have to be sprayed as per terms and conditions

mentioned in the contract (As per MOU).

3.

Every evening pest control book to be checked by the pest control in

charge/housekeeping supervisor as per pest control daily schedule.

4.

Equipments & chemicals are to be provided by the contractor (As per MOU).

5.

Clearance of bill is subject to the pest free premises of entire building as per quality

standards and as per schedule.

6. Any complaint received from area in lodged in a complaint format (as below)

PEST COMPLAINT FORMAT

DATE:

Type of complaint...……………………………………………………………………………………

Area...………………………..………………………………………………………………………………

Complaint given by…………

Given to………………………

Received time ……………

Time complaint attended…….……

Measures taken…………………………………………………………………………………………

Housekeeping Supervisor/Pest control supervisor sign………………………… Company supervising…………………………………………………………………………….


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5.0 RECORDS TO BE MAINTAINED BY THE HOUSEKEEPING SUPERVISOR

(As per MOU with respective District Hospital)

1)

Monthly Indent Register For Disinfectants And Consumables

2)

Stock Register For Disinfectants And Consumables

3)

Floor Wise/ Area Wise Cleaning And Disinfection Schedule

4)

Biomedical Waste Segregation Record

5)

Fumigation Record (Separate For Operation Theatre And Wards

6)

Incident Record (For Spill Management)

(With Corrective and Preventive Actions)

7)

Attendance Register/ Duty Roaster

8)

Record Of Housekeepers For Needle Stick Injuries (Duplicate Copy)

9)

Training Record

10)

Lost And Found Record

6.0 SUGGESTIVE LIST OF EQUIPMENT/GADGETS/MACHINERY FOR

HOUSEKEEPING DEPARTMENT

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

1) Dry Vacuum Cleaners

2)

Floor Scrubbers cum wet Drier (Walk Behind Type)

3)

Biomedical Waste Transportation trolley with Covers

4) Wet Jet Washers

5)

Cob Web Remover

6)

Floor Mopper (Trolley Mounted)

7) Floor Wiper

8)

Glass Clearing Roller

9) Aluminium Ladder for Cleaning Purpose

10)

Wheel Barrows

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Housekeeping Manual 2014

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