Clean and Safe Health Facilities (CASH) Audit Tool. Medical Services Directorate-MOH Ethiopia

Transcription

1 Clean and Safe Health Facilities (CASH) Audit Tool Medical Services Directorate-MOH Ethiopia October 2015 i

2 Contents Contents... ii Acronyms/Abbreviations... iii Foreword... 1 Introduction... 2 Objectives of the audit tool:... 4 Structure for CASH implementation... 4 The CASH audit process... 5 Scope of the Audit tool... 9 Using the Audit tool The CASH Audit Tool Cleanliness and safety elements and standards Part one: General facility management services HOSPITAL COMPOUND (INTERNAL AND EXTERNAL AREAS) WASTE MANAGEMENT KITCHEN APPLIANCES AND FIXTURES COMMON FACILITIES LAUNDRY STAFF APPEARANCE PART TWO: CLEANICAL SERVICE AREAS PATIENT EQUIPMENT Fixtures: Electrical fixtures and appliances FURNISHINGS AND FIXTURES WATER, HAND WASH SINKS AND BATHROOM AND FIXTURES ii

3 Acronyms/Abbreviations CASH CEO EHRIG HCWM IPC IPPS MD QC WHO Clean and Safe Health Facilities Chief Executive Officer Ethiopian Hospital Reform Implementation Guidelines Health care waste management Infection prevention and control Infection prevention and patient safety Medical Director Quality Committee World Health Organization iii

4 Foreword The Federal Ministry of Health has launched a flagship CASH initiative in an effort to make health facilities clean, safe and comfortable to patients, staff and visitors. The program was launched in recognition to the currently unacceptable conditions of our health facilities in relation to cleanliness and safety conditions. There has been increasing consensus that the cleanliness of our health facilities particularly hospitals are not up to the expectation of acceptable standards and remains to be the source of public complaints on hospitals. The problem is deep rooted in the society so much so that people associate bad odors with hospitals and in rare occasions where people encounter clean hospitals, expressions like it smells not like a hospital is very common. There has been increasing consensus that attitudinal problems at all levels are the main reasons for the unacceptable situations of our hospitals. Not surprisingly therefore, the CASH initiative has targeted attitudinal changes at all levels to make health facilities better. Ever since its official launch, a number of undertakings have been done at the national, regional and hospital levels and encouraging improvements have been observed. To galvanize the ongoing efforts and to standardize the CASH initiative monitoring mechanism, this national audit too has been prepared. The audit tool has been informed by experiences from similar national audit tools from different countries. We have attempted to develop a simple and objective tool that could be used by any health professional. Although every effort has been exerted to make the national audit tool very objective, it always should be complemented with the subjective judgement of professionals. Both internal and external audits are requirements to track the progress of CASH. It is expected that the national CASH movement would be part of the regular health care reform process and as such, the audit tool would pave the way for better integration of the CASH initiative in to the Ethiopian Hospitals Reform Implementation Guidelines (EHRIG). Therefore, hospitals and administrators at all levels are expected to utilize this audit tool to track the progress of CASH implementation regularly and findings of the audit process need to be promptly acted upon according to the recommended schedule. 1

5 Introduction Hospital cleanliness is an important determinant of quality of care and patient satisfaction. Health care provided in health facilities should be safe, effective, patient-centered, timely, efficient and equitable. Health facilities should ensure that patients are the corner-stone in the whole health care delivery process. This would entail for health facilities to be responsive to the values, beliefs and culture of patients in all aspects as well as creating a healing health care environment. Cleanliness in hospitals is about more than just keeping the place clean. It makes a statement to patients and visitors about the attitudes of staff, managers and the board in terms of attention to detail on the level of care and the way the hospital is organized and run. It is not possible to have a good hospital without being clean and tidy. Excellence in patient care is dependent on getting the basics right, making sure that the food is good, making sure that the patients are cared for appropriately and that the surr oundings are clean, tidy, comfortable and safe. It is also said that cleanliness is everybody s responsibility.the advantages of a clean hospital include clean, comfortable and safe environment for patients, attendants, visitors, staff and members of the general public; increased patient confidence in local health care settings in relation to environmental hygiene and the organizations commitment to reduce the incidence of hospital acquired infections. The essence of good cleaning is not only that thing look clean but they are also technically clean. This calls for measurement of cleanliness both in aspects of environmental cleanliness as well as technical cleanliness measures. Staffs that provide the cleaning services are only part of the wider team who has the responsibility for cleanliness. The hospital board and senior management have strategic responsibilities, and all other staffs including persons responsible for facility management, cleaning and hosteling services etc. play key roles. All health care facilities need to be able to demonstrate that their wards and departments are clean and that an acceptable level of cleanliness is maintained at all times. This is best achieved as multi-disciplinary approach between service providers and service users. 2

6 Preparing national standards for cleanliness and specifications for elements of cleaning is important. The specifications which are expected to be patient focused provide clarity in regard to staff responsibilities for cleanliness. They also ensure quality assurance as well as become consistent with infection control standards, in addition to setting clear objectives and outcomes that can be benchmarked with other facilities. Cleaning is the physical removal of foreign material i.e. bloody and body substances, rust, dust, debris, spillages, etc. Cleaning physically removes rather than kills microorganisms. This basic function could be achieved with water, detergent and mechanical action. It is said that cleaning by normal housekeeping methods is sufficient for general hospital cleaning and is a prerequisite for decontamination. If an item is not cleaned, dirt can prevent an item from being decontaminated i.e. the dirt prevents the action of the disinfectant making it ineffective. Disinfectants are only necessary to decontaminate when potential infection is suspected and after spillage of organic matter, blood, pus etc. The concept of hospitals as healing places in all aspects should reverberate among staff, attendants, patients and management.however to the contrary; most of our hospitals are not clean so much so that when one thinks of a hospital in Ethiopia, the image of an odorous, poorly organized institution with filthy environment is common. Oftentimes, hospitals are portrayed as institutions not suitable for the staff, patients and attendants. Although efforts to improve the situation of hospital cleanliness have been underway through the implementation of Infection prevention standards, the condition of our hospitals with regard to cleanliness remains abysmal. A recent technical assessment of all Addis Ababa public hospitals indicated that many hospitals have weak health care waste management system resulting in lack of the critical cleaning functions including consistent availability of clean water supply, incinerators, placental pits, etc. Besides, most hospitals compounds and underground floors are crammed with old furniture and equipment making the hospitals unclean to sight. Service areas such as cleaning, kitchen, laundry, facility management are not well developed. 3

7 Objectives of the audit tool: To standardize the monitoring of CASH implementation To integrate CASH in to the health care reform process Identify areas for improvement and best practices for scale up To recognize best performing hospitals and publicly announce the lowest scoring hospitals Structure and roles and responsibilities for CASH implementation 1. Hospital CEO/Medical Director/SMT Conduct baseline and ongoing assessment Assign team and conduct launching ceremony at facility level Mobilize and allocate resources Evaluate the progress of implementation Assess and reward departments and service area Ensure availability of cleaning supplies 2. CASH Coordinating Team (IPC/QC Team) Develop CASH specific action plan Support the implementation of the facility CASH plan Conduct ongoing assessment and give feedback to service area Provide training to clinical and non clinical staff specially cleaners Organize hospital wide cleaning campaign 3. Full Time Environmental Officers Act as a secretary at CASH implementing team Follow waste management practice regularly Conduct daily supervision to key function areas and give information to CASH implementing team Participate on senior management team representing CASH implementing team 4. Ward Head Nurses/Midwives, Lab Head, Pharmacy Head and other department heads Comply with checklist distributed by CASH implementing team 4

8 Supervise the cleaning of respective departments Discuss with team to change attitude on cleanliness Conduct cleaning campaign at department level Provide report to CASH implementing team 5. All Hospital Staff Every staff is responsible to keep his/her working area clean and safe all the time All staff should attend trainings organized by the hospital All staff expected to participate department and hospital level cleaning campaign Expected to report when there is cleaning problem in the working area The CASH audit process Monitoring the progress of the CASH initiative at all levels is very important to track the progress and identify best practices. Hospitals will also be compared with each other based on the national CASH audit tool and best and worst performers will be recognized and made publicly known. There are two aspects of the audit process. The first one is internal audit process which is conducted on scheduled bases by different functional units of the hospital and the hos pital management. The internal audit process is a continuous process for monitoring the CASH standards and its aim is to track the progress and make continuous improvement. Internal audits could be conducted to address a small sample of the hospital each week and may be element based e.g. Walls or a number of rooms from the hospital wards. Additionally, regular comprehensive internal audits should be done by multidisciplinary team under the auspices of the management. The external audit process which is conducted by Regional Health Bureaus, Ministry of Health or other relevant external bodies mainly focuses on validating the performance of respective hospitals as well as documenting best practices. As much as possible, this step should be integrated into the regular performance monitoring mechanism of the Ethiopian Hospitals. 5

9 The aim of setting standards for cleanliness is to ensure that everyone can determine whether the health care unit is sufficiently clean. It is recommended that there will be three levels of auditing: 1. Technical Audit Regular audits by front line supervisory staff such as cleaning services managers and ward head nurses should form part of the daily management or supervisory functions of the CASH initiative. 2. Managerial Audit Regular scheduled multidisciplinary audits should form part of the ongoing management of the cleaning services. Multidisciplinary team composed of different professionals should conduct regular audit of respected areas and provide feedback and monitor the progress regularly. 3. External Audit Validation of audit reports from health facilities should be conducted regularly by external parties. Hospital Boards, Regional Health Bureaus and Ministry of Health in collaboration with partners are expected to conduct regular validation of hospital audit reports and make necessary follow up on the findings. External audits could well be coordinated with regular hospitals supportive supervision mechanisms. The hospital management should decide the frequency of internal regular audits by considering the cleanliness level already achieved for a particular unit and the level of risk the functional unit could pose. Tables 1, 2 and 3 are general guides to plan the auditing process in hospitals. 6

10 Table.1 Guide for Functional Area Categorization Category Status Functional Areas included 1. Very High Risk Control of infection wards & areas cohosting infectious patients Intensive Care Units Neonatal ICU Operating theatres/endoscopy Renal Dialysis Unit High Risk Patients Immune compromised patients 2. High Risk CSSD Accident and Emergency Isolation Rooms Catering facilities Day Hospital/Day services including Chemo Day ward/opd including Treatment rooms & Clinical Consult Rooms /Radiology Suits where invasive procedures are carried out, eg. Vascular and neuroradiology, barium studies, etc. Treatment/Clinical Consulting rooms Wards-Maternity, CCU and surgical 3. Moderate Risk Wards-All other ward types Day activity areas(noninvasive) Rehabilitation area General pharmacy Laboratory,including pathology Mortuary Radiology& Medical Imaging OPD, Treatment Rooms &Clinical Consult Rooms(Noninvasive) Public thoroughfares Residential/On-call /overnight accommodation Physiotherapy Occupational Therapy Main stairwells 7

11 4. Low Risk Administrative areas Non-sterile supply areas Record Storage and archives Engineering workshops Plant rooms External Surrounds Central Stores Fire escapes Library Meeting Rooms Retail areas Staff Change Facilities Table 2 Frequency for conducting Technical and Managerial audits Risk Very High Risk High Risk Moderate Risk Low Minimum Requirement for Internal Audit Two times per week Weekly Monthly Quarterly 8

12 Table 3.Response time for corrective action Risk Priority Time frame for corrective action Very High Constant, cleaning critical Immediately High Constant, cleaning critical Immediately Moderate Frequent, cleaning important and requires maintaining 0-3 hours Low Maintenance Regular, on a less frequent scheduled basis and as required in between cleans Maintenance issues which pose an infection control or health and safety risk 0-48 hours Same day where possible Maintenance Maintenance issues which do not pose an infection control or health and safety risk 2-7 days Scope of the Audit tool This tool will be applicable to all health facilities throughout the country This tool be used by Health facilities, Regional Health Bureaus, Federal Ministry of Health and partners Covers the following areas: patient, staff and hospital environment, waste management, kitchen, laundry, toilette and privacy and dignity. The hospitals shall comply with all requirements set out in the General Service Specification relevant to the delivery of the Cleaning Services. Hospitals shall comply with the CASH Standards and Requirements of this Service Specific Specification. The hospitals shall provide the Cleaning and Hygiene Service 24 hours per day 365(7) days per year on a scheduled and reactive basis as maybe required to meet the required standard 9

13 Cleaning Service including: scheduled and reactive cleaning, planned cleaning, barrier cleaning; Hygiene Services including waste management, accommodation services; (and any other as specified by the hospital) Using the Audit tool The audit tool has been prepared in such a way that it can be used by anyone with basic training. Standard definitions for acceptable (score 1) or unacceptable (score 0) have been provided. The person or team conducting the audit process should decide the cleanliness score based on the objective criteria outlined. Each room should be reviewed for the elements not present and discount them as not applicable for that particular area. An Excel worksheet has been provided with this manual to simplify the scoring and reporting processes. The score sheet calculates the percentage score of for each room and for each functional area as well as for each element in the hospital. The findings of the scoring process should be communicated immediately to the responsible unit for prompt corrective action. Once all applicable elements in a room have been scored, the total number of acceptable scores should be expressed as percentages of the total number of achievable scores. For example, if a room has achieved a score of 30 out of the total possible score of 6o, the percentage score achievement for that particular room would be 50%.The functional area score similarly is calculated taking the average of the individual room scores. In general the following principles are applicable when using the CASH audit tool: 1. A separate audit tool should be used for each area 2. There are a total of 75 elements of which 36 of them apply to all areas. 3. The auditor should score each element as listed as acceptable or unacceptable in accordance with the cleaning elements specifications. Acceptable is indicated by a score of 1 and unacceptable is indicated as a score of 0.The scoring process is based on the all-or-none principle where any of the element in a standard is missing, it is scored as not acceptable and the gaps identified recorded. 10

14 4. Some of the elements may be deemed not applicable and as such, should be excluded from the marking. 5. If an element is deemed unacceptable, the auditor should make a comment as to why it is not acceptable and indicate the correction action needed including the time frame. Similarly, the auditor should also record a note where there are particularly good findings. 6. As much as there is an objective guide in deciding for the scoring, the auditor should use his/her subjective knowledge to score a particular area. Where there are disagreements between auditors, consulting experienced persons on the area is advisable. 7. The physical condition must also be taken in to account, it may not be possible to remove some stains from a wall that needs painting, however, poor standards of maintenance does not justify poor standards of cleanliness and this should be carefully interpreted. 8. The total number of acceptable scores should be expressed as both a percentage of the total score available in that element. 9. An average score for the functional area can be reached by adding all the total element scores and dividing by the applicable number of elements. 11

15 The CASH Audit Tool Hospital General Information Date of Assessment Hospital name and type Region, Zone/Sub city, District/Woreda Name and contact of CEO Name of Medical Director Staff- total number Specialists General Practitioners Health Officers Nurses Midwives Environmental Health Officers Lab Technologists Lab Technicians Pharmacists Pharmacy Technicians Cleaners Laundry workers Kitchen workers Total bed number 1. Food 2. Cleaning 3. Security 4. Laundry Basic service in-house? Outsourced 12

16 CASH implementation Yes/No If yes verify 1. Baseline assessment and Baseline assessment Action plan Documents, 2. Team Establishment TOR/Letter, Minutes 3. Launched/Ambassador Pictures, Report 4. Regular Cleaning Campaign/ Name of Assessors Pictures, Report 13

17 Cleanliness and safety elements and standards Part one: General facility management services 1.1. HOSPITAL COMPOUND (INTERNAL AND EXTERNAL AREAS) No Element Standard Score Remark 1. Surrounding fence The hospital should have a fence which surrounds all the hospital grounds which will not allow the entrance of pets and other animals with a functional gate. The fence should be safe especially for psychiatric and pediatric patients. There should be at least two gates that could aid in case of emergencies. 2. External grounds appearance and tidiness 3. Internal compound appearance and tidiness The external area surrounding the hospital building/s is tidy and well maintained and are free from any hospital and community generated waste, including human excreta. The internal grounds of the hospital should be tidy and well maintained, and free from abandoned medical equipment/ old cars, etc. There should be designated social (green) areas/parks with seating facilities. Clinical waste containers should not be placed around the hospital grounds and domestic waste containers should be placed in appropriate places. The journey from the parking area(s) should be clearly marked, well lit and safe. 4. Signage Hospital signs directing people around should be at a height which makes them easy to see (approximately 5meter from floor level). There should be a clear signage in the hospital showing the name of the hospital, wards, departments/clinics, hazards, etc. Signs on doors, toilets, etc should 14

18 No Element Standard Score Remark have either pictures, words or both and should be consistent in appearance. Signs for toilets should be visible from all patient areas. 5. Hospital buildings and immediate surrounds 6. Hospital building corridors Hospital building(s) should look clean, well maintained and free from cracks. The drainage system within and around hospital building(s) e.g. gutters, pipes,etc, should be free from any obstructions, e.g. vegetation, etc and pipes and wires should be securely and safely fixed. Windows and window frames are should be clean and free from damage and, where appropriate, painted frames should be in good condition. All corridors should be visibly clean, free of obstacles(any) and well lit Stairs, steps and lifts, internal and external, including all component parts, should be clean and well-maintained with no blood or body substances, rust, dust, dirt, debris and spillages. 7. Sound pollution The hospital compound should be free from internal sound disturbance No noise/sound pollution sign should be posted 1.2. WASTE MANAGEMENT No Element Standard Score Remark 8. Manual/SOP The Health Care Waste Management Manual/SOP should be available in all clinical areas of the hospital. 9. Waste bins The hospital should have functional color coded waste bins with cover and disposable plastic bags at each service 10. Waste storage area point. Fenced and protected areas should be available for the storage of waste awaiting removal from the hospital. Score Remark 15

19 No Element Standard Score Remark 11. Waste transport facility Separate functional waste transport equipment for clinical, domestic and in the case of Mercury & other toxic materials should be available. 12. Placenta pit Clean and functional without unpleasant or distasteful odor placental pit should be available. 13. Incinerator Functional and well-designed incinerator should be available 14. Waste pits Domestic waste pit(for burning of noninfectious waste) and burial pit(for the burial of non-combustive waste) should be available and free from odor /offensive smell 15. Sewerage system The hospital should have a proper liquid waste management system with sewerage line connected to a municipal or own septic tank. Before discharging liquid wastes generated from Laundry, Laboratory, OR etc should be treated KITCHEN APPLIANCES AND FIXTURES No Element Standard Score Remark 16. Kitchen room and store 17. Food making appliances 18. Fridges and freezers Kitchen room and store are visibly clean with no blood and body substances, dust, dirt, debris, stains, spillages or food debris. The kitchen and store rooms should be ventilated, odor free, well lit and free from rodents. Food making appliances should be visibly clean with no dust, dirt, debris, stains, spillages, food debris or no any crack. Fridges and freezers should be visibly clean with no blood and body substances, dust, dirt, debris, spillages, food debris or build- up of ice. 16

20 No Element Standard Score Remark 19. Hot water boilers 20. Kitchen cupboards and shelves Hot water boilers including all component parts should be clean and well-maintained with no rust, dust, dirt, debris and spillages. Kitchen cupboards should be visibly clean with no blood and body substances, dust, dirt, debris, stains, spillages or food debris. 21. Dishwasher There should be three compartments Dishwashers & all other appliances, including all component parts should be clean, and wellmaintained, with no blood or body substances, rust, dust, dirt, debris, stains, spillages and food debris 22. Microwave Microwave, including all component parts should be clean, and well-maintained, with no blood or body substances, rust, dust, dirt, debris, stains, spillages and food debris 23. Regular medical checkup All food handlers of the kitchen should have a periodic medical checkup, no active illness or wound 24. Kitchen Staffs Kitchen staff should wear clean and appropriate Uniforms while on the job 1.4. COMMON FACILITIES No. Elements Standard Score Remark Water availability There should be continuous water availability (24/7) in the hospital with backup source. Water containers/tankers should be clean and the waters should be bacteriological tested regularly. 26. Electricity availability There should be continuous electricity availability (24/7) in the hospital with backup source. 17

21 No. Elements Standard Score Remark 27. Fire safety The hospital should have functional fire extinguishers at easily recognizable places. 28. Pest control system 29. Store for cleaning equipment The hospital should have a pest control system/mechanism to avoid pests, rodents and insects. The hospital should have a store for cleaning equipment s 30. Showers All in-patient wards should have a separate male and female based shower with continuous water availability and light The shower, wall-attached shower chairs should be visibly clean with no blood and body substances, scum, dust, lime scale, stains, deposit or smears. The bathroom should have a door with lock. If there is no door, privacy curtains should be installed. 31. Toilets Hospitals should have the recommended ratio of toilets for patients, staff and the public. For e.g. a separate male and female toilet in each in-patient ward and out patients of patients, a male and female sex toilets in OPD/ER areas of the hospital. All toilets should be visibly clean with no blood and body substances, scum, dust, lime scale, stains, deposit or smears, as well as, odorless/free of unpleasant smell. The toilets should ensure security/privacy for the clients by having door and lock. All toilets should have adequate functional artificial light for the night time 18

22 No. Elements Standard Score Remark 32. Patient/Client waiting area 1.5. LAUNDRY There should be adequate patient/client waiting area at all service units. No. Elements Standard Score Remark 33. Laundry machines Hospital laundry should have at least3 functional machines (washing, drying and ironing). 34. Laundry space 35. Proper designed drainage system. 36. Laundry detergents The laundry should have separate clean and soiled linen areas. The hospital/laundry service should have its own store. The laundry should have its own hand wash facility The laundry should have 2 doors for clean and soiled linen. The laundry room should have continuous water supply and a functional drainage system. The laundry should have adequate amount of detergents 37. Laundry PPE laundry staff should wear appropriate and personal protective equipment while on the job 1.6. STAFF APPEARANCE No. Elements Standard Score Remark 38. Staff wearing appearance Staff should be appropriately dressed with clean uniforms. The list below covers the majority of issues, but others should be recorded as and when they are seen: Staff should be wearing name and job title identification. Uniforms or other clothing should comply with the hospital s dress code (teams will need to determine what this is). 19

23 No. Elements Standard Score Remark All staff should wear appropriate and personal protective equipment while on the job) 39. Staff canteen/ restaurant All staff canteen/restaurant equipment should be visibly clean and free from any dirt, debris, stains, spillages and anybody substances. All staff uniforms should not be worn in staff canteens/restaurants. (Not allowed ) Apply kitchen/waste management/water availability standards here. 20

24 PART TWO: CLINICAL SERVICE AREAS 2.1. PATIENT EQUIPMENT No Element Standards Score Remark 40. Commodes All parts including underneath should be visibly clean with no blood and body substances, dust, dirt, debris or spillages. 41. Weighing scales All parts including underneath should be visibly clean with no blood and body substances, dust, dirt, debris or spillages. 42. Drip stands All parts including underneath should be visibly clean with no blood and body substances, dust, dirt, debris or spillages. 43. All Medical Equipment 44. Bed sheet/linens 45. Patient washbowls All parts including underneath should be visibly clean with no blood and body substances, dust, dirt, debris or spillages, All medical equipment in use fully functional and non-functional medical equipment should be identified and stored away or taken to medical equipment workshop room for repairs. All bed sheets/linens should be visibly clean with no blood and body substances, or dirt All parts including underneath should be visibly clean with no blood and body substances, dust, dirt, debris or spillages. 21

25 46. Floor The complete floor including all edges, corners and main floor spaces should have a uniform appearance, even color, shine and be visibly clean with no blood and body substances, dust, dirt, debris, spillages or scuff marks 47. Switches, sockets and data points These should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages These should be with no loss and be safe for clients and staffs 48. Walls All wall surfaces including skirting should be washable and visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages. 49. Ceilings All ceiling surfaces should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape, spillages, cracks and with no holes. 50. Doors All parts of the door structure should be visibly clean, smooth and washable so that all door surfaces, vents, frames and jambs have no blood or body substances, dust, dirt, debris, adhesive tape or spillages. 51. All windows and frames ( internal and external surfaces and partitions) All windows and frames(internal and external surfaces and partitions) surfaces should be visibly clean and smear-free with no blood and body substances, dust, dirt, debris, adhesive tape or spillages. They should have a uniform shine appearance and free from damage. 52. Mirrors Mirrors should be visibly clean and smear-free with no blood and body substances, dust, dirt, debris, adhesive tape or spillages. 53. Notice Board The available notice board should be visibly clean, tidy and outdated notice removed. 54. TV for entertainment system 55. Radiators or baby incubators 56. Ventilation grilles/extracto rs/inlets All part of the public/patient TV should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or stains. All part of the radiator (including between panels) should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages. The external part of the ventilation grille should be visibly clean with no blood and body substances, dust, dirt, debris or cobwebs. 22

26 57. Odor Unpleasant odor is not expected in any clinical and non-clinical service rooms Fixtures: Electrical fixtures and appliances No Element Standard Score Remark 58. Electrical items The casing of electrical items should visibly clean with no blood and body substances, dust, dirt, debris or adhesive tape. Electrical sockets/wires/lines- should be free of tears/breaks and fully functional. 59. Lighting Natural light should be available wherever possible. Where artificial lighting is used, this should simulate natural light and provide enough light to make areas bright and easy to walk through. Lighting should also be even e.g. without pools of light and/or dark areas, stripes or shadows. 60. Ventilation Each service unit should have adequate ventilation either natural or artificial. 61. Cleaning equipment Cleaning equipment should be visibly clean with no blood and body substances, dust, dirt, debris or moisture FURNISHINGS AND FIXTURES No Element Standard Score Remark 62. Chairs All parts of the furniture should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape, stains or spillages. 63. Beds All parts of the bed (including mattress, bed frame, wheels, castors, patient pajamas, and bed nets) should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages. 64. Lockers All parts of the locker (including wheels, castors and inside)should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape, stains or spillages. 23

27 No Element Standard Score Remark 65. Tables All parts of the table (including wheels, castors and Underneath) should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape, stains or spillages. 66. Hand wash containers All part of the surfaces of hand soap, paper towel containers should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages. 67. Hand hygiene alcohol rub dispensers All part of the surfaces of hand hygiene alcohol rub dispensers should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages. Dispensers should be kept stocked. 68. Waste receptacle(bin) The waste receptacle should be visibly clean including lid and pedal with no blood and body substances, dust, dirt, debris, stains or spillages. Receptacles should be emptied frequently and not allowed to overflow. 69. Curtains, blinds(including screens) Curtains/blinds should be visibly clean with no blood and body substances, dust, dirt, debris, stains or spillages WATER, HAND WASH SINKS AND BATHROOM AND FIXTURES No Element Standard Score Remark 70. Water availability Apart the water availability in the laundry, adequate water provision with back up should be available 24 hours/7 days a week/365 days a year in all areas. 71. Replenishment There should be plenty of all consumables and soap. 72. Hand wash Sinks Functional hand washing sinks should be available in each room The sink and wall-attached dispensers should be visibly clean with no blood and body substances, dust, dirt, debris, lime scale, stains or spillages. Plugholes and overflow should be free from build-up. 73. Baths Available baths should be visibly clean with no blood and body substances, dust, dirt, debris, lime scale, stains or spillages, Plug holes and overflow should be free from build-up. 24

28 74. Toilets Available toilets should be visibly clean with no blood and body substances, dust, dirt, debris, lime scale, stains or spillages, Plug holes and overflow should be free from build-up 75. Privacy Is all sleeping accommodation separated into single sex areas? Note: children may be accommodated in single or mixed accommodation. Are all bedside curtains long and wide enough so that they provide a private space when closed? (N/A for single rooms) Is there enough space between and around beds? (N/A for single rooms) Is there a private room on the ward where patients can go for conversations? (N/A for single rooms) There should be a separate treatment room on the ward for minor procedures/wound dressing? 25

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